Moral distress in nursing students: Cultural adaptation and validation study.

BACKGROUND: Moral distress, defined as moral suffering or a psychological imbalance, can affect nursing students. However, many new instruments or adaptations of other scales that are typically used to measure moral distress have not been used for nursing students. AIM: This study aimed to translate, culturally adapt and evaluate the psychometric properties of an Italian version of the Moral Distress Scale for Nursing Students (It-ESMEE) for use with delayed nursing students (students who could not graduate on time or failed the exams necessary to progress to the next level). RESEARCH DESIGN: The study used a cross-sectional research design. PARTICIPANTS AND RESEARCH CONTEXT: Incidental sampling resulted in a sample of 282 delayed nursing students (mean age = 26.73 ± 4.43 years, 73% female) enrolled between May and August 2020 in a University of central Italy. ETHICAL CONSIDERATIONS: The research protocol was approved by the internal review board of the university, and all participants provided their written informed consent. RESULTS: The study confirmed a multidimensional second-order factorial structure for the It-ESMEE with five dimensions: improper institutional conditions to teach user care, authoritarian teaching practices, disrespect for the ethical dimension of vocational training, lack of competence of the teacher and commitment of ethical dimension of user care. The internal consistency was high (0.753-0.990 across the factors), and the standard error of measurement and smallest detectable change were adequate. DISCUSSION: The It-ESMEE is able to assess moral distress in delayed nursing students with good validity and reliability. It can be used in research and to determine moral distress levels, helping teachers to monitor the condition in nursing students. CONCLUSION: This instrument can help in comprehending moral distress, enabling students to develop coping and intervention strategies to maintain their well-being, and to ensure the quality of nurse education.

Psychometric Characteristics of the Caregiver Contribution to Self-care of Heart Failure Index in a South American Population.

BACKGROUND: Caregivers can contribute enormously to the self-care of patients with heart failure (HF). The Caregiver Contribution to Self-care of Heart Failure Index (CC-SCHFI) measures these contributions across 3 scales: self-care maintenance, which evaluates caregiver contributions to symptom monitoring and treatment adherence; self-care management, which evaluates caregiver contributions in dealing with symptoms; and caregiver confidence, which assesses caregiver self-efficacy in managing all contributions to self-care. Although the CC-SCHFI has been used in several investigations, only 1 study has evaluated its psychometric characteristics. OBJECTIVE: The aim of this study was to evaluate the psychometric properties of the CC-SCHFI in Brazil. METHODS: A cross-sectional design was used in this study. Confirmatory factor analysis was used to assess construct validity, and factor score determinacy coefficients were computed to evaluate internal consistency reliability. RESULTS: The sample comprised 99 caregivers of patients with HF. Most were women (73%), with a mean age of 48 ± 14 years; 57% were patients' spouses. Confirmatory factor analysis confirmed the original factor structure of the instrument, with supportive fit indices for all 3 scales (comparative fit index, 0.95-1.00; root-mean-square error of approximation, 0.00-0.057). Reliability estimates were adequate for each CC-SCHFI scale (0.77-0.96). CONCLUSIONS: The CC-SCHFI is a valid and reliable scale to measure caregiver contributions to self-care maintenance, caregiver contributions to self-care management, and caregiver confidence in HF.

Surgical safety in catheterization laboratory. / Segurança cirúrgica em laboratório de cateterismo.

OBJECTIVE: To describe the process of implanting the surgical safety checklist in a catheterization laboratory (CL). METHOD: Descriptive case report study about the safety strategies developed in the last six years in a university hospital in the southern region of Brazil. RESULTS: The six international patient safety goals (IPSG) were incorporated into the care practice in accordance with the hospital's Joint Comission International (JCI) accreditation program, through a continuous process of educational nature. The checklist was adapted considering the characteristics of the unit and the procedures performed. CONCLUSION: The implementation of the checklist provided the promotion of patient safety, greater staff integration, advances in communication among professionals and the recording of in-room care information.

Cross-cultural Adaptation of the Self-care of Hypertension Inventory Into Brazilian Portuguese.

BACKGROUND: Lifestyle changes and treatment adherence still constitute a challenge to healthcare providers involved in the care of persons with hypertension. The lack of validated instruments measuring the ability of hypertensive patients to manage their disease has slowed research progress in this area. The Self-care of Hypertension Inventory, originally developed in the United States, consists of 23 items divided across 3 scales: Self-care Maintenance, Self-care Management, and Self-care Confidence. These scales measure how well patients with hypertension adhere to treatment and manage elevated blood pressure, as well as their confidence in their ability to perform self-care. A rigorous cross-cultural adaptation and validation process is required before this instrument can be used in other countries. OBJECTIVE: The aims of this study were to translate the Self-care of Hypertension Inventory into Brazilian Portuguese with cross-cultural adaptation and to evaluate interobserver reliability and temporal stability. METHODS: This methodological study involved forward translation, synthesis of forward translations, back-translation, synthesis of back-translations, expert committee review, and pretesting. Interobserver agreement and the temporal stability of the scales were assessed. RESULTS: The expert committee proposed semantic and cultural modifications to some items and the addition of guidance statements to facilitate administration of the scale. Interobserver analysis demonstrated substantial agreement. Analysis of temporal stability showed near-perfect agreement. CONCLUSIONS: Cross-cultural adaptation of the Self-care of Hypertension Inventory successfully produced a Portuguese-language version of the instrument for further evaluation of psychometric properties. Once that step is completed, the scale can be used in Brazil.

[Adherence to appointments and medication treatment of patients from randomized clinical trials of the industry]. / Adesão às consultas e ao tratamento medicamentoso de pacientes em ensaios clínicos randomizados da indústria.

Historical cohort study that assessed the adherence rate of patients of randomized clinical trials (RCT) of pharmaceutical industry in cardiology to appointments and follow-up medical treatment. This study was conducted at the cardiology research unit in a public university hospital in Porto Alegre, Rio Grande do Sul, Brazil. High adherence was regarded as > or = 80%. Seven RCT (120 medical records) were revised. We discovered that 117 (97%) of patients had adherence to follow-up visits to > or = 80%; 83.3% of patients had rates of > or = 80% adherence to medication in the study; the median number of tablets ingested, among patients with good adherence was 175 (72-500), and among patients with lower adherence was 500 (500-962). These results indicate that patients in studies with longer follow up and greater number of oral medication present loss in adherence

Validity and reliability of the self-care of hypertension inventory (SC-HI) in a Brazilian population.

BACKGROUND: Poor self-care in patients with hypertension is associated with worse patient outcomes. The Self-Care of Hypertension Inventory (SC-HI) measures self-care in patients with hypertension and includes three scales: self-care maintenance, which measures adherence to prescribed treatments and behaviors; self-care management, which evaluates the responses to signs and symptoms of high blood pressure; and self-care confidence, which measures self-efficacy in dealing with the entire process. OBJECTIVE: To test the psychometric characteristics of the Brazilian version of the SC-HI. METHODS: We enrolled a sample of 360 patients with hypertension and performed confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) to test the factorial structure of the SC-HI and computed the factor score determinacy coefficient to evaluate the SC-HI internal consistency reliability. RESULTS: The sample was predominantly female (65%), mean age of 65 years (SD = 10), white (70%). The self-care maintenance scale resulted in a unidimensional scale, with supportive fit indices (CFI = 0.901, RMSEA = 0.048); the self-care management did not reflect the original factorial structure and had unsupportive fit indices. EFA showed a different factorial solution in reference to the original study. Finally, the self-care confidence scale resulted in a unidimensional scale with supportive fit indices (CFI = 0.940, RMSEA = 0.093). The reliability of the self-care maintenance, management, and confidence scales resulted in factor score determinacy coefficients of 0.83, 0.78, and 0.97 respectively. CONCLUSION: This study shows that the SC-HI is a valid and reliable tool to measure self-care in patients with hypertension among the Brazilian population.

Effect of motivational interviewing in hypertensive patients (MIdNIgHT): study protocol for a randomized controlled trial.

BACKGROUND: Only one-third of hypertensive patients achieve and maintain blood-pressure control. This is attributed to low treatment adherence and has a negative impact on clinical outcomes. Adherence is multidimensional and involves aspects both related to patient characteristics and to the chronic nature of the disease. In this context, motivational interviewing has been proposed as an approach to foster patients' motivations to change their behavior for the benefit of their own health, thus providing more lasting behavioral changes. DESIGN AND METHODS: Single-center, parallel, randomized controlled trial with outcome-assessor blinding. This study will select adult patients (n = 120) diagnosed with hypertension who receive regular follow-up in a specialized outpatient clinic. Patients will be randomly allocated across two groups: the intervention group will have appointments focused on motivational interviewing, while the control group will have traditional appointments. Patients will be monitored face-to-face, once monthly for six months. The primary outcomes will be a reduction of at least 8 mmHg in systolic blood pressure and changes in mean blood pressure measured by 24-h ambulatory blood pressure monitoring. Secondary outcomes include improvement of adherence to a low-sodium diet, adherence to self-care behaviors, regular use of antihypertensive medications, increase or maintenance of physical activity, weight reduction, evaluation of changes in daytime sleepiness, and cessation of smoking. DISCUSSION: This study shows an intervention strategy that will be tested and, if effective, warrant replication in monitoring of other chronic diseases. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02892929 . Registered on 24 August 2016.

Analysis of agreement in the evaluation of pain in newborns during hepatitis B vaccination / Análise de concordância na avaliação da dor de recém-nascidos durante a vacinação contra hepatite B

ABSTRACT BACKGROUND AND OBJECTIVES: Healthy newborns inevitably undergo painful procedures from the first hours of life and pain assessment is essential for choosing the right treatment. The objective of this study was to evaluate the agreement between evaluators of the Neonatal Facial Coding System (NFCS) pain scale in healthy newborns before, during and after hepatitis B vaccination performed in the first 48 hours of life. METHODS: This is an analysis of agreement between two evaluators, carried out as part of a quasi-experimental intervention study, developed in a maternity hospital in Belo Horizonte. Two researchers carried out an independent evaluation based on filming 2 minutes before, during and 2 minutes after the procedure. RESULTS: The study included 129 newborns between August and December 2022, 60 (46.51%) in the control group (facilitated restraint) and 69 (53.49%) in the intervention group (breastfeeding). There was substantial agreement between the researchers before (0.69) and after (0.70) vaccination. When the agreement between the groups was analyzed, it was substantial for the evaluations of newborns submitted to facilitated restraint before and after the procedure. In the breastfeeding group, agreement was almost perfect before and substantial after the procedure. CONCLUSION: There was substantial agreement between the researchers who used the NFCS scale before, during and after vaccination. This data validates the use of the scales when assessing the pain of newborns undergoing easy restraint and breastfeeding, even though it is an indirect method of assessment. It is important to highlight the importance of periodic staff training programs for the use of pain assessment scales at bedside.

RESUMO JUSTIFICATIVA E OBJETIVOS: Recém-nascidos saudáveis são submetidos a procedimentos dolorosos desde as primeiras horas de vida e a avaliação da dor é essencial para escolha do tratamento adequado. O objetivo deste estudo foi avaliar a concordância entre pesquisadores da escala Neonatal Facial Coding System (NFCS) antes, durante e após a vacinação contra hepatite B nas primeiras 48 horas de vida de recém-nascidos saudáveis. MÉTODOS: Trata-se de uma análise de concordância entre pesquisadores, realizada como um estudo de intervenção quase-experimental, desenvolvido em uma maternidade pública de Belo Horizonte. Dois pesquisadores procederam a avaliação independente a partir de filmagens 2 minutos antes, durante e 2 minutos após o procedimento. RESULTADOS: Foram incluídos 129 recém-nascidos entre agosto e dezembro de 2022, sendo 60 (46,51%) no grupo controle (contenção facilitada) e 69 (53,49%) no grupo intervenção (amamentação). Observou-se concordância substancial entre os pesquisadores antes (0,69) e após (0,70) a vacinação. Quando analisada concordância entre os grupos, ela foi substancial para as avaliações de recém-nascidos submetidos à contenção facilitada antes e após o procedimento. No grupo submetido à amamentação, a concordância foi quase perfeita antes e substancial depois do procedimento. CONCLUSÃO: Há concordância substancial entre os pesquisadores que utilizaram a escala NFCS antes, durante e após a vacinação. Este dado valida a utilização das escalas durante a avaliação da dor de recém-nascidos submetidos à contenção facilitada e amamentação, mesmo tratando-se de um método indireto de avaliação. É importante destacar a importância de programas periódicos de capacitação da equipe para utilização de escalas de avaliação da dor à beira leito.

Síndrome de burnout em preceptores e residentes vinculados a programas de residência em saúde da família / Síndrome de burnout en preceptores y residentes asociados a programas de residencia en salud de la familia / Burnout syndrome in preceptors and residents linked to family health residency programs

RESUMO Objetivo: identificar a presença de Burnout e seus fatores associados em preceptores e residentes de Programas de Residência. Método: estudo transversal realizado com 64 preceptores e residentes no contexto da Atenção Primária à Saúde, de outubro a novembro de 2016. Utilizou-se formulário socioprofissional e o questionário Maslach Burnout Inventory. Para análise dos dados, aplicaram-se os testes Exato de Fisher e Kruskal-Wallis. Considerou-se o nível de significância de 5% (p<0,05). Resultados: os participantes apresentaram sentimento de Incompetência Profissional, Desgaste Emocional e Despersonalização moderados, com médias de 23,1; 17,5 e 4,1, respectivamente. Evidenciou-se associação entre as dimensões do Maslach Burnout Inventory e a variável Distrito Sanitário. Conclusão: não foi identificada a presença de Burnout entre os participantes. No entanto, níveis moderados de sentimento de incompetência profissional, desgaste emocional e despersonalização podem influenciar negativamente a qualidade da assistência prestada. Esta pesquisa contribui para o conhecimento pré-existente por envolver residentes e preceptores multiprofissionais.

RESUMEN: Objetivo: identificar la presencia de Burnout y los factores asociados en preceptores y residentes de Programas de Residencia. Método: estudio transversal que se realizó con 64 preceptores y residentes en el contexto da Atención Básica a la Salud, de octubre a noviembre de 2016. Se utilizó formulario socio profesional y cuestionario Maslach Burnout Inventory. Para análisis de los datos, se aplicaron las pruebas Exacta de Fisher y Kruskal-Wallis. Se consideró el nivel de significancia de 5% (p<0,05). Resultados: los participantes presentaron sentimiento de Incompetencia Profesional, Agotamiento Emocional y Despersonalización moderados, con promedios de 23,1; 17,5 y 4,1, respectivamente. Se constató asociación entre las dimensiones del Maslach Burnout Inventory y la variable Distrito Sanitario. Conclusión: no se identificó la presencia de Burnout entre los participantes. Sin embargo, niveles moderados de sentimiento de incompetencia profesional, agotamiento emocional y despersonalización pueden influenciar negativamente la cualidad de la asistencia prestada. Esta investigación contribuye para el conocimiento preexistente por involucrar residentes y preceptores multi profesionales.

ABSTRACT Objective: to identify the Burnout and its associated factors in preceptors and residents of Residency Programs. Method: a cross-sectional study carried out with 64 preceptors and residents in the context of Primary Health Care, from October to November 2016. A socio-professional form and the Maslach Burnout Inventory questionnaire were used. For data analysis, Fisher's Exact and Kruskal-Wallis tests were applied. The significance level was set at 5% (p<0.05). Results: the participants showed moderate feelings of Professional Incompetence, Emotional Exhaustion and Depersonalization, with averages of 23.1; 17.5 and 4.1, respectively. There was an association between the dimensions of the Maslach Burnout Inventory and the Health District variable. Conclusion: Burnout among the participants was not found. However, moderate levels of feeling of professional incompetence, emotional distress and depersonalization can negatively influence the quality of care provided. This research contributes to the pre-existing knowledge by involving residents and multi-professional tutors.

Práticas obstétricas de uma parteira: contribuições para a gestão do cuidado de enfermagem à parturiente / Prácticas obstéricas de una matrona: contribuciones para la gestión del cuidado de enfermería a la parturiente / Obstetric practices of a midwife: contributions for the management of nursing care with the parturient

OBJETIVO: descrever as práticas obstétricas realizadas por uma parteira leiga tencionando uma reflexão sobre as contribuições dessas práticas para a gestão do cuidado de enfermagem à parturiente. MÉTODO: utilizou-se da história oral temática, na perspectiva qualitativa, tendo como participante, uma parteira leiga, residente em um município do Norte do Estado do Rio Grande do Sul, que atuou na assistência a gestantes, parturientes, puérperas, recém-nascidos e seus familiares. Na coleta de dados, utilizaram-se entrevistas e diário de campo. Os dados foram submetidos à análise temática de conteúdo. RESULTADOS: demonstraram a atuação da parteira no pré-natal, no parto, no pós-parto e na condução de complicações, com práticas voltadas para a gestão do cuidado de Enfermagem durante o período gravídico-puerperal, pautadas na humanização do parto e nascimento, cuidado seguro e empoderamento da mulher. CONCLUSÃO: as práticas obstétricas realizadas pela parteira têm potencial para contribuir para a gestão do cuidado de Enfermagem à parturiente, embora algumas técnicas adotadas, nas décadas de 1940 a 1970, necessitem de respaldo científico

OBJECTIVE: describe the obstetric practices performed by a lay midwife with a reflection on the contributions of these practices to the management of nursing care to the parturient. METHOD: thematic oral history was used in the qualitative perspective, having as a participant a lay midwife, resident in a municipality in the North of the State of Rio Grande do Sul, which assisted in the care of pregnant women, parturients, mothers who has recently given birth, newborns and their families. In the data collection, we used interviews and field diary. The data were submitted to thematic content analysis. RESULTS: demonstrated the performance of the midwife in prenatal care, in the delivery, postpartum and in the management of complications, with practices aimed at the management of Nursing care during the pregnancy-puerperal period, based on the humanization of childbirth and birth, safe care and empowerment of women. CONCLUSION: this description may contribute to the orientation of obstetrical practices for the management of nursing care, although some techniques adopted require scientific support

OBJETIVO: describir las prácticas obstétricas realizadas por una partera laica teniendo una reflexión sobre las contribuciones de estas prácticas para la gestión del cuidado de enfermería a la parturienta. MÉTODO: se utilizó de la historia oral temática, en la perspectiva cualitativa, teniendo como participante una partera laica, residente en un municipio del Norte del Estado de Rio Grande do Sul, que actuó en la asistencia a embarazadas, parturientas, puérperas, recién nacidos y sus familiares. En la recolección de datos, se utilizaron entrevistas y diario de campo. Los datos se sometieron al análisis de contenido temático. RESULTADOS: demostraron la actuación de la partera en el prenatal, en el parto, en el postparto y en la conducción de complicaciones, com prácticas dirigidas a la gestión del cuidado de Enfermería durante el período gravídico-puerperal, pautadas en la humanización del parto y nacimiento, cuidado seguro y empoderamiento de la mujer. CONCLUSIÓN: las prácticas obstétricas realizadas por la partera tienen potencial para contribuir para la gestión del cuidado de Enfermería a la parturiente, aunque algunas técnicas adoptadas, em las décadas de 1940 a 1970, necesiten de respaldo científico

Segurança cirúrgica em laboratório de cateterismo / Seguridad quirúrgica en laboratorio de cateterismo / Surgical safety in catheterization laboratory

Resumo OBJETIVO Descrever o processo de implantação da lista de verificação de segurança cirúrgica em laboratório de cateterismo (LC). MÉTODO Estudo descritivo do tipo relato de experiência das estratégias de segurança desenvolvidas nos últimos seis anos em hospital universitário da região Sul do Brasil. RESULTADOS Foram incorporadas na prática assistencial as seis metas internacionais de segurança do paciente (MISP) em consonância com o programa de acreditação hospitalar pela Joint Comission International (JCI), por meio de um processo contínuo com caráter educativo. A lista de verificação foi adaptada considerando as características da unidade e os procedimentos realizados. CONCLUSÕES A implantação da lista de verificação proporcionou a promoção da segurança do paciente, maior integração da equipe, avanços na comunicação entre os profissionais e no registro das informações da assistência em sala.

Resumen OBJETIVO Describir el proceso de implantación de la lista de verificación de seguridad quirúrgica en un laboratorio de cateterismo (LC). MÉTODO Estudio descriptivo del tipo relato de experiencia sobre las estrategias de seguridad desarrolladas en los últimos seis años en un hospital universitario de la región Sur de Brasil. RESULTADOS Se incorporaron en la práctica asistencial las seis metas internacionales de seguridad del paciente (MISP) en consonancia con el programa de acreditación hospitalaria por la Joint Comission International (JCI), a través de un proceso continuo con carácter educativo. La lista de verificación fue adaptada considerando las características de la unidad y los procedimientos realizados. Conclusión: La implantación de la lista de verificación proporcionó la promoción de la seguridad del paciente, una mayor integración del equipo, avances en la comunicación entre los profesionales y en el registro de las informaciones de la asistencia en sala.

Abstract OBJECTIVE To describe the process of implanting the surgical safety checklist in a catheterization laboratory (CL). METHOD Descriptive case report study about the safety strategies developed in the last six years in a university hospital in the southern region of Brazil. RESULTS The six international patient safety goals (IPSG) were incorporated into the care practice in accordance with the hospital's Joint Comission International (JCI) accreditation program, through a continuous process of educational nature. The checklist was adapted considering the characteristics of the unit and the procedures performed. CONCLUSION The implementation of the checklist provided the promotion of patient safety, greater staff integration, advances in communication among professionals and the recording of in-room care information.

Cross-cultural adaptation and psychometric testing of the brazilian version of the self-care of heart failure index version 6.2.

Objective. To adapt and evaluate the psychometric properties of the Brazilian version of the SCHFI v 6.2. Methods. With the approval of the original author, we conducted a complete cross-cultural adaptation of the instrument (translation, synthesis, back translation, synthesis of back translation, expert committee review, and pretesting). The adapted version was named Brazilian version of the self-care of heart failure index v 6.2. The psychometric properties assessed were face validity and content validity (by expert committee review), construct validity (convergent validity and confirmatory factor analysis), and reliability. Results. Face validity and content validity were indicative of semantic, idiomatic, experimental, and conceptual equivalence. Convergent validity was demonstrated by a significant though moderate correlation (r = -0.51) on comparison with equivalent question scores of the previously validated Brazilian European heart failure self-care behavior scale. Confirmatory factor analysis supported the original three-factor model as having the best fit, although similar results were obtained for inadequate fit indices. The reliability of the instrument, as expressed by Cronbach's alpha, was 0.40, 0.82, and 0.93 for the self-care maintenance, self-care management, and self-care confidence scales, respectively. Conclusion. The SCHFI v 6.2 was successfully adapted for use in Brazil. Nevertheless, further studies should be carried out to improve its psychometric properties.

Determinantes do início do uso de métodos contraceptivos após o parto em usuárias da Atenção Primária à Saúde / Determinants of the initiation of the use of contraceptive methods after childbirth in users of Primary Health Care

SILVEIRA, L. M. Determinantes do início do uso de métodos contraceptivos após o parto em usuárias da Atenção Primária à Saúde. 2022. 96p. Dissertação (Mestrado em Enfermagem) - Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, 2022. Introdução: A contracepção após o parto é estratégia essencial para prevenir gestações não planejadas e garantir o intervalo interpartal recomendado, visto que engravidar em um espaço de tempo menor do que 12 meses aumenta os riscos maternos, neonatais e infantis. Sabe-se ainda que características sociodemográficas e assistenciais podem influenciar o início precoce ou tardio de métodos contraceptivos (MC) após o parto. Objetivos: Verificar se as características sociodemográficas e assistenciais estão associadas ao tempo até o início do uso de contraceptivos no primeiro ano após o parto em usuárias da Atenção Primária à Saúde. Metodologia: Estudo longitudinal, do tipo coorte prospectiva, de gestantes e puérperas cuja linha de base foi aninhada a um projeto multicêntrico de abrangência nacional e Belo Horizonte foi um centro colaborador. Contou com amostra de 236 mulheres na linha de base, 108 na primeira onda e 68 na segunda onda. As entrevistas da linha de base foram realizadas presencialmente com as gestantes. As entrevistas da linha de base foram interrompidas devido à pandemia de COVID-19. O seguimento deu-se por meio de ligações telefônicas, 6 meses após o parto e 1 ano após o nascimento do bebê. Foram analisados os tipos de MC iniciados e calculado o tempo até o início dos mesmos segundo características sociodemográficas e assistenciais. A fração de mulheres que permaneceram sem usar o método contraceptivo ao longo do primeiro ano após o parto foi calculada usando a estimativa de Kaplan Meier. O teste log-rank foi utilizado para analisar se havia diferença entre os grupos (p<0,05). O Modelo de Riscos Proporcionais de Cox com cálculo do risco relativo (RR) não ajustado e ajustado e seus intervalos de 95% de confiança (IC95%) foi usado para estimar os determinantes sociodemográficos e assistenciais associados ao início do uso de métodos. Resultados: Das 108 mulheres, mais de 90% relataram utilizar algum MC, sendo o injetável o mais utilizado (25,9%), seguido das camisinhas (25,0%), das pílulas (23,2%) e do DIU (13,0%). Mais de 48% das mulheres iniciaram o uso de MC 40 dias após o parto. Ou seja, os outros 50% iniciaram após e outras nem iniciaram. A mediana do tempo até o início do MC foi: 39,5 dias (IC95%: 32,1-44). Essa mediana foi menor para mulheres com idade igual ou maior que 35 anos (12,5 dias; IC95%: 0,5-37,3), pardas/pretas (22 dias; IC95%: 4,1-54,1) e que recebiam bolsa família (33 dias; IC95%: 20,3-67,4). Observou ainda que as mulheres que iniciaram o uso de MC mais rapidamente receberam orientações na maternidade (23 dias; IC95% 7,1-42,6) ; foram atendidas por enfermeiros (32 dias; IC95%: 0,71-48,3), e realizaram mais de 6 consultas de pré-natal (33 dias; IC95%: 27,4-41,0). Após ajuste de todas as variáveis, a idade das mulheres e o número de consultas de pré-natal (PN) foram determinantes do início de uso de MC. Mulheres mais jovens (18 até 34 anos) se associaram ao início mais tardio do uso de MC e o maior número de consultas PN ao início mais rápido do uso de MC. Conclusão: Apesar da alta prevalência do uso de MC, persistem desigualdades sociodemográficas e assistenciais em relação ao tempo até o início da contracepção após o parto, como também, uma insegurança contraceptiva. Ressalta-se a necessidade de uma política de promoção do uso de MC eficazes nesse período para reduzir os desfechos adversos associados ao curto intervalo interpartal e os riscos relacionados a ocorrência de gestações pouco espaçadas. Descritores: Planejamento Familiar; Anticoncepção; Período Pós-Parto; Intervalo entre os nascimentos; Saúde da Mulher; Saúde Sexual e Reprodutiva; Enfermagem.

SILVEIRA, L. M. Determinants of the initiation of the use of contraceptive methods after childbirth in users of Primary Health Care. 2022. 96p. Dissertation (Master in Nursing) ­ School of Nursing, Federal University of Minas Gerais, Belo Horizonte, 2022. Introduction: The postpartum contraception is an essential strategy to prevent unplanned pregnancies and ensure the recommended interpregnancy interval, since becoming pregnant in a period of time of less than 12 months increases maternal, neonatal and infant risks. It is also known that sociodemographic and health assistance characteristics can influence the early or late initiation of contraceptive methods (CM) after the giving birth. Objective: To verify whether sociodemographic and assistance characteristics are associated with the time until the initiation of contraceptive use in the first year after giving birth in users of Primary Health Care service. Methods: Longitudinal, prospective cohort type of study of pregnant and postpartum women whose baseline was nested in a nationwide multicenter project and Belo Horizonte was a collaborative center. It had a sample of 236 women at baseline, 108 in the first wave and 68 in the second wave. The baseline interviews were conducted face-to-face with pregnant women. The baseline interviews were discontinued due to the COVID-19 pandemic. The follow-up was conducted through phone calls, 6 months after they gave birth and 1 year after the baby's birth. The types of CM that were initiated were analyzed, and the time until the initiation was calculated according to sociodemographic and assistance characteristics. The fraction of women who remained not using a contraceptive method throughout the first year after giving birth was calculated using Kaplan Meier estimation. The log-rank test was used to analyze if there was a difference between the groups (p<0.05). The Cox Proportional Risk Model with unadjusted and adjusted relative risk (RR) calculation and its 95% confidence intervals (95% CI) was used to estimate the sociodemographic and assistance determinants associated with the beginning of the use of methods. Results: Out of the 108 women, over 90% reported using some CM, with the injectable one being the most commonly used (25.9%), followed by condoms (25.0%), pills (23.2%) and IUD (13.0%). More than 48% of women started using CM 40 days after giving birth. This means the other 50% started after and others did not start at all. The median time to the start of CM was: 39.5 days (95%CI: 32.1-44). This average was lower for women aged 35 years or older (12.5 days; 95%CI: 0.5-37.3), brown/black (22 days; 95%CI: 4.1-54.1) and receiving family allowance (33 days; 95%CI: 20.3-67.4). It was also noted that women who started using CM more quickly received orientation at the maternity hospital (23 days; 95%CI 7.1-42.6); were seen by nurses (32 days; 95%CI: 0.71-48.3), received, and had more than 6 prenatal visits (33 days; 95%CI: 27.4-41.0). After the adjustment of all variables, women's age and the number of prenatal (PN) appointments were determinants of the beginning of CM use. Younger women (18 up to 34 years old) were associated with a later beginning of CM use, and more prenatal visits were associated with a faster beginning of CM use. Conclusion: Despite the high prevalence of CM use, sociodemographic and assistance inequalities persist regarding the time until the beginning of contraception after delivery, as well as contraceptive insecurity. We emphasize the need for a policy to promote the use of effective CM in this period to reduce the adverse outcomes associated with the short intrapartum interval and the risks related to the occurrence of poorly spaced pregnancies. Keywords: Family Planning; Contraception; Postpartum Period; Interval between births; Women's Health; Sexual and Reproductive Health; Nursing.

Adesão às consultas e ao tratamento medicamentoso de pacientes em ensaios clínicos randomizados da indústria / Adhesión a las consultas y al tratamiento medicamentoso de pacientes en ensayos clínicos randomizados de la industria / Adherence to appointments and medication treatment of patients from randomized clinical trials of the industry

Estudo de coorte histórico que avaliou a taxa adesão dos pacientes de ensaios clínicos randomizados (ECR) da indústria farmacêutica na área de cardiologia às consultas de seguimento e ao tratamento medicamentoso. Estudo conduzido na unidade de pesquisa de cardiologia de um hospital público e universitário em Porto Alegre, Rio Grande do Sul. A adesão foi considerada como ≥ a 80 por cento. Foram revisados os registros de sete ECR (120 prontuários). Verificou-se que 117 (97 por cento) pacientes apresentaram adesão às visitas de seguimento ≥ a 80 por cento; 83,3 por cento dos pacientes apresentaram taxa de adesão ≥ 80 por cento à medicação do estudo; a mediana do número de comprimidos ingeridos entre os pacientes com boa adesão foi de 175 (72-500) e entre os pacientes com menor adesão foi de 500 (500-962). Estes resultados indicam que pacientes em estudos com seguimento mais longo e maior número de comprimidos apresentam prejuízo na adesão.

Estudio de cohorte histórica para evaluar la tasa de adherencia de los pacientes de ensayos clínicos randomizados (ECR) de la industria farmacéutica en la consulta de cardiología y el seguimiento de tratamiento médico. Un estudio realizado en la investigación en cardiología en un hospital público y de la universidad de Porto Alegre, Rio Grande Sul, Brasil. Alta adhesión fue considerada como un ≥ 80 por ciento. Revisado siete ECR (120 prontuarios). Se constató que 117 (97 por ciento) de los pacientes tenían la adhesión a las visitas de seguimiento a ≥ 80 por ciento, 83,3 por ciento de los pacientes tenían tasas de ≥ 80 por ciento la adherencia a la medicación en el estudio; la mediana del número de comprimidos ingeridos, entre pacientes con buena adherencia fue 175 (72-500) y entre los pacientes con menor adhesión fue 500 (500-962). Estos resultados indican que los estudios con seguimiento por más tiempo y mayor número de comprimidos perjudican la adhesión de pacientes.

Historical cohort study to assess the adherence rate of patients randomized clinical trials (RCT) of the pharmaceutical industry in the cardiology appointment and follow-up medical treatment. A study conducted at the cardiology research in a public hospital and university in Porto Alegre, Rio Grande do Sul, Brazil. High adherence was regarded as a ≥ 80 percent. Revised seven- RCT (120 medical records). It was found that 117 (97 percent) of patients had adherence to follow-up visits to ≥ 80 percent, 83.3 percent of patients had rates of ≥ 80 percent adherence to medication in the study; the median number of tablets ingested, among patients with good adherence was 175 (72-500) and among patients with lower adherence was 500 (500-962). These results indicate that patients in studies with longer follow up and greater number of oral medications present loss in adhesion.