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Distribuição espacial e tendência temporal da tuberculose em pessoas privadas de liberdade no Brasil

2026-09-25T17:21:14Z

Title: Distribuição espacial e tendência temporal da tuberculose em pessoas privadas de liberdade no Brasil Authors: Carvalho, Kaique Máximo de Oliveira Abstract: Introduction: tuberculosis (TB) is a major public health problem, especially in vulnerable populations. The prison environment, characterized by overcrowding, inadequate ventilation, high turnover, and limited access to health services, enhances disease transmission and challenges its control. In Brazil, the growth of the inmate population in recent decades has been accompanied by an increase in the TB burden within this group, reinforcing the need for analyses that integrate epidemiological, temporal, and spatial aspects. Objective: to analyze the epidemiological, temporal, and spatial patterns of TB among persons deprived of liberty (PDL) in Brazil from 2014 to 2024. Methods: population-based ecological study with temporal and spatial components, using secondary data from the Notifiable Diseases Information System and the National Penitentiary Information System, aggregated by Federative Unit. All new cases of TB reported between 2014 and 2024 were included. Incidence rates were calculated based on the estimated prison population. Temporal trends were analyzed using segmented regression (Joinpoint), estimating the Annual Percent Change (APC) and the Average Annual Percent Change (AAPC), with their respective 95% confidence intervals. Spatial distribution was assessed through choropleth maps of the mean incidence by Federative Unit. Sociodemographic, clinical, and diagnostic characteristics, comorbidities, associated conditions, and treatment outcomes were also analyzed. Results: a total of 821,172 new cases of TB were analyzed in Brazil, of which 78,034 occurred among PDL. There was a predominance of male individuals (97.03%), aged between 20 and 49 years (94.86%), non-white (63.10%), and with low educational level. The pulmonary clinical form was predominant (95.34%). Laboratory confirmation was high (81.78%), although gaps were identified in testing, such as culture and molecular rapid test, which was not performed in 46.08% of cases. Incidence showed an increasing trend during the analyzed period (AAPC: 4.79%; 95%CI: 0.21–9.58), with an inflection point in 2017, followed by stabilization. The highest incidence rates and growth trends were observed in the North and Northeast regions. Spatial distribution revealed a concentration of high rates in states such as Rio Grande do Norte, Pará, Sergipe, and Rio de Janeiro. Regarding outcomes, a higher proportion of cure was observed among PPL (73.69%) compared to the nondeprived population (68.45%). Conclusion: TB among PDL shows high magnitude, an increasing trend, and significant territorial inequality in Brazil. These findings highlight the need to strengthen epidemiological surveillance actions, expand early diagnosis, improve the quality of care, and implement intersectoral public policies aimed at reducing structural vulnerabilities in the prison system.

Efeito da prática deliberada em ciclos rápidos na performance técnica da equipe multiprofissional no manejo da ventilação mecânica

2026-09-21T14:52:25Z

Title: Efeito da prática deliberada em ciclos rápidos na performance técnica da equipe multiprofissional no manejo da ventilação mecânica Authors: Passos, Meiriane do Carmo Abstract: Introduction: Mechanical ventilation is widely used in the care of critically ill patients; however, it is associated with preventable complications such as Ventilator-Associated Pneumonia (VAP). Adherence to preventive measures depends on the technical performance of the multidisciplinary team, which is still characterized by variability in clinical practice. In this context, Rapid Cycle Deliberate Practice (RCDP) has emerged as an educational strategy based on structured task repetition and immediate feedback. Objective: To analyze the effect of simulation-based training using Rapid Cycle Deliberate Practice on the knowledge and technical performance of a multidisciplinary team in the management of mechanically ventilated patients. Methods: A multimethod study composed of a scoping review and a quasi experimental before-and-after study with repeated measures. The scoping review followed the Joanna Briggs Institute and PRISMA-ScR guidelines, with searches conducted in PubMed, Scopus, ScienceDirect, ERIC, and the Virtual Health Library databases. The quasi experimental study was carried out with healthcare professionals from adult Intensive Care Units. The intervention consisted of simulation-based training structured according to RCDP principles, including immediate interruption upon errors, instructional feedback, and task repetition until proficiency was achieved. Theoretical knowledge, technical performance, and participants’ perceptions of the methodology were assessed. Data were analyzed using descriptive and inferential statistics, with a significance level of 5%. Results: The scoping review included 31 studies and demonstrated positive effects of RCDP on technical and non technical skills, self-confidence, and performance of procedures in critical situations. However, gaps remain regarding skill retention, transfer to clinical practice, and impact on patient outcomes. In the quasi-experimental study (n=124), a significant increase in knowledge scores was observed after the intervention (7.60±1.64 vs. 8.14±1.42; p<0.001). Technical performance showed a high overall proficiency level (89.5±5.3), with 90.8% of participants achieving the predefined proficiency criterion. The highest proficiency rates were observed in the domains related to artificial airway management, sedation management, and ventilator weaning. Regarding participants’ perceptions, most strongly agreed that RCDP contributed to the development of skills required for mechanical ventilation management (87.9%), improved technical performance through rapid practice-feedback cycles (87.1%), and increased confidence in applying procedures in clinical practice (91.1%). At the 30-day follow-up (n=13), partial retention of knowledge gains was observed, with lower scores compared to the immediate post-test, although the difference was not statistically significant (p=0.080). Conclusion: RCDP demonstrated potential to improve knowledge, promote high levels of proficiency in the implementation of VAP prevention measures, and strengthen the self confidence of multidisciplinary healthcare professionals in the management of mechanically ventilated patients. These findings support the applicability of RCDP as a continuing education strategy in intensive care and its potential to enhance standardization of clinical practices and patient safety. Nevertheless, limitations related to the short follow-up period and the absence of clinical outcome assessment warrant cautious interpretation of the results.

Fatores associados à catastrofização da dor aguda pós-cesária e seus impactos na recuperação funcional de puérperas em pós-operatório mediato: um estudo transversal

2026-09-17T13:22:59Z

Title: Fatores associados à catastrofização da dor aguda pós-cesária e seus impactos na recuperação funcional de puérperas em pós-operatório mediato: um estudo transversal Authors: Pereira, Milena Santos Abstract: Introduction: Cesarean section is one of the most commonly performed surgical procedures among women of reproductive age, and acute postoperative pain is one of its most frequent complications. Acute post-cesarean pain represents a major challenge to postpartum recovery. Pain catastrophizing, characterized by a negative cognitive and emotional response to actual or anticipated pain, has been associated with greater pain intensity and impaired functional recovery. Objective: To evaluate the factors associated with acute post-cesarean pain catastrophizing and its impact on the functional recovery of women during the early postoperative postpartum period. Method: This was a cross-sectional analytical study conducted in a low-risk maternity hospital in the interior of Sergipe, Northeastern Brazil. Puerperal women in the intermediate postoperative period (≥24 h) after cesarean section were included. The primary outcome was pain catastrophizing, assessed using the 13-item Pain Catastrophizing Scale (PCS), which measures catastrophic thinking related to pain using a 5- point Likert scale. Independent variables included pain characteristics, sociodemographic, clinical, obstetric, and perioperative factors. Descriptive statistics were presented as absolute and relative frequencies. Bivariate associations were tested using Pearson’s chi-square or Fisher’s exact test, with Cramér’s V estimation. Correlations between catastrophizing and functional outcomes were assessed using Pearson’s correlation coefficient with bootstrap resampling (1,000 samples) and BCa 95% confidence intervals. The overall impact of catastrophizing on functionality was analyzed using multivariate analysis of covariance (MANCOVA), adjusted for pain intensity. Multivariate significance was evaluated using Pillai’s trace. Following a significant global effect, ANCOVAs were performed for each functional outcome, with bootstrap adjustment and Bonferroni correction. Results were expressed as estimated marginal means and effect sizes (partial eta squared, η²p), adopting a 5% significance level. Results: The sample comprised 232 puerperal women experiencing pain in the intermediate postoperative period following cesarean section, with a predominance of moderate to severe pain at the time of interview (52.6%). Most participants were younger than 35 years (79.3%), self-identified as non-White (88.8%), were users of the public health system (78.4%), unemployed (79.7%), recipients of governmental financial assistance (59.9%), and lived in owned housing (68.1%) in urban areas (56.9%). Educational level was predominantly ≥12 years of schooling (59.1%). Pain catastrophizing was correlated with functional impairments. Multivariate analysis (MANCOVA) demonstrated a significant effect of catastrophizing on functional outcomes (Pillai’s trace = 0.49; F(34,426) = 4.110; p < 0.001; ηp2 = 0.247). In the univariate analyses adjusted for pain intensity (ANCOVA), catastrophizing significantly impacted 15 of the 17 functional outcomes assessed (p < 0.05). Post hoc multiple comparisons showed that women with low levels of catastrophizing had significantly better functionality than those with high/very high levels across most outcomes, with pronounced mean differences in general activity (Mdiff = −3.36; p < 0.001), mood (Mdiff = −3.59; p < 0.001), and breastfeeding (Mdiff = −3.20; p = 0.002). Significant differences were also observed between the low and moderate catastrophizing groups, particularly regarding ambulation (p < 0.001) and newborn care activities, such as bathing (p = 0.010) and holding the infant (p = 0.013). Conclusion:Pain catastrophizing was associated with pain and functionality in the postoperative period following cesarean section. Associations were observed with gynecological-obstetric characteristics, childbirth care, and pain-related factors. A previous history of postpartum depression and labor induction increased the likelihood of elevated levels of this construct, independently of age and pain intensity. Catastrophizing significantly impacted functional outcomes, with greater impairments among women with higher levels of catastrophizing.

Construção e validação de um instrumento de transição de cuidados neonatal para recém-nascido pré-termo

2026-08-17T15:06:59Z

Title: Construção e validação de um instrumento de transição de cuidados neonatal para recém-nascido pré-termo Authors: Santos, José Matheus de Melo Abstract: Preterm newborns from intensive care units undergo several services after discharge, going to follow-up clinics and primary care. This transition is a crucial time where health information must be passed on securely. Therefore, the development of a standardized transition form that guarantees this transition becomes a viable strategy to promote the continuity of care effectively and safely. The objective of this research was to develop a neonatal care transition form to standardize the transition of information between the units responsible for the care of preterm infants. Therefore, a methodological research was carried out in three stages, respectively: the survey of the theoretical-methodological framework, the semantic analysis of the proposed form, and the content validation of the version of the transition of care form. The sample was non-probabilistic, meeting the inclusion and exclusion criteria. The construction of the form was carried out based on the Instrument Construction Model. The Delphi method was used to validate the form. Data obtained from Google Forms were transferred to Microsoft Excel and analyzed in version 4.1.0 of the R software. Data were subjected to statistical analysis using the Content Validation Index (CVI), the binomial test, Cronbach's alpha coefficient and Kendall's coefficient of agreement. Content validation was considered when the CVI≥ 0.80. All domains were approved after one round of semantic analysis and two rounds of content validation. This study enabled the construction and validation of a care transition form that will enable the transmission of information between units in a standardized way and with greater data security.