Modelación de los flujos de pacientes de alto riesgo con COVID-19 en Matanzas con enfoque Lean

Introducción: En el contexto de la pandemia, la gestión eficiente de los flujos de pacientes con enfoque en su trayectoria es crucial. En este sentido, el enfoque Lean permite aumentar el rendimiento del sistema sanitario, al eliminar actividades que no generan valor al paciente. Objetivo: Realizar un análisis integral de los flujos de pacientes de alto riesgo con COVID-19 en Matanzas, utilizando el enfoque Lean. Materiales y métodos: Se implementó una metodología de tipo cuantitativa, estructurada en cuatro etapas, para la gestión integrada de los flujos de pacientes de alto riesgo con COVID-19, mediante el enfoque Lean. Esta metodología integra herramientas para la selección de expertos, representación de procesos, análisis estructural y mapas de flujos de valor. Se aplicó durante del período de mayor incidencia de la pandemia en Matanzas (1 de mayo al 1 de agosto de 2021). Resultados: Se identificaron deficiencias relacionadas con los flujos de pacientes de alto riesgo con COVID-19 en Matanzas. Se realizó un análisis integral de los flujos, con el fin de realizar una propuesta de mejoras con enfoque Lean. La propuesta garantizó una optimización de 1510 minutos por ciclos de atención, con una eficiencia del 85,86 % del tiempo total de cada ciclo (etapa del tratamiento), y del 59,38 % de los tiempos de espera entre ellos. Conclusiones: Las herramientas Lean permiten realizar un análisis integral de los flujos de pacientes, además de mostrar una vía para su gestión, centrada en la trayectoria y no en la ocupación del recurso.

Introduction: In the context of the pandemic, the efficient management of the patients flow with a focus on their trajectory is crucial. In this sense, the Lean approach allows to increase the performance of the health care system, eliminating activities that do not generate value for the patient. Objective: To carry out an integral analysis of the high risk patients flow with COVID-19 in Matanzas, using the Lean approach. Materials and methods: A quantitative methodology, structured in four stages was implemented for the integrated management of the flow of high risk patients with COVID-19, using the Lean approach. This methodology integrates tools for the selection of experts, process representation, structural analysis and value flow maps. It was applied during the period of highest incidence of the pandemic in Matanzas (May 1st to August 1st 2021). Results: Deficiencies related to the flows of high risks patients with COVID-19 in Matanzas were identified. A comprehensive analysis of the flows was carried out in order to make a proposal for improvements with a Lean approach. The proposal guaranteed an optimization of 1 500 minutes per service cycle, with an efficiency of 85.86% of the total time of each cycle (treatment stage), and 59.38% of the waiting times between them. Conclusions: Lean tools allow a comprehensive analysis of the patients' flow, in addition to showing a route for their management, focused on the trajectory and not on the occupation of the resource.

Integrated management during the perinatal period for total anomalous pulmonary venous connection / 中国当代儿科杂志

OBJECTIVES@#To evaluate the clinical effectiveness of integrated management during the perinatal period for fetuses diagnosed with total anomalous pulmonary venous connection (TAPVC) by prenatal echocardiography.@*METHODS@#Clinical data of 64 cases of TAPVC fetuses diagnosed by prenatal echocardiography and managed with integrated perinatal care in Qingdao Women and Children's Hospital from January 2017 to December 2021 were retrospectively analyzed. Integrated perinatal care included multidisciplinary collaboration among obstetrics, fetal medicine, ultrasound, pediatric cardiology, pediatric anesthesia, and neonatology.@*RESULTS@#Among the 64 TAPVC fetuses, there were 29 cases of supracardiac type, 27 cases of intracardiac type, 2 cases of infracardiac type, and 6 cases of mixed type. Chromosomal analysis was performed in 42 cases, and no obvious abnormalities were found. Among the 64 TAPVC fetuses, 37 were induced labor, and 27 were followed up until term birth. Among the 27 TAPVC cases, 2 cases accepted palliative care, 2 cases were referred to another hospital for treatment and lost to follow-up, while the remaining 23 cases underwent primary repair surgery. One case died within 6 months after the operation due to low cardiac output syndrome, while the other 22 cases were followed up for (2.1±0.3) years with good outcomes (2 cases underwent a second surgery within 1 year after the first operation due to anastomotic stenosis or pulmonary vein stenosis).@*CONCLUSIONS@#TAPVC fetuses can achieve good outcomes with integrated management during the perinatal period.

Pharmacopuncture with a low dosage of B complex vitamins in the Da Zhui acupoint (Governing Vessel 14) for controlling gastrointestinal parasitism in periparturient ewes / Farmacopuntura com dose baixa de vitaminas do complexo B no acuponto Da Zhui (Vaso Governador 14) para o controle da parasitose gastrintestinal em ovelhas no periparto

Gastrointestinal parasites are a significant challenge in sheep farming, and periparturient ewes are one of the most susceptible categories in sheep flocks. This study aimed to verify whether the injection of B vitamins at the acupuncture point governing vessel 14 (GV14) can influence the parasitic load or host-parasite interaction in naturally infected ewes during the peripartum period. Four weeks before parturition, 25 ewes were divided into five treatment groups: (1) Dose Control: 0.2 mL of B complex via IM; (2) Drug Control: 2 mL Complex B via IM; (3) Acupoint Control: 0.2 mL of Water at GV14 point; (4) Control; (5) Test group: 0.2 mL of B complex at the GV14 point. Treatments were performed at weeks -3, -1, 2, 4, and 6 about the parturition time. Fecal samples to estimate the parasitic load by fecal egg counts (FEC) and total blood samples for hemogram examination were performed seven days after the treatment, coinciding with weeks -2, 3, 5, and 7 about the parturition time. The number of peripheral eosinophils was higher in group 3 than in group 1 (p <0.05). Although groups 3 and 5 had lower mean values of FEC and higher hematological values at the time of weaning, these differences were not statistically significant (p> 0.05) according to the F test. However, all animals in groups 3 and 5 maintained low parasitism levels until the end of the experiment. Further studies should be performed with larger sample sizes and minor changes to the experimental protocol to elucidate the role of GV14 acupoint stimulation in the host-parasite relationship.(AU)

A parasitose gastrointestinal é o principal desafio sanitário para a criação de ovinos a pasto, e as ovelhas no periparto são uma das categorias mais susceptíveis a esta infeção no rebanho. O objetivo deste trabalho foi verificar se a injeção de vitaminas do complexo B no acuponto Vaso Governador 14 (VG14) poderia influenciar a carga parasitária ou modular a interação hospedeiro-parasito em ovelhas naturalmente infectadas no período de periparto. Quatro semanas antes da data prevista para o parto, 25 ovelhas foram divididas em cinco grupos de tratamento (1) Controle da dose: 0,2 mL de vitaminas do complexo B via IM; (2) Controle do fármaco: 2mL complexo B via IM; (3) Controle do Ponto: 0,2 mL de água destilada no ponto VG14; (4) Controle sem tratamento; (5) Grupo teste: 0,2 mL de complexo B no pontoVG14. Estes tratamentos foram realizados nas semanas -3; -1; 2; 4 e 6 em relação à data do parto. Amostras de fezes para contagem de ovos por grama de fezes (OPG), assim como amostras de sangue para realizar o hemograma, foram obtidas dos animais sete dias após os tratamentos, coincidindo com as semanas -2, 3, 5 e 7 do parto. O número de eosinófilos periféricos foi superior no grupo 3 se comparado ao grupo 1 (p <0,05). Os animais dos grupos 3 e 5 tiveram menores valores de OPG e maior hematócrito, mas estas diferenças não foram consideradas significativas pelo teste F (p> 0,05). No entanto, todas as ovelhas dos grupos 3 e 5 se mantiveram com níveis baixos de parasitismo durante todo o experimento. Sugere-se que novos estudos sejam realizados com algumas modificações deste protocolo a fim de aprofundar o conhecimento do potencial imunomodulador do acuponto VG14.(AU)

Exploration and practice of multi-campus integrated management of hospital human resources in the Second Affiliated Hospital Zhejiang University School of Medicine / 中华医院管理杂志

In the process of multi-campus hospital development, the main challenge of hospital human resource management is to meet the rapidly increasing demand for human resources in new hospital areas, ensure the quality of medical human resources, improve the efficiency of human resource management, and ensure effective balance among the three. Over the years of practice, the Second Affiliated Hospital Zhejiang University School of Medicine had always adhered to " hospital area coordinated management" and " personnel homogeneous management" , coordinated personnel recruitment and introduction, coordinated human resource allocation across multi-campus in the same discipline, unified job management across multi-campus, unified employee qualification, assessment and training system, and established an integrated digital human resource management platform, which ensured the high-quality expansion and reasonable layout of the hospital′s human resources, and ensured the rational layout and orderly development of disciplines.

Research and practice on integrated management of multi-campus in public hospitals / 中华医院管理杂志

The development of multi-campus is an effective way to expand and enlarge high-quality medical resources for public hospitals. In view of the problems in the relationship between power, responsibility and benefit, functional positioning, discipline layout, homogenization of medical quality and service, and management of human and financial resources in multi-campus, the authors introduced the integrated management system built by the Second Affiliated Hospital Zhejiang University School of Medicine in the process of multi-campus construction. The system included a standard-oriented quality system, a demand-oriented service system, a position-oriented personnel system, an efficiency-oriented financial system, a sharing-oriented information system and a mutual integration-oriented culture system, and formed an integrated management mode of " hospital-area synergy, differential positioning, and homogeneous development" , which significantly improved the management efficiency, service capacity and operational efficiency of the hospital, and could provide an effective reference for public hospital managers.

Role Of Individualised Homoeopathic Medicines In Integrated Management Of Post Dengue Fever Weakness

Background:Communicable diseases are major health hazards in developing countries like India. Due to alteration in host, environment or agent factors, there are various manifestations as well as severity were seen in Dengue cases. So, it is imperative to know about management of this communicable disease in brief as well as preventive measures to maintain good health in Community. Integrated approach with alternative medicine opens a new path for management of Communicable diseases in effective way.Material And Methods:At the Manglam Clinic Rajkot, 30 year old patient with Post Dengue Fever weakness was treated with individualized homoeopathy between 30/09/2021 to 03/10/2021. The treatment involved prescription of individually selected homoe opathic single remedy. During Follow up visits, outcome was assessed with Blood Report and general wellbing feeling of patient. Result:over an observation, an increasingly beneficial result from individualized Homoeopathy was noted in post Dengue Fever Weakness as well as on laboratory reports.Conclusion:Homoeopathy is branch of medical science and known for its gentle healing. This gentle art of healing finds a good scope in integrated Management of Post Dengue Fever Weakness

Current status analysis and development strategy of united Organ Procurement Organization / 器官移植

With the reform of organ donation and transplantation in China, the establishment of Organ Procurement Organization (OPO) will become more centralized and enlarged in scale, evolving into the united OPO development stage coordinated by multiple hospitals. How to enhance the operation management and scientific development planning of united OPO has become an urgent and novel issue facing the administrators at all levels. At present, certain constraint factors of united OPO still exist in the integrated management, cost control, service homogenization, cultural integration and discipline layout. To give full play to the large-scale benefits and expand the supply of high-quality organ donation services, the development principle of putting connotation construction first and the appropriate direction of public welfare should be upheld. Leading and driving the development of organ donation services of our province are the responsibility, and discipline construction and talent training serve as the core. The overall development plan should be determined in a scientific pattern and homogeneous management should be implemented according to local conditions, aiming to provide successful experience for establishing a provincial unified OPO.

Practice and thinking of the multi-district hospital management under the new pattern of national regional medical center / 中华医院管理杂志

The authors took the management practice of " one hospital with multiple districts" in Children′s Hospital Affiliated of Zhengzhou University as the research object, analyzed the main problems and challenges faced by the multi-district hospital management under the new pattern of national regional medical center. Through coordinating the hospital′s strategic planning and the development of discipline layout, building an integrated management system, improving the level of homogeneous service and other key countermeasures, the hospital has significantly improved its management efficiency and operation efficiency, and the medical service capacity of each district has developed in a balanced way. It could give full play to the pilot value for the construction of national regional medical center, hoping to provide reference for hospital administrators.

Breastfeeding and diseases prevalent in the first two years of a child's life: a cross-sectional study / Lactancia materna y enfermedades prevalentes en los dos primeros años de vida del niño: un estudio transversal / Amamentação e as doenças prevalentes nos primeiros dois anos de vida da criança: estudo transversal

ABSTRACT Objectives: to assess the association between breastfeeding and diseases prevalent in the first two years of a child's life. Methods: a retrospective cross-sectional study that analyzed electronic medical records of 401 children. Data on birth, growth, breastfeeding and medical care in the first two years of life were collected. In the analysis, Poisson regression with robust variance was used. Results: 27.9% of children were exclusively breastfed until six months, and, at 24 months, 93.3% had already had some prevalent childhood disease. In the crude analysis, 5-minute Apgar association, length, weight at 12 months, exclusive and non-exclusive breastfeeding time had association. In the adjusted analysis, only the variable breastfeeding at six months maintained the association with prevalent childhood diseases. Conclusions: children who were not breastfed, exclusively or not, up to six months of age, had a higher prevalence of diseases compared to breastfed children.

RESUMEN Objetivos: evaluar la asociación entre lactancia materna y enfermedades prevalentes en los dos primeros años de vida del niño. Métodos: estudio transversal retrospectivo que analizó las historias clínicas electrónicas de 401 niños. Se recogieron datos sobre nacimiento, crecimiento, lactancia y atención médica en los dos primeros años de vida. En el análisis se utilizó la regresión de Poisson con varianza robusta. Resultados: el 27,9% de los niños fueron amamantados exclusivamente hasta los seis meses de edad y, a los 24 meses, el 93,3% ya había tenido alguna enfermedad infantil prevalente. En el análisis crudo presentaron asociación de Apgar al minuto 5, longitud, peso a los 12 meses, tiempo de lactancia materna exclusiva y no exclusiva. En el análisis ajustado, sólo la variable lactancia materna a los seis meses mantuvo la asociación con las enfermedades prevalentes de la infancia. Conclusiones: los niños que no fueron amamantados, exclusivamente o no, hasta los seis meses de edad, presentaron mayor prevalencia de enfermedades en comparación con los niños amamantados.

RESUMO Objetivos: avaliar a associação do aleitamento materno e as doenças prevalentes nos primeiros dois anos de vida da criança. Métodos: estudo transversal retrospectivo, que analisou prontuários eletrônicos de 401 crianças. Foram coletados dados sobre nascimento, crescimento, aleitamento materno e atendimentos médicos nos dois primeiros anos de vida. Na análise, utilizou-se Regressão de Poisson com variância robusta. Resultados: receberam aleitamento exclusivo até os seis meses 27,9% das crianças, e, aos 24 meses de vida, 93,3% já haviam tido alguma doença prevalente da infância. Na análise bruta, apresentaram associação Apgar no 5º minuto, comprimento, peso aos 12 meses, tempo de aleitamento exclusivo e não exclusivo. Na análise ajustada, apenas a variável aleitamento materno aos seis meses manteve a associação com as doenças prevalentes da infância. Conclusões: as crianças que não foram amamentadas, exclusivamente ou não, até os seis meses, apresentaram maior prevalência de doenças em relação às amamentadas.

Factores de riesgo de enfermedades prevalentes de la infancia en hogares de atención integral

RESUMEN Introducción: La Organización Mundial de la Salud manifiesta que las enfermedades prevalentes de la infancia en el 2016 causaron una mortalidad de 5 millones en menores de 5 años, a causa de neumonía y enfermedad diarreica aguda. Objetivo: Examinar los factores de riesgo modificables de enfermedades prevalentes de la infancia en los hogares comunitarios tradicionales del bienestar en Cúcuta, Colombia. Métodos: Se realizó un estudio observacional, descriptivo, transversal en el 2018, en 23 hogares del Instituto Colombiano del Bienestar Familiar en Cúcuta; la información se recolectó a partir del instrumento de identificación de factores de riesgo de enfermedades prevalentes de la infancia previo prueba inicial. Resultados: Se atendieron 276 menores, 56,8 % niños. Se identificaron factores de riesgo modificables en los hogares, en 22,0 % de estos, los infantes deben mejorar el lavado de manos; con un porcentaje similar, se demostró que se debe insistir en la limpieza del material didáctico, juguetes, ventiladores y cortinas; en 17,3 % se observaron condiciones regulares en cuanto a la infraestructura; además, 20,0 % de los menores compartían alimentos, se presentó asistencia de infantes con enfermedades en curso y ausencia de protocolos de atención a seguir en tales casos, entre otros. Conclusiones: Los factores de riesgo pueden ser intervenidos a través de la estrategia de atención integrada a las enfermedades prevalentes de la infancia desde sus componentes clínico, comunitario y organización local para su prevención, con el interés y comprensión de la responsabilidad compartida para la atención de esta problemática en salud.

ABSTRACT Introduction: The World Health Organization states that prevalent childhood diseases in 2016 caused a mortality of 5 million in children under 5 years old, due to pneumonia and acute diarrheal disease. Objective: Examine modifiable risk factors for prevalent childhood diseases in traditional community welfare homes in Cucuta, Colombia. Methods: An observational, descriptive, cross-sectional study was conducted in 2018 in 23 households of the Colombian Institute of Family Welfare in Cúcuta; the information was collected from the instrument to identify risk factors for prevalent childhood diseases after initial testing. Results: 276 children were attended, 56.8% of them were boys. Modifiable risk factors were identified in homes; in 22,0% of these, children should improve hand washing; with a similar percentage, it was shown that the cleaning of teaching materials, toys, fans and curtains should be insisted upon; in 17.3% regular infrastructure conditions were observed. In addition, 20,0% of the children shared food, there were children with ongoing diseases and absence of care protocols to follow in such cases, among others. Conclusions: The risk factors can be intervened through the strategy of integrated care for prevalent childhood diseases from its clinical, community and local organization components for its prevention, with the interest and understanding of the shared responsibility for the care of this health problem.

Spectral detection of nematodes in soybean at flowering growth stage using unmanned aerial vehicles / Detecção espectral de nematóides na soja em estádio de florescimento por meio de veículos aéreos não-tripulados

ABSTRACT: Soybean is one of the main crop species grown in the world. However, there is a decline in productivity due to the various types of stress, including the nematodes Heterodera glycines and Pratylenchus brachyurus. The objectives were to determine the best spectral band for detecting H. glycines and P. brachyurus at the beginning of flowering (R1). Soil and root sampling was conducted at nine sampling sites in each of the five nematode-infested regions, totaling 45 sampling points. Flights were made at all regions using Phantom 4 Advanced, Sequoia and 14-band customized Sentera. For H. glycines, the red spectral band best explained the variability on soil and root nematode counts as well as the second stage of juveniles in soil. For P. brachyurus, Sentera RedEdge best explained the variability in root nematode counts and Sequoia NIR best explained soil juveniles. A multiple linear regression model using spectral data for detecting P. brachyurus and H. glycines improved R² compared to simple linear regressions. At flowering growth stage (R1), soybean spectral reflectance was associated with the number of H. glycines and P. brachyurus on soil and roots using low-cost and multispectral sensors.

RESUMO: A soja é uma das principais espécies de planta cultivadas no mundo. Todavia, perdas de produtividade são ocasionadas por vários tipos de estresses, incluindo os nematoides H. glycines e P. brachyurus. Como objetivo, buscou-se determinar a melhor banda espectral para a detecção do H. glycines e P. brachyurus com o uso de modelos de regressões lineares simples e definir um modelo matemático de regressão linear múltiplo para sua detecção, no início do florescimento (R1). Para isto, foram definidos nove pontos de coleta em cinco reboleiras, totalizando 45 pontos. As coletas foram feitas em um padrão específico de distâncias, de forma a ter amostras com tipos variados de populações de nematoides. Foram realizados voos com o Phantom 4 Advanced, Sequoia e Sentera sobre cada uma das reboleiras. O comprimento de onda do vermelho melhor explicou a variabilidade dos dados para H. glycines no solo e na raiz, bem como dos juvenis de segundo estádio no solo. Para P. brachyurus, a RedEdge da Sentera foi a que explicou melhor a variabilidade dos dados para nematoide na raiz e a NIR da Sequoia a que melhor explicou para juvenis no solo. Quando se utilizou um modelo matemático para a detecção do P. brachyurus e H. glycines, percebe-se uma grande melhora no R² e p-valor com relação às regressões lineares simples. No início da floração (R1), a refletância espectral da soja foi associada ao número de H. glycines e P. brachyurus no solo e nas raízes, usando sensores de baixo custo e multiespectrais.

Apoio institucional para agentes comunitários de saúde usando o programa de Atenção Integrada às Doenças Prevalentes na Infância em Ruanda / Institutional support to community health workers using integrated management of childhood illness program in Rwanda

O objetivo foi explorar o apoio e descrever a supervisão de agentes comunitários de saúde que implementam o programa de atenção integrada às doenças prevalentes na infância (AIDPI). Um desenho não experimental, exploratório, descritivo e quantitativo foi adotado neste estudo. Os dados foram coletados entre 305 participantes (30% da população) por meio de um questionário estruturado. Dupla digitação foi utilizada e os dados foram limpos e analisados usando o Statistics Package of Social Sciences (SPSS) 19. Em Ruanda, o apoio e supervisão são fornecidos pela instituição base e supervisores. Os agentes comunitários de saúde (ACS) frequentemente enfrentam escassez de medicamentos e equipamentos (63,3%) e 87,5% ficaram sem equipamentos, medicamentos e consumíveis, o que criou barreiras para a assistência das crianças doentes. Para melhorar o apoio institucional dado aos agentes comunitários de saúde, supervisão de apoio contínua e regular, além do fornecimento de suprimentos, é essencial.

The objective was to explore the support given to community health workers who use the integrated management of childhood illness (IMCI) approach and describe the supervision given to them. A non-experimental, exploratory, descriptive, quantitative design was used for this study. Data were collected using a structured questionnaire; 305 were interviewed (30% sample). The data were double entered, cleaned, and analyzed using Statistics Package of Social Sciences (SPSS) 19. Support and supervision in Rwanda are provided by the base institution and by supervisors. CHWs often had a shortage of drugs and equipment (63.3%) and 87.5% have experienced run out of equipment, medicines, and consumables. This created barriers to caring for sick children. To improve institutional support for community health workers, regular and continuous supportive supervision and supplies are essential.

La práctica pedagógica en la atención integrada de las enfermedades prevalentes de la infancia desde la perspectiva de Basil Bernstein / Pedagogical practice in the integrated management of prevalent childhood illness from the perspective of Basil Bernstein / A prática pedagógica na atenção integrada das doenças prevalentes da infância da perspectiva de Basil Bernstein

Resumen La estrategia "Atención integrada de las enfermedades prevalentes de la infancia" (aiepi) es reconocida por las entidades de salud internacionales y nacionales como una estrategia que impacta la salud de la población infantil y que sus componentes clínico y comunitario desarrollan la educación para la salud. Objetivo: Comprender cómo se desarrolla la práctica pedagógica en la consulta médica atendida bajo la estrategia aiepi, en una institución de primer nivel de atención durante el año 2015. Metodología: Investigación cualitativa, con una perspectiva hermenéutica. Para la comprensión de la construcción social de la práctica pedagógica se tuvo una orientación etnográfica y el sistema de reglas (jerarquía, secuencia y criterio) propuesto por Bernstein. Las técnicas etnográficas utilizadas fueron entrevista cualitativa, observación participante y entrevista grupal. Se entrevistó a once cuidadores y tres médicas. Resultados: Para las médicas, muchas de las enfermedades son "autolimitadas", se resuelven solas. El propósito de la educación es convencer a los cuidadores de que la información suministrada por las médicas es verdadera. Los temas en educación son determinados por las médicas y centrados en la enfermedad. Para los cuidadores, la médica es referente de conocimiento. Las médicas reconocen que hay saber popular que se estudia y se acepta por el conocimiento científico; sin embargo, solo el conocimiento científico es válido. Conclusión: En la atención de aiepi, la práctica pedagógica es visible, porque se centra en el desempeño del cuidador y en la cantidad de texto que él aprende mediante la repetición, y las médicas ejercen poder sobre los cuidadores, al poseer el conocimiento hegemónico (válido y verdadero) que refuerza el modelo biomédico en la práctica pedagógica.

Abstract The strategy "Integrated Management of Childhood Illness"(IMCI) is recognized by international and national health bodies as a strategy that affects the health of the child population and whose clinical and community components develop health education. Objective: To understand how pedagogical practice develops in medical consultation attended under the IMCI strategy, in a first level care institution in 2015. Methodology: Qualitative research, with a hermeneutic perspective. To understand the social construction of pedagogic practice an ethnographic stance and the system of rules (hierarchy, sequence and criterion) proposed by Bernstein were adopted. The ethnographic techniques used were qualitative interview, participant observation and group interview. Eleven caregivers and three doctors were interviewed. Results: For the doctors, many of the diseases are "self-limiting", i.e. they resolve on their own. The purpose of education is to convince the caregivers that the information provided by the doctors is true. The education topics are determined by the doctors and focused on the disease. For the caregivers, the doctor is a reference of knowledge. The doctors recognize that there is popular knowledge that is studied and accepted by scientific knowledge; however, only scientific knowledge is valid. Conclusion: Pedagogical practice is visible in IMCI care because it focuses on the performance of the caregiver and the amount of text that he learns through repetition, and the doctors exert power over caregivers, as they possess hegemonic (valid and true) knowledge that reinforces the biomedical model in pedagogical practice..

Resumo A estratégia "Atenção integrada das doenças prevalecentes da infância" (AIEPI), é reconhecida pelas entidades de saúde nacionais e internacionais como uma estratégia que impacta a saúde da população infantil e que seus componentes clínicos e comunitários desenvolvem a educação para a saúde. Objetivo: Compreender como se desenvolve a prática pedagógica na consulta médica atendida sob a estratégia AIEPI, numa instituição de primeira linha de atenção durante o ano de 2015. Metodologia: Pesquisa qualitativa com uma perspectiva hermenêutica. Para a compreensão da construção social da prática pedagógica se teve uma orientação etnográfica e o sistema de regras (hierarquia, sequência e critério) proposto por Bernstein. As técnicas etnográficas usadas foram: entrevista qualitativa, observação participante e entrevista grupal. Foram entrevistados 11 cuidadores e 3 médicas. Resultados: De acordo com as médicas, muitas das doenças são "autolimitadas", se curam sozinhas. O objetivo da educação é convencer os cuidadores de que a informação fornecida pelas médicas é verídica. Os temas relacionados à educação são determinados pelas médicas e focados nas doenças. Para os cuidadores, a médica é um referencial de conhecimento. As médicas reconhecem que existe um conhecimento popular que é estudado e aceito pelo conhecimento científico; porém, só o conhecimento científico é válido. Conclusão: No que se refere à atenção de AIEPI, a prática pedagógica é visível, porque está centralizada no desempenho do cuidador e na quantidade de informação escrita que ele aprende através da repetição e as médicas influenciam os cuidadores já que possuem o conhecimento hegemônico (válido e verídico) que reforça o modelo biomédico na prática pedagógica.

Discussion on Strengthening Medical Supplies Management on Open Platform / 中国医疗器械杂志

We introduce the background of Shanghai medical purchasing service and supervision platform (later we call it "open platform") and the effect of its implementation. We also analyze the problems occurred by medical institutions in the management of supplies, explore how to use open platform to strengthen the management of medical supplies, further optimize the structure of supplies, standardize the clinical reasonable use and charges, and ensure the quality, safety and traceability of supplies.

Trend of preventable deaths up to the 6th day of life in the state of São Paulo - 2008 to 2017 / Tendência das mortes evitáveis até o 6º dia de vida no estado de São Paulo - 2008 a 2017

ABSTRACT OBJECTIVE: To analyze the trend of early neonatal infant mortality in the state of São Paulo according to preventability and region of residence. METHODS: Ecological study with secondary data from 2008 to 2017, obtained from the Sistema de Informação sobre Nascidos Vivos (Sinasc - Live Birth Information System) and the Sistema de Informação sobre Mortalidade (SIM - Mortality Information System). The causes of death were classified according to preventability groups, and the annual percentage changes in the death rates of each preventability group were estimated using the Joinpoint software. RESULTS: The early neonatal component showed a reduction trend with an annual percentage change of −1.18 (95%CI −1.63 to −0.72), less pronounced than the other age components of infant mortality. In the analysis according to preventability, the causes reducible by attention to the woman during pregnancy and those reducible by attention to the fetus and the newborn presented annual percentage change of −1.03 (95%CI: −1.92 to −0.13) and −2.6 (95%CI: −4.07 to −1.11), respectively. In the causes reducible by attention to women during delivery, no reduction trend was observed. Regional discrepancies occurred in the variation of early neonatal infant mortality rates according to type of preventability. CONCLUSIONS: Mortality up to the 6th day of life presented greater difficulty of reduction when compared with the other age components. The absence of a reduction trend in preventable deaths due to the attention to women during delivery points to possible fragility in the attention to delivery.

RESUMO OBJETIVO: Analisar a tendência da mortalidade infantil neonatal precoce no estado de São Paulo segundo evitabilidade e região de residência. MÉTODO: Estudo ecológico com dados secundários de 2008 a 2017, obtidos a partir do Sistema de Informação sobre Nascidos Vivos e do Sistema de Informação sobre Mortalidade. As causas de óbito foram classificadas segundo grupos de evitabilidade, sendo estimadas as variações percentuais anuais das taxas de óbito de cada grupo de evitabilidade, por meio do software Joinpoint . RESULTADOS: O componente neonatal precoce apresentou tendência de redução com variação percentual anual de −1,18 (IC95% −1,63 - −0,72), menos acentuado que os demais componentes etários da mortalidade infantil. Na análise segundo evitabilidade, as causas reduzíveis por atenção à mulher na gestação e as reduzíveis por cuidado ao feto e ao recém-nascido apresentaram variação percentual anual, respectivamente de −1,03 (IC95%: −1,92 - −0,13) e −2,6 (IC95%: −4,07 - −1,11). Nas causas reduzíveis por atenção à mulher no parto, não se observou tendência de redução. Ocorreram discrepâncias regionais na variação das taxas de mortalidade infantil neonatal precoce segundo evitabilidade. CONCLUSÕES: A mortalidade até o 6º dia de vida apresentou maior dificuldade de redução na comparação com os outros componentes etários. A ausência de tendência de redução nos óbitos evitáveis pelo cuidado à mulher no parto aponta para possível fragilidade na atenção ao parto.

Effect of chemical and biological seed treatments on common bean seeds inoculated with Fusarium oxysporum f. sp. phaseoli / Efeito de tratamentos químicos e biológicos de sementes em sementes de feijoeiro inoculadas com Fusarium oxysporum f. sp. phaseoli

Currently, the common bean (Phaseolus vulgaris L.) productivity has been reduced by the fungus Fusarium oxysporum f. sp. phaseoli (Fop), the causative agent of Fusarium wilt. Considering the integrated management of diseases, the objectives of the present work were to verify the compatibility between chemical and biological fungicides for Fusarium oxysporum Schlecht. f. sp. phaseoli Kendrick & Snyder (Fop) control in common bean seeds. In laboratory, the effects of the treatments were evaluated by sanity, germination, seedling total length and seedling dry matter tests. In greenhouse conditions, the emergence speed rate, the percentage of emergence and the rate of pathogen transmission through the pathogen infestation in a substrate to plants were evaluated. Common bean seeds BRS Estilo were artificially inoculated with Fop isolate (IAC 11.299-1). In the seeds' treatment, the chemical fungicides fludyoxonyl, flutriafol, methyl tiofanate, and biological products of Trichoderma sp. (isolates SF04, GF 422 and strain 1306), separately and mixed, were used. Treatments that promoted the best pathogen control in seeds were the combination of methyl tiophanate with biological products. Both flutriafol and GF 422 isolated and in mixed treatments affected the seeds' physiological quality. The protective effect of the products was noted in the transmission test, whose Fop incidence was from 5 to 40% in the hypocotyl and from 5 to 30% in common bean roots.(AU)

Atualmente, a produtividade do feijão comum (Phaseolus vulgaris L.) foi reduzida pelo fungo Fusarium oxysporum f. sp. ­phaseoli (Fop), o agente causador da murcha de Fusarium. Considerando o manejo integrado de doenças, os objetivos do presente trabalho foram verificar a compatibilidade entre fungicidas químicos e biológicos para Fusarium oxysporum Schlecht. f. sp. phaseoli Kendrick & Snyder (Fop) em sementes de feijão. Em laboratório, foram avaliados os efeitos dos tratamentos pelos testes de sanidade, germinação, comprimento total de plântulas e matéria seca de plântulas. Em uma estufa, foram avaliadas a velocidade de emergência, a porcentagem de emergência e a taxa de transmissão de patógenos através da infestação de patógenos no substrato às plantas. As sementes de feijão comum BRS Estilo foram inoculadas artificialmente com isolado Fop (IAC 11.299-1). No tratamento das sementes, foram utilizados os fungicidas químicos fludioxoxil, flutriafol, tiofanato metílico e produtos biológicos de Trichoderma sp. (isolados SF04, GF 422 e cepa 1306), separadamente e misturados. Os tratamentos que promoveram o melhor controle de patógenos nas sementes foram a combinação de tiofanato de metila com produtos biológicos. Tanto o flutriafol quanto o GF 422 isolados e em tratamentos com misturas afetaram a qualidade fisiológica das sementes. O efeito protetor dos produtos foi observado no teste de transmissão, cuja incidência de Fop foi de 5 a 40% no hipocótilo e de 5 a 30% nas raízes do feijão comum.(AU)

Case-based learning in integrated management of neonatal and childhood illness

Background: This complete-enumeration, before-and-after type of study (without controls) was conducted on 61 third-year medical students at Rajiv Gandhi Medical College, Thane, Maharashtra state to study the difference in cognitive domain scores after attending lecture-based learning (by a pre-test) and after attending case-based learning (by a post-test).Methods: After approval from the institutional ethics committee, the purpose of the study was explained to third-year medical students and written informed consent was obtained. After curriculum-based lectures on integrated management of neonatal and childhood Illness, a pre-test was administered wherein each student was asked to fill up case sheets for five case scenarios. The maximum marks obtainable were 10 marks per case (total 50 marks).' Case-based learning was conducted in two sub-groups comprising 31 and 30 randomly assigned students by the same faculty and students in each sub-group were exposed to identical case scenarios. The post-test was conducted using case scenarios and case sheets that were identical to that of the pre-test.Results: The overall mean score increased and the difference between the case-wise pre-test and post-test scores of both female (n=35) and male (n=26) students was highly significant (p <0.00001). However, the gender differences in pre-test score (Z=1.038; p=0.299) and post-test score were not significant (Z=0.114; p=0.909).Conclusions: Using case scenarios augmented the cognitive domain scores of participating students and the gender differences in scores were not statistically significant. The post-test scores showed higher variability. Remedial educational interventions would be required for students who obtained low scores in the post-test.

Prácticas pa ra la prevención de accidentes en el hogar en cuidadores de niños de 1 a 5 años en un barrio de Cartagena (Colombia) / Practices for the prevention of accidents in the home in caregivers of children from 1 to 5 years in a district of Cartagena (Colombia)

Introducción: los accidentes en la población infantil constituyen una importante causa de morbilidad y mortalidad convirtiéndose hoy día en un problema de salud pública mundial, principalmente la población más afectada son los niños en etapa preescolar, por la vulnerabilidad y dependencia del cuidador. Objetivos: describir las prácticas para la prevención de accidentes en el hogar en cuidadores de niños de 1 a 5 años en un barrio de Cartagena (Colombia). Materiales y métodos: estudio cuantitativo descriptivo transversal. Constituido por 354 cuidadores de niños menores de 5 años, se utilizó la técnica de observación y la aplicación del instrumento con base a la práctica N° 15 de AIEPI (Atención Integrada a las Enfermedades Prevalentes de la Infancia). Resultados: socio demográficamente los cuidadores fueron principalmente de género femenino (87%), con 20 ­ 29 años de edad (44,9%), madres de los niños (61,3%), conviven en unión libre (54,2%), son bachilleres (50,3%), de estrato uno (91,8%), amas de casa (62,7%), con hijos (93,8%), residen en casas (54,5%). Los niños de 1 a 5 años fueron mayoritariamente de género masculino (51,7%), y han presentado accidentes (75,1%), sobre todo, caídas (61,9%). El nivel de riesgo de accidentes en el hogar fue bajo (85%), y las prácticas de prevención suelen ser regulares (55,1%). Conclusión: los niños enfrentan relativamente bajo riesgo de accidente en el hogar, sin embargo, las prácticas para prevenirlos resultan ser regulares..(AU)

Introduction: accidents in children are an important cause of morbidity and mortality,becoming today a global public health problem, mainly the most affected population are children in preschool, for the vulnerability and dependence of the caregiver. Objectives:to describe the practices for the prevention of accidents at home in caregivers of children from 1 to 5 years of age, in a neighborhood of Cartagena (Colombia). Materials and methods: quantitative, descriptive and cross-sectional study. Consisting of 354 caregivers of children under 5 years of age, the technique of observation and the application of the instrument was used based on practice No. 15 of IMCI (Integrated Management of Childhood Illness). Results: demographic partner caregivers were mainly female (87%), with 20 - 29 years of age (44.9%), mothers of children (61.3%), live together in a free union (54.2%), are high school graduates (50.3%), of stratum one (91.8%), housewives (62.7%), with children (93.8%), reside in houses (54.5%). Children from 1 to 5 years old were male (51.7%), and had accidents (75.1%), especially falls (61.9%). The level of accident risk in the home was low (85%), and prevention practices are usually regular (55.1%). Conclusion: children face relatively low risk of accident in the home, however, practices to prevent them turn out to be regular..(AU)

Assessment of Medical Officers Regarding Knowledge on Integrated Management of Neonatal and Childhood Illness in Belagavi District

Background: To decrease morbidity and mortality in under-5 children and also to improve their growth and development, integrated management of neonatal and childhood illness (IMNCI) strategy was adopted in India in 2005.Objective: The objective of the study was to assess the knowledge of medical officers regarding IMNCI in five talukas of Belagavi district.Materials and Methods: Across-sectional study was conducted on 50 medical officers who have undergone IMNCI training. Participants were selected across five talukas of Belagavi district by convenience sampling. Ethical clearance was obtained. Data were collected from each participant using a pretested questionnaire after obtaining informed consent. All the questions were based on IMNCI guidelines. Data were analyzed using Statistical Package for the Social Sciences version 22.Results: Median score of knowledge was 13.2% of medical officers had inadequate knowledge, 54% had moderate knowledge, and 22% had adequate knowledge.Conclusion: The overall knowledge score of medical officers regarding IMNCI was good, but periodic refresher training workshops should be conducted to reaffirm and update the existing knowledge.