Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...

Objective: To analyze the occurrence of the phenomenon of physical violence within intimate and affective relationships involving women aged 15 to 49 years living in an economically vulnerable area of the Federal District. Method: Cross-sectional study in a random sample and the ecological model. We used chi-square test, significance level (5%), odds ratios (OR) adjusted and confidence interval (95%). Results: 58.6% of women suffered some kind of physical violence throughout life of which only 5.8% sought health care. Drug use (OR 14:27, CI 1.73-117.37) and increased control of behavior by the partner (OR 13.39, CI 4.60-38.99) had the highest odds ratio for physical violence against women. Conclusion: The high prevalence of use of force in intimate relationships suggests the need for an investigation of abuses of power in intimate and affective relationships of women attended by nurse and practitioners of the health team.

Objective: to identify the knowledge and adherence of nurses to the standard precautions in critical care units. Method: descriptive and cross-sectional study, with a quantitative approach, with the population of nurses from a university hospital in the Distrito Federal, Brazil. For data collection, three instruments were used. A semi-structured questionnaire with identification and occupational data of nurses, the questionnaire to evaluate knowledge to standard precautions and the Questionnaire of adherence to standard precautions. Descriptive analysis was used with absolute and relative frequency values. Results: the population was composed of 40 participating nurses, 75% were female, with an average age of 32.5 years, ranging from 24 to 50 years. Professionals with five or more years of training (67.5%) predominated, 25 (62.5%) had only one job and had experience in the area of critical patient care for more than three years. Although with a high percentage of accuracy, with regard to the moments that required hand hygiene, this frequency was 97.5%. Gloves are always used for intramuscular or subcutaneous injection by 67.5% of professionals, but 17.5% still consider it unnecessary to wear disposable caps and surgical shoe covers. The use of sharps, handling and reporting of occupational accidents were not performed as expected. Conclusion: gaps were identified in relation to the knowledge and adherence of nurses in units that provide care to critical patients of a university hospital with regard to standard precautions.

Objective: To verify whether there is a connection between the functional capacity of the elderly and the presence of violent situations in their daily lives. Methods: A population-based cross-sectional study developed with 237 elderly individuals. Standard and validated research instruments were used. Results: Mean age of 70.25 years (standard deviation of 6.94), 69% were female, 76% were independent in basic activities of daily living and 54% had a partial dependence on at least one instrumental activity. The most prevalent violence was psychological and the relation between being dependent on basic activities of daily living and suffering physical violence was statistically significant. Conclusion: When the elderly needs assistance to perform self-care activities, there is a greater chance of exposure to a situation of abuse, such as physical violence. ResumoObjetivo: Verificar se há relação entre a capacidade funcional do idoso e a presença de situações de violência em seu cotidiano. Métodos: Trata-se de estudo transversal de base populacional com 237 idosos. Foram utilizados instrumentos de pesquisa validados e padronizados. Resultados: A média de idade de 70,25 anos (desvio padrão de 6,94), 69% eram do gênero feminino, 76% eram independentes nas Atividades Básicas de Vida Diária e 54% possuíam dependência parcial em pelo menos uma atividade instrumental. A violência mais prevalente foi a psicológica e foi estatisticamente significativa a relação entre ser dependente em Atividades Básicas de Vida Diária e sofrer violência física. Conclusão: Quando o idoso necessita de ajuda para realizar atividades de autocuidado, maior é a chance de exposição à situação de maus-tratos do tipo violência física.

The results showed isolated religiosity is not an effective protective factor, but it strengthens resilience in the face of disease and serves as a support network for the elderly.

Objetivo: Analisar o impacto que a Doença de Alzheimer tem sobre a qualidade de vida do idoso. Métodos: Trata-se de uma revisão integrativa da literatura, na qual o levantamento bibliográfico foi realizado em bases de dados nacionais e internacionais. Foram utilizados os descritores em saúde: Idoso, Qualidade de Vida, Doença de Alzheimer. Fizeram parte da amostra final 9 artigos que se encaixavam nos critérios de inclusão. Resultados: Os artigos foram agrupados em duas classes de assuntos gerais: Aspectos fisiopatológicos e epidemiológicos da Doença de Alzheimer; e Qualidade de vida e sua relação com a família e o cuidador de idosos com Doença de Alzheimer. Os fatores encontrados que culminaram na menor qualidade de vida dos idosos com Doença de Alzheimer estão relacionados a disfunção cognitiva e a perda de memória, que de modo progressivo compromete a autonomia das atividades diárias básicas. Considerações Finais: Frente a prevalência das doenças neurodegenerativas progressivas acometidas na população idosa foi possível observar que ocorre uma redução expressiva da qualidade de vida dos idosos portadores da Doença de Alzheimer, relacionadas sobremaneira, a perda de autonomia e dependência em suas atividades diárias.

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Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P &lt; 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P &lt; 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P &lt; 0.001). Conclusion Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.