Zenewton André da Silva Gama

Influência do intervalo de tempo entre as sessões de alongamento no ganho de flexibilidade dos isquiotibiais

CONTEXT: The optimization of flexibility training is related to the use of ideal stretching parameters. However, the time interval between sessions has been little investigated. OBJECTIVE: To verify if the variation in time interval between stretching sessions influences in flexibility gain. METHODOLOGY: Twenty-eight women, average age of 22.5 ± 1.8 years, were randomly distributed into three groups. Group 0X was the control and performed no stretching. Group 3X (n = 10) took part in three sessions per week (interval = 48 hours) and group 5X (n = 10) in five times (interval = 24 hours). Ten stretching sessions were applied (hold-relax) to the right hamstring. The measurement of active knee extension was performed using photometric analyses on AutoCAD® 2000 software. Statistical analysis was carried out with ANOVA and Newman-Keuls post hoc test for a significance level of p < 0.05. RESULTS: After 10 sessions, increased flexibility was identified in the experimental groups (p < 0.01), but with no difference between them. Group 3X significantly increased flexibility from the tenth day of the program (fifth session) and group 5X from the third day (third session). CONCLUSIONS: Stretching increases hamstring flexibility, regardless of the time between sessions (24 or 48 hours). Moreover, the interval between the sessions does not influence total flexibility gain. However, with five weekly stretching sessions, flexibility increases more rapidly than it does with three, suggesting that flexibility gain is session-dependent.CONTEXT: The optimization of flexibility training is related to the use of ideal stretching parameters. However, the time interval between sessions has been little investigated. OBJECTIVE: To verify if the variation in time interval between stretching sessions influences in flexibility gain. METHODOLOGY: Twenty-eight women, average age of 22.5 ± 1.8 years, were randomly distributed into three groups. Group 0X was the control and performed no stretching. Group 3X (n = 10) took part in three sessions per week (interval = 48 hours) and group 5X (n = 10) in five times (interval = 24 hours). Ten stretching sessions were applied (hold-relax) to the right hamstring. The measurement of active knee extension was performed using photometric analyses on AutoCAD® 2000 software. Statistical analysis was carried out with ANOVA and Newman-Keuls post hoc test for a significance level of p < 0.05. RESULTS: After 10 sessions, increased flexibility was identified in the experimental groups (p < 0.01), but with no difference between them. Group 3X significantly increased flexibility from the tenth day of the program (fifth session) and group 5X from the third day (third session). CONCLUSIONS: Stretching increases hamstring flexibility, regardless of the time between sessions (24 or 48 hours). Moreover, the interval between the sessions does not influence total flexibility gain. However, with five weekly stretching sessions, flexibility increases more rapidly than it does with three, suggesting that flexibility gain is session-dependent.

Avaliação da qualidade da atenção primária à saúde sob a perspectiva do idoso

The scope of this study was to assess the quality of Primary Health Care (PHC) provided to the elderly from their viewpoint. The study design was cross-sectional and observational in a stratified random sample of elderly individuals, enrolled in 10 of the 20 Basic Health Units (BHU) in the city of Macaiba, State of Rio Grande do Norte, Brazil. After an interview conducted using the adult version of the primary care assessment tool (PCATool-Brazil), the quality level was estimated (0-10, based on desirable attributes) and the association between demographic and socioeconomic factors was analyzed. The participants (n = 100) assigned a score of fair (5.7) to Quality; Longitudinality of care was awarded a high score (7.3), however Integrality (4.7), Family Orientation (4.1) and Accessibility (3.8) were considered weak. Socio-demographic factors linked to vulnerability (low income, rural area and older age) were positively associated with different PHC attributes. A margin for improvement in PHC attributes was observed, especially with respect to increasing the focus on the family, extending working hours in BHUs and enhancing prevention of diseases and ensuing complications.

Avaliação da adesão ao checklist de cirurgia segura da OMS em cirurgias urológicas e ginecológicas, em dois hospitais de ensino de Natal, Rio Grande do Norte, Brasil

The WHO surgical safety checklist is a useful tool for decreasing the number of adverse events in hospitals, but its implementation is still a challenge. This study aimed to assess adherence to the checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte, Brazil. A cross-sectional observational design was used, elective surgeries were selected, and data were collected from medical charts. Adherence was based on the quality and proper completion of the checklist, and the association of structural and socio-professional factors was analyzed using multiple regression. Of the 375 surgeries reviewed, 61% included a checklist and 4% were correctly filled out. The existence of a checklist was associated with gynecological surgeries (OR = 130.18) and longer operating time (OR = 2.13), while quality of the checklist was related to urological surgeries (β = 26.36). Adherence to the checklist needs to be improved, and the observed differences suggest the influence of distinct implementation strategies at the two institutions.The WHO surgical safety checklist is a useful tool for decreasing the number of adverse events in hospitals, but its implementation is still a challenge. This study aimed to assess adherence to the checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte, Brazil. A cross-sectional observational design was used, elective surgeries were selected, and data were collected from medical charts. Adherence was based on the quality and proper completion of the checklist, and the association of structural and socio-professional factors was analyzed using multiple regression. Of the 375 surgeries reviewed, 61% included a checklist and 4% were correctly filled out. The existence of a checklist was associated with gynecological surgeries (OR = 130.18) and longer operating time (OR = 2.13), while quality of the checklist was related to urological surgeries (β = 26.36). Adherence to the checklist needs to be improved, and the observed differences suggest the influence of distinct implementation strategies at the two institutions.

Equivalência semântica, conceitual e de itens do Observable Indicators of Nursing Home Care Quality Instrument

Long-term care facilities (LTCFs) for the elderly are an important health care alternative in the world, though Brazil does not yet have a valid instrument to monitor the quality of these institutions. This study sought to describe the initial stages of the cross-cultural adaptation of the Observable Indicators of Nursing Home Care Quality (OIQ) instrument used to assess the quality of care in LTCFs. Conceptual equivalence was conducted to assess the relevance and feasibility of the OIQ within the Brazilian context, using the Content Validity Index (CVI). The operational, idiomatic and semantic equivalence was then performed. This item consisted of 5 phases: (1) two translations; (2) the respective back translations; (3) formal appraisal; (4) review; and (5) application of the pre-test in three LTCFs. Significant changes were made to ensure the validity of the OIQ. The CVI instrument for the Brazilian contextwas 94.3% (viability) and 95.3% (relevance). The OIQ proved to be easy to understand and apply in the pre-test. Cross-cultural adaptation of the OIQ contributes to assessing and improving quality in Brazilian LTCFs, though the findings should be complemented by a psychometric evaluation of the instrument.

Assessment of adherence to the WHO surgical safety checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte State, Brazil

The WHO surgical safety checklist is a useful tool for decreasing the number of adverse events in hospitals, but its implementation is still a challenge. This study aimed to assess adherence to the checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte, Brazil. A cross-sectional observational design was used, elective surgeries were selected, and data were collected from medical charts. Adherence was based on the quality and proper completion of the checklist, and the association of structural and socio-professional factors was analyzed using multiple regression. Of the 375 surgeries reviewed, 61% included a checklist and 4% were correctly filled out. The existence of a checklist was associated with gynecological surgeries (OR = 130.18) and longer operating time (OR = 2.13), while quality of the checklist was related to urological surgeries (β = 26.36). Adherence to the checklist needs to be improved, and the observed differences suggest the influence of distinct implementation strategies at the two institutions.The WHO surgical safety checklist is a useful tool for decreasing the number of adverse events in hospitals, but its implementation is still a challenge. This study aimed to assess adherence to the checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte, Brazil. A cross-sectional observational design was used, elective surgeries were selected, and data were collected from medical charts. Adherence was based on the quality and proper completion of the checklist, and the association of structural and socio-professional factors was analyzed using multiple regression. Of the 375 surgeries reviewed, 61% included a checklist and 4% were correctly filled out. The existence of a checklist was associated with gynecological surgeries (OR = 130.18) and longer operating time (OR = 2.13), while quality of the checklist was related to urological surgeries (β = 26.36). Adherence to the checklist needs to be improved, and the observed differences suggest the influence of distinct implementation strategies at the two institutions.

Cultura de segurança do paciente em três hospitais brasileiros com diferentes tipos de gestão

Resumo O objetivo do estudo foi avaliar a cultura de seguranca do paciente e fatores associados em hospitais brasileiros com diferentes tipos de gestao: federal, estadual e privado. O desenho foi observacional transversal. Enviaram-se 1576 questionarios aos profissionais de tres hospitais do estado do Rio Grande do Norte, utilizando o Hospital Survey on Patient Safety Culture, adaptado para o Brasil, que mede 12 dimensoes da cultura de seguranca. As percepcoes sao descritas atraves de uma nota geral (0 a 10) e dos percentuais de respostas positivas para estimar fortalezas e fragilidades em cada dimensao. A taxa de resposta foi de13,6% (n = 215). A seguranca do paciente teve nota entre 7 e 10, para 78,1% dos respondentes, sendo a maior media das notas apresentada pelo hospital privado (8,32). O tipo de gestao hospitalar, unidade de servico, cargo e quantidade de notificacao de eventos adversos estiveram associados a nota geral da seguranca do paciente (p < 0,001). Apenas o hospital privado apresentou fortalezas nas dimensoes analisadas, enquanto que as fragilidades apareceram em todos os hospitais.

A qualitative study analyzing access to physical rehabilitation for traffic accident victims with severe disability in Brazil

Abstract Purpose To identify access barriers to physical rehabilitation for traffic accident (TA) victims with severe disability and build a theoretical model to provide guidance towards the improvement of these services. Methods Qualitative research carried out in the city of Natal (Northeast Brazil), with semi-structured interviews with 120 subjects (19 key informer health professionals and 101 TA victims) identified in a database made available by the emergency hospital. The interviews were analyzed using Alceste software, version 4.9. Results The main barriers present in the interviews were: (1) related to services: bureaucratic administrative practises, low offer of rehabilitation services, insufficient information on rehabilitation, lack of guidelines that integrate hospital and ambulatory care and (2) related to patients: financial difficulties, functional limitations, geographic distance, little information on health, association with low education levels and disbelief in the system and in rehabilitation. Conclusion The numerous access barriers were presented in a theoretical model with causes related to organizational structure, processes of care, professionals and patients. This model must be tested by health policy-makers and managers to improve the quality of physical rehabilitation and avoid unnecessary prolongation of the suffering and disability experienced by TA survivors. Implications for rehabilitation Traffic accidents (TAs) are a global health dilemma that demands integrality of preventive actions, pre-hospital and hospital care and physical rehabilitation (PR). This study lays the foundation for improving access to PR for TA survivors, an issue of quality of care that results in preventable disabilities. The words of the patients interviewed reveal the suffering of victims, which is often invisible to society and given low priority by health policies that relegate PR to a second plan ahead of prevention and urgent care. A theoretical model of the causes of the problem of access to PR was built. The identified barriers are potentially preventable through the intervention of health policy-makers, managers, regulators and rehabilitation professionals, and by encouraging the participation of patients. Addressing timely access barriers involves the expansion of the supply of services and rehabilitation professionals, regulation and standardization of referencing practises and encouraging the provision of information to patients about continuity of care and their health needs.

Patient safety culture and related factors in a network of Spanish public hospitals

Based on experiences and reflections reported by health professionals, the aim of this study was to critically analyze the actions, situations, and decisions in healthcare services that involve breastfeeding, examining aspects that favor or limit its possibilities. This was a qualitative study based on the conceptual framework of vulnerability and healthcare, using focus groups with 25 healthcare professionals participating in the Committee on Breastfeeding in Londrina, Paraná State, Brazil. The material was produced with a comprehensive format, focusing on questions that involved the breastfeeding process and its approaches and decisions. The study raises issues for understanding how the way mothers and families deal with breastfeeding is linked to organization of the practices and individual and social aspects, requiring integration between practical and technical/scientific knowledge. The article portrays the complexity of healthcare for women and children, allowing an enhanced approach to routine healthcare and the related strategies for breastfeeding.

Adaptation and validation of the World Health Organization’s on Safe Childbirth Checklist for the Brazilian context

A mortalidade materno-infantil ainda e um grave problema de saude publica no Brasil, apesar do amplo acesso a partos institucionalizados. A Organizacao Mundial da Saude desenvolveu o Safe Childbirth Checklist, uma tecnologia potencialmente util para melhorar a qualidade da assistencia durante o parto e favorecer melhores resultados em saude. O objetivo deste trabalho e adaptar culturalmente e validar a Lista de Verificacao para o Parto Seguro da OMS para os hospitais brasileiros, pois a simples traducao entra em choque com praticas clinicas nacionais consolidadas. Apos traducao para o portugues do Brasil, houve tres etapas de adaptacao e validacao: 1- grupo nominal com painel de especialistas, sendo tres enfermeiras obstetras e seis medicas (tres obstetras e tres pediatras), que se realizou de forma presencial (duas primeiras votacoes) e finalizou a distância (votacao final); 2- Conferencia de Consenso em dois Hospitais Universitarios, em reunioes ampliadas para todos os profissionais que utilizariam a lista; e 3- questionario estruturado aos profissionais de saude (n=40) apos estudo piloto de 30 dias utilizando a lista. Os criterios da validacao foram a validade de face e conteudo da lista, adequacao aos protocolos nacionais, terminologia e viabilidade no contexto local. Na primeira etapa, todos os 29 itens foram aprovados apos 3 rodadas e algumas adaptacoes nacionais (ex. teste rapido para HIV em vez de CD4). Na segunda etapa, ocorreu acrescimo de 24 itens e modificacoes em itens iniciais. Na terceira etapa, ocorreu a exclusao de 3 itens nao viaveis, 2 itens sofreram juncao e 1 item foi acrescentado devido a sua importância clinica no contexto brasileiro. O processo de validacao possibilitou a disponibilizacao de uma Lista de Verificacao para o Parto Seguro de 49 itens potencialmente util para o contexto brasileiro, apresentando indicios de validade e viabilidade para o contexto nacional que devem ser confirmados em estudos futuros com foco na efetividade ou validade de criterio.

Improving the quality of radiological examinations: effectiveness of an internal participatory approach

Quality problem or issue To assess the quality of radiological examinations (REs) and to evaluate the effectiveness of a participatory continuous improvement approach to ensure best practices in a Portuguese hospital imaging department. Initial assessment At baseline, we found 232 (10.2%) non-compliances, mostly related to the criteria image centering and framing in chest radiography (CXR), proper use of radiological protection equipment in other conventional RE (CR) and X-ray beam collimation (CXR/CR). Choice of solution A baseline and three consecutive evaluations of the RE quality were conducted. Each assessment was followed by participatory focused interventions for improvement. Implementation For each evaluation, we selected a random sample (n = 60) of cases for four types of examination (total n = 240 for each assessment, and 960 for the whole project). Both the building of quality criteria and the design of interventions for improvement were participatory, involving the radiology technicians. Estimates of criteria compliance were calculated with 95% confidence intervals. The statistical significance of absolute and relative improvements was tested using one-tail z-tests. Evaluation After the intervention, non-compliances decreased to 48 (2.1%). Compliance estimates improved in 25 of 38 criteria assessed, with statistical significance for 5 criteria in CXR and 3 in CR and digestive examination. Lessons learned The internal participatory approach enabled the identification of existing quality problems and, by focusing on the more frequent quality defects, was effective in improving the quality of RE.