Interpersonal violence against people with intellectual disabilities in São Paulo, Brazil: characteristics of victims, perpetrators and referrals.

INTRODUCTION: Interpersonal violence is a phenomenon that can occur with different people and conditions. However, people with intellectual disabilities have increased vulnerability to this problem, with potential risks to their health and well-being. The aim of this study was to identify the sociodemographic characteristics of people with disabilities who have been victims of interpersonal violence, the profile of the perpetrators and the measures taken after the victims have been cared for. METHODS: This is an exploratory, descriptive, cross-sectional study using the Interpersonal Violence Notification Forms entered into the Brazilian Ministry of Health's Notifiable Diseases Information System. The city of São Paulo was chosen as the setting because it is the largest city in Latin America and has a faster data processing system than other cities. The period covered notifications made between 2016 and 2022. The information was collected between October and November 2023 and a univariate statistical analysis was carried out. Fisher's exact test was used, with a significance level of 5% (α = 0.05). RESULTS: There were 4,603 notifications against people with intellectual disabilities in the period. The forms of physical violence, neglect/abandonment and psychological/moral violence were more frequent in the 15-19 age group, while sexual violence was more frequent in the 10-14 age group (p < 0.001). The sex most often attacked was female in all the forms investigated (p < 0.001) and the skin colors of the most victimized people were black and/or brown, except in cases of neglect/abandonment (p = 0.058). Most of the victims had little schooling (p = 0.012). The aggressions were committed by one person (p < 0.001), known or related to the victim, such as mother or father, except in cases of sexual violence, where strangers were the main perpetrators (p < 0.001). The sex of the perpetrator was male, except in cases of neglect and/or abandonment (p < 0.001), and the age was between 25 and 29 (p = 0.004). In cases of sexual violence, rape was the most frequent and the procedures carried out were blood collection followed by prophylaxis for Sexually Transmitted Infections (STIs) were the main procedures carried out by health professionals (p = 0.004). The majority of referrals made after receiving care were to the health and social assistance network, with few referrals to bodies such as the human rights reference center, guardianship council and police stations (p < 0.001). CONCLUSION: People with intellectual disabilities are highly vulnerable to the forms of violence studied, especially children and adolescents, black or brown, with low levels of education. The perpetrators are usually close people, male and older than the victims. The referrals made by health professionals did not prioritize the victim's safety and the guarantee of human rights. Lines of care for the health of victims of violence should be implemented, taking into account special aspects, such as people with intellectual disabilities, whose search for help can be difficult.

Non-violent communication as a technology in interpersonal relationships in health work: a scoping review.

BACKGROUND: Working in healthcare environments is highly stressful for most professionals and can trigger problems in interpersonal relationships that can result in horizontal violence. In order to prevent violence and improve the working environment, some strategies can be implemented to provide well-being for all those involved, whether directly or indirectly in health care, such as non-violent communication. The aim of this study was to map and synthesize the available scientific evidence on the use of Nonviolent Communication as a technology for a culture of peace in interpersonal relationships in healthcare. METHODS: This is a scoping review carried out in the National Library of Medicine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Excerpa Medica DataBASE (Embase), PsycINFO - APA/ PsycNET (American Psychological Association) and Latin American and Caribbean Health Sciences Literature (LILACS) databases between March and August 2023. The eligibility criteria used were studies that addressed the topic of NVC in the area of health, published in Portuguese, Spanish or English, with no time restrictions. RESULTS: 53 studies were found in the databases. Two additional studies were extracted from of primary research. In the first exclusion phase, 16 texts were removed due to being duplicated. 39 articles were potentially relevant, and full-texts were reviewed for eligibility along with the inclusion and exclusion criteria Thus, seven studies were included in this review, published in English (five) and Portuguese (two), two of which were carried out in Brazil, one in the United States of America, one in South Korea, one in France, one in Canada and one in Thailand. In terms of the type of study/publication, two studies were reflections, one was a review, one was a mixed study, one was an experience report and two were experimental. The studies were predominantly of high and moderate methodological quality (85.7%). The total number of participants in the studies was 185. The studies showed that NVC is a technology that has made it possible to improve interpersonal relationships between health professionals. Training programs or educational intervention projects on the subject are useful for familiarizing professionals with the subject and demonstrating situations in which the technique can be included. CONCLUSION: The global scientific literature indicates that Nonviolent Communication is a significant resource for improving interpersonal relationships in healthcare work. This approach can be adopted as a strategy by managers and decision-makers, both to resolve conflicts and to prevent aggressive situations between health professionals, especially when it comes to moral or psychological aspects.

Characterization of cardiac arrest in the emergency department of a Brazilian University Reference Hospital: A prospective study.

BACKGROUND & OBJECTIVES: Sudden cardiac arrest (CA) represents one of the greatest challenges for medicine due to the vast number of cases and its social and economic impact. Despite advances in cardiopulmonary resuscitation (CPR) techniques, mortality rates have not significantly decreased over decades. This study was undertaken to characterize patients that have suffered CA and to identify factors related to mortality. METHODS: This prospective study was conducted at Emergency Department of São Paulo Hospital, Brazil. Two hundred and eighty five patients were followed for one year after treatment for CA. The mean age was 66.3±17.2 yr, and they were predominantly male (55.8%) and Caucasian (71.9%). Mortality rate and factors associated with mortality were the primary and secondary outcome measures. Data were collected using an in-hospital Utstein-style report. A logistic regression analysis was used to determine which variables were related to mortality. RESULTS: Regarding the characteristics of CPR, 76.5 per cent occurred in hospital, respiratory failure was the most common presumed immediate cause of CA (30.8%) and pulseless electrical activity was the most frequent initial rhythm (58.7%). All attempts at CPR utilized chest compressions and ventilation and the most utilized interventions were epinephrine (97.2%) and intubation (68.5%). Of all patients treated, 95.4 per cent died. Patients with pulseless electrical activity had a higher risk of death than those patients with ventricular fibrillation. INTERPRETATION & CONCLUSIONS: The findings of the study highlighted that the mortality rate among CA patients was high. The variable that best explained mortality was the initial CA rhythm.

Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case-control study.

BACKGROUND: Infection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy. The rates of bloodstream infection in hemodialysis patients vary according to the type of venous access used. Gram-positive bacteria are most frequently isolated in blood cultures of hemodialysis patients. This study evaluated risk factors for the development of bloodstream infections in patients undergoing hemodialysis. METHODS: Risk factors associated with bloodstream infections in patients on hemodialysis were investigated using a case-control study conducted between January 2010 and June 2013. Chronic renal disease patients on hemodialysis who presented with positive blood cultures during the study were considered as cases. Controls were hemodialysis patients from the same institution who did not present with positive blood cultures during the study period. Data were collected from medical records. Logistic regression was used for statistical analysis. RESULTS: There were 162 patients included in the study (81 cases and 81 controls). Gram-positive bacteria were isolated with the highest frequency (72%). In initial logistic regression analysis, variables were hypertension, peritoneal dialysis with previous treatment, type and time of current venous access, type of previous venous access, previous use of antimicrobials, and previous hospitalization related to bloodstream infections. Multiple regression analysis showed that the patients who had a central venous catheter had an 11.2-fold (CI 95%: 5.17-24.29) increased chance of developing bloodstream infections compared with patients who had an arteriovenous fistula for vascular access. Previous hospitalization increased the chance of developing bloodstream infections 6.6-fold (CI 95%: 1.9-23.09). CONCLUSIONS: Infection prevention measures for bloodstream infections related to central venous catheter use should be intensified, as well as judicious use of this route for vascular access for hemodialysis. Reducing exposure to the hospital environment through admission could contribute to a reduction in bloodstream infections in this population.

[Nursing staff sizing in the emergency room of a university hospital]. / Dimensionamento de enfermagem em sala de emergência de um hospital-escola.

OBJECTIVE: To verify the adequacy of the professional nursing staff in the emergency room of a university hospital and to evaluate the association between categories of risk classification triage with the Fugulin Patient Classification System. METHOD: The classification of patients admitted into the emergency room was performed for 30 consecutive days through the methodology proposed by Gaidzinski for calculating nursing requirements. RESULTS: The calculation determines the need for three registered nurses and four non-registered nursing for each six hour shift. However, only one registered nurse and four non-registered nurse were available per shift. There was no correlation between triage risk classification and classification of care by the Fugulin Patient Classification System. CONCLUSION: A deficit in professional staff was identified in the emergency room. The specificity of this unit made it difficult to measure. To find the best strategy to do so, further studies should be performed.

[Advantages of a cohort study on cardiac arrest conducted by nurses]. / Vantagens do estudo de coorte realizado por enfermeiros em parada cardiorrespiratória.

OBJECTIVE: Identifying factors associated to survival after cardiac arrest. METHOD: An experience report of a cohort study conducted in a university hospital, with a consecutive sample comprised of 285 patients. Data were collected for a year by trained nurses. The training strategy was conducted through an expository dialogue lecture. Collection monitoring was carried out by nurses via telephone calls, visits to the emergency room and by medical record searches. The neurological status of survivors was evaluated at discharge, after six months and one year. RESULTS: Of the 285 patients, 16 survived until hospital discharge, and 13 remained alive after one year, making possible to identify factors associated with survival. There were no losses in the process. CONCLUSION: Cohort studies help identify risks and disease outcomes. Considering cardiac arrest, they can subsidize public policies, encourage future studies and training programs for CPR, thereby improving the prognosis of patients.

Nursing rights in comics: educational technological innovation report.

OBJECTIVES: to report an educational technology construction on nursing professionals' rights. METHODS: an experience report on educational technology construction during the crediting of university extension hours in an undergraduate nursing course at a Brazilian public university, between March and June 2023. The Deming cycle was used as a procedural method. RESULTS: four meetings were held between students and extension workers. Eight comic books were produced based on the Code of Ethics for Nurses, addressing professional autonomy, fair remuneration, risk-free work, denial of exposure in the media and others. The Deming cycle proved to be an important strategy for constructing products. CONCLUSIONS: nursing professionals' rights must be discussed and improved. Educational technologies, such as comic books, provide playful and reflective learning.

Primary Health Care and Tuberculosis Detection during the COVID-19 Pandemic: Crucial Actions for Intensifying Efforts.

BACKGROUND: Tuberculosis has been considered a global emergency since 1993, and controlling it has become even more challenging since 2020 due to the health and social crisis resulting from the COVID-19 pandemic. This study aimed to identify the impact of the COVID-19 pandemic on tuberculosis case detection activities within primary health Care in the largest city in Brazil. METHODS: This is a cross-sectional and analytical study on the provision of tuberculosis detection actions in primary healthcare units during the pandemic period. A descriptive analysis was performed for characterization, and Generalized Mixed Models were used for evaluating associations, with a Bonferroni post hoc test applied. RESULTS: The study sample comprised 80 health units in the municipality. There was a moderate alteration level in the provision of consultations for individuals with signs and symptoms of tuberculosis in 2020 (13.8%) and in 2021 (15.1%). Statistical significance (p < 0.05) was found between the pandemic period and detection actions, with a lower alteration level in 2022. CONCLUSIONS: Tuberculosis detection activities underwent changes due to the COVID-19 pandemic, mainly in 2020, which was associated with alterations in consultation and case notification provision.

King's Parkinson's Disease Pain Questionnaire: reliability and convergent construct validity.

OBJECTIVES: to assess the evidence of reliability and convergent construct validity of the King's Parkinson's Disease Pain Questionnaire. METHODS: psychometric study of 75 older adults with Parkinson's disease. The instrument was applied by two researchers separately and reapplied by one researcher 15 days later. In terms of reliability, internal consistency was assessed using the Cronbach's alpha test and stability using the intraclass correlation coefficient. Scores of the King's Parkinson's Disease Pain Questionnaire were compared to those of the Geriatric Pain Measure in the assessment of construct validity. RESULTS: the mean Cronbach's alpha obtained between the three assessments was above 0.60, the intraclass correlation between the three assessments was above 0.90, and there was a weak but significant correlation between the two applied scales. CONCLUSIONS: the instrument showed adequate evidence of convergent construct validity and reliability, and can be used in clinical practice.

Profile and characteristics of violence against older adults during the COVID-19 pandemic.

OBJECTIVE: to identify the sociodemographic profile and the characteristics of interpersonal violence against older adults during the first year of the COVID-19 pandemic in a capital city from the Brazilian Southeast region. METHOD: a descriptive and exploratory research study with a cross-sectional design based on the notifications of suspected or confirmed cases of violence against older adults between March 2020 and March 2021. A univariate statistical analysis and Fisher's exact test (p<0.05) were performed. RESULTS: a total of 2,681 notifications were recorded during the period. The main victims were individuals aged between 60 and 64 years old, female, white-skinned and with low schooling levels. The instances of violence were more frequent in the victims' homes. Physical and psychological violence predominated, through physical force/beatings and threats, respectively. Most of the aggressors were male, younger than the victims and generally their children or intimate partners. The aggressions were perpetrated more than once and were driven by generational conflicts. There was low referral to entities for the protection of older adults. CONCLUSION: the sociodemographic profile found evidences vulnerable victims, subjected to many types of violence, and at a potential risk against their overall health.

Self-inflicted violence and suicide in people living with HIV/AIDS: a systematic review.

OBJECTIVES: to analyze intellectual productions on self-inflicted violence and suicide in people living with HIV/AIDS. METHODS: a systematic review, carried out between March and April 2021, in the PubMed®/MEDLINE®, Web of Science and LILACS databases, subsidized in the Strengthening the Reporting of Observational Studies in Epidemiology. The period outlined was from 2011 to 2020. RESULTS: a total of 199 studies were identified, and 16 composed the final sample, grouped into the categories: Sociodemographic characteristics of victims of self-inflicted violence/suicide and their intervening factors (pointing to young adults, especially homosexuals, with low social support and a history of mental illness or substance abuse as usual victims); Successful measures for suicide prevention/control in people living with HIV/AIDS (suggesting more frequent psychosocial and clinical follow-up of those starting antiretroviral and immunocompromised treatment). CONCLUSIONS: biopsychosocial follow-up, analysis of sociodemographic profile and intervening factors should be frequent in this population for disease prevention/control.

Association of the Charlson index with risk classification, clinical aspects, and emergency outcomes.

OBJECTIVE: To exam the association of the age-adjusted Charlson comorbidity index with the categories of risk classification, the clinical aspects, and the patient outcomes in the emergency department. METHOD: Cross-sectional, analytical study that analyzed the medical records of 3,624 patients seen in the emergency department. Charlson index scores greater than 2 showed a high rate of comorbidity (mortality risk). T-test and analysis of variance were applied in the analyses. RESULTS: There was a significant difference between the Charlson comorbidity index and the risk classification, with higher scores found in patients classified in the white (2.57) and red (2.06) categories. Patients with vascular, endocrine, neurological, cardiologic, or device problems, and those who underwent a head tomography had a high rate of comorbidity. In addition, those admitted, transferred, or who died in the emergency room had significantly higher index scores compared to those who were discharged from the hospital. CONCLUSION: The high rate of comorbidity was associated with the categories of risk classification, main and nonspecific complaints, performance of a head tomography, and patient outcomes in the emergency room.

Factors associated with risk, perception and knowledge of falls in elderly people.

OBJECTIVE: To verify the factors associated with risk, perception, and knowledge of falls; and pain among older adults. METHOD: A cross-sectional study carried out in the Emergency Service of a teaching hospital in the city of São Paulo between September 2019 and March 2020. We selected 197 older adults aged 65 and over, who were not disoriented or confused, of both genders. The instruments Awareness Questionnaire on the Risk of Falls, Morse Fall Scale and Numerical Pain Scales were applied. Mann-Whitney and Kruskal-Wallis tests were used. RESULTS: Interviewees with a high risk of falls in older adults (p = 0.0041); those with a support network had a lower perception and knowledge about the risk of falls (p = 0.0025) and lower percentage of severe pain (p = 0.0033). CONCLUSION: Factors associated with risk, perception and knowledge of falls and pain among older adults were age, family income, number of dependents, caregiver, support network, hypertension, impaired walking, antihypertensive medication, lipid-lowering medication, level of education, comorbidities and religion.

Vulnerability and quality of life of older persons in the community in different situations of family care.

OBJECTIVE: to correlate socio-contextual aspects, physical vulnerability and quality of life of older persons in the community in different situations of family care. METHODS: epidemiological, a cross-sectional and analytical study, with elderly people in the community (n=769), with application of the instruments: Vulnerable Elders Survey-13 (VES-13), World Health Organization Quality of Life for Older Persons (WHOQOL-OLD) and the World Health Organization Quality of Life (WHOQOL-BREF); and socio-contextual data questionnaire. RESULTS: the population assessed presented an average of regular quality of life in both the WHOQOL-BREF and the WHOQOL-OLD. Older non-vulnerable persons (62.2%) and those with close family contact (82.6%) have a better quality of life than the vulnerable (p<0.0001). CONCLUSION: lower quality of life scores and more distant families are related to vulnerable elderly people; thus, the assessment of family proximity and physical vulnerability of older persons is shown to be an important factor in improving quality of life.

Breast cancer screening in Primary Health Care in Brazil: a systematic review.

OBJECTIVES: to analyze care strategies for breast cancer screening in Primary Health Care in Brazil. METHODS: this is a systematic review following the Cochrane Collaboration recommendations. RESULTS: among 355 manuscripts, five were eligible. The patient navigation program by Community Health Agent stood out with the best result, among the strategies: flexibility of goals considering viability; community engagement; team training; active search of the target population by Community Health Agent; request for mammography by physicians; actions integrated to women's health; monitoring of mammography results, absent users, and population coverage by physician and nurse; and assessment of criteria for requesting screening mammography by means of an information system. The population coverage rate in the program ranged from 23% to 88%. CONCLUSIONS: Primary Health Care in Brazil presents devices with potential to induce the production of care for breast cancer screening.

Manchester Triage System: assessment in an emergency hospital service.

OBJECTIVES: to analyze demographic data, clinical profile and outcomes of patients in emergency services according to Manchester Triage System's priority level. METHODS: a cross-sectional, analytical study, carried out with 3,624 medical records. For statistical analysis, the Chi-Square Test was used. RESULTS: white individuals were more advanced in age. In the red and white categories, there was a higher percentage of men when compared to women (p=0.0018) and higher prevalence of personal history. Yellow priority patients had higher percentage of pain (p<0.0001). Those in red category had a higher frequency of altered vital signs, external causes, and death outcome. There was a higher percentage of exams performed and hospitalization in the orange category. Blue priority patients had a higher percentage of non-specific complaints and dismissal after risk stratification. CONCLUSIONS: a higher percentage of altered vital signs, number of tests performed, hospitalization and death were evidenced in Manchester protocol's high priority categories.

Evaluation of the Manchester Triage System quality indicator: service time.

OBJECTIVE: to verify the conformity of the time interval between the end of the risk classification and the beginning of medical care with that recommended by the Manchester protocol and to relate the times of care and the risk categories with the outcome. METHOD: Cross-sectional, retrospective, and analytical study. The t test, the analysis of variance and the generalized linear model were used. RESULTS: The average time for medical care in the red and orange categories was 3 and 39.5 minutes, respectively. Death outcome was associated with the red category, with an average time to start the classification of 5.5 minutes and an average length of stay of 2.3 hours. CONCLUSION: The waiting time for medical care in the high priority categories was longer than recommended, which suggests the need to continuously monitor the system. Shorter waiting times for classification and permanence were related to the red category and the outcome of death.

Religious/spiritual experiences, quality of life and satisfaction with life of hospitalized octogenarians.

OBJECTIVES: to assess quality of life (QoL) and satisfaction with life (SWL) indices and verify whether the frequency of religious and spiritual experiences is associated with QoL and SWL in hospitalized octogenarians. METHOD: this is a cross-sectional study, with 128 octogenarians. World Health Organization QoL instruments and Scales applied: Daily Spiritual Experience (DSES) and Satisfaction With Life (SWLS). RESULTS: more committed domains related to QoL and SWL: autonomy and physical capacity. The higher the score in DSES, the higher the scores in the psychological domains and past, present, and future QoL activities. The higher the score in DSES, the higher the score in the social involvement aspect. CONCLUSION: the results of this study showed that the higher frequency of religious and spiritual experiences of hospitalized elderly people was associated with better QoL and SWL. It is emphasized that religious and spiritual experiences should be explored in the hospital therapeutic context.

Quality of life and spirituality of patients with chronic kidney disease: pre- and post-transplant analysis.

OBJECTIVE: to compare the quality of life (QoL) of patients under dialysis and after kidney transplant; correlate the QoL of transplant patients to sociodemographic, morbid and spirituality/religiosity variables. METHOD: prospective study with a quantitative approach, with a sample of 27 patients who underwent peritoneal dialysis or dialysis undergoing kidney transplant. QoL and spirituality were assessed by the KDQOL-SF and WHOQOL-SRPB tools, being correlated with sociodemographic and economic variables. RESULTS: the dimensions of total mental component, kidney disease effects and kidney disease burden showed significant improvement in the post-transplant period, with p <0.0004. There was a significant correlation between four dimensions of spirituality and seven dimensions of QoL; p ranged from 0.04 to 0.006. CONCLUSION: there was a significant improvement in QoL in the post-transplant period. The dimensions of spirituality: wholeness and integration, spiritual connection, wonder and inner peace were positively correlated with seven dimensions of QoL.

Functional capacity and quality of life of elderly people admitted to emergency service. / Capacidade funcional e qualidade de vida de pessoas idosas internadas no serviço de emergência.

OBJECTIVE: To correlate the functional capacity and quality of life of elderly people admitted to emergency service. METHOD: This is a cross-sectional and analytical study carried out with elderly patients admitted to a university hospital's emergency service in the city of São Paulo, between December 2015 and January 2017. Data were collected through interviews using a structured questionnaire, the Medical Outcome Study 36, the Katz of Independence in Activities of Daily Living, and the Functional Independence Measure. RESULTS: Two hundred fifty elderly people with a mean age of 71.9 years, male (56.8%), white in color (67.2%), married (54.0%), with low education (32.0%), low income (58.0%), with comorbidities (81.2%) and home providers (53.6%) have participated. The most compromised Quality of Life dimensions were physical aspect (11.4%), emotional aspect (21.6%) and functional capacity (25.2%). Concerning functional capacity, independence was characterized for Basic Activities of Daily Living and moderate dependence for Instrumental Activities of Daily Living. The higher the scores of the Functional Independence Measure, the higher the quality of life scores. CONCLUSION: The more independent the elderly the better their quality of life.