Online Integrative Community Therapy in Latin America: Health Promotion in Times of COVID-19.

This study described integrative community therapy (ICT) in the online modality as a health promotion resource in the context of COVID-19 in Latin America, characterizing the ICT circles, the ICT training centers, and the community therapists involved in this practice. It is a descriptive, observational, and cross-sectional study with a quantitative approach. Data were collected from November 2020 to July 2021 through an online questionnaire created on the Google Forms platform. The study's first stage involved the participation of ICT training centers, while the second involved community therapists. Forty-three centers participated in the first stage; 86.1% offered online ICT in the period evaluated, and 74.4% trained professionals to implement this modality. In the second stage, 66 community therapists responded to the questionnaire. Of these, 49 (74.2%) resided in Brazil, 84.8% were female, and 72.7% performed the work voluntarily, with an average of 6.1 hours per week dedicated to online circles. Community-based circles were the most cited, followed by those linked to the public sector, with an average of 20.7 participants/circle in the period. The most frequent themes were stress and negative emotions, problems with work/unemployment, and family conflicts. Strengthening self-care, participation in ICT circles, and personal empowerment stood out among the coping strategies. In conclusion, online ICT proved to be an innovative resource for health promotion during the pandemic through the articulation and engagement of community therapists and different institutions, expanding solidary social networks, and showing itself as a sustainable practice in the Latin American scenario.

Core competencies for the training of advanced practice nurses in oncology: a Delphi study.

OBJECTIVE: To map out and validate the core competencies for the training of advanced practice nurses in oncology. METHODS: Exploratory-descriptive research with a quantitative approach using the Delphi technique. Initially, a matrix composed of six domains outlining 112 core competencies of the clinical nurse specialist in oncology was elaborated. The Likert scale was used to measure the degree of agreement. Data collection took place through the Google Forms® platform from February to May 2021. Data were compiled and analyzed based on expert suggestions and literature. RESULTS: 100 competencies achieved consensus (agreement level above 85.7%) in the first round; 13 new competencies were proposed by expert members; and 125 were validated during the Delphi technique. CONCLUSION: The mapping and validation of core competencies will allow the development of new training models aimed at advanced practice in oncology and future educational harmonization.

Cross-cultural measurement invariance of the fear of COVID-19 scale in three Portuguese-speaking countries.

This study evaluated the measurement invariance of the Portuguese version of the Fear of COVID-19 Scale (FCV-19S) across three countries: Brazil (South America), Mozambique (East Africa), and Portugal (Southwest Europe). A total of 8694 participants were recruited through convenience sampling (7430 Brazilians, 387 Mozambicans, and 877 Portuguese adults). The unidimensional structure of the FCV-19S fitted well with each country's data. Multigroup confirmatory factor analysis showed that the FCV-19S was partially invariant across countries and fully invariant across gender and age groups, thus providing a solid basis for cross-group comparisons. Structural invariance tests revealed different levels of fear across countries and genders but not across age groups.

Fear of COVID-19 scale: Assessing fear of the coronavirus pandemic in Brazil.

This study aimed to assess the fear of COVID-19 in the Brazilian population, validate the FCV-19S and examine the association of its scores with sociodemographic and pandemic-related variables. A total of 7430 participants were recruited in an online survey. From the factor analysis results, FCV-19S proved to be suitable, indicating a higher level of fear for women and also for those aged 18-29 years. Besides, belonging to a high-risk group and having relatives diagnosed or deceased by COVID-19 showed a positive association with fear. These findings pointed out the most vulnerable groups, which can assist in planning mental health actions.

Risk perception of COVID-19: Susceptibility and severity perceived by the Brazilian population.

This study investigated how the Brazilian population perceived the risk of COVID-19, people's behavior in response to the pandemic, and trust in the health system in case of COVID-19 infection. The sample comprised 7430 Brazilian recruited through non-probability sampling. Association analysis was performed using logistic regression. The results revealed that the economically active population and those who lived with health professionals most perceived greater susceptibility to infection. In addition, the high severity of COVID-19 was more perceived by the elderly and by those who lived with individuals in high-risk groups.

Core competencies for the training of advanced practice nurses in oncology: a Delphi study / Competencias centrales para la formación del enfermero de práctica avanzada en oncología: un estudio Delphi / Competências centrais para a formação do enfermeiro de prática avançada em oncologia: um estudo Delphi

ABSTRACT Objective: To map out and validate the core competencies for the training of advanced practice nurses in oncology. Methods: Exploratory-descriptive research with a quantitative approach using the Delphi technique. Initially, a matrix composed of six domains outlining 112 core competencies of the clinical nurse specialist in oncology was elaborated. The Likert scale was used to measure the degree of agreement. Data collection took place through the Google Forms® platform from February to May 2021. Data were compiled and analyzed based on expert suggestions and literature. Results: 100 competencies achieved consensus (agreement level above 85.7%) in the first round; 13 new competencies were proposed by expert members; and 125 were validated during the Delphi technique. Conclusion: The mapping and validation of core competencies will allow the development of new training models aimed at advanced practice in oncology and future educational harmonization.

RESUMEN Objetivo: Mapear y validar competencias centrales para la formación del enfermero de práctica avanzada en oncología. Métodos: Investigación exploratoria-descriptiva, de abordaje cuantitativo, con utilización de la técnica Delphi. Inicialmente, elaborado una matriz compuesta por seis dominios, con 112 competencias centrales del enfermero clínico especialista en oncología. Utilizado la escala de Likert para mensurar el grado de concordancia. La recolecta de datos ocurrió mediante la plataforma Google Forms® de febrero a mayo de 2021. Los datos fueron compilados y analizados basados en las sugestiones de especialistas y la literatura. Resultados: 100 competencias obtuvieron consenso (nivel de concordancia arriba de 85,7%) en la primera rodada; 13 nuevas competencias fueron propuestas por los miembros especialistas; y 125 fueron validadas en el transcurrir de la técnica Delphi. Conclusión: El mapeo y validación de competencias centrales permitirán la elaboración de nuevos modelos de formación vueltos a la práctica avanzada en oncología y harmonización educacional futura.

Resumo Objetivo: Mapear e validar as competências centrais para a formação do enfermeiro de prática avançada em oncologia. Métodos: Pesquisa exploratório-descritiva, de abordagem quantitativa, com utilização da técnica Delphi. Inicialmente, elaborou-se uma matriz composta por seis domínios, com 112 competências centrais do enfermeiro clínico especialista em oncologia. Utilizou-se a escala de Likert para mensurar o grau de concordância. A coleta de dados ocorreu por meio da plataforma Google Forms® de fevereiro a maio de 2021. Os dados foram compilados e analisados com base nas sugestões de especialistas e na literatura. Resultados: 100 competências obtiveram consenso (nível de concordância acima de 85,7%) na primeira rodada; 13 novas competências foram propostas pelos membros especialistas; e 125 foram validadas no transcorrer da técnica Delphi. Conclusão: O mapeamento e a validação de competências centrais permitirão a elaboração de novos modelos de formação voltados para a prática avançada em oncologia e harmonização educacional futura.

Gender and pandemic perception: analyzing perceived risk and fear among Brazilian women.

OBJECTIVE: The World Health Organization has warned of the importance of looking at the pandemic from a gender perspective since biological, social, and cultural aspects can produce differences in the way women and men experience the ongoing pandemic situation. This study aimed to investigate Brazilian women's perception of COVID-19 concerning the susceptibility to infection, the severity of COVID-19, and the collective behavior in response to pandemic risks. It also sought to examine the COVID-19 level of perceived fears by the level of fear across specific COVID-19 fears, such as the risk of infection and the threat posed to life. METHODS: The sample consisted of 5527 Brazilian women aged between 18 and 74 years (mean age = 41, SD = 13.5) recruited from an online cross-sectional survey conducted in Brazil. The analysis addressed questions about the chance of COVID-19 infection, the impact on daily activities in case of infection, the threat to life posed by COVID-19, and the collective behavior in the pandemic context. In addition, the fear of COVID-19 was assessed using the Fear of COVID-19 Scale (FCV-19S). RESULTS: Women's age and personal conditions, particularly those related to family and domestic life, showed association with the perceived susceptibility to infection and the severity of COVID-19. The higher the perceived susceptibility and severity, the greater the fear level. The fear level was also higher among women whose perception was that people were ignoring the pandemic risks. CONCLUSION: This study provides insight into Brazilian women's perception of COVID-19 and their fear level during the pandemic's early stages. Our findings can increase the understanding of the adverse consequences caused by the COVID-19 pandemic on women, assisting in the strategic planning of public policies.

Validation of the FCV-19 Scale and Assessment of Fear of COVID-19 in the Population of Mozambique, East Africa.

PURPOSE: This study aimed to validate the Portuguese version of the Fear of COVID-19 Scale (FCV-19S) and investigate its association with sociodemographic and pandemic-related variables in the population of Mozambique. PARTICIPANTS AND METHODS: A cross-sectional online survey recruited 387 Mozambicans aged 18 to 70 years. The psychometric properties of the Portuguese version of the FCV-19S were evaluated using confirmatory factor analysis and Rash analysis. Additionally, the association of the FCV-19S with sociodemographic and pandemic-related variables was investigated using the two-sample t-test, one-way analysis of variance, and logistic regression. RESULTS: The unidimensional factor structure of the Portuguese version of the FCV-19S was confirmed, and the scale showed good internal consistency reliability. The FCV-19S properties tested from the Rasch analysis were satisfactory. Women and those with lower education levels had higher scores of fear. Moreover, significantly higher levels of fear were observed among those being in an at-risk group for COVID-19, having family members or friends diagnosed or with death confirmed by COVID-19, and not being confident that they would receive adequate care from the public health services in case of COVID-19 infection. CONCLUSION: The Portuguese version of FCV-19S has strong psychometric properties and can be used to assess the fear of COVID-19 in the Portuguese-speaking population of Mozambique. As the adverse impacts of the COVID-19 pandemic on mental health represents a challenge to clinical psychiatry, and information on mental health in African countries is still scarce, our findings may assist in the planning of public mental health policies, aimed mainly at specific segments of the population, such as women and people in extreme poverty.

Survival analysis of patients with heart failure: implications of time-varying regression effects in modeling mortality.

BACKGROUND: Several models have been designed to predict survival of patients with heart failure. These, while available and widely used for both stratifying and deciding upon different treatment options on the individual level, have several limitations. Specifically, some clinical variables that may influence prognosis may have an influence that change over time. Statistical models that include such characteristic may help in evaluating prognosis. The aim of the present study was to analyze and quantify the impact of modeling heart failure survival allowing for covariates with time-varying effects known to be independent predictors of overall mortality in this clinical setting. METHODOLOGY: Survival data from an inception cohort of five hundred patients diagnosed with heart failure functional class III and IV between 2002 and 2004 and followed-up to 2006 were analyzed by using the proportional hazards Cox model and variations of the Cox's model and also of the Aalen's additive model. PRINCIPAL FINDINGS: One-hundred and eighty eight (188) patients died during follow-up. For patients under study, age, serum sodium, hemoglobin, serum creatinine, and left ventricular ejection fraction were significantly associated with mortality. Evidence of time-varying effect was suggested for the last three. Both high hemoglobin and high LV ejection fraction were associated with a reduced risk of dying with a stronger initial effect. High creatinine, associated with an increased risk of dying, also presented an initial stronger effect. The impact of age and sodium were constant over time. CONCLUSIONS: The current study points to the importance of evaluating covariates with time-varying effects in heart failure models. The analysis performed suggests that variations of Cox and Aalen models constitute a valuable tool for identifying these variables. The implementation of covariates with time-varying effects into heart failure prognostication models may reduce bias and increase the specificity of such models.

[Factors associated with duration of breastfeeding for children of low-income families from southern Curitiba, Paraná State, Brazil]. / Fatores associados à duração do aleitamento materno em crianças de famílias de baixa renda da região sul da cidade de Curitiba, Paraná, Brasil.

Various studies have focused on breastfeeding and the possible factors associated with early weaning. This study aimed to identify risk factors and protective factors for duration of breastfeeding in low-income families in southern Curitiba, Paraná State, Brazil. A cohort study from November 2006 to March 2007 included 118 mothers of children less than two years of age and enrolled in the TC Health Unit (USTC) located in the southern area of Curitiba. Statistical analyses using the Kaplan-Meier method and Cox regression model identified the following protective factors for breastfeeding: mother's awareness of the benefits of extended breastfeeding, exclusive feeding with mother's breast milk while in the maternity ward, and rooming-in. Factors contributing to early weaning were low birth weight, mother's work outside the home, and difficulties experienced by the mother in breastfeeding during the first days postpartum.

Fatores associados à duração do aleitamento materno em crianças de famílias de baixa renda da região sul da cidade de Curitiba, Paraná, Brasil / Factors associated with duration of breastfeeding for children of low-income families from southern Curitiba, Paraná State, Brazil

O aleitamento materno e os possíveis fatores associados ao desmame precoce têm sido alvos de diversos estudos. Este trabalho teve como objetivo identificar, em famílias de baixa renda da região sul de Curitiba, Paraná, Brasil, fatores de risco ou de proteção associados à duração do aleitamento materno. Um estudo de coorte foi conduzido entre novembro de 2006 e março de 2007 com 118 mães de crianças menores de dois anos de idade com vínculo na Unidade de Saúde TC (USTC), localizada na região sul de Curitiba. Análises estatísticas realizadas com o auxílio do método de Kaplan-Meier e do modelo de regressão de Cox apontaram como fatores protetores do aleitamento materno: a consciência da mãe sobre os benefícios da amamentação por tempo estendido, a amamentação da criança com leite exclusivamente materno na maternidade e o alojamento conjunto da mãe e criança na maternidade. Por outro lado, o baixo peso da criança ao nascimento, o trabalho da mãe fora de casa e as dificuldades encontradas pela mãe para amamentar nos primeiros dias pós-parto foram fatores apontados como contribuidores do desmame precoce.

Various studies have focused on breastfeeding and the possible factors associated with early weaning. This study aimed to identify risk factors and protective factors for duration of breastfeeding in low-income families in southern Curitiba, Paraná State, Brazil. A cohort study from November 2006 to March 2007 included 118 mothers of children less than two years of age and enrolled in the TC Health Unit (USTC) located in the southern area of Curitiba. Statistical analyses using the Kaplan-Meier method and Cox regression model identified the following protective factors for breastfeeding: mother's awareness of the benefits of extended breastfeeding, exclusive feeding with mother's breast milk while in the maternity ward, and rooming-in. Factors contributing to early weaning were low birth weight, mother's work outside the home, and difficulties experienced by the mother in breastfeeding during the first days postpartum.

Fit of cast commercially pure titanium and Ti-6Al-4V alloy crowns before and after marginal refinement by electrical discharge machining.

STATEMENT OF PROBLEM: Titanium has been suggested as a replacement for alloys currently used in single-tooth restorations and fixed partial dentures. However, difficulties in casting have resulted in incomplete margins and discrepancies in marginal fit. PURPOSE: This study evaluated and compared the marginal fit of crowns fabricated from a commercially pure titanium (CP Ti) and from Ti-6Al-4V alloy with crowns fabricated from a Pd-Ag alloy that served as a control. Evaluations were performed before and after marginal refinement by electrical discharge machining (EDM). MATERIAL AND METHODS: Forty-five bovine teeth were prepared to receive complete cast crowns. Stone and copper-plated dies were obtained from impressions. Fifteen crowns were cast with each alloy (CP Ti, Ti-6Al-4V, and Pd-Ag). Marginal fit measurements (in micrometers) were recorded at 4 reference points on each casting with a traveling microscope. Marginal refinement with EDM was conducted on the titanium-based crowns, and measurements were repeated. Data were analyzed with the Kruskal-Wallis test, paired t test, and independent t test at a 1% probability level. RESULTS: The Kruskal-Wallis test showed significant differences among mean values of marginal fit for the as-cast CP Ti crowns (mean [SD], 83.9 [26.1] microm) and the other groups: Ti-6Al-4V (50.8 [17.2] microm) and Pd-Ag (45.2 [10.4] microm). After EDM marginal refinement, significant differences were detected among the Ti-6Al-4V crowns (24.5 [10.9] microm) and the other 2 groups: CP Ti (50.6 [20.0] microm) and Pd-Ag (not modified by EDM). Paired t test results indicated that marginal refinement with EDM effectively improved the fit of CP Ti crowns (from 83.9 to 50.6 microm) and Ti-6Al-4V crowns (from 50.8 to 24.5 microm). However, the difference in improvement between the two groups was not significant by t test. CONCLUSION: Within the limitations of this study, despite the superior results for Ti-6Al-4V, both groups of titanium-based crowns had clinically acceptable marginal fits. After EDM marginal refinement, the fit of cast CP Ti and Ti-6Al-4V crowns improved significantly.