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OBJECTIVE: to analyze the psychometric properties of the Incivility in Nursing Education - Revised Survey - Brazilian version with undergraduate nursing students. METHOD: methodological study conducted in a nursing school in São Paulo state. It is the analysis of the psychometric properties (reliability and construct validity) of the items in the INE-R survey - Brazilian version. Construct validity was performed by Confirmatory Factor Analysis, and reliability by test-retest in order to verify the instrument's stability, as calculated by the Intraclass Correlation Coefficient and the Internal Consistency of the items according to Cronbach's alpha, ordinal alpha and McDonalds's omega coefficients. RESULTS: Confirmatory Factor Analysis fitted the proposed model with two factors (low and high incivility), with a suggestion to exclude one of student items. Most of the fitting values for the student items and all of the faculty-member items complied with the references established in the literature; the values for Internal Consistency Coefficients were greater than 0.80, and Intraclasss Correlation Coefficients were greater than 0.75. CONCLUSION: the Brazilian version of the Incivility in Nursing Education - Revised Survey is validated for the studied context, as it has shown satisfactory reliability and validity by means of factor analysis, which has confirmed the original two-factor model, with 23 items addressing student behaviors and 24 items applied to faculty behaviors. HIGHLIGHTS: (1) Incivility is a global and growing phenomenon in higher education.(2) An uncivil environment interferes with learning and health indicators.(3) A validated survey to measure incivility in nursing education is presented.
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Educación en Enfermería , Incivilidad , Psicometría , Humanos , Brasil , Educación en Enfermería/normas , Masculino , Femenino , Adulto Joven , Estudiantes de Enfermería/psicología , Encuestas y Cuestionarios/normas , Adulto , LenguajeRESUMEN
BACKGROUND: Tuberculosis (TB) is a disease that is influenced by social determinants of health. However, the specific structural and intermediary determinants of TB in Eastern Amazonia remain unclear. Despite being rich in natural resources, the region faces significant challenges related to poverty, inequality, and neglected diseases. The objective of this study was to use mathematical modeling to evaluate the influence of structural and intermediary determinants of health on TB in Eastern Amazonia, Brazil. METHODS: This cross-sectional included all TB cases diagnosed and registered in the Notifiable Diseases Information System (SINAN) from 2001 to 2017. Data on social determinants were collected at the census tract level. The generalized additive model for location, scale, and shape (GAMLSS) framework was employed to identify the effect of social determinants on communities with a high TB prevalence. The Double Poisson distribution (DPO) was chosen, and inclusion of quadratic effects was tested. RESULTS: A total of 1730 individuals were diagnosed with TB and reported in SINAN during the analyzed period. The majority were female (59.3%), aged 31 to 59 years (47.6%), identified as blacks (67.9%), and had incomplete elementary education (46.6%). The prevalence of alcoholism was 8.6% and mental illness was 0.7%. GAMLSS analyses demonstrated that the risk of community incidence of TB is associated with the proportion of the population lacking basic sanitation, as well as with the age groups of 16-31 years and > 61 years. CONCLUSIONS: The study highlights the strategic utility of GAMLSS in identifying high-risk areas for TB. Models should encompass a broader range of social determinants to inform policies aimed at reducing inequality and achieving the goals of the End TB strategy.
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INTRODUCTION: Drug-drug interactions among people with suicidal behavior is a challenging topic, considering the harm it poses for patients already vulnerable and the lack of literature on the thematic. This aspect must not be neglected in research and clinical practice, and thus requires thorough investigation. OBJECTIVE: to investigate predictors of drug-drug interaction of prescribed drugs and the prescription of two or more drugs for people admitted due to suicidal behavior in a psychiatric emergency department (short-stay hospital ward). METHOD: A cross-sectional study with retrospective approach, carried out in a Brazilian psychiatric emergency unit in 2015. Data about first and last medical prescriptions were collected from 127 patients' files. Descriptive statistics and the Zero Adjusted Logarithmic Distribution (ZALG) model were adopted, with the significance level α = 0.05. RESULTS: Potential drug-drug interactions were found in most of the first and last prescriptions. The sample majority were female, with previous suicide attempts, being discharged from the hospital with three drugs (or more) prescribed, and without referral to any health service. Age and comorbidities were predictors of more drug prescriptions and the amount of prescribed drugs was the most important predictor of drug-drug interactions (quantity and severity). CONCLUSIONS: the variables associated with drug-drug interactions and prescription of two or more drugs among people with suicidal behavior needs to be investigated in different contexts and addressed in interventions with the aim to promote patient safety.
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OBJECTIVE: to assess the level of trust in health services during the COVID-19 pandemic in Brazil. METHODS: A cross-sectional study, carried out between 2020 and 2021, among Brazilians over 18. Nonprobabilistic sampling was used. Descriptive and inferential statistics were applied, using the local bivariate Moran's technique to verify the existence of spatial dependence between the incidence and mortality of COVID-19 and trust in health services. Furthermore, multinomial regression was also used to analyze the factors associated with the confidence level, with the calculation of the odds ratio and with a confidence interval of 95%. RESULTS: A total of 50.6% reported trust in hospital services, while 41.4% did not trust primary health care services. With the application of the local bivariate Moran, both for the incidence and mortality of COVID-19, the trust in tertiary care and primary care services showed a statistically significant spatial association predominant in the Midwest (high-low) and North (low-high) regions of Brazil. The level of trust was associated with education, religion, region of the country and income. CONCLUSIONS: The level of trust in hospital services, more than primary health care services, may be related to the population's culture of prioritizing the search for hospital care at the detriment of health promotion and disease prevention.
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COVID-19 , Humanos , Brasil/epidemiología , COVID-19/epidemiología , Estudios Transversales , Pandemias , ConfianzaRESUMEN
(1) Background: Tuberculosis remains a public health problem in the world. The study analyzed the factors associated with drug-resistant tuberculosis in the prison population of the state of Paraná. (2) Methods: Ecological study of drug-resistant tuberculosis cases registered in the Paraná Information System, Brazil (2008 to 2018). We performed descriptive statistics of quantitative parameters calculated with absolute frequencies. Additionally, we used binary regression logistics, where the odds ratio with its respective confidence interval was calculated. (3) Results: Of the 653 cases registered as cases of tuberculosis in the incarcerated population, 98 were drug-resistant tuberculosis. We observed that educational level of up to 8 to 11 years of schooling, negative bacterial culture (test outcome) and no tobacco use were factors associated with the non-development of drug-resistant tuberculosis, while clinically confirmed pulmonary TB and positive sputum smear microscopy in the fourth month of follow-up showed an association for the development of drug resistance. (4) Conclusions: The study showed that clinically confirmed pulmonary TB and a positive sputum smear microscopy in the fourth month of follow-up were associated with drug-resistant tuberculosis.
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Mycobacterium tuberculosis , Prisioneros , Tuberculosis Resistente a Múltiples Medicamentos , Tuberculosis Pulmonar , Tuberculosis , Humanos , Brasil/epidemiología , Esputo/microbiología , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Pulmonar/epidemiologíaRESUMEN
BACKGROUND: Psychological morbidity is commonly experienced by people with a spinal cord injury (SCI), but whether it is associated with occupational role transitions in is unknown. OBJECTIVE: To analyze whether anxiety or depression symptoms are independently associated to increased likelihoods of role transitions in adults with SCI. METHODS: Cross-sectional study; multivariate analysis using a heteroscedastic Dirichlet regression. PARTICIPANTS: Thirty persons with traumatic SCI. MEASURES: Role Checklist (e.g. role transitions: dependent variables) and Beck's Depression Inventory and State-Trait Anxiety Inventory (independent variables), adjusted for socio-demographic, functional, and injury-level confounders. RESULTS: Greater depression symptoms independently increased the likelihood of occupational role transitions, either for roles loss [adjusted Odds Ratio (AOR): 1.04; 95% confidence interval (CI):1.009-1.080] or roles gain [AOR: 1.07; 95% CI:1.02-1.13], as opposed to continued occupational roles. Higher anxiety as a trait, in turn, independently reduced the likelihood of occupational roles gain [AOR: 0.93; 95% CI: 0.869-0.992]. The "worker" role was the one lost more frequently (83%). CONCLUSION: Psychological morbidity is associated to occupational role transitions, as opposed to continued roles. Further research (e.g. with larger samples, longitudinal design, using structural equation modelling) should elucidate on the intricate relationships between mental health status and occupational role transitions in people experiencing SCI.
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Depresión , Traumatismos de la Médula Espinal , Adulto , Ansiedad/epidemiología , Ansiedad/etiología , Brasil/epidemiología , Estudios Transversales , Depresión/complicaciones , Depresión/epidemiología , Humanos , Análisis Multivariante , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/epidemiologíaRESUMEN
BACKGROUND: A diagnosis of tuberculosis (TB) does not mean that the disease will be treated successfully, since death may occur even among those who are known to the health services. Here, we aimed to analyze patient survival time from the diagnosis of TB to death, precocious deaths, and associated factors in southern Brazil. METHODS: We conducted a longitudinal study with patients who were diagnosed with TB and who died due to the disease between 2008 and 2015 in southern Brazil. The starting point for measuring survival time was the patient's diagnosis date. Techniques for survival analysis were employed, including the Kaplan-Meier test and Cox's regression. A mixed-effect model was applied for identifying the associated factors to precocious deaths. Hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (95% CI) were estimated. We defined p value <0.05 as statistically significant for all statistics applied. RESULTS: One hundred forty-six patients were included in the survival analysis, observing a median survival time of 23.5 days. We observed that alcoholism (HR=1.55, 95% CI=1.04-2.30) and being male (HR=6.49, 95% CI=1.03-2.68) were associated with death. The chance of precocious death within 60 days was 10.48 times greater than the chance of early death within 30 days. CONCLUSION: Most of the deaths occurred within 2 months after the diagnosis, during the intensive phase of the treatment. The use of alcohol and gender were associated with death, revealing inequality between men and women. This study advanced knowledge regarding the vulnerability associated with mortality. These findings must be addressed to fill a gap in the care cascades for active TB and ensure equity in health.
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OBJECTIVE: To analyse the association between social inequalities and the leprosy burden in a low endemicity scenario in the state of São Paulo, Brazil. METHODS: This ecological study was carried out in the city of Ribeirão Preto, state of São Paulo, Brazil, considering leprosy cases notified from 2006 to 2016. Regarding social inequalities, dimensions related to high household density, literacy, home occupation conditions, health conditions, household income, ethnicity and age were considered. The generalised additive model for location, scale and shape (GAMLSS) was used to verify the association between the social inequalities and leprosy burden. RESULTS: The increase in men and women with no education and people with an income of 1 to 2 minimum wages was associated with a relative increase in the number of leprosy cases (7.37%, 7.10% and 2.44%, respectively). Regarding the ethnicity variables, the increase in the proportion of men (black) and women (mixed race) with no schooling was associated with a relative increase in the number of cases of the disease (10.77% and 4.02%, respectively). Finally, for people of mixed race or ethnicity, the increase in the proportion of households with 1/2 to 1 minimum wage was related to a relative decrease in the total number of cases (-4.90%). CONCLUSION: The results show that the determinants associated with the increase in leprosy cases are similar to those in Brazilian hyperendemic regions, and that even in cities with low endemicity, social inequality is one of the main determinants of the disease.
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Enfermedades Endémicas/estadística & datos numéricos , Lepra/epidemiología , Factores Socioeconómicos , Adulto , Brasil/epidemiología , Brasil/etnología , Ciudades/epidemiología , Ciudades/etnología , Escolaridad , Ambiente , Etnicidad/estadística & datos numéricos , Femenino , Humanos , Lepra/etnología , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
PURPOSE: To apply the Rasch model to test the psychometric assessment of the nursing outcome Swallowing status among poststroke patients. METHODS: Cross-sectional study was conducted with 227 poststroke patients, which were evaluated by a nurse. The Rasch model was used to examine psychometric properties. FINDINGS: Indicators fit the Rasch model and presented good reliability and good ability for separation index. The 5-point Likert scale did not present adequate discrimination and classification levels were compiled into three. CONCLUSIONS: Data evidenced the use of a robust method to perform a clinical validity of the Swallowing status, complementing previous validation studies. RELEVANCE TO CLINICAL PRACTICE: Using Rasch analysis serve as reference points to assess Swallowing status on a single scale. OBJETIVO: Aplicar o modelo Rasch para testar as medidas psicométricas do resultado de enfermagem Estado da deglutição em pacientes acometidos por acidente vascular cerebral. MÉTODOS: Estudo transversal, realizado com 227 pacientes após AVC avaliados por um único enfermeiro. O modelo Rasch foi usado para examinar propriedades psicométricas. RESULTADOS: Os indicadores se ajustaram ao modelo Rasch e apresentam boa confiabilidade e boa capacidade de separação. A escala Likert de 5 pontos não apresentou discriminação adequada e os níveis de classificação foram compilados em três pontos. CONCLUSÃO: Os dados evidenciaram o uso de um método robusto para a validade clínica do Estado da deglutição, complementando os estudos de validação anteriores. RELEVÂNCIA PARA A PRÁTICA CLÍNICA: O uso do modelo Rasch serve como ponto de referência para avaliar o Estado da deglutição em uma única escala.
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Deglución , Modelos de Enfermería , Evaluación de Resultado en la Atención de Salud , Psicometría , Accidente Cerebrovascular/fisiopatología , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/enfermeríaRESUMEN
Introduction: The time taken for screening, detection and initiation of treatment is a determining factor for therapeutic management in oncology. The availability of reliable data guides decisions for public policies and evaluates compliance with these policies. Objective:To analyze the survival and outcomes of pediatric patients with leukemia and lymphoma from 2000 to 2022. Method: Epidemiological, descriptive study, with data extracted from Fundação Oncocentro do Estado de São Paulo, according to the International Classification of Childhood Cancer (ICCC). The time elapsed between the first consultation and diagnosis was evaluated, between diagnosis and the start of oncological treatment, and the survival of these patients, calculated according to the Peto-Peto test. Results: 12,030 cases were analyzed, 6,994 in males and 7,292 with leukemia. The probability of the time between consultation and diagnosis exceeds 30 days was 49.29% for leukemias and 76.31 for lymphomas, a significant result for treatment and relapses (p < 0.001) but not in relation to sex; the time between diagnosis and treatment exceeding 60 days was 38.04% for leukemias and 71.97% for lymphomas. Not undergoing treatment was significant (p < 0.001) while waiting for diagnosis after consultation for patients with leukemia and lymphomas, except surgery, chemotherapy and radiotherapy combined. Conclusion: Despite the advances, a considerable percentage of patients wait longer than expected for diagnosis and initiation of treatment, impacting their survival rates
ntrodução: O tempo no rastreio, detecção e início do tratamento é fator determinante para o manejo terapêutico em oncologia. A disponibilidade de dados confiáveis orienta decisões para políticas públicas e avalia o cumprimento dessas políticas. Objetivo: Analisar a sobrevivência e desfechos de pacientes pediátricos com leucemias e linfomas de 2000 a 2022. Método:Estudo epidemiológico, descritivo, com dados extraídos da Fundação Oncocentro do Estado de São Paulo, segundo a Classificação Internacional de Câncer na Infância. Avaliou-se o tempo decorrido entre a primeira consulta e o diagnóstico; entre o diagnóstico e o início do tratamento oncológico; e a sobrevivência desses pacientes, calculada conforme o teste Peto-Peto. Resultados: Foram analisados 12.030 casos, com prevalência no sexo masculino 6.994; 7.292 corresponderam às leucemias. A probabilidade de o tempo entre a consulta e o diagnóstico ter sido superior a 30 dias foi de 49,29% para as leucemias e de 76,31 para os linfomas, significativo para o tratamento e recidivas (p < 0,001) e não por sexo; o tempo entre o diagnóstico e tratamento, superior a 60 dias, foi de 38,04% para as leucemias e de 71,97% para os linfomas. Não realizar tratamento foi significante (p< 0,001) na espera entre a consulta e o diagnóstico para os pacientes com leucemias; o mesmo para os linfomas, exceto para a combinação de cirurgia, quimioterapia e radioterapia. Conclusão: À despeito dos avanços obtidos, uma porcentagem considerável de pacientes aguarda um tempo maior do que o esperado para o diagnóstico e o início do tratamento, repercutindo nas taxas de sobrevivência desses pacientes
Introducción: El tiempo necesario para el screening, detección e inicio del tratamiento es un factor determinante para el manejo terapéutico en oncología. La disponibilidad de datos confiables orienta las decisiones de políticas públicas y evalúa el cumplimiento de estas políticas. Objetivo:Analizar la supervivencia y desenlaces de pacientes pediátricos con leucemia y linfoma en el período de 2000 a 2022. Método: Estudio epidemiológico, descriptivo, con datos extraídos de la Fundación Oncocentro del estado de São Paulo, según la Clasificación Internacional del Cáncer Infantil. Se evaluó el tiempo transcurrido entre la primera consulta y el diagnóstico; entre el diagnóstico y el inicio del tratamiento oncológico, y la supervivencia de estos pacientes, calculada según la prueba de Peto-Peto. Resultados: Se analizaron 12 030 casos, con una prevalencia masculina de 6994; 7292 correspondieron a leucemia. La probabilidad de que el tiempo entre consulta y diagnóstico sea mayor a 30 días fue del 49,29% para leucemias y del 76,31 para linfomas, significativa para tratamiento y recaídas (p < 0,001) y no para sexo; para el tiempo entre diagnóstico y tratamiento, superior a 60 días, fue del 38,04% para las leucemias y del 71,97% para los linfomas. No recibir tratamiento fue significativo (p < 0,001) en la espera entre la consulta y el diagnóstico en pacientes con leucemia; lo mismo para los linfomas, excepto la combinación de cirugía, quimioterapia y radioterapia. Conclusión: A pesar de los avances logrados, un porcentaje considerable de pacientes espera un tiempo más de lo esperado para el diagnóstico y el inicio del tratamiento, impactando en las tasas de supervivencia de estos pacientes.