Salud: Dignidad, Derechos y Ética

La salud y la atención de las personas enfermas implican no solo aspectos de diagnósticos y tratamientos médicos; por el contrario, encierran un conjunto de aspectos que están intrínsecamente vinculados (o deberían estarlo) aun cuando aparentemente no sean visibilizados con facilidad. La salud de las personas involucra las perspectivas de respeto a la dignidad de las personas, el ejercicio de sus derechos, y el desempeño ético de los protagonistas (los que atienden y los atendidos), que no deben ser dejadas de lado en el momento real que sucede cada atención de salud.

SUMMARY Health and care for sick people involve not only aspects of medical diagnosis and treatment; on the contrary, it contains a set of aspects that are intrinsically linked (or should be) even though they are apparently not easily visible. The health of the people involves the perspectives of respect for the dignity of the people, the exercise of their rights, and the ethical performance of the protagonists (those who attend and those attended), which should not be left aside in the real moment. that happens every health care.

Prevalencia y características clínicas de los síntomas depresivos y ansiosos de los trabajadores de una institución de salud en Medellín durante la pandemia por COVID-19

Introducción: Afrontar las circunstancias de la vida y el trabajo que la pandemia por COVID-19 ha impuesto al personal sanitario implica un reto extraordinario: cuidar y atender a otros, exponiéndose a sí mismos al contagio. A médicos, enfermeras, terapeutas y demás personal asistencial y no asistencial en clínicas y hospitales, se les pide estar preparados para trabajar en situaciones extraordinariamente complejas y estresantes, lo que los hace vulnerables a problemas mentales. Objetivo: Determinar la prevalencia y las características clínicas de los síntomas ansiosos y depresivos del personal que trabaja en una institución de salud en Medellín, Colombia. Métodos: Estudio observacional, descriptivo y transversal, a partir de una encuesta disenada al efecto, la cual incluyó 2 escalas para tamizar síntomas depresivos y ansiosos, además de variables sociodemográficas. Resultados: Se incluyó a 1.247 trabajadores de la institución de salud. El 14,6% reportó síntomas depresivos y el 18,5%, ansiosos clínicamente significativos. Se encontró una mayor proporción de síntomas depresivos y ansiosos moderados-graves en la modalidad de trabajo presencial. Conclusiones: Los síntomas ansiosos y depresivos son muy prevalentes entre los trabajadores de una institución de salud de Medellín durante la pandemia de COVID-19. Dado el papel vital del sector salud en tiempos de pandemia, el desarrollo de programas de salud mental que aborden los problemas de esta población debería considerarse una prioridad.

Introduction: The COVID-19 pandemic has represented an extraordinary challenge for health workers as they care for others while exposing themselves to contagion. Doctors, nurses, therapists and other non-care staff in clinics and hospitals are asked to be prepared to work in particularly complex and stressful situations, which makes them vulnerable to mental health problems. Objective: To determine the prevalence and clinical characteristics of anxiety and depression symptoms in staff working at a health institution in Medellin, Colombia. Methods: Observational, descriptive and cross-sectional study, based on a survey designed for the investigation, which included two scales to screen depression and anxiety symptoms, as well as sociodemographic variables. Results: A total of 1,247 workers from the health institution were included. Of these, 14.6% reported symptoms of depression and 18.5% of clinically significant anxiety. A higher proportion of moderate to severe depression and anxiety symptoms was found in those working face to face. Conclusions: Anxiety and depression symptoms are highly prevalent among staff at a health institution in Medellin, Colombia, during the COVID-19 pandemic. Given the vital role of the health sector in times of pandemic, the development of mental health programmes that address the problems of this population should be considered a priority.

Leadership in health and medical education: lessons from a symposium on health sector development in Ghana

The Ghana College of Physicians and Surgeons (GCPS) has established an annual leadership symposium celebrating innovative leadership in the health sector. The 2022 symposium under the theme "Health Sector Development in Ghana; The Power of Good Leadership" was held in honour of Professor Samuel Ofosu-Amaah (the laureate), an Emeritus Professor of Public Health at the University of Ghana, about his leadership legacy. This article reflects on the leadership challenges in the health sector, the lessons learnt from the symposium, and the way forward. Leadership challenges identified in the health sector included the need for mentorship and coaching, the importance of teamwork and networking for delivering high-quality healthcare, and the role of leadership and governance in the health system. Key lessons from the symposium focused on skills in leading an event organisation, effective collaboration and teamwork, and learning from recognising prominent leaders' contributions to the health sector while these leaders are still alive. Key lessons from the personal and professional life of the laureate included a focus on giving back to the community, building mentorship of health leaders, being a catalyst of change, leadership and governance in public health institutions and publication of research findings. Suggestions were made to name the School of Public Health of the University of Ghana after Professor OfosuAmaah, to include a leadership and management module in all training modules at the GCPS and to establish a health leadership "Observatory" to focus on research on how leadership influences

Governance for health: A critical, but poorly understood, health system component

@#The paper by Bernal-Sundiang et al.1 in this issue of Acta Medica Philippina provides one of the more extensive and in-depth empirical discussion of governance in the health sector. Utilizing data collected over a one-year period as part of the Philippine Primary Care Studies in urban, rural, and remote settings, the authors reported on challenges their team encountered in project implementation as it relates to leadership and governance. One strength of the paper is that it situates leadership and governance as a health system keystone that links to all the other components of infrastructure and supply chains, information system, health workforce, financing, and stakeholder engagement, and monitoring and evaluation. This harks back to the framework posited in the World Health Report 20002, highlighting the interaction between governance and the other system elements. Despite this critical role of governance, however, it has been characterized as being poorly understood, and often difficult to operationalize, not least because of poor capacities of different institutions and actors to bring to the fore the good governance agenda.3 For instance, it has been suggested that good governance, regardless of the sector, is “accountable, transparent, responsive, equitable and inclusive, effective and efficient, participatory, consensus-oriented and follows the rule of law.”4 This characterization assumes the existence of traditions and institutions that places the common good front and center, something which may not be present, if not willfully disregarded, in many jurisdictions. Another set of related buzzwords for governance is that it entails a “whole-of-government” and “whole-of-society” approaches, which means the mobilization of public agencies, on the one hand, and private sector and civil society organizations, on the other, towards the realization of shared goals.5 Aside from the need for conceptual and operational clarity on these two terms, the reality of token participation and siloed working environments remain barriers to achieving true multisectoral approaches in health and other areas. Relatedly, I wish to bring to the discussion one insight from our case study of tuberculosis program implementation.6 In this research, we identified facilitating and hindering factors to the successful implementation of the tuberculosis prevention and control program in cities and municipalities, and we posited that these factors were rooted in a common source of governance for health. We further extended the argument by stating that focusing on the local chief executive as the responsible entity for good governance is a myopic view of the issue as it only covers the levels that can be labelled as “broader governance environment” and “public policies.”7 The more fine-grained institutional or sectoral governance is within the ambit of the local health officer, while what we propose to refer to as “program-level” governance is the realm of the program coordinator. The scope and specificity of governance as exercised across these levels, and consequent access to precise information, differ, which highlights the shared responsibility of these three principal actors at the local level in so far as exercise of good governance is concerned. Good governance in health has been an aspirational goal for many decades, and was identified as an important constituent in our quest for better health and sustainable development. The recommendations outlined by Bernal-Sundiang et al.1 provide a starting point on how we can gradually improve the health sector to come closer to this ambition. However, embedding good governance in institutions and society at large will be critical in sustaining such gains moving forward.

Pilares y líneas de acción para los sistemas de salud integrados y centrados en las personas y las comunidades / Pillars and lines of action for integrated and people- and community-centered health systems / Pilares e linhas de ação para sistemas integrados de saúde centrados nas pessoas e nas comunidades

RESUMEN Se presenta el posicionamiento del grupo de trabajo latinoamericano de la Fundación Internacional para los Cuidados Integrados (1) (IFIC, por su sigla en inglés). Este reúne a diversos actores y organizaciones de América Latina, con el objeto de apoyar acciones que faciliten la transformación de los sistemas de salud en la Región hacia sistemas integrados y centrados en las personas, no como individuos aislados, sino como sujetos de derecho, en los contextos sociales y ambientales complejos donde viven y se vinculan. El grupo de trabajo plantea nueve pilares de la atención integrada para ser utilizados como marco conceptual en la elaboración de políticas y de cambios en las prácticas: 1) visión y valores compartidos, 2) salud de las poblaciones, 3) las personas y las comunidades como socias, 4) comunidades resilientes, 5) capacidades del talento humano en salud, 6) gobernanza y liderazgo, 7) soluciones digitales, 8) sistemas de pago alineados, y 9) transparencia ante la ciudadanía. Desde estos pilares se proponen líneas de trabajo en los ámbitos del fortalecimiento de alianzas y redes, la abogacía, la investigación y generación de capacidades, que contribuyan a materializar sistemas de salud y sociales efectivamente integrados y centrados no solo en las personas, sino también en las comunidades en América Latina.

ABSTRACT This paper presents the position of the Latin American working group of the International Foundation for Integrated Care (IFIC). The working group brings together various Latin American actors and organizations in support of actions that facilitate the transformation of health systems in the region towards integrated systems that focus on people not as isolated individuals but as subjects of law in the complex social and environmental contexts where they live and interact. The working group proposes nine pillars of integrated care to be used as a conceptual framework for policy development and changes in practices: 1) shared vision and values; 2) population health; 3) people and communities as partners; 4) resilient communities; 5) capacities of human resources for health; 6) governance and leadership; 7) digital solutions; 8) aligned payment systems; and 9) public transparency. Based on these pillars, lines of work are proposed to strengthen alliances and networks, advocacy, research, and capacity-building, in order to help develop health and social systems that are effectively integrated and focused not only on people but also on communities in Latin America.

RESUMO Este artigo apresenta o posicionamento do grupo de trabalho latino-americano da Fundação Internacional de Cuidados Integrados (1) (IFIC, na sigla em inglês). A IFIC reúne diversos atores e organizações da América Latina com o fim de apoiar ações que facilitem a transformação dos sistemas de saúde na região para sistemas integrados e centrados nas pessoas, não como indivíduos isolados, mas como sujeitos de direito, nos complexos contextos sociais e ambientais em que vivem e participam. O grupo de trabalho propõe nove pilares de atenção integrada a serem utilizados como marco conceitual na elaboração de políticas e de mudanças nas práticas: 1) visão e valores compartilhados, 2) saúde das populações, 3) pessoas e comunidades como parceiros, 4) comunidades resilientes, 5) capacitação de talento humano em saúde, 6) governança e liderança, 7) soluções digitais, 8) sistemas de pagamento alinhados e 9) transparência perante a população. Com base nesses pilares, são propostas linhas de trabalho nas áreas de fortalecimento de alianças e redes, incidência política, pesquisa e capacitação, que contribuam para materializar na América Latina sistemas sociais e de saúde efetivamente integrados e centrados não só nas pessoas, como também nas comunidades.

Satisfacción laboral y compromiso organizacional: un análisis de percepción en el sector sanitario / Job satisfaction and organizational commitment: an analysis of perception in the healthcare sector

Es importante el estudio de variables del comportamiento organizacional, ya que ayudan a la empresa a tener una mejor gestión de los recursos humanos, debido a que la satisfacción laboral tiene relaciones positivas y estadísticamente significativas con el desempeño laboral. El objetivo de este estudio fue medir los niveles de percepción laboral de empleados del sector sanitario del área pública y privada, con respecto a las variables satisfacción laboral y compromiso organizacional. El estudio es de tipo transversal y descriptivo, el instrumento de medición es una encuesta que consta de 3 partes y la muestra estuvo conformada por 271 administrativos. Se presentaron análisis univariados principales, luego un análisis de conglomerados para segmentar a los participantes, y finalmente se efectúan modelos de regresión. Se determinó que existen tres segmentos de trabajadores que son claramente definidos, compuestos por aquellos administrativos con una baja percepción en general (21% y 42%, respectivamente), aquellos con una percepción media (54% y 38%, respectivamente) y aquellos con una percepción alta (25% y 20%, respectivamente). Se confirma que el compromiso organizacional afecta significativamente y de forma positiva a la satisfacción laboral(AU)

The study of variables of organizational behavior is important, since they help the company better manage its human resources, as job satisfaction has been positively and significantly correlated with job performance. The objective of this study was to measure the levels of job perception of employees in the public and private healthcare sector, with respect to job satisfaction and organizational commitment. The study was cross-sectional and descriptive, and the measurement instrument was a survey consisting of three sections. The study sample consisted of 271 administrative staff. We present the main univariate analysis results, followed by a cluster analysis to segment the participants, and then regression analysis. We identified three clearly defined segments of workers, consisting of administrative staff with a low overall perception of hob satisfaction and organizational commitment (21% and 42%, respectively), those with a medium perception (54% and 38%, respectively) and those with a high perception (25% and 20%, respectively). The results confirm that organizational commitment significantly and positively affects job satisfaction(AU)

Estructuración de la Homeopatía en Brasil: directrices para el entrenamiento y la formación de recursos humanos / Structuring of Homeopathy in Brazil: guidelines for the training and education of human resources

La formación de recursos humanos de elevada cualificación en el área homeopática debe encararse como una de las prioridades para una sólida y definitiva consolidación de la Homeopatía en territorio brasileño. La cuestión de la estructuración de la Homeopatía en Brasil, por su parte, no puede ser convenientemente entendida sin un análisis de los sistemas formadores y captadores de recursos humanos homeopáticos. Es decir, el análisis debe recaer sobre la enseñanza homeopática de graduación y posgrado, pero también sobre las condiciones del mercado de trabajo para el médico homeópata. La reflexión sobre la enseñanza de la Homeopatía, en cambio, conduce inevitablemente al abordaje del problema de la investigación homeopática. Este artículo no tiene la intención de realizar un diagnóstico exhaustivo de la situación de la Homeopatía en lo que se refiere a la enseñanza, la investigación y el mercado de trabajo en Brasil. Sin embargo, a partir de algunos presupuestos y constataciones personales, delinearemos un marco general que permita definir algunas directrices relativas al problema de estructuración de la Homeopatía en Brasil.

The formation of highly qualified human resources in the homeopathic sector must be faced as a priority for a solid and definitive consolidation of Homeopathy in Brazilian territory. On the other hand, the structuring of Homeopathy in Brazil, cannot be conveniently understood without an analysis of both the training and recruiting systems for homeopathic human resources. In other words, the analysis must not only fall upon homeopathic teaching at a postgraduate level, but also the job-market conditions for the homeopathic physician. On the other hand, the reflection upon the teaching of Homeopathy, inevitably leads to an approach to the problem of homeopathic investigation. This article does not have the intention of carrying out an exhaustive diagnosis of the educational, investigational and jobmarket aspects of Homeopathy in Brazil. However, on some based budgets and personnel records, a general framework that will allow the definition of several directives pertaining to the problem of the structuration of Homeopathy in Brazil, will be outlined.

Esquema de confianza basado en Infraestructura de clave pública (PKI) para el intercambio de información clínica electrónica en el sistema XAVIA HIS / PKI-based trust scheme for the exchange of electronic clinical information in the XAVIA HIS system

La seguridad informática se ha convertido en una necesidad y un derecho de todos los ciudadanos. Los sistemas informáticos empleados en el sector de salud poseen un almacenamiento digital fácil y sostenible que debe garantizar la privacidad e integridad de la información, lo cual constituye cuestión delicada. En Cuba no está definido un esquema PKI (Públic Key Infraestructure) o Infraestructura de Clave Pública, centralizado a nivel nacional que propicie y garantice la seguridad de la información sensible en el sistema de salud pública, lo cual pone en riesgo la autenticidad, integridad y confidencialidad de los datos médicos personales. Este trabajo tiene como objetivo diseñar una estructura de seguridad centrada en la PKI entre las instituciones de salud, a partir de la infraestructura de llave pública nacional como autoridad de certificación raíz. Se realizó un análisis documental sobre la actualidad del tema, se realizaron entrevistas a administrativos, gestores hospitalarios y especialistas en seguridad informática, lo cual permitió crear las bases de la investigación. Se obtuvo un esquema de confianza que propicia el intercambio seguro de los registros médicos de los pacientes entre instituciones de salud. La implementación de una infraestructura PKI en el sector sanitario permite que las instituciones que requieran intercambiar registros médicos, a través de una red, puedan hacerlo con un alto nivel de seguridad(AU)

Computer security has become a necessity and a right for all citizens. The IT systems used in the health sector have much easier and more sustainable digital storage and guarantee the privacy and integrity of information, which are sensitive issues. In Cuba, there is no centralized PKI (Public Key Infrastructure) scheme at the national level that promotes and guarantees the security of sensitive information in the public health system, which puts the authenticity, integrity and confidentiality of personal medical data at risk. The aim of our work was to design a security structure centered on PKI among health institutions, based on the national public key infrastructure as root certificate authority (CA). In order to achieve this, a documentary analysis was carried out on the current state of the art in the subject; as well as interviews with administrative staff, hospital managers and specialists in computer security, which allowed the research bases to be created. As a result, a trust scheme was obtained that promotes the secure exchange of patients' medical records between health institutions. The implementation of a PKI infrastructure in the health sector allows institutions to exchange medical records through a network with a high level of security(AU)

Dr. C. Ramón Syr Salas Perea y su aporte a la educación en Ciencias de la Salud

Varios autores califican de Maestro a todo aquel que enseña; el Dr. Ramón Syr Salas Perea considerado de esta forma, contribuyó al desarrollo de profesionales de la salud, pues guió, asesoró y estimuló el comportamiento de los profesores en el sector salud, así como la búsqueda del objeto del saber. "Cuando se ha cumplido bien la obra de la vida", quedan el recuerdo y las enseñanzas para siempre en aquellos que se han educado; es este el caso de la fructífera y laboriosa existencia del maestro Dr. Ramón Syr Salas Perea durante su vida y sus aportes en la formación de los recursos humanos en el sector salud.

A Teacher is the one who teaches, as several authors have expressed. Dr. Ramón Syr Salas Perea was considered an outstanding teacher who contributed to the development of health professionals since he guided, advised, and encouraged the teachers' behavior in the health sector and made them realize the importance of the search for knowledge. When the work of life has been well fulfilled, memories and teaching actions will ever remain in the memory of those who have been educated. This is the case of the fruitful and hard-working labor carried out by the university teacher Dr. Ramón Syr Salas Perea during all his life, as well as his contributions in the training of human resources in the health sector.

Vacunación canina y felina masiva en México: pobre rectoría y fallo de mercado / Massive canine and feline vaccination in Mexico: poor governance and market failure

Resume: Objetivo: Analizar la rectoría y los mecanismos de procuración de insumos en el contexto del Programa de Acción Específico de Prevención y Control de la Rabia Humana y la Semana Nacional de Vacunación Antirrábica canina y felina en México (SNVA-C). Material y métodos: La información se obtuvo mediante solicitudes al Instituto Nacional de Transparencia, Acceso a la Información y Protección de Datos Personales. Resultados: De 2009 a 2017 se aplicaron 158.9 millones de dosis de vacuna antirrábica canina y felina (VAR-CF) por un monto de compra aproximado de 1 915 MDP. Se documentó una débil rectoría que permite prácticas monopólicas y compras fragmentadas y directas. Las adquisiciones se han fincado con precios que varían entre entidades federativas y son significativamente más altos que los precios internacionales. Conclusión: Después de 30 años de operación de la SNVA-C en México, persisten pagos excesivos para la VAR-CF, los cuales son indicativos de una falla importante del mercado, caracterizada por nula competencia, información asimétrica y estructuras de incentivos desalineadas que impiden obtener un precio competitivo.

Abstract: Objective: To analyze decision-making concerning stewardship and procurement mechanisms in the context of the Program for Prevention and Control of Human Rabies and the National Canine and Feline Vaccination Week in Mexico. Materials and methods: The information was obtained through requests to the National Institute of Transparency, Access to Information and Protection of Personal Data. Results: From 2009 to 2017, 158.9 million doses of canine rabies vaccine (VAR-CF) were applied with an estimated budget of 1 915 million pesos. Our findings suggest weak stewardship and ineffective governance that allows monopolistic practices and fragmented and direct purchases. Prices for the same product vary discretionally between states and are significantly higher than those offered at international level. Conclusions: After 30 years of operation of the SNVA-C in Mexico, high prices of the VAR-CF persist, which are indicative of a significant market failure, characterized by zero competition, asymmetric information and misaligned incentive structures that precluded favorable price negotiation.

Resultados de la estrategia de formación doctoral en el trabajo en Escuela Nacional de Salud Pública / Outcomes of the doctoral training strategy in the work developed by the National School of Public Health

Introducción: El propósito actual de incrementar la formación de doctores en el sector sanitario responde a la necesidad de los solucionar problemas relativos a la salud de la población y a su atención a través de servicios organizados, a partir del trabajo de profesionales formados con un enfoque científico. Objetivo: Describir los resultados de la estrategia de formación doctoral de los profesores de la Escuela Nacional de Salud Pública entre 2017 y 2018. Métodos: Investigación descriptiva y transversal, que estudió la totalidad de los profesores de la Escuela Nacional de Salud Pública. La información disponible partió de los jefes de los departamentos docentes y se estructuró en bases de datos de la Oficina de doctorado de dicha institución. También se analizó la base de datos que incluía a los matriculados en el Programa de doctorado en Ciencias de la Salud o en otra área del conocimiento fuera de la institución. Resultados: Se logró un buen funcionamiento en la conducción de la estrategia y la inserción de los aspirantes a grupos de investigación resultó una experiencia positiva. Se evidenció la lentitud de algunos profesores en la fase de definición del tema y de aprobación de los proyectos por el consejo científico. Esto produjo estancamiento en el desarrollo de los docentes, por lo que debe considerarse con mayor peso en su evaluación. Conclusiones: La Escuela Nacional de Salud Pública ha ejecutado la estrategia de formación doctoral para sus profesores desde su puesto de trabajo, y ha logrado vincular las líneas de investigación de doctorado con las tesis de maestrías y especialidades. Esta estrategia ha mostrado factibilidad y resultados satisfactorios, aunque subsisten algunas brechas que forman parte de las proyecciones de la institución para mejorar la formación doctoral(AU)

Introduction: The current purpose of increasing the training of doctors in the health sector responds to the need to solve problems related to population health and care through organized services, based on the work of professionals trained with a scientific approach. Objective: To describe the outcomes of the doctoral training strategy of the professors of the National School of Public Health between 2017 and 2018. Methods: Descriptive and cross-sectional research, which studied all the professors of the National School of Public Health. The information available was obtained from the heads of the teaching departments and structured in databases of the Doctoral Programs Office of that institution. The database that included those enrolled in the PhD in Health Sciences or another area of knowledge outside the institution was also analyzed. Results: A good functioning was achieved in the conduction of the strategy and the insertion of the candidates to research groups was a positive experience. Some slowness was evidenced in some professors regarding the phase of definition of their subjects and in the approval of the projects by the scientific committee. This caused stagnation in the development of teachers, so it should be considered with greater weight in its evaluation. Conclusions: The National School of Public Health has implemented the strategy of doctoral training for its professors from their posts, and has managed to link the lines of doctoral research with theses of master's degrees and medical specialties. This strategy has shown feasibility and satisfactory outcomes, although there are still some gaps that are part of the institution's projections to improve doctoral training(AU)

Perceptions of Spanish nurses on economic crisis and the impacts on health care system / Percepciones de enfermeras españolas acerca de la crisis económica y sus impactos en el sistema sanitario / Percepções de enfermeiras espanholas sobre a crise econômica e os impactos no sistema de saúde

ABSTRACT Objective: to analyze the perceptions of Spanish nurses regarding the country's economic crisis situation, and its impacts on nursing work, health system and population's health. Methods: qualitative approach, with data collection using an internet-based questionnaire and individual in-depth interviews. Data were analyzed according to Thematic-Categorical Content Analysis, supported by Historical and Dialectical Materialism perspective. Results: the categories produced discuss themes as: cutbacks in health care and the consequences of workforce non-replacement and work overload; salary impact; care model changes; negative impacts on population health. The impact on population health and work was discussed, especially regarding vulnerable groups, as well as in assistance model reconfiguration, reinforcing the biomedical and assistance perspective.

RESUMEN Objetivo: analizar las percepciones de las enfermeras españolas en cuanto a la coyuntura de crisis económica vivenciada por el país y sus impactos en el trabajo, en el sistema de salud y en la salud de la población. Métodos: enfoque cualitativo, con recolección de datos por medio de un cuestionario publicado en Internet y a partir de entrevistas individuales en profundidad. Los datos fueron analizados con base en el Análisis de Contenido Temático-Categorial, con suporte teórico del Materialismo Histórico y Dialético. Resultados: las categorías discuten temas como: los cortes financieros y sus impactos de no-reposición de la fuerza de trabajo, sobrecarga de trabajo, impacto salarial y en las plazas de trabajo; énfasis en un modelo asistencial biomedico; impactos negativos en la salud de la población. Se discutieron los impactos en el trabajo y la salud de la población, sobre todo en los grupos vulnerables, así como en la reconfiguración del modelo asistencial, reforzando la perspectiva biomédica y asistencial. Consideraciones finales: la perspectiva de la enfermería española apunta hacia el agravamiento de las políticas liberales y su expresión en la salud, y para el papel de la enfermería en los sistemas universales de salud.

RESUMO Objetivo: analisar as perceções de enfermeiras espanholas quanto à conjuntura de crise econômica e seus impactos no trabalho, no sistema de saúde e na saúde da população. Método: abordagem qualitativa; coleta de dados por questionário publicado na internet e em entrevistas individuais. Análise com base na Análise de Conteúdo Temático-Categorial, apoiada pela perspectiva teórica do materialismo histórico-dialético. Resultados: as categorias produzidas abordam temas como: cortes financeiros e seus impactos de não reposição da força de trabalho, sobrecarga de trabalho, impacto salarial e na oferta de emprego; ênfase em um modelo de saúde biomédico; impactos negativos na saúde da população. Discussão: destacam-se impactos no trabalho e na saúde, sobretudo nos grupos vulneráveis, assim como sobre o modelo assistencial reforçando a perspectiva biomédica. Considerações finais: as percepções da enfermagem espanhola apontam para o acirramento das políticas liberais e sua expressão na saúde e para o papel da enfermagem nos sistemas de saúde.

Óbices da governança pública e sua influência sobre a atenção à saúde bucal no Estado de Santa Catarina, Brasil / Obstacles to public governance and their influence on oral healthcare in the state of Santa Catarina, Brazil / Obstáculos de la gobernanza pública y su influencia sobre la atención en la salud bucal en el estado de Santa Catarina, Brasil

Resumo: Objetivou-se analisar a governança pública empreendida na rede regionalizada de atenção à saúde em Santa Catarina, Brasil, e sua influência sobre a tomada de decisão quanto à estruturação da atenção à saúde bucal. Estudo exploratório-analítico, com abordagem qualitativa e sustentação metodológica na Teoria Fundamentada nos Dados. Realizaram-se 30 entrevistas em profundidade com gestores das Comissões Intergestores Regional (CIR) e Bipartite (CIB), da Secretaria Estadual de Saúde, representantes do Conselho Estadual de Saúde e gestores de serviços especializados em saúde bucal, em dois grupos amostrais, além de observação não participante em reuniões da CIB. Após análise comparativa dos dados, formulou-se o modelo teórico cuja categorial central foi expressa sob título Influência das Falhas da Governança sobre a Rede de Atenção à Saúde Bucal: A Expansão Errante de Serviços por Indução Vertical e Ratificação do Caráter Periférico Dado à Saúde Bucal. A governança empreendida no sistema de saúde catarinense apresenta estruturas formais e de apoio bem estabelecidas, como a consolidação das CIR. No entanto, identificaram-se fragilidades as quais revelam problemas na legitimidade do sistema de governança. Perpetua-se a posição periférica dada à estruturação da atenção à saúde bucal em rede e à expansão errante dos serviços, caracterizada por indução vertical e sem o reconhecimento contextualizado dos agravos em saúde bucal como guia para o planejamento dos serviços. Há a necessidade de maior conscientização pública e inclusão de profissionais e gestores com espírito de advocacy para propugnar um novo protagonismo da atenção à saúde bucal nas políticas públicas de saúde.

Abstract: The study aimed to analyze public governance in the regionalized healthcare network in the state of Santa Catarina, Brazil, and its influence on decision-making in the organization of oral healthcare. This was an exploratory analytical study with a qualitative approach, with the methodology based on Grounded Theory. Thirty in-depth interviews were held with managers from the Regional Inter-Managers Commissions and Bipartite Commissions (CIR and CIB, respectively, in Portuguese), under the State Health Department, representatives from the State Health Councils, and administrators of specialized oral healthcare services, in two sample groups, in addition to non-participant observation in CIB meetings. After comparative data analysis, the theoretical model was formulated in which the central category was expressed in the title Influence of Failures in Governance on the Oral Healthcare Network: The Erratic Expansion of Services by Vertical Induction and Confirmation of the Peripheral Status Assigned to Oral Health. The governance practiced in the Santa Catarina State Health System displays well-established formal support structures, such as the consolidation of the CIR. However, weaknesses were identified that reveal problems in the governance systems' legitimacy. The situation perpetuates the peripheral status assigned to the structuring of oral healthcare in network format and the erratic expansion of services, characterized by vertical induction and without contextualized recognition of oral health problems as guidance for planning the services. There is a need for greater public awareness and the inclusion of professionals and managers that can advocate for the importance of oral health as a major priority in public health policies.

Resumen: El objetivo del trabajo fue analizar la gobernanza pública emprendida en la red regionalizada de atención en salud en Santa Catarina, Brasil, y su influencia sobre la toma de decisiones respecto a la estructuración de la atención en la salud bucal. Se trata de un estudio exploratorio-analítico, con enfoque cualitativo, y apoyado metodológicamente en la Teoría Fundamentada en Datos. Se realizaron 30 entrevistas en profundidad, con gestores de las Comisiones Intergestoras Regional (CIR) y Bipartita (CIB), de la Secretaría Provincial de Salud, representantes del Consejo Provincial de Salud y gestores de servicios especializados en salud bucal, en dos grupos de muestras; además de la observación no participante en reuniones de la CIB. Tras el análisis comparativo de los datos, se formuló un modelo teórico, cuya categoría central se expresó bajo el título Influencia de los Fallos de la Gobernanza sobre la Red de Atención en Salud Bucal: La Expansión Errante de Servicios por Inducción Vertical y Ratificación del Carácter Periférico Otorgado a la Salud Bucal. La gobernanza emprendida en el sistema de salud catarinense presenta estructuras formales y de apoyo bien establecidas, como la consolidación de las CIR. No obstante, se identificaron fragilidades, que revelan problemas en la legitimidad del sistema de gobernanza. Se perpetúa su posición periférica, debido a la estructuración en red de la atención en salud bucal y la expansión errante de sus servicios, caracterizada por la inducción vertical, y sin el reconocimiento contextualizado de los problemas en salud bucal, como guía para la planificación de los servicios. Existe la necesidad de una mayor concienciación pública, así como la inclusión de profesionales y gestores con espíritu de advocacy para que propugnen un nuevo protagonismo de la atención en salud bucal dentro de las políticas públicas de salud.

Alteridade ou austeridade: uma revisão acerca do valor da equidade em saúde em tempos de crise econômica internacional / Alterity or austerity: a review on the value of health equity in times of international economic crises

Resumo Nas últimas décadas, o sistema capitalista, transformado por meio de crises mais agressivas e globais, tem submetido a sociedade à austeridade fiscal e tensionado a garantia dos direitos à saúde, como imposição para ampliar a eficiência e efetividade dos sistemas de saúde. A equidade em saúde, por outro lado, opera como fator protetor em relação aos efeitos nocivos da austeridade sobre a saúde da população. O objetivo deste artigo é analisar o efeito da crise financeira global quanto à valorização da equidade em saúde frente à efetividade nas comparações internacionais de eficiência dos sistemas de saúde na literatura científica. Realizada revisão integrativa, com busca nas bases de dados PubMed e BVS, de 2008-18, com análise cross-case. O equilíbrio entre equidade e efetividade deve ser buscado desde o financiamento até os resultados em saúde, de modo eficiente, como forma de fortalecimento dos sistemas de saúde. A escolha entre alteridade ou austeridade deve ser feita de forma explícita e transparente, com resiliência dos valores societais e princípios de universalidade, integralidade e equidade.

Abstract In recent decades, the global and aggressive crises-transformed capitalist system has subjected society to fiscal austerity and strained the assurance of its right to health, as an imposition to increase health systems efficiency and effectiveness. Health equity, on the other hand, provides protection against the harmful effects of austerity on population health The aim of this article is to analyse the effect of the global financial crisis on how health equity is considered against effectiveness in international comparisons of health systems efficiency in the scientific literature. Integrative review, based on PubMed and VHL databases searches, 2008-18, and cross-case analysis. The balance between equity and effectiveness must be sought from health financing to results, in an efficient way, as a means to strengthening health systems. The choice between alterity or austerity must be made explicitly and transparently, with resilience of societal values and the principles of universality, integrality and equity.

La formación del talento humano en el área de la salud en las zonas económicas especiales de Venezuela. Retos y logros I / The formation of human talent in the area of health in the special economic zones of Venezuela. Challenges and achievements I

A partir del gobierno de Hugo Chávez, la salud y la educación se convirtieron en derechos consagrados en la Constitución de 1999, por lo cual, las políticas públicas se aplicaron desde el principio para que no fuera letra muerta y saldar la deuda social que dejaron los gobiernos neoliberales de la IV República. Es por ello que una de las acciones, entre otras, que se ejecutaron para impulsar la inclusión a la educación universitaria (EU) fue el de crear el Sistema Nacional de Ingreso (SNI), hecho que ocurrió en el 2008 en el CNU, y posteriormente se ratificó y modificó en el 2014. Con el fin de estudiar los efectos de tales políticas, en esta primera parte del trabajo, se enfocó como ha sido la inclusión a las instituciones de educación universitaria (IEU) a nivel nacional, especialmente en el área de las Ciencias de la Salud, mediante un análisis descriptivo y comparativo de los parámetros académicos: Demanda, oferta académica y asignación de cupos por las IEU; la matrícula universitaria y el número de egresados durante los últimos 20 años; así como la inversión financiera por Estado a la EU. Los resultados obtenidos reflejan el incremento de la inclusión a la EU por las mayorías del país, logrando la formación del talento humano para el sector salud, en el cual hay muchas necesidades. A pesar de estos esfuerzos, aún existen problemas serios sobre el proceso de inclusión y la cobertura de la oferta académica.

From the Hugo Chávez government, health and education became rights enshrined in the 1999 Constitution, therefore, public policies were applied from the beginning so that it was not a dead letter and to pay the social debt left by the neoliberal governments of the IV Republic. That is why one of the actions, among others, that were carried out to promote inclusion in university education (EU) was to create the National Income System (SNI), a fact that occurred in 2008 at the CNU, and later it was ratified and modified in 2014. In order to study the effects of such policies, in this first part of the work the focus was on the inclusion of university education institutions (IEU) at the national level, especially in the area of the Health Sciences, by means of a descriptive and comparative analysis of the academic parameters: Demand, academic supply and allocation of quotas by the SNI; university enrollment and the number of graduates during the last 20 years; as well as the financial investment by State to the EU. The results obtained reflect the increase in inclusion in the EU by the majority of the country, achieving the training of human talent for the health sector, in which there are many needs. Despite these efforts, there are still serious problems regarding the inclusion process and the coverage of the academic offer

La formación del talento humano en el área de la salud en las zonas económicas especiales de Venezuela. Retos y logros II / The formation of human talent in the area of health in the special economic zones of Venezuela. Challenges and achievements II

En esta segunda parte del estudio sobre las políticas del gobierno para el incremento de la inclusión a la educación universitaria (EU), especialmente para el sector salud, quisimos hacer el análisis descriptivo y comparativo en las cuatro Zonas Económicas Especiales (ZEE) que ha creado el presidente Nicolás Maduro en su primera gestión, recordando que la primera parte las estudiamos a escala nacional. En esta oportunidad, realizamos el estudio con similares parámetros académicos, enfocados al área de las Ciencias de la Salud. Es decir, la demanda de cupos universitarios por parte del estudiantado, la oferta de plazas por las Instituciones de Educación Universitaria (IEU) y la asignación de cupos por el Sistema Nacional de Ingreso (SNI). Sin embargo, la matrícula y los valores de egresados de las IEU se estudiaron en tres periodos diferentes: Los tres últimos años de la presidencia de Rafael Caldera (1996-1998); los tres últimos años del presidente Hugo Chávez (2010-2012) y los cuatro primeros años de la primera gestión del presidente Nicolás Maduro (2013-2016). Finalmente, se investigó sobre los proyectos académicos aprobados por el CNU que han introducido las IEU de gestión pública de las ZEE desde 2006 hasta el 2013. Los resultados obtenidos evidencian que los primeros años de la revolución se ha logrado incrementar notablemente los valores de todos estos parámetros, indicando el aumento de la inclusión a la EU en las regiones, pero existen deficiencias notables sobre la oferta académica, algunas veces divorciadas de la realidad circundante de la ZEE, la demanda no satisfecha aún y los pocos proyectos académicos aprobados por el CNU

In this second part of the study on government policies for increasing inclusion in university education (EU), especially for the health sector, we wanted to do a descriptive and comparative analysis in the four Special Economic Zones (EEZ) that it has created President Nicolás Maduro in his first term, remembering that we studied the first part on a national scale. In this opportunity, we carried out the study with similar academic parameters, focused on the area of Health Sciences. That is, the demand for university quotas by the student body, the offer of places by the University Education Institutions (IEU) and the allocation of quotas by the National Income System (SNI). However, the enrollment and values of IEU graduates were studied in three different periods: The last three years of Rafael Caldera's presidency (1996-1998); the last three years of President Hugo Chávez (2010-2012) and the first four years of President Nicolás Maduro's first term (2013-2016). Finally, research was carried out on the academic projects approved by the CNU that have been introduced by the UIS of public management of the EEZs from 2006 to 2013. The results obtained show that the first years of the revolution have managed to significantly increase the values of all these parameters, indicating the increase of the inclusion to the EU in the regions, but there are notable deficiencies in the academic offer, sometimes divorced from the surrounding reality of the ZEE, the demand not yet satisfied and the few academic projects approved by the CNU

Health workforce in India: opportunities and challenges

Health system reforms in India during the past decade yielded an impressive growth of medical, dental and nursing education opportunities, but health workforce density remains low in comparison to the World Health Organization (WHO) norms. Apart from shortage, retaining qualified health workforce in the rural and underserved areas remains a huge challenge. This crisis is likely to persist until and unless health system addresses the fundamental requirements of health workers as envisaged in health policies. Concerted attention and long term political commitments are required to overcome health system barriers to achieve rural recruitment and retention across various cadres in states. As the major share of health workforce belongs to the private sector, their resources need to be harnessed to meet health system goals through partnerships and collaborations. There is an urgent need for better regulation and enforcement of standards in medical education and delivery of health services across the public and private sectors.

Percepción de las demencias y la intersectorialidad en el contexto del Policlínico Docente Playa / Dementias' and intersectotiality's perception in to Teaching Polyclinic Playa's area

Introducción: Las demencias son consideradas la primera causa de discapacidad en los adultos mayores. A la vez, los ancianos, por lo general, suelen necesitar progresivas atenciones y, por lo tanto, se vuelven en cierta medida dependientes, contribuyendo así a la carga económica y al estrés psicológico de sus familiares, cuidadores, enfermeros y de sí mismos. Objetivos: Evaluar la percepción acerca de las demencias y la intersectorialidad en el área del Policlínico Docente de Playa. Método: Se realizó un estudio descriptivo de corte transversal en un universo conformado por actores de los sectores socioeconómicos de la comunidad, del cual, por muestreo intencional, se seleccionó un líder de los sectores: CDR, FMC, Cultura, Deporte, Institución Religiosa, Comercio, Gastronomía, Educación, Asistencia Social; y se incluyeron todos los médicos de la familia (14) y los 63 cuidadores (sector población), que cumplían con los criterios de selección. Se emplearon cuestionarios autoadministrados. Resultados: Las demencias fueron percibidas como problema solo por 59,8 por ciento de los encuestados; 95,2 por ciento de los cuidadores percibió dificultades para el control de las demencias en el contexto en contraste con los demás sectores; la intersectorialidad se consideró pertinente para el control de las demencias en 72,4 por ciento de las respuestas; principalmente a expensas de los cuidadores. 63,2 por ciento de los encuestados fue incapaz de mencionar elementos que favorecían la intersectorialidad y 59,8 por ciento percibió obstáculos. Conclusiones: De forma general, las demencias no fueron percibidas de manera adecuada, lo cual conspira contra la adopción de acciones intersectoriales encaminadas a un mejor control de sus causas y repercusiones, esta situación debe ser valorada a la hora de concebir acciones para su abordaje en el contexto estudiado(AU.

Introduction: Dementia is considered the first disability cause in bigger adults, the bigger dependence taxpayer; it overloads economic and psychological stress for sick persons, caregivers and relatives. Objective: To evaluate the perception about dementia and intersectoriality in the area of the Teching Polyclinic Playa. Method: It was carried out a descriptive study of traverse court in an universe conformed by the socioeconomic sectors of the community of which was selected a leader of the sectors, CDR, FMC, Culture, Sport, Religious Institution, Trade, Gastronomy, Education, Social Attendance by intentional sampling; also 14 doctors of the family and 63 caregivers. The approaches were picked up through a self-administered questionnaire. Results: Dementias were perceived as a problem only by 59,8 percent of the respondents; 95,2 percent of the caregivers perceived difficulties in the control of dementias in the context in contrast with the other sectors; the intersectoriality was considered relevant for the control of dementias in 72,4 percent; mainly at the expense of caregivers. The majority of respondents 63,2 percent were unable to mention elements that favored intersectoriality and 59,8 percent perceived obstacles. Conclusions: The dementias were not perceived adequately in the context, which conspires against the adoption of intersectorial actions aimed at a better control of their causes and repercussions(AU)

A community based cross-sectional study on the health system responsiveness in the urban field practicing area of tertiary health care centre, Hyderabad

Background: According to WHO, responsiveness is an important goal of the health system, in addition to the two predominant goals of improving health and fairness of financing. Responsiveness includes non-medical aspects of health care. As the progress to universal health coverage is gaining pace, the present study has attempted to study the domains of responsiveness in the government and private health services and health care providers.Methods: A community based cross-sectional study for a period of 3 months in the households of the urban field practising area. Sampling technique was simple random sampling. Assuming the prevalence of 50% and allowable error of 5%, 400 households were surveyed. KISH table method was used at household level. Study tool was World Health Survey responsiveness module questionnaire for the eight responsiveness domains-prompt attention, dignity, communication, autonomy, confidentiality, choice, quality of basic facilities and social support (for inpatients).Results: The mean age (yrs) of the study subjects is 46.078±13.998. 68.25% (273) were males.31.75% (127) were females. 46.25% (185) were using government services and 53.75% (215) were using private services. The mean waiting time (min) in the public health facilities was 135.2±111.2 which was more than private facilities, 62.4±40.8.Conclusions: All the responsiveness domains (except confidentiality) were found to be positively associated (p<0.05) with the government health services. Proportion of people rating the responsiveness domains from most important to the least important showed prompt attention (52%) and dignity (30%) as the most important domains.

Trayectoria laboral y satisfacción de los egresados de Licenciatura en Enfermería de la Facultad de Estudios Superiores Zaragoza / Career path and satisfaction of graduales of Nursing Bachelor from the Faculty of Higher Studies Zaragoza

Introducción: la dinámica del mercado laboral involucra las formas de producir y ofertar servicios, así como la selección de la fuerza de trabajo. El seguimiento de la inserción y trayectoria laboral de los egresados aporta información esencial para las instituciones educativas. Objetivo: describir la ubicación, trayectoria laboral y satisfacción de los egresados de la Licenciatura de Enfermería en la Facultad de Estudios Superiores Zaragoza de la Universidad Nacional Autónoma de México. Métodos: estudio descriptivo transversal con una muestra no probabilística de 140 egresados de la Licenciatura de Enfermería. Se aplicó un cuestionario con 30 ítems, sobre la ubicación y trayectoria de los egresados en el mercado laboral y un apartado sobre la satisfacción con su actividad laboral valorado con escala de Likert. Resultados: el 66.4% de los egresados de la Licenciatura en Enfermería tiene empleo en el sector salud. El 49% se encuentra en instituciones públicas y 51% en instituciones privadas. Los egresados valoran sentirse satisfechos con su actividad laboral, el 60% de ellos tiene la posibilidad de responder a problemas de relevancia social y el 57.1% aplica los conocimientos aprendidos. Conclusiones: la inserción de los egresados al mercado laboral está determinada no solo por factores académicos, sino también por factores sociales, laborales y sindicales. Entre los factores académicos están la buena aceptación de la carrera en el mercado laboral, las competencias adquiridas y el prestigio de la institución.

Introduction: The dynamics of the labor market involves the ways of producing and offering services and the selection of the work force. The monitoring of the insertion and trajectory of the graduates provides essential information for educational institutions. Objective: To describe the location, career path and satisfaction of graduates of nursing degree in the Faculty of Higher Studies Zaragoza of the Universidad Nacional Autónoma de México. Methods: Cross-sectional descriptive study with a non-probabilistic sample of 140 graduate students in nursing. A questionnaire with 30 items was applied, on the location and trajectory of graduates in the labor market and a section on satisfaction with their work activity assessed with a Likert scale. Results: 66.4% of the graduates of bachelor's degree in nursing have jobs in the health sector. 49% are in public institutions and 51% in private institutions. The graduate's value feeling satisfied with their work activity, 60% of them have the possibility of responding to problems of social relevance and 57.1% applies the knowledge learned. Conclusions: The insertion of graduates to the labor market is determined not only by academic factors but also by social, labor and union factors. Among the academic factors are the good acceptance f the career in the labor market, the skills acquired and the prestige of the institution.