Risk Factors For The Ill-defined Causes Of Death In The Brazilian States: A Multilevel Analysis

This study describes the spatial-temporal changes of the proportion of ill-defined causes of death in Brazil (1998-2012) and investigates which demographic and socioeconomic factors affect this proportion. We collected information of the proportion of ill-defined causes of death by age (15-59 years), sex, period, locality, and socioeconomic data. We used a multilevel Poisson model to investigate which factors affect the risk of ill-defined causes of death. Unlike states located in the South and Midwest, we detected clusters with high proportional levels of these deaths in states in the North and Northeast regions. A greater proportion occurred in 1998-2002 (0.09), in the North and Northeast (0.14 and 0.12, respectively), in older age groups (0.09), and in places with poor socioeconomic conditions. The adjusted analysis showed differences in proportion according to the region, age, period, schooling, social inequality, and income. The results indicate that the lower the age group and the better the socioeconomic situation, the lower the risk to register the cause of death as ill-defined. Although over the past years, the quality of Brazil’s mortality data has gradually increased, investments towards improving mortality registries cannot be discontinued

Photovoice como método de pesquisa para educação em saúde: uma revisão integrativa

Photovoice e? um me?todo de pesquisa onde o participante registra por fotografia suas experie?ncias, analisadas em ciclos de reflexa?o, avaliac?a?o e ac?a?o. Objetivou-se analisar publicac?o?es que relatem a utilizac?a?o de photovoice por enfermeiros na educac?a?o para sau?de. Procedeu-se a uma revisa?o integrativa da literatura nas bases de dados Medline® CINAHL®, LILACS®, SCOPUS, IBECS, BDENF, CAPES. Foram selecionados 27 estudos, publicados entre 2007 e 2018, identificando-se duas a?reas tema?ticas: Transic?a?o sau?de-doenc?a e Criac?a?o de ambientes favora?veis a? sau?de. Estudos trouxeram subsi?dios norteadores de pesquisa em educac?a?o para a sau?de usando photovoice, tanto para compreender e atuar em diferentes circunsta?ncias do processo sau?de-doenc?a quanto para criar estrate?gias educacionais favora?veis a ambientes sauda?veis. Escassa produc?a?o dos enfermeiros brasileiros acerca de photovoice demonstra o desconhecimento das amplas possibilidades do me?todo nas pesquisas de enfermagem, motivando-nos a enfatizar a necessidade de divulga?-la entre os pesquisadores da enfermagem, destacando seus u?teis recursos investigativos

Miradas desde la historia social y la historia intelectual: América Latina en sus culturas: de los procesos independistas a la globalización

Fil: Benito Moya, Silvano G. A. Universidad Católica de Córdoba. Facultad de Filosofía y Humanidades; Argentina.Fil: Universidad Católica de Córdoba. Facultad de Filosofía y Humanidades; Argentina

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Rastreamento de problemas de idosos na atenção primária e proposta de roteiro de triagem com uma abordagem multidimensional

Resumo: O objetivo foi examinar as caraterísticas psicométricas de testes de triagem para idosos e propor um roteiro para a atenção primária. Etapas: (1) confiabilidade interaferidores para testes de desempenho e perguntas de autoavaliação para 8 funções; (2) sensibilidade e especificidade de questões para depressão e apoio social; (3) encontro de especialistas para seleção das atividades instrumentais da vida diária (AIVD); (4) elaboração do roteiro. A triagem durou 16 minutos. A confiabilidade interaferidores para os testes de desempenho foi excelente, mas pobre para perguntas. Depressão e apoio social apresentaram sensibilidade e especificidade satisfatórias (0,74/0,77 e 0,77/0,96). Quatro AIVD foram selecionadas por mais de 55% dos especialistas. Após os resultados, elaborou-se um roteiro que priorizou o uso de testes de desempenho, mantendo questões para humor, apoio social e AIVD. O estudo sugere maior reprodutibilidade de testes de performance em relação a perguntas. Para humor e apoio social, as questões podem constituir uma primeira etapa de triagem. O roteiro proposto possibilita o rápido rastreamento de problemas

Prevalência de sobrecarga e respectivos fatores associados em cuidadores de idosos dependentes, em uma região pobre do Rio de Janeiro, Brasil

Resumo: O envelhecimento populacional ocasionou aumento da dependência e da sobrecarga de cuidadores familiares de idosos dependentes. O objetivo foi verificar, entre cuidadores familiares, a prevalência de sobrecarga e os fatores associados a ela em uma região pobre e violenta do Rio de Janeiro, Brasil. Trata-se de estudo transversal com 140 idosos e cuidadores familiares, para investigar apoio social, maus tratos, coabitação e sobrecarga nos cuidadores familiares, além de dependência, declínio cognitivo e depressão no idoso. Modelos logísticos múltiplos foram construídos no intuito de explicar a sobrecarga dos cuidadores familiares. As seguintes características dos idosos se associaram à sobrecarga: idade (OR = 0,94; p < 0,002), depressão (OR = 2,59; p < 0,005) e declínio cognitivo (OR = 3,19; p < 0,03). Em relação aos fatores dos cuidadores familiares, apenas apoio social manteve a relevância (OR = 2,35; p < 0,005). Conclui-se que investigar e tratar depressão e demência em idosos, assim como prover apoio aos seus cuidadores, podem contribuir para o manejo efetivo da sobrecarga de cuidadores familiares, melhorando a qualidade do cuidado e a saúde de ambos

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN