Vanderlei José Haas

The effects of skin-to-skin contact during acute pain in preterm newborns.

Background and purpose: Several promising non‐pharmacological interventions have been developed to reduce acute pain in preterm infants including skin‐to‐skin contact between a mother and her infant. However, variability in physiological outcomes of existing studies on skin‐to‐skin makes it difficult to determine treatment effects of this naturalistic approach for the preterm infant. The aim of this study was to test the efficacy of mother and infant skin‐to‐skin contact during heel prick in premature infants.

Adultos e idosos em hemodiálise: avaliação da qualidade de vida relacionada à saúde

Objectives: To categorize adults and elderly people in hemodialysis treatment residing in Ribeirao Preto, SP, Brazil. To evaluate and describe the differences in the Health-Related Quality of Life (HRQOL)of these patients. Methods: Cross-sectional and population study with 194 patients in hemodialysis in four dialyses services in the city. The instruments used were: Mini Exam of Mental State to characterize the population and Kidney Disease and Quality of Life-Short Form (KDQOL-SF TM ). Results: There were 132 adults and 62 elderly individuals in the study. Differences between the two groups’ average scores were found with statistical significance in the KDQOL-SF TM dimensions: physical functioning, role-physical, role-emotional, Burden of kidney disease and dialysis staff encouragement. Conclusion: Chronic renal failure and hemodialysis are related to the HRQOL of adults and elders. The results can support the health professionals’ actions in providing the care to the patients’ imminent needs, prevent complications and aim at a better HRQOL.

Factors related to patient adherence to antidiabetic drug therapy

The objective of the present study was to assess patient adherence to antidiabetic drug therapy and its association with factors related to the patient, patient-provider relationship, therapeutic regimen and the disease itself. The study comprised 46 diabetic patients enrolled in a research and extension education center in the State of Sao Paulo, southeastern Brazil, in 2007. Data was collected through interviews using a questionnaire and the Treatment Adherence Measure (TAM). The patient adherence level to antidiabetic drug therapy was 78.3%. In conclusion, since prevalence of adherence is below that recommended in the literature, and in the light of poor blood glucose control and alleged failure of therapeutic regimen, health providers are urged to measure diabetic patient treatment adherence, because it is key to adequate diabetes management with drugs.The objective of the present study was to assess patient adherence to antidiabetic drug therapy and its association with factors related to the patient, patient-provider relationship, therapeutic regimen and the disease itself. The study comprised 46 diabetic patients enrolled in a research and extension education center in the State of Sao Paulo, southeastern Brazil, in 2007. Data was collected through interviews using a questionnaire and the Treatment Adherence Measure (TAM). The patient adherence level to antidiabetic drug therapy was 78.3%. In conclusion, since prevalence of adherence is below that recommended in the literature, and in the light of poor blood glucose control and alleged failure of therapeutic regimen, health providers are urged to measure diabetic patient treatment adherence, because it is key to adequate diabetes management with drugs.

Avaliação prospectiva da ocorrência de infecção em pacientes críticos de unidade de terapia intensiva

BACKGROUND AND OBJECTIVES: Care in the intensive care unit (ICU) is constantly challenged by infections related to invasive procedures, which result in increased morbidity and mortality, hospitalization term and costs. This study aimed to prospectively evaluate critical patients according to age, clinical conditions, hospitalization term, occurrence of hospital infection, topography of hospital infection, occurrence of microbial multi-resistance or not, use of invasive procedures and antimicrobial agents. METHODS: This is a prospective, observational, clinical research, carried out at an ICU between February and July 2006. The research subjects were critical patients hospitalized for more than 24 hours at the ICU, followed from admission until discharge, transference or death. RESULTS: The study group consisted of 71 patients with a mean age of 53.5 ± 18.75 years. Forty-seven of these patients (66.2%) acquired hospital infection. Twenty-nine infections (37.6%) occurred in the blood stream, 20 (26%) respiratory and 13 (16.9%) urinary. The most frequent multi-resistant strains were: 14 (10.85%) Pseudomonas aeruginosa, 4 (3.1%) coagulase-negative Staphylococcus sp and 4 (3.1%) Staphylococcus aureus. The most used antimicrobial agents were carbapenem (22.4%), glycopeptides (21.6%) and cephalosporin (21.6%). Twenty-nine (40.8%) of these patients died. CONCLUSIONS: Hospital infection is aggravated if associated to the increased resistance of the microorganisms to the antibiotics.

Ocorrência de bactérias multiresistentes em um centro de Terapia Intensiva de Hospital brasileiro de emergências

BACKGROUND AND OBJECTIVES: Nosocomial infection represents a challenge in clinical practice involving hospitalized patients, as they considerably extend the hospitalization period and morbidity and mortality rates and, at the same time, increase hospital costs. Given their clinical conditions, which require invasive procedures and antimicrobial treatment, hospitalized patients, especially at the Intensive Care Unit, are particularly susceptible to hospital infection. This study aimed to evaluate the occurrence of multiresistant bacteria in patients hospitalized at the Intensive Care Unit of a Brazilian emergency hospital. METHODS: Our retrospective study was approved by the Ethics Committee and considered the period between October 2003 and September 2004. A database was developed through variable coding and double entry, and Statistical Package for Social Sciences (SPSS) software, version 10.0, was used for statistical analysis. RESULTS: Multiresistant bacteria were identified in 68 patients, 47 (69.1%) of whom were men, with 55 years as the mean age. All patients were submitted to endotracheal intubation and central venipuncture. The most frequent bacteria were coagulase-negative Staphylococcus sp. (36.4%), followed by Staphylococcus aureus (19%). Cephalosporin was the most frequently used (21.4%) antimicrobial agent. CONCLUSIONS: Knowledge on infection occurrence provokes reflections on multiresistance, directs educative actions and favors interventions to prevent and control problem situations.

Cross-cultural adaptation and validity of the 'Edmonton Frail Scale - EFS' in a Brazilian elderly sample.

This study aimed to assess the cross-cultural adaptation of the Edmonton Frail Scale (EFS) and its validity in a Brazilian elderly sample. Translation and back-translation were performed, as well as discussion with professionals and elderly for conceptual equivalence, semantic validation and pre-test of the scale. The scale was applied to 137 elderly aged 65 years or older who lived in the community. In the know-groups validation of the frailty diagnosis between gender, age and cognitive deficit, elder elderly, female and with a cognitive deficit scored higher on the frailty diagnosis. A negative convergent correlation was found between the EFS and the Functional Independence Measure (FIM) (-0.53, p< 0.01) and the total score of the Mini-Mental State Examination (MMSE) (-0.60, p< 0.01). The watch test presented high sensitivity and low specificity levels. The Portuguese version of the EFS was considered valid in the study sample.El objetivo de este estudio fue evaluar la adaptacion cultural de la Edmonton Frail Scale (EFS) y su validez enuna muestra de ancianos brasilenos. Fueron realizadas las etapas de traduccion y retrotraduccion, discusioncon profesionales y ancianos para equivalencia conceptual, validacion semantica y prueba piloto de la escala.El instrumento fue aplicado en 137 ancianos, con 65 anos o mas de edad, que vivian en la comunidad. En lavalidacion de grupos conocidos, del diagnostico de fragilidad entre sexo, edad y deficit cognitivo, los ancianoscon edad mas avanzada, sexo femenino y con deficit cognitivo tuvieron mayor puntuacion en el diagnostico defragilidad. Hubo una correlacion convergente negativa de la EFS con la Medida de Independencia Funcional(MIF) (-0,53, p<0,01) y el puntaje bruto del Mini-Examen del Estado Mental (MEEM) (-0,60, p<0,01). La pruebadel reloj presento alta sensibilidad y baja especificidad. La version para la lengua portuguesa de la EFS fueconsiderada valida en la muestra estudiada.DESCRIPTORES: anciano fragil; investigacion metodologica en enfermeria; comparacion transcultural; estudiosde validacion

Diferenciais socioeconômicos e de saúde entre duas comunidades de idosos longevos

OBJETIVO: Identificar diferencias demograficas y socioeconomicas relacionadas con el estado de salud de ancianos mas viejos residentes en dos ciudades de diferentes regiones de Brasil. METODOS: Estudio epidemiologico transversal y comparativo de ancianos mas viejos (>80 anos) residentes en Ribeirao Preto (RP - Sureste de Brasil) y Caxias do Sul (Sur), con muestra probabilistica de 117 sujetos en CS y 155 en RP, realizados entre 2007 y 2008. El instrumento de colecta incluyo datos demograficos y socioeconomicos mini-examen del estado mental, Medida de Independencia Funcional, numero de comorbilidades autoreferidas y Escala de Depresion Geriatrica. RESULTADOS: La edad promedio fue similar, con predominancia de mujeres (~70%) y viudos (~60%) en ambos municipios. La escolaridad promedio no difirio estadisticamente, pero la renta promedio del anciano fue mayor en RP que en CS (p=0,05). RP presento mayor concentracion de individuos en los extremos de escolaridad y renta que CS. El escore promedio del mini-examen del estado mental fue similar entre los dos grupos y mayor para individuos del sexo masculino, con edad entre 80 y 84 anos, casados y con mayor escolaridad. Se observo mejor desempeno funcional entre ancianos de 80 a 84 anos en ambos municipios, entre los de mayor escolaridad en RP; y entre los de sexo masculino y los casados en CS. Ancianos de CS presentaron mayor numero de comorbilidades que los de RP (p<0,001). Ancianos del sexo masculino, casados, y con mayor renta presentaron menos sintomas depresivos en ambos grupos; y los de RP presentaron mayor escores en la Escala de Depresion Geriatrica que los de CS (p<0,001). CONCLUSIONES: Aunque los ancianos de CS presenten menor desigualdad socioeconomica y menos sintomas depresivos, poseen tambien mayor numero promedio de comorbilidades y menor nivel de independencia funcional, al compararlos con los de RP.OBJECTIVE To identify demographic and socioeconomic differentials associated with the health status of oldest-old individuals living in two cities of different Brazilian regions. METHODS A comparative and cross-sectional epidemiological study was conducted with the oldest-old (> 80 years), living in the cities of Ribeirão Preto (RP, Southeastern Brazil) and Caxias do Sul (CS, Southern). The probabilistic sample included 117 individuals in CS and 155 in RP, and data were collected between 2007 and 2008. The instrument included demographic and socioeconomic data, Mini-Mental State Examination, Functional Independence Measure, number of self-reported comorbidities and Geriatric Depression Scale. RESULTS Mean age was similar, with predominance of women (~70%) and widowed individuals (~60%) in both cities. Mean level of education did no differ statistically, although mean income was higher in RP than in CS (p = 0.05). RP showed a higher concentration of individuals in the extreme levels of education and income than that of CS. Mean score of the Mini-Mental State Examination was similar in both groups and higher among men, individuals aged between 80 and 84 years, married and with a higher level of education. Better functional performance was observed in elderly individuals aged between 80 and 84 years in both cities, in those with higher level of education in RP; and in males and married individuals in CS. Elderly individuals in CS showed higher number of comorbidities than those in RP (p < 0.001). Male elderly individuals, married and with -higher income level showed fewer depressive symptoms in both groups; and those in RP showed higher Geriatric Depression Scale score than the others in CS (p < 0.001). CONCLUSIONS Although the oldest old in CS showed lower socioeconomic inequality and fewer depressive symptoms, they also had a higher mean number of comorbidities and lower level of functional independence, when compared to those in RP.

Profile of patients with spinal cord injuries and occurrence of pressure ulcer at a university hospital

Pacientes con lesion traumatica de medula espinal (LTME) tienen riesgo elevado de desarrollar ulceras de presion (UP). Este estudio retrospectivo identifico a traves de la revision de las historias clinicas en hospital nivel III, caracteristicas de pacientes atendidos y la ocurrencia de UP. La mayoria fue de sexo masculino, blanca y el 36,2% entre 21 a 30 anos de edad. La causa mas frecuente de LTME fue herida por arma de fuego, seguida de choque/volcadura de auto. Hubo predominio de lesion a nivel toraxico, seguido del cervical. Las UP aparecieron en 20 pacientes (42,5%). Las regiones de mayor frecuencia fueron la sacra y los calcaneos. Solo el 25% de las historias tenia registro sobre la dimesion de la UP, el 80% describio el aspecto y el 52,1% no registro el estadio. Se observa la necesidad de un mejor registro de las UP para que las intervenciones utilizadas en el tratamiento puedan ser evaluadas.Patients with traumatic spinal cord injury (TSCI) have an increased risk of developing pressure ulcers (PU). It is a retrospective study done by review of records in order to identify the characteristics of patients who were assisted at a tertiary hospital as well as the occurrence of PU. Most patients were male, white and 36,2% between 21 and 30 years. The most common causes of TSCI were wound by fire weapons followed by vehicle crash/overturn. There was a predominance of injury at the toracic level followed by cervical. The PU occurred in 20 pacientes (42,5%). The most frequent regions of occurrence were the sacral and heels. Only 25% of the records had PUs dimensions charted, 80% stated the aspect, and 52.1% did not state the stage. There is a need for better documentation of PU so that interventions used for treatment can be evaluated.

The effect of educative interventions on the pressure ulcer prevention knowledge of nursing professionals

OBJECTIVE: The aim was to evaluate the effect of the educative interventions on nursing staff knowledge about pressure ulcer prevention in Intensive Care Centers (ICC). It is a descriptive-comparative study. METHODS: Data were collected from nursing team members before and after educative interventions using a knowledge test with true-false questions related to pressure ulcer prevention and description as a research instrument. RESULTS: Seven registered nurses participated in the pre-intervention phase only and obtained 86.4% of correct answers. The nursing assistants and technicians (n=25) obtained 74.3% of correct answers in the pre-intervention phase and 81.2% (n=36) in the post-intervention phase, showing improvement in the results after the intervention for this group. CONCLUSION: Even though the strategies used were not totally effective, as in some questions the rate of correct answers was below 70%. New interventions might be used to obtain greater staff adhesion and to improve their knowledge about the issue.Resumen pt: Objetivo: Avaliar o efeito de intervencoes educativas, no nivel de conhecimento dos membros da equipe de enfermagem sobre a prevencao de ulceras por pres...

The demands of family caregivers of elderly individuals with dementia

As finalidades deste estudo foram identificar as caracteristicas dos cuidadores de idosos demenciados, os tipos de demandas de cuidados e relacionar a demanda com o estagio da demencia. O estudo seccional e observacional foi conduzido em 2004, com 104 idosos e 90 cuidadores, em Ribeirao Preto/SP, por meio do instrumento OARS e de um questionario para o cuidador. Dos 104 idosos, 66.3% eram mulheres, a idade media de 75.5 anos, sendo que 86.5% deles tinham cuidadores. Entre os cuidadores, 80% eram mulheres, membros da familia, com idade media de 52.3 anos. Dedicavam 15.10 horas/dia para a atividade de cuidar, sem nenhuma ajuda. Encontrou-se importante relacao entre a sobrecarga do cuidador, o esforco fisico e emocional, e o estagio da demencia. A sobrecarga emocional foi maior nos estagios iniciais e tardios da demencia, mas a diferenca foi estatisticamente nao-significante. Os resultados atuais revelam a urgente necessidade de planejar estrategias de suporte formal e informal para cuidadores de idosos brasileiros com demencia.The purpose of this cross-sectional observational study was to identify characteristics of caregivers of elderly people with dementia, types of care demands and to relate demands to the stage of dementia. The study was carried out in 2004 with 104 older adults and 90 caregivers in Ribeirão Preto, state of São Paulo. The OARS instrument was utilized and a questionnaire answered by caregivers. Among older adults, 66.3% were female, aged 75.5 years in average and 86.5% had caregivers. Eighty percent of the caregivers were women family members, aged 52.3 years in average. They spent 15.10 hours/day with care, without help. An important relationship was observed between caregivers burden, physical and emotional effort and stage of dementia. Emotional overburden was higher at dementia early and late stages, this difference was statistically non-significant. Results reveal the urgent need to plan formal and informal support strategies to caregivers of Brazilian elderly people with dementia.