ObjectiveTo examine the prevalence of the use of electronic medical record systems in Brazilian intensive care units and the perceptions of intensive care physicians regarding the contribution of electronic medical record systems toward improving safety and quality in clinical practice.MethodsUsing an online questionnaire, physicians working in Brazilian intensive care units answered questions about the use of electronic medical record systems in the hospitals in which they worked. They were asked about the types of electronic medical record systems used and their levels of satisfaction with these systems in terms of improving quality and safety.ResultsOf the 4,772 invitations sent, 204 physicians responded to the questionnaire. Most used electronic medical record and prescription systems (92.6%), worked in private hospitals (43.1%), worked in general adult intensive care units (66.7%) and used Private System A (39.2%); most systems had been used for between 2 and 4 years (25.5%). Furthermore, the majority (84.6%) believed that the electronic system provided better quality than a paper system, and 76.7% believed that electronic systems provided greater safety than paper systems.ConclusionElectronic medical record systems seem to be widely used by the Brazilian intensive care physicians who responded to the questionnaire and, according to the data, seem to provide greater quality and safety than do paper records.

RESUMO: Introdução: Os impactos negativos isolados da violência comunitária e da violência familiar na autoavaliação de saúde (AAS) dos indivíduos são conhecidos, mas existe pouca evidência sobre o efeito combinado desses dois tipos de violência interpessoal. Objetivo: Analisar a associação entre a exposição à violência comunitária/por desconhecidos e à violência familiar/por conhecidos e a AAS negativa, distinguindo o tipo de violência sofrido e também considerando sua exposição cumulativa. Métodos: Estudo epidemiológico de corte transversal desenvolvido com os dados da Pesquisa Nacional de Saúde (PNS) 2013. Foram realizados modelos de regressão logística multinominal brutos e ajustados para teste de associação das variáveis. Resultados: Todos os tipos de violência analisados se associaram à AAS negativa. A violência interpessoal comunitária/por desconhecidos isolada esteve associada à AAS como regular (odds ratio - OR=1,38) e ruim (OR = 1,79). A exposição à violência familiar/por conhecidos mostrou-se associada à autoavaliação regular (OR = 1,52) e ruim (OR = 2,70). A exposição concomitante às duas violências mostrou-se associada à avaliação regular (OR = 4,00) e ruim da saúde (OR = 7,81), sendo essa associação de maior magnitude que aquelas para as violências isoladas. Conclusão: O efeito cumulativo da exposição à violência familiar/por conhecido e comunitária/por desconhecido potencializa a avaliação negativa do estado de saúde. Os profissionais de saúde devem estar atentos à polivitimização e ao seu impacto na saúde de vítimas que acessam os serviços de saúde.

The negative impacts of community or domestic violence on individuals self-rated health are known, but there is little evidence of the combined effect of these two types of interpersonal violence.To analyze the association between exposure to community and domestic violence and negative self-rated health status, distinguishing the type of violence suffered and also considering its cumulative exposure.Cross-sectional epidemiological study developed with the data from Brazilian ‘National Health Survey – 2013’. We used crude and adjusted multinominal logistic regression models to test the association of variables. All types of violence analyzed were associated with negative self-rated health. Exposure to community violence only was associated with regular (OR=1.39, 95% CI 1.14 to 1.70) and poor (OR=1.81, 95% CI, 1.30 to 2, 52) self-rated health. Exposure to domestic violence was associated with regular (OR=1.59, 95% CI 1.31 to 1.92) and poor (OR=2.93, 95% CI 2.23 to 3.84) self-rated health. Cumulative exposure to the two types of violence was associated with a regular (OR=3.97, 95% CI 2.32 to 6.78) and poor (OR=7.90, 95% CI 3.04 to 20, 56) self-rated health, being this association of greater magnitude.The effect of domestic violence was stronger than that of community violence, and the combined exposure was greater than isolated type violence. When considering violence a psychosocial stressor it is possible to understand such findings, since the characteristics between the types of violence differ, being possible to consider each type of violence a new stressor. In Brazil, community violence is evaluated as endemic, there is an increase in state violence and a structural collapse of public policies, which reinforces the possibility of polivitimization. Therefore, health professionals should be aware of polivitimization and its impact on the health and, above all, public policies should be strengthen aimed at promoting a safer environment and prevention of exposure to violence.

AgradecimentosAcredito que as coletividades nos fazem mais potentes. A concretude desse trabalho só se fez possível, pois tive uma rede de pessoas com as quais pude compartilhar essa jornada. Deixo um pouco de cada uma delas pelas páginas dessa dissertação, mas, mais do que isso, as carrego comigo para os próximos caminhos. À minha orientadora, Maria Fernanda Tourinho Peres, que me acolheu e me mostrou o caminho por entre minhas ideias, por vezes confusas. Obrigada pela leveza das trocas e pelos encorajamentos necessários. À Ana Flávia Pires Lucas D´Oliveira, Maria Amélia de Sousa Mascena Veras e Claúdia Renata dos Santos Barros, que compuseram a banca de qualificação e contribuiram com apontamentos precisos que transformaram o caminho desta dissertação. À Catarina Machado Azeredo, que colaborou na composição de meu primeiro artigo e trouxe clareza metodológica nos momentos de dúvida. Ao Departamento de Medicina Preventiva da FMUSP, que, desde a residência, me recepcionou e me abraçou nessa selva de pedras. Muito de meu crescimento profissional e pessoal perpassam por esses corredores. À Denise Schout, que me aconselhou e motivou durante o processo, além de fazer com que fosse possível conciliar o trabalho com a academia. Aos colegas do Núcleo de Vigilância Epidemiológica do HCFMUSP, que compartilharam comigo os primeiros passos desse trabalho e me abriram as portas para o mundo profissional. vi À Dulce Consuelo Correa Barone, minha mãe, mulher guerreira e meu primeiro exemplo de feminismo, que por meio de seu cuidado, afeto e incentivo mostrou que eu podia ser tudo o que eu quissesse. Ao Henrique Barone de Andrade e Julia Barone de Andrade, meus irmãos, que reinventam a saudade e me ensinam constantemente o que é amor incondicional. À Sarah Maria Parize Clemente, que ressignificou minha vida e que, com amor e paciência, me apoiou do início ao fim. Sua presença e companherismo fez com que eu tivesse fólego para seguir em frente. E aos amigos, em especial Natalia Junqueira e Thais Basso, que permitiram que eu compartilhasse angústias, compreenderam ausências e tornaram meu dia-adia mais leve. Foi no apartamento 61 que São Paulo virou casa. Anexo B: Submissão de manuscrito para a Revista Brasileira de Epidemiologia

Objective: To understand the use of tools, protocols and comfort measures related to sedation/ analgesia, and to screen the occurrence of delirium in pediatric intensive care units. Methods: A survey with 14 questions was distributed by e-mail to Brazilian critical care pediatricians. Eight questions addressed physician and hospital demographics, and six inquired practices to assess sedation, analgesia, and delirium in pediatric intensive care units. Results: Of 373 questionnaires sent, 61 were answered (16.3%). The majority of physicians were practicing in the Southeast region (57.2%). Of these, 46.5% worked at public hospitals, 28.6% of which under direct state administration. Of respondents, 57.1% used formal protocols for sedation and analgesia, and the Ramsay scale was the most frequently employed (52.5%). Delirium screening scores were not used by 48.2% of physicians. The Cornell Assessment of Pediatric Delirium was the score most often used (23.2%). The majority (85.7%) of physicians did not practice daily sedation interruption, and only 23.2% used non-pharmacological measures for patient comfort frequently, with varied participation of parents in the process. Conclusion: This study highlights the heterogeneity of practices for assessment of sedation/analgesia and lack of detection of delirium among critical care pediatricians in Brazil.