Assessing equity and quality indicators for older people - Adaptation and validation of the Assessing Care of Vulnerable Elders (ACOVE) checklist for the Portuguese care context.

BACKGROUND: Development has promoted longer and healthier lives, but the rise in the proportion of older adults poses new challenges to health systems. Susceptibilities of older persons resulting from lower knowledge about services availability, health illiteracy, lower income, higher mental decline, or physical limitations need to be identified and monitored to assure the equity and quality of health care. The aim of this study was to develop equity indicators for the Assessing Care of Vulnerable Elders (ACOVE)-3 checklist and perform the first cross-cultural adaptation and validation of this checklist into Portuguese. METHODS: A scoping literature review of determinants or indicators of health (in)equity in the care of older people was performed. A total of 5 language experts and 18 health professionals were involved in the development and validation of the equity and quality indicators through expert opinion and focus groups. Data collected from focus groups was analyzed through directed or conventional content analysis. The usefulness of the indicators was assessed by analyzing the clinical records of 30 patients. RESULTS: The literature review revealed that there was a worldwide gap concerning equity indicators for older people primary health care. A structured and complete checklist composed of equity and quality indicators was obtained, validated and assessed. A significant number of non-screened quality or equity related potential occurrences that could have been avoided if the proposed indicators were implemented were detected. The percentage of non-registered indicators was 76.6% for quality and 96.7% for equity. CONCLUSIONS: Applying the proposed checklist will contribute to improve the monitoring of the clinical situation of vulnerable older people and the planning of medical and social actions directed at this group.

Effectiveness of Brushing Associated With Oral Irrigation in Maintenance of Peri-Implant Tissues and Overdentures: Clinical Parameters and Patient Satisfaction.

Hygiene of implant-supported prostheses and the health of peri-implant tissues are considered to be predictive factors of successful prosthetic rehabilitation. Therefore, the purpose of this study was to evaluate the effectiveness of brushing associated with oral irrigation measured as biofilm-removing capacity, maintenance of healthy oral tissues, and patient satisfaction. A randomized, crossover clinical trial was conducted with 38 patients who wore conventional maxillary complete dentures and mandibular overdentures retained by the O-ring system. The patients were instructed to use the following hygiene methods for 14 days: mechanical brushing (MB; brush and dentifrice, control) and MB with oral irrigation (Waterpik [WP], experimental). Biofilm-removing capacity and maintenance of healthy oral tissues were evaluated by the modified plaque index (PI), gingival index (GI), probing depth (PD), and bleeding on probing index (BP) recorded at baseline and after each method. In parallel, patients answered a specific questionnaire using a visual analog scale after each hygiene method. Data were analyzed by Friedman and Wilcoxon tests (α = .05). The results showed significantly lower PI, GI, PD, and BP after application of the hygiene methods (P < .001) than those observed at baseline. However, no significant difference was found between MB and WP. The responses to the satisfaction questionnaire for both methods showed high mean values for all questions, with no statistically significant difference found between the answers given after the use of MB and WP (P > .05). The findings suggest that WP was effective in reducing PI, GI, PD, and BP indices and provided a high level of patient satisfaction.

Sleep Disorders and Subjective Well-Being in Portuguese Adults: Evidence from a Representative Study.

Objective The quality and quantity of sleep affect people's well-being, as chronic sleep disorders are associated with social, physical, and psychological problems, as well as low self-reported life satisfaction. The present cross-sectional study examined the associations of sleep disorders with self-reported life satisfaction in Portuguese adults. Materials and Methods Data from a representative sample of the Portuguese population (14,341 participants, aged ≥ 18 years) extracted from the Sixth Portuguese National Health Survey was analyzed. Data on subjective well-being and sleep disorders was collected through a questionnaire, and multivariable regression models were performed to examine the associations between these variables, adjusted for potential confounders such as age, gender, level of schooling, degree of urbanization, and family income. Results Sleep disorders were negatively associated with self-reported life satisfaction. Having at least one sleep disturbance in the last two weeks was significantly associated with a 3-point decrease in life satisfaction: ß = -3.0 (95% confidence interval = -3.2--2.7). Discussion Among Portuguese adults, sleep disorders were associated with a decline in life satisfaction. The present study provides new evidence from a representative sample to support the promotion of good sleep hygiene intervention programs.

Evaluation of Current Antiemetic Therapy Response in Patients Undergoing MEC or HEC Regimens in Portugal.

Chemotherapy-induced nausea and vomiting (CINV) negatively impact cancer patients' quality of life and treatment outcomes. This study evaluated the achievement of complete response to CINV prophylaxis during the first five days after chemotherapy in adult outpatient cancer clinics with solid malignant tumours receiving Moderate or Highly Emetogenic Chemotherapy (MEC or HEC) in Portugal. During the study, patients completed three evaluations, and nausea severity and CINV impact on patients' daily life was assessed. A complete response (no emetic episodes, no use of rescue antiemetic medication, and no more than mild nausea) was observed in 72% of the cycles (N = 161) throughout the five days after chemotherapy. Amongst the patient population, 25% classified their CINV episodes as severe. Though more than half of the patients achieved a complete response, suggesting that a therapeutic effort is being made to minimise this side effect, the overall scenario is barely optimistic. Significantly, new CINV-control measures in MEC/HEC patients should be adopted, specifically avoiding the single use of dexamethasone and 5-HT3 and raising awareness of using NK1-RAs. Thus, it is critical to improve CINV prophylactic treatment and implement practical international antiemetic guidelines in Portuguese clinical practice, envisaging the improvement of supportive care for cancer patients.

Effect of Different Frequencies of Electroacupuncture on Chronic Low Back Pain in Older Adults: A Triple-blind, Placebo-controlled, Randomized Clinical Trial.

BACKGROUND: Acupuncture is one of the most widely used therapies to treat chronic low back pain, whose analgesic effect seems to be potentiated by the addition of electric current (electroacupuncture). However, we are not aware of any clinical trial that has evaluated the effectiveness of this technique in adults > 65 years. OBJECTIVE: To evaluate the effect of electroacupuncture in the treatment of chronic low back pain in the elderly. STUDY DESIGN: Triple-blind, controlled, and randomized clinical trial. SETTING: Faculty of Medicine, University of São Paulo (USP); Sector of Biological Sciences - Physiotherapy Course, Federal University of Paraná (UFPR). METHODS: The study included 125 elderly people with chronic nonspecific low back pain who were randomized to one of 5 study groups: 3 of electroacupuncture; one control; and one placebo, all of them treated for 5 weeks. The primary endpoint was pain intensity, and secondary endpoints included the qualitative aspect of pain, functional disability (Roland-Morris and sit and stand test), emotional functioning (depression and anxiety), and psychosocial factors. Data analysis followed the intention-to-treat principle. The confidence interval was set at 95% and the significance level at 5%. RESULTS: All groups achieved a reduction in pain intensity; however, a significant difference was only detected between electroacupuncture and placebo, where the latter showed greater pain reduction. Regarding secondary outcomes, all groups showed good posttreatment results for all assessments but without statistical significance. Among the groups, the placebo was the one that obtained the best results between the pre- and post-treatment for depression, qualitative aspect of pain, and functional disability, but only for the qualitative aspect of pain and for the sit-and-stand test was a significant reduction found in the intergroup comparison. The analysis of the overall effect perceived by the participants in relation to low back pain revealed that individuals from all groups felt close to full recovery. LIMITATIONS: Absence of follow-up and a relatively small number of patients. CONCLUSIONS: This study provides evidence that there is no one frequency of electroacupuncture that is most effective in treating chronic low back pain in the elderly and that electroacupuncture is not superior to manual acupuncture or placebo treatment.

Impact of physical exercise programs in breast cancer survivors on health-related quality of life, physical fitness, and body composition: Evidence from systematic reviews and meta-analyses.

Background: Breast cancer is the most common cancer worldwide, and despite remarkable progress in its treatment, the survivors' quality of life is hampered by treatment-related side effects that impair psychosocial and physiological outcomes. Several studies have established the benefits of physical exercise in breast cancer survivors in recent years. Physical exercise reduces the impact of treatment-related adverse events to promote a better quality of life and functional outcomes. Aim: This study aims to provide an overview of systematic reviews and meta-analyses on the effect of physical exercise on the health-related quality of life, cardiorespiratory fitness, muscle strength, and body composition of breast cancer survivors. Methods: PubMed and Cochrane databases were searched for systematic reviews and meta-analyses from January 2010 to October 2022. The main focus was ascertaining the effectiveness of physical exercise in breast cancer survivors undergoing curative treatment (surgery and/or radiotherapy and/or chemotherapy). Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. Results: A total of 101 studies were identified, and 12 were yielded for final analysis. The eligible studies included nine systematic reviews/meta-analyses, one meta-analysis/meta-regression, and two systematic reviews. The number of randomised clinical trials included in each review varied from 11 to 63, and the number of participants was from 214 to 5761. A positive and significant effect of different physical exercise interventions on health-related quality of life was reported in 83.3% (10 studies) of the eligible studies. Physical exercise also improved cardiorespiratory fitness (3 studies; 25%) and showed to be effective in reducing body weight (3 studies; 25%) and waist circumference (4 studies; 33.3%). Conclusions: Our results suggest that physical exercise is an effective strategy that positively affects breast cancer survivors' quality of life, cardiorespiratory fitness, and body composition. Healthcare professionals should foster the adoption of physical exercise interventions to achieve better health outcomes following breast cancer treatments. Systematic review registration: https://inplasy.com/inplasy-2022-11-0053/, identifier INPLASY2022110053.

Evaluation of Parenting Interventions to Prevent Violence Against Children in Colombia: A Randomized Controlled Trial.

The effects of the International Child Development Programme (ICDP) and the specific addition of a violence prevention module were observed in a preidentified population in Colombia where children are experiencing high levels of violence. Participants were 176 parents of 3- to 4-year-olds attending child centers who were randomly allocated to one of three conditions: organized Community Activities at child centers and ICDP (CA + ICDP), CA, ICDP, and a preventive Violence Curriculum (CA + ICDP + VC), or a comparison group with only CA. The parents completed questionnaires about corporal punishment, intimate partner violence, community violence, and mental health at baseline and at 6 months follow-up. Univariate logistic regressions were used to examine uses of child violence, predictors of intimate partner violence, and prevalence of mental health problems. McNemar tests were used to assess differences between intervention groups and comparison group at two different time points. Participants were mostly female (78.5%) and had an average age of 32 years. Among these, 58.5% had been exposed to community violence and 98.3% reported using physical assault to discipline their children. Reported prevalence of child violence decreased in all groups whereas the reduction of severe forms of violence was larger for the intervention groups, and especially for the CA + ICDP + VC group. There was a significant reduction of victimization of intimate partner violence in both intervention groups as well as a decrease in mental health problems, especially for the CA + ICDP group (from 22.4% to 5.1%). The general ICDP seems effective in reducing violence. The addition of a specific violence intervention component seemed to reduce intimate partner violence, but not violence related to children. The comparison group attending the child center and other social activities also reported reduced violence but to a lesser extent than the groups who attended specific interventions.

Immediate analgesic effect of two modes of transcutaneous electrical nerve stimulation on patients with chronic low back pain: a randomized controlled trial.

OBJECTIVE: To compare and assess the immediate analgesic effects of conventional and burst transcutaneous electrical nerve stimulation in patients with chronic low back pain. METHODS: We conducted a three-arm single-blinded randomized controlled trial. A total of 105 patients with non-specific chronic low back pain aged between 18 and 85 years were randomly assigned into the following groups: Placebo Group (sham electrical stimulation), Conventional TENS Group (continuous stimulation at 100Hz for 100µs with sensory intensity), and Burst TENS Group (stimulation at 100Hz modulated at 2Hz for 100µs with motor-level intensity). All groups received a single application of transcutaneous electrical nerve stimulation for 30 minutes. The outcomes, namely, pain intensity, quality of pain, and pressure pain threshold were measured by the visual analog scale, McGill pain questionnaire, and algometry, respectively. The patients were evaluated before and immediately after the transcutaneous electrical nerve stimulation application. RESULTS: Pain intensity (visual analog scale score) and quality of pain (McGill pain questionnaire score) significantly decreased (p<0.05) in Intervention Groups (Conventional TENS Group and Burst TENS Group). A positive effect was observed in the interventions compared to the Placebo Group in all domains of the McGill pain questionnaire (p<0.05), excepting for the pain intensity. Pressure pain threshold significantly increased (p<0.05) immediately after the transcutaneous electrical nerve stimulation application in both Intervention Groups, but not in the Placebo Group. For significant difference was found during assessment when comparing both Intervetion Group. CONCLUSION: Both transcutaneous electrical nerve stimulation modes were effective for pain modulation. Moreover, there was an increase in the pressure pain threshold. No significant results were found to indicate the best mode for the treatment of chronic low back pain.Clinical Trial Registration: RBR-59YGRB.

Educação em saúde: gerenciamento de resíduos hospitalares e uso de equipamentos de proteção individual / Health education: hospital waste management and use of personal protective equipment / Educación sanitaria: gestión de residuos hospitalarios y uso de equipos de protección personal

Objetivo: Desenvolver intervenção educativa sobre gerenciamento dos resíduos de serviços de saúde e uso de equipamentos de proteção individual com profissionais de enfermagem. Métodos: Pesquisa-ação, realizada com profissionais de enfermagem de um hospital da rede pública no nordeste brasileiro, entre janeiro a julho de 2018. Os dados foram organizados com apoio do software webQDA© e análise de conteúdo de Bardin. Resultados: Emergiram duas categorias: Gerenciamento dos Resíduos de Serviços de Saúde e Utilização de Equipamentos de Proteção Individuais. Parte dos profissionais possuíam conhecimento adequado sobre o gerenciamento dos resíduos de serviços de saúde. Os resultados apontam que parcela dos participantes reconhecem a periculosidade que os grupos de resíduos de serviços de saúde possuem, adotando cuidados, porém, reconhecem a ocorrência de condutas não seguras, como uso incorreto de equipamentos de proteção individual. Além disso, os técnicos de enfermagem demostraram conhecimento incipiente sobre os resíduos de serviços de saúde e expressaram mais exposição a riscos ocupacionais. Conclusão: A intervenção educativa realizada evidenciou a necessidade de efetivar a construção de conhecimentos coletivos no âmbito da educação permanente relacionado aos resíduos e riscos ocupacionais entre profissionais de enfermagem. Recomendam-se outros estudos para avaliar a efetividade e impacto da intervenção educativa no ambiente hospitalar. (AU)

Objective: Develop educational intervention on health care waste management and the use of personal protective equipment with nursing professionals. Methods: Action research, carried out with nursing professionals from a public hospital in northeastern Brazil, between January and July 2017. The data were organized with the support of webQDA © software and content analysis by Bardin. Results: Two categories emerged: Waste Management from Health Services and Use of Personal Protective Equipment. Part of the professionals had adequate knowledge about the management of waste from health services. The results show that a portion of the participants recognize the dangerousness that the health service waste groups have, adopting care in relation to these, however, they recognize the occurrence of unsafe conduct, such as incorrect use of personal protective equipment. In addition, nursing technicians demonstrated incipient knowledge about health service waste and expressed more exposure to occupational risks. Conclusion: The educational intervention carried out showed the need to carry out the construction of collective knowledge within the scope of permanent education related to GRSS and occupational risks among nursing professionals. Further studies are recommended to assess the effectiveness and impact of educational intervention in the hospital environment. (AU)

Objetivo: Desarrollar una intervención educativa sobre la gestión de residuos sanitarios y el uso de equipos de protección personal con profesionales de enfermería. Métodos: Investigación acción, realizada con la profesión de un hospital público en el noreste de Brasil, entre enero y julio de 2017. Los datos se organizan con el apoyo del software webQDA © y el análisis de contenido Bardin. Resultados: Surgieron dos categorías: Gestión de dos Residuos de Servicios de Salud y Uso de Equipos de Protección Personal. Los profesionales de la segunda parte tienen el conocimiento o manejo adecuado de dos residuos de los servicios de salud. Los resultados indican que dos participantes reconsideran la peligrosidad que representaban los grupos de residuos del servicio de salud, adhiriéndose cuidados, por lo que reconsideran la ocurrencia de conductas inseguras, como el uso incorrecto de equipos de protección personal. Además, los técnicos de enfermería demostrarán un conocimiento incipiente sobre el desperdicio de servicios de salud y expresarán una mayor exposición a los riesgos laborales. Conclusión: La intervención educativa realizada mostró la necesidad de realizar la construcción de conocimientos colectivos fuera del ámbito de la educación permanente relacionada con los GRSS y los riesgos laborales entre los profesionales de la enfermedad. Recomendamos otros estudios para evaluar la efectividad y el impacto de la intervención educativa en el ámbito hospitalario. (AU)

Health policies in Southern Europe and deregulation of labour relations: a glimpse of Portugal. / Políticas de saúde do Sul da Europa e desregulação das relações de trabalho: um olhar sobre Portugal.

Under the Troika Memorandum (2011-2015), health policies in Portugal know a political agenda, business and organizational schedule guided by the principles of privatisation, deregulation and underfinancing of public services by the State. In this article, the authors provide a review of the literature on health systems in the countries of the Southern European countries, highlighting the Portuguese situation regarding reform processes and major health inequalities before and during the economic crisis. Complementarily, the testimonies of different professionals of the health sector (doctor, nurse, therapeutics technician, unions and heads of care units) are summoned. Based on an exploratory study, it is our purpose to discuss political-organisational transformations and their consequences in the deregulation and precariousness of labour relations in the health sector. Wage reductions, career freeze, contractual instability, professional demotivation, intensification of the work pace and disqualification of services are some of the most visible signs of a management agenda that conflicts with the missions of a universal National Health System (NHS) at the service of Portuguese society.

Sob o efeito do Memorando da Troika (2011-2015), as políticas de saúde em Portugal conhecem uma agenda política, empresarial e organizacional orientada por princípios de privatização, desregulação e subfinanciamento dos serviços públicos por parte do Estado. Neste artigo, faz-se uma revisão da literatura sobre os sistemas de saúde dos países do Sul, destacando-se a situação portuguesa quanto aos processos de reforma e principais desigualdades de saúde antes e durante a crise econômica. Complementarmente, convocam-se os testemunhos de diferentes profissionais do setor da saúde (médico, enfermeiro, técnico de terapêutica, sindicatos e dirigentes de unidades de cuidados). Baseado num estudo exploratório, discutem-se as transformações político-organizacionais e suas consequências na desregulação e precarização das relações de trabalho no setor da saúde. Reduções salariais, congelamento de carreira, instabilidade contratual, desmotivação profissional, intensificação do ritmo de trabalho e desqualificação dos serviços são alguns dos sinais mais visíveis de uma agenda gestionária que conflitua com as missões de um Sistema de Saúde Pública (SNS) universal ao serviço da sociedade portuguesa.

ABORDAGEM MULTIPROFISIONAL QUANTO AO USO E ABUSO DE DROGAS DURANTE A GESTAÇÃO: Usuárias do CAPS AD III / MULTIPROFESSIONALIONAL APPROACH TO DRUG USE AND ABUSE DURING PREGNANCY: Users of CAPS AD III

O artigo possui o objetivo de problematizar a abordagem multiprofissional no CAPS ADIII da Cidade de Vitória da Conquista, para gestantes usuárias de drogas dessa unidade. Isso porque, as drogas são substâncias que alteram as funções cerebrais e mudam a percepção, humor e comportamentos. Tal elemento utilizado na gestação ocasiona ao feto, morbidades e/ou aborto. Para evitar essas consequências, médicos ou enfermeiros da UBS devem-se, nas primeiras consultas de pré-natal, rastrear as gestantes dependentes das psicotrópicas, objetivando encaminhá-las ao CAPS ADIII. O estudo foi de caráter descritivo, exploratório, qualitativo de corte transversal. A coleta de dados foi por meio da aplicação de uma entrevista, utilizando a TALP. A pesquisa resultou em uma contribuição da compreensão de como é a abordagem e papel da equipe multiprofissional do CAPS ADIII, apontando às dificuldades e desafios enfrentados pela equipe na prática de suas atividades, na tentativa de incorporar não somente os cuidados físicos, mas também à abordagem psicológica e social. Considera-se a construção de uma diretriz específica para o tratamento das gestantes usuárias de drogas, uma vez que isso visa proporcionar uma melhor e eficaz articulação entre os CAPS ADIII e as UBS.

The article aims to problematic the multi-professional approach in CAPS ADIII of the city of Victory of Conquest, for pregnant women who use drugs from this unit. That's because, drugs are substances that alter brain functions and change perception, mood and behaviors. This element used in pregnancy causes the fetus, morbidity is and/or abortion. To avoid these consequences, UBS doctors or nurses should, at first consultations, examine pregnant women dependent on psychotropic women, with the aim of referring them to CAPS ADIII. The study was descriptive, exploratory, qualitative transverse. The data collection was through the application of an interview, using TALP. The research resulted in a contribution of understanding how is the approach and role of the multidisciplinary team of CAPS ADIII, pointing to the difficulties and challenges faced by the team in the practice of their activities, in an attempt to incorporate not only physical care, but also the psychological and social approach. It is considered the construction of a specific guideline for the treatment of pregnant drug users, since this aims to provide a better and effective articulation between caps ADIII and ubs.

Gerenciamento dos resíduos de serviços de saúde em um hospital público do Maranhão / Management of waste health services in a public hospital in Maranhão / Gestión de residuos de servicios de salud en un hospital público de Maranhão

Objetivo: descreveras etapas do gerenciamento dos resíduos de serviços de saúde de um hospital público do Maranhão, considerando o ambiente/investigando os profissionais. Métodos:estudo transversal descritivo, com visitas às enfermarias e postos de enfermagem, cada local observado durante umahora (com cincoréplicas) seguindo um roteiro pré-estabelecido e com aplicação de questionário semiestruturado com a equipe de enfermagem. Resultados:os postos de enfermagem apresentaram maior quantidade de geraçãode resíduos perfurocortantes, com destaque para agulhas e seringas; o Descartex apresentava localização e posição adequada e segura, mas com volume excedido; resíduos infectantes, biológicos e de lixo comum, foram acondicionados em sacos plásticos segundoo normatizado. A frequência de coleta e limpeza estava de acordo com a normatização, embora as lixeiras estivessem sem tampa e pedal. O transporte foi realizado em containersadequados embora o tempo de remoção dos resíduos até o armazenamento externo estivesse em desacordo com o estabelecido. 88% dos técnicos e 100% dos enfermeiros relataram que há diferença no manejo dos diferentes grupos de resíduos, tendo como resíduos mais gerados os perfurocortantes, máscaras, luvas e papel. 94% dos técnicos e todos os enfermeiros afirmaram existir a etapa de segregação. 36,3% dos técnicos e 20% dos enfermeiros afirmaram já terem sofrido algum acidente ocupacional envolvendo resíduos perfuro cortantes. Conclusões: Observou-se maior produção dos resíduos biológicos,perfurocortantese comuns, com determinados pontos em desacordo com a legislação normativa, ressaltando a necessidade dos profissionais da equipe de enfermagem conhecerem as etapas do gerenciamento dos resíduos.

Objective: to describethe stages of waste management from health services in a public hospital in Maranhão, considering the environment/investigating professionals. Methods:descriptive cross-sectional study, with visits to the wards and nursing stations, with each location being observed for onehour (with fivereplicas) following a pre-established script and applying a semi-structured questionnaire with the nursing team. Results:the nursing stations showed a greater amount of generation of sharp waste, especially needles and syringes; Descartex had an adequate and safe location and position, but with excess volume; infectious, biological andcommon garbage residues were packed in plastic bags in accordance with regulations. The frequency of collection and cleaning was in accordance with regulations, although the bins had no lid and pedal. Transport was carried out in suitable containers, although the time from waste removal to external storage was not in accordance with what was established. 88% of technicians and 100% of nurses reported that there is a difference in the management of different groups of waste, with sharps, masks, gloves and paper as the most generated waste. 94% of technicians and all nurses stated that there was a segregation stage. 36.3% of the technicians and 20% of the nurses said they had already suffered an occupational accident involving sharp waste. Conclusions:There was agreater production of biological, sharp and common waste, with certain points at odds with normative legislation, highlighting the need for nursing staff professionals to know the stages of waste management.

Objetivo: describir las etapas de la gestión de residuos de los servicios de salud en un hospital público de Maranhão, considerando el medio ambiente/investigando a los profesionales. Métodos:estudio descriptivo transversal, con visitas a las salas y puestos de enfermería, cada local observado durante una hora (con cinco repeticiones) siguiendo un guión preestablecido y aplicación de un cuestionario semiestructurado con el equipo de enfermería. Resultados:los puestos de enfermería tuvieron mayor generación de residuos cortopunzantes, especialmente agujas y jeringas; Descartex tenía una ubicación y posición adecuada y segura, pero con volumen rebasado; Los residuos infecciosos, biológicos y de desecho común fueron empacados en bolsas plásticas de acuerdo a normatividad. La frecuencia de recogida y limpieza fue conforme a la normativa, aunque las papeleras no tenían tapa ni pedales. El transporte se realizó en contenedores adecuados, aunque el tiempo desde la retirada de los residuos hasta el almacenamiento externo no se ajustaba a lo establecido. El 88% de los técnicos y el 100% de las enfermeras informaron que existe diferencia en el manejo de los diferentes grupos de residuos, siendo los punzantes, mascarillas, guantes y papel los residuos más generados. El 94% de los técnicos y todos los enfermeros manifestaron que hubo una etapa de segregación. El 36,3% de los técnicos y el 20% de los enfermeros afirmaron haber sufrido ya un accidente de trabajo con residuos cortantes. Conclusiones:Hubo una mayor producción de desechos biológicos, cortopunzantes y comunes, con ciertos puntos en desacuerdo con la legislación normativa, destacando la necesidad de que los profesionales del equipo de enfermería conozcan las etapas de la gestión de desechos.

Aplicação de feixes de intervenção numa unidade de terapia intensiva portuguesa / Aplicación de vigas de intervención en una unidad portuguesa de cuidados intensivos / Application of intervention bundles in a portuguese intensive care unit

Objetivo identificar a associação entre a aplicação de Feixes de Intervenção e características sociodemográficas e profissionais de enfermeiros em uma unidade de terapia intensiva portuguesa. Método estudo descritivo e transversal, com amostra de 44 enfermeiros de uma Unidade de Terapia Intensiva Portuguesa. Na coleta de dados, aplicou-se questionário de maio a junho de 2019. Tratamento incluiu estatística descritiva e inferencial. Resultados a maioria da amostra não executava auditorias (86,4%) quanto às infeções em estudo. A pontuação do Feixe de Intervenção da Infeção do Trato Urinário e da Pneumonia Associada à Intubação diferiu significativamente entre os sexos (T de Student: p<0,047 e p<0,037), bem como entre o exercício profissional total e tempo de exercício na Unidade de Terapia Intensiva, respetivamente (T de Student: p<0,001 e p<0,026). Conclusão a aplicação dos Feixes de Intervenção associou-se às características sociodemográficas e ao tempo de exercício profissional de enfermeiros de unidade de terapia intensiva portuguesa.

Objetivo identificar la asociación entre la aplicación de Vigas de Intervención y las características sociodemográficas y los profesionales de enfermería en una unidad de cuidados intensivos portuguesa. Método estudio descriptivo y transversal, con una muestra de 44 enfermeras de una Unidad de Cuidados Intensivos portuguesa. Se aplicó un cuestionario de mayo a junio de 2019 en la recolección de datos. El tratamiento incluyó estadísticas descriptivas e inferenciales. Resultados la mayoría de la muestra no realizó auditorías (86,4%) respecto a las infecciones en estudio. La puntuación del Vigas de Intervención de Infección urinaria y Neumonía Asociada a Intubación difirió significativamente entre los sexos (T de Student: p<0,047 y p<0,037), así como entre el ejercicio profesional total y el tiempo de ejercicio en la Unidad de Cuidados Intensivos, respectivamente (T de Student: p<0,001 y p<0,026). Conclusión la aplicación de los Vigas de Intervención se asoció con características sociodemográficas y tiempo de práctica profesional de las enfermeras de una unidad de cuidados intensivos portuguesa.

Objective to identify the association between the application of Intervention Bundles and sociodemographic and professional characteristics of nurses in a Portuguese intensive care unit. Method descriptive and cross-sectional study, with a sample of 44 nurses from a Portuguese Intensive Care Unit. A questionnaire was applied from May to June 2019 in the data collection. Treatment included descriptive and inferential statistics. Results the majority of the sample did not perform audits (86.4%) regarding the infections under study. The score of the Intervention Bundle of Urinary Tract Infection and Pneumonia Associated with Intubation differed significantly between the genders (Student's T: p<0.047 and p<0.037), as well as between the total professional exercise and exercise time in the Intensive Care Unit, respectively (Student's T: p<0.001 and p<0.026). Conclusion the application of the Intervention Bundles was associated with sociodemographic characteristics and time of professional practice of nurses from a Portuguese intensive care unit.

Mental health problems in male young offenders in custodial versus community based-programs: implications for juvenile justice interventions.

BACKGROUND: Young offenders are known to be a population with high prevalence of mental health disorders. In most cases, these disorders are neither identified nor treated properly, with the majority of them being chronic and difficult to treat. In many countries, the prevalence rates of psychopathology in male young offenders are still unknown and no psychotherapeutic interventions are delivered. Therefore, the main goal of the present study was to assess mental health problems in Portuguese male young offenders placed in either custodial or community-based programs and discuss treatment implications within the juvenile justice interventions. METHODS: Participants in this study included 217 male young offenders aged between 14 and 20 years old that were randomly selected using a random number table. From the total sample, 122 (56.3 %) participants were placed in juvenile detention facilities, and 95 (43.7 %) were receiving community-based programs. Participants were interviewed with the Mini-International Neuropsychiatric Interview for Children and Adolescents, a structured interview that assesses DSM-IV Axis I Mental Disorders. Participants aged 18 years or older were also assessed with the antisocial personality disorder section from the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. RESULTS: Results showed a high prevalence of mental health disorders, with a global prevalence of 91.2 % in the total sample. In both groups, global prevalence rates were equally high (93.4 % in youth in custodial versus 88.4 % in youth in community-based programs). Substance-related disorders were more prevalent in youth placed in juvenile facilities, whereas anxiety and mood disorders were more often found in the community-based group. Moreover, oppositional defiant disorder was more prevalent in youth from the community, whereas antisocial personality disorder and conduct disorder were less prevalent than expected in this same group. A high comorbidity rate was also found, with the majority of participants from both groups' fulfilling criteria for two or more disorders. Additionally, participants with conduct disorder were over four times more likely to fulfill criteria for substance abuse. CONCLUSIONS: Our findings inform about specific needs concerning mental health intervention that should be taken into account when deciding and planning rehabilitation programs for male young offenders, either from custodial or community-based programs.

Evaluation of tissue in repair with natural latex and / or hyaluronic acid in surgical bone defects

Abstract This study evaluated the bone repair in surgical defects of rats treated with hyaluronic acid (HA) associated or not with Hevea brasiliensis fraction protein (F-1). Bone defect were created in 15 albino Wistar rats divided into 3 groups (n=5): Control group (1) - blood clot; HA group (2) - 0.5% hyaluronic acid; HAF1 group (3) - 0.1% F-1 protein fraction dissolved in 0.5% hyaluronic acid. After 4 weeks, the animals were euthanized and the bone repair was evaluated through histomorphometric analysis, zymography and immunohistochemistry. The neoformed bone area did not show a significant difference (p = 0.757), but there was a tendency for bone trabeculation to increase in the groups HA and HAF1. For immunohistochemically analysis, there was a difference in vascular endothelial growth factor (VEGF) labeling (p = 0.023), being higher in the groups HA and HAF1 than the control group. No significant difference in bone sialoprotein (BSP) (p = 0.681), osteocalcin (p = 0.954), however, significant difference in platelet endothelial cell adhesion molecule-1 (CD-31) (p = 0.040), with HAF1 group being significantly lower than the control. For zymographic analysis, there was no significant difference for metalloproteinase-2 (MMP-2) (p = 0.068), but there was a tendency to increase MMP-2 in the HA group. Despite the influence on angiogenic factors and the apparent tendency for greater trabeculation in the HA and HAF1 groups, there was no significant difference in the area of ​​newly formed bone tissue in the analyzed period.

Resumo Este estudo avaliou o reparo ósseo em defeitos cirúrgicos de ratos tratados com ácido hialurônico (AH) associado ou não à fração proteica de Hevea brasiliensis (F-1). Foram criados defeitos ósseos em 15 ratos albinos Wistar divididos em 3 grupos (n = 5): Grupo controle (1) - coágulo sanguíneo; Grupo HA (2) - ácido hialurônico 0,5%; Grupo HAF1 (3) - fração proteica F-1 0,1% dissolvida em ácido hialurônico a 0,5%. Após 4 semanas, os animais foram submetidos à eutanásia e o reparo ósseo avaliado por meio de análise histomorfométrica, zimografia e imunohistoquímica. A área óssea neoformada não apresentou diferença significativa (p = 0,757), mas houve tendência de aumento da trabeculação óssea nos grupos HA e HAF1. Para a análise imunoistoquímica, houve diferença na marcação do fator de crescimento endotelial vascular (VEGF) (p = 0,023), sendo maior nos grupos HA e HAF1 do que no grupo controle. Nenhuma diferença significativa na sialoproteína óssea (BSP) (p = 0,681), osteocalcina (p = 0,954), no entanto, diferenças significativas foram encontradas para a molécula de adesão de células endoteliais plaquetárias-1 (CD-31) (p = 0,040), com o grupo HAF1 sendo significativamente inferior ao controle. Para a análise zimográfica, não houve diferença significativa para metaloproteinase-2 (MMP-2) (p = 0,068), mas houve tendência de aumento da MMP-2 no grupo HA. Apesar da influência sobre os fatores angiogênicos e da aparente tendência de maior trabeculação nos grupos HA e HAF1, não houve diferença significativa na área de tecido ósseo neoformado no período analisado.

Evaluation of misfit and stress distribution in implant-retained prosthesis obtained by different methods

Abstract This study evaluated the vertical misfit, passivity, and stress distribution after tightening the screws of different prosthesis. Two implants were used to simulate the rehabilitation of partially edentulous mandible space from the second premolar to the second molar. 40 three-element screw-retained fixed dental prosthesis with distal cantilever were fabricated and divided into four groups according to the method of production of framework (n = 10): G1 = conventional casting one-piece framework, G2 = conventional casting sectioned and laser welding, G3 = conventional casting sectioned and tungsten inert gas (TIG) welding and G4 = framework obtained by CAD/CAM (computer-aided design/computer-aided manufacturing) system. The vertical misfits (both screws tightened) and the passive fit (one screw tightened) were measured under a comparator optical microscope. The data was submitted to Shapiro-Wilk test to enable comparison with ANOVA followed by Tukey with Bonferroni adjust (α = .05). The qualitative analysis of the stress distribution was performed by the photoelastic method. The vertical misfit (both screws tightened) of the G2 (24 μm) and G3 (27 μm) were significantly higher than G4 (10 μm) (p = 0,006). The passive fit (for the non-tightened) of the G1(64 μm) and G3 (61 μm) were significantly higher than the G4 (32 μm) (p=0,009). G1 showed high stress between the implants in the photoelastic analysis and G4 presented lower stress. In conclusion, CAD/CAM method results in less vertical misfit, more passivity, and consequently better stress distribution to the bone.

Resumo Neste estudo foi avaliado desajuste vertical, a passividade e a distribuição de tensões após o aperto dos parafusos de diferentes próteses. Dois implantes foram usados ​​para simular a reabilitação do espaço edêntulo da mandíbula do segundo pré-molar ao segundo molar. Quarenta próteses dentárias fixas parafusadas de três elementos com cantilever distal foram confeccionadas e separadas em quatro grupos de acordo com o método de obtenção da infraestrutura (n = 10): G1 = fundição convencional estrutura monobloco, G2 = fundição convencional seccionada e soldagem a laser, G3 = fundição convencional seccionada e soldagem com gás inerte de tungstênio (TIG) e G4 = infraestrutura obtida pelo sistema CAD / CAM (computer-aided design/computer-aided manufacturing). Os desajustes verticais com ambos os parafusos apertados e os desajustes relativos à avaliação de passividade com um parafuso apertado foram medidos com microscópio comparador óptico. Os dados foram submetidos ao teste de Shapiro-Wilk para comparação com ANOVA seguida de ajuste de Tukey com Bonferroni (α = 0,05). A análise qualitativa da distribuição de tensões foi realizada pelo método fotoelástico. G2 (24 μm) e G3 (27 μm) apresentaram valores significativamente maiores que G4 (10 μm) (p = 0,006) de desajuste vertical (ambos os parafusos apertados). Os valores de desajustes nos G1 (64 μm) e G3 (61 μm), do lado não apertado, foram significativamente maiores que no G4 (32 μm) (p = 0,009). G1 apresentou maior tensão entre os implantes na análise fotoelástica e G4 apresentou menor tensão. O método CAD/CAM resultou em menor desajuste, maior passividade e melhor distribuição de tensões no osso.

Influence of metal bar lever-arm on screws detorque for dental prosthesis implant supported / Influência do cantilever no destorque de parafusos de barras metálicas utilizadas em próteses do tipo protocolo de Brannemark

Introduction: The cantilever length of implant-supported fixed prosthesis metal structure has been considered an important factor to transfer occlusion forces to the dental implant. Objective: This study evaluated the influence of different extensions of cantilevers of Branemark protocol implant prosthesis when submitted to mechanical thermocycling by screw loosening evaluation. Material and method: The groups G10 (n = 5), G15 (n = 5) and G20 (n = 5) were formed according to the distance in millimeters between the force application site in the cantilever and the center of the last implant. All metal structures (n = 15) were submitted to a 120 N cyclic vertical load in a chewing simulation machine (MSM-Elquip, São Carlos-SP, Brazil) under controlled temperature and moisture conditions. Two hundred and fifty thousand mechanical cycles were performed with a frequency of 2 Hz that simulates a masticatory activity similar to 3 months. To compare the data obtained regarding the loosening of the metal structure screws, implant position and sites of load application, the analysis of variance with two factors and the Tukey test were performed. Result: Statistical analysis showed that the G10 group presented greater torque loss, statistically different from G15 (p = 0.001) and G20 (p = 0.002), and there was no significant difference between groups G15 and G20. Conclusion: It can be concluded from the results that all the screws presented torque loss after simulation of 3 month masticatory activity, suggesting the need for periodical evaluation to prevent failures in the treatment.

Introdução: O comprimento do cantilever da infraestrutura de prótese implanto-suportada tem sido considerado um importante fator de transferência de força de oclusão para o implante dentário. Objetivo: Esse trabalho avaliou a influência das diferentes extensões do cantilever da prótese sobre implantes tipo protocolo de Branemark submetidas à termociclagem mecânica pela avaliação dos afrouxamentos dos parafusos de fixação. Material e método: Os grupos G10 (n=5), G15 (n=5) e G20 (n=5) foram formados de acordo com a distância, em milímetros, entre o local de aplicação de força no cantilever e o centro do último implante. Todas as barras (n=15) foram submetidas a carga vertical cíclica de 120 N em uma máquina de simulação de mastigação (MSM-Elquip, São Carlos/SP, Brasil), em condições de temperatura e umidade controladas. Foram realizados 250 mil ciclos mecânicos com frequência de 2 Hz que simulou uma atividade mastigatória correspondente a 3 meses. Para comparar os dados obtidos quanto à soltura dos parafusos da barra, a posição dos implantes e os locais de aplicação de carga, foi realizada a análise de variância com dois fatores e o teste de Tukey. Resultado: A análise estatística mostrou que o grupo G10 apresentou maior perda de torque, diferente estatisticamente de G15 (p=0,001) e G20 (p=0,002) e que não houve diferença significante entre os grupos G15 e G20. Conclusão: Pode-se concluir que todos os parafusos apresentaram perda de torque após o ensaio simulando uma atividade mastigatória de 3 meses, sugerindo a necessidade de avaliação clínica periódica afim de prevenir fracasso no tratamento.

Effects of swimming associated with risedronate in osteopenic bones: An experimental study with ovariectomized rats.

Physical activity and risedronate sodium have effects on metabolic bone diseases, maintaining the integrity of bone tissue. Our objective was to evaluate the effects of swimming associated with risedronate as a prophylactic means in osteopenic bone of ovariectomized rats. A total of 24 animals of the Wistar strain were used and separated into four groups containing six animals: Ovariectomy (OVX), ovariectomy and swimming (OVXS), ovariectomy and risedronate (OVXM), ovariectomy, risedronate and swimming (OVXMS). The effectiveness of the treatments were evaluated using the tibia by means of biomechanical, radiographic, histomorphometric analyzes. Statistical analysis was performed by the non-parametric Kruskal-Wallis test (p<0.05). The OVXM and OVXMS groups showed higher values ​​compared to OVX in maximum strength and rigidity. Microscopic analysis showed increased trabecular bone in the OVXM group in relation to the others, and in the OVXMS compared to OVXS. Proximal densitometry in the OVXM and OVXMS groups showed higher values than the OVX and OVXS groups. There were no significant differences in overall densitometry. In conclusion, when comparing the prophylactic means, risedronate was able to preserve bone mass significantly, unlike exercise where an improvement of bone tissue was observed, although not significant, and when swimming and risedronate are combined the result was even better.

Effect of cleanser solutions on the retention force of oring attachment: an in vitro study

Abstract The aim of this study was to evaluate the effect of cleaning solutions on the retention force of o-ring-type overdenture attachments. The effect of four solutions on nitrile rings were evaluated: Cepacol (C), Cepacol with fluoride (CF), Listerine (L) and 0.05% sodium hypochlorite (SH); deionized water (DW) was used as a control. Matrices containing two implants and abutments and acrylic specimens with the metal capsules were obtained and divided into the groups. A simulation of 90 overnight immersions (8 h) was performed, and the tensile strength value was obtained at the beginning (T0) and in every 30 days (T1, T2 and T3) (n=6). In order to analyze o-ring surface damage after the immersions, a scanning electron microscopy (SEM) was used (n=1). For statistical analysis of the results, analysis of variance (ANOVA) and multiple comparisons with Bonferroni adjustment (test power=1.000; a=0.05) were used. There was a significant difference for the factors time (p<0.001), solution (p<0.001) and for the interaction time × solution (p<0.001). Considering the times of each solution, only for DW there was no significant loss of retention over time. Comparing the solutions in each moment, there was no difference among the solutions in T0. From T1, CF and SH provided less retention than DW (p<0.005). Through SEM it was possible to observe changes in the surface of the CF and SH nitrile o-rings. CF and SH should be avoided due to deleterious action in o-rings.

Resumo O objetivo do estudo foi avaliar o efeito de soluções higienizadoras sobre a força de retenção de encaixes do tipo o-ring. Foram avaliadas quatro soluções: Cepacol (C); Cepacol com flúor (CF), Listerine (L), hipoclorito de sódio 0,05% (HS) e água deionizada (controle/AD) em o-rings de nitrilo. Matrizes contendo dois implantes e pilares e espécimes em acrílico com as cápsulas metálicas foram obtidas e divididas entre os grupos. Foi realizada a simulação de 90 imersões noturnas (8 h), sendo obtido o valor da resistência à tração no início e a cada 30 dias (T0, T1, T2 e T3) por meio da máquina de ensaios mecânicos (n=6). Microscopia eletrônica de varredura (MEV) foi utilizada para análise de danos na superfície do o´ring após a imersão (n=1). Para análise estatística dos resultados foi utilizada análise de variância (ANOVA) e múltiplas comparações com ajuste de Bonferroni (poder do teste=1,000; a=0,05). Houve diferença significante para os fatores tempo (p<0,001), solução (p<0,001) e para interação de tempo × solução (p<0,001). Considerando-se os tempos de cada solução, apenas AD não apresentou perda significativa de retenção ao longo do tempo. Comparando as soluções em cada momento, não houve diferença entre as soluções em T0. A partir de T1, CF e HS propiciaram menor retenção quando comparados à AD (p <0,005). Através do MEV foi possível observar alterações nas superfícies dos o-rings de nitrilo imersos em CF e HS. O Cepacol com flúor e hipoclorito de sódio devem ser evitados devido à ação deletéria nos o-rings.

Learning from mistakes: analyzing incidents in a neonatal care unit / Aprendendo com os erros: análise dos incidentes em uma unidade de cuidados neonatais / Aprendiendo con los errores: análisis de los incidentes en una unidad de cuidados neonatales

ABSTRACT Objective: to analyze incidents reported in a neonatal care unit. Method: a quantitative, cross-sectional and retrospective study with a sample of 34 newborns. Data were collected through a structured form, composed of two parts: sociodemographic/clinical characteristics of the newborns, and characteristics of the reported incidents. Data were collected from the institution's computer system, in a period corresponding to 13 months, and analyzed by means of descriptive statistics. Results: the majority of the newborns were preterm (70.6%), male (52.9%) and born through caesarean section (76.5%). During the study period, 54 incidents were reported, totaling a frequency of 1.6 incident per newborn. It was found that 61.1% of incidents were related to medicines, 14.8% to accidental loss of tracheal tube and 9.3% to catheter obstruction. Conclusion: analysis of the reported incidents has shown that most incidents refer to the drug process. Information about the incidents can increase the perception of health professionals regarding the impact of their actions.

RESUMO Objetivo: analisar os incidentes notificados em uma unidade de cuidados neonatais. Método: estudo quantitativo, transversal e retrospectivo, com amostra de 34 recém-nascidos. A coleta dos dados ocorreu mediante preenchimento de formulário estruturado, composto por duas partes: características sociodemográficas/clínicas dos recém-nascidos, e características dos incidentes notificados. Os dados foram coletados do sistema informático da instituição, em um período correspondente a 13 meses, sendo analisados por meio de estatística descritiva. Resultados: quanto às características sociodemográficas e clínicas, a maioria dos recém-nascidos era de prematuros (70,6%), do sexo masculino (52,9%) e que nasceu por meio de cesariana (76,5%). No período estudado foram notificados 54 incidentes, totalizando uma frequência de 1,6 incidente por recém-nascido. Encontrou-se que 61,1% dos incidentes estavam relacionados a medicamentos, 14,8% associados à perda acidental de tubo traqueal e 9,3% ligados à obstrução de cateteres. Conclusão: a análise dos incidentes notificados demonstrou que a maioria dos incidentes se refere ao processo de medicamentos. As informações sobre os incidentes podem ampliar a percepção dos profissionais de saúde em relação ao impacto das suas ações.

resumen Objetivo: analizar los incidentes notificados en una unidad de cuidados neonatales. Método: estudio cuantitativo, transversal y retrospectivo, con muestra de 34 recién nacidos. La recolección de los datos fue completando el formulario estructurado, compuesto por dos partes: características sociodemográficas/clínicas de los recién nacidos y características de los incidentes notificados. Los datos fueron recogidos del sistema informático de la institución, en un período correspondiente a 13 meses, siendo analizados por medio de estadística descriptiva. Resultados: en las características sociodemográficas y clínicas, la mayoría de los recién nacidos era prematuros (70,6%), del sexo masculino (52,9%) y nacieron por medio de cesárea (76,5%). En el período estudiado fueron notificados 54 incidentes, totalizando una frecuencia de 1,6 incidentes por recién nacido. Se encontró que 61,1% de los incidentes estaban relacionados a medicamentos, 14,8% asociados a pérdida accidental de tubo traqueal y 9,3% ligados a obstrucción de catéteres. Conclusión: el análisis de los incidentes notificados demostraron que la mayoría de los incidentes se refiere al proceso de medicamentos. Las informaciones sobre los incidentes pueden ampliar la percepción de los profesionales de salud en relación al impacto de sus acciones.