Lycopene, Mesoporous Silica Nanoparticles and Their Association: A Possible Alternative against Vulvovaginal Candidiasis?

Commonly found colonizing the human microbiota, Candida albicans is a microorganism known for its ability to cause infections, mainly in the vulvovaginal region known as vulvovaginal candidiasis (VVC). This pathology is, in fact, one of the main C. albicans clinical manifestations, changing from a colonizer to a pathogen. The increase in VVC cases and limited antifungal therapy make C. albicans an increasingly frequent risk in women's lives, especially in immunocompromised patients, pregnant women and the elderly. Therefore, it is necessary to develop new therapeutic options, especially those involving natural products associated with nanotechnology, such as lycopene and mesoporous silica nanoparticles. From this perspective, this study sought to assess whether lycopene, mesoporous silica nanoparticles and their combination would be an attractive product for the treatment of this serious disease through microbiological in vitro tests and acute toxicity tests in an alternative in vivo model of Galleria mellonella. Although they did not show desirable antifungal activity for VVC therapy, the present study strongly encourages the use of mesoporous silica nanoparticles impregnated with lycopene for the treatment of other human pathologies, since the products evaluated here did not show toxicity in the in vivo test performed, being therefore, a topic to be further explored.

Natural product-based nanomedicine applied to fungal infection treatment: A review of the last 4 years.

Fungal infections are one of the main public health problems, especially in immunocompromised patients, nosocomial environments, patients with chronic diseases, and transplant recipients. These diseases are increasingly frequent and lethal because the microorganism has a high capacity to acquire resistance to available therapy. The main resistance factors are the emergence of new strains and the uncontrolled use of antifungals. It is, therefore, important to develop new methods that contribute to combating fungal diseases in the clinical area. Natural products have considerable potential for the development of new drugs with antifungal activity, mainly due to their biocompatibility and low toxic effect. This promising antimicrobial activity of natural products is mainly due to the presence of flavonoids, terpenes, and quinones, which explains their antifungal potential. Pharmaceutical nanotechnology has been explored to enhance the delivery, selectivity, and clinical efficacy of these products. Nanotechnological systems provide a safe and selective environment for various substances, such as natural products, improving antifungal activity. However, further safety experiments (in vivo or clinical trials) need to be carried out to prove the therapeutic action of natural products, since they may have undesirable, toxic, and mutagenic effects. Therefore, this review article addresses the main nanotechnological methods using natural products for effective future treatment against the main fungal diseases.

Prevalence of vulvovaginal candidiasis in Brazil: A systematic review.

Vulvovaginal candidiasis (CVV) is a condition in which signs and symptoms are related to inflammation caused by Candida spp infection. It is the second leading cause of vaginitis in the world, representing a public health problem. The present systematic review comes with the proposal of analyze and identify the available evidence on CVV prevalence in Brazil, pointing out its variability by regions. For this, a systematic literature review was carried out with meta-analysis of cross-sectional and cohort studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guide recommendations, and was registered in the International Prospective Register of Systematic Reviews (PROSPERO 2020 CRD42020181695). The databases used for survey were LILACS, Scielo, Scopus, PUBMED, Web of Science and CINAHL. Fifteen studies were selected to estimate CVV prevalence in the Brazilian territory. South and Southeast regions have higher prevalences than the North and Northeast regions, no data were found for the Midwest region. The estimated prevalence for Brazil is 18%, however, it is suggested that this number is higher due to underreporting and the presence of asymptomatic cases. Therefore, new epidemiological studies are recommended throughout Brazil, to elucidate the profile of this disease in the country, in addition to assisting in the elaboration of an appropriate prevention plan by state. LAY SUMMARY: Data found in the literature regarding the epidemiological profile of vulvovaginal candidiasis in Brazil are obsolete and incomplete, so the present systematic review has the proposal to analyze and identify the evidence on vulvovaginal candidiasis prevalence in Brazil. The estimated prevalence is 18%; however, this number can be higher.

Coqueluche na infância: revisão integrativa da doença / Pertussis in children: an integrative review / Tos ferina en la infancia: revisión integrativa de la enfermedad

Justificativa e Objetivos: Apesar dos esforços despendidos pelo Programa Nacional de Imunizações, a coqueluche é um agravo que ainda gera grandes preocupações para a saúde pública. Assim, o objetivo deste estudo foi descrever as evidências na literatura sobre coqueluche na infância que indicassem as práticas de assistência à saúde necessárias para sua prevenção, promoção e controle. Método: Revisão integrativa da literatura nas bases de dados LILACS, MedLine, PubMed, SciELO, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) utilizando os descritores Whooping Cough, Epidemiology, Vaccination. A revisão foi realizada em maio de 2020 e abrangeu a literatura disponível na íntegra, publicada em português, inglês ou espanhol, sem delimitação de ano. Resultados: Dentre os 1.248 artigos selecionados apenas nove foram analisados (a maioria norte-americana), dos quais 55% eram estudos realizados para prevenção de coqueluche. Quanto à autoria dos estudos, em 67% das publicações havia participação de um epidemiologista. Conclusão: Esta investigação mostra as evidências científicas sobre a coqueluche na infância, necessárias para prevenir, controlar, promover a assistência e definir o perfil epidemiológico desse agravo nessa população. Os resultados revelaram nível de evidência cinco, sugerindo que as pesquisas desenvolvidas na área não retratam fortes evidências.(AU)

Background and Objectives: Despite the efforts of the National Immunization Program, pertussis remains a serious health problem. Thus, this study described the evidence in the literature on pertussis during childhood, which elucidates the health-care practices necessary for prevention, promotion, and control of the disease. Methods: This is an integrative literature review conducted in the LILACS, MedLine, PubMed, SciELO, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, using the following descriptors: "Whooping Cough", "Epidemiology", and "Vaccination". The search was restricted to humanities, in English, Portuguese, or Spanish, without year delimitation. The search was completed on May 2020, Results: in total, 1,248 articles were selected, of which only nine articles were analyzed, mostly from North America, and 55% of the analyzed studies were about preventing pertussis. Regarding the authorship of the studies, epidemiologists participated in 67% of the publications. Conclusion: This study presents the necessary scientific evidence on pertussis during childhood is necessary for prevention, control, promotion, and epidemiological profile of this disease in this population. The results revealed a level of evidence of five, suggesting that the research in this area does not show strong evidence.(AU)

Justificación y Objetivos: La tos ferina todavía es un grave problema de salud a pesar de los esfuerzos realizados por el Programa Nacional de Inmunización. El objetivo de este estudio fue identificar las evidencias científicas en la literatura sobre la tos ferina en la infancia que indican las prácticas de asistencia sanitaria necesarias a la prevención, promoción y control de la enfermedad. Métodos: Revisión integrativa de la literatura en las bases de datos LILACS, MedLine, PubMed, SciELO, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) utilizando las palabras clave: Whooping Cough, Epidemiology, Vaccination. Se llevó a cabo en mayo de 2020 la búsqueda de artículos publicados en portugués, inglés y español, disponibles en su totalidad y sin delimitación de año. Resultados: Se seleccionaron un total de 1.248 artículos, de los cuales solo se analizaron nueve, en su mayoría norteamericanos; el 55% de los estudios analizados fueron sobre la prevención de la tos ferina. Respecto de la autoría de los estudios, un epidemiólogo participó en el 67% de las publicaciones. Conclusiones: Esta investigación muestra evidencias científicas sobre la tos ferina en la infancia necesarias para la prevención, el control, la promoción de la asistencia y la definición del perfil epidemiológico de la enfermedad en esa población. Los resultados revelaron que el nivel de evidencia se remite a cinco, lo que sugiere que la investigación en el área no muestra evidencias sólidas.(AU)

Anthelmintic drugs for treating ascariasis.

BACKGROUND: Ascaris lumbricoides is a common infection, and mainly affects children living in low-income areas. Water and sanitation improvement, health education, and drug treatment may help break the cycle of transmission, and effective drugs will reduce morbidity. OBJECTIVES: To compare the efficacy and safety of anthelmintic drugs (albendazole, mebendazole, ivermectin) for treating people with Ascaris infection. SEARCH METHODS: We searched the Cochrane Infectious Disease Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, three other databases, and reference lists of included studies, without language restrictions, up to 4 July 2019. SELECTION CRITERIA: Randomized controlled trials (RCT) that compared albendazole, mebendazole, and ivermectin in children and adults with confirmed Ascaris infection. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion, assessed risk of bias, and extracted data from the included trials. A third review author checked the quality of data extraction. We used the Cochrane 'Risk of bias' assessment tool to determine the risk of bias in included trials. We used risk ratios (RRs) with 95% confidence intervals (CIs) to compare dichotomous outcomes in treatment and control groups. We used the fixed-effect model for studies with low heterogeneity and the random-effects model for studies with moderate to high heterogeneity. We assessed the certainty of the evidence using the GRADE approach. We used the control rate average to provide illustrative cure rates in the comparison groups. MAIN RESULTS: We included 30 parallel-group RCTs, which enrolled 6442 participants from 17 countries across Africa, Asia, Central America and the Caribbean, and South America. Participants were from 28 days to 82 years of age, recruited from school, communities, and health facilities. Twenty studies were funded or co-funded by manufacturers, while 10 studies were independent of manufacturer funding. Twenty-two trials had a high risk of bias for one or two domains (blinding, incomplete outcome data, selective reporting). Single dose of albendazole (four trials), mebendazole (three trials) or ivermectin (one trial) was compared to placebo. Parasitological cure at 14 to 60 days was high in all the studies (illustrative cure of 93.0% in the anthelmintic group and 16.1% in the placebo group; RR 6.29, 95% CI 3.91 to 10.12; 8 trials, 1578 participants; moderate-certainty evidence). Single dose of albendazole is as effective as multiple doses of albendazole (illustrative cure of 93.2% with single dose, 94.3% with multiple doses; RR 0.98, 95% CI 0.92 to 1.05; 3 trials, 307 participants; high-certainty evidence); or as single dose of mebendazole (illustrative cure of 98.0% with albendazole, 96.9% with mebendazole; RR 1.01, 95% CI 1.00 to 1.02; 6 trials, 2131 participants; high-certainty evidence). Studies did not detect a difference between a single dose of albendazole and a single dose of ivermectin (cure rates of 87.8% with albendazole, 90.2% with ivermectin; RR 0.99, 95% CI 0.91 to 1.08; 3 trials, 519 participants; moderate-certainty evidence). Across all the studies, failure after single dose of albendazole ranged from 0.0% to 30.3%, mebendazole from 0.0% to 22.2%, and ivermectin from 0.0% to 21.6%. The egg reduction rate (ERR) measured up to 60 days after the treatment was high in all treated groups, regardless of the anthelmintic used (range 96% to 100%). It was not possible to evaluate parasitological cure by classes of infection intensity. No included trials reported complication or serious adverse events. Other adverse events were apparently similar among the compared anthelmintic groups (moderate- to low-certainty evidence). The most commonly reported other adverse events were nausea, vomiting, abdominal pain, diarrhoea, headache, and fever. AUTHORS' CONCLUSIONS: Single-dose of albendazole, mebendazole, and ivermectin all appeared effective against Ascaris lumbricoides infection, yielding high parasitological cure and large reductions in eggs excreted, with no differences detected between them. The drugs appear to be safe to treat children and adults with confirmed Ascaris infection. There is little to choose between drugs and regimens in terms of cure or adverse events.

Improving adherence to Standard Precautions for the control of health care-associated infections.

BACKGROUND: 'Standard Precautions' refers to a system of actions, such as using personal protective equipment or adhering to safe handling of needles, that healthcare workers take to reduce the spread of germs in healthcare settings such as hospitals and nursing homes. OBJECTIVES: To assess the effectiveness of interventions that target healthcare workers to improve adherence to Standard Precautions in patient care. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, LILACS, two other databases, and two trials registers. We applied no language restrictions. The date of the most recent search was 14 February 2017. SELECTION CRITERIA: We included randomised trials of individuals, cluster-randomised trials, non-randomised trials, controlled before-after studies, and interrupted time-series studies that evaluated any intervention to improve adherence to Standard Precautions by any healthcare worker with responsibility for patient care in any hospital, long-term care or community setting, or artificial setting, such as a classroom or a learning laboratory. DATA COLLECTION AND ANALYSIS: Two review authors independently screened search results, extracted data from eligible trials, and assessed risk of bias for each included study, using standard methodological procedures expected by Cochrane. Because of substantial heterogeneity among interventions and outcome measures, meta-analysis was not warranted. We used the GRADE approach to assess certainty of evidence and have presented results narratively in 'Summary of findings' tables. MAIN RESULTS: We included eight studies with a total of 673 participants; three studies were conducted in Asia, two in Europe, two in North America, and one in Australia. Five studies were randomised trials, two were cluster-randomised trials, and one was a non-randomised trial. Three studies compared different educational approaches versus no education, one study compared education with visualisation of respiratory particle dispersion versus education alone, two studies compared education with additional infection control support versus no intervention, one study compared peer evaluation versus no intervention, and one study evaluated use of a checklist and coloured cues. We considered all studies to be at high risk of bias with different risks. All eight studies used different measures to assess healthcare workers' adherence to Standard Precautions. Three studies also assessed healthcare workers' knowledge, and one measured rates of colonisation with methicillin-resistant Staphylococcus aureus (MRSA) among residents and staff of long-term care facilities. Because of heterogeneity in interventions and outcome measures, we did not conduct a meta-analysis.Education may slightly improve both healthcare workers' adherence to Standard Precautions (three studies; four centres) and their level of knowledge (two studies; three centres; low certainty of evidence for both outcomes).Education with visualisation of respiratory particle dispersion probably improves healthcare workers' use of facial protection but probably leads to little or no difference in knowledge (one study; 20 nurses; moderate certainty of evidence for both outcomes).Education with additional infection control support may slightly improve healthcare workers' adherence to Standard Precautions (two studies; 44 long-term care facilities; low certainty of evidence) but probably leads to little or no difference in rates of health care-associated colonisation with MRSA (one study; 32 long-term care facilities; moderate certainty of evidence).Peer evaluation probably improves healthcare workers' adherence to Standard Precautions (one study; one hospital; moderate certainty of evidence).Checklists and coloured cues probably improve healthcare workers' adherence to Standard Precautions (one study; one hospital; moderate certainty of evidence). AUTHORS' CONCLUSIONS: Considerable variation in interventions and in outcome measures used, along with high risk of bias and variability in the certainty of evidence, makes it difficult to draw conclusions about effectiveness of the interventions. This review underlines the need to conduct more robust studies evaluating similar types of interventions and using similar outcome measures.

Commonly-used versus less commonly-used methods in the loss of resistance technique for identification of the epidural space: A systematic review and meta-analysis of randomized controlled trials.

STUDY OBJECTIVE: To summarize the efficacy of less-commonly used modern methods (e.g. epidrum, lidocaine, acoustic device, Macintosh balloon) compared to more commonly-used methods (i.e. air, saline, both) in the loss of resistance technique for identification of the epidural space. DESIGN: A systematic review. SETTING: A hospital-affiliated university. MEASUREMENTS: The following databases were searched: PubMed, CENTRAL, EMBASE, and LILACS. We used the GRADE approach to rate overall certainty of the evidence. RESULTS: Eight randomized trials including 1583 participants proved eligible. Results suggested a statistically significantly reduction in inability to locate the epidural space (RR 0.29, 95% CI 0.11, 0.77; P=0.01; I2=60%, risk difference (RD) 104/1000, moderate quality evidence), accidental intravascular catheter placement and accidental subarachnoid catheter placement (RR 0.35, 95% CI 0.21, 0.59; P<0.0001; I2=0%, risk difference (RD) 108/1000, moderate quality evidence), and unblocked segments (RR 0.37, 95% CI 0.18, 0.77; P=0.008; I2=0%, risk difference (RD) 56/1000, moderate quality evidence) with the use of epidrum, lidocaine, acoustic device, or modified Macintosh epidural balloon methods in comparison to air. Compared to saline, lidocaine presented higher rates of reduction in the inability to locate the epidural space (RR 0.31, 95% CI 0.12, 0.82; P=0.02; I2=not applicable). CONCLUSIONS: Moderate-quality evidence shows that less commonly-used modern methods such as epidrum, lidocaine and acoustic devices, are more efficacious compared to more commonly-used methods (i.e. air, saline, both) in terms of the loss of resistance technique for identification of the epidural space. These findings should be explored further in the context of the clinical practice among anaesthesiologists.

Differences between the real and the desired worlds in the results of clinical trials.

OBJECTIVE: We refer to the effectiveness (known as pragmatic or real world) and efficacy (known as explanatory or desired or ideal world) of interventions. However, these terms seem to be randomly chosen by investigators who design clinical trials and do not always reflect the true purpose of the study. A pragmatic-explanatory continuum indicator summary tool was thus developed with the aim of identifying the characteristics of clinical trials that distinguish between effectiveness and efficacy issues. We verified whether clinical trials used the criteria proposed by the indicator summary tool, and we categorized these clinical trials according to a new classification. METHOD: A systematic survey of randomized clinical trials was performed. We added a score ranging from 0 (more efficacious) to 10 (more effective) to each domain of the indicator summary tool and proposed the following classifications: high efficacy (<25), moderate efficacy (25-50), moderate effectiveness (51-75), and high effectiveness (<75). RESULTS: A total of 844 randomized trials were analyzed. No analyzed trials used the criteria proposed by the indicator summary tool. Approximately 44% of the trials were classified as having moderate effectiveness, and 43.82% were classified as having moderate efficacy. CONCLUSIONS: Most clinical trials used the term "efficacy" to illustrate the application of results in clinical practice, but the majority of those were classified as having moderate effectiveness according to our proposed score. The classification based on the 0-100 score is still highly subjective and can be easily misunderstood in all domains based on each investigator's own experiences and knowledge.

Differences between the real and the desired worlds in the results of clinical trials

OBJECTIVE:We refer to the effectiveness (known as pragmatic or real world) and efficacy (known as explanatory or desired or ideal world) of interventions. However, these terms seem to be randomly chosen by investigators who design clinical trials and do not always reflect the true purpose of the study. A pragmatic-explanatory continuum indicator summary tool was thus developed with the aim of identifying the characteristics of clinical trials that distinguish between effectiveness and efficacy issues. We verified whether clinical trials used the criteria proposed by the indicator summary tool, and we categorized these clinical trials according to a new classification.METHOD:A systematic survey of randomized clinical trials was performed. We added a score ranging from 0 (more efficacious) to 10 (more effective) to each domain of the indicator summary tool and proposed the following classifications: high efficacy (<25), moderate efficacy (25-50), moderate effectiveness (51-75), and high effectiveness (<75).RESULTS:A total of 844 randomized trials were analyzed. No analyzed trials used the criteria proposed by the indicator summary tool. Approximately 44% of the trials were classified as having moderate effectiveness, and 43.82% were classified as having moderate efficacy.CONCLUSIONS:Most clinical trials used the term “efficacy” to illustrate the application of results in clinical practice, but the majority of those were classified as having moderate effectiveness according to our proposed score. The classification based on the 0-100 score is still highly subjective and can be easily misunderstood in all domains based on each investigator’s own experiences and knowledge.

Knowledge of nursing undergraduate students about the use of contact precautions measures / Conocimiento de los graduandos en enfermería acerca del uso de las medidas de precaución de contacto / Conhecimento dos graduandos em enfermagem sobre o uso das medidas de precauções de contato

Objective. To assess knowledge of nursing undergraduate students about the use of contact precautions. Methodology. There were 106 nursing undergraduate students from three universities within the state of Sao Paulo. The data collection was done between April and May 2012. A questionnaire was elaborated with questions assessing knowledge regarding contact precautions. The data were submitted to statistical procedures in the package MINITAB version 16. The knowledge were rated as adequate, partially adequate and inadequate. Results. There was a predominance of females (86%) and age group between 20 and 29 years (70%). Regarding the definition of contact precaution of diseases in which these measures are used, undergraduate's knowledge was partially adequate (92% and 44%, respectively). The knowledge was considered adequate for the preventive measures used during assistance (86%). As difficulties mentioned in the use of these measures were discomfort, lack of material, personnel and time. Conclusion. Although undergraduate students know what measures to be used in contact precaution, they do not have adequate knowledge about which diseases they should use them. The three participating universities should reflect on the quality of training for nursing students regarding biosecurity and contact precautions.

Objetivo. Evaluar el conocimiento de los graduandos en enfermería acerca del uso de las medidas de precaución de contacto. Metodología. Entrevista a 106 graduandos del pregrado de enfermería de tres universidades del interior del estado de São Paulo. La recolección de la información se hizo entre abril y mayo de 2012; se elaboró un formulario con preguntas que evaluaban conocimiento acerca de las precauciones de contacto. Los datos fueron sometidos a procedimientos estadísticos en el paquete MINITAB, versión 16. Los conocimientos fueron calificados como adecuados, parcialmente adecuados e inadecuados. Resultados. Hubo predominio del sexo femenino (86%) y del grupo etario entre 20 y 29 años (70%). En cuanto a la definición de precaución de contacto y de las enfermedades en las que se utilizan estas medidas el conocimiento de los graduandos fue parcialmente adecuado (92% y 44%, respectivamente). El conocimiento fue adecuado en las medidas preventivas a ser utilizadas durante la asistencia (86%). Como dificultades en la utilización de estas medidas citaron la incomodidad, la falta de material, personal y tiempo. Conclusión. Aunque los graduandos conocen cuáles son las medidas a ser implementadas en la precaución de contacto, no tienen un conocimiento adecuado sobre las enfermedades en las cuales deben utilizarlas. En las tres universidades participantes debe reflexionarse sobre la calidad de la formación a los estudiantes de enfermería en bioseguridad y precauciones de contacto.

Objetivo. Avaliar o conhecimento dos graduandos em enfermaria a respeito do uso das medidas de precaução de contato. Metodologia. 106 graduandos da pré-graduação de enfermagem de três universidades do interior do estado de São Paulo. A recolha da informação se fez entre abril e maio de 2012; elaborou-se um formulário com perguntas que avaliavam conhecimento a respeito das precauções de contato. Os dados foram submetidos a procedimentos estatísticos no pacote MINITAB versão 16. Os conhecimentos foram qualificados como adequados, parcialmente adequados, e inadequados. Resultados. Teve predomínio do sexo feminino (86%) e do grupo etário entre 20 e 29 anos (70%). Quanto à definição de precaução de contato e das doenças nas que se utilizam estas medidas o conhecimento dos graduandos foi parcialmente adequado (92% e 44%, respectivamente). O conhecimento foi adequado nas medidas preventivas a ser utilizadas durante à assistência (86%). Como dificuldades na utilização destas medidas foram citadas a incomodidade, a falta de material, pessoal e tempo. Conclusão. Apesar de que os graduandos conhecem quais são as medidas a ser utilizadas na precaução de contato, não têm um conhecimento adequado sobre as doenças em que devem utilizá-las. Nas três universidades participantes deve reflexionar-se sobre a qualidade da formação aos estudantes de enfermagem em biossegurança e precauções de contato.

Systematic reviews showed insufficient evidence for clinical practice in 2004: what about in 2011? The next appeal for the evidence-based medicine age.

RATIONALE AND AIM: The aims of the Cochrane systematic reviews are to make readily available and up-to-date information for clinical practice, offering consistent evidence and straightforward recommendations. In 2004, we evaluated the conclusions from Cochrane systematic reviews of randomized controlled trials in terms of their recommendations for clinical practice and found that 47.83% of them had insufficient evidence for use in clinical practice. We proposed to reanalyze the reviews to evaluate whether this percentage had significantly decreased. METHODS: A cross-sectional study of systematic reviews published in the Cochrane Library (Issue 7, 2011) was conducted. We randomly selected reviews across all 52 Cochrane Collaborative Review Groups. RESULTS: We analyzed 1128 completed systematic reviews. Of these, 45.30% concluded that the interventions studied were likely to be beneficial, of which only 2.04% recommended no further research. In total, 45.04% of the reviews reported that the evidence did not support either benefit or harm, of which 0.8% did not recommend further studies and 44.24% recommended additional studies; the latter has decreased from our previous study with a difference of 3.59%. CONCLUSION: Only a small number of the Cochrane collaboration's systematic reviews support clinical interventions with no need for additional research. A larger number of high-quality randomized clinical trials are necessary to change the 'insufficient evidence' scenario for clinical practice illustrated by the Cochrane database. It is recommended that we should produce higher-quality primary studies in active collaboration and consultation with global scholars and societies so that this can represent a major component of methodological advance in this context.

Use of music and play in pediatric nursing care in the hospital context / Utilización de la música y del juego en el cuidado de enfermería pediátrico en ambiente hospitalario / Utilização da música e do jogo no cuidado de enfermaria pediátrico em ambiente hospitalar

Objective. To identify and analyze scientific publications on the use of music and play in pediatric nursing care in the hospital context. Method. In this bibliographic study, papers were sought that were published in Portuguese or English between 2004 and 2009 and included the descriptors: hospitalized child, childhood, child recreation, nursing team, nursing, pediatric nursing, alternatives therapies, music, music therapy, play and playthings, play therapy, playing. For the review, the bibliographic databases used were MEDLINE, ScIELO and LILACS. Results. Seventeen publications were obtained, among which: 59% adopted a quantitative method; mainly nursing developed the activities (88%); per type of article, reviews on the theme and assessments of clinical changes associated with the use of music and play were frequent (59% and 18%, respectively); and the utility of this kind of therapies in nursing care is acknowledged (94%). Conclusion. Play and music are useful therapies that can be used in nursing care for pediatric patients.

Objetivo. Identificar y analizar las publicaciones científicas que abordaran el uso de la música y del juego en el cuidado de enfermería pediátrico en ambiente hospitalario. Metodología. Estudio bibliográfico en el que se buscaron artículos en portugués o en inglés publicados entre 2004 - 2009 que incluyeran los descriptores: niño hospitalizado, niñez, recreación infantil, equipo de enfermería, enfermería, enfermería pediátrica, terapias alternativas, música, musicoterapia, juegos y juguetes, ludoterapia, jugar. Para la revisión se utilizaron las bases de datos bibliográficas MEDLINE, ScIELO y LILACS. Resultados. Se obtuvieron 17 publicaciones, de las cuales tienen metodología cuantitativa (59%), las actividades fueron desarrolladas principalmente por enfermería (88%), por tipo de artículo son frecuentes las revisiones de tema y la evaluación de cambios clínicos asociados al empleo de la música y del juego (59% y 18%, respectivamente); y hay reconocimiento de la utilidad de este tipo de terapias en el cuidado de enfermería (94%). Conclusión. El juego y la música son terapias útiles que pueden ser empleadas en el cuidado de enfermería del paciente pediátrico.

Objetivo. Identificar e analisar as publicações científicas que abordassem o uso da música e do jogo no cuidado de enfermaria pediátrico em ambiente hospitalar. Metodologia. Estudo bibliográfico no que procuraram artigos em português ou em inglês publicados entre 2004 - 2009 que incluíssem os descritores: menino hospitalizado, meninice, recreação infantil, equipe de enfermaria, enfermaria, enfermaria pediátrica, terapias alternativas, música, musicoterapia, jogos e brinquedos, ludoterapia, jogar. Para a revisão se utilizaram as bases de dados bibliográficas MEDLINE, SciELO e LILACS. Resultados. Obtiveram-se 17 publicações, das quais: têm metodologia quantitativa (59%), as atividades foram desenvolvidas principalmente por enfermaria (88%), por tipo de artigo são frequentes as revisões de tema e a avaliação de mudanças clínicas sócios ao emprego da música e do jogo (59% e 18%, respectivamente); e há reconhecimento da utilidade deste tipo de terapias no cuidado de enfermaria (94%). Conclusão. O jogo e a música são terapias úteis que podem ser empregadas no cuidado de enfermagem ao paciente pediátrico.

Bacteria on the hands of school-age children at a Pediatric Hospitalization Unit / Bacterias presentes en las manos de los niños en edad escolar en la Unidad de Internación Pediátrica

Objective. To estimate the prevalence of bacteria isolated in samples from the hands of school-age children at a hospitalization unit. Methodology. In 2009, strains were cultured from the hands of 90 school-age children at the pediatric hospitalization unit of Hospital Estadual Bauru (São Paulo, Brazil). After culture of the samples, the isolated bacteria were identified. Results. In 98% of the samples taken from the children, bacteria were isolated. Coagulase-negative Staphilococcus was isolated in 64% of the samples, followed by Staphilococcus aureus (5%) and Pseudomonas aeruginosa(1%). Conclusion. In most of the samples from the children’s hands, bacteria were isolated. Therefore, educative actions about hygiene habits in- and outside the hospital environment should be reinforced, aimed at children and their companions.

Objetivo. Estimar la prevalencia de bacterias aisladas en las manos de los niños en edad escolar en una unidad de internación. Metodología. En 2009 se hicieron cultivos de las manos de 90 niños en edad escolar de la unidad de internación pediátrica del Hospital Estadual Bauru (São Paulo, Brasil). Se hizo cultivo de las muestras y posteriormente se realizó identificación de las bacterias aisladas. Resultados. En el 98% de las muestras tomadas a los niños se hicieron aislamientos de bacterias. Stafilococcus coagulasa negativa se aisló en el 64% de las muestras; Staphilococcus aureus, en un 5%, y Pseudomonas aeruginosa, en un 1%. Conclusión. En la mayor parte de las muestras de las manos de los niños internados se aislaron bacterias, por lo que se deben reforzar las acciones educativas a los niños y a sus acompañantes en relación con los hábitos de higiene en el ambiente hospitalario y fuera de él.

Objetivo. Estimar a prevalência de bactérias isoladas em mostras das mãos dos meninos em idade escolar numa unidade de internação. Metodologia. Em 2009 se fizeram cultivos das mãos de 90 meninos em idade escolar da unidade de internação pediátrica do Hospital Estadual Bauru (São Paulo, Brasil). Fez-se cultivo das mostras e posteriormente se fez identificação das bactérias isoladas. Resultados. No 98% das mostras tomadas aos meninos se fizeram isolamentos de bactérias. Stafilococcus coagulasa negativa se isolou no 64% das mostras, seguiram-lhe Staphilococcus aureus (5%) e Pseudomonas aeruginosa (1%). Conclusão.Na maior parte das mostras das mãos dos meninos internados se isolaram bactérias, pelo que se devem reforçar as ações educativas aos meninos e a seus acompanhantes em relação com os hábitos de higiene no ambiente hospitalar e fora dele.

Lectura de cuentos infantiles como estrategia de humanización en el cuidado del niño encamado en ambiente hospitalario / Reading fairy tales as a humanization strategy of hospitalized children care

Objetivo. Evaluar la estrategia de humanización en el cuidado del niño encamado en una unidad de hospitalización pediátrica a partir de la lectura de las historias infantiles. Metodología. Estudio cualitativo en el que se utilizó para la recolección de los datos: entrevista individual, cuestionario, dibujos e historias elaboradas por los niños antes y después de la primera y cuarta sesión de lectura de cuentos infantiles. Resultados. Durante las sesiones de lectura se percibió mejoría en las reacciones de los niños: estuvieron más atentos, participativos, entusiastas y alegres. A su vez los acompañantes también aceptaron de buen agrado esta intervención. El análisis de la información a partir de la entrevista, el cuestionario, la narrativa y los dibujos, mostró enormes posibilidades de la práctica de la lectura de cuentos a los niños hospitalizadps. Conclusión. La estrategia de humanización del cuidado con la ayudad de lectura de cuentos infantiles tuvo un impacto positivo en la internación del niño.

Objetivo. Avaliar a leitura das histórias infantis como estratégia de humanização do cuidado da criança hospitalizada. Metodologia. Estudo qualitativo no que se coletou informação procedente de: leitura de contos infantis: entrevista individual, questionário, desenhos e histórias elaboradas pelas crianças. Resultados. Durante as sessões de leitura se percebeu melhoria nas reações das crianças: estiveram mais atenciosos, participativos, entusiastas e alegres; os acompanhantes também aceitaram de bom agrado esta intervenção. A análise da informação da entrevista, o questionário, a narrativa e os desenhos se mostrou favorável à prática da leitura de contos. Conclusão. A estratégia de humanização do cuidado com a ajuda de leitura de contos infantis teve um impacto positivo na internação do menino.

Objective. To asses fairy tales reading as a humanization strategy of hospitalized children care. Methodology. Qualitative study in which data was collected from: fairy tales reading: individual interview, questionnaire, drawings and stories created by the children. Results. During reading sessions, improvement in the children’s reactions was seen: They were more focused, participative, enthusiastic and happy; those accompanying the children liked and accepted this intervention. Data analysis collected from Interviews, questionnaires, narratives and drawings, showed results in favor of the tales reading practice. Conclusion. The humanization strategy of care supported by fairy tales reading, had a positive impact in the children’s admission to the hospital.

Higienización de las manos: el cotidiano del profesional de la salud en una unidad de internación pediátrica / Higiene das mãos: o cotidiano do profissional da saúde numa unidade de internação pediátrica / Hand cleaning: every day of the health professionals in a pediatric inpatient unit

Objetivo. Describir el comportamiento en relación con la higienización de las manos de los profesionales de salud que actúan en la unidad de internación pediátrica de un hospital universitario. Metodología. Estudio descriptivo en el que la población de estudio fue el personal sanitario que laboraba en una unidad de internación pediátrica de un hospital universitario, en total 43 personas. La toma de la información fue realizada a través del proceso de observación y aplicación de encuesta sobre la técnica del lavado de las manos al momento de inicio del estudio y la segunda al mes de realizada la primera. Resultados. En solo 7% de las observaciones realizadas los participantes se lavaron las manos antes de realizar el procedimiento, y de éstos uno de cada dos siguió los pasos descritos en la técnica. La falla más frecuente en el lavado de manos se presentó en el paso de restregar la palma de la mano derecha contra el dorso de la mano izquierda entrelazando los dedos y viceversa (18%). Conclusión. Los participantes en este estudio no tienen el hábito de lavarse las manos de acuerdo con la técnica recomendada. Los datos sugieren la necesidad de promover acciones educativas para cambiar el comportamiento y las actitudes del personal de salud con relación a los pasos de la técnica del lavado de las manos antes y después de la realización de los procedimientos.

Objective. To describe behaviors related to hand cleaning in health professionals who work in the pediatric inpatient unit of a university hospital. Methodology. Descriptive study, in which the studied population was the sanitary staff who worked in a pediatric inpatient unit of a university hospital, there were a total of 43 people. Information was collected through an observation process and a survey applied on hand washing techniques, at the beginning of the study and a month later of the first one. Results. In just 7% of the observations, participants washed their hands before developing the procedure; one out of two followed the steps described in the technique. The most frequent failure in hand washing was presented in the step of rubbing the right hand palm over the left had dorsum, crossing the fingers and vice versa (18%). Conclusion. Participants of the study didn’t have the habit to wash their hands according to the recommended technique. Data suggest the necessity to promote educational actions to change staff behaviors and attitudes towards the steps and techniques of hand washing before and after performing any procedure.

Objetivo. Descrever o comportamento em relação com a higiene das mãos dos profissionais de saúde que atuam na unidade de internação pediátrica de um hospital universitário. Metodologia. Estudo descritivo no que a população de estudo foi o pessoal sanitário que laborava numa unidade de internação pediátrica de um hospital universitário, ao todo 43 pessoas. A tomada da informação foi realizada através do processo de observação e aplicação de enquete sobre a técnica da lavagem das mãos ao momento de início do estudo e a segunda ao mês de realizada a primeira. Resultados. Em só o 7% das observações realizadas os participantes se lavaram as mãos antes de realizar o procedimento, e destes, um de cada dois seguiu os passos descritos na técnica. As falha mais frequente no lavado mãos se apresentou no passo de esfregar a palma da mão direita contra o dorso da mão esquerda entrelaçando os dedos e vice-versa (18%). Conclusão. Os participantes neste estudo não têm o hábito de lavarem-se as mãos de acordo com a técnica recomendada. Os dados sugerem a necessidade de promover ações educativas para mudar o comportamento e as atitudes do pessoal de saúde com relação aos passos da técnica da lavagem das mãos antes e depois da realização dos procedimentos.

Reflexão sobre as vantagens, desvantagens e dificuldades dobrincar no ambiente hospitalar / Considerations about the advantages, disadvantages and difficulties of interned children playing in the hospital / Reflexión sobre las ventajas, desventajas y dificultades de jugar en el ambiente hospitalario

Estudo qualitativo no qual os sujeitos foram mães/acompanhantes das crianças hospitalizadas na Unidade de Internação Pediátrica do Hospital das Clínicas da Faculdade de Medicina de Botucatu, da Universidade Estadual Paulista. O objetivo com o estudo foi refletir sobre as vantagens, desvantagens e dificuldades do brincar no ambiente hospitalar. Foram realizadas 14 entrevistas gravadas em fita cassete, após o consentimento dos entrevistados, sendo que, posteriormente, realizou-se a interpretação, a análise e a preparação dos resultados de pesquisa. De modo geral, os dados mostraram que as mães percebem o brincar no ambiente hospitalar como uma forma importante para a distração e a alegria da criança durante a internação.

This is a qualitative study whose subjects were mothers or companions of children admitted at the Pediatric Unit ofthe public Medical School of Botucatu, SP. It aims to consider the advantages, disadvantages and difficulties of children who play in the hospital. After consent, fourteen interviews were recorded, studied and then analyzed. Results indicate that, in general, mothers feel that playing in the hospital is an important way to amuse and bring joy to their children during internment.

Se trata de un estudio cualitativo cuyos sujetos eran las madres/acompañantes de niños hospitalizados en la unidadde la internación de pediátrica del Hospital de Clínicas de la Facultad de Medicina de Botucatu de la Universidad Estatal Paulista. Teniendo como objetivo reflexionar acerca de las ventajas, desventajas y dificultades de jugar en el ambiente hospitalario. Con el consentimiento de los entrevistados se realizaron catorce entrevistas grabadas en cinta cassette y después la interpretación, análisis y preparación de los resultados de la investigación. En general, los datos demostraron que las madres sienten que jugar en el hospital es una forma importante para distraer y traer alegría alos niños durante su internación.

Educação em saúde - revisão bibliográfica de 2005 a 2007 / Healthcare education - literature review from 2005 to 2007 / Educación en salud - revisión bibliográfica de 2005 a 2007

Neste estudo, foram analisadas as publicações sobre educação em saúde no período de 2005 a 2007, por meio de categorias preestabelecidas sobre concepção de saúde, o que possibilitou a elaboração das seguintes subtemáticas: autonomia de indivíduos e grupos/educação tradicional, estilo de vida dos indivíduos/condições de vida e de trabalho, riscos comportamentais passíveis de mudança e determinantes sociais positivos. A autonomia foi questionada quando reconhecida uma educação autoritária, impossibilitando as decisões pessoais e influenciando o estilo de vida, com restrição a reflexão dos riscos em relação à saúde. A promoção da saúde se faz necessária ao processo permanente, democrático e coletivo com impacto na saúde e qualidade de vida das pessoas. Reconhece-se que a integralidade na educação em saúde deve ser um princípio assumido pelos profissionais. Articular as atividades educativas aos saberes da sociedade é ação essencial para uma prática transformadora, que favorece a prevalência dos direitos de cidadania, autonomia e liberdade.

In this study we assessed publications on health education from 2005 to 2007 using pre-established categories concerning the concept of health. We then elaborated the following sub-themes: autonomy of individuals and groups / traditional education, lifestyle of individuals / life and work conditions, behavioral risks subject to change and positive social determinants. Autonomy was questioned whenever an authoritarian education was recognized, since it inhibits personal decision making and alters lifestyle, restricting discussions about health hazards. Health promotion is necessary for a permanent, democratic and collective process that impacts positively on people's health and quality of life. We recognize that integrality in health education must be a principle assumed by professionals. It is essential to articulate educational activities for a transforming practice that favors the prevalence of civil rights, autonomy and freedom.

Este estudio analizó publicaciones sobre educación en salud del período comprendido entre los años 2005 y 2007 por medio de categorías preestablecidas sobre la concepción de salud. Ello permitió elaborar los siguientes subtemas: autonomía de individuos y grupos/educación tradicional, estilo de vida de los individuos/condiciones de vida y de trabajo, riesgos comportamentales factibles de cambio y determinantes sociales positivos. La autonomía fue cuestionada al observarse que la educación era autoritaria, que no permitía decisiones personales, influía en el estilo de vida y restringía reflexionar sobre los riesgos relacionados con la salud. La promoción de la salud es necesaria para un proceso permanente, democrático y colectivo con impacto en la salud y calidad de vida de las personas. Se reconoce que la integralidad en la educación en salud debe ser un principio asumido por los profesionales. Articular las actividades educativas a los saberes de la sociedad es una acción esencial para una práctica transformadora, que favorece la prevalencia de los derechos de ciudadanía, autonomía y libertad.

Utilización de la música en busca de la asistencia humanizada en el hospital / The use of music in the search for humanized hospital care

Objetivo: este estudio tiene como objetivo identificar las percepciones del equipo de enfermería sobre las ventajas y desventajas de la utilización de la música en la búsqueda de la asistencia humanizada al niño hospitalizado. Metodología: se trata de un estudio cualitativo en el que los sujetos fueron los enfermeros, técnicos y auxiliares de enfermería que actúan en el área de aislamiento de la Unidad de Internación Pediátrica del Hospital das Clínicas da Universidade Estadual Paulista. El equipo respondió a una pregunta guía sobre las ventajas, desventajas y dificultades del equipo de enfermería para la utilización de la música en la atención al niño hospitalizado. Resultados: los entrevistados perciben la música como algo benéfico y piensan que ese tipo de acciones debería darse con más frecuencia para proporcionar al niño y al propio equipo efectos como relajamiento, tranquilidad, mayor facilidad de interacción entre el niño y el equipo. Conclusiones: esta investigación sugiere la necesidad de divulgación y muestra el potencial de la música en el área de la salud y el estímulo a todo el equipo para que reflexione sobre el uso de la música como estrategia de acogida en la búsqueda de asistencia humanizada.

Objective: Our objective was to identify advantages and disadvantages for the nursing team in using music when looking for humanized care. Methodology: This was a qualitative study, where subjects are nurses, technicians, and nursing assistants in the Paediatric inpatient isolation unit HC-UNESP. The team answered questions relating to their perceptions of advantages and disadvantages in using music with hospitalized children. Results: the interviewed people perceive music as something beneficial and think that that type of performance would have to occur more times to provide to the boy and the own equipment effects like relaxation, tranquillity, greater facility of interaction between the boy and the equipment. Conclusion: this study suggests there is a need to promote the potential of music in healthcare and stimulate the whole team to reflect on using music as a humanizing strategy, and even as an alternative treatment, for those staying in hospital, and using this resource when seeking to provide humanized care.

Música no cuidado ao paciente hospitalizado: revisão sistematizada da literatura / Música en el cuidado del paciente internado: revisión sistemática de la literatura / Music in the care of interned patient: systematic review of literature

A música é algo constante em nossas vidas. Já nascemos num mundo de sons, nosso corpo trabalha em um ritmo, nossa vida tem um ritmo. Este estudo teve como objetivo identificar publicações relacionadas com o usoda música em ambiente hospitalar. Os artigos foram localizados em base de dados, compreendendo o períodoentre 2000 e 2006. Como resultado obteve-se 28 publicações. Do total, quinze (53,5 por cento) referências foramexcluídas deste estudo por não terem atendido os critérios. Os resultados apontam para o reconhecimento douso da musica no ambiente hospitalar como uma alternativa no cuidado que dá a oportunidade de tratar o paciente de forma integral e humana e, portanto, fazendo grande diferença no ambiente hospitalar.

Music is something constant in our lives. We were already born in a world of sounds; our body works in a rhythm,our life has a rhythm. This study has as objective to identify publications related to the use of music in the hospital. The articles were found in files, comprehending the period between 2000 and 2006. As result, 28 publications were obtained. From all of them, 15 (53. 5 per cent) references were excluded from this study because they didn’t match the criteria. The results point out recognition of the use of music in the hospital as an alternative thatgive the opportunity to treat the patient in an integral way and, therefore, making difference in the hospital.

La música es algo muy constante en nuestras vidas. Nacimos ya en un mundo de los sonidos, nuestros trabajosdel cuerpo en un ritmo, nuestro vivo tenemos un ritmo. Este estudio tiene como objetivo para identificar laspublicaciones relacionadas con el uso de la música en el hospital. Los artículos fueron encontrados en archivos,comprendiendo el período entre 2000 y 2006. Como el resultado fue obtenida 28 publicaciones. De todos, 15 referencias (del 53.5 por ciento) fueron excluidas de este estudio porque no emparejaron los criterios. Los resultadosprecisan el reconocimiento del uso de la música en el hospital como alternativa que dé la oportunidad de tratar al paciente de una manera integral y, diferencia por lo tanto, de la fabricación en el hospital.

Prevenção de acidentes domésticos à criança menor de 5 anos: percepção materna / Prevention of household accidents in children aged below 5 years: perceptions of the mother / Prevención de accidentes domésticos con niños menores de 5 años: opinión materna

O presente estudo tem por finalidade analisar a percepção materna na prevenção de acidentes domésticos à criança menor de 5 anos. Trata-se de um estudo exploratório, descritivo a partir da perspectiva de abordagem qualitativa. As avaliações mostram que as mães apresentam dificuldade em dissociar o fenômeno - acidente doméstico - da imprevisibilidade. Não identificam o risco aumentado, em função do desenvolvimento e da construção de habilidades cognitivas, o que dificulta a concretização da noção de perigo pela criança. Cabe aos profissionais ajudar as mães na compreensão do desenvolvimento dos filhos, assim como na mudança e adaptação do ambiente identificando e eliminando fatores que comprometem a proteção da criança.

The present study maternal in the prevention of domestic accidents to the lesser child of 5 years has for purpose to identify the perception. One is about an exploratory, descriptive study from the perspective of qualitative boarding. The evaluations show that the mothers present difficulty in dissocial the phenomenon of the unforeseeable. It does not identify the increased risk, in function of the development and the construction of its cognitive abilities, what it makes it difficult its concretion of the danger notion. It fits to the professionals to help the mothers in the understanding of the development of the children; as well as, change in the environment identifying and eliminating factors that compromise the protection of the child.

Este estudio tiene por objeto analizar la opinión materna en cuanto a la prevención de accidentes domésticos con niños menores de 5 años. Se trata de un estudio descriptivo exploratorio desde la perspectiva del enfoque cualitativo. Las evaluaciones indican que las madres tienen dificultad para disociar el fenómeno - accidente doméstico - de lo imprevisible. No identifican el riesgo aumentado, debido a la construcción de habilidades cognitivas, y eso hace más difícil que el niño concrete la noción de peligro. Les corresponde a l os profesionales ayudar a las madres a entender el desarrollo de sus hijos así como modificar y adaptar el ambiente identificando y eliminando factores que comprometan la protección del niño.