Fatores associados à qualidade de vida de crianças com epilepsia em um hospital nacional de Honduras / Factors associated to the quality of life in children with epilepsy in a national hospital in Honduras

A epilepsia representa um problema de grande escala que afeta a esfera social dos pacientes que dela sofrem. O presente estudo tem como objetivo avaliar a qualidade de vida de pacientes pediátricos com epilepsia e identificar os fatores associados à sua menor qualidade de vida. Foi realizado um estudo transversal, descritivo e analítico em pacientes com diagnóstico clínico e eletroencefalográfico de epilepsia, atendidos no ambulatório do serviço de neuropediatria do Hospital Universitário. Foi aplicado um questionário subdividido em dados da criança, dados dos pais ou cuidador, tipo de epilepsia, tratamento e Escala de Qualidade de Vida para Crianças com Epilepsia (CAVE). As variáveis foram analisadas por meio de estatística descritiva e modelo de regressão múltipla para encontrar preditores de qualidade de vida. Dos 187 pacientes, 68 (36,4%) apresentaram boa qualidade de vida. Não foram observadas diferenças significativas por sexo em nenhum dos itens estudados, nem na pontuação geral do questionário. Ter menos necessidades básicas insatisfeitas (P=<0,0001) e não ter epilepsia refratária foram preditores de melhor qualidade de vida (P=<0,0001). A qualidade de vida relatada pelos pais foi em sua maioria boa ou razoável, ter um maior número de necessidades básicas insatisfeitas e ser classificado como tendo epilepsia de difícil manejo foram preditores de piora na qualidade de vida medida pelo questionário CAVE.

Epilepsy represents a large-scale problem that affects the social sphere of the patients who suffer from it. The following study aims to assess the quality of life of pediatric patients with epilepsy and to identify the factors associated with a lower quality of life. A cross-sectional, descriptive and analytical study was carried out in patients with clinical and electroencephalographic diagnosis of epilepsy, who attended the outpatient clinic of the neuropediatric service of the Teaching Hospital. A survey was administered, subdivided into data on the child, data on the parents or caregiver, type of epilepsy, treatment and the Quality of Life Scale for Children with Epilepsy (CAVE). The variables were analyzed using descriptive statistics and a multiple regression model to find predictors of quality of life. Of the 187 patients, 68 (36.4%) had a good quality of life. No significant gender differences were observed, nor in the overall score of the survey. Having fewer unmet basic needs (P=<0.0001) and not having refractory epilepsy were predictors of better quality of life (P=<0.0001). Parent-reported quality of life was mostly good or fair, having a higher number of unmet basic needs and being classified as having difficult-to-manage epilepsy were predictors of worsening quality of life as measured by the CAVE scale.

Professional quality of life and occupational stress in nursing workers during the COVID-19 pandemic / Calidad de vida profesional y estrés ocupacional en trabajadores de enfermería durante la pandemia del COVID-19 / Qualidade de vida profissional e estresse ocupacional em trabalhadores de enfermagem durante pandemia por COVID-19

ABSTRACT Objective: To identify the levels of professional quality of life and the occupational stress in nursing professionals. Method: Cross sectional study conducted between April and August 2020, with nursing professionals working in inpatient units for clinical and surgical patients of a large hospital. The Work Stress Scale and the Professional Quality of Life Scale were applied. Results: The sample consisted of 150 professionals, with a mean age of 43 ± 8.89 years, being 84.7% (127) female. The mean of the work stress scale was 1.9 (± 0.71), a moderate level of stress. It was found that compassion satisfaction had a median of 50.3 (9.1 - 64.6), burnout of 48.5 (32.2 - 84.8) and post-traumatic stress disorder of 47.1 (38.6 - 98.3). Conclusion: Stress at work and Compassion Fatigue were identified in the sample, especially in secondary-level professionals, demonstrating the need to implement strategies to reduce psycho-emotional harm in these professionals.

RESUMEN Objetivo: Identificar los niveles de calidad de vida profesional y estrés laboral en los profesionales de enfermería. Método: Estudio transversal realizado entre abril y agosto de 2020, con profesionales de enfermería que laboran en unidades de internación para pacientes clínicos y quirúrgicos de un gran hospital. Se aplicó la Escala de Estrés Laboral y la Escala de Calidad de Vida Profesional. Resultados: La muestra estuvo formada por 150 profesionales, con una edad media de 43 ± 8,89 años, siendo el 84,7% (127) mujeres. El promedio de la escala de estrés en el trabajo fue de 1,9 (± 0,71), un nivel de estrés moderado. Se encontró que la satisfacción a través de la compasión tuvo una mediana de 50,3 (9,1 - 64,6), el agotamiento de 48,5 (32,2 - 84,8) y el trastorno de estrés postraumático de 47,1 (38,6 - 98,3). Conclusión: En la muestra se identificaron estrés en el trabajo y fatiga por compasión, especialmente en profesionales de nivel medio, lo que demuestra la necesidad de implementar estrategias para reducir el daño psicoemocional en estos profesionales.

RESUMO Objetivo: Identificar os níveis de qualidade de vida profissional e o estresse ocupacional em profissionais da enfermagem. Método: Estudo transversal realizado entre abril e agosto de 2020, com profissionais da enfermagem atuantes em unidades de internação para pacientes clínicos e cirúrgicos de um hospital de grande porte. Os instrumentos utilizados foram a Escala de Estresse no Trabalho e Escala de Qualidade de Vida Profissional. Resultados: A amostra foi constituída por 150 profissionais, com média de idade de 43 ± 8,89 anos, sendo 84,7% (127) do sexo feminino. A média da escala de estresse no trabalho foi 1,9 (± 0,71), nível moderado de estresse. Verificou-se que satisfação por compaixão apresentou mediana de 50,3 (9,1 - 64,6), burnout de 48,5 (32,2 - 84,8) e estresse pós-traumático de 47,1 (38,6 - 98,3). Conclusão: Identificou-se estresse no trabalho e Fadiga por Compaixão na amostra, principalmente nos profissionais de nível médio, demonstrando a necessidade de implementar estratégias para a redução do dano psicoemocional nestes profissionais.

Constipation scoring system validated for the portuguese language (índice de gravidade da constipação intestinal): is it reliable in assessing the severity of intestinal chronic constipation in our population? / O instrumento constipation scoring system validado para a língua portuguesa (índice de gravidade da constipação intestinal): é confiável na avaliação da gravidade da constipação intestinal crônica em nossa população?

ABSTRACT BACKGROUND: There is a lack of valid and specific tools to measure chronic constipation severity in Brazil. AIMS: To validate the Constipation Scoring System for Brazilian spoken Portuguese. METHODS: Translation, cultural adaptation, and validation itself (reliability and convergent and divergent validation). Translation: definitive version from the original version's translation and evaluation by specialists. Cultural adaptation: score content analysis of the definitive version, as an interview to patients. Interobserver reliability: application by two researchers on the same day. Intraobserver reliability: same researcher at different times, in a 7-day interval. Divergent validation: non-constipated volunteers. Convergent validation: two groups, good response to clinical treatment and refractory to treatment. RESULTS: Cultural adaptation: 81 patients, 89% female, with mean age of 55 and seven years of schooling, and overall content validity index was 96.5%. Inter and intraobserver reliability analysis: 60 patients, 86.7% female, mean age of 56 and six years of schooling, and the respective intraclass correlation coefficients were 0.991 and 0.987, p<0.001. Divergent validation: 40 volunteers, 25 male, mean age of 49 years, and the mean global score was 2. Convergent validation of patients with good response to clinical treatment: 47 patients, 39 female, mean age of 60 and six years of schooling, and the pre- and post-treatment scores were 19 and 8, respectively (p<0.001). Convergent validation of refractory to clinical treatment patients: 75 patients, 70 female, mean age of 53 and seven years of schooling, and the global average score was 22. CONCLUSIONS: The Constipation Scoring System (Índice de Gravidade da Constipação Intestinal) validated for the Brazilian population is a reliable instrument for measuring the severity of intestinal chronic constipation.

RESUMO RACIONAL: No Brasil há escassez de instrumentos específicos e validados para a avaliação da gravidade da constipação intestinal crônica. OBJETIVOS: Validar o instrumento Constipation Scoring System para pacientes com constipação crônica. MÉTODOS: Tradução, adaptação cultural e validação propriamente dita. Tradução: versão definitiva a partir de traduções do original avaliadas por especialistas. Adaptação cultural: avaliação do conteúdo por entrevista a pacientes. Confiabilidade interobservadores: entrevista por dois pesquisadores no mesmo dia. Confiabilidade intraobservador: duas entrevistas pelo mesmo pesquisador (intervalo de 7 dias). Validação divergente: voluntários não constipados. Validação convergente: dois grupos, boa resposta e refratários ao tratamento clínico. RESULTADOS: Adaptação cultural: 81 pacientes, sendo 89% do sexo feminino, com média de idade de 55 anos e 7 anos de escolaridade. O índice de validade de conteúdo global foi de 96,5%. Confiabilidade interobservadores e intraobservador: 60 pacientes, sendo 86,7% do sexo feminino, com média de idade de 56 anos e 6 anos de escolaridade. O coeficiente de correlação intraclasse foi de 0,991 e 0,987 (p<0,001), respectivamente. Validação divergente: 40 voluntários, sendo 62,5% do sexo masculino, com média de idade de 49 anos e pontuação média: 0. Validação convergente dos pacientes com boa resposta do tratamento clínico: 47 pacientes, sendo 83% do sexo feminino, com média de idade de 60 anos e 6 anos de escolaridade. Os índices pré e pós-tratamento foram 19 e 8 (p<0,001), respectivamente. Validação convergente dos pacientes refratários ao tratamento clínico: 75 pacientes sendo 93% do sexo feminino, com média de idade de 53 anos e 7 anos escolaridade. A pontuação média foi 22. CONCLUSÕES: O Constipation Scoring System validado para população brasileira (Índice de Gravidade da Constipação Intestinal), é instrumento confiável para a aferição da gravidade da constipação intestinal crônica.

Programa educativo sobre cáncer de mama para mujeres del Consultorio Médico 028-2. Manicaragua / Educational program on breast cancer for women of the Doctor´s Office 028-2. Manicaragua, Cuba

Fundamento: el cáncer de mama representa un problema sanitario mundial por su alta incidencia; en la actualidad este es el de tipo de cáncer más frecuente en las mujeres. Objetivo: desarrollar un programa educativo sobre el cáncer de mama dirigido a las mujeres del Consultorio Médico 028-2, del Policlínico Docente "50 Aniversario", en Manicaragua. Métodos: se desarrolló un estudio prexperimental de intervención educativa evaluado por especialistas, en el Consultorio Médico 028-2, del Policlínico Docente "50 Aniversario" del municipio Manicaragua, entre enero 2021-enero 2022. Se utilizaron métodos teóricos: análisis-síntesis, inductivo-deductivo e histórico-lógico; empírico: análisis documental, encuesta y matemático-estadísticos para el análisis de los datos investigados. Resultados: predominaron las edades de 45 a 54 años, la mayoría no tenían antecedentes patológicos personales y sus conocimientos sobre cómo prevenir la enfermedad eran insuficientes, por lo que se diseñó un programa educativo, el cual fue valorado por criterios de especialistas. Conclusiones: después de ser valorado como adecuado, fue aplicado con muy buenos resultados entre las féminas; este programa se alerta sobre la necesidad de intensificar la labor educativa del médico y demás personal involucrado en la atención a las mujeres para que desarrollen conciencia sobre la importancia de la detección temprana de esta neoplasia.

Background: breast cancer represents a global health problem due to its high incidence; at present this is the most frequent type of cancer in women. Objective: to develop an educational program on breast cancer aimed at the women of the Doctor´Office 028-2, of the "50th Anniversary" Teaching Polyclinic, in Manicaragua. Methods: a pre-experimental study of educational intervention was developed, evaluated by specialists, in the Medical Office 028-2, of the "50 Aniversario" Teaching Polyclinic of the Manicaragua municipality, from January 2021 to January 2022. Theoretical methods were used: analysis-synthesis, inductive -deductive and historical-logical; Empirical ones: documentary, survey and mathematical-statistical for the analysis of the investigated data. Results: the ages of 45 to 54 years predominated, the majority had no past medical history and their knowledge on how to prevent the disease was insufficient, for which an educational program was designed, which was assessed by specialist criteria. Conclusions: after being evaluated as adequate, it was applied with very good results among the females; the need to intensify the educational work of the physician and other personnel involved in caring for women is alerted so that they develop awareness of the importance of early detection of this neoplasm.

Programa educativo para prevenir la leptospirosis en una zona rural de Jibacoa, Manicaragua, Cuba / Educational program to prevent leptospirosis in a rural area of Jibacoa, Manicaragua, Cuba

Fundamento: la leptospirosis es una zoonosis de distribución mundial que puede presentarse en zonas urbanas y rurales cuyo evidente resurgimiento se ilustra en los brotes recientes en todos los continentes. Objetivo: desarrollar un programa educativo sobre la leptospirosis en el Consultorio Médico 036-11, del poblado de Jibacoa, Manicaragua. Métodos: se desarrolló un estudio prexperimental de intervención educativa aprobado por especialistas, en el Consultorio Médico 036-11, de Jibacoa, Manicaragua entre marzo 2020-marzo 2022. Se utilizaron métodos teóricos: análisis-síntesis, inductivo-deductivo e histórico-lógico; empírico: análisis documental y cuestionario; y matemático-estadísticos para el análisis de los datos encontrados. Resultados: en el diagnóstico realizado predominaron los trabajadores del sexo masculino, la mayoría de ellos con riesgos para contraer la leptospirosis, la presencia de animales domésticos y roedores, e inadecuados conocimientos sobre la enfermedad. El análisis de situación de salud permitió caracterizar la comunidad rural con condiciones favorables para la proliferación de las leptospiras, por lo que se diseñó un programa educativo para capacitar a los habitantes del lugar sobre el tema, el cual valorado por criterios de especialistas. Conclusiones: después de valorado como adecuado se aplicó y demostró su efectividad al modificar positivamente los conocimientos de los habitantes en riesgo dentro de esa comunidad rural.

Background: leptospirosis is a zoonosis with worldwide distribution that can occur in urban and rural areas whose evident resurgence is illustrated in recent outbreaks on all continents. Objective: to develop an educational program on leptospirosis in the Doctor´s Office 036-11, in the town of Jibacoa, Manicaragua. Methods: a pre-experimental study of educational intervention approved by specialists was carried out at Doctor´s Office 036-11, in Jibacoa, Manicaragua from March 2020 to March 2022. Theoretical methods were used: analysis-synthesis, inductive-deductive and historical-logical; empirical: documentary analysis and questionnaire; and mathematical-statistical for the analysis of the data found. Results: male workers predominated in the diagnosis, most of them at risk of contracting leptospirosis, the presence of domestic animals and rodents, and inadequate knowledge about the disease. The analysis of the health situation allowed to characterize the rural community with favorable conditions for the proliferation of leptospirosis, for which an educational program was designed to train the inhabitants of the place on the subject, which was valued by specialist criteria. Conclusions: after being assessed as adequate, it was applied and demonstrated its effectiveness by positively modifying the knowledge of the inhabitants at risk within that rural community.

Audiovisual para adolescentes "Cuidar la sonrisa protege la salud bucal y general" / Audiovisual for adolescents "Taking care of the smile protects oral and general health"

Fundamento: los adolescentes son un grupo de referencia importante en quienes los medios audiovisuales sobre la salud bucal aportan valor motivacional y desarrollan un aprendizaje significativo. Objetivo: diseñar un audiovisual sobre cuidados de la salud bucal y general dirigido a los adolescentes. Métodos: se realizó un estudio de desarrollo tecnológico en el período de febrero a noviembre de 2019. Se utilizaron métodos teóricos para la fundamentación de la investigación y empíricos: análisis documental, cuestionario y entrevista. Se consultó a especialistas para la valoración del audiovisual diseñado. Resultados: predominó en el nivel de información sobre la salud bucal la categoría regular. Los temas de mayor desinformación fueron: las consecuencias de algunas enfermedades bucales en la salud general y viceversa, la placa dentobacteriana, importancia de una sonrisa sana y aspectos sobre higiene bucodental. Sustentado en estos hallazgos, se diseñó un guión previo a la confección del audiovisual. El producto final fue valorado por especialistas y usuarios, teniendo en cuenta determinados indicadores. Conclusiones: el medio diseñado aportó útiles conocimientos los que fueron aceptados por el grupo etario al que fue destinado. Fue valorado satisfactoriamente por especialistas y usuarios. Se cumplieron las expectativas de la experiencia pedagógica.

Background: adolescents are an important reference group in whom audiovisual media on oral health provide motivational value and develop meaningful learning. Objective: to design an audiovisual on oral and general health care aimed at adolescents. Methods: a study of technological development was carried out in the period from February to November 2019. Theoretical methods were used to support the research and empirical ones: documentary analysis, questionnaire and interview. Specialists were consulted for the assessment of the audiovisual designed. Results: the average category prevailed in the level of information on oral health. The topics with the greatest misinformation were: the consequences of some oral diseases on general health and vice versa, dental plaque, the importance of a healthy smile and aspects of oral hygiene. Based on these findings, a script was designed prior to the production of the audiovisual. The final product was valued by specialists and users, taking into account certain indicators. Conclusions: the designed aid provided useful knowledge that was accepted by the age group for which it was intended. It was satisfactorily valued by specialists and users. The expectations of the pedagogical experience were met.

Comportamiento de la mortalidad según necropsia en Servicios de Medicina Interna y Geriatría de Cienfuegos

RESUMEN Fundamento: la mortalidad es uno de los principales indicadores de calidad en la atención y gestión hospitalaria porque se considera una medida de la efectividad de la intervención sanitaria. Objetivo: determinar las causas de mortalidad según necropsia en los Servicios de Medicina Interna y Geriatría de Cienfuegos en el en el período 2017-2019. Métodos: se realizó un estudio descriptivo-retrospectivo de serie de casos, de los 730 pacientes fallecidos a los que se les practicó necropsia entre enero de 2017 y diciembre de 2019. Se emplearon variables clínicas y epidemiológicas. La información obtenida se almacenó y procesó en el paquete estadístico SPSS versión 21.0 para Windows. A las variables cuantitativas se les aplicaron medidas de tendencia central y las cualitativas fueron medidas en índice, frecuencias absolutas y relativas, dependiendo de la distribución de cada una de ellas. Resultados: la media de la edad fue de 75 años. Predominó el sexo masculino (57,8 %). El grupo etáreo más representado fue 70-79 años (28,9 %). El mayor número de necropsias se realizó en el 2017 (37,7 %). La estadía hospitalaria media fue de 8 días. La estadía menor de tres días predominó en la serie (39,9 %). Las causas de muerte directa más declaradas fueron la bronconeumonía/neumonía (61,3 %), luego la cardioangioesclerosis-edema pulmonar (13,1 %) y el estadio final de neoplasia de pulmón (5,3 %). Conclusiones: las causas de muerte directa más declaradas fueron la bronconeumonía y la neumonía. Existió una adecuada correlación clínico-patológica en estos grupos. Los mejores niveles de concordancia clínico-patológica se dieron en las enfermedades del sistema nervioso central, los tumores y las patologías respiratorias. Existió una peor correlación entre las enfermedades digestivas, algunas infecciones y las patologías circulatorias.

ABSTRACT Background: mortality is one of the main indicators of quality in hospital care and management because it is considered a measure of the effectiveness of health intervention Objective: to determine the causes of mortality according to autopsy in the Internal Medicine and Geriatrics Services of Cienfuegos in the period 2017-2019. Methods a descriptive-retrospective case series was carried out, of the 730 deceased patients who underwent autopsy between January 2017 and December 2019. Clinical and epidemiological variables were used. The information obtained was stored and processed in the statistical package SPSS version 21.0 for Windows. Measures of central tendency were applied to the quantitative variables; the qualitative ones were measured in index, in absolute and relative frequencies, depending on the distribution of each one of them. Results: the mean age was 75 years. Male sex predominated (57.8 %). The most represented age group was 70-79 years (28.9 %). The highest number of autopsies was performed in 2017 (37.7 %). The mean hospital stay was 8 days. The stay of less than three days predominated in the series (39.9 %). The most commonly reported causes of direct death were bronchopneumonia / pneumonia (61.3 %), then cardioangiosclerosis-pulmonary edema (13.1 %) and end-stage lung neoplasia (5.3 %). Conclusions: the most declared causes of direct death were bronchopneumonia and pneumonia. There was an adequate clinical-pathological correlation in these groups. The best levels of clinicopathological agreement were found in diseases of the central nervous system, tumors, and respiratory diseases. There was a worse correlation between digestive diseases, some infections and circulatory pathologies.

Validation of the Skindex-17 quality of life assessment instrument for a Brazilian population

Abstract Background: Health-related quality of life assesses how diseases affect the daily life of people; there are several generic instruments for this assessment in dermatology. Skindex was created in 1996; it is a multidimensional instrument, aiming to encompass some psychological and social aspects not yet addressed by other questionnaires. Among its versions (Skindex-29, 16, and 17), Skindex-17 had not been validated in Brazil. Objectives: To validate Skindex-17 for use in Brazilians with dermatological diseases. Methods: This was a methodological, cross-sectional, and prospective study of 217 patients attended at the Dermatology Service Outpatient Clinic, Faculdade de Medicina de Botucatu - Universidade Estadual Paulista (Botucatu, SP, Brazil), from December 2017 to September 2019. The following were evaluated: content validity, filling time, internal consistency, dimensional structure, concurrent validity (DLQI), temporal stability, and responsiveness. Results: The sample consisted of 71% women, mean age (SD) of 45 (16) years; phototypes II−IV accounted for 95% of the cases. Cronbach's alpha coefficients were 0.82 and 0.93 for the symptoms and psychosocial conditions, respectively. A high correlation was observed with the DLQI score: symptoms (rho = 0.69) and psychosocial conditions (rho = 0.75). The instrument's two-dimensional structure was confirmed through confirmatory factor analysis. Temporal stability (ICC > 0.9) and score responsiveness (p ≤ 0.02) were verified. The instrument was shown to be feasible in clinical practice due to the content validation performed by professionals and patients, as well as the low time spent completing it (< 5 min). Study limitations: Single-center study, with patients exclusively from the public healthcare system. Conclusions: Skindex-17 was shown to be a valid and consistent instrument for assessing quality of life among patients with dermatological diseases, in Brazil. Its two-dimensional structure was confirmed.

Associação entre a qualidade de vida e o estresse em estudantes de Fonoaudiologia / Association between quality of life and stress in speech, language, and hearing sciences students

RESUMO Objetivo Verificar a associação entre a qualidade de vida - a partir dos domínios "bem-estar físico e material"; "relações com outras pessoas"; "atividades sociais, comunitárias e cívicas"; "desenvolvimento pessoal e realização" e "recreação" -, com o estresse em estudantes de Fonoaudiologia. Métodos Quarenta estudantes (34 do gênero feminino), de um curso de graduação em Fonoaudiologia, com idades entre 19 e 39 anos, responderam às questões da Escala de Qualidade de Vida de Flanagan e do Inventário de Sintomas de Stress para Adultos de Lipp e os resultados foram analisados por meio de regressão logística binária. Resultados Os domínios relacionados à qualidade de vida com piores resultados foram "bem-estar físico e material" e "desenvolvimento pessoal e realização" e o domínio que apresentou melhores resultados foi "relações com outras pessoas", sendo capaz de prever 21,2% dos casos de estresse. A qualidade de vida no domínio "relações com outras pessoas" foi uma preditora significativa do estudo, sendo considerada como protetora para o estresse na amostra investigada. Conclusão Uma boa qualidade de vida no domínio "relações com outras pessoas" apresentou-se como fator protetor do estresse em estudantes do curso de Fonoaudiologia.

ABSTRACT Purpose To verify the association between quality of life - from the physical and material well-being domains; relationships with other people; social, community and civic activities; personal development; achievement and recreation -, with stress in Speech, Language, and Hearing Sciences. Methods 40 students (34 females) from an undergraduate course in Speech, Language, and Hearing Sciences, aged between 19 and 39, answered the Flanagan Quality of Life Scale and Lipp's Stress Symptoms Inventory. The results were analyzed using binary logistic regression. Results The domains related to the quality of life with the worst results were "physical and material well-being" and "personal development and achievement," and the domain that showed the best results were "relationships with other people", being able to predict 21.2% of the cases of stress. The quality of life in the "relationships with other people" domain was a significant predictor of the study, being considered as protective for stress in the investigated sample. Conclusion A good quality of life in the domain "relationships with other people" was a protective factor of stress in students of the Speech, Language, and Hearing Sciences.

Avaliação da qualidade de vida profissional e estresse ocupacional em trabalhadores de enfermagem de um hospital durante pandemia por COVID-19 / Assessment of the quality of professional life and occupational stress in nursing workers at a hospital during a COVID-19 pandemic

Introdução: O profissional de enfermagem trabalha com pessoas, saudáveis e doentes, em ambientes de alta, média e baixa complexidade. Dessa forma, esse profissional está sujeito a reagir ao contato com esses pacientes e familiares, podendo experimentar sentimentos de compaixão que podem ou não afetar sua qualidade de vida profissional. O profissional de enfermagem tem de lidar, também, com os colegas, chefias, ambiente e recursos no trabalho, que podem gerar estresse ocupacional nesses indivíduos. Além disso, atualmente o Brasil e o mundo passam por uma nova realidade na sociedade e no ambiente hospitalar devido à pandemia por COVID-19, que se originou na China. Objetivo: Identificar os níveis de qualidade de vida profissional e o estresse ocupacional em profissionais da enfermagem de unidades de internação. Metodologia: Estudo quantitativo transversal e aninhado no projeto de pesquisa "Efeito do biofeedback no estresse, ansiedade e qualidade de vida profissional nas equipes de enfermagem em um hospital universitário: ensaio clínico randomizado". A pesquisa foi desenvolvida em unidades de internação para pacientes clínicos e cirúrgicos de um hospital de grande porte, com atendimento ao Sistema Único de Saúde. A coleta de dados ocorreu entre abril e agosto de 2020, através do preenchimento de questionários autoaplicáveis: questionário sociodemográfico e de informações sobre saúde, escala de estresse no trabalho e qualidade de vida profissional. O tamanho amostral foi calculado por meio do programa Winpepi com poder de 80%, nível de significância de 5%, resultando em 150 sujeitos. A amostragem foi aleatória, estratificada de acordo com o número de profissionais, com distribuição de dois técnicos ou auxiliares de enfermagem para cada enfermeiro pesquisado. Os dados foram analisados no pacote estatístico SPSS, versão 25, foram utilizados testes não paramétricos. Este projeto foi aprovado por Comitê de Ética em Pesquisa sob Certificado de Apresentação de Apreciação Ética 23346619000005327. Resultados: A amostra incluiu 127 (84,7%) profissionais do sexo feminino com média de idade de 43 anos (± 8,89). Quanto às categorias, 33,3% (50) eram enfermeiros e 66,7% (100) eram técnicos e auxiliares de enfermagem. Na escala de estresse no trabalho, verificou-se que a média total dos escores foi de 1,9 (± 0,71), sendo considerada como nível moderado de estresse. As faixas de idade "menor de 30 anos" e "maior de 60 anos" não apresentaram escores de altos níveis de estresse. Observando separadamente as subescalas de qualidade de vida profissional, verificou-se que satisfação por compaixão (SC) teve mediana de 50,3 (9,1 ­ 64,6), burnout (BO) de 48,5 (32,2 ­ 84,8) e estresse pós-traumático (ETS) de 47,1 (38,6 ­ 98,3). Todos os escores encontrados são considerados como moderados. Entre as subescalas, observou-se que a satisfação por compaixão apresentou correlação inversa e moderada na subescala de burnout (ρ = -0,416; p = 0,000), sendo que na de estresse traumático secundário foi inversa e fraca (ρ = -0,272; p< 0,001). A correlação entre as duas subescalas da fadiga por compaixão foi positiva e moderada (ρ = 0,464; p = 0,000). Relacionando estresse e qualidade de vida no trabalho, observou-se que, conforme aumentam os níveis de estresse, diminuem os níveis de qualidade de vida profissional. Verificou-se associação significativa entre prática de atividade física e resultados elevados de satisfação por compaixão (X² = 6,397; p = 0,041). Ocorreu também uma tendência de relação (X² = 5,992; p = 0,05) entre fadiga por compaixão e renda familiar inferior a quatro mil e quinhentos reais. Conclusão: Observou-se maior prevalência de estresse ocupacional na categoria de técnicos de enfermagem, bem como maiores níveis de Fadiga por Compaixão.

Introduction: The nursing professional works with people, healthy and sick, in environments of high, medium and low complexity. Thus, this professional is subject to react to contact with these patients and family members, and may experience feelings of compassion that may or may not affect their quality of professional life. The nursing professional also has to deal with colleagues, managers, environment and resources at work, which can generate occupational stress in these individuals. In addition, Brazil and the world are currently experiencing a new reality in society and in the hospital environment due to the COVID-19 pandemic, which originated in China. Objective: To identify the levels of quality of professional life and occupational stress in nursing professionals from inpatient units. Methodology: Quantitative cross-sectional study nested in the research project "Effect of biofeedback on stress, anxiety and quality of professional life in nursing teams at a university hospital: randomized clinical trial". The research was developed in inpatient units for clinical and surgical patients of a large hospital, serving the Unified Health System. Data collection took place between April and August 2020, by completing self-administered questionnaires: sociodemographic questionnaire and information on health, work stress scale and quality of professional life. The sample size was calculated using the Winpepi program with a power of 80%, a significance level of 5%, resulting in 150 subjects. The sample selection was random and categorical, proportional to the number of professionals, with the distribution of two nursing technicians or assistants for each nurse surveyed. The data were analyzed using the SPSS statistical package, version 25. This project was approved by the Research Ethics Committee under the Certificate of Presentation of Ethical Appreciation 2334661900005327. Results: The sample included 127 (84.7%) female professionals with an average age of 43 years (± 8.89). As for the categories, 33.3% (50) were nurses and 66.7% (100) were nursing technicians and assistants. On the work stress scale, it was found that the total average of the scores was 1.9 (± 0.71), being considered as a moderate level of stress. The age groups "under 30 years old" and "over 60 years old" did not show high stress levels. Looking separately at the subscales of quality of professional life, it was found that satisfaction for compassion (SC) has a median of 50.3 (9.1 - 64.6), burnout (BO) of 48.5 (32.2 - 84) , 8) and post-traumatic stress (ETS) of 47.1 (38.6 - 98.3). All scores found are considered as moderate. Among the subscales, it was observed that satisfaction with compassion showed an inverse and moderate correlation with the subscale of burnout (ρ = - 0.416; p = 0.000) and inverse and weak with secondary traumatic stress (ρ = -0.272; p = 0.001) . The correlation between the two subscales of compassion fatigue was positive and moderate (ρ = 0.464; p = 0.000). Relating stress and quality of life at work, it is observed that, as the levels of stress increase, the levels of quality of professional life decrease. There was a significant relationship (X² = 6.397; p = 0.041) between performing physical activity and high results of satisfaction for compassion. There was also a tendency for a relationship (X² = 5.992; p = 0.05) between fatigue due to compassion and family income of less than four and a half thousand reais. Conclusion: There was a higher prevalence of occupational stress in the category of nursing technicians, as well as higher levels of Compassion Fatigue. There was a positive and moderate correlation between compassion fatigue and occupational stress.

Evaluación del subprograma de Atención Comunitaria al Adulto Mayor en Mantua / Evaluation of the subprograms for the Community Care of the Elderly in Mantua

RESUMEN Introducción: la evaluación de los programas en la Atención Primaria de Salud permite medir el impacto real de su aplicación, y surge como instrumento de perfección y desarrollo. Objetivo: mostrar los resultados de la evaluación del subprograma de Atención Comunitaria al Adulto Mayor, en el Policlínico Principal de Urgencias Dr. Juan Bruno Zayas, de Mantua, en el año 2017. Métodos: se realizó una Investigación en Sistemas y Servicios de Salud, de tipo observacional y analítica, el universo del estudio lo constituyeron las 4 648 personas de 60 años y más, que fueron atendidas, así como todos los médicos y enfermeras de los 27 Consultorios Médicos de la Familia; con un total de 53 prestadores. Para la selección de la muestra de los gerontes se utilizó un muestreo probabilístico aleatorio simple, a razón de ocho por consultorio hasta seleccionar 216 adultos mayores, a los cuales se les aplicó una encuesta para evaluar el nivel de satisfacción. A los prestadores se les aplicó otra encuesta diseñada con el mismo objetivo. Se utilizaron los indicadores de actividades, resultados establecidos en el subprograma y los estándares correspondientes del programa. Resultados: los tres componentes del subprograma resultaron evaluados de no satisfactorios. La mayoría de sus índices trazadores no alcanzaron los estándares deseados. Conclusiones: se evaluó el subprograma de Atención Comunitaria al Adulto Mayor, en el municipio de Mantua, lo que evidenció deficiencias en su ejecución, así como poca disponibilidad de literatura sobre el mismo.

ABSTRACT Introduction: the evaluation of programs in Primary Health Care allows measuring the true impact of their application and arises as an instrument of accuracy and development. Objective: to show the results of the evaluation of the subprogram for the Community Care of the elderly at Dr. Juan Bruno Zayas Main Emergency Polyclinic in Mantua during 2017. Methods: an observational and analytical Research on Health Systems and Services was carried out. The target group of the study was comprised of 4648 people 60 years of age and older who were attended, as well as all the doctors and nurses of the 27 Family Physician Offices, with a total of 53 providers. For the selection of the sample of geronts, a simple random probability sampling was used, at a rate of eight per clinic until 216 old people were chosen, to whom a survey was applied to evaluate the level of satisfaction. Providers were given another survey designed for the same purpose. The indicators of activities, results established in the subprogram and the corresponding program standards were applied. Results: the three components of the subprograms were evaluated as unsatisfactory. Most of its tracer indicators of hospital management did not meet the desired standards. Conclusions: the subprogram of community care to the elderly was evaluated in the municipality of Mantua, which evidenced deficiencies in its implementation, as well as limited availability of medical literature concerning this topic.

Indicadores para avaliação da efetividade assistencial de hospitais / Indicators for assessing the effectiveness of hospitals

Resumo: Introdução: Indicadores de efetividade prestam-se a nortear os hospitais a avaliarem apropriadamente os resultados da assistência que oferecem. Há descrição na literatura sobre os atributos recomendáveis a indicadores de desempenho, contudo não foram validados por especialistas os indicadores de efetividade hospitalar com mais atributos para captar esta dimensão que expressa a qualidade dos resultados da assistência. Considera-se que um indicador de efetividade ideal é aquele que tem mais atributos para capturar o efeito de processos assistenciais na saúde e no bem estar dos pacientes. Objetivo: Validar um rol de indicadores selecionados na literatura nacional e internacional que possibilitem a medida da efetividade da assistência em hospitais e suas respectivas fichas técnicas. Método: Estudo descritivo-exploratório, de abordagem mista do tipo survey, com 52 participantes recrutados pela técnica de bola de neve (pesquisadores, docentes ou técnicos brasileiros experientes em indicadores), mediante a Técnica Delphi eletrônica, em duas rodadas, entre maio a setembro de 2017. Para cada indicador foi elaborada uma ficha técnica, fundamentada na literatura, aperfeiçoada nas duas rodadas pelos especialistas. Cada indicador foi avaliado quanto à sua correspondência a onze atributos de qualidade: disponibilidade; confiabilidade; simplicidade; representatividade; sensibilidade; abrangência; objetividade; baixo custo; utilidade; estabilidade e tempestividade. Estipulou-se o consenso mínimo entre as respostas dos especialistas de 70% para validação de conteúdo. Os dados foram submetidos à análise descritiva uni e bivariada, e as sugestões às fichas técnicas foram incorporadas com respaldo na literatura, nas duas rodadas. Resultados: Foram validados 17 indicadores na dimensão segurança do paciente, quatro na dimensão cuidado centrado no paciente e 11 na dimensão efetividade clínica. Os trinta e dois indicadores validados são: cirurgia no local errado do corpo do paciente; cirurgia realizada no paciente errado; material estranho deixado no corpo durante um procedimento; deiscência de ferida pós-operatória; embolia pulmonar ou trombose venosa profunda pós-operatória; fratura de quadril por queda em pacientes internados; fratura de quadril pós-operatória por queda em pacientes internados; incidentes graves relacionados a equipamentos; incidentes devido a falhas de identificação do paciente; hemorragia ou hematoma pós-operatório em cirurgias de grande porte; infecção de sítio cirúrgico em cirurgias limpas; quedas com dano em pacientes internados; lesão por pressão; densidade de infecção primária de corrente sanguínea em pacientes em uso de cateter venoso central, internados em unidade de terapia intensiva de adulto; densidade de infecção do trato urinário associada ao cateter vesical de demora em pacientes internados em UTI; reação transfusional graus II, III e IV; reações hemolíticas por incompatibilidade sanguínea; satisfação do paciente; cirurgias canceladas no dia agendado; recomendação do hospital pelo paciente; envolvimento do paciente com o próprio cuidado; mortalidade cirúrgica padronizada; óbitos em grupos de diagnósticos relacionados de baixa mortalidade; densidade de incidência de pneumonia associada à ventilação mecânica em UTI adulto; pneumotórax iatrogênico; sepse pós-operatóra; mortalidade institucional padronizada; reinternação não programada pós-alta hospitalar; reinternações na UTI durante a permanência do paciente no hospital; readmissão no serviço de emergência adulto do hospital; infecções resistentes em UTI (MRSA e VRE); mortalidade em UTI adulto. Os sete indicadores não validados são: complicações anestésicas; erro de medicação; adesão institucional à estratégia multimodal de higiene de mãos; compreensão dos pacientes sobre sua medicação (transição do cuidado); pacientes informados pela equipe sobre a ocorrência de incidentes com danos; orientação ao paciente (comunicação eficaz e informação transparente); percepção do paciente sobre a efetividade da preparação para sua alta. O atributo disponibilidade dos dados não alcançou o consenso mínimo em sete indicadores. Conclusão: Os indicadores validados permitem o monitoramento da efetividade assistencial e, os não validados podem também ser utilizados, mediante o atendimento de recomendações específicas e estratégias para a disponibilização de dados institucionais.

Abstract: Introduction: Indicators of effectiveness are intended to guide hospitals to appropriately evaluate the results of the care they provide. Even though there exists a description in the literature about the recommended attributes for performance indicators, those of hospital effectiveness, with extra attributes to capture the dimension of quality of care outcomes, have not yet been validated by specialists. It is assumed that an ideal effectiveness indicator is one that has more attributes to capture the effect of care processes on patients' health and well-being. Objective: To validate a selection of indicators, from both national and international literature, that would make it possible to measure the effectiveness of care in hospitals. Method: A descriptive-exploratory study, with a mixed approach of the survey type, with 52 participants recruited by the technique of snowball (researchers, teachers or Brazilian technicians experienced in indicators) using the Delphi Electronic technique in two rounds between May and September of 2017. Data were submitted to univariate and bivariate descriptive analysis. Eleven quality attributes for each indicator were evaluated: availability; reliability; simplicity; representativeness; sensitivity; comprehensiveness; objectivity; low cost; utility; stability; and timing. Results: In the patient safety dimension, seventeen of twenty indicators were validated; in the patient-centered care dimension, four of eight indicators were validated, and in the clinical effectiveness dimension, all eleven indicators were validated. The thirty-two validated indicators are: surgery at the wrong site of the patient's body; surgery performed on the wrong patient; foreign material left in the body during a procedure; postoperative wound dehiscence; pulmonary embolism or deep postoperative venous thrombosis; hip fracture due to fall in hospitalized patients; postoperative hip fracture due to fall in hospitalized patients; serious incidents related to equipment; incidents due to patient identification failures; hemorrhage or postoperative hematoma in large surgeries; surgical site infection in clean surgeries; falls with damage to hospitalized patients; pressure injury; density of primary bloodstream infection in patients using a central venous catheter admitted to an adult intensive care unit; density of urinary tract infection associated with delayed bladder catheter in ICU patients; degree II, III and IV transfusion reaction; hemolytic reactions due to blood incompatibility; patient satisfaction; surgeries canceled at the scheduled date; hospital recommendation by the patient; involvement of the patients with their own care; standardized surgical mortality; deaths in related groups of low mortality; incidence density of ventilator-associated pneumonia in adult ICU; iatrogenic pneumothorax; postoperative sepsis; standardized institutional mortality; nonscheduled rehospitalization after hospital discharge; readmissions in the ICU during the patient's stay in the hospital; readmission to the hospital emergency room; resistant infections in ICUs (MRSA and VRE); mortality in adult ICU. The seven indicators that have not been validated are: anesthetic complications; medication error; institutional adherence to the multimodal hand hygiene strategy; patients' understanding of their medication (care transition); patients reported by the team on the occurrence of incidents with damage; patient guidance (effective communication and transparent information); perception of the effectiveness of the preparation for discharge. The data availability attribute did not reach the stipulated minimum consensus of 70% for validation in seven indicators.

VES-13 and WHOQOL-bref cutoff points to detect quality of life in older adults in primary health care

ABSTRACT OBJECTIVE: To determine Vulnerable Elders Survey (VES-13) and WHOQOL-bref cutoff points to detect poor quality of life (QoL) in older individuals. METHODS: This is a cross-sectional study, performed in all primary health care units in Samambaia, DF, Brazil. The data were collected from August 2016 to May 2017. The sample size of 466 older individuals treated in primary health care was obtained considering a 5% margin of error, 95% confidence level, 50% prevalence, and 20% possible losses, in a population of 13,259 older individuals. The subjects answered the VES-13 and WHOQOL-bref questionnaires. They were divided into 3 subgroups: poorQoL (older individuals with self-reported very poor or poor QoL AND very dissatisfied or dissatisfied with their health), goodQoL (very good or good QoL AND very satisfied or satisfied with Health) and indeterminateQoL (NOT belonging to poorQoL or goodQoL subgroups). A receiver-operating characteristic (ROC) curve was performed with poorQoL (case) versus goodQoL (control) to determine the cutoff score in VES-13 and WHOQOL-bref. A diagnostic test using these cutoffs was carried out in all older individuals (n = 466). RESULTS: The VES-13 and WHOQOL-bref cutoff points to detect poorQoL were ≥ 2 and < 60, respectively. The area under ROC curve of VES-13 and WHOQOL-bref was 0.741 (CI95% 0.659-0.823; p < 0.001) and 0.934 (CI95% 0.881-0.987; p < 0.001), respectively. In diagnostic tests, VES-13 showed 84% sensitivity and 98.2% negative predictive value, and WHOQOL-bref, 88% sensitivity and 99% negative predictive value. CONCLUSIONS: VES-13 score ≥ 2 and WHOQOL-bref score < 60 adequately detected poorQoL in patients treated in primary health care. Our data suggest that older individuals with these scores require special treatment such as geriatrics collaborative care to improve this scenario, considering QoL impact on mortality.

Relação entre indicadores de qualidade e econômicos: um estudo em uma rede de hospitais do terceiro setor do Sul do Brasil / Relationship between quality and financial indicators: a study in a hospital network of the third sector of South Brazil

Resumo Introdução A gestão hospitalar é uma área complexa da administração, pois compreende um conjunto organizacional em que todos os setores são interdependentes e funcionam ao mesmo tempo. Um dos principais objetivos dessas organizações é proporcionar serviços de qualidade com os recursos disponíveis para a melhoria contínua da qualidade dos serviços por meio de aprimoramentos no ambiente. Objetivo Analisar a relação dos indicadores econômicos e financeiros com os índices de qualidade hospitalar. Método Estudo de caráter descritivo, documental e de abordagem quantitativa, baseada em hospitais do terceiro setor do Sul do país, com a utilização dos relatórios gerenciais, de enfermaria e de internação, para os indicadores de qualidade, e dos demonstrativos contábeis, para os indicadores financeiros. Para a análise, foram empregados testes de estatística univariada (descritiva e correlação de Pearson). Resultados A relação entre os índices demonstra a existência de correlação significativa entre os indicadores analisados, apresentando quais indicadores que devem ser observados pelo gestor hospitalar. Conclusão Considera-se que, quanto mais as entidades hospitalares prestarem um serviço de qualidade, maior será o retorno financeiro e, portanto, maiores serão os recursos para investimentos, no intuito de aprimorar a qualidade dos serviços.

Abstract Background Hospital management is a complex area of ​​administration since it has an organizational set where all sectors are interdependent and work at the same time. One of the main goals of these organizations is to provide quality services with the resources available to continuously improve the quality of services through improvements in the environment. Objective To analyze the relationship between economic and financial indicators with hospital quality indices. Method This is a descriptive, documentary and quantitative study based on the third sector hospitals in the south of the country. Management, nursing, and hospitalization reports are used for the quality indicators and the financial statements for the financial indicators. Univariate statistical tests (descriptive and Pearson correlation) were used for the analysis. Results The relationship between the indexes shows the existence of a significant correlation between the analyzed indicators, demonstrating which indicators should be observed by the hospital manager. Conclusion the more hospital entities providing a quality service, the greater the financial return, and therefore the greater the resources for investments to improve the quality of services.

Translation and validation of the Simplified Psoriasis Index (SPI) into Brazilian Portuguese

Abstract: Background: The Simplified Psoriasis Index is a tool that assesses the current severity, psychosocial impact, past history and interventions in patients with psoriasis through separate components. Two versions are available, one in which the current severity of the disease is evaluated by the patient themselves and another by the physician. Objectives: Translate the Simplified Psoriasis Index into Brazilian Portuguese and verify its validity. Methods: The study was conducted in two stages; the first stage was the translation of the instrument; the second stage was the instrument's validation. Results: We evaluated 62 patients from Complexo Hospitalar Santa Casa de Porto Alegre and Hospital Universitário de Brasília. The Simplified Psoriasis Index translated into Portuguese showed high internal consistency (Cronbach test 0.68). Study limitations: Some individuals, because of poor education, might not understand some questions of the Simplified Psoriasis Index. Conclusions: The Brazilian Portuguese version of the Simplified Psoriasis Index was validated for our population and can be recommended as a reliable instrument to assess the patients with psoriasis.

Translation into Portuguese language (Brazil), transcultural adaptation and validation of the quality of life questionnaire in female pattern hair loss (WAA-QoL-BP)

Abstract: Background: Female pattern hair loss (FPHL) is a common complaint in adult women and inflicts major impact in quality of life, however, there is no specific questionnaire available in Portuguese for such evaluation. Objectives: Translation into Brazilian Portuguese, cultural adaptation and validation of the WAA-QoL (Women's Androgenetic Alopecia Quality of Life Questionnaire). Methods: Methodological study. After authorization by the author, cultural (linguistic) translation and adaptation to Portuguese of the WAA-QoL questionnaire were carried out. The translated version (WAA-QoL-BP) and DLQI (Dermatology Life Quality index) were submitted to patients with FPHL for concurrent validation. Twenty patients were reevaluated to assess temporal stability. Results: A total of 116 patients with APF were evaluated, the mean age (SD) was 47 (14) years, and 89 (76%) patients were classified as grades II and III (Sinclair). There was high internal consistency: Cronbach´s alpha was 0.97 for the WAA-QoL-BP and 0.87 for the DLQI. The correlation between WAA-QoL and DLQI resulted in (rho) 0.81 (p <0.01). The intraclass correlation coefficient for complete agreement of WAA-QoL-BP was 0.95 (p <0.01) in the test-retest comparison. Study Limitations: Sampling of patients only from the State of São Paulo. Conclusions: A Brazilian version for WAA-QoL was translated and adapted, which proved to be valid and consistent.

Avaliação dos índices de qualidade de vida (MELASQoL e DLQI) e do MASI em pacientes com melasma tratadas com Polypodium Leucotomos / Analysis of melasma quality OF life scales (MELASQoL and DLQI) and MASI in Polypodium Leucotomos treated patients

Introdução: Melasma é distúrbio de pigmentação que acomete principalmente mulheres em idade fértil com fototipos elevados. Polypodium leucotomos tem atividade antioxidante, fotoprotetora e imunomodulatória, sendo tratamento adjuvante do melasma. Objetivo: Avaliar a eficácia, em relação à qualidade de vida e à melhora objetiva, do uso de PL no tratamento do melasma. Métodos: Estudo prospectivo e individualizado. Nove voluntárias portadoras de melasma foram submetidas ao tratamento com Polypodium leucotomos durante 45 dias. Escores MELASQoL, DLQI e MASI foram calculados no D0 e no D45. Realizou-se a análise de variância Anova com pós-teste de Tukey para comparação entre D0 e D45 (p < 0,05). Resultados: Todas as pacientes eram do sexo feminino, com média de idade de 37,18 ± 6,78 anos, história familiar de melasma em 55,6%, e fotoexposição desprotegida e uso de estrogênio em 88,9%. Após 45 dias de tratamento com Polypodium leucotomos houve redução significativa do MELASQoL e DLQI (p < 0,05) e melhora do MASI em 55,6% das pacientes. Conclusões: Houve melhora do MASI em 55,6% das pacientes após 45 dias de tratamento. A despeito da discreta melhora no MASI, houve reflexo na melhora dos escores de qualidade de vida (DLQI e MELASQoL).

Introduction: Melasma is a pigmentation disorder that mainly affects women of childbearing age with high phototypes. Polypodium leucotomos has antioxidant, photoprotective and immuno-modulatory activity, and can be considered as an adjunctive treatment for melasma. Objective: To evaluate the efficacy, in relation to quality of life and objective improvement, of the use of Polypodium leucotomos in the treatment of melasma. Methods: Prospective and individualized study. Nine volunteers with melasma were submitted to treatment with Polypodium leucotomos for 45 days. MELASQoL, DLQI and MASI scores were calculated at the beginning (D0) and 45 days after (D45). Analysis of variance ANOVA with Tukey post-test for comparison be-tween D0 and D45 (p <0.05). Results: All patients were females, mean age of 37.18 ± 6.78 years. Family history of melasma in 55.6%; 88.9% with unprotected photoexposure and use of estrogen. After 45 days of treatment with Polypodium leucotomos there was a significant reduction of ME-LASQoL and DLQI (p <0.05) and improvement of MASI in 55.6% of the patients. Conclusions: There was improvement of MASI in 55.6% of patients after 45 days of treatment. In spite of the slight improvement in MASI, there was a reflex in the improvement of quality of life scores (DLQI and MELASQoL).

Description of the quality indicators defined in the National Reference Laboratory in Tuberculosis of CRPHF/Ensp/Fiocruz by means of the process mapping methodology / Descrição dos indicadores da qualidade definidos pelo Laboratório de Referência Nacional em Tuberculose do CRPHF/Ensp/Fiocruz por meio da metodologia de mapeamento de processos

ABSTRACT Introdution: The National Reference Laboratory (LRN) in Tuberculosis (TB) is a laboratory unit of highly specialized technical excellence that has developed projects involving training in human resources and the enhancement of techniques essential for the diagnosis of TB. Its purpose is the continuous improvement of all laboratory processes and their quality management, with the purpose of collaborating on and strengthening the actions in the network that integrate it in the aid of surveillance and in the fight against TB. Objectives: This research aims to describe the quality indicators that were defined through the process mapping methodology, with the objective of promoting and raising the level of quality and reliability of the different laboratory processes performed at LRN in TB. Method: For the definition of indicators, process mapping was used which, through flow charts, can establish and determine the most appropriate indicators for LRN in TB. After defining these indicators, they were described with their respective titles, preventive and corrective measures, importance and goals. Results: The results of the research suggest that the established indicators are fundamental for the laboratory processes, since they improve quality management. Conclusion: Through this study, we seek to encourage and impel the managers involved in the field of TB and in the field of health on the utility and the need to control and measure processes, being able to standardize them with the help of indicators or other quality tools.

RESUMO Introdução: O Laboratório de Referência Nacional (LRN) em Tuberculose (TB) é uma unidade laboratorial de excelência técnica altamente especializada que tem desenvolvido projetos envolvendo a capacitação de recursos humanos e o aprimoramento de técnicas fundamentais para o diagnóstico da TB. Seu propósito é a melhoria contínua de todos os processos laboratoriais e a sua gestão da qualidade, com o intuito de colaborar e fortalecer as ações na rede que o integram no auxílio à vigilância e no combate da TB. Objetivos: Esta pesquisa tem a finalidade de descrever os indicadores da qualidade que foram definidos por meio do método de mapeamento de processos, com o objetivo de promover e elevar o nível da qualidade e da confiabilidade dos diferentes processos laboratoriais realizados no LRN em TB. Método: Para a definição dos indicadores, foi utilizado o mapeamento de processos que, por meio de fluxogramas, pode estabelecer e determinar os indicadores mais adequados para o LRN em TB. Após a definição desses indicadores, eles foram descritos com seus respectivos títulos, medidas preventivas e corretivas, importância e metas. Resultados: Os resultados da pesquisa sugerem que os indicadores estabelecidos são fundamentais para os processos do laboratório, visto que melhoram a gestão da qualidade. Conclusão: Por intermédio deste estudo, buscamos incentivar e impulsionar os gestores envolvidos no campo da TB e no campo da saúde sobre a utilidade e a necessidade de controlar e medir os processos, podendo padronizá-los com a ajuda dos indicadores ou outras ferramentas da qualidade.

Enfermedades crónicas y factores de riesgo en adultos mayores de Argentina: años 2001 - 2009 / Chronic diseases and risk factors in older adults from Argentina: years 2001 to 2009

RESUMEN El presente documento evalúa el impacto de las enfermedades crónicas prevalentes en la población mayor de 65 años en Argentina en el período 2001 - 009, a través del método de la Esperanza de Vida Ajustada por Discapacidad. Complementariamente, se describe la prevalencia de estas enfermedades en el país en el mismo período de tiempo, así como de los factores de riesgo asociadas a ellas. Se evidencia un aumento de la prevalencia de enfermedades crónicas no transmisibles, como son la hipertensión arterial y la diabetes, entre otras, pero también un progreso en la calidad de vida de las personas afectadas por estas enfermedades, que mejoraría a medida que envejece la población.

ABSTRACT This paper evaluates the impact of chronic diseases prevalent in the population over 65 years in Argentina in 2001 - 2009, through the method of Disability Adjusted Life Expectancy. In addition, the prevalence of these diseases is described in the same time period as well as the risk factors associated with them. An increased prevalence of chronic noncommunicable diseases is evident, such as hypertension and diabetes, among others, but also an improvement in the quality of life of people affected by these diseases, which improve as the population ages.

Incidence, clinical manifestations and clipping of nail psoriasis in the dermatology center of the Hospital Universitário Evangélico de Curitiba

Abstract: Background: Psoriasis is a chronic inflammatory skin disease that often progresses with nail alterations. It is suspected that there is a correlation between nail psoriasis and enthesitis of the distal interphalangeal joint, seeming to serve as a predictor. Objectives: To analyze the profile of patients with nail psoriasis and correlate the presence of nail alterations with psoriatic arthritis, quality of life, extent of psoriasis and the histopathology of the nail. Methods: An observational cross-sectional study with 40 patients with a diagnosis of psoriasis and without systemic treatment. The patient profile was researched, including quality of life and evaluated for the presence of psoriatic arthritis. The severity of the skin psoriasis and the presence of nail lesions were evaluated. Nail fragments were collected and analyzed through clipping. It obtained 100% of positivity for psoriasis in the histopathology exam of the nail plate. Results: Of the 40 patients, 65% were diagnosed with nail psoriasis. Suggestive findings of psoriatic arthritis in hands were present in 33%, being more frequent in those with nail alteration (p = 0.01). In 92.3% of patients diagnosed with psoriatic arthritis in the hands there was some nail injury. The most frequent injuries were pitting and onycholysis. Conclusions: Patients with nail psoriasis are usually men, with worse quality of life and higher chance of psoriatic arthritis. The correlation between the nail involvement of psoriasis and psoriatic arthritis in hands confirms the association between these two forms. The clinical diagnosis of nail psoriasis did not correlate with the histological diagnosis.