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Trend Analysis of Automobile Collision Amongst 15-19 year olds in Virginia, 2000-2004Ndem, Imo F. 01 January 2007 (has links)
Purpose. This research study on automobile collision in Virginia amongst fifteen to nineteen (15-19) year olds looked into the trend analysis over a five (5) year period of 2000 to 2004. Trend analysis is usually done for aggregates of all injurieseither intentional or unintentional injuries, or both. The primary objective of this research study was to examine the trend in hospitalization rates and mortality rates for males and females independently. It further looked into the trend, if any, in hospitalization rates, mortality rates, and case-fatality rates, for both males and females combined. The different Tables illustrate the extent and the impact of automobile collision in terms of demographics and characteristics of hospitalizations, types of hospitalizations, hospitalization rates, mortality rates and case-fatality rates among this age group.Methods: An investigation was carried out in a case control manner of 2353 cases using data from the Virginia Department of Health-Division of Injury Prevention & Violence on automobile collision amongst 15-19 year olds, from 2000 to 2004, a (5) five year period. Hospitalization data were obtained from Virginia Health Information, coded in line with International Classification of Diseases, 9th revision (ICD-9); external cause of injury (E)-codes. Mortalityldeath rates and case fatality rates were calculated using U.S. Census Bureau, Census 2000 for Virginia's population data. Frequency distribution analysis was done with SPSS 14.0, data entry using M.S. Excel, while rate ratio and confidence intervals for hospitalization rates, mortality rates were calculated. Linear trend was analyzed for hospitalization rates, mortality rates and case-fatality rates, using Chi square statistics test for significance. Geographical Information System (GIs) methods were used to display counties in Virginia.Results: Out of 2353 cases of automobile collision in Virginia, amongst 15-19 year olds, from 2000 to 2004, the demographic did not changed much. Males were fairly distributed over the five year period, while automobile collision characteristics showed that 2142 cases (91%) were more likely to be hospitalized on an emergency basis, with males having a higher percentage, fifty-nine (59%) percent, and forty (40%)percent for females. (Table 1 & 2). The hospitalization rates were higher for males than females, with rate ratio (RR>1) greater than one over the five years of study (Table 3). Mortality rates showed increase rates for males, over the five year of study (RR>1.5) (Table 4). Test for linear trend in hospitalization rates (Chi. Sq.=14.127, p-value ≤ 0.001) were significant for both males and females. Mortality rates test for trend were also significant for both males and females. (Chi Sq. = 377.0, p-value ≤ 0.001). Case-fatality rates trend test were significant for both males and females. (Chi sq. = 11.580, p value ≤ 0.001). The trend in hospitalization, mortality and case-fatality rates, showed a decrease over the five year of study.Conclusion: Given the impact of injuries in ,the U.S., mainly automobile collisions, it is socially beneficial to continue research, intervention and prevention programs in this area, particularly directed and targeted to this population - Healthy People 2010 objectives.
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Možnosti prevence katetrových sepsí během hospitalizace / Options preventing catheter-related sepsis during hospitalizationSlavkovská, Jana January 2014 (has links)
The thesis is focused on the assessment of nurse's knowledge in the prevention of catheter sepsis. The aim of the study was to expertise knowledge in the prevention of catheter sepsis among nurses working in intensive care units. Map out the latest theoretical and practical possibilities of nurses working in intensive care units in the prevention of catheter-related sepsis of hospitalized patients. The work is divided into theoretical and practical part. The theoretical part consists of three chapters. In the first chapter, we focused on a theoretical overview of nosocomial and bloodstream infections. The second chapter is focused on an overview of invasive inputs. The third chapter focuses on prevention of catheter sepsis. Practical part was divided into two chapters. In the first section of the empirical part of the diploma thesis, which is the fourth chapter, we characterized the survey sample, the evaluation of the survey data that have been collected through the questionnaire. Practical part was divided into two chapters. The fifth chapter consists of discussion and suggestions. Key words: sepsis, prevention, nursing, catheter, nurse, hospitalization.
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Psychická zátěž a zvládání stresu u rodičů dětí se zevní komorovou drenáží / Mental stress and coping with stress in parents of children with external ventricular drainageProcházková, Kateřina January 2016 (has links)
Presented theoretical and empirical thesis deals with the issue of external ventricular drainage and coping with stress in parents of children hospitalized at the intensive care unit of an unnamed workplace. The theoretical part of the definition of ,,external ventricular drainage" and the problems associated with the care of children with established external ventricular drainage. As part of the anatomy and pathophysiology of the brain, where the drainage introduced. This chapter also discussed the hospitalization of the child, including accompanying persons and the possible effect on the entire family of the situation. At the end of this part are mapped psychological stress, stress and stress management techniques to assist. The research part of this work was aimed at comparing whether the parents of sick children plays an important factor in coping with this stressful situation nursing staff or a close family. It was also determined the rate of information provided to parents of young patients by medical personnel. Furthermore, the aim was to work to determine overall satisfaction with the approach of parents and professionals work at the specific workplace. In the empirical part contains the results of quantitative research implemented initially, with the help of special questionnaire, which...
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Využití canisterapie u hospitalizovaných dětí / Animal Assisted Activities at Children in HospitalJakubcová, Šárka January 2013 (has links)
The thesis titled "Use of animal assisted therapy for the hospitalized children" deals with the theoretical background of animal assisted therapy as a supporting method in complex rehabilitation and its practical use during the visits of volunteers with their dogs and its influence to the health of children in hospital care. In the available literature are often described the positive effects of the animal assisted therapy onto the mental and physical condition of the person, the impact on improving communication as well as other factors in the social life of the client. The main focuse of my work is whether these effects can be observed (noticed) even in the short term or even after a single visit of the dog. Using quantitative and qualitative methods, I have tried to describe this impact and possibly uncover additional benefits that can be attributed to the visits of the volunteers with a dog at pediatric hospital.
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Risk factors for sciaticaEuro, U. (Ulla) 20 August 2019 (has links)
Abstract
Sciatica is a common musculoskeletal disorder, especially among the working-age population. It causes huge costs to society through work absenteeism and hospital treatments. The common cause of sciatica is the herniated lumbar disc compressing the nerve root. The neurological deficit resulting from this compression can be either sensory or motor-related. Earlier studies have shown both genetic and environmental factors to exist in the aetiology of sciatica.
The aim of this study was to investigate how individual, physical and work-related risk factors associate with sciatica, and to determine the prevalence of sciatic pain among Finnish adolescents. The data used in this study were from large, population-based Finnish surveys: the Northern-Finland Birth Cohort 1986, the Mobile Clinic Health Examination Survey, the Mini-Finland Health Survey, Health 2000, the Young Finns Study, and the Helsinki Health Studies.
The results of this study showed that sciatic symptoms are already common among adolescents. Young women in particular reported sciatic pain more often than men. Low back pain at the age of 16 predicted sciatic pain at the age of 18. Physically demanding work, smoking and obesity were found to predict an increased risk of hospitalization for sciatica. In the Mobile Clinic Health Examination Survey, leisure-time physical activity protected men from hospitalization for sciatica, whereas among women obesity increased this risk. Occupation also modified the effects of various risk factors. In the Mini-Finland Health Survey, overweight and obese participants who had been exposed to whole body vibration in their work were at a higher risk of hospitalization due to sciatica. In addition, lifting and carrying heavy objects at work, or sedentary work involving the handling of heavy objects predicted an increased risk of hospitalization for sciatica. Heavy or very heavy work protected against hospitalization for sciatica. A meta-analysis of four prospective cohort studies showed that walking and cycling to work reduced the risk of hospitalization for sciatica.
This thesis extends our knowledge regarding the risk factors for sciatica. Its results show that these risk factors are complex and can modify each other’s effects. Thus, further research on the interactions of the various risk factors is needed. / Tiivistelmä
Iskias on etenkin työikäisten keskuudessa yleinen sairaus, joka aiheuttaa paljon työkyvyttömyyttä ja sairaalahoitoja ja siten kustannuksia yhteiskunnalle. Iskiaksen taustalla on yleensä välilevyn pullistuma, joka painaa hermojuuria. Hermojuuren puristuksesta aiheutuva neurologinen puutosoire voi olla joko sensorinen tai motorinen. Aiemmat tutkimukset ovat osoittaneet iskiaksen taustalla olevan sekä geneettisiä että ympäristötekijöitä.
Tämän tutkimuksen tavoitteena oli selvittää yksilöllisten, fyysisten ja työhön liittyvien riskitekijöiden yhteyttä iskiakseen sekä tutkia iskiaskivun yleisyyttä suomalaisilla nuorilla aikuisilla. Aineistoina tutkimuksessa käytettiin laajoja väestöpohjaisia suomalaisia aineistoja: Pohjois-Suomen syntymäkohorttia 1986, Autoklinikka- ja Mini-Suomi-aineistoja sekä Terveys 2000-, Young Finns- ja Helsinki Health Study -tutkimuksia.
Tutkimuksessa selvisi, että iskiasoireet ovat yleisiä jo nuorilla aikuisilla ja etenkin naiset raportoivat iskiaskipua useammin miehiin verrattuna. 16-vuotiaana ilmennyt alaselkäkipu oli myös yhteydessä iskiasoireisiin 18 vuoden iässä. Työn fyysisen rasittavuuden, tupakoinnin ja lihavuuden todettiin lisäävän sairaalahoitoon johtaneen iskiaksen riskiä. Autoklinikka-aineistossa vapaa-ajan fyysinen aktiivisuus suojasi miehiä sairaalahoitoon johtaneelta iskiakselta, naisilla taas ylipaino lisäsi iskiaksen riskiä. Lisäksi ammatti näytti muokkaavan riskitekijöiden assosiaatioita. Mini-Suomi-aineistossa ylipainoiset ja lihavat henkilöt, jotka olivat altistuneet työssään koko kehon tärinälle, olivat korkeammassa riskissä sairaalahoitoon johtaneen iskiaksen suhteen. Töissä raskaiden esineiden nostaminen tai kantaminen tai painavien esineiden käsittelyä sisältävä istumatyö lisäsivät myös iskiaksen riskiä. Raskas tai erittäin raskas fyysinen työ taas näytti suojaavan sairaalahoitoon johtaneelta iskiakselta. Neljän prospektiivisen kohorttitutkimuksen meta-analyysissä selvisi, että työmatkapyöräily tai -kävely vähensivät sairaalahoitoon johtaneen iskiaksen riskiä.
Tämä väitöstutkimus kasvattaa ymmärtämystä iskiaksen taustalla olevista riskitekijöistä. Tulokset osoittavat, että iskiaksen riskitekijät ovat moniulotteisia ja voivat muokata toistensa vaikutuksia, joten lisätutkimusta eri riskitekijöiden välisistä interaktioista tarvitaan.
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Atendimentos por condições sensíveis à atenção primária à saúde em uma unidade de pronto-atendimento: proposta de comunicação para coordenação do cuidado, / Ambulatory Care Sensitive Conditions in a emergency department: Communication proposal for care coordination.Lima, Ana Claudia Medeiros Galvão de 28 November 2017 (has links)
Introdução: O estudo da Atenção Primária à Saúde (APS) tem promovido discussões a respeito da organização dos sistemas de saúde e como eles se comunicam, no Brasil e no mundo. A falta de coordenação da atenção à saúde é apontada como um dos principais obstáculos na instituição de melhorias no cuidado aos usuários. Uma vertente de avaliação da APS em diversos países tem utilizado a análise das internações por condições sensíveis à atenção primária (ICSAP), por meio de indicadores de sua efetividade. As taxas de ICSAP podem ser utilizadas como forma de avaliar o acesso, a cobertura, a qualidade e o desempenho da APS e, assim, pensar em melhorias na comunicação entre os serviços de saúde. Objetivos: Propor um fluxo de comunicação entre um serviço de urgência e emergência e a APS em uma região do município de São Paulo; identificar os pontos de fragilidade e potencialidade na comunicação entre os serviços de urgência e emergência e a Atenção Primária à Saúde a partir da análise das condições sensíveis à atenção primária (CSAP). Método: Trata-se de um estudo transversal, descritivo, exploratório e retrospectivo, com abordagem quantitativa, desenvolvido na Unidade de Pronto-Atendimento (UPA 24h) Campo Limpo a partir de dados secundários obtidos de um banco de dados, referente ao período de janeiro de 2015 a dezembro de 2016. As análises foram realizadas com o auxílio do pacote estatístico SPSS. O fluxograma de comunicação foi proposto a partir do sistema informatizado NISI-online. Resultados: O banco de dados foi composto por 434.883 atendimentos, no período de 2 anos, com prevalência de ICSAP de 17,1%. O sexo feminino foi o mais acometido pelas internações sensíveis e crianças de 1 a 4 anos apresentaram chance aumentada de atendimento por ICSAP. A maioria das ICSAP foi composta por infecções de ouvido, nariz e garganta (45,4%). Há evidências de aumento da chance de atendimento por ICSAP em pacientes crônicos (p< 0,001), com possibilidade estimada em torno de quatro vezes a dos pacientes não crônicos. A proposta de fluxograma de comunicação entre UPA e APS se deu a partir de pacientes com doenças crônicas (asma/bronquite, hipertensão arterial sistêmica, diabetes mellitus e transtorno mental) com importância de intervenção junto à APS. Conclusão: A consolidação das Redes de Atenção à Saúde voltada para a coordenação do cuidado, por meio da utilização de abordagens que aproximem os diferentes pontos de atenção à saúde, constitui-se como instrumento importante na continuidade do cuidado aos pacientes crônicos com ICSAP. / Introduction: The study of Primary Health Care has promoted discussions about the organization of the health systems and how they integrate to each other in Brazil and around the world. The lack of coordination is pointed out as one of the main obstacles to implement improvements in the health care. Some countries are using the numbers of Ambulatory care sensitive conditions (ACSC) as parameter to evaluate the Primary Health Care effectiveness. ACSC indexes can be used to evaluate the coverage, quality, and performance of Primary Health Care, analyzing the potential improvements in communication between the health services. Objectives: Introduce a communication flow between an emergency department and Primary Health Care in determinate region from São Paulo city; Identifying the fragilities and potentialities in the communication between an emergency department and Primary Health Care using the analysis of the ACSC cases. Method: This is a cross-sectional, descriptive, exploratory and retrospective study, with a quantitative approach, developed at the Emergency Department Campo Limpo based on secondary data obtained from a database, from the period of January 2015 to December 2016. The analyzes were executed with the assistance of the statistical package SPSS. The communication flowchart was developed using data from the NISI-online computerized system. Results: The database was composed by 434,883 consultations in a 2-year period, with 17.1% prevalence of ACSC. The female gender was the most affected by the sensitive hospitalizations and children from 1 to 4 years old presented an increased tendency of ACSC. Most of ACSC were composed by ear, nose and throat infections (45.4%). There are evidences that increases the chances four times more for ACSC care in chronic patients (p < 0.001), when comparing to non-chronic patients. The proposed communication flow between Emergency department and Primary Health Care was based on patients with chronic diseases (asthma / bronchitis, systemic arterial hypertension, diabetes mellitus and mental disorder) highly recommended to have Primary Health Care intervention. Conclusion: The consolidation of health care networks focused on the coordination of care process using an approach that turn close the different scenarios of health care is important for the continuity of care for chronic patients with ACSC.
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Poluição, internação e renda: uma abordagem espacial no município de São José dos Campos / Pollution, hospitalization and income: a spatial approach in São José dos CamposMauro, Antonio Carlos Cortez 15 December 2014 (has links)
Introdução - São José dos Campos é um importante centro econômico e polo industrial, situado em uma região de vale e baixa dispersão atmosférica. Essas características são sugestivas de importante poluição do ar local, a qual pode afetar a saúde de populações mais vulneráveis, como a de idosos. Considerando que hospitalização de idosos pode estar relacionada também a fatores de risco, como a exposição à poluição em decorrência do local de moradia e à renda familiar, este trabalho propõe um estudo da distribuição espacial dos locais de habitação de idosos internados por doenças respiratórias e cardiovasculares, que podem ser associadas a processos da poluição do ar, verificando a existência de distribuição aleatória ou formação de agrupamentos e a correlação com a renda familiar predominante nos setores socioeconômicos do Município. Casuística e Métodos - Foi elaborado um banco de dados registrando os endereços, com coordenadas geográficas, de pacientes idosos internados por doenças cardiovasculares e respiratórias no Hospital Municipal de São José dos Campos, no ano de 2010. Foi realizada a espacialização desses endereços sobre o mapa da área urbana, bem como a espacialização da Taxa de Internação desses idosos sobre o mapa dos setores socioeconômicos do Município. Analisou-se a distribuição espacial da Taxa de Internação, utilizando-se estatística descritiva e Índice de Moran. Foi analisada a distribuição geográfica dos locais de habitação dos pacientes internados, aplicando-se o Estimador de Kernel. Resultados - Foram identificadas 1.200 internações de idosos por doenças respiratórias e cardiovasculares. O Índice de Moran, com base na divisão socioeconômica e taxas de internação do Município, não identificou agrupamentos de setores. Porém, a aplicação do Estimador de Kernel na espacialização dos locais de habitação permitiu a visualização de agrupamentos no entorno de importante autoestrada e fonte emissora de poluentes. Conclusões - A existência de agrupamentos de habitações de pacientes internados, próximos à principal rodovia que atravessa o Município, sugere correlação com a poluição por emissões veiculares. Não foram observadas evidências conclusivas sobre a correlação espacial entre taxa de internação e renda. O Inventário de Emissões de Poluentes Atmosféricos do Município, através da caracterização das fontes de poluição, corroborou a identificação de fatores de risco sanitário e ambiental / Introduction - São José dos Campos is an important economic and industrial hub center, located in a valley and region of low atmospheric dispersion. These features are suggestive of important local air pollution, which can affect the health of vulnerable populations such as the aged. Whereas hospitalization of the aged may also be related to risk factors such as exposure to pollution from the place of residence and family income, this thesis proposes a study of the spatial distribution of housing sites for aged patients hospitalized for respiratory and cardiovascular diseases which may be associated to air pollution processes, checking for random distribution or formation of clusters and the correlation with the predominant household income in socioeconomic sectors of the Municipality. Casuistry and Methods - A database was developed registering addresses with geographical coordinates of aged patients hospitalized for cardiovascular and respiratory diseases at São José dos Campos Municipal Hospital, in the year 2010. The spatial distribution of these addresses was performed on the map of the urban area as well as the spatial rate of hospitalization of the aged on the socio-economic sectors map of the Municipality. The spatial distribution of the hospitalization rate was analyzed, using descriptive statistics and the Moran\'s Index. The geographic distribution of housing sites of hospitalized patients was analyzed by applying the Kernel Estimator. Results - 1,200 hospitalizations of aged people were identified for respiratory and cardiovascular diseases. The Moran\'s Index, based on socioeconomic division and admission rates to the municipality, not identified groups of sectors. However, the application of Kernel Estimator for interpolation of local housing allowed the visualization of clusters around the major highway and emission source of pollutants. Conclusions - The existence of clusters of dwellings inpatients, near the main highway that runs through the municipality, suggests correlation with pollution from vehicle emissions. No conclusive evidence on the spatial correlation between hospitalization rate and income were observed. The Emission Inventory of Air Pollutants of the Municipality, through the characterization of pollution sources, corroborated the identification of health and environmental risk factors
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Tendência de internações hospitalares de pacientes com e sem o diagnóstico de diabetes mellitus submetidos à amputação não traumática de extremidades inferiores, Ribeirão Preto - SP, 2001-2008 / Tendency of hospital admissions of patients with and without a diagnosis of diabetes mellitus undergoing non-traumatic amputation of lower extremities, Ribeirão Preto, 2001-2008Rodrigues, Flavia Fernanda Luchetti 20 March 2015 (has links)
Estudo quantitativo, descritivo e retrospectivo de internações hospitalares de pacientes com e sem o diagnóstico de diabetes submetidos a amputação não traumática de extremidades inferiores, no período de 2001 a 2008, em Ribeirão Preto - SP - Brasil. Este estudo teve como objetivos caracterizar as internações hospitalares de pacientes com e sem o diagnóstico de diabetes mellitus submetidos a amputação não traumática de extremidades inferiores segundo sexo, idade, período da internação hospitalar, tipo de atendimento e condições da alta; relacionar as internações hospitalares com as variáveis tipo de alta e atendimento, sexo, idade e tempo de internação, e analisar a tendência das internações hospitalares em Ribeirão Preto-SP, no período de 2001-2008. Utilizaram-se dados de fonte secundária de internações hospitalares, do Sistema de Informações do Centro de Processamento de Dados Hospitalares. Os resultados mostraram que das 2296 internações hospitalares relacionadas ao procedimento de amputação não traumática de extremidades inferiores, 954 (41,6%) tinham o diagnóstico de diabetes mellitus. A maioria (58,7%) é do sexo masculino; idade média de 63,9 anos; 54,8% residiam em Ribeirão Preto-SP e 72,6% receberam assistência hospitalar pelo Sistema Único de Saúde. O tempo de internação hospitalar variou de 0 a 128 dias, média de 9,9 dias. A taxa de reinternações foi de 12,7% e de óbito 7,9%. A tendência de internações hospitalares não obedece a um padrão regular e o modelo de regressão linear ajustado para verificar a existência de tendência não mostrou significância estatística. O teste Qui-quadrado apresentou significância estatística, p-valor < 0,001, para variável sexo e o teste de Mann-Whitney mostrou significância estatística p-valor <0,001 para o tempo de internação hospitalar. Esses resultados apontam a importância de reforçar as ações de educação aos pacientes com diabetes mellitus com vistas à prevenção de amputações como desfecho da doença / Quantitative, descriptive and retrospective study of hospital admissions of patients with and without a diagnosis of diabetes mellitus undergoing non-traumatic amputation of the lower extremities, in the period from 2001 to 2008 in Ribeirão Preto - SP - Brazil. This study aimed to characterize the hospital admissions of patients with and without a diagnosis of diabetes undergoing non-traumatic amputation of lower extremities by sex, age, hospitalization time, type of care and discharge conditions; relate the hospitalizations with the variable type of discharge and attendance, sex, age and hospitalization time and analyze the tendency of hospital admissions in Ribeirão Preto-SP, in the period from 2001 to 2008. Source of data were used secondary hospitalizations, from the National Hospital Data Processing Center Information. Of 2296 hospital admissions related to non-traumatic amputation procedure of the lower extremities, 954 (41.6%) had a diagnosis of diabetes mellitus, most (58.7%) were male, mean age 63.9 years. 54.8% live in Ribeirão Preto-SP, 72.6% received hospital care by SUS, hospital stay ranging from 0 to 128 days, an average of 9.9 days. The readmission rate was 12.7% and 7.9% died. The trend of hospitalizations did not follow a regular pattern and the linear regression model adjusted to check the trend was not statistically significant.The chi-square test was statistically significant, p <0.001, for gender variable and the Mann-Whitney test revealed statistically significant p-value <0.001 for the variable hospital stay. These results show the importance of strengthening education activities to patients with diabetes in order to prevent amputations as the outcome of the disease
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Contribuições de crianças e adolescentes ao processo de hospitalização: subsídios para o cuidado de enfermagem / Contributions of children and adolescents to the hospitalization process: support for nursing careCassemiro, Larissa Karoline Dias da Silva 27 November 2017 (has links)
A hospitalização afasta a criança e o adolescente da vida cotidiana, do espaço familiar, dos amigos e das brincadeiras. Quando hospitalizados, vivenciam um ambiente muitas vezes de incertezas, permeado por novas rotinas, odores específicos, procedimentos dolorosos, equipamentos estranhos e pessoas desconhecidas. Além disto, muitas vezes não compreendem o motivo da internação e, consequentemente, a hospitalização é traduzida como uma experiência negativa e ameaçadora, que suscita sentimentos diversos como medo, angústia, tristeza e ansiedade. Buscar compreender este processo sob a perspectiva de crianças e adolescentes pode contribuir para iluminar aspectos da hospitalização, com base nas suas reais necessidades. Sendo assim, o presente estudo tem como objetivo identificar as necessidades de crianças e adolescentes diante do processo de hospitalização, a fim de contribuir para a assistência integral e humanizada. Estudo descritivo e exploratório, com análise qualitativa dos dados, tendo como quadro teórico a humanização do cuidado em saúde e o processo de hospitalização. Foi desenvolvido em um hospital universitário do estado de São Paulo, na unidade de pediatria, com a participação de 30 crianças e adolescentes, com idades entre 7 e 17 anos e predominância (21) na faixa etária de 13 a 16 anos. Os dados foram coletados por meio de entrevista semiestruturada, intermediada pelo desenho, e complementados por informações clínicas obtidas no prontuário. A análise seguiu a técnica de análise de conteúdo do tipo temática indutiva. Com relação à caracterização dos participantes, os diagnósticos mais frequentes foram: Neoplasias (7), Fibrose Cística (6), Diabetes Mellitus tipo 1(5) e Lúpus Eritematoso (3); 11 eram de Ribeirão Preto, e os demais de cidades da região ou de outros estados. Os participantes estavam acompanhados, em sua maioria, por suas mães (25), irmãs (2), avó (1), avô (1) e pai (1). A faixa etária dos acompanhantes variou entre 21 e 86 anos; três tinham o ensino superior completo, nove o ensino médio e 15 o fundamental. Da análise do material empírico emergiram três categorias temáticas: a) o hospital sob a ótica da criança e do adolescente, na qual se identificou que os participantes classificavam o hospital como \"ruim\", lugar onde se toma injeção; lugar de pessoas doentes; lugar que afasta da família, dos amigos e das atividades diárias; lugar que não oferece privacidade; lugar que serve comida ruim e lugar pouco atrativo e, ao mesmo tempo, como o local onde são construídas amizades, que proporciona atividades lúdicas, além de ser um instrumento de apoio para a cura tão desejada; b) o que sei e o que não sei a respeito do processo de hospitalização, assinalando a necessidade de obter maior conhecimento sobre seu diagnóstico, tratamento e hospitalização; e c) o hospital projetado, revelando aspectos voltados para os princípios da humanização em saúde e ambiência hospitalar, buscando pela confortabilidade, valorização de subjetividades, individualidades e singularidade. Os resultados do estudo poderão contribuir para qualificar o cuidado em saúde, particularmente a assistência de enfermagem, com vistas à produção de cuidados que atendam às reais necessidades de crianças e adolescentes hospitalizados, bem como de seus familiares / Hospitalization takes children and adolescents away from everyday life, the family environment, friends and play. Then, they experience an environment often of uncertainties, inhabited by new routines, specific odors, painful procedures, strange equipment and unknown people. In addition, they often do not understand the reason for their hospitalization and, consequently, hospitalization is translated as a negative and threatening experience that causes diverse feelings, such as fear, anguish, sadness and anxiety. Seeking to understand this process from the perspective of children and adolescents can contribute to clarify aspects of the hospitalization based on their actual needs. Therefore, the aim in this study is to identify the needs of children and adolescents in the hospitalization process, in order to contribute to comprehensive and humanized care. A descriptive and exploratory study was carried out with a qualitative analysis of the data, based on the humanization of health care and the hospitalization process. It was developed in a university hospital in the state of São Paulo, in the pediatric unit, with the participation of 30 children and adolescents, aged between seven and 17 years, with predominance (21) of the age group between 13 and 16 years old. The data were collected through the semi-structured interview intermediated by drawing, complemented by clinical information obtained from the medical record. The data were analyzed by thematic-inductive content analysis. Regarding the characterization of the participants, the most frequent diagnoses were Cancer (7), Cystic Fibrosis (6), Type 1 Diabetes Mellitus (5) and Lupus Erythematosus (3); 11 came from Ribeirão Preto and the rest from cities in the region or from other states. Participants were mostly accompanied by their mothers (25), sisters (2), grandmother (1), grandfather (1) and father (1). The age group of the companions varied between 21 and 86 years; three had completed higher, nine secondary and 15 primary education. From the analysis of the empirical material, three thematic categories emerged: a) the hospital from the perspective of the child and the adolescent, in which we identified that the participants classified the hospital as \"bad\", a place where you get an injection; place of sick people; place away from family, friends and daily activities; place that has no privacy; place that serves bad food and an unattractive place, yet also pointed out as a place to make friends, which has play activities, besides being an instrument of support for the so desired cure; b) what I know and do not know about the hospitalization process, pointing out the need to obtain more knowledge about the diagnosis, treatment and hospitalization and c) the hospital drawn, revealing aspects focused on the principles of humanization in health and hospital environment, seeking comfort, valuation of subjectivities, individualities and uniqueness. The results of the study can contribute to qualify health care, particularly nursing care, with a view to the production of care that meets the real needs of hospitalized children and adolescents, as well as their families
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Delirium em idosos hospitalizados: análise de características clínicas e prognóstico / Delirium in hospitalized older adults: analysis of clinical characteristics and prognosisSilva, Thiago Junqueira Avelino da 01 February 2016 (has links)
INTRODUÇÃO: Delirium é um problema médico frequente em idosos e está potencialmente associado a desfechos desfavoráveis, como prolongamento da hospitalização, declínio funcional e cognitivo, e maior mortalidade. Contudo, considerando que, geralmente, ocorre em situações de grande complexidade clínica, o efeito ajustado de delirium e seus subtipos motores sobre o prognóstico de pacientes acometidos ainda não foi suficientemente explorado. OBJETIVOS: Investigar em idosos agudamente enfermos hospitalizados: (1) a associação independente entre ocorrência de delirium e tempo para óbito intra-hospitalar, e em 12 meses de seguimento; (2) a associação independente entre subtipos motores de delirium e tempo para óbito intra-hospitalar, e em 12 meses de seguimento. MÉTODOS: Estudo de coorte prospectivo realizado em uma enfermaria de geriatria de um hospital universitário terciário, em São Paulo, Brasil. Foram incluídas internações de pacientes agudamente enfermos, com idade igual ou superior a 60 anos, hospitalizados entre junho de 2009 e maio de 2014. Delirium foi detectado pelo Confusion Assessment Method e classificado de acordo com o subtipo motor em hipoativo, hiperativo, ou misto. Os desfechos primários foram tempo para óbito intra-hospitalar, e tempo para óbito em 12 meses (para a amostra que recebeu alta). Os pacientes foram avaliados na admissão seguindo modelo de avaliação geriátrica ampla que incluiu variáveis sociodemográficas, clínicas, funcionais, cognitivas, e laboratoriais. Informações adicionais sobre a hospitalização foram registradas na alta ou no óbito. As análises multivariadas foram realizadas por meio de modelos de riscos proporcionais de Cox. Foi examinada a presença de modificação do efeito de delirium sobre os desfechos por análises de interação com outros fatores clínicos. RESULTADOS: Incluímos 1.034 hospitalizações, com uma média de idade de 80 anos. Na amostra geral, 61% eram mulheres, e 35% tinham demência. A mortalidade intra-hospitalar foi de 22%, com uma mortalidade cumulativa de 44% em 12 meses. Delirium ocorreu em 52% das internações, e o subtipo motor predominante foi o hipoativo (53%). Nas hospitalizações com delirium, 32% dos idosos faleceram no hospital, com uma taxa de óbitos cumulativa de 59% em 12 meses. Verificamos que delirium teve associação independente com tempo até óbito intra-hospitalar (HR=1,63 IC95%=1,11-2,40), porém não encontramos associação estatisticamente significante com sobrevida em 12 meses após ajuste para as covariáveis selecionadas. Constatamos, ainda, que os subtipos hipoativo e misto se associaram independentemente com o desfecho intra-hospitalar (HR=1,87 IC95%=1,24-2,83; HR=1,65 IC95%=1,022,67), mas não houve associação estatisticamente significante com o desfecho em 12 meses. O efeito de delirium sobre o tempo até óbito intrahospitalar não foi modificado de modo significativo por sua interação com idade, câncer, desnutrição, ou valores de albumina sérica. CONCLUSÕES: Um terço dos idosos agudamente enfermos internados que tiveram delirium faleceu ainda no hospital. Delirium se associou a menor tempo de sobrevida intra-hospitalar, mesmo após ajuste para características clínicas coexistentes. Além disso, profissionais da saúde devem ter especial atenção com os subtipos hipoativo e misto de delirium, que também se associaram independentemente com maior mortalidade intra-hospitalar em idosos / BACKGROUND: Delirium in older adults is common and potentially associated with unfavorable outcomes, such as longer hospital stay, functional and cognitive decline, and higher mortality. However, given that it usually occurs in a context of great clinical complexity, the adjusted effect of delirium and its motor subtypes on the prognosis of affected patients has not been sufficiently explored. OBJECTIVES: To investigate in acutely ill hospitalized older adults: (1) the independent association between delirium and time to death in the hospital, and in a 12-month follow-up; (2) the independent association between delirium motor subtype and time to death in the hospital, and in a 12-month follow-up. METHODS: Prospective cohort study completed in a geriatric ward of a tertiary university hospital, in Sao Paulo, Brazil. We included admissions of acutely ill patients aged 60 years and over, who were hospitalized from June 2009 to May 2014. Delirium was detected using the Confusion Assessment Method and classified according to its motor subtype in hypoactive, hyperactive, or mixed. Primary outcomes were time to death in the hospital, and time to death in 12 months (for the discharged sample). Patients were evaluated at admission according to a comprehensive geriatric assessment model that included socio-demographic, clinical, functional, cognitive, and laboratory variables. Further clinical data were documented upon death or discharge. Multivariate analyses were performed using Cox proportional hazards models. We investigated the potential modification of the effect of delirium on outcomes including an interaction term between delirium and other clinical variables. RESULTS: We included 1,034 hospitalizations, with a mean age of 80 years. Overall, 61% were women, and 35% had dementia. The proportion of in-hospital deaths was of 22%, with a cumulative mortality of 44% in 12 months. Delirium ensued in 52% of the admissions, and the predominant motor subtype was hypoactive (53%). In-hospital death occurred in 32% of the cases with delirium, while cumulative 12-month mortality reached 59% in this group. We verified that delirium was independently associated with time to in-hospital death (HR=1.63 95%CI=1.11-2.40), but did not find statistically significant association with 12month survival after adjusting for selected covariates. We additionally found that hypoactive and mixed motor subtypes were independently associated with in-hospital death (HR=1.87 95%CI=1.24-2.83; HR=1.65 95%CI=1.02-2.67), but there were no significant associations with 12-month mortality. The effect of delirium on time to in-hospital death was not significantly modified by its interaction with age, cancer, malnutrition, or serum albumin levels. CONCLUSIONS: One third of acutely ill hospitalized older adults who suffered delirium died in the hospital. Delirium was associated with decreased survival in the hospital, even after adjusting for coexistent clinical characteristics. In addition, health care providers should be attentive for the hypoactive and mixed subtypes of delirium, as they were also independently associated with poorer in-hospital outcomes in older adults
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