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A Consulta de Enfermagem (CE) é uma estratégia do cuidado, considerada uma Prática Avançada de Enfermagem, com vistas a identificar problemas, condições ineficazes de saúde e promover saúde. Dentre outras finalidades, a CE age como uma ferramenta eficaz para sensibilizar a pessoa a manejar a própria saúde e controlar fatores de risco modificáveis. Este estudo teve como objetivo compreender a CE em um ambulatório de enfermagem em cardiologia de um hospital público de alta complexidade no interior do Estado de São Paulo; com vistas à obtenção de um modelo padronizado de atendimento à pessoa com Doença Arterial Coronária (DAC) na Atenção Secundária. Trata-se de estudo exploratório, transversal e de abordagem qualitativa; desenhado de acordo com as recomendações das diretrizes Consolidated Criteria for Reporting Qualitative Studies (COREQ). Foram acompanhadas CE de pessoas com DAC no com base no emprego do referencial teórico da fenomenologia interpretativa, em que a pesquisadora esteve na posição de ouvinte sem interferir na assistência prestada, tomando notas de características tais como perguntas norteadoras realizadas pelas enfermeiras, ordem cronológica dos eventos ocorridos dentro da consulta e tempo despendido. Como resultado, gerou-se um roteiro para elaboração da CE à pessoa com DAC, estabelecido em nove etapas/passos. A CE aborda aspectos importantes ao tratamento em saúde além das terapias convencionais, trazendo questões como comportamentos em saúde e fatores de risco modificáveis. Entretanto, são prementes os estudos experimentais que avaliem o efeito da CE nos desfechos de saúde das pessoas assistidas pela enfermagem.

Introduction: The recent transformations undergone by Brazilian labor court, especially with the introduction of electronic process of law (processo judicial eletrônico [PJe]), had a significant influence on how people work. Objectives: This study aimed to evaluate the occurrence of musculoskeletal symptoms and work ability in public sector employees working in a specialized labor court body. Methods: A cross-sectional study was conducted with 449 workers, who provided demographic and occupational information and completed the Nordic Musculoskeletal Questionnaire (NMQ) and the Work Ability Index (WAI). Results: Symptoms occurred more frequently in wrists/hands (62.4%), shoulders (62.1%), and neck (60.4%) in the past 12 months, and in the neck (29.8%), shoulders (29.4%), and wrists/hands (29.2%) in the past 7 days. The mean WAI score was 38.7 (6.4), and 31.4% of participants had poor or moderate work ability. WAI scores were poorer when participants had previous problems, and the number of body segments involved in complaints was greater among those with inadequate work ability. Conclusions: Higher frequency of musculoskeletal symptoms in wrists/hands, shoulders, and neck may be related to using PJe for work and is associated with poorer work ability scores, highlighting the importance of preventive interventions for work-related musculoskeletal disorders.

To evaluate the effects of an implementation intention intervention on adherence to an oral anti-diabetic medication regime, diabetes-related distress and on glycemic control in patients with type 2 diabetes mellitus.A randomized, parallel-group, single-center controlled trial was conducted among adults with type 2 diabetes being managed at the primary care level. The intervention group (IG, n = 45) received an 'implementation intention' intervention; the control group (CG, n = 45) received standard care. Primary outcomes were the taking of oral anti-diabetic medication, global adherence and level of glycated hemoglobin. The secondary outcome was diabetes-related distress. Data were gathered at baseline and after 15 weeks.The IG showed improvements in adherence to an oral anti-diabetic medication regime (p 0.0001), glycemic control (p 0.0001) and diabetes-related distress (p 0.0001) relative to the CG.The implementation intention intervention enhanced adherence to an oral anti-diabetic medication regime, which had positive effects on blood glucose levels and diabetes-related distress.Adherence to an oral anti-diabetic medication regime can decrease blood glucose levels and diabetes-related distress and thus reduce complications of type 2 diabetes.

Objective: to presenting the linguistic validation of the Diabetic Foot Ulcer Scale Short-Form (DFS-SF) among patients with ulcer diabetic foot (DFU) to Brazilian Portuguese and evaluate its content, practicability and acceptability.Methods and casuistry: a cross-sectional, methodological research, was conducted among 30 outpatients in follow-up for DF, assessed regarding QoL, sociodemographic and clinical data. International recommendations provided bythe Mapi Research Trust on adaptation procedures were followed: the stages of Forward translation, Backward translation and the Cognitive interview were carried out. The Content Validity Index was calculated and a pre-test were gathered to produce a pre-final version. Practicability and acceptability were also assessed. Results: the semantic, idiomatic, cultural and conceptual equivalences between the linguistic validated and the original version were obtained.The DFS-SF was practical, well accepted and easy to understand. Conclusion: the linguistic validation process of the Brazilian version of the DFS-SF has been completed in accordance with internationally recommended standards.The instrument was easy to apply, to understand and presented short time for administration.

AIMS AND OBJECTIVES The aim of this study was to identify the psychosocial determinants of adherence to oral antidiabetic medication, according to the Theory of Planned Behaviour (TPB). BACKGROUND Appropriate adherence to oral antidiabetic medication contributes to long-term glycaemic control. However, glycaemic control is often poor in people with type 2 diabetes, mainly due to the poor adherence to oral antidiabetic agents. DESIGN Prospective study with 2 waves of data collection, based on STROBE checklist was conducted. One hundred and fifty-seven adults with type 2 diabetes, in chronic use of oral antidiabetic agents, composed the sample. At baseline, self-reported measures of medication adherence (proportion and global evaluation of adherence) and of metabolic control (glycated haemoglobin) of diabetes were obtained. METHODS The TPB main constructs (attitude, subjective norm and perceived control) and related beliefs were measured. Adherence and metabolic control measurements were obtained in a two-month follow-up (n = 157). RESULTS Attitude and subjective norm, together, explained 30% of the variability in intention; their underlying belief-based measures (behavioural and normative beliefs) explained 28% of the variability in intention. In addition, intention predicted behaviour at follow-up. However, when added to the prediction model, past behaviour was the only explanatory factor of adherence behaviour. CONCLUSION Adherence behaviour to oral antidiabetic medication was predicted by intention, which, in turn, was determined by attitude and subjective norm. In order to promote adherence to oral antidiabetic agents, health professionals should include motivational strategies as well as strategies targeted to attitude and subjective norm when designing interventions. RELEVANCE TO CLINICAL PRACTICE The nonadherence to antidiabetic medication contributes to lack of control of diabetes and ensuing complications. The comprehension of the factors explaining the variability in medication adherence can inform the design of theory-based interventions aimed at promoting this behaviour.

BACKGROUND: The implementation of the electronic judicial process (PJe) in recent years is associated with an increase in workload and stricter control through productivity targets in the Brazilian labor judiciary. OBJECTIVES: To evaluate the relations between musculoskeletal symptoms, psychosocial factors and work ability in civil servants of a labor justice body in the context of the PJe. METHODS: A cross-sectional exploratory study with a quantitative approach involving 449 workers. Sociodemographic, occupational and related data were collected through questionnaires validated in the Brazilian context. Data analysis was conducted by descriptive and inferential statistics: Mann-Whitney test, Spearman’s correlation coefficient and multiple linear regression. RESULTS: There was a correlation between musculoskeletal symptoms and psychosocial factors (p

Objectives To verify the content validity of questions of an insulin adherence questionnaire based on the Theory Planned Behavior in outpatients with type 2 diabetes mellitus. Methods The instrument was derived from a tool created to evaluate psychosocial determinants of adherence to oral antidiabetics medications in the Brazilian context, and was submitted for evaluation by a committee of experts and members of the target population. The item-level content validity index, the scale-level content validity index averaging calculation method, and the modified kappa coefficient were used to evaluate agreement among specialists. The comprehensibility of the instrument by members of the target population was qualitatively analyzed. Results The item-level content validity index was found to be lower than desired in 6 of the 20 items analyzed. Of these, one item was modified and 5 were excluded after the comprehensibility evaluation by members of the target population; one item from the perceived control scale was excluded. Content validation resulted in an instrument with 14 items, distributed in the domains intention (4 items), attitude (3 items), perceived norm (4 items), and perceived control (4 items) scales. Conclusions The findings support good evidence of the content validity of the instrument for use among people with type 2 diabetes mellitus receiving insulin therapy.

Background: Non-adherence to oral antidiabetics drugs (OADs) has been a common problem and may contribute to poor glycemic control.Aim: To describe an experimental study protocol that aims at implementing and evaluating the effect of the “action planning and coping planning” interventions on medication adherence to OADs in patients with type 2 diabetes mellitus (T2DM) in follow-up at primary care services.Design: A randomized controlled trial.Methods: Two groups (intervention and control) will be followed over a period of 105 days. The intervention group will receive a combination of the “action planning” and “coping planning” intervention strategies. There will be in-person meetings and phone calls to reinforce the intervention. The control group will receive the usual care from the health unit.Conclusions: It is hoped that this study will help health professionals to improve their approach with patients who have T2DM in relation to medication adherence.

The purpose of this paper is to provide measurement properties evaluation and factor analysis of the Brazilian version of the diabetic foot ulcer scale-short form (DFS-SF). This methodological study evaluated the measurement properties of the DFS-SF by ceiling and floor effect reliability, responsiveness, and structural construct validity. The study included 290 people with diabetic foot under regular follow-up in a specialised outpatient clinic in inland Sao Paulo. Reliability was assessed by internal consistency using Cronbach's alpha and composite reliability. Ceiling and floor effects were assessed by the percentage of participants who scored the 15% worst (floor) and 15% best (ceiling) possible scale results. Validity was tested by correlating the instrument values with the domains of the Brazilian version of the Short Form Health Survey (SF-36). Responsiveness (n = 34) was accessed through the wound area obtained by photography and evaluated by the Image J Features program and the DFS-SF score at two moments, with a 4-week interval between them. The instrument had good evidence of reliability, shown by adequate internal consistency (Cronbach's alpha in domains >0.70) and compound reliability (0.84 > CC > 0.92); and of convergent validity, by significant positive correlations of moderate to strong magnitude with SF-36. Structural construct validity was examined by applying the DFS-SF confirmatory factor analysis, which indicated that the Brazilian version of the instrument is properly fitted to the original dimensional structure. The ceiling and floor effect analysis showed no ceiling or floor effects. Responsiveness was observed in the wound area, but not in the DFS-SF scores in the times. The Brazilian version of the DFS-SF presented evidence of validity and reliability, suggesting that this instrument is a valid tool for assessing the quality of life of people with diabetic foot in the Brazilian population.

Study Design: Study Design: This mixed-methods study. Objective: To describe action plans related to the behavior of adherence to oral antidiabetic medications produced by people with type 2 diabetes mellitus and identify the challenges and coping strategies for the establishment of this behavior. Methods: The study followed-up 44 people with type 2 diabetes mellitus who used oral antidiabetic medications from southeast Brazil. Adults were invited to build action and coping plans based on the Implementation Intention Theory. The plans were quantitative and qualitatively analyzed. Results: Action plans included three major themes: (1) binding oral antidiabetic medication to time markers or the sleep/wake cycle; (2) in specific environments; (3) associated with daily life activities. The motivation for coping with the perceived barriers focused on placing the pills in visible places, asking for help from family members, establishing a routine and feeding properly. Conclusions: The most effective way to manage satisfactory oral antidiabetic medication adherence seems to be recognizing the perceived barriers by patients. The implementation of specific and individualized action and coping plans to overcome perceived barriers was the stark difference.

A insuficiência cardíaca é uma doença crônica, de elevada prevalência no Brasil e no mundo, e apresenta importante impacto na realização de atividades de vida diária e na qualidade de vida. Desta forma, este trabalho tem como objetivo avaliar o autocuidado em pacientes com insuficiência cardíaca e testar a sua relação com a aptidão cardiorrespiratória. Trata-se de um estudo descritivo-exploratório, de corte transversal. Foram incluídos pacientes com insuficiência cardíaca das classes funcionais I, II e III da New York Heart Association, com idade entre 18 e 65 anos. Foram coletados dados sociodemográficos e clínicos; avaliado o autocuidado por meio do European Heart Failure Self-Care Behaviour Scale e a aptidão cardiorrespiratória pelo Veterans Specific Activity Questionnaire. Os dados foram analisados de forma descritiva, por meio de testes de correlação e comparação. Identificamos que os pacientes são em sua maioria eram do sexo masculino (63,1%), brancos (46,4%), casados (54,7%), aposentados (30,9%), tinham fração de ejeção reduzida (70%) e pertenciam a classe funcional 2 (50%). Os resultados deste estudo oferecerão subsídios para o desenvolvimento de intervenções voltadas à implementação de comportamentos de autocuidado por parte dos pacientes com IC.

Objetivo: identificar as barreiras ou problemas enfrentados pelos enfermeiros para realizar a monitorizacao cardiaca de acordo com as recomendacoes atuais e apontar as intervencoes realizadas para solucao dos problemas identificados. Metodo: Foi relaizada uma revisao integrativa da literatura. Para a selecao dos estudos, utilizou-se as bases de dados PubMed, Scopus e Web of Science. Resultados: foram incluidos 20 artigos, sendo as principais barreiras para a realizacao da monitorizacao cardiaca adequada o desconhecimento sobre recomendacoes para a correta monitorizacao eletrocardiografica e a dificuldade de interpretacao do ritmo cardiaco. Estrategias de educacao continuada e personalizacao dos parâmetros dos monitores tem demonstrado serem eficazes para que as boas praticas na monitorizacao cardiaca sejam implementadas nas instituicoes hospitalares.

As doenças cardiovasculares (DCV) são a principal causa de morbimortalidade no país e no mundo, com destaque para a doença arterial coronária (DAC). O sedentarismo é relevante fator de risco para a progressão da doença e a prática regular de atividade física (AF) faz parte das ações para prevenção e reabilitação da DAC. Esse estudo teve como objetivo validar o conteúdo de um instrumento para oferecimento de uma intervenção para promoção de caminhada na DAC; e pré testá-lo junto à população alvo. Para a validação, o comitê de especialistas foi composto por 5 experts que avaliaram o instrumento quanto à clareza, pertinência e abrangência. Foi utilizado o Índice de Validade de Conteúdo (IVC), que mensura a proporção ou porcentagem de experts em concordância acerca dos aspectos e itens do instrumento. De acordo com os especialistas, 9 itens apresentaram IVC≥0,8 e 6 itens apresentaram IVC

The relationship between salt intake and cardiovascular diseases is a contemporary scientific controversy, which has been attributed to the limits of the measures of salt intake used in the studies. Thus, this article sought to systematically review the literature on the methods used to estimate salt intake in different study designs. Of the 124 articles, 60.5% used only biochemical measures, 26.6% only self-report measures and 12.9% reported the combined use of both methods. The 24-hour urinary sodium excretion was the predominant biochemical method (79.1%) and the Food Frequency Questionnaire was the predominant self-report measure (36.4%). Interventional studies used mostly 24-hour urinary sodium excretion; while longitudinal studies used self-report measures. The question guiding the study and its design, as well as constraints related to costs, sample size and feasibility seems to influence the choice of the type of measurement.

Sao bem estabelecidos na literatura os beneficios decorrentes da pratica de atividade fisica (AF) regular para pacientes com doenca arterial coronaria (DAC), como a reducao dos niveis sericos de colesterol, controle da pressao arterial e peso corporal, melhora do humor e da saude mental, entre outros. Avaliar a relacao entre AF de lazer, aptidao cardiorrespiratoria, o desempenho das enzimas cardiacas e o desfecho obtido por meio do cateterismo cardiaco em pacientes com DAC, internados na Unidade Coronariana. Estudo exploratorio transversal em que a AF foi avaliada por meio do Godin-Shephard Leisure-Time Physical Activity Questionnaire, Questionario de Atividade Fisica Habitual de Baecke; e a aptidao cardiorrespiratoria pelo Veterans Specific Activity Questionnaire. A troponina I, enzima CKMB e resultados do cateterismo cardiaco foram obtidos por meio do prontuario. O estudo foi aprovado sob o CAAE no 58449216.8.0000.5404. Foram realizadas analises descritivas, de correlacao e associacao para avaliar a relacao entre a AF, a aptidao cardiorrespiratoria e os desfechos clinicos. A amostra (n=68) foi composta por homens, com idade entre 50 e 60 anos, brancos, que viviam acompanhados, ativos, com baixas renda e escolaridade; com diagnostico de infarto agudo do miocardio sem supra desnivelamento de segmento ST, com precordialgia, hipertensao arterial e dislipidemia, pouco ativos quanto a AF de lazer. A presenca de sintomas evidenciou pior aptidao cardiorrespiratoria entre aqueles com historico de infarto previo. Pacientes com diabetes mellitus apresentaram menor aptidao cardiorrespiratoria, maior elevacao da CKMB e mais arterias coronarias comprometidas. Quanto a coronariografia, aqueles com menos arterias comprometidas apresentaram maior escore de AF e maiores medias de idade e escolaridade. Foram constatadas correlacoes positivas entre AF e escolaridade; entre a aptidao cardiorrespiratoria e a escolaridade e a renda; e correlacao negativa entre a aptidao cardiorrespiratoria e a idade; e entre AF e a idade.

ObjectiveTo assess salt intake and its dietary sources using biochemical and self-report methods and to characterize salt intake according to sociodemographic and disease-related variables in a sample of the Brazilian population.DesignPopulation-based cross-sectional survey.SettingSalt intake was assessed by biochemical (24 h urinary Na excretion) and self-report methods (sodium FFQ, 24 h dietary recall, seasoned-salt questionnaire, discretionary-salt questionnaire and total reported salt intake).ParticipantsAdults and older people (n 517) aged 20–80 years, living in Artur Nogueira, São Paulo, Brazil.ResultsMean salt intake based on 24 h urinary Na excretion and total reported salt intake was 10·5 and 11·0 g/d, respectively; both measures were significantly correlated. Discretionary salt and seasoned salt were the most important sources of salt intake (68·2 %). Men in the study consumed more salt than women as estimated by 24 h urinary Na excretion (11·7 v. 9·6 g salt/d; PConclusionsSalt intake in this population was well above the recommended amount. The main source of salt intake came from salt added during cooking. Salt intake varied according to sex and waist circumference.

A ulceracao nas extremidades e a complicacao mais frequente em pessoas com diabetes mellitus (DM) e representa um grave problema de saude. Ha evidencias de que a qualidade de vida relacionada a saude (QVRS), por sua vez, se agrava conforme os pacientes apresentam maiores complicacoes nos pes. A QVRS desses pacientes pode ser avaliada por meio de instrumentos de medida, os quais sao escassos na populacao brasileira. Disponibilizar a versao brasileira do instrumento Diabetic foot ulcer scale- short form (DFS-SF), um instrumento que avalia a QV de pessoas com pe diabetico e avaliar a sua validade de conteudo. Estudo metodologico, composto pelas etapas: 1) validacao linguistica: composta por traducao, retrotraducao, avaliacao pelo comite de especialistas e pre-testagem junto aos pacientes-alvos; e 2) avaliacao da validade de conteudo, praticabilidade e aceitabilidade. O estudo foi realizado em um Ambulatorio de Pe Diabetico do interior do estado de Sao Paulo. Foi utilizado um instrumento previamente testado de caracterizacao sociodemografica e a versao brasileira do DFS-SF. O estudo foi aprovado sob o CAAE no 66816717.1.0000.5404. A amostra (n=30) foi composta por homens (76,7%), com 57,4 anos, brancos (86,7%); a maioria (56,7%) possuia mais de oito anos de estudo e era aposentada (56,7%). A maior parte (53,3%) apresentava diagnostico de DM ha mais de 19 anos; Classificacao de Wagner 2 (46,7%); ulcera neuropatica (76,7%) e relataram ter ulcera no pe por mais de 3 meses (73,3%). As equivalencias semântica, idiomatica, cultural e conceitual entre a versao traduzida e a versao original foram obtidas. O DFS-SF foi bem aceito e de facil entendimento. A versao brasileira do DFS-SF parece ser compreensivel e de facil aplicacao. Outros estudos estao sendo desenvolvidos para avaliar sua estrutura fatorial, confiabilidade e validade interna e permitir sua utilizacao na pratica clinica.

Excessive salt intake has been directly associated with cardiovascular diseases, especially hypertension, and non-cardiovascular diseases. Despite the current recommendations, salt intake remains high, indicating the need to develop theory-based interventions aimed at reducing this intake.The purpose of this study was to test the impact of a theory-based intervention - the SALdável Program - to promote the use of less than 4 g of salt/day during cooking.This was a two-arm parallel-group randomized study. A total of 92 hypertensive women were randomly assigned to an intervention or control group. The intervention was aimed at motivating participants to reduce salt addition by increasing self-efficacy and counteracting the negative influence of habit. Primary outcomes were the behavioral question of salt addition and total salt addition, secondary outcomes were overall salt intake, provided by 24-hour urinary sodium excretion, and psychosocial variables (intention, self-efficacy, and habit).At three-month follow-up, the intervention group improved significantly more than the control group regarding salt addition measures (p-values between 0.05 and 0.001) and psychosocial variables (all p-values ⩽0.001). The reduction in 24-hour urinary sodium excretion was not significant.The findings showed that this theory-based intervention was effective to motivate and change the behavior of hypertensive women regarding daily salt use in cooking meals. This was accomplished by means of improvements in intention and self-efficacy and reduction of the habit of using more than 4 g of salt/day during cooking.

OBJECTIVE: to compare the general and specific health-related quality of life (HRQoL) between the Intervention (IG) and Control (CG) groups of coronary artery disease patients after the implementation of Action Planning and Coping Planning strategies for medication adherence and to verify the relationship between adherence and HRQoL. METHOD: this was a controlled and randomized study. RESULTS: the sample (n=115) was randomized into two groups, IG (n=59) and CG (n=56). Measures of medication adherence and general and specific HRQoL were obtained in the baseline and after two months of monitoring. CONCLUSION: the findings showed that the combination of intervention strategies - Action Planning and Coping Planning for medication adherence did not affect the HRQoL of coronary artery disease patients in outpatient monitoring. OBJETIVO: comparar la calidad de vida relacionada a la salud (CVRS) - general y específica de pacientes con enfermedad coronaria entre los grupos Intervención y Control después de la implementación de las estrategias de Planificación de Acción y de Enfrentamiento de Obstáculos para adherencia a medicamentos y verificar la relación entre adherencia y CVRS. MÉTODO: se trata de estudio controlado y aleatorio. RESULTADOS: la muestra (n=115) fue del tipo aleatorio en los grupos GI (n=59) y GC (n=56). Fueron obtenidas medidas de adherencia a medicamentos y de CVRS general y específica, en la fase inicial del estudio y después de dos meses de seguimiento. CONCLUSIÓN: los hallazgos evidenciaron que la combinación de estrategias de intervención - Planificación de Acción y de Enfrentamiento de Obstáculos para adherencia a medicamentos no influenció la CVRS de pacientes con enfermedad coronaria en seguimiento en ambulatorio. OBJETIVO: comparar a qualidade de vida relacionada à saúde - geral e específica - de pacientes coronariopatas entre os grupos Intervenção e Controle, após a implementação das estratégias de Planejamento de Ação e de Enfrentamento de Obstáculos para adesão medicamentosa e verificar a relação entre adesão e qualidade de vida, relacionada à saúde. MÉTODO: trata-se de estudo controlado e randomizado. RESULTADOS: a amostra (n=115) foi aleatorizada nos grupos Intervenção (n=59) e Controle (n=56). Foram obtidas medidas de adesão medicamentosa e de qualidade de vida relacionada à saúde geral e específica, na fase inicial do estudo e após dois meses de seguimento. CONCLUSÃO: os achados evidenciaram que a combinação de estratégias de intervenção - Planejamento de Ação e de Enfrentamento de Obstáculos para adesão medicamentosa não influenciou a qualidade de vida relacionada à saúde de pacientes coronariopatas em seguimento ambulatorial.

Objectives To culturally adapt the instrument “Evidence-Based Practice Questionnaire” (EBPQ) to the Portuguese language and assess its psychometric qualities. Methods The steps of cultural adaptation of measurement instruments were followed. Reliability was verified through internal consistency, stability by test-retest, and construct validity by the contrasted groups approach. Results High Cronbach’s alpha (0.91 to 0.68) and satisfactory Intraclass Correlation Coefficient (0.90) were obtained in all domains. In assessing construct validity, significant differences were found between groups of nurses with different backgrounds. Conclusion The steps of cultural adaptation of measurement instruments have been successfully completed. The Brazilian version obtained presents reliable psychometric properties for its use in this population.

Objetivo: atualizar o conhecimento sobre a manutencao da permeabilidade dos Dispositivos de Acesso Vascular Central (DAVC) em paciente com câncer. Conteudo: os pacientes que fazem uso de quimioterapicos muitas vezes necessitam de DAVC seguros e de longa permanencia; a obstrucao ocorre em 36% dos pacientes com DAVC inseridos no periodo de 2 anos, que pode ser classificada como mecânica, por precipitacao de medicamento/minerais e pela formacao de coagulos. A equipe de enfermagem e responsavel por realizar os cuidados para manter a permeabilidade desses dispositivos atraves do Flushing e Locking . O uso de heparina demonstrou baixa evidencia quando comparado ao Soro Fisiologico (SF), em relacao a diminuicao da obstrucao. Conclusao: o uso de SF na manutencao dos DAVC mostra-se seguro, eficaz e com menor custo financeiro. ABSTRACT Objective: to update the knowledge on the maintenance of permeability of Central Vascular Access Devices (CVAD) in cancer patients. Content: Patients on chemotherapy often require safe, long-term CKD. Obstruction occurs in 36% of patients with CVAD inserted in a 2-year period, which can be classified as mechanical due to drug / mineral precipitation and clot formation. The nursing staff is responsible for taking care to maintain the permeability of these devices through Flushing and Locking. The use of heparin showed low evidence when compared to saline (SF), regarding the reduction of obstruction. Conclusion: the use of DES to maintain CVAD is safe, effective and has a lower financial cost. RESUMEN Objetivo : actualizar los conocimientos sobre el mantenimiento de la permeabilidad del dispositivo de acceso vascular central (DAVC) en pacientes con cancer. Contenido: los pacientes que usan quimioterapicos a menudo necesitan DAVC seguros y de larga permanencia. La obstruccion ocurre en el 36% de los pacientes con DAVC insertados en el periodo de 2 anos y puede ocorir por precipitacion de medicamento / minerales y por la formacion de coagulos. El equipo de enfermeria es responsable de realizar los cuidados para mantener la permeabilidad de estos dispositivos a traves del Flushing y Locking. El uso de heparina demostro una baja evidencia en comparacion con el Suero Fisiologico (SF), en relacion con la disminucion de la obstruccion. Conclusion: el uso de SF en el mantenimiento de los DAVC se muestra seguros, eficaz y con menor costo financiero.

AIM: this paper reports the results of a nursing-administered theory-based intervention, the "Moving Heart Program", based on the implementation intention theory and pointed at improving physical activity adherence among coronary heart disease outpatients in Brazil. METHODS: this experimental study applied assessments at baseline, 1 and 2 months after baseline. The Consolidated Standards of Reporting Trials statement was followed. Participants were randomly assigned to intervention, comprising action and coping plans on how to deal with anticipated barriers (n=69), or a standard-care control group (n=67). RESULTS: participants submitted to the intervention showed significant higher levels of physical activity 2 months after baseline and were significantly more active than the control group. CONCLUSIONS: the results indicate that the intervention is feasible for patients with coronary heart disease and can be a useful tool to facilitate intended lifestyle changes. This study brings relevant contributions to the Nursing field and other health-related areas, once the intervention presents low cost to health services and can be applied in cardiac rehabilitation programs, showing significant benefits to participants. OBJETIVO: en este estudio, se presentan los resultados de una intervención de enfermería - "El Programa Corazón en Movimiento", basada en las premisas teóricas del "implementation intention" para mejorar la actividad física entre pacientes con enfermedad coronaria en Brasil. MÉTODOS: este estudio experimental aplicó las evaluaciones al inicio del estudio, 1 y 2 meses después. La declaración Consolidated Standards of Reporting Trials fue seguida. Los participantes fueron asignados al azar al Grupo Intervención, que comprende los planes de acción y de hacer frente a la manera de lidiar con los obstáculos (n=69); o al Grupo Control (n=67). RESULTADOS: los participantes sometidos a la intervención mostraron niveles significativamente más altos de actividad física después de 2 meses y eran más activos que los del grupo control. CONCLUSIÓN: la intervención es viable para pacientes con enfermedad coronaria y es una herramienta útil para facilitar los cambios de estilo de vida. Este estudio aporta contribuciones relevantes en el campo de enfermería y de otras áreas relacionadas a la salud, una vez que la intervención tiene costo bajo para los servicios de salud y se puede aplicar en los programas de rehabilitación cardíaca, y muestra beneficios significativos para los participantes. OBJETIVO: este estudo reporta os resultados de uma intervenção denominada "Programa Coração em Movimento", baseada nos pressupostos teóricos da "implementação da intenção", para incrementar o nível de atividade física entre pacientes coronariopatas, em seguimento ambulatorial, no Brasil. MÉTODOS: neste estudo experimental foram avaliados os pacientes numa abordagem inicial, um e dois meses após. A declaração CONSORT foi seguida. Os participantes foram aleatoriamente alocados nos grupos intervenção (GI) e controle (GC). O GI (n=69) foi submetido ao planejamento de ação e de enfrentamento de obstáculos e o GC (n=67) recebeu tratamento de rotina. RESULTADOS: os participantes submetidos à intervenção apresentaram níveis significativamente mais elevados de atividade física dois meses após a abordagem inicial e foram mais ativos do que aqueles no GC. CONCLUSÕES: os resultados indicam que a intervenção é possível ser aplicada em pacientes coronariopatas e pode ser uma ferramenta útil para facilitar mudanças no estilo de vida. Este estudo traz contribuições relevantes para a área de enfermagem e outras áreas afins, uma vez que essa intervenção apresenta baixo custo aos serviços de saúde e pode ser aplicada em programas de reabilitação cardíaca, com evidências de benefícios significativos aos participantes.

Cornelio M.E., Gallani M.-C.B.J., Godin G., Rodrigues R.C.M., Nadruz Jr W. & Mendez R.D.R. (2012) Behavioural determinants of salt consumption among hypertensive individuals. J Hum Nutr Diet. 25, 334–344 Abstract Background: High salt consumption among populations remains a challenge for health professionals dealing with prevention and control of hypertension. The present study aimed to identify the psychosocial predictors of salt consumption among hypertensive individuals, based on an extended version of the Theory of Planned Behaviour (TPB). Three salt consumption behaviours were studied: Behaviour 1– using

The mechanisms by which dietary sodium modulates cardiovascular risk are not fully understood. This study investigated whether sodium intake is related to carotid structure and hemodynamics and to plasma matrix metalloproteinase (MMP) activity in hypertensive adults. One hundred thirty-four participants were cross-sectionally evaluated by clinical history, anthropometry, carotid ultrasound, and analysis of hemodynamic, inflammatory, and metabolic variables. Daily sodium intake (DSI) was estimated by 24-h recall, discretionary sodium, and a FFQ. In 42 patients, plasma MMP-2 and MMP-9 activities were also analyzed. The mean DSI was 5.52 ± 0.29 g/d. Univariate analysis showed that DSI correlated with common carotid artery systolic and diastolic diameter (r = 0.36 and 0.34; both P < 0.001), peak and mean circumferential tension (r = 0.44 and 0.39; both P < 0.001), Young's Elastic Modulus (r = 0.40; P < 0.001), intima-media thickness (r = 0.19; P < 0.05), and internal carotid artery resistive index (r = 0.20; P < 0.05). Multivariate analyses revealed that only artery diameter, circumferential wall tension, and Young's Elastic Modulus were independently associated with DSI. Conversely, plasma MMP-9 activity was associated with DSI (r = 0.53; P < 0.001) as well as with common carotid systolic diameter (r = 0.33; P < 0.05) and Young's Elastic Modulus (r = 0.38; P < 0.01). In conclusion, sodium intake is associated with carotid alterations in hypertensive adults independently of systemic hemodynamic variables. The present findings also suggest that increased MMP-9 activity might play a role in sodium-induced vascular remodeling.

Upper arm circumference (UAC) measurement is necessary for the proper sizing of cuffs and is recommended for accurate blood pressure (BP) assessment. The aim of this report is to identify and quantify the relationships between UAC and the usual anthropometric measurements of body fat distribution and cardiac structure in hypertensive subjects. We evaluated 339 patients (202 women and 137 men) by medical history, physical examination, anthropometry, metabolic and inflammatory parameters, and echocardiography. Partial correlation analyses adjusted for age and body mass index revealed that anthropometric variables were significantly associated with echocardiographic parameters exclusively in women. In this regard, UAC correlated with interventricular septum thickness, posterior wall thickness, and relative wall thickness >or=0.45, while waist circumference was related to left cardiac chamber diameter. Multivariate analyses including age, body mass index, systolic BP, homeostasis model assessment index, and use of antihypertensive medications demonstrated that UAC was an independent predictor of left ventricular wall thickness and concentric hypertrophy in women. Further linear regression analyses revealed that waist circumference was an independent predictor of left ventricular end-diastolic and left atrial diameters in this gender. Overall, these findings suggest that UAC determination might serve not only as a routine approach preceding BP evaluation but also as a simple and feasible predictor of adverse LV remodeling in hypertensive women.

This was a systematic review aimed at identifying and characterizing measuring instruments, developed in the context of cardiology, which were adapted into Portuguese language of Brazil. Systematic searches were performed in six databases. Information extracted included cultural adaptation process and measurement properties. To assess the methodological quality of studies, criteria based on international guidelines for cultural adaptation of instruments were used. Among the 114 articles found, 14 were eligible for review. Of these, most evaluated quality of life (35.7%) and health knowledge/learning (28.6%). Most studies followed all stages of the adaptation process recommended in the literature. With respect to measurement properties, internal consistency, verified by Cronbach’s alpha, was the property reported in the majority of the studies, as well as construct and criterion validity. This study is expected to provide to the scientific community a critical evaluation of adapted questionnaires available in the context of cardiology. Esta revisión sistemática tuvo como objetivo: identificar y caracterizar los instrumentos de medición desarrollados en el contexto de la cardiología que fueron adaptados a la lengua portuguesa de Brasil. Se llevaron a cabo búsquedas sistemáticas en seis bases de datos. Se extrajeron los datos sobre el proceso de adaptación cultural y las propiedades de medición. Para evaluar la calidad metodológica de los estudios, fueron utilizados criterios basados en las directrices internacionales para la adaptación cultural de instrumentos. Entre los 114 artículos encontrados, 14 fueron elegibles para su revisión. De los 14, la mayoría evaluaba la calidad de vida (35,7%) y los procesos de conocimiento / aprendizaje en salud (28,6%). La mayoría de los estudios incluyeron todas las etapas del proceso de adaptación recomendadas por la literatura. En relación a la medición de las propiedades, la consistencia interna, verificada por el alfa de Cronbach, fue la propiedad reportada en la mayoría de los estudios, así como la validez de constructo y la validez de criterio. Con este estudio, se espera brindar a la comunidad científica una cuidadosa evaluación de los cuestionarios adaptados disponibles en el contexto de la cardiología. Revisão sistemática com o objetivo de identificar e caracterizar instrumentos de medida desenvolvidos no contexto da cardiologia que foram adaptados para a língua portuguesa do Brasil. Buscas sistematizadas foram realizadas em seis bases de dados. Extraíram-se informações referentes ao processo de adaptação cultural e as propriedades de medida. Para avaliação da qualidade metodológica dos estudos, foram utilizados critérios com base em diretrizes internacionais para adaptação cultural de instrumentos. Dentre os 114 artigos levantados, 14 foram considerados elegíveis para a revisão. Desses, a maioria avaliava qualidade de vida (35,7%) e conhecimento/aprendizagem em saúde (28,6%). A maioria dos estudos contemplou todas as etapas do processo de adaptação recomendadas pela literatura. Com relação às propriedades de medida, a consistência interna, verificada por meio do alfa de Cronbach, foi a propriedade relatada na maioria dos estudos, bem como as validades de constructo e critério. Com este estudo, espera-se disponibilizar para a comunidade científica uma avaliação criteriosa dos questionários adaptados disponíveis no contexto da cardiologia.

This experimental study was aimed at assessing the potential effect of a theory-driven intervention—implementation intentions—on reducing salt intake among hypertensive Brazilian women. Ninety-eight participants were randomly assigned to participate in an implementation intentions intervention aimed at promoting lower salt intake through decreased addition of salt and salty spices to meals (intervention group,n=49; group,n=49). Endpoints were assessed at baseline and at the 2-month follow-up. Primary endpoints were a self-reporting measure of salt intake given by salt addition to meals (discretionary salt + salty spices = total added salt) and the 24 h urinary-sodium excretion. Secondary endpoints included intention, self-efficacy, and habit related to adding salt to meals. Patients in the intervention group showed a significant reduction in salt intake as assessed by 24 h urinary-sodium excretion. A significant reduction in the measure of habit was observed for both groups. No differences were observed for intention and self-efficacy. The results of this pilot study suggest the efficacy of planning strategies to help hypertensive women reduce their salt intake.

Aim To examine the effect of action and coping planning strategies in the adherence to medication among outpatients with coronary artery disease. Background Action and coping planning strategies are based on implementation intention, which requires self-regulation by the individual, to prioritize intentionally planned responses over learned or habitual ones, from daily routines to stressful situations. Design Randomized controlled trial. Methods Participants (n = 115) were randomized into intervention (use of action and coping planning strategies, n = 59) or control (usual care, n = 56) groups. The study was conducted between June 2010–May 2011 in two in-person visits: baseline and 2-month follow-up. Participants in the intervention group received telephone reinforcement between baseline and 2-month follow-up. Adherence to medication for cardioprotection and symptoms relief was evaluated by proportion of adherence, global measure of adherence evaluation and Morisky Self-Reported Measure of Medication Adherence Scale at both baseline and 2-month follow-up. Findings When using the measure of global measure of adherence, participants in the intervention group reported adherence to therapy more often than controls (odds ratio = 5·3), but no statistically significant change was observed in the other two outcome measures. Conclusion This study has shown that individuals who use action and coping planning report higher adherence to drug treatment, when measured by the global adherence evaluation. Further studies with longer follow-ups are needed to assess if the effect of planning strategies has long-term duration.

OBJECTIVE: to evaluate the relationship between the behaviors of salt consumption and socio-demographic and clinical variables. METHOD: sodium consumption was evaluated using the methods: self-reporting (considering 3 different behaviors related to salt consumption), 24- hr dietary recall, discretionary salt, food frequency questionnaire, estimation of total sodium intake and 24-hr urinary excretion of sodium (n=108). RESULTS: elevated salt intake according to the different measurements of consumption of the nutrient was associated with the variables: male sex, low level of schooling and monthly income, being Caucasian, and being professionally inactive; and with the clinical variables: elevated Body Mass Index, tensional levels, ventricular hypertrophy and the number of medications used. CONCLUSION: the data obtained shows a heterogenous association between the different behaviors related to salt consumption and the socio-demographic and clinical variables. This data can be used to optimize the directing of educational activities with a view to reducing salt consumption among hypertensives. OBJETIVO: evaluar la relación entre los comportamientos de consumo de sal y variables sociodemográficas y clínicas. MÉTODO: el consumo de sodio fue evaluado según los métodos: de autorrelato (objetivando 3 diferentes comportamientos relacionados al consumo de sal), recordatorio de 24h, sal per cápita, cuestionario de frecuencia alimentaria, estimativa de consumo total de sodio y excreción urinaria de sodio (n=108). RESULTADOS: el consumo elevado de sal según las diferentes medidas de consumo del nutriente fue asociado a las variables: sexo masculino, bajo nivel de escolaridad y de renta mensual, color blanco, inactividad profesional y a las variables clínicas: Índice de Masa Corporal elevada, niveles de tensión, indicadores de hipertrofia ventricular y número de medicaciones utilizadas. CONCLUSIÓN: los datos obtenidos muestran una asociación heterogénea entre los diferentes comportamientos relacionados al consumo de sal y a las variables sociodemográficas y clínicas. Estos datos pueden ser utilizados para optimizar la orientación de las actividades educativas objetivando la reducción del consumo de sal entre hipertensos. OBJETIVO: avaliar a relação entre os comportamentos de consumo de sal e variáveis sociodemográficas e clínicas. MÉTODO: o consumo de sódio foi avaliado segundo os métodos: de autorrelato (visando 3 diferentes comportamentos relacionados ao consumo de sal), recordatório de 24h, sal per capita, questionário de frequência alimentar, estimativa de consumo total de sódio e excreção urinária de sódio (n=108). RESULTADOS: o consumo elevado de sal, segundo as diferentes medidas de consumo do nutriente foi associado às variáveis: sexo masculino, baixo nível de escolaridade e de renda mensal, cor branca, inatividade profissional e às variáveis clínicas: índice de massa corpórea elevada, níveis tensionais, indicadores de hipertrofia ventricular e número de medicações utilizadas. CONCLUSÃO: os dados obtidos mostram uma associação heterogênea entre os diferentes comportamentos relacionados ao consumo de sal e às variáveis sociodemográficas e clínicas. Esses dados podem ser utilizados para otimizar o direcionamento das atividades educativas, visando a redução do consumo de sal entre hipertensos.

OBJECTIVE: to validate the content of persuasive messages for promoting walking among patients with coronary heart disease (CHD). The messages were constructed to strengthen or change patients' attitudes to walking. METHOD: the selection of persuasive arguments was based on behavioral beliefs (determinants of attitude) related to walking. The messages were constructed based in the Elaboration Likelihood Model and were submitted to content validation. RESULTS: the data was analyzed with the content validity index and by the importance which the patients attributed to the messages' persuasive arguments. Positive behavioral beliefs (i.e. positive and negative reinforcement) and self-efficacy were the appeals which the patients considered important. The messages with validation evidence will be tested in an intervention study for the promotion of the practice of physical activity among patients with CHD. OBJETIVO: validar el contenido de mensajes persuasivos para promover la caminata entre pacientes con enfermedad arterial coronaria (DAC). Los mensajes fueron construidos objetivando al fortalecimiento/cambio de la actitud del paciente con relación a la caminata. MÉTODO: la selección de los argumentos persuasivos fue basada en las creencias comportamentales (determinantes de la actitud) relacionadas a la caminata. Los mensajes fueron construidos con base en el Modelo de Probabilidad de Elaboración y sometidos a la validez de contenido. RESULTADOS: los datos fueron analizados por medio del índice de validez de contenido y por la importancia atribuida por los pacientes a los argumentos persuasivos de los mensajes. Las creencias comportamentales positivas (ejemplo: refuerzo positivo y negativo) y la autoeficacia fueron los reclamos considerados importantes por los pacientes. Los mensajes con evidencias de validación serán testadas en estudio de intervención para promoción de la práctica de actividad física entre pacientes con DAC. OBJETIVO: validar o conteúdo de mensagens persuasivas para promover a caminhada entre pacientes com doença arterial coronária (DAC). As mensagens foram construídas com vistas ao fortalecimento/mudança da atitude do paciente em relação à caminhada. MÉTODO: a seleção dos argumentos persuasivos foi baseada nas crenças comportamentais (determinantes da atitude), relacionadas à caminhada. As mensagens foram construídas com base no Modelo de Probabilidade de Elaboração e submetidas à validade de conteúdo. RESULTADOS: os dados foram analisados por meio do índice de validade de conteúdo e pela importância atribuída pelos pacientes aos argumentos persuasivos das mensagens. As crenças comportamentais positivas (i.e. reforço positivo e negativo) e a autoeficácia foram os apelos considerados importantes pelos pacientes. As mensagens com evidências de validação serão testadas em estudo de intervenção para promoção da prática de atividade física entre pacientes com DAC.