Surveillance system for Healthcare-associated endophthalmitis at state level in a middle-income country: preliminary results / Sistema de vigilância epidemiológica para endoftalmites em nível estadual em um país de renda média: resultados preliminares

ABSTRACT Purpose: To describe the implementation pro cess and the preliminary results of a surveillance system for healthcare-associated endophthalmitis. Methods: This is a case study of the implementation of a surveillance system for healthcare-associated endophthalmitis. The system for healthcare-associated endophthalmitis is a structured system that enables surveillance of cases of healthcare-associated endophthalmitis after intraocular procedures, developed and coordinated by the Division of Hospital Infection at the State Health Department, São Paulo, Brazil. The implementation process included a pilot phase, followed by a scaling-up phase. Data were reported monthly to the Division of Hospital Infection by participating healthcare facilities that performed intraocular procedures in the state of São Paulo, Brazil, from September 2017 to December 2019. Results: Among the 1,483 eligible healthcare facilities, 175 engaged in the study (participation rate of 11.8%), reporting 222,728 intraocular procedures performed, of which 164,207 were cataract surgery and 58,521 were intravitreal injections. The overall incidence rate of endophthalmitis was reported to be 0.05% (n=105; 80 cases after cataract surgery and 25 cases after intravitreal injections). The incidence rates for healthcare facilities ranged from 0.02% to 4.55%. Most cases were caused by gram-positive bacteria, mainly Staphylococcus spp. In 36 (46.2%) of the cases, there was no bacterial growth; no sample was collected in 28 (26.7%) cases. This system for healthcare-associated endophthalmitis enabled the identification of an outbreak of four cases of endophthalmitis after intravitreal injections. Conclusion: The system for healthcare-associated endophthalmitis proved to be operationally viable and efficient for monitoring cases of endophthalmitis at the state level.

RESUMO Objetivo: Descrever o processo de implementação e os resultados preliminares de um sistema de vigilância epidemiológica para endoftalmites associada à assistência à saúde. Métodos: Trata-se de um estudo de caso de implementação de um sistema de vigilância epidemiológica para endoftalmites. O sistema de vigilância epidemiológica para endoftalmites é um sistema estruturado que possibilita a vigilância de casos de endoftalmite associados à assistência à saúde após procedimentos oftalmológicos invasivos, desenvolvido e coordenado pela Divisão de Infecção Hospitalar da Secretaria de Estado da Saúde, São Paulo, Brasil. O processo de implementação incluiu uma fase piloto, seguida pela fase de expansão. Os dados foram enviados mensalmente à Divisão de Infecção Hospitalar pelos estabelecimentos de saúde participantes que realizaram procedimentos oftalmológicos no estado de São Paulo, Brasil no período de setembro de 2017 a dezembro de 2019. Resultados: Entre os 1.483 estabelecimentos de saúde elegíveis, 175 participaram do estudo (taxa de adesão de 11,8%), relatando 222.728 procedimentos oftalmológicos realizados, sendo 164.207 cirurgias de catarata e 58.521 injeções intravítreas. A taxa de incidência global de endoftalmite relatada foi de 0,05% (n=105; 80 casos após cirurgia de catarata e 25 casos após injeção intravítrea). As taxas de incidência entre os estabelecimentos de saúde variaram de 0,02% a 4,55%. A maioria dos casos foi causada por bactérias gram-positivas, principalmente Staphylococcus spp. Em 36 (46,2%) casos não houve crescimento bacteriano; nenhuma amostra foi coletada em 28 (26,7%) casos. O sistema de vigilância epidemiológica para endoftalmites possibilitou a identificação de um surto de quatro casos de endoftalmite após injeção intravítrea. Conclusão: O sistema de vigilância epidemiológica para endoftalmites mostrou-se operacionalmente viável e eficiente para o monitoramento de casos de endoftalmite em nível estadual.

Do it fast! Early access to specialized care improved long-term outcomes in rheumatoid arthritis: data from the REAL multicenter observational study

Abstract Background Early rheumatoid arthritis (RA) offers an opportunity for better treatment outcomes. In real-life settings, grasping this opportunity might depend on access to specialized care. We evaluated the effects of early versus late assessment by the rheumatologist on the diagnosis, treatment initiation and long-term outcomes of RA under real-life conditions. Methods Adults meeting the ACR/EULAR (2010) or ARA (1987) criteria for RA were included. Structured interviews were conducted. The specialized assessment was deemed "early" when the rheumatologist was the first or second physician consulted after symptoms onset, and "late" when performed afterwards. Delays in RA diagnosis and treatment were inquired. Disease activity (DAS28-CRP) and physical function (HAQ-DI) were evaluated. Student's t, Mann-Whitney U, chi-squared and correlation tests, and multiple linear regression were performed. For sensitivity analysis, a propensity score-matched subsample of early- vs. late-assessed participants was derived based on logistic regression. The study received ethical approval; all participants signed informed consent. Results We included 1057 participants (89.4% female, 56.5% white); mean (SD) age: 56.9 (11.5) years; disease duration: 173.1 (114.5) months. Median (IQR) delays from symptoms onset to both RA diagnosis and initial treatment coincided: 12 (6-36) months, with no significant delay between diagnosis and treatment. Most participants (64.6%) first sought a general practitioner. Notwithstanding, 80.7% had the diagnosis established only by the rheumatologist. Only a minority (28.7%) attained early RA treatment (≤ 6 months of symptoms). Diagnostic and treatment delays were strongly correlated (rho 0.816; p < 0.001). The chances of missing early treatment more than doubled when the assessment by the rheumatologist was belated (OR 2.77; 95% CI: 1.93, 3.97). After long disease duration, late-assessed participants still presented lower chances of remission/low disease activity (OR 0.74; 95% CI: 0.55, 0.99), while the early-assessed ones showed better DAS28-CRP and HAQ-DI scores (difference in means [95% CI]: −0.25 [−0.46, −0.04] and − 0.196 [−0.306, −0.087] respectively). The results in the propensity-score matched subsample confirmed those observed in the original (whole) sample. Conclusions Early diagnosis and treatment initiation in patients with RA was critically dependent on early access to the rheumatologist; late specialized assessment was associated with worse long-term clinical outcomes.

The importance of compassionate care / A importância do cuidado humanizado na Odontologia

Recently, studies have highlighted the importance of compassionate care in healthcare. Not only does it improve patient outcomes and satisfaction, but it also improves the healthcare providers' overall well-being. Furthermore, it helps streamline the healthcare system by shortening hospital stays and rates or readmittance. Unfortunately, patients report that they feel there is a lack of compassionate care provided to them, thus shedding light on the compassion crisis. The compassion crisis seems to have its roots in healthcare professional education, as evidenced by the high levels of burnout experienced by students, particularly in dental students. Compassion training, however, not only equips healthcare professionals with strategies to more effectively treat their patients, but also with coping mechanisms to better handle the stressors of their profession. Dentistry is no exception and has some unique barriers to care as well such as communication, the physical barrier during treatment. This further highlights the importance of compassionate care while providing treatment. Implementing compassionate care to be taught in school will improve patient outcomes and provider well-being (AU)

Recentemente, estudos destacaram a importância da empatia na área da saúde. A empatia não só melhora resultados e satisfação do paciente, mas também melhora o bem-estar dos profissionais de saúde. Além disso, ajuda a diminuir o custo do sistema de saúde ao reduzir as internações hospitalares e as taxas de reinternação. Infelizmente, os pacientes relatam que sentem falta de empatia, levando a uma atual crise de falta de empatia nos servicos de saúde. A crise da falta de empatia parece ter suas raízes na formação dos profissionais de saúde, como evidenciado pelos altos níveis de burnout experimentados pelos alunos, principalmente em estudantes de Odontologia. Treinamento para empatia, no entanto, não apenas prepara os profissionais de saúde com estratégias para tratar de forma mais eficaz seus pacientes, mas também com mecanismos de enfrentamento para lidar melhor com os fatores de estresse da profissão. A Odontologia não é exceção e tem algumas barreiras específicas, como a comunicação, que fica comprometida durante o tratamento odontológico. Isso destaca ainda mais a importância da empatia durante o tratamento. Ensinando empatia nos cursos de Odontologia melhorará os resultados para os pacientes e o bem-estar dos profissionais. (AU)

Analysis of the supervision status of intensive countywide medical community in Fujian province based on thematic frame analysis / 中华医院管理杂志

Objective:To analyze the supervision mode and problems of intensive countywide medical communities and explore the methods and strategies to improve their supervision system.Methods:From March 2022 to May 2022, a stratified random sampling method was used and the intensive countywide medical communities in the province were selected for field study. In-depth interviews were made with the staff of the healthcare administration departments and health insurance agencies affiliated with intensive countywide medical communities, directors of general hospitals, directors of township hospitals, and heads of functional departments. These interviews mainly covered the principal entities of countywide medical community supervision, supervision measures and contents, supervision effects, supervision weaknesses, and how to improve internal and external supervision mechanisms. The interviews results were analyzed using thematic framework analysis and the data were subject to a descriptive analysis.Results:23 persons of five intensive countywide medical communities were selected for key person interview. The finalized framework of regulatory elements of intensive countywide medical communities consists of such five general themes as regulatory subjects, regulatory content, regulatory measures, regulatory effectiveness and existing problems, comprising 14 level-1 indicators and 52 level-2 indicators. The main regulatory bodies were mainly government departments (15 times), the regulatory content was focused on medical resources (10 times), the regulatory measures cover specific regulations (4 times), specific activities (4 times) and assessment and evaluation (4 times). And the regulatory effectiveness demonstrated a currently strong regulation strength of medical communities (5 times), and the existing problems were insufficient government supervision (12 times), difficulties encountered by social forces in their supervision (11 times) and internal governance (5 times).Conclusions:The supervision system of intensive countywide medical communities should be optimized by improving the governmental supervision mechanism, inviting supervision of social forces and building an effective internal governance.

Intrinsic Capacity of Rural Elderly in Thar Desert using World Health Organization Integrated Care for Older Persons Screening Tool: A Pilot Study

Integrated Care for Older Persons (ICOPE) screening tool helps to address declines in physical and mental capacities in older people. In India, majority of the older population resides in rural areas and there is a paucity of studies that demonstrates the utility of the ICOPE screening tool in India. Thus, a cross-sectional study was conducted to demonstrate the feasibility of using the World Health Organization ICOPE screening tool in a rural population. Comprehensive geriatric assessment of intrinsic capacity revealed cognitive decline in 31.5% (n = 142) participants, diminished mobility 52.1% (n = 235) participants, eye problems in 49.4% (n = 223) participants, and hearing loss in 68.3% (n = 308) participants. Gender difference was statistically significant with mobility limitation (P = 0.005; ?2 = 7.95) and feeling of pain (P = 0.001; ?2 = 15.64), being more in females than males. This tool seems suitable in identifying the intrinsic capacity of the rural elderly.

Desafios da articulação intersetorial entre saúde e assistência social: uma revisão integrativa / Challenges of intersectoral articulation between health care and social support: an integrative review / Desafíos de la articulación intersectorial entre salud y asistencia social: una revisión integrativa

A organização do modelo de atenção à saúde vigente no Brasil a partir da implementação do Sistema Único de Saúde (SUS) incorporou a intersetorialidade como premissa essencial, definida como a pactuação de diferentes atores no contexto do planejamento e assistência a políticas e programas. Nesse âmbito, enfatiza-se a relevância da articulação entre os setores de saúde e assistência social, pretendendo maior resolutividade das demandas e integralidade da assistência. A partir disso, este estudo pretende analisar os desafios para a colaboração intersetorial entre saúde e assistência social assim como suas implicações para a gestão do cuidado. Para tanto, foi conduzida uma revisão integrativa da literatura disponível nas bases de dados SCIELO e LILACS entre o período 2010-2020. Entre a amostra selecionada para a revisão, é constatado um panorama amplo, heterogêneo e complexo das experiências entre os dois setores, marcadas por variabilidades e desafios institucionais, operacionais e de recursos, sendo unânime o entendimento de que essas experiências ainda se mostram isoladas e verticalizadas. Diversos são os entraves associados ao exercício da intersetorialidade enquanto eixo norteador da elaboração de políticas públicas robustas para a população, especialmente no que tange ao binômio saúde e assistência social, o que reitera a necessidade de revisitar os processos de trabalho, gestão, formação, organização e disposição da atenção à saúde no Brasil tendo em vista a proposição e alcance de resultados mais efetivos na busca pela redução das iniquidades em saúde e fortalecimento das estratégias de bem-estar social.

Following implementation of the Unified Health System (SUS), the current organization of Brazil's health care model incorporated intersectoriality, defined as the agreement of different actors in the context of planning and assisting programs and policies, as an essential premise. This emphasizes the importance of intersectoral articulation between health care and social support for greater resolution of demands and comprehensive care. Given this context, this integrative review analyzes the challenges of intersectoral collaboration between health and social support, and its implications for care management. Bibliographic research was conducted in the SciELO and LILACS databases for articles published between 2010 and 2020. The final sample was characterized by a broad, heterogeneous, and complex panorama of experiences between the two sectors, marked by institutional, operational, and resource challenges and variability, with the unanimous understanding that such experiences are still isolated and verticalized. Many obstacles are associated with the implementation of intersectoriality as a guiding principle for elaborating robust public policies, especially regarding the binomial health and social support, reiterating the need to revise work, management, training, organization and health care processes in Brazil, given the proposal and achievement of more effective results in the search for reducing health inequalities and strengthening social well-being strategies.

La organización del actual modelo de atención a la salud en Brasil a partir de la implementación del Sistema Único de Salud (SUS) incluyó como premisa esencial la intersectorialidad, definida como la concertación de diferentes actores en el contexto de la planificación y asistencia a programas y políticas. En este contexto, se destaca la importancia de la articulación entre los sectores de salud y asistencial, con miras a una mayor resolución de demandas y una atención integral. Ante lo anterior, este estudio pretende analizar los desafíos para la colaboración intersectorial entre salud y asistencia social, así como sus implicaciones para la gestión del cuidado. Para ello, se realizó una revisión integrativa de la literatura en las bases de datos SciELO y LILACS, en el período de 2010-2020. Entre la muestra seleccionada para la revisión, se verificó un panorama vasto, heterogéneo y complejo de las experiencias entre los dos sectores, marcadas por la variabilidad institucional, operativa y de recursos, y fue unánime el entendimiento de que estas experiencias aún son aisladas y verticalizadas. Son varios los obstáculos asociados al ejercicio de la intersectorialidad en tanto eje de la elaboración de sólidas políticas públicas a la población, especialmente en lo que se refiere al binomio salud-asistencia social, lo que plantea la necesidad de revisar los procesos de trabajo, la gestión, la formación, la organización y la atención a la salud en Brasil con miras a proponer y lograr resultados más efectivos en la búsqueda de la reducción de las inequidades en salud y el fortalecimiento de las estrategias de bienestar social.

Evaluation of thyroid nodules in the brazilian public health care system, supplementary health system, and private health system in the northeastern region of the state of São Paulo

ABSTRACT Objective: To obtain data about the evaluation of thyroid nodules (TNs) in the northeastern of the State of São Paulo, compared by health care type, and measure the performance of cytology as a screening test for thyroid cancer (TC). Subjects and methods: We collected data of 597 patients treated in the Brazilian public health care system (SUS), supplementary health (SH) and in private health system (PHS) in 2014. A total of 803 TNs were aspirated, and 125 patients underwent surgery. Results: The distribution of all cytologic results according to the Bethesda system was: I, 135 (16.8%); II, 475 (59.2%); III, 107 (13.3%); IV, 32 (4.0%); V, 20 (2.5%); VI, 34 (4.2%). The time between cytologic analysis and surgery was longer in the SUS than in the SH for TNs in general (p < 0.001) and for TNs with Bethesda V and VI cytology (p = 0.01). The sizes of the TNs and resected malignant TNs was larger in the SUS than in the SH (p = 0.001 and p = 0.02, respectively). The number of PHS surgeries was too small and was not compared. The prevalence of TC was 9.2% and 23.6% of them were treated in the SUS. Cytology showed a 93.6% sensitivity, 95.8% specificity, and 94.7% accuracy when Bethesda III and IV were excluded. Conclusion: Cytology was a good screening test for TC categories Bethesda II, V, and VI. The differences between the SUS and SH indicate a need for improved access to consultations and specialized tests in the SUS.

Impact of the COVID-19 pandemic in patient admission to a high-complexity cancer center in Southern Brasil

SUMMARY OBJECTIVE: The aim of our study was to investigate whether there has been a reduction in patient admission to a high-complexity cancer care center in Brasil during the COVID-19 pandemic, similar to what was reported in Europe. METHODS: We reviewed the cancer tracking database of the largest cancer center in southern Brasil and performed statistical tests to compare first-time appointments from the onset of the outbreak until the end of June to those of the equivalent period in 2019. RESULTS: We observed a dramatic reduction (-42%) in first-time appointments during the pandemic compared to the same period in the previous year (P <0.001). This reduction was observed among all medical specialties (P <0.001). CONCLUSION: The onset of COVID-19 was correlated with a reduction in admission to a high-complexity cancer care center in Brasil. Since a delay in diagnosis and treatment may influence prognosis, it is important that cancer centers and public health strategies reinforce care for non-COVID-19 patients to prevent potentially unnecessary deaths.

Early Hospital Readmission (EHR) in kidney transplantation: a review article / Readmissão Hospitalar Precoce no transplante renal: artigo de revisão

Abstract Early hospital readmission (EHR), defined as all readmissions within 30 days of initial hospital discharge, is a health care quality measure. It is influenced by the demographic characteristics of the population at risk, the multidisciplinary approach for hospital discharge, the access, coverage, and comprehensiveness of the health care system, and reimbursement policies. EHR is associated with higher morbidity, mortality, and increased health care costs. Monitoring EHR enables the identification of hospital and outpatient healthcare weaknesses and the implementation of corrective interventions. Among kidney transplant recipients in the USA, EHR ranges between 18 and 47%, and is associated with one-year increased mortality and graft loss. One study in Brazil showed an incidence of 19.8% of EHR. The main causes of readmission were infections and surgical and metabolic complications. Strategies to reduce early hospital readmission are therefore essential and should consider the local factors, including socio-economic conditions, epidemiology and endemic diseases, and mobility.

Resumo A Readmissão Hospitalar Precoce (RH), definida como todas as readmissões dentro de 30 dias após a alta hospitalar inicial, é uma métrica da qualidade hospitalar. É influenciada pelas características demográficas da população em risco, pela abordagem multidisciplinar da alta hospitalar inicial, pelo acesso, pela cobertura e pela abrangência do Sistema de Saúde e pelas políticas de reembolso. A readmissão hospitalar precoce está associada a maior morbidade, mortalidade e aumento dos custos com saúde. O monitoramento da RH permite a identificação das fragilidades hospitalares e ambulatoriais e a implementação de intervenções corretivas. Entre os receptores de transplante renal nos EUA, a RH varia entre 18% e 47% e está associada a maior mortalidade e perda do enxerto no primeiro ano do transplante. Um estudo no Brasil mostrou uma incidência de 19,8% de RH. As principais causas de readmissão foram infecções e complicações cirúrgicas e metabólicas. As estratégias para reduzir a readmissão hospitalar precoce são, portanto, essenciais e devem considerar o ambiente local, incluindo condições socioeconômicas, epidemiologia local, doenças e mobilidade endêmicas.

Real-world evidence of health outcomes and medication use 24 months after bariatric surgery in the public healthcare system in Brazil: a retrospective, single-center study

OBJECTIVES: The number of bariatric procedures has significantly increased in Brazil, especially in the public Unified Health System. The present study describes health outcomes and medication use in obese patients treated in a major hospital that performs publicly funded surgery in Brazil. METHODS: A retrospective, single center study was conducted to collect real-world evidence of health outcomes and medication use in 247 obese patients (female, 82.2%) who underwent open Roux-en-Y gastric bypass. Changes in weight and body mass index (BMI), presence of apnea, hypertension, and type 2 diabetes (T2D), and medication use (hypertension, diabetes, and dyslipidemia) were assessed preoperatively and up to 24 months postoperatively. The mean cost of medications was calculated for the 12-month preoperative and 24-month postoperative periods. RESULTS: During the surgery, the mean age of patients was 43.42 years (standard deviation [SD], 10.9 years), and mean BMI was 46.7 kg/m2 (SD, 6.7 kg/m2). At 24 months, significant declines were noted in weight (mean, -37.6 kg), BMI (mean, -14.3 kg/m2); presence of T2D, hypertension, and apnea (-29.6%, -50.6%, and -20.9%, respectively); and number of patients using medications (-66.67% for diabetes, -41.86% for hypertension, and -55.26% for dyslipidemia). The mean cost of medications (total costs for all medications) decreased by >50% in 12-24 postoperative months compared to that in 12 preoperative months. CONCLUSION: Roux-en-Y gastric bypass successfully reduced weight, BMI, and comorbidities and medication use and cost at 24 months in Brazilian patients treated in the public Unified Health System.

Position Value for Relative Comparison of Healthcare Status of Korea in 2016 / 보건행정학회지

This study investigated the healthcare status of South Korea and member states of the Organization for Economic Cooperation and Development (OECD). By employing the position value for relative comparison index, healthcare status was measured through the following components: demand, supply, accessibility, quality, and cost. Statistical analysis was conducted through the Mann-Kendall test from analyzing trends from 2000 onwards. Results showed that while Korea, on average, scores higher than the OECD average in most of the investigated components, it is below average in certain indexes including primary care and mental health care. Considering the various health issues that have been raised about these indexes, it is important these components be improved upon by policy-makers.

A Clinical Audit of the Process of Care for Women with Gestational Diabetes Mellitus in a Malaysian Public Polyclini

@#Introduction: Proper gestational diabetes mellitus (GDM) care is essential for optimal control and thus prevents adverse perinatal outcomes. This audit aimed to determine the quality of GDM care provided by a public polyclinic. Methods: The audit was performed on the clinic-based medical record of GDM patients who had undergone at least three prenatal follow-ups and one postnatal follow-up between January and November 2012. Patients with pre-existing diabetes mellitus were excluded. Results: A total of 74 medical records were audited and it showed that 94.6% of patients were of age 25 and above, 91.9% were Malays, 71.6% were multigravida and 98.6% had risk factors of GDM. 54.1% of diagnoses were made during the second trimester, while 25.7% and 20.2% of cases were detected during the first and third trimester respectively. All of the GDM patients had their weight and blood pressure monitored, 85.1% had their fundal height checked as scheduled and 85.1% were referred for diet counselling. 81.9% and 100% of GDM patients who were not on treatment and on treatment correspondingly had their blood sugar profile monitoring done as recommended. Only 13.5% of GDM patients were given prenatal family planning counselling and 35.1% were given a six weeks’ postnatal oral glucose tolerance test appointment. Monthly ultrasound screening and HbA1c monitoring was done in merely 51.4% and 58.1% of the GDM patients respectively. Conclusion: The GDM care process in this public polyclinic could be improved further to achieve the standard recommendations

Representações sociais de enfermeiras acerca da violência doméstica contra a mulher: estudo com abordagem estrutural / Representaciones sociales de enfermeras acerca de la violencia doméstica contra la mujer: estudio con enfoque estructural / Social representations of nurses concerning domestic violence against women: study with a structural approach

Resumo OBJETIVO Analisar a estrutura e os conteúdos das representações sociais de enfermeiras acerca da violência doméstica contra a mulher. MÉTODOS Estudo qualitativo realizado com 100 enfermeiras entre maio/setembro de 2014 em dois hospitais de Rio Grande/RS. Colheram-se os dados por meio de evocação-livre e entrevistas semiestruturadas. Foram tratados pelo software Evoc e análise contextual, respectivamente. RESULTADOS Observa-se uma representação negativa com elementos nucleares aludindo às formas de violência e ao seu julgamento, expresso em "agressão física" e "desrespeito". Na periferia, "medo" revela tanto o sentimento das profissonais quanto das vítimas frente ao agressor, e "submissão" é pontuada como causa da violência. Infere-se a possibilidade de um subgrupo com representação diferenciada, frente ao termo "agressão verbal" na zona de contraste. CONCLUSÕES A visão centralizada nos agravos físicos e na culpabilização da vítima pode limitar as ações de cuidado, portanto é fundamental problematizar este objeto com profissionais da saúde.

Resumen OBJETIVO Analizar la estructura y el contenidos de las representaciones sociales de los enfermeros sobre la violencia doméstica contra las mujeres. MÉTODOS Estúdio cualitativo cumplido em dos hospitales de Río Grande/RS. Los datos fueron recolectados entre mayo/septiembre de 2014 a través de entrevistas semi-estructuradas, cumplido con 100 enfermera, y evocaciones com 34. Fueron tratadas por un software Evoc y análisis contextual, respectivamente. RESULTADOS Se observa una representación negativa con elementos nucleares en alusión a las formas de violencia y su juicio, como "agresión física" y "falta de respeto". En la primera periferia, "miedo", revela tanto la sensación de profissonais como las víctimas contra el agresor, y "sumisión" se califica como una causa de la violencia. Se deduce de la posibilidad de una representación del subgrupo diferente, a través del la presencia del término "agression verbal", en la zona de contraste. CONCLUSIONES Una visión centralizada las lesiones físicas y culpabilidad a la víctima puede limitar las acciones de atención, por lo tanto es fundamental discutir este tema con profesionales de la salud.

Abstract OBJECTIVE To analyse the structure and contents of the social representations of nurses concerning domestic violence against women. METHODS This is a qualitative study conducted with 100 nurses between May and September 2014 in two hospitals of Rio Grande, RS, Brazil. Data were collected through evocations and semi-structured interviews. The data were processed in Evoc software and subjected to contextual analysis, respectively. RESULTS A negative representation was identified with core elements alluding to forms of violence and its judgment, expressed as "physical aggression" and "contempt". In the periphery, "fear" is how the professionals and the victims feel toward the aggressor and "submission" is mentioned as a cause of violence. The term "verbal aggression" in the contrast zone suggests the possibility of a subgroup with a different representation. CONCLUSIONS A centralised view regarding physical injuries and the culpabilisation of domestic abuse victims can limit care actions, revealing the need to discuss this subject with health workers.

Tamizaje en el diagnóstico y prevalencia de retinopatía diabética en atención primaria / Coverage of a screening program and prevalence of diabetic retinopathy in primary care

Background: Diabetic retinopathy is the first cause of blindness during working years. Aim: Provide knowledge of screening coverage, prevalence and level of diabetic retinopathy in patients that belong to the Cardiovascular Health Program in primary care. Material and Methods: Analysis of retinographies performed to 9076 diabetic patients aged 61 ± 13 years (61% women) adscribed to a Cardiovascular Health program in primary care centers of South-East Metropolitan Santiago. The examination was carried out by the evaluation of retinographies by trained optometrists. Results: The coverage of the screening program was 21%. The prevalence of sight threatening diabetic retinopathy was 3,1%. The prevalence of these entities was 45% higher in people aged between 18 and 44 years than in older people. Their prevalence in urban communities was 32% higher than in rural locations. Conclusions: The coverage of the screening program is low. Diabetic patients aged 18 to 44 years and those coming from urban communities have a higher prevalence of severe non-proliferative and proliferative diabetic retinopathy.

A integração das Unidades de Pronto Atendimento (UPA) com a rede assistencial no município do Rio de Janeiro, Brasil / The integration of the Emergency Care Units (UPA) with healthcare services in the city of Rio de Janeiro, Brazil / Integración de las Unidades de Atención de Emergencia (UPA) con la red sanitaria en el municipio de Rio de Janeiro, Brasil

No município do Rio de Janeiro, a implantação das Unidades de Pronto Atendimento 24h (UPA) foi o fio condutor da política de saúde e modelo para estruturação da rede de urgência e emergência (RUE). Este estudo analisou a integração das UPAs na rede assistencial do município. Foram realizadas nove entrevistas, com gestores centrais e locais, analisadas à luz da Teoria da Estruturação de Giddens. Resultados mostraram pouca integração das UPAs, por deficiências estruturais da rede de serviços e fragmentação gerencial, pela ausência de governança unificada. Apesar do investimento político e financeiro, essa estratégia não logrou contornar os problemas de integração entre as unidades de saúde e, ainda, ressaltou a baixa prioridade governamental para a atenção básica. Assim, as UPAs pouco contribuíram para o desenvolvimento de redes de atenção à saúde e para a reorientação do modelo assistencial.

The launching of Emergency Care Units (UPA in Portuguese) was a prominent health policy in the city of Rio de Janeiro during recent years. The aim of this study was to examine UPAs’ integration with other health services in order to assess their impact on the development of integrated healthcare networks. Nine interviews with state and local managers, UPAs’ coordinators and primary care units’ coordinators were performed. The data collected were interpreted under Giddens’ Structuration Theory. UPAs presented a low level of integration with other healthcare facilities within local emergency care network, due to structural problems as well as managerial fragmentation. In spite of the political and financial investment, the strategy of the UPAs has not been able to overcome the low degree of integration among local health services. Moreover, primary care services remain a lower priority. Thus, UPAs have contributed in lesser extent to the development of integrated healthcare networks.

En el municipio de Rio de Janeiro, la implementación de las Unidades de Atención de Emergencia (UPA) fue principio rector de la política de salud y modelo para la estructuración de la red de emergencia (RUE). Esta encuesta analizó la integración de las UPA con otros servicios de salud. Fueran realizadas nueve entrevistas con los gerentes centrales y locales, interpretadas según la Teoría de la Estructuración de Anthony Giddens. Los resultados mostraron poca integración de las UPA, causadas por debilidades estructurales de la red y por la fragmentación de la gestión de los servicios. A pesar de la inversión política y financiera, esta estrategia no ha logrado superar los problemas de integración entre los servicios de salud, señalando la baja prioridad que el gobierno coloca para la atención primaria y el poco desarrollo de las redes de atención a la salud.

Cuidar mulheres em situação de violência: empoderamento da enfermagem em busca de equidade de gênero / Cuidar de las mujeres en situación de violencia: fortalecimiento de la enfermería en la búsqueda de la equidad de género / Care for women victims of violence: empowering nurses in the pursuit of gender equity

RESUMO Objetivos Conhecer as ações de cuidar de mulheres em situação de violência por enfermeiras em serviços de urgência e emergência e analisar as ações que busquem o empoderamento de mulheres para a equidade de gênero. Métodos Estudo qualitativo, descritivo, realizado mediante entrevistas com 10 enfermeiras trabalhadoras do Centro Obstétrico e Pronto Socorro de um Hospital Universitário do Sul do Brasil e Pronto Atendimento Municipal, de janeiro a abril de 2013. Realizou-se Análise de Conteúdo Temática, adotando-se gênero como categoria analítica. Resultados Elementos do cuidado clínico: remetem-se aos procedimentos e técnicas de enfermagem. Elementos de cuidado não clínico: remetem-se a conversa, escuta e orientação às mulheres e familiares. Conclusões Desvelar tais ações torna-se relevante a fim de qualificar a assistência de enfermagem junto aos demais profissionais de saúde e os serviços de atenção às mulheres em situação de violência.

RESUMEN Objetivos : conocer las acciones de cuidado de las enfermeras en servicios de urgencia y emergencias y analizar las acciones que buscan el empoderamiento de las mujeres para la equidad de género. Métodos : estudio cualitativo, descriptivo, realizado a través de entrevistas con 10 trabajadores del centro obstétrico y sala de urgencias de un Hospital Universitario en el sur de Brasil y Servicio de Urgencia, de enero a abril de 2013. Se utilizó la técnica de análisis de contenido temático, adoptando la categoría analítica de género. Resultados : Elementos clínicos: relacionados con procedimientos y técnicas de enfermería. Elementos que no son clínicos: la conversación, escucha y orientación a las mujeres y familias. Conclusión : Revelar tales acciones es relevante para calificar la atención de enfermería con otros profesionales de la salud y atención servicios a mujeres en situación de violencia.

ABSTRACT Objectives To study the care of women victims of violence provided by nurses in emergency services and to analyse the practices that target the empowerment of women and gender equity. Methods A qualitative, descriptive study conducted by means of interviews with 10 nurses of an emergency and obstetrics unit of a university hospital and local emergency service of a city in southern Brazil from January to April 2013. We used thematic content analysis and defined gender as the analytical category. Results Clinical elements refer to nursing procedures and techniques. Non-clinical elements refer to conversation, listening and orientation to the women and their families. Conclusion Revealing these actions is important to qualify nursing care in relation to the other health professionals and care services for women victims of violence.

Barreras de acceso a los servicios de salud: narrativas de mujeres con cáncer de mama enColombia / Barriers to healthcare access: narratives of women with breast cancer in Colombia

Objetivo: explorar la existencia de barreras de acceso a losservicios de salud en las historias de mujeres con cáncer demama, que han recibido apoyo de seis ong colombianas.Metodología: se llevó a cabo un estudio cualitativodescriptivo interpretativo, en cinco ciudades colombianas:Bogotá, Medellín, Cali, Valledupar y Santa Marta, incluyendo44 mujeres apoyadas por seis ong. Se realizaron gruposfocales y entrevistas en profundidad. Resultados: en elproceso emergieron cuatro categorías: barreras ligadas alos determinantes estructurales, barreras originadas en losdeterminantes intermedios, herramientas para enfrentar lasbarreras y una categoría que hace referencia a la oportunidadde obtener un diagnóstico y un tratamiento de cáncer de mama.A partir de estas categorías, se propone un modelo de barrerasde acceso en cáncer de mama, desde la perspectiva de losdeterminantes sociales. Discusión: a pesar de los esfuerzos delpaís por mejorar la oportunidad en prevención, diagnóstico ytratamiento del cáncer ùincluyendo la promulgación de la ley1384 de 2010 (Ley Sandra Ceballos)ù, las mujeres con cáncerde mama enfrentan barreras de acceso a los servicios de salud,que están determinadas socialmente, y frente a las cuales elsistema muestra cierto nivel de incapacidad...

Objective: to explore the existence of barriers to healthcareaccess in the narratives of women with breast cancer who havereceived the support of six Colombian NGOs. Methodology:a descriptive qualitative interpretive study was carried out infive Colombian cities: Bogotá, Medellín, Cali, Santa Martaand Valledupar. Data was collected through focus groups andinterviews with 44 women supported by six NGOs. Results:in the process, four categories emerged: barriers linked to structural determinants, barriers arising from intermediatedeterminants, tools to address barriers and a category referring tothe opportunity for diagnosis and breast cancer treatment. Fromthese categories, a model of barriers preventing access to breastcancer-related healthcare is proposed from the perspective ofsocial determinants. Discussion: despite the Country's efforts toimprove the opportunity for prevention, diagnosis and treatmentof cancer -including the enactment of Act 1384 of 2010 (SandraCeballos Act)- women with breast cancer face barriers tohealthcare access which are socially determined and againstwhich the system shows some degree of inability...

Evolution of post-deployment indicators of oral health on the Family Health Strategy / Evolução de indicadores pós-implantação da saúde bucal na Estratégia Saúde da Família

Objective To evaluate the evolution of indicators after the implementation of 21 Oral Healthcare Teams in the Family Health Strategy. Methods We used data from outpatient services of Oral Healthcare Teams to evaluate efficiency, access, percentage of absences and emergencies of oral healthcare professionals who worked in the partnership between the Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein and the Secretaria Municipal de Saúde de São Paulo, during the period 2009-2011. Results Percentages of emergencies, income, and access showed a significant difference during the period analyzed, but no difference for percentage of absences was found. When monthly analysis was made, it is noteworthy that at the beginning of service implementation a fluctuation occurred, which may indicate that the work was consolidated over the months, becoming capable of receiving new professionals and increasing the population served. Comparison of the indicators in that period with the goals agreed upon between the Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein and the Secretaria Municipal de Saúde de São Paulo made it possible to notice that the Oral Health Teams had a good performance. Conclusion The results showed that the goals were achieved reflecting the increasing number of professionals, the maturing of work processes in the Oral Health Teams, and optimization of the manpower available to perform the activities. Understanding these results will be important to guide the actions of Oral Health Teams for the following years and to assess the achievement of goals. .

Objetivo Avaliar a evolução de indicadores após a implantação de 21 Equipes de Saúde Bucal na Estratégia Saúde da Família. Métodos Foram utilizados os dados de produção ambulatorial dos profissionais das Equipes de Saúde Bucal, o qual é o instrumento oficial utilizado pela Secretaria Municipal de Saúde de São Paulo para acompanhar o desempenho dos profissionais da saúde bucal em relação a rendimento, acesso, percentual de faltas e de urgências. Esses profissionais trabalharam na parceria entre a Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein e a Secretaria Municipal de Saúde de São Paulo, no período de 2009 a 2011. Resultados Para os indicadores: percentual de urgência, rendimento e acesso, houve diferença significativa entre os anos analisados. Para o indicador percentual de faltas, não houve diferença estatisticamente significante. Quando feita a análise mensal, destaca-se que, no início da implantação do serviço, ocorreu oscilação, podendo indicar que o trabalho foi consolidado ao longo dos meses, sendo capaz de receber novos profissionais e aumento da população atendida. Ao se compararem os indicadores do período com as metas pactuadas com a Secretaria Municipal de Saúde de São Paulo, é possível perceber que as Equipes de Saúde Bucal tiveram bom desempenho. Conclusão Os resultados alcançados junto às metas pactuadas certamente refletem o aumento do número de profissionais, o amadurecimento dos processos de trabalho dessas Equipes de Saúde Bucal e a otimização da mão de obra disponível para realização das atividades. O entendimento desses resultados é importante para nortear as ações das Equipes de Saúde Bucal para os anos ...

La obligación de informar al paciente: Cuestiones sobre el derecho a ser informado / The obligation to inform the patient: Issues on the right to be informed

This article aims to analyze, from a legal perspective, the boundaries of the obligation imposed on health care providers to inform the patient. This requirement originated and was developed as an ethical issue. However, with the newly approved law regulating the rights and duties of patients, the obligation to inform can be viewed from prisms and principles that differ from those governing medical ethics. With this purpose, we will focus on the comparative experience, which will allow us to evaluate the responsibility of health care providers when this duty is breached. We will try to answer the following questions: Which medical information must be informed to the patient? When should the doctor inform the patient? In which form should this information be provided?.

Para além das grades e punições: uma revisão sistemática sobre a saúde penitenciária / Beyond bars and punishments: a systematic review of prison health

A systematic review of scientific production on Prison Health was conducted, seeking to verify how the subject matter has been dealt with, establishing which is the most exploited focus and identifying possible gaps. The search was carried out in the Virtual Health Library. 1160 articles were located: 1104 on MEDLINE, 19 on LILACS and 37 on SciELO, published from 1993 to 2010. As MEDLINE and LILACS do not show the entire articles, the places, dates and languages of the texts were charted. In-depth analysis was restricted to works which were shown in their entirety and free of charge hosted on SciELO. It revealed that scientific production is present all over the world with a predominantly quantitative approach. It focuses on identifying the socio-demographic profile and health conditions of prisoners, the incidence of tuberculosis, Human Immunodeficiency and Hepatitis C virus infections. There is a predominance of studies carried out with male prisoners, in comparison with the female sex. It is clear that prisoner health is a public health problem on the rise, which demands research that can orient health policies and strategies.

Procedeu-se a uma revisão sistemática acerca das produções científicas sobre Saúde Penitenciária, objetivando verificar como a temática vem sendo abordada, identificar qual o foco mais explorado e apontar possíveis lacunas. A busca foi realizada na Biblioteca Virtual de Saúde. Foram localizados 1160 artigos: 1104 na Medline; 19 na Lilacs e 37 na SciELO, publicados no período de 1993 a 2010. Como as bases de dados da Medline e da Lilacs não disponibilizam os artigos na integra, foram mapeados os locais, as datas e o idioma de publicação dos textos. O aprofundamento analítico delimitou-se aos trabalhos cujos textos estavam na íntegra e disponibilizados gratuitamente, hospedados na SciELO. Evidenciou-se que a produção científica está presente nos cinco continentes do mundo, apresentando predominância da abordagem quantitativa, com foco na identificação do perfil sociodemográfico e das condições de saúde dos encarcerados: incidência de tuberculose, de infecção pelo Vírus da Imunodeficiência Humana e pelo Vírus da Hepatite C. Há uma predominância de estudos realizados com detentos do sexo masculino, em comparação ao sexo feminino. Percebe-se que a saúde dos detentos é um problema de saúde pública emergente, que demanda pesquisas que possam vir a orientar políticas e estratégias de saúde.