Managing long COVID symptoms and accessing health services in Brazil: A grounded theory analysis.

Background: The worldwide community has shown significant interest in researching the management of Long COVID. However, there is scarce evidence about the daily experiences of people living with Long COVID and their insights into the healthcare services provided to them. Aims: This study aims to understand the experience of Long COVID sufferers with their symptoms and in accessing health services. Method: We employed Charmaz's grounded theory methodology, informed by constructivism, and applied the COREQ guidelines for qualitative research. Sixty-six Brazilians living with Long COVID participated in the study. The data was collected using semi-structured telephone interviews and analyzed using a constant comparative process. Findings: The findings refer firstly to the consequences of persistent Long COVID symptoms. Secondly, they describe how the disease trajectory required Long COVID sufferers to reorganize their routines and develop adaptive strategies. Lastly, they reflect a diverse array of both positive and negative interactions inside the healthcare system conveyed by individuals suffering from Long COVID. These elements converge towards the core category of the study: "The limbo of Long COVID sufferers: between the persistence of symptoms and access to health services". Conclusions: Long COVID is characterized by its varied nature, including a range of physical and emotional repercussions experienced by individuals. There is a need for enhanced comprehension and discourse about Long COVID across several domains, including the general public, policy-making entities, and healthcare professionals. In this sense, the development of specialized services or the reinforcement of existing services to support long COVID sufferers is imperative.

Factors associated with hospitalizations and deaths of pregnant women from Paraná due to COVID-19: a cross-sectional study.

OBJECTIVE: To analyze the factors associated with hospitalization in the ward and intensive care unit (ICU), and with death from COVID-19 in pregnant women with confirmed cases. METHODS: Observational, cross-sectional study, carried out with data from pregnant women with a confirmed case of COVID-19 from the Influenza Epidemiological Surveillance Information System and the Paraná's state COVID-19 notification system. The association between the independent and dependent variables (hospitalization in the ward and ICU, and death) was investigated using the Poisson regression model with robust variance. RESULTS: 4,719 pregnant women comprised the study population. 9.6 and 5.1% were hospitalized in wards and ICU, respectively. 1.9% died. There was an association between advanced maternal age and hospitalization in wards (PR=1.36; 95%CI 1.10-1.62) and ICU (PR=2.25; 95%CI 1.78-2.71), and death (PR=3.22; 95%CI 2.30-4.15). An association was found between the third trimester and hospitalization in wards (PR=5.06; 95%CI 2.82-7.30) and ICU (PR=6.03; 95%CI 3.67-8.39) and death (PR=13.56; 95%CI 2.90-24.23). The second trimester was associated with ICU admission (PR=2.67; 95%CI 1.36-3.99). Pregnant women with cardiovascular disease had a higher frequency of hospitalization in wards (PR=2.24; 95%CI 1.43-3.05) and ICU (PR=2.66; 95%CI 1.46-3.87). Obesity was associated with ICU admission (PR=3.79; 95%CI 2.71-4.86) and death (PR=5.62; 95%CI 2.41-8.83). CONCLUSIONS: Advanced maternal age, the end of the gestational period and comorbidities were associated with severe COVID-19.

Prevalence and factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná.

OBJECTIVE: To estimate the prevalence and to analyze the factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná. METHOD: Cross-sectional study conducted with secondary data from older people with a positive diagnosis of Covid-19 living in the State of Paraná, collected from March 1, 2020 to August 31, 2021. Prevalence ratios were obtained by adjusting the regression model. RESULTS: A total of 16,153 deaths of older people hospitalized in the State of Paraná were analyzed. The adjusted model revealed an association between death and some factors such as: belonging to the age group of 75 to 84 years (PR = 1.28; CI95% = 1.24-1.32) and 85 years or over (PR = 1.52; CI95% = 1.45-1.59); male (PR = 1.17; CI95% = 1.13-1.21); obesity (PR = 1.23; CI95% = 1.16-1.29); other morbidities (PR = 1.25; CI95% = 1.20-1.30); and having used ventilatory support (PR = 2.60; CI95% = 2.33-2.86). Older people vaccinated against influenza had a probability of death reduced by 11% (PR = 0.89; CI95% = 0.86-0.93). CONCLUSION: The association of age, sex, and diagnosis of previous comorbidities with unfavorable outcomes from Covid-19 was identified. Having received the flu vaccine provided protection to elderly people who contracted SARS-CoV-2.

Perceived quality of life and associated factors in long COVID syndrome among older Brazilians: A cross-sectional study.

AIMS AND OBJECTIVES: This paper aims to: (a) determine the personal, sociodemographic, clinical, behavioural, and social characteristics of older Brazilians with clinical evidence of long COVID; (b) evaluate perceived quality of life and determine its association with personal, sociodemographic, behavioural, clinical and social variables; and (c) assess significant predictors of high perceived QoL. BACKGROUND: Given the inherent vulnerabilities of the ageing process, the older people are an at-risk group for both contagion of SARS-CoV-2 and the perpetuation of residual symptoms after infection, the so-called long COVID or post-COVID syndrome. DESIGN: A cross-sectional survey design using the STROBE checklist. METHODS: Brazilian older people with long COVID syndrome (n = 403) completed a phone survey measuring personal, sociodemographic, behavioural, clinical, and social characteristics, and perceived Quality of Life (QoL). Data were collected from June 2021-March 2022. A multiple linear regression model was performed to identify salient variables associated with high perceived QoL. RESULTS: The mean age of participants was 67.7 ± 6.6 years old. The results of the multivariate regression model showed that race, home ownership, daily screen time, musculoskeletal and anxiety symptoms, and work situation were the significant predictors of QoL among COVID-19 survivors. CONCLUSIONS: Knowledge about the persistence of physical, emotional, and social symptoms of COVID-19 can help nurses and other healthcare providers to improve the management of survivors, bringing benefits to the whole society. RELEVANCE TO CLINICAL PRACTICE: Given the novelty of long-COVID and its heterogeneous trajectory, interventions focusing on the repercussions and requirements unique to more vulnerable older persons should be developed and these aspects should be included in public health recommendations and policymakers' concerns. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was required to design, to outcome measures or undertake this research. Patients/members of the public contributed only to the data collection.

Miscelânea de sentimentos: reflexões de quem sobreviveu a covid-19 / Mixture of feelings: reflections of those who survived covid-19 / Mezcla de sentimientos: reflejos de quienes sobrevivieron al covid-19

O objetivo deste estudo foi compreender os sentimentos atribuídos à pandemia da COVID-19 por indivíduos que vivenciaram a doença. Trata-se de um estudo qualitativo que utilizou como referencial teórico o Interacionismo Simbólico e metodológico a Teoria Fundamentada nos Dados vertente construtivista, realizado em um município de médio porte situado na região noroeste do Paraná. A coleta de dados ocorreu no período de abril a novembro de 2021, por meio de entrevistas individuais mediadas por tecnologias. Os informantes foram 19 indivíduos hospitalizados pela COVID-19. A análise seguiu a codificação aberta e focalizada proposta pelo método. Os resultados demonstram como houve a ressignificação da pandemia da COVID-19 por indivíduos hospitalizados pela doença, sendo que este momento levou a uma maior valorização da vida e mudanças comportamentais. Conclui-se que os sentimentos revelaram uma nova percepção de vida diante do contexto da pandemia de COVID-19, com alterações de rotinas, sentimentos e readaptações, o que gerou o desenvolvimento de estratégias de enfrentamento.

The objective of this study was to understand the feelings attributed to the COVID-19 pandemic by individuals who experienced the disease. This is a qualitative study that used Symbolic and methodological Interactionism as a theoretical framework, the Data-Based Theory, constructivist aspect, carried out in a medium-sized municipality located in the northwest region of Paraná. Data collection took place from April to November 2021, through individual interviews mediated by technology. The informants were 19 individuals hospitalized by COVID-19. The analysis followed the open and focused coding proposed by the method. The results demonstrate how the COVID-19 pandemic was given new meaning by individuals hospitalized for the disease, and this moment led to a greater appreciation of life and behavioral changes. It is concluded that the feelings revealed a new perception of life, given the context of the COVID-19 pandemic, with changes in routines, feelings and readaptations, which generated the development of coping strategies.

El objetivo de este estudio fue comprender los sentimientos atribuidos a la pandemia de COVID-19 por parte de las personas que vivieron la enfermedad. Se trata de un estudio cualitativo que utilizó como marco teórico el Interaccionismo simbólico y metodológico, la Teoría Basada en Datos, vertiente constructivista, realizado en un municipio de mediano tamaño ubicado en la región noroeste de Paraná. La recolección de datos se realizó de abril a noviembre de 2021, a través de entrevistas individuales mediadas por tecnología. Los informantes fueron 19 personas hospitalizadas por COVID-19. El análisis siguió la codificación abierta y enfocada propuesta por el método. Los resultados demuestran cómo las personas hospitalizadas por la enfermedad dieron un nuevo significado a la pandemia de COVID-19, y este momento condujo a una mayor apreciación de la vida y cambios de comportamiento. Se concluye que los sentimientos revelaron una nueva percepción de la vida, dado el contexto de pandemia COVID-19, con cambios en rutinas, sentimientos y readaptaciones, que generaron el desarrollo de estrategias de afrontamiento.

Hospitalização de idosos por COVID-19 no Paraná: uma análise de fatores associados / Hospitalización de personas mayores por COVID-19 en Paraná: un análisis de factores asociados / Hospitalization of elderly people due to COVID-19 in the State of Paraná, Brazil: analysis of associated factors

Resumo Objetivo Analisar a prevalência e os fatores associados à hospitalização de idosos com COVID-19 no estado do Paraná, PR, Brasil. Métodos Estudo transversal vinculado à coorte "Acompanhamento Longitudinal de adultos e idosos que receberam alta da internação hospitalar por COVID-19", realizado por meio de informações contidas nas fichas de notificação compulsória do Sistema de Informação de Agravos de Notificação. As análises foram realizadas através de frequências relativas e absolutas, com aplicação do teste de qui-quadrado adotado no modelo de regressão logística. A população do estudo englobou pessoas residentes no Estado do Paraná com idade de 60 anos ou mais, hospitalizadas por COVID-19 no período de março de 2020 a setembro de 2021. Resultados Foi identificada maior prevalência de hospitalização entre idosos com escolaridade igual ou maior a oito anos. Indivíduos não vacinados contra COVID-19 apresentaram maior chance de internação. O sexo masculino apresentou mais chance de admissão em Unidade de Terapia Intensiva em comparação com o sexo feminino. Doenças cardiovasculares, pneumopatia e obesidade aumentaram a prevalência da forma grave da doença. Conclusão Fatores tais como escolaridade e não adesão à vacinação contra COVID-19 podem aumentar o risco de hospitalização pela doença. Pessoas idosas do sexo masculino apresentam maior chance de hospitalização na UTI se comparadas às do sexo feminino; além disso, a não utilização de antivirais pode contribuir para o agravamento do estado de saúde.

Resumen Objetivo Analizar la prevalencia y los factores asociados a la hospitalización de personas mayores por COVID-19 en el estado de Paraná. Métodos Estudio transversal vinculado a la cohorte "Seguimiento longitudinal de adultos y personas mayores que recibieron alta de internación hospitalaria por COVID-19", realizado mediante información contenida en las fichas de notificación obligatoria del Sistema de Información de Agravios de Notificación. Los análisis fueron realizados a través de frecuencias relativas y absolutas, con aplicación de la prueba ji cuadrado adoptada en el modelo de regresión logística. La población del estudio incluyó personas residentes del estado de Paraná, de 60 años o más, hospitalizadas por COVID-19 en el período de marzo de 2020 a septiembre de 2021. Resultados Se identificó mayor prevalencia de hospitalización en personas mayores con escolaridad igual o mayor a ocho años. Individuos no vacunados contra COVID-19 presentaron mayor probabilidad de internación. El sexo masculino presentó más probabilidad de admisión en Unidad de Cuidados Intensivos en comparación con el sexo femenino. Enfermedades cardiovasculares, neumopatía y obesidad aumentaron la prevalencia de la forma grave de la enfermedad. Conclusión Factores tales como escolaridad y no adhesión a la vacunación contra COVID-19 pueden aumentar el riesgo de hospitalización por la enfermedad. Personas mayores de sexo masculino presentaron mayor probabilidad de hospitalización en la UCI al compararlas con las de sexo femenino. Además, la no utilización de antivirales puede contribuir al agravamiento del estado de salud.

Abstract Objective To analyze the prevalence and factors associated with hospitalization of elderly people with COVID-19 in the State of Paraná, PR, Brazil. Methods A cross-sectional study linked to the cohort "Longitudinal Monitoring of adults and elderly people who were discharged from hospital admission due to COVID-19", was carried out using information contained in the compulsory notification forms of the Notifiable Diseases Information System. Analyzes were carried out using relative and absolute frequencies, applying the chi-square test adopted in the logistic regression model. The study population included people aged 60 years or over and residing in the State of Paraná, who were hospitalized for COVID-19 from March 2020 to September 2021. Results A higher hospitalization prevalence was identified among elderly people with eight years of education or more. Individuals not vaccinated against COVID-19 had a greater chance of hospitalization. Males had a greater chance of admission to the Intensive Care Unit compared to females. Cardiovascular diseases, lung disease, and obesity have increased the prevalence of the severe form of the disease. Conclusion Factors such as education and non-adherence to vaccination against COVID-19 can increase the risk of hospitalization due to the disease. Elderly people of the male sex have a greater chance of hospitalization in the ICU compared to the female sex. Furthermore, not using antivirals can contribute to worsening health status.

Factors associated with hospitalizations and deaths of pregnant women from Paraná due to COVID-19: a cross-sectional study / Fatores associados a hospitalizações e óbitos de gestantes paranaenses por COVID-19: estudo transversal

ABSTRACT Objective: To analyze the factors associated with hospitalization in the ward and intensive care unit (ICU), and with death from COVID-19 in pregnant women with confirmed cases. Methods: Observational, cross-sectional study, carried out with data from pregnant women with a confirmed case of COVID-19 from the Influenza Epidemiological Surveillance Information System and the Paraná's state COVID-19 notification system. The association between the independent and dependent variables (hospitalization in the ward and ICU, and death) was investigated using the Poisson regression model with robust variance. Results: 4,719 pregnant women comprised the study population. 9.6 and 5.1% were hospitalized in wards and ICU, respectively. 1.9% died. There was an association between advanced maternal age and hospitalization in wards (PR=1.36; 95%CI 1.10-1.62) and ICU (PR=2.25; 95%CI 1.78-2.71), and death (PR=3.22; 95%CI 2.30-4.15). An association was found between the third trimester and hospitalization in wards (PR=5.06; 95%CI 2.82-7.30) and ICU (PR=6.03; 95%CI 3.67-8.39) and death (PR=13.56; 95%CI 2.90-24.23). The second trimester was associated with ICU admission (PR=2.67; 95%CI 1.36-3.99). Pregnant women with cardiovascular disease had a higher frequency of hospitalization in wards (PR=2.24; 95%CI 1.43-3.05) and ICU (PR=2.66; 95%CI 1.46-3.87). Obesity was associated with ICU admission (PR=3.79; 95%CI 2.71-4.86) and death (PR=5.62; 95%CI 2.41-8.83). Conclusions: Advanced maternal age, the end of the gestational period and comorbidities were associated with severe COVID-19.

RESUMO Objetivo: Analisar os fatores associados à hospitalização em enfermaria e unidade de terapia intensiva (UTI), e ao óbito pela COVID-19 em gestantes com caso confirmado. Métodos: Pesquisa observacional, transversal, realizada com dados de gestantes com caso confirmado para COVID-19 provenientes do Sistema de Informação de Vigilância Epidemiológica da Gripe e do Sistema Estadual Notifica COVID-19, do Paraná. Investigou-se a associação entre variáveis independentes e dependentes (hospitalização em enfermaria e UTI, e óbito) pelo modelo de regressão de Poisson com variância robusta. Resultados: 4.719 gestantes compuseram a população do estudo; 9,6 e 5,1% foram hospitalizadas em enfermaria e UTI, respectivamente; 1,9% evoluíram para óbito. Houve associação entre a idade materna avançada e internação em enfermaria (RP=1,36; IC95% 1,10-1,62) e UTI (RP=2,25; IC95% 1,78-2,71), e óbito (RP=3,22; IC95% 2,30-4,15). Verificou-se associação entre o terceiro trimestre gestacional e hospitalização em enfermaria (RP=5,06; IC95% 2,82-7,30) e UTI (RP=6,03; IC95% 3,67-8,39) e óbito (RP=13,56; IC95% 2,90-24,23). O segundo trimestre associou-se à internação em UTI (RP=2,67; IC95% 1,36-3,99). Gestantes com cardiopatia apresentaram maior frequência de hospitalização em enfermaria (RP=2,24; IC95% 1,43-3,05) e UTI (RP=2,66; IC95% 1,46-3,87). A obesidade foi associada à admissão em UTI (RP=3,79; IC95% 2,71-4,86) e ao óbito (RP=5,62; IC95% 2,41-8,83). Conclusão: A idade materna avançada, o final do período gestacional e comorbidades foram fatores associados a quadros graves de COVID-19.

Encontrar un nuevo equilibrio: Estudio cualitativo sobre los efectos del COVID-19 en la vida familiar / Striking a new balance: A qualitative study of how family life has been affected by COVID-19 / Conquistando um novo equilíbrio: Um estudo qualitativo de como a vida familiar foi afetada pela COVID-19

Objetivo: examinar las repercusiones de la pandemia en el sistema familiar enfocándose en la perspectiva de familiares que han contraído y padecido COVID-19. Método: estudio exploratorio de enfoque cualitativo realizado con 27 personas que tuvieron COVID-19. Los datos se recolectaron por medio de entrevistas telefónicas que se grabaron en audio y estuvieron guiadas por un instrumento semiestructurado. El análisis se basó en un proceso inductivo respaldado por Análisis Temático Reflexivo. Resultados: la pandemia y el hecho de que un familiar contrajera la enfermedad fueron fuerzas impulsoras que generaron movilizaciones nuevas e intensas en el sistema familiar. Inicialmente, notaron repercusiones negativas como preocupaciones, temor, angustia, estrés, distanciamiento y aislamiento social. Con el paso del tiempo y empleando tecnologías para facilitar la comunicación, comenzaron a percibir repercusiones positivas como más cercanía, fortalecimiento de vínculos, desarrollo de nuevos roles y cuidado mutuo. Las familias también identificaron que recuperaban una posición de equilibrio, con retorno de cierto reajuste en la dinámica y el funcionamiento familiar. Conclusión: los profesionales de la salud deben admitir que la enfermedad por COVID-19 ha generado repercusiones en los sistemas familiares, además de proponer intervenciones que ayuden a las familias a hacer frente a este momento y a recuperar más fácilmente una posición de equilibrio para su buen funcionamiento.

Objective: to examine the repercussions of the pandemic on the family system by focusing on the perspective of family members who contracted and experienced COVID-19. Method: an exploratory study with a qualitative approach conducted with 27 individuals who had COVID-19. Data collection took place through telephone interviews that were audio-recorded and guided by a semi-structured instrument. Data analysis was based on an inductive process supported by Reflexive Thematic Analysis. Results: the pandemic and illness of a family member acted as driving forces generating new and intense movements in the family system. Initially, they noticed negative repercussions such as concerns, fear, anguish, stress, distancing and social isolation. As time progressed and by using technologies to ease communication, they began to perceive positive repercussions such as increased proximity, strengthening of ties, development of new roles and care. The families also identified recovery of a balanced position, with return of certain readjustment in family dynamics and functioning. Conclusion: health professionals need to recognize that the COVID-19 disease has imposed repercussions on family systems, proposing interventions that help families face this moment and more easily recover a balanced position for their functioning.

Objetivo: examinar as repercussões da pandemia no sistema familiar a partir da perspectiva dos familiares que contraíram e vivenciaram a COVID-19. Método: estudo exploratório com abordagem qualitativa realizado com 27 indivíduos que tiveram COVID-19. A coleta de dados ocorreu por meio de entrevistas telefônicas gravadas em áudio e guiadas por um instrumento semiestruturado. A análise dos dados baseou-se num processo indutivo apoiado na Análise Temática Reflexiva. Resultados: a pandemia e o adoecimento de um familiar atuaram como motores geradores de novos e intensos movimentos no sistema familiar. Inicialmente, perceberam repercussões negativas como preocupações, medo, angústia, estresse, distanciamento e isolamento social. Com o passar do tempo e com o uso das tecnologias para facilitar a comunicação, os familiares começaram a perceber repercussões positivas como maior proximidade, fortalecimento dos laços, desenvolvimento de novos papéis e cuidado. As famílias também identificaram recuperação de uma posição equilibrada, com retorno de certo reajuste na dinâmica e funcionamento familiar. Conclusão: os profissionais de saúde precisam reconhecer que a doença COVID-19 impôs repercussões nos sistemas familiares, propondo intervenções que ajudem as famílias a enfrentar esse momento e recuperar mais facilmente uma posição equilibrada para seu funcionamento.

Striking a new balance: A qualitative study of how family life has been affected by COVID-19. / Encontrar un nuevo equilibrio: Estudio cualitativo sobre los efectos del COVID-19 en la vida familiar.

OBJECTIVE: to examine the repercussions of the pandemic on the family system by focusing on the perspective of family members who contracted and experienced COVID-19. METHOD: an exploratory study with a qualitative approach conducted with 27 individuals who had COVID-19. Data collection took place through telephone interviews that were audio-recorded and guided by a semi-structured instrument. Data analysis was based on an inductive process supported by Reflexive Thematic Analysis. RESULTS: the pandemic and illness of a family member acted as driving forces generating new and intense movements in the family system. Initially, they noticed negative repercussions such as concerns, fear, anguish, stress, distancing and social isolation. As time progressed and by using technologies to ease communication, they began to perceive positive repercussions such as increased proximity, strengthening of ties, development of new roles and care. The families also identified recovery of a balanced position, with return of certain readjustment in family dynamics and functioning. CONCLUSION: health professionals need to recognize that the COVID-19 disease has imposed repercussions on family systems, proposing interventions that help families face this moment and more easily recover a balanced position for their functioning.

"Feeling Trapped in Prison" Due to the COVID-19 Pandemic: Perceptions and Practices among Healthcare Workers and Prison Staff from a Brazilian Maximum Security Unit.

The COVID-19 pandemic had several repercussions on prison staff, but the currently available evidence has mainly ignored these effects. This qualitative study aimed to understand the impact of COVID-19 on the prison system through the narratives of health and security professionals, using the methodological framework of the constructivist grounded theory proposed by Charmaz. The sample included 10 healthcare workers and 10 security professionals. Data collection took place between October and November 2022 through individual in-depth interviews. The data were analyzed using the MaxQDA software. Three categories of interrelated data emerged: (1) "Confrontation and disruption" caused by the COVID-19 pandemic in the prison system; (2) "Between disinfodemic and solicitude" referring to the tension between information management and the practice of care centered on the needs of inmates; and, finally, (3) "Reorganization and mitigation strategies during the fight against COVID-19". Continuous education and the development of specific skills are essential to enable professionals to face the challenges and complex demands that arise in prison contexts. The daily routines professionals had previously taken for granted were disrupted by COVID-19. Thus, investing in adequate training and emotional support programs is crucial to promote the resilience and well-being of these professionals, ensuring an efficient and quality response to critical events.

Assessment of the Psychosocial Care Center multidisciplinary team from users' and family members' perspective.

OBJECTIVES: to assess the multidisciplinary team of a Psychosocial Care Center I from users' and family members' perspective. METHODS: an evaluative study, anchored in the fourth generation evaluation theoretical-methodological framework, carried out in a Psychosocial Care Center I, from September 2021 to March 2022. Eleven users and 06 family members participated. Data were collected through non-participant observation, individual interviews and negotiation sessions, and analyzed using the Constant Comparative Method, using the MAXQDA software. RESULTS: the team develops its care based on individual and collective care, with integrated and complementary work by professionals. They seek to facilitate treatment initiation and continuation, considering health needs and offering support, understanding and guidance to users and their families. FINAL CONSIDERATIONS: the multidisciplinary team's work is based on the psychosocial paradigm, which can qualify care and strengthen the service role in the mental health network.

Meanings and Experiences of Prisoners and Family Members Affected by the COVID-19 Pandemic in a Brazilian Prison Unit: A Grounded Theory Analysis.

Worldwide, the COVID-19 pandemic represented a health emergency for prisons. This study sought to understand the meanings and experiences through the narratives of prisoners and family members affected by the COVID-19 pandemic in the context of a maximum-security state penitentiary complex in southern Brazil. For this purpose, a qualitative study was developed based on the methodological framework of constructivist grounded theory. Data were collected between February and August 2022 through individual in-depth interviews and field notes. The sample consisted of 41 participants: 28 male prisoners, and 13 family members. Guided by the Charmaz method of grounded theory analysis, the study afforded the core category "Feeling trapped in prison during the COVID-19 pandemic" with three interrelated phases: "Triggering", "Escalating", and "Readjustment". The "Triggering" phase refers to COVID-19-related elements or events that triggered certain reactions, processes, or changes in prison. During the "Escalating" phase, participants became overwhelmed by the suffering caused by incarceration and the pandemic crisis. The "Readjustment" phase involved adapting, reorienting, or reformulating previous approaches or strategies for dealing with a specific situation. Prisons faced complex challenges during the pandemic and were forced to prioritize protecting public health. However, the measures adopted must be carefully evaluated, ensuring their needs and that they are based on scientific evidence. The punitive approach can undermine inmate trust in prison authorities, making it difficult to report symptoms and adhere to preventive measures.

Matrix support in specialized care backed by the care model for chronic conditions: evaluative research.

OBJECTIVE: To analyze the matrix support for health teams in Specialized Outpatient Care, according to the Chronic Conditions Care Model. METHOD: Qualitative evaluative research, conducted by the Chronic Conditions Care Model, carried out from February to July 2020. For data collection, interviews were carried out with 21 health professionals, assistance observation and document analysis of the service. Data were analyzed by data triangulation, with the aid of the MAXQDA software, respecting all ethical aspects. RESULTS: The matrix support provided approximation between Primary and Secondary Care; implemented case management and qualified comprehensive care for people with chronic conditions. Weaknesses in communication and understanding of the theoretical bases of matrix support were obstacles to the proper implementation of matrix strategies. FINAL CONSIDERATION: Matrix support for specialized health teams qualified the professional care given to people with chronic conditions treated at the service.

The Institutionalisation of Brazilian Older Abused Adults: A Qualitative Study among Victims and Formal Carers.

Abuse against elders is acknowledged as a severe and pervasive problem in society. If support services are not tailored to the victims' knowledge or perceived needs, the intervention is likely to be unsuccessful. This study aimed to explore the experience of institutionalisation of abused older people from the perspective of the victims and their formal carers in a Brazilian social shelter. A qualitative descriptive study was performed with 18 participants, including formal carers and older abused persons admitted to a long-term care institution in the south of Brazil. Qualitative thematic analysis was used to analyse the transcripts of semi-structured qualitative interviews. Three themes were identified: (1) personal, relational, and social bonds: broken or weakened; (2) denial of the violence suffered; and (3) from imposed protection to compassionate care. Our findings provide insights for effective prevention and intervention measures in elder abuse. From a socio-ecological standpoint, vulnerability and abuse might be averted at the community and societal levels (e.g., education and awareness of elder abuse) by creating a minimum standard for the care of older individuals (e.g., law or economic incentives). Further study is needed to facilitate recognition and raise awareness among individuals in need and those offering assistance and support.

The self-care process of community-dwelling older adults during the COVID-19 pandemic.

OBJECTIVES: to understand the self-care process of community-dwelling older adults during the COVID-19 pandemic. METHODS: this is an explanatory study with a qualitative approach based on the constructivist Grounded Theory, carried out with 18 community-dwelling older adults. Data collection took place through interviews and content was analyzed through initial and focused coding. RESULTS: two categories were obtained: "Building connections to support self-care practices" and "Living with the risk group stigma". From their interaction, the phenomenon "Performing self-care in old age during the COVID-19 pandemic" emerged. FINAL CONSIDERATIONS: it was possible to identify how older adults' experiences curing the COVID-19 pandemic had repercussions on their self-care process, being influenced by factors such as information about the disease and the impacts of risk group stigmas.

Distribuição espacial de violência com idosos antes e durante a pandemia de covid-19 / Spatial distribution of violence against older adults before and during the covid-19 pandemic / Distribución espacial de la violencia hacia las personas mayores antes y durante la pandemia covid-19

RESUMO: Objetivo: analisar a distribuição espacial da violência contra a pessoa idosa na região Sul do Brasil antes e no primeiro ano de vigência da pandemia de COVID-19. Método: estudo ecológico que analisou as notificações de violência contra o idoso, entre 2019 e 2020, no Sul do Brasil. Foram calculadas as taxas bayesianas empíricas locais, o Índice de Autocorrelação Local de Moran e a análise de Getis Ord Gi. Resultados: houve redução da taxa suavizada de violência contra o idoso. As cidades alto-alto e hot-spot em 2019, se tornaram mais violentas em 2020; e as cidades com baixa prevalência, se tornaram menos violentas em 2020. As maiores taxas de letalidade por COVID-19 também foram naquelas cidades com maiores taxas de violência. Conclusão: os dados reforçam a complexidade da violência e seu agravamento pela pandemia. E contribuem com as tomadas de decisões na enfermagem, desatacando-se a necessidade de suscitar novas pesquisas sobre esta temática.

ABSTRACT Objective: to analyze the spatial distribution of violence against older adults in the Brazilian South region before and in the first year of the COVID-19 pandemic. Method: an ecological study that analyzed reports of violence against older adults between 2019 and 2020, in Southern Brazil. Local empirical Bayesian rates, Moran's Local Autocorrelation Index and Getis Ord Gi analysis were calculated. Results: there was a reduction in the smoothed rate of violence against older adults. The high-high and hot-spot cities in 2019 became more violent in 2020; and cities with low prevalence became less violent in 2020. The highest COVID-19 fatality rates were also in those cities with the highest violence rates. Conclusion: the data reinforces the complexity of violence and its worsening due to the pandemic. In addition, they contribute to decision-making in Nursing, highlighting the need to encourage new research studies on this theme.

RESUMEN Objetivo: analizar la distribución espacial de la violencia contra las personas mayores en la región sur de Brasil antes y durante el primer año de la pandemia de COVID-19. Método: estudio ecológico que analizó denuncias de violencia contra las personas mayores, entre 2019 y 2020, en la región sur de Brasil. Se calcularon las tasas bayesianas empíricas locales, el índice de autocorrelación local de Moran y el análisis Getis Ord Gi. Resultados: hubo reducción en la tasa suavizada de violencia contra las personas mayores. Las ciudades alto-alto y hotspot de 2019 se volvieron más violentas en 2020; y las ciudades con baja prevalencia se volvieron menos violentas en 2020. Las tasas de mortalidad por COVID-19 más altas también se registraron en las ciudades con mayores tasas de violencia. Conclusión: los datos confirman la complejidad de la violencia y el agravamiento debido a la pandemia; además contribuyen a la toma de decisiones en enfermería y destacan la necesidad de fomentar nuevas investigaciones sobre este tema.

Aged people's health needs in the face of long covid-19 and access to health services / Requerimientos de salud de adultos mayores frente a covid-19 prolongado y acceso a servicios de salud / Necessidades de saúde dos idosos frente à covid longa e o acesso aos serviços de saúde

ABSTRACT Objective: to understand the health needs of aged people who had long Covid-19 and details about access to the health system to meet these demands. Method: an exploratory and qualitative study carried out with 41 aged individuals who had Covid-19 in 2020 and presented residual symptoms 18 months after the infection. Data collection took place between February and July 2022 through semi-structured interviews via telephone calls. In the analysis, initial and focused coding analytical techniques were used and the conceptual basis was grounded on the Primary Health Care "Accessibility" attribute. Results: four categories emerged when analyzing the results, namely: Understanding the need for professional care; Recognizing the demands that led aged people to seek health services; Understanding availability of the services; and Analyzing payment capacity. Conclusion: the aged population has developed specific health demands related to long Covid-19, and public and private health services are heterogeneous in their approach to this new condition, as care based on guidelines proposed by official bodies is not unanimous in public and private services and Health Plan Operators.

RESUMEN Objetivo: averiguar las necesidades de salud de los adultos mayores que tuvieron Covid-19 prolongado y detalles del acceso al sistema de salud para suplir estos requerimientos. Método: estudio cualitativo y exploratorio realizado con 41 adultos mayores que tuvieron Covid-19 en 2020 y presentaron síntomas residuales 18 meses después de la infección. La recolección de datos tuvo lugar entre febrero y julio de 2022 por medio de entrevistas telefónicas semiestructuradas; en el análisis se utilizaron las técnicas analíticas de codificación inicial y focalizada y la base conceptual se fundamentó en el atributo "Accesibilidad" de la Atención Primaria de la Salud. Resultados: surgieron cuatro categorías en el análisis de los resultados, a saber: Comprender la necesidad de atención profesional; Reconocer los requerimientos que llevaron a los adultos mayores a procurar un servicio de salud; Percibir la disponibilidad de los servicios; y Analizar la capacidad de pago. Conclusión: la población anciana desarrolló requerimientos de la salud específicos relacionados con Covid-19 prolongado y los servicios de salud públicos y privados presentan cierta heterogeneidad en relación al enfoque de esta nueva condición, puesto que la atención basada en directrices propuestas por órganos oficiales no es unánime en los servicios públicos, privados y de Operadoras de Planes de Salud.

RESUMO Objetivo: conhecer as necessidades de saúde dos idosos que tiveram a Covid longa e o acesso ao sistema de saúde para atender essas demandas. Método: estudo qualitativo exploratório, realizado com 41 idosos que tiveram Covid-19 no ano de 2020 e apresentaram sintomas residuais após 18 meses da infecção. A coleta de dados ocorreu entre fevereiro e julho de 2022 por meio de entrevistas semiestruturadas via telefone. Na análise foram utilizadas as técnicas de codificação inicial e focalizada e a base conceitual se fundamentou no atributo "Acessibilidade" da Atenção Primária à Saúde. Resultados: na análise dos resultados emergiram quatro categorias: Compreendendo a necessidade de atendimento profissional; Reconhecendo as demandas que levaram os idosos a buscar o serviço de saúde; Percebendo a disponibilidade dos serviços; e Analisando a capacidade de pagamento. Conclusão: a população idosa desenvolveu demandas específicas de saúde relacionadas à Covid longa, e os serviços de saúde público e privado possuem heterogeneidade quanto à abordagem dessa nova condição, uma vez que o atendimento pautado em diretrizes propostas por órgãos oficiais não é unânime nos serviços públicos, privados e Operadoras de Plano de Saúde.

Reorganização do processo de trabalho na atenção primária à saúde no enfrentamento à covid-19 / Reorganization of the work process in primary health care in coping with covid-19 / Reorganización del proceso de trabajo en la atención primaria de la salud para enfrentar el covid-19

RESUMO Objetivo: avaliar o processo de trabalho dos profissionais de saúde na atenção primária no enfrentamento à Covid-19. Método: estudo qualitativo, que utilizou como base conceitual o processo de trabalho em saúde, e, como referencial metodológico, a pesquisa avaliativa. A coleta foi realizada com 23 profissionais de saúde, entre julho e setembro de 2021, nas unidades básicas de saúde em um município no noroeste do Paraná-Brasil. Para a análise organizaram-se os dados por meio do software MAXQDA, e cada segmento de dado foi organizado conforme os significados. Resultados: emergiram duas categorias, a saber: Dificuldades enfrentadas na reorganização da ambiência, atividades programáticas e dimensionamento dos profissionais da atenção primária à saúde; e Organização do fluxo de atendimento ao usuário com Covid-19 na atenção primária à saúde. Conclusão: este estudo reforça a indispensabilidade da avaliação do processo de trabalho para melhoria da assistência em saúde, principalmente em condições de emergência de saúde pública.

ABSTRACT Objective: to assess the work process of Primary Health Care professionals in coping with COVID-19. Method: a qualitative study that used the health work process as conceptual basis and qualitative research as methodological framework. The collection procedure was carried out with 23 health professionals from July to September 2021, in the basic health units from a municipality in northwestern Paraná, Brazil. For the analysis, the data were organized by means of the MAXQDA software, and each data segment was organized according to the meanings. Results: two categories emerged, namely: Difficulties faced in reorganization of the ambience, programmatic activities and staffing of Primary Health Care professionals; and Organization of the care flow for users with COVID-19 in Primary Health Care. Conclusion: this study reinforces the indispensability of assessing the work process for health care improvement, especially in conditions of a public health emergency.

RESUMEN Objetivo: evaluar el proceso de trabajo de los profesionales de la salud en la atención primaria para enfrentar el Covid-19. Método: estudio cualitativo, que utilizó como base conceptual el proceso de trabajo en salud, y como referente metodológico la investigación evaluativa. La recolección se realizó con 23 profesionales de la salud, entre julio y septiembre de 2021, en unidades básicas de salud de un municipio del noroeste del estado de Paraná, Brasil. Para el análisis, los datos se organizaron utilizando el software MAXQDA, y cada segmento de datos se organizó en función de los significados. Resultados: surgieron dos categorías, a saber: Dificultades enfrentadas al reorganizar el ámbito, actividades programáticas y dimensionamiento de los profesionales de la atención primaria de la salud; y Organización del flujo de atención a usuarios con Covid-19 en la atención primaria de la salud. Conclusión: este estudio refuerza que es indispensable evaluar el proceso de trabajo para mejorar la atención de la salud, especialmente en condiciones de emergencia de salud pública.

Matrix support in specialized care backed by the care model for chronic conditions: evaluative research / Apoyo matriz en atención especializada apoyado en el modelo de atención a condiciones crónicas: investigación evaluativa / Apoio matricial na atenção especializada respaldado no modelo de atenção às condições crônicas: pesquisa avaliativa

ABSTRACT Objective: To analyze the matrix support for health teams in Specialized Outpatient Care, according to the Chronic Conditions Care Model. Method: Qualitative evaluative research, conducted by the Chronic Conditions Care Model, carried out from February to July 2020. For data collection, interviews were carried out with 21 health professionals, assistance observation and document analysis of the service. Data were analyzed by data triangulation, with the aid of the MAXQDA software, respecting all ethical aspects. Results: The matrix support provided approximation between Primary and Secondary Care; implemented case management and qualified comprehensive care for people with chronic conditions. Weaknesses in communication and understanding of the theoretical bases of matrix support were obstacles to the proper implementation of matrix strategies. Final consideration: Matrix support for specialized health teams qualified the professional care given to people with chronic conditions treated at the service.

RESUMEN Objetivo: Analizar la matriz de apoyo a los equipos de salud en Atención Ambulatoria Especializada, según el Modelo de Atención de Condiciones Crónicas. Método: Investigación cualitativa evaluativa, realizada por el Modelo de Atención de Condiciones Crónicas, realizada de febrero a julio de 2020. Para la recolección de datos, se realizaron entrevistas a 21 profesionales de la salud, observación asistencial y análisis documental del servicio. Los datos fueron analizados por triangulación de datos, con la ayuda del software MAXQDA, respetando todos los aspectos éticos. Resultados: El soporte matricial proporcionó una aproximación entre la Atención Primaria y Secundaria; implementó gestión de casos y atención integral calificada para personas con condiciones crónicas. Las debilidades en la comunicación y comprensión de las bases teóricas del soporte matricial fueron obstáculos para la adecuada implementación de las estrategias matriciales. Consideraciones finales: Matriz de apoyo a equipos de salud especializados cualificó la atención profesional prestada a personas con condiciones crónicas atendidas en el servicio.

RESUMO Objetivo: Analisar o apoio matricial para equipes de saúde na Atenção Ambulatorial Especializada, segundo o Modelo de Atenção às Condições Crônicas. Método: Pesquisa avaliativa qualitativa, conduzida pelo Modelo de Atenção às Condições Crônicas, realizada de fevereiro a julho de 2020. Para coleta de dados, foram feitas entrevistas com 21 profissionais de saúde, observação da assistência e análise documental do serviço. Os dados foram analisados pela triangulação de dados, com auxílio do software MAXQDA, respeitando todos os aspectos éticos. Resultados: O matriciamento proporcionou aproximação entre Atenção Primária e Secundária; implantou a gestão de casos e qualificou a integralidade da assistência às pessoas com condições crônicas. Fragilidades na comunicação e na compreensão das bases teóricas do apoio matricial foram obstáculos para a adequada implementação das estratégias matriciais. Considerações finais: O apoio matricial para as equipes de saúde especializadas qualificou a atenção profissional dispensada às pessoas com condições crônicas atendidas no serviço.

Prevalence and factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná / Prevalencia y factores asociados a la muerte de personas mayores hospitalizadas por Covid-19 en el estado de Paraná / Prevalência e fatores associados ao óbito de idosos hospitalizados por Covid-19 no estado do Paraná

ABSTRACT Objective: To estimate the prevalence and to analyze the factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná. Method: Cross-sectional study conducted with secondary data from older people with a positive diagnosis of Covid-19 living in the State of Paraná, collected from March 1, 2020 to August 31, 2021. Prevalence ratios were obtained by adjusting the regression model. Results: A total of 16,153 deaths of older people hospitalized in the State of Paraná were analyzed. The adjusted model revealed an association between death and some factors such as: belonging to the age group of 75 to 84 years (PR = 1.28; CI95% = 1.24-1.32) and 85 years or over (PR = 1.52; CI95% = 1.45-1.59); male (PR = 1.17; CI95% = 1.13-1.21); obesity (PR = 1.23; CI95% = 1.16-1.29); other morbidities (PR = 1.25; CI95% = 1.20-1.30); and having used ventilatory support (PR = 2.60; CI95% = 2.33-2.86). Older people vaccinated against influenza had a probability of death reduced by 11% (PR = 0.89; CI95% = 0.86-0.93). Conclusion: The association of age, sex, and diagnosis of previous comorbidities with unfavorable outcomes from Covid-19 was identified. Having received the flu vaccine provided protection to elderly people who contracted SARS-CoV-2.

RESUMEN Objetivo: Prevalencia y factores asociados a la muerte de personas mayores hospitalizadas por Covid-19 en el estado de Paraná* Método: Estudio transversal realizado con datos secundarios de personas mayores con diagnóstico positivo de Covid-19 residentes en el Estado de Paraná, recolectados del 1 de marzo de 2020 al 31 de agosto de 2021. Las razones de prevalencia se obtuvieron ajustando el modelo de regresión. Resultados: Se analizaron 16.153 muertes de personas mayores hospitalizadas en el Estado de Paraná. El modelo ajustado reveló asociación entre la muerte y algunos factores como: pertenecer al grupo etario de 75 a 84 años (RP = 1,28; IC95% = 1,24-1,32) y 85 años o más (RP = 1,52; IC95% = 1,45-1,59); masculino (RP = 1,17; IC95% = 1,13-1,21); obesidad (RP = 1,23; IC95% = 1,16-1,29); otras morbilidades (RP = 1,25; IC95% = 1,20-1,30); y haber utilizado soporte ventilatorio (RP = 2,60; IC95% = 2,33-2,86). Las personas mayores vacunadas contra la influenza tuvieron una probabilidad de muerte reducida en un 11% (RP = 0,89; IC95% = 0,86-0,93). Conclusión: Se identificó la asociación de la edad, el sexo y el diagnóstico de comorbilidades previas con resultados desfavorables por Covid-19. Haber recibido la vacuna contra la gripe brindó protección a las personas mayores que contrajeron el SARS-CoV-2.

RESUMO Objetivo: Estimar a prevalência e analisar os fatores associados ao óbito de idosos hospitalizados por Covid-19 no Estado do Paraná. Método: Estudo transversal conduzido com dados secundários de idosos com diagnóstico positivo de Covid-19 residentes no Estado do Paraná, coletados no período de 01 de março de 2020 a 31 de agosto de 2021. As razões de prevalências foram obtidas por meio do ajuste de modelo de regressão. Resultados: Foram analisados 16.153 óbitos de idosos hospitalizados no Estado do Paraná. O modelo ajustado revelou associação do óbito a alguns fatores como: pertencer a faixa etária dos 75 a 84 anos (RP = 1,28; IC95% = 1,24-1,32) e 85 anos ou mais (RP = 1,52; IC95% = 1,45-1,59); sexo masculino (RP = 1,17; IC95% = 1,13-1,21); obesidade (RP = 1,23; IC95% = 1,16-1,29); outras morbidades (RP = 1,25; IC95% = 1,20-1,30); e ter utilizado suporte ventilatório (RP = 2,60; IC95% = 2,33-2,86). Idosos vacinados contra a gripe tiveram probabilidade de morte reduzida em 11% (RP = 0,89; IC95% = 0,86-0,93). Conclusão: Identificou-se a associação da idade, sexo e diagnóstico de comorbidades prévias aos desfechos desfavoráveis da Covid-19. Ter recebido o imunizante contra a gripe conferiu proteção aos idosos que contraíram o SARS-CoV-2.