Minimum acceptable diet in a cohort of children aged between 6 and 15 months: Complementary feeding assessment and associated factors in the Brazilian western Amazon.

OBJECTIVE: The goal of the article was to assess complementary feeding patterns, and associated factors, of children between 6 and 15-month old in Rio Branco-Acre, Brazil, based on the minimum acceptable diet indicator. METHODS: This study was cross-sectional, including 857 children between ages 6 and 15 mo, from a 2015 birth cohort of Rio Branco, Brazil. The prevalence of complementary feeding indicators, minimum meal frequency, minimum dietary diversity, and minimum acceptable diet was estimated based on the recommendations of the World Health Organization. Sociodemographic characteristics, infant and maternal habits, prenatal information, birth characteristics, breastfeeding, and complementary feeding were evaluated. Differences between the proportions were evaluated by the χ2 test and univariate and multiple logistic regression analyses, to determine associated factors with child minimum acceptable diet. RESULTS: The minimum frequencies of meals and dietary diversity were observed in 81.0% and 51.8% of the children, respectively. The minimum acceptable diet prevalence was 47.1%. Also, minimum acceptable diet was inversely associated with C, D, and E social classes (adjusted odds ratio = 0.49; 95% CI, 0.33-0.72), number of living siblings (adjusted odds ratio for two or three children = 0.69; 95% CI, 0.48-0.98, and adjusted odds ratio for ≥ 4 children = 0.56; 95% CI, 0.37-0.84). Maternal regular consumption of fruits, vegetables, and legumes (adjusted odds ratio = 2.62; 95% CI, 1.69-4.05), child age from 12 to 15 mo (adjusted odds ratio = 2.05; 95% CI, 1.32-3.18), and receiving guidance regarding complementary feeding during postnatal consultations (adjusted odds ratio = 1.38; 95% CI, 1.03-1.86) were directly associated with minimum acceptable diet. CONCLUSIONS: Fewer than 50% of the children received adequate food with adequate frequency and diversity. Low socioeconomic status and having ≥ 2 living siblings reduced the chance of minimum acceptable diet, whereas maternal healthy diet, child age (12-15 mo), and complementary feeding counseling during postnatal appointments increased the chance of minimum acceptable diet.

Effect of prenatal care quality on the risk of low birth weight, preterm birth and vertical transmission of HIV, syphilis, and hepatitis.

BACKGROUND: Averse birth-outcomes still affect newborns worldwide. Although high-quality prenatal care is the main strategy to prevent these outcomes, the effect of prenatal care based on Kotelchuck index combined with consultation contents is still unclear. Thus, this article to evaluate the effect of the quality of prenatal care (PC) process on birth indicators in a cohort of puerperaes who attended maternity hospitals in Brazilian western Amazon, city of Rio Branco, in the state of Acre, Brazil, in 2015. METHODS: This research was a hospital-based cohort study. The sample consisted of 1,030 women who gave birth in maternity hospitals in the city between April 6 and June 30, 2015. This research was a hospital-based cohort study. The sample consisted of 1,030 women who gave birth in maternity hospitals in Rio Branco between April 6th. and June 30th., 2015. Prenatal care was classified as fully adequate when started ≤4th month; ≥80.0-109% expected consultations for GA according to the Kotelchuck Index; ≥5 records of blood pressure, weight, GA, fundal height, ≥4 records of fetal heart rate, fetal movements or equivalent to 75% of the number of consultations; in addition to recording ABO/RH, hemoglobin, VDRL, urine, glucose, anti-HIV and anti-toxoplamosis during the 1st trimester. The evaluated outcomes were low birth weight (LBW), preterm birth and vertical transmission of human immunodeficiency virus (HIV)/hepatitis/syphilis. Differences between proportions were assessed using the X² test, and the crude and adjusted odds ratios (OR) (95% CI) were estimated using unconditional logistic regression. RESULTS: Overall cohort, the outcomes incidences were 8.8% for LBW, 9.2% for preterm birth, and 1.1% for vertical transmission (syphilis/HIV/hepatitis). Crude and adjusted OR showed that inadequate PC increased the risk statistically significant of LBW (ORcrude: 1.84; 95%CI: 0.99-3.44; ORadjusted: 1.87; 95%CI: 1.00-3.52), and preterm birth (ORcrude: 1.79; 95%CI: 1.00-3.29; ORadjusted: 3.98; 95%CI: 1.40-11.29). CONCLUSION: The results draw attention to the importance of quality PC in reducing the risks of LBW, preterm birth, and vertical transmission of syphilis/HIV/hepatitis. Moreover, using this proposed quality prenatal care indicator based on Kotelchuck index combined with consultations contents adjusted by GA may accurately predict unfavorable outcomes.

Breastfeeding patterns and factors associated with early weaning in the Western Amazon.

OBJECTIVE: To characterize breastfeeding patterns in the first six months of life and factors associated with early weaning in a birth-cohort in Rio Branco, state of Acre. METHODS: This is a prospective study with all babies born between April and June 2015. The mothers were interviewed soon after birth and between 6 and 15 months postpartum. At hospital discharge, breastfeeding was defined as exclusively (EBF), and breastfeeding (BF). In the follow-up, breastfeeding patterns were exclusive breastfeeding (EBF), predominant breastfeeding (PBF), and breastfeeding (BF). The interruption of breastfeeding in the first six months was classified as early weaning. The Kaplan Meier method (log-rank: 95%) was used to estimate the conditional probability of change in breastfeeding pattern, and early weaning risk. Crude and adjusted proportional Cox regression models, and their respective 95% confidence intervals (95%CI), were used to analyze the factors associated with early weaning. RESULTS: The study included 833 infants in EBF (95.4%) and BF (4.6%) at hospital discharge. During the first six months of life, the infant likely discharged in EBF remaining in EBF, becoming PBF, and BF, were respectively 16.4%, 32.3%, and 56.5%. The weaning likely at six months was statistically higher for infants discharged in BF (47.4%) when compared with those discharged in EBF (26%). Factors associated with early weaning were BF at hospital discharge (HR = 1.82; 95%CI 1.06-3.11), no mother cross-breastfeeding (HR = 2.50; 95%CI 1.59-3.94), pacifier use (HR = 6.23; 95%CI 4.52-8.60), less than six months of breastfeeding intention (HR = 1.93; 95%CI 1.25-2.98), lack of breastfeeding in the first hour of life (HR = 1.45; 95%CI 1.10-1.92), and pregnancy alcohol consumption (HR = 1.88; 95%CI 1.34-2.90). CONCLUSION: Compared to infants in EBF, those in BF at hospital discharge were more likely to wean. Public health efforts should prioritize EBF at hospital discharge, promote breastfeeding in the first hour of life, and prevent alcohol consumption risks during pregnancy, cross-breastfeeding and pacifier use.

Breastfeeding patterns and factors associated with early weaning in the Western Amazon / Padrões de amamentação e fatores associados ao desmame precoce na Amazônia ocidental

ABSTRACT OBJECTIVE: To characterize breastfeeding patterns in the first six months of life and factors associated with early weaning in a birth-cohort in Rio Branco, state of Acre. METHODS: This is a prospective study with all babies born between April and June 2015. The mothers were interviewed soon after birth and between 6 and 15 months postpartum. At hospital discharge, breastfeeding was defined as exclusively (EBF), and breastfeeding (BF). In the follow-up, breastfeeding patterns were exclusive breastfeeding (EBF), predominant breastfeeding (PBF), and breastfeeding (BF). The interruption of breastfeeding in the first six months was classified as early weaning. The Kaplan Meier method (log-rank: 95%) was used to estimate the conditional probability of change in breastfeeding pattern, and early weaning risk. Crude and adjusted proportional Cox regression models, and their respective 95% confidence intervals (95%CI), were used to analyze the factors associated with early weaning. RESULTS: The study included 833 infants in EBF (95.4%) and BF (4.6%) at hospital discharge. During the first six months of life, the infant likely discharged in EBF remaining in EBF, becoming PBF, and BF, were respectively 16.4%, 32.3%, and 56.5%. The weaning likely at six months was statistically higher for infants discharged in BF (47.4%) when compared with those discharged in EBF (26%). Factors associated with early weaning were BF at hospital discharge (HR = 1.82; 95%CI 1.06-3.11), no mother cross-breastfeeding (HR = 2.50; 95%CI 1.59-3.94), pacifier use (HR = 6.23; 95%CI 4.52-8.60), less than six months of breastfeeding intention (HR = 1.93; 95%CI 1.25-2.98), lack of breastfeeding in the first hour of life (HR = 1.45; 95%CI 1.10-1.92), and pregnancy alcohol consumption (HR = 1.88; 95%CI 1.34-2.90). CONCLUSION: Compared to infants in EBF, those in BF at hospital discharge were more likely to wean. Public health efforts should prioritize EBF at hospital discharge, promote breastfeeding in the first hour of life, and prevent alcohol consumption risks during pregnancy, cross-breastfeeding and pacifier use.

RESUMO OBJETIVO: Caracterizar os padrões de amamentação nos primeiros seis meses de vida e fatores associados ao desmame precoce numa coorte de nascidos vivos em Rio Branco, Acre. MÉTODOS: Estudo prospectivo com nascidos vivos entre abril e junho de 2015. As entrevistas com as mães ocorreram logo após o nascimento e entre 6 e 15 meses pós-parto. Na alta hospitalar, o aleitamento foi definido em exclusivo (AME) e materno (AM). No seguimento, os padrões de amamentação foram AME, aleitamento materno predominante (AMP) e AM. A interrupção da amamentação nos primeiros seis meses foi classificada como desmame precoce. Utilizou-se o método de Kaplan Meier (log-rank: 95%) para estimar a probabilidade condicional de mudança no padrão de amamentação e risco de desmame. Os fatores associados ao desmame e seus intervalos de confiança de 95% (IC95%) foram analisados pela regressão proporcional de Cox bruta e ajustada. RESULTADOS: Participaram do estudo 833 lactentes que na alta hospitalar estavam em AME (95,4%) e AM (4,6%). A probabilidade do lactente em AME na alta hospitalar permanecer em AME, ou se tornar AMP ou AM, aos seis meses, foi de 16,4%, 32,3% e 56,5% respectivamente. A probabilidade de desmame aos seis meses foi estaticamente maior para lactentes em AM na alta hospitalar (47,4%) em comparação com aqueles em AME (26%). Mostraram-se associados ao desmame precoce: o AM na alta hospitalar (HR = 1,82; IC95% 1,06-3,11), ausência de amamentação cruzada praticada pela mãe (HR = 2,50; IC95% 1,59-3,94), usar chupeta (HR = 6,23; IC95% 4,52-8,60), pretender amamentar por menos de seis meses (HR = 1,93; IC95% 1,25-2,98), não amamentar na primeira hora de vida (HR = 1,45; IC95% 1,10-1,92) e consumir álcool na gestação (HR = 1,88; IC95% 1,34-2,90). CONCLUSÃO: Comparados aos lactentes em AME, aqueles em AM, na alta hospitalar, apresentaram maior probabilidade de desmame. Esforços em saúde pública devem priorizar o AME na alta hospitalar, promover amamentação na primeira hora de vida e orientar sobre os riscos do consumo de álcool na gestação, amamentação cruzada e uso de chupeta.

Self- Reported morbidity in adults: population survey in Rio Branco, Brazil, 2007 - 2008 / Morbidade Autorreferida em Adultos: inquérito populacional em Rio Branco, AC 2007 - 2008

INTRODUCTION: Epidemiological data allow to know the needs of the communities and can provide subsidies for planning and actions in the health services, hence, it is necessary to investigate illness and chronic non-communicable diseases in the population of interestOBJECTIVE: The objectives of this study are to describe and verify the association between the most prevalent self-reported morbidities in adults regarding the characteristics: socioeconomic, demographic and lifestyleMETHODS: This is a population-based survey conducted with adults (≥18 years of age), living in Rio Branco, Acre State, Brazil, during the period 2007/2008. The sample consisted of 1516 individuals, from a probabilistic sampling in two stages of a drawRESULTS: The most prevalent self-reported morbidity was spine/back disease with a percentage of 30.8%, followed by hypertension (28.3%), malaria (28.3%) and depression (18.7%). Regarding socioeconomic and demographic aspects, the most prevalent characteristics were: female gender and low level of formal education, with statistical significance. As for life habits, the most common characteristics with statistical significance were: smoking and physical inactivityCONCLUSION: In view of the scarcity of studies of this nature in the North region of Brazil, and especially in the State of Acre, the results regarding the most prevalent self-reported morbidities in the adult population of Rio Branco are of fundamental importance, to alert researchers and health professionals. This contributes to a better adaptation and/or implementation of public strategies for promotion, protection and health assistance

INTRODUÇÃO: Dados epidemiológicos permitem conhecer as necessidades das comunidades e podem fornecer subsídios para planejamento e ações nos serviços de saúde. Para este norte, faz-se necessário a investigação das doenças e agravos crônicos não transmissíveis na população de interesseOBJETIVO: Os objetivos deste foram descrever e verificar associação entre as morbidades autorreferidas mais prevalentes identificadas no estudo quanto às características: socioeconômicas, demográficas e de hábitos de vidaMÉTODO: Trata-se de um inquérito populacional, realizado com adultos (≥18 anos de idade), residentes em Rio Branco/AC entre 2007/2008. A amostra constituiu-se de 1516 indivíduos, a partir de uma amostragem probabilística em duas etapas de sorteioRESULTADOS: A morbidade autorreferida mais prevalente foi a doença de coluna/costas com o percentual de 30,8%, seguida da hipertensão (28,3%), malária (28,3%) e depressão (18,7%). Quanto aos aspectos socioeconômicos e demográficos as características mais prevalentes nas morbidades pesquisadas foram: sexo feminino, faixa etária mais elevada e menor escolaridade, com significância estatística. Quanto aos hábitos de vida, as características mais prevalentes com significância estatística nas morbidades foram: tabagismo e inatividade físicaCONCLUSÃO: Tendo em vista a escassez de estudos desta natureza na região Norte, e principalmente no Estado do Acre, os resultados referentes às morbidades autorreferidas mais prevalentes a população adulta de Rio Branco, são de fundamental importância, uma vez que possibilita alertar os pesquisadores e profissionais de saúde e contribui para uma melhor adequação ou implantação de estratégias públicas de promoção, proteção e de assistência à saúde

Tendência temporal da mortalidade em idosos em municípios no estado do Acre / Temporal trend of mortality in old people in cities in the state of Acre

Resumo Objetivo Analisar a tendência temporal da mortalidade na população de idosos em municípios selecionados das cinco regionais de desenvolvimento no estado do Acre, Brasil. Método Estudo descritivo, ecológico de séries temporais, que utilizou dados do Sistema de Informações sobre Mortalidade (SIM), no qual foi selecionado o universo de óbitos ocorridos em idosos, registrados nos municípios acreanos de 1996 a 2015. Foram calculadas as taxas de mortalidade brutas e ajustadas por idade, utilizando o método direto e a população mundial como referência. Para a análise das tendências, foi realizada a estimativa da variação percentual anual da mortalidade com nível de confiança de 95% pelo software Joinpoint Regression Program. Resultados A tendência da mortalidade geral apresentou-se decrescente em Rio Branco e com oscilações nos demais municípios investigados. As principais causas de óbito foram as doenças do aparelho circulatório, respiratório e neoplasias. Em Rio Branco, as taxas de mortalidade padronizadas por idade nas doenças do aparelho circulatório reduziram 2,26% (p<0,001) ao ano e as neoplasias apresentaram tendência crescente e constante com uma variação anual de 1,02% (p=0,010). Conclusão O estudo mostrou evidências de polarização epidemiológica, geográfica e social no comportamento das tendências da mortalidade. Rio Branco, a capital do estado, apresentou padrões semelhantes aos das regiões desenvolvidas brasileiras. Por outro lado, os demais municípios apresentaram consideráveis oscilações nas tendências que podem estar relacionadas à elevada proporção de causas mal definidas. Esses achados podem auxiliar no planejamento de ações estratégicas e sugestões de hipóteses para novos estudos.

Abstract Objective To analyze the temporal trend of mortality in the old people population in selected municipalities in the five regional development areas in the state of Acre, Brazil. Method Descriptive, ecological study of time series, which used data from the Mortality Information System (SIM), in which the universe of deaths occurred in old people, recorded in the cities of Acre from 1996 to 2015 was selected. Crude and age-adjusted mortality rates were calculated using the direct method and the world population as a reference. For the analysis of trends, the annual percentage change in mortality was estimated with a 95% confidence level using the Joinpoint Regression Program software. Results The general mortality trend was decreasing in Rio Branco and with fluctuations in the other municipalities investigated. The main causes of death were diseases of the circulatory, respiratory and neoplasms. In Rio Branco, mortality rates standardized by age in diseases of the circulatory system decreased by 2.26% (p<0.001) per year and neoplasms showed an increasing and constant trend with an annual variation of 1.02% (p=0.010). Conclusion The study showed evidence of epidemiological, geographical and social polarization in the behavior of mortality trends. Rio Branco, the state capital, presented similar patterns to those of the developed Brazilian regions. On the other hand, the other municipalities showed considerable fluctuations in trends that may be related to the high proportion of ill-defined causes. These findings can assist in the planning of strategic actions and hypothesis suggestions for further studies.

Beliefs about Breast Cancer among Women in the Western Amazon: A Population-Based Study

Objective: Evaluate the beliefs about the risk factors for breast cancer in a population of women from the western Amazon and determine the factors associated with the higher belief scores presented by this population. Methods: A population-based cross-sectional study included 478 women aged >40 years residing in Rio Branco, Acre, Brazil. An American Cancer Society questionnaire was applied to assess the knowledge, attitudes, and beliefs about breast cancer. Results: The main beliefs about the risk factors for breast cancer were breast trauma (95%), use of underwire bra (58.5%), and a high number of sexual partners (55.5%). Women from younger age groups presented higher belief scores (Bcoefficient: ­0.04, 95% CI: ­0.07; ­0.01) than those of women from older age groups. A strong association was noted between high knowledge scores of risk factors and signs/symptoms of the disease and high belief scores in the study group (Bcoefficient:0.33;95%CI:0.28;0.38). Conclusion: The results indicate the existence of important beliefs related to the risk factors for breast cancer. Women from younger age groups, women who have seen a gynecologist in the past 2 years, and women who had more knowledge about the risk factors and signs and symptoms of breast cancer had higher belief scores.

Evaluation of the Patient Safety Culture in the Western Amazon / Avaliação da cultura de segurança do paciente na Amazônia Ocidental

INTRODUCTION: The safety culture of the patient is a contributing factor for the maintenance of the user's well-being in the health system because, through it, an organized systematization and quality of patient care are obtained, preventing possible intercurrences that can cause damages. OBJECTIVE: To analyze the Patient Safety Culture (PSC) from the perspective of health professionals at the Reference Hospital of the Upper Juruá River, in the Brazilian Western Amazon. METHODS: This is a cross-sectional study developed in a medium-sized public hospital in a municipality in Western Amazonia. The Survey for Patient Safety Culture survey of the Agency for Healthcare Research and Quality was applied to 280 professionals from December 2016 to February 2017. Descriptive analysis of the data and the internal consistency of the instrument were performed. RESULTS: The results indicate the best evaluations in the dimensions of Teamwork in the scopes of the units (60%) and Organizational learning (60%). The aspects with the worst results were the dimensions of non-punitive responses to errors (18%) and frequency of events reported (32%). The internal reliability (Cronbach's Alpha) analysis of the dimensions ranged from 0.35 to 0.90. CONCLUSION: The "culture of fear" seems to predominate in this hospital, however, the study showed that there is scope for improvement in all dimensions of CSP. The values of Cronbach's Alpha presented similarity to the results obtained by the validation process.

INTRODUÇÃO: A cultura de segurança do paciente é fator contribuinte para a manutenção do bem-estar do usuário no sistema de saúde, pois por meio dela obtém-se uma sistematização organizada e de qualidade do cuidado ao paciente, prevenindo possíveis intercorrências que possam trazer danos. OBJETIVO: Analisar a Cultura de Segurança do Paciente (CSP) na perspectiva dos profissionais de saúde no Hospital de Referência do Alto Rio Juruá, na Amazônia Ocidental Brasileira. MÉTODO: Trata-se de um estudo transversal desenvolvido em um hospital público de médio porte em um município da Amazônia Ocidental. O questionário Hospital Survey on Patient Safety Culture, da Agency for Healthcare Research and Quality foi aplicado em 280 profissionais, no período dezembro de 2016 a fevereiro de 2017. Foi realizada a análise descritiva dos dados e a consistência interna do instrumento. RESULTADOS: Os resultados apontam as melhores avaliações nas dimensões de Trabalho em equipe nos âmbitos das unidades (60%) e Aprendizado organizacional (60%). Os aspectos com os piores resultados foram as dimensões de Respostas não punitivas aos erros (18%) e Frequência de eventos relatados (32%). A análise de confiabilidade interna (Alpha de Cronbach) das dimensões variou entre 0,35 a 0,90. CONCLUSÃO: A cultura do medo parece predominar nesse hospital, contudo o estudo demonstrou que há possibilidades de melhoria em todas as dimensões da CSP. Os valores do Alpha de Cronbach apresentaram semelhança com os resultados obtidos pelo processo de validação.

Breast Cancer Awareness among Women in Western Amazon: a Population Based Cross-Sectional Study

Background: A general lack of women`s awareness of breast cancer has been one of the barriers to screening and early presentation. Thus, the aim of this study was to evaluate levels of knowledge about risk factors, and early warning signs of breast cancer, and to determine factors associated with better levels of comprehension. Methods: A population-based cross-sectional study was carried out among 478 women over 40 years old, living in Rio Branco city, western Amazon. All were interviewed using the "Breast cancer knowledge, attitudes and practice scale", developed by American Cancer Society. Results: Among the respondents, only 28.6% of women were aware that advanced age highly increases the risk. Around 30% of participants recognized nipple retraction as a sign of breast cancer. Breast cancer knowledge varied according to age in such a way that the mean scores were high from 40-69 years and decreased dramatically among those aged ≥70 (ß=-0.06,p=0.031). Access to health services such as the Pap-test (ß=2.45,p=0.027) and attending a gynecologist in the past two years (ß=1.88,p=0.005) were statistically associated with the score of breast cancer knowledge. Conclusion: The findings indicate that women living in urban areas, having gynecological assessment, considering herself at high risk of developing breast cancer and thinking that breast cancer is a fatal disease are statistically associated with good knowledge of breast cancer risk factors, signs and symptoms, even adjusting for age and education.

Phlebitis associated with peripheral intravenous catheters in adults admitted to hospital in the Western Brazilian Amazon.

OBJECTIVE: To identify the presence of phlebitis and the factors that influence the development of this complication in adult patients admitted to hospital in the western Brazilian Amazon. METHOD: Exploratory study with a sample of 122 peripheral intravenous catheters inserted in 122 patients in a medical unit. Variables related to the patient and intravenous therapy were analyzed. For the analysis, we used chi-square tests of Pearson and Fisher exact test, with 5% significance level. RESULTS: Complication was the main reason for catheter removal (67.2%), phlebitis was the most frequent complication (31.1%). The mean duration of intravenous therapy use was 8.81 days in continuous and intermittent infusion (61.5%), in 20G catheter (39.3%), inserted in the dorsal hand vein arc (36.9 %), with mean time of usage of 68.4 hours. The type of infusion (p=0.044) and the presence of chronic disease (p=0.005) and infection (p=0.007) affected the development of phlebitis. CONCLUSION: There was a high frequency of phlebitis in the sample, being influenced by concomitant use of continuous and intermittent infusion of drugs and solutions, and more frequent in patients with chronic diseases and infection. OBJETIVO: Identificar a presença de flebite e os fatores que influenciam o desenvolvimento desta complicação em pacientes adultos internados em hospital da Amazônia Ocidental Brasileira. MÉTODO: Estudo exploratório, com amostra de 122 cateteres intravenosos periféricos instalados em 122 pacientes de uma unidade de clínica médica. Foram analisadas variáveis relacionadas ao paciente e à terapia intravenosa. Para a análise utilizaram-se os testes de Qui-quadrado de Pearson e Exato de Fisher, com nível de significância de 5%. RESULTADOS: A complicação foi o principal motivo da retirada do cateter (67,2%), e a flebite a complicação mais frequente (31,1%). O tempo médio de uso de terapia intravenosa foi de 8,81 dias, em infusão contínua e intermitente (61,5%), em cateter calibre 20G (39,3%), inseridos nas veias do arco dorsal da mão (36,9%), com média de tempo de permanência de 68,4 horas. O tipo de infusão (p=0,044) e a presença de doença crônica (p=0,005) e de infecção (p=0,007) influenciaram o desenvolvimento de flebite. CONCLUSÃO: Houve alta frequência de flebite na amostra estudada, sendo influenciada pelo emprego concomitante de infusão contínua e intermitente de fármacos e soluções, e mais frequente em pacientes com doenças crônicas e infecção.

Phlebitis associated with peripheral intravenous catheters in adults admitted to hospital in the Western Brazilian Amazon / Flebitis asociadas con catéteres intravenosos periféricos en adultos ingresados en hospital de la Amazonía Occidental Brasileña / Flebite associada a cateteres intravenosos periféricos em adultos internados em hospital da Amazônia Ocidental Brasileira

Abstract OBJECTIVE To identify the presence of phlebitis and the factors that influence the development of this complication in adult patients admitted to hospital in the western Brazilian Amazon. METHOD Exploratory study with a sample of 122 peripheral intravenous catheters inserted in 122 patients in a medical unit. Variables related to the patient and intravenous therapy were analyzed. For the analysis, we used chi-square tests of Pearson and Fisher exact test, with 5% significance level. RESULTS Complication was the main reason for catheter removal (67.2%), phlebitis was the most frequent complication (31.1%). The mean duration of intravenous therapy use was 8.81 days in continuous and intermittent infusion (61.5%), in 20G catheter (39.3%), inserted in the dorsal hand vein arc (36.9 %), with mean time of usage of 68.4 hours. The type of infusion (p=0.044) and the presence of chronic disease (p=0.005) and infection (p=0.007) affected the development of phlebitis. CONCLUSION There was a high frequency of phlebitis in the sample, being influenced by concomitant use of continuous and intermittent infusion of drugs and solutions, and more frequent in patients with chronic diseases and infection.

Resumen OBJETIVO Identificar la presencia de flebitis y los factores que influencian el desarrollo de esta complicación en pacientes adultos ingresados en hospital de la Amazonía Occidental Brasileña. MÉTODO Estudio exploratorio, con muestra de 122 catéteres intravenosos periféricos instalados en 122 pacientes de una unidad de clínica médica. Fueron analizadas variables relacionadas con el paciente y la terapia intravenosa. Para el análisis se utilizaron las pruebas de Chi cuadrado de Pearson y Exacta de Fisher, con nivel de significación del 5%. RESULTADOS La complicación fue el principal motivo de la retirada del catéter (67,2%), y la flebitis la complicación más frecuente (31,1%). El tiempo medio de uso de terapia intravenosa fue de 8,81 días, en infusión continua e intermitente (61,5%), en catéter calibre 20G (39,3%), insertados en las venas del arco dorsal de la mano (36,9%), con promedio de tiempo de permanencia de 68,4 horas. El tipo de infusión (p=0,044) y la presencia de enfermedad crónica (p=0,005) y de infección (p=0,007) influenciaron el desarrollo de flebitis. CONCLUSIÓN Hubo alta frecuencia de flebitis en la muestra estudiada, siendo influenciada por el empleo concomitante de infusión continua e intermitente de fármacos y soluciones, y más frecuente en pacientes con enfermedades crónicas e infección.

Resumo OBJETIVO Identificar a presença de flebite e os fatores que influenciam o desenvolvimento desta complicação em pacientes adultos internados em hospital da Amazônia Ocidental Brasileira. MÉTODO Estudo exploratório, com amostra de 122 cateteres intravenosos periféricos instalados em 122 pacientes de uma unidade de clínica médica. Foram analisadas variáveis relacionadas ao paciente e à terapia intravenosa. Para a análise utilizaram-se os testes de Qui-quadrado de Pearson e Exato de Fisher, com nível de significância de 5%. RESULTADOS A complicação foi o principal motivo da retirada do cateter (67,2%), e a flebite a complicação mais frequente (31,1%). O tempo médio de uso de terapia intravenosa foi de 8,81 dias, em infusão contínua e intermitente (61,5%), em cateter calibre 20G (39,3%), inseridos nas veias do arco dorsal da mão (36,9%), com média de tempo de permanência de 68,4 horas. O tipo de infusão (p=0,044) e a presença de doença crônica (p=0,005) e de infecção (p=0,007) influenciaram o desenvolvimento de flebite. CONCLUSÃO Houve alta frequência de flebite na amostra estudada, sendo influenciada pelo emprego concomitante de infusão contínua e intermitente de fármacos e soluções, e mais frequente em pacientes com doenças crônicas e infecção.

[Factors associated with use of medication during first pregnancies in Rio Branco, Acre State, Brazil]. / Fatores associados ao uso de medicamentos na gestação em primigestas no Município de Rio Branco, Acre, Brasil.

This cross-sectional study in a sample of 887 primigravidae in Rio Branco, Acre State, Brazil aimed to analyze factors associated with the use of medicines during the first pregnancy. Information was obtained from interviews and prenatal cards. Medicines were classified according to the Anatomical Therapeutic Chemical (ATC) Classification System of the World Health Organization and risk categories according to the U.S. Food and Drug Administration. Mean age was 21 years and mean number of medicines used was 2.42. The most frequently consumed medicines were antianemics (47.5%), supplements and vitamins (18.7%), analgesics (13.8%), and antibiotics (10.5%). In the risk categorization, 69.3% belonged to category A, 22.3% to B, 7.6% to C, and 0.8% to D. The odds of having used risky medicines were higher among primigravidae in unit B (OR = 2.10; 95%CI: 1.26-3.50), in the 19 to 24-year age bracket (OR = 2.79; 95%CI: 1.58-4.93), and in the presence of a medical prescription (OR = 1.86; 95%CI: 1.18-2.95). Essential drugs were less used by women with higher family income (OR = 0.63; 95%CI: 0.42-0.96) and those who had received private prenatal care (OR = 0.53; 95%CI: 0.38-0.74).

Fatores associados ao uso de medicamentos na gestação em primigestas no Município de Rio Branco, Acre, Brasil / Factors associated with use of medication during first pregnancies in Rio Branco, Acre State, Brazil / Factores asociados con el uso de fármacos en el embarazo de primigestas en Río Branco, Acre, Brasil

Estudo transversal, envolvendo 887 primigestas com o objetivo de analisar os fatores associados ao uso de medicamentos na gestação no Município de Rio Branco, Acre, Brasil. As informações tiveram como base uma entrevista e o cartão de pré-natal. Os medicamentos foram classificados de acordo com o Sistema Anatômico Terapêutico Químico (ATC), da Organização Mundial da Saúde, e com a categoria de risco do Food and Drug Administration (Estados Unidos). A média de idade foi 21 anos, a média do uso de medicamentos foi 2,42; os medicamentos mais consumidos foram os antianêmicos (47,5%), suplementos e vitaminas (18,7%), analgésicos (13,8%) e antibióticos (10,5%). Na categorização de risco, 69,3% pertenciam à categoria A; 22,3% à B; 7,6% à C e 0,8% à D. A chance de ter sido exposta à utilização de medicamentos de risco foi maior nas primigestas na unidade B (RC = 2,10; IC95%: 1,26-3,50), na faixa etária de 19 a 24 anos (RC = 2,79; IC95%: 1,58-4,93) e com prescrição médica (RC = 1,86; IC95%: 1,18-2,95). Os medicamentos essenciais foram menos utilizados entre as mulheres com maior renda familiar (RC = 0,63; IC95%: 0,42-0,96), e que realizaram o pré-natal na rede privada (RC = 0,53; IC95%: 0,38-0,74).

This cross-sectional study in a sample of 887 primigravidae in Rio Branco, Acre State, Brazil aimed to analyze factors associated with the use of medicines during the first pregnancy. Information was obtained from interviews and prenatal cards. Medicines were classified according to the Anatomical Therapeutic Chemical (ATC) Classification System of the World Health Organization and risk categories according to the U.S. Food and Drug Administration. Mean age was 21 years and mean number of medicines used was 2.42. The most frequently consumed medicines were antianemics (47.5%), supplements and vitamins (18.7%), analgesics (13.8%), and antibiotics (10.5%). In the risk categorization, 69.3% belonged to category A, 22.3% to B, 7.6% to C, and 0.8% to D. The odds of having used risky medicines were higher among primigravidae in unit B (OR = 2.10; 95%CI: 1.26-3.50), in the 19 to 24-year age bracket (OR = 2.79; 95%CI: 1.58-4.93), and in the presence of a medical prescription (OR = 1.86; 95%CI: 1.18-2.95). Essential drugs were less used by women with higher family income (OR = 0.63; 95%CI: 0.42-0.96) and those who had received private prenatal care (OR = 0.53; 95%CI: 0.38-0.74).

Estudio transversal con 887 primigestas para analizar los factores asociados al consumo de medicamentos durante el embarazo en Río Branco, Acre, Brasil. La información se basó en entrevistas y tarjeta prenatal. Los medicamentos se calificaron de acuerdo con el sistema anatómico terapéutico químico (ATC), de la Organización Mundial de la Salud y con la categoría de riesgo del Food and Drug Administration (Estados Unidos). La media de edad fue de 21 años; la media del uso de medicamentos fue de un 2,42; los medicamentos más consumidos fueron los antianémicos (47,5%), los suplementos y vitaminas (18,7%), analgésicos (13,8%) y antibióticos (10,5%). En la clasificación de riesgo, un 69,3% pertenecían a la categoría A; 22,3% a B; 7,6% a C y 0,8% a la D. La posibilidad de haber estado expuestas al riesgo en el consumo de medicamentos fue mayor en primigestas en la unidad B (OR = 2,10, IC95%: 1,26-3,50), con edades entre 19 y 24 años (OR = 2,79, IC95%: 1,58-4,93) y con prescripción (OR = 1,86, IC95%: 1,18-2,95). Los medicamentos esenciales fueron utilizados con menos frecuencia en las mujeres con mayores ingresos de los hogares (OR = 0,63, IC95%: 0,42-0,96) y que realizaron el cuidado prenatal en una red clínica privada (OR = 0,53, IC95%: 0,38- 0,74).

Percepção de saúde e fatores associados em adultos: inquérito populacional em Rio Branco, Acre, Brasil, 2007-2008 / Self-rated health and associated factors in adults: a population survey in Rio Branco, Acre State, Brazil, 2007-2008

O conceito subjetivo de saúde incluso no processo de autoavaliação de saúde possibilita identificar os fatores que estão associados à percepção de vida saudável das populações. Objetivou-se verificar a autoavaliação de saúde e os fatores associados em Rio Branco, Acre, Brasil, por meio de um estudo transversal de base populacional com amostra composta de 1.516 adultos, entre 2007-2008. A análise multivariada foi realizada por meio de regressão de Poisson, adotando-se, como variável dependente, a percepção regular/ruim do estado de saúde. Diferenças entre gênero, grupo etário, nível de instrução e renda desfavoráveis afetaram negativamente a percepção de saúde dos indivíduos. Após ajuste para idade, sexo e morbidade autorreferida, os riscos estimados para percepção "não boa" de saúde foram maiores para os inativos, obesos e indivíduos com alguma morbidade autorreferida. Os resultados sugerem que as diferenças de condições de vida dos residentes em Rio Branco estão relacionadas com a autoavaliação precária do estado de saúde.

The subjective concept of health included in the self-rated health process allows identifying factors associated with good self-rated health in populations. This cross-sectional population-based study in 2007-2008 focused on self-rated health and associated factors among adults (n = 1,516) in Rio Branco, Acre State, Brazil. The multivariate analysis used Poisson regression, with fair/poor self-rated health as the dependent variable. Differences in gender, age group, level of schooling, and income negatively affected individuals' self-rated health. After adjusting for age, gender, and self-reported illness, the estimated risks for fair/poor health were higher for the unemployed, obese, and those with some self-reported illness. The results suggest that differences in living conditions for adults in Rio Branco are associated with precarious self-rated health.

Seguridad del paciente en la terapéutica medicamentosa y la influencia de la prescripción médica en los errores de dosis

Los objetivos fueron analizar la redacción de la prescripción médica en los errores de dosis ocurridos en unidades de clínica médica de cinco hospitales brasileños e identificar las clases farmacológicas envueltas en esos errores. Se trata de un estudio descriptivo que utilizó datos secundarios obtenidos de una investigación multicéntrica realizada en 2005. La población fue compuesta de 1.425 errores de medicación y la muestra por 215 errores de dosis. De estos, 44,2% ocurrieron en el hospital E. Se verificó: presencia de siglas y/o abreviaturas en 96,3% de las prescripciones; ausencia del registro del paciente en 54,4%; falta de posología en 18,1%, y omisión de la fecha en 0,9%. Con relación al tipo de medicamento, 16,8% eran broncodilatadores; 16,3% eran analgésicos; 12,1%, antihipertensivos y 8,4% eran antimicrobianos. La ausencia de la posología en las prescripciones puede favorecer la administración de dosis equivocadas, resultando en ineficiencia del tratamiento, comprometiendo así, la calidad de la asistencia prestada a los pacientes hospitalizados.

[Self-rated health and associated factors in adults: a population survey in Rio Branco, Acre State, Brazil, 2007-2008]. / Percepção de saúde e fatores associados em adultos: inquérito populacional em Rio Branco, Acre, Brasil, 2007-2008.

The subjective concept of health included in the self-rated health process allows identifying factors associated with good self-rated health in populations. This cross-sectional population-based study in 2007-2008 focused on self-rated health and associated factors among adults (n = 1,516) in Rio Branco, Acre State, Brazil. The multivariate analysis used Poisson regression, with fair/poor self-rated health as the dependent variable. Differences in gender, age group, level of schooling, and income negatively affected individuals' self-rated health. After adjusting for age, gender, and self-reported illness, the estimated risks for fair/poor health were higher for the unemployed, obese, and those with some self-reported illness. The results suggest that differences in living conditions for adults in Rio Branco are associated with precarious self-rated health.

Patient Safety in Drug Therapy and the Influence of the Prescription in Dose Errors / Segurança do paciente na terapêutica medicamentosa e a influência da prescrição médica nos erros de dose / Seguridad del paciente en la terapéutica medicamentosa y la influencia de la prescripción médica en los errores de dosis

The aims of this study were to analyze the redaction of the prescription in dose errors that occurred in general medical units of five Brazilian hospitals and to identify the pharmacological classes involved in these errors. This was a descriptive study that used secondary data obtained from a multicenter study conducted in 2005. The population consisted of 1,425 medication errors and the sample of 215 dose errors. Of these, 44.2 percent occurred in hospital E. The presence of acronyms and/or abbreviations was verified in 96.3 percent of prescriptions; absence of the patient registration in 54.4 percent; absence of posology in 18.1 percent; and omission of date of 0.9 percent. With respect to medication type, 16.8 percent were bronchodilators; 16.3 percent were analgesics; 12.1 percent, antihypertensives; and 8.4 percent were antibiotics. The absence of posology in the prescriptions may facilitate the administration of the wrong dose, resulting in inefficiency of the treatment, compromising the quality of care provided to hospitalized patients.

Os objetivos foram analisar a redação da prescrição médica nos erros de doses, ocorridos em unidades de clínica médica de cinco hospitais brasileiros, e identificar as classes farmacológicas envolvidas nesses erros. Este é estudo descritivo que utilizou dados secundários, obtidos de pesquisa multicêntrica, realizada em 2005. A população foi composta por 1425 erros de medicação e a amostra por 215 erros de doses. Desses, 44,2 por cento ocorreram no hospital E. Verificou-se presença de siglas e/ou abreviaturas em 96,3 por cento das prescrições, ausência do registro do paciente em 54,4 por cento, falta de posologia em 18,1 por cento e omissão da data em 0,9 por cento. Com relação ao tipo de medicamento, 16,8 por cento eram broncodilatadores, 16,3 por cento eram analgésicos, 12,1 por cento, anti-hipertensivos e 8,4 por cento eram antimicrobianos. A ausência da posologia nas prescrições pode favorecer a administração de doses erradas, resultando em ineficiência do tratamento, comprometendo a qualidade da assistência prestada aos pacientes hospitalizados.

Los objetivos fueron analizar la redacción de la prescripción médica en los errores de dosis ocurridos en unidades de clínica médica de cinco hospitales brasileños e identificar las clases farmacológicas envueltas en esos errores. Se trata de estudio descriptivo que utilizó datos secundarios obtenidos de en una investigación multicéntrica realizada en 2005. La población fue compuesta de 1.425 errores de medicación y la muestra por 215 errores de dosis. De estos, 44,2 por ciento ocurrieron en el hospital E. Se verificó: presencia de siglas y/o abreviaturas en 96,3 por ciento de las prescripciones; ausencia del registro del paciente en 54,4 por ciento; falta de posología en 18,1 por ciento, y omisión de la fecha en 0,9 por ciento. Con relación al tipo de medicamento, 16,8 por ciento eran broncodilatadores; 16,3 por ciento eran analgésicos; 12,1 por ciento, antihipertensivos y 8,4 por ciento eran antimicrobianos. La ausencia de la posología en las prescripciones puede favorecer la administración de dosis equivocadas, resultando en ineficiencia del tratamiento, comprometiendo así, la calidad de la asistencia prestada a los pacientes hospitalizados.

Errors in medicine administration - profile of medicines: knowing and preventing / Perfil de medicamentos envolvidos com erros de administração: conhecer para prevenir / Perfil de medicamentos envueltos en errores de administración: conocer para prevenir

OBJECTIVES: To describe the pharmacological characteristics of medicines involved in administration errors and determine the frequency of errors with potentially dangerous medicines and low therapeutic index, in clinical units of five teaching hospitals, in Brazil. METHODS: Multicentric study, descriptive and exploratory, using the non-participant observation technique (during the administration of 4958 doses of medicines) and the anatomical therapeutic chemical classification (ATC). RESULTS: Of that total, 1500 administration errors were identified (30.3 percent). The administration of pharmacological groups - ATC (cardiovascular system, nervous system, alimentary tract and metabolism system and anti-infectives for systemic use) showed a higher frequency of errors. In 13.0 percent of errors were involved potentially dangerous medicines and in 12.2 percent medicines with low therapeutic index. CONCLUSION: The knowledge of the pharmacological profile could be an important strategy to be used in the prevention medication errors in health institutions.

OBJETIVOS: Descrever as características farmacológicas dos medicamentos envolvidos em erros de administração e determinar a frequência desses erros com medicamentos potencialmente perigosos e de baixo índice terapêutico em unidades de clínica médica de cinco hospitais de ensino brasileiros. MÉTODOS: Estudo multicêntrico, descritivo/exploratório utilizando a técnica de observação não participante durante a administração de 4958 doses de medicamentos e a classificação anatômica terapêutica química (ATC). RESULTADOS: Dentre esse total, foram identificados 1500 erros de administração de medicamentos (30,3 por cento). A administração dos fármacos dos grupos ATC - sistema cardiovascular, sistema nervoso, trato alimentar e metabolismo e antinfecciosos de uso sistêmico apresentou maior frequência de erros. Em 13,0 por cento dos erros estavam envolvidos medicamentos potencialmente perigosos e em 12,2 por cento medicamentos de baixo índice terapêutico. CONCLUSÃO: O conhecimento do perfil farmacológico pode ser uma importante estratégia a ser utilizada na prevenção de erros de medicação em instituições de saúde.

OBJETIVOS: Describir las características farmacológicas de los medicamentos envueltos en errores de administración y determinar la frecuencia de esos errores en medicamentos potencialmente peligrosos y en los de bajo índice terapéutico, en unidades de clínica médica de cinco hospitales de enseñanza brasileños. MÉTODOS: Estudio multicéntrico, descriptivo-exploratorio utilizando la técnica de observación no participante (durante la administración de 4.958 dosis de medicamentos) y la clasificación anatómica terapéutica química (ATC). RESULTADOS: Fueron identificados 1500 errores de administración de medicamentos (30,3 por ciento). La administración de los fármacos de los grupos ATC (sistema cardiovascular, sistema nervioso, sistema digestivo y metabolismo, y, anti-infecciosos) de uso sistémico presentó mayor frecuencia de errores. En 13,0 por ciento de los errores estaban envueltos medicamentos potencialmente peligrosos y en 12,2 por ciento medicamentos de bajo índice terapéutico. CONCLUSIÓN: El conocimiento del perfil farmacológico puede ser una importante estrategia para prevenir los errores de medicación en las instituciones de salud.

Patient safety in drug therapy and the influence of the prescription in dose errors.

The aims of this study were to analyze the redaction of the prescription in dose errors that occurred in general medical units of five Brazilian hospitals and to identify the pharmacological classes involved in these errors. This was a descriptive study that used secondary data obtained from a multicenter study conducted in 2005. The population consisted of 1,425 medication errors and the sample of 215 dose errors. Of these, 44.2% occurred in hospital E. The presence of acronyms and/or abbreviations was verified in 96.3% of prescriptions; absence of the patient registration in 54.4%; absence of posology in 18.1%; and omission of date of 0.9%. With respect to medication type, 16.8% were bronchodilators; 16.3% were analgesics; 12.1%, antihypertensives; and 8.4% were antibiotics. The absence of posology in the prescriptions may facilitate the administration of the wrong dose, resulting in inefficiency of the treatment, compromising the quality of care provided to hospitalized patients.

[The integrated curriculum in nursing undergraduate training: between the traditional and the disruptive ethos]. / O currículo integrado na graduação em enfermagem: entre o ethos tradicional e o de ruptura.

The contemporary world reveals new needs to society, stimulating the universities to search ways to understand these demands and to train people to supply them. This article discusses Nursing undergraduate studies,focusing on an integrated curriculum as a novel instrument that allows the faculty and the students to analyze problems from the perspective of other areas of knowledge beyond those taken by the regular disciplines. The importance of an integrated curriculum is highlighted as a mechanism to socially share knowledge using flexible pedagogical tools that take into consideration new models of society, stressing the differences between the traditional and disruptive ethos.