Percepción de enfermeros colombianos sobre un entorno laboral saludable para la práctica asistencial en el ámbito hospitalario

Objetivo: Explorar la percepción de enfermeros profesionales colombianos sobre la definición y las principales características de un entorno laboral saludable (ELS) para la práctica asistencial de enfermería en el ámbito hospitalario. Metodología: Estudio de tipo cualitativo descriptivo. Se realizaron entrevistas semiestructuradas a nueve enfermeros profesionales reclutados mediante un muestreo no probabilístico. Las entrevistas fueron grabadas, transcritas literalmente y codificadas. A través de la organización y estructuración de estos códigos se logró establecer categorías y subcategorías. Resultados: Del análisis de los datos fue posible establecer una definición de entorno laboral saludable y se obtuvieron dos dimensiones (categorías) y diez características principales (subcategorías) del concepto. Conclusiones: Los hallazgos de este estudio permiten tener una mejor comprensión acerca de la percepción de los enfermeros colombianos sobre la definición y características esenciales de un ELS para la práctica de enfermería en el ámbito hospitalario. Estos hallazgos aportan al desarrollo de herramientas de medición de los ELS que se ajusten a las condiciones y a la realidad del ejercicio profesional en el ámbito hospitalario colombiano.

Objective: To explore the perception of Colombian professional nurses about the definition and the main characteristics of a healthy work environment (HWE) for nursing care practice in the hospital setting. Methodology: Descriptive qualitative study. Semi-structured interviews were conducted with nine professional nurses recruited through non-probabilistic sampling. The interviews were recorded, literally transcribed and coded. Through the organization and structuring of these codes, it was possible to establish categories and subcategories. Results: From the data analysis it was possible to establish a definition of healthy work environment and two dimensions (categories), and 10 main characteristics (subcategories) of the concept were obtained. Conclusions: The findings of this study allow a better understanding of the perception of Colombian nurses about the definition and essential characteristics of an HWE for nursing practice in the hospital setting. These findings contribute to the development of HWE measurement tools that are adjusted to the conditions and reality of professional practice in the Colombian hospital setting.

Concordância da avaliação da via alimentar entre fonoaudiólogo e médico baseado na escala FOIS: coorte retrospectiva / Agreement in the assessment of the food pathway between speech therapists and physicians based on the FOIS scale: a retrospective cohort study / Concordancia en la evaluación de la vía alimentaria entre fonoaudiólogos y médicos basada en la escala FOIS: un estudio de cohorte retrospectivo

Introdução: A avaliação fonoaudiológica hospitalar tem um importante papel na prevenção e manejo de pacientes com risco de broncoaspiração. No entanto, nem sempre cabe ao fonoaudiólogo a primeira avaliação e definição da via alimentar nos pacientes hospitalares. Objetivo: Comparar as decisões fonoaudiológicas e médicas quanto à viabilidade da via alimentar em um hospital geral e identificar fatores associados com a melhora da deglutição. Métodos: Trata-se de um estudo retrospectivo de pacientes internados em hospital em Joinville durante março a agosto de 2018. A via alimentar foi considerada com base na Functional Oral Intake Scale (FOIS) sendo a primeira decisão comparada entre o fonoaudiólogo e o médico para o mesmo paciente. Resultados: Dos 171 pacientes, houve maior concordância entre as condutas médica e fonoaudiológica para alimentação por sonda nasoenteral (SNE) (88,7%) e alimentação oral livre (81,9%). No entanto, houve apenas 35% de concordância na definição de dieta adaptada, sendo a concordância geral moderada (Kappa 0,486). Houve evolução na alimentação por via oral em 62 pacientes (36%). Maior limitação da via alimentar, verificado pela necessidade de SNE (OR = 3,17; p = 0,025) e o maior número de atendimentos fonoaudiológicos intra-hospitalares (OR = 1,09; p = 0,020) foram associados com a melhora da disfagia. Conclusão: Encontrou-se concordância entre a avaliação dietética de casos para uso de SNE ou dieta livre entre o fonoaudiólogo e médico. Uso de SNE, como indicador de gravidade do paciente, e o maior número de sessões de fonoterapia foram associados com a melhora da disfagia durante a internação. (AU)

Introduction: Hospital-based speech-language pathology plays a crucial role in preventing and managing patients at risk of bronchoaspiration. However, the initial evaluation and determination of the feeding route in hospitalized patients may not always fall under the responsibility of the speech-language pathologist. Objective: To compare the decisions of speech-language pathologists and medical professionals regarding the feasibility of the feeding route in a general hospital and identify factors associated with swallowing improvement. Methods: This is a retrospective study of patients admitted to a hospital in Joinville from March to August 2018. The feeding route was assessed based on the Functional Oral Intake Scale (FOIS), with the initial decision compared between the speech-language pathologist and the physician for the same patient. Results: Among 171 patients, there was higher agreement between medical and speech-language pathology decisions for nasoenteral tube feeding (88.7%) and oral unrestricted intake (81.9%). However, there was only 35% agreement in defining an adapted diet, with overall moderate agreement (Kappa 0.486). Oral feeding improved in 62 patients (36%). The presence of nasoenteral tube feeding (OR = 3.17; p = 0.025) and a higher number of in-hospital speech-language pathology appointments (OR = 1.09; p = 0.020) were identified as independent predictors for dysphagia improvement. Conclusion: Concordance was found in the dietary assessment for the use of nasoenteral tube feeding or oral unrestricted intake between speech-language pathologists and physicians. The use of nasoenteral tube feeding as an indicator of patient severity and a higher number of speech-language pathology sessions were associated with dysphagia improvement during hospitalization. (AU)

Introducción: La evaluación fonoaudiológica hospitalaria desempeña un papel crucial en la prevención y el manejo de pacientes con riesgo de broncoaspiración. Sin embargo, no siempre corresponde al fonoaudiólogo la primera evaluación y definición de la vía alimentaria en los pacientes hospitalizados.Objetivo: Comparar las decisiones fonoaudiológicas y médicas sobre la viabilidad de la vía alimentaria en un hospital general e identificar factores asociados con la mejora de la deglución. Métodos: Se trata de un estudio retrospectivo de pacientes hospitalizados en un hospital de Joinville durante marzo a agosto de 2018. La vía alimentaria se evaluó según la Escala Funcional de Ingesta Oral (FOIS), siendo la primera decisión comparada entre el fonoaudiólogo y el médico para el mismo paciente. Resultados: De 171 pacientes, hubo una mayor concordancia entre las decisiones médicas y fonoaudiológicas para la alimentación por sonda nasoenteral (SNE) (88,7%) y la alimentación oral libre (81,9%). Sin embargo, solo hubo un 35% de concordancia en la definición de una dieta adaptada, siendo la concordancia general moderada (Kappa 0,486). La alimentación oral mejoró en 62 pacientes (36%). Una mayor limitación de la vía alimentaria, indicada por la necesidad de SNE (OR = 3,17; p = 0,025), y un mayor número de sesiones fonoaudiológicas intrahospitalarias (OR = 1,09; p = 0,020) se asociaron con la mejora de la disfagia.Conclusión: Se encontró concordancia en la evaluación dietética para el uso de SNE o dieta libre entre el fonoaudiólogo y el médico. El uso de SNE, como indicador de la gravedad del paciente, y un mayornúmero de sesiones de fonoterapia se asociaron con la mejora de la disfagia durante la hospitalización. (AU)

Associação entre autopercepção auditiva e comprometimento cognitivo em idosos brasileiros: estudo populacional / Association between self-perceived hearing status and cognitive impairment in the older Brazilian population: a population-based study

Resumo Saúde cognitiva é um fator importante para qualidade de vida e a autonomia dos idosos, sendo influenciada pela capacidade auditiva. O objetivo deste artigo é analisar a associação entre autopercepção auditiva e comprometimento cognitivo em idosos brasileiros. Trata-se de um estudo transversal de base populacional com 4.977 idosos que participaram do ELSI Brasil 2015. Comprometimento cognitivo (desfecho, categorizado como sim e não) e a variável de interesse (autopercepção auditiva, categorizada como boa, regular e ruim), ambos obtidos de forma autorreferida. Para a cognição foram considerados os domínios orientação temporal, memória (curto e longo prazo) e linguagem (recente e tardia). Foi utilizada a regressão de Poisson com estimativa de variância robusta para aferir a associação nas análises bruta e ajustada. Variáveis sociodemográficas, de estilo de vida e de histórico clínico foram utilizadas para ajuste das análises. Dos participantes, 31,8% relataram audição regular ou ruim e 42% apresentaram comprometimento cognitivo. Na análise ajustada, idosos com audição ruim apresentaram maior força de associação com comprometimento cognitivo, em comparação com seus pares com audição boa. Em idosos brasileiros, quanto pior a autopercepção auditiva, maior a associação com o comprometimento cognitivo.

Abstract Cognitive health plays an important role in the quality of life and autonomy of older adults. and it is influenced by hearing ability. This article aims to analyze the association between self-perceived hearing status and cognitive impairment in Brazilian older adults. This cross-sectional population-based study was conducted with 4,977 older adults who participated in ELSI Brazil 2015. The cognitive impairment status (outcome. categorized as "yes" and "no") and variable of interest (self-perceived hearing status. categorized as "good" "fair" and "poor") were obtained using a self-report method. The following domains were considered for cognition: temporal orientation. memory (short and long term). and language (recent and late). Poisson regression with robust variance estimation was used to assess the self-perceived hearing status-cognitive impairment association in the crude and adjusted analyses. Sociodemographic. lifestyle. and medical history variables were used to adjust the analyses. We found that 31.8% of the participants reported fair or poor hearing and 42% had cognitive impairment. In the adjusted analysis. older adults with poor hearing were revealed to have a stronger association with cognitive impairment than their peers with good hearing. Therefore. in older Brazilian adults. lower self-perceived hearing status is associated higher levels of cognitive impairment.

Percepção dos cuidadores frente a dor pós-operatória pediátrica e cuidados de enfermagem / Percepición de los cuidadores sobre el dolor posoperatorio pediátrico y los cuidados de enfermería / Caregivers' perception of pediatric postoperative pain and nursing care

Objetivo: descrever a percepção dos cuidadores frente a dor pós-operatória pediátrica e cuidados de enfermagem. Método: estudo descritivo, realizado na Unidade de Pediatria de um Hospital Universitário no Paraná com dados coletados mediante formulário sociodemográfico e questionário de Dor de MCGill-Melzack adaptado e análise a partir de estatística descritiva. Resultados: participaram do estudo 24 cuidadores de crianças submetidas a intervenções cirúrgicas, predominantemente, mulheres (22), preponderando as crianças do sexo masculino. Os resultados apresentaram maior utilização de dipirona como analgesia (50%), tendo a maioria dos cuidadores descrito a dor como breve (33,3%). O principal comportamento de dor relatado foi choro (35%). De forma geral, os cuidadores classificaram a assistência de enfermagem como muito boa ou excelente. Conclusão: o profissional de enfermagem, reconhece a dor como um evento importante e presta assistência. O estudo incita a necessidade de padronização de instrumentos de avaliação e manejo da dor pediátrica pós-operatória.

Objective: to describe the perception of caregivers regarding pediatric postoperative pain and nursing care.Method:descriptive study, carried out at the Pediatrics Unit of a University Hospital in Paraná with data collected using a sociodemographic form and an adapted MCGill-Melzack Pain questionnaire and analysis based on descriptive statistics. Results: 24 caregivers of children undergoing surgical interventions participated in the study, predominantly women (22), with a predominance of male children. The results showed a greater use of dipyrone as analgesia (50%), with most caregivers describing the pain as brief (33.3%). The main reported pain behavior was crying (35%). In general, caregivers rated nursing care as very good or excellent.Conclusions: the nursing professional recognizes pain as an important event and provides assistance. The study highlights the need for standardization of postoperative pediatric pain assessment and management instruments.

Objetivo: describir la percepción de los cuidadores sobre el dolor posoperatorio pediátrico y el cuidado de enfermería. Método: estudio descriptivo, realizado en la Unidad de Pediatría de un Hospital Universitario de Paraná con datos recolectados mediante formulario sociodemográfico y cuestionario MCGill-Melzack Pain adaptado y análisis con base en estadística descriptiva. Resultados: participaron del estudio 24 cuidadores de niños sometidos a intervenciones quirúrgicas, predominantemente mujeres (22), con predominio de niños varones. Los resultados mostraron un mayor uso de dipirona como analgesia (50%), con la mayoría de los cuidadores describiendo el dolor como breve (33,3%). La principal conducta de dolor reportada fue el llanto (35%). En general, los cuidadores calificaron la atención de enfermería como muy buena o excelente. Conclusiones: el profesional de enfermería reconoce el dolor como un evento importante y brinda asistencia. El estudio destaca la necesidad de estandarizar los instrumentos de evaluación ymanejo del dolor pediátrico posoperatorio.

Entorno laboral de enfermería en un hospital de Bogotá, 2022 / Nursing Work Environment at a Hospitalb in Bogota, 2022 / Ambiente de trabalho da enfermagem em um hospital de Bogotá, 2022

Introducción: La preocupación por el entorno laboral en enfermería se ha hecho aun mayor desde la pandemia Covid-19, que afectó la cantidad y calidad del personal de enfermería alrededor del mundo. Objetivo. Describir el entorno laboral de los enfermeros que desempeñan funciones asistenciales en un hospital de Bogotá, Colombia. Método: Estudio descriptivo exploratorio, con un componente correlacional. Se remitió el cuestionario ENLASA a todos los enfermeros asistenciales del hospital objeto de estudio a través de RedCapÒ. Resultados. El cuestionario completo fue respondido por el 50% de los enfermeros asistenciales (49 enfermeros) de la institución e invitados a participar en el estudio. El 57,1% de los respondientes consideró el entorno laboral no saludable. La dimensión de elementos estructurales se consideró no saludable (64,49/100), y la de procesos organizacionales como saludable (71,18/100). Las subdimensiones no saludables fueron, en estructura, la planeación del recurso de enfermería, (54,66/100) y políticas de recursos humanos (58,91/100) y en procesos, la interacción enfermero-organización (63,10/100) y autonomía (66,07/100). No se encontró asociación entre las variables sociodemográficas y el entorno laboral de enfermería. La única asociación estadísticamente significativa entre entorno laboral y resultados fue la relativa a la motivación para trabajar. (Phi 0,362, p=0,040). Conclusiones. Se sugiere intervenir las dimensiones y subdimensiones identificadas como no saludables, y continuar monitoreando este fenómeno.

Introduction: concern for the work environment in nursing has become even greater since the COVID-19 pandemic, which affected the quantity and quality of nursing personnel around the world. Objective: to describe the work environment of nurses performing care functions in a hospital in Bogota, Colombia. Method: exploratory descriptive study. The Enlasa -Nursing Questionnaire was sent to all the nurses in the hospital under study through RedCap. Results: 50% of the nurses (49 nurses) of the institution invited to participate in the study answered the complete questionnaire. The work environment was considered unhealthy by 57.1% of the respondents. The dimension of structural elements was seen as unhealthy (64.49/100), and that of organizational processes as healthy (71.18/100). The sub-dimensions considered unhealthy in structure were nursing resource planning (54.66/100) and human resources policies (58.91/100). With respect to processes were nurse-organization interaction (63.10/100) and autonomy (66.07/100). No association was found between sociodemographic variables and nursing work environment. The only statistically significant association between work environment and results was the one related to motivation to work (Phi 0.362, p=0.040). Conclusions: it is suggested to intervene in the dimensions and subdimensions identified as unhealthy and to continue monitoring this phenomenon.

Introdução: a preocupação pelo ambiente de trabalho dos enfermeiros tornou-se ainda maior desde a pandemia de COVID-19, que afetou a quantidade e qualidade do pessoal de enfermagem em todo o mundo. Objetivo: descrever o ambiente de trabalho dos enfermeiros que desenvolvem funções assistenciais em um hospital de Bogotá, Colômbia. Método: estudo descritivo exploratório. O questionário Enlasa-Enfermagem foi enviado a todos os enfermeiros assistenciais do hospital objeto de estudo através de RedCap®. Resultados: 50% dos enfermeiros assistenciais (49 enfermeiros) da instituição convidados a participar do estudo respondeu ao questionário completo. 57,1% dos entrevistados considerou o ambiente laboral não saudável. A dimensão de elementos estruturais foi vista como não saudável (64,49/100), e a de processos organizacionais como saudável (71,18/100). As subdimensões consideradas não saludáveis em estrutura foram planejamento do recurso de enfermagem (54,66/100) e políticas de recurso humano (58,91/100). Quanto aos processos, foram interação enfermeiro-organização (63,10/100) e autonomia (66,07/100). Não foi encontrada associação entre as variáveis sociodemográficas e o ambiente laboral de enfermagem. A única associação estatisticamente significativa entre ambiente de trabalho e resultados foi relacionada à motivação para trabalhar. (Phi 0,362, p=0,040). Conclusões: sugere-se intervir nas dimensões e subdimensões identificadas como não saudáveis e continuar monitorando esse fenômeno.

"Sonhei que morri": guerra e morte nos sonhos de jovens que cumprem medida socioeducativa de privação de liberdade / "Soñé que moría" guerra y muerte en los sueños de jóvenes que se encuentran en medidas socioeducativas / "I dreamed I died" war and death on adolescents' dreams who are subjected to socio-educational measures / "J'ai rêvé que je mourais" guerre et mort dans les rêves des jeunes en mesures socio-éducatives

Este artigo apresenta reflexões acerca da experiência com as Rodas de Sonhos, um dispositivo clínico-político construído em meio aos trabalhos de pesquisa-intervenção do NUPPEC junto aos adolescentes que cumpriam medida socioeducativa de privação de liberdade. Destacamos a temática da guerra e da morte presente nos relatos dos sonhos dos meninos em enlace com o desejo de morte que a sociedade brasileira dirige a esses jovens. Explicitamos o contexto violento da juventude brasileira em situação de vulnerabilidade social, sustentado pela lógica dos discursos capitalistas e neoliberais. Compartilhamos algumas narrativas oníricas, nas quais problematizamos os efeitos das políticas de morte e da violência dirigidas aos jovens negros e pobres do país. Entendemos que as Rodas de Sonhos oferecem um modo de resistência frente aos discursos mortíferos dirigidos a esses jovens

Este artículo presenta reflexiones sobre la experiencia con Rodas de Sonhos, un dispositivo clínico-político, construido en medio del trabajo de investigación-intervención del NUPPEC, con adolescentes que cumplían una medida socioeducativa de privación delibertad. Destacamos el tema de la guerra y la muerte presente en los relatos de los sueños de los chicos en relación con el deseo de muerte que la sociedad brasileña dirige a estos jóvenes. Explicamos el contexto violento de la juventud brasileña en situación de vulnerabilidad social, apoyados en la lógica de los discursos capitalista y neoliberal. Compartimos algunas narrativas oníricas, en las que problematizamos los efectos de las políticas de muerte y violencia dirigidas a los jóvenes negros y pobres del país. Entendemos que las Rodas de Sonhos ofrecen una forma de resistir los discursos mortíferos dirigidos a estos jóvenes

This article presents the reflections about the experience with Wheels of Dreams (Rodas dos Sonhos), a clinical-political device, developed around the research-intervention work of NUPPEC, with teenagers who are on depravation of liberty on detention centers for juvenile offenders. We emphasize the theme of war and death present in the narration of the dreams of teenagers in association with the desire for death that Brazilian society directed to these young people. We explicit the violent context of Brazilian youth in social vulnerability situation, sustained by the logic of capitalist and neoliberal discourses. We share some oneiric narratives, in which we problematized the effects of death policies and violence towards the country's young black and poor people. We understand that the Wheels of Dreams offer a mode of resistance in the face of deadly discourses directed at these young people

Cet article expose des réflexions sur l'expérience avec les Roues de Rêves, un dispositif clinique-politique, construit parmi aux travaux de recherche-intervention du NUPPEC, avec des adolescents qui purgeaient une mesure socio-éducatif de privation de liberté. Nous soulignons le thème de la guerre et de la mort présent dans les rapports des rêves des garçons combinés avec le souhait de mort que la société brésilienne apporte à ces jeunes. Nous explicitons le contexte violent de la jeunesse brésilienne en situation de vulnérabilité sociale, soutenu par la logique des discours capitalistes et néolibéraux. Nous partageons quelques récits oniriques, dans lesquels nous problématisons les effets des politiques de mort et de violence destinées à les jeunes noirs et pauvres du pays. Nous comprenons que les Roues de Rêves proposent une manière de résistance aux discours mortels destinés à ces jeunes

Effect of platelet-derived growth factor-BB on pulmonary vascular remodeling in neonatal rats with hypoxic pulmonary hypertension and its mechanism / 中国当代儿科杂志

OBJECTIVES@#To study the effect of platelet-derived growth factor-BB (PDGF-BB) on pulmonary vascular remodeling in neonatal rats with hypoxic pulmonary hypertension (HPH).@*METHODS@#A total of 128 neonatal rats were randomly divided into four groups: PDGF-BB+HPH, HPH, PDGF-BB+normal oxygen, and normal oxygen (n=32 each). The rats in the PDGF-BB+HPH and PDGF-BB+normal oxygen groups were given an injection of 13 μL 6×1010 PFU/mL adenovirus with PDGF-BB genevia the caudal vein. After 24 hours of adenovirus transfection, the rats in the HPH and PDGF-BB+HPH groups were used to establish a neonatal rat model of HPH. Right ventricular systolic pressure (RVSP) was measured on days 3, 7, 14, and 21 of hypoxia. Hematoxylin-eosin staining was used to observe pulmonary vascular morphological changes under an optical microscope, and vascular remodeling parameters (MA% and MT%) were also measured. Immunohistochemistry was used to measure the expression levels of PDGF-BB and proliferating cell nuclear antigen (PCNA) in lung tissue.@*RESULTS@#The rats in the PDGF-BB+HPH and HPH groups had a significantly higher RVSP than those of the same age in the normal oxygen group at each time point (P<0.05). The rats in the PDGF-BB+HPH group showed vascular remodeling on day 3 of hypoxia, while those in the HPH showed vascular remodeling on day 7 of hypoxia. On day 3 of hypoxia, the PDGF-BB+HPH group had significantly higher MA% and MT% than the HPH, PDGF-BB+normal oxygen, and normal oxygen groups (P<0.05). On days 7, 14, and 21 of hypoxia, the PDGF-BB+HPH and HPH groups had significantly higher MA% and MT% than the PDGF-BB+normal oxygen and normal oxygen groups (P<0.05). The PDGF-BB+HPH and HPH groups had significantly higher expression levels of PDGF-BB and PCNA than the normal oxygen group at all time points (P<0.05). On days 3, 7, and 14 of hypoxia, the PDGF-BB+HPH group had significantly higher expression levels of PDGF-BB and PCNA than the HPH group (P<0.05), while the PDGF-BB+normal oxygen group had significantly higher expression levels of PDGF-BB and PCNA than the normal oxygen group (P<0.05).@*CONCLUSIONS@#Exogenous administration of PDGF-BB in neonatal rats with HPH may upregulate the expression of PCNA, promote pulmonary vascular remodeling, and increase pulmonary artery pressure.

Is pectoralis muscle index a risk factor for mortality in left ventricular assist device patients?

SUMMARY OBJECTIVE: We aimed to investigate whether sarcopenia measured from pectoralis muscles is a risk factor for long-term mortality in left ventricular assist device patients. METHODS: Patients aged >18 years implanted with a left ventricular assist device in a single center between 2013 and 2019 were retrospectively included. Patients without a thoracic computed tomography scan performed within 3 months of left ventricular assist device implantation and without computed tomography scans appropriate for pectoralis muscle measurement were excluded. Pectoralis muscle measurements were made on thoracic computed tomography slices, and pectoralis muscle indices were calculated for each patient. Sarcopenia was defined as being in the gender-specific lowest tertile of pectoralis muscle index. Survival was compared between patients with and without sarcopenia. RESULTS: The study was conducted on 64 left ventricular assist device patients who met the inclusion criteria. Notably, 21 (32.8%) of the study patients were sarcopenic. Diabetes mellitus and sarcopenia were more common in patients with 2-year mortality in our cohort. Patients with sarcopenia had a worse 2-year survival (p<0.001). Sarcopenia had an adjusted hazard ratio of 4.04 (95% confidence interval (CI) 1.36-12.02, p=0.012), while diabetes mellitus was associated with an adjusted hazard ratio of 3.14 (95%CI 1.17-8.39, p=0.023). CONCLUSION: Sarcopenia defined by low pectoralis muscle index increases the risk for 2-year mortality in left ventricular assist device patients.

Mortality attributed to sickle cell disease in children and adolescents in Brazil, 2000-2019 / Mortalidade atribuída à doença falciforme em crianças e adolescentes no Brasil, 2000-2019

ABSTRACT OBJECTIVE Estimate rates and describe mortality trends attributed to sickle cell disease in children and adolescents in Brazil from 2000 to 2019. METHODS This is an ecological study of the time-trend of mortality rates that used the autoregressive method, proposed by Prais-Winsten, to evaluate trends in the estimated rates of sickle cell disease deaths in children and adolescents in Brazil. Deaths with code D57 were obtained from the Mortality Information System, considering age groups (0-4, 5-9, 10-14, 15-19 years) and were used to estimate age-specific and standardized rates by gender and age. RESULTS From 2000 to 2019, Brazil had 2,422 deaths from sickle cell disease in people under 20 years of age, with higher frequency in the Northeast (40.46%), followed by the Southeast (39.02%), Midwest (9.58%), North (7.84%), and South (3.10%). The main victims were people of Black skin/race (78.73%). In Brazil, the global standardized average rate was 0.20/100,000 people-year, with an elevation trend (annual percentage change - APC = 5.44%; confidence interval - 95%CI: 2.57-8.39). The pattern was repeated in males (APC = 4.38%; 95%CI: 2.17-6.64) and females (APC = 6.96%; 95%CI: 3.05-11.01). Elaborating age-specific rates showed that the range up to four years experienced the highest rates, without distinction by region. The age group of 15 and 19 years was the second most affected in Brazil and in the Northeast, Southeast, and Midwest regions. CONCLUSION Deaths due to sickle cell disorders showed an elevation trend in children and adolescents. Considering that the magnitude of deaths was more evident in the first years (0-4) and late adolescence (15-19), the study suggests that age-specific approaches may impact the control of fatal outcomes caused by sickle cell disease in Brazil.

RESUMO OBJETIVO Estimar taxas e descrever tendências de mortalidade atribuídas à doença falciforme em crianças e adolescentes no Brasil, de 2000 a 2019. MÉTODOS Este é um estudo ecológico do tipo séries temporais de taxas de mortalidade que usou o método autorregressivo, proposto por Prais-Winsten, para avaliar tendências das taxas estimadas de mortes por doença falciforme em crianças e adolescentes no Brasil. Os óbitos com código D57 foram obtidos no Sistema de Informações sobre Mortalidade, considerando as faixas etárias (0-4, 5-9, 10-14, 15-19 anos) e usados para estimar taxas específicas por idade e taxas padronizadas por sexo e idade. RESULTADOS De 2000 a 2019, houve 2.422 óbitos por doença falciforme em menores de 20 anos no Brasil, com maior frequência na região Nordeste (40,46%), seguida de Sudeste (39,02%), Centro-Oeste (9,58%), Norte (7,84%) e Sul (3,10%). As principais vítimas foram pessoas de raça/cor da pele negra (78,73%). No Brasil, a taxa média padronizada global foi de 0,20/100 mil pessoa-ano, com tendência de elevação (mudança percentual anual - APC = 5,44%; intervalo de confiança - IC95% 2,57-8,39). O padrão se repetiu no sexo masculino (APC = 4,38%; IC95% 2,17-6,64) e no sexo feminino (APC = 6,96%; IC95% 3,05-11,01). A elaboração de taxas específicas por idade mostrou que a faixa até quatro anos experimentou as maiores taxas, sem distinção por região. A faixa etária de 15 e 19 anos foi a segunda mais afetada no Brasil e nas regiões Nordeste, Sudeste e Centro-Oeste. CONCLUSÃO Houve tendência de aumento dos óbitos por transtornos falciformes em crianças e adolescentes. Considerando que a magnitude dos óbitos foi mais evidente nos primeiros anos (0-4) e no final da adolescência (15-19), o estudo sugere que abordagens específicas por faixa etária podem impactar no controle dos desfechos fatais causados pela doença falciforme no Brasil.

THE RELATIONSHIP BETWEEN CONSCIENTIOUS INTELLIGENCE AND ORGANIZATIONAL IDENTIFICATION IN NURSES, TURKEY

To determine the relationship between conscientious intelligence and organizational identification in nurses. This descriptive correlational study was conducted in a private hospital in Ankara. 223 nurses were recruited using the simple random sampling method. Data were collected with a personal information form, the Conscientious Intelligence Scale, and the Organizational Identification Scale. Data were analyzed using SPSS 20 statistics program. Kruskal Wallis variance analysis, multiple linear regression, and correlation analysis were used to analyze the data. There was a linear positive medium level relationship between the Organizational Identification Scale and the total and sub-dimensions of the Conscientious Intelligence Scale. The Conscientious Intelligence Scale (with job tenure and shift style subdimensions) explains 26.6% of the Organizational Identification Scale. The Conscientious Intelligence Scale (? = 0.477) has more effect on the Organizational Identification Scale than other variables. The total scores of the nurses on Conscientious Intelligence Scale and Organizational Identification Scale were above average. Overall job tenure, tenure at the organization, and the level of conscientious intelligence among nurses increase organizational identification

EXPERIENCES OF MEN IN NURSING: A QUALITATIVE STUDY OF PERSPECTIVES OF NURSES

This study aims to explore the reasons for men to choose nursing as a profession in Turkey and their experiences in the profession from their perspectives. This is a qualitative study. The study sample consisted of male nurses working in a private hospital and in a public hospital of Ministry of Health in Turkey. The data were collected using a semi- structured in-depth interview questionnaire prepared based on literature. The study sample consisted of 11 male nurses. We used thematic analysis to analyse the data. Male nurses reported that the primary reason why they choose nursing as a career was job security. Male nurses also reported that especially female patients had negative perceptions and attitudes towards them and occasionally female patients refused to get health care services from them due to social norms. They were preferred in strength-related tasks rather than in care-related tasks

Microbiological Spectrum of Nosocomial ECMO Infections in a Tertiary Care Center

Abstract Introduction: Extracorporeal membrane oxygenation (ECMO) is a life-saving treatment in cardiogenic and respiratory shock. It is prone to various complications, infection being among the most frequent. This study aims to define the prevalence and characteristics of infections in ECMO patients in a tertiary care center for cardiac diseases. Methods: All ECMO patients between 2012 and 2016 in a single cardiac center were retrospectively included. Demographic data, ECMO indications, type, site, duration, and infection-related data were recorded. Data were analyzed among all patients and separately between pediatric and adult patient groups. Results: One hundred and twenty-six patients, 66 (53.4%) pediatric and 60 (47.6%) adult, received ECMO within the study period. Mean age was 3.54±4.27 years in the pediatric group and 54.92±15.57 years in the adult group. The main indication for ECMO was postcardiotomy shock (77.8%). Forty-six (36.5%) of all cases developed a culture-proven nosocomial infection with a rate of 49/1000 ECMO days. Infection was associated with > 5 days of ECMO duration and hemodialysis requirement in all patients and lower age in the pediatric group. The most frequent infection site was the lower respiratory tract (14.3%), while the most common isolated organisms were Klebsiella (8.7%) and Streptococcus (4.8%) species. Conclusion: The respiratory tract is the most common site of infection, however, all sites impose a threat to recovery, with longer treatment durations required for patients with culture-proven infections. A better understanding of the infectious spectrum and its effect on the mortality and morbidity is required for more successful treatment of ECMO patients.

Coronas cementadas comparado con coronas atornilladas para pacientes con restauraciones fijas implantosoportadas / Cement-retained versus screw-retained crowns in patients with implant rehabilitation

RESUMEN: Introducción: Los implantes dentales se han transformado en una opción de tratamiento de suma relevancia para pacientes parcial o totalmente desdentados. El éxito del tratamiento puede verse afectado por la elección del tipo de retención de estos (cementada o atornillada). A pesar que ambas presentan ventajas, aún no existe consenso sobre el mejor tipo de retención para restauraciones fijas implantosoportadas. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 14 revisiones sistemáticas que en conjunto incluyeron 43 estudios primarios, de los cuales cinco corresponden a ensayos aleatorizados. De estos, solamente dos ensayos responden a la pregunta de interés de manera directa. Concluimos que las coronas atornilladas podrían aumentar levemente el riesgo de pérdida de implante a largo plazo, podrían resultar en nula o poca diferencia en el riesgo de pérdida de implante a mediano plazo, reabsorción ósea y periimplantitis, pero la certeza de evidencia ha sido evaluada como baja. Por otro lado, no es posible establecer con claridad si las coronas cementadas disminuyen el riesgo de complicaciones estéticas y protésicas, ya que la certeza de la evidencia existente ha sido evaluada como muy baja.

ABSTRACT: Introduction: Dental implants have become a highly relevant treatment option for partially or totally edentulous patients. Implant retention systems (cemented or screwed) can influence the treatment success. Although both have advantages, there is still no consensus on the best type of retention for implant-supported fixed restorations. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified 14 systematic reviews including 43 primary studies overall, of which five were randomized trials. Of these, only two trials answer the question of interest. We concluded that screw-retained crowns may increase long-term implant loss, may make little or no difference in the risk of medium-term implant loss, bone resorption, and peri-implantitis, but the certainty of the evidence has been assessed as low. On the other hand, it is not possible to clearly establish whether cemented crowns reduce the risk of cosmetic and prosthetic complications, since the certainty of the evidence has been assessed as very low.

Emergency contraception in university students: prevalence of use and knowledge gaps / Anticoncepção de emergência em universitárias: prevalência de uso e falhas no conhecimento

ABSTRACT OBJECTIVE Investigate prevalence of use and knowledge about emergency contraception (EC) among female university students from two higher education institutions. METHODS Cross-sectional study with 1,740 undergraduates in the city of Santa Maria (RS), from May to October 2017. Information was collected in a semi-structured and self-administered 24-question questionnaire. The investigated variables were grouped into sociodemographic characteristics, sexual behavior, and knowledge of EC. Logistic regression was used for univariate and multivariate analysis, considering variables that presented p < 0.05. The model was adjusted using the Hosmer-Lemeshow test. RESULTS The prevalence of EC use among undergraduates was 52.9%. However, only 11.9% of respondents received guidance on EC, especially on how to use it. Only 0.2% of the participants marked 120 hours as the maximum time of use, and 25.7% considered the EC to be abortive. EC use was associated with the age of first sexual intercourse. CONCLUSION EC use had a high prevalence among female university students, however, several gaps in method knowledge still exists and it demonstrates the importance of discussing this issue earlier and planning actions of an informative nature.

RESUMO OBJETIVO Investigar a prevalência de uso e o conhecimento sobre anticoncepção de emergência (AE) de mulheres universitárias de duas instituições de ensino superior. MÉTODOS Estudo transversal com 1.740 graduandas na cidade de Santa Maria (RS), no período de maio a outubro de 2017. As informações foram coletadas por meio de questionário semiestruturado e autoaplicável de 24 questões. As variáveis investigadas foram agrupadas em características sociodemográficas, comportamento sexual e conhecimento da AE. Utilizou-se regressão logística para a análise univariada e multivariada, considerando variáveis que apresentaram p < 0,05. O modelo foi ajustado pelo teste de Hosmer-Lemeshow. RESULTADOS A prevalência de uso da AE entre as graduandas foi de 52,9%. Contudo, apenas 11,9% das entrevistadas receberam orientação sobre a AE, principalmente no que se refere ao modo de uso. Apenas 0,2% das participantes marcou 120 horas como tempo máximo de uso, e 25,7% consideraram a AE abortiva. Houve associação entre uso da AE e idade da primeira relação sexual. CONCLUSÃO Constatou-se alta prevalência de uso da AE entre mulheres universitárias, no entanto, ainda existem diversas lacunas no conhecimento sobre o método, o que demonstra a importância de se discutir esse assunto mais precocemente e planejar ações de caráter informativo.

Efeito imediato da hidratação laríngea de superfície associada à técnica de vibração sonorizada de língua em cantores amadores / Immediate effect of surface laryngeal hydration associated with tongue trill technique in amateur singers

RESUMO Objetivo Analisar o efeito imediato da hidratação de superfície laríngea associado à técnica de vibração sonorizada de língua (TVSL) em cantores. Método Participaram 30 cantores, sem queixas vocais ou alterações laríngeas, divididos em grupo controle (GC) e experimental (GE). O GC realizou a TVSL por cinco minutos. O GE foi submetido à nebulização de 3 ml de solução salina seguido da TVSL por cinco minutos. Foram realizadas autoavaliação vocal, análise acústica e avaliação perceptivoauditiva nos momentos pré (PréTVSL) e pós (PTVSL) no GC e no momento pré (PréHTVSL), pós hidratação (PH) e pós hidratação+TVSL (PHTVSL) no GE. Na autoavaliação foram avaliados: qualidade, estabilidade, rouquidão e intensidade vocal. Os parâmetros acústicos analisados foram Frequência Fundamental; Jitter%; Shimmer%, Noise-to-harmonic Ratio e Cepstral Peak Prominence-Smoothed (CPPs). A avaliação perceptivoauditiva foi realizada por uma fonoaudióloga experiente. Resultados Na comparação dos resultados da autoavaliação, entre os grupos, observou-se melhora da percepção de estabilidade e intensidade vocal no PTVSL (GC) em relação ao PH (GE). Na comparação entre os momentos do GE houve diferença estatística na sensação de intensidade vocal, apontando melhor resultado para PHTVSL. Não houve diferença estatística entre os grupos investigados na avaliação perceptivoauditiva e na análise acústica. Conclusão A hidratação laríngea de superfície não potencializa o efeito da TVSL em cantores em condição natural de hidratação com uso de 3ml de nebulização. Para os profissionais da voz com grande demanda vocal, a hidratação de superfície pode ser introduzida durante a utilização da voz, para manutenção da qualidade vocal, sem perda de sua qualidade.

ABSTRACT Purpose To analyze the immediate effect of laryngeal surface hydration associated with the performance of Tongue Trills (TT) on singers. Methods Thirty singers without vocal complaints or laryngeal alterations divided into control (CG) and experimental (EG) groups. The CG performed the TT for five minutes. The EG was submitted a nebulization with 3 ml of saline solution followed by TT for five minutes. Voice self-assessment, acoustic analysis and perceptual assessment were performed at Pre (Pre TT) and post (PTT) moments in CG and pre (Pre TT), post hydration (PH) and post hydration + TT (PHTT) in GE. In the self-assessment were evaluated quality, stability, vocal intensity and hoarseness. There were extract the values of the Fundamental frequency; Jitter%; Shimmer%, Noise-to-harmonic Ratio e Cepstral Peak Prominence-Smoothed (CPPs) in the acoustic analyze. The perceptual evaluation was performed by an experienced speech therapist. Results Comparing the results of self-assessment between groups showed improvement in the perception of stability and vocal intensity in the PTT (CG) in relation to PH (EG). Comparison between the EG moments showed a statistical difference in the vocal intensity perception, indicating a better results for PHTT. There was no statistical difference between the groups investigated in the perceptual assessments and acoustic analysis. Conclusion Surface laryngeal hydration does not potentiate the effect of TT on naturally hydrated singers with 3ml nebulization. For voice professionals with high vocal demand, surface hydration can be introduced during voice use to maintain vocal quality.

Efficacy of injectable platelet-rich fibrin in the erosive oral lichen planus: a split-mouth, randomized, controlled clinical trial

Abstract Objective Our study compared the effects of injectable platelet-rich fibrin (i-PRF) with those of corticosteroids in the treatment of erosive oral lichen planus (EOLP). Methodology This split-mouth study included 24 individuals diagnosed histopathologically with bilateral EOLP. One bilateral lesion was injected with i-PRF, whereas the other was injected with methylprednisolone acetate in four sessions at 15-day intervals. Visual analog scale (VAS) for pain and satisfaction, oral health impact profile scale-14, and the lesion size were used. Results The intragroup comparisons showed a significant decrease in VAS-pain and lesion size in both the i-PRF group (from 81.88±17.74 to 13.33±18.34, and from 4.79±0.41 to 1.88±1.08, respectively) and the corticosteroid group (from 80.21±17.35 to 23.33±26.81, and from 4.71±0.46 to 2.21±1.35, respectively) in the 6th month compared to baseline (p<0.001). Moreover, VAS-satisfaction increased significantly in both the i-PRF group (from 26.67±17.8 to 85.63±16.24) and the corticosteroid group (from 28.33±17.05 to 74.38±24.11) in the 6th month compared to baseline (p<0.001). However, no significant difference in any value occurred in the intergroup comparisons. Conclusion In patients with EOLP, both methods decreased pain and lesion size similarly, and both increased satisfaction. Therefore, the use of i-PRF may be considered an option in cases refractory to topical corticosteroid therapy. Biochemical and histopathological studies are required to reveal the mechanism of i-PRF action in EOLP treatment.

Clinical complications during early treatment of anterior open bite

Abstract The object of this study was to compare the clinical complications of 4 different appliances used in the early treatment of anterior open bite (AOB), and to test the null hypothesis that there is no difference in the number of complications among the appliances. Records from 99 Class I malocclusion patients with AOB treated using bonded spurs, BS, n = 25; chin cup, CC, n = 25; fixed palatal crib, FPC, n = 25; and removable palatal crib, RPC, n = 24) were examined. The total number and frequency of clinical complications that occurred over 12 months were described and compared by using chi-square and Kruskal-Wallis tests (Dunn's post-test) (α = 5%, CI = 95%). The incidence of clinical complications was 66.7%, comprising: breakage, bond failure, maladjustment, allergy, soft-tissue lesion, loss of removable appliance and abandonment. Eighteen patients gave up treatment; this occurred more frequently in the groups with removable appliances. Regarding the total number of complications per patient, Group BS exhibited a significantly higher number than the other groups (p < 0.0001). A low frequency of complications (1 to 3) was found in the groups, except for Group BS, in which 8% of the patients presented moderate frequency (4 to 6). In terms of appliance types (fixed or removable), there was no difference in the incidence of complications (p > 0.094). The null hypothesis was rejected, since the BS group exhibited the highest total number and frequency of complications. There was no difference between fixed and removable appliances in terms of incidence of clinical complications, although more patients using removable appliances abandoned their treatment.

General Anesthesia versus Conscious Sedation in Mechanical Thrombectomy / 대한뇌졸중학회지

Background@#and Purpose Anesthesia regimen in patients undergoing mechanical thrombectomy (MT) is still an unresolved issue. @*Methods@#We compared the effect of anesthesia regimen using data from the German Stroke Registry-Endovascular Treatment (GSR-ET) between June 2015 and December 2019. Degree of disability was rated by the modified Rankin Scale (mRS), and good outcome was defined as mRS 0–2. Successful reperfusion was assumed when the modified thrombolysis in cerebral infarction scale was 2b–3. @*Results@#Out of 6,635 patients, 67.1% (n=4,453) patients underwent general anesthesia (GA), 24.9% (n=1,650) conscious sedation (CS), and 3.3% (n=219) conversion from CS to GA. Rate of successful reperfusion was similar across all three groups (83.0% vs. 84.2% vs. 82.6%, P=0.149). Compared to the CA-group, the GA-group had a delay from admission to groin (71.0 minutes vs. 61.0 minutes, P<0.001), but a comparable interval from groin to flow restoration (41.0 minutes vs. 39.0 minutes). The CS-group had the lowest rate of periprocedural complications (15.0% vs. 21.0% vs. 28.3%, P<0.001). The CS-group was more likely to have a good outcome at follow-up (42.1% vs. 34.2% vs. 33.5%, P<0.001) and a lower mortality rate (23.4% vs. 34.2% vs. 26.0%, P<0.001). In multivariable analysis, GA was associated with reduced achievement of good functional outcome (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.71 to 0.94; P=0.004) and increased mortality (OR, 1.42; 95% CI, 1.23 to 1.64; P<0.001). Subgroup analysis for anterior circulation strokes (n=5,808) showed comparable results. @*Conclusions@#We provide further evidence that CS during MT has advantages over GA in terms of complications, time intervals, and functional outcome.

Desenvolvimento, validação e utilização de material educativo sobre armazenamento correto de medicamentos / Development, validation and use of educational material on the correct storage of medicine

Estudo metodológico de construção de material educativo impresso (MEI) sobre armazenamento correto de medicamentos nos domicílios e validação por 50 usuários dos serviços de saúde e 52 juízes ­ profissionais da área de saúde. O MEI aborda a maneira correta de armazenar medicamentos, riscos de degradação, ineficiência e intoxicação acidental. A validação de conteúdo foi estabelecida a partir do Level Content Validity Index (CVI) maior que 0,8 para juízes, os quais avaliaram a relevância de informações, clareza, compreensão de texto e ilustrações e aplicabilidade do material. Os usuários analisaram o MEI quanto aos parâmetros de aparência, motivação, conteúdo e organização escrita. Todos os itens foram considerados relevantes pelos avaliadores e o CVI-médio entre juízes foi de 0,96, e entre os usuários, de 0,94. O MEI validado foi utilizado em ações de promoção da saúde apresentando-se como uma ferramenta altamente relevante, técnica e acessível para conscientização sobre o armazenamento correto de medicamentos.

Current methodological study analyzes the construction of printed educational material (PEM) on the correct storage of medicine at home and its validation by 50 users of health service and 52 health professionals/judges. PEM deals with the correct storage of medicine, gradation risks, inefficaciousness and accidental intoxication. Validation of contents was established by Level Content Validity Index (CVI) higher than 0.8 for health professionals/judges who evaluated relevance of data, clarity, text comprehension and illustrations and applicability of the matter. Users analyzed PEM with regard to the parameters appearance, motivation, contents and written organization. All items were considered to be relevant by the evaluators, with mean CVI at 0.96 and 0.94 among health professionals/judges and users respectively. Validated PEM was employed in activities for health promotion as a highly relevant, technical and accessible tool for conscience-awareness on the correct storage of medicines.