Effectiveness of a Nursing Educational Intervention in Adults to Promote Control Behaviors Against Dengue: Protocol for a Randomized Controlled Trial.

BACKGROUND: The increase in dengue cases can be attributed to social, demographic, environmental changes, or community-driven factors. In this regard, different strategies have been established in health education, using educational interventions as necessary tools for the reduction of the disease with the aim of reinforcing and stimulating the prevention and control of dengue. OBJECTIVE: This study aims to evaluate the effectiveness of a nursing educational intervention for dengue control. METHODS: A randomized controlled trial will be conducted with adults living in rural areas and participating in health promotion and disease prevention programs. We will enroll 116 adults. Adults will be randomized 1:1, with 58 adults assigned to the educational intervention group and 58 to the usual care group. Participants will receive 4 sessions over the course of a month, 1 week apart, and will be followed up for 1 month after the end of the educational intervention. Nursing Outcome Classification labels will be used to measure the outcomes: risk control (1902) and participation in health care decisions (1606). RESULTS: The participants in the intervention group are expected to achieve better dengue control behaviors than those in the usual care group. CONCLUSIONS: Risk factors are fostered by the community, largely caused by artificial reservoirs or unprotected tanks in homes; also, the lack of information hinders the identification of symptomatology and the poor implementation of effective measures, and the development of standardized educational strategies can contribute to efficient and cost-effective control of the disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT05321264; https://clinicaltrials.gov/study/NCT05321264. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/54286.

Variation of modulation and expression of biomarkers associated with inflammation in bariatric surgery patients: A systematic review and meta-analysis.

BACKGROUND: Bariatric surgery is an effective intervention that causes a series of metabolic changes related to inflammatory processes; however, the variation of biomarkers related to these processes is not entirely understood. Our objective was to investigate the variation of modulation and expression of biomarkers associated with inflammation in patients who underwent bariatric surgery. METHODS: We searched the MEDLINE (via PubMed), EMBASE (via Elsevier), Cochrane Central Register of Controlled Trials, Latin American and Caribbean Literature on Health Sciences (via virtual health library), Cumulative Index to Nursing and Allied Health Literature (via EBSCO), Web of Science core collection, and Scopus (via Elsevier) databases, and the gray literature was examined from inception to January 2022. Three pairs of reviewers performed data screening, extraction, and quality assessment independently. Meta-analysis with random effects models was used for general, subgroup, and sensitivity analyses. The I2 statistic was used to assess heterogeneity between studies. RESULTS: In total, 96 articles were included in this systematic review; of these, 87 studies met the criteria for the meta-analysis, involving 3,533 participants. Five biomarkers were included in the meta-analysis (tumor necrosis factor alpha; interleukin 6; leptin; interleukin 1 beta, and lipopolysaccharides). Only leptin showed a significant decrease in the first month after surgery (mean difference -20.71; [95% confidence interval: -28.10 to -13.32, P < .0001; I2 = 66.7%), with moderate heterogeneity. The 12 months after surgery showed a significant decrease in tumor necrosis factor alpha (mean difference -0.89; [95% confidence interval: -1.37 to -0.42], P = .0002; I2 = 94.7%), interleukin 6 (mean difference -1.62; [95% confidence interval: -1.95 to -1.29], P < .0001; I2 = 94.9%), leptin (mean difference -28.63; [95% confidence interval: -34.02 to -23.25], P < .0001; I2 = 92.7%), and interleukin 1 beta (mean difference -2.46; [95% confidence interval: -4.23 to -0.68], P = .006; I2 = 98.3%), all with high heterogeneity. The type of surgery did not show significant differences for the biomarkers at the first month and 12 months, and the results have not changed with high-quality studies. In the 12-month measurement, variations in tumor necrosis factor alpha and leptin were associated with body mass index. CONCLUSION: The findings of this meta-analysis suggest that Roux-en-Y gastric bypass and sleeve gastrectomy bariatric surgeries are associated with a significant reduction in leptin at 1 month after bariatric surgical intervention and tumor necrosis factor alpha, leptin, and interleukin 1 beta after 12 months.

Associations Between Coronary Artery Calcification and Left Ventricular Global Longitudinal Strain and Diastolic Parameters: the ELSA-Brasil Study.

Atherosclerosis burden can be evaluated in asymptomatic patients by measuring coronary artery calcification (CAC), whereas the global longitudinal strain (GLS) and diastolic function parameters (mitral E/e' ratio, septal e', and lateral e') are used to evaluate subclinical left ventricular (LV) dysfunction. We investigated whether subjects with CAC (CAC >0 Agatston units) would present with an impairment in LV functional parameters. Among the participants of the ELSA-Brasil cohort free of clinically prevalent cardiovascular disease who performed cardiac computed tomography and echocardiography within the study protocol, we tested whether those with CAC >0 presented with worse GLS and diastolic function parameters. CAC >0 was present in 203 of the 612 included participants (33.17%; age 51.4 ± 8.6 years, 52.1% women). Absolute CAC values did not correlate with GLS (ro = 0.07, p = 0.105) but did so with E/e' (ro = 0.19, p <0.001), septal e' (ro = 0.28, p <0.001), and lateral e' (ro = 0.30, p <0.001), with stronger correlations in men. Those with CAC >0 had worse mitral E/e' ratios (7.75 ± 0.13 vs 7.01 ± 0.09; p ≤0.001), septal e' (8.25 ± 0.15 vs 9.59 ± 0.11 cm/s; p <0.001), and lateral e' (10.13 ± 0.20 vs 11.99 ± 0.14 cm/s; p ≤0.001), respectively. However, these associations were not independent of diabetes, obesity, hypertension, smoking, and low-density lipoprotein cholesterol, persisting only as significant associations of CAC >0 with mitral E/e' ratio and septal e' in men. There is an association between subclinical coronary atherosclerosis and impaired LV functional parameters. These associations are more likely attributed to the presence of common cardiovascular risk factors in the general population. However, in men, it seems to exist as an independent association.

Educational Interventions in Adults with Type 2 Diabetes Mellitus in Primary Health Care Settings. A Scoping Review / Intervenciones educativas en adultos con diabetes mellitus tipo 2 en entornos de atención primaria de salud: una revisión de alcance / Intervenções educacionais em adultos com diabetes mellitus tipo 2 em ambientes de atenção primária à saúde: uma revisão de escopo

Objective. To synthesize the evidence of studies with educational interventions for adults with type-2 diabetes mellitus (DM2) in primary health care settings. Methods. A scoping review was conducted following the recommendations by the Joanna Briggs Institute and by the PRISMA declaration. The protocol was registered in INPLASY20215009. The search was carried out in: MEDLINE (via PubMed), EMBASE, Web of Science, LILACS, and grey literature. Results. Seventeen studies were included; most were randomized clinical trials of which 65% were conducted in high-income countries,and all the studies represented 5 656 participants. The results showed four big categories derived from educational interventions: therapeutic adherence (significant results on the satisfaction with the treatment); self-care and self-management in diabetes (improvement in self-efficacy, empowerment, and disease awareness); glycemic control in diabetes (significant results in reducing glycosylated hemoglobin); nursing and its role in the educational interventions on patients with DM2 (guidance in restructuring behaviors). Conclusion. The findings of this review suggest that educational interventions on patients with DM2 within the setting of primary health care can impact positively on therapeutic adherence, self-control, and knowledge of the disease. Moreover, it was possible to identify the influence of multidisciplinary health teams, where the relevance of nursing professionals in the construction and implementation of educational interventions is evidenced in obtaining better health results.

Objetivo. Sintetizar la evidencia de estudios con intervenciones educativas para adultos con diabetes mellitus tipo 2 (DM2) en la atención primaria de salud. Métodos. Se realizó una revisión de alcance siguiendo las recomendaciones del Instituto Joanna Briggs y de la declaración PRISMA. El protocolo se registró en INPLASY20215009. La búsqueda se realizó en: MEDLINE (vía PubMed), EMBASE, Web of Science, LILACS y literatura gris. Resultados. Diecisiete estudios fueron incluidos, la mayoría fueron ensayos clínicos aleatorizados, de estos 65% fueron conducidos en países de ingresos altos, y todos los estudios en total representaron 5656 participantes. Los resultados mostraron cuatro grandes categorías derivadas de las intervenciones educativas: adherencia terapéutica (resultados significativos en la satisfacción con el tratamiento); autocuidado y automanejo en diabetes (mejora en la autoeficacia, empoderamiento y conciencia de la enfermedad); control glucémico en diabetes (resultados significativos en la reducción de la hemoglobina glicosilada); enfermería y su papel en las intervenciones educativas en pacientes con DM2 (orientación en la reestructuración de comportamientos). Conclusión. Los hallazgos de esta revisión sugieren que las intervenciones educativas en pacientes con DM2 en el ámbito de la atención primaria de salud pueden impactar positivamente en la adherencia terapéutica, el autocontrol y el conocimiento de la enfermedad. Además, fue posible identificar la influencia de los equipos multidisciplinarios de salud, donde se evidencia la relevancia de los profesionales de enfermería en la construcción e implementación de intervenciones educativas para la obtención de mejores resultados de salud.

Objetivo. Sintetizar as evidências de estudos sobre intervenções educacionais para adultos com diabetes mellitus tipo 2 (DM2) na atenção primária à saúde. Métodos.Foi realizada uma revisão de escopo seguindo as recomendações do Joanna Briggs Institute e a declaração PRISMA. O protocolo foi registrado no INPLASY20215009. A pesquisa foi realizada em: MEDLINE (via PubMed), EMBASE, Web of Science, LILACS e literatura cinzenta. Resultados. Dezessete estudos foram incluídos, a maioria eram ensaios clínicos randomizados, 65% deles foram conduzidos em países de alta renda e todos os estudos, no total, contaram com 5656 participantes. Os resultados mostraram quatro grandes categorias derivadas das intervenções educacionais: adesão (resultados significativos na satisfação com o tratamento); autocuidado e autogestão da diabetes (melhoria na autoeficácia, fortalecimento e conscientização sobre a doença); controle glicêmico na diabetes (resultados significativos na redução da hemoglobina glicada); enfermagem e seu papel nas intervenções educacionais em pacientes com DM2 (orientação na reestruturação de comportamentos). Conclusão. Os achados desta revisão sugerem que as intervenções educacionais em pacientes com DM2 no ambiente da atenção primária à saúde podem impactar positivamente na adesão, no autogerenciamento e no conhecimento da doença. Além disso, foi possível identificar a influência das equipes multidisciplinares de saúde, onde fica evidente a relevância dos profissionais de enfermagem na construção e implementação de intervenções educacionais para obter melhores resultados de saúde.

The role of environmental pollutants in body composition: Systematic review and meta-analysis.

The effects of environmental pollution are associated with higher rates of mortality, morbidity, and years of life lost. It is known that these produce alterations in the human body, including changes in body composition. Research has focused on the association between contaminants and BMI through cross-sectional studies. The objective of this study was to synthesize the evidence for the association of pollutants on different measures of body composition. The PECOS strategy was defined, in which "P": participants of any age, sex, or ethnicity, "E": a higher level of environmental pollution, "C": a lower level of environmental pollution, "O": body composition measurements and "S": longitudinal studies. Studies from the following databases were included: MEDLINE, EMBASE, SciELO, LILACS, Scopus, Web of Science, SPORTDiscus, and gray literature from inception to January 2023.3069 studies were identified, 18 were included in the systematic review, and 13 in the meta-analysis. These studies included 8.563 people, 47 environmental contaminants, and 16 measures of body composition. The meta-analysis by subgroup found that the association between dioxins, furans, PCBs, and waist circumference was ß = 1.0 (95% CI: 0.85 to 1.16; I2: 95%), and the sum of four skinfolds ß = 1.02 (95% CI: 0.88 to 1.16; I2: 24%). The association between pesticides and waist circumference was ß = 1.00 (95% CI: 0.68 to 1.32; I2: 98%), and the fat mass was ß = 0.99 (95% CI: 0.17 to 1.81; I2: 94%). Pollutants, especially endocrine-disrupting chemicals, among which dioxins, furans, PCBs, and pesticides, are associated with changes in body composition, mainly with waist circumference and the sum of four skinfolds.

Competencia en cuidado espiritual en enfermería: Revisión integrativa de literatura / Spiritual Care Competence in Nursing: Integrative Literature Review

Introducción: El cuidado espiritual puede considerarse un elemento central de la filosofía del cuidado holístico. Objetivo: Identificar investigaciones de intervención con perspectivas y estrategias educativas para el desarrollo de competencias en cuidado espiritual. Materiales y métodos: Revisión de la literatura en el período 2001-2021 de las bases de datos PubMed, ProQuest, Scopus, Lilacs y BVS (Biblioteca Virtual en Salud). Se siguieron las recomendaciones PRISMA y se basaron en parámetros definidos por Whittemore y Knafl para la identificación de problemas, búsqueda bibliográfica, evaluación y análisis de datos. Resultados: se encontraron 10 artículos de intervención publicados. Los entrenamientos relacionados con el desarrollo de habilidades para el cuidado espiritual fueron realizados en programas de formación superior del personal de enfermería. Las estrategias de instrucción son cursos específicos, sesiones cortas o programas a lo largo del plan de estudios. Las intervenciones muestran efectos sobre las habilidades y conocimientos. La espiritualidad individual de los estudiantes predice la capacidad de brindar atención espiritual. Conclusiones: Hay evidencia de estrategias para desarrollar la competencia de estudiantes y profesionales de enfermería en cuidado espiritual, aún son escasas las publicaciones sobre el tema, por lo que se necesitan nuevas y más rigurosas estrategias para desarrollar competencia en este enfoque de la disciplina de enfermería.

Introduction: Spiritual care can be considered a basic component of the philosophy of holistic care. Objective: Identify intervention studies with educational perspectives and strategies for developing spiritual care competencies in nurses and nursing students. Materials and methods: Integrative review of literature conducted in the period 2001-2021, in the databases PubMed, ProQuest, Scopus, LILACS, and VHL (Virtual Health Library). PRISMA statement guidelines were followed for the review, and it was based on Whittemore and Knafl's stages for integrative reviews: problem formulation, literature search, evaluation of data, data analysis, and presentation of results. Results: Ten published intervention articles were found. Education for the development of spiritual care competencies has been provided by educational programs and activities in undergraduate nursing programs and with professional nurses in practice. Instructional strategies include specific courses, short sessions, or programs throughout the curriculum. Interventions have an impact on skills and knowledge. Students' individual spirituality is a predictor of the competence to provide spiritual care. Conclusions: There is evidence of strategies to develop spiritual care competencies in nursing students and professionals, but publications on the subject are scarce. Therefore, implementing new and more rigorous strategies that allow the development of competencies for approaching spirituality in nursing is required.

Introdução: o cuidado espiritual pode ser considerado um componente básico da filosofia do cuidado holístico. Objetivo: determinar estudos de intervenção com perspectivas e estratégias educativas para o desenvolvimento da competência em cuidado espiritual em profissionais e estudantes de enfermagem. Materiais e Métodos: Revisão integrativa da literatura realizada no período de 2001-2021, nas bases de dados PubMed, ProQuest, Scopus, Lilacs e BVS (Biblioteca Virtual em Saúde). As recomendações do PRISMA foram seguidas e baseadas nos parâmetros estabelecidos por Whittemore e Knafl para identificação do problema, busca na literatura, avaliação dos dados, análise dos dados e apresentação dos resultados. Resultados: foram encontrados 10 artigos de intervenção publicados. A educação para o desenvolvimento de competências no cuidado espiritual tem sido realizada a partir de programas e atividades educativas, na graduação e nos profissionais de enfermagem durante sua prática. As estratégias de ensino são cursos específicos, sessões curtas ou programas ao longo do currículo. As intervenções mostram impactos nas habilidades e competências de conhecimento. A espiritualidade individual nos alunos é um preditor da capacidade de fornecer cuidados espirituais. Conclusões: Existem evidências de estratégias para desenvolver competências no cuidado espiritual em enfermagem em estudantes e profissionais, as publicações sobre o assunto são escassas, pelo que é necessária a implementação de estratégias inovadoras e mais rigorosas que permitam o desenvolvimento de competências para a abordagem em Enfermagem.

Intervenciones educativas para la prevención y control del dengue en adultos: una revisión integrativa / Educational interventions for the prevention and control of dengue in adults: An integrative review

Objetivo: Revisar y sintetizar la producción científica de intervenciones educativas para la prevención y control del dengue en adultos. Método: Revisión integrativa de la literatura, protocolo registrado en INPLASY (202170038). La búsqueda fue realizada en MEDLINE, LILACS, Web of Science y EMBASE, sin fecha de inicio y hasta el 31 de marzo de 2021. Se incluyeron estudios de intervención: ensayos clínicos aleatorizados, estudios clúster y cuasiexperimentales. El desenlace evaluado fue la prevención y el control del dengue. Se realizó la evaluación de la calidad metodológica y del nivel de evidencia de los estudios incluidos. Resultados: Se incluyeron 10 estudios con niveles de evidencia entre 1c a 2dm, correspondiente a países de bajos y medianos ingresos de Asia y América. Se evidenció el uso de ayudas didácticas frente a procesos de educación mediante herramientas digitales y se observó un campo de acción por parte de enfermería desde la educación para la salud. Conclusiones: La educación para la salud en escenarios diferentes a los clínicos puede favorecer el empoderamiento por parte de la población para mejorar las conductas de salud. Por otro lado, la utilización de herramientas electrónicas resulta de gran ayuda para evaluar el efecto de una intervención.(AU)

Objective: To review and synthesize the scientific production of educational interventions for the prevention and control of dengue in adults. Method: Integrative literature review, protocol registered in INPLASY (202170038). The search was performed in MEDLINE, LILACS, Web of Science and EMBASE, with no start date until March 31, 2021. Intervention studies were included: randomized clinical trials, cluster and quasi-experimental studies. The outcome evaluated was dengue prevention and control. The evaluation of the methodological quality and the level of evidence of the included studies was carried out. Results: Ten studies were included with levels of evidence between 1c and 2dm, corresponding to low- and middle-income countries in Asia and America. The use of didactic aids was evidenced against educational processes, digital tools, and a field of action by nursing was observed, from health education. Conclusions: Health education in scenarios other than clinical ones can favor empowerment by the population to improve health behaviors. On the other hand, the use of electronic tools is of great help in evaluating the effect of an intervention.(AU)

Brazilian instrument for assessing of eating disorders in children and adolescents / Instrumento brasileño para la evaluación de los trastornos alimentarios en niños y adolescentes

Objective: This study aimed to develop the Brazilian instrument for assessing eating disorders in children and adolescents and test its psychometric quality using item response theory (IRT). Design: Cross-sectional study. Participants: Participants aged between five and twelve years old of both sexes. Main measures: IRT logistic model of two parameters was used to evaluate the item's severity and discrimination and test information curve of symptoms of eating disorders’ latent trait symptoms. Content validity and reliability were also assessed. The IRT evaluation suggested that the instrument contained items that performed differently concerning severity, discrimination, and test information curve presented good accuracy. Results: There was agreement on the clarity of language (83.3%) and theoretical relevance (91.7%), indicating good content validity. The value of the Cronbach's Alpha was 0.63 (95% confidence interval), and the result of the Spearman–Brown test was 0.65. Conclusion: These results indicate good performance of the screening tool in assessing the level of eating disorders in children and adolescents.(AU)

Objetivo: Este estudio tuvo como objetivo desarrollar un instrumento brasileño para la evaluación de los trastornos alimentarios en niños y adolescentes, y testar el análisis psicométrico utilizando la teoría de respuesta al ítem (TRI). Diseño: Estudio observacional, transversal. Participantes: Individuos de ambos sexos entre los 5 y 12 años de edad. Mediciones principales: Se utilizó el modelo logístico TRI de 2 parámetros para evaluar la gravedad y la discriminación del ítem, y probar la curva características del test (CCT) de los síntomas del rasgo latente de los trastornos alimentarios. También se evaluaron la validez de contenido y la confiabilidad. Resultado: La evaluación TRI sugirió que el instrumento contenía ítems que funcionaban de manera diferente en cuanto a severidad, discriminación y la CCT presentando una buena precisión. Hubo concordancia en la claridad del lenguaje (83,3%) y en la relevancia teórica (91,7%), indicando buena validez de contenido. El valor del alfa de Cronbach fue de 0,63 (intervalo de confianza del 95%) y el resultado de la prueba de Spearman-Brown fue de 0,65. Conclusión: Estos resultados indican un buen desempeño de la herramienta de detección en la evaluación del nivel de los trastornos alimentarios en niños y adolescentes.(AU)

Brazilian instrument for assessing of eating disorders in children and adolescents.

OBJECTIVE: This study aimed to develop the Brazilian instrument for assessing eating disorders in children and adolescents and test its psychometric quality using item response theory (IRT). DESIGN: Cross-sectional study. PARTICIPANTS: Participants aged between five and twelve years old of both sexes. MAIN MEASURES: IRT logistic model of two parameters was used to evaluate the item's severity and discrimination and test information curve of symptoms of eating disorders' latent trait symptoms. Content validity and reliability were also assessed. The IRT evaluation suggested that the instrument contained items that performed differently concerning severity, discrimination, and test information curve presented good accuracy. RESULTS: There was agreement on the clarity of language (83.3%) and theoretical relevance (91.7%), indicating good content validity. The value of the Cronbach's Alpha was 0.63 (95% confidence interval), and the result of the Spearman-Brown test was 0.65. CONCLUSION: These results indicate good performance of the screening tool in assessing the level of eating disorders in children and adolescents.

Usefulness of Acceptability and Feasibility Assessment in Studies of Nursing Interventions

Nursing interventions constitute an essential component in the discipline and play a central role in the distinction of the nursing practice with regards to other health professionals. In light of the theory, authors like Burns and Grove,(1) define nursing interventions as deliberate cognitive, physical or verbal activities, which are implemented in individuals and families, seeking therapeutic objectives that contribute to health and wellbeing. In turn, for Sidani and Braden,(2) these are described as treatments, therapies, procedures, or actions developed by health professionals within a specific situation of the patient, for the purpose of modifying current conditions and leading to beneficial health outcomes. These approaches aim, in addition to guiding professional to respond to the needs of individuals and/or families, to move towards evaluating the achievement of the results; for this, structured, systematic and rigorous evaluation processes of the interventions are required.

Educational interventions for the prevention and control of dengue in adults: An integrative review.

OBJECTIVE: To review and synthesize the scientific production of educational interventions for the prevention and control of dengue in adults. METHOD: Integrative literature review, protocol registered in INPLASY (202170038). The search was performed in MEDLINE, LILACS, Web of Science and EMBASE, with no start date until March 31, 2021. Intervention studies were included: randomized clinical trials, cluster and quasi-experimental studies. The outcome evaluated was dengue prevention and control. The evaluation of the methodological quality and the level of evidence of the included studies was carried out. RESULTS: 10 studies were included with levels of evidence between 1c and 2dm, corresponding to low- and middle-income countries in Asia and America. The use of didactic aids was evidenced against educational processes, digital tools, and a field of action by nursing was observed, from health education. CONCLUSIONS: Health education in scenarios other than clinical ones can favor empowerment by the population to improve health behaviors. On the other hand, the use of electronic tools is of great help in evaluating the effect of an intervention.

Diseño, validación e implementación de una intervención personalizada para mejorar la adherencia terapéutica en el adulto con hipertensión arterial / Design, Validation and Implementation of a Tailored Intervention to Improve Therapeutic Adherence in Adults with Arterial Hypertension / Desenvolvimento, validação e implementação de uma intervenção personalizada para melhorar a aderência terapêutica no adulto com hipertensão arterial

Objetivo: describir el proceso de diseño, validación e implementación de una intervención de enfermería personalizada para mejorar la adherencia terapéutica en adultos con hipertensión arterial. Método: estudio para el desarrollo de intervenciones según la propuesta de Sidani y Braden, que contempla el diseño de la intervención, la operacionalización en un manual de intervención y el estudio piloto. Resultados: la intervención sustentada en los postulados de la teoría salutogénica fue organizada en 4 sesiones, cada sesión de carácter semanal y duración de 20 minutos, presenciales y por teléfono. Los expertos (n=5) evaluaron la fidelidad teórica con una relevancia del 96 %, viabilidad del 94 % y claridad del 98 %. Conclusión: seguir las recomendaciones de Sidani y Braden permitió el diseño de una intervención con adecuado rigor metodológico, fundamentada en el uso de una teoría y de la evidencia científica que demuestra la fidelidad teórica y viabilidad de la intervención para mejorar la adherencia terapéutica en adultos con hipertensión arterial.

Objective: Describe the process of design, validation and implementation of a tailored nursing intervention to improve therapeutic adherence in adults with arterial hypertension. Method: Study the interventions development as proposed by Sidani & Braden, which includes the design of the intervention, operationalization of an intervention handbook and a pilot study. Results: The intervention based on the postulates of the salutogenic theory was organized in 4 sessions, each weekly lasting 20 minutes, in person and by telephone. The experts (n=5) evaluated the theoretical fidelity with a relevance of 96 %, feasibility of 94 % and clarity of 98 %. Conclusion: Following the recommendations of Sidani & Braden allowed designing an intervention with adequate methodological rigor, based on a theory and scientific evidence that demonstrate the theoretical fidelity and feasibility of the intervention to improve therapeutic adherence in adults with arterial hypertension.

Objetivo: descrever o processo de concepção, validação e implementação de uma intervenção de enfermagem personalizada para melhorar a adesão terapêutica em adultos com hipertensão arterial. Método: estudo para desenvolvimento de intervenções segundo a proposta de Sidani & Braden, que inclui o concepção da intervenção, a operacionalização em manual de intervenção e o estudo piloto. Resultados: a intervenção baseada nos postulados da teoria salutogênica foi organizada em 4 sessões, uma semanal, com duração de 20 minutos cada, ministradas presencialmente e por telefone. Os especialistas (n=5) avaliaram a fidelidade teórica com relevância de 96 %, viabilidade de 94 % e clareza de 98 %. Conclusão: seguir as recomendações de Sidani & Braden permitiu o desenvolvimento de uma intervenção, com rigor metodológico adequado, baseado na utilização de uma teoria e evidências científicas que demonstram a fidelidade teórica e viabilidade da intervenção para melhorar a adesão terapêutica em adultos com hipertensão arterial.

Educational Interventions in Adults with Type 2 Diabetes Mellitus in Primary Health Care Settings. A Scoping Review.

Objective: To synthesize the evidence of studies with educational interventions for adults with type-2 diabetes mellitus (DM2) in primary health care settings. Methods: A scoping review was conducted following the recommendations by the Joanna Briggs Institute and by the PRISMA declaration. The protocol was registered in INPLASY20215009. The search was carried out in: MEDLINE (via PubMed), EMBASE, Web of Science, LILACS, and grey literature. Results: Seventeen studies were included; most were randomized clinical trials of which 65% were conducted in high-income countries, and all the studies represented 5 656 participants. The results showed four big categories derived from educational interventions: therapeutic adherence (significant results on the satisfaction with the treatment); self-care and self-management in diabetes (improvement in self-efficacy, empowerment, and disease awareness); glycemic control in diabetes (significant results in reducing glycosylated hemoglobin); nursing and its role in the educational interventions on patients with DM2 (guidance in restructuring behaviors). Conclusion: The findings of this review suggest that educational interventions on patients with DM2 within the setting of primary health care can impact positively on therapeutic adherence, self-control, and knowledge of the disease. Moreover, it was possible to identify the influence of multidisciplinary health teams, where the relevance of nursing professionals in the construction and implementation of educational interventions is evidenced in obtaining better health results.

Competencia en cuidado espiritual en enfermería: Revisión integrativa de literatura / Spiritual Care Competence in Nursing: Integrative Literature Review

Introducción: El cuidado espiritual puede considerarse un elemento central de la filosofía del cuidado holístico. Objetivo: Identificar investigaciones de intervención con perspectivas y estrategias educativas para el desarrollo de competencias en cuidado espiritual. Materiales y métodos: Revisión de la literatura en el período 2001-2021 de las bases de datos PubMed, ProQuest, Scopus, Lilacs y BVS (Biblioteca Virtual en Salud). Se siguieron las recomendaciones PRISMA y se basaron en parámetros definidos por Whittemore y Knafl para la identificación de problemas, búsqueda bibliográfica, evaluación y análisis de datos. Resultados: se encontraron 10 artículos de intervención publicados. Los entrenamientos relacionados con el desarrollo de habilidades para el cuidado espiritual fueron realizados en programas de formación superior del personal de enfermería. Las estrategias de instrucción son cursos específicos, sesiones cortas o programas a lo largo del plan de estudios. Las intervenciones muestran efectos sobre las habilidades y conocimientos. La espiritualidad individual de los estudiantes predice la capacidad de brindar atención espiritual. Conclusiones: Hay evidencia de estrategias para desarrollar la competencia de estudiantes y profesionales de enfermería en cuidado espiritual, aún son escasas las publicaciones sobre el tema, por lo que se necesitan nuevas y más rigurosas estrategias para desarrollar competencia en este enfoque de la disciplina de enfermería.

Introduction: Spiritual care can be considered a basic component of the philosophy of holistic care. Objective: Identify intervention studies with educational perspectives and strategies for developing spiritual care competencies in nurses and nursing students. Materials and methods: Integrative review of literature conducted in the period 2001-2021, in the databases PubMed, ProQuest, Scopus, LILACS, and VHL (Virtual Health Library). PRISMA statement guidelines were followed for the review, and it was based on Whittemore and Knafl's stages for integrative reviews: problem formulation, literature search, evaluation of data, data analysis, and presentation of results. Results: Ten published intervention articles were found. Education for the development of spiritual care competencies has been provided by educational programs and activities in undergraduate nursing programs and with professional nurses in practice. Instructional strategies include specific courses, short sessions, or programs throughout the curriculum. Interventions have an impact on skills and knowledge. Students' individual spirituality is a predictor of the competence to provide spiritual care. Conclusions: There is evidence of strategies to develop spiritual care competencies in nursing students and professionals, but publications on the subject are scarce. Therefore, implementing new and more rigorous strategies that allow the development of competencies for approaching spirituality in nursing is required.

Introdução: o cuidado espiritual pode ser considerado um componente básico da filosofia do cuidado holístico. Objetivo: determinar estudos de intervenção com perspectivas e estratégias educativas para o desenvolvimento da competência em cuidado espiritual em profissionais e estudantes de enfermagem. Materiais e Métodos: Revisão integrativa da literatura realizada no período de 2001-2021, nas bases de dados PubMed, ProQuest, Scopus, Lilacs e BVS (Biblioteca Virtual em Saúde). As recomendações do PRISMA foram seguidas e baseadas nos parâmetros estabelecidos por Whittemore e Knafl para identificação do problema, busca na literatura, avaliação dos dados, análise dos dados e apresentação dos resultados. Resultados: foram encontrados 10 artigos de intervenção publicados. A educação para o desenvolvimento de competências no cuidado espiritual tem sido realizada a partir de programas e atividades educativas, na graduação e nos profissionais de enfermagem durante sua prática. As estratégias de ensino são cursos específicos, sessões curtas ou programas ao longo do currículo. As intervenções mostram impactos nas habilidades e competências de conhecimento. A espiritualidade individual nos alunos é um preditor da capacidade de fornecer cuidados espirituais. Conclusões: Existem evidências de estratégias para desenvolver competências no cuidado espiritual em enfermagem em estudantes e profissionais, as publicações sobre o assunto são escassas, pelo que é necessária a implementação de estratégias inovadoras e mais rigorosas que permitam o desenvolvimento de competências para a abordagem em Enfermagem.

Health education interventions on knowledge and self-care practices for hypertensive disorders during pregnancy: systematic review and meta-analysis protocol / Intervenciones en educación para la salud sobre conocimientos y prácticas de autocuidado para los trastornos hipertensivos durante el embarazo: protocolo de revisión sistemática y meta análisis / Intervenções em educação para a saúde sobre conhecimento e práticas de autocuidado para os distúrbios hipertensivos durante a gravidez: protocolo de revisão sistemática e meta- análise

Introduction: Hypertensive disorders during pregnancy are a global health problem. Health education is a strategy that provides pregnant women with knowledge and skills for self-care. Objective: evaluate the effect of health education interventions on pregnant women's knowledge and self-care practices for hypertensive disorders in pregnancy, compared to standard prenatal care. Materials and Methods: Systematic review and meta-analysis protocol. The study record can be consulted in PROSPERO (CRD42021252401). The search will be conducted in the following databases, PubMed/MEDLINE, CENTRAL, LILACS, CINAHL, EMBASE, and WoS. Additionally, clinical trial records in ClinicalTrials and grey literatura in OpenGrey and Google Scholar. The search will include studies of health education intervention in knowledge and self-care practices about hypertensive disorders in pregnancy. All statistical analysis will be carried out with the Review Manager software. Data will be combined using random-effects models, binary data with odds ratios or relative risks, and continuous data using mean differences. Heterogeneity between studies will be assessed using the Q-Cochran test to measure the significance and the l2 statistic to measure magnitude. Discussion: This study will contribute to the knowledge of health interventions that are effective in guiding and educating pregnant women about the disease and self-care practices. Conclusion: The results of this study will be used to provide recommendations in the management of maternal perinatal care, that promote comprehensive care in accordance with the Primary Health Care policy.

Introducción: Los trastornos hipertensivos durante el embarazo constituyen un problema de salud a nivel mundial. La educación para la salud es una estrategia que brinda a la mujer embarazada conocimientos y habilidades para el autocuidado. Objetivo: evaluar el efecto de intervenciones en educación para la salud sobre el conocimiento y las prácticas de autocuidado de mujeres embarazadas ante los trastornos hipertensivos en el embarazo, en comparación con la atención estándar del control prenatal. Materiales y Métodos: Protocolo de revisión sistemática y metaanálisis. El registro del estudio puede ser consultado en PROSPERO (CRD42021252401). La búsqueda se realizará en las siguientes bases de datos, PubMed/MEDLINE, CENTRAL, LILACS, CINAHL, EMBASE y WoS. Adicionalmente, registros de ensayos clínicos en ClinicalTrials y literatura gris en OpenGrey y Google Scholar. La búsqueda incluirá estudios de intervenciones en educación para la salud sobre conocimientos y prácticas de autocuidado ante los trastornos hipertensivos del embarazo. Los análisis estadísticos se llevarán a cabo con el software Review Manager. Los datos se combinarán mediante modelos de efectos aleatorios, los datos binarios con odds ratios o riesgos relativos y los datos continuos mediante diferencia de medias. La heterogeneidad entre los estudios se evaluará mediante la prueba Q-Cochran para medir la significancia y el estadístico l2 para medir la magnitud. Discusión: Este estudio aportará en el conocimiento de las intervenciones en salud que son efectivas para orientar y educar a las mujeres embarazadas sobre la enfermedad y prácticas de autocuidado. Conclusión: Los resultados de este estudio servirán para proporcionar recomendaciones en la gestión del cuidado materno perinatal, que promuevan atención integral acorde con la política de Atención Primaria en Salud.

Introdução: Os distúrbios hipertensivos durante a gravidez são um problema de saúde globalA educação em saúde é uma estratégia que proporciona às gestantes conhecimentos e habilidades para o autocuidado. Objetivo: avaliar o efeito das intervenções de educação em saúde no conhecimento e nas práticas de autocuidado das gestantes para os distúrbios hipertensivos na gravidez, em comparação com o pré-natal padrão. Materiais e Métodos: Protocolo de revisão sistemática e meta-análise.O registro do estudo pode ser consultado no PROSPERO (CRD42021252401). A busca será realizada nas seguintes bases de dados, PubMed/MEDLINE, CENTRAL, LILACS, CINAHL, EMBASE e WoS. Além disso, registros de ensaios clínicos no ClinicalTrials e literatura cinzenta no OpenGrey e Google Scholar. A pesquisa incluirá estudos de intervenção de educação em saúde no conhecimento e nas práticas de autocuidado sobre as doenças hipertensivas na gravidez. Todas as análises estatísticas serão realizadas com o software Review Manager. Os dados serão combinados usando modelos de efeitos aleatórios, dados binários com razões de chances ou riscos relativos e dados contínuos usando diferenças médias. A heterogeneidade entre os estudos será avaliada utilizando o teste Q-Cochran para medir a significância e a estatística l2 para medir a magnitude. Discussão: Este estudo contribuirá para o conhecimento de intervenções em saúde eficazes na orientação e educação das gestantes sobre a doença e as práticas de autocuidado. Conclusão: Os resultados deste estudo serão utilizados para fornecer recomendações na gestão da atenção perinatal materna, que promovam a integralidade da atenção de acordo com a política de Atenção Primária à Saúde.

Adaptación transcultural para Colombia y validez de contenido de la escala RAC de evaluación del riesgo de infección en el adulto hospitalizado / Cross-cultural adaptation for Colombia and content validity of the RAC scale for assessing the risk of infection in hospitalized adults

Introducción: Las Infecciones Asociadas a la Atención en Salud (IAAS) son un grave problema de salud pública, que puede ser prevenidas al identificar los factores de riesgo con el uso de escalas. Objetivo: Adaptar transculturalmente y realizar la validación de contenido y de face de la escala Rodríguez-Almeida-Cañon (RAC) de evaluación del riesgo de infección en adultos hospitalizados. Materiales y Métodos: Estudio metodológico de adaptación transcultural. La recolección de datos se realizó de junio a noviembre de 2020. La muestra estuvo compuesta por 11 especialistas. La escala RAC se evaluó en su conjunto, determinando su alcance, los ítems fueron evaluados individualmente, verificando su claridad, relevancia y pertinencia. Para evaluar cada ítem se utilizó una escala tipo Likert de cuatro niveles. La validez de contenido fue evaluada a través del índice de validez de contenido (IVC). Resultados: Por medio de la evaluación del comité de especialistas fue posible determinar que la escala RAC es apta para uso en el contexto cultural colombiano. Se realizaron ajustes para mejorar la interpretación de algunos ítems. El IVC de los ítems estuvo entre 0.90 a 1.0 y el IVC promedio de la escala fue de 0.98. Discusión: Esta escala permite medir el riesgo de IAAS a un bajo costo, con el fin de poder planear y ejecutar intervenciones por parte del equipo multidisciplinario que tiene a cargo la salud y el cuidado del paciente. Conclusiones: La escala RAC en su versión en español es un instrumento apropiado para la evaluación del riesgo de IAAS en el adulto hospitalizado en Colombia.

Introduction: Health care­associated infections (HAI) are a serious public health problem, which can be prevented by identifying risk factors with the use of scales. Objective: To adapt cross-culturally and perform content and face validation of the Rodríguez-Almeida-Cañon (RAC) scale for assessing the risk of infection in hospitalized adults. Materials and Methods: Methodological study of cross-cultural adaptation. Data collection was carried out from June to November 2020. The sample consisted of 11 specialists. The RAC scale was evaluated as a whole, determining its scope, the items were evaluated individually, verifying their clarity, relevance and pertinence. To evaluate each item, a four-level Likert-type scale was used. The content validity was evaluated through the content validity index (CVI). Results: Through the evaluation of the committee of specialists it was possible to determine that the RAC scale is suitable for use in the Colombian cultural context. Adjustments were made to improve the interpretation of some items. The CVI of the items was between 0.90 to 1.0 and the average CVI of the scale was 0.98. Discusión: This scale makes it possible to measure the HAI risk at a low cost, in order to be able to plan and execute interventions by the multidisciplinary team in charge of the health and care of the patient. Conclusions: The RAC scale in its Spanish version is an appropriate instrument for assessing the risk of HAI in hospitalized adults in Colombia.

Introdução: As infecções associadas à assistência à saúde (IAAS) são um grave problema de saúde pública, que pode ser prevenido por meio da identificação de fatores de risco com o uso de escalas. Objetivo: Adaptar transculturalmente e realizar a validação de conteúdo e de face da escala Rodríguez-Almeida-Cañon (RAC), de avaliação do risco de infecção em adultos hospitalizados. Materiais e Métodos: Estudo metodológico de adaptação transcultural. A coleta de dados foi realizada no período de junho a novembro de 2020. A amostra foi composta por 11 especialistas. A escala RAC foi avaliada como um todo, determinando seu escopo, os itens foram avaliados individualmente, verificando sua clareza, relevância e pertinência. Para avaliar cada item, foi utilizada uma escala do tipo Likert de quatro níveis. A validade de conteúdo foi avaliada por meio do índice de validade de conteúdo (IVC). Resultados: Por meio da avaliação do comitê de especialistas, foi possível constatar que a escala RAC é adequada para uso no contexto cultural colombiano. Ajustes foram feitos para melhorar a interpretação de alguns itens. O IVC dos itens ficou entre 0,90 a 1,0 e o IVC médio da escala foi de 0,98. Discussão: Esta escala permite mensurar o risco de IAAS a baixo custo, de forma a poder planejar e executar intervenções da equipe multiprofissional responsável pela saúde e cuidado do paciente. Conclusões: A escala RAC em sua versão em espanhol é um instrumento adequado para a avaliação do risco de IAAS em adultos hospitalizados na Colômbia.

Environmental pollution and attention deficit hyperactivity disorder: A meta-analysis of cohort studies.

There is already knowledge of the extensive risk factors for attention deficit hyperactivity disorder (ADHD) and recent studies suggest that environmental pollution may contribute to an increase in the incidence of the disorder. The aim of our study was to perform a systematic review and meta-analysis of the risk of ADHD in people younger than 18 years old after exposure to environmental pollution. We searched the MEDLINE, Embase, SciELO, CINAHL, LILACS, Cochrane Central, and Web of Science databases and investigated the grey literature from inception until May 31, 2021. All cohort studies that provided data on exposure to environmental pollutants and ADHD in children and adolescents aged from zero to 18 years old were included. Two reviewers independently selected the studies and applied the quality criteria. If there was a divergence, a third reviewer contributed to the final decision. For the meta-analysis, risk ratios and their confidence intervals were calculated with the MetaXL 5.3 program, using the random effects model. In total, 21 articles were included in this systematic review, and 18 studies met the criteria for the meta-analysis, involving 134,619 participants. The meta-analysis suggested that children exposed to higher levels of heavy metal (RR: 2.41, 95% CI: 1.49-3.90), with low heterogeneity (I2 = 39%), and lead (RR: 2.37, 95% CI: 1.28-4.40), with moderate heterogeneity (I2 = 54%), are at greater risk of developing ADHD than those exposed to lower levels. This meta-analysis suggests that children exposed to higher levels of lead and heavy metal pollution are at greater risk of developing ADHD than those exposed to lower levels.

Reference percentiles for bioimpedance body composition parameters of healthy individuals: A cross-sectional study.

OBJECTIVES: The aim of this study was to estimate the percentage distribution of body composition parameters for healthy people at different ages from the assessment of electrical bioimpedance. METHODS: A cross-sectional study of healthy Brazilian aged 5 years and older. Were evaluated: total body fat; percent body fat; fat-free mass; percent lean mass; fat mass index; and fat-free mass index. RESULTS: Of 1240 participants, with a median age of 27.0 years, 52.5% were female, and 73.7% were Caucasian. Most of the body composition variables were associated with age. The fat-free mass increased from youth to adult and decreased in the elderly in both sexes, with higher values in males than in females. In males, the percentage of lean mass has higher values in adolescence compared to childhood, and in adults compared to the elderly, when analyzed from the 50th percentile. In women, fat-free mass compared to adulthood, values were higher in childhood and lower in older ages. CONCLUSIONS: The study is the first to describe the Brazilian reference values for most clinical parameters of bioimpedance in percentiles stratified by different life cycles and sex. These findings can be very useful in clinical practice for health promotion and monitoring the nutritional status of the individual.

Assessing eating disorder symptoms in low and middle-income countries: a systematic review of psychometric studies of commonly used instruments.

BACKGROUND: Various well-validated interview and self-report instruments are available to assess eating disorder symptomatology. However, most psychometric studies have been conducted in high-income countries. The aim of the present study was to systematically review the available psychometric studies conducted in low- and middle-income countries on well-known measures for assessing eating disorder symptoms. METHODS: Psychometric studies with the following instruments were included: the Eating Disorder Examination (EDE), the Eating Disorder Examination Questionnaire (EDE-Q), the Eating Disorder Inventory (EDI), the Eating Attitudes Test (EAT), and the Children's Eating Attitudes Test (ChEAT). Searches were conducted on August 30, 2021, in the following databases: MEDLINE, EMBASE, LILACS, Web of Science, PsycINFO, and CABI. The methodological quality of the studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The studies were considered to have conducted the minimum psychometric evaluation if they assessed at least the three types of validity (content, criteria, and construct) or diagnostic performance. The psychometric properties were also evaluated considering the cut-off points described in the literature for each of the analysis methods used to evaluate validity and reliability and two reviewers independently selected the studies and evaluated the quality criteria. RESULTS: A total of 28 studies were included. The studies were conducted in 13 countries (10 middle income and 3 low income). The instruments that were most used in the studies were the EAT and EDE-Q. According to the overall COSMIN assessment, in most (57%) of the studies the psychometric properties assessed were not described. Forty-three percent of the studies conducted the minimum psychometric evaluation. However, according to the described cut-off points, the results for the psychometric properties assessed showed, in general, acceptable validity and reliability. CONCLUSION: The results of this review suggest a lack of studies with the recommended psychometric properties in low- and middle-income countries on these commonly used instruments. With the steady increase in the prevalence of eating disorders globally, psychometric investigations of instruments for measuring eating disorder symptoms in these countries should be encouraged to promote their early detection and treatment.

The prevalence of eating disorders has increased worldwide. Various instruments are available to assess eating disorder symptomatology, but most psychometric studies have been conducted in high-income countries. The current study aimed to systematically review studies from low- and middle-income countries that have examined the psychometric properties of commonly used measures for assessing eating disorder symptoms. The findings of this study suggest a lack of research in low- and middle-income countries on the psychometric properties of commonly used eating disorder instruments. To promote the early detection and treatment of eating disorder symptoms, instruments with adequate psychometric properties must be available worldwide.