Health needs of mothers of children with Congenital Zika Syndrome: an integrative review / Necesidades de salud de las madres de niños con Síndrome Congénito por el virus del Zika: una revisión integradora / Necessidades de saúde de mães de crianças com Síndrome Congênita pelo vírus Zika: revisão integrativa

ABSTRACT Objectives: to evidence and analyze the health needs of mothers of children with Congenital Zika Syndrome. Methods: a total of 44 articles published between October/2015 and March/2021 on PubMed, LILACS, Scopus, Web of Science and Science Direct were included. The RTI bank and CASP score were applied to classify the methodological quality of the studies. Reflective content analysis and Cecílio and Matsumoto's taxonomy were used for analysis. Visual map was used as a technique for presenting the results. Results: mothers need access to social protection, family-centered, multi-professional empathetic monitoring, cultivating bonds and affection by professionals, sharing of care between health network services, strengthening the social support network and fostering coexistence groups between them. Final Considerations: intersectoral initiatives must be implemented for better housing conditions, fighting stigma, holding parents accountable and resuming life project.

RESUMEN Objetivos: demostrar y analizar las necesidades de salud de las madres de niños con Síndrome Congénito causado por el virus del Zika. Métodos: se incluyeron 44 artículos publicados entre octubre/2015 y marzo/2021 en PubMed, LILACS, Scopus, Web of Science y Science Direct. Se aplicó el puntaje RTI bank y CASP para clasificar la calidad metodológica de los estudios. Para el análisis se utilizó el análisis de contenido reflexivo y la taxonomía de Cecílio y Matsumoto, y se utilizó el mapa visual como técnica para presentar los resultados. Resultados: las madres necesitan acceso a protección social, centrado en la familia, multidisciplinar, seguimiento empático, cultivar vínculos y afectos por parte de los profesionales, compartir la atención entre los servicios de la red de salud, fortalecer la red de apoyo social y fomentar grupos de convivencia entre ellas. Consideraciones Finales: se deben implementar iniciativas intersectoriales para mejorar las condiciones de vivienda, combatir el estigma, responsabilizar al padre y retomar el proyecto de vida.

RESUMO Objetivos: evidenciar e analisar as necessidades de saúde de mães de crianças com Síndrome Congênita pelo vírus Zika. Métodos: foram incluídos 44 artigos publicados, entre outubro/2015 e março/2021, na PubMed, LILACS, Scopus, Web of Science e Science Direct. Foram aplicados o RTI bank e escore CASP, para classificar a qualidade metodológica dos estudos. A análise de conteúdo reflexiva e a taxonomia de Cecílio e Matsumoto foram utilizadas para análise, e o mapa visual, enquanto técnica de apresentação dos resultados. Resultados: as mães necessitam de acesso à proteção social, acompanhamento multiprofissional empático centrado na família, cultivo de vínculo e afeto por parte dos profissionais, compartilhamento de cuidados entre serviços da rede de saúde, fortalecimento da rede de apoio social e fomento de grupos de convivência entre elas. Considerações Finais: devem ser implementadas iniciativas intersetoriais para melhores condições de moradia, enfrentamento do estigma, responsabilização do genitor e retomada do projeto de vida.

Gestão participativa na Estratégia Saúde da Família: reorientação da demanda à luz do Método Paideia / Participatory management in the Family Health Strategy: reorientation of demand in the light of the Paideia Method

RESUMO Objetivou-se descrever a construção de um plano de ação de corresponsabilização entre gestores, profissionais e usuários, para a reorientação da demanda espontânea em uma Unidade de Saúde da Família, por meio de ferramentas de gestão participativa. Tratou-se de um estudo intervencionista do tipo pesquisa-ação, realizado com uma equipe de Estratégia Saúde da Família do município de Petrolina (PE). Participaram do estudo 11 sujeitos, selecionados pela técnica de amostragem da representatividade qualitativa, sendo 3 gestores da atenção básica do município, 4 profissionais de saúde da Estratégia Saúde da Família envolvida no estudo e 4 líderes comunitários, representantes dos usuários. O referencial teórico adotado para a análise da intervenção foi o método de análise e cogestão de coletivos, o Método Paideia. O estudo evidenciou o despreparo dos coletivos para atuarem na gestão participativa, ao tempo que revelou que as possibilidades de reestruturação dos serviços são otimizadas quando pensadas de maneira democrática e corresponsável. Considerou-se que as principais contribuições deste estudo foram a sensibilização e a mobilização dos sujeitos para atuarem de maneira participante no planejamento e na gestão dos problemas de saúde.

ABSTRACT The objective was to describe the construction of a co-responsibility action plan involving managers, professionals and users, aimed at reorienting spontaneous demand in a Family Health Unity, by means of participatory management tools. This was an interventional research study, the action-research type, carried out with a Family Health Strategy team in the municipality of Petrolina (PE). The study involved eleven participants, who were selected using the qualitative representativeness sampling technique, and included three primary care managers in the municipality, four health professionals from the Family Health Strategy involved in the study and four community leaders, representatives of users. The theoretical framework adopted for the analysis of the intervention was the method of analysis and co-management of collectives - the Paideia method. The study revealed the unpreparedness of collectives to act in participatory management, while showing that possibilities of restructuring services are optimized when thought of in a democratic and co-responsible way. It was considered that the main contributions of this research were the awareness and the mobilization of the subjects to act in a participatory way in the planning and management of health problems.

O itinerário da famílias na atenção às necessidades da criança preterma no primeiro ano de vida / Families' itinerary in attention to the needs of the preterm child in the first year of life

A continuidade dos cuidados de crianças nascidas prematuras egressas da Unidade de Terapia Intensiva Neonatal faz-se necessária para o atendimento às necessidades de saúde apresentadas por essas crianças relacionadas à prematuridade. As trajetórias para o cuidado em saúde de seus filhos pode ser mediada por aspectos sócio-econômicos e culturais Objetivo geral: Analisar o itinerário de cuidados de famílias para o atendimento às necessidades de saúde de suas crianças nascidas prematuras no primeiro ano de vida. Objetivos específicos: verificar as ações de cuidado realizadas pelas famílias no domicílio e identificar subsistemas utilizados pelas famílias para o cuidado de suas crianças no primeiro ano de vida. Método: Trata-se de um Estudo de Caso Coletivo, longitudinal, de abordagem qualitativa. O Modelo de Sistemas de Cuidados em Saúde e o Modelo das Necessidades Essenciais das Crianças foram os referenciais teóricos desse estudo. Utilizamos a observação, a entrevista com roteiro semiestruturado, o genograma e o ecomapa para a produção de dados em campo. Oito famílias de crianças nascidas com menos de 32 semanas e egressas de três Unidades de Terapia Intensiva Neonatal de Belo Horizonte foram acompanhadas ao longo do primeiro ano de vida. Os dados foram coletados, inicialmente, no domicílio e, posteriormente, por via telefônica devido à pandemia da covid-19. A análise dos dados foi orientada pela técnica de Análise de Conteúdo Direcionada e apoiada pelo software MaxQDA versão 18.0 para organização e tratamento dos dados. Resultados: Os itinerários de cuidados de crianças prematuras foram mediados pelos três subsistemas do Modelo de Sistemas de Cuidados em Saúde em maior ou menor intensidade. Eles também influenciaram as ações de cuidado das famílias das crianças nascidas prematuras no primeiro ano de vida. As necessidades de saúde foram atendidas por meio dos subsistemas destacando o potencial atendimento à necessidade de proteção física, segurança e regulamentação. Entretanto para o atendimento à necessidade de estabelecimento de limites, organização e expectativas e de experiências individuais precisam ser mais exploradas pelo subsistema profissional. Conclusões: As famílias de crianças nascidas prematuras necessitam de apoio para a continuidade do cuidado após a alta da Terapia Intensiva. O subsistema profissional deve constituir-se como um apoio tanto para o fortalecimento do subsistema informal acessado pelas mães como para a construção do itinerário no primeiro ano de vida. Considerações para a enfermagem: a enfermagem como uma profissão do cuidado necessita encontrar caminhos para realizar ações do campo de conhecimento que lhe é próprio como se fazer reconhecer como rede de apoio para o fortalecimento das competências familiares para o cuidado de seus filhos prematuros no domicílio favorecendo o atendimento às necessidades de saúde dessas crianças e de suas famílias.

The continuity of care for children born prematurely and exiting the Neonatal Intensive Care Unit is necessary to meet the health needs presented by these children related to prematurity. The health care trajectories of their children may be mediated by socio-economic and cultural aspects General objective: To analyze the care itinerary of families to meet the health needs of their children born prematurely in the first year of life. Specific objectives: to verify the care actions performed by families at home and to identify subsystems used by families to care for their children during the first year of life.Method: This is a longitudinal Collective Case Study with a qualitative approach. The Health Care Systems Model and the Children's Essential Needs Model were the theoretical references of this study. We used observation, semi-structured interviews, the genogram and the ecomap to produce data in the field. Eight families of children born at less than 32 weeks and exiting three Neonatal Intensive Care Units in Belo Horizonte were followed during the first year of life. Data were collected, initially, at home and, later, by telephone due to the covid-19 pandemic. Data analysis was guided by the Directed Content Analysis technique and supported by MaxQDA software version 18.0 for data organization and treatment. Results: The care itineraries of premature infants were mediated by the three subsystems of the Health Care Systems Model to a greater or lesser extent. They also influenced the care actions of the families of children born prematurely in the first year of life. Health needs were met through the subsystems highlighting the potential meeting of the need for physical protection, safety and regulation. However for meeting the need for limit setting, organization and expectations and individual experiences need to be further explored by the professional subsystem. Conclusions: Families of prematurely born children need support for the continuity of care after discharge from intensive care. The professional subsystem must be a support for both the strengthening of the informal subsystem accessed by the mothers and for the construction of the itinerary in the first year of life. Considerations for nursing: nursing as a profession of care needs to find ways to perform actions in its own field of knowledge as to be recognized as a support network for the strengthening of family competences for the care of their premature children at home, favoring the care of the health needs of these children and their families.

Theorizing demand by Family Health Strategy professionals and users: spontaneous, scheduled, suppressed / Teorización de la demanda por profesionales y usuarios de la Estrategia de Salud Familiar: espontáneo, programado, reprimido / Teorização da demanda por profissionais e usuários da Estratégia Saúde da Família: espontânea, programada, reprimida

ABSTRACT Objective: to understand spontaneous, scheduled and suppressed demands in the face of health needs and accessibility, from the perspective of Family Health Strategy professionals and users. Method: a qualitative study using Grounded Theory and Symbolic Interactionism, with 34 participants, 16 of whom are health professionals and 18 are users. The sources of evidence were open, intensive and individual interviews and memos. Data collection occurred between October/2016 to May/2017. Data analysis took place in interdependent steps: open, axial, selective coding, for the process. Results: thirty-two in vivo codes were indicated that represent the statement and meanings of the research participants regarding demand at Family Health Strategy, compiled in three theoretical codes that originated the central category "The Theory of Demand at Family Health Strategy: spontaneous, scheduled or suppressed?". Spontaneous demand turns to complaints and illness, in daily appointments without previous scheduling, with restricted hours and as a means of accessing the health service. Scheduled demand is established in scheduling medical appointments for specific groups. Suppressed demand, more and more frequent in the daily routine of health services, is associated with the lack of access and resolution. Conclusion: health demands are configured in a space of lack of access and accessibility, denoting the main problem experienced by FHS users and professionals.

RESUMEN Objetivo: comprender las demandas espontáneas, programadas y reprimidas ante las necesidades de salud y accesibilidad, desde la perspectiva de los profesionales y usuarios de la Estrategia de Salud Familiar. Método: estudio cualitativo, utilizando el método de la Teoría Fundamentada y el marco teórico Interaccionismo Simbólico, con 34 participantes, entre ellos 16 profesionales de la salud y 18 usuarios. Las fuentes de evidencia fueron entrevistas y memorandos abiertos, intensivos e individuales. La recolección de datos ocurrió entre octubre/2016 y mayo/2017. El análisis de datos se llevó a cabo en pasos interdependientes: codificación abierta, axial, selectiva, para el proceso. Resultados: indicó 32 códigos in vivo que representan el discurso y los significados de los participantes de la investigación sobre la demanda en la Estrategia de Salud Familiar, recopilados en tres códigos teóricos que dieron origen a la categoría central "La teoría de la demanda en la Estrategia Salud de la Familia: ¿espontánea, programada o reprimida?". La demanda espontánea se convierte en quejas y enfermedades, en citas diarias sin programación previa, con horario restringido y como vía de acceso al servicio de salud. La demanda programada se establece en la programación de citas médicas para grupos específicos. La demanda reprimida, cada vez más frecuente en la vida cotidiana de los servicios de salud, se asocia a la falta de acceso y resolución. Conclusión: las demandas de salud se configuran en un espacio de falta de acceso y accesibilidad, denotando el principal problema que viven los usuarios y profesionales de la ESF.

RESUMO Objetivo: compreender as demandas espontânea, programada e reprimida frente às necessidades de saúde e à acessibilidade, sob a ótica de profissionais e usuários da Estratégia Saúde da Família. Método: estudo qualitativo, sob o método da Teoria Fundamentada nos Dados e do referencial teórico Interacionismo Simbólico, com 34 participantes, sendo 16 profissionais de saúde e 18 usuários. As fontes de evidências foram entrevistas aberta, intensiva e individual e memorandos. A coleta de dados ocorreu entre outubro/2016 a maio/2017. A análise dos dados se deu em etapas interdependentes: codificação aberta, axial, seletiva, para o processo. Resultados: indicaram 32 códigos in vivo que representam a alocução e os significados dos participantes da pesquisa frente à demanda na Estratégia Saúde da Família, compilados em três códigos teóricos que originaram a categoria central "A teoria da demanda na Estratégia Saúde da Família: espontânea, programada ou reprimida?". A demanda espontânea se volta à queixa e ao adoecimento, em atendimentos diários sem agendamento prévio, com restrição de horários e como meio de acesso ao serviço de saúde. A demanda programada se estabelece no agendamento de consultas médicas para grupos específicos. A demanda reprimida, cada vez mais frequente no cotidiano dos serviços de saúde, está associada à falta de acesso e de resolutividade. Conclusão: as demandas em saúde se configuram em um espaço de falta de acesso e acessibilidade, denotando o principal problema vivenciado pelos usuários e profissionais da ESF.

O que pessoas que usam drogas buscam em serviços de saúde? Compreensões para além da abstinência / What do people who use drugs look for in healthcare services? Understanding this issue beyond abstinence / ¿Qué es lo que las personas que usan drogas buscan en los servicios de salud? Comprensiones más allá de la abstinencia

Proposições de modificação da Atenção no Sistema Único de Saúde (SUS) às pessoas que usam drogas têm desconsiderado suas necessidades, demandas e expectativas. A partir de contribuições da Saúde Coletiva, buscou-se compreendê-las por meio de pesquisa qualitativa que envolveu entrevistas semiestruturadas, grupos focais e observação participante em Centros de Atenção Psicossocial-Álcool e Drogas (Caps-AD). Constatou-se que os usuários se dirigem aos serviços não apenas para interromper o consumo de drogas, mas também para reduzi-lo, para receber atenção em relação a comprometimentos orgânicos ou psíquicos, construir laços sociais, ter acesso a condições básicas de vida e conquistar autonomia. A pesquisa, ao ampliar as compreensões sobre as demandas, necessidades e expectativas das pessoas que usam drogas, apresentou contribuições para a análise e redefinição das práticas e do modelo de atenção adotados no SUS.(AU)

Proposals to modify the care provided for drug users in the Brazilian National Health System (SUS) have not been considering their needs, demands and expectations. Based on contributions from Collective Health, our objective was to understand them by means of a qualitative research that involved semi-structured interviews, focus groups and participant observation at Alcohol and Drugs Psychosocial Care Centers (Caps AD). We found that users go to the services not only to interrupt drug use, but also to reduce it, to receive care for organic or psychological problems, to construct social bonds, to have access to basic life conditions, and to achieve autonomy. By amplifying the understanding about the demands, needs and expectations of people who use drugs, the research has contributed to the analysis and redefinition of the care practices and model adopted by SUS.(AU)

Las propuestas de modificación de la atención en el Sistema Brasileño de Salud (SUS) para las personas que usan drogas han desconsiderado sus necesidades, demandas y expectativas. A partir de contribuciones de la Salud Colectiva, se buscó comprenderlas por medio de una investigación cualitativa que envolvió entrevistas semiestructuradas, grupos focales y observación participante en Centros de Atención Psicosocial - Alcohol y Drogas (Caps AD). Se constató que los usuarios se dirigen a los servicios no solo para interrumpir el consumo de drogas, sino también para reducirlo, para recibir atención para comprometimientos orgánicos o psíquicos, construir lazos sociales, tener acceso a condiciones básicas de vida y conquistar autonomía. La investigación, al ampliar las comprensiones sobre las demandas, necesidades y expectativas de las personas que usan drogas, presentó contribuciones para el análisis y redefinición de las prácticas y del modelo de atención adoptados en el SUS.(AU)

Sexualidade e saúde sexual de adolescentes: interseção de demandas para o cuidado / Adolescent sexuality and sexual health: intersecting demands for care / Sexualidad y salud sexual de adolescentes: intersección de demandas para el cuidado

Objetivo: conhecer as demandas para o cuidado no âmbito da sexualidade de adolescentes. Metodologia: estudo descritivo, abordagem qualitativa, tendo o gênero como categoria analítica. Realizado com 12 adolescentes de dois colégios públicos estaduais do interior da Bahia, em 2014. Foram utilizados oficinas de reflexão e questionário para coleta de dados e o tratamento se deu pela técnica de análise de discurso. Resultados: adolescentes consideram a sexualidade como dimensão humana que demanda atenção à saúde, com necessidade de orientações e cuidado direcionados a vulnerabilidades e conhecimento do corpo. É também processo afetivo-sexual, com prazer compartilhado, caminho para superação de desigualdades de gênero. Conclusão: as demandas apresentadas revelam um grupo que defende uma sexualidade saudável e prazerosa, livre de tabus e preconceitos, mas carente de orientações. As demandas extrapolam o que está posto como prioridade para atenção à saúde e urge a aproximação escola e serviços de saúde para implementar políticas de formação e cuidado de adolescentes.

Objective: to examine demands for care in the field of adolescent sexuality. Methodology: deploying gender as an analytical category, this qualitative, descriptive study was carried out in 2014 with 12 adolescents from two state public colleges in Bahia. Reflection workshops and a questionnaire were used for data collection and data were analysis by the discourse analysis technique. Results: adolescents consider sexuality to be a human dimension demanding health care, posing needs for guidance and care directed to vulnerabilities and body knowledge. It is also an affective and sexual process of shared pleasure, and a pathway to overcoming gender inequalities. Conclusion: the demands presented revealed a group that advocates healthy, pleasurable sexuality, free from taboos and prejudices, but lacking guidelines. The demands extend beyond what are considered health care priorities, and urge approximation between school and health services to implement adolescent education and care policies.

Objetivo: conocer las necesidades para el cuidado en el área de la sexualidad de adolescentes. Metodología: estudio descriptivo, de enfoque cualitativo, siendo el género la categoría de análisis. Fue realizado junto a 12 adolescentes de dos colegios públicos estatales del interior de Bahía, en 2014. Se han utilizado talleres de reflexión y cuestionarios para la recolección de datos y el análisis se basó en la técnica de análisis del discurso. Resultados: adolescentes consideran la sexualidad como dimensión humana que demanda atención a la salud, con necesidad de orientaciones y cuidado dirigidos a las vulnerabilidades y el conocimiento del cuerpo. Es también un proceso afectivo-sexual, con placer compartido, un camino para la superación de desigualdades de género. Conclusión: las demandas presentadas revelan un grupo que aboga por una sexualidad saludable y placentera, sin tabús y prejuicios, pero con pocas orientaciones. Las demandas extrapolan lo que se muestra como prioridad para la atención a la salud y urge el acercamiento escuela y servicios de salud para poner en marcha políticas de formación y cuidado de los adolescentes.

Demand forecast in the emergency department in Minas Gerais, Brazil / Previsão de demanda no departamento de emergência e Minas Gerais, Brasil

This study presents a mathematical model to carry out the demand forecasts in relation to patientes classified as green in the emergency department of a municipality in Minas Gerais, Brazil. In addition, another approach will investigate whether the green patients demand remains the same over the weekend, as compared to the weekdays, since there is no support from Primary Health Care units over the weekend. A retrospective study of the emergency service in the municipality of Monte Carmelo was carried out from January 2014 to December 2017.The time series of the patients classified as green during the host by the nurse, according to the Manchester Triage Scale, was analyzed in the temporal domain for the construction of a parametric model with the purpose of realizing the demand forecast. The Manchester Triage Scale has been adopted in most emergency department as a guiding instrument for risk classification, prioritizing the most serious cases. The data processing was fulfilled using Software R Version 3.4. The ARIMA model (1,1,1)presented a better fit for this forecast. The predictions of this model are values close to those observed for the number of patients seen that ranges from 1780.4 to 1796.6 patients per month. In relation to the demand of patients classified as green at the weekend, it has shown that it is slightly lower than the weekend, but it is still an expressive demand. The application of the models must be seen by the managers as a tool to aid decisions, thus it must support processes of planning, management and evaluation of public policies. In this context, mathematical models for demand forecasting are an instrument for management care and services.

Este estudo apresenta um modelo matemático para realizar as previsões de demanda em relação aos pacientes classificados como verdes no departamento de emergência de um município de Minas Gerais. Além disso, outra abordagem investigará se a demanda dos pacientes verdes permanece a mesma no final de semana, em relação aos dias da semana, uma vez que não há apoio das unidades de Atenção Primária de Saúde no final de semana. Um estudo retrospectivo do serviço de emergência no município de Monte Carmelo foi realizado no período de janeiro de 2014 a dezembro de 2017. A série temporal dos pacientes classificados como verdes durante o acolhimento pelo enfermeiro, segundo o Sistema de Triagem de Manchester, foi analisada no domínio temporal para a construção de um modelo paramétrico com a finalidade de realizar a previsão de demanda. O Sistema de Triagem de Manchester foi adotado na maioria dos serviços de emergência como instrumento orientador para a classificação de risco, priorizando os casos mais graves. O processamento de dados foi realizado usando o Software R Versão 3.4. O modelo ARIMA (1,1,1) apresentou melhor ajuste para essa previsão. As previsões deste modelo são valores próximos aos observados para o número de pacientes atendidos que variam de 1780.4 a 1796.6 pacientes por mês. Em relação à demanda de pacientes classificados como verdes no final de semana, constatou que é ligeiramente inferior a do fim de semana, mas ainda é uma demanda expressiva. A aplicação dos modelos deve ser vista pelos gestores como uma ferramenta para auxiliar as decisões, portanto, deve apoiar processos de planejamento, gestão e avaliação de políticas públicas. Nesse contexto, os modelos matemáticos para previsão de demanda são um instrumento de atendimento e serviços gerenciais.

Development of a measuring tool for elderly care service needs in the community and its reliability and validity / 中华全科医师杂志

Objective To develop a measuring tool for the elderly care service needs in the community.Methods Based on the literature search and Delphi expert consultation,a measuring tool for elderly care service needs was developed.The reliability (internal consistency coefficient) and validity (surface validity,content validity,criterion-related validity) of the developed measurement tool were evaluated with on-site expert consultation and the cross-sectional survey.Results A 11-dimension measurement tool was developed,which covered physical health,mental health and desires for old-age support assessment.The reliability evaluation showed that there was significant correlation (P＜0.05) among the measurement dimensions of the physical health and the mental health of the elderly in community.The validity evaluation showed that the measurement methods for the measurement dimensions of the elderly care needs,including the evaluation items,evaluation methods,and rating methods,all got below 2 scores in applicability assessment,and the measurement methods of the self-care ability,vision,the self-willingness/information expression of the elderly,the ability of the elderly to understand the willingness/information expressed by others,and the ability to provide family care were all supported by more than 50％ experts,which indicated that the surface validity and content validity were good.There was a significant positive correlation between the living places of the elderly and the needsof elderly care services (r=0.214,P＜0.01),and there were significant correlations between all measurement dimensions with the living place except anxiety (P＜0.05),which indicated that the measurement tool had an acceptable criterion-related validity.The consistency of self-supporting willingness,the family willingness to care for the elderly with the current old-age care place were relatively poor (Kappa=0.063,P=0.007;Kappa=0.051,P=0.006).Conclusion The overall performance of the measurement tool for the elderly care service needs developed in this study is acceptable.It has been approved by both the elderly care service suppliers and the elderly care service needs evaluators.It also shows some internal consistency in measurement results of the demanders,and is consistent with the actual living place.

Development and reliability and validity evaluation of needs questionnaire of the integrated services for medicine, pension, rehabilitation and care of community elderly / 中国实用护理杂志

Objective@#The purpose of the research was to draw up the questionnaire of the integrated services demand for medicine, pension, rehabilitation and care of community elderly and to provide elderly people with a effective tool for evaluating the needs of medicine, pension, rehabilitation and care.@*Methods@#The theoretical framework of the questionnaire was based on the qualitative interview results of 12 community elderly and community health care workers. A preliminary draft was formed through two rounds of expert consultation and a preliminary survey of 102 elderly people in 3 communities in Taian. Construct validity was used to evaluate the validity of the questionnaire, and Cronbach's alpha coefficient and split half reliability were used to evaluate the reliability of the questionnaire.@*Results@#Sixteen experts were invited to conduct two rounds of consultation on 61 items of the questionnaire. The authoritative coefficient of experts was 0.881, and the positive coefficient of experts was 100%. In the first round, items I-CVI, S-CVI/UA and S-CVI/Ave were 0.68-1.00, 0.72 and 0.83, respectively. Seven items were modified, six items were deleted and three items were added. In the second round, one item was deleted and one item was added, and a questionnaire consisting of seven dimensions and 58 items was formed.7 common factors were extracted from exploratory factor analysis, and the cumulative contribution rate was 63.078%. Finally, 7 dimensions and 51 item questionnaires were formed. Each dimension is the community public health service and general services, health education, pension services, rehabilitation services, family beds, service charges The total Cronbach's alpha coefficient was 0.919, the Cronbach' s alpha coefficient of each dimension was 0.615-0.808, the retest reliability coefficient of the total questionnaire was 0.862.and the Guttman half coefficient is 0.865. The total questionnaire CVI was 0.85 and the item CVI was 0.80-1.00. Item analysis showed that the correlation coefficients of the 7 items were lower than 0.3, and the rest were all between 0.3~0.7, and were significantly correlated at P<0.05 level.@*Conclusion@#The questionnaire of the integrated services demand for medicine, pension, rehabilitation and care of community elderly had good reliability and validity, and it could be used to evaluate the needs of medicine, pension, rehabilitation and care in the elderly.

Development and reliability and validity evaluation of needs questionnaire of the integrated services for medicine, pension, rehabilitation and care of community elderly / 中国实用护理杂志

Objective The purpose of the research was to draw up the questionnaire of the integrated services demand for medicine, pension, rehabilitation and care of community elderly and to provide elderly people with a effective tool for evaluating the needs of medicine, pension, rehabilitation and care. Methods The theoretical framework of the questionnaire was based on the qualitative interview results of 12 community elderly and community health care workers. A preliminary draft was formed through two rounds of expert consultation and a preliminary survey of 102 elderly people in 3 communities in Taian. Construct validity was used to evaluate the validity of the questionnaire, and Cronbach 's alpha coefficient and split half reliability were used to evaluate the reliability of the questionnaire. Results Sixteen experts were invited to conduct two rounds of consultation on 61 items of the questionnaire. The authoritative coefficient of experts was 0.881, and the positive coefficient of experts was 100% . In the first round, items I-CVI, S-CVI/UA and S-CVI/Ave were 0.68-1.00, 0.72 and 0.83, respectively. Seven items were modified, six items were deleted and three items were added. In the second round, one item was deleted and one item was added, and a questionnaire consisting of seven dimensions and 58 items was formed.7 common factors were extracted from exploratory factor analysis, and the cumulative contribution rate was 63.078%. Finally, 7 dimensions and 51 item questionnaires were formed. Each dimension is the community public health service and general services, health education, pension services, rehabilitation services, family beds, service charges The total Cronbach's alpha coefficient was 0.919, the Cronbach' s alpha coefficient of each dimension was 0.615-0.808, the retest reliability coefficient of the total questionnaire was 0.862.and the Guttman half coefficient is 0.865. The total questionnaire CVI was 0.85 and the item CVI was 0.80-1.00. Item analysis showed that the correlation coefficients of the 7 items were lower than 0.3, and the rest were all between 0.3~0.7, and were significantly correlated at P<0.05 level. Conclusion The questionnaire of the integrated services demand for medicine, pension, rehabilitation and care of community elderly had good reliability and validity, and it could be used to evaluate the needs of medicine, pension, rehabilitation and care in the elderly.

Relationship between mental health service demand, loneliness, anxiety and depression of rural left-behind women / 中华行为医学与脑科学杂志

Objective To explore the correlation between psychological health service demand and loneliness and anxiety depression in rural left-behind women.Methods 260 left-behind wo nen in Hebei province were surveyed by psychological health service demand scale,UCLA loneliness scale,trait anxiety scale and the center for epidemiologic studies depression scale (CES-D).Results There were statistically significant differences between the only child and non-only child left-behind women in mental health service demand ((131.72±13.91) vs (122.94±14.76)),loneliness ((52.94±5.65) vs (49.864±5.90)) and anxiety ((50.97±6.38) vs (47.16±4.80)) (t=3.313,2.899,4.151,P＜0.01).The mental health service demand,loneliness,anxiety and depression of left-behind women were different in the age of marriage (F=6.196,9.441,5.257,4.221,all P＜0.01),husband go out time (F=2.761,27.020,4.550,2.830,all P＜0.05) and degree of farm work (F=12.142,6.403,4.115,5.366,all P＜0.001).The anxiety of left-behind women was positively correlated with service content,service demand and depression (r=0.138-0.221,P＜0.01).Depression was negatively correlated with mental health service demand and service teams (r=-0.352--0.223,P＜ 0.01).Loneliness was positively correlated with service content,anxiety and depression (r=0.177-0.262,P＜ 0.01).Multiple linear regression showed that husbands go out time (β=0.326),farm work in very heavy degree (β=-0.376) and relatively heavy degree (β=-0.281),depression (β=-0.194) had a predictive effect on mental health services.Conclusion The mental health service demand of left-behind women are affected by their age,whether the only child,the age of marriage,their husbands' go out time and the degree of heavy farm work.

Acesso à vacinação no cotidiano da atenção primária à saúde na região ampliada oeste de minas gerais, sob a ótica dos usuários / Acceso a la vacunación en el cotidiano de la atención primaria a la salud en la región ampliada oeste de minas generales, bajo la óptica usuarios / Access to daily vaccination in primary health care in the west region of minas gerais, under the optics of users

Este estudo teve por objetivo compreender o acesso à vacinação no cotidiano da Atenção Primária à Saúde na Região Ampliada Oeste do Estado de Minas Gerais, sob a ótica do usuário. Trata-se de estudo de casos múltiplos holístico-qualitativo, fundamentado na Sociologia Compreensiva do Cotidiano. Contém quatro casos que se constitui pelas microrregiões sanitárias e teve como unidade única de análise: "O acesso à vacinação na APS". As fontes de evidências foram: a entrevista aberta com roteiro semiestruturado, a visita técnica às salas de vacinas e notas de campo. Para análise dos dados, utilizou-se da Análise de Conteúdo Temática, obedecendo à técnica analítica da síntese cruzada dos casos. Participaram do estudo 74 usuários de sete municípios representantes de quatro microrregiões da Região Ampliada de Saúde Oeste de Minas Gerais, Brasil. Resultados: Originaram três categorias: "Adequação funcional e uma agenda para o acesso à vacinação na APS sob a ótica do usuário", "Acesso à vacinação na APS na voz do usuário: sentidos e sentimentos frente ao atendimento" e "Vacinação como demanda programada: um acesso que pode ser facilitado". Os entraves relacionados aos aspectos organizacionais dos serviços, como o estabelecimento de dias específicos para a realização de determinadas vacinas, falta do imunobiológico e inadequado horário de funcionamento das salas de vacina foram descritos na primeira categoria. A segunda categoria traz as perspectivas dos usuários frente à realidade vivenciada do acesso vacinação na APS, por meio da manifestação dos sentidos e sentimentos atribuídos às dificuldades enfrentadas pelos aspectos geográficos, financeiros e sociais. A terceira categoria revela que os usuários conferem à vacinação o atributo de ser uma demanda programada em saúde, indicam que o uso de sistemas informatizados para registro dos dados de imunização e o envolvimento da equipe de saúde, com as atividades de imunização, favorecem o acesso oportuno à imunização e evitam situações de oportunidades perdidas de vacinação. Conclusão: Este estudo possibilitou conhecer aspectos intrinsecamente relacionadas ao acesso do usuário à imunização no âmbito da Atenção Primária à Saúde, considerando a subjetividade. Os entraves organizacionais, geográficos e socio demográficos identificados comprometem a prestação de um serviço de vacinação adequado, conforme estabelecido pelo Programa Nacional de Imunizações. O conhecimento desses fatores contribui para o planejamento da promoção vacinal e indica a necessidade de reforçar políticas mais equitativas. Uma agenda para o melhor acesso à vacinação na APS foi sugerida pelos usuários. O estudo apresenta contribuições para a área de Enfermagem e da Saúde, uma vez que a realidade apresenta entraves à incorporação da vacinação como demanda programada no cotidiano dos serviços, e que a programação dessa demanda pode promover o acesso a essa ação. Ressalta-se a importância de os serviços identificarem suas fragilidades e adotarem estratégias que viabilizem uma atenção usuário-centrada, promovendo o acesso aos serviços de saúde e, consequentemente, à imunização

Vaccination access in Everyday Life of primary health care of the Western Extended Health Region of Minas Gerais, from the user's standpoint This study was intended to understand the vaccination access in Everyday Life of primary health care of the Western Extended Health Region of Minas Gerais, from the user's standpoint. This is a holistic-qualitative and multiple-case study, which was underpinned on the Comprehensive Sociology of Everyday Life. It contains four cases encompassing the sanitary micro-regions and had as single analysis unit: "The access to vaccination in APS". The sources of evidence were: the open interview with semi-structured script, the technical visit to the vaccination rooms, and field notes. In order to analyze the data, we used the Thematic Content Analysis, following the analytical technique of the cross-synthesis of cases. The study was attended by 74 users from seven cities representing four micro-regions of the Western Extended Health Region of Minas Gerais, Brazil. Results: The analysis gave rise to three categories: "Functional adequacy, and an agenda for access to vaccination from the user's standpoint", "Vaccination access in Everyday Life of primary health care from the user's voice: senses and feelings about health care" and "Vaccination as a programmed demand: an access that may be eased". Barriers related to the organizational aspects of services, such as the establishment of specific days for administering certain vaccines, lack of immunobiological products and inappropriate hours of operation of vaccine rooms were shown in the first category. The second category brings the users' perspectives about the experienced reality of access to vaccination in APS, through the manifestation of the senses and feelings assigned to the difficulties faced by the geographic, financial and social dimensions. The third category shows that users endow vaccination with the assignment of being a programmed health demand, highlighting that the use of computerized systems to record immunization data and the involvement of the health team with immunization activities foster access to the vaccine room and prevent situations of, missed vaccination opportunities. Conclusion: This study has enabled us to know aspects intrinsically related to the user's access to immunization in the context of Primary Health Care, considering subjectivity. The identified organizational, geographic and sociodemographic barriers undermine the provision of an appropriate vaccination service, as established by the National Immunization Program. The knowledge of these factors contributes to the planning of vaccine promotion and signalizes the need to reinforce more equitable policies. An agenda for better access to the vaccine room has been suggested by users. The study presents contributions to the area of Nursing and Health, since the reality presents barriers to the incorporation of vaccination as a programmed demand in the daily services, and that the programming of this demand may promote access to this action. We should highlight the importance of services in identifying their weaknesses and adopting strategies that enable a user-centered health care, thereby promoting access to health services and, consequently, immunization

Acesso à vacinação no cotidiano da atenção primária à saúde na região ampliada oeste de minas gerais, sob a ótica dos usuários / Acceso a la vacunación en el cotidiano de la atención primaria a la salud en la región ampliada oeste de minas generales, bajo la óptica usuarios / Access to daily vaccination in primary health care in the west region of minas gerais, under the optics of users

Este estudo teve por objetivo compreender o acesso à vacinação no cotidiano da Atenção Primária à Saúde na Região Ampliada Oeste do Estado de Minas Gerais, sob a ótica do usuário.Trata-se de estudo de casos múltiplos holístico-qualitativo, fundamentado na Sociologia Compreensiva do Cotidiano. Contém quatro casos que se constitui pelas microrregiões sanitárias e teve como unidade única de análise: “O acesso à vacinação na APS”. As fontes de evidências foram: a entrevista aberta com roteiro semiestruturado, a visita técnica às salas de vacinas e notas de campo. Para análise dos dados, utilizou-se da Análise de Conteúdo Temática,obedecendo à técnica analítica da síntese cruzada dos casos. Participaram do estudo 74 usuários de sete municípios representantes de quatro microrregiões da Região Ampliada de Saúde Oeste de Minas Gerais, Brasil. Resultados: Originaram três categorias: “Adequação funcional e uma agenda para o acesso à vacinação na APS sob a ótica do usuário”, “Acesso à vacinação na APS na voz do usuário: sentidos e sentimentos frente ao atendimento” e “Vacinação como demanda programada: um acesso que pode ser facilitado”. Os entraves relacionados aos aspectos organizacionais dos serviços, como o estabelecimento de dias específicos para a realização de determinadas vacinas, falta do imunobiológico e inadequado horário de funcionamento das salas de vacina foram descritos na primeira categoria. A segunda categoria traz as perspectivas dos usuários frente à realidade vivenciada do acesso vacinação na APS, por meio da manifestação dos sentidos e sentimentos atribuídos às dificuldades enfrentadas pelos aspectos geográficos, financeiros e sociais

Vaccination access in Everyday Life of primary health care of the Western Extended HealthRegion of Minas Gerais, from the user’s standpointThis study was intended to understand the vaccination access in Everyday Life of primaryhealth care of the Western Extended Health Region of Minas Gerais, from the user’s standpoint.This is a holistic-qualitative and multiple-case study, which was underpinned on theComprehensive Sociology of Everyday Life. It contains four cases encompassing the sanitarymicro-regions and had as single analysis unit: “The access to vaccination in APS”. The sourcesof evidence were: the open interview with semi-structured script, the technical visit to thevaccination rooms, and field notes. In order to analyze the data, we used the Thematic ContentAnalysis, following the analytical technique of the cross-synthesis of cases. The study wasattended by 74 users from seven cities representing four micro-regions of the Western ExtendedHealth Region of Minas Gerais, Brazil. Results: The analysis gave rise to three categories:“Functional adequacy, and an agenda for access to vaccination from the user’s standpoint”,“Vaccination access in Everyday Life of primary health care from the user’s voice: senses andfeelings about health care” and “Vaccination as a programmed demand: an access that may beeased”. Barriers related to the organizational aspects of services, such as the establishment ofspecific days for administering certain vaccines, lack of immunobiological products andinappropriate hours of operation of vaccine rooms were shown in the first category. The secondcategory brings the users’ perspectives about the experienced reality of access to vaccination inAPS, through the manifestation of the senses and feelings assigned to the difficulties faced bythe geographic, financial and social dimensions

Medical Radiation: Status and Availability in The Bahamas / Radiación Médica: Estatus y Disponibilidad en las Bahamas

ABSTRACT Introduction: The Bahamas became a member state of the International Atomic Energy Agency (IAEA) on January 7, 2014 (1). The purpose of this paper is to inform the reader on The Bahamas' ability to provide services that utilize radiation. Method: A study was conducted on various clinics across The Bahamas, New Providence in particular (primary sample area), Grand Bahama, Abaco and Exuma. Twenty per cent of the staff members of the respective locations were given questionnaires and the chief personnel were interviewed. Staff members were advised that their responses would remain anonymous and were welcomed to participate, thereafter. Microsoft Excel was used for data input and processing. Original surveys were checked against the dataset for potential errors. Results: Thirty-one clinics were approached to participate in the survey, of which 25 participated resulting in an 81% response rate. Fifty questionnaires were completed in total. Two clinics had multiple locations; therefore, 27 clinics (23 private, 4 public) participated in total. The included map illustrates the sample area of the survey, with New Providence being the primary sample area. The number of modalities, patients treated and frequency of quality assurance checks were also evaluated. Conclusion: Most of the examined clinics outsourced technicians and physicists to perform quality checks. This suggests that there is a need for qualified local technical support. Further studies are needed to understand the full extent of the country's needs regarding medical radiation and figuring out the steps necessary for approaching this subject.

RESUMEN Introducción: Las Bahamas se convirtieron en un Estado Miembro de la Agencia Internacional de Energía Atómica (AIEA) el 7 de enero de 2014 (1). El propósito de este trabajo es informar al lector sobre la capacidad de las Bahamas para prestar servicios que utilizan radiación. Método: Se realizó un estudio en varias clínicas a través de las Bahamas, Nueva Providencia en particular (área de muestra primaria), Gran Bahama, Abaco y Exuma. El veinte por ciento de los miembros del personal de las respectivas locaciones recibieron cuestionarios y el personal dirigente fueron entrevistados. A los miembros del personal se les informó que sus respuestas permanecerían anónimas, y se les dio la bienvenida por su participación. Para la entrada y el procesamiento de datos se usó Microsoft Excel. Las encuestas originales se chequearon contra el conjunto de datos para a fin de detectar posibles errores. Resultados: Treinta y una clínicas fueron abordadas para participar en la encuesta, de las cuales 25 participaron, para una tasa de respuesta de 81%. En total se completaron 50 cuestionarios. Dos clínicas tenían múltiples localidades. Por lo tanto, 27 clínicas (23 privadas, 4 públicas) participaron en total. El mapa incluido ilustra el área de la muestra de la encuesta, en la que Nueva Providencia es el área de la muestra primaria. El número de modalidades, los pacientes tratados, y la frecuencia de los controles de garantía de calidad, también fueron evaluados. Conclusión: La mayor parte de las clínicas examinadas subcontrataron técnicos y físicos para realizar chequeos de la calidad. Esto sugiere que hay necesidad de apoyo técnico local calificado. Se necesitan estudios adicionales para entender el alcance completo de las necesidades del país en relación con la radiación médica y los pasos necesarios para abordar este asunto.

Investigation of the Potential Needs and Peace of Mind of Patients in Relation to Out-of-Hours Pharmacy Services / 社会薬学

This study aimed to investigate pharmacy service needs of patients and peace of mind of patients in relation to out-of-hours pharmacy services. For patients who came to the health insurance pharmacy, we conducted a survey on the patients’ attitudes toward composition and consultation needs and peace on mind in relation to out-of-hours pharmacy services to investigate the potential characteristic of the needs regarding pharmacy services. We also found that a factor that influenced their peace of mind with regard to services offered by pharmacies was out-of-hours dispensation services. We analyzed patient attributes and local and composition and consultation needs using chi-square test. As a result, significant difference was observed in a ratio of distribution of the composition needs in six items including “sex” and “age.” Similarly, significant difference was observed in four items including “sex.” In addition, in a patient with multiple factors that needs becomes higher, it was shown that composition and consultation had a big influence of “the living together with a child.” The patient attribute that composition and consultation became high in the needs together was “a woman”, “under 60 years old”, “the living together with a child” and “local region”. For analysis by Generalized Linear Model, the two factors of “consultation during holiday,” “nighttime dispensation” were extracted. Furthermore, in a crowd “a woman” and “local region”, “consultation during holiday” was extracted, and a difference was seen in influence in a case for the whole. In this study, it became clear that pharmacy service to give the peace of mind to a patient was a holiday and night composition. From the result, in the community medicine system, it was suggested that the improvement of these service offers was important.

Research on Status of Functioning and Disability, Unmet Needs and Service Development of Rehabilitation for People with Disabilities in Shenzhen, Guangdong, China / 中国康复理论与实践

Objective To analyze functioning and disability, unmet needs and the service for people with disabilities in Shenzhen, Guangdong, China. Methods Based on International Classification of Functioning, Disability and Health (ICF) and World Report on Disabil-ity, the theoretical framework had been constructed, and the unmet needs and service status for people with disabilities in Shenzhen in 2015 had been statistically analyzed. Results For the statistics of disability by categories, physical disability composed of 42.5%, speech disability composed of 1.5%;people with severe and extremely severe disabilities composed of 52.8%;Futian District composed of 19.7%, Yantian District composed of 2.2%;people aged 0 to 18 years composed of 17.4%, and people aged over 60 years (27.0%) were the larger group. For the unmet needs of people with disabilities, 25%needed rehabilitation therapy, 18.8%needed functional training, 23.2%needed assis-tive devices, and 32.9%had no need. For rehabilitation sevice in Shenzhen, 24.4%received rehabilitation therapy, 17.4%received function-al training, 20.4%received assistive devices, and 37.6%did not receive any service. For the barrier-free reconstruction, 4.6%needed bath-room reconstruction, and 0.7%needed internet access screen software. Conclusion The status of functioning and disability, unmet needs and service development of rehabilitation in Shenzhen had been analyzed. There was still a gap between unmet needs and services of rehabilita-tion. It recommended to construct precise services delivery based on unmet needs, improve the full coverage and quality of service of reha-bilitation.

Research on Social Economic Development and Service Needs of Families with More than One Disabled in Henan, China / 中国康复理论与实践

Objective To research the social economic development and service needs of families with more than one disabled in Henan, China. Methods The data of 2016 Basic Service Status and Needs of People with Disabilities in Henan was analyzed. Results A to-tal of 74,732 (4.0%) people with disabilities from all 19 cities in Henan had been surveyed, 54.9%were males and 83.2%were from rural ar-eas. In terms of social and economic development, 41.8%of people with disabilities in urban areas were below least living baseline, 14.7%met standards of low income;23.9%of people with disabilities in rural areas were recorded as national poverty household, 35.7%were not recorded as national poverty household, 39.9%were not in poverty. In terms of housing, 75.3%of people with disabilities in urban areas had their own houses, 7.1%had housing security welfare, 12.9%had no house; 70.5%of people with disabilities in rural areas had their own houses in good condition, 3.5%had their own houses which were identified as houses in risk, 15.9%had their own houses which were sus-pected to be houses in risk, 1.7%had no house, and 2.2%had their own houses reconstruction. There were significant differences in the eco-nomic and housing conditions among different types of disabilities (χ2>51.267, P8.400, P70.149, P0.05). In terms of employment needs, vocational skills training 5.0%, introducing a job 3.9%, practical training in rural areas 6.6%, capital credit support 7.6%, and others 10.7%. There were significant differences in the employ-ment needs among different types of disabilities (χ2>73.180, P11.440, P38.960, P99.220, P68.000, P46.960, P<0.001). Conclusion The social economic development of families with more than one disabled were faced risk. Recommendation to policy development included to improve the support efforts, and ensure their ba-sic housing, pay attention to their individual differences in employment poverty alleviation needs and provide more opportunities to get jobs, and provide financial support, increase support for home care, increase inputs of funding and assistive devices for rehabilitation services, and attach importance to their needs of barrier-free reconstruction.

Effect of air pollution on health service demand of the elderly and middle-age patients with hypertension,cardiovascular and cerebrovascular diseases:based on analysis of data from CHARLS / 北京大学学报(医学版)

Objective:To study the association of air pollution with health service demand of the elderly and middle-age patients with cardiovascular and cerebrovascular diseases,and to provide a scientific ba-sis for development of environmental protection policy and health service policy of the Chinese govern-ment.Methods:This study included survey data on self-evaluated health,outpatient service demand and inpatient service demand of the patients with hypertension,heart disease and stroke in 62 cities of 1 7 provinces from China Health and Retirement Longitudinal Study(CHARLS)in 201 1 and 201 3,and com-bined it with the data on the annual concentrations of inhalable particulate matter(PM1 0 ),sulfur dioxide (SO2 )and nitrogen dioxide(NO2 )of those provinces and cities.Conditional Logistic regression was car-ried out to assess the possible effects of air pollutants on self-evaluated health and health service utiliza-tion.Results:The results showed that turning points existed in the effects of concentrations of NO2 and SO2 on the health service demand of the patients with hypertension,heart disease and stroke.The inpa-tient service demand of the hypertension patients increased with NO2 concentration when it was lower than 35.1 μg/m3 and decreased with NO2 concentration for higher value.Self-evaluated health of the patients with heart disease and stroke decreased with SO2 concentration when it was lower than 63.8 μg/m3 and increased with SO2 concentration for higher value.In addition,no evidence was found for the association between PM1 0 and health service demand.Conclusion:Air pollution may have effects on health service demand of the patients with hypertension,cardiovascular and cerebrovascular diseases,and different air pollutants at high or low concentration may have different health effects.

Frequent users of emergency services: associated factors and reasons for seeking care / Usuários frequentes de serviço de emergência: fatores associados e motivos de busca por atendimento / Usuarios frecuentes de servicios de emergencia: factores asociados y motivos de la búsqueda de atención

Aim: to identify the profile of frequent users of emergency services, to verify the associated factors and to analyze the reasons for the frequent use of the services. METHOD: An explanatory sequential type mixed method was adopted. Quantitative data were collected from the electronic medical records, with a sample of 385 users attended four or more times in an emergency service, during the year 2011. Qualitative data were collected through semi-structured interviews with 18 users, intentionally selected from the results of the quantitative stage. Quantitative data were analyzed using descriptive and inferential statistics and qualitative data using thematic analysis. RESULTS: It was found that 42.9% were elderly, 84.9% had chronic diseases, 63.5% were classified as urgent, 42.1% stayed for more than 24 hours in the service and 46.5% were discharged. Scheduled follow-up appointment, risk classification, length of stay and outcome were factors associated with frequent use. The reasons for seeking the services were mainly related to the exacerbation of chronic diseases, to easier access and concentration of technology, to the bond, and to the scheduled appointments. CONCLUSIONS: The results contribute to comprehending the repeated use of emergency services and provide additional data to plan alternatives to reduce frequent use. .

OBJETIVO: identificar o perfil de usuários frequentes de serviço de emergência, verificar fatores associados e analisar os motivos para utilização frequente do serviço. MÉTODO: adotou-se método misto, do tipo sequencial explanatório. Os dados quantitativos foram coletados em registros de prontuários eletrônicos, com amostra de 385 usuários, atendidos quatro vezes ou mais em um serviço de emergência, durante o ano de 2011. Os dados qualitativos foram obtidos por meio de entrevistas semiestruturadas, com 18 usuários, selecionados intencionalmente a partir dos resultados da etapa quantitativa. Os dados quantitativos foram analisados com estatística descritiva e inferencial e os qualitativos com análise temática. RESULTADOS: identificou-se que 42,9% eram idosos, 84,9% tinham doenças crônicas, 63,5% foram classificados como urgentes, 42,1% permaneceram mais de 24 horas no serviço e 46,5% tiveram alta. Os fatores associados à utilização frequente são retorno agendado, classificação de risco, tempo de permanência e desfecho. Os motivos da busca pelo serviço são relacionados, principalmente, à agudização de doenças crônicas, maior facilidade de acesso, concentração de tecnologia, vínculo e retornos agendados. CONCLUSÕES: os resultados contribuem para compreensão do uso repetido de serviços de emergência e oferecem subsídios para planejamento de alternativas para redução da utilização frequente. .

OBJETIVO: identificar el perfil de usuarios frecuentes de servicios de emergencia, verificar los factores asociados y analizar los motivos para utilización frecuente de ese servicio. MÉTODO: se adoptó un método mixto del tipo secuencial explicativo. Los datos cuantitativos fueron recolectados en registros de fichas electrónicas, con muestra de 385 usuarios atendidos cuatro veces o más, en un servicio de emergencia, durante el año de 2011. Los datos cualitativos fueron obtenidos por medio de entrevistas semiestructuradas con 18 usuarios, seleccionados intencionalmente a partir de los resultados de la etapa cuantitativa. Los datos cuantitativos fueron analizados con estadística descriptiva e inferencial y los cualitativos con análisis temático. RESULTADOS: se identificó que 42,9% eran ancianos, 84,9% tenían enfermedades crónicas, 63,5% fueron clasificados como urgentes, 42,1% permanecieron más de 24 horas en el servicio y 46,5% tuvieron alta para el domicilio. El retorno programado, la clasificación de riesgo, el tiempo de permanencia y el resultado, son factores asociados a la utilización frecuente. Los motivos de la búsqueda por el servicio son relacionados, principalmente a: la agudización de enfermedades crónicas, la mayor facilidad de acceso y concentración de tecnología, los vínculos, y a los retornos programados. CONCLUSIONES: los resultados contribuyen para la comprensión del uso repetido de servicios de emergencia y ofrecen informaciones para planificar alternativas para reducción de la utilización frecuente. .

Perfil de encaminhamentos a fisioterapia por um serviço de Atenção Primária à Saúde, 2012* / Profile of patients referred to physiotherapy by a Primary Health Care Service in 2012

Descrever a frequência de encaminhamentos e as características dos usuários da Atenção Primária à Saúde (APS) encaminhados aos serviços de fisioterapia, por Unidades de Saúde do Serviço de Saúde Comunitária do Grupo Hospitalar Conceição em Porto Alegre-RS, Brasil. Métodos: estudo transversal descritivo com dados primários e secundários, obtidos a partir de questionários e dos formulários de encaminhamento referentes ao período de julho a setembro de 2012. Resultados: do total de 258 formulários, a frequência de encaminhamentos a fisioterapia foi de 1,1 por cento; predominaram mulheres (70,5 por cento) não idosas (59,4 por cento); os diagnósticos clínicos mais prevalentes foram a osteoartrose (29,1 por cento) e as tendinopatias/lesões de tecidos moles (27,1 por cento); 87,1 por cento dos usuários referiram dor, estando 48,1 por cento destes, pelo menos, parcialmente impossibilitados de trabalhar. Conclusão: a frequência de encaminhamentos à fisioterapia pela APS foi baixa, embora a população esteja em um processo de adoecimento por problemas crônicos, com presença de dor e redução da capacidade laboral...

To describe the frequency of referrals and the characteristics of patients referred to physiotherapy services by Conceição Hospital Group Community Health Service Primary Health Care Units (PHCU). Methods: this is a cross-sectional and descriptive study using primary and secondary data obtained from questionnaires and referral forms for the period July to September 2012. Results: analyzing 258 forms, we found 1.1 per cent frequency of referral to physical therapy with higher prevalence of women (70.5 per cent) and non-elderly women (59.4 per cent). The two most prevalent clinical diagnoses were osteoarthrosis (29.1 per cent) and tendinosis/soft tissue injuries (27.1 per cent). 87.1 per cent of patients referred pain and at last 48.1 per cent of these were partially unable to work. Conclusion: prevalence of PHCU referrals to physiotherapy is low, although the population is subject to chronic illness problems, with pain as an aggravating factor and interference in work capacity...