Factors associated with changes in plantar pressure of people with peripheral diabetic neuropathy.

Abstract: Diabetic neuropathy is one of the main complications of Diabetes Mellitus, which can lead to loss of protective sensation, motor, and plantar pressure alteration, generating deformities, abnormal gait and mechanical trauma to the feet. Objective: to evaluate the distribution of plantar pressure, sensorimotor changes, balance and associated factors to plantar pressure changes in people with peripheral diabetic neuropathy. Method: Cross-sectional study conducted with individuals registered in the primary public health service of a city in the east of São Paulo - Brazil. The sample was composed by people with Diabetes Mellitus and Peripheral Neuropathy identified by the Michigan Screening Instrument. It were investigated variables such as sensory-motor changes, static and dynamic plantar pressure using baropodometry and balance using the Berg scale. A significance level of 5% was adopted for all tests used. Results: Of the 200 individuals evaluated, 52.55% had no plantar protective sensitivity, the static evaluation did not demonstrated changes in the peak of plantar pressure, however in the dynamics the mean in the right foot was 6.0 (±2) kgf/cm2 and 6,7 (±1.62) kgf/cm2 on the left foot, the center of static pressure on the right foot was lower (10.55 ± 3.82) than on the left foot (11.97 ± 3.90), pointing hyper plantar pressure. The risk of falling was high, ranging from 8 to 56 points, with an average of 40.9 (±10.77). Conclusion: The absence of protective plantar sensitivity, increased pressure, biomechanical changes lead to loss of balance and are predictive of complications in the feet due to diabetic neuropathy.

Rastreamento de risco de ulceração nos pés em participantes de campanhas de prevenção e detecção do diabetes mellitus / Rastreo de riesgo de ulceración en los pies de participantes de campañas de prevención y de detección de diabetes mellitus / Foot ulcer risk screening in prevention campaign participants and detection of diabetes mellitus

Resumo Objetivo Analisar as características clínicas e sociodemográficas relacionadas ao rastreamento de risco de ulcerações nos pés em participantes de campanhas de detecção do diabetes mellitus. Métodos Estudo seccional conduzido durante campanhas de detecção do diabetes mellitus realizadas pela Associação Nacional de Assistência ao Diabético ANAD, entre 2013 e 2017, na cidade de São Paulo para a detecção do risco de ulceração nos pés segundo variáveis demográficas e clínicas. A população do estudo foi composta por pessoas com ou sem diagnóstico prévio de diabetes. Os instrumentos de coleta utilizados foram a entrevista e o exame físico específico dos pés dos participantes. Aplicaram-se cálculos das medidas referentes às variáveis qualitativas e testes do qui quadrado e Exato de Fisher. Resultados Um total de 2.110 pessoas foram analisadas, a maioria do sexo feminino, média de idade de 64 anos, ensino fundamental, predominância de diabetes mellitus tipo 2. Identificou-se associação entre os graus de risco de ulcerações nos pés e duração da doença (p=0,021), ausência de higiene nos pés (p=0,029), pele ressecada, alteração da sensação protetora plantar, pulsos periféricos ausentes, presença de onicomicose, deformidades, úlcera e amputação (p<0,001) e 65,5% dos participantes referiram não ter recebido orientações prévias para os cuidados com os pés. Conclusão Os sinais de risco para ulcerações nos pés durante as campanhas de detecção do diabetes foram identificados e contribuem para o rastreamento das complicações e se constituem em estratégias para as ações de prevenção realizadas por estudantes de extensão acadêmica.

Resumen Objetivo Analizar las características clínicas y sociodemográficas relacionadas al rastreo de riesgo de ulceraciones en los pies de participantes de campañas de detección de diabetes mellitus. Métodos Estudio seccional conducido durante campañas de detección de diabetes mellitus realizadas por la Asociación Nacional de Atención al Diabético ANAD, entre 2013 y 2017, en la ciudad de São Paulo, para la detección del riesgo de ulceración en los pies de acuerdo con variables demográficas y clínicas. La población del estudio estuvo compuesta por personas con o sin diagnóstico previo de diabetes. Los instrumentos utilizados para la recopilación fueron la entrevista y el examen físico específico de los pies de los participantes. Se aplicaron cálculos de las medidas referentes a las variables cualitativas y pruebas de Ji cuadrado y Exacta de Fisher. Resultados Se analizaron un total de 2.110 personas, en su mayoría del sexo femenino, promedio de edad de 64 años, educación primaria, predominio de diabetes mellitus tipo 2. Se identificó una asociación entre los grados de riesgo de ulceraciones en los pies y la duración de la enfermedad (p=0,021), la ausencia de higiene en los pies (p=0,029), piel seca, alteración de la sensación protectora plantar, pulsos periféricos ausentes, presencia de onicomicosis, deformidades, úlcera y amputación (p<0,001). El 65,5 % de los participantes mencionó no haber recibido orientaciones previas sobre los cuidados de los pies. Conclusión Se identificaron las señales de riesgo de ulceraciones en los pies durante las campañas de detección de diabetes. Esto contribuye al rastreo de complicaciones y se refleja en estrategias para las acciones de prevención realizadas por estudiantes de extensión académica.

Abstract Objective To analyze the clinical and sociodemographic characteristics related to foot ulcer risk screening in participants of diabetes mellitus detection campaigns. Methods This is a cross-sectional study conducted during diabetes mellitus detection campaigns carried out by the Brazilian National Association for Diabetic Care (ANAD - Associação Nacional de Atenção ao Diabetes), between 2013 and 2017, in the city of São Paulo, to detect foot ulceration risk according to demographic and clinical variables. The study population consisted of people with or without a previous diagnosis of diabetes. The collection instruments used were the interview and the specific physical examination of participants' feet. Measurements relating to qualitative variables and chi-square and Fisher's exact tests were applied. Results We assessed 2,110 people, most of them female, mean age of 64 years, complete elementary school, predominance of type 2 diabetes mellitus. An association was identified between the degrees of foot ulcer risk and disease duration (p=0.021), lack of foot hygiene (p=0.029), dry skin, change in plantar protective sensation, absent peripheral pulses, presence of onychomycosis, deformities, ulcer and amputation (p<0.001), and 65.5% of participants reported not having received previous guidance for foot care. Conclusion The signs of foot ulceration risk during diabetes detection campaigns were identified and contributed to screening complications, being strategies for prevention actions carried out by academic extension students.

Construction and validation of an instrument for classifying nipple and areola complex lesions resulting from breastfeeding / Construcción y validación de un instrumento para la clasificación de las lesiones areolares del pezón derivadas de la lactancia / Construção e validação de um instrumento de classificação das lesões mamilo-areolares decorrentes da amamentação

ABSTRACT Objectives: to construct and validate a classification of nipple and areola complex lesions resulting from breastfeeding, according to content and appearance. Methods: this is a methodological study, developed in four stages: operational definition, instrument construction, content and appearance validation. The Delphi technique and a Likert-type scale were used to validate content and appearance, through the participation of ten and sixteen judges, respectively. For analysis, Content Validity Index and Kappa Coefficient were applied. Results: Content Validity Index obtained an overall value of 0.93 and, for appearance, 0.94. Kappa values ranged between 0.46 and 1. The high rates of agreement among judges demonstrated the quality of the proposed content validity. Conclusions: the Nipple and Areola Complex Lesions Classification Instrument developed obtained acceptable values of its indexes, proving to be valid in terms of content and appearance.

RESUMEN Objetivos: construir y validar una clasificación de las lesiones pezón-areolares resultantes de la lactancia materna según su contenido y apariencia. Métodos: estudio metodológico, desarrollado en cuatro etapas: definición operativa, construcción del instrumento, validación de contenido y apariencia. Para validar contenido y apariencia se utilizó la técnica Delphi y la escala tipo Likert, mediante la participación de diez y dieciséis jueces, respectivamente. Para el análisis se aplicó el Índice de Validez de Contenido y el Coeficiente Kappa. Resultados: el Índice de Validez de Contenido obtuvo un valor global de 0,93 y, por apariencia, 0,94. Los valores de Kappa oscilaron entre 0,46 y 1. Las altas tasas de acuerdo entre los jueces demostraron la calidad de la validez del contenido propuesto. Conclusiones: el Instrumento de Clasificación de Lesiones Pezón-Areolares desarrollado obtuvo valores aceptables para sus índices, demostrando ser válido en términos de contenido y apariencia.

RESUMO Objetivos: construir e validar uma classificação das lesões mamilo-areolares decorrentes da amamentação segundo conteúdo e aparência. Métodos: estudo metodológico, desenvolvido em quatro etapas: definição operacional, construção do instrumento, validação de conteúdo e de aparência. Utilizaram-se a técnica Delphi e a escala tipo Likert para a validação de conteúdo e de aparência, por meio da participação de dez e dezesseis juízes, respectivamente. Para análise, aplicou-se o Índice de Validade de Conteúdo e o Coeficiente Kappa. Resultados: o Índice de Validade de Conteúdo obteve valor global de 0,93 e, de aparência, 0,94. Os valores de Kappa variaram entre 0,46 e 1. As altas taxas de concordância entre os juízes demonstraram a qualidade da validade de conteúdo proposta. Conclusões: o Instrumento de Classificação das Lesões Mamilo-Areolares desenvolvido obteve valores aceitáveis de seus índices, mostrando-se válido quanto ao conteúdo e aparência.

Construction and validation of an instrument for classifying nipple and areola complex lesions resulting from breastfeeding.

OBJECTIVES: to construct and validate a classification of nipple and areola complex lesions resulting from breastfeeding, according to content and appearance. METHODS: this is a methodological study, developed in four stages: operational definition, instrument construction, content and appearance validation. The Delphi technique and a Likert-type scale were used to validate content and appearance, through the participation of ten and sixteen judges, respectively. For analysis, Content Validity Index and Kappa Coefficient were applied. RESULTS: Content Validity Index obtained an overall value of 0.93 and, for appearance, 0.94. Kappa values ranged between 0.46 and 1. The high rates of agreement among judges demonstrated the quality of the proposed content validity. CONCLUSIONS: the Nipple and Areola Complex Lesions Classification Instrument developed obtained acceptable values of its indexes, proving to be valid in terms of content and appearance.

Dor devido à polineuropatia simétrica distal em diabetes mellitus / Dolor por polineuropatía simétrica distal en la diabetes mellitus / Distal Symmetric Polyneuropathy Pain in Diabetes Mellitus

Objective: To evaluate neuropathic pain (NP), its intensity, and complications in people with type 2 diabetes mellitus (T2DM) in a city of eastern São Paulo. Method: Cross-sectional study conducted with 96 individuals with T2DM served by primary health units in São João da Boa Vista-SP. The following instruments were used to screen NP: Michigan Neuropathy Screening Instrument, Leeds Assessment of Neuropathic Symptoms and Signs, Douleur Neuropathique 4, and Brief Pain Inventory. The data were analyzed using descriptive and inferential statistics, with a 5 % significance level. Results: Of the 96 people with T2DM for longer than five years, 22.9 % had pain. NP was related to high levels of fasting blood glucose (mean = 214 ± 65.58 mg/dl; p = 0.0002), glycated hemoglobin (mean = 8.8 ± 0.11 %; p < 0.001), absence of a balanced diet (p = 0.0066), obesity (p = 0.023), and high blood pressure (p < 0.001). Conclusion: Higher values ​​of glycated hemoglobin rates increased three times the chance of NP. The screening and management of painful diabetic neuropathy is a challenge but adopting a screening protocol supports the secondary prevention of this manifestation.

Objetivo: evaluar el dolor neuropático (DN), su intensidad y sus complicaciones en personas con diabetes mellitus tipo 2 (DM2) en una ciudad del este de São Paulo. Método: estudio transversal realizado con 96 individuos con DM2 atendidos en unidades básicas de salud en São João da Boa Vista-SP. Se utilizaron los siguientes instrumentos para rastrear el DN: el instrumento para la detección de la neuropatía de Michigan, la evaluación de signos y síntomas neuropáticos de Leeds, el cuestionario Douleur Neuropathique 4 y el inventario breve del dolor. Los datos se analizaron mediante estadística descriptiva e inferencial, con un nivel de significancia del 5 %. Resultados: de las 96 personas con DM2 durante más de cinco años, el 22,9 % tenía dolor. El DN se relacionó con niveles altos de glucosa en sangre en ayunas (media = 214 ± 65,58 mg/dl; p = 0,0002), la hemoglobina glucosilada (media = 8,8 ± 0,11 %; p < 0,001), la ausencia de una dieta (p = 0,0066), la obesidad (p = 0,023) y la hipertensión arterial (p < 0,001). Conclusión: los altos valores en las tasas de hemoglobina glucosilada aumentaron tres veces la probabilidad de DN. La detección y el tratamiento de la neuropatía diabética dolorosa es un desafío, pero la adopción de un protocolo de detección contribuye a la prevención secundaria de esta manifestación.

Objetivo: avaliar a dor neuropática (DN), sua intensidade e suas complicações em pessoas com diabetes mellitus tipo 2 (DM2) numa cidade do leste de São Paulo, Brasil. Método: estudo transversal realizado com 96 indivíduos com DM2 atendidos em unidades básicas de saúde em São João da Boa Vista, São Paulo. Foram utilizados os seguintes instrumentos para rastrear a DN: o instrumento para detectar a neuropatia de Michigan, a avaliação de sinais e sintomas neuropáticos de Leeds, o questionário de Douleur Neuropathique 4 e a escala breve da dor. Os dados foram analisados por meio de estatística descritiva e inferencial, com um nível de significância de 5 %. Resultados: das 96 pessoas com DM2 durante mais de cinco anos, 22,9 % sentiam dor. A DN esteve relacionada com níveis altos de glicose em sangue em jejum (média = 214 ± 65,58 mg/dl; p = 0,0002), hemoglobina glicosilada (média = 8,8 ± 0,11 %; p < 0,001), ausência de dieta (p = 0,0066), obesidade (p = 0,023) e hipertensão arterial (p < 0,001). Conclusões: os altos valores nas taxas de hemoglobina glicosilada aumentaram três vezes a probabilidade de DN. A detecção e o tratamento da neuropatia diabética dolorosa são um desafio, mas a adoção de um protocolo de detecção contribui para a prevenção secundária dessa manifestação.

Development and validation of a pocket guide for the prevention of diabetic foot ulcers.

OBJECTIVE: Diabetic foot ulcers can have serious consequences, including amputation. This project aimed to develop and validate a diabetes care management model-a pocket guide on the prevention of foot ulceration to assist health professionals and scientific societies. METHODS: An adaptation of the Iowa method of evidence-based practice to promote high-quality care was employed. After problems are identified, the Iowa method supports the development of an action plan for addressing them. An evidence-based protocol based on the five cornerstones of the 2015 guidance on the diabetic foot by the International Working Group on the Diabetic Foot was developed in two phases and validated using the Delphi technique. RESULTS: A model was developed to promote these five cornerstones, which are the main recommendations for managing the diabetic foot. These are: foot examination; risk assessment for ulceration; education in diabetes; appropriate footwear; and treatment of pre-ulcerative lesions. To adapt this into a health information document, the management model was synthesised and designed as a pocket guide. The model's individual and global content validity indices surpass 0.78 and 0.90 respectively. CONCLUSION: A management model was created and validated, and produced as a pocket guide to deliver instructions on the care and prevention of diabetic foot problems in people with diabetes.

Fatores sociodemográficos, clínicos e psicossociais correlacionados ao autocuidado em diabetes / Sociodemographic, clinical and psychosocial factors related to diabetes self-care / Factores sociodemográficos, clínicos y psicosociales relacionados con el autocuidado de la diabetes

Resumo Introdução Apesar de haver elucidação científica sobre diversos fatores intervenientes na adesão ao autocuidado em diabetes, lacunas ainda existem, principalmente em relação aos comportamentos de autocuidado entre pessoas com perfis socioeconômicos distintos. O objetivo do estudo foi identificar a adesão ao autocuidado em diabetes e correlações com fatores sociodemográficos, clínicos e psicossociais, entre usuários do sistema de saúde suplementar, em São Paulo. Materiais e Métodos Estudo transversal, com 214 participantes com diabetes tipo 2, que utilizou as versões brasileiras dos: The Summary of Diabetes Self-Care Activities; Diabetes Attitudes Questionnaire e Diabetes Empowerment Scale. Utilizou-se um modelo de regressão múltipla (método Stepwise Backward) para delinear as correlações entre as variáveis. Resultados Os participantes revelaram adesão moderada ao autocuidado global. Ser mulher, casada/em união estável, aposentada, com maior tempo de diagnóstico e atitude mais positiva frente o diabetes explicaram 93,0% da variância do autocuidado global. Discussão O estudo é inédito ao caracterizar o autocuidado em diabetes entre usuários do sistema de saúde suplementar no Brasil. Os resultados semelhantes a estudos nacionais e internacionais sugerem que, dada a complexidade da doença, o autocuidado com o diabetes é constantemente negligenciado e requer maior capacitação dos profissionais de saúde para lidar com os aspectos psicossociais associados. Conclusão Os resultados sugerem que as intervenções educativas para promover o autocuidado sejam desenhadas levando em consideração o perfil sociodemográfico e clínico dos participantes e considerem a promoção da autoeficácia para diminuir a atitude negativa frente o diabetes.

Abstract Introduction Although science has discovered several factors involved in diabetes self-care, there are still some gaps especially regarding self-care behaviors among people with different socioeconomic statuses. The objective of this study is to identify adherence to diabetes self-care and its correlation with sociodemographic, clinical and psychosocial factors among users of the supplementary health system in Sao Paulo. Materials and Methods A cross-sectional study was conducted with 214 participants who had type 2 diabetes by using the Brazilian versions of the Summary of Diabetes Self-Care Activities Measure, Diabetes Attitudes Scale and Diabetes Empowerment Scale. A multiple linear regression model (backward stepwise regression) was used to delineate the correlations between variables. Results Participants showed moderate adherence to general self-care. Factors such as being a woman, being married/in a stable union, being retired, having been diagnosed for a longer time and showing a more positive attitude towards diabetes explained 93.0% of the variance in general self-care. Discussion This is an unprecedented study in the characterization of diabetes self-care among users of the supplementary health system in Brazil. Although the results are similar to those of national and international studies, they suggest that, given the complexity of the disease, diabetes self-care is constantly neglected and more training is required among healthcare professionals to address related psychosocial factors. Conclusions The results suggest that educational interventions for the promotion of diabetes self-care should be developed taking into account the sociodemographic and clinical profile of the participants, as well as the promotion of self-efficacy to decrease negative attitudes towards diabetes.

Resumen Introducción Aunque la ciencia ha descubierto diversos factores que intervienen en el autocuidado de la diabetes, todavía quedan algunos vacíos sobre todo en lo que respecta a los comportamientos de autocuidado entre personas con diferentes características socioeconómicas. El objetivo del presente estudio fue identificar la adherencia al autocuidado de la diabetes y su correlación con factores sociodemográficos, clínicos y psicosociales entre los usuarios del sistema de salud suplementaria en Sao Paulo. Materiales y métodos Se realizó un estudio transversal con 214 participantes que padecían diabetes tipo 2, en el que se utilizaron las versiones brasileñas del cuestionario de actividades de autocuidado en diabetes, el cuestionario de actitudes sobre diabetes y la escala de empoderamiento de la diabetes. Se empleó un modelo de regresión lineal múltiple (método regresión stepwise) para delinear las correlaciones entre las variables. Resultados Los participantes mostraron una adherencia moderada al autocuidado global. Factores como ser mujer, estar casado/en unión libre estable, ser jubilado, tener más tiempo de diagnóstico y mostrar una actitud más positiva frente a la diabetes explicaron el 93.0% de la varianza en el autocuidado global. Discusión El estudio es inédito en la caracterización del autocuidado de la diabetes entre los usuarios del sistema de salud complementaria en Brasil. Si bien los resultados son similares a los de estudios nacionales e internacionales, estos se sugieren que, dada la complejidad de la enfermedad, el autocuidado de la diabetes se descuida constantemente y se requiere una mayor formación entre los profesionales de la salud para tratar los aspectos psicosociales asociados. Conclusión Los resultados sugieren que las intervenciones educativas para la promoción del autocuidado deben diseñarse teniendo en cuenta el perfil sociodemográfico y clínico de los participantes, así como la promoción de la autoeficacia para disminuir la actitud negativa hacia la diabetes.

COVID-19 patients in prone position: validation of instructional materials for pressure injury prevention.

OBJECTIVE: to perform the content and face validation of a checklist and a banner on pressure injury prevention in patients in prone position. METHOD: this is a methodological study of content and face validation with 26 nurses with specialization. Professionals assessed the checklist and the banner in relation to clarity, theoretical relevance, practical relevance, relation of the figures to the text and font size. The Content Validity Index was calculated for each item, considering one with a value equal to or greater than 0.8 as valid. RESULTS: all the actions described in the checklist and in the banner had a Content Validity Index greater than 0.80, with standardization of verbal time and esthetic adjustments in the banner's layout, as suggested. CONCLUSIONS: the checklist and the banner were validated and can be used in clinical practice to facilitate pressure injury preventions in patients in prone position.

Digital educational technology for care management of diabetes mellitus people's feet.

OBJECTIVE: to develop and validate a distance learning course aimed at the pillars of care management of diabetes mellitus people's feet. METHOD: a technological production research using Moodle Virtual Learning Environment, based on Andragogy, Constructionism and Instructional Design. Content is based on consensus guidelines on diabetic foot. Validation was carried out by distance education, diabetes and/or diabetic foot experts. RESULTS: the course's content is based on diabetic foot guidelines, and is structured in units with didactic material, videos, forums and questionnaires to assess the participants' learning. The judges considered it appropriate to meet nurses' needs in clinical practice. CONCLUSION: the virtual learning course has been validated, being a promising strategy for training nurses on care management of diabetes mellitus people's feet.

Topical Oxygen Jet Therapy (TOJT) for treating infected chronic surgical wounds.

OBJECTIVES: To evaluate the effectiveness of Topical Oxygen Jet Therapy (TOJT) in the treatment of surgical wounds in adult patients who has clinical signs of infection for over 30 days; and to identify the pathogens causing complicated skin and soft tissue infections. METHOD: Parallel, randomized clinical trials randomly divided into "Control Group" (CG) and "Treatment Group" (TG), which were followed up for 10 consecutive days. Venous antibiotics and dressings were used in both groups. In addition, TOJT were used on the wounds in the TG. The outcome criteria were based on clinical indicators: Pressure Ulcer Scale for Healing (PUSH) and Visual Analog Scale Pain (VAS). The paired t-test or Wilcoxon, chi-squared or Fisher's exact test, and Student's t-test or Mann-Whitney tests were used with a significance level of 5%. RESULTS: 73 inpatients were included and followed up: 39 in TG and 34, CG. There were no significant differences in socio-demographic variables or of initial laboratory tests, except for blood glucose that was higher in TG than in CG (p = 0.044). Ten days into treatment, both the area of PUSH wounds (p < 0.001) and the pain scale (p = 0.029) were significantly reduced in TG. Staphylococcus aureus was the most prevalent pathogen (40%) with no significant difference between the two groups. DISCUSSION: Although the follow-up time was of only ten days, a significant improvement was observed in TG. As a limitation of the study, the small sample size precluded the comparison of S. aureus infections between the two groups. CONCLUSION: TOJT accelerated the healing process, reduced pain and contributed to an improvement in the clinical status of the wounds when compared to CG. These findings demonstrate the effectiveness and relevance of the employed technique. It can be easily incorporated as a routine procedure in hospitals without extra investment.

Neuropathic pain screening for diabetes mellitus: a conceptual analysis / Rastreamento de dor neuropática para diabetes mellitus: uma análise conceitual

ABSTRACT BACKGROUND AND OBJECTIVES: The assessment and early diagnosis of neuropathic pain associated to Peripheral Diabetic Neuropathy has been a challenge in clinical practice, requiring the systematization of risk tracking through the identification of specific instruments to guide treatment. The objective of this study was to identify specific instruments for tracking neuropathic pain and Peripheral Diabetic Neuropathy in order to build a protocol. CONTENTS: Integrative review using the indexed databases Scielo, Cochrane and Pubmed between 2007 and 2020, identifying the most used validated instruments in high predictive value for tracking Peripheral Diabetic Neuropathy and neuropathic pain, building a specific protocol directing clinical treatment. 44 selected articles pointed out 14 different instruments for screening of Peripheral Diabetic Neuropathy and neuropathic pain, most prevalent being: the Screening Instrument for Assessment of Peripheral Diabetic Neuropathy (MNSI), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) and Douleur Neuropathique (DN4) for clinical assessment of neuropathic pain and Brief Pain Inventory (BPI) for numerical pain assessment, highlighted by their predictive values above 80%. CONCLUSION: Such instruments enable the development of a neuropathic pain screening protocol that will assist in the early diagnosis of this complication in Diabetes, directing clinical and physiotherapeutic treatment.

RESUMO JUSTIFICATIVA E OBJETIVOS: A avaliação e o diagnóstico precoce da dor neuropática associada à neuropatia diabética periférica tem sido um desafio na prática clínica, sendo necessária a sistematização de um rastreamento de risco por meio da identificação de instrumentos específicos que direcionem o tratamento. O objetivo deste estudo foi identificar instrumentos específicos para rastreamento da dor neuropática e Neuropatia Diabética Periférica para construção de um protocolo. CONTEÚDO: Revisão integrativa utilizando as bases de dados indexadas Scielo, Cochrane e Pubmed entre 2007 e 2020, identificando os instrumentos validados mais utilizados com alto valor preditivo para rastreamento da neuropatia diabética periférica e dor neuropática, construindo um protocolo específico direcionando o tratamento clínico. Quarenta e quatro artigos selecionados apontaram 14 diferentes instrumentos para o rastreamento da neuropatia diabética periférica e dor neuropática, entre os mais prevalentes: o Screening instrument for classification of Peripheral Diabetic Neuropathy (SPDN), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) e Douleur Neuropathique (DN4) para avaliação clínica da dor neuropática e Brief Pain Inventory (BPI) para avaliação numérica da dor, destacados por seus valores preditivos acima de 80%. CONCLUSÃO: Tais instrumentos possibilitaram o desenvolvimento de um protocolo de rastreamento da dor neuropática que auxiliará no diagnóstico precoce desta complicação na diabetes, direcionando o tratamento clínico e fisioterapêutico.

Qualidade de vida de idosos brasileiros e portugueses: uma análise comparativa / Análisis comparativo de la calidad de vida de los adultos mayores de Brasil y Portugal / Quality of Life in Older Adults in Brazil and Portugal: A Comparative Analysis

Introdução: A longevidade tornou-se uma das maiores conquistas da segunda metade do século XX. Objetivo: Comparar a qualidade de vida de idosos brasileiros e portugueses usuários da atenção primária à saúde. Materiais e Métodos: Estudo quantitativo, transversal e comparativo, aplicado a amostra probabilística englobando 294 idosos acompanhados pela Saúde da Família divididos em dois grupos: 130 idosos em Benevides/Brasil, e 164 em Coimbra/Portugal, no período de 2015-2017. A caracterização sociodemográfica e avaliação da qualidade de vida foram obtidos pelo instrumento World Health Organization Questionnaire of Quality of Life (WHOQOL-bref), consta de 26 questões divididas em quatro domínios: físico, psicológico, relações sociais e meio ambiente. Aplicado o Teste U de Mann-Whitney para análise estatística comparativa. Resultados: Nos grupos verificou-se predomínio do sexo feminino, casados, aposentados e com baixo grau de escolaridade (1 a 4 anos). A média da distribuição etária foi 70 anos para brasileiros e 76 anos para portugueses; na comparação da qualidade de vida, os idosos brasileiros obtiveram os melhores escores no domínio psicológico (79,1) enquanto portugueses tiveram melhor escore no domínio meio ambiente (65,6). Em Benevides o escore mais baixo foi o domínio meio ambiente (56,3) e, em Coimbra, o domínio com escore mais baixo foi o físico (60,7). Discussão: A qualidade de vida no envelhecimento é importante preditor para a preservação da autonomia do idoso. Conclusões: Estes resultados ampliam a concepção da importância da atenção integral no processo de envelhecimento com vista a proporcionar melhor qualidade de vida contribuindo para satisfazer as necessidades especificas da população idosa.

Introduction: Longevity is one of the greatest achievements in the last half of the 20th century. Objective: To compare the quality of life in older adults in Brazil and Portugal receiving primary health care. Materials and Methods: A comparative cross-sectional quantitative study was conducted with a probability sample of 294 older adults, who had been assisted with the Family Health strategy, being divided into two groups: 130 older adults living in Benevides, Brazil and 164 in Coimbra, Portugal during 2015 and 2017. The sociodemographic characterization and the quality of life assessment were determined through the WHO Quality of Life-BREF (WHOQOL-BREF), which consists of 26 questions assessing four domains: physical health, psychological health, social relationships and environment. The Mann-Whitney U test was applied for comparative statistical analysis. Results: There was a prevalence of married, retired women with a lower level of education (1 to 4 years) in the groups. The average age was 70 years in Brazil and 76 years in Portugal. In terms of quality of life, Brazilian older adults got better scores in the psychological health domain (79.1%) while Portuguese older adults scored best in the environmental domain (65.6%). The lowest scores were found in the environmental domain in Benevides (56.3%) and in the physical health domain in Coimbra (60.7%). Discussion: Quality of life in aging is a major predictor for the preservation of autonomy in older adults. Conclusion: These results help to broaden the importance of comprehensive care in the aging process to provide a better quality of life, which contributes to meeting the specific needs of older population.

Introducción: La longevidad se ha convertido en uno los mayores logros de la segunda mitad del siglo XX. Objetivo: Comparar la calidad de vida de los adultos mayores de Brasil y Portugal que reciben atención primaria de salud. Materiales y métodos: Se realizó un estudio cuantitativo transversal comparativo con una muestra probabilística de 294 adultos mayores que fueron acompañados por la estrategia de Salud Familiar y divididos en dos grupos: 130 adultos mayores ubicados en Benevides, Brasil y 164 en Coímbra, Portugal durante 2015 y 2017. La caracterización sociodemográfica y la evaluación de la calidad de vida se obtuvieron mediante el Cuestionario de Calidad de Vida de la Organización Mundial de la Salud (WHOQOL-BREF), que consta de 26 preguntas divididas en cuatro áreas: salud física, salud psicológica, relaciones sociales y ambiente. Se aplicó la prueba U de Mann-Whitney para el análisis estadístico comparativo. Resultados: En los grupos se observó el predominio de las mujeres casadas, jubiladas y con baja escolaridad (entre 1 y 4 años). La edad media fue de 70 años en Brasil y 76 años en Portugal. En cuanto a la calidad de vida, los adultos mayores brasileños obtuvieron mejores puntuaciones en el área de salud psicológica (79.1%) mientras que los adultos mayores portugueses tuvieron la mejor puntuación en el área ambiental (65.6%). Las puntuaciones más bajas se presentaron en el área ambiental en Benevides (56.3%) y en la salud física (60.7%) en Coímbra. Discusión: La calidad de vida en el proceso de envejecimiento es un importante predictor para la preservación de la autonomía de los adultos mayores. Conclusiones: Estos resultados amplían la concepción de la importancia de la atención integral en el proceso de envejecimiento para brindar una mejor calidad de vida, lo que contribuye a satisfacer las necesidades específicas de la población de edad avanzada.

COVID-19 patients in prone position: validation of instructional materials for pressure injury prevention / Pacientes con COVID-19 en decúbito prono: validación de materiales instructivos para la prevención de lesiones por presión / Pacientes com COVID-19 em prona: validação de materiais instrucionais para prevenção de lesões por pressão

ABSTRACT Objective: to perform the content and face validation of a checklist and a banner on pressure injury prevention in patients in prone position. Method: this is a methodological study of content and face validation with 26 nurses with specialization. Professionals assessed the checklist and the banner in relation to clarity, theoretical relevance, practical relevance, relation of the figures to the text and font size. The Content Validity Index was calculated for each item, considering one with a value equal to or greater than 0.8 as valid. Results: all the actions described in the checklist and in the banner had a Content Validity Index greater than 0.80, with standardization of verbal time and esthetic adjustments in the banner's layout, as suggested. Conclusions: the checklist and the banner were validated and can be used in clinical practice to facilitate pressure injury preventions in patients in prone position.

RESUMEN Objetivo: realizar la validación de contenido y rostro de un checklist y un banner sobre la prevención de úlceras por presión en pacientes en decúbito prono. Método: estudio metodológico de contenido y validación facial con 26 enfermeros con especialización. Los profesionales evaluaron el checklist y el banner en relación a la claridad, relevancia teórica, relevancia práctica, relación de las figuras con el texto y tamaño de fuente. Para cada ítem se calculó el Índice de Validez de Contenido, considerando válido aquel con valor igual o superior a 0,8. Resultados: todas las acciones descritas en el checklist y en el banner tuvieron un Índice de Validez de Contenido mayor a 0,80, con estandarización del tiempo verbal y ajustes estéticos en la maquetación del banner, como se sugirió. Conclusiones: el checklist y el banner fueron validados y pueden ser utilizados en la práctica clínica para facilitar la prevención de úlceras por presión en pacientes en decúbito prono.

RESUMO Objetivo: realizar a validação de conteúdo e de face de um checklist e de um banner sobre prevenção de lesão por pressão em pacientes na posição prona. Método: estudo metodológico de validação de conteúdo e de face com 26 enfermeiros com especialização. Os profissionais avaliaram o checklist e o banner em relação à clareza, pertinência teórica, relevância prática, relação das figuras com o texto e tamanho da fonte. O Índice de Validade de Conteúdo foi calculado para cada item, considerando válido aquele com valor igual ou superior a 0,8. Resultados: todas as ações descritas no checklist e no banner apresentaram Índice de Validade de Conteúdo superior a 0,80, com uniformização do tempo verbal e adequações estéticas na diagramação do banner, conforme sugestões. Conclusões: o checklist e o banner foram validados, podendo ser utilizados na prática clínica para facilitar a prevenção de lesões por pressão em pacientes na posição prona.

Topical Oxygen Jet Therapy (TOJT) for treating infected chronic surgical wounds

ABSTRACT Objectives: To evaluate the effectiveness of Topical Oxygen Jet Therapy (TOJT) in the treatment of surgical wounds in adult patients who has clinical signs of infection for over 30 days; and to identify the pathogens causing complicated skin and soft tissue infections. Method: Parallel, randomized clinical trials randomly divided into "Control Group" (CG) and "Treatment Group" (TG), which were followed up for 10 consecutive days. Venous antibiotics and dressings were used in both groups. In addition, TOJT were used on the wounds in the TG. The outcome criteria were based on clinical indicators: Pressure Ulcer Scale for Healing (PUSH) and Visual Analog Scale Pain (VAS). The paired t-test or Wilcoxon, chi-squared or Fisher's exact test, and Student's t-test or Mann-Whitney tests were used with a significance level of 5%. Results: 73 inpatients were included and followed up: 39 in TG and 34, CG. There were no significant differences in socio-demographic variables or of initial laboratory tests, except for blood glucose that was higher in TG than in CG (p = 0.044). Ten days into treatment, both the area of PUSH wounds (p < 0.001) and the pain scale (p = 0.029) were significantly reduced in TG. Staphylococcus aureus was the most prevalent pathogen (40%) with no significant difference between the two groups. Discussion: Although the follow-up time was of only ten days, a significant improvement was observed in TG. As a limitation of the study, the small sample size precluded the comparison of S. aureus infections between the two groups. Conclusion: TOJT accelerated the healing process, reduced pain and contributed to an improvement in the clinical status of the wounds when compared to CG. These findings demonstrate the effectiveness and relevance of the employed technique. It can be easily incorporated as a routine procedure in hospitals without extra investment.

Digital educational technology for care management of diabetes mellitus people's feet / Tecnología educativa digital para el manejo del cuidado de los pies de personas con diabetes mellitus / Tecnologia educacional digital para a gestão de cuidados dos pés de pessoas com diabetes mellitus

ABSTRACT Objective: to develop and validate a distance learning course aimed at the pillars of care management of diabetes mellitus people's feet. Method: a technological production research using Moodle Virtual Learning Environment, based on Andragogy, Constructionism and Instructional Design. Content is based on consensus guidelines on diabetic foot. Validation was carried out by distance education, diabetes and/or diabetic foot experts. Results: the course's content is based on diabetic foot guidelines, and is structured in units with didactic material, videos, forums and questionnaires to assess the participants' learning. The judges considered it appropriate to meet nurses' needs in clinical practice. Conclusion: the virtual learning course has been validated, being a promising strategy for training nurses on care management of diabetes mellitus people's feet.

RESUMEN Objetivos: desarrollar y validar un curso, en la modalidad a distancia, dirigido a los pilares del manejo del cuidado del pie de personas con diabetes mellitus. Método: investigación de producción tecnológica utilizando el Entorno Virtual de Aprendizaje Moodle, basado en Andragogía, Construccionismo y Modelo de Diseño Instruccional. El contenido se basa en las directrices de Consenso sobre el pie diabético. La validación fue realizada por jueces expertos en el campo de la educación a distancia, diabetes y/o pie diabético. Resultados: el contenido del curso se basa en las directrices sobre pie diabético, estando estructurado en unidades con material didáctico, videos, foros y cuestionarios para evaluar el aprendizaje de los participantes. Los jueces lo consideraron adecuado para satisfacer las necesidades de las enfermeras en la práctica clínica. Conclusión: se ha validado el curso virtual de aprendizaje, siendo una estrategia prometedora para la capacitación de enfermeros en la gestión del cuidado del pie para personas con diabetes

RESUMO Objetivos: desenvolver e validar um curso, na modalidade a distância, voltado para os pilares da gestão dos cuidados com os pés das pessoas com diabetes mellitus. Método: pesquisa de produção tecnológica utilizando o Ambiente Virtual de Aprendizagem Moodle, fundamentado na Andragogia, Construcionismo e Modelo de Design Instrucional. O conteúdo é baseado nas diretrizes do Consenso sobre o pé diabético. A validação foi realizada por juízes especialistas no campo da educação a distância, diabetes e/ou pé diabético. Resultados: o conteúdo do curso é baseado nas diretrizes sobre o pé diabético, sendo estruturado em unidades com material didático, vídeos, fóruns e questionários para avaliar a aprendizagem dos participantes. Os juízes consideraram adequado para atender às necessidades dos enfermeiros na prática clínica. Conclusão: o curso virtual de aprendizagem foi validado, sendo uma estratégia promissora para a qualificação de enfermeiros sobre gerenciamento dos cuidados com os pés de pessoas com diabetes.

A relação entre a mulher com diabetes e o seu corpo: o risco da diabulimia / La relación entre mujeres con diabetes y su cuerpo: el riesgo de diabulimia / The relationship between women with diabetes and their body: the risk of diabulimia

Resumo Objetivo compreender a relação que as mulheres com diabulimia têm com o corpo. Método pesquisa qualitativa, desenvolvida com o Método da História Oral Temática, com quatro mulheres entre 18 e 30 anos que autorreferiram diabulimia. Resultados a relação das mulheres com o seu corpo foi pautada pela pressão social de magreza feminina que distorce a autoimagem, gera insatisfação com o corpo e a diminuição da autoestima. A perda de peso é proporcionalmente associada ao aumento da aceitação social e justifica a utilização de métodos deletérios à saúde como a diminuição da dose ou a suspensão do uso de insulina. As narradoras demonstraram conhecer os riscos, mas admitiram repeti-la em determinados contextos. Considerações finais e implicações para a prática o desejo que as mulheres com Diabetes Mellitus têm de perder peso precisa ser incorporado às estratégias de cuidado com a atenção dos profissionais da saúde à subjetividade, atuando para reconhecer e prevenir os transtornos alimentares em mulheres com diabetes e minimizar a adoção de ações prejudiciais à saúde.

Resumen Objetivo comprender la relación que tienen las mujeres con diabulimia con el cuerpo. Método investigación cualitativa, desarrollada con el Método de Historia Oral Temática, con cuatro mujeres entre 18 y 30 años que autoinformado diabulimia. Resultados la relación de la mujer con su cuerpo estuvo guiada por la presión social de la delgadez femenina que distorsiona la imagen de sí misma, genera insatisfacción con el cuerpo y la disminución de la autoestima. La pérdida de peso se asocia proporcionalmente con una mayor aceptación social y justifica el uso de métodos nocivos para la salud, como reducir la dosis o suspender el uso de insulina. Los narradores demostraron conocer los riesgos, pero admitieron repetirlo en determinados contextos. Consideraciones finales e implicaciones para la práctica el deseo que tienen las mujeres con Diabetes Mellitus de adelgazar debe incorporarse a las estrategias de atención con la atención de los profesionales de la salud a la subjetividad, actuando para reconocer y prevenir los trastornos alimentarios en mujeres con diabetes y minimizar la adopción de acciones nocivas para la salud.

Abstract Objective to understand the relationship that women with diabulimia have with the body. Method a qualitative research, developed with the Thematic Oral History Method, with four women between 18 and 30 years of age who reported diabulimia. Results women's relationship with their bodies has been guided by the social pressure of female thinness that distorts self-image, generates dissatisfaction with the body and diminishes self-esteem. Weight loss is proportionally associated with increased social acceptance and justifies the use of harmful methods to health such as reducing the dose or suspending the use of insulin. The narrators showed to know the risks, but admitted to repeat it in certain contexts. Final considerations and implications for practice the desire that women with Diabetes Mellitus have to lose weight needs to be incorporated into the strategies of care with the attention of health professionals to subjectivity, acting to recognize and prevent eating disorders in women with diabetes and minimize the adoption of actions harmful to health.

Determinantes sociales y demográficos relacionados con la cicatrización de heridas en un centro de asistencia y educación en enfermería.

OBJECTIVE: Analyse the social and demographic variables that affect healing in patients with hard-to-heal wounds. METHOD: This retrospective study looked at 349 patient records of people with hard-to-heal wounds at an educational and care centre in San Pablo, Brazil, between 1994 and 2015. Healing was measured using the Pressure Ulcer Scale for Healing (PUSH). RESULTS: A total of 128 patient records were included. Most had identified themselves as white (62%), with an incomplete education (31%), household income under three minimum wages (86%), diabetes mellitus (61%), and systemic hypertension (58.4%). The PUSH scale varied between 4-7. The healing rate was 60%. Patients with white/yellow skin had 3.43 more chances to achieve healing (p<0,001). CONCLUSION: The social determinants observed were similar to Brazil's major inequality indicators. Statistical significance for white/yellow skin colour related to wound healing was observed. Nursing consultations contributed in achieving wound healing.

OBJETIVO: Analizar los determinantes sociodemográficos que influyen en la evolución de los pacientes con heridas de difícil cicatrización. MÉTODO: Este estudio epidemiológico retrospectivo analizó 349 historias clínicas de personas con heridas de difícil cicatrización en un centro de asistencia y educación en enfermería en San Pablo, Brasil, entre 1994 y 2015. Se usó la escala Pressure Ulcer Scale for Healing (PUSH) para evaluar la cicatrización. RESULTADOS: Se analizaron datos de 128 personas, la mayoría, adultos mayores. Los participantes se autodeclararon blancos (62%), con educación básica incompleta (31%), ingresos económicos familiares de hasta tres salarios mínimos (86%), diabetes mellitus (61%), e hipertensión arterial sistémica (58,4%). La escala PUSH varió entre 4 y 17 puntos (0­17 posibles), y el puntaje medio en la última valoración fue de, aproximadamente, 12. La tasa de cicatrización fue 60%. El color de piel blanca/amarilla aumentó 3,43 veces las chances de lograr la cicatrización (p<0,001). CONCLUSIÓN: Los atributos sociales estudiados se asemejan a los principales indicadores de inequidades sociales en salud en Brasil. Se observó significancia estadística para los colores de piel blanca/amarilla, relacionados con la cicatrización de la herida. La consulta de enfermería contribuyó en lograr la cicatrización de las heridas. CONFLICTO DE INTERÉS: Ninguno.

Association between NDO-LID and PGL-1 for leprosy and class I and II human leukocyte antigen alleles in an indigenous community in Southwest Amazon

The frequencies of the Human leukocyte antigen (HLA) alleles in the Puyanawa indigenous reserve population and their association with the NDO-LID and ELISA PGL-1 rapid serological test was assessed. This was a cross-sectional study with an epidemiological clinical design conducted in two indigenous communities in the state of Acre, Brazil. Blood was collected in a tube with EDTA to identify HLA alleles and perform serological tests. DNA was obtained using the salting out procedure. The LabType™ technique (One-Lambda-USA) was used for HLA class I (loci A*, B* and C*) and II (loci DRB1*, DQA1* and DQB1*) typing. Allele frequency was obtained by direct count, and the chi-square test was used to assess the association with the NDO-LID and PGL-1 tests. The most frequent alleles in the two communities were: HLA-A*02:01, HLA-B*40:02, HLA-DRB1*16:02, HLA-DQA1*05:05 and HLA-DQB1*03:01. The allele HLA-C*04:01 was the most common in the Barão community, and the allele HLA-C*07:01 in Ipiranga. Among individuals who presented seropositivity to the NDO-LID test, the association with alleles HLA-A*02 (43.18% vs 24.8%, p = 0.03, OR = 2.35) and HLA-B*53 (6.83% vs 0.0%, p = 0.03, OR = 8.95) was observed in the Barão community. HLA-B*15 was associated with non-seroconversion to the NDO-LID test in Ipiranga. In both communities, HLA-B*40 and HLA-C*03 were associated with positive serological response to ELISA PGL-1. The HLA class I and II alleles most frequently found in this study have already been described among Terena indigenous groups, and HLA class I contributes to seroconversion to NDO-LID and PGL-1 tests in inhabitants of the Barão and Ipiranga communities(AU).

Módulo educativo en ambiente virtual de aprendizaje en Diabetes Mellitus / Educational module in a virtual learning environment on Diabetes Mellitus / Módulo educativo em ambiente virtual de aprendizagem em Diabetes Mellitus

INTRODUCCIÓN: Los profesionales de enfermería necesitan ser capacitados y cualificados para atender a las personas con diabetes y uno de los aspectos considerado como fundamental para esa capacitación es el conocimiento de los recursos tecnológicos indicados para el desarrollo del proceso de enseñanza-aprendizaje, como informática, internet, hipermedia, multimedia, y las diversas herramientas de interacción y comunicación. OBJETIVOS: Los objetivos de este estudio fueron desarrollar un módulo educativo sobre pie diabético en Ambiente Virtual de Aprendizaje - AVA en la plataforma Moodle para estudiantes de enfermería y someter el programa a la evaluación de los alumnos. MÉTODO: Se trata de un estudio descriptivo transversal, realizado con 31 estudiantes. El módulo educativo fue desarrollado como curso distribuido en cuatro capítulos versando sobre pie diabético. Después del curso los alumnos evaluaron el módulo utilizando instrumento validado conteniendo aspectos pedagógicos (contenido, interacción y actividades) y aspecto técnico (calidad de la interfaz) del AVA. RESULTADOS: Las características obtenidas consideradas como favorables al aprendizaje fueron "contenido" (91,6%), "actividades" (85,8%) y "calidad de la interfaz" (89,7%). La característica "interacción" fue la que obtuvo menor índice (52,7%). CONCLUSIÓN: Considerando la mayoría de las características evaluadas, concluimos que Moodle se mostró una herramienta eficaz de enseñanza. En cuanto a la característica "interacción", es necesario perfeccionar las cuestiones que afectan a las actividades programadas, estas son el foro y chat para propiciar una mayor relación entre los participantes

INTRODUCTION: Nursing professionals need to be trained and qualified to care for people with diabetes, where one of the aspects considered as fundamental for this training is the knowledge of the technological resources indicated for the development of the teaching-learning process, such as computer science, internet, hypermedia, multimedia, besides the various tools of interaction and communication. OBJECTIVE: The objectives of this study were to develop an educational module about diabetic foot in a Virtual Learning Environment - VLE in the Moodle platform for nursing students and to submit the program to the evaluation of the students. METHOD: It is a cross-sectional descriptive study, carried out with 31 students. The educational module was developed as a course distributed in four chapters dealing with diabetic foot. After the course, the students evaluated the module using a validated instrument containing pedagogical aspects (content, interaction and activities) and technical aspect (interface quality) of VLE. RESULTS: The characteristics that were considered favorable to learning were "content" (91.6%), "activities" (85.8%) and "interface quality" (89.7%). The "interaction" characteristic was the one that obtained the lowest rate (52.7%). CONCLUSION: By considering most of the evaluated characteristics, we conclude that Moodle has proved to be an effective teaching tool. Regarding the "interaction" characteristic, it is necessary to improve the questions that involve the scheduled activities, such as forum and chat, in order to provide a greater relationship among the participants

INTRODUÇÃO: Os profissionais de enfermagem necessitam ser capacitados e qualificados para o atendimento às pessoas com diabetes e um dos aspectos considerado como fundamental para essa capacitação é o conhecimento dos recursos tecnológicos indicados para o desenvolvimento do processo de ensino-aprendizagem, como informática, internet, hipermídia, multimídia, e as diversas ferramentas de interação e comunicação. OBJETIVOS: Os objetivos deste estudo foram desenvolver um módulo educativo sobre pé diabético em Ambiente Virtual de Aprendizagem - AVA na plataforma Moodle para estudantes de enfermagem e submeter o programa à avaliação dos alunos. MÉTODO: Trata-se de um estudo descritivo transversal, realizado com 31 estudantes. O módulo educativo foi desenvolvido como curso distribuído em quatro capítulos versando sobre pé diabético. Após o curso os alunos avaliaram o módulo utilizando-se instrumento validado contendo aspectos pedagógicos (conteúdo, interação e atividades) e aspecto técnico (qualidade da interface) do AVA. RESULTADOS: As características obtidas consideradas como favoráveis à aprendizagem foram "conteúdo" (91,6%), "atividades" (85,8%) e "qualidade da interface" (89,7%). A característica "interação" foi a que obteve menor índice (52,7%). CONCLUSÃO: Considerando-se a maioria das características avaliadas, concluímos que o Moodle se mostrou uma ferramenta eficaz de ensino. Já em relação à característica "interação", torna-se necessário aprimorar as questões que envolvam as atividades programadas, tais como fórum e chat para propiciar uma maior relação entre os participantes

Association between NDO-LID and PGL-1 for leprosy and class I and II human leukocyte antigen alleles in an indigenous community in Southwest Amazon.

The frequencies of the Human leukocyte antigen (HLA) alleles in the Puyanawa indigenous reserve population and their association with the NDO-LID and ELISA PGL-1 rapid serological test was assessed. This was a cross-sectional study with an epidemiological clinical design conducted in two indigenous communities in the state of Acre, Brazil. Blood was collected in a tube with EDTA to identify HLA alleles and perform serological tests. DNA was obtained using the salting out procedure. The LabType™ technique (One-Lambda-USA) was used for HLA class I (loci A*, B* and C*) and II (loci DRB1*, DQA1* and DQB1*) typing. Allele frequency was obtained by direct count, and the chi-square test was used to assess the association with the NDO-LID and PGL-1 tests. The most frequent alleles in the two communities were: HLA-A*02:01, HLA-B*40:02, HLA-DRB1*16:02, HLA-DQA1*05:05 and HLA-DQB1*03:01. The allele HLA-C*04:01 was the most common in the Barão community, and the allele HLA-C*07:01 in Ipiranga. Among individuals who presented seropositivity to the NDO-LID test, the association with alleles HLA-A*02 (43.18% vs 24.8%, p=0.03, OR=2.35) and HLA-B*53 (6.83% vs 0.0%, p=0.03, OR=8.95) was observed in the Barão community. HLA-B*15 was associated with non-seroconversion to the NDO-LID test in Ipiranga. In both communities, HLA-B*40 and HLA-C*03 were associated with positive serological response to ELISA PGL-1. The HLA class I and II alleles most frequently found in this study have already been described among Terena indigenous groups, and HLA class I contributes to seroconversion to NDO-LID and PGL-1 tests in inhabitants of the Barão and Ipiranga communities.