ABSTRACT
Considerado patrimônio natural, o litoral piauiense é referência nacional e internacional para o Kitesurf, esporte na natureza pouco estudado, embora conste em pesquisas sobre desenvolvimento turístico na região. Este artigo analisa implicações da prática do Kitesurf nesse litoral e identifica ações que podem contribuir para sua conservação. Realizou-se pesquisa qualitativa, exploratória, mediante pesquisa bibliográfica e documental. Em certas praias há conflitos entre kitesurfista, pescador e/ou banhista; além da prática oferecer riscos para animais silvestres. Todavia, há kitesurfista que recolhe lixo no mar e promove discussões sobre efeitos do esporte na região. Abordar a educação ambiental em clínicas de certificação de kitesurfistas e regulamentar o Kitesurf pode colaborar com a resolução de conflitos e perspectivar um turismo mais sustentável, almejando conservar esse patrimônio e suas potencialidades.
The coast of Piauí, considered a natural heritage, is a national and international reference for kitesurfing, sport in naturelittle studied, although it is part of research on the regional tourism development. This article analyzes the implications of the practice of kitesurfing on this coast and identifies actions that can contribute to its conservation. Qualitative, exploratory research was carried out through bibliographical and documentary research. On certain beaches there are conflicts between kitesurfers, fishermen and/ or bathers; in addition, its practice offers risks to wild animals. However, there are kitesurfers who collects garbage at sea and promotes discussions about the effects of the sport in the region. Addressing environmental education of kitesurfers in certification clinics and regulating kitesurfing can collaborate with conflict resolution and envisage a more sustainable tourism, aiming to conserve this heritage and its potential.
Subject(s)
Sports , Coasts , Marine Environment , Certification , Negotiating , Environmental Health Education , TourismABSTRACT
Introducción: la colegiación médica obligatoria es el ámbito con competencia exclusiva para el juzgamiento de la responsabilidad ética de los médicos en Uruguay. Objetivos: sistematizar los resultados de los primeros diez años de la vigencia de la colegiación obligatoria, conocer el número de denuncias y su evolución histórica, algunas características relevantes de las denuncias, los denunciantes y los médicos denunciados por presuntos apartamientos de la ética médica, características y resultados de los procedimientos, así como relevar las normas éticas y jurídicas referenciadas por los tribunales en los fallos sancionatorios. Material y método: se analizaron fuentes de información de acceso público: fallos del Tribunal de Ética y del Tribunal de Alzada, resoluciones del Ministerio de Salud Pública y datos de la actividad del Tribunal de Ética Médica contenidos en las memorias anuales del Colegio Médico del Uruguay. Resultados: a la fecha de cierre del reporte se habían publicado 100 fallos firmes. Los denunciantes fueron principalmente personas físicas (n=85), y, dentro de ellos, mayoritariamente médicos (n=56); los 29 restantes fueron pacientes, familiares de pacientes u otros miembros de la comunidad. Hubo 15 denuncias interpuestas por instituciones: 8 privadas y 7 públicas. La mayoría de las denuncias fueron promovidas por médicos o por instituciones médicas (n=63). Las denuncias involucraron a 131 médicos, de los cuales 89 son hombres (FR: 0,68); la edad promedio fue 52 años. Los fallos definitivos tuvieron por probado que 71 médicos habían cometido la falta ética denunciada. Conclusiones: 1. Hubo cierta estabilidad en el número de denuncias admitidas, con tendencia al crecimiento. 2. El universo de los denunciados es más masculinizado y envejecido que el promedio, con mayor exposición en servicios de emergencia o internación, especialidades quirúrgicas o que ejecutan procedimientos invasivos, así como para los cargos de gestión, administración o políticos. 3. La mayoría de las denuncias instruidas y de las sanciones aplicadas derivaron de conflictos en la interna de los equipos de salud. 4. Las sanciones más graves derivaron de conflictos con pacientes o sus familias, y, en especial, de actos abusivos con connotación sexual. 5. Los fallos sancionatorios se fundaron en normas jurídicas diversas que en los últimos años incluyeron referencias a convenciones internacionales y legislación nacional de derechos humanos.
Mandatory medical membership is the exclusive jurisdiction for the adjudication of ethical responsibilities of physicians in Uruguay. Objectives: To systematize the results of the first ten years of mandatory membership, to learn about the number of complaints and their historical evolution, to identify relevant characteristics of the complaints, the complainants, and the physicians accused of alleged breaches of medical ethics, to examine the features and outcomes of the proceedings, and to document the ethical and legal standards referenced by the courts in punitive rulings. Method: Publicly accessible sources of information were analyzed, including rulings from the Ethics Tribunal and the Court of Appeal, Resolutions from the Ministry of Public Health, and data regarding TEM's (Tribunal de Ética Médica or Medical Ethics Tribunal) activities found in the annual reports of the CMU (Colegio Médico del Uruguay or Medical Association of Uruguay). Results: As of the report's closing date, 100 final rulings had been published. The reporting individuals were primarily individuals (n=85), with most of them being medical professionals (n=56). The remaining 29 reporting individuals included patients, patients' family members, or other community members. There were 15 complaints filed by institutions: 8 private institutions and 7 public institutions. Most of the allegations were initiated by physicians or medical institutions (n=63). The reports involved 131 physicians, of whom 89 were male (male-to-female ratio: 0.68), with an average age of 52 years. The final rulings established that 71 physicians had committed the alleged ethical misconduct. Conclusions: 1. There was a degree of stability in the number of admitted allegations, with a trend toward growth. 2. The group of individuals who were reported is characterized by a higher proportion of males and tends to be older compared to the average. They also have a greater exposure to emergency or inpatient services, surgical specialties, or fields involving invasive procedures, as well as holding positions in management, administration, or politics. 3. Most of the investigations and sanctions issued stemmed from conflicts within healthcare teams. 4. The most severe sanctions resulted from conflicts with patients or their families, particularly those involving abusive acts with sexual connotations. 5. The punitive rulings were based on various legal standards, including recent references to international conventions and national human rights legislation.
A filiação médica obrigatória ao Colegio Médico del Uruguay (CMU) é a área de competência exclusiva para julgar a responsabilidade ética dos médicos no Uruguai. Objetivos: sistematizar os resultados dos dez primeiros da vigência da adesão obrigatória, conhecer o número de reclamações e a sua evolução histórica, algumas características relevantes das reclamações, os denunciantes e os médicos denunciados por supostos desvios à ética médica, características e resultados dos procedimentos, bem como destacar os padrões éticos e legais mencionadas pelos tribunais nas decisões sancionatórias. Material e método: foram analisadas fontes de informação de acesso público: acórdãos do Tribunal de Ética e do Tribunal da Relação, Resoluções do Ministério da Saúde Pública e dados sobre a atividade do Tribunal de Ética Médica constantes dos relatórios anuais do CMU. Resultados: até a data de encerramento do relatório, 100 decisões finais foram publicadas. Os reclamantes eram, em sua maioria indivíduos (n=85) e, entre eles, principalmente médicos (n=56); os 29 restantes eram pacientes, familiares de pacientes ou outros membros da comunidade. Quinze denúncias foram apresentadas por instituições: 8 privadas e 7 públicas. A maioria das reclamações forma iniciadas por médicos ou instituições médicas (n=63). As denúncias envolveram 131 médicos, dos quais 89 eram homens (FR: 0,68); a idade média era de 52 anos. As decisões finais provaram que 71 médicos haviam cometido os desvios éticos relatados. Conclusões: 1. Verificou-se alguma estabilidade no número de reclamações admitidas, com tendência ao crescimento. 2. O universo dos denunciados é mais masculino e mais velho que a média, com maior exposição a serviços de urgência ou de internação, especialidades cirúrgicas ou que realizam procedimentos invasivos, bem como a cargos de gestão, administração ou políticos. 3. A maioria das queixas apresentadas e das sanções aplicadas decorrem de conflitos no seio das equipes de saúde. 4. As sanções mais graves derivam de conflitos com pacientes ou seus familiares e, especialmente, de atos abusivos com conotações sexuais. 5. As decisões de sanção foram baseadas em diversas normas legais, que nos últimos anos incluíram referências a convenções internacionais e legislação nacional em matéria de direitos humanos.
Subject(s)
Certification , Liability, Legal , Ethics, Medical , UruguayABSTRACT
La educación de postgrado de la neurocirugía en Argentina ha sido una preocupación constante desde el inicio de la especialidad. Actualmente las organizaciones activas en educación de postgrado son la Asociación Argentina de Neurocirugía y el Colegio Argentino de Neurocirujanos. Ambas consideran que la residencia médica es el sistema de formación más apropiado para que un médico recién graduado pueda convertirse en un especialista. Para regular y organizar el desarrollo pedagógico de las mismas se diseñó un marco de referencia en donde se establecieron los estándares a alcanzar, junto con un programa de acreditación para lograr la homogeneidad de los parámetros de calidad, y además se crearon becas junto con el reglamento para su acreditación, para completar la formación en aquellos aspectos que durante la residencia no fueron suficientemente desarrollados. Como la certificación profesional es obligatoria para ejercer se crearon cursos ad hoc que constituyen la base teórica tanto para neurocirugía general como la cirugía de columna. Los postulantes deben completar una serie de requisitos y transitar por diferentes instancias de formación que incluyen, además, la residencia. Para mantener la calidad de la atención médica se creó un programa de revalidación o recertificación periódica. Toda la situación actual fue sometida a un análisis de sus fortalezas, oportunidades, debilidades y amenazas para diseñar las estrategias que permitan mejorarla(AU)
Postgraduate education in neurosurgery has been a constant concern since the beginning of the specialty. Currently active organizations in postgraduate education are the Asociación Argentina de Neurocirugía y el Colegio Argentino de Neurocirujanos. Both consider that medical residency is the most appropriate training system for a recently graduated doctor to become a specialist. To regulate and organize their pedagogical development, a reference framework was designed where the standards to be achieved were established, along with an accreditation program to achieve homogeneity of quality parameters, and fellowships were also created along with the regulations. for its accreditation, to complete the training in those aspects that were not sufficiently developed during the residency. Since professional certification is mandatory to practice, ad hoc courses were created that constitute the theoretical basis for both general neurosurgery and spinal surgery. Applicants must complete a series of requirements and go through different training instances that also include residence. To maintain the quality of medical care, a periodic revalidation or recertification program was created. The entire current situation was subjected to an analysis of its strengths, opportunities, weaknesses and threats to design strategies to improve it(AU)
Subject(s)
Education, Medical , Reference Standards , Specialization , Certification , Education, Graduate , Accreditation , NeurosurgeryABSTRACT
As the special subject of the applicant for registration of medical device, the research and development institutions have insufficient conditions and abilities to become medical device registrants, and there are certain difficulties in the actual registration application process, such as not clearing the certification path for the research and development institutions to hold the certificate. In view of the existing problems, by comparing the path of medicine research and development institutions to become medical device registrants and combining with the actual medical device industry to give relevant suggestions, including improving quality management over the whole life cycle of medical devices, quality and safety responsibility ability of research and development institutions, establishing the registration and certification path of research and development institutions, supporting laws and regulations, etc., so as to ensure that the research and development institutions become medical device registrants successfully.
Subject(s)
Research , CertificationABSTRACT
This paper introduced the overview of the "eight trends" of Chinese medicinal materials(CMM) industry in 2021, analyzed the problems of CMM production, and put forward development suggestions. Specifically, "eight trends" could be summarized as follows.(1) The growing area of CMM tended to be stable, and some provinces began to release the local catalog of Dao-di herbs.(2) The protection process of new varieties accelerated, and a number of excellent varieties were bred.(3) The theory of ecological cultivation was further enriched, and the demonstration effect of ecological cultivation technology was prominent.(4) Some CMM realized complete mechanization and formed typical model cases.(5) The number of cultivation bases using the traceability platform increased, and provincial internet trading platforms were set up.(6) The construction of CMM industrial clusters accelerated, and the number of provincial-level regional brands increased rapidly.(7) Many new agricultural business entities were founded nationwide, and a variety of methods were used to drive the intensified development of CMM.(8) A number of local TCM laws were promulgated, and the management regulation of food and medicine homology substances catalogs was issued. On this basis, four suggestions for CMM production were proposed.(1) It is suggested to speed up the formulation of the national catalog of Dao-di herbs and carry out the certification of Dao-di herbs production bases.(2) Ecological planting of forest and grassland medicine should be further strengthened in terms of technical research and promotion based on the principle of ecological priority.(3) The basic work of disaster prevention should be paid more attention and technical measures for disaster mitigation should be developed.(4) The planted area of commonly used CMM should be incorporated into the national regular statistical system.
Subject(s)
Agriculture , Certification , Commerce , Industry , ChinaABSTRACT
BACKGROUND@#Internal medicine (IM) doctors in Japan play the role of primary care physicians; however, the shortage of rural physicians continues. This study aims to elucidate the association of age, sex, board certification, type of work, and main clinical work with the retention or migration of IM doctors to rural areas.@*METHODS@#This retrospective cohort study included 82,363 IM doctors in 2010, extracted from the national census data of medical doctors. The explanatory variables were age, sex, type of work, primary clinical work, and changes in board certification status. The outcome was retention or migration to rural areas. The first tertile of population density (PD) of municipalities defined as rural area. After stratifying the baseline ruralities as rural or non-rural areas, the odds ratios (ORs) of the explanatory variables were calculated using generalized estimation equations. The analyses were also performed after age stratification (<39, 40-59, ≥60 years old).@*RESULTS@#Among the rural areas, women had a significantly higher OR for retention, but obtaining board certification of IM subspecialties had a significantly lower OR. Among the non-rural areas, physicians who answered that their main work was IM without specific subspecialty and general had a significantly higher OR, but obtaining and maintaining board certification for IM subspecialties had a significantly lower OR for migration to rural areas. After age stratification, the higher OR of women for rural retention was significant only among those aged 40-59 years. Those aged under 40 and 40-59 years in the non-rural areas, who answered that their main work was IM without specific subspecialty had a significantly higher OR for migration to rural areas, and those aged 40-59 years in the rural areas who answered the same had a higher OR for rural retention.@*CONCLUSIONS@#Obtaining and maintaining board certification of IM subspecialties are possible inhibiting factors for rural work, and IM doctors whose main work involves subspecialties tend to work in non-rural areas. Once rural work begins, more middle-aged female IM doctors continued rural work compared to male doctors.
Subject(s)
Middle Aged , Humans , Male , Female , Retrospective Studies , East Asian People , Certification , Physicians , Internal MedicineABSTRACT
La formación en medicina física y rehabilitación en Argentina se inició entre los años cincuenta y cuarenta, y su registro formal en el Ministerio de Salud Pública como especialidad se llevó a cabo en los años sesenta. Los centros de formación en medicina física y rehabilitación en un comienzo fueron instituciones privadas y públicas del ámbito asistencial y posteriormente los títulos de especialista empezaron a ser otorgados por los colegios médicos y por las universidades. Actualmente es posible acceder al título de especialista por medio de residencias, concurrencias y cursos superiores universitarios. Respecto al pregrado, la mayor parte de las facultades de medicina del país carecen de la asignatura Rehabilitación dentro del plan de estudios como materia obligatoria, siendo la excepción y no la regla. En cuanto a los servicios de rehabilitación, en la mayoría del territorio argentino existe algún tipo de servicio público o privado ambulatorio; sin embargo, hay pocos servicios especializados monovalentes con internación y los que existen se encuentran concentrados en algunas zonas del país. Referente a la producción de artículos de investigación, es escasa por múltiples razones.
Training in physical medical and rehabilitation in Argentina started between the 1940s and 1950s, and its formal registration in the Ministry of Public Health as a specialty took place in the 1960s. The training centers in physical medicine and rehabilitation were initially private and public institutions in the health care setting, and later, the specialist titles began to be granted by the medical colleges and universities. Currently, it is possible to access the title of specialist through residencies, attendances and university advanced courses. Regarding the undergraduate level, most of the medical schools in the country lack the Rehabilitation subject within the curriculum as a compulsory subject, being the exception rather than the rule. As for the rehabilitation services, in most of the Argentine territory there is some type of public or private outpatient service; however, there are few monovalent specialized inpatient services and those that exist are concentrated in some areas of the country. Regarding the production of research articles, it is scarce for multiple reasons.
Subject(s)
Humans , Argentina , CertificationABSTRACT
Introducción: la capacitación no escolarizada en psicoterapia se define como la enseñanza de esta intervención por fuera de los entornos clínicos universitarios y de la normativa de educación universitaria. Aunque esta forma de estudios es bastante aceptada por psiquiatras y otros profesionales de la salud mental, esta podría no garantizar una adecuada capacitación y certificación. La presente revisión describe las características de la capacitación no escolarizada en psicoterapia en el Perú y aborda los potenciales problemas con la capacitación y certificación. Método: se realiza un análisis de la capacitación no escolarizada de psicoterapia y se la compara con el modelo formativo en psicoterapia de la residencia de Psiquiatría. Resultados: la capacitación no escolarizada en psicoterapia es una modalidad válida de estudios. Sin embargo, su alcance académico y profesional debe ser mejor valorado ya que estos programas podrían no contar con los recursos para reemplazar la capacitación universitaria, y no cuentan con el valor legal para facultar el ejercicio profesional de la psicoterapia de acuerdo a las normativas actuales de la educación universitaria y de licenciamiento profesional. Conclusión: es necesario fortalecer la capacitación de psicoterapia en la residencia de Psiquiatría y la apertura de programas universitarios de postgrado (programas de especialización, maestría o doctorado) para que la capacitación y certificación de psicoterapia sigan los canales formativos y de licenciamiento profesional oficiales.
Introduction: non-school training in psychotherapy is defined as the teaching of this intervention outside of university clinical settings and university education regulations. Although this form of study is widely accepted by psychiatrists and other mental health professionals, it may not guarantee adequate training and certification. This review describes the characteristics of non-school training in psychotherapy in Peru and addresses possible problems with training and certification. Method: an analysis of the non-schooled psychotherapy training is carried out and compared with the training model in psychotherapy of the psychiatric residency. Results: non-school training in psychotherapy is a valid study modality. However, their academic and professional scope should be better valued since these programs may not have the resources to replace university training, and they do not have the legal value to license the professional practice of psychotherapy according to current regulations of college education and professional licensing. Conclusion: it is necessary to strengthen psychotherapy training in psychiatry residency and the opening of postgraduate university programs (specialization, master or doctorate programs) so that psychotherapy training and certification follow the official training and professional licensing channels.
Subject(s)
Humans , Psychiatry/education , Psychotherapy/education , Education, Medical , Internship and Residency , Peru , Universities , CertificationABSTRACT
La presente publicación responde a la necesidad de encuadrar la situación actual de los profesionales de Cirugía Plástica, Estética y Reparadora. Encuadre que se presentará a partir de las diferentes instituciones y actores intervinientes y de los marcos normativos que, en la actualidad, subyacen al reconocimiento de la especialidad y de los profesionales que la ejercen.
This publication responds to the need to frame the current situation of Plastic, Aesthetic and Reconstructive Surgery professionals. This frame that will be presented from the different institutions and actors involved and the regulatory frameworks that, currently, underlie the recognition of the specialty and the professionals who practice it.
Subject(s)
Humans , Male , Female , Certification/organization & administration , Enacted Statutes , Accreditation/organization & administration , Licensure/legislation & jurisprudenceABSTRACT
El Ministerio de Salud, a través de la Dirección de Prevención y Control de la Discapacidad conjuntamente con la Oficina General de Tecnologías de la Información, han propiciado un Proyecto de Desarrollo e Implementación del Sistema de Software, denominado HIS-DISCAP WEB, en su finalidad de contribuir a generar condiciones que faciliten el acceso de las Personas con Discapacidad, a los procesos para la evaluación, calificación y certificación de la discapacidad
Subject(s)
Software , Certification , Disabled Persons , Information TechnologyABSTRACT
El presente documento es una guía para el reconocimiento y registro de la pertenencia étnica en el Certificado de Discapacidad. Variable recientemente incorporada en la actualización del HIS DSCAP WEB, versión 2.0
Subject(s)
Information Systems , Ethnicity , Certification , Disabled Persons , Cultural Diversity , Health Equity , Ethnic DistributionABSTRACT
En el marco de la difusión e implementación de la NTS N° 127-MINSA/2016/DGIESP "Evaluación, Calificación y Certificación de la persona con discapacidad" y en coordinación con el Instituto Nacional de Rehabilitación, se elaboró el plan de implementación, dándose inicio a la capacitación de médicos rehabilitadores, otras especialidades relacionadas al diagnóstico de la discapacidad, en uso del instrumento y a los médicos generales, en generar las competencias para la evaluación, calificación y certificación de la persona con discapacidad, así como la Certificación de la Discapacidad
Subject(s)
Specialization , Certification , Disabled Persons , Diagnosis , General PractitionersABSTRACT
En el marco de la difusión e implementación de la NTS N° 127-MINSA/2016/DGIESP "Evaluación, Calificación y Certificación de la persona con discapacidad" y en coordinación con el Instituto Nacional de Rehabilitación, se elaboró el plan de implementación, dándose inicio a la capacitación de médicos rehabilitadores, otras especialidades relacionadas al diagnóstico de la discapacidad, en uso del instrumento y a los médicos generales, en generar las competencias para la evaluación, calificación y certificación de la persona con discapacidad. La presente publicación pertenece al compendio Caja de Herramientas para la Certificación de la Discapacidad
Subject(s)
National Health Strategies , Handicapped Advocacy , Certification , Disabled Persons , Mentoring , Health PrioritiesABSTRACT
This study assessed the relative risk of using male and partner contraceptive methods relative to non-use, identified the types of methods preferred by participants, and assessed the associated determinants of the use of male and partner methods. It used secondary data from the Demographic and Health Surveys conducted in Lesotho, Namibia, South Africa, and Zimbabwe. Participants were sexually active men aged 1554. The study found that 32% of respondents did not utilize any method, while 36% and 32% used partner and male methods, respectively. The male method was more prevalent among men who had two or more sexual partners and among urban dwellers, while the partner method was predominant among those with less than two children and those who were indifferent about whether contraception is a woman's business. The study recommends that family planning programs should pay attention to male contraceptive needs and concerns. (Afr J Reprod Health 2022; 26[6]:27-35).
Subject(s)
Humans , Male , Community Health Workers , Contraceptive Agents, Male , Certification , Contraceptive Agents , Klinefelter SyndromeABSTRACT
Background:Ethiopia utilisesthedistrict health information systemfor health information management. However,the lower level health structure seems inaccurate in comparisonto theparallel reportingsystem, withlimited evidence on its effect ondata quality and information use.Therefore,the present study aimed to assess the influence of a parallel reporting system on data quality and information use at the lower level structuresof the Amhara region, Northwest Ethiopia.Methods:The study was conducted in five districts of the Amhara region using an explanatory case study design. Twenty respondents were interviewed from the 1st30thApril 2021,usinga semi-structured key informant interview(KII)guide with multiple probes to explore relevant information. The data was transcribed into English and transferred to the Open-Code 4.02 software for analysis. Textual data werecoded, and themes were identified from the synthesis. Inductive thematic analysis was applied to identify the relationships among the emerging themes in order todraw a relevant conclusion. Results:Five themeswere emerged fromthe analysis, includingthe current practice of parallel reporting, a program area of parallel reporting, the influence of parallel reporting, reasonsfor parallel reporting,and means to avoid parallel reporting.Likewise, parallelreportingwasdone at the district level and at the point of service delivery. The respondents described maternal and child health programs often usingparallel reporting. Parallel reporting was described as havingundesirable impacts on routinely collected health data quality and use. Moreover, it increases the work burden; andaffects service quality,the the satisfactionlevelsof clients and staff, and the overall efficiency. The main reasons for practicingparallel reporting were:missing important data elements in DHIS2, single language, varying stakeholders' interests, and lack of conductinga partnerforum.Conclusion and implication:Against the national health information system'sguiding principlesand vision, parallelreporting is practicedat the lower health system levelsfor various programs. Therefore, a corrective measure should be taken to achieve the country's information revolution (IR) agenda. To avoid parallel reporting mechanisms, it is recommended that regular partner forums at the district level must be strengthened, important data elements should beincorporated into the DHIS 2, and additional language platforms should be be included in theDHIS2 system.
Subject(s)
Humans , Parallel Lagoons , Data Accuracy , Abortifacient Agents , Certification , Lower ExtremityABSTRACT
RESUMO Objetivo: relatar a experiência da implantação de Linhas de Cuidado com base na Resolução Normativa (RN) 440, em um serviço de Atenção Primária à Saúde (APS) Suplementar. Método: estudo qualitativo, de caráter descritivo, que consiste em um relato de experiência sobre o processo de implantação das Linhas de Cuidado com base na RN 440, de janeiro a abril de 2020. O processo de estruturação foi realizado por duas enfermeiras, durante quatro meses, para a organização dos fluxos, protocolos e processo de trabalho da equipe, norteado pelo Manual de Certificação de Boas Práticas em APS de Operadoras de Planos Privados de Assistência à Saúde. Discussão: a adesão à certificação deu direcionamento para a reestruturação da APS com base legal e científica em todos os âmbitos do serviço. Levando em consideração a população alvo do serviço e o perfil epidemiológico, foram estabelecidas quatro Linhas de Cuidado: Saúde da Mulher; Saúde Mental; Hipertensos e Diabéticos. Considerações finais: um desafio nesse processo é a inserção da cultura de autocuidado e do entendimento do usuário frente a esse modelo de atenção. Sugere-se a realização de pesquisas sobre a Certificação em Boas Práticas da APS Suplementar, devido à escassez de estudos sobre a temática.
RESUMEN Objetivo: relatar la experiencia de la implantación de Líneas de Cuidado con base en la Resolución Normativa (RN) 440, en un servicio de Atención Primaria de Salud (APS) Complementaria. Método: estudio cualitativo, de carácter descriptivo, que consiste en un relato de experiencia sobre el proceso de implantación de las Líneas de Cuidado con base en la RN 440, de enero a abril de 2020. El proceso de estructuración fue realizado por dos enfermeras, durante cuatro meses, para la organización de los flujos, protocolos y proceso de trabajo del equipo, guiado por el Manual de Certificación de Buenas Prácticas en APS de Operadores de Planes Privados de Asistencia a la Salud. Discusión: la adhesión a la certificación puso em marcha la reestructuración de la APS con base legal y científica en todos los ámbitos del servicio. Teniendo en cuenta la población objetivo del servicio y el perfil epidemiológico, se establecieron cuatro Líneas de Cuidado: Salud de la Mujer; Salud Mental; Hipertensos y Diabéticos. Consideraciones finales: un desafío en este proceso es la inserción de la cultura de autocuidado y del entendimiento del usuario frente a este modelo de atención. Se sugiere la realización de investigaciones sobre la Certificación en Buenas Prácticas de la APS Complementaria, debido a la escasez de estudios sobre la temática.
ABSTRACT Objective: to report the experience of the implementation of Lines of Care based on Normative Resolution (NR) 440, in a Supplementary Primary Health Care (PHC) service. Method: qualitative, descriptive study, which consists of an experience report on the process of implementation of the Lines of Care based on RN 440, from January to April 2020. The structuring process was carried out by two nurses, during four months, for the organization of the team's flows, protocols and work process, based on the Manual of Certification of Good Practices in PHC of Private Health Care Plan Operators. Discussion: the certification's access gave direction for the restructuring of PHC on a legal and scientific basis in all areas of the service. Taking into account the target population of the service and the epidemiological profile, four Lines of Care were established: Women's Health; Mental Health; Hypertensive and Diabetic. Final considerations: a challenge in this process is the insertion of the culture of self-care and the user's understanding of this model of care. It is suggested to conduct research on the Certification in Good Practices of Supplementary PHC, due to the scarcity of studies on the subject.
Subject(s)
Primary Health Care , Certification , Health , Health Services , Accreditation , Patient Care Team , Population , Self Care , Work , Health Profile , Organizations , Culture , Delivery of Health Care , Empathy , Supplemental Health , Health Services Needs and Demand , NursesABSTRACT
O queijo Canastra possui grande importância na cultura e economia local, é parte do Patrimônio Imaterial do Brasil (IPHAN, 2014) e recebeu o selo de produto com designação de origem em 2012 (INPI, 2016). Sua produção utiliza leite, sal, coalho e uma cultura iniciadora natural, chamada popularmente de pingo. Esse estudo visou a caracterização da microbiota presente no queijo maturado da Serra da Canastra e no pingo utilizado em sua produção utilizando técnicas avançadas de sequenciamento em larga escala para identificação das bactérias e fungos ali presentes. Nossos dados da microbiota bacteriana foram comparados com dados da microbiota de outros queijos brasileiros e do mundo disponíveis na literatura. As principais bactérias encontradas em amostras de pingo pertencem aos gêneros Lactococcus (45.6%), Streptococcus (30.3%), Staphylococcus (5.1%), e em amostras de queijo aos gêneros Lactococcus (22.5%), Streptococcus (27.2%), Corynebacterium (18.8%), Staphylococcus (13.6%), Leuconostoc (6.3%) e Weissella (6%). Os principais gêneros de fungos encontrados nos queijos foram Debaryomycesa (78.6%), Trichosporona (7.8%). Nosso estudo foi capaz de separar a microbiota dos queijos produzidos na Serra da Canastra de outros queijos na Europa e América do Norte, sendo o pH um possível fator de segregação. Também foi observada uma diferença entre a microbiota do queijo Canastra com outros queijos Brasileiros. Além disso, visualizamos que a distância geográfica entre produtores e a sazonalidade possuem um efeito sobre a microbiota dos pingos e queijos. A partir da análise de todos os microrganismos encontrados na microbiota bacteriana, foram detectados táxons que discriminam produtores por suas aplicações de boas práticas de fabricação e por sua infraestrutura. Observamos proporções menores de um táxon de Kocuria Kristinae nos pingos e um de Streptococcus nos queijos e proporções maiores de um táxon de Staphylococcus nos queijos. Também pudemos observar uma diminuição nas proporções de táxons de Debaryomycesa e aumento na proporção de táxons de Trichosporona na composição fúngica dos queijos, possivelmente devido a transição sazonal do período seco para o chuvoso. Usando técnicas moleculares de sequenciamento em larga escala, demonstramos que há uma diferença na microbiota presente em diferentes áreas da Serra da Canastra, um possível efeito da sazonalidade na composição fúngica e bacteriana. E evidenciamos que táxons de Streptococcus, Staphylococcus e Kocuria estão correlacionados às boas práticas de produção e elucidamos a conexão existente entre a microbiota do pingo e a do queijo. Estes resultados podem influenciar o desenvolvimento de métodos de rastreamento de sub-regiões específicas da Canastra e auxiliar os produtores na produção de queijos de boa qualidade, mantendo as características específicas de sua região
The Canastra cheese has great importance for the local culture and economy, being part of the Intangible Heritage of Brazil (IPHAN, 2014). It has received the protected designation of origin certification in 2012 (INPI, 2016). It's made using milk, salt, rennet and a endogenous starter culture, popularly called as "pingo". This study aimed to characterize the microbiota present in the Serra da Canastra's cheese and the pingo used in its production. In order to conduct this research we used next generation sequencing to identify the bacteria and fungi present there. Our bacterial microbiota dataset was compared with microbiota datasets from other Brazilian and world cheeses available in the literature. The main bacteria found were Lactococcus (45.6%), Streptococcus (30.3%) and Staphylococcus (5.1%) in the endogenous starter samples and Lactococcus (22.5%), Streptococcus (27.2%), Corynebacterium (18.8 %), Staphylococcus (13.6%), Leuconostoc (6.3%) and Weissella (6%) in cheese samples. The main fungi found in the cheeses were Debaryomycesa (78.6%) and Trichosporona (7.8%). We were able to separate the microbiota from Serra da Canastra cheeses and other cheeses in Europe and North America, being the pH a possible segregation factor. Furthermore, a difference was also observed between the microbiota of Canastra and other Brazilian cheeses. In addition, we observed that the geographical distance between producers and the seasonality could be affecting the pingos and cheeses microbiota. We found bacterial taxa that could discriminate producers by their good manufacturing practices and their local infrastructure. Low levels of good manufacturing practices (GMPs) were assigned to bigger proportions of a Kocuria Kristinae taxon in the pingos and a Staphylococcus taxon in the cheeses. Also, higher levels of GMPs were assigned to smaller proportions of Streptococcus taxons in the cheeses. Furthermore We could observe a decrease of Debaryomycesa and an increase of Trichosporona proportions in the fungal composition of cheeses. This could be due to a climate transition: from the dry season to the rainy season. Using large-scale sampling coupled with molecular sequencing techniques, we observe a connection between pingo and cheeses microbiota. We show that the microbiota of different areas in Serra da Canastra is different, also, there is a possible effect of seasonality on fungal and bacterial composition. Furthermore, we could see that Streptococcus, Staphylococcus and Kocuria taxons are correlated with good practices. These results may influence the development of tracking methods for specific Canastra subregions and assist producers to manufacture good quality cheeses while maintaining the specific characteristics of their region
Subject(s)
Cheese/analysis , Good Manufacturing Practices , Microbiota , Bacteria/isolation & purification , Certification/standards , Total Quality Management , Corynebacterium/isolation & purification , MilkABSTRACT
According to the teaching philosophy of the outcome-based education, this study elaborates the development of a practical innovation course for biological engineering major after five runs of teaching practice and continuous improvement. It mainly includes the methods for selection of teaching subjects, implementation of teaching process, process assessment, evaluation and improvement. Based on the performance and achievements of three grades of students majored in bioengineering, we found that the logic and methods of the practical innovation course could greatly stimulate the motivation of students for learning, as well as their scores. Therefore, the logic and methods described in this study may serve as a reference for the reforms of practical training courses of engineering major under the background of Engineering Education Certification.