Research on the Innovation Path of College Students’ Volunteer Service under the Background of Epidemic Prevention and Control: Taking Beijing University of Chinese Medicine as an Example / 中国医学伦理学

Volunteer service is an important way for contemporary Chinese college students to carry out social practice, and an effective carrier for strengthening ideological and political work in the new era. During the prevention and control of the COVID-19, college students, as a solid force in the volunteer team, actively participated in the anti-epidemic volunteer service, which not only improved their practical ability, but also practiced the core socialist values and inherited the excellent traditional Chinese culture. Based on the existing practical experience in volunteer service, Beijing University of Chinese Medicine has made use of multiple channels and resources to improve the volunteer training system, strengthen the guarantee of volunteer service, realize the high-quality leapfrog development of college students’ volunteer service, and provide experience and reference for the innovation of college students’ volunteer service in the new era.

Research on the supply guarantee system of orphan drugs in South Korea from the perspective of accessibility and its enlightenment / 中国药房

OBJECTIVE To systematically introduce the supply guarantee system of orphan drugs in South Korea， and to provide reference for improving the accessibility of orphan drugs in China. METHODS The basic characteristics and practical experience of supply guarantee system of orphan drugs in South Korea were summarized by studying the marketing incentive mechanism， reserve supply mechanism and emergency use mechanism. Then， based on the research on the current situation and existing problems of orphan drug supply in China， specific suggestions were put forward to improve the accessibility of orphan drugs in China. RESULTS & CONCLUSIONS South Korea has effectively improved the accessibility of orphan drugs through orphan drug identification channels and supporting incentive policies， relying on the reserve supply mechanism and the import route for emergency use. Therefore， it is suggested that China should guarantee the normal supply of orphan drugs from three aspects： improving the recognition and incentive policy of orphan drugs， building a full-time management department of orphan drugs， and optimizing the temporary import path.

Ethical Enlightenment of Foreign Rare Disease Treatment Guarantee System to China / 中国医学伦理学

By summarizing the policies and regulations of foreign countries on rare disease research and drug research and development, referring to the relevant policy support of treatment guarantee system in the development of rare diseases abroad, and combining with China’s national conditions, this paper analyzed the feasible points that China can learn from, and then put forward some suggestions on the ethical problems existing in the current rare disease research, so as to provide reference suggestions for the relevant policy formulation of rare disease treatment guarantee in China: adjusting regional differences based on the principle of fairness, and establishing a national rare disease information collection center; improving the ethical quality of scientific research in pharmaceutical companies, and strengthening ethical supervision; and the government and society fulfill their obligations to protect the rights and interests of patients with rare diseases.

Effect of intraoperative ventilation modes on postoperative pulmonary complications after cardiac surgery under cardiopulmonary bypass: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To evaluate the association of intraoperative ventilation modes with postoperative pulmonary complications (PPCs) in adult patients undergoing selective cardiac surgery under cardiopulmonary bypass (CPB). Methods    The clinical data of 604 patients who underwent selective cardiac surgical procedures under CPB in the West China Hospital, Sichuan University from June to December 2020 were retrospectively analyzed. There were 293 males and 311 females with an average age of 52.0±13.0 years. The patients were divided into 3 groups according to the ventilation modes, including a pressure-controlled ventilation-volume guarantee (PCV-VG) group (n=201), a pressure-controlled ventilation (PCV) group (n=200) and a volume-controlled ventilation (VCV) group (n=203). The association between intraoperative ventilation modes and PPCs (defined as composite of pneumonia, respiratory failure, atelectasis, pleural effusion and pneumothorax within 7 days after surgery) was analyzed using modified poisson regression. Results    The PPCs were found in a total of 246 (40.7%) patients, including 86 (42.8%) in the PCV-VG group, 75 (37.5%) in the PCV group and 85 (41.9%) in the VCV group. In the multivariable analysis, there was no statistical difference in PPCs risk associated with the use of either PCV-VG mode (aRR=0.951, 95%CI 0.749-1.209, P=0.683) or PCV mode (aRR= 0.827, 95%CI 0.645-1.060, P=0.133) compared with VCV mode. Conclusion    Among adults receiving selective cardiac surgery, PPCs risk does not differ significantly by using different intraoperative ventilation modes.

La prostitución en Colombia, un camino hacia la formalización / Prostitution in Colombia: A Pathway to Formalization

Resumen La regulación normativa y la jurisprudencia referente a la formalización de la práctica de la prostitución ha tenido avances significativos en el Estado Colombiano. Sin embargo, persisten una serie de dificultades que hace que el ejercicio de esta actividad se vea frustrada por falta de garantías en el ejercicio de los derechos, haciendo que los personas que ejercen esta actividad económica, se vean inmersas en la informalidad que históricamente ha caracterizado esta labor.

Abstract The normative regulation and jurisprudence regarding the formalization of the practice of prostitution has had significant advances in the Colombian State. However, there are still a series of difficulties, which frustrate the exercise of this activity due to the lack of guarantees in the exercise of rights, by causing people, who exercise this economic activity, to be immersed in the informality, which has historically characterized this work.

El agente educativo en la garantía de la protección integral de la primera infancia / The Educational Agent in Ensuring Comprehensive Early Childhood Protection

Resumen Al identificar los aportes investigativos sobre el rol que ejercen los docentes de primera infancia para la garantía de la protección integral en la niñez, se evidenciaron las brechas en la garantía de la protección integral a la infancia, las cuales surgen desde el mismo núcleo familiar, desde el Estado por la dificultad de cumplir con esta labor, por la falta de corresponsabilidad social frente a los niños y la recarga en los docentes como principales actores en este proceso. Aunque el agente educativo, es un actor significativo para el desarrollo integral de los niños, no puede recaer en su quehacer toda la responsabilidad de la protección a la primera infancia, es necesario articular esfuerzos estatales que comprometan otras instancias institucionales y actores sociales, que posibiliten brindar servicios educativo formativos a la primera infancia, propiciar y recrear espacios para la participación de las familias y de personas significativas en las acciones orientadas a la Protección infantil.

Abstract By identifying research contributions to the role played by teachers in early childhood for ensuring comprehensive protection in children, gaps in ensuring comprehensive child protection, which arise from the same family nucleus, from the State because of the difficulty of fulfilling this work, by the lack of social co-responsibility against children and recharging on teachers as key players in this process, were evident. Although the educational agent, a significant player for the integral development of children, cannot rest with its responsibility for early childhood protection, it is necessary to articulate state efforts, which compromise other institutional instances and social actors, which make it possible to provide educational services early childhood training, to foster, and to recreate spaces for the participation of families and significant people in actions oriented to child protection.

Caracterización de los recobros realizados por la Secretaría Seccional de Salud y Protección Social de Antioquia al Fondo de Solidaridad y Garantía por atenciones No pos. 2010-2013 / Characterization of reimbursements claimed by the Departmental Health and Social Protection Secretariat of Antioquia and submitted to the Solidarity and Guarantee Fund for non-POS interventions. 2010-2013 / Caracterização dos pedidos de ressarcimento realizados pela Secretaria Seccional de Saúde e Proteção Social de Antioquia ao Fundo de Solidariedade e Garantia por atendimentos Não-POS 2010/2013

Resumen Objetivo: Caracterizar los recobros realizados por la Secretaría Seccional de Salud y Protección Social de Antioquia (ssspsa) al Fondo de Solidaridad y Garantía, por atenciones No pos entre 2010-2013. Metodología: Se realizó un estudio descriptivo retrospectivo, según información oficial suministrada por la ssspsa, teniendo en cuenta el total de facturas recobradas (894), por $7 815 241 869. Resultados: 1) las facturas recobradas disminuyeron del 56 al 9 %, con variación negativa de -84 %; los valores recobrados disminuyeron del 51 al 15 %, con variación negativa del -71 %, y los pacientes implicados tuvieron una variación negativa de -79 %; 2) las facturas avaladas pasaron de 81 a 3 %, con variación negativa de -96 %; los valores, del 56,9 al 15 %, con una variación negativa de -79 %, y los pacientes con valores avalados, con variación negativa de -95 %. La glosa fue del 60 %, y solo se reconoció el 5 % de las respuestas. Predominaron recobros y avales para medicamentos, con el 67,5 y 61 % respectivamente. Estuvieron comprometidas 17 instituciones y 399 pacientes, con promedio de 2,2 facturas / paciente. Conclusión: Disminuyeron las solicitudes de recobro y los avales, y predominaron los medicamentos como evento recobrado y avalado. El alto porcentaje de glosa y la baja recuperación por las respuestas a las mismas, hacen el proceso ineficiente e inefectivo, lo que retarda los pagos a las instituciones prestadoras de salud y aumenta el riesgo de crisis hospitalaria, con consecuencias negativas para la salud y la salud pública de la población.

Abstract Objective: To characterize reimbursements claimed by the Departmental Health and Social Protection Secretariat of Antioquia (SSSPSA) and submitted to the Solidarity and Guarantee Fund for non-POS interventions [services not covered by the Compulsory Health Plan] between 2010 and 2013. Methodology: A retrospective descriptive study was performed based on official information provided by the SSSPSA considering the total of reimbursed claims (894) corresponding to 7,815,241,869 COP. Results: 1) Reimbursed claims decreased from 56 to 9%, with a negative variance of -84 %; reimbursed items decreased from 51 to 15%, with a negative variance of -71 %, and patients involved had a negative variance of -79 %; 2) accepted claims decreased from 81 to 3% with a negative variance of -96 %, values decreased from 56.9 to 15 %, with a negative variance of -79 %, and patients with accepted items exhibited a negative variance of -95 %. The percentage of rejected claims was 60% and only 5% of justifications were accepted. Reimbursements and approvals for medications prevailed at 67.5 and 61 % respectively. 17 institutions and 399 patients were involved with an average of 2.2 claims/patient. Conclusion: Medical claims and approvals decreased, and medications as approved and reimbursed events prevailed. The high percentage of rejected claims and the low reimbursement rates of the medical claims make the billing process inefficient and ineffective. They also delay payments to health care facilities and increase the risk of health crisis with negative consequences for the health of population.

Resumo Objetivo: Caracterizar os ressarcimentos realizados pela Secretaria Seccional de Saúde e Proteção Social de Antioquia (SSSPSA) ao Fundo de Solidariedade e Garantia, pelos atendimentos Não-POS (Plano Obrigatório de Saúde) entre 2010/2013. Metodologia: Foi realizado um estudo descritivo retrospectivo, de acordo com a informação oficial concedida pela SSSPSA, considerando o total de faturas ressarcidas (894), pelo valor de $7.815.241.869 pesos colombianos. Resultados: 1) As faturas ressarcidas diminuíram de 56 a 9%, com variação negativa de -84%; os valores ressarcidos diminuíram de 51 a 15%, com variação negativa de -71% e os pacientes envolvidos tiveram uma variação negativa de -79%; 2) As faturas avaliadas passaram de 81 a 3% com variação negativa de -96%; os valores de 56,9 a 15% com uma variação negativa de -79% e os pacientes com valores avaliados, com variação negativa de -95%. As explicações adicionais foram de 60% e apenas 5% das respostas foram consideradas. Predominaram os ressarcimentos e garantias para medicamentos com 67,5% e 61% respectivamente. No processo, envolveram-se 17 instituições e 399 pacientes, com uma média de 2,2 faturas por paciente. Conclusão: Foram reduzidos os pedidos de ressarcimento e garantias, predominando os medicamentos como evento ressarcido e garantido. A alta porcentagem de explicações adicionais e a baixa recuperação pelas respostas às mesmas fazem com que o processo seja ineficiente e ambíguo, o que atrasa os pagamentos às instituições prestadoras de serviços de saúde e aumenta os riscos de crise hospitalar, com consequências negativas para a saúde e para o sistema de saúde pública em geral.

Analysis on the Reasons and Countermeasures of Drug Network Withdrawa l under the Background of the Nor- malization of Centralized Volume-based Procurement / 中国药房

OBJECTIVE：To provid e reference for the optimization and improvement of centralized volume-based procurement policy of drugs in China. METHODS ：Six provinces ，i.e. Hebei ，Jiangsu，Hainan，Henan，Jiangxi and Yunnan ，were randomly selected nationwide by random sampling to summarize and analyze the information of drug network withdrawal from Jan. 1st，2018 to Nov. 30th，2020. RESULTS & CONCLUSIONS ：Jiangsu province had the largest number of withdrawn products from the network，being 6 331；Yunnan province had the smallest ，being 101. Product price was the leading factor for drug network withdrawal，accounting for 89.12％；the second factor was product quality ，accounting for 7.06％；the third factor was the product supply，accounting for 2.91％. At present ，there were many problems in drug network withdrawal in China ，such as inconsistent withdrawal regulations in different regions ，unclear subjects of withdrawal behavior ，difficulty in sharing information of purchasing platforms in different regions ，unreasonable bidding rules of online drugs ，etc. Some suggestions are put forward to promote standardization of drug network withdrawal ，promote information sharing among provincial platforms ，actively develop drug price monitoring，support enterprises to make reasonable pricing based on cost ，strengthen departmental linkage and guarantee of drug supply so as to improve centralized volume-based procurement policy of drugs.

Os usos do abuso sexual / Los usos del abuso sexual / The uses of sexual abuse

Resumo Este artigo analisa as narrativas de mulheres e homens; mães e pais; cuidadoras e cuidadores de crianças e adolescentes envolvidos em denúncias de abuso sexual, na condição de vítimas, e que foram, por essa razão, inseridas/os no sistema de garantia de direitos, objetivando demonstrar o que pensam, que enunciados utilizam para falar sobre o abuso sexual e os sentidos atribuídos à sua inserção na rede de atendimentos. Para auxiliar a operar teoricamente utilizou-se a noção de biopolítica, enquanto uma forma de governo e uma tecnologia do poder de Foucault, associada às ideias de um governo pela psicologia de Castel e à retórica do trauma de Fassin. A partir da análise, é possível descrever como o abuso se torna a forma de legitimação maior para que se possa acessar a proteção do Estado e como as formas de governar capturam a todos/as e balizam as narrativas em sutis esferas.

Resumen Este artículo analiza las narrativas de mujeres y hombres, madres y padres, cuidadores de niñas, niños y adolescentes involucrados en denuncias de abuso sexual, como víctimas, y que fueron, por eso, insertados en el sistema de garantía de derechos, con el objetivo de demostrar lo que piensan, qué declaraciones utilizan para hablar sobre el abuso sexual y los significados atribuidos a su inserción en la red de asistencia. Para ayudar a operar teóricamente, se utilizó la noción de biopolítica, como una forma de gobierno y una tecnología de poder de Foucault, asociada a las ideas de un gobierno de la psicología de Castel y la retórica del trauma de Fassin. A partir del análisis es posible describir cómo el abuso se convierte en la forma de mayor legitimación para que se pueda acceder a la protección del Estado y cómo las formas de gobernar capturan a todas y todos y marcan las narrativas en esferas sutiles.

Abstract This article analyzes the narratives of men and women; mothers and fathers and caretakers of children and adolescents involved in sexual abuse allegations, as victims, and that, for that reason, they have been inserted in the Rights Guarantee System, aiming to demonstrate what they think, what statements they use to talk about sexual abuse and the meanings attributed to their insertion in the care network. To facilitate the theoretical comprehension, the notion of Biopolitics was used as a type of government and one of Foucault's technologies of power, also linked to the ideas of a government for Castel's psychology and to Fassin's rhetoric of trauma. From the analysis it is possible to describe how the abuse becomes the major way of legitimizing in order to access the government protection, and how the forms of government capture all people and support the narratives in subtle ways.

Safety in equipment and dressing changes for central vascular catheters: an observational study / Seguridad en el cambio de equipos y vendajes para el catéter vascular central: un estudio de observación / Segurança na troca de equipos e curativos para cateter vascular central: um estudo observacional

ABSTRACT Objective: to evaluate the compliance of the nursing team's care practice in handling the central vascular catheter when changing dressings and equipment in an intensive care unit. Method: a descriptive, prospective, and observational research study. Data collection was conducted from January to March 2016 in an Intensive Care unit of a public hospital in Sergipe, northeastern Brazil. Direct observation of the professionals was conducted using a safe checklist. Descriptive statistics was used to determine the process indicators, and inferential statistics to determine the association between the variables, using the chi-square and Fisher's tests, with a 5% significance level. Results: 534 procedures corresponding to the exchange of equipment and dressings were observed, corresponding to 5,073 actions. As for the change of equipment, 2,136 actions were evaluated, most of them carried out by nursing technicians. Of the eight actions evaluated in each procedure, only two (25%) reached the desired compliance, with a positivity index between 90% and 99%. Regarding the dressing change, 2,937 actions were evaluated, all of which were performed by nurses. Of the eleven evaluated actions, eight (72%) achieved desired compliance, with a positivity index between 80% and 100%. Conclusion: the results analyzed are far from the desired compliances, demonstrating the need to implement strategies to ensure the safety culture during the care provided.

RESUMEN Objetivo: evaluar la conformidad de la práctica asistencial del equipo de Enfermería en la manipulación del catéter vascular central al momento de cambiar vendajes y equipos en una Unidad de Cuidados Intensivos. Método: investigación descriptiva, prospectiva y de observación. La recolección de datos tuvo lugar entre enero y marzo de 2016 en una Unidad de Cuidados Intensivos de un hospital público de Sergipe, noreste de Brasil. Se realizó una observación directa de los profesionales por medio de una checklist de verificación segura. Se utilizó análisis descriptivo para determinar los indicadores de proceso, y estadística inferencial para determinar la asociación entre las variables, usando las pruebas de chi-cuadrado y de Fisher, con un nivel de significancia del 5%. Resultados: se observaron 534 procedimientos correspondientes al cambio de equipos y vendajes, lo que correspondió a 5.073 acciones. En relación al cambio de equipos, se evaluaron 2.136 acciones, la mayoría realizadas por técnicos en Enfermería. De las ocho acciones evaluadas en cada procedimiento, solamente dos (25%) alcanzaron la conformidad deseada, con un índice de positividad del 90% al 99%. En relación con el cambio de vendajes, se evaluaron 2.937 acciones, todas ejecutadas por Enfermeros. De las once acciones evaluadas, ocho (72%) alcanzaron la conformidad deseada, con un índice de positividad del 80% al 100%. Conclusión: los resultados analizados distan de los niveles de conformidad deseados, lo que demuestra la necesidad de implementar estrategias para garantizar la cultura de la seguridad durante la atención provista.

RESUMO Objetivo: avaliar a conformidade da prática assistencial da equipe de enfermagem no manuseio do cateter vascular central na troca de curativos e de equipos em unidade de terapia intensiva. Método: pesquisa descritiva, prospectiva, observacional. A coleta de dados ocorreu de janeiro a março de 2016 em uma unidade de terapia intensiva de um hospital público do Sergipe, nordeste do Brasil. Realizada observação direta dos profissionais utilizando checklist de verificação segura. A análise descritiva foi utilizada para determinação dos indicadores de processo, e a estatística inferencial para determinar a associação entre as variáveis, usando os testes de Qui-Quadrado e Fisher, com nível de significância de 5%. Resultados: observados 534 procedimentos correspondentes a troca de equipos e curativos, correspondendo a 5073 ações. Quanto à troca de equipo 2.136 ações foram avaliadas, a maioria realizadas por técnicos em Enfermagem. Das oito ações avaliadas em cada procedimento, apenas duas (25%) alcançaram conformidade almejada, com índice de positividade entre 90% e 99%. Referente a troca de curativo, 2.937 ações foram avaliadas, sendo todas executadas por Enfermeiros. Das onze ações avaliadas, oito (72%) alcançaram conformidade desejada, com índice de positividade entre 80% e 100%. Conclusão: os resultados analisados estão distantes das conformidades almejadas, demonstrando a necessidade de implementação estratégias para garantir a cultura de segurança durante a assistência prestada.

Política de Formação Profissional e trabalho decente: ferramentas de erradicação do trabalho infantil? / Educational and Training Policy and decent work: tools to eradicate child labor? / Política de Formación Profesional y trabajo decente: ¿Herramientas de erradicación del trabajo infantil?

Este artigo objetiva analisar a Política de Formação Profissional (PFP) e sua contribuição para a erradicação do trabalho infantil, a partir da perspectiva dos jovens que dela participam. A amostra desse estudo foi composta por 187 jovens que se encontravam inseridos na PFP. Foi utilizado um questionário e duas escalas de avaliação, analisadas através do software SPSS. Os dados revelaram que aqueles que acessaram a Política são em sua maioria do sexo feminino, consideram-se pardos e têm renda familiar baixa, sendo, por vezes, os principais provedores da família. Cerca de 92% desses jovens enxergam o programa como uma ferramenta de combate ao trabalho infantil, por ofertar trabalho legalizado e a garantia dos direitos trabalhistas aos jovens que dele participam. Contudo, foi possível perceber uma herança da política assistencialista na forma de ocupar e disciplinar o jovem, o que torna a PFP uma alternativa limitada de promover mudança social eficaz

This article aims to analyze the Educational and Training Policy (PFP) and its contribution to the eradication of child labor, from the perspective of the young people participating in it. The study included 187 young people enrolled in the policy. We used a questionnaire and two assessment scales, carried out by the SPSS software. Data showed that young people who accessed the policy are mostly female, consider themselves dark-skinned, have a low family income, and are sometimes the main breadwinner. About 92% of these young people perceive the program as a tool to combat child labor and as something that contributes to the legalized work and to the guarantee of labor rights. However, welfare policy is still marked in society and influences the way of occupying and disciplining young people, thus vocational training policy becomes a limited alternative to promote effective social change

Este artículo tiene como objetivo analizar la Política de Formación Profesional (PFP) y su contribución a la erradicación del trabajo infantil, desde la perspectiva de los jóvenes que participan en ella. La muestra de este estudio se compuso de 187 jóvenes que se encontraban inseridos en la PFP. Fue utilizado un cuestionario y dos escalas de evaluación, con ayuda del software SPSS. Los datos mostraron que aquellos que accedieron la Política, son en su mayoría del sexo femenino, se consideran pardos y tienen renta familiar baja, siendo, a veces, los principales sostenedores de la familia. Cerca del 92% de estos jóvenes ven el programa como una herramienta de combate al trabajo infantil, por ofrecer trabajo legalizado y la garantía de los derechos laborales a los jóvenes que participan en él. Sin embargo, fue posible percibir una herencia de la política asistencialista en la forma de ocupar y disciplinar al joven, lo que hace a la PFP una alternativa limitada de promover un cambio social eficaz

Study Feasibility of Multi-payment for Drugs for Rare Diseases ——Taking Gaucher’s Disease in Qingdao as Example / 中国药房

OBJECTIVE： To investigate the feasibility of multi-payment for drugs for rare diseases and also provide reference for rare disease treatment and the formulation of related policy. METHODS： Taking Gaucher’s disease in Qingdao as an example， the relevant medical insurance policies and drug supply were analyzed； according to the sources of financing， the economic burden of treatment drugs for patients with Gaucher’s disease in Qingdao was estimated. Based on the average total cost of patients with Gaucher’s disease in Qingdao， the drug cost burden of patients with Gaucher’s disease in the whole country was simulated according to the relevant epidemiological survey data， and the problems of medical insurance model for rare diseases in Qingdao were analyzed. RESULTS & CONCLUSIONS： A series of medical insurance policies were formulated in Qingdao. The financing mode of medical insurance includes social funds （from Qingdao Charity Federation， drugs are provided by pharmaceutical manufacturers）， medical insurance funds （used for personal self-payment assistance within the scope of medical insurance co-ordination） and civil assistance （used for assistance outside the scope of medical insurance co-ordination）. Imidase is currently the only approved specific drug for Gaucher’s disease in China. The designated physician， treatment and drug-taken system is adopted in Qingdao. By the end of 2017， the annual drug consumption of 8 patients in Qingdao was 38-170 bottles， totaling 686 bottles. The annual cost of treatment ranged from 786 600 to 3 519 000 yuan， totaling 1 420 200 yuan. The self-paid expenses ranged from 9 800 to 197 400 yuan （the self-paid ratio ranged from 0.46％ to 8.87％）， totaling      661 400 yuan. The reimbursement cost by supplementary medical insurance was 509 800 to 1 789 800 yuan （accounting for 54.59％ to 65.94％）， totaling 8 577 800 yuan. Three patients received civil assistance， the amount of which ranged from 23 100 to 13 000 yuan （accounting for 1.89％ to 4.18％）， totaling 241 400 yuan. According to the relevant epidemiological survey data （the prevalence rate was 0.15 per 100 000）， it is estimated that there are about 2 093 patients with Gaucher’s disease in China. Referring to Qingdao multi-payment model， it is estimated that the total cost of drugs for Gaucher's disease in China is about 3.715 billion yuan， charitable assistance can bear 1.238 billion yuan， while medical insurance expenditure is about 2.255 billion yuan， and individual self-payment is about 222 million yuan. From the point of view of drug cost burden， the multi-payment model in Qingdao has lightened the personal burden of patients’ has achieved significant results. There are problems in Qingdao’s multi-payment model， such as “medical insurance immigration”， low drug accessibility， drug price monopoly， three-level disease prevention needs to be strenghten， etc. The state or provinces and cities can refer to Qingdao model when formulating policies related to rare diseases. Great importance should be paid attention to the existing problems.

The analysis of prevalence of pneumoconiosis and assistance guarantee of the migrant workers of the district in Chongqing from 2006 to 2017 / 中华劳动卫生职业病杂志

Objective@#To analyze the prevalence of pneumoconiosis and assistance guarantee of the migrant workers of the district in Chongqing from 2006 to 2017, so as to provide scientific basis for prevention and control of pneumoconiosis of the migrant workers.@*Methods@#The database of new pneumoconiosis cases of the migrant workers and assistance guarantee of the district in Chongqing from 2006 to 2017 were subjected to systematic arrangement. SPSS 18.0 was adopted for statistical description and analysis.@*Results@#From 2006 to 2017 a total of 2188 new cases of pneumoconiosis were diagnosed, including I (917, 41.91%) , II (1003, 45.84%) , III (268, 12.25%) . Most of new cases of pneumoconiosis were silicosis. The median length of seniority was 6 years. The mean diagnostic age was 44.25. Significant difference was found in diagnosis age between different stages (F=3.161, P=0.043) . 98.77% of migrant workers had no units. There were 5.07% of migrant workers who took out industrial injury insurance, 14.58% receiving civil aid, 31.12% receiving aid from poverty alleviation, and 93.46% participating medical insurance.@*Conclusion@#The prevalence of pneumoconiosis of the migrant workers of the district in Chongqing was serious. The prevention and control of pneumoconiosis should be enhanced to reduce the harm of pneumoconiosis of the migrant workers in Chongqing.

Investigation and analysis of social security in patients with lung diseases in Kaizhou district of Chongqing / 中华劳动卫生职业病杂志

Objective@#To analyze the social insurance guarantee of pneumoconiosis patients in Kaizhou from 2006 to 2018, and to provide basis for the prevention and treatment of pneumoconiosis in the future.@*Methods@#The social security situation of pneumoconiosis patients in Kai Zhou District in 2006-2018 years was analyzed.@*Results@#There were 3357 cases of pneumoconiosis in Kaizhou District, with a social security rate of 99%; 79.4% of the coal mine pneumoconiosis patients, 87.5% of whom enjoy industrial injury insurance; the majority of the Xiangyu Railway pneumoconiosis patients were over 60 years old, accounting for 3.4%, all enjoy special treatment of Xiangyu Railway; the former township enterprises restructure pneumoconiosis patients, mainly under 60 years old, accounting for 3.4%. Among them, 79% enjoy work-related injury insurance, and 15.2% were rural poverty victims.@*Conclusion@#Kaizhou district provides better social security for pneumoconiosis patients in this area, which can provide basis for formulating social security policies for pneumoconiosis patients in other areas.

Construcción de un sistema participativo de garantía con y para la Arac (Asociación Red Agroecológica Campesina) en el municipio de Subachoque, Cundinamarca, en 2015 / Construction of a participatory guarantee system with and for the peasant agroecological network association (Arac for its acronym in spanish) in the municipality of Subachoque, Cundinamarca, in 2015

Introducción. Una de las principales necesidades manifiestas de la ARAC en 2014, era el mejoramiento y ampliación de sus canales de comercialización, así como la falta de confianza y verificación de sus procesos productivos para ser coherentes con su misión en producción agroecológica. Objetivo. En este contexto, la presente investigación tuvo como objetivo la creación de un Sistema Participativo de Garantía (SPG) con y para la organización ARAC. Metodología. Se desarrolló una Investigación Acción Participativa (IAP) durante el año 2015. El proceso incluyó a todos los productores, aunque no contó con los consumidores por la dificultad de coordinar sus tiempos. Las cuatro fases de la investigación incluyeron: diagnóstico, estructuración del SPG de la ARAC, visitas de certificación y Escuelas Agroecológicas de Campo (EAC). Resultados. Como resultados se creó el SPG-ARAC con un comité vinculado a la estructura orgánica de la asociación y un reglamento que reúne normas y procedimientos a seguir en la implementación de los procesos productivos, así como mecanismos de control y verificación inspirados en los principios agroecológicos de la ARAC y en la Resolución 187 de 2006 del Ministerio de Agricultura y Desarrollo Rural (MADR). Se realizaron visitas de certificación a 22 sistemas de producción agropecuaria o de procesamiento y cuatro EAC. Conclusión. La implementación del SPG-ARAC demuestra que fue posible desarrollar un SPG con y para la ARAC, y que la organización se encuentra cerca de completar la transición agroecológica en los subsistemas de producción agrícola, mientras en los sistemas de producción pecuaria y de transformación se encuentran varias dificultades. Las principales limitantes identificadas gracias al SPG, para lograr la transición agroecológica de la organización son: la consecución de semillas y pie de cría ecológicos, el abastecimiento continuo de agua, la producción de pastos y forrajes ecológicos para la alimentación animal, y el uso de medicina alopática.

Introduction: One of the main obvious needs of the ARAC in 2014 was the improvement and expansion of its commercialization channels, as well as the lack of trust and verification of its productive processes, to be consistent with its mission in agroecological production. Objective: In this context, this research aimed to create a Participatory Guarantee System (SPG by its acronym in Spanish) with and for the ARAC organization. Methodology: A Participatory Action Research strategy (IAP for its acronym in Spanish) was applied during 2015. The process included all producers, although there were no consumers due to the difficulty for coordinating their times. The four phases of the research included: diagnosis, structuring of the SPG-ARAC, certification visits, and Agroecological Field Schools (EAC for its acronym in Spanish). Results: As a result, the SPG-ARAC was created with a committee linked to the organizational structure of the association, and a regulation that gathers standards and procedures to follow in the implementation of production processes, as well as control and verification mechanisms inspired by the agroecological principles of ARAC and stated in Resolution 187 of 2006 of the Ministry of Agriculture and Rural Development (MADR for its acronym in Spanish). Certification visits were made to 22 agricultural or processing production systems and to 4 EAC. Conclusions: The implementation of the SPG-ARAC demonstrates that it was possible to develop an SPG with and for the ARAC, and that the organization is close to completing the agroecological transition in the agricultural production subsystems, while in the livestock production and transformation systems there are several difficulties. The main limitations identified thanks to the SPG to achieve the agroecological transition of the organization are: the achievement of organic seeds and breeding stock, the continuous supply of water, the production of pastures and organic forages for animal feed, and the use of allopathic medicine.

Atendimento Escolar Hospitalar: Trajetória pela Fundamentação Científica e Legal1 / Hospital School Assistance: Ways Throughout Scientific and Legal Bases

RESUMO: O atendimento escolar hospitalar é normatizado por legislação própria há quase duas décadas. Dessa forma, o objetivo deste artigo foi analisar a trajetória científica e legal dessa temática, a partir de estudo comparado entre os artigos publicados na Revista Brasileira de Educação Especial que tratam especificamente desse assunto, os resultados dos encontros nacionais promovidos, os informativos semestrais divulgados e alguns trabalhos acadêmicos recentes relacionados ao tema. A técnica de pesquisa utilizada foi a pesquisa bibliográfica e documental, e a análise proposta foi a de conteúdo. Os resultados apontam que essa área do conhecimento se fundou a partir de pesquisas que, à época, mesmo que incipientes, nortearam o que se delimitaria como a essência do atendimento escolar ao doente. Apesar do aumento da oferta desse tipo de ensino, ela não necessariamente está circunscrita à escolarização no hospital, demonstrando entendimento diverso do que preconizam as normativas legais para esse serviço. Os encontros nacionais mantêm a discussão, mas também se projetam para temáticas que não dialogam diretamente com a proposta de escolarização no hospital, mas com outros aspectos relacionados à vida do doente. Os informativos semestrais focam mais especificamente nessa área de atuação. Estes divulgam estudos, legislações, eventos pertinentes, assim como aproximam os interessados por essa modalidade educacional. Considerando-se também a realidade dessa escolarização em outros países, é possível afirmar que o reconhecimento e respeito do direito de escolaridade do doente fazem com que esse serviço seja oferecido com a jurisprudência e a qualidade necessárias para o cumprimento de suas atribuições junto ao alunado doente.

ABSTRACT: Hospital school assistance has been regulated by its own legislation for almost two decades. Thus, the objective of this paper was to analyze the scientific and legal bases of this subject using a comparative study between the papers published in the Brazilian Journal of Special Education that deal specifically with this theme, the results of national meetings promoted, the biannual newsletters disseminated and some recent academic papers related to the topic. The research technique used was the bibliographical and documentary research, and the proposed analysis was the content analysis. The results point out that this area of knowledge was based on research that at the time, even if incipient, guided what would be delimited as the essence of school assistance to the patient. Despite the increase in the supply of this type of education, it is not necessarily restricted to schooling in the hospital, demonstrating a different understanding of what the legal regulations for this service prescribe. The national meetings continue the discussion, but they are also projected for themes that do not directly dialogue with the proposal of schooling in the hospital, but with other aspects related to the life of the patient. Biannual newsletters focus more specifically on this area. They disseminate studies, legislation, relevant events, and bring the interested people in this educational modality closer. Considering also the reality of this schooling in other countries, it is possible to affirm that the recognition and respect of the right to schooling of the patient make this service be offered with the jurisprudence and the quality necessary for the fulfillment of its attributions with the sick pupils.

Entorno y cuidado: circunstancias que influyen en la calidad de la atención médica percibida por los colombianos / Environment and care: circumstances that influence the quality of healthcare perceived by the people in Colombia / Ambiente e cuidado: circunstâncias que influenciam a qualidade da atenção médica percebida pelos colombianos

Introducción. El análisis de las situaciones de salud, en el acto del cuidado de la enfermería, requiere de conocimientos, pues es el marco conceptual y la guía de esta labor. Aunque el cuidado integral de la salud, según Watson, depende del compromiso moral del enfermero de preservar la dignidad humana; son frecuentes los informes que muestran una mala percepción de la prestación de servicios de salud. En los informes, se indica que el 36% de los encuestados tienen una mala o muy mala percepción de la calidad de la atención médica. El objetivo es reflexionar sobre las circunstancias que influyen en la calidad de la atención médica percibida por los colombianos. Temas de reflexión. Se abordará el tema desde los patrones de conocimiento de la enfermería: el empírico, el estético, el ético, el sociocultural y el personal. Discusión. Las condiciones que influyen en la percepción de la calidad de la atención médica se agrupan en dos conceptos del metaparadigma de la enfermería. El primero es el entorno, en el que existen barreras de oferta y demanda, como la tecnificación, la infraestructura y los recursos del sistema de salud. El segundo es el cuidado, en el que la condición laboral tiene incidencia, ya que los profesionales de enfermería sienten culpabilidad, agotamiento y estrés, y comprometen la buena percepción del cuidado médico y el sentido de trascendencia profesional. Conclusiones. El acto del cuidado de la enfermería está rodeado de situaciones poco favorables, dadas las barreras en el sistema de salud colombiano, que comprometen la labor del enfermero. Por lo tanto, es necesario reflexionar y desarrollar conceptos relacionados con los patrones de conocimiento de la disciplina, que inciden en la formación de los nuevos profesionales. Esto, con el fin de cumplir a cabalidad el deber ser y el hacer de la enfermería en Colombia. [Duque-Castro JA, Ortiz-Urbano J, Rengifo-Arias DM. Entorno y cuidado: circunstancias que influyen en la calidad de la atención percibida por los colombianos. MedUNAB. 2018;21(2):60-68. doi:10.29375/01237047.2799].

Introduction. The analysis of health situations, in terms of nursing care, requires knowledge, since it is the conceptual framework and guide for this work. Although comprehensive healthcare, according to Watson, depends on the nurse's moral commitment to preserve human dignity, there are frequent reports that show a poor perception of the provision of healthcare services. The reports indicate that 36% of those surveyed had a poor or very poor perception of the quality of healthcare. The objective is to reflect on the circumstances that influence the quality of healthcare perceived by the people in Colombia. Topics of reflection. The topic will be addressed through the patterns of knowledge of nursing: empirical, aesthetic, ethical, sociocultural and personal. Discussion. The conditions that influence the perception of healthcare quality are grouped into two nursing metaparadigm concepts. The first is the environment, in which there are supply and demand barriers, such as technification, infrastructure and resources of the healthcare system. The second is the care, on which the employment status has an influence, since nursing professionals feel guilt, exhaustion and stress, and compromise the good perception of healthcare and the sense of professional importance. Conclusions. The act of caring in nursing is surrounded by unfavorable situations, given the barriers in the Colombian healthcare system that compromise the work of nurses. Therefore, it is necessary to reflect and develop concepts related to the patterns of knowledge of this discipline, which have an effect on the training of new professionals. This is in order to fully comply with the duty and practice of nursing in Colombia. [Duque-Castro JA, Ortiz-Urbano J, Rengifo-Arias DM. Environment and care: circumstances that influence the quality of medical care perceived by the people in Colombia. MedUNAB. 2018;21(2):60-68. doi:10.29375/01237047.2799].

Introdução. A análise das situações de saúde, no ato do cuidado da enfermagem, requer conhecimento, pois é o referencial conceitual e o guia desta atividade. Embora os cuidados integrais de saúde, segundo Watson, dependem do compromisso moral do enfermeiro para preservar a dignidade humana; há relatos frequentes que mostram uma má percepção da prestação de serviços de saúde. Nos relatórios, indica-se que 36% dos entrevistados têm uma percepção ruim ou muito ruim da qualidade do atendimento médico. O objetivo é refletir sobre as circunstâncias que influenciam a qualidade da atenção médica percebida pelos colombianos. Temas para reflexão. O tema será abordado a partir dos padrões de conhecimento da enfermagem: o empírico, o estético, o ético, o sociocultural e o pessoal. Discussão. As condições que influenciam a percepção da qualidade da atenção médica são agrupadas em dois conceitos do metaparadigma da enfermagem. O primeiro é o ambiente, no qual existem barreiras de oferta e demanda, como a tecnificação, a infraestrutura e os recursos do sistema de saúde. O segundo é o cuidado, no qual a condição de trabalho tem impacto, uma vez que os profissionais de enfermagem sentem-se culpados, exaustos e estressados, comprometendo a boa percepção do cuidado médico e o sentido de transcendência profissional. Conclusões. O ato do cuidado de enfermagem está cercado de situações desfavoráveis, dadas as barreiras no sistema de saúde colombiano, que comprometem o trabalho do enfermeiro. Portanto, é necessário refletir e desenvolver conceitos relacionados aos padrões de conhecimento da disciplina, que afetam a formação dos novos profissionais. Isso, a fim de cumprir integralmente o dever de ser e exercer a enfermagem na Colômbia. [Duque-Castro JA, Ortiz-Urbano J, Rengifo-Arias DM. Ambiente e cuidado: circunstâncias que influenciam a qualidade da atenção médica percebida pelos colombianos. MedUNAB. 2018;21(2):60-68. doi:10.29375/01237047.2799].

O extermínio de jovens negros pobres no Brasil: práticas biopolíticas em questão / The extermination of young poor black in Brazil: practices biopolitics in question / El exterminio de los jóvenes negros pobres en Brasil: las prácticas biopolíticas en cuestión

Este artigo versa sobre a prática de extermínio de jovens pobres e negros, com baixa escolaridade, moradores das periferias urbanas brasileiras, em uma análise da biopolítica em Foucault. O crescente e massivo genocídio desse grupo, somado ao aumento do contingente de aprisionamento dessa população, assinala que o Brasil optou por duas táticas de segurança em defesa social contra um suposto inimigo penal: cadeia e caixão. Interrogar essa realidade e colocá-la em questão é uma inquietação de quem atua com pesquisas em direitos a serem garantidos e protegidos. A crítica à militarização do cotidiano e às subjetividades baseadas no medo e na insegurança deve ser uma pauta da Psicologia, na formação, na extensão, na pesquisa e na publicação.

This article deals with the practice of extermination of poor young people and blacks, with low schooling, residents of suburbs Brazilian, in an analysis biopolitics, in Foucault. The growing and massive genocide of this group plus the increase in the quota for trapping this population notes that Brazil has opted for two tactics of security, in social defense against an alleged criminal enemy, chain and coffin Ask this reality and put it in question is a concern for anyone who works with research social rights to be guaranteed and protected. The criticism of the militarization of everyday life and the subjectivities based on fear and insecurity must be an agenda of Psychology in the areas of education and training, extension, research and publication.

En este artículo se refiere a la práctica de la exterminación de los jóvenes pobres y negros, con baja escolaridad, los residentes de los suburbios brasileños, en un análisis de la biopolítica, en Foucault. La creciente y genocidio en gran escala de este grupo y el aumento de la cuota de captura esta población observa que el Brasil ha optado por dos tácticas de seguridad, de defensa social contra un presunto delincuente enemigo, cadena y ataúd preguntar a esta realidad y se la pone en cuestión es una preocupación para cualquier persona que trabaja en la investigación que se les garanticen los derechos y la protección. Las críticas a la militarización de la vida cotidiana y las subjetividades basadas en el miedo y la inseguridad debe ser un programa de psicología en las áreas de educación y capacitación, extensión, investigación y publicación.

Valor ético de la incorporación del estudiante de Medicina al sistema de garantía de la calidad hospitalaria / Ethical value of incorporating medical student system of hospital quality assurance

Se realizó una propuesta metodológica en el Hospital Militar Clínico Quirúrgico Docente Doctor Octavio de la Concepción y la Pedraja de Camagüey durante el año 2014 con el objetivo de argumentar el valor ético que tiene para el estudiante de Medicina ser insertado al sistema de garantía de la calidad hospitalaria. Se emplearon métodos de nivel teórico como análisis y síntesis, histórico-lógico, inducción-deducción. La vinculación del estudiante universitario al sistema de garantía de calidad en un centro asistencial docente permite elevar la utilización correcta del método clínico y provee al discente de conocimiento para que al egresar desempeñe un servicio de excelencia y alcance a reducir los errores e insatisfacciones de la población y con ello los costos innecesarios.

In order to increase the ethical value integrating medical students into a hospital quality guarantee system has, a methodological proposal was put forward in the Doctor Octavio de la Concepcion y la Pedraja Teaching Clinical-Surgical Military Hospital of Camaguey during 2014. Theoretical methods such as analysis and synthesis, historical-logical methods and induction-deduction were used. Linking college students to the quality guarantee system allows increasing the proper use of the clinician and it provides the learner with the knowledge he needs to carry out an excellent service and to reduce errors making and people dissatisfactions, therefore cutting on unnecessary costs.

Research on training quality guarantee system of medical graduate students based on project management / 中华医学教育探索杂志

Aiming at the problems faced by the medical postgraduate students in the cooperative medical education and the classified training mode,combined with the characteristics of the cultivation of medical postgraduates,the article constructed the quality guarantee system of graduate education based on project management.From the three dimensions of time dimension,corpus dimension and objective dimension,the article established a model of training quality guarantee system and analyzed the four work modules:construction of project organization,standardization of whole life cycle process,control of project quality and integration of project information.In addition,the article introduced the practice of this quality guarantee system in Binzhou Medical University.