Content analysis of the nursing diagnosis of ineffective peripheral tissue perfusion in patients with diabetic foot.

AIM: To analyse the content of the nursing diagnosis ineffective peripheral tissue perfusion in patients with diabetic foot. DESIGN: A methodological study with a quantitative approach was performed. METHODS: The analysis was performed between January and May 2021 by 34 nurses with clinical/theoretical/research experience with diabetes or nursing diagnoses. These nurses evaluated the relevance, clarity and precision of 12 diagnosis-specific etiological factors, 22 clinical indicators and their conceptual and operational definitions. FINDINGS: All 12 etiological factors analysed were considered relevant to diagnostic identification. However, five showed inconsistencies regarding the clarity or precision of the operational definitions, requiring adjustments. Regarding the 22 clinical indicators evaluated, all of them presented a Content Validity Index (CVI) that was statistically significant. However, in the indicators, the colour does not return to lowered limb after 1 min of leg elevation, and cold foot had Content Validity Index (CVI) <0.9 regarding relevance and accuracy of operational definitions. CONCLUSIONS: Twelve etiological factors and 22 clinical indicators were validated. Thus, this study revealed new and relevant aspects characterising peripheral perfusion in patients with diabetic foot that have not yet been clinically validated. IMPLICATIONS FOR NURSING PRACTICE: This study contributes to support the professional practice of nurses through the early identification of etiological factors and clinical indicators in persons with diabetic foot. As a proposal, we suggest the inclusion of new defining characteristics and related factors for the nursing diagnosis ineffective peripheral tissue perfusion in the NANDA-I taxonomy. IMPACT: The research highlights new and relevant aspects such as etiological factors and clinical indicators to characterise peripheral perfusion in patients with diabetic foot. Based on these findings, clinical validation is recommended to confirm the relevance of the proposed elements in the population studied for greater reliability and improved diagnostic assessment for the professional practice of nurses. REPORTING METHOD: EQUATOR guidelines were adhered to using the GRRAS checklist for reporting reliability and agreement studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Effect of cashew nut flour on hematological parameters of children living with HIV.

Aim: To assess the effect of cashew nut flour on the hematological parameters of children living with HIV-AIDS. Method: A 32-week randomized, blind clinical trial conducted at a specialized outpatient clinic. Children aged 2-12 years were allocated to intervention groups (IGs) (n = 11) receiving 12 g/day of cashew nut flour and control groups (CGs) (n = 9) receiving 12 g/day of carboxymethyl cellulose. Parameters of erythrocytes, leukocytes, platelets, and lipid profiles were evaluated. Results: In the IG, the elevation and reduction of leukocyte and lipid profile biomarkers, respectively, were not statistically significant (p > 0.05). A clinically and statistically significant increase in mean corpuscular hemoglobin concentration was observed in the CG (p = 0.018), with a large effect size (Cohen's d = 0.9). There were no statistically significant changes in platelet counts among participants (p = 0.18). The effect size for white blood cell count, low-density lipoprotein cholesterol, very low-density lipoprotein, and triglycerides was moderate in the IG compared to the CG. Conclusion: Cashew nut flour supplementation may increase levels of leukocytes and lipid profile parameters in children living with HIV. Brazilian Clinical Trials Registry (REBEC): U1111.1276.6591.

Influence of simultaneous comorbidities on COVID-associated acute respiratory distress syndrome mortality in people with diabetes.

Objectives: This study analyzed the influence of 23 comorbidities on COVID-associated acute distress respiratory syndrome (CARDS) mortality in people with a history of diabetes mellitus. Methods: An observational, analytical, cross sectional study was utilized to investigate data from 6723 health services in Brazil, comprising 5433 people with diabetes. Adjusted logistic regression models for demographic factors such as age, sex, and race were used to analyze the association between CARDS mortality and comorbidities. Results: Persons with two (p < 0.001), three (p < 0.001), four (p < 0.001), and five (p < 0.001) simultaneous comorbidities had a higher chance of dying. We identified that diabetes patients who had concomitant metabolic diseases (p = 0.019), neurological disorders (p < 0.001), or were smokers (p < 0.001) had a higher predicted mortality risk based on CADRS. Conclusion: The number of comorbidities plays a determining role in CARDS mortality in people with diabetes, especially those who suffer from smoking and neurological diseases simultaneously.

Vulnerable territories to tuberculosis-diabetes mellitus comorbidity in a northeastern Brazilian scenario.

INTRODUCTION: Epidemiological investigations on tuberculosis-diabetes comorbidity using spatial analysis should be encouraged towards a more comprehensive view of the health of individuals affected by such comorbidity in different contexts. This study analyzes the territories vulnerable to tuberculosis-diabetes comorbidity in a municipality in northeastern Brazil using spatial analysis techniques. METHODS: An ecological study was carried out in Imperatriz, Maranhão, Brazil. Tuberculosis-diabetes cases reported in the Brazilian Notifiable Diseases Information System between 2009 and 2018 were analyzed. Kernel density estimation and spatial scanning techniques were used to identify the areas with the greatest occurrence of spatial clusters. RESULTS: A heterogeneous spatial distribution was found, ranging from 0.00 to 4.12 cases/km2. The spatial scanning analysis revealed three high-risk spatial clusters with statistical significance (p < 0.05), involving eleven strictly urban sectors with a relative risk of 4.00 (95% CI: 2.60-6.80), 5.10 (95% CI: 2.75-7.30), and 6.10 (95% CI: 3.21-8.92), indicating that the population living in these areas had a high risk of tuberculosis-diabetes comorbidity. CONCLUSIONS: The highest concentration of cases/km2, as well as risk clusters, were found in areas with high circulation of people and socio-economic and environmental vulnerabilities. Such findings reinforce the need for public health interventions to reduce social inequalities.

Tuberculosis/HIV co-infection in Northeastern Brazil: Prevalence trends, spatial distribution, and associated factors.

INTRODUCTION: The objective was to analyze the prevalence trend, spatial distribution, and TB-HIV co-infection-associated factors in an endemic scenario for TB in Northeastern Brazil. METHODS: An ecological and temporal series study was conducted based on secondary data obtained from the Brazilian Notifiable Diseases Information System between January 2008 and December 2019. The prevalence rates were determined for each year and the average for the period. Prais-Winsten regressions were used for temporal variation analysis, scanning techniques were used to detect spatial clusters, and the Poisson regression model was used to explore the factors associated with the outcome. RESULTS: A total of 947 TB cases were reported, of which 501 (52.9%) underwent HIV testing, and of these, 73 were positive. The average prevalence was 20.0%, ranging from 1.5% in 2018 to 44.4% in 2009. A decreasing trend was found. Sixty-seven cases (92%) were geocoded, and two statistically significant (p < 0.005) high relative risk (RR) spatial clusters were detected. Statistically significant associations (p < 0.05) between the co-infection and variables such as male gender, living in the urban area, entry due to relapse, and case closure due to loss to follow-up were evidenced, and these variables constituted risk factors. CONCLUSIONS: A decreasing prevalence of TB-HIV co-infection has been found, as well as a heterogeneous spatial distribution with the formation of spatial clusters in urban areas characterized by socio-spatial inequalities associated with clinical-epidemiological factors. Such findings provide subsidies for rethinking health care activities and improving public policies for vulnerable populations.

Avaliação do uso de álbum seriado sobre amamentação como estratégia de intervenção educativa no puerpério / Evaluation of the use of a flipchart about breastfeeding as an educational intervention strategy in the puerperium

Introdução: A amamentação é um ato que vai além de nutrir a criança. A implementação de tecnologias educacionais pode favorecer a promoção do aleitamento materno. Objetivo: Avaliar o uso de álbum seriado sobre amamentação com estratégia de intervenção educativa no puerpério imediato entre puérperas de maternidade pública de acordo com o perfil sociodemográfico e obstétrico. Materiais e métodos: Estudo quase-experimental de modelo pré e pós-teste com único grupo, realizado entre novembro de 2019 e março de 2020. Dados coletados através da escala de autoeficácia em aleitamento materno Breastfeeding Self-Efficacy Scale ­ short form. Avaliou-se a quantidade de mulheres em alta autoeficácia antes e depois da intervenção. Por não apresentarem normalidade e/ou homogeneidade de variância, foram realizados testes não paramétricos de Kruskal-Wallis com post-hoc de Nemenyi. Resultados: Os resultados demonstraram que houve aumento da autoeficácia após a intervenção, sobretudo em puérperas menores de 18 anos, com Ensino Fundamental, donas de casa, com menos de seis consultas, as orientadas sobre amamentação no pré-natal e as que não amamentaram anteriormente. Discussão: O perfil sociodemográfico das genitoras pode representar influência sobre a autoeficácia na amamentação. Conclusão: a tecnologia educativa foi eficaz no aumento da autoeficácia materna em amamentar no puerpério imediato.

Introduction: Breastfeeding is an act that goes beyond nourishing the child. The implementation of educational technologies can favor the promotion of breastfeeding. Objective: To evaluate the use of a flipchart about breastfeeding as an educational intervention strategy in the immediate postpartum period among mothers in a public maternity hospital according to their sociodemographic and obstetric profile. Materials and Methods: Quasi-experimental study of a pre- and post-test model with a single group, carried out between November 2019 and March 2020. Data collected through the Breastfeeding Self-Efficacy Scale ­ short form. The number of women with high self-efficacy before and after the intervention was evaluated. As they did not show normality and/or homogeneity of variance, non-parametric Kruskal-Wallis tests with post-hoc Nemenyi tests were performed. Results: The results showed that there was an increase in self-efficacy after the intervention, especially in puerperal women under 18 years of age, with Elementary Education, housewives, with less than six consultations, those oriented about breastfeeding during prenatal care and those who had not previously breastfed. Discussion: The sociodemographic profile of mothers may influence self-efficacy in breastfeeding. Conclusion: educational technology was effective in increasing maternal self-efficacy in breastfeeding in the immediate puerperium.

Introducción: La lactancia materna es un acto que va más allá de nutrir al niño. La implementación de tecnologías educativas puede favorecer la promoción de la lactancia materna. Objetivo: Evaluar el uso de un rotafolio sobre lactancia materna como estrategia de intervención educativa en el puerperio inmediato en puérperas de una maternidad pública según su perfil sociodemográfico y obstétrico. Materiales y Métodos: Estudio cuasiexperimental de un modelo de pre y post test con un solo grupo, realizado entre noviembre de 2019 y marzo de 2020. Datos recolectados a través de la Escala de Autoeficacia en Lactancia Materna ­ forma corta. Se evaluó el número de mujeres con alta autoeficacia antes y después de la intervención. Debido a que no mostraron normalidad y/u homogeneidad de varianza, se realizaron pruebas no paramétricas de Kruskal-Wallis con pruebas post-hoc de Nemenyi. Resultados: Los resultados mostraron que hubo un aumento en la autoeficacia después de la intervención, especialmente en las puérperas menores de 18 años, con Educación Primaria, amas de casa, con menos de seis consultas, las orientadas sobre lactancia materna durante el prenatal y las que tenían no amamantado previamente. Discusión: El perfil sociodemográfico de las madres puede influir en la autoeficacia en la lactancia. Conclusión: la tecnología educativa fue efectiva para aumentar la autoeficacia materna en la lactancia materna en el puerperio inmediato.