Clinical validity of the nursing diagnosis risk for unstable blood glucose level in persons with type 2 diabetes mellitus: A case-control study.

OBJECTIVE: To assess clinical-causal validity evidence of the nursing diagnosis, risk for unstable blood glucose level (00179), in individuals with type 2 diabetes mellitus. METHODS: A case-control study was conducted in 5 primary healthcare units, involving 107 subjects with type 2 diabetes mellitus, 60 in the case group and 47 in the control group. Causality was determined by the association between sociodemographic and clinical factors, risk factors related to the nursing diagnosis, and the occurrence of unstable blood glucose level. An association was considered when the risk factor had a p-value of <0.05 and odds ratio >1. RESULTS: Risk factors, such as stress, inadequate physical activity, and low adherence to therapeutic regimen, were prevalent in the sample. Time since diagnosis between 1-5 and 6-10 years, multiracial ethnicity, and the risk factor of low adherence to therapeutic regimen increased the likelihood of the outcome. Completion of high school education was identified as a protective factor. CONCLUSIONS: The clinical validation of the nursing diagnosis, risk for unstable blood glucose level, has been successfully established, revealing a clear association between sociodemographic and clinical factors and the risk factors inherent to the nursing diagnosis. IMPLICATIONS FOR NURSING PRACTICE: The results contribute to advancing scientific knowledge related to nursing education, research, and practice and provide support for the evolution of nursing care processes for individuals with type 2 diabetes mellitus.

OBJETIVO: Avaliar a evidência de validade clínico­causal do diagnóstico de enfermagem, risco para nível instável de glicose no sangue (00179), em indivíduos com diabetes mellitus tipo 2. MÉTODO: Foi realizado um estudo caso­controle em cinco unidades básicas de saúde, envolvendo 107 indivíduos com diabetes mellitus tipo 2, 60 no grupo caso e 47 no grupo controle. A causalidade foi determinada pela associação entre fatores sociodemográficos e clínicos, fatores de risco relacionados ao diagnóstico de enfermagem e a ocorrência de nível instável de glicose no sangue. Uma associação foi considerada quando o fator de risco tinha um valor de p < 0.05 e odds ratio > 1. RESULTADOS: Fatores de risco como estresse, atividade física inadequada e baixa adesão ao regime terapêutico foram predominantes na amostra. O tempo desde o diagnóstico entre 1 e 5 anos e 6 a 10 anos, a etnia parda e o fator de risco baixa adesão ao regime terapêutico aumentaram a probabilidade do resultado. A conclusão do ensino médio foi identificada como um fator de proteção. CONCLUSÕES: A validação clínica do diagnóstico de enfermagem, risco para nível instável de glicose no sangue, foi estabelecida com sucesso, revelando uma clara associação entre fatores sociodemográficos e clínicos e os fatores de risco inerentes ao diagnóstico de enfermagem. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Os resultados contribuem para o avanço do conhecimento científico relacionado à educação, à pesquisa e à prática de enfermagem e fornecem suporte para a evolução dos processos de cuidados de enfermagem para indivíduos com diabetes.

Etiological factors of chronic pain syndrome in young adults with post-coronavirus disease 2019 condition.

PURPOSE: The coronavirus disease 2019 (COVID-19) generates long-term sequelae, but studies investigating patients with chronic pain syndrome (CPS) are limited. This study aimed to establish the etiological factors of CPS in patients with post-COVID-19 conditions. METHODS: This was a case-control retrospective study. The predictor variables were sex, diabetes mellitus, obesity (predisposing factors), unfavorable socioeconomic conditions, impaired rehabilitation (disabling factors), repeated exposure to COVID-19 (precipitating factor), home isolation, stress overload, fear of dying, admission to intensive care unit, prone positioning, and use of medications (reinforcing factors). The outcome variable was the presence of CPS. FINDINGS: This study included 120 individuals. Prolonged days of isolation (p = 0.005), fear (p < 0.001), stress overload (p < 0.001), and impaired rehabilitation (p = 0.003) were significantly associated with CPS. CONCLUSIONS: A significant relationship was found between prolonged days of isolation, fear, stress overload, impaired rehabilitation, and CPS. IMPLICATIONS FOR NURSING PRACTICE: The study findings can assist nurses by promoting their knowledge of the causes of CPS and supporting the care planning needs of patients with post-COVID-19 conditions, in addition to promoting the use of the NANDA-International taxonomy.

Analysis of Readiness for enhanced health literacy in patients with type 2 diabetes mellitus.

PURPOSE: To estimate the prevalence of Readiness for enhanced health literacy in patients with type 2 diabetes mellitus through the diagnostic accuracy of the defining characteristics. METHODS: A diagnostic accuracy study on the diagnosis of Readiness for enhanced health literacy in patients with type 2 diabetes mellitus was conducted using the latent class analysis model. The sample comprised 180 individuals attending a referral outpatient clinic in Maranhão, Brazil. The data analysis was conducted in the R Core Team software. FINDINGS: The prevalence of the nursing diagnosis was 55.23%. The main defining characteristics were expresses desire to enhance health communication with healthcare providers and expresses desire to enhance the understanding of health information to make healthcare choices. All defining characteristics showed significant specificity values. CONCLUSIONS: Accurate diagnoses contribute to individualized care plans for patients. IMPLICATIONS FOR NURSING PRACTICE: The diagnosis Readiness for enhanced health literacy should be considered in implementing care plans, including interventions to reduce complications in the health status of patients with type 2 diabetes mellitus.

Research, Reading, and Publication Habits of Nurses and Nursing Students Applied to Impact Journals: International Multicentre Study.

Publishing in JCR and SJR journals has become crucial for curricular development. Results from nursing investigations "compete" for publication in journals which are not specific to the field of care, affecting the academic development of these investigators. This phenomenon may lead to an ongoing adverse effect on nursing researchers and academics engaged in research in nursing care. The aim of this study was to evaluate habits regarding scientific literature consulting, the transfer of published material, and the citation of nursing investigations. A cross-sectional descriptive study by means of questionnaires was carried out, focusing on both Spanish and Portuguese nurses. The findings of the study reveal the following reasons for reading the scientific literature: that the language was understood; for learning and applying what was learnt; that the journal was of open access; for elaborating protocols and work procedures; and that the journal was indexed in scientific databases and in nursing databases. The reasons for reading, using, and publishing in journals were related to knowledge of the language and the associated usefulness of learning and applying knowledge. Creating a specific index of research publications in nursing will have a positive effect on the scientific production of caring methodologies.

Models of Support for Caregivers and Patients with the Post-COVID-19 Condition: A Scoping Review.

BACKGROUND: In December 2019, an outbreak of the coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), occurred in the city of Wuhan, China. On 30 January 2020, the World Health Organization declared the outbreak a public health emergency of international concern. In October 2021, with the advancement of the disease, the World Health Organization defined the post-COVID-19 condition. The post-COVID-19 condition occurs in individuals with a history of probable or confirmed infection with SARS-CoV-2, usually 3 months after the onset of the disease. The chronicity of COVID-19 has increased the importance of recognizing caregivers and their needs. METHODS: We conducted a scoping review following international guidelines to map the models of support for caregivers and patients with the post-COVID-19 condition. The searches were conducted in electronic databases and the grey literature. The Population, Concept, and Context framework was used: Population: patients with the post-COVID-19 condition and caregivers; Concept: models of caregiver and patient support; and Context: post-COVID-19 condition. A total of 3258 records were identified through the electronic search, and 20 articles were included in the final sample. RESULTS: The studies approached existing guidelines and health policies for post-COVID-19 condition patients and support services for patients and home caregivers such as telerehabilitation, multidisciplinary care, hybrid models of care, and follow-up services. Only one study specifically addressed the home caregivers of patients with this clinical condition. CONCLUSIONS: The review indicates that strategies such as telerehabilitation are effective for training and monitoring the patient-family dyad, but the conditions of access and digital literacy must be considered.

Construction of a nomogram for predicting COVID-19 in-hospital mortality: A machine learning analysis.

Background and objectives: We aim to verify the use of ML algorithms to predict patient outcome using a relatively small dataset and to create a nomogram to assess in-hospital mortality of patients with COVID-19. Methods: A database of 200 COVID-19 patients admitted to the Clinical Hospital of State University of Campinas (UNICAMP) was used in this analysis. Patient features were divided into three categories: clinical, chest abnormalities, and body composition characteristics acquired by computerized tomography. These features were evaluated independently and combined to predict patient outcomes. To minimize performance fluctuations due to low sample number, reduce possible bias related to outliers, and evaluate the uncertainties generated by the small dataset, we developed a shuffling technique, a modified version of the Monte Carlo Cross Validation, creating several subgroups for training the algorithm and complementary testing subgroups. The following ML algorithms were tested: random forest, boosted decision trees, logistic regression, support vector machines, and neural networks. Performance was evaluated by analyzing Receiver operating characteristic (ROC) curves. The importance of each feature in the determination of the outcome predictability was also studied and a nomogram was created based on the most important features selected by the exclusion test. Results: Among the different sets of features, clinical variables age, lymphocyte number and weight were the most valuable features for prognosis prediction. However, we observed that skeletal muscle radiodensity and presence of pleural effusion were also important for outcome determination. Integrating these independent predictors was successfully developed to accurately predict mortality in COVID-19 in hospital patients. A nomogram based on these five features was created to predict COVID-19 mortality in hospitalized patients. The area under the ROC curve was 0.86 ± 0.04. Conclusion: ML algorithms can be reliable for the prediction of COVID-19-related in-hospital mortality, even when using a relatively small dataset. The success of ML techniques in smaller datasets broadens the applicability of these methods in several problems in the medical area. In addition, feature importance analysis allowed us to determine the most important variables for the prediction tasks resulting in a nomogram with good accuracy and clinical utility in predicting COVID-19 in-hospital mortality.

Influence of adjuvants added to teflubenzuron spray on resistant and susceptible strains of the soybean looper Chrysodeixis includens (Lepidoptera: Noctuidae) / Influência da adição de adjuvantes à calda de pulverização de teflubenzuron em linhagens resistentes e suscetíveis da lagarta falsa-medideira Chrysodeixis includens em soja (Lepidoptera: Noctuidae)

The soybean looper (SBL), Chrysodeixis includens (Walker, [1858]) (Lepidoptera: Noctuidae), is a soybean and cotton pest in South America countries. Field-evolved resistance of SBL to inhibitors of chitin biosynthesis has been reported in Brazil; however, this mode of action is still widely used against SBL. On this basis, we conducted laboratory bioassays to investigate if adjuvants (Nimbus®, TA 35®, Break-Thru® S 240, and Rizospray Extremo®) added to the teflubenzuron spray increase the mortality of SBL strains (resistant, heterozygous, and susceptible to chitin biosynthesis inhibitors). Using chromatography analysis, we also evaluated the amount of teflubenzuron on soybean leaves when applied alone or in combination with adjuvants. In laboratory bioassays, the biological activity of teflubenzuron increased against the susceptible SBL strain when adjuvants were added. In contrast, no relevant effects of adjuvants added to the teflubenzuron spray against heterozygous and resistant SBL larvae were detected. In leaf bioassays, even leaves from the upper third part of the plants containing a significantly higher amount of teflubenzuron (3.4 mg/kg vs 1.7 and 0.6 mg/kg); the mortality of SBL strains was similar when teflubenzuron was applied alone or in mixture with adjuvants. Our findings indicated that adjuvants added to teflubenzuron spray do not provide a substantial increase in the mortality of SBL strains resistant to chitin biosynthesis inhibitors. Therefore, it is necessary to reduce the use of this mode-ofaction insecticide against SBL and to give preference to other insecticides or control tactic.

A lagarta falsa-medideira, Chrysodeixis includens (Walker, [1858]) (Lepidoptera: Noctuidae), é uma praga da soja e do algodão nos países da América do Sul. A resistência de C. includens a inibidores da biossíntese de quitina tem sido relatada no Brasil. Entretanto, esse modo de ação ainda é amplamente utilizado para controle de C. includens. Com base nisso, conduzimos bioensaios em laboratório para investigar se adjuvantes (Nimbus®, TA 35®, Break-Thru® S 240 e Rizospray Extremo®) adicionados à calda inseticida de teflubenzuron aumentam a mortalidade de linhagens de C. includens (resistentes, heterozigotos e suscetíveis a inibidores da biossíntese de quitina). Usando análise cromatográfica, também avaliamos a quantidade de teflubenzuron em folhas de soja quando aplicado isolado ou em combinação com adjuvantes. Em bioensaios de laboratório, a atividade biológica do teflubenzuron aumentou para a linhagem suscetível quando os adjuvantes foram adicionados à calda inseticida. Em contraste, nenhum efeito relevante de adjuvantes adicionados ao teflubenzuron foi detectado para os heterozigotos e resistentes. Em bioensaios de folhas, mesmo naquelas do terço superior das plantas, as quais apresentaram uma maior deposição de teflubenzuron (3,4 mg/kg vs 1,7 e 0,6 mg/kg); a mortalidade das linhagens de C. includens foi semelhante quando o teflubenzuron foi aplicado isolado ou com adjuvantes. Nossos resultados indicam que os adjuvantes adicionados ao teflubenzuron não fornecem um aumento substancial na mortalidade de linhagens de C. includens resistentes aos inibidores da biossíntese de quitina. Portanto, é necessário reduzir o uso desse modo de ação para o manejo de C. includens e dar preferência a outros inseticidas ou tática de controle.

Tecnologias educacionais disponíveis para orientação e manejo da dor / Educational technologies avaliable for pain guidance and managment / Tecnologías educativas disponibles para la orientación y el manejo del dolor

Objetivo:Identificar, na literatura científica, as tecnologias educacionais disponíveis para orientação e manejo da dor. Método:Revisão integrativa da literatura conduzida nas bases de dados LILACS, PubMed Central, Scopus, SciELO, CINAHL e Web of Sciencepor meioda questão norteadora: Quais as tecnologias educacionais disponíveis para educação em saúde e capacitação profissional sobre manejo da dor? Resultados:Selecionou-se 12 artigos, por meio da análise dos quais foram encontradas tecnologias educativas como cartilhas, aplicativos vídeos, folheto e realidade virtual, voltadas para públicos variados como crianças, pacientes com dor crônica, idosos, pessoas com diagnóstico de dor patelofemural e cegos. Já as tecnologias voltadas a capacitação profissional foram: vídeo instrucional, módulo e-learning, programa de Avaliação da Dor Neonatal II e objeto virtual de aprendizagem. Conclusão:As tecnologias observadas mostraram-se como dispositivos facilitadores dos processos educativos sobre manejo da dor tanto para pacientes quanto para estudantes e profissionais de saúde.

Objective: To identify, in the scientific literature, the educational technologies available for guidance and pain management.Method: Integrative literature review conducted in LILACS, PubMed Central, Scopus, SciELO, CINAHL and Web of Science databases through the guiding question: What educational technologies are available for health education and professional training on pain management?Results: 12 articles were selected, through the analysis of which educational technologies such as booklets, video applications, leaflet and virtual reality were found, which were aimed at different audiences such as children, patients with chronic pain, the elderly, people diagnosed with pain patellofemoral and blind. The technologies aimed at professional training were: instructional video, e-learning module, Neonatal Pain Assessment II program and virtuallearning object. Conclusion: The technologies observed proved to be devices that facilitate educational processes on pain management for both patients, students and health professionals.

Objetivo: Identificar, en la literatura científica, las tecnologías educativas disponibles para la orientación y el manejo del dolor.Método: Revisión integrativa de la literatura realizada en las bases de datos LILACS, PubMed Central, Scopus, SciELO, CINAHL y Web of Science a través de la pregunta orientadora: ¿Qué tecnologías educativas están disponibles para la educación en salud y la formación profesional en el manejo del dolor?Resultados: se seleccionaron 12 artículos, através del análisis de los cuales se encontraron tecnologías educativas como cuadernillos, aplicaciones de video, tríptico y realidad virtual, dirigidas a diferentes públicos como niños, pacientes con dolor crónico, adultos mayores, personas diagnosticadas con dolor. patelofemoral y ciego. Las tecnologías destinadas a la formación profesional fueron: video instructivo, módulo e-learning, programa Neonatal Pain Assessment II y objeto virtual de aprendizaje.Conclusión:Las tecnologías observadas demostraronser dispositivos que facilitan los procesos educativos sobre el manejo del dolor tanto para pacientes, estudiantes y profesionales de la salud.

Low skeletal muscle radiodensity and neutrophil-to-lymphocyte ratio as predictors of poor outcome in patients with COVID-19.

Inflammatory states and body composition changes are associated with a poor prognosis in many diseases, but their role in coronavirus disease 2019 (COVID-19) is not fully understood. To assess the impact of low skeletal muscle radiodensity (SMD), high neutrophil-to-lymphocyte ratio (NLR) and a composite score based on both variables, on complications, use of ventilatory support, and survival in patients with COVID-19. Medical records of patients hospitalized between May 1, 2020, and July 31, 2020, with a laboratory diagnosis of COVID-19 who underwent computed tomography (CT) were retrospectively reviewed. CT-derived body composition measurements assessed at the first lumbar vertebra level, and laboratory tests performed at diagnosis, were used to calculate SMD and NLR. Prognostic values were estimated via univariate and multivariate logistic regression analyses and the Kaplan-Meier curve. The study was approved by the local Institutional Review Board (CAAE 36276620.2.0000.5404). A total of 200 patients were included. Among the patients assessed, median age was 59 years, 58% were men and 45% required ICU care. A total of 45 (22.5%) patients died. Multivariate logistic analysis demonstrated that a low SMD (OR 2.94; 95% CI 1.13-7.66, P = 0.027), high NLR (OR 3.96; 95% CI 1.24-12.69, P = 0.021) and both low SMD and high NLR (OR 25.58; 95% CI 2.37-276.71, P = 0.008) combined, were associated with an increased risk of death. Patients who had both low SMD and high NLR required more mechanical ventilation (P < 0.001) and were hospitalized for a longer period (P < 0.001). Low SMD, high NLR and the composite score can predict poor prognosis in patients with COVID-19, and can be used as a tool for early identification of patients at risk. Systemic inflammation and low muscle radiodensity are useful predictors of poor prognosis, and the assessment of these factors in clinical practice should be considered.

Influence of hydroclimatic variability on dengue incidence in a tropical dryland area.

Dengue is an endemic disease in more than 100 countries, but there are few studies about the effects of hydroclimatic variability on dengue incidence (DI) in tropical dryland areas. This study investigates the association between hydroclimatic variability and DI (2008-2018) in a large tropical dryland area. The area studied comprehends seven municipalities with populations ranging from 32,879 to 2,545,419 inhabitants. First, the precipitation and temperature impacts on interannual and seasonal DI were investigated. Then, the monthly association between DI and hydroclimatic variables was analyzed using generalized least squares (GLS) regression. The model's capability to reproduce DI given the current hydroclimatic conditions and DI seasonality over the entire time period studied were assessed. No association between the interannual variation of precipitation and DI was found. However, seasonal variation of DI was shaped by precipitation and temperature. February-July was the main dengue season period. A precipitation threshold, usually above 100 mm, triggers the rapid DI rising. Precipitation and minimum air temperature were the main explanatory variables. A two-month-lagged predictor was relevant for modeling, occurring in all regressions, followed by a non-lagged predictor. The climate predictors differed among the regression models, revealing the high spatial DI variability driven by hydroclimatic variability. GLS regressions were able to reproduce the beginning, development, and end of the dengue season, although we found underestimation of DI peaks and overestimation of low DI. These model limitations are not an issue for climate change impact assessment on DI at the municipality scale since historical DI seasonality was well simulated. However, they may not allow seasonal DI forecasting for some municipalities. These findings may help not only public health policies in the studied municipalities but also have the potential to be reproducible for other dryland regions with similar data availability.

Health literacy and adherence to the pharmacological treatment by people with arterial hypertension.

OBJECTIVE: To analyze the association between health literacy and the adherence to the pharmacological treatment of Brazilians with arterial hypertension. METHODS: Cross-sectional study with 234 participants who responded an on-line sociodemographic and clinical characterization questionnaire, in addition to evaluation of health literacy and of the adherence to their pharmacological treatment. Data were analyzed using descriptive statistics and difference and correlation tests. RESULTS: People with post-graduation, who were actively working and did not smoke, had better health literacy results. Elders and those who were retired or lived on government subsidies adhered better to the medication treatment. There was a correlation between the numerical dimension (rs=0.189; p=0.004) and the global health literacy result (r2=0.170; p=0.009) with the adherence. CONCLUSIONS: A better numerical and global understanding of health literacy was associated with better adherence to arterial hypertension medication treatment.

Repercussions of COVID-19 in hemodialysis patients: a systematic review / Repercusiones del COVID-19 en pacientes en hemodiálisis: Una revisión sistemática / Repercussões da COVID-19 em pacientes em hemodiálise: uma revisão sistemática

ntrodution: The immunosuppressive state of patients with CKD increases their risk of developing poor clinical outcomes if they acquire COVID-19 infection. Objetive: To identify the scientific evidence about the repercussions of COVID-19 in hemodialysis patients. Materials and méthods: A systematic review was conducted in this study. The databases Cochrane Library, Web of Science, Science Direct, PubMed, and Virtual Health Library were searched to identify relevant studies. The methodological quality of the studies was assessed using the adapted Downs and Black checklist. The review adhered to the PRISMA guidelines. Results:A total of 16 articles were included after the screening process. All articles had a methodological quality higher than 66.8%. The most common repercussions of COVID-19 in hemodialysis patients were the increased mortality rate (75%), development of typical signs and symptoms of the disease such as fever, cough, dyspnea, and fatigue (68.75%), lymphopenia (68.75%), progression to severe acute respiratory syndrome (56.25%), need for mechanical ventilation (50%), and admission to intensive (50%). Conclusión: The hemodialysis patients are more susceptible to COVID-19 infection and, when infected by SARS-CoV-2, these patients have more adverse clinical outcomes, more serious diseases, higher mortality, and worse prognosis than the general population. The repercussions of COVID-19 in hemodialysis patients reveal a need for preventive nursing care in hemodialysis clinics.

Introducción: El estado de inmunosupresión de los pacientes con enfermedad renal crónica (ERC) aumenta su riesgo de obtener resultados clínicos desfavorables si llegaran a contraer COVID-19. Objetivo: Identificar la evidencia científica acerca de las repercusiones que tiene el COVID-19 en los pacientes en hemodiálisis. Materiales y Métodos: Se realizó una revisión sistemática en este estudio. Se hizo una búsqueda en las bases de datos Cochrane Library, Web of Science, Science Direct, PubMed y Virtual Health Library para identificar estudios relevantes. La calidad metodológica de los estudios se evaluó mediante la lista de chequeo adaptada por Downs y Black. La revisión siguió los lineamientos de la declaración PRISMA. Resultados:Tras el proceso de selección se incluyeron un total de 16 artículos en la revisión. Todos los artículos obtuvieron una calidad metodológica superior a 66,8%. Las repercusiones más comunes del COVID-19 en los pacientes en hemodiálisis fueron el aumento de la tasa de mortalidad (75%), el desarrollo de signos y síntomas típicos de la enfermedad como fiebre, tos, disnea y fatiga (68,75%), linfopenia (68,75%), progresión a un síndrome respiratorio agudo grave (56,25%), necesidad de ventilación mecánica (50%) e ingreso a cuidados intensivos (50%). Conclusiones: Los pacientes en hemodiálisis son más susceptibles a contraer COVID-19 y, cuando contraen el SARS-CoV-2, tienen resultados clínicos más adversos, enfermedades más graves, mayor mortalidad y peor pronóstico que la población general.

Introdução: O estado imunossupressor dos pacientes com CKD aumenta seu risco de desenvolver maus resultados clínicos se eles adquirirem a infecção COVID-19. Objetivo: Identificar as evidências científicas sobre as repercussões da COVID-19 em pacientes com hemodiálise. Materiais e Métodos: Uma revisão sistemática foi conduzida neste estudo. As bases de dados Cochrane Library, Web of Science, Science Direct, PubMed e Virtual Health Library foram pesquisadas para identificar estudos relevantes. A qualidade metodológica dos estudos foi avaliada utilizando a lista de verificação Downs e Black adaptada. A revisão seguiu as diretrizes do PRISMA. Resultados: Um total de 16 artigos foram incluídos após o processo de triagem. Todos os artigos tinham uma qualidade metodológica superior a 66,8%. As repercussões mais comuns da COVID-19 em pacientes de hemodiálise foram o aumento da taxa de mortalidade (75%), desenvolvimento de sinais e sintomas típicos da doença como febre, tosse, dispnéia e fadiga (68,75%), linfopenia (68,75%), progressão para síndrome respiratória aguda grave (56,25%), necessidade de ventilação mecânica (50%) e admissão a intensivo (50%). Conclusões: Os pacientes em hemodiálise são mais suscetíveis à infecção por COVID-19 e, quando infectados pela SRA-CoV-2, estes pacientes têm resultados clínicos mais adversos, doenças mais graves, maior mortalidade e pior prognóstico do que a população em geral. As repercussões da COVID-19 em pacientes de hemodiálise revelam uma necessidade de cuidados preventivos de enfermagem em clínicas de hemodiálise.

Evaluación de un juego educativo sobre salud cerebrovascular para personas con enfermedades crónicas: estudio cuasiexperimental / Avaliação de um jogo educacional sobre saúde cerebrovascular para pessoas com doenças crônicas: estudo quaseexperimental / Evaluation of an educational game on cerebrovascular health for people with chronic diseases: A quasi-experimental study

Objetivo: evaluar la implementación de un juego educativo para el reconocimiento temprano de la enfermedad cerebrovascular aguda en personas con diabetes mellitus e hipertensión arterial. Materiales y métodos: estudio con diseño cuasiexperimental, tipo antes-después, realizado con un grupo de 213 adultos con hipertensión y/o diabetes, bajo la modalidad acción educativa, entre junio de 2018 y junio de 2020. Las sesiones de acción se realizaron en cuatro Unidades Básicas de Salud. Esta actividad se realizó en dos momentos: primero, la construcción y validación de una tecnología sanitaria en forma de juego educativo; segundo, la implementación de acciones. Resultados: la mayoría de los participantes eran mujeres (70,89%),con una edad media de 60,29 años. El 86,38% de los participantes logró reconocer tres o más signos y síntomas de accidente cerebrovascular y el 93,89% comenzó a identificar los principales factores de riesgo de esta enfermedad. Una gran proporción de los participantes presentaron un logro de aproximadamente 95% al realizar la posprueba. Sin embargo, no se registró una diferencia estadística significativa entre las medias obtenidas en los grupos durante la preprueba y la posprueba (p=0,9967). Conclusiones: la implementación del juego educativo propició un aumento en los puntajes obtenidos por los participantes sobre el reconocimiento temprano de la enfermedad cerebrovascular aguda y sus factores de riesgo, según muestran las evaluaciones realizadas antes y después del juego.

Objetivo: avaliar a implementação de um jogo educacional para reconhecer precocemente a doença cerebrovascular aguda em pessoas com diabetes mellitus e hipertensão arterial. Materiais e métodos: estudo com desenho quase experimental, do tipo antes e depois, realizado com 213 adultos com hipertensão e/ou diabetes, na modalidade de ação educativa, no período de junho de 2018 a junho de 2020. As sessões de ação foram realizadas em quatro Unidades Básicas de Saúde. Essa atividade foi realizada em dois momentos: primeiro, construção e validação de uma tecnologia em saúde na formade um jogo educacional; segundo, implementação de ações. Resultados: amaioria dos participantes erado sexo feminino (70,89%), com média de idade de 60,29 anos. Dos participantes,86,38% conseguiram reconhecer três ou mais sinais e sintomas de acidente vascular cerebral, assim como 93,89% passaram a identificar os principais fatores de risco para esta doença. A maioria dos participantes apresentou um aproveitamento de aproximadamente 95% ao realizar o pós-teste. No entanto, não houve diferença estatisticamente significativa entre as médias obtidas dos grupos no pré-teste e no pós-teste (p=0,9967). Conclusões: a implementação do jogo educacional levou a um aumento nas notas obtidas pelos participantes sobre o reconhecimento precoce da doença cerebrovascular aguda e de seus fatores de risco, entre as avaliações realizadas antes e depois do jogo.

Objective: To assess the implementation of an educational game for the early recognition of acute cerebrovascular disease in people with diabetes mellitus and hypertension. Materials and methods: Quasi-experimentalstudy, before-and-after type, conducted with 213 adults with hypertension and/or diabetes, under the educational action modality, from June 2018 toJune2020. The action sessions were carried out at fourBasic Health Units in two moments: first, construction and validation of a health technology in the form of an educational game; and second, the implementation of actions. Results:Most participants were women (70.89%),with a mean age of 60.29 years. Of the total number of individuals, 86.38% were able to recognize three or more signs and symptoms of stroke, while93.89% began to identify the main risk factors for this disease. A big share of the participants presented an achievement of approximately 95% when performing the post-test. However, there were no statistically significant differences between the means obtained between the groups during the pre-test and the post-test (p=0.9967). Conclusions: The implementation of the educational game led to an increase in the scores obtained by participants regarding the early recognition of acute cerebrovascular disease and its associated risk factors, as shown by the assessments performed before and after the game.

Health Interventions for Preventing Climate-Sensitive Diseases: Scoping Review.

Climate variations cause public health problems, but the literature is still scarce on studies involving health interventions against climate-sensitive diseases. The objective of this review was to identify health interventions for the prevention of such diseases. We conducted a scoping review using the JBI Methodology. Six large research databases were searched (PubMed, Scopus, Web of Science, Lilacs, Embase, and Cochrane). The following inclusion criterion was used: studies addressing health interventions to prevent climate-sensitive diseases or consequences of climate on people's health. The exclusion criteria consisted of thesis, dissertations, conference proceedings, studies with unclear information/methodology, and studies not addressing climate-related health interventions. No language or date restrictions were applied. Of 733 studies identified and screened by title and abstract, 55 studies underwent full-text screening, yielding 13 studies for review. The health interventions identified were classified into three levels of management. The macro level included the use of epidemiological models, renewable energy, and policies sensitive to climate change. The meso level comprised interventions such as the creation of environmental suitability maps, urban greening, chemoprophylaxis, water security plans, and sanitation projects, among other measures. Some interventions are at the intersection, such as educational campaigns and the modification of artificial larvae sites. Finally, the micro level contained interventions such as the inspection of window screens and the use of light-colored clothing and repellents. The health interventions at the macro, meso, and micro levels and the intersection may serve as a basis for public managers to implement appropriate interventions against climate-sensitive diseases.

Accuracy of the defining characteristics of the nursing diagnosis hypothermia in patients on hemodialysis.

OBJECTIVE: to analyze the accuracy of the defining characteristics of hypothermia in patients on hemodialysis. METHODS: a diagnostic accuracy study was assembled within a cross-sectional study with 124 patients from two dialysis centers. A latent class model was used for data analysis. RESULTS: the nursing diagnosis hypothermia was present in 13 (10.48%) study participants. The most prevalent defining characteristics were hypoxia (100%), decrease in blood glucose level (83.1%), hypertension (65.3%), piloerection (45.2%), and skin cool to touch (41.1%). The defining characteristics acrocyanosis (99.96%) and cyanotic nail beds (99.98%) had a high sensitivity. Acrocyanosis (91.8%), skin cool to touch (64.8%), and peripheral vasoconstriction (91.8%) had high specificity. CONCLUSION: specific and sensitive indicators of hypothermia work as good clinical indicators for confirming this diagnosis in patients on hemodialysis. The study findings can assist nurses in their clinical reasoning for a correct inference of hypothermia.

Cardiovascular risk and cardiovascular risk factors in adolescents.

OBJECTIVES: to identify cardiovascular risk and cardiovascular risk factors in adolescents and verify correlations between these variables and biochemical markers, and between blood pressure percentiles, Body Mass Index, and biochemical markers. METHODS: a cross-sectional study, conducted at a Brazilian school, from August to September 2019, including 205 participants who were interviewed. After the interview, anthropometric assessments, including weight, height, arm circumference, blood pressure checking, and blood collection for laboratory tests were performed. Descriptive and inferential analysis using the chi-square test was conducted. RESULTS: a total of 18.5% had blood pressure percentiles >95%, 25.4% were overweight, and 25.9% were at very high cardiovascular risk. Statistically significant associations were found between cardiovascular risk and sex, Body Mass Index and blood pressure percentiles, and between blood pressure percentiles and triglycerides. CONCLUSIONS: high prevalence of risk factors among school adolescents reinforces the need for interventions for cardiovascular risk reduction in this population.

Assessment of Neurological Status in Patients with Cerebrovascular Diseases through the Nursing Outcome Classification: A Methodological Study.

Nurses play an important role in healthcare, and the Nursing Outcomes Classification is a key tool for the standardization of care. This study aims to validate the nursing outcome "Neurological Status" for patients with cerebrovascular diseases. A methodological study was performed in four phases. In Phase 1, the relevance of the indicators was evaluated by seven specialists and the modified kappa coefficient and content validity index were calculated. In Phase 2, conceptual and operational definitions were formulated. In addition, their content was validated with a focus group in Phase 3. In Phase 4, the results were applied in clinical practice and convergence with the National Institute of Health Stroke Scale was verified. The reliability was measured by Cronbach's alpha. Of the 22 initial indicators, 6 were excluded. The focus group suggested changes in the definitions and the exclusion of two indicators. In Phase 4, only 13 indicators were validated due to the impossibility of measuring intracranial pressure. A strong correlation between the two scales and agreement among all the indicators were observed. Following the specialists' review, the nursing outcome was reliable and clinically validated with 13 indicators: consciousness, orientation, language, central motor control, cranial sensory and motor function, spinal sensory and motor function, body temperature, blood pressure, heart rate, eye movement pattern, pupil size, pupil reactivity, and breathing pattern.

Educação em saúde na prevenção de quedas para idosos com hipertensão / Health education for fall prevention in older adults with hypertension / Educación en salud en la prevención de caídas en ancianos con hipertensión

Objetivo: relatar a experiência de ações educativas sobre a prevenção de quedas em idosos com hipertensão arterial. Método: relato de experiência sobre encontros educativos acerca da prevenção de quedas, realizados para 36 idosos com hipertensão arterial, acompanhados pela atenção primária, no interior cearense. Durante os encontros, utilizou-se do jogo adaptado "Não deixe a vovó cair". Além disso, houve a confecção de fôlderes e cartazes para fornecer as informações de forma mais ilustrativa. Resultados: a aplicação do jogo estimulou os idosos a refletirem sobre situações inadequadas no ambiente domiciliar que podem ser adaptadas para evitar quedas. Alguns idosos apresentaram dificuldades cognitivas, quando solicitados a identificarem os fatores de riscos presentes em cada cômodo da casa, mas, após os exemplos do cotidiano, foram capazes de entender as situações do jogo. Com as orientações, os idosos puderam compreender a relevância dos fatores que favorecem o risco de quedas. Conclusão: a educação em saúde é uma potencial estratégia para realização de atividades educativas sobre a prevenção de quedas em idosos com hipertensão arterial. Para isso, torna-se importante a utilização de metodologias lúdicas, como jogos e materiais que proporcionem a fixação das orientações, a exemplo dos fôlderes. Descritores: Idoso; Hipertensão; Acidente por Quedas; Fatores de Risco; Educação em Saúde.(AU)

Objective: to report the experience of using educational actions for fall prevention in older adults with arterial hypertension. Method: this is an experience report on educational meetings about fall prevention carried out with 36 older adults with arterial hypertension accompanied by primary care in the countryside of Ceará. The adapted game "Do not let grandma fall" was used during the meetings. In addition, folders and posters were made to provide illustrative information. Results: it was noticed that the game stimulated the older adults to reflect on inappropriate situations in their home environment that can be adapted to prevent falls. Some older adults had cognitive difficulties when asked to identify the risk factors present in each room of the house, but after the examples, they were able to understand the game situations. With the guidelines, the older adults could understand the relevance of the factors that favor the risk of falls. Conclusion: it is concluded that health education is a potential strategy to prevent falls in older adults with arterial hypertension. Therefore, it is important to use playful methodologies such as games and materials that provide guidelines for fall prevention, such as folders.(AU)

Objetivo: relatar la experiencia de acciones educativas sobre prevención de caídas en ancianos con hipertensión arterial. Método: relato de experiencia sobre encuentros educativos sobre prevención de caídas, realizados con 36 ancianos con hipertensión arterial, acompañados por atención primaria, en el interior de Ceará. Durante las reuniones se utilizó el juego adaptado "Que no se caiga la abuela". Además, se realizaron carpetas y carteles para brindar información de una manera más ilustrativa. Resultados: la aplicación del juego animó a los ancianos a reflexionar sobre situaciones inapropiadas en el ambiente domiciliario que pueden ser adaptadas para prevenir caídas. Algunos ancianos tenían dificultades cognitivas cuando se les pedía que identificaran los factores de riesgo presentes en cada habitación de la casa, pero, tras los ejemplos cotidianos, lograban comprender las situaciones del juego. Con las orientaciones, los ancianos lograron comprender la relevancia de los factores que favorecen el riesgo de caídas. Conclusión: la educación en salud es una estrategia potencial para la realización de actividades educativas sobre la prevención de caídas en ancianos con hipertensión arterial. En consecuencia, es importante utilizar metodologías lúdicas, como juegos y materiales que sirvan de marco de pautas, como carpetas.(AU)

Accuracy of the clinical indicators for Readiness for enhanced health management.

PURPOSE: to analyze accuracy measures of the clinical indicators of Readiness for enhanced health management in patients with arterial hypertension and/or diabetes mellitus METHODS: prospective diagnostic accuracy study conducted with 359 patients with hypertension and/or diabetes mellitus, followed up in primary healthcare. Stratified random sampling was used to recruit participants. An assessment form was applied with sociodemographic data, health conditions, and information related to the clinical indicators under investigation. Sensitivity, specificity, predictive values, and likelihood ratios were analyzed FINDINGS: the sample was composed of 359 participants. The prevalence of Readiness for enhanced health management was 93.8%. There was a statistically significant association between the diagnosis and age under 60 years (p < 0.001), having only one chronic condition (p < 0.001), having normal blood pressure (p = 0.017) and blood glucose (p = 0.013) values, and having a nonsedentary (p = 0.026) and nonalcoholic (p = 0.044) lifestyle. All clinical indicators had high predictive values in predicting the nursing diagnosis under investigation. The indicator expresses desire to enhance management of symptoms was the most sensitive (99.7%) and specific (100%). The indicator expresses desire to enhance management of prescribed regimens was also highly specific (100%) CONCLUSION: all clinical indicators were accurate in predicting Readiness for enhanced health management IMPLICATIONS FOR NURSING PRACTICE: knowing which clinical indicators and sociodemographic/clinical characteristics best predict Readiness for enhanced health management, nurses in primary care can better plan nursing interventions and direct their goals.