Description of the scientific method for the preparation and validation of educational technologies in digital format: a methodological study

Introduction: the use of digital technologies constitutes a process that allows the dynamization of the care process, based on aspects related to criticality and creativity. It is emphasized that the development of technologies must, therefore, be inserted in a context for changes and innovation in response to the population's health demand, and must follow a precise methodological path that goes from the construction to the validation of the appearance, content and effect . Objective: to describe the scientific method of elaboration and validation of educational technologies in digital format. Methods: methodological study, conducted according to the following steps: development of the research project and submission to the Research Ethics Committee; data collection; elaboration of the content, script, illustrations and layout of the booklet; and validation of educational technology. Results: the process of developing a technology requires methodological rigor, enabling coherence between theory and the purpose of the desired product, guaranteeing the internal quality of the developed technology. The use of educational technologies in health reinforces information, serving as a guide for guidelines regarding care and assisting in decision-making. Technological innovations in health, consists of a socio-technical process , permeated by professional and user reflections and experiences. Final considerations: educational technologies represent a potential resource for the development of health education practices, encouraging greater interaction between professionals and users, and an active attitude regarding self-care actions related to their health condition.

Introdução: o uso de tecnologias digitais constitui como um processo que permite a dinamização no processo de cuidar, pautada nos aspectos relacionados a criticidade e criatividade. Enfatiza-se, que o desenvolvimento de tecnologias deve, portanto, insere-se em um contexto por mudanças e inovação em resposta a demanda de saúde da população devendo seguir um percurso metodológico preciso que vai desde a construção à validação da aparência, conteúdo e efeito. Objetivo: descrever o método científico de elaboração e validação de tecnologias educativas no formato digital. Método: estudo metodológico, conduzido de acordo com as seguintes etapas: elaboração do projeto de pesquisa e submissão ao Comitê de Ética em Pesquisa; levantamento dos dados; elaboração do conteúdo, roteiro, ilustrações e diagramação da cartilha; e validação da tecnologia educacional. Resultados: o processo de elaboração de uma tecnologia requer rigor metodológico, possibilitando coerência entre teoria e finalidade do produto desejado, garantindo qualidade interna da tecnologia elaborada. O uso de tecnologias educativas em saúde reforça informações, servindo como guia para orientações quanto ao cuidado e auxiliando nas tomadas de decisões. Inovações tecnológicas em saúde, consiste em um processo sócio-técnico, permeado por reflexões e experiências profissionais e usuários. Considerações finais: tecnologias educacionais representam um recurso potencializador para o desenvolvimento de práticas de educação em saúde, estimulando maior interação entre profissionais e usuários, e uma postura ativa quanto a ações de autocuidado relacionado a sua condição de saúde.

Analysis of the perinatal mortality rate in the metropolitan region of grande Vitória, Espírito Santo, Brazil, between 2008 and 2017

Introduction: perinatal mortality is characterized by fetal deaths that occur after the 22nd week of management and neonatal deaths that precede six full days of life. This indicator has been a matter of concern and discussion on the part of entities and organizations involved in comprehensive health care for women and children.Objective: to characterize perinatal deaths in the Metropolitan Region of Greater Vitória (RMGV) in Espírito Santo and identify associated maternal factors in the period between 2008 and 2017.Methods: ecological and descriptive study with a quantitative approach, carried out in 2019 on perinatal mortality from 2008 to 2017 at RMGV. Data collection was performed by extracting data from the SIM, SINASC, IBGE databases of the Espírito Santo State Health Department, about perinatal deaths and associated maternal factors. The research respects the ethical precepts of resolution 466/12 of the National Health Council.Results: the distribution of deaths did not occur homogeneously in the municipalities in the RMGV. The municipality of Vitória had the lowest perinatal mortality rates during the study period, on the other hand, in the comparative analysis between the different municipalities that make up the RMGV, the municipality of Fundão presents the worst scenario regarding perinatal mortality over the years. Regarding the underlying causes of death, it is noted that in this study, the three causes with the highest number of occurrences are complications of the placenta, umbilical cord and maternal affections, not necessarily related to the current pregnancy and intrauterine hypoxia.Conclusion: there were no significant changes in mortality rates in the Metropolitan Region of Greater Vitória. However, the main deaths occurred in neighborhoods with greater socioeconomic inequalities. Maternal causes were highly representative of deaths, raising issues associated with the improvement of public health policies.

Introdução: a mortalidade perinatal caracteriza-se pelos óbitos fetais que ocorrem a partir da 22ª semana de gestão e os óbitos neonatais que antecedem seis dias completos de vida. Este indicador tem sido motivo de preocupação e discussão por parte de entidades e organizações envolvidas na atenção à saúde integral da mulher e da criança. Objetivo: caracterizar os óbitos perinatais da Região Metropolitana da Grande Vitória (RMGV) no Espírito Santo e identificar fatores maternos associados, no período entre 2008 e 2017. Método: estudo ecológico e descritivo de abordagem quantitativa, realizado no ano de 2019 acerca da mortalidade perinatal entre os anos de 2008 a 2017 na RMGV. A coleta de dados foi realizada através extração dos dados das bases SIM, SINASC, IBGE da Secretaria de Saúde do Estado do Espírito Santo, acerca dos óbitos perinatais e fatores maternos associados. A pesquisa respeita os preceitos éticos da resolução 466/12 do Conselho Nacional de Saúde. Resultados: a distribuição dos óbitos não ocorreu de forma homogênea nos municípios na RMGV. O município de Vitória apresentou os menores índices de mortalidade perinatal durante o período estudado, em contrapartida, na análise comparativa entre os diferentes municípios que compõe a RMGV, o município de Fundão apresenta o pior cenário relativo à mortalidade perinatal ao longo dos anos. Acerca das causas bases de óbitos, nota-se que neste estudo, as três causas com maior número de ocorrência são complicações da placenta, do cordão umbilical e afecções maternas, não obrigatoriamente relacionadas com a gravidez atual e hipóxia intrauterina. Conclusão: não houve mudanças significativas nas taxas de mortalidade na Região Metropolitana da Grande Vitória. Contudo, os principais óbitos ocorreram em bairros com maiores desigualdades socieconomicas. As causas maternas representaram uma grande representatividade frente aos óbitos, levantando questões associadas a melhora de políticas públicas de saúde.

Profile of Maternal Mortality of COVID-19 in Ceará, in the Period of 2020.

The aim of this paper is to describe the profile of maternal mortality of COVID-19 in the state of Ceará, Brazil, in the period 2020. Ecological, exploratory, cross-sectional study, with secondary data from the Influenza Epidemiological Surveillance Information System, were made available by the Obstetric Observatory Brazilian COVID-19. A total of 485 pregnant and postpartum women were included, and the analysis considered the notifications from the year 2020. The variables of interest and the outcome (death/cure by COVID-19) were analyzed in a descriptive way. Most pregnant and postpartum women were between 20 and 35 years old, brown/white skin color and residing in an urban area. The proportion of deaths was 5.8% in the year 2020. In that period, the rates of hospitalization in the ward increased by 95.5%, 12.6% of hospitalization in the Unit of Intensive Care (ICU), and 7.2% needed invasive ventilatory support. Maternal mortality from COVID-19 suggests an emergency in terms of the development of health actions and policies due to the aggravation and risks due to this disease.

Prevalence of diabetic foot and its risk factors in the state of espirito santo, brazil

Introdução: O Pé Diabético (PD) é a principal causa de amputações não traumáticas nos países ocidentais, causando morte ou incapacidade física e mental, má qualidade de vida e alto custo para a sociedade. Objetivo: Analisar a prevalência de DF e fatores de risco relacionados na população diabética residente no Estado do Espírito Santo, Brasil. Métodos: Estudo transversal, descritivo, com delineamento de série temporal, utilizando dados secundários de morbidade de indivíduos com DF residentes no Estado do Espírito Santo, cadastrados e acompanhados pelo Sistema de Cadastro e Acompanhamento de Hipertensos e Diabéticos. Resultados: Dos 64.196 diabéticos, 3,9% tinham DM tipo 1, 10,9% DM tipo 2 e 85,2% eram hipertensos. A prevalência de DF foi de 2,9% no DM tipo 1, 3,3% no DM tipo 2 e 4,5% no DM com hipertensão. Maiores taxas de DF foram observadas no sexo masculino, com idade acima de 60 anos no DM tipo 1 e tipo 2, e até 19 anos no DM com hipertensão, tabagismo, sedentarismo, Infarto Agudo do Miocárdio (IAM), AVC e Doença Renal Crônica (DRC) ). Nos indivíduos com excesso de peso, a prevalência de DF foi maior apenas no DM tipo 1. Houve associação significativa em todas as variáveis exceto sobrepeso em ambos os tipos de DM, sedentarismo e acidente vascular cerebral no DM tipo 1. Conclusão: Os achados mostraram importantes prevalências de DF, com maior concentração em homens com mais de 60 anos, sobre tabagismo, sedentarismo, IAM, AVC e DRC, com associação estatística significativa nas variáveis analisadas, com exceção do excesso de peso em ambos os tipos de DM, como bem como sedentarismo e acidente vascular cerebral no DM tipo 1.

Introduction: Diabetic Foot (DF) is the leading cause of non-traumatic amputations in Western countries, causing death or physical and mental disability, poor quality of life and high cost to society. Objetive: To analyze the prevalence of DF and related risk factors in the diabetic population residing in Espírito Santo State, Brazil. Methods: Cross-sectional, descriptive study with time series design, using secondary data on morbidity of individuals with DF living in the State of Espírito Santo, registered and followed by the Hypertensive and Diabetic Registration and Monitoring System. Results: From 64,196 diabetic patients, 3.9% had Type 1 DM, 10.9% Type 2 DM and 85.2% had hypertension. The prevalence of DF was 2.9% in type 1 DM, 3.3% in type 2 DM and 4.5% in DM with hypertension. Higher rates of DF were observed in males, aged over 60 years in type 1 and type 2 DM, and up to 19 years in DM with hypertension, smoking, sedentary lifestyle, Acute Myocardial Infarction (AMI), stroke and Cronic Kidney disease (CKD). In overweight individuals, the prevalence of DF was higher only in type 1 DM. There was a significant association in all variables except overweight in both types of DM, sedentary lifestyle and stroke in type 1 DM. Conclusion: Findings showed important prevalence of DF, with higher concentration in men older than 60 years, on smoking, sedentary lifestyle, AMI, stroke and CKD, with significant statistical association in the analized variables, except for overweight in both types of DM, as well as sedentary lifestyle and stroke in type 1 DM.

Assistência do enfermeiro frente a pacientes com critério de paliatividade em unidade de terapia intensiva / Nurse assistance in front of patients with palliativeness criteria in the intensive care unit / Asistencia de enfermería a pacientes con criterios de cuidados paliativos en la unidad de cuidados intensivos

Objetivo: descrever a assistência do profissional de enfermagem frente a pacientes com critérios de paliatividade internados em Unidade de Terapia Intensiva. Metodologia: trata-se de uma revisão da literatura nas bases Biblioteca Virtual de Saúde e PubMed. Resultados:existem critérios para os cuidados paliativos de pacientes que se encontram em Unidades de Terapia Intensiva, e a enfermagem proporciona conforto e respeito para o paciente, levando cuidados não somente focados no corpo, mas nos aspectos psicossociais e de seus familiares. Conclusão: o cuidado paliativo evidenciou-se como cuidado integral voltado para indivíduos em condições terminais, com ênfase no aspecto físico, psicossocial e espiritual do indivíduo e família; qualidade de vida; cuidado baseado em uma abordagem humanística; a prioridade do cuidado sobre a cura e o apoio ao luto. Sendo a enfermagem quem assiste o paciente a todo o tempo e propicia os cuidados a serem feitos para melhorar sua qualidade de vida.

Objectives: to describe the assistance provided by nursing professionals to patients with palliative care criteria admitted to an Intensive Care Unit. Methodology: this is a literature review on the Virtual Health Library and PubMed databases. Results: there are criteria for palliative care for patients who are in Intensive Care Units, and nursing provides comfort and respect for the patient, taking care not only focused on the body, but on the psychosocial aspects and those of their families. Conclusion: palliative care proved to be comprehensive care aimed at individuals in terminal conditions, with emphasis on the physical, psychosocial and spiritual aspects of the individual and family; quality of life; care based on a humanistic approach; the priority of care over healing and grief support. Nursing is the one who assists the patient at all times and provides the care to be taken to improve their quality of life.

Objetivos:describir la asistencia que brindan los profesionales de enfermería a los pacientes con criterios de cuidados paliativos ingresados en una Unidad de Cuidados Intensivos. Metodología: se trata de una revisión bibliográfica sobre la Biblioteca Virtual en Salud y las bases de datos PubMed. Resultados: existen criterios de cuidados paliativos para pacientes que se encuentran en Unidades de Cuidados Intensivos, y la enfermería brinda comodidad y respeto al paciente, cuidando no solo centrado en el cuerpo, sino en los aspectos psicosociales y de sus familiares. Conclusión: los cuidados paliativos demostraron ser cuidados integrales dirigidos a personas en condiciones terminales, con énfasis en los aspectos físicos, psicosociales y espirituales del individuo y la familia; calidad de vida; atención basada en un enfoque humanista; la prioridad del cuidado sobre la curación y el apoyo al duelo. Enfermería es quien asiste al paciente en todo momento y le brinda los cuidados que debe tener para mejorar su calidad de vida.

Perinatal Mortality Analysis in Espírito Santo, Brazil, 2008 to 2017.

This is an ecological and time-series study using secondary data on perinatal mortality and its components from 2008 to 2017 in Espírito Santo, Brazil. The data were collected from the Mortality Information System (SIM) and Live Births Information System (SINASC) of the Unified Health System Informatics Department (DATASUS) in June 2019. The perinatal mortality rate (×1000 total births) was calculated. Time series were constructed from the perinatal mortality rate for the regions and Espírito Santo. To analyze the trend, the Prais-Winsten model was used. From 2008 to 2017 there were 8132 perinatal deaths (4939 fetal and 3193 early neonatal) out of a total of 542,802 births, a perinatal mortality rate of 15.0/1000 total births. The fetal/early neonatal ratio was 1.5:1, with a strong positive correlation early neonatal mortality rate, perinatal mortality rate, r (9) = 0.8893, with a significance level of p = 0.000574. The presence of differences in trends by health region was observed. Risk factors that stood out were as follows: mother's age ranging between 10 and 19 or 40 and 49 years old, with no education, a gestational age between 22 and 36 weeks, triple and double pregnancy, and a birth weight below 2499 g. Among the causes of death, 49.70% of deaths were concentrated in category of the tenth edition of the International Classification of Diseases, fetuses and newborns affected by maternal factors and complications of pregnancy, labor, and delivery (P00-P04), and 11.03% were in the category of intrauterine hypoxia and birth asphyxia (P20-P21), both related to proper care during pregnancy and childbirth. We observed a slow reduction in the perinatal mortality rate in the state of Espírito Santo from 2008 to 2017.

Brazilian National Policy of Comprehensive Women's Health Care and mortality during climacteric period: has anything changed?

BACKGROUND: The National Policy for Integral Attention to Women's Health Care (PNAISM) was implemented in 2004, with monitoring of potential benefits. One of the life cycles of women contemplated in this health policy was the importance of health care during the climacteric. Prevention and health promotion are actions carried out by the Brazil National Health System and enshrined in health Brazilian policies for women. Thus, our purpose was to identify climacteric women's main causes of death as well as the mortality trends of such causes, especially after implementation of PNAISM. METHODS: An ecological study was conducted from 2018 to 2020. Data were retrieved from the Brazilian Health Department by accessing the mortality information system of the National Health Information, divided into periods 1996-2004 and 2005-2016 the latter to correspond with the implementation of the National Policy. The death records of Brazilian women aged 40 to 64 years who had a designated cause of death were retrieved. Trends and differences between periods were evaluated using linear regression. The significance level was set at 5%. RESULTS: The main causes of death in women from 1996 to 2016 were circulatory system diseases (22.47%, 697,636 deaths), neoplasms (19.69%, 611,495 deaths), respiratory system diseases (5.5%, 170,716 deaths), endocrine, nutritional, and metabolic disorders (5.27%, 163,602 deaths), and digestive system diseases (3.74%, 116.280 deaths). Analyzing the changes in the major causes of death of climacteric women after implementation of the PNAISM we observed that mortality from circulatory system diseases and endocrine and nutritional diseases were significantly declined in post-PNAISM period: (ß = - 3.63; 95% CI - 4.54 to - 2.73 r2 = 0.87; p < 0.001; ß = - 0.51; 95% CI, - 0.71 to - 0.31; R2 = 0.73; p < 0.001, respectively). No changes were observed in mortality from neoplasms and respiratory system diseases in post-PNAISM period (p = 0,765; p = 0,233, respectively). CONCLUSIONS: After implementation of the PNAISM, we observed a downward trend in rates of mortality from diseases of the circulatory and digestive systems and from endocrine, nutritional, and metabolic diseases but stability in the rates of death from neoplasm and respiratory system diseases.

Health Services, Socioeconomic Indicators, and Primary Care Coverage in Mortality by Lower Genital Tract and Breast Neoplasias in Brazilian Women during Reproductive and Non-Reproductive Periods.

Women's health assistance at the low-complexity level is focused on the most common diseases and can be affected by primary health care coverage, particularly in areas far away from large urban centers. Thus, in this work, we aim to analyze the relationship between socioeconomic status, health care indicators, and primary care coverage in mortality from neoplasms of the lower genital tract and breast in Brazilian women during reproductive and non-reproductive periods. We conducted an ecological study at the Gynecology Discipline, Medicine School, University of São Paulo. Secondary data were collected from women according to reproductive periods and mortality data from the Mortality Information System based on International Classification of Disease-10th edition regarding breast and lower genital tract neoplasms in 2017. The health service and socioeconomic indicators were obtained from the Informatics Department of the Unified Health System and Brazilian Institute of Geography and Statistics. Our results showed that primary care coverage and health service indicators were not associated with mortality from breast cancer and the female lower genital tract, both in reproductive and non-reproductive periods. Sociodemographic indicators were found to be associated with mortality from breast cancer and the female lower genital tract, with income being associated with reproductive period (ß = -0.4; 95% CI, -0.8 to -0.03) and educational level in the non-reproductive period (ß = 9.7; 95% CI, 1.5 to 18.0).

Analysis of Diabetes Mellitus-Related Amputations in the State of Espírito Santo, Brazil.

Background and objectives: Diabetes mellitus (DM) stands out among the most important public health problems worldwide since it represents a high burden on health systems and is associated with higher hospitalization rates, and a higher incidence of cardiovascular diseases. Amputations are among the most common complications, leading to disability and increasing care costs. This research aims to analyze the prevalence of DM-related amputations, comorbidities and associated risk factors in the diabetic population residing in the State of Espírito Santo, Brazil. Materials and Methods: This is a quantitative, exploratory, cross-sectional study with a time series design and the use of secondary data registered and followed by the system of Registration and Monitoring of Hypertension and Diabetes-SisHiperdia. Results: The sample consisted of 64,196 diabetic patients, out of them, 3.9% had type 1 DM, 10.9% with type 2 DM, and 85.2% with DM coexisting with hypertension. Most were female (66.6%), aged 40 to 59 years (45.6%), and 60 years and older (45.2%). The prevalence of DM-related amputations in the analyzed sample was 1.2% in type 1 DM, 1.5% in type 2 DM, and 2.2% in concomitant DM and hypertension. Higher amputation rates were observed in males in the age group above 60 years in type 1 DM and type 2 DM and were slightly higher in the age groups up to 29 years in DM with hypertension. A higher prevalence of amputation was related to smoking, physical inactivity, acute myocardial infarction (AMI), stroke, chronic kidney disease (CKD), and diabetic foot (DF) in all types of DM. Conclusions: The present study showed a significant prevalence of DM-related amputations. An increased prevalence was evidenced when correlated with smoking, physical inactivity, AMI, stroke, CKD, and DF with significant statistical associations, except for a sedentary lifestyle in type 1 DM.

Tecnologia educativa para adolescentes: construção e validação de álbum seriado sobre sífilis adquirida / Educational technology for adolescents: construction and validation of an acquired syphilis flip chart / Tecnología educativa para adolescentes: construcción y validación de álbum ilustrado sobre sífilis adquirida

Objetivo: Construir e validar um álbum seriado sobre sífilis adquirida a ser utilizado como estratégia educativa para adolescentes. Métodos: Trata-se de um estudo do tipo metodológico realizado em Recife, Pernambuco, no período de novembro de 2018 a abril de 2019. Obtiveram-se dados provenientes de 22 juízes especialistas para validação de aparência e conteúdo do álbum seriado e de 40 adolescentes de uma escola pública, os quais avaliaram o álbum quanto à aparência. Analisou-se a validade de conteúdo considerando: o Item ­ Level Content Validity Index (I-CVI); a concordância entre os juízes, por meio do coeficiente de correlação intraclasse (ICC); e a validade de aparência, usando o Suitability Assessment of Materials (SAM). Utilizou-se o software Statistical Package for the Social Sciences (SPSS) para análise. Resultados: O álbum seriado possui 20 páginas e contém orientações sobre a sífilis adquirida. A média do I-CVI foi de 0,97 pelos juízes especialistas; constatando-se como excelente nível de concordância entre as respostas. A partir do formulário o SAM, o álbum foi julgado como superior, obtendo uma média de 80,99% entre os juízes, sendo recomendada sua utilização pelo público ao qual se destina. Houve unanimidade pelos adolescentes na aprovação do material, julgando ser claro, de fácil compreensão e relevante. Conclusão: O álbum seriado foi construído e validado em seu conteúdo e aparência por juízes e, quanto à aparência, pelo público-alvo, podendo ser utilizado com adolescentes no ambiente escolar ou em outras realidades.

Objective: To construct and validate an acquired syphilis flip chart to be used as an educational strategy for adolescents. Methods: This methodological study was carried out in Recife, Pernambuco, from November 2018 to April 2019. Data were collected from 22 expert judges to validate the appearance and content of the flip chart and 40 adolescents from a public school who evaluated the album for appearance. The content validity was analyzed using the Item ­ Level Content Validity Index (I-CVI) and agreement between the judges using the Intraclass Correlation Coefficient (ICC). The appearance validity was analyzed using the Suitability Assessment of Materials (SAM). The Statistical Package for the Social Sciences (SPSS) software was used for analysis. Results: The flip chart has 20 pages and contains guidelines on acquired syphilis. The mean I-CVI measured by the expert judges was 0.97, with an excellent level of agreement between the responses. According to the SAM form, the flip chart met superior criteria, with a mean score of 80.99% among the judges, and its use was recommended by the target audience. The adolescents unanimously approved the material, believing it to be clear, easy to understand and relevant. Conclusion: The flip chart was constructed, and judges validated its content and appearance and the target audience validated its appearance. It can be used with adolescents in the school environment or in other realities.

Objetivo: Construir y validar un álbum ilustrado sobre la sífilis adquirida para utilizarla como estrategia educativa para adolescentes. Métodos: Se trata de un estudio del tipo metodológico realizado en Recife, Pernambuco, en el período entre noviembre de 2018 y abril de 2019. Se recogieron datos de 22 jueces especialistas para la validación de la apariencia y del contenido del álbum ilustrado y de 40 adolescentes de una escuela pública los cuales evaluaron la apariencia del álbum. Se analizó la validez del contenido considerándose el Item ­ Level Content Validity Index (I-CVI); la concordancia entre jueces a través del coeficiente de correlación intraclase (ICC); y la validez de la apariencia usando el Suitability Assessment of Materials (SAM). Se utilizó el software Statistical Package for the Social Sciences (SPSS) para el análisis. Resultados: El álbum ilustrado tiene 20 páginas y orientaciones sobre la sífilis adquirida. La media del I-CVI ha sido de 0,97 de parte de los jueces especialistas, constatándose como excelente nivel de concordancia entre las respuestas. El álbum ha sido considerado como superior por el formulario SAM con una media del 80,99% entre los jueces y la recomendación de su utilización por el público de destino. Hubo unanimidad de los adolescentes para la aprobación del material considerándolo claro, de fácil comprensión y relevante. Conclusión: El álbum ilustrado ha sido construido e validado por jueces por su contenido y apariencia y solo por la apariencia por el público investigado y puede ser utilizado con adolescentes en su entorno escolar o en otras realidades.

Adolescent nutrition monitoring the Health Program in School / Acompanhamento nutricional de adolescentes no Programa Saúde na Escola

INTRODUCTION: Overweight and obesity in childhood and adolescence are important public health problems. In this context, the school has been identified as a favorable environment for carrying out health education programs. The Health at School Program and its important performance stand out. Thus, considering these discussions, they ask: How are the actions developed by the Health at School Program, focused on nutrition, being implemented?OBJECTIVE: Analyze the teenager monitoring in the School Health Program (PSE in Brazil) opposite actions to the nutritional aspects of adolescentsMETHODS: This is a descriptive, qualitative study in Juazeiro municipality North-Ce, with the subject 18 nurses of the Family Health Strategy (FHS) inserted in the PES that municipalityRESULTS: Nurses have limited assistance in the face of food practices, which implies in its operations; report having difficulty performing their actions outside the conventional health units and focus on strategies for a food menuCONCLUSION: The monitoring of adolescents in the School Health Program ahead nutritional value is still limited to preventive practices involving specific actions, limited to a Sfood education focused on the health problem and not the needs of adolescents

INTRODUÇÃO: O sobrepeso e a obesidade na infância e na adolescência constituem importantes problemas de saúde pública. Nesse contexto, a escola vem sendo apontada como um ambiente favorável para realização de programas de educação em saúde. Destaca-se o Programa Saúde na Escola e sua importante atuação. Assim, considerando essas discussões, questionam-se: Como estão sendo implementadas as ações desenvolvidas pelo Programa Saúde na Escola, voltadas para nutrição?OBJETIVO: Analisar o acompanhamento do adolescente no Programa Saúde na Escola (PSE) frente a ações voltadas para os aspectos nutricionais dos adolescentesMÉTODO: Trata-se de um estudo descritivo, qualitativo, realizado no município de Juazeiro do Norte-Ce, tendo como sujeitos 18 enfermeiros da Estratégia Saúde da Família (ESF) inseridos no PSE do referido município. Utilizou-se como técnica para coleta do material a entrevista semiestruturada e organizados seguindo a proposta da análise de conteúdoRESULTADOS: Evidenciou-se que os enfermeiros tem uma assistência limitada frente às praticas alimentares, o que implica na sua atuação; compreendem a educação em saúde na escola como intervenções pontuais e preventivista, assim como, relatam ter dificuldades em executar suas ações fora das unidades convencionais de saúde e focam em estratégias voltadas para um cardápio alimentar não na perspectiva de promover a saúde, atuando quando o problema é detectadoCONCLUSÃO: O acompanhamento dos adolescentes no Programa Saúde na Escola frente aos aspectos nutricionais ainda está limitada a práticas preventivistas, envolvendo ações pontuais, limitadas a uma educação alimentar focada no problema de saúde e não nas necessidades dos adolescentes

Evaluation of growth and nutritional condition of children in Public Schools in Florianópolis, Santa Catarina, Brazil / Avaliação do crescimento e do estado nutricional de crianças em idade escolar em Escolas Públicas de Florianópolis, Santa Catarina, Brasil

INTRODUCTION: Obesity is becoming more and more frequent in children, which can result in health problems both in childhood and in adulthood. Considering that, at school age, eating habits may be influenced by the context in which the child is inserted, mainly, lifestyle, inside and outside the school environment, it is important to evaluate the growth achieved in height, as well as their nutritional status, since this can be an indication of future and possible nutritional disorders, allowing to direct resources and effective public policies in this age groupOBJECTIVE: Evaluate the growth in stature and nutritional condition of schoolchildren by gender and age in Florianopolis, Santa Catarina, Brazil, in the first semester of the 2012 school yearMETHODS: A cross-sectional study was conducted with 595 children of six to ten years of age, through the marketing of Public Municipal Elementary Schools, in the city of Florianópolis, State of Santa Catarina, Brazil. The statistical analysis of the data was performed with the Statistical Package for the Social Science, version 20.0RESULTS: It was assessed a larger proportion of children between seven and nine years of age, and both in relation to the stature as the Body Mass Index (BMI). The medians are higher when compared to the reference (World Health Organization), revealing that the children are growing well, even above the average for the benchmark. However, at the same time, they have a BMI higher than expected, even considering their high stature. The diagnosis of nutritional status among the boys and girls showed no statistical differences. However, it is worth highlighting that, although the bigger prevalence is eutrophic children (70.3%), a high prevalence of excess weight (overweight, obesity and severe obesity) can also be observed, around 28% of the sampleCONCLUSION: Although most children were found to be in normal nutritional condition, some were identified as being overweight or obese. It was evident that nutritional condition does not differ in relation to gender, but is influenced by age and height

INTRODUÇÃO: A obesidade vem se tornando cada vez mais frequente em crianças, o que pode resultar em agravos à saúde tanto na infância quanto na idade adulta. Considerando que, na idade escolar, os hábitos alimentares podem sofrer influência do contexto em que a criança está inserida, principalmente, estilo de vida, dentro e fora do ambiente escolar, torna-se importante avaliar o crescimento alcançado em estatura, bem como o seu estado nutricional, visto que este pode ser um indicativo de futuros e possíveis distúrbios nutricionais, permitindo direcionar recursos e políticas públicas efetivas nessa faixa etáriaOBJETIVO: Avaliar o crescimento em estatura e o estado nutricional de crianças em idade escolar em função do sexo e idade em Florianópolis no primeiro semestre do ano letivo de 2012MÉTODO: Estudo de corte transversal, realizado com 595 crianças de seis a dez anos de idade, frequentadoras de Escolas Públicas Municipais de Ensino Fundamental I, na cidade de Florianópolis, Estado de Santa Catarina, Brasil. Utilizou-se um questionário para coleta de dados. Os dados foram digitados e armazenados em planilhas, utilizando o programa Microsoft Excel 2007. A análise estatística dos dados foi realizada com o Statistical Package for the Social Science (SPSS), versão 20.0. O peso e a altura foram inicialmente comparados à curva normal, aplicando-se o teste de distância Kolmogorov-Smirnov. Foram utilizados estatística descritiva e o teste de correlação de PearsonRESULTADOS: Evidenciou-se uma proporção maior de crianças entre os sete e nove anos de idade, e tanto em relação à estatura quanto ao IMC, as medianas estão superiores quando comparadas ao do referencial (Organização Mundial de Saúde), revelando que as crianças estão crescendo bem, inclusive acima da média do referencial, mas que ao mesmo tempo apresentam um IMC acima do esperado, mesmo considerando a elevada estatura. O diagnóstico do estado nutricional entre os meninos e meninas não apresentaram diferenças estatísticas. Contudo, vale destacar que, embora a maior prevalência seja de crianças eutróficas (70,3%), pode-se observar alta prevalência de excesso de peso (sobrepeso, obesidade e obesidade grave), em torno de 28% da amostraCONCLUSÃO: Embora com prevalência do estado nutricional normal, identificou- se o sobrepeso e a obesidade. Evidenciou-se que o estado nutricional não tem diferença em função do sexo, contudo é influenciado pela idade e estatura

Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis.

Background and Objectives: Several factors can compromise patient safety, such as ineffective teamwork, failed organizational processes, and the physical and psychological overload of health professionals. Studies about associations between burn out and patient safety have shown different outcomes. Objective: To analyze the relationship between burnout and patient safety. Materials and Methods: A systematic review with a meta-analysis performed using PubMed and Web of Science databases during January 2018. Two searches were conducted with the following descriptors: (i) patient safety AND burnout professional safety AND organizational culture, and (ii) patient safety AND burnout professional safety AND safety management. Results: Twenty-one studies were analyzed, most of them demonstrating an association between the existence of burnout and the worsening of patient safety. High levels of burnout is more common among physicians and nurses, and it is associated with external factors such as: high workload, long journeys, and ineffective interpersonal relationships. Good patient safety practices are influenced by organized workflows that generate autonomy for health professionals. Through meta-analysis, we found a relationship between the development of burnout and patient safety actions with a probability of superiority of 66.4%. Conclusion: There is a relationship between high levels of burnout and worsening patient safety.

Association between culture of patient safety and burnout in pediatric hospitals.

INTRODUCTION: Providing safety culture is the first and undoubtedly most important feature that patient care should have, as it is the basis for other measures. There are associations between Burnout Syndrome and lower perceptions of safety culture and greater risks in patient safety. OBJECTIVE: To analyze the relationship between patient safety culture and burnout in pediatric hospitals. METHOD: This is a cross-sectional study with a quantitative approach performed with health professionals who work in pediatric hospitals located in the Metropolitan Region of Cariri, Northeastern Brazil. The study enrolled 148 professionals who performed direct health care for the child in three different hospitals. For the evaluation of the Patient Safety Culture, the version, translated and validated for Brazil, of the Survey on Patient Safety Culture (HSOPSC) questionnaire was applied and to evaluate the occurrence of Burnout, we chose the Maslach Burnout Inventory (MBI). RESULTS: Among the dimensions of burnout that presented the most moderate to high, depersonalization and low professional achievement stand out. When considering the syndrome with the professional who presented a "high" score in only one of the three dimensions, it was identified that 44.6% presented the disease. All patient safety dimensions studied correlated with some dimension of burnout. CONCLUSION: The study evidenced the influence of all patient safety domains for the development of burnout syndrome in pediatric professionals. Also, it was identified that the organizational climate is the main determinant of burnout, especially in what refers to "teamwork between units".

Access to minor surgical procedures in a community family health unit: an initiative for improving care and access as basic health units / Acesso aos procedimentos cirúrgicos em uma unidade de saúde da família: uma iniciativa para melhorar o cuidado e o acesso a unidades básicas de saúde

It was describe the implantation of small surgical procedures performed by physicians living in a Brazilian Family Health Unit. This is an experience report carried out in the city of Vitória, Espírito Santo, Brazil, describing the introduction of small surgical procedures by the Family and Community Medicine medical residency program in a Basic Health Unit (UBS) of the municipality. The selected US did not have a room for minor surgery procedures or the necessary materials. It was evidenced that the population demanded surgical complaints without resolution of the same ones, being these patients referenced to other specialties.

O estudo descreve a implantação de pequenos procedimentos cirúrgicos realizados por médicos residentes em uma Unidade de Saúde da Família. Trata-se de um relato de experiência realizado na cidade de Vitória, Espírito Santo, Brasil, descrevendo a introdução de pequenos procedimentos cirúrgicos pelo programa de residência médica em Medicina de Família e Comunidade em uma Unidade Básica de Saúde (UBS) do município. As unidades selecionadas não tinham espaço para pequenos procedimentos cirúrgicos ou os materiais necessários. Evidenciou-se que a população demandava queixas cirúrgicas sem resolução das mesmas, sendo esses pacientes encaminhados para outras especialidades.

Internações hospitalares por condições sensíveis à atenção primária à saúde / Hospital admissions for sensitive conditions to primary health care / Ingresos hospitalarios por condiciones sensibles de la atención primaria de salud

Objetivo: Analisar as internações hospitalares por condições sensíveis à Atenção Primária à Saúde (APS) no estado de Minas Gerais. Métodos: Estudo ecológico com delineamento de série temporal, de base populacional, realizado no estado de Minas Gerais, acerca da internação hospitalar e as principais causas de internações por condições sensíveis à APS. A análise foi baseada na Autorização de Internação Hospitalar, considerando custos, ano, sexo e faixa etária, de acordo com os dados do Sistema de Informação Hospitalar (SIH). Os microdados foram extraídos do serviço de transferência de arquivos no Departamento de Informática do Sistema Único de Saúde (DATASUS) em junho de 2018. Os registros analisados são referentes ao período de janeiro de 2008 a dezembro de 2017, sendo incluídas todas as internações por condições sensíveis à Atenção Primária à Saúde. Resultados: Evidenciou-se que, no período de 2008 a 2017, as internações sensíveis à atenção primária representaram 21,21% (2.506.782) do total de internações no estado de Minas Gerais, com a região Jequitinhonha, seguida das regiões Nordeste e Centro Sul, contribuindo com os maiores percentuais. Com relação às causas, a maior prevalência se concentra em doenças do aparelho circulatório 54,22% (816.617), seguida pelas doenças do aparelho respiratório 43,48% (586.809), doenças endócrinas 85,70% (325.082), doenças geniturinárias 37,13% (309.281) e doenças infecciosas e parasitárias 38,37% (266,294). Conclusão: As internações hospitalares por condições sensíveis à Atenção Primária à Saúde no estado de Minas Gerais seguem o padrão nacional. Embora as internações estejam decrescendo, ainda representam mais de 20% do total de internações realizadas.

Objective: To analyze hospital admissions for conditions sensitive to Primary Health Care in the state of Minas Gerais, Brazil. Methods: It is an ecological study with population-based time-series design in the state of Minas Gerais, concerning the hospital admissions and the main causes of them for conditions sensitive to primary care. The analysis was performed based on the Hospitalization Authorization according to the costs, year, gender, and age group based on data from the Hospital Information System (SIH). The micro data were extracted from the file transfer service at the Department of Informatics of the Unified Health System (DATASUS) in June 2018. The records analyzed refer to the period from January 2008 to December 2017, including all hospitalizations for conditions sensitive to primary health care. Results: It was evident that from 2008 to 2017, hospitalizations sensitive to primary care accounted for 21.21% (2,506,782) of the total hospitalizations in the state of Minas Gerais, with Jequitinhonha Region followed by the Northeast and Center South contributing to the higher percentages. Regarding causes, the highest prevalence is concentrated in circulatory system diseases 54.22% (816,617), followed by respiratory system diseases 43.48% (586,809), endocrine diseases 85.70% (325,082), genitourinary diseases 37 , 13% (309,281) and infectious and parasitic diseases 38.37% (266,294). Conclusion: hospital admissions due to conditions sensitive to Primary Health Care in the state of Minas Gerais follow a national pattern, but although hospitalizations are decreasing, it still represents more than 20% of all hospitalizations.

Objetivo: Analizar los ingresos hospitalarios por condiciones sensibles de la Atención Primaria de Salud (APS) del estado de Minas Gerais. Métodos: Estudio ecológico de delineamiento de serie temporal, de base poblacional realizado en el estado de Minas Gerais sobre el ingreso hospitalario y las principales causas de ingreso por condiciones sensibles de la APS. El análisis está basado en el Permiso de Ingreso Hospitalario considerando los costes, el año, el sexo y la franja de edad, según los datos del Sistema de Información Hospitalario (SIH). Se han identificado los micros datos del servicio de transferencia de archivos del Departamento Informático del Sistema Único de Salud (DATASUS) en junio de 2018. Los registros analizados son del período entre enero de 2008 y diciembre de 2017 y se han incluido todos los ingresos por condiciones sensibles de la Atención Primaria de Salud. Resultados: Se ha evidenciado que en el período entre 2008 y 2017 los ingresos sensibles de la atención primaria han representado el 21,21% (2.506.782) del total de ingresos del estado de Minas Gerais, con la región de Jequitinhonha, seguida de las regiones Noreste y Centro Sur contribuyendo con los mayores porcentajes. Respecto las causas, la mayor prevalencia está en las enfermedades del aparato circulatorio con el 54,22% (816.617), seguido de las enfermedades del aparato respiratorio con el 43,48% (586.809), las enfermedades endócrinas con el 85,70% (325.082), las enfermedades genitourinarias con el 37,13% (309.281) y las enfermedades infecciosas y parasitarias con el 38,37% (266,294). Conclusión: Los ingresos hospitalarios por condiciones sensibles de la Atención Primaria de Salud del estado de Minas Gerais siguen el patrón nacional. Aunque los ingresos disminuyen aún representan más del 20% del total de ingresos realizados.

Álcool e drogas na adolescência: processo de trabalho no programa saúde na escola / Alcohol and drugs in adolescence: work process in health in school program

INTRODUCTION: Adolescence is characterized as a transition period between childhood and adult life that imposes great physical, cognitive and psychosocial changes. During that period, the adolescent is exposed and vulnerable to the consumption of alcohol and drugs, and has been an scenery where nurses who works in the School Health Programs (SHP) interact with them. In this sense, the interaction between education and health can influence adolescents to become questioners of the risks they are exposed and look together for better options to improve their quality of life. OBJECTIVE: To analyse the perception and health practices of Nurses working in the School Health Programs of prevention of alcohol and drugs during adolescence. METHODS: This is a descriptive and qualitative study carried out in the city of Juazeiro do Norte, Ceará, Brazil, with 18 nurses participating in the SHP, who implement actions with adolescents in schools. The data collection took place through a semi structured interview and their organization through thematic analysis. : The participants affirmed that the importance of their actions and work is directed to prevent the use of alcohol and drugs among adolescents, excluding the precepts of health promotion. They pointed out that the interaction between education and health is characterized as an effective strategy in the prevention of damages caused by the use of alcohol and drugs, emphasizing the participation of family members during the process of elaboration, application and continuity. It was also evidenced that the educational practices are performed mostly through lectures, characterizing a work centred on clinical, individual and curative practice. CONCLUSION: Nurses understand that the interaction between health and education is an effective strategy to prevent the use of alcohol and drugs in adolescents, emphasizing the importance of family participation in the process of construction and support of this context. However, it is possible to identify that the actions developed by these professionals are still restricted to modify some behaviours such as to improve their willing of sharing new knowledge.

INTRODUÇÃO: A adolescência é caracterizada como um período de transição no desenvolvimento entre a infância e a vida adulta que impõe grandes mudanças físicas, cognitivas e psicossociais. Frente a isso, o adolescente encontra-se exposto e vulnerável ao consumo de álcool e drogas, que tem sido um meio para a atuação do enfermeiro através do Programa Saúde na Escola (PSE). Nesse sentido, a interação entre educação e saúde pode influenciar os adolescentes a tornarem-se questionadores dos riscos a que estão expostos e alcançar em conjunto, uma melhor qualidade de vida. OBJETIVO: Analisar a percepção e práticas de saúde dos Enfermeiros atuantes no Programa Saúde na Escola, frente ao uso de álcool e drogas na adolescência. MÉTODO: Trata-se de um estudo descritivo, qualitativo realizado no município de Juazeiro do Norte, CE, tendo como participantes 18 enfermeiros atuantes no PSE. A coleta de dados ocorreu por meio de uma entrevista semiestruturada e a organização por meio de análise temática. RESULTADOS: Os participantes afirmaram que a importância de sua atuação está voltada para ações de prevenção ao uso de álcool e drogas entre adolescentes, excluindo os preceitos da promoção da saúde. Apontaram que a interação entre educação e saúde se caracteriza como estratégia eficaz na prevenção de danos causados pelo uso de álcool e drogas, ressaltando a participação dos familiares durante o processo de elaboração, aplicação e continuidade. Ainda evidenciou-se que as práticas educativas são realizadas em sua maioria através de palestras, caracterizando um trabalho centrado na prática clínica, individual e curativa. CONCLUSÃO: Os enfermeiros compreendem que a interação entre saúde e educação consiste em uma estratégia eficaz na prevenção do uso de álcool e drogas no público adolescente, ressaltando a importância da participação dos familiares no processo de construção e apoio deste contexto. Porém, é possível identificar que as ações desenvolvidas por esses profissionais ainda se restringem a modificação de comportamentos inadequados, sem o compartilhamento de novos conhecimentos.

Non-linear indices of heart rate variability during endodontic treatment.

Dental treatment promotes psychosomatic change that can influence the procedure and compromise the general well-being of the patient. In this context, it highlights the importance of evaluating the function of the autonomic nervous system in individuals undergoing endodontic treatment. Thus, this manuscript aimed to analyse cardiac autonomic modulation, through non-linear indices of heart rate variability (HRV) during endodontic treatment. Analysis of 50 subjects of either sex aged between 18 and 40 years diagnosed with irreversible pulp necrosis of lower molars undergoing endodontic treatment was undertaken. We carried out fractal and symbolic analysis of HRV, which was recorded in the first session of the endodontic treatment at four intervals: T1: 0-10 min before the onset of the treatment session; T2: 0-10 min after the application of anaesthesia; T3: throughout the period of treatment; and T4: 0-30 min after the end of the treatment session. There was reduction of α1 in T2 compared to T1 and T4 (p < 0.0001). The α2 index also reduced in T2 compared to T3 (p = 0.0035). There was an increase in the α1/α2 ratio in T4 compared to T2 and T3 (p = 0.0003). It was found that 0V% was significantly lower in T2 (p = 0.002), while 2UV% was significantly higher (p < 0.0001) when compared to other points in time. In conclusion, HRV is reduced during endodontic treatment, and after applying local anaesthetic the parasympathetic component of HRV increases. These data indicate that endodontic treatment acutely overcharges the heart, supporting the stress involved in this situation.

Non-linear indices of heart rate variability during endodontic treatment

Abstract Dental treatment promotes psychosomatic change that can influence the procedure and compromise the general well-being of the patient. In this context, it highlights the importance of evaluating the function of the autonomic nervous system in individuals undergoing endodontic treatment. Thus, this manuscript aimed to analyse cardiac autonomic modulation, through non-linear indices of heart rate variability (HRV) during endodontic treatment. Analysis of 50 subjects of either sex aged between 18 and 40 years diagnosed with irreversible pulp necrosis of lower molars undergoing endodontic treatment was undertaken. We carried out fractal and symbolic analysis of HRV, which was recorded in the first session of the endodontic treatment at four intervals: T1: 0-10 min before the onset of the treatment session; T2: 0-10 min after the application of anaesthesia; T3: throughout the period of treatment; and T4: 0-30 min after the end of the treatment session. There was reduction of α1 in T2 compared to T1 and T4 (p < 0.0001). The α2 index also reduced in T2 compared to T3 (p = 0.0035). There was an increase in the α1/α2 ratio in T4 compared to T2 and T3 (p = 0.0003). It was found that 0V% was significantly lower in T2 (p = 0.002), while 2UV% was significantly higher (p < 0.0001) when compared to other points in time. In conclusion, HRV is reduced during endodontic treatment, and after applying local anaesthetic the parasympathetic component of HRV increases. These data indicate that endodontic treatment acutely overcharges the heart, supporting the stress involved in this situation.