Type 1 diabetes care delivery in Yaoundé, Cameroon: Social and political representations

Background: Increasing chronic diseases challenges the health systems of low- and middleincome countries, including Cameroon. Type 1 diabetes (T1D), among the most common chronic diseases in children, poses particular care delivery challenges. Aim: We examined social representations of patients' roles and implementation of T1D care among political decision-makers, healthcare providers and patients within families. Setting: The study was conducted in Yaoundé, Cameroon. Methods: Eighty-two individuals were included in the study. The authors conducted semistructured interviews with policy makers (n = 5), healthcare professionals (n = 7) and patients 'parents (n = 20). Questionnaires were administered to paediatric patients with T1D (n = 50). The authors also observed care delivery at a referral hospital and at a T1D-focused nongovernmental organisation over 15 days. Data were analysed using thematic content analysis and descriptive statistics. Results: Cameroonian health policy portrays patients with T1D as passive recipients of care. While many practitioners recognised the complex social and economic determinants of adherence to T1D care, in practice interactions focused on specific biomedical issues and offered brief guidance. Cultural barriers and policy implementation challenges prevent patients and their families from being fully active participants in care. Parents and children prefer an ongoing relationship with a single clinician and interactions with other patients and families. Conclusion: Patients and families mobilise experience and lay knowledge to complement biomedical knowledge, but top-down policy and clinical practice limit their active engagement in T1D care. Contribution: Children with T1D and their families, policy makers, healthcare professionals, and civil society have new opportunities to contribute to person-centred care, as advocated by the Sustainable Development Goals.

Visualization analysis of the current situation of tiered health care system of type 2 diabetes in China based on CiteSpace / 公共卫生与预防医学

Objective To analyze the research hotspot and development trend of tiered health care system of type 2 diabetes in China. Methods The relevant research in the field of the tiered health care system of type 2 diabetes in China was sorted out and summarized by using CNKI, WangFang, VIP and Web of Science databases as search objects, and the relevant literature collected between January 1, 2009, and September 28, 2022, was searched. CiteSpace was used to describe the number of articles published, high-frequency keywords, emerging words, and trends. Results A total of 147 valid papers were included. The overall volume of related articles published showed an upward trend. After visual analysis, nine clusters were obtained, including family doctors, tiered health care system, health service system, and primary care. In the past two years, the research trends were mainly focused on primary care, general practitioners, specialist nurses, and quality of survival. Conclusion Research hotspots are focused on the areas of hierarchical diagnosis and treatment, primary care, family doctors, and community health services, with the words “medical association” and “specialist nurse” emerging in the past two years. In the future, research should be devoted to improving the tiered health care system of type 2 diabetes and opening up a multi-level cooperative research model, so as to effectively bring into play the advantages and effects of the tiered health care system.

Role Of "Aardram Mission" In Delivering Public Health Care Services In The State

“Mission Aardram” synonymously can be called as pillar of Kerala model of Development as it has been implemented for the provision of wellbeing of the citizen. Developing nations are facing issues related to the health care offered by the nation to its public hence in turn affect its human development index (HDI). Life Expectancy Index, Education Index and Gross National Income index are the different indicators of HDI which comes from the different dimensions, say, Long and healthy life, knowledge and a decent standard of living respectively. Mission Aardram is concentrating more on the first dimension of HDI, i.e.; Long and healthy Life. In order to keep its people healthy, the state of Kerala has taken an initiative called “Mission Aardram” as part of “Nava Kerala Karma Padhathi”. The Government of Kerala has implemented such a Novel scheme to provide good health care to its people by transforming all Primary Health Centres (PHC) into Family Health Centres (FHC) as the first stage health delivery point, then they intend to strengthen the system by offering five kinds of services, namely, Promotive services, Preventive Services, Palliative services, Rehabilitative services and Curative services. It is mentioned by the Institute of Medicine (IOM) that Mission Aardram has the main six characteristics that should have in any good quality health care system. As per the word of IOM if a health care system is said to be of good quality if and only if the system has Patient safety, Effectiveness, Efficiency, Patient-centered focus, Timely Referral Care and equity in treatment. Hence it is important to evaluate the role of Mission Aardram in delivering public health care by analyzing the above-mentioned factors.

Sistema de salud en Japón y su énfasis en la protección de la salud oral: una comparación con Chile / Oral health system in Japan: a comparation with Chile

Japón está compuesto por 126 millones de habitantes y corresponde a la tercera potencia económica mundial. El sistema de salud se basa en un único seguro obligatorio universal, con cobertura médica y odontológica. En las últimas décadas, el envejecimiento poblacional ha sido un punto importante a considerar en la planificación de políticas públicas sanitarias. La eficiencia de este sistema ha sido punto de comparación con distintos países, no así con Chile. Por ello, el objetivo de esta revisión narrativa es comparar el sistema de salud oral chileno y japonés. Se realizó una revisión narrativa utilizando los repositorios de revistas científicas Science Direct, y PubMed, así como publicaciones disponibles en páginas gubernamentales de Japón y Chile.El seguro japonés prioriza la promoción de salud y prevención de enfermedades, enfatizando en la población más vulnerable. Al contrario, en Chile el sistema de salud tiene énfasis en la curación y rehabilitación. Japón ha adoptado un seguro debido a la transición demográfica y epidemiológica, para garantizar la sustentabilidad del sistema en el tiempo, modelo que podría ser aplicado en Chile; considerando el envejecimiento poblacional y la carga de enfermedades crónicas no transmisibles. Ambos países tienen ventajas y limitaciones en los atributos de sus sistemas de salud. Chile tiene una Red integrada de servicios de salud y ha implementado políticas como GES. Japón tiene un sistema universal, más eficiente y equitativo. Las fortalezas del sistema japonés podrían implementarse en Chile, a través de nuevas políticas públicas que fortalezcan la salud del país, incluyendo la odontología.

Japan has a population of 126 million, and it is the third national economy in the world. The health system is on a single universal mandatory insurance, with medical and dental coverage. In the last decades, Japan has faced the ageing of its population, and this has been a relevant matter in the planning of public health policies. The efficiency of the health system has been a point of comparison in different countries, but not in Chile. Thus, the objective of this narrative review is to compare the Chilean oral-health system with the Japanese.A non-systematic review was made using Science Direct, PubMed repositories of journals and official Japanese and Chilean government pages. The Japanese healthcare insurance prioritizes health promotion and disease prevention, emphasizing the most vulnerable population. Conversely, Chile has a health system that focalizes on healing and rehabilitation. Japan has adopted insurance because of the demographic transition to guarantee the system's sustainability. Considering the increased ageing population and the non-communicable disease load, this insurance model could be applied in Chile.Both Chile and Japan have advantages and limitations regarding the attributes of their health systems. Japan has a universal, more efficient, and equitable system. Chile should study the strengths of the Japanese system for its implementation of new public policies that strengthen the country's health, including dentistry.

Fatores que influenciam a via de parto no Brasil / Factor influencing the mode of delivery in Brazil

Introdução: A prevalência de cesarianas cresceu no Brasil. Gestação e parto são influenciados por aspectos culturais e econômicos da sociedade em que a gestante está inserida. Objetivo: Analisar fatores que influenciam a escolha da via de parto pela gestante. Métodos: Trata-se de revisão narrativa da literatura incluindo artigos publicados entre 2009 e 2020. Foram feitas buscas nas bases de dados Pubmed, LILACS e SciELO, com descritores "Bioética", "Cesárea", "Comportamento de escolha", "Decisão", "Direitos da mulher", "Gravidez", "Parto", "Parto normal", "Sistema único de saúde". Resultados: Foram encontradas taxas de cesariana no setor privado maiores do que no público. Menor idade materna e escolaridade, raça negra, residência em meio rural e nas regiões Norte e Nordeste foram associados a menor prevalência de cesariana. Obesidade materna, cesariana prévia, intercorrências na gravidez, apresentação fetal não cefálica, macrossomia estiveram mais relacionados a cesariana. Dor, previsibilidade, relação da mãe com o recém-nascido, alta hospitalar, vida sexual e retorno às atividades foram relacionados a escolha do parto vaginal. Discussão: A disparidade de cesarianas no setor público e privado sugere o impacto de aspectos financeiros na escolha. Variáveis socioeconômicas são importantes nessa decisão. Conclusões: A escolha da via de parto é influenciada por vários fatores. [au]

Introduction: The prevalence of caesarean sections has grown in Brazil. Pregnancy and childbirth are influenced by cultural and economic aspects of the society in which the pregnant woman is inserted. Objective: To analyze factors that influence the choice of the mode of delivery by the pregnant woman. Methods:This is a narrative literature review including articles published between 2009 and 2020. Searches were made in Pubmed, LILACS and SciELO databases, with descriptors "Bioethics", "Caesarean section", "Choice behavior", "Decision", "Women's rights", "Pregnancy", "Childbirth", "Normal delivery" and "The Unified Brazilian Health Care System". Results: Caesarean section rates were found to be higher in the private sector than in the public sector. Lower maternal age and education, black race, residence in rural areas and in the North and Northeast regions were associated with lower prevalence of caesarean section. Maternal obesity, previous caesarean section, complications in pregnancy, non-cephalic fetal presentation and macrosomia were more related to caesarean section. Pain, predictability, mother's relationship with the newborn, hospital discharge, sexual life and return to activities were related to the choice of vaginal delivery. Discussion: The disparity of caesarean sections in the public and private sectors suggests the impact of financial aspects on the choice. Socioeconomic variables are important in this decision. Conclusions: The choice of mode of delivery is influenced by several factors. [au]

Cambio en la mortalidad intrahospitalaria durante el primer pico por SARS- COV-2 en Bogotá, Colombia / Change of in-hospital mortality during the first SARS-COV-2 surge in Bogotá, Colombia

Resumen Introducción: La mortalidad por SARS-COV-2 ha disminuido en diferentes países, pero no se ha evaluado si es igual en Colombia, o si se relaciona con las carac terísticas de los pacientes y tratamientos utilizados. Objetivo: Comparar la mortalidad por SARS-COV-2, en dos periodos de tiempo controlando por factores de riesgo asociados con mortalidad. Metodología: Estudio observacional, basado en una cohorte retrospectiva de pacientes con SARS-COV-2 atendidos en el Hospital Universitario San Ignacio, Bogotá (Colombia), desde el 19 de marzo al 12 de noviembre, 2020. Se comparó la tasa de mortalidad intrahospitalaria de los pacientes egresados antes y después del 21 de agosto de 2020 (primer pico de mortalidad en Colombia) y se analizó el impacto del momento de atención controlando por comorbilidades, severidad al ingreso y tratamiento recibido, usando un modelo de regresión logística. Resultados: 1399 pacientes (944 antes y 455 después del primer pico de mortalidad) fueron analizados. La tasa de mortalidad intrahospitalaria global fue similar en ambos periodos (17.6% vs 16.3%, p=0.539). En el análisis multivariado se encontró que la atención en el segundo periodo de tiempo se asoció a menor mortalidad (OR 0.66 IC95% 0.47; 0.93, p=0.018), a diferencia del aumento de la misma asociado a la edad (OR 1.06 IC95% 1.05; 1.07, p<0.001), sexo masculino (OR 1.84 IC95% 1.33; 2.54 p<0.001), cirrosis (OR 1.89 IC95% 1.24; 2.88, p=0.003), enfermedad renal (OR 1.36 IC95% 1.00; 1.83, p=0.043) y el uso de dexametasona (OR 1.53 IC95% 1.03; 2.28, p=0.031). Conclusiones: La tasa de mortalidad intrahospitalaria se redujo después del 21 de agosto durante la primera ola de la pandemia en Bogotá, posiblemente asociado a la mejoría en la capacidad de respuesta del sistema de salud en ese momento, o a un menor inoculo viral de los pacientes infectados. Estos hallazgos pueden cambiar con la saturación del sistema de salud.

Abstract Introduction: Mortality secondary to SARS-COV 2 has decreases around the world, however this has not been evaluated in Colombia neither has the correlation between patient characteristics or treatments. Objective: To compare the mortality due to SARS-COV-2, in two periods of time, controlling risk factors associated with mortality. Methodology: Observational retrospective cohort study of patients with SARS- COV-2 treated at the San Ignacio University Hospital in Bogotá (Colombia), from March 19 to November 12, 2020. The in-hospital mortality rate of patients discharged before and after August 21, 2020 (surge mortality in Colombia) was com pared. The impact of the moment of attention was analyzed controlled by comorbidities, severity at admission and treatment received using a bivariate and multivariate logistic regression model. Results: 1399 patients (944 before and 455 after August 21) were analyzed. The overall in-hospital mortality rate was similar at both times (17.6%vs16.3percentage, p=0.539). In the multivariate analysis, it was found that the moment of attention was associated with lower mortality (OR 0.66 95% CI0.47;0.93,p=0.018), in contrast to its increase associated with age (OR 1.06 95% CI 1.05;1.07,p=<0.001), male sex (OR 1.84 95%CI 1.33;2.54,p=<0.001), cirrhosis (OR1.89 95%CI 1.24;2.88, p=0.003), kidney disease (OR 1.36 95% CI1.00;1.83,p=0.043) and the use of dexamethasone (OR1.53 95%CI 1.03;2.28,p=0.031). Conclusions: The in-hospital mortality rate fell after August 21 during the first wave of the pandemic in Bogotá-Colombia, possibly associated with an improvement in response capacity, or a lower viral inoculum of infected patients. These findings may change with the saturation of the health system

Predict the hospitalization in COVID-19: Magic is in the air

Background: Although pathogenesis and pattern of disease are still not completely understood, tactical management of overcrowding of hospitals and rational usage of resources is the need of the hour. Aims and Objectives: The study objectives were as follows: Finding of correlation between various attributes of COVID; evaluation of the association of common characteristics with hospital stay; prediction of cooccurrence of different symptoms; calculation of odds ratio of prolonged hospitalization due to various symptoms; and estimation of the rate of prolonged hospitalization due to different symptoms and comorbidities. Materials and Methods: Retrospective data of 6918 COVID-19-positive cases from SCB Medical College and Hospital, India, were obtained from the hospital records from March 2020 to January 2021. The patients’ age, gender, symptoms, and comorbidities were analyzed against their hospital stay using R software (version 4.0.2). Results: Elderly patients (>65 years) had a higher rate (91.22%) of prolonged hospital stay as compared to others (47.61%). Frequently observed symptoms (in decreasing order) were fever (73.93%), cough (67.52%), myalgia (62.11%), dyspnea (49.59%), dizziness (47.38%), and anosmia (44.10%). The risk of prolonged hospitalization was highest with dyspnea [odds ratio: 2.29 (95% confidence interval: 2.07–2.52)], followed by diarrhea [odds ratio [OR] 1.98 (confidence interval [CI] 1.77–2.21)], fever [OR 1.89 (CI 1.69–2.10)], anosmia [OR 1.86 (CI 1.69–2.05)], and dizziness [OR 1.46 (CI 1.32–1.60)]. The rate of hospitalization for more than 7 days was highest with diabetes (86.80%) followed by respiratory illnesses (71.85%) and hypertension (71.28%). Conclusion: These findings can help manage patients based on their symptoms and comorbidities before admission.

Composición y evolución del gasto en salud de Colombia y su financiamiento en el periodo 2013-2018 / Composition and evolution of Colombia's health expenditure and its financing in the period 2013-2018

RESUMEN Objetivo Examinar la magnitud, la composición y evolución del gasto en salud de Colombia y su forma de financiamiento durante el periodo 2013 2018, con el propósito de aportar evidencia reciente para el mejor conocimiento y seguimiento de los flujos de recursos del sistema de salud. Métodos El análisis se sustenta en los conceptos y clasificaciones de la metodología SHA-2011 adoptada en la actualidad por la mayoría de los países miembros de la Organización Mundial de la Salud para sus estimaciones anuales del gasto en salud. La fuente principal de información es la base de datos de gasto global en salud de la misma entidad, algunos de cuyos resultados se complementan con cálculos adicionales utilizando fuentes oficiales nacionales. Resultados Desde el lado del gasto, el componente más importante corresponde al gasto público en salud, el cual representa, en promedio, 76,4% del gasto corriente en salud para el periodo en referencia, cuyo financiamiento con recursos públicos fiscales y contribuciones a la seguridad social representa 70,6% del financiamiento total; en tanto que el restante 23,6% corresponde al financiamiento privado representado por los pagos de bolsillo de los hogares (15,8%) y los pagos de seguros voluntarios (7,8%) también como promedios del mismo periodo. Conclusiones Colombia, como la mayoría de los países latinoamericanos, sigue un modelo de financiamiento predominantemente público, cuya composición de fondos registró un cambio en favor de los recursos de origen fiscal, como resultado de un cambio en las políticas de financiamiento durante el periodo analizado.

ABSTRACT Objective Examine the magnitude, composition, and evolution of health spending in Colombia and its financing methodology between the period 2013-2018. The aim is to provide recent evidence for better understanding and monitoring the health system flows resources. Methods The analysis focuses on concepts and classifications of the SHA-2011 methodology, currently adopted by most World Health Organization member countries in their annual health spending estimates. The primary source of information is the global health expenditure database from the same entity, whose results are comple-mented with additional calculations using official national sources. Results Considering the spending side, the most relevant component refers to public spending on health, which represents, on average, 76.4% of the current health spending and whose financing with public fiscal resources and contributions to security social, represents 70.6% of total financing. The remaining 23.6% corresponds to private financing spending, representing average values for out-of-pocket household payments (15.8%) and voluntary insurance payments (7.8%). Conclusions Colombia, like most Latin American countries, follows a predominantly public financing model, in which funds composition registered a positive change in fiscal resources as a result of financing policies adopted during the analyzed period.

El Psicólogo en el Primer Nivel de Atención de Salud: desafíos para Uruguay

Resumen: En Uruguay cada vez más se reconoce la importancia del profesional psicólogo en el Primer Nivel de Atención (PNA). En la actualidad se transita una oportunidad única ya que el Plan Nacional de Salud Mental 2020-2027 (PNSM) recientemente aprobado, plantea su incorporación en forma expresa. El presente artículo analiza el rol del psicólogo en el PNA, realiza un recorrido internacional seleccionando algunos países en los que se muestran diversos modos de incorporación de los psicólogos en este rol. Se aborda a continuación cuál es la situación del psicólogo en el PNA en Uruguay. Por último, se plantean algunos de los desafíos que implica renovar el trabajo tradicional del psicólogo clínico, e incorporar las competencias y prácticas profesionales características del PNA.

Abstract: In Uruguay, the importance of the professional psychologist in the First Level of Health Care (PNA) is increasingly recognized, and currently there is a unique opportunity since the recently approved National Mental Health Plan 2020-2027 (PNSM), raises its incorporation expressly. This article analyzes the role of the psychologist in PNA, makes an international review selecting some countries in which the various ways in which psychologists have been incorporated into this role are shown. The situation of the psychologist in the PNA in Uruguay is discussed below. Finally, some of the challenges faced are raised, which implies renewing the traditional role of the clinical psychologist, and incorporating the competencies and professional practices characteristic of the PNA.

Resumo: No Uruguai, a importância do psicólogo profissional no Primeiro Nível de Atenção de Saúde (PNA) é cada vez mais reconhecida, e atualmente existe uma oportunidade única desde o recém-aprovado Plano Nacional de Saúde Mental 2020-2027 (PNSM), levanta expressamente a sua incorporação. Este artigo faz análise do papel do psicólogo na PNA, faz uma revisão internacional selecionando alguns países nos quais são mostradas as diversas formas pelas quais os psicólogos foram incorporados a essa função. A seguir se discute a situação do psicólogo na PNA do Uruguai. Por fim, são apresentados alguns dos desafios que implica a renovação do papel tradicional do psicólogo clínico e incorporar as competências e práticas profissionais próprias da PNA.

Acesso e uso de medicamentos sob a perspectiva da pessoa em situação de rua / Access and use of medication from the perspective of homeless people

INTRODUÇÃO: As pessoas em situação de rua representam uma parcela da população diretamente interligada às desigualdades. As condições culturais, socioeconômicas e políticas em que estão inseridos os usuários, interferem diretamente no acesso à saúde, no processo de prescrição e, principalmente, na utilização dos medicamentos. OBJETIVOS: Descrever o acesso e o uso de medicamentos de pessoas em situação de rua, as estratégias e a frequência de acesso a medicamentos, o entendimento dos usuários sobre o modo de uso e de armazenamento; a identificação dos medicamentos mais consumidos e as indicações mais frequentes. METODOLOGIA: Trata-se de uma pesquisa com abordagem mista, qualitativa/quantitativa, de caráter descritivo. Os sujeitos de pesquisa foram pessoas em situação de rua no município de Porto Alegre/RS. A coleta de dados foi realizada através de entrevistas semi-estruturadas. O conteúdo foi analisado a partir da análise de conteúdo proposta por Bardin. RESULTADOS: Doze pessoas foram incluídas neste estudo, sendo a maioria homens (83%), pretos ou pardos, com idade entre 25 e 59 anos (67%). O local de maior procura para atendimentos foram as Unidades Básicas e o Consultório na Rua foi o mais citado, demonstrando a importância do vínculo desta população com a equipe. Assim como o acesso à saúde foi limitado ao SUS, o acesso a medicamentos também foi em farmácias públicas. A maioria apontou o uso de medicamentos para patologias agudas e os que relataram medicamentos de uso contínuo não apresentavam adesão ao tratamento. Automedicação e formas alternativas de acesso aos medicamentos foram citadas, além do abuso de álcool e o uso de substâncias psicoativas. CONCLUSÃO: Apesar de referirem não observar dificuldades para acessar serviços ou recursos de saúde, ao longo de seus discursos, diversas barreiras foram identificadas, seja em relação à disponibilidade de atendimento, demora e discriminação, ou ainda ao acesso, uso e armazenamento dos medicamentos. Contudo, a interação exitosa entre equipe e usuários não só deve beneficiar o acesso, mas também oportunizar que usuários possam integrar-se dos recursos de saúde oferecidos de maneira mais clara e acessível.

CONTEXT: Homeless people represent a quota of the population directly linked to inequalities. The cultural, socioeconomic and political conditions in which the users are inserted directly interfere in the access to health, in the prescription process and, mainly, in the use of medicines. OBJETIVES: describe the access and the use of medications by homeless people, the tactics and the frequency of access to medications, the knowledge of how it should be taken and storage; the identification of the most taken drugs. METODOLOGY: It is a research with a mixed approach, quantitative and qualitative method, with descriptive character. The subjects were homeless people in the city of Porto Alegre/RS. The data collection was taken through interviews that were recorded and transcripted. Data analyses were based on content analysis proposed by Bardin. RESULTS: Twelve people were included in this study, being the major mens (83%), dark or brown skin, with age between 25 and 59 years old (67%). The local with more demand were the basic health units and Homeless Clinic as the most cited demonstrates the importance of the bond between population and the team. Access to health was limited to the Sistema Único de Saúde (SUS ­ Single Health Care System), access to medicines was also available in public pharmacies. Most pointed to the use of drugs for acute pathologies and those who reported continuous use of drugs did not show adherence to treatment. Self-medication and alternative forms of access to medicines were mentioned, in addiction to alcohol abuse and the use of psychoactive substances. CONCLUSIONS: Although they reported not seeing difficulties in accessing health services or resources, throughout their speeches, several barriers were identified, whether in relation to the availability of care, delay and discrimination or even access, use and storage of medicines. However, successful interaction between staff and users should not only benefit access, but also provide opportunities for users to integrate the health resources offered in a clearer and more accessible way.

A enfermeira gestora de casos na Espanha: enfrentando o desafio da cronicidade por meio de uma prática integral / Case management nurse in Spain: facing the challenge of chronicity through a comprehensive practice

Resumo Em fins da década de 1990, instituiu-se um novo tipo de atuação para a enfermeira no sistema de saúde espanhol, denominada atualmente de enfermeira gestora de casos, com vistas à garantia do acesso aos recursos necessários para o enfrentamento das condições de cronicidade e atendimento integral no domicílio. O objetivo do artigo é o de apresentar essa figura e discutir aspectos de sua atuação. A metodologia baseou-se em revisão bibliográfica de artigos e publicações normativas e entrevistas com enfermeiras de Atenção Primária de Saúde, docentes de enfermagem e enfermeiras gestoras de casos. Apresenta-se um breve histórico de implantação da enfermeira gestora de casos e as bases conceituais e operacionais de sua prática em três comunidades autônomas espanholas: Andaluzia, Comunidade Valenciana e País Basco, discutindo potencialidades e questões a respeito dessa atuação dentro de um sistema de saúde de características universais. Nas conclusões, são tecidas algumas considerações a respeito das possibilidades para a implantação da figura da enfermeira gestora de casos no sistema brasileiro de saúde.

Abstract A new type of nurse role was established in the Spanish health care system in the late 1990s, currently called case manager nurse, to ensure access to resources needed to cope with chronic conditions and comprehensive home care. This paper aims to present this figure and discuss aspects of its work. The methodology was based on the bibliographic review of papers and normative publications and interviews with primary health care nurses, nursing faculty, and case management nurses. We present a brief history of the implementation of the case manager nurse role and the conceptual and operational bases of her practice in three autonomous Spanish communities: Andalusia, Valencian Community, and Basque Country, discussing potentialities and issues concerning this practice. In the conclusions, we make some considerations on the possible implementation of the case manager nurse in the Brazilian health system.

Perspectives on the Continuous Medication Monitoring Function of Pharmacies in the Community Health Care System: A Nationwide Survey in Japan / 日本補完代替医療学会誌

Objective: The objective of this study was to identify the perceived importance of various pharmacy functions among residents in the community health care system.Methods: We conducted an online survey of nationwide panelists enrolled by a research company to assess the perceived degree of importance of having a pharmacy that performs various functions in the community health care system (i.e., “comprehensive importance”).Results: “Comprehensive importance” was compared among 2,400 respondents disaggregated into several groups. The results revealed that “encouragement for medical consultations at medical institutions” had a strong effect on “comprehensive importance”.Conclusion: The results of this survey highlight the need for preventive medical care and a further expansion of the consultation function at pharmacies in the future.

Challenges in the work process in the Family Health Strategy / Desafio do processo de trabalho na Estratégia Saúde da Família

ABSTRACT Purpose: to analyze the work process of the Family Health teams in the municipality of Caxias do Sul, in Rio Grande do Sul State, Brazil. Methods: this is a qualitative, descriptive and exploratory research conducted in four Family Health Strategy (FHS) units, with the participation of 22 health professionals. The data were collected through a semi-structured interview and analyzed through the theme content analysis, aided by the Atlas.ti software. Results: the results were organized in three categories: (1) Roles, reality and idealization of working in the FHS, in which health prevention and curative practices appeared as the focus of the work process; (2) Elements of working in the FHS, which dealt with the purpose of the work connected to health prevention, related instruments, hard technologies and work object, in relation to professional specificities; and (3) Challenges and perspectives of working in the FHS, which emphasizes the fragilities, due to the shortage of professionals and the need for managerial improvement, as well as commitment and teamwork as potentialities. Conclusion: in the work process in health, the preventive professional actions with curative focus were predominant. The challenges were centered on redirecting the work process toward the Family Health approach.

RESUMO Objetivo: analisar o processo de trabalho das equipes de Saúde da Família no município de Caxias do Sul, RS, Brasil. Métodos: trata-se de uma pesquisa qualitativa, descritiva e exploratória. O estudo foi realizado em quatro Estratégia Saúde da Família (ESF) e participaram 22 profissionais de saúde. Os dados foram coletados por entrevista semiestruturada e analisados pela análise de conteúdo temática, com auxílio do software Atlas.ti. Resultados: foram organizados em três categorias: (1) Funções, realidade e idealização do trabalho na ESF, sendo a prevenção a saúde e as práticas curativistas apareceram como foco do processo de trabalho; (2) Elementos do trabalho na ESF, contemplou a finalidade do trabalho ligada à prevenção das doenças, os instrumentos vinculados as tecnologias duras e objeto de trabalho, relacionada as especificidades profissionais; e, (3) Desafios e perspectivas do trabalho na ESF, os quais enfatizam as fragilidades pela falta de profissionais e a necessidade de melhorias na gestão, bem como, o comprometimento e o trabalho em equipe como potencialidades. Conclusão: no processo de trabalho em saúde predominaram as ações profissionais preventivas com foco curativista, com desafios centrados no redirecionamento do processo de trabalho na lógica da Saúde da Família.

Delays in the health care system for children, adolescents, and young adults with bone tumors in Brazil / Atrasos no sistema de saúde para crianças, adolescentes e adultos jovens com tumores ósseos no Brasil

ABSTRACT Objective: To identify delays in the health care system experienced by children and adolescents and young adults (AYA; aged 0-29 years) with osteosarcoma and Ewing sarcoma using information from the Brazilian hospital-based cancer registries. Methods: Patient data were extracted from 161 Brazilian hospital-based cancer registries between 2007 and 2011. Hospital, diagnosis, and treatment delays were analyzed in patients without a previous histopathological diagnosis. Referral, hospital, and health care delays were calculated for patients with a previous histopathological diagnosis. The time interval was measured in days. Results: There was no difference between genders in overall delays. All delays increased at older ages. Patients without a previous histopathological diagnosis had the longest hospital delay when compared to patients with a previous histopathological diagnosis before first contact with the cancer center. Patients with Ewing sarcoma had longer referral and health care delays than those with osteosarcoma who had a previous histopathological diagnosis before first contact with the cancer center. The North and Northeast regions had the longest diagnosis delay, while the Northeast and Southeast regions had the longest treatment delay. Conclusion: Health care delay among patients with a previous diagnosis was longer, and was probably associated with the time taken for to referral to cancer centers. Patients without a previous histopathological diagnosis had longer hospital delays, which could be associated with possible difficulties regarding demand and high-cost procedures. Despite limitations, this study helps provide initial knowledge about the healthcare pathway delays for patients with bone cancer inside several Brazilian hospitals.

RESUMO Objetivo: Identificar atrasos no sistema de saúde em crianças e adolescentes e adultos jovens (AAJ; até 29 anos) com osteossarcoma e sarcoma de Ewing com informações dos registros de câncer de base hospitalar do Brasil. Métodos: Os dados dos pacientes foram extraídos de 161 registros de câncer de base hospitalar brasileiros entre 2007 e 2011. Os atrasos no hospital, no diagnóstico e no tratamento foram analisados em pacientes sem um diagnóstico histopatológico anterior. Os atrasos no encaminhamento, no hospital e no sistema de saúde foram calculados para pacientes com diagnóstico histopatológico anterior. O intervalo de tempo foi medido em dias. Resultados: Não houve diferença entre os sexos nos atrasos em geral. Todos os atrasos aumentaram na faixa etária mais velha. Os pacientes sem um diagnóstico histopatológico anterior apresentaram o atraso hospitalar mais longo em comparação com os pacientes com diagnóstico histopatológico anterior antes do primeiro contato com o centro de câncer. Os pacientes com sarcoma de Ewing apresentaram atrasos no encaminhamento e no sistema de saúde mais longos do que os com osteossarcoma, que apresentaram diagnóstico histopatológico anterior antes do primeiro contato com o centro oncológico. As regiões Norte e Nordeste apresentaram o atraso mais longo no diagnóstico, ao passo que as regiões Nordeste e Sul apresentaram o atraso mais longo no tratamento. Conclusão: O atraso no sistema de saúde entre os pacientes com diagnóstico anterior foi maior e provavelmente associado ao tempo de encaminhamento para os centros oncológicos. Os pacientes sem um diagnóstico histopatológico anterior apresentaram atrasos mais longos no hospital, o que pode ser associado a possíveis dificuldades com relação à demanda e aos procedimentos de alto custo. Apesar das limitações, nosso estudo ajuda a fornecer um conhecimento inicial sobre os atrasos no sistema de saúde para tratamento de pacientes com câncer em vários hospitais brasileiros.

Inmunización en personal de salud / Immunization in health care workers

Resumen Justificación: la inmunoprofilaxis del personal sanitario conlleva múltiples propósitos que engloban tanto la protección de los pacientes como de los funcionarios mismos, y redunda en un claro beneficio para el empleador. En particular, la protección de pacientes inmunocomprometidos y con bajo potencial de desarrollar respuestas vacunales efectivas es de suma importancia. Programas de inmunización sistemática del personal de salud pueden reducir el riesgo de enfermedad, minimizar el impacto de accidentes laborales con materiales infecciosos y mantener la fuerza de trabajo indemne en los centros médicos durante los brotes estacionales de algunas infecciones. Objetivos: concatenar los esquemas de vacunación recomendados actualmente para los funcionarios que laboran en centros de salud y ofrecer una guía adaptada a la realidad epidemiológica nacional. Métodos: se efectuó una revisión no sistemática de bibliografía médica publicada en Internet entre 1990 y 2018, concerniente a vacunación de empleados sanitarios. De igual manera, se compararon los respectivos esquemas de inmunización vigentes en América y Europa. Conclusiones: la trasmisión de enfermedades infecciosas en los centros sanitarios es un problema de salud pública frecuentemente no reconocido, pero sustancial, que pone en riesgo tanto a los usuarios como al personal de estas instituciones. La inmunización de los trabajadores sanitarios es una estrategia fundamental para prevenir y contener la diseminación de agentes infecciosos a nivel hospitalario. Esta medida puede crear "inmunidad de rebaño" para proteger a pacientes y funcionarios que no se hayan vacunado o no puedan generar inmunidad suficiente contra determinados patógenos. Además, la vacunación de los empleados de salud constituye un punto de referencia para motivar las inmunizaciones en los demás segmentos de la población.

Abstract Background: Immune prophylaxis in health care personnel induces multiple positive effects that include protection for patients, as well as for employees and results with a clear benefit for the employers. Especially in immunological compromised patient groups and individuals who present a diminished potential to develop immunity to vaccination, contagion prevention is of highest importance. Systematic immunization programs can help to lower disease risks, minimize impact of occupational accidents related to handling of contagious materials and maintain the intactness of workforce in medical centers during periods of seasonal infection outbreaks. Objectives: this article resumes the present recommended schemes for vaccination of health care personnel and concludes them in a guideline adapted to the country´s epidemiologic reality. Methods: a non-systematic revision of medical literature related to immunization of health care personnel, published online between 1990 and 2018, was realized. In the same manner, a comparison of active vaccination schemes existing in Europe and the United States of America has been executed. Conclusion: the transmission of infectious diseases in health care installations represents a frequently ignored problem which substantially elevates the infection risk of patients as well as of health care personnel. The vaccination of health care personnel represents the easiest to imply and most effective strategy to inhibit this kind of transmission of infectious diseases. As well, this measure can create a "herd immunity" protecting patients and health care personnel who are not vaccinated or in conditions where they can not develop sufficient immunity against infectious agents. Furthermore, the immunization of the health care workers represents a reference and an example of motivation to other parts of the population.

Satisfaction with care in a Brazilian psychiatric inpatient unit: differences in perceptions among patients according to type of health insurance / Satisfação com o cuidado em uma unidade de internação psiquiátrica brasileira: diferenças nas percepções dos pacientes segundo tipo de plano de saúde

Abstract Introduction User satisfaction assessment in mental health services is an important indicator of treatment quality. The objective of this study was to evaluate treatment satisfaction in a sample of inpatients with mental disorders and the associations between levels of satisfaction and clinical/sociodemographic variables. Methods This exploratory study investigated 227 psychiatric inpatients who answered the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and the Perception of Change Scale (EMP). SATIS scores were analyzed according to associations with clinical and sociodemographic data. Pearson correlations were used to correlate SATIS scores with other variables. Results We found a high degree of satisfaction with care at the psychiatric inpatient unit assessed. In general, patients rated maximum satisfaction for most items. The highest satisfaction scores were associated with patients receiving treatment through the Brazilian Unified Health System (SUS) and with less education. SATIS showed a moderate positive correlation with EMP. The worst evaluated dimension was physical facilities and comfort of the ward. Conclusion Patients treated via SUS may be more satisfied than patients with private health insurance when treated in the same facility. The evaluation of treatment satisfaction can be used to reorganize services at psychiatric inpatient units.

Resumo Introdução A avaliação da satisfação do usuário nos serviços de saúde mental é um importante indicador da qualidade do tratamento. O objetivo deste estudo foi avaliar a satisfação com o tratamento em uma amostra de pacientes internados com transtornos mentais e as associações entre os níveis de satisfação e variáveis clínicas/sociodemográficas. Métodos Este estudo exploratório investigou 227 pacientes psiquiátricos internados que responderam a Escala de Satisfação do Paciente com os Serviços de Saúde Mental (SATIS-BR) e a Escala de Percepção da Mudança (EMP). Os escores SATIS-BR foram analisados segundo associações com dados clínicos e sociodemográficos. Correlações de Pearson foram usadas para correlacionar escores SATIS com outras variáveis. Resultados Encontramos alto grau de satisfação com o atendimento na unidade de internação psiquiátrica avaliada. Em geral, os pacientes atribuíram satisfação máxima para a maioria dos itens. Os maiores escores de satisfação foram associados a pacientes em tratamento pelo Sistema Único de Saúde (SUS) e com menor escolaridade. A SATIS mostrou uma correlação positiva moderada com EMP. A pior dimensão avaliada foi associada às instalações físicas e conforto da enfermaria. Conclusão Pacientes com cobertura pelo SUS podem estar mais satisfeitos do que pacientes com planos privados de saúde quando tratados na mesma unidade. A avaliação da satisfação com o tratamento pode ser usada para reorganizar serviços em unidades de internação psiquiátrica.

Comparative Study of Health Care System in Three Central Asian Countries: Kazakhstan, Kyrgyzstan, Uzbekistan / 보건행정학회지

BACKGROUND: The objectives of the study are to find out the effect of the implementing reform in three Central Asian countries, identify its impact on health status and health care delivery systems. This study address to identify strong and weak points of the health systems and provide a recommendation for further health care organization. METHODS: A comparative analysis was conducted to evaluate the effects of implemented policy on health care system efficiency and equity. Secondary data were collected on selected health indicators using information from the World Health Organization Global Health Expenditure Database, European Health Information Platform, and World Bank Open Data. RESULTS: In terms of population status, countries achieved relatively good results. Infant mortality and under-5 mortality rate decreased in all countries; also, life expectancy increased, and it was more than 70 years. Regulations of the health systems are still highly centralized, and the Ministry of Health is the main organ responsible for national health policy developing and implementation. Among the three countries, only Kyrgyzstan was successful in introducing a national health system. Distribution of health expenditure between public expenditure and out-of-pocket payments was decreased, and out-of-pocket payments were less the 50% of total health expenditure in all countries, in 2014. CONCLUSION: After independent, all three countries implemented a certain number of the policy reform, mostly it was directed to move away from the old the Soviet system. Subsequent reform should be focused on evidence-based decision making and strengthening of primary health care in terms of new public health concepts.

Social and Clinical Impact of Congenital Urological Malformations in a Developing Country: The Need for a Transdisciplinary Way of Treatment / Impacto social y clínico de las malformaciones urológicas congénitas en un país en desarrollo: La necesidad de un tratamiento transdisciplinario

Zoom Image Abstract Introduction The prognosis of congenital anomalies (CAs) can be improved if detected and treated accurately. Given the complexity of some anomalies, it is almost always necessary to approach them with an interdisciplinary team. Our objective was to contact patients with congenital urological anomalies (CUAs) and follow them up during their first years of life and evaluate their clinical status, as well as their social and health care limitations. Method Based on the Bogota Congenital Malformations Surveillance Program (BCMSP), we have contacted by phone all the patients with CUAs and evaluated their follow-up. We have included all the registered patients from 2006 until 2015. A standardized questionnaire was applied by a trained staff. The questions assessed on each call included: evaluation of the clinical status of the patient, the clinical treatments and evaluations performed by clinical and surgical subspecialties, health care limitations, and social barriers. The first call was made at the 2nd month, then every 3 months during the 1st year and every 6 months thereafter. Results A total of 277 patients were contacted, 97.3% of whom have an increased risk of mortality or significant disability. The malformation related mortality was of 38.1%. Only 38.7% of the patients were evaluated by a specialist, while 57.4% where still waiting to be seen by a specialist. Ninety eight percent of the limitations related to the health care system were the long waiting lists to be seen by a specialist. Conclusion Many of the pathologies that we have found belong to the group that has a significant reduction in mortality when treated accurately and promptly. However, we have a profound problem in our health care system, in that many of the patients have not been seen by a specialist, which results in a worse prognosis and recovery rate.

Introducción El pronóstico de las anomalías congénitas puede mejorarse si se detectan y tratan adecuadamente. Dada la complejidad de algunas anomalías, casi siempre es necesario abordarlas con un equipo interdisciplinario. Nuestro objetivo fue contactar a los pacientes con anomalías urológicas congénitas (CUA) con posterior seguimiento durante los primeros años de vida, se evaluó su estado clínico así como las limitaciones sociales y de atención médica. Método Basado en el Programa de Vigilancia de Malformaciones congénitas de Bogotá, contactamos por teléfono a todos los pacientes con CUA y evaluamos su seguimiento. Fueron incluidos todos los pacientes desde 2006 hasta 2015. Un cuestionario estandarizado fue aplicado por personal capacitado. Las preguntas evaluadas durante la llamada incluyeron: evaluación del estado clínico, tratamientos clínicos realizados y evaluaciones por subespecialidades clínicas y quirúrgicas, limitaciones de atención médica y barreras sociales. La primera llamada se realizó en el segundo mes y luego cada tres meses durante el primer año y luego cada 6 meses a partir de entonces. Resultados Se contactó a un total de 277 pacientes en los que el 97,3% tenía un riesgo de mortalidad o de discapacidad significativa. La mortalidad relacionada con la malformación fue del 38.1%. Solo el 38,7% de los pacientes fueron evaluados por un especialista, mientras que el 57,4% aún esperaban ser atendidos por un especialista. El noventa y ocho por ciento de las limitaciones relacionadas con el sistema de atención fueron las largas listas de espera para ser visto por un especialista. Conclusión Muchas de las patologías pertenecen al grupo que cuando son tratadas adecuadamente y prontamente tienen una reducción significativa en la mortalidad. Sin embargo, tenemos un problema profundo en nuestro sistema de atención médica donde muchos de los pacientes no han sido atendidos por un especialista, lo que resulta en un peor pronóstico y tasa de recuperación.

La donación de órganos y el veto familiar. Razones bioéticas para un cambio / Organ donation and family refusal. Bioethical reasons for a change

Cases of next-of-kin veto, i.e., a family refusal to allow organs harvest contrary to donor wishes or when the law presumes consent, is a widespread practice that seriously harms thousands of people. This is a practice settled in many countries Family refusal to donate reduces an already shallow donor pool by approximately 43% in the Americas, 25% in Europe (37,3% in United Kingdom) and 54% in Asia. Some countries, such Argentina, France, Colombia and Wales, current reversed its policy on organ donations to a system that prevents next of kin to dishonoring the donor's wishes restricting the confirm donor status only with the National Donor Registry and unless evidence of their objection is produced. In part I we review the latest amended transplant legislation of those countries that are trying to change this scenario. In part II we question the most frequently cited arguments to uphold the next-of-kin veto right and the countries that successfully changed their legislation banning this practice to encourage organ donation. We conclude that it is imperative to change this practice because the harm caused by promoting the family veto is greater and more serious than the potential harm of not allowing it

Los casos de veto familiar a la donación de órganos es una práctica generalizada que perjudica seriamente a miles de personas. Esta es una práctica establecida en muchos países. La negativa de la familia a donar reduce en un 43% las donaciones bajas de los donantes en las Américas, un 25% en Europa (37,3% en el Reino Unido) y un 54% en Asia. Algunos países como Argentina, Francia, Colombia y Gales han intentado revertir su política de donación de órganos de modo de impedir que los parientes revoquen los deseos del donante. En la primera parte, revisamos las más recientes reformas legislativas de aquellos países que están tratando de cambiar este escenario. En la segunda parte cuestionamos los argumentos más citados para defender el derecho de veto de la familia. Concluimos que es imperativo cambiar esta práctica porque el daño causado por el veto familiar es mayor y más grave que el daño potencial de no permitirlo

Agenda Social para mejorar el desempeño de un sistema de salud: caso de estudio / Social agenda to improve performance of health system: case study / Agenda Social para melhorar o desempenho de um sistema de saúde: estudo de caso

RESUMEN Objetivo Empoderamiento por parte de la Asociación Civil "Hijos de Morán" del Sistema de Salud del Municipio Morán del Estado Lara, Venezuela. Métodos Se implementa una metodología de evaluación basada en los preceptos de Lasswell y Torgerson para realizar una Agenda Social y una evaluación técnica del Sistema de Salud. Para la realización de la agenda social, se utilizó la combinación de la "Estructuración de los Problemas Públicos" y el "Marco Lógico"; y para la Evaluación Técnica, se generaron diversos instrumentos cumpliendo con las normas de ingeniería y requerimientos en servicios médicos. Luego, se realizó una aproximación de los costos a cinco años para mejorar las tecnologías médicas. Resultados La Agenda Social fue discutida con los actores del Sistema de Salud incluidos los actores políticos. Las tomas de decisión se dividieron en dos aspectos: la primera referida a los determinantes que influyen en la salud, y los elementos constitutivos del Sistema de Salud. Los costos a cinco años para mejorar las tecnologías médicas es US$ 5 421 818. Discusión Se considera que la metodología implementada es replicable para las diferentes regiones, especialmente donde existe déficit de consenso, que lamentablemente es en la gran mayoría y se hacen recomendaciones de políticas públicas orientadas a mejorar el desempeño institucional del Sistema de Salud.(AU)

ABSTRACT Objective Empowerment on the part of the Civil Association "Hijos de Morán" of the Health System of the Morán Municipality of Lara State, Venezuela. Methods The fundamentals of the Harol Lasswell and Douglas Torgerson methodologies were implemented to create a Social Agenda and conduct a technical assessment of the healthcare system. To develop the Social Agenda, the Logic Framework and the Public Problem Structuration methodologies were implemented. For the technical assessment, multiple instruments were generated, complying with engineering standards and medical service requirements. Finally, a five-year cost approximation was made to improve medical technologies. Results The Social Agenda was discussed with all the health care system stakeholders, including politicians. Decision-making was divided into two aspects: the first referred to the determinants that influence health, and the second to the constituent elements of the health system. The five-year cost necessary for improving medical technologies is USD 5 421 818. Discussion The methodology implemented is considered replicable in different regions, especially in those are where there is a consensus deficit, which unfortunately are the vast majority. Public policy recommendations are made aimed at improving the institutional performance of the health care system.(AU)

RESUMO Objetivo Empoderamento da Associação Civil "Hijos de Morán" do Sistema de Saúde do Município de Morán do Estado de Lara, Venezuela. Métodos Uma metodologia de avaliação baseada nos preceitos de Lasswell e Torgerson é implementada para realizar uma Agenda Social e uma avaliação técnica do Sistema de Saúde. Para a execução da agenda social, foi utilizada a combinação da "Estruturação de Problemas Públicos" e do "Quadro Lógico"; e para a Avaliação Técnica, foram gerados diversos instrumentos atendendo a normas e requisitos de engenharia em serviços médicos. Em seguida, uma aproximação de custo de cinco anos foi realizada para melhorar as tecnologias médicas. Resultados A Agenda Social foi discutida com os atores do Sistema Único de Saúde, incluindo atores políticos. A tomada de decisão foi dividida em dois aspectos: o primeiro referia-se aos determinantes que influenciam a saúde e aos elementos constituintes do Sistema de Saúde. O custo de cinco anos para melhorar as tecnologias médicas é de US $ 5.421.818. Discussão Considera-se que a metodologia implementada é replicável para as diferentes regiões, principalmente onde há falta de consenso, que infelizmente é na grande maioria e são feitas recomendações de políticas públicas voltadas para a melhoria do desempenho institucional do Sistema de Saúde.(AU)