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Claudia Milena Garizábalo-Dávila,1 Alba Luz Rodríguez-Acelas,1 Rita Mattiello,2 Wilson Cañon-Montañez1 1Faculty of Nursing, Universidad de Antioquia, Medellín, Colombia; 2School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, BrazilCorrespondence: Wilson Cañon-MontañezFaculty of Nursing, Universidad de Antioquia, Cl. 64 #53-09, Medellín, 050010, ColombiaTel +57 4 2196300Email wilson.canon@udea.edu.coBackground: Social support interventions seek to improve the self-management of type 2 diabetes mellitus (T2DM). They provide an opportunity to generate greater social value in nursing care and achieve preventive health behaviors.Methods: A randomized controlled trial will be employed, covering 94 adults diagnosed with T2DM who attend outpatient diabetes consultations. Using 1:1 random allocation, 47 patients will be assigned to the social support intervention group and 47 will be assigned to the usual care group. The participants will be assessed using the following Nursing Outcomes Classification (NOC) labels: self-management: diabetes (1619); and social support (1504). The study participants will receive four individualized fortnightly sessions of social support, lasting 40 minutes each, and will be followed up on for three months afterwards.Results: The participants in the social support intervention group are expected to achieve greater self-management of T2DM than the participants in the usual care group.Discussion: Testing a social support intervention provided to adults by nurses for self-management of T2DM is a novel approach based on disciplinary theoretical support. It is consistent with the new paradigms, providing opportunities for comprehensive care and enabling those who live with diabetes to be more autonomous and empowered and to enjoy better health outcomes and a better quality of life.Keywords: self-management, social support, diabetes mellitus, type 2, nursing, protocol

Background: Cardiovascular diseases are characterized by chronic inflammation, leading to increased inflammatory markers that can cause cell damage and death. Phase angle has emerged as a marker of cellular health. It is considered a prognostic factor in various acute and chronic conditions. However, few studies have examined its association with cardiovascular disease risk measures. This study aims to investigate the relationship between phase angle, the general Framingham risk score, and the HEARTS cardiovascular risk score., Methods: This cross-sectional study included a convenience sample of adult patients of 2 primary health care services. Phase angle was measured using multifrequency bioimpedance analysis at 50 kHz. The risk of cardiovascular events was calculated using the Framingham and HEARTS risk scores. Statistical analysis included generalized linear regression models, unadjusted and adjusted according to sex and age, to determine the association between scores, risk factors, and phase angle., Results: The study included 164 individuals with a mean age 52.2 (SD 17.9). According to the HEARTS score, low-risk patients had higher phase angle values than those with high or very high risk [ß = -0.57 (95% CI -0.95; -0.19), P = 0.003]. Framingham scores showed a trend toward significance for higher mean phase angle values in low-risk than high-risk patients [ß = -0.43 (95% CI -0.88 to 0.02), P = 0.06]., Conclusion: Phase angle values were lower in high and very high-risk patients than in low-risk patients, which shows that phase angle is a promising risk predictor for patients with cardiovascular diseases., (© 2024. The Author(s).)

Background: Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition affecting communication, social interaction, and behavior. Evidence suggests that environmental pollutants are associated with ASD incidence. This review aimed to analyze the effect of environmental pollutants on ASD., Methods: Systematic review and meta-analysis of cohort studies evaluated the association between exposure to environmental pollutants and ASD. We searched COCHRANE CENTRAL, MEDLINE, CINAHL, LILACS, EMBASE, PsycINFO, Web of Science, SciELO, and gray literature from inception to January 2023. The model used for meta-analysis was inverse variance heterogeneity (IVhet). The effect measures were the beta coefficient (β) and the relative risk (RR) with their 95% confidence intervals (95% CI). Sensitivity analyses were carried out using an instrument to screen or diagnose autism., Results: A total of 5,780 studies were identified; 27 were included in the systematic review, and 22 were included in the meta-analysis. These studies included 1,289,183 participants and 129 environmental pollutants. Individual meta-analyses found a significant association between nitrogen dioxide RR = 1.20 (95% CI: 1.03 to 1.38; I 2 : 91%), copper RR = 1.08 (95% CI: 1.03 to 1.13; I 2 : 0%), mono-3-carboxy propyl phthalate β = 0.45 (95% CI: 0.20 to 0.70; I 2 : 0%), monobutyl phthalate β = 0.43 (95% CI: 0.13 to 0.73; I 2 : 0%) and polychlorinated biphenyl (PCB) 138 RR = 1.84 (95% CI: 1.14 to 2.96; I 2 :0%) with ASD. Subgroup meta-analyses found a significant association with carbon monoxide RR = 1.57 (95% CI: 1.25 to 1.97; I 2 : 0%), nitrogen oxides RR = 1.09 (95% CI: 1.04 to 1.15; I 2 : 34%) and metals RR = 1.13 (95% CI: 1.01 to 1.27; I 2 :24%)., Conclusion: This study found positive associations nitrogen dioxide, copper, mono-3-carboxypropyl phthalate, monobutyl phthalate, and PCB 138, and the development of ASD, likewise, with subgroups of pollutants carbon monoxide, nitrogen oxides, and metals. Therefore, it is important to identify these risk factors in children and adolescents to contribute to ASD and identify prevention strategies effectively., (© 2024. The Author(s).)

Objective . Synthesize the approaches used to study the convergence between cardiometabolic and infectious diseases in adults from a syndemic perspective based on the scientific evidence available to date worldwide. Methods . Scoping review that follows the recommendations of the PRISMA statement. The protocol was registered in INPLASY202150048. The search for studies was carried out in MEDLINE, LILACS, Web of Science and Scopus. Results . Since the COVID-19 pandemic, there has been an increase in studies in the field of convergence between cardiometabolic and infectious diseases from a syndemic perspective, but only three studies were classified as true syndemics. There are weaknesses in the adherence to the elements of the syndemic theory, given a low incorporation of population measurements, and until now it has not been possible to find convincing empirical evidence that supports the bio-bio interface. Quantitative methods predominated through models focused on "sum scores". Conclusions . Future studies should comprehensively address the elements of syndemics, review discrepancies between additive analyses versus other modeling, and incorporate the influence of large-scale social forces. The lack of these aspects distances studies from the notion of syndemic, bringing them closer to comorbidity or multimorbidity approaches.

Background: The increase in dengue cases can be attributed to social, demographic, environmental changes, or community-driven factors. In this regard, different strategies have been established in health education, using educational interventions as necessary tools for the reduction of the disease with the aim of reinforcing and stimulating the prevention and control of dengue., Objective: This study aims to evaluate the effectiveness of a nursing educational intervention for dengue control., Methods: A randomized controlled trial will be conducted with adults living in rural areas and participating in health promotion and disease prevention programs. We will enroll 116 adults. Adults will be randomized 1:1, with 58 adults assigned to the educational intervention group and 58 to the usual care group. Participants will receive 4 sessions over the course of a month, 1 week apart, and will be followed up for 1 month after the end of the educational intervention. Nursing Outcome Classification labels will be used to measure the outcomes: risk control (1902) and participation in health care decisions (1606)., Results: The participants in the intervention group are expected to achieve better dengue control behaviors than those in the usual care group., Conclusions: Risk factors are fostered by the community, largely caused by artificial reservoirs or unprotected tanks in homes; also, the lack of information hinders the identification of symptomatology and the poor implementation of effective measures, and the development of standardized educational strategies can contribute to efficient and cost-effective control of the disease., Trial Registration: ClinicalTrials.gov NCT05321264; https://clinicaltrials.gov/study/NCT05321264., International Registered Report Identifier (irrid): PRR1-10.2196/54286., (©Yolima Judith Llorente Pérez, Alba Luz Rodríguez-Acelas, Rita Mattiello, Wilson Cañon-Montañez. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 23.02.2024.)

Background: Bariatric surgery is an effective intervention that causes a series of metabolic changes related to inflammatory processes; however, the variation of biomarkers related to these processes is not entirely understood. Our objective was to investigate the variation of modulation and expression of biomarkers associated with inflammation in patients who underwent bariatric surgery., Methods: We searched the MEDLINE (via PubMed), EMBASE (via Elsevier), Cochrane Central Register of Controlled Trials, Latin American and Caribbean Literature on Health Sciences (via virtual health library), Cumulative Index to Nursing and Allied Health Literature (via EBSCO), Web of Science core collection, and Scopus (via Elsevier) databases, and the gray literature was examined from inception to January 2022. Three pairs of reviewers performed data screening, extraction, and quality assessment independently. Meta-analysis with random effects models was used for general, subgroup, and sensitivity analyses. The I 2 statistic was used to assess heterogeneity between studies., Results: In total, 96 articles were included in this systematic review; of these, 87 studies met the criteria for the meta-analysis, involving 3,533 participants. Five biomarkers were included in the meta-analysis (tumor necrosis factor alpha; interleukin 6; leptin; interleukin 1 beta, and lipopolysaccharides). Only leptin showed a significant decrease in the first month after surgery (mean difference -20.71; [95% confidence interval: -28.10 to -13.32, P < .0001; I 2  = 66.7%), with moderate heterogeneity. The 12 months after surgery showed a significant decrease in tumor necrosis factor alpha (mean difference -0.89; [95% confidence interval: -1.37 to -0.42], P = .0002; I 2  = 94.7%), interleukin 6 (mean difference -1.62; [95% confidence interval: -1.95 to -1.29], P < .0001; I 2  = 94.9%), leptin (mean difference -28.63; [95% confidence interval: -34.02 to -23.25], P < .0001; I 2  = 92.7%), and interleukin 1 beta (mean difference -2.46; [95% confidence interval: -4.23 to -0.68], P = .006; I 2  = 98.3%), all with high heterogeneity. The type of surgery did not show significant differences for the biomarkers at the first month and 12 months, and the results have not changed with high-quality studies. In the 12-month measurement, variations in tumor necrosis factor alpha and leptin were associated with body mass index., Conclusion: The findings of this meta-analysis suggest that Roux-en-Y gastric bypass and sleeve gastrectomy bariatric surgeries are associated with a significant reduction in leptin at 1 month after bariatric surgical intervention and tumor necrosis factor alpha, leptin, and interleukin 1 beta after 12 months., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Atherosclerosis burden can be evaluated in asymptomatic patients by measuring coronary artery calcification (CAC), whereas the global longitudinal strain (GLS) and diastolic function parameters (mitral E/e' ratio, septal e', and lateral e') are used to evaluate subclinical left ventricular (LV) dysfunction. We investigated whether subjects with CAC (CAC >0 Agatston units) would present with an impairment in LV functional parameters. Among the participants of the ELSA-Brasil cohort free of clinically prevalent cardiovascular disease who performed cardiac computed tomography and echocardiography within the study protocol, we tested whether those with CAC >0 presented with worse GLS and diastolic function parameters. CAC >0 was present in 203 of the 612 included participants (33.17%; age 51.4 ± 8.6 years, 52.1% women). Absolute CAC values did not correlate with GLS (ro = 0.07, p = 0.105) but did so with E/e' (ro = 0.19, p <0.001), septal e' (ro = 0.28, p <0.001), and lateral e' (ro = 0.30, p <0.001), with stronger correlations in men. Those with CAC >0 had worse mitral E/e' ratios (7.75 ± 0.13 vs 7.01 ± 0.09; p ≤0.001), septal e' (8.25 ± 0.15 vs 9.59 ± 0.11 cm/s; p <0.001), and lateral e' (10.13 ± 0.20 vs 11.99 ± 0.14 cm/s; p ≤0.001), respectively. However, these associations were not independent of diabetes, obesity, hypertension, smoking, and low-density lipoprotein cholesterol, persisting only as significant associations of CAC >0 with mitral E/e' ratio and septal e' in men. There is an association between subclinical coronary atherosclerosis and impaired LV functional parameters. These associations are more likely attributed to the presence of common cardiovascular risk factors in the general population. However, in men, it seems to exist as an independent association., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The effects of environmental pollution are associated with higher rates of mortality, morbidity, and years of life lost. It is known that these produce alterations in the human body, including changes in body composition. Research has focused on the association between contaminants and BMI through cross-sectional studies. The objective of this study was to synthesize the evidence for the association of pollutants on different measures of body composition. The PECOS strategy was defined, in which "P": participants of any age, sex, or ethnicity, "E": a higher level of environmental pollution, "C": a lower level of environmental pollution, "O": body composition measurements and "S": longitudinal studies. Studies from the following databases were included: MEDLINE, EMBASE, SciELO, LILACS, Scopus, Web of Science, SPORTDiscus, and gray literature from inception to January 2023.3069 studies were identified, 18 were included in the systematic review, and 13 in the meta-analysis. These studies included 8.563 people, 47 environmental contaminants, and 16 measures of body composition. The meta-analysis by subgroup found that the association between dioxins, furans, PCBs, and waist circumference was β = 1.0 (95% CI: 0.85 to 1.16; I 2 : 95%), and the sum of four skinfolds β = 1.02 (95% CI: 0.88 to 1.16; I 2 : 24%). The association between pesticides and waist circumference was β = 1.00 (95% CI: 0.68 to 1.32; I 2 : 98%), and the fat mass was β = 0.99 (95% CI: 0.17 to 1.81; I 2 : 94%). Pollutants, especially endocrine-disrupting chemicals, among which dioxins, furans, PCBs, and pesticides, are associated with changes in body composition, mainly with waist circumference and the sum of four skinfolds., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To synthesize the evidence of studies with educational interventions for adults with type-2 diabetes mellitus (DM2) in primary health care settings., Methods: A scoping review was conducted following the recommendations by the Joanna Briggs Institute and by the PRISMA declaration. The protocol was registered in INPLASY20215009. The search was carried out in: MEDLINE (via PubMed), EMBASE, Web of Science, LILACS, and grey literature., Results: Seventeen studies were included; most were randomized clinical trials of which 65% were conducted in high-income countries, and all the studies represented 5 656 participants. The results showed four big categories derived from educational interventions: therapeutic adherence (significant results on the satisfaction with the treatment); self-care and self-management in diabetes (improvement in self-efficacy, empowerment, and disease awareness); glycemic control in diabetes (significant results in reducing glycosylated hemoglobin); nursing and its role in the educational interventions on patients with DM2 (guidance in restructuring behaviors)., Conclusion: The findings of this review suggest that educational interventions on patients with DM2 within the setting of primary health care can impact positively on therapeutic adherence, self-control, and knowledge of the disease. Moreover, it was possible to identify the influence of multidisciplinary health teams, where the relevance of nursing professionals in the construction and implementation of educational interventions is evidenced in obtaining better health results., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright� by the Universidad de Antioquia.)

Objective: This study aimed to develop the Brazilian instrument for assessing eating disorders in children and adolescents and test its psychometric quality using item response theory (IRT)., Design: Cross-sectional study., Participants: Participants aged between five and twelve years old of both sexes., Main Measures: IRT logistic model of two parameters was used to evaluate the item's severity and discrimination and test information curve of symptoms of eating disorders' latent trait symptoms. Content validity and reliability were also assessed. The IRT evaluation suggested that the instrument contained items that performed differently concerning severity, discrimination, and test information curve presented good accuracy., Results: There was agreement on the clarity of language (83.3%) and theoretical relevance (91.7%), indicating good content validity. The value of the Cronbach's Alpha was 0.63 (95% confidence interval), and the result of the Spearman-Brown test was 0.65., Conclusion: These results indicate good performance of the screening tool in assessing the level of eating disorders in children and adolescents., (Copyright © 2023 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To review and synthesize the scientific production of educational interventions for the prevention and control of dengue in adults., Method: Integrative literature review, protocol registered in INPLASY (202170038). The search was performed in MEDLINE, LILACS, Web of Science and EMBASE, with no start date until March 31, 2021. Intervention studies were included: randomized clinical trials, cluster and quasi-experimental studies. The outcome evaluated was dengue prevention and control. The evaluation of the methodological quality and the level of evidence of the included studies was carried out., Results: 10 studies were included with levels of evidence between 1c and 2dm, corresponding to low- and middle-income countries in Asia and America. The use of didactic aids was evidenced against educational processes, digital tools, and a field of action by nursing was observed, from health education., Conclusions: Health education in scenarios other than clinical ones can favor empowerment by the population to improve health behaviors. On the other hand, the use of electronic tools is of great help in evaluating the effect of an intervention., (Copyright © 2022. Published by Elsevier España, S.L.U.)

There is already knowledge of the extensive risk factors for attention deficit hyperactivity disorder (ADHD) and recent studies suggest that environmental pollution may contribute to an increase in the incidence of the disorder. The aim of our study was to perform a systematic review and meta-analysis of the risk of ADHD in people younger than 18 years old after exposure to environmental pollution. We searched the MEDLINE, Embase, SciELO, CINAHL, LILACS, Cochrane Central, and Web of Science databases and investigated the grey literature from inception until May 31, 2021. All cohort studies that provided data on exposure to environmental pollutants and ADHD in children and adolescents aged from zero to 18 years old were included. Two reviewers independently selected the studies and applied the quality criteria. If there was a divergence, a third reviewer contributed to the final decision. For the meta-analysis, risk ratios and their confidence intervals were calculated with the MetaXL 5.3 program, using the random effects model. In total, 21 articles were included in this systematic review, and 18 studies met the criteria for the meta-analysis, involving 134,619 participants. The meta-analysis suggested that children exposed to higher levels of heavy metal (RR: 2.41, 95% CI: 1.49-3.90), with low heterogeneity (I 2  = 39%), and lead (RR: 2.37, 95% CI: 1.28-4.40), with moderate heterogeneity (I 2  = 54%), are at greater risk of developing ADHD than those exposed to lower levels. This meta-analysis suggests that children exposed to higher levels of lead and heavy metal pollution are at greater risk of developing ADHD than those exposed to lower levels., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The phase angle of bioimpedance is an important prognostic tool in clinical practice. The aim of this study was to investigate the association between phase angle and cardiovascular diseases. Electronic searches were carried out on MEDLINE, EMBASE, Cochrane, SCIELO, LILACS, CINAHL, Scopus, and the Web of Science. The PECO was "P" adults over 18 years of age, "E" the presence of cardiovascular disease, "C" absence of cardiovascular disease, and "O" phase angle values. The phase-angle means difference (MD) was analyzed separately by sex. Subgroup metanalysis with age, body mass index, and heart failure disease and meta-regressions were analyzed with random-effects models. Sensitivity analysis was performed considering only studies with high quality. The heterogeneity among studies was assessed using the Q-Cochran test and I² statistics. Four-hundred-thirty-nine articles were identified, and 22 studies were included in this systematic review, totaling 10.010 participants. Eight studies met the criteria for the meta-analysis, involving 2164 participants. The phase angle (PA) was measured at 50 kHz frequency in all studies. Individuals with cardiovascular disease had a smaller PA compared to the control group, for both males (MD -0.70; 95% CI -1.01 to -0.39) and females (MD -0.76; 95% CI -1.39 to -0.13). In the sensitivity analysis, in men, the quality of studies (P &lt; 0.01), and in women, heart failure (P &lt; 0.01) was significantly different between groups.The values of the phase angle were lower in individuals with cardiovascular disease than in control subjects. This result reinforces the importance of this tool in clinical practice, highlighting its potential to assess health status. Registration: The systematic review protocol was registered in the PROSPERO database as CRD42020164178., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Objectives: The aim of this study was to estimate the percentage distribution of body composition parameters for healthy people at different ages from the assessment of electrical bioimpedance., Methods: A cross-sectional study of healthy Brazilian aged 5 years and older. Were evaluated: total body fat; percent body fat; fat-free mass; percent lean mass; fat mass index; and fat-free mass index., Results: Of 1240 participants, with a median age of 27.0 years, 52.5% were female, and 73.7% were Caucasian. Most of the body composition variables were associated with age. The fat-free mass increased from youth to adult and decreased in the elderly in both sexes, with higher values in males than in females. In males, the percentage of lean mass has higher values in adolescence compared to childhood, and in adults compared to the elderly, when analyzed from the 50 th  percentile. In women, fat-free mass compared to adulthood, values were higher in childhood and lower in older ages., Conclusions: The study is the first to describe the Brazilian reference values for most clinical parameters of bioimpedance in percentiles stratified by different life cycles and sex. These findings can be very useful in clinical practice for health promotion and monitoring the nutritional status of the individual., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2022 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Various well-validated interview and self-report instruments are available to assess eating disorder symptomatology. However, most psychometric studies have been conducted in high-income countries. The aim of the present study was to systematically review the available psychometric studies conducted in low- and middle-income countries on well-known measures for assessing eating disorder symptoms., Methods: Psychometric studies with the following instruments were included: the Eating Disorder Examination (EDE), the Eating Disorder Examination Questionnaire (EDE-Q), the Eating Disorder Inventory (EDI), the Eating Attitudes Test (EAT), and the Children's Eating Attitudes Test (ChEAT). Searches were conducted on August 30, 2021, in the following databases: MEDLINE, EMBASE, LILACS, Web of Science, PsycINFO, and CABI. The methodological quality of the studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The studies were considered to have conducted the minimum psychometric evaluation if they assessed at least the three types of validity (content, criteria, and construct) or diagnostic performance. The psychometric properties were also evaluated considering the cut-off points described in the literature for each of the analysis methods used to evaluate validity and reliability and two reviewers independently selected the studies and evaluated the quality criteria., Results: A total of 28 studies were included. The studies were conducted in 13 countries (10 middle income and 3 low income). The instruments that were most used in the studies were the EAT and EDE-Q. According to the overall COSMIN assessment, in most (57%) of the studies the psychometric properties assessed were not described. Forty-three percent of the studies conducted the minimum psychometric evaluation. However, according to the described cut-off points, the results for the psychometric properties assessed showed, in general, acceptable validity and reliability., Conclusion: The results of this review suggest a lack of studies with the recommended psychometric properties in low- and middle-income countries on these commonly used instruments. With the steady increase in the prevalence of eating disorders globally, psychometric investigations of instruments for measuring eating disorder symptoms in these countries should be encouraged to promote their early detection and treatment., (© 2022. The Author(s).)

Aims: Hypertension (HTN) is a chronic long-term, slowly progressing disease. For HTN control, management, and prevention of associated complications, adequate adherence to treatment is required. It has been proposed that tailored interventions to individual needs are required to address the phenomenon of adherence to treatment. However, studies evaluating the effects of tailored interventions to improve adherence are still scarce. The aim of this study is to evaluate the effectiveness of a tailored intervention using a salutogenic approach, to improve adherence in patients with HTN., Methods and Results: A non-randomized trial design was used in this study. Adult patients with HTN were allocated in two groups: tailored intervention (n = 75) and standard care (n = 78). The content of the tailored intervention was based on personal resources and elaboration of an action plan with objectives in agreement with the patients. Patient outcomes (treatment adherence, blood pressure) were assessed both at the beginning of the study and at the 4-week follow-up for the intervention group and the standard care group. The Treatment Adherence Questionnaire for Patients with Hypertension was used to measure adherence. The results of this study showed that the total score and each dimension of the adherence questionnaire (medications, diet, physical activity, weight control, stimulation, and stress relief) increased significantly in the experimental group compared with the control group (P < 0.05). For the group assigned to tailored intervention, the delta score of the total adherence score increased in the final evaluation to 9.4 (95% CI = 8.60-10.28)., Conclusion: A tailored intervention with a salutogenic approach appears to be effective for improving adherence in patients with HTN. Randomized controlled trials are required to confirm the effect of tailored interventions in this type of population., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)

Healthcare-associated infections represent a public health problem, and they have repercussions for patient safety. The aim of this study was to determine the psychometric properties of the Rodríguez-Almeida-Cañon (RAC) adult infection risk scale, focusing on the construct and predictive validity and reliability. The study enrolled 278 patients at a large hospital in southern Brazil. The research process involved the following three phases: construct validation, assessing predictive validity, and assessing reliability. Confirmatory factor analysis showed a good fit using a two-factor model with 15 items. The logistic regression analysis showed an association between the scale score and prediction of developing healthcare-associated infections (odds ratio: 1.18; 95% confidence interval: 1.08-1.28). The Cronbach's alpha was 0.72 for intrinsic factors subscale and 0.71 for extrinsic factors subscale. A high level of inter-rater agreement (intraclass correlation coefficient ≥0.97) was found for both subscales. The Bland and Altman method showed narrow agreement limits, demonstrating good agreement between evaluators. The findings of this study showed that the RAC adult infection risk scale is a new, reliable, and psychometrically valid instrument to assess healthcare-associated infections risk. Future research using this scale may lead to a better understanding of the healthcare-associated infections risk and assist health professionals in decision-making for interventions to improve patient safety., (© 2021 Wiley Periodicals LLC.)

Objectives: To estimate the combined effect of educational interventions (EI) on decreased readmissions and time of hospital stay in adults with heart failure, compared with usual care., Methods: Systematic review (SR) and meta-analysis (MA) of randomized controlled trials that followed the recommendations of the PRISMA statement. The protocol was registered on PROSPERO (CRD42019139321). Searches were made from inception until July 2019 in the databases of PubMed/Medline, Embase, Cochrane CENTRAL, Lilacs, Web of Science, and Scopus. The MA was conducted through the random effects model. The effect measure used for the dichotomous outcomes was relative risk (RR) and for continuous outcomes the mean difference (MD) was used, with 95% confidence intervals (CI). Heterogeneity was evaluated through the inconsistency statistic (I2)., Results: Of 2369 studies identified, 45 were included in the SR and 43 in the MA. The MA of studies with follow-up at six months showed a decrease in readmissions of 30% (RR: 0.70; 95% CI: 0.58 to 0.84; I2: 0%) and the 12-month follow-up evidenced a reduction of 33% (RR: 0.67; 95% CI: 0.58 to 0.76; I2: 52%); both analyses in favor of the EI group. Regarding the time of hospital stay, a reduction was found of approximately two days in patients who received the EI (MD: -1.98; 95% CI: -3.27 to -0.69; I2: 7%)., Conclusions: The findings support the benefits of EI to reduce readmissions and days of hospital stay in adult patients with heart failure., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright� by the Universidad de Antioquia.)

Purpose: To evaluate pain levels in patients who underwent total hip arthroplasty (THA) using the Nursing Outcomes Classification (NOC)., Methods: Prospective cohort study conducted in the surgical hospitalization units of a university hospital in southern Brazil. Twenty-four patients were evaluated and followed-up for four consecutive days after THA., Findings: A significant difference was found between the first and last evaluations for the outcome pain level (2102). Two indicators also showed statistically significant differences overtime., Conclusions: The NOC outcome and indicators demonstrated the different pain levels of patients who underwent THA., Implications for Nursing Practice: The NOC system is applicable to clinical practice, because it facilitated the follow-up of patient progression., (© 2019 NANDA International, Inc.)

Purpose: To assess the surgical wound (SW) healing in orthopedic patients with Impaired tissue integrity according to the Nursing Outcomes Classification (NOC)., Methods: A prospective longitudinal study performed with 24 patients. Data collection was performed through an instrument containing the NOC indicators., Findings: The indicators skin approximation, drainage, surrounding skin erythema, periwound edema, increased skin temperature, and foul wound odor presented a statistically significant increase when compared the means between the first and the last day of evaluation., Conclusion: The NOC indicators allowed to monitor the SW healing indicating an improvement., Implications for Nursing Practice: The NOC can favor an earlier identification of the degree of commitment for each patient and enables implementation of care to achieve target outcomes., (© 2018 NANDA International, Inc.)

Purpose: To evaluate patients in a smoking cessation support group using the Nursing Outcomes Classification (NOC)., Methods: Prospective observational cohort study conducted with 21 patients participating in a smoking cessation support group. Data were collected using an instrument consisting of 2 NOC outcomes and 20 indicators, applied during each of the six support group meetings., Findings: The two NOC outcomes, Smoking Cessation Behavior (1625) and Substance Withdrawal Severity (2108), showed statistically significant differences over time in many of their indicators., Conclusions: The NOC outcomes demonstrated the clinical evolution and behavioral improvement of patients during the smoking cessation process., Implications for Nursing Practice: The findings highlight important elements of the evaluation of behavioral change and severity of withdrawal symptoms., (© 2018 NANDA International, Inc.)

Background: Type 2 diabetes is increasing among the young, and gestational diabetes (GDM) offers a unique opportunity for diabetes prevention. We aimed to systematically review postpartum randomized trials to summarize the benefits of lifestyle interventions for women with previous GDM. Methods: We searched for RCTs involving women with previous GDM that compared lifestyle interventions-diet, physical activity or breastfeeding-at postpartum with usual care up to May 2018. Results: Of 1,895 abstracts identified, we selected 15 studies investigating incidence of diabetes or changes in glycemia. Most interventions focused on changes in diet and physical activity, only one also on incentive to breastfeeding. Meta-analysis of 8 studies investigating incidence of diabetes revealed a homogeneous (I 2 = 10%), reduction of 25% (RR = 0.75; 95%CI: 0.55-1.03) borderline statistically significant. Only trials offering intervention soon after delivery (< 6 months post-partum) were effective (RR = 0.61; 95%CI: 0.40-0.94; p for subgroup comparison = 0.11). Overall, no benefit was found regarding measures of glycemia. Although moderate reductions in weight (MD = -1.07 kg; -1.43-0.72 kg); BMI (MD = -0.94 kg/m 2 ; -1.79 -0.09 kg/m 2 ); and waist circumference (MD = -0.98 cm; -1.75 -0.21 cm) were observed, effects were larger with longer follow-up. Conclusions: Summary results of the available evidence support benefits of lifestyle interventions at postpartum for women with previous GDM. Benefits, although smaller than those of major trials based in older subjects receiving intensive interventions, appear clinically relevant for this young subset of woman. Further studies are needed to improve the quality of the evidence and to further tailor interventions to this specific setting.

Introduction and Objectives: Subclinical systolic dysfunction is one of the proposed mechanisms for increased cardiovascular risk associated with metabolic syndrome (MS). This study investigated the association between MS and impaired left ventricular global longitudinal strain (GLS) and the role of each MS criteria in this association., Methods: We analyzed a random sample of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) after excluding participants with prevalent heart disease., Results: Among the 1055 participants fulfilling the inclusion criteria (53% women; 52±9 years), 444 (42%) had MS. Those with MS had worse GLS (-18.0%±2.5%) than those without (-19.0%±2.4%; P<.0001). In multiple linear regression models, MS was associated with worse GLS after adjustment for various risk factors (GLS difference=0.86%; P <.0001), even after inclusion of body mass index. Adjusted PR for impaired GLS as assessed by 3 cutoffs (1, 1.5, and 2 standard deviations) were higher among participants with than without MS: GLS -16.1% (PR, 1.76; 95%CI, 1.30-2.39); GLS -14.8% (PR, 2.35; 95%CI, 1.45-3.81); and GLS -13.5% (PR, 2.07; 95%CI, 0.97-4.41). After inclusion of body mass index in the models, these associations were attenuated, suggesting that they may, at least in part, be mediated by obesity. In quantile regression analyses, elevated waist circumference was the only MS component found to be independently associated with GLS across the whole range of values., Conclusions: Metabolic syndrome is independently associated with impaired GLS. Among the MS criteria, central obesity best depicted the link between metabolic derangement and cardiac function., (Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Health care-associated infections (HAIs) are a public health problem that increase health care costs. This article aimed to systematically review the literature and meta-analyze studies investigating risk factors (RFs) independently associated with HAIs in hospitalized adults., Methods: Electronic databases (MEDLINE, Embase, and LILACS) were searched to identify studies from 2009-2016. Pooled risk ratios (RRs) or odds ratios (ORs) or mean differences (MDs) and 95% confidence intervals (CIs) were calculated and compared across the groups. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement., Results: Of 867 studies, 65 met the criteria for review, and the data of 18 were summarized in the meta-analysis. The major RFs independently associated with HAIs were diabetes mellitus (RR, 1.76; 95% CI, 1.27-2.44), immunosuppression (RR, 1.24; 95% CI, 1.04-1.47), body temperature (MD, 0.62; 95% CI, 0.41-0.83), surgery time in minutes (MD, 34.53; 95% CI, 22.17-46.89), reoperation (RR, 7.94; 95% CI, 5.49-11.48), cephalosporin exposure (RR, 1.77; 95% CI, 1.30-2.42), days of exposure to central venous catheter (MD, 5.20; 95% CI, 4.91-5.48), intensive care unit (ICU) admission (RR, 3.76; 95% CI, 1.79-7.92), ICU stay in days (MD, 21.30; 95% CI, 19.81-22.79), and mechanical ventilation (OR, 12.95; 95% CI, 6.28-26.73)., Conclusions: Identifying RFs that contribute to develop HAIs may support the implementation of strategies for their prevention, therefore maximizing patient safety., (Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)