[Trend in breast cancer mortality rate among women aged 20 years or older in Brazil, 2005-2019]. / Tendência da taxa de mortalidade por câncer de mama em mulheres com 20 anos ou mais no Brasil, 2005-2019.

The aim is to analyze the trend in breast cancer mortality rates and its correlation with the socioeconomic development status in Brazil. It involved an ecological time series study carried out in the 26 units of the federation, Federal District and regions of Brazil. Data sources included the Mortality Information System (number of deaths), the Brazilian Institute of Geography and Statistics (resident population) and the study of the Global Burden of Disease (Socio-demographic Index - SDI). Data from 2005 to 2019 were used. The trend was analyzed using Prais-Winsten regression models. The relationship between the mortality rate and the SDI was analyzed using Spearman's correlation coefficient. During the study period, 207,683 deaths from breast cancer occurred. The average standardized mortality rate was 19.95 deaths per 100,000 women in Brazil. All the regions of Brazil showed an increasing trend in mortality. Of the total federative units, 22 showed an increasing trend. There was a positive relationship between the mortality rate and the SDI. The standardized mortality rate for breast cancer showed an increasing trend in Brazil, in all regions and in most states. There was a direct association between mortality and SDI, indicating a greater magnitude in more developed regions.

O objetivo é analisar a tendência da taxa de mortalidade por câncer de mama e sua correlação com o status de desenvolvimento socioeconômico no Brasil. Estudo ecológico de séries temporais realizado nos 26 estados, Distrito Federal e regiões do Brasil. As fontes de dados foram o Sistema de Informação sobre Mortalidade (número de óbitos), o Instituto Brasileiro de Geografia e Estatística (população residente) e o estudo da Carga Global de Doenças (socio-demographic index - SDI). Foram usados dados de 2005 a 2019. A tendência foi analisada pelos modelos de regressão de Prais-Winsten. A relação entre a taxa de mortalidade e o SDI foi analisada pelo coeficiente de correlação de Spearman. No período do estudo ocorrerem 207.683 óbitos por câncer de mama. A taxa padronizada de mortalidade média foi de 19,95 óbitos por 100.000 mulheres no Brasil. O Brasil e todas as regiões apresentaram tendência crescente da mortalidade. Do total de estados, 22 apresentaram tendência crescente. Verificou-se relação positiva entre a taxa de mortalidade e o SDI. A taxa de mortalidade padronizada por câncer de mama apresentou tendência crescente no Brasil, em todas as regiões e na maioria das unidades da federação. Verificou-se associação direta entre mortalidade e SDI, indicando maior magnitude em regiões mais desenvolvidas.

Tendência da taxa de mortalidade por câncer de mama em mulheres com 20 anos ou mais no Brasil, 2005-2019 / Trend in breast cancer mortality rate among women aged 20 years or older in Brazil, 2005-2019

Resumo O objetivo é analisar a tendência da taxa de mortalidade por câncer de mama e sua correlação com o status de desenvolvimento socioeconômico no Brasil. Estudo ecológico de séries temporais realizado nos 26 estados, Distrito Federal e regiões do Brasil. As fontes de dados foram o Sistema de Informação sobre Mortalidade (número de óbitos), o Instituto Brasileiro de Geografia e Estatística (população residente) e o estudo da Carga Global de Doenças (socio-demographic index - SDI). Foram usados dados de 2005 a 2019. A tendência foi analisada pelos modelos de regressão de Prais-Winsten. A relação entre a taxa de mortalidade e o SDI foi analisada pelo coeficiente de correlação de Spearman. No período do estudo ocorrerem 207.683 óbitos por câncer de mama. A taxa padronizada de mortalidade média foi de 19,95 óbitos por 100.000 mulheres no Brasil. O Brasil e todas as regiões apresentaram tendência crescente da mortalidade. Do total de estados, 22 apresentaram tendência crescente. Verificou-se relação positiva entre a taxa de mortalidade e o SDI. A taxa de mortalidade padronizada por câncer de mama apresentou tendência crescente no Brasil, em todas as regiões e na maioria das unidades da federação. Verificou-se associação direta entre mortalidade e SDI, indicando maior magnitude em regiões mais desenvolvidas.

Abstract The aim is to analyze the trend in breast cancer mortality rates and its correlation with the socioeconomic development status in Brazil. It involved an ecological time series study carried out in the 26 units of the federation, Federal District and regions of Brazil. Data sources included the Mortality Information System (number of deaths), the Brazilian Institute of Geography and Statistics (resident population) and the study of the Global Burden of Disease (Socio-demographic Index - SDI). Data from 2005 to 2019 were used. The trend was analyzed using Prais-Winsten regression models. The relationship between the mortality rate and the SDI was analyzed using Spearman's correlation coefficient. During the study period, 207,683 deaths from breast cancer occurred. The average standardized mortality rate was 19.95 deaths per 100,000 women in Brazil. All the regions of Brazil showed an increasing trend in mortality. Of the total federative units, 22 showed an increasing trend. There was a positive relationship between the mortality rate and the SDI. The standardized mortality rate for breast cancer showed an increasing trend in Brazil, in all regions and in most states. There was a direct association between mortality and SDI, indicating a greater magnitude in more developed regions.

Nurseped: educational technology for safety in the management of intravenous antibiotics in pediatrics. / Nurseped: tecnología educativa para la seguridad en el manejo de antibióticos intravenosos en pediatría.

OBJECTIVE: to develop and validate the content of a serious game on the safe management of intravenous medications in pediatrics. METHOD: methodological study for the development and content validation of an educational technology. The cases and challenges of the serious game were developed based on a literature review and validated by 11 nurses with training and experience in the area. Content validity and agreement indices were adopted to analyze agreement and internal consistency (minimum of 0.8). RESULTS: the content is based on the main antibiotics used in the clinical management of infections in hospitalized children and patient safety. Absolute agreement was obtained in 60 of the 61 items evaluated, and the minimum obtained was 0.82 in the content validation index and 0.80 in agreement. Adjustments were suggested by experts in the response statement for a specific case and implemented to improve the quality of the technology content. CONCLUSION: the content of the serious game Nurseped was validated by nurse experts in child health regarding clinical cases, question statements and multiple-choice answers, in addition to feedback that presents the user with an evidence-based answer after getting the challenge right or wrong.

Nurseped: tecnología educativa para la seguridad en el manejo de antibióticos intravenosos en pediatría / Nurseped: educational technology for safety in the management of intravenous antibiotics in pediatrics / Nurseped: tecnologia educacional para a segurança no manejo de antibióticos endovenosos em pediatria

Objetivo: desarrollar y validar el contenido de un serious game sobre el manejo seguro de medicamentos intravenosos en pediatría. Método: estudio metodológico para el desarrollo y validación de contenido de una tecnología educativa. Los casos y desafíos del serious game se basaron en una revisión de la literatura y fueron validados por 11 enfermeros con formación y experiencia en el área. Se adoptaron índices de validez de contenido y concordancia para el análisis de concordancia y consistencia interna (mínimo de 0,8). Resultados: el contenido se basa en los principales antibióticos utilizados en el manejo clínico de infecciones en niños hospitalizados y en la seguridad del paciente. Se obtuvo una concordancia absoluta en 60 de los 61 ítems evaluados, y el mínimo obtenido fue de 0,82 en el índice de validación de contenido y 0,80 en concordancia. Los expertos sugirieron ajustes en la formulación de respuestas de un caso específico y se implementaron para mejorar la calidad del contenido de la tecnología. Conclusión: el contenido del serious game Nurseped fue validado por enfermeros expertos en salud infantil en cuanto a casos clínicos, enunciados de preguntas y respuestas de opción múltiple, además del feedback que presenta al usuario una respuesta basada en evidencia tras acertar o fallar en el desafío.

Objective: to develop and validate the content of a serious game on the safe management of intravenous medications in pediatrics. Method: methodological study for the development and content validation of an educational technology. The cases and challenges of the serious game were developed based on a literature review and validated by 11 nurses with training and experience in the area. Content validity and agreement indices were adopted to analyze agreement and internal consistency (minimum of 0.8). Results: the content is based on the main antibiotics used in the clinical management of infections in hospitalized children and patient safety. Absolute agreement was obtained in 60 of the 61 items evaluated, and the minimum obtained was 0.82 in the content validation index and 0.80 in agreement. Adjustments were suggested by experts in the response statement for a specific case and implemented to improve the quality of the technology content. Conclusion: the content of the serious game Nurseped was validated by nurse experts in child health regarding clinical cases, question statements and multiple-choice answers, in addition to feedback that presents the user with an evidence-based answer after getting the challenge right or wrong.

Objetivo: desenvolver e validar o conteúdo de um serious game sobre o manejo seguro de medicamentos endovenosos em pediatria. Método: estudo metodológico para o desenvolvimento e validação de conteúdo de uma tecnologia educacional. Os casos e desafios do serious game foram desenvolvidos com base em revisão da literatura e validados por 11 enfermeiros com formação e atuação na área. Adotou-se os índices de validade de conteúdo e concordância, para análise de concordância e consistência interna (mínimo de 0,8). Resultados: o conteúdo é baseado nos principais antibióticos utilizados no manejo clínico de infecções em crianças hospitalizadas e na segurança do paciente. Obteve-se concordância absoluta em 60 dos 61 itens avaliados, o mínimo obtido foi 0,82 no índice de validação de conteúdo e 0,80 na concordância. Ajustes foram sugeridos pelos experts no enunciado de respostas de um caso específico e implementados para o aprimoramento da qualidade do conteúdo da tecnologia. Conclusão: o conteúdo do serious game Nurseped foi validado por enfermeiros experts em saúde da criança quanto aos casos clínicos, aos enunciados das perguntas e às respostas de múltipla escolha, além do feedback que apresenta ao usuário uma resposta baseada em evidências após o acerto ou erro do desafio.

Environmental and behavioral factors associated with household transmission of SARS-CoV-2 in children and adolescents.

Objective: To analyze the association between risk behaviors and environmental factors and SARS-CoV-2 infection in children and adolescents in the family environment. Methods: Cross-sectional study. A total of 267 children and adolescents aged 5-19 years who have contact with COVID-19-positive essential workers were tested between June and October 2020. Behavioral and environmental variables associated with SARS-CoV-2 infection were investigated. Association between these variables was performed using Poisson regression. Results: SARS-CoV-2 prevalence was 25.1%. Following the confirmation of COVID-19 diagnosis of the index case, 92.1% of adults reported hand hygiene and 83.5% showed habits of respiratory etiquette. However, 12.7% wore masks in common areas of the residence before COVID-19. Sharing common objects was a risk factor for SARS-CoV-2 infection in the sample. Conclusion: Sharing objects among family members was identified as a risk factor associated with SARS-CoV-2 infection in children and adolescents who lived with infected adults. There was high frequency of hand hygiene and low prevalence of mask use.

Academic performance beyond the metrics: A qualitative content analysis of nursing students' perceptions.

AIM: To explore the undergraduate nursing students' perceptions about the factors influencing their academic performance. BACKGROUND: Academic performance is the measure for the achievement of learning objectives and skills development. Thus, the literature on nursing education has already pointed out the factors associated with this construct. However, it is essential to understand the in-depth influencers of academic performance from the perspective of nursing students. For this, it is essential to analyze not only numerical indicators, but also to understand the perceptions of undergraduate students about the factors that can influence this performance. DESIGN: Descriptive study with qualitative approach. METHODS: Twenty-two undergraduate nursing students were recruited from a Brazilian public university. Interviews were collected and submitted to Content Analysis, thematic modality, and discussed according to references of critical and humanist education. RESULTS: Two thematic categories emerged from the interviews representing the students' perceptions: 1. The student - history and relationships, with the thematic axis quality of previous education, intrafamily processes and roles, family support, socioeconomic aspects, interpersonal relationships, copping with difficulties, mental health, and physical well-being; and 2. Academic experiences and their challenges, with the thematic axis academic adaptation, professor's didactics and preparation, structure and support provided by the University, management of study time, and participation in extracurricular activities. The students saw them as intervening factors in their academic performance, physical and psychological well-being, established interpersonal relationships (including the relation with peers and professors), family structure, socioeconomic aspects, academic conditions, and the transition to higher education. CONCLUSION: From the perspective of students, socio-historical aspects and constructs established in relationships with colleagues and professors at the university are directly related to their academic performance and directly influence their ability to achieve the proposed learning objectives and acquire essential competencies for their education.

Influence of simulation design on stress, anxiety and self-confidence of nursing students: Systematic review with meta-analysis.

AIM: To evaluate the simulation design characteristics that may influence the stress, anxiety and self-confidence of undergraduate nursing students during learning. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Searchers were conducted in October 2020 and updated in August 2022 in the databases CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, Scopus and Web of Science, PQDT Open (ProQuest), BDTD, Google Scholar and specific journals on simulation. REVIEW METHODS: This review was conducted according to the recommendations of Cochrane Handbook for Systematic Reviews and reported according to the PRISMA Statement. Experimental and quasi-experimental studies that compared the effect of simulation on stress, anxiety and self-confidence of nursing students were included. The selection of studies and data extraction was performed independently by two reviewers. Simulation information was collected as prebriefing, scenario, debriefing, duration, modality, fidelity and simulator. Data summarization was performed by qualitative synthesis and meta-analytical methods. RESULTS: Eighty studies were included in the review, and most reported in detail the structure of the simulation, contemplating prebriefing, scenario, debriefing and the duration of each step. In subgroup meta-analysis, the presence of prebriefing, duration of more than 60 min and high-fidelity simulations helped reduce anxiety, while the presence of prebriefing and debriefing, duration, immersive clinical simulation modalities and procedure simulation, high-fidelity simulations and use of mannequins, standardised patients and virtual simulators, contributed to greater students' self-confidence. CONCLUSIONS: Different modulations of simulation design components imply reduction of anxiety and increased self-confidence in nursing students, especially highlighting the quality of the methodological report of simulation interventions. RELEVANCE TO CLINICAL PRACTICE: These findings help to support the need of more rigorous methodology in simulation designs and research methods. Consequently, impact on the education of qualified professionals prepared to work in clinical practice. No Patient or Public Contribution.

The simulation design in health and nursing: A scoping review.

AIMS: The aims of this study were to map the components of the simulation design in health and nursing and to propose a classification based on their definitions to support the planning of simulation-based experiences. DESIGN: Scoping review. METHOD: Searches were performed in the databases LILACS, Embase, MEDLINE/PubMed, SCOPUS, Web of Science, Google Scholar and ProQuest Thesis and Dissertation were performed, without time limitation, to identify studies about simulation design. RESULTS: This study mapped 19 components of the simulation design found in 26 studies included, which can contribute to the development of simulation-based experiences, classified into structural, methodological and theoretical-pedagogical components. The simulation design can be described according to its fundamental components: structural-define the basic formulation of a simulation in terms of infrastructure and conceptual framework; methodological-define the participants, roles and the instruction format; and theoretical-pedagogical-define the educational references used to support the simulation strategy.

Cohort study protocol of the Brazilian collaborative research network on COVID-19: strengthening WHO global data.

INTRODUCTION: With the COVID-19 pandemic, hospitals in low-income countries were faced with a triple challenge. First, a large number of patients required hospitalisation because of the infection's more severe symptoms. Second, there was a lack of systematic and broad testing policies for early identification of cases. Third, there were weaknesses in the integration of information systems, which led to the need to search for available information from the hospital information systems. Accordingly, it is also important to state that relevant aspects of COVID-19's natural history had not yet been fully clarified. The aim of this research protocol is to present the strategies of a Brazilian network of hospitals to perform systematised data collection on COVID-19 through the WHO platform. METHODS AND ANALYSIS: This is a multicentre project among Brazilian hospitals to provide data on COVID-19 through the WHO global platform, which integrates patient care information from different countries. From October 2020 to March 2021, a committee worked on defining a flowchart for this platform, specifying the variables of interest, data extraction standardisation and analysis. ETHICS AND DISSEMINATION: This protocol was approved by the Research Ethics Committee (CEP) of the Research Coordinating Center of Brazil (CEP of the Hospital Nossa Senhora da Conceicao), on 29 January 2021, under approval No. 4.515.519 and by the National Research Ethics Commission (CONEP), on 5 February 2021, under approval No. 4.526.456. The project results will be explained in WHO reports and published in international peer-reviewed journals, and summaries will be provided to the funders of the study.

Effect of simulation on stress, anxiety, and self-confidence in nursing students: Systematic review with meta-analysis and meta-regression.

INTRODUCTION: Simulation is a promising strategy in health education, with evidence of importance for learning, but the available systematic reviews are still inconclusive about the effect of the strategy on stress, anxiety, and self-confidence of nursing students, which impact the adherence to and sustainment of this strategy. Thus, better evidence is needed of the impact of simulation on these competences, essential for health professional education. OBJECTIVE: To evaluate the effect of simulation-based experiences on stress, anxiety, self-confidence and learning of undergraduate nursing students compared to conventional teaching strategies or no intervention. DESIGN: Systematic review with meta-analysis and meta-regression. DATA SOURCES: The databases used included: CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, SCOPUS and Web of Science. Additional searches occurred in PQDT Open (ProQuest), BDTD, Google Scholar and journals with a specific scope in clinical simulation. REVIEW METHODS: This study was conducted by the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Experimental and quasi-experimental studies that compared the effects of simulation on stress, anxiety, and self-confidence of nursing students were included. Study selection and data extraction steps were performed independently by two reviewers. Critical appraisal of the studies was managed by means of the risk of bias tools RoB 2 and ROBINS-I, and quality of evidence by means of the GRADE tool. Data summarization was performed by qualitative synthesis with descriptive analysis and quantitative synthesis by meta-analytic methods and meta-regression. RESULTS: Sixty-two studies were included covering an overall sample of 4570 undergraduate nursing students. When comparing simulation with other teaching strategies, simulation showed small effect size for anxiety (d = -0.33; 95% CI: -0.66-0.002; p = 0.051) and medium effect size for self-confidence (d = 0.71; 95% CI: 0.46-0.95; p < 0.001); there was no difference in the effect-size for stress (d = 0.04; 95% CI:-0.91-0.99; p = 0.90). Subgroup analyses showed an effect of methodological characteristics of the studies on students' anxiety and self-confidence. A positive relationship between self-confidence and learning was identified by meta-regression (p = 0.018; R2 = 20.96%). CONCLUSION: Simulation is an effective strategy for reducing anxiety and increasing self-confidence compared to conventional teaching strategies. Results are still inconclusive for stress. The use of simulation-based experiences in nursing education obtains positive results on anxiety and self-confidence in students, providing support for its implementation in undergraduate curricula to improve the education of qualified nurses. REGISTRATION NUMBER: CRD42020206077. TWEETABLE ABSTRACT: Simulation is an effective teaching strategy for reducing anxiety and increasing self-confidence in learning.

Negative Self-Assessment of Health in Women: Association with Sociodemographic Characteristics, Physical Inactivity and Multimorbidity.

INTRODUCTION: Women present a higher prevalence of negative self-assessment of health (NSAH) when compared to men. However, there is a gap in the literature of factors associated with NSAH in women from developing countries such as Brazil. In addition, few studies have assessed the magnitude of the association between multimorbidity and NSAH in this population. Thus, the aim of this study was to evaluate the association between NSAH and sociodemographic characteristics, lifestyle and multimorbidity in women from the Midwest region of Brazil. METHODS: A study based on data from the National Health Survey, a household survey that investigated health situation, lifestyle and risk factors for chronic diseases in the adult population of Brazil, was held. Sampling was performed in multiple stages. The selected women answered a standardized questionnaire on sociodemographic data, self-assessment of health and potential determinants. Poisson regression was used to analyze the association between NSAH and sociodemographic characteristics, lifestyle and multimorbidity. A significance level of 0.05% was established. RESULTS: The study included 4233 women. The prevalence of NSAH found was 6.0% (95% Confidence Interval [95% CI]: 5.1-7.0%). There was an association between NSAH and advancing age, low schooling, physical inactivity and multimorbidity. Furthermore, there was an association between NSAH and diseases/disorders such as chronic back pain, systemic arterial hypertension, mental disorders, depression, cardiovascular diseases, stroke, cancer, hypercholesterolemia and diabetes mellitus. CONCLUSION: The prevalence of NSAH was low. A strong association was found between this variable and multimorbidity. In addition, increased age, low schooling and physical inactivity were predictors of NSAH in women.

Nursing supervised curricular internship in the Covid-19 pandemic: experience in the program Brasil Conta Comigo.

OBJECTIVE: To report the experience of the nursing supervised curricular internship in the program "O Brasil Conta Comigo" carried out in the Covid-19 pandemic. METHOD: Experience report of activities developed in Primary Health Care in a municipality in the southern region of the state of Goiás during the Covid-19 pandemic, from April to November 2020. RESULTS: The inclusion in the government program allowed the strengthening of the student's active role in the teaching-learning process and teaching-service approximation, with the student as the point of connection, which resulted in the implementation of actions for the fight against the pandemic in the municipality, such as elaboration, implementation, and evaluation of the service flowchart for people with suspected Covid-19. CONCLUSION: The experience was successful, as it consolidated knowledge regarding leadership and autonomy, integration between theory and practice, critical thinking, and evidence-based problem solving. The participation in the program allowed for contributions to assistance and management in the actions to combat the new coronavirus in the scope of primary care, as well as for the contribution to the training of the student tutored by nurses in the field and supervised by professors from the federal university of origin.

Academic performance, adaptation and mental health of nursing students: A cross-sectional study.

AIM: To evaluate the institutional indicators of academic success, performance and failure and to identify the factors that influence the performance, academic adaptation and mental health of nursing students. DESIGN: Descriptive, cross-sectional study. METHODS: Data collection was performed between April 2018 and January 2020, focusing on academic data of nursing students (n = 348) and answers to a questionnaire with active students of the course with at least two years since admission (n = 88). RESULTS: Academic data indicates negative trends on academic failure and dropouts. Mean academic performance was 7.56 out of 10 and ALEQ-r results showed high academic adaptation in all dimensions, except in the personal dimension of scale. The prevalence of depressive symptoms reported was 60.2% (95%CI: 49.8-70.1%) and presented as predictors of this condition both academic performance and adaptation. CONCLUSIONS: There was found a trend in academic failure and dropouts among nursing students, as well as a relevant prevalence of depressive symptoms despite good average of academic adaptation and academic performance.

Professional insertion of registered nurses: a study with alumni. / A inserção profissional de enfermeiros licenciados: um estudo de egressos.

OBJECTIVE: To analyze the professional insertion of registered nurses, taking into account the current structure of work in the health area and in the training of technical workers, from the perspective of training of professionals who will develop their activities in the Brazilian Unified Health System. METHOD: Quantitative, cross-sectional, and exploratory study, with descriptive and inferential statistical analysis using Fisher's exact test, carried out with 105 alumni of a nursing undergraduate course. An electronic questionnaire was applied. RESULTS: The alumni worked as nurses (n = 59, 56.2%) or teachers (n = 18, 17.1%). The areas with the greatest absorption of alumni were hospitals (n = 37, 62.7%), the public sector (n = 35, 59.3%), and high-school level technical professional education (n = 16, 88.9%). Most participants were dissatisfied with their income (n = 56, 72.7%) and pointed out that the received values were incompatible with the work (n = 59, 76.6%). CONCLUSION: The alumni faced problems in developing their professional activities, especially because of the current policies, which establish limits on the recognition of healthcare workers and education as a public asset. Progress in the recognition of the profession of registered nurse is necessary, given the relevance of these professionals in the health and education systems and the nature of the profession's practice of providing education and care, which have a transformative potential.

Analysis of the factors related to academic disapproval in the education of nurses: A mixed-method study.

OBJECTIVE: to evaluate the frequency and factors associated to disapproval among nursing students. METHOD: a descriptive and cross-sectional study, outlined by the convergent mixed method. A total of 88 nursing students of a Brazilian public university took part. The Reduced Academic Experiences Questionnaire was used for evaluating academic adaptation. The association of the variables in the study with disapproval was verified by bivariate analysis. RESULTS: the frequency of disapprovals in the sample was 68.2%, recurrences in the same discipline in 39.8%, with the associated factors: age over or equal to 22 years old (p=0.015), family income below 2 minimum wages (p=0.019) and lag in the curricular flow (p<0.001). Disciplines with higher frequencies of disapprovals are of the basic area, taught in the first two years of the course and common to the health courses. Students without disapprovals had better perception of physical and psychological well-being (p=0.002), good interpersonal relationships (p=0.017) and more assertive study behaviors (p=0.005). Personal, study-related and institutional issues were motivating. CONCLUSION: the results reveal a high rate of disapproval, especially in the basic area. An association was found between disapprovals and mental health for nursing students during their education process, and difficulties were pointed out that can culminate with the disapproval rate in the curricular flow.

Design and evaluation of a 3D serious game for communication learning in nursing education.

BACKGROUND: Communication is essential for nursing practice; such competence is not intuitive and must be taught. Serious games in 3D virtual reality can support the nursing teaching-learning process; students connected to the virtual world can apply what they have learned in their professional practice. AIM: To describe the design and heuristic evaluation of a serious game in 3D immersive VR for the development of communication competence. METHOD: A methodological study was conducted to develop and evaluate the serious game in a 3D immersive virtual environment using Oculus Rift®, called Comunica-Enf. The game consists of the user asking for authorization to the patient's avatar to perform a nursing procedure using communication abilities. Professors from six nursing courses and 30 students from two undergraduate nursing courses were recruited to evaluate the usability and appearance of the Comunica-Enf serious game. After using the game, the participants completed the Heuristic Evaluation of Digital Educational Games. A maximum of 25% of high or urgent priority problems in the whole game or heuristics is necessary to validate the game. RESULT: The participants considered Comunica-Enf suitable for nursing education because none of the heuristics reached more than 25% of high or urgent priority problems. The participants made suggestions that were analyzed and incorporated into the Comunica-Enf when possible. CONCLUSION: Comunica-Enf is an educational technology that uses Oculus Rift® and a 3D virtual reality perspective as an innovative resource. It had its appearance and usability validated for nursing students, providing a safe and pleasant environment for communication competence.

Lanolin and prenatal health education for prevention of nipple pain and trauma: Randomized clinical trial. / Lanolina y educación para la salud en la prevención de dolor y lesiones en los pezones: ensayo clínico aleatorizado.

OBJECTIVE: To investigate the effect of lanolin on nipple pain and trauma in breastfeeding after application of a health education. METHOD: Randomized controlled clinical trial, with two arms, open, with 66 participants during prenatal care in the primary health care network in Goiania - Goias, Brazil. Participants were randomized (1:1) using computer generated numbers in both experimental group (EG) and control group (CG). The EG received lanolin and health education on breastfeeding at two different times with clinical demonstration using cloth didactic breast and illustrative album as the intervention, while the CG received standard health education. Health education was carried out by the same researchers in both groups. Measurement of pain, nipple trauma, and breastfeeding technique occurred on postpartum day eight. The analysis included descriptive statistics and inferential analysis by means chi-square or Fisher test, and Student's t-test, significance level set at 0.05. RESULTS: A majority of the participants experienced no nipple trauma (59.1%) in both groups, and 60.6% of women experienced pain. In both groups, women showed favorable breastfeeding behaviors, except in the condition of the breasts. There were no significant differences between groups in pain prevention (p=0.61), nipple lesions (p=0.21), and breastfeeding technique (p>0.05). CONCLUSION: It is not clear whether the intervention, lanolin combined with health education, has a positive effect on the prevention of nipple pain and trauma. Further research is needed to elucidate this question. Registration number: RBR-7tvhq8. Registry website: http://www.ensaiosclinicos.gov.br/.

A inserção profissional de enfermeiros licenciados: um estudo de egressos / Inserción laboral de licenciados en enfermería: estudio sobre graduados / Professional insertion of registered nurses: a study with alumni

RESUMO Objetivo Analisar a inserção profissional de enfermeiros licenciados, considerando a conformação atual do trabalho na área da saúde e na formação dos trabalhadores técnicos, na perspectiva da formação de profissionais atuantes no SUS. Método Estudo quantitativo, transversal e exploratório, com análise estatística descritiva e inferencial por teste exato de Fisher, com 105 egressos de um curso de Bacharelado e Licenciatura. Aplicado questionário eletrônico. Resultados Os egressos atuam como enfermeiros (n = 59, 56,2%) e professores (n = 18, 17,1%). A área com maior absorção dos egressos foi a hospitalar (n = 37; 62,7%), o setor público (n=35; 59,3%) e a educação profissional técnica de nível médio (n = 16, 88,9%). 56 (72,7%) estavam insatisfeitos com a renda. 59 (76,6%) indicaram rendimentos incompatíveis com o trabalho. Conclusão A atuação dos egressos enfrenta problemas quanto às políticas atuais, com limites na valorização do trabalhador da saúde e da educação como bem público. Avanços na valorização da profissão do enfermeiro licenciado são necessários, considerando a relevância desse profissional no sistema de saúde e de educação e a natureza de sua práxis de educar e cuidar com potencial transformador.

RESUMEN Objetivo Analizar la inserción laboral de licenciados en enfermería, considerando la conformación actual del trabajo del área de salud y de formación de trabajadores técnicos, en vista de la formación de profesionales actuantes en el SUS. Método Estudio cuantitativo, transversal, exploratorio, con análisis estadístico descriptivo e inferencial por test exacto de Fisher, con 105 graduados de un curso de Licenciatura y Profesorado. Aplicado cuestionario electrónico. Resultados Los graduados actúan como enfermeros (n = 59; 56,2%) y profesores (n = 18; 17,1%). Las áreas con mayor captación de graduados fueron: la hospitalaria (n = 37; 62,7%), el sector público (n = 35; 59,3%) y la educación profesional técnica nivel medio (n = 16; 88,9%). 56 (72,7%) mostraron insatisfacción por sus ingresos. 59 (76,6%) refirieron ingresos incompatibles con el trabajo. Conclusión La actuación de los graduados enfrenta problemas respecto de las políticas actuales, que limitan la valoración del trabajador de salud y de educación como bienes públicos. Son necesarios avances de valoración profesional del enfermero docente, considerando la importancia de estos profesionales en el sistema de salud y educativo, y el carácter de su praxis de educar y cuidar con potencial transformador.

ABSTRACT Objective To analyze the professional insertion of registered nurses, taking into account the current structure of work in the health area and in the training of technical workers, from the perspective of training of professionals who will develop their activities in the Brazilian Unified Health System. Method Quantitative, cross-sectional, and exploratory study, with descriptive and inferential statistical analysis using Fisher's exact test, carried out with 105 alumni of a nursing undergraduate course. An electronic questionnaire was applied. Results The alumni worked as nurses (n = 59, 56.2%) or teachers (n = 18, 17.1%). The areas with the greatest absorption of alumni were hospitals (n = 37, 62.7%), the public sector (n = 35, 59.3%), and high-school level technical professional education (n = 16, 88.9%). Most participants were dissatisfied with their income (n = 56, 72.7%) and pointed out that the received values were incompatible with the work (n = 59, 76.6%). Conclusion The alumni faced problems in developing their professional activities, especially because of the current policies, which establish limits on the recognition of healthcare workers and education as a public asset. Progress in the recognition of the profession of registered nurse is necessary, given the relevance of these professionals in the health and education systems and the nature of the profession's practice of providing education and care, which have a transformative potential.

Estudo ecológico das tendências de mortalidade em menores de 5 anos em Goiás, 2000­2018 / Ecological study of under-5 mortality trends in Goiás, 2000­2018

Identificar a taxa de mortalidade em crianças menores de 5 anos e descrever sua evolução no estado de Goiás quanto ao componente etário, variáveis sociodemográficas e evitabilidade. Métodos: Trata-se de um estudo ecológico de séries temporais utilizando regressão linear generalizada pelo método de Prais-Winsten para a análise de tendência. Resultados: A correlação das taxas de mortalidade com a cobertura da Estratégia Saúde da Família foi verificada pelo coeficiente de correlação de Pearson. O estado de Goiás apresentou tendência decrescente na taxa de mortalidade em crianças menores de 5 anos, com variação percentual anual de -1,6% (IC95% -1,8%­ -0,9%) e correlação negativa com a cobertura da Estratégia Saúde da Família (r=-0,193; p=0,023). Conclusão: As séries das taxas por evitabilidade e subgrupos de causas evitáveis foram decrescentes, com exceção dos óbitos reduzíveis por adequada atenção à mulher na gestação. Prevaleceram óbitos por causas evitáveis, sugerindo necessidade de melhorias na assistência materno-infantil.

Objective: To identify the mortality rate in children under 5 years old and describe its evolution in the state of Goiás in regard to the component of age, sociodemographic variables, and preventability. Methodology: This is an ecological time series study using generalized linear regression via the Prais-Winsten method for trend analysis. Results: The correlation between mortality rates and the coverage of the Estratégia de Saúde da Família (Family Health Strategy) was verified by the Pearson correlation coefficient. The state of Goiás showed a decreasing trend in the mortality rate in children under 5 years old, with an annual percentage change of -1.6% (95%CI -1.8%­ -0.9%) and a negative correlation with Family Health Strategy coverage (r=-0.193; p=0.023). Conclusion: The rates for preventability and subgroups of preventable causes were decreasing, except for deaths that can be prevented with adequate care for women during pregnancy. Deaths from preventable causes prevailed, suggesting the need for improvements in maternal and childcare.

Analysis of the factors related to academic disapproval in the education of nurses: A mixed-method study / Análise dos fatores relacionados à reprovação acadêmica na formação do enfermeiro: estudo de método misto / Análisis de los factores relacionados con la reprobación académica en la educación de Enfermería: un estudio de método mixto

Objective: to evaluate the frequency and factors associated to disapproval among nursing students. Method: a descriptive and cross-sectional study, outlined by the convergent mixed method. A total of 88 nursing students of a Brazilian public university took part. The Reduced Academic Experiences Questionnaire was used for evaluating academic adaptation. The association of the variables in the study with disapproval was verified by bivariate analysis. Results: the frequency of disapprovals in the sample was 68.2%, recurrences in the same discipline in 39.8%, with the associated factors: age over or equal to 22 years old (p=0.015), family income below 2 minimum wages (p=0.019) and lag in the curricular flow (p<0.001). Disciplines with higher frequencies of disapprovals are of the basic area, taught in the first two years of the course and common to the health courses. Students without disapprovals had better perception of physical and psychological well-being (p=0.002), good interpersonal relationships (p=0.017) and more assertive study behaviors (p=0.005). Personal, study-related and institutional issues were motivating. Conclusion: the results reveal a high rate of disapproval, especially in the basic area. An association was found between disapprovals and mental health for nursing students during their education process, and difficulties were pointed out that can culminate with the disapproval rate in the curricular flow.

Objetivo: avaliar a frequência e fatores associados à reprovação entre estudantes de enfermagem. Método: estudo descritivo, transversal, delineado pelo método misto convergente. Participaram 88 estudantes de enfermagem de uma universidade pública brasileira. Para avaliação da adaptação acadêmica utilizou-se o Questionário de Vivências Acadêmicas Reduzido. A associação das variáveis do estudo com a reprovação foi verificada por análise bivariada. Resultados: a frequência de reprovações na amostra foi de 68,2%, reincidentes na mesma disciplina em 39,8%, com os fatores associados: idade maior ou igual a 22 anos (p=0,015), renda familiar inferior a 2 salários mínimos (p=0,019) e defasagem no fluxo curricular (p<0,001). Disciplinas com maiores frequências de reprovações são da área básica, ministradas nos dois primeiros anos do curso e comuns aos cursos da saúde. Estudantes sem reprovações apresentaram melhor percepção de bem-estar físico e psicológico (p=0,002), bom relacionamento interpessoal (p=0,017) e comportamentos de estudo mais assertivos (p=0,005). Questões pessoais, relacionadas ao estudo e institucionais foram motivadores apontados. Conclusão: os resultados revelam alto índice de reprovações, sobretudo na área básica. Foi encontrada associação entre reprovações e saúde mental dos estudantes de enfermagem durante seu processo de formação, e foram apontadas dificuldades que podem culminar com a taxa de insucesso no fluxo curricular.

Objetivo: evaluar la frecuencia y los factores asociados a la reprobación entre estudiantes de Enfermería. Método: estudio descriptivo y transversal, delineado por el método mixto convergente. Participaron 88 estudiantes de Enfermería de una universidad pública brasileña. Para evaluar la adaptación académica se utilizó el Cuestionario de Experiencias Académicas Reducidas. La asociación de las variables de estudio con la reprobación se verificó mediante análisis bivariado. Resultados: la frecuencia de reprobaciones en la muestra fue del 68,2%, siendo el 39,8% recurrente en la misma asignatura, con los siguientes factores asociados: edad mayor o igual a 22 años (p=0,015), ingreso familiar por debajo de 2 salarios mínimos (p=0,019) y desfase en el flujo curricular (p<0,001). Las asignaturas con mayor frecuencia de reprobación se encuentran en el campo básico, se imparten en los dos primeros años del curso y son comunes a los cursos de salud. Los estudiantes sin reprobaciones tuvieron una mejor percepción del bienestar físico y psicológico (p=0,002), buenas relaciones interpersonales (p=0,017) y conductas de estudio más asertivas (p=0,005). Cuestiones personales, relacionadas con el estudio e institucionales fueron motivadores señalados. Conclusión: los resultados muestran un elevado índice de reprobaciones, especialmente en el campo básico. Se encontró una asociación entre reprobaciones y la salud mental de los estudiantes de Enfermería durante su proceso de formación, y se señalaron dificultades que pueden culminar en el índice de reprobaciones en el flujo curricular.