Accuracy of the defining characteristics of the nursing diagnosis ineffective peripheral tissue perfusion in patients with diabetic foot.

OBJECTIVE: To evaluate the accuracy of the defining characteristics of the nursing diagnosis ineffective peripheral tissue perfusion in patients with diabetic foot. METHOD: A diagnostic accuracy study with a cross-sectional design was carried out with patients with type 2 diabetes mellitus on outpatient diabetic foot treatment. We evaluated 134 patients with diabetic foot to determine the accuracy of the defining characteristics of ineffective peripheral tissue perfusion. A latent class model with random effects was used to establish the sensitivity and specificity of the defining characteristics assessed. RESULTS: Ineffective peripheral tissue perfusion was present in 83.79% of the patients. The defining characteristics color does not return to lowered limb after 1-minute leg elevation and edema had high sensitivity (0.8370 and 0.7213) and specificity (0.9991 and 0.9995). CONCLUSION: The defining characteristics color does not return to lowered limb after 1-minute leg elevation and edema are good clinical indicators that can be used for screening and confirming ineffective peripheral tissue perfusion in patients with diabetic foot.

Analysis of Readiness for enhanced health literacy in patients with type 2 diabetes mellitus.

PURPOSE: To estimate the prevalence of Readiness for enhanced health literacy in patients with type 2 diabetes mellitus through the diagnostic accuracy of the defining characteristics. METHODS: A diagnostic accuracy study on the diagnosis of Readiness for enhanced health literacy in patients with type 2 diabetes mellitus was conducted using the latent class analysis model. The sample comprised 180 individuals attending a referral outpatient clinic in Maranhão, Brazil. The data analysis was conducted in the R Core Team software. FINDINGS: The prevalence of the nursing diagnosis was 55.23%. The main defining characteristics were expresses desire to enhance health communication with healthcare providers and expresses desire to enhance the understanding of health information to make healthcare choices. All defining characteristics showed significant specificity values. CONCLUSIONS: Accurate diagnoses contribute to individualized care plans for patients. IMPLICATIONS FOR NURSING PRACTICE: The diagnosis Readiness for enhanced health literacy should be considered in implementing care plans, including interventions to reduce complications in the health status of patients with type 2 diabetes mellitus.

COVID-19 em profissionais de enfermagem no Maranhão (2020-2021): características clínico-epidemiológicas dos casos e fatores associados aos óbitos / COVID-19 in nursing professionals in Maranhão (2020-2021): clinical-epidemiological characteristics of cases and factors associated with deaths / COVID-19 en profesionales de enfermería en Maranhão (2020-2021): características clínico-epidemiológicas de casos y factores asociados a muerte

Objetivo: descrever características clínico-epidemiológicas dos casos de COVID-19 em profissionais de enfermagem e analisar fatores associados aos óbitos. Método: estudo transversal realizado com casos e óbitos por COVID-19 em profissionais de enfermagem registrados no período entre abril de 2020 e março de 2021 no estado do Maranhão. Utilizou-se a estatística descritiva e modelos de regressão logística. Resultados: verificaram-se 2.116 casos de COVID-19 em profissionais de enfermagem, a maioria eram técnicos (63,23%), sexo feminino (86,48%), raça/cor preta/parda (48,20%), na faixa etária de 31 a 40 anos (40,69%) e média de idade de 38,11 anos (DP=9,58). A hipertensão arterial sistêmica foi a principal comorbidade apresentada (62,03%). Os fatores de risco para o óbito foram: idade >60 anos, comorbidades como hipertensão arterial sistêmica, diabetes mellitus e obesidade. Conclusão: esses dados podem direcionar intervenções em saúde mais efetivas com intuito de minimizar os riscos de infecção e os danos à saúde desses trabalhadores.

Objective: to identify clinical-epidemiological characteristics of two cases of COVID-19 in nursing professionals and to analyze factors associated with deaths. Method: a cross-sectional study was carried with cases and deaths from COVID-19 in nursing professionals registered between April 2020 and March 2021 in Maranhão. Descriptive statistics and logistic regression models were used. Results: we verified 2,116 cases of COVID-19 in nursing professionals, mostly among technicians (63.23%), females (86.48%), of black/white/brown ethnicity (48.20%), aged from 31 to 40 years (40.69%), and with a mean age of 38.11 years (SD=9.58). Systemic arterial hypertension was the main comorbidity (62.03%). The risk factors for death are age >60 years and comorbidities such as systemic arterial hypertension, diabetes mellitus, and obesity. Conclusion: our findings can support more effective health interventions to minimize the risk of infection and damage to the health of these workers.

Objetivo: identificar las características clínico-epidemiológicas de casos de COVID-19 en profesionales de enfermería y analizar los factores asociados a muertes. Método: se realizó un estudio transversal con casos y muertes por COVID-19 en profesionales de enfermería registrados entre abril de 2020 y marzo de 2021 en Maranhão. Se utilizaron estadísticas descriptivas y modelos de regresión logística. Resultados: verificamos 2.116 casos de COVID-19 en profesionales de enfermería, en su mayoría técnicos (63,23%), del sexo femenino (86,48%), de etnia negra/blanca/morena (48,20%), con edad de 31 a 40 años (40,69%) y edad media de 38,11 años (DE=9,58). La hipertensión arterial sistémica fue la principal comorbilidad presentada (62,03%). Los factores de riesgo de muerte fueron: edad > 60 años y comorbilidades como hipertensión arterial sistémica, diabetes mellitus y obesidad. Conclusión: esos hallazgos pueden respaldar intervenciones de salud más efectivas para minimizar el riesgo de infección y daño a la salud de estos trabajadores.

Therapeutic Potential of Punica granatum and Isolated Compounds: Evidence-Based Advances to Treat Bacterial Infections.

Punica granatum Linn has been known for its nutritional and medicinal value since ancient times and is used in the treatment of various pathologies owing to its antibacterial properties. This review reports the results of the most recent studies on the antibacterial effects of P. granatum and its isolated compounds on bacteria of clinical interest. A search in the PubMed, Scopus, Science Direct, and Science Citation Index Expanded (Web of Science) databases was performed, which included articles that evaluated the antibacterial activity of P. granatum extracts and excluded articles that analyzed other microorganisms or nonpathogenic bacteria, as well as theses, dissertations, duplicate articles, and those not fully available. The literature suggests that P. granatum extracts can act on bacteria, such as methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), Streptococcus mutans, Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae. In addition, fruit peel was the most commonly used pharmacogen and methanol, ethanol, and water were the most common solvents for the extraction of bioactive compounds. The antibacterial potential of the methanolic extract of pomegranate peel could be attributed to the presence of active compounds, such as 5-hydroxymethylfurfural, punicic acid, gallic acid, and punicalagin. Thus, there is evidence that these plant extracts, having high polyphenol content, can disrupt the bacterial plasma membrane and inhibit the action of proteins related to antimicrobial resistance. P. granatum shows antibacterial activity against Gram-positive and Gram-negative bacteria, with great potential against multidrug-resistant strains. Further research is needed to clarify the mechanism of action related to this biological activity and investigate the isolated substances that may be responsible for the antibacterial effects.

Individual, socioeconomic and healthcare access factors influencing the delays in leprosy presentation, diagnosis and treatment: a qualitative study.

BACKGROUND: This study investigated the factors influencing the presentation, diagnosis and treatment of leprosy in primary healthcare. METHODS: Qualitative research was conducted on patients undergoing treatment in a priority hyperendemic region for leprosy control in northeastern Brazil. Interviews were conducted between September and December 2020 at primary healthcare centers. Data were analysed based on the basic interpretive qualitative structure according to Andersen and Newman's model of healthcare utilisation. RESULTS: Knowledge of leprosy symptoms influenced patients' search for a diagnosis. Unfavorable socioeconomic conditions experienced by patients made diagnosis and treatment difficult. Incorrect evaluations by health professionals caused difficulties and delays in obtaining a diagnosis of leprosy. Perceptions about the disease, such as non-acceptance of the disease and the adverse effects of the medications, affected treatment seeking and treatment continuity. CONCLUSIONS: Patients with leprosy faced delays and healthcare access barriers related to knowledge of the disease, socioeconomic conditions and the structure of healthcare services, which must be considered when creating care plans, surveillance and control actions against leprosy. Appropriate interventions are necessary to reduce delays and better control the disease.

Immunomodulatory Activity of Probiotics in Models of Bacterial Infections.

As resistance to conventional antibiotics among bacteria continues to increase, researchers are increasingly focusing on alternative strategies for preventing and treating bacterial infections, one of which is microbiota modulation. The objective of this review is to analyze the scientific literature on the immunomodulatory effects of probiotics in bacterial infections. This is an integrative review of the literature based on systematic steps, with searches performed in the databases Medline, PubMed, Scopus, Embase, and ScienceDirect. The most prevalent bacterial genera used to evaluate infectious processes were Salmonella, Escherichia, Klebsiella, and Streptococcus. Lactobacillus was the most commonly used probiotic genus, with Lactobacillus delbrueckii subsp. bulgaricus is the most frequently used species. In most studies, prophylactic treatment with concentrations of probiotics equal to or greater than 8 log CFU/mL was chosen. However, there was considerable heterogeneity in terms of effective treatment duration, indicating that the results cannot be generalized across all studies. This review found that probiotics interact with the immune system through different mechanisms and have a positive effect on preventing different types of bacterial infections.

Spatiotemporal risk assessment and COVID-19 trend estimation in a federative unit in northeastern Brazil.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread worldwide, causing a high burden of morbidity and mortality, and has affected the various health service systems in the world, demanding disease monitoring and control strategies. The objective of this study was to identify risk areas using spatiotemporal models and determine the COVID-19 time trend in a federative unit of northeastern Brazil. METHODS: An ecological study using spatial analysis techniques and time series was carried out in the state of Maranhão, Brazil. All new cases of COVID-19 registered in the state from March 2020 to August 2021 were included. Incidence rates were calculated and spatially distributed by area, while the spatiotemporal risk territories were identified using scan statistics. The COVID-19 time trend was determined using Prais-Winsten regressions. RESULTS: Four spatiotemporal clusters with high relative risks for the disease were identified in seven health regions located in the southwest/northwest, north and east of Maranhão. The COVID-19 time trend was stable during the analysed period, with higher rates in the regions of Santa Inês in the first and second waves and Balsas in the second wave. CONCLUSIONS: The heterogeneously distributed spatiotemporal risk areas and the stable COVID-19 time trend can assist in the management of health systems and services, facilitating the planning and implementation of actions toward the mitigation, surveillance and control of the disease.

Síndrome Respiratória Aguda Grave por COVID-19: Perfil Clínico- Epidemiológico e Distribuição Espacial dos Óbitos nas Unidades Federativas do Brasil / Severe Acute Respiratory Syndrome by COVID-19: Clinical- Epidemiological Profile and Spatial Distribution of Deaths in the States of Brazil

A Síndrome Respiratória Aguda Grave (SRAG) é uma manifestação grave da infeção por COVID-19 que, em alguns casos, pode resultar em morte. No cenário epidemiológico global atual, o Brasil é o segundo país em número de óbitos pela doença, assim, faz-se necessário conhecer características clínico-epidemiológicas dos óbitos e como se distribuem espacialmente pelos territórios. Desse modo, objetivou-se descrever as características clínico-epidemiológicas e a distribuição espacial dos óbitos de SRAG por COVID-19 nas unidades federativas do Brasil. Trata-se de estudo descritivo e ecológico dos óbitos de SRAG por COVID-19 nos estados brasileiros, no período de março de 2020 a junho de 2021, a partir de dados secundários disponíveis no openDataSUS. Realizou-se estatística descritiva para as variáveis clínico-epidemiológicas e determinaram-se as taxas de mortalidade mensais por unidade federada e foram confeccionados mapas temáticos no software QGIS versão 2.4.17. Foram registrados 196.109 óbitos no período investigado, sendo predominante o sexo masculino, idade avançada, cor branca e baixa escolaridade. Nas variáveis clínicas, destacaram-se tosse, desconforto respiratório, dispneia e presença de comorbidades. Observou-se distribuição espacial heterogênea dos óbitos, com taxas variando de 0,00 a 24,59 óbitos/100 mil habitantes, as maiores taxas foram nos estados do Rio de Janeiro, Amazonas, Ceará, Sergipe, São Paulo e Pernambuco. Tais achados suscitam a necessidade de investimentos por parte da gestão pública e dos sistemas e serviços de saúde dos estados mais afetados, aperfeiçoamentos da vigilância epidemiológica, educação permanente em saúde, ampliação do acesso à imunização e medidas de prevenção de saúde para controle e monitoramento da SRAG por COVID-19.

Severe Acute Respiratory Syndrome (SARS) is a severe manifestation of COVID-19 infection that, in some cases, can result in death. In the current global epidemiological scenario, Brazil is the second country with highest number of deaths from the disease; thus, it is necessary to know the clinical and epidemiological characteristics of deaths and how they are spatially distributed across territories. Therefore, the objective was to describe the clinical and epidemiological characteristics and the spatial distribution of SARS deaths due to COVID-19 in the Brazilian federative units (states). This is a descriptive and ecological study of SARS deaths due to COVID-19 in Brazilian states, from March 2020 to June 2021, based on secondary data available on the openDataSUS database. Descriptive statistics were performed for the clinical-epidemiological variables and the monthly mortality rates were determined by state and thematic maps were made in QGIS software version 2.4.17. A total of 196,109 deaths were recorded in the investigated period, predominantly male, older, white, and low-educated. Among the clinical variables, cough, respiratory distress, dyspnea, and the presence of comorbidities stood out. A heterogeneous spatial distribution of deaths was observed, with rates ranging from 0.00 to 24.59 deaths/100,000 inhabitants, the highest rates were in the states of Rio de Janeiro, Amazonas, Ceara, Sergipe, Sao Paulo, and Pernambuco. These findings raise the need for investments on the part of public management and health systems and services in the most affected states, improvements in epidemiological surveillance, permanent health education, increased access to immunization and health prevention measures to control and monitor SARS caused by COVID-19.

Social inequalities associated with the onset of tuberculosis in disease-prone territories in a city from northeastern Brazil.

INTRODUCTION: Tuberculosis remains a major health problem worldwide, killing thousand adults and children every year mainly in developing countries as Brazil. The disease is socially determined, caused mainly by inequalities as overcrowding, bad conditions of housing, unemployment, and limited access to health care. The aim of this study was to identify the social inequalities associated with the onset of tuberculosis in disease-prone territories in a city from the Northeast. METHODOLOGY: This was an ecological study, which has gathered patients diagnosed with tuberculosis through secondary data source in a city from the northeast of Brazil. The GAMLSS statistical model has been applied considering as response variable the count of Tuberculosis cases and the independent variable, the social conditions. The double Poisson distribution was considered in the analysis. The best model fitted was selected according the Akaike information criterion value. For all tests, the p value < 0.05 was considered as statistically significant. RESULTS: 460 patients with diagnosis of tuberculosis were identified, which represents an incidence of 36.3 cases/100,000 in males and 20.7 cases/100,000 in females. Regarding social inequality associated with tuberculosis, income (households with per capita income between 1/8 and 3 minimum wages), gender and age (Proportion of males under 15 years of age) were associated with the disease. CONCLUSIONS: The findings evidenced the social determinants associated with tuberculosis, with a greater occurrence of the disease in areas with mostly male children and low-income families, these issues must be managed within and beyond the health sector, which is mandatory for the Tuberculosis elimination.

Autoeficácia do aleitamento materno em puérperas de uma maternidade pública do nordeste brasileiro / Autoefectividad de la lactancia en mujeres embarazadas de una maternidad pública en el noreste de brasil / Self-efficacy of breastfeeding in postpartum women assisted in a public maternity in northeastern brazil

Objetivo: Verificar associação entre variáveis de contextos sociodemográfico e obstétrico com a autoeficácia em amamentar de puérperas residentes no Nordeste brasileiro. Método: Estudo transversal quantitativo realizado em maternidade pública de referência, com 160 mulheres que estavam no puerpério imediato até o 60º dia pós-parto. Dados coletados por meio de entrevistas individuais aplicando-se um formulário para obter informações acerca das características sociodemográficas e obstétricas, além da aplicação da escala de autoeficácia em aleitamento materno, na versão em português. Resultados: Mulheres com idade entre 26 e 35 anos tiveram quase 13 vezes mais chance de praticar alta autoeficácia em amamentar e mulheres com mais de 35 anos tiveram 21 vezes mais chance de ter maior alta autoeficácia. Mulheres que cursaram o ensino fundamental tiveram 39 vezes mais chance de ter maior alta autoeficácia e multíparas tiveram 4,44 mais chance de ter maior alta autoeficácia. Denotou-se que as puérperas tiveram alta autoeficácia para amamentar. Conclusões: A idade materna, a escolaridade, a situação obstétrica mostraram-se estatisticamente significativas para a alta autoeficácia do aleitamento materno, o que demonstra um panorama favorável ao aleitamento materno, sendo necessário acompanhamento do profissional enfermeiro para garantir assistência mais efetiva no apoio à amamentação.(AU)

Objective: To verify the association between variables of sociodemographic and obstetric contexts with the self-efficacy in breastfeeding of postpartum women living in Northeast Brazil. Method: Quantitative cross-sectional study carried out in a public maternity of reference, with 160 women who were in the immediate puerperium until the 60th postpartum day. Data collected through individual interviews using a form to obtain information about sociodemographic and obstetric characteristics, in addition to the application of the self-efficacy scale in breastfeeding, in the Portuguese version. Results: Women aged between 26 and 35 years were almost 13 times more likely to practice high self-efficacy in breastfeeding and women over 35 years were 21 times more likely to have greater high self-efficacy. Women who attended elementary school were 39 times more likely to have greater high self-efficacy and multiparous women were 4.44 more likely to have greater high self-efficacy. It was noted that mothers had high self-efficacy to breastfeed. Conclusions: Maternal age, education, obstetric situation were statistically significant for the high self-efficacy of breastfeeding, which demonstrates a favorable scenario for breastfeeding, requiring monitoring by the professional nurses to ensure more effective assistance support breastfeeding.(AU)

Objetivo: Verificar la asociación entre variables de contextos sociodemográficos y obstétricos con la autoeficacia en la lactancia materna de mujeres puerperas que viven en el noreste de Brasil. Método: Estudio cuantitativo transversal realizado en un hospital público de maternidad de referencia, con 160 mujeres que estuvieron en el puerperio inmediato hasta el día 60 posparto . Datos recopilados a través de entrevistas individuales utilizando un formulario para obtener información sobre las características sociodemográficas y obstétricas, además de la aplicación de la escala de autoeficacia en la lactancia materna en la versión portuguesa. Resultados: Las mujeres de entre 26 y 35 años tenían casi 13 veces más probabilidades de practicar una alta autoeficacia en la lactancia materna y las mujeres mayores de 35 años tenían 21 veces más probabilidades de tener una mayor autoeficacia. Las mujeres que fueron a la escuela primaria tenían 39 veces más probabilidades de tener una mayor autoeficacia y las mujeres multíparas tenían 4,44 más probabilidades de tener una autoeficacia alta. Se observó que las madres tenían una alta autoeficacia para amamantar. Conclusiones: La edad materna, la educación, la situación obstétrica fueron estadísticamente significativas para la alta autoeficacia de la lactancia materna, lo que demuestra un escenario favorable para la lactancia materna, que requiere el seguimiento de la enfermera profesional para garantizar una asistencia más efectiva en el apoyo a la lactancia materna.(AU)

Effects of Cashew Nut (Anacardium occidentale L.) Seed Flour in Moderately Malnourished Children: Randomized Clinical Trial.

The monitoring and combined use of dietary supplements to restore adequate growth are paramount and highly recommended in child malnutrition, an important public health problem. The objective of this study was to analyze the effects of cashew nut seed flour in children with moderate malnutrition, treated at primary healthcare services. This is a randomized clinical trial conducted from April to October 2017 in the city of Imperatriz, Brazil. The sample comprised 30 children born at term, aged between 2 and 5 years, and newly diagnosed with malnutrition (60 days or less), randomized into experimental and control groups. The intervention consisted of daily intake of cashew nut seed flour. There was intragroup statistically significant difference in the glucose levels of children who were assigned to the control group (p=0.02) and in the glycated hemoglobin in the experimental group (p < 0.01). Intergroup analysis of glycated hemoglobin levels showed statistically significant differences in favor of the experimental group (p=0.01). HDL and LDL had, respectively, increased and decreased in the experimental group. The use of cashew nut seed flour in a 24-week period had positive effects on glycated hemoglobin, HDL, and LDL parameters in moderately malnourished children.

Ineffective Airway Clearance in Surgical Patients: Evaluation of Nursing Interventions and Outcomes.

PURPOSE: To evaluate the benefits of NIC interventions in postoperative patients with ineffective airway clearance (00031). METHODS: Quasi-experimental study with interrupted time-series design. A total of 101 patients were evaluated during 4 days based on the nursing outcome Respiratory Status: Airway Patency (0410). FINDINGS: Interventions such as cough enhancement (3250), ventilation assistance (3390), and airway management (3140) contributed to significative improvements of the patients' airway patency. Site of surgery and patients' intrinsic characteristics were proven to have influence in the NOC ratings. CONCLUSIONS: Interventions implemented during the research contributed to improvement of clinical indicators of airway patency. IMPLICATIONS FOR NURSING PRACTICE: Postoperative respiratory complications can be minimized by the use of standardized nursing languages.

Patients' perceptions on the performance of a local health system to eliminate leprosy,Paraná State, Brazil.

BACKGROUND: In Brazil, leprosy has been listed among the health priorities since 2006, in a plan known as the "Pact for life" (Pacto pela Vida). It is the sole country on the American continent that has not reached the global goal of disease elimination. Local health systems face many challenges to achieve this global goal. The study aimed to investigate how patients perceive the local health system's performance to eliminate leprosy and whether these perceptions differ in terms of the patients' income. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study was conducted in Londrina, State of Paraná, Brazil. Interviews were performed with the leprosy patients. The local health system was assessed through a structured and adapted tool, considering the domains judged as good quality of health care. The authors used univariate, bivariate and multivariate analyses. One hundred and nineteen patients were recruited for the study, 50.4% (60) of them were male, 54.0% (64) were between 42 and 65 years old and 66.3% (79) had finished elementary school. The results showed that patients used the Primary Health Care service near their place of residence but did not receive the leprosy diagnosis there. Important advances of this health system were verified for the elimination of leprosy, verifying protocols for good care delivery to the leprosy patients, but these services did not develop collective health actions and did not engage the patients' family members and community. CONCLUSIONS/SIGNIFICANCE: The patients' difficulty was observed to have access to the diagnosis and treatment at health services near their homes. Leprosy care is provided at the specialized level, where the patients strongly bond with the teams. The care process is individual, with limited perspectives of integration among the health services for the purpose of case management and social mobilization of the community to the leprosy problem.