Digital technology and its effects on knowledge improvement for diabetes management: An integrative review.

AIM: To evaluate the effectiveness of educational digital technology in improving patients' and health professionals' knowledge about diabetes management. BACKGROUND: The use of digital technologies has been expanding in recent years in several areas of healthcare and education. DESIGN: Integrative literature review. DATA SOURCES: The following databases were searched: PubMed, Lilacs, BDENF, Web of Science and SciELO (1 January 2016 and 31 December 2020). REVIEW METHODS: Titles and abstracts were screened and selected by independent reviewers based on eligibility criteria. A consensus was drawn on which articles should be included. Data were extracted using an instrument created by the authors, and the synthesis of knowledge was made by compiling the results in a table and identifying thematic axes. RESULTS: Seventy-one articles were retrieved, and after the final analysis, a total of 11 were included. Most studies have pointed out benefits from the use of digital technologies in diabetes education, with two thematic categories emerging: 'Digital technologies in the education of patients with diabetes' and 'Digital technologies in continuing professional education in diabetes'. CONCLUSION: The use of digital technologies is beneficial and effective both for continuing professional education and educating patients about diabetes management.

Mobile Application for Adhering to Diabetic Foot Self-care: Randomized Controlled Clinical Trial.

This study aimed to analyze the effectiveness of a mobile application for adherence to foot self-care in people with type 2 diabetes at risk for diabetic foot ulcer. A double-blind randomized controlled clinical trial was conducted with people with type 2 diabetes in a secondary healthcare unit. A total of 42 patients were recruited, matched, and allocated into two groups: one (intervention group) undergoing standard nursing consultations and application use and the other (control group) receiving only standard nursing consultations. The outcome variable was the adherence to foot self-care, measured by completing questionnaires on diabetes self-care activities and adherence to foot self-care. Measures of central tendency and dispersion were calculated, in addition to bivariate associations, considering a significance level of P ≤ .05. The intragroup and intergroup analyses regarding diabetes self-care did not show statistical significance; however, the intervention group showed a considerable increase in the frequency of daily assessments ( P = .048) and adherence to foot self-care ( P = .046). The use of the app, combined with the nursing consultation, increased adherence to foot self-care of people with type 2 diabetes. Brazilian Registry of Clinical Trials: U1111-1202-6318.

E-MunDiabetes: A Mobile Application for Nursing Students on Diabetes Education During the COVID-19 Pandemic.

The COVID-19 pandemic caused tremendous disruption of health systems worldwide. Patients with diabetes are at a high risk of COVID-19 exposure because face-to-face consultations have been standard for diabetes management. This study describes the development and validation of a mobile application for nursing students on diabetes education during the COVID-19 pandemic. The application was developed by a certified diabetes educator nurse and by a freelance programmer and, in the next step, validated in terms of content and appearance by a group of expert nurses on diabetes (n = 29), nursing students (n = 40), and information technology experts (n = 11). Validity indexes of 0.99 for content and 0.92 for appearance were obtained, and usability values of 78.9 (±15.3) and 78.2 (±10.8) were obtained from nursing and information technology experts, respectively. The self-assessment and satisfaction items evaluated by nursing students had a total agreement of 96.3% and an intraclass correlation coefficient of 0.91. Both the content and the appearance of the application were considered adequate, and the usability scores indicate that the application is useful and easy to use.

Hierarchical analysis of factors associated with hospital readmissions for coronary heart disease: A case-control study.

AIMS AND OBJECTIVES: To analyse, hierarchically, factors associated with hospital readmissions for acute coronary syndrome. BACKGROUND: Hospital readmissions have risen, especially in patients with multiple comorbidities, which are most often chronic. The leading causes of hospital readmission include acute coronary syndrome, which is costly and often preventable. Determining clinical and nonclinical variables that increase the chances of readmission is important to assess and evaluate patients hospitalised for coronary heart diseases. DESIGN: A case-control study whose dependent variable was hospital readmission for acute coronary syndrome. METHODS: The study included 277 inpatients, of whom 132 were in their first hospitalisation and 145 had already been hospitalised for acute coronary syndrome. The independent variables for this hierarchical model were sociodemographic conditions, life habits, access to health services and physical health measures. Data were obtained by interviews, anthropometric measurements and patient records. Logistic regression analysis was performed using the stepwise technique, with Microsoft Excel and R version 3.2.3. The research was reported via strengthening the reporting of observational studies in epidemiology (STROBE). RESULTS: In the final hierarchical logistic model, the following risk factors were associated with readmission for acute coronary syndrome: inadequate drug therapy adherence, stress, history of smoking for 30 years or more, and the lack of use of primary healthcare services. CONCLUSIONS: Clinical and nonclinical variables are related to hospital readmission for acute coronary syndrome and can increase the chance of readmission by up to six times. RELEVANCE TO CLINICAL PRACTICE: The predictive model can be used to avoid readmission for acute coronary syndrome, and it represents an advance in the prediction of the occurrence of the outcome. This implies the need for a reorientation of the network for postdischarge care in the first hospitalisation for acute coronary syndrome.

Influence of Paleolithic diet on anthropometric markers in chronic diseases: systematic review and meta-analysis.

BACKGROUND: The Paleolithic diet has been studied in the scope of prevention and control of chronic noncommunicable diseases (CNCD). The objective of this study was to analyze the influence of the Paleolithic diet on the prevention and control of CNCD in humans, specifically on anthropometric markers, through a systematic review with meta-analysis. METHODS: What is the effect of the Paleolithic diet on anthropometric parameters (weight, body mass index and waist circumference) compared to other control diets based on recommendations in adults? We included only randomized studies with humans that used the Paleolithic Diet in the prevention and control of CNCD published in Portuguese, English or Spanish. The search period was until March 2019, in the LILACS, PubMed, Scielo, Science Direct, Medline, Web of Science and Scopus databases. The abstracts were evaluated by two researchers. We found 1224 articles, of which 24 were selected and 11 were included in the meta-analysis. The effect of dietary use on body weight, body mass index and waist circumference was evaluated. RESULTS: The summary of the effect showed a loss of - 3.52 kg in the mean weight (CI 95%: - 5.26; - 1.79; p < 0,001; I2 = 24%) of people who adopted the Paleolithic diet compared to diets based on recommendations. The analysis showed a positive association of adopting the Paleolithic diet in relation to weight loss. The effect was significant on weight, body mass index and waist circumference. CONCLUSION: The Paleolithic diet may assist in controlling weight and waist circumference and in the management of chronic diseases. However, more randomized clinical studies with larger populations and duration are necessary to prove health benefits. TRIAL REGISTRATION: CRD42015027849 .

[Self-perceived health and clinical characteristics in young adult students from the Brazilian northeast]. / Autopercepção de saúde e características clínicas em adultos jovens escolares de um interior do nordeste brasileiro.

OBJECTIVE: To analyze the association between socioeconomic situation, clinical characteristics referred and the family history of cardiovascular disease, with the Self-perceived health of young adults education and their implications for clinical characteristics observed. METHOD: Analytical study conducted with 501 young adults who are students in countryside city in the Brazilian Northeast. We used binary logistic regression. RESULTS: The final model explained 83.3% of the self-perceived positive health, confirming the association of Self-perceived health with male, residence in the community, have excellent/very good lifestyle and does not have or do not know that there are cases of stroke in the family. CONCLUSION: Health perception was often optimistic, being important to identify devices to be worked closer to their perception of their actual health condition, increasing the effectiveness of health promotion activities undertaken by professionals.

[Educational technologies designed to promote cardiovascular health in adults: integrative review]. / Tecnologias educacionais desenvolvidas para promoção da saúde cardiovascular em adultos: revisão integrativa.

OBJECTIVE: Investigating the educational technologies developed for promoting cardiovascular health in adults. METHOD: Integrative review carried out in the databases of PubMed, SciELO and LILACS, with 15 articles selected. RESULTS: Over half (60%) of the studies were randomized clinical trials. The developed educational technologies were programs involving three strategies, with duration of one year, use of playful technologies with storytelling, computer programs or software for smartphones, and electronic brochure. These technologies resulted in reduction of blood pressure, weight, waist circumference, decreased hospitalizations and increased years of life. CONCLUSION: The studies with better impact on the cardiovascular health of adults were those who brought the technology in the form of program and duration of one year.

Prevalence, Incidence and Factors Associated with Diabetic Foot in People with Type 2 Diabetes: Systematic Review with Meta-Analysis.

BACKGROUND: Diabetic Foot is a severe chronic complication of diabetes and an important factor in the morbidity of diabetic people, resulting in high health costs and increased risk of death. OBJECTIVE: To analyze the incidence, prevalence, and risk factors associated with diabetic foot in people with type 2 Diabetes Mellitus. METHOD: Systematic literature review. Searches in MedLine via PubMed, LILACS, Web of Science, Scopus CINAHL, and Cochrane Library databases were performed. Inclusion of 52 studies. The R program, Metan packages, was used to calculate the meta-analysis. Given the heterogeneity of studies, the random effect was used to calculate the meta-analysis of risk factors. RESULTS: The meta-analysis showed that the prevalence of diabetic foot was 14% in a hospital setting and 5% in a community setting. The overall prevalence and incidence were 9% and 4%, respectively. Significant risk factors included time of DM (odds ratio [OR] =1.46, confidence interval [CI], 0.36-2.57, P = 0.009), smoking (OR = 1.46, CI, 1.16 -1.85, P< .001), glycated hemoglobin (OR = 0.96, CI, 0.50; 1.42, P< .001), peripheral arterial disease (OR = 3.38, CI, 2.07; 5.53, P < .001) and peripheral neuropathy (OR = 5.88, CI, 2.39-14.45, P<.001). CONCLUSION: Multidisciplinary monitoring, educational strategies, periodic foot examination for alterations, and early identification of risk factors are essential to prevent ulceration and reduce the disease burden.

Clinical decision support systems for diabetic foot ulcers: a scoping review.

OBJECTIVE: Map the scientific evidence on the use of clinical decision support systems in diabetic foot care. METHOD: A scoping review based on the JBI Manual for Evidence Synthesis and registered on the Open Science Framework platform. Searches were carried out in primary and secondary sources on prototypes and computerized tools aimed at assisting patients with diabetic foot or at risk of having it, published in any language or period, in eleven databases and grey literature. RESULTS: A total of 710 studies were identified and, following the eligibility criteria, 23 were selected, which portrayed the use of decision support systems in diabetic foot screening, predicting the risk of ulcers and amputations, classifying the stage of severity, deciding on the treatment plan, and evaluating the effectiveness of interventions, by processing data relating to clinical and sociodemographic information. CONCLUSION: Expert systems stand out for their satisfactory results, with high precision and sensitivity when it comes to guiding and qualifying the decision-making process in diabetic foot prevention and care.

[Experiencing acute stroke: the meaning of the illness for hospitalized patients]. / Vivendo o acidente vascular encefálico agudo: significados da doença para pessoas hospitalizadas.

The aim was to understand the meaning of the experience of the acute stroke patient. This was a qualitative study, based on the conceptual theory of symbolic interaction. It was conducted in a unit specialized in the treatment of stroke at a tertiary hospital in Fortaleza-CE and the ethical aspects were respected. The study included ten patients and data were collected through open interviews. The data were organized and analyzed according to enunciation techniques. The meaning of the illness experience was constructed based on the perception of the feelings that arose during the hospitalization and was characterized by fear of death and the sequelae of the disease; sorrow for the distance from home; relief, when a patient perceived an improved clinical course; and a desire to change one´s lifestyle. The experience of illness due to stroke is complex, as meanings are elaborated ​​from the feelings, actions and behaviors of the subjects.

[Content validation of the dimensions constituting non-adherence to treatment of arterial hypertension]. / Validação de conteúdo das dimensões constitutivas da não adesão ao tratamento da hipertensão arterial.

The objective of the study was to validate the content of the dimensions that constituted nonadherence to treatment of arterial systemic hypertension. It was a methodological study of content validation. Initially an integrative review was conducted that demonstrated four dimensions of nonadherence: person, disease/treatment, health service, and environment. Definitions of these dimensions were evaluated by 17 professionals, who were specialists in the area, including: nurses, pharmacists and physicians. The Content Validity Index was calculated for each dimension (IVCi) and the set of the dimensions (IVCt), and the binomial test was conducted. The results permitted the validation of the dimensions with an IVCt of 0.88, demonstrating reasonable systematic comprehension of the phenomena of nonadherence.

Evaluative instruments of patients' knowledge about systemic arterial hypertension and diabetes mellitus: A scoping review.

AIM: To map out the evaluative instruments used by nurses to measure the knowledge of patients affected by hypertension and diabetes. BACKGROUND: The construction of evaluative instruments has gained more and more space in Brazil, in nursing, evaluative instruments of knowledge are very relevant, they make it possible to diagnose the knowledge of patients in an area and analyze its evolution over time. DESIGN: Scoping review. METHODS: This is a scope review, guided by the recommendations of the Joanna Briggs Institute. To conduct the research, a structured question was created based on the Population strategy (nurses), Concept (instruments for measuring patients' knowledge) and Context (Systemic Arterial Hypertension and Diabetes Mellitus). RESULTS: Data analysis occurred with the synthesis of selected studies. Out of 1746 articles found in the searched databases, after removing duplication, 1244 articles remained. After reading the abstracts and titles, 955 articles were not included. After reading 289 articles in their entirety, 21 articles were included because they met the established inclusion criteria. We highlight the development of questionnaires with a peer review process and application for validation in the population, knowledge evaluation via previously constructed and internationally validated questionnaires, and cross-cultural adaptation of evaluative questionnaires for different Title Page (with Author Details) realities of the proposal. CONCLUSIONS: The evidences elucidated that the knowledge measurement questionnaires are valid and constitute a relevant mechanism for evaluating users of health services.

Vulnerability to physical inactivity: evidence of content validity and response processes.

OBJECTIVE: To analyze content validity evidence and response processes of a bank of items for measuring vulnerability to physical inactivity in adults. METHOD: Methodological study, with 13 specialists and 46 representatives of the target population. The Content Validity Index (CVI) and binomial test were calculated; data obtained through validity based on response processes were collected through interviews. RESULTS: Of the 105 constructed items, 16 were excluded (CVI<0.78); 89 items showed agreement <80% in the psychometric criteria, being modified. Of the 101 items that remained (CVI>0.78), 34 were changed and 4 were deleted after evaluating the evidence of response processes. In the end, 97 items remained, with a global CVI of 0.92, organized into two dimensions: Subject (CVI=0.91) and Social (CVI=0.94). CONCLUSION: The items presented adequate parameters and evidence of validity; and can subsidize the construction of instruments that consider the subject's and social vulnerability in understanding physical inactivity.

Relationship between social development indicators and mortality due to Diabetes Mellitus in Brazil: a space-time analysis. / Relación entre indicadores de desarrollo social y mortalidad por Diabetes Mellitus en Brasil: análisis espacial y temporal.

OBJECTIVE: to identify the space-time pattern of mortality due to Diabetes Mellitus in Brazil, as well as its relationship with social development indicators. METHOD: an ecological and time series nationwide study based on secondary data from the Unified Health System Informatics Department, with space-time analysis and inclusion of indicators in non-spatial and spatial regression models. The following was performed: overall mortality rate calculation; characterization of the sociodemographic and regional profiles of the death cases by means of descriptive and time analysis; and elaboration of thematic maps. RESULTS: a total of 601,521 deaths related to Diabetes Mellitus were recorded in Brazil, representing a mean mortality rate of 29.5/100,000 inhabitants. The states of Rio Grande do Norte, Paraíba, Pernambuco, Alagoas and Sergipe, Rio de Janeiro, Paraná and Rio Grande do Sul presented high-high clusters. By using regression models, it was verified that the Gini index (ß=11.7) and the Family Health Strategy coverage (ß=3.9) were the indicators that most influenced mortality due to Diabetes Mellitus in Brazil. CONCLUSION: in Brazil, mortality due to Diabetes presents an overall increasing trend, revealing itself as strongly associated with places that have worse social indicators. HIGHLIGHTS: (1) The time-space pattern of mortality due to Diabetes presents an increasing trend. (2) The Northeast and South regions present high rates of mortality due to Diabetes. (3) Mortality due to Diabetes is associated with worse sociodemographic indicators. (4) A relationship is observed between income, access to health and mortality due to Diabetes.

Palliative care in the treatment of women with breast cancer: a scoping review protocol.

INTRODUCTION: Currently, breast cancer ranks first among female malignancies; hence, there are strong recommendations for the early inclusion of these patients in palliative care. Palliative care aims to alleviate symptoms improving the quality of life of dying patients, an essential component of breast cancer care. This study aimed to map and synthesise the available evidence on palliative care for women with breast cancer and to discuss the review results with stakeholders. METHODS: A scoping review protocol is presented in this article, consisting of two phases. In the first phase, a scoping review study will be conducted adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and guided by the Joanna Briggs Institute Manual for Evidence Synthesis. Nine databases, an electronic repository, a trial register website, grey literature and additional sources will be searched. A focus group discussion with six stakeholders will occur in the second phase. The analysis will be performed through inductive and manifest content analysis using the IRaMuTeQ V.0.7 alpha software. ETHICS AND DISSEMINATION: The scoping review protocol did not require ethical approval. However, the study's second phase has been approved by the institutional review board of Maternidade Escola Assis Chateaubriand/MEAC/UFC. The findings will be disseminated through professional networks, conference presentations and publications.

[Risk factors and complications in patients with hypertension/diabetes in a regional health district of northeast Brazil]. / Fatores de risco e complicações em hipertensos/diabéticos de uma regional sanitária do nordeste brasileiro.

The objective of this study was to identify the risk factors and associated complications present in clients with hypertension/diabetes, enrolled in the HIPERDIA of the Executive Regional Health Department VI in Fortaleza, CE. This analytical documental study included 2,691 people. Of this total, 73.6% were women; 44.6% were between 60-79 years of age (mean age of 60.8 years); 87.4% were Caucasian, Asian or Pardo; 63.7% had eight or fewer years of education; 79.7% were non-smokers; 56.6% were considered sedentary; 59.6% were overweight/obese; and 48.4% had a family history of cardiovascular disease. An association was observed between having a sedentary lifestyle and being overweight/obese among patients with diabetes, and those with both diabetes and hypertension; family history of cardiovascular disease in patients with hypertension and those with both diabetes and hypertension; stroke, coronary artery disease and chronic renal failure in patients with hypertension and those with both diabetes and hypertension; and infarction and stroke in patients with diabetes. A family history of cardiovascular disease was associated with coronary artery disease and infarction. A relevant presence of risk factors and complications was found, highlighting the need for health education among clients.

[Hermeneutics and health: reflections on the thinking of Hans-Georg Gadamer]. / Hermenêutica e saúde: reflexões sobre o pensamento de Hans-Georg Gadamer.

This article has as its objective the desire to contribute to nursing practice with the use of Gadamer's hermeneutics. It reflects on the incorporation of the conceptual paradigm of health, care and therapeutic dialogue. In the first section the article discusses the Gadamerian concepts of the work Truth and Method, the hermeneutics philosophy proposed by the philosopher, and it concludes with the articulation of the health concept presented in the work The Hidden Character of Health, which proposes care mediated by therapeutic dialogue and its use by nursing professionals.

[The use of validated questionnaires to measure adherence to arterial hypertension treatments: an integrative review]. / Utilização de questionários validados para mensurar a adesão ao tratamento da hipertensão arterial: uma revisão integrativa.

The objective of this study was to analyze the scientific production in collective health regarding which validated questionnaires are being used to evaluate adherence to hypertension treatments. This integrative review was performed on the SciELO, MEDLINE and LILACS databases. Nine studies were selected, which used seven questionnaires: Moriski-Green Test, Cuestionário de Valoración de Adherencia, Cuestionário MBG, Questionário QAM-Q, Haynes Test, Escala de Conductas em Salud, and Hill-Bone compliance Scale. We concluded that the evaluation of hypertension treatment adherence is still an field open of research, due to the fact that the different instruments used have limitations, and there is no ideal method yet identified.

Effect of an app on students' knowledge about diabetes during the COVID-19 pandemic. / Efeito de um aplicativo no conhecimento de estudantes sobre diabetes durante a pandemia da COVID-19.

OBJECTIVE: to analyze the effect of an app on Nursing students' knowledge about diabetes during the COVID-19 pandemic, as well as their self-assessment and satisfaction level. METHOD: a quasi-experimental study carried out with 40 Nursing students from the Brazilian Northeast region. The E-MunDiabetes® app was used to assess the participants' knowledge at the pre-test, immediate post-test and after 15 days, as well as their self-assessment and satisfaction level in relation to using the app. The analysis was performed by means of descriptive and inferential statistics (binomial test, Intraclass Correlation Coefficient and Wilcoxon's test). RESULTS: the comparison of the medians of correct answers in the three periods revealed a significant increase in the post-test. The self-assessment and satisfaction items presented an Agreement Index > 80%, with a total Agreement Index of 96.3% and an Intraclass Correlation Coefficient of 0.91. CONCLUSION: the app was considered satisfactory and promoted a significant increase in the students' knowledge, therefore being suitable for its intended use.

Cultural adaptation and content validity evidence of the Nutritional Literacy Scale Brazilian version.

OBJECTIVE: To investigate the evidence of content validity and reliability of the Brazilian version of the Nutritional Literacy Scale (NLS) after the cultural adaptation process. METHODS: Psychometric study of 1,197 users of the National Health Service (Brazilian SUS). The NLS was culturally adapted to Brazilian Portuguese and six items of the original scale were modified to improve its understanding, giving rise to the Brazilian version of the scale named NLS-BR. The analysis of evidence of content validity of the NLS-BR was performed using the Item Response Theory (IRT). RESULTS: The final version of the NLS-BR had 23 items and proved to be adequate to assess nutritional literacy in adults assisted by the Brazilian SUS. FINAL CONSIDERATIONS: The NLS-BR proved to be of adequate understanding and demonstrated evidence of content validity and reliability for users of the Brazilian SUS.