􀀙􀀄􀀓􀀒􀀌􀀎􀀋􀀟􀀓􀀆􀀌􀀄: Access to healthcare in the quilombola communities of Santarém, Pará, is
conditioned by historical inequalities and characteristics specific to the Amazon region, such
as long distances, population dispersion, transportation difficulties, and limited infrastructure.
These elements combine and shape the way services are used and meet the health demands of
the population, expressing challenges that have persisted over time. 􀀑􀀤􀀥􀀂􀀟􀀓􀀆􀀈􀀂: To identify and
characterize the main social determinants that influence access to health services by quilombola
communities located in the municipality of Santarém, state of Pará. 􀀚􀀂􀀓􀀍􀀌􀀎􀀐: This crosssectional
study, using a quantitative approach, was conducted with 512 residents of certified
quilombola communities. The analyses involved descriptive statistics, association tests, simple
and multiple regressions, analysis of variance, equity indicators, principal component analysis,
and multilevel modeling. Territorial indicators and accessibility measures based on
geographical distance were also used. The findings were organized into five manuscripts that
explore, in a complementary manner, the socioeconomic, territorial, organizational, and
epidemiological dimensions of access. 􀀕􀀂􀀐􀀋􀀇􀀓􀀐: The results showed that the spatial layout of
services, combined with the long distance to urban centers and limited transportation, constitute
concrete obstacles to care, especially among rural and riverside communities, where the
territory acts as a significant physical barrier. Socioeconomic variables such as education,
income, housing, and internet access had a direct influence on the use and effectiveness of
services, highlighting internal inequalities and inequalities between communities. The
territorial analysis reinforced that more isolated communities had lower use and lower
effectiveness, even when formal services were available. 􀀬􀀆􀀄􀀃􀀇 􀀟􀀌􀀄􀀐􀀆􀀎􀀂􀀒􀀃􀀓􀀆􀀌􀀄􀀐􀀣 The results
indicate the need for territorialized policies and intersectoral actions that value the specificities
of each quilombola community. Guaranteeing access depends on strengthening transportation,
improving infrastructure, ensuring the continuous presence of health teams, incorporating
technologies such as telemedicine, and valuing traditional care practices. Overcoming
inequalities requires continuous planning, complementary research, and political commitment
to a care model that respects the Amazonian reality and promotes a more equitable and
culturally sensitive care network.

Introduction: The phenomenon of metastases remains poorly understood and is the leading cause of death for over 90% of cancer patients. Although bone metastases are quite common, there are no adequate/standardized national clinical protocols. In this scenario, the use of validated technologies becomes pertinent, as they facilitate the work of nurses, bringing greater precision and speed to actions, especially during nursing consultations. Objective: to validate a nursing instrument for evaluating patients with bone metastases undergoing radiotherapy. Methodology: This is a methodological study, with a quantitative approach, carried out exclusively in a virtual environment, developed in three macro stages: 1) content validation, 2) semantic validation and 3) construction of the final validated version. In the first stage, ten experts participated, who evaluated the relevance, pertinence and clarity of each item of the instrument. Data analysis was performed using the Content Validity Index (CVI). In the second stage of the study, semantic validation was performed with the target audience (ten clinical nurses), considering: objectives, organization, writing style, appearance and motivation. Data analysis was performed using the Semantic Concordance Index (SIC). After the suggested modifications, the final version of the instrument was constructed. Results: In the content validation, the majority of experts were female (90%), aged 30 to 39 years (40%), of which 70% lived in the state of Pará - Brazil, with a master's degree (60%) and 1 to 9 years of experience in radiotherapy (60%). An overall CVI of 0.96 was achieved considering relevance (CVI = 0.98), pertinence (CVI = 0.92) and clarity (CVI = 1.0). In the semantic validation, with the target audience, most participants were female (90%), the predominant age groups were 20 to 29 years and 30 to 39 years, both with 30%. Most participants lived in the state of Rio de Janeiro (40%) and had specialist qualifications (70%). The overall ICS was 0.94 considering the objectives (ICS = 0.93), organization (ICS = 0.88), writing style (ICS = 0.98), appearance (ICS = 1.0) and motivation (ICS = 0.92). The final version was composed of nine thematic domains: 1) Characterization of metastasis and radiotherapy treatment; 2) Complementary treatment; 3) Pain assessment; 4) Pathological fracture; 5) Spinal cord compression; 6) Hypercalcemia; 7) Main instructions to the patient regarding events related to the skeleton; 8) Referrals to the multidisciplinary team and 9) End of treatment. Final considerations: The developed instrument demonstrated satisfactory statistical validity, both among specialists and among the target audience, proving to be suitable for application during nursing consultations for patients with bone metastases undergoing radiotherapy. The research contributes to the qualification of care practice, strengthening the role of nurses in complex oncological contexts and supporting future care, teaching and research actions.

Introduction: Intensive Care Units (ICUs) are complex environments that demand constant updates, refined technical skills, and quick decision-making from nursing professionals, amid intense work routines. In this context, Permanent Health Education (PHE) becomes essential for the continuous qualification of workers, promoting learning integrated with professional practice. Innovative educational technologies, such as podcasts, emerge as viable and accessible tools to support nurses’ training, considering their time constraints and the need for frequent updates. Objective: To describe the process of semantic validation of a collection of educational podcasts on good nursing practices in ICUs, aimed at intensive care nurses. Methodology: This methodological study was conducted in two main stages: the first involved the semantic validation of the scripts, and the second comprised the recording and publishing of the episodes. Eight nurses with extensive ICU clinical experience participated in the validation process, selected based on training and professional experience. The developed scripts covered five core topics: care of vascular and urinary catheters, nasoenteric catheterization, cardiopulmonary arrest, patient safety, and wound care. Evaluation was performed using a structured instrument with a 4-point Likert scale, assessing clarity, language, organization, and applicability. Results: Weighted averages of the items ranged from 1.00 to 1.75, indicating high appropriateness of the scripts to the evaluators’ professional context. Qualitative comments reinforced the material’s quality while offering suggestions such as deepening complex topics, extending episode duration, and adjusting language for specific content. These suggestions were incorporated into the revision stage, resulting in more robust, coherent, and contextualized scripts. In the next stage, revised scripts were recorded using appropriate audio production software and equipment. The episodes followed an informative structure with contextual introduction, logical content development, and conclusion. Productions were published on free-access digital platforms such as Spotify and Google Podcasts, facilitating access regardless of time or location. Data analysis revealed that podcasts can be an effective strategy to support ongoing education for intensive care nurses. The initiative aligned with the demands of healthcare professionals working in high-complexity settings, allowing flexible access to relevant technical content. The validation process confirmed the thematic relevance, communicative clarity, and practical utility of the collection, highlighting podcasts’ potential as a complementary teaching-learning resource. Conclusion: The integration of educational technologies such as podcasts into intensive care nursing can significantly contribute to care quality, provided that content is rigorously developed, validated by the target audience, and offered in accessible formats suitable for professional realities

INTRODUCTION: Perinatal asphyxia is a condition that affects the fetus or newborn, characterized by inadequate oxygenation (hypoxia) and altered perfusion, which may lead to biochemical and systemic damage. In this context, early stimulation emerges as an essential strategy to promote neuropsychomotor development and improve the quality of life of affected infants. This stimulation aims to foster motor, sensory, perceptual, proprioceptive, linguistic, cognitive, emotional, and social development, especially during the early years of life, a period of greater brain plasticity and rehabilitation potential. OBJECTIVE: To understand the experiences of family members regarding home care for infants who experienced perinatal asphyxia, in the light of the Adaptation Theory. METHOD: An exploratory, qualitative, and survey-type study carried out in a Specialized Maternal and Child Reference Unit that serves women, children, and adolescents throughout the State of Pará, Brazil. Data were collected between December 2024 and March 2025 through in-depth interviews with family members of children who presented perinatal anoxia. Data were subjected to thematic content analysis according to Bardin and processed using the IRaMuTeQ software (version 0.7 alpha 2), employing Descending Hierarchical Classification, Similarity, and Word Cloud analyses. RESULTS: Six family members participated, most of them women. The reports revealed that the arrival of the baby, initially idealized as a moment of joy, was marked by frustration due to complications arising from perinatal asphyxia, requiring hospitalizations and intensive care. The adaptation process to this new reality was permeated by significant emotional and social impacts. The support network, composed of relatives and other parents, proved fundamental in coping with these challenges. Participants emphasized the lack of clear information in health services and the need for more humanized and attentive care during childbirth. In response to this demand, an educational printed technology was developed to guide parents on prevention, warning signs, and home care for perinatal asphyxia, contributing to reducing anxiety and strengthening the bond between families and health professionals. FINAL CONSIDERATIONS: Families of infants with perinatal asphyxia face significant challenges in home care, with social support networks and access to information being essential factors for adaptation and coping. The creation of educational material represents a relevant contribution to nursing practice and to improving the quality of life of both infants and caregivers.

INTRODUCTION: The coinfection of tuberculosis (TB) and the human immunodeficiency virus (HIV) represents a significant public health challenge due to the dynamic interaction between both pathogens and the immune system. HIV weakens the host's immune response, facilitating the survival and proliferation of Mycobacterium tuberculosis, while the activation of TCD4+ and CD8+ T lymphocytes by the bacillus can intensify viral replication, accelerating TB progression and worsening the clinical condition of coinfected individuals. People with TB-HIV coinfection are at greater risk of developing severe forms of tuberculosis, experiencing adverse treatment reactions, and developing drug resistance. The immunosuppression caused by HIV hinders TB diagnosis and increases the likelihood of infection. Therefore, coinfection requires an integrated and careful approach, and it is essential that healthcare professionals understand the clinical challenges to provide qualified and effective care for those affected by these diseases. OBJECTIVE: To analyze the prevalence of tuberculosis-HIV coinfection among people living with HIV in the municipality of Parintins, Amazonas, as well as to identify and examine the socioeconomic and clinical-epidemiological factors associated with it. METHODOLOGY: A retrospective and descriptive approach with a quantitative focus was used. Data were collected from the period of 2019 to 2024, based on medical records from the reference health unit in the municipality of Parintins. Eligibility criteria included individuals diagnosed with HIV and treated for tuberculosis, aged ≥18 years, excluding incomplete records. Data analysis was performed using Excel 2019® and SPSS 20.0, employing Chi-square tests and Spearman’s or Pearson’s correlation tests, in addition to multivariate analyses to explore the relationships between socioeconomic variables and coinfection, with a significance level of 0.05. RESULTS: A total of 63 medical records of people living with HIV/AIDS in Parintins-AM, from 2019 to 2024, were analyzed. Among them, 60.3% presented tuberculosis coinfection. Most coinfected individuals were male, of mixed race (parda), aged between 18 and 39 years, and had low educational attainment. The pulmonary form of tuberculosis was the most prevalent and showed a statistically significant association with the cure outcome (p = 0.0253). No statistical association was found between cure or death and variables such as education level, age, antiretroviral therapy (ART) use, or type of entry into care. Multivariate analysis and the correlation matrix confirmed the success of treatment of the pulmonary form in patient recovery. DISCUSSION: The high prevalence of TB-HIV coinfection in Parintins highlights the overlap of social and clinical vulnerabilities in the Amazon region. The predominance of cases among young, mixed-race men with low educational levels reveals structural inequalities that affect access to diagnosis and continuity of care. The significant association between the pulmonary form of TB and cure outcomes underscores the importance of early diagnosis. The absence of correlations with other variables reinforces the need to consider unmeasured factors, such as treatment adherence and psychosocial support. These findings point to challenges in follow-up and the effectiveness of surveillance actions, demanding intersectoral strategies and greater integration of services. Thus, it becomes urgent to strengthen primary health care and promote integrated regional policies that are sensitive to local specificities. FINAL CONSIDERATIONS: Based on the results obtained, it was possible to understand the prevalence and characteristics of the interaction between these diseases in the municipality, aiming to provide information to healthcare professionals on the front lines of care. These professionals will be able to adapt effective strategies to address these infections, which may be essential for supporting public policies focused on the control and prevention of TB-HIV coinfection, through the implementation of preventive measures aimed at raising community awareness.

Introduction: The health of the quilombola population deserves attention due to the presence of social inequalities. Women, in particular, experience heightened vulnerabilities resulting from racial and gender issues, as well as geographic barriers. Maternal health care is limited, with difficulties in accessing prenatal services. Despite the existence of public policies, there are still shortcomings in their implementation and in the provision of culturally sensitive care.
Objectives: To analyze the social determinants that influence the maternal health of quilombola women in Santarém, Pará. Methodology: This is a quantitative and descriptive study conducted in quilombola communities in the municipality of Santarém, Pará. Data collection took place in 2024 and early 2025, after approval by the Research Ethics Committee of the State University of Pará (UEPA), CAAE: 82771624.2.0000.5168, across three settings: Primary Health Care Units, participants’ homes, and during mobile outreach activities. To overcome logistical challenges and ensure community participation, the study partnered with the project “Connecting Knowledge in the Amazon” (UFOPA/CNPq), which enabled the involvement of quilombola high school students as scholarship collaborators in data collection. Data were organized using Microsoft Excel spreadsheets. Descriptive analyses (absolute and relative frequencies) were performed, along with Pearson's chi-square and Fisher’s exact tests, with a significance level of p < 0.05. Additionally, analyses were carried out using Python, employing the pandas, scipy, and statsmodels libraries, supported by descriptive graphs. Results: The study identified key social determinants, including significant educational heterogeneity (p < 0.0001), with a higher prevalence of completed high school education (26.15%), although low educational levels such as incomplete primary and secondary education (13.85%) were also found. Regarding occupation, most participants (69.23%) did not report any professional activity. Low household income was predominant (83.08%). In terms of housing, most women owned their homes (66.15%). Concerning gestational and cultural aspects, the majority (83.3%) reported receiving family support and prenatal guidance. However, despite accessing dental care, tensions between traditional practices and health services were identified. While 66.7% perceived health professionals as respectful of cultural traditions, 33.4% reported neutral or negative attitudes. This perception of professional stance toward cultural practices was associated with a higher occurrence of gestational complications (p = 0.0498). A total of 57.8% of participants reported experiencing at least one gestational complication. Nevertheless, 90.6% did not report difficulties accessing neonatal services. Although cases of previous fetal or neonatal death were limited (4.7%), they underscore the need for vigilance. Discussion: The findings reveal a complex interconnection between social determinants, cultural practices, and maternal health outcomes experienced by quilombola women in Santarém. Direct engagement with these communities highlighted that the diversity in educational levels—especially the prevalence of low schooling—combined with the high rate of unemployment and predominance of low income, reflects structural vulnerabilities that affect and compromise gestational care. Although most women reported receiving family support and some level of prenatal guidance, the data indicate that such coverage alone does not ensure adequate or effective follow-up. Significant gaps persist, both in the cultural sensitivity of healthcare professionals and in the continuity of care. Conclusion: The study emphasizes the urgent need for strategies that promote more humanized and culturally sensitive obstetric care. The findings suggest that even when primary care services are available, their actions do not always align with the specific cultural and social realities of these women, which limits the effectiveness of maternal health interventions.

Introduction: Gestational Hypertensive Syndrome (GHS) is one of the leading causes of maternal mortality in Brazil, accounting for the high rate of perinatal deaths and the significant increase in premature neonates at high risk of sequelae. According to the Brazilian Network of Studies on Hypertension in Pregnancy (RBEHG), it can be divided into five forms: chronic arterial hypertension, gestational hypertension, preeclampsia/eclampsia, chronic arterial hypertension superimposed on preeclampsia, and white coat hypertension (Peraçoli et al, 2023). Objective: To analyze the defining characteristics and factors associated with the occurrence of hypertensive syndrome in postpartum women in the state of Pará. Method: This is a descriptive, epidemiological, cross-sectional study with a quantitative approach. The study population consisted of 100 postpartum women hospitalized with Hypertensive Syndrome in the Postpartum Units of the Fundação Santa Casa de Misericórdia do Pará – FSCMP, located in Belém-PA. Data collection took place in April and May 2025 through a questionnaire and a documentary data collection instrument. Data analysis was conducted using descriptive and inferential statistics with the software Bioestat 5.3, applying the Chi-square test and the Kruskal-Wallis test, considering p ≤ 0.05 as significant. Results: The epidemiological profile of postpartum women with hypertensive syndrome in the state of Pará shows that the majority were between 18 and 38 years old (93%), single (40%) or in a stable relationship (30%), had completed high school (57%) or incomplete high school (13%), and self-identified as brown (71%). Regarding occupation, 42% were housewives, and 61% had an income of up to two minimum wages. The majority were from Belém (30%) and Ananindeua (10%). The main risk factors identified in the postpartum women were: 81% had a family history of hypertension, 67% were obese, 61% were multiparous, and 35% had a family history of diabetes. A progressive increase in BMI was observed, which went from 29.7 (25.5–33.3) in the 1st trimester to 33.0 (29.7–37.01) in the 3rd trimester, indicating significant weight gain. Statistically significant differences in systolic and diastolic blood pressure were observed between the 1st and 3rd trimester (p < 0.05) and between the 2nd and 3rd trimester (p = 0.05). Forty-nine percent of postpartum women used antihypertensive medications, while the majority (74%) did not use acetylsalicylic acid (ASA) or calcium prophylaxis. Cesarean delivery was predominant (90%), and after delivery, 72% were discharged in good condition, while 28% required admission to the Intensive Care Unit (ICU) postpartum. Regarding the number of prenatal consultations, 59% had between seven and 12 consultations. In the third trimester, preeclampsia became the predominant condition (97%), with one isolated case of eclampsia (1%). Conclusion: The profile of postpartum women with GHS in Pará is composed of young, low-income women, with a moderate level of education, self-identified as brown, single, obese, and with inadequate nutrition. Given these results, the importance of quality prenatal care is emphasized. Qualified care during consultations is necessary, focusing on the early identification of maternal and fetal health problems.

Laparoscopic surgery has been considered a technological innovation that emerges as an
alternative to surgical, diagnostic, and therapeutic procedures. Laparoscopy is a minimally
invasive surgical technique in which small incisions are made in the abdomen to allow the insertion of a laparoscope, a surgical camera, and other surgical instruments. With so many
advantages, new challenges have arisen, including the establishment of guidelines for the safe processing of instruments and their complex accessories. To ensure the safety and
maintenance of the quality of laparoscopic materials, the Central Sterile Supply Department (CSSD) plays a crucial role in the Processing of Health Products (HPD). In this context, the study addressed the construction of a serial album as an educational technology aimed at the handling of laparoscopic materials in the CSSD. Its objective was: To evaluate the usefulness of a serial album as an instructional technology, developed for the handling of laparoscopic materials, from the perspective of nursing professionals in the CSSD. A descriptive and
methodological study was developed, structured as an integrative review, prototype development, and data collection with 15 nursing and nursing technician professionals working in the Central Sterile Supply Department (CSSD). Interviews were conducted using
lexical analysis in IRAMUTEQ, revealing seven thematic classes related to the clarity,
organization, applicability, and potential for improvement of the material. The results demonstrated high acceptance, highlighting the album's contribution to understanding the instruments, standardizing processes, and strengthening professional practice, with specific suggestions for visual enhancement and inclusion of videos. The study concludes that the serial album constitutes an effective instructional technology, capable of improving the handling of laparoscopic instruments and strengthening safety, autonomy, and continuing
education in the Central Sterile Supply Department.

Introduction: Vaccination is one of the central pillars of public health, responsible
for preventing immunopreventable diseases and providing collective protection.
However, vaccine hesitancy and the spread of misleading information have
compromised adherence to immunization campaigns in Brazil. From Vygotsky’s
socioconstructivist perspective, attitudes and perceptions about vaccines are
socially constructed and mediated by cultural, linguistic, and symbolic interactions,
which underscores the need for accessible, contextualized educational
technologies sensitive to the realities of users of the Brazilian Unified Health
System (SUS). Objective: To evaluate a vaccination guide for SUS users in light
of socioconstructivist theory. Method: This is a methodological study conducted in
two complementary stages: semantic evaluation, carried out with primary health
care users through a structured questionnaire, and readability assessment using
the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) formulas.
Data collection took place in the vaccination room of the Centro de Saúde Escola
do Marco, with 20 service users from different educational levels, ensuring
sociocultural diversity. The study fully complied with the ethical guidelines of
Resolution 466/12. Results: The material showed high acceptance among
participants, with an overall semantic validation index of 94.6% and agreement
above 93% in all evaluated domains, particularly organization and structure
(95.6%), motivation (94.5%), and linguistic characteristics (94.4%). Readability
was classified as “fairly easy to read” (FRE = 76.2), requiring a comprehension
level equivalent to complete elementary education (FKGL =
7.9). Conclusion: The results confirm that the guide is a clear, socially relevant,
and potentially effective educational technology to support health education
actions, reduce vaccine hesitancy, and strengthen the protagonism of SUS users,
especially in the Amazonian context, contributing to greater communication equity
and improved adherence to the vaccination schedule.

Introduction: The covid-19 pandemic highlighted the vulnerability of pregnant and postpartum women and negatively affected maternal mortality reduction. The lack of specific data on factors associated with covid-19 in this group in Pará, Brazil, motivated this study. Objective: To analyze factors associated with covid-19 among pregnant and postpartum women confirmed by RT-PCR in Pará, from 2020 to 2023. Methodology: This is a retrospective, cross-sectional epidemiological study using secondary data from the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) and the Live Birth Information System (SINASC) of Pará, from 2020 to 2023. Pregnant and postpartum women residing in Pará, with RT-PCR confirmation and recorded outcomes, were included. Descriptive analysis was performed using absolute and relative frequencies. Associations were assessed using the Chi-square or Fisher’s exact test and Odds Ratios. Binary logistic regression was applied to identify factors associated with death. A significance level of 0.05 was adopted. Results: Women who progressed to maternal death due to SRAG associated with covid-19 were predominantly of mixed race, in the postpartum period or in the third trimester of pregnancy, and had low educational attainment. A high proportion of unvaccinated women was observed. Respiratory symptoms, especially respiratory distress and oxygen saturation below 95%, as well as fever and vomiting, showed significant association with death. The category “other morbidities” also remained significantly associated. Binary logistic regression demonstrated higher risk among postpartum women (OR=3.58) and in the presence of oxygen desaturation (OR=2.48), whereas vaccination (OR=0.246) and nonspecific symptoms (OR=0.207) acted as protective factors in Pará, Brazil. Conclusion: Maternal deaths due to covid-19 in Pará were more prevalent among postpartum women, mixed-race women, those with low educational levels, and unvaccinated individuals. Respiratory distress, oxygen desaturation, and the presence of other morbidities were the main predictors of fatal outcomes. Vaccination demonstrated a significant protective effect. The study highlights the need to strengthen epidemiological surveillance, improve postpartum care, and expand immunization campaigns targeting socially vulnerable populations to reduce maternal mortality associated with covid-19.

Introduction: Post-Covid-19 Syndrome can cause significant impacts on human health, causing
greater suffering due to the emergence of sequelae that delay the disappearance of the initial clinical
picture of the pathology, thus triggering changes in the nervous and musculoskeletal system, as well
as the impairment of other vital tissues such as the heart and respiratory tissues. Objective: To
evaluate the Functional Status and the impact of Post-COVID-19 Syndrome on the quality of life of
quilombolas in the municipality of Santarém. Methodology: This is a field study with a quantitative
and transversal approach. The research was carried out in the quilombola community of Tiningu,
located approximately 45 kilometers from the municipality of Santarém-Pará. Data collection took
place from August to September 2023, and the selection of participants occurred randomly, for
convenience. 25 quilombola communities participated in the present study. For data collection, a
questionnaire was used covering questions about sociodemographic characteristics and validated
instruments for the purpose of evaluating the quality of life and Post-Covid-19 functional status of
study participants, such as: Scale Fatigue Assessment Test (EAF), 1-minute Sit and Stand Test (TSL),
and the HAD Scale - assessment of the level of anxiety and depression. Data analysis was carried out
using descriptive statistics (absolute and relative frequency) and inferential statistics, using SPSS 20.0
software, using the Poisson regression test. The study was approved by opinion N: 6,391,280 from
the Research Ethics Committee (CEP). Results and discussion: Demographic analysis reveals
diversity in quilombola communities, with male predominance, racial, religious and socioeconomic
variability. HAD Scale responses highlight a significant range of emotional experiences, highlighting
complexities in post-COVID-19 mental health. Participants reported a significant prevalence of
extreme fatigue, mental confusion, and limitations in functional capacity. Inferential statistical
analysis identified significant associations between fatigue levels and health perception, highlighting
the heterogeneity of the experiences of individuals affected by post-COVID-19 syndrome. A high
occurrence of anxious and depressive symptoms was also revealed among post-covid patients, with
significant implications for the perception of health, quality of life and the influence of socioeconomic
factors, such as social support and educational level, on the experience of the syndrome. post-covid.
Final considerations: Finally, specific measures need to be adopted to meet the needs of quilombola
communities in the Amazon, such as: Psychosocial intervention programs, easier access to mental
health services and the implementation of community support networks are fundamental. In addition,
the need for holistic strategies to face the challenges posed by Post-COVID-19 Syndrome was
highlighted, thus emphasizing the importance of understanding the multiple facets of this condition
and mobilizing resources to ensure a complete and inclusive recovery for all affected. Furthermore,
the importance of future research is recognized to expand the understanding of these impacts and
develop effective interventions, ensuring that everyone has access to healthcare in the post-covid-19
syndrome, especially in quilombola communities and collectives.

Introduction: Among the different types of cancer, colon and rectal cancer is among the 10 most prevalent in both sexes. This type of cancer is growing rapidly in the population, which leads us to seek to identify its causes and consequences in the lives of those affected by it. Objective: To validate an educational technology on self-care of peristomal skin of cancer patients with intestinal ostomy. Method: validation study of educational-care technology of the methodological research type with a quantitative approach, aimed at validating the content of the produced technology (educational video) and proposing the applicability of this technology to a focus group of ostomized patients in a timely manner. The research is divided into 2 moments: 1) Online: validation of the produced technology with experts via Google forms and; 2) In-person with patients: applicability of the technology in a focus group of patients with colorectal cancer with intestinal ostomy and hospitalized at the Teaching Hospital, a public, medium and high complexity, reference in oncology in the city of Belém-PA. In the present study, moment 1 was followed. Moment 2 will be applied in a timely manner, in a continuity study. Results: The sample of participants in this research was made up of 14 specialists, most of whom had a master's degree (57.1% (n = 8), with experience in stomatherapy (50% (n = 7), oncology (21.42% (n = 3)) and other areas of care (28.58% (palliative care n = 1, family health n = 2 and Intensive Care Unit (ICU) n = 1). Regarding the “objectives” domain, after calculating the IVC, we observed a variation between 0.78% and 1% of agreement, with the average between them corresponding to 0.88% of agreement among the judges, in accordance with the minimum value stipulated in this research. Regarding the “structure and presentation” domain, the IVC values varied between 0.71% and 1%, with the average value being the 0.83% agreement index among the specialists. Finally, in the “relevance” domain, we reached an agreement variation between 0.71% and 0.92%, with an overall average CVI of 0.79%, considered below the minimum value stipulated in this study and reflecting the experts' statements regarding the necessary changes that would need to be made so that the technology would in fact become more suitable for circulation in scientific circles and as a tool to aid in health education for patients with intestinal ostomy. After analyzing the data and applying the Content Validity Index calculation, we obtained an overall CVI of 83%, a value that is within the percentage stipulated as acceptable in this research. The technology produced showed satisfactory agreement among the experts, but with recommendations for some adjustments in the structure and content of the video presented. Conclusion: The educational video was considered valid by the participating experts. The validation process goes far beyond numbers obtained in a table. It was essential for the product to be able to show its best version of all the points covered, from the visual aspect to the content itself, with the intention of offering the public quality and reliable material regarding the objectives it proposes, which in this case is health education for cancer patients with intestinal ostomy. With all the research carried out and with the adjustments suggested by the experts and accepted, and made by the author, it is believed that the video can be used in a focus group with the target audience and, later, made available so that patients and professionals can use it as a tool to assist in their care

Introduction: information on the prevention of the Human Immunodeficiency Virus (HIV) is essential to guarantee quality health for the population. Young men stand out as a key population, due to the increase in the HIV detection rate, their health practices, the vulnerable conditions to which they are subject and the increasing technological development in the dissemination of information. Therefore, it is necessary to understand the subjectivities that lead them to reflect on the information accessed and attribute meanings to them, incorporating them into their daily lives, making them familiar, which indicates that this is an object of social representation, capable of being analyzed in light of the Theory of Social Representations. Objectives: to understand the social representations of young men regarding information for HIV prevention; and describe the implications for the preventive practices adopted by them, in light of these representations. Method: descriptive study, with a qualitative approach, based on the procedural aspect of the Theory of Social Representations. Held at the Maria&Marias institute, in the Guamá and Terra Firme neighborhoods, in Belém, Pará, Brazil. 60 young men, aged 18 to 24, registered at the institute participated. Individual audio-recorded interviews were carried out, using a semi-structured script to understand the sociodemographic profile and explore the object of study. The interviews were transcribed to compose the corpus, submitted to lexical analysis with the software Interface de R pour les Analyzes Multidimensionnelles de Textes et de Questionnaires, version 0.7, alpha 2, through descending hierarchical classification. The data were interpreted based on the Theory of Social Representations and the relevant scientific literature. Results: among the participants, the age of 18 predominated (n=12; 20%), 28 (46.7%) lived in Guamá and 32 (53.3%) in Terra Firme, of which 47 (78.3%) %) had lived there since birth. The corpus consisted of 60 texts and 1,294 text segments, with 94.3% use, generating five lexical classes. To understand the process of formation of young people's social representations, these classes were organized into three thematic axes: “Information about HIV: possibilities and limitations”, with classes 5 and 2; “Repercussions of information about HIV infection”, with class 1; and “Preventive practices: meanings attributed to information”, with classes 3 and 4. Final Considerations: social representations pointed out that information about preventing HIV infection is multifactorial, permeated by reified knowledge, focusing on school, and the consensual universe, focusing on the home environment. They carry stigmas that make prevention difficult and have a multiplicity of meanings, with fear being the main feeling, but it makes it possible to understand the need to protect oneself from the virus. The fragility of the combined prevention model adopted by the Ministry of Health to reach this public was also identified, expressed by low access to information, prejudices in interpersonal relationships and hegemonic masculinity. It is noteworthy that adapting communication should be a priority as a strategy to reach young people, to achieve global goals to combat HIV.

This study aimed to validate an educational video on clinical screening for blood donors by evaluating the content and appearance of experts, as well as acceptance by the target audience. This is a methodological study with a quantitative approach carried out in a reference blood center in the State of Pará and with the University of the State of Pará as its anchor institution. Validation was carried out in three stages. In the first, it was submitted to the assessment of 8 health specialists, in which the Cronbach's Alpha statistical reliability test was used as a criterion for stopping the number of content specialists, in the second 8 specialists in the field of design, advertising and journalism and in the third 17 blood donors. For content specialists, the 4-point Likert scale was used as a data collection instrument, for appearance specialists the adapted SAM instrument and for the target audience an adapted Galdino instrument. As a result of the first stage, all blocks achieved a CVI of 1.0, in the second stage, SAM scores were evaluated between 69.2% and 100%, and in the third stage, an agreement rate greater than 75% was achieved in the positive responses evaluated. It is concluded that the study achieved its objective by validating an educational video on clinical screening for blood donors by experts and the target audience, justifying the importance of using validated educational technologies as a way of assisting the educational process for which it was proposed

Introduction: The focus of this study is the content validation and heuristic usability evaluation of a mobile technology on congenital heart disease to mediate the continuing education of professionals in a neonatal unit, with the purpose of explaining the main clinical characteristics presented by the newborn due to established congenital heart disease, as well as the main nursing care interventions. Studies on mobile devices point to it as a technological revolution with the greatest impact today, after the revolution caused by the internet and social networks. Objective: To evaluate the evidence of content validity and the usability of a mobile technology in the form of an application on congenital heart diseases to mediate the continuing education of professionals in a neonatal unit. Methodology: This is a usability validation and evaluation study based on methodological research and Nielsen's heuristics (1994), with a quantitative approach, developed with 4 Stages: content validation; suitability of the application (second version); usability heuristics; correction of usability problems. The study had as its anchor unit the Neonatal Intensive Care Unit of a Public Hospital Reference in cardiology in Belém- Pará and took place from July 2023 to March 2024. 13 content experts from the health area participated in the content validation process. Data collection was through a questionnaire formatted by Google Forms, and structured according to the Likert scale, applied to health specialists. For the analysis, the Content Validation Index was calculated. In the usability evaluation process, 5 usability experts from the computing and designer areas participated. They responded to Krone's adapted form. The index scale was measured, and the heuristics were analyzed and the heuristic severity index was calculated. Results: in the content validation stage, according to the agreement of the experts' responses, an overall CVI of 96.5% was obtained. The Cronbach's Alpha of all items in the blocks was >0.90, classified as very high reliability. Changes were made to the second version of the application, according to the suggestions of content experts, adapting the design and colors and improving certain scientific information, such as replacing the term hypertrophy with right ventricular dilation in the context of the topic of signs and symptoms of atrial communication. Present in the application. In the evaluation of the usability heuristics, no serious or catastrophic error was found in any of the 10 heuristics evaluated, with the highest value being IGH 2.5, which characterizes a small error, resulting in a second functional version of the “My little cardiac heart” application. Final Considerations: the application showed evidence of significant validity and after correcting the errors found in the usability heuristics, a viable version for use of the application was found, demonstrating that it is viable to mediate the ongoing education of professionals in a neonatal unit. The expectation, in this sense, is that the “My Little Heart” application will provide intensive care professionals with necessary information in a practical way to optimize their care planning for newborns with heart disease and support the team in making the best decision

Introduction: Exposure to Hg can cause intoxication in addition to serious damage to maternal and fetal health, affecting the cardiovascular, genitourinary, central and peripheral nervous, respiratory and musculoskeletal systems. In the fetus it can develop neurological problems, in the mother it can cause insomnia, irritability, apathy and cognitive difficulties due to its teratogens. Objectives: to analyze the clinical-epidemiological profile of pregnant women exposed to Mercury, in the municipality of Santarém Pará. Method: This is an observational, descriptive study, of quantitative investigation and of an analytical and exploratory nature. As for its technical procedures, it can be classified as bibliographical, field and laboratory research. As for its development over time, it is a cross-sectional study, with research data acquired from short-term analyses. The study was approved by the CEP under opinion number 6,042,366 and CAAE: 68121023.7.0000.0171, complying with the health guidelines proposed in Resolution No. 466 of 2012. The target audience, women aged between 18 and 59 years, pregnant women from the 2nd week of pregnancy. Results: 51 pregnant women participated in the study, the predominant age group being 21-40 years old (86.3%), self-declared mixed race 78.4% (n = 40). The majority (76%, n= 39) had degrees of education up to the 9th year of study, 41.2% were above the considered safe limits of HgT in the blood and 15.7% in the hair, presenting average HgT levels of 7.71 μg/L, and a maximum of 24.95 μg/L, above that recommended by the US EPA. Regarding the characteristics of pregnant women, mercury in (blood) 35% with high exposure (Hg = 24.95 μg/L) and mercury (hair) 14% with high exposure (Hg = 17.17μg/L). Correlating age group and gestational age with mercury levels in blood and hair using Spearman's r 1) Hg levels in blood and age, (2) mercury levels in hair and age, (3) mercury levels in blood and gestational age, (4) of Hg levels in hair and gestational age, there was a positive correlation, but not statistically significant in both results. Discussion: : There are few studies on mercury exposure in pregnant women in our region. Mainly about the results above the safety limits established by the EPA, this study being the pioneer in this topic related to exposure to mercury in pregnant women in the municipality of Santarém-Pa and diseases correlated to exposure and the damage it can cause to the endocrine system such as Hypertension, DM, Metabolic Syndrome, cardiovascular and neurological problems. Final considerations: This study shows values relating to the amount of mercury in the body of pregnant women, which are high and harmful during the gestational period, which requires attention from the health system and the government, due to the damage that exposure can cause to health. Nursing in primary health care, during prenatal care, must analyze the dietary profile of pregnant women, the origin of the water consumed and for personal use, which foods are being consumed as sources of protein. Regarding care, it is essential that nursing supports pregnant women, analyzing signs and symptoms, and assisting researchers in the development of research projects on exposure to mercury.

Introduction: The Amazon region, with its vast expanse and socio-environmental complexity, faced unique challenges in the context of the COVID-19 pandemic. Within this context, the riverine communities of Pará stand out as priority areas of attention due to their remote location, limited access to health services, and specific population characteristics. In this scenario, the actions of Primary Health Care services played a fundamental role in combating COVID-19 in the Pará riverine community. Objective: The objective of this study was to investigate the actions of Primary Health Care services in addressing COVID-19 in the Pará riverine community. Methodology: This is a descriptive and exploratory case study with a qualitative approach, conducted with health professionals from the Arapixuna Riverine Family Health Unit – Santarém-Pará. Twelve health professionals who worked in combating COVID-19 in the riverine community between March 2020 and March 2022 participated in the study. Individual interviews were conducted using a semi-structured script, aiming to understand the sociodemographic/professional characteristics of the participants and explore the health services’ actions provided to riverine users in the fight against COVID-19. The interviews were transcribed and subsequently analyzed using Laurence Bardin’s Content Analysis. The study was approved under the CEP approval number: 6.148.106. This research takes an interdisciplinary perspective, engaging with Education, Geography, Political Science, Epidemiology, and Environmental Sciences, emphasizing the relationships between various fields of study and highlighting the necessary connection between human beings and the environment in which they are situated. Results: Among the participants, the majority were female (66.7%) and aged between 37 and 49 years. Most participants (91.7%) did not have another paid job, while 8.3% reported having another occupation. Regarding other variables, 41.7% reported having contracted COVID-19, 58.3% did not experience the loss of someone close due to COVID-19, and 41.4% considered leaving the profession. The results allowed for the construction of three thematic categories: Category 1: Health service actions related to health promotion, prevention, and protection carried out in the riverine community, including awareness campaigns on hygiene and social distancing, distribution of personal protective equipment, use of masks, and hand sanitizers. Category 2: Health service actions related to diagnosis, treatment, rehabilitation, and health maintenance developed in the riverine community, highlighting strategies for monitoring and follow-up of COVID-19 cases, as well as the adaptation and reorganization of primary care services and the continuity of care for users. Category 3: Health service actions related to epidemiological and sanitary surveillance carried out in the riverine community, which implemented continuous monitoring systems, facilitating the adoption of effective preventive strategic measures. Final Considerations: Health service actions in Primary Health Care were crucial in addressing COVID-19 in the Pará riverine community. This study revealed a series of initiatives and strategies adopted by primary health care services to tackle the challenges presented by the COVID-19 pandemic in Pará’s Amazonian riverine community, ranging from the implementation of preventive measures and establishment of protocols to the reorganization of health services to ensure long-term access to continuous health care.

Perioperative nursing accompanies the patient from the decision to undergo surgery until hospital discharge. The nursing team will provide information about the surgical process and the necessary care in the pre-, intra- and post-operative periods. The pre-operative period is divided into mediate and immediate periods, and this is the ideal time to provide care and guidance regarding the patient's surgery. Therefore, the objective of this research is to “Validate a technology in checklist format, on nursing care for the patient in the immediate pre-operative period”. This is a methodological study with a quantitative approach, and the participants were judges with expertise in perioperative nursing, at the Ophir Loyola Hospital, where they received an invitation letter, followed by the TCLE, checklist and validation form after approval by the ethics committee. The result was satisfactory for the modification of the constructed checklist. Conclusion: The checklist validation process goes through several stages, one of which is the understanding of what may be usual in hospital practice, in day-to-day life, where demands are high and what we find in the literature.

Introduction: The practice of health education for pregnant women supported by Educational Technologies can enhance nursing care. Educational Technologies in the format of games emerge as a promising strategy for promoting patient understanding, engagement, and self-care in health education activities. Games with specific goals, known as Serious Games, have a defined purpose and offer opportunities to generate behavioral changes. However, for them to be effective, it is essential to present an engaging design, undergo alpha testing, and validation processes. Objective: To evaluate an educational technology in the form of a serious game named "My Birth Show" aimed at promoting women's empowerment and protagonism in the gestational process. Method: This is a methodological study with a mixed approach focused on evaluating a serious game. It was developed in four stages: redesign, alpha testing, content validation and adjustments after content validation, culminating in version 3.0 of the game. The redesign stage was carried out by the researcher. In the alpha testing stage, five members of the "Gamification Applied to Teaching Methods and Health" Research Group participated, and theoretical thematic analysis was used to obtain the results. Content validation involved 16 experts in areas related to women's health care, using a Likert scale questionnaire and performing descriptive statistical analysis, along with content validity index (CVI) analysis and Cronbach's alpha. Results: In the redesign phase, version 1.0 needed to be revised and improved to enhance its playability and appearance, resulting in version 1.1. After two alpha testing sessions, thematic areas requiring revisions and improvements were identified, including the game dynamics, mechanics, components, and interaction between the game and the player, leading to versions 2.0 and 2.1. Regarding content validation, a general CVI of 93.6% was achieved, and the content was considered validated, resulting in version 3.0 of the "My Birth Show" game. Conclusion: The game presents itself as a promising tool for perinatal education, offering potential benefits for both nursing and pregnant women. For nursing, the game provides an innovative and playful approach, facilitating the interactive transmission of knowledge about pregnancy and childbirth. For pregnant women, the game is expected to contribute to their empowerment through evidence-based information presented in an accessible and non-intimidating manner. Therefore, this study should be expanded with further research to allow for semantic and usability validation with the target audience, as well as experimental or quasi-experimental studies to test the application of the serious game in the context for which it was designed.

Introduction: Quilombola adolescents live with social vulnerabilities related to their place of residence, with less access to formal education and health services. It is of fundamental importance to approach this public, moving towards a liberating perspective by strengthening the participation of quilombola adolescents in confronting social determinants. Based on this context, educational technology can be one of the best ways to guide the expansion of interventions for prevention and health promotion. Objectives: Identify themes related to health promotion in adolescence in a quilombola context; and build an educational technology in comic book format with quilombola adolescents. Method: Methodological research with a participatory interface, based on Freire's dialogical theory, carried out in Quilombo América, municipality of Bragança-Pará. 15 quilombola teenagers who attended collective actions of the Remnant Association of the Quilombola Community of America participated. Data collection took place in two stages: Stage 1) Diagnosis of the experiences of quilombola adolescents in self-care, which made it possible to choose the essential topics for Educational Technology; Step 2) Production of storyboards. For data collection, a semi-structured interview guide was used to guide the focus groups. The interviews were transcribed and subsequently analyzed with the software Interface de R pour les Analyzes Multidimensionnelles de Textes et de Questionnaires, version 0.7, alpha 2, using descending hierarchical classification. Results: Through descending hierarchical classification, the texts (n=10) were divided into 228 text segments, with 190 (83.33%) being used, generating five lexical classes, organized into three thematic axes: “Conceptions of adolescence ”, with class 1; “The constitution of identity aspects in the experience of recognizing one’s health”, with classes 1, 2 and 4; and “Experiences of contact with the health service and use of educational materials for health promotion” with class 3. Based on the interpretation of the thematic axes, a diagnosis of the main elements highlighted by the adolescents was prepared, considering Freirian principles of coding and decoding, allowing them to be worked on in the workshops to construct the plots of four comic strips and co-creation of the Educational Technology entitled “Quilombo Gang: our history, our health”. Final considerations: The educational technology created using dialogical strategies with quilombola adolescents reaffirms approaches that dialogue with the cultural universe and provide opportunities for health education practices to form criticism about the reality in which they are inserted, so that they can become a human being. autonomous and emancipated. Valuing the broad expression of knowledge, experiences and attitudes carried out in everyday life, and reinforcing the health-promoting aspects present in the community's cultural tradition

Introduction: Among the complications that can occur during pregnancy, one of the most  common is related to Gestational Hypertensive Syndromes. Among the complications arising  from this Syndrome, one of the most serious is HELLP Syndrome. In order to take care of these  complications, we have health technologies, which are tools that assist in assistance and  comprise a group of protocols, systems, techniques, devices and everything that can be  implemented to contribute to the provision of care and improvement of professional assistance.  Objectives: To build an assistance technology to mediate the care provided by obstetric and  intensive care nurses to patients with HELLP syndrome. Methods: This is a methodological  research, with a qualitative and descriptive approach, carried out in three stages: integrative  literature review, interview with obstetric and intensive care nurses and synthesis and  composition of the assistance technology of the flowchart type. The research was carried out at  the Santa Casa da Misericórdia Foundation with nurses with experience in caring for high-risk  pregnant women. The data were analyzed using the Bardin method, with the aid of the Iramuteq  software. Results and discussion: Six articles were evaluated in the integrative review, which  generated two categories: “signs and symptoms of HELLP syndrome and treatment” and  “nursing care for pregnant women with HELLP syndrome” and Twenty-seven nurses were  interviewed, and after textual analysis using the Reinert method, three main categories emerged:  “Difficulties and complications encountered by nurses in the care of patients with HELLP  syndrome”, “Nursing care for pregnant women with HELLP syndrome” and “Nurses'  knowledge about HELLP syndrome”. Through the analysis of the interviews together with the  results found in the RIL, it was possible to construct a flowchart to assist in the care of pregnant  women with HELLP syndrome. Final considerations: The RIL process was necessary to  collect important data from the literature that should be highlighted in the care of pregnant  women, and the nurses' experience and time in practice were essential for the construction of  this flowchart. The instrument that originated from this research will be to help the nursing team  to provide systematic and holistic care to pregnant women with HELLP syndrome, in order to  remember important points to be evaluated and strategies to be followed during nursing care.

Introduction: CRF, which was once attributed to population aging, is now frequently diagnosed at crucial stages of development, such as childhood and adolescence, and continues to accompany the individual throughout their lives. When it occurs in young women, it brings with it several peculiar concerns, as they will have to live with the changes, losses and the process of subjectivity attributed to the illness and will also have to manage aspects involving professional concerns, emotional relationships, motherhood and others. Thus, the usefulness of approaching young women was realized. Objective: understand how the meanings attributed to the experience of young women with chronic renal failure have materialized in their speeches; identify the impacts that chronic renal failure and dialysis therapy have had on the lives of young women; identify the discursive formations mobilized in the speech of young women with renal failure and analyze the meanings and feelings attributed by young women with chronic renal failure regarding the treatment. Method: this is an exploratory, descriptive study with a qualitative approach, based on the Sensitive Creative Method (MCS), within the dynamics of art and creativity "Lifeline" and "Body Knowledge" adapted in the settings of the Renal Replacement Therapy Services of the State Public Foundation Hospital Clínicas Gaspar Vianna and the Monteiro Leite Hemodialysis Clinic annex, both located in the city of Belém. Fifteen participants aged between 21 and 40 years participated in the study. The data produced were analyzed in the light of French Discourse Analysis (FDA). The position of women when confronted with CKD was explained in the light of Paulo Freire and Callista Roy. Results: the young woman's discourse revealed the dialectics of a daily life affected by CRF; the disease crosses adaptive modes in different components and becomes a contender for the construction processes in all phases of the young woman's life. In the physiological mode, the permanence in dialysis added to clinical complications and comorbidities are elements that hinder access to transplantation, interfering with the desire for pregnancy; in the self-concept mode, the physical changes impact on the self-image and self-image, promote changes in self-consistency and have repercussions on social relationships and the support network, which can make CRF a heavier burden. The inferences of CRF generate and awaken somatic elements, contained in the subjectivity that culminate in the desire for death, in a context in which mothers and children are motivating elements for the young woman not to give up on life. Final considerations: the impacts promoted on the life of young women on dialysis are processed through aspects that go beyond the need to adhere to diet, treatment and prescribed medications and slide through the assimilation and implication of the desire to become pregnant, undertake business, transplant and the issues of identity and gender that are little discussed in effective adaptation. This problem would be resolved by strengthening specific public health policies, the organ procurement network and the involvement of health professionals, including nurses, with an education strategy that includes inclusive issues on sexuality, reproductive rights, femininity and other issues related to women, in order to break the cycle of oppression in which young women on dialysis are trapped.

Policies and measures need to be discussed, expanded and applied to support the fight against cancer, with a view to reducing the inconveniences suffered, especially by women who have undergone mastectomies. It is understood that Nursing can, in its practice, contemplate the expectations and needs of these women, through Nursing consultations guided by care guidelines, ensuring physical, emotional and spiritual safety, and favoring self-care interventions among women. There is a need for new support devices for women, with a view to creating a constructive dynamic of knowledge. There is also a need for greater coordination of rehabilitation care after the clinical discharge of women who have undergone mastectomies, in order to guarantee continuity of care and personalized monitoring in the adaptation process from the perspective of rehabilitation care in the community. An application can be a useful resource for both nursing professionals, who will have educational and didactic material to complement the guidance given to women during the processes involving mastectomy, and for users who will have information at home that they can consult whenever necessary. Objective: to develop a prototype of a mobile application for self-care in the pre- and post-operative periods of mastectomy. Method: this is a development research based on the evidence-based production modality. The study was developed in three stages. In stage 1, evidence was obtained through an integrative review; in stage 2, to develop the prototype content, the domains of care were mapped with a view to developing care and self-care interventions; in stage 3, the mobile application screens were prototyped. Results: in the first stage, an integrative review was conducted and a sample of 26 articles was obtained. In the second stage, the prototype content was outlined according to the four domains of care: physical, psychological, social, and spiritual, both for the pre- and post-operative periods. For each domain, the care interventions to be performed by the nurse to encourage self-care interventions among women were indicated. The application was called “MeuPlas”. It contains a start screen, presentation screen, login screen, publication feed screen, appointment schedule screen, clinical trajectory mapping 7 screen, guidance records according to the domains mapped in the literature, among other relevant functions. The screens are available on the Adobe xd Platform, a design platform. Final considerations: the evidence-based production approach proved to be promising, as the thematic axes that enabled both the mapping of the care domains and the organization of current care and self-care interventions ratified by the literature were identified. The mobile application prototype, after validation and evaluation, may contribute to the educational processes performed by nurses and to women's self-care in the pre- and post-operative period of mastectomy.

Malaria, a neglected infectious disease, is a serious public health problem in several countries around the world, especially in developing countries. It mainly impacts human groups that are most socially and economically vulnerable. In this context, the present study aims to analyze the spatial distribution of malaria among indigenous people, correlating it with deforestation. This is an ecological study, with a quantitative approach, carried out with 24,946 cases of malaria in indigenous people, reported to the Epidemiological Surveillance-Malaria Information System. Indigenous population data from the Special Secretariat for Indigenous Health were used. Descriptive statistical analysis was performed using the R Core Team statistical package, version 4.1.1. Next, the Annual Parasitic Incidence of malaria was calculated by Special Indigenous Health District. Afterwards, inferential analysis of simple linear regression, considering a significance level of 5%. Next, malaria cases were related to the geographic location values of each infection location. The thematic maps were built using the QGis software version 3.16. Pearson Correlation analysis was carried out to investigate the relationship between annual deforestation and the number of malaria cases. The study showed a higher occurrence of malaria in males, among young people aged 20 to 29 years and in people with incomplete primary education. The clinical form of the disease was caused by Plasmodium vivax and a higher proportion of diagnoses by thick drop/smear predominated. There was a growing trend in the Annual Parasitic Incidence of malaria in the Rio Tapajós District. In the Pearson Correlation analysis, a strong and positive correlation was presented in the Special Indigenous Health District Rio Tapajós, moderate and positive in Guamá-Tocantins, weak and positive in Altamira and a weak and negative correlation in Kaiapó do Pará. Such findings suggest the need redefining strategies to prevent infection, as well as improving public policies aimed at these human groups. The use of spatial analysis tools allowed the visualization of malaria patterns in indigenous people and the identification of priority areas for action

Introduction: The indigenous peoples of Brazil have the right guaranteed by the union to differentiated attention during health care, respecting their beliefs, culture, knowledge and practices. The regional CASAI have as acharacteristic the reception of indigenous people from the most varied ethnic groups, speaking approximately 200 languages in Brazil, being fundamental the valorization and preservation of these languages. Communication is the foundation for effective health care, and the success of the therapeutic process depends on it. Therefore, care-educational technologies sensitive to cultural aspects, developed from the professional praxis, contribute to  empowerment and autonomy in daily processes, ensuring support to culturally

adequate care and education practices. Objective: To semantically validate a care educational technology in the form of a mini-dictionary of indigenous dialects for multidisciplinary use in the care of indigenous people undergoing out-of-village health treatment. Method: Methodological study for semantic validation of care-educational technology, conducted in a Regional CASAI located in Belém-Pará. Twenty members of the multiprofessional team working in the institution participated. For data collection a Likert scale was used, with 19 items divided into 4 blocks: Objectives, Organization, Appearance and Writing Style, and Motivation. The answers were organized in a database and tabulated in the International Business Machines Statistics Package Social Science IBM® SPSS® Statistics, 23.0.0.0. To measure the agreement between the answers the Semantic Concordance Index (SCI) was used, calculated per block and globally, considering the cut-off point of 70%. Results: 18/90% of the participants were female, 11/55% aged ≥59 years, 11/55% nursing technicians, 5/25% nurses and 4/20% corresponding to the other professional categories (Social Worker, Nutritionist, Pharmacist and Pharmacy Assistant),19/95% had worked in indigenous health for more than one year. The evaluation of the target audience showed a variation of SCI per block between 93% and 100% and an overall SCI of 97%. Discussion: The minidictionary was considered a communication tool in the context of indigenous health, promoting well-being through an interactive environment as advocated by the National Humanization Policy in order to improve working conditions and care for the indigenous population, with the potential to transform relationships in health care spaces where this population is inserted. Conclusion: The study achieved its objective by demonstrating, through validation, that the minidictionary of indigenous languages Interlocutions with Health Professionals is suitable for use in the process of mediating communication between health professionals and indigenous people, as assessed by the target audience. 

It is evident that patients with cancer require blood transfusion, in many cases this is the only therapy capable of saving lives, in this field nursing has been gaining prominence, as it is closely linked to the transfusion process, thus, educational technologies can help in this scenario. The general objective: to build an educational technology to mediate nursing care during the blood transfusion process in cancer patients. The specifics: carrying out an Integrative Review on educational technology, nursing care, blood transfusion and cancer patients, identifying nursing care during the blood transfusion process in cancer patients and synthesizing the information obtained in the integrative review and on nursing care during the process of blood transfusion in cancer patients to compose the educational technology. It is a methodological research with a qualitative approach, carried out in two moments: the first moment was the realization of the Integrative Review, the second moment the individual interview. The databases selected to compose the integrative review were: Latin American and Caribbean Literature in Health Sciences (LILACS), Medical Literature, Analysis and Retrieval System Online (MEDLINE), Database of Nursing (BDENF) and Scientific Electronic Library Online (SCIELO). The search period for articles was from January 2016 to January 2021, using the descriptors: Neoplasms; Blood transfusion; Patient safety; Nursing Care and Educational Technology. The inclusion criteria are as follows: primary studies, in English, Portuguese and Spanish, published between January 2016 and January 2021 and available in full. Editorials, experience reports, case studies, gray literature (monographs, dissertations and theses) were excluded. 17 articles were selected to compose the review. The field research was carried out at the Ophir Loyola Hospital, 11 nurses who work in the Surgical and Hematological Clinics participated in this study. To carry out the content analysis, we used the Bardin technique supported by the IRAMUTEQ software through the method of Descending Hierarchical Classification, proposed by Reinert. Six classes emerged from the corpus and were organized into three categories: I - Main information about the transfusion act for technology composition; II- Transfusion safety from the perspective of patient safety; III - The transfusion act from the nurse's perspective. From the context, an educational technology of the booklet type was produced. It is concluded that cancer patients who receive blood transfusions need nursing care and that educational technology makes it possible to ensure an improvement in the effectiveness and dynamics of nursing care for these patients

Introduction: this is a study of construction and validation of educational technology (ET) to mediate the care of health professionals for children with gastrostomy. A gastrostomy is a surgically created feeding tract in which a catheter is inserted into the lumen of the stomach. The use of technologies by health professionals is a common practice in different practice scenarios, whether public and/or private institutions, with various technologies being made available, such as equipment/products/instruments/guides that assist in the care of children with gastrostomy, thus guaranteeing access specialized care by an interdisciplinary team that meets the specific needs of these children. Objective: to develop a guide to mediate the care of healthcare professionals for children with gastrostomy. Methods: The integrative review was developed in six stages, using the Virtual Health Library databases; Periodical Portal of the Coordination for the Improvement of Higher Education Personnel and Web Of Science, considering the period 2011-2021. 21 experts participated in the content validation stage and 24 health professionals participated in the semantic validation. For data collection, two instruments were applied with the Likert Scale, one for specialists containing three assessment blocks (objective, structure and organization and relevance) and the other for health professionals containing four assessment blocks (objectives, organization, appearance, motivation). Data were analyzed using the Statistical Package For The Social Science SPSS® version 21.0. for Windows®10, for better data elucidation. The study was approved by the Human Research Ethics Committee. Results: for the textual composition of the educational technology, the synthesis of the integrative literature review of six articles, a manual and a consensus were included, from which three thematic axes emerged: concept and indication of gastrostomy, perioperative care -pre, trans and post- surgery, gastrostomy devices). The thematic axes were used to construct the first version of the educational technology. The Content Validity Index per item was greater than 85%. Cronbach's Alpha of all items in the blocks with 95%. The Semantic Validity Index was greater than 95% per block. The main changes were editing some images and changing items. The educational technology titled “Gastroguide: device to mediate the care of health professionals to children with gastrostomy”, is considered valid by experts in the health field and by the target audience (health professionals) in terms of content and semantics, a since it obtained levels of agreement above those recommended in the literature. 

Introduction: In Brazil, it is estimated that for the three-year period 2023-2025 there will be 704,000 new cases of cancer, of which 71,730 are prostate cancer, becoming the most frequent in all regions of the country, among which is Pará, with estimate of 1050 cases for 2023. The repercussion of cancer as an incurable disease causes damage that permeates the biological scope and reaches psychocultural and social dimensions, affecting the people who experience this process. Objectives: To analyze the social representations of prostate cancer by men with this diagnosis and its repercussions on their ways of coping and self-care. Method: Research with a qualitative, descriptive and exploratory approach based on the Theory of Social Representations in its procedural approach. Participants were 31 men diagnosed with prostate cancer enrolled at the High Complexity Oncology Unit in the State of Pará. Data were produced from April to June 2022 and took place through in-depth semi-structured individual interviews. Sociodemographic data were collected using a questionnaire, which were subsequently tabulated and organized using Excel software, version 2016. The content of the interviews was transcribed in full and submitted to the ALCESTE software, version 2012. The ethical principles were respected and approved by the Committee. of Ethics in Research at the University of the State of Pará, under opinion number 5214281. Results: Men were mostly married; declared themselves Catholic; age range from 65 to 69 years; coming from the interior of the state; incomplete primary education; retirees, monthly family income between one and two minimum wages. ALCESTE generated six lexical classes, divided into two blocks: Block A- meaning the sick body and Block B- the perception of oneself with prostate cancer: a new day in a new time. The results pointed to the therapeutic itinerary of men from the initial symptoms of the oncological disease, as well as the triggering of memories with family members who had cancer, when experiencing the signs and symptoms of the disease and the side effects of the treatments, causing conflicting feelings. like the fear of finitude. Final Considerations: Understanding the way men represent prostate cancer and how they deal with this process can instigate the professional team, especially nurses, to reflect and intervene in order to meet their biological and subjective demands, contributing to coping of the disease and maintenance of hope and continuity of treatment.

INTRODUCTION: Surveillance of child development is made up of activities aimed at promoting typical development and detecting problems, it should take place from birth and include child development assessment activities, early guidance to parents. In this context, Autism Spectrum Disorder or Autism is a developmental disorder that shows signs in early childhood, around up to 36 months, with changes in behavior, functional and symbolic verbal language of the child, and there should be a screening still in childcare and screening for children who need diagnostic investigation. OBJECTIVE: to understand how nurses in their childcare practices evaluate child development surveillance and tracking of early signs of autism in children up to 3 years of age. MATERIALS AND METHODS: this is an exploratory study with a qualitative approach, carried out with 22 primary care nurses in Tucuruí, in the state of Pará. The data collection instrument was a semi-structured interview script prepared by the researcher. Data analysis was carried out through content analysis proposed by Bardin and through the descending hierarchical classification (CHD) analysis of the Iramuteq software. RESULTS: it was identified that nurses were 18 female and 4 male, aged between 23 and 62 years, the training time ranged from 1 year to 27 years and the time working in the ESFs is between the period of 8 months to 23 years. From the CHD, the analysis of the textual Corpus was carried out, where it was possible to obtain 6 classes of text segments that, at the same time, presented similar vocabulary. rereading the segments with the aim of interpreting the scenario and central theme in each of the 6 emerging classes and, based on the classes generated by CHD, 3 sub-bodies: the first aggregates the nurses' conceptions through classes 5 and 4, the second is composed of Knowledge with classes 1, 6 and 3, and the third brings together Practices with class 2, establishing connections with the object of study and constituted three categories: 1- Nurses' conceptions about child development, 2- Knowledge nurses' professionals in identifying signs of ASD and 3- Surveillance practices for screening early signs of ASD in childcare by nurses.. FINAL CONSIDERATIONS: it was evident that the nurses in the research present a conceptual confusion about child development and scarce knowledge about ASD, which subtract actions of tracking early signs of ASD in the context of childcare

The occurrence of death due to SARS has become a constant concern in the context of human health, with the Covid-19 pandemic making it necessary to constantly observe this event as an indicator of the capacity to control the disease in the territory. Objective: This study aimed to analyze the spatial distribution of deaths from severe Acute Respiratory Syndrome due to Covid-19 in Pará between 2020 and 2022. This is an exploratory ecological study, based on spatial analysis. The demographic, population and socioeconomic data of the resident population of Pará were structured and organized in order to describe the profile of the population facing or dying from SARS due to Covid-19, using descriptive statistics techniques, by absolute and relative frequencies. The Mortality Index was calculated considering the sum of deaths that occurred throughout the period. Spatial analysis was performed using qgis v3.8.1. and, within it, the 23,109 cases of death were distributed by health region and municipality of residence. A higher proportion of cases were observed in males (57.27%). In the age group over 80 years old (22.43%). The brown color concentrated the largest number of cases (61.06%). Having completed high school (10.34%), had heart disease (22.67%), had Down Syndrome (0.11), Chronic liver disease (27.28%), asthmatics (42.40%), Diabetics (0.61%), Neuropath (0.36%), Pneumopath (0.84%), immunocompromised (1.27%), chronic renal disease (24.76%), obese (4.96%). As for the clinical profile, they presented fever (65.12%), cough (68.50%), sore throat (17.90%), dyspnea (78.31%), respiratory discomfort (59.69%), saturation < 95 (53.99%), Diarrhea (9.77%), Vomiting (5.50%), Abdominal pain (4.25%), fatigue (11.44%), loss of smell (4.97%), loss of taste (4.92%), ICU support (57.74%), ventilatory support (50.55%). For diagnosis, they collected a sample (75.13%), nasopharyngeal secretion (62.30%), detectable for Covid in PCR (46.40%), typical covid tomography (22.73%), immunofluorescence (35.59%), rapid test (8.58%), positive Igg (5.58%), positive Igm (6.53%), Iga (0.25%). The mortality rate was higher in 2020 (114.77/100 thousand inhabitants), in Metropolitana I (256.20/100 thousand inhabitants). It is concluded that from the study carried out, it was possible to identify the ecological pattern of the health regions most affected during the analysis period and demonstrate that the ecological pattern points to the densest ecological regions, with the need for further studies to identify the contributing factors of this profile

Introduction: a chronic infectious disease, tuberculosis is caused by bacillus of the genus Mycobacterium, a context in which latent tuberculosis infection also stands out. Due to contact with patients, certain groups are characterized by a greater risk of contracting this infection, such as nursing students. Considering the possibility of becoming infected with the bacillus during practical activities during the course, it is necessary to research the subjective issues that permeate their thoughts and practices in the face of latent infection, which, in this context, constitutes a social phenomenon, as it strongly raises awareness production of subjectivities. Therefore, it is important to understand their social representations based on what they know, think, feel and practice about this object. Objectives: to analyze nursing students’ social representations about latent tuberculosis infection; and discuss the possible repercussions of these representations in their personal, academic and professional daily lives. Method: a descriptive study, with a qualitative approach, carried out at the Escola de Enfermagem “Magalhães Barata”, Universidade do Estado do Pará. Participants were 37 regularly enrolled students, studying from the first to the fifth grade of the Undergraduate Nursing Course, and who were reactive to the tuberculin skin test. Individual interviews were carried out with a semi-structured script, in order to understand participants’ sociodemographic/academic profile and explore the object of study. The interviews were transcribed and analyzed with the software Interface de R pour les Analyzes Multidimensionnelles de Textes et de Questionnaires, version 0.7, alpha 2, using descending hierarchical classification. Results: among the participants, 24 (64.86%) were female, and their ages ranged from 19 to 40 years, with a predominance of the 19 to 23 age group (n=28; 75.68%). Through descending hierarchical classification, the texts (n=37) were divided into 1,939 text segments, with 1,686 being used (86.95%), generating seven lexical classes. Presenting different aspects that constitute students’ social representations, these classes were organized into three thematic axes: “Meaning LTBI and tuberculosis: knowledge, affections and memories”, with classes 1, 3 and 4; “Being a reactor: discovering, taking care of yourself and others”, with classes 2, 5 and 6; and “Informing to better care: challenges and possibilities in higher education”, with class 7. Final considerations: social representations indicate the repercussions of the phenomenon in students’ personal, academic and professional daily lives. From this perspective, fear appeared as the main feeling due to the fact of discovering a reactor, considering the possibility of developing tuberculosis and, therefore, facing the challenges of treatment, social stigma and the possible manifestation of a serious form of the disease. However, for them, this did not prevent them from talking about their condition with classmates, professors and family as well as with other people in the future. Given the relevance of the topic, self-care actions and the willingness to care for others were constituted as strategies to face this condition, anchored in the understanding that qualified information on the topic supports care.

The diagnosis of stillbirth is an extremely painful moment for a pregnant woman and her family. The emotional impact is profound, and in many cases, the mother can experience a wide range of feelings, including sadness, anger, guilt, and even depression. The role of nurses and other healthcare professionals is of utmost importance in the care, support, and guidance of patients, especially when it comes to mothers who have experienced the tragedy of fetal death, where the professional training of nurses plays a vital role in ensuring proper care and necessary emotional support. The aim of this dissertation was to construct a care guide to assist nursing professionals in approaching and caring for patients with fetal death. This is a methodological research of technology construction type, with a qualitative approach, which was developed in three distinct stages: Development of the Integrative Literature Review (ILR), analysis of the results, and the process of constructing the care guide. The corpus consisted of 17 texts, corresponding to the set of selected articles. The collected data were analyzed according to Bardin's proposal, with the assistance of the IRAMUTEQ software. 1,116 text segments (TS) were identified, with 857 TS utilized, totaling 76.79%. There were 40,994 occurrences (words, forms, or terms), with 5,345 distinct words and 2,604 with a single occurrence. IRAMUTEQ® dimensioned and classified the TS based on CHD, generating five classes through a dendrogram, which were organized into three categories: I-Management of technical-assistance and bureaucratic-administrative activities (Class 05); II-Nursing care - Aspects related to stillbirth, mother, and family (Class 02); III-Emotional and knowledge barriers of nurses when dealing with mothers of fetal death (Classes 01, 03, and 04). From this context, a care guide technology was produced. The purpose of the guide is to provide guidance to professionals in the field regarding this care, understanding the mourning period as the loss not only of a baby but also of a series of expectations and dreams experienced by the entire family

O Mycobacterium tuberculosis e o Vírus da Imunodeficiência Humana estão entre os patógenos mais letais em todo o mundo. A coinfecção TB-HIV tornou-se uma grande ameaça à saúde pública nos países em desenvolvimento. Fatores clínicos e sociodemográficos possuem influência no adoecimento e desfecho do tratamento. Este estudo teve por objetivo analisar o desfecho do tratamento da coinfecção TB-HIV à luz das variáveis clínicas e sociodemográficas. Trata-se de um estudo epidemiológico, transversal, analítico com abordagem quantitativa, realizado no estado do Pará com 3.788 casos de coinfecção TB-HIV, notificados entre os anos de 2009 e 2020, no Sistema de Informação de Agravos e Notificações, além de dados populacionais extraídos no site do IBGE. As análises estatísticas foram realizadas no programa Minitab 18 e definido como nível de significância p<0,05. Realizou-se análise temporal, espacial, cálculo da taxa de incidência e mortalidade. Aplicou-se o teste Qui-quadrado de Pearson e o teste G para determinar a associação entre os desfechos e as variáveis independentes. A análise de regressão logística bivariada e multivariada foram adotadas para identificar a razão de chance para o óbito nos pacientes com desfechos conhecidos (cura e óbito por tuberculose). Os resultados foram expostos por meio de tabelas e figuras. Os dados apontam uma tendência crescente e significativa (p=0.0003) na taxa de incidência e a cada ano houve um aumento de 0.14 casos por 100 mil habitantes. Em relação a mortalidade, identificouse diminuição de percentuais, regredindo de 1,9 em 2009 para 1,2 óbitos/100 mil habitantes em 2020, no entanto, a taxa de mortalidade não apresentou tendência significativa (p=0.0735). Ao analisar o desfecho do tratamento, a maior proporção evoluiu à cura da tuberculose e foi associada às pessoas jovens do sexo masculino que não possuíam hábitos prejudiciais à saúde. O abandono mostrou-se associado à baixa escolaridade, à forma clínica pulmonar, ao não uso de tabaco e outras causas de adoecimento. O óbito, aos que estavam acometidos por Aids. As variáveis que

apresentaram associação significativas com o desfecho do tratamento da coinfecção foram: sexo (p=0,0001), faixa etária (p=0,0001), escolaridade (p=0.0001), forma clínica daTB (p=0,0001), tabagismo (p=0,0030), uso de drogas ilícitas (p=0,0008), alcoolismo (0,0423), Aids (p=0.0504) e outras causas (p=0,0461). A análise de regressão logística bivariada identificou a forma pulmonar e extrapulmonar (OR=2.91; IC95%: 1.80 – 4.71: p<0.0001), o tabaco (OR=3.07; IC 95%: 2.05 – 4.99: p<0.0001) e o uso de droga (OR=2.44; IC95%: 2.09 – 5.01: p<0.0001). A análise multivariada identificou a forma pulmonar e extrapulmonar (OR=2.66; IC95%: 1.63 – 4.35: p<0.0001) e o tabaco (OR=2.69; IC95%: 1.13 – 6.36: p<0.0001). As evidências apontam para necessidade de melhora nas ações de prevenção da TB em pessoas vivendo com HIV. O diagnóstico e o tratamento precoce de ambos os agravos podem favorecer o estabelecimento de estratégias no enfrentamento a essas doenças, contribuindo para redução da morbimortalidade por TB-HIV e assim viabilizar melhor qualidade de vida aos acometidos.

Descritores: Tuberculose; Infecção por HIV; Coinfecção; Resultado do tratamento;

Epidemiologia.

ABSTRACT

OLIVEIRA, A. P. R. Factors associated with treatment outcome for TB-HIV

coinfection in the state of Pará. 2022. 109 f. Thesis (Master in Nursing) – University

of the State of Pará, Belém, 2022.

The Mycobacterium tuberculosis and human immunodeficiency virus are one of the

most lethal pathogens around the world. The coinfection TB-HIV turned a great

threaten to the public health on developing countries. Clinical and Sociodemographic

factors held great influence on treatment results. This essay plans to analyze the

results of TB-HIV coinfection treatments under the light of clinical and

sociodemographic variables. It's an epidemiologic, transversal, analytic study with

quantitative approach, developed in the state of Pará with 3788 events of coinfection

TB-HIV, notificated between the years of 2009 and 2020 on the System of Information

of harm and notifications, as well as populational data extracted from IBGE site. The

statistical analysis was made in the computer program Minitab 18 and defined as level

of significance p<0,05. Temporal and spatial analyses, calculation of incidence and

mortality rates were performed. The chi square test of pearson test and the G test were

applied to determinate the association between the results and the independent

variables. The analysis of univariate and multivariate logistic regression was adopted

to identify the risk factors to death in patients with known results (cure and death

caused by TB). The results were exposed by charts and figures. The data appoints to

a rising and significant tendency (p=0.0003) in the incidence rate, each year had a

growth of 0.14 events per 100 thousand inhabitants. Regarding mortality a decrease

in percentages was identified, regressing from 1.9 in 2009 to 1.2 deaths/100 thousand

inhabitants in 2020, whoever, the mortality rate did not show a significant trend

(p=0,0735). After analyze the results of treatment, the greater proportion evolved to

the TB cure and were associated to young people of masculine gender that didn't had

prejudicial habits to health. The abandonment was associated to people with low

scholarity levels, who had the pulmonary clinical form, didn't used tobacco, neither had

other illness causes. The death was associated to those affected by Aids. The

variables that shown significant association with the coinfection treatment results were

gender (0,0001), age (p= 0,0001), scholarity level (p=0.0001), clinical form of TB

(p=0.0001), smoking (p=0,0030), illicit drugs usage (p=0,0008), alcoholism (0,0423),

AIDS (p=0.0504) and other causes (p=0.0461). The univariate logistic regression

analysis identified the pulmonary and extrapulmonary types (OR=2.91; IC95%; 1.80 -

4.71; p<0.0001), the tobacco usage (OR=3.07; IC 95%; 2.05 - 4.99; p<0.0001) and

illicit drugs usage (OR=2.44; IC 95%; 2.09 - 5.01; p<0.0001). The multivariate analysis

identified the pulmonary and extrapulmonary types (OR=2 66, IC95%; 1.63 - 4 35 p<0

0001) and the tobacco usage (OR=2 69; IC95% 1 13 - 6 36: p<0 0001). The evidence

appoints the necessity of improvement in the actions of prevention of TB in people

living whit hiv. Precocious diagnosis and treatment of both harms, may favor the

establishment of strategies of confrontation to these illnesses, contributing to the

reduction of morbidity by TB-HIV and enabling better life quality to the affected people.

Cervical cancer is caused by persistent infection by some oncological types of Human

Papillomavirus that produce cellular alterations that are easily detected in oncotic colpocytology exam and have been shown to be a serious public health problem. This study aimed to analyze the association of cervical cancer with the Adapted Living Condition Index among indigenous people in the state of Pará, in the period 2015- 2019. This is a cross-sectional, analytical study with a quantitative approach, having the state of Pará as the study site. Data were obtained from the Indigenous Health Care Information System and the Brazilian Institute of Geography and Statistics, organized in a spreadsheet in Microsoft® Office Excel® 2010. The Statistical Package for Social Sciences (SPSS) version 19.0 was used for statistical analysis. . In order to analyze the association between cervical cancer and the Adapted Living Condition Index among indigenous people, statistical data were described, and a synthetic index of living conditions was constructed using the selected variables, according to factor analysis and cluster, represented by a dendrogram. The results obtained showed that between the years 2015-2019, 112 cases of cervical cancer were reported, with a higher proportion in the Kayapó do Pará DSEI (n=98). There was a predominance among women aged 35 to 39 years, with low schooling, an average of 2 children and low income. Through the Adapted Living Condition Index, it was possible to observe the socioeconomic heterogeneity of the indigenous population of Pará and its association with cases of cervical cancer. It was concluded that cervical cancer associated with low living conditions reinforces the importance of discussing Social Determinants in Health in the health-disease process, thus supporting effective actions in the context of indigenous health. Thus, the identification of factors that influence the development of cervical cancer is essential for planning and implementing measures to prevent and intervene in the disease, considering cultural peculiarities.

Leprosy is a transmissible disease, with a prolonged and potentially disabling evolution. It is directly related to people's poverty and social vulnerability, as factors that favor the prevalence of the disease in less favored populations. Taking into account that the municipality of Belém has a high endemicity for the disease, and that the contacts of people affected by leprosy have a high risk when compared to the general population, therefore, the importance of the adherence of contacts to surveillance actions is reinforced , for disease control and prevention. This study aimed to: analyze the association between sociodemographic determinants of leprosy contacts and adherence to epidemiological surveillance in the city of Belém. This is an analytical retrospective epidemiological study, with secondary data from the municipality of Belém, from January 2010 to December 2019, obtained from SINAN, stored in spreadsheets. Statistical analyzes were performed using the BioEstat Software version 5.0. The data showed that in the years 2010 to 2019, the municipality of Belém registered 10,019 contacts, of which 4,425 were examined and 5,594 were not examined. The rate of non-evaluated contacts was (55.83%), which resulted in poor classification, according to the parameters established by the Ministry of Health. 000, The evidence indicates that sociodemographic determinants influence the adherence of contacts to surveillance actions, through individual and social vulnerabilities, which reinforces the importance of health education with guidance on the prevention and treatment of leprosy.

The objective was to analyze the quality of information regarding drug-resistant tuberculosis according to the official banks that store epidemiological and operational data on the disease. This is an epidemiological, descriptive research carried out with data from the Notifiable Diseases Information System (SINAN), the Laboratory Environment Management System (GAL) and the Tuberculosis Special Treatment Information System (SITE-TB), obtained from the Pará State Department of Public Health, for the period 2016-2020. The analysis was performed using descriptive statistics, using the Rx64 4.0.0 program, through RStudio Desktop. A total of 889 records distributed in the three databases were analyzed, with a predominance of cases in the GAL (433), followed by the SITE-TB (350) and the SI-NAN (220). There was a predominance of records in the age group from 25 to 44 years and in males. The largest number of culture records for Myco-bacterium tuberculosis typing was identified in the GAL. Duplicate cases were identified, 121 in the GAL, 45 in the SITE-TB and 4 in the SINAN. Among the 433 cases registered in the GAL, five were also included in the SINAN and six were identified in the SINAN and SITE-TB. Of the 350 cases registered in SITE-TB, 242 were not included in the other databases and 97 were in SINAN. Regarding the 220 cases in SINAN, 154 wereonlyincluded in it and six cases were in the three systems simultaneously. Regarding the distribution of records in the Health Regions of Pará, a higher proportion was identified in the GAL, in the Xingu region (98.5%) and in Metropolitana I (26%), with the other regions showing records below 10 cases. Regarding the data contained only in SINAN, Metropolitan I had 93 (18.8%) cases and in the other regions the records were less than 10. In SITE TB, Metropolitan I concentrated the highest frequency, with 174 (35.1%) cases, followed by the Metropolitan Region II, with 15 (71.4%). As for the concurrence of data in two systems, the Metropolitan region I was the only one that presented records(0.8%) in the GAL and SITE-TB. And it stands out in SINAN and SITE TB, with a higher frequency (18.3%), the other regions had a number of cases less than 10 or had no records. Six concurrent records were identified in the three databases (SINAN, SI-TE TB and GAL), five in Metropolitana I and one in Baixo Amazonas. The existence of underreporting in the systems is a challenge, as it raises questions about the quality of the data and, consequently, of the tuberculosis control actions.

Indigenous peoples have undergone several changes, which permeate cultural, social, economic, and environmental aspects, producing an impact on the health of these peoples. One of the changes concerns the epidemiological profile, in accelerated transition, often unfavorable, with increased rates of morbidity and mortality, showing inequalities between indigenous people and the population in general. Therefore, the objective of this study was to analyze the health indicators of indigenous children related to morbidity, mortality, vaccination coverage and breastfeeding in children under one year of age in the state of Pará. This is an epidemiological, analytical study, with a quantitative approach. with data on morbidity and mortality in indigenous children, notified to the Indigenous Care Information System, from 2013 to 2018. The records related to vaccination coverage and types of breastfeeding were also studied, and for this last variable, the period was 2015-2018 due to data unavailability. Infant birth and mortality rates and proportions of vaccination coverage, morbidity, assessment of nutritional status and types of breastfeeding by Special Indigenous Health District were calculated and the Chi-square (x2) statistical tests were applied to measure associations and Wald test to assess the influence of socioeconomic variables in relation to weight classification. Among the results, it was identified that the main causes of morbidity were infectious and parasitic diseases (19.4%; n = 3,506), diseases of the respiratory system (17.0%; n = 3,079), diseases of the genitourinary system (8, 8%; n = 1,590), of the musculoskeletal system and connective tissue (8.7%; n = 1,587). Mortality rates were above the national average, especially the Kaiapó Pará Indigenous Special Sanitary District with the highest figures, reaching 85.3 / 1,000 live births in the year 2018. The Altamira Indigenous Special Sanitary District had very high vaccination coverage. low, with only 8% of children under one year of age with a complete vaccination schedule in 2015 and 31.9% in 2016. The number of children on exclusive breastfeeding in the 2015-2018 period was approximate in the four districts, ranging from 52,9% (n = 426) in the Altamira Indigenous Special Sanitary District at 45% (n = 427) in Kaiapó do Pará. Regarding the nutritional status, it was identified that 87.5% (n = 3,589) of the children had adequate weight for age, varying between 85% (n = 806) in Kaiapó do Pará and 89.9% (n = 1,406) in the Tapajós River. It is concluded that even with the existence of a subsystem of health care for indigenous peoples, it is necessary to invest more, with public policies, that produce actions that, in fact, ensure a better quality of life for indigenous children, to be evidenced. favorable indicators of morbidity and mortality. Such investments must take into account the cultural profile of each ethnic group in order to enhance it in a way that respects local cosmology. 

Cancer presents itself as a global public health problem affecting mainly people in developing countries. When in an advanced stage of the disease, palliative care is indicated, aiming no longer at cure, but at controlling symptoms and alleviating suffering and promoting the quality of life of the patient and his family. At this time, the nurse, through the Systematization of Nursing Care and the Nursing Process, can use the Edmonton Symptom Assessment Scale (ESAS-BR), in order to properly manage the symptoms of cancer patients in care palliatives. Thus, this study aimed to assess the physical and psychological symptoms reported by cancer patients in palliative care; This is a descriptive, cross-sectional study with a quantitative approach, with a sample of 73 patients in palliative care hospitalized at the Palliative Oncology Care Clinic (CCPO) and the Abdominal Oncology Surgery Clinic at Hospital Ophir Loyola. As a data collection instrument, the ESAS-Br and a form of the sociodemographic and clinical profile of the patients were used. For data analysis, we used the Statistical Package for Social Sciences (SPSS), version 21 and the R software version 3.6.3. The reliability test of the ESAS-Br was carried out through the analysis of internal consistency: Cronbach's alpha coefficient (correlation of the instrument's items). Bivariate analysis of independent variables with the

measurement of symptoms of the ESAS-Br was carried out using the Chi-square and Fisher's exact tests. The significance level adopted was 5% (p< 0.05). Of the 73 patients, 54.8% were women and 45.2% were men, with ages ranging from 28 to 79 years, and 72.6% described themselves as brown. As for the intensity of symptoms addressed in the ESAS-Br Scale, it was obtained: mild pain intensity (69.9%); severe intensity of tiredness (39.7%); mild intensity of nausea (71.2%); moderate and severe intensity of sadness (38.4%), respectively; severe anxiety intensity (64.4%); moderate intensity of sleepiness (38.4%); mild appetite intensity (38.4%); moderate intensity of well-being sensation (57.5%); mild intensity of breathlessness (69.9%) and mild sleep intensity (46.6%). There were reports of symptoms not covered by the ESAS-Br, such as constipation (56.3%), vaginal bleeding (15.6%), edema of the lower limbs (12.5%), among others. It was observed that patients enter the oncology service in advanced stages of cancer, a factor that impacts the burden of symptoms, as well as the adoption of palliative therapy, exclusive or associated with other treatments. The association between the burden of symptoms and sociodemographic and clinical data was evidenced, demonstrating aspects that exacerbate or reduce its manifestations. It is concluded that the application of the ESAS-Br proved to be extremely important in the assessment of symptoms by nurses, and can be used as an instrument for data collection. The research results may significantly contribute to patient care practice in palliative cancer care

INTRODUCTION: The incidence of new cases of cancer is higher in individuals over 65 years of age, who are among the greatest fatal victims of the disease, representing about 70% of cases of death from malignant neoplasms. When in an advanced stage, cancer can evolve to the condition of impossibility of cure, with the presence of uncontrollable signs and symptoms such as pain, nausea, vomiting, anorexia, fatigue, depression, anxiety, constipation, among others, in these cases the care provided cancer patients are no longer curative and become palliative. OBJECTIVE: To develop a Care Protocol for Nursing Interventions for the Elderly with Cancer in palliative care within the scope of Primary Health Care. MATERIALS AND METHOD: This is a descriptive study of the development of a technology of a methodological development research type, with a qualitative approach, which proposed to develop a nursing care protocol for the Elderly with Cancer in Palliative Care in Primary Health Care. The research was developed in two stages, namely: 1st) development of a bibliometric review and 2nd) elaboration of the care protocol. The data from the first stage were analyzed using the Voviewer® software and also through the content analysis proposed by Minayo. RESULTS AND DISCUSSION: We identified n=198 publications, distributed in 48 journals and with publications in 46 countries. First, in relation to the year, it was evidenced that most selected publications are concentrated between the years 2019 with n=44 (22.22%) publications, 2018 with n=37 (18.69%) publications, 2016 and 2015 with n =20 (10.10%) publications respectively, 2017 with n=19 (9.60%) publications and the year 2014 with n=17 (8.59%) publications on the subject. From the analysis of the selected studies, it was observed that the publications that made up this Bibliometric review addressed 3 large distinct thematic groups: 1) Nursing Diagnoses Observed in the Elderly with Cancer in Chemotherapy Treatment; 2) Nursing Interventions for the Elderly with Cancer in Palliative and Family Care and 3) Nursing Assistance to the Elderly with Cancer in the Finitude Process at Home. After completing the previous step, Step 2 was started, the thematic axes found in the previous step guided the moment of elaboration of the Protocol. To better guide the construction of technology in a holistic way and with a focus on the principles of Palliative Care, the 5 (five) elements of the Peaceful End of Life Theory were used as theoretical support. In this way, the AP was built, thinking about and respecting all the humanistic aspects of the palliative patient, promoting better quality of life and dignity of the elderly in the moment of finitude. CONCLUSION: Nursing interventions are part of the Nursing Process and, through them, the nurse makes it possible to improve the quality of life of cancer patients and their families, and when performed in the PHC, they avoid the search for Tertiary Care

INTRODUCTION: it is evident that the reception of people with infertility needs in Basic Health Units is still, in many cases, absent or of low resolution, sometimes resulting in unnecessary referrals to medium and high complexity. Nursing gained prominence in this scenario, fundamentally ensuring humanized care, in addition to acting as the main articulator of information and conduct with the multidisciplinary team. For the treatment of assisted infertility it is necessary that the infertile couple have the first assistance in a Basic Health Unit, and then forwarded to a reference unit or center for infertility treatment. OBJECTIVE: to analyze the conditions of couples assisted in an assisted human reproduction program with a view to producing educational technology to mediate the reception performed by nurses. METHOD: methodological research developed in 2 phases: research based on context and technological production (illustrations, layout, design and texts). Data collection was carried out at the Maternal and Child Reference Unit from June to September/2019. Twenty couples attended in the assisted human reproduction program participated in this study. Data production was through interviews and construction of educational technology. Data were analyzed from the perspective of Bardin's analysis supported by the IRAMUTEQ software-Descending Hierarchical Classification method, proposed by Reinert. RESULTS: six classes emerged from the corpus and were organized into three categories: I-Knowledge about the assisted human reproduction program; II- Reasons for looking for the assisted human reproduction program; III- Needs and suggestions to mediate the reception in the assisted human reproduction program. From the context, an educational technology of the folder type was produced. FINAL CONSIDERATIONS: The conditions of couples indicate the need for an informed reception. The production of technology based on context favors the collection of social evidence. Technologies based on such evidence can better support the reception performed by nurses in assisted human reproduction programs.

Since the emergence of labor relations in Prehistory to the present days, it is known that work can have harmful consequences for the health of workers due to occupational diseases and accidents at work. Accidents at work are public health problems, worldwide 2.3 million people die each year as a result and 800 million suffer from various types of injuries during professional practice, while in Brazilian psychiatric hospitals as accident rates vary between 1.7% to 71.6%; in which at least 50% of workers who suffered accidents at work have a psychic suffering. Thus, the present study aimed to analyze the meanings evaluated by healthcare professionals in the psychiatric clinic regarding accidents at work. The research was carried out in a Public Hospital reference in hospital psychiatry in the Northern region of Brazil, 52 healthcare professionals participated and the data collection was carried out through semi- structured interview, which the statements were coded and submitted to the proposed exploratory analysis by Laurence Bardin associated with the Iramuteq Software version 07 alpha 2.0, through the Descending Hierarchical Classification (CHD) and the findings were interpreted based on the Theory of Psychodynamics of Work Developed by Christophe Dejours. The results indicate that occupational accidents have a negative significance for the professionals, which demonstrate the harmfulness of mental health sectors for the integral health of workers and may indicate experiences of pathogenic suffering. The main causes of accidents at work are incorrect handling of the patient during mechanical containment, inattention of the healthcare professionals and structural vulnerabilities of the studied hospital. The negative meanings give rise to defensive strategies such as constant alertness, union of the multidisciplinary team, care for the workers’ mental health, use of personal protective equipment and therapeutic care for family members. Among the suggested improvements, the participants believe in the need for further training and training on mechanical containment and institutional flows, in addition to creating discussion spaces permeated by occupational psychologists. It is believed that the constant events of accidents at work, mainly due to aggressions, translate suffering and anguish beyond excoriations and physical disabilities, which can go beyond institutional walls and become social or personal shadows for the professionals affected. Reflection on the mental health care of health professionals is encouraged, something considered taboo and is a marginalized issue in training academies

Leprosy, also known as Hansen’s disease, is one of the oldest diseases affecting people. In 2018, Brazil was the second in absolute number of cases in the world. It is a neglected disease and its reminiscences transpose to chronology and biomedical advances, emerging in contemporaneity and generate stigmas and prejudices. This work aimed to analyze the social representations of leprosy by people who experience the disease; describe the way of dealing with it and their care practices; relate the way of dealing with it and with their care practices from their social representations. This is a qualitative descriptive study, based on the Theory of Social Representations in its procedural approach. There were 41 patients participating in treatment for leprosy from four health units in the city of Marabá - PA. The information was produced by an individual, semi-structured, in-depth interview. Descriptive statistics were used to characterize the sociodemographic and clinical profile of patients; the IRAMUTEC 0.7 alpha2 software enabled the textual processing of the interviews. Males predominated among the participants; age group 29-43 years; low education; evangelical religion. IRAMUTEC generated six lexical classes which were divided into three blocks: leprosy: memories, knowledge and time; the role of the patient in the self-care: to him or her, for him or her, and for others; the maintenance of stigma and prejudice: the look and act of people who have been hurt. The results showed that the discovery of the diagnosis of leprosy is distressing, triggers feelings of shame and fear for the stigma of the disease. Acceptance of being infected with leprosy requires cognitive effort to understand the disease process, acceptance and self-care. It is concluded that the objectives were achieved: the social representations of leprosy are based on the history of leprosy, mobilize affections and impact on the ways of dealing with the disease and taking care of themselves.

HIV is still characterized as a health problem in developing countries. Historically, blood centers were the first institutions to provide tests for sexually transmitted infections, among them HIV, offering an opportunity to contribute to the understanding of users' risk behaviors for this infection. This study aimed to evaluate the spatial distribution of HIV cases and the association of sociodemographic, clinical and behavioral characteristics in blood donors. This is an ecological study, with cross-sectional development and a quantitative approach, carried out at the Hemocentro de Belém, with 165 blood donors. The data were extracted from the blood bank system and a standard form of the institution, and done in two stages, the first one concerns the description and association of the variables, using a descriptive analysis, chi-square test and regression, the inferential analysis was performed using geoprocessing techniques. For inferential analysis, the software Qgis 3.10 was used for mapping and geographic analysis of the data. The epidemiological profile of HIV in donors was found to be predominant in males, in donors with high school education, single, widowed or divorced, with heterosexual behavior. Female donors and married were the ones that took on average longer to retest, moreover, they were more prevalent first-time donors, who were voluntarily motivated, who did not use drugs, and who did not have 3 or more partners, eventual relationship, co-infection and who did not use condoms. The findings revealed that the capital and neighboring cities have a high concentration of infection and that among the variables studied, marital status, sex, education, sexual behavior MSM, reason for donation, condom use, type of donor, city of donor and coinfection showed association. The identification of risk areas and enhancers that influence the development of HIV in blood donors is essential for planning and formulating intervention measures to combat and control infection in the most vulnerable groups and areas at risk.

Chronic, transmissible and neglected disease, leprosy has alarming indicators and, when not diagnosed and treated early, leads to the occurrence of permanent physical disabilities. In addition to the many possible complications of leprosy, disabilities can significantly interfere with the individual's life, hampering the development of their day-to-day activities, such as work activities. The reduction of work capacity, caused by the disease, compromises productivity, which can lead to interruption of work, distancing or even definitively excluding individuals from the productive chain. The work leave due to illness has financial and psychosocial repercussions on theworker. This study aimed to analyze the correlation of leprosy with the removal of theworker who is being treated at the Basic Health Unit. This is a transversal, analytical study with a quantitative approach carried out in ten health units reporting leprosy in the city of Belém - Pará. Were selected 72 patients with a diagnosis of leprosy, aged 18 years or more and who had some labor activity, regardless of the employment relationship. The sample consisted of workers with a mean age of 42.9 years, 69.4% male, 45.8% with a primary schooling level, monthly income of 1 to 3 minimum wages (59.7%), occupying positions of service workers, store sellers and markets (31.9%). It was evidenced predominance of the clinical form Dimorfa (72.2%), without affected nerves (52.8%) and with 5 to 10 cutaneous lesions (51.3%). The presence of  physical disabilities was identified in 34.7% of the workers, being this the main cause indicated for work leave, a problem referred by 59.7% of the workers. Other problems related to work leave, indicated by workers were: work restriction (56.9%), reduction of work capacity (55.5%), omission of the diagnosis of the disease (43%), lack of readaptation change of function (90.2%) and prejudice (26.3%). The time to leave work due to leprosy was greater than 6 months in 48.8% of the cases. In the bivariate analysis we identified a statistical relationship with the work away from: reduction of labor capacity (p <0.000), work restriction (p = 0.0001), higher number of nerves affected (p = 0.0015), presence of reactive? episodes (p = 0.0086). It was observed that the work leave was related, with greater degree of significance, to multibacillary forms of the disease, to workers with low educational level, occupying functions that require little or no technical knowledge in the informal work sector. It is concluded that there is a significant relationship between leprosy and the patient's absence from work in the Basic Health Unit and that the presence of physical disabilities is considered the main cause of the worker's absence. Greater articulation between the strategies of attention to leprosy and the health of the worker is necessary for the proposition of measures that aim at the minimization of absences from work due to the disease

Introduction: Tuberculosis is a serious public health problem in Brazil. Several measures and strategies were created with the objective of eliminating the disease as a public health problem, and the nurses' performance is extremely relevant in the context of actions development of their control in Primary Care. Objectives: To discuss knowledge and practices of nurses in tuberculosis control actions in Basic Health Units; To verify the knowledge of nurses about the tuberculosis control policy in the Basic Health Units; To know the actions of nurses in the control of tuberculosis, developed with the patients in the Basic Health Units; Identify the intervening factors for the implementation of tuberculosis control in these units. Method: Descriptive, qualitative study. The information was collected from November to March 2019, through individual interviews with 29 nurses who were active in the control of tuberculosis in the Basic Health Units of the city of Belém - Pará. Data were analyzed through the technique of analysis content, which originated three thematic categories: Nurses' knowledge about the national tuberculosis control policy in the Basic Health Units; The actions of nurses to control tuberculosis in the Basic Health Units and the Factors that interfere in the effective control of tuberculosis in the Basic Health Units. Results: It can be affirmed that nurses have superficial knowledge regarding the policy and management of the care, identify intervening factors, related to services and patients, which makes difficult the actions of tuberculosis control in the Basic Health Units. Final considerations: Nurses cannot carry out actions in their fullness, for issues related to the services organization, to central management that does not provide adequate support and, therefore, professionals cannot effectively plan the management of the action in their work environment. 

Objective: To know the clinical and epidemiological profile of women with cervical cancer precursor lesions in relation to their sociodemographic and reproductive variables assisted in a secondary care service in Belém do Pará. Method: This is a cross-sectional study with a quantitative approach, conducted at the reference unit in Belém do Pará with 196 women, diagnosed with high-grade squamous intraepithelial lesion. Data collection took place from October 2018 to February 2019, by applying a form and reading the clinical records of each participant. Data were condensed into a spreadsheet and analyzes were performed with the support of the Bioestat 5.0 program. Results: after analyzes, the following characteristics were identified: adult women with a middle age of 38.2 years, separately colored, catholic, married / stable union, low school, low income, in the circus of sexual activity with average age of 16.18 years, average of 5.42 sexual, multiple partners, non-smoking and other laboral activity among other. Considering the association of risk cofactors for the development of lesions, a strong association was found related to the age of the participants, the origin and the non-use of condoms in sexual relations, all with p <0.05. Regarding the time interval between the diagnosis of the Pap smear and the first consultation at the reference service, the median number of days was 12. Conclusions: This study is expected to contribute to the orientation of primary care services, as the direction of actions aimed at sex education, reproductive and preventive studies related to lifestyles and periodicity of the Pap smear. As well as the theoretical basis for planning cervical cancer prevention and control actions, in order to contribute to the reduction of cases of pre-cancer lesions and therefore of the cervical cancer itself.

Laryngeal cancer is the most common cancer in the head and neck region, affecting mainly older patients, with a higher incidence between the sixth and seventh decade of life. The objective of this study is to analyze the association between epidemiological and clinical characteristics and tumor staging of laryngeal cancer patients. This is a descriptive, retrospective study with a quantitative approach, performed at the Ophir Loyola Hospital, which is a reference for cancer treatment, in which 494 medical records of laryngeal cancer patients treated from 2008 to 2018 were analyzed. Data were collected using a form composed of epidemiological and clinical variables, which were analyzed using descriptive statistics and organized through the Bioestat 5.3 program. And to verify the dependency relationship between the variables, the Chi-square test and the Mann-Whitney test were used, with a significance level of 5%. The analysis of medical records showed an essentially male population, with an average age of 63 years, coming mostly from the interior of the State of Pará, smokers and alcoholics, with over 40 years of alcohol and tobacco use, presenting advanced staging (III and IV) the diagnosis. The most significant therapeutic approaches in this study were radiotherapy and chemotherapy, the median time to start treatment since diagnosis was 141 days. Half of the patients who underwent laryngectomy as treatment had surgical complications, and over 90% of them had pharyngocutaneous fistula as a complication. Because of this, a considerable number of deaths were obtained among the patients studied, despite underreporting. The research findings also revealed that the distance between the patient's county and the center of diagnosis and treatment is related to the advance of tumor staging. Another statistically significant factor for disease progression was prolonged smoking time. This study also highlighted the difficulties and weaknesses of the nursing process, emphasizing the importance of technical and scientific knowledge and skills for the planning and implementation of appropriate and individualized care for these patients. Thus providing better results to ensure the patient's quality of life. Therefore, the clinical and epidemiological study, symptomatology, clinical evolution and treatment of laryngeal cancer offer support for the optimization of patient care in its entirety

The measurement of health-related quality of life is considered an important indicator in the evaluation of health interventions and treatments. Gamification is used as a strategy to increase engagement in a given activity, contributing to favorable behavioral changes. Objective: The aim of this study was to produce and test a gamified strategy aimed at improving the quality of life of children and chronic kidney adolescents undergoing hemodialysis. Method: This is an applied research, methodological and almost experimental development. It was carried out in two stages, namely: production of the gamified strategy; and testing of the gamified strategy with the target audience in three phases: pre-test, testing, post-test in a single group. The research was approved by the ethics committee of the institution of origin of the researchers and the co-participating institution where data collection took place. The study participants were 8 children and adolescents who underwent hemodialysis treatment in the Pediatric Substitute Renal Therapy Sector of the Fundação Santa Casa de Misericórdia do Pará, aged between 8 and 16 years. The data were analyzed with the aid of programs GraphPadPrism® 6.0 and Biostat® 5.0, for statistical analysis, paired t-student parametric test was used. The significance level of the survey was 5%. Results: A gamified strategy was developed in the format of a game called Nefro Hero, a simplified model of a table RPG, adaptable to the needs of children and adolescents undergoing hemodialysis. The adventures presented in the game sought to retract fantastically situations potentially real lives experienced by these patients. The use of gamification, allowed greater involvement of the target public in the proposed activity and the game elements sought to alter the perception of chronic kidney children and adolescents about their health condition, strengthening their characteristics and contributing to increase their adherence and acceptance of treatment. The QoL scores in the pre-intervention moment showed that the physical dimension and independence were the most affected in these patients lives. At the time after intervention the physical dimension remained one of the most affected, having undergone little alteration from the introduction of the game. The correlation between pre and post-test measurements showed significant improvement in the independence and emotional dimensions measured after game introduction. Conclusion: the results found demonstrate that the adoption of this strategy produced improvement in the scores of the independence and emotional dimensions and that this type of technology has the potential to favor changes in behavior and posture in the context of health. This study contributes to nursing as it provides subsidies for the development of new strategies that may contribute to the adaptation of chronic renal patients to hemodialysis treatment and consequently to improve their quality of life

Contributions applied to obstetric nurses (ON), who need to implement a humanized model, lie in valuing various aspects of parturition: autonomy, female empowerment, pain exhaustion, fetal progress, bonding, testing and safety, despite adverse conditions, these professionals continue to encourage humanized childbirth. This study aimed to understand the role of obstetric nurses in the directive of the humanization of labor and birth. Descriptive study with a qualitative approach, conducted in three states of the northern region (Amapá; Amazonas; Pará), consisting of a random interview with 41 obstetric nurses working in labor and birth, conducted between November/2018 and February/2019, approved by research ethics committee of the State University of Pará. As the information was collected through in-depth semi-structured interviews, in the analysis and interpretation of the information, it was based in Bardin´s content analysis techniques were used and to aid in processing, they were used as software or IRAMUTEQ software, which brings statistical rigor to research, according to the Descending Hierarchical Classification. In the analysis of the collected information, was interviewed in each state: 11 ON in Amapá; 17 ON in Amazonas and 13 ON in Pará. Age ranged from 26 to 53 years; predominantly female and with title of specialists in the modality of residence, all acting directly or indirectly with assistance to institutionalized childbirth. The obstetric nurses understand that vocational training, postgraduate education, humanization direction, extreme relevance for the preparation of who will conduct care for women and their families during childbirth, the development of techniques and technical emotions for this moment; it has a woman as the central focus of safe and reliable care, seeking to meet the desires and timely requirements or rights of clarification, opinion and decision; value the use of unique, multidirectional and relational care technology, applied to their daily practice, guided by scientific studies; Recognize as difficulties that interfere in a more integral and humanized delivery and birth, such as coping with adversity can contribute to the understanding and search for solutions, to achieve progressive and permanent advances, in the sense of quality in the delivery and birth scenario. The study found that obstetric nurses directly at the birth and birth scene materializes or considers the form of action relevant and has an important involvement for the safe humanized implanted model guided by scientific research; Allow to contribute to the technical-scientific improvement, a collaboration of science in nursing; professional autonomy; search for qualification and improvement; qualified assistance to the parturient and her family; finding ways to reduce obstetric violence