TECNOLOGIAS EDUCATIVAS NO CONTEXTO DA ASSISTÊNCIA À ATENÇÃO PRIMÁRIA: UMA REFLEXÃO SOB A ÓTICA DE PAULO FREIRE

Educational technologies are devices that enable the consideration of the singularities of the subjects involved in the work process. Therefore, it is necessary that health professionals be aware of these technologies in order to improve the quality of the care they provide. The objective was to contribute to critical reflection on the adherence to educational technologies in health care by the multiprofessional team in the context of primary care. It was based on an integrative review, with qualitative subsidy and reflexive bias, when the data were interpreted from the critical view of the researchers and in the light of Paulo Freire's theoretical subsidy about the educative practice. The electronic bibliographic bases LILACS and BDENF were used, accessed through the advanced search in the Virtual Health Library. The inclusion criteria were: primary studies, available in full, published between the years 2017 and 2021, in Portuguese, English and Spanish, and that addressed the theme. Twelve articles were analyzed. It was found that primary care uses some types of light technologies such as: qualified listening, bonding, welcoming, educational actions in health and accountability. In Paulo Freire's reflective approach to inclusive education, which can be achieved through educational technologies that increase the access to health actions offered to the population and induce the integrality of care. In this scenario, the adherence to these tools enables the active participation of the professional as an educator in the learning process, providing the continuous development of the assistance skills of both the patient and the health professionals.Las tecnologías educativas son dispositivos que permiten la consideración de las singularidades de los sujetos involucrados en el proceso de trabajo, por lo que es necesario sensibilizar a los profesionales de la salud sobre estas tecnologías con el fin de mejorar la calidad de la atención producida por ellos. El objetivo fue contribuir a la reflexión crítica en el apoyo de las tecnologías educativas en la atención sanitaria por parte del equipo multidisciplinar en el contexto de la atención primaria. Se basó en una revisión integradora, con apoyo cualitativo y sesgo reflexivo, cuando los datos fueron interpretados desde la perspectiva crítica de los investigadores y a la luz del apoyo teórico de Paulo Freire sobre la práctica educativa. Se utilizaron las bases de datos bibliográficas electrónicas: LILACS y BDENF, a las que se accedió a través de la búsqueda avanzada en la Biblioteca Virtual en Salud (BVS). Los criterios de inclusión fueron: estudios primarios, disponibles en su totalidad, publicados entre 2017 y 2021, en los idiomas portugués, inglés y español que abordaron el tema. Se analizaron 12 artículos. Se encontró que la atención primaria utiliza algunos tipos de tecnologías de luz como: escucha calificada, vinculación, acogida, acciones educativas en salud y rendición de cuentas. En el aspecto reflexivo de Paulo Freire, en el sesgo de la educación inclusiva, que se puede lograr a través de tecnologías educativas que han aumentado el acceso a las acciones de salud ofrecidas a la población e inducen la integralidad de la atención.Este estudo buscou contribuir com a reflexão crítica na adesão das tecnologias educativas na assistência à saúde pela equipe multiprofissional no contexto da atenção primaria. Baseou-se de uma revisão integrativa, com subsídio qualitativa e viés reflexivo, quando os dados foram interpretados a partir do olhar crítico dos pesquisadores e à luz do subsídio teórico de Paulo Freire sobre a prática educativa. Trata-se de uma revisão integrativa com viés reflexivo viés reflexivo, a partir do olhar crítico dos pesquisadores e à luz do subsídio teórico de Paulo Freire sobre a prática educativa. As buscas foram realizadas nas bases de dados: LILACS e BDENF, acessadas por meio da busca avançada na BVS. Utilizou-se os descritores associados pelos operadores booleanos: “Atenção Primaria” AND Tecnologia OR Saúde, incluindo, estudos de reflexão, teses, dissertações e artigos originais disponíveis na íntegra no formato on-line, publicados na íntegra entre os anos de 2015 a 2021.De acordo com os critérios de elegibilidade, foram inclusos 12 artigos neste estudo. Nessa perspectiva, a partir da ótica reflexiva de Paulo Freire, no viés da educação inclusiva, que pode ser alcançada através das tecnologias educativas que aumentaram o acesso às ações de saúde oferecidas à população e induzem a integralidade da assistência. Portanto, a adesão dessas ferramentas possibilita a participação ativa do profissional como educador no processo da aprendizagem, propiciando o desenvolvimento contínuo das habilidades assistências tanto do paciente quanto dos profissionais da área de saúde

TECNOLOGIAS EDUCATIVAS NO CONTEXTO DA ASSISTÊNCIA À ATENÇÃO PRIMÁRIA: UMA REFLEXÃO SOB A ÓTICA DE PAULO FREIRE

Educational technologies are devices that enable the consideration of the singularities of the subjects involved in the work process. Therefore, it is necessary that health professionals be aware of these technologies in order to improve the quality of the care they provide. The objective was to contribute to critical reflection on the adherence to educational technologies in health care by the multiprofessional team in the context of primary care. It was based on an integrative review, with qualitative subsidy and reflexive bias, when the data were interpreted from the critical view of the researchers and in the light of Paulo Freire's theoretical subsidy about the educative practice. The electronic bibliographic bases LILACS and BDENF were used, accessed through the advanced search in the Virtual Health Library. The inclusion criteria were: primary studies, available in full, published between the years 2017 and 2021, in Portuguese, English and Spanish, and that addressed the theme. Twelve articles were analyzed. It was found that primary care uses some types of light technologies such as: qualified listening, bonding, welcoming, educational actions in health and accountability. In Paulo Freire's reflective approach to inclusive education, which can be achieved through educational technologies that increase the access to health actions offered to the population and induce the integrality of care. In this scenario, the adherence to these tools enables the active participation of the professional as an educator in the learning process, providing the continuous development of the assistance skills of both the patient and the health professionals.Las tecnologías educativas son dispositivos que permiten la consideración de las singularidades de los sujetos involucrados en el proceso de trabajo, por lo que es necesario sensibilizar a los profesionales de la salud sobre estas tecnologías con el fin de mejorar la calidad de la atención producida por ellos. El objetivo fue contribuir a la reflexión crítica en el apoyo de las tecnologías educativas en la atención sanitaria por parte del equipo multidisciplinar en el contexto de la atención primaria. Se basó en una revisión integradora, con apoyo cualitativo y sesgo reflexivo, cuando los datos fueron interpretados desde la perspectiva crítica de los investigadores y a la luz del apoyo teórico de Paulo Freire sobre la práctica educativa. Se utilizaron las bases de datos bibliográficas electrónicas: LILACS y BDENF, a las que se accedió a través de la búsqueda avanzada en la Biblioteca Virtual en Salud (BVS). Los criterios de inclusión fueron: estudios primarios, disponibles en su totalidad, publicados entre 2017 y 2021, en los idiomas portugués, inglés y español que abordaron el tema. Se analizaron 12 artículos. Se encontró que la atención primaria utiliza algunos tipos de tecnologías de luz como: escucha calificada, vinculación, acogida, acciones educativas en salud y rendición de cuentas. En el aspecto reflexivo de Paulo Freire, en el sesgo de la educación inclusiva, que se puede lograr a través de tecnologías educativas que han aumentado el acceso a las acciones de salud ofrecidas a la población e inducen la integralidad de la atención.Este estudo buscou contribuir com a reflexão crítica na adesão das tecnologias educativas na assistência à saúde pela equipe multiprofissional no contexto da atenção primaria. Baseou-se de uma revisão integrativa, com subsídio qualitativa e viés reflexivo, quando os dados foram interpretados a partir do olhar crítico dos pesquisadores e à luz do subsídio teórico de Paulo Freire sobre a prática educativa. Trata-se de uma revisão integrativa com viés reflexivo viés reflexivo, a partir do olhar crítico dos pesquisadores e à luz do subsídio teórico de Paulo Freire sobre a prática educativa. As buscas foram realizadas nas bases de dados: LILACS e BDENF, acessadas por meio da busca avançada na BVS. Utilizou-se os descritores associados pelos operadores booleanos: “Atenção Primaria” AND Tecnologia OR Saúde, incluindo, estudos de reflexão, teses, dissertações e artigos originais disponíveis na íntegra no formato on-line, publicados na íntegra entre os anos de 2015 a 2021.De acordo com os critérios de elegibilidade, foram inclusos 12 artigos neste estudo. Nessa perspectiva, a partir da ótica reflexiva de Paulo Freire, no viés da educação inclusiva, que pode ser alcançada através das tecnologias educativas que aumentaram o acesso às ações de saúde oferecidas à população e induzem a integralidade da assistência. Portanto, a adesão dessas ferramentas possibilita a participação ativa do profissional como educador no processo da aprendizagem, propiciando o desenvolvimento contínuo das habilidades assistências tanto do paciente quanto dos profissionais da área de saúde

Relação entre circunferência abdominal e pressão arterial sistólica em policiais militares do estado do Maranhão

Obesity is a non-communicable, complex and multifactorial chronic disease whose main characteristic is the excessive accumulation of fat, increasing the abdominal circumference (WC). The aim of this study was to analyze whether WC is directly related to the increase in systolic blood pressure (SBP) in military police (PM) during the operational period. The sample consisted of 415 female and male police officers. Through the physical evaluation, the body mass (kg); height (m); SBP (mmHg) and WC (cm). For data analysis, the sample was stratified into less or more than 60 months (5 years) of military service time (TTM), using Pearson's Correlation to verify the relationship between WC and SBP, with values ​​presented by mean and standard deviation. With TTM less than 60 months, there were 249 police officers aged = 29.95±4.49 years, TTM = 30.79±18.92 months, WC=90.68±9.59 cm and SBP 130.102±15.12 mmHg. With TTM greater than 60 months, there were 166 police officers aged = 44.08±6.99 years, TTM=257.95±93.86 months, WC=97.29±10.16 cm and SBP=133.97± 18.40 mmHg. There was a moderate and significant correlation between WC and PAS for officers with less than five years in the position (r=0.30; p<0.01) and low and significant for officers with more than five years in the position (r=0.27; p<0.01). The WC value does not seem to be an indication that explains the SBP variation in this population and context, suggesting that other factors are more important in this variation.A obesidade é uma doença crônica não transmissível, complexa e multifatorial que tem como característica principal o acúmulo excessivo de gordura, aumentando a circunferência abdominal (CA). O objetivo deste estudo foi analisar se a CA está diretamente relacionada ao aumento da pressão arterial sistólica (PAS) em policiais militares (PM). A amostra foi de 415 policiais dos sexos feminino e masculino. Através da avaliação física foram mensuradas a massa corporal (kg); estatura (m); PAS (mmHg) e CA (cm). Para análise dos dados houve a estratificação da amostra em menos ou mais que 60 meses (5 anos) de tempo de trabalho militar (TTM), utilizando-se da Correlação de Pearson para verificar a relação entre a CA e PAS, com valores apresentados por média e desvio padrão. Com TTM menor que 60 meses foram 249 policiais com idade = 29,95±4,49 anos, TTM=30,79±18,92 meses, CA = 90,68±9,59 cm e PAS 130,102±15,12 mmHg. Com TTM maior que 60 meses, foram 166 policiais com idade = 44,08±6,99 anos, TTM = 257,95±93,86 meses, CA=97,29±10,16 cm e PAS=133,97±18,40 mmHg. Houve correlação moderada e significativa entre CA e PAS para policiais com menos de cinco anos no cargo (r=0,30; p<0,01) e baixa e significativa para policiais com mais de cinco anos no cargo (r=0,27; p<0,01). O valor da CA não parece um indicativo que explique a variação da PAS nessa população e contexto, sugerindo que outros fatores tenham maior importância nesta variação

Os desafios do atendimento de pacientes com sequelas cardiovasculares decorrentes de trauma do tórax / Challenges in the care of patients with cardiovascular sequels resulting from chest trauma

Introdução: O tórax apresenta estruturas de diversos sistemas de sustentação da vida, dentre eles o respiratório e o cardiovascular. Por conter, estruturas nobres para a manutenção da vida, os potenciais para ocorrer lesões graves em decorrência de traumas são muito grandes, como dados mostram, 25% das mortes são secundárias a trauma torácico. Dentro deste contexto, questiona-se quais os desafios no atendimento de pacientes com sequelas cardiovasculares decorrentes de traumas torácicos? Portanto, esse estudo tem como objetivo identificar as dificuldades enfrentadas na assistência de saúde de pacientes com repercussões cardiovasculares devido a trauma de tórax, através da elaboração de um formulário baseado em revisão bibliográfica de dados da literatura científica publicados sobre esse tema. Metodologia: O trabalho baseia-se numa revisão integrativa de literatura, na qual foram analisados artigos publicados em revistas científicas, utilizando-se das bases de dados da BVS (Biblioteca Virtual da Saúde), como: Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e Scielo (Scientific Electronic Library Online). Resultados: Após as análises e seleção, restaram-se sete artigos para integrar a discussão. Os artigos selecionados, estão descritos na tabela, com autores, título, metodologia, resultados e conclusão. Em seguida, foi realizada uma discussão acerca destes artigos. Conclusão: Cada um dos casos revisados neste estudo demonstra a necessidade e a importância de acompanhamento cuidadoso de todos os pacientes que sofreram trauma torácico fechado, mesmo que a avaliação cardíaca inicial possa ser negativa.

O perfil semiológico do paciente portador de hemorragia digestiva alta

OBJETIVO: O seguinte estudo objetivou descrever a semiologia do paciente portador de hemorragia digestiva alta, considerando como determinante na avaliação de potencias focos hemorrágicos. METODOLOGIA: Foram realizadas buscas nas plataformas do SciELO, LILACS, PubMed, Scopus e Google Scholar,utilizando os descritores gastrointestinal bleeding, peptic ulcerous disease e varicose hemorrhage, sendo identificados 35 estudos, dos quais foram incluídos 13 artigos completos. Desses estudos, 5 avaliaram as principais etiologias, 2 o surgimento de novos testes diagnósticos, 2 analisaram os aspectos epidemiológicos e 1 a sintomatologia apresentada pelo acometimento da hemorragia digestiva alta. Observou-se inicialmente a abundâncias de informações conceituais sobre o sangramento, como um transtorno clínico comum, acompanhada de inúmeras manifestações, considerando que o foco hemorrágico pode ocorrer em qualquer porção do trato gastrointestinal. Neste estudo, todas as publicações eleitas apresentaram o quadro semiológico composto por algia abdominal, indícios de choque hipovolêmico e taquicardia, alguns exibiram quedas abruptas da pressão arterial, odinofagia, êmese, náuseas e estado ictérico. Os pacientes implicados, cronicamente, já manifestaram ocorrências prévias, devido ao caráter recidivante torna-se essencial investigar a existência de varizes, fístula aorto-entérica, angiodisplasia e doença ulcerosa. CONCLUSÃO: Elucida-se que a hemorragia digestiva alta representa a principal causa de sangramento do trato gastrointestinal, majoritamente manifesta-se como hematêmese ou melena e cursam com o quadro sintomatológico que auxilia na avaliação da gravidade deste e o embasamento de potenciais focos de sangramento e que contribuam para disseminação de informações e intervenções futuras

Understanding the relation between Zika virus infection during pregnancy and adverse fetal, infant and child outcomes: a protocol for a systematic review and individual participant data meta-analysis of longitudinal studies of pregnant women and their infants and children

IntroductionZika virus (ZIKV) infection during pregnancy is a known cause of microcephaly and other congenital and developmental anomalies. In the absence of a ZIKV vaccine or prophylactics, principal investigators (PIs) and international leaders in ZIKV research have formed the ZIKV Individual Participant Data (IPD) Consortium to identify, collect and synthesise IPD from longitudinal studies of pregnant women that measure ZIKV infection during pregnancy and fetal, infant or child outcomes.Methods and analysisWe will identify eligible studies through the ZIKV IPD Consortium membership and a systematic review and invite study PIs to participate in the IPD meta-analysis (IPD-MA). We will use the combined dataset to estimate the relative and absolute risk of congenital Zika syndrome (CZS), including microcephaly and late symptomatic congenital infections; identify and explore sources of heterogeneity in those estimates and develop and validate a risk prediction model to identify the pregnancies at the highest risk of CZS or adverse developmental outcomes. The variable accuracy of diagnostic assays and differences in exposure and outcome definitions means that included studies will have a higher level of systematic variability, a component of measurement error, than an IPD-MA of studies of an established pathogen. We will use expert testimony, existing internal and external diagnostic accuracy validation studies and laboratory external quality assessments to inform the distribution of measurement error in our models. We will apply both Bayesian and frequentist methods to directly account for these and other sources of uncertainty.Ethics and disseminationThe IPD-MA was deemed exempt from ethical review. We will convene a group of patient advocates to evaluate the ethical implications and utility of the risk stratification tool. Findings from these analyses will be shared via national and international conferences and through publication in open access, peer-reviewed journals.Trial registration numberPROSPERO International prospective register of systematic reviews (CRD42017068915).</jats:sec

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat