Moderate or severe scorpion sting: identification of risk factors

OBJECTIVE

To characterize scorpion accidents at the Information and Toxicological Assistance Center (CIATox) in Campinas, to analyze risk factors related to the moderate and severe classification, and to determine the age group at greatest risk for this classification.

METHOD

Cross-sectional and retrospective study, with patients assisted in person at CIATox, who had a scorpion accident, from January 2015 to December 2019. Descriptive and inferential analysis was conducted. For the age variable, a ROC curve was constructed to determine cutoff points in relation to the severity classification. Poisson regression models were adjusted considering severity classification as the dependent variable.

RESULTS

A total of 754 cases with a mean age of 36.05 years, mostly female and non-occupational accidents that occurred in the urban area, was analyzed. The most frequent scorpion was the Tityus serrulatus. The risk factors found for greater severity were age group up to 22 years and previous care in other health services.

CONCLUSION

The age range up to 22 years old should be used as a predictive factor of severity in the clinical evaluation of patients stung by scorpions to carry out adequate management of cases.

Device- and Nondevice-Guided Slow Breathing to Reduce Blood Pressure in Patients with Hypertension: Protocol for a Systematic Review and Meta-analysis

Background

Physiotherapy can include both device-guided slow breathing (DGSB) and nondevice-guided slow breathing (NDGSB) in the treatment of systemic arterial hypertension.

Objective

The aim of this study is to summarize the effects of DGSB on blood pressure levels of patients with hypertension based on the published literature to date.

Methods

A systematic search of all published randomized controlled trials (RCTs) on the effects of device-guided and nondevice-guided slow breathing in patients with hypertension, without language restriction, was carried out up to a publication date of January 2020 in nine databases: PubMed/MEDLINE, Latin American and Caribbean Health Sciences Literature (LILACS), EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), Physiotherapy Evidence Database (PEDro), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, Web of Science, and Livivo. Clinical trial records databases (ClinicalTrials.gov), and bases for the open gray literature, including Gray Literature Report and ProQuest Central (Citation, Abstract or Indexing, and Dissertations and Theses), were also searched for potentially eligible RCTs. The quality assessment of the included studies will be performed using the Cochrane Risk of Bias Tool for Randomized Trials. The overall quality of the evidence for each outcome will be assessed using the GRADE (Grading of Recommendations, Development and Evaluation) system.

Results

As of December 2021, the review was completed and all data from continuous variables referring to blood pressure values (mmHg) were synthesized.

Conclusions

This systematic review will provide a summary of the current evidence on the effects of both DGSB and NDGSB on blood pressure levels. This information can contribute to decision-making by health professionals related to the use of these interventions in patients with hypertension.

Trial Registration

PROSPERO (Prospective International Register of Systematic Reviews) CRD42020147554; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=147554

International Registered Report Identifier (IRRID)

RR1-10.2196/33579

Evaluation of oscillometric blood pressure measurement devices available for online sale

ABSTRACT Objectives: to characterize oscillometric blood pressure measurement devices for sale in the virtual market and identify which ones have undergone a validation study. Methods: this was a cross sectional study. The search for devices for sale was conducted on websites, and the sample was composed of 137 devices obtained from 644 ads. We conducted a bibliographic survey in five databases and web pages enlisting devices submitted for validation. The Kolmogorov-Smirnov test was used to check data distribution, followed by Mann-Whitney and Kruskal-Wallis tests for comparisons, using the SAS 9.4 program. Results: only 16.7% of the devices were validated. The home devices ranged from USD 10.57 to USD 275.67. Only 102 ads informed the cuff size, with different nomenclatures. Conclusions: most ads contained non-validated devices, which were cheaper. We identified some ads falsely informing validation.

Psychosocial Determinants of the Intention to Take Oral Antihypertensive Drugs: A Cross-sectional Study

Objective: To identify the psychosocial predictors that influence the behavioral intention to take oral antihypertensive drugs. Materials and methods: A cross-sectional study, based on the theory of planned behavior. A questionnaire constructed and validated was applied to 220 individuals with systemic arterial hypertension in outpatient follow-up at a public hospital. The chi-square and Fisher’s exact tests, Spearman’s correlation and multiple logistic regression were used for data analysis. Results: The participants presented a high intention of taking antihypertensive drugs. The behavioral beliefs (ß = 0.0432; p = 0.0364), subjective norm (ß = -1.5708; p < 0.01) and perceived behavioral control (ß = 2.2809; p = 0.0028) explained the behavioral intention in 33 %. Conclusions: The behavioral beliefs, the subjective norm, and the perceived behavioral control are significant psychosocial predictors of taking antihypertensive drugs and must be valued, individually and jointly, in the health actions targeted at this population.

Cardiometabolic risk in adolescents students of high school: influence of work

OBJECTIVES

to evaluate and compare the prevalence of cardiometabolic risk factors among high school adolescents with or without jobs, and to establish an association between risk factors and changes in lifestyle after starting to work.

METHODS

quantitative cross-sectional study. An instrument was applied to assess socio-demographic characteristics and habits. Dietary pattern was assessed by the Brazilian Healthy Eating Index. Nutritional status was assessed by the Z-score. Data were submitted to statistical analysis and comparison between groups and periods, as well as association and correlation was done.

RESULTS

the prevalence of high blood pressure was 7.7%. High BP affected 4.5% of non-workers and 10.9% of workers. Dietary patterns were inappropriate and 51.2% did not engage in physical activity. The prevalence of obesity was 28.3%. The results showed an association between work and alcohol consumption, lack of physical activity and reduced sleep quality.

CONCLUSIONS

work increased exposure to certain cardiometabolic risk factors.

Blood pressure measurement by oscillometric and auscultatory methods in normotensive pregnant women

OBJECTIVE

to compare blood pressure values obtained by auscultatory and oscillometric methods in different gestational periods, considering cuff width.

METHOD

it is a cross-sectional and quasi-experimental study approved by the Research Ethics Committee. The sample consisted of 108 low-risk pregnant women. Blood pressure measurements were performed in gestational periods of 10-14, 19-22 and 27-30 weeks.

RESULTS

The oscillometric device presented values similar to the auscultatory method in systolic blood pressure, but overestimated diastolic blood pressure. Underestimation of blood pressure occurred when using the standard width cuff rather than the correct width cuff in both measuring methods.

CONCLUSION

Verification of brachial circumference and use of adequate cuffs in both methods are indispensable to obtain reliable blood pressure values in pregnant women. We recommend performance of additional studies to evaluate diastolic blood pressure overestimation by the Microlife 3BTO-A.

Effects of different hormonal contraceptives in women's blood pressure values

OBJECTIVE

To identify evidence in the literature of the relationship between the use of different hormonal contraceptive methods and alterations in women's blood pressure values.

METHOD

This is an integrative literature review, consisting of ten scientific articles published in PubMed and BVS, between 2012 and 2016, selected by keywords, available fully and free of charge, in English, Portuguese, or Spanish.

RESULTS

The articles showed that exogenous estrogen helps in the activation of the renin-angiotensin-aldosterone system causing hypertensive effects even in small doses; and that combined use with drospirenone reduces these effects. Routes of administration without passage through the liver and use of isolated progestin showed promising results in reducing the effects on blood pressure.

CONCLUSION

There is evidence in the literature of pressure alterations associated with different hormonal contraceptives and that personal history of morbidities are to be considered in an attempt to reduce the effects on the cardiovascular system.

Healthcare and discourse: exploration of interprofessional learning within a Brazilian context

This paper reports a qualitative study on the contribution of a Program of Education through Work (PET) in Healthcare, based at a Brazilian State University, to interprofessional education. Data were collected from ten undergraduate students of Nursing, Medicine, and Phonoaudiology (speech therapy), who were part of PET at the University. Data were analyzed using the Discourse of the Collective Subject technique. Central ideas were gathered into three categories: (1) teamwork and interprofessionality; (2) PET influences on SUS (Brazilian Unified Health System); (3) teaching-service-community integration. The study found evidence that PET enabled the students with opportunities to be involved in an education that supported the SUS principles and guidelines and to engage with interprofessional learning where there were exchanges of different professional experiences. The PET also supported the development of critical thinking for professional performance, as well as an integrated teaching experience that could support community development.

Revalidation of game for teaching blood pressure auscultatory measurement: a pilot study

ABSTRACT Objective: To adapt a pre-existing educational game, making it specific to the teaching of blood pressure auscultatory measurement, and to apply this game in a pilot study. Method: The original game cards were altered by the authors and submitted to content validation by six experts in the field. After redesigns, the game was applied to 30 subjects, who answered a questionnaire (pre-test and post-test) on auscultatory measurement. Data were analyzed descriptively and by the paired Student's t-test and paired Wilcoxon test. Results: Throughout the content validation process, 17 of the 28 original cards were modified. Of these 17 cards, 13 obtained 80% agreement, and the rest were modified according to the judges' suggestions. The obtained grades significantly increased between pre- and the post-test. Conclusion: It was concluded that the reformulated game presented satisfactory evidence of content validity. Its use as a teaching-learning method was effective for this sample.

Nursing process in mental health: an integrative literature review

Objective:

to identify evidences from the literature on the application of nursing process in care developed by the nurse in mental health.

Method:

integrative literature review between 1990 and 2013, in the PubMed, Scopus, CINAHL and LILCACS bases. Descriptors: nursing processes, mental health, nursing care.

Results:

19 papers were identified. Limited and partial usage of the nursing process in care established by a therapeutic relationship that respects the patient's individuality. We observe care proposals systematized for patients that present pathological aspects in the limits between the physical and psychical, which might be a response to the influence of the practice based on evidences.

Conclusion:

it was found an antagonistic movement between care based on the relationship and located in the standardization of diagnoses that respond to physical malaise. A lack of evidence was verified for the usage of the nursing process in mental health, and we point at the necessity for the creation of new possibilities for dialogue between relational and biological perspectives.

CARACTERIZAÇÃO E CLASSIFICAÇÃO DE RISCO EM URGÊNCIA E EMERGÊNCIA HIPERTENSIVA

Objetivou-se caracterizar usuários com urgência/emergência hipertensiva em unidade de pronto atendimento de Minas Gerais, quanto às condições socioeconômicas, níveis pressóricos e classificação de risco. Estudo transversal e retrospectivo que utilizou dados secundários de 63 prontuários de usuários atendidos de outubro a dezembro de 2013. A coleta de dados foi realizada em 2014, com formulário contendo dados do usuário e da classificação de risco. Para análise dos dados, aplicou-se o teste qui-quadrado e nível de significância de 5%. As faixas etárias mais prevalentes foram 41-45 (15,9%) e 46-50 anos (19%). A pressão arterial sistólica concentrou-se nas faixas 170-219 mmHg e a diastólica 120-129 mmHg. Apesar de apresentar pressão diastólica ≥ 120 mmHg, 27% dos pacientes não foram encaminhados como atendimento de urgência. Estes resultados indicam a importância de identificar os usuários com pressão diastólica elevada e encaminhá-los a tratamento adequado, conforme a prioridade clínica.

[Nurses of adult intensive care unit: evaluation about direct and indirect blood pressure measurement]

This is a descriptive and cross-sectional study with the aim to evaluate and self-evaluate the knowledge of nurses from adult Intensive Care Units about direct and indirect blood pressure measurement. Fifty-four nurses from three Intensive Care Units were approached. They answered a self-administered questionnaire with 65 questions (40 related to blood pressure). Nurses had insufficient performance on the test that assessed knowledge (average score 4.6). Half of the sample felt dissatisfied with their knowledge about blood pressure. After answering the questionnaire the subjects self-rated their knowledge as regular (48.2%), bad (27.8%) and poor (9.3%) indicating they are aware of the importance for the subject to practice. The results show the need of urgent implementation of continuing education for this sample, since they are professionals who work directly with a priority vital sign on care to critical patients.

[Comparison of the techniques of measuring blood pressure in one and in two steps]

Measuring blood pressure is an essential and initial step in seeking a proper diagnosis of hypertension, once blood pressure levels are an important risk marker for cardiovascular disease. Measuring blood pressure, however, can result in inappropriate conclusions if basic technical standards are not obeyed. This study compared the use of the technique for measuring blood pressure in one step with the technique in two steps, recommended by the American Heart Association in 2005. Measurements were made by both techniques in fourteen adults, using mercury sphygmomanometer and a digital device. Through analysis of the data it was concluded that the technique in one step showed similar results to those obtained with the technique in two steps.

Formulário para comunicação diária de enfermagem em unidades hospitalares: validação de um instrumento

Estudo descritivo com o objetivo de validar o conteúdo do instrumento Registro Diário da Unidade, que se propõe a registrar informações relacionadas à movimentação e perfil de pacientes, recursos humanos, procedimentos, pendências e intercorrências de cada turno. Foi realizado em um hospital do interior de São Paulo. Avaliado pelos juízes, especialistas na área, obteve um nível de concordância acima de 70%, sendo disponibilizado nas unidades durante os 30 dias do mês de junho. Foi novamente analisado e reformulado. Concluiu-se que o instrumento foi validado quanto ao seu conteúdo por não apresentar discordância significativa na avaliação dos juízes. Com isso sugere-se um novo estudo para avaliar a aplicabilidade do instrumento validado.

Desenvolvimento de instrumento de coleta de dados de enfermagem para pacientes com câncer de pulmão em quimioterapia ambulatorial

O câncer é um grave problema de saúde pública, e, dentre suas variedades, há o câncer de pulmão, que vem crescendo na população brasileira e mundial. A principal causa do câncer de pulmão é o tabagismo. Há três formas de tratamento: cirurgia, radioterapia e quimioterapia; para essa patologia a mais utilizada é a terceira. A enfermeira deve estar apta a lidar com as dificuldades desses pacientes, que durante o tratamento ambulatorial manifestam em seus domicílios efeitos colaterais. Os objetivos desta pesquisa são elaborar um instrumento de coleta de dados para pacientes com câncer de pulmão em quimioterapia ambulatorial e avaliar a validade de seus conteúdos e sua confiabilidade. Teve como guia a teoria do autocuidado de Dorothea Orem. Para sua validação, o instrumento foi primeiramente avaliado por juízes; após isso, foram realizados o pré-teste e o teste de confiabilidade pelo método da equivalência entre observadores. O instrumento se demonstrou confiável, considerando aquilo que se pretendia medir.

[Scientific production of Brazilian nurses on blood pressure measurement]

In the previous issue of this journal the authors celebrated in an article the discovery of the Korotkoff sounds, in 1905, and presented the historical facts that determined the important role of the University of São Paulo's Nursing School (EEUSP) in the development of the oldest blood pressure research line in Brazilian Nursing: "Cuff Width Influence in Blood Pressure Measurement." This new article presents the scientific production derived from the studies carried out by nurses with a PhD from EEUSP during and after their doctoral programs in the area. The path each researcher followed in his/her group and laboratory is emphasized. The data presented is aimed at offering a number of qualitative and quantitative indicators that make possible to evaluate the impact of the research that they have carried out, as well as the development of knowledge in the area.

[Hypertension associated factors and blood pressure among adolescent workers]

The aim of this study was to identify hypertension associated factors (AF) and verify blood pressure (BP) levels among adolescent workers. Interviews were conducted with 193 working adolescents--135 men and 58 women between 16 and 18 years. After five minutes in seated position, their arm circumferences were measured and their BP was determined using correct (CCW) and standard (SCW) cuff widths. The values were related to AF. BP was, in average, 105.2/60.9 mmHg (CCW) and 101.0/57.9 (SCW- p < 0.05). Among the AF found, only skin color and alcoholic drinking were associated to BP elevation, also noted in male adolescents. When using CCW, more hypertensive and borderline adolescents were found than using SCW. All of them had at least one AF. It can be concluded that there are several hypertension AF among this population, and some of them are already causing BP elevation. Studies such as this should be made frequently because adolescent blood pressure levels can predict hypertension in adulthood.

Sons de Korotkoff: desenvolvimento da pesquisa em esfigmomanometria na Escola de Enfermagem da USP

Este artigo tem como objetivos reverenciar Sergei Nicolai Korotkoff por ocasião do centenário da descoberta do método auscultatório de medida da pressão arterial na Rússia, em 1905; relatar os fatos que culminaram no desenvolvimento da esfigmomanometria no Brasil; historiar a valiosa contribuição da Escola de Enfermagem da Universidade de São Paulo (EEUSP) no desenvolvimento da pesquisa, na área da medida da pressão e analisar o produto da linha de pesquisa "Influência da Largura do Manguito na Medida da Pressão Arterial", gerada na EEUSP a partir de 1974. O artigo relata a consolidação dos achados iniciais pelos estudos que permitiram a formação dos primeiros doutores na área, que sugere a confirmação de hipóteses em estudos longitudinais.

[Intra-arterial versus auscultation blood pressure values as a function of cuff width]

We compared intra-arterial to auscultation blood pressure values using correct (CCW) or standard (SCW) cuff widths. Intra-arterial values were obtained from the radial artery using a digital monitor. Measurements were simultaneously made by two observers: one recorded intra-arterial values, while the other registered values by auscultation (brachial artery). Systolic intra-arterial pressure (mmHg) values were 125.04 vs. 119.75 (CCW), and 124.84 vs 116.39 (SCW). Diastolic pressure values were 68.72 vs. 73.26 (CCW), and 68.63 vs. 70.56 (SCW). Auscultation underestimated systolic pressure, particularly when SCW was used, whereas it overestimated diastolic pressure, when CCW was used. Auscultation using CCW yielded higher agreement of systolic pressure values and lower agreement of diastolic pressure values as compared to intra-arterial blood pressure measurements.