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.

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.

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.

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.

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.

Vivências de familiares cuidadores de idosos dependentes no processo de cuidado* / Experiencias de cuidadores familiares de personas mayores dependientes en el proceso de cuidado / Experiences of family caregivers of dependent older people in the care process

Objetivo: compreender as vivências de cuidadores familiares de idosos em relação ao cuidado. Método: estudo descritivo, de abordagem qualitativa, realizado em um município do Sul do Brasil com 14 cuidadores familiares de idosos dependentes. As entrevistas realizadas entre outubro e novembro de 2022 foram audiogravadas, transcritas na íntegra e submetidas à Análise de Conteúdo, modalidade temática. Resultados: os familiares assumem o cuidado de forma inesperada. Apesar de ele ser pouco compartilhado, a família, especialmente nos primeiros tempos, se reorganiza para apoiar o idoso. Com a vivência continuada da assistência domiciliar, os familiares percebem a sobrecarga, contudo, são capazes de (re)significar seu papel e demonstram que a experiência é fonte de aprendizagem e retribuição. Conclusão: profissionais de saúde devem estar atentos à forma com que o processo de cuidar de idosos se estabelece na vida dos familiares e desenvolver intervenções que os apoiem, diminuam a sobrecarga e ampliem suas fortalezas.

Objective: to understand the experiences of family caregivers of the older people in relation to care. Method: a descriptive study with a qualitative approach, conducted in a city in southern Brazil with 14 family caregivers of dependent older people. The interviews carried out between October and November 2022 were audio recorded, fully transcribed and submitted to Content Analysis, a thematic modality. Results: Family members take care unexpectedly. Although it is little shared, the family, especially in the early days, reorganizes to support the older adult. With the continued experience of home care, family members perceive the burden, however, they are able to (re)signify their role and demonstrate that the experience is a source of learning and retribution. Conclusion: Health professionals should be attentive to the way in which the process of caring for the older people is established in the lives of family members and develop interventions that support them, reduce overload and expand their strengths.

Objetivo: comprender las experiencias de cuidadores familiares de personas mayores en relación al cuidado. Método: estudio descriptivo, con abordaje cualitativo, realizado en una ciudad del sur de Brasil con 14 cuidadores familiares de personas mayores dependientes. Las entrevistas realizadas entre octubre y noviembre de 2022 fueron audiograbadas, transcritas íntegramente y sometidas al análisis temático. Resultados: los familiares asumen el cuidado de manera inesperada. Aunque rara vez se comparte, la familia, sobre todo en los primeros días, se reorganiza para apoyar al paciente. Con la experiencia continuada del cuidado domiciliario, los familiares perciben la sobrecarga, sin embargo, logran (re)significar su rol y demostrar que la experiencia es fuente de aprendizaje y retribución. Conclusión: los profesionales de la salud deben ser conscientes de la forma en que el proceso de cuidado del anciano se establece en la vida de los familiares y desarrollar intervenciones que los apoyen, reduzcan la carga y amplíen sus fortalezas.

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.

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.

Illness Experiences of Brazilian People Who Were Hospitalized Due to COVID-19 and Faced Long COVID Repercussions in Their Daily Life: A Constructivist Grounded Theory Study.

Long COVID is a multisystem condition that has multiple consequences for the physical, mental, and social health of COVID-19 survivors. The impact of the long COVID condition remains unclear, particularly among middle-aged and older adults, who are at greater risk than younger people of persisting symptoms associated with COVID-19. Therefore, we aimed to understand the experiences of middle-aged and older people who had been hospitalized for COVID-19 and the repercussions of long-term COVID symptoms in their daily lives. A qualitative study was carried out, adopting the framework of the constructivist grounded theory (CGT) proposed by Kathy Charmaz. Fifty-six middle-aged and older adult participants from the southern region of Brazil were recruited. Data were gathered from semi-structured telephone interviews. Concomitantly a comparative analysis was performed to identify categories and codes using the MaxQDA® software (version 2022). Three subcategories were identified: (1) experiencing COVID-19 in the acute phase; (2) oscillating between 'good days' and 'bad days' in long COVID; and (3) (re)constructing identity. These concepts interact with each other and converge upon the central category of this study: recasting oneself to the uniqueness of the illness experience of long COVID. Our findings provided insights related to the disruption in the lives of long COVID-19 sufferers who still live with persistent symptoms of the disease, including physical, social, family, emotional and spiritual repercussions. Likewise, this study may aid in developing friendly and welcoming social environments, lowering stigma and prejudice towards patients with long COVID, and fostering prompt and suitable policy support and mental health care for these individuals.

The self-care process of community-dwelling older adults during the COVID-19 pandemic / El proceso de autocuidado de los adultos mayores comunitarios en el contexto de la pandemia por COVID-19 / O processo de autocuidado de idosos comunitários no contexto da pandemia de COVID-19

ABSTRACT 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.

RESUMEN Objetivos: comprender el proceso de autocuidado de los ancianos en la comunidad en el contexto de la pandemia de COVID-19. Métodos: se trata de un estudio explicativo con enfoque cualitativo basado en la Teoría Fundamentada en Datos constructivista, realizado con 18 ancianos residentes en la comunidad. La recolección de datos se realizó a través de entrevistas y el contenido se analizó a través de una codificación inicial y focalizada. Resultados: se obtuvieron dos categorías: "Establecer vínculos para apoyar prácticas de autocuidado" y "Convivir con el estigma de grupo de riesgo". De su interacción surgió el fenómeno "Ejercer el autocuidado en la vejez en el contexto de la pandemia del COVID-19". Consideraciones Finales: fue posible identificar cómo las vivencias de los adultos mayores durante el período de la pandemia de COVID-19 repercutieron en su proceso de autocuidado, siendo influenciados por factores como la información sobre la enfermedad y los impactos de los estigmas del grupo de riesgo.

RESUMO Objetivos: compreender o processo de autocuidado dos idosos da comunidade no contexto da pandemia de COVID-19. Métodos: trata-se de um estudo explicativo de abordagem qualitativa, com referencial da Teoria Fundamentada nos Dados construtivista, realizada com 18 idosos comunitários. A coleta de dados ocorreu através de entrevistas, e o conteúdo foi analisado por meio da codificação inicial e focalizada. Resultados: foram obtidas duas categorias: "Estabelecendo conexões para apoiar práticas de autocuidado" e "Convivendo com o estigma de grupo de risco". A partir da interação dessas, emergiu o fenômeno "Exercendo o autocuidado na terceira idade no contexto da pandemia de COVID-19". Considerações Finais: foi possível identificar como as vivências dos idosos no período de pandemia de COVID-19 repercutiram no seu processo de autocuidado, sendo influenciados por fatores, como informações sobre a doença e os impactos dos estigmas do grupo risco.

Use of grounded theory in the extraction, coding and analysis of data in literature meta-analyses / Aplicabilidad de la teoría fundamentada en la extracción, análisis y codificación de datos en meta-análisis de literatura / Utilização da grounded theory na extração, codificação e análise de dados em metassínteses de literatura

ABSTRACT Objective: to describe the conduction of data extraction, analysis and codification using the Straussian perspective of Grounded Theory, in Literature Meta-analysis. Method: this is a theoretical-reflexive study on the data extraction from reviews with meta-anaylses. To design the process of searching for qualitative studies, this study briefly addresses the sequential steps of Preferred Reporting Items for Systematic Review and Meta-Analyses and the Joanna Briggs Institute. The extraction, analysis and codification process were carried out following the assumptions of grounded theory, with the Straussian perspective. They are the theoretical-methodological bases in the first stages of the guidelines of the literature review and Meta-analyses guides, starting with the research question until reaching the review stages, divided into identification, selection, eligibility, and inclusion. Results: the results describe the process of data extraction, analysis and codification from the Straussian perspective, using comparative analysis of data, memoranda, diagrams and possibilities of new sample groups from the detailed analytical reading of the included studies. Finally, theoretical saturation is performed, with an analysis of the findings, with examples of categories and subcategories, the emergence of the central phenomenon and presentation of the paradigmatic model. Conclusion: the essay presents subsidies for the understanding of the conduction of extraction, analysis and codification of data in meta-analyses based on the Straussian perspective, enabling the systematized analysis of qualitative evidence and contributing to the development of models or theories of conceptual character

RESUMEN Objetivo: describir la conducta de extracción, análisis y codificación de datos utilizando la Teoría Fundamentada, en la perspectiva Straussiana, en la Metasíntesis de la Literatura. Método: se trata de un ensayo teórico-reflexivo sobre la conducción de la extracción de datos a partir de revisiones de metasíntesis. Para delinear el proceso de búsqueda de estudios cualitativos, este ensayo aborda brevemente los pasos secuenciales de los Elementos de informe preferidos para la revisión sistemática y los metanálisis y el Instituto Joanna Briggs. El proceso de extracción, análisis y codificación se realizó siguiendo los supuestos de la Grounded Theory, con la perspectiva straussiana. Son las bases teórico-metodológicas en las primeras etapas de los lineamientos de las guías de revisión de literatura y Metasíntesis, partiendo de la pregunta de investigación hasta llegar a las etapas de revisión, divididas en identificación, selección, elegibilidad e inclusión. Resultados: los resultados describen el proceso de extracción, análisis y codificación de datos desde la perspectiva straussiana, utilizando análisis de datos comparativos, memorandos, diagramas y posibilidades de nuevos grupos de muestra a partir de una lectura analítica exhaustiva de los estudios incluidos. Finalmente, se realiza una saturación teórica, con una síntesis de los hallazgos, con ejemplos de categorías y subcategorías, emergencia del fenómeno central y presentación del modelo paradigmático. Conclusión: el ensayo presenta subsidios para la comprensión de la extracción, análisis y codificación de datos en Metasíntesis a partir de la perspectiva straussiana, permitiendo, de forma sistemática, la síntesis de evidencias cualitativas y contribuyendo al desarrollo de modelos o teorías de carácter conceptual. naturaleza.

RESUMO Objetivo: descrever a condução de extração, análise e codificação de dados utilizando a Grounded Theory, na perspectiva Straussiana, em Metassínteses de literatura. Método: trata-se de um ensaio teórico-reflexivo sobre a condução da extração de dados de revisões com metassíntese. Para delineamento do processo de busca dos estudos qualitativos, este ensaio aborda, de forma sucinta, as etapas sequenciais do Preferred Reporting Items for Systematic Review and Meta-Analyses e da Joanna Briggs Institute. O processo de extração, análise e codificação foi realizado seguindo os pressupostos da Grounded Theory, com a perspectiva Straussiana. São as bases teórico-metodológicas nas primeiras etapas das diretrizes dos guias de revisão de literatura e Metassíntese, iniciando com a pergunta de pesquisa até chegar às etapas da revisão, divididas em identificação, seleção, elegibilidade e inclusão. Resultados: nos resultados são descritos o processo de extração, análise e codificação de dados na perspectiva Straussiana, com uso de análise comparativa dos dados, memorandos, diagramas e possibilidades de novos grupos amostrais a partir da leitura analítica minuciosa dos estudos inclusos. Por fim, é realizada a saturação teórica, com síntese dos achados, com exemplos de categorias e subcategorias, emersão do fenômeno central e apresentação da modelo paradigmático. Conclusão: o ensaio apresenta subsídios para a compreensão da condução de extração, análise e codificação de dados em Metassínteses baseada na perspectiva Straussiana, possibilitando, de forma sistematizada, a síntese de evidências qualitativas e contribuindo no desenvolvimento de modelos ou teorias de caráter conceitual.

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.

A possibility for active aging: university activities for the elders.

OBJECTIVE: To reveal the conditions that allow the Open University for the Elderly to be a possibility for active aging. METHOD: Qualitative study anchored in the theoretical framework of Symbolic Interactionism and in the methodology of Grounded Theory. From April to October 2020, 14 elderly people, two coordinators, and six teachers linked to university activities for the elderly participated in individual interviews. Data analysis was carried out by three interdependent coding steps - open, axial and integration - with the support of the Atlas.ti software. RESULTS: The conditions that allow the program to be configured as an opportunity for active aging are related to the meanings attributed to aging well; the social determination of participation; motivations in the search for the program; the functions performed by the program; and public and institutional policies of the university to which it is linked. FINAL CONSIDERATIONS: University activities for the elderly are a possibility for active aging, but socially constructed barriers make access to them difficult.