Parametrização dos alarmes de frequência respiratória em ventiladores mecânicos de pacientes durante o banho / Parameterization of respiratory rate alarms in mechanical ventilators of patients during the bath / Parametrización de las alarmas de frecuencia respiratoria en ventiladores mecánicos de pacientes durante el baño

RESUMO Objetivo: medir os efeitos da parametrização dos alarmes sonoros de frequência respiratória dos ventiladores mecânicos para redução do número de alarmes disparados durante o banho no leito. Método: ensaio clínico pragmático, para comparar o número de alarmes do ventilador mecânico nos grupos: intervenção - os alarmes de Frequência Respiratória foram parametrizados no início do banho; controle - não realizada parametrização. Estudo registrado em 27/08/2019 no Registro Brasileiro de Ensaios Clínicos, RBR-6y6tyc, Rio de Janeiro, Brasil. Resultados: os modelos de regressão evidenciaram que a parametrização, realizada e mantida durante e após o banho no grupo intervenção, teve o efeito de aumentar 12,5 e 6,4 vezes, respectivamente, o número médio de disparos de alarmes de frequência respiratória alta; e não teve efeito nos alarmes de frequência respiratória baixa. Conclusão: a contribuição deste estudo é auxiliar os profissionais de saúde na formulação de protocolos de parametrização individualizada dos alarmes dos Ventiladores Mecânicos.

ABSTRACT Objective: to measure the effects of parameterizing the audible respiratory rate alarms of mechanical ventilators to reduce the number of alarms triggered during bed bath. Method: pragmatic clinical trial, to compare the number of alarms of the mechanical ventilator, in the groups: intervention - the Respiratory Rate alarms were parameterized at the beginning of the bath; control - no parameterization performed. Study registered on 27/08/2019 in the Brazilian Registry of Clinical Trials, RBR-6y6tyc, Rio de Janeiro, Brazil. Results: Regression models showed that parameterization, performed and maintained during and after bath in the intervention group, had the effect of increasing the average number of high respiratory rate alarm triggers by 12.5 and 6.4 times, respectively; and had no effect on low respiratory rate alarms. Conclusion: The contribution of this study is to assist health professionals in formulating protocols for individualized parameterization of alarms for Mechanical Ventilators.

RESUMEN Objetivo: medir los efectos de la parametrización de las alarmas sonoras de frecuencia respiratoria de los ventiladores mecánicos para reducir el número de alarmas disparadas durante el baño en cama. Método: ensayo clínico pragmático, para comparar el número de alarmas del ventilador mecánico en los grupos: intervención - se parametrizaron las alarmas de Frecuencia Respiratoria al inicio del baño; control - no se realizó parametrización. Estudio registrado el 27/08/2019 en el Registro Brasileño de Ensayos Clínicos, RBR-6y6tyc, Río de Janeiro, Brasil. Resultados: Los modelos de regresión mostraron que la parametrización, realizada y mantenida durante y después del baño en el grupo de intervención, tuvo el efecto de aumentar 12,5 y 6,4 veces, respectivamente, el número medio de disparos de alarmas de frecuencia respiratoria alta; y no tuvo ningún efecto sobre las alarmas de frecuencia respiratoria baja. Conclusión: la contribución de este estudio es ayudar a los profesionales de la salud en la formulación de protocolos para la parametrización individual de las alarmas de los Ventiladores Mecánicos.

Parametrização dos alarmes de frequência respiratória em ventiladores mecânicos de pacientes durante o banho / Parameterization of respiratory rate alarms in mechanical ventilators of patients during the bath / Parametrización de las alarmas de frecuencia respiratoria en ventiladores mecánicos de pacientes durante el baño

RESUMO Objetivo: medir os efeitos da parametrização dos alarmes sonoros de frequência respiratória dos ventiladores mecânicos para redução do número de alarmes disparados durante o banho no leito. Método: ensaio clínico pragmático, para comparar o número de alarmes do ventilador mecânico nos grupos: intervenção - os alarmes de Frequência Respiratória foram parametrizados no início do banho; controle - não realizada parametrização. Estudo registrado em 27/08/2019 no Registro Brasileiro de Ensaios Clínicos, RBR-6y6tyc, Rio de Janeiro, Brasil. Resultados: os modelos de regressão evidenciaram que a parametrização, realizada e mantida durante e após o banho no grupo intervenção, teve o efeito de aumentar 12,5 e 6,4 vezes, respectivamente, o número médio de disparos de alarmes de frequência respiratória alta; e não teve efeito nos alarmes de frequência respiratória baixa. Conclusão: a contribuição deste estudo é auxiliar os profissionais de saúde na formulação de protocolos de parametrização individualizada dos alarmes dos Ventiladores Mecânicos.

ABSTRACT Objective: to measure the effects of parameterizing the audible respiratory rate alarms of mechanical ventilators to reduce the number of alarms triggered during bed bath. Method: pragmatic clinical trial, to compare the number of alarms of the mechanical ventilator, in the groups: intervention - the Respiratory Rate alarms were parameterized at the beginning of the bath; control - no parameterization performed. Study registered on 27/08/2019 in the Brazilian Registry of Clinical Trials, RBR-6y6tyc, Rio de Janeiro, Brazil. Results: Regression models showed that parameterization, performed and maintained during and after bath in the intervention group, had the effect of increasing the average number of high respiratory rate alarm triggers by 12.5 and 6.4 times, respectively; and had no effect on low respiratory rate alarms. Conclusion: The contribution of this study is to assist health professionals in formulating protocols for individualized parameterization of alarms for Mechanical Ventilators.

RESUMEN Objetivo: medir los efectos de la parametrización de las alarmas sonoras de frecuencia respiratoria de los ventiladores mecánicos para reducir el número de alarmas disparadas durante el baño en cama. Método: ensayo clínico pragmático, para comparar el número de alarmas del ventilador mecánico en los grupos: intervención - se parametrizaron las alarmas de Frecuencia Respiratoria al inicio del baño; control - no se realizó parametrización. Estudio registrado el 27/08/2019 en el Registro Brasileño de Ensayos Clínicos, RBR-6y6tyc, Río de Janeiro, Brasil. Resultados: Los modelos de regresión mostraron que la parametrización, realizada y mantenida durante y después del baño en el grupo de intervención, tuvo el efecto de aumentar 12,5 y 6,4 veces, respectivamente, el número medio de disparos de alarmas de frecuencia respiratoria alta; y no tuvo ningún efecto sobre las alarmas de frecuencia respiratoria baja. Conclusión: la contribución de este estudio es ayudar a los profesionales de la salud en la formulación de protocolos para la parametrización individual de las alarmas de los Ventiladores Mecánicos.

The COVID-19 epidemic in Brazil: how statistics education may contribute to unravel the reality behind the charts.

The world is now facing the most severe health, social, and economic event of the last hundred years, which has made the need to acquire statistical thinking to interpret the information disseminated on a daily basis by the media clear to society. This article proposes a discussion on the role that statistics education might play in supporting the acquisition of such knowledge, contributing to the development of critical citizens, aware of their social responsibility. In this context, we present examples of curves and other charts to demonstrate how to use the several levels defined by experts in reading and interpreting the charts. At a more advanced level, these examples will allow discussion on the impacts of this epidemic on the most vulnerable population in Brazil. The charts presented reveal a great regional inequality, suggesting that mortality due to the virus is distinguished by region and micro-region when considering access to hospital beds. The examples signpost ways for educators to be able to develop projects or research based on the discussion on the reality of the pandemic, the necessary public policies, and how political coordination grounded on science and on a humanitarian vision would have mitigated the Brazilian tragedy.

Matriz de competências para o ensino da homeopatia na graduação médica / Competency matrix for undergraduate medical education in homeopathy

Resumo: Introdução: Currículos médicos de graduação são extremamente carregados em seu conteúdo, tornando-se primordial a necessidade de otimizar competências essenciais. As Diretrizes Curriculares Nacionais (DCN) do Curso de Graduação em Medicina preconizam uma valorização do tratamento do doente que possui muitas interfaces com a homeopatia. Apesar de ser uma especialidade médica no Brasil reconhecida desde 1980, a homeopatia ainda é pouco presente na graduação médica. Objetivo: Este estudo teve como objetivo desenvolver uma matriz de competências essenciais composta de conhecimentos e habilidades desejáveis para o ensino da homeopatia na graduação médica. Métodos: Trata-se de um estudo quanti-qualitativo realizado por meio da técnica Delphi normativa, em duas rodadas, com os docentes especialistas em homeopatia do país. Na primeira rodada, aplicou-se um questionário anônimo on-line para identificar as competências (conhecimentos e habilidades) necessárias em homeopatia para os discentes de graduação em Medicina. Após a análise de conteúdo, os temas foram agrupados nessas duas categorias que retornaram para apuração na segunda rodada, em que os especialistas assinalaram o grau de concordância (escala de Likert de quatro pontos: de não relevante a muito relevante). Para a definição de consenso, adotaram-se dois critérios: índice de De Loe e uma nota de relevância adotada pelos autores com vistas a discriminar mais os graus de consenso. Resultados: Dos 14 temas/subtemas relacionados como competências/conhecimentos, consideraram-se 11 como de alto consenso, dos quais cinco foram avaliados como primordiais, pois obtiveram nota de relevância acima de 9,0 (três relacionados ao grande tema clínica homeopática; um, à teoria e técnica homeopáticas; e outro, à pesquisa homeopática). Em relação às competências/habilidades, oito das 11 foram consideradas de alto consenso, e somente duas alcançaram nota acima de 9,0, ambas relacionadas à clínica homeopática. Conclusão: O ensino da homeopatia pode contribuir para a mudança paradigmática da medicina no sentido de valorizar o doente e promover a saúde, permitindo uma atuação médica mais humanizada e centrada no doente, o que justificaria a adoção de seu ensino, inclusive obrigatório, nas faculdades de Medicina. A elaboração de uma matriz de competências do que deve ser ensinado de homeopatia aos discentes da graduação médica vem ao encontro das DCN e instrumentaliza a reflexão na elaboração de uma futura ementa.

Abstract: Introduction: Undergraduate medical curricula are overloaded with content, making the need to optimize essential skills and knowledge paramount. The National Curricular Guidelines for the medical course (DCNs) put focus on patient treatment, which involves several interfaces with homeopathy. However, despite it being recognized as a medical specialty in Brazil since 1980, homeopathy is rarely present in undergraduate medical education. Objective: To develop a collection of essential skills and knowledge for teaching homeopathy as part of the undergraduate medical curriculum. Methods: Quanti-qualitative study performed using the standard Delphi technique in two rounds with specialized homeopathy teachers from Brazil. An anonymous online questionnaire was conducted to identify the learning competences needed in homeopathy for undergraduate medical students. Following content analysis, the themes and sub-themes were grouped into the two main categories of knowledge and skills, which were returned to the specialists who rated their importance for each item using the "Four-Point Likert Scale" from not at all important to very important. For the purpose of generating a general consensus, two criteria were adopted: the "De Loe index" and a importance score. Results: There was a high degree of consensus regarding eleven of the fourteen themes/sub-themes, five of which were considered essential, with an importance score above 9.0 (three related to the general theme, Homeopathic Clinic, one to Homeopathic Theory and Method and another to Homeopathic Research). There was also a high level of consensus regarding eight of the eleven skills, but only two gained a score of above 9.0, both related to Homeopathic Clinic. Conclusion: The teaching of Homeopathy can contribute to a paradigmatic change in medicine, particularly in the sense of prioritizing the patient and promoting health, as well as allowing for a more humanized and patient-centered medical engagement. These factors would justify the adoption of its teaching, so much so it could be made mandatory across all medical study. The establishment of a "competency matrix" for homeopathy study, which ought to be taught to students of the medical field, meets the DCNs and would be instrumental in future syllabuses.

The influence of nursing activities score on clinical alarms service.

OBJECTIVES: to estimate the magnitude of the Nursing Activities Score effect on multiparametric monitor alarm response and staff response time. METHODS: an observational, cross-sectional study outlined as an open cohort, performed in an Adult General Intensive Care Unit. The time taken for alarms triggered by the multi-parameter monitors was timed and characterized as attended or not. RESULTS: the study obtained a total of 254 alarms triggered from the multiparameter monitors of 63 patients. The mean number of alarms triggered was 4.5 alarms per period/observation and 1.5 alarms/hour. The study showed that the Nursing Activities Score is associated with an additional probability of 4% (p < 0.05) of an alarm being met, for each additional point in the scale, and reduction in team response time. CONCLUSION: it has been verified that Nursing Activities Score has a direct relationship with the attendance and with the response time to the alarms triggered.

Handling errors in conventional and smart pump infusions: A systematic review with meta-analysis.

OBJECTIVE: To identify the scientific evidence on the frequency of handling errors of conventional and smart pump infusions in intravenous insulin therapy in intensive care units. METHOD: A systematic review with meta-analysis conducted in the Virtual Health Library, MEDLINE via PubMed, Scopus and Web of Science databases. Articles were assessed regarding the level of evidence by applying the Oxford Center for Evidence-Based Medicine Evidence Scale. RESULTS: Twelve (12) publications were selected which met the eligibility criteria. The programming error rate using the conventional infusion pump ranged from 10% to 40.1%, and the smart pump technology error rate ranged from 0.3 to 14%. The meta-analysis of two studies favored the smart pump in reducing the relative risk of programming errors by 51%. CONCLUSION: Based on selected articles, the smart pump reduces the risk of programming errors.

Handling errors in conventional and smart pump infusions: A systematic review with meta-analysis / Errores de manejo en la bomba de infusión convencional y smart pump: revisión sistemática con metaanálisis / Erros de manuseio na bomba de infusão convencional e smart pump: revisão sistemática com metanálise

Abstract Objective: To identify the scientific evidence on the frequency of handling errors of conventional and smart pump infusions in intravenous insulin therapy in intensive care units. Method: A systematic review with meta-analysis conducted in the Virtual Health Library, MEDLINE via PubMed, Scopus and Web of Science databases. Articles were assessed regarding the level of evidence by applying the Oxford Center for Evidence-Based Medicine Evidence Scale. Results: Twelve (12) publications were selected which met the eligibility criteria. The programming error rate using the conventional infusion pump ranged from 10% to 40.1%, and the smart pump technology error rate ranged from 0.3 to 14%. The meta-analysis of two studies favored the smart pump in reducing the relative risk of programming errors by 51%. Conclusion: Based on selected articles, the smart pump reduces the risk of programming errors.

Resumen Objetivo: Identificar las evidencias acerca de la frecuencia de errores en el manejo de las bombas de infusión convencional y smart pump en la terapia insulínica intravenosa en unidades de cuidados intensivos. Método: Revisión sistemática con metaanálisis llevada a cabo en las bases de datos Biblioteca Virtual de Saúde, MEDLINE por vía PubMed, Scopus y Web of Science. Los artículos fueron evaluados en cuanto al nivel de evidencia por la aplicación de la Escala de Evidencia del Oxford Centre for Evidence-Based Medicine. Resultados: Se seleccionaron 12 publicaciones que atendieron los criterios de elegibilidad. El índice de errores de programación utilizando la bomba de infusión convencional varió del 10% al 40,1% y en la tecnología smart pump varió del 0,3% al 14%. El metaanálisis de dos estudios fue favorable a la smart pump en la reducción del riesgo relativo de errores de programación en el 51%. Conclusión: Considerando como base los artículos seleccionados, la smart pump reduce el riesgo de errores de programación.

Resumo Objetivo: Identificar as evidências científicas acerca da frequência de erros no manuseio das bombas de infusão convencional e smart pump na terapia insulínica intravenosa em unidades de cuidados intensivos. Método: Revisão sistemática com metanálise realizada nas bases de dados Biblioteca Virtual de Saúde, MEDLINE via PubMed, Scopus e Web of Science. Os artigos foram avaliados quanto ao nível de evidência pela aplicação da Escala de Evidência do Oxford Centre for Evidence-Based Medicine. Resultados: Foram selecionadas 12 publicações que atenderam aos critérios de elegibilidade. A taxa de erros de programação usando a bomba de infusão convencional variou de 10% a 40,1% e na tecnologia smart pump variou de 0,3 a 14%. A metanálise de dois estudos foi favorável a smart pump na redução do risco relativo de erros de programação em 51%. Conclusão: Considerando como base os artigos selecionados, a smart pump reduz o risco de erros de programação.

The influence of nursing activities score on clinical alarms service / La influencia de la nursing activities score en el servicio de alarmas clínicas / A influência do nursing activities score no atendimento aos alarmes clínicos

ABSTRACT Objectives: to estimate the magnitude of the Nursing Activities Score effect on multiparametric monitor alarm response and staff response time. Methods: an observational, cross-sectional study outlined as an open cohort, performed in an Adult General Intensive Care Unit. The time taken for alarms triggered by the multi-parameter monitors was timed and characterized as attended or not. Results: the study obtained a total of 254 alarms triggered from the multiparameter monitors of 63 patients. The mean number of alarms triggered was 4.5 alarms per period/observation and 1.5 alarms/hour. The study showed that the Nursing Activities Score is associated with an additional probability of 4% (p < 0.05) of an alarm being met, for each additional point in the scale, and reduction in team response time. Conclusion: it has been verified that Nursing Activities Score has a direct relationship with the attendance and with the response time to the alarms triggered.

RESUMEN Objetivos: estimar la magnitud del efecto del Nursing Activities Score en la atención a las alarmas de los monitores multiparamétricos y en el tiempo de respuesta del equipo. Métodos: estudio observacional, seccional delineado como una cohorte abierta, realizado en una Unidad de Terapia Intensiva General de Adultos. El tiempo hasta la atención de las alarmas disparadas de los monitores multiparamétricos fue cronometrado y caracterizados como atendidos o no. Resultados: el estudio obtuvo un total de 254 alarmas disparadas de los monitores multiparamétricos de 63 pacientes. El promedio de alarmas disparadas fue de 4,5 alarmas por período/observación y 1,5 alarmas/hora. El estudio demostró que el Nursing Activities Score está asociado a una probabilidad adicional de 4% (p < 0,05) de una alarma ser atendida, para cada punto adicional en la escala, y reducción en el tiempo de respuesta del equipo. Conclusiones: se verificó que Nursing Activities Score tiene relación directa con la atención y con el tiempo de respuesta a las alarmas disparadas.

RESUMO Objetivos: estimar a magnitude do efeito do Nursing Activities Score no atendimento aos alarmes dos monitores multiparamétricos e no tempo de resposta da equipe. Métodos: estudo observacional, seccional delineado como coorte aberta, realizado em uma Unidade de Terapia Intensiva geral de adultos. O tempo até o atendimento dos alarmes disparados dos monitores multiparamétricos foi cronometrado e caracterizado como atendido ou não. Resultados: o estudo obteve um total de 254 alarmes disparados dos monitores multiparamétricos de 63 pacientes. A média de alarmes disparados foi de 4,5 alarmes por período/observação e 1,5 alarmes/hora. O estudo demonstrou que o Nursing Activities Score está associado a uma probabilidade adicional de 4% (p < 0,05) de um alarme ser atendido, para cada ponto adicional na escala, e redução no tempo de resposta da equipe. Conclusões: verificou-se que Nursing Activities Score possui relação direta com o atendimento e com o tempo de resposta aos alarmes disparados.

Avaliação da qualidade do sono de pós-graduandos de enfermagem / Evaluation of sleep quality of post-graduation nursing students

Objetivo: avaliar a qualidade e a duração do sono de enfermeiros pós-graduandos de mestrado e doutorado. Método: trata-se de um estudo quantitativo, descritivo, de natureza observacional e analítica, com amostra constituída por conveniência, com 32 estudantes que preencheram o questionário Índice de Qualidade do Sono de Pittsburgh (PSQI), a escala de Sonolência de Epworth (ESE), avaliando-se a atividade e a vigília pela actigrafia. Realizou-se o Teste t e de Wilcoxon para verificar se existiam diferenças entre a qualidade de sono, os níveis de sonolência excessiva e as medidas do actígrafo. Analisaram-se as diferenças significativas das variáveis qualitativas pelo teste Qui-quadrado e apresentaram-se os resultados em forma de tabelas. Resultados: exibiram-se, por 68,75% dos participantes, distúrbios do sono (PSQI> 5). Constatou-se o tempo total de sono com média de 368,8 minutos, sendo menor em quem faz uso de álcool (p=0.01). Conclusão: devem-se educar, a partir disso, os pós-graduandos sobre a importância da duração adequada do sono para a prevenção de riscos.(AU)

Objective: to evaluate the duration and quality of sleep of post-graduate nurses (Masters and Doctorate students). Method: this is a quantitative, descriptive, observational and analytical study with a convenience sample of 32 students who completed the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS), evaluating the activity and wakefulness by the actigraphy. The Wilcoxon test and the Student's Ttest were performed to verify if there were differences among sleep quality, levels of excessive drowsiness and measures of the actigraph. It was analyzed the significant differences of the qualitative variables by the Chi-square test and presented the results in the form of tables. Results: sleep disorders (PSQI> 5) were present in 68.75% of the participants. The total time of sleep was 368.8 minutes, being lower in those who drank alcoholic beverages (p = 0.01). Conclusion: post-graduate students should be educated about the importance of adequate sleep duration for prevention of future problems.(AU)

Objetivo: evaluar la calidad y la duración del sueño de enfermeros post graduados de maestría y doctorado. Método: es un estudio cuantitativo, descriptivo, de naturaleza observacional y analítica, con muestra constituida por conveniencia, con 32 estudiantes que llenaron el cuestionario Índice de Calidad del Sueño de Pittsburgh (PSQI), la escala de Sonolencia de Epworth (ESE ), evaluándose la actividad y la vigilia por la actigrafía. Se realizó la prueba t y de Wilcoxon para verificar si existían diferencias entre la calidad del sueño, los niveles de somnolencia excesiva y las medidas del actígrafo. Se analizaron las diferencias significativas de las variables cualitativas por el test Chi-cuadrado y se presentaron los resultados en forma de tablas. Resultados: se exhibieron, por el 68,75% de los participantes, disturbios del sueño (PSQI> 5). Se constató el tiempo total de sueño con promedio de 368,8 minutos, siendo menor en quien hace uso de alcohol (p = 0.01). Conclusión: se debe educar, a partir de eso, a los postgraduados sobre la importancia de la duración adecuada del sueño para la prevención de riesgos. Descriptores: Sueño; Estudiantes de Enfermería; Trastornos del Sueño-Vigilia; actigrafía; Trastornos del inicio y del mantenimiento del sueño; Enfermería.(AU)

The representation of getting ill in adolescents with systemic lupus erythematosus.

INTRODUCTION: This study, developed in a federal hospital in the city of Rio de Janeiro, has aimed to analyze the social representation of chronic disease and its treatment, in the perspective of adolescents and their caregivers. METHODS: The sample consisted of 31 adolescents (11-21 years) with systemic lupus erythematosus and 19 caregivers (32-66 years), followed in the pediatrics and in the internal medicine outpatient clinics for a period of six months. Data was collected from the free association of words test, using chronic disease and treatment of chronic disease impulses, and later submitted to the Multiple Correspondence Analysis using the R software. RESULTS: The group of adolescents associated the impulse chronic disease with the words medication, bad, illness, difficulty, no cure, faith and joy; and in the group of caregivers, to care, treatment, no cure and the word 'no'. The impulse treatment of chronic disease was associated, in the group of adolescents, with the words patience, improvement, help, affection, care and bad; and in the group of caregivers, to caring, hope, schedule, knowledge, obedience, medication, professional and improvement. Caregivers also associated impulses and words according to age: chronic disease was associated with the word care (over 61 years), pain and impotence (42-61 years), treatment (22-41 years); and treatment of chronic disease, with the words strength (over 61 years), professional, knowledge and improvement (42-61 years), affection and schedule (22-41 years). CONCLUSIONS: Considering as subjective and dynamic the experience of getting ill, knowing the representations can contribute to the orientation of conduct and type of psychotherapeutic intervention needed.

The representation of getting ill in adolescents with systemic lupus erythematosus / A representação do adoecer em adolescentes com lúpus eritematoso sistêmico

ABSTRACT Introduction: This study, developed in a federal hospital in the city of Rio de Janeiro, has aimed to analyze the social representation of chronic disease and its treatment, in the perspective of adolescents and their caregivers. Methods: The sample consisted of 31 adolescents (11–21 years) with systemic lupus erythematosus and 19 caregivers (32–66 years), followed in the pediatrics and in the internal medicine outpatient clinics for a period of six months. Data was collected from the free association of words test, using chronic disease and treatment of chronic disease impulses, and later submitted to the Multiple Correspondence Analysis using the R software. Results: The group of adolescents associated the impulse chronic disease with the words medication, bad, illness, difficulty, no cure, faith and joy; and in the group of caregivers, to care, treatment, no cure and the word ‘no’. The impulse treatment of chronic disease was associated, in the group of adolescents, with the words patience, improvement, help, affection, care and bad; and in the group of caregivers, to caring, hope, schedule, knowledge, obedience, medication, professional and improvement. Caregivers also associated impulses and words according to age: chronic disease was associated with the word care (over 61 years), pain and impotence (42–61 years), treatment (22–41 years); and treatment of chronic disease, with the words strength (over 61 years), professional, knowledge and improvement (42–61 years), affection and schedule (22–41 years). Conclusions: Considering as subjective and dynamic the experience of getting ill, knowing the representations can contribute to the orientation of conduct and type of psychotherapeutic intervention needed.

RESUMO Introdução: Esse estudo, feito em um hospital federal na cidade do Rio de Janeiro, teve por objetivo analisar a representação social da doença crônica e de seu tratamento, na perspectiva de adolescentes e de seus cuidadores. Métodos: A amostra consistiu de 31 adolescentes (11–21 anos) com lúpus eritematoso sistêmico e 19 cuidadores (32–66 anos), seguidos em serviços pediátricos e de clínica médica durante seis meses. Foram coletados dados com a aplicação do Teste de Associação Livre de Palavras, com o uso dos impulsos doença crônica e tratamento da doença crônica, mais tarde submetidos à Análise de Correspondência Múltipla com o uso do programa de computador R. Resultados: O grupo de adolescentes associou o impulso doença crônica com as palavras remédio, ruim, doença, dificuldade, sem cura, fé, e alegria; e o grupo de cuidadores com as palavras carinho, tratamento, sem cura, e com a palavra “não”. O impulso tratamento da doença crônica foi associado, no grupo de adolescentes, com as palavras paciência, melhoria, ajuda, afeto, carinho e ruim; e, no grupo dos cuidadores, com as palavras carinho, esperança, horário, conhecimento, obediência, remédio, profissional e melhoria. Os cuidadores também associaram os impulsos e palavras de acordo com a faixa etária: doença crônica foi associado à palavra carinho (> 61 anos), dor e impotência (42–61 anos), tratamento (22–41 anos); e tratamento da doença crônica foi associado às palavras força (> 61 anos), profissional, conhecimento e melhoria (42–61 anos), afeto e horário (22–41 anos). Conclusões: Considerando a experiência do adoecer como subjetiva e dinâmica, o conhecimento das representações pode contribuir para a orientação da conduta e tipo de intervenção psicoterapêutica necessária.

Caracterização do envelhecimento populacional no município do Rio de Janeiro: contribuições para políticas públicas sustentáveis / Demographic aging characterization in the city of Rio de Janeiro: contributions to sustainable public policies

Resumo Objetivo Descrever o estágio do envelhecimento populacional no município do Rio de Janeiro. Métodos Estudo ecológico tendo como unidades de observação os 160 bairros que compõem o município, utilizando indicadores sociais e demográficos construídos a partir de informações do Censo 2010. Realizou-se análise exploratória por meio de mapas temáticos e determinou-se a dependência espacial pelo Índice de Moran Global. Para agrupar bairros em estágios semelhantes do envelhecimento foi realizada uma análise de agrupamento a partir do método K-means. Resultados Encontraram-se três grupos de bairros em estágios diferentes de envelhecimento populacional, identificando-se uma tendência espacial no sentido oeste-leste com os bairros da “Zona Sul” se encontrando no estágio mais avançado de envelhecimento. Conclusão O estudo identificou as diferenças no processo de envelhecimento populacional e na composição etária dos bairros, apontando para a necessidade de políticas de saúde pública específicas que contemplem as particularidades desse processo em cada localidade, visando garantir um envelhecimento sustentável.

Abstract Objective Describe the stage of population aging in the city of Rio de Janeiro. Methods Ecological study with the 160 city neighborhoods as observational units, using social and demographic indicators built with information from the 2010 census. The exploratory analysis was undertaken with thematic maps, and the spatial dependence was measured with the Global Moran’s Index. K-means clustering was used for grouping neighborhoods with similar aging stages. Results Three neighborhood clusters in different stages of population aging were found and a spatial trend in the west-east direction was identified, with neighborhoods in the ‘South Zone’ in a more advanced stage of population aging. Conclusion The study identified differences in the population aging process and in the age composition of neighborhoods, indicating the need for specific public health policies that allow for the particularities of this process in each location, aiming a sustainable population aging.

Análise de sobrevivência: teoria e aplicações em saúde / Survival analysis: theory and applications in health

O objetivo apoiar o desenvolvimento metodológico em análise de dados longitudinais, através da aplicação, teste e disseminação de métodos estatísticos inovadores no contexto da saúde, particularmente os voltados para a análise de sobrevida

Factors associated with time to acquisition of bloodstream infection in a pediatric intensive care unit.

OBJECTIVE: To evaluate the risk factors that influence time to acquisition of a laboratory-confirmed bloodstream infection (LCBI). DESIGN: Prospective cohort study with an 18-month follow-up. SETTING: A 16-bed medical and/or surgical pediatric intensive care unit that cares for patients of the Brazilian Public Health System exclusively. PATIENTS: We included children from 0 to 18 years old who were represented by 875 consecutive admissions to the pediatric intensive care unit from January 1, 2005, through June 30, 2006. The children from all but 5 (0.6%) of the admissions were followed up until discharge or death. The majority (506 [58.2%]) were hospitalized for surgical pathology, and 254 (29.2%) underwent heart surgery. METHODS: We used a standardized questionnaire and data collection from daily charts. Information on risk factors was collected before the onset of first LCBI. Survival analysis was performed using the Kaplan-Meier method. The effect of the variables on the risk of LCBI each day was estimated through a Cox model fitting. RESULTS: Fifty-seven children (6.6%) developed an LCBI, 54 (94.7%) of whom made use of a central venous catheter. LCBI incidence was 11.27 episodes/1,000 patient-days and 17.92 episodes/1,000 patient-days when associated with a central venous catheter. Factors associated with time to the first LCBI in the Cox model were age less than 2 years (hazard ratio [HR], 1.99; 95% confidence interval [CI], 1.02-3.89), malnutrition (HR, 1.74; 95% CI, 1.01-3.00), use of a central venous catheter (HR, 4.36; 95% CI, 1.30-14.64), use of antibiotics before admission (HR, 0.58; 95% CI, 0.33-0.98), and use of transfused blood products (HR, 0.40; 95% CI, 0.22-0.74). CONCLUSION: Factors associated with time to acquisition of LCBI were age less than 2 years, weight-for-age z score less than -2, and the use of a central venous catheter. Therefore, intensification of LCBI prevention efforts in patients with these characteristics is fundamental.

Risk factors for healthcare-associated infection in a pediatric intensive care unit.

OBJECTIVE: Identify risk factors for first-onset healthcare-associated infection (HAI) in a pediatric intensive care unit (PICU). DESIGN: Prospective cohort study. SETTING: Medical-surgical PICU in a hospital for patients in the public healthcare system. PATIENTS: From January 2005 to June 2006, daily surveillance was carried out on 870 patients ages 0 to 18 yrs during their stay in the PICU through to 48 hrs after discharge (5773 patient-days). MEASUREMENTS AND MAIN RESULTS: In 256 admissions, there were 363 episodes of HAI, with a cumulative incidence of 41.7% and a density of 62.9 of 1000 patient-days. Intrinsic and extrinsic factors were investigated and measured until occurrence of first-onset HAI (diagnosed according to Nosocomial Infection Surveillance System criteria) or until discharge or death. In the multivariate logistic regression analysis, risk factors for first-onset HAI in the PICU (controlled for length of stay) were as follows: age under 2 years (odds ratio [OR]), 1.80; 95% confidence interval [CI]), 1.30-2.49); days on ventilator duration (OR, 1.16; 95% CI, 1.08-1.25); transfused blood products (OR, 1.49; 95% CI, 1.08-2.06), glucocorticoids (OR, 1.45; 95% CI, 1.04-2.02) and H2 blockers (OR, 1.47; 95% CI, 1.05-2.06). CONCLUSIONS: Efforts toward a reduction in the exposure to extrinsic risk factors should be made, as each of these factors separately explains 30% of the risk of HAI. Interventions directed at processes related to the use of a ventilator and limitations on its duration of use should be a priority in HAI control strategies, as each day of ventilator use increases the risk of HAI.

[Stroke prevalence among the elderly in Vassouras, Rio de Janeiro State, Brazil, according to data from the Family Health Program]. / Prevalência de acidente vascular cerebral em idosos no Município de Vassouras, Rio de Janeiro, Brasil, através do rastreamento de dados do Programa Saúde da Família.

This study estimated the prevalence of stroke among the elderly in Vassouras, Rio de Janeiro State, Brazil, based on data from the Family Health Program (FHP). The elderly population was chosen since it is growing as a proportion of the general population, and since stroke risk increases with age. Data were screened for all the elderly registered in the FHP in Vassouras, identifying those with a history of stroke and analyzing their socio-demographic profile. The study used data from the Information System on Primary Care, the population census conducted by the Brazilian Institute of Geography and Statistics (IBGE), and the Ministry of Health's standardized FHP patient form. Quality of stroke diagnoses in the FHP was analyzed. Data screening detected 122 elderly with a history of stroke diagnosis (prevalence = 2.9%; 3.2% in men, 2.7% in women) and a progressive increase with age. The prevalence rate was the same in the rural and urban area of the municipality (2.9%). Knowledge of stroke prevalence in the elderly population is essential to improve health planning.

Prevalência de acidente vascular cerebral em idosos no Município de Vassouras, Rio de Janeiro, Brasil, através do rastreamento de dados do Programa Saúde da Família / Stroke prevalence among the elderly in Vassouras, Rio de Janeiro State, Brazil, according to data from the Family Health Program

O estudo estimou a prevalência de acidente vascular cerebral (AVC) em idosos em Vassouras, Rio de Janeiro, Brasil, pelo rastreamento de dados do Programa Saúde da Família (PSF). A população idosa foi escolhida por seu aumento no Brasil e pelo risco do AVC aumentar com a idade. Foram rastreados todos os idosos de Vassouras cadastrados no PSF, identificando os acometidos por AVC e analisando o seu perfil sócio-demográfico. Foram utilizados os dados do Sistema de Informação e Atenção Básica, do censo populacional do Instituto Brasileiro de Geografia e Estatística e a ficha de atendimento padronizada pelo PSF, do Ministério da Saúde. Avaliou-se a qualidade dos diagnósticos de AVC do PSF. No rastreamento, foram encontrados 122 idosos com diagnóstico de AVC, com prevalência de 2,9 por cento, e aumento progressivo com o avançar da idade, sendo a prevalência nos homens (3,2 por cento) maior do que nas mulheres (2,7 por cento). A taxa de prevalência foi igual tanto na zona rural quanto na zona urbana (2,9 por cento). O conhecimento da magnitude da prevalência do AVC na população idosa é fundamental para melhor planejamento de saúde.

This study estimated the prevalence of stroke among the elderly in Vassouras, Rio de Janeiro State, Brazil, based on data from the Family Health Program (FHP). The elderly population was chosen since it is growing as a proportion of the general population, and since stroke risk increases with age. Data were screened for all the elderly registered in the FHP in Vassouras, identifying those with a history of stroke and analyzing their socio-demographic profile. The study used data from the Information System on Primary Care, the population census conducted by the Brazilian Institute of Geography and Statistics (IBGE), and the Ministry of Health's standardized FHP patient form. Quality of stroke diagnoses in the FHP was analyzed. Data screening detected 122 elderly with a history of stroke diagnosis (prevalence = 2.9 percent; 3.2 percent in men, 2.7 percent in women) and a progressive increase with age. The prevalence rate was the same in the rural and urban area of the municipality (2.9 percent). Knowledge of stroke prevalence in the elderly population is essential to improve health planning.

[A methodology to estimate incidence from prevalence rates in household surveys: the example of literacy]. / Uma metodologia para estimar a incidência a partir de prevalências obtidas em Pesquisas Nacionais por Amostra de Domicílios: o exemplo da alfabetização.

Age and time-specific incidence rates are highly relevant to epidemiologists. Due to the mathematical relationship between incidence and prevalence, several methods have been developed to obtain incidence based on prevalence. The present study didactically describes a method to estimate age and time incidence, based on: repeated measurements of prevalence for an event; events related to the individual's age; and events with the characteristics of a chronic disease. The method was used to analyze literacy in the Brazilian population, using prevalence by age obtained from the National Household Sample Survey (PNAD) for 1981, 1985, 1989, 1992, 1995, and 2001, and allowed obtaining literacy incidence estimates for ages 5 to 20 years, for the years 1960 through 2001. The method adjusts incidence parameters for age and time with the help of a generalized linear model for categorical data and uses the EM algorithm to obtain non-observed data.

Effect of predominant breastfeeding duration on infant growth: a prospective study using nonlinear mixed effect models.

OBJECTIVE: The aim of this study is to assess the effect of predominant breastfeeding duration on infant growth by means of repeated measurements model. METHODS: This prospective study is comprised of four follow-up evaluations at approximately 0.5, 2, 6 and 9 months after birth, including structured interviews that simultaneously gathered information regarding infant growth and breastfeeding practices. The study took place in a healthcare center in Rio de Janeiro, Brazil, from 1999 to 2001. Four hundred seventy-nine postpartum women and their newborns were enrolled in the cohort. Body weight and length measurements taken at five different occasions (birth, 0.5, 2, 6, and 9 months) constituted the dependent variables. We expressed the growth process using nonlinear mixed models. RESULTS: Infants with longer predominant breastfeeding duration, although growing faster in the first months of life, reached an inferior equilibrium body weight and length compared to infants who received nonhuman milk earlier in life. The age at which the rate of weight gain of the formula-fed infants becomes greater than that of the breastfed infants is approximately 6.75 months for boys and 7 months for girls. CONCLUSIONS: This study confirms the differences observed in infant growth according to different breastfeeding practices starting from the sixth month of life. Use of nonlinear models allowed for a greater precision of parameter estimates. We believe that this approach facilitates the analysis and interpretation of growth data at the individual and population levels.

Uma metodologia para estimar a incidência a partir de prevalências obtidas em Pesquisas Nacionais por Amostra de Domicílios: o exemplo da alfabetização / A methodology to estimate incidence from prevalence rates in household surveys: the example of literacy

Conhecer a incidência de algum evento por idade e tempo é sem dúvida um dos maiores interesses da epidemiologia. Devido à relação matemática que existe entre as medidas de incidência e prevalência, alguns métodos foram desenvolvidos com o objetivo de obter a incidência a partir da prevalência. Este estudo descreve, de forma tutorial, um método que fornece estimativas de incidências por idade e tempo desde que existam prevalências repetidas de um evento, que a ocorrência do mesmo esteja relacionada à idade do indivíduo e que este possua características de uma doença crônica. O estudo foi realizado para a alfabetização da população brasileira, utilizando as prevalências por idade obtidas na Pesquisa Nacional por Amostra de Domicílios (PNAD) 1981, 1985, 1989, 1992, 1995 e 2001, e permitiu recuperar as estimativas da incidência de alfabetização nas idades entre 5 e 20 anos entre os anos de 1960 a 2000. O método ajusta os parâmetros de incidência para idade e tempo com o auxílio de um modelo linear generalizado para dados categóricos e utiliza o algoritmo EM para obter os dados não observados.

Age and time-specific incidence rates are highly relevant to epidemiologists. Due to the mathematical relationship between incidence and prevalence, several methods have been developed to obtain incidence based on prevalence. The present study didactically describes a method to estimate age and time incidence, based on: repeated measurements of prevalence for an event; events related to the individual's age; and events with the characteristics of a chronic disease. The method was used to analyze literacy in the Brazilian population, using prevalence by age obtained from the National Household Sample Survey (PNAD) for 1981, 1985, 1989, 1992, 1995, and 2001, and allowed obtaining literacy incidence estimates for ages 5 to 20 years, for the years 1960 through 2001. The method adjusts incidence parameters for age and time with the help of a generalized linear model for categorical data and uses the EM algorithm to obtain non-observed data.