Conectar
Patients living with chronic obstructive pulmonary disease (COPD) experience periods of disease stability and exacerbations (ECOPD). COPD imposes a negative and impactful extrapulmonary impairment and commonly overlaps with multimorbidity, particularly cardiovascular disease. Pulmonary rehabilitation (PR) aims to improve physical activity (PA) and quality of life, while behavioural change interventions (BCIs) aim to promote lifestyle changes and autonomy. However, after ECOPD, a variety of barriers often delay patient referral to PR. This study aims to assess the effects of a BCI for patients after ECOPD, focusing on cardiovascular health, PA and functionality. Additionally, the study will assess 6-month sustainability of PA and conduct a cost-utility analysis comparing a non-intervention group in the Unified Health System.
This randomised clinical trial will assess patients with ECOPD over 12 weeks using a BCI based on self-determination theory to increase daily steps. First, the cardiovascular and functional profile will be evaluated. Afterwards, the patients will receive an accelerometer to monitor the PA level. After 7 days, questionnaires will be applied on quality of life, symptoms and motivational levels for PA. Patients will be randomised into control group or intervention groups, both will receive educational booklets and IG will also receive an educational interview. PA will be tracked using activPAL accelerometer at weeks 1, 4 and 12, and follow-up at 6 months. Data analysis will include unpaired Student’s t-test or Mann-Whitney test for group comparison, and a linear mixed model to assess intervention effects over time. Economic evaluation, using STATA (V.14), will involve correlation analysis, and p
This study has been approved by the Federal University of São Carlos’ Ethics Committee, Irmandade Santa Casa de Misericórdia de São Carlos and Base Hospital of São José do Rio Preto. All procedures will be conducted in accordance with the Declaration of Helsinki, Good Clinical Practice guidelines and applicable regulatory requirements. All results will be presented in peer-reviewed medical journals and international conferences.
Brazilian Registry of Clinical Trials under the registration number RBR-6m9pwb7.
To explore the enablers of and barriers to implementing advanced practice nursing in primary health care in Germany and Brazil.
A qualitative cross-country comparative study.
Nine focus groups were conducted: 4 in Brazil and 5 in Germany with 48 participants (23 primary health care policy stakeholders and 25 nurses practicing in primary health care and general practitioners) between May 2022 and June 2023. The data were analysed by content analysis using a deductive–inductive approach.
Our findings reveal a need for clarity around the concept, specific roles and responsibilities of advanced practice nurses in primary health care. Although there is still no regulation in place for practising advanced practice nursing in either country, clear drivers can be observed, with Germany strengthening community health nursing and Brazil following clinical protocols in nursing practice. Dialogue among stakeholders—at both the policy and practitioner levels—is essential to bridge communication gaps. Additionally, involving patients in the implementation process is crucial for the holistic integration of advanced nursing roles.
Political, organisational and financial barriers persist, such as the need to establish both legal foundations and regulatory frameworks, enhance political participation within the nursing profession, and involve stakeholders in dialogue and consensus-building efforts. Giving advanced practice nursing a higher priority on political and research agendas—with policy adjustments and input from practitioners—can help integrate advanced practice nursing into primary health care.
Our findings highlight that actively involving nursing as an equal partner in political discourse is seen by stakeholders as crucial to drive the implementation process forward sustainably.
This study addresses the lack of data on the enablers and barriers to implementing advanced practice nursing in primary health care in Germany and Brazil. It underscores the need for clearer definitions of advanced practice nursing in primary health care, as well as sufficient regulation and funding. Dialogue is essential to bridge gaps and foster mutual understanding. The findings support future practice development and research, especially in countries that have introduced advanced nursing practice roles in primary health care.
The COnsolidated criteria for REporting Qualitative research (COREQ).
No involvement of patient and public contribution.
Our study highlights the growing adoption of expanded nursing responsibilities even in countries that have not yet formally implemented advanced practice nursing roles.
Analyse data collected through the WHO Regional Office for Europe to describe the proportion of European Union (EU) member states that have relevant policies related to physical activity (PA) counselling and exercise referral schemes in healthcare settings and the education of health professionals in health-enhancing PA (HEPA).
Cross-sectional survey.
An online survey (LimeSurvey) was sent to nominated government representatives of the 27 EU member states (via the EU PA Focal Point Network) in March 2021. The survey was open for 2 months, with support offered to all national representatives by the WHO Regional Office for Europe throughout. The survey had been developed by a panel of experts and was previously disseminated (and analysed) in 2015 and 2018.
National recommendations regarding (1) PA counselling in healthcare settings and (2) the inclusion of HEPA within teaching curricula.
All 27 countries responded. Of the 18 countries that reported national policies to provide PA counselling by healthcare professionals (HCPs), all reported that counselling on PA was provided through primary care, with an additional half also reporting PA counselling provision as part of secondary care. Twenty-one countries reported that HEPA is taught in the curricula of HCPs, but large variations exist regarding which cadres of HCPs have HEPA integrated within their curricula and whether the HEPA teaching is a mandatory or optional component of training.
Despite PA counselling being a key recommendation for promoting PA at the population level, only two-thirds of EU member states have national policies in place. Although three-quarters of EU member states report healthcare education curricula, including HEPA, more research is required to understand the methods and content of delivery and the subsequent effectiveness on knowledge and clinical outcomes.
Traditional peoples and communities (TPCs), such as indigenous peoples and quilombolas (communities descended from escaped African slaves), face challenges related to food security and the impact of the food environment on their health. Changes in food systems, urbanisation and loss of territorial rights have contributed to less healthy eating patterns, with increased consumption of ultra-processed foods and a higher prevalence of chronic non-communicable diseases. Despite this, there are gaps in knowledge about how the food environments of these communities are investigated, especially in relation to the physical, economic, political and sociocultural dimensions.
This scoping review will be conducted following the methodological framework developed by the Joanna Briggs Institute for scoping reviews, and its reporting will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews checklist. A systematic search will be carried out in the following databases: PubMed, SciELO, Web of Science, Embase and EBSCO, using terms related to traditional populations and food environments. The studies to be included will be selected according to the inclusion and exclusion criteria defined based on the population, concept and context technique. The study population will include TPCs, such as indigenous peoples and quilombolas; the concept will address the food environment in its physical, economic, political and sociocultural dimensions; and the context will encompass studies conducted at a global level, without any restrictions on geographic location. The study type will include original articles and grey literature. The screening of studies will involve independent reviewers and predefined inclusion and exclusion criteria. Data synthesis will be presented in tables, including information on focus, geographic scope and methodology of the selected studies. The risk of bias will be assessed using the Risk of Bias in Non-randomised Studies of Exposure tool.
As the study does not involve the collection of primary data or human participants, it does not require ethical approval. The results will be submitted to peer-reviewed journals and presented at public health and nutrition conferences, contributing to the advancement of knowledge on food environments of TPCs.
Dermoscopy has a proved validity in the diagnosis of cutaneous melanoma, which is one of the most aggressive forms of skin cancer. Although some studies have demonstrated a relationship between specific dermoscopic and pathologic melanoma features, there is no solid evidence allowing reliable conclusions. This study will evaluate the evidence regarding this association.
Observational studies eligible for our systematic review will enrol adults with histological cutaneous non-volar melanoma diagnosis and with dermoscopy image analysis. We will search the following databases: PubMed, Embase, Web of Science, MEDLINE and Cochrane Library. We will not impose any language or date restrictions. Outcomes of interest include the association of at least one of the melanoma dermoscopy features (irregular pigmentation, blue-white veil, atypical network, multicomponent pattern, atypical dots and/or globules, regression, peripheral tan structureless area, negative network, shiny white structures, atypical vessels and streaks/pseudopods), with melanoma Breslow index or other histopathology characteristics (melanoma subtype, mitotic index and presence of ulceration). Two reviewers will independently screen and search results, extract data from eligible studies and assess risk of bias. The evidence derived by this study will elucidate the possible link between melanoma dermoscopy and histopathology. If we could predict melanoma thickness based on dermoscopy, we would be able to anticipate melanoma treatment with impact on survival.
Ethical approval is not required because this is a literature-based study. It will be published in scientific Pubmed indexed open access journals to ensure its accessibility.
CRD42024564919.
We examined studies that analysed the spatial association of cancers with demographic, environmental, behavioural and/or socioeconomic factors and the statistical methods applied.
Systematic mapping review.
Web of Science (SSCI) (search on 28 July 2022), MEDLINE, SocINDEX and CINAHL (search on 4 August 2022), additional searches included grey literature.
(1) Focused on the constituent countries of the UK (England, Wales, Scotland and Northern Ireland) and its major regions (eg, the North West); (2) compared cancer(s) outcomes with demographic, environmental, behavioural and socioeconomic characteristics by applying methods to identify their spatial association; (3) reported cancer prevalence, incidence rates, relative risk or ORs for a risk factor or to an average level of cancer.
A standardised data extraction form was developed and for all studies, core data were extracted including bibliographic information, study design, geographical factors analysed, data aggregation level, methods applied and main findings. We described and synthesised the characteristics of the studies using summary tables, charts and graphs.
52 studies were included covering a variety of objectives and geographical scales. These studies considered different types of cancer, with the most common cancer types analysed being blood and lymphoid cell cancers. The most common methods used to assess the association between cancers and geographical level factors were regression analyses, with the majority being Poisson regression, then logistic and linear regression. Studies were usually conducted at ward and local authority level, or by exact point location when distances from putative risk sources were considered. The results were usually presented in plots or as tables, instead of maps.
Our results highlight the lack of consideration of spatially explicit models in the analysed studies, with the risk of having failed the assumption of independence in the data.
CRD42022349165.
The way communication is conducted directly influences the professional–patient relationship, how patients cope with their diagnosis, and their sense of hope throughout treatment. This study aims to map the literature on strategies that healthcare professionals can use to promote hope in communication with pediatric patients and their families in the context of chronic illness. Based on this objective, the study highlights an algorithm to assist healthcare professionals in instilling hope in this population through communication.
Scoping review.
This systematized review was conducted using the databases PubMed, LILACS, PsycInfo, Embase, CINAHL, and Scopus, employing the PCC framework and the Boolean operators AND and OR. The time frame was limited to the last 20 years (2004–2024). A total of 734 studies were identified across the databases, with an additional four retrieved through manual citation searches, resulting in 19 articles included in the final sample.
The findings highlight three key pillars for promoting hope in communication: (1) careful preparation for information delivery, which involves identifying the diverse needs of families and creating a physically comfortable and emotionally supportive environment; (2) providing information and emphasizing how it is presented—considering content, clarity, honesty, empathy, and adaptation to the recipient's specific needs; and (3) follow-up after information delivery, ensuring emotional support and active, skilled listening.
Interpersonal communication between the healthcare professional, the patient, and the family was mainly focused on the transmission of information about the disease and treatment in a clear and empathetic manner, considering who is receiving the information and how the information is interpreted.
This review provides guidance for healthcare professionals in implementing communication strategies that foster hope in the context of pediatric chronic illness. Additionally, this guide may serve as a model for training students and healthcare professionals. Further research is needed to implement and explore additional effective communication strategies for this population across diverse cultural settings.
Objetivo: El estudio tiene como objetivo identificar los efectos de la Reforma Universitaria durante la gestión 1978-1982 de la Escuela de Enfermería de Ribeirão Preto (EERPUSP). Metodología: Estudio en el campo de la Historia, en el ámbito de la Historia de la Enfermería, con enfoque de Micro-Historia. Para alcanzar su objetivo, el estudio utilizó la Historia Oral Temática. Resultados: Los avances identificados en la gestión estuvieron relacionados con los recursos humanos, infraestructura física, consolidación de posgrados, normativa y formación de profesionales de la salud. Como efectos de la Reforma Universitária, se observó la exigencia, en la Universidad de São Paulo, de la categoría de profesor titular para el ejercicio de director, hecho que condujo a dieciséis años de dirección por parte de profesores no enfermeros, la adhesión a la unificación del vestibular, consolidación de los estudios de posgrado y cambios curriculares. Consideraciones finales: El estudio se centró en la labor de los dos directores en su momento, pero se infiere que otros personajes pudieron haber ejercido protagonismo en la concreción de los avances registrados en las actas de congregación de la Escuela.
This study aimed to describe the process of construction, validation, and usability of the chatbot ESTOMABOT to assist in the self-care of patients with intestinal ostomies. Methodological research was conducted in three phases: construction, validation, and usability. The first stage corresponded to the elaboration of a script through a literature review, and the second stage corresponded to face and content validation through a panel of enterostomal therapy nurses. In the third phase, the usability of ESTOMABOT was assessed with the participation of surgical clinic nurses, patients with intestinal elimination ostomies, and information technology professionals, using the System Usability Scale. The ESTOMABOT content reached excellent criteria of adequacy, with percentages of agreement equal to or greater than 90%, which were considered adequate, relevant, and representative. The evaluation of the content validity of the script using the scale content validity index/average proportion method reached a result above 0.90, and the Fleiss κ was excellent (P Objetivo: Analizar las repercusiones de la pandemia por el nuevo coronavirus en la salud de los profesionales de enfermería. Método: Investigación cuantitativa, descriptiva, realizada en un hospital universitario de Salvador, Bahía, Brasil, entre septiembre y octubre de 2020. La recolección de datos se realizó a través de un cuestionario electrónico estructurado, que fue respondido por 209 profesionales de enfermería de la institución. El proyecto fue aprobado por un Comité de Ética en Investigación (nº CAAE 36841720.0.0000.0049). Resultados: La mayoría de los profesionales relató insomnio o dormir menos de lo necesario (62,67%); mostró aumento del deseo de comer (46,89%) o pérdida del apetito (16,75%); tuvo pérdidas en actividades de ocio (97,6%); relataron una disminución en la práctica de actividad física (91,87%); mostró alteraciones en el estado de ánimo (83,75%); reportó algún grado de ansiedad (89,95%); y tenía diagnóstico de covid-19 (28,23%). Conclusión: Los resultados indican las repercusiones que trajo la pandemia para la salud física y mental de los profesionales de enfermería.
Objetivo principal: Aprehender las experiencias de los profesionales de enfermería en el cuidado de pacientes con covid-19. Metodología: Investigación cualitativa realizada con 17 profesionales de enfermería en un hospital universitario de Salvador, Bahía, Brasil. La información fue recolectada a través de entrevistas semiestructuradas y analizada con el apoyo del software IRAMUTEQ. Resultados principales: La experiencia de las prácticas fue descrita como difícil, aterradora, complicada, causando miedo, aprensión y estrés. Surgió el énfasis en las medidas de autoprotección y como medio para superar el aislamiento, los profesionales utilizaron estrategias para favorecer la aproximación y la comunicación entre los pacientes y el equipo, evidenciando así un cuidado sensible a las necesidades del otro. Conclusión principal: Las reacciones indican que los profesionales desarrollaron estados emocionales negativos; adaptaron el servicio; y el fortalecimiento del autocuidado mediante la exposición al riesgo de contaminación y utilizaron estrategias de atención permeadas por la sensibilidad.
Objetivo: describir las facilidades y dificultades de los técnicos de enfermería para realización del electrocardiograma (ECG) después del entrenamiento en servicio. Métodos: investigación cualitativa, realizada en una unidad cardiovascular de un Hospital Universitario de Salvador - Bahía, Brasil, con 10 técnicos de enfermería. Resultados: el análisis permitió identificar tres categorías: formación como facilitador de la práctica asistencial; uso adecuado de ECG en la rutina de servicio después del entrenamiento; escasez de recursos materiales necesarios para realizar el ECG. Los resultados mostraron que además de los beneficios para los usuarios del servicio, el curso de ECG también puede ofrecer al profesional algunas ventajas, como un mayor conocimiento y un aprendizaje favorecido. Conclusión: las facilidades fueron descritas como ampliación del conocimiento y favoreciendo el aprendizaje de las técnicas correctas para la realización del procedimento, conduciendo a una disminución de errores y el uso adecuado del dispositivo. Las dificultades estaban relacionadas con la escasez de materiales y las precarias condiciones de algunos dispositivos.
Objetivo: Analizar las notificaciones de lesiones de piel en un hospital universitario. Método: Estudio descriptivo, realizado en un hospital universitario, localizado en Salvador, Bahia, Brasil, con datos secundarios de notificaciones de incidentes. Fueron investigadas características sociodemográficas de los pacientes con lesiones de piel y características de las lesiones notificas en los años 2016 y 2017. Los datos fueron recolectados entre los meses de septiembre 2018 y mayo 2019 y el estudio respetó los principios éticos de investigación. Resultados: Fueron notificados 96 casos de lesión de piel. La mayoría fue adquirida en la hospitalización (89,58%), siendo frecuente la lesión por presión (77,08%), en la región sacra o glútea (61,46%), con pérdida de piel (54,17%), en grado leve (89,58%) y que prolongaron la hospitalización (7,29%). Conclusión: A pesar de ser realizada evaluación del riesgo para lesión, en más de la mitad de las notificaciones se observa que el tipo más prevalente fue la lesión por presión.
FreshRSS 