As redes vivas na produção do cuidado com o usuário na centralidade do tratamento para tuberculose multidroga resistente / Las redes vivas en la producción del cuidado con el usuario en la centralidad del tratamiento para la tuberculosis multidrogo resistente / Live networks in care production with the user at the center of the treatment for multidrugresistant tuberculosis

Vivenciamos a trajetória de uma usuária-guia no tratamento para tuberculose multidroga resistente (TB-MDR). As narrativas das redes vivas na produção de cuidado apontam para os seguintes itens: 1) cuidar no ato de viver: suplantar os estigmas e cultivar vínculos que ajudem a superar os discursos fomentados pelo medo, preconceitos, exclusão e invisibilidade dos sujeitos; 2) redes vivas de cuidado: os entremeios da norma; e 3) as interfaces de atenção usuário-trabalhador da saúde: como desmistificar o julgamento dos trabalhadores da saúde, que, subordinados a protocolos limitantes, muitas vezes estigmatizam o usuário como "abandonador de tratamento"?. A usuária-guia vislumbrou que cuidar é se desterritorializar, é colocar os desejos como potência para transformação, saindo do modus operandi rumo à criatividade, tendo o usuário no centro do processo. (AU)

Presenciamos la trayectoria de una usuaria-guía en el tratamiento para tuberculosis multidrogo resistente (TB-MDR). Las narrativas de las Redes Vivas en la producción de cuidado señalan: 1) cuidar en el acto de vivir: suplantar los estigmas y cultivar vínculos que ayuden a superar los discursos fomentados por el miedo, prejuicios, exclusión e invisibilidad de los sujetos. 2) Redes Vivas de cuidado: los entresijos de la norma y 3) las interfaces de atención usuario-trabajador de la salud: ¿cómo desmistificar el juicio de los trabajadores de la salud quienes, subordinados a protocolos limitantes, muchas veces estigmatizan al usuario como "abandonador de tratamiento"? La usuaria-guía vislumbró que cuidar es desterritorializarse, es colocar los deseos como potencia para trasformación, saliendo del modus operandi rumbo a la creatividad, colocando al usuario en el centro del proceso. (AU)

We followed the trajectory of a guiding user undergoing treatment for multidrug-resistant tuberculosis (MDR-TB). The narratives of Live Networks in care production showed: 1) Caring in the act of living: Overcoming stigmas and cultivating bonds that help overcome discourses fostered by fear, prejudice, exclusion and invisibility of subjects; 2) Live Networks of care: The in-betweens of the norm; and 3) Interfaces of user-health worker care: How can we demystify the judgment of health workers who, subordinated to limiting protocols, often stigmatize the user as someone who "abandons the treatment"? The guiding user perceived that caring means deterritorializing oneself, expressing one's desires as power for transformation, and leaving the modus operandi towards creativity, with the user at the center of the process. (AU)

A Scoping Review of Biobehavioural Interventions to Improve PrEP Continuum of Care in Latin America

According to the literature, biobehavioural interventions or combined strategies would reduce the risk of HIV infection by more than 7,000 new cases each day, which would contribute to the battle facing Latin America, where despite the high incidence and prevalence of HIV in the region, access to PrEP (pre-exposure prophylaxis) is very limited. The objective of this research was, consistent with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), to conduct a scoping review to assess the evidence of available outcome data on biobehavioural interventions and programs to address gaps in the PrEP continuum of care in Latin America. The search was conducted in the databases EBSCOhost, WoS, Scopus, and ProQuest, and include all studies published from 2010 to 2021. One hundred eighty-six studies were identified and evaluated according to the eligibility criteria in six stages starting with the elimination of duplicates until the selection of studies that met the previously mentioned criteria; at the end five studies were chosen which were submitted to the methodological quality assessment including compliance with ethical guidelines. Results show that biobehavioural interventions promoting PrEP in Latin America are effective in increasing condom use, decreasing HIV risk, and increasing PrEP awareness, uptake, adherence, and retention. The limited number of interventions in the PrEP continuum of care indicates a need for the uptake of dissemination and implementation science (D&I) frameworks. D&I could help facilitate the translation of evidence-based practices, interventions, and policies to address the HIV crisis in Latin America.

Según la literatura, las intervenciones bioconductuales o estrategias combinadas reducirían el riesgo de infección por VIH en más de 7000 nuevos casos cada día, lo que contribuiría a la batalla que enfrenta América Latina, región en la que, a pesar de la alta incidencia y prevalencia del VIH, el acceso a la PrEP (profilaxis preexposición) es muy limitado. De acuerdo con las directrices de PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), el objetivo de esta investigación fue realizar una revisión de alcance para evaluar la evidencia de los datos de resultados disponibles sobre intervenciones bioconductuales y programas para abordar las brechas en el continuo de atención de PrEP en América Latina. La búsqueda se realizó en las bases de datos EBSCOhost, WoS, Scopus y ProQuest, e incluyó todos los estudios publicados de 2010 a 2021. Se identificaron ciento ochenta y seis estudios, y se evaluaron de acuerdo con los criterios de elegibilidad en seis etapas, iniciando por la eliminación de duplicados hasta la selección de estudios que cumplieran los criterios previamente mencionados; al final se eligieron cinco estudios, los cuales fueron sometidos a la evaluación de calidad metodológica, incluyendo el cumplimiento de los lineamientos éticos. Los resultados muestran que las intervenciones bioconductuales que promueven la PrEP en América Latina son efectivas para aumentar el uso del condón, disminuir el riesgo de VIH y aumentar la conciencia, la aceptación, la adherencia y la retención de la PrEP. El número limitado de intervenciones en el continuo de atención de la PrEP indica la necesidad de adoptar marcos científicos de difusión e implementación (D&I); marcos que podrían ayudar a facilitar la traducción de prácticas, intervenciones y políticas basadas en la evidencia para abordar la crisis del VIH en América Latina.

Clima laboral: percepción del personal de Enfermería y las oportunidades de mejora / Work environment: perception of nursing staffand opportunities for improvement

La presente investigación pretende analizar la percepción del personal de enfermería sobre el clima laboral que vivencia; se identificarán las oportunidades de mejoras por medio de su autogestión de capacidades y se pondrán en práctica las acciones que serán evaluadas para determinar el impacto que produjeron. Material y método: se llevó a cabo un estudio aplicando el modelo de investigación acción participativa con el personal de enfermería del internado general del Sanatorio Allende en el año 2022; para la recolección inicial de datos se suministró una encuesta digital que valoraba la opinión personal sobre el clima laboral que percibe. Se realizó con el equipo completo de enfermeras del internado general del turno de la mañana el cual esta compuesto por 15 enfermeras; debido al número de integrantes no se realizará una muestra, sino que todas estarán contempladas. El proceso constó de cinco etapas: acercamiento y sensibilización, inducción, interacción, implementación, y sistematización. Resultados: se presenta una síntesis de los resultados más destacados en cada etapa: el origen de la situación planteada, revisión de la bibliografía, las acciones para lograr el acercamiento, los argumentos usados en la sensibilización, las herramientas para la inducción, el logro de la interacción y como se aplicaron las oportunidades de mejoras por medio de una sistematización. Conclusiones: la investigación acción participativa permitió a los profesionales determinar cual es su percepción actual de su ambiente laboral, individualmente construyeron probables soluciones a obstáculos en el trabajo en equipo que se podrán poner en práctica colectivamente y de este modo poder reevaluar en el futuro si es necesario conservar o modificar acciones ya que son autoras y partícipes de las acciones de mejora[AU]

This research aims to analyze the perception of nursing staff about the work environment they experience, opportunities for improvement will be identified through self-management of capacities and actions will be put into practice that will be evaluated to determine the impact they produced. Material and method: a study was carried out applying the participatory action research model with the nursing staff of the general boarding school of Sanatorio Allende in the year 2022. For the initial data collection, a digital survey was provided that assessed the personal opinion on the perceived work environment. It is carried out with the complete team of nurses from the general internship, which is made up of 15 nurses. Due to the number of members, a sample will not be made, but all will be contemplated. The process consisted of five stages: approach and awareness, induction, interaction, implementation, and systematization. Results: a synthesis of the most outstanding results in each stage is presented: the origin of the situation raised, review of the biblio-graphy, the actions to achieve rapprochement, the arguments used in raising awareness, the tools for induction, the achievement of the interaction and how the improvement opportunities were applied through a systematization. Conclusions: participatory action research allowed professionals to determine what their current perception of their work environment is, individually they built possible solutions to obstacles in teamwork that could be put into practice collectively and thus be able to reassess in the future if it is It is necessary to pre-serve or modify actions since they are authors and participate in the improvement actions.Palabra chave: ambiente de trabalho, enfermagem, percepção, pesqui-sa-ação participativa, pesquisa participativa baseada na comunidade[AU]

A presente pesquisa tem como objetivos analisar a percepção dos trabalhadores de enfermagem sobre o ambiente de trabalho que vivenciam. Serão identificadas oportunidades de melhorias através da autogestão de capacidades e serão colocadas em prática ações que serão avaliadas para determinar o impacto que produziram. Material e método: foi realizado um estudo aplicando o mode-lo de pesquisa-ação participativa com a equipe de enfermagem do internato geral do Sanatório Allende em 2022. Para a coleta ini-cial de dados, foi disponibilizada uma pesquisa digital que avaliou a opinião pessoal sobre o ambiente de trabalho que percebem. Foi realizado com toda a equipe de enfermeiros do internato geral do turno matutino, que é composta por 15 enfermeiros. Devido ao número de associados, não será realizada amostra, mas todas serão incluídas. O processo consistiu em cinco etapas: abordagem e sensibilização, indução, interação, implementação e sistemati-zação. Resultados: é apresentada uma síntese dos resultados mais notáveis em cada etapa: a origem da situação levantada, revisão da literatura, ações para alcançar a reaproximação, argumentos utili-zados na sensibilização, ferramentas para indução, concretização da interação e como as oportunidades para melhorias foram apli-cadas por meio de sistematização. Conclusões: a pesquisa-ação participativa permitiu aos profissionais determinar sua percepção atual sobre seu ambiente de trabalho, individualmente construí-ram prováveis soluções para os obstáculos no trabalho em equipe que poderiam ser colocadas em prática coletivamente e assim po-der reavaliar no futuro se é necessário preservar ou modificar ações já que são autores e participantes das ações de melhoria.is presented: the origin of the situation raised, review of the biblio-graphy, the actions to achieve rapprochement, the arguments used in raising awareness, the tools for induction, the achievement of the interaction and how the improvement opportunities were applied through a systematization. Conclusions: participatory action research allowed professionals to determine what their current perception of their work environment is, individually they built possible solutions to obstacles in teamwork that could be put into practice collectively and thus be able to reassess in the future if it is It is necessary to pre-serve or modify actions since they are authors and participate in the improvement actions[AU]

Vigilância Popular da Saúde, Ambiente e Trabalho (VPSAT): uma revisão integrativa da literatura / Popular Health, Environmental and Occupational Surveillance: an integrative literature review

Resumo Objetiva-se identificar concepções, experiências, métodos e técnicas em Vigilância Popular da Saúde, Ambiente e Trabalho (VPSAT). Trata-se de uma revisão integrativa com os descritores: participação da comunidade, vigilância em saúde, vigilância da saúde, saúde ambiental e saúde do trabalhador, envolvendo cinco bancos de dados: Biblioteca Virtual da Saúde, EBSCOhost, Embase, Scopus e Web Of Science. A revisão selecionou 15 estudos, a partir dos critérios de inclusão: experiências de vigilância com protagonismo comunitário; e exclusão: pesquisas sem dados primários e desenvolvidas apenas pelo serviço de saúde. Identificaram-se como bases teóricas e metodológicas dos estudos a ciência cidadã, educação popular e justiça ambiental; e experiências como mapeamentos e monitoramentos participativos; métodos como pesquisa-ação, "faça você mesmo" e investigação baseada na comunidade; e técnicas como "Photovoice" e Jornal Comunitário. Destacam-se as comunidades urbanas de baixa renda, indígenas, jovens e trabalhadores como protagonistas. O reconhecimento da VPSAT como importante fonte de dados e de intervenção pelos sistemas de saúde públicos e pela academia contribui para que a vigilância em saúde seja mais dialógica e efetiva.

Abstract The objective is to identify concepts, experiences, methods, and techniques in Popular Health, Environmental and Occupational Surveillance (VPSAT). This is an integrative review that used the descriptors: Community Participation, Public Health Surveillance, Environmental Health, and Occupational Health, using five databases: Virtual Health Library, EBSCOhost, Embase, Scopus and Web of Science. The review selected 15 studies, based on the inclusion criteria: surveillance experiences with community protagonism; and exclusion criteria: research without primary data and developed only by the health service. The theoretical and methodological bases of the studies were identified as citizen science, popular education, and environmental justice; experiences such as participatory mapping and monitoring; methods such as action research, 'do-it-yourself', and community-based research; and techniques such as "Photovoice" and Community Journal. Low-income urban communities, indigenous peoples, young individuals, and workers stand out as the protagonists. The recognition of the VPSAT as an important source of data and intervention by public health systems and academia contributes to making health surveillance more dialogic and effective.

Prioridades nacionales de investigación en salud bucal, Perú 2022-2026: proceso, experiencias y perspectivas / National priorities for oral health research, Peru 2022-2026: process, experiences and perspectives

El Instituto Nacional de Salud, ha llevado a cabo por primera vez el proceso de identificación de Prioridades Nacionales de Investigación en Salud Bucal a cargo de la Subdirección de Investigación y Laboratorios de Enfermedades No Transmisibles del Centro Nacional de Salud Pública con la asesoría técnica de la Dirección de Investigación e Innovación en Salud y en coordinación con la Dirección Ejecutiva de Salud Bucal de la Dirección General de Intervenciones Estratégicas en Salud Pública del Ministerio de Salud mediante metodología participativa de tres actores claves: investigadores/especialistas, expertos y decisores. El objetivo de este artículo es describir el proceso seguido para la identificación de estas prioridades, el cual comprendió cinco fases: i) identificación de objetivos estratégicos del MINSA, ii) identificación de necesidades de investigación en salud bucal, iii) revisión por expertos y valoración de las necesidades según criterios, iv) priorización (valoración de la lista de prioridades según calificación) y v) presentación de las prioridades. Como resultado se obtuvieron las 12 prioridades que posteriormente fueron aprobadas por Resolución Ministerial N.° 262-2022/MINSA, con un periodo de vigencia 2022-2026. Además, se brindaron recomendaciones para futuros procesos.

The National Institute of Health has, for the first time, identified National Priorities for Oral Health Research, this process was carried out by the Subdirectorate of Research and Laboratories of Noncommunicable Diseases of the National Center for Public Health with the technical advice of the Directorate of Research and Innovation in Health and in coordination with the Executive Directorate of Oral Health of the General Directorate of Strategic Interventions in Public Health of the Ministry of Health, using a participatory methodology with three key actors: researchers/specialists, experts and decision-makers. This article aims to describe the process used to identify these priorities, which consisted of five phases: i) identification of the strategic objectives of the Ministry of Health, ii) identification of needs in oral health research, iii) review by experts and assessment of needs according to criteria and v) presentation of the priorities. As a result, 12 priorities were obtained, which were subsequently approved by Ministerial Resolution No. 262-2022/MINSA, for a period of 2022-2026. In addition, we provide recommendations for future processes.

Prevalence of eczema among older persons: A population-based cross-sectional study

Background: There are very few population-based studies on the prevalence of eczema among older persons Aims: To estimate the prevalence and types of eczema in those aged 65 years or more in the community and to evaluate the effectiveness of community-based interventions for case finding. Methods: In the first stage of this cross-sectional survey, trained health workers of a non-governmental organization surveyed the eligible population and identified persons likely to have eczema. In the second stage, dermatologists examined such persons to ascertain the diagnosis. Statistical analysis was done using Epi Info software version 7. Prevalence of eczema was expressed in percentages. Chi-square test was used for comparing the difference in prevalence of eczema in various age groups and sex. Results: Health workers identified 98 persons as possible cases of eczema after interviewing 385 older persons in the community. Among them 95 persons were examined by dermatologists and 44 were confirmed to have eczema (diagnostic accuracy of health workers = 46.3%).Point prevalence of eczema was 11.4% (44/385). Prevalence was similar in males and females. It was greater (18.2 %) among persons aged 81 years or more. Asteatotic eczema, gravitational eczema and lichen simplex chronicus were the more common types of eczema. Limitations: Possible underestimation of the prevalence rates due to limited medical knowledge of health workers; limited facilities for examination and investigations at the medical camps and home visits. Conclusion: There appears to be a considerable burden of eczema among older persons in the community. A community-based approach involving non-governmental organizations has the potential to identify cases and offer care close to their homes

Association Of Socio-Demographic Determinants with Economic Burden Among Road Traffic Accident Victims: A Longitudinal Study

Background: RTA are the sixth leading cause of death in India with a greater share of hospitalization, disabili-ties, deaths and socio-economic losses. The study was conducted to assess the socio-demographic determi-nants associated with households’ economic burden among RTA victims. Methods: A longitudinal study was conducted for 2 years in Puducherry employing simple random sampling to include 169 accident victims. Baseline data was collected with a semi-structured questionnaire on socio-demographic details, direct and indirect costs towards road traffic injuries. Follow up was at 6th and 12thmonth from the day of accident. Data entry and analysis were performed using Epi-data. Written informed consent from each participant was sought. Ethical clearance received. Results: Mean age of the accident victims was 36.2 (11.4) years. The median (IQR) for direct, indirect and to-tal expenses were INR 1500 (1000-22100), 18000 (2400-46500) and 3000 (1037-47125) respectively. Asso-ciation between the median (IQR) indirect expenses and marital status as well as socio-economic status of vic-tims were found to be statistically significant. Conclusion: Accident victims and their family faced financial burden, as a large proportion of victims were from productive age group belonging to lower- and middle-class income group

Emergência dos complexos culturais nas ecovilas: estudos etnográficos Brasil/Suíça / The emergence of cultural complexes in ecovillages: ethnographic studies Brazil/Switzerland

Este artigo contribui com o estudo sobre subjetividade dos moradores de ecovilas a partir do conceito de complexo cultural. A pesquisa foca nos complexos que emergiram em relação ao indivíduo, ao coletivo e à natureza, procurando entender como eles se desenvolveram e foram trabalhados. Contamos com a noção de complexos culturais para compreendermos as relações dos indivíduos consigo, com os outros e com o meio ambiente em contextos comunitários. Fizemos observações participantes em três ecovilas. As análises nos mostram que a vida em ecovilas desenvolve complexos coletivos que mediam as relações dos indivíduos com os seus respectivos grupos no que tange aos aspectos da individualidade e da coletividade, bem como aos modos de se relacionar com a natureza. Contudo, em cada comunidade, o contexto físico e a presença ou ausência de trabalhos de autorreflexão desenvolviam os complexos culturais de formas distintas, produzindo relações específicas de cada indivíduo com seu contexto.

This article aims to contribute to the subjectivity study of ecovillage dwellers based on the concept of cultural complex. The investigation focused on the complexes that emerged with regard to the individual, collective, and nature, how they developed and were worked on. We rely on the notion of cultural complexes to understand the relationships of individuals with themselves, with others, and with the environment in the community framework. We observed the participants in two ecovillages in Switzerland and one in Brazil. The analyses evidenced that life in ecovillages develops collective complexes that mediate the relationships of individuals with their relevant groups regarding aspects of individuality and collectivity and ways of relating to nature. However, in each community, the physical context and the presence or absence of self-reflection works developed cultural complexes in different ways, producing specific relationships between each individual and their context.

Construction of basic rehabilitation training course for family doctor teams serving for people with disabilities based on WHO rehabilitation competency framework / 中国康复理论与实践

ObjectiveTo develop basic training courses for family doctor teams for people with disabilities. MethodsUtilizing the methods and theories of the World Health Organization (WHO) rehabilitation competency framework (RCF), and referring to the WHO universal health coverage global competency framework, the rehabilitation competency characteristics of family doctor teams for people with disabilities in community settings were analyzed, and a basic training course system for these teams based on the RCF was developed. Results and ConclusionBased on RCF, a competency framework for family doctor teams serving people with disabilities has been constructed. The objectives, content and training course system for basic rehabilitation training has been established.

Status quo of home care for community-dwelling elderly from the perspective of family doctor teams: a qualitative study / 中华全科医师杂志

Objective:To investigate the perspective of family doctor teams on the status quo of home care for community-dwelling elderly.Methods:The focus group interviews on the status quo of home care for community-dwelling elderly were conducted from August 19 to December 28, 2021. One urban area and 1 suburban area of Beijing was selected by purpose sampling method as target areas. Five community health service centers were selected from each area, and 5 family doctor team members were selected as interviewees in each center. The outline of interviews was as follows: what kinds of home care does the family doctor team provide for the community-dwelling elderly; how does the family doctor team evaluate the existing community-based home care; what suggestions on developing community-based home care for the elderly in the future. The data of the interview were analyzed by the thematic framework.Results:Xicheng district and Miyun district were selected as the study sites in the urban and suburban areas of Beijing, and 41 family doctor team members were interviewed. Three themes and 6 sub-themes were extracted. The study showed that: (1) the family doctor contracted service for the elderly was carried out smoothly in the community; (2) the current situation of home care for the elderly in the community varied, the chronic disease management for the elderly was effective, the health education in the community was popular, the implementation of free annual health check for the elderly in urban areas was more difficult than that in suburban areas, and the family doctor team provided home visits as needed and required; (3) the members of family doctor team usually undertook multiple tasks due to the insufficiency of auxiliary staff, and the incentive mechanism of the home visit was not perfect, which needed to be improved.Conclusion:From the perspective of family doctor teams, the contract service for the elderly is generally carried out smoothly in Beijing communities, but it varies in different types of home care for the elderly, and the work and incentive mechanism of family doctor team need to be improved.

Designing a content validated community needs assessment questionnaire for two densely populated barangays in Binangonan, Rizal: a psychometric study protocol

BACKGROUND@#Prior to developing a community-based rehabilitation program, there is a need to conduct a needs assessment to identify the factors that may affect the quality of life (QOL) in a community. However, after reviewing related literature, no community needs assessment tools were readily accessible and were directed toward the target population and research locale of this study. @*OBJECTIVE@#The study aims to develop and validate a questionnaire that assesses the needs of selected barangays in Binangonan, Rizal as part of the first phase of the PRECEDE-PROCEED model. @*METHODS@#A purposive sampling method will be utilized in recruiting via email a panel of experts, consisting of five content experts and five lay experts, to evaluate the researcher-developed questionnaire’s content validity. Content validity will be assessed through evaluation of the tool’s grammar, choice of words, question construction, and scoring of items. The data will then be analyzed by a statistician using content validity ratio (CVR) and content validity index (CVI) where questions may be retained, revised, or eliminated.@*EXPECTED RESULTS@#The study expects to produce a content-validated questionnaire in English consisting of four dimensions: social, epidemiological, educational, and administrative/policy. For an item to be considered valid, scores for CVR and CVI should be equal to or greater than the cut-off values. The information from the questionnaire may be utilized by healthcare professionals aiming to improve the QOL in the community.

The effectiveness of telerehabilitation in hypertension management of adults in communities: protocol for a systematic review

BACKGROUND@#The emergence of Telerehabilitation in managing hypertension showed positive outcomes as an alternative approach to deliver healthcare services. With the ongoing COVID-19 pandemic which necessitates less physical contact, the study aims to determine the effectiveness of Telerehabilitation versus the usual care in hypertension management among adults in communities, especially in rural settings. @*METHODS@#A comprehensive electronic search was conducted in the following databases: ProQuest, EBSCOhost, AHA Journals, PubMed, Google Scholar, Scopus, HERDIN, Web of Science, JSTOR, and ScienceDirect in March 2022 and was updated in August 2022. Inclusion criteria are randomized controlled trial studies that involve participants aged ≥ 18 years old with hypertension or baseline blood pressure of >140/90 mmHg and the use of technologies and digital services to address hypertension versus non-Telerehabilitation approaches in rural communities or through community- based rehabilitation. Exclusion criteria are non-randomized controlled trials, qualitative studies, unfinished and article type records. The revised Cochrane Collaboration Risk of Bias tool will be used to evaluate the content for risk of bias, quality, and internal validity. An electronic data collection form and Raxter will be utilized to extract and to organize the following: demographics, objectives, design, settings, interventions, outcome measures, and significant findings. Review Manager (RevMan) version 5.4 will be used to perform quantitative synthesis of the pooled data if homogeneity is observed in the outcomes. @*EXPECTED RESULTS@#The study will determine the effectiveness of Telerehabilitation in managing hypertension and aiding in its implementation in response to the global trend of urbanization in rural areas.

Health benefits of integrating physical activity with chronic disease management in community-dwelling older adults: a scoping review / 中国康复理论与实践

ObjectiveTo construct a health intervention model for community-dwelling older adults with chronic diseases based on the International Classification of Diseases, Eleventh Revision (ICD-11) and the International Classification of Functioning, Disability and Health (ICF), and to analyze the health outcomes of three types of intervention models that integrate physical activity and chronic disease management. MethodsA scoping review was conducted by searching CNKI, Web of Science, PubMed and EBSCO databases for literature on community-based management of chronic diseases, physical activity, exercise rehabilitation, physical activity prescription intervention and related health outcomes up to May, 2023. ResultsEight studies from four countries were included, involving 568 randomized controlled trials and 4 359 participants aged 50 to 72. The studies were published mainly between 2017 and 2022. Community-based health intervention models for older adults with chronic diseases were categorized into three types: community health service models (chronic disease management and exercise rehabilitation), community physical activity models (prevention and health promotion) and mixed models (a combination of these two models). The community health service model focused on chronic disease management in the community, integrating community sports, and involving physical activity intervention, health education, dietary intervention, monitoring and motivation intervention, and care coordination, for six to 24 months, with the intervention attribute of rehabilitation and health promotion. The personnel involved doctors, nurses, dietitians, pharmacists, social workers and primary healthcare clinicians. The community physical activity model focused on design and implementation physical activity intervention for chronic disease in the community environment, providing relevant physical activity advice and guidance, and personalized reinforcement and support. The physical activities included walking, cycling, warm-up exercises, cardiopulmonary fitness, muscle strength and balance training, coordination and stretching exercises, Taijiquan, Yoga, Qigong, and water sports; ten to 150 minutes a time, low to vigorous, for eight to twelve months, with the intervention attribute of prevention and health promotion. The personnel involved clinical staff, primary healthcare staff, exercise intervention experts and consultants, doctors, nurses, social workers and certified exercise coaches. The mixed model involved a chronic disease prevention and management plan, including physical activity counseling, lifestyle intervention related to physical activity, personalized health guidance and exercise program design, for six to twelve months, with the intervention attribute of prevention, rehabilitation and health promotion. The personnel involved sports coaches and retired professional athletes, dietitians, nurses, personal trainers, general practitioners, occupational therapists and physiotherapists. The main health outcomes involved body function-related indicators, such as control of weight, blood pressure, waist circumference, systolic blood pressure, triglyceride and high-density lipoprotein cholesterol levels, to reduce cardiovascular risk; relief of arthritis and herpes zoster pain, improvement in cognitive function and depressive symptoms. In terms of activity-related outcomes, the physical fitness improved, involving agility and dynamic balance, flexibility, muscle strength, and aerobic endurance; while the amount of physical activity increased, as well as the time spent on mild, moderate and vigorous exercise or leisure activities; the risk of fall reduced, the level of daily physical activity improved, and the self-efficacy and level of social participation increased. ConclusionThe community-based physical activity and health services models for older adults with chronic diseases may be classified as community health service model, community physical activity model and mixed model. A comprehensive intervention integrating physical activity and community health services can improve the health status, control the symptoms of chronic diseases, improve physical and mental functions, and increase the level of physical activity and quality of life for older adults with chronic diseases. The mixed model is a hybrid model that incorporates physical activity into community health services, which can provide comprehensive health interventions to make better health and health-related benefits.

Relationships of habitual daily alcohol consumption with all-day and time-specific average glucose levels among non-diabetic population samples

BACKGROUND@#Alcohol consumption is a prevalent behavior that is bi-directionally related to the risk of type 2 diabetes. However, the effect of daily alcohol consumption on glucose levels in real-world situations in the general population has not been well elucidated. This study aimed to clarify the relationship between alcohol consumption and all-day and time-specific glucose levels among non-diabetic individuals.@*METHODS@#We investigated 913 non-diabetic males and females, aged 40-69 years, during 2018-2020 from four communities across Japan. The daily alcohol consumption was assessed using a self-report questionnaire. All-day and time-specific average glucose levels were estimated from the interstitial glucose concentrations measured using the Flash glucose monitoring system for a median duration of 13 days. Furthermore, we investigated the association between all-day and time-specific average glucose levels and habitual daily alcohol consumption levels, using never drinkers as the reference, and performed multiple linear regression analyses after adjusting for age, community, and other diabetes risk factors for males and females separately.@*RESULTS@#All-day average glucose levels did not vary according to alcohol consumption categories in both males and females. However, for males, the average glucose levels between 5:00 and 11:00 h and between 11:00 and 17:00 h were higher in moderate and heavy drinkers than in never drinkers, with the difference values of 4.6 and 4.7 mg/dL for moderate drinkers, and 5.7 and 6.8 mg/dL for heavy drinkers. Conversely, the average glucose levels between 17:00 and 24:00 h were lower in male moderate and heavy drinkers and female current drinkers than in never drinkers; the difference values of mean glucose levels were -5.8 for moderate drinkers, and -6.1 mg/dL for heavy drinkers in males and -2.7 mg/dL for female current drinkers.@*CONCLUSIONS@#Alcohol consumption was associated with glucose levels in a time-dependent biphasic pattern.

Association between vaccination status and COVID-19-related health outcomes among community-dwelling COVID-19 patients in Nara, Japan

BACKGROUND@#Many previous studies have reported COVID-19 vaccine effectiveness, but there are few studies in Japan. This community-based, retrospective observational study investigated the association between vaccination status and COVID-19-related health outcomes in COVID-19 patients by SARS-CoV-2 variant type.@*METHODS@#The study participants were 24,314 COVID-19 patients aged 12 or older whose diagnoses were reported to the Nara Prefecture Chuwa Public Health Center from April 2021 to March 2022, during periods when the alpha, delta, and omicron variants of COVID-19 were predominant. The outcome variables were severe health consequences (SHC) (i.e., ICU admission and COVID-19-related death), hospitalization, and extension of recovery period. The explanatory variable was vaccination status at least 14 days prior to infection. Covariates included gender, age, population size, the number of risk factors for aggravation, and the number of symptoms at diagnosis. The generalized estimating equations of the multivariable Poisson regression models were used to estimate the adjusted incidence proportion (AIP) and 95% confidence interval (CI) for each health outcome. We performed stratified analyses by SARS-CoV-2 variant type, but the association between vaccination status and COVID-19-related health outcomes was stratified only for the delta and omicron variants due to the small number of vaccinated patients during the alpha variant.@*RESULTS@#Of the 24,314 participants, 255 (1.0%) had SHC; of the 24,059 participants without SHC, 2,102 (8.7%) were hospitalized; and of the 19,603 participants without SHC, hospitalization, and missing data on recovery period, 2,960 (15.1%) had extension of recovery period. Multivariable Poisson regression models showed that regardless of SARS-CoV-2 variant type or health outcome, those who received two or more vaccine doses had significantly lower risk of health outcomes than those who did not receive the vaccine, and there was a dose-response relationship in which the AIP for health outcomes decreased with an increased number of vaccinations.@*CONCLUSION@#A higher number of vaccinations were associated with lower risk of COVID-19-related health outcomes, not only in the delta variant but also in the omicron variant. Our findings suggest that increasing the number of COVID-19 vaccine doses can prevent severe disease and lead to early recovery of patients not requiring hospitalization.

Saúde da Família, territórios quilombolas e a defesa da vida / Salud de la Familia, territorios quilombolas y la defensa de la vida / Family Health, quilombola territories and the defense of life

RESUMO Este artigo apresenta e discute elementos históricos de luta e resistência quilombolas, aspectos significativos para a produção de saúde e defesa da vida nesses territórios. Articula e tece reflexões sobre a importância e os limites da Estratégia Saúde da Família no reconhecimento, na valorização e na integração de saberes e práticas de comunidades quilombolas ao cuidado profissional em saúde com foco em seus processos de trabalho. Trata-se dos resultados de uma pesquisa-ação participativa em saúde desenvolvida com trabalhadores de uma unidade de Saúde da Família em uma comunidade quilombola no norte do Rio de Janeiro no período da pandemia da Covid-19. Concluiu-se com a pesquisa que, apesar das potencialidades da Estratégia Saúde da Família, os desafios para a integralidade da atenção à saúde no território estudado tendem a comprometer o protagonismo da comunidade - especialmente das mulheres - e a efetividade do cuidado. Não são valorizados, no âmbito da Estratégia, saberes, experiências e memórias ancestrais de cuidado do quilombo - aspectos com pouco rebatimento na atenção territorializada da saúde e, por conseguinte, distantes de uma política pública de direitos.

RESUMEN Este artículo presenta y discute elementos históricos de lucha y resistencia de quilombolas, aspectos significativos para la producción de salud y defensa de la vida en estos territorios. Articula y digiere reflexiones sobre la importancia y los límites de la Estrategia de Salud de la Familia en el reconocimiento, la valoración y la integración de conocimientos y prácticas de comunidades quilombolas a la atención profesional de la salud, centrándose en sus procesos de trabajo. Se trata de los resultados de una investigación y acción participativa en salud desarrollada con los trabajadores de una unidad de salud familiar en una comunidad quilombola en el norte de Río de Janeiro durante el período de la pandemia de Covid-19. Se concluyó con la investigación que, a pesar del potencial de la Estrategia de Salud de la Familia, los desafíos para la atención integral de la salud en el territorio estudiado tienden a comprometer el protagonismo de la comunidad - especialmente de las mujeres - y la efectividad del cuidado. En el marco de la Estrategia no se valoran los conocimientos, experiencias y recuerdos ancestrales de la atención del quilombo, aspectos con escaso refutación en la atención territorializada de la salud y, por lo tanto, alejados de una política pública de derechos.

ABSTRACT This article presents and debates historical elements of quilombola struggle and resistance as significant aspects for the production of health and defense of life in these territories. We articulate and reflect upon the importance and limits of the Family Health Strategy in the recognition, appreciation and integration of knowledge and practices of quilombola communities to professional health care focusing on their work processes. This study results from a participatory health research developed with workers of a Family Health Strategy in a quilombola community from north of Rio de Janeiro (Brazil) during the COVID-19 pandemic. We concluded that, despite the potential of the Family Health Strategy, the challenges for comprehensive health care in the territory studied tend to compromise the community's protagonism - especially that of women - and the effectiveness of care. Quilombola knowledge, experiences and ancestral memories of care are not valued within the scope of the Family Health Strategy. These aspects have little impact on territorialized health care and, therefore, far from a public policy of rights.

Postpartum Depression and its Clinico-Social Correlates – A Community-Based Study in Aligarh

Context: Postpartum depression (PPD) is onset of depressive symptoms in postpartum period from 2 weeks to 1 year. It causes maternal morbidity and long?term negative effects on growth and development of infant and child. It is often unreported and underdiagnosed. Aims: (1) To estimate the prevalence of PPD,(2) To determine socio?demographic, clinical, and obstetric correlates of the same. Settings and Design: A cross-sectional study was done in urban and rural areas of District Aligarh. Methods: A total of 304 females between 6 weeks and 6 months’ postpartum period giving consent were included in this study. Sociodemographic, obstetric, and clinico-social factors were recorded using predesigned, pretested questionnaire. Edinburgh Postnatal Depression Scale (EPDS) score ?10 was used to screen for PPD and International Classification of Disease (ICD?10) criteria for confirmation. Statistical Analysis Used: Correlates of PPD were determined using logistic regression analysis. Results: The prevalence of PPD was 9.5% using EPDS and was confirmed by ICD?10 criteria. History of abortion (adjusted odds ratio [AOR]: 6.0, 95% Confidence Interval [CI] 2.2–16.5), poor relationship with in?laws(AOR: 5.1; 95% CI 1.3–20.5), marital conflict (AOR: 13.3; 95% CI 2.2–77.6), and substance abuse in husband (AOR: 3.1; 95% CI 1.1–9.0) were found to be significant correlates for PPD. Conclusions: About one in every 10 postpartum females suffered from depression but did not seek health care for the same. Women facing social pathologies such as substance abuse in husband, marital conflict, and poor relationship with in?laws are more at risk of PPD. Screening for PPD should be included in the maternal and child health care programs to ensure early diagnosis and treatment.

Effect of COVID-19 Lockdown on Lifestyle Habits and Self-Care Practices of Diabetic and Hypertensive Patients in Rural Shimla and Udaipur – Findings from the HealthRise India program

Background: COVID-19 pandemic has increased the risk of mortality among patients with noncommunicable diseases. Maintaining a good metabolic control, lifestyle modification along with improved self?care practices are not only associated with less severe COVID?19 infections but also with a high recovery rate. Objectives: This research article explores the changes in lifestyle habits, self-care practices, and metabolic control among patients enrolled in the HealthRise program. The study compares behavioral changes, before COVID-19 pandemic and during COVID-19 pandemic, between intervention and control arms in Shimla and Udaipur. Methods: A quasi-experimental study design was employed for program implementation in select villages of Shimla district, and Udaipur district. A total of 459 patients from Shimla and 309 patients from Udaipur with diabetes mellitus or hypertension or with both were enrolled and followed for 1 year. Results: Metabolic control in Shimla intervention arm was 2.6 times higher than in control arm (P = 0.001) before COVID?19 pandemic. During COVID?19 pandemic, Odds of metabolic control in Shimla intervention was 1.5 times higher when compared with control arm (P = 0.03). In Udaipur, metabolic control before COVID-19 pandemic was comparable between control and intervention arms. During the pandemic, metabolic control in intervention arm of Udaipur was 5 times higher when compared to the control arm ((P = 0.001). Conclusion: Participants exposed to support, appreciate, learn, and transfer-community life competence process (SALT-CLCP) intervention maintained metabolic control during the COVID-19 pandemic with improved behavioral and self-care practices. Community-based interventions such as SALT-CLCP method bring ownership and empower community in achieving the better health outcomes.

Selección participativa de niños como promotores de salud para prevenir la obesidad infantil en tiempos de COVID-19

Introducción: La obesidad infantil es un problema de salud pública a nivel mundial. Determinar las estrategias para enfrentar esta epidemia requiere de su desarrollo desde una perspectiva holística y con base en el contexto local. Además, es necesario involucrar a la comunidad en la elaboración de propuestas que propicien un estilo de vida saludable. Objetivo: Utilizar herramientas virtuales durante la pandemia de COVID-19 para seleccionar participativamente a niños promotores de salud. Metodología: Mediante la dinámica de teatro guiñol se recrearon los actos correspondientes a las características de un promotor de salud (simpatía, empatía, responsabilidad y solidaridad), bajo el marco de la investigación participativa basada en la comunidad (IPBC), en cuatro escuelas primarias de Hermosillo, Sonora, México. Debido a la emergencia sanitaria y la modalidad de trabajo en casa implementada desde marzo de 2020, la actividad se realizó en plataformas virtuales. Resultados: . A través de un ejercicio participativo los compañeros de aula eligieron a 79 estudiantes que cumplían con las características para ser promotor de salud, quienes llevarán a cabo iniciativas dirigidas a toda la comunidad escolar en la siguiente fase del estudio. Conclusiones: La herramienta de teatro guiñol y el proceso participativo en la elección de niños promotores de salud se ejecutaron adecuadamente con ayuda de la comunicación en línea, siguiendo los principios de la IPBC.

Introduction. Childhood obesity is a major worldwide public health problem. To face this epidemic, society requires strategies developed from the structures and possibilities of the community local context and from a holistic approach. Community participation in the development of strategies is necessary to promote a healthy lifestyle. Objective. Select child promoters through online tools during COVID-19 pandemic using a participatory approach. Methods. . Puppet theater was used as a tool to select health promoters using a Community Based Participatory Research (CBPR) methodology; five acts regarding the characteristics of a health promoter (Sympathy, Empathy, Solidarity, Responsibility) were presented to children from four elementary schools in Hermosillo, Sonora, Mexico. Due to the COVID-19 pandemic lock down and the work-at-home modality implemented since March 2020 in Mexico, the strategy was developed using on-line platforms. Results. Through the CBPR practice, the classmates of four schools selected 79 students whom they considered met the characteristics to be a health promoter and then carry out a health promotion program aimed at the entire school community in a later study phase. Conclusion: The election participation process was adequately developed through online communication and CBPR principles, using the puppet theater tool.

Social Mapping in Nursing Education- Steps and Implication

Background: Social mapping, though an old approach in public health education and research, not prac-ticed much in nursing education. This study was conducted to describe the social mapping process in a semi-urban area in the Chittoor district of Andhra Pradesh in India and to describe the implications of such social mapping from the students' perspective. Methods: This participatory rural appraisal was conducted for the Bachelor of Nursing Students in a semi-urban settlement in the state of Andhra Pradesh in India. The social mapping process was conduct-ed in three broad steps- classroom-based teaching of social mapping, conducting social mapping in the community and a debriefing session with the students. The major outcome of this educational activity was the social map. In addition, we also came up with the students’ implications through group discus-sion. Results: A facility map was constructed by the community members which was replicated by the teach-ers. The map was triangulated by the teachers through a transect walk in that area. The students came out with various academic, clinical, and administrative implications from this educational session. Conclusion: Social mapping can be used as a potential tool in nursing education. More evidence is re-quired on this learning approach before recommending it in the Community Nursing curriculum.