BARRIERS TO IMPLEMENTING SOLAR ENERGY SYSTEMS IN BUILDINGS: THE COMPANY PERSPECTIVE WITH REFERENCE IN TIRUNELVELI DISTRICT

Fossil fuels, such as coal and natural gas are typically used to generate electricity. Fossil fuels are non-renewable resources and harmful to the environment as they release greenhouse gases when burned. With the increased demand of cleaner sources for electricity generation, renewable sources need to be adopted. In India, Tirunelveli District, solar energy has been used in numerous industrial buildings as a source of electricity generation since the country benefits from high solar radiation throughout the year. However, solar energy is still not used in residential buildings despite a wide interest from the sector. This paper identified and assessed the barriers to implementing solar energy in residential buildings from the perspective of homeowners in India, Tirunelveli District. Based on a literature search followed by a ranking and factor analysis of data from a questionnaire survey, key barriers were identified. Ninety-one responses from residents in India, Tirunelveli District were obtained. The questionnaire results showed that the main barriers to adopting solar systems are financial limitations followed by limited solar suppliers in the region and lack of awareness of government incentives. The results of this study could be used to help suppliers and industrial stakeholders in understanding the major barriers and the government to put forward policies to promote solar systems for electricity generation in residential buildings.

Exploring key-stakeholder perceptions on non-communicable disease care during the COVID-19 pandemic in Kenya

Introduction: over one third of total Disability-Adjusted-Life-Years lost in Kenya are due to non-communicable diseases (NCD). In response, the Government declared significant commitment towards improving NCD care. The COVID-19 pandemic increased the burden on the already overstretched health systems in Kenya. The aims of this study are to assess whether health care providers perceived NCD care to be optimal during the pandemic and explore how to improve responses to future emergencies. Methods: this cross-sectional online survey included healthcare personnel with non-clinical roles (public health workers and policy-makers) and those delivering health care (doctors and nurses). Respondents were recruited between May and September 2021 by random sampling, completed by snowball sampling. Results: among 236 participants (42% in clinical, 58% in non-clinical roles) there was an overall consensus between respondents on NCD care being disrupted and compromised during the pandemic in Kenya. Detracted supplies, funding, and technical resources affected the continuity of NCDs response, despite government efforts. Respondents agreed that the enhanced personnel capacity and competencies to manage COVID-19 patients were positive, but noted a lack of guidance for redirecting care for chronic diseases, and advocated for digital innovation as a solution. Conclusion: this paper explores the perceptions of key stakeholders involved in the management of NCDs in Kenya to improve planning for future emergency responses. Gaps were identified in health system response and preparedness capacity during the pandemic including the perceived need to strengthen NCD services, with solutions offered to guide resilience efforts to protect the health system from disruption.

Construction of AQHI based on joint effects of multi-pollutants in 5 provinces of China / 环境与职业医学

Background Air pollution is a major public health concern. Air Quality Health Index (AQHI) is a very important air quality risk communication tool. However, AQHI is usually constructed by single-pollutant model, which has obvious disadvantages. Objective To construct an AQHI based on the joint effects of multiple air pollutants (J-AQHI), and to provide a scientific tool for health risk warning and risk communication of air pollution. Methods Data on non-accidental deaths in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces from January 1, 2013 to December 31, 2018 were obtained from the corresponding provincial disease surveillance points systems (DSPS), including date of death, age, gender, and cause of death. Daily meteorological (temperature and relative humidity) and air pollution data (SO2, NO2, CO, PM2.5, PM10, and maximum 8 h O3 concentrations) at the same period were respectively derived from China Meteorological Data Sharing Service System and National Urban Air Quality Real-time Publishing Platform. Lasso regression was first applied to select air pollutants, then a time-stratified case-crossover design was applied. Each case was matched to 3 or 4 control days which were selected on the same days of the week in the same calendar month. Then a distributed lag nonlinear model (DLNM) was used to estimate the exposure-response relationship between selected air pollutants and mortality, which was used to construct the AQHI. Finally, AQHI was classified into four levels according to the air pollutant guidance limit values from World Health Organization Global Air Quality Guidelines (AQG 2021), and the excess risks (ERs) were calculated to compare the AQHI based on single-pollutant model and the J-AQHI based on multi-pollutant model. Results PM2.5, NO2, SO2, and O3 were selected by Lasso regression to establish DLNM model. The ERs for an interquartile range (IQR) increase and 95% confidence intervals (CI) for PM2.5, NO2, SO2 and O3 were 0.71% (0.34%–1.09%), 2.46% (1.78%–3.15%), 1.25% (0.9%–1.6%), and 0.27% (−0.11%–0.65%) respectively. The distribution of J-AQHI was right-skewed, and it was divided into four levels, with ranges of 0-1 for low risk, 2-3 for moderate risk, 4-5 for high health risk, and ≥6 for severe risk, and the corresponding proportions were 11.25%, 64.61%, 19.33%, and 4.81%, respectively. The ER (95%CI) of mortality risk increased by 3.61% (2.93–4.29) for each IQR increase of the multi-pollutant based J-AQHI , while it was 3.39% (2.68–4.11) for the single-pollutant based AQHI . Conclusion The J-AQHI generated by multi-pollutant model demonstrates the actual exposure health risk of air pollution in the population and provides new ideas for further improvement of AQHI calculation methods.

Notificação de incidentes e a segurança do paciente em tempos de pandemia / Notificación de incidentes y la seguridad del paciente en tiempos de pandemia / Incident notification and patient safety in times of a pandemic

Resumo Objetivo Analisar as notificações de incidentes ocorridos durante a pandemia de COVID-19. Métodos Estudo com delineamento transversal de abordagem quantitativa do tipo descritivo exploratório. Foram analisadas 1.466 notificações à gerência de risco de um hospital privado, no período de setembro de 2020 a setembro de 2021. Utilizou-se a análise estatística descritiva, aplicando o teste Qui-quadrado de Pearson ou o teste da Razão de Verossimilhança. A margem de erro utilizada foi de 5%. Resultados Identificou-se como incidentes prevalentes a falha na comunicação (358 - 24,5%), falha no uso de sondas e cateteres (232 - 15,9%) e falha no uso de artigos e equipamentos (132 - 9,1%). A circunstância notificável totalizou (55,9%) dos relatos e destas, (33,4%) eram falha na comunicação. Os eventos adversos foram em número de 416 (28,6%) e a queda esteve relacionada a dano leve (43,9%); Infecção relacionada à assistência à saúde ao dano moderado (31%) e a falha no uso de medicamentos a (50%) como dano grave e óbito. Conclusão Falha na comunicação foi a circunstância de risco mais notificada, seguida de falha no uso de medicamentos como evento adverso com dano grave. A unidade de enfermaria evidenciou a possibilidade de maior número de eventos adversos; enquanto que nas unidades de terapia intensiva o grau de dano dos eventos adversos foi superior.

Resumen Objetivo Analizar las notificaciones de incidentes ocurridos durante la pandemia de COVID-19. Métodos Estudio con diseño transversal de enfoque cuantitativo del tipo descriptivo exploratorio. Se analizaron 1.466 notificaciones de la gestión de riesgo de un hospital privado, en el período de septiembre de 2020 a septiembre de 2021. Se utilizó el análisis estadístico descriptivo, aplicando la prueba χ2 de Pearson o la prueba de razón de verosimilitud. El margen de error utilizado fue del 5 %. Resultados Se identificaron como incidentes prevalentes la falla en la comunicación (358 - 24,5 %), falla en el uso de sondas y de catéteres (232 - 15,9 %) y falla en el uso de artículos y equipos (132 - 9,1 %). Las circunstancias que pueden ser notificadas totalizaron (55,9 %) de los relatos y, entre ellas, (33,4 %) era una falla en la comunicación. Los eventos adversos totalizaron 416 (28,6 %) y la disminución estuvo relacionada con el daño leve (43,9 %); infección relacionada con la atención a la salud al daño moderado (31 %) y a la falla al usar medicamentos (50 %) como daño grave y defunción. Conclusión La falla en la comunicación fue la circunstancia de riesgo más notificada, seguida de falla al usar medicamentos como evento adverso con daño grave. La unidad de enfermería evidenció la posibilidad de un número más elevado de eventos adversos; mientras que en las unidades de terapia intensiva el grado de daño de los eventos adversos fue superior.

Abstract Objective To review notification of incidents that occurred during the COVID-19 pandemic. Methods This is a cross-sectional, exploratory descriptive quantitative study. A total of 1,466 notifications to risk management of a private hospital were analyzed from September 2020 to September 2021. Descriptive statistical analysis was used, applying Pearson's chi-square test or the likelihood ratio test. The margin of error used was 5%. Results Communication failure (358 - 24.5%), probe and catheter use failure (232 - 15.9%) and article and equipment use failure (132 - 9.1%) were identified as prevalent incidents. The notifiable circumstance totaled 55.9% of reports, and, of these, 33.4% were communication failure. Adverse events were 416 (28.6%), and fall was related to mild damage (43.9%), health care-associated infections, to moderate harm (31%), and medication use failure (50%), to severe harm and death. Conclusion Communication failure was the most reported risk circumstance, followed by medication use failure as an adverse event with severe harm. The nursing unit showed the possibility of a greater number of adverse events, while in Intensive Care Units, the degree of harm from adverse events was higher.

Barreras y facilitadores en la atención primaria de salud en personas con discapacidad física / Barriers and facilitators in primary health care for people with physical disabilities

Introducción: La discapacidad se considera un problema de salud a nivel mundial. Las personas con discapacidad física son susceptibles de padecer distintos problemas de salud. A pesar de ser un grupo priorizado, el acceso a los servicios de salud es menor que el de la población en general, debido a barreras de distintos tipos. Objetivo: Describir las barreras y facilitadores de acceso a la atención primaria de salud en personas con discapacidad física. Métodos: Se realizó una revisión bibliográfica cuya metodología estuvo basada en la búsqueda, selección, revisión, interpretación y síntesis de la evidencia científica relacionada con el problema de investigación. Se utilizó como fuente de literatura científica primaria la publicada en las bases de datos Scielo, Redalyc, Latindex y PudMed en los últimos 5 años, con los términos de búsqueda MeSH en idoma español, inglés y portugués. Desarrollo: Se identificó un total de 67 documentos de los cuales se empleó 46 en la investigación realizada. Los restantes 21 manuscritos fueron excluidos por presentar deficiencias metodológicas que limitaban su utilización. Las principales barreras son las condiciones físicas de las unidades de salud; el funcionamiento del Sistema de Salud; el acceso de las personas con discapacidad a la atención primaria de salud; y las características del paciente y su entorno familiar. El principal facilitador es el relacionado con el Sistema de Salud. Conclusiones: El acceso de las personas con discapacidad física a los servicios de salud está condicionado por situaciones que se interpretan como barreras o facilitadores. En este sentido los factores relacionados con el sistema de salud nacional y con las características y el entorno de la persona con discapacidad pueden comportarse como barrera o como facilitador, en dependencia de su expresión(AU)

Introduction: Disability is considered a health problem worldwide. People with physical disabilities are susceptible to different health problems. Despite being a prioritized group, access to health services is lower than that of the general population, conditioned by the presence of different types of barriers. Objective: To describe the barriers and facilitators of access to primary health care in people with physical disabilities. Methods: A bibliographic review was carried out whose methodology was based on the search, selection, review, interpretation and synthesis of the scientific evidence related to the research problem. It was used as a source of primary scientific literature published in the databases Scielo, Redalyc, Latindex and PudMed in the last 5 years, with the MeSH search terms in Spanish, English and Portuguese. Results: A total of 67 documents were identified, of which 46 were used in the research carried out. The remaining 21 manuscripts were excluded due to methodological deficiencies that limited their use. Conclusions: The access of people with physical disabilities to health services is conditioned by situations that are interpreted as barriers or facilitators. In this sense, the factors related to the national health system and the characteristics and environment of the person with a disability can act as a barrier or as a facilitator, depending on their expression(AU)

HIVAIDS services quality in health centers of East Shoa zone, Oromia, Ethiopia

Background: HIV/AIDS is a major public health, social and economic problem in Ethiopia. However, little has been done on assessment of the quality of the services given to patients in this country. Objective: To assess the quality of HIV/AIDS services in health centers of East Shoa Zone, Oromia region, Ethiopia. Method: Cross sectional survey was undertaken in selected health centers of East Shoa Zone between February and May 2017. Data was collected using researcher administered structured questionnaire, logistics indicators assessment tool and observation check list. SPSS for windows version 20 was utilized in the analysis of the collected data. Results: The study facilities were providing various services to HIV/AIDS patients. All (100%) and 6(75%) facilities respectively had shortage of trained human power required to give ART and TB services. Regarding ARV medicines availability, majority of the study facilities, 5 (62.50%) reported that they had the stockout of AZT300/3TC150/NVP200 in six months prior to study while 4 (66.7%) of the facilities had the stockout of NVP 240ml (50mg/5ml) syrup on day of visit. Among anti-TB medicines, E100 was out of stock in three facilities (37.5%) on day of visit and INH100 had been out of stock in 4 (50%) of the facilities in six months prior to the study. From OIs medicines, Cotrimoxazole 960mg tablet stocked out in 4 (66.70%) on day of visit and in 5 (83.30%) health centers in six months prior to the study. Considerable number of study facilities, 4 (66.70%) had the stockout of tramadol 50mg tablet on day of visit and ibuprofen 400mg tablet in six months prior to the study, 5 (71.40%). Conclusion: The studied facilities were challenged by different factors including, scarcity of human power, stockout of various HIV/AIDS related medicines and inability to make patients adhere to the services given by the facilities. The consequences of these factors can be dangerous to the patients as well as to the wider public and hence making available the appropriate human resource and HIV/AIDS related commodities including medicines should be the priority for the health facilities and the region to improve the quality of HIV/AIDS services in the study area

Establishment of air quality health index based on cumulative health risk of air pollution in Tianjin / 环境与职业医学

Background Cumulative risk index (CRI), as a commonly used approach to estimate the joint effects of multiple air pollutants on health, has been used by few studies to construct an air quality health index (AQHI). Objective To construct an AQHI based on the CRI of air pollution in Tianjin and evaluate the validity of the AQHI. Methods Daily data on air pollutants, meteorological factors, and non-accidental deaths during 2015–2019 in Tianjin were collected to create a time-series object. Descriptive statistical analyses were used to describe the characteristics of the data. To determine the best lag day and indicative pollutant, single-pollutant and two-pollutant generalized additive models were fitted to construct the exposure-response relationships between air pollutants and non-accidental deaths. After that we evaluated a CRI of air pollution using multi-pollutant models and constructed an AQHI and its classifications based on the CRI. Finally, we compared the exposure-response associations and coefficients of the AQHI and the conventional air quality index (AQI) with non-accidental deaths, and evaluated the health risk communication validity of the AQHI using generalized cross validation (GCV) values and R2 values. Results We selected lag1 as the best lag day and PM2.5, SO2, NO2 and O3 as the appropriate pollutants according to the unqualified rates of pollutants and significant statistical results. One μg·m−3 increase of PM2.5, SO2, NO2, and O3 was associated with −0.00002, 0.00079, 0.00015, and 0.00042 increase in effect size b of the non-accidental mortality, respectively. Based on these coefficients, we calculated the CRI and AQHI. According to a pre-determined classification scheme of the AQHI, the air quality of 63% study days was low risks and that of 34% study days was median risks. The associations of AQHI and AQI with non-accidental deaths in different populations were evaluated. The results showed that the excess risks of non-accidental deaths in total, female, and male populations for per interquartile range (IQR) increase in AQHI were higher than the corresponding values of AQI. The GCV values of the AQHI model (2.694, 1.819, and 1.938, respectively) were lower than those of the AQI model (2.747, 1.850, and 1.961, respectively), and the R2 values of the AQHI model (0.849, 0.780, and 0.820, respectively) were higher than those of the AQI model (0.846, 0.776, and 0.817, respectively). Conclusion Compared with AQI, the CRI-based AQHI may communicate the air pollution-related health risk to the public more effectively in Tianjin.

Construction of an air quality health index for pediatric respiratory diseases in Shanghai / 环境与职业医学

Background Air quality health index (AQHI) has been widely used to quantify the health effects of multiple pollutants observed in population-based epidemiological studies, and can better reflect the widespread linear non-threshold between air pollution and health effects. Objective To explore an AQHI for pediatric respiratory diseases (AQHIr) in Shanghai and evaluate its feasibility. Methods The daily numbers of hospital outpatient visits for pediatric respiratory diseases from 2015 to 2019 were obtained from five general hospitals in Xuhui, Baoshan, Hongkou, Jinshan, and Chongming Districts of Shanghai. Monitoring data on air pollutants (PM2.5, PM10, SO2, NO2, and O3), air quality index (AQI), and meteorological variables (temperature, relative humidity, air pressure, and wind speed) were collected from five air quality monitoring sites nearest to selected hospitals. Time-series analysis using generalized additive model (GAM) was conducted to estimate the associations between respiratory-related pediatric outpatient visits and the concentrations of air pollutants. The sum of excess risk (ER) of hospital outpatient visits was used to construct AQHIr. To assess the predictive power of AQHIr, the associations of AQHIr and AQI with the number of pediatric respiratory outpatient visits in three hospitals in Xuhui, Hongkou, and Chongming districts were compared. Results Air pollutants had various effects on respiratory diseases outpatient visits. PM2.5, NO2, and O3 had most significant impacts on lag0 day and the associated ERs of hospital outpatient visits for each 10 μg·m−3 increase in pollutant concentration were 1.27% (95%CI: 0.88%-1.66%), 0.75% (95%CI: 0.40%-1.11%), and 0.36% (95%CI: 0.10%-0.62%), respectively. PM10 and SO2 had most significant impacts on lag3 day and the associated ERs of hospital outpatient visits for each 10 μg·m−3 increase in pollutant concentration were 0.81% (95%CI: 0.51%-1.12%) and 5.64% (95%CI: 3.37%-7.96%), respectively. There were significant effects of combinations of two pollutants among PM2.5, PM10, NO2, SO2, and O3 except for PM10+NO2, SO2+PM2.5, and SO2+NO2 (P<0.05). According to the results of single-pollutant and two-pollutant models, PM2.5, NO2, SO2, and O3 were selected to construct AQHIr. The comparison showed that for every interquartile range increase in AQHIr, the ER for pediatric outpatient visits was higher than that for the value corresponding to AQI. Conclusion Air pollutants in Shanghai have an impact on the number of pediatric respiratory outpatient visits. The AQHIr based on and outpatient visits for pediatric respiratory diseases can be a sensitive index to predict the effects of air pollution on children's respiratory health.

Abrindo os armários do acesso e da qualidade: uma revisão integrativa sobre assistência à saúde das populações LGBTT / Opening the closets of access and quality: an integrative review on the health of LGBTT populations

Resumo A pesquisa buscou estudar as situações que condicionam o acesso e a qualidade da assistência à saúde de lésbicas, gays, bissexuais, travestis e transexuais (LGBTT) nos serviços de saúde, a partir de uma revisão integrativa da literatura nacional e internacional, cuja amostra de 41 artigos foi selecionada nas bases PubMed, Lilacs e SciELO, no período entre 2007 e 2018. O acesso e a assistência à saúde das populações LGBTT foram discutidos em três dimensões: relacional, que diz respeito às relações intersubjetivas entre usuários e profissionais; organizacional, que se refere aos modos de organizar os serviços e os processos de trabalho; e contextual, que engloba como situações de vulnerabilidades imbricadas com os determinantes sociais afetam as condições de satisfação das necessidades de saúde. Os dados mostraram que as populações LGBTT são alvo de preconceitos, violências e discriminações, que, somados a diferentes marcadores sociais, engendram um contexto de vulnerabilidades no acesso e na assistência à saúde. É necessário transformar as práticas e as relações sociais que se dão no interior das instituições de saúde, do contrário, corre-se o risco de afastar cada vez mais parte dessas populações dos serviços de saúde.

Abstract The research aimed to study the situations that condition access and quality of health care to lesbians, gays, bisexuals, transvestites and transsexuals (LGBTT) in health services from an integrative review of national and international literature, whose sample of 41 papers was selected in PubMed, Lilacs and SciELO databases from 2007 to 2018. Access and health issues of LGBTT people were discussed in three dimensions: relational, concerning intersubjective relationships among users and professionals; organizational, concerning the organization of services and work processes; and contextual, which covers the effect of vulnerable situations enmeshed with social determinants on the conditions of satisfaction of health needs. The related data showed that LGBTT populations are the target of prejudice, violence, and discrimination, which, added to different social indicators, engender a context of vulnerabilities in access and healthcare. It is necessary to transform health institutions' practices and social relationships. Otherwise, there is a risk of increasingly warding off those populations from health services.

Vivencia de madres gestantes de niños y niñas con malformaciones incompatibles con la vida / Pregnancy experience associated to fetal abnormality incompatible with life / Experiência das mães grávidas de crianças com má formação genéticas incompatíveis com a vida

Resumen: 14. La creciente precocidad diagnóstica fetal permite conocer anticipadamente la condición de salud de un hijo o hija por nacer. Cuando este diagnóstico arroja un resultado de incompatibilidad con la vida, ello presenta una dificultad emocional y dilemas éticos a la gestante y profesionales de salud que la atienden, así como complejidades al sistema de salud para una atención de calidad. Mediante un estudio cualitativo, se entrevistó a siete matronas/es, una psicóloga y tres mujeres que dieron a luz hijos que fallecieron dada su condición, residentes del Valle de Aconcagua (Región de Valparaíso, Chile). Se recogió su experiencia acerca del proceso de embarazo, parto y puerperio, y su percepción de la respuesta del sistema sanitario. El impacto emocional del diagnóstico es elevado y el periodo de gestación, parto y puerperio transcurre con sentimientos de ambivalencia y como un duelo prolongado y de alto costo psicológico para la mujer. El acompañamiento de los profesionales de salud, particularmente la matronería, presenta complejidades, y si bien hay esfuerzos para una mejor atención, se señalan aspectos claves que deben ser reforzados para facilitar el proceso, incluso en un contexto de legalización probable del aborto terapéutico.

Abstract: 18. Increasing precocity of fetal diagnosis allows parents an early knowledge of the health conditions of their unborn child. When a fetal abnormality incompatible with life is diagnosed, the pregnant woman receives an emotional shock and faces ethical dilemmas, and the health care system must deal with complexities in quality service provision. In a qualitative study at the Aconcagua Valley, seven male and female midwives, a psychologist and three women that gave birth to newborns that died due to their condition, were interviewed. The interviews shed light on the women´s processes at their pregnancy, childbirth and postnatal stages, and on their impression of the healthcare system´s response: the diagnosis has a high emotional impact and the pregnancy evolves with an important psychological cost for the pregnant woman, who faces the situation with ambivalent feelings, and as a prolonged period of mourning. For the health professionals, particularly for midwives assisting these cases, the situation is complex, and even though the professionals strive for improved care, the process should be facilitated by developing key aspects tending towards an integral approach to health provision, even in the context of a probable legalized therapeutic abortion.

Resumo: 22. A crescente prematuridade diagnóstica fetal permite saber de antemão o estado de saúde de um filho ou filha que está para nascer. Quando este diagnóstico gera um resultado de incompatibilidade com a vida, este apresenta uma dificuldade emocional e dilemas éticos para a gestante e profissionais de saúde que a acompanham, bem como complexidades para o sistema de saúde para uma assistência de qualidade. Por meio de um estudo qualitativo, foram entrevistadas sete parteiras/os, um psicólogo e três mulheres que deram à luz crianças que foram à óbito dado a suas condições, residentes do Valle de Aconcagua (região de Valparaíso, Chile). Foram coletadas as experiências sobre o processo de gravidez, o parto, o puerpério e sua percepção da resposta do sistema de saúde. O impacto emocional do diagnóstico é elevado e o período de gravidez, parto e puerpério traz sentimentos de ambivalência e como um duelo prolongado e de alto custo psicológico para a mulher. O acompanhamento de profissionais de saúde, particularmente a figura da parteira, apresenta complexidades e enquanto há esforços para uma melhor atenção, são designados os aspectos chaves para facilitar o processo, mesmo em um contexto de legalização de aborto terapêutico.

Aporte del uso de herramientas básicas de Telemedicina en la atención de niños y adolescentes con Artritis idiopática juvenil, en el Hospital de Puerto Montt. Chile / Contribution of the use of basic telemedicine tools to the care of children and adolescents with juvenile idiopathic arthritis at the Puerto Montt Hospital, Chile

Resumen: Niños y adolescentes con enfermedades reumatológicas, requieren atención especializada e integral, sin embargo, reumatólogos e inmunólogos pediátricos se concentran en hospitales con tecnología específica, costosa y moderna. Como algunos pacientes con Artritis idiopática juvenil (AIJ) vive en áreas rurales, lejanas y de accesibilidad limitada, el uso de Telemedicina (TM) puede optimizar el diagnóstico, seguimiento y pronóstico. Objetivo: Mostrar 10 años de experiencia de un modelo de atención mixta: presencial y a distancia, usando TM básica; el impacto institucional, ventajas, des ventajas y aceptación reportados por padres y pacientes. Pacientes y Método: Estudio exploratorio, descriptivo, retrospectivo con componente cualitativo. Previa autorización de comité ético-científico del Servicio de salud del Reloncaví y la aplicación de consentimiento/asentimiento informado, se efectuó revisión de historias clínicas y se aplicó encuesta cualitativa a padres y niños mayores de 14 años con AIJ, atendidos entre 2005-2015 en el policlínico de reumatología infantil Hospital Puerto Montt. Resultados: Participaron 27/35 pacientes con AIJ atendidos por pediatra capacitado, aseso rado a distancia (1.000 km) por inmunólogo. 8/35 pacientes no contestaron por opción o cambio de domicilio. 70 % de padres y pacientes aceptaron el modelo de atención y 4% preferirían atención esporádica solo por especialista para diagnóstico y seguimiento. El número de pacientes trasladados anualmente disminuyó de 10 a 1. Las ventajas del modelo de atención superaron las desventajas per cibidas por padres y pacientes con AIJ. Conclusión: El uso de herramientas de TM en AIJ disminuyó los traslados, mejoró el seguimiento y fue considerado ventajoso por los padres y pacientes.

Abstract: Children and adolescents with rheumatologic diseases require specialized and comprehensive care, but pediatric rheumatologists and immunologists are concentrated in hospitals with specific, high-cost and modern technology. Considering that some patients with juvenile idiopathic arthritis (JIA) live in rural, remote and limited accessibility areas, the use of Telemedicine (TM) can optimize diag nosis, follow-up and prognosis. Objective: Reporting 10 years of experience of a mixed care model: face-to-face and distance, using basic TM; the institutional impact, advantages, disadvantages and acceptance informed by parents and patients. Patients and Method: Exploratory, descriptive, and re trospective study with qualitative component. After the authorization of a scientific-ethics committee of the Reloncaví Health Service and the application of informed consent, a review of medical records was carried out and a qualitative survey was applied to parents and children over 14 years of age with JIA, seen between 2005-2015 in the pediatric ambulatory rheumatology polyclinic of Puerto Montt Hospital. Results: The were 27/35 participating patients with JIA attended by a trained pediatrician and assisted by distance (1,000 km) by an immunologist. The 8/35 patients did not answer by choice or change of address. The 70% of parents and patients accepted the model of care and 4% would pre fer sporadic care only by specialists for diagnosis and follow-up. The number of patients transferred annually decreased from 10 to 1. The advantages of the care model outweighed the disadvantages perceived by parents and JIA patients. Conclusion: The use of TM tools in JIA decreased transfers, improved follow-up and were considered advantageous by patients and their parents.

La superación continua de enfermería y su contribución al desempeño de excelencia / The continuous preparation of the nursing career and its contribution to a performance of excellence

Introducción: la actualización permanente de los profesionales de enfermería es un deber y una necesidad, contribuye al desarrollo de nuevas competencias, a un mejor desempeño y, por tanto, a lograr excelencia en los servicios de salud. Objetivo: identificar la participación de los licenciados en enfermería en la superación postgraduada y su contribución al desempeño de excelencia. Métodos: estudio descriptivo y transversal realizado con 178 licenciados en enfermería (33 % de los 538 que constituyen el universo) que laboraban en cuatro áreas del hospital universitario "Dr. Gustavo Aldereguía Lima". El estudio se realizó en enero y febrero de 2014 y la muestra fue seleccionada por el método estratificado (considerando cada área un estrato) y aleatorio simple para seleccionar los enfermeros. Con el criterio de expertos, a través de una encuesta y con la revisión de documentos, se recogieron las variables del estudio. Los datos fueron procesados con SPSS realizando análisis porcentual y los resultados se muestran en tablas.Resultados: el 79,77 por ciento tenían 6 o más años de graduados, el 74,70 por ciento llevaban ese tiempo en el servicio. El 82,58 por ciento participó en alguna forma de superación; el 52,80 por ciento refirió satisfacción con las ofertas que reciben y el 96,63 por ciento lo considera muy necesario. El 95,50 por ciento asegura que la superación contribuye a la excelencia en los servicios. Conclusiones: la superación postgraduada se ha incrementado de forma progresiva y contribuye al desempeño de excelencia de los profesionales, lo que garantiza una mejor calidad de las intervenciones de enfermería(AU)

Introduction: The constant updating of the nursing professionals is a duty and a need that contributes to the development of the upcoming competence, to a better performance as well as to accomplish the excellence in the health services. Objective: Identifying the participation in the post- graduate preparation in the nursing bachelors and its contribution to a performance of excellence. Methods: A tranversal and descriptive study applied to 178 bachelors that work in 4 areas of the teaching hospital "Dr. Gustavo Aldereguía Lima". The study was made in January and February 2014, and a sample of the 33 percent, of the total group was taken and selected by using the stratum based and simple random study. Using the experts` criteria, a poll applied and the revision of documents it was selected the variables of the study. Data was processed with SPSS and the results were showed by using charts. Results: 79,77 percent of the studied group have 8 or more year of post-graduate professional experience, while the 74,70 percent have been working in the field all that time. 82,58 percent participated in some way of preparation and the 52,80 percent manifested to be satisfied with the offers. For a 96,63 percent of the studied group their preparation is a need. On the other hand, 95,50 percent assures that the preparation contributes to the excellence in the services. Conclusions: The post-graduate preparation has increased progressively and contributes to the performance in the excellence of our professionals and it garanties a top quality in the nursing training(AU)

Leite UAT e cru informal comercializados em Rio Doce ­ MG: qualidade e perfil dos consumidores / Milk UAT and raw traded in Rio Doce - MG: quality and consumer profile

Objetivou-se avaliar a qualidade físico química e microbiológica de cinco amostras de duas marcas de leite Ultra Alta Temperatura (UAT) e de quatro amostras diferentes de leite cru vendido informalmente em Rio Doce - MG. Entrevistas foram realizadas em 74 residências para avaliação dos hábitos de consumo de leite da população. Amostras de leite cru não se adequaram à legislação quanto à estabilidade ao álcool-alizarol, acidez titulável, crioscopia, densidade, teores de proteína, sólidos totais, sólidos desengordurados e contagem de micro- organismos mesófilos aeróbios. Todas as amostras de leite cru informal não atenderam aos parâmetros de coliformes totais. Todas as amostras de leite UAT apresentaram acidez fora do padrão legal e duas amostras apresentaram contagem de mesófilos aeróbios acima do permitido pela legislação. A discordância de amostras de leite cru foi superior à discordância das amostras de leite UAT. O alto consumo de leite cru vendido informalmente coloca em risco a saúde da população de Rio Doce. É necessária maior fiscalização do comércio de leite a fim de desestimular o consumo de leite cru.

Calidad del cuidado de enfermería percibida por pacientes hospitalizados / The Quality of Nursing Care as Perceived by Hospitalized Patients / Qualidade do cuidado de enfermagem percebida por pacientes hospitalizados

Objetivo: determinar la calidad del cuidado de enfermería percibida por pacientes hospitalizados en una clínica privada de Barranquilla, Colombia. Materiales y métodos: estudio descriptivo, transversal, cuantitativo. El tamaño muestral fue de 147 pacientes que tenían orden de egreso. Se utilizó el Cuestionario de Calidad del Cuidado de Enfermería (CUCACE), versión en castellano, previo cumplimiento de criterios de inclusión. Se tuvieron en cuenta aspectos éticos y normativos, guardando el rigor científico y metodológico. Los datos fueron organizados en Excel y procesados en SPSS. Resultados: la satisfacción y las experiencias de los pacientes con el cuidado de enfermería están por encima del 70%, lo que indica resultados altamente positivos según la escala del CUCACE. Los resultados de asociación solo mostraron relación entre dichas variables y el sexo, mas no se encontró asociación significativa con el resto de las variables sociodemográficas. El 58,5% fueron mujeres y el 41,5%, hombres. El 96,6% de los pacientes con que el cuidado de enfermería no requiere mejoría. Discusión y conclusión: los pacientes tienen una percepción positiva sobre el cuidado de enfermería recibido en la institución, con una puntuación de 93,22 para la dimensión de experiencia con el cuidado y de 78,12 en la dimensión de satisfacción, lo cual indica que la calidad del cuidado de enfermería percibida por los pacientes en la institución es buena. Los resultados son coherentes con lo hallado en estudios similares a nivel nacional e internacional.

Objective: This research was intended to determine the quality of nursing care as perceived by patients hospitalized at a private clinic in Barranquilla , Colombia. Materials and Methods: A descriptive, cross-sectional quantitative study was conducted with a sample of 147 patients who had orders to be discharged. The Spanish version of the CUCACE questionnaire was used, subsequent to compliance with the criteria for inclusion. Ethical and regulatory aspects were taken into account, and scientific and methodological rigor was maintained. The data were organized in Excel and processed in SPSS. Results: Patient satisfaction and experiences with nursing care are above 70%. This indicates very positive results according to the CUCACE scale. The results for association only showed a relationship between these variables and gender; no significant association with the other socio-demographic variables was found. Women comprised 58.5% of the sample and men, 41.5%. In all, 96.6% of the patients in the sample felt no improvement in nursing care is required. Discussion and Conclusion: The patients have a positive perception of the nursing care they received at the institution. The score for experience with care was 93.22 and 78.12 for satisfaction, indicating patients perceive the quality of nursing care provided at the institution as being good. The results are consistent with those of similar studies conducted nationwide and internationally.

Objetivo: determinar a qualidade do cuidado de enfermagem percebida por pacientes hospitalizados num hospital particular de Barranquilla (Colômbia). Materiais e métodos: estudo descritivo, transversal e quantitativo. A amostra foi de 147 pacientes que tinham ordem de entrada. Foi utilizado o questionário CUCACE, versão em espanhol, com prévio cumprimento de critérios de inclusão. Foram considerados aspectos éticos e normativos, que guardam o rigor científico e metodológico. Os dados foram organizados em Excel e processados em SPSS. Resultados: a satisfação e as experiências dos pacientes com o cuidado de Enfermagem estão acima de 70%, o que indica resultados altamente positivos segundo a escala do CUCACE. Os resultados de associação somente mostraram relação entre essas variáveis e o sexto, mas não se constatou associação significativa com o restante das variáveis sociodemográficas. 58,5% foram mulheres e 41,5%, homens. 96,6% dos pacientes consideraram que o cuidado de enfermagem não requer melhoras. Discussão e conclusão: os pacientes têm uma percepção positiva sobre o cuidado de enfermagem recebido na instituição, com uma pontuação de 93,22 para a dimensão de experiência com o cuidado e de 78,12 na dimensão de satisfação, o que indica que a qualidade do cuidado de enfermagem percebida pelos pacientes na instituição é boa. Os resultados são coerentes com as constatações em estudos no âmbito nacional e internacional.

Las guías de práctica clínica: una herramienta de participación en la construcción de una política pública / Clinical practice guidelines: a participation tool in the construction of public policy

Las guías en práctica clínica buscan brindar recomendaciones basadas en evidencia para abordar los procesos de atención para así alcanzar los más altos estándares de calidad. Son procesos participativos e interdisciplinarios. El objetivo de este documento es describir los procesos metodológicos que facilitan desarrollar las recomendaciones de las guías y ofrecer un análisis del contexto que puede modificar el proceso en su conjunto, deteniéndose en los tipos de relacionamiento que lo hacen posible. Se presenta un análisis del desarrollo de la estrategia de elaboración de guías en práctica clínica en Colombia como herramienta del subsistema de calidad y se revisan los antecedentes y avances a la fecha. Se discuten los aspectos teóricos y prácticos de los mecanismos de participación y su alcance en la formulación de recomendaciones. Se ilustra a manera de ejemplo el caso de la Guía de atención en enfermedad cerebro vascular. Se dispone de un Manual de Elaboración de Guías y de un Manual de Implementación, así como de un número de productos para patologías específicas y se esperan nuevas guías en el próximo año. Los mecanismos de participación se enmarcan en las dinámicas de empoderamiento de actores dentro del ámbito social. Las guías son herramientas útiles para resolver problemas específicos en la atención de problemas de salud desde una perspectiva amplia de construcción social de políticas públicas en salud que enfrentan retos y dificultades que deben superarse.

Clinical practice guidelines (CPG) seek to provide evidence-based recommendations for clinicians and decision-makers aiming at the highest quality standards of care. CPG are developed by multidisciplinary teams and through social participation. To describe the methodological process and contextual analysis of the development of CPG. To analyze the social participation process in the formulation of health policy. This paper presents an analysis of a new strategy for the development of CPG in Colombia as a tool for the sub-system of quality in health. The starting point and the current advances of the CPG movement in Colombia are described. We discuss the theoretical and practical mechanisms of social participation and their influence in the formulation of CPG recommendations. We report the case-study of the development of Stroke Clinical Practice Guideline for Colombia. We used, as framework, a CPG Development Manual and an Implementation Manual, as well, as several technical reports of specific pathologies. The mechanisms of social participation are based on the dynamics of stakeholders' empowerment into the Colombian social context. Clinical practice guidelines are useful tools for solving specific issues with health care providers. From the point of view of the social construction of health policies, CPG implementation has still several barriers to overcome.

Assistência ao parto sob a ótica das mulheres atendidas em um hospital público / Asistencia al parto desde el punto de vista de las mujeres atendidas en un hospital público / Delivery service under the perspective of women attended in a public hospital

Introdução: nas últimas décadas, notadamente a partir dos anos 1970, com o ressurgimento do movimento feminista, tem lugar as críticas à ideologia da maternidade, tendo como focos a desapropriação do próprio corpo pelas mulheres e o exercício da reprodução como um direito que inclui necessariamente, o acesso a serviços de saúde de qualidade. Objetivos: analisar a assistência ao parto sob a ótica das mulheres atendidas em um hospital público de ensino da cidade do Recife-Pernambuco, Brasil. Caracteriza-se como descritivo, exploratório, com abordagem qualitativa. Métodos: estudo descritivo, exploratório com abordagem qualitativa. Os dados foram coletados por meio de uma entrevista semiestruturada a vinte mulheres em um hospital público da cidade do Recife-Pernambuco, Brasil, no ano de 2011 e posteriormente analisados pela técnica do Discurso do Sujeito Coletivo. Resultados: mostram o desejo dessas mulheres em serem bem atendidas, enfatizaram os cuidados ofertados no parto por enfermeiras que rompem com a fragmentação e medicalização anteriores, favorecendo a compreensão do parto como um evento fisiológico. As mulheres mostraram sua indignação com a imposição de condutas, verticalização de ações, e a falta de respeito à autonomia no processo decisório. Conclusões: no cenário de uma assistência ao parto marcada por diferentes modelos de atenção, coexistem profissionais que prestam o cuidado de forma integral e outros que reafirmam opressão e poder sobre o corpo da mulher, institucionalizado pelo modelo biomédico(AU)

Introducción: en las últimas décadas, notablemente a partir de los años 70, con el resurgimento del movimento feminista han tenido lugar críticas a la ideología de la maternidad, cuyo foco ha sido la desapropriación del derecho de las mujeres en el ejercicio de la reproducción como un derecho que incluye necesariamente el acceso a servicios de salud de calidad. Objetivo: analizar la asistencia al parto desde el punto de vista de mujeres atendidas en un hospital público de enseñanza de la ciudad de Recife-Pernambuco, Brasil. Métodos: estudio descriptivo, exploratorio y con abordaje cualitativo. Datos recolectados mediante entrevista semiestructurada a veinte mujeres de la ciudad de Recife, Pernambuco, Brasil, en el año de 2011, y analizados mediante la técnica del Discurso del Sujeto Colectivo. Resultados: las mujeres del estudio mostraron el deseo de ser bien atendidas, hicieron hincapié en la atención ofrecida por las enfermeras en el parto, que rompe la fragmentación de la misma y medicalización, fomentando la comprensión del parto como un evento fisiológico. Las mujeres mostraron su indignación por la imposición de enfoques, acciones verticales y la falta de respeto a la autonomía en la toma de decisiones. Conclusiones: en una asistencia al parto marcada por diferentes modelos de atención, coexisten profesionales que prestan el cuidado de forma integral y otros que manifiestan opresión y poder sobre la mujer, institucionalizada por el modelo biomédico(AU)

Objective: analyze the delivery care from the perspective of women attended in a public teaching hospital. Method: It is characterized as descriptive, exploratory study with a qualitative approach. Data were collected through a semi-structured interview of twenty women, in Recife, Pernambuco, Brazil, in 2011 and subsequently analyzed using the Collective Subject Discourse. Results: show the desire of these women to be well met, emphasized the care offered by nurses at delivery that breaks the previous fragmentation of these and medicalization, fostering understanding of childbirth as a physiological event. The women showed their outrage at the imposition of approaches, vertical actions, and lack of respect for autonomy in decision making. Conclusions: in scenario of assistance to delivery marked by different care model, professionals who provide care holistically and others reaffirming oppression and power over women's bodies institutionalized by the biomedical model coexist(AU)

Aspectos significativos surgidos de la experiencia de haber sido responsable de un evento adverso en salud / Significant Aspects Arising from the Experience of Having Been Responsible for an Adverse Health Event / Aspectos significativos surgidos da experiência de ter sido responsável por um evento adverso em saúde

Objetivo: conocer los aspectos significativos para las enfermeras sobre su experiencia de haber sido responsables de un evento adverso en salud. Materiales y métodos: estudio cualitativo exploratorio, con el enfoque de la hermenéutica dialéctica. Se utilizó la técnica de análisis de contenido. Muestra constituida por doce enfermeras que tuvieron al menos una experiencia de responsabilidad ante un evento adverso con un paciente, y por cuatro supervisores de enfermería con responsabilidad de supervisión al ocurrir el evento adverso. Resultados: bajo el enfoque de la hermenéutica dialéctica, el análisis de los datos permitió construir las siguientes categorías relacionadas con la organización de salud y los recursos humanos: el contexto organizacional, el desconocimiento del proceso de notificación, la sobrecarga de trabajo, la ausencia de descanso. Conclusiones: reconocer la importancia del contexto organizacional donde se desarrollan los cuidados, el desconocimiento del proceso de notificación como aspecto por mejorar, la sobrecarga de trabajo y la ausencia de descanso del personal. Es necesario profundizar en el tema mediante investigaciones y desarrollo de intervenciones que promuevan la cultura de seguridad en la atención sanitaria, con implicaciones en la práctica y para la formación de las enfermeras.

Objective: Know what nurses regard as the significant aspects of their experience with being responsible for an adverse health event. Materials and methods: This is an exploratory qualitative study based on hermeneutics with a dialectical approach. The content analysis technique was used. The sample consisted of twelve nurses who had at least one experience with being responsible for an adverse event involving a patient, and four nursing supervisors with supervisory responsibility when an adverse event occurred. Results: Using a dialectical approach to hermeneutics, the analysis of the data allowed for construction of the following categories related to the health organization and its human resources: the organizational context, ignorance of the notification process, overwork and lack of rest. Conclusions: The importance of the organizational context in which care is provided must be recognized. Ignorance about the notification process is an aspect that requires improvement, as do situations involving overwork and lack of rest for staff members. This issue needs to be examined in greater depth through research and the development of interventions that promote a culture of safety in health care, with implications for nursing practice and training.

Objetivo: conhecer os aspectos significativos para as enfermeiras sobre sua experiência de ter sido responsáveis por um evento adverso em saúde. Materiais e métodos: estudo qualitativo exploratório, com o enfoque da hermenêutica dialética. Utilizou-se a técnica de análise de conteúdo. Amostra constituída por 12 enfermeiras que tiveram pelo menos uma experiência de responsabilidade ante um evento adverso com um paciente, e por quatro supervisores de enfermagem com responsabilidade de supervisão ao ocorrer o evento adverso. Resultados: sob o enfoque da hermenêutica dialética, a análise dos dados permitiu construir as seguintes categorias relacionadas com a organização de saúde e dos recursos humanos: o contexto organizacional, o desconhecimento do processo de notificação, o excesso de trabalho, a ausência de descanso. Conclusões: reconhecer a importância do contexto organizacional em que se desenvolvem os cuidados, o desconhecimento do processo de notificação como aspecto para melhorar, o excesso de trabalho e a ausência de descanso do pessoal. É necessário aprofundar no tema por meio de pesquisas e desenvolvimento de intervenções que promovam a cultura de segurança no atendimento sanitário, com implicações na prática e para a formação das enfermeiras.

Calidad de vida de la luxación acromioclavicular / Quality of life of patients with acromioclavicular dislocation

Objetivo: Comparar la calidad de vida en pacientes con luxación acromioclavicular tipo III de Tossy tratados mediante técnica RAFI de placa gancho, técnica Weaver Dunn y técnica Bosworth. Material y métodos: Se realizó una encuesta transversal, analítica, de Enero de 2012 a Abril 2013, en pacientes con diagnóstico de luxación acromioclavicular tipo III de Tossy intervenidos con la técnica de RAFI con placa gancho, técnica Weaver y Dunn y técnica de Bosworth. Se incluyeron a los pacientes con edades de entre 18 y 70 años y cirugía realizada dentro de las primeras tres semanas del diagnóstico. El grado de calidad de vida fue evaluado mediante el cuestionario de DASH heteroadministrado, previo consentimiento informado. Resultados: Se operaron 47 pacientes divididos en 3 grupos, técnica RAFI placa gancho 26 pacientes, técnica Weaver y Dunn 11 pacientes y la técnica de Bosworth, 10 pacientes. El sexo y la edad fueron similares en los tres grupos con una p = 0.137 y p = 0.252 respectivamente. El tiempo de evolución de la cirugía fue similar en los tres grupos, con una p = 0.051. La técnica, RAFI placa gancho fue la más empleada con 26 cirugías; 96.4% de pacientes mostró discapacidad leve y síntomas leves con técnica RAFI placa gancho y 100% en la técnica Bosworth y Weaver y Dunn. Conclusiones: La calidad de vida fue similar con las tres técnicas quirúrgicas con una discapacidad y síntomas leves. La técnica RAFI placa gancho fue la más utilizada.

To compare quality of life in patients with Tossy type III acromioclavicular dislocation treated with the hook-plate ORIF technique, the Weaver & Dunn technique and the Bosworth technique. Material and methods: A cross-sectional analytical survey was conducted from January 2012 to April 2013 in patients with a diagnosis of Tossy type III acromioclavicular dislocation treated surgically with the hook-plate ORIF technique, the Weaver & Dunn technique, and the Bosworth technique. We included patients ages 18 to 70 years old, operated within three weeks after the diagnosis. Quality of life was assessed using the hetero-administered DASH questionnaire once the informed consent was obtained. Results: Forty-seven patients were operated on. They were divided into 3 groups: hook-plate ORIF technique, with 26 patients: Weaver & Dunn technique, 11 patients; and Bosworth technique, 10 patients. Sex and age distribution were similar in all 3 groups, with p = 0.137 and p = 0.252, respectively. Time elapsed after surgery was similar in all 3 groups, with p = 0.051. The hook-plate ORIF technique was the most frequently used one, in 26 surgeries. 96.4% of patients had mild disability and symptoms with the hook-plate ORIF technique, and 100% with the Bosworth and Weaver & Dunn techniques. Conclusions: Quality of life was similar with all 3 surgical techniques and involved mild disability and symptoms. The hook-plate ORIF technique was the most frequently used technique.

The implications of professional practice of nurses’ obstetricians graduated from EEAN: the quality of care / As implicações da prática profissional de enfermeiros obstetras egressos da EEAN: a qualidade da assistência / Las consecuencias de la práctica profesional de enfermeros obstetras gradúados de EEAN: la calidad de la atención

Objetivo: Analisar as implicações da prática profissional desses enfermeiros egressos dos CEEO da EEAN/UFRJ para a qualidade da assistência à saúde da mulher. Método: Trata-se de um estudo qualitativo, onde os sujeitos foram vinte (20) enfermeiros obstetras egressos do CEEO/EEAN que atuam no Município do Rio de Janeiro. Resultados: A autonomia e a apropriação da prática dos enfermeiros obstetras são legitimadas e faz valer o direito como enfermeiro obstetra, entretanto, a autonomia da assistência ao parto está limitada por seu desconhecimento sobre o respaldo legal para atuar nesta área do cuidado, por conta do impedimento e preconceito o exercício profissional provenientes de instituições de saúde e da equipe médica por meio de violência verbal e de suas derivações, gerando implicações negativas para a qualidade da atenção e sua prática. Conclusão: Então, o reconhecimento profissional pela aceitação do exercício de enfermagem na sua plenitude deve ser legitimado.

Objective: To analyze the implications of professional practice of these nurses graduated from the CEEO EEAN / UFRJ for quality health care for women. Method: This was a qualitative study, where the subjects were twenty (20) obstetrician nurses graduated at CEEO / EEAN who work in the city of Rio de Janeiro. Results: The autonomy and ownership of the practice of midwives are legitimized and enforces the law as a nurse midwife, however, the autonomy of childbirth care is limited by its lack of knowledge about the legal support to serve in this area of care, due to the impediment professional practice and prejudice from health institutions and medical staff through verbal violence and its derivations, generating negative implications for the quality of care and practice. Conclusion: So, professional recognition by the acceptance of nursing practice in its entirety should be legitimized.

Objetivo: Analizar las implicaciones de esas enfermeras de práctica egresados de la EEAN CEEO / UFRJ para la atención de salud de calidad para las mujeres. Método: Se realizó un estudio cualitativo, donde los sujetos fueron veinte (20) parteras graduados CEEO / EEAN que trabajan en la ciudad de Río de Janeiro. Resultados: La autonomía y la propiedad de la práctica de las parteras son legitimadas y hace cumplir la ley como una partera, sin embargo, la autonomía de la atención del parto se ve limitada por su falta de conocimiento sobre el apoyo legal para servir en esta área de atención, debido al impedimento la práctica profesional y los prejuicios de las instituciones de salud y personal médico a través de la violencia verbal y sus derivaciones, generando consecuencias negativas para la calidad de la atención y la práctica. Conclusión: Por lo tanto, el reconocimiento profesional por la aceptación de la práctica de enfermería en su totalidad debe ser legitimado.

MICROBIOLOGICAL AND PHYSICOCHEMICAL QUALITY OF CURD CHESSE SOLD IN THE STATE OF ALAGOAS (BRAZIL)

The present study aimed to evaluate the microbiological and physicochemical quality of curd cheese commercialized in Alagoas (BRAZIL). Thirty samples were collect during a fi ve months period in six points of sale. It was estimated the number of coagulase-positive Staphylococcus and coliforms, as well as the presence of Salmonella spp. and Listeria monocytogenes. Regarding physicochemical characteristics, pH, fat content and humidity were evaluated. Among the thirty analyzed samples, 20 (66.6%) were in accordance with Brazilian legislation parameters for coliforms, while 10 (33.3%) surpassed those limits. For coagulase-positive Staphylococcus 15 samples (50%) showed values above the allowed by legislation. None of the samples analyzed harbored Salmonella spp. or Listeria monocytogenes. Regarding physicochemical parameters, the average values observed were of 5.89 for pH, 23.6% for fat content and 46.96 g/100 g for humidity. Overall, the results obtained refl ect the poor hygienic conditions observed from manufacture to commercialization, pointing towards a potential health risk for curd cheese consumers. Furthermore is necessary to regulate physicochemical standards for curd cheese fabication.