Preparation and validation of the instrument "QualiAPS digital-Brazil" for assessing digital health care in primary health care: a required tool.

Introduction: The use of Information and Communication Technologies in the field of health is increasing across the world, demarcating the field of digital health. The goal of this study is to formulate and validate a matrix of indicators, design assessment scripts and indicate data collection techniques for assessing the quality of digital health care in Brazilian Primary Health Care (PHC). Methodology: This is a validation study divided into three phases: preparation of the instrument, analysis of validity and pilot study. The instrument was prepared based on the PHC assessment model from a literature review; the analysis of validity used the Delphi technique associated with the nominal group and the evidence from the literature reference. In the pilot study, audio-recorded interviews were conducted with strategic primary care actors. Results: The matrix of indicators "QualiAPS Digital-Brazil" introduces a set of 37 indicators, distributed into three distinct components and their respective dimensions. The component "Structure" includes the dimension "Resources"; the component "Processes" includes the dimensions "Technical," "Organizational" and "Relational"; and the component "Results" includes the dimensions "Short-Term Results" and "Medium-Term Results." The general values obtained for CVI and IRR were 0.89 and 1.00; respectively. Therefore, it was possible to design assessment scripts and indicate qualitative data collection techniques for assessing digital health in Brazilian PHC. Conclusion: The instrument presented was validated regarding its relevance, content and theoretical support to evaluate the quality of digital health care, supporting decision-making by managers and health professionals in the search for improving remote primary care provided to the population.

Digital home care interventions and quality of primary care for older adults: a scoping review.

BACKGROUND: Population aging is forcing the transformation of health care. Long-term care in the home is complex and involves complex communication with primary care services. In this scenario, the expansion of digital health has the potential to improve access to home-based primary care; however, the use of technologies can increase inequalities in access to health for an important part of the population. The aim of this study was to identify and map the uses and types of digital health interventions and their impacts on the quality of home-based primary care for older adults. METHODS: This is a broad and systematized scoping review with rigorous synthesis of knowledge directed by the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The quantitative data were analyzed through descriptive statistics, and the qualitative data were analyzed through basic qualitative content analysis, considering the organizational, relational, interpersonal and technical dimensions of care. The preliminary results were subjected to consultation with stakeholders to identify strengths and limitations, as well as potential forms of socialization. RESULTS: The mapping showed the distribution of publications in 18 countries and in the Sub-Saharan Africa region. Older adults have benefited from the use of different digital health strategies; however, this review also addresses limitations and challenges, such as the need for digital literacy and technological infrastructure. In addition to the impacts of technologies on the quality of health care. CONCLUSIONS: The review gathered priority themes for the equitable implementation of digital health, such as access to home caregivers and digital tools, importance of digital literacy and involvement of patients and their caregivers in health decisions and design of technologies, which must be prioritized to overcome limitations and challenges, focusing on improving quality of life, shorter hospitalization time and autonomy of older adults.

Alignment and specifics of Brazilian health agencies in relation to the international premises for the implementation of digital health in primary health care: a rhetorical analysis.

Digital health and sustainable development goals have had strong impacts with the COVID-19 pandemic. In Brazil, the health crisis scenario required changes in social welfare programs and policies, based on recommendations from international agencies, such as the UN and WHO. This study aims to analyze the alignment of the arguments of Brazilian and international organizations for the adoption of digital health in Primary Health Care based on the COVID-19 pandemic. This is a qualitative documentary study of the rhetorical analysis type, based on Perelman and Obrechts-Tyteca's Theory of Argumentation. The search for documents was carried out by two independent researchers, between December 2021 and June 2022, through the websites of the World Health Organization, the Pan American Health Organization, the Brazilian Ministry of Health, and the Federal Councils of Medicine and Brazilian nursing, with the terms "digital health," "telehealth," "telemedicine," "e-health," "telehealth," "telenursing," "telemedicine," and "digital health." Twenty official documents were analyzed and identified in terms of context, authorship, authenticity, reliability, nature, and key concepts. The international and Brazilian arguments emphasize the applicability of Information and Communication Technologies (ICTs) in the health field. In logical arguments, based on the structure of reality, international agencies emphasize the overlap between health needs and the conditions for the applicability of ICTs. In Brazil, however, there was a need to regulate the digital practices of health professionals. In the international discourse, in the structuring of reality, there are illustrations of the relationship between the context of the health crisis caused by COVID-19 and the concrete conditions for the applicability of digital health; while in the Brazilian discourse, the need to strengthen an environment conducive to digital health is explicit. The Brazilian alignment in relation to the international premises is evident. Yet, there is a need, socially and economically sustainable, to strengthen the inclusion of digital health in PHC policy.

Use of the Maslach Burnout Inventory Among Public Health Care Professionals: Scoping Review.

BACKGROUND: Work can be considered a source of living, well-being, and socioeconomic development. When the work environment negatively influences individuals, it may trigger emotional disturbances, behavioral problems, chronic stress conditions, and illnesses such as burnout syndrome (BS). Recently, studies on BS have increased and placed a special focus on health care professionals. The prevalence of BS among health professionals is associated with their chronic exposure to human hardship and long working hours without proper rest. These factors have contributed to greater stress and high physical and emotional exhaustion levels. OBJECTIVE: This study aims to identify and map studies using the Maslach Burnout Inventory (MBI) scale to identify burnout syndrome in health professionals working in public health services. METHODS: This scoping review was developed based on the Joanna Briggs Institute (JBI) Reviewers Manual and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A total of 6 databases were searched to identify relevant studies: Embase, LILACS, MEDLINE or PubMed, PsycInfo, Scopus, and Web of Science. Gray literature was consulted on ProQuest Dissertations and Theses Global, Google Scholar, Brazilian Digital Library of Theses and Dissertations, and Open Access Theses and Dissertations. Additionally, the reference lists were searched to retrieve studies not previously selected. The steps followed in this study were proposed by Arskey and O'Malley and Levac, Colquhoun, and O'Brien: identification of research questions, identification of potential studies, study selection, data extraction and imputation, data analyses and interpretation, and consultation with stakeholders. The detailed methodology was published in a protocol. RESULTS: A total of 55 articles were identified after screening for eligibility criteria, published between 1999 and 2021 in 32 countries. Most reports were published in Brazil, Spain, and China. A total of 22 versions of the MBI were identified, presenting different items, scores, and cutoff points. The included studies had recommendations and implications for clinical practice. The consultation with stakeholders allowed knowledge translation for those interested in BS. CONCLUSIONS: Studies mostly included physicians (34/55, 61.8%) and nurses (24/55, 43.6%), and the original version of MBI was predominantly used. Divergences in BS classification were highlighted, which may be related to MBI cross-cultural adaptations and applications in other countries. This study contributes to the advancement of research regarding burnout syndrome as an occupational illness since it has harmful consequences for workers, health care services, and the quality of care provided to the population.

Tecnologias educacionais sobre saúde mental na área da saúde: protocolo de scoping review / Education technologies for mental health in healthcare: scoping review protocol

OBJETIVO: Identificar e mapear as tecnologias educacionais sobre saúde mental utilizadas no ensino da saúde. MÉTODO: Será conduzida uma scoping review, seguindo o referencial do Joanna Briggs Institute, com o objetivo de responder à questão: "Quais são as tecnologias educacionais sobre saúde mental que têm sido utilizadas na área da saúde?". Para a identificação dos estudos, serão utilizadas bases de dados eletrônicas multidisciplinares em ciências da saúde, bem como repositórios de dissertações e teses. A identificação e o mapeamento da evidência disponível por meio deste estudo revelarão aspectos relevantes acerca das tecnologias educacionais existentes, seus impactos e desafios neste campo, o que é considerado relevante para subsidiar a melhoria da qualidade do ensino, seja na educação permanente, educação em saúde ou formação acadêmica. Espera-se que a scoping review contribua para a análise crítica das tecnologias educacionais sobre saúde mental na área da saúde, dada a potencialidade de impacto no desenvolvimento das competências educacionais.

OBJECTIVE: To identify and map educational technologies related to mental health in healthcare. METHOD: A scoping review will follow the Joanna Briggs Institute guidelines to answer the question: "What educational technologies related to mental health have been used in healthcare?". Multidisciplinary electronic databases in the health sciences and dissertation or thesis repositories will be used. The review aims to identify and map available evidence regarding educational technologies, their impact, and challenges in the field. This information is essential to improve teaching quality in continuing education, health education, or academic training. The scoping review is anticipated to contribute to a critical analysis of educational technologies focused on mental health in the health sector, given their potential impact on the development of educational competencies.

Use of the Maslach Burnout Inventory Among Public Health Care Professionals: Protocol for a Scoping Review.

BACKGROUND: Burnout syndrome is a chronic response to stressors in the workplace. It is characterized by emotional exhaustion and physical and mental burnout and may lead to high employee turnover, work absenteeism, and increased occupational accidents. Most studies use the Maslach Burnout Inventory (MBI) to identify burnout and implement preventive actions and treatments. OBJECTIVE: This study presents a scoping review protocol to identify and map studies that used MBI to assess burnout syndrome in health care professionals working in public health services. METHODS: This scoping review protocol follows the Joanna Briggs Institute reviewers' manual, and this protocol consists of 6 stages: identifying the research question, identifying relevant studies, study selection, data extraction and coding, analysis and interpretation of results, and consultation with stakeholders. We will conduct searches in Embase, LILACS, PubMed/MEDLINE, PsycINFO, Scopus, Web of Science databases, and gray literature. The main research question is as follows: how is MBI used to identify burnout syndrome in health care professionals working in public health services? Inclusion criteria will comprise qualitative and quantitative studies using MBI to identify burnout syndrome in health care professionals working in public health services and no restrictions in language and publication dates. Data will be extracted using a spreadsheet adapted from the Joanna Briggs Institute model. Quantitative and qualitative data will be analyzed using descriptive statistics and thematic analysis, respectively. The consultation with stakeholders will be essential for increasing the knowledge about MBI, identifying new evidence, and developing future strategies to guide public policies preventing burnout syndrome in health care professionals working in public services. RESULTS: This protocol will guide a scoping review to identify and map studies that used MBI to identify burnout syndrome in health care professionals working in public health services. The results of this review may be useful to public health care professionals, managers, policymakers, and the general population because these findings will help understand the validated, translated, and adapted versions of MBI and domains, number of items, Likert scales, and cutoff points or the latent profile analysis most used in the literature. Furthermore, possible research gaps may be identified to guide future studies. All information regarding the stages of the scoping review favor its transparency and allow it to be methodologically replicated according to the principles of open science, thereby reducing the risk of bias and data duplication. CONCLUSIONS: This study may reveal the multiplicity of scales described in the literature and the different forms of assessing burnout syndrome in health care professionals. This study may help to standardize the assessment of burnout syndrome in health care professionals working in public health services and contribute to the discussion and knowledge dissemination about burnout syndrome and mental health in this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42338.

Surveillance of Drinking Water Quality Worldwide: Scoping Review Protocol.

Universal access to clean and safe drinking water is essential for life maintenance since exposure to poor quality water is harmful to health. Drinking water quality is part of public health actions and, together with sanitation, a human right essential for life and a sustainable development goal. Moreover, an independent surveillance system conducted by the Ministry of Health or government agencies is needed for the safety of drinking water quality. We propose a scoping review protocol to identify and map worldwide surveillance actions and initiatives of drinking water quality implemented by government agencies or public health services. This scoping review protocol is based on the Joanna Briggs Institute manual and guided by the PRISMA-ScR. Articles, theses, dissertations, and official documents consulted in the following databases will be included: Medline/PubMed, Scopus, LILACS, Web of Science, Embase, Engineering Village, and gray literature. No date limit or language will be determined. The authors will develop a worksheet for data extraction. Quantitative (simple descriptive statistics) and qualitative data (thematic analysis) will be analyzed. The final scoping review will present the main findings, impacts, challenges, limitations, and possible research gaps related to surveillance of drinking water quality on population health.

Digital Health Opportunities to Improve Primary Health Care in the Context of COVID-19: Scoping Review.

BACKGROUND: The COVID-19 pandemic brought social, economic, and health impacts, requiring fast adaptation of health systems. Although information and communication technologies were essential for achieving this objective, the extent to which health systems incorporated this technology is unknown. OBJECTIVE: The aim of this study was to map the use of digital health strategies in primary health care worldwide and their impact on quality of care during the COVID-19 pandemic. METHODS: We performed a scoping review based on the Joanna Briggs Institute manual and guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. A systematic and comprehensive three-step search was performed in June and July 2021 in multidisciplinary health science databases and the gray literature. Data extraction and eligibility were performed by two authors independently and interpreted using thematic analysis. RESULTS: A total of 44 studies were included and six thematic groups were identified: characterization and geographic distribution of studies; nomenclatures of digital strategies adopted; types of information and communication technologies; characteristics of digital strategies in primary health care; impacts on quality of care; and benefits, limitations, and challenges of digital strategies in primary health care. The impacts on organization of quality of care were investigated by the majority of studies, demonstrating the strengthening of (1) continuity of care; (2) economic, social, geographical, time, and cultural accessibility; (3) coordination of care; (4) access; (5) integrality of care; (6) optimization of appointment time; (7) and efficiency. Negative impacts were also observed in the same dimensions, such as reduced access to services and increased inequity and unequal use of services offered, digital exclusion of part of the population, lack of planning for defining the role of professionals, disarticulation of actions with real needs of the population, fragile articulation between remote and face-to-face modalities, and unpreparedness of professionals to meet demands using digital technologies. CONCLUSIONS: The results showed the positive and negative impacts of remote strategies on quality of care in primary care and the inability to take advantage of the potential of technologies. This may demonstrate differences in the organization of fast and urgent implementation of digital strategies in primary health care worldwide. Primary health care must strengthen its response capacity, expand the use of information and communication technologies, and manage challenges using scientific evidence since digital health is important and must be integrated into public service.

Digital health interventions and quality of home-based primary care for older adults: A scoping review protocol.

Introduction: The use of digital health interventions has expanded, particularly in home-based primary care (HBPC), following the increase in the older adult population and the need to respond to the higher demand of chronic conditions, weakness and loss of autonomy of this population. There was an even greater demand with COVID-19 and subsequent isolation/social distancing measures for this risk group. The objective of this study is to map and identify the uses and types of digital health interventions and their reported impacts on the quality of HBPC for older adults worldwide. Methods and analysis: This is a scoping review protocol which will enable a rigorous, transparent and reliable synthesis of knowledge. The review will be developed from the theoretical perspective of Arksey and O'malley, with updates by Levac and Peters and respective collaborators based on the Joanna Briggs Institute manual, and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Data from white literature will be extracted from multidisciplinary health databases such as: the Virtual Health Library, LILACS, MEDLINE/PubMed, Scopus, Web of Science, Cinahl and Embase; while Google Scholar will be used for gray literature. No date limit or language restrictions will be determined. The quantitative data will be analyzed through descriptive statistics and qualitative data through thematic analysis. The results will be submitted to stakeholder consultation for preliminary sharing of the study and will later be disseminated through publication in open access scientific journals, scientific events and academic and community journals. The full scoping review report will present the main impacts, challenges, opportunities and gaps found in publications related to the use of digital technologies in primary home care. Discussion: The organization of this protocol will increase the methodological rigor, quality, transparency and accuracy of scoping reviews, reducing the risk of bias.

Worldwide Surveillance Actions and Initiatives of Drinking Water Quality: A Scoping Review.

This study identified and mapped worldwide surveillance actions and initiatives of drinking water quality implemented by government agencies and public health services. The scoping review was conducted between July 2021 and August 2022 based on the Joanna Briggs Institute method. The search was performed in relevant databases and gray literature; 49 studies were retrieved. Quantitative variables were presented as absolute and relative frequencies, while qualitative variables were analyzed using the IRaMuTeQ software. The actions developed worldwide and their impacts and results generated four thematic classes: (1) assessment of coverage, accessibility, quantity, and drinking water quality in routine and emergency situations; (2) analysis of physical-chemical and microbiological parameters in public supply networks or alternative water supply solutions; (3) identification of household water contamination, communication, and education with the community; (4) and investigation of water-borne disease outbreaks. Preliminary results were shared with stakeholders to favor knowledge dissemination.

Telemedicine in primary healthcare for the quality of care in times of COVID-19: a scoping review protocol.

INTRODUCTION: Telemedicine gained strength in primary healthcare (PHC) during the COVID-19 pandemic. Thus, there is a need to know its scope, technologies used and impacts on people's health. This study will map telemedicine use in PHC around the world and its impacts on quality of care in the context of the COVID-19 pandemic. METHODS: This is a scoping review protocol developed according to Arksey and O'Malley and Levac et al, based on the Joanna Briggs Institute manual, and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). The records will be mapped in the following multidisciplinary health sciences databases: Virtual Health Library, PubMed, Scopus, Web of Science, CINAHL and Embase. Searches will also be conducted on Google Scholar, preprint repositories and specific COVID-19 databases (grey literature). Quantitative data will be analysed using descriptive statistics, while thematic analysis will be performed for qualitative data. Preliminary findings will be presented to stakeholders to identify missing studies and develop effective dissemination strategies. ETHICS AND DISSEMINATION: Results will be disseminated through publication in an open access scientific journal, scientific events, and academic and community newspapers. Ethical approval was obtained due to stakeholder consultation, but will not involve the direct participation of patients. Link to the protocol record in the Open Science Framework (OSF) (osf.io/q94en).

Formação acadêmica e qualificação profissional dos enfermeiros para a prática em Cuidados Paliativos / Academic Education And Professional Qualification Of Nurses For Practice In Palliative Care

Objetivo: Avaliar a percepção dos enfermeiros acerca de sua formação acadêmica e qualificação profissional para a prestação de Cuidados Paliativos. Métodos: Estudo de campo de natureza descritiva, com abordagem qualitativa, realizado com 14 enfermeiros da Estratégia de Saúde da Família do município de Cajazeiras, Paraíba. Os dados foram coletados por meio de entrevista semiestruturada, processados utilizando-se do software IRAMUTEQ® e analisados em uma perspectiva temática e categorial. Resultados: Foram construídas duas categorias temáticas: Categoria 1 ­ Conhecimento dos enfermeiros sobre Cuidados Paliativos; Categoria 2 ­ Formação acadêmica e qualificação profissional dos enfermeiros para a prestação de Cuidados Paliativos. A maioria dos participantes referiu não haver nenhuma disciplina sobre a temática nas instituições de ensino onde cursaram a graduação e nenhum deles participou de Educação Permanente em Saúde sobre o tema, sugerindo conhecimento limitado dos profissionais sobre Cuidados Paliativos, condição que reflete negativamente na qualidade da assistência. Conclusão: Evidencia-se a necessidade de aproximação dos enfermeiros com os Cuidados Paliativos em seu processo formativo e de qualificação profissional, visando o desenvolvimento de competências necessárias para prestar uma assistência eficiente. (AU)

Objective: To evaluate the nurses' perception of their academic education and professional qualification for the provision of Palliative Care. Methods: Field study of a descriptive nature with a qualitative approach, conducted with 14 nurses from the Family Health Strategy in the municipality of Cajazeiras, Paraíba. Data were collected through semi-structured interviews, processed using the IRAMUTEQ® software and analyzed in a thematic and categorical perspective. Results: Two thematic categories were constructed: Category 1 ­ Nurses' knowledge about Palliative Care; Category 2 ­ Academic education and professional qualification of nurses for the provision of Palliative Care. Most participants reported not having discipline about the theme in the institutions where they finished their degrees and none participated in Permanent Health Education about the theme, being abel to suggest limited knowledge of professionals about Palliative Care, which reflects negatively on the quality of the assistance. Conclusion: The need to approach nurses wiith palliative care is evidente in their education and professional qualification process for devoloping necessary skills to provide efficient assistance. (AU)

Objetivo: Evaluar la percepción de los enfermeros de su educación académica y calificación profesional para la provisión de Cuidados Paliativos. Métodos: Estudio de campo de carácter descriptivo con enfoque cualitativo, realizado con 14 enfermeros de la Estrategia de Salud Familiar en el municipio de Cajazeiras, Paraíba. Los datos fueron recolectados a través de entrevistas semiestructuradas, procesadas usando el software IRAMUTEQ® y analizadas en una perspectiva temática y categórica. Resultados: se construyeron dos categorías temáticas: Categoría 1 ­ conocimiento de los enfermeros sobre cuidados paliativos; Categoría 2 ­ formación académica y calificación profesional de enfermeros para la prestación de cuidados paliativos. La mayoría de los participantes informaron que no tenían disciplina sobre el tema en las instituciones donde completaron sus títulos y ninguno participó en la Educación Permanente en Salud sobre el tema, lo que puede sugerir un conocimiento limitado de profesionales en Cuidados Paliativos, lo que se refleja negativamente en la calidad de la asistencia. Conclusión: La necesidad de acercar a los enfermeros a los cuidados paliativos es evidente en su proceso de capacitación y calificación profesional para el desarrollo de las habilidades necesarias para proporcionar una asistencia eficiente. (AU)

Estudo bibliométrico da produção científica da Revista Brasileira de Geriatria e Gerontologia entre 2014 e 2019 / Bibliometric study of the scientific production of Brazilian Journal of Geriatrics and Gerontology between 2014 and 2019

Resumo Objetivo Descrever e analisar o perfil das publicações da Revista Brasileira de Geriatria e Gerontologia (RBGG) entre 2014 e 2019. Método Trata-se de um estudo bibliométrico da produção científica da RBGG, durante o período de janeiro de 2014 a dezembro de 2019. A coleta de dados foi realizada por quatro pesquisadoras independentes, previamente treinadas e orientadas para a uniformização desse processo. Os dados coletados foram dispostos numa planilha no Microsoft Excel® e analisados no programa Stata versão 10.0. As variáveis analisadas foram organizadas em quatro eixos: identificação da publicação; tipo de estudo; autores; e processo editorial. Resultados Publicou-se um total de 504 estudos de 2014 a 2019, destes, 75% são artigos originais e 13,49% de revisão, 95,4% dos autores eram de nacionalidade brasileira e as instituições de afiliação eram majoritariamente do Sudeste (41,8%) e Sul (28,68%). A abordagem quantitativa foi predominante (70,5%) e as temáticas que se destacaram foram saúde pública (33,1%), doenças (19,9%) e assistência em saúde (19,4%). O tempo de aprovação apresentou uma redução média de quatro meses e o de publicação três meses. Conclusão Houve um aumento no número de publicações durante o período analisado, com destaque para artigos originais e estudos quantitativos. A diversidade de temas revela a tendência mais abrangente, para além daquelas centradas na doença, e mais para processos biopsicossociais e comportamentais, conforme verificado nos estudos em saúde pública. O processo editorial tem se mostrado célere com redução expressiva no tempo entre o recebimento e a publicação, e aumento no quantitativo de aprovação dos artigos recebidos.

Abstract Objective To describe and analyze the profile of publications of the Revista Brasileira de Geriatria e Gerontologia (RBGG) from 2014 to 2019. Method This is a bibliometric study of the scientific production of RBGG, during the period from January 2014 to December 2019. Data collection was performed by four independent researchers, previously trained and oriented to standardize this process. The collected data were arranged in a spreadsheet in Microsoft Excel® and analyzed using the Stata version 10.0 program. The analyzed variables were organized into four axes: Publication identification; Kind of study; Authors; and Editorial process. Results A total of 504 studies were published from 2014 to 2019, of which 75% are original articles and 13.49% reviews, 95.4% of the authors were Brazilian nationals and affiliation institutions were mostly in the Southeast (41.8%) and South (28.68%). The quantitative approach (70.5%) was predominant and the themes that stood out were public health (33.1%), diseases (19.9%), and health care (19.4%). The approval time showed a reduction lasted an average of four months and the publication three months. Conclusion There was an increase in the number of publications during the analyzed period, with emphasis on original articles and quantitative studies. The diversity of themes reveals the most common trend, beyond those centered on the disease, and more towards biopsychosocial and behavioral processes, as verified in studies in public health. The editorial process was rapid with a significant reduction in the time between receipt and publication, and an increase in the amount of approval of the articles received.

Risk communication in the fight against COVID-19 in Brazil: A rhetorical analysis / Comunicação de risco no enfrentamento da COVID-19 no Brasil: uma análise retórica

Abstract The objective was to analyze the information related to the new coronavirus pandemic in Brazil, conveyed by national and state authorities, through the lens of risk communication and community engagement. This is a qualitative and reflective study, anchored in rhetorical analysis. Two groups of speeches were analyzed. The first, nationwide, subdivided into the discourse by the Presidency of the Republic of Brazil and by the Ministry of Health. The second, of the states, represented by their normative actions related to the fight against the pandemic. Some recommendations in the management of the disease have unanimous understanding. Other actions, however, do not find the same support in the national and subnational discourse, reason why the following is adopted for a more detailed analysis in this article: the organization of risk communication and community engagement; the practice of social distancing; and the use of medications to treat the disease. Risk communication is based on the premise that every public health emergency faces communication challenges and may benefit from the lessons already learned. The fact that there are different discourses among the entities of the Federation implies disorganization of information, disagreements, and a greater degree of uncertainty in the population about the disease and how to prevent it.

Resumo Objetivou-se analisar as informações relacionadas à pandemia do novo coronavírus no Brasil, veiculadas pelas autoridades nacionais e estaduais, pelas lentes da comunicação de risco e engajamento comunitário. Trata-se de um estudo qualitativo, reflexivo, ancorado na análise retórica. Foram analisados dois grupos de discursos. O primeiro, de âmbito nacional, subdividido em discurso da Presidência da República do Brasil e do Ministério da Saúde. O segundo, dos estados, representados por seus atos normativos relacionados ao enfrentamento da pandemia. Algumas recomendações no manejo da doença têm compreensão unânime. Outras ações, no entanto, não encontram o mesmo amparo no discurso nacional e subnacional, por esse motivo sendo tomado para análise mais detalhada nesse artigo, a saber: a organização da comunicação de risco e o engajamento comunitário; a prática de distanciamento social; e o uso de medicamentos para o tratamento da doença. A comunicação de risco parte da premissa de que toda emergência de saúde pública enfrenta desafios de comunicação e pode se beneficiar das lições aprendidas anteriormente. O fato da existência de discursos distintos entre os entes da federação implica na desorganização das informações, desentendimentos e maior grau de incerteza da população sobre a doença e como se prevenir.

Estigma, preconceito e adesão ao tratamento: representações sociais de pessoas com tuberculose / Stigma, discrimination, and treatment adherence: social representations of people with tuberculosis / Estigma, prejuicio y adhesión al tratamiento: representaciones sociales de personas con tuberculosis

Introdução: A tuberculose é uma doença marcada por estigmas, tabus e crenças que afetam as pessoas pela possibilidade de vivenciarem preconceitos. Este estudo objetivou analisar as representações sociais dos sujeitos acometidos pela tuberculose acerca da vivência do preconceito e estigma atrelados à doença. Materiais e Métodos: Estudo exploratório, descritivo, com abordagem qualitativa. A população foi composta por indivíduos notificados com tuberculose, residentes no município de Cajazeiras ­ PB, sendo a amostra constituída por setes sujeitos. Os dados foram obtidos por meio de entrevistas semiestruturadas, com dados de identificação e questões acerca da representação social da tuberculose. Os resultados foram considerados mediante a análise de conteúdo temática, à luz da Teoria das Representações Sociais. Resultados: Identificou-se a formulação das seguintes categorias temáticas: Vivendo com a tuberculose: concepções sobre a doença; O contexto familiar e social; A dor que mais dói: O afastamento; O tratamento e suas dimensões particulares; O (des)apoio dos serviços de saúde. Discussão: O estigma e a discriminação são fatores que contribuem para a baixa adesão ao tratamento da tuberculose. Conclusões: O sucesso no tratamento de doenças negligenciadas, transmissíveis e que perpassam pelo preconceito, como a tuberculose, depende em parte, de como os sujeitos acometidos são acolhidos no convívio familiar, social e pelos profissionais de saúde durante o diagnóstico e todo o tratamento.

Introduction: Tuberculosis is a disease surrounded by stigmas, taboos, and misconceptions that affect people as they may experience possible discrimination. This study aimed to analyze the social representations of subjects affected by tuberculosis on the basis of the experience of discrimination and stigma related to the disease. Materials and Methods: A descriptive exploratory qualitative study was conducted with a population composed of individuals diagnosed with tuberculosis, residents of the city of Cajazeiras (PB), from which seven subjects were selected for the sample. Data were collected through semi-structured interviews including identification data and questions about the social representation of tuberculosis. The results were examined through thematic content analysis based on the Theory of Social Representations. Results: The creation of the following thematic categories was identified: living with tuberculosis: conceptions about the disease; family and social context; the most excruciating pain: distancing; treatment and its particular dimensions; support or lack thereof by healthcare services. Discussion: Stigma and discrimination lead to poor adherence to TB treatment. Conclusions: Success in treating neglected, communicable and biased diseases such as tuberculosis partly depends on how affected individuals are received in family and social settings and by healthcare professionals during their diagnosis and treatment.

Introducción: La tuberculosis es una enfermedad marcada por estigmas, tabúes y creencias que afectan a las personas por la posibilidad de experimentar prejuicios. Este estudio tuvo como objetivo analizar las representaciones sociales de los sujetos afectados por la tuberculosis sobre la experiencia de prejuicio y estigma relacionados con la enfermedad. Materiales y Métodos: Estudio exploratorio, descriptivo con enfoque cualitativo. La población estaba compuesta por individuos diagnosticados con tuberculosis, residentes en la ciudad de Cajazeiras - PB, y la muestra consistió en siete sujetos. Los datos se obtuvieron mediante entrevistas semiestructuradas con datos de identificación y preguntas sobre la representación social de la tuberculosis. Los resultados se consideraron a través del análisis de contenido temático, a la luz de la Teoría de las Representaciones Sociales. Resultados: Se identificó la formulación de las siguientes categorías temáticas: vivir con tuberculosis: concepciones sobre la enfermedad; el contexto familiar y social; el dolor que más duele: el alejamiento; el tratamiento y sus dimensiones particulares; el apoyo o falta de este por parte de los servicios de salud. Discusión: El estigma y la discriminación contribuyen a una mala adhesión al tratamiento de la tuberculosis. Conclusiones: El éxito en el tratamiento de enfermedades desatendidas, transmisibles y sujetas a prejuicios, como la tuberculosis, depende en parte de cómo los individuos afectados sean acogidos en la convivencia familiar y social, y por los profesionales de la salud durante el diagnóstico y tratamiento.

Fatores predisponentes de tuberculose em indivíduos privados de liberdade: revisão integrativa / Predisposing factors of tuberculosis in liberty-deprived: an integrative review

Introdução: O ambiente prisional proporciona predisposição de diversas doenças, como é o caso da tuberculose, cujo risco de adoecimento aumenta em 28 vezes no interior das prisões. Objetivo: Integrar os fatores causadores de tuberculose em indivíduos privados de liberdade, mencionados na literatura nacional e internacional. Materiais e Métodos: Trata-se de uma revisão integrativa realizada nas bases de dados LILACS, MEDLINE e PUBMED nos meses de abril a junho de 2017. Resultados: A amostra foi constituída por 12 estudos. Os resultados permitiram constatar que o uso de drogas ilícitas injetáveis, o tempo de encarceramento, o compartilhamento de cela com outros detentos e a coinfecção HIV/TB foram os principais fatores relacionados ao adoecimento por tuberculose na população penitenciária. Ademais, a tuberculose pulmonar foi o principal achado dentro do ambiente prisional, seguida pela infecção latente por tuberculose. Conclusão: O controle da tuberculose é uma necessidade urgente na sociedade. O desenvolvimento de programas de controle desta, bem como a instalação de serviços de saúde efetivos, que promovam um cuidado integral e a prevenção e promoção, assim como a reabilitação da saúde das pessoas privadas de liberdade constitui-se em uma necessidade imperiosa no contexto prisional.

Introduction: The prison environment provides a predisposition for several diseases, such as tuberculosis. The risk of getting infected is increased by 28 times within prisons. Objective: To integrate the causative factors of tuberculosis in liberty-deprived individuals reported in both national and international literature. Materials and Methods: A literature review was performed to identify published studies from April to June 2017. Published studies were identified using an initial search of the LILACS, MEDLINE, and PUBMED database. Results: The literature search resulted in the identification of 12 studies. The results showed that injecting drug use, incarceration time, cell sharing with other inmates, and HIV/TB coinfection were the main factors related to tuberculosis in prison population. In addition, pulmonary tuberculosis was the main finding within the prison environment, followed by latent tuberculosis infection. Conclusion: Tuberculosis control is an urgent need in society. The development of programs to control it, as well as the establishment of effective health services that deliver integral health care, prevention and promotion of health care. Furthermore, the rehabilitation of prisoners' health constitutes a compelling need in the prisoner context.

Violência escolar entre adolescentes: prevalência e fatores associados a vítimas e agressores / School violence between adolescents: prevalence and factors associated to victims and aggressors / Violencia escolar entre adolescentes: prevalencia y factores asociados a víctimas y agresores

OBJETIVO: analisar a prevalência de violência escolar entre adolescentes brasileiros com foco nos fatores associados aos comportamentos de vitimização e agressão entre os atores escolares. MÉTODOS: estudo transversal com 678 estudantes de 10 e 19 anos, de escolas públicas municipais de Campina Grande, Brasil. Analisaram-se as variáveis: sexo, idade, violência escolar, violência escolar física, psicológica, material, virtual e simbólica; uso de álcool, arma branca e arma de fogo na escola. Utilizou-se a Escala de Violência Escolar (EVE). Os dados foram organizados com o programa estatístico SPSS, considerando-se o nível de significância de 5% e intervalo de confiança de 95%. RESULTADOS: a violência escolar foi reportada por 86,3% dos escolares. Adolescentes femininos foram vítimas de violência psicológica (79,7%), enquanto os masculinos sofreram mais vitimização por violência física (65,4%). Observou-se associação entre a variável "ser agressor" com o "uso de álcool" (p<0,001; RP=3,92 [2,01-7,65]), "portar arma branca na escola" (p=0,03; RP=2,17 [1,08-4,34]) e "portar arma de fogo" (RP=17,73; [2,32-135,02]). CONCLUSÃO: a ocorrência de violência escolar é elevada e envolve, predominantemente, estudantes do sexo masculino, que demonstram comportamento de risco tanto como vítimas quanto como agressores.(AU)

Objective: analyzing the prevalence of school violence among Brazilian adolescents, focusing on the factors associated with the behavior of victimization and aggression in school actors. Methods: cross-sectional study with 678 students from 10 to 19 years of age in public municipal schools of Campina Grande, Brazil. The following variables were analyzed: sex, age, school violence, physical, psychological, material, virtual, and symbolic violence; use of alcohol, melee weapons, and firearms at school. The Escala de Violência Escolar (EVE) was used. Data were organized using the statistical program SPSS, considering a significance level of 5% and a confidence interval of 95%. Results: school violence was reported by 86.3% of students. Female adolescents were victims of psychological violence (79.7%), while male adolescents were more victimized by physical violence (65.4%). An association was found between the variable "being an aggressor" and "use of alcohol" (p<0.001; RP=3.92 [2.01-7.65]), "carrying melee weapons at school" (p=0.03; RP=2.17 [1.08-4.34]) and "carrying firearms" (RP=17.73; [2.32-135.02]). Conclusion: school violence is high and involves, predominantly male students, who show risk behavior both as victims and as aggressors. (AU)

Objetivo: analizar la prevalencia de la violencia escolar entre los adolescentes brasileños con un enfoque en los factores asociados con las conductas de victimización y agresión entre los actores escolares. Método: estudio transversal con 678 estudiantes de 10 y 19 años, de escuelas públicas de Campina Grande, Brasil. Se analizaron las siguientes variables: género, edad, violencia escolar, violencia escolar física, psicológica, material, virtual y simbólica; consumo de alcohol, armas blancas y armas de fuego en la escuela. Se utilizó la Escala de violencia escolar (EVE). Los datos se organizaron utilizando el programa estadístico SPSS, considerando un nivel de significancia del 5% y un intervalo de confianza del 95%. Resultados: el 86.3% de los estudiantes reportaron violencia escolar. Las adolescentes fueron víctimas de violencia psicológica (79.7%), mientras que los varones fueron más víctimas de violencia física (65.4%). Hubo una asociación entre la variable "ser agresor" con "consumo de alcohol" (p <0.001; PR = 3.92 [2.01-7.65]), "llevar un arma blanca a la escuela" (p = 0 , 03; RP = 2.17 [1.08-4.34]) y "llevar un arma de fuego" (RP = 17.73; [2.32-135.02]). Conclusión: La incidencia de violencia escolar es alta e involucra predominantemente a estudiantes varones, quienes demuestran comportamientos de riesgo como víctimas y agresores. (AU)

Análise dos resultados do teste de papanicolaou entre usuárias da atenção primária: estudo transversal / Analysis of the results of the papanicolaou test among primary care users: a cross-sectional study

Objetivo: Identificar os resultados do teste de Papanicolaou correlacionando-os com o início da atividade sexual e o número de parceiros de mulheres. Metodologia: Estudo transversal com mulheres que realizaram o teste de Papanicolaou. Na análise dos dados, consideraram-se os resultados dos exames normais e alterados, por meio do teste não paramétrico Kruskal- Wallis. As médias das variáveis foram comparadas entre o grupo normal e cada infecção, por meio do teste t de Student. Resultados: Foi identificada prevalência de infecções genitais em 25,5%, com índice por Gardnerella vaginalis de 49% e por Candida spp de 38%. A idade do início da atividade sexual e o número de parceiros sugeriram associação com as infecções genitais. Conclusão: Deve-se realizar a educação em saúde e o teste de Papanicolaou para a prevenção primária e secundária de infecções sexualmente transmissíveis.

Objective: To identify the results of the Papanicolaou test and correlate them with the beginning of sexual activity and the number of partners of women. Methodology: Cross-sectional study with women who made the Papanicolaou test. In the analysis of the data, consider the results of the normal and altered exams using the Kruskal-Wallis non-parametric test. The averages of the variables were compared between the normal group and each infection, using Student’s t test. Results: The prevalence of genital infections was identified in 25.5%, with a index by Gardnerella vaginalis of 49% and by Candida spp of 38%. The age of beginning of sexual activity and the number of partners suggested association with the genital infections. Conclusion: Must be performed the health education and the Papanicolaou test for primary and secondary prevention of sexually transmitted infections.

Objetivo: Identificar los resultados de la prueba de Papanicolaou correlacionándolos con el inicio de la actividad sexual y el número de parejas de mujeres. Métodos: Estudio transversal con mujeres que realizaron la prueba de Papanicolaou. En el análisis de los datos, se consideraron los resultados de los exámenes normales y alterados, por medio del test no paramétrico Kruskal-Wallis. Las medias de las variables fueron comparadas entre el grupo normal y cada infección, por medio del test t de Student. Resultados: Se identificó prevalencia de infecciones genitales en el 25,5%, con índice por Gardnerella vaginalis del 49% y por Candida spp del 38%. La edad del inicio de la actividad sexual y el número de parejas sugieren asociación con las infecciones genitales. Conclusión: Se debe realizar la educación en salud y la prueba de Papanicolaou para la prevención primaria y secundaria de infecciones de transmisión sexual.

Percepção dos enfermeiros assistenciais sobre a comissão de controle de infecção hospitalar / Understanding of assistant nurses about the hospital infection control committee

Objetivo: analisar a percepção dos enfermeiros assistenciais sobre a função da Comissão de Controle de Infecção Hospitalar. Metodologia: pesquisa descritiva, com abordagem qualitativa, desenvolvida em um hospital universitário, com oito enfermeiros. Para a análise dos dados, utilizou-se a análise de conteúdo. Resultados: emergiram três categorias temáticas: conhecimento acerca da função da CCIH; reconhecimento da importância do enfermeiro na CCIH e contribuição do enfermeiro assistencial para com a CCIH. Conclusão: destaca-se o não reconhecimento da Comissão como órgão preventivo, mas muitas vezes atrelado somente à pós-exposição a acidentes de trabalho, evidenciando a cultura curativa no ambiente hospitalar.

Objective: To analyze the understanding of assistant nurses on the role of the Hospital Infection Control Committee. Methodology: Descriptive research, with a qualitative approach, developed in a university hospital, with eight nurses. For the analysis of the data, the content analysis was used. Results: Three subject areas emerged: Awareness about the role of HICC; Recognition of the importance of nurses in the HICC and their contribution to it. Conclusion: Failure to recognize the Commission as a preventive body stands out, but often only linked to post-exposure to work accidents, revealing the curative care culture in the hospital environment.

Objetivo: Analizar la percepción de los enfermeros asistenciales sobre el papel de la Comisión de Control de Infecciones Hospitalarias. Metodología: estudio descriptivo con un enfoque cualitativo, desarrollado en un hospital universitario, con ocho enfermeros. Para la análisis de los datos, se utilizó la análisis de contenido. Resultados: tres categorías temáticas surgieron: El conocimiento de la función de CCIH; El reconocimiento de la importancia de los enfermeros en CCIH y la contribuición del enfermero asistencial por el CCIH. Conclusión: Es digno de mención o no reconocimiento de la Comisión como órgano preventiva, a menudo torpe justo después de la exposición a los accidentes de trabajo, mostrando una cultura curativa en el ámbito hospitalario.