RESUMENObjetivo: identifi car la incidencia y describir los factores asociados con las úlceras de presión en pacientes críticamente enfermos. Métodos: es un estudio de cohorte prospectivo con 77 pacientes, uso clínico, metabólico y factores asociados a la evaluación de las úlceras de presión, la aplicación de las escalas de riesgo (Braden y Waterlow) y clasifi cación en categorías de las úlceras. Resultados: se encontró una incidencia del 22% (IC del 95%: 12.6-31.5), y el 17 con 32 úlceras por presión en la región sacra (47%) y Clase I (72%). Duración de la estancia superior a 10 días (71%), tipo de hospital quirúrgico (53%), insufi ciencia cardíaca congestiva (24%) y alto riesgo en la escala de Braden (59%). Conclusión: el estudio pone de manifi esto la alta incidencia de úlceras de presión, clínicas, metabólicas y factores asociados y el resultado de muerte, lo que requiere, por lo tanto, de medidas preventivas. Descriptores: Úlcera de Presión; Evaluación de Riesgos; Escalas; Cuidados de Enfermería; Incidencia. RESUMO Objetivo: identifi car a incidência e descrever os fatores associados à úlcera por pressão em pacientes críticos. Método: tratase de uma coorte prospectiva, com 77 pacientes, usando a avaliação clínica, metabólica e de fatores associados à úlcera por pressão, aplicando as escalas de risco (Braden e Waterlow) e classifi cando as úlceras em categorias. Resultados: constatou-se uma incidência de 22% (IC 95% 12,6 -31,5), sendo 17 com 32 úlceras por pressão em região sacral (47%) e na categoria I (72%). Tempo de internação maior que 10 dias (71%), tipo de internação cirúrgica (53%), insufi ciência cardíaca congestiva (24%) e alto risco na Escala de Braden (59%). Conclusão: ressalta-se a elevada incidência de úlcera por pressão, características clínicas, metabólicas e fatores associados, além do desfecho por óbito, necessitando, portanto, de medidas de prevenção. Descritores: Úlcera por Pressão; Medição de Risco; Escalas; Cuidados de Enfermagem; Incidência.ABSTRACT Objective: to identify the incidence and describe the associated factors for pressure ulcers in critically ill patients. Method: this was a prospective cohort study with 77 patients, using a clinical, metabolic assessment and the associated factors for pressure ulcer, applying the risk scales (Braden and Waterlow) and assigning ulcers to categories. Results: an incidence of 22% (95% CI 12.6 -31.5), with 17 patients with 32 pressure ulcers in the sacral region (47%), and of Class I (72%). The length of stay was greater than ten days (71%), most admissions were surgical (53%) or for congestive heart failure (24%), and were high risk on the Braden Scale (59%). Conclusion: the study highlights the high incidence of pressure ulcers, clinical and metabolic characteristics and associated factors, as well as the outcome of death, requiring, therefore, preventive measures. Descriptors: Pressure Ulcer; Risk Assessment; Scales; Nursing Care; Incidence. Pressure ulcers in critically ill patients: incidence and associated factors. When PU development wa...

Desvendando os processos de trabalho do agente comunitário de saúde nos cenários revelados na Estratégia Saúde da Família no município de Vitória (ES, Brasil)Disclosing the work processes of the community health agents on the Family Health Strategy in Vitória (ES, Brazil)

AIMS: to evaluate the accuracy of the Braden and Waterlow risk assessment scales in critically ill inpatients. METHOD: this prospective cohort study, with 55 patients in intensive care units, was performed through evaluation of sociodemographic and clinical variables, through the application of the scales (Braden and Waterlow) upon admission and every 48 hours; and through the evaluation and classification of the ulcers into categories. RESULTS: the pressure ulcer incidence was 30.9%, with the Braden and Waterlow scales presenting high sensitivity (41% and 71%) and low specificity (21% and 47%) respectively in the three evaluations. The cut off scores found in the first, second and third evaluations were 12, 12 and 11 in the Braden scale, and 16, 15 and 14 in the Waterlow scale. CONCLUSION: the Braden scale was shown to be a good screening instrument, and the Waterlow scale proved to have better predictive power.

Objective: To describe the process of development and validation of a mobile application on foot assessment and risk classification of people with Diabetes mellitus. Methods: Methodological study, conducted in four stages: definition of requirements for and development of the conceptual model; generation of alternatives for implementation and prototyping; testing; and, implementation. The application was developed based on the national and international guidelines on Diabetes mellitus; it followed the standard of the Brazilian Association of Technical Standards for Software Engineering, and used the Intel XDK program for IOS and Android platforms. The product was evaluated by the development team for usability through the Nielsen heuristics, and validated by nurses regarding functionality, reliability, usability and efficiency aspects. Results: The CuidarTech mobile application "Foot examination" is composed of seven screens that integrate the elements for assessment and risk classification, and eight screens (forms) with the sequence of the examination. After its execution, a screen shows the risk classification and the clinical findings, with recommendations for each type of risk. Conclusion: According to the nurse experts, the application is functional, reliable, adequate, and efficient. ResumoObjetivo: Descrever o processo de desenvolvimento e validação de um aplicativo para dispositivos móveis sobre avaliação e classificação de risco dos pés de pessoas com Diabetes mellitus. Métodos: Estudo metodológico, realizado em quatro etapas: Definição de requisitos e elaboração do modelo conceitual; Geração das alternativas de implementação e prototipagem; Testes e Implementação. O aplicativo foi desenvolvido baseado nas diretrizes nacionais e internacionais sobre Diabetes mellitus; seguiu as normas da Associação Brasileira de Normas Técnicas para Engenharia de Software e utilizou o programa Intel XDK, para plataformas IOS e Android. O produto foi avaliado quanto a usabilidade pelas heurísticas de Nielsen, pela equipe de desenvolvimento e validado por enfermeiros quanto aos aspectos de funcionalidade, confiabilidade, usabilidade e eficiência. Resultados: O aplicativo móvel CuidarTech "Exame dos Pés" possui sete telas que integram os elementos para avaliação e classificação de risco e oito telas (formulários) com a sequência do exame, após sua execução aparece uma tela com a classificação de risco e os achados clínicos com as recomendações para cada tipo de risco. Conclusão: O aplicativo segundo avaliação dos juízes e enfermeiros é funcional, confiável, adequado e eficiente.

BackgroundOver the last decade tuberculosis (TB) incidence and mortality in Brazil have been steadily declining. However, this downward trend has not been observed among HIV-infected patients. We describe the epidemiological and clinical profile of TB patients by HIV status using the Brazilian National Surveillance System.MethodsAll TB diagnoses with HIV status information between January 1, 2007 and December 31, 2011 were categorized as either HIV or non-HIV at time of TB diagnosis. Co-infected patients (TB-HIV) were compared to TB patients with no HIV-infection using a hierarchical logistic regression model using Stata 13.0.ResultsThe prevalence of TB-HIV co-infection was 19% among adults ≥ 15 years of age. We analyzed data from 243,676 individuals, of whom 46,466 were TB-HIV and 197,210 were only TB cases. The following factors increased risk of co-infection: male sex (OR: 1.06, 95% CI 1.03-1.10), 20 to 39 years of age (OR = 4.82, 95% CI 4.34-5.36), black (OR = 1.08, 95% CI 1.04-1.13), 4–7 years of education (OR = 1.13, 95% CI 1.19-1.28), diagnosed following default (OR = 2.65, 95% CI 1.13-6.25), presenting with pulmonary and extra-pulmonary forms of TB simultaneously (OR = 2.80, 95% CI 1.56-5.02), presenting with histopathologic examination suggestive of TB (OR = 2.15, 95% CI 1.13-4.07). Co-infected patients were less likely to live in rural areas (OR = 0.45, 95% CI 0.42-0.48), have diabetes (OR = 0.45, 95% CI 0.40-0.50) and be smear positive (OR = 0.55, 95% CI 0.32-0.95), and co-infected patients had higher risk of default (OR = 2.96, 95% CI 2.36-3.71) and death from TB (OR = 5.16, 95% CI 43.04-5.77).ConclusionsThe prevalence of co-infection with HIV among TB patients is 19% in Brazil. By identifying predictors of co-infection targeted interventions can be developed to prevent both TB and HIV, and to diagnose each disease earlier and ultimately decrease poor treatment outcomes and death.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-415) contains supplementary material, which is available to authorized users.

Objective To evaluate the epidemiological profile of patients with tuberculosis (TB) only and that of patients with TB/AIDS in the state of Espírito Santo, Brazil, between 2000 and 2006. Methods For the patients of interest, we collected demographic and clinical data from the Epidemiological Surveillance Center (TB database), Brazilian Case Registry Database, and Brazilian National Mortality Database, as well as the Brazilian National CD4+/CD8+ T Lymphocyte Count and Viral Load Network Laboratory Test Control System and the Logistic Medication Monitoring System (HIV/AIDS databases). All of the compiled data were cross-referenced. Results During the study period, we identified 9,543 TB patients > 15 years of age, 437 of whom (4.6%) had AIDS. The median age did not differ between TB/AIDS and TB-only patients (35 years vs. 38 years). Of the 437 TB/AIDS patients, 298 (68.2%) were male, and 156 (35.8%) were in the 30–39 age bracket. In terms of TB treatment outcome, 79.0% were cured, 9.7% were referred to other facilities, 6.0% died, 5.2% abandoned treatment, and 0.2% developed multidrug-resistant TB. Death was 4.75 times more common in patients with TB/AIDS than in those with TB only. Pulmonary TB accounted for 82.4% of the cases. The combination of pulmonary and extrapulmonary TB was 8.2 times more common in the TB/AIDS patients than in the TB-only patients (95% CI: 6.2–10.8). Conclusions Our results emphasize the significance of AIDS among TB patients in Brazil, as well as the importance of evaluating secondary data in order to improve their quality and develop public health interventions.

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is a threat for the global TB epidemic control. Despite existing evidence that individualized treatment of MDR-TB is superior to standardized regimens, the latter are recommended in Brazil, mainly because drug-susceptibility tests (DST) are often restricted to first-line drugs in public laboratories. We compared treatment outcomes of MDR-TB patients using standardized versus individualized regimens in Brazil, a high TB-burden, low resistance setting.MethodsThe 2007–2013 cohort of the national electronic database (SITE-TB), which records all special treatments including drug-resistance, was analysed. Patients classified as MDR-TB in SITE-TB were eligible. Treatment outcomes were classified as successful (cure/treatment completed) or unsuccessful (failure/relapse/death/loss to follow-up). The odds for successful treatment according to type of regimen were controlled for demographic and clinical variables.ResultsOut of 4029 registered patients, we included 1972 recorded from 2010 to 2012, who had more complete outcome data. The overall success proportion was 60%. Success was more likely in non-HIV patients, sputum-negative at baseline, with unilateral disease and without prior DR-TB. Adjusted for these variables, those receiving standardized regimens had 2.7-fold odds of success compared to those receiving individualized treatments when failure/relapse were considered, and 1.4-fold odds of success when death was included as an unsuccessful outcome. When loss to follow-up was added, no difference between types of treatment was observed. Patients who used levofloxacin instead of ofloxacin had 1.5-fold odds of success.ConclusionIn this large cohort of MDR-TB patients with a low proportion of successful outcomes, standardized regimens had superior efficacy than individualized regimens, when adjusted for relevant variables. In addition to the limitations of any retrospective observational study, database quality hampered the analyses. Also, decision on the use of standard or individualized regimens was possibly not random, and may have introduced bias. Efforts were made to reduce classification bias and confounding. Until higher-quality evidence is produced, and DST becomes widely available in the country, our findings support the Brazilian recommendation for the use of standardized instead of individualized regimens for MDR-TB, preferably containing levofloxacin. Better quality surveillance data and DST availability across the country are necessary to improve MDR-TB control in Brazil.Electronic supplementary materialThe online version of this article (10.1186/s12879-017-2810-1) contains supplementary material, which is available to authorized users.

Socio-economic vulnerability has a significant effect on treatment outcomes among TB-HIV co-infected patients in Brazil. Enhancing social support, incorporation of alcohol abuse screening and counseling into current TB surveillance programs and targeting interventions to specific age groups are interventions that could improve treatment outcomes.