Clinical decision support systems for diabetic foot ulcers: a scoping review.

OBJECTIVE: Map the scientific evidence on the use of clinical decision support systems in diabetic foot care. METHOD: A scoping review based on the JBI Manual for Evidence Synthesis and registered on the Open Science Framework platform. Searches were carried out in primary and secondary sources on prototypes and computerized tools aimed at assisting patients with diabetic foot or at risk of having it, published in any language or period, in eleven databases and grey literature. RESULTS: A total of 710 studies were identified and, following the eligibility criteria, 23 were selected, which portrayed the use of decision support systems in diabetic foot screening, predicting the risk of ulcers and amputations, classifying the stage of severity, deciding on the treatment plan, and evaluating the effectiveness of interventions, by processing data relating to clinical and sociodemographic information. CONCLUSION: Expert systems stand out for their satisfactory results, with high precision and sensitivity when it comes to guiding and qualifying the decision-making process in diabetic foot prevention and care.

Vulnerabilidade em saúde: evidências de validade de um banco de itens / Vulnerabilidad en salud: evidencias de validez de un banco de ítems / Health vulnerability: evidence of validity of an item bank

Resumo Objetivo Analisar as evidências de validade de conteúdo e processo de resposta de um banco de itens sobre vulnerabilidade em saúde. Métodos Estudo psicométrico, subsidiado pelo polo teórico de Pasquali. Foram selecionados 62 especialistas com características sociodemográficas e acadêmicas distintas. Desses, 15 responderam ao questionário de validade de conteúdo. Após os ajustes, o banco passou para fase de validade de processo de resposta e foi avaliado por 12 usuários dos serviços de saúde. Utilizou-se coeficiente de validade de conteúdo para avaliação dos itens e do banco, cuja confiabilidade foi verificada pelo teste binomial, considerando percentual de 80% e p-valor >0,05. Resultados O banco apresentou boa evidência de validade de conteúdo pelos especialistas, cujos coeficientes foram 0,87 para o elemento sujeito, 0,86 para o elemento social e 0,865 para o geral. O público-alvo realizou sugestões na fase de validade de processo de resposta para melhor compreensão dos itens (coeficiente total: 0,89), sendo considerado, claro, preciso e compreensível. Conclusão A versão final do banco de itens possui 535 itens, sendo 238 para o sujeito e 297 para o social. Apresenta indícios de evidência de validade de conteúdo e processo de resposta e está apto para testagem de validade de estrutura interna.

Resumen Objetivo Analizar las evidencias de validez de contenido y proceso de respuesta de un banco de ítems sobre vulnerabilidad en salud. Métodos Estudio psicométrico, fundamentado por el polo teórico de Pasquali. Se seleccionaron 62 especialistas con características sociodemográficas y académicas diferentes. Entre ellos, 15 respondieron al cuestionario de validez de contenido. Después de las adaptaciones, el banco pasó a la fase de validez del proceso de respuesta y fue evaluado por 12 usuarios de los servicios de salud. Se utilizó el coeficiente de validez de contenido para evaluar los ítems y el banco, cuya fiabilidad ser verificó mediante la prueba binominal, que consideró un porcentaje de 80 y p-valor >0,05. Resultados El banco presentó buena evidencia de validez de contenido por los especialistas, cuyos coeficientes fueron 0,87 en el elemento sujeto, 0,86 en el elemento social y 0,865 en el general. El público destinatario realizó sugerencias en la fase de validez del proceso de respuesta para una mejor comprensión de los ítems (coeficiente total: 0,89) y fue considerado claro, preciso y comprensible. Conclusión La versión final del banco de ítems contiene 535 ítems, de los cuales 238 son para el sujeto y 297 para el social. Presenta indicios de evidencia de validez de contenido y proceso de respuesta y está apto para una prueba de validez de estructura interna.

Abstract Objective To analyze the evidence of content validity and response process of a health vulnerability item bank. Methods Psychometric study with support of Pasquali's theoretical pole in which 62 specialists with different sociodemographic and academic characteristics were selected and 15 of them responded to the content validity questionnaire. After adjustments, the bank moved to the response process validity phase and was evaluated by 12 health service users. A content validity coefficient was used to evaluate the items and the bank, which had the reliability assessed by the binomial test, considering a percentage of 80% and p-value >0.05. Results The bank presented good evidence of content validity by experts. The coefficients were 0.87 for the subject element, 0.86 for the social element and 0.865 for the general element. The target audience made suggestions in the response process validity phase to better understand the items (total coefficient: 0.89), which were considered clear, accurate and understandable. Conclusion The final version of the item bank has 535 items, 238 for the subject and 297 for the social element. It presents evidence of validity of content and response process and is suitable for testing the validity of internal structure.

Anti-Bullying Interventions With an Emphasis on Bystanders: A Scoping Review.

BACKGROUND: Bystanders' role in bullying situations is important, and may exacerbate or minimize the problem. Thus, this article aims to identify the characteristics of anti-bullying programs with an emphasis on bystanders. METHODS: This is a scoping review. We included studies that addressed interventions with an emphasis on bystanders, carried out with school children and adolescents, aimed at reducing bullying/cyberbullying and/or increasing defending behavior. Fifteen portals/databases were searched. The selection and extraction processes were carried out through the blind review strategy. The synthesis took place descriptively. RESULTS: We found 12 interventions. The most investigated were KiVa (n = 9), STAC (n = 3), and Curriculum-Based Anti-Bullying (n = 2). CONCLUSIONS: There are few anti-bullying programs with an emphasis on bystanders, and the majority are universal programs with strategies applied by teachers, giving little attention to parents. Moreover, most of these programs lack a broader mix of anti-bullying strategies. Therefore, we suggest developing anti-bullying programs with multiple components that contain universal, selective, and indicated strategies.

Mobile Application for Adhering to Diabetic Foot Self-care: Randomized Controlled Clinical Trial.

This study aimed to analyze the effectiveness of a mobile application for adherence to foot self-care in people with type 2 diabetes at risk for diabetic foot ulcer. A double-blind randomized controlled clinical trial was conducted with people with type 2 diabetes in a secondary healthcare unit. A total of 42 patients were recruited, matched, and allocated into two groups: one (intervention group) undergoing standard nursing consultations and application use and the other (control group) receiving only standard nursing consultations. The outcome variable was the adherence to foot self-care, measured by completing questionnaires on diabetes self-care activities and adherence to foot self-care. Measures of central tendency and dispersion were calculated, in addition to bivariate associations, considering a significance level of P ≤ .05. The intragroup and intergroup analyses regarding diabetes self-care did not show statistical significance; however, the intervention group showed a considerable increase in the frequency of daily assessments ( P = .048) and adherence to foot self-care ( P = .046). The use of the app, combined with the nursing consultation, increased adherence to foot self-care of people with type 2 diabetes. Brazilian Registry of Clinical Trials: U1111-1202-6318.

Clinical decision support systems for diabetic foot ulcers: a scoping review / Sistemas de apoyo a decisiones clínicas para las úlceras del pie diabético: una revisión de alcance / Sistemas de apoio à decisão clínica em úlceras de pé diabético: revisão de escopo

ABSTRACT Objective: Map the scientific evidence on the use of clinical decision support systems in diabetic foot care. Method: A scoping review based on the JBI Manual for Evidence Synthesis and registered on the Open Science Framework platform. Searches were carried out in primary and secondary sources on prototypes and computerized tools aimed at assisting patients with diabetic foot or at risk of having it, published in any language or period, in eleven databases and grey literature. Results: A total of 710 studies were identified and, following the eligibility criteria, 23 were selected, which portrayed the use of decision support systems in diabetic foot screening, predicting the risk of ulcers and amputations, classifying the stage of severity, deciding on the treatment plan, and evaluating the effectiveness of interventions, by processing data relating to clinical and sociodemographic information. Conclusion: Expert systems stand out for their satisfactory results, with high precision and sensitivity when it comes to guiding and qualifying the decision-making process in diabetic foot prevention and care.

RESUMEN Objetivo: Mapeo de la evidencia científica sobre el uso de sistemas de apoyo a la toma de decisiones clínicas en el cuidado del pie diabético. Método: Revisión de alcance basada en el Manual de Síntesis de la Evidencia del JBI y registrada en la plataforma Open Science Framework. Se realizaron búsquedas en fuentes primarias y secundarias sobre prototipos y herramientas informatizadas dirigidas a la asistencia de pacientes con pie diabético o en riesgo de padecerlo, publicadas en cualquier idioma o periodo, en once bases de datos y literatura gris. Resultados: Se identificaron 710 estudios y, tras cumplir los criterios de elegibilidad, se seleccionaron 23, que retrataban el uso de sistemas de apoyo a la toma de decisiones en el diagnóstico del pie diabético, la predicción del riesgo de úlceras y amputaciones, la clasificación del estadio de gravedad, la decisión sobre el plan de tratamiento y la evaluación de la eficacia de las intervenciones, mediante el procesamiento de datos relativos a la información clínica y sociodemográfica. Conclusión: Los sistemas expertos destacan por sus resultados satisfactorios, con gran precisión y sensibilidad a la hora de orientar y cualificar el proceso de toma de decisiones en la prevención y el cuidado del pie diabético.

RESUMO Objetivo: Mapear as evidências científicas sobre uso de Sistemas de Apoio à Decisão Clínica no pé diabético. Método: Revisão de escopo fundamentada no JBI Manual for Evidence Synthesis e registrada na plataforma Open Science Framework. Realizaram-se buscas, em fontes primárias e secundárias, sobre protótipos e ferramentas informatizadas direcionadas à assistência ao paciente com pé diabético ou em risco de tê-lo, publicados em qualquer idioma ou período, em onze bases de dados e literatura cinza. Resultados: Foram identificados 710 estudos e, após critérios de elegibilidade, foram selecionados 23 que retratam o uso de sistemas de apoio à decisão no rastreio do pé diabético, predição do risco de úlceras e amputações, classificação do estágio de gravidade, decisão quanto ao plano de tratamento e avaliação da efetividade das intervenções, por meio do processamento de dados referentes a informações clínicas e sociodemográficas. Conclusão: Os sistemas especialistas destacam-se por resultados satisfatórios, com alta precisão e sensibilidade no que tange à orientação e qualificação do processo de tomada de decisão na prevenção e no cuidado ao pé diabético.

Vulnerability to physical inactivity: evidence of content validity and response processes.

OBJECTIVE: To analyze content validity evidence and response processes of a bank of items for measuring vulnerability to physical inactivity in adults. METHOD: Methodological study, with 13 specialists and 46 representatives of the target population. The Content Validity Index (CVI) and binomial test were calculated; data obtained through validity based on response processes were collected through interviews. RESULTS: Of the 105 constructed items, 16 were excluded (CVI<0.78); 89 items showed agreement <80% in the psychometric criteria, being modified. Of the 101 items that remained (CVI>0.78), 34 were changed and 4 were deleted after evaluating the evidence of response processes. In the end, 97 items remained, with a global CVI of 0.92, organized into two dimensions: Subject (CVI=0.91) and Social (CVI=0.94). CONCLUSION: The items presented adequate parameters and evidence of validity; and can subsidize the construction of instruments that consider the subject's and social vulnerability in understanding physical inactivity.

Structure internal of the dimension Human Person of the Questionnaire of Health Vulnerability in Heart Failure.

OBJECTIVE: to analyze the evidence of validity of the internal structure of the dimension Human Person of the Questionnaire of Health Vulnerability in Heart Failure. METHOD: psychometric study with 1,008 people with heart failure, in a tertiary healthcare institution located in Northeastern Brazil. The internal structure was assessed by exploratory factor analysis with a polychoric correlation matrix, followed by confirmatory factor analysis to verify the quality of the model fit. Internal consistency was measured by composite reliability (CR) and McDonald's omega (ω). RESULTS: psychometric parameters revealed 22-item model, distributed in five factors, total explained variance of 64.9%, factor loadings (0.38 to 0.97) and adequate communalities (0.20 ≤ h2 ≤ 0.98) and acceptable indicators of precision (0.79 ≤ ORION ≤ 0.98), representativeness (0.89 ≤ FDI ≤ 0.99), sensitivity (1.92 ≤ SR ≤ 7.07), factor expectancy (88.3% ≤ EPTD ≤ 97.9%), replicability (0.82 ≤ H-latent ≤ 0.97; 0.81 ≤ H-observed ≤ 0.87) and reliability (CR = 0.92 and ω = 0.83). Adequate adjustment quality was achieved (TLI = 0.99; CFI = 0.99; GFI = 0.99; RMSEA = 0.04 and RMSR = 0.04). CONCLUSION: We obtained an instrument with good evidence of internal structure validity for construct measurement.

Serial album on Continuous Insulin Infusion System as an innovative educational technology in diabetes.

OBJECTIVE: to build and validate a serial album content and appearance on insulin therapy using a Continuous Infusion System. METHOD: a methodological study, carried out in three stages in Fortaleza, Ceará, Brazil, from August to November 2018. The serial album construction and content and appearance validity were carried out by experts, and assessment, by the target audience. Content Validity Index and Concordance Index were calculated. RESULTS: the judges considered the serial album content and appearance to be valid, which means that the material is suitable as an educational technology. Experts suggested adjustments, incorporated into the material for print production of the final version. The target audience also assessed the serial album positively. CONCLUSION: we realized that the serial album was considered an innovative educational technology in diabetes, valuable for promoting knowledge about Continuous Insulin Infusion System, with rich, updated content, combined with clarity, suitable format and explanatory illustrations.

Diabetes as a factor associated with hospital deaths due to COVID-19 in Brazil, 2020. / Diabetes como um fator associado ao óbito hospitalar por COVID-19 no Brasil, 2020.

OBJECTIVE: To analyze the association between diabetes mellitus and hospital deaths due to Covid-19 in Brazil, from February to August 2020. METHODS: This was a cross-sectional study on hospitalized flu-like syndrome cases, with a positive test result for COVID-19, reported on the Influenza Epidemiological Surveillance Information System. Poisson regression with robust variance was used to estimate the magnitude of the association between diabetes and deaths. RESULTS: Data from 397,600 hospitalized cases were analyzed, of which 32.0% (n = 127,231) died. The prevalence of death among people with diabetes was 40.8% (PR = 1.41; 95%CI 1.39;1.42). After adjustments for the variables sociodemographic and comorbidities, it could be seen that those with diabetes (95%CI 1.14;1.16) were 1.15 time more likely to die. CONCLUSION: 3 out of every 20 deaths due to COVID-19 occurred among individuals with diabetes mellitus, highlighting this population susceptibility and the need to control this chronic disease.

Effect of an app on students' knowledge about diabetes during the COVID-19 pandemic. / Efeito de um aplicativo no conhecimento de estudantes sobre diabetes durante a pandemia da COVID-19.

OBJECTIVE: to analyze the effect of an app on Nursing students' knowledge about diabetes during the COVID-19 pandemic, as well as their self-assessment and satisfaction level. METHOD: a quasi-experimental study carried out with 40 Nursing students from the Brazilian Northeast region. The E-MunDiabetes® app was used to assess the participants' knowledge at the pre-test, immediate post-test and after 15 days, as well as their self-assessment and satisfaction level in relation to using the app. The analysis was performed by means of descriptive and inferential statistics (binomial test, Intraclass Correlation Coefficient and Wilcoxon's test). RESULTS: the comparison of the medians of correct answers in the three periods revealed a significant increase in the post-test. The self-assessment and satisfaction items presented an Agreement Index > 80%, with a total Agreement Index of 96.3% and an Intraclass Correlation Coefficient of 0.91. CONCLUSION: the app was considered satisfactory and promoted a significant increase in the students' knowledge, therefore being suitable for its intended use.

E-MunDiabetes: A Mobile Application for Nursing Students on Diabetes Education During the COVID-19 Pandemic.

The COVID-19 pandemic caused tremendous disruption of health systems worldwide. Patients with diabetes are at a high risk of COVID-19 exposure because face-to-face consultations have been standard for diabetes management. This study describes the development and validation of a mobile application for nursing students on diabetes education during the COVID-19 pandemic. The application was developed by a certified diabetes educator nurse and by a freelance programmer and, in the next step, validated in terms of content and appearance by a group of expert nurses on diabetes (n = 29), nursing students (n = 40), and information technology experts (n = 11). Validity indexes of 0.99 for content and 0.92 for appearance were obtained, and usability values of 78.9 (±15.3) and 78.2 (±10.8) were obtained from nursing and information technology experts, respectively. The self-assessment and satisfaction items evaluated by nursing students had a total agreement of 96.3% and an intraclass correlation coefficient of 0.91. Both the content and the appearance of the application were considered adequate, and the usability scores indicate that the application is useful and easy to use.

Effect of thermometry on the prevention of diabetic foot ulcers: a systematic review with meta-analysis. / Efeito da termometria na prevenção de úlceras de pé diabético: revisão sistemática com metanálise.

OBJECTIVE: to analyze the effect of cutaneous foot thermometry in people with Diabetes Mellitus, compared with the standard prevention of foot ulcers adopted in these patients. METHOD: a systematic review with meta-analysis. Protocol registered with PROSPERO (CRD42020202686). The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed. The search was performed in the following data sources: SCOPUS, Web of Science, MEDLINE via PubMed, MEDLINE via EBSCO, MEDLINE via Biblioteca Virtual em Saúde, Embase, CINAHL, Cochrane Library, LILACS via Biblioteca Virtual em Saúde, Google Scholar, Biblioteca Digital Brasileira de Teses e Dissertações, Catálogo de Teses & Dissertações-Capes, Open Grey and ProQuest Dissertations and Theses. The risk of bias was assessed by the Cochrane Collaboration Risk of Bias Tool (RoB 2), the meta-analysis was performed in the Review Manager 5.4 software and the Certainty of evidence in the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: of the 670 records, five articles were eligible. The meta-analysis was calculated for the prevention of the incidence of diabetic foot ulcers outcome, with effect summarization (RR 0.53; 95%CI 0.29-0.96; p=0.02), with certainty of moderate evidence. CONCLUSION: thermometry showed a protective effect on the incidence of diabetic foot ulcers when compared to standard foot care.

Requirements for building educational and care technology on heart failure.

OBJECTIVES: to investigate the requirements for building an educational and care application about heart failure. METHODS: exploratory study, carried out with 15 people with heart failure and 19 family members/caregivers, assisted in a tertiary unit in the Brazilian Northeast. Individual semi-structured interviews were carried out between November and December 2020. Hannah Arendt's theoretical framework was adopted. RESULTS: two units of meaning emerged: "The plurality of care in heart failure" and "Expectations on the construction and use of educational and care technology for heart failure". The requirements involved the need to know the disease and its nuances, as well as the health network, through an application that can minimize individual and social precariousness; and highlighted the importance of the participation of the multidisciplinary team in the development and dissemination of the application. CONCLUSIONS: requirements on educational and care technology were identified and will support the creation of an application that promotes care, aiming to obtain positive health outcomes.

Vulnerabilidade programática na saúde: análise do conceito / Vulnerabilidad programática en la salud: análisis del concepto / Programmatic vulnerability in health: concept analysis

RESUMO Objetivo: analisar, conceitualmente, a vulnerabilidade programática com identificação de seus antecedentes, atributos e consequentes. Método: modelo de análise conceitual segundo metodologia de Walker e Avant. Foram etapas, I. seleção do conceito: vulnerabilidade programática; II. determinação dos objetivos: análise do uso do conceito; III. identificação de usos do conceito: estudo de revisão integrativa (buscou-se a expressão não controlada "programmatic vulnerabilty" nas bases de dados embase, web of science e Medline via pubmed e nos repositórios de artigos Biblioteca Virtual em Saúde e Scielo); IV. determinação dos atributos: análise dos registros da etapa III; V. identificação do caso modelo e casos adicionais: construção com base nos atributos e um caso contrário; VI. identificação de antecedentes e consequentes: painel de dados para elaboração de fenômenos antes e depois da vulnerabilidade programática; VII. referência empíricas: definições operacionais extraídas dos registros. Resultados: 20 registros foram incluídos na análise do conceito. Identificaram-se as variações do termo e os significados mais presentes e caracterizadores da vulnerabilidade programática, sendo a dimensão programática e acesso à saúde as mais frequentes. Foi construído o caso modelo. Os antecedentes, atributos e consequentes foram agrupados em quadro por similitude, no qual referências empíricas do conceito foram indicadas. Conclusão: a vulnerabilidade programática tem elementos discursivos importantes, sendo sua principal característica a falta de consultas disponibilizadas (antecedente), insuficiência/dificuldade no acesso à saúde (atributo) e evolução da doença (consequente).

RESUMEN Objetivo: analizar conceptualmente la vulnerabilidad programática con la identificación de sus antecedentes, atributos y consecuencias. Método: modelo de análisis conceptual según la metodología de Walker y Avant. Los pasos fueron: I. selección del concepto: vulnerabilidad programática; II. determinación de los objetivos: analizar el uso del concepto; III. identificación de los usos del concepto: se utilizó un estudio de revisión integrador (se buscó la expresión no controlada " programmatic vulnerabilty " en las bases de datos embase, Web of Science y Medline a través de pubmed y en los repositorios de artículos Virtual Health Library y Scielo); IV. determinación de los atributos: análisis de los registros del paso III; V. identificación del caso modelo y de los casos adicionales: se construyó a partir de los atributos y de un caso contrario; VI. identificación de los antecedentes y las consecuencias: panel de datos para la elaboración de los fenómenos antes y después de la vulnerabilidad programática; VII. referencia empírica: definiciones operativas extraídas de los registros. Resultados: se incluyeron veinte registros en el análisis conceptual. Se identificaron las variaciones del término y los significados más presentes y característicos de la vulnerabilidad programática, siendo la dimensión programática y el acceso a la salud los más frecuentes. Se construyó el caso modelo. Los antecedentes, atributos y consecuencias se agruparon en una tabla por similitud, en la que se indicaron las referencias empíricas del concepto. Conclusión: la vulnerabilidad programática tiene importantes elementos discursivos, siendo su principal característica la falta de consultas disponibles (antecedente), la insuficiencia/dificultad en el acceso a la salud (atributo) y la evolución de la enfermedad (consecuente).

ABSTRACT Objective: to conceptually analyze programmatic vulnerability with the identification of its antecedents, attributes, and consequences. Method: conceptual analysis model according to the Walker and Avant methodology. There were steps, I. selection of the concept: programmatic vulnerability; II. determination of objectives: analysis of the use of the concept; III. identification of uses of the concept: integrative review study (the uncontrolled expression "programmatic vulnerabilty" was searched in the Embase, Web of Science and Medline databases via Pubmed and in the article repositories Biblioteca Virtual em Saúde and Scielo); IV. determination of attributes: analysis of records from stage III; V. identification of the model case and additional cases: construction based on attributes and an otherwise; VI. identification of antecedents and consequences: panel of data for elaboration of phenomena before and after programmatic vulnerability; VII. empirical reference: operational definitions extracted from the records. Results: 20 records were included in the concept analysis. Variations of the term and the most common meanings that characterize programmatic vulnerability were identified, with the programmatic dimension and access to health being the most frequent. The model case was built. The antecedents, attributes and consequences were grouped in a table by similarity, in which empirical references of the concept were indicated. Conclusion: programmatic vulnerability has important discursive elements, its main characteristic being the lack of available consultations (antecedent), insufficiency/difficulty in accessing health (attribute) and disease evolution (consequent).

Spatial Distribution of Mortality for Heart Failure in Brazil, 1996 - 2017. / Distribuição Espacial de Mortalidade por Insuficiência Cardíaca no Brasil, 1996-2017.

BACKGROUND: Heart failure (HF) is a leading cause of mortality and morbidity worldwide, and is associated with the high use of resources and healthcare costs. In Brazil, the HF prevalence is around 2 million patients, and its incidence is of approximately 240,000 new cases per year. OBJECTIVE: The present investigation aimed to analyze the spatiotemporal trend of mortality caused by HF in Brazil, from 1996 to 2017. METHODS: This is an ecological study developed with secondary data on HF mortality in Brazil. During the period, 1,242,014 cases of death caused by heart failure were analyzed. The existence of spatial autocorrelation of cases was calculated using the Global Moran Index (GMI) and, when significant, the Local Moran Index, considering p<0.05. The relative risk of the clusters was calculated. RESULTS: The mortality rate due to HF was diversified in all Brazilian regions, with an emphasis in the South, Southeast, and Northeast. The GMI indicated positive spatial autocorrelation (p=0.01) in all periods. Municipalities located in the South, Southeast, Northeast, and Midwest showed a higher Relative Risk for mortality from HF, and most municipalities in the North were classified as a protective factor against this cause of death. CONCLUSIONS: The study showed a decline in mortality rates across the national territory. The highest concentration of mortality rates is in the North and Northeast regions, highlighting priority vulnerable areas in the planning and controlling strategies of health services.

FUNDAMENTO: Insuficiência cardíaca (IC) é uma das principais causas de mortalidade e morbidade no mundo, e está associada ao alto uso de recursos e custos com saúde. No Brasil, a prevalência de IC é de aproximadamente 2 milhões de pacientes, e sua incidência é de aproximadamente 240.000 novos casos por ano. OBJETIVO: A investigação objetivou analisar a tendência espaço-temporal da mortalidade causada por IC no Brasil, de 1996 a 2017. MÉTODOS: Este é um estudo ecológico desenvolvido com dados secundários sobre mortalidade por IC no Brasil. Durante o período, 1.242.014 casos de morte causada por IC foram analisados. A existência da autocorrelação espacial de casos foi calculada utilizando o Índice de Moran Global (IMG) e, quando significativo, o Índice de Moran Local, considerando p <0,05. O risco relativo dos grupos foi calculado. RESULTADOS: A taxa de mortalidade causada por IC foi diversificada em regiões brasileiras, com ênfase no sul, sudeste e nordeste. O IMG indicou autocorrelação espacial positiva (p=0,01) em todos os períodos. Cidades localizadas no sul, sudeste, nordeste e centro-oeste mostraram maior risco relativo para mortalidade causada por IC, e a maioria das cidades do norte foi classificada como um fator protetivo contra esta causa de morte. CONCLUSÕES: O estudo demonstrou declínio nas taxas de mortalidade no território nacional. A maior concentração de taxas de mortalidade está nas regiões norte e nordeste, enfatizando as áreas prioritárias de vulnerabilidade no planejamento e estratégias de controle de serviços de saúde.

Diabetes as a factor associated with hospital death from COVID-19 in Brazil, 2020 / La diabetes como factor asociado a la muerte hospitalaria por COVID-19 en Brasil, 2020 / Diabetes como um fator associado ao óbito hospitalar por COVID-19 no Brasil, 2020

Objective: to analyze the association between diabetes and hospital death from COVID19 in Brazil, between February and August 2020. Methods: Cross-sectional study with cases reported as flu-like syndrome in the Influenza Surveillance Information System, positive for COVID-19 and hospitalized. The magnitude of the association between diabetes and death was estimated by robust Poisson regression. Results: data from 397,600 hospitalized cases were analyzed, of which 32.0% (n=127,231) died. The prevalence of death among people with diabetes was 40.8% (PR=1.41 ­ Confidence Interval of 95% [95%CI]: 1.39;1.42). After adjusting for sociodemographic variables, signs and symptoms, comorbidities and conditions of severity, it was observed that death was 1.13 times more frequent among those with diabetes (95%CI 1.12;1.14). Conclusion: thirteen out of one hundred deaths from COVID-19 occurred in individuals with diabetes, highlighting the susceptibility of this population and the need to control this chronic disease.

Objetivo: analizar la asociación entre diabetes y muerte hospitalaria por COVID-19 en Brasil, de febrero a agosto de 2020. Métodos: Estudio transversal con casos notificados como síndrome gripal en el Sistema de Información de Vigilancia de Influenza, positivos a COVID-19 y hospitalizados. La magnitud de la asociación entre diabetes y muerte se estimó mediante regresión de Poisson robusta. Resultados: se analizaron datos de 397.600 casos hospitalizados, de los cuales 32,0% (n=127.231) fallecieron. La prevalencia de muerte entre las personas con diabetes fue 40,8% (RP=1,41 ­ intervalo de confianza del 95% [IC95%]: 1,39;1,42). Después de ajustar povariables sociodemográficas, signos y síntomas, comorbilidades y condiciones de gravedad, se observó que la muerte era 1,13 veces más frecuente entre los diabéticos (IC95% 1,12;1,14). Conclusión: trece de cada cien muertes por COVID-19 ocurrieron en individuos con diabetes, destacando la susceptibilidad de esta población y la necesidad de control de esta enfermedad crónica.

Objetivo: Analisar a associação entre diabetes mellitus e óbito hospitalar por COVID-19 no Brasil, de fevereiro a agosto de 2020. Métodos: Estudo transversal, sobre casos notificados como síndrome gripal no Sistema de Informação de Vigilância da Gripe, positivos para COVID-19 e hospitalizados. A magnitude da associação do diabetes com o óbito foi estimada por regressão de Poisson robusta. Resultados: Foram analisados dados de 397.600 casos hospitalizados, dos quais 32,0% (n=127.231) evoluíram a óbito. A prevalência de óbito entre pessoas com diabetes foi de 40,8% (RP=1,41 ­ intervalo de confiança de 95% [IC95%]: 1,39;1,42). Após ajustes por variáveis sociodemográficas, sinais e sintomas, comorbidades e condições de gravidade, observou-se que o óbito foi 1,13 vezes mais frequente entre aqueles com diabetes (IC95%: 1,12;1,14). Conclusão: Treze a cada cem óbitos por COVID-19 ocorreram em indivíduos com diabetes mellitus, destacando-se a suscetibilidade dessa população e a necessidade de controle dessa doença crônica.

Percepção da equipe de saúde sobre aplicação dos cuidados paliativos à pessoa submetida a transplante cardíaco / Perception of the health team on the application of palliative care to the person undergoing heart transplantation

Objetivo: elucidar a relação entre cuidados paliativos e transplante cardíaco na visão da equipe de transplante e desenvolver um mapa mental que ajude a repensar a abordagem paliativa à pessoa pós transplante cardíaco. Métodos: estudo descritivo, com abordagem qualitativa, foi realizado por meio de entrevista semiestruturada, com 17 profissionais de saúde. O corpus constituído foi processado pelo software IRaMuTeQ. Utilizou-se análise de conteúdo de Minayo, e elaboração de mapa mental. Resultados: as narrativas revelaram dificuldade em estabelecer critérios para indicar uma pessoa pós transplante cardíaco para o cuidado paliativo. Medo, preconceito e falta de conhecimento retardam a abordagem paliativa. O mapa mental evidencia condições que podem ser consideradas para a indicação de cuidados paliativos para pessoas em pós transplante cardíaco. Conclusão: a abordagem paliativa no contexto do transplante cardíaco, na visão dos profissionais, é permeada por sentimentos negativos e déficit de informações por parte das equipes. O mapa mental proposto elucidou elementos que podem orientar os profissionais para a inserção da pessoa pós transplante cardíaco na abordagem paliativa.

Objective: to elucidate the relationship between palliative care and heart transplantation in the view of the transplant team, and to develop a mind map that helps to rethink the palliative approach to the person after heart transplantation. Methods: a descriptive study with a qualitative approach was carried out through a semi-structured interview with 17 health professionals. The constituted corpus was processed by the IRaMuTeQ software. Minayo's content analysis and mind map were used. Results:the narratives revealed difficulty in establishing criteria to indicate a person after heart transplantation for palliative care. Fear, prejudice and lack of knowledge delay the palliative approach. The mind map shows conditions that can be considered for the indication of palliative care for people after heart transplantation. Conclusion: the palliative approach in the context of heart transplantation, in the view of professionals, is permeated by negative feelings and lack of information on the part of the teams. The proposed mind map brought elements that can guide professionals for the insertion of the person after heart transplantation in the palliative approach.

Distribuição Espacial de Mortalidade por Insuficiência Cardíaca no Brasil, 1996-2017 / Spatial Distribution of Mortality for Heart Failure in Brazil, 1996 - 2017

Resumo Fundamento Insuficiência cardíaca (IC) é uma das principais causas de mortalidade e morbidade no mundo, e está associada ao alto uso de recursos e custos com saúde. No Brasil, a prevalência de IC é de aproximadamente 2 milhões de pacientes, e sua incidência é de aproximadamente 240.000 novos casos por ano. Objetivo A investigação objetivou analisar a tendência espaço-temporal da mortalidade causada por IC no Brasil, de 1996 a 2017. Métodos Este é um estudo ecológico desenvolvido com dados secundários sobre mortalidade por IC no Brasil. Durante o período, 1.242.014 casos de morte causada por IC foram analisados. A existência da autocorrelação espacial de casos foi calculada utilizando o Índice de Moran Global (IMG) e, quando significativo, o Índice de Moran Local, considerando p <0,05. O risco relativo dos grupos foi calculado. Resultados A taxa de mortalidade causada por IC foi diversificada em regiões brasileiras, com ênfase no sul, sudeste e nordeste. O IMG indicou autocorrelação espacial positiva (p=0,01) em todos os períodos. Cidades localizadas no sul, sudeste, nordeste e centro-oeste mostraram maior risco relativo para mortalidade causada por IC, e a maioria das cidades do norte foi classificada como um fator protetivo contra esta causa de morte. Conclusões O estudo demonstrou declínio nas taxas de mortalidade no território nacional. A maior concentração de taxas de mortalidade está nas regiões norte e nordeste, enfatizando as áreas prioritárias de vulnerabilidade no planejamento e estratégias de controle de serviços de saúde.

Abstract Background Heart failure (HF) is a leading cause of mortality and morbidity worldwide, and is associated with the high use of resources and healthcare costs. In Brazil, the HF prevalence is around 2 million patients, and its incidence is of approximately 240,000 new cases per year. Objective The present investigation aimed to analyze the spatiotemporal trend of mortality caused by HF in Brazil, from 1996 to 2017. Methods This is an ecological study developed with secondary data on HF mortality in Brazil. During the period, 1,242,014 cases of death caused by heart failure were analyzed. The existence of spatial autocorrelation of cases was calculated using the Global Moran Index (GMI) and, when significant, the Local Moran Index, considering p<0.05. The relative risk of the clusters was calculated. Results The mortality rate due to HF was diversified in all Brazilian regions, with an emphasis in the South, Southeast, and Northeast. The GMI indicated positive spatial autocorrelation (p=0.01) in all periods. Municipalities located in the South, Southeast, Northeast, and Midwest showed a higher Relative Risk for mortality from HF, and most municipalities in the North were classified as a protective factor against this cause of death. Conclusions The study showed a decline in mortality rates across the national territory. The highest concentration of mortality rates is in the North and Northeast regions, highlighting priority vulnerable areas in the planning and controlling strategies of health services.

Vulnerabilidade à inatividade física: validação de conteúdo dos marcadores para adultos / Vulnerabilidad a la inactividad física: validación de contenido de los marcadores para adultos / Vulnerability to physical inactivity: content validation of markers for adults

Resumo Objetivo Objetivou-se validar o conteúdo dos marcadores de vulnerabilidade à inatividade física em adultos. Métodos Estudo metodológico, fundamentado na Psicometria, que visa à elaboração das definições constitutivas e operacionais dos marcadores de vulnerabilidade à inatividade física em adultos e sua validação de conteúdo por especialistas. Os dados foram analisados mediante cálculo do Índice de Validade de Conteúdo (IVC) e Teste Binomial. Resultados Participaram da validação 13 juízes, profissionais da área da saúde, pesquisadores com publicações sobre o tema, provenientes de sete Estados brasileiros (Ceará, Pernambuco, Piauí, Bahia, Amazonas, Santa Catarina e Rio de Janeiro). Foram validados 40 marcadores, com 40 definições constitutivas e 133 definições operacionais. Esses foram agrupados em duas dimensões inter-relacionadas (Sujeito e Social) e 12 subdimensões (Situação Física, Situação Psicoemocional, Comportamento, Letramento Funcional, Relações Interpessoais, Perfil Socidemográfico, Ambiente, Políticas, Contexto Institucional, Cultura, Direitos Fundamentais). Todos apresentaram IVC excelentes (≥ 0,78). Conclusão Os marcadores propostos apresentaram parâmetros adequados de validade e podem ser usados para operacionalizar a mensuração do fenômeno vulnerabilidade à inatividade física na construção de instrumentos e estratégias para o cuidado de pacientes e enfrentamento da inatividade física.

Resumen Objetivo Validar el contenido de los marcadores de vulnerabilidad a la inactividad física en adultos. Métodos Estudio metodológico, fundamentado en la psicometría, que busca elaborar las definiciones constitutivas y operativas de los marcadores de vulnerabilidad a la inactividad física en adultos y su validación de contenido por especialistas. Los datos fueron analizados mediante cálculo del Índice de Validez de Contenido (IVC) y prueba binominal. Resultados Participaron de la validación 13 jueces, profesionales del área de la salud, investigadores con publicaciones sobre el tema, provenientes de siete estados brasileños (Ceará, Pernambuco, Piauí, Bahia, Amazonas, Santa Catarina y Rio de Janeiro). Fueron validados 40 marcadores, con 40 definiciones constitutivas y 133 definiciones operativas. Fueron agrupados en dos dimensiones interrelacionadas (Sujeto y Social) y 12 subdimensiones (Situación física, Situación psicosocial, Comportamiento, Alfabetización funcional, Relaciones interpersonales, Perfil sociodemográfico, Ambiente, Políticas, Contexto institucional, Cultura, Derechos fundamentales). Todos presentaron IVC excelente (≥ 0,78). Conclusión Los marcadores propuestos presentan parámetros adecuados de validez y pueden ser usados para operacionalizar la medición del fenómeno vulnerabilidad a la inactividad física en la elaboración de instrumentos y estrategias para el cuidado de pacientes y afrontamiento de la inactividad física.

Abstract Objective To validate the content of markers of vulnerability to physical inactivity in adults. Methods This is a methodological study, based on psychometrics, which aims to develop constitutive and operational definitions of markers of vulnerability to physical inactivity in adults and content validation by experts. Data were analyzed by calculating Content Validity Index (CVI) and binomial test. Results Thirteen judges, health professionals, researchers with publications on the subject, from seven Brazilian states (Ceará, Pernambuco, Piauí, Bahia, Amazonas, Santa Catarina and Rio de Janeiro), participated in the validation. A total of 40 markers were validated, with 40 constitutive definitions and 133 operational definitions. These were grouped into two interrelated dimensions (subject and social) and 12 subdimensions (physical situation, psycho-emotional situation, behavior, functional literacy, interpersonal relationships, sociodemographic profile, environment, policies, institutional context, culture, fundamental rights). All had excellent CVI (≥ 0.78). Conclusion The proposed markers presented adequate parameters of validity and can be used to operationalize the measurement of vulnerability to physical inactivity phenomenon in the construction of instruments and strategies for patient care and coping with physical inactivity.

Diabetes mellitus e gravidade por COVID-19 em brasileiros hospitalizados / Diabetes mellitus and severity by COVID-19 in hospitalized Brazilians

RESUMO Objetivo estimar a prevalência de gravidade de casos hospitalizados de COVID-19 e sua associação com o diabetes mellitus. Métodos estudo transversal, que utilizou base de dados secundários do Sistema de Informação de Vigilância Epidemiológica da Gripe, totalizando 405.294 casos confirmados. Para verificar a associação do diabetes e a gravidade em pacientes com COVID-19 hospitalizados, foram usados modelos de regressão de Poisson com estimador de variância robusta. Inicialmente, verificou-se a associação da doença com o desfecho; em seguida, foram realizados diversos ajustes para os potenciais confundidores. Resultados a prevalência de diabetes nos 405.294 casos hospitalizados e positivos foi de 25,7% (Intervalo de Confiança: 25,5% - 25,8%). Após ajustes, observou-se que a diabetes aumentou a gravidade da COVID-19 em 19% (Intervalo de Confiança: 1,17 - 2,21). Conclusão identificou-se associação importante do diabetes mellitus com casos graves de infecção pela COVID-19. Contribuições para a prática: a evidência gerada pelo estudo guia a estratificação de risco de pacientes e direciona o manejo clínico.

ABSTRACT Objective to estimate the prevalence of severity of hospitalized cases of COVID-19 and its association with diabetes mellitus. Methods a cross-sectional study, which used secondary data from the Influenza Epidemiological Surveillance Information System, totaling 405,294 confirmed cases. To verify the association of diabetes and severity in hospitalized patients with COVID-19, Poisson regression models with robust variance estimator were used. Initially, the association of disease with outcome was verified; next, several adjustments for potential confounders were performed. Results the prevalence of diabetes in the 405,294 hospitalized and positive cases was 25.7% (Confidence Interval: 25.5% - 25.8%). After adjustments, diabetes was found to increase the severity of COVID-19 by 19% (Confidence Interval: 1.17 - 2.21). Conclusion a significant association of diabetes mellitus with severe cases of COVID-19 infection has been identified. Contributions to practice: the evidence generated by the study guides the risk stratification of patients and directs clinical management.