Cuidados paliativos em neonatologia sob a ótica do enfermeiro / Cuidados paliativos en neonatología desde la perspectiva de la enfermera / Palliative care in neonatology from nurses' perspective

Resumo Objetivo apreender as percepções e vivências de enfermeiros sobre os cuidados paliativos em neonatologia. Método pesquisa de abordagem qualitativa, tendo como base conceitual os cuidados paliativos, realizada com enfermeiros atuantes em Unidades de Terapia Intensiva Neonatal de três hospitais localizados em um município na região norte do Paraná. Os dados foram coletados no período de novembro de 2019 a janeiro de 2020, analisados por meio do referencial metodológico Discurso do Sujeito Coletivo Resultados participaram 20 enfermeiros, em sua maioria com tempo de experiência menor que 5 anos. Três temas traduzem as percepções e vivências dos enfermeiros: 1) Cuidados paliativos: da formação à vivência profissional; 2) Significando os cuidados paliativos em neonatologia; 3) Elegibilidade para os cuidados paliativos neonatais. Conclusão e implicações para a prática o enfermeiro refere lacunas em sua formação para a assistência ao recém-nascido em cuidados paliativos, no entanto muitos apresentaram a compreensão do significado de cuidados paliativos com foco na qualidade de vida dos bebês acometidos por uma situação ou doença incurável, incluindo a família. Tais aspectos apontam para a necessidade de formação e educação em saúde voltada para essa temática, bem como a implantação dos cuidados paliativos no serviço de neonatologia.

Resumen Objetivo comprender las percepciones y experiencias de los enfermeros sobre los cuidados paliativos en neonatología. Método investigación cualitativa, con base conceptual en los cuidados paliativos, realizada con enfermeros que actúan en Unidades de Cuidados Intensivos Neonatales de tres hospitales ubicados en un municipio de la región norte de Paraná. Los datos fueron recolectados desde noviembre de 2019 a enero de 2020, analizados mediante el marco metodológico Discurso del Sujeto Colectivo. Resultados participaron 20 enfermeras, la mayoría con menos de 5 años de experiencia. Tres temas reflejan las percepciones y experiencias de los enfermeros: 1) Cuidados paliativos: de la formación a la experiencia profesional; 2) Significado de los cuidados paliativos en neonatología; 3) Elegibilidad para cuidados paliativos neonatales. Conclusión e implicaciones para la práctica las enfermeras reportan lagunas en su formación para asistir a los recién nacidos en cuidados paliativos, sin embargo, muchas presentaron una comprensión del significado de los cuidados paliativos con un enfoque en la calidad de vida de los bebés afectados por una situación o enfermedad incurable, incluyendo la familia. Estos aspectos apuntan a la necesidad de capacitación y educación en salud enfocada en este tema, así como la implementación de cuidados paliativos en el servicio de neonatología.

Abstract Objective to grasp nurses' perceptions and experiences about palliative care in neonatology. Method qualitative research, with palliative care as its conceptual basis, carried out with nurses working in Neonatal Intensive Care Units of three hospitals located in a municipality in the northern region of Paraná. Data were collected from November 2019 to January 2020, analyzed using the Discourse of the Collective Subject methodological framework. Results twenty nurses participated, most of them with less than 5 years of experience. Three topics reflect nurses' perceptions and experiences: 1) Palliative care: from training to professional experience; 2) Meaning palliative care in neonatology; 3) Eligibility for neonatal palliative care. Conclusion and implications for practice nurses report gaps in their training for assisting newborns in palliative care; however, many presented an understanding of the meaning of palliative care with a focus on quality of life of babies affected by an incurable situation or illness, including the family. These aspects point to the need for training and health education focused on this topic as well as the implementation of palliative care in the neonatology service.

Facility-based directly observed therapy (DOT) for tuberculosis during COVID-19: A community perspective.

Facility-based directly observed therapy (DOT) has been the standard for treating people with TB since the early 1990s. As the commitment to promote a people-centred model of care for TB grows, the use of facility-based DOT has been questioned as issues of freedom, privacy, and human rights have been raised. The disruptions caused by the COVID-19 pandemic and ensuing lockdown measures have fast-tracked the need to find alternative methods to provide treatment to people with TB. In this study, we present quantitative and qualitative findings from a global community-based survey on the challenges of administering facility-based DOT during a pandemic as well as potential alternatives. Our results found that decreased access to transportation, the fear of COVID-19, stigmatization due to overlapping symptoms, and punitive measures against quarantine violations have made it difficult for persons with TB to receive treatment at facilities, particularly in low-resource settings. Potential replacements included greater focus on community-based DOT, home delivery of treatment, multi-month dispensing, and video DOT strategies. Our study highlights the need for TB programs to re-evaluate their approach to providing treatment to people with TB, and that these changes must be made in consultation with people affected by TB and TB survivors to provide a true people-centred model of care.

Antifungal activity and Shore A hardness of a tissue conditioner incorporated with terpinen-4-ol and cinnamaldehyde.

PURPOSE: This study investigated the anti-Candida activity and the Shore A hardness of a tissue conditioner (Softone™) modified by incorporation of terpinen-4-ol and cinnamaldehyde. MATERIAL AND METHODS: Agar diffusion, microdilution, and mechanism of action methods were performed to determine to evaluate the antifungal activity of phytoconstituents. Then, phytoconstituents in varying concentrations were incorporated into the tissue conditioner. The anti-Candida effect of the modified conditioner was evaluated through agar punch well and biofilm formation methods. Shore A hardness of the experimental liners was evaluated after baseline, 24 h, 48 h, 4 days, and 7 days immersion on artificial saliva. RESULTS: The phytoconstituents incorporated into Softone showed completely inhibited fungal growth in concentrations of 20-40% and did not present significant antifungal activity until their concentrations where higher than 5%. There were differences between non-modified Softone and M5, M10, C10, and T10% (p < 0.05). The groups containing 10-40% of cinnamaldehyde incorporated into Softone were able to completely inhibit the biofilm. Concentrations below 40% of terpinen-4-ol showed unsatisfactory biofilm inhibition. The T40% and C40% groups presented the lowest Shore A hardness values. Hardness values from groups T40% at 7 days (p = 0.476); C40% at 4 days (p = 0.058); and T20% (p = 0.058), C20% (p = 0.205), T30% (p = 0.154), and C30% (p = 0.874) after 48 h did not differ from the control group. CONCLUSIONS: Cinnamaldehyde incorporated into Softone inhibited Candida biofilm formation at concentrations of 10-40%, being more effective than terpinen-4-ol modification despite of halo inhibition observed by both products. CLINICAL RELEVANCE: All modifications showed a very similar pattern of hardness being useful for clinical practice.

Identifying socioeconomic, epidemiological and operational scenarios for tuberculosis control in Brazil: an ecological study.

OBJECTIVES: To identify scenarios based on socioeconomic, epidemiological and operational healthcare factors associated with tuberculosis incidence in Brazil. DESIGN: Ecological study. SETTINGS: The study was based on new patients with tuberculosis and epidemiological/operational variables of the disease from the Brazilian National Information System for Notifiable Diseases and the Mortality Information System. We also analysed socioeconomic and demographic variables. PARTICIPANTS: The units of analysis were the Brazilian municipalities, which in 2015 numbered 5570 but 5 were excluded due to the absence of socioeconomic information. PRIMARY OUTCOME: Tuberculosis incidence rate in 2015. DATA ANALYSIS: We evaluated as independent variables the socioeconomic (2010), epidemiological and operational healthcare indicators of tuberculosis (2014 or 2015) using negative binomial regression. Municipalities were clustered by the k-means method considering the variables identified in multiple regression models. RESULTS: We identified two clusters according to socioeconomic variables associated with the tuberculosis incidence rate (unemployment rate and household crowding): a higher socioeconomic scenario (n=3482 municipalities) with a mean tuberculosis incidence rate of 16.3/100 000 population and a lower socioeconomic scenario (2083 municipalities) with a mean tuberculosis incidence rate of 22.1/100 000 population. In a second stage of clusterisation, we defined four subgroups in each of the socioeconomic scenarios using epidemiological and operational variables such as tuberculosis mortality rate, AIDS case detection rate and proportion of vulnerable population among patients with tuberculosis. Some of the subscenarios identified were characterised by fragility in their information systems, while others were characterised by the concentration of tuberculosis cases in key populations. CONCLUSION: Clustering municipalities in scenarios allowed us to classify them according to the socioeconomic, epidemiological and operational variables associated with tuberculosis risk. This classification can support targeted evidence-based decisions such as monitoring data quality for improving the information system or establishing integrative social protective policies for key populations.