Cross-cultural adaptation and validation of instrument to measure nursing care dependency.

OBJECTIVE: To cross-culturally adapt and validate the INICIARE instrument for use in Brazil. METHOD: methodological study divided into two phases: cross-cultural adaptation and validation. The first phase took place in six stages: translation, synthesis, back-translation, expert review, pre-test and submission to the author. The second, carried out with 130 patients, took place at a private hospital in Porto Alegre, Rio Grande do Sul, Brazil, between May and July 2019. The study was approved by the Research Ethics Committee. Data were analyzed for stability, equivalence and internal consistency. RESULTS: In the cross-cultural adaptation, the expert committee adjusted the translated version, validating the content. At validation, most patients were women (64.6%) with a mean age of 59 ± 15.3. The reliability index was 0.744. CONCLUSION: The version of the instrument adapted for Brazil proved to be adequate and reflects the reality of daily nursing practice.

Cross-cultural adaptation and validation of instrument to measure nursing care dependency / Adaptación transcultural y validación de instrumentos para medir la dependencia del cuidado de enfermería / Adaptação transcultural e validação de instrumento para medir a dependência de cuidados de enfermagem

ABSTRACT Objective: To cross-culturally adapt and validate the INICIARE instrument for use in Brazil. Method: methodological study divided into two phases: cross-cultural adaptation and validation. The first phase took place in six stages: translation, synthesis, back-translation, expert review, pre-test and submission to the author. The second, carried out with 130 patients, took place at a private hospital in Porto Alegre, Rio Grande do Sul, Brazil, between May and July 2019. The study was approved by the Research Ethics Committee. Data were analyzed for stability, equivalence and internal consistency. Results: In the cross-cultural adaptation, the expert committee adjusted the translated version, validating the content. At validation, most patients were women (64.6%) with a mean age of 59 ± 15.3. The reliability index was 0.744. Conclusion: The version of the instrument adapted for Brazil proved to be adequate and reflects the reality of daily nursing practice.

RESUMEN Objetivo: Adaptar y validar transculturalmente el instrumento INICIARE para uso en Brasil. Método: estudio metodológico dividido en dos fases: adaptación y validación transcultural. La primera, en seis etapas: traducción, síntesis, retrotraducción, revisión de expertos, pre-test y envío al autor. El segundo, realizado con 130 pacientes, se llevó a cabo en un hospital privado de Porto Alegre, Rio Grande do Sul, Brasil, entre mayo y julio/2019. El estudio fue aprobado por el Comité de Ética en Investigación. Los datos se analizaron mediante estabilidad, equivalencia y consistencia interna. Resultados: En la adaptación transcultural, el comité de expertos ajustó la versión traducida, validando el contenido. En el momento de la validación, la mayoría de los pacientes eran mujeres (64,6%) con una edad media de 59 ± 15,3 años. La fiabilidad fue de 0,744. Conclusión: La versión del instrumento adaptada para Brasil resultó adecuada y refleja la realidad de la práctica diaria de enfermería.

RESUMO Objetivo: Adaptar transculturalmente e validar o instrumento INICIARE para uso no Brasil. Método: estudo metodológico dividido em duas fases: adaptação transcultural e validação. A primeira ocorreu em seis etapas: tradução, síntese, retrotradução, revisão por especialistas, pré-teste e submissão à autora. A segunda, realizada com 130 pacientes, ocorreu em um hospital privado de Porto Alegre, Rio Grande do Sul, Brasil, entre maio e julho de 2019. O estudo obteve aprovação pelo Comitê de Ética em Pesquisa. Os dados foram analisados através da estabilidade, equivalência e da consistência interna. Resultados: Na adaptação transcultural, o comitê de especialistas ajustou a versão traduzida, validando o conteúdo. Na validação, a maioria dos pacientes era mulher (64,6%) com média de idade 59 ±15,3. A confiabilidade foi de 0,744. Conclusão: A versão do instrumento adaptado para o Brasil mostrou-se adequada e reflete a realidade da prática diária da enfermagem.

Sexual Dysfunction in Women with Hypertension: a Systematic Review and Meta-analysis.

PURPOSE OF REVIEW: We aimed to evaluate the prevalence of sexual dysfunction in hypertensive women and compare sexual dysfunction between hypertensive and non-hypertensive women. RECENT FINDINGS: Conducted a systematic review in the following databases: PubMed, EMBASE, Scopus, Web of Science, IBECS, and Lilacs. We included articles evaluating the prevalence of sexual dysfunction in a woman and/or comparing sexual dysfunction between hypertensive and non-hypertensive women. Studies were excluded if they evaluated patients with secondary hypertension, examined sexual dysfunction caused by drugs, did not distinguish by gender, or included patients with hypertension and other comorbidities/pathologies. We conducted an I2 test to calculate heterogeneity and a meta-analysis to compare sexual dysfunction between hypertensive and non-hypertensive women. A meta-regression equation calculated the relationship between sexual dysfunction risk for hypertensive and age. Eleven articles were included: five were included in the meta-analysis (1057 hypertensive and 715 normotensive). The prevalence of sexual dysfunction in articles varied from 14.1 to 90.1%. In the meta-analysis of the sexual dysfunction, the relative risk between hypertensive and normotensive women was found to be significant and has a high heterogeneity (I2 =92.6%, p < 0.001); the pooled results revealed a significant risk ratio of 1.81 (95% CI 1.10-2.97, p < 0.05). The relative risk for hypertensive women showed an association with age (b = 0.0333, p < 0.0001). The studies analyzed presented significant limitations in relation to methodology and a small sample size. Consequently, the meta-analysis was highly heterogeneous and reinforced the need for further research in this area.

Hypertension as a risk factor for female sexual dysfunction: cross-sectional study.

OBJECTIVE: to evaluate the sexual dysfunction in hypertensive patients compared to normotensive patients. METHOD: this was a cross-sectional study. Samples were composed of 54 hypertensive patients and 54 normotensive patients. The female sexual dysfunction was evaluated by the Female Sexual Function Index (FSFI). RESULTS: the average FSFI score differed highly between hypertensive and normotensive patients (22.4± 7.4 versus 26.8 ±5.4, p< 0.001). Among hypertensive patients, 63% showed sexual dysfunction in opposition to 39% of normotensive patients (p=0.02). Hypertensive women had 1.67 more chances of showing the dysfunction than women with normal blood pressure. CONCLUSION: the sexual dysfunction prevalence is higher in hypertensive than in normotensive women hence, hypertension is a potentiator factor for female sexual dysfunction.

Hypertension as a risk factor for female sexual dysfunction: cross-sectional study / Hipertensão como fator de risco para disfunção sexual feminina: estudo transversal / La hipertensión como un factor de riesgo para la disfunción sexual femenina: estudio transversal

ABSTRACT Objective: to evaluate the sexual dysfunction in hypertensive patients compared to normotensive patients. Method: this was a cross-sectional study. Samples were composed of 54 hypertensive patients and 54 normotensive patients. The female sexual dysfunction was evaluated by the Female Sexual Function Index (FSFI). Results: the average FSFI score differed highly between hypertensive and normotensive patients (22.4± 7.4 versus 26.8 ±5.4, p< 0.001). Among hypertensive patients, 63% showed sexual dysfunction in opposition to 39% of normotensive patients (p=0.02). Hypertensive women had 1.67 more chances of showing the dysfunction than women with normal blood pressure. Conclusion: the sexual dysfunction prevalence is higher in hypertensive than in normotensive women hence, hypertension is a potentiator factor for female sexual dysfunction.

RESUMO Objetivo: avaliar a disfunção sexual em pacientes hipertensas em comparação com pacientes normotensas. Método: estudio transversal. Las muestras estaban compuestas por 54 pacientes hipertensos y 54 normotensos. La disfunción sexual femenina fue evaluada por el Índice de Función Sexual Femenina (FSFI). Resultados: a pontuação média do FSFI foi muito diferente entre pacientes hipertensas e normotensas (22,4 ± 7,4 versus 26,8 ± 5,4, p <0,001). Da amostra de pacientes hipertensas, 63% apresentaram disfunção sexual, ante 39% da amostra de pacientes normotensas (p=0,02). As mulheres hipertensas apresentaram 1,67 vezes mais chances de ter a disfunção do que mulheres com pressão arterial normal. Conclusão: a prevalência de disfunção sexual é maior em mulheres hipertensas do que em mulheres normotensas. Portanto, a hipertensão é um fator que potencializa a disfunção sexual feminina.

RESUMEN Objetivo: evaluar la disfunción sexual en pacientes hipertensos en comparación con pacientes normotensos. Método: estudio transversal. Las muestras estaban compuestas por 54 pacientes hipertensos y 54 normotensos. La disfunción sexual femenina fue evaluada por el Índice de Función Sexual Femenina (FSFI). Resultados: el puntaje FSFI promedio fue muy diferente entre pacientes hipertensos y normotensos (22.4±7.4 versus 26.8 ± 5.4, p<0.001). El 63% de los pacientes de la muestra de hipertensos demonstraron disfunción sexual, en oposición al 39% de la muestra de pacientes normotensos (p=0,02). Las mujeres hipertensas presentaron 1.67 más posibilidad de mostrar la disfunción que las mujeres con presión arterial normal. Conclusión: la prevalencia de disfunción sexual es mayor en mujeres hipertensas que en mujeres normotensas. Entonces, la hipertensión es un potenciador de la disfunción sexual femenina.

Uso crônico de anticoagulante oral: implicações para o controle de níveis adequados / Constant use of oral anticoagulants: implications in the control of their adequate levels / Uso crónico de anticoagulante oral implicaciones para el control de niveles adecuados

FUNDAMENTO: Dosagens inapropriadas e subterapêuticas anticoagulantes podem resultar em sérias complicações tromboembólicas. O uso dessa terapêutica requer especial atenção e precisa de um acompanhamento clínico e laboratorial rigoroso. OBJETIVO: Identificar fatores associados ao controle adequado dos níveis de anticoagulação oral, verificando o conhecimento e a percepção dos pacientes relacionados à terapêutica empregada. MÉTODOS: Estudo transversal que incluiu 140 pacientes acompanhados no ambulatório de anticoagulação oral, de novembro de 2005 a junho de 2006. Um questionário estruturado foi elaborado e aplicado para obtenção de características clínicas, conhecimento sobre a terapêutica, adesão ao tratamento (teste de Morisky) e percepção do paciente. RESULTADOS: As principais indicações para uso do anticoagulação oral foram fibrilação atrial (61,4 por cento) e prótese metálica (55 por cento). O tempo de uso variou entre 24 e 72 meses, e o femprocumona (58 por cento) foi o mais empregado. Em relaçãoà percepção da terapêutica, 95 por cento dos pacientes mencionaram preocupação com o uso diário dessa medicação. A realização periódica de exames de sangue (21,4 por cento) e a tomada rigorosa de anticoagulação oral (12,8 por cento) foram compreendidas como limitantes. Observou-se conhecimento adequado entre os pacientes com international normalized ratio (INR) fora da faixa (64 por cento) e na aderência entre os pacientes com INR dentro da faixa terapêutica (54 por cento), porém sem significância estatística. CONCLUSÃO: Os resultados deste estudo demonstraram uma prevalência de pacientes em uso de anticoagulação oral com o INR dentro dos valores ideais, embora tenha sido grande a porcentagem de pacientes não-aderentes à terapêutica. O conhecimento insatisfatório quanto à terapêutica empregada e ao autocuidado torna-se evidente nessa população.

BACKGROUND: Inappropriate and subtherapeutic anticoagulants dosages may result in severe thromboembolic and bleeding complications. The use of this treatment requires special attention and strict clinical and laboratory follow-up. OBJECTIVE: To identify factors associated with appropriate control of the oral anticoagulant use, assessing the patients' knowledge and perception of the treatment. METHODS: A cross-sectional study which included 140 patients followed in the oral anticoagulation outpatient clinic from November 2005 to June 2006. A structured questionnaire was drafted and applied to obtain the clinical characteristics of the patients and their knowledge about the treatment, their compliance with the treatment (Morisky´s test) and their perception of the treatment. RESULTS: The main indications for the use of oral anticoagulation therapy were atrial fibrillation (61.4 percent) and a prosthetic heart valve (55 percent). The duration of anticoagulation ranged from 24 to 72 months, and phenprocoumon (58 percent) was the most commonly used anticoagulant. As to the perception of the treatment, 95 percent of the patients mentioned concern about daily use of this medication. Periodic blood tests (21.4 percent) and the strict intake of oral anticoagulant (12.8 percent) were considered limiting factors. Adequate knowledge was outstanding in patients with an international normalized ratio (INR) outside the therapeutic range (64 percent), compared to patients with an INR within the therapeutic range (62 percent), as well as compliance with treatment in patients with an INR within the therapeutic range (54 percent), but with no statistical significance. CONCLUSION: The results of this study show a prevalence of patients using oral anticoagulant with an INR within optimal values, although a high percentage of patients do not comply with the treatment. In this population it is clearly seen that they do not fully understand the treatment.

FUNDAMENTO: Dosis inapropiadas y subterapéuticas anticoagulantes pueden resultar en serias complicaciones tromboembólicas. El uso de esta terapéutica requiere especial atención y precisa un seguimiento clínico y analítico riguroso. OBJETIVO: Identificar factores asociados al control adecuado de los niveles de anticoagulación oral, verificando el conocimiento y la percepción de los pacientes relacionados a la terapéutica empleada. MÉTODOS: Estudio transversal que incluyó a 140 pacientes seguidos en el ambulatorio de anticoagulación oral, desde noviembre de 2005 a junio de 2006. Se elaboró y se aplicó un cuestionario estructurado para la obtención de características clínicas, conocimiento sobre la terapéutica, adhesión al tratamiento (test de Morisky) y percepción del paciente. RESULTADOS: Las principales indicaciones para uso de anticoagulación oral fueron fibrilación atrial (61,4 por ciento) y prótesis metálica (55 por ciento). El tiempo de uso varió entre 24 y 72 meses, y el fenprocumona (58 por ciento) fue el más empleado. Con relación a la percepción de la terapéutica, el 95 por ciento de los pacientes mencionaron preocupación con el uso diario de esta medicación. La realización periódica de análisis de sangre (21,4 por ciento) y el tomar anticoagulación oral rigurosamente (12,8 por ciento) fueron comprendidos como limitantes. Se observó conocimiento adecuado entre los pacientes con international normalized ratio (INR) fuera del intervalo (64 por ciento) y en la adhesión entre los pacientes con INR dentro del intervalo terapéutico (54 por ciento), aunque sin significancia estadística. CONCLUSIÓN: Los resultados de este estudio mostraron una prevalencia de pacientes en uso de anticoagulación oral con el INR dentro de los valores ideales, aunque haya sido grande el porcentaje de pacientes no adheridos a la terapéutica. El conocimiento insatisfactorio con relación a la terapéutica empleada y al autocuidado se vuelve evidente en esa población.

Constant use of oral anticoagulants: implications in the control of their adequate levels.

BACKGROUND: Inappropriate and subtherapeutic anticoagulants dosages may result in severe thromboembolic and bleeding complications. The use of this treatment requires special attention and strict clinical and laboratory follow-up. OBJECTIVE: To identify factors associated with appropriate control of the oral anticoagulant use, assessing the patients' knowledge and perception of the treatment. METHODS: A cross-sectional study which included 140 patients followed in the oral anticoagulation outpatient clinic from November 2005 to June 2006. A structured questionnaire was drafted and applied to obtain the clinical characteristics of the patients and their knowledge about the treatment, their compliance with the treatment (Morisky s test) and their perception of the treatment. RESULTS: The main indications for the use of oral anticoagulation therapy were atrial fibrillation (61.4%) and a prosthetic heart valve (55%). The duration of anticoagulation ranged from 24 to 72 months, and phenprocoumon (58%) was the most commonly used anticoagulant. As to the perception of the treatment, 95% of the patients mentioned concern about daily use of this medication. Periodic blood tests (21.4%) and the strict intake of oral anticoagulant (12.8%) were considered limiting factors. Adequate knowledge was outstanding in patients with an international normalized ratio (INR) outside the therapeutic range (64%), compared to patients with an INR within the therapeutic range (62%), as well as compliance with treatment in patients with an INR within the therapeutic range (54%), but with no statistical significance. CONCLUSION: The results of this study show a prevalence of patients using oral anticoagulant with an INR within optimal values, although a high percentage of patients do not comply with the treatment. In this population it is clearly seen that they do not fully understand the treatment.

Adesão medicamentosa e não medicamentosa de pacientes com doença arterial coronariana / Adhesión a la terapia medicamentosa y no medicamentosa de pacientes con enfermedad arterial coronaria / Patients' with coronary arterial disease' adherence to pharmacological and non-pharmacological therapy

OBJETIVOS: Verificar a adesão à terapêutica farmacológica e não farmacológica de pacientes atendidos por uma equipe multidisciplinar, em um ambulatório de prevenção secundária da doença arterial coronariana, bem como identificar fatores que possam interferir na adesão. MÉTODOS: Estudo transversal que avaliou a adesão farmacológica através do teste de Morisky e a não farmacológica, através das modificações no estilo de vida em pacientes após primeiro infarto. RESULTADOS: Dos 92 pacientes avaliados, 64,1 por cento eram homens e a média de idade foi de 56,4±10,9 anos. Adesão à terapêutica farmacológica foi verificada em 56,5 por cento e adesão à não farmacológica, em 40,2 por cento dos pacientes. CONCLUSÃO: Os resultados demonstraram pacientes com baixa aderência à terapêutica de prevenção secundária da doença arterial coronariana.

OBJECTIVES: To determine whether patients with coronary artery disease adhere to pharmacological and non-pharmacological therapy and to identify factors that might influence these patients' adherence to the therapies. METHODS: A cross-sectional study was used. The sample consisted of 92 patients who had their first myocardium infarction. Adherence to pharmacological therapy was determined with Morisky test. Adherence to non-pharmacological therapy was evaluated though lifestyle modifications. RESULTS: The majority of the participants (64.1 percent) were male and had a mean age of 56.4 (SD = 10.9) years. More than a half of them (56.5 percent) adhered to pharmacological therapy while 40.2 percent of participants adhered to non-pharmacological therapy. CONCLUSION: The results show low levels of adherence to recommended therapy for secondary prevention of coronary arterial disease.

OBJETIVOS: Verificar la adhesión a la terapia farmacológica y no farmacológica de pacientes atendidos por un equipo multidisciplinario, en un consultorio externo de prevención secundaria de la enfermedad arterial coronaria, así como identificar factores que puedan interferir en la adhesión. MÉTODOS: En este estudio transversal se evaluó la adhesión farmacológica a través del test de Morisky y la no farmacológica, a través de las modificaciones en el estilo de vida en pacientes después del primer infarto. RESULTADOS: De los 92 pacientes evaluados, el 64,1 por ciento eran hombres y el promedio de edad fue de 56,4±10,9 años. La adhesión a la terapia farmacológica fue verificada en el 56,5 por ciento y la adhesión a la no farmacológica, en el 40,2 por ciento de los pacientes. CONCLUSIÓN: Los resultados demostraron la presencia de pacientes con baja adherencia a la terapia de prevención secundaria de la enfermedad arterial coronaria.

Sexual activity after myocardial infarction: taboo or lack of knowledge?

BACKGROUND: Despite its clinical and social relevance, resumption of sexual activity after an acute coronary syndrome (ACS) is a subject that is poorly addressed by healthcare providers and one that is given scant emphasis during hospitalization. Erectile dysfunction is a common complaint among cardiac patients, and these patients are in doubt regarding the safety of resuming sexual activity after a cardiovascular event. OBJECTIVE: To describe how well informed patients are in regard to acute an myocardial infarction (AMI) and what sort of guidance they receive regarding resumption of sexual activity. METHODS: A cross-sectional study was performed from June to July 2005 with patients on the sixth day of AMI. A questionnaire was applied to assess not only patients' knowledge of AMI, but also their expectations regarding their resumption of sexual activity - and frequency of same - following hospital discharge. RESULTS: Ninety-six patients were included in the study (mean age 59 +/- 12); 70% of them were male and 80% had experienced their first AMI. Of these, 96% lacked any knowledge of AMI clinical manifestations and possible limitations, 63% reported an active sex life before the event, 60% were in doubt regarding their sex life following hospital discharge, and only 4% received sexual guidance from healthcare providers during their hospital stay. CONCLUSION: According to our findings, the recommendations patients receive during hospitalization are suboptimal in regard to both AMI and resumption of sexual activity. The updating of healthcare providers may change this situation. This is especially true for the nursing staff, since they spend more time with patients.

Atividade sexual pós-infarto do miocárdio: tabu ou desinformação? / Sexual activity after myocardial infarction: taboo or lack of knowledge?

FUNDAMENTO: O retorno à atividade sexual após síndrome coronária aguda (SCA), apesar da importância clínica e social, é assunto pouco abordado pela equipe de saúde, e que tem recebido pouca ênfase durante a internação. A disfunção erétil tem sido uma queixa freqüente entre pacientes cardiopatas, aliada a dúvidas sobre a segurança no retorno à atividade sexual após evento cardiovascular. OBJETIVO: Descrever o conhecimento dos pacientes quanto ao infarto agudo do miocárdio (IAM) e às orientações recebidas para o retorno à atividade sexual. MÉTODOS: Estudo transversal realizado entre junho e julho de 2005. Foram incluídos pacientes que se encontravam no sexto dia pós-IAM. Foi aplicado um instrumento relacionado ao conhecimento sobre o IAM, à freqüência e às expectativas de retorno à atividade sexual no período pós-alta hospitalar. RESULTADOS: Foram incluídos 96 pacientes, dos quais 70 por cento eram do sexo masculino, com média de idade de 59 ± 12 anos, e 80 por cento eram vítimas de primeiro infarto agudo do miocárdio. Desses pacientes, 96 por cento desconheciam as manifestações clínicas e as possíveis limitações provocadas pelo IAM, 63 por cento relataram ter vida sexual ativa antes do evento, 60 por cento tinham dúvidas quanto ao retorno à atividade sexual após a alta, e apenas 4 por cento dos pacientes receberam orientações pelos profissionais de saúde durante o período de internação. CONCLUSÃO: Nossos achados indicam que as orientações dispensadas pela equipe aos pacientes durante a internação são subótimas, no que tange tanto ao IAM quanto ao retorno à atividade sexual. A atualização da equipe de saúde, principalmente dos enfermeiros que despendem mais tempo com os pacientes, são estratégias que podem melhorar esses resultados.

BACKGROUND: Despite its clinical and social relevance, resumption of sexual activity after an acute coronary syndrome (ACS) is a subject that is poorly addressed by healthcare providers and one that is given scant emphasis during hospitalization. Erectile dysfunction is a common complaint among cardiac patients, and these patients are in doubt regarding the safety of resuming sexual activity after a cardiovascular event. OBJECTIVE: To describe how well informed patients are in regard to acute an myocardial infarction (AMI) and what sort of guidance they receive regarding resumption of sexual activity. METHODS: A cross-sectional study was performed from June to July 2005 with patients on the sixth day of AMI. A questionnaire was applied to assess not only patients' knowledge of AMI, but also their expectations regarding their resumption of sexual activity - and frequency of same - following hospital discharge. RESULTS: Ninety-six patients were included in the study (mean age 59 ± 12); 70 percent of them were male and 80 percent had experienced their first AMI. Of these, 96 percent lacked any knowledge of AMI clinical manifestations and possible limitations, 63 percent reported an active sex life before the event, 60 percent were in doubt regarding their sex life following hospital discharge, and only 4 percent received sexual guidance from healthcare providers during their hospital stay. CONCLUSION: According to our findings, the recommendations patients receive during hospitalization are suboptimal in regard to both AMI and resumption of sexual activity. The updating of healthcare providers may change this situation. This is especially true for the nursing staff, since they spend more time with patients.