Monitoramento de pacientes cirúrgicos no pós-alta: avaliação do risco de complicações

O monitoramento das complicações de pacientes cirúrgicos no período pós-alta é um desafio, principalmente pela dificuldade de seguimento no ambiente domiciliar. Neste sentido, este estudo possibilitou construir e validar diretrizes para monitorar pacientes cirúrgicos no período pós-alta hospitalar durante o período de aparecimento de complicações. Para isso, foi desenvolvida uma pesquisa multimétodo em quatro etapas consecutivas e encadeadas: 1 - Prospecção, revisão e análise dos aplicativos voltados ao paciente cirúrgico; 2 - Revisão integrativa sobre as complicações pós-alta; 3 - Desenvolvimento de diretrizes de monitoramento; e 4 - Avaliação da viabilidade da diretriz proposta por meio do seguimento de egressos de artroplastia de joelho e quadril. Na primeira etapa, nas bases de dados, 14 estudos que apresentavam algum aplicativo (apps) para smartphone voltados ao paciente cirúrgico foram selecionados, sendo predominante estudos procedentes dos Estados Unidos da América (28.6%). Das bases de patentes, 10 registros foram recuperados, sendo 60% dos apps na base de patente americana (USPTO), hospedados em sistemas híbridos (iPhone e Android) e desenvolvidos de 2014 a 2018 (80%). Havia uma série de apps voltados aos pacientes cirúrgicos, como alvos e/ou usuários, no entanto, pautados, sobretudo, na troca de mensagens de texto e imagens e concentrados no auxílio ao médico/equipe de saúde na preparação do paciente, durante o procedimento ou no período pós-cirúrgico hospitalar, não havendo aplicativos para assistência pós-alta em domicílio. Na segunda etapa, 10 estudos primários incluídos mostraram que as complicações infecciosas foram as mais comuns, com destaque para pneumonia e infecção urinária e do sítio cirúrgico. Nos estudos, a presença de complicações esteve ligada à necessidade de reoperações ou pior sobrevida e aumento da mortalidade. A frequência de monitoramento e o tempo de seguimento foram incomuns nos estudos. Com base nisto, na etapa 3, criou-se uma diretriz em que foram elencadas 16 complicações elegíveis para serem utilizadas no monitoramento de pacientes cirúrgicos no período pós-alta hospitalar. De acordo com o consenso dos especialistas, é necessário o monitoramento do paciente, ao menos, uma vez por dia (68,8%). Por outro lado, o tempo máximo de monitoramento apresentou maior variação, de 48 horas até 30 dias, no caso da presença de sinais e sintomas de infecção. Ao testar a aplicabilidade do instrumento com 99 pacientes, 32,3% desenvolveram, ao menos, uma complicação, sendo que 10,1% desenvolveram mais de uma complicação num seguimento de 30 dias. Dor (31; 31,3%) e Infecção (12; 12,1%) foram as complicações mais prevalentes. Identificou-se associação estatística entre os desfechos clínicos dos pacientes submetidos à cirurgia de joelho e quadril e a presença de complicações no período pós-operatório (p<0,001). Desta forma, acredita-se que a monitorização do egresso cirúrgico no domicilio é imprescindível para a vigilância epidemiológica da ocorrência de complicações e direcionamento da politicas públicas de prevenção e controle.Monitoring the complications of surgical patients in the post-discharge period is a challenge, mainly due to the difficulty of follow-up at home. This study made it possible to build and validate guidelines for monitoring surgical patients in the post-discharge period during the period of complications. For this, a multi-method research was developed in four consecutive and linked stages: 1 - Prospecting, reviewing and analyzing applications aimed at surgical patients; 2 - Integrative review on the main post-discharge complications; 3 - Development of monitoring guidelines; and 4 - Evaluation of the feasibility of the proposed guideline through home follow-up of patients undergoing knee and hip arthroplasty surgery. In the first stage, in the databases, 14 studies that presented an application (apps) for smartphones aimed at the surgical patient were selected, with predominant studies coming from the United States of America (28.6%). From the patent bases, 10 records were recovered, 60% of the apps on the United States patent base (USPTO), hosted on hybrid systems (iPhone and Android) and developed from 2014 to 2018 (80%). There were a number of apps aimed at surgical patients, as targets and / or users, however, based mainly on the exchange of text messages and images and focused on assisting the doctor / health team in preparing the patient during the procedure, or in the hospital post-surgical period, with no applications for post-discharge assistance at home. In the second stage, 10 primary studies included showed that infectious complications were the most common, with emphasis on pneumonia and urinary and surgical site infection. In the studies, the presence of complications was linked to the need for reoperations or worse survival and increased mortality. Monitoring frequency and follow-up time were uncommon in the studies. Based on this, in step 3, a guideline was created in which 16 eligible complications were listed for use in monitoring surgical patients in the post-hospital discharge period. According to the experts' consensus, it is necessary to monitor the patient at least once a day (68.8%). On the other hand, the maximum monitoring time showed a greater variation, from 48 hours to 30 days, in the case of the presence of signs and symptoms of infection. When testing the applicability of the instrument with 99 patients, 32.3% developed at least one complication, with 10.1% developing more than one complication in a 30-day follow-up. Pain (31; 31.3%) and Infection (12; 12.1%) were the most prevalent complications. A statistical association was identified between the clinical outcome of patients undergoing knee and hip surgery and the presence of complications in the postoperative period (p <0.001). Thus, it is believed that the monitoring of surgical egress at home is essential for the epidemiological surveillance of the occurrence of complications and the direction of public policies for prevention and control

between precision public health and stigma risk

Viruela del mono: entre la salud pública de precisión y el riesgo de estigmapublishersversionpublishersversionpublishersversionpublishe

Men’s mental health in the COVID-19 pandemic: the role of intolerance of uncertainty and social support

The COVID-19 pandemic exerted a tremendous toll on individuals’ mental health. This study aimed to examine the associations between men’s common mental disorders (CMD), intolerance of uncertainty (IU), and social support (SS). A cross-sectional online study was carried out in all Brazilian states. Participants were 1.006 adult men recruited through social media using a snowball technique. Men completed the Self-Report Questionnaire-20, the Intolerance of Uncertainty Scale, the Two-Way Social Support Scale, and a sociodemographic questionnaire. In addition, a t-Test and a regression analysis were performed.&nbsp; Men in the clinical group reported significantly higher levels of IU and lower levels of SS. Furthermore, SS moderated the relationship between IU and CMD, suggesting that SS might help protect men’s mental health against the deleterious effects of IU in a pandemic scenario. These results indicate that different forms of social support seem to be a promising focus of psychosocial intervention in this context.La pandemia de COVID-19 afectó considerablemente la salud mental individual. Este estudio examinó las asociaciones entre los trastornos mentales comunes (TMC) de los hombres, la intolerancia a la incertidumbre (II) y el apoyo social (AS). Es un estudio transversal online realizado en los estados brasileños, con 1.006 hombres adultos reclutados en redes sociales mediante la técnica de bola de nieve. Respondieron el Self-Report Questionnaire-20, la Escala de Intolerancia a Incertidumbre, la Escala de Apoyo Social Two-way y un cuestionario sociodemográfico. Se realizaron el test t y el análisis de regresión. Hombres del grupo clínico informaron significativamente niveles superiores de II e inferiores de AS. Además, AS moderó la relación entre II y TMC, lo que sugiere que AS protege la salud mental de los hombres contra los efectos nocivos de II en la pandemia. Estos resultados sugieren que el apoyo social es un foco prometedor de intervención psicosocial en este contexto.A pandemia da COVID-19 impactou consideravelmente a saúde mental dos indivíduos. Este estudo teve por objetivo examinar associações entre transtornos mentais comuns (TMC) de homens, a intolerância à incerteza (II) e apoio social (AS). Trata-se de um estudo transversal online realizado em todos os estados brasileiros, com 1.006 homens adultos recrutados em redes sociais mediante a técnica de bola de neve. Os participantes responderam ao Self-Report Questionnaire-20, à Escala de Intolerância à Incerteza, à Escala de Apoio Social Two-way e a um questionário sociodemográfico. Teste t e análise de regressão foram realizados. Os homens do grupo clínico relataram significativamente níveis maiores de II e níveis inferiores de AS. Além disso, o AS moderou a relação entre II e TMC, sugerindo que AS protege a saúde mental dos homens contra efeitos deletérios da II na pandemia. Esses resultados sugerem que o apoio social parece ser um foco promissor de intervenção psicossocial nesse contexto

an integrative review

OBJECTIVE: to identify the main complications in the late postoperative period of surgical patients. METHOD: an integrative review from the CINAHL, LILACS, Science direct, Web of Science, SCOPUS, Europe PMC, and MEDLINE databases. Descriptors and keywords were combined without language or time restriction. R RESULTS: ten primary studies were included. Infectious complications were the most common, especially surgical site infection, pneumonia and urinary tract infection. The presence of complications was linked to increased mortality, need for reoperations and worse survival. Few studies report on monitoring frequency, follow-up time and/or when complications started to be observed.  CONCLUSION: infectious complications were the most prevalent postoperatively. The scarcity of guidelines that guide the monitoring of complications regarding monitoring frequency, follow-up time and classification makes it difficult to establish an overview of them and consequently propose intervention strategies. Objetivo: identificar as principais complicações ocorridas no pós-operatório tardio de pacientes cirúrgicos. Método: revisão integrativa a partir das bases CINAHL, LILACS, Science Direct, Web of Science, SCOPUS, Europe PMC e MEDLINE. Combinaram-se descritores e palavras-chave, sem restrição de idioma ou tempo. Resultados: dez estudos primários foram incluídos. As complicações infecciosas foram as mais comuns, com destaque para infecção do sitio cirúrgico, pneumonia e infecção urinária. A presença de complicações esteve ligada ao aumento na mortalidade, necessidade de reoperações e pior sobrevida. Poucos estudos relatam a frequência de monitoramento, tempo de seguimento e/ou quando as complicações começaram a serem observadas. Conclusão: as complicações infecciosas foram as mais prevalentes no pós-operatório. A escassez de diretrizes que guiem a vigilância das complicações no que concerne a frequência de monitoramento, tempo de seguimento e classificação dificulta estabelecer um panorama das mesmas e consequentemente propor estratégias de intervenção. Objetivo: identificar las principales complicaciones que ocurren en el postoperatorio tardío de los pacientes quirúrgicos. Método:   revisión integradora de CINAHL, LILACS, Science Direct, Web of Science, SCOPUS, Europe PMC y MEDLINE. Descriptores y palabras clave fueron combinadas sin restricción de idioma o tiempo. Resultados:   se incluyeron diez estudios primarios. Las complicaciones infecciosas fueron las más comunes, especialmente la infección del sitio quirúrgico, la neumonía y la infección del tracto urinario. La presencia de complicaciones se relacionó con un aumento de la mortalidad, la necesidad de reoperaciones y una peor supervivencia. Pocos estudios informan sobre la frecuencia de monitoreo, el tiempo de seguimiento y/o cuándo comenzaron a observarse complicaciones. Conclusión: las complicaciones infecciosas fueron las más frecuentes después de la operación. La escasez de pautas que guían la vigilancia de las complicaciones con respecto a la frecuencia de monitoreo, el tiempo de seguimiento y la clasificación hace que sea difícil establecer una visión general de las mismas y, en consecuencia, proponer estrategias de intervención.publishersversionpublishe

a scoping review

Background: The interest in Global Health (GH) as an academic discipline has increased in the last dec-ade. This article reports the findings of a scoping review of studies about Global Health education in the Americas. Objective: To analyse educational programs on global health in the Americas. Method: Five electronic databases were used in a scoping review: PubMed, Scopus, Web of Knowledge, CINAHL, and Lilacs. Data collection happened in November 2017–March 2018. The following stages were rigorously observed: identification, selection, charting, and summarizing the studies that were included. To process the data, we used IRaMuTeQ software. Findings: Forty-six studies were identified and organized in categories: 1) diversity of the topics addressed in GH; 2) models of teaching; 3) emotional, cultural, and collaborative aspects in teaching GH; 4) student preparation for GH experiences; and 5) structures required for a GH course. Conclusions: The existing global health curriculum in the Americas is diffuse and limited, with a greater focus on clinical aspects. Thus, a minimum curriculum for students from different areas is needed. Results evidenced that the teaching of global health in the Americas is still incipient, although it is promising. The lack of a common curriculum for the courses in the region makes it difficult to train sensitive and capable professionals to achieve the 2030 Sustainable Development Goals.publishersversionpublishe

Hospital infection control programs: assessment of process and structure indicators

Objective: To assess hospital infection control committees in relation to structure and process indicators of hospital infection control programs. Method: Descriptive, cross-sectional study conducted with hospital committees registered in the National Registry of Healthcare Facilities. Primary and secondary data collection was conducted through structured interview using validated instruments and verification of documents, respectively. Results: Fourteen committees participated in the research. Mean values of conformity of 80.58% were evidenced for the technical-operational structure assessment indicator, 60.77% for the infection control and prevention operational guidelines indicator, 81.59% for the epidemiological surveillance system assessment indicator, and 63.44% for hospital infection control and prevention activities assessment indicator. Conclusion: Among the four instruments applied to assess hospital infection control programs, only two presented results with more than 80.0% of conformity: those related to the epidemiological surveillance and technical-operational structure assessments.Objective: To assess hospital infection control committees in relation to structure and process indicators of hospital infection control programs. Method: Descriptive, cross-sectional study conducted with hospital committees registered in the National Registry of Healthcare Facilities. Primary and secondary data collection was conducted through structured interview using validated instruments and verification of documents, respectively. Results: Fourteen committees participated in the research. Mean values of conformity of 80.58% were evidenced for the technical-operational structure assessment indicator, 60.77% for the infection control and prevention operational guidelines indicator, 81.59% for the epidemiological surveillance system assessment indicator, and 63.44% for hospital infection control and prevention activities assessment indicator. Conclusion: Among the four instruments applied to assess hospital infection control programs, only two presented results with more than 80.0% of conformity: those related to the epidemiological surveillance and technical-operational structure assessments

Results from a Nationwide Study

Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.Introduction: Little is known about how sheltering in place to contain the spread of COVID-19 over extended periods affects individuals’ psychological well-being. This study’s objective was to analyze the factors associated with MSM’s (men who have sex with men) low psychological well-being in the COVID-19 pandemic context. Method: This cross-sectional study was conducted online across Brazil (26 states and federal district) in April and May 2020. The participants were recruited using snowball sampling and Facebook posts. Data were collected using social media and MSM dating apps. We estimated the prevalence, crude prevalence ratio (PR), and the respective confidence intervals (CI95%). Results: The prevalence of low psychological well-being found in the sample was 7.9%. Associated factors were belonging to the youngest group (PR 2.76; CI95% 1.90–4.01), having polyamorous relationships (PR 2.78; CI95% 1.51–5.11), not complying with social isolation measures (PR 6.27; CI95% 4.42–8.87), not using the social media to find partners (PR 1.63; CI95% 1.06–2.53), having multiple sexual partners (PR 1.80; CI95% 1.04–3.11), having reduced the number of partners (PR 2.67; CI95% 1.44–4.95), and group sex (PR 1.82; CI95% 1.23–2.69) Conclusion: The well-being of MSM living in Brazil was negatively affected during the social distancing measures intended to control the spread of COVID-19. The variables that contributed the most to this outcome include social isolation, relationships established with partners, and sexual behavior. Policy Implications: Planning and implementing public policies and actions to promote psychological well-being are needed to improve MSM’s resilience by adopting safe strategies and behavior.publishersversionpublishe

Sex education for adolescents by teachers from a community education center

Objective: raising teachers' knowledge about sexuality, to provide subsidies for the development of education practices in health care by Nursing. Methods: a descriptive study of a qualitative approach developed in a Community Education Center, with middle and high school teachers (n: 15). After compiling the data, there were analyzed and structured by semantic similarities. This study was a research project approved by the Research Ethics Committee, CAAE: 02700212.4.0000.5214. Results: in the research, four categories emerged: "The importance of the theme approach in School", "Sexuality demonstrations by students", "The role of teachers in sexual education of students" and "How the school should address the theme?". Conclusion: the approach is based on a vertical transmission of knowledge, based mainly on biological aspects

Factors associated with unprotected sex in people who consume sexually explicit media

OBJECTIVE: To analyze the factors associated with sex without the use of condoms in consumers of sexually explicit media (SEM). METHODS: Cross-sectional study, with a sample of 172 participants selected and collected through social media. To assess the predictors of unprotected sexual practices, the Poisson regression model was used. Values were expressed as a robust prevalence ratio (PR) with their respective confidence intervals. RESULTS: There was a statistically significant association between, the use of condoms and the type of scenes that the participants prefer (p = 0.03), the preference for films with scenes involving unprotected sex or even those that do not care about protection (p = 0.02), the type of pornography watched influencing sexual relations (p = 0.017), and the number of scenes seen per week (p = 0.05). CONCLUSIONS: The lack of condom use was associated with the access to erotic scenes.publishersversionpublishe

revisión integradora

Publisher Copyright: © 2021 Revista Latino-Americana de Enfermagem.Objective: to analyze evidence concerning the feasibility of antimicrobial-impregnated fabrics in preventing and controlling microbial transmission in health services. Method: An integrative review using the following databases: MEDLINE (via PubMed), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Latin American and Caribbean Health Sciences Literature (LILACS), regardless of language and date of publication. Seven studies were included in the analysis to verify the types of fabrics and substances used to impregnate the fabrics, applicability in health services, and decrease in microbial load. Results: Silver nanoparticles and copper oxide are the main antimicrobial substances used to impregnate the fabrics. The patients’ use of these fabrics, such as in bed and bath linens and clothing, was more effective in reducing antimicrobial load than in health workers’ uniforms. Conclusion: The use of these antimicrobial-impregnated textiles, especially by patients, is a viable alternative to prevent and control microbial transmission in health services. Implementing these fabrics in health workers’ uniforms requires further studies, however, to verify its effectiveness in decreasing microbial load in clinical practice.publishersversionpublishe