Research status of correlation between myopia and accommodative function / 国际眼科杂志(Guoji Yanke Zazhi)

Ocular accommodation refers to the process by which the ciliary muscle creates a clear image of the object in the retina by changing the refractive power of the lens. When the accommodation ability of the eye is insufficient, the imaging focus falls on the region behind the retina and hyperopic defocus is easily formed, resulting in axial growth and leading to the development of myopia, and it is found that most myopic patients usually have some accommodation dysfunction. Myopia has become a public health problem in China, and the prevalence of adolescents has increased dramatically. How to prevent and stop the occurrence and development of myopia is a major challenge. Previous studies have found that ocular accommodation dysfunction is associated with the occurrence and development of myopia, and the measurement of parameters related to accommodation function has certain guiding significance for the prevention and control of myopia. The purpose of this paper is to review the correlation between myopia and ocular accommodation function, with a view to providing new ideas for the prevention, control and treatment of myopia.

Avaliação estrutural das unidades de atenção integral às doenças inflamatórias intestinais no Brasil / Structural evaluation of inflammatory bowel disease comprehensive care units in brazil

ABSTRACT Background: The most efficient way to prevent complications from inflammatory bowel disease (IBD) is to provide patients with optimized care. Nonetheless, in Brazil, there is no validated methodology for evaluating health services recognized as comprehensive care units (CCU), making it difficult to assess the quality of care provided. Objective: To understand the current scenario, map the distribution of centers and identify strengths and weaknesses, considering local and regional characteristics. Methods: The study was carried out in three phases. Initially, the Brazilian Organization for Crohn's disease and colitis (GEDIIB) developed 22 questions to characterize CCU in Brazil. In the second phase, all GEDIIB members were invited to respond to the survey with the 11 questions considered most relevant. In the last phase, an interim analysis of the results was performed, using the IBM SPSS Statistics v 29.0.1.0 software. Descriptive statistics were used to characterize the center's profile. The chi-square test was used to compare categorical variables. Results: There were 53 responses from public centers (11 excluded). Most centers were concentrated in the Southeastern (n=22/52.4%) and only 1 (2.4%) in the Northern region of Brazil. Thirty-nine centers (92.9%) perform endoscopic procedures, but only 9 (21.4%) have access to enteroscopy and/or small bowel capsule endoscopy. Thirty-three centers (78.6%) offer infusion therapy locally, 26 (61.9%) maintain IBD patient records, 13 (31.0%) reported having an IBD nurse, 34 (81.0%) have specific evidence-based protocols and only 7 (16.7%) have a patient satisfaction methodology. In the private scenario there were 56 responses (10 excluded). There is also a concentration in the Southeastern and Southern regions. Thirty-nine centers (84.8%) have access to endoscopic procedures and 19 perform enteroscopy and/or small bowel capsule endoscopy, more than what is observed in the public environment. Infusion therapy is available in 24 centers (52.2%). Thirty-nine centers (84.8%) maintain a specific IBD patient database, 17 (37%) have an IBD nurse, 36 (78.3%) have specific evidence-based protocols, and 22 (47. 8%) apply a patient satisfaction methodology. Conclusion: IBD CCU in Brazil were mainly located in the Southeastern and Southern regions of the country. Most centers have dedicated multidisciplinary teams and IBD specialists. There is still a current need to improve the proportion of IBD nurses in IBD care in Brazil.

RESUMO Contexto: A forma mais eficiente de prevenir complicações da doença inflamatória intestinal (DII) é proporcionar aos pacientes cuidados otimizados. Contudo, no Brasil não existe uma metodologia validada para avaliação de serviços de saúde reconhecidos como unidades de atenção integral (UAI), dificultando a avaliação da qualidade da assistência prestada. Objetivo: Compreender o cenário atual, mapear a distribuição dos polos e identificar pontos fortes e fracos, considerando as características locais e regionais. Métodos: O estudo foi realizado em três fases. Inicialmente, a Organização Brasileira para Doença de Crohn e Colite (GEDIIB) desenvolveu 22 questões para caracterizar as UAI no Brasil. Na segunda fase, todos os membros do GEDIIB foram convidados a responder ao inquérito com as 11 questões consideradas mais relevantes. Na última fase foi realizada uma análise dos resultados, utilizando o software IBM SPSS Statistics v 29.0.1.0. Estatísticas descritivas foram utilizadas para caracterizar o perfil do centro. O teste qui-quadrado foi utilizado para comparar variáveis categóricas. Resultados: Houve 53 respostas de centros públicos (11 excluídas). A maioria das UAI concentrou-se na região sudeste (n=22/52,4%) e apenas 1 (2,4%) na região norte do Brasil. Trinta e nove centros (92,9%) realizam procedimentos endoscópicos, mas apenas 9 (21,4%) têm acesso à enteroscopia e/ou cápsula endoscópica. Trinta e três centros (78,6%) oferecem terapia de infusão localmente, 26 (61,9%) mantêm registros de pacientes com DII, 13 (31,0%) relataram ter uma enfermeira para DII, 34 (81,0%) têm protocolos específicos baseados em evidências e apenas 7 (16,7%) %) possuem uma metodologia de satisfação do paciente. No cenário privado houve 56 respostas (10 excluídas). Há também concentração nas regiões sudeste e sul. Trinta e nove centros (84,8%) têm acesso a procedimentos endoscópicos e 19 realizam enteroscopia e/ou cápsula endoscópica, mais do que o observado no ambiente público. A terapia infusional está disponível em 24 centros (52,2%). Trinta e nove centros (84,8%) mantêm um banco de dados específico de pacientes com DII, 17 (37%) têm uma enfermeira para DII, 36 (78,3%) têm protocolos específicos baseados em evidências e 22 (47,8%) aplicam uma metodologia de satisfação do paciente. Conclusão: As UAI do DII no Brasil estavam localizadas principalmente nas regiões sudeste e sul do país. A maioria dos centros possui equipes multidisciplinares dedicadas e médicos com experiencia em DII. Ainda há uma necessidade atual de melhorar a proporção de enfermeiros no tratamento de DII no Brasil.

Quality of emergency oncological surgery: time for advanced oncological life support

SUMMARY In the emergency care of cancer patients, in addition to cancer-related factors, two aspects influence the outcome: (1) where the patient is treated and (2) who will perform the surgery. In Brazil, a significant proportion of patients with surgical oncological emergencies will be operated on in general hospitals by surgeons without training in oncological surgery. OBJECTIVE: The objective was to discuss quality indicators and propose the creation of an urgent oncological surgery advanced life support course. METHODS: Review of articles on the topic. RESULTS: Generally, nonelective resections are associated with higher rates of morbidity and mortality, as well as lower rates of cancer-specific survival. In comparison to elective procedures, the reduced number of harvested lymph nodes and the higher rate of positive margins suggest a compromised degree of radicality in the emergency scenario. CONCLUSION: Among modifiable factors is the training of the emergency surgeon. Enhancing the practice of oncological surgery in emergency settings constitutes a formidable undertaking that entails collaboration across various medical specialties and warrants endorsement and support from medical societies and educational institutions. It is time to establish a national registry encompassing oncological emergencies, develop quality indicators tailored to the national context, and foster the establishment of specialized training programs aimed at enhancing the proficiency of physicians serving in emergency services catering to cancer patients.

The nursing practice environment in a university hospital during the covid-19 pandemic / Ambiente de la práctica profesional de la enfermería en un hospital universitario frente al covid-19 / Ambiente da prática profissional da enfermagem em hospital universitário frente à covid-19

ABSTRACT Objective: to assess the environment of nursing professional practice during the COVID-19 pandemic. Method: cross-sectional study addressing a sample comprising nursing workers from a university hospital. The Brazilian version of the Practice Environment Scale was used, with 24 items distributed into five subscales. The analyses were performed in Statistical Package for the Social Sciences, version 25; the statistical significance was set at 5% (p≤0.05), and the internal consistency was assessed with Cronbach's alpha. Results: 243 workers participated in the study: 62.1% of nursing technicians and aides and 37.9% of nurses. The mean score on the Practice Environment Scale was 2.58 (standard deviation=0.69). Three of the five subscales were poorly assessed: "Nursing foundations for quality of care" (mean 2.58 and SD ± 0.73), "Nursing manager, ability, leadership, and support of nurses" (mean 2.74 and SD ± 0.82), and "Collegial nurse-physician relations" (mean 2.78 and SD ± 0.76). The perception of the professionals who received training to care for Covid-19 patients was more favorable than those who did not receive any training. Conclusion: The nursing work environment during the pandemic was considered mixed; therefore, improvements are required to make nursing working conditions as adequate as possible.

RESUMEN Objetivo: evaluar el ambiente de la práctica profesional de la enfermería durante la pandemia del COVID-19. Método: estudio transversal, realizado en una muestra constituida por el equipo de enfermería que actuaba en un hospital universitario. Se utilizó la escalaPractice Environment Scale(versión brasileña) con 24 ítems distribuidos en cinco subescalas. Los análisis fueron realizados en elStatistical Package for the Social Sciences, versión 25, y se aplicó una significancia estadística de 5% (p≤0,05). La consistencia interna del instrumento fue evaluada con el Alfa de Cronbach. Resultados: participaron de la investigación 243 profesionales, siendo 62,1% técnicos y auxiliares de enfermería y 37,9% enfermeros. La media del puntaje para laPractice Environment Scalefue de 2,58 (Desviación Estándar = 0,69). Los participantes consideraron tres de las cinco subescalas favorables: "Fundamentos de enfermería orientados para la calidad del cuidado" (media 2,58 e DE ± 0,73); "Habilidad, liderazgo y soporte de los coordinadores/supervisores de enfermería a los enfermeros/equipo de enfermería" (media 2,74 y DE ± 0,82) y "Relaciones de compañerismo entre enfermeros y médicos" (media 2,78 y DE ± 0,76). Los profesionales capacitados para el cuidado de los pacientes con Covid-19 tuvieron una percepción más favorable en relación a aquellos que no lo fueron. Conclusión: el ambiente de trabajo de la enfermería fue considerado mixto, en la pandemia, por tanto, necesita de mejorías para que las condiciones de trabajo de la enfermería sean las más adecuadas posibles.

RESUMO Objetivo: avaliar o ambiente da prática profissional da enfermagem durante a pandemia da Covid-19. Método: estudo transversal, conduzido em uma amostra constituída pela equipe de enfermagem que atuava em um hospital universitário. Utilizou-se a escala Practice Environment Scale (versão brasileira) com 24 itens distribuídos em cinco subescalas. As análises foram realizadas no Statistical Package for the Social Sciences, versão 25, e aplicou-se significância estatística de 5% (p≤0,05). A consistência interna do instrumento foi avaliada pelo alfa de Cronbach. Resultados: participaram da pesquisa 243 profissionais, sendo 62,1% técnicos e auxiliares de enfermagem e 37,9% enfermeiros. A média do escore para a Practice Environment Scale foi de 2,58 (desvio-padrão = 0,69) e os participantes consideraram três das cinco subescalas favoráveis: "Fundamentos de enfermagem voltados para a qualidade do cuidado" (média 2,58 e dp ± 0,73); "Habilidade, liderança e suporte dos coordenadores/supervisores de enfermagem aos enfermeiros/equipe de enfermagem" (média 2,74 e dp ± 0,82) e "Relações colegiais entre enfermeiros e médicos" (média 2,78 e dp ± 0,76). Os profissionais capacitados para o cuidado dos pacientes com COVID-19 tiveram percepção mais favorável em relação àqueles que não o foram. Conclusão: o ambiente de trabalho da enfermagem foi considerado misto, na pandemia, portanto, necessita de melhorias para que as condições de trabalho da enfermagem sejam as mais adequadas possíveis.

Vulnerabilidad de la infraestructura sanitaria en relación a la Covid-19 en el distrito de Castilla-Piura 2021- 2022

Objetivo: Analizar la relación entre la infraestructura sanitaria: equipos y suministros, ambientes construidos, humanización de la atención y la COVID-19 dentro del Desarrollo Urbano Sostenible en el distrito de Castilla - Piura en el año 2022. Métodos: Adopta el paradigma hermenéutico, con un diseño de tipo transversal, de tipo cualitativo, en base a encuestas aplicadas a una muestra estadística del sector de Castilla; a su vez, se realizaron entrevistas no estructuradas, dirigidas a expertos profesionales de la salud. Resultados: Se observa que el 100% de los hospitales de II y III nivel y centros de salud en Piura, se encuentran en condiciones inadecuadas para lograr la eficiencia y la efectividad en la atención, tanto en infraestructura sanitaria, equipos y suministros, como en los ambientes construidos y humanizados. Conclusión: El estado deficiente de los establecimientos de salud, ha determinado el incremento de casos de COVID-19, durante la pandemia, porque no cuentan con ambientes adecuados para atender diferentes patologías así como por la inadecuada zonificación de las áreas de aislamiento respiratorio y de vectores, las que deben responder a la realidad de esta región; esta situación plantea la necesidad de formular un plan de contingencia regional, la misma que garantice atención prioritaria y de calidad frente a situaciones de emergencia, así como la vivida durante la pandemia.

Objective: The relationship between the sanitary infrastructure, considering three aspects such as: equipment and supplies; built environments; humanization of care against COVID-19 in the district of Castilla - Piura in the year 2022. Methods: It adopts the Hermeneutic paradigm, with a cross-sectional, qualitative design, based on surveys applied to a statistical sample from the Castilla sector, unstructured interviews were conducted, aimed at health professional experts. Results: It is observed that 100% of the II and III level hospitals and health centers in Piura are in inadequate conditions to achieve efficiency and effectiveness in care, both in infrastructure-equipment, in built environment and humanized. Conclusion: The deficient state of health establishments has determined the increase in cases of COVID 19, during the pandemic, because they do not have adequate environments to treat different pathologies, as well as due to inadequate zoning of respiratory and vector isolation areas, those that must respond to the reality of this Region; This situation raises the need to formulate a regional contingency plan, the same one that guarantees priority and quality care in emergency situations, as well as life during the pandemic.

Methods for the analysis of uranium aerosol concentration in the workplace of uranium processing and fuel fabrication facilities / 中国辐射卫生

Objective To establish a method for uranium aerosol sample collection, dry ashing treatment, and laboratory laser-fluorescence measurement in the workplace of uranium processing and fuel fabrication facilities. Methods Through optimization experiments, the effects of sampling flow, sample pH value, and test temperature on uranium aerosol concentration results were studied, and the detection limit, precision, and recovery rate of the method were tested. Results Under the optimal test conditions, the detection limit of the method was 0.025 ng/mL; the minimum detectable concentration of 1 m3 of aerosol samples was 1.25 × 10−3 μg/m3; the relative standard deviation (RSD) of the measurement results was less than 5%; the recovery rate was between 96% and 104%. Conclusion The detection limit, precision, and accuracy of the method meet the testing requirements for uranium aerosol samples in the workplace of uranium processing and fuel fabrication facilities.

Investigation on present state of radiation protection of a 60Co irradiation facility / 中华放射医学与防护杂志

Objective:To explore the present state of radiation protection in an operational large-sized irradiation facility and the distribution of incurred radiation doses in the controlled area under abnormal conditions, and to analyze the acompanied radiation risk.Methods:With an irradiation facility in operation as the research object, the radiation doses were measured using AT1121 X and gamma dose rate meters for the soruce both in working and storage. Thermoluminescent dosimeters (TLDs) were used to measure the dose distribution in an irradiation field under abnormal conditions. The radiation safety features were checked against the several relevant national standards, with the radiation risks evaluated.Results:The radiation dose rates were in the range of 0.09-0.11 μSv/h, lower than the environmental background level whether in storage or working. Under abnormal working conditions, the radiation dose values from high to low were 1.0-101.3 Sv, 32.7-514.0 mSv and 8.7-183.2 μSv in the irradiation field, respectively. At the outside maze, the doses were close to the background level.Conclusions:The protection features of the irradiation facility meet the requirements of the relevant national standards. Under abnormal conditions, radiation could cause serious damages to the persons staying in the irradiation field. These persons were suggested to access to maze as soon as possible to reduce the exposure time, and activate the emergency protection equipments to deescalate the 60Co source onto the well.

Interpretation of and lessons from the guidelines on infection prevention and control of old-age institutions in the context of COVID-19 pandemic / 上海预防医学

This paper interprets the content and recommendations of the guidelines on infection prevention and control in long-term care facilities put forward by the World Health Organization （WHO） during the 2019 coronavirus disease （COVID-19） pandemic， and actively explores the key points of nursing and infection prevention and control measures for the long-term care facilities under the background of repeated outbreaks， with the aim of providing care measures and infection prevention and control measures that suit our national conditions to improve the living standards of the elderly and protect them from viral infection amid the recurring pandemic.

Investigation of COVID-19 vaccination among elderly adults in long-term care facilities and analysis of influencing factors / 西安交通大学学报(医学版)

【Objective】 To understand the status of COVID-19 vaccination among elderly adults in long-term care facilities and analyze the influencing factors so as to provide scientific basis for improving the policy of COVID-19 vaccination. 【Methods】 The socio-demographic characteristics, disease-related data, disability, and COVID-19 vaccination status of 575 elderly adults who resided in long-term care facilities in Shaanxi Province were collected via Sojumpin in January 2022. Factors that affected non-vaccinated elderly adults were analyzed by using the SPSS 25.0 software. 【Results】 Of the included 575 participants, 199 (34.6%) were not vaccinated against COVID-19. Univariate analysis showed that COVID-19 vaccination was associated with age, room type, length of stay, marital status, number of children, chronic diseases (i.e., diabetes, stroke, dementia), disability degree, and long-term medication use. Logistic regression analysis demonstrated that age of 90 years or above (OR=4.25), triple room (OR=6.17), moderate disability (OR=2.94), severe disability (OR=6.67), long-term medication use (OR=1.81), and stroke (OR=1.74) were independent risk factors for not injecting COVID-19 vaccine. 【Conclusion】 The COVID-19 vaccination coverage rate of elderly adults in long-term care facilities needs to be improved, and more attention should be paid to the high-risk groups (e.g., who are older, and have disability, long-term medication use, or stroke).

Cuidados de enfermagem em instituição de longa permanência para pessoas idosas no contexto da covid-19: revisão de escopo / Nursing care in a long-term care facility for older people in the context of COVID-19: scoping review

Resumo Objetivo Identificar as evidências científicas sobre os cuidados de enfermagem à pessoa idosa em instituição de longa permanência no contexto da pandemia covid-19. Método Trata-se de revisão de escopo baseada nas orientações do Manual para Revisões do Joanna Briggs Institute (JBI). A formulação da questão ocorreu a partir do acrônimo PCC, em que o "P" correspondeu a "pessoa idosa", o "C" a "cuidados de enfermagem" e o "C" a "covid-19". A busca das evidências cientificas foi realizada nas bases de dados LILACS, MEDLINE®, CINAHL® e Web of ScienceTM. Foram analisados artigos recuperados ao se empregar os descritores controlados e não controlados, e aqueles provenientes da literatura cinzenta, sites e repositórios. A análise deu-se por estatística descritiva e crítica dos estudos. Resultados A amostra final do estudo foi composta por 14 evidências cientificas. Verificou-se que a maioria das produções pertenciam a modalidade relatório técnico (35,7%) publicadas no Brasil (64,28%). Os cuidados de enfermagem foram organizados em: intervenções gerenciais; intervenções educacionais; intervenções assistenciais em especial aquelas voltadas à prevenção e controle da disseminação do SARS-CoV-2, residentes com quadro suspeito ou confirmado de covid-19 e ao corpo em caso de óbito; intervenções voltadas a facilitar a comunicação entre os residentes e seus familiares/amigos e entre esses e o enfermeiro; além de intervenções de apoio emocional aos profissionais/cuidadores e aos residentes. Conclusão Diante da pandemia covid-19, os cuidados de enfermagem são imprescindíveis para prevenir e controlar a disseminação do SARS-CoV-2.

Abstract Objective To Identify the scientific evidence on nursing care for older people in a long-term care facility in the context of the COVID-19 pandemic. Method This scoping review was based on the Joanna Briggs Institute Reviewers' Manual guidelines. The question was formulated from the acronym PCC, in which "P" corresponded to "older people, "C" to "nursing care" and "C" to "COVID-19". The search for scientific evidence was carried out on the LILACS, MEDLINE®, CINAHL® and Web of ScienceTM databases. Articles retrieved using controlled and uncontrolled descriptors, and those from gray literature, websites and repositories were analysed. Descriptive and critical analysis of statistics from the studies was performed. Results The final study sample consisted of 14 scientific publications. Most of the output constituted technical reports (35.7%) published in Brazil (64.28%). Nursing care was categorized under: managerial interventions; educational interventions; care interventions, especially those forts preventing and controlling the spread of SARS-CoV-2, residents with suspected or confirmed COVID-19, and handling the corpse in the event of death; interventions facilitating communication between residents and their family/friends and between this group and the nurse; in addition to emotional support interventions for professionals/caregivers and residents. Conclusion Amid the COVID-19 pandemic, nursing care is essential to prevent and control the spread of SARS-CoV-2.

Ambiente de prática profissional e Burnout em instituições hospitalares no contexto da pandemia da COVID-19 / Professional practice environment and Burnout in hospital institutions in the context of the COVID-19 pandemic

O ambiente de trabalho interfere na qualidade e na segurança do cuidado fornecido, bem como situações e transformações no mundo do trabalho são precursoras do burnout, afetando a qualidade do serviço e o bem-estar geral dos profissionais de saúde, especialmente durante a pandemia da COVID-19. Esse estudo buscou analisar o ambiente da prática profissional, e os níveis de Burnout percebido pelos enfermeiros e explorar a associação entre o ambiente de prática profissional e a Síndrome de Burnout (SB) de instituições hospitalares no contexto pandêmico. Trata-se de um estudo observacional, analítico, transversal, realizado nas unidades de internação clínicas e cirúrgicas de uma instituição hospitalar de grande porte, a população constituída por 187 enfermeiros assistenciais, na maioria mulheres (80,6%). Utilizou-se questionários autoaplicáveis e as variáveis de interesse foram mensuradas pelos instrumentos, Practice Environment Scale (PES) - Versão brasileira, e pelo Inventário de Burnout de Copenhagen (Copenhagen Burnout Inventory - Brazilian version- CBI-Br), características demográficas foram coletadas. Verificou-se que a instituição hospitalar estudada é um local de trabalho misto, pontuando o PES em 2,5 em duas subescalas. O valor médio do total das escalas CBI-Br foi ligeiramente inferior ao ponto médio (50), indicando que os enfermeiros não experienciam o Burnout, sendo limítrofe (47,9). Houve associação significativa na análise bivariada entre as subescalas da PES, e as variáveis sexo com o teste de associação pelo x2, sendo a participação dos enfermeiros na discussão dos assuntos hospitalares (p=0,017), fundamentos de enfermagem voltados para a qualidade do cuidado (p=0,008), adequação da equipe e de recursos (p=0,035), habilidade, liderança e suporte dos coordenadores (p=0,022). Para o instrumento o CBI e o sexo utilizando o mesmo teste de associação indicou diferença significativa, em todas as subescalas Burnout Pessoal (BP) (p<0,001), Burnout relacionado ao Trabalho (BT) (p=0,001), Burnout relacionado ao Colega (BC) (p=0,031). O teste Mann-Whitney indicou associação significativa entre o tempo de experiencia na instituição para as subescalas BC (p=0,031). Houve ainda associação significativa entre todas as subescalas do PES e do CBI por meio do teste de associação pelo x2. Ambientes considerados não favoráveis para a prática profissional, independente da subescala da PES, apresentaram quantitativo maior de profissionais que experienciavam o BT e o BP, menor BC nos ambientes considerados favoráveis. Para estatística inferencial, foi utilizado o teste de correlação de Spearman, que indicou correlação significativa e negativa entre as cinco subescalas do PES, e os três domínios do CBI-Br (p < 0,001 em todos os casos), logo quanto maior participação dos enfermeiros nos assuntos hospitalares, maior o uso de fundamentos de enfermagem para a qualidade do atendimento, melhor a capacidade dos gerentes de enfermagem, liderar e apoiar os enfermeiros e equipe, quanto mais adequado forem os recursos e melhores as relações entre enfermeiros e médicos, ocorre redução dos níveis de Burnout em relação ao trabalho, colegas e pessoal. Constatou-se assim que o ambiente de trabalho do enfermeiro está associado a presença do Burnout e que medidas que aprimorem o ambiente de trabalho das instituições podem suportar e garantir o bem-estar da enfermagem nas instituições de saúde.

The work environment has an impact on the quality and safety of provided care. Additionally, changes and developments in the world of work act as precursors of burnout, affecting the quality of service and the overall well-being of healthcare professionals, particularly during the COVID-19 pandemic. This study aimed to assess the professional practice environment and levels of perceived Burnout among nurses, as well as explore the relationship between the professional practice environment and Burnout Syndrome (BS) within hospital institutions during the pandemic. This was an observational, analytical, cross-sectional study conducted in the clinical and surgical inpatient units of a large hospital institution. The population consisted of 187 clinical nurses, the majority being women (80.6%). Self-administered questionnaires were used, measuring the variables of interest through the Practice Environment Scale (PES) - Brazilian version, and the Copenhagen Burnout Inventory (Copenhagen Burnout Inventory - Brazilian version- CBI-Br). Demographic characteristics were also collected. It was found that the studied hospital institution is a mixed workplace, scoring 2.5 on the PES in two subscales. The mean value of the total CBI-Br scales was slightly below the midpoint (50), suggesting that nurses did not experience Burnout significantly, but were borderline (47.9). In the bivariate analysis, there was a significant association between the PES subscales and gender variables using the x2 association test. Participation of nurses in hospital discussions (p=0.017), focus on nursing fundamentals for quality care (p=0.008), adequacy of the team and resources (p=0.035), and leadership and support from coordinators (p=0.022) were all positively associated with the PES subscales. Regarding the CBI instrument, there was a significant difference in all subscales: Personal Burnout (BP) (p<0.001), Work-related Burnout (BT) (p=0.001), and Colleague-related Burnout (BC) (p=0.031), when analyzed in relation to gender using the association test. The Mann-Whitney test indicated a significant association between the length of experience at the institution and the BC subscales (p=0.031). Additionally, there was a significant association between all PES and CBI subscales using the x2 association test. Unfavorable work environments, regardless of the PES subscale, were linked to higher levels of Personal and Work-related Burnout, and less Colleague-related Burnout in favorable environments. The Spearman correlation test revealed a significant and negative correlation between all five PES subscales and the three domains of the CBI-Br (p < 0.001 in all cases). Thus, a greater nurse participation in hospital matters, focus on nursing fundamentals for quality care, effective leadership and support from nursing managers, adequate resources, and improved relationships between nurses and physicians were all associated with reduced Burnout levels related to work, colleagues, and staff. In conclusion, this study suggests that the work environment of nurses is linked to the presence of Burnout. Measures aimed at improving the work environment in institutions can support and ensure the well-being of nursing professionals in healthcare settings.

Functionality and 25-hydroxyvitamin D levels in institutionalized older adults / Funcionalidade e níveis de 25-hidroxivitamina D em idosos institucionalizados

OBJECTIVES: To evaluate the frequency of hypovitaminosis D among older adults and its association with the level of functionality. METHODS: This cross-sectional observational study of older adults residing in a non-profit long-term care facility assessed functionality with the Katz Index of Independence in Activities of Daily Living. Vitamin D levels were classified as: deficient (< 20 ng/mL), insufficient (21-29 ng/mL), or normal (≥ 30 ng/mL). We used the chi-square test and Student's t-test to compare dichotomous and continuous variables, respectively. Analysis of variance with Tukey's post hoc test was used to assess differences between groups. RESULTS: The sample consisted of 63 individuals whose mean age was 81 (61-113) years: 36 (55.4%) women and 27 (44.6%) men. The mean vitamin D level was 18.6 ng/mL, being < 30 ng/mL in 84.1%. The level was normal in 10 (15.9%), insufficient in 17 (27%), and deficient in 36 (57.1%). Vitamin D deficiency was present in 76.5% of those with total functional dependence (Katz = 5-6). CONCLUSIONS: We observed a high frequency of hypovitaminosis D, especially vitamin D deficiency, which was very common among those with significant functional dependence.

OBJETIVOS: Avaliar a frequência de hipovitaminose D em idosos de uma instituição filantrópica de longa permanência e sua associação com grau de funcionalidade. METODOLOGIA: Estudo transversal, observacional e analítico de idosos de uma instituição filantrópica de longa permanência. A funcionalidade foi avaliada pela Escala de Katz. Os níveis de vitamina D foram classificados em: deficiência (valores menores que 20 ng/mL); insuficiência (valores entre 21 - 29 ng/mL) e normais (valores igual ou superior a 30 ng/mL). Empregamos teste qui-quadrado e t de student, para compararmos variáveis dicotômicas e contínuas, respectivamente; e análise de variância (ANOVA) com teste post hoc de Tukey, para avaliarmos as diferenças entre os grupos. RESULTADOS: Sessenta e três indivíduos foram analisados com média de idade de 81 anos (61 - 113), sendo 36 (55,4%) mulheres e 27 (44,6%) homens. A média de vitamina D foi 18,6 ng/mL, 84,1% com níveis menores que 30 ng/mL; dez apresentaram níveis normais (15,9%), 17 com insuficiência (27%) e 36 com deficiência (57,1%); ainda, 76,5% dos portadores de dependência funcional total (Katz = 5 - 6) apresentam deficiência de vitamina D. CONCLUSÕES: Observamos uma alta frequência de hipovitaminose D, especialmente deficiência, muito frequentes naqueles com dependência funcional importante

An assessment on the implementation of same day antiretroviral therapy initiation in eThekwini clinics, KwaZulu­Natal, South Africa

The World Health Organization (WHO) recom mends same day initiation (SDI) of antiretroviral therapy (ART) for all individuals diagnosed with HIV irrespective of CD4+ count or clinical stage. Implementation of program is still far from reaching its goals. This study assessed the level of implementation of same day ART initiation. A longitudinal study was conducted at four primary healthcare clinics in eThekwini municipality KwaZulu Natal. Data was collected between June 2020 to October 2020 using a data extraction form. Data on individuals tested HIV positive, number of SDI of ART; and clinicians working on UTT program were compiled from clinic registers, and Three Interlinked Electronic Registers.Net (TIER.Net). Non governmental organisations (NGO) supporting the facility and services information was collected. Among the 403 individuals who tested HIV positive, 279 (69.2%) were initiated on ART on the same day of HIV diagnosis from the four facilities. There was a significant association between health facility and number of HIV positive individuals initiated on SDI (chi square=10.59; P value=0.008). There was a significant association between facilities with support from all NGOs and ART SDI (chi square=10.18; P value=0.015. There was a significant association between staff provision in a facility and SDI (chi square=7.51; P value=0.006). Urban areas clinics were more likely to have high uptake of SDI compared to rural clinics (chi square=11,29; P value=0.003). Implementation of the Universal Test and Treat program varies by facility indi cating the need for the government to monitor and standardize implementation of the policy if the program is to yield success.

Vacinação contra covid-19 em pessoas idosas: informações veiculadas pela mídia jornalística / Vaccination against covid-19 in older people: information provided by the news media

Resumo Objetivo Avaliar o conteúdo midiático produzido acerca da vacinação contra a covid-19 direcionada à pessoa idosa no Brasil. Método Trata-se de uma pesquisa documental a partir da análise de 19 matérias veiculadas pelos jornais Estadão, Folha de S. Paulo, O Globo e GAÚCHAZH, publicadas entre dezembro de 2020 e setembro de 2021. Os dados foram submetidos ao Resultados O corpus originou cinco classes temáticas. Nestas, verifica-se a difusão das informações sobre a vacinação contra a covid-19 para idosos como uma medida necessária à saúde dessa população, o que justifica a intensa veiculação de notícias acerca da campanha vacinal. As matérias evidenciaram a organização das políticas de imunização, bem como os benefícios da mesma para o referido público, sobretudo àqueles que se encontravam institucionalizados. Além disso, a vacina emergiu como protagonista na luta para conter a disseminação do coronavírus, aumentando a proteção dos residentes das instituições de longa permanência para idosos e, inegavelmente, diminuindo a mortalidade dos mais velhos. Conclusão Os achados salientam a indispensabilidade de fomentar políticas para promoção da saúde pelos meios de comunicação mais diversos, permitindo o acesso a informações em saúde por todos os públicos e reforçando a urgência de práticas coletivas de cuidado ofertadas às pessoas idosas, incluindo àquelas residentes em instituições.

Abstract Objective To evaluate the media content produced about vaccination against covid-19 aimed at the older population in Brazil. Method A desk research study based on the analysis of 19 articles published by the newspapers Estadão, Folha de S. Paulo, O Globo and GAÚCHAZH between December 2020 and September 2021. The data were processed by the Iramuteq software, analyzed using Descending Hierarchical Classification (DHC) and interpreted by Content Analysis. Results The corpus yielded five thematic classes. These classes revealed the dissemination of information about vaccination against covid-19 for older people as a necessary measure for the health of this population, justifying the intense reporting of news on the vaccination campaign. The articles highlighted the organization of immunization policies, as well as their benefits for the older population, especially institutionalized individuals. In addition, the vaccine emerged as a key element in the fight to contain the spread of the coronavirus, increasing the protection of older residents of long-term care facilities and, undeniably, reducing the mortality of this population. Conclusion The findings highlight the importance of disseminating health promotion policies across a wide variety of communication channels, allowing access to health information by all audiences and reinforcing the urgency of collective care practices offered to older people, including those residing in institutions.

Fatores associados ao empoderamento psicológico da enfermagem em serviços de hemodiálise / Factores asociados al empoderamiento psicológico de enfermería en servicios de hemodiálisis / Factors associated with the psychological empowerment of nursing in hemodialysis services

Resumo Objetivo Explorar as associações entre o empoderamento psicológico de profissionais de enfermagem e o ambiente da prática, o clima de segurança e as variáveis sociodemográficas e laborais. Métodos Estudo quantitativo e correlacional. A população foi constituída por 64 profissionais de enfermagem atuantes em quatro serviços de hemodiálise localizados no Estado de São Paulo, Brasil. Para a coleta de dados, foram aplicados: questionário de caracterização sociodemográfica e laboral, as versões brasileiras do Psychological Empowerment Instrument, do Practice Environment Scale e o domínio Clima de segurança do Safety Attitudes Questionnaire. Os dados foram analisados por meio de estatística descritiva, testes de associação e regressão linear. Resultados A média geral do empoderamento psicológico foi 68,7 (DP=10,8), do ambiente da prática 2,9 pontos (DP=0,8) e do clima de segurança 71,1 (DP=19,5). Foram encontradas evidências de associações positivas e de forte intensidade do empoderamento psicológico e o ambiente da prática (r=0,57; p<0,001) e o clima de segurança (r=0,62; p<0,001). Cada ponto no domínio do clima de segurança e no ambiente da prática elevou, respectivamente, 0,24 (p<0,001) e 4,17 (p=0,021), em média, os valores do empoderamento psicológico. Simultaneamente, os valores do ambiente da prática e do clima de segurança influenciaram o empoderamento psicológico em 44%. Os sensos de autodeterminação (p=0,007) e de impacto (p=0,019) foram mais elevados entre os enfermeiros. Conclusão O empoderamento psicológico dos profissionais de enfermagem é influenciado pelas características do ambiente da prática, pelo clima de segurança e pela categoria profissional.

Resumen Objetivo Estudiar las relaciones entre el empoderamiento psicológico de profesionales de enfermería y el ambiente de la práctica, el clima de seguridad y las variables sociodemográficas y laborales. Métodos Estudio cuantitativo y correlacional. La población fue formada por 64 profesionales de enfermería que trabajan en cuatro servicios de hemodiálisis ubicados en el estado de São Paulo, Brasil. Para la recopilación de datos se aplicaron los siguientes instrumentos: cuestionario de caracterización sociodemográfica y laboral, las versiones brasileñas de Psychological Empowerment Instrument, Practice Environment Scale y el dominio Clima de seguridad del Safety Attitudes Questionnaire. Los datos fueron analizados mediante estadística descriptiva, pruebas de asociación y regresión lineal. Resultados El promedio general del empoderamiento psicológico fue 68,7 (DP=10,8), del ambiente de la práctica 2,9 puntos (DP=0,8) y del clima de seguridad 71,1 (DP=19,5). Se encontraron evidencias de asociaciones positivas y de fuerte intensidad entre empoderamiento psicológico y el ambiente de la práctica (r=0,57; p<0,001) y el clima de seguridad (r=0,62; p<0,001). Cada punto del dominio del clima de seguridad y del ambiente de la práctica elevó en promedio 0,24 (p<0,001) y 4,17 (p=0,021), respectivamente, los valores del empoderamiento psicológico. Al mismo tiempo, los valores del ambiente de la práctica y del clima de seguridad influyeron en el empoderamiento psicológico un 44 %. El sentido de autodeterminación (p=0,007) y de impacto (p=0,019) fueron más elevados entre los enfermeros. Conclusión El empoderamiento psicológico de los profesionales de enfermería está influenciado por las características del ambiente de la práctica, por el clima de seguridad y por la categoría profesional.

Abstract Objective To explore the associations between psychological empowerment of nursing professionals and the practice environment, safety climate and sociodemographic and labor variables. Methods This is a quantitative and correlational study. The population consisted of 64 nursing professionals working in four hemodialysis services located in the state of São Paulo, Brazil. For data collection, the following were applied: sociodemographic and labor characterization questionnaire, the Brazilian versions of the Psychological Empowerment Instrument, the Practice Environment Scale and the Safety climate domain of the Safety Attitudes Questionnaire. Data were analyzed using descriptive statistics, association tests and linear regression. Results The overall mean of psychological empowerment was 68.7 (SD=10.8), of the practice environment, 2.9 points (SD=0.8), and of safety climate, 71.1 (SD=19.5). Evidence of positive and strong associations between psychological empowerment and the practice environment (r=0.57; p<0.001) and safety climate (r=0.62; p<0.001) were found. Each point in the domain of safety climate and in the practice environment increased, respectively, 0.24 (p<0.001) and 4.17 (p=0.021) in mean the values of psychological empowerment. At the same time, the practice environment and safety climate values influenced psychological empowerment by 44%. Self-determination (p=0.007) and impact (p=0.019) were higher among nurses. Conclusion The psychological empowerment of nursing professionals is influenced by the practice environment characteristics, safety climate and professional category.

Establishing Normative Values for Amplitude of Accommodation and Accommodative Facility among University Students in Malawi

The study aimed to examine the distribution of Accommodative Facility (AF) and Amplitude of Accommodation (AA) and compare the findings with established guidelines.Place and Duration of Study: Mzuzu University, Malawi. Between May and July 2022.Methods: This cross-sectional study was conducted among students at Mzuzu university in Malawi. We recruited 77 students using a stratified random sampling technique. The participants' age ranged from 16 to 35 years of age. We measured AA using the push-up method while AF was measured using +/- 1.50 Diopters (D) flippers. Both techniques utilized black reading material on white background held at 40 centimeters (cm). Next, we measured the accommodation facility by counting the number of Cycles per Minute (c/m). We utilized the Pearson correlation test and the One-way ANOVA where appropriate. The value of p< 0.05 was considered statistically significant. Results: The participants comprised 44 (57.1%) males and 33 (42.9%) females. Monocular AA was 10.04D (SD=2.71) and Binocular AA was 10.51 (3.641). The difference was statistically significant (p=0.04). While Monocular AF and Binocular AF were 9 c/m (SD= SD=1.84) and 8.96 (SD=1.539) respectively but the difference was non-significant (p=0.868). AF and AA were not significantly different between males and females. All the parameters decreased with age. The measured AA was significantly higher than using Hofstetter’s formula.Conclusion: The study provides a cut-off value for practitioners diagnosing Accommodation anomalies. However, indices in the study differ from the well-established guidelines hence practitioners should endeavor to perform the clinical assessment instead of relying on equations.

La intersectorialidad como tecnología gerencial en las donaciones voluntarias de sangre en Cuba

En Cuba existe amplia experiencia en el trabajo intersectorial para la solución de problemas de salud en la comunidad y la gestión de las donaciones de sangre no constituye una excepción. Este trabajo tuvo como objetivo documentar sobre el trabajo intersectorial en la gestión de las donaciones de sangre en Cuba y aportar elementos teóricos que contribuyan a su perfeccionamiento. Se realizó una revisión bibliográfica de la literatura sobre la intersectorialidad y los procesos para la gestión de donaciones de sangre en el país; para ello se consultaron trabajos publicados en sitios de Internet, así como textos y otros documentos disponibles en repositorios del portal web de la red Infomed. Se teoriza e ilustra acerca de la intersectorialidad como tecnología gerencial y sobre su uso e importancia aplicados en la promoción, captación y reclutamiento de donantes potenciales así como en la organización de las colectas de sangre. Se concluye que el empleo de la intersectorialidad en la gestión sanitaria de las donaciones voluntarias de sangre fortalece y singulariza el Programa de Donaciones de Sangre cubano con relación al resto del mundo; no obstante, es necesario perfeccionar las alianzas estratégicas entre el sector de la salud y los demás sectores de la sociedad civil organizada que intervienen en las actividades que comprenden este proceso.

In Cuba there is wide experience in intersectoral work to solve health problems in the community and the management of blood donations is no exception. The objective of this work was to document the intersectoral work in the management of blood donations in Cuba and to provide theoretical elements that contribute to its improvement. A bibliographic review of the literature on intersectoriality and the processes for the management of blood donations in the country was carried out; For this, works published on Internet sites were consulted, as well as texts and other documents available in repositories of the Infomed web portal network. Intersectoriality is theorized and illustrated as a managerial technology and its use and importance applied in the promotion, capture and recruitment of potential donors and in the organization of blood collections. It is concluded that the use of intersectoriality in the health management of voluntary blood donations, strengthens and distinguishes the Cuban Blood Donation Program in relation to the rest of the world, however, it is necessary to improve the strategic alliances between the health sector and other sectors of organized civil society involved in the activities that comprise this process.

Desafios no caminho metodológico de construção do processo de Acreditação Institucional de ouvidorias do SUS / Challenges in the methodological path of building the Institutional Accreditation process for SUS ombudpersons

RESUMO O artigo buscou refletir sobre os desafios teórico-práticos enfrentados no caminho metodológico de construção do processo de Acreditação Institucional de ouvidorias do Sistema Único de Saúde (SUS), na elaboração dos materiais pedagógicos e nas dinâmicas de interações fundamentais entre os atores envolvidos. Discorre-se sobre a trajetória de uma parceria de trabalho entre uma equipe de pesquisadores e um departamento do Ministério da Saúde, que visa apoiar teórico-metodologicamente as ações do setor trabalhando os grandes temas da participação e do controle social e, em particular, das ouvidorias, gerando evidências para a tomada de decisões da gestão. São apresentados e problematizados desafios enfrentados no caminho da parceria e do processo de um ponto de vista metodológico, reflexivo e participativo, apresentando-se ideias, noções e conceitos que sofreram evolução, e que presidem os materiais pedagógicos elaborados para instrumentalização do processo de Acreditação Institucional de ouvidorias do SUS enquanto balizamento teórico-prático. Conclui-se que a adoção de um desafiador método de trabalho construtivista e participativo representa um salutar esforço pelo autoaperfeiçoamento e pela garantia da afirmação de valores e princípios democráticos, efetivos na busca constante pela qualificação das ações das ouvidorias, da própria atividade de pesquisa, da prática da gestão e dos serviços e políticas públicas.

ABSTRACT This paper aims to reflect on the theoretical and practical challenges in the methodological path of building the Institutional Accreditation process of the Unified Health System (SUS) ombudspersons, developing teaching materials, and the dynamics of fundamental interactions between the stakeholders involved. It discusses the trajectory of a working partnership between a team of researchers and a department of the Ministry of Health, which aims to theoretically and methodologically support the actions of the sector working on the principal participation and social control topics and, in particular, the ombudspersons, generating evidence for management decision-making. The authors present the challenges in partnership and the process and discuss from a methodological, reflective, and participatory viewpoint, presenting ideas and concepts that have evolved and govern the pedagogical materials prepared for the instrumentalization of the Institutional Accreditation process of SUS ombudspersons as a theoretical-practical framework. The authors conclude that adopting a challenging constructivist method is a healthy effort for self-improvement and guarantee of the affirmation of democratic values, effective in the constant search for the qualification of the actions of the ombudspersons, research activity, management practice, and services and public policies.

Item analysis of multiple-choice questions in anatomy for first year MBBS

Background: Multiple choice questions (MCQs) are preferred tools of assessment because of objectivity, ease of scoring and how each MCQ functions as an item can be understood by Item analysis. Aims and Objectives: The aim of the study was (i) to carry out item analysis of MCQs used in formative assessment to know the validity and (ii) to carry out a post validation item analysis of MCQ’s of 1st MBBS students in anatomy to use results for further actions. Materials and Methods: 45 MCQs were administered to 112 students of 1st M.B.B.S. as a formative assessment. Difficulty index and Discrimination index were calculated. Results: Mean difficulty index was 56.67 ± 22.09, and mean discrimination index was 0.35 ± 0.23. Distribution of easy, moderate, and difficult MCQ was 20, 67, and 13%, respectively. About 20% of MCQs were poor, 20% with acceptable discriminating index, 27% had good, and 33% MCQ were of excellent discrimination index. No item was negatively discriminating and all distractor were functional. Very easy and very difficult items had poor discriminating index. Conclusion: Most of items had moderate difficulty and good to excellent discrimination. Too easy and too difficult items showcased poor discrimination, no negatively discriminating item and absence of non-functional distractor suggest good quality framing of the MCQs.

El "barbering": un problema frecuente en ratones de laboratorio / Barbering: a frequent problem in laboratory mice / O comportamento de barbeiro: um problema frequente in camundongos de laboratório

Resumen El barbering es una conducta que consiste en halar o recortar el pelo y en algunos casos incluso ingerirlo. Este comportamiento ha sido reportado tanto en el ser humano como en otras especies, no obstante, su presentación en ratones de laboratorio es frecuente en algunos linajes, genera impacto sobre su bienestar y la fiabilidad de los resultados de investigación, siendo un problema destacado en los bioterios de ratones. Al realizar una revisión de literatura disponible sobre esta condición, se identifican múltiples causas, entre estas, deficiencias en el enriquecimiento ambiental, alteraciones de manejo, estrés, conductas aprendidas, ansiedad y dominancia, así como causas genéticas haciendo que algunas cepas, linajes y modelos genéticamente modificados sean más susceptibles al barbering y ayudando a facilitar la comprensión de rutas metabólicas involucradas en esta condición. La etiología múltiple del barbering permite abordar opciones de manejo orientadas hacia la intervención ambiental y algunas estrategias farmacológicas que podrían ser útiles para reducir su incidencia y los problemas de salud y desempeño reproductivo asociados.

Abstract Barbering is a behavior that consists of pulling, cutting, or even ingesting hair. This behavior has been reported in humans or other animals; nevertheless, its presentation in laboratory mice is common in some mice strains, affects these animals' welfare, and results of research studies being a problem in mice facilities. After reviewing the available literature on this condition, multiple causes are identified, including deficiencies in environmental enrichment, management alterations, stress, learned behaviors, anxiety, and dominance, as well as genetic causes, making some strains, lineages, and genetically modified models more susceptible to barbering and helping to facilitate the understanding of metabolic pathways involved in this condition. The multiple etiology of barbering makes it possible to approach management options oriented towards environmental intervention and some pharmacological strategies that could be useful to reduce its incidence and associated reproductive health and performance problems.

Resumo O comportamento de barbeiro consiste em puxar ou aparar o pelo e, em alguns casos, até mesmo ingeri-lo. Esse comportamento tem sido relatado tanto em humanos quanto em outras espécies, entretanto, sua apresentação em camundongos de laboratório é frequente em algumas linhagens, gerando impacto no seu bem-estar e na confiabilidade dos resultados das pesquisas, sendo um problema de destaque nos biotérios. Ao realizar uma revisão da literatura disponível sobre esta condição, múltiplas causas foram identificadas, incluindo deficiências no enriquecimento ambiental, alterações de manejo, estresse, comportamentos aprendidos, ansiedade e dominância, além de causas genéticas, tornando mais suscetíveis à barbearia à algumas linhagens e modelos geneticamente modificados e ajudando a facilitar o entendimento das vias metabólicas envolvidas nessa condição. A múltipla etiologia deste comportamento de barbeiro permite abordar opções de gestão orientadas para a intervenção ambiental e algumas estratégias farmacológicas que podem ser úteis para reduzir a sua incidência e os problemas de saúde e desempenho reprodutivos associados.