Describing Trends in Maternal Mortality in the State of São Paulo, Brazil, from 2009 to 2019.

BACKGROUND: Maternal mortality is a significant public health concern, with varying impacts across different regions in Brazil, particularly affecting women from lower-income social classes with limited access to social resources. The aim of this study is to describe the trends in maternal mortality in São Paulo, Brazil, from 2009 to 2019. MATERIALS AND METHODS: This study employed an ecological approach utilizing a time-series design to examine maternal deaths. Secondary data from the Mortality Information System (SIM) and the Live Births Information System (SINASC) from 2009 to 2019 were utilized. The analysis included all maternal deaths among women aged 10 to 49 years residing in the state of São Paulo. Time-series data for maternal mortality ratios were constructed for the seven regions within São Paulo State. Joinpoint regression analysis was applied to characterize the maternal mortality ratio. The study estimated the annual percentage variation, the average annual percentage variation, and their respective 95% confidence intervals. RESULTS: In São Paulo, a total of 3075 maternal deaths were reported, resulting in a mortality ratio of 45.9 deaths per 100,000 live births. The leading causes of maternal death were eclampsia (7.13%), gestational hypertension (6.09%), and postpartum hemorrhage (5.89%). The analysis of the annual percentage change in the maternal mortality ratio for São Paulo State and its six clusters showed stationarity. CONCLUSIONS: The assessment of the maternal mortality ratio in the state of São Paulo, Greater São Paulo, and Baixada Santista revealed an increase in the maternal death ratio over the studied period.

Description of the scientific method for the preparation and validation of educational technologies in digital format: a methodological study

Introduction: the use of digital technologies constitutes a process that allows the dynamization of the care process, based on aspects related to criticality and creativity. It is emphasized that the development of technologies must, therefore, be inserted in a context for changes and innovation in response to the population's health demand, and must follow a precise methodological path that goes from the construction to the validation of the appearance, content and effect . Objective: to describe the scientific method of elaboration and validation of educational technologies in digital format. Methods: methodological study, conducted according to the following steps: development of the research project and submission to the Research Ethics Committee; data collection; elaboration of the content, script, illustrations and layout of the booklet; and validation of educational technology. Results: the process of developing a technology requires methodological rigor, enabling coherence between theory and the purpose of the desired product, guaranteeing the internal quality of the developed technology. The use of educational technologies in health reinforces information, serving as a guide for guidelines regarding care and assisting in decision-making. Technological innovations in health, consists of a socio-technical process , permeated by professional and user reflections and experiences. Final considerations: educational technologies represent a potential resource for the development of health education practices, encouraging greater interaction between professionals and users, and an active attitude regarding self-care actions related to their health condition.

Introdução: o uso de tecnologias digitais constitui como um processo que permite a dinamização no processo de cuidar, pautada nos aspectos relacionados a criticidade e criatividade. Enfatiza-se, que o desenvolvimento de tecnologias deve, portanto, insere-se em um contexto por mudanças e inovação em resposta a demanda de saúde da população devendo seguir um percurso metodológico preciso que vai desde a construção à validação da aparência, conteúdo e efeito. Objetivo: descrever o método científico de elaboração e validação de tecnologias educativas no formato digital. Método: estudo metodológico, conduzido de acordo com as seguintes etapas: elaboração do projeto de pesquisa e submissão ao Comitê de Ética em Pesquisa; levantamento dos dados; elaboração do conteúdo, roteiro, ilustrações e diagramação da cartilha; e validação da tecnologia educacional. Resultados: o processo de elaboração de uma tecnologia requer rigor metodológico, possibilitando coerência entre teoria e finalidade do produto desejado, garantindo qualidade interna da tecnologia elaborada. O uso de tecnologias educativas em saúde reforça informações, servindo como guia para orientações quanto ao cuidado e auxiliando nas tomadas de decisões. Inovações tecnológicas em saúde, consiste em um processo sócio-técnico, permeado por reflexões e experiências profissionais e usuários. Considerações finais: tecnologias educacionais representam um recurso potencializador para o desenvolvimento de práticas de educação em saúde, estimulando maior interação entre profissionais e usuários, e uma postura ativa quanto a ações de autocuidado relacionado a sua condição de saúde.

MeTA-Edu: a new methodology for enhancing validation of health education technologies applied to COVID-19 prevention in adults with cancer

Introdução: O uso de tecnologias educacionais validadas favorece o acesso às informações confiáveis e adequadas e representa uma importante ferramenta de comunicação de risco para portadores de câncer durante emergências em saúde pública.Objetivo: Avaliar a validade e confiabilidade de uma cartilha eletrônica sobre a COVID-19 para adultos portadores de câncer. Métodos: Estudo metodológico de validação por 22 juízes especialistas residentes vinculados à plataforma nacional de curriculum vitae do Brasil. A amostragem foi realizada por conveniência e bola-de-neve, e a seleção, conforme os critérios de Jasper. A validade da cartilha foi avaliada por questionário eletrônico através do índice de validade de conteúdo (CVI), coeficiente de correlação intraclasse (ICC), o instrumento de avaliação da adequabilidade de materiais (SAM) e a análise temática metalinguística para tecnologias educacionais (MeTA-Edu) de proposições dissertativas. Resultados: A banca avaliadora foi composta por 22 doutores com características sociodemográficas homogêneas e elevado especialização na área de educação (86,4%) e experiência docente (média = 17,8 anos). De modo geral, a tecnologia educacional foi validada pelos juízes especialistas quanto ao conteúdo (CVI global = 0,953) com alto grau de concordância (ICC= 0,958) e adequação de conteúdo, literacia necessária para a compreensão, desenho gráfico, layout e tipografia, estimulação e motivação de aprendizagem e adequação cultural (SAM= 90,6%). Após análise temática, foram identificadas 94 proposições dissertativas, principalmente no tipo de linguagem visual (47,9%), e função referencial/informativa (68,1%). Assim, 83,0% das sugestões foram acatadas e 17,0%, rejeitadas mediante justificativa. Conclusão: A validade e confiabilidade da cartilha "Descomplicando a COVID-19 para pessoas com câncer" foi ratificada pelos juízes especialistas. Estes achados podem contribuir para a otimização metodológica da validação de tecnologias educacionais e inovação de estratégias de educação em saúde, subsidiando a assistência oncológica em tempos de crise.

Introduction: validated educational technologies favor access to reliable and adequate information, representing a critical risk communication tool for cancer patients during public health emergencies.Objective: to assess the validity and reliability of an electronic booklet on COVID-19 for adults with cancer. Methods: methodological validation by a panel of 22 experts linked to Brazil's national curriculum vitae database. Sampling was performed by convenience, snowball, and selection techniques according to Jasper's criteria. The validity of the booklet was evaluated by an electronic questionnaire using the content validity index (CVI), intraclass correlation coefficient (ICC), the suitability assessment of materials (SAM) instrument, and the metalinguistic thematic analysis for educational technologies (MeTA-Edu) of dissertation proposals. Results: the expert panel consisted of 22 doctors with homogeneous sociodemographic characteristics, high specialization in education (86.4%), and teaching experience (mean = 17.8 years). In general, the educational technology was validated by experts for content (overall CVI = 0.953) with a high degree of agreement (ICC = 0.958) and suitability of the content, literacy demand, graphics, layout, and typography, learning stimulation and motivation, and cultural appropriateness (SAM = 90.6%). After thematic analysis, 94 dissertation proposals were identified, mainly of the visual language type (47.9%) and referential/informative function (68.1%). Most expert suggestions were accepted (83.0%), and only 17.0% were rejected.Conclusion: the validity and reliability of the booklet "Uncomplicating COVID-19 for people with cancer" were ratified by experts. These findings can contribute to the methodological optimization of the validation of educational technologies and innovation of health education strategies, subsidizing cancer care in times of crisis

The Use of Cardiac Autonomic Responses to Aerobic Exercise in Elderly Stroke Patients: Functional Rehabilitation as a Public Health Policy.

BACKGROUND AND PURPOSE: The development of public policies must be guided by full knowledge of the health-disease process of the population. Aerobic exercises are recommended for rehabilitation in stroke patients, and have been shown to improve heart rate variability (HRV). Our aim was to compare the cardiac autonomic modulation of elderly stroke patients with that of healthy elderly people during and after an acute bout of aerobic exercise. METHODS: A total of 60 elderly people participated in the study (30 in the control group, mean age of 67 ± 4 years; 30 in the stroke group, mean age of 69 ± 3 years). HRV was analyzed in rest-10 min of rest in supine position; exercise-the 30 min of peak exercise; and recovery-30 min in supine position post-exercise. RESULTS: Taking rest and exercises together, for SDNN, RMSSD, pNN50, RRTri, and TINN, there was no difference between the stroke and control groups (p = 0.062; p = 0.601; p = 0.166; p = 0.224, and p = 0.059, respectively). The HF (ms2) was higher and the LF/HF ratio was lower for the stroke group than the control group (p < 0.001 and p = 0.007, respectively). The SD2 was lower for the stroke group than for the control group (p = 0.041). CONCLUSION: Stroke patients present reduced variability at rest, sympathetic predominance during exercise, and do not return to baseline after the 30 min of recovery, with similar responses found in the healthy elderly group.

Autonomic cardiac modulation in postmenopausal women with dry eye syndrome: a cross-sectional analytical study.

OBJECTIVE: The aim of this study was to assess cardiac autonomic modulation in postmenopausal women with and without dry eye syndrome (DES) and to identify associations between clinical and socioeconomic factors. METHODS: A cross-sectional study was carried out at the Institute of Ocular Surgery of the Northeast (ICONE), Brazil. Convenience sample of postmenopausal women, over 40 years old, who were divided into two groups: with and without DES. Clinical, sociodemographic, and ophthalmological characteristics of these women were assessed. Capture of RR intervals was performed using a cardio frequency meter. Differences between the groups were analyzed using the Chi-square test, the Student's t test, and the Mann-Whitney test. RESULTS: Women with DES were present in 60.4% (n=58), highest median age (63.5 years, 95%CI 62.0-67.9; p<0.001), median length of time menopause (19 years old, 95%CI 10.4-24.0; p<0.001). There was a difference in the standard deviation of all normal-to-normal index between the groups. However, when the differences were adjusted to the clinical model, no association was found between DES and heart rate variability (HRV). CONCLUSIONS: The analysis of cardiac autonomic modulation in postmenopausal women is similar in the presence or absence of DES. Clinical factors, time of menopause, and intensity of symptoms were not associated with HRV indices.

Autonomic cardiac modulation in postmenopausal women with dry eye syndrome: a cross-sectional analytical study

SUMMARY OBJECTIVE The aim of this study was to assess cardiac autonomic modulation in postmenopausal women with and without dry eye syndrome (DES) and to identify associations between clinical and socioeconomic factors. METHODS A cross-sectional study was carried out at the Institute of Ocular Surgery of the Northeast (ICONE), Brazil. Convenience sample of postmenopausal women, over 40 years old, who were divided into two groups: with and without DES. Clinical, sociodemographic, and ophthalmological characteristics of these women were assessed. Capture of RR intervals was performed using a cardio frequency meter. Differences between the groups were analyzed using the Chi-square test, the Student's t test, and the Mann-Whitney test. RESULTS Women with DES were present in 60.4% (n=58), highest median age (63.5 years, 95%CI 62.0-67.9; p<0.001), median length of time menopause (19 years old, 95%CI 10.4-24.0; p<0.001). There was a difference in the standard deviation of all normal-to-normal index between the groups. However, when the differences were adjusted to the clinical model, no association was found between DES and heart rate variability (HRV). CONCLUSIONS The analysis of cardiac autonomic modulation in postmenopausal women is similar in the presence or absence of DES. Clinical factors, time of menopause, and intensity of symptoms were not associated with HRV indices.

The effects of cataract surgery on autonomic heart rate control: a prospective cross-sectional and analytical study.

OBJECTIVES: We aimed to evaluate the effects of cataract surgery on cardiac autonomic modulation. METHODS: A cross-sectional and analytical study was conducted at the Hospital Maria Braido in the city of São Caetano do Sul, São Paulo, between 2015 and 2016. We investigated 19 patients of both sexes who were all over 50 years old; all patients had a diagnosis of senile or bilateral cataracts and were recommended to undergo implantation of the intraocular lens. Heart rate variability (HRV) was evaluated before, during and after cataract surgery. RESULTS: There were no significant changes in the time and geometric domains of HRV before, during or after surgery. The high-frequency (HF) band in normalized units (nu) on the spectral analysis significantly increased (p=0.02, Cohen's d=0.9, large effect size). However, the low-frequency (LF) band in nu significantly decreased during surgery (p=0.02, Cohen's d=0.9, large effect size). CONCLUSION: Throughout the intraocular lens implantation cataract surgery, there was an increase in parasympathetic modulation and a decrease in the sympathetic component of the heart rate (HR). We propose that this result is attributable to the supine position of the patients during surgery and the trigeminal reflex.

The effects of cataract surgery on autonomic heart rate control: a prospective cross-sectional and analytical study

OBJECTIVES: We aimed to evaluate the effects of cataract surgery on cardiac autonomic modulation. METHODS: A cross-sectional and analytical study was conducted at the Hospital Maria Braido in the city of São Caetano do Sul, São Paulo, between 2015 and 2016. We investigated 19 patients of both sexes who were all over 50 years old; all patients had a diagnosis of senile or bilateral cataracts and were recommended to undergo implantation of the intraocular lens. Heart rate variability (HRV) was evaluated before, during and after cataract surgery. RESULTS: There were no significant changes in the time and geometric domains of HRV before, during or after surgery. The high-frequency (HF) band in normalized units (nu) on the spectral analysis significantly increased (p=0.02, Cohen's d=0.9, large effect size). However, the low-frequency (LF) band in nu significantly decreased during surgery (p=0.02, Cohen's d=0.9, large effect size). CONCLUSION: Throughout the intraocular lens implantation cataract surgery, there was an increase in parasympathetic modulation and a decrease in the sympathetic component of the heart rate (HR). We propose that this result is attributable to the supine position of the patients during surgery and the trigeminal reflex.

[Práticas integrativas no SUS: Constelação Familiar]

A Constelação Familiar ou Constelação Sistêmica é uma técnica desenvolvida por um alemão [Bert Hellinger] e que se baseia em abordar como a história e as relações familiares influenciam as emoções e padrões de comportamento das pessoas. Ela se difundiu pelo mundo e sua eficácia é reconhecida no campo da saúde mental e até na área judiciária, onde ela é usada como estratégia para a solução de conflitos. A terapia foi incorporada ao rol das Práticas Integrativas e Complementares em Saúde (PICS) do SUS. No programa, a apresentadora Marcela Morato conversa com o terapeuta constelador familiar Álvaro Dantas. Participações: André Tredinnick, juíz da 1ª Vara da Família do Fórum Leopoldina do Tribunal de Justiça do Rio de Janeiro.

Chronic obstructive pulmonary disease and heart rate variability: a literature update.

BACKGROUND: The literature indicates that chronic obstructive pulmonary disease (COPD) affects cardiac autonomic control. In this study, we conducted a literature review in order to investigate the heart rate variability (HRV) in COPD subjects. METHODS: A search was performed in Medline database, using the link between the keywords: "autonomic nervous system", "cardiovascular system", "COPD" and "heart rate variability". RESULTS: The search resulted in a total of 40 references. Amongst these references, the first exclusion resulted in the barring of 29 titles and abstracts, which were not clearly related to the purpose of review. This resulted in a total of 11 articles that were then read and utilized in the review. The selected studies indicated that there is significant reduction of HRV in patients with COPD, characterized by reduction of indices that assess parasympathetic activity in addition to dealing with the global autonomic modulation. We also established that supervised exercise can reduce these harmful effects in COPD patients. Also, it was reported that the use of non-invasive ventilation in these patients may contribute to the improvement of respiratory symptoms, with no impairing, and may even induce positive responses in cardiac autonomic regulation. CONCLUSION: The studies indicate a need for further investigations to guide future therapies to improve the treatment of cardiovascular system in the respiratory diseases.