Digital Health Literacy Instrument: Brazilian Version-Cross-Cultural Adaptation and Content Validity for Individuals With Heart Failure.

Background and purpose: Assessment of digital health literacy should be a major concern for healthcare providers. We aimed to translate and adapt the Digital Health Literacy (DHL) Instrument into Brazilian Portuguese and examine the content validity for individuals with heart failure (HF). Methods: The instrument was translated, back translated, and evaluated by a panel of six experts regarding linguistic equivalences. An agreement analysis was performed, with values ≥80% considered acceptable. The experts then evaluated clarity, theoretical relevance, and practical pertinence. The content validity index (CVI) was calculated for each item. A CVI ≥.83 was considered acceptable. The expert's opinions were also evaluated through the modified kappa coefficient for content validity studies. Values >.74 were considered excellent. The content validity ratio (CVR) was also calculated. A critical value of CVR of 1.00 was determined. Cognitive testing (understanding the meaning of each item and their respective answers) was performed with 33 individuals with HF. Results: The adapted version obtained an agreement of ≥83.3% for each item on linguistic equivalences. Total CVI was ≥0.83, kappa values for each item were >.74, and the CVR values were 1.00 for all items. After two rounds of evaluation, all patients were able to understand the items and response scale. Conclusions: The Brazilian version has satisfactory evidence of linguistic and content validity to measure DHL in patients with HF. Additional psychometric properties will be tested in the country.

Sense of coherence and social support as predictors of mental health during COVID-19 pandemic.

OBJECTIVES: to verify the role of sense of coherence, sense of national coherence, social support and trust in institutions to predict mental health in Brazilians during the COVID-19 pandemic. METHODS: a cross-sectional study, carried out from November, 2020 to January, 2021 via an online survey. Standardized instruments were used. The sample consisted of 1,630 Brazilians. Pearson's correlation and linear regression were performed in data analysis. RESULTS: sense of coherence was the only predictor of anxiety [ß= -0.61; p<0.001], explaining 38% of the variance in its scores, while sense of coherence [ß= 0.52; p<0.001], sense of national coherence [ß= 0.16; p<0.001], and social support [ß= 0.15; p<0.001] predicted positive mental health and together explained 51% of its variance. CONCLUSIONS: the findings suggest that sense of coherence, sense of national coherence and social support represent important predictors for mental health and that strengthening these resources, could potentially promote Brazilians' mental health.

Relação do letramento digital em saúde e a COVID-19 / Relationship of digital health literacy and COVID-19

O letramento digital em saúde representa a capacidade do indivíduo em analisar, compreender e aplicar os conceitos para a saúde e a comunidade. Esse estudo objetiva identificar o nível desse letramento com a ocorrência da COVID-19. Trata-se de um estudo transversal que utilizou a versão validada do instrumento eHEALS, questões sociodemográficas e questões relacionadas ao enfrentamento dessa pandemia. Utilizou-se redes sociais digitais: WhatsApp, Facebook e e-mail para convidar usuários a participarem do estudo para posteriormente classificá-los em dois grupos: 1) COVID e 2) Não-COVID, analisando-os particularmente e relacionando ao nível de letramento. Observou-se que o letramento digital em saúde e a prevenção do contágio não tiveram pontos expressivos no nível de literacia em saúde, algo justificado pelo aumento da transmissão de notícias falsas, o uso incorreto das medidas preventivas a falta de apoio governamental em um estado de emergência, além da insegurança da população frente a uma vacina emergencial. Por fim, nota-se que dos participantes da pesquisa a maioria considera importante ter acesso sobre saúde na internet, porém uma minoria sente-se confiante para usar essas informações para tomada de decisões. Sendo assim, o letramento digital pode auxiliar na promoção da saúde e melhora na qualidade de vida da população.

Digital health literacy represents an individual's ability to analyze, understand, and apply health concepts to oneself and the community. This study aims to identify the level of digital health literacy in relation to the occurrence of COVID-19. It is a cross-sectional study that used the validated version of the eHEALS instrument, sociodemographic questions, and questions related to coping with this pandemic. Digital social networks such as WhatsApp, Facebook, and email were used to invite users to participate in the study and subsequently classify them into two groups: 1) COVID and 2) non-COVID, analyzing them individually and relating them to the level of literacy. It was observed that digital health literacy and prevention of contagion did not have significant points in the level of health literacy, something justified by the increase in transmission of fake news, the incorrect use of preventive measures, the lack of government support in a state of emergency, and the population's insecurity towards an emergency vaccine. Finally, it is noted that the majority of the research participants consider it important to have access to health information on the internet, but a minority feel confident in using this information to make decisions. Thus, digital literacy can help promote health and improve the population's quality of life.

Construção e evidência de validade do Instrumento de Avaliação do Conhecimento sobre Prevenção Quaternária / Construction and evidence of validity of the knowledge assessment instrument on quaternary prevention / Construcción y pruebas de validez del instrumento de evaluación de los conocimientos sobre prevención cuaternaria

Objetivo: desenvolver e estimar a evidência de validade de um instrumento para avaliar a percepção dos acadêmicos de medicina sobre a prevenção quaternária. Método: Trata-se de um estudo metodológico desenvolvido em três etapas: 1) construção do instrumento para avaliação do conhecimento sobre Prevenção Quaternária a partir de referenciais teóricos; 2) evidência de validade baseada no conteúdo, realizada por 13 juízes; 3) evidência de validade baseada na estrutura interna, realizada por 180 acadêmicos de medicina. Análises fatoriais foram realizadas para verificar a estrutura hierárquica do modelo a partir das duas dimensões inicialmente construídas: Domínio Conhecimento e Domínio Prático. Resultados: O coeficiente de evidência de validade de conteúdo da escala total (CVCt) foi de 0,98, demonstrando uma alta concordância entre os avaliadores com a conceituação teórica subjacente. Quanto à precisão do instrumento, todos os itens apresentaram valores de Alfa de Cronbach acima de 0,7, indicando boa precisão. Verificou-se bons indicadores de precisão para a escala com dois fatores (Domínio Conhecimento e Domínio Prático) ƛ2= 109.746, gl= 103; p<0,001; ƛ2/gl= 0,30; CFI= 0,98 e RMSEA 0,019. Conclusão: o instrumento IP4-15 apresentou as evidências de validade de conteúdo, estrutura interna, precisão e propriedades dos itens adequadas para avaliar o conhecimento e a prática da prevenção quaternária de acadêmicos do curso de medicina. Serão necessários estudos futuros para investigar a aplicabilidade do IP4-15 para outras populações.(AU)

Objective: to develop and estimate the evidence of validity of an instrument to assess the perception of medical students about Quaternary Prevention. Method: this is a methodological study carried out in three steps: 1) construction of the instrument to assess knowledge about Quaternary Prevention based on theoretical references; 2) content-based evidence of validity, performed by 13 judges; 3) internal structure-based evidence of validity, performed by 180 medical students. Factor analyzes were performed to verify the hierarchical structure of the model based on the two dimensions initially constructed: Knowledge Domain and Practical Domain. Results: The total scale content validity evidence coefficient (CVCt) was 0.98, demonstrating a high inter-rater agreement with the underlying theoretical conceptualization. As for instrument precision, all items had Cronbach's Alpha values above 0.7, indicating good precision. Good precision indicators were found for the scale with two factors (Knowledge Domain and Practical Domain) ƛ2= 109,746, gl= 103; p<0.001; ƛ2/gl=0.30; CFI=0.98 and RMSEA 0.019. Conclusion: the IP4-15 instrument presented adequate evidence of content validity, internal structure, precision, and properties of the items to assess the knowledge and practice of Quaternary Prevention of medical students. Future studies will be needed to investigate the applicability of IP4-15 to other populations.(AU)

la percepción de los estudiantes de medicina sobre la Prevención Cuaternaria. Método:se trata de un estudio metodológico desarrollado en tres etapas: 1) construcción de un instrumento para evaluar el conocimiento sobre Prevención Cuaternaria basado en referencias teóricas; 2) prueba de validez basada en el contenido, realizada por 13 jueces; 3) prueba de validez basada en la estructura interna, realizada por 180 estudiantes de Medicina. Se realizaron análisis factoriales para verificar la estructura jerárquica del modelo a partir de las dos dimensiones construidas inicialmente: Dominio del conocimiento y dominio práctico. Resultados: el coeficiente de evidencia de validez de contenido de la escala total (CVCt) fue de 0,98, lo que demuestra...(AU)

E-Questionnaire on health knowledge, attitudes and practices (KAP-Health) for Brazilian students in distance learning.

BACKGROUND: The role of universities in health promotion has been strengthened by institutional policies and the Health Promoting Universities movement. Together they seek to identify behaviours that are harmful to the health of university students and implement programs or interventions to promote the health of students within the physical environment of universities. However, the COVID-19 pandemic rapidly increased the number of students learning by distance. Under these circumstances, there is an increased need to assess the knowledge, attitudes and health practices of students in distance learning. OBJECTIVE: To develop a KAP (knowledge, attitude and practice) questionnaire on the health of distance learning students. METHODS: Development was carried out in four stages: 1) literature review to identify existing health programs in universities; 2) formulation of questions based on WHO theoretical frameworks, National Health Promotion Policy and the literature review; 3) selection of interdisciplinary expert judges and submission of the KAP-Health questionnaire for analysis of appearance, efficiency/consistency, clarity/understanding, pertinence of content and sequence of items; and 4) content validation by applying the content validity coefficient (CVC). RESULTS: The mean CVCs obtained were all equal to or greater than 0.96, 0.95 and 0.93 for the Knowledge, Attitudes and Practices domains, respectively; all comfortably above the cut-off score of 80% (CVCt = 0.80). CONCLUSIONS: At this stage of the study, the judges consider the content of the KAP-Health questionnaire adequate to identify issues related to the health of students in distance learning. However, it is important to note that the next step is to test the usefulness of this questionnaire. We believe that our KAP-Health instrument is both original and useful for planning institutional policies in order to implement assertive strategies to promote the health of remote-learning students in Brazil and in other parts of the world.

Sustainable development goals: a bibliometric analysis of literature reviews.

The research in sustainable development goals (SDG) increases year by year since its approval in 2015. Typically, after a phase of exponential growth, the number of publications increases at lower rates, suggesting a consolidation process in which literature reviews become a relevant and high-evidence type of document. In this context, the aim of this study was to perform an unprecedented bibliometric analysis of literature reviews on SDG to assess the evolution and consolidation of the scientific research. Article reviews on SDG from 2015 to 2022 were retrieved from Web of Science core collection and a descriptive bibliometric analysis was performed by growth rate, research area, source, citation, and region. Mapping and cluster analysis using keyword co-occurrence, co-authorship, and bibliographic coupling were also applied. The result revealed that SDG is a fast-growing field, with a trend in the diversification of research areas. Most of the review documents were categorized in general aspects of sustainability. Technology (SDG 9) and economic growth (SDG 8) were spotted as hidden key research areas. This result is contrary to previous bibliometric studies on SDG, demonstrating the rapid evolution and change in the field. In addition, literature reviews on reduced inequalities (SDG 10), gender equality (SDG 5); oceans, seas, and marine environments (SDG 14); and peace, justice, and strong institutions (SDG 16) were revealed as research gaps. Thus, the results demonstrated that the research on SDG cannot yet be considered a consolidated area of research, as it leaves many SDG unexplored. Future research has been proposed accordingly.

Sense of coherence and social support as predictors of mental health during COVID-19 pandemic / Senso de coerência e apoio social como preditores de saúde mental durante a pandemia de COVID-19 / Sentido de coherencia y apoyo social como predictores de salud mental durante la pandemia de COVID-19

ABSTRACT Objectives: to verify the role of sense of coherence, sense of national coherence, social support and trust in institutions to predict mental health in Brazilians during the COVID-19 pandemic. Methods: a cross-sectional study, carried out from November, 2020 to January, 2021 via an online survey. Standardized instruments were used. The sample consisted of 1,630 Brazilians. Pearson's correlation and linear regression were performed in data analysis. Results: sense of coherence was the only predictor of anxiety [β= -0.61; p<0.001], explaining 38% of the variance in its scores, while sense of coherence [β= 0.52; p<0.001], sense of national coherence [β= 0.16; p<0.001], and social support [β= 0.15; p<0.001] predicted positive mental health and together explained 51% of its variance. Conclusions: the findings suggest that sense of coherence, sense of national coherence and social support represent important predictors for mental health and that strengthening these resources, could potentially promote Brazilians' mental health.

RESUMO Objetivos: verificar o papel do senso de coerência, senso de coerência nacional, apoio social e confiança em instituições como preditores da saúde mental dos brasileiros durante a pandemia de COVID-19. Métodos: estudo transversal, realizado de novembro de 2020 a janeiro de 2021 por meio de questionário online. Foram utilizados instrumentos padronizados. A amostra foi composta por 1.630 brasileiros. Foram realizadas correlação de Pearson e regressão linear na análise dos dados. Resultados: o senso de coerência foi o único preditor de ansiedade [β=-0,61; p<0,001], explicando 38% da variação em seus escores, enquanto senso de coerência [β=0,52;p<0,001], senso de coerência nacional [β=0,16;p<0,001] e apoio social [β=0,15;p<0,001] foram preditores da saúde mental positiva e juntos explicaram 51% da sua variação. Conclusões: os achados sugerem que senso de coerência, senso de coerência nacional e apoio social representam importantes preditores da saúde mental e que o fortalecimento desses recursos, poderia potencialmente promover a saúde mental dos brasileiros.

RESUMEN Objetivos: verificar el papel del sentido de coherencia, sentido de coherencia nacional, apoyo social y confianza en las instituciones como predictores de salud mental en brasileños durante la pandemia de COVID-19. Métodos: estudio transversal, realizado de noviembre de 2020 a enero de 2021 mediante cuestionario online. Se utilizaron instrumentos estandarizados. La muestra estuvo compuesta por 1.630 brasileños. En el análisis de datos se realizaron correlación de Pearson y regresión lineal. Resultados: el sentido de coherencia fue el único predictor de ansiedad [β= -0,61;p<0,001], explicando el 38% de la variación de sus puntuaciones, mientras que el sentido de coherencia [β=0,52;p<0,001], sentido de coherencia nacional [β= 0,16;p<0,001] y apoyo social [β=0,15;p<0,001] fueron predictores de salud mental positiva y en conjunto explicaron el 51% de su variación. Conclusiones: los hallazgos sugieren que sentido de coherencia, sentido de coherencia nacional y el apoyo social representan importantes predictores de salud mental y que el fortalecimiento de estos recursos, podría potencialmente promover la salud mental de los brasileños.

Adaptação transcultural e evidências da validade da eHealth Literacy Scale para uso no Brasil / Cross-cultural adaptation and evidence of the validity of the eHealth Literacy Scale for use in Brazil / Adaptación transcultural y evidencias de la validez de la eHealth Literacy Scale para su uso en Brasil

Resumo Enquadramento: Literacia digital em saúde é a capacidade de procurar, encontrar, entender e avaliar informações sobre saúde em fontes eletrónicas para a resolução de problemas de saúde. Objetivo: Adaptar transculturalmente a versão portuguesa da eHealth Literacy Scale e analisar as evidências de validade psicométricas da versão brasileira. Metodologia: Análise do conteúdo foi realizada pelo coeficiente de validação de conteúdo e o constructo por análise fatorial exploratória e confirmatória, e medidas de confiabilidade. A validade convergente foi obtida pela variância média extraída e validade concorrente pelo coeficiente de Pearson. Resultados: Obteve-se coeficiente de validação de conteúdo de 0,86, alfa de Cronbach de 0,90 e índices aceitáveis para validade de constructo. As cargas fatoriais indicaram valores adequados entre 0,65 e 0,88 para modelo unidimensional. Conclusão: A versão brasileira apresenta confiabilidade e validade consistentes para auxiliar estudos de literacia digital em saúde de utilizadores das redes sociais digitais no Brasil. Contudo, deve ter-se em consideração a limitação deste estudo, uma vez que a amostra populacional apresentou escolaridade e rendimentos superiores à média brasileira.

Abstract Background: Digital health literacy is the ability to seek, find, understand, and appraise health information from electronic sources to solve health problems. Objective: To cross-culturally adapt the European Portuguese version of the eHealth Literacy Scale and analyze the evidence on the psychometric validity of the Brazilian Portuguese version. Methodology: Content validity was assessed using the content validity coefficient, and construct validity was examined using exploratory and confirmatory factor analysis and reliability measures. Convergent validity was analyzed using the extracted average variance, and concurrent validity was analyzed using Pearson's correlation coefficient. Results: A content validity coefficient of 0.86, a Cronbach's alpha value of 0.90, and an acceptable construct validity were obtained. Factor loadings indicated adequate values, ranging from 0.65 to 0.88 for a one-dimensional model. Conclusion: The Brazilian Portuguese version has consistent reliability and validity to inform studies on the digital health literacy of users of digital social networks in Brazil. However, a limitation of this study was that the sample had a higher level of education and income than the average population in Brazil.

Resumen Marco contextual: La alfabetización digital en la salud es la capacidad de buscar, encontrar, comprender y evaluar la información sanitaria procedente de fuentes electrónicas para resolver problemas de salud. Objetivo: Adaptar transculturalmente la versión portuguesa de la eHealth Literacy Scale y analizar las evidencias de validez psicométricas de la versión brasileña. Metodología: Análisis de contenido realizado mediante el coeficiente de validación de contenido y constructo mediante el análisis factorial exploratorio y confirmatorio, y medidas de fiabilidad. La validez convergente se obtuvo mediante la varianza media extraída y la validez concurrente mediante el coeficiente de Pearson. Resultados: Se obtuvo un coeficiente de validación de contenido de 0,86, un alfa de Cronbach de 0,90 e índices aceptables de validez de constructo. Las cargas factoriales indicaron valores adecuados entre 0,65 y 0,88 para el modelo unidimensional. Conclusión: La versión brasileña muestra una fiabilidad y validez consistentes para apoyar los estudios sobre la alfabetización digital en la salud entre los usuarios de las redes sociales digitales en Brasil. Sin embargo, hay que tener en cuenta la limitación de este estudio, ya que la muestra de población tenía una educación y unos ingresos superiores a la media brasileña.

Nanotechnology in Improving the Treatment of Huntington's Disease: a Systematic Review.

Huntington's disease (HD) is a degenerative genetic condition characterized by cognitive, motor, and psychiatric disturbance. It is caused by a dominantly inherited alteration in the huntingtin gene. Even though symptomatic management is the mainstay of HD treatment, in the thesis, one of the leading causes of the low success of current therapy is their low efficacy for crossing the blood-brain barrier (BBB). The improvement in drug delivery through the BBB may be achieved by some endogenous uptake mechanisms and nanocarrier systems, increasing the bioavailability and slow-release of macromolecular drugs in the central nervous system. In the present study, we present state-of-the-art scientific production on nanotechnology in the treatment of HD symptoms. Here, we discussed the benefits of nanotechnology pharmacological therapy tested in rodent animal models and in vitro specific analyses. We presented why we could apply nanotechnology to improve the transport of drugs through BBB based on already postulated hypotheses about potential pharmacological therapy against some HD symptoms.

Income transfer programme for children and adolescents with disabilities in Brazil.

BACKGROUND: In Brazil, there are 55 million people living in extreme poverty. People with disabilities are doubly impacted by low income and the presence of the disability. The Continuous Cash Benefit Program (BPC) is an aid granted by the Brazilian federal government to people who attest to the condition of disability as an impediment to a life on an equal basis with other individuals. Requests to BPC are made to the national competence body that carries out an expert medical and social assessment, by means of an instrument that determines the degree of the disability. Our objective was to analyse the standard of BPC concessions for children and young people with disabilities and to identify the prevalence of major diseases in the concessions. METHODS: The exploratory, cross-sectional and retrospective research used primary data collected from 332 expert medical assessments of children under 16 years old. The standard and determinants of the concessions were established through Cluster Analysis by Ward's criterion and Euclidean distance, specifying the homogeneous groups of dysfunction classes. The prevalence of major diseases was performed by frequency analysis according to the International Classification of Diseases (ICD). The socioeconomic profile of BPC requirements and the main causes of BPC rejection were analysed through descriptive analysis. RESULTS: There was a predominance of male, preschoolers and illiterate individuals in the requirements and concessions. In the granting standard for impaired function class, problems related to congenital changes received benefits even in the absence of impairment, with childhood autism being the most prevalent diagnosis. CONCLUSIONS: The concessions seemed more dependent on the diagnosis itself and on the age of the beneficiaries than on the degree of dysfunction suffered, without exclusions, by the individuals.

Letramento digital em saúde de estudantes de enfermagem ou medicina: fatores relacionados / Alfabetización digital en salud de estudiantes de enfermería o medicina: factores relacionados / Digital health literacy of nursing or medical students: related factors

Resumo Objetivo Identificar fatores relacionados ao letramento digital em saúde de estudantes de medicina ou enfermagem. Métodos O nível de letramento digital em saúde de graduandos de enfermagem ou medicina de três instituições foi avaliado pela eHealth Literacy Scale (eHEALS), versão brasileira, cujo escore varia de 8 a 40; quanto maior a pontuação, maior o nível de letramento autorreferido. Relações entre o escore do eHEALS e variáveis sociodemográficas e acadêmicas foram verificadas por meio dos testes de Mann Whitney ou Kruskal Wallis, com significância de 5%. Quando havia significância do teste de Kruskal Wallis, foi utilizado teste de Dunn para comparações dois a dois. Resultados Participaram 346 estudantes, com idade média de 23,0±5,0 anos, 71,5% do sexo feminino, 51,6% do curso de Enfermagem. A pontuação média do eHEALS foi de 31,6±4,4. Maiores escores do eHEALS se associaram a: sexo masculino, instituição pública, curso integral, maior tempo desde o início da graduação, ter pessoas próximas que buscam informações sobre saúde online, dominar outro idioma, se sentir bem/muito bem sobre a saúde atual. O nível de letramento se correlacionou positivamente com idade, utilidade da internet e seu conteúdo de saúde. O item "Sinto-me confiante em usar informações da Internet para tomar decisões de saúde" teve pontuação mais baixa. Conclusão Características sociodemográficas e acadêmicas se relacionam ao letramento digital em saúde de estudantes universitários. Esses resultados podem subsidiar e direcionar esforços curriculares nas universidades, engajando futuros profissionais da saúde na disseminação de informações confiáveis dentro e fora do contexto acadêmico, bem como na assistência assistida por tecnologias.essionals in the dissemination of reliable information inside and outside the academic context, and in technology-assisted care.

Resumen Objetivo Identificar factores relacionados a la alfabetización digital en salud de estudiantes de medicina o enfermería. Métodos El nivel de alfabetización digital en salud de estudiantes universitarios de enfermería o medicina de tres instituciones fue evaluado por la eHealth Literacy Scale (eHEALS), versión brasileña, cuya puntuación varía de 8 a 40; cuanto más alta la puntuación, más alto el nivel de alfabetización autorreferido. La relación entre la puntuación de eHEALS y variables sociodemográficas y académicas se verificó a través de las pruebas de Mann Whitney o de Kruskal Wallis, con una significancia del 5 %. Cuando había significancia en la prueba de Kruskal Wallis, se utilizó la prueba de Dunn para comparaciones de a dos. Resultados Participaron 346 estudiantes, de edad promedio de 23,0±5,0 años, 71,5 % del sexo femenino, 51,6 % del curso de Enfermería. El puntaje promedio del eHEALS fue de 31,6±4,4. Las puntuaciones más altas de eHEALS se asociaron con: sexo masculino, institución pública, curso integral, más tiempo desde el inicio del curso universitario, tener a personas próximas que buscan información sobre salud online, dominar otro idioma, sentirse bien/muy bien sobre la salud actual. El nivel de alfabetización se correlacionó positivamente con la edad, utilidad de internet y su contenido de salud. El ítem "Me siento seguro al usar información de internet para tomar decisiones de salud" obtuvo un puntaje más bajo. Conclusión Características sociodemográficas y académicas se relacionan con la alfabetización digital en salud de estudiantes universitarios. Esos resultados pueden respaldar y orientar iniciativas curriculares en las universidades, y así involucrar a futuros profesionales de salud en la diseminación de información confiable dentro y fuera del contexto académico, así como a la atención auxiliada por tecnologías.

Abstract Objective To identify factors related to the digital health literacy of medical or nursing students. Methods The level of digital health literacy of undergraduate nursing or medical students from three institutions was assessed using the Brazilian version of the eHealth Literacy Scale (eHEALS), whose score ranges from 8 to 40; the higher the score, the higher the self-reported literacy level. Relationships between the eHEALS score and sociodemographic and academic variables were assessed using the Mann Whitney or Kruskal Wallis tests, with a significance level of 5%. When the Kruskal Wallis test was significant, the Dunn's test was used for two by two comparisons. Results 346 students participated in the study, with a mean age of 23.0±5.0 years, 71.5% female, 51.6% from the Nursing course. The mean eHEALS score was 31.6±4.4. Higher eHEALS scores were associated with the male gender, attending a public institution, full-time course, longer time since enrollment in the course, having close people who seek health information online, mastering another language, and feeling good/very good about their current health. The literacy level was positively correlated with age, and the usefulness of the internet and its health content. Lower scores were reached in the item "I feel confident in using information from the internet to make health decisions". Conclusion Sociodemographic and academic characteristics are related to the digital health literacy of university students. These results can support and direct curricular efforts in universities, engaging future health professionals in the dissemination of reliable information inside and outside the academic context, and in technology-assisted care.

Evidência de validade da Escala de Literacia em Saúde e eHEALS para idosos / Validity of the evidence of the Health Literacy Scale and eHEALS for older people

RESUMO O presente artigo busca apresentar evidências de validade de dois instrumentos, Literacia em Saúde e Literacia Digital em Saúde para utilização em idosos e avaliar suas propriedades psicométricas, por meio de um estudo com método descritivo, quantitativo e transversal, realizado com 379 participantes idosos, que responderam aos questionários: a) sociodemográfico, b) Escala de Literacia em Saúde e c) electronic Health Literacy Scale (eHEALS). Foram realizadas análises fatoriais exploratória e confirmatória, com validade convergente dos fatores que foram estimadas por meio da Variância Média Extraída e Confiabilidade Composta, tendo como resultados a apresentação dos instrumentos com cargas fatoriais adequadas (> 0.4), além de confiabilidade adequada (> 0.7). A validade externa testada pela correlação entre os dois instrumentos apresentou correlação estatisticamente significante, positiva e moderada (r = 0.35; p< 0.001), indicando evidências de validade e consistência na Escala de Literacia em Saúde para uso em idosos, e atestando ao instrumento eHEALS confiabilidade adequada e válida para o público idoso brasileiro.

ABSTRACT This article aims to adapt cross-culturally two instruments (Health Literacy and Digital Health Literacy) for use with older people and to assess their psychometric properties, through a study with a descriptive, quantitative, and cross-sectional method, carried out with 379 older person participants, who answered the following questionnaires: a) sociodemographic, b) Health Literacy Scale and c) electronic Health Literacy Scale (eHEALS). The analyses performed were exploratory and confirmatory factor analysis, the convergent validity of the factors that were estimated through the Average Variance Extracted and Composite Reliability. The result was the presentation of instruments with adequate factor loadings (> 0.4), in addition to adequate reliability (> 0.7). The external validity tested by the correlation between the two instruments showed a statistically significant, positive, and moderate correlation (r = 0.35; p<0.001), presenting evidence of validity and consistency in the Health Literacy Scale for use with older people and attesting to the eHEALS instrument adequate reliability and validity for this population.

Determining factors in the development of coronary plates and obstructions / Fatores determinantes no desenvolvimento de placas e obstruções coronarianas

INTRODUCTION: Coronary artery disease is the largest cause of mortality in the world. The main risk factors for its development include systemic arterial hypertension and type 2 diabetes mellitus. OBJECTIVE: To search for predictors of the development of plaques and obstructions in coronary arteries and to determine whether the exercise test is a reliable pretest for coronary angiotomography. METHODS: 883 computed tomography reports of coronaries were analyzed. Sociodemographic information, health conditions and results of the exercise test from patients were collected, along with calcium score, percentile and number of arterial segments with significant obstruction. The data were analyzed using descriptive and inferential statistics. Significance was considered for p<0.05. RESULTS: It observed that the statistically significant predictors to the calcium score were male, being over 60 years old, having type 2 diabetes mellitus and systemic arterial hypertension. There was no relationship with high BMI and coronary obstruction. Regarding the exercise test, it was possible to observe that the majority of individuals who were positive in the exercise test, did not have a positive calcium score or significant coronary obstructions. CONCLUSION: The predictors for the development of coronary plaques and obstructions were male, aged ≥60 years, having type 2 diabetes mellitus and systemic arterial hypertension.

INTRODUÇÃO: A doença arterial coronariana representa a maior causa de mortalidade no mundo, sendo que os principais fatores de risco para o seu desenvolvimento incluem a hipertensão arterial sistêmica e a diabetes mellitus tipo 2. OBJETIVO: Detectar os preditores para o desenvolvimento de placas e obstruções coronarianas detectadas através da tomografia computadorizada de artérias coronárias além de determinar se o teste de esforço é um pré-teste fidedigno para a realização angiotomografia coronariana. MÉTODOS: Foi realizada análise de 883 laudos de exames de TC de coronárias e coletados dados sociodemográficos, de saúde e o resultado do teste de esforço, juntamente com escore de cálcio, percentil e quantidade de segmentos arteriais com obstruções significativas. Os dados foram analisados pela estatística descritiva e inferencial (p<0,05). RESULTADOS: Foi possível observar que os preditores com valores estatisticamente significantes em relação ao escore de cálcio foi ser do sexo masculino, possuir idade acima de 60 anos, portar diabetes mellitus tipo 2 e hipertensão arterial sistêmica, não houve relação entre IMC elevado, que sugere sobrepeso, e obstrução coronariana. Em relação ao teste de esforço foi possível observar que a maioria dos indivíduos que apresentaram positividade no teste de esforço, não apresentavam escore de cálcio positivo ou obstruções coronarianas significativas. CONCLUSÃO: Os preditores para o desenvolvimento de placas e obstruções coronarianas foi pertencer ao sexo masculino, apresentar idade ≥60 anos, ser portadores de diabetes mellitus tipo 2 e hipertensão arterial sistêmica.

Educational Intervention Using WhatsApp on Medication Adherence in Hypertension and Diabetes Patients: A Randomized Clinical Trial.

Background: Low adherence to pharmacological therapy by patients with diabetes mellitus and hypertension is frequent and represents a worldwide challenge. Introduction: This study examined the effect of an educational intervention using WhatsApp® messaging on medication adherence of patients with hypertension and diabetes. Materials and Methods: A randomized clinical trial was performed with 403 patients who had diabetes and/or hypertension and who had enrolled in the 33 Basic Health Units of Maringá-PR, Brazil. The patients were randomly assigned to either the intervention group (n = 203), which received usual care (multi-professional educational appointments according to each Unit schedule) plus 55 audio, image or text WhatsApp messages about health care promotion, with an emphasis on medication adherence, or the control group. The control group (n = 200) only received usual care. Medication adherence, as measured by the Morisky-Green Test, was compared through the chi-square test after 16 weeks. Relative risk (RR) was used as a measure of effect size. Results: After the follow-up period (4 months), 67.5% of the patients in the intervention group were adherent versus 58.5% in the control group (RR: 1.15, 95% confidence interval = 0.99-1.34, p = 0.077). Discussion: Although the effect of the intervention was not statistically significant, there was a clinically significant impact associated with a 15% increase in medication adherence. Conclusion: Given the complexity of adherence to the use of antidiabetic and antihypertensive medications, educational interventions using WhatsApp could be useful as a reinforcement to increase adherence to medication.

Is WhatsApp Effective at Increasing the Return Rate of Blood Donors?

Background: WhatsApp® is one of the most used apps in Brazil. One of its main features is the potential to overcome geographical, cultural, and socioeconomic disparities. This app is increasingly being used as a tool for mobile health (m-health) interventions; however, with regard to blood donation, scientific studies are still lacking. The recruitment, return, and loyalty of blood donors are public health challenges, especially in developing countries. Objective: To verify the effectiveness of WhatsApp as a tool to increase the return rates of blood donors (first-time and loyal donors). Methods: The study was carried out with 548 individuals who voluntarily went to a private blood bank in the city of Maringá, south of Brazil, to donate blood. The participants were divided randomly into an intervention group (IG) and a control group (CG). Four messages were created following a strategy of persuasive communication and sent using an automatic system (Bulk System) to the list of participants in the IG after they had donated blood. Results: In contrast to our expectations, after the intervention, no significant difference in the return rates was observed between the IG and the CG. Loyal donors, regardless of whether they received the messages or not, returned in higher numbers compared with the first-time and sporadic donors. Conclusion: The intervention using WhatsApp was not effective at increasing the blood donors' return rates, suggesting that the motivations of blood donors are different from those of people who are undergoing self-care interventions. Furthermore, the difference in the blood donors' return rates suggests that specific interventions should be created according to the different stages of the donors' careers.

Scientometrics on interventions used for adherence of hypertension and diabetes therapies.

OBJECTIVE: To identify interventions aimed to improve adherence to medical and non-medical antihypertensive and antidiabetic therapy. METHODS: Scientometric study conducted in February and March 2018, based on data collected on PubMed ® and SciELO databases, using the following search terms: "interventions to improve adherence to diabetes therapy", "interventions to improve adherence to hypertension therapy" and "interventions to improve adherence to therapy for hypertension and diabetes". RESULTS: A total of 95 articles were selected. Scientific production increased as of 2009, with a higher number of studies published between 2015 and 2017. Most interventions described in literature were aimed at diabetic patients (46.31%). Face-to-face interventions were more common (46.31%), followed by telephone-based (31.58%) and digital (26.31%) interventions. North America stood out as the continent with the highest number of publications (68.42%), followed by Europe (14.74%). Most studies (63.16%) were based on a single type of intervention. CONCLUSION: Traditional intervention methods were more widely used to promote adherence to antihypertensive and antidiabetic therapy; digital technology emerged as a trend in interventions aimed to improve hypertension and diabetes-related health behaviors.

Scientometrics on interventions used for adherence of hypertension and diabetes therapies / Cienciometria em intervenções usadas para adesão ao tratamento de hipertensão e diabetes

ABSTRACT Objective To identify interventions aimed to improve adherence to medical and non-medical antihypertensive and antidiabetic therapy. Methods Scientometric study conducted in February and March 2018, based on data collected on PubMed ® and SciELO databases, using the following search terms: "interventions to improve adherence to diabetes therapy", "interventions to improve adherence to hypertension therapy" and "interventions to improve adherence to therapy for hypertension and diabetes". Results A total of 95 articles were selected. Scientific production increased as of 2009, with a higher number of studies published between 2015 and 2017. Most interventions described in literature were aimed at diabetic patients (46.31%). Face-to-face interventions were more common (46.31%), followed by telephone-based (31.58%) and digital (26.31%) interventions. North America stood out as the continent with the highest number of publications (68.42%), followed by Europe (14.74%). Most studies (63.16%) were based on a single type of intervention. Conclusion Traditional intervention methods were more widely used to promote adherence to antihypertensive and antidiabetic therapy; digital technology emerged as a trend in interventions aimed to improve hypertension and diabetes-related health behaviors.

RESUMO Objetivo Identificar as intervenções utilizadas para melhorar a adesão de terapias medicamentosas e não medicamentosas de pacientes hipertensos e diabéticos. Métodos Estudo cienciométrico realizado nos meses de fevereiro e março de 2018, utilizando os termos "intervenções para melhorar a adesão à terapia do diabetes", "intervenções para melhorar a adesão à terapia de hipertensão" e "intervenções para melhorar a adesão à terapia da hipertensão e diabetes", nas bases de dados PubMed®e SciELO. Resultados Foram selecionados 95 artigos. A partir do ano 2009, observou-se crescimento da produção científica com maior volume entre os anos 2015 e 2017. O maior número de intervenções encontradas na literatura foi para pacientes com diabetes (46,31%). A intervenções mais utilizadas foram a face a face (46,31%), por chamada telefônica (31,58%) e a digital (26,31%). A América do Norte destacou-se no número de pesquisas, com 68,42% das publicações, seguida pela Europa, com 14,74%. Dentre os estudos, a maioria (63,16%) utilizou apenas um tipo de intervenção. Conclusão Métodos de intervenção tradicionais foram mais empregados para promover a adesão às terapias anti-hipertensão e antidiabetes, embora o uso de tecnologias digitais desponte como tendência para melhorar esses comportamentos de saúde.

Ação de Comunicação em Saúde no WhatsApp com base no Perfil Digital de Portadores de Hipertensão e Diabetes / Health Communication Action on WhatsApp based on the Digital Profile of People with Hypertension and Diabetes

As doenças crônicas não transmissíveis são causa de grande número de mortes no Brasil e demandam novas abordagens de educação e comunicação em saúde, inclusive incorporando as tecnologias digitais. No entanto, disparidades sociais e de acesso a essas tecnologias tornam o desenho de campanhas e intervenções de educação em saúde um desafio. Diante disso, o objetivo do estudo foi avaliar o perfil digital de usuários do SUS, portadores de hipertensão e Diabetes Mellitus (DM) para elaboração de estratégia de comunicação em saúde considerando o perfil desses usuários. Foram entrevistados de 499 indivíduos em Maringá-Paraná, destes 57 eram diabéticos, 280 hipertensos e 162 diabéticos e hipertensos. Para a criação de conteúdo utilizou-se os princípios do design, softwares de criação gráfica e de áudio, bem como diretrizes para a elaboração de conteúdo em saúde sobre adesão à terapia medicamentosa. Observou-se que 32,87% dos participantes pertenciam a faixa etária de 50 a 59 anos, sendo 64,93% do sexo feminino. Com relação ao perfil digital dos usuários, 81,56% possuem redes sociais, sendo WhatsApp (95,79%) e o Facebook, (68,54%) os mais populares. Os dados permitiram definir um público-alvo, persona e veículo a ser utilizado na intervenção (WhatsApp). 58 imagens, 14 arquivos de áudio e 49 mensagens de texto com conteúdo de educação em saúde foram orginalmente produzidos pela equipe. O presente estudo apontou para o uso de recurso multimídia do WhatsApp com foco em imagens e áudios que atendessem perfil socioeconômico da população alvo. O conhecimento prévio do perfil dos receptores promove uma comunicação mais assertiva e objetiva de campanhas de comunicação em saúde, diferindo das estratégias de comunicação de massa que não tem por finalidade a personalização da mensagem para os variados segmentos de público.

Chronic noncommunicable diseases are the cause of a large number of deaths in Brazil and require new approaches to health education and communication, including incorporating digital technologies. However, social disparities and access to these technologies make the design of health education campaigns and interventions a challenge. Therefore, the objective of this study was to evaluate the digital profile of SUS users, patients with hypertension and Diabetes Mellitus (DM) to develop a health communication strategy considering the profile of these users. 499 individuals were interviewed in Maringá-Paraná and of these 57 were diabetic, 280 were hypertensive and 162 were diabetic and hypertensive. For the creation of content, the principles of design, software for graphic and audio creation, as well as guidelines for the development of health content on adherence to drug therapy were used. It was observed that 32.87% of the participants belonged to the age group of 50 to 59 years old, with 64.93% being female. Regarding the users' digital profile, 81.56% have social networks, of which WhatsApp (95.79%) and Facebook (68.54%) were the most popular. The data allowed to define a target audience, persona and vehicle to be used in the intervention (WhatsApp). 58 images, 14 audio files and 49 text messages with health education content were originally produced by the team. The present study pointed to the use of WhatsApp's multimedia resource with a focus on images and audios that would meet the socioeconomic profile of the target population. Prior knowledge of the recipients' profile promotes a more assertive and objective communication of health communication campaigns, differing from mass communication strategies that are not intended to personalize the message for the various segments of the public.

Atuação das universidades promotoras de saúde na prevenção de neoplasias do colo do útero / Health-promoting universities in the prevention of cervix cancer

Estudo descritivo de corte transversal realizado com mulheres (n= 61) que atuam no setor de limpeza de uma instituição de ensino superior privada no município de Maringá-PR. O objetivo foi avaliar a percepção delas sobre a prevenção da neoplasia do colo do útero. Foram aplicados questionários semiestruturados, elaborados com base nas informações do Instituto Nacional do Câncer. Verificou-se que 8,20% das funcionárias nunca realizaram o preventivo (grupo NR); 26,23% realizaram há mais de dois anos (grupo R+2); 65,57% há menos de dois anos (grupo R-2). Para NR, 20% reconhecem o HPV como fator necessário para o câncer, 43,75% para NR, e 40% para R+2. Para NR, 60% reconhecem que o preventivo auxilia no diagnóstico, 70% para R+2, e 80% para R-2. Para R+2, 25% reconhecem que toda mulher entre 25 e 64 anos de idade deve fazer o exame, e 7,5% para R-2. Para R+2, 12,5% têm hábito de realizar exames rotineiramente, e 30% para R-2. Conclui-se que a adesão ao exame preventivo é intuitiva e o conhecimento sobre a doença é limitado, ressaltando a necessidade de educação em saúde.

Current transversal and descriptive study was undertaken with females (n=61) who work in the cleaning sector of a private university in Maringá, Brazil. Their perception on the prevention of cervix cancer was evaluated. Half-structured questionnaires, prepared on information retrieved from database of the Cancer National Institute, were applied. Further, 8.20% of the employees never undertook any preventive examination (group NR); 26.23% undertook the test more than two years ago (group R+2); 65.57% undertook the test less than two years ago (group R-2). For NR, 20% acknowledge HPV as a necessary factor for cancer; 43.75% for NR and 40% for R+2. In the case of NR, 60% acknowledge that prevention helps in diagnosis, 70% in R+2 and 80% in R-2. In the case of R+2, 25% acknowledge that every female between 25 and 64 years should undertake the test and 7.5% in the case of R-2. In the case of R+2, 12.5% have routine tests and 30% for R-2. Results show that adhesion to preventive test is intuitive and knowledge on the disease is limited. Health education is highly recommended.

Socioeconomic and demographic determinants in the provision of assistance to elderly people with a fractured femur. / Determinantes socioeconômicos e demográficos na assistência à fratura de fêmur em idosos.

Femur fracture affects the elderly with high morbidity and mortality. The purpose of the present study was to analyze the profile of the assistance given to the elderly who have femoral fractures, relating to their socioeconomic and demographic conditions, in the state of Paraná between the years 2008 to 2013. These relationships were obtained through factor analysis and the development and analysis of the following rates: PAE - the potential of primary health care to the elderly, whose variable was represented by the contribution of the elderly to the municipal GDP, PAP - the potential of the primary health care to the population, represented by GDP per capita and TE - treatment efficiency represented by the annual rate of fractures and annual rate of death per residence. The municipalities were classified according to the rate variation range. In relation to PAE, 10 municipalities were classified with low potential of care for the elderly, 357 with moderate potential and 32 had low potential. In relation to PAE, 12 municipalities were classified with low potential of primary care for the elderly, 303 with moderate potential and 84 had low potential. In relation to TE, 109 municipalities showed high treatment efficiency, 110 with moderate efficiency and 180 had low efficiency. Our conclusion was that the performance of the economy exerts significant influence on femoral fracture morbidity in the elderly.

A fratura de fêmur afeta os idosos apresentando alta morbimortalidade. O objetivo do estudo foi analisar o perfil da assistência à fratura de fêmur em idosos, relacionando às condições socioeconômicas e demográficas, no Paraná entre os anos 2008 a 2013. As relações foram obtidas por meio de análise fatorial e construção dos índices: PAI - potencial de atenção ao idoso, cuja variável foi representada pelo PIB municipal idoso; PAP - potencial de atenção à população, representado pelo PIB per capta; e ET - eficiência do tratamento representado pela taxa anual de fraturas e taxa anual de óbitos por residência. Os municípios foram classificados de acordo com a faixa de variação por índice. Em relação ao PAI, 10 municípios foram classificados com baixo potencial de atenção ao idoso; 357 com moderado potencial; e 32 com baixo potencial. Em relação ao PAP, 12 municípios foram classificados com alto potencial de atenção à população; 303 com moderado potencial; e 84 com baixo potencial. Em relação ao ET, 109 municípios apresentaram alta eficiência do tratamento; 110 com moderada eficiência; e 180 com baixa eficiência. Conclui-se que o desempenho da economia exerce significativa influência na assistência à fratura de fêmur em idosos.