Melhores práticas no cuidado às pessoas que vivem com HIV em diferentes modelos de cuidado* / Mejores prácticas en la atención a personas viven con VIH en diferentes modelos de asistencia / Best practices in the care provided to people living with HIV in different care models

Objetivo: compreender os significados atribuídos às melhores práticas do cuidado às pessoas que vivem com HIV em dois diferentes modelos de cuidado em municípios prioritários do sul do Brasil. Método: Teoria Fundamentada nos Dados Construtivista, com 52 entrevistas em profundidade aplicadas em 2020 e 2021, para profissionais da atenção primária, especializada, gestores e pessoas que vivem com HIV. Resultados: o fenômeno "Significando as melhores práticas como gradativas e consistentes em diferentes municípios prioritários", permite compreender que no cuidado centralizado são desenvolvidas ações de prevenção e promoção da saúde, aconselhamento, diagnóstico precoce e encaminhamento, e no modelo descentralizado destaca-se a ampliação da clínica do enfermeiro e do médico de família no manejo da infecção, vinculação, longitudinalidade e integralidade. Conclusão: as melhores práticas em modelos distintos de cuidado requerem uma sucessão de diferentes momentos, que respeitem as falas dos profissionais e das pessoas que vivem com HIV.

Objective: to understand the meanings attributed to best practices in the care of people living with HIV in two different care models in priority municipalities from southern Brazil. Method: Constructivist Grounded Theory, with 52 in-depth interviews conducted in 2020 and 2021, involving professionals from primary and specialized care, managers and people living with HIV. Results: the phenomenon of "Signifying best practices as gradual and consistent across different priority municipalities" allows for an understanding that actions related to health prevention and promotion, counseling, early diagnosis and referral are developed in the centralized care model. In the decentralized model, the emphasis is on expanding the role of nurses and family physicians in infection management, establishing connections, ensuring care continuity, and providing comprehensive care. Conclusion: best practices in different care models require a succession of different moments that respect the perspectives and input of both health professionals and individuals living with HIV.

Objetivo: comprender los significados atribuidos a las mejores prácticas de atención a personas que viven con VIH en dos modelos de asistencia diferentes en municipios prioritarios del sur de Brasil. Método: Teoría Constructivista Fundamentada en los Datos, con 52 entrevistas en profundidad realizadas en 2020 y 2021, para profesionales de Atención Primaria y Especializada, administradores y personas que viven con VIH. Resultados: el fenómeno de "Representar las mejores prácticas como graduales y consistentes en diferentes municipios prioritarios" permite comprender que se desarrollan acciones relacionadas con prevención y promoción de la salud, asesoramiento, diagnóstico temprano y derivaciones en el modelo de atención descentralizado. En el modelo descentralizado, el énfasis radica en expandir el rol de los enfermeros y médicos de familia en el manejo de infecciones, establecer conexiones, garantizar continuidad de la atención y brindar asistencia integral. Conclusión: las mejores prácticas en distintos modelos de atención requieren cierta sucesión de diferentes momentos que deben respetar los discursos de los profesionales y las personas que viven con VIH.

Educational technologies for HIV prevention in black people: scope review / Tecnologías educativas para la prevención del VIH en negros: revisión del alcance / Tecnologias educativas para prevenção do HIV em negros: revisão de escopo

ABSTRACT Objective: To map the educational technologies implemented for HIV prevention in black people. Method: Scope review, performed according to the recommendations of The Joanna Briggs Institute, in Medline/PubMed, Embase, LILACS, CINAHL, Scopus, Cochrane and PsycINFO databases, using the Preferred Reporting Items for Systematic reviews and Meta- Analyses extension for Scoping Reviews (PRISMA-ScR). Results: There were 14 studies published between 1999 and 2020. The main health impacts for black people involved a reduction in rates of unprotected sex, greater use of condoms, a decrease in risky behaviors, a minimization of the number of partners, a greater request for HIV testing and an increase in the use of Pre-exposure prophylaxis (PrEP). Conclusion: The educational technologies mapped were: workshops, courses, messages, dramatization, videos, application, pamphlet, media and radio campaigns, Facebook groups, website, computer programs and multimedia software.

RESUMEN Objetivo: Mapear las tecnologías educativas implementadas para la prevención del VIH en negros. Método: Revisión de alcance, realizada de acuerdo con las recomendaciones de The Joanna Briggs Institute, en las bases de datos Medline/PubMed, Embase, LILACS, CINAHL, Scopus, Cochrane y PsycINFO, utilizando Preferred Reporting Items for Systematic reviews y Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Resultados: Se publicaron 14 estudios entre 1999 y 2020. Los principales impactos en la salud de los negros involucraron una reducción en las tasas de sexo sin protección, mayor uso de condones, una disminución en los comportamientos de riesgo, una minimización del número de parejas, una mayor solicitud de pruebas de VIH y un aumento en el uso de Pre-exposición profilaxis (PrEP). Conclusión: Las tecnologías educativas mapeadas fueron: talleres, cursos, mensajes, dramatización, videos, aplicación, folleto, campañas en medios y radio, grupos de Facebook, sitio web, programas informáticos y software multimedia.

RESUMO Objetivo: Mapear as tecnologias educativas implementadas para prevenção do HIV em negros. Método: Revisão de escopo, realizada conforme as recomendações do The Joanna Briggs Institute, nas bases de dados Medline/PubMed, Embase, LILACS, CINAHL, Scopus, Cochrane e PsycINFO, utilizando-se do instrumento Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Resultados: Encontraram-se 14 estudos publicados entre 1999 e 2020. Os principais impactos para saúde dos negros envolveram a redução das taxas de relações sexuais desprotegidas, o maior uso de preservativos, a diminuição de comportamentos de risco, a minimização do número de parceiros, a maior solicitação de testagens para HIV e o aumento do uso de Profilaxia Pré-exposição (PrEP). Conclusão: As tecnologias educativas mapeadas foram: workshops, cursos, mensagens, dramatização, vídeos, aplicativo, panfleto, campanhas de mídia e de rádio, grupos de Facebook, site, programas de computadores e softwares multimídia.

Educational technologies for HIV prevention in black people: scope review.

OBJECTIVE: To map the educational technologies implemented for HIV prevention in black people. METHOD: Scope review, performed according to the recommendations of The Joanna Briggs Institute, in Medline/PubMed, Embase, LILACS, CINAHL, Scopus, Cochrane and PsycINFO databases, using the Preferred Reporting Items for Systematic reviews and Meta- Analyses extension for Scoping Reviews (PRISMA-ScR). RESULTS: There were 14 studies published between 1999 and 2020. The main health impacts for black people involved a reduction in rates of unprotected sex, greater use of condoms, a decrease in risky behaviors, a minimization of the number of partners, a greater request for HIV testing and an increase in the use of Pre-exposure prophylaxis (PrEP). CONCLUSION: The educational technologies mapped were: workshops, courses, messages, dramatization, videos, application, pamphlet, media and radio campaigns, Facebook groups, website, computer programs and multimedia software.

Effectiveness of educational interventions in knowledge, attitude, and practice for preventing respiratory infections: a systematic review and meta-analysis.

OBJECTIVES: to demonstrate the effectiveness of educational interventions in knowledge, attitude and practice for preventing respiratory infections in adults and older adults. METHODS: this is a systematic review carried out in 11 databases. Primary studies, without language and time restrictions, of the randomized, non-randomized and before-and-after clinical trial type, were selected. The risk of bias was assessed by two independent researchers, and the methodological quality was generated by the Grading of Recommendations, Assessment, Development and Evaluation. RESULTS: the intervention effectiveness was evidenced in seven studies. The results of the random effects meta-analysis show that there is a statistically significant difference between knowledge about preventing respiratory diseases, with an OR of 2.82 (95%CI 1.70 to 4.69) for the occurrence of events represented by improved knowledge. CONCLUSIONS: most studies show the effectiveness of educational interventions, which was determined through the Knowledge, Attitude and Practice survey.

Instrumento ilustrado para avaliar o conhecimento de idosos sobre prevenção do HIV/Aids: estudo metodológico / Illustrated instrument to assess older adults' knowledge about HIV/AIDS prevention: a methodological study / Instrumento ilustrado para evaluar el conocimiento de los adultos mayores sobre la prevención del VIH/SIDA: estudio metodológico

OBJETIVO: Construir e validar o conteúdo de um instrumento ilustrado para avaliar o conhecimento de pessoas idosas sobre a prevenção do HIV/Aids. MÉTODO: Estudo metodológico realizado em três etapas: revisão da literatura, construção e validação de conteúdo. A validação foi realizada de acordo com o modelo de Pasquali. RESULTADOS: Da construção chegou-se a um instrumento com duas partes: caracterização da pessoa idosa e avaliação do conhecimento sobre a prevenção do HIV/Aids com 12 questões de múltipla escolha ("verdadeiro", "falso" e "não sei") ilustradas com imagens de idosos em situações quotidianas. Da validação com 10 juízes-especialistas atingiu-se o Índice de Validade de Conteúdo de 0,90. CONCLUSÃO: O instrumento construído foi considerado adequado pelos juízes e se apresenta como um dispositivo educacional para avaliar o conhecimento da pessoa idosa e, a partir disso, suscita ganhos para as intervenções de educação em saúde relativas à prevenção do HIV/Aids.

OBJECTIVE: To elaborate and validate the content of an illustrated instrument to assess older adults' knowledge about HIV/AIDS prevention. METHOD: A methodological study carried out in three stages: literature review, elaboration, and content validation. Validation was performed according to Pasquali's model. RESULTS: Elaboration of an instrument with two parts: characterization of the older adult and evaluation of the knowledge about HIV/AIDS prevention with 12 multiple-choice questions ("true", "false" and "I don't know"), illustrated with images of aged individuals in everyday situations. From the validation with 10 expert judges, a Content Validity Index of 0.90 was reached. CONCLUSION: The instrument elaborated was considered adequate by the judges and presents itself as an educational device to evaluate older adults' knowledge and, from this, it offers gains for health education interventions related to HIV/AIDS prevention.

OBJETIVO: Elaborar y validar el contenido de un instrumento ilustrado para evaluar el conocimiento de los adultos mayores sobre la prevención del VIH/SIDA. MÉTODO: Estudio metodológico realizado en tres etapas: revisión de la literatura, elaboración y validación de contenido. La validación se realizó según el modelo de Pasquali. RESULTADOS: A partir de la elaboración se llegó a un instrumento con dos partes: caracterización del adulto mayor y evaluación del conocimiento sobre la prevención del VIH/SIDA con 12 preguntas de opción múltiple ("verdadero", "falso" y "no sé") ilustrado con imágenes de personas mayores en situaciones cotidianas. La validación con 10 jueces expertos dio como resultado un índice de validez de contenido de 0,90. CONCLUSIÓN: El instrumento elaborado fue considerado adecuado por los jueces y se presenta como un dispositivo educativo para evaluar el conocimiento de los adultos mayores y, por ende, favorece las intervenciones de educación para la salud relacionadas con la prevención del VIH/SIDA.

Nurses' knowledge, attitudes and practices regarding hepatitis b: an integrative review / Conocimentos, actitudes y prácticas de enfermeros en relación a la hepatitis b: una revisión integradora / Conhecimento, atitudes e práticas de enfermeiros sobre hepatite b: revisão integrativa

ABSTRACT Objective: to analyze, in the literature, the nurses' knowledge, attitudes and practices regarding Hepatitis B. Method: an integrative review, with search and selection conducted independently by peers, after electronic queries in the CINAHL, MEDLINE, SCOPUS, Web of Science, LILACS, BDENF and IBECS databases in January 2021. The sample consisted in 15 primary studies published with no time or language restrictions. Analysis and synthesis of the results were carried out in a descriptive manner. Results: limitations in knowledge, inconsistent attitudes and commonly neglected assistance-related practices were identified, related to prevention, immunization and biosafety measures, to risk management and to monitoring of symptoms and complications, which contributed to greater occupational exposure. Among the associated factors, low participation in permanent education activities, training level, working conditions, limitations in the availability of immunization tests (anti-HBs) and underreporting of health problems stood out. Conclusion: the knowledge, attitudes and practices developed by nurses in relation to Hepatitis B proved to be limited and inconsistent, which may result in greater occupational exposure, as well as exert a direct impact on vaccination coverage and occurrence of incidents.

RESUMEN Objetivo: analizar, en la literatura, los conocimientos, las actitudes y las prácticas de los enfermeros en relación a la Hepatitis B. Método: revisión integradora, en la cual la búsqueda y la selección fueron realizadas por pares y de manera independiente, luego de consultas electrónicas en las siguientes bases de datos: CINAHL, MEDLINE, SCOPUS, Web of Science, LILACS, BDENF e IBECS en enero de 2021. La muestra estuvo compuesta por 15 estudios primarios publicados sin restricciones de tiempo o de idioma. El análisis y la síntesis de los resultados se realizaron en forma descriptiva. Resultados: se identificaron limitaciones en el conocimiento, actitudes inconsistentes y prácticas asistenciales comúnmente desatendidas, relacionadas con las medidas de prevención, inmunización y bioseguridad, y con la administración del riesgo y el monitoreo de síntomas y complicaciones, que contribuyeron a una mayor exposición ocupacional. Entre los factores asociados, se destacaron los siguientes: escasa participación en actividades de educación permanente, el nivel de formación, las condiciones laborales, las limitaciones en la disponibilidad de pruebas de inmunización (anti-HBs) y la subnotificación de problemas de salud. Conclusión: los conocimientos, las actitudes y las prácticas desarrolladas por los enfermeros, en relación con la Hepatitis B, demostraron ser limitados e inconsistentes, con la posibilidad de derivar en una mayor exposición ocupacional, al igual que de afectar directamente la cobertura de las vacunas y la frecuencia de incidentes.

RESUMO Objetivo: analisar, na literatura, o conhecimento, as atitudes e as práticas de enfermeiros sobre hepatite B. Método: revisão integrativa, com busca e seleção realizadas por pares e de forma independente, após consulta eletrônica às bases de dados CINAHL, MEDLINE, SCOPUS, Web of Science, LILACS, BDENF e IBECS em janeiro de 2021. A amostra foi constituída por 15 estudos primários publicados sem restrição temporal ou de idioma. A análise e a síntese dos resultados ocorreram de forma descritiva. Resultados: foram identificadas limitações no conhecimento, atitudes inconsistentes e práticas assistenciais comumente negligenciadas, relacionadas às medidas de prevenção, imunização e biossegurança, ao gerenciamento de risco e monitoramento de sintomas e complicações, que contribuíram para uma maior exposição ocupacional. Dentre os fatores associados, destacaram-se a baixa participação em atividades de educação permanente, o nível de formação, as condições laborais, as limitações na disponibilização de testes de imunização (anti-HBs) e a subnotificação de agravos. Conclusão: o conhecimento, as atitudes e as práticas desenvolvidos por enfermeiros, relacionados à hepatite B, mostraram-se limitados e inconsistentes, podendo resultar na maior exposição ocupacional, assim como impactar diretamente a cobertura vacinal e a ocorrência de incidentes.

Effectiveness of educational interventions in knowledge, attitude, and practice for preventing respiratory infections: a systematic review and meta-analysis / Efectividad de las intervenciones educativas en conocimiento, actitud y práctica para la prevención de infecciones respiratorias: revisión sistemática y metaanálisis / Efetividade de intervenções educacionais na prevenção das infecções respiratórias: revisão sistemática e metanálise

ABSTRACT Objectives: to demonstrate the effectiveness of educational interventions in knowledge, attitude and practice for preventing respiratory infections in adults and older adults. Methods: this is a systematic review carried out in 11 databases. Primary studies, without language and time restrictions, of the randomized, non-randomized and before-and-after clinical trial type, were selected. The risk of bias was assessed by two independent researchers, and the methodological quality was generated by the Grading of Recommendations, Assessment, Development and Evaluation. Results: the intervention effectiveness was evidenced in seven studies. The results of the random effects meta-analysis show that there is a statistically significant difference between knowledge about preventing respiratory diseases, with an OR of 2.82 (95%CI 1.70 to 4.69) for the occurrence of events represented by improved knowledge. Conclusions: most studies show the effectiveness of educational interventions, which was determined through the Knowledge, Attitude and Practice survey.

RESUMEN Objetivos: demostrar la efectividad de las intervenciones educativas en conocimiento, actitud y práctica para la prevención de infecciones respiratorias en adultos y ancianos. Métodos: revisión sistemática realizada en 11 bases de datos. Se seleccionaron los estudios primarios, sin restricciones de idioma y marco de tiempo, del tipo de ensayo clínico aleatorizado, no aleatorizado y de tipo antes y después. El riesgo de sesgo fue evaluado por dos investigadores independientes y la calidad metodológica fue generada por el Grading of Recommendations, Assessment, Development and Evaluation. Resultados: la efectividad de la intervención se evidenció en siete estudios. Los resultados del metanálisis de efectos aleatorios muestran que existe una diferencia estadísticamente significativa entre el conocimiento sobre la prevención de enfermedades respiratorias, con un OR de 2,82 (IC del 95%: 1,70 a 4,69) para la aparición de eventos representados por un conocimiento mejorado. Conclusiones: la mayoría de los estudios muestran la efectividad de las intervenciones educativas, la cual se determinó a través de la encuesta Conocimiento, Actitud y Práctica.

RESUMO Objetivos: evidenciar a efetividade das intervenções educacionais no conhecimento, atitude e prática para a prevenção de infecções respiratórias em adultos e idosos. Métodos: revisão sistemática, realizada em 11 bases de dados. Selecionaram-se estudos primários, sem restrição de idiomas e de recorte temporal, do tipo ensaio clínico randomizado, não randomizado e antes e depois. O risco de viés foi avaliado por dois pesquisadores independentes, e a qualidade metodológica foi gerada pelo Grading of Recommendations, Assessment, Development and Evaluation. Resultados: a efetividade da intervenção foi evidenciada em sete estudos. Os resultados da metanálise de efeitos aleatórios mostram que existe diferença estatisticamente significativa entre o conhecimento sobre prevenção de doenças respiratórias, com OR de 2,82 (IC95% 1,70 a 4,69) para a ocorrência de eventos representados por melhora de conhecimento. Conclusões: a maioria dos estudos evidencia a efetividade das intervenções educacionais, a qual foi determinada por meio do inquérito Conhecimento, Atitude e Prática.

Jogo de tabuleiro como dispositivo de informação sobre hiv/aids para idosos / Board game as an information device on hiv/aids for aged individuals / Juego de mesa como recurso de información sobre vih/sida para ancianos

RESUMO Objetivo: validar o jogo de tabuleiro "Mural do Risco" sobre prevenção do Vírus da Imunodeficiência Humana/Síndrome da Imunodeficiência Adquirida entre idosos estudantes da Educação de Jovens e Adultos. Método: estudo metodológico desenvolvido no estado de Recife, Brasil, que validou o conteúdo do jogo e do guia de uso entre setembro e novembro de 2020 via e-mail. Participaram 27 juízes da área da saúde e 18 de outras áreas. Dados analisados por estatística descritiva para obtenção do Índice de Validade de Conteúdo e Escore Suitability Assessment of Materials. Resultados: ambos obtiveram Índice de Validade de Conteúdo de 0,90; o Escore Suitability Assessment of Materials foi de 22 pontos e do guia 24. Houve reestruturação das imagens, priorizando clareza, tamanho e relações com o idoso. Conclusão: o jogo e o guia estão adequados e, após o registro, poderão mediar práticas educacionais de prevenção do Vírus da Imunodeficiência Humana/Síndrome da Imunodeficiência Adquirida com idosos no contexto escolar.

ABSTRACT Objective: to validate the board game called "Mural do Risco" ("Risk Wall") on the prevention of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome among aged individuals attending Youth and Adults Education. Method: a methodological study developed in the state of Recife, Brazil, which validated the content of the game and its user's guide from September to November 2020 via e-mail. The participants were 27 evaluators from the health area and another 18 from other fields. The data were analyzed by means of descriptive statistics to obtain the Content Validity Index and the Suitability Assessment of Materials score. Results: both obtained a Content Validity Index of 0.90; and the Suitability Assessment of Materials score was 22 points for the game and 24 for the guide. The images were restructured, prioritizing clarity, size and relationships with aged individuals. Conclusion: the game and the guide are adequate and, after registration, they will be able to mediate educational practices to prevent Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome among aged individuals in the school context.

RESUMEN Objetivo: validar el juego de mesa "Mural do Risco" ("Muro del riesgo") sobre prevención del Virus de la Inmunodeficiencia Humana/Síndrome de Inmunodeficiencia Adquirida entre ancianos estudiantes de la Educación de Jóvenes y Adultos. Método: estudio metodológico desarrollado en el estado de Recife, Brasil, que validó el contenido del juego y de la guía del usuario entre septiembre y noviembre de 2020 por correo electrónico. Los participantes fueron 27 evaluadores del área de la salud y 18 de otros campos. Los datos se analizaron por medio de estadística descriptiva para obtener el Índice de Validez de Contenido y la puntuación Suitability Assessment of Materials. Resultados: tanto el juego como la guía obtuvieron un Índice de Validez de Contenido de 0,90; las puntuaciones Suitability Assessment of Materials fueron 22 puntos para el juego y 24 para la guía. Se reestructuraron las imágenes, priorizando la claridad, el tamaño y las relaciones con los ancianos. Conclusión: el juego y la guía son adecuados y, tras su registro, podrán mediar prácticas educativas de prevención del Virus de la Inmunodeficiencia Humana/Síndrome de Inmunodeficiencia Adquirida con ancianos en el contexto escolar.

Application of Data Mining Algorithms for Dementia in People with HIV/AIDS.

Dementia interferes with the individual's motor, behavioural, and intellectual functions, causing him to be unable to perform instrumental activities of daily living. This study is aimed at identifying the best performing algorithm and the most relevant characteristics to categorise individuals with HIV/AIDS at high risk of dementia from the application of data mining. Principal component analysis (PCA) algorithm was used and tested comparatively between the following machine learning algorithms: logistic regression, decision tree, neural network, KNN, and random forest. The database used for this study was built from the data collection of 270 individuals infected with HIV/AIDS and followed up at the outpatient clinic of a reference hospital for infectious and parasitic diseases in the State of Ceará, Brazil, from January to April 2019. Also, the performance of the algorithms was analysed for the 104 characteristics available in the database; then, with the reduction of dimensionality, there was an improvement in the quality of the machine learning algorithms and identified that during the tests, even losing about 30% of the variation. Besides, when considering only 23 characteristics, the precision of the algorithms was 86% in random forest, 56% logistic regression, 68% decision tree, 60% KNN, and 59% neural network. The random forest algorithm proved to be more effective than the others, obtaining 84% precision and 86% accuracy.

Tecnologia educacional para idosos sobre prevenção do HIV/AIDS: validação semântica / Educational technology on HIV/AIDS prevention for older adults: semantic validation / Tecnología educativa para adultos mayores sobre prevención del VIH/SIDA: validación semántica

OBJETIVO: Validar a aparência do jogo de tabuleiro "Mural do Risco" sobre prevenção do HIV/aids com idosos em contexto escolar. MÉTODO: Estudo metodológico de validação semântica/de aparência com o público-alvo/idosos em contexto escolar, guiado pelo modelo de Pasquali. Aplicou-se instrumento com 20 itens referentes aos domínios objetivo, organização, estilo da escrita, aparência e motivação. A coleta de dados, realizada de modo síncrono com dez pessoas idosas, ocorreu em janeiro e fevereiro de 2021. Para a análise, considerou-se um Índice de Concordância Semântica mínimo igual ou superior a 0,80. RESULTADO: Todos os itens obtiveram Índice de Concordância Semântico igual ou superior a 0,80 e as sugestões foram acatadas integralmente, o que possibilitou a estruturação da versão final do jogo. CONCLUSÃO: O processo de validação de aparência realizado com o público idoso em contexto escolar evidenciou que o jogo de tabuleiro "Mural do Risco" está adequado.

OBJECTIVE: To validate the appearance of the board game entitled "Mural do Risco" ("Risk Wall") on HIV/AIDS prevention with older adults in a school context. METHOD: A methodological study of semantic/face validation with older adults in a school context as target audience, guided by Pasquali's model. An instrument with 20 items referring to the objective, organization, writing style, appearance, and motivation domains was applied. Data collection, carried out synchronously with 10 older adults, took place in January and February 2021. For the analysis, a minimum Semantic Agreement Index equal to or above 0.80 was considered. RESULT: All the items obtained a Semantic Agreement Index equal to or above 0.80 and the suggestions were fully accepted, which made it possible to structure the final version of the game. CONCLUSION: The face validation process carried out with the aged population in a school context evidenced that the board game entitled "Mural do Risco" is adequate.

OBJETIVO: Validar el aspecto del juego de mesa "Mural do Risco" sobre la prevención del VIH/SIDA con adultos mayores en el ámbito educativo. MÉTODO: Estudio metodológico de validación semántica/de aspecto con público objetivo/adultos mayores en ámbito educativo, guiado por el modelo de Pasquali. Se aplicó un instrumento con 20 ítems referidos a los dominios: objetivo, organización, estilo de redacción, aspecto y motivación. La recolección de datos, realizada sincrónicamente con diez adultos mayores, ocurrió en enero y febrero de 2021. Para el análisis se consideró un Índice de Concordancia Semántica mínimo igual o superior a 0,80. RESULTADO: Todos los ítems obtuvieron un Índice de Concordancia Semántica igual o superior a 0,80 y las sugerencias fueron aceptadas en su totalidad, lo que permitió estructurar la versión final del juego. CONCLUSIÓN: El proceso de validación de aspecto realizado con adultos mayores en un ámbito educativo demostró que el juego de mesa "Mural do Risco" es adecuado.

Proteomic research and diagnosis in bladder cancer: state of the art review.

PURPOSE: Proteomic biomarkers have been emerging as alternative methods to the gold standard procedures of cystoscopy and urine cytology in the diagnosis and surveillance of bladder cancer (BC). This review aims to update the state of the art of proteomics research and diagnosis in BC. MATERIALS AND METHODS: We reviewed the current literature related to BC research on urinary, tissue, blood and cell line proteomics, using the Pubmed database. FINDINGS: Two urinary protein biomarkers are FDA-approved (NMP22® and BTA® tests), only if performed along with cystoscopy for surveillance after initial diagnosis, but not in the primary diagnostic setting due to high false-positive rates in case of infections, stones and hematuria. There are a great number of non-FDA approved proteins being studied, with good preliminary results; panels of proteins seem valuable tools to be refined in ongoing trials. Blood proteins are a bigger challenge, because of the complexity of the serum protein profile and the scarcity of blood proteomic studies in BC. Previous studies with the BC tissue proteome do not correlate well with the urinary proteome, likely due to the tumor heterogeneity. Cell line proteomic research helps in the understanding of basic mechanisms that drive BC development and progression; the main difficulty is culturing low-grade tumors in vitro, which represents the majority of BC tumors in clinical practice. CONCLUSION: Protein biomarkers have promising value in the diagnosis, surveillance and prognostic of BC. Urine is the most appropriate body fluid for biomarker research in BC due to its easiness of sampling, stability and enrichment of shed and secreted tumor-specific proteins. Panels of biomarkers may exhibit higher sensitivity than single proteins in the diagnosis of BC at larger populations due to clinical and tumor heterogeneity. Prospective clinical trials are warranted to validate the relevance of proteomic data in the clinical management of BC.

Fatal trauma injuries in a Brazilian big metropolis: a study of autopsies.

OBJECTIVE: This study aims to review a series of deaths by trauma in a large metropolis. The intention is to identify preventable causes of death. METHODS: We prospectively studied 500 unselected and consecutive cases of death associated with trauma. The study variables were: mechanism of injury, etiology, site of injury, surgical intervention, medical malpractice, damaged organs and the prevention of mortality. The cases were grouped according to the mechanism of injury in: penetrating trauma, blunt trauma, poisoning, drowning, burns and suffocation. RESULTS: We examined 418 (83.6%) males and 82 (16.4%) females (mean age 39 ± 19.6 years, ranging from three to 91 years). Penetrating trauma accounted for 217 (43%) cases, while blunt trauma accounted for 40% of cases. The most common mechanism of injury in death by penetrating trauma was gunshot, representing 41% of cases. Within the set of blunt trauma, the most common mechanism was traffic accident, which represented 22% of total deaths. There were 71 (14%) cases of preventable deaths: thromboembolism in 35 (7%), infectious complications in 25 (5%), medical malpractice in seven (1%) and treatable lesions in outpatients in five (1%). CONCLUSION: This study shows that traumatic death in the city of São Paulo is associated with serious and complex injuries. Prevention of these types of death would be related to the control of violence.

Lesões fatais em trauma numa grande metrópole Brasileira: um estudo de autópsias / Fatal trauma injuries in a Brazilian big metropolis: a study of autopsies

OBJETIVO: Este estudo tem o objetivo revisar uma série de mortes por trauma em uma grande metrópole. A intenção é identificar as causas evitáveis de morte. MÉTODOS: Foram estudados prospectivamente 500 casos não selecionados e consecutivos de morte associada ao trauma. As variáveis do estudo foram as seguintes: mecanismo do trauma, etiologia, local da morte, a intervenção cirúrgica, imperícia médica, órgãos lesados e prevenção da mortalidade. Os casos foram agrupados, segundo o mecanismo de trauma, em: trauma penetrante, trauma contuso, intoxicação, afogamento, queimadura e asfixia. RESULTADOS: Foram abordados 418 (83,6 por cento) casos do sexo masculino e 82 (16,4 por cento) do sexo feminino (média de idade 39 ± 19,6 anos, variando de três a 91 anos). O trauma penetrante correspondeu a 217 (43 por cento) casos; já o trauma contuso representou 40 por cento dos casos. O mecanismo de trauma mais comum de morte entre o trauma penetrante foi lesão por arma de fogo, representando 41 por cento do total de casos. Dentro do conjunto dos traumas contusos, o mecanismo mais comum foi o de acidentes de transporte, o que representou 22 por cento do total de óbitos. Aconteceram 71 (14 por cento) casos de mortes evitáveis: tromboembolismo em 35 (7 por cento); complicações infecciosas em 25 (5 por cento), imperícia médica em sete (1 por cento) e lesões tratáveis em pacientes não hospitalizados cinco (1 por cento). CONCLUSÃO: Este estudo mostra que a morte traumática, na cidade de São Paulo, está associada à lesões graves e complexas. Prevenção da morte está relacionada ao controle da violência.

OBJECTIVE: This study aims to review a series of deaths by trauma in a large metropolis. The intention is to identify preventable causes of death. METHODS: We prospectively studied 500 unselected and consecutive cases of death associated with trauma. The study variables were: mechanism of injury, etiology, site of injury, surgical intervention, medical malpractice, damaged organs and the prevention of mortality. The cases were grouped according to the mechanism of injury in: penetrating trauma, blunt trauma, poisoning, drowning, burns and suffocation. RESULTS: We examined 418 (83.6 percent) males and 82 (16.4 percent) females (mean age 39 ± 19.6 years, ranging from three to 91 years). Penetrating trauma accounted for 217 (43 percent) cases, while blunt trauma accounted for 40 percent of cases. The most common mechanism of injury in death by penetrating trauma was gunshot, representing 41 percent of cases. Within the set of blunt trauma, the most common mechanism was traffic accident, which represented 22 percent of total deaths. There were 71 (14 percent) cases of preventable deaths: thromboembolism in 35 (7 percent), infectious complications in 25 (5 percent), medical malpractice in seven (1 percent) and treatable lesions in outpatients in five (1 percent). CONCLUSION: This study shows that traumatic death in the city of São Paulo is associated with serious and complex injuries. Prevention of these types of death would be related to the control of violence.

Duodenal bypass does not decrease glucose levels of lean individuals with gastric cancer submitted to partial or total gastrectomy.

Change in glucose metabolism after bariatric operations may be credited to duodenal bypass. This study aims to evaluate the effect of duodenal bypass on glucose levels in lean individuals submitted to gastrectomy for gastric cancer. We reviewed 56 non-diabetic and 6 diabetic patients submitted to gastrectomy and Roux-en-Y for gastric cancer (partial gastrectomy in 66%/total gastrectomy in 34%). Glucose levels were not significantly altered after operation (P = 0.5). Diabetes control was improved in one patient with oral medication. In conclusion, duodenal bypass do not decrease glucose levels in lean individuals treated for gastric cancer.

Gastrectomy and lymphadenectomy for gastric cancer: is the pancreas safe?

INTRODUCTION: Resection of the capsule of the pancreas is part of the radical operation proposed by oriental authors for the treatment of gastric cancer. It is unclear; however, if resection of the capsule is a safe procedure or even if it is necessary. This study aims to assess in patients treated for gastric cancer the occurrence of: (a) pancreatic fistula and (b) metastasis to the pancreatic capsule. METHODS: We studied 80 patients (mean age 61 years, 42 males) submitted to gastrectomy with resection of the pancreatic capsule by hydrodissection. Patients with pancreatic disease, tumoral invasion of the pancreas, submitted to concomitant splenectomy, or anastomotic leakage were excluded. The tumor was located in the distal third of the stomach in 60% of the patients, in the middle third in 27%, and proximally in 12%. Total gastrectomy was performed in 27% of the cases and partial gastrectomy in 73%. In all patients, amylase activity in the drainage fluid was measured on day 2. If initial measurement was abnormal, subsequent measurements were performed in alternated days until normalization. Pancreatic fistula was defined as amylase levels greater than 600. In 25 of these patients (mean age 53 years, 16 males), the pancreatic capsule was histologically analyzed for metastasis. RESULTS: Pancreatic fistula was diagnosed in eight (10%) patients. The mean amylase level was 5,863. Normalization of amylase levels was achieved within 7 days in all patients. No patient developed clinical signs of fistula besides abnormal amylase levels in the drainage fluid, such as intra-abdominal abscesses. Pancreatic fistula was associated to younger age (p = 0.03) but not to gender (p = 0.1), tumor location (p = 0.6), and type of gastrectomy (p = 0.8). Metastasis to the pancreatic capsule was not identified. CONCLUSION: In conclusion, resection of the pancreatic capsule must be discouraged due to subclinical pancreatic fistula in a significant number of the cases and absence of metastasis.

Surgical treatment of primary esophageal motility disorders.

Named primary esophageal motility disorders (PEMD) present with specific manometric patterns classified as: (1) hypertensive lower esophageal sphincter, (2) nutcracker esophagus (also hypercontratile, hypertensive, or hypercontracting esophagus), (3) diffuse esophageal spasm, and (4) achalasia. These conditions, with the exception of achalasia, are rare, poorly understood, and inadequately studied. Treatment of these conditions is based on symptoms and aimed at symptomatic improvement. The authors reviewed current literature on surgical treatment of non-achalasia PEMD. The review shows that: (a) surgical therapy may be an attractive alternative in patients with PEMD; (b) proper selection of patients based on symptoms evaluation and esophageal function tests is essential; (c) laparoscopic myotomy with proximal extent tailored to manometric findings seems to be the ideal surgical therapy; and (d) esophagectomy may be necessary as a last resource due to multiple failures of surgical conservative treatment.

Estágio de doutorando (sanduíche) em enfermagem: uma experiência em Portugal / Sandwich nursing doctorate?s period of training: an experience in Portugal / Etapa del doctorado de enfermería: una experiencia en Portugal

Durante o transcorrer do nosso aprimoramento científico, pessoal e profissional, no curso de Doutorado fomos contempladas pela Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), por meio de concurso nacional, com um Estágio de Doutorando (Sanduíche) na cidade do Porto, em Portugal. O desenvolvimento do Projeto O Cuidado Humanístico de Enfermagem ao Recém-Nascido na Unidade de Internação Neonatal: experiência de intercâmbio em Portugal, ocorreu no período de setembro a dezembro de 2005 e constou de uma observação participante junto a 10 enfermeiros de Unidades de Cuidados Intensivos Neonatais, atuantes em duas instituições hospitalares da cidade do Porto, quanto aos cuidados ao recém-nascido, sob a perspectiva humanística à luz da Teoria Humanística de Enfermagem, de Paterson e Zderad (1976). Ressaltamos a importância deste intercâmbio para a ampliação da Enfermagem Neonatal e o crescimento humano e profissional dos enfermeiros como capazes de repensar o fazer e o ser e participar, com todos os envolvidos, de uma nova maneira de cuidar de forma humanizada em Enfermagem, na pesquisa e no ensino.

During the course of our scientific improvement, personal and professional development in the Doctorate Course we were contemplated by the Coordination of Postgraduate Personnel Improvement (CAPES), through a national contest, with a (Sandwich) Doctorate Period of Training in the city of Porto, Portugal. The development of the project Nursing Humanistic Care to the Newborn in the Neonatal Care Unit: interchange experience in Portugal, was held in the period from September through December 2005 and was composed of a participant observation with 10 nurses from Neonatal Intensive Care Units, acting in two hospitals of Porto, about the care to newborns, on the humanistic perspective in the light of the Nursing Humanistic Theory, of Paterson and Zderad (1976). We highlight the importance of this interchange for the enhancement of the Neonatal Nursing and the human and professional growth of the nurses as able to rethink the do and the be and participate, with all the people involved, of a new way to take care in a humanized way in Nursing, in the research and in the teaching.

Durante el transcurrir de nuestro aprimoramiento científico, personal y además profesional, en el curso de Doctorado fuimos contemplados por la Coordinação de Perfeccionamiento de Personal de Nivel Superior (CAPES), a través de concurso nacional, con un Etapa del Doctorado en una otra institución, en la ciudad del Porto, en Portugal. El desarrollo del Proyecto La Atención Humanística de Enfermería al Recién Nacido en la Unidad de Internación Neonatal: experiencia de intercambio en Portugal, ocurrió en el período de septiembre a diciembre de 2005 y constó de una observación participante junto a 10 enfermeros de Unidades de Atenciones Intensivas Neonatales, actuantes en dos instituciones hospitalares de la ciudad de Porto, mientras a las atenciones al recién nacido, bajo la perspectiva humanística a la luz de la Teoría Humanística de Enfermería, de Paterson y Zderad (1976). Así, resaltamos la importancia de este intercambio para la ampliación de la Enfermería Neonatal y el crescimiento humano y profesional de los enfermeros como capaces de pensar una vez más lo hacer y lo ser y además participar con todos los envueltos de una nueva manera de cuidar de forma humanizada en Enfermería, ahora en la investigación y en la enseñanza.