Prevalence, Incidence and Factors Associated with Diabetic Foot in People with Type 2 Diabetes: Systematic Review with Meta-Analysis

BACKGROUND

Diabetic Foot is a severe chronic complication of diabetes and an important factor in the morbidity of diabetic people, resulting in high health costs and increased risk of death.

OBJECTIVE

To analyze the incidence, prevalence, and risk factors associated with diabetic foot in people with type 2 Diabetes Mellitus.

METHOD

Systematic literature review. Searches in MedLine via PubMed, LILACS, Web of Science, Scopus CINAHL, and Cochrane Library databases were performed. Inclusion of 52 studies. The R program, Metan packages, was used to calculate the meta-analysis. Given the heterogeneity of studies, the random effect was used to calculate the meta-analysis of risk factors.

RESULTS

The meta-analysis showed that the prevalence of diabetic foot was 14% in a hospital setting and 5% in a community setting. The overall prevalence and incidence were 9% and 4%, respectively. Significant risk factors included time of DM (odds ratio [OR] =1.46, confidence interval [CI], 0.36-2.57, P = 0.009), smoking (OR = 1.46, CI, 1.16 -1.85, P< .001), glycated hemoglobin (OR = 0.96, CI, 0.50; 1.42, P< .001), peripheral arterial disease (OR = 3.38, CI, 2.07; 5.53, P < .001) and peripheral neuropathy (OR = 5.88, CI, 2.39-14.45, P<.001).

CONCLUSION

Multidisciplinary monitoring, educational strategies, periodic foot examination for alterations, and early identification of risk factors are essential to prevent ulceration and reduce the disease burden.

Formação profissional do técnico de enfermagem em segurança do paciente: estudo misto

Resumo Objetivo: analisar a formação de técnicos de enfermagem em segurança do paciente. Método: estudo de método misto paralelo convergente, em que elementos qualitativos e quantitativos foram concomitantemente implementados e igualmente priorizados, realizado em três colégios técnicos vinculados a uma instituição pública federal do Nordeste brasileiro. No qualitativo, realizou-se entrevista semiestruturada com 24 docentes e aplicou-se a análise temática. No estudo quantitativo, survey, utilizou-se instrumento para rastrear termos sobre segurança do paciente com 84 discentes. A interpretação geral dos dados realizou a combinação dos resultados e balizou-se no Guia Curricular de Segurança do Paciente. Resultados: emergiram duas categorias temáticas: Compreensão dos docentes acerca do tema segurança do paciente na formação de técnicos de enfermagem e Aplicação e projeção do ensino da segurança do paciente na formação de técnicos de enfermagem. No estudo quantitativo, dos 46 termos rastreadores, predominou a identificação de termos no contexto teórico-prático, nos Cursos A e C, totalizando 36 (78,3%) e 25 (54,3%), respectivamente. No Curso B, destacou-se ensino teórico, com 26 termos (56,5%). Conclusão: a formação profissional do discente técnico de enfermagem apresenta foco tecnicista e não contempla, integralmente, no processo ensino-aprendizagem, questões de segurança do paciente e, assim, configura-se desafio para as instituições formadoras e docentes.

Formación profesional del técnico en enfermería en seguridad del paciente: estudio mixto

Resumen Objetivo: analizar la formación de los técnicos en enfermería en seguridad del paciente. Método: estudio de método mixto paralelo convergente, en el que los elementos cualitativos y cuantitativos fueron implementados simultáneamente y considerados con el mismo nivel de prioridad, realizado en tres escuelas técnicas vinculadas a una institución pública federal en el Nordeste brasileño. En el estudio cualitativo se realizó una entrevista semiestructurada a 24 profesores y se aplicó el análisis temático. En el estudio cuantitativo, survey, se utilizó un instrumento para detectar términos sobre seguridad del paciente con 84 estudiantes. Para la interpretación general de los datos se realizó la combinación de los resultados y se tomó como base la Guía Curricular de Seguridad del Paciente. Resultados: surgieron dos categorías temáticas: Comprensión de los docentes sobre la seguridad del paciente en la formación de técnicos en enfermería e Implementación y proyección de la enseñanza de la seguridad del paciente en la formación de técnicos en enfermería. En el estudio cuantitativo, en los 46 términos indicadores, predominó la identificación de términos en el contexto teórico-práctico, en las carreras A y C, con un total de 36 (78,3%) y 25 (54,3%), respectivamente. En la carrera B se destacó la enseñanza teórica, con 26 términos (56,5%). Conclusión: la formación profesional de los estudiantes de la carrera de técnico en enfermería tiene un enfoque técnico y no considera de forma integral los temas que tienen que ver con la seguridad del paciente en el proceso de enseñanza-aprendizaje, por lo que es un desafío para las instituciones formadoras y para los docentes.

Educational intervention performed by nurses for blood pressure control: a systematic review with meta-analysis

to assess the effect of an educational intervention performed by nurses for blood pressure control in people with arterial hypertension, when compared to usual care. a systematic review with meta-analysis of randomized clinical trials, conducted in six databases. The studies included were those in which an educational intervention was performed by nurses on people with arterial hypertension. The risk of bias was assessed by means of the Risk of Bias Tool, the meta-analysis was performed in the Review Manager software and certainty of the evidence was calculated in the Grading of Recommendations Assessment, Development and Evaluation system. a total of 1,692 studies were found, which were peer-reviewed, including eight of them in the meta-analysis. The meta-analysis was calculated for the "systolic blood pressure" and diastolic blood pressure" outcomes, in subgroups by time and by intervention performance type. For the in-person educational intervention, performed individually combined with a group activity, the effect estimate was -12.41 mmHg (95% Confidence Interval: from -16.91 to -7.91, p<0,00001) for systolic pressure and -5.40 mmHg (95% Confidence Interval: from -7.98 to -2.82, p<0,00001) for diastolic pressure, with high certainty of evidence. the educational intervention performed by nurses, individually and combined with a group activity, presents a statistically significant clinical effect. PROSPERO registration No.: CRD42021282707.

Pregnant women's perception about prenatal monitoring during the COVID-19 pandemic

Objetivo:  Compreender a percepção de gestantes no acompanhamento pré-natal durante a pandemia da COVID-19. Métodos: Estudo analítico com abordagem qualitativa, realizado com onze gestantes atendidas por duas equipes de Estratégia Saúde da Família do município de Colinas, Maranhão. A coleta de dados foi realizada mediante entrevistas semiestruturadas gravadas e após transcritas. Os dados foram processados com o auxílio do software IRaMuTeQ por meio da Classificação Hierárquica Descendente e analisados por meio de interpretação de sentidos. Resultados:  O processamento dos dados resultou em seis classes que, após a interpretação de sentidos, deram origem à duas categorias: Percepções ao atendimento pré-natal durante a pandemia da COVID-19 e Experiências, aprendizados e cuidados na gestação diante da pandemia. Conclusão: A aquisição de medidas para o controle da transmissão do vírus mostrou-se geradora de dificuldades na adesão ao pré-natal, afetando a qualidade do atendimento em questão. O distanciamento social e a redução do tempo de permanência nas consultas afetaram a relação estabelecida entre profissional e gestante, com isso a atenção foi prejudicada.  

Nursing technicians' professional training in patient safety: A mixed-methods study

OBJECTIVE

to analyze nursing technicians' training in patient safety.

METHOD

a convergent parallel mixed-methods study, where qualitative and quantitative elements were concomitantly implemented and equally prioritized, carried out in three technical colleges linked to a federal public institution in the Brazilian Northeast region. In the qualitative phase, semi-structured interviews were conducted with 24 professors and thematic analysis was applied. In the quantitative study, of the survey type, an instrument was used to screen terms about patient safety with 84 students. The results were combined during the general data interpretation, which was based on the Patient Safety Curricular Guide.

RESULTS

two thematic categories emerged: The professors' understanding about the theme of patient safety in nursing technicians' training; and Application and projection of the teaching of patient safety in nursing technicians' training. In the quantitative study, among the 46 screening terms, their identification in the theoretical-practical context predominated in Courses A and C, totaling 36 (78.3%) and 25 (54.3%), respectively. Theoretical teaching stood out in Course B, with 26 terms (56.5%).

CONCLUSION

professional training of Nursing Technician students has a technical focus and does not fully contemplate patient safety issues in the teaching-learning process and, thus, constitutes a challenge for training institutions and professors alike.

Usefulness of the Tidal Model concepts to the care of adolescents deprived of liberty

OBJECTIVE

To reflect on the usefulness of the concepts of the Tidal Model in nursing care for adolescents deprived of liberty.

METHOD

Critical reflection of the theory, according to the evaluation proposed by Meleis, focusing on the usefulness of the theory, based on the practice criterion, according to the unit of analysis applicability of the theory.

RESULTS

The Tidal Model is composed of concepts that allow the understanding of the context in which the adolescent deprived of liberty is inserted and prepare nurses for the operationalization of their clinical practice aimed at this adolescent, enabling the professional to observe its limits, such as issues related to social reintegration, which requires intersectoral partnerships, and the need for anchoring in other theories.

FINAL CONSIDERATIONS

The concepts of the Tidal Model are useful and can be applied to the nursing care provided to adolescents in situation of deprivation of liberty, promoting the centrality of care for this adolescent.

Structure internal of the dimension Human Person of the Questionnaire of Health Vulnerability in Heart Failure

OBJECTIVE

to analyze the evidence of validity of the internal structure of the dimension Human Person of the Questionnaire of Health Vulnerability in Heart Failure.

METHOD

psychometric study with 1,008 people with heart failure, in a tertiary healthcare institution located in Northeastern Brazil. The internal structure was assessed by exploratory factor analysis with a polychoric correlation matrix, followed by confirmatory factor analysis to verify the quality of the model fit. Internal consistency was measured by composite reliability (CR) and McDonald's omega (ω).

RESULTS

psychometric parameters revealed 22-item model, distributed in five factors, total explained variance of 64.9%, factor loadings (0.38 to 0.97) and adequate communalities (0.20 ≤ h2 ≤ 0.98) and acceptable indicators of precision (0.79 ≤ ORION ≤ 0.98), representativeness (0.89 ≤ FDI ≤ 0.99), sensitivity (1.92 ≤ SR ≤ 7.07), factor expectancy (88.3% ≤ EPTD ≤ 97.9%), replicability (0.82 ≤ H-latent ≤ 0.97; 0.81 ≤ H-observed ≤ 0.87) and reliability (CR = 0.92 and ω = 0.83). Adequate adjustment quality was achieved (TLI = 0.99; CFI = 0.99; GFI = 0.99; RMSEA = 0.04 and RMSR = 0.04).

CONCLUSION

We obtained an instrument with good evidence of internal structure validity for construct measurement.

Tendência da Cobertura Vacinal em crianças de zero a 12 meses – Piauí, Brasil, 2013-2020

RESUMO O estudo teve como objetivo analisar a tendência temporal da Cobertura Vacinal (CV) em crianças de zero a 12 meses de idade. Trata-se de estudo ecológico de série temporal da CV em crianças de zero a 12 meses de idade, Piauí, de 2013 a 2020, utilizando dados do Sistema de Informações do Programa Nacional de Imunizações. Empregou-se o modelo autorregressivo de Prais-Winsten para estimar a tendência da CV para oito imunobiológicos. As tendências foram categorizadas em decrescente, crescente ou estacionária. Verificou-se redução na CV de todos os imunobiológicos. Observou-se tendência decrescente na CV de Hepatite B (Variação Percentual Anual [VPA] = -4,5; IC95%: -7,3; -1,6), Meningocócica C (VPA = -1,7; IC95%: -3,1; -0,2), Pentavalente (VPA = -4,2; IC95%: -7,0; -1,3) e Febre Amarela (VPA = -3,2; IC95%: -5,9; -0,5); e estacionária para BCG (VPA = -2,5; IC95%: -5,7; 0,9), Rotavírus Humano (VPA = -1,5; IC95%: -3,2; 0,2), Pneumocócica (VPA -0,7; IC95%: -2,7; 1,3) e Poliomielite (VPA = -2,1; IC95%: -5,3; 1,1). Concluiu-se que, com as tendências decrescentes e estacionárias das CV, é necessário o desenvolvimento de políticas públicas para esclarecimento e recrutamento da população acerca da vacinação em crianças de zero a 12 meses de idade.

MELHORES PRÁTICAS DE ENFERMEIROS NO MANEJO DA INCONTINÊNCIA FECAL EM CONTEXTO HOSPITALAR: REVISÃO INTEGRATIVA

RESUMO Objetivo analisar, na literatura, as melhores práticas de enfermeiros acerca do manejo da Incontinência Fecal em contexto hospitalar. Método trata-se de uma revisão integrativa da literatura com busca realizada em setembro de 2021 nas bases de dados MEDLINE/PubMed, Web of Science e no banco de dados da Biblioteca Virtual em Saúde, que incluiu as bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Base de Dados de Enfermagem e Índice Bibliográfico Español en Ciencias de la Salud. A análise considerou os métodos descritivos e a elaboração de um corpus textual mediante o software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados foram incluídos 11 estudos (e a análise destes permitiu evidenciar a prevalência do idioma inglês) publicados entre os anos de 1977 e 2021 e que apresentaram, em maior ocorrência, delineamento metodológico observacional com nível de evidência 2C. Os resultados foram agrupados em duas categorias: “Evidências de cuidados para gerenciamento da Incontinência Fecal”, tendo como maior predominância o uso dos sistemas de drenagem fecal, e “Dispositivos de apoio e prevenção de complicações”, apresentando, com maior ocorrência, os dispositivos de contenção. Conclusão identificou-se que as melhores práticas adotadas pelos enfermeiros no contexto hospitalar estão associadas ao uso de sistemas de drenagem e dispositivos de contenção do conteúdo fecal. Evidenciou-se a limitação da equipe de Enfermagem quanto ao uso de outras práticas benéficas ao paciente com Incontinência Fecal.

VALIDATION OF AN EDUCATIONAL BOOKLET: EFFECT ON THE KNOWLEDGE ABOUT PREVENTION OF METABOLIC SYNDROME IN ADOLESCENTS

ABSTRACT Objective: to validate an educational booklet for the promotion of knowledge about the prevention of Metabolic Syndrome in adolescents. Method: a time series quasi-experiment conducted in 2020 with 37 adolescents from five public schools belonging to the teaching state network of Picos, Piauí, Brazil. It was conducted in two phases: 1) development of a script of questions about the prevention of MS and its content validation by 17 experts; 2) quasi-experiment with reading of the booklet called “Síndrome Metabólica: Como me prevenir?” (“Metabolic Syndrome: How can I protect myself?”, and assessment of the adolescents' knowledge through a script of questions before and after reading the booklet. To analyze content validity of the script of questions, the Content Validity Ratio was calculated (CVR>0.529). The McNemar test (p<0.05) was used to investigate the effect of the educational booklet on the adolescents' knowledge. The study was approved by the Research Ethics Committee of Universidade Federal do Piauí. Results: the script of question's overall CVR was 0.718, representing good content validation. Three assertions were removed (CVR<0.529). Regarding the adolescents' knowledge, 45.9% improved it, with no significant difference (p=0.067). Conclusion: the adolescents' knowledge was higher in almost half of the participants in the post-test, showing that reading the educational booklet favored knowledge about the prevention of Metabolic Syndrome.

NURSES' BEST PRACTICES IN THE MANAGEMENT OF FECAL INCONTINENCE IN THE HOSPITAL CONTEXT: AN INTEGRATIVE REVIEW

ABSTRACT Objective to analyze, in the literature, the nurses' best practices towards management of Fecal Incontinence in the hospital context. Method this is an integrative literature review with a search carried out in September 2021 in the MEDLINE/PubMed and Web of Science, as well as in the Biblioteca Virtual em Saúde database, which included the Literatura Latino-Americana e do Caribe em Ciências da Saúde, Base de Dados de Enfermagem and Índice Bibliográfico Español en Ciencias de la Salud databases. The analysis considered the descriptive methods and elaboration of a textual corpus in the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software program. Results a total of 11 studies were included (and their analysis allowed evidencing prevalence of the English language) published between 1977 and 2021 and which presented, in a greater proportion, an observational methodological design with level of evidence 2C. The results were grouped into two categories: “Care evidence for the management of Fecal Incontinence”, with greater predominance of the use of fecal drainage systems; and “Support devices and prevention of complications”, presenting, in a greater proportion, the containment devices. Conclusion it was identified that the best practices adopted by nurses in the hospital context are associated with the use of drainage systems and fecal content containment devices. A limitation was evidenced in the nursing team regarding use of other beneficial practices for patients with Fecal Incontinence.

Efeito do uso de aplicativo móvel no conhecimento sobre vírus da imunodeficiência humana entre universitários

RESUMO Objetivo: Avaliar o efeito do uso de aplicativo móvel no conhecimento sobre vírus da imunodeficiência humana entre universitários. Método: Estudo de intervenção do tipo antes e depois, com 196 universitários, no período de agosto a dezembro de 2018. A intervenção consistiu no uso do aplicativo móvel educ@aids por 15 dias. Foram realizadas análises univariadas, por meio de estatísticas descritivas simples e para comparação do conhecimento antes e após intervenção foi utilizado o Teste de McNemar. Resultados: Houve melhora no conhecimento após uso do educ@aids nas variáveis relacionadas ao conhecimento acerca da transmissão do vírus; conhecimento acerca do tratamento, cura e prevenção; conhecimento de outras informações sobre o vírus da imunodeficiência humana. Conclusão: O uso do educ@aids aumentou o conhecimento sobre o vírus da imunodeficiência humana entre os universitários da saúde.

Effect of mobile application use on knowledge about human immunodeficiency virus among university students

ABSTRACT Objective: To evaluate the effect of using a mobile application on knowledge about human immunodeficiency virus among university students. Method: A before-and-after intervention study, with 196 university students, from August to December 2018. The intervention consisted of using the educ@aids mobile application for 15 days. Univariate analyzes were performed using simple descriptive statistics and the McNemar test was used to compare knowledge before and after the intervention. Results: There was an improvement in knowledge after using educ@aids in the variables related to knowledge about the transmission of the virus; knowledge about treatment, cure and prevention; knowledge of other information about human immunodeficiency virus. Conclusion: The use of educ@aids increased knowledge about the human immunodeficiency virus among health university students.

Knowledge of caregivers and factors associated with neuropsychomotor development in children

OBJECTIVES

to analyze the knowledge of caregivers and the factors associated with neuropsychomotor development in children.

METHODS

a cross-sectional study, with a quantitative approach, was conducted with 220 child-caregiver binomials attended in the public health services of the municipality of Parnaíba, State of Piauí. The study used the "Denver Test II" and the "Inventory of Child Development Knowledge".

RESULTS

the study classified 197 children with natural development and 23 with suspicious development. Caregivers with a higher level of knowledge about child development were associated with children with better development. The study considered caregiver knowledge, gestational age, and exclusive breastfeeding as protective factors for appropriate neuropsychomotor development when used the regression model.

CONCLUSIONS

actions aimed at indicators that presented positive associations must be implemented to improve child development, such as educational activities to increase the level of knowledge of caregivers, improvement of prenatal monitoring, and encouragement of breastfeeding.

Construção e validação de tecnologia educacional para promoção do aleitamento materno no período neonatal

Resumo Objetivo Este estudo teve como objetivos construir e validar um pacote de mensagens de texto e figuras para promoção do aleitamento materno no período neonatal. Métodos tratou-se de um estudo metodológico, realizado em quatro etapas: revisão integrativa da literatura, construção de pacote de mensagens e figuras, análise de legibilidade e validação de conteúdo e aparência. Para validação, participaram 11 juízes com expertise em aleitamento materno. O critério para validação foi concordância superior a 80%, analisada por meio dos índices de validação de conteúdo e aparência. Resultados a versão final do pacote de mensagens e figuras apresentou índice de validade de conteúdo de 0,86, índice de validade de aparência de 0,85 e validade convergente com correlação de 0,73 entre o conteúdo e a aparência (p<0,01). Conclusões e implicações para a prática o pacote de mensagens de texto e figuras foi considerado válido em conteúdo, aparência e convergência para promoção do aleitamento materno, no período neonatal, constituindo tecnologia educacional adequada para ser compartilhada via mensagens telefônicas, com intuito de se aproximar das nutrizes, ajudando-as a reagir frente aos problemas comuns no período neonatal.

Development of an appearance validity instrument for educational technology in health

OBJECTIVES

to develop and evaluate the convergence of the instrument for the appearance validity of educational technologies in health.

METHODS

methodological study conducted in two steps. In step 1, the instrument items were developed, with subsequent content validity by nine specialists in the development of educational technologies in health. In step 2, the convergent validity between another instrument and the appearance instrument was performed. Correlation results above r> 0.3 and p <0.05 were considered as plausible convergent validity.

RESULTS

the ten items of the initial version of the appearance instrument were submitted to content validity that resulted in a final version with 12 items (Content Validity Index = 0.93). The correlation indexes were strong with the objective and appearance domains; moderate with motivation, organization and total; and weak with writing style.

CONCLUSIONS

the appearance instrument demonstrated content validity and convergent validity, in addition to a strong correlation with the other instrument.

The effects of felted foam in diabetic foot treatment: systematic review with meta-analysis

OBJECTIVE

To evaluate the effects of felted foam in the treatment of diabetic foot plantar ulcer.

METHOD

Systematic review with meta-analysis. Research was conducted in Cochrane Library, PubMed, CINAHL, Science Direct, Web of Science, SCOPUS, IBECS and LILACS. Cochrane Collaboration Risk of Bias Tool was employed to evaluate risk of bias. The meta-analyses were calculated in the program Review Manager, while Grades of Recommendation, Assessment, Development and Evaluation was used for evaluating evidence quality.

RESULTS

Four clinical essays and two cohorts were included. Mean plantar pressure of individuals exposed to felt was reduced by 10.77 kilopascals (CI 95% -14.92, -6.62; p<0.001).

CONCLUSION

Higher reduction of plantar pressure was observed to be associated with the use of felt. Development of new models of relief orthosis with felted foam for plantar pressure is recommended, along with more clinical research elucidating related outcomes.

Theoretical, methodological and analytical aspects of ethnographic research in obstetric nursing: an integrative review

OBJECTIVE

To characterize ethnographic research in the area of obstetric nursing regarding its theoretical, methodological and analytical aspects.

METHOD

An integrative review performed in the MEDLINE®, LILACS, BDENF and CINAHL databases, as well as the SciELO virtual library.

RESULTS

Thirty (30) articles formed the analytical corpus after screening and reading the primary references in full. The most used methods were ethno-nursing, ethnography and institutional ethnography; the immersion time in the field ranged from 12 visits to 48 months occurring in institutional contexts. The main data collection techniques were observation, individual interviews and training guides for ethno-nursing. The data were organized as themes and subthemes, analyzed through the ethno-nursing analysis guide, implementing the Theory of Diversity and Universality of Cultural Care as theoretical reference.

CONCLUSION

Ethnographic studies in the area of obstetric nursing are within the scope of microethnographies and are operationalized based on theoretical-methodological nursing references, being useful to analyze the complexity of phenomena involving obstetric nursing care, and focusing on the etic (professional) and emic (women) perspectives.

Validity of Nursing Outcomes Classification health promotion behavior scale in college students

ABSTRACT Objective: to verify the reliability and validity of the health promotion behavior scale, of the Nursing Outcomes Classification, in university students. Method: methodological study carried out with 324 university students from a federal institution, based in a city in the Northeast of Brazil. Internal consistency was verified using Cronbach’s alpha and item-total correlation. Validity was performed through exploratory factor analysis via main components. Results: the scale showed a Cronbach’s alpha of 0.83, showing good reliability. The item-total correlations remained above 0.3 for most items, only items 01, 13, 19 and 20 were below this mark. In the exploratory factor analysis, two components were extracted whose variances explained 44.54% of the instrument’s composition. Conclusion: the health promotion behavior scale showed good reliability and validity, demonstrating that it can be applied to the population of university students.

Nursing Care Interpersonal Relationship Questionnaire: elaboration and validation

Objective:

to elaborate an instrument for the measurement of the interpersonal relationship in nursing care through the Item Response Theory, and the validation thereof.

Method:

methodological study, which followed the three poles of psychometry: theoretical, empirical and analytical. The Nursing Care Interpersonal Relationship Questionnaire was developed in light of the Imogene King’s Interpersonal Conceptual Model and the psychometric properties were studied through the Item Response Theory in a sample of 950 patients attended in Primary, Secondary and Tertiary Health Care.

Results:

the final instrument consisted of 31 items, with Cronbach’s alpha of 0.90 and McDonald’s Omega of 0.92. The parameters of the Item Response Theory demonstrated high discrimination in 28 items, being developed a five-level interpretive scale. At the first level, the communication process begins, gaining a wealth of interaction. Subsequent levels demonstrate qualitatively the points of effectiveness of the interpersonal relationship with the involvement of behaviors related to the concepts of transaction and interaction, followed by the concept of role.

Conclusion:

the instrument was created and proved to be consistent to measure interpersonal relationship in nursing care, as it presented adequate reliability and validity parameters.

Prevalence of Metabolic Syndrome in individuals with Type 2 Diabetes Mellitus

OBJECTIVE

to identify the prevalence of Metabolic Syndrome and its components in a population of patients with type 2 Diabetes Mellitus.

METHOD

a cross-sectional study was conducted with 201 diabetic patients. A descriptive analysis and Chi-square and Fisher's exact tests ( p <0.05) were performed.

RESULTS

the majority of participants were females and overweight, with a mean age of 63.1 years and a low level of education, and categorized as physically inactive. Of all individuals investigated, 50.7% were diagnosed with Metabolic Syndrome and 92% had at least one of the syndrome components with values beyond those recommended.

CONCLUSION

it is essential to take preventive actions and develop studies that help to identify the factors associated with this syndrome.

Measuring the quality of life in hypertension according to Item Response Theory

OBJECTIVE

To analyze the Miniquestionário de Qualidade de Vida em Hipertensão Arterial (MINICHAL - Mini-questionnaire of Quality of Life in Hypertension) using the Item Response Theory.

METHODS

This is an analytical study conducted with 712 persons with hypertension treated in thirteen primary health care units of Fortaleza, State of Ceará, Brazil, in 2015. The steps of the analysis by the Item Response Theory were: evaluation of dimensionality, estimation of parameters of items, and construction of scale. The study of dimensionality was carried out on the polychoric correlation matrix and confirmatory factor analysis. To estimate the item parameters, we used the Gradual Response Model of Samejima. The analyses were conducted using the free software R with the aid of psych and mirt.

RESULTS

The analysis has allowed the visualization of item parameters and their individual contributions in the measurement of the latent trait, generating more information and allowing the construction of a scale with an interpretative model that demonstrates the evolution of the worsening of the quality of life in five levels. Regarding the item parameters, the items related to the somatic state have had a good performance, as they have presented better power to discriminate individuals with worse quality of life. The items related to mental state have been those which contributed with less psychometric data in the MINICHAL.

CONCLUSIONS

We conclude that the instrument is suitable for the identification of the worsening of the quality of life in hypertension. The analysis of the MINICHAL using the Item Response Theory has allowed us to identify new sides of this instrument that have not yet been addressed in previous studies.

OBJETIVO

Analisar o Miniquestionário de Qualidade de Vida em Hipertensão Arterial (MINICHAL) por meio da Teoria da Resposta ao Item.

MÉTODOS

Estudo analítico realizado com 712 pessoas com hipertensão arterial atendidas em 13 unidades de atenção primária em saúde de Fortaleza, CE, em 2015. As etapas da análise pela Teoria da Resposta ao Item foram: avaliação da dimensionalidade, estimação dos parâmetros dos itens e construção da escala. O estudo da dimensionalidade foi realizado sobre a matriz de correlação policórica e análise fatorial confirmatória. Para a estimação dos parâmetros dos itens, foi utilizado o Modelo de Resposta Gradual de Samejima. As análises foram conduzidas no software livre R com o auxílio dos pacotes psych e mirt.

RESULTADOS

A análise permitiu a visualização dos parâmetros dos itens e suas contribuições individuais na mensuração do traço latente, gerando mais informação, permitindo a construção de uma escala com um modelo interpretativo que demonstra a evolução da piora da qualidade de vida em cinco níveis. Quanto aos parâmetros dos itens, houve bom desempenho daqueles referentes ao estado somático, pois apresentaram melhor poder de discriminar os indivíduos com pior qualidade de vida. Os itens relacionados ao estado mental foram os que contribuíram com menor quantidade de informação psicométrica no MINICHAL.

CONCLUSÕES

Conclui-se que o instrumento é indicado para a identificação da deterioração da qualidade de vida em hipertensão arterial. A análise do MINICHAL pela Teoria da Resposta ao Item permitiu identificar novas facetas desse instrumento ainda não abordadas em estudos anteriores.

Quality of life and treatment adherence in hypertensive patients: systematic review with meta-analysis

OBJECTIVE

To verify the effects of antihypertensive treatment (pharmacological and non-pharmacological) on the health-related quality of life of individuals with hypertension.

METHODS

We conducted a systematic review with meta-analysis using the following databases: IBECS, LILACS, SciELO, Medline, Cochrane, Science Direct, Scopus and the Brazilian Capes Theses and Dissertations Database. The statistical analysis was performed using Review Manager, version 5.2. The average difference was used for the summarization of meta-analytic effect by the fixed-effect model. Twenty studies were included.

RESULTS

The summarization of the effect showed an average increase of 2.45 points (95%CI 1.02-3.87; p < 0.0008) in the quality of life of individuals adhering to non-pharmacological treatment for arterial hypertension. Adherence to pharmacological treatment indicated an average increase of 9.24 points (95%CI 8.16-10.33; p < 0.00001) in the quality of life of individuals with arterial hypertension.

CONCLUSIONS

Non-pharmacological treatment improves the overall quality of life and physical domain of people with arterial hypertension. Adherence to pharmacological treatment has a positive impact on the mental and physical domains of patients, as it did on the overall quality of life score.

OBJETIVO

Verificar os efeitos do tratamento anti-hipertensivo (farmacológico e não-farmacológico) na qualidade de vida relacionada à saúde de pessoas com hipertensão arterial.

MÉTODOS

Foi conduzida revisão sistemática com metanálise utilizando as bases de dados IBECS, Lilacs, SciELO, Medline, Cochrane, Science Direct, Scopus e o banco de teses da Capes. A análise estatística foi realizada pelo Review Manager versão 5.2. Foi utilizada a diferença da média na sumarização do efeito metanalítico pelo modelo de efeito fixo. Vinte estudos foram incluídos.

RESULTADOS

A sumarização do efeito mostrou incremento de 2,45 pontos na média (IC95% 1,02-3,87; p < 0,0008) da qualidade de vida em pessoas com adesão ao tratamento não farmacológico para hipertensão arterial. A adesão ao tratamento farmacológico indicou aumento de 9,24 pontos na média (IC95% 8,16-10,33; p < 0,00001) da qualidade de vida em pessoas com hipertensão arterial.

CONCLUSÕES

O tratamento não-farmacológico melhora a qualidade de vida global e o domínio físico de pessoas com hipertensão arterial. A adesão ao tratamento farmacológico impacta positivamente nos domínios mental, físico e escore total da qualidade de vida.

Effectiveness of Educational Technology in Promoting Quality of Life and Treatment Adherence in Hypertensive People

The objective of this study was to test the effectiveness of an educational intervention with use of educational technology (flipchart) to promote quality of life (QOL) and treatment adherence in people with hypertension. It was an intervention study of before-and-after type conducted with 116 hypertensive people registered in Primary Health Care Units. The educational interventions were conducted using the flipchart educational technology. Quality of life was assessed through the MINICHAL (lowest score = better QOL) and the QATSH (higher score = better adherence) was used to assess the adherence to hypertension treatment. Both were measured before and after applying the intervention. In the analysis, we used the Student's t-test for paired data. The average baseline quality of life was 11.66 ± 7.55, and 7.71 ± 5.72 two months after the intervention, showing a statistically significant reduction (p <0.001) and mean of differences of 3.95. The average baseline adherence to treatment was 98.03 ± 7.08 and 100.71 ± 6.88 two months after the intervention, which is statistically significant (p < 0.001), and mean of differences of 2.68. The conclusion was that the educational intervention using the flipchart improved the total score of quality of life in the scores of physical and mental domains, and increased adherence to hypertension treatment in people with the disease.

ASSOCIATION BETWEEN TREATMENT COMPLIANCE AND DIFFERENT TYPES OF CARDIOVASCULAR COMPLICATIONS IN ARTERIAL HYPERTENSION PATIENTS

ABSTRACT: This cross-sectional analytical study was carried out at 23 Family Health Centers in Fortaleza-CE, Brazil. The objective was to verify the link between anti-hypertension treatment compliance and the types of cardiovascular complications present in hypertensive patients. The sample was composed of 182 hypertensive patients registered in the Sistema de Gestão Clínica de Hipertensão Arterial e Diabetes Mellitus da Atenção Básica who accepted to answer and fill in a structured form and an instrument to assess compliance. Among the arterial hypertension patients questioned, 62.0% were women, 66.9% were elderly people, 52.2% were patients with a family income between 1.5 and four monthly minimum wages, 61.2% had between one and eight years of education and 60.4% lived in households with two to four people. The most frequent complications found were cerebrovascular accident (37.9%) followed by acute myocardial infarction (20.3%). Treatment compliance was present in 52.0% of patients and was associated to cerebrovascular accident (p<0.001; OR=3.048; 95%CI=1.633-5.681). The results obtained suggest the need for a behavioral change in hypertensive patients, adopting health promotion measures in order to prevent further cardiovascular complications.

Educational technologies designed to promote cardiovascular health in adults: integrative review

Objective Investigating the educational technologies developed for promoting cardiovascular health in adults. Method Integrative review carried out in the databases of PubMed, SciELO and LILACS, with 15 articles selected. Results Over half (60%) of the studies were randomized clinical trials. The developed educational technologies were programs involving three strategies, with duration of one year, use of playful technologies with storytelling, computer programs or software for smartphones, and electronic brochure. These technologies resulted in reduction of blood pressure, weight, waist circumference, decreased hospitalizations and increased years of life. Conclusion The studies with better impact on the cardiovascular health of adults were those who brought the technology in the form of program and duration of one year.

Assessment of risk for pressure ulcers in intensive care units: an integrative review

Objetivo: Analisar na produção científica a utilização de escalas de avaliação de risco para Úlcera por Pressão (UPP) em Unidade de Terapia Intensiva. Métodos: Realizou-se uma revisão integrativa nas bases de dados LILACS, MEDLINE e SciELO com seleção de 18 artigos. Resultados: Constataram-se vários fatores de risco como a divergência na predominância da UPP em relação aos sexos, o índice de massa corporal e a dificuldade de mobilidade no leito, a percepção sensorial alterada comprometendo a verbalização de desconforto, e o uso da Sonda Vesical de Demora prevendo o surgimento das lesões. As pontuações das escalas mantiveram-se em risco elevado e a utilização da escala de coma de Glasgow ajudou na prevenção do risco para UPP quando associada à de bradem. Conclusão: são necessárias novas pesquisas que avaliem os riscos para UPP bem a fim de proporcionar conhecimento que possa modificar essa realidade.

[Content validation of the dimensions constituting non-adherence to treatment of arterial hypertension]

The objective of the study was to validate the content of the dimensions that constituted nonadherence to treatment of arterial systemic hypertension. It was a methodological study of content validation. Initially an integrative review was conducted that demonstrated four dimensions of nonadherence: person, disease/treatment, health service, and environment. Definitions of these dimensions were evaluated by 17 professionals, who were specialists in the area, including: nurses, pharmacists and physicians. The Content Validity Index was calculated for each dimension (IVCi) and the set of the dimensions (IVCt), and the binomial test was conducted. The results permitted the validation of the dimensions with an IVCt of 0.88, demonstrating reasonable systematic comprehension of the phenomena of nonadherence.

Utilização de questionários validados para mensurar a adesão ao tratamento da hipertensão arterial: uma revisão integrativa

Este estudo teve como objetivo analisar na produção científica da saúde coletiva quais questionários validados estão sendo utilizados para avaliar a adesão ao tratamento da hipertensão. Trata-se de uma Revisão Integrativa realizada nas bases de dados SciELO, MEDLINE e LILACS. Foram selecionados nove estudos que utilizaram sete questionários: Teste de Moriski-Green, Cuestionário de Valoración de Adherencia, Cuestionário MBG, Questionário QAM-Q, Teste de Haynes, Escala de Conductas em Salud e Hill-Bone compliance Scale. Concluímos que a avaliação da adesão ao tratamento da hipertensão ainda é campo aberto para pesquisa, os diferentes instrumentos utilizados têm suas limitações e não há um método ideal.

[Hypertension communicated and hypertension understood: nursing know-how and practices in a Family Health Program in Fortaleza, State of Ceará]

The scope of the study was to examine the communication practices of nurses in consultation of arterial hypertension in the Family Health Program in Fortaleza, Ceará, revealing the elements that cause asymmetry of power between nurses and the hypertensive individuals verbal expression. The theoretical references are Critical Discourse Analysis and Pragmatics. This is an exploratory descriptive and qualitative study, in which participant observation was conducted in a Basic Family Health Unit. The following discourses arose: the nurse as conductor of the interaction with verbal and nonverbal discursive commands; the hypertensive subject as subjugated by the nurse; the nurse as an articulated instrument that communicates a body of social practice; the body of the hypertensive person as a tool that supports an imaginary power load; the interaction between nurse and the hypertensive person in a one-sided situation, obliging the hypertensive individual to obey orders. The relationship between the nurse and the hypertensive person develops asymmetrically, built on symbolic materials of social practices under the legitimacy of the paradigm of current Nursing Consultation in our society.