Doutorado em Enfermagem e Saúde (FEN)
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Item Qualidade da assistência especializada a pessoas com diabetes mellitus e hipertensão arterial segundo o Chronic Care Model(Universidade Federal de Goiás, 2022-04-27) Borges, Dalma Alves Pereira; Brasil, Virginia Visconde; http://lattes.cnpq.br/1940761888797180; Brasil, Virginia Visconde; Vila, Vanessa da Silva Carvalho; Vitorino, Priscila Valverde de Oliveira; Zanini, Claudia Regina de Oliveira; Rezende, Marina Aleixo DinizINTRODUCTION: Support for self-management of chronic conditions and health literacy are essential elements in the development of person-centered services. The use of integrated care models that focus on the person, and not just on the specific disease, represent a viable solution for effective care. The Chronic Care Model is a model that is based on the relationship between motivated and informed users and the proactive and prepared health team. However, there is evidence of gaps in the attention and care that should be provided in the care of chronic conditions, especially in hypertension and diabetes. OBJECTIVE: To characterize the quality of care provided and the health literacy conditions reported by people with arterial hypertension and diabetes mellitus in a secondary care service. METHODS: Crosssectional study, carried out in an outpatient clinic that is a reference in the care of arterial hypertension, in a large Brazilian center, where diabetes is prevalent morbidity. Eighty-two people with diabetes mellitus and arterial hypertension were evaluated, with a follow-up of at least five years and ten consultations. Sociodemographic and clinical data were obtained through a nursing consultation. The Patient Assessment of Care for Chronic Conditions - PACIC questionnaire was applied, with 20 questions and five scales. Higher scores (> 3.0) indicate a perception of greater involvement in self-management and support. Three scales from the Brazilian version of the Health Literacy Questionnaire - HLQ-Br were also used. The score of each scale indicates the person's strengths and weaknesses in relation to their health literacy. Internal consistency was evaluated; Mann-Whitney test, Spearman test and significance of 5% were applied. RESULTS: The mean age of the participants was 68.98±8.79 years, female (82.93%), with a median of 4 years of study (IQR 3 - 8). Most parents (70.73%) did not study. Less than half of the users had controlled values of glycated hemoglobin - HbA1c (34.15%) and blood pressure (36.59%). The Cronbach alpha of PACIC was 0.85 and that of HLQ-Br was 0.75. There was a positive correlation between the time of diagnosis of diabetes and HbA1c. The overall PACIC score was 3.4 (IQR 2.8-3.8) out of a high of 5.0. The highest score was evidenced on the scale of care/decision-making model (4.3) and the lowest on the scale of coordination of care/follow-up (2.8). Support for selfmanagement is assessed by the treatment adherence scores (3.0), problem-solving / follow-up contextualization (3.0), and goal setting (3.8). Those with ≥ 4 years of schooling had higher scores for Attention Coordination / Follow-up (p=0.039). Participants whose parents had some schooling had higher scores for Adherence to treatment (p=0.038), Coordination of care / Follow-up (p=0.042) and general PACIC (p=0.026). Lower scores were identified among participants who did not have HbA1c control, on the Goal Setting scale (p=0.003). Health literacy showed mean scores of 4.07 ± 0.87 on the Ability to interact with the team scale; 3.02±1.31 in Understanding the information and 2.84±1.25 in Finding good information. Male users had higher scores for interacting with professionals, finding information and understanding information (p=0.039, p=0.00 and p=0.003). Those with ≥ to 4 years of schooling had higher scores for Finding and Understanding information (p=0.002 and p< 0.001), as well as those whose parents had some schooling (p=0.036 and p=0.037). Those who were overweight had a higher score for Understanding the information (p= 0.040). There was a positive correlation between the time of diagnosis of diabetes and HbA1c and no correlation was identified between the general value of PACIC and the HLQ-Br scales. CONCLUSIONS: The quality of care was considered high according to the general PACIC, and moderate in terms of the person's participation in decision-making and the contextualization of the treatment plan. Weakness was identified in the dependence on other people to be able to access and understand written information, but the ease of involvement with professionals can favor the use of communication strategies to improve health self-management.Item Fatores associados à qualidade de vida relacionada à saúde do portador de doença renal crônica em tratamento pré-dialítico(Universidade Federal de Goiás, 2014-12-19) Cordeiro, Jacqueline Andréia Bernardes Leão; Brasil, Virginia Visconde; http://lattes.cnpq.br/1940761888797180; Brasil, Virginia Visconde; Canhestro, Mônica Ribeiro; Barbosa, Maria Alves; Vila, Vanessa da Silva Carvalho; Freitas, Ana Tereza Vaz de SouzaChronic kidney disease is considered a worldwide public health problem because of the high mortality rates and the physical, social and emotional limitations that interfere significantly in quality of life. The evaluation of the quality of life of chronic kidney disease carrier has demonstrated commitment to many aspects of life of these individuals and it was directed mainly to patients on dialysis. The number of referrals for pre - dialysis monitoring, resulting from complications due to comorbidities such as hypertension and diabetes mellitus is growing, and it requires that the focus of assistance is not only early diagnosis and treatment of disease, but also, aspects related to subjectivity, the perceptions of individuals in relation to their well - being and quality of life (QOL). At present there is no specific instrument to assess QOL of individuals in pre- dialysis treatment. This study aimed to analyze the factors associated with QOL related to the health of the chronic kidney disease carrier in pre- dialysis treatment. An analytical cross-sectional study was developed in three nephrology clinics of large hospitals in the city of Goiânia/Goiás, with 130 patients in stage IV and V of chronic kidney disease. Data collection was done through the application of socio - demographic - clinical - laboratory questionnaire and the specific QOL instrument for kidney disease, KDQOL -SF. A total of 57.7% of patients were male and the group average age was approximately 64 years old. Most patients were classified as stage 4 (69.2%) and some had no schooling (54.6 %). Among the comorbidities detected hypertension was more prevalent, followed by diabetes mellitus and 28.5% of patients had hemoglobin levels lower than expected. The dimensions of quality of life "the professional role" (25.38) and "the physical function" (28.08) showed lower values while "the stimulus by the clinic staff" (88.37) and "the cognitive function" (86.00) had the highest average. QOL is more compromised in women and in patients with five or more children who do not work and have no income, who are obese, hypertensive and show alterations especially in urea and creatinine. It was shown that QOL is influenced by chronic kidney disease, especially when there is change in laboratory parameters which control may extend the start of dialysis therapy or even minimize possible organic misfits. The KDQOL -SF was adequate to evaluate the QOL of individuals in pre- dialysis treatment. The gaps shown by the assessment of QOL in this study showed the importance of care to the kidney patient in the pre- dialysis phase, requiring more effective attention to the subjective demands. This could be achieved if the individual is taught to manage his condition, and it is essential a multidisciplinary monitoring to consider the level of patient understanding, so he can transform the information provided in benefits for his own health.Item A efetividade de escovas descartáveis e submetidas à desinfecção para a higiene bucal em pacientes ventilados mecanicamente: ensaio clínico(Universidade Federal de Goiás, 2019-04-30) Gonçalves, Fernanda Alves Ferreira; Torres, Ieda Maria Sapateiro; http://lattes.cnpq.br/0836649494981715; Campos, Cerise de Castro; http://lattes.cnpq.br/9109822142576433; Brasil, Virginia Visconde; http://lattes.cnpq.br/1940761888797180; Brasil, Virginia Visconde; Souza, Adenícia Custódia Silva e; Roriz, Virgílio Moreira; Melo, Dulcelene de Sousa; Tipple, Anaclara Ferreira VeigaINTRODUCTION: Invasive ventilatory and intubated patients are dependent on the nursing team. The mechanical removal of the biofilm with toothbrush is the first option, but after single use it can be contaminated by microorganisms from the oral cavity, as well as from the external environment. The use of the brush should be associated with chemical control of chlorhexidine digluconate, which is semi-critical and requires high level disinfection or be discarded. Peracetic acid is a high-level disinfectant, but has not been tested for use on toothbrushes. AIM: To compare the effectiveness of the use of disposable toothbrushes and disinfection with peracetic acid used for oral hygiene (OH) of patients under mechanical ventilation. MATERIALS AND METHODS: Randomized-controlled clinical trial performed at an intensive care unit of a public hospital in Goiânia / GO. Data were collected from 31 patients, intubated and under mechanical ventilation, between June 2017 and August 2018. The patients were divided into Control Group (OH with disinfected brushes) and Intervention Group (HB with brushes discarded). A dental evaluation was performed on day 1. Saliva collection was performed on day 1, day 3 and day 5 for counting of colony forming units (CFU). HB was performed twice a day, for up to five days, with 0.12% CHX gel and disinfected or discarded brushes. RESULTS: At admission, patients presented poor oral hygiene, periodontal disease, periodontitis and gingivitis. Most of the participants were male, with a mean age of 59.0 ± 14.4 years and mean of 19 teeth. Throughout the days of HB there was a decreasing tendency of buccal and lingual biofilms, however, there was no significant reduction of UFC, with no difference between the groups that used disposable brushes and disinfected brushes. In relation to the bacteria isolated on the fifth day, there was homogeneity in both groups, with predominance of Pseudomonas aeruginosa, Enterococcus faecium, Klebsiella pneumoniae and Staphylococcus haemolyticus. CONCLUSIONS: There was no difference in tooth and tongue brushing, performed with single use brushes, discarded or disinfected at each use. The important thing is to brush properly, following established protocols.