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

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

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

BACKGROUND: Disorders 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. METHODS: We 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. FINDINGS: Globally, 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. INTERPRETATION: As 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