Professional Narratives about Older Adults and Health Services Responsive to Fall-Inducing Frailty.

The second external cause of death from unintentional injuries is falls in people over 60 and is a worldwide Public Health problem. Associated factors are identified early in Primary Health Care. Thus, we analyze professional narratives about older adults/old age and the organization of services in the presence of fall-inducing frailty. A structured narrative was applied under the following stages: understanding the context, setting/plot/character analysis, and interpretive synthesis. Data were collected from August to November 2022, distributing 21 health professionals in three Narrative Focus Groups. In the analyses, the collective conceptions dialogued with Bourdieu's Epistemology of field, habitus, and capital. Technical and common sense representations of older adults were simultaneously observed among the results, along with the belief of old age as a problematic life stage. Care is centered on the installed disease/ailment. Encouraging autonomy and self-care emerges in integrative health practices, which older adults underestimate. Professionals access the lives of older adults according to their habitus, which, in turn, is structured (structuring) in the disputes for installed capital. Thus, the care provided disregards subjectivities and symbolic systems associated with falls.

Socioeconomic and Demographic Contexts of Brazilian and International University Students Regarding the Use of Dental Services.

This article characterizes the different socioeconomic and demographic contexts regarding the use and access to dental services by Brazilian and African students at a Brazilian university of international nature. This is a cross-sectional, analytical, observational study with a quantitative approach, with data produced by 350 students from a public university in the state of Ceará. Sociodemographic and economic factors, participation in educational activities, self-perception of oral health, and use of dental services by academics were analyzed. The results obtained indicated that of the university students participating in the study, 74.0% had already used dental services, of which 57.43% were Brazilian and 42.57% international. There was a significant association between being a Brazilian academic and having already used dental services, having an income less than or equal to the minimum wage, and having used the public dental service. The determination of the prevalence of use of dental services and the different contexts of university students can assist in planning future actions in oral health that prioritize groups of university students with greater difficulties in the use and access of these services.

Stroke Hospital Admissions during the COVID-19 Outbreak in São Paulo, Brazil.

BACKGROUND: Globally, stroke remains an important cause of death and long-term disability, and the impact of coronavirus disease (COVID-19) on the health system may have impaired stroke care. Previous studies suggest significant reduction in hospital admissions for stroke after COVID-19 onset as patients may hesitate seeking medical help due to fear of exposure. METHODS: This cross-sectional study included cases of hospital admissions for stroke, identified from the Hospital Information System of the Unified Health System (Sistema Único de Saúde), which contains official and public data in Brazil. Data were collected in duplicate, then categorized according to the International Classification of Diseases, tenth revision (ICD-10), considering codes I60-I69. Linear regression was used to estimate the variation in hospital admissions for stroke in the city of São Paulo (SP) - the largest and most populous city in Brazil and Latin America, between January and June of each analyzed year (2017-2020). The percentage variation between June and January 2020 was also compared. The level of significance was set at 5%, and the statistical program used was Stata, version 14.0. RESULTS: In the city of SP, during the first wave of COVID-19, from January to June 2020, there were registered decreases in absolute numbers and mean monthly admissions for stroke. Compared to January 2020, data from June 2020 showed 17% reduction in hospitalizations for intracerebral hemorrhage, 32% for cerebral infarction, 26% for stroke unspecified, and 47% for other cerebrovascular diseases. CONCLUSION: We argue for policies aimed at improving stroke care and developing awareness campaigns regarding the importance of early diagnosis and treatment, as even in less severe presentations, stroke can trigger an increase in mortality, cost, and long-term disability.

Prevention Actions of Burnout Syndrome in Nurses: An Integrating Literature Review.

AIMS: To identify the strategies for the prevention of burnout syndrome in nurses; and discuss the results for future interventions that can decrease burnout in these professionals. DESIGN: An integrative review of the literature. DATA SOURCES: PubMed, Lilacs, Medline, Scielo, and Science Direct, from April 2018 to July 2018. METHODS: The sources were in all 553 references were found. The following guiding question was: Which interventions for the prevention of burnout in nurses have been applied and have obtained high effectiveness? RESULTS: Based on the inclusion and exclusion factors, 30 studies were selected for analysis. The studies were categorized in individual, group and organizational, being the studies with actions in groups those of greater prevalence. CONCLUSION: The actions used to cope with burnout were, for the most part, effective, with some demonstrating greater success than others. From the 30 reviewed studies, the results did not obtain satisfactory improvement in burnout in only three interventions: 1) Systematic nursing supervision; 2) Basic nursing care; and 3) Psycho-oncological training program.

Mental health and public policies implemented in the Northeast of Brazil: A systematic review with meta-analysis.

INTRODUCTION: Studies about mental disorders are very rare in the Northeast of Brazil, especially when psychopathologies in children and adolescents are considered. The consequence is a small availability of data and an absence of a real epidemiological profile. METHODS: This is a systematic review with meta-analysis, following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol, in the period from 2003 to 2015, using the databases LILACS, SciELO and BVS. The analysis comprised the keywords 'models of primary and secondary healthcare in mental health', 'psychiatric reform' and 'policies and services in mental health', using the Boolean operator '# AND'. Original texts based on secondary data from the Hospital Information System of the Brazilian Unified Health System were also included via the Citizen Electronic Record System, Instituto Brasileiro de Geografia e Estatística, and Ministry of Health. Grey literature was used by means of hand searching. RESULTS: A combined analysis of the strategies mentioned in the analyzed articles shows a combined odds ratio of 1.291 (confidence interval (CI) = 1.054-1.582), thus it demonstrates the efficacy of using such strategies in the elaboration of institutional apparatus in mental health. The p-value of the chi-square distribution resulted in .9753, which does not reject the hypothesis of association between strategies in mental health and possible development of institutional apparatus in mental health. CONCLUSIONS: A combined analysis of all strategies mentioned in the analyzed studies shows efficacy of using strategies to elaborate institutional apparatus in mental health.

Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review.

BACKGROUND: The relationship between users and health services is considered essential to strengthen the quality of care. However, the Lesbian, Gay, Bisexual, and Transgender population suffer from prejudice and discrimination in access and use of these services. This study aimed to identify the difficulties associated with homosexuality in access and utilization of health services. METHOD: A systematic review conducted using PubMed, Cochrane, SciELO, and LILACS, considering the period from 2004 to 2014. The studies were evaluated according to predefined inclusion and exclusion criterias. Were included manuscripts written in English or Portuguese, articles examining the Lesbian, Gay, Bisexual, and Transgender population's access to health services and original articles with full text available online. RESULTS: The electronic databases search resulted in 667 studies, of which 14 met all inclusion criteria. Quantitative articles were predominant, showing the country of United States of America to be the largest producer of research on the topic. The studies reveal that the homosexual population have difficulties of access to health services as a result of heteronormative attitudes imposed by health professionals. The discriminatory attendance implies in human rights violations in access to health services. CONCLUSIONS: The non-heterosexual orientation was a determinant factor in the difficulties of accessing health care. A lot must still be achieved to ensure access to health services for sexual minorities, through the adoption of holistic and welcoming attitudes. The results of this study highlight the need for larger discussions about the theme, through new research and debates, with the aim of enhancing professionals and services for the health care of Lesbian, Gay, Bisexual, and Transgender Persons.

ICD-10 mental and behavioural disorders due to use of crack and powder cocaine as treated at a public psychiatric emergency service: an analysis of visit predictors.

The present study investigated the predictors of an increased number of visits from individuals with some of the diagnoses noted in chapter F14 of ICD-10, from calls to the emergency psychiatric unit of a general hospital in São Paulo state, Brazil, in the period 2011-2012. Poisson regression models were carried out for the outcome variable, accounting for number of subsequent visits to the psychiatric emergency unit. For the analysis of this outcome we took into account the exposure time of each individual in the study. Our findings point to a population at risk for frequent psychiatric emergency service visits: individuals over 25 years. This population should be targeted for interventions on entry into public healthcare due to increased psychiatric morbidity and greater clinical morbidity already confirmed by previous studies. We discussed the need of these individuals for special attention during the clinical or psychiatric emergency consultation which, unfortunately, may be the access point for the public health system. None of the other variables were related to the outcome of interest, such as those related to the level of individual entry into the care network before and after treatment, and other variables related to medical acts during the visit.

Spirituality in childhood cancer care.

To deal with the suffering caused by childhood cancer, patients and their families use different coping strategies, among which, spirituality appears a way of minimizing possible damage. In this context, the purpose of the present study was to analyze the influence of spirituality in childhood cancer care, involving biopsychosocial aspects of the child, the family, and the health care team facing the disease. To accomplish this purpose, a nonsystematic review of literature of articles on national and international electronic databases (Scientific Electronic Library Online [SciELO], PubMed, and Latin American and Caribbean Health Sciences Literature [LILACS]) was conducted using the search terms "spirituality," "child psychology," "child," and "cancer," as well as on other available resources. After the search, 20 articles met the eligibility criteria and were included in the final sample. Our review showed that the relation between spirituality and health has lately become a subject of growing interest among researchers, as a positive influence of spirituality in the people's welfare was noted. Studies that were retrieved using the mentioned search strategy in electronic databases, independently assessed by the authors according to the systematic review, showed that spirituality emerges as a driving force that helps pediatric patients and their families in coping with cancer. Health care workers have been increasingly attentive to this dimension of care. However, it is necessary to improve their knowledge regarding the subject. The search highlighted that spirituality is considered a source of comfort and hope, contributing to a better acceptance of his/her chronic condition by the child with cancer, as well as by the family. Further up-to-date studies facing the subject are, thus, needed. It is also necessary to better train health care practitioners, so as to provide humanized care to the child with cancer.

Childhood depression: a systematic review.

As an important public health issue, childhood depression deserves special attention, considering the serious and lasting consequences of the disease to child development. Taking this into consideration, the present study was based on the following question: what practical contributions to clinicians and researchers does the current literature on childhood depression have to offer? The objective of the present study was to conduct a systematic review of articles regarding childhood depression. To accomplish this purpose, a systematic review of articles on childhood depression, published from January 1, 2010 to November 24, 2012, on MEDLINE and SciELO databases was carried out. Search terms were "depression" (medical subject headings [MeSH]), "child" (MeSH), and "childhood depression" (keyword). Of the 180 retrieved studies, 25 met the eligibility criteria. Retrieved studies covered a wide range of aspects regarding childhood depression, such as diagnosis, treatment, prevention and prognosis. Recent scientific literature regarding childhood depression converge to, directly or indirectly, highlight the negative impacts of depressive disorders to the children's quality of life. Unfortunately, the retrieved studies show that childhood depression commonly grows in a background of vulnerability and poverty, where individual and familiar needs concerning childhood depression are not always taken into consideration. In this context, this review demonstrated that childhood-onset depression commonly leads to other psychiatric disorders and co-morbidities. Many of the retrieved studies also confirmed the hypothesis that human resources (eg, health care team in general) are not yet adequately trained to address childhood depression. Thus, further research on the development of programs to prepare health care professionals to deal with childhood depression is needed, as well as complementary studies, with larger and more homogeneous samples, centered on prevention and treatment of childhood depression.

[Primary healthcare: a multidimensional study on challenges and potential in the São Paulo Metropolitan Region (SP, Brazil)]. / Atenção primária em saúde: um estudo multidimensional sobre os desafios e potencialidades na Região Metropolitana de São Paulo (SP, Brasil).

This paper presents some results of a case study in the Metropolitan Region of São Paulo (SP, Brazil) as part of a multicentric study conducted in Argentina, Brazil, Paraguay and Uruguay. The aim is to evaluate Primary Health Care (PHC) as a strategy to achieve integrated and universal healthcare systems. The methodological approach was based on five analytical dimensions: stewardship capability; financing; provision; comprehensiveness and intersectoral approach. The techniques included literature review, document analysis and interviews with key informants: policy makers; managers, experts, users and professionals. The results were organized in response to the challenges and possibilities of PHC as a structural system according to the five dimensions. The following emerged from the interviews: different interpretations on the concept and role of PHC and a consensus as the gateway to the system; weaknesses in funding; challenges in health workforce administration and the need for new legal-institutional design for regional management. The potential aspects were: broader coverage/universality, PHC as the basis for the organization of the system; connection with the territory and understanding specific population needs.