Prevalence of trachoma in the non-indigenous Baixo Jaguaribe micro-region, Ceará State, Northeast Brazil.

BACKGROUND: The aim of the current study was to estimate the population prevalence of trachoma in non-indigenous populations in the Baixo Jaguaribe micro-region, in the state of Ceará, northeast region of Brazil, 2021-2022. METHODS: A population-based prevalence survey focusing on detecting cases of trachomatous inflammation-follicular (TF) in children aged 1-9 y and trachomatous trichiasis (TT) 'unknown to the health system' in people aged ≥15 y, was conducted in rural areas of the Baixo Jaguaribe micro-region in the state of Ceará. Indigenous populations will be further researched. RESULTS: There was no detection of cases of TF and TT. In 900 households, 2234 people were examined. In the Baixo Jaguaribe micro-region, females (54.6%; 1219/2234) and the mixed/Pardo-Brazilian ethnicity (68.1%; 1521/2234) predominated. The most commonly reported educational level was elementary and middle school (41.8%; 702/1679). In 56.2% (506/900) of households, there was a source of water within the household. The monthly income range of 50%-100% of the minimum wage predominated in the families of the Baixo Jaguaribe micro-region (43.1%; 388/900). CONCLUSIONS: Although no cases of TF and TT were detected in the Baixo Jaguaribe micro-region in the state of Ceará during the study period, considering the historical endemicity, we emphasise the need for monitoring and sustainability of surveillance actions in areas at risk for trachoma, common contexts for neglected populations.

Excessive Noise in Neonatal Units and the Occupational Stress Experienced by Healthcare Professionals: An Assessment of Burnout and Measurement of Cortisol Levels.

Excessive noise in the work environment has been associated with extra-auditory symptoms, which can have harmful long-term effects on individuals. The purpose of this study was to identify noise levels in neonatal intensive care units and investigate their impact on the occurrence of stress among healthcare professionals, using cortisol levels as a biomarker for Burnout Syndrome. This descriptive, observational, and cross-sectional study was conducted in four public teaching hospitals in Fortaleza, Ceará, Brazil. Sound pressure levels in the environment were measured, and questionnaires were administered to collect sociodemographic data and assess perceptions of the work environment and Burnout symptoms. Saliva samples were collected at the beginning and end of work shifts for cortisol quantification. The average sound pressure ranged from 59.9 to 66.4 dB(A), exceeding the recommended levels set by Brazilian and international legislation. Among the 256 participants, the average age was 39.4 years, with 95% being female. The majority (70.9%) were nurses, and 22.7% were physicians. There was no significant association found between noise and Burnout Syndrome, nor with changes in cortisol levels. However, a significant association was observed between the perception of excessive noise and the sensation of a stressful work shift (p = 0.012). All evaluated professionals displayed symptoms of Burnout. The high sound pressure levels indicated that the assessed environments did not meet the recommended standards for acoustic comfort, and this was associated with the participants' perception of stressful work shifts. While Burnout symptoms were evident in our participants, it was not possible to confirm a correlation with high noise levels.

Health Professionals' Chronotype Association with Salivary Cortisol and Occupational Stress in Neonatal Intensive Care Units.

Burnout syndrome has been reported among health workers, particularly those working in critical areas, and is considered a significant public health problem. This study aimed to investigate the relationship between chronotype and work-related stress, as measured by salivary cortisol levels and burnout, among health professionals working in neonatal intensive care units. A cross-sectional study was conducted across four public hospitals in Fortaleza, Ceará, Brazil. Two hundred and fifty-six health professionals were administered the brazilian version of the Burnout Characterization Scale, the morningness-eveningness questionnaire, for chronotype, a sociodemographic questionnaire that included lifestyle habits and a salivary cortisol test. The results indicated that morning chronotype workers were significantly associated with the following: advanced age (p < 0.001), female gender (p = 0.032), married status (p = 0.014), and having children (p = 0.030) compared to those with evening and intermediate chronotypes. However, no significant association was found between signs of burnout syndrome and chronotype (p = 0.316). Participants whose work shift did not match their chronotype had significantly higher initial salivary cortisol levels (p = 0.013). The findings suggest that adapting working hours to an individual's biological rhythm can help mitigate potential negative effects on physical and mental health. Thus, it is recommended that professionals' working hours be adjusted accordingly.

Effects of Educational Interventions on Maternal Self-efficacy and Childhood Diarrhea: A Randomized Clinical Trial.

OBJECTIVE: Diarrhea still causes high morbidity and mortality in children under five, requiring constant interventions. Thus, the study aims to evaluate the effects of educational technologies on maternal self-efficacy to prevent childhood diarrhea. METHODS: Randomized clinical trial carried out in Fortaleza, Ceará, Brazil, with four randomized groups of mothers of children under 5 years of age, as follows: control group (n = 61), group A (booklet, n = 60), group B (video, n = 60), and group AB (booklet and video, n = 60). From June to October 2015, data collection was carried out in three moments (the first in person and the others by telephone monitoring). RESULTS: All groups improved their self-efficacy after the intervention, with higher scores in the group AB (booklet and video). A statistically significant association was found between the occurrence of diarrhea and maternal self-efficacy in groups A (booklet) (p = 0.023) and AB (booklet and video) (p = 0.042) at the second moment of data collection. From the second moment to the third moment, the risk of diarrhea decreased in group A, from 12.8 to 1.3, and in group AB, from 8.5 to 1.1. CONCLUSION: The technologies used, isolated or combined, were effective in improving maternal self-efficacy and decreasing the occurrence of childhood diarrhea; therefore, they can be used by nurses as health education tools.

Educational interventions using a primer and motivational interviewing: randomized clinical trial.

BACKGROUND: Many educational technologies have been used to promote the health of the population. Thus, the objective was to assess the effect of using an individual educational primer along with the Brief Motivational Interviewing (BMI) for increasing maternal self-efficacy for preventing childhood diarrhoea. METHODS: Randomized clinical trial, conducted in Fortaleza/Ceará-Brazil, composed of 181 mothers and/or guardians of children under five years, who were randomized into three groups: experimental group A (EG A)-who read the primer, experimental group B (EG B)-application of the primer and BMI and the control group (CG). The participants' assessment was based on the Maternal Self-Efficacy Scale for Preventing Childhood Diarrhoea and the diarrhoea Investigation Form at the beginning of the intervention and then 30 and 60 days after the first contact with the participants. RESULTS: There were 60 participants in EG A and CG and 61 in EG B. It was noted a greater incidence of participants with high self-efficacy in EG B after applying the technologies. All groups manifested diarrhoea among children after the interventions, although with a lower number in EG B, one-month post-intervention (P = 0.025). CONCLUSIONS: The combined use of the primer and the BMI contributed significantly over time to increase maternal self-efficacy in preventing childhood diarrhoea and reduce cases of this disease.

Application of a Bundle in the Prevention of Peri-Intraventricular Hemorrhage in Preterm Newborns.

The purpose of this study was to evaluate the impact of implementing a care bundle for preventing peri-intraventricular hemorrhage (PIVH) in preterm newborns. A longitudinal, quantitative, quasi-experimental study was conducted with preterm newborns from a neonatal unit. The study was divided into 2 stages: the first consisted of a retrospective cohort of newborns (control group) not exposed to the bundle, and the second consisted of 5 practical steps of implementing a care bundle for preventing PIVH in eligible newborns. The results show that a significant reduction in PIVH occurred, from 34.8% before the intervention to 26.3% after application of the bundle. Also, after implementation of the bundle, there was a reduction in the severe forms of PIVH in the newborns who presented with hemorrhage compared with the control group. The study shows how the use of a low-cost and easy operationalization tool can contribute to the health of preterm newborns. It was found that the bundle is directly related to the decrease in the incidence of PIVH. The results may contribute to the improvement in care quality, thus promoting safe care for premature newborns.

Factors Associated With Body Image Perception Among Brazilian Students From Low Human Development Index Areas.

This study aimed to evaluate sociodemographic, behavioral, and individual factors associated with body image perception in a sample of adolescents from schools in low Human Development Index areas in Brazil. This cross-sectional study included 609 boys and 573 girls (aged 11-17 years). Body image perception (nine-silhouettes scale) and sociodemographic, behavioral, and individual variables were included. Multinomial logistic regression analysis was used. Most boys (76.9%) and girls (77.5%) were dissatisfied with their body image. Body mass index status and healthy body image evaluation were significantly associated with body image dissatisfaction in both boys and girls ( p < .001), and daily fruit consumption was associated with body image dissatisfaction only in boys ( p = .035). Education and health care focused on body image can pay special attention to young people from vulnerable areas with unhealthy nutritional status and focus on strategies that enable improving the perception of a healthy body and a healthy diet.

The use of educational video to promote maternal self-efficacy in preventing early childhood diarrhoea.

Diarrhoea is responsible for high rates of infant morbidity and mortality. It is multifactorial, manifested by socioeconomic, hygienic, and maternal factors. The aim of this study is to evaluate the effects of an educational video on maternal self-efficacy for the prevention of childhood diarrhoea. This was a randomized trial conducted in the state of Ceará, Brazil. Participants were 2 groups (comparison and intervention), composed of mothers of children under 5 years of age. Group membership was allocated by cluster randomization. Outcomes were maternal self-efficacy measured using the Maternal Self-efficacy Scale for Prevention of Early Childhood Diarrhoea; outcome data collectors were blinded to group allocation. Ninety participants were randomized to each group; 83 intervention group and 80 comparison group members were contained in the final analysis. Maternal self-efficacy in preventing childhood diarrhoea increased in both groups, but average scores of the intervention group were higher at all time than those of the comparison group. The educational video had a significant effect on maternal self-efficacy.

Association Between Confidence in Smiling and Esthetic Characteristics.

OBJECTIVE: This study aimed to analyze which facial, gingival and dental characteristics are associated with confidence in smiling among 75 subjects seeking treatment in a northern Brazilian public dental university. MATERIALS AND METHODS: Clinical examinations and three standardized photographs of each subject were taken by one trained examiner. In addition, a questionnaire was applied to assess confidence in smiling. The subjects were dichotomized into two groups, non-confident (n = 36) and confident (n = 39) in smiling. Chi-square/Fischer exact test were used to associate the facial, gingival and dental characteristics between groups. RESULTS: The subjects that reported to be non-confident in smiling were statistically associated with smile type (p = 0.030) and wrongly positioned teeth (p = 0.047). On the other hand, gender (p = 0.491), marital status (p = 0.217), gum pigmentation (p = 0.930), midline (p = 0.176), volume of the upper (p = 0.380), and lower (p = 0.615) lips were not associated with self-reported confidence in smiling. CONCLUSION: In patients seeking dental treatment in a public dental university, non-confidence in smiling was associated only with some oral and intraoral characteristics and not with demographic characteristics. CLINICAL SIGNIFICANCE: This study showed that only smile type and wrongly positioned teeth were statistically associated with confidence in smiling. Dentists should pay attention to those intraoral characteristics, but the clinical decision making should always include the patients' perception. (J Esthet Restor Dent 29:E56-E66, 2017).

Weight-Gain Velocity in Newborn Infants Managed with the Kangaroo Method and Associated Variables.

Objectives The Kangaroo method helps promote maternal breastfeeding and adequate growth of low birthweight preterm infants. The objective of this study was to analyze the association between weight-gain velocity during use of the Kangaroo method and maternal and infant variables. Methods A nested cross-sectional study in a cohort of newborn infants managed using the Kangaroo method was carried out at a reference center for the method in Brazil. Data on low birthweight and preterm infants managed using the Kangaroo Method (n = 78) and on their respective mothers (n = 70) was collected between January and July 2014. Maternal and infant variables were associated and correlated with weight-gain velocity (g/kg/day) at each phase of the method (p < 0.05). Results Mean weight-gain velocity increased from 0.12 ± 11.11 g/kg/day in the first phase to 13.47 ± 4.84 g/kg/day in the third phase (p < 0.001), and percentage of adequate weight increased at phase 3 (p < 0.001). Birthweight was inversely correlated with weight-gain velocity at phases 1 and 2 of the Kangaroo method. Birthweight of under 1500 g was associated with a lower likelihood of inadequate weight-gain velocity of the newborn at phase 1 (OR = 0.1; 95 % CI 0.01-0.78; p = 0.012). In phase 3, maternal age was directly correlated with weight-gain velocity. Conclusions Weight-gain velocity was associated with maternal (age) and infant (gestational age at birth, birthweight, weight for gestational age at birth, length of hospital stay and five-minute Apgar score) variables. Knowledge of the factors influencing weight-gain velocity and its behavior at each phase of the method can help guide conduct toward potentializing factors that promote adequate weight-gain.

Validation of the Adherence Determinants Questionnaire scale among women with breast and cervical cancer.

OBJECTIVES: the aim was to translate and culturally adapt the Adherence Determinants Questionnaire scale for the Portuguese language in the Brazilian context, and to check its reliability and validity to analyze the elements of the adherence of patients to the clinical treatment for breast and cervical cancer. METHOD: this was a methodological study, carried out in two oncology reference centers. The sample consisted of 198 participants, with 152 being treated for breast cancer and 46 being treated for cervical cancer. The content validation was performed by a committee of experts. The construct validation was demonstrated through factor analysis and the reliability was analyzed using Cronbach's alpha. RESULTS: the committee of experts made the necessary adjustments so that the scale was adapted to the Brazilian context. The factor analysis suggested a reduction from seven to five factors and the maintenance of 38 items similar to those of the original scale. The reliability, investigated through Cronbach's alpha, was .829, showing high internal consistency. CONCLUSION: it was concluded that the Brazilian version of the Adherence Determinants Questionnaire scale is a valid and reliable instrument that is able to measure the elements of adherence to the treatment for breast and cervical cancer.

Translation and cultural adaptation of the Mother-Generated Index into Brazilian Portuguese: A postnatal quality of life study.

OBJECTIVE: quality of life issues are central to maternal health and well-being. Within the context of a study examining postnatal quality of life, we set out to translate into Brazilian Portuguese the Mother-Generated Index and ensure its cross-cultural adaption for use in a Brazilian context. DESIGN: the Mother-Generated Index, a subjective quality of life tool, underwent a validated process of translation and cultural adaptation: synthesis of two independently translated versions, back-translation and review by an expert committee was followed by testing of the preliminary tool with 30 mothers. SETTINGS: community-based study in city in north-eastern Brazil. PARTICIPANTS: 30 postpartum mothers, interviewed approximately 30 days after birth. FINDINGS: while the mothers understood the concept of identifying and scoring quality of life aspects, many did not grasp the concept behind the use of 'spending points' to produce a relative ranking of these aspects. We resolved this by giving the mothers 'spending beans' instead; beans are a regional food staple. This use of a physical 'currency' solved the problem. DISCUSSION: this modified approach was ratified by the committee of experts and used with success on a further sample of 91 mothers. The whole process aimed to ensure semantic equivalence of the translated tool, and following this process we concluded that face validity of the Brazilian Portuguese Mother-Generated Index was good. While considerable resources are required to ensure a robust process of translation and adaptation, this is necessary if valid and reliable tools are to be produced. IMPLICATIONS: We conclude that the Mother-Generated Index is a valid tool to measure quality of life among Brazilian postpartum mothers, as it allows a simple and understandable way of assessing the various dimensions involved in their quality of life. Moreover, the Mother-Generated Index can provide healthcare professionals the opportunity to become aware of all significant aspects of a woman's life after childbirth.

Factors associated with asthma in adolescents in the city of Fortaleza, Brazil.

OBJECTIVE: Asthma is a chronic inflammatory airway disease. In Brazil, little is known about factors associated with this disease. This study aimed to identify factors associated with asthma in 13- to 14-year-old adolescents in Fortaleza, Ceará, Brazil. METHODS: It is a cross-sectional population-based study, with a probability sample of 3015 students in 2006-2007. We used the questionnaires about asthma, rhinitis and socio-demographic/environmental factors from the International Study for Asthma and Allergies in Childhood (ISAAC) protocol. Current asthma was defined as physician-diagnosed asthma and wheezing in the previous 12 months. Bivariate analysis was performed between asthma and factors included in the study, using prevalence ratio and Chi-square test. Confidence intervals (95%) and odds ratio (OR) were also calculated. Factors associated with asthma in bivariate analysis were then assessed using logistic regression. RESULTS: Final sample was composed by 694 adolescents, 179 with asthma. Rhinoconjunctivitis and consumption of stuffed biscuits and fried snacks three or more times per week were independently and positively associated with asthma; consumption of fruits three or more times per week was negatively associated with asthma. CONCLUSIONS: Dietary factors were the most associated with asthma in this study. Besides rhinoconjunctivitis, consumption of stuffed biscuits and fried snacks (foods with high content of saturated fat) three or more times per week were independently associated with asthma as aggravating factors, while the consumption of fruits three or more times per week was associated with asthma as protective factor. Interventions acting on these factors may decrease the occurrence of asthma in this population.

[Validation of the general guidelines of communication between the nurse and the blind]. / Validação das diretrizes gerais de comunicação do enfermeiro com o cego.

This quantitative study, conducted between 2008 April and 2009 March in Fortaleza-CE, Brazil, aimed to validate the general guidelines of the communication of the nurse with the blind. Thirty nurses and 30 blinds, divided into control and experimental groups, participated in the study. Thirty nursing consultations were videotaped and analyzed by experts. In contrast to the control group, the experimental group showed good and excellent performance in all guidelines for verbal and non-verbal communication with the blinds. The study results point to the urgency of adopting the teaching of these general guidelines for communicating with the blind in nursing courses, in addition to training nurses in caring for the blind people.

[Knowledge, attitudes and practices for the prevention of diabetic foot]. / Conhecimento, atitudes e práticas de medidas preventivas sobre pé diabético.

The purpose of this study was to identify the knowledge, attitudes and practices for the prevention of diabetic foot in patients with diabetes mellitus type 2. This study was based on a cross-sectional survey conducted in two Family Health Units, in the city of Picos--PI, Brazil, with 85 diabetics of both sexes, by means of a semi-structured Knowledge, Attitude and Practice questionnaire. There was a predominance of females in the study (62.4%). On the topic of foot care, 49.4% had no knowledge on hygiene or what to observe in their feet. In relation to nail care, 56.5% were unaware of the correct way to cut nails. Regarding attitudes, 80% were willing to engage in self-care. In terms of practice, results showed that activities such as washing, drying, moisturizing and massaging were not executed together. It is therefore necessary to develop educational strategies to create awareness, both for diabetics and health professionals, on the effective prevention of diabetic foot.

Prevalence of metabolic components in university students.

OBJECTIVE: to identify the frequency of components of Metabolic Syndrome (MetS) among university students. METHOD: descriptive study with 550 students, from various courses run by a public university. The socioeconomic data, lifestyle, and components of MetS were filled out using a questionnaire. Blood sample collection was undertaken in the university itself by a contracted clinical analysis laboratory. RESULTS: 66.2% were female, with a mean age of 22.6±4.41; 71.7% were sedentary; 1.8% stated that they smoke; and 48.5% were classified as at medium risk for alcoholism. 5.8% had raised abdominal circumference and 20.4% had excess weight; 1.3% and 18.9% had raised fasting blood glucose levels and triglycerides, respectively; 64.5% had low HDL cholesterol and 8.7% had blood pressure levels compatible with borderline high blood pressure. Thus, of the sample, 64.4% had at least one component for MetS; 11.6% had two, and 3.5% had three or more. CONCLUSION: a significant proportion of the population already has the components for metabolic syndrome, and this profile reinforces the importance of early diagnosis so as to reduce the risk of developing chronic comorbidities.

Translation and validation of the parent-adolescent communication scale: technology for DST/HIV prevention.

OBJECTIVES: accomplishment of the transcultural adaptation of the Parent-adolescent Communication Scale, which evaluates the frequency of communication between parents and children concerning the subjects related to sex, condom, DST, HIV and pregnancy. METHOD: Methodological research of quantitative approach, accomplished with 313 adolescent pupils of the feminine sex in the 14 to 18 year age group in Fortaleza-CE. The content validity was carried through by means of the initial translation, back translation, pre-final version and final version, being analyzed by a committee of specialists; the reliability was verified by the Cronbach's Alpha and ascertained by testing the hypotheses and test-retest within five weeks. The scale was applied via computer in the online modality in the period November/2010 to January/2011. RESULTS: The version of the instrument in Portuguese presented an Alpha of 0.86 regarding the validity of the structure, was partially verified since the testing of the hypotheses of the contracted group was not confirmed. CONCLUSION: The version of the instrument adapted for Portuguese is considered valid and reliable in the study sample.

[Nursing diagnoses related to breastfeeding in a rooming-in unit]. / Diagnósticos de enfermagem relacionados à amamentação em unidade de alojamento conjunto.

The study aimed to identify, in a Rooming-in unit, diagnoses related to the phenomenon of breastfeeding according to the NANDA-I Taxonomy II. It was conducted a descriptive exploratory study involving 83 mothers and their babies in the period of February to April 2011. Data were collected by means of an instrument based on the Theory of Basic Human Needs and, after statistical analysis, presented in tables. The results showed that the most frequent nursing diagnosis was Effective breastfeeding, identified in 65 (78.3%) cases. It is estimated that the nursing diagnoses related to breastfeeding can contribute to nursing care so that it can be more targeted, in order to promote a more qualified, effective and human care.

[Quality of life in patients with spinal cord injury]. / Qualidade de vida em pacientes com lesão medular.

It was aimed to measure the quality of life of adults with spinal cord injury and identify domains that affect the quality of life of these individuals. Epidemiological study, conducted in 2007-2008 in Health Basic Units of Campina Grande/PB. There were 47 participants. It was used a questionnaire composed by: sociodemographic variables, etiology of injury; validated instrument to measure quality of life containing four domains: Physical Health, Environmental, Social Relationships and Psychological with their respective facets. The data collected were processed using descriptive and statistical analysis. The domains with lowest scores were: Environmental (55.20 points), Physical health (58.59 points). The facets that compromise the domains: mobility (55.3%), work capacity (55.3%), Financial resources (80.9%), Opportunities for acquiring new information and skills (51%), Participation in and opportunities for recreation/leisure activities (68.1%) and Sexual activity (34%). Results express the dissatisfaction of participants with quality of life. Nurses should contribute to rehabilitation and social reinsertion of those people, respecting their limitations, emphasizing the remaining potential and capacity for self-care.

Effects of the use of semipermeable membranes on fluid loss in low-birth-weight premature newborns.

Studies have shown that the application of semipermeable membranes to the skin of premature newborns (NBs) can aid in protecting the skin, reduce disturbances in fluid and electrolyte levels, and decrease neonatal mortality. The aim of this study was to verify the effect of using semipermeable membranes in low-birth-weight preterm newborns (PTNBs). A randomized controlled trial was carried out in the neonatal intensive care unit (NICU) with 42 NBs split evenly into an intervention group (IG), in which semipermeable membranes were used to cover large areas of the skin for the first 7 days of life, and a control group (CG), which received normal care. The variables investigated for the study were weight, hydration status, urinary density, glycemic control, sodium concentration, and daily hydration quota. The following variables displayed significant daily variation: weight, hydration quota, and sodium concentration. Statistically significant individual effects by day and by group were found only for sodium concentration. In the overall analysis of the intersubject effects, sodium concentration, alone, proved to be significant (p = .055). Significant effects by group in relation to the sodium concentration were found, with the IG showing a lower average sodium concentration than the CG. Thus, the use of semipermeable membranes reduced fluid loss in premature NBs in the current study, confirming the findings of previous studies. Guidelines for practice may now be warranted.