Síntomas depresivos, síntomas de insomnio y eventos estresantes en ancianos hipertensos: estudio de corte transversal / Depressive symptoms, symptoms of insomnia and stressful events in hypertensive older adults: Cross-sectional study

Objetivos: El objetivo de este estudio fue determinar si los síntomas de insomnio y la intensidad de los eventos de vida estresantes se asocian de forma independiente con los síntomas depresivos en ancianos hipertensos que viven en la comunidad. Métodos: Estudio de tipo observacional transversal. Los participantes fueron 438 ancianos con hipertensión arterial que completaron cuestionarios sobre síntomas depresivos, eventos estresantes, síntomas de insomnio y características sociodemográficas. Se realizó un análisis de conglomerados para obtener grupos según los síntomas de insomnio. Se identificaron los siguientes grupos: mala calidad del sueño, despertar temprano y buena calidad del sueño. Las asociaciones se probaron mediante un análisis de regresión lineal y un análisis de regresión de Poisson múltiple. Resultados: Los factores que contribuyeron de manera independiente al aumento de los síntomas depresivos fueron: pertenecer al grupo de mala calidad del sueño (p<0,001) y al grupo despertar temprano (p=0,005), reportando mayor intensidad de eventos de vida estresantes (p<0,001) y tener menos escolaridad (p=0,003). Conclusión: Las personas mayores con hipertensión arterial necesitan un abordaje integral de su atención en salud, considerando los síntomas depresivos y su relación con la intensidad de los eventos estresantes, los síntomas de insomnio y la escolaridad.(AU)

Objectives: The aim of this study was to determine whether symptoms of insomnia and intensity of stressful life events are independently associated with depressive symptoms in community-dwelling hypertensive older adults. Methods: This was an observational cross-sectional study. Participants were 438 older adults with arterial hypertension who completed questionnaires about depressive symptoms, stressful events, self-reported symptoms of insomnia and socio-demographic characteristics. Cluster analysis was performed to obtain groups according to insomnia symptoms. The following groups were identified: Poor Sleep Quality, Early Waking and Good Sleep Quality. Associations were tested using linear regression analysis and multiple Poisson regression analysis. Results: The factors that independently contributed to the increase of depressive symptoms were belonging to the Poor Sleep Quality group (P<.001) and Early Waking group (P=.005), reporting higher intensity of stressful life events (P<.001) and having less schooling (P=.003). Conclusion: older adults with hypertension need a comprehensive approach to their health care that considers depressive symptoms and their relationship with intensity of stressful events, insomnia symptoms and schooling.(AU)

Device- and Nondevice-Guided Slow Breathing to Reduce Blood Pressure in Patients with Hypertension: Protocol for a Systematic Review and Meta-analysis.

BACKGROUND: Physiotherapy can include both device-guided slow breathing (DGSB) and nondevice-guided slow breathing (NDGSB) in the treatment of systemic arterial hypertension. OBJECTIVE: The aim of this study is to summarize the effects of DGSB on blood pressure levels of patients with hypertension based on the published literature to date. METHODS: A systematic search of all published randomized controlled trials (RCTs) on the effects of device-guided and nondevice-guided slow breathing in patients with hypertension, without language restriction, was carried out up to a publication date of January 2020 in nine databases: PubMed/MEDLINE, Latin American and Caribbean Health Sciences Literature (LILACS), EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), Physiotherapy Evidence Database (PEDro), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, Web of Science, and Livivo. Clinical trial records databases (ClinicalTrials.gov), and bases for the open gray literature, including Gray Literature Report and ProQuest Central (Citation, Abstract or Indexing, and Dissertations and Theses), were also searched for potentially eligible RCTs. The quality assessment of the included studies will be performed using the Cochrane Risk of Bias Tool for Randomized Trials. The overall quality of the evidence for each outcome will be assessed using the GRADE (Grading of Recommendations, Development and Evaluation) system. RESULTS: As of December 2021, the review was completed and all data from continuous variables referring to blood pressure values (mmHg) were synthesized. CONCLUSIONS: This systematic review will provide a summary of the current evidence on the effects of both DGSB and NDGSB on blood pressure levels. This information can contribute to decision-making by health professionals related to the use of these interventions in patients with hypertension. TRIAL REGISTRATION: PROSPERO (Prospective International Register of Systematic Reviews) CRD42020147554; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=147554. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/33579.

Leadership, adequate staffing and material resources, and collegial nurse-physician relationships promote better patients, professionals and institutions outcomes.

AIM: To test a theoretical model aiming to understand which characteristics of the professional nursing practice environment most affect patients, professionals and institution outcomes. DESIGN: A cross-sectional and correlational study, using a structural equation model. METHODS: One thousand seven hundred and seventy-three staff nurses were recruited using convenience sampling in five Brazilian hospitals from November 2017 to July 2018. Structural equation modelling was used to assess the relationship between the characteristics of the nursing work environment and patients (climate of safety and quality of care), nursing professionals (job satisfaction and emotional exhaustion) and institutions (intention to leave the job) outcomes. The model was tested using the partial least squares method, considering the bootstrapping technique to estimate the results. The path coefficients and their respective 95% confidence intervals were calculated. The quality of fit of the structural model was assessed by calculating the coefficient of determination (R2 ), the predictive validity coefficient (Q2 ) and the effect size (f2 ). RESULTS: The characteristics that most affected the outcomes for patients were Nurse manager ability, leadership and support of nurses (λ=0.27), and Staffing and resource adequacy (λ=0.26); for nursing professionals, Staffing and resource adequacy (λ=-0.19), and Collegial nurse-physician relations (λ=0.19); and for institutions, Nurse manager ability, leadership and support of nurses (λ=-0.10), and Collegial nurse-physician relations (λ=-0.10). CONCLUSION: The characteristics of the professional nursing practice environment that most contribute to achieving better outcomes include nurse manager ability, leadership and support of nurses, staffing and resource adequacy, and collegial nurse-physician relations. IMPACT: This study allowed us to assess which strategies should be prioritized in the professional nursing practice environment to achieve better results. Thus, investment in the training of leadership, in the adequacy of resources, and in physician-nurse relations will bring better results for patients, nursing professionals, and institutions.

A protocol for systematic review of Plantago major L. effectiveness in accelerating wound-healing in animal models.

BACKGROUND: Studies have indicated that Plantago major L. (P. major) has therapeutic properties, such as anti-inflammatory, antioxidant, antifungal, immunostimulatory, and tissue regeneration. This plant species is assumed to provide potent tissue repair and healing in treatments of skin wound injuries, but the understanding of its effectiveness is still unclear. The systematic review proposed herein aims to assess effectiveness of P. major for wound healing in animal models. METHODS: We will conduct database searches in BVS, PubMed, Scopus, Web of Science, CINAHL, and CABDirect. Reviewers will independently evaluate titles, abstracts, and full-text articles retrieved from databases to identify potentially eligible studies. Relevant articles will be assessed for risk of bias and quality. The database searches will include analysis of wound healing rate through macroscopic evaluation, photo images, or calculation of the wound area retraction until the wound closure. Relevant data will be compiled for the capability and effectiveness of P. major treatments in accelerating wound healing. Random effects meta-analysis models will be employed to compare among groups based on outcome variables from studies reporting sufficient high-quality data. DISCUSSION: Results of this systematic review will be presented in a narrative synthesis form. They will provide a summary and clear understanding of the relevant current questions and evidences directly related to P. major effective tissue repair and healing. Outcomes of this systematic review will contribute with important information that could benefit future research efforts and potential applicability in humans. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019121962.

Napping, functional capacity and satisfaction with life in older adults: A population-based study.

AIM AND OBJECTIVE: To analyse the association between napping, functional capacity and satisfaction with life in older adult residing in the community. METHOD: A cross-sectional population-based study using data from a health survey conducted in a city of the state of São Paulo. Information on sociodemographic and clinical variables was collected through a questionnaire, as well as the occurrence or not of napping and satisfaction with life. Functional capacity was assessed using the Katz Index and Lawton-Brody Scale. Statistical analysis was performed using the Rao-Scott chi-square test and a hierarchical analysis using stepwise backward multiple Poisson regression. p-Values <0.05 were considered significant. In this paper, we adhere to STrengthening the Reporting of OBservational studies in Epidemiology guidelines. RESULTS: There was predominance of the 60-69 years age group (51.3%) and of females (60.8%). The majority of the older adults (57.5%), of both sexes, reported napping. A higher prevalence of napping was found in the older subjects, the male sex, the subjects without children, those with health problems and those that were partially dependent in instrumental activities of daily living. CONCLUSIONS: The study showed that naps are prevalent in older adults. The need to identify the issues that permeate napping is emphasised, in order to promote health in individuals of this age group, before classifying the practice as beneficial or harmful. RELEVANCE TO CLINICAL PRACTICE: It is essential that health professionals, in their practices, consider the complaints and reports of naps in the elderly, in an attempt to detect and reduce possible consequences in activities of daily living.