Taxa e custos médicos diretos de cesáreas em beneficiárias da saúde suplementar no estado de São Paulo, Brasil: 2015 a 2021 / Rate and direct medical costs of cesarean sections among supplementary health plan holders living in the state of São Paulo, Brazil: 2015-2021

Resumo O Brasil tem a segunda maior taxa de cesárea do mundo. Há diferença dessas taxas nos setores públicos e privados. Foram utilizados dados de internação de beneficiárias residentes no estado de São Paulo, internadas entre 2015 e 2021, com idades entre 10 e 49 anos, para verificar as taxas e custos das cesáreas no setor privado. Foi realizado estudo parcial de avaliação econômica em saúde na perspectiva da saúde suplementar considerando custos médicos diretos de internação. Foram analisadas 757.307 internações, com gasto total de R$ 7,701 bilhões. As taxas de cesáreas foram de 80% no período. São menores nas gestantes mais novas (69%) e maiores nas mais velhas (86%), e sempre superiores a 67%. Essa população tem taxas 71% maiores do que aquelas do SUS. Há maior proporção de internações com uso de unidade de terapia intensiva nas cesáreas. O custo mediano da cesárea é 15% maior do que o parto normal e são duas vezes maiores nas seguradoras do que nas cooperativas médicas. Há oportunidade de aplicação de políticas públicas de saúde amplamente utilizadas no Sistema Único de Saúde visando a redução das taxas, dos custos diretos da internação e dos planos de saúde.

Abstract Brazil has the second largest cesarean section rate in the world. Differences in rates exist between the public and private health sectors. This study used data on admissions of supplementary health plan holders aged between 10 and 49 years living in the state of São Paulo admitted between 2015 and 2021 to determine cesarean section rates and costs in the private health sector. We conducted a partial economic analysis in health from a supplementary health perspective focusing on the direct medical costs of admissions. A total of 757,307 admissions were analyzed with total costs amounting to R$7.701 billion. The cesarean section rate over the period was 80%. Rates were lowest in young women (69%) and highest in the oldest age group (86%), exceeding 67% across all groups. The rate was 71% higher than in public services. The proportion of admissions with use of the intensive care unit was higher among cesarian deliveries. The median cost of a cesarean was 15% higher than that of a normal delivery and twice as high in insurance companies than healthcare cooperatives. There is an opportunity to apply policies that are widely used in public services to the private sector with the aim of reducing cesarean rates in private services, direct costs of admission, and the cost of supplementary health plans.

Como as professoras em escolas privadas vivenciaram o trabalho durante a pandemia? / How did female teachers in private schools experience their work during the pandemic?

A pandemia de COVID-19 teve consequências graves também para o mundo do trabalho. Exemplo disso, foi a pressão que as professoras de escolas privadas tiveram por rapidamente transporem as atividades de ensino para o modelo remoto. O objetivo desta pesquisa foi analisar como as professoras de escola privada vivenciaram o seu trabalho docente durante a pandemia de COVID-19. Partindo da Psicologia Histórico-Cultural, realizamos 12 entrevistas em profundidade com professoras de escolas privadas da cidade de Natal-RN, sendo esses dados analisados quanto aos seus núcleos de significação. Encontramos cinco núcleos de significação: significações sobre o trabalho de professora; dificuldades do dia a dia de trabalho; consequências da pandemia; agravamentos gerados pela pandemia; e enfrentamentos diante dos desafios. Concluímos que a pandemia operou como um catalizador de problemas que as professoras já enfrentavam, decorrente da exploração do trabalho, machismo e neoliberalismo. Diante desse cenário, consideramos que as formas de enfrentamento e resistência passem por estratégias coletivas e que visem a superação desses processos históricos de precarização do trabalho.

The pandemic COVID-19 had serious consequences for the world of work as well. One example of this was the pressure that private school teachers were under to quickly transition their teaching activities to the remote learning model. The aim of this research was to analyze how private school teachers experienced their teaching work during the pandemic COVID-19. Based on Cultural-Historical Psychology, we carried out 12 in-depth interviews with private school teachers from the city of Natal-RN, and these data were analyzed according to their Nuclei of Meaning. We found five nuclei of meaning: meanings about working as a teacher; difficulties in daily work; consequences of the pandemic; aggravations generated by the pandemic; and confrontations with the challenges. We concluded that the pandemic acted as a catalyst for problems that women teachers were already facing, resulting from labor exploitation, sexism, and neoliberalism. Facing this scenario, we believe that the forms of confrontation and resistance go through collective strategies aimed overcoming these historical processes of precarization of work.

Fatores associados ao estresse ocupacional entre cirurgiões-dentistas do setor privado no primeiro ano da pandemia de COVID-19 / Factors related to occupational stress among private sector dentists in the first year of the COVID-19 pandemic

Resumo O objetivo deste estudo transversal foi analisar os fatores associados ao estresse ocupacional entre cirurgiões-dentistas atuantes no setor privado no primeiro ano da pandemia de COVID-19 no Brasil. Incluiu 384 profissionais do estado do Paraná, cujos dados foram obtidos entre agosto e outubro de 2020 por meio de formulário online. Dois desfechos compuseram proxy de estresse ocupacional: (1) ansiedade e preocupação e (2) preparo e segurança para o trabalho durante a pandemia. As variáveis independentes foram agrupadas segundo modelo teórico explicativo em fatores individuais, organizacionais e extraorganizacionais. As associações foram testadas por regressão logística bi e multivariada. Apesar de preparados e seguros, os profissionais se sentiam ansiosos e preocupados para o atendimento clínico. Mulheres, mais jovens e que não receberam orientações sobre as medidas de segurança apresentaram maiores chances de relatar insegurança e despreparo. Profissionais mais jovens, que não participavam da tomada de decisões e que às vezes dispunham de auxiliar para o trabalho a quatro mãos, tiveram maiores chances de se sentirem ansiosos e preocupados. Além dos fatores individuais, fatores organizacionais do trabalho estão associados ao estresse ocupacional entre cirurgiões-dentistas no primeiro ano da pandemia.

Abstract This cross-sectional study examined factors associated with occupational stress among 384 dentists working in the private sector in the first year of the COVID-19 pandemic in Brazil. Data were collected from August to October 2020 through an online form. Two outcomes - (1) anxiety and worry and (2) preparation and safety for work during the pandemic - constituted a proxy for occupational stress. The independent variables were grouped according to the explanatory theoretical model into individual, organisational and extra-organisational factors. Associations were tested by bivariate and multivariate logistic regression. Although prepared and confident, dentists felt anxious and worried about providing clinical care. Women, younger respondents and those who received no guidance on safety measures were more likely to report insecurity and unpreparedness. Younger professionals, those who did not participate in decision-making and who only sometimes had an assistant for four-hand work, were more likely to feel anxious and worried. In addition to individual factors, work organisation factors were associated with occupational stress among dentists in the first year of the pandemic.

Estratégias de inovação em medicamentos e vacinas no âmbito do Ceis - modelos, mecanismos e expectativas / Innovation strategies in medicines and vaccines within the scope of CEIS - models, mechanisms, and expectations

RESUMO O artigo objetivou apresentar informações relevantes e originais sobre as estratégias de inovação utilizadas por Laboratórios Farmacêuticos Oficiais (LFO) para redução das vulnerabilidades do Sistema Único de Saúde (SUS) e capacitação produtiva e tecnológica do Complexo Econômico-Industrial da Saúde. Como métodos, foram utilizadas a revisão da literatura e a análise de dados primários oriundos de entrevistas realizadas em dois dos maiores LFO do País. Foram identificados e analisados os seus esforços e resultados em Pesquisa e Desenvolvimento (P&D) assim como a incorporação de tecnologias de medicamentos e vacinas, com destaque para as Parcerias para Desenvolvimento Produtivo (PDP). Conclui-se que, apesar de as atividades de P&D ainda precisarem avançar, benefícios foram trazidos pelos acordos de transferência de tecnologia, especialmente pelas PDP. No entanto, a capacidade industrial e tecnológica dos Institutos ainda é limitada e carente de investimentos, dificultando a acumulação e a difusão tecnológica. Dessa forma, melhorias são necessárias para que as estratégias de inovação para o SUS apresentem resultados mais efetivos e possam ser revertidos para o bem-estar da sociedade.

ABSTRACT The article aimed to present relevant and original information about the innovation strategies used by Official Pharmaceutical Laboratories (LFO) to reduce the vulnerabilities of the Brazilian Unified Health System (SUS) and the productive and technological capacity of the Health Economic-Industrial Complex. The methods used included a literature review and the analysis of primary data from interviews conducted in two of the largest LFOs in the country. Their efforts and results in Research and Development (R&D) and incorporation of medicines and vaccine technologies were identified and analyzed, with emphasis on Productive Development Partnerships (PDP). Although R&D activities still need to advance, benefits were brought about by technology transfer agreements, especially by PDPs. However, the industrial and technological capacity of the Institutes is still limited and lacks investments, which hinders technological accumulation and diffusion. Thus, improvements are necessary so that the innovation strategies for the SUS present more effective results and can be reversed to the welfare of society.

How can internal marketing practices help achieve organizational success? / ¿Cómo las prácticas de marketing interno pueden ayudar a lograr el éxito organizacional? / Como as práticas de marketing interno podem ajudar a alcançar o sucesso organizacional?

Abstract Internal marketing is a concept still little recognized and disseminated, with most of the research on this area of marketing focusing on the service sector and well-consolidated and industrialized markets. This article sheds light on the importance of internal marketing practices by identifying their impact on workers' proactive behavior and life satisfaction while observing the effects of affective commitment and job satisfaction. The study collected 428 valid questionnaires from Portuguese workers (218 in the private sector and 210 in the public sector) and applied structural equation modeling to test the hypotheses. The results showed how adopting an internal marketing perspective can contribute to successful organizational and human resource management. It was observed that internal marketing practices lead to affective commitment and job satisfaction in both the private and public sectors, although more pronounced in the private sector. Also, the findings pointed out that the workers' affective commitment leads to adopting proactive behavior and life satisfaction only in the public sector and that job satisfaction leads to proactive behavior and life satisfaction for workers of both the private and public sector. This study contributes to increasing understanding of internal marketing, its applicability, and its importance for workers and organizations. Additionally, comparing the private and public sectors helps understand and show how this practice matches the workers' expectations.

Resumen Este artículo tiene como objetivo arrojar luz sobre la importancia de las prácticas de marketing interno, identificando su impacto en el comportamiento proactivo y en la satisfacción con la vida de los trabajadores, a través de los efectos del compromiso afectivo y la satisfacción laboral. El marketing interno sigue siendo un concepto poco reconocido y difundido. Esta investigación compara estos efectos entre los trabajadores del sector público y privado para reforzar la importancia de dicho concepto. En total, se recogieron 428 cuestionarios válidos de trabajadores portugueses (218 del sector privado y 210 del sector público). Se utilizó el modelo de ecuaciones estructurales para testar las hipótesis de estudio. Esta investigación muestra cómo la adopción de una perspectiva de marketing interno puede contribuir a una gestión organizacional y gestión de personas exitosa. Los resultados mostraron que las prácticas de marketing interno generan compromiso afectivo y satisfacción laboral, tanto en el sector privado como en el público, aunque de forma más acentuada en el sector privado. También se constató que el compromiso afectivo conduce a la adopción de conductas proactivas y a la satisfacción con la vida de los trabajadores del sector público únicamente, y que la satisfacción laboral conduce a la adopción de esta conducta y a la satisfacción con la vida para ambos, sector público y privado. Este trabajo contribuye a una mejor comprensión del concepto de marketing interno y su aplicabilidad e importancia para los trabajadores y las organizaciones. Además, al comparar los sectores público y privado, ayuda a comprender y mostrar cómo esta práctica coincide con las expectativas de los trabajadores de estos dos sectores.

Resumo Este estudo pretende evidenciar a importância das práticas de marketing interno, identificando o seu impacto no comportamento proativo e na satisfação com a vida dos trabalhadores, através dos efeitos do compromisso afetivo e da satisfação no trabalho. O marketing interno continua a ser um conceito com pouco reconhecimento e divulgação, uma vez que a maioria das pesquisas relacionadas com esse campo de marketing é direcionada para o setor de serviços e concentra-se predominantemente em mercados bem estabelecidos e industrializados. Esta pesquisa compara esses efeitos entre trabalhadores do setor privado e público para reforçar a importância deste conceito, sendo que, no total, foram recolhidos 428 questionários válidos junto de trabalhadores portugueses (218 no setor privado e 210 no setor público). O modelo de equações estruturais foi utilizado para testar as hipóteses de investigação. Esta pesquisa mostra como a adoção do marketing interno pode contribuir para o sucesso da gestão organizacional e da gestão de pessoas. Os resultados mostraram que as práticas de marketing interno levam ao comprometimento afetivo e à satisfação no trabalho, tanto no setor privado como no público, embora mais pronunciadas no setor privado. Constatou-se também que o comprometimento afetivo leva à adoção de comportamentos proativos e leva à satisfação com a vida dos trabalhadores, mas apenas do setor público, e que a satisfação no trabalho leva à adoção desse comportamento e à satisfação com a vida para ambos, setor privado e público. Este trabalho contribui para uma melhor compreensão do conceito de marketing interno, da sua aplicabilidade e importância, quer para os trabalhadores, como para as organizações. Além disso, ao comparar os setores privado e público, ajuda a entender e mostrar como essa prática atende às expectativas dos trabalhadores desses dois setores.

Perceptions of Private Practitioners Regarding Revised National Tuberculosis Control Program- A Cross-sectional Study in Sonepat, Haryana

Background: A substantial proportion of tuberculosis patients either take treatment from private care providers or first-time visit private hospitals to diagnose tuberculosis. Hence the role of private providers is too essential to ignore to realize the ambition of tuberculosis elimination in India. Aim and Objectives: To understand the perception of private practitioners of Sonepat district of Haryana state regarding. Setting and Design: A cross-sectional study was done among the private practitioners of the Sonepat district of Haryana Methods and Material: 78 randomly selected practitioners from the list provided by the district health authority were interviewed using a pretested semi-structured questionnaire. The ethics committee of the study institute approved the study. Statistical analysis used: Descriptive analysis in terms of proportion and percentages was conducted. Results: One-third of the study participants were in the age group of 30-40 years. Half of the practitioners were reportedly practicing medicine for less than twenty years. A significant proportion agreed that the government could not single-handedly eliminate tuberculosis without collaborating with private providers. Mostly agreed on the effectiveness of Tuberculosis regimens under the program; however, over-relying on the sputum examination was perceived as a negative component of the program. Conclusions: Private providers understand their pivotal role in tuberculosis-related programs. However, their full participation has not been realized in the program.

ROLE OF MARKETING MIX IN THE EFFICACY OF BANKS AFTER EMERGENCE OF COVID-19: AN EMPIRICAL STUDY OF PUBLIC AND PRIVATE BANKS OPERATING IN UDAIPUR

Purpose – The study aims to identify role of marketing mix with regard to Public and Private sector Banks of Udaipur after the emergence of COVID-19. A total of 200 respondents from the city of Udaipur Design/methodology/approach – provided the primary data. Structured questionnaires were used by the researcher. Initially, 230 participants were polled, but only 200 of them offered insightful responses, and the other 30 were unresponsive, incomplete responses that were removed for research purposes. The Findings – results revealed that there are differences among the respondents on building up of marketing mix in private and public sector banks in Udaipur city. The degree of change can be seen more in Private banks than in Public ones. Research limitations/implications – With a small sample size and a constrained sample area, data from the public and private sector banks were collected; a larger sample size and expanded sample area would have produced more accurate results. Practical implications – The study offers information aboutmarketing mix creation, emergence of COVID-19, its combination and effect on respondents, which on itself is a crucial subject. The write-up is based on the Originality/value – researcher's personal opinion and the findings from the data collection, which was done on a primary basis.

A Study On Workplace Ostracism, Psychological Capital And Work Engagement Among Private Sector Employees In Mumbai

The current study focuses on the relationship between workplace ostracism, psychological capital and work engagement among private sector employees in Mumbai. The data was collected from a total of 180 private sector employees (i.e., 90 males, 90 females). The tools been administered are The Workplace Ostracism Scale by Ferris et al. (2008), Psychological Capital Questionnaire- PsyCap-12 by Luthans et al. (2007), and The Utretch Work Engagement Scale- UWES-9S by Schaufeli et al. (2002). Correlational research design using quantitative approach was used. The findings of the study indicate significant relationships between the variables, with perceived workplace ostracism accounting for a significant variational impact on psychological capital and work engagement.Years of work experience also show to have a significant difference on the perception of workplace ostracism. Surprisingly, no significant gender difference was observed.

The Commodification of Health Services: an Alternative for the Marginalized Population of Mexico City / A mercantilização dos serviços de saúde: uma alternativa para a população marginalizada da Cidade do México

Abstract The Doctor's Office Adjacent to Pharmacies (DAP) model has grown exponentially in Mexico. Its proliferation is due to two factors. The first is the high cost of medical consultations in private hospitals, and the second is that public health services are insufficient. To gauge the importance this model has acquired, it is necessary to analyze the pattern of distribution and operation of this type of doctors' offices and determine whether they are responding to the unmet demand of a population that is socio-territorially marginalized from health infrastructure. A database was created with updated, geo-referenced information on the precise location of DAP throughout Mexico City and its metropolitan area. Information was obtained on the location, condition and type of franchise, and the infrastructure of each establishment. The analysis found that the distribution pattern of DAP satisfies an unmet need in areas with the highest demand for health services. This situation occurs particularly in areas inhabited by the most marginalized population.

Resumo No México, o modelo Consultório Médico Adjacente às Farmácias (DPA) cresceu exponencialmente. Sua proliferação se deve a dois fatores. A primeira é o alto custo das consultas médicas em hospitais privados e a segunda é que os serviços públicos de saúde são insuficientes. Para determinar a importância que este modelo adquiriu, é necessário analisar o padrão de distribuição e funcionamento deste tipo de consultórios e verificar se estão a responder à procura não satisfeita de uma população socioterritorialmente marginalizada da infraestrutura de saúde. Metodologicamente, foi criado um banco de dados com informações atualizadas e georregerenciadas sobre a localização precisa dos DAP em toda a Cidade do México e sua região metropolitana. Foram obtidas informações sobre a localização, condição e tipo de franquia, e a infraestrutura de cada estabelecimento. A análise constatou que o padrão de distribuição de DAP atende a uma necessidade não atendida em áreas com maior demanda por serviços de saúde. Esta situação ocorre particularmente coincide onde se encontra a população mais marginalizada.

The impact of patients with generalized anxiety disorder in the Brazilian Private Healthcare System: a claim database study with expert's perspective / O impacto de pacientes com transtorno de ansiedade generalizada no Sistema Único de Saúde: um estudo de base de sinistros com a perspectiva de especialistas

This study describes the healthcare resource use and costs associated with anxiety assessing claim database outcomes and expert opinion from the perspective of the Brazilian Private Healthcare System. A retrospective analysis of the Orizon database was conducted, containing claims data of anxiety patients reported in Private Healthcare Systems (2015-2017) according to the ICD-10 code (F40 or F41 and their subtypes). Further, a 3-hour online meeting brought together five anxiety and Health Insurance Companies experts to discuss their perspectives. The total cost of the 18,069 patients identified in the database was BRL 490 million: related to medical appointments (2%), exams (16%), emergency room (5%), and others (77%). The mean number of appointments was 5.1 in a 4-year period, performed by 61% of the patients. Approximately 2,595 visits were made to psychiatrists by 923 patients, and 95% underwent at least one examination (100.6 examinations per patient, on average). The identification of anxiety patients and their corresponding burden is challenging to estimate. The higher impact is related to the frequency of healthcare use before the diagnosis than the treatment itself. These outcomes may help plan and implement adequate healthcare programs for patients with anxiety.

Este estudo descreve o uso de recursos de saúde e os custos relacionados à ansiedade associando resultados de uma base de dados administrativa e opinião de especialistas na perspectiva do Sistema Privado de Saúde Brasileiro. Foi realizada uma análise retrospectiva da base de dados da Orizon de pacientes com ansiedade em atendimento hospitalizar ou ambulatorial no Sistema Privado de Saúde (2015 - 2017) com o código CID-10 (F40 ou F41 e os seus subtipos), adicionalmente promovemos uma reunião online de 3 horas com cinco especialistas em ansiedade e em seguros de saúde para discutir as suas perspectivas. O custo total dos 18.069 pacientes identificados no banco de dados foi de R$ 490 milhões, relacionados a consultas médicas (2%), exames (16%), pronto-socorro (5%) e outros (77%). A média de consultas foi de 5,1 em um período de 4 anos, realizadas por 61% dos pacientes. Aproximadamente 2.595 visitas foram feitas a psiquiatras por 923 pacientes, e 95% realizaram pelo menos um exame (média de 100,6 exames por paciente. É desafiador identificar e estimar o impacto da doença no Sistema Privado de Saúde Brasileiro. O impacto maior está relacionado à frequência de uso de serviços de saúde antes do diagnóstico, em comparação com o próprio tratamento. Esses resultados podem ajudar a planejar e implementar programas de saúde adequados para pacientes com ansiedade.

The impact of depression in the Brazilian private healthcare system: patient journey and economic burden study associating claim database and expert's opinion approach / O impacto da depressão no sistema de saúde privado brasileiro: estudo da jornada do paciente e da carga econômica associando banco de dados de sinistros e abordagem de opinião de especialistas

Objective: The study aimed to describe the profile and economic burden of patients with depression from the perspective of the Brazilian Private Healthcare System (PHS). Methods: A two-step methodological quantitative-qualitative research design was performed: retrospective descriptive analysis of the Orizon database of patients with at least one claim of depression (F33, F38, or F39) in PHS (2013-2019) and experienced physicians perspective from an expert meeting. Results: 1,802 patients fulfilling the eligibility criteria counted BRL 74,978 million across the 4-year period. Over this period, nearly 60% of patients had a medical appointment (6.6 appointments per patient, on average), 61% had a psychologist, 9.8% had a psychiatrist appointment, and an average of 115.2 exams and 8.7 emergency visits per patient were performed. According to the experts, the economic impact of depression is more significant when considering the indirect costs related to productivity loss and impairment in occupational and interpersonal functioning. Conclusion: Identifying and diagnosing patients with depression and their real burden is challenging; even with significant costs identified in the claim database analyses in the Brazilian PHS, the real impact must be higher if indirect costs are considered. The depressive disorder should be prioritized in the Brazilian PHS to establish more adequate health policies.

Objetivo: O estudo teve como objetivo descrever o perfil e a carga econômica de pacientes com depressão na perspectiva do Sistema Único de Saúde (SUS). Métodos: Foi realizado um projeto de pesquisa quantitativo-qualitativo metodológico em duas etapas: análise descritiva retrospectiva do banco de dados Orizon de pacientes com pelo menos uma alegação de depressão (F33, F38 ou F39) no PHS (2013- 2019) e perspectiva de médicos experientes de uma reunião de especialistas. Resultados: 1.802 pacientes que preencheram os critérios de elegibilidade totalizaram R$ 74,978 milhões no período de 4 anos. Nesse período, cerca de 60% dos pacientes tiveram consulta médica (6,6 consultas por paciente, em média), 61% tiveram psicólogo, 9,8% consulta com psiquiatra e foram realizados em média 115,2 exames e 8,7 atendimentos de emergência por paciente . Segundo os especialistas, o impacto econômico da depressão é mais significativo quando considerados os custos indiretos relacionados à perda de produtividade e prejuízo no funcionamento ocupacional e interpessoal. Conclusão: Identificar e diagnosticar pacientes com depressão e sua real carga é desafiador; mesmo com custos significativos identificados nas análises da base de sinistros do SUS brasileiro, o impacto real deve ser maior se considerados os custos indiretos. O transtorno depressivo deve ser priorizado na APS brasileira para o estabelecimento de políticas de saúde mais adequadas.

Adaptation of the Psychological Wellbeing Scale in Mexican medical students / Adaptación de la Escala de Bienestar Psicológico en estudiantes Mexicanos de medicina

Abstract Introduction The Ryff Scale of Psychological Well-Being is the most widely used instrument for assessing the eudemonic perspective of well-being. Although it has been adapted for the Spanish population, it has not been modified for health science students in the Mexican population. Objective Adapt and obtain the psychometric properties of this scale for medical students in the Mexican population. Method The study was conducted with 1,974 undergraduate students, 1,551 from the UNAM Medicine Faculty and 423 from the La Salle University Mexican School of Medicine. The analysis was undertaken using the IBM SPSS Statistics 21 and AMOS 21 SPSS programs. Results An instrument with a robust structure derived from the exploratory and confirmatory factor analyses carried out was obtained, with satisfactory explained variance, adequate internal consistency obtained through the Cronbach's alpha coefficient, and appropriate discrimination. Discussion and conclusion Our adaptation is a suitable version for Mexican medical students with four final dimensions; purpose in life, personal rejection and self-acceptance, personal control, and personal growth.

Resumen Introducción La Escala de Bienestar Psicológico de Carol Ryff es la más utilizada para evaluar la perspectiva eudaimónica de bienestar. Si bien se ha adaptado para población española no se ha adaptado para estudiantes de ciencias de la salud de población mexicana. Objetivo Realizar adaptación y obtener propiedades psicométricas de esta escala para estudiantes de medicina de población mexicana. Método El estudio se desarrolló con 1974 estudiantes de pregrado, 1551 de la Facultad de Medicina de la UNAM y 423 de la Escuela Mexicana de Medicina de la Universidad La Salle. El análisis desarrollado se realizó mediante el programa IBM SPSS Statistics 21 y AMOS 21 de SPSS. Resultados Se obtuvo un instrumento con una estructura sólida derivada de los análisis factoriales exploratorios y confirmatorios desarrollados, con una varianza explicada satisfactoria, una consistencia interna obtenida mediante el coeficiente alfa de Cronbach adaptada y una discriminación favorable. Discusión y conclusión El artículo es una adaptación del instrumento adecuada para estudiantes de medicina mexicanos con cuatro dimensiones finales; proyecto de vida, rechazo personal y auto aceptación, control personal y crecimiento personal.

Vulnerability to Mental Health Problems in Indian Population during Lockdown amidst COVID-19 Pandemic: An Alarm not to Snooze

Background: Lockdown measures are being implemented in several parts of the world to control the spread of novel coronavirus. This unprecedented crisis has significantly affected the lives of people in different ways. Aim: To understand the experiences and vulnerability to mental health problems during lockdown among the Indian population during COVID-19 pandemic. Materials and Methods: A cross-sectional study was conducted using an online survey form circulated through various social media platforms from April 12 to May 3, 2020 containing self-reported questionnaires to collect lockdown related experiences and scales to assess anxiety (GAD-7) and depression (PHQ-9). A convenience sampling method was used. Results: 442 valid responses were received from different states of India. Statistical analysis revealed that one-third of the respondents suffered from some form of anxiety and depression during a lockdown. Less than 10% of them had severe levels of symptoms. The majority were males aged 18-45 years and private sector employees. Delivering essential services was involved with significant anxiety and depression. Availability of food and daily essentials was the most common problem. Difficulty in availing medicines and financial crisis were significant predictors of anxiety and depression. Worsening of interpersonal relationships was associated with higher levels of anxiety and depression. Conclusions: The study concluded that experiences during the lockdown and associated psychological outcomes are important factors to consider and appropriate preventive measures to be taken in case of any future lockdowns.

Evolución de la cesárea en Colombia y su asociación con la naturaleza jurídica de la institución donde se atiende el parto / Evolution of cesarean sections in Colombia and its association with the legal standing of the institutions where deliveries take place

RESUMEN Objetivos: Describir la evolución de la frecuencia de la cesárea en Colombia a partir de 1998, tanto global como discriminada según la naturaleza jurídica de las instituciones prestadoras de salud (IPS) donde se atienden los partos, y calcular la magnitud de la asociación entre la naturaleza jurídica de la IPS y la realización de cesáreas entre 2015 y 2017. Materiales y métodos: Estudio de corte transversal que describe la frecuencia de partos por cesárea entre los años 1998 y 2020, y un componente analítico para estimar la asociación entre la naturaleza jurídica y la vía del parto entre los años 2015 y 2017, a partir de las bases de registros de nacimientos del Departamento Administrativo Nacional de Estadística (DANE) de Colombia. Se presentan las proporciones de cesárea por año y el incremento en la proporción de cesárea por tipo de institución; como estimador de esta asociación se utilizó la razón de prevalencia. Resultados: En 1998, la proporción de cesárea fue 25,7 %, incrementó hasta 46,4 % en 2015 y descendió a 44,6 % para 2020. A partir de 1998, la proporción de cesárea en las IPS públicas pasó de 26,2 a 42,9 % para el año 2014 y en las privadas de 45,0 a 57,7 % para el año 2013. La razón de prevalencia de la cesárea de las instituciones privadas con respecto a las públicas fue 1,57 (IC 95 %: 1,56-1,57). Conclusiones: Después de un periodo largo de incremento sostenido, se está presentando una disminución en la proporción de cesáreas en el país; las IPS públicas incrementaron estos procedimientos en mayor proporción durante la mayor parte del tiempo estudiado y en las IPS privadas se realizan con mayor frecuencia a todos los subgrupos de mujeres. Se deberá evaluar en el futuro, mediante metodologías más robustas, si el descenso en la frecuencia de cesárea es una tendencia real o secular.

ABSTRACT Objectives: To describe how the frequency of cesarean section has evolved in Colombia since 1998, both in overall terms as well as discriminated according to the legal standing of the healthcare providers (IPSs) where delivery takes place, and to estimate the size of the association between the legal standing of the institutions and the performance of cesarean sections between 2015 and 2017. Material and methods: A cross-sectional cohort study that describes the frequency of cesarean deliveries between 1998 and 2020, plus an analytical component to estimate the association between the legal nature and the route of delivery between 2015 and 2017, based on the birth records of the Colombian National Statistics Administrative Department (DANE). Proportions of cesarean sections and their increase by institution type are presented. The prevalence ratio was used as an estimator of this association. Results: In 1998, the proportion of cesarean deliveries was 25.7 %; it increased to 46.4 % by 2015 and then dropped to 44.6 % by 2020. After 1998, the proportion of cesarean sections in public hospitals increased from 26.2 % to 42.9 % by 2014, while in private providers it increased from 45.0 % to 57.7 % by 2013. The prevalence ratio of cesarean sections in private versus public institutions was 1.57 (95 % CI: 1.56-1.57). Conclusions: After a long period of sustained growth, there is now a reduction in the proportion of cesarean sections in the country. In public health care institutions, these procedures increased in greater proportion during most of the study period, while in private healthcare providers they are carried out at a higher frequency in all subgroups of women. It will be necessary to evaluate in the future, using more robust methodologies, whether the decrease in the frequency of cesarean section is a real or secular trend.

Oferta de leitos exclusivos para Covid-19 no estado do Espírito Santo / Offer of exclusive beds for COVID-19 in the state of Espírito Santo

RESUMO A pandemia trouxe vários desafios a toda estrutura social, requisitando a organização e desenvolvimento de políticas públicas para conduzir o quadro sanitário. Com relação à saúde, as ações inicialmente envolveram medidas não farmacológicas e preparação do sistema de saúde. No caso do Brasil, em março de 2020 foram deliberadas portarias específicas sobre a oferta de leitos UTI Covid-19. Em abril de 2020, o estado do Espírito Santo iniciou a estruturação dos hospitais referência para Covid-19 habilitando leitos em hospitais públicos de gestão direta e indireta, e em hospitais privados e filantrópicos. Assim sendo, o objetivo deste estudo é analisar a relação de compra e oferta de leitos exclusivos para Covid-19 pela rede SUS no estado do Espírito Santo. Os dados revelam uma rede com diferentes formatos jurídicos, com forte presença de setor filantrópico, seja por Organizações Sociais de Saúde (OSS) ou hospitais. Por fim, o estudo concluiu que a condução da rede hospitalar para leitos UTI Covid-19 ocorreu pela heterogeneidade de formatos jurídicos, com a participação da gestão pública direta substituída por diferentes tipos de gestão, condicionando o estado a reafirmar as contratualizações conforme lógica do mercado.

ABSTRACT The pandemic brought several challenges to the entire social structure, demanding the organization and development of public policies to guide the health situation. With regard to health, actions so far have involved non-pharmacological measures and preparation of the health system. In the case of Brazil, in March 2020, specific ordinances were deliberated on the offer of COVID-19 ICU beds. In April 2020, the state of Espírito Santo began structuring reference hospitals for COVID-19, enabling beds in public hospitals under direct and indirect management, and in private and philanthropic hospitals. Therefore, the objective of this study is to analyze the relationship of purchase and supply of exclusive beds for COVID-19 by the SUS network in the State of Espírito Santo. The data reveal a network with different legal formats, with a strong presence of the philanthropic sector, whether by Social Health Organizations (OSS) or hospitals. Finally, the study concluded that the conduction of the hospital network for COVID-19 ICU beds occurred due to the heterogeneity of legal formats, with the participation of direct public management replaced by different types of management, conditioning the state to reaffirm the contractualizations according to market logic.

Comparative study of length of stay of COVID-19 recovered patients in government and private tertiary care setup

Background: COVID-19 pandemic placed an unprecedented strain on health-care systems. The demand for healthcare in hospitals and intensive care units increased everywhere in the world in the form of beds, staff, equipment, medicines, etc. In this process, length of stay in hospital of COVID-infected patients is a crucial point for hospital authorities to plan to provide effective healthcare to patients arriving at the hospital and also to treat non-COVID patients and other medical emergencies. Aims and Objectives: The aims of this study were to find the difference in length of stay in government and private tertiary care setup, to find the length of stay of COVID recovered patient with and without morbidities. Materials and Methods: After taking due permission from the ethical committee and respective authorities concerned in private and government tertiary care hospitals, case sheets of patient recovered from COVID were taken and analyzed in terms of patients condition while presentation to hospital, SpO2, morbidities, number of days symptoms developed, and length of stay in hospital. Results: In my study, the length of stay of COVID-infected people in private and government setup was almost the same, around 11–12 days. Patients with comorbidities had a higher length of stay in hospital in both private and government setup, but the duration of stay was higher in government setup 14 days in government setup, 11–12 days in private setup. Good SpO2 at time of admission had decreased the length of stay of hospital in both setups. There is no correlation between length of stay in hospital and period of symptoms before admission in both private and government setup. Conclusions: In my study, the length of stay of patient with COVID infection was higher in government setup by 1 day without morbidities and 2–3 days with morbidities.

Notas sobre as atribuições privativas dos(as) assistentes sociais no contexto da pandemia de covid-19 / Notes on the private duties of social workers in the context of the Covid-19 pandemic

Este artigo versa sobre as atribuições privativas dos(as) assistentes sociais no contexto de calamidade pública deflagrada pela pandemia de covid-19, cuja principal característica, no âmbito social e econômico, foi o aprofundamento da desigualdade social. Desse modo, nosso objetivo é trazer para o debate os desafios postos à profissão mediante suas atribuições privativas em um contexto que também demarcou mudanças significativas na atuação devido às novas demandas que exigiram do profissional novas competências, evidenciando a necessidade de uma formação continuada. Do ponto de vista metodológico, nos baseamos em referências bibliográficas e nos principais documentos que fundamentam a profissão

This article deals with the private attributions of social workers in the context of public calamity triggered by the Covid-19 pandemic whose main characteristic, in the social and economic sphere, was the deepening of social inequality. In this way, our objective is to bring to the debate the challenges posed to the profession through its private attributions in a context that also marked significant changes in performance through the new demands that required new skills from the professional, highlighting the need for continued education. From a methodological point of view, we rely on bibliographic references and on the main documents that support the profession

"¿Qué opción les queda a las personas, más que nosotros?": Las funciones de los consultorios adyacentes a farmacias en la pandemia de covid-19 / "What choice do people have other than us?": The role of doctors' offices adjacent to private pharmacies in the Covid-19 pandemic

RESUMEN Con la llegada del coronavirus a México, los consultorios adyacentes a farmacias desempeñaron un rol preponderante en el diagnóstico, atención y prevención del covid-19. De acuerdo a las encuestas nacionales, entre el 11,7% y el 23% de las personas con síntomas de covid-19 se atendieron en uno. Por ello, este artículo busca identificar el papel de los consultorios adyacentes a farmacias (CAF) como sistema de salud privado que atendió a personas con síntomas de covid-19 en la ciudad de Oaxaca y describir y analizar los factores que influyeron en su utilización. Desde una metodología cualitativa, entre septiembre de 2020 y agosto de 2022 se entrevistó a 12 médicos y médicas y se aplicó un cuestionario a 59 personas usuarias de los consultorios adyacentes a farmacias del municipio de Oaxaca de Juárez. Asimismo se hizo una recopilación y análisis de fuentes secundarias. Entre los hallazgos, se describen sus funciones como frente de atención al covid-19 y a otras necesidades de salud que emergieron con la crisis sanitaria y se analizan los factores determinantes en las trayectorias de atención de personas usuarias de estos consultorios, como son el incremento en la percepción del riesgo y la desconfianza hacia los servicios públicos o hacia las estrategias implementadas por el gobierno federal.

ABSTRACT With the arrival of coronavirus in Mexico, doctors' offices adjacent to private pharmacies (DAPPs) played a major role in the diagnosis, care, and prevention of Covid-19, providing treatment for 11.7% to 23% of people with Covid-19 symptoms according to national surveys. Therefore, this article seeks to identify the role of DAPPs as a private health system providing care for patients with Covid-19 symptoms in the city of Oaxaca, and to describe and analyze the factors that influenced their utilization. Using a qualitative methodology, twelve physicians were interviewed and 59 users responded to a questionnaire at doctors' offices adjacent to pharmacies in the municipality of Oaxaca de Juárez between September 2020 and August 2022. Secondary data were also collected. Among the findings, the function of these offices at the front line of care for Covid-19 and other health needs that emerged with the public health crisis is described, and the determining factors in care trajectories of users that sought care there are analyzed, such as the increase in perception of risk and mistrust towards public services or strategies implemented by the federal government..

Impacts of the COVID-19 pandemic on private hospitals in Brazil

ABSTRACT Objective To analyze the operational and/or financial impacts of regulatory measures implemented by the National Agency for Supplementary Health and government health departments in response to the COVID-19 pandemic on a group of 118 private hospitals affiliated with the National Association of Private Hospitals. Methods This study used a quantitative methodological design of descriptive, cross-sectional, and retrospective studies, utilizing secondary data provided by the National Agency for Supplementary Health. Results There was a -20.1% reduction in hospital admissions and hospital occupancy rate and a decrease of -4.4 percentage points in earnings before interest, taxes, depreciation, and amortization margins. Additionally, the average length of hospital stay increased by +0.5, while total expenses for hospital leaves and total net revenue for hospital leaves increased by +39.4% and +23.6%, respectively. Comparing the participation of the different International Classification of Diseases, according to ICD-10 in 2019 and 2020, revealed the following variations in percentage points of hospitalizations. Hospitalizations for infectious diseases (including COVID-19), treatment of neoplasms, and pregnancy increased by +2.1, +2.4, and +1.2, respectively. However, hospitalizations for respiratory diseases decreased by -4.1. Conclusion The most critical period of the pandemic required the redirection of activities to concentrate efforts on caring for COVID-19 cases. This situation highlighted the non-prioritization of primary care, as many problems presented by patients not affected by COVID-19 had to be referred to emergency services when and if appropriate.

Proadi-SUS: analysis of financial resources in the three-year periods 2009-2011, 2012-2014 and 2015-2017 / Proadi-SUS: análise dos recursos financeiros nos triênios 2009-2011, 2012-2014 e 2015-2017

ABSTRACT OBJECTIVE To characterize the tax exemption resources used in the Support Program for Institutional Development of the Unified Health System (Proadi-SUS) in the 3-year periods 2009-2011, 2012-2014, 2015-2017, considering the total volume of resources linked to the debate on tax expenditures on health and the constitution of a "new form of philanthropy" in the sector. METHODS To understand the philanthropic sector, tax expenditures between 2001 and 2017 were analyzed. To evaluate the resources used in the program, the values of projects and areas of activity were examined. RESULTS A real increase in the values of general tax expenses and tax expenses referring to the philanthropic sector was found. There was also a real increase in the program's resources. A total of 407 projects were carried out, amounting to R$ 3.4 billion for the period. An analysis of the average value of the projects shows an increase in values for all hospitals included in the program, with the exception of one of the institutions. In the 2009-2011 and 2012-2014 periods, the area with the highest number of projects and the most resources was "Management techniques and operation in health services". In the 3-year period 2015-2017, however, the sector that received the most investments and the largest number of projects developed was "Human Resources Training". CONCLUSION The program characterizes a different expression of the public-private partnership in the health sector linked to the principles of the new public management. As a development for future investigations, a qualitative characterization of the projects developed and the actions' impact on the public sector demands is necessary.

RESUMO OBJETIVO Caracterizar os recursos de isenção fiscal usufruídos no Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (Proadi-SUS) nos triênios 2009-2011, 2012-2014, 2015-2017, considerando o volume total dos recursos atrelado ao debate dos gastos tributários em saúde e a constituição de uma "nova modalidade de filantropia" no setor. MÉTODOS Para compreender o setor filantrópico, analisaram-se os gastos tributários no período de 2001 e 2017. Para avaliar os recursos utilizados no programa, foram examinados os valores dos projetos e das áreas de atuação. RESULTADOS Foi constatado um crescimento real dos valores dos gastos tributários gerais e dos gastos tributários referentes ao setor filantrópico. Constatou-se, também, um aumento real dos recursos do programa. Foram realizados 407 projetos, totalizando um valor de R$ 3,4 bilhões para o período. Ao se analisar o valor médio dos projetos, explicita-se ampliação dos valores para todos os hospitais inseridos no programa, com exceção de uma das instituições. Nos triênios 2009-2011 e 2012-2014, a área de atuação com maior número de projetos e mais recursos foi a "Área de técnicas e operação de gestão em serviços de saúde". Já no triênio 2015-2017, o setor que contou com mais investimentos e maior número de projetos desenvolvidos foi o de "Capacitação de recursos humanos". CONCLUSÃO O programa caracteriza outro patamar na relação do setor público com o setor privado/empresariado da saúde, atrelado aos princípios da nova gestão pública. Faz-se necessária, como desdobramento para futuras investigações, uma caracterização qualitativa dos projetos desenvolvidos e do impacto das ações diante das demandas do setor público.