Tatiana Yonekura

Integrative Review: Concepts And Methods Used In Nursing

Resumen 
La Revision Integradora (RI) tiene una reputacion internacional en la investigacion en enfermeria y en la practica basada en la evidencia. Esta RI tuvo como objetivo identificar y analizar los conceptos y los metodos indicados para la realizacion de una RI en enfermeria. Fueron consultados nueve recursos de informacion y fuentes de literatura gris. Se incluyeron diecisiete estudios de RI. Los resultados indican que: la mayoria de los estudios primarios fueron realizados en EE.UU.; es posible tener varias preguntas de investigacion o hipotesis e incluir estudios primarios de diferentes perspectivas teoricas y metodologias; es un tipo de analisis que puede ir mas alla de la sintesis de las conclusiones de los estudios primarios, permitiendo abarcar otras dimensiones de la investigacion y finalmente presenta potencial para el desarrollo de nuevas teorias y problemas de investigacion. En conclusion, la RI es comprendida como un tipo de revision de naturaleza compleja que demanda metodos normalizados y sistematicos para garantizar el rigor requerido en la investigacion cientifica y por lo tanto la legitimidad de las evidencias establecidas.UNLABELLED Integrative review (IR) has an international reputation in nursing research and evidence-based practice. This IR aimed at identifying and analyzing the concepts and methods recommended to undertaking IR in nursing. Nine information resources,including electronic databases and grey literature were searched. Seventeen studies were included. The results indicate that: primary studies were mostly from USA; it is possible to have several research questions or hypotheses and include primary studies in the review from different theoretical and methodological approaches; it is a type of review that can go beyond the analysis and synthesis of findings from primary studies allowing exploiting other research dimensions, and that presents potentialities for the development of new theories and new problems for research. CONCLUSION IR is understood as a very complex type of review and it is expected to be developed using standardized and systematic methods to ensure the required rigor of scientific research and therefore the legitimacy of the established evidence.

The Educative Game as a Sensitization Strategy for the Collection of Data with Adolescents

UNLABELLED The aim of this study was to understand and analyze the potential of a game as a sensitization strategy for the performance of focal groups with adolescents in investigations into values. Twenty nine groups were realized in 10 social institutions of the municipality of Santo André. The sample was composed of 209 adolescents of 15 to 19 years of age. The results indicated that the majority expressed themselves without difficulties, discussing each of the valorative expressions drawn during the game with resourcefulness, involvement and respect for differing opinions, as well as being a method to promote reflection and stimulate debate about social values. CONCLUSIONS The game was adequate for the collection of data. The ludic character allowed the participation of adolescents in an intense, relaxed, enjoyable and interactive way, which facilitated the deepening of discussions on the topic. The evaluation also identified a strong motivation for adolescents to discuss social values.O objetivo deste estudo foi conhecer e analisar a potencialidade de um jogo como estrategia de sensibilizacao para a consecucao de grupos focais com adolescentes, em investigacoes sobre valores. Foram realizados 29 grupos em 10 instituicoes sociais, do municipio de Santo Andre, SP A amostra foi composta por 209 adolescentes de 15 a 19 anos. Os resultados indicaram que a maioria se expressou sem dificuldades, discutindo cada uma das frases com desenvoltura, envolvimento e respeito as opinioes divergentes, alem de ser um metodo capaz de promover a reflexao e estimular o debate acerca de valores sociais. Pode-se concluir que o jogo mostrou-se adequado para a apreensao de dados. O carater ludico possibilitou a participacao dos adolescentes de forma intensa, descontraida, prazerosa e interativa, o que facilitou o aprofundamento das discussoes sobre o tema. A avaliacao tambem permitiu identificar forte motivacao dos adolescentes para discutir valores sociais.

Revisão integrativa: conceitos e métodos utilizados na enfermagem

Resumen 
La Revision Integradora (RI) tiene una reputacion internacional en la investigacion en enfermeria y en la practica basada en la evidencia. Esta RI tuvo como objetivo identificar y analizar los conceptos y los metodos indicados para la realizacion de una RI en enfermeria. Fueron consultados nueve recursos de informacion y fuentes de literatura gris. Se incluyeron diecisiete estudios de RI. Los resultados indican que: la mayoria de los estudios primarios fueron realizados en EE.UU.; es posible tener varias preguntas de investigacion o hipotesis e incluir estudios primarios de diferentes perspectivas teoricas y metodologias; es un tipo de analisis que puede ir mas alla de la sintesis de las conclusiones de los estudios primarios, permitiendo abarcar otras dimensiones de la investigacion y finalmente presenta potencial para el desarrollo de nuevas teorias y problemas de investigacion. En conclusion, la RI es comprendida como un tipo de revision de naturaleza compleja que demanda metodos normalizados y sistematicos para garantizar el rigor requerido en la investigacion cientifica y por lo tanto la legitimidad de las evidencias establecidas.UNLABELLED Integrative review (IR) has an international reputation in nursing research and evidence-based practice. This IR aimed at identifying and analyzing the concepts and methods recommended to undertaking IR in nursing. Nine information resources,including electronic databases and grey literature were searched. Seventeen studies were included. The results indicate that: primary studies were mostly from USA; it is possible to have several research questions or hypotheses and include primary studies in the review from different theoretical and methodological approaches; it is a type of review that can go beyond the analysis and synthesis of findings from primary studies allowing exploiting other research dimensions, and that presents potentialities for the development of new theories and new problems for research. CONCLUSION IR is understood as a very complex type of review and it is expected to be developed using standardized and systematic methods to ensure the required rigor of scientific research and therefore the legitimacy of the established evidence.

Marxismo como referencial teorico-metodologico em saude coletiva: implicacoes para a revisao sistematica e sintese de evidencias

In this study, we discuss the integration in systematic reviews of research developed from a Marxist perspective of knowledge production and their results as evidence in healthcare. The study objectives are to review the assumptions of dialectical and historical materialism (DHM) and discuss the implications of dialectics for a literature review and the synthesis of evidence. DHM is a powerful framework for knowledge generation and transformation of policies and practices in healthcare. It assumes that social contradictions underlie the health–disease process, the fundamental theoretical construction in the field of collective health. Currently, we observe a considerable influence of the critical paradigm, of Marxist origin, in the construction of knowledge in health. Studies based on this critical paradigm incorporate complex methods, which are inherent to the guidelines of dialect, to identify the object and arrive at results that constitute evidence in healthcare. Systematic reviews should address the methodological difficulties associated with entirely integrating these results to healthcare.In this study, we discuss the integration in systematic reviews of research developed from a Marxist perspective of knowledge production and their results as evidence in healthcare. The study objectives are to review the assumptions of dialectical and historical materialism (DHM) and discuss the implications of dialectics for a literature review and the synthesis of evidence. DHM is a powerful framework for knowledge generation and transformation of policies and practices in healthcare. It assumes that social contradictions underlie the health-disease process, the fundamental theoretical construction in the field of collective health. Currently, we observe a considerable influence of the critical paradigm, of Marxist origin, in the construction of knowledge in health. Studies based on this critical paradigm incorporate complex methods, which are inherent to the guidelines of dialect, to identify the object and arrive at results that constitute evidence in healthcare. Systematic reviews should address the methodological difficulties associated with entirely integrating these results to healthcare.

Systematic review of theories: a tool to evaluate and analyze selected studies

The objective of this study is to report on the experience of constructing and using an instrument to collect and analyze theoretical-methodological references of studies, in systematic literature reviews. The goal is for researchers to have available an instrument that is appropriate for evaluating the studies that present their theoretical foundations, and for health professionals to have access to the theoretical explanations for study results and their applications in the practice of health care. The dissociation of theory from practice may lead to a lack of motivation at the work site and practices of repeating procedures without any awareness of the underlying concepts that base the interpretation of a health-disease phenomenon. Therefore we call on researchers to conduct reviews on the theoretical foundations of certain health-disease phenomena and we propose questions related to the inclusion criteria, critical appreciation and data extraction to be addressed in instruments.The objective of this study is to report on the experience of constructing and using an instrument to collect and analyze theoretical-methodological references of studies, in systematic literature reviews. The goal is for researchers to have available an instrument that is appropriate for evaluating the studies that present their theoretical foundations, and for health professionals to have access to the theoretical explanations for study results and their applications in the practice of health care. The dissociation of theory from practice may lead to a lack of motivation at the work site and practices of repeating procedures without any awareness of the underlying concepts that base the interpretation of a health-disease phenomenon. Therefore we call on researchers to conduct reviews on the theoretical foundations of certain health-disease phenomena and we propose questions related to the inclusion criteria, critical appreciation and data extraction to be addressed in instruments.

Revisão sistemática de teorias: uma ferramenta para avaliação e análise de trabalhos selecionados

The objective of this study is to report on the experience of constructing and using an instrument to collect and analyze theoretical-methodological references of studies, in systematic literature reviews. The goal is for researchers to have available an instrument that is appropriate for evaluating the studies that present their theoretical foundations, and for health professionals to have access to the theoretical explanations for study results and their applications in the practice of health care. The dissociation of theory from practice may lead to a lack of motivation at the work site and practices of repeating procedures without any awareness of the underlying concepts that base the interpretation of a health-disease phenomenon. Therefore we call on researchers to conduct reviews on the theoretical foundations of certain health-disease phenomena and we propose questions related to the inclusion criteria, critical appreciation and data extraction to be addressed in instruments.The objective of this study is to report on the experience of constructing and using an instrument to collect and analyze theoretical-methodological references of studies, in systematic literature reviews. The goal is for researchers to have available an instrument that is appropriate for evaluating the studies that present their theoretical foundations, and for health professionals to have access to the theoretical explanations for study results and their applications in the practice of health care. The dissociation of theory from practice may lead to a lack of motivation at the work site and practices of repeating procedures without any awareness of the underlying concepts that base the interpretation of a health-disease phenomenon. Therefore we call on researchers to conduct reviews on the theoretical foundations of certain health-disease phenomena and we propose questions related to the inclusion criteria, critical appreciation and data extraction to be addressed in instruments.

Marxism as a theoretical and methodological framework in collective health: implications for systematic review and synthesis of evidence

In this study, we discuss the integration in systematic reviews of research developed from a Marxist perspective of knowledge production and their results as evidence in healthcare. The study objectives are to review the assumptions of dialectical and historical materialism (DHM) and discuss the implications of dialectics for a literature review and the synthesis of evidence. DHM is a powerful framework for knowledge generation and transformation of policies and practices in healthcare. It assumes that social contradictions underlie the health–disease process, the fundamental theoretical construction in the field of collective health. Currently, we observe a considerable influence of the critical paradigm, of Marxist origin, in the construction of knowledge in health. Studies based on this critical paradigm incorporate complex methods, which are inherent to the guidelines of dialect, to identify the object and arrive at results that constitute evidence in healthcare. Systematic reviews should address the methodological difficulties associated with entirely integrating these results to healthcare.In this study, we discuss the integration in systematic reviews of research developed from a Marxist perspective of knowledge production and their results as evidence in healthcare. The study objectives are to review the assumptions of dialectical and historical materialism (DHM) and discuss the implications of dialectics for a literature review and the synthesis of evidence. DHM is a powerful framework for knowledge generation and transformation of policies and practices in healthcare. It assumes that social contradictions underlie the health-disease process, the fundamental theoretical construction in the field of collective health. Currently, we observe a considerable influence of the critical paradigm, of Marxist origin, in the construction of knowledge in health. Studies based on this critical paradigm incorporate complex methods, which are inherent to the guidelines of dialect, to identify the object and arrive at results that constitute evidence in healthcare. Systematic reviews should address the methodological difficulties associated with entirely integrating these results to healthcare.

El juego educativo como estrategia de sensibilización para recolección de datos con adolescentes

UNLABELLED The aim of this study was to understand and analyze the potential of a game as a sensitization strategy for the performance of focal groups with adolescents in investigations into values. Twenty nine groups were realized in 10 social institutions of the municipality of Santo André. The sample was composed of 209 adolescents of 15 to 19 years of age. The results indicated that the majority expressed themselves without difficulties, discussing each of the valorative expressions drawn during the game with resourcefulness, involvement and respect for differing opinions, as well as being a method to promote reflection and stimulate debate about social values. CONCLUSIONS The game was adequate for the collection of data. The ludic character allowed the participation of adolescents in an intense, relaxed, enjoyable and interactive way, which facilitated the deepening of discussions on the topic. The evaluation also identified a strong motivation for adolescents to discuss social values.O objetivo deste estudo foi conhecer e analisar a potencialidade de um jogo como estrategia de sensibilizacao para a consecucao de grupos focais com adolescentes, em investigacoes sobre valores. Foram realizados 29 grupos em 10 instituicoes sociais, do municipio de Santo Andre, SP A amostra foi composta por 209 adolescentes de 15 a 19 anos. Os resultados indicaram que a maioria se expressou sem dificuldades, discutindo cada uma das frases com desenvoltura, envolvimento e respeito as opinioes divergentes, alem de ser um metodo capaz de promover a reflexao e estimular o debate acerca de valores sociais. Pode-se concluir que o jogo mostrou-se adequado para a apreensao de dados. O carater ludico possibilitou a participacao dos adolescentes de forma intensa, descontraida, prazerosa e interativa, o que facilitou o aprofundamento das discussoes sobre o tema. A avaliacao tambem permitiu identificar forte motivacao dos adolescentes para discutir valores sociais.

Rifampicin chemoprophylaxis in preventing leprosy in contacts of patients with leprosy: a comprehensive systematic review protocol

Review question/objective What is the effectiveness of rifampicin chemoprophylaxis in preventing leprosy in contacts of patients with leprosy? What are the experiences and acceptability with the use of rifampin chemoprophylaxis in the prevention of disease from contacts with patients who have leprosy, in patients with leprosy following treatment and in family and health care professionals? Background Leprosy is globally acknowledged as a millenary and stigmatizing disease and a condition with attributed consequences such as physical deformities and disabilities. From a multi‐causal perspective, there is evidence that leprosy occurs more often in men than in women, is distributed across all age groups and occurs mainly among people living in unfavorable socioeconomic circumstances, who are also the most affected by public segregation policies. 1–4 In 2013, a total of 215,656 new cases of leprosy were detected worldwide. Regions with the highest number of cases are Southeast Asia (72.1%) the Americas (15.3%). Whereas the countries with the highest prevalence were India (58.8%) and Brazil (14.4%). 5 Hansens bacillus (Mycobacterium leprae) is considered a microorganism of high infectivity and low pathogenicity and virulence. It is transmitted via nasal oropharyngeal secretions and breaks in the skin of infected patients. Therefore, the main form of transmissibility is inter‐human and the greatest risk of contagion is cohabitation with these patients.1–3 It is estimated that most individuals have a natural resistance to Mycobacterium leprae (M. leprae) and that some are prone to developing a severe form of the disease, the multibacillary forms. Studies on exogenous reinfection and endogenous reactivation in chronic diseases, such as tuberculosis and leprosy, show that susceptible individuals become infected by the bacillus through contact with multibacillary patients.1–3,6,7 The surveillance of leprosy contacts is a priority action for control of the disease. Children are exposed to the highest risk of becoming infected by being in contact with a family member or anyone close to them who has the disease. Having a current case of leprosy in the family is associated with a 2.9 times greater risk of a healthy family member becoming infected, and that risk increases when the family has a history of the disease.3,6–9 Bakker et al.7 reported that household contacts of multibacillary patients presented a four times greater risk of becoming infected with the disease compared to non‐contacts. For Ximenes et al.,10 the condition of being a contact of individuals with leprosy represented twice the risk of retreatment due to recurrence in relation to the control group. Therefore, alternative or complementary strategies, such as chemoprophylaxis, must be sought as a form of prevention of the disease. Chemoprophylaxis is defined as the administration of drugs capable of preventing an infection or keeping infected individuals from falling ill. In leprosy, the preventive strategy consists of employing medications to prevent the infection by M. leprae in people with a higher risk of exposure to the disease, i.e. those in contact with the patient. Therefore, chemoprophylaxis plays an important role in the protection of individuals vulnerable to the disease. However, studies regarding its effective utilization are inconclusive.11–15 The first investigations of the utilization of prophylaxis in leprosy contacts in the 1960s and 1970s included dapsone and acedapsone and later in the 1980s and 1990s rifampicin. However, interest in this type of research decreased after 1982 when the World Health Organization (WHO) introduced multidrugtherapy (MDT) for the treatment of leprosy.16–19 Multidrugtherapy is a combination of three drugs, dapsone, rifampicin and clofazimine, to prevent the selection of resistant strains. As of 1997, the WHO adopted the alternative rifampicin, ofloxacin and minocycline (ROM) regimen, recommended for paucibacillary cases with a single lesion without the involvement of nerve stems.19,20 Adoption of these measures was expected to result in a reduction in the incidence of leprosy as a public health problem; however, the observed result was not significant in terms of reducing the incidence of newly detected cases. Furthermore, considering the evidence of resistance to monotherapy with dapsone, there was a rise in interest in intervention studies, particularly using rifampicin in household and community contacts.1,2,5,11,12 However, some studies have indicated little or no protection against the disease through the use of rifampicin. While Moet et al.14 and Feenstra et al.21 observed protection of two years in household contacts with a single dose of rifampicin, Bakker et al.13 showed no difference between the experimental group and the control group with two doses of rifampicin, 600 mg for adults and 300 mg for children. Another study of people at high risk of contracting the disease that used a single dose of ROM and rifampicin showed that there was a reduction of type immunoglobulin M antibodies among adults in both interventions.22 Meta‐analyis of dapsone, acepdapsone and rifampicin compared with placebo showed that chemoprophlasys is an effective measure to prevent leprosy. 12 Currently, strategies using a combination of the Bacillus Calmette‐Guérin (BCG) and chemoprophylaxis with rifampicin in leprosy contacts appear to be complementary measures for protection against the disease. This strategy showed a protective effect of 80%.23 Studies of acceptability and experience of chemoprophylaxis to control leprosy with individuals and health professionals are scarce. In a qualitative study, Feenstra et al.24 concluded that chemoprophylaxis for household contacts of leprosy patients is an effective and socially acceptable addition to the current leprosy control program. A preliminary search of the Joanna Briggs Database of Systematic Reviews and Implementation Reports, the Cochrane Library, CINAHL, PubMed and PROSPERO has revealed that there are no systematic reviews (either published or underway) on this topic. In this context, it is unquestionably useful to integrate the scientific evidence from studies that evaluated the effectiveness of the rifampicin chemoprophylaxis in leprosy contacts, the experiences and acceptability of contacts of leprosy patients, patients with leprosy following treatment and family and health care professionals about this strategy for the prevention of the disease. This knowledge can support the measures adopted to reduce endemicity, which strengthens the quality of the care delivered to the population most vulnerable to becoming ill. Operational definitions: Leprosy patients: individuals who present one or more of the following cardinal signs and who require multidrugtherapy: lesion(s) and/or skin areas with altered sensitivity; affected peripheral nerve(s), with or without thickening, associated with sensitive and/or motor and/or autonomic changes; and a positive skin smear bacilloscopy. Cases are classified as paucibacillary or multibacillary based on the number of lesions and/or bacilloscopy when available; cases are considered paucibacillary when patients present five or fewer skin lesions and/or negative bacilloscopy, corresponding to the undetermined and tuberculoid clinical forms; multibacillary cases are when patients present more than five skin lesions and positive bacilloscopy,corresponding to the dimorphous and Virchows forms of the disease.1–4,25 Leprosy case: term used in epidemiology to identify individuals with leprosy for purposes of monitoring the health conditions of a population.2,26 Chemoprophylaxis: the administration of drugs capable of preventing the infection or keeping infected individuals from falling ill.11,12 Contacts: those who cohabit or have cohabited with leprosy patients.12,14,21 Index case: the first case of the disease among several similar cases that are epidemiologically related with the secondary case (index case contacts).21 Recurrence: the reappearance of signs and symptoms of the disease after recuperation from a first occurrence of the disease, usually within five years.6,10,27 Treatment abandonment: interrupting treatment for over twelve months.6,10 Therapeutic regimen established for confirmed leprosy cases: for paucibacillary (PB) cases, six monthly supervised doses of rifampicin (RFM) 450‐600mg, and daily self‐administered doses of dapsone (DDS) 50‐100mg, for up to nine months; for multibacillary (MB) cases, twelve supervised monthly doses of rifampicin (RFM) 450‐600mg and clofazimine (CFZ) 100‐300mg, associated to daily self‐administered doses of dapsone (DDS) 50‐100mg and CFZ 50mg, for up to 18 months. An alternative treatment for MB is 24 doses within 36 months.1,2,19 Rifampicin chemoprophylaxis regimens: single‐dose rifampicin of 25 mg/kg or monthly dose for six months; double‐dose rifampicin or combined regimens of ROM ‐ rifampicin (600 mg), ofloxacin (400 mg) and minocycline (100mg), according to body weight.13–15,21 Efficacy/effectiveness: proof (or not) of successful intervention. Efficacy is the result of an intervention performed under ideal, well‐controlled conditions, such as in randomized clinical trials. Effectiveness refers to the result of an intervention applied under usual medical practice conditions.28 Operational classification: paucibacillary and multibacillary.1,2, 25 Comorbidities: morbidities possibly associated with leprosy, such as tuberculosis, diabetes, HIV/AIDS, and others.1,2 BCG vaccination scar: resulting from the intradermal injection of Bacillus Calmette‐Guérin (BCG) vaccine on the deltoid, used to prevent tuberculosis and leprosy.23,29 Adverse events: negative effects resulting from the actions of drugs.1,2 Incidence rate: measures the frequency or likelihood of new cases of diseases occurring in a population.30 Estimated effect of an intervention: shows the theoretical distribution of possible effects in

Evidence in public health: steps to make it real.

This study addresses the methodological trends in the development of systematic reviews in public health, and examines the reviews of the Cochrane Public Health Group in order to exemplify syntheses of evidence in public health and its implementation and impact on practice and research.