Incidence of infections associated with the use of invasive devices in an ICU after application of the Improvement Science Method

Objective: To reduce the incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) in the intensive care unit (ICU) using the Improvement Science method. Methods: This was a single-center retrospective cohort study. A collaborative quality improvement team developed and implemented local changes to HAI-related processes and protocols. Pre-intervention, intervention, and post-intervention periods were compared. The study was conducted at the Adult ICU of a hospital in southern Brazil. Variables were analyzed using interrupted time series analysis with segmented linear regression, simple correlation, and hypothesis testing. Results: There was a reduction in the incidence density of all infections. VAP was reduced from 27.2% to 7.2% (p < 0.001), CLABSI from 3.0% to 0.9% (p = 0.017), and CAUTI from 8.3% to 1.8% (p < 0.001). The ICU stay was also reduced from 6.7 to 6 days (p = 0.018). Conclusion: There was an improvement in all the evaluated parameters. Ongoing monitoring of related indicators and adherence to implemented measures are essential to sustain improvements. Applying the Improvement Science methodology can reduce the incidence of HAIs in the ICU.

Analysis of notified drug poisoning among children in Santa Catarina state, 2016-2020 / Análise das intoxicações medicamentosas notificadas em crianças no estado de Santa Catarina, 2016-2020

ABSTRACT Objective: The aim of this study was to analyze the incidence of drug poisoning in children registered in the Santa Catarina Information and Toxicological Assistance Center between 2016 and 2020. Methods: This observational epidemiological study, with a historical cohort design, was carried out from reported cases of drug poisoning in children aged 0-12 years. Census sampling was used to collect data. Results: There were 4839 reported cases of drug poisoning among children in the State of Santa Catarina in the surveyed period, with an average annual incidence rate of 6 cases/1000 live births. The median age was 3 years. Most cases of poisoning occurred among girls aged 0-3 years by accidental ingestion of drugs at home. There was a predominance of signs and symptoms affecting the nervous system; only a small portion required hospitalization. Most cases were considered mild poisoning with a favorable outcome. No deaths were recorded. There was a tendency of increasing cases over time, however not significant. There is a predominance of incident cases in the Great West of the state, followed by the Midwest and Serra Catarinense regions. Conclusions: Drug poisoning in children is predominant in early childhood, mainly caused by accidental ingestion of drugs at home. These findings highlight the importance of preventive and educational measures among family members and caregivers.

RESUMO Objetivo: Analisar a incidência das intoxicações medicamentosas em crianças registradas no Centro de Informação e Assistência Toxicológica de Santa Catarina entre os anos de 2016 e 2020. Métodos: Estudo epidemiológico observacional, com delineamento de coorte histórica. Foi realizado com base nos casos notificados de intoxicação por medicamentos em crianças de zero a 12 anos. A amostra foi do tipo censo. Resultados: Foram notificadas 4.839 intoxicações medicamentosas em crianças no Estado de Santa Catarina no período, com taxa de incidência média anual de 6 casos/mil nascidos vivos. A idade apresentou mediana de três anos. A maioria (51,5%) dos casos de intoxicação ocorreu entre meninas, até os três anos de idade, de causa acidental, por exposição oral e no domicílio. Houve predomínio de sinais e sintomas que afetaram o sistema nervoso e apenas uma pequena parcela (6,2%) necessitou de hospitalização. A maioria dos casos (65,6%) foi considerada intoxicação leve com evolução favorável. Nenhum óbito foi registrado. Houve tendência de aumento dos casos ao longo do tempo, porém não significativo. Observa-se predomínio de casos incidentes no Grande Oeste, seguido do Meio-Oeste e Serra Catarinense. Conclusões: As intoxicações medicamentosas em crianças predominam na primeira infância, de forma acidental, sendo o ambiente doméstico o principal local. Esses achados destacam a importância de intensificar medidas preventivas e educativas entre familiares e cuidadores de crianças.

Temporary trend of breast cancer mortality in the state of Santa Catarina in the period from 1996 to 2019

Introduction: Breast cancer is the most common female cancer and the leading cause of cancer death in women around the world. It has repercussions not only on human health, but also on health services due to the high incidence resulting in a large number of consultations and treatments. The disease is responsible for a large demand for hospitalizations throughout Brazil, where an increase in mortality rates is observed and Santa Catarina does not differ from the national scenario. The study aimed to analyze the temporal trend of the breast cancer mortality rate in the state of Santa Catarina from 1996 to 2019 Methods: This is an ecological epidemiological study of time series of breast cancer mortality in the population residing in the state according to age groups and health macro-regions. Data were obtained from the Mortality Information System and the Brazilian Institute of Geography and Statistics. Simple linear regression of standardized mortality rates according to the world standard population was performed. p<0.05 was considered significant. Results: Data showed 9,637 deaths in the period. There was a significant upward trend in mortality in the state (from 6.50 to 7.92/100,000 women). An upward trend was observed in the age groups of 30­39 years, 60­69 years, and over 80 years. All seven health macro-regions showed an upward trend in mortality. Conclusion:The overall mortality rate from breast cancer in Santa Catarina showed a significant upward trend. A significant increase was also observed in the age groups of 30­39 years, 60­69 years, and 80 years old or older and in all health macro-regions. Problems in public health infrastructure, lack of control of risk factors and deficiency in mammographic screening are revealed. The elaboration and strengthening of public policies to control the disease are fundamental.

Time trend and causes of HIV/AIDS mortality in the state of Santa Catarina, 2010­2019 / Tendência temporal e causas de mortalidade por HIV/AIDS no estado de Santa Catarina, 2010­2019

Introduction: Although the acquired immunodeficiency syndrome (AIDS) has no cure, antiretroviral treatment has considerably increased the survival of people living with the disease or with the human immunodeficiency virus (HIV), reducing the incidence of opportunistic infections in these patients. Thus, this treatment changed mortality rates and diversified the causes of death, including reasons related to increased longevity, such as chronic noncommunicable diseases, common in the uninfected population. Therefore, the current epidemiological transition motivated us to study the death profile of people with HIV/AIDS in the state of Santa Catarina. Objective: To investigate case characteristics, as well as the time trend and distribution of deaths, among people with HIV/AIDS in Santa Catarina between 2010 and 2019. Methods: In this ecological, epidemiological study, we consulted all death records from the Santa Catarina Mortality Information System that had HIV/AIDS among the causes and occurred between 2010 and 2019. Results: A total of 5,174 death records were analyzed. In the period, the mean mortality rate among people with HIV/AIDS was 7.64 deaths per 100 thousand inhabitants (95% confidence interval ­ 95%CI 6.61­8.67) ­ 8.99 in 2010 and 6.06 in 2019 ­, showing a downward trend of 0.38% per year. Conclusion: We identified a downward trend in mortality. Deaths were concentrated on the coast, in more populous cities. Furthermore, the finding of improper completion of the death certificate points to the need to invest in improving the training of professionals responsible for this document.

Introdução: Embora a síndrome da imunodeficiência adquirida (AIDS) não tenha cura, o tratamento antirretroviral aumentou consideravelmente a sobrevida das pessoas que vivem com a doença ou com o vírus da imunodeficiência humana (HIV), diminuindo a ocorrência de infecções oportunistas nesses pacientes. Assim, esse tratamento mudou as taxas de mortalidade e diversificou as causas de óbito, incluindo motivos relacionados ao aumento da longevidade, como doenças crônicas não transmissíveis comuns à população não infectada. Dessa forma, a atual transição epidemiológica motiva o estudo do perfil dos óbitos em pessoas com HIV/AIDS no estado de Santa Catarina. Objetivo: Investigar as características dos casos, a tendência temporal e a distribuição dos óbitos em pessoas com HIV/AIDS no estado de Santa Catarina entre os anos de 2010 e 2019. Métodos: Neste estudo epidemiológico com delineamento ecológico, foram consultados todos os registros de óbitos do Sistema de Informação sobre Mortalidade de Santa Catarina ocorridos entre os anos de 2010 e 2019 que apresentassem entre as causas o HIV/AIDS. Resultados: Foram analisados 5.174 registros de óbitos. A taxa de mortalidade média entre pessoas com HIV/AIDS do período foi de 7,64 óbitos a cada 100 mil habitantes (95% intervalo de confiança ­ IC95% 6,61­8,67), sendo de 8,99 em 2010 e 6,06 em 2019, mostrando tendência de queda de 0,38 pontos percentuais ao ano. Conclusão: Observou-se tendência de queda na mortalidade. A concentração dos óbitos foi na faixa litorânea, em cidades mais populosas. Ademais, a constatação do falho preenchimento da declaração de óbito aponta para a necessidade de investir no aprimoramento do treinamento dos profissionais responsáveis por esse documento.

Tendência temporal e distribuição espacial dos casos de transmissão vertical do HIV em Santa Catarina, 2007-2017: um estudo ecológico / Tendencia temporal y distribución espacial de los casos de transmisión vertical del VIH en el estado de Santa Catarina, Brasil, 2007-2017: un estudio ecológico / Temporal trend and spatial distribution of cases of mother-to-child transmission of HIV in the state of Santa Catarina, Brazil, 2007-2017: an ecological study

Objetivo: Analisar a tendência temporal e a distribuição espacial dos casos de transmissão vertical do HIV, Santa Catarina, 2007-2017. Métodos: Estudo ecológico misto, com dados do Sistema de Informação de Agravos de Notificação. Realizou-se regressão linear para análise de série temporal; calcularam-se as taxas médias no período e variações percentuais médias anuais das taxas de gestantes infectadas pelo HIV, de crianças expostas ao HIV na gestação e de soroconversão das crianças expostas ao HIV/aids na gestação, além do geoprocessamento dos dados. Resultados: Foram registradas 5.554 gestantes infectadas pelo HIV, com taxa de 5,6 gestantes/1 mil nascidos vivos. A taxa média de soroconversão foi de 13,5/100 mil nascidos vivos (IC95% 6,8;20,1) e apresentou tendência decrescente (APC = -99,4%; IC95% -99,9;-93,1). A taxa de soroconversão foi mais elevada em municípios de pequeno porte. Conclusão: A taxa de gestantes infectadas pelo HIV foi estável; houve diminuição de crianças infectadas com HIV por via vertical.

Objetivo: Estimar la tendencia temporal y la distribución de casos de VIH por transmisión vertical en Santa Catarina, 2007-2017. Métodos: Estudio ecológico mixto con datos del Sistema de Información de Enfermedades de Declaración Obligatoria. Se utilizó la regresión lineal para análisis de series temporales y se calcularon las tasas medias en el período y los cambios porcentuales medios anuales en las tasas de mujeres embarazadas infectadas por el VIH; de niños expuestos al VIH; y seroconversión de niños expuestos al VIH/SIDA durante el embarazo, además del geoprocesamiento de datos Resultados: Había 5.554 gestantes infectadas por el VIH, con tasa de 5,6 gestantes/1.000 nacidos vivos. La tasa media de seroconversión fue 13,5/100.000 de nacidos vivos (IC95% 6,8;20,1) y mostró tendencia decreciente (APC = -99,4%; IC95%-99,9;-93,1). La tasa de seroconversión fue más expresiva en los municipios pequeños. Conclusão: Hubo una tasa estable de mujeres embarazadas infectadas por el VIH, mientras que el número de niños infectados por el VIH disminuyó.

Objective: To analyze the temporal trend and spatial distribution of mother-to-child HIV transmission in Santa Catarina between 2007 and 2017. Methods: This was a mixed ecological study with data from the Notifiable Health Conditions Information System. Linear regression was performed for time series analysis and the mean rates in the period and mean annual percentage changes in the rates of HIV-infected pregnant women were calculated, children exposed to HIV during pregnancy, and seroconversion of children exposed to HIV/AIDS during pregnancy, in addition to data geoprocessing. Results: There were 5,554 records of HIV-infected pregnant women, with a rate of 5.6 pregnant women per 1,000 live births. The mean seroconversion rate was 13.5/100,000 live births (95%CI 6.8;20.1) and it showed a falling trend (APC = -99.4%; 95%CI -99.9;-93.1). The seroconversion rate was more expressive in small towns. Conclusion: The rate of HIV-infected pregnant women was stable in the period, whereas the number of children infected with HIV through mother-to-child transmission decreased.

Sífilis adquirida na população de 50 anos ou mais: distribuição geográfica e tendências / Acquired syphilis in the population with 50 years old or more: geographic distribution and trends

Objetivo: avaliar a prevalência de sífilis adquirida na população ≥50 anos residente em Santa Catarina, sua distribuição geográfica e tendência no período 2013-2018. Métodos: estudo ecológico exploratório, analisando dados na plataforma virtual da Diretoria de Vigilância Epidemiológica, relativos às notificações de sífilis na população catarinense com ≥50 anos, sendo a faixa etária dividida em quatro grupos: 50-59 anos, 60-69 anos, 70-79 anos e ≥80 anos. Resultados: a taxa de ocorrência de sífilis na população estudada aumentou de 18,2 para 110,7 casos /100.000 habitantes no período. O incremento foi observado em todas as faixas etárias a partir dos 50 anos e sexos, destacando-se a população de 50-59 anos. As maiores incidências foram verificadas nas macrorregiões Grande Florianópolis e Planalto Norte/Nordeste. Conclusão: houve crescimento exponencial do agravo no período 2013-2018, na população referida, para ambos os sexos, ocorrendo de forma diferenciada segundo macrorregião de saúde. Os resultados obtidos preocupam e merecem atenção da gestão pública.

Aims: To evaluate the prevalence of acquired syphilis in the population ≥ 50 years old residing in Santa Catarina with, it's geographic distribution and trends from 2013 to 2018. Methods: Exploratory ecological study, analyzing data in the virtual platform of Epidemiological Surveillance Board, concerning syphilis notifications from the population of Santa Catarina ≥50 years old, with age divided into four groups: 50-59 years, 60-69 years, 70-79 years and ≥80 years. Results: the occurrence of syphilis in the said population increased from 18.2 to 112.7 cases/100.000 residents in the period. The increment was perceived in all age groups over 50 years and sexes, standing out the 50-59 age group. The highest incidences were found in the macro regions of "Grande Florianópolis" and "Planalto Norte-Nordeste". Conclusion: there was an exponential growth of the disease between 2013 - 2018, for both sexes, occurring differently according to each macro region of health. The obtained results are concerning and deserve attention from the public management.

Internal construct validity of the Brazilian version of a tool for assessing the population's knowledge of human papillomavirus / Validade interna do construto da versão brasileira de um instrumento para aferição do conhecimento sobre o papilomavírus humano

ABSTRACT: Objective: To verify the internal construct validity of the Brazilian Portuguese version of a tool for measuring the general population's knowledge of human papillomavirus (HPV). Materials and methods: A cross-culturally adapted Brazilian Portuguese version of a measurement tool originally designed for English speaking populations was administered to 330 adults in Tubarão, Santa Catarina, Southern Brazil. After examining the overall suitability of the method, we performed investigations based on the item response theory and exploratory factor analysis. Results: Ten of the 29 items presented a low contribution to the construct and were excluded from subsequent analysis. The factor analysis yielded three factors, which explained approximately 51% of the variance variability. A different arrangement from the original measurement tool was found: general HPV knowledge, with six items; HPV vaccination knowledge, with five items; HPV transmission and testing knowledge, with eight items. Conclusion: The Brazilian Portuguese version under study presented a different behavior from the original measurement tool, but proved to be a reliable and valid instrument in assessing the Brazilian population's knowledge about HPV.

RESUMO: Objetivo: Verificar a validade interna do construto da versão em português de uma ferramenta para aferir o conhecimento da população sobre o papilomavírus humano (HPV). Materiais e métodos: Uma versão brasileira transculturalmente adaptada de uma ferramenta de aferição de conhecimento sobre HPV originalmente projetada para ser utilizada em populações de língua inglesa foi aplicada a 330 adultos em Tubarão/SC, Brasil. Após examinar a adequação geral do método, foram realizadas análises baseadas na Teoria de Resposta ao Item e na Análise Fatorial Exploratória. Resultados: Dez dos 29 itens apresentaram baixa contribuição para o construto e foram excluídos das análises subsequentes. Três fatores foram gerados pela análise fatorial e explicaram aproximadamente 51% da variabilidade da variância. Um arranjo diferente em relação ao instrumento de medida original foi encontrado, baseado em: conhecimento geral do HPV, com seis perguntas; conhecimento sobre vacinação contra o HPV, com cinco perguntas; e conhecimento sobre transmissão e teste de HPV com oito perguntas. Conclusão: A versão brasileira em estudo apresentou um comportamento diferente da ferramenta de aferição original, mas demonstrou ser um instrumento confiável e válido para acessar o conhecimento da população brasileira sobre o HPV.

Cross-Cultural Adaptation and Validation of the COHIP-SF19 to be used in Brazil

Objective: To carry out a cross-cultural adaptation and validation of the Child Oral Health Impact Profile - COHIP-SF 19 to be used in Brazil. Material and Methods: The adaptation process followed five stages: translation into Portuguese, synthesis of different translations, back-translation, expert panel analysis, and pre-final version testing. The final version was administered at two different moments to a sample of 100 schoolchildren aged 8-15 years in Criciúma, Brazil. The Brazilian version of the Child Perceptions Questionnaire (CPQ11-14) was administered as a comparison parameter. In both administrations of the questionnaire, factor analysis, principal component extraction, and factor rotation were performed. The internal validation was performed by using the α-Cronbach coefficient and the congruence coefficient between the rotated factors in the two administrations of the questionnaire. In order to analyze the external validity, the factors of the first administration of COHIP-SF 19 and CPQ11-14 factors were compared by using simple linear regression analysis and congruence coefficient. Results: A Brazilian version of the questionnaire was obtained. The results of the internal validity analysis indicated adequate internal consistency and statistically significant internal congruence in the two factors identified in the factorial analysis. The linear regression analysis between the COHIP-SF 19 and CPQ11-14 showed weak correlations, and the congruence indices were not statistically significant. Conclusion: The Brazilian version of COHIP-SF 19 showed good internal consistency, but lacked external validity when compared to CPQ11-14.

Internal construct validity of a Brazilian version of the McMaster Family Assessment Device / Validade interna de construto de uma versão brasileira do McMaster Family Assessment Device

ABSTRACT Objective To assess the internal validity of a Brazilian version of the McMaster Family Assessment Device (FAD). Methods The questionnaire was applied to a sample of 80 adults of both sexes. An exploratory factor analysis was conducted after previous analysis of communalities and global suitability of the method to determine questions that did not share a significant percentage of variance with the defined factors. Varimax rotation method with Kaiser’s normalization was used to minimize the number of questions that had high factor loads. Results The Brazilian version maintained 28 questions distributed in four new dimensions containing 11, 5, 7, and 5 questions, respectively. To obtain those four factors or dimensions, we selected those with eigenvalue greater than two, which explained about 50% of the data variability. Conclusion The Brazilian version under examination showed different behaviors from those in the original instrument. A review of the instrument questions and dimensions is clearly needed. Further research with larger samples is required to examine the rating scale and its suitability to the Brazilian context.

RESUMO Objetivo Proceder estudo de validação interna de uma versão brasileira do McMaster Family Assessment Device – FAD. Métodos O questionário foi aplicado em uma amostra de 80 indivíduos adultos de ambos os sexos. Foi realizada análise fatorial exploratória após análise prévia de adequabilidade global do método e análise de comunalidades para averiguar perguntas que não compartilhavam percentual significativo de variância com os fatores definidos. Para minimizar a quantidade de perguntas que apresentavam elevadas cargas, foi utilizado o método de rotação Varimax com normalização de Kaiser. Resultados Na versão brasileira em estudo foram mantidas 28 perguntas em quatro novas dimensões contendo 11, 5, 7 e 5 perguntas. Para obtenção de quatro fatores ou dimensões, foram selecionados aqueles com autovalores superiores a dois, o que explicou cerca de 50% da variabilidade dos dados. Conclusão A versão brasileira em estudo apresentou comportamento diferente do instrumento original. Observou-se a necessidade de revisar as perguntas e as dimensões do instrumento e também a realização de mais pesquisas com amostras maiores para observar o comportamento da escala e sua adequabilidade para utilização no contexto brasileiro.