Intrabreath oscillometry is a sensitive test for assessing disease control in adults with severe asthma.

BACKGROUND: Asthma control is not well reflected by spirometry, yet this is the most frequently used measure of lung function in asthma clinics. Oscillometry is an alternative technique suitable for those with severe asthma. OBJECTIVE: To investigate usefulness of oscillometry in subjects with severe asthma to determine which outcome variables best reflected asthma control. METHODS: Adults with severe asthma were recruited from a severe asthma clinic in Brazil. Oscillometry (conventional multifrequency measurements between 6 and 32 Hz; intrabreath tracking at 8 Hz) and spirometry were performed. Asthma control was determined by the asthma control test. RESULTS: A total of 60 adults were evaluated; mean age was 56.7 years. There was predominance of women (82%), and most patients (63%) reported onset of asthma symptoms in childhood or adolescence. There were no differences between controlled and uncontrolled asthma in spirometry. Uncontrolled asthma was associated with higher resistance (at 8 and 10 Hz) and more negative reactance (for 6, 8, and 10 Hz) (P < .05) on conventional oscillometry. Intrabreath oscillometry revealed significant differences between controlled and uncontrolled patients with asthma (P < .01 for changes in resistance and reactance between end expiration and end inspiration). The accuracy of the lung function tests in discriminating between controlled and uncontrolled asthma was higher for intrabreath variables (area under the curve = 0.65-0.72). CONCLUSION: Oscillometry, particularly the intrabreath technique, better reflected asthma control than spirometry measures. Our findings suggest that oscillometry may be a useful technique to aid management of severe asthma, with a potential to reflect loss of disease control.

Asthma and Obesity in Children Are Independently Associated with Airway Dysanapsis.

BACKGROUND: An increase in the prevalence of overweight and asthma has been observed. Both conditions affect negatively lung function in adults and children. The aim of this study was to analyze the effect of overweight and asthma on lung function in children. METHODS: We designed a case-control study of healthy and asthmatic subjects nested within an epidemiological asthma prevalence study in children between 8 and 16 years of age. The effect of asthma and overweight on lung function was assessed by impulse oscillometry and spirometry obtained at baseline and 10-15 min after salbutamol. RESULTS: 188 children were recruited, 114 (61%) were asthmatics and 72 (38%) were overweight or obese. Children with asthma and overweight had a higher FVC (+1.16 z scores, p < 0.001) and higher FEV1 (+0.79 z scores, p = 0.004) and lower FEV1/FVC (-0.54 z scores, p = 0.008) when compared to healthy controls. Compared to normal weight asthmatics, the overweight had higher FVC (+0.78 z scores, p = 0.005) and lower FEV1/FVC (-0.50 z scores, p = 0.007). In the multivariate analysis, overweight was associated with an increase of 0.71 and 0.44 z scores in FVC and FEV1, respectively, and a reduction in FEV1/FVC by 0.40 z scores (p < 0.01 for all). Overweight had no effect on maximal flows and airway resistance at baseline, and this was not modified by inhalation of a bronchodilator. Asthma was also associated with higher post-BD FVC (0.45 z scores, p = 0.012) and FEV1 (0.35 z scores, p = 0.034) but not with FEV1/FVC and FEF25-75%. Two-way analysis of variance did not detect any interaction between asthma and overweight on lung function variables before or after bronchodilator. CONCLUSION: Our results suggest that asthma and overweight are independently associated with airway dysanaptic growth in children which can be further scrutinized using impulse oscillometry. Overweight contributed more to the reduction in FEV1/FVC than asthma in children without increasing airway resistance. Spirometry specificity and sensitivity for obstructive diseases may be reduced in populations with high prevalence of overweight. Adding impedance oscillometry to spirometry improves our understanding of the ventilatory abnormalities in overweight children.

Perfil de Atitudes acerca da Morte e Nível de Resiliência em Técnicos de Enfermagem em Terapia Intensiva / Prevalence of burden in elderly caregivers assisted in Primary Health Care

Objetivo: identificar os níveis de Resiliência e o Perfil de Atitudes Acerca da Morte (EAPAM) apresentados por técnicos de enfermagem de uma unidade de terapia intensiva (UTI). Método: Trata-se de uma pesquisa tipo exploratório e transversal, com abordagem quantitativa, desenvolvida a partir da aplicação da Escala ER (Escala de Resiliência) e escala EAPAM (Escala de Avaliação do Perfil de Atitudes Acerca da Morte), ambas autoaplicáveis com respostas do tipo "likert" para técnicos de enfermagem de um hospital federal do Rio Grande do Sul. As variáveis foram descritas por média e desvio padrão. Na análise estatística, para comparação de médias utilizou-se o teste t-student, complementada por Tukey e teste qui-quadrado para comparação de proporções. Para avaliar a associação entre as variáveis contínuas e ordinais, os coeficientes de correlação de Pearson e Spearman foram utilizados, respectivamente. Resultados: Identificou-se que 74% dos técnicos de enfermagem mostram-se resilientes e a Atitude Acerca da Morte mais frequente foi a Aceitação Neutral (87%). Evidenciou-se relação significativa entre a presença de resiliência e atitude de Aceitação Neutral (r=a,298; p=0,004). Conclusão: os dados obtidos permitem vislumbrar fragilidades e potencialidades a serem trabalhadas com a equipe visando seu bem-estar. Como limitação, apontamos à necessidade de estender a avaliação aos demais membros da equipe multiprofissional.

Internações por câncer de mama feminino na região metropolitana de Porto Alegre / Female breast cancer hospitalizations in the metropolitan region of Porto Alegre / Hospitalizaciones por cáncer de mama femenino en la región metropolitana de Porto Alegre

Objetivo: caracterizar as internações por câncer de mama feminino na rede pública da Região Metropolitana de Porto Alegre de 2016 a 2018. Método: estudo epidemiológico de base populacional, observacional, transversal e retrospectivo com análise de dados secundários em saúde acessados no Sistema de Informações Hospitalares do Sistema Único de Saúde das internações com diagnóstico de câncer de mama. As variáveis extraídas foram internações por faixa etária, raça/cor, tempo de permanência, óbitos, taxa de mortalidade e gasto hospitalar. Resultados: Nesse período ocorreram 7.049 internações, 3.807(54%) entre 50 a 69 anos. A média de permanência na internação foram 4 dias e o custo médio total/ano pelo SUS de 375.374,604 reais. No triênio ocorreram 504 (7,15%) pela doença. Conclusão: As internações por câncer de mama em mulheres na RMPA repercutem diretamente no aumento de gastos e no mais prolongado uso de leitos hospitalares, tornando a assistência a esse tipo de agravo cada vez mais oneroso.(AU)

Objective: to characterize hospitalizations for female breast cancer in the public network of the Metropolitan Region of Porto Alegre from 2016 to 2018. Method: population-based epidemiological study, observational, cross-sectional and retrospective study with analysis of secondary health data accessed in the Hospital Information System of the Unified Health System of hospitalizations with a diagnosis of breast cancer. The extracted variables were hospitalizations by age group, race/color, length of stay, deaths, mortality rate and hospital expenditure. Results: In this period, 7,049 hospitalizations occurred, 3,807 (54%) between 50 and 69 years of age. The average stay in hospital was 4 days and the average total cost/year by SUS was 375,374.604 reais. In the triennium there were 504 (7.15%) due to the disease. Conclusion: Hospitalizations for breast cancer in women in the RMPA have a direct impact on thein crease in expenses and on the longer use of hospital beds, making assistance to this type of disease increasingly costly.(AU)

Objetivo: caracterizar lashospitalizaciones por cáncer de mama femeninoenlared pública de laRegión Metropolitana de Porto Alegre de 2016 a 2018. Método: estudio epidemiológico poblacional, observacional, transversal y retrospectivo conanálisis de datossecundarios de salud a los que se accedeenel Sistema de Información Hospitalaria del Sistema Único de Salud de hospitalizacionescon diagnóstico de cáncer de mama. Lasvariables extraídas fueronhospitalizaciones por grupo de edad, raza/color, tiempo de estancia, defunciones, tasa de mortalidad y gasto hospitalario. Resultados: En este período ocurrieron 7.049 hospitalizaciones, 3.807 (54%) entre 50 y 69 años. La estadíapromedioenel hospital fue de 4 días y elcosto total promedio/año por el SUS fue de 375.374,604 reales. Eneltrieniohubo 504 (7,15%) debido a laenfermedad. Conclusión: Lashospitalizaciones por cáncer de mama enmujeres de la RMPA tienenun impacto directoenel aumento de los gastos y enelmayor uso de lascamas hospitalarias, haciendo que laatención a este tipo de enfermedadessea cada vez más costosa.(AU)

Desafios da Enfermagem Brasileira no Combate da COVID-19: uma reflexão / Challenges of brazilian nursing in combating COVID-19

Objetivo: Refletir sobre desafios enfrentados pela Enfermagem brasileira no combate ao COVID-19. Método: Artigo reflexivo acerca dos desafios da Enfermagem nos serviços de saúde brasileiros em tempos de pandemia. Resultados: Em um país com grandes diferenças econômicas, culturais e sociais são diversos desafios enfrentados pela Enfermagem nas dimensões: institucionais, profissionais e pessoais. A categoria profissional encontra-se na linha de frente no combate a pandemia, com alto risco de exposição ao vírus. Os trabalhadores, maioria sexo feminino, estão trabalhando com medo, sob pressão, adoecendo e muitos morrendo. Indicadores do Conselho Federal de Enfermagem evidenciaram maioria dos óbitos na faixa etária entre 31 e 40 anos. Recomendações sobre medidas de prevenção não estão sendo suficientes para barrar as infecções entre os funcionários, é necessário o serviço de saúde fornecer infraestrutura material e pessoal, associado ao diálogo e capacitação contínua dos trabalhadores. Conclusão: A pandemia marcou o ano internacional de comemorações da Enfermagem dando visibilidade a profissão. A história da profissão é permeada por lutas pela dignidade e reconhecimento. O cenário pandêmico acentuou os mais diversos riscos e problemas enfrentados diariamente pelos trabalhadores, entretanto, o compromisso com o cuidado biopsicossocial dos pacientes, família e comunidade sempre se mantém independentemente da situação vivenciada. (AU)

Objective: To reflect on the challenges faced by Brazilian Nursing in the fight against COVID-19. Method: Reflective article about the challenges of Nursing in Brazilian health services in times of pandemic. Results: In a country with great economic, cultural and social differences, there are several challenges faced by Nursing in the following dimensions: institutional, professional and personal. The professional category is at the frontline in fighting the pandemic, with a high risk of exposure to the virus. The workers, mostly female, are working in fear, under pressure, getting sick and many dying. Indicators of the Federal Nursing Council showed the majority of deaths in the age group between 31 and 40 years old. Recommendations on preventive measures are not being enough to stop infections among employees, it is necessary for the health service to provide material and personal infrastructure, associated with dialogue and continuous training of workers. Conclusion: The pandemic marked the international year of Nursing celebrations, giving visibility to the profession. The history of the profession is permeated by struggles for dignity and recognition. The pandemic scenario accentuated the most diverse risks and problems faced daily by workers, however, the commitment to the biopsychosocial care of patients, family and community always remains independent of the situation experienced. (AU)

Objetivo: Reflexionar sobre los desafíos que enfrenta la Enfermería brasileña en la lucha contra COVID-19. Método: Artículo reflexivo sobre los desafíos de la enfermería en los servicios de salud brasileños en tiempos de pandemia. Resultados: En un país con grandes diferencias económicas, culturales y sociales, la Enfermería enfrenta varios desafíos en las siguientes dimensiones: institucional, profesional y personal. La categoría profesional está a la vanguardia en la lucha contra la pandemia, con un alto riesgo de exposición al virus. Los trabajadores, en su mayoría mujeres, trabajan con miedo, bajo presión, enfermándose y muchos muriendo. Los indicadores del Consejo Federal de Enfermería mostraron la mayoría de las muertes en el grupo de edad entre 31 y 40 años. Las recomendaciones sobre medidas preventivas no son suficientes para detener las infecciones entre los empleados, es necesario que el servicio de salud brinde infraestructura material y personal, asociada con el diálogo y la capacitación continua de los trabajadores. Conclusión: La pandemia marcó el año internacional de las celebraciones de enfermería, dando visibilidad a la profesión. La historia de la profesión está impregnada de luchas por la dignidad y el reconocimiento. El escenario de la pandemia acentuó los riesgos y problemas más diversos que enfrentan diariamente los trabajadores, sin embargo, el compromiso con la atención biopsicosocial de los pacientes, la familia y la comunidad siempre es independiente de la situación experimentada. (AU)

Conhecimento dos enfermeiros sobre o novo código de ética do profissional de enfermagem / Knowledge of nurses on the code of professional ethics of nursing / Conocimiento de las enfermeras sobre el nuevo código de ética para profesionales de enfermería

Com a recente atualização do Código de Ética dos Profissionais de Enfermagem, essa tornou-se conhecida apenas por parte dos profissionais. Objetivo: avaliar o conhecimento dos enfermeiros sobre o Código de Ética dos Profissionais de Enfermagem. Método: Trata-se de um estudo observacional, descritivo e transversal, com dados coletados no período de setembro a outubro de 2018, por meio de um questionário online, via Plataforma Google Forms®. Participaram da pesquisa 217 enfermeiros, sendo 190 (87,46%) do sexo feminino e 27 (12,44%) do sexo masculino. Resultado: Em relação aos direitos, os participantes obtiveram respostas semelhantes, considerando a alternativa mais coerente. Quanto aos deveres e proibições, apresentaram grande diversidade e discordância entre as alternativas escolhidas, demonstrando dúvida ou equívoco por parte dos participantes. Conclusão: Foi possível observar que o conhecimento dos enfermeiros acerca do Código de Ética Profissional de Enfermagem é limitado em relação aos deveres e proibições da profissão.(AU)

With the recent update of the Nursing Professionals Code of Ethics, this became known only by professionals. Objective: to evaluate nurses' knowledge of the Nursing Professionals Code of Ethics. Method: This is an observational, descriptive and cross-sectional study, with data collected from September to October 2018, through an online questionnaire, via the Google Forms® Platform. 217 nurses participated in the research, 190 (87.46%) female and 27 (12.44%) male. Result: Regarding rights, the participants obtained similar responses, considering the most coherent alternative. As for duties and prohibitions, they showed great diversity and disagreement between the alternatives chosen, showing doubt or misunderstanding on the part of the participants. Conclusion: It was possible to observe that the nurses' knowledge about the Nursing Professional Code of Ethics is limited in relation to the duties and prohibitions of the profession.(AU)

Con la reciente actualización del Código de Ética de los Profesionales de Enfermería, esto solo se dio a conocer por los profesionales. Objetivo: evaluar el conocimiento de los enfermeros sobre el Código de Ética para Profesionales de Enfermería. Método: Se trata de un estudio observacional, descriptivo y transversal, con datos recolectados de septiembre a octubre de 2018, a través de un cuestionario en línea, vía Google Forms® Platform. En la investigación participaron 217 enfermeras, 190 (87,46%) mujeres y 27 (12,44%) hombres. Resultado: En cuanto a derechos, los participantes obtuvieron respuestas similares, considerando la alternativa más coherente. En cuanto a deberes y prohibiciones, mostraron gran diversidad y desacuerdo entre las alternativas elegidas, mostrando dudas o incomprensiones por parte de los participantes. Conclusión: se pudo observar que el conocimiento de las enfermeras sobre el Código de Ética Profesional de Enfermería es limitado en relación a los deberes y prohibiciones de la profesión.(AU)

Active post-operative phoned search for late infections of surgical site and thromboembolic events in the late postoperative period of plastic surgeries in a day hospital in the municipality of Porto Alegre

Introduction: Elective and plastic surgical procedures are normally considered safer than emergency surgeries, although they cause concern to health services. The aim of this study was to analyze the active phoned search as a screening instrument for the diagnosis of surgical site infection (SSI) and thromboembolic events (TEs) in the late postoperative care of plastic surgeries in a private day hospital in the city of Porto Alegre. Methods: Quantitative, descriptive, retrospective, cross-sectional study. Data was collected from a database provided by phoned active search of sign and symptoms for epidemiological monitoring by the control infection service of a day-hospital, from July 2015 to February 2017. Results: A total of 3.595 patients were effective contacted in the indicated period. Among these patients, 77.6% received guidance on TEs. Moreover, 0.4% and 0.2% of patients reported signs and symptoms of SSI and TE, respectively. Associated procedures caused 50.0% of SSIs and 87.5% of TEs. Phoned search increased in 0.2% the number of reported cases of both adverse events in the overall sample. Conclusion: SSI and TE are worrying events for health institutions, since they can put patient safety at risk. Therefore, the data obtained in this study were used as a basis to qualify phoned search as an effective screening instrument for SSI and TE and provided support for the development of more consistent phoned search mechanisms for monitoring these postoperative events. (AU)