Impact of Mobile Dental Clinics on the Quality of Life of Children

ABSTRACT Objective: To evaluate the impact of mobile dental clinics on the oral health-related quality of life (OHRQL) of children. Material and Methods: A longitudinal epidemiological study was conducted with participants from seven mobile dental clinics carried out between May 2019 and January 2020 by the NGO Missão Sorrisos. Parents and children who attended the program had their sociodemographic data collected. Both completed the Scale of Oral Health 5 (SOHO-5) self-reported questionnaire before treatment and again 30 days after treatment. Results: The improvement in the children's oral health after treatment at the mobile clinics is reflected in the pre-and post-treatment medians measured by the SOHO-5 total score from the children's own reports from the parents' reports. The procedures performed were effective in reducing pain and difficulties in eating, drinking, and sleeping. An improvement in the perception of the children's appearance and self-confidence was reported, both from the perspective of the parents/guardians and the children themselves. The chance of improvement in the perception of the children's oral health was greater for parents (OR=5.96; CI95%: 1.32-26.84) and children (OR=5.76; CI95%: 1.28-25.95) from families whose main caregiver was not professionally active at the time of the study. Conclusion: The mobile dental clinics had a positive impact on the OHRQL of children from the perspective of the participants of the study.

Desgastes físicos e emocionais do enfermeiro decorrentes do atendimento pré-hospitalar móvel / Desgaste físico y emocional de los enfermeros como resultado de la atención prehospitalaria móvil / Nurses' physical and emotional exhaustion resulting from mobile pre-hospital care

Objetivo: descrever as principais queixas causadas pelas cargas psíquicas no processo de trabalho dos enfermeiros no atendimento móvel pré-hospitalar. Método: pesquisa qualitativa realizada com 15 enfermeiros do Serviço de Atendimento Móvel de Urgência de uma cidade do norte do Paraná. O instrumento de coleta tinham informações de caracterização sociodemográfica e do trabalho. Os dados foram submetidos à análise de conteúdo. Resultados: evidenciaram-se desgastes emocionais e físicos causados pelas cargas psíquicas associadas ao estresse no trabalho: apreensão, ansiedade, irritação, nervosismo, insônia, falta de paciência, imediatismo das coisas, medo do desconhecido, alteração dos sinais vitais, frustração, desânimo, tristeza, desmotivação, ausência de reconhecimento profissional, força física, entre outros. Conclusões: recomenda-se que a instituição disponibilize suporte psicológico, momentos de confraternização/lazer, vigilância em Saúde do Trabalhador, entre outras atividades que podem proporcionar qualidade de vida no trabalho do enfermeiro, reduzindo desgastes físicos e emocionais ocasionados pelo desempenho da sua função no Serviço Móvel de Urgência.(AU)

Objective: to describe the main complaints caused by psychic loads in the work process of nurses in pre-hospital mobile care. Method: qualitative research carried out with 15 nurses from the Mobile Emergency Care Service in a city in northern Paraná. The collection was about sociodemographic and work characteristics. Data were submitted to content analysis. Results: emotional and physical strains caused by the psychological burdens associated with work stress were evidenced: apprehension, anxiety, irritation, nervousness, insomnia, lack of patience, immediacy of things, fear of the unknown, alteration of vital signs, frustration, discouragement, sadness, lack of motivation, lack of professional recognition, physical strength, among others. Conclusions: it is recommended that the institution provide psychological support, moments of socializing/leisure, surveillance in Occupational Health, among other activities that can provide quality of life in the work of nurses, reducing physical and emotional exhaustion caused by the performance of their role in the work.(AU)

Objetivo: describir las principales quejas provocadas por las cargas psíquicas en el proceso de trabajo de los enfermeros en la atención móvil prehospitalaria. Método: investigación cualitativa realizada con 15 enfermeros del Servicio Móvil de Atención de Emergencia en norte de Paraná. La recolección fue sobre caracterización sociodemográfica y laboral. El análisis fue de contenido. Resultados: se evidenciaron tensiones emocionales y físicas provocadas por las cargas psicológicas asociadas al estrés laboral: aprensión, ansiedad, irritación, nerviosismo, insomnio, falta de paciencia, inmediatez de las cosas, miedo a lo desconocido, alteración de los signos vitales, frustración, desánimo, tristeza, falta de motivación, falta de reconocimiento profesional, fuerza física, entre otros. Conclusiones: se recomienda que la institución brinde apoyo psicológico, momentos de socialización/ocio, vigilancia en Salud Ocupacional, entre otras actividades que pueden brindar calidad de vida en el trabajo, reduciendo el desgaste físico y emocional ocasionado por el desempeño de su rol de trabajo.(AU)

Challenges encountered by human immunodeficiency virus positive pregnant women on taking antiretrovirals in a public health unit of the Manzini region, Swaziland

In Swaziland, the Ministry of Health adopted the prevention of mother-to-transmission (PMTCT) Option A as a feasible and less costly way to expand the PMTCT services nationwide. Despite major success since the programme started, some barriers, such as the challenge of follow-up care for human immunodeficiency virus (HIV)-positive pregnant mothers still exist. The present study aimed to describe the challenges that HIV-positive pregnant mothers encountered on taking antiretrovirals (ARVs) in a health unit of the Manzini region, Swaziland. A qualitative, exploratory and descriptive research design was used, and data were collected through semi-structured individual interviews and field notes. Purposive sampling was used to select the study site and the population. Permission was requested from the participants to record the interviews. The study population were HIV-positive pregnant mothers, aged between 18 and 40 years, which were enrolled in the PMTCT B+ programme. The PMTCT B+ programme was perceived as preventing the transfer of HIV transmission from mother to child. It boosts the mother's immune system, prevents opportunistic infections and prolongs life. Challenges of taking ARVs emerged as a theme. The participants displayed knowledge and understanding of the programme, yet discrimination and no support from families and partners were mentioned. (Afr J Reprod Health 2022; 26[5]: 41-49).

Perfil dos acidentes de trânsito atendidos por Serviço de Atendimento Móvel de Urgência / Profile of traffic accidents served by the mobile emergency care service / Perfil de accidentes de tráfico atendidos por el servicio móvil de emergencias

Objetivo: descrever o perfil dos acidentes de trânsito e das vítimas assistidas pelo Serviço de Atendimento Móvel de Urgência. Método: estudo epidemiológico descritivo. A coleta dos dados foi realizada em 633 fichas de atendimento do Serviço de Atendimento Móvel de Urgência de uma cidade do interior do Brasil. Os dados foram transferidos para o programa estatístico Statistical Package for Social Sciences e realizada uma análise descritiva dos dados. Resultados: 74% das vítimas foram do sexo masculino, com idade mais prevalente de 20 a 29 anos (37%). As motocicletas estiveram mais envolvidas nos acidentes e ocorreram em maior parte nos dias de finais de semana. Todos os óbitos registrados por esse serviço envolviam motos. Conclusão: os dados apresentados neste estudo são semelhantes com as características do perfil de acidentes de trânsito encontradas em outras pesquisas realizadas no país, principalmente em relação a motociclistas. (AU)

Objective: To describe the profile of traffic accidents and victims assisted by the Mobile Emergency Care Service. Methods: Descriptive epidemiological study. Data collection was carried out on 633 medical charts of the Mobile Emergency Care Service in a city in the Brazilian countryside. The data were transferred to the statistical program Statistical Package for Social Sciences, and then a descriptive analysis was performed. Results: A total of 74% of the victims were male, with the most prevalent age between 20 and 29 years old (37%). Motorcycles were more involved in accidents, which occurred mostly on weekends. All deaths recorded by this service involved motorcycles. Conclusion: It is concluded that the data presented in this study are similar to the characteristics of the profile of traffic accidents found in other surveys conducted in the country, mainly in relation to motorcyclists. (AU)

Objetivo: Describir el perfil de accidentes de tráfico y víctimas atendidas por el Servicio Móvil de Emergencias. Método: Estudio epidemiológico descriptivo. La recolección de datos se realizó sobre 633 expedientes de atención del Servicio Móvil de Emergencia en una ciudad del interior de Brasil. Los datos fueron transferidos al programa estadístico Statistical Package for Social Sciences y se realizó un análisis descriptivo de los datos. Resultados: El 74% de las víctimas eran hombres, siendo la edad más prevalente entre 20 y 29 años (37%). Las motocicletas estuvieron más involucradas en accidentes y ocurrieron principalmente los fines de semana. Todas las muertes registradas por este servicio involucraron motocicletas. Conclusión: Se concluye que los datos presentados en este estudio son similares a las características del perfil de accidentes de tránsito encontrados en otras encuestas realizadas en el país, principalmente en relación a motociclistas. (AU)

Perfil, dificuldades e particularidades no trabalho de profissionais dos serviços de atendimento pré-hospitalar móvel: revisão integrativa / Perfil, dificultades y particularidades en el trabajo de los profesionales de atención prehospitalaria móvil: una revisión integradora / Profile, difficulties and particularities at work of mobile prehospital care professionals: an integrative review

Resumo Objetivou-se identificar as características do trabalho dos profissionais dos Serviços de Atendimento Pré- Hospitalar Móvel. Trata-se de uma revisão integrativa de caráter descritivo, realizada na Biblioteca Virtual em Saúde, com artigos originais, disponíveis na íntegra, em idioma português, publicados entre os anos de 2010 a 2016, que atendiam ao objetivo proposto. Foram encontrados 247 artigos, que passaram por três etapas de análise, resultando assim na inclusão de 09 artigos. Os artigos inclusos retratam as características do Serviço de Atendimento Pré-Hospitalar Móvel, onde houve uma predominância de pesquisas realizadas no Serviço de Atendimento Móvel de Urgência das diversas regiões do país. A discussão foi dividida em três tópicos para melhor organização dos achados: perfil dos profissionais, principais dificuldades encontradas no trabalho e particularidades dos atendimentos. Conclui-se que a maioria dos profissionais e das vítimas atendidas são do sexo masculino, há uma predominância maior de técnicos de enfermagem, as principais dificuldades encontradas estão relacionadas ao estresse ocupacional, falta de conhecimento da população, dificuldade de comunicação e desvalorização profissional e a respeito das ocorrências, a maior incidência são as de origens clínicas e traumáticas.

Abstract The objective of this study was to identify the characteristics of the work of the professionals of the Prehospital Mobile Care Services. This is an integrative review of a descriptive character, carried out in the Virtual Health Library, with original articles, available in the whole, in Portuguese language, published between the years 2010 and 2016, which met the proposed objective. We found 247 articles, which went through three stages of analysis, resulting in the inclusion of 09 articles. The articles included on the characteristics of the Mobile Pre-Hospital Care Service, where there was a predominance of research carried out in the Mobile Emergency Care Service of the different regions of the country. The discussion was divided in three topics to better organize the findings: profile of the professionals, main difficulties encountered in the work and particularities of care. It is concluded that the majority of the professionals and victims attended are male, there is a greater predominance of nursing technicians, the main difficulties are related to occupational stress, lack of knowledge of the population, difficulty of communication and professional devaluation and Regarding the occurrences, the highest incidence is those of clinical and traumatic origins.

Resumen El objetivo de este estudio fue identificar las características del trabajo de profesionales de los Servicios de Atención Pre-Hospitalaria Móvil. Se trata de una revisión integradora de carácter descriptivo, que fue realizada en la Biblioteca Virtual en Salud, con artículos originales disponibles en su totalidad, en portugués, publicados entre los años 2010 a 2016, que cumplieron el objetivo. Fueron encontrados 247 artículos, que pasaron por tres etapas de análisis, resultando así en la inclusión de 09 artículos. Los artículos incluidos retratan las características del Servicio de Atención Pre-Hospitalaria Móvil, donde hubo un predominio de investigaciones realizadas en el Servicio de Atención Móvil de Urgencia de las diversas regiones del país. La discusión fue dividida en tres tópicos para mejor organización de los hallazgos: perfil de los profesionales, principales dificultades encontradas en el trabajo y particularidades en las atenciones. Se concluye que la mayoría de los profesionales y de las víctimas atendidas son del sexo masculino, hay una predominancia mayor de técnicos de enfermería, las principales dificultades encontradas están relacionadas al estrés ocupacional, falta de conocimiento de la población, dificultad de comunicación y devaluación profesional, con relación a las ocurrencias, la mayor incidencia son las de orígenes clínicos y traumáticos.

Atendimentos pré-hospitalares em população jovem do Distrito Federal / Pre-hospital care in young population of the Federal District

Objective:To describe the types of pre-hospital care for young people, carried out by a Fire Department, and to compare them according to the characteristics of the victims and the incidents. Method:Cross-sectional, retrospective, descriptive and analytical study, with a quantitative approach, composed of 198 incidents attended, in 2015, in the Federal District. Data retrieved from the service's file records. For the proposed comparison, the chi-square test and the likelihood ratio were applied, adopting p <0.05. Results:Most of those attended were male (54.0%) and over 18 years old (86.4%).The rescue with response time less than 10 minutes (83.8%) and severity classified as stable (98.0%) predominated. The comparison result was significant for the trauma category in terms of age, sex, place of incident and regional destination, all with p≤0,0001. Conclusion:The young population studied, with an emphasis on the male sex, is vulnerable to traumatic events, specifically on public roads. The exposed data point to the need for health education and intersectoral actions that promote the prevention of these incidents in the young population.

Objetivo: Descrever os tipos de atendimentos pré-hospitalares de jovens, realizados por um Grupamento do Corpo de Bombeiro, e compará-los segundo as características das vítimas e das ocorrências. Método: Estudo transversal, retrospectivo, descritivo e analítico, com abordagem quantitativa, composto por 198 ocorrências atendidas, em 2015, no Distrito Federal. Os dados foram coletados a partir das fichas de atendimentos do serviço. Para comparação proposta, aplicou-se o teste qui-quadrado e a razão de verossimilhança, adotando-se p<0,05.Resultados:A maioria dos atendidos era do sexo masculino (54,0%) e idade superior a 18 anos (86,4%). Predominaram-se os atendimentos com tempo de resposta menor que 10 minutos (83,8%) e gravidade classificada estável (98,0%). O resultado da comparação foi significativo para a categoria trauma quanto às características de idade, sexo, local de ocorrência e regional de destino, todas com p≤0,0001.Conclusão: A população jovem estudada, com ênfase ao sexo masculino, é vulnerável a ocorrências traumáticas, especificamente aos atendimentos ocorridos em via pública. Os dados expostos apontam para a necessidade de educação em saúde e ações intersetoriais que promovam a prevenção dessas ocorrências na população jovem.

Síndrome de burnout entre profissionais de um serviço de atendimento móvel de urgência do paraná / Síndrome de burnout entre profesionales de un servicio de atendimiento móvil de urgencia de paraná / Burnout syndrome in professionals of a mobile emergency service in the state of paraná

RESUMO Objetivo: identificar o risco para o desenvolvimento da Síndrome de Burnout em profissionais do Serviço de Atendimento Móvel de Urgência (SAMU). Metodologia: estudo transversal, não probabilístico, realizado entre agosto e outubro de 2017 com 101 profissionais atuantes em um SAMU do Paraná, utilizando questionário autoaplicável - Maslach Burnout Inventory. A análise de dados envolveu os testes de associação Qui-quadrado, Wilcoxon e Mann-Whitney. Resultados: observa-se que o risco para desenvolvimento e manifestação da síndrome de Burnout foi identificado em 52 profissionais (51,9%) e foi mais frequente entre médicos e teleatendentes, indivíduos do sexo feminino, com mais de 40 anos, sem companheiro, sem filhos, que tinham outro vínculo empregatício e renda superior a 10 salários mínimos. Porém, só os que trabalhavam durante o dia apresentaram risco significativamente maior (p=0,0075). Conclusão: as características do processo de trabalho no SAMU geram sobrecarga aos profissionais, sendo importante a implementação de estratégias que possam minimizar os efeitos estressores desta atuação.

RESUMEN Objetivo: identificar el riesgo para el desarrollo del Síndrome de Burnout en profesionales del Servicio de Atendimiento Móvil de Urgencia (SAMU). Metodología: estudio trasversal, no probabilístico, que se realizó entre agosto y octubre de 2017 con 101 profesionales que actúan en un SAMU de Paraná, utilizando cuestionario auto aplicable - Maslach Burnout Inventory. El análisis de datos abarcó las pruebas de asociación Chi cuadrado, Wilcoxony Mann-Whitney. Resultados: se identificó riesgo para desarrollo y manifestación del síndrome de Burnout en 52 profesionales (51,9%), siendo éste más frecuente entre médicos y profesionales que operan el teléfono, individuos del sexo femenino, con más de 40 años, sin pareja, sin hijos, que tenían otro vínculo laboral y renta superior a 10 sueldos mínimos. Sin embargo, solamente aquellas personas que trabajaban durante el día presentaron riesgo significativamente mayor (p=0,0075). Conclusión: las características del proceso de trabajo en SAMU generan sobrecarga a los profesionales, siendo importante la implementación de estrategias que puedan minimizar los efectos estresores de esta actuación.

ABSTRACT Objective: To identify the risk for the development of Burnout Syndrome in professionals of the Mobile Emergency Care Service (SAMU). Methodology: Cross-sectional non-probabilistic study conducted between August and October 2017 with 101 professionals of a Mobile Emergency Care Service (SAMU) of the State of Paraná, through the self-administered questionnaire - Maslach Burnout Inventory. Data analysis was performed using Chi-square, Wilcoxon and Mann-Whitney association tests. Results: The risk for the development and manifestation of Burnout syndrome was identified in 52 professionals (51.9%) and was more frequent among physicians and telephone operators, females over 40 years old, without partners, without children, who had another employment and income of more than 10 minimum wages. However, only those who worked in the day shift were at a significantly higher risk for the syndrome (p = 0.0075). Conclusion: The daily process of work at the SAMU mobile emergency generates overload of work to health professionals. Therefore, strategies aimed to minimize the stressful effects of their work activities should be implemented.

Perfil de atendimento e satisfação dos usuários do Serviço de Atendimento Móvel de Urgência (SAMU) / Perfil de atención y satisfacción de los usuarios del Servicio de Atención Móvil de Urgencia (SAMU) / Profile of service and satisfaction of users of the Mobile Emergency Care Service (SAMU)

Resumo OBJETIVO Conhecer o perfil de atendimento e satisfação dos usuários atendidos pelo Serviço de Atendimento Móvel de Urgência (SAMU). MÉTODOS Estudo transversal dos 854 atendimentos realizados pelas equipes de Suporte Avançado de Vida (SAV) do SAMU de Porto Alegre/RS, no primeiro trimestre de 2016. Participaram 164 usuários ou responsáveis que responderam via telefone questões referentes ao atendimento realizado. Análise realizada através dos Testes de Spearman e Qui-quadrado. Estudo aprovado em Comitê de Ética e Pesquisa das Instituições envolvidas. RESULTADOS Observou-se maior percentual de atendimentos clínicos (48,2%) seguidos pelos atendimentos aos traumas (32,8%). Sobre o atendimento pelo telefone, 71,4% dos participantes classificaram o serviço como 'muito bom' enquanto o atendimento presencial foi assim classificado por 76,8% dos respondentes. Desses, 81,1% afirmaram que o atendimento foi resolutivo. CONCLUSÕES O tipo clínico se destaca entre os atendimentos e os usuários revelam satisfação com o serviço prestado, considerando que esse atende a população resolutamente.

Resumen OBJETIVO Conocer el perfil de atención y satisfacción de los pacientes atendidos por el Servicio de Atención Móvil de Urgencia (SAMU). MÉTODOS Estudio transversal de 854 atenciones realizadas por los equipos de Soporte Avanzado de Vida (SAV) del SAMU de Porto Alegre/RS, en el primer trimestre de 2016. Participaron 164 pacientes o responsables que respondieron vía teléfono las preguntas referentes a la atención realizada. Análisis realizado a través de las pruebas de Spearman y Chi-cuadrado. Estudio aprobado por el Comité de Ética e Investigación de las Instituciones involucradas. RESULTADOS Se observó un mayor porcentaje de atenciones clínicas (48,2%) seguido por traumas (32,8%). Sobre la atención telefónica, 71,4% de los participantes clasificaron el servicio como 'muy bueno', mientras que la atención presencial fue clasificada de la misma forma por el 76,8% de los encuestados. De ellos, 81,1% afirmó que la atención fue resolutiva. CONCLUSIONES El tipo clínico se destaca entre las atenciones y los usuarios que revelan satisfacción con el servicio brindado, considerando que este atiende a la población resolutivamente.

Abstract OBJECTIVE To know the profile of service and satisfaction of users served by the Mobile Emergency Care Service (SAMU). METHODS A cross-sectional study of the 854 services performed by the Advanced Life Support (SAV) teams from SAMU of Porto Alegre/RS, in the first quarter of 2016. A total of 164 users or respondents answered by phone to the questions regarding the service performed. Analysis performed using the Spearman and Chi-square tests. Study approved in Ethics and Research Committee of the Institutions involved. RESULTS A higher percentage of clinical visits (48.2%) followed by trauma care (32.8%). Regarding telephone calls, 71.4% of respondents rated the service as 'very good' while the service was classified by 76.8% of the respondents. From them, 81.1% stated that the service was resolving. CONCLUSIONS The clinical type stands out among the assistances and the users reveal satisfaction with the service provided, considering that it serves the population resolutely.

Content analysis of mobile health applications on pregnancy yoga

Background: The awareness of yoga has improved its utilisation for health benefits across the globe. This work analysed the contents of the available mobile apps on Android and iPhone operating system (iOS) platforms. Understanding the existing apps will form a base to develop a better app to encourage and mentor the pregnant women while performing yoga for health benefits.Aim: The aim of this study is to analyse the contents of the available mobile apps on Android and iOS platforms on 'Pregnancy Yoga'.Methods: Both the researchers independently searched online and analysed the contents present in the mobile health apps (mhealth apps) related to pregnancy yogas that were available in two platforms ­ The Apple and Google Play stores. A search for pregnancy yoga apps in both these platforms yielded a total of 100 and 200 apps, respectively. A cross-sectional study was performed on this sample of 300 available mobile apps.Results: Out of the 300 mhealth apps identified, it was found that five pregnancy yoga apps from iOS and 45 from Google Play stores were relevant to pregnancy yoga and the other apps focused either on pregnancy-related health tips or common yoga apps. Therefore, only 50 (16.6%) mhealth apps could be included as per the criteria. The mobile apps that met the inclusion criteria were 5 (1.6%) from iOS and 45 (15%) from Google play stores.Conclusion: The study shows that the content of a number of apps is not sufficient and evidences the presence of apps that include videos to track yoga poses, their benefits for each trimester, especially videos, and also the apps that enable one to set-up reminders. Pranayama techniques such as bhamari, sithagiri and yoga nithra (relaxation) require information to improve the well-being of pregnant women. These data are not included in the pregnancy mobile apps. Hence, there is a need for well-designed applications to promote yoga in every stage of pregnancy. The available apps should be able to track the yoga practice and provide immediate feedback and consultation by experts

Sensibilidad a drogas de primera línea frente a cepas de M. tuberculosis del CRN Micobacterias, Guayas, 2016 / Sensitivity to first-line drugs against strains of M. tuberculosis of the CRN Micobacterias, Guayas, 2016

Objetivo: Determinar el perfil de sensibilidad de Mycobacterium tuberculosis a drogas de primera línea en cepas que llegan de diferentes unidades de salud de la provincia del Guayas. Materiales y métodos. Se trabajó con 614 cepas de Mycobacterium tuberculosis, las cuales se le realizó las pruebas de sensibilidad a drogas de primera (rifampicina, isoniacida, estreptomicina y etambutol) por el por el método de proporciones (Rist, Canetti, Grosset) y pirazinamida evaluada por el método Wayne. Resultado: Se realizó perfil de sensibilidad a 614 cepas, de las cuales el 70 % (n=427) es sensible a todas las drogas, 20 % (n=124) presentó resistencia al menos a una droga, el restante corresponden a cepas MDR. TB-Monorresistente tiene mayor incidencia (n=83) que la MDR (n=12) en pacientes sin tratamiento previo. Por otro lado en pacientes antes tratado la TB-Monorresistente es menor a la MDR (n=41 y n=51 respectivamente). Conclusiones: el método de proporciones sigue siendo la técnica de referencia. Se observa mayor sensibilidad a drogas de primera línea en pacientes sin tratamiento previo. Es de importancia clínica llevar un correcto seguimiento a pacientes que presenten algún tipo de resistencia, pero es prioridad preventiva la no conversión de los pacientes sensibles a fin de evitar la diseminación de cepas resistentes.

Objective: Difine first line susceptibility drug profile of Mycobacterium tuberculosis, to diferent strain from Province Guayas health establishments. Material and Methods.614 Mycobacterium tuberculosis strain were analized by first line susceptibility drug test (rifampicin, isoniazid, streptomycin, ethambutol) used proportions method (Rist, Canetti, Grosset) and pyrazinamide Wayne´s methods. Results: 614 strain were studied, 70 % strains (n=427) result sensible, 20 % (n=124) have at least resistence one drug; the residue responds to MDR strains. The TB-Monoresistence haved more incidence (n=83) than MDR (n=12) in virgin treatments patients. Nevertheless; in previous treatment patients, the TB-Monoresistence is smaller than MDR (n=41 y n=51 respectively). Conclutions: The proportion method is the reference technique. The analize shown biggest sensibility in virgin treatment patients for first line drugs. Is very important have a correct control of resistant pactients, but is preventive priority the non conversion of sensibility patients to avoid dissemination resistance strain.

Development of the IMB Model and an Evidence-Based Diabetes Self-management Mobile Application / 대한의료정보학회지

OBJECTIVES: This study developed a diabetes self-management mobile application based on the information-motivation-behavioral skills (IMB) model, evidence extracted from clinical practice guidelines, and requirements identified through focus group interviews (FGIs) with diabetes patients. METHODS: We developed a diabetes self-management (DSM) app in accordance with the following four stages of the system development life cycle. The functional and knowledge requirements of the users were extracted through FGIs with 19 diabetes patients. A system diagram, data models, a database, an algorithm, screens, and menus were designed. An Android app and server with an SSL protocol were developed. The DSM app algorithm and heuristics, as well as the usability of the DSM app were evaluated, and then the DSM app was modified based on heuristics and usability evaluation. RESULTS: A total of 11 requirement themes were identified through the FGIs. Sixteen functions and 49 knowledge rules were extracted. The system diagram consisted of a client part and server part, 78 data models, a database with 10 tables, an algorithm, and a menu structure with 6 main menus, and 40 user screens were developed. The DSM app was Android version 4.4 or higher for Bluetooth connectivity. The proficiency and efficiency scores of the algorithm were 90.96% and 92.39%, respectively. Fifteen issues were revealed through the heuristic evaluation, and the app was modified to address three of these issues. It was also modified to address five comments received by the researchers through the usability evaluation. CONCLUSIONS: The DSM app was developed based on behavioral change theory through IMB models. It was designed to be evidence-based, user-centered, and effective. It remains necessary to fully evaluate the effect of the DSM app on the DSM behavior changes of diabetes patients.

Barriers between community screening for visual problems and treatments in a tertiary center

ABSTRACT OBJECTIVE To evaluate the effectiveness of mobile ophthalmic unit screenings and to investigate barriers between community care and resolution of the problem at a tertiary center. METHODS This prospective study evaluated a convenience sample from 10 municipalities in São Paulo State, Brazil. Patients were assessed in the municipality by a mobile ophthalmic unit and underwent a complete ophthalmic consultation. Patients were referred as warranted to a tertiary hospital. RESULTS The mobile ophthalmic unit screened 1,928 individuals and 714 (37%) were referred. The mean age of the referred patients was 57.12 (SD = 19.5) years with best corrected visual acuity of 0.37 (SD = 0.36) logMAR. Forty-seven (6.6%) patients were blind and 185 (26.5%) were visually impaired. Cataracts (44.7%) and pterygium (14.7%) accounted for most referrals. Of those referred, 67.1% presented to the tertiary center. The diagnosis by the mobile ophthalmic unit corresponded to the one by the tertiary center in 88.5% of the cases. There were a significantly higher number of blind and visually impaired persons among those who presented to the hospital. There was a significantly greater attendance among patients living in more distant municipalities from the reference center with a higher number of inhabitants and a greater number of ophthalmologists in the cities of origin (p < 0.05, all comparisons). Complete treatment was performed in 65.6% of patients, and loss to follow-up was the main cause of incomplete treatment in 50.7% of patients. A total of 313 cataract surgeries were performed, which reduced the number of blind patients from 20 to 2 and of visually impaired individuals from 87 to 2 (p < 0.001). CONCLUSIONS Only 37% of the patients assessed by a mobile ophthalmic unit required referral to a tertiary hospital. Among the referred patients, 67.1% presented to the hospital, and complete resolution after treatment was approximately 65.5%. There was a significant improvement in visual acuity and a reduction in the prevalence of blindness and visual impairment postoperatively.

Atenção à saúde de pessoas em situação de rua: estudo comparado de unidades móveis em Portugal, Estados Unidos e Brasil / Health care of people in homelessness: a comparative study of mobile units in Portugal, United States and Brazil

Resumo O trabalho descreve e analisa o quadro legal e normativo que orienta o uso de unidades móveis em Portugal, Estados Unidos e Brasil, que buscam melhorar o acesso e a continuidade dos cuidados em saúde de pessoas em situação de rua. Utilizou-se a análise comparada, por meio de revisão bibliográfica e documental relacionando três categorias: contexto (demográfico, socioeconômico e epidemiológico), sistema de serviços (acesso, cobertura, organização, gestão e financiamento) e as unidades móveis especificamente (concepção, modelo de atenção e financiamento). A análise fundamentou-se na teoria da convergência/divergência entre os sistemas de saúde, pela perspectiva da equidade em saúde. A melhoria do acesso, a abordagem do uso abusivo de substâncias psicoativas, busca ativa e trabalho multidisciplinar mostrou-se comuns aos três países, com potencial para reduzir as iniquidades. As relações com a atenção primária, uso de veículos e o tipo de financiamento são consideradas de maneira divergente nos três países, influenciando o maior ou menor alcance da equidade nas propostas analisadas.

Abstract This paper describes and analyzes the legal and normative framework guiding the use of mobile units in Portugal, United States and Brazil, which seek to improve access and continuity of care for people in homelessness. We used a comparative analysis through literature and documentary review relating three categories: context (demographic, socio-economic and epidemiological), services system (access, coverage, organization, management and financing) and, specifically, mobile units (design, care and financing model). The analysis was based on the theory of convergence/divergence between health systems from the perspective of equity in health. Improving access, addressing psychoactive substances abuse, outreach and multidisciplinary work proved to be common to all three countries, with the potential to reduce inequities. Relationships with primary healthcare, use of vehicles and the type of financing are considered differently in the three countries, influencing the greater or lesser extent of equity in the analyzed proposals.

Cost-Effectiveness analysis of family planning services offered by mobile clinics versus static clinics in Assiut, Egypt

Cost effectiveness studies of family planning (FP) services are very valuable in providing evidence-based data for decision makers in Egypt. Cost data came from record reviews for all 15 mobile clinics and a matched set of 15 static clinics and interviews with staff members of the selected clinics at Assiut Governorate. Effectiveness measures included couple years of protection (CYPs) and FP visits. Incremental cost-effectiveness ratios (ICER) and sensitivity analyses were calculated. Mobile clinics cost more per facility, produced more CYPs but had fewer FP visits. Sensitivity analysis was done using: total costs, CYP and FP visits of mobile and static clinics and showed that variations in CYP of mobile and static clinics altered the ICER for CYP from $2 -$6. Mobile clinics with their high emphasis on IUDs offer a reasonable cost effectiveness of $4.46 per additional CYP compared to static clinics. The ability of mobile clinics to reach more vulnerable women and to offer more long acting methods might affect a policy decision between these options. Static clinics should consider whether emphasizing IUDs may make their services more cost-effective

Disaster medicine: current status and future directions of emergency medical team for overseas disaster crisis

Through the Declaration of Montevideo in 2011, the World Medical Association suggested that doctors worldwide should be trained in basic disaster response regardless of their specialty. The Haiti earthquake in 2010, which had the highest number of foreign medical team dispatched from all over the world, proved that untrained and disorganized team only brought confusion. This event led the World Health Organization to develop the ‘Classification and Minimum Standards for Foreign Medical Teams in Sudden Onset Disasters ’ in 2013. This guideline will become the standard for organizing an international emergency medical team. We should be able to provide high standard of care through field hospital set up and continuous training of disaster medicine specialists.

Estudio de costo efectividad de las brigadas, móviles amazónicas. Modelo de atención integral con énfasis en VIH en poblaciones indígenas / Cost-effectiveness study of the Amazonian mobile brigades. Comprehensive care model with emphasis on HIV in indigenous populations

La publicación describe diversos estudios de costo- beneficio y costo-efectividad sobre intervenciones o programas de prevención en VIH , así como las evaluaciones económicas de intervenciones de prevención en VIH en comunidades indígenas y su impacto económico. El horizonte del programa en estudio era de un año y fue desarrollado en las comunidades indígenas de Condorcanqui y Datem del Marañón de los pueblos indígenas, Achuar, Awajún, Chapra, Kandozi, Kichwa, Shawi y Wampis