Right to health, autonomy, and access to prenatal services.

BACKGROUND: The concept of the right to health includes decent conditions of work, housing, and leisure. It can be assessed through the evaluation of access to health services and programs. The creation of the Brazilian Unified Health System expanded access to healthcare for the entire Brazilian population. AIM: This study aimed to understand the use of the Brazilian Unified Health System by pregnant women who live on the Brazil-Paraguay border, whose residents are known as Braziguayans. METHODS: We conducted 16 semi-structured interviews with users of prenatal services at Unified Health System units located at the border of the municipalities of Ponta Porã and Pedro Juan Caballero. ETHICAL CONSIDERATIONS: The Research Ethics Committee of the Federal University of Mato Grosso do Sul approved of this research. All participants were provided with project information and signed an informed consent form. FINDINGS: Through content analysis of the interviews, "right to health" and "autonomy, pathways, and access" were two recurrent themes that have arisen. These suggested that Braziguayan women live in conditions of social vulnerability. They do not fully experience the right to healthcare, despite sufficient knowledge about the Brazilian and Paraguayan healthcare systems from which to choose prenatal care. The interviewees acknowledged that Unified Health System use is a right of Brazilian citizens and considered its units to be safe environments. These women also understand the structuring of Unified Health System and the mechanisms of accessing healthcare programs. CONCLUSION: We can conclude that, despite widely known difficulties, Unified Health System represents, for Braziguayan women, potential access to reliable health services for adequate prenatal and childbirth assistance.

Plantar Cutaneous Sensory Stimulation Improves Foot Sensibility and Gait Speed in Older Adults With Diabetes: A Clinical Trial.

OBJECTIVE: To determine the effect of an intervention involving muscular ankle strengthening and feet sensory stimuli to improve gait speed and balance in older adults with diabetes mellitus type 2 (DM2). DESIGN: A clinical trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: The trial enrolled 66 people 60 years or older with DM2 who were physically independent (did not require assistance with activities of daily living). INTERVENTION: The experimental group performed 12 weeks of plantiflexor and dorsiflexor muscle strengthening exercises with resistance bands, proprioceptive exercises on balance boards and a buoy, and plantar sensory stimulation with bristle brushes and cloths, as well as general foot care instructions. The control group received foot care instructions only. OUTCOME MEASURES: The primary outcome was plantar cutaneous sensibility as measured with Semmes-Weinstein monofilaments. Secondary outcomes included muscular strength (plantar flexion and dorsiflexion torque as measured with an isokinetic dynamometer), gait speed, and balance (total displacement area, mediolateral displacement, anteroposterior displacement, mediolateral displacement speed, and anteroposterior displacement speed) on right and left bipedal and unipedal supports. RESULTS: In comparison with the control group, the experimental group demonstrated improved plantar cutaneous sensibility on the right foot (3.46 points; 95% confidence interval [CI], 3.85-9.80), left foot (3.46 points; 95% CI, 4.06-9.76), and an increase in gait speed (0.15 m/s; 95% CI 0.12-0.42). There were no meaningful changes in participants' ankle muscle strength or balance. CONCLUSIONS: This study showed that plantar cutaneous sensory stimulation can improve foot sensibility and increase the gait speed of older adults with DM2. However, there were no meaningful dorsiflexor or plantiflexor gains after 12 weeks.

Conceptual structure of aging in different ethnicities. / Estrutura conceptual do envelhecimento em diferentes etnias.

OBJECTIVE: To develop a conceptual framework that explains how elderly people from different cultures experience aging, formulate concepts and assign values to the process of aging. METHOD: Qualitative research conducted with 33 elderly people in a municipality of the triple border. The data were collected between February and August of 2011, using Symbolic Interactionism and the Grounded Theory as the theoretical and methodological strategy. RESULTS: The central theme identified was: "Having to age: sociocultural practices guiding aging in different ethnicities", which was made up of sub processes that characterize the study's structural concepts: aging conceived as multifactorial (physical, biopsychic and sociocultural); Experiencing aging in the process of cultural adaptation; Experiencing aging as the continuation of life; Redefining social roles; and The culture influencing habits and customs in healthcare. CONCLUSION: The experience of aging proved to be a unique process for each individual and the values assigned to it are influenced by one's own culture.

[Association between self-reported health and sociodemographic characteristics with cardiovascular diseases in adults]. / Associação entre autopercepção de saúde e características sociodemográficas com doenças cardiovasculares em indivíduos adultos.

OBJECTIVE: To assess the association of sociodemographic and self-rated health in the presence of cardiovascular diseases and the association of this perception with the type of disease. METHODS: A cross-sectional population survey study carried out with 1,232 individuals aged between 20 and 59 years of both genders living in the metropolitan region of Maringá-PR. Data were analyzed using multiple and simple logistic regression. RESULTS: In multivariate analysis, the age range and self-rated health were associated with cardiovascular disease, and in the univariate analysis self-rated regular health was associated with arterial hypertension, while self-rated poor health was associated to heart failure, stroke, and to acute myocardial infarction (heart attack). CONCLUSION: The differences in association of self-rated health with these diseases can indicate how individuals with certain characteristics cope with the disease, allowing for more individualized and specific health care.

[Quality of life and living conditions from the viewpoint of residents in a seniors condominium]. / Qualidade e condições de vida sob a ótica dos residentes de um condominio do idoso.

The aim of the study was to understand how residents of a condominium Aging realize the quality and conditions of life in this new housing modality. This is an exploratory qualitative study of 20 elderly residents of the condominium Maringá. Data were collected in February 2012 in the household were semistructured and subjected to content analysis interviews. The results indicate the factors valued by the elderly in their perception of quality of life such as independence, autonomy, having an occupation, developing leisure and acceptance of the aging process activities. Also valued the structure and characteristics of this housing method due to the possibility of social interaction. We conclude that the identification of these aspects allows the planning of strategies for integrated care for the elderly and it is suggested that nurses recognize and value the aspects highlighted in the planning of care with elderly people in general.

Adherence to Covid-19 vaccination during the pandemic: the influence of fake news.

OBJECTIVES: to understand how fake news has influenced adherence to Covid-19 immunization, from the perspective of health professionals. METHODS: a qualitative, descriptive-exploratory study was conducted in Campo Grande - MS. Twenty nursing professionals working in vaccine rooms or managing immunobiologicals participated through semi-structured interviews. The interviews were audio-recorded, fully transcribed, and subjected to thematic content analysis. RESULTS: two categories emerged in which the professionals highlighted an increase in vaccine hesitancy among the population, influenced by fake news and denialist actions, which negatively interfered with the population's trust in vaccines and in the professionals administering them. FINAL CONSIDERATIONS: concerns about vaccine safety and denialist actions by authorities and media outlets can contribute to the phenomenon of non-vaccination. The valorization of science, the promotion of educational actions, and raising public awareness about immunization were presented as strategies to increase vaccine coverage.

Pregnancy loss in women with systemic lupus erythematosus: Grounded Theory.

OBJECTIVE: to learn the meanings attributed to pregnancy loss by women with Lupus. METHOD: qualitative research, based on Symbolic Interactionism and Grounded Theory. Data collection took place between January and August 2022 through in-depth interviews. Data analysis went through the stages of initial and focused coding. RESULTS: seventeen women participated. The central phenomenon "The climb to motherhood: falls and overcoming" was constructed, consisting of three categories: "Falling to the ground during the climb: the experience of pregnancy loss"; "Getting up and following the path: new attempts to conceive"; and "Remembering the journey: meanings attributed to pregnancy losses". FINAL CONSIDERATIONS: experiencing pregnancy is, analogously, like climbing a mountain, where obstacles need to be overcome to reach the summit. The experience of pregnancy loss is seen as complex, especially when there is fragility in healthcare and a lack of awareness regarding feelings of loss and grief.

[Use of health services by residents at a seniors-only living facility]. / Utilização dos serviços de saúde por residentes em um condomínio exclusivo para idosos.

The objective of the study was to compare the use of medical and dental services by seniors residing at a seniors-only living facility and in the general community. It was a quantitative study, among 50 residents of the living facility and 173 in the general community. The data were collected between November 2011 and February 2012 through a questionnaire, and subjected to statistical analysis. Performance of clinical exams and satisfaction with health services was greater among seniors living in the general community; however, physical therapy treatment was more common among those living in the facility. The use of medical and dental services showed a statistically significant difference. The seniors in both groups need oral health monitoring and those living in the facility also require coverage by the Family Health Strategy. The presence of professionals with the right profile to adequately serve residents and the network of available services are determining factors for the success of this new housing policy.

[Living with hepatitis: impact on the daily life of infected subjects]. / Convivendo com hepatite: repercussões no cotidiano do indivíduo infectado.

We performed a descriptive, exploratory, and qualitative study, to identify changes in the daily life of subjects with hepatitis. The data were collected in October 2011 from 12 patients with hepatitis B and/or C, through semi-structured interview, and subjected to thematic content analysis. The majority of the subjects were diagnosed with hepatitis B. The time of diagnosis ranged from less than 6 months to 12 years, and the diagnosis was made mainly through blood donation. Only two patients were taking interferon. The results were divided into two categories that describe feelings and reactions experienced by the interviewees, as well as some lifestyle changes. It was concluded that health professionals need to be aware of the complexity of phenomena concerning the illness process and life with hepatitis.

Tecnologias educacionais utilizadas para promoção do autocuidado de pessoas com diabetes mellitus: revisão integrativa.

OBJECTIVE: To summarize the scientific productions that used educational technologies to promote self-care for people with diabetes. METHOD: Integrative review carried out from October 2022 to January 2023, in the databases: LILACS; Scopus; Embase; PubMed/MEDLINE and CINAHL. The search was paired, and the sample consisted of ten articles. The levels of evidence were analyzed by the Hierarchy of Evidence for Intervention Studies, and the results were synthesized for interpretation of the findings. RESULTS: The educational technologies identified to promote self-care were: mobile applications, interactive platforms, print, telemonitoring, video and simulation. The focus of the contents was on the promotion of foot care, prevention of neuropathy, self-management, knowledge, and expectation of people with diabetes and prevention of acute complications. CONCLUSION: The synthesis of knowledge about educational technologies to promote self-care for people with diabetes pointed to the need for robust evidence.

Factors associated with demand for emergency medical services by people with hypertension and diabetes.

OBJECTIVES: to analyze the association between recurrence of emergency service visits due to lack of blood pressure and/or glycemic control with sociodemographic variables and disease registration in Primary Care. METHODS: quantitative study, which consulted medical records of people who attended these services two or more times for 26 months. Descriptive statistics and multiple logistic regression models were used in analysis. RESULTS: most people did not have hypertension and/or diabetes record in their Primary Care records. The absence of this record was more frequent in males, aged between 18 and 59 years, with low education and lack of blood pressure. There was association between greater number of people seeking these services in the same year and not monitoring the chronic condition in specialized care. CONCLUSIONS: people who do not follow up hypertension and/or diabetes in Primary Care are more likely to need assistance due to blood pressure and/or glycemic management.

Health care network for children with zika virus from the perspective of professionals.

OBJECTIVE: To know the perspective of health professionals working in specialized care regarding the assistance offered to children with Congenital Zika Virus Syndrome in the Health Care Network. METHOD: Qualitative study carried out in Campo Grande-MS through semi-structured interviews, between September and October 2020, with 12 professionals working in a reference service for people with physical and intellectual disabilities. Minayo's thematic analysis and the theoretical subsidies of the care model for chronic conditions were used for interpretation. RESULTS: Assistance in the network is weakened by aspects related to access, monitoring and integration between different professionals/services. The potential involves the implementation of the referral and counter-referral system, the communication/integration between these services and the training of professionals. FINAL CONSIDERATIONS: The participants perceive that assistance is influenced by the availability of trained professionals to work in a network and the optimization of access and follow-up at different points of care.

Quality of health care in Primary Care: perspective of people with Diabetes Mellitus.

OBJECTIVES: to identify how people with diabetes assess the care offered by Primary Care teams. METHODS: a cross-sectional study based on structured interviews with the application of the Patient Assessment of Chronic Illness instrument to people with Type 2 Diabetes Mellitus. Data were submitted to statistical analysis. RESULTS: 451 individuals participated in the study, more than half aged 60 years or older (64.0%); 63.9% had been diagnosed for more than five years; and 23.9% used insulin. The average score obtained was 2.5, which indicated little involvement in self-care and low support for the care of the chronic condition by the Family Health Strategy team, and was higher among women and people with a partner. CONCLUSIONS: people with diabetes consider that they do not receive individualized treatment, with dialogue and discussion for setting goals, and that they are not prepared for self-managing their health condition.

Educational intervention in social skills for Primary Care nurses.

OBJECTIVE: to assess an educational intervention on social skills for nurses who work in Primary Health Care. METHOD: a qualitative research-intervention study, carried out in the municipalities covered by the 17th Health Regional of Paraná. It was developed in three interrelated stages: exploratory, where meetings were held with the managers to define the groups and logistics for running the course; intermediate, developed in meetings with different groups of nurses, addressing selected topics; assessment, in which the nurses developed a personal plan to improve their social skills. RESULTS: participants were 57 nurses who acted as coordinators of Primary Care. They considered the educational intervention in social skills fundamental for positive changes in their professional performance. FINAL CONSIDERATIONS: the educational intervention in social skills was assessed as an important strategy to strengthen the development of nurses' managerial and care skills.

Coping with the health condition from the perspective of people with HIV who abandoned treatment.

OBJECTIVES: to understand how people living with HIV who have abandoned treatment face their health condition. METHODS: a qualitative study, based on the Chronic Care Model theoretical precepts. Data were collected between April and August 2021, through interviews with 24 people registered in a specialized service in the Brazilian Midwest. RESULTS: coping with the health condition included good and bad moments and is influenced by individual behaviors and the way in which the network was organized. Treatment abandonment was motivated by the absence of signs and symptoms, the way care is provided and medication side effects. FINAL CONSIDERATIONS: care actions focusing on behavior change and maintenance become necessary in order to favor continuity of treatment. Furthermore, the gaps identified in the way health services are organized are subject to intervention.

Analysis of factors associated with hematopoietic stem-cell retransplantation: a case-control study. / Análise dos fatores associados ao retransplante de células-tronco hematopoiéticas: estudo caso-controle.

OBJECTIVE: to analyze the factors associated with the failure of Hematopoietic Stem Cell Transplantation (HSCT) in patients undergoing Hematopoietic Stem Cell Retransplantation (HSCR). METHOD: this study implemented a quantitative approach and was a case-control type which addressed patients undergoing HSCR. To do so, a paired sample of two controls was used for each case (2:1). The case group consisted of the medical records of all patients who underwent HSCR (28) and the control group (56) of those who underwent only one transplant. Three variables guided the pairing: gender, diagnosis and type of transplant. RESULTS: a total of 24 (85.71%) patients in the case group were re-transplanted due to disease relapse and four (14.29%) due to graft failure. There was a statistical difference in the analysis between patients who did not use ursodeoxycholic acid, opioid analgesics and immunosuppressants. The need for HSCR among those who used these medications inappropriately was 16.12, 12.79 and 4.5 times more likely, respectively, than those who used them correctly. CONCLUSION: there was a difference regarding the reasons which led to the retransplantation and the analyzed subjects, and this study concluded that the predictive reason for retransplantation in the studied sample was disease relapse.

Breastfeeding and diseases prevalent in the first two years of a child's life: a cross-sectional study.

OBJECTIVES: to assess the association between breastfeeding and diseases prevalent in the first two years of a child's life. METHODS: a retrospective cross-sectional study that analyzed electronic medical records of 401 children. Data on birth, growth, breastfeeding and medical care in the first two years of life were collected. In the analysis, Poisson regression with robust variance was used. RESULTS: 27.9% of children were exclusively breastfed until six months, and, at 24 months, 93.3% had already had some prevalent childhood disease. In the crude analysis, 5-minute Apgar association, length, weight at 12 months, exclusive and non-exclusive breastfeeding time had association. In the adjusted analysis, only the variable breastfeeding at six months maintained the association with prevalent childhood diseases. CONCLUSIONS: children who were not breastfed, exclusively or not, up to six months of age, had a higher prevalence of diseases compared to breastfed children.

From diagnosis to complications: experiences of those who live with systemic lupus erythematosus.

OBJECTIVE: To understand how people with lupus experience the diagnosis and how they deal with complications arising from the disease. METHOD: Qualitative study, whose data were collected between February and July 2019, through semi-structured interviews with 26 individuals and submitted to content analysis. RESULTS: Three categories emerged that show illness from lupus as a difficult experience, permeated by sadness, fear and suffering, which, in addition to being linked to society's lack of knowledge about the disease, negatively impacts the lives of those who experience it. Furthermore, they show that the time of living with the disease favors the development of self-care strategies and greater therapeutic adherence and, consequently, longer periods of disease remission. CONSIDERATIONS: More disclosure about the disease and its implications in the daily lives of those affected is essential, culminating in greater understanding of family, friends and colleagues and improvements in health care and quality of life for these people.

HIV/AIDS and the social determinants of health: a time series study.

OBJECTIVE: To analyze the time trend, spatial distribution, and the cases of human immunodeficiency virus/acquired immunodeficiency syndrome cases with social determinants of health. METHODS: Ecological and analytical study, carried out based on the cases of human immunodeficiency virus/acquired immunodeficiency syndrome notified in a state in the Brazilian Midwest, from 2009 to 2018. The study used descriptive analysis, polynomial regression, and geospatial analysis. RESULTS: In 10 years, there were 9,157 notifications, growing each year. There was a growing trend for both sexes (p<0.001, r2=0.94). The City Human Development Index was related to the higher number of cases (city of notification, p=0.01; and city where the person lives, p=0.02). The highest concentration was in cities that house health macro-regions. CONCLUSION: Social determinants have a relationship with the time trend and the spatial distribution of cases and can direct strategies for prevention and care.

Prevalence of non-communicable chronic diseases and associated factors in deaf people.

OBJECTIVE: To analyze the prevalence and factors associated with non-communicable chronic diseases in deaf people. METHODS: Cross-sectional study with 110 deaf people in Maringá-Paraná, selected using the snowball sampling technique. Data were collected from February to August 2019, using a structured instrument; and, in the analysis, multiple logistic regression was used. RESULTS: The self-reported prevalence of chronic diseases was 43.6%, the most frequent being: arterial hypertension (12.7%), depression (6.4%), diabetes mellitus (5.4%), respiratory disease (5.4%) and hypothyroidism (4.5%). Using health services for routine consultations was significantly associated with being bimodal bilingual. The only risk behavior significantly associated with chronic disease was excessive consumption of sweet foods. CONCLUSION: The prevalence of chronic diseases in this population may be higher than that found, as there is a possibility of underdiagnosis due to the low demand for routine consultations and the difficulty of communication with health professionals.