Objective: To analyze the applicability of the Braden Scale to individuals admitted to an Intensive Care Unit (ICU) with the nursing diagnosis Impaired Physical Mobility, in its prediction potential to develop pressure ulcer (PU). Methods: A cross-sectional, quantitative study that evaluated all patients hospitalized in an ICU between November 2016 and February 2017, with the Braden Scale. Results: The prevalence of PU was 35.8% (24/67), in male individuals 58.3% (14/24), diagnosed with ischemic CVA 51.9% (12/27), and with hemorrhagic CVA 7.4% (2/27). Among patients classified at severe risk of developing pressure ulcer, 83.3% (20/53) developed it, and 76.7% (33/53) did not develop it. Conclusion: The performance of the Braden Scale showed a balance between sensitivity and specificity, confirming it as a better predictive risk assessment instrument in this group of patients.

BackgroundAnti-NMDA receptor encephalitis is an autoimmune disease that was identified in 2007, and manifests in a stepwise manner with psychiatric, neurological and autonomic symptoms. The disease is caused by autoantibodies against NMDA receptors. It can have a paraneoplastic origin, mainly secondary to ovarian teratomas, but it can also be unrelated to the tumor. This disease can affect both sexes and all ages.Case presentationHere, we present a case of a 15 year-old female adolescent with first-episode psychosis with anti-NMDA receptor encephalitis not related to tumor, which manifested with delusion, hallucinations, panic attacks, agitation, and neurological symptoms, and later with autonomic instability. She was treated with immunotherapy and psychiatric medication resulting in improvement of her main psychiatric and neurological symptoms.ConclusionOur main objective in presenting this case is to alert clinicians to this challenging and recent disease that has a clinical presentation that might resemble a functional psychiatric condition and can be underdiagnosed in the context of child and adolescent psychiatry.

HIV-1 transmitted-drug-resistance and genetic diversity are dynamic and may differ in distinct locations/risk groups. In Brazil, increased AIDS incidence and related mortality have been detected in the Northeast region, differently from the epicenter in the Southeast. This cross-sectional study describes transmitted-dru- resistance and HIV-1 subtypes in protease/PR and reverse transcriptase/RT regions among antiretroviral naïve patients from Piauí State, Northeast Brazil. Among 96 patients recruited 89 (92.7%) had HIV-1 PR/RT regions sequenced: 44 females and 45 males, 22 self-declared as men who have sex with men. Transmitted-drug-resistance was investigated by CPR tool (Stanford HIV-1 Drug Resistance/SDRM). HIV-1 subtypes were assigned by REGA and phylogenetic inference. Overall, transmitted-drug-resistance rate was 11.2% (10/89; CI 95%: 5.8-19.1%); 22.7% among men who have sex with men (5/22; CI 95%: 8.8-43.4%), 10% in heterosexual men (2/20; CI 95%: 1.7-29.3%) and 6.8% in women (3/44; CI 95%: 1.8-17.4%). Singleton mutations to protease-inhibitor/PI, nucleoside-reverse-transcriptase-inhibitor/NRTI or non-nucleoside-reverse-transcriptase-inhibitor/NNRTI predominated (8/10): PI mutations (M46L, V82F, L90M); NRTI mutations (M41L, D67N) and NNRTI mutations (K103N/S). Dual class resistance mutations to NRTI and NNRTI were observed: T215L (NRTI), Y188L (NNRTI) and T215N (NRTI), F227L (NNRTI). Subtype B prevailed (86.6%; 77/89), followed by subtype F1 (1.1%, 1/89) and subtype C (1.1%, 1/89). B/F1 and B/C intersubtype recombinants represented 11.2% (10/89). In Piauí State extensive testing of incidence and transmitted-drug-resistance in all populations with risk behaviors may help control AIDS epidemic locally.

The present paper shows a theoretical reflection on action research methodology as an alternative strategy to the conventional model of scientific investigation. Methodology is discussed from the perspective of two scholars who propose two different structural models: action-investigation cycle and flexible stage model. We provide examples of the use of action research from studies carried out by nurses. Action research is an emergent model which is being more and more adopted in educational and nursing fields, reflecting the necessity of deeper theoretical knowledge and revealing itself as a useful instrument in nursing research.

The Brazilian AIDS epidemic is characterized by significant geographic contrasts: a reduction in incidence and mortality in the epicenter (southeast) and an increase in the northeast. HIV-1-transmitted drug resistance (TDR) and genetic diversity were investigated among 106 antiretroviral (ARV)-naive patients from Maranhão State, northeast. The HIV-1 protease (PR) and reverse transcriptase (RT) regions were sequenced; subtypes were assigned by REGA/phylogenetic analysis. TDR to the nucleoside/nonnucleoside reverse transcriptase inhibitor (NRTI/NNRTI) and protease inhibitor (PI) was identified by the Calibrated Population Resistance tool (Stanford). The median age was 31 years (range 18-72), with 54.7% women, 78.3% heterosexual transmission, and 17.9% men who have sex with men (MSM). Around 30% had <350 CD4(+) T cells/μl and 47.2% had plasma viral loads ≤10,000 copies/ml. The TDR rate was 3.8% (4/106; CI 95%, 1.2-8.9%) (three males, two of them MSM). Only single class mutations to NRTI (M184V; T215S) or NNRTI (K103S/N) were detected. Subtype B represented 81.1% (86/106), F1 1.9% (2/106), and C 2.8% (3/106); 14.2% were mosaics: 13 BF1 and 2 BC. Surveillance of TDR and HIV-1 genetic diversity is important to improve control strategies regionally.

Child Mental Health Services have been dealing¸ over the last decades, with a growing number of children in need of evaluation and treatment. Recent studies estimate that 10 to 20% of children and adolescents met criteria for, at least, one psychiatric diagnosis, and that only one fifth gets appropriate treatment. Thus, in order to optimize service planning and management we performed an analysis of the cases referred to and observed at one Child and Adolescent Psychiatry Clinic between 2004 and 2007, as well as descriptive analysis of the youth population observed at the same clinic during 2007. In the 4 year period studied, 1923 children were consulted in a total of 9609 appointments. Sample mean age was 9.89 years with a clear male gender preponderance. During 2007, 480 patients were consulted and it was possible to observe a predominance of nuclear family structure and around 71% of cases living in Sintra. Regarding the source of referral, 29% of the cases were referred by the assistant physician and in 26% by school teachers; the main complaints were behavior problems (30%) and learning disabilities (15%). It was also possible to characterize complaints according to the different referral sources. On a psychodynamic diagnostic level, 56% of all cases met criteria for a Depressive Organization. According to DSM-IV-TR diagnostic criteria for Axis I disorders, we found 30% of Emotional Disorders and 24.8% of Conduct Disorders and Attention Deficit and Hyperactive Disorder. Mean waiting times between referral and the first appointment varied between 55 days (cases referred from the Emergency Department) and 141 days (school referrals). Only a deeper and detailed analysis of this reality will allow the planning and implementation of measures needed to optimize Child and Adolescent Mental Health services and the answer they can give to patients and families.

Visceral leishmaniasis (VL) is an infectious disease predominant in countries located in the tropics. The prediction of occurrence of infectious diseases through epidemiologic modeling has revealed to be an important tool in the understanding of its occurrence dynamic. The objective of this study was to develop a forecasting model for the incidence of VL in Maranhão using the Seasonal Autoregressive Integrated Moving Average model (SARIMA). We collected monthly data regarding VL cases from the National Disease Notification System (SINAN) corresponding to the period between 2001 and 2018. The Box-Jenkins method was applied in order to adjust a SARIMA prediction model for VL general incidence and by sex (male or female) for the period between January 2019 and December 2013. For 216 months of this time series, 10,431 cases of VL were notified in Maranhão, with an average of 579 cases per year. With regard to age range, there was a higher incidence among the pediatric public (0 to 14 years of age). There was a predominance in male cases, 6437 (61.71%). The Box-Pierce test figures for overall, male and female genders supported by the results of the Ljung-Box test suggest that the autocorrelations of residual values act as white noise. Regarding monthly occurrences in general and by gender, the SARIMA models (2,0,0) (2,0,0), (0,1,1) (0,1,1) and (0,1,1) (2, 0, 0) were the ones that mostly adjusted to the data respectively. The model SARIMA has proven to be an adequate tool for predicting and analyzing the trends in VL incidence in Maranhão. The time variation determination and its prediction are decisive in providing guidance in health measure intervention.

Objetivo: Avaliar o clima de segurança sob a perspectiva dos profissionais da equipe de enfermagem, atuantes nas clínicas médica e cirúrgica de dois hospitais do interior do estado do Maranhão, Brasil, após realização de uma capacitação sobre segurança do paciente. Material e método: Estudo com abordagem quantitativa do tipo pós-intervenção que recrutou 105 profissionais de enfermagem atuantes nas clínicas médica e cirúrgica de dois hospitais. Após uma capacitação sobre segurança do paciente aplicou o Safety Attitudes Questionnaire (SAQ). Resultados: Os escores por cada domínio do SAQ nas clínicas médica e cirúrgica em Açailândia e Imperatriz respectivamente foram: