Manutenção dos serviços de média e alta complexidade em contexto de alta transição de usuários: um estudo ecológico de séries temporais no Estado do Rio de Janeiro, Brasil / Maintenance of medium- and high-complexity health services in the context of high patient transition: a time series ecological study of the state of Rio de Janeiro, Brazil

Resumo O estudo explora as históricas disparidades regionais na distribuição da rede de média e alta complexidade e os limites impostos para a o remanejamento dos tetos de financiamento entre o município do Rio de Janeiro e municípios limítrofes da Região Metropolitana 1. Foi realizado um estudo ecológico com dados referentes à cidade do Rio de Janeiro, escolhido por ter uma grande rede de assistência e limites com territórios vulneráveis e carentes de serviços de saúde, caracterizando um lócus representativo das situações enfrentadas em todo o país. Foi observado um decréscimo dos valores brutos das cotas programadas em todos os municípios do Rio de Janeiro a partir de 2016. A tendência temporal das cotas programadas se manteve estacionária para todos os municípios da Região Metropolitana 1, mesmo com aumentos significativos nas cotas para municípios limítrofes. A resultante sobrecarga no aporte local de recursos impede o aumento da capacidade para antecipar flutuações de demanda, tanto conhecidas quanto inesperadas, comprometendo a responsividade do sistema de saúde no que respeita seu funcionamento regular, bem como a capacidade de ajuste para lidar com eventos extraordinários, características essenciais da resiliência.

Abstract The study addresses the historical disparities in the distribution of the medium- and high-complexity health network and the limits to budget adjustments between the municipality of Rio de Janeiro and its neighboring municipalities of the Metropolitan region 1. An ecological study was conducted with data related to the municipality of Rio de Janeiro, chosen because it has a large assistance network, while located on the borders of vulnerable and underprivileged areas, characterizing a locus that is representative of the situations faced throughout the country. A decrease in the gross values of the programmed quotas in all municipalities of Rio de Janeiro was observed from 2016 onwards. The temporal trend of the programmed quotas remained stable for all municipalities in the Metropolitan Region 1, even with significant increases in the accomplished quotas for neighboring municipalities. The resulting overload in local expenditure prevents the increase of capacity to anticipate fluctuations in demand, both known and unexpected ones, compromising the responsiveness of the health system regarding its regular operation, as well as the ability to adjust to cope with extraordinary events, essential characteristics of resilience.

Gerenciamento de Leitos: do Planejamento à Implementação em um Serviço Hospitalar / Hospital bed management: from planning to implementation in a hospital service

Objetivo: A falta de leitos hospitalares no Brasil é queixa comum entre usuários do Sistema Único de Saúde. Objetivo: Relatar a experiência da construção de um Serviço de Gerenciamento de leitos e apresentar a atuação do enfermeiro como gestor, em prol da visibilidade e fortalecimento da classe de enfermagem. Método: Relato de experiência da implementação da gestão de leitos de um hospital público estadual de médio porte, em um município do interior do estado de São Paulo. Resultado: A partir da implantação houve mudanças no perfil dos indicadores dos setores assistencias, com a utilização dos leitos aproveitados em sua capacidade máxima. Observou-se a diminuição da fila de espera para internação em consequência do acesso oportuno e ordenado à vaga. Conclusão: Pode-se inferir que o gerenciamento de leitos é efetivo e eficiente na gestão hospitalar com resultados operacionais e financeiros satisfatórios e um fator preponderante para a segurança e satisfação dos clientes.(AU)

Objective: The lack of hospital beds in Brazil is a common complaint among users of the Unified Health System. Objective: To report the experience of the construction of a Bed Management Service and to present the nurse's role as manager, for the visibility and strengthening of the nursing class. Method: Experience report of the implementation of bed management in a public hospital of medium size, in a city in the interior of the state of São Paulo. Result: From the implementation there were changes in the profile of the indicators of the care sectors, with the use of beds used to their maximum capacity. A reduction in the waiting list for hospitalization was observed as a result of the timely and orderly access to vacancies. Conclusion: It can be inferred that the management of beds is effective and efficient in hospital management with satisfactory operational and financial results and a preponderant factor for the customers' safety and satisfaction.(AU)

Objetivo: La falta de camas hospitalarias en Brasil es una queja común entre los usuarios del Sistema Único de Salud. Objetivo: Relatar la experiencia de la construcción de un Servicio de Gestión de camas y presentar la actuación de la enfermera como gestora, para la visibilidad y fortalecimiento de la clase de enfermería. Método: Relato de experiência da implementação da gestão de lechos de um hospital público estadual de médio porte, em um município do interior do estado de São Paulo. Resultado: A partir da implementação houve mudanças no perfil dos indicadores dos setores assistência, com o uso de camas utilizadas ao seu máximo de capacidade. Observou-se a diminuição da fila de espera para internação em consequência do acesso oportuno e ordenado à vaga. Conclusão: É possível inferir que a gestão de camas é eficaz e eficiente na gestão hospitalar com resultados operacionais e financeiros satisfatórios e um factor preponderante para a segurança e satisfação dos clientes.(AU)

Cuidado humanizado: Reto para el profesional de enfermería / Humanized Care: A Challenge for the Nursing Professional

Objetivo: El objetivo general de la investigación fue analizar el cuidado humanizado: Reto para el profesional de enfermería. Método: Se desarrolló desde un enfoque cuantitativo con una metodología descriptiva con diseño no experimental, la cual se apoya en el análisis documental­bibliográfico. Se organizó un proceso investigativo en donde la población de estudio, se basó primordialmente en documentos escritos como tesis, revistas arbitradas y artículos científicos. Resultados: Se planteó la idea de desconstruir el significado de humanizar y reconstruir el concepto de cuidad desde la humanización. En conclusión: Sin duda alguna el profesional de enfermería se enfrenta a grandes retos en la gestión de cuidado humanizado, en un mundo globalizado y en donde se están desarrollando tecnologías que buscan desplazar la acción del ser humano, sin embargo, la calidez y acompañamiento que ofrece este profesional a los pacientes y familiares no podrán ser sustituidos.

Objective: The general objective of the research was to analyze humanized care: Challenge for the nursing professional. Method: It was developed from a quantitative approach with a descriptive methodology with non-experimental design, which is supported by documentary-bibliographic analysis. A research process was organized in which the study population was based primarily on written documents such as theses, peer-reviewed journals and scientific articles. Results: The idea of deconstructing the meaning of humanizing and reconstructing the concept of care from humanization was proposed. In conclusion: Undoubtedly, the nursing professional faces great challenges in the management of humanized care, in a globalized world where technologies are being developed that seek to displace the action of the human being, however, the warmth and accompaniment offered by this professional to patients and family members cannot be replaced.

Safety and prevention of sports injuries in popular ice and snow sports / Segurança e prevenção de lesões esportivas em esportes populares no gelo e neve / Seguridad y prevención de lesiones deportivas en los deportes populares de hielo y nieve

ABSTRACT Introduction: Following the development of ice and snow sports tourism projects, the hidden dangers of early extensive construction have gradually emerged. It mainly manifests itself in the sports safety of ice and snow sports tourism projects. Objective: Explore the management strategy of sports safety under the snow and ice sports tourism landscape. Methods: Literature research, interviews, and questionnaires were used to analyze the development in the study area of ice and snow tourism, the tourists themselves, and regional site construction. Finally, the paper analyzes strategies to improve sports safety management in related areas from the landscape manager's point of view. Results: The development of snow and ice sports tourism projects in the study area is satisfactory; however, due to the epidemic's impact, the current situation is relatively low, showing a trend of slow improvement. In terms of sports injury risk, after optimal training and safety management, the proportion of climatic characteristics of the site was 24.81%; the proportion of the population on the ski slopes was 40.92%; the proportion of equipment cleaning and maintenance was 59.23%; the degree of congestion on the ski slopes was 41.30%; the proportion of public safety was 34.42%; the proportion of basic emergency medical treatment was 32.30%; epidemics and other infectious diseases accounted for 83.13% of the total. Follow-up is done before the start, in the process, and after the occurrence of multiple managements. Conclusion: The safety management strategy of snow and ice sports tourism combines the factors of tourists and managers, and has great practical significance, so it is worthy of promotion. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Com o desenvolvimento de projetos de turismo esportivo no gelo e na neve, os perigos ocultos da construção extensiva precoce têm surgido gradualmente. Ele se manifesta principalmente na segurança esportiva de projetos de turismo de esportes de gelo e neve. Objetivo: Explorar a estratégia de gestão da segurança esportiva sob o panorama do turismo esportivo de neve e gelo. Métodos: Pesquisa bibliográfica, entrevistas e questionários foram usados para analisar o desenvolvimento na área de estudo do turismo de gelo e neve, e dos próprios turistas bem como a construção de locais regionais. Finalmente, do ponto de vista do gerente de paisagens, o trabalho analisa as estratégias para melhorar a gestão da segurança esportiva em áreas relacionadas. Resultados: O desenvolvimento de projetos de turismo esportivo de neve e gelo na área de estudo é satisfatório, porém, devido ao impacto da epidemia, a situação atual é relativamente reduzida, mostrando uma tendência de lenta melhoria. Em termos de risco de lesões esportivas, após treinamento otimizado e gerenciamento da segurança, a proporção de características climáticas do local foi de 24,81%; a proporção de população nas pistas de esqui foi de 40,92%; a proporção de limpeza e manutenção dos equipamentos foi de 59,23%; o grau de congestionamento das pistas de esqui foi de 41,30%; a proporção de segurança pública foi de 34,42%; a proporção de tratamento médico básico de emergência foi de 32,30%; epidemias e outras doenças infecciosas representaram 83,13% do total. O acompanhamento é feito antes do início, no processo, e após a ocorrência de múltiplas gestões. Conclusão: A estratégia de gerenciamento de segurança do turismo esportivo de neve e gelo combina os fatores de turistas e gerentes, e tem grande significado prático, por isso é digna de promoção. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Con el desarrollo de los proyectos turísticos de deportes de hielo y nieve, han ido apareciendo gradualmente los peligros ocultos de la construcción extensiva temprana. Se manifiesta principalmente en la seguridad deportiva de los proyectos turísticos de deportes de hielo y nieve. Objetivo: Explorar la estrategia de gestión de la seguridad deportiva en el marco del paisaje turístico de los deportes de nieve y hielo. Métodos: Se utilizó la investigación bibliográfica, entrevistas y cuestionarios para analizar el desarrollo en la zona de estudio del turismo de hielo y nieve, y a los propios turistas, así como la construcción de emplazamientos regionales. Por último, desde el punto de vista del gestor del paisaje, se analizan estrategias para mejorar la gestión de la seguridad deportiva en ámbitos afines. Resultados: El desarrollo de proyectos de turismo deportivo de nieve y hielo en la zona de estudio es satisfactorio, sin embargo, debido al impacto de la epidemia, la situación actual es relativamente baja, mostrando una tendencia de lenta mejora. En cuanto al riesgo de lesiones deportivas, tras optimizar la formación y la gestión de la seguridad, la proporción de características climáticas del lugar fue del 24,81%; la proporción de población en las pistas de esquí fue del 40,92%; la proporción de limpieza y mantenimiento del equipo fue del 59,23%; el grado de congestión de las pistas de esquí fue del 41,30%; la proporción de seguridad pública fue del 34,42%; la proporción de tratamiento médico básico de urgencia fue del 32,30%; las epidemias y otras enfermedades infecciosas representaron el 83,13% del total. El seguimiento se realiza antes del inicio, en el proceso y después de que se produzcan múltiples gestiones. Conclusión: La estrategia de gestión de la seguridad del turismo deportivo de nieve y hielo combina los factores de los turistas y los gestores, y tiene una gran importancia práctica, por lo que merece ser promovida. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Application effect of information platform based on Internet of Things in screening and management of chronic obstructive pulmonary disease / 中华健康管理学杂志

Objective:To analyze the application effect of the information platform based on the Internet of Things (IoT) in the screening and management of patients with chronic obstructive pulmonary disease (COPD).Methods:In this cross-sectional study, 151 062 residents who participated in the screening in the districts covered by 33 general hospitals and 289 primary medical institutions within the framework of Henan Provincial Center for COPD Prevention and Treatment from November 2021 to October 2022 were included as the subjects. Spirometer based on the IoT was used to conduct pulmonary function tests for subjects who scored 16 points or more with COPD Screening Questionnaire (COPD-SQ), and the subjects were evaluated and managed through the structured electronic data in the information platform. The distribution characteristics and follow-up of the subjects and COPD patients were described and the application effect of this strategy in patients screening and management was analyzed.Results:A total of 151 062 residents with complete basic information in the information platform completed the questionnaire. High-risk population of COPD accounted for 26.5% (40 042/151 062) of the population who received the questionnaire screening, and more than 50% had respiratory symptoms, such as chronic cough (59.4%), or shortness of breath (77.6%). The proportion of high-risk population increased with age, especially after 50 years old. Compared with non-smokers, the proportion of high-risk group was significantly higher (77.1% vs 16.4%) in the group with smoking index over 600. Biofuel exposure (61.3% vs 22.1%) and family history of respiratory diseases (64.2% vs 22.6%) were associated with an increased proportion of high-risk groups, with statistically significant differences ( P<0.001). 5 268 patients were diagnosed with COPD by pulmonary function tests, and the prevalence of COPD in high-risk groups was 27.8% (5 268/18 965), the prevalence rate of male was 34.0% (3 942/11 588), which was higher than that of female 18.0% (1 326/7 377). 2 950 patients (56.0%) completed at least one follow-up of symptom questionnaire and 510 patients (9.7%) completed more than one follow-up of pulmonary function test. Conclusion:The screening and management strategy of COPD based on the IoT and information technology can improve the efficiency of COPD screening, and improve the status quo of under-diagnosis and discontinuous follow-up of COPD.

Prevention and management of pancreatic fistula after pancreatoduodenectomy with precise and comprehensive opinion / 中华消化外科杂志

Pancreaticoduodenectomy (PD) is a major operation of abdominal surgery, with high risk, complex operation, more complications and high mortality. Pancreatic fistula is the main cause of death after PD. Due to its complexity and obstinacy, pancreatic fistula has become the top challenge of pancreatic surgery. The authors review the relevant literature and summarize the prevention and management of pancreatic fistula after PD, such as the optimization strategies for pancreatic anastomosis, the use of external stents, prophylactic drains in surgical field, the applica-tion of somatostatin and its analogues, and whole-course nutrition management, based on the precise and comprehensive opinion, in order to provide reference for improving the prevention and treatment of pancreatic fistula after PD.

Abordagem de narrativas como método de pesquisa em saúde pública: aproximações conceituais e contribuições da psicanálise / Narrative research in public health: conceptual approximations and contributions from psychoanalysis / Enfoque en narrativas como método de investigación en salud pública: aproximaciones conceptuales y aportaciones del psicoanálisis

Este artigo refere-se à parte de uma pesquisa de doutorado, realizada em hospital de alta complexidade do Sistema Único de Saúde, cujos participantes são os profissionais de saúde. O objetivo deste artigo é analisar o potencial da abordagem das narrativas como método de pesquisa e intervenção nos serviços de saúde, traçando aproximações com a teoria psicanalítica. Sua relevância no campo da Saúde Pública está calcada no reconhecimento do papel do sujeito como agente de mudanças. O texto divide-se em duas partes: na primeira, explora as especificidades do trabalho na área da saúde, o paradigma da saúde pública no que concerne à gestão e possíveis contribuições da clínica ampliada para esse modelo. Na segunda parte, analisa o uso das narrativas como método de pesquisa nesse campo e as aproximações conceituais entre a narrativa em Walter Benjamin e a psicanálise em Freud. Busca na literatura referências sobre experiências análogas que fundamentem a proposta ora realizada e conclui pela importância de, no momento atual, apostar na força germinativa das narrativas como fonte criativa de novas formas de cuidar.(AU)

This article derives from a PhD research conducted with health professionals at a high-complexity public hospital from the Brazilian Unified Health System (SUS). It analyzes the potential of the narrative as a research and intervention method in health services, outlining approximations with psychoanalysis. In the field of Public Health, the narrative approach acknowledges the individual as an agent of change. The text is divided into two parts. The first presents an overview of the peculiarities involved in healthcare, the Public Health paradigm regarding service management and possible contributions from the expanded clinic to this model. The second analyzes the use of narratives as a research method in this field and the conceptual approximations between Benjamin's narrative and Freud's psychoanalysis. It searches the literature for references on similar experiences to support the present proposal and concludes by highlighting the importance of betting on the creative power of narratives as a source for new ways to care.(AU)

Este artículo es parte de una investigación doctoral, realizada con los profesionales de la salud de un hospital de alta complejidad del Sistema Único de Salud de Brasil. Su propósito es analizar el potencial del enfoque en narrativas como método de investigación e intervención en los servicios de salud, esbozando aproximaciones entre las narrativas y la teoría del psicoanálisis. Su relevancia en el campo de la salud pública se basa en el reconocimiento del rol del sujeto como agente de cambio. El texto se divide en dos partes: La primera investiga las especificidades del trabajo en el área de la salud, el paradigma de la salud pública en la gestión de los servicios y las posibles contribuciones de la clínica ampliada a este modelo. En la segunda parte, analiza el uso de narrativas como método de investigación en este campo y las aproximaciones conceptuales entre la narrativa de Walter Benjamin y el psicoanálisis de Freud. Este estudio busca en la literatura referencias sobre experiencias similares que apoyen la propuesta ahora realizada y concluye con la importancia de, en el momento actual, apostar por el poder de las narrativas como fuente creadora de nuevas formas de cuidar.(AU)

Regionalização da saúde no Rio Grande do Sul: olhar dos gestores estaduais / Health regionalization in Rio Grande do Sul, Brazil: view of state managers

Resumo Este artigo teve como objetivo analisar, através da perspectiva dos gestores estaduais, como ocorreu a implementação do processo da regionalização da saúde no Rio Grande do Sul, a partir dos anos 2000. Trata-se de um estudo qualitativo descritivo, desenvolvido na Secretaria da Saúde do Estado do Rio Grande do Sul. As informações foram obtidas através de dez entrevistas semiestruturadas. Para a interpretação dos dados levantados, utilizou-se análise de conteúdo, modalidade temática. Como resultados, destacaram-se a melhoria na qualidade da atenção à saúde, o progresso na organização do sistema de saúde do estado, a mudança na função da gestão estadual, o desenvolvimento da tecnologia e o reconhecimento das instâncias de pactuação para a tomada de decisão. Identificou-se que a governança regional foi dificultada pela fragmentação do sistema e a histórica insuficiência de planejamento. Concluiu-se que se faz necessário implementar uma cultura de gestão estratégica, amparada pela alocação adequada de recursos e qualificação da governança nas regiões de saúde.

Abstract This article aims to analyze, from the perspective of state administrators, the implementation of the health regionalization process in Rio Grande do Sul, beginning in the 2000s. This is a qualitative-descriptive study, conducted in the State Health Department. We obtained information from ten semi-structured interviews with state administrators from the central level. We interpreted the data using content analysis, thematic method. As results, we highlight the improvement in healthcare quality, the progress in the organization of the state's health system, the change in the role of the state administration, the development of the technology and the acknowledgment of pact-making spaces for decision-making. We note that the system's fragmentation and the historical planning insufficiency hamper regional governance. In conclusion, implementing a culture of strategic management is necessary, with the backing of adequate resource allocation and enhancement of governance in the health regions.

Perfil clínico dos pacientes atendidos em uma unidade especializada em queimados: estudo transversal / Clinical profile of patients treated at a burns unit: a cross-sectional study / Perfil clínico de pacientes atendidos en una unidad especializada en quemados: estudio transversal

Objetivo: descrever o perfil clínico do paciente admitido terapêutica em um Centro de Tratamento de Queimados. Método: estudo transversal e retrospectivo realizado em um hospital militar do Rio de Janeiro da cidade do Rio de Janeiro. Amostra composta por 43 prontuários. Análise de variáveis de admissão e desfecho óbito. Protocolo de pesquisa aprovados pelos Comitês de Ética em Pesquisa das instituições envolvidas. Resultados: homens de até 39 anos foi o público mais afetado com lesões prevalentes de segundo e terceiro graus, com maior acometimento na região torácica, por agente causador de origem física, apresentando como principal complicação a sepse e desfecho óbito relacionada com a maior taxa de superfície corpórea queimada. Conclusão: os achados demonstram semelhança aos dados do Ministério de Saúde do Brasil, e representam informações adicionais como agente, extensão e grau de queimadura, que podem contribuir na prática assistencial e no gerenciamento de recursos humanos.

Objective: to describe the clinical profile of patients admitted to therapy at a Burn Treatment Center. Method: this retrospective, cross-sectional study was conducted at a military hospital in Rio de Janeiro city on a sample of 43 medical records to examine admission variables and death as outcome. The research protocol was approved by the research ethics committees of the institutions involved. Results: the group most affected was males up to 39 years old, with prevalent second- and third-degree injuries, mostly involving the thoracic region, caused by agents of physical origin, with sepsis as the main complication, and death as outcome related to greater burn surface area. Conclusion: the findings proved similar to data from Brazil's Ministry of Health, and constitute additional information, such as agent, extent, and degree of burns, which can contribute to care practice and human resource management.

Objetivo: describir el perfil clínico del paciente ingresado a terapia en un Centro de Tratamiento de Quemados. Método: estudio transversal y retrospectivo realizado en un hospital militar de Río de Janeiro, en la ciudad de Río de Janeiro. Muestra compuesta por 43 historias clínicas. Análisis de las variables de ingreso y desenlace de muerte. Protocolo de investigación aprobado por los Comités de Ética en Investigación de las instituciones involucradas. Resultados: hombres de hasta 39 años fue el público más afectado, con prevalencia de lesiones de segundo y tercero grados, con mayor número de lesiones en la región torácica, por agente causal de origen físico, siendo la principal complicación la sepsis y la muerte relacionada con la tasa más alta superficie corporal quemada. Conclusión: los hallazgos demuestran similitud con los datos del Ministerio de Salud de Brasil y representan información adicional, como el agente, la extensión y el grado de la quemadura, que pueden contribuir para la práctica asistencial y la gestión de recursos humanos.

Brasil entre o passado e o futuro: o que temos e o que queremos ­ método dialógico / Brazil between the past and the future: what we have and what we want ­ dialogic method / Brasil entre el pasado y el futuro: lo que tenemos y lo que queremos ­método dialógico

Objetivo: Este artigo objetiva discutir o que sentimos falta com relação às mudanças no sistema educacional brasileiro (via método dialógico), levando em conta os dados existentes nos últimos governos (Bolsonaro, Dilma e Lula), especificamente sobre a Educação Básica e Superior. Metodologia: Metodologicamente, é um ensaio teórico (pesquisa bibliográfica e documental) com abordagem de análise crítica. Resultados:A justificativa para esse estudo são as políticas promovidas pelo governo atual que provocam, em nível nacional e internacional, um amplo debate na mídia e nas comunidades científicas,além de uma possibilidade de refletir sobre o contexto da pandemia e as inseguranças geradas pela ausência de ações governamentais. Conclusões: O levantamento identifica que nãohá um sistema nacional que coordene as responsabilidades pela educação brasileira. Além disso, há extrema confusão no atual governo, falta investimento público, disputa de um projeto político-ideológico, entre outros fatores que impossibilitam a gestão daeducação no país de forma democrática (AU).

Objective:This article aims to discuss what we miss in relation to changes in the Brazilian educational system (via the dialogic method), consideringexisting data in recent governments (Bolsonaro, Dilma and Lula), specifically on Basic and Higher Education. Methodology:Methodologically, it is a theoretical essay (bibliographic and documentary research) with a critical analysis approach. Results:The justification for this study is the policies promoted by the current government that provoke, at a national and international level, a wide debate in the media and in the scientific communities,in addition to a possibility to reflect on the context of the pandemic and the insecurities generated by the absence of government actions. Conclusion: The survey identifiesthat there is no national system that coordinates responsibilities for Brazilian education. In addition, there is extreme confusion in the current government, lack of public investment, dispute over a political-ideological project, among other factors that make it impossible to manage education in the country in a democratic way (AU).

Objetivo: Este artículo tiene como objetivo discutir lo que extrañamos con respecto a los cambios en el sistema educativo brasileño (a través del método dialógico), teniendo en cuenta los datos existentes en los últimos gobiernos (Bolsonaro, Dilma y Lula), específicamente en Educación Básica y superior. Metodología:Metodológicamente, es un ensayo teórico (investigación bibliográfica y documental) con un enfoque de análisis crítico. Resultados:La justificación de este estudio son las políticas impulsadas por el actual gobierno que provocan, a nivel nacional e internacional, un amplio debate en los medios de comunicación y en las comunidades científicas. Además de una posibilidad de reflexionar sobre el contexto de la pandemia y las inseguridades generadas por la ausencia de acciones gubernamentales. Conclusión: La encuesta identifica que no existe un sistema nacional que coordine las responsabilidades de la educación brasileña. Además, existe extrema confusión en el actual gobierno, falta de inversión pública, disputapor un proyecto político-ideológico, entre otros factores que imposibilitan gestionar la educación en el país de manera democrática (AU).

Panorama dos Planos Municipais de Saneamento Básico e Planos Diretores de Drenagem Urbana em municípios de pequeno porte de Minas Gerais / Panorama of elaboration of Municipal Basic Sanitation Plans and Urban Drainage Master Plans of Minas Gerais' small municipalities

RESUMO No Brasil, os impactos socioambientais da crise hídrica são intensificados uma vez que a drenagem e o manejo das águas pluviais são marcados por ausências e limitações de políticas públicas. O saneamento básico é de titularidade municipal e, para o exercício desse direito e dever, é fundamental que os municípios estruturem a política municipal, sendo o planejamento seu principal instrumento. Nesse contexto, buscou-se neste artigo identificar e analisar o panorama da elaboração de Planos Municipais de Saneamento Básico e de Planos Diretores de Drenagem Urbana nos municípios do estado de Minas Gerais com população inferior a 50 mil habitantes e comparar esses resultados com as informações divulgadas pelo Sistema Nacional de Informações sobre Saneamento no ano de 2019. Realizaram-se buscas na internet e contatos com os municípios, por telefone, e foi possível identificar que, entre os 752 municípios de Minas Gerais de pequeno porte, 499 possuem Planos Municipais de Saneamento Básico, enquanto nenhum possui Planos Diretores de Drenagem Urbana. Ao comparar esses resultados com as informações divulgadas pelo Sistema Nacional de Informações sobre Saneamento, observou-se que 79 municípios prestaram informações inconsistentes relacionadas à existência de Planos Municipais de Saneamento Básico e 48 afirmaram possuir Planos Diretores de Drenagem Urbana. Conclui-se que muitos municípios mineiros ainda não possuem Planos Municipais de Saneamento Básico, e que o processo de coleta dos dados do Sistema Nacional de Informações sobre Saneamento precisa ser aprimorado para que haja melhor qualidade dos dados divulgados. A ausência de instrumentos de planejamento que auxiliem a efetivação da política municipal é um importante problema a ser superado para o enfrentamento dos complexos desafios que envolvem a drenagem e o manejo das águas pluviais municipal.

ABSTRACT In Brazil, the impacts of the water crisis are intensified since the Drainage and Rainwater Management are marked by absences and limitations of public policies. Basic sanitation is a municipal property and for the exercise of this right and duty, it is essential that the municipalities structure the municipal policy, with planning as their main instrument. In this context, this article aimed to identify and analyze the panorama of the elaboration of Municipal Basic Sanitation Plans and Master Plans for Urban Drainage in the municipalities of the state of Minas Gerais with a population of less than 50,000 inhabitants and to compare these results with the information released by the National Sanitation Information System, in 2019. Internet searches and contacts with the municipalities were carried out by telephone, so that it was possible to identify that among the 752 small-sized ones in Minas Gerais, 499 of them have Municipal Basic Sanitation Plans, while none of them have Master Plans for Urban Drainage. When comparing these results with the information released by the National Sanitation Information System, it was observed that 79 municipalities provided inconsistent information related to the existence of Municipal Basic Sanitation Plans and 48 municipalities claimed to have Master Plans for Urban Drainage. It is concluded that many municipalities in Minas Gerais do not yet have Municipal Basic Sanitation Plans and that the process of collecting National Sanitation Information System data needs to be improved so that there is a better quality of the data released. The absence of planning instruments to assist the implementation of municipal policy is an important problem to be overcome in order to face the complex challenges involving municipal Stormwater Drainage and Management.

Convergências entre planejamento de atenção primária à saúde e os Objetivos de Desenvolvimento Sustentável: uma avaliação de planos municipais de saúde do Brasil e Chile / Convergences between primary health care planning and the Sustainable Development Goals: an evaluation of municipal health plans in Brazil and Chile

Resumo O objetivo deste estudo é explorar a importância da Atenção Primária à Saúde (APS) para a consecução dos Objetivos de Desenvolvimento Sustentável (ODS), avaliando as convergências entre duas agendas municipais de APS e a Agenda global 2030. Para tanto, utilizou-se a técnica de análise de conteúdo nas ações de APS previstas nos planos municipais de saúde dos municípios de Santiago do Chile e São Paulo, Brasil. A análise de conteúdo de ambos os planos mostrou que as ações previstas pela APS de Santiago contribuíam com 14 ODS, enquanto em São Paulo foram identificadas ações que contribuíam com a totalidade da Agenda 2030, ainda quando em ambos os planos houve algumas faltas de referência aos ODS. Conclui-se que as ações previstas pela APS em um nível municipal demostram ser essenciais à consecução dos ODS. Porém, esta relação não é informada adequadamente, o que pode comprometer a injeção de maiores incentivos neste setor. Logo, se requer maior alinhamento dos planos e políticas locais, nacionais e globais de ação, uma formação integrada e continuada nas comunidades e para as equipes de saúde, e maior uso e difusão de tecnologias já disponibilizadas em abordagem territorial e intersetorial dos planos municipais de saúde.

Abstract This study addresses the importance of Primary Health Care (PHC) to achieve the Sustainable Development Goals (SDGs), assessing convergences between two municipal PHC agendas and the 2030 Global Agenda. For this purpose, the PHC actions included in the municipal health plans of Santiago, Chile, and São Paulo, Brazil, were evaluated by content analysis. Results showed that the PHC actions planned in Santiago contributed to 14 SDGs while in São Paulo, the actions contributed to the entire 2030 Agenda, although both plans lacked references to the SDGs. Thus, the PHC actions provided in municipal agendas are essential to achieve the SDGs. However, this relationship is not adequately reported, which can compromise the investment of greater resources in this sector. Therefore, a greater alignment between local, national, and global action plans and policies is required, as well as integrated and continuous training for communities and health teams and a greater use and diffusion of technologies already available in regional and intersectoral approaches to municipal health plans.

Construction and application effect of high quality scientific research management information platform based on combination of education and management in hospitals / 中华医学科研管理杂志

Objective:To explore a more efficient and standardized scientific research management mode, in order to enhance the best practice of conducting research, improve the agency and satisfaction of scientific research investigators, to improve the efficiency of scientific research management.Methods:According to the problems and deficiencies identified during the process of scientific research management, combined with the latest scientific research management policies and guidelines, the research and development concept of hospital scientific research management platform was formed, and tailored scientific research management information platform was developed by making good use of information technology.Results:After the application of the tailored scientific research management information platform, the efficiency of reimbursement and information access of scientific research personnel was significantly improved, with a significant difference.Conclusions:The construction of scientific research information platform based on the combination of education and management helps to achieve the goal of efficient, standardized and refined scientific research management.

Present situation and future development for undergraduate major construction of health service and management / 中华健康管理学杂志

Objective:To evaluate the present situation and future development for undergraduate major construction of health service and management.Methods:One hundred and twenty-three domestic universities with undergraduate health service and management major were selected as the research subjects. This paper analyzed the present situation of major distribution and aim setting, faculty, curriculum system, construction of teaching material, enrollment number, graduate destination, among other areas, using network data collection, questionnaire survey, and descriptive analysis methods. It also analyzed the development trend of this major with regards to the national policy guidance and discipline development dynamics.Results:The results showed that the number of domestic universities with undergraduate major for health service and management had increased from 5 in 2016 to 123 at present, with an average annual growth rate of 472.0%. The curriculum system of various universities covered 13 core courses, such as management and introduction to basic medicine. The total credits required for graduation ranged from 149 to 224, and the proportion of practical teaching in the teaching plan ranged from 12.1% to 45.1%. The credit requirements varied greatly; moreover, the proportion of practical teaching in most universities was not high and the content was narrow. Among the 21 universities participating in the questionnaire survey, 47.6% of them focused their education on cultivating versatile talents, 52.4% had 4-6 full-time teachers, 47.2% of all full-time teachers were 31-40 years old, 42.9% universities had teachers with senior professional titles accounting for 30%-40% of the faculty, and 28.6% universities had teachers with doctoral degrees comprising ≥50% of the faculty. The aim setting of most universities was more or less vague, the number of full-time teachers couldn′t meet the needs of major development, and the connotation construction lagged relatively.Conclusions:The inconsistency of the rapid increasing number of universities with the connotation construction of major has become a key barrier to the connotative development of undergraduate major of health service and management. In the future, building the quality of teaching according to national standards; advancing the integration of government, industry, university, research, and implementation; improving faculty quality; and optimizing the curriculum system will be part of the development trend.

Infrastructure of radiation oncology in China: a national survey for development and allocation of radiotherapy equipment during the 14 th Five-Year Plan period / 中华放射肿瘤学杂志

Objective:To investigate the current status of radiotherapy personnel and equipment in China, and to provide data basis for scientific allocation and effective use of radiotherapy equipment during the 14 th Five-year Plan period. Methods:From October to December 2020, a group of experts from China Association of Medical Equipment carried out an online questionnaire investigating the basic situation of radiotherapy in China, and the contents of the survey include radiotherapy centers, professional personnel, equipment, technology, equipment utilization rate, forecast of personnel and equipment in the next five years, etc. The data were reviewed by provincial medical societies/associations.Results:There were 1538 radiotherapy centers and 32978 radiotherapy professionals in Mainland China, including 18966 radiotherapy physicians, 4475 physicists and 9537 technicians. There were 2139 linear accelerators, 57 cobalt 60 accelerators, 457 afterloaders, 6 proton/heavy ion machines, 1034 conventional 2D simulators, 1208 CT simulators, and 89 MR simulators. 1459 centers can provide 3D conformal radiotherapy, 1256 centers can deliver intensity-modulated radiotherapy, 514 centers can offer volumetric modulated arc therapy, 422 centers can provide brachytherapy. According to the estimated data reported by the participating centers, in the next five years, the demand of professionals and machines will be increased by 4868 radiotherapy physicians, 2078 physicists and 3796 technicians, and 994 linacs, 896 CT simulators, 313 MR simulators and 54 proton heavy ions.Conclusions:The radiotherapy industry in China grows fast. During the 14 th Five-Year Plan period, the radiotherapy industry still has strong market demand as well as increase demand of personnel and equipment. Strengthening the market competitiveness of domestic radiotherapy enterprises, improving the equipment utilization rate in primary hospitals, providing comprehensive and systematic training and promoting standardized clinical application can resolve the issues of the lack and unbalanced distribution of radiotherapy resources, and maintain the fast and sustainable development of radiotherapy in China.

Application value of evaluation and management of patients with acute chest pain in China score in risk stratification for patients with acute chest pain / 中国医师进修杂志

Objective:To explore the application value of evaluation and management of patients with acute chest pain in China (EMPACT) score in risk stratification for patients with acute chest pain.Methods:According to the methods of prospective cohort study, 548 patients with chest pain in the Affiliated Hospital of Jining Medical University from February to April 2021 were selected. The risk stratification was performed according to EMPACT score. The primary endpoint was the major adverse events (MAE) within 30 d, including death from all causes, acute myocardial infarction (AMI), emergency revascularization, cardiac arrest, cardiogenic shock and other life-threatening situations that need urgent attention. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of EMPACT score for MAE.Results:Among the 548 patients, 75 cases had MAE within 30 d (MAE group), and the incidence of MAE was 13.7%; 473 cases did not occur MAE (non-MAE group). The EMPACT score in MAE group was significantly higher than that in non-MAE group: 8 (12, 18) scores vs. 5 (2, 8) scores, and there was statistical difference ( Z = 8.94, P<0.01). Spearman correlation analysis result showed that EMPACT score was positively correlated with MAE ( r = 0.38, P<0.01). ROC curve analysis result showed that the area under the curve of EMPACT score in prediction within 30 d MAE was 0.820 (95% CI 0.770 to 0.871), the cut-off value was 9.5 scores (since all the scoring systems were integers, the cut-off value was 10 scores), the sensitivity was 88.6%, and the specificity was 60.0%. Conclusions:The EMPACT score has a good risk stratification capability to achieve safe and effective triage of acute chest pain.

Satisfaction survey of medical staff to the scientific research communication management mechanism of a tertiary hospital / 中华医学科研管理杂志

Objective:In order to improve the hospital scientific research communication management level, enhance the efficiency of hospital management, a survey on the satisfaction of the scientific research communication management mechanism among the medical employees in a third-grade hospital was conducted to explore its influencing factors, as well as to provide reference for improving the scientific research communication management system.Methods:A third grade hospital in Tianjin was selected as the questionnaire survey unit, 233 people were selected by stratified sampling method to conduct the questionnaire survey on their satisfaction with the communication management mechanism. SPSS 23.0 was used for single factor chi-square test and multivariate Logistic regression analysis.Results:The overall satisfaction of 233 employees surveyed was 88.4%. Single factor chi-square test results showed that different age, ″research managers actively communicate″, ″frequency″, "understanding the role of communication mechanisms″, ″understanding of the mechanisms of communication″, ″communication with senior management leadership″, ″communication mechanism in the team″, ″communication mechanism with other hospital team and departments″, ″familiar of the team plans and work progress″, ″form of obtaining scientific research information″, ″demands for obtaining scientific research information″, ″attitude towards scientific research information″ and other items had statistically significant association with satisfaction ( P<0.05). Multivariate Logistic regression analysis results showed that ″Science management personnel actively communicate″ (OR=0.129, 95%CI: 0.020-0.851), ″medium frequency of communication frequency″ (OR=0.254, 95%CI: 0.068-0.951), ″communication mechanism can ensure that most of the information is received″ (OR=0.073, 95%CI: 0.010-0.563), ″Good communication with superior management leadership″ (OR=0.044, 95%CI: 0.005-0.361), ″Good communication mechanism in team″ (OR=0.039, 95%CI: 0.010-0.563) were protective factors of medical employees′ satisfaction. Conclusions:The overall satisfaction of the medical employees in the third grade a hospital to the scientific research communication management mechanism is relatively high. However, further measurements still need to be carried out, including strengthen the popularization of communication mechanism and conduct communication with appropriate frequency. At the same time, the hospital should pay more attention to the role of team communication in the hospital scientific research communication management mechanism. Various ways and incentive mechanisms should be adopted to improve the satisfaction of medical employees on the hospital scientific research communication and communication management mechanism, and further to improve the efficiency of scientific research, be more productive, and create greater value for the hospital.

The application of three different risk stratification scores in patients with acute chest pain / 中华全科医师杂志

Objective:To assess the application of three risk stratification scoring systems in evaluation and management of patients with acute chest pain.Methods:Patients with chest pain who visited the emergency department of Affiliated Hospital of Jining Medical University from February 2021 to April 2021 were recruited. The risk stratification evaluation was performed with EMPACT, HEART-Pathway and EDACS-ADP scoring systems. The primary endpoint was the major adverse events (MAE) within 30 days.The application values of three scales in identifying high-risk chest pain were evaluated.Results:A total of 628 patients with acute chest pain were enrolled, and 92 of them(14.95%) had MAE within 30 days. The scores of three scales were all positively correlated with MAE occurrence, while the EMPACT score had the highest correlation( r=0.41, P<0.001). ROC curve analysis showed that the area under the curve (AUC) of EMPACT score, HEART score and EDACS for predicting MAE within 30 days was 0.834(95% CI:0.790-0.878), 0.763(95% CI:0.710-0.817) and 0.635(95% CI:0.578-0.691), respectively. When the cut-off value was 9.5, the Yorden index of EMPACT score was the highest (0.561). Since all the scoring systems used integers, the EMPACT score of 10 was the threshold to distinguish low-risk chest pain from high-risk chest pain. The sensitivity of EMPACT, HEART-Pathway and EDACS-ADP scores in identifying high-risk chest pain patients was 0.707, 0.576 and 0.783, and the specificity of them was 0.854, 0.882 and 0.509, respectively. Conclusion:The EMPACT score has a good risk stratification ability, and it can be used for identifying patients with acute chest pain.

Status quo and problem analysis of market operation and management of DTP pharmacies in Guizhou province / 中国药房

OBJECTIVE To in vestigate the existing problems about store construction and market operation and management of DTP （direct-to-patient）pharmacies in Guizhou province ，and to provide countermeasures and suggestions for the improvement and development of professional operation of DTP pharmacies in Guizhou province. METHODS According to the literature review ， the questionnaire was designed. Then the field survey of 11 DTP pharmacies and questionnaire survey for the person in charge （or store managers ） in Guizhou province were conducted from April to May 2021. The questionnaire mainly included the basic information，online sales channel construction ，pharmaceutical logistics distribution ，pharmaceutical care ，vocational training ， construction of pharmacy management system and application of drug management information system etc. ，in order to analyze the inadequacies of market operation and management of DTP pharmacies in Guizhou province and put forward suggestions. RESULTS Totally 11 questionnaires were delivered and 9 valid questionnaires were retrieved ，the effective response rate of questionnaires was 81.82％ . The sample pharmacies were all from Guiyang ，most of them （77.78％）were established by local pharmaceutical enterprises in Guizhou province ，and only 22.22％ of the sample pharmacies had opened online drug purchase channels. In terms of pharmaceutical care ，55.56％ of the sample pharmacies provided basic testing and life style interventions respectively ，44.44％ of the sample pharmacies provided adverse drug reaction monitoring ，and 33.33％ of the sample pharmacies implemented health education presentations and chronic disease rehabilitation program respectively. In term of personnel training ，only 11.11％ of the sample pharmacies implemented weekly business training ，and 66.67％ of the sample pharmacies received innovative and academic pharmacy information training. The construction of DTP pharmacy management systems in Guizhou province was completed basically ， but in terms of application of drug management information system ， 22.22％ of the sample pharmacies conducted drug application analysis and monitoring. CONCLUSIONS The development of DTP pharmacies in Guizhou province is still in initial stage currently. The convenience and accessibility of medicines for patients and the construction of online sales channel need to be improved ；the internet channel construction is slow ；an effective selection and evaluation mechanisms for pharmaceutical logistics enterprises need to be created ；pharmaceutical care ability and pharmacy service personnel training system need to be strengthened ；informatization management and industrial recognition of DTP pharmacies in Guizhou province need to be promoted. Therefore ，the enterprises ， government， universities and associations should work together and strengthen the professionalization ， informatization， institutionalization and standardization of DTP pharmacies in Guizhou province ，in order to provide patients with a convenient drug sales channels and high-quality personalized pharmaceutical care platforms eventually.

Planificação da atenção à saúde e planejamento: experiência do Rio Grande do Sul / Planification of health care and planning: experience of Rio Grande do Sul

O objetivo do presente relato é apresentar a experiência do processo de Planificação da Atenção à Saúde da Secretaria de Estado da Saúde do Rio Grande do Sul (RS). A Planificação da Atenção à Saúde no RS, estruturada com o apoio do Conselho Nacional de Secretários de Saúde, trata-se de um conjunto de oficinas, além de processos de tutoria em unidades-laboratórios, para as equipes de saúde e gestores municipais. Visa à organização dos macro e microprocessos da Atenção Primária à Saúde (APS) e sua organização estruturada com a Atenção Ambulatorial Especializada. Em fevereiro de 2018, as oficinas já haviam sido concluídas em duas Regiões de Saúde - com aproximadamente 120 facilitadores e 1.000 trabalhadores da APS, e estava em fase de finalização em outras duas Regiões de Saúde - com cerca 1.300 trabalhadores da APS. O desafio para o planejamento e para a gestão estadual é ampliar a Planificação da Atenção à Saúde para as demais 26 Regiões de Saúde do RS, bem como o monitoramento e a avaliação do processo. Em última análise, a Planificação, como método de planejamento, visa ao fortalecimento da Atenção Primária à Saúde como base para a implementação das Redes de Atenção à Saúde no território gaúcho.

The objective of the present report is to present the experience of the Health Care Planification process of the State Health Department of Rio Grande do Sul (RS). The Planification of Health Care in RS, structured with the support of the National Council of Health Secretaries, is a set of workshops, as well as tutoring processes in laboratory units for health workers and municipal managers. It aims to organize macro and micro-processes of Primary Health Care (PHC) and its organization structured with Specialized Ambulatory Care. In February 2018, the workshops were completed in two Health Regions - with approximately 120 facilitators and 1,000 PHC workers- and were finalized in two other Health Regions - with approximately 1,300 PHC workers. The challenge for planning and state management is to expand the Health Care Planification for the other 26 Health Regions of RS, as well as the monitoring and evaluation of the process. As a planning method, Health Care Planification aims to strengthen Primary Health Care as the basis for the implementation of Health Care Networks in the state of Rio Grande do Sul.