Guidelines for occupational therapy assistance in COVID-19 pandemic and post-pandemic perspectives

INTRODUÇÃO: A COVID-19 é uma doença altamente contagiosa, de apresentação recente, causada pelo novo coronavírus, denominado SARS-CoV-2 por ser da família SARS (Síndrome Respiratória Aguda Grave). São necessárias diretrizes cientificamente fundamentadas sobre as intervenções dos terapeutas ocupacionais no cuidado de pessoas com a COVID-19 e sobre as perspectivas de atenção pós-pandemia. OBJETIVO: Apresentar diretrizes e recomendações aos terapeutas ocupacionais sobre o manejo clínico de pacientes com COVID-19 em diferentes níveis de atenção à saúde, para favorecer a assistência segura e com qualidade técnico-científica. MÉTODO: Dez terapeutas ocupacionais de diferentes estados brasileiros, experts em suas áreas de atuação, reuniram-se, por meio de web conferências, para desenvolver diretrizes para a atuação do terapeuta ocupacional na pandemia da COVID-19. O público-alvo destas diretrizes é composto por terapeutas ocupacionais, gestores e outros profissionais interessados no conhecimento e nas ações da terapia ocupacional com pacientes com COVID-19 e seus familiares. Como ainda não existem estudos e revisões sistemáticas de evidências científicas relativas à terapia ocupacional na COVID-19, foram analisadas as melhores diretrizes e evidências disponíveis na literatura. Foi realizada uma ampla revisão de documentos nacionais e internacionais publicados sobre o tema, como artigos científicos e resoluções da Organização Mundial da Saúde e do Ministério da Saúde do Brasil. Foram também revisadas publicações disponibilizadas por sociedades ou organizações profissionais internacionais de terapia ocupacional, como a Federação Mundial de Terapeutas Ocupacionais, a Associação Americana dos Terapeutas Ocupacional, o Royal College of Occupational Therapists, do Reino Unido, e o Colegio Profesional de Terapeutas Ocupacionales de la Comunidad de Madrid, Espanha. RESULTADOS: As diretrizes reunidas nesta publicação não substituem as políticas institucionais e nacionais. Estão baseadas nos princípios da Ciência Ocupacional e nas melhores evidências disponíveis na literatura, balizadas pela experiência de todos os profissionais envolvidos na produção deste documento. Foram abordados temas como a privação ocupacional decorrente da pandemia e da estratégia de distanciamento social e os recursos técnicos recomendados para a promoção do desempenho ocupacional e manejo de dor e de sintomas em diferentes contextos, com destaque para a atuação do terapeuta ocupacional na atenção básica, na atenção hospitalar e nos cuidados paliativos. CONSIDERAÇÕES FINAIS: Dada a recente apresentação da COVID-19, há necessidade de constante atualização das informações e novas evidências científicas poderão ser publicadas. O raciocínio clínico é imprescindível para o planejamento e implementação da assistência aos pacientes e seus familiares ou cuidadores e será necessário o acompanhamento dos pacientes positivos para o SARS-CoV-2 para a verificação das consequências da COVID-19, das necessidades e demandas de reabilitação das pessoas acometidas, pós-hospitalização e pós-pandemia.INTRODUCTION: COVID-19 is a highly contagious disease of a recent presentation, caused by the new coronavirus called SARS-CoV-2 because it belongs to the SARS family (Severe Acute Respiratory Syndrome). Scientifically grounded guidelines are needed on occupational therapists’ interventions in caring for people with COVID-19 and on prospects for post-pandemic care. OBJECTIVE: To present guidelines and recommendations to occupational therapists on the clinical management of patients with COVID-19 at different levels of health care, to favor safe care with technical and scientific quality. METHOD: Ten occupational therapists from different Brazilian states, experts in their areas of expertise, met, through web conferences, to develop guidelines for the work of the occupational therapist in the pandemic of COVID-19. The target audience of these guidelines is composed of occupational therapists, managers, and other professionals interested in the knowledge and actions of Occupational Therapy with patients with COVID-19 and their families. As there are still no studies and systematic reviews of scientific evidence related to occupational therapy in COVID-19, the best guidelines and evidence available in the literature were analyzed. A wide review of national and international documents published on the subject, such as scientific articles and resolutions of the World Health Organization and the Ministry of Health of Brazil, was carried out. Publications made available by international occupational therapy societies or professional organizations, such as the World Federation of Occupational Therapists, the American Association of Occupational Therapists, the Royal College of Occupational Therapists from United Kingdom, and the Colegio Profesional de Terapeutas Ocupacionales de la Comunidad from Madrid, Spain. RESULTS: The guidelines in this publication do not replace institutional and national policies. They are based on the principles of Occupational Science and the best evidence available in the literature and the experience of all professionals involved in the production of this document. Topics such as occupational deprivation resulting from the pandemic and the strategy of social detachment and the technical resources recommended for the promotion of occupational performance and management of pain and symptoms in different contexts were addressed, with emphasis on the role of the occupational therapist in primary care, hospital care and palliative care. FINAL CONSIDERATIONS: Given the recent presentation of COVID-19, there is a need for constant updating of information, and new scientific evidence may be published. Clinical reasoning is essential for planning and implementing assistance to patients and their families or caregivers. It will be necessary to monitor patients who tested positive for SARS-CoV-2 to verify the consequences of COVID-19, their needs and demands of rehabilitation, post-hospitalization, and post-pandemic

Mortalidade Materna no Brasil (2013-2023): Desigualdades Regionais nas Causas Obstétricas

Introdução: No território brasileiro, a mortalidade materna ainda se mantém abaixo dos parâmetros estabelecidos pelos Objetivos de Desenvolvimento Sustentável (ODS), o que apesar dos avanços na saúde nas últimas décadas, ainda há uma persistência de mortes obstétricas de causas diretas e indiretas, principalmente nas regiões mais pobres do país. Neste âmbito, muitos são os fatores relacionados que contribuem para a mortalidade materna, sendo eles orgânicos, psíquicos, sociais e assistenciais, nas quais o pré-natal e a qualidade da assistência são fulcral para a contribuição dessas taxas, principalmente quando se fala das desigualdades regionais no Brasil. Dessa forma, apesar de existir ações para minimizar os índices de óbitos maternos, a sua persistência em grupos específicos ainda revela um cuidado desigual. Objetivos: Descrever e analisar os óbitos maternos no Brasil no período de 2013 a 2023 relacionando-os com as variáveis região e causa do óbito. Metodologia: Trata-se de um estudo epidemiológico, quantitativo, descritivo e retrospectivo. Utilizando-se a base de dados secundários obtidos do Sistema de Informações sobre Nascidos Vivos (SINASC) e do Departamento de Informática do Sistema Único de Saúde (DATASUS). Conclusão: Destarte, as desigualdades regionais e raciais permanecem enraizadas em todo o território brasileiro, evidenciando a necessidade da implementação fidedigna das políticas públicas e ações direcionadas ao cuidado obstétrico de forma individualizada e humanizada

Anais do V Encontro Brasileiro de Educomunicação: Educação midiática e políticas públicas

A presente coletânea, que chega ao público através de um suporte digital, tem como objetivo disponibilizar os papers, bem como os relatos de experiências educomunicativas apresentados durante o V ENCONTRO BRASILEIRO DE EDUCOMUNICAÇÃO, que teve como tema central: “Educação Midiática e Políticas Públicas”. O evento foi realizado em São Paulo, entre 19 e 21 de setembro de 2013, a partir de uma parceria entre o NCE/USP - Núcleo de Comunicação e Educação da USP, a Licenciatura em Educomunicação da ECA/USP, a ABPEducom – Associação Brasileira de Pesquisadores e Profissionais da Educomunicação e a FAPCOM – Faculdade Paulus de Tecnologia e Comunicação, que ofereceu seu campus, na Vila Mariana, para os atos do evento. Os presentes anais disponibilizam o texto de abertura, de autoria do coordenador geral do evento, denominado “Educação midiática e políticas públicas: vertentes históricas da emergência da Educomunicação na América Latina”. Na sequência, apresentam 61 papers sobre aspectos específicos da temática geral, resultantes de pesquisas na área, seguidos de 27 relatos de práticas educomunicativas, em nível nacional

Total pain in people with advanced lung cancer - mixed method study

Introdução: São múltiplas as causas de dor de pessoas com câncer, relacionadas tanto ao adoecimento quanto ao tratamento. De acordo com o conceito de Dor Total preconizado por Cicely Saunders, além da dimensão física da dor, há componentes emocionais, sociais e espirituais que influenciam na gênese da dor e do sofrimento, nos modos de enfrentamento ao longo do tratamento e diante da morte. A identificação da Dor Total permite o oferecimento de melhor assistência e promoção de bem-estar e qualidade de vida no processo de morte e morrer. Objetivos: Investigar o conceito multidimensional da Dor Total, sua complexidade na sua avaliação em pessoas com câncer de pulmão avançado e analisar, do ponto de vista multidimensional, como os participantes do estudo compreendem seu processo doloroso, compreendido como Dor Total. Método: Estudo de método misto, sequencial explanatório, realizado com pessoas diagnosticadas com câncer de pulmão avançado. Foi realizado em duas etapas: na primeira, quantitativa, com 81 pessoas, foram descritas as características sociodemográficas e clínicas dos participantes e foram aplicados instrumentos de avaliação multidimensional de dor e sintomas. Na segunda fase, com metodologia qualitativa, foi explorada a perspectiva dos participantes sobre a experiência da dor total, por meio de entrevistas semiestruturadas com 8 participantes previamente selecionados. Para análise dos dados quantitativos, foi realizada análise descritiva simples e utilizado a classe de modelos aditivos generalizados GAMLSS. Para os dados qualitativos, foi utilizado o método de análise temática reflexiva. Resultados: Na etapa quantitativa, houve a prevalência de participantes do sexo masculino (55,6%) e a associação com a variável sexo mostrou um aumento relativo de 49,22% no escore médio de dor para participantes do sexo feminino em relação aos do sexo masculino. Em relação à escolaridade, houve um aumento relativo de 74,53% no nível médio de dor entre os participantes com ensino fundamental. Pacientes de baixa renda apresentaram aumento relativo de 9,99% na pontuação média de sintomas e dor, tristeza e ansiedade, em relação aos participantes com maior escolaridade. Na etapa qualitativa houve prevalência de mulheres (n=7) e foram analisadas e contextualizadas as percepções sobre o diagnóstico, tratamento e interferência da dor na vida dos participantes. Os dados foram organizados em três categorias temáticas, com seus respectivos subtemas: Unidade de sentido 1, referente ao modo como os participantes compreendem e vivenciam o diagnóstico e tratamento; Unidade de sentido 2- referente as dimensões da dor total; Unidade de sentido 3- referente as vivências dos participantes em relação à finitude da vida. Os resultados indicaram que problemas relacionados à dor influenciaram no cotidiano, acarretaram preocupações e afetaram a qualidade de vida dos participantes. Níveis mais elevados de ansiedade e depressão foram observados naqueles que tinham dores e preocupações sociais e emocionais. Religiosidade e espiritualidade apareceram nas entrevistas como recursos no enfrentamento da Dor Total em sua forma multifacetada, de acordo com suas dimensões emocionais, sociais e espirituais/existenciais. Por fim, a análise das duas etapas ocorreu por meio da narração, transformação e exibição conjunta dos dados através de joint displays para cada participante, retratando as citações relacionadas ao marco teórico referencial da dor total e a interface com os escores quantitativos dos instrumentos aplicados. Conclusão: A integração dos dados permitiu inferir que os sentidos das falas dos participantes da etapa qualitativa, deu suporte e conferiu validade aos resultados da etapa quantitativa. A abordagem conjugada ou integrada, de acordo com o método misto, permitiu compreender a dor em sua multidimensionalidade e complexidade, o pode favorecer uma abordagem do cuidado integral. A identificação e avaliação da Dor Total em suas múltiplas dimensões, em cada fase do tratamento, permite melhorar a assistência oncológica, principalmente em cuidados paliativos.Introduction: There are multiple causes of pain in people with cancer, related to both illness and treatment. According to the concept of Total Pain advocated by Cicely Saunders, in addition to the physical dimension of pain, there are emotional, social and spiritual components that influence the genesis of pain and suffering, in the ways of coping during treatment and in the face of death. The identification of Total Pain allows the provision of better assistance and promotion of well-being and quality of life in the process of death and dying. Objectives: To investigate the multidimensional concept of Total Pain, its complexity in its assessment in people with advanced lung cancer and to analyze, from a multidimensional point of view, how the study participants understand their painful process, understood as Total Pain. Method: A mixed-method, sequential, explanatory study conducted with people diagnosed with advanced lung cancer. It was carried out in two stages: in the first, quantitative, with 81 people, the sociodemographic and clinical characteristics of the participants were described and instruments for the multidimensional assessment of pain and symptoms were applied. In the second phase, with a qualitative methodology, the participants\' perspective on the experience of total pain was explored through semi-structured interviews with 8 previously selected participants. For the analysis of quantitative data, a simple descriptive analysis was performed and the GAMLSS generalized additive model class was used. For qualitative data, the reflective thematic analysis method was used. Results: In the quantitative stage, there was a prevalence of male participants (55.6%) and the association with the gender variable showed a relative increase of 49.22% in the mean pain score for female participants in relation to to the males. Regarding education, there was a relative increase of 74.53% in the average level of pain among participants with elementary education. Low-income patients showed a relative increase of 9.99% in the average score of symptoms and pain, sadness and anxiety, in relation to participants with higher education. In the qualitative stage, there was a prevalence of women (n=7) and perceptions about the diagnosis, treatment and interference of pain in the participants\' lives were analyzed and contextualized. Data were organized into three thematic categories, with their respective subthemes: Unit of meaning 1, referring to the way participants understand and experience the diagnosis and treatment; Unit of meaning 2- referring to the dimensions of total pain; Unit of meaning 3- referring to the participants\' experiences in relation to the finitude of life. The results indicated that pain-related problems influenced daily life, caused concerns and affected the participants\' quality of life. Higher levels of anxiety and depression were seen in those who had social and emotional pain and concerns. Religiosity and spirituality appeared in the interviews as resources for coping with Total Pain in its multifaceted form, according to its emotional, social and spiritual/existential dimensions. Finally, the analysis of the two stages took place through the narration, transformation and joint display of data through joint displays for each participant, portraying the citations related to the theoretical framework of total pain and the interface with the quantitative scores of the applied instruments. Conclusion: The integration of data allowed us to infer that the meanings of the speeches of the participants in the qualitative stage supported and validated the results of the quantitative stage. The combined or integrated approach, according to the mixed method, made it possible to understand pain in its multidimensionality and complexity, which can favor a comprehensive care approach. The identification and evaluation of Total Pain in its multiple dimensions, in each phase of treatment, allows improving cancer care, especially in palliative care

Use of alternative communication technology on quality of life evaluation of head and neck neoplasms patients

Introduction: Communication, social interactions and health-related quality of life (HRQoL) of the person affected by head and neck cancer (HNC) are affected by both diagnosis and treatment. Objective: The aim of this study was to evaluate the use of alternative communication software as a resource for the application of HRQoL assessment tools for people with HNC who underwent laryngectomy. Method: An exploratory, cross-sectional study with 100 adult individuals of both genders. A Sociodemographic identification form was used and the Brazilian Criteria for Economic Classification was applied the Functional Assessment of Cancer Therapy-Head and Neck-FACT-H&N scale. These instruments were inserted, in their original format, into the alternative communication software Livox, which is an auxiliary communication resource that favors the communication of people with speech difficulties providing a conversion of text into sounds. Results: The dimensions of functional well-being and emotional well-being were the most affected in the evaluation of HRQoL. Most interviewees did not have difficulty in using Livox to respond to the questionnaires. However, there was an association between the age and professional activity in relation to the use of the software, since 100% of the over-58s and non-active retirees reported some difficulties in their use. Conclusion: The use of technological resources may facilitate access to services and treatments by laryngectomized individuals, however, the elderly present greater difficulties in the use of modern communication technologies due to sociocultural contexts, cognitive and emotional difficulties. Occupational therapy can facilitate this adaptation through the use of resources, strategies, and techniques for the use of technology instruments as facilitators for communication in intra- and extra-hospital contexts, providing autonomy and independence for the subjects

The importance of a continuum of rehabilitation from diagnosis of advanced cancer to palliative care

Identifying the evidence found in the international scientific literature, referring to the concept of rehabilitation in the setting of oncologic palliative care. Integrative literature review based on articles published in indexed journals on the electronic databases: LILACS, CINAHL and PubMed/MEDLINE, WEB OF SCIENCE, OTSEEKER and PEDRO, following the PRISMA criteria. The quantitative articles were evaluated using the McMaster form for quantitative studies and the qualitative studies were assessed by the Critical Appraisal Skills Program. The studies were inserted in the Rayyan™ application. The final sample was composed of 21 qualitative and quantitative articles published in the period from 2004 to 2021, in nine different countries. Three thematic units were defined addressing the interface between palliative care and rehabilitation, the concept of palliative rehabilitation and the barriers to its implementation. The quality of the articles reviewed varied from 31% to 100% of the criteria met. The international scientific production reinforces the importance of including rehabilitation in care in oncologic palliative care, highlighting the concept of palliative rehabilitation, but there is a need for expanding and divulging new research on the theme and the results.IMPLICATIONS FOR REHABILITATIONPalliative care services and rehabilitation services should take and create opportunities to promote rehabilitation for people living with incurable cancer.Palliative rehabilitation has an important role in the treatment of people with advanced cancer, helping increase the quality of life, relief of pain, symptoms, and distress.It is considered an integral part of palliative care, given that rehabilitation and palliative care are related to the continuum of care.It is important to understand this gap in the international literature on the continuum between rehabilitation and palliative rehabilitation to improve the provision of this approach in both rehabilitation and palliative care services. Palliative care services and rehabilitation services should take and create opportunities to promote rehabilitation for people living with incurable cancer. Palliative rehabilitation has an important role in the treatment of people with advanced cancer, helping increase the quality of life, relief of pain, symptoms, and distress. It is considered an integral part of palliative care, given that rehabilitation and palliative care are related to the continuum of care. It is important to understand this gap in the international literature on the continuum between rehabilitation and palliative rehabilitation to improve the provision of this approach in both rehabilitation and palliative care services.</p

The importance of a continuum of rehabilitation from diagnosis of advanced cancer to palliative care

Identifying the evidence found in the international scientific literature, referring to the concept of rehabilitation in the setting of oncologic palliative care. Integrative literature review based on articles published in indexed journals on the electronic databases: LILACS, CINAHL and PubMed/MEDLINE, WEB OF SCIENCE, OTSEEKER and PEDRO, following the PRISMA criteria. The quantitative articles were evaluated using the McMaster form for quantitative studies and the qualitative studies were assessed by the Critical Appraisal Skills Program. The studies were inserted in the Rayyan™ application. The final sample was composed of 21 qualitative and quantitative articles published in the period from 2004 to 2021, in nine different countries. Three thematic units were defined addressing the interface between palliative care and rehabilitation, the concept of palliative rehabilitation and the barriers to its implementation. The quality of the articles reviewed varied from 31% to 100% of the criteria met. The international scientific production reinforces the importance of including rehabilitation in care in oncologic palliative care, highlighting the concept of palliative rehabilitation, but there is a need for expanding and divulging new research on the theme and the results.IMPLICATIONS FOR REHABILITATIONPalliative care services and rehabilitation services should take and create opportunities to promote rehabilitation for people living with incurable cancer.Palliative rehabilitation has an important role in the treatment of people with advanced cancer, helping increase the quality of life, relief of pain, symptoms, and distress.It is considered an integral part of palliative care, given that rehabilitation and palliative care are related to the continuum of care.It is important to understand this gap in the international literature on the continuum between rehabilitation and palliative rehabilitation to improve the provision of this approach in both rehabilitation and palliative care services. Palliative care services and rehabilitation services should take and create opportunities to promote rehabilitation for people living with incurable cancer. Palliative rehabilitation has an important role in the treatment of people with advanced cancer, helping increase the quality of life, relief of pain, symptoms, and distress. It is considered an integral part of palliative care, given that rehabilitation and palliative care are related to the continuum of care. It is important to understand this gap in the international literature on the continuum between rehabilitation and palliative rehabilitation to improve the provision of this approach in both rehabilitation and palliative care services.</p