[Assisting diabetics in Portugal: the structuring role of the Association to Protect Poor Diabetics, 1926-1946]

Assistance to diabetics in Portugal was quintessentially linked to the 1926 foundation of the Association to Protect Poor Diabetics (Associação Protetora dos Diabéticos Pobres) which was decisive in structuring diabetology in Portugal. This article shows how during the first half of the twentieth century, this association helped create a model of assistance for diabetics in this country based on the principles of modern diabetology. First, we examine its functional and clinical organization to comply with assistance policy during the New State period in Portugal. Next, we depict the organization of the assistance model, which included treatment and education of poor patients with diabetes.

Evidence of intrauterine device insertion by nurses in Primary Health Care: an integrative review

OBJECTIVES

to synthesize and analyze evidence on intrauterine device insertion by nurses in Primary Health Care.

METHODS

an integrative review, carried out in the BDENF, CINAHL, LILACS, SciELO, Scopus, PubMed and Web of Science databases in June 2022, delimiting the period from 1960 to 2022.

RESULTS

141 articles were identified in the initial search, and 10 studies made up the final sample. Four (40%) were developed in the United States and one (10%) in Brazil, with publications from 1979 to 2021. The findings were grouped into three categories: Nurse training to insert an intrauterine device; Nurses' competency to insert an intrauterine device; and Women's access to intrauterine devices.

CONCLUSIONS

nurse theoretical and practical training is a prominent element, consolidated in the favorable outcomes of insertions performed by nurses and satisfaction among women, a practice that has expanded access to the contraceptive method in Primary Health Care.

Educational intervention in social skills for Primary Care nurses

OBJECTIVE

to assess an educational intervention on social skills for nurses who work in Primary Health Care.

METHOD

a qualitative research-intervention study, carried out in the municipalities covered by the 17th Health Regional of Paraná. It was developed in three interrelated stages: exploratory, where meetings were held with the managers to define the groups and logistics for running the course; intermediate, developed in meetings with different groups of nurses, addressing selected topics; assessment, in which the nurses developed a personal plan to improve their social skills.

RESULTS

participants were 57 nurses who acted as coordinators of Primary Care. They considered the educational intervention in social skills fundamental for positive changes in their professional performance.

FINAL CONSIDERATIONS

the educational intervention in social skills was assessed as an important strategy to strengthen the development of nurses' managerial and care skills.

Performance of Family Health Strategy Nurses in LGBT+ Healthcare

OBJECTIVE

To analyze the role of Family Health Strategy (FHS) nurses in the health care of LGBT+ individuals.

METHODS

This qualitative study is based on Institutional Analysis. Data was collected in August 2021 through semi-structured interviews with 14 Family Health Strategy nurses from municipalities in the state of São Paulo. The data was processed using the IRaMuTeQ® software and analyzed lexically.

RESULTS

The textual corpus gave rise to three themes, which addressed the nurses' practice, the difficulties and challenges they face in providing care to LGBT+ individuals, and the direct association of LGBT+ individuals with sexually transmitted infections.

CONCLUSION

Lack of preparedness, access to information, and the need for expanded listening skills are still gaps in the performance of FHS nurses in caring for LGBT+ individuals. However, fostering acceptance and building strong relationships have been effective strategies in bridging the gap in nursing care for the LGBT+ community.

Expansion of Psychosocial Care Centers and their relationship with health and human rights

OBJECTIVE

To analyze the factors associated with the expansion of the number of Brazilian Psychosocial Care Centers (CAPS) considering aspects related to the general health scenario and the institutionalization of human rights.

METHODS

An analytical document-based study, developed between February 2020 and May 2022, whose secondary data on the 27 Brazilian capitals were collected on platforms in the public domain, based on the time series from 2015 to 2020. Indicators were listed based on health system infrastructure and quality of life. For data analysis, descriptive statistics, Pearson's correlation test and Student's t test were used.

RESULTS

The capitals that expanded the number of CAPS in the analyzed period were the ones that presented the greatest political-legal framework for the protection of human rights.

CONCLUSION

The results suggest that the greater the commitment of governments in favor of human rights, the greater the investment for CAPS expansion.

Quality of health care in Primary Care: perspective of people with Diabetes Mellitus

OBJECTIVES

to identify how people with diabetes assess the care offered by Primary Care teams.

METHODS

a cross-sectional study based on structured interviews with the application of the Patient Assessment of Chronic Illness instrument to people with Type 2 Diabetes Mellitus. Data were submitted to statistical analysis.

RESULTS

451 individuals participated in the study, more than half aged 60 years or older (64.0%); 63.9% had been diagnosed for more than five years; and 23.9% used insulin. The average score obtained was 2.5, which indicated little involvement in self-care and low support for the care of the chronic condition by the Family Health Strategy team, and was higher among women and people with a partner.

CONCLUSIONS

people with diabetes consider that they do not receive individualized treatment, with dialogue and discussion for setting goals, and that they are not prepared for self-managing their health condition.

THE LANGUAGE MODELS IN HEALTHCARE AND THE ROLE OF CHATGPT: COMMENTS

The introduction of chatbots has been one of the most intriguing advances in artificial intelligence. There are numerous potential uses for artificial intelligence in clinical research. However, there are also some issues that require attention. Everyone agrees that AI requires a more stable foundation and that a cutting-edge approach is necessary for AI to operate effectively.

Factors associated with decision time to seek care in the face of ischemic stroke

OBJECTIVE

To verify the association between sociodemographic, clinical, environmental, cognitive, and emotional factors and the decision time of people with ischemic stroke to seek a health service after the onset of symptoms or wake up stroke.

METHOD

Cross-sectional study carried out from March to October 2019, with 304 patients, in a public hospital, a reference in neurology. Data obtained through interview and from medical records. Decision time was analyzed as a geometric mean. In the bivariate and multivariate analyses, linear regression was used and the Akaike Information Criterion was used to select the best model. Statistical significance of 5% was adopted.

RESULTS

The geometric mean of decision time was 0.30h (95% CI 0.23-0.39). The final model explained this time in 41%, showing an increase of 0.5 min for people with arterial hypertension; 10.8 min for those who waited for symptoms to improve; 1.4 min for those who were alone at the onset of symptoms; 3.9 min for those at home; 3.2 min for the ones at work; and 2.1 for those on the street/public space.

CONCLUSION

The mean decision time for seeking a health service was high and influenced by clinical, environmental, cognitive, and emotional variables. The results guide nurses regarding health education.

[The roots of trauma: a review of the history of psychotrauma]

Perceptions of the importance of the role of psychological trauma in the origins of psychiatric problems have oscillated throughout the history of psychiatry. However, since the conception of post-traumatic stress disorder (PTSD), western societies have witnessed a marked expansion of the discourse of trauma in the interpretation of devastating human experiences like catastrophes, genocides, disasters, and epidemics. Through an integrative literature review, this article analyzes some of the historical and epistemological determinants behind the emergence of traumatic memory and the establishment of trauma as a semantic field that orients clinical responses and political strategies in the field of the humanities and the health sciences.

Factors associated with the time to treat breast cancer in the pandemic period: an observational study

OBJECTIVES

to analyze the factors associated with the time to surgical treatment for breast cancer in patients seen at a reference mastology outpatient clinic in the State of Ceará.

METHODS

analytical, longitudinal study with medical charts from the Mastology Outpatient Clinic of Assis Chateaubriand Maternity School. We used 140 medical charts of breast cancer patients with surgeries performed during the pandemic.

RESULTS

the study evidenced associations between schooling and shorter time to treatment in patients who underwent biopsy before the first outpatient visit (p = 0.026; OR: 0.16; CI = 0.03-0.85); in the group who had the biopsy performed by the outpatient clinic, was associated the type of tumor (p = 0.019) and neoadjuvant therapy (p = 0.000).

CONCLUSIONS

the lesser educational level, tumor type, and use of neoadjuvant therapy were factors associated with the time to treatment during the pandemic period.

Professional burnout and patient safety culture in Primary Health Care

OBJECTIVES

to analyze the association between the risk of occupational exhaustion (burnout) and safety culture in Primary Health Care.

METHODS

ross-sectional study conducted in 18 Primary Health Care Units in the Northeast of Brazil. Three questionnaires were used: sociodemographic, Maslach Burnout Inventory, and the Medical Office Survey on Patient Safety Culture. The study was approved by the Research Ethics Committee.

RESULTS

seventy-eight healthcare workers participated, of which 64.1% presented a reduced risk of burnout; and 11.5%, a high risk (p=0.000). The following were identified as weakened dimensions of safety culture: Work pressure and pace; Owner, managing partners, leadership support; Overall ratings on quality; and Overall rating on patient safety.

CONCLUSIONS

an association was found between low risk of developing burnout syndrome and positive evaluation of safety culture.

The pandemic changes daily life and ways of living: technosociality and user/families experiences

OBJECTIVES

understand the changes imposed by the COVID-19 pandemic in the daily lives of users of Primary Health Care and their families and its impact on self-care and health promotion.

METHODS

this is a holistic-qualitative multiple case study, based on the Comprehensive Sociology of Everyday Life, in which 61 users participated.

RESULTS

experiencing a new daily life in COVID-19 pandemic times, users express their feelings, adaptation to new habits and ways of living. Health technologies and virtual social networks stand out in helping with everyday tasks, in communicating with loved ones and health professionals, and in validating dubious information. Faith and spirituality arise in the face of uncertainty and suffering.

FINAL CONSIDERATIONS

it is imperative to pay close attention to the changes in daily life caused by the COVID-19 pandemic, in order to offer care directed to the singular and collective needs.

Perceptions about exposure to pesticides among rural school students: identified controversies

OBJECTIVES

to identify, according to students' perception, controversies related to the term "pesticide" and its influence on health.

METHODS

field research, with qualitative analysis via discursive textual analysis. Collective interviews were carried out with students of ninth grade of elementary school from four rural schools in the western region of Paraná.

RESULTS

when analyzing students' statements, it was identified that pesticides are part of their reality and that of the local community Controversies related to pesticides and health arose, with emphasis on the form of production and the understanding of the real harm generated by exposure and use of pesticides.

CONCLUSIONS

approaching pesticides in the context of education and health is essential so that there is a strengthening of discussions, in a critical and contextualized way, in school spaces, expanding the look at the topic as a way of enriching understandings and discourses on the subject.

Development and validation of an instrument for the evaluation of HIV care in Primary Health Care

OBJECTIVE

To develop and validate an instrument to evaluate the decentralization process of care for People Living with HIV in Primary Health Care.

METHOD

Methodological study, developed in four stages: elaboration of the logical model based on the triad Structure-Process-Outcomes; development of the instrument; content validation by expert judges and technical reviewers; and semantic validation. Online questionnaires were used, and the Kappa index was used for analysis.

RESULTS

The instrument with 68 items and 8 factors was submitted to validation by expert judges who recommended the exclusion of 3 items and the alteration of 2 factors. In the validation by technical reviewers, 2 items were excluded and 6 factors were highlighted; the agreement index was ≥0.75. In the semantic validation, 87.3% of the judges answered "totally agree" for the items presented.

CONCLUSION

The instrument is validated for its content, has 63 items and has the potential to assess the care provided for people living with HIV in Primary Health Care.

Prevalence of characteristics associated with sarcopenia in elders: a cross-sectional study

Objectives:

to identify the prevalence and characteristics associated with sarcopenia in elders in Primary Health Care Units.

Methods:

cross-sectional study with 384 elders. To evaluate sarcopenia, we measured: strength and muscle mass, and physical performance. The elderly were classified as having: probable sarcopenia; sarcopenia; or severe sarcopenia. The chi-squared test and the multinomial logistic regression method were used.

Results:

the prevalence of probable sarcopenia was 25.52%; of sarcopenia, 11.98%; and of severe sarcopenia, 9.90%. Probable sarcopenia is 1.75 times more prevalent in men; osteoporosis is 2.16 times more prevalent in people with severe sarcopenia; polypharmacy is 1.57 times more likely in individuals with probable sarcopenia; and calf circumference below 31 cm is 2.24 times more likely in patients with sarcopenia and 2.19 times more likely in patients with severe sarcopenia.

Conclusions:

the highest prevalence was of probable sarcopenia, and the characteristics associated with sarcopenia were sex, osteoporosis, polypharmacy, overweight, obesity, and calf circumference.

Elderly Mortality due to Ambulatory Care Sensitive Conditions and Primary Health Care Coverage in the Federal District

OBJECTIVES

To describe the mortality coefficients of elderly due to primary care sensitive conditions, from 2008 to 2018, and determine its association with the coverage of the Primary Health Care (Family Health Strategy and Basic Care models) in the Federal District.

METHODS

Ecological time series of mortality in Federal District elderly, from 2008 to 2018. The Poisson regression model was applied, considering as significant those with p<0.05, with a CI of 95%.

RESULTS

There were 70,503 deaths. There was a decrease in the risk of death of elders due to cardiovascular diseases and diabetes. Higher primary care coverage decreased the chance of death by sensitive conditions, both in Basic Care (OR: 0.994, CI: 0.990-0.998) and in the Family Health Strategy (OR: 0.997, CI: 0.995-0.999).

CONCLUSIONS

Primary Care coverage was associated with a lower chance of death of the elderly due to Ambulatory Care Sensitive Conditions, especially in Basic Care.

Tangency and multiple factors of violence against lecturer: nuances of the experience in pedagogical practices in health education

OBJECTIVE

to identify factors that lead the teacher to experience violence in their pedagogical practice in health education.

METHOD

research with a qualitative approach, based on the Grounded Theory, conducted with 11 professors of the nursing course of a public university in the central region of Brazil in 2020 and 2021. Online semi-structured interviews were analyzed partially in the light of the Constructivist Grounded Theory.

RESULTS

factors that lead lecturer to experience violence are characterized by institutional culture, gender, professor's perception of violence, and the triggers that drive students to commit violence. Social status and inequalities lead to positions of domination and, consequently, create a fertile ground for violence.

FINAL CONSIDERATIONS

analyzing violence under Bourdieu's theory, it is clear that student violence towards lecturer and the reports contained in this study deserve pedagogical reflection. However, it is necessary to include these discussions as a background in teaching environments.

Analysis of the convergence of the Safety Attitudes Questionnaire and the Hospital Survey on Patient Safety Culture

OBJECTIVES

to analyze patient safety culture from nursing professionals' perception at a university hospital, by assessing the convergence between the Safety Attitudes Questionnaire and the Hospital Survey on Patient Safety Culture.

METHODS

a cross-sectional study, with 434 nursing professionals. Data collection took place through the application of both instruments. Descriptive and inferential statistics were used.

RESULTS

in the Hospital Survey on Patient Safety Culture, the "teamwork within the units" dimension was considered a strong area of patient safety. In the Safety Attitudes Questionnaire, the "job satisfaction" and "perception of stress" domains reached the score for a good safety culture. Patient safety culture perception is correlated, in both instruments, with high magnitude.

CONCLUSIONS

the two instruments converge towards a similar assessment of patient safety culture.

Nursing protocol in chronic kidney disease prevention in older adults in primary care

OBJECTIVES

to develop a protocol for Nursing Process operationalization in approaching older adults with vulnerability to chronic kidney disease in Primary Health Care, based on Neuman's stressors.

METHODS

a methodological study, carried out in two stages: 1) synthesis of evidence using an inductive strategy (mixed method study) and 2) protocol development to support the nursing process operationalization with older adults enrolled in a Basic Health Unit, using a deductive strategy (Neuman's stressor concepts, NANDA, NIC, and NOC taxonomies, Risner's line of reasoning, and cross-mapping), described according to A Step-by-Step Guide to Developing Protocols.

RESULTS

102 older adults participated, and 17 diagnoses, 34 interventions and 26 nursing outcomes were identified.

CONCLUSIONS

the protocol developed is a technology that makes it possible to operationalize the Nursing Process, based on Neuman's stressors and on taxonomy, conceptual and care frameworks, guiding care and nursing records.

Women who live in mining on the French-Brazilian border: daily challenges

OBJECTIVES

to describe the daily life of Brazilian women who work in mining.

METHODS

a descriptive, qualitative study, with analysis based on the theory of Symbolic Interactionism. Non-participant observations, field diary writing, sociodemographic form, non-directive interviews, recorded and transcribed in full, were carried out with 19 women who work in mining areas on the French-Brazilian Amazon border.

RESULTS

two categories emerged: Life trajectories: women's work in mining; Woman, mother and prospector: the multiple facets of gender inequality on the Amazon border.

FINAL CONSIDERATIONS

assessing the daily experiences of women in the Amazonian mines allowed identifying their health needs, evidencing the need to direct and implement public and social policies and health practices for comprehensive care of these women's health.

Quality of life and self-perceived health of adolescents in Middle School

PURPOSE

Quality of life and self-perception of health are useful indicators for children and adolescents, as they are associated with objective and subjective states of health, including physical, cognitive, social, emotional, and environmental aspects. This study aims to characterize the adolescents at a Brazilian private financing school and to analyze the association between quality of life, health self-perception, and the sociodemographic profile.

METHODS

This is a cross-sectional, observational study conducted with 124 elementary school students. The questionnaires of Characterization of the participants, Health Self-perception and Pediatric Quality of Life Inventory ™ (PedsQL™) were applied to the adolescents and, to the parents or guardians, the Brazil Economic Classification Criteria questionnaires and PedsQLTM.

RESULTS

The majority of the participants were female, belonged to economy class A, declared to have excellent health self-perception, and attributed a good score for their health. The majority of parents and adolescents evaluated positively the physical, psychosocial, and overall quality of life dimensions. Having a positive health self-perception increased the chances of having a good quality of life and the increase of one year in age decreased the chances of the adolescent having a positive quality of life assessment.

CONCLUSION

The study of adolescence is essential to broaden the understanding of aspects related to the quality of life, both in its physical and psychosocial dimension and to self-perception. This knowledge will provide adolescents with an incentive for their well-being, better performance of their activities, and greater preparation for adult life.

Cesarean childbirth: an institutional socio-clinical study of the professional practices and discourses

OBJECTIVE

to analyze how the social, historical, economic and professional elements influence the institutionalization process of cesarean childbirth in Brazil and France.

METHOD

a qualitative study grounded on the theoretical framework of the institutional socioclinic. The data were produced through focus groups and individual interviews, supported by semi-structured scripts, with health professionals, mothers and fathers and a research diary. The study had 83 participants. The analysis was based on the theoretical framework and thematic analysis. Cross analysis was developed between the different types of data, services and groups, as well as between countries.

RESULTS

the participants were characterized in terms of schooling, employment, level of training and workplace. The countries researched have their own peculiar health and educational structure and are marked by a social-historical-economic construction outlined by patriarchy. The New Public Management influences both contexts and makes health care precarious. The technical and organizational dimensions reinforce an intellectual and social division of work and knowledge in health.

CONCLUSION

the institutionalization process of childbirth in the countries is marked by social, economic and professional aspects. Practices and speeches of the professionals in their work process influence the occurrence, or not, of cesarean sections.

Stress level among undergraduate nursing students related to the training phase and sociodemographic factors

OBJECTIVE

identify the stress level among nursing undergraduates and the associated sociodemographic and academic factors; to compare stress level among college students according to the training phase in the course.

METHOD

cross-sectional study with 286 university students. The instrument of sociodemographic and academic characterization and the stress scale were applied. The overall stress level was assessed by standardized score. In the bivariate analysis, Pearson's chi-square or Fisher's exact test was used, and multiple logistic regression analysis was performed using the Poisson model. Statistical significance of 5% was adopted.

RESULTS

higher proportion of college students presented medium/high level of global stress. Students from 6th to 10th semesters presented higher levels of stress compared to those from 1st to 5th, in the Realization of practical activities, Professional Communication (p = 0.014), Environment (p = 0.053) and Vocational Training (p = 0.000) domains). In the multivariate analysis, they contributed to the highest level of stress the variables attending the 6th to 10th semesters, female gender, monthly income ≤ one minimum wage and income considered insufficient.

CONCLUSION

women in a more advanced stage of education and with low economic condition present a higher level of stress in their academic education.

[Vulnerabilities of children admitted to a pediatric inpatient care unit]

OBJECTIVE:

To identify the vulnerabilities of children admitted to a pediatric inpatient unit of a university hospital.

METHODS:

Cross-sectional, descriptive study from April to September 2013 with36 children aged 30 days to 12 years old, admitted to medical-surgical pediatric inpatient units of a university hospital and their caregivers. Data concerning sociocultural, socioeconomic and clinical context of children and their families were collected by interview with the child caregiver and from patients, records, and analyzed by descriptive statistics.

RESULTS:

Of the total sample, 97.1% (n=132) of children had at least one type of vulnerability, the majority related to the caregiver's level of education, followed by caregiver's financial situation, health history of the child, caregiver's family situation, use of alcohol, tobacco, and illicit drugs by the caregiver, family's living conditions, caregiver's schooling, and bonding between the caregiver and the child. Only 2.9% (n=4) of the children did not show any criteria to be classified in a category of vulnerability.

CONCLUSIONS:

Most children were classified has having a social vulnerability. It is imperative to create networks of support between the hospital and the primary healthcare service to promote healthcare practices directed to the needs of the child and family.

Quantitative and qualitative analysis on the legislative production relating to healthcare in passage in the National Congress in the years 2007 and 2008

CONTEXT AND OBJECTIVES

The Federal Constitution of 1988 allowed the National Congress to contribute towards formulation of new public policies. The objective of this study was to analyze the legislative production that dealt with health issues that was in passage in the National Congress between January 2007 and December 2008.

DESIGN AND SETTING

Descriptive-exploratory cross-sectional study with quantitative and qualitative approaches, conducted in a federal university.

METHODS

The analysis material for the study comprised 144 draft bills that were classified and subsequently randomly evaluated by 155 professionals working within the healthcare system.

RESULTS

The analysis showed that the Workers' Party (PT) and Brazilian Democratic Movement Party (PMDB) were the parties that presented the largest proportions of the draft bills (12.5% and 11.1%); 25.4% of the draft bills were presented by congress members with academic qualifications within healthcare and only 1.4% of the draft bills became transformed into legal regulations. In questionnaire responses, 51.5% of the evaluators did not consider the draft bills to be viable, 40.6% did not consider them to be relevant and 52.5% said that if the draft bills were not approved it would not be harmful to Brazilian society.

CONCLUSION

In analyzing the data from this study, it was noted that the legislative production relating to healthcare was low and the transformation rate from draft bill to legal regulation was negligible. The results from the evaluation showed that the quality of legislative production was impaired.

Lifestyle, health characteristics and alcohol abuse in young adults who are non-daily smokers

CONTEXT AND OBJECTIVES

Despite the decline in the prevalence of tobacco use in many countries, including Brazil, there are growing numbers of smokers who continue to smoke at a low daily rate, or less frequently (non-daily smokers). This group needs to be better characterized in order to direct preventive actions and public health policies. The aim here was to compare lifestyle, health characteristics and alcoholism problems among young adult smokers, non-daily smokers and non-smokers.

DESIGN AND SETTING

This was a cross-sectional study in which volunteers from the university community and its surrounds in Santa Maria, State of Rio Grande do Sul, Brazil, were included between October 2007 and January 2008.

METHODS

Out of 1240 volunteers initially contacted in a university cafeteria, a total of 728 participants of mean age 22.45 ± 3.32 years were selected for final analysis. Data were collected using structured questionnaires.

RESULTS

In general, it was observed that the non-daily smokers showed intermediate characteristics in relation to the smokers and non-smokers. However, there was a significant association between non-daily smoking and alcohol abuse. The non-daily smokers presented an odds ratio of 2.4 (95% confidence interval: 1.10-5.48) in relation to the daily smokers and an odds ratio of 3.3 (confidence interval: 1.7-6.5) in relation to the non-smokers, with regard to presenting a positive CAGE test, thereby indicating alcohol abuse or dependence.

CONCLUSION

The study suggested that non-daily smoking and alcohol consumption were concomitant behaviors.