Interdisciplinary training program for pediatric cardiorespiratory arrest using rapid cycle deliberate practice: A descriptive cross-sectional study.

BACKGROUND: cardiorespiratory arrest (CRA) is a severe public health concern, and clinical simulation has proven to be a beneficial educational strategy for training on this topic. OBJECTIVE: To describe the implementation of a program for pediatric cardiac arrest care using rapid-cycle deliberate practice (RCDP), the quality of the technique employed, and participants' opinions on the methodology. DESIGN AND SETTING: This descriptive cross-sectional study of pre- and post-performance training in cardiopul monary resuscitation (CPR) techniques and reaction evaluation was conducted in a hospital in São Paulo. METHODS: Multidisciplinary groups performed pediatric resuscitation in a simulated scenario with RCDP mediated by a facilitator. The study sample included professionals working in patient care. During the simulation, the participants were evaluated for their compliance with the CRA care algorithm. Further, their execution of chest compressions was assessed pre- and post-intervention. RESULTS: In total, 302 professionals were trained in this study. The overall quality of CPR measured pre-intervention was inadequate, and only 26% had adequate technique proficiency, whereas it was 91% (P < 0.01) post-intervention. Of the participants, 95.7% responded to the final evaluation and provided positive comments on the method and their satisfaction with the novel simulation. Of these, 88% considered that repetition of the technique used was more effective than traditional simulation. CONCLUSIONS: The RCDP is effective for training multidisciplinary teams in pediatric CPR, with an emphasis on the quality of chest compressions. However, further studies are necessary to explore whether this trend translates to differential performances in practical settings.

Interdisciplinary training program for pediatric cardiorespiratory arrest using rapid cycle deliberate practice: A descriptive cross-sectional study

ABSTRACT BACKGROUND: cardiorespiratory arrest (CRA) is a severe public health concern, and clinical simulation has proven to be a beneficial educational strategy for training on this topic. OBJECTIVE: To describe the implementation of a program for pediatric cardiac arrest care using rapid-cycle deliberate practice (RCDP), the quality of the technique employed, and participants' opinions on the methodology. DESIGN AND SETTING: This descriptive cross-sectional study of pre- and post-performance training in cardiopul monary resuscitation (CPR) techniques and reaction evaluation was conducted in a hospital in São Paulo. METHODS: Multidisciplinary groups performed pediatric resuscitation in a simulated scenario with RCDP mediated by a facilitator. The study sample included professionals working in patient care. During the simulation, the participants were evaluated for their compliance with the CRA care algorithm. Further, their execution of chest compressions was assessed pre- and post-intervention. RESULTS: In total, 302 professionals were trained in this study. The overall quality of CPR measured pre-intervention was inadequate, and only 26% had adequate technique proficiency, whereas it was 91% (P < 0.01) post-intervention. Of the participants, 95.7% responded to the final evaluation and provided positive comments on the method and their satisfaction with the novel simulation. Of these, 88% considered that repetition of the technique used was more effective than traditional simulation. CONCLUSIONS: The RCDP is effective for training multidisciplinary teams in pediatric CPR, with an emphasis on the quality of chest compressions. However, further studies are necessary to explore whether this trend translates to differential performances in practical settings.

Adjustable sling for the treatment of post-prostatectomy urinary incontinence: systematic review and meta-analysis.

Urinary incontinence after prostatectomy has a significant negative impact on the quality of life of the patient. The surgical treatment includes several models of male slings, such as adjustable slings. The objective of this study was to evaluate the effectiveness and safety of adjustable sling in the treatment of post-prostatectomy urinary incontinence. This is a systematic review of literature. The following electronic databases were searched until January 2018: PubMed®, Embase, CENTRAL and LILACS. The keywords used in the search strategies were: "prostatectomy" [Mesh], "urinary incontinence" [Mesh] and "suburethral slings" [Mesh]. Randomized clinical trials and observational studies, with or without Control Group, and follow-up of more than 12 months were included. Only one randomized study with high risk of bias was included and it concluded the effectiveness equivalence between adjustable and non-adjustable slings. All other studies were cases series with patients of varying levels of incontinence intensity and history of pelvic radiation therapy and previous surgeries. The meta-analysis for 0 pad in 24 hours demonstrated an effectiveness of 53%. For the 0 to 1 pad test in 24 hours, the meta-analysis resulted in an effectiveness of 69%. Risk factors for surgery failure include prior radiation, severity of post-prostatectomy urinary incontinence, and previous surgeries. The meta-analysis of the extrusion rate was 9.8% and the most commonly reported adverse effects were pain and local infection. Evidence of low quality indicates that adjustable slings are effective for treating post-prostatectomy urinary incontinence, with frequency of adverse events similar to the surgical option considered gold standard (the artificial urinary sphincter implant).

Adjustable sling for the treatment of post-prostatectomy urinary incontinence: systematic review and meta-analysis / Implante de sling ajustável no tratamento da incontinência urinária pós-prostatectomia: revisão sistemática e meta-análise

ABSTRACT Urinary incontinence after prostatectomy has a significant negative impact on the quality of life of the patient. The surgical treatment includes several models of male slings, such as adjustable slings. The objective of this study was to evaluate the effectiveness and safety of adjustable sling in the treatment of post-prostatectomy urinary incontinence. This is a systematic review of literature. The following electronic databases were searched until January 2018: PubMed®, Embase, CENTRAL and LILACS. The keywords used in the search strategies were: "prostatectomy" [Mesh], "urinary incontinence" [Mesh] and "suburethral slings" [Mesh]. Randomized clinical trials and observational studies, with or without Control Group, and follow-up of more than 12 months were included. Only one randomized study with high risk of bias was included and it concluded the effectiveness equivalence between adjustable and non-adjustable slings. All other studies were cases series with patients of varying levels of incontinence intensity and history of pelvic radiation therapy and previous surgeries. The meta-analysis for 0 pad in 24 hours demonstrated an effectiveness of 53%. For the 0 to 1 pad test in 24 hours, the meta-analysis resulted in an effectiveness of 69%. Risk factors for surgery failure include prior radiation, severity of post-prostatectomy urinary incontinence, and previous surgeries. The meta-analysis of the extrusion rate was 9.8% and the most commonly reported adverse effects were pain and local infection. Evidence of low quality indicates that adjustable slings are effective for treating post-prostatectomy urinary incontinence, with frequency of adverse events similar to the surgical option considered gold standard (the artificial urinary sphincter implant).

RESUMO A incontinência urinária pós-prostatectomia tem importante impacto negativo na qualidade de vida do portador. O tratamento cirúrgico inclui slings masculinos e, entre os diversos modelos, os slings ajustáveis. O objetivo deste estudo foi avaliar a efetividade e a segurança do sling ajustável no tratamento da incontinência urinária pós-prostatectomia. Trata-se de revisão sistemática de literatura. Foram pesquisadas as seguintes bases de dados eletrônicas até janeiro de 2018: PubMed®, Embase, CENTRAL e LILACS. As palavras-chaves utilizadas nas estratégias de busca foram: "prostatectomy" [Mesh], "urinary incontinence" [Mesh] e "suburethral slings" [Mesh]. Foram incluídos ensaios clínicos randomizados e estudos observacionais controlados ou não com seguimento maior que 12 meses. Apenas um estudo randomizado com alto risco de viés foi localizado e concluiu a equivalência de efetividade de slings ajustáveis e não ajustáveis. Todos os outros estudos foram série de casos com pacientes de variados níveis de intensidade da incontinência e histórico de radioterapia pélvica e cirurgias prévias. A metanálise para 0 pad em 24 horas demonstrou efetividade de 53%. Para o desfecho 0 a 1 pad em 24 horas, a metanálise resultou em efetividade de 69%. Os fatores de risco para insucesso da cirurgia incluem radiação prévia, gravidade da incontinência urinária pós-prostatectomia e cirurgias anteriores. A metanálise da taxa de extrusão foi de 9,8%, e os efeitos adversos mais relatados foram dor e infecção local. Evidências de baixa qualidade indicam que os slings ajustáveis são efetivos para o tratamento da incontinência urinária pós-prostatectomia, com frequência de eventos adversos semelhantes à opção cirúrgica considerada padrão-ouro (o implante de esfíncter urinário artificial).

Immediate versus delayed treatment for recently symptomatic carotid artery stenosis

ABSTRACT BACKGROUND: The timing of surgery for recently symptomatic carotid artery stenosis remains controversial. Early cerebral revascularization may prevent a disabling or fatal ischemic recurrence, but it may also increase the risk of hemorrhagic transformation, or of dislodging a thrombus. This review examined the randomized controlled evidence that addressed whether the increased risk of recurrent events outweighed the increased benefit of an earlier intervention. OBJECTIVES: To assess the risks and benefits of performing very early cerebral revascularization (within two days) compared with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis. METHODS: Search methods: We searched the Cochrane Stroke Group Trials Register in January 2016, the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, issue 1), MEDLINE (1948 to 26 January 2016), EMBASE (1974 to 26 January 2016), LILACS (1982 to 26 January 2016), and trial registers (from inception to 26 January 2016). We also handsearched conference proceedings and journals, and searched reference lists. There were no language restrictions. We contacted colleagues and pharmaceutical companies to identify further studies and unpublished trials Selection criteria: All completed, truly randomized trials (RCT) that compared very early cerebral revascularization (within two days) with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis. Data collection and analysis: We independently selected trials for inclusion according to the above criteria, assessed risk of bias for each trial, and performed data extraction. We utilized an intention-to-treat analysis strategy. MAIN RESULTS: We identified one RCT that involved 40 participants, and addressed the timing of surgery for people with recently symptomatic carotid artery stenosis. It compared very early surgery with surgery performed after 14 days of the last symptomatic event. The overall quality of the evidence was very low, due to the small number of participants from only one trial, and missing outcome data. We found no statistically significant difference between the effects of very early or delayed surgery in reducing the combined risk of stroke and death within 30 days of surgery (risk ratio (RR) 3.32; confidence interval (CI) 0.38 to 29.23; very low-quality evidence), or the combined risk of perioperative death and stroke (RR 0.47; CI 0.14 to 1.58; very low-quality evidence). To date, no results are available to confirm the optimal timing for surgery. AUTHORS CONCLUSIONS: There is currently no high-quality evidence available to support either very early or delayed cerebral revascularization after a recent ischemic stroke. Hence, further randomized trials to identify which patients should undergo very urgent revascularization are needed. Future studies should stratify participants by age group, sex, grade of ischemia, and degree of stenosis. Currently, there is one ongoing RCT that is examining the timing of cerebral revascularization.

Immediate versus delayed treatment for recently symptomatic carotid artery stenosis.

BACKGROUND:: The timing of surgery for recently symptomatic carotid artery stenosis remains controversial. Early cerebral revascularization may prevent a disabling or fatal ischemic recurrence, but it may also increase the risk of hemorrhagic transformation, or of dislodging a thrombus. This review examined the randomized controlled evidence that addressed whether the increased risk of recurrent events outweighed the increased benefit of an earlier intervention. OBJECTIVES:: To assess the risks and benefits of performing very early cerebral revascularization (within two days) compared with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis. METHODS:: Search methods: We searched the Cochrane Stroke Group Trials Register in January 2016, the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, issue 1), MEDLINE (1948 to 26 January 2016), EMBASE (1974 to 26 January 2016), LILACS (1982 to 26 January 2016), and trial registers (from inception to 26 January 2016). We also handsearched conference proceedings and journals, and searched reference lists. There were no language restrictions. We contacted colleagues and pharmaceutical companies to identify further studies and unpublished trials Selection criteria: All completed, truly randomized trials (RCT) that compared very early cerebral revascularization (within two days) with delayed treatment (after two days) for people with recently symptomatic carotid artery stenosis.Data collection and analysis: We independently selected trials for inclusion according to the above criteria, assessed risk of bias for each trial, and performed data extraction. We utilized an intention-to-treat analysis strategy. MAIN RESULTS:: We identified one RCT that involved 40 participants, and addressed the timing of surgery for people with recently symptomatic carotid artery stenosis. It compared very early surgery with surgery performed after 14 days of the last symptomatic event. The overall quality of the evidence was very low, due to the small number of participants from only one trial, and missing outcome data. We found no statistically significant difference between the effects of very early or delayed surgery in reducing the combined risk of stroke and death within 30 days of surgery (risk ratio (RR) 3.32; confidence interval (CI) 0.38 to 29.23; very low-quality evidence), or the combined risk of perioperative death and stroke (RR 0.47; CI 0.14 to 1.58; very low-quality evidence). To date, no results are available to confirm the optimal timing for surgery. AUTHORS CONCLUSIONS:: There is currently no high-quality evidence available to support either very early or delayed cerebral revascularization after a recent ischemic stroke. Hence, further randomized trials to identify which patients should undergo very urgent revascularization are needed. Future studies should stratify participants by age group, sex, grade of ischemia, and degree of stenosis. Currently, there is one ongoing RCT that is examining the timing of cerebral revascularization.

Perioperative corticosteroids for preventing complications following facial plastic surgery

BACKGROUND: Early recovery is an important factor for people undergoing facial plastic. However, the normal inflammatory processes that are a consequence of surgery commonly cause oedema (swelling) and ecchymosis (bruising), which are undesirable complications. Severe oedema and ecchymosis delay full recovery, and may make patients dissatisfied with procedures. Perioperative corticosteroids have been used in facial plastic surgery with the aim of preventing oedema and ecchymosis. OBJECTIVES: To determine the effects, including safety, of perioperative administration of corticosteroids for preventing complications following facial plastic surgery in adults. METHODS: Search strategy: In January 2014, we searched the following electronic databases: the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid Embase; EBSCO CINAHL; and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). There were no restrictions on the basis of date or language of publication. Selection criteria: We included RCTs that compared the administration of perioperative systemic corticosteroids with another intervention, no intervention or placebo in facial plastic surgery. ata collection and analysis: Two review authors independently screened the trials for inclusion in the review, appraised trial quality and extracted data. MAIN RESULTS: We included 10 trials, with a total of 422 participants, that addressed two of the outcomes of interest to this review: swelling (oedema) and bruising (ecchymosis). Nine studies on rhinoplasty used a variety of different types, and doses, of corticosteroids. Overall, the results of the included studies showed that there is some evidence that perioperative administration of corticosteroids decreases formation of oedema over the first two postoperative ...

Continuing education on child development for primary healthcare professionals: a prospective before-and-after study.

CONTEXT AND OBJECTIVE: Children's developmental disorders are often identified late by healthcare professionals working in primary care. The aim of this study was to assess the impact of a continuing education program on child development, on the knowledge and practices of these professionals. DESIGN AND SETTING: Prospective single-cohort study (before-and-after study), conducted in the city of Belém, Pará , Brazil. METHODS: Two hundred and twenty-one professionals working in primary healthcare (82.2%) participated in a continuing education program on child development and were assessed before and after implementation of the program through tests on their knowledge of child development, consisting of 19 questions for physicians and 14 for nurses, and questionnaires on their professional practices. RESULTS: One to three years after the program, the mean number of correct answers in the tests had increased from 11.5 to 14.3 among physicians in the Healthy Family Program (Programa Família Saudável, PFS); 13.0 to 14.3 among physicians in Municipal Health Units (Unidades Municipais de Saúde, UMS); 8.3 to 10.0 among PFS nurses; and 7.8 to 9.4 among UMS nurses. In interviews with mothers attended by these professionals before the program, only 21.7% reported that they were asked about their children's development, 24.7% reported that the professional asked about or observed their children's development and 11.1% received advice on how to stimulate them. After the program, these percentages increased to 34.5%, 54.2% and 30.3%, respectively. CONCLUSIONS: Professionals who participated in the program showed improved performance regarding child development knowledge and practices.

Continuing education on child development for primary healthcare professionals: a prospective before-and-after study / Educação continuada em desenvolvimento infantil para profissionais da atenção primária em saúde: estudo prospectivo do tipo antes-e-depois

CONTEXT AND OBJECTIVE: Children's developmental disorders are often identified late by healthcare professionals working in primary care. The aim of this study was to assess the impact of a continuing education program on child development, on the knowledge and practices of these professionals. DESIGN AND SETTING: Prospective single-cohort study (before-and-after study), conducted in the city of Belém, Pará , Brazil. METHODS: Two hundred and twenty-one professionals working in primary healthcare (82.2%) participated in a continuing education program on child development and were assessed before and after implementation of the program through tests on their knowledge of child development, consisting of 19 questions for physicians and 14 for nurses, and questionnaires on their professional practices. RESULTS: One to three years after the program, the mean number of correct answers in the tests had increased from 11.5 to 14.3 among physicians in the Healthy Family Program (Programa Família Saudável, PFS); 13.0 to 14.3 among physicians in Municipal Health Units (Unidades Municipais de Saúde, UMS); 8.3 to 10.0 among PFS nurses; and 7.8 to 9.4 among UMS nurses. In interviews with mothers attended by these professionals before the program, only 21.7% reported that they were asked about their children's development, 24.7% reported that the professional asked about or observed their children's development and 11.1% received advice on how to stimulate them. After the program, these percentages increased to 34.5%, 54.2% and 30.3%, respectively. CONCLUSIONS: Professionals who participated in the program showed improved performance regarding child development knowledge and practices. .

CONTEXTO E OBJETIVO: Alterações do desenvolvimento em crianças frequentemente têm sido tardiamente identificadas por profissionais de saúde que atuam na atenção básica. O objetivo deste estudo foi avaliar o impacto de um programa de educação permanente sobre desenvolvimento infantil nos conhecimentos e práticas desses profissionais. TIPO DE ESTUDO E LOCAL: Estudo de coorte única prospectivo (antes-e-depois), realizado no município de Belém, Pará, Brasil. MÉTODOS: 221 (82,2%) profissionais da rede básica de saúde que participaram do programa de educação permanente sobre desenvolvimento infantil foram avaliados antes e após a implantação do programa, através de testes sobre seus conhecimentos em desenvolvimento infantil com 19 questões para médicos e 14 para enfermeiros, e questionários sobre sua prática profissional. RESULTADOS: Um a três anos após o programa, a média de perguntas certas dos testes aumentou de 11,5 para 14,3 entre os médicos do Programa da Família Saudável (PFS); 13,0 para 14,3 entre os médicos de Unidades Municipais de Saúde (UMS); 8,3 para 10,0 entre os enfermeiros de PFS e 7,8 para 9,4 entre os enfermeiros de UMS. Nas entrevistas com mães atendidas por esses profissionais, verificou-se que, antes do programa, apenas 21,7% informaram que foram indagadas sobre o desenvolvimento dos seus filhos, 24,7% relataram que o profissional perguntou ou observou o desenvolvimento da sua criança e 11,1% receberam orientação sobre como estimulá-las; após o programa, esses percentuais aumentaram para 34,5%, 54,2% e 30,3%, respectivamente. CONCLUSÃO: Profissionais que participaram do programa apresentaram melhor desempenho quanto aos conhecimentos e práticas sobre desenvolvimento infantil. .

Survey of calcium supplementation to prevent preeclampsia: the gap between evidence and practice in Brazil.

BACKGROUND: Preeclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide and especially in Latin America. High quality evidence indicates that calcium supplementation during pregnancy significantly reduces the incidence of preeclampsia and its consequences, including severe maternal morbidity and death. Few studies have assessed the implementation of this intervention in clinical practice. The study aimed to assess the proportion of pregnant women who received calcium supplements in Brazilian public antenatal care clinics. METHODS: This cross-sectional study interviewed women waiting for antenatal care visits in 9 public clinics in 4 Brazilian cities in 2010-2012. Trained interviewers used a standardized anonymous questionnaire to collect socio demographic and obstetric data, information on ingestion of dairy products and on prescriptions received during current pregnancy. RESULTS: A total of 788 valid questionnaires were analyzed. Participants were young (mean age 25.9), mostly multiparous (71.3%) and in the 2nd or 3rd trimesters of pregnancy at the time of interview (87.6%). Only 5.1% (40/788) had received a prescription for calcium supplements. Based on their reported ingestion of dairy products, the mean daily dietary calcium intake of the participants was 210 (+ 265) mg/day and over 90% consumed less than 1 g of calcium/day. CONCLUSIONS: Despite good quality evidence indicating the benefits of this practice especially for women with low calcium diets, less than 6% of a sample of women receiving antenatal care in Brazilian public clinics received a prescription for calcium supplements. There is an urgent need to upscale the implementation of this life-saving intervention.

Low-level laser therapy for treatment of pain associated with orthodontic elastomeric separator placement: a placebo-controlled randomized double-blind clinical trial.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of the use of irradiation with a low-level laser therapy (LLLT), wavelength 830 nm, for treating pain inherent to tooth movement caused by orthodontic devices, simulated by positioning interdental elastomeric separators. METHODS: Sixty orthodontic patients were randomly assigned to two groups: GA (ages 12-25 years; mean 17.1 years) was the control, and GB (ages 12-26 years; mean 17.9 years) the intervention group. All patients received elastomeric separators on the mesial and distal surfaces of one of the lower first molars, and immediately after insertion of the separators received irradiation as randomly indicated. The intervention group (GB) received irradiation with LLLT (aluminum gallium arsenide diode), by a single spot in the region of the radicular apex at a dose of 2 J/cm(2) and application along the radicular axis of the buccal surface with three spots of 1 J/cm(2) (wavelength 830 nm; infrared). Control group (GA) received irradiation with a placebo light in the same way. This was a double-blind study. All the patients received a questionnaire to be filled out at home describing their levels of pain 2, 6, and 24 h and 3 and 5 days after orthodontic separator placement, in situations of relaxed and occluded mouth. RESULTS: The patients in the intervention group (LLLT) had lower mean pain scores in all the measures. The incidence of complete absence of pain (score=0) was significantly higher the intervention group. CONCLUSIONS: Based on this study, authors concluded that single irradiation with LLLT of wavelength 830 nm efficiently controlled the pain originating from positioning interdental elastomeric separators, to reproduce the painful sensation experienced by patients when fixed orthodontic devices are used.

Cianoacrilato como uma nova abordagem para a hipersensibilidade dentinária - um ensaio clínico-piloto / Cyanoacrylate as a new approach to dentin hypersensitivity - a pilot clinical trial

Este estudo teve como objetivo avaliar a efetividade clínica do cianoacrilato (Super Bonder) na redução da hipersensibilidade dentinária, quando comparado com o uso de laser de baixa intensidade. Foi adotado um desenho boca dividida em 11 pacientes, nos quais 17 hemiarcos foram tratados com laser e 17 foram tratados com cianoacrilato. Os tratamentos foram realizados em três sessões, com intervalos de 48 horas. A dor foi avaliada por um único examinador calibrado e cego, através de uma Escala de Avaliação Numérica (EAN), em quatro momentos diferentes: baseline e após o tratamento, em intervalos de 24 horas (T1), 30 dias (T2) e 120 dias (T3). O maior valor da EAN em cada quadrante foi considerado para análise estatística. Uma redução significativa na sensibilidade foi encontrada em 24 horas (p=0,001) com o tratamento com cianoacrilato; aos 120 dias (p=0,001), a sensibilidade foi estatisticamente menor para o grupo tratado com laser, quando o estímulo usado foi o Endo-Ice. Com estímulo evaporativo, o grupo tratado com cianoacrilato demonstrou sensibilidade estatisticamente menor aos 120 dias (p=0,010). Concluiu-se que o cianoacrilato pode fornecer uma alternativa de fácil acesso e viável para o tratamento da sensibilidade dentária, quando comparado à laserterapia.

Access to health information on the internet: a public health issue?

OBJECTIVE: To progress in the understanding of the user profile and of search trends for health information on the internet. METHODS: Analyses were performed based on 1,828 individuals who completed an electronic questionnaire available on a very popular health website. At the same time, through the "elite survey" method, 20 specialists were interviewed, aiming at assessing quality control strategies regarding health information disseminated online. RESULTS: A predominance of female users who research information for themselves (= 90%), who consider the internet one of their main sources of health information (86%), and who spend from 5 to 35 hours online every week (62%) was verified. High reliability is assigned to information from specialists (76%), and low reliability to television, radio, or blogs (14%). CONCLUSION: It can be concluded that the internet is proving to be a major source of health information for the population, and that website certification is a strategy to be contemplated to improve the quality of information and to promote public health.

Acesso a informações de saúde na internet: uma questão de saúde pública? / Access to health information on the internet: a public health issue?

OBJETIVO: Avançar no entendimento sobre o perfil do usuário e as tendências de busca por informações de saúde na internet. MÉTODOS: As análises foram feitas a partir de 1.828 indivíduos que responderam a um questionário eletrônico disponibilizado em um portal de saúde de grande acesso. Paralelamente, por meio do método de "survey de elites", 20 especialistas foram entrevistados para avaliar estratégias de controle de qualidade das informações de saúde veiculadas na rede. RESULTADOS: Verificou-se o predomínio de usuários do gênero feminino que buscam informações para própria saúde(= 90%), que consideram a internet uma de suas principais fontes de informação em saúde (86%) e passam de 5 a 35 horas na web por semana (62%). Atribui-se alta confiança às informações vindas de especialistas (76%) e baixa confiança na televisão, rádio ou blogs (14%). CONCLUSãO: Conclui-se que a internet tem-se mostrado uma fonte de informação em saúde de grande relevância para população e que a certificação de sites é uma estratégia a ser considerada, na perspectiva de melhoria da qualidade das informações e promoção da saúde pública.

OBJECTIVE: To progress in the understanding of the user profile and of search trends for health information on the internet. METHODS: Analyses were performed based on 1,828 individuals who completed an electronic questionnaire available on a very popular health website. At the same time, through the "elite survey" method, 20 specialists were interviewed, aiming at assessing quality control strategies regarding health information disseminated online. RESULTS: A predominance of female users who research information for themselves (= 90%), who consider the internet one of their main sources of health information (86%), and who spend from 5 to 35 hours online every week (62%) was verified. High reliability is assigned to information from specialists (76%), and low reliability to television, radio, or blogs (14%). CONCLUSION: It can be concluded that the internet is proving to be a major source of health information for the population, and that website certification is a strategy to be contemplated to improve the quality of information and to promote public health.

Biological, behavioral, and socioeconomic factors associated with death from AIDS in Brasília, Brazil, in 2007.

INTRODUCTION: In the jurisdiction of Brasília, Brazil, significant reductions in mortality rates and lethality resulting from acquired immunodeficiency syndrome (AIDS) were observed shortly after the introduction of highly active antiretroviral therapy. In recent years, however, the decline of these rates has not been as significant. Non-adherence to treatment and delayed diagnosis appear to be the main factors that increase the risk of death from AIDS. Behavioral, socioeconomic, and biological factors could also be associated with increased risk of death due to AIDS. This study aimed to identify which of these factors were associated with deaths from AIDS in Brasília. METHODS: A case-control study was undertaken using the data recorded in the Information System of Notifiable Diseases. Cases consisted of AIDS deaths occurring in 2007, residing in Brasília, and over 12 years of age. Controls consisted of AIDS patients who did not die until December 31 2007, also residing in Brasília, and over 12 years of age. For each group, frequency and proportion tables for the variables were prepared. The statistical association of each factor in isolation with the occurrence of the deaths was verified through a model of multivariate analysis using logistic regression. RESULTS: The factors that were associated with an increased risk of death were intravenous drug use, age 50 years or more, and residing in a region whose residents have low per capita income. CONCLUSIONS: We identified factors associated with death due to AIDS that can guide health planning.

Biological, behavioral, and socioeconomic factors associated with death from AIDS in Brasília, Brazil, in 2007 / Fatores biológicos, comportamentais e socioeconômicos associados ao óbito por AIDS em Brasília, Brasil, em 2007

INTRODUCTION: In the jurisdiction of Brasília, Brazil, significant reductions in mortality rates and lethality resulting from acquired immunodeficiency syndrome (AIDS) were observed shortly after the introduction of highly active antiretroviral therapy. In recent years, however, the decline of these rates has not been as significant. Non-adherence to treatment and delayed diagnosis appear to be the main factors that increase the risk of death from AIDS. Behavioral, socioeconomic, and biological factors could also be associated with increased risk of death due to AIDS. This study aimed to identify which of these factors were associated with deaths from AIDS in Brasília. METHODS: A case-control study was undertaken using the data recorded in the Information System of Notifiable Diseases. Cases consisted of AIDS deaths occurring in 2007, residing in Brasília, and over 12 years of age. Controls consisted of AIDS patients who did not die until December 31 2007, also residing in Brasília, and over 12 years of age. For each group, frequency and proportion tables for the variables were prepared. The statistical association of each factor in isolation with the occurrence of the deaths was verified through a model of multivariate analysis using logistic regression. RESULTS: The factors that were associated with an increased risk of death were intravenous drug use, age 50 years or more, and residing in a region whose residents have low per capita income. CONCLUSIONS: We identified factors associated with death due to AIDS that can guide health planning.

INTRODUÇÃO: No Distrito Federal, Brasil, houve importante redução das taxas de mortalidade e de letalidade por AIDS logo após a introdução da terapia antirretroviral altamente ativa, mas nos últimos anos o declínio dessas taxas não foi significativo. Não adesão ao tratamento e diagnóstico tardio parecem ser os principais fatores que elevam o risco de óbito por AIDS. Fatores comportamentais, socioeconômicos e biológicos também podem estar associados ao maior risco de óbito por AIDS. O objetivo deste estudo foi identificar quais desses fatores apresentaram associação com os óbitos por AIDS no Distrito Federal. MÉTODOS: Estudo do tipo caso-controle, utilizando os dados registrados no Sistema de Informação de Agravos de Notificação, em que foram considerados casos os óbitos por AIDS ocorridos em 2007, residentes no Distrito Federal e maiores de 12 anos de idade e, controles os doentes de AIDS que não foram a óbito até 31 de dezembro de 2007, também residentes no Distrito Federal e com mais de 12 anos de idade. Prepararam-se, para cada grupo, tabelas de frequência e proporção para as variáveis. Foi verificada a associação estatística de cada fator isoladamente com a ocorrência dos óbitos e também por meio de um modelo de análise multivariável por regressão logística. RESULTADOS: Os fatores que apresentaram associação com maior risco de óbito foram: usar drogas injetáveis, ter idade maior ou igual a 50 anos e residir em local cujos moradores possuem baixa renda per capita. CONCLUSÕES: Identificaram-se fatores associados ao óbito por AIDS que poderão nortear o planejamento em saúde.

Blood pressure control in hypertensive patients within Family Health Program versus at Primary Healthcare Units: analytical cross-sectional study.

CONTEXT AND OBJECTIVE: Hypertension is a public health problem due to its high prevalence and long-term cardiovascular complications. In Brazil in 2005, cardiovascular diseases were responsible for 28% of all deaths. Efforts are being made within primary care to achieve adequate hypertension control. The Family Health Program (FHP) has the aims of promoting quality of life and intervening in factors that put this at risk. The objective of this study was to evaluate the rate of blood pressure control among patients followed up at FHP units compared with those at primary healthcare units (PHUs). DESIGN AND SETTING: Analytical cross-sectional study in the municipality of Petrópolis, Rio de Janeiro, from January to December 2005. METHODS: Five hundred patients with a diagnosis of hypertension were included: 250 were being followed up at two FHP units and 250 at two PHUs. The diagnosis of hypertension was based on the Fourth Brazilian Hypertension Consensus, and the patients needed to have been under follow-up at the units for at least 12 months. Patients' blood pressure was considered to be under control if it was less than 140/90 mmHg at the last consultation. RESULTS: Blood pressure was under control in 29.2% (n = 73) at FHP units and 39.23% (n = 98) at PHUs (odds ratio = 0.64; confidence interval = 0.44-0.93; P = 0.024). CONCLUSION: Blood pressure control was better among patients followed up at PHUs than among those followed up at FHP units.

Brazilian health technology assessment bulletin: editorial process, dissemination strategies, critical appraisal, and initial impact.

OBJECTIVES: This study reports on the Brazilian experience of developing a specialized bulletin, the Brazilian Health Technology Assessment Bulletin (BRATS), on health technology assessments (HTA). METHODS: The editorial process, format, and dissemination strategy of the publication are presented. A critical appraisal of the available issues was made using the checklist for HTA reports of the International Network of Agencies for Health Technology Assessment. The initial impact was estimated based on a retrospective observational measurement of the types of publications that cite the bulletin as a source of information. The publications citing BRATS were identified using Google Scholar. RESULTS: Since June 2008, fourteen issues of the bulletin have been produced. BRATS has not presented any significant limitation that would compromise generalizations of its results within the Brazilian context. The initial impact of the bulletin, however, has been small, which may be due to its exclusively electronic dissemination format and technical language. We found nine publications citing BRATS in Google Scholar. CONCLUSIONS: It is hoped that the bulletin will promote the continuity of HTA actions among health-sector managers and professionals in Brazil.

Blood pressure control in hypertensive patients within family health program versus at primary healthcare units: analytical cross-sectional study / Controle da hipertensão arterial em pacientes no programa de saúde da família versus na unidade básica de saúde: estudo transversal analítico

CONTEXT AND OBJECTIVE: Hypertension is a public health problem due to its high prevalence and long-term cardiovascular complications. In Brazil in 2005, cardiovascular diseases were responsible for 28% of all deaths. Efforts are being made within primary care to achieve adequate hypertension control. The Family Health Program (FHP) has the aims of promoting quality of life and intervening in factors that put this at risk. The objective of this study was to evaluate the rate of blood pressure control among patients followed up at FHP units compared with those at primary healthcare units (PHUs). DESIGN AND SETTING: Analytical cross-sectional study in the municipality of Petrópolis, Rio de Janeiro, from January to December 2005. METHODS: Five hundred patients with a diagnosis of hypertension were included: 250 were being followed up at two FHP units and 250 at two PHUs. The diagnosis of hypertension was based on the Fourth Brazilian Hypertension Consensus, and the patients needed to have been under follow-up at the units for at least 12 months. Patients' blood pressure was considered to be under control if it was less than 140/90 mmHg at the last consultation. RESULTS: Blood pressure was under control in 29.2% (n = 73) at FHP units and 39.23% (n = 98) at PHUs (odds ratio = 0.64; confidence interval = 0.44-0.93; P = 0.024). CONCLUSION: Blood pressure control was better among patients followed up at PHUs than among those followed up at FHP units.

CONTEXTO E OBJETIVO: A hipertensão arterial (HA) é um problema de saúde pública por sua elevada prevalência e complicações em longo prazo. No Brasil as doenças cardiovasculares foram responsáveis, em 2005, por 28% do total de óbitos em geral. Esforços vêm sendo implementados na atenção básica para o seu adequado controle. O Programa de Saúde da Família tem o objetivo de promover qualidade de vida assim como intervir nos fatores que a coloquem em risco. O objetivo deste estudo foi verificar a taxa de controle da HA em pacientes acompanhados nas Unidades de Saúde da Família (USF) comparados com pacientes acompanhados nas Unidades Básicas de Saúde (UBS). TIPO DE ESTUDO E LOCAL: Estudo transversal analítico, no município de Petrópolis, Rio de Janeiro, entre janeiro e dezembro de 2005. MÉTODOS: Foram incluídos 500 pacientes com diagnóstico de HA, sendo 250 em acompanhamento em duas USF e 250 em duas UBS. O diagnóstico de HA foi baseado no IV Consenso Brasileiro de Hipertensão e os pacientes precisavam estar em acompanhamento nas Unidades por no mínimo 12 meses. Foram considerados controlados os pacientes que apresentaram níveis pressóricos inferiores a 140/90 mmHg na última consulta. RESULTADOS: A taxa de controle da pressão arterial foi de 29,2% (n = 73) nas USF e de 39,23% (n = 98) nas UBS (odds ratio = 0,64; intervalo de confiança = 0,44-0,93), P = 0,024). CONCLUSÃO: Foi observado melhor controle da pressão arterial nos pacientes acompanhados nas UBS quando comparados aos pacientes acompanhados nas USF.

Saúde da criança: fatores de risco aplicados em programas de atenção básica à saúde / Child health: risk factors applied in programs of primary health care

OBJETIVO: comparar as frequências dos fatores de risco em crianças matriculadas em unidades básicas de saúde (UBS) em dois períodos (1988-1989 e 2005-2006) e analisar a associação desses fatores com desnutrição, internação e óbito. MÉTODOS:Estudo de abordagem quantitativa, tipo coorte retrospectiva com amostra probabilística (n=414) de crianças menores de um ano matriculadas em duas UBSs do Embu (SP), em 2005-2006. Variáveis independentes: alto risco e presença de fatores de risco. Desfechos: evolução ponderal desfavorável, déficit nutricional, internação, óbito. Estatística: Qui-Quadrado e Odds Ratio. RESULTADOS: em 2005-2006, verificou-se: maior frequência de intercorrências neonatais e mães adolescentes; menor freqüência de desnutrição ou óbito de irmão < 5 anos; evolução ponderal desfavorável (1,6%); deficit nutricional (2,9%); IMC > 2z (17,9%); internações (21,8%); nenhum óbito. Baixo peso ao nascer associou-se à internação (OR=4,04;IC95%:1,35-12,04). CONCLUSÕES: Baixo peso ao nascer permanece, como importante fator de risco e a proporção de sobrepeso/obesidade indica necessidade de redirecionamento das ações de saúde da criança.

OBJECTIVE:To compare the frequency of risk factors in children attending basic health units (UBS) in two periods (1988-1989 and 2005-2006) and to analyze the association of these factors with malnutrition, hospitalization and death. METHODS: A retrospective study using a quantitative approach with a random cohort sample (n = 414) of children under one year of age, enrolled in two UBS of Embu (SP) in 2005-2006. Independent variables: high risk and presence of risk factors. Outcomes: unfavorable weight gain, malnutrition, hospitalization and death. Statistics: Chi-square and Odds Ratio. RESULTS: In 2005-2006, we found: a higher frequency of neonatal complications and adolescent mothers; lower rates of malnutrition or death of a sibling <5 years; unfavorable weight gain (1.6%); nutritional deficit (2.9%); BMI > 2z (17.9%); hospitalizations (21.8%); no deaths. Low birth weight was associated with hospitalization (OR = 4.04, 95% : 1,35-12, 04). CONCLUSIONS: Low birth weight remains an important risk factor and the proportion of overweight / obesity indicates a need for redirection of child health activities.

OBJETIVO: comparar las frecuencias de los factores de riesgo en niños matriculados en unidades básicas de salud (UBS) en dos períodos (1988-1989 y 2005-2006) y analizar la asociación de esos factores con desnutrición, internamiento y óbito. MÉTODOS: Estudio de abordaje cuantitativo, tipo cohorte retrospectivo con muestra probabilística (n=414) de niños menores de un año matriculados en dos UBSs de Embu (SP), en 2005-2006. Las variables independientes: alto riesgo y presencia de factores de riesgo. Desenlace: evolución ponderal desfavorable, déficit nutricional, internamiento, óbito. Estadística: Chi-Cuadrado y Odds Ratio. RESULTADOS: en 2005-2006, se verificó: mayor frecuencia de variaciones neonatales y madres adolescentes; menor frecuencia de desnutrición u óbito de hermano < 5 años; evolución ponderal desfavorable (1,6%); déficit nutricional (2,9%); IMC > 2z (17,9%); internamientos (21,8%); ningún óbito. Bajo peso al nacer se asoció al internamiento (OR=4,04;IC95%:1,35-12,04). CONCLUSIONES: Bajo peso al nacer permanece, como un importante factor de riesgo y la proporción de sobrepeso/obesidad indica la necesidad de redireccionamiento de las acciones de salud del niño.