Early and Frequent Psychiatric Readmissions in a Brazilian Cohort of Hospitalized Patients Between 2001 and 2013

OBJECTIVE

To characterize the profile of patients who were readmitted for mental and behavioral disorders, in the Brazilian Unified Health System, from 2001 to 2014, and the factors associated with early and frequent readmission.

METHOD

A retrospective, non-concurrent cohort study of patients admitted with a primary diagnosis of mental or behavioral disorders, from 2001 to 2014. This study selected demographic variables and clinical variables, as well as variables related to the characteristics of the hospitals. Poisson Regression methods with a robust variance estimator were used to estimate the incidence rate ratio (IRR) for each of the outcomes.

RESULTS

Early readmission occurred for 6.8% of the patients and frequent readmission for 8.3%. Characteristics such as being male, younger, with a diagnosis of a bipolar disorder, and admitted to a specialized hospital show a higher IRR for early readmission. The occurrence of early readmission was the most heavily associated characteristic with an increased rate of early readmission, and the magnitude of this increase depends on the patient's age.

CONCLUSION

Early and frequent readmissions are linked to patients' demographics, clinical information and health system's organization. Early readmission should be a priority in treatment planning to prevent frequent readmissions due to its strong association.

Impact of 48-h water and feed deprivation and hydroxychloride sources of copper and zinc on the metabolism and performance of grazing Nellore cattle during the dry period

Procedures such as transport and marketing can subject animals to water and feed deprivation and impair animal health and performance. Maintaining the mineral status of animals under these conditions can bring benefits to health and performance. The use of hydroxychloride mineral sources can improve mineral status, nutrient digestibility and performance. Two studies were conducted to investigate how the supplementation of 02 trace mineral sources of Cu and Zn and 48-hour water/feed deprivation would affect the performance and metabolism of grass-fed beef cattle. In the first study, 20 castrated and rumen-canulated Nellore steers (BW = 350 ± 132 kg; 20 m) were distributed in individual pens, in a 2 × 2 factorial arrangement: supplemental Cu and Zn sources from inorganic vs hydroxychloride (HTM) and 48-hours deprivation (WFD) vs unrestricted (WFU) access to water and feed. The 57d of study was divided into two periods: (1) Adaptation from -21d to -1d and (2) evaluation from 0d to 36d. Interaction between deprivation × period was detected (P < 0.05) for digestibility of DM (DMD), organic matter (OMD), neutral detergent fiber (NDFD), and acid detergent fiber (ADFD). Deprivation increased DMD, OMD, NDFD, and ADFD immediately after the deprivation period (3-5d), but impaired digestibility at longer periods such as 11-13d and 32-34d. DM (DMI) and nutrient intake (P = 0.075), as well as NDFD were higher in HTM. Several ruminal parameters were affected by deprivation: short-chain fatty acids concentration decreased, while rumen pH increased (deprivation × time; P < 0.05); decreased propionate, butyrate and increased isobutyrate, isovalerate, and valerate in WFD (deprivation × time; P < 0.05), respectively. In the second study, eighty-four intact Nellore males (BW = 260 ± 35 kg) were blocked by BW and randomly assigned to Urochloa brizantha cv. Marandu paddocks for 131d in a 2 × 2 factorial arrangement. Liver Cu was higher in WFU/HTM animals (mineral × deprivation; P < 0.05). Interaction between deprivation × period (P < 0.05) was detected for BW and average daily gain (ADG). On 2d and 12d after deprivation, WFD increased ADG and recovered the BW lost. In conclusion, water and feed deprivation imposed in these trials were able to impact several nutrient digestibility and ruminal fermentation parameters in short- and long-term. Performance was not affected by the studied factors. Furthermore, supplementation with sources of Cu and Zn hydroxychloride increased Cu in the liver and tended to increase DMI and NDFD.

[Beneficiaries of private health plans that used the public outpatient hemodialysis network in Brazil between 2012 and 2019]

Reimbursement to Brazilian Unified National Health System (SUS) is the most visible interface of the public-private relationship and its analysis can expand our understanding of the use of SUS by the supplementary sector. The study aims to characterize the beneficiaries of private health plans who underwent hemodialysis in the SUS, from 2012 to 2019, in relation to: gender, age group, region of residence, characteristics of the private health plans and the operators and of the care provided to them. The characteristics of the private health plans and the modality of the operators of the beneficiaries where then compared with data of the other beneficiaries in Brazil. An individual-centered database was constructed based on data from the Brazilian National Supplementary Health Agency (ANS); information on beneficiaries in Brazil was consulted in Brazilian Health Informatics Department (DATASUS). Frequency distributions were used to summarize the data, standardization by age and sex for characteristics of the private health plans and modality of the operators and ratio to compare frequencies. A total of 31,941 beneficiaries underwent hemodialysis in the SUS, 11,147 (34.9%) outside their municipality of residence, and 6,423 (20.11%) used the SUS for 25 months or more. When compared with other beneficiaries in Brazil, those who underwent hemodialysis in the SUS were more frequently linked to old private health plans (ratio, r = 2.41), collective by adherence (r = 1.76), individual/family (r = 1.36), outpatient (r = 4.66), municipal (r = 3.88), and/or philanthropic (r = 7.32). Private health plans with restrictive characteristics may have hindered the access of beneficiaries who performed hemodialysis in SUS to the networks of their operators and have represented one more among the factors that may have influenced the use of SUS by those beneficiaries, even with coverage provided for in their contracts.

Translation, cross-cultural adaptation and validation of the sickle cell self-efficacy scale (SCSES)

OBJECTIVE

To translate, cross-culturally adapt and validate the Sickle Cell Self-Efficacy Scale for application in the Brazilian cultural context.

METHODS

This is a methodological study performed in 6 steps: 1- Forward translation; 2- Translation synthesis; 3- Back-translation; 4- Assessment by expert committee, with computation of the Content Validity Index (CVI); 5- Cultural adequacy (pre-test); 6- Reproducibility. A pre-test was performed with the participation of 10 adolescents/young adults with sickle cell disease through a telephone call and their responses were recorded on a form in a web platform. The instrument validation step was carried out with 55 adolescents/young adults with sickle cell disease, 43 of them having participated in the retest. The analysis of internal consistency and reproducibility was calculated using the Cronbach's alpha coefficient and the Intraclass Correlation Coefficient (ICC), in the R statistical programming environment.

RESULTS

The translated instrument had good acceptance among the experts, reaching an average CVI of 1.0. In assessing reliability, the scale showed acceptable internal consistency, with a Cronbach's alpha of 0.84. In the agreement analysis, the ICC was 0.923 (95% CI: 0.857 to 0.958), which indicates good temporal reproducibility.

CONCLUSIONS

Following the process of translation, cross-cultural adaptation and validation, we obtained the Brazilian version of the Sickle Cell Self-Efficacy Scale, considered valid and reliable to be applied to adolescents and young adults with sickle cell disease in Brazil.

THE EFFECT OF BETA-HYDROXY-BETA-METHYLBUTYRATE (HMB) WITH NUTRITIONAL INTERVENTION ON ANTHROPOMETRIC MUSCLE MASS MARKERS, STRENGTH, FUNCTIONALITY, AND QUALITY OF LIFE IN PATIENTS ON THE WAITING LIST FOR LIVER TRANSPLANTATION: A DOUBLE-BLIND STUDY

OBJECTIVE

Patients on the waiting list for liver transplantation (LTx) usually lose muscle mass. Supplementation with β-hydroxy β-methylbutyrate (HMB) may have a promising effect on this clinical condition. This study aimed to evaluate the effects of HMB on muscle mass, strength, functionality, and quality of life in patients on the LTx waiting list.

METHODS

A double-blind, randomized study was conducted of 3g supplementation of HMB or 3g supplementation of maltodextrin (active control) with nutritional counselling for 12 wk in patients >18 y, evaluated at five points or timepoints. Body composition and anthropometric data (resistance, reactance, phase angle, weight, body mass index, arm circumference [AC], arm muscle area, and adductor pollicis muscle thickness) were collected, and muscle strength was assessed through dynamometry and muscle function by the frailty index (FI). Quality of life was assessed.

RESULTS

A total of 47 patients were enrolled (HMB: 23 and active control: 24). There was a significant difference in both groups for AC (P = 0.03), dynamometry (P = 0.02), and FI (P = 0.01). There was an increase in dynamometry between weeks 0 and 12 in both groups (HMB [Δdynamometry: 10.1% ± 16.4%; P < 0.05] and active control [Δdynamometry: 23.0% ± 70.3%; P < 0.05]). The AC increased in both groups between weeks 0 and 4 (HMB [ΔAC: 0.9% ± 2.8%; P < 0.05] and active control [ΔAC: 1.6% ± 3.6%; P < 0.05]) and between weeks 0 and 12 (HMB [ΔAC: 3.2% ± 6.7%; P < 0.05] and active control [ΔAC: 2.1% ± 6.6%; P < 0.05]). The FI decreased in both groups, between weeks 0 and 4 (HMB [ΔFI: -4.2% ± 6.9%; P < 0.05) and active control [ΔFI: -3.2% ± 9.6%; P < 0.05]) and between weeks 0 and 12 (HMB ΔFI: -4.4% ± 11.2%; P < 0.05] and active control [ΔFI: -5.5% ± 11.3%; P < 0.05]). The other variables did not change (P > 0.05).

CONCLUSIONS

Nutritional counselling with supplementation with HMB or active control in patients on the LTx waiting list improved AC, dynamometry, and the FI in both groups.

[Evaluation of the behavioral program in type 2 diabetes mellitus: a randomized clinical trial]

The scope of this article was to evaluate the effect of the behavioral group education program and telephone intervention in modifying psychological attitudes, enhancing empowerment, and self-care practices aimed at improving clinical control in type 2 diabetes mellitus. It involved a randomized cluster clinical trial, carried out with 199 people with diabetes. In order to perform intragroup comparisons (final and initial phases) and between groups with respect to the indices of the psychological attitude, empowerment, self-care and glycated hemoglobin level variables, the Generalizing Estimating Equation (GEE) approach was used. In all analyses, a 5% significance level and 95% confidence interval were used. When compared to the CG, the IG showed a significant reduction in the mean values of glycated hemoglobin (95%CI: -1.49 to -0.45), a statistically significant increase in the change in psychological attitude scores (95%CI: 9.70 to 15.40), on the empowerment scale (95%CI: 0.81 to 2.72) and adherence to self-care practices (95%CI: 1.44 to 2.10) at the end of the study. The behavioral program proved to be capable of modifying psychological attitudes, improving empowerment, self-care practices and clinical control.

MOTIVACIÓN PARA EL CAMBIO EN EL CONSUMO DE ALCOHOL: LA INTERVENCIÓN BREVE COMO ESTRATEGIA MOTIVACIONAL

Objetivo: analizar el efecto de una intervención breve sobre la motivación para el cambio en el consumo de alcohol. Método: Estudio experimental, de seguimiento, realizado con 43 participantes en dos Unidades Básicas de Salud. Se aplicó el Alcohol Use Disorders Identification Test, la Regla de Disposición al Cambio y un cuestionario socioeconómico. Resultados: el grupo experimental mostró una mediana igual a 10 puntos (fase de mantenimiento) al principio y después de 30 días. En el segmento, la mediana era igual a ocho puntos (etapa de acción). El grupo de control tenía una mediana igual a ocho puntos al principio y después de 30 días (etapa de acción). En el segmento, la mediana es igual a siete puntos (fase de planificación). En la evaluación intermedia de 30 días, se observó que había una diferencia estadística en la motivación entre los dos grupos (p=0,029). Conclusión: se concluyó que la Intervención Breve fue eficaz para mantener la motivación en las etapas de acción y mantenimiento del cambio en el consumo de alcohol.

MOTIVATION FOR CHANGE IN ALCOHOL CONSUMPTION: BRIEF INTERVENTION AS A MOTIVATIONAL STRATEGY

Objective: to analyze the effect of brief intervention on motivation to change alcohol consumption. Method: experimental, follow-up study, conducted with 43 participants in two Basic Health Units. The Alcohol Use Disorders Identification Test, the Change Readiness Ruler, and a socioeconomic questionnaire were applied. Results: The experimental group showed a median equal to 10 points (maintenance stage) at the beginning and after 30 days. In the segment, the median was equal to eight points (action stage). The control group had a median equal to eight points at the beginning and after 30 days (action stage). In the segment, median equal to seven points (planning stage). In the 30-day intermediate evaluation, it was noted that there was a statistical difference in motivation between the two groups (p=0.029). Conclusion: it was concluded that the Brief Intervention was effective in maintaining motivation in the stages of action and maintenance of change in the consumption of alcoholic drinks.

MOTIVAÇÃO PARA MUDANÇA NO CONSUMO DE BEBIDAS ALCOÓLICAS: INTERVENÇÃO BREVE COMO ESTRATÉGIA MOTIVACIONAL

Objetivo: analisar o efeito da intervenção breve na motivação para mudança do consumo de bebidas alcoólicas. Método: estudo experimental, de follow-up, realizado com 43 participantes em duas Unidades Básicas de Saúde. Foi aplicado o Alcohol Use Disorders Identification Test, a Régua de Prontidão para Mudança e um questionário socioeconômico. Resultados: o grupo experimental apresentou mediana igual a 10 pontos (fase de manutenção) no início e após 30 dias. No segmento, mediana igual a oito pontos (estágio de ação). O grupo- controle, mediana igual a oito pontos no início e após 30 dias (fase de ação). No segmento, a mediana igual a sete pontos (fase de planejamento). Na avaliação intermediária de 30 dias, notou-se que houve diferença estatística na motivação entre os dois grupos (p=0,029). Conclusão: concluiu-se que a Intervenção Breve foi eficaz para manter a motivação nos estágios de ação e manutenção da mudança no consumo de bebidas alcoólicas.

Influence of nutrition claims on different models of front-of-package nutritional labeling in supposedly healthy foods: Impact on the understanding of nutritional information, healthfulness perception, and purchase intention of Brazilian consumers

Nutrition claims are positive information about foods, which are widely used as a marketing strategy on labels. On the contrary, front-of-package nutritional labeling (FoPNL) aims to make it easier for consumers to understand the nutritional composition of foods and favor healthy food choices. However, the concomitant presence of nutrition claims and FoPNL may hinder the understanding, judgment, and choices of consumers at the moment of purchase. Therefore, the objective of this study was to evaluate the influence of nutrition claims on the efficacy of FoPNL models in the understanding of nutritional information, healthfulness perception, and purchase intention of Brazilian consumers. It was an experimental cross-sectional study carried out using an online questionnaire, with a total of 720 participants randomly divided into four FoPNL conditions: control, octagon, triangle, and magnifying glass. Each participant looked at 12 food packages, which were produced following the factorial design: (i) food category (cereal bar, whole grain cookies, and snacks); (ii) product type (containing one critical nutrient × containing two critical nutrients); and (iii) nutrition claims (present × absent). The comprehension of nutritional information was evaluated through the identification of excessive nutrients, and the healthfulness perception and purchase intention were evaluated using a seven-point scale. The results indicated that the presence of FoPNL increased the understanding of the information and reduced healthfulness perception and purchase intention. The presence of nutrition claims influenced the three outcomes, decreasing the probability of understanding information about food composition by 32% (OR 0.68, 95% confidence interval 0.58–0.78, p &lt; 0.01) and significantly increasing (p &lt; 0.05) average health scores (1.95–2.02) and purchase intention (2.00–2.05). Nonetheless, the interaction “FoPNL × claims” was not significant, which indicated that claims act independently. All FoPNL models were more effective than the control. For the least healthful type of product (two nutrients in excess), the octagon and triangle models were superior to the magnifying glass, regarding the outcome of healthfulness perception. The results prove the efficacy of FoPNL in consumer understanding and judgment. Despite the positive effects of FoPNL, it did not cancel the positivity bias generated by the claims.

Tratamento ambulatorial do câncer do colo do útero em tempo oportuno: a influência da região de residência de mulheres no Estado de Minas Gerais, Brasil

O objetivo deste estudo é investigar se há associação entre as Regiões Ampliadas de Saúde (RAS) de residência de Minas Gerais, Brasil, e o intervalo entre diagnóstico e início de tratamento de mulheres que realizaram tratamento ambulatorial (quimioterapia ou radioterapia) para câncer do colo do útero pelo Sistema Único de Saúde (SUS), entre 2001 e 2015. Trata-se de um estudo transversal, recorte de uma coorte, com 8.857 mulheres. Para avaliar a associação da RAS de residência e o intervalo entre diagnóstico e início de tratamento (em dias), foram utilizados modelos de regressão binomial negativa, considerando nível de significância de 5%. Os modelos foram construídos usando blocos de covariáveis sociodemográficas, clínicas e relacionadas ao tratamento. Foi determinado que a RAS de residência das mulheres está associada ao intervalo entre o diagnóstico e o início de tratamento. A RAS Norte foi a região do estado onde a média de tempo para iniciar o tratamento foi menor, e não residir nessa RAS aumenta a média de tempo para iniciar o tratamento entre 24% e 93% em comparação com outras RAS do estado. Fica evidente a disparidade no intervalo entre diagnóstico e início de tratamento entre as regiões do Estado de Minas Gerais. A disponibilidade de serviços habilitados para o tratamento do câncer nas RAS não reflete necessariamente em maior agilidade para início de tratamento. Compreender os fluxos das Redes de Atenção Oncológica e suas diferenças regionais é fundamental para aprimorar políticas públicas que garantam o cumprimento de leis vigentes, como a Lei nº 12.732/2012, que preconiza o início do tratamento de pacientes com câncer em até 60 dias após o diagnóstico.

Blood donor candidates and blood donations performed between 2005 and 2019 in Minas Gerais, Brazil: A time series analysis

Introduction

Time series studies related to blood donor candidates and blood donations are rare in Brazil. Population aging suggests a better understanding of the context related to blood donor candidates and blood donations performed.

Objective

The monthly series of candidates eligible to donate blood and actual donations between 2005 and 2019 at the Hemominas Foundation, Minas Gerais, Brazil, were described and analyzed.

Methods

Ten time series were constructed of blood donor candidates and blood donations. Each series covered the period from January 2005 to December 2019. The stationarity of the series was verified by the unit root test; the data distribution, by the Shapiro-Wilk test; the trend, by the Cox-Stuart test, and; the seasonality, by the Fisher's test (significance levels of 10% for the first test and 5% for the last three).

Results

All series were identified as non-stationary and presented trend and seasonality components. The rate of blood donor candidates and the rate of blood donations performed evidenced a positive upward trend until the last two-year analysis, when a drop occurred, from 1.75% and 1.42% in 2017 to 1.64% and 1.35% in 2019, respectively. The rate of blood donations trended downward, from 0.054% in 2005 to 0.046% in 2019. The proportion of unsuitable or unretained candidates reduced.

Conclusion

The study emphasized the need to stimulate blood donation by specific groups and increase ways to reduce the demand for blood components through the implementation of programs that expand alternatives to blood transfusions.

Evaluation of the Psychometric Properties of the Immunobiological Agent Conservation Assessment Scale

INTRODUCTION AND OBJECTIVE

The cold chain of immunobiological agent conservation occupies a strategic position in the immunization system and, therefore, needs to be evaluated. This study psychometrically evaluated the Immunobiological Agent Conservation Assessment Scale (Escala de Avaliação da Conservação de Imunobiológicos-EACI).

METHODS

Methodological study carried out in Minas Gerais, Brazil, including 275 immunization rooms, divided into three stages: (a) pilot study; (b) internal consistency and temporal reproducibility; (c) criterion validity and structural validity.

RESULTS

The EACI items were analyzed for comprehension and clarity; presenting internally consistency (Cronbach's alpha: 0.72 [95% CI: 0.666-0.763]) and temporal reproducibility (ICC: 0.948 [95% CI: 0.911-0.981]), in addition to explaining 72% of the variance and discriminating the groups criteria (p = .0025).

CONCLUSION

The EACI is psychometrically reliable and valid and is the first assessment instrument available for this construct.

The scope of practice of primary health care physicians in rural and urban areas in Brazil

This study aimed to identify differences in the scope of practice of primary care physicians and find the main factors associated with expanded practice in rural and urban areas of Brazil. Data from an online survey with 2,277 primary care physicians, conducted between January and March 2016, were used. Differences regarding activities and procedures performed by physicians per area were verified using Kruskal-Wallis/Dunn's post hoc and chi-square tests. Multivariate linear regression analyses were done using a bootstrap technique to identify the main factors associated with an expanded scope of practice. Regardless of the location, the results showed that the practices of the primary care physicians are below their competences. Rural physicians performed a higher number of procedures and activities compared with their peers from intermediate and urban municipalities. Within the overall sample, the variables related to a broader scope of practice included: male gender, work in rural municipalities, participation in training and continuing education programs and consultation of clinical protocols, articles and books. This study contributes with evidence that the medical scope of practice varies according to location. Recognizing and understanding the differences and associated factors for an expanded scope of practice is necessary to determine the skills and resources required for practice in rural and urban areas, collaborating in proposals of strategies to improve quality and access of health care services.

Quality of life of patients with cancer undergoing chemotherapy in hospitals in Belo Horizonte, Minas Gerais State, Brazil: does individual characteristics matter?

This study aims to evaluate changes in quality of life of cancer patients at the beginning of the first and the second cycle of chemotherapy (CT) in hospitals in Belo Horizonte, Minas Gerais State, Brazil. Longitudinal, prospective, descriptive study with a quantitative approach. We enrolled 230 patients, from a broader cohort, diagnosed with the five most frequent types of cancer (breast, colorectal, cervical, lung, and head and neck), aged 18 years or older, who were initiating CT for the first time. quality of life was assessed with the EORTC QLQ-C30 version 3, applied at the beginning of the first and second chemotherapy cycle. The paired Wilcoxon test was used to identify differences in quality of life between the two time points. A multivariate linear regression analysis was performed using the bootstrap method to investigate potential predictors of global health Status/quality of life. There was a significant increase in patients' emotional function scores (p < 0.001) as well as symptom scores for pain (p = 0.026), diarrhea (p = 0.018), and nausea/vomiting (p < 0.001) after initiation of CT. Widowhood was associated with improvements in the global health Status/quality of life (p = 0.028), whereas the presence of cervical cancer (p = 0.034) and being underweight (p = 0.033) were related to poorer global health status/quality of life scores. CT has detrimental effects on patients' physical health but, on the other hand, it leads to improvements in the emotional domain. Patients' individual characteristics at the beginning of CT are associated with changes in their quality of life. Our study could help identify these characteristics.

Comorbidities and in-hospital death of viral pneumonia adults admitted to SUS (2002-2015)

OBJECTIVE

To identify demographic and clinical characteristics of adult patients hospitalized in the Brazilian Unified Health System (SUS) due to viral pneumonia and investigate the association between some comorbidities and death during hospitalization.

METHODS

This retrospective cohort study was conducted with secondary data of adults admitted to SUS due to viral pneumonia between 2002 and 2015. Patient profile was characterized based on demographic and clinical variables. The association between the ten Elixhauser comorbidities and in-hospital death was investigated using Poisson regression models with robust standard errors. Results were quantified as incidence rate ratio (IRR) with 95% confidence intervals (CI), and we built five models using successive inclusion of variables blocks.

RESULTS

Hospital admissions for viral pneumonias decreased throughout the study period, and it was observed that 5.8% of hospitalized patients had an in-hospital death. We observed significant differences in demographic and clinical characteristics by comparing individuals who died during hospitalization with those who did not, with the occurrence of one or more comorbidities being more expressive among patients who died. Although not considered risk factors for in-hospital death, chronic pulmonary disease and congestive heart failure were the most common comorbidities. Conversely, IRR for in-hospital death increased with other neurological disorders, diabetes, cancer, obesity, and especially with HIV/AIDS.

CONCLUSIONS

Individuals presenting with pulmonary and cardiovascular diseases require proper attention during hospitalization, as well as those with other neurological diseases, diabetes, cancer, obesity, and especially HIV/AIDS. Understanding the influence of chronic diseases on viral infections may support the healthcare system in achieving better outcomes.

Validity and reliability of the QLQ-MY20 module for assessing the health-related quality of life in Brazilians with multiple myeloma

PURPOSE

Multiple myeloma (MM) is a rare but treatable hematological cancer, which makes the health-related quality of life (HRQoL) an important patient-report outcome measure in clinical studies. The Quality of Life Questionnaire Multiple Myeloma Module (QLQ-MY20) was developed by the European Organization for Research and Treatment of Cancer (EORTC) to measure HRQoL in people with MM. However, the Brazilian Portuguese version of QLQ-MY20 has not yet been validated for Brazil. This study aimed to evaluate the validity and reliability of the instrument for application in Brazilian patients with MM.

METHODS

This is a cross-sectional methodological study with patients seen in health services in Belo Horizonte, Brazil. The variables were collected through face-to-face interviews with the QLQ-MY20 instrument and complemented with data from medical records. Content validity analyses (content validity coefficient [CVC]; correctness ratio), convergent and divergent validity (Spearman's correlation coefficient [CC]), internal consistency, and temporal reproducibility (test-retest; intraclass correlation coefficient [ICC]) were performed.

RESULTS

225 patients were included and 71.1% were older than 60. The analysis of the judging committee showed adequate content validity. We observed mainly a good internal consistency of the items and good discrimination power in the convergent and divergent validity. High ICC values were observed through the test-retest, and there was no difference in the scores between the two moments, which shows good temporal stability of the instrument.

CONCLUSION

The study allowed us to conclude that the Brazilian version of the QLQ-MY20 module is valid and reliable, and thus suitable for application in Brazilians living with MM.

Evaluation of group education strategies and telephone intervention for type 2 diabetes

OBJECTIVE

To evaluate group education strategies and telephone intervention regarding the variables empowerment, self-care practices, and glycemic control of people with diabetes.

METHOD

Clinical trial with eight randomized clusters, conducted between 2015 and 2016, with 208 users with type 2 diabetes mellitus allocated for group education, telephone intervention, or control group. Sociodemographic data, glycated hemoglobin, empowerment, and self-care practices were collected.

RESULTS

The user mean age was of 63.5 years (SD = 8.9 years), with the participation of 124 women, which amounts to 59.6% of these users. The strategies led to a statistically significant reduction in the levels of glycated hemoglobin (p < 0.001). The telephone intervention was also observed to present statistically significant results regarding self-care practices (p < 0.001) and empowerment in diabetes (p < 0.001) when compared to group education.

CONCLUSION

The telephone intervention presented statistically significant results for empowerment and practices of self-care when compared to group education. Brazilian Registry of Clinical Trials (Registro Brasileiro de Ensaios Clínicos): RBR-7gb4wm.

Psychiatric hospitalizations by the Unified Health System in Brazil between 2000 and 2014

OBJECTIVE

To characterize the profile of patients hospitalized for mental and behavioral disorders by the Unified Health System (SUS) in Brazil between 2000 and 2014, and to verify how aspects of the new mental health policy influenced the rate of hospitalized patients in that period.

METHODS

Non-concurrent prospective cohort study using secondary data from inpatients with a primary diagnosis of mental and behavioral disorders between 01/01/2000 and 12/31/2014. Sociodemographic, clinical, and hospital characteristics variables were selected. Overall rates of hospitalized patients were calculated according to reason for admission, type of hospital, legal nature, and number of admissions per year for each patient. The association between rates of hospitalized patients, number of psychiatric beds per year, and number of Psychosocial Care Centers per year were tested.

RESULTS

We selected a total of 1,549,298 patients, whose most frequent diagnoses on first admission were psychoactive substance use disorders, followed by schizophrenia and mood disorders. The median of hospitalizations per patient was 1.9 and the length of stay per patient was 29 days. The overall rate of hospitalized patients was reduced by almost half in the period. The number of beds per year was positively associated with the rates of hospitalized patients; the number of CAPS per year was negatively associated with some rates of hospitalized patients.

CONCLUSION

Even in the face of adversity, the National Mental Health Policy has advanced in its goal of progressively reducing hospital beds and increasing the supply of substitute services such that both strategies were associated with the reduced inpatient rates. But the changes were felt with greater intensity in the first years of the policy's implementation, becoming less pronounced in recent years.

Spatiotemporal dynamics and risk estimates of COVID-19 epidemic in Minas Gerais State: analysis of an expanding process

COVID-19 is an infectious disease caused by the recently discovered coronavirus SARS-Cov-2. The disease became pandemic affecting many countries globally, including Brazil. Considering the expansion process and particularities during the initial stages of the epidemic, we aimed to analyze the spatial and spatiotemporal patterns of COVID-19 occurrence and to identify priority risk areas in Minas Gerais State, Southeast Brazil. An ecological study was performed considering all data from human cases of COVID-19 confirmed from the epidemiological week (EW) 11 (March 08, 2020) to EW 26 (June 27, 2020). Crude and smoothed incidence rates were used to analyze the distribution of disease patterns based on global and local indicators of spatial association and space-time risk assessment. Positive spatial autocorrelation and spatial dependence were found. Our results suggest that the metropolitan region of the State capital Belo Horizonte (MRBH) and Vale do Rio Doce mesoregions, as major epidemic foci in the beginning of the expansion process, have had important influence on the dispersion of SARS-CoV-2 in Minas Gerais State. Triangulo Mineiro/Alto Paranaiba region presented the highest risk of infection. In addition, six statistically significant spatiotemporal clusters were identified in the State, three at high risk and three at low risk. Our findings contribute to a greater understanding of the space-time disease dynamic and discuss strategies for identification of priority areas for COVID-19 surveillance and control.

National Program for the Evaluation of Health Services (PNASS) 2015-2016: an analysis on Brazil's hospitals

AIM

The present work aims to evaluate the performance of hospitals participating on the National Program for the Evaluation of Health Services (Programa Nacional de Avaliação de Serviços de Saúde - PNASS, 2015-2016).

METHODS

This is a descriptive cross-sectional quantitative study, which measured the performance of hospitals participating in the program, using data from the first PNASS 2015-2016 evaluation instrument. The processes evaluation questionnaire used in hospitals had 102 items, 17 criteria, grouped into four blocks or dimensions.

RESULTS

A total of 1,681 hospitals was evaluated. The average score for each block was: Organizational management (64); technical and logistical support for care provision (73); health care and care management (64); specific services/units (72). Regarding the administrative sphere, the best average performance was of the federal sphere, followed by the state and municipal ones. The hospitals located in the Southern and Southeastern regions presented the best performance (73), followed by the Midwestern (62.7), Northeastern (61.2), and Northern (58.5) regions.

CONCLUSION

The hospitals that perform highly complex procedures, just like those large and special ones, obtained a better performance. Public federal hospitals, with municipal management, also had the best results, as well as hospitals from the Southern and Southwestern regions of the country.

Impact of clinical, sociodemographic and quality of life factors on dialysis patient survival: a nine-year follow-up cohort study

Although renal replacement therapy has contributed to the survival of chronic kidney failure (CKF) patients, mortality remains a major concern. This study aimed to identify the factors associated with mortality in a prospective cohort of CKF patients. Sociodemographic, clinical, nutritional, lifestyle and quality of life data were collected from 712 patients. The instruments used were the Short-Form Health Survey (SF-36), Global Subjective Assessment (GSA) and Charlson Comorbidity Index (CCI) questionnaires. A total of 444 patients died during the study. After five years of follow-up, factors such as not being married (hazard ratio - HR = 1.289, 95%CI: 1.001; 1.660), a low frequency of leisure activities (HR = 1.321; 95%CI: 1.010; 1.727) and not being transplanted (HR = 7.246; 95%CI: 3.359; 15.630) remained independently associated with the risk of mortality. At the end of the follow-up period, factors such as not being married (HR = 1.337, 95%CI: 1.019; 1.756), not being transplanted (HR = 7.341, 95%CI: 3.829; 14.075) and having a worse nutritional status (HR = 1.363, 95%CI: 1.002; 1.853) remained independently associated with an increased risk of mortality, whereas a high schooling level (10 to 12 years, HR = 0.578, 95%CI: 0.344; 0.972; and over 12 years, HR = 0.561, 95%CI: 0.329; 0.956) and a better SF-36 physical functioning score (HR = 0.992, 95%CI: 0.987; 0.998) were protective factors associated with survival. The survival of patients with CKF is associated with factors not restricted to the clinical spectrum. The following factors were associated with high mortality: not being married, low schooling level, a limited social routine, a longer time on dialysis, worse nutritional status, and worse physical functioning.

Risk factors associated with antineoplastic chemotherapy-induced nausea and vomiting

OBJECTIVE

To estimate the incidence and to evaluate risk factors for antineoplastic nausea and vomiting with high and moderate emetogenic chemotherapy in adult patients in the first treatment cycle.

METHODS

Prospective cohort study with follow-up of 269 adults during the first cycle of antineoplastic chemotherapy. The incidence of nausea and vomiting was evaluated in the acute phase (0-24 hours), in the late phase (24 hours-5th day) and in the total phase (0-5th day).

RESULTS

In total, 152 patients underwent high emetogenic chemotherapy and 117 moderate emetogenic chemotherapy. The relative frequency of nausea was higher when compared with vomiting in the acute phase (p < 0.001) and in the late phase (p < 0.001). The risk factors identified were: age group ≤ 49 years (odds ratio = 0.47; 95%CI 0.23-0.95) and 50-64 years (odds ratio = 0.45; 95%CI 0.23-0.87), tobacco use (odds ratio = 0.35; 95%CI 0.14-0.88), and high emetogenic chemotherapy (odds ratio 0.55; 95%CI 0.31-0.95).

CONCLUSION

The incidence of nausea was higher than that of vomiting, and adverse effects were more frequent in the late phase. The results suggest the risk factors for chemotherapy-induced nausea and vomiting are tobacco, age (young adults), and high emetogenic chemotherapy.

Climacteric symptoms and quality of life in yoga practitioners

BACKGROUND

Yoga is among the most commonly studied complementary therapies for managing climacteric symptoms. However, it is unclear whether yoga practices in premenopause can affect the occurrence of symptoms when women reach menopause.

OBJECTIVE

To assess climacteric symptoms and quality of life in regular yoga practitioners and to determine whether yoga practices before menopause may avoid or mitigate climacteric-related symptoms.

DESIGN

This study of 108 women between 40 and 65 years old included 28 women who started to practice yoga in premenopause and had already practiced for at least five years, and as controls 30 physical activity practitioners (PA) who had practiced for at least five years, and 50 sedentary women.

MAIN OUTCOME MEASURES

Climacteric symptoms were evaluated with the Kupperman Menopausal Index (KMI) and the Women's Health Questionnaire (WHQ). Moreover, we measured the quality of life with the WHQ.

RESULTS

The KMI showed that 39.3% of yoga practitioners had no menopausal symptoms, and none reported severe symptoms. The WHQ indicated a few symptoms and a good quality of life for yoga practitioners (3.56; 3.35-3.80). In addition, we found that the yoga group had significantly less moderate and severe symptoms (p = 0.002) compared with the sedentary group. We also observed that yoga practitioners had less vasomotor symptoms and memory/concentration disorders than PA practitioners (p = 0.010 and p = 0.047) and sedentary women (p = 0.001 and p = 0.001) and also used fewer drugs than the PA (p < 0.001) and the sedentary groups (p = 0.001).

CONCLUSIONS

Yoga practitioners who started to practice in premenopause had satisfactory results on the frequency and intensity of climacteric symptoms and quality of life. Although further research is required to support our findings, we conclude that yoga practice may represent an efficient non-pharmacological approach to manage and prevent climacteric symptoms.

Comparative PCR-based diagnosis for the detection of Leishmania infantum in naturally infected dogs

The applicability of molecular biology/PCR for canine visceral leishmaniasis diagnosis presents challenges, mainly due to the diversity of targets described. The objectives of this study were to compare the sensitivities and reliability of five targets (kDNA/120, kDNA/145, ITS1, hsp70/234 and hsp70/1300) in four different tissue samples (bone marrow, popliteal lymph node, skin and conjunctival swab). Sixty-five dogs (32 males and 33 females) naturally infected with Leishmania infantum and ten dogs without infection were examined. Dogs were characterized by serological and parasitological methods. The parasitological test was considered the gold standard for analysis. All tests presented high specificity 100% (95% CI 0.72-1), and variable sensitivity. The targets kDNA/145, ITS1, kDNA/120, hsp70/234 and hsp70/1300 detected 100% (65/65), 93.4% (61/65), 92.3% (60/65), 84.61% (55/65) and 72.3% (77/65) of positive animals respectively. The performance of PCR methods was analyzed in two different scenarios. The highest sensitivity value identified in all scenarios studied was kDNA/145. Our results suggest that popliteal lymph node and conjunctival swab samples, besides being less invasive collections, represent a good substratum for PCR-based diagnosis, and the target kDNA/145 is the best choice for detecting L. infantum DNA in naturally infected dogs.

Hospitalizations and length of stay of cancer patients: A cohort study in the Brazilian Public Health System

The hospitalizations are part of cancer care and has been studied by researchers worldwide. A better understanding about their associated factors may help to achieve improvements on this area. The aims of this study were to investigate the association between demographic and clinical characteristics and hospitalizations, as well as between these characteristics and the length of stay (LOS), within the first year of outpatient treatment, for the most incident cancers in the Brazilian population. In this cohort study, we investigated 417,477 patients aged 19 years or more, who started outpatient cancer treatment, from 2010-2014, for breast, prostate, colorectal, cervix, lung and stomach cancers. The outcomes evaluated were: i) Hospitalizations within the first year of outpatient cancer treatment; and ii) LOS of the hospitalized patients. It was performed a binary logistic regression to evaluate the association between the explanatory variables and the hospitalizations and a negative binomial regression to evaluate their influence on the length of hospital stay. The hospitalizations occurred for 34% of patients, with a median of LOS of 6 days (IQR: 2-15). Female patients were 16% less likely to be hospitalized (OR: 0.84; 95% CI: 0.82-0.86), with lower average of LOS (AR: 0.98; 95% CI: 0.97-0.99), each additional year of age reduced in 2% the hospitalization odds (OR: 0.98; 95% CI: 0.98-0.99) and in 1% the average of LOS (AR: 0.99; 95% CI: 0.98-0.99), patients from South region had twice more chances of hospitalization than from North region (OR: 2.01; 95% CI: 1.93-2.10) and patients with colorectal cancer had greater probability of hospitalization (OR: 4.42; 95% CI: 4.27-4.48), with the highest average of LOS (AR: 1.37; 95% CI: 1.35-1.40). In view of our results, we consider that the government must expand the policies with potential to reduce the number of hospitalizations.

Validity of an instrument to evaluate the immunobiological cold chain

Objective: To develop and to test the validity of content and layout of a multidimensional tool to evaluate maintenance of the cold chain for immunobiological conservation.Method: A methodological study carried out in three steps: integrative review; development of theoretical and logical model for the development of the tool; implementation of the Delphi Technique to test the validity of content and layout. The Content Validity Index (CVI) and Content Validity Ratio (CVR) were calculated considering appropriate those values greater than or equal to 75% and 0.4, respectively.Results: The instrument consisted of 7 questions about structure and 20 about process, subdivided into three components: Transportation/Reception (n=3); Storage/Handling (n=13); Supervision/Permanent education (n=4). The CVI value was 87.4%, with values equal to 85.7% and 89% in the structure and process dimensions, respectively. The process components obtained CVI values equal to 88.9, 88.9 and 89.2%, respectively. The CVR was 0.8, with values equal to 0.7 and 0.8 in the structure and process dimensions. As for the layout validation, the questionnaire was considered intelligible.Conclusion: The study provides an instrument with validity of content and layout for health professionals in charge of the supervision of activities of immunobiological conservation, ensuring the maintenance of the immunogenic quality of the products offered to the population.

What are the perspectives for blood donations and blood component transfusion worldwide? A systematic review of time series studies

BACKGROUND

Analysis of the literature suggests that changes relating to blood donations and blood component transfusion are occurring due to the aging of the population.

OBJECTIVE

To gain better understanding of the demand and supply of these inputs over time, and to identify the main associated demographic characteristics.

DESIGN AND SETTING

Systematic review conducted on time series relating to blood donations and blood component transfusions worldwide.

METHODS

A systematic review of the literature was conducted based on articles that presented time series relating to blood donation or blood component transfusion.

RESULTS

We found 1,814 articles. After the deletion process, only thirteen were read. Overall, these suggested that there is increasing demand for blood components and decreasing donation. The existence of seasonality regarding blood donation was pointed out. Men usually donated more blood and demanded more blood components than women. Approximately 50% of blood transfusions were performed in people aged ≥ 60 years.

CONCLUSIONS

This analysis on articles that presented time series relating to blood donations and blood component transfusion showed that aging of the population was the main factor associated with the increasing demand for blood and the decreasing supply of blood.

Knowledge of professional healthcare providers about sickle cell disease: Impact of a distance education course

Objective

To assess the impact of the distance education course “Sickle Cell Disease: Primary Health Care Line” on knowledge acquisition of professional healthcare providers.

Methods

A cross-sectional study was conducted with a quantitative approach at the Educational and Support Center for Hemoglobinopathies (Cehmob-MG), state of Minas Gerais, Brazil, in 2016. One hundred and fifty-three out of 300 professional healthcare providers were invited to participate in the proposed distance course. Of the participating professional healthcare providers, 72 (47%) successfully concluded the course (Group A), whereas 81 (53%) did not complete their course assignments and did not meet the minimum requirements for regular attendance (Group B). Knowledge acquisition was assessed with the Knowledge of Sickle Cell Disease Instrument, DFConhecimento, applied using the web tool eSurv. Univariate analysis by Poisson regression was employed to assess the influence of sociodemographic variables on the DFConhecimento score and to select variables to compose the initial multivariate regression model (p-value < 0.20). The analysis was performed in the statistical programming environment R.

Results

The average score was 9.76 for Group A and 6.54 for Group B. The two groups were considered statistically different (p-value < 0.05) for all items with the proportion of correct items being greater in Group A. Professional healthcare providers who concluded the course had a significantly higher DFConhecimento score (45%) when compared to those who did not successfully conclude the course.

Conclusion

Participation in a distance education course on sickle cell disease had a positive impact on the acquisition of knowledge about the disease by professional healthcare providers.

PREVALÊNCIA DE PRÁTICAS INTEGRATIVAS E COMPLEMENTARES EM PACIENTES SUBMETIDOS À QUIMIOTERAPIA ANTINEOPLÁSICA

Objetivo: analisar a prevalência das práticas integrativas e complementares em pacientes querealizam quimioterapia antineoplásica.Método: estudo quantitativo, observacional, transversal, realizado em um Ambulatório deQuimioterapia de um hospital universitário de Belo Horizonte, Minas Gerais. A amostra foi compostapor 70 pacientes com dados obtidos entre outubro de 2017 e maio de 2018. Os dados foramanalisados no programa Statistical Package for Social Science utilizando-se estatística descritiva einferencial.Resultados: os cânceres predominantes foram mama e cólon e reto. A prevalência de utilização depráticas integrativas foi de 77,1%, sendo a espiritualidade a mais utilizada. O custeio das práticas foipredominantemente não realizado pelo Sistema Único de Saúde. Não foram encontrados fatoresassociados para utilização de práticas integrativas.Conclusão: os pacientes referem benefícios da utilização das práticas integrativas complementares.É relevante que o enfermeiro conheça a prevalência de sua utilização e tenha conhecimento paraindicá-las ou contraindicá-las, quando necessário.

Performance of different serological tests in the diagnosis of natural infection by Leishmania infantum in dogs

Visceral leishmaniasis (VL) is a zoonosis caused by the parasite Leishmania infantum and the dog is its main reservoir in rural and urban areas. The diagnosis of infection is mainly based on the presence of anti-Leishmania IgG antibodies in the serum of infected dogs. In this study, the sensitivity and specificity of qualitative rapid tests (RTs) dual path platform (DPP) Bio-Manguinhos, rapid enzyme-linked immunosorbent assay (ELISA) IDEXX, Kalazar Detect and ALERE, as well as quantitative ELISA Bio-Manguinhos and in-house indirect immunofluorescence assay (IFA) tests were analyzed in sera from infected and uninfected dogs. Serial dilutions of the in-house IFA were compared with RTs and ELISA Bio-Manguinhos. The results showed that none of the tests reached 100% sensitivity and specificity. There was no statistical difference between the analyzed RTs. The most sensitive test was the DPP Bio-Manguinhos (97.9%), while the rapid ELISA IDEXX showed higher specificity (100%). In the treatment setting of infected and/or diseased animals, quantitative tests for monitoring the evolution of antibody titers are required, which indicates the maintenance of in-house IFA in animal handling. Furthermore, we demonstrate that the RTs present higher sensitivity in serum samples with superior antibody titers obtained in the in-house IFA. However, the RTs exhibited false negatives in samples with low titers of antibodies. Among the RTs, only the DPP Bio-Manguinhos presented better performance in this situation. Therefore, the use of RTs for the diagnosis of VL in dogs with low titers of antibodies, such as asymptomatic, should be carefully evaluated.

Translation and cross-cultural adaptation of the Behavior Change Protocol for educational practices in Diabetes Mellitus

Objective

to translate and cross-culturally adapt the Behavior Change Protocol for educational practices in Diabetes Mellitus.

Method

methodological study aimed at cross-cultural adaptation, comprising the steps of translation, back-translation, assessment by an expert committee and pre-testing of the instrument on a sample of 30 healthcare service users with type 2 Diabetes Mellitus.

Results

the instrument was assessed based on criteria pertaining semantic, idiomatic, conceptual and cultural equivalence between the original instrument and the translated version, its mean Content Validity Index being 0.85.

Conclusion

results showed content validity indicating the instrument’s successful cross-cultural adaptation to the Brazilian culture for use in educational practices targeting self-care in type 2 DM.

Depression and anxiety among patients undergoing dialysis and kidney transplantation: a cross-sectional study

BACKGROUND

Depression and anxiety are the most prevalent psychological disorders among end-stage renal disease patients and are associated with various conditions that result in poorer health outcomes, e.g. reduced quality of life and survival. We aimed to investigate the prevalences of depression and anxiety among patients undergoing renal replacement therapy.

DESIGN AND SETTING

Cross-sectional study in Belo Horizonte, Brazil.

METHODS

Patients' depression and anxiety levels were assessed using the Beck Inventory. The independent variables were the 36-Item Short-Form Health Survey (SF-36), Charlson Comorbidity Index and Global Subjective Assessment, along with sociodemographic and clinical characteristics.

RESULTS

205 patients were included. Depression and anxiety symptoms were detected in 41.7% and 32.3% of dialysis patients and 13.3% and 20.3% of transplantation patients, respectively. Lower SF-36 mental summary scores were associated with depression among transplantation patients (odds ratio, OR: 0.923; 95% confidence interval, CI: 0.85-0.99; P = 0.03) and dialysis patients (OR: 0.882; 95% CI: 0.83-0.93; P ≤ 0.001). Physical component summary was associated with depression among dialysis patients (OR: 0.906; 95% CI: 0.85-0.96; P = 0.001). Loss of vascular access (OR: 3.672; 95% CI: 1.05-12.78; P = 0.04), comorbidities (OR: 1.578; 95% CI: 1.09-2.27; P = 0.01) and poorer SF-36 mental (OR: 0.928; 95% CI: 0.88-0.97; P = 0.002) and physical (OR: 0.943; 95% CI: 0.89-0.99; P = 0.03) summary scores were associated with anxiety among -dialysis patients.

CONCLUSIONS

Depression and anxiety symptoms occurred more frequently among patients undergoing dialysis. Quality of life, comorbidities and loss of vascular access were associated factors.

Short Message Service (SMS) e promoção do autocuidado em DM2: revisão integrativa

Resumo Objetivo: Sintetizar e analisar as evidências disponíveis na literatura científica sobre os efeitos do uso de Short Message Service (SMS) na promoção do autocuidado em diabetes mellitus tipo 2. Métodos: Foi desenvolvida uma revisão integrativa da literatura, no período de 2007 a 2017, utilizando para a busca dos estudos as seguintes bases de dados: Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Scopus, Web of Science, Base de dados de enfermagem, Campus Virtual de Saúde Pública, Coleção Nacional das Fontes de Informação do Sistema Único de Saúde, Coordenadoria Regional de Saúde Sul, Índice Bibliográfico Español en Ciencias de la Salud (iBECS), Literatura Latino-Americana e do Caribe em Ciências da Saúde e PubMed. Para isso, utilizou-se descritores como: mensagem de texto, autocuidado, educação em saúde, promoção em saúde e diabetes mellitus, bem como os respectivos descritores em inglês e espanhol, e os Medical Subject Headings associados. Foi identificada uma amostra inicial de 739 artigos, dos quais 23 foram classificados como elegíveis para compor a amostra final. Resultados: Em geral, os trabalhos reportaram resultados positivos. Dentre estes, destacam-se: melhora significativa dos níveis de hemoglobina glicada, maior adesão aos medicamentos, melhora das práticas de autocuidado, aumento do conhecimento acerca do diabetes e melhor cuidado com os pés. Conclusão: Evidências científicas na literatura mostram que o uso de SMS como estratégia metodológica pode favorecer a melhora das práticas de autocuidado em diabetes tipo 2.

Modality transition on renal replacement therapy and quality of life of patients: a 10-year follow-up cohort study

PURPOSE

Despite advance in renal replacement therapy (RRT), patients with chronic end-stage renal disease (ESRD) face various limitations, and renal transplantation (Tx) is the treatment that impacts most on quality of life (QoL). This study aimed to assess changes in QoL in a cohort of ESRD dialysis patients.

METHODS

Sociodemographic, clinical, nutritional, lifestyle, and QoL data were collected from 712 patients at baseline (time 1) and after 10 years of follow-up (time 2) for patients surviving. The QoL was assessed through the 36-Item Short Form Health Survey (SF-36) and the multiple linear regression model was used to analyze the factors associated with change in QoL.

RESULTS

A total of 205 survivors were assessed and distributed into three groups according to current RRT (Dialysis-Dialysis, Dialysis-Tx, and Dialysis-Tx-Dialysis). At time 1, only age was significantly different among groups; at time 2, transplant patients sustained greater social participation, job retention, and improvement in SF-36 scores. The factors associated with change in QoL were more time on dialysis interfering negatively on physical functioning (p = 0.002), role-physical limitations (p  = 0.002), general health (p  = 0.007), social functioning (p = 0.02), role-emotional (p = 0.003), and physical components ( p = 0.002); non-participation in social groups at times 1 and 2 reducing vitality (p = 0.02) scores; and having work at time 2, increasing vitality (p = 0.02) and mental health (p  = 0.02) scores.

CONCLUSIONS

QoL was shown to be dynamic throughout the years of RRT, transplantation being the treatment with more benefits to the ESRD. More time on dialysis and limited social and occupational routine were associated with a reduction in QoL.

Effectiveness of the Brazilian Visceral Leishmaniasis Surveillance and Control Programme in reducing the prevalence and incidence of Leishmania infantum infection

Background

Control strategies adopted by the Brazilian Visceral Leishmaniasis Surveillance and Control Programme (VLSCP) include identifying and culling seropositive infected dogs, early diagnosis and treatment of human cases, chemical control of the vector and population awareness. This study evaluated the effectiveness of the VLSCP on the prevalence and incidence rates of Leishmania infantum in children residing in areas under different VLSCP intervention times.

Methods

A quasi-experimental epidemiological study with a panel (two cross-sectional) and a concurrent cohort was performed in three areas of Belo Horizonte, southeast Brazil. The first cross-sectional study (I) was carried out with 1875 children, 478 of which were enrolled in the cohort study. In the second cross-sectional study (II), 413 additional children were included, totalizing 891 children. Laboratory diagnosis was performed by ELISA-rK39. Analyses included multilevel logistic and Poisson regression models.

Results

The incidence rates of L. infantum infection were: 14.4% in the area where VLSCP intervention was initiated in 2006 (AI2006); 21.1% in the area where intervention was initiated in 2008 (AI2008); and 11.6% in the area where intervention was initiated in 2010 (AI2010 - control area). A follow-up period of 24 months showed that the persons-time incidence rates in AI2006, AI2008, and AI2010 were: 6.2/100, 10/100, and 5.6/100 persons/24 months, respectively. The final prevalence rates of infection (cross-sectional II - in 2012), compared to the initial rates (cross-sectional I - in 2010), increased 83.7% in AI2006, 74.1% in AI2008, and decreased 5% in AI2010. Analysis of the effectiveness revealed that children residing in AI2008 are more likely to be infected (OR = 1.84; 95% CI: 1.06-3.23) and present a higher risk of infection (IRR = 1.76; 95% CI: 1.05-2.95) compared to those in AI2010. No statistically significant differences were observed in asymptomatic infection (OR and IRR) in AI2006 compared to AI2010.

Conclusions

The VLSCP was not effective at controlling L. infantum infection in areas where interventions had respectively been carried out for six and four years. However, it is unclear what the consequences in terms of human infection and diseases would be in the absence of the VLSCP. Efforts to improve the effectiveness of control measures remain a necessary priority.

Electronic supplementary material

The online version of this article (10.1186/s13071-018-3166-0) contains supplementary material, which is available to authorized users.

Aplicativos móveis para o manejo da doença falciforme: revisão integrativa

Resumo Objetivo Investigar, na literatura nacional e internacional, os aplicativos móveis existentes desenvolvidos para gerenciamento da doença falciforme. Métodos Estudo de revisão integrativa, conduzido nas bases de dados Medline/via PubMed, BVS, Current Index to Nursing and Allied Health Literature (Cinahl), Web of Science e Scopus, no período de setembro de 2016 a março de 2018. Os artigos selecionados foram analisados de acordo com a Agency for Healthcare Research and Quality (AHQR). Resultados Integraram esta revisão 12 artigos, sendo dois da Web of Science e o restante da PubMed. Conclusão Esta revisão mostrou a incipiência de estudos que contemplam o desenvolvimento de aplicativos móveis no contexto da doença falciforme. No Brasil não foram identificados estudos que utilizem aplicativos móveis direcionados à população com doença falciforme, apesar da alta incidência desta condição crônica. Este estudo aponta para a necessidade de desenvolvimento de aplicativos móveis como importante recurso educativo que possa apoiar a prática de autocuidado das pessoas com doença falciforme.

Mental health in primary care: an evaluation using the Item Response Theory

OBJECTIVE To determine the items of the Brazilian National Program for Improving Access and Quality of Primary Care that better evaluate the capacity to provide mental health care. METHODS This is a cross-sectional study carried out using the Graded Response Model of the Item Response Theory using secondary data from the second cycle of the National Program for Improving Access and Quality of Primary Care, which evaluates 30,523 primary care teams in the period from 2013 to 2014 in Brazil. The internal consistency, correlation between items, and correlation between items and the total score were tested using the Cronbach's alpha, Spearman's correlation, and point biserial coefficients, respectively. The assumptions of unidimensionality and local independence of the items were tested. Word clouds were used as one way to present the results. RESULTS The items with the greatest ability to discriminate were scheduling of the agenda according to risk stratification, keeping of records of the most serious cases of users in psychological distress, and provision of group care. The items that required a higher level of mental health care in the parameter of location were the provision of any type of group care and the provision of educational and mental health promotion activities. Total Cronbach's alpha coefficient was 0.87. The items that obtained the highest correlation with total score were the recording of the most serious cases of users in psychological distress and scheduling of the agenda according to risk stratification. The final scores obtained oscillated between -2.07 (minimum) and 1.95 (maximum). CONCLUSIONS There are important aspects in the discrimination of the capacity to provide mental health care by primary health care teams: risk stratification for care management, follow-up of the most serious cases, group care, and preventive and health promotion actions.

[Integration of primary care in the healthcare network: analysis of the components in the external evaluation of the PMAQ-AB]

This cross-sectional study examined the integration of primary care in the healthcare network of the Brazilian Unified National Health System (SUS), using the Gradual Response Model of Item Response Theory. Based on data from 17,202 teams that participated in the National Program for Access and Quality Improvement in Primary Care (PMAQ-AB, 2012), we measured gradients of integration to identify the teams' profile by level of integration. The results show that the items pertaining to matrix support measures (medical consultations, case discussions, shared clinical action, joint elaboration of therapeutic projects, permanent educational activities, work process discussions, interventions in the territory, and visits with primary care professionals) improved the performance of primary care teams. Communications devices between teams reinforced this understanding. Still, the approximately 50% of answers associated with the worst scenario for some study items evidenced the need to upgrade the integration between primary care activities and specialized care for the consolidation of comprehensive primary healthcare.

Evaluation of the effects of a diabetes educational program: a randomized clinical trial

OBJECTIVE

Evaluate the effectiveness of a diabetes mellitus educational program in primary health care.

METHODS

This cluster randomized trial was conducted in a sample of 470 people with type 2 diabetes mellitus from eight health units, randomly assigned to two groups: intervention (n = 231) and control (n = 239). The intervention group participated in the educational program composed of three strategies: group education, home visit, and telephone intervention. Simultaneously, the control group was monitored individually. Group monitoring took place over nine months in the year 2012. Clinical evaluations were performed at the initial time (T₀), three (T₃), six (T₆) and nine (T₉) months after the beginning of the intervention.

RESULTS

After nine months of follow-up, 341 users remained in the study, 171 in the control group and 170 in the intervention group. The average age of users was 60.6 years. In both groups, statistically significant differences were observed in mean HbA1c levels over the follow-up time (p < 0.05). However, the mean HbA1c level at T₃, T₆ and T₉ times were significantly lower among the people in the intervention group (p < 0.05).

CONCLUSIONS

The educational program model developed was effective to improve the glycemic control of the intervention group participants.

Translation, cultural adaptation and validation of the Diabetes Attitudes Scale - third version into Brazilian Portuguese

OBJECTIVE

to perform the translation, adaptation and validation of the Diabetes Attitudes Scale - third version instrument into Brazilian Portuguese.

METHODS

methodological study carried out in six stages: initial translation, synthesis of the initial translation, back-translation, evaluation of the translated version by the Committee of Judges (27 Linguists and 29 health professionals), pre-test and validation. The pre-test and validation (test-retest) steps included 22 and 120 health professionals, respectively. The Content Validity Index, the analyses of internal consistency and reproducibility were performed using the R statistical program.

RESULTS

in the content validation, the instrument presented good acceptance among the Judges with a mean Content Validity Index of 0.94. The scale presented acceptable internal consistency (Cronbach's alpha = 0.60), while the correlation of the total score at the test and retest moments was considered high (Polychoric Correlation Coefficient = 0.86). The Intra-class Correlation Coefficient, for the total score, presented a value of 0.65.

CONCLUSION

the Brazilian version of the instrument (Escala de Atitudes dos Profissionais em relação ao Diabetes Mellitus) was considered valid and reliable for application by health professionals in Brazil.

Comparison of education group strategies and home visits in type 2 diabetes mellitus: clinical trial

Objective:

to compare the adherence and empowerment of patients with type 2 diabetes mellitus for self-care practices and glycemic control in group education strategies and home visits.

Method:

Clinical trial with ten randomized clusters, performed with 238 patients with type 2 diabetes mellitus distributed in group education, home visit, and control group. Socio-demographic data, glycated hemoglobin and those obtained from the self-care and empowerment questionnaires were collected. Statistical analysis was performed separately by educational strategy.

Results:

the mean age of the patients was 57.8 years old (SD = 9.4 years old), with a predominantly female participation (66.4%). Both strategies presented similar results regarding adherence to self-care practices and patient empowerment. There was also a reduction in glycated hemoglobin levels; however, only in the education group, the difference presented statistical significance (p <0.001).

Conclusion:

the strategies were effective; however, group education presented better glycemic control results in relation to the home visit. International registry: NCT02132338 and national: RBR-92j38t in the clinical trials registry.

Adesão e empoderamento de usuários com diabetes mellitus para práticas de autocuidado: ensaio clínico randomizado

RESUMO Objetivo: Avaliar a adesão e o empoderamento do usuário com diabetes mellitus para as práticas de autocuidado e controle glicêmico na educação em grupo. Método: Ensaio clínico randomizado por cluster, com a participação de usuários com diabetes mellitus tipo 2. Todos os usuários estavam vinculados às Unidades de Estratégia de Saúde da Família do município de Divinópolis/MG, Brasil, durante os anos de 2014 e 2015. Foram coletados dados com relação à adesão às práticas de autocuidado, ao empoderamento e à hemoglobina glicada para comparação entre grupos na linha de base, assim como comparação entre o antes e o depois intragrupo. Foi considerado um nível de significância de 0,05. Resultados: Participaram do estudo 183 usuários, sendo que 72 foram alocados no grupo intervenção e 111 no grupo controle. Os resultados revelaram uma redução estatisticamente significativa (< 0,001) para o valor de hemoglobina glicada e um aumento dos escores referentes à adesão ao autocuidado e à escala de empoderamento para os participantes do grupo intervenção (< 0,001). Conclusão: Os efeitos da educação em grupo proporcionaram o aumento nas escalas da adesão e empoderamento às práticas de autocuidado, além de melhora dos níveis glicêmicos, evidenciada pelos resultados da hemoglobina glicada. Registro Brasileiro de Ensaios Clínicos: RBR-92j38t.

Spatial and temporal trends of visceral leishmaniasis by mesoregion in a southeastern state of Brazil, 2002-2013

Background

Visceral leishmaniasis (VL) is expanding in Brazil and in other South American countries, a process that has been associated with the urbanization of the disease. This study analyzes the spatial and temporal distribution of VL in the Brazilian state of Minas Gerais and identifies the areas with higher risks of transmission.

Methodology

An ecological study with spatial and time series analyzes of new confirmed cases of VL notified to the Brazilian Notifiable Disease Information System between 2002 and 2013, considering the 12 mesoregions of Minas Gerais. Two complementary methodologies were used: thematic maps of incidence and Poisson (log-linear) generalized linear model. Thematic maps using crude and smoothed cumulative incidences were generated for four trienniums. Poisson Regression measured the variation of the average number of cases from one year to the following, for each mesoregion.

Principal findings

The 5,778 cases analyzed revealed a heterogeneous spatial and temporal distribution of VL in Minas Gerais. Six mesoregions (Central Mineira, Jequitinhonha, Metropolitan area of Belo Horizonte, Northwest of Minas, North of Minas, and Vale do Rio Doce) were responsible for the expansion and maintenance of VL, with incidence rates as high as 26/100,000 inhabitants. The Vale do Rio Doce and Jequitinhonha mesoregions showed a considerable increase in the incidence rates in the last period studied. The other six mesoregions reported only sporadic cases and presented low and unsteady incidence rates, reaching a maximum of 1.2/100,000 inhabitants.

Conclusions/Significance

The results contribute to further the current understanding about the expansion of VL in Minas Gerais and may help guide actions for disease control.

This article presents the spatial and temporal distribution of visceral leishmaniasis (VL) in Minas Gerais State and identifies the greater risk areas of transmission. This study is both timely and substantive because Minas Gerais is an important Brazilian state in the number of cases of visceral leishmaniasis. The results showed that during the 12-year time series the VL had a heterogeneous spatial and temporal distribution in the state of Minas Gerais. Among the 12 existing mesoregions, six (Central Mineira, Jequitinhonha, Metropolitan area of Belo Horizonte, Northwest of Minas, North of Minas, and Vale do Rio Doce) were responsible for the expansion and maintenance of VL in the state. Among them, the Vale do Rio Doce and Jequitinhonha mesoregions presented a considerable increase in the incidence rates of the disease in the last period. In the other six mesoregions only sporadic cases of the disease were reported during the study period. The results of in this study may contribute to a better understanding the dynamic of the disease in Minas Gerais. Also these findings can provide subsidies to assist the actions of the control program of VL.

Aplicativos para adolescentes com diabetes mellitus tipo 1: revisão integrativa da literatura

Resumo Objetivo: Examinar os recursos de aplicativos para dispositivos móveis destinados ao autocuidado de adolescentes com diabetes mellitus tipo 1. Métodos: Revisão integrativa por meio da busca de artigos nos periódicos indexados nas bases de dados: Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Literatura Latino-Americana em Ciências da Saúde, PubMed (National Library of Medicine), Scopus, e Web of Science no período de 2012 a 2017, utilizando os seguintes descritores: aplicativos móveis, autocuidado e diabetes mellitus tipo 1, bem como respectivos descritores em inglês e espanhol. Resultados: A busca gerou um total de 248 artigos, dos quais 12 artigos atenderam os critérios de seleção. Os recursos dos aplicativos foram examinados a partir das funções de controle glicêmico, insulinoterapia, alimentação, atividade física, abordagem dos sentimentos e relações sociais. Observou-se que nenhum artigo descreveu um aplicativo que integrasse todos os recursos examinados. Conclusão: Os recursos de aplicativos para dispositivos móveis foram apontados como necessários para auxiliar no controle glicêmico de adolescentes com diabetes mellitus tipo 1.

Care coordination in PMAQ-AB: an Item Response Theory-based analysis

OBJECTIVE

Analyze the quality of the National Program for Primary Care Access and Quality Improvement variables to evaluate the coordination of primary care.

METHODS

A cross-sectional study based on data from 17,202 primary care teams that participated in the National Program for Primary Care Access and Quality Improvement in 2012. Based on the Item Response Theory, Samejima's Gradual Response Model was used to estimate the score related to the level of coordination. The Cronbach's alpha and Spearman' coefficients and the point-biserial correlation were used to analyze the internal consistency and the correlation between the items and between the items and the total score. We evaluated the assumptions of unidimensionality and local independence of the items. Cloud-type word charts aided in the interpretation of coordination levels.

RESULTS

The Program items with the greatest discrimination in coordination level were: telephone/Internet existence, institutional communication flows, and matrix support actions. The specialists' contact frequency with the primary care and integrated electronic medical record required a greater level of coordination among the teams. The Cronbach' alpha was 0.8018. The institutional communication flows and telephone/Internet items had a higher correlation with the total score. Coordination scores ranged from -2.67 (minimum) to 2.83 (maximum). More communication, information exchange, matrix support, health care in the territory and the domicile had a significant influence on the levels of coordination.

CONCLUSIONS

The ability to provide information and the frequency of contact among professionals are important elements for a comprehensive, continuous and high-quality care.

OBJETIVO

Analisar a qualidade das variáveis do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica para avaliar a coordenação na atenção básica do cuidado.

MÉTODOS

Estudo transversal baseado em dados de 17.202 equipes de atenção básica que participaram do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica em 2012. Baseado na Teoria de Resposta ao Item, o Modelo de Resposta Gradual de Samejima foi utilizado para estimação do escore relacionado ao nível de coordenação. Os coeficientes alfa de Cronbach, Spearman e ponto bisserial foram utilizados para análise da consistência interna e da correlação entre os itens e de itens com o escore total. Foram avaliadas as suposições de unidimensionalidade e de independência local dos itens. Gráficos do tipo nuvem de palavras auxiliaram na interpretação dos níveis de coordenação.

RESULTADOS

Os itens do Programa com maior discriminação do nível de coordenação foram: existência de telefone/internet, fluxos institucionais de comunicação e ações de apoio matricial. A frequência de contato de especialistas com a atenção básica e prontuário eletrônico integrado exigiram maior nível de coordenação das equipes. O coeficiente alfa de Cronbach total 0,8018. Os itens fluxos institucional de comunicação e telefone/internet tiveram maior correlação com o escore total. Os escores de coordenação variaram entre -2,67 (mínimo) e 2,83 (máximo). Maior grau de comunicação, troca de informações, apoio matricial, cuidado no território e domicílio tiveram peso relevante nos níveis de coordenação.

CONCLUSÕES

A capacidade de disponibilizar a informação e a frequência de contato entre os profissionais são elementos importantes para o cuidado abrangente, contínuo e de qualidade.

Avaliação da visita domiciliar para o empoderamento do autocuidado em diabetes

Resumo Objetivo Avaliar o efeito da visita domiciliar na adesão e empoderamento das práticas de autocuidado em diabetes mellitus tipo 2. Métodos Ensaio clínico randomizado por clusters, com a participação de 145 usuários com diabetes mellitus tipo 2, sendo 34 do Grupo intervenção e 111 do Grupo controle. Foram utilizados os questionários de Autocuidado com o diabetes e Diabetes Empowerment Scale-Short Form para comparação entre grupos na linha de base, assim como entre o antes e depois intragrupo. O nível de significância foi 0,05. Resultados O grupo intervenção apresentou aumento estatisticamente significativo do escore mediano referente à adesão às práticas de autocuidado em diabetes (p=0,005) e à escala de empoderamento (p<0,001). Conclusão A visita domiciliar promoveu à adesão às práticas de autocuidado com diabetes mellitus tipo 2.

Translation, cross-cultural adaptation and validation of the Diabetes Empowerment Scale - Short Form

OBJECTIVE

To translate, cross-culturally adapt and validate the Diabetes Empowerment Scale – Short Form for assessment of psychosocial self-efficacy in diabetes care within the Brazilian cultural context.

METHODS

Assessment of the instrument’s conceptual equivalence, as well as its translation and cross-cultural adaptation were performed following international standards. The Expert Committee’s assessment of the translated version was conducted through a web questionnaire developed and applied via the web tool e-Surv. The cross-culturally adapted version was used for the pre-test, which was carried out via phone call in a group of eleven health care service users diagnosed with type 2 diabetes mellitus. The pre-test results were examined by a group of experts, composed by health care consultants, applied linguists and statisticians, aiming at an adequate version of the instrument, which was subsequently used for test and retest in a sample of 100 users diagnosed with type 2 diabetes mellitus via phone call, their answers being recorded by the web tool e-Surv. Internal consistency and reproducibility of analysis were carried out within the statistical programming environment R.

RESULTS

Face and content validity were attained and the Brazilian Portuguese version, entitled Escala de Autoeficácia em Diabetes – Versão Curta, was established. The scale had acceptable internal consistency with Cronbach’s alpha of 0.634 (95%CI 0.494– 0.737), while the correlation of the total score in the two periods was considered moderate (0.47). The intraclass correlation coefficient was 0.50.

CONCLUSIONS

The translated and cross-culturally adapted version of the instrument to spoken Brazilian Portuguese was considered valid and reliable to be used for assessment within the Brazilian population diagnosed with type 2 diabetes mellitus. The use of a web tool (e-Surv) for recording the Expert Committee responses as well as the responses in the validation tests proved to be a reliable, safe and innovative method.