Health Interventions for Preventing Climate-Sensitive Diseases: Scoping Review.

Climate variations cause public health problems, but the literature is still scarce on studies involving health interventions against climate-sensitive diseases. The objective of this review was to identify health interventions for the prevention of such diseases. We conducted a scoping review using the JBI Methodology. Six large research databases were searched (PubMed, Scopus, Web of Science, Lilacs, Embase, and Cochrane). The following inclusion criterion was used: studies addressing health interventions to prevent climate-sensitive diseases or consequences of climate on people's health. The exclusion criteria consisted of thesis, dissertations, conference proceedings, studies with unclear information/methodology, and studies not addressing climate-related health interventions. No language or date restrictions were applied. Of 733 studies identified and screened by title and abstract, 55 studies underwent full-text screening, yielding 13 studies for review. The health interventions identified were classified into three levels of management. The macro level included the use of epidemiological models, renewable energy, and policies sensitive to climate change. The meso level comprised interventions such as the creation of environmental suitability maps, urban greening, chemoprophylaxis, water security plans, and sanitation projects, among other measures. Some interventions are at the intersection, such as educational campaigns and the modification of artificial larvae sites. Finally, the micro level contained interventions such as the inspection of window screens and the use of light-colored clothing and repellents. The health interventions at the macro, meso, and micro levels and the intersection may serve as a basis for public managers to implement appropriate interventions against climate-sensitive diseases.

Effectiveness of the fall prevention intervention in older adults with arterial hypertension: randomized clinical trial.

OBJECTIVE: To evaluate the effectiveness of the nursing intervention Fall Prevention in reducing falls in older adults with arterial hypertension. METHODS: Pilot clinical trial, with 118 participants with arterial hypertension from a city in the Northeast of Brazil. Participants were allocated by simple randomization into two groups: intervention (n = 58) and control (n = 60). The intervention was carried out at the participants' homes and consisted of guidelines for modifying environmental and behavioral risk factors for falls. A protocol with nursing activities associated with the Fall Prevention intervention proposed in the Nursing Interventions Classification (NIC) taxonomy was used. The outcome was the self-reported occurrence of falls. RESULTS: There was a significant difference between the groups in the frequency of self-reported falls (p=0.38) with fewer falls occurring in the intervention group. Sixteen participants fell, of which 5.1% attributed the fall to difficulty walking, 6.8% fell in the living room, 3.4% had a sprain, and 6.8% reported to be afraid to fall again. CONCLUSION: The nursing intervention Fall Prevention was effective in reducing the occurrence of falls in older adults with arterial hypertension. These findings contribute to the advancement of clinical protocols for the prevention of falls in older adults, as the educational intervention investigated is applicable to different sociodemographic and cultural scenarios.

Hierarchical analysis of factors associated with hospital readmissions for coronary heart disease: A case-control study.

AIMS AND OBJECTIVES: To analyse, hierarchically, factors associated with hospital readmissions for acute coronary syndrome. BACKGROUND: Hospital readmissions have risen, especially in patients with multiple comorbidities, which are most often chronic. The leading causes of hospital readmission include acute coronary syndrome, which is costly and often preventable. Determining clinical and nonclinical variables that increase the chances of readmission is important to assess and evaluate patients hospitalised for coronary heart diseases. DESIGN: A case-control study whose dependent variable was hospital readmission for acute coronary syndrome. METHODS: The study included 277 inpatients, of whom 132 were in their first hospitalisation and 145 had already been hospitalised for acute coronary syndrome. The independent variables for this hierarchical model were sociodemographic conditions, life habits, access to health services and physical health measures. Data were obtained by interviews, anthropometric measurements and patient records. Logistic regression analysis was performed using the stepwise technique, with Microsoft Excel and R version 3.2.3. The research was reported via strengthening the reporting of observational studies in epidemiology (STROBE). RESULTS: In the final hierarchical logistic model, the following risk factors were associated with readmission for acute coronary syndrome: inadequate drug therapy adherence, stress, history of smoking for 30 years or more, and the lack of use of primary healthcare services. CONCLUSIONS: Clinical and nonclinical variables are related to hospital readmission for acute coronary syndrome and can increase the chance of readmission by up to six times. RELEVANCE TO CLINICAL PRACTICE: The predictive model can be used to avoid readmission for acute coronary syndrome, and it represents an advance in the prediction of the occurrence of the outcome. This implies the need for a reorientation of the network for postdischarge care in the first hospitalisation for acute coronary syndrome.

Clinical validation of the nursing outcome falls prevention behavior in people with stroke.

PURPOSE: To review the nursing outcome, Fall Prevention Behavior, and clinically validate its indicators in people with stroke. METHODS: A methodological study performed with 106 patients in two outpatient clinics, from July to September of 2013. Two pairs of trained nurses applied the NOC scale, one with and one without the use of operational definitions. The internal consistency, stability and difference between the medians obtained by nurses were compared within and between pairs. RESULTS: Most participants were men, elderly, with low education and income. Statistically significant differences were noted in twelve indicators. Five indicators had different means that were greater than the least significant difference. CONCLUSIONS: The indicators were statistically significant; the internal consistency was similar between the pairs and the intraclass correlation coefficient was more satisfactory in the pair that used the definitions. Thus, the construction of empirical referents and the clinical validation process makes the nursing indicators and outcomes more adequate for specific populations and provides an effective means to better evaluate the nursing actions.

[Acute pain in myocardial infarction: analysis of concept]. / Dor aguda no infarto agudo do miocárdio: análise do conceito.

OBJECTIVE: To analyze the concept "sharp pain" in the context of acute myocardial infarction. METHODS: Conceptual analysis method proposed by Walker and Avant. This makes it possible to clarify the concept of attributes. We conducted an integrative review to assist the search of studies published in 2006 and 2012, using the descriptors 'Acute Pain' and 'myocardial infarction', through consultation to Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Public/Publish Medline (PubMed) data. RESULTS: A sample of 29 studies was selected in which the background identified was: reduction of myocardial perfusion and/or death of myocardial tissue; attributes: quality, location, time, duration and irradiation; and consequent: report of pain, dyspnea, high heart rate, nausea, vomiting, high blood pressure, high respiratory rate, sleep disturbance, diaphoresis, fatigue, paleness, weakness, anxiety and fear. CONCLUSION: The findings have clarified the attributes of the concept sharp pain in myocardial infarction.

[Hygiene practices for patients with HIV/AIDS]. / Práticas de higiene para pacientes com HIV/AIDS.

The objective of this study was to analyze the scientific production on health interventions related to hygiene for adults with HIV/AIDS. An integrative literature review was performed using six databases in June 2013. The descriptors AIDS and Hygiene were used, in Portuguese, English or Spanish. A total of 682 articles were found and 16 were selected. Personal hygiene practices were identified, such as hand washing, showers, tooth brushing and quitting smoking. Food hygiene practices involved washing food and kitchen utensils, using treated water, conserving and cooking food. Environmental hygiene took into account raising domestic animals, control of disease vectors, household cleanliness, waste disposal and basic sanitation. In conclusion, these specific hygiene interventions can be applied to the general population and, especially, to people with HIV/AIDS, due to immunosuppression.

[Instruments of health literacy used in nursing studies with hypertensive elderly]. / Instrumentos de letramento em saúde utilizados nas pesquisas de enfermagem com idosos hipertensos.

This study aimed to analyze nursing research regarding the instruments used to evaluate health literacy in elderly hypertensive patients. This is an integrative literature review done in the databases LILACS, PubMed, CINAHL, Scopus, and Cochrane, in June 2013. The articles, electronically available, were selected for full-text review by nurses, who assessed health literacy of elderly with hypertension. Eight studies were selected for analysis and four different instruments were used in the research. The instruments were developed according to a methodology and they were all designed to evaluate the abilities of elderly regarding reading, numeracy, pronunciation and recognition of some health-related words. The nursing research analyzed in this study revealed the gaps in care related to measures aimed to increase patient's involvement in decision-making. Also, the instruments used for measuring health literacy showed limitations, and there is no gold standard test.

[Nursing: promoting the health of overweight children and adolescents in the school context]. / Enfermagem: promoção da saude de crianças e adolescentes com excesso de peso no contexto escolar.

The study aimed to analyze the nursing interventions related to the competencies of health promotion of overweight children and adolescents in the school context, in light of the Galway Consensus through an integrative review. Articles published between 1988 and June, 2013 were found in the databases CINAHL, SCOPUS, MEDLINE/PubMed, Cochrane, LILACS and SciELO. A total of 139 publications were obtained from indexed descriptors. Ten articles were selected after reading. The most evident competencies for health promotion were: catalyzing change, needs assessment and impact assessment. The highlights were activities of health education and partnerships with other health professionals and the families of students. It was found that the skills of health promotion developed by nurses can contribute to the adoption of healthy habits by overweight children and adolescents.

Clinical indicators of 'caregiver role strain' in caregivers of stroke patients.

The main objectives of this study were to investigate the prevalence of the nursing diagnosis caregiver role strain (CRS) in caregivers of patients with stroke and to identify the accuracy of this diagnosis's clinical indicators. A total of 42 stroke patient caregivers who provided in-home care services in a city in north-eastern Brazil. The sensitivity, specificity, and predictive value of clinical indicators of nursing diagnosis 'CRS' were analyzed. Study participants were mostly female, married and the daughters of stroke patients. CRS was present in 73.8% of caregivers. The presence of the clinical indicators, specifically, lack of time to meet personal needs (p = 0.011), increased emotional lability (p = 0.001), withdrawal from social life (p = 0.002), and changes in leisure activities (p = 0.002), presented high values for statistical measures of diagnostic accuracy.

[Review of nursing diagnosis sedentary lifestyle in individuals with hypertension: conceptual analysis]. / Revisão do diagnóstico de enfermagem estilo de vida sedentário em pessoas com hipertensão arterial: análise conceitual.

This study aims to review the components of the nursing diagnosis Sedentary Lifestyle (SL) proposed by NANDA (North American Nursing Diagnosis Association)-l in individuals with hypertension. The review was developed based on a concept analysis and supported by the Integrative Literature Review method, through which 43 articles were surveyed from five databases (LILACS, CINAHL, PUBMED, SCOPUS and COCHRANE). The following combinations of descriptors and their English and Spanish equivalents were used: Sedentary Lifestyle and Hypertension and Sedentary and Hypertension. Based on the review process, we found that the SL definition has changed, some clinical indicators have been identified and other indicators have been added to the definition. The study promotes a direction for diagnostic efficiency of clinical SL indicators, contributing to the refinement and improvement of this diagnosis and its components.

[Evaluation of patients with stroke monitored by home care programs]. / Avaliação de pacientes com acidente vascular cerebral acompanhados por programas de assistência domiciliária.

The purpose of this study was to evaluate the patient with a stroke in home treatment, investigating physical capacity, mental status and anthropometric analysis. This was a cross-sectional study conducted in Fortaleza/CE, from January to April of 2010. Sixty-one individuals monitored by a home care program of three tertiary hospitals were investigated, through interviews and the application of scales. The majority of individuals encountered were female (59%), elderly, bedridden, with a low educational level, a history of other stroke, a high degree of dependence for basic (73.8%) and instrumental (80.3 %) activities of daily living, and a low cognitive level (95.1%). Individuals also presented with tracheostomy, gastric feeding and urinary catheter, difficulty hearing, speaking, chewing, swallowing, and those making daily use of various medications. It was concluded that home care by nurses is an alternative for care of those individuals with a stroke.

[Nursing diagnoses analysis under the bayesian perspective]. / A análise de diagnósticos de enfermagem sob uma perspectiva bayesiana.

The use of Bayesian statistical techniques is an approach that is well accepted and established in fields outside of nursing as a paradigm to reduce the uncertainty present in a given clinical situation. The purpose of this article is to provide guidance regarding the specific use of the Bayesian paradigm in the analysis of nursing diagnoses. The steps and interpretations of Bayesian analysis are discussed. One theoretical and one practical example of Bayesian analysis of nursing diagnoses are presented. It describes how the Bayesian approach can be used to summarize the available knowledge and make point and interval estimates of the true probability of a nursing diagnosis. It was concluded that the application of Bayesian statistical methods is an important tool for more accurate definition of probabilities related to nursing diagnoses.

[Identification of the nursing diagnosis of fall risk in elderly with stroke]. / Identificação do diagnóstico de enfermagem "risco de quedas em idosos com acidente vascular cerebral.

The purpose of this study was to verify the presence of a nursing diagnosis of fall risk in elderly with stroke. Observational exploratory and cross-sectional study with descrziptive analysis. Performed in a charitable rehabilitation association in Fortaleza city, from January to March 2010, by primary source, by interviews and physical examination with elderly people who had at least one episode of stroke 37 individuals participated of which 20 (54.1%) were women, with mean age of 70.6years, and 18 (48.6%) lived with a partner and had an average of 5.2 years of study. The risk of falls was found in all elderly. Among the risk factors identified it is possible to highlight Impaired balance (100%), Age above 65 years (83.7%), and Proprioceptive deficit (83.7%). Nurses must consider the risk of falls as a nursing carefocus and implement and evaluate the results of interventions for fall prevention.

[Nursing interventions for stroke patients: an integrative literature review]. / Intervenções de enfermagem aos pacientes com acidente vascular encefálico: uma revisão integrativa de literatura.

The objective of this study was to analyze the knowledge on nursing interventions for hospitalized stroke patients. An integrative literature review was performed by accessing five online databases, in September 2009. The descriptors used in the search were nursing care and stoke, in Portuguese, English and Spanish. A total 223 articles were found, and 12 were selected. It was found in the articles that there was a greater number of clinical nursing interventions, followed by educational, managerial and research interventions. Clinical interventions are more related to the biological aspects of patients. As to the educational interventions, the articles point at the fundamental role of nurses, as well as that of relatives and caregivers. The main managerial intervention was the coordination of health care. As for research interventions, only one was identified and described as the development and improvement of health care practice through clinical evidence.

Nursing consultation protocol for patients after myocardial revascularization: influence on anxiety and depression.

The objective was to evaluate the influence of the Nursing Consultation Protocol in aspects of anxiety and depression in patients after myocardial revascularization using the Hospital Anxiety and Depression scale (HAD). A randomized clinical trial developed in the outpatient clinic of a public hospital in Fortaleza-Ceará. One hundred and forty six patients, who underwent myocardial revascularization, composed the population, providing the sample of 39 patients in the control group (CG) and 39 in the intervention group (IG). The results were presented in tables. Anxiety had a mean of 5.41 in the CG and a median of 5 and a mean in the IG of 5.21 and a median of 4. Depression predominated in the CG, with a mean 4.82 and a median of 4, while the IG had a mean of 3.79 and a median of 3. It was found that people monitored in accordance with the Nursing Consultation Protocol had a lower percentage of anxiety and depression after six months.

Demographic factors and risk indicators of stroke: comparison between inhabitants of Fortaleza municipal district and the national profile.

The aim of this study was to compare the demographic factors and the risk indicators for the occurrence of the stroke in the city of Fortaleza with other cities, based on national studies. A transversal study developed with 180 patients who were diagnosed with stroke in nine different public institutions within the period from October 2007 to April 2008. For data collection, a questionnaire was applied by interviewing the patient and/or their companions. The following tests were used for the comparative analysis of epidemiological data: The Chi-Square Test for the adherence and the T-Test for the mean. The patients with stroke evaluated in Fortaleza were younger and had higher rates of hypertension than in the national profile, however, fewer were smokers or consumers of alcohol. It is necessary to increase knowledge about the health of the Brazilian population by region, since there are specific influential factors in the occurrence of stroke.

[Blood pressure tracking: study with children and adolescents with familial history of hypertension]. / Acompanhamento da pressão arterial: estudo com crianças e adolescentes com história familiar de hipertensão.

The purpose of this study is to analyze the evolution of the percentiles of blood pressure in children and adolescents with familial history of arterial hypertension. This is a longitudinal study developed in a community in Fortaleza. Ceará, Brazil. The blood pressure was evaluated in five home visits from January, 2004 to December, 2006. The group was composed of 141 participants, of which 92 were children and 49 adolescents. Of the children, 67.4% remained with no alterations of the percentiles of blood pressure in all the evaluations; of the adolescents, 65.3% remained in the same condition. Most individuals kept their values and percentiles of systolic blood pressure and diastolic blood pressure, and many that did not initially present alterations started to show some during the follow up. As a result, routine monitoring of blood pressure of children and adolescents proves necessary for the early detection and prevention of complications.

[Nursing consultation: space for creation and use of protocol for patients after myocardial revascularization]. / Consulta de enfermagem: espaço para criação e utilização de protocolo para pacientes após revascularização miocárdica.

A descriptive study aiming to describe a nursing consultation protocol tested for patients after myocardial revascularization. The protocol is implemented in a hospital cardiac unit, has goals that must be achieved during the consultation period or in between. For reaching each goal, it has been established that nursing actions should be implemented by the nurse, displayed in three tables: Strategies for nursing consultation related to the first care; Strategies for nursing consultations related to the second, third and forth nursing visits; Strategies for nursing consultations related to the fifth nursing visit, referring to the sixth month after surgery. It is believed that the implementation of the protocol allows a systematic evaluation of the patient, raising their real problems, for planning and implementation of nursing interventions, especially those related to behavioral changes.

[Nursing diagnosis: impaired physical mobility in patients with stroke]. / Diagnóstico de enfermagem: mobilidade física prejudicada em pacientes acometidos por acidente vascular encefálico.

The study aimed to investigate the occurrence of Nursing Diagnosis Impaired Physical Mobility in patients with stroke. This exploratory study was developed at rehabilitation units from November 2007 to march 2008, through an interview and physical examination. Nursing diagnoses were made using NANDA Taxonomy II. A total 121 patients were evaluated. Subjects' average age was 62.1 years, 52.3% were males with an average 1.5 stroke events in 3.4 years. The diagnosis was present in 90%, with an average of 5.8 defining characteristic. Difficulty turning was the most present characteristic and there were 3.4 related factors per patient, and most reported decreased strength and endurance besides neuromuscular impairment (100%). There should be a closer look towards this diagnosis when planning interventions after a stroke with aiming at health promotion for these patients.

Nursing Diagnosis Risk for Unstable Blood Glucose Level in Patients with Diabetes Mellitus.

AIM: To validate the nursing diagnosis risk for unstable blood glucose level in adult/elderly patients with type 1 and type 2 diabetes. METHOD: Study Methodological was used in this article. The validation process was carried out using the model proposed by Hoskins (1989). RESULTS: The risk factors ineffective medication management and high carbohydrate and lipid food intake achieved a concordance index greater than 85%. CONCLUSION: This study contributed to the identification of new risk factors, at risk populations, and important associated conditions. IMPLICATIONS FOR NURSING PRACTICE: It is believed that the findings reported in this paper can be used to improve clinical protocols for the prevention of unstable blood glucose, in addition to contributions to the advancement of nursing science.