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