VALIDAÇÃO DE INSTRUMENTO PARA CUIDADO DA PESSOA IDOSA COM XEROSE CUTÂNEA

Objective: To build and validate an instrument for nursing care to assess, prevent, and treatcutaneous xerosis in older adults.Method: A methodological study, carried out from June 2017 to August 2018 in João Pessoaand developed in three stages: integrative literature review, instrument construction, andcontent validation by a panel of judges who subject matter experts.Results: Upon completing the validation, the instrument displayed a total content validitycoefficient equal to 0.887 from the aspects of language clarity, practical relevance, theoreticalrelevance and dimension, and Kappa index equal to 0.77.Conclusion: The instrument proved to be valid, contributing to the practice of nurses as anintegral part in the process of caring for the skin of older adults.Objetivo: construir e validar um instrumento para os cuidados de Enfermagem para avaliar, prevenir e tratar a xerose cutânea em pessoas idosas.Método: estudo metodológico, realizado no período de junho de 2017 a agosto de 2018, em João Pessoa, desenvolvido em três etapas: revisão integrativa da literatura, construção do instrumento e validação de conteúdo sob um painel de juízes expertises na área.Resultados: mediante a realização da validação, o instrumento apresentou um coeficiente de validade de conteúdo total igual a 0,887 a partir dos aspectos clareza da linguagem, pertinência prática, relevância teórica e dimensão e índice de Kappa igual a 0,77.Conclusão: o instrumento mostrou-se válido, contribuindo para a prática dos enfermeiros como parte integrante no processo do cuidar da pele de pessoas idosas.Objetivo: construir y validar un instrumento para los cuidados de Enfermería con el fin deevaluar, prevenir y tratar la xerosis cutánea en adultos mayores.Método: estudio metodológico realizado entre junio de 2017 y agosto de 2018 en JoãoPessoa, y desarrollado en tres etapas: revisión integradora de la literatura, construcción delinstrumento y validación del contenido por parte de un panel jueces expertos en el área.Resultados: una vez finalizada la validación, el instrumento presentó un coeficiente de validezde contenido total igual a 0,887 a partir de los siguientes aspectos: claridad de lenguaje,pertinencia práctica, relevancia teórica y dimensión e índice de Kappa igual a 0,77.Conclusión: el instrumento demostró ser válido, lo que contribuye a la práctica de losenfermeros como componente del proceso del cuidado de la piel de los adultos mayores

O burnout em profissionais de enfermagem que atuam em um complexo psiquiátrico

Aim: To investigate burnout in nursing professionals working in a Psychiatric Complex. Method: exploratory, quantitative research conducted with 42 nursing professionals. For the collection, we used an instrument consisting of sociodemographic and professional data, and the Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo – CESQT. Results: when considering the percentile, 17 (40.5%) nursing professionals had very low levels suggestive of burnout. Working time in the institution was associated with psychic burnout (p = 0.03). Conclusion: on average, the respondents did not show values suggestive of burnout, but the length of action was associated with the dimensions of the injury. It is noteworthy that preventive measures should be performed to eliminate or reduce the possible chances of emergence of the diseaseObjetivo: investigar el agotamiento en los profesionales de enfermería que trabajan en un complejo psiquiátrico. Método: investigación exploratoria cuantitativa realizada con 42 profesionales de enfermería. Para la recopilación, utilizamos un instrumento que consta de datos sociodemográficos y profesionales, y la Cuestionário para la Evaluación del Síndrome de Quemarse por el Trabajo - CESQT. Resultados: al considerar el percentil, 17 (40.5%) profesionales de enfermería tenían niveles muy bajos que sugerían agotamiento. El tiempo de trabajo en la institución se asoció con agotamiento psíquico (p = 0.03). Conclusión: en promedio, los encuestados no mostraron valores sugestivos de agotamiento, pero la duración de la acción se asoció con las dimensiones de la lesión. Es de destacar que se deben tomar medidas preventivas para eliminar o reducir las posibles posibilidades de aparición de la enfermedad.Objetivo: investigar o burnout em profissionais de enfermagem que atuam em um Complexo Psiquiátrico. Método: pesquisa exploratória, quantitativa, realizada com 42 profissionais de enfermagem. Para a coleta, utilizou-se um instrumento constando de dados sociodemográficos e profissionais, e o Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo – CESQT. Resultados: quando considerado o percentil, 17 (40,5%) profissionais de enfermagem encontravam-se com níveis muito baixos sugestivos de burnout. O tempo de trabalho na instituição teve associação com o desgaste psíquico (p= 0,03). Conclusão: em média, os entrevistados não apresentaram valores sugestivos do burnout, porém o tempo de atuação esteve associado às dimensões do agravo. Ressalta-se que medidas de prevenção devem ser realizadas para eliminar ou reduzir as possíveis chances de surgimento do agravo

Nurses' livingness about palliative care / Vivência de enfermeiros acerca dos cuidados paliativos

Objetivo: analisar a percepção de enfermeiros acerca da sua vivência em cuidados paliativos. Método: estudo descritivo e exploratório com abordagem qualitativa realizado em um hospital de referência em cuidados paliativos. A amostra foi constituída por 12 enfermeiros assistenciais. Para coleta de dados foi realizada uma entrevista com um roteiro semiestruturado composto por duas partes: a primeira abrangendo dados sociodemográficos e a segunda contemplava quatro questões para atender aos objetivos do estudo. Os dados oriundos da entrevista foram transcritos e em seguida avaliados mediante análise de conteúdo que permitiu a construção de três categorias: percepções acerca do que são cuidados paliativos; pontos relevantes a serem considerados para a realização dos cuidados paliativos; e o manejo da dor em cuidados paliativos. Resultados: os enfermeiros destacam que os cuidados paliativos devem contemplar não só a atenção aos pacientes, mas a família, ainda revelando sentimentos e medidas importantes como afeto, carinho e conforto. Conclusão: há um processo de efetivação acerca dos princípios que permeiam esse tipo de cuidado e cabe salientar que é um serviço novo que está em processo de formação e capacitação contínuo, o que tem contribuído para os resultados

Percepção de enfermeiros acerca dos cuidados e a utilização de hidrogel em lesões por pressão

The study aimed to know the perception of nurses about the use of hydrogels in pressure injuries. This is a research with a qualitative approach conducted in a public hospital in João Pessoa / Paraíba, where the sample consisted of 17 nurses working in the Intensive Care Center, skin committee and red room. Data were collected through an interview using a semi-structured form, and the analysis was performed using the Thematic Content Analysis. It was revealed that there are weaknesses regarding nurses'knowledge regarding pressure injuries and hydrogel application. Noting the need for continuing education in health services, with the aim of alleviating nurses' knowledge limitations regarding the concept, classification and causes of pressure injuries, as well as the use of hydrogel.El estudio tuvo como objetivo conocer la percepción de las enfermeras sobre el uso de hidrogeles en lesiones por presión. Esta es una investigación con un enfoque cualitativo realizada en un hospital público en João Pessoa / Paraíba, donde la muestra consistió en 17 enfermeras que trabajan en el Centro de Cuidados Intensivos, el comité de la piel y la sala roja. Los datos fueron recolectados a través de una entrevista usando una forma semiestructurada, y el análisis se realizó usando la técnica de Análisis de Contenido Temático. Se reveló que existen debilidades con respecto al conocimiento de las enfermeras con respecto a las lesiones por presión y la aplicación de hidrogel. Observando la necesidad de educación continua en los servicios de salud, con el objetivo de aliviar las limitaciones de conocimiento de las enfermeras con respecto al concepto, clasificación y causas de las lesiones por presión, así como el uso de hidrogel.O estudo objetivou conhecer a percepção dos enfermeiros sobre a utilização do hidrogel em lesões por pressão. Trata-se de pesquisa com abordagem qualitativa realizada em uma instituição hospitalar pública de João Pessoa/Paraíba, onde a amostra foi composta por 17 enfermeiros atuantes no Centro de Terapia Intensiva, comissão de pele e sala vermelha. Os dados foram coletados através de uma entrevista utilizando um formulário semiestruturado, e a análise deu-se por meio da técnica de Análise de Conteúdo Temática. Foi revelado que existem fragilidades no que concerne aos conhecimentos dos enfermeiros em relação às lesões por pressão e à aplicação hidrogel. Observando-se a necessidade de realizar educação continuada nos serviços de saúde, com o objetivo de atenuar as limitações de conhecimentos dos enfermeiros no que se refere ao conceito, à classificação e às causas das lesões por pressão, bem como sobre a utilização do hidrogel

Perfil de pacientes de uma unidade de terapia intensiva de adultos de um município paraibano

Objective: to investigate the profile of patients admitted to an intensive care unit of a hospital in Paraíba in Brazil. Method: This is a retrospective documentary study, with a quantitative approach, carried out in the Intensive Care Unit of a general hospital. Descriptive statistics were used to determine the frequency and the chi-square test for comparison. Results: From a sample of 461 patients, there was a higher frequency in the age group between 71 and 80 years, 50.8% women, 43.4% coming from emergency and diagnoses related to cardiovascular diseases with 28%. Regarding their evolution, 45.3% were discharged, 52% died, 2% were transferred and 0.7% remained in the Unit. Of these, 71.1% did not present pressure injuries when admitted. Conclusion: Most of the patients admitted to the Intensive Care Unit are elderly, with comorbidities, with gender equivalence. It is noteworthy that the information acquired in the study can contribute to assistance, financial and permanent education in service planning.Objetivo: investigar el perfil de los pacientes ingresados en una unidad de cuidados intensivos de un hospital en Paraíba en Brasil. Método: Este es un estudio documental, retrospectivo, con un enfoque cuantitativo, realizado en la Unidad de Cuidados Intensivos de un hospital general. Se utilizaron estadísticas descriptivas para determinar la frecuencia y la prueba de chi-cuadrado para la comparación. Resultados: De una muestra de 461 pacientes, hubo una mayor frecuencia en el grupo de edad entre 71 y 80 años, 50.8% mujeres, 43.4% provenientes de urgencia y diagnósticos relacionados con enfermedades cardiovasculares con 28%. En cuanto a su evolución, el 45,3% fueron dados de alta, el 52% falleció, el 2% fueron transferidos y el 0,7% permaneció en la Unidad. De estos, el 71.1% no presentó lesiones por presión cuando ingresó. Conclusión: La mayoría de los pacientes ingresados en la Unidad de Cuidados Intensivos son ancianos, con comorbilidades, con equivalencia de género. Es de destacar que la información adquirida en el estudio puede contribuir a la asistencia, educación financiera y permanente en la planificación del servicio.Objetivo: investigar o perfil dos pacientes internados em uma unidade de terapia intensiva de um hospital da Paraíba, Brasil. Método: estudo retrospectivo, documental, com abordagem quantitativa, realizado na Unidade de Terapia Intensiva de um hospital geral. A estatística descritiva foi utilizada para determinar a frequência e o teste do qui-quadrado para comparação. Resultados: De uma amostra de 461 pacientes, houve maior frequência na faixa etária entre 71 e 80 anos, 50,8% mulheres, 43,4% procedentes de emergência e diagnósticos relacionados a doenças cardiovasculares com 28%. Quanto à evolução, 45,3% tiveram alta hospitalar, 52% faleceram, 2% foram transferidos e 0,7% permaneceram na Unidade. Destes, 71,1% não apresentaram lesões por pressão na internação. Conclusão: A maioria dos pacientes internados em Unidade de Terapia Intensiva são idosos, com comorbidades, com equivalência de gênero. Ressalta-se que as informações adquiridas no estudo podem contribuir para a educação assistencial, financeira e permanente no planejamento do serviço

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation