Self-care Level of Adults With Arterial Hypertension in Outpatient Follow-up in Brazil: A Cross-sectional Study.

BACKGROUND: Self-care is essential for minimizing the long-term progression of hypertension (HTN) and improving global health outcomes. However, little is known about the predictors of HTN self-care among adults with HTN in Brazil. OBJECTIVE: The aim of this study was to evaluate the self-care practices and the association of sociodemographic and clinical factors of adults with HTN in Brazil. METHODS: This was a cross-sectional study conducted by telephone with 120 adults with HTN monitored in a specialized outpatient clinic of a teaching hospital. Sociodemographic and clinical information was collected by a questionnaire survey. Self-care was assessed by the Self-care of Hypertension Inventory version 2. Multiple regression and Kendall's correlation analyses were performed to determine possible predictors. RESULTS: Low levels of self-care were observed across maintenance, management, and confidence measures. A weak correlation was observed between self-care maintenance and education (-0.13), the time of diagnosis (0.16), and the number of medications (0.15); self-care management and family income (0.13) and cognitive function (0.17); and self-care confidence and systolic (-0.15) and diastolic (-0.18) blood pressure values and time of diagnosis (0.16). In multiple regression analysis, self-care confidence was a predictor of self-care maintenance ( ß = 0.30; 95% confidence interval, 0.10-0.36) and management ( ß = 0.20; 95% confidence interval, 0.03-0.46). CONCLUSION: Confidence was essential in the maintenance and management of self-care and is central to the control of HTN. Self-care interventions must consider the different aspects that may affect self-care, highlighting improving self-care confidence as a main goal.

In-hospital breastfeeding and predictive factors during the SARS-CoV-2 pandemic: A retrospective cohort study - Aleitamento materno hospitalar e fatores preditores durante a pandemia pelo SARS-CoV-2: Coorte retrospectiva.

PURPOSE: To analyze breastfeeding and the factors that positively influence the first hour of life, during hospitalization, and at discharge during the SARS-CoV-2 pandemic. DESIGN AND METHOD: This is a retrospective cohort study, with data collected from medical records. Consisting of 225 mother-newborn dyads with deliveries between 2020 and 2021. Breastfeeding in the first hour of life, during hospitalization, and at discharge was considered as the outcome variable. The independent variables were sociodemographic, obstetric, and neonatal data. The analysis was performed with bivariate and multivariate regression through a generalized linear model (Poisson family), with a 5% significance level. It was approved by the Institutional Review Board (IRB), under approval number 4,911,317. RESULT: Newborns of women without COVID-19 suspicion or diagnosis and who had skin-to-skin contact with their mother at birth are twice as likely to be breastfed in the first hour of life. Absence of complications in the newborn during hospitalization and no COVID-19 suspicion or diagnosis double the exclusive breastfeeding rate during hospitalization. Newborns exclusively breastfed during hospitalization present 1.6 times more chances of being exclusively breastfeeding at hospital discharge. CONCLUSION: It was evidence that women who gave birth without COVID-19 suspicion, and newborns who had skin-to-skin contact with their mother at birth represented a predictive factor for favoring exclusive breastfeeding. PRACTICE IMPLICATIONS: This research contributes to the innovation of evaluating breastfeeding in the newborn's first hour of life, during hospitalization, and at discharge in a pandemic context.

Influence of simulation design on stress, anxiety and self-confidence of nursing students: Systematic review with meta-analysis.

AIM: To evaluate the simulation design characteristics that may influence the stress, anxiety and self-confidence of undergraduate nursing students during learning. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Searchers were conducted in October 2020 and updated in August 2022 in the databases CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, Scopus and Web of Science, PQDT Open (ProQuest), BDTD, Google Scholar and specific journals on simulation. REVIEW METHODS: This review was conducted according to the recommendations of Cochrane Handbook for Systematic Reviews and reported according to the PRISMA Statement. Experimental and quasi-experimental studies that compared the effect of simulation on stress, anxiety and self-confidence of nursing students were included. The selection of studies and data extraction was performed independently by two reviewers. Simulation information was collected as prebriefing, scenario, debriefing, duration, modality, fidelity and simulator. Data summarization was performed by qualitative synthesis and meta-analytical methods. RESULTS: Eighty studies were included in the review, and most reported in detail the structure of the simulation, contemplating prebriefing, scenario, debriefing and the duration of each step. In subgroup meta-analysis, the presence of prebriefing, duration of more than 60 min and high-fidelity simulations helped reduce anxiety, while the presence of prebriefing and debriefing, duration, immersive clinical simulation modalities and procedure simulation, high-fidelity simulations and use of mannequins, standardised patients and virtual simulators, contributed to greater students' self-confidence. CONCLUSIONS: Different modulations of simulation design components imply reduction of anxiety and increased self-confidence in nursing students, especially highlighting the quality of the methodological report of simulation interventions. RELEVANCE TO CLINICAL PRACTICE: These findings help to support the need of more rigorous methodology in simulation designs and research methods. Consequently, impact on the education of qualified professionals prepared to work in clinical practice. No Patient or Public Contribution.

Symptoms of Depression in the Postpartum Period: Targeting Maternal Mental Health in the Perinatal Period.

This cross-sectional study aimed to examine the relationship between postpartum depression symptoms, anxiety, and stress during the postpartum period. A total of 101 women were assessed using the Depression, Anxiety and Stress Scale (DASS-21) and the Edinburgh Postnatal Depression Scale (EPDS) within 14 days after delivery. Multivariate regression analysis revealed that paid work, tobacco use, and stress symptoms were significantly associated with a higher incidence of postpartum depression symptoms. These results underscore the importance of comprehensive prenatal care and effective postpartum follow-up to address maternal mental health and prevent adverse outcomes for both mothers and children.

Melatonin in Human Milk: A Scoping Review.

Melatonin is vital in human circadian rhythm and infant development. This scoping review summarized the current knowledge about melatonin's presence and effects in human milk to promote better understanding of its secretion pattern and clinical advancement of maternal-infant health. The review followed the Joanna Briggs Institute guideline and answered the question: What is the current knowledge about melatonin hormone in human milk? The databases searched were PubMed, CINAHL, SCOPUS, Web of Science, LILACS, Scielo, EMBASE, Science Direct, Eric, Cochrane, in addition to grey literature and reference lists of included sources. Research papers included English, Spanish, or Portuguese languages, regardless of study type or publication date. The study selection and data extraction involved two independent reviewers. Twenty-nine studies met inclusion criteria. The studies, conducted between 1993 and 2023, employed diverse designs, with cross-sectional studies being the most prevalent. Melatonin concentration exhibited a consistent pattern, being higher at night, and elevated in colostrum. The analysis methods for melatonin concentration evolved, with recent advancements contributing to more accurate measurements. Factors influencing melatonin levels, such as delivery type, maternal age, and health conditions, demonstrated a complex relationship, potentially impacting the health and development of infants. The dynamic nature of melatonin in human milk calls for continued interdisciplinary research, bridging gaps between clinical, biochemical, and epidemiological perspectives. Standardizing melatonin analysis methods are needed. Nurses should assess factors influencing melatonin levels in milk to promote interventions and guidance aimed at enhancing the regulation of the circadian cycle during the perinatal period and its benefits.

[Trend in breast cancer mortality rate among women aged 20 years or older in Brazil, 2005-2019]. / Tendência da taxa de mortalidade por câncer de mama em mulheres com 20 anos ou mais no Brasil, 2005-2019.

The aim is to analyze the trend in breast cancer mortality rates and its correlation with the socioeconomic development status in Brazil. It involved an ecological time series study carried out in the 26 units of the federation, Federal District and regions of Brazil. Data sources included the Mortality Information System (number of deaths), the Brazilian Institute of Geography and Statistics (resident population) and the study of the Global Burden of Disease (Socio-demographic Index - SDI). Data from 2005 to 2019 were used. The trend was analyzed using Prais-Winsten regression models. The relationship between the mortality rate and the SDI was analyzed using Spearman's correlation coefficient. During the study period, 207,683 deaths from breast cancer occurred. The average standardized mortality rate was 19.95 deaths per 100,000 women in Brazil. All the regions of Brazil showed an increasing trend in mortality. Of the total federative units, 22 showed an increasing trend. There was a positive relationship between the mortality rate and the SDI. The standardized mortality rate for breast cancer showed an increasing trend in Brazil, in all regions and in most states. There was a direct association between mortality and SDI, indicating a greater magnitude in more developed regions.

O objetivo é analisar a tendência da taxa de mortalidade por câncer de mama e sua correlação com o status de desenvolvimento socioeconômico no Brasil. Estudo ecológico de séries temporais realizado nos 26 estados, Distrito Federal e regiões do Brasil. As fontes de dados foram o Sistema de Informação sobre Mortalidade (número de óbitos), o Instituto Brasileiro de Geografia e Estatística (população residente) e o estudo da Carga Global de Doenças (socio-demographic index - SDI). Foram usados dados de 2005 a 2019. A tendência foi analisada pelos modelos de regressão de Prais-Winsten. A relação entre a taxa de mortalidade e o SDI foi analisada pelo coeficiente de correlação de Spearman. No período do estudo ocorrerem 207.683 óbitos por câncer de mama. A taxa padronizada de mortalidade média foi de 19,95 óbitos por 100.000 mulheres no Brasil. O Brasil e todas as regiões apresentaram tendência crescente da mortalidade. Do total de estados, 22 apresentaram tendência crescente. Verificou-se relação positiva entre a taxa de mortalidade e o SDI. A taxa de mortalidade padronizada por câncer de mama apresentou tendência crescente no Brasil, em todas as regiões e na maioria das unidades da federação. Verificou-se associação direta entre mortalidade e SDI, indicando maior magnitude em regiões mais desenvolvidas.

A systematic review of the interventions for nipple trauma in breastfeeding mothers.

PURPOSE: To identify the most effective interventions to treat nipple trauma in breastfeeding mothers. DESIGN AND METHODS: Systematic literature review using the PICO strategy. The search was conducted on the electronic information systems Medline-PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), World Health Organization Library Information System (WHOLIS), Cochrane, ScienceDirect (Elsevier), Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), using standardized and unstandardized descriptors. Studies were selected if they were controlled or uncontrolled randomized clinical trials written in English, Portuguese, or Spanish. Two reviewers evaluated the studies independently using a guide, and in case there were disagreements, a third reviewer was called on to reach a consensus. Of the 496 studies located, five were included. FINDINGS: The treatments investigated were lanolin, lanolin in association with breast protection shells, breast milk, hydrogel, adhesive polyethylene film dressings, a spray containing chlorhexidine with alcohol, and distilled water. All the groups in every study received breastfeeding education. The best outcomes for the treatment of nipple trauma used lanolin (recommendation B, evidence level 2) and breast milk (recommendation B, evidence level 2). Although one clinical study was found with positive outcomes resulting from treatment using a spray containing alcohol and chlorhexidine 0.2% (recommendation B, evidence level 2), this treatment modality should be further investigated since literature is not in favor of using antiseptic substances in skin wound treatment. CONCLUSIONS: Considering the treatments investigated, the most favorable evidence indicates the use of lanolin alone or in association with breast protection shells and breast milk expressed and rubbed into the nipple and areola after each feeding session. However, the results obtained in this review are inconclusive, indicating the need for further studies in order to clarify the action of breast milk and lanolin on the damaged tissues, as well as studies involving samples representative of the number needed to treat. CLINICAL RELEVANCE: This study provides evidence for nursing practice, thus contributing to the improvement of lactating mothers with nipple trauma care and, consequently, improving the rates of successful breastfeeding as well as the quality of life of breastfeeding mothers.

Educational intervention improves knowledge and adherence to treatment amongst puerperal women with syphilis: randomized clinical trial.

BACKGROUND: Gestational syphilis requires early detection and proper treatment to prevent negative maternal-fetal outcomes. This study aimed to evaluate the effectiveness of an educational intervention on treatment adherence and knowledge about syphilis in postpartum women with positive Treponema pallidum results. METHODS: A randomized, parallel, and open clinical trial was conducted with 64 postpartum women who tested positive for T. pallidum, assigned to two groups (1:1 ratio). The Intervention Group (IG) received an educational intervention on syphilis, including an explanatory leaflet and hands-on demonstrations, along with standard guidelines. The Control Group (CG) received standard guidelines alone. Pre-test and post-test assessments were conducted to measure knowledge and treatment adherence. Statistical analyses included descriptive and inferential methods, assessing group homogeneity using the Chi-square or Fishers exact test. The interventions effectiveness was determined using relative risk, and pre- and post-test scores were compared using the independent t test. RESULTS: The post-test revealed improvements in knowledge scores for general knowledge, treatment, and prevention domains (p < .05). The IG demonstrated an increase in post-test knowledge scores (p = .001), with association between post-test scores and treatment adherence (p = .001). CONCLUSION: The educational intervention on syphilis improved knowledge and treatment adherence in postpartum women with syphilis.

Cardiovascular risk factors in the elderly: a 10-year follow-up survival analysis.

AIMS: Cardiovascular risk factors present a high prevalence and have an impact on the morbimortality of the elderly; however, studies evaluating the impact of cardiovascular risk factors in the elderly have had short follow-up times and have not allowed specific analyses of the effects of these factors in the aged population, including how they affect the survival of the elderly. This study aimed to analyse the survival of elderly individuals living in the community, considering the presence of cardiovascular risk factors. METHODS AND RESULTS: A prospective 10-year follow-up was initiated in 2008 with a cohort of 418 elderly people living in a community in Central Brazil. The Kaplan-Meier method and the Cox proportional hazards model were used to examine the association between survival and cardiovascular risk factors. The mean age of the participants was 70.6 (±7.1) years; most participants were hypertensive (81.6%) and participated in irregular physical activity (44%), and 43.3% smoked. After a mean follow-up of 8.38 (±2.82) years, 59.3% had survived and 34.1% had died; among the deaths, 14.1% were due to cardiovascular causes. Age [hazard ratio (HR) 1.067, 95% confidence interval (CI) 1.027-1.109], hypertension (HR 3.178, 95% CI 1.144-8.826), and smoking (HR 2.235, 95% CI 1.253-3.987) were confirmed as risk factors for reduced survival, whereas physical activity was a protective factor (HR 0.456, 95% CI 0.206-1.007). CONCLUSION: The results from this study highlight the need for educational policies towards hypertension and smoking prevention among elderly people, and participation in physical activity needs to be encouraged.

Educational Resources and Curriculum on Lactation for Health Undergraduate Students: A Scoping Review.

BACKGROUND: Breastfeeding is a fundamental component of health care, and health professionals need to be adequately prepared. As part of the system, health care professionals have the ability to influence the establishment and maintenance of breastfeeding. The global literature regarding the curricular approach or established best practices for health professional education in lactation is inconclusive and lacking in rigor. RESEARCH AIM: To explore the literature for the educational resources, methods, and curriculum used in the education of undergraduate health students related to lactation. METHODS: A scoping review examining the curricular programs of health professional students in lactation was undertaken exploring and summarizing evidence from peer reviewed and grey literature. A scoping review with a five-stage review process was followed. The database search between 1982-2018 generated 625 results, 79 full-text articles were reviewed, and 29 articles published in English met the inclusion criteria. RESULTS: In general, educational resources, methods, curricular approaches, and foundational topics were based on best practice standards. Some authors incorporated a variety of learning methods and provided experiential learning, with evidence of translation of knowledge into clinical practice. In the studies examined, researchers reported that students had improved their: knowledge and attitudes (59%); breastfeeding support skills (45%); and confidence (10%). However, even in programs that focused on developing students' breastfeeding support skills, authors reported a lack of change in students' confidence. CONCLUSIONS: Although only English articles met the inclusion criteria, this review was unique in its search of multidisciplinary, multilingual, and international studies. Consistency in teaching across disciplines is key and not evident in the studies reviewed.

Effect of simulation on stress, anxiety, and self-confidence in nursing students: Systematic review with meta-analysis and meta-regression.

INTRODUCTION: Simulation is a promising strategy in health education, with evidence of importance for learning, but the available systematic reviews are still inconclusive about the effect of the strategy on stress, anxiety, and self-confidence of nursing students, which impact the adherence to and sustainment of this strategy. Thus, better evidence is needed of the impact of simulation on these competences, essential for health professional education. OBJECTIVE: To evaluate the effect of simulation-based experiences on stress, anxiety, self-confidence and learning of undergraduate nursing students compared to conventional teaching strategies or no intervention. DESIGN: Systematic review with meta-analysis and meta-regression. DATA SOURCES: The databases used included: CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, SCOPUS and Web of Science. Additional searches occurred in PQDT Open (ProQuest), BDTD, Google Scholar and journals with a specific scope in clinical simulation. REVIEW METHODS: This study was conducted by the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Experimental and quasi-experimental studies that compared the effects of simulation on stress, anxiety, and self-confidence of nursing students were included. Study selection and data extraction steps were performed independently by two reviewers. Critical appraisal of the studies was managed by means of the risk of bias tools RoB 2 and ROBINS-I, and quality of evidence by means of the GRADE tool. Data summarization was performed by qualitative synthesis with descriptive analysis and quantitative synthesis by meta-analytic methods and meta-regression. RESULTS: Sixty-two studies were included covering an overall sample of 4570 undergraduate nursing students. When comparing simulation with other teaching strategies, simulation showed small effect size for anxiety (d = -0.33; 95% CI: -0.66-0.002; p = 0.051) and medium effect size for self-confidence (d = 0.71; 95% CI: 0.46-0.95; p < 0.001); there was no difference in the effect-size for stress (d = 0.04; 95% CI:-0.91-0.99; p = 0.90). Subgroup analyses showed an effect of methodological characteristics of the studies on students' anxiety and self-confidence. A positive relationship between self-confidence and learning was identified by meta-regression (p = 0.018; R2 = 20.96%). CONCLUSION: Simulation is an effective strategy for reducing anxiety and increasing self-confidence compared to conventional teaching strategies. Results are still inconclusive for stress. The use of simulation-based experiences in nursing education obtains positive results on anxiety and self-confidence in students, providing support for its implementation in undergraduate curricula to improve the education of qualified nurses. REGISTRATION NUMBER: CRD42020206077. TWEETABLE ABSTRACT: Simulation is an effective teaching strategy for reducing anxiety and increasing self-confidence in learning.

Lanolin and prenatal health education for prevention of nipple pain and trauma: Randomized clinical trial. / Lanolina y educación para la salud en la prevención de dolor y lesiones en los pezones: ensayo clínico aleatorizado.

OBJECTIVE: To investigate the effect of lanolin on nipple pain and trauma in breastfeeding after application of a health education. METHOD: Randomized controlled clinical trial, with two arms, open, with 66 participants during prenatal care in the primary health care network in Goiania - Goias, Brazil. Participants were randomized (1:1) using computer generated numbers in both experimental group (EG) and control group (CG). The EG received lanolin and health education on breastfeeding at two different times with clinical demonstration using cloth didactic breast and illustrative album as the intervention, while the CG received standard health education. Health education was carried out by the same researchers in both groups. Measurement of pain, nipple trauma, and breastfeeding technique occurred on postpartum day eight. The analysis included descriptive statistics and inferential analysis by means chi-square or Fisher test, and Student's t-test, significance level set at 0.05. RESULTS: A majority of the participants experienced no nipple trauma (59.1%) in both groups, and 60.6% of women experienced pain. In both groups, women showed favorable breastfeeding behaviors, except in the condition of the breasts. There were no significant differences between groups in pain prevention (p=0.61), nipple lesions (p=0.21), and breastfeeding technique (p>0.05). CONCLUSION: It is not clear whether the intervention, lanolin combined with health education, has a positive effect on the prevention of nipple pain and trauma. Further research is needed to elucidate this question. Registration number: RBR-7tvhq8. Registry website: http://www.ensaiosclinicos.gov.br/.

[The use of NANDA's Taxonomy II for assessing puerperal anxiety within a community]. / Utilização da Taxonomia II da NANDA para avaliação da ansiedade puerperal na comunidade.

This paper aims to analyze the occurrence of nursing diagnosis Anxiety, in puerperal women immediately after and in the later period, within a community context. This is a transversal descriptive quantitative study. The no probabilistic samples consisted of 40 puerperal women. During data collection, interview procedures were used, in addition to physical examination and home observation. Anxiety was present in 80% of puerperal women. The anxiety-related factors predominating in puerperal women were stress (62.5%) and maturational crisis (34.4%); mainly evidenced by the behavioral defining characteristic: worries expressed due to changes in life events (46.9%), and insomnia (43.8%). In addition to concerns about the child's wellbeing and an increased demands in burden of activities. The application of nursing diagnoses provides the identification of priorities in the assistance and enables the adequate implementation of early intervention can be planned.

Autogestão ineficaz de linfedema em mulheres mastectomizadas: análise de conceito / Autogestión ineficaz de linfedema en mujeres mastectomizadas: análisis de concepto / Ineffective self-management of lymphedema in mastectomized women: concept analysis

Resumo Objetivo Analisar o conceito de "autogestão ineficaz do linfedema" em mulheres mastectomizadas. Métodos Trata-se de uma análise do conceito proposto por Walker e Avant operacionalizada por meio de uma revisão integrativa da literatura, organizada em oito etapas e baseada nas seguintes questões norteadoras: Qual é a definição de autogestão ineficaz em mulheres mastectomizadas? Quais os antecedentes, atributos e consequências da autogestão ineficaz em mulheres mastectomizadas? Como a autogestão ineficaz de linfedema tem sido definida no contexto de mulheres que passaram por mastectomia? A busca de artigos foi realizada em cinco bases de dados eletrônicas, sem limite de data, no período de julho de 2022 a fevereiro de 2023. Resultados Foram identificados 30 antecedentes e 19 consequentes; os mais frequentes entre eles foram respectivamente os seguintes: falta de apoio familiar/social e diminuição da qualidade de vida. Os atributos definidores mais frequentemente identificados foram os seguintes: edema, inchaço no braço, sensação de peso no membro, dor, dormência e diminuição da função do membro. Foram ainda elaborados os casos modelo e contrário para auxiliar na decisão sobre o uso do conceito. Conclusão Os conceitos resultantes da análise contribuem para clarificar os termos e o desenvolvimento da linguagem na enfermagem, devendo ser validados por juízes e prática clínica para melhor aplicação na oncologia clínica.

Resumen Objetivo Analizar el concepto de "autogestión ineficaz de linfedema" en mujeres mastectomizadas. Métodos Se trata de un análisis del concepto propuesto por Walker y Avant, realizado mediante una revisión integradora de la literatura, organizado en ocho etapas y basado en las siguientes preguntas orientadoras: ¿Cuál es la definición de autogestión ineficaz en mujeres mastectomizadas? ¿Cuáles son los antecedentes, atributos y consecuencias de la autogestión ineficaz en mujeres mastectomizadas? ¿Cómo se define la autogestión ineficaz de linfedema en el contexto de mujeres que pasaron por una mastectomía? La búsqueda de artículos fue realizada en cinco bases de datos electrónicas, sin límite de fecha, en el período de julio de 2022 a febrero de 2023. Resultados Se identificaron 30 antecedentes y 19 consecuentes. El antecedente más frecuente fue falta de apoyo familiar/social y el consecuente, reducción de la calidad de vida. Los atributos definidores identificados más frecuentemente fueron los siguientes: edema, hinchazón en el brazo, sensación de peso en el miembro, dolor, adormecimiento y reducción de la función del miembro. Además, se elaboraron los casos modelo y contrarios para ayudar en la decisión sobre el uso del concepto. Conclusión Los conceptos resultantes del análisis contribuyen a clarificar los términos y el desarrollo del lenguaje en enfermería y deben ser validados por jueces y práctica clínica para una mejor aplicación en la oncología clínica.

Abstract Objective To analyze the concept of "ineffective self-management of lymphedema" in mastectomized women. Methods This is an analysis of the concept proposed by Walker and Avant, operationalized through an integrative literature review, organized into eight stages, and based on the following guiding questions: What is the definition of ineffective self-management in mastectomized women? What are the antecedents, attributes, and consequences of ineffective self-management in mastectomized women? How has ineffective self-management of lymphedema been defined in the context of women who have undergone mastectomy? The search for articles was carried out in five electronic databases, with no date limit, from July 2022 to February 2023. Results Antecedents (30) and consequents (19) were identified. Among them, the most frequent were the following, respectively: lack of family and/or social support and decreased quality of life. The most frequently identified defining attributes were the following: edema, swelling in the arm, feeling of heaviness in the limb, pain, numbness, and reduced function of the limb. Model and contrary cases were also designed to help decide on the use of the concept. Conclusion The concepts resulting from the analysis contribute to clarifying the terms and development of language in nursing, and should be validated by judges and clinical practice for better application in clinical oncology.

Tendência da taxa de mortalidade por câncer de mama em mulheres com 20 anos ou mais no Brasil, 2005-2019 / Trend in breast cancer mortality rate among women aged 20 years or older in Brazil, 2005-2019

Resumo O objetivo é analisar a tendência da taxa de mortalidade por câncer de mama e sua correlação com o status de desenvolvimento socioeconômico no Brasil. Estudo ecológico de séries temporais realizado nos 26 estados, Distrito Federal e regiões do Brasil. As fontes de dados foram o Sistema de Informação sobre Mortalidade (número de óbitos), o Instituto Brasileiro de Geografia e Estatística (população residente) e o estudo da Carga Global de Doenças (socio-demographic index - SDI). Foram usados dados de 2005 a 2019. A tendência foi analisada pelos modelos de regressão de Prais-Winsten. A relação entre a taxa de mortalidade e o SDI foi analisada pelo coeficiente de correlação de Spearman. No período do estudo ocorrerem 207.683 óbitos por câncer de mama. A taxa padronizada de mortalidade média foi de 19,95 óbitos por 100.000 mulheres no Brasil. O Brasil e todas as regiões apresentaram tendência crescente da mortalidade. Do total de estados, 22 apresentaram tendência crescente. Verificou-se relação positiva entre a taxa de mortalidade e o SDI. A taxa de mortalidade padronizada por câncer de mama apresentou tendência crescente no Brasil, em todas as regiões e na maioria das unidades da federação. Verificou-se associação direta entre mortalidade e SDI, indicando maior magnitude em regiões mais desenvolvidas.

Abstract The aim is to analyze the trend in breast cancer mortality rates and its correlation with the socioeconomic development status in Brazil. It involved an ecological time series study carried out in the 26 units of the federation, Federal District and regions of Brazil. Data sources included the Mortality Information System (number of deaths), the Brazilian Institute of Geography and Statistics (resident population) and the study of the Global Burden of Disease (Socio-demographic Index - SDI). Data from 2005 to 2019 were used. The trend was analyzed using Prais-Winsten regression models. The relationship between the mortality rate and the SDI was analyzed using Spearman's correlation coefficient. During the study period, 207,683 deaths from breast cancer occurred. The average standardized mortality rate was 19.95 deaths per 100,000 women in Brazil. All the regions of Brazil showed an increasing trend in mortality. Of the total federative units, 22 showed an increasing trend. There was a positive relationship between the mortality rate and the SDI. The standardized mortality rate for breast cancer showed an increasing trend in Brazil, in all regions and in most states. There was a direct association between mortality and SDI, indicating a greater magnitude in more developed regions.

Scientific evidence on perineal trauma during labor: Integrative review.

OBJECTIVE: To assess the scientific evidence for management and preservation of perineal integrity during the expulsive stage of labor. STUDY DESIGN: Integrative review that employed the Population, Intervention, Comparison, Outcome strategy to formulate the research question: Which perineal measure(s) is(are) effective in maintaining perineal integrity during labor? The search was performed in the databases MEDLINE, LILACS, BDENF and SciELO. The ten selected studies were analyzed based on their level of evidence and grade of recommendation. RESULTS: Four categories of measures were located: antenatal perineal care, perineal massage during the expulsive phase of labor, manual perineal support during the expulsive phase of labor and perineal hyaluronidase injection. CONCLUSION: Based on its level of evidence, perineal massage with lubricants performed by the women or their partners at the end of pregnancy may be recommended as a measure favorable for perineal protection.

Effects of Anhydrous Lanolin versus Breast Milk Combined with a Breast Shell for the Treatment of Nipple Trauma and Pain During Breastfeeding: A Randomized Clinical Trial.

INTRODUCTION: The purpose of this study was to compare the effect of anhydrous lanolin with the effect of breast milk combined with a breast shell for treatment of nipple trauma and pain during breastfeeding. METHODS: A randomized clinical trial was conducted in a maternity ward in a hospital accredited as a Baby-Friendly Hospital located in the middle-western region of Brazil. Breastfeeding women with obvious nipple trauma were randomized into 2 groups. In both groups, breastfeeding education was conducted. For up to 10 days, in Group 1, anhydrous lanolin was applied daily after each breastfeeding session, whereas in Group 2, breast milk combined with a breast shell was applied. Trauma was assessed using the Nipple Trauma Score, and pain was assessed using a numerical scale and sensory descriptors from the McGill Questionnaire. RESULTS: One hundred women participated, with 50 women in each of the 2 groups. The healing of nipple trauma was faster in the group treated with breast milk combined with a breast shell, starting on the third day of intervention (P = .032). The intensity of pain was lower in the group treated with breast milk combined with a breast shell starting on the fifth day of treatment (P = .008). The use of anhydrous lanolin had a progressively reduced treatment efficacy, with values of 86.4% on the third day (95% confidence interval [CI], -4.5%-98.2%), 58.3% on the fifth day (95% CI, 20.1%-78.3%), 48.1% on the seventh day (95% CI, 20.1%-66.2%), and 26.9.% on the tenth day (95% CI, 6.4%-43%) of intervention. The resolution of nipple trauma was significantly associated with the use of the nipple shell on all intervention days. DISCUSSION: The intervention with breast milk combined with a breast shell was more effective than anhydrous lanolin for the treatment of nipple trauma and pain in breastfeeding women. This treatment should be encouraged among breastfeeding women to promote healing and reduce pain.

Demonstração clínica no pré-natal para o manejo da prevenção do ingurgitamento mamário: estudo quase-experimental / Demostración clínica prenatal para el manejo de la prevención de la ingurgitación de mama: estudio casi experimental / Prenatal clinical demonstration for the management of the breast engorgement prevention: quasi-experimental study

RESUMO Objetivo: investigar a efetividade da educação em saúde sobre amamentação no pré-natal para a adoção de medidas de prevenção do ingurgitamento mamário decorrente do aleitamento materno. Método: trata-se de um estudo quase-experimental com 136 participantes. No grupo experimental (n=91) foi realizada intervenção educativa com demonstração clínica sobre amamentação durante a gestação e reforço das orientações por telefone; o grupo-controle (n=45) recebeu as orientações habituais da unidade de saúde sem interferência da equipe de pesquisa. Para a análise dos dados foi realizada estatística descritiva inferencial, e risco relativo para associação das variáveis de interesse. Resultado: a adoção de medidas de manejo do ingurgitamento mamário foi superior no grupo experimental (p=0,026). A técnica adequada de amamentação foi prevalente entre as mulheres que receberam a intervenção (p=0,030), em especial na posição (RR: 1,39; IC 95%: 1,002-1,94) e pega (RR:20,03; IC 95%: 5,2-77,8). Além disso, o grupo experimental realizou a interrupção da mamada de forma adequada (p<0,001). Conclusão: a educação em saúde com utilização de demonstração clínica é efetiva no manejo do ingurgitamento mamário, na técnica adequada de amamentação e comportamentos de proteção ao aleitamento materno.

RESUMEN Objetivo: investigar la efectividad de la educación en salud sobre lactancia materna en la atención prenatal para la adopción de medidas para prevenir la ingurgitación de mama resultante de la lactancia materna. Método: se trata de un estudio casi-experimental con 136 participantes. En el grupo experimental (n = 91) se realizó una intervención educativa con demostración clínica sobre lactancia materna durante el embarazo y refuerzo de las guías telefónicas; el grupo control (n = 45) recibió las instrucciones habituales de la unidad de salud sin interferencia del equipo de investigación. Para el análisis de los datos se realizó estadística descriptiva inferencial y riesgo relativo para la asociación de las variables de interés. Resultado: la adopción de medidas para el manejo de la congestión mamaria fue superior en el grupo experimental (p = 0.026). La técnica de lactancia adecuada prevaleció entre las mujeres que recibieron la intervención (p = 0,030), especialmente en la posición (RR: 1,39; IC 95%: 1,002-1,94) y agarre (RR: 20,03; IC 95%: 5,2-77,8). Además, el grupo experimental realizó la interrupción de la lactancia de forma adecuada (p <0,001). Conclusión: la educación en salud con el uso de la demostración clínica es eficaz en el manejo de la congestión mamaria, en la técnica adecuada de lactancia materna y conductas protectoras frente a la lactancia materna.

ABSTRACT Objective: to investigate the effectiveness of health education on breastfeeding in prenatal care for the adoption of measures to prevent breast engorgement resulting from breastfeeding. Method: this is a quasi-experimental study with 136 participants. In the experimental group (n = 91) an educational intervention was carried out with clinical demonstration on breastfeeding during pregnancy and reinforcement of guidelines by telephone; the control group (n = 45) received the usual instructions from the Primary Health Care without interference from the research team. For the analysis of the data, inferential descriptive statistics and relative risk for the association of the variables of interest were performed. Result: the adoption of measures to manage breast engorgement was superior in the experimental group (p = 0.026). The adequate breastfeeding technique was prevalent among women who received the intervention (p = 0.030), especially in the position (RR: 1.39; 95% CI: 1.002-1.94) and latching on (RR: 20.03; 95% CI: 5.2-77.8). Also, the experimental group performed the interruption of breastfeeding appropriately (p <0.001). Conclusion: health education with the use of clinical demonstration is effective in the management of breast engorgement, in the appropriate technique of breastfeeding, and protective behaviors against breastfeeding.

Educational interventions in improving quality of life for hypertensive people: integrative review / Intervenciones educativas en el mejoramiento de la calidad de vida de hipertensos: revisión integradora / Intervenções educativas na melhora da qualidade de vida de hipertensos: revisão integrativa

ABSTRACT Objective: to evaluate the effectiveness of educational interventions in improving the quality of life of people with arterial hypertension. Method: an integrative literature review which included studies that conducted educational interventions aimed at the hypertensive public to improve quality of life. The search was performed in the following databases: MEDLINE, LILACS, IBECS, CUMED, BDENF, SciELO and CINAHL, without restriction of language, date and sample size. For this, the following descriptors were crossed: "hipertensão" (hypertension), "educação em saúde" (health education) and "qualidade de vida" (quality of life). 619 articles were retrieved and after the selection and analysis process, a total of 10 made up this review. Data extraction and analysis were performed with the help of validated instruments and the result summarized. Results: Most studies were developed on a quasi-experimental basis, using generic instruments to measure quality of life with significant improvement after educational interventions, with group technology being the most used educational strategy. Just one study used a specific instrument to evaluate hypertensive patients. Conclusion: these results may direct the interventions to be implemented by health professionals in managing arterial hypertension. Further investigations are needed to identify and verify the most effective interventions for hypertensive patients, considering heterogeneous profiles and aiming at improving quality of life.

RESUMO Objetivo: evaluar la eficacia de las intervenciones educativas en el mejoramiento de la calidad de vida de personas con hipertensión arterial. Método: revisión integradora de la literatura que incluyó estudios que han realizado intervenciones educativas direccionadas al público hipertenso con el objetivo de mejorar su calidad de vida. La búsqueda se realizó en las bases de datos MEDLINE, LILACS, IBECS, CUMED, BDENF, SciELO e CINAHL, sin restricción de idioma, fecha ni tamaño de muestra. A tal efecto, se utilizaron los descriptores "hipertensión", "educación en salud" y "calidad de vida". Se tomaron 619 artículos y luego de un proceso de selección y análisis esta revisión se compone de un total de 10. La extracción y el análisis de datos se realizaron con el auxilio de instrumentos validados e se procedió a la síntesis de los resultados. Resultados: la mayor parte de los estudios se desarrolló con carácter casi experimental mediante el uso instrumentos genéricos para medir la calidad de vida, con significativa mejoría después de realizadas las intervenciones educativas, siendo la tecnología grupal la estrategia educacional más utilizada. Apenas un estudio utilizó un instrumento específico para la evaluación de hipertensos. Conclusión: estos resultados pueden direccionar las intervenciones que deben llevarse a cabo por profesionales de la salud en el manejo de la presión arterial. Es necesario profundizar las investigaciones para identificar y verificar las intervenciones más eficientes en pacientes hipertensos, considerando perfiles heterogéneos a fin de mejorar su calidad de vida.

RESUMO Objetivo: avaliar a efetividade de intervenções educativas na melhora da qualidade de vida de pessoas com hipertensão arterial. Método: revisão integrativa da literatura que incluiu estudos que realizaram intervenções educacionais direcionadas ao público hipertenso com vistas à melhora da qualidade de vida. Busca realizada nas bases de dados: MEDLINE, LILACS, IBECS, CUMED, BDENF, SciELO e CINAHL, sem restrição de idioma, data e tamanho amostral. Para tal, cruzaram-se os descritores: "hipertensão", "educação em saúde" e "qualidade de vida". Foram resgatados 619 artigos e após o processo de seleção e análise, um total de 10 compuseram esta revisão. A extração e análise dos dados foram realizadas com auxílio de instrumentos validados e o resultado sumarizado. Resultados: a maioria dos estudos foi desenvolvida em caráter quase experimental, utilizando-se de instrumentos genéricos para mensuração da qualidade de vida com melhora significativa após a realização de intervenções educativas, sendo a tecnologia grupal a estratégia educacional mais utilizada. Apenas um estudo utilizou instrumento específico para avaliação em hipertensos. Conclusão: estes resultados podem direcionar as intervenções a serem implementadas por profissionais de saúde no manejo da hipertensão arterial. Futuras investigações são necessárias para identificar e verificar as intervenções mais eficazes aos pacientes hipertensos, considerando perfis heterogêneos e visando à melhora da qualidade de vida.

Fatores envolvidos na não realização dos exames de rastreamento para o câncer de mama / Factors involved in the non-performance of breast cancer screening tests

O objetivo foi analisar as evidências disponíveis na literatura sobre os fatores envolvidos na não realização dos exames de rastreamento para o câncer de mama. A coleta de dados foi realizada nas bases de dados LILACS, MEDLINE e Scopus. A estratégia de busca foi: (tw:("breast cancer screening")) AND (tw:("Health Knowledge, Attitudes, Practice")) AND (tw:(mammography)) OR (tw:(ultrasonography)) OR (tw:("clinical breast exam")). A amostra final constituiu-se de 10 artigos. Os fatores que demonstraram serem associados a não realização dos exames de rastreamento do câncer de mama foram: internos - medos, crenças/cultura, atitudes de vergonha/pudor, conhecimento sobre o câncer de mama e externos - serviços, profissionais de saúde, fatores sociopolíticos, organizacionais. Assim, estes fatores demonstram a necessidade de utilização do serviço de forma organizada e universal, com profissionais preparados a acolher e orientar as mulheres, proporcionando o enfrentamento de fatores que inviabilizam a realização do rastreamento do câncer de mama.

The objective ot this study was to analyze the evidence available in the literature on the factors involved in the non-performance of breast cancer screening tests. Data collection was performed in the LILACS, MEDLINE and Scopus databases. The search strategy was: (tw:("breast cancer screening")) AND (tw:("Health Knowledge, Attitudes, Practice")) AND (tw:(mammography)) OR (tw:(ultrasonography)) OR (tw:("clinical breast exam")). The final sample consisted of 10 articles. The factors that demonstrated to be associated with the non-performance of breast cancer screening tests were internal: fears, beliefs/culture, attitudes of shame/ embarrassment, knowledge about breast cancer; and external: health services, health professionals, sociopolitical factors, organizational factors. Thus, these factors demonstrate the need to use the service in an organized and universal way, with professionals prepared to welcome and guide women, coping with the factors that impede the performance of breast cancer screenings.