Suicidal behavior during the COVID-19 pandemic: clinical aspects and associated factors / Comportamento suicida durante a pandemia da COVID-19: aspectos clínicos e fatores associados / Comportamiento suicida durante la pandemia de COVID-19: aspectos clínicos y factores asociados

Resumo Objetivo Analisar os aspectos clínicos e os fatores associados ao comportamento suicida durante a pandemia da COVID-19. Métodos Estudo transversal e analítico, realizado com registros assistenciais de 130 pacientes que buscaram atendimento em emergência psiquiátrica após ideação, planejamento ou tentativa de suicídio. Utilizou-se um formulário para caracterização sociodemográfica, clínica e terapêutica, assim como para identificação das necessidades de cuidados e dos fatores associados. A análise dos dados foi constituída pelos testes Exato de Fischer, Qui-quadrado de Pearson e pela Regressão de Poisson, considerando nível de significância de 5%. Resultados O comportamento suicida foi expresso pela tentativa de suicídio, ideação e planejamento, predominando no sexo feminino, em adultos jovens, desempregados e de baixa renda familiar, assim como em pacientes com histórico de transtorno mental, de internação psiquiátrica, de tentativas prévias e de abandono terapêutico. As principais alterações psíquicas envolveram ansiedade, depressão, sentimentos de desesperança, alucinações audiovisuais e delírios persecutórios. O consumo de substâncias psicoativas elevou em até 13,8 vezes o risco para tentativa de suicídio e as crises situacionais em 10,6 vezes a ideação. Ainda, a perda de renda e a internação anterior foram associados à manifestação do comportamento. As evidências de cuidados envolveram intervenções medicamentosas, medidas de vigilância e admissão hospitalar. Conclusão Durante a pandemia da COVID-19, o comportamento suicida foi associado à maior predisposição para o consumo de substâncias psicoativas, crises situacionais e perda de renda. Destaca-se a necessidade de políticas públicas voltadas para identificação, prevenção e gerenciamento adequado dos estados de risco.

Resumen Objetivo Analizar los aspectos clínicos y los factores asociados al comportamiento suicida durante la pandemia de COVID-19. Métodos Estudio transversal y analítico, realizado con registros asistenciales de 130 pacientes que buscaron atención en emergencia psiquiátrica después de ideación, planificación o intento de suicidio. Se utilizó un formulario para la caracterización sociodemográfica, clínica y terapéutica, como también para la identificación de las necesidades de cuidados y de los factores asociados. El análisis de los datos estuvo constituido por la prueba Exacta de Fisher, Ji cuadrado de Pearson y por la Regresión de Poisson, considerando un nivel de significancia del 5 %. Resultados El comportamiento suicida se expresó a través del intento de suicidio, ideación y planificación, con predominio del sexo femenino, adultos jóvenes, desempleados y con bajos ingresos familiares, así como pacientes con historial de trastorno mental, de internación psiquiátrica, de intentos previos y de abandono terapéutico. Las principales alteraciones psíquicas incluyeron ansiedad, depresión, sentimientos de desesperanza, alucinaciones audiovisuales y delirios de persecución. El consumo de substancias psicoactivas aumentó 13,8 veces el riesgo de intento de suicidio, y las crisis situacionales aumentaron 10,6 veces la ideación. Además, la pérdida de ingresos e internaciones anteriores se asociaron a la manifestación del comportamiento. Las evidencias de cuidados incluyeron intervenciones medicamentosas, medidas de vigilancia y admisión hospitalaria. Conclusión Durante la pandemia de COVID-19, el comportamiento suicida se asoció a un aumento de la predisposición al consumo de sustancias psicoactivas, crisis situacionales y pérdida de ingresos. Se destaca la necesidad de políticas públicas orientadas hacia la identificación, prevención y una gestión adecuada de los estados de riesgo.

Abstract Objective To analyze the clinical aspects and factors associated with suicidal behavior during the COVID-19 pandemic. Methods Cross-sectional analytical study performed with care records of 130 patients who sought care in the psychiatric emergency department after suicidal ideation, planning or attempt. A form was used for sociodemographic, clinical and therapeutic characterization, and for identification of care needs and associated factors. Data analysis consisted of Fischer's exact test, Pearson's chi-square test and Poisson's regression, considering a significance level of 5%. Results Suicidal behavior was expressed by suicide attempt, ideation and planning. It was predominant in the female sex, young adults, unemployed, with low family income, and in patients with a history of mental disorder, psychiatric hospitalization, previous attempts and of therapeutic abandonment. The main psychic alterations involved anxiety, depression, feelings of hopelessness, audiovisual hallucinations and persecutory delusions. The consumption of psychoactive substances increased by up to 13.8 times the risk for suicide attempt, while situational crises increased suicidal ideation by up to 10.6 times. The loss of income and previous hospitalization were associated with manifestation of the behavior. Evidence of care involved drug interventions, surveillance measures, and hospital admission. Conclusion During the COVID-19 pandemic, suicidal behavior was associated with a greater predisposition to consume psychoactive substances, situational crises and loss of income. The need for public policies aimed at the identification, prevention and adequate management of risk states stands out.

Skin lesions associated with the use of N95 respirators among health professionals in Brazil in 2020. / Lesiones cutáneas asociadas con el uso de respiradores N95 en profesionales de la salud de Brasil durante 2020.

OBJECTIVE: to investigate the prevalence of skin lesions and factors associated with the use of N95 respirators among health professionals in Brazil. METHOD: cross-sectional study conducted with 11,368 health professionals using a respondent-driven sampling method adapted for online environments. Univariate and multivariate analyses were performed to investigate the association between the "skin lesions with the use of N95 respirators" variable and gender, professional category, workplace, training, COVID-19 diagnosis, and availability of sufficient and high-quality Personal Protective Equipment. RESULTS: the prevalence of skin lesions was 61.8%. Women were 1.203 times (95% CI: 1.154-1.255) more likely to develop a lesion than men. The chances of skin lesions in psychologists (PR=0.805; 95% CI: 0.678-0.956) and dentists (PR=0.884; 95% CI: 0.788-0.992), were lower when compared to Nursing professionals. Professionals with a positive COVID-19 diagnosis and working in the Intensive Care Unit have an increased chance of presenting skin lesions (PR=1.074; 95% CI: 1.042-1.107); (PR=1.203; 95% CI: 1.168-1.241), respectively. CONCLUSION: the prevalence of skin lesions caused by the use of N95 respirators was 61.8% and was associated with female gender, professional category, workplace, training, COVID-19 diagnosis, and availability of sufficient and highquality Personal Protective Equipment. (1) The overall prevalence of skin lesions was 61.8%. (2) The most affected professional category was Nursing. (3) Women were more likely to develop skin lesions than men.

Increased use of psychoactive substances among Brazilian health care professionals during the COVID-19 pandemic.

This study aimed to estimate the prevalence of increased psychoactive substance use (PSU) and associated factors among health care professionals. A cross-sectional and analytical study with 12,086 Brazilian health professionals was undertaken. An online questionnaire was used to gather data concerning sociodemographic factors, increased consumption of alcoholic beverages, tobacco, and hypnotics or sedatives during the COVID-19 pandemic. The prevalence of tobacco, alcoholic beverages, and hypnotic or sedative consumption were 17.8 %, 69.0 % and 17.1 %, respectively. Regression analyses indicated that having no religion and social isolation were associated with increased PASU during the pandemic. COVID-19 pandemic stressors may increase PASU, and increased PASU may increase the risk of substance use disorders and substance use-related chronic diseases, such as cancer.

FATORES ASSOCIADOS AO ISOLAMENTO FAMILIAR DE PROFISSIONAIS DE ENFERMAGEM BRASILEIROS DURANTE A PANDEMIA DE COVID-19

Introdução A Pandemia da COVID-19 provocou mudanças na dinâmica da Convivência familiar, principalmente em decorrência do risco de infecção. Objetivo Analisar os fatores associados ao isolamento familiar de profissionais de enfermagem brasileiros durante a pandemia de COVID-19. Método Estudo transversal analítico realizado com profissionais de enfermagem brasileiros entre os meses de outubro a dezembro de 2020. Os dados foram coletados por meio de questionário on-line construído na plataforma Survey Monkey. Foi usada regressão logística para determinar os fatores associados ao isolamento familiar de profissionais de enfermagem brasileiros durante a pandemia de COVID-19. Resultados Participaram do estudo 7595 profissionais de enfermagem, 4813 (63,4%) enfermeiros, 6832 (90%) na faixa etária de 18 a 30 anos, 6482 (85,3%) do sexo feminino. As variáveis: “ter crianças menores de 12 anos residindo no mesmo domicílio” (Odds ajustadas: 1,324;IC 95% 1,199 – 1,462;p = 0,000), “receber da instituição de trabalho EPI em quantidade suficiente para o uso” (Odds ajustadas 1,397;IC 95% 1,222-1,598;p = 0,000), “receber da instituição de trabalho EPI de boa qualidade” (Odds ajustadas: 1,247;IC 95% 1,107-1,405;p = 0,000) e “não terem sido diagnosticados com COVID-19” (Odds ajustadas 1,438;IC 95% 1,299 - 1,591;p = 0,000) foram independentemente associadas ao isolamento familiar. Conclusão Profissionais da equipe de enfermagem adotaram medidas de isolamento do convívio familiar, em especial aqueles com crianças menores de 12 anos residindo no mesmo domicílio, que receberam EPI de em quantidade suficiente para uso e de boa qualidade e os que não foram diagnosticados com COVID-19.

Use of recommended personal protective equipment among Brazilian health professionals during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic is one of the biggest health crises in the world and the use of personal protective equipment (PPE) is significant measures to prevent the transmission of SARS-CoV-2. However, PPE needs to be used properly by healthcare professionals. OBJECTIVE: To analyze the use of PPE among Brazilian health professionals and associated factors during a period of the COVID-19 pandemic. METHODS: An analytical cross-sectional study was carried out from October to December 2020. For data collection, the respondent-driven sampling technique was used, adapted for social media, with a link to an online survey form. RESULTS: The study considered 12,086 Brazilian health professionals. Most (69%) used PPE recommended for the care of patients with suspected or diagnosed COVID-19. Factors associated with the use of PPE were: working in an Intensive Care Unit (ICU) or in a field hospital, receiving training, being provided with sufficient, high-quality PPE by the workplace and being an odontologist compared to nursing professionals. For procedures that generate aerosols in the context of COVID-19, 54.1% of them used the recommended PPE, the associated factors were: being married or in a stable relationship compared to a single/divorced professional, working in an ICU, being offered training, providing sufficient, high-quality PPE, and being an odontologist compared to nursing professionals. CONCLUSIONS: For the care of patients with COVID-19, 69% of health professionals used PPE properly, and several factors interfered with the use of this equipment.

Factors associated with the diagnosis of COVID-19 among Brazilian health professionals COVID-19 and health professionals.

INTRODUCTION: Health professionals are on the front lines against the Coronavirus 2019 (COVID-19) pandemic and are at high risk for acquiring the infection. Failures in precautionary measures, inadequacy/scarcity of Personal Protective Equipment (PPE), and lack of social and family distancing may be associated with increased exposure and contamination by the new coronavirus. This study investigated the prevalence of COVID-19 among Brazilian health professionals and associated factors according to demographic and occupational characteristics. METHODS: A cross-sectional, analytical study was conducted using an online survey with 12,086 health professionals from all regions of Brazil. Data were collected using an adaptation of the respondent-driven sampling method for the virtual environment. The outcome variable was the diagnosis of COVID-19. Bivariate and multiple logistic regression analyzes were used to identify an association between the diagnosis of COVID-19 and demographic and occupational variables. Variables were considered statistically significant based on p<0.05. RESULTS: Most participants were female, from the northeast region, and nursing professionals. A prevalence of 31.95% (95%CI: 31.0%, 32.9%) of COVID-19 was estimated. Following multiple regression analysis, the variables associated with the diagnosis of COVID-19 among health professionals were: male gender, married individuals, professionals who provide care to patients with COVID-19, who work in a field hospital, and those who work in institutions that did not offer enough quality PPE. CONCLUSIONS: The study found a high prevalence of COVID-19 infection, with male professionals being those with greater chances. Inadequate supply or poor quality of PPE offered by health institutions compromises the health of professionals with an increase in positive diagnosis for COVID-19.

Reusing and/or reprocessing the N95 face respirator mask or equivalent: An integrative review Reutilización y/o reprocesamiento de la mascarilla facial tipo N95 o equivalente: revisión integradora Reuso e/ou reprocessamento de máscara respiratória facial tipo N95 ou equivalente: revisão integrativa

Objective: to analyze the scientific evidence available on the different reprocessing methods and the necessary conditions for reuse of the N95 face respirator mask or equivalent. Method: an integrative literature review. The PICO strategy was used to elaborate the question. The search was conducted in four databases: PubMed, SciVerse Scopus, WebofScience and EMBASE, considering any period of time. Results: a total of 32 studies were included from the 561 studies identified, and they were presented in two categories: “Conditions for reuse” and “Reprocessing the masks”. Of the evaluated research studies, seven(21.8%) addressed the reuse of the N95 face respirator mask or equivalent and 25(78.1%) evaluated different reprocessing methods, namely: ultraviolet germicidal irradiation(14);hydrogen peroxide(8);vapor methods(14);using dry heat(5) and chemical methods(sodium hypochlorite[6], ethanol[4] and sodium chloride with sodium bicarbonate and dimethyldioxirane[1]). We emphasize that different methods were used in one same article. Conclusion: no evidence was found to support safe reprocessing of face respirator masks. In addition, reuse is contraindicated due to the risk of self-contamination and inadequate sealing.

Knowledge, Behaviors, and Perceptions of Risk of COVID-19 Among Brazilian Nursing Students: A Cross-sectional Study.

BACKGROUND: The COVID-19 pandemic presented important challenges for the education of nursing students to provide health care with competence, quality, and safety. OBJECTIVES: The purpose was to analyze knowledge, behavior, and perception of risk regarding COVID-19 and associated factors. METHODS: A cross-sectional study was conducted among 2637 Brazilian undergraduate nursing students using a self-reported online survey. RESULTS: Students' knowledge about COVID-19 in general was considered inadequate. Students had limited knowledge about preventive measures in the hospital environment and recommendations for aerosol precautions. More than 90% of graduates adopted recommended prevention measures, and 86.1% perceived themselves to be at a greater risk of acquired SARS-CoV-2 during clinical practice. CONCLUSIONS: The results show the need to rethink undergraduate nursing education regarding the prevention and control of infectious diseases, including the most appropriate strategies for COVID-19 prevention measures.