Abstract Background: Rheumatoid arthritis primarily affects the working-age population and may cause key functional and work limitations. As the disease progresses, individuals become increasingly unable to conduct daily activities, which has a substantial personal and socioeconomic impact. Fairly recent prior studies showed that patients with RA stop working 20 years earlier than age-matched controls. Factors related to sociodemographic, clinical, care and disease profiles might affect the loss of work capacity. The purpose of this study was to assess the factors associated with the prevalence of working patients with rheumatoid arthritis in the municipality of Blumenau. Methods: A cross-sectional, population-based study was conducted between July 2014 and January 2015, with 296 individuals aged 20 years or older, male and female, living in Blumenau, Santa Catarina state, Brazil, and diagnosed with rheumatoid arthritis according to the 1987 American College of Rheumatology criteria. The prevalence of working patients with RA was assessed by employment status self-reporting during the interview. The chi-squared test, Wald test and Poisson regression analysis were used to test the possible associations between the independent variables and outcome. Results: The prevalence of working patients with rheumatoid arthritis was 44.3%. Patients aged 20 to 59 years had a 90% higher prevalence of outcome than subjects aged 60 years or older. The prevalence of working patients was 132% and 73% higher among individuals with low income and high functional disability, measured using the Health Assessment Questionnaire (HAQ), respectively. Conclusion: The prevalence of working RA patients was highest among adult patients with low income and high functional disability. The first variable is directly related to the individual characteristic, the second reflects the socioeconomic context of the patient, and the third reflects the degree of disability caused by the disease, which may be modifiable by health professionals.

Resumo Objetivo: Estimar a prevalência da doença isquêmica cardíaca e os fatores associados em pacientes com artrite reumatoide. Métodos: Estudo transversal que usou o critério diagnóstico do Colégio Americano de Reumatologia para selecionar pacientes atendidos nas unidades de saúde da atenção primária ou secundária em Blumenau, Santa Catarina, sul do Brasil, em 2014. A presença de doença cardíaca isquêmica foi definida com infarto agudo do miocárdio com intervenção coronariana percutânea ou cirurgia de revascularização do miocárdio que tenha ocorrido depois do diagnóstico. Para testar as associações usou-se o teste exato de Fischer, o teste de tendência linear de Wald e a análise de regressão logística multivariada. Resultados: Entre 296 pacientes, 83,1% de mulheres, com média de 56,6 anos, tempo médio de artrite reumatoide de 11,3 anos, 13 relatam ter tido infarto agudo do miocárdio que necessitou de procedimento de reperfusão percutânea ou cirúrgica, prevalência de 4,4% (IC 95% 2,0-6,7). O diabetes melittus (razão de chance de 4,9 [IC 95% 1,6-13,8]) e o tempo de doença maior do que 10 anos (razão de chance de 8,2 [IC 95% 1,8-39,7]) foram os únicos fatores associados com a doença isquêmica que permaneceram no modelo final após análise multivariada. Conclusão: A prevalência de infarto agudo do miocárdio foi semelhante com a observada em outros estudos. Entre os fatores de risco tradicionais e entre os fatores relacionados à artrite reumatoide, o diabetes melittus e o tempo de doença foram as variáveis associadas à comorbidade

Abstract Objective: To estimate the prevalence of ischemic heart disease and associated factors in patients with rheumatoid arthritis. Methods: A cross-sectional study using the American College of Rheumatology diagnostic criteria in order to select patients seen at primary or secondary health care units in Blumenau, Santa Catarina, Southern Brazil, in 2014. The presence of ischemic heart disease was defined as an acute myocardial infarction with percutaneous coronary intervention or coronary artery bypass graft surgery that has occurred after diagnosis. Fischer's exact test, Wald's linear trend test, and multivariate logistic regression analysis were used to test the associations. Results: Among 296 patients (83.1% female) with a mean age of 56.6 years and a mean rheumatoid arthritis duration of 11.3 years, 13 reported having acute myocardial infarction requiring a percutaneous or surgical reperfusion procedure, a prevalence of 4.4% (95% CI 2.0-6.7). Diabetes Mellitus (odds ratio [OR] 4.9 [95% CI 1.6-13.8]) and disease duration >10 years (OR 8.2 [95% CI 1.8-39.7]) were the only factors associated with an ischemic disease that remained in the final model, after the multivariate analysis. Conclusion: The prevalence of acute myocardial infarction was similar to that observed in other studies. Among the traditional risk factors, Diabetes Mellitus, and among the factors related to rheumatoid arthritis, disease duration, were the variables associated with comorbidity.

RESUMO Introdução: Poucos estudos fizeram uma análise descritiva e de tendência dos dados disponíveis do Sistema Único de Saúde (SUS) entre os períodos pré e pós-dispensação gratuita do tratamento medicamentoso da artrite reumatoide (AR) sob a perspectiva do sistema público de saúde em termos de custo direto da doença entre adultos e idosos moradores do Estado de Santa Catarina, Brasil. O presente trabalho tem o objetivo de caracterizar o custo direto de procedimentos clínicos e cirúrgicos antes e após o fornecimento de medicamentos no estado. Métodos: Estudo do tipo série temporal com levantamentos transversais entre 1996 e 2009 dos dados do Sistema de Informação Hospitalar (SIH) e Ambulatorial (SIA) do SUS. Resultados: Entre 1996 a 2009, o gasto total para o tratamento hospitalar e medicamentoso ambulatorial da artrite reumatoide foi de R$ 26.659.127,20. Após a dispensação do tratamento medicamentoso pelo SUS observou-se queda de 36% do número de internações hospitalares. Entretanto notou-se um aumento de 19% nos procedimentos clínicos. Conclusão: No período observado notou-se uma redução do número de internações hospitalares tanto para procedimentos clínicos quanto cirúrgicos ortopédicos relacionadas a essa doença. Apesar disso, ocorreu um aumento do custo das internações clínicas.

ABSTRACT Introduction: There are few studies that carried out a descriptive and trend analysis based on available data from the Unified Health System (SUS) between pre- and post-free dispensing of pharmacological treatment of rheumatoid arthritis (RA) from the perspective of the public health system, in terms of the direct cost of the disease among adults and elderly residents of the State of Santa Catarina, Brazil. This study aims to characterize the direct cost of medical and surgical procedures before and after the dispensing of drugs in this state. Methods: This is a time series-type study with a cross-sectional survey of data from the Hospital (SIH) and Outpatient (SIA) Information System of SUS during the period from 1996 to 2009. Results: Between 1996 and 2009, the total expenditure for hospital- and outpatient pharmacological treatment of rheumatoid arthritis was R$ 26,659,127.20. After the dispensing of drug treatment by SUS a decrease of 36% in the number of hospital admissions was observed; however, an increase of 19% in clinical procedures was noted. Conclusion: During the observed period, a reduction in the number of hospital admissions for both clinical and orthopedic surgical procedures related to this disease was observed. Nevertheless, there was an increase in the cost of medical admissions.

Resumo Introdução: A efetividade do tratamento das doenças crônicas depende da participação do paciente, influenciada por diferentes motivos socioculturais, pouco reconhecidos pela rotina assistencial. Objetivo: Identificar os fatores de adesão ao tratamento e o uso dos recursos assistenciais de pacientes com doença isquêmica do coração. Método: Estudo transversal com entrevistas presenciais de 347 indivíduos submetidos a questionários semiestruturados, com 141 delas gravadas para análise qualitativa com identificação dos descritores distribuídos por oito categorias. Os dados quantitativos tiveram análise descritiva de frequência. Resultados: Somente 2% tiveram boa adesão medicamentosa; 23% compraram estatina, os demais obtiveram o medicamento em serviços públicos. Foram classificadas 36 falas com as categorias: conhecimento sobre a doença e o tratamento, dificuldade de aquisição do medicamento, gerenciamento pessoal do tratamento, acesso aos serviços de saúde, efeito colateral das estatinas, apoio do cuidador, transporte até o ambulatório, receios quanto à evolução da doença, efeito colateral das estatinas. Foi observado que 1/3 dos atendimentos fora da instituição podem ser caracterizados como tentativa de racionalização da rede. Conclusão: A melhora da adesão ao tratamento da doença isquêmica do coração depende do estabelecimento de fluxos efetivos para referência e contrarreferência entre unidades assistenciais; adequada informação e esclarecimento das dúvidas do paciente; atenção dos profissionais de saúde aos múltiplos fatores sociais e culturais envolvidos com a adesão. São necessários novos estudos sobre o papel da assistência farmacêutica, grupos educativos e integração da equipe multiprofissional no engajamento do paciente para compartilhar as decisões sobre o tratamento, e assim ampliar seu grau de comprometimento com a própria saúde.

Summary Introduction: The effectiveness of the treatment of chronic diseases depends on the participation of the patient, influenced by different sociocultural factors, which are not fully recognized by the treatment routine. Objective: To search for some of these factors that hinder or facilitate adherence to treatment and use of healthcare resources, approaching patients with ischemic heart disease. Method: A cross-sectional study was conducted using face-to-face interviews. We applied semi-structured questionnaires to 347 individuals and recorded 141 interviews for qualitative analysis. Descriptors were selected to identify eight categories of analyses. The quantitative data were submitted to descriptive analysis of frequency. Results: Only 2% had good medication adherence according to score on Morisky questionnaire. About 23% bought statins; the others obtained statin in the public health institution. Thirty-six speeches were selected and classified according to the following categories: knowledge about disease and medication, difficulty of acquisition, self management of treatment, difficulties of access to health services, side effect of statins, caregiver support, transportation to health services and concerns about the disease progression. However, it was noticed that about 1/3 of the care outside the research institution can be characterized as an attempt to bring rationalization to the health system. Conclusion: The improved adherence to chronic treatment of ischemic heart disease depends on the establishment of effective flows for referral and counter-referral from one care unit to another, relevant information and clarification of the questions for the patients and the attention of health professionals to the many social and cultural factors involved in treatment adherence. New research should be focused on educational groups by integrated multidisciplinary teams in order to share treatment decisions, thereby increasing the patient's commitment to his own health.

The aim of this study was to identify and reflect on the methods employed by studies focusing on intervention programs for the primordial and primary prevention of cardiovascular diseases. The PubMed, EMBASE, SciVerse Hub-Scopus, and Cochrane Library electronic databases were searched using the terms ‘effectiveness AND primary prevention AND risk factors AND cardiovascular diseases’ for systematic reviews, meta-analyses, randomized clinical trials, and controlled clinical trials in the English language. A descriptive analysis of the employed strategies, theories, frameworks, applied activities, and measurement of the variables was conducted. Nineteen primary studies were analyzed. Heterogeneity was observed in the outcome evaluations, not only in the selected domains but also in the indicators used to measure the variables. There was also a predominance of repeated cross-sectional survey design, differences in community settings, and variability related to the randomization unit when randomization was implemented as part of the sample selection criteria; furthermore, particularities related to measures, limitations, and confounding factors were observed. The employed strategies, including their advantages and limitations, and the employed theories and frameworks are discussed, and risk communication, as the key element of the interventions, is emphasized. A methodological process of selecting and presenting the information to be communicated is recommended, and a systematic theoretical perspective to guide the communication of information is advised. The risk assessment concept, its essential elements, and the relevant role of risk perception are highlighted. It is fundamental for communication that statements targeting other people’s understanding be prepared using systematic data.

This study reviewed the effectiveness of school-based physical activity interventions aimed at reducing overweight, obesity and hypertension in children. We searched 14 databases and analyzed studies published between April 2009 and September 2012. Only randomized controlled trials performed at the school level that included elements of physical activity but did not include nutritional co-interventions were analyzed. Studies were assessed by two recommended tools (EPHPP and GRADE), and the standardized mean differences with 95% confidence intervals were collected for a random-effect meta-analysis. A total of 12 papers were included in the meta-analysis, and these were divided according to three outcomes: body mass index (11 trials, n  =  4,273, −0.02, 95% CI: −0.13 to 0.17, p  =  0.8); body weight (5 trials, n  =  1,330, −0.07, 95% CI: −0.18 to 0.04, p  =  0.2); and blood pressure (6 trials, n  =  1,549), including systolic (0.11, 95% CI: −0.10 to 0.31, p  =  0.3) and diastolic pressure (−0.00, 95% CI: −0.10 to 0.10, p  =  0.9). This meta-analysis of data from 11 randomized, school-based physical activity interventions suggests that, regardless of the potential benefits of physical activity in the school environment, the interventions did not have a statistically significant effect. However, it is difficult to generalize from these results because the duration, intensity and type of physical activity used in the interventions varied greatly.

OBJECTIVES: Though elderly persons with chronic atrial fibrillation have more comorbidities that could limit indications for the chronic use of anticoagulants, few studies have focused on the risk of falls within this particular group. To evaluate the predictors of the risk of falls among elderly with chronic atrial fibrillation, a cross-sectional, observational study was performed. METHODS: From 295 consecutive patients aged 60 years or older with a history of atrial fibrillation who were enrolled within the last 2 years in the cardiogeriatrics outpatient clinic of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 107 took part in this study. Their age was 77.9±6.4 years, and 62 were female. They were divided into two groups: a) no history of falls in the previous year and b) a history of one or more falls in the previous year. Data regarding the history of falls and social, demographic, anthropometric, and clinical information were collected. Multidimensional assessment instruments and questionnaires were applied. RESULTS: At least one fall was reported in 55 patients (51.4%). Among them, 27 (49.1%) presented recurrent falls, with body lesions in 90.4% and fractures in 9.1% of the cases. Multivariate logistic regression showed that selfreported difficulty maintaining balance, use of amiodarone, and diabetes were independent variables associated with the risk of falls, with a sensitivity of 92.9% and a specificity of 44.9%. CONCLUSION: In a group of elderly patients with chronic atrial fibrillation who were relatively independent and able to attend an outpatient clinic, the occurrence of falls with recurrence and clinical consequences was high. Difficulty maintaining balance, the use of amiodarone and a diagnosis of diabetes mellitus were independent predictors of the risk for falls. Thus, simple clinical data predicted falls better than objective functional tests.

FUNDAMENTO: A doença cardiovascular é a principal causa de mortalidade no mundo. Há evidências que demonstram a associação dessa patologia com fatores de risco cardiovascular, relacionados ao estilo de vida, incorporados na fase da adolescência. OBJETIVO: Identificar, em adolescentes, a prevalência de sobrepeso e do estilo de vida associado a risco para o desenvolvimento de doenças cardiovasculares, além dos fatores que os influenciam. MÉTODOS: Foi realizado um estudo observacional de dados individuais, transversal, com adolescentes matriculados em escolas públicas e privadas do município de São Paulo, englobando as séries de 5ª a 8ª do ensino fundamental; as informações foram obtidas através da aplicação de um questionário anônimo e da realização de medidas de peso e altura. RESULTADOS: Foram analisados 2.125 adolescentes, com idade média de 12,9 anos. Do total estudado: de 14,4% a 32,1% não praticaram esporte ou competição; de 56,0% a 73,6% ficaram mais de duas horas à frente de TV, videogame ou computador; aproximadamente 80% consumiram frutas e legumes de forma considerada inadequada; de 34,9% a 45,3% relataram consumo aumentado de sal; e de 60,9% a 74,4% consumo de refrigerantes. A prevalência de sobrepeso variou de 18,7% a 41,6%. CONCLUSÃO: É alta a prevalência em adolescentes escolares de fatores de risco associados ao desenvolvimento de doenças cardiovasculares no adulto. Outros estudos são necessários para compreender melhor como esses fatores de risco se correlacionam e, assim, possibilitar a implementação de medidas preventivas, na fase da adolescência, com vistas à prevenção das doenças cardiovasculares do adulto.

BACKGROUND: Cardiovascular disease is the leading cause of mortality worldwide. There is evidence demonstrating the association of this disease with cardiovascular risk factors related to lifestyle, incorporated in adolescence. OBJECTIVE: To identify, in adolescents, the prevalence of overweight and lifestyle factors associated with risk for developing cardiovascular diseases, and the factors that influence them. METHODS: It was conducted an observational study of individual cross-sectional data with adolescents enrolled in public and private schools in São Paulo, covering grades 5 to 8 of elementary school. The information was obtained through the application of an anonymous questionnaire and weight and height measurements. RESULTS: 2,125 adolescents with mean age of 12.9 years were studied. From the total sample: 14.4% to 32.1% did not practice sports or competitions; 56.0% to 73.6% remained more than two hours watching TV, playing video game or working on the computer; approximately 80% consumed fruits and vegetables improperly; 34.9% to 45.3% reported high salt consumption; and 60.9% to 74.4% reported consumption of soft drinks. Prevalence of overweight ranged from 18.7% to 41.6%. CONCLUSION: In school adolescents, this study found high prevalence of risk factors associated with the development of cardiovascular disease in adults. Further studies are required to better understand how these risk factors are related and thus enable the implementation of preventive measures in adolescence in order to prevent cardiovascular disease in adults.

FUNDAMENTO: La enfermedad cardiovascular es la principal causa de mortalidad el mundo. Hay evidencias que demuestran la asociación de esa patología con factores de riesgo cardiovascular, relacionados al estilo de vida, incorporados en la fase de la adolescencia. OBJETIVO: Identificar en adolescentes, la prevalencia de sobrepeso y del estilo de vida asociado a riesgo para el desarrollo de enfermedades cardiovasculares, además de los factores que los influyen. MÉTODOS: Fue realizado un estudio observacional de datos individuales, transversal, con adolescentes matriculados en escuelas públicas y privadas del municipio de São Paulo, englobando los grados de 5ª a 8ª de la enseñanza fundamental; las informaciones fueron obtenidas a través de la aplicación de un cuestionario anónimo y de la realización de medidas de peso y altura. RESULTADOS: Fueron analizados 2.125 adolescentes, con edad media de 12,9 años. Del total estudiado: de 14,4% a 32,1% no practicaron deporte o competición; de 56,0% a 73,6% se quedaron más de dos horas frente a la TV, videogame o computadora; aproximadamente 80% consumieron frutas y legumbres de forma considerada inadecuada; de 34,9% a 45,3% relataron consumo aumentado de sal; y de 60,9% a 74,4% consumo de bebidas gaseosas. La prevalencia de sobrepeso varió de 18,7% a 41,6%. CONCLUSIÓN: Es alta la prevalencia en adolescentes escolares de factores de riesgo asociados al desarrollo de enfermedades cardiovasculares en el adulto. Otros estudios son necesarios para comprender mejor como esos factores de riesgo se correlacionan y, así, posibilitar la implementación de medidas preventivas, en la fase de la adolescencia, con vistas a la prevención de las enfermedades cardiovasculares do adulto.

INTRODUCTION: The present study was motivated by the need to systematically assess the research productivity of the Heart Institute (InCor), Medical School of the University of São Paulo, Brazil. OBJECTIVE: To explore methodology for the assessment of institutional scientific research productivity. MATERIALS AND METHODS: Bibliometric indicators based on searches for author affiliation of original scientific articles or reviews published in journals indexed in the databases Web of Science, MEDLINE, EMBASE, LILACS and SciELO from January 2000 to December 2003 were used in this study. The retrieved records were analyzed according to the index parameters of the journals and modes of access. The number of citations was used to calculate the institutional impact factor. RESULTS: Out of 1253 records retrieved from the five databases, 604 original articles and reviews were analyzed; of these, 246 (41%) articles were published in national journals and 221 (90%) of those were in journals with free online access through SciELO or their own websites. Of the 358 articles published in international journals, 333 (93%) had controlled online access and 223 (67%) were available through the Capes Portal of Journals. The average impact of each article for InCor was 2.224 in the period studied. CONCLUSION: A simple and practical methodology to evaluate the scientific production of health research institutions includes searches in the LILACS database for national journals and in MEDLINE and the Web of Science for international journals. The institutional impact factor of articles indexed in the Web of Science may serve as a measure by which to assess and review the scientific productivity of a research institution.

OBJETIVO: Investigar a presença de transtornos psiquiátricos em pacientes com dor torácica de origem não cardíaca que não respondem aos tratamentos regulares. MÉTODO: Dezoito pacientes com dor torácica sem origem cardíaca e considerados por seus clínicos como não respondentes aos tratamentos regulares instituídos foram avaliados por um psiquiatra treinado. As entrevistas foram realizadas com base no Present State Examination e os diagnósticos psiquiá-tricos, de acordo com os critérios do Manual de Diagnóstico e Estatística da Associação Psiquiátrica Americana, 3ª Edição Revisada (DSM-III-R). RESULTADOS: Depressão maior no momento da avaliação foi diagnosticada em 6 (30%) pacientes, somatização em 1 (6%) e transtorno do pânico em 1 (6%) paciente. Sete pacientes estavam recebendo antidepressivos tricíclicos com doses < 75 mg/dia. CONCLUSÕES: A baixa dose de ADTs usadas para o tratamento da dor nesses pacientes pode ter melhorado parcialmente os sintomas depressivos, tornando mais difíceis o diagnóstico e o tratamento apropriado(s) da depressão e, assim, contribuindo para a persistência da dor e outras queixas. As futuras pesquisas deverão focalizar a eficácia do tratamento da depressão nesses pacientes e o impacto deste no alívio da dor torácica não cardíaca.

OBJECTIVE: To investigate the presence of psychiatric disorders in patients with chest pain not responsive to treatment. METHOD: We evaluated 18 patients judged by their physicians to have a chest pain not responsive to usual treatment, which included anti-pain medicines and investigation and treatment of possible etiological causes such as coronary artery disease, and gastroesophageal reflux disease. A psychiatrist interviewed the patients using the Present State Examination and made the diagnosis based on the DSM-III-R criteria. Current major depression was diagnosed in 6 (30%) patients, somatization in 1 (6%) and panic disorder in 1 (6%) patient. Seven patients were receiving tricyclics antidepressant with doses > 75 mg/day. DISCUSSION: Patients were receiving doses of tricyclics antidepressants efficacious for pain but not for major depression. It is possible that the low dose of antidepressants used to treat pain may partially ameliorate depressive symptoms, making the appropriate diagnosis and treatment of major depression even more difficult, consequently contributing to the persistence of pain and other complains. Considering the wide alternatives to effectively treat depression, a focus on detection and treatment of major depression in patients with chest pain is warranted by clinicians and researchers.

OBJETIVO: A crescente utilização de opióides em doentes com dor crônica de etiologias variadas e os possíveis efeitos desses fármacos em atividades diárias suscitam a importância de se avaliar tais efeitos. Com essa finalidade, desenvolveu-se este estudo de revisão sistemática que avaliou a influência de opióides nas funções cognitivas de doentes com dor crônica. MÉTODOS: Onze bases de dados foram analisadas utilizando-se os descritores opioids, opiates, narcotics, cognitive impairment, cognitive dysfunction, cognitive disorders e pain. Os critérios de inclusão foram: ensaios clínicos ou relatos de caso de dor crônica em tratamento com opióides, testes específicos para avaliação cognitiva e publicação em inglês, espanhol ou português. RESULTADOS: Dezesseis pesquisas, publicadas entre 1980 e 2004, atenderam aos critérios: seis ensaios controlados, sendo dois deles randomizados, e dez estudos de menor força de evidência científica. Os ensaios de melhor qualidade, no contexto clínico do doente com dor crônica, principalmente na dor de origem não oncológica, mostraram que o uso de opióides não prejudica a função cognitiva. CONCLUSÃO: A ausência de prejuízo cognitivo com uso de opióides precisa ser confirmada em novos ensaios randomizados com número maior de pacientes com dor crônica.

OBJECTIVE: The increasing use of opioids by patients suffering from chronic pain caused by different etiologies, and the possible effects of those substances on everyday activities, require careful evaluation of their effects. For this purpose, a systematic review was developed to assess the influence of opioids on the cognitive function in patients with chronic pain. METHODS: Eleven databases were analyzed using the following descriptors: opioids, opiates, narcotics, cognitive impairment, cognitive dysfunction, cognitive disorders and pain. The inclusion criteria were: clinical trials or case reports which included patients with chronic pain in treatment with opioids, cognitive assessment by specific tests and publication in English, Spanish or Portuguese. RESULTS: Sixteen surveys published between 1980 and 2004 met the criteria: six controlled trials, two randomized trials, and 10 studies of a lower scientific evidence level. All better quality controlled trials did not show cognitive impairment of patients under opioid therapy. CONCLUSION: These results must be confirmed by additional randomized trials including a greater number of patients with chronic pain.

Evidence based practice is the use of the best scientific evidence to support the clinical decision making. The identification of the best evidence requires the construction of an appropriate research question and review of the literature. This article describes the use of the PICO strategy for the construction of the research question and bibliographical search.

La práctica basada en evidencias permite la elección de la mejor evidencia científica para subsidiar la toma de decisión clínica. Para lo cual, se requiere de una adecuada construcción de la pregunta de investigación y de la revisión de la literatura. Este artículo describe el uso de la estrategia PICO para la construcción de la pregunta de investigación y la búsqueda bibliográfica.

Prática baseada em evidências é a utilização da melhor evidência científica para subsidiar a tomada de decisão clínica. Identificar a melhor evidência requer adequada construção da pergunta de pesquisa e de revisão da literatura e este artigo descreve o uso da estratégia PICO para a construção da pergunta de pesquisa e busca bibliográfica.

Prática baseada em evidências é a utilização da melhor evidência científica para subsidiar a tomada de decisão clínica. Identificar a melhor evidência requer adequada construção da pergunta de pesquisa e de revisão da literatura e este artigo descreve o uso da estratégia PICO para a construção da pergunta de pesquisa e busca bibliográfica.

Evidence based practice is the use of the best scientific evidence to support the clinical decision making. The identification of the best evidence requires the construction of an appropriate research question and review of the literature. This article describes the use of the PICO strategy for the construction of the research question and bibliographical search.

La práctica basada en evidencias permite la elección de la mejor evidencia científica para subsidiar la toma de decisión clínica. Para lo cual, se requiere de una adecuada construcción de la pregunta de investigación y de la revisión de la literatura. Este artículo describe el uso de la estrategia PICO para la construcción de la pregunta de investigación y la búsqueda bibliográfica.