Modifiable behavioral risk factors for NCDs and sleep in Brazilian adolescents.

OBJECTIVE: To analyze the association between modifiable behavioral risk factors for non-communicable diseases and sleep parameters in Brazilian adolescents. METHODS: This was a cross-sectional study that used data from the RPS Cohort Consortium, São Luís, Brazil for the follow-up of adolescents aged 18-19 years (n = 2,515). The outcomes were excessive daytime sleepiness (Epworth Sleepiness Scale - ESS) and sleep quality (Pittsburgh Sleep Quality Index - PSQI). The exposures of interest were the behavioral risk factors for non-communicable diseases (NCDs): screen time, physical inactivity, alcohol, smoking, illicit drugs, caffeine intake, and consumption of sugar-sweetened beverages. Excess weight was considered a possible mediator of this association between the exposures of interest and the outcomes. The models were analyzed by modeling with structural equations. RESULTS: Physical inactivity (standardized coefficient, SC = 0.112; p = 0.001), higher consumption of alcohol (SC = 0.168; p = 0.019) and of sugar-sweetened beverages (SC = 0.128; p < 0.001) were associated with excessive daytime sleepiness in adolescents; better socioeconomic status was also associated with this outcome (SC = 0.128; p < 0.001). Physical inactivity (SC = 0.147; p < 0.001) and higher consumption of sugar-sweetened beverages (SC = 0.089; p = 0.003) were also associated with poor sleep quality. Overweight was neither a mediator nor associated with sleep quality or excessive daytime sleepiness. CONCLUSIONS: The main modifiable behavioral risk factors for NCDs are associated with worse sleep parameters already in adolescence, which serves as a warning toward the accumulation of risks for sleep disorders in the future.

Modifiable behavioral risk factors for NCDs and sleep in Brazilian adolescents / Fatores de risco comportamentais modificáveis para DNT e sono em adolescentes brasileiros

ABSTRACT OBJECTIVE To analyze the association between modifiable behavioral risk factors for non-communicable diseases and sleep parameters in Brazilian adolescents. METHODS This was a cross-sectional study that used data from the RPS Cohort Consortium, São Luís, Brazil for the follow-up of adolescents aged 18-19 years (n = 2,515). The outcomes were excessive daytime sleepiness (Epworth Sleepiness Scale - ESS) and sleep quality (Pittsburgh Sleep Quality Index - PSQI). The exposures of interest were the behavioral risk factors for non-communicable diseases (NCDs): screen time, physical inactivity, alcohol, smoking, illicit drugs, caffeine intake, and consumption of sugar-sweetened beverages. Excess weight was considered a possible mediator of this association between the exposures of interest and the outcomes. The models were analyzed by modeling with structural equations. RESULTS Physical inactivity (standardized coefficient, SC = 0.112; p = 0.001), higher consumption of alcohol (SC = 0.168; p = 0.019) and of sugar-sweetened beverages (SC = 0.128; p < 0.001) were associated with excessive daytime sleepiness in adolescents; better socioeconomic status was also associated with this outcome (SC = 0.128; p < 0.001). Physical inactivity (SC = 0.147; p < 0.001) and higher consumption of sugar-sweetened beverages (SC = 0.089; p = 0.003) were also associated with poor sleep quality. Overweight was neither a mediator nor associated with sleep quality or excessive daytime sleepiness. CONCLUSIONS The main modifiable behavioral risk factors for NCDs are associated with worse sleep parameters already in adolescence, which serves as a warning toward the accumulation of risks for sleep disorders in the future.

RESUMO OBJETIVO Analisar a associação entre fatores de risco comportamentais modificáveis para doenças não transmissíveis e parâmetros do sono em adolescentes brasileiros. MÉTODOS Estudo transversal que utilizou dados do Consórcio de Coortes RPS, São Luís, Brasil para o seguimento de adolescentes de 18-19 anos (n = 2.515). Os desfechos foram a sonolência diurna excessiva (Escala de Sonolência de Epworth - ESE) e a qualidade do sono (Índice de Qualidade do Sono de Pittsburgh - IQSP). As exposições de interesse foram os fatores de risco comportamentais para doenças não transmissíveis (DNT): tempo de tela, inatividade física, álcool, cigarro, drogas ilícitas, consumo de cafeína, consumo de bebidas adoçadas com açúcar. O excesso de peso foi considerado um possível mediador dessa associação entre as exposições de interesse e os desfechos. Os modelos foram analisados por modelagem com equações estruturais. RESULTADOS A inatividade física (Coeficiente padronizado, CP = 0,112; p = 0,001), maior consumo de álcool (CP = 0,168; p = 0,019) e de bebidas adoçadas com açúcar (CP = 0,128; p < 0,001) foram associados a sonolência diurna excessiva nos adolescentes; a melhor situação socioeconômica também foi associada a este desfecho (CP = 0,128; p < 0,001). A inatividade física (CP = 0,147; p < 0,001) e o maior consumo de bebidas adoçadas com açúcar (CP = 0,089; p = 0,003) também se associaram com a qualidade do sono ruim. O excesso de peso não foi mediador e nem associado à qualidade do sono ou à sonolência diurna excessiva. CONCLUSÕES Os principais fatores de risco comportamentais modificáveis para DNT estão associados a piores parâmetros do sono já na adolescência; alertando para um quadro de acúmulos de riscos para distúrbios de sono no futuro.

Reabilitação Respiratória para pacientes submetidos à cirurgia torácica e abdominal / Respiratory rehabilitation for patients submitted to thoracic and abdominal surgery

Objetivo: descrever a experiência relacionada a reabilitação respiratória para pacientes submetidos à cirurgia torácica e abdominal superior durante a execução de um programa de extensão universitária. Método: relato de experiência, com abordagem descritiva, sobre a criação de um programa interdisciplinar de reabilitação respiratória para pacientes submetidos à cirurgia torácica e abdominal superior com parceria entre universidade pública e hospital municipal de Imperatriz, Maranhão. Resultados: as atividades do programa universitário de reabilitação respiratória para pacientes em pós-operatório são desempenhadas em três eixos in locus: Educação em Exercícios Respiratórios, Capacitação sobre assistência de enfermagem no pós-operatório de cirurgias torácicas e abdominais e, Educação em saúde e intervenções de enfermagem na atenção ao paciente no período pós-operatório. Conclusão: a atuação em projeto respiratório interdisciplinar, focado em ações educativas, mostrou-se uma ferramenta inovadora de apoio ao cuidado clínico de pacientes submetidos à cirurgia torácica e abdominal superior. (AU)

Objective: To describe the experience related to respiratory rehabilitation for patients undergoing thoracic and upper abdominal surgery during the execution of a university extension program. Methods: Experience report, with a descriptive approach, on the creation of an interdisciplinary program of respiratory rehabilitation for patients undergoing thoracic and upper abdominal surgery in partnership with a public university and a municipal hospital in Imperatriz, Maranhão. Results: The activities of the university respiratory rehabilitation program for patients in the postoperative period are performed in three axes in locus: Education in Respiratory Exercises, Training in nursing care in the postoperative period of thoracic and abdominal surgeries, and Health education and interventions nursing in patient care in the postoperative period. Conclusion: Acting in an interdisciplinary respiratory project, focused on educational actions, proved to be an innovative tool to support the clinical care of patients undergoing thoracic and upper abdominal surgery. (AU)

Objetivo: Describir la experiencia relacionada con la rehabilitación respiratoria para pacientes sometidos a cirugía torácica y abdominal superior durante la ejecución de un programa de extensión universitaria. Métodos: Informe de experiencia, con un enfoque descriptivo, sobre la creación de un programa interdisciplinario de rehabilitación respiratoria para pacientes sometidos a cirugía torácica y abdominal superior en colaboración con una universidad pública y un hospital municipal en Imperatriz, Maranhão. Resultados: Las actividades del programa universitario de rehabilitación respiratoria para pacientes en el postoperatorio se realizan en tres ejes en el locus: educación en ejercicios respiratorios, capacitación en cuidados de enfermería en el postoperatorio de cirugías torácicas y abdominales, y educación e intervenciones de salud enfermería en atención al paciente en el postoperatorio. Conclusión: Actuar en un proyecto respiratorio interdisciplinario, centrado en acciones educativas, demostró ser una herramienta innovadora para apoyar la atención clínica de pacientes sometidos a cirugía torácica y abdominal superior. (AU)

Leprosy in children under 15 years of age in a municipality in northeastern Brazil: evolutionary aspects from 2003 to 2015.

INTRODUCTION: The Integrated Program of Leprosy Control was initiated in 2003 in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy. Here, we present the evolution of the indicators of leprosy within the established period in children aged <15 years. METHODS: This is a descriptive study based on an active search for cases and spontaneous healthcare demand for leprosy, with an evolutionary analysis of the detection coefficient of new cases. We considered individuals aged <15 years diagnosed with leprosy from January 2003 to December 2015. To evaluate the factors associated with clinical and operational forms, Chi-square, Fisher's exact, or Fisher-Freeman-Halton tests were performed. RESULTS: A total of 61 new cases were detected (6.9% of the total leprosy cases diagnosed in the municipality during the study period), and the majority was found in males (62.3%). The most frequent operational classification was paucibacillary (67.2%), and this association increased with age. The tuberculoid clinical form was the most prevalent in both sexes and in the age range of 10 to <15 years. There was a reduction in the detection coefficient from 21.84/100,000 inhabitants in 2003 to 2.79/100,000 in 2015. CONCLUSIONS: Despite the progress in the control of leprosy, this historical series shows that it is necessary to strengthen educational measures and implement control actions, so that the disease ceases to be a public health problem in the population aged <15 years.

Effect of early determinants on adolescent fat-free mass: RPS cohort of São Luís - MA.

OBJECTIVE: To analyze the effects of early determinants on adolescent fat-free mass. METHODS: A cohort study with 579 adolescents evaluated at birth and adolescence in a birth cohort in São Luís, Maranhão. In the proposed model, estimated by structural equation modeling, socioeconomic status (SES) at birth, maternal age, pregestational body mass index (BMI), gestational smoking, gestational weight gain, type of delivery, gestational age, sex of the newborn, length and weight at birth, adolescent socioeconomic status, "neither study/nor work" generation, adolescent physical activity level and alcohol consumption were tested as early determinants of adolescent fat-free mass (FFM). RESULTS: A higher pregestational BMI resulted in higher FFM in adolescence (Standardized Coefficient, SC = 0.152; p < 0.001). Being female implied a lower FFM in adolescence (SC = -0.633; p < 0.001). The negative effect of gender on FFM was direct (SC = -0.523; p < 0.001), but there was an indirect negative effect via physical activity level (SC = -0.085; p < 0.001). Women were less active (p < 0.001). An increase of 0.5 kg (1 Standard Deviation, SD) in birth weight led to a gain of 0.25 kg/m2 (0.106 SD) in adolescent FFM index (p = 0.034). Not studying or working had a negative effect on the adolescent's FFM (SC = -0.106; p = 0.015). Elevation of 1 SD in the adolescent's physical activity level represented an increase of 0.5 kg/m2 (0.207 SD) in FFM index (p < 0.001). CONCLUSIONS: The early determinants with the greatest effects on adolescent FFM are gender, adolescent physical activity level, pregestational BMI, birth weight and belonging to the "neither-nor" generation.

Nursing outcome "airway permeability" in postoperative patients.

OBJECTIVES: to evaluate the evolution of clinical indicators that characterize airway permeability in patients in the postoperative period of thoracoabdominal surgeries and to analyze their relationship with the occurrence of the diagnosis "ineffective airway clearance". METHODS: descriptive, quantitative, longitudinal research with 60 patients who were followed for five consecutive days. Eleven indicators of the nursing outcome "respiratory status: airway permeability" were used. RESULTS: on the first day of evaluation, the most compromised indicators were: respiratory rate, cough, depth of breath and use of accessory muscles. During follow-up, most of the indicators presented a slight deviation from normal variation and, in the last evaluation, there was a predominance of indicators with some degree of impairment. CONCLUSIONS: with the aid of the Nursing Outcomes Classification, it was observed that patients submitted to thoracoabdominal surgeries may present compromised airway permeability even days after surgery.

Asociación entre diagnósticos e intervenciones de enfermeras en pacientes sometidos a cirugía torácica o abdominal superior / Associations between respiratory nursing diagnoses and nursing interventions in patients submitted to thoracic or upper abdominal surgery

Objetivo: Determinar la asociación entre diagnósticos de enfermería respiratorios e intervenciones de enfermería en pacientes sometidos a cirugía toráícica o abdominal superior. Método: Estudio cuantitativo y transversal. Los participantes fueron 312 pacientes dentro de las primeras 48 horas después de cirugía torácica o del abdomen superior. Los pacientes fueron exminados por el equipo de investigación utilizando un instrumento con variables relacionadas con la función respiratoria. El equipo de investigación estableció la presencia de tres diagnósticos de enfermería e intervenciones usando la clasificación NANDA-I y la Clasificación de Intervenciones de Enfermería. Las correlaciones se analizaron con la prueba de chi-cuadrado o de Fisher. Resultados: Del total de 312 evaluaciones, la limpieza ineficaz de las vías aéreas estuvo presente en 185 evaluaciones (59,3%), patrón respiratorio ineficaz en 123 (39,4%) y deterioro del intercambio gaseoso en 141 (45,4). Los pacientes con limpieza ineficaz de las vías aéreas tenían más probabilidades de requerir manejo del dolor (OR: 2,27), fisioterapia torácica (OR: 2,96) y posicionamiento (OR: 1,8), mientras que los pacientes con deterioro del intercambio gaseoso tenían menos probabilidades de necesitar de manejo de las vías aéreas (OR: 0,13) y fisioterapia (OR: 0,28). Conclusiones: Aquellos pacientes con el diagnóstico de enfermería de limpieza ineficaz de las vias aéreas presentaron asociación con las intervenciones manejo del dolor, fisioterapia y posicionamiento, mientras el diagnóstico deterioro del intercambio gaseoso estuvo asociado con la intervención manejo de las vías aéreas y fisioterapia. Los resultados proporcionan una base para que las enfermeras desarrollen planes de atención efectivos y minimicen las complicaciones respiratorias postoperatorias

Objective: To determine associations between respiratory nursing diagnoses and nursing interventions in patients submitted to thoracic or upper abdominal surgery. Method: Cross sectional quantitative study. Participants were 312 adult patients within the first 48 hours after thoracic or upper abdominal surgery. Patients were examined by the research team using an instrument with variables related to the respiratory function. The research team established the presence/absence of three nursing diagnoses and proposed interventions using the NANDA-I classification and the Nursing Interventions Classification. Correlations were tested using the chi-square or Fisher's test. Results: From the total 312 examinations, ineffective airway clearance was present in 185 (59.3%) assessments, ineffective breathing pattern in 123 (39.4%), and impaired gas exchange in 141 (45.4%). Significant correlations showed that patients with ineffective airway clearance were more likely to require pain management (or: 2.27), chest physiotherapy (or: 2.96), and positioning (or:1.8), while patients with impaired gas exchange were less likely to require airway management (or: 0.13) and chest physiotherapy (or: 0.28). Conclusions: Patients with ineffective airway clearance had more chances of requiring pain management, chest physiotherapy, and positioning, while the nursing diagnosis impaired gas exchange was related with airway management and chest physiotherapy. The findings provide basis for nurses to develop effective care plans and to minimize postoperative respiratory complications

Relação entre orientação em saúde e complicações no pós-operatório de cirurgias torácicas e abdominais altas / Correlation between the healthcare guidance and thoracic and upper abdominal post-operative care / Relación entre orientación en salud y complicaciones en el postoperatorio de cirugías torácicas y abdominales alta

Objetivo: avaliar a influência das orientações em saúde nas complicações no pós-operatório de cirurgias torácicas e abdominais altas. Método: estudo quantitativo transversal realizado com 266 indivíduos. Os dados foram coletados por um questionário sociodemográfico, clínico e assistencial. Foram incluídos sujeitos de ambos os sexos, com faixa etária de 18 a 80 anos, que estivessem na enfermaria em pós-operatório de cirurgias torácicas e ou abdominais altas. Resultados: 82 (30%) dos indivíduos receberam orientações no período de pós-operatório e 184 (70%) não receberam nenhum tipo de orientação. Quatro dos sujeitos que receberam orientações desenvolveram algum tipo de complicação e 16 dos que não receberam tiveram complicações; não apresentando resultados estatisticamente significativos quanto aos pesquisados que tiveram orientação e os que não tiveram orientações (p=0,4). Conclusão: em relação ao número de complicações, ao comparar os indivíduos que receberam orientações com os que não receberam não houve resultado estatisticamente significativo

Objective: to evaluate correlation between health guidelines and complications in the postoperative period after thoracic and upper abdominal surgeries. Method: a cross-sectional quantitative study with 266 individuals. Data were collected by a sociodemographic, clinical and care questionnaire. We included subjects of both sexes, with ages ranging from 18 to 80 years, who were in the postoperative ward after thoracic and/ or upper abdominal surgeries. Results: 82 (30%) of the subjects received guidance in the postoperative period and 184 (70%) received no guidance. Four of the subjects who received guidelines developed some type of complication while 16 of those who did not receive guidance developed complications; therefore, the results were not statistically significant (p=0,4). Conclusion: in relation to the number of complications, when comparing individuals who received guidelines with those who did not receive, there was no statistically significant result

Objetivo: evaluar la influencia de las orientaciones en salud en las complicaciones en el postoperatorio de cirugías torácicas y abdominales altas. Metodo: estudio cuantitativo transversal realizado con 266 individuos. Los datos fueron recolectados por un cuestionario sociodemográfico, clínico y asistencial. Se incluyeron sujetos de ambos sexos, con rango de edad de 18 a 80 años, que estuvieran en la enfermería en postoperatorio de cirugías torácicas y / o abdominales alta. Resultados: 82 (30%) de los individuos recibieron orientaciones en el período de postoperatorio y 184 (70%) no recibieron ningún tipo de orientación. Cuatro de los sujetos que recibieron orientaciones, desarrollaron algún tipo de complicación y 16 de los que no recibieron tuvieron complicaciones; no presentando resultados estadísticamente significativos en cuanto a los encuestados que tuvieron orientación y los que no tuvieron orientaciones (p=0,4). Conclusión: en relación al número de complicaciones, al comparar a los individuos que recibieron orientaciones con los que no recibieron no hubo resultado estadísticamente significativo

Effect of early determinants on adolescent fat-free mass: RPS cohort of São Luís - MA

ABSTRACT OBJECTIVE: To analyze the effects of early determinants on adolescent fat-free mass. METHODS: A cohort study with 579 adolescents evaluated at birth and adolescence in a birth cohort in São Luís, Maranhão. In the proposed model, estimated by structural equation modeling, socioeconomic status (SES) at birth, maternal age, pregestational body mass index (BMI), gestational smoking, gestational weight gain, type of delivery, gestational age, sex of the newborn, length and weight at birth, adolescent socioeconomic status, "neither study/nor work" generation, adolescent physical activity level and alcohol consumption were tested as early determinants of adolescent fat-free mass (FFM). RESULTS: A higher pregestational BMI resulted in higher FFM in adolescence (Standardized Coefficient, SC = 0.152; p < 0.001). Being female implied a lower FFM in adolescence (SC = −0.633; p < 0.001). The negative effect of gender on FFM was direct (SC = −0.523; p < 0.001), but there was an indirect negative effect via physical activity level (SC = −0.085; p < 0.001). Women were less active (p < 0.001). An increase of 0.5 kg (1 Standard Deviation, SD) in birth weight led to a gain of 0.25 kg/m2 (0.106 SD) in adolescent FFM index (p = 0.034). Not studying or working had a negative effect on the adolescent's FFM (SC = −0.106; p = 0.015). Elevation of 1 SD in the adolescent's physical activity level represented an increase of 0.5 kg/m2 (0.207 SD) in FFM index (p < 0.001). CONCLUSIONS: The early determinants with the greatest effects on adolescent FFM are gender, adolescent physical activity level, pregestational BMI, birth weight and belonging to the "neither-nor" generation.

Leprosy in children under 15 years of age in a municipality in northeastern Brazil: evolutionary aspects from 2003 to 2015

Abstract INTRODUCTION The Integrated Program of Leprosy Control was initiated in 2003 in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy. Here, we present the evolution of the indicators of leprosy within the established period in children aged <15 years. METHODS: This is a descriptive study based on an active search for cases and spontaneous healthcare demand for leprosy, with an evolutionary analysis of the detection coefficient of new cases. We considered individuals aged <15 years diagnosed with leprosy from January 2003 to December 2015. To evaluate the factors associated with clinical and operational forms, Chi-square, Fisher's exact, or Fisher-Freeman-Halton tests were performed. RESULTS A total of 61 new cases were detected (6.9% of the total leprosy cases diagnosed in the municipality during the study period), and the majority was found in males (62.3%). The most frequent operational classification was paucibacillary (67.2%), and this association increased with age. The tuberculoid clinical form was the most prevalent in both sexes and in the age range of 10 to <15 years. There was a reduction in the detection coefficient from 21.84/100,000 inhabitants in 2003 to 2.79/100,000 in 2015. CONCLUSIONS Despite the progress in the control of leprosy, this historical series shows that it is necessary to strengthen educational measures and implement control actions, so that the disease ceases to be a public health problem in the population aged <15 years.

Nursing outcome "airway permeability" in postoperative patients / Resultado de enfermería "permeabilidad de las vías aéreas" en pacientes en el posoperatorio / Resultado de enfermagem "permeabilidade das vias aéreas" em pacientes no pós-operatório

ABSTRACT Objectives: to evaluate the evolution of clinical indicators that characterize airway permeability in patients in the postoperative period of thoracoabdominal surgeries and to analyze their relationship with the occurrence of the diagnosis "ineffective airway clearance". Methods: descriptive, quantitative, longitudinal research with 60 patients who were followed for five consecutive days. Eleven indicators of the nursing outcome "respiratory status: airway permeability" were used. Results: on the first day of evaluation, the most compromised indicators were: respiratory rate, cough, depth of breath and use of accessory muscles. During follow-up, most of the indicators presented a slight deviation from normal variation and, in the last evaluation, there was a predominance of indicators with some degree of impairment. Conclusions: with the aid of the Nursing Outcomes Classification, it was observed that patients submitted to thoracoabdominal surgeries may present compromised airway permeability even days after surgery.

RESUMEN Objetivos: valorar la evolución de los indicadores clínicos que caracterizan la permeabilidad de las vías aéreas en pacientes en el posoperatorio de cirugías toracoabdominales y evaluar su relación con la ocurrencia del diagnóstico "desobstrucción ineficaz de las vías aéreas". Métodos: investigación descriptiva, cuantitativa, longitudinal en la cual participaron 60 pacientes que recibieron seguimiento por cinco días. Se utilizaron 11 indicadores del resultado de enfermería "estado respiratorio: permeabilidad de las vías aéreas". Resultados: en el primer día de evaluación, los indicadores más comprometidos fueron: frecuencia respiratoria, tos, profundidad de la respiración y utilización de músculos accesorios. Durante el seguimiento, se verificó que la mayor parte de los indicadores presentó una leve desviación de la variación normal y, en la última evaluación, hubo un predominio de indicadores con algún grado de comprometimiento. Conclusiones: con la ayuda de la Clasificación de los resultados de enfermería, se observó que los pacientes sometidos a cirugías toracoabdominales pueden presentar comprometimiento de la permeabilidad de las vías aéreas incluso después de algunos días de realizar el procedimiento quirúrgico.

RESUMO Objetivos: avaliar a evolução dos indicadores clínicos que caracterizam a permeabilidade das vias aéreas em pacientes no pós-operatório de cirurgias toracoabdominais e analisar sua relação com a ocorrência do diagnóstico "desobstrução ineficaz das vias aéreas". Métodos: pesquisa descritiva, quantitativa, longitudinal realizada com 60 pacientes que foram acompanhados por cinco dias consecutivos. Foram utilizados 11 indicadores do resultado de enfermagem "estado respiratório: permeabilidade das vias aéreas". Resultados: no primeiro dia de avaliação os indicadores mais comprometidos foram: frequência respiratória, tosse, profundidade da respiração e uso de músculos acessórios. Durante o acompanhamento, verificou-se que a maior parte dos indicadores apresentou desvio leve da variação normal e, na última avaliação, houve predomínio de indicadores com algum grau de comprometimento. Conclusões: com auxílio da Classificação dos resultados de enfermagem, observou-se que pacientes submetidos a cirurgias toracoabdominais podem apresentar comprometimento da permeabilidade das vias aéreas mesmo após dias da realização do procedimento cirúrgico.

Factors Associated with Multibacillary Leprosy in a Priority Region for Disease Control in Northeastern Brazil: A Retrospective Observational Study.

BACKGROUND: Leprosy is an infectious disease that can lead to physical disabilities and stigmatization. It remains an important public health problem, especially in Brazil. OBJECTIVE: To analyse sociodemographic and clinical factors associated with multibacillary leprosy in a hyperendemic region of the disease in northeastern Brazil. METHOD: This is a retrospective observational study with secondary data acquired from 2012 to 2015, from a group of leprosy cases reported in a reference outpatient clinic for the treatment and followup of leprosy in the city of Imperatriz, Maranhao, in northeastern Brazil. RESULTS: From 905 new cases of leprosy studied, 656 (72.5%) were classified as multibacillary leprosy and 249 (27.5%) as paucibacillary leprosy. We observed that men were more likely to present 5 to 15 skin lesions (OR: 1.32; 95% CI: 1.18-1.49; p <0.0001) and >15 skin lesions (OR: 1.26; 95% CI: 1.09 -1.45; p = 0.005) and a lower chance of having <5 skin lesions (OR: 0.67; 95% CI: 0.59-0.76; p <0.0001). Women were more likely to have no affected nerves compared to men (OR: 1.46; 95% CI: 1.20-1.77; p <0.0001). The age range of 16 to 60 years showed a greater chance of having <5 skin lesions (OR: 1.01; 95% CI: 1.007-1.20; p = 0.03) and a lower chance of having 5 to 15 skin lesions (OR: 1.12, 95% CI: 1.03-1.23; p= 0.008) and a lower chance of being a grade I disability ( CI= 0.73-0.94; p=0.83) and II (OR: 0.82; 95% CI: 0.77-0.98; p=000.1). CONCLUSION: Cases of multibacillary leprosy were associated with male gender, low educational level, and clinical variables such as number of skin lesions and grade I or II disability.

Factors associated with leprosy in a municipality of the Pre-Amazon region, state of Maranhão, Brazil.

INTRODUCTION: The Integrated Program of Leprosy Control was initiated in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy in 2003. It aims at assessing the clinical and epidemiological characteristics of the disease to reduce the detection rate of new cases until 2015. Here, we present the evolution of the indicators of leprosy within the period from 2003 to 2015. METHODS: We conducted a descriptive analytical study based on the active search for and voluntary referral of cases of leprosy. The detection rate of new cases was analyzed over time. We included individuals diagnosed with leprosy between January 2003 and December 2015. The association between categorical variables was assessed using the chi-square test of independence, considering a level of significance of 5%. When the association was significant, the detection rate (with a confidence interval of 95%) was calculated. RESULTS: Overall, 879 new leprosy cases were detected; the majority of the affected individuals were men (65.9%). Multibacillary leprosy was the most common type of the disease, according to the operational classification (55.5%); it showed the strongest association with an age ≥60 years. We also detected an association between the male sex and both, lepromatous and multibacillary leprosy. The detection rate reduced from 211.09/100,000 population in 2003 to 50.26/100,000 population in 2015. CONCLUSIONS: We found an improvement in leprosy control, with a reduction in the detection rate and the absolute number of cases. Strengthening of disease control measures should be prioritized to eliminate leprosy as a public health concern in this municipality.

Factors associated with leprosy in a municipality of the Pre-Amazon region, state of Maranhão, Brazil

Abstract INTRODUCTION: The Integrated Program of Leprosy Control was initiated in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy in 2003. It aims at assessing the clinical and epidemiological characteristics of the disease to reduce the detection rate of new cases until 2015. Here, we present the evolution of the indicators of leprosy within the period from 2003 to 2015. METHODS: We conducted a descriptive analytical study based on the active search for and voluntary referral of cases of leprosy. The detection rate of new cases was analyzed over time. We included individuals diagnosed with leprosy between January 2003 and December 2015. The association between categorical variables was assessed using the chi-square test of independence, considering a level of significance of 5%. When the association was significant, the detection rate (with a confidence interval of 95%) was calculated. RESULTS: Overall, 879 new leprosy cases were detected; the majority of the affected individuals were men (65.9%). Multibacillary leprosy was the most common type of the disease, according to the operational classification (55.5%); it showed the strongest association with an age ≥60 years. We also detected an association between the male sex and both, lepromatous and multibacillary leprosy. The detection rate reduced from 211.09/100,000 population in 2003 to 50.26/100,000 population in 2015. CONCLUSIONS: We found an improvement in leprosy control, with a reduction in the detection rate and the absolute number of cases. Strengthening of disease control measures should be prioritized to eliminate leprosy as a public health concern in this municipality.

Prepregnancy body mass index, gestational weight gain, and birth weight in the BRISA cohort.

OBJECTIVE To analyze the effects of maternal pre-pregnancy body mass index and weight gain during pregnancy on the baby's birth weight. METHODS We conducted a cross-sectional study with 5,024 mothers and their newborns using a Brazilian birth cohort study. In the proposed model, estimated by structural equation modeling, we tested socioeconomic status, age, marital status, pre-pregnancy body mass index, smoking habit and alcohol consumption during pregnancy, hypertension and gestational diabetes, gestational weight gain, and type of delivery as determinants of the baby's birth weight. RESULTS For a gain of 4 kg/m2 (1 Standard Deviation [SD]) in pre-pregnancy body mass index, there was a 0.126 SD increase in birth weight, corresponding to 68 grams (p < 0.001). A 6 kg increase (1 SD) in gestational weight gain represented a 0.280 SD increase in newborn weight, correponding to 151.2 grams (p < 0.001). The positive effect of pre-pregnancy body mass index on birth weight was direct (standardized coefficient [SC] = 0.202; p < 0.001), but the negative indirect effect was small (SC = -0.076, p < 0.001) and partially mediated by the lower weight gain during pregnancy (SC = -0.070, p < 0.001). The positive effect of weight gain during pregnany on birth weight was predominantly direct (SC = 0.269, p < 0.001), with a small indirect effect of cesarean delivery (SC = 0.011; p < 0.001). Women with a higher pre-pregnancy body mass index gained less weight during pregnancy (p < 0.001). CONCLUSIONS The effect of gestational weight gain on the increase in birth weight was greater than that of pre-pregnancy body mass index.

Prepregnancy body mass index, gestational weight gain, and birth weight in the BRISA cohort

ABSTRACT OBJECTIVE To analyze the effects of maternal pre-pregnancy body mass index and weight gain during pregnancy on the baby's birth weight. METHODS We conducted a cross-sectional study with 5,024 mothers and their newborns using a Brazilian birth cohort study. In the proposed model, estimated by structural equation modeling, we tested socioeconomic status, age, marital status, pre-pregnancy body mass index, smoking habit and alcohol consumption during pregnancy, hypertension and gestational diabetes, gestational weight gain, and type of delivery as determinants of the baby's birth weight. RESULTS For a gain of 4 kg/m2 (1 Standard Deviation [SD]) in pre-pregnancy body mass index, there was a 0.126 SD increase in birth weight, corresponding to 68 grams (p < 0.001). A 6 kg increase (1 SD) in gestational weight gain represented a 0.280 SD increase in newborn weight, correponding to 151.2 grams (p < 0.001). The positive effect of pre-pregnancy body mass index on birth weight was direct (standardized coefficient [SC] = 0.202; p < 0.001), but the negative indirect effect was small (SC = -0.076, p < 0.001) and partially mediated by the lower weight gain during pregnancy (SC = -0.070, p < 0.001). The positive effect of weight gain during pregnany on birth weight was predominantly direct (SC = 0.269, p < 0.001), with a small indirect effect of cesarean delivery (SC = 0.011; p < 0.001). Women with a higher pre-pregnancy body mass index gained less weight during pregnancy (p < 0.001). CONCLUSIONS The effect of gestational weight gain on the increase in birth weight was greater than that of pre-pregnancy body mass index.

Laparotomía exploratoria y colecistectomía: análisis de la frecuencia respiratoria y saturación de oxígeno de los pacientes en el postoperatorio inmediato / Laparotomia exploratória e colecistectomia: análise da frequência respiratória e saturação de oxigênio de pacientes no pós-operatório imediato / Exploratory laparotomy and cholecystectomy: analysis of respiratory rate and oxygen saturation of patients in the immediate postoperative period

Objetivo: Evaluar y comparar la tasa respiratoria y saturación de oxígeno de los pacientes en el postoperatorio inmediato de la laparotomía exploratoria y la colecistectomía. Material y Métodos: Se trata de un estudio transversal, cuantitativo con 63 pacientes tratados entre noviembre 2014 a abril 2015. Los datos fueron recolectados a través de un cuestionario estructurado aplicado a los pacientes ingresados en la Clínica Quirúrgica del Hospital Municipal Imperatriz. Los participantes del estudio eran pacientes de ambos sexos, con edades comprendidas entre 18-59 años en el postoperatorio inmediato de la laparotomía exploratoria (Grupo I) y colecistectomía (Grupo II). Del cuestionario se extrajeron los datos de tasa por frecuencia respiratoria (FR) y saturación de oxígeno. Los datos fueron analizados estadísticamente empleando el programa BioEstat 5.0 y prueba de Shapiro-Wilk para la normalidad entre variables, análisis de Mann-Whitney inferencial y la prueba de Spearman para la correlación entre las variables. Se comprobó que no hubo significación estadística en cuanto a los cambios clínicamente relevantes a FR (p=0,4) y los cambios clínicos en saturación de oxígeno (p=0,8) en comparación con las muestras de ambos grupos y los procedimientos quirúrgicos realizados. Los casos en los que se alteraron los valores de ambas variables analizadas, que muestran las condiciones de taquipnea o hipopnea e hipoxemia fueron casos aislados, poco significativos estadísticamente. Conclusión: Se encontró que, independientemente de los procedimientos quirúrgicos realizados, el patrón de respiración se mantuvo de normal a mínimamente alterado, no habiendo en estos individuos interferencia directa de estas cirugías en la función respiratoria que causase de forma significativa alteración clínica de la respiración (AU)

Objetivo: Avaliar e comparar a frequência respiratória e a saturação de oxigênio de pacientes no pós-operatório imediato de laparotomia exploratória e colecistectomia. Material e Método: Trata-se de uma pesquisa transversal, quantitativa, com 63 pacientes atendidos entre novembro de 2014 a abril de 2015. Os dados foram coletados por meio de um questionário estruturado aplicado aos pacientes internados na Clínica Cirúrgica do Hospital Municipal de Imperatriz. Participaram do estudo pacientes de ambos os sexos, com faixa etária entre 18 a 59 anos, no pós- operatório imediato de laparotomia exploratória (Grupo I) e colecistectomia (Grupo II). Do questionário foram extraídos dados relacionados frequência respiratória (FR) e saturação de oxigênio (SapO2). Os dados foram analisados estatisticamente empregando-se o programa BioEstat 5.0, bem como teste Shapiro Wilk para normalidade entre variáveis, teste analítico inferencial Mann-Whitney, e teste Spearman para correlação entre variáveis. Resultados: Evidenciou-se que não houve significância estatística quanto a alterações clínicas pertinentes a FR (p=0,4) e alterações clínicas da SapO2 (p=0,8) quando comparadas as amostras de ambos os grupos e os procedimentos cirúrgicos realizados. Os casos em que os valores de ambas as variáveis analisadas mostraram-se alterados, evidenciando condições de taquipneia ou bradipneia e hipoxemia foram casos isolados, pouco expressivos estatisticamente. Conclusão: Constatou-se que independentemente dos procedimentos cirúrgicos realizados, o padrão respiratório permaneceu normal a minimamente alterado, não havendo, nesses indivíduos interferência direta dessas cirurgias sobre a função respiratória que provocasse de forma significativa alteração clínica da respiração (AU)

Objective: To evaluate and compare the respiratory rate and oxygen saturation of patients in the immediate postoperative period of exploratory laparotomy and cholecystectomy. Material and Method: This is a cross-sectional and quantitative study with 63 patients seen between November 2014 and April 2015. Data were collected through a structured questionnaire applied to patients admitted to the Surgical Clinic of the Municipal Hospital of Imperatriz City. Patients of both sexes, aged from 18 to 59 years, in the immediate postoperative period of exploratory laparotomy (Group I) and cholecystectomy (Group II) participated in the study. Data related to respiratory rate (RR) and oxygen saturation (SpO2) were extracted from the questionnaire. Data were analyzed statistically using the BioEstat 5.0 program, as well as Shapiro Wilk test for normality between variables, Mann-Whitney inferential analytical test, and Spearman test for correlation between variables. Results: There was no statistical significance regarding the clinical changes of RR (p = 0.4) and clinical changes of SpO2 (p = 0.8) when comparing the samples from both groups and the surgical procedures performed. The cases in which the values of both analyzed variables were altered, evidencing conditions of tachypnoea or bradypnea and hypoxemia, were isolated cases, not statistically significant. Conclusion: Regardless of the surgical procedures performed, the respiratory pattern remained normal to minimally altered and, in these individuals, there was no direct interference of these surgeries on the respiratory function that caused a significant clinical alteration of respiration (AU)

Fatores influenciadores do conhecimento dos estudantes de enfermagem sobre hanseníase: estudo transversal / Factors influencing nursing students' knowledge about hansen's disease: a cross-section study

Aim: to identify the factors that influence Nursing students' knowledge about Hansen's disease. Method: this is a cross-section study with a quantitative approach, performed from May to June 2016. The sample was composed by 167 Nursing students of a public university located in the Northeastern region of Brazil. Result: the majority of students knows the main aspects of the disease. Factors such as being single, not having another occupation or income, to live with few other people, and search for information with professor were associated to a higher level of understanding about leprosy. Female students demonstrated less chances to know about Hansen's disease. Conclusion: Nursing students know about leprosy, however there are still questions regarding the transmission of the illness.(AU)

Objetivo: identificar os fatores que influenciam o conhecimento de estudantes de Enfermagem sobre hanseníase. Método: estudo transversal, com abordagem quantitativa, realizado no período de maio a junho de 2016. A amostra foi constituída por 167 estudantes de Enfermagem de uma universidade pública do Nordeste do Brasil. Resultado: a maioria dos estudantes conhece os principais aspectos da doença. Fatores como ser solteiro, não possuir outra ocupação nem atividade remunerada, morar com poucas pessoas e buscar informações com os professores estavam associados ao maior conhecimento sobre hanseníase. Estudantes do sexo feminino demonstraram menores chances de conhecer a doença. Conclusão: os estudantes de Enfermagem possuem conhecimento sobre hanseníase, porém ainda existem dúvidas quanto ao modo de transmissão da doença.(AU)

Respiratory status of adult patients in the postoperative period of thoracic or upper abdominal surgeries / Estado respiratório de pacientes adultos no período pós-operatório de cirurgias torácicas ou abdominal superior / Estado respiratorio de pacientes adultos en el postoperatorio de cirugías torácicas o de abdomen superior

ABSTRACT Objective: to evaluate the respiratory status of postoperative adult patients by assessing the nursing outcome Respiratory Status. Method: descriptive, cross-sectional study developed with 312 patients. Eighteen NOC indicators were assessed and rated using a Likert-scale questionnaire and definitions. Descriptive and correlative analysis were conducted. Results: the most compromised clinical indicators were coughing (65.5%), auscultated breath sounds (55%), and respiratory rate (51.3%). Factors associated with worse NOC ratings in specific clinical indicators were sex, age, pain, and general anesthesia. Conclusions: certain clinical indicators of respiratory status were more compromised than others in postoperative patients. Patient and context-related variables can affect the level of respiratory compromise.

RESUMO Objetivo: avaliar o estado respiratório de pacientes adultos no pós-operatório por meio da análise do resultado de enfermagem Estado Respiratório. Método: estudo descritivo e transversal desenvolvido com 312 pacientes. Dezoito indicadores da Classificação dos Resultados de Enfermagem (Nursing Outcomes Classification - NOC) foram avaliados e classificados utilizando um questionário contendo escalas Likert e definições. Foram realizadas análises descritivas e de correlações. Resultados: os indicadores clínicos mais comprometidos foram tosse (65,5%), ausculta de sons respiratórios (55%) e frequência respiratória (51,3%). Fatores associados com escores NOC comprometidos para indicadores clínicos específicos foram gênero, idade, dor e anestesia geral. Conclusões: certos indicadores clínicos do estado respiratório foram mais comprometidos do que outros em pacientes no pós-operatório. O paciente e as variáveis relacionadas aos pacientes e ao contexto podem afetar o nível de comprometimento respiratório.

RESUMEN Objetivo: evaluar el estado respiratorio de pacientes adultos en postoperatorio por la evaluación del resultado de enfermería Estado Respiratorio. Método: estudio descriptivo transversal realizado con 312 pacientes. Dieciocho indicadores de la Clasificación de Resultados en Enfermería (Nursing Outcomes Classification - NOC) fueron evaluados y calificados utilizando un cuestionario conteniendo escalas Likert y definiciones. Análisis descriptivos y de correlaciones fueron realizados. Resultados: los indicadores clínicos más comprometidos fueron tos (65,5%), auscultación de sonidos respiratorios (55%) y frecuencia respiratoria (51,3%). Factores asociados con puntuaciones NOC comprometidas en indicadores clínicos específicos fueron género, edad, dolor y anestesia general. Conclusiones: ciertos indicadores clínicos de estado respiratorio fueron más comprometidos que otros en pacientes postoperatorios. El paciente y las variables relacionadas con el paciente y el contexto pueden afectar el nivel de compromiso respiratorio.

Ineffective airway clearance in adult patients after thoracic and upper abdominal surgery.

AIM: The aim of this study is to analyze the accuracy of the defining characteristics of ineffective airway clearance (IAC) in patients after thoracic and upper abdominal surgery. BACKGROUND: Although numerous studies have described the most prevalent respiratory NANDA-I diagnoses, only few investigates the precision of nursing assessments. METHODS: A cross-sectional study was conducted with 192 patients in a surgical clinic. Accuracy measures were obtained by the latent class analysis method. RESULTS: IAC was present in 46.73% of the sample. The defining characteristics with better predictive capacity were changes in respiratory rate and changes in respiratory rhythm. However, other defining characteristics also had high specificity, such as restlessness, cyanosis, excessive sputum, wide-eyed, orthopnea, adventitious breathing sounds, ineffective cough, and difficulty vocalizing. CONCLUSION: Results can contribute to the improvement of nursing assessments by providing information about the key clinical indicators of IAC.