Demanda de cuidado nutricional de crianças com transtorno do espectro autista em uma região de acesso remoto / Demandas de atención nutricional de niños con trastorno del espectro autista en una región de acceso remoto / Nutritional care demands of children with autism spectrum disorder in a remote access region

Introdução: O transtorno do espectro autista é uma condição neuropsiquiátrica que demanda atenção interdisciplinar e multiprofissional. A abordagem nutricional é necessária frente aos possíveis sintomas associados, como seletividade alimentar e alterações do hábito intestinal. Famílias residentes em locais de acesso limitado à serviços de saúde podem possuir dificuldades para o adequado acompanhamento. Objetivo: Relatar a experiência de atendimentos em nutrição realizados pela Liga Acadêmica de Nutrição e Saúde Coletiva a crianças com transtorno do espectro autista explorando as principais demandas identificadas e enfrentadas em uma região de acesso remoto. Metodologia: Abordagem descritiva, do tipo relato de experiência, de atendimentos realizados no município de Coari, interior do Amazonas. Os encontros foram realizados com vista a identificar demandas e refletir sobre a melhor maneira de auxiliar as crianças com essas comorbidades. Resultados: Foram atendidas 9 crianças, nem todas com o diagnóstico fechado. Seletividade alimentar, distúrbios gastrointestinais e excesso de peso foram desafios recorrentes. Nota-se a carência da percepção da importância do acompanhamento nutricional, em um cenário de relatos importantes sobre as dificuldades no acesso a medicações, por falta no município ou por ausência de recursos para aquisição, assim como terapias especializadas. Aspectos que se tornam ainda mais desafiadores frente à distância geográfica e carência de profissionais especializados e que realizem uma atenção multiprofissional. Conclusões: O acompanhamento nutricional adequado é essencial para atender às necessidades específicas e melhorar a qualidade de vida dessas crianças. Diante das limitações identificadas na região, são necessários esforços contínuos para desenvolver soluções que garantam uma assistência inclusiva e eficaz às crianças com transtorno do espectro autista no interior do Amazonas. A colaboração entre instituições, a conscientização da comunidade e o fortalecimento da rede de saúde local são cruciais para promover uma abordagem abrangente e de alta qualidade para essas crianças e suas famílias (AU).

Introduction: Autism spectrum disorder is a neuropsychiatric condition that demands interdisciplinary and multidisciplinary attention. Nutritional intervention is necessary in the face of possible associated symptoms, such as food selectivity and changes in bowel habits. Families living in places with limited access to health services may have difficulties in obtaining adequate support and follow-up.Objective: Reporting the experience of nutrition services provided by the Academic League of Nutrition and Public Health to children with autism spectrum disorder, exploring the main identified demands and challengesfaced in a remote access region. Methodology:Descriptive approach, experience of an report, of services provided in the municipality of Coari, in the interiorof Amazonas. The meetings were held with the aim identifying demands and reflecting on the best way to assistchildren with these comorbidities. Results: Ninechildren attended to, not all with a confirmed diagnosis. Food selectivity, gastrointestinal disorders and overweight were recurring challenges. There is a lack of perception of the importance of nutritional monitoring, in a scenario where there areimportant reportsofdifficulties in accessing medications, either due to lack of availability in the municipality or lack of resources for acquisition, as well as specialized therapies. Theseaspects become even more challenging given the geographical distance and scarcity of specialized professionals whocanprovide multidisciplinary care. Conclusions: Adequate nutritional monitoring is essential to meet the specific needs and improve the quality of life of these children. Given the limitations identified in the region, continuous efforts are needed to develop solutions that guarantee inclusive and effective assistance for children with autism spectrum disorder in the interior of Amazonas. Collaboration between institutions, community awareness, and strengthening the local health network are crucial to promoting a comprehensive, high-quality approach for these children and their families (AU).

Introducción: El trastorno del espectro autista es una condiciónneuropsiquiátrica que requiere atención interdisciplinaria y multidisciplinaria. El enfoque nutricionales frente a losposibles síntomas, como selectividad alimentaria y alteraciones delhábitosintestinales. Las familias que viven en lugares con accesolimitado a los servicios de salud pueden tener dificultades para recibir un seguimiento adecuado. Objetivo: Reportar la experiencia de los servicios de nutrición brindados por la Liga Académica de Nutrición y Salud Pública a niños con trastorno del espectro autista, explorando las principales demandas identificadas y enfrentadas en una región de acceso remoto.Metodología: Enfoque descriptivo, relato de experiencia, de los servicios prestados en Coari, en el interior de Amazonas. Los encuentros se realizaron con el objetivo de identificar demandas y reflexionar sobre la mejor manera de ayudar. Resultados:Se atendieron 9 niños, no todos con diagnóstico confirmado. Selectividad alimentaria, trastornos gastrointestinales y exceso de peso fueron desafíos recurrentes. Se observa una falta percepción de la importancia del seguimiento nutricional, en un escenario de informes importantes sobre las dificultades en el acceso a medicamentos, debido a lafaltade suministro en el municipio o a la falta de recursos para su adquisición, así como terapias especializadas. Estosaspectos que se vuelven aún más desafiantes dada la distancia geográfica y falta de profesionales especializados que brinden una atención multidisciplinaria.Conclusiones: Un adecuado seguimiento nutricional es fundamental para satisfacerlas necesidades específicas y mejorar la calidad de vida de estos niños. Antelas limitaciones identificadas, se necesitan esfuerzos continuos para desarrollar soluciones que garanticen una atención inclusiva y efectiva estosniños en el interior de Amazonas. Colaboración entre instituciones, concientización comunitaria y fortalecimiento de la red de salud local son cruciales para promover un enfoque integral y de alta calidad para estos niños com trastorno del espectro autista y sus familias (AU).

Experiences and challenges of enrolled nurses undertaking a Bachelor of Nursing Science programme in Namibia

Background: Globally, enrolled nurses (ENs) are embarking on an educational journey to become registered nurses (RNs) in order to enhance their knowledge and career opportunities. However, their aspiration is not without challenges. In Namibia, the experiences of these nurses have not been extensively researched. Objectives: This study aims to explore and describe the experiences and challenges of ENs undertaking a Bachelor of Nursing Science at the University of Namibia. Method: A qualitative, exploratory, descriptive and contextual research strategy was followed as the basis of conducting the study. A sample of 15 nursing students was purposively selected from the target population of 73 nursing students. This sample size was determined by the saturation of data as reflected in repeating themes. The collected data were analysed thematically using an inductive approach. Results: Three main themes subsequently emerged from the study: ENs' positive experiences advancing in the Bachelor of Nursing Science (BNSc) programme; nurses' negative experiences advancing in the BNSc programme; and recommendations to ensure effective advancement in the BNSc programme Conclusion: The findings of this study revealed that ENs positively experience becoming a RN when it comes to self-development; however, they have negative experiences such as not receiving exemptions for prior learning and having to learn a new curriculum. Contribution: These findings may be used by the Faculty of Health Sciences, School of Nursing and Public Health management in order to develop targeted interventions and ongoing strategies during their curriculum review cycles to ensure positive student experiences and success within the programme.

Ethical Challenges and Countermeasures of Doctor-patient Relationship in the Context of Artificial Intelligence Medical Treatment / 中国医学伦理学

Medical Artificial Intelligence (AI) makes the traditional doctor-patient relationship present a new pattern, but also highlights many ethical problems: inability to protect the rights and interests of patients, weakening the main responsibility of medical personnel, weakening the practical ability of medical personnel, and challenging the main status of medical personnel, etc.. It is necessary to improve relevant laws, regulations and regulatory system, adhere to the main status of medical personnel, improve the public awareness and acceptance of medical AI, and strengthen the construction of ethical system of AI, so as to deal with the ethical anomie caused by intelligent medical treatment and promote the harmonious development of doctor-patient relationship. It is expected that through the combination of AI and professional ethics principles, AI will be brought into daily clinical practice responsibly, to provide patients with better medical services.

An integrative literature review of the potential technical challenges in Forensic Odontology practice ­ an exploratory study / Uma revisão integrativa da literatura sobre os potenciais desafios técnicos na prática da Odontologia Forense ­ um estudo exploratório

Forensic Odontology deals with the presentation of dental evidence in a court of law. An academic exploration revealed instances of technical challenges within the field. This study endeavours to delve into the spheres where these challenges occur, with the core objective of enhancing the quality of practice. An integrative literature review was conducted using the online platforms SCOPUS and Web of Science. Based on the selection criteria, 29 pertinent papers dated 2000-2023 were included. Quantitative analysis of the categories of selected articles was performed using Microsoft Excel 2019 (Microsoft Corp., Redmond, WA, USA). Technical concerns were reported in all facets of Forensic Odontology with the general role of expert witnesses being reported the most (n=8; 27.58%). Within the different facets of the field, age estimation was the most prominent area of concern (n=8; 27.58%) and child abuse and neglect (n=1; 3.57%) represented the least reported category. Findings indicate that there is a need to prioritize avenues to enhance the quality of practice in the general role of expert witnesses and the specific area of dental age estimation. To this end, increased support for researchers must be provided to help validate methodologies. It is advisable to institute mandatory formal training and proficiency testing within the field. Inadequate knowledge of dentists regarding child abuse and neglect has been noted, demonstrating the need for more dedicated quality training. Recommendations for Forensic Odontologists have been curated combining this study's results and the codes of ethics of various forensic organisations

A Odontologia Legal trata da apresentação de provas odontológicas em juízo. Uma exploração acadêmica revelou exemplos de desafios técnicos na área. Este estudo procura aprofundar as esferas onde estes desafios ocorrem, com o objetivo central de melhorar a qualidade da prática. Foi realizada uma revisão integrativa da literatura utilizando as plataformas online SCOPUS e Web of Science. Com base nos critérios de seleção, foram incluídos 29 artigos pertinentes datados de 2000-2023. A análise quantitativa das categorias dos artigos selecionados foi realizada no Microsoft Excel 2019 (Microsoft Corp., Redmond, WA, EUA). Preocupações técnicas foram relatadas em todas as áreas da Odontologia Legal, sendo o papel geral dos peritos o mais relatado (n=8; 27,58%). Dentro das diferentes áreas de atuação, a estimativa da idade foi a área de preocupação mais proeminente (n=8; 27,58%), e o abuso infantil e a negligência (n=1; 3,57%) representaram a categoria menos relatada. Os resultados indicam que há uma necessidade de priorizar caminhos para melhorar a qualidade da prática no papel geral dos peritos e na área específica da estimativa da idade dental. Para este efeito, deve ser prestado maior apoio aos investigadores para ajudar a validar metodologias. É aconselhável instituir treinamento formal obrigatório e testes de proficiência na área. Foi observado um conhecimento inadequado dos dentistas sobre abuso e negligência infantil, demonstrando a necessidade de uma formação mais dedicada e de qualidade. As recomendações para Dentistas Forenses foram selecionadas combinando os resultados deste estudo e os códigos de ética de várias organizações forenses.

Entering the “Field”: Challenges of conducting fieldwork in an infertility clinic

Carrying out fieldwork in private infertility clinics poses its own specific set of challenges. Gaining access to these field sites not only obliges researchers to negotiate with gatekeepers but also to deal with structures of hierarchy and power. Based on my preliminary fieldwork in Lucknow city of Uttar Pradesh, I discuss the challenges of conducting fieldwork in infertility clinics and how methodological challenges push the researcher to question the academically established notions of the “field”, “fieldwork” and “research ethics”. The paper stresses the importance of discussing the challenges of doing fieldwork in private health setups and is an attempt to answer vital questions about the nature of fieldwork, how the fieldwork was conducted, and the need to include questions and dilemmas that anthropologists might face in the process of making decisions in the field.

A design process to define public challenges addressing SDGs / Un proceso de diseño para definir los desafíos públicos relacionados con los ODS / Um processo de design para definir desafios públicos envolvendo os ODS

Abstract How might we define local innovation challenges that are user-centered but also address strategic goals, such as the Sustainable Development Goals (SDGs)? We propose a design process that introduces a relevant contribution to the practices of the Mission-oriented Innovation Policies (MIPs) field as it goes from Grand Societal Challenges (GSCs) to local innovation challenges, which are more relevant to local needs and capabilities of solution. The main goal of the design process is to go from a GSC, such as "access to health" and one of its missions, like "reducing chronic Non-Communicable Diseases (NCD)," to a more able-to-solve innovation challenge, passing by its mission, and different problems and aspects. Snowball sampling methods allow us to find and mobilize electable subjects and design thinking techniques to process problem mapping, election, and clustering, as well as create challenge statements. It was possible to translate GSC to the local reality while reducing contestation and complexity and producing a problem-grouped map with prioritization and three problem statements (challenges) with open phrasing and solution criteria to foster the users' desired outcomes.

Resumen ¿Cómo podemos definir desafíos locales de innovación local que estén centrados en el usuario pero que también aborden objetivos estratégicos, como los Objetivos de Desarrollo Sostenible (ODS)? Proponemos un proceso de diseño que introduce una contribución relevante a las prácticas en el campo de las políticas de innovación orientadas por misión (en inglés, Mission-oriented Innovation Policies - MIPs), ya que va desde los grandes desafíos sociales (en inglés, Grand Societal Challenges - GSCs), comenzando con los ODS, hasta los desafíos locales de innovación, que son más relevantes para necesidades locales y capacidades de solución. El objetivo principal del proceso de diseño es ir desde un GSC, como "acceso a la salud" y una de sus misiones, como "reducir las Enfermedades Crónicas No Transmisibles (ECNT)", a un desafío de innovación más concreto, pasando por la misión, y por diferentes problemas y aspectos. Los métodos de muestreo de bola de nieve nos permiten encontrar y movilizar sujetos elegibles, y técnicas de design thinking, procesar el mapeo, la elección y la agrupación de problemas; y crear declaraciones de desafío. Fue posible traducir GSC a la realidad local, al mismo tiempo que se reducía la contestación y la complejidad, y se producía un plano agrupado de problemas con priorización, y tres declaraciones de problemas (desafíos) con redacción abierta y criterios de solución para promover los resultados deseados por los usuarios.

Resumo Como podemos definir os desafios locais de inovação que são centrados no usuário, mas também abordam objetivos estratégicos, como os Objetivos de Desenvolvimento Sustentável (ODS)? Propomos um processo de design que apresenta uma contribuição relevante para as práticas no campo das políticas de inovação orientadas para a missão (em inglês, Mission-oriented Innovation Policies - MIPs), uma vez que vai dos grandes desafios societais (em inglês, Grand Societal Challenges - GSCs) aos desafios locais de inovação, que são mais relevantes para as necessidades locais e capacidades de solução. O principal objetivo do processo de desenho é passar de um GSC, como o "acesso à saúde" e uma de suas missões, como "reduzir as Doenças Crônicas Não Transmissíveis (DCNT)", para um desafio de inovação mais capaz de resolver, passando pela sua missão, diferentes problemas e aspectos. Os métodos de amostragem bola de neve nos permitem encontrar e mobilizar assuntos elegíveis e técnicas de design thinking para processar o mapeamento de problemas, eleição e agrupamento; e criar declarações de desafio. Foi possível traduzir o GSC para a realidade local, reduzindo a contestação e a complexidade, e produzindo um mapa agrupado de problemas com priorização e três declarações de problemas (desafios) com formulação aberta e critérios de solução para promover os resultados desejados pelos usuários.

Transition to online teaching during COVID-19 pandemic: Perspective of higher education teachers from India

Objectives: This cross-sectional, anonymous and questionnaire-based study was undertaken to analyse online teaching experiences during COVID-19 lockdown in higher education from teachers’ perspectives. This was thought to help in improving long-distance education. Materials and Methods: An online survey was conducted to collect both quantitative and qualitative data from higher education teachers. Results: Benefits identified by online teachers indicate that distance education can cater to a large group and helps the students to access educational resources. Major challenges faced were internet connectivity (78.80%), increased workloads (68.80%) and lack of personal communication with students (84%). They believed that the online mode of teaching is the only alternative for students in such an extraordinary situation. It can be valuable for additional discussions but cannot replace traditional offline teaching. Conclusion: Suggestions pointed toward providing internet facilities and electronic databases to students and the necessity of faculty development programmes.

BIOMEDICAL WASTE MANAGEMENT IN INDIA - A CONSORIOUS APPROACH

The duty of all people supporting and ?nancing healthcare activities is to manage safely and sustainably biomedical waste (BMW), so that it does not adversely affect the environment and society. In order to maintain a healthy and clean environment, effective management of Biomedical Waste is very crucial. This study has made an extensive review on the recent Biomedical Waste Management Rules,2016, practical problems w.r.t effective implementation of rules and regulations with respect to Biomedical Waste (BMW), addressing major hindrances with respect to applying appropriate techniques and methods to be adopted for ejecting Biomedical Waste (BMW). The new rules and regulations are framed and structured in order to: 1. Improving the process of segregation, transportation, and disposal method. 2. Reducing level of environmental pollution and degradation thereby making dynamic change in the disposal of BMW and its process of treatment in India. Collaborative teamwork should be done with government support in order to develop from the perspective of: 1. Finance 2. Infrastructure 3. Providing facilities for healthcare workers for their safety 4. Continuous Monitoring of Biomedical Waste Disposal Practices

Challenges in Obtaining Informed Consent in Qualitative Research and Suggestions to Improve It- A Descriptive Qualitative Study

Introduction: The dynamic and flexible nature of qualitative studies is expected to impose new challenges upon the researchers in obtaining informed consent. The study objectives were to explore the challenges per-ceived by the researchers in obtaining informed consent in qualitative research and their suggestions to im-prove it. Material and Methods: It was a descriptive qualitative study in which In-depth interviews were conducted among ten qualitative researchers purposively selected from one medical college in Puducherry. Transcripts prepared from the audio recordings were thematically analyzed manually. Results: The challenges identified were inadequate knowledge of the researcher in designing qualitative con-sent form, reluctance to sign consent document by participant, ensuring confidentiality and risk benefit com-munication. The main suggestions provided by the participants were to use of multimedia tools to improve their understanding and creating a rapport to enhance their trust to participate in the study. Conclusions: Since most of the challenges were related to the reluctance of participants to provide consent due to various reasons and lack of adequate knowledge of the researcher, creating a good rapport with the participants and providing simple information through multimedia approaches and ethical training of qualita-tive researchers will aid us to overcome majority of these challenges.

DIGITAL INDIA - AN OVERVIEW

Digital India is a scheme launched by Government of India. The main objective of this scheme is to make India digitally empowered in technology. It is also ensure that government services are accessible by the citizens electronically. By improving online infrastructure as well as internet connectivity. The vision of digital India is the development in the field of including electronic services, products, manufacturing and Job oriented schemes etc. Digital technologies including mobile application and cloud computing is causes an important role in rapid development for economic growth and digitally empowered Indian citizens across the world. This paper overview the concept of Digital India and its challenges and opportunities.

Options of Funding and Ethical Clearance for Medical Researchers in India

Research forms an integral part of present world development and interest. It is the primary source of speculation and outcome-based decision making. Medical research work proves to be a big challenge in low- and middle-income countries due to the constraint of resources and capacity building. The disparities in the distribution of resources, inadequate policy implementation, and lack of prioritization of research make the research challenging. There has been an increase in medical research in India but it is not adequate when compared to other countries or areas. Medical researchers face multiple issues, mainly funding and ethical approval and are stunted by the unacceptance in high-indexed journals. In this paper, we have compiled the options for funding and ethical options and ways available for researchers in India. This will help and encourage researchers pro-actively by providing some guidance on the issues related to finance and ethics required for conducting scientific research.

Evaluation of Anaesthetic Challenges in Primary Cleft Lip and Palate Surgeries in a Single Center Study

Background: One of the most prevalent congenital malformations and the most frequent craniofacial defects in children is cleft lip and palate. The aim of the study was to investigate the anaesthetic procedures employed and to determine the challenges and postoperative complications associated with cleft lip and palate surgery. Material & Methods: A retrospective review of the anaesthetic procedures carried out from January 2022 to December 2022 at the Dhaka Dental College and Hospital. The hospital records were reviewed in order to learn about every occurrence of orofacial cleft surgery. In this study, a total number of 120 cases were reviewed. Results: Among 120 cases, 53 (44.2%) of the patients were female and 67 (55.8%) were male. The bulk of patients came after their first year of life. About 54(45%) of them were younger than five years old. 68(56.67%) underwent cleft lip surgery, 37(30.83%) for cleft palate surgery and rest 15(12.5%) patients under went for combined cleft lip and cleft palate surgeries. Upper Respiratory Tract Infection (URTI) was reported as the most common pre-existing morbidity. Bronchospasm was the main intraoperative complications occurred in 8 (6.67%) of the cases with URTI. After surgey 6(5%) patients experienced bleeding, 3(2.5%) patients needed to be reintubated. In addition, 2 (1.67%) instances had trouble controlling their pain, only 1(0.83%) patient had trouble swallowing and 1(0.83%) recovered slowly. Conclusion: Anaesthesia for surgical repair of cleft lip or palate in children is challenging. After a thorough preoperative evaluation, a trained anaesthesiologist should administer anaesthesia under strict supervision to minimize postoperative complications.

Three years of COVID-19 pandemic: comparative analysis of incidence, lethality and mortality among the States of the south region of Brazil / Três anos de pandemia da COVID-19: análise comparativa da incidência, letalidade e mortalidade entre os Estados da região sul do Brasi

Introduction: the first COVID-19 case in Brazil was confirmed on February 26, 2020. As of March 17, 2023, the Ministry of Health reported 699,634 deaths from COVID-19, with a case fatality rate of 1.9%. The impact of the COVID-19 pandemic in Brazil extends to socioeconomic and healthcare systems, reflecting significant regional disparities. Objective: To analyze mortality, incidence, and case fatality rates for COVID-19 in the states of Paraná and Santa Catarina, in the southern region of Brazil. Methods: This is an ecological time-series study using official Brazilian secondary data for COVID-19 cases and deaths. Data were extracted from the dashboard of the State Health Department of Santa Catarina and Paraná. Temporal series were developed for trend analysis using the Prais-Winsten regression model. Statistical analyses were performed using STATA 14.0 software (College Station, TX, USA, 2013). Results: In the analysis of rates over the entire period, trends for mortality, case fatality, and incidence in the state of Santa Catarina are decreasing, decreasing, and stationary, respectively. In Paraná, rates over the entire period showed a stationary trend for mortality, decreasing for case fatality, and increasing for incidence. Conclusion: COVID-19 had a devastating effect on the states of Santa Catarina and Paraná. Both states experienced the progression of the COVID-19 pandemic, with higher case fatality and mortality rates observed in Paraná, while Santa Catarina had a higher incidence rate over the three years of the COVID-19 pandemic.

Improved visibility of illuminated chopper-assisted cataract surgery involving iris challenges

Purpose: The aim of this study was to evaluate the efficacy of the illuminated chopper?assisted cataract surgery in terms of shortening the surgical time and reducing the use of pupil expansion devices in eyes with iris challenges. Methods: This was a retrospective case series of a university hospital. Four hundred forty?three eyes of 433 consecutive patients who underwent illuminated chopper?assisted cataract surgery were included in this study. Cases with preoperative or intraoperative miosis, iris prolapse, and intraoperative floppy iris syndrome were included in the iris challenge group. Use of tamsulosin, iris hooks, pupil size, surgical time, and improved visibility (100/surgical time × pupil size) were compared between eyes with and without iris challenges. Mann–Whitney U test, Pearson’s Chi?square test, and Fisher’s exact test were used for statistical analysis. Results: Of 443 eyes, 66 were included in the iris challenge group (14.9%). Tamsulosin use was more common in patients with iris challenges and iris hooks were used more frequently (9.1% vs. 0%, P < 0.001) in patients with iris challenges than in those without iris challenges. Pupil size was smaller in patients with iris challenges (6.01 vs. 7.64 mm, P < 0.001). However, surgical time was not different (16.9 vs. 16.5 min, P = 0.064) between the two groups. As a result, improved visibility was calculated to be higher in patients with iris challenges (1.05 vs. 0.81, P < 0.001). Conclusion: In terms of surgical time and improved visibility, using the illuminated chopper simplified cataract surgery involving iris challenges. The use of an illuminated chopper is expected to be a good solution for challenging cataract surgeries.

Estudantes-atletas: reflexões acerca de seu desenvolvimento / Student-athletes: reflections about their development / Estudiantes-deportistas: reflexiones sobre su desarrollo

O presente ensaio tem como objetivo refletir sobre o desenvolvimento do estudante-atleta, tendo como base o documento intitulado Modelo de Desenvolvimento Esportivo, proposto pelo Comitê Olímpico do Brasil. Ao longo do texto, são discutidos os desafios do estudante-atleta ao seguir a carreira-dupla, bem como sobre a dupla-carreira no Brasil e no mundo. Por fim, sugere-se a criação de uma legislação nacional e de políticas institucionais que promovam o acesso, a permanência e a finalização da formação destes estudantes-atletas. (AU).

The present study aimed to reflect on the development of student-athletes based on the document named Sports Development Model proposed by the Brazilian Olympic Committee. Throughout the ext, the student-athlete and their challenges when following a dual ca-reer are discussed, as well as the dual career in Brazil and in the world. Finally, it is suggested the development of national legislation and insti-tutional policies that promote access, permanence and finalization of the graduation for these student-athletes (AU).

Este ensayo tuvo como objetivo reflexionar sobre el desar-rollo de los estudiantes-atletas a partir del documento titulado Modelo de Desarrollo Deportivo, propuesto por el Comité Olímpico de Brasil. A lo largo del texto, se discute el estudiante-atleta y sus desafíos al se-guir una carrera dual, así como la carrera dual en Brasil y en el mundo. Finalmente, se sugiere la creación de legislación nacional y políticas ins-titucionales que promuevan el acceso, permanencia y culminación de la formación de estos estudiantes deportistas (AU).

ENHANCING EDUCATION USING BLOCKCHAIN TECHNOLOGY

Blockchain technology means chaining the block of information together in the databases stored digitally or in the form of ledgers. With the advancement of computing, internet services along with IoT, the block chain technology has revolutionized every area of human life whether it is relating to financial transactions, electronic voting, and logistics management to education sector. The education sector is going to be completely digitalized after Covid-19 pandemic. The block chain technology can play an important role in designing a fully automated and secure evaluation and assessment module. The study focuses on the applications of blockchain to evaluate and assess the students located globally that too in fair manner with the need to design more secure evaluation systems.

Challenges faced by frontline health managers during the implementation of COVID-19 related policies in India: A qualitative analysis

Background & objectives: The COVID-19 pandemic exposed the strengths and weaknesses of the healthcare systems across the world. Many directives, guidelines and policies for pandemic control were laid down centrally for its implementation; however, its translation at the periphery needs to be analyzed for future planning and implementation of public health activities. Hence, the objectives of this study were to identify the challenges faced by frontline health managers in selected States in India during the pandemic with regard to implementation of the COVID-19-related policies at the district level and also to assess the challenges faced by the them in adapting the centrally laid down COVID-19 guidelines as per the local needs of the district. Methods: A qualitative study using the grounded theory approach was conducted among frontline district-level managers from eight different States belonging to the north, south, east and west zones of India. The districts across the country were selected based on their vulnerability index, and in-depth interviews were conducted among the frontline managers to assess the challenges faced by them in carrying out COVID-19 related activities. Recorded data were transcribed verbatim, manually coded and thematically analyzed. Results: Challenges faced in implementing quarantine rules were numerous, and it was also compounded by stigma attached with the disease. The need for adapting the guidelines as per local considerations, inclusion of components of financial management at local level, management of tribal and vulnerable populations and migrants in COVID context were strongly suggested. The need to increase human resource in general and specifically data managers and operators was quoted as definite requirement. Interpretation & conclusions: The COVID-19 guidelines provided by the Centre were found to be useful at district levels. However, there was a need to make some operational and administrative modifications in order to implement these guidelines locally and to ensure their acceptability.

Awareness, willingness, and challenges of the informal sector toward state National Health Insurance Services in Benin City, Nigeria

Background: As access to vital health services expands and universal health coverage is attained, health insurance is projected to serve as a critical risk protection for families and small enterprises. Aim: To assess the informal sector’s awareness, willingness, and problems in enrolling in the state national health insurance program. Materials and Methods: This cross-sectional descriptive study was done in Benin City, Nigeria, in the unorganized sector. A self-structured questionnaire was created, distributed, and retrieved for this study, which was conducted among 155 artisans chosen through a stratified random sample procedure. To evaluate the data, Statistical Package for the Social Sciences, SPSS version 22 was used. Results: In total, 138 people (89.0%) are aware of the National Health Insurance Scheme (NHIS), while only 93 people (60.0%) know that Edo state has a state-owned Health Insurance Scheme (SHIS). Only 17 people, or 11.0%, are engaged in the NHIS/SHIS program, whereas 107 people, or 77.5%, have expressed interest. Lack of accessibility to authorized healthcare facilities near house 22 (71.0%) is a significant deterrent to enrollment in the program. Long lines at service points (3.88, 1.093), the time it takes to enroll new members in the program (3.78, 1.101), the time it takes for health maintenance organizations to issue authorization codes (3.62, 1.316), the accessibility of NHIS services outside of registration institutions (3.29, 1.289), and the standard of drugs provided by the SHIS (3.12, 1.358) are all factors that hinder utilization. Sex and place of residence each strongly correlated with readiness to sign up for the program (AOR = 4.234, P = 0.017, 95% CI: 1.293–13.873 and AOR = 5.224, P = 0.007, 95% CI: 1.557–17.530, respectively). Conclusion: The artisans have a low rate of health insurance coverage but are eager to sign up for the program. State policymakers should increase their reach and make enrollment required to attain a higher range.

Experiences, challenges, and solutions of physical educators in online teaching / Experiências, desafios, soluções e boas práticas de educadores físicos no ensino online

ABSTRACT The study aimed to determine the lived experiences of physical education teachers in online teaching during the pandemic. This study is qualitative in nature, utilizing phenomenological research design to identify the experiences of physical educators teaching online. The participants in the study consisted of four physical education teachers from two private schools, who are experienced in teaching PE in an online class environment. A semi-structured interview was conducted with an open-ended questionnaire. Transcribing, coding, and thematic analysis were used to analyze the data. From the analysis, themes emerged based on the experiences encountered by PE teachers in teaching online in terms of positive experiences, problems encountered, and solutions taken in dealing with problems or difficulties in online teaching. The findings of the study showed that PE teachers had expressed their lived experiences in teaching PE online, with benefits and problems encountered, as well as solutions and best teaching practices during the COVID-19 pandemic.

RESUMO O estudo teve como objetivo conhecer as experiências vividas por professores de educação física no ensino online durante a pandemia. Este estudo é de natureza qualitativa, utilizando desenho de pesquisa fenomenológica para identificar as experiências de educadores físicos ensinando online. Os participantes do estudo foram quatro professores de educação física de duas escolas particulares, com experiência no ensino de EF em ambiente de aula online. Foi realizada uma entrevista semiestruturada com questionário aberto. Para análise dos dados foram utilizadas transcrição, codificação e análise temática. Da análise, surgiram temas baseados nas experiências encontradas pelos professores de EF no ensino online em termos de experiências positivas, problemas encontrados e soluções tomadas ao lidar com problemas ou dificuldades no ensino online. As conclusões do estudo mostraram que os professores de EF expressaram as suas experiências vividas no ensino de EF online, com os benefícios e problemas encontrados, bem como as soluções e melhores práticas de ensino durante a pandemia da COVID-19.

Os desafios enfrentados na amamentação para a mulher cega: uma revisão integrativa da literatura / The challenges faced in breastfeeding by blind women: an integrative literature review / Los retos de la lactancia materna en mujeres ciegas: una revisión bibliográfica integradora

Introdução: A maternidade para mulheres cegas é um processo de modificação descrito como um evento crítico, marcado por inseguranças e preocupações. Essas mulheres sofrem preconceito e além de lidarem com uma limitação física, também precisam vivenciar limitações impostas pela sociedade. Objetivo: Esse estudo teve como objetivo destacar a prática da amamentação e os desafios para as mulheres cegas. Métodos: Trata-se de uma revisão bibliográfica integrativa, elaborada a partir de trabalhos científicos acerca dos desafios enfrentados na amamentação para a mulher cega. Foram considerados artigos originais e completos publicados em português, espanhol e inglês nos últimos dez anos, de 2013 até 2023, obtidos nas plataformas SCIELO, PUBMED, LILACS e BVS. Resultados: Os estudos atuais mostram que os desafios enfrentados pelas mulheres cegas durante a amamentação são pouco discutidos e podem levar ao distanciamento das recém-mães dessa prática. Deve-se sempre ser alertado sobre a importância da amamentação, pois está associada não apenas à saúde da criança, mas também à saúde materna e ao maior vínculo entre mãe e filho. Conclusão: Fica nítido a necessidade de desenvolver ações de educação em saúde, orientações, informações no pré-natal sobre as mudanças que ocorrerão no período gestacional, cuidados de enfermagem no parto e pós-parto direcionados às especificidades da mulher cega, além de orientações sobre cuidados iniciais do bebê, como banho, amamentação e prevenção de acidentes.

Introduction: Motherhood for blind women is a process of change described as a critical event, marked by insecurities and concerns. These women suffer prejudice and besides dealing with a physical limitation, they also need to experience limitations imposed by society. Objective: This study aimed to highlight the practice of breastfeeding and the challenges for blind women. Methods: This is an integrative literature review, based on scientific papers about the challenges faced by blind women in breastfeeding. Original and complete articles published in Portuguese, Spanish and English in the last ten years, from 2013 to 2023, obtained from the SCIELO, PUBMED, LILACS and BVS platforms were considered. Results: The current studies show that the challenges faced by blind women during breastfeeding are little discussed and may lead to the distancing of new mothers from this practice. One should always be alerted about the importance of breastfeeding, since it is associated not only with the child's health, but also with maternal health and the greater bond between mother and child. Conclusion: It is clear the need to develop health education actions, guidelines, information in prenatal care about the changes that will occur during pregnancy, nursing care during delivery and postpartum directed to the specificities of blind women, as well as guidelines on initial care of the baby, such as bathing, breastfeeding and accident prevention.

Introducción: La maternidad para las mujeres ciegas es un proceso de cambio descrito como un acontecimiento crítico, marcado por inseguridades y preocupaciones. Estas mujeres sufren prejuicios y, además de lidiar con una limitación física, también tienen que experimentar las limitaciones impuestas por la sociedad. Objetivo: Este estudio tuvo como objetivo destacar la práctica de la lactancia materna y los desafíos para las mujeres ciegas. Métodos: Trata-se de uma revisão bibliográfica integrativa, elaborada a partir de trabalhos científicos acerca dos desafios enfrentados na amamentação para a mulher cega. Se consideraron artículos originales y completos publicados en portugués, español e inglés en los últimos diez años, de 2013 a 2023, obtenidos de las plataformas SCIELO, PUBMED, LILACS y BVS. Resultados: Los estudios actuales muestran que los desafíos enfrentados por las mujeres ciegas durante la lactancia materna son poco discutidos y pueden llevar al distanciamiento de las nuevas madres de esta práctica. Se debe alertar siempre sobre la importancia de la lactancia materna, pues está asociada no sólo a la salud del niño, sino también a la salud materna y al mayor vínculo entre madre e hijo. Conclusão: Fica nítida a necessidade de desenvolver ações de educação em saúde, orientações, informações no pré-natal sobre as mudanças que ocorrerão no período gestacional, cuidados de enfermagem no parto e pós-parto direcionados às especificidades da mulher cega, além de orientações sobre cuidados iniciais do bebê, como banho, amamentação e prevenção de acidentes.