Social determinants and access to health services in patients with COVID-19: a cross-sectional study / Determinantes sociales y acceso a los servicios sanitarios en pacientes con COVID-19: un estudio transversal / Determinantes sociais e acesso aos serviços de saúde em pacientes com COVID-19: estudo seccional

ABSTRACT Objective: To verify the association between social determinants of health and access to health services for COVID-19 patients. Method: Analytical, cross-sectional study, carried out in three states in the Northeast of Brazil (Ceará, Maranhão and Pernambuco), with 968 patients, using questionnaires with sociodemographic data, determinants and the Primary Care Assessment Tool, adapted to the reality of COVID-19, with 58 items, classified as high (score ≥ 6.6) and low (score < 6.6), whose high value reveals better standards of access to health services. The Chi-square test was used for comparative analysis. Results: There was a significant difference (p < 0.05) between the domains of the instrument and the following determinants: age, skin color, body mass index, origin, schooling, employment, services close to home, first service, income and means of transport. Conclusion: Access to health services for people with COVID-19 was associated with various determinants, including individual, behavioural and social ones, correlated with the structural and organizational aspects of the health services offered by the three states of Northeastern Brazil.

RESUMEN Objetivo: Verificar la asociación de los determinantes sociales de la salud con el acceso de los pacientes con COVID-19 a los servicios de salud. Método: Estudio analítico, transversal, realizado en tres estados del Nordeste de Brasil (Ceará, Maranhão y Pernambuco), con 968 pacientes, utilizando cuestionarios con datos sociodemográficos, determinantes y la Herramienta de Evaluación de la Atención Primaria (PCATool), adaptada a la realidad de la COVID-19, con 58 ítems, clasificados en alto (puntuación ≥ 6,6) y bajo (puntuación < 6,6), cuyo valor alto revela mejores estándares de acceso a los servicios de salud. Se utilizó la prueba de chi-cuadrado para analizar las comparaciones. Resultados: Hubo diferencia significativa (p < 0,05) entre los dominios del instrumento y los siguientes determinantes: edad, color de piel, índice de masa corporal, origen, escolaridad, empleo, servicios cercanos al domicilio, primer servicio, ingreso y medio de transporte. Conclusión: El acceso a los servicios de salud de las personas con COVID-19 se asoció a diversos determinantes, entre ellos individuales, comportamentales y sociales, correlacionados con los aspectos estructurales y organizativos de los servicios de salud ofrecidos por los tres estados del nordeste de Brasil.

RESUMO Objetivo: Verificar a associação dos determinantes sociais da saúde com o acesso de pacientes com COVID-19 aos serviços de saúde. Método: Estudo analítico, transversal, desenvolvido em três estados do Nordeste brasileiro (Ceará, Maranhão e Pernambuco), com 968 pacientes, utilizando-se de questionários de dados sociodemográficos, determinantes e do Primary Care Assessment Tool, adaptado para realidade da COVID-19, com 58 itens, classificado em alto (escore ≥ 6,6) e baixo (escore < 6,6), cujo valor alto revela melhores padrões de acesso aos serviços de saúde. Para análise comparativa, empregou-se o teste do Qui-quadrado. Resultados: Verificou-se diferença significativa (p < 0,05) entre os domínios do instrumento e os seguintes determinantes: idade, cor da pele, índice de massa corporal, procedência, escolaridade, vínculo empregatício, serviços próximos à residência, primeiro serviço de atendimento, renda e meios de transporte. Conclusão: O acesso aos serviços de saúde de pessoas com COVID-19 esteve associado aos diversos determinantes, sendo estes individuais, comportamentais, sociais, correlacionados aos aspectos estruturais e organizacionais dos serviços de saúde ofertados pelos três estados do Nordeste brasileiro.

COVID-19 nas prisões: validação de um inquérito de conhecimento, atitude e prática / COVID-19 en las cárceles: validación de un estudio de conocimiento, actitud y práctica / COVID-19 in prisons: validity of a knowledge, attitude and practice survey

Resumo Objetivo Validar um inquérito de conhecimento, atitude e prática sobre medidas preventivas da COVID-19 para os funcionários do sistema penitenciário, fundamentado na teoria ambientalista. Métodos Estudo metodológico desenvolvido em quatro etapas: estabelecimento da estrutura conceitual, elaboração do instrumento, validação do conteúdo por juízes e avaliação da aparência pelo público-alvo. O conteúdo de cada item foi validado quanto a objetividade, clareza e relevância. A aparência do inquérito foi avaliada quanto ao objetivo, a organização, ao estilo da escrita e a motivação. Utilizou-se o coeficiente de validação de conteúdo para avaliar a concordância entre os juízes e entre o público-alvo. Os dados foram analisados por meio de distribuições brutas, percentuais, medidas de posição e de dispersão. O índice alfa de Cronbach foi utilizado para analisar a consistência das avaliações dos juízes e do público-alvo. Resultados Quanto ao conteúdo e a aparência, os requisitos avaliados obtiveram concordância superior a 0,9. Na avaliação da consistência, obteve-se índice alfa de Cronbach > 0,9 e > 0,7, quanto ao conteúdo e à aparência, respectivamente, indicando que juízes e público-alvo tenderam a fazer avaliações similares. Conclusão O inquérito apresentou validade de conteúdo e aparência para a coleta de dados referentes a conhecimento, atitude e prática sobre prevenção da COVID-19, para os funcionários do sistema penitenciário, indicando que poderá contribuir para o planejamento e a avaliação de ações de educação em saúde.

Resumen Objetivo Validar un estudio de conocimiento, actitud y práctica sobre medidas preventivas de COVID-19 para los empleados del sistema penitenciario, fundamentado en la teoría ambientalista. Métodos Estudio metodológico llevado a cabo en cuatro etapas: establecimiento de la estructura conceptual, elaboración del instrumento, validación del contenido por jueces y evaluación de la apariencia por el público destinatario. Se validó el contenido de cada ítem respecto a la objetividad, claridad y relevancia. Se evaluó la apariencia del estudio respecto al objetivo, la organización, el estilo de escritura y la motivación. Se utilizó el coeficiente de validez de contenido para evaluar la concordancia entre los jueces y entre el público destinatario. Los datos se analizaron mediante distribuciones brutas, porcentajes, medidas de posición y de dispersión. Se utilizó el índice alfa de Cronbach para analizar la consistencia de las evaluaciones de los jueces y del público destinatario. Resultados Respecto al contenido y a la apariencia, los requisitos evaluados obtuvieron concordancia superior a 0,9. En la evaluación de la consistencia, se obtuvo un índice alfa de Cronbach > 0,9 respecto al contenido y > 0,7 respecto a la apariencia, lo que indica la tendencia de los jueces y del público destinatario a realizar evaluaciones similares. Conclusión El estudio presentó validez de contenido y apariencia para la recopilación de datos referentes a conocimiento, actitud y práctica sobre prevención de COVID-19 para empleados del sistema penitenciario, lo que indica que podrá contribuir a la planificación y evaluación de acciones de educación para la salud.

Abstract Objective To validate a knowledge, attitude and practice survey on preventive measures against COVID-19 for penitentiary system staff based on environmental theory. Methods This is a methodological study developed in four stages: conceptual structure establishment; instrument elaboration; content validity by judges; and appearance assessment by the target audience. The content of each item was validated for objectivity, clarity and relevance. Survey appearance was assessed regarding objective, organization, writing style and motivation. Content validity coefficient was used to assess agreement among judges and the target audience. Data were analyzed using gross distributions, percentages, position and dispersion measures. Cronbach's alpha index was used to analyze the consistency of judges' and target audience's assessments. Results Regarding content and appearance, the assessed requirements achieved agreement greater than 0.9. In consistency assessment, a Cronbach's alpha index > 0.9 and > 0.7 was obtained for content and appearance, respectively, indicating that judges and target audiences tended to make similar assessments. Conclusion The survey presented content and appearance validity for collecting data regarding knowledge, attitude and practice regarding COVID-19 prevention for penitentiary system staff, indicating that it could contribute to health education action planning and assessment.

Formação da identidade profissional de enfermeiros para o trabalho no sistema prisional / Development of the professional identity of nurses to work in the prisonal system / Formación de la identidad profesional de los enfermeros para trabajar en el sistema penitenciario

Objetivo:analisar elementos motivadores da construção da identidade profissional de enfermeiros do sistema prisional. Método: estudo histórico-social, qualitativo, sob o método de triangulação de fontes orais e documentais coletados de maio a dezembro de 2020, iluminado pelo referencial foucaultiano. Protocolo de pesquisa aprovado pelo Comitê de Ética e Pesquisa da instituição signatária. Resultados: a realização de concurso público para o sistema prisional foi motivada pela aquisição de estabilidade. Os enfermeiros concursados eram despreparados para cuidar de pessoas presas. A disciplina e os poderes exercidos pelos guardas e presos surpreenderam estes enfermeiros, que precisaram se adaptar ao sistema num contexto social marcado pela violência urbana. Considerações finais: destaca-se, na construção da identidade destes profissionais, a capacidade para contornar medos e inseguranças, exercício de poder disciplinar e normatização do cuidado para o enfrentamento do cotidiano do trabalho. Emerge a necessidade de capacitação de enfermeiros nesta área na formação profissional.

Objective: to analyze elements that motivate the construction of the professional identity of nurses in the prison system. Method: historical-social, qualitative study, under the method of triangulation of oral and documental sources collected from May to December 2020, illuminated by the Foucaultian reference. Approved by the Ethics and Research Committee. Results: the holding of a public tender for the prison system was motivated by the acquisition of stability. The registered nurses were unprepared to take care of prisoners. The discipline and powers exercised by guards and prisoners surprised these nurses, who had to adapt to the system in a social context marked by urban violence. Final considerations: in the construction of the identity of these professionals, the ability to overcome fears and insecurities, exercising disciplinary Power and standardizing care for coping with daily work is highlighted. The need to train nurses in thisarea in professional training emerges.

Objetivo: analizar elementos que motivan la construcción de la identidad profesional de las enfermeras en el sistema penitenciario. Método: estudio histórico-social, cualitativo, iluminado por el referente foucaultiano, que utiliza el método de triangulación de fuentes orales y documentales recolectadas de mayo a 20 de diciembre. El Comité de Ética en Investigación de la institución firmante aprobó el protocolo de investigación. Resultados: la realización de un concurso público para el sistema penitenciario estuvo motivada por la adquisición de estabilidad. Los enfermeros aprobados por ese concurso público no estaban preparados para cuidar a los presos. La disciplina y los poderes que ejercían los guardias y presos sorprendieron a estos enfermeros, que debieron adaptarse al sistema en un contexto social marcado por la violencia urbana. Consideraciones finales: en la construcción de la identidad de estos profesionales se destaca la capacidad de superación de miedos e inseguridades, ejercicio de poder disciplinario y estandarización de los cuidados para hacer frente al cotidiano del trabajo. Surge la necesidad de capacitar a enfermeros en esta área en la formación profesional.

Caracterización de los pacientes oncológicos que ingresan por comorbilidades en el Hospital Universitario «Dr. Celestino Hernández Robau» / Characterization of cancer patients admitted for comorbidities at "Dr. Celestino Hernández Robau" University Hospital

Introducción Según datos de la Organización Mundial de Salud (OMS), el cáncer se ha convertido en una de las primeras causas de muerte a nivel mundial debido al aumento progresivo, si no existe control de su propagación. La valoración conjunta del paciente por parte de distintos especialistas que asumen su abordaje desde diferentes perspectivas, siempre mejora la atención de los mismos y en el caso del paciente oncológico no es una excepción. Objetivo: Caracterizar los pacientes oncológicos que ingresaron por comorbilidades en el Hospital Universitario «Dr. Celestino Hernández Robau» de la provincia Villa Clara. Métodos: Se realizó un estudio descriptivo de corte transversal, en el Hospital Universitario «Dr. Celestino Hernández Robau», de enero a diciembre del 2020, mediante la revisión documental de las historias clínicas al egreso. Resultados: En el sexo femenino, en pacientes de 60 años y más, predominaron los tumores de pulmón, mama y colorrectal, y en el sexo masculino, de pulmón, próstata y hemolinfopoyético El tumor de pulmón fue la localización más frecuente, predominó entre las comorbilidades, las neumonías en pacientes del sexo femenino, mayores de 60 años. Los pacientes ingresados por Diabetes Mellitus, presentaban una enfermedad estable, seguidos por los que se encontraban en progresión, los que ingresaron con insuficiencia cardiaca, presentaban tumor en pulmón o laringe. Conclusiones: Los pacientes que ingresaron por tener tumor de pulmón se asociaron a mayor número de complicaciones y egresos fallecidos. Recomendamos perfeccionar la atención integral de estos pacientes por oncólogos e internistas.

ABTRACT Introduction: according to data from the World Health Organization (WHO), cancer has become one of the leading causes of death worldwide due to its progressive increase, if there is no control of its spread. The joint assessment of the patients by different specialists who assume their approach from different perspectives always improves their care and in the case of cancer patients this is not an exception. Objective: to characterize cancer patients admitted for comorbidities at "Dr. Celestino Hernández Robau" University Hospital in Villa Clara province. Methods: a descriptive cross-sectional study was carried out at "Dr. Celestino Hernández Robau" University Hospital from January to December 2020, through documentary review of the medical records at discharge. Results: females aged 60 years and over predominated; lung, breast, and colorectal tumours predominated in this gender, as well as lung, prostate, and hemolymphopoietic tumours in males. Lung tumour was the most frequent location; pneumonia prevailed among the comorbidities, in females older than 60 years. Patients admitted for diabetes mellitus had a stable disease, followed by those who were in progression; those who were admitted with heart failure had a lung or larynx tumour. Conclusions: patients admitted for having a lung tumour were associated with a greater number of complications and deaths at discharge. We recommend improving a comprehensive care of these patients by oncologists and internists.

Desafios dos profissionais de enfermagem na promoção da saúde no sistema prisional / Challenges of nursing professionals in health promotion in the prision system / Desafíos de los profesionales de enfermaría en la promoción de la salud en el sistema penitenciario

Conclusão: há a necessidade de maior formação e treinamento para que esses profissionais consigam gerenciar questões éticas, manter sua identidade e autonomia e desenvolver mais habilidades no contexto prisional

Conclusion:there is a need for greater education and training so that these professionals can manage ethical issues, maintain their identity and autonomy, and develop more skills in the prison context

Conclusión: son necesarios más formación y entrenamiento para que los profesionales de enfermería puedan gestionar cuestiones éticas, mantener su identidad y autonomía y desarrollar mayores habilidades en el contexto penitenciario

Contribution margin per hour of operating room to reallocate unutilized operating room time: a cost-effectiveness analysis

Abstract Background and objectives: Contribution margin per hour (CMH) has been proposed in healthcare systems to increase the profitability of operating suites. The aim of our study is to propose a simple and reproducible model to calculate CMH and to increase cost-effectiveness. Methods: For the ten most commonly performed surgical procedures at our Institution, we prospectively collected their diagnosis-related group (DRG) reimbursement, variable costs and mean procedural time. We quantified the portion of total staffed operating room time to be reallocated with a minimal risk of overrun. Moreover, we calculated the total CMH with a random reallocation on a first come-first served basis. Finally, prioritizing procedures with higher CMH, we ran a simulation by calculating the total CMH. Results: Over a two-months period, we identified 14.5 hours of unutilized operating room to reallocate. In the case of a random ''first come -first serve'' basis, the total earnings were 87,117 United States dollars (USD). Conversely, with a reallocation which prioritized procedures with a high CMH, it was possible to earn 140,444 USD (p < 0.001). Conclusion: Surgical activity may be one of the most profitable activities for hospitals, but a cost-effective management requires a comprehension of its cost profile. Reallocation of unused operating room time according to CMH may represent a simple, reproducible and reliable tool for elective cases on a waiting list. In our experience, it helped improving the operating suite cost-effectiveness.

A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE REGARDING HAND HYGIENE AMONG NURSING STAFF AND AVAILABILITY OF HAND-WASHING FACILITIES IN A TERTIARY CARE HOSPITAL

BACKGROUND: Practicing hand hygiene is a simple yet effective way to prevent Health Care Related Infections. The objectives of the study were to study the knowledge and attitude regarding hand hygiene among nursing staff and study the availability of hand-hygiene facilities in a tertiary care hospital. A METHODS: cross-sectional study was conducted and a total of 100 study participants were selected by simple random sampling. Knowledge and attitude of the nurses were captured by interviewing the nurses and recording the data on pre-tested questionnaire. The results were compiled on Windows Excel spreadsheet and summarized by calculating proportions and percentages. Chi-square test was applied to identify association between knowledge and attitude regarding hand-hygiene and likely determinants. It was found that there was significant positive association between knowledge and attitude of nursing staff and formal training received during previous one year regarding hand hygiene.

The effects of gratitude interventions: a systematic review and meta-analysis

ABSTRACT Introduction Gratitude has several implications. Over time, a logical relationship has been established between gratitude and well-being. In addition, researchers aimed to establish associations between gratitude and other factors of positive feelings using scientific methods. We conducted a systematic review and meta-analysis of interventions to develop gratitude and its benefits to human beings. Objective This study aimed to evaluate and quantify the available scientific evidence on interventions to acquire knowledge on gratitude as a quantifiable causal factor of benefit to human beings. Methods A systematic literature search was conducted to identify studies that investigated the effects of gratitude interventions. MEDLINE, Embase, and Central Cochrane databases were searched in addition to gray (Google Scholar) and manual search. Two authors independently evaluated the titles and abstracts, and selected the studies that met the inclusion criteria. The searches were conducted between January and July 2022. Results Sixty-four randomized clinical trials were included. The meta-analysis demonstrated that patients who underwent gratitude interventions experienced greater feelings of gratitude, better mental health, and fewer symptoms of anxiety and depression. Moreover, they experienced other benefits such as a more positive mood and emotions. Conclusion The results demonstrate that acts of gratitude can be used as a therapeutic complement for treating anxiety and depression and can increase positive feelings and emotions in the general population. Prospero database registration: (www.crd.york.ac.uk/prospero) under the number CRD42021250799.

Systematic review of the research on rational drug use among the elderly in Chinese elderly care facilities / 中国药房

OBJECTIVE To understand the current status of the research on rational drug use among the elderly population in Chinese elderly care facilities， and to provide ideas for future related research. METHODS Retrieved from PubMed， Web of Science， Embase， CNKI， Wanfang database and VIP， relevant literature about the research on rational drug use among the elderly population in Chinese elderly care facilities were collected to evaluate the current status of research on the rational drug use among the elderly population in elderly care facilities. RESULTS A total of 14 cross-sectional studies were included. All included studies were completed before 2019 and focused on the eastern coastal areas of China. The AXIS quality scores of the included studies showed a mean score of 11.14±2.25， with six studies having a quality score ＞10. The 14 studies examined a total of 5 770 older adults in elderly care facilities， involving 181 elderly care facilities. Eight studies reported the type of chronic disease in the older adult population of the elderly care facilities； seven studies reported the type of medication used. Nine studies had medication compliance as an outcome， among which seven studies used different analytical methods to analyze the factors influencing medication compliance. The results showed that age， education， duration of illness， type of elderly care facilities， and level of staff attention had significant influence on medication compliance in the elderly population in the elderly care facilities. CONCLUSIONS There is insufficient research related to rational drug use among the elderly population in the elderly care facilities in China， and there is a lack of interventional studies to assess the effectiveness of the rational drug use service in the elderly population in the elderly care facilities. Most of the current research is based on cross-sectional studies， focusing on medication compliance.

Association between Norovirus epidemics and school toilets design and management in Chengdu City / 中国学校卫生

Objective@#To analyze the relationship between the toilet design and sanitary condition of primary and secondary schools in Chengdu and the epidemic situation of Norovirus infection, so as to provide scientific references for school toilet design and Norovirus prevention and control.@*Methods@#A total of 78 cases of norovirus epidemics from 2019 to 2020 were included in this study. These epidemics happened in 78 schools and the causes were indicated as human-to-human transmission. The Chi square and Mann-Whitney U test were used to compare categorical and continuous data respectively. Unconditional binary Logistic regression was used to examine the multivariate associations.@*Results@#Most epidemics happened from October in 2019 to March in 2020(79.49%, 62 cases), in primary schools (71.79%, 56 cases) and in the center area (52.56%, 41 cases). The median of the case number in each epidemic was 10. Overall, 56 schools (71.79%) were equipped with toilets which were flushed independently, and 22 schools (28.21%) were equipped with toilets which were flushed uniformly. There were 27 schools (34.62%) that did not have enough water taps. Logistic regression analysis found that those with toilets flushed uniformly had a stronger epidemic, compared to the schools with toilets flushed independently( OR=5.53, 95%CI=1.63-18.76, P <0.05).@*Conclusion@#In order to prevent intestinal infectious diseases , it is suggested that schools should design or reconstruct independent flushing toilets with adequate faucets.

Critical assessment of resource waste in staging and follow-up of breast cancer

SUMMARY BACKGROUND: Breast cancer is a public health problem with both high incidence and cure rates. After treatment, patients are monitored for long periods of time due to the risk of recurrence. Thus, staging and follow-up strategies should consider not only the best results for the patient but also its costs for the public health system. OBJECTIVE: The objective of this study was to quantify the waste of resources on breast cancer follow-up and evaluate its impact on the public health system. METHODS: This is a retrospective analysis of consecutive medical records to identify the intervals between consultations and tests used for staging and during the first 2 years of follow-up of patients with breast cancer treated at a public hospital in Brazil. Data were compared with the guidelines of the main international consensus. RESULTS: Medical records of 60 consecutive patients treated in 2018 were selected, of whom 52 had 2 or more years of follow-up, and 8 had only 1 year of complete follow-up. A total of 34 patients (56.67%) underwent excessive examinations for stating. During follow-up, 125 surplus consultations were performed (33.6%). In this phase, 111 surplus exams were also performed, representing an increase of 100.9%. A total of 423 laboratory tests were performed for 18 patients in the first year and 229 tests for 14 patients in the second year. CONCLUSION: Excessive tests and consultations significantly burdened the Unified Health System without any benefit to patients. Better adherence to staging and follow-up recommendations could reduce costs and optimize the limited resources used in the public health system.

The language models in healthcare and the role of chatgpt: comments / Os modelos de linguagem em saúde e o papel do chatgpt: comentários

ABSTRACT The introduction of chatbots has been one of the most intriguing advances in artificial intelligence. There are numerous potential uses for artificial intelligence in clinical research. However, there are also some issues that require attention. Everyone agrees that AI requires a more stable foundation and that a cutting-edge approach is necessary for AI to operate effectively.

RESUMO A introdução de chatbots foi um dos avanços mais intrigantes da inteligência artificial. Existem inúmeros usos potenciais para a inteligência artificial (IA) na pesquisa clínica. No entanto, há também outras questões que requerem atenção. Todos concordam que a IA precisa de uma base mais estável. Todos podemos concordar que uma abordagem de ponta é necessária para que a IA opere de forma eficaz.

Processamento de linguagem natural não supervisionado na identificação de pacientes suspeitos de infecção por COVID-19 / Procesamiento del lenguaje natural no supervisado para identificar a los pacientes sospechosos de infección por COVID-19 / Unsupervised natural language processing in the identification of patients with suspected COVID-19 infection

Os pacientes com síndrome pós-COVID-19 se beneficiam de programas de promoção de saúde e sua rápida identificação é importante para a utilização custo efetiva desses programas. Técnicas tradicionais de identificação têm fraco desempenho, especialmente em pandemias. Portanto, foi realizado um estudo observacional descritivo utilizando 105.008 autorizações prévias pagas por operadora privada de saúde com aplicação de método não supervisionado de processamento de linguagem natural por modelagem de tópicos para identificação de pacientes suspeitos de infecção por COVID-19. Foram gerados seis modelos: três utilizando o algoritmo BERTopic e três modelos Word2Vec. O modelo BERTopic cria automaticamente grupos de doenças. Já no modelo Word2Vec, para definição dos tópicos relacionados a COVID-19, foi necessária análise manual dos 100 primeiros casos de cada tópico. O modelo BERTopic com mais de 1.000 autorizações por tópico sem tratamento de palavras selecionou pacientes mais graves - custo médio por autorizações prévias pagas de BRL 10.206 e gasto total de BRL 20,3 milhões (5,4%) em 1.987 autorizações prévias (1,9%). Teve 70% de acerto comparado à análise humana e 20% de casos com potencial interesse, todos passíveis de análise para inclusão em programa de promoção à saúde. Teve perda importante de casos quando comparado ao modelo tradicional de pesquisa com linguagem estruturada e identificou outros grupos de doenças - ortopédicas, mentais e câncer. O modelo BERTopic serviu como método exploratório a ser utilizado na rotulagem de casos e posterior aplicação em modelos supervisionados. A identificação automática de outras doenças levanta questionamentos éticos sobre o tratamento de informações em saúde por aprendizado de máquina.

Los pacientes con síndrome pos-COVID-19 pueden beneficiarse de los programas de promoción de la salud. Su rápida identificación es importante para el uso efectivo de estos programas. Las técnicas de identificación tradicionales no tienen un buen desempeño, especialmente en pandemias. Se realizó un estudio observacional descriptivo, con el uso de 105.008 autorizaciones previas pagadas por un operador de salud privado mediante la aplicación de un método no supervisado de procesamiento del lenguaje natural mediante modelado temático para identificar a los pacientes sospechosos de estar infectados por COVID-19. Se generaron 6 modelos: 3 con el uso del algoritmo BERTopic y 3 modelos Word2Vec. El modelo BERTopic crea automáticamente grupos de enfermedades. En el modelo Word2Vec para definir temas relacionados con la COVID-19, fue necesario el análisis manual de los primeros 100 casos de cada tema. El modelo BERTopic con más de 1.000 autorizaciones por tema sin tratamiento de palabras seleccionó a pacientes más graves: costo promedio por autorizaciones previas pagada de BRL 10.206 y gasto total de BRL 20,3 millones (5,4%) en 1.987 autorizaciones previas (1,9%). Además, contó con el 70% de aciertos en comparación con el análisis humano y el 20% de los casos con potencial interés, todos los cuales pueden analizarse para su inclusión en un programa de promoción de la salud. Hubo una pérdida significativa de casos en comparación con el modelo tradicional de investigación con lenguaje estructurado y se identificó otros grupos de enfermedades: ortopédicas, mentales y cáncer. El modelo BERTopic sirvió como un método exploratorio para ser utilizado en el etiquetado de casos y su posterior aplicación en modelos supervisados. La identificación automática de otras enfermedades plantea preguntas éticas sobre el tratamiento de la información de salud mediante el aprendizaje de máquina.

Patients with post-COVID-19 syndrome benefit from health promotion programs. Their rapid identification is important for the cost-effective use of these programs. Traditional identification techniques perform poorly especially in pandemics. A descriptive observational study was carried out using 105,008 prior authorizations paid by a private health care provider with the application of an unsupervised natural language processing method by topic modeling to identify patients suspected of being infected by COVID-19. A total of 6 models were generated: 3 using the BERTopic algorithm and 3 Word2Vec models. The BERTopic model automatically creates disease groups. In the Word2Vec model, manual analysis of the first 100 cases of each topic was necessary to define the topics related to COVID-19. The BERTopic model with more than 1,000 authorizations per topic without word treatment selected more severe patients - average cost per prior authorizations paid of BRL 10,206 and total expenditure of BRL 20.3 million (5.4%) in 1,987 prior authorizations (1.9%). It had 70% accuracy compared to human analysis and 20% of cases with potential interest, all subject to analysis for inclusion in a health promotion program. It had an important loss of cases when compared to the traditional research model with structured language and identified other groups of diseases - orthopedic, mental and cancer. The BERTopic model served as an exploratory method to be used in case labeling and subsequent application in supervised models. The automatic identification of other diseases raises ethical questions about the treatment of health information by machine learning.

Reseña histórica de la revista ONCOLOGÍA (Ecuador) / Historical review of the journal ONCOLOGÍA (Ecuador)

La revista Oncología (Ecuador) es una revista médica de acceso abierto que se publica cuatrimestralmente por la Sociedad de Lucha contra el Cáncer del Ecuador (SOLCA). La revista fue fundada en 1993 y publica artículos originales, revisiones bibliográficas, artículos especiales, casos clínicos y cartas al editor en el campo de la oncología.La revista Oncología (Ecuador) está indexada en las siguientes bases de datos: Latindex, LILACS, DOAJ, tiene un comité editorial internacional que está compuesto por expertos en oncología de todo el mundo. Los manuscritos enviados a la revista son revisados por pares.La revista Oncología (Ecuador) es una importante fuente de información para los profesionales de la salud que trabajan en el campo de la oncología.

The journal Oncología (Ecuador) is an open-accessmedical journal published quarterly by the Society for the Fight against Cancer of Ecuador (SOLCA). The journal was founded in 1993 and publishes original articles, literature reviews, special articles, clinical cases,and letters to the editor in the field of oncology.The journal Oncología (Ecuador) is indexed in the following databases: Latindex, LILACS, and DOAJ, which havean international editorial board that is made up of oncology experts from around the world. Manuscripts submitted to the Journal are peer-reviewed.The JpurnalOncología (Ecuador) is an essentialsource of information for health professionals working in oncology

Análisis comparativo de la acreditación de unidades médicas en Canadá, Chile, la Comunidad Autónoma de Andalucía, Dinamarca y México / Comparative analysis of the accreditation of medical facilities in Canada, Chile, the Autonomous Community of Andalusia, Denmark, and Mexico / Análise comparativa da acreditação de estabelecimentos de saúde no Canadá, Chile, Comunidade Autônoma da Andaluzia, Dinamarca e México

RESUMEN Objetivo. Contrastar las características del proceso de acreditación de establecimientos de salud en Canadá, Chile, la Comunidad Autónoma de Andalucía, Dinamarca y México, con el fin de identificar elementos comunes y diferencias, y las lecciones aprendidas que puedan ser de utilidad para otros países y regiones. Métodos. Estudio observacional, analítico y retrospectivo en el que se usaron fuentes secundarias de libre acceso sobre acreditación y certificación de establecimientos de salud durante el período 2019-2021 en estos países y regiones. Se describen las características generales del proceso de acreditación y sus respuestas a puntos clave del diseño de estos programas. Además, se generaron categorías de análisis para el avance en su implementación y su nivel de complejidad, y se resumen los resultados favorables y desfavorables informados. Resultados. Los componentes operativos del proceso de acreditación son peculiares de cada país, aunque comparten similitudes. El programa de Canadá es el único que contempla algún tipo de evaluación responsiva. Hay una amplia variación en la cobertura de establecimientos acreditados entre países (desde 1% en México a 34,7% en Dinamarca). Entre las lecciones aprendidas, se destacan la complejidad de aplicación del sistema mixto público-privado (Chile), el riesgo de una excesiva burocratización (Dinamarca) y la necesidad de incentivos claros (México). Conclusiones. Los programas de acreditación operan de forma peculiar en cada país o región, logran alcances diferentes y presentan problemáticas también diversas, de las que podemos aprender. Es necesario considerar los elementos que obstaculizan la implementación y generar adecuaciones para los sistemas de salud en cada país o región.

ABSTRACT Objective. To compare and contrast the characteristics of the accreditation process for health care facilities in Canada, Chile, the Autonomous Community of Andalusia (Spain), Denmark, and Mexico, in order to identify shared characteristics, differences, and lessons learned that may be useful for other countries and regions. Methods. An observational, analytical, retrospective study using open-access secondary sources on the accreditation and certification of health care facilities in 2019-2021 in these countries and regions. The general characteristics of the accreditation processes are described and comments are made on key aspects of the design of these programs. Additionally, analytical categories were created for degree of implementation and level of complexity, and the positive and negative results reported are summarized. Results. The operational components of the accreditation processes are country-specific, although they share similarities. The Canadian program is the only one that involves some form of responsive evaluation. There is a wide range in the percentage of establishments accredited from country to country (from 1% in Mexico to 34.7% in Denmark). Notable lessons learned include the complexity of application in a mixed public-private system (Chile), the risk of excessive bureaucratization (Denmark), and the need for clear incentives (Mexico). Conclusions. The accreditation programs operate in a unique way in each country and region, achieve varying degrees of implementation, and have an assortment of problems, from which lessons can be learned. Elements that hinder their implementation should be considered and adjustments made for the health systems of each country and region.

RESUMO Objetivo. Comparar as características do processo de acreditação de estabelecimentos de saúde no Canadá, Chile, Comunidade Autônoma da Andaluzia, Dinamarca e México, a fim de identificar elementos comuns e diferenças, bem como lições aprendidas que podem ser úteis para outros países e regiões. Métodos. Estudo observacional, analítico e retrospectivo usando fontes secundárias de livre acesso sobre acreditação e certificação de estabelecimentos de saúde durante o período 2019-2021 nos países e regiões supracitados. As características gerais do processo de acreditação e suas respostas a pontos-chave no delineamento de tais programas foram descritas. Além disso, foram geradas categorias de análise para o andamento de sua implantação e seu grau de complexidade, e os desfechos favoráveis e desfavoráveis relatados foram resumidos. Resultados. Os componentes operacionais do processo de acreditação são peculiares a cada país, embora compartilhem certas semelhanças. O programa canadense é o único que contempla algum tipo de avaliação responsiva. Houve grande variação entre países no percentual de estabelecimentos acreditados (de 1% no México a 34,7% na Dinamarca). Entre as lições aprendidas, destacam-se a complexidade da aplicação do sistema misto público-privado (Chile), o risco de burocratização excessiva (Dinamarca) e a necessidade de incentivos claros (México). Conclusões. Os programas de acreditação operam de forma peculiar em cada país ou região, têm diferentes escopos e também apresentam diversos problemas a partir dos quais podemos aprender. É preciso considerar os elementos que dificultam a implementação e realizar as adequações necessárias para os sistemas de saúde de cada país ou região.

Capital estrangeiro e mudança estrutural no mercado privado de serviços de saúde brasileiro / Foreign capital and structural change in the Brazilian private health services market / Capital extranjero y cambio estructural en el mercado privado de servicios de salud brasileño

Resumo: Este artigo analisa o processo de transformação estrutural no mercado privado de serviços de saúde brasileiro a partir dos anos 2000, com ênfase na crescente participação de fundos financeiros e do capital estrangeiro no processo de expansão e consolidação do setor. A análise do movimento de ingresso do capital estrangeiro nos serviços e planos de saúde no Brasil foi desenvolvida a partir da construção de uma base dados com um total de 297 operações patrimoniais envolvendo empresas com atividades em serviços de saúde, inclusive operadoras de planos e seguros de saúde e administradoras de benefícios em saúde. A análise dessas operações evidencia que o afluxo de capital estrangeiro foi fundamental para viabilizar a centralização de capital em determinadas empresas e catalisar o processo de concentração e transformação estrutural do setor de serviços de saúde ao longo das últimas duas décadas. Conclui-se que o acirramento da disputa intercapitalista no mercado de serviços de saúde levou à emergência de grandes corporações no mercado e a novos modelos de negócio, com destaque especial para o surgimento de redes verticalizadas de atendimento (operação de planos, serviços hospitalares, ambulatoriais, de diagnóstico e tratamento e de atenção básica).

Abstract: This article analyzes the process of structural transformation within the Brazilian private health services market since the 2000s, with emphasis on the growing participation of financial funds and foreign capital in the process of expansion and consolidation of the sector. The analysis of the movement of foreign capital into health services and plans in Brazil was developed from the construction of a database with a total of 297 equity operations involving companies with activities in health services, including companies operating health plans and insurance and companies administering health benefits. The analysis of these operations shows that the influx of foreign capital was fundamental to enable the centralization of capital in certain companies and catalyze the process of concentration and structural transformation of the health services sector over the last two decades. We concluded that the intensification of the intercapitalist dispute within the health services market led to the emergence of large corporations and new business models, with special emphasis on the emergence of verticalized care networks (operation of plans, hospital services, outpatient services, diagnosis and treatment, and primary care).

Resumen: Este artículo analiza el proceso de transformación estructural en el mercado privado de servicios de salud brasileño, a partir de los años 2000, con énfasis en la creciente participación de fondos financieros y del capital extranjero en el proceso de expansión y consolidación del sector. El análisis del movimiento de ingreso del capital extranjero en los servicios y planes de salud en Brasil fue desarrollado a partir de la construcción de una base datos con un total de 297 operaciones de capital de empresas con actividades en servicios de salud; inclusive las empresas operadoras de planes y seguros de salud y las empresas administradoras de beneficios en salud. El análisis de esas operaciones muestra que la entrada de capital extranjero fue fundamental para viabilizar la centralización de capital en determinadas empresas y catalizar el proceso de concentración y transformación estructural del sector de servicios de salud a lo largo de las últimas dos décadas. La conclusión que el recrudecimiento de la disputa intercapitalista dentro del mercado de servicios de salud llevó a la emergencia de grandes corporaciones en el mercado y nuevos modelos de negocio, con destaque especial para surgimiento de redes verticalizadas de atención (operación de planes, servicios hospitalarios, ambulatorios, de diagnóstico y tratamiento y de atención básica).

Desigualdades de cor/raça na disponibilidade de instalações para a prática de atividades físicas e esportes nas escolas públicas de educação básica do Brasil / Color/race inequalities in the availability of facilities for physical activities and sports in public elementary schools in Brazil / Desigualdades de color/raza en la disponibilidad de instalaciones para la práctica de actividades físicas y deportivas en escuelas públicas de educación básica en Brasil

RESUMO O objetivo deste estudo ecológico foi estimar desigualdades nas instalações para atividades físicas e esportes (AF) nas escolas públicas de Educação Básica brasileiras (n=70.276), conforme a proporção de matrículas de estudantes autodeclarados negros. Os resultados mostraram que escolas urbanas e rurais com maior proporção de matrículas de estudantes negros (≥60%) apresentaram menos pátio descoberto, quadra coberta e descoberta, parque infantil, estúdio de dança e materiais para a prática desportiva e recreação. Essas desigualdades são traços do racismo, que é estruturante na sociedade brasileira e é institucionalizado na oferta de condições desfavoráveis ao engajamento em AF nas escolas públicas que atendem um maior número de alunos pretos e pardos.

ABSTRACT The aim of this study was to estimate inequality in physical activity and sports facilities at Brazilian public elementary schools, according to percent of self-reported black students. Our results showed that schools from urban or rural areas with a higher percentage of enrollments of self-reported black students (≥60%) presented fewer outdoor courtyards, sport court indoor and outdoor, playgrounds, dance studios, and materials for sports and recreation. These inequalities are a feature of racism, which is structural in Brazilian society and institutionalized in unfavorable conditions for engaging in physical activity and sports at public elementary schools where there is a higher number of black students.

RESUMEN Este estudio ecológico tuvo como objetivo estimar las desigualdades en las instalaciones para actividades físicas y deportivas (AF) en las escuelas públicas brasileñas de Educación Básica (n=70.276), según la proporción de matrículas de alumnos que se declararon negros. Los resultados mostraron que las escuelas urbanas y rurales con mayor proporción de matrículas de estudiantes negros (≥60%) tenían menos patio al aire libre, canchas interiores y exteriores, parques infantiles, estudios de danza y materiales para deportes y recreación. Esas desigualdades son rasgos del racismo, que es estructural en la sociedad brasileña y está institucionalizado al ofrecer condiciones desfavorables para la práctica de AF en las escuelas públicas que atienden a un mayor número de alumnos negros y pardos.

Coping with the economic burden of non-communicable diseases among hypertensive and diabetic patients in private and public health facilities in Ado-Ekiti, Nigeria

Objective: To assess and compare how private and public health facilities patients cope with the economic burden of non-communicable diseases. Design: Comparative cross-sectional study. Setting: Thirty-nine private and eleven public health facilities in Ado-Ekiti, Nigeria Participants: Three hundred and forty-eight (Private:173; Public:175) patients with hypertension or diabetes, or both were recruited. Main Outcome Measures: Specific coping methods and numbers of coping strategies used by participants, as well as the perceived ability of participants to cope with the economic burden of non-communicable diseases. Results: Majority of participants paid through out-of-pocket (OOP) than through health insurance(HI) (Private:OOP:90.2% HI:9.8%; Public:OOP:94.3% HI:5.7%; p=0.152). More participants in private used instalment payments(p<0.001). However, other coping strategies showed no significant difference in both groups(p>0.05). Delayed treatment (Private:102; Public:95) was the most used strategy in both arms, and the number of strategies used by the participants showed no significant difference(p=0.061). Lower levels of education, out-of-pocket payment, increasing number of clinic visits, and hospital admission were associated with the use of higher numbers of coping strategies in both groups while being female and retired/unemployed were associated with the private arm. Conclusion: Although most patients in both groups pay out-of-pocket and use detrimental coping strategies, more patients in private arm use instalment payment, a non-detrimental method. Healthcare providers, especially public providers, should adopt policies encouraging patients to use non-detrimental coping strategies to meet their healthcare expenditures.

Community health workers' experiences of supervision by nurses at clinics in Limpopo Province

Background: Supervision of community health workers (CHWs) is considered, among others, a strategy to achieve universal healthcare globally. In South Africa, it is incorporated in the ward-based primary healthcare (PHC) outreach teams' policy and strategy, a national health insurance policy component. Supervision of CHWs by nurses in the policy is considered a measure to facilitate PHC service provision to communities. However, CHWs experienced varying levels of supervision from nurses and other workers globally and in South Africa. Aim: This study explored and described the experiences of CHWs about supervision received from nurses at PHC facilities in Limpopo Province. Setting: Participants were drawn from seven PHC facilities in Polokwane and Lepelle-Nkumpi subdistricts of the Capricorn District. Methods: A qualitative exploratory-descriptive and contextual study design was employed. Participants were selected utilising a purposive sampling method. Semi-structured interviews were conducted to collect data. Data were analysed according to themes and their associated categories. Measures to ensure rigour and ethical principles were applied. Results: Two main themes emerged: positive supervision experienced by CHWs and supervision challenges experienced by CHWs. Conclusion: The varying experiences of CHWs about supervision from nurses emerged and reflected the need for functioning supervision mechanisms. Contribution: The experiences of CHWs indicated inconsistent delivery of supervision by nurses in PHC facilities. The findings highlighted the need for effective supervision measures that are vital for the success of the CHW supervision programme.

Respuesta en la atención del cáncer durante la pandemia por COVID-19 en Colombia: gestión en clínicas y hospitales / Cancer Care Response During the COVID-19 Pandemic in Colombia: Management in Clinics and Hospitals / Resposta no atendimento ao câncer durante a pandemia de COVID-19 na Colômbia: gestão em clínicas e hospitais

Introducción. El principal reto en la atención del cáncer durante la pandemia causada por la COVID-19 fue asegurar la oportunidad en el diagnóstico y tratamiento a cerca de 100,000 casos nuevos de cáncer al año en Colombia. El objetivo de esta investigación fue conocer la respuesta de las Instituciones Prestadoras de Servicios de Salud sobre su gestión en los servicios para la atención de la patología oncológica en el primer semestre del año 2020. Metodología. Estudio descriptivo y transversal tipo encuesta sobre la caracterización de los pacientes oncológicos con COVID-19, la capacidad instalada, la atención integral del cáncer, la implementación de telesalud/telemedicina y el apoyo institucional durante la pandemia. Participaron veinticinco prestadores con servicio de cirugía oncológica y quimioterapia o radioterapia. Resultados. El 56% de prestadores reportó pacientes oncológicos con COVID-19. Todos reportaron cambios de gestión en la capacidad resolutiva ante la pandemia: el 76% acondicionó infraestructura y dispositivos, el 84% adoptó la telesalud/telemedicina y el 92% recibió asistencia en planes de acción. El 48% de las instituciones prestadoras evidenciaron una disminución en el tamizaje de cáncer. Discusión. Este estudio evidencia que la emergencia de la pandemia obligó a apresurar los esfuerzos de infraestructura y recursos en las entidades oncológicas de Colombia. Los resultados obtenidos en la disminución de tamización de cáncer a nivel nacional se equiparán con los datos reportados por distintos países, incluyendo la región de las Américas. Conclusión. Los hallazgos evidencian la necesidad de mejorar la capacidad de respuesta del sistema de salud en escenarios de emergencia sanitaria que eviten el retraso en la atención y las acciones en salud pública del cáncer.

Introduction. The main challenge in cancer care during the COVID-19 pandemic was to ensure the timelines of diagnosis and treatment of nearly 100,000 new cancer cases per year in Colombia. The objective of this research was to know the response of the Health Service Provider Institutions on their management of services for cancer care in the first semester of the year 2020. Methodology. Descriptive, cross-sectional, survey-type study on the characterization of cancer patients with COVID-19, installed capacity, comprehensive cancer care, telehealth/telemedicine implementation, and institutional support during the pandemic. Twenty-five providers with oncological surgery and chemotherapy or radiotherapy services participated. Results. Fifty-six percent of providers reported cancer patients with COVID-19. Everyone reported management changes in pandemic response capacity: 76% upgraded infrastructure and devices, 84% adopted telehealth/telemedicine and 92% received assistance in action plans. Forty-eight percent of the provider institutions showed a decrease in cancer screening. Discussion. This study shows that the emergency of the pandemic forced to rush the efforts of infrastructure and resources in the oncological entities of Colombia. The results obtained in the decrease of cancer screening nationally will be equated with the data reported by different countries, including the Americas region. Conclusion. The findings show the need to improve the response capacity of the health care system in health emergency scenarios to avoid delays in cancer care and public health actions.

Introdução. O principal desafio no tratamento do câncer durante a pandemia causada pelo COVID-19 foi garantir oportunidade no diagnóstico e tratamento de quase 100,000 novos casos de câncer por ano na Colômbia. O objetivo desta pesquisa foi conhecer a resposta das Instituições Prestadoras de Serviços de Saúde sobre sua gestão nos serviços para atendimento de patologia oncológica no primeiro semestre do ano de 2020. Metodologia. Estudo descritivo e transversal do tipo enquete sobre caracterização de pacientes oncológicos com COVID-19, capacidade instalada, atenção integral ao câncer, implantação de telessaúde/telemedicina e apoio institucional durante a pandemia. Participaram vinte e cinco prestadores de serviços de cirurgia oncológica e quimioterapia ou radioterapia. Resultados. 56% dos provedores relataram pacientes oncológicos com COVID-19. Todos relataram mudanças de gestão na capacidade de resposta diante da pandemia: 76% adaptaram infraestrutura e dispositivos, 84% adotaram telessaúde/telemedicina e 92% receberam assistência em planos de ação. 48% das instituições prestadoras apresentaram uma diminuição no rastreamento do câncer. Discussão. Este estudo mostra que a emergência da pandemia obrigou a acelerar os esforços de infraestrutura e recursos nas entidades oncológicas da Colômbia. Os resultados obtidos na redução do rastreamento do câncer em nível nacional são equivalentes com os dados relatados por diferentes países, incluindo a região das Américas. Conclusão. Os achados mostram a necessidade de melhorar a capacidade de resposta do sistema de saúde em cenários de emergência sanitária que evitem atrasos no atendimento e nas ações de saúde pública para o câncer.