Brazilian Adults' Attitudes and Practices Regarding the Mandatory COVID-19 Vaccination and Their Hesitancy towards Childhood Vaccination.

BACKGROUND: This study investigated the attitudes and practices of Brazilian adults regarding the mandatory COVID-19 vaccination and their hesitancy towards the vaccination of children. METHODS: Between March and May 2022, Brazilian adults answered an online questionnaire distributed through social media. The SAGE-WG questionnaire was adapted to measure hesitancy to the vaccination of children. RESULTS: Of the 1007 participants, 67.4% believed that adult COVID-19 vaccination should be mandatory. Just over half of the participants (51.5%) believed that parents and/or guardians should decide if their children should be vaccinated against COVID-19 or not and 9.1% were unsure. Individuals who were younger, non-religious and had higher awareness of COVID-19 risks and critics of the federal government's performance in combating the pandemic were more likely to agree with mandatory adult vaccination. However, less agreement among parents and/or guardians concerning children's vaccination was observed, with lower scores for hesitancy to the vaccination of children. CONCLUSION: In Brazil, there is still far from a consensus on mandatory COVID-19 vaccination for adults and a significant proportion of the population believes that parents and/or guardians should be free to decide on their children's vaccination. These views are associated with age, religion, knowledge of COVID-19 risks and political inclination.

Evidence of validity of internal structure of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12) in Brazilian adolescents with chronic health conditions.

This study explored the evidence of validity of internal structure of the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing Scale (FACIT-Sp-12) in Brazilian adolescents with chronic health conditions. The study involved 301 Brazilian adolescents with cancer, type 1 diabetes mellitus, or cystic fibrosis. Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and Item Response Theory (IRT) were used to test the internal structure. Reliability was determined with Cronbach's Alpha and McDonald's Omega. The EFA suggested a one-dimensional scale structure in contrast to the original 2-factor model or the 3-factor model which were not reproduced in the current CFA. All quality indicators for the EFA one-factor exceeded the required criteria (FDI = 0.97, EAP = 0.97, SR = 3.96 and EPTD = 0.96, latent GH = 0.90. and the observed GH = 0.85). The FACIT-Sp-12 for adolescents yielded strong evidence for a 1-factor model and with good reliability.

Measuring Spiritual Well-Being in Brazilian Adolescents with Chronic Illness Using the FACIT-Sp-12: Age Adaptation of the Self-Report Version, Development of the Parental-Report Version, and Validation.

Spiritual well-being is a major issue in health care, but instruments for measuring this construct in adolescents are lacking. This study adapted the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-Sp-12) for use with Brazilian adolescents with chronic diseases and developed a parental observer-rated version, using an expert panel, back-translation, and cognitive interviews with 72 participants. The psychometric properties of both versions were verified with two- and three-factor models by testing with 212 participants. The self- and parental-reported versions showed face validity, content validity, and acceptable levels of internal consistency for the overall scale and the two-factor model. The convergent validity was satisfactory for most items in both two- and three-factor models, but there was a lack of discrimination in the three-factor model using multitrait-multimethod analysis. This study presents the first instrument to assess the spiritual well-being of adolescents from their point of view and to allow their parents to serve as evaluators. However, we recommend further psychometric testing of the self- and parental-report scales to assess spiritual well-being in adolescents with chronic diseases in Brazil.

[Systematic review on bullying and family: an analysis based on bioecological systems]. / Revisão sistemática sobre bullying e família: uma análise a partir dos sistemas bioecológicos.

OBJECTIVE: Analyze the relationships between family context and involvement in school bullying. METHODS: The following databases were searched: Web of Science, PsycoInfo, Pub-Med, Lilacs and SciELO virtual library, using the terms bullying, family and parents. A total of 61 papers met the eligibility criteria. The corpus was analyzed through the Bioecological Development Framework. RESULTS: The experiences of students experiencing situations of bullying are multifaceted and are related to the family context. Elements from the microsystem, such as violence in the family, parental practices, environment and type of family arrangements, were the elements more frequently explored and related to bullying, though the relationships of parents with the children's friends, the parents' education and socioeconomic conditions, along with the exo, meso and macro systems were also related to bullying. CONCLUSION: The review contributes to the literature by broadening the approach to this phenomenon that affects the health and development of children and adolescents.

Effect of cryotherapy on relief of perineal pain after vaginal childbirth with episiotomy: a randomized and controlled clinical trial.

OBJECTIVE: Verify the effectiveness of cryotherapy in relieving perineal pain in women after vaginal delivery with episiotomy. DESIGN: Randomized controlled clinical trial. SETTING: Reference Center of Women's Health of Ribeirão Preto (MATER), in the state of São Paulo. PARTICIPANTS: The study included 50 women who reported pain in the postpartum period following vaginal delivery with episiotomy. INTERVENTION: The women in the experimental group applied a bag of crushed ice to the perineal region for 20minutes. Both groups were assessed before, immediately after removal of the ice bag, and one hour after cryotherapy treatment. MAIN OUTCOME MEASURES: Complaint of pain was evaluated using a numerical pain assessment scale (0 to 10). Perineal temperature was also measured using an infrared thermometer, and the satisfaction of women undergoing the treatment was assessed using a questionnaire. RESULTS: Pain relief was verified for the experimental group compared to the control group in the second (immediately after use of cryotherapy) and third evaluations (one hour after cryotherapy). The temperature of the perineal region was found to be related to the intensity of pain, e.g. the lower the temperature provided by cryotherapy, the lower the woman's complaint of pain. 88% of women reported being satisfied with the treatment. CONCLUSION: After 20minutes of application, cryotherapy was effective in relieving perineal pain in women in the immediate postpartum period after vaginal birth with episiotomy. TRIAL REGISTRATION NUMBER: ACTRN12613000052730.

Children and adolescents with chronic kidney disease in haemodialysis: perception of professionals.

OBJECTIVE: to identify aspects impacting on quality of life for children and adolescents with chronic kidney disease on hemodialysis, from the perspective of health professionals, as an essential step for the construction of a specific module of the DISABKIDS® instrument. METHOD: methodological study. Data was collected between May and June 2012, through personal interviews with 12 participants, in two dialysis centers. The empirical material was analyzed according to the thematic content analysis, using the program MAXQDA - Qualitative Data Analysis Software. RESULTS: we identifi ed seven themes: self-care, family support, impact of diagnosis, expectation of kidney transplant, truancy, socialization and stigma, grouped into three domains. CONCLUSION: the results showed aspects that impact the quality of life of these customers and, therefore, will be considered in the development of specifi c DISABKIDS® module. In addition, these aspects are relevant to the preparation and planning of actions directed towards children and adolescents with chronic kidney disease.

[Design and semantic validation of a new instrument to assess policy transfer of directly observed treatment for tuberculosis]. / Elaboração e validação semântica de um instrumento de avaliação da transferência do tratamento diretamente observado como política de controle da tuberculose.

OBJECTIVE: To design and semantically validate an instrument to evaluate the transfer of directly observed therapy (DOT) as a policy for tuberculosis control taking into consideration the experience of mid- and higher level health care workers. METHODS: This methodological investigation was developed in two stages: literature review to design the first draft of the instrument; and semantic validation of the first draft using questionnaires adapted from the DISABKIDS® project. The information obtained was analyzed using quantitative (descriptive statistics) or qualitative (content theme analysis) methods. RESULTS: Twenty-four mid- and higher level health care workers engaged in tuberculosis control participated in the study. The instrument was considered important for the work of study participants. The answers provided by participants led to changes in both the structure and content of the instrument. The process resulted in a final, semantically validated questionnaire. CONCLUSIONS: Semantic validation is important to ensure the applicability of assessment instruments, as shown by the contributions provided by participants. The instrument whose semantic validation was described in this study will now be assessed in terms of psychometric characteristics and usefulness to measure the transfer of DOT to health professionals as a tuberculosis control policy.

Assessment of the coordination of integrated health service delivery networks by the primary health care: COPAS questionnaire validation in the Brazilian context.

BACKGROUND: Health systems organized as networks and coordinated by the Primary Health Care (PHC) may contribute to the improvement of clinical care, sanitary conditions, satisfaction of patients and reduction of local budget expenditures. The aim of this study was to adapt and validate a questionnaire - COPAS - to assess the coordination of Integrated Health Service Delivery Networks by the Primary Health Care. METHODS: A cross sectional approach was used. The population was pooled from Family Health Strategy healthcare professionals, of the Alfenas region (Minas Gerais, Brazil). Data collection was performed from August to October 2013. The results were checked for the presence of floor and ceiling effects and the internal consistency measured through Cronbach alpha. Construct validity was verified through convergent and discriminant values following Multitrait-Multimethod (MTMM) analysis. RESULTS: Floor and ceiling effects were absent. The internal consistency of the instrument was satisfactory; as was the convergent validity, with a few correlations lower then 0.30. The discriminant validity values of the majority of items, with respect to their own dimension, were found to be higher or significantly higher than their correlations with the dimensions to which they did not belong. CONCLUSION: The results showed that the COPAS instrument has satisfactory initial psychometric properties and may be used by healthcare managers and workers to assess the PHC coordination performance within the Integrated Health Service Delivery Network.

High validity and reliability of the PedsQL™ Multidimensional Fatigue Scale for Brazilian children with cancer.

Among the main factors that affect patients' quality of life, fatigue is a significant symptom experienced by children during treatment. Despite the high incidence, there has been no validated scale to evaluate fatigue in children with cancer in Brazil. The purpose of this study was to examine the psychometric properties of the PedsQL™ Multidimensional Fatigue Scale, using self-reports of Brazilian children, 8 to 18 years of age, and proxy reports. A cross-sectional method was used to collect data from 216 subjects over an 18-month period. Reliability ranged from .70 to .90 except for sleep/rest fatigue, self-report (α = .55). No floor or ceiling effects were found in any dimension. Convergent validity was higher than .40 and divergent validity had 100% adjustment. The root mean square error of approximation was acceptable. The comparative fit index was lower than expected. The agreement between self and proxy responses was weak and moderate. The results demonstrate the reliability and validity of the Brazilian version in children with cancer. This is the first validated scale that assesses fatigue in Brazilian children and adolescents with cancer.

Validity of the DISABKIDS®-Cystic Fibrosis Module for Brazilian children and adolescents.

OBJECTIVES: To validate the health-related quality of life measuring instrument DISABKIDS®-Cystic Fibrosis Module (self version) for Brazilian children and adolescents. METHOD: Methodological study in which a sample of 113 participants (54 girls and 59 boys; mean age 11.91 years and SD=2.79) was considered, from four Brazilian states, São Paulo, Paraná, Minas Gerais and the Federal District, 51 of whom participated in the pilot study and 62 in the field study. The answers to the questionnaire were analyzed, considering the frequency distributions with regard to the floor and ceiling effects, Cronbach's Alpha statistics, Pearson's Linear Correlation Coefficient, Mulitrait-Multimethod analysis and Confirmatory Factor Analysis according to Structural Equations Modeling. RESULTS: The instrument showed a high internal consistency coefficient (verified using Cronbach's Alpha) and construct validity, according to the Multitrait-Multimethod analysis. The DISABKIDS®-Cystic Fibrosis Module, self version, maintained the same factorial structure as in the originally proposed model. CONCLUSION: The instrument validation has been finished and indicates that the self version is validated for use in Brazil and can be included into the monitoring routine of this population.

Cultural adaptation to Brazil of the questionnaire Costs of caring for children with cancer.

OBJECTIVE: to present the cultural adaptation of the questionnaire Costs of caring for children with cancer, offering a valid and reliable tool to assess the economic repercussions of childhood cancer for Brazilian families. METHOD: it is a methodological research with a cross-sectional design. The methodological framework to validate the questionnaire was a combined process that included seven steps: translation to Portuguese; first translated consensus version; evaluation by Expert Committee; consensus on the Expert Committee version; back-translation; consensus of back-translated versions; semantic validation. The study was conducted in two phases: phase one was the translation and back-translations process, with five expert committee members. Phase two was the semantic validation, with 24 participants, who answered an instrument about their impressions of the questionnaire and suggested modifications. RESULTS: in phase one, items were included, excluded, and replaced to make the content equivalent and valid for use with Brazilian context. In phase two, the majority of the participants were mothers, who made suggestions about the relevance and clarity of the items in the questionnaire. CONCLUSIONS: the authors discussed these recommendations and made adaptations, turning the questionnaire into a valid and reliable tool for application.

[Children and adolescents on hemodialysis: attributes associated with quality of life]. / Crianças e adolescents em hemodiálise: atributos associados à qualidade de vida.

OBJECTIVE: To identify quality of life impacting attributes related to health of children and adolescents with chronic renal failure,on hemodialysis, as initial step to build the specific module DISABKIDS®. METHOD: An Exploratory descriptive study, with qualitative approach, with data collected between August of 2011 to March of 2013, through focus group analysis, with 42 participants between 8 and 18 years, their parents and caregivers. The data analysis was conducted following the thematic content, using the program Qualitative Data Analysis Software. RESULTS: Seven themes were identified:water and food restrictions, limitations imposed by the treatment, time dedicated to treatment, change in body image related to the vascular access and growth,stigma, self-care and hope of kidney transplantation. CONCLUSION: Relevant aspects to the participants' experience regarding the disease and the treatment were apprehended, trying to understand how this process is associated to quality of life.

Deaths from homicides: a historical series.

OBJECTIVE: to describe mortality from homicides in Itabuna, in the State of Bahia. METHOD: study with hybrid, ecological and time-trend design. The mortality coefficients per 1,000 inhabitants, adjusted by the direct technique, proportional mortality by sex and age range, and Potential Years of Life Lost were all calculated. RESULTS: since 2005, the external causes have moved from third to second most-common cause of death, with homicides being responsible for the increase. In the 13 years analyzed, homicides have risen 203%, with 94% of these deaths occurring among the male population. Within this group, the growth occurred mainly in the age range from 15 to 29 years of age. It was ascertained that 83% of the deaths were caused by firearms; 57.2% occurred in public thoroughfares; and 98.4% in the urban zone. In 2012, the 173 homicides resulted in 7,837 potential years of life lost, with each death causing, on average, the loss of 45.3 years. CONCLUSIONS: mortality by homicide in a medium-sized city in Bahia reaches levels observed in the big cities of Brazil in the 1980s, evidencing that the phenomenon of criminality - formerly predominant only in the big urban centers - is advancing into the rural area of Brazil, causing changes in the map of violent homicide in Brazil.

Evaluation of an educational technology regarding clinical evaluation of preterm newborns.

AIM: To evaluate, from the students' point of view, educational software developed as a tool to help teachers and students in neonatal nursing. METHOD: The study evaluates the contents and simulations addressed in the software. A total of 57 undergraduate nursing students affiliated with five Brazilian public colleges participated. RESULTS: The general assessment of the software was highly satisfactory: 82.4% of the sample characterized the software as quite effective as a teaching tool. Most components were assessed as good or very good. The participants' suggestions and comments are being considered in the improvement and adaptation of the new software version. CONCLUSION: The results show that the product is adequate for use in neonatal nursing courses and nursing training on the physical examination techniques and semiology of preterm newborns, falling within the pedagogical framework of active methods.

[Examination of the oral cavities of patients with cancer: clinical evaluation and indirect measurement of the nitric oxide level]. / Exame da cavidade bucal de pacientes com câncer: avaliação clínica e dosagem indireta de óxido nítrico.

This observational study aimed to verify the association between the clinical state of the oral cavity (based on the Index of Decayed, Missing, and Filled Teeth and the Simplified Oral Hygiene Index) and the indirectly determined nitric oxide level in patients with oncologic and hematologic diseases. This study included 20 hospitalized patients who were in the evaluation phase prior to starting chemotherapy and who had been diagnosed with leukemia (35%), lymphoma (50%) or myeloma (15%). Fifty percent of these patients had normal oral health (no injury or trauma), and most had satisfactory (35%) or typical (35%) hygiene, but 30% had poor or very poor hygiene. The indirectly measured levels of nitric oxide ranged from 13.34 to 257. The nitric oxide level was not associated with other parameters, and there was great variability in its level. Further studies are necessary given the potential of using this indicator in the early detection of oral diseases.

Clinical validation of the nursing diagnosis labor pain.

OBJECTIVE: The study intends to identify the presence of clinical indicators of pain during labor and to correlate the verbal reference of pain intensity with uterine contractions as a proposal to validate the clinical nursing diagnosis Labor Pain. METHOD: Observational study of the 22 clinical indicators that represented the defining characteristics for the diagnosis. RESULTS: There were 55 participants in labor (18 in the initial active stage, 6 in the final active stage and 31 in both stages), over 18 years old, in their first pregnancy, with effective contractions and cervical dilation of 4 cm or more. Among the 22 defining characteristics tested, 6 were present in most participants during the two stages: verbal or codified report, noted evidence of uterine contraction, altered muscle tension, noted evidence of pain, expressive behavior and facial expression of pain. There were differences between the stages in relation to perspiration, facial expression of pain, protective gestures, anodyne position, distractive behavior, self-focus and perineum pressure feeling. CONCLUSIONS: A positive linear correlation was noted between pain intensity scores and the extent of intra-uterine pressure in the initial stage. Labor pain was proven to be compatible with a nursing diagnosis.

Central catheter dressing in a simulator: the effects of tutor's assistance or self-learning tutorial.

AIMS: to compare the performance of undergraduate students concerning semi-implanted central venous catheter dressing in a simulator, with the assistance of a tutor or of a self-learning tutorial. METHOD: Randomized controlled trial. The sample consisted of 35 undergraduate nursing students, who were divided into two groups after attending an open dialogue presentation class and watching a video. One group undertook the procedure practice with a tutor and the other with the assistance of a self-learning tutorial. RESULTS: in relation to cognitive knowledge, the two groups had lower performance in the pre-test than in the post-test. The group that received assistance from a tutor performed better in the practical assessment. CONCLUSION: the simulation undertaken with the assistance of a tutor showed to be the most effective learning strategy when compared to the simulation using a self-learning tutorial. Advances in nursing simulation technology are of upmost importance and the role of the tutor in the learning process should be highlighted, taking into consideration the role this professional plays in knowledge acquisition and in the development of critical-reflexive thoughts and attitudes. (ClinicalTrials.gov Identifier: NCT 01614314).

Production of nursing care in primary health care services.

This descriptive and quantitative study aimed to characterize the production of nursing care in primary health care services in a region of the city of Ribeirão Preto, state of São Paulo, Brazil. The study sample comprised care actions delivered by nurses and registered in the HygiaWeb Information System, from 2006 to 2009. Statistical analysis was performed. Results showed that nursing care delivered by nurses accounted for 9.5 to 14.6% of total professional care provided by professionals. Eventual care actions were the most frequent. The concentration of programmatic care was higher for children, women, pregnant and postpartum women. In conclusion, the predominance of eventual care demonstrated that the health system has been focused on acute conditions. Little of nursing work has been directed at the achievement of comprehensiveness, considering the inexpressive share of longitudinal follow up in total care delivery. The expansion of nursing staff represents potential for care delivery to the population, but further qualification of nursing actions is needed.

[Prevalence and determinants of exclusive breastfeeding in the city of Serrana, São Paulo, Brazil]. / Prevalência e determinantes do aleitamento materno exclusivo no município de Serrana, São Paulo, Brasil.

The objective of this cross-sectional and quantitative study was to identify the prevalence and determinants of exclusive breastfeeding among infants less than six months of age in the city of Serrana, Sao Paulo, Brazil in 2009. A validated semi-structured questionnaire was administered to the guardians of the children less than six months of age who attended the second phase of a Brazilian vaccination campaign against polio. Univariate and multivariate analysis presented in odds ratios and confidence intervals was accomplished. Of the total of 275 infant participants, only 29.8% were exclusively breastfed. Univariate analysis revealed that mothers who work outside the home without maternity leave, mothers who did not work outside the home, adolescent mothers, and the use of pacifiers have a greater chance of interrupting exclusive breastfeeding. In the multivariate analysis, mothers who work outside the home without maternity leave are three times more likely to wean their children early. Results provide suggestions for the redirection and planning of interventions targeting breastfeeding.

[The effects of professional factors on the quality of life of family health team nurses]. / A relação dos aspectos profissionais na qualidade de vida dos enfermeiros das equipes Saúde da Família.

The objective of this study was to identify the professional factors affecting the quality of life of nurses working in the family health teams in the Macro Health Region, referred to as the South Triangle, in the State of Minas Gerais. This is a descriptive, cross-sectional study. The participants were 90 nurses, who answered a questionnaire containing the professional variables and the Quality of Life assessment instrument - WHOQOL-100. The results showed a negative impact regarding the number of jobs, unstable jobs, excessive workload and job dissatisfaction in the nurses' Quality of Life domains. There is a need to (re)define the public policies that control the working conditions of these professionals. Actions that contribute towards improving nurses' Quality of Life are important, considering their strong influence on the quality of the healthcare that is delivered.