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OBJECTIVES: To evaluate the effect of an extended visitation model compared with a restricted visitation model on the occurrence of delirium among ICU patients. DESIGN: Prospective single-center before and after study. SETTING: Thirty-one-bed medical-surgical ICU. PATIENTS: All patients greater than or equal to 18 years old with expected length of stay greater than or equal to 24 hours consecutively admitted to the ICU from May 2015 to November 2015. INTERVENTIONS: Change of visitation policy from a restricted visitation model (4.5 hr/d) to an extended visitation model (12 hr/d). MEASUREMENTS AND MAIN RESULTS: Two hundred eighty-six patients were enrolled (141 restricted visitation model, 145 extended visitation model). The primary outcome was the cumulative incidence of delirium, assessed bid using the confusion assessment method for the ICU. Predefined secondary outcomes included duration of delirium/coma; any ICU-acquired infection; ICU-acquired bloodstream infection, pneumonia, and urinary tract infection; all-cause ICU mortality; and length of ICU stay. The median duration of visits increased from 133 minutes (interquartile range, 97.7-162.0) in restricted visitation model to 245 minutes (interquartile range, 175.0-272.0) in extended visitation model (p < 0.001). Fourteen patients (9.6%) developed delirium in extended visitation model compared with 29 (20.5%) in restricted visitation model (adjusted relative risk, 0.50; 95% CI, 0.26-0.95). In comparison with restricted visitation model patients, extended visitation model patients had shorter length of delirium/coma (1.5 d [interquartile range, 1.0-3.0] vs 3.0 d [interquartile range, 2.5-5.0]; p = 0.03) and ICU stay (3.0 d [interquartile range, 2.0-4.0] vs 4.0 d [interquartile range, 2.0-6.0]; p = 0.04). The rate of ICU-acquired infections and all-cause ICU mortality did not differ significantly between the two study groups. CONCLUSIONS: In this medical-surgical ICU, an extended visitation model was associated with reduced occurrence of delirium and shorter length of delirium/coma and ICU stay.

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O desenrolar da transição do perfil nutricional ocorrida nos últimos 30 anos resulta em um cenário epidemiológico preocupante, que leva a população brasileira a sérios agravos em saúde. O sobrepeso e a obesidade infantil vêm ganhando espaços para reflexão e discussão importantes, a fim de buscar estratégias para melhor entender essa questão. Este estudo identifica as percepções dos profissionais de saúde acerca do papel da sociedade e da família na atenção ao sobrepeso e obesidade infantil no Sistema Único de Saúde (SUS). Participaram deste estudo 7 profissionais da saúde atuantes nos diferentes níveis de atenção do SUS. Uma entrevista semiestruturada e a análise de conteúdo foram, respectivamente, utilizadas como métodos de coleta e análise de dados. Os resultados sugerem que as modificações nas estruturas familiares, os papéis sociais de gênero e os valores de uma sociedade capitalista não apenas contribuem para que essa característica se instale, mas, também, podem ser considerados fatores determinantes da questão do sobrepeso e da obesidade infantil. Talvez o caminho para alcançar melhorias na atenção à saúde das crianças seja retroceder na satisfação plena dos desejos individuais e resgatar objetivos coletivos, focando no fortalecimento dessas instituições...

The unfolding of the nutrition profile transition that took place within the last 30 years results in an epidemiological scenario that is a matter of concern, leading the Brazilian population to severe health problems. Child overweight and obesity have gained ground for significant discussion and reflection, in order to seek for strategies to better understand this issue. This study identifies the perceptions of health professionals regarding the role of society and family in the provision of care for child overweight and obesity in the Brazilian National Health System. This study relied on the participation of 7 health professionals working at the different levels of care in the National System. A semi-structured interview and content analysis were respectively used as methods for collecting and analyzing data. The results suggest that changes in family structures, social gender roles, and values of a capitalist society not only contribute so that this characteristic is deployed, but they can also be considered as determining factors for the issue of child overweight and obesity. Perhaps, the pathway to achieve improvements in the provision of care for children is moving backwards from the full satisfaction of individual wishes and resuming collective objectives, with a focus on strengthening these institutions...

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O aumento da incidência de doenças crônicas tem despertado a mobilização de gestores e profissionais da saúde que buscam estratégias para melhor atender a essa demanda tão expressiva. A obesidade infantil destaca-se por representar um fator de risco importante para outros agravos em saúde. Este estudo buscou investigar a percepção dos profissionais da saúde com relação à assistência aos usuários com sobrepeso e obesidade infantil no Sistema Único de Saúde - SUS. Participaram desse estudo sete profissionais da saúde atuantes nos diferentes níveis de atenção do SUS. Uma entrevista estruturada e a Análise de Conteúdo foram, respectivamente, utilizadas como método de coleta e análise de dados. Os resultados apontam estrangulamentos no sistema de saúde, com déficits na comunicação e no referenciamento, que afetam diretamente na qualidade assistencial, fazendo com que a tomada de decisões seja baseada em critérios de gravidade, muitas vezes deixando esta população relativamente desassistida.(AU)

The increase in incidence of non-transmittable chronic diseases has generated a mobilization of health professionals and administrators in order to find strategies to better cope with this considerable demand. Childhood obesity stands out for being an important risk factor for other health problems. The present study aims at investigating the perception of health professionals regarding the assistance to patients with childhood overweight and obesity in the Brazilian public health system (SUS). The participants of this study were seven health professionals working at different levels of attention in the health care system. Structured interview and content analysis were used as data gathering method and data analysis, respectively. The results indicate bottleneck problems in the health care system, with deficits in communication and referencing. This directly affects the quality of assistance making professionals take gravity-based decisions.(AU)