Alinhamento partidário e oferta de políticas públicas no Brasil / Alineación partidaria y provisión de políticas públicas en Brasil / Partisan alignment and public policies provision in Brazil

Resumo Municípios partidariamente alinhados com o presidente ofertam mais políticas públicas? A entrega de serviços públicos é uma das atividades centrais dos governos. Uma vez que são os partidos políticos que controlam o Poder Executivo tanto no Governo Federal quanto no governo local, é razoável esperar que seus interesses partidários e eleitorais influenciem o curso da implementação de serviços. Neste artigo, analiso a cobertura da atenção básica à saúde como indicador de oferta. Dado o forte compartilhamento de responsabilidades entre os entes federados, argumento que o Governo Federal implementa políticas públicas de forma estratégica, aumentando a oferta de serviços em municípios partidariamente alinhados. Para testar empiricamente essa relação, estimo o efeito causal do alinhamento por meio de um desenho de regressão descontínua para eleições acirradas. Os resultados indicam que os municípios partidariamente alinhados com a Presidência da República têm cobertura da atenção básica à saúde, em média, 3% maior que outros governados por partidos oposicionistas. Em uma cidade com 10 mil habitantes, por exemplo, isso significaria 300 pessoas a mais sendo adequadamente atendidas por equipes de saúde.

Resumen ¿Los municipios alineados partidariamente con el presidente ofrecen más políticas públicas? La prestación de servicios públicos es una de las actividades centrales de los gobiernos. Dado que son los partidos políticos los que controlan el Poder Ejecutivo tanto en el Gobierno federal como en el local, es razonable esperar que sus intereses partidistas y electorales influyan en el curso de la implementación. En este artículo analizo la cobertura de la atención primaria de salud como indicador de provisión. Dada la fuerte compartición de responsabilidades entre las entidades federativas, argumento que el Gobierno federal implementa las políticas públicas de manera estratégica, aumentando la provisión de servicios en los municipios alineados partidariamente. Para probar empíricamente esta relación, estimo el efecto causal del alineamiento utilizando un diseño de regresión discontinua para elecciones reñidas. Los resultados indican que los municipios partidariamente alineados tienen, en promedio, una cobertura de atención primaria un 3% más alta que otros gobernados por partidos de oposición. En una ciudad de 10.000 habitantes, por ejemplo, esto significaría 300 personas más adecuadamente atendidas por los equipos de salud.

Abstract This research examines whether local governments politically aligned with the president's party offer more public policies. The delivery of public services is one of the central activities of governments. Since the political parties control the executive branch in both federal and local government, it is reasonable to expect that their partisan and electoral interests will influence policy implementation. This study analyzes the coverage of primary healthcare as an indicator of policy delivery. Given the strong sharing of responsibilities among federated entities, I argue that the federal government implements public policies strategically, increasing the supply of services in partisan-aligned municipalities. To empirically test this relationship, I estimate the causal effect of alignment using a regression-discontinuity design for close elections. The results indicate that partisan-aligned municipalities have, on average, 3% higher coverage of primary healthcare than others governed by opposition parties. In a city with 10,000 inhabitants, for example, this would mean 300 more people receiving healthcare.

Geografia das respostas sociais para as pessoas idosas em Portugal / Geography of social care for older people in Portugal

Resumo: Este estudo analisa a distribuição geográfica das respostas sociais dirigidas à população idosa em Portugal continental, e compara os padrões espaciais dos equipamentos dos sectores público, solidário e lucrativo. Os resultados mostram uma distribuição heterogénea e uma tendência para a concentração espacial das estruturas do sector privado em áreas mais urbanizadas. Conclui-se que a crescente liberalização do sector constitui um risco para a equidade territorial dos cuidados sociais.

Abstract: This study analyses the geographical distribution of social care for older adults in mainland Portugal, and compares the spatial patterns of public, non-profit and profit institutions. The results show a heterogeneous distribution and a tendency towards spatial concentration of private sector structures in more urbanised areas. We conclude that the increasing liberalisation of the sector constitutes a risk to the territorial equity of social care provision.

Factors of abandonment of tuberculosis treatment in the public health network / Factores de abandono al tratamiento de la tuberculosis en la red pública de salud

ABSTRACT This study determines the factors of abandonment of tuberculosis treatment in the public health network of Cali, Colombia, during years 2016 to 2018. We conducted an operational case-control investigation including 224 patients with tuberculosis (112 abandoned treatment and 112 completed it). We found that treatment abandonment for tuberculosis is driven by factors related to the individuals and health services that facilitate non-adherence and drive them away from the care provided in medical institutions.

RESUMEN Este estudio determina los factores de abandono al tratamiento de la tuberculosis en la red pública de salud de Cali, Colombia, durante los años 2016 a 2018. Se realizó una investigación operativa de casos y controles en la que se incluyeron 224 pacientes con tuberculosis (112 abandonaron el tratamiento y 112 lograron completarlo). Se encuentra que el abandono del tratamiento para la tuberculosis está impulsado por factores relacionados con el individuo y los servicios de salud que facilitan la no adherencia y los alejan de la atención brindada en las instituciones médicas.

Access to childbirth care services in the interior of Pernambuco, Northeast region of Brazil / Acesso aos serviços de atenção ao parto no interior de Pernambuco, Nordeste do Brasil

ABSTRACT OBJECTIVE To analyze the access of women to the public health system network to childbirth care, highlighting the barriers related to the "availability and accommodation" dimension in a health macroregion of Pernambuco. METHODS Ecological study, conducted based on hospital birth records from the Hospital Information System of the Brazilian Unified Health System (SUS), and information from the state's Hospital Beds Regulation Center, about women residing in health macroregion II, in 2018. Displacements were reviewed considering the geographic distance between the municipality of residence and that of the childbirth; estimated time of displacement of pregnant women; ratio of shifts blocked for admission of pregnant women for delivery; and the reason for unavailability. RESULTS In 2018, health macroregion II performed 84% of usual risk childbirths, and 46.9% of high-risk childbirths. The remaining high-risk childbirths (51.1%) occurred in macroregion I, especially in Recife. The reference maternity for high-risk childbirths in that macroregion had 30.4% of the days of day shifts and 38.9% of the night shifts blocked for admission of childbirths; the main reason was the difficulty in maintaining the full team in service. CONCLUSIONS Women residing in the health macroregion II of Pernambuco face great barriers of access in search of hospital care for childbirth, traveling great distances even when pregnant women of usual risk, leading to pilgrimage in search of this care. There is difficulty regarding availability and accommodation in high-risk services and obstetric emergencies, with shortage of physical and human resources. The obstetric care network in macroregion II of Pernambuco is not structured to ensure equitable access to care for pregnant women at the time of childbirth. This highlights the need for restructuring this healthcare services pursuant to what is recommended by the Cegonha Network.

RESUMO OBJETIVO Analisar o acesso de mulheres atendidas na rede pública aos serviços de atenção ao parto, destacando-se as barreiras relacionadas à dimensão "disponibilidade e acomodação" em uma macrorregião de saúde de Pernambuco. MÉTODOS Estudo ecológico, realizado a partir dos registros de partos hospitalares do Sistema de Informação Hospitalar e de informações da Central de Regulação de Leitos do estado sobre mulheres residentes na macrorregião de saúde II, em 2018. Analisou-se os deslocamentos, considerando a distância geográfica entre o município de residência e o de ocorrência do parto, o tempo estimado do deslocamento das gestantes, a proporção de plantões bloqueados para admissão das gestantes para o parto e o motivo da indisponibilidade. RESULTADOS Em 2018, a macrorregião de saúde II realizou 84% dos partos de risco habitual e 46,9% de alto risco. Os demais partos de alto risco (51,1%) ocorreram na macrorregião I, sobretudo no Recife. A maternidade de referência para partos de alto risco dessa macrorregião teve 30,4% dos dias de plantões diurnos bloqueados para admissão de partos e 38,9% dos noturnos; o principal motivo foi a dificuldade em manter a equipe completa no serviço. CONCLUSÕES Mulheres residentes na macrorregião de saúde II de Pernambuco enfrentam grandes barreiras de acesso em busca de atendimento hospitalar para o parto, percorrendo grandes distâncias, mesmo quando gestantes de risco habitual, levando à peregrinação em busca dessa assistência. Há dificuldade de disponibilidade e acomodação nos serviços de alto risco e de emergências obstétricas, com insuficiente capacidade física e de recursos humanos. A rede de atenção obstétrica na macrorregião II de Pernambuco não está estruturada para garantir um acesso equânime à assistência das gestantes no momento do parto, o que evidencia a necessidade de sua reestruturação em aproximação ao preconizado pela Rede Cegonha.

Impacto sanitario económico de dos modelos de provisión de prótesis desde un sistema público de salud / Financial and health impact of two models of providing prostheses in a public health system / Impacto econômico e sanitário de dois modelos de fornecimento de próteses em um sistema público de saúde

RESUMEN Objetivo. Comparar los resultados sanitarios y económicos de dos sistemas de adquisición de prótesis: un sistema tradicional en el cual la compra se inicia al solicitar el insumo versus un modelo de insumos en existencia denominado Banco de Prótesis. Métodos. Estudio descriptivo-analítico, en usuarios del Ministerio de Salud de la provincia de Buenos Aires, Argentina. Los pacientes pertenecían a dos grupos de estudio 1) prótesis provistas por vía tradicional del Sistema Informático para Adquisición y Contrataciones Hospitalarias (SIPACH); 2) prótesis provistas por Banco de Prótesis (BDP). Se limitó el análisis a prótesis endovasculares del tipo stent coronario y prótesis de cadera. Se utilizaron bases de datos oficiales gubernamentales. El periodo de estudio comprendió del 01/01/2018 hasta el 31/10/2022. Las variables analizadas fueron: edad, sexo, diagnóstico, hospital, tipo de implante o prótesis; fecha solicitud; fecha adquisición; precio unitario, costos directos e indirectos; costos promedio de la internación diaria, costo-efectividad e impacto presupuestario. Resultados. Se analizaron 4 106 solicitudes. En el sistema tradicional, 13,5% de los pacientes no consiguieron sus prótesis, hubo 50 días más de demora que con BDP, y los costos totales fueron superiores en SIPACH (stent coronarios +463%, prótesis de cadera +133%). El BDP ahorró US$ 3,2 millones anuales y evitó 22 muertes con la provisión temprana de prótesis endovasculares. Conclusiones. El BDP demostró superioridad al modelo tradicional de provisión de prótesis tanto en términos sanitarios, por lograr mayor acceso, acortar tiempos de espera y evitar muertes; como económicos, por reducir significativamente los precios unitarios y globales, logrando un notable ahorro en los presupuestos asignados.

ABSTRACT Objective. Compare the health outcomes and financial outcomes of two systems for the procurement of prostheses: the traditional system, in which procurement is initiated when a product is requested; and the "Prosthesis Bank" model, based on a current inventory of supplies. Methods. Descriptive-analytical study of users of Ministry of Health services in the province of Buenos Aires, Argentina. The patients belonged to two study groups: 1) prostheses were provided through the traditional computerized system for hospital procurement and contracting, known as SIPACH; and 2) prostheses were provided by the Prosthesis Bank. The study was limited to endovascular prostheses (coronary stents) and hip prostheses. Official government databases were used. The study period was from 01/01/2018 to 31/10/2022. The variables analyzed were: age, sex, diagnosis, hospital, type of implant or prosthesis, date of request, date received, unit price, direct and indirect costs, average cost of daily hospitalization, cost-effectiveness, and budgetary impact. Results. A total of 4 106 applications were analyzed. In the traditional system: 13.5% of patients did not get their prostheses; it took 50 days longer than with the Prosthesis Bank; and total costs were higher in SIPACH (coronary stent, +463%; hip prosthesis, +133%). The Prosthesis Bank saved USD 3.2 million annually and prevented 22 deaths through early provision of endovascular prostheses. Conclusions. The Prosthesis Bank proved to be superior to the traditional model for providing prostheses, both in terms of health—by achieving better access, shortening waiting times, and avoiding deaths—and financially—by significantly reducing unit and overall prices, achieving significant savings in allocated budgets.

RESUMO Objetivo. Comparar os resultados econômicos e sanitários de dois sistemas de aquisição de próteses: um sistema tradicional, no qual a compra é iniciada mediante solicitação, e um modelo em estoque chamado Banco de Próteses (BDP). Métodos. Estudo descritivo-analítico com usuários do Ministério da Saúde da província de Buenos Aires, Argentina. Os pacientes pertenciam a dois grupos de estudo: 1) próteses fornecidas pelo método tradicional do Sistema Informatizado de Aquisição e Contratações Hospitalares (SIPACH); e 2) próteses fornecidas pelo BDP. A análise se restringiu a próteses endovasculares do tipo stent coronariano e próteses de quadril. Foram utilizados bases de dados oficiais do governo. O período do estudo foi de 01/01/2018 a 31/10/2022. As variáveis analisadas foram: idade, sexo, diagnóstico, hospital, tipo de implante ou prótese; data de solicitação; data de aquisição; preço unitário, custos diretos e indiretos; custo médio diário de internação, relação custo-efetividade e impacto orçamentário. Resultados. Foram analisadas 4 106 solicitações. No sistema tradicional, 13,5% dos pacientes não receberam as próteses e houve 50 dias a mais de espera do que pelo BDP. Além disso, os custos totais foram maiores no SIPACH (+463% no caso dos stents coronários e +133% para as próteses de quadril). O BDP economizou US$ 3,2 milhões ao ano e evitou 22 mortes com o fornecimento precoce de próteses endovasculares. Conclusões. O BDP demonstrou superioridade em relação ao modelo tradicional de fornecimento de próteses, tanto em termos sanitários, ao oferecer maior acesso, diminuir o tempo de espera e evitar mortes, quanto em termos econômicos, ao reduzir significativamente os preços unitários e totais, gerando economias significativas nos orçamentos alocados.

Aplicaciones de aprendizaje automático para el análisis industrial de la provisión azucarera en Matanzas, Cuba

El análisis de los servicios ecosistémicos puede aportar conocimientos importantes sobre cómo se procesan y se obtienen los bienes del sistema agroindustrial azucarero. Para este trabajo, se recopilaron 346 datos del procesamiento industrial de la caña de azúcar en tres zafras, en la agroindustria del municipio Calimete, Provincia Matanzas (Cuba), con el objetivo de emplear algoritmos de aprendizaje automáticos, para predicciones relacionadas a datos biofísicos y económicos. Se analizaron siete predictores y mediante best subset selection, se identificó la combinación de rendimiento potencial en caña y pérdidas industriales totales, para predecir el servicio de provisión azucarera, mediante la regresión lineal múltiple. Se ajustó, también, un segundo modelo, que predice el efecto económico de las pérdidas industriales. En ambos modelos, se logró explicar por encima del 70 % de la variabilidad observada, en las variables dependientes, con un test F significativo (p-value: < 0,05), además de cumplirse con las condiciones de diagnóstico y validación.

The analysis of ecosystem services can provide important insights into how goods are processed and obtained from the sugar agro-industrial system. For this work, 346 data were collected on the industrial processing of sugarcane in three harvest, in the agroindustry of the Calimete municipality, Matanzas Province (Cuba), with the objective to use the machine learning algorithm, to predict both, biophysical and economic data. Seven predictors were analyzed and by best subset selection, it was identified both the potential yield in sugarcane and the total industrial losses combination to predict the sugar provision service, by multiple linear regression. In addition, it was adjusted a second model to predict the economic effect of the industrial losses. In both models were able to explain over 70 % of the variability observed, in the dependent variables, with a significant F test (p-value: <0.05), also the diagnostic and validation conditions were met.

O processo de monitoramento, controle e avaliação do Programa Mais Médicos no estado da Bahia / The monitoring, control and evaluation process of the Mais Médicos Program in Bahia / El proceso de seguimiento, control y evaluación del Programa Más Médicos EN EL ESTADO DE Bahía

Este artigo tem o objetivo de avaliar o processo de aprimoramento e acompanhamento das variáveis envolvidas na consolidação do Progama Mais Médicos para o Brasil (PMMB) na Bahia, bem como a gestão da informação associada aos avanços tecnológicos. A pesquisa é de natureza qualitativa e do tipo estudo de caso. Os dados pertinentes ao monitoramento e planejamento estratégico do PMMB, no estado da Bahia, foram coletados mensalmente, a partir das bases de dados do Ministério da Saúde, Ministério da Educação e municípios, para serem agrupados em uma planilha eletrônica do Microsoft Excel, por meio do recurso Power Business Intelligence (Power BI), programa que está em constante modificação, permitindo visualizar a qualquer momento as variáveis desejadas. Assim, a distribuição de médicos atuantes no PMMB, no território baiano, corrobora os estudos que apontam o crescimento do provimento de médicos, sobretudo nas regiões mais isoladas, pobres e vulneráveis. A construção dos painéis, realizada pela captação e sistematização de diferentes fontes de dados relativos à gestão do PMMB na Bahia, permitiu avaliar: a distribuição dos médicos atuantes no PMMB na Bahia, as regiões de maior concentração de médicos, a porcentagem dos municípios contemplados pelo programa, a distribuição da rede de apoio no estado da Bahia, a distribuição dos cursos de medicina no estado e as regiões que realizam teleconsultorias. Por meio desta pesquisa, foi possível concluir que o número de médicos destinados à atenção de saúde nas populações mais carentes e isoladas vem aumentando gradativamente, embora ainda seja insufuciente. Além disso, pode-se concluir que a gestão da informação associada aos avanços tecnológicos podem servir como instrumento de monitoramento e avaliação na área da saúde.

Este estudio tiene como objetivo evaluar el proceso de mejora y seguimiento de las variables involucradas en la consolidación del Programa Más Médicos (PMM) en Bahía (Brasil), así como la gestión de la información asociada a los avances tecnológicos. La investigación es de carácter cualitativo, de tipo estudio de caso. Los datos relevantes para el seguimiento y la planificación estratégica del PMM en el estado de Bahía fueron recopilados mensualmente de las bases de datos del Ministerio de Salud, del Ministerio de Educación y municipios, para ser agrupados en una hoja de cálculo de Microsoft Excel, a través del recurso Power BI que se modifica constantemente, lo que permite ver las variables en cualquier momento. Así, la distribución de los médicos que actúan en el PMM en el amplio territorio de Bahía corrobora estudios que apuntan al crecimiento de la oferta de médicos, especialmente en las regiones más aisladas, pobres y vulnerables. La construcción de los paneles, realizada a partir de la captura y sistematización de diferentes fuentes de datos, relacionados con la gestión del PMM de Bahía, permitió evaluar: la distribución de los médicos que actúan en el PMM de Bahía, las regiones con mayor concentración de médicos, el porcentaje de municipios cubiertos por el programa, la distribución de la red de apoyo en el estado de Bahía, la distribución de los cursos de medicina en el estado, y las regiones que realizan teleconsultas. Esta investigación permite concluir que el número de médicos dedicados a la atención de la salud en las poblaciones más necesitadas y aisladas ha ido aumentando paulatinamente, aunque aún es insuficiente. Además, se concluye que el manejo de la información asociada a los avances tecnológicos puede servir como una herramienta de seguimiento y evaluación en salud.

This qualitative case study evaluates the improvement and monitoring processes concerning the variables involved in the consolidation of the More Doctors Program (PMM) in Bahia, Brazil, as well as the management of information associated with technological advances. Data relevant for monitoring and strategic planning the PMM in the state were collected monthly from the Ministry of Health, Ministry of Education and municipalities databases, and then grouped in a Microsoft Excel spreadsheet using power BI, an everchanging software that allow us to view the desired variables at any time. The results on the distribution of PMM doctors in the broad territory of Bahia corroborate studies that point to an increased supply of physicians, especially in more isolated, poorer and vulnerable regions. The panels developed by capturing and systematizing different data sources regarding PMM management in Bahia allowed to evaluate: the distribution of PMM doctors in the state, the regions with the highest concentration, the percentage of municipalities covered by the program, the distribution of the support network within the state, the distribution of medical undergraduate programs in the state; the regions that offer teleconsultations. In conclusion, the number of physicians offering health care to the poorest and most isolated populations has been increasing gradually, but remains insufficient. Moreover, the management of information associated with technological advances can serve as a monitoring and evaluation instrument in health care.

Reactions of physicians in the state of São Paulo to the use of telemedicine during the SARS-CoV-2 pandemic: cross-sectional study

ABSTRACT BACKGROUND: Telemedicine can be a component of integrated healthcare practices and its use is not a recent phenomenon around the world. In Brazil, its more widespread use began during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, through extraordinary authorization from the Brazilian Ministry of Health. OBJECTIVES: To describe some aspects of use of teleconsultation among a sample of physicians in the state of São Paulo during the SARS-CoV-2 pandemic. DESIGN AND SETTING: Cross-sectional study based on a survey conducted by the São Paulo Medical Association (Associação Paulista de Medicina, APM) on medical practice during the SARS-CoV-2 pandemic between December 18, 2020, and January 18, 2021. RESULTS: This survey generated responses from 2,052 physicians. Of these, 981 (47.8%) reported not practicing any form of telemedicine. Among those who reported practicing telemedicine, 274 (28.4%) reported not receiving remuneration directly for the attendance provided and 225 (23.3%) reported receiving remuneration equal to what they would have received from face-to-face consultations. Regarding the professional linkage of the physicians who undertook telemedicine attendance, the majority (499; 51.8%) only attended private patients. Regarding the resources used to provide telemedicine attendance, most of the respondents used specialized digital platforms (594; 61.6%), electronic health records (592; 61.4%) and electronic prescriptions (700; 72.6%). CONCLUSION: This study demonstrates that important issues such as professional remuneration, use of electronic platforms and medical records, ensuring data protection and relationships between physicians and other stakeholders still need to be better defined, in order to achieve the desired scale and reach the outcomes defined.

Referentes teóricos que sustentan la actuación de Enfermería en el cuidado a pacientes con cáncer / Theoretical Referents that Support Nursing Performance in the Care of Cancer Patients

Introducción: La actuación de enfermería y el desarrollo de su práctica social están guiadas, de manera general, por los conceptos propuestos por las diferentes teorías y modelos de la profesión y el método científico que mediante una adecuada valoración de las necesidades afectadas contribuye al bienestar físico y psicológico del paciente oncológico. Objetivo: Identificar los referentes teóricos que sustentan la actuación de los profesionales de enfermería en el cuidado a los pacientes con cáncer. Métodos: Se efectuó una sistematización de la literatura científica en repositorios y bases de datos electrónicas en revistas nacionales e internacionales de las bases de datos SciELO, Medline, Dialnet y Scopus, sobre los sustentos teóricos que respaldan la actuación de los profesionales de enfermería en el cuidado de personas con diagnóstico médico de cáncer. Resultados: La revisión realizada permitió documentar la aplicabilidad de las teorías y modelos en el cuidado del paciente oncológico, son la Teoría de los Síntomas Desagradables, el Modelo de Promoción de Salud (MPS), la Teoría del Déficit de Autocuidado y la Teoría de la Transculturación, expuestos en las dimensiones de fatiga, actividad física, autocuidado y cuidados culturales. Conclusiones: La sistematización realizada permitió identificar algunos referentes teóricos que sustentan la actuación del profesional de enfermería en el cuidado al paciente con cáncer. Todo esto ha quedado documentado de forma tal que sirva como modelo a seguir en la asistencia al relacionar los diferentes tratamientos y los cuidados que se brindan con un respaldo científico, que se traduce en una atención de calidad(AU)

Introduction: Nursing performance and the development of nursing as a social practice are guided, in general, by the concepts proposed by the different theories and models of the profession and the scientific method that, through an adequate assessment of the affected, contributes to the physical and psychological well-being of the oncology patient. Objective: To identify the theoretical referents that support the performance of nursing professionals in the care of cancer patients. Methods: A systematization was carried out with the scientific literature from repositories and electronic databases in national and international journals of the SciELO, Medline, Dialnet and Scopus databases, about the theoretical foundations that support the performance of nursing professionals in the care of people with a medical diagnosis of cancer. Results: The review carried out allowed documenting the applicability of theories and models with respect to the care of the oncological patient: the unpleasant symptom theory, the health promotion model, the self-care deficit theory, and the transculturation theory, exposed in the dimensions of fatigue, physical activity, self-care, and cultural care. Conclusions: The systematization carried out allowed the identification of some theoretical referents that support the performance of the nursing professional in the care of the patient with cancer. All this has been documented in such a way that it serves as a model to be followed in the assistance, by relating the different treatments and care provided with scientific support, which translates into quality care(AU)

Diferenças na disponibilidade de medicamentos prescritos na Atenção Primária: evidências do Projeto Prover / Differences in prescribed medicine availability in Primary Health Care: evidence from the Prover Project

Resumo Estudo transversal da disponibilidade de medicamentos prescritos na Atenção Primária, com amostra probabilística de 1221 usuários das farmácias públicas de município polo de saúde em Minas Gerais, em 2017. Foram estimados indicadores de disponibilidade dos medicamentos e realizou-se regressão logística hierárquica, segundo o modelo comportamental de uso de serviços de saúde. Apenas 39,3% dos usuários receberam todos os medicamentos nas quantidades prescritas. Os medicamentos mais e menos disponíveis foram, respectivamente, os que atuam no sistema digestivo/metabolismo, e no sangue e órgãos hematopoiéticos. A disponibilidade integral do tratamento se mostrou associada a mais escolaridade (≥ 8 anos OR: 1,7; IC 95%: 1,3-2,4); proximidade até a farmácia (≤15 min OR: 1,7; IC 95%: 1,2-2,3); ausência de gastos privados com medicamentos (OR: 2,2; IC 95%: 1,7-2,9) e menor número de medicamentos prescritos (≤ 2 OR: 3,2; IC 95%: 2,3-4,4; 3/4 OR: 1,6; IC 95%: 1,2-2,1). Esses resultados mostram diferenças na disponibilidade de medicamentos dentro do SUS, evidenciando a necessidade de reorganização da rede de atendimento dos serviços de dispensação e do planejamento das aquisições de medicamentos, além da proposição de políticas públicas que priorizem a população mais vulnerável.

Abstract This is a cross-sectional study on the availability of prescribed medicines in Primary Health Care (PHC), with a probabilistic sample of 1,221 users of public pharmacies in a health pole municipality in Minas Gerais, in 2017. Medicine availability indicators were estimated, and a hierarchical logistic regression was performed, according to the behavioral model of health service use. Only 39.3% of patients received all medicines in the prescribed quantities. The most and the least available medicines were, respectively, those for the digestive system/metabolism, and for blood and hematopoietic organs. Full availability of the prescribed treatment was associated with higher schooling (≥ 8 years OR: 1.7; 95% CI: 1.3-2.4); proximity to the pharmacy (≤15 min OR: 1.7; 95% CI: 1.2-2.3); absence of out-of-pocket expenditure on medicines (OR: 2.2; 95% CI: 1.7-2.9), and a smaller number of prescription drugs (≤ 2 OR: 3.2; 95% CI: 2.3-4.4; 3/4 OR: 1.6; 95% CI: 1.2-2.1). These results showed differences in medicine availability within the Brazilian Unified Health System (SUS), and highlighted the need to reorganize the dispensing services network and pharmaceutical procurement planning, as well as to develop public policies to protect the vulnerable population.

Los límites propios de los mercados en la provisión de los bienes y servicios / The limits of markets in the provision of goods and services

RESUMEN Se examinan cuatro aproximaciones sobre los procesos y limitaciones de los mercados, y los de no mercado: Smith, Arrow, Becker y Roth. Smith centra la atención en el sentimiento moral de la simpatía, Arrow pone el énfasis en las asimetrías lógicas que se presentan entre la elección individual y la colectiva, Becker busca ampliar el sistema de precios a través de los incentivos y Roth destaca la relevancia de la sicología y de la conducta humana.

ABSTRACT Four approaches to the processes and limitations of markings, and those of non-market, are examined: Smith, Arrow, Becker and Roth. Smith focuses on the moral feeling of sympathy, Arrow emphasizes the logical asymmetries that arise between individual and collective choice, Becker seeks to expand the price system through incentives, and Roth highlights the relevance of psychology and human behavior.

Strengthen the management of external provision of human genetic resource information in clinical trials / 中华医学科研管理杂志

Objective:By strengthening the management of external provision of data generated by clinical trials in medical institutions, to improve the effectiveness of supervision of human genetic resource information, and to promote the legal sharing and effective use of data.Methods:Analyzed problems identified in filing human genetic resource information in clinical trials since July 1, 2019, put forward possible solutions and suggestions.Results:Main problems were identified in external provision of human genetic resource information, including the specification and time limit of external provision of information, the information recipient, the storage location and the final disposal method of information.Conclusions:Hospital and regulatory authority need to carry out more tailored training, optimize management systems and procedures in order to strengthen the management of the external provision of human genetic resources information.

Clinical outcomes of immediate implantation and provisionalization combined with guided bone regeneration for a single anterior maxillary tooth with a thin facial bone phenotype / 口腔疾病防治

Objective@#To study the postoperative soft and hard tissue changes and aesthetic effect of immediate implantation and provisionalization (IIPP) combined with guided bone regeneration (GBR) for a single anterior maxillary tooth with a thin facial bone phenotype.@*Methods @# A total of 34 patients with thin facial bone (<1 mm) were categorized into two groups: a flapped GBR group and a flapless group. Tooth extraction and IIPP were conducted at the sites in both groups. Implant survival rates, dimensional changes in soft and hard tissues during the six- and twelve-month follow-ups, the pink esthetic score (PES) and patient satisfaction scores at the twelve-month follow-up were measured.@*Results @#The implant survival rates were 100% in both groups, and no complications occurred during the 12 months after surgery. The facial bone thickness remained over 2 mm on all measured sides, and the height of the facial bone crest remained at 1.39 mm at the 12-month follow-up in the flapped GBR group, while the facial bone thickness remained less than 2 mm on all measured sides, and the height of the facial bone crest remained at 1.03 mm at the 12-month follow-up in the flapless group. The absorption of facial bone at all measured sides in the flapped GBR group was greater than that in the flapless group (P<0.05). There was no significant difference between the two groups in the dimensional changes of labial soft tissues during the six- and twelve-month follow-ups (P>0.05). The mean PES scores were 10.29 ± 2.34 for the flap GBR group and 10.12±1.78 for the flapless group (P = 0.807). The mean patient satisfaction scores were 8.65 ± 1.27 in the flapped GBR group and 8.76 ± 1.25 in the flapless group, and the patients in both of the groups were satisfied with the esthetic outcomes (P = 0.787). @*Conclusion @#IIPP combined with GBR might be a prospective treatment strategy for a single anterior maxillary tooth with a thin facial bone phenotype, but the esthetic risks should never be ignored.

A Study of Factors That Promote Patients’ Provision of Information to Pharmacists and Evaluation Items for Evaluating Patients’ Willingness to Provide Information / 社会薬学

The purpose of this study was to identify patient-side factors that facilitate their provision of information to pharmacists (Survey A) and identify questions to assess their willingness to provide information to pharmacies (Survey B). Two web-based surveys were conducted among individuals aged 50-79 years who regularly brought their prescriptions to pharmacies. Survey A was conducted in February 2020 with 540 respondents. Multiple regression analysis was conducted, with “patients’ provision of information to pharmacies” as the objective variable. Survey B was conducted in November 2020 with 126 respondents for each three patterns of questions regarding “patients’ provision of information to pharmacies.” The distribution of responses was compared. More than half of the respondents were willing to provide information to pharmacists on the contents of the initial questionnaire. In contrast, less than half of the respondents were willing to provide information about the physician’s explanation of drug treatment, history of the disease, concerns and consultations about medication, blood tests results, and unusual symptoms. Factors on the patients’ side that promoted the provision of information included having a family pharmacist, a sense of trust in the pharmacist, recognition as a medical professional, and understanding the pharmacist’s work. As an indicator to evaluate the increase in patients’ willingness to provide information, the questionnaire statement “I will actively tell the pharmacist about [　].” was found to be appropriate. Words such as a physician’s explanation of drug treatment, history of the disease were included in [　].

Developing and prioritising strategies to improve the implementation of maternal healthcare guidelines in South Africa: The nominal group technique

Background: In South Africa, maternal healthcare guidelines are distributed to primary health care (PHC) facility for midwives to refer and implement during maternal healthcare services. Different training was offered for the use of maternal care guidelines. However, poor adherence and poor implementation of guidelines were discovered. Aim: This study aimed to develop and prioritise strategies to improve the implementation of maternal healthcare guidelines at PHC facilities of Limpopo province, South Africa. Method: Strengths, weaknesses, opportunities and threats analysis and its matrix together with the nominal group technique were used to develop the current strategy. Midwives, maternal, assistant and operational managers from PHC facilities of the two selected district of the Limpopo province were selected. Criterion-based purposive sampling was used to select participants. Data collection and analysis involved the four steps used in the nominal group technique. Results: Strategies related to strengths and weaknesses such as human resources, maternal health services and knowledge deficit were identified. Opportunities and threats such as availability of guidelines, community involvement and quality assurance as factors that influenced the provision of maternal healthcare services were identified. Conclusion: Researchers formulated actions that could build on identified strengths, overcome weaknesses such as human resources, explore opportunities and mitigate the threats such as quality assurance

Study on Evaluation of Efficiencies for Drug information by Video and Paper Media in Community Pharmacies / 医薬品情報学

Objective: While pharmacies focus on interpersonal work, patients need to process a lot of information. Therefore, it is important for the pharmacy to provide information according to the situation. This study was conducted for the purpose of providing a video and paper media, and clarifying that it is useful to provide information in various mediums about the method of administering the powdered medicine, which requires an understanding of the operation.Method: Conducted a survey for those who brought prescriptions for infants from March 2016 to about a year and a half. We compared and verified the understanding of the medication method for infants between the paper medium group and the moving image medium group.Results: Differences in the background between the two media use groups were clarified, and path analysis confirmed differences in the factors that affect the reliable administration of each medium to infants. It was revealed that the evaluation of moving image media was higher than the comparison between the groups in terms of usability. Although there was no difference in the ability to use the medium at his own pace, the moving images were significantly higher in understanding the motion.Discussion: There is a limit to the understanding of motions with a single explanation at the pharmacy counter. It was confirmed in this study that information provision using a medium that can be used depending on the situation of the patient is useful as a complementary role in medication instruction. Providing information while appropriately combining information provision in various media is thought to reduce the burden on patients and contribute to improved adherence.

Japanese Medical Academic Organizations Surveyed on the Current Situation of Medical Information Providedto the Public on the Internet / 医薬品情報学

Objective: The internet isflooded with drug information; however, some of it isinappropriate and thisinadequate information could expose the public to health hazards. Therefore, we conducted research on the idea of transmitting drug information to the public via the internet and the current state of the information currently provided by each academic society relevant to the field of Medical Informatics.Methods: A questionnaire was mailed to the website managers for the website of 129 specialist medical societies, all members of the Japanese Association of Medical Sciences. We conducted our research between October to November 2018. We investigated each website administrator’s opinion about offering drug information for consumers via the internet and what information each academic society is currently providing.Results: The effective response rate was 43.4% (56/129 groups). Most respondents thought that drug information overflowed in the current Internet society. Moreover, more than half of the respondents thought that the quality of drug information transmitted to the public wasinadequate. Currently, 30 of the academic groupssurveyed are providing information to the public. When providing information, they did not refer to the “Drug Guide for Patients” much. More than 80% of respondents said they would cooperate with linking to the information provided to the public. However, each academic society felt there would be many problems with doing so such as the need for a system to check the contents of the information provided and a system to perform maintenance.Conclusion: The results showed that the website administrators recognized that there is a need to improve the quality of and system for providing drug information to the public. We believe that an integrated information system can be constructed by aggregating the drug information held by each academic society. However, this cannot be realized without first solving many problems.

Utilización de anticonceptivos en población migrante: el caso de las gestantes migrantes venezolanas en dos ciudades receptoras de la costa norte de Colombia / Contraceptive use in the migrant population: the case of pregnant Venezuelan migrants in two receiving cities on the north coast of Colombia / Uso de anticoncepcionais em população migrante: O caso das gestantes migrantes venezuelanas em duas cidades receptoras do litoral norte da Colômbia

Resumen Objetivo: Describir la utilización de métodos anticonceptivos de gestantes migrantes venezolanas, en dos ciudades de la costa norte de Colombia (Barranquilla y Riohacha), entre 2018 y 2019. Metodología: Se diseñó un estudio descriptivo de corte transversal. Las participantes se seleccionaron mediante muestreo sistemático en hospitales y muestreo en bola de nieve en la comunidad. Un cuestionario estandarizado permitió la recolección de variables sociodemográficas, de migración, de uso de anticonceptivos, entre otras. Resultados: Fueron encuestadas 552 mujeres gestantes provenientes de Venezuela, principalmente jóvenes, casadas o en unión libre; la minoría de los embarazos fueron planificados (37,7 %), aun cuando las mujeres conocían sobre métodos de anticoncepción. El preservativo (condón) y la píldora fueron los métodos más conocidos (94,7 y 96,1 %, respectivamente). Conclusión: Casi todas las mujeres conocen métodos anticonceptivos y los lugares dónde obtenerlos; no obstante, solo la mitad logró conseguirlos la última vez que los buscó; así, la mayoría de los embarazos fueron no planificados. La garantía de los derechos sexuales y reproductivos, incluyendo la satisfacción de necesidades de planificación familiar, debe ser una prioridad en las acciones de atención a la población migrante, en el marco del fenómeno migratorio colombo-venezolano.

Abstract Objective: To describe the use of contraceptive methods by pregnant Venezuelan migrants in two cities on the north coast of Colombia (Barranquilla and Riohacha), between 2018 and 2019. Methodology: A descriptive cross-sectional study was designed. Participants were selected through systematic sampling in hospitals and snowball sampling in the community. A standardized questionnaire allowed the sociodemographic, migration, contraceptive use and other variables to be collected. Results: 552 pregnant, mainly young, women from Venezuela who are married or living with their partner were surveyed. The minority of pregnancies were planned (37.7%), even though the women knew about contraception methods. The condom and the pill were the most well-known methods (94.7 and 96.1%, respectively). Conclusion: Nearly all of the women knew about birth control and where it can be accessed. However, only half managed to get them the last time they looked for them, meaning that most of the pregnancies were unplanned. Guaranteed sexual and reproductive rights, including satisfactory family planning requirements, must be a priority in actions aimed at the migrant population, within the framework of the Colombian-Venezuelan migratory phenomenon.

Resumo Objetivo: Descrever o uso de métodos anticoncepcionais de gestantes migrantes venezuelanas, em duas cidades do litoral norte da Colômbia (Barranquilla e Riohacha), entre 2018 e 2019. Metodologia: Foi desenhado um estudo de corte transversal descritivo. As participantes foram selecionadas através de uma amostragem sistemática em hospitais e amostragem em bola de neve feita na comunidade. Um questionário padrão permitiu a coleta de variáveis sócio demográficas, de informação relacionada à migração, ao uso de anticoncepcionais, entre outras. Resultados: O questionário foi aplicado a 552 mulheres gestantes vindas da Venezuela, principalmente jovens, casadas ou em união estável; a minoria das gestações foi planejada (37,7%), mesmo conhecendo os métodos anticoncepcionais. O preservativo (camisinha) e a pílula foram os métodos mais identificados (94,7 e 96,1% respectivamente). Conclusão: Quase todas as mulheres conhecem métodos anticoncepcionais e os lugares onde podem obtê-los; porém somente a metade delas conseguiu adquiri-los quando procuraram pela última vez; assim que a maioria das gestações não foi planejada. A garantia dos direitos sexuais e reprodutivos, incluindo a satisfação das necessidades de planejamento familiar, deve ser uma prioridade nos programas de atenção à população migrante, dentro do marco do fenômeno migratório colombo-venezuelano.

Programa Médicos pelo Brasil: mérito e equidade / Médicos pelo Brasil Program: merit and equity / Programa Médicos pelo Brasil: mérito y equidad

O Programa Médicos pelo Brasil (PMPB) foi lançado em 2019 pelo Ministério da Saúde com objetivo de ampliar a oferta de serviços médicos em locais de difícil provimento ou alta vulnerabilidade. As principais mudanças propostas no PMPB são: obrigatoriedade de registro no Conselho Federal de Medicina; alocação de vagas com prioridade para as pequenas e distantes cidades, contratação dos profissionais via CLT e formação qualificada em Medicina de Família e Comunidade (MFC), permitindo a titulação dos médicos após dois anos. Com essas mudanças, espera-se um aprofundamento na interiorização dos profissionais, com possibilidade efetiva de fixação, além da formação em larga escala de MFCs. A formação através da residência também será impulsionada, com incentivo financeiro municipal para esse fim, em consonância com as ações do novo financiamento federal da Atenção Primária à Saúde (APS), o Programa Previne Brasil. O PMPB será executado pela Agência para o Desenvolvimento da Atenção Primária à Saúde (Adaps), um modelo inovador de gestão pública, que trará eficiência ao programa. Com essas características, o PMPB pretende oferecer um solução perene para a oferta de serviços médicos no âmbito da APS do Sistema Único de Saúde.

The Médicos pelo Brasil Program (PMPB) was launched in 2019 by the Ministry of Health with the objective to expand the supply of medical services in places of difficult provision or high vulnerability. The main changes proposed in the PMPB are: mandatory registration with the Federal Council of Medicine; allocation of vacancies with priority for small and distant cities, hiring of professionals via national labor legislation and qualified training in Family Medicine (FM), allowing the doctor's speciality certification after two years. With these changes, it is expected to deepen the internalization of professionals, with effective possibility of fixation, in addition to training in scale in FM. Training through residency will also be promoted, with municipal financial incentives for this purpose, aligned with the actions of the new federal financing of Primary Health Care (PHC), the Previne Brasil Program. The PMPB will be executed by the Agency for the Development of Primary Health Care (Adaps), an innovative management model that will bring efficiency to the program. With these characteristics, the PMPB intends to offer a solution for the provision of medical services within the PHC of the Brazilian Public Health System

El Programa de Médicos pelo Brasil (PMPB) fue lanzado en 2019 por el Ministerio de Salud con el bjetivo expandir la oferta de servicios médicos en lugares de difícil provisión o alta vulnerabilidad. Los rincipales cambios propuestos en el PMPB son: registro obligatorio en el Consejo Federal de Medicina; designación de vacantes con prioridad para ciudades pequeñas y distantes, contratación de profesionales a través de las leyes laborales nacionales y capacitación calificada en medicina familiar y comunitaria (MFC), lo que permite la certificación de especialidad después de dos años. Con estos cambios, se espera profundizar la internalización de profesionales, con posibilidad efectiva de fijación, además de capacitación a gran escala de los MFC. La capacitación a través de la residencia también será promovida, con incentivos financieros municipales para este propósito, en línea con las acciones del nuevo financiamiento federal de Atención Primaria de Salud (APS), el Programa Previne Brasil. El PMPB será ejecutado por la Agencia para el desarrollo de la atención primaria de salud (Adaps), un modelo de gestión innovador. Eso traerá eficiencia al programa. Con estas características, el PMPB pretende ofrecer un solución perenne para la prestación de servicios médicos dentro de la APS del Sistema Único de Salud.

Advanced Practice Nursing in Primary Health Care in the Spanish National Health System / Enfermagem Prática Avançada em atenção primária no Sistema Nacional de Saúde espanhol

Abstract The primary health care in the Spanish National Health System is organised in health centres with multi-professional teams, composed of doctors and nurses specialised in family and community health, in addition to other professionals. This article analyses the role of primary health care nurses in the Spanish National Health System. In the last decade, new concepts of task sharing between doctors and nurses as well as advanced nursing roles have been evolved in the health centres that focus on improving care for chronically ill patients and access to primary care. With shared responsibility, nurses are responsible for chronic patients in stable conditions, health prevention and promotion. The scaling up of advanced nursing tasks is limited by uncertainties of roles, disparities between states, and legislations that do not cover the full extent of advanced nursing tasks. The case study of Spain indicates that a strong multi-professional model of primary health care teams is a crucial basis for the evolvement of advanced nursing practice and its acceptance in daily routines. However, advantageous education structures and legislations are needed to allow nurses to develop their contribution in the full potential.

Resumo A atenção primária no Sistema Nacional de Saúde espanhol é prestada em centros de saúde públicos, com equipe composta de médicos e enfermeiros especialistas em família e comunidade, além de outros profissionais. Neste artigo, se analisa a atuação do enfermeiro na atenção primária no Serviço Nacional de Saúde espanhol. Na última década, buscando efetividade no manejo de condições crônicas e melhor acesso à atenção, novos modelos de ações compartilhadas entre médicos e enfermeiros, bem como práticas avançadas de enfermagem foram desenvolvidas. Atualmente, com responsabilidades compartilhadas, enfermeiros são responsáveis por pacientes com condições crônicas estáveis, além de ações de prevenção e promoção. Não obstante, a prática avançada em enfermagem é limitada por indefinição de funções, disparidade de atuação entre Estados e legislação insuficiente, que não abarca o potencial desta prática. O caso da Espanha indica que um modelo de atenção multiprofissional forte na atenção primária é crucial para o desenvolvimento da enfermagem de prática avançada. Entretanto, promover formação e legislação adequada à essa prática é necessário, para que os enfermeiros contribuam com todo o seu potencial na atenção primária à saúde.