Type 1 diabetes care delivery in Yaoundé, Cameroon: Social and political representations

Background: Increasing chronic diseases challenges the health systems of low- and middleincome countries, including Cameroon. Type 1 diabetes (T1D), among the most common chronic diseases in children, poses particular care delivery challenges. Aim: We examined social representations of patients' roles and implementation of T1D care among political decision-makers, healthcare providers and patients within families. Setting: The study was conducted in Yaoundé, Cameroon. Methods: Eighty-two individuals were included in the study. The authors conducted semistructured interviews with policy makers (n = 5), healthcare professionals (n = 7) and patients 'parents (n = 20). Questionnaires were administered to paediatric patients with T1D (n = 50). The authors also observed care delivery at a referral hospital and at a T1D-focused nongovernmental organisation over 15 days. Data were analysed using thematic content analysis and descriptive statistics. Results: Cameroonian health policy portrays patients with T1D as passive recipients of care. While many practitioners recognised the complex social and economic determinants of adherence to T1D care, in practice interactions focused on specific biomedical issues and offered brief guidance. Cultural barriers and policy implementation challenges prevent patients and their families from being fully active participants in care. Parents and children prefer an ongoing relationship with a single clinician and interactions with other patients and families. Conclusion: Patients and families mobilise experience and lay knowledge to complement biomedical knowledge, but top-down policy and clinical practice limit their active engagement in T1D care. Contribution: Children with T1D and their families, policy makers, healthcare professionals, and civil society have new opportunities to contribute to person-centred care, as advocated by the Sustainable Development Goals.

Prácticas y creencias con el uso de plantas medicinales en lactantes de San Andrés Isla

Introducción: El uso de plantas medicinales es parte de la cultura tradicional de muchas poblaciones alrededor del mundo, se utilizan para prevenir enfermedades y preservar la salud de los individuos, siendo un conocimiento que conservan las madres y abuelas para el cuidado de la primera infancia. Sin embargo, existen muchos vacíos en la investigación con respecto al uso y propiedades de plantas medicinales en lactantes y población general. Objetivo: Analizar y describir las prácticas y creencias con el uso ancestral de plantas medicinales en lactantes de la comunidad raizal en San Andrés Isla. Materiales y métodos: Estudio cualitativo descriptivo etnográfico aplicado a una muestra por conveniencia de ocho abuelas de la comunidad Raizal de San Andrés Isla. Se realizó la descripción y el análisis de las ideas, prácticas sociales, comportamientos, creencias, significados y conocimientos en torno al uso de plantas medicinales en lactantes. Resultados: Aún se conservan los conocimientos ancestrales con el uso de plantas medicinales liderado por las abuelas. El uso de plantas medicinales en lactantes se rige únicamente por la necesidad de manejo de situaciones de salud. En esta investigación se encontraron 23 ejemplares de plantas medicinales de uso en lactantes, de estas son pocas las que se encuentran registradas en el vademécum colombiano de plantas medicinales. Discusión: Los hallazgos concuerdan con los resultados de otros estudios que evidencian la importancia de la tradición cultural en el cuidado de los lactantes, el protagonismo de la experiencia acumulada de las abuelas en estos saberes y prácticas; además de corroborar que el uso de plantas medicinales en lactantes se rige únicamente por la necesidad de cuidado ante situaciones de salud que lo ameritan. Solo dos ejemplares de las plantas medicinales clasificadas por las mujeres raizales de este estudio se encuentran referenciadas en el vademécum colombiano de plantas medicinales. Conclusiones: Las plantas medicinales abordan un amplio espectro de usos y propiedades que necesitan un extenso estudio para su registro y divulgación.

Introduction: The use of medicinal plants is part of the traditional culture of many populations around the world. Used to prevent diseases and preserve the health of individuals, it is a knowledge that mothers and grandmothers keep for early childhood care. However, there are many gaps in research regarding the use and properties of medicinal plants in infants and the general population. Objective: Analyze and describe the practices and beliefs with the ancestral use of medicinal plants in infants by the Raizal community in San Andrés Island. Materials and methods: It's a qualitative study with a descriptive ethnographic design applied to a convenience sample of 8 grandmothers from the Raizal community of San Andrés Island. We made out a description and analysis of the ideas, social practices, behaviors, beliefs, meanings, and knowledge about the uses of medicinal plants on infants. Results: The ancestral knowledge of medicinal plants use led by the grandmothers still persevered. The use of medicinal plants on infants administers only to the need of health situations. The investigation found 23 specimens of medicinal plants used in infant breastmilk, just a few plants found in this study are registered in the Colombian Vademecum of medicinal plants. Discussion: The findings agree with the results of other studies that show the importance of cultural traditions in the care of infants, the role of the accumulated experience of grandmothers in this knowledge and practices. In addition to corroborating that the use of medicinal plants in infants is governed solely by the need for care in health situations that warrant it. Only two specimens of the medicinal plants classified by the Raizal women in this study are referenced in the Colombian Vademecum of medicinal plants. Conclusion: Medicinal plants address a wide spectrum of uses and properties that need extensive study for their registration and dissemination.

Systemic emergency department performance in a low resource tertiary health facility in central Kenya: Micro level emergency care system evaluation

Introduction Helicopter Emergency Medical Services (HEMS) is integrated into modern emergency medical services because of its suggested mortality benefit in certain patient populations, it is an expensive resource and appropriate use/feasibility in low- to middle income countries (LMIC) is highly debated. To maximise benefit, correct patient selection in HEMS is paramount. To achieve this, current practices first need to be described. The study aims to describe a population of patients utilising HEMS in South Africa, in terms of flight data, patient demographics, provisional diagnosis, as well as clinical characteristics and interventions. Methods A retrospective flight- and patient-chart review were conducted, extracting clinical and mission data of a single aeromedical operator in South Africa, over a 12-month period (July 2017 ­ June 2018) in Gauteng, Free State, Mpumalanga and North-West provinces. Results A total of 916 cases were included (203 primary cases, 713 interfacility transport (IFT) cases). Most patients transported were male (n=548, 59.8%) and suffered blunt trauma (n=379, 41.4%). Medical pathology (n=247, 27%) and neonatal transfers (n=184, 20.1%) follows. Flights occurred mainly in daylight hours (n=729, 79.6%) with median mission times of 1-hour 53 minutes (primary missions), and 3 hours 10 minutes (IFT missions). Median on-scene times were 26 minutes (primary missions) and 55 minutes (IFT missions). Almost half were transported with an endotracheal tube (n=428, 46.7%), with a large number receiving no respiratory support (n=414, 45.2%). No patients received fibrinolysis, defibrillation, cardioversion or cardiac pacing. Intravenous fluid therapy (n=867, 94.7%) was almost universal, with common administration of sedation (n=430, 46.9%) and analgesia (n=329, 35.9%). Conclusion Apart from the lack of universal call-out criteria and response to the high burden of trauma, HEMS seem to fulfil an important critical care transport role. It seems that cardiac pathologies are under-represented in this study and might have an important implication for crew training requirements.

Visualization analysis of the current situation of tiered health care system of type 2 diabetes in China based on CiteSpace / 公共卫生与预防医学

Objective To analyze the research hotspot and development trend of tiered health care system of type 2 diabetes in China. Methods The relevant research in the field of the tiered health care system of type 2 diabetes in China was sorted out and summarized by using CNKI, WangFang, VIP and Web of Science databases as search objects, and the relevant literature collected between January 1, 2009, and September 28, 2022, was searched. CiteSpace was used to describe the number of articles published, high-frequency keywords, emerging words, and trends. Results A total of 147 valid papers were included. The overall volume of related articles published showed an upward trend. After visual analysis, nine clusters were obtained, including family doctors, tiered health care system, health service system, and primary care. In the past two years, the research trends were mainly focused on primary care, general practitioners, specialist nurses, and quality of survival. Conclusion Research hotspots are focused on the areas of hierarchical diagnosis and treatment, primary care, family doctors, and community health services, with the words “medical association” and “specialist nurse” emerging in the past two years. In the future, research should be devoted to improving the tiered health care system of type 2 diabetes and opening up a multi-level cooperative research model, so as to effectively bring into play the advantages and effects of the tiered health care system.

Role Of "Aardram Mission" In Delivering Public Health Care Services In The State

“Mission Aardram” synonymously can be called as pillar of Kerala model of Development as it has been implemented for the provision of wellbeing of the citizen. Developing nations are facing issues related to the health care offered by the nation to its public hence in turn affect its human development index (HDI). Life Expectancy Index, Education Index and Gross National Income index are the different indicators of HDI which comes from the different dimensions, say, Long and healthy life, knowledge and a decent standard of living respectively. Mission Aardram is concentrating more on the first dimension of HDI, i.e.; Long and healthy Life. In order to keep its people healthy, the state of Kerala has taken an initiative called “Mission Aardram” as part of “Nava Kerala Karma Padhathi”. The Government of Kerala has implemented such a Novel scheme to provide good health care to its people by transforming all Primary Health Centres (PHC) into Family Health Centres (FHC) as the first stage health delivery point, then they intend to strengthen the system by offering five kinds of services, namely, Promotive services, Preventive Services, Palliative services, Rehabilitative services and Curative services. It is mentioned by the Institute of Medicine (IOM) that Mission Aardram has the main six characteristics that should have in any good quality health care system. As per the word of IOM if a health care system is said to be of good quality if and only if the system has Patient safety, Effectiveness, Efficiency, Patient-centered focus, Timely Referral Care and equity in treatment. Hence it is important to evaluate the role of Mission Aardram in delivering public health care by analyzing the above-mentioned factors.

Sistema de salud en Japón y su énfasis en la protección de la salud oral: una comparación con Chile / Oral health system in Japan: a comparation with Chile

Japón está compuesto por 126 millones de habitantes y corresponde a la tercera potencia económica mundial. El sistema de salud se basa en un único seguro obligatorio universal, con cobertura médica y odontológica. En las últimas décadas, el envejecimiento poblacional ha sido un punto importante a considerar en la planificación de políticas públicas sanitarias. La eficiencia de este sistema ha sido punto de comparación con distintos países, no así con Chile. Por ello, el objetivo de esta revisión narrativa es comparar el sistema de salud oral chileno y japonés. Se realizó una revisión narrativa utilizando los repositorios de revistas científicas Science Direct, y PubMed, así como publicaciones disponibles en páginas gubernamentales de Japón y Chile.El seguro japonés prioriza la promoción de salud y prevención de enfermedades, enfatizando en la población más vulnerable. Al contrario, en Chile el sistema de salud tiene énfasis en la curación y rehabilitación. Japón ha adoptado un seguro debido a la transición demográfica y epidemiológica, para garantizar la sustentabilidad del sistema en el tiempo, modelo que podría ser aplicado en Chile; considerando el envejecimiento poblacional y la carga de enfermedades crónicas no transmisibles. Ambos países tienen ventajas y limitaciones en los atributos de sus sistemas de salud. Chile tiene una Red integrada de servicios de salud y ha implementado políticas como GES. Japón tiene un sistema universal, más eficiente y equitativo. Las fortalezas del sistema japonés podrían implementarse en Chile, a través de nuevas políticas públicas que fortalezcan la salud del país, incluyendo la odontología.

Japan has a population of 126 million, and it is the third national economy in the world. The health system is on a single universal mandatory insurance, with medical and dental coverage. In the last decades, Japan has faced the ageing of its population, and this has been a relevant matter in the planning of public health policies. The efficiency of the health system has been a point of comparison in different countries, but not in Chile. Thus, the objective of this narrative review is to compare the Chilean oral-health system with the Japanese.A non-systematic review was made using Science Direct, PubMed repositories of journals and official Japanese and Chilean government pages. The Japanese healthcare insurance prioritizes health promotion and disease prevention, emphasizing the most vulnerable population. Conversely, Chile has a health system that focalizes on healing and rehabilitation. Japan has adopted insurance because of the demographic transition to guarantee the system's sustainability. Considering the increased ageing population and the non-communicable disease load, this insurance model could be applied in Chile.Both Chile and Japan have advantages and limitations regarding the attributes of their health systems. Japan has a universal, more efficient, and equitable system. Chile should study the strengths of the Japanese system for its implementation of new public policies that strengthen the country's health, including dentistry.

Fatores que influenciam a via de parto no Brasil / Factor influencing the mode of delivery in Brazil

Introdução: A prevalência de cesarianas cresceu no Brasil. Gestação e parto são influenciados por aspectos culturais e econômicos da sociedade em que a gestante está inserida. Objetivo: Analisar fatores que influenciam a escolha da via de parto pela gestante. Métodos: Trata-se de revisão narrativa da literatura incluindo artigos publicados entre 2009 e 2020. Foram feitas buscas nas bases de dados Pubmed, LILACS e SciELO, com descritores "Bioética", "Cesárea", "Comportamento de escolha", "Decisão", "Direitos da mulher", "Gravidez", "Parto", "Parto normal", "Sistema único de saúde". Resultados: Foram encontradas taxas de cesariana no setor privado maiores do que no público. Menor idade materna e escolaridade, raça negra, residência em meio rural e nas regiões Norte e Nordeste foram associados a menor prevalência de cesariana. Obesidade materna, cesariana prévia, intercorrências na gravidez, apresentação fetal não cefálica, macrossomia estiveram mais relacionados a cesariana. Dor, previsibilidade, relação da mãe com o recém-nascido, alta hospitalar, vida sexual e retorno às atividades foram relacionados a escolha do parto vaginal. Discussão: A disparidade de cesarianas no setor público e privado sugere o impacto de aspectos financeiros na escolha. Variáveis socioeconômicas são importantes nessa decisão. Conclusões: A escolha da via de parto é influenciada por vários fatores. [au]

Introduction: The prevalence of caesarean sections has grown in Brazil. Pregnancy and childbirth are influenced by cultural and economic aspects of the society in which the pregnant woman is inserted. Objective: To analyze factors that influence the choice of the mode of delivery by the pregnant woman. Methods:This is a narrative literature review including articles published between 2009 and 2020. Searches were made in Pubmed, LILACS and SciELO databases, with descriptors "Bioethics", "Caesarean section", "Choice behavior", "Decision", "Women's rights", "Pregnancy", "Childbirth", "Normal delivery" and "The Unified Brazilian Health Care System". Results: Caesarean section rates were found to be higher in the private sector than in the public sector. Lower maternal age and education, black race, residence in rural areas and in the North and Northeast regions were associated with lower prevalence of caesarean section. Maternal obesity, previous caesarean section, complications in pregnancy, non-cephalic fetal presentation and macrosomia were more related to caesarean section. Pain, predictability, mother's relationship with the newborn, hospital discharge, sexual life and return to activities were related to the choice of vaginal delivery. Discussion: The disparity of caesarean sections in the public and private sectors suggests the impact of financial aspects on the choice. Socioeconomic variables are important in this decision. Conclusions: The choice of mode of delivery is influenced by several factors. [au]

Cambio en la mortalidad intrahospitalaria durante el primer pico por SARS- COV-2 en Bogotá, Colombia / Change of in-hospital mortality during the first SARS-COV-2 surge in Bogotá, Colombia

Resumen Introducción: La mortalidad por SARS-COV-2 ha disminuido en diferentes países, pero no se ha evaluado si es igual en Colombia, o si se relaciona con las carac terísticas de los pacientes y tratamientos utilizados. Objetivo: Comparar la mortalidad por SARS-COV-2, en dos periodos de tiempo controlando por factores de riesgo asociados con mortalidad. Metodología: Estudio observacional, basado en una cohorte retrospectiva de pacientes con SARS-COV-2 atendidos en el Hospital Universitario San Ignacio, Bogotá (Colombia), desde el 19 de marzo al 12 de noviembre, 2020. Se comparó la tasa de mortalidad intrahospitalaria de los pacientes egresados antes y después del 21 de agosto de 2020 (primer pico de mortalidad en Colombia) y se analizó el impacto del momento de atención controlando por comorbilidades, severidad al ingreso y tratamiento recibido, usando un modelo de regresión logística. Resultados: 1399 pacientes (944 antes y 455 después del primer pico de mortalidad) fueron analizados. La tasa de mortalidad intrahospitalaria global fue similar en ambos periodos (17.6% vs 16.3%, p=0.539). En el análisis multivariado se encontró que la atención en el segundo periodo de tiempo se asoció a menor mortalidad (OR 0.66 IC95% 0.47; 0.93, p=0.018), a diferencia del aumento de la misma asociado a la edad (OR 1.06 IC95% 1.05; 1.07, p<0.001), sexo masculino (OR 1.84 IC95% 1.33; 2.54 p<0.001), cirrosis (OR 1.89 IC95% 1.24; 2.88, p=0.003), enfermedad renal (OR 1.36 IC95% 1.00; 1.83, p=0.043) y el uso de dexametasona (OR 1.53 IC95% 1.03; 2.28, p=0.031). Conclusiones: La tasa de mortalidad intrahospitalaria se redujo después del 21 de agosto durante la primera ola de la pandemia en Bogotá, posiblemente asociado a la mejoría en la capacidad de respuesta del sistema de salud en ese momento, o a un menor inoculo viral de los pacientes infectados. Estos hallazgos pueden cambiar con la saturación del sistema de salud.

Abstract Introduction: Mortality secondary to SARS-COV 2 has decreases around the world, however this has not been evaluated in Colombia neither has the correlation between patient characteristics or treatments. Objective: To compare the mortality due to SARS-COV-2, in two periods of time, controlling risk factors associated with mortality. Methodology: Observational retrospective cohort study of patients with SARS- COV-2 treated at the San Ignacio University Hospital in Bogotá (Colombia), from March 19 to November 12, 2020. The in-hospital mortality rate of patients discharged before and after August 21, 2020 (surge mortality in Colombia) was com pared. The impact of the moment of attention was analyzed controlled by comorbidities, severity at admission and treatment received using a bivariate and multivariate logistic regression model. Results: 1399 patients (944 before and 455 after August 21) were analyzed. The overall in-hospital mortality rate was similar at both times (17.6%vs16.3percentage, p=0.539). In the multivariate analysis, it was found that the moment of attention was associated with lower mortality (OR 0.66 95% CI0.47;0.93,p=0.018), in contrast to its increase associated with age (OR 1.06 95% CI 1.05;1.07,p=<0.001), male sex (OR 1.84 95%CI 1.33;2.54,p=<0.001), cirrhosis (OR1.89 95%CI 1.24;2.88, p=0.003), kidney disease (OR 1.36 95% CI1.00;1.83,p=0.043) and the use of dexamethasone (OR1.53 95%CI 1.03;2.28,p=0.031). Conclusions: The in-hospital mortality rate fell after August 21 during the first wave of the pandemic in Bogotá-Colombia, possibly associated with an improvement in response capacity, or a lower viral inoculum of infected patients. These findings may change with the saturation of the health system

Predict the hospitalization in COVID-19: Magic is in the air

Background: Although pathogenesis and pattern of disease are still not completely understood, tactical management of overcrowding of hospitals and rational usage of resources is the need of the hour. Aims and Objectives: The study objectives were as follows: Finding of correlation between various attributes of COVID; evaluation of the association of common characteristics with hospital stay; prediction of cooccurrence of different symptoms; calculation of odds ratio of prolonged hospitalization due to various symptoms; and estimation of the rate of prolonged hospitalization due to different symptoms and comorbidities. Materials and Methods: Retrospective data of 6918 COVID-19-positive cases from SCB Medical College and Hospital, India, were obtained from the hospital records from March 2020 to January 2021. The patients’ age, gender, symptoms, and comorbidities were analyzed against their hospital stay using R software (version 4.0.2). Results: Elderly patients (>65 years) had a higher rate (91.22%) of prolonged hospital stay as compared to others (47.61%). Frequently observed symptoms (in decreasing order) were fever (73.93%), cough (67.52%), myalgia (62.11%), dyspnea (49.59%), dizziness (47.38%), and anosmia (44.10%). The risk of prolonged hospitalization was highest with dyspnea [odds ratio: 2.29 (95% confidence interval: 2.07–2.52)], followed by diarrhea [odds ratio [OR] 1.98 (confidence interval [CI] 1.77–2.21)], fever [OR 1.89 (CI 1.69–2.10)], anosmia [OR 1.86 (CI 1.69–2.05)], and dizziness [OR 1.46 (CI 1.32–1.60)]. The rate of hospitalization for more than 7 days was highest with diabetes (86.80%) followed by respiratory illnesses (71.85%) and hypertension (71.28%). Conclusion: These findings can help manage patients based on their symptoms and comorbidities before admission.

Composición y evolución del gasto en salud de Colombia y su financiamiento en el periodo 2013-2018 / Composition and evolution of Colombia's health expenditure and its financing in the period 2013-2018

RESUMEN Objetivo Examinar la magnitud, la composición y evolución del gasto en salud de Colombia y su forma de financiamiento durante el periodo 2013 2018, con el propósito de aportar evidencia reciente para el mejor conocimiento y seguimiento de los flujos de recursos del sistema de salud. Métodos El análisis se sustenta en los conceptos y clasificaciones de la metodología SHA-2011 adoptada en la actualidad por la mayoría de los países miembros de la Organización Mundial de la Salud para sus estimaciones anuales del gasto en salud. La fuente principal de información es la base de datos de gasto global en salud de la misma entidad, algunos de cuyos resultados se complementan con cálculos adicionales utilizando fuentes oficiales nacionales. Resultados Desde el lado del gasto, el componente más importante corresponde al gasto público en salud, el cual representa, en promedio, 76,4% del gasto corriente en salud para el periodo en referencia, cuyo financiamiento con recursos públicos fiscales y contribuciones a la seguridad social representa 70,6% del financiamiento total; en tanto que el restante 23,6% corresponde al financiamiento privado representado por los pagos de bolsillo de los hogares (15,8%) y los pagos de seguros voluntarios (7,8%) también como promedios del mismo periodo. Conclusiones Colombia, como la mayoría de los países latinoamericanos, sigue un modelo de financiamiento predominantemente público, cuya composición de fondos registró un cambio en favor de los recursos de origen fiscal, como resultado de un cambio en las políticas de financiamiento durante el periodo analizado.

ABSTRACT Objective Examine the magnitude, composition, and evolution of health spending in Colombia and its financing methodology between the period 2013-2018. The aim is to provide recent evidence for better understanding and monitoring the health system flows resources. Methods The analysis focuses on concepts and classifications of the SHA-2011 methodology, currently adopted by most World Health Organization member countries in their annual health spending estimates. The primary source of information is the global health expenditure database from the same entity, whose results are comple-mented with additional calculations using official national sources. Results Considering the spending side, the most relevant component refers to public spending on health, which represents, on average, 76.4% of the current health spending and whose financing with public fiscal resources and contributions to security social, represents 70.6% of total financing. The remaining 23.6% corresponds to private financing spending, representing average values for out-of-pocket household payments (15.8%) and voluntary insurance payments (7.8%). Conclusions Colombia, like most Latin American countries, follows a predominantly public financing model, in which funds composition registered a positive change in fiscal resources as a result of financing policies adopted during the analyzed period.

El Psicólogo en el Primer Nivel de Atención de Salud: desafíos para Uruguay

Resumen: En Uruguay cada vez más se reconoce la importancia del profesional psicólogo en el Primer Nivel de Atención (PNA). En la actualidad se transita una oportunidad única ya que el Plan Nacional de Salud Mental 2020-2027 (PNSM) recientemente aprobado, plantea su incorporación en forma expresa. El presente artículo analiza el rol del psicólogo en el PNA, realiza un recorrido internacional seleccionando algunos países en los que se muestran diversos modos de incorporación de los psicólogos en este rol. Se aborda a continuación cuál es la situación del psicólogo en el PNA en Uruguay. Por último, se plantean algunos de los desafíos que implica renovar el trabajo tradicional del psicólogo clínico, e incorporar las competencias y prácticas profesionales características del PNA.

Abstract: In Uruguay, the importance of the professional psychologist in the First Level of Health Care (PNA) is increasingly recognized, and currently there is a unique opportunity since the recently approved National Mental Health Plan 2020-2027 (PNSM), raises its incorporation expressly. This article analyzes the role of the psychologist in PNA, makes an international review selecting some countries in which the various ways in which psychologists have been incorporated into this role are shown. The situation of the psychologist in the PNA in Uruguay is discussed below. Finally, some of the challenges faced are raised, which implies renewing the traditional role of the clinical psychologist, and incorporating the competencies and professional practices characteristic of the PNA.

Resumo: No Uruguai, a importância do psicólogo profissional no Primeiro Nível de Atenção de Saúde (PNA) é cada vez mais reconhecida, e atualmente existe uma oportunidade única desde o recém-aprovado Plano Nacional de Saúde Mental 2020-2027 (PNSM), levanta expressamente a sua incorporação. Este artigo faz análise do papel do psicólogo na PNA, faz uma revisão internacional selecionando alguns países nos quais são mostradas as diversas formas pelas quais os psicólogos foram incorporados a essa função. A seguir se discute a situação do psicólogo na PNA do Uruguai. Por fim, são apresentados alguns dos desafios que implica a renovação do papel tradicional do psicólogo clínico e incorporar as competências e práticas profissionais próprias da PNA.

COVID-19 e instituciones de cuidados a largo plazo en México: una deuda impostergable / COVID-19 and long-term care facilities in Mexico: a debt that cannot be postponed

Resumen Ante la pandemia de COVID-19, el grupo más afectado ha sido el de las personas mayores que viven en instituciones de cuidados a largo plazo (ICLP), el cual ha acumulado entre 30 y 60 % de los fallecimientos en el mundo. En México se han reportado brotes en residencias de por lo menos ocho entidades federativas. Diversos factores hacen susceptibles a este grupo y a las ICLP: la convivencia en lugares comunes, dormitorios compartidos y el contacto físico con el personal que ahí labora, aunados a la falta de protocolos y estándares de cuidados de observancia obligatoria, así como a la escasa capacitación del personal. Se evidencia la necesidad de desarrollar un Sistema Nacional de Cuidados que brinde apoyo a las personas con dependencia de cuidados y sus familias y que incluya a las ICLP. Derivado de los retos por la carencia de información y competencias en prevención y control de infecciones en las ICLP, un conjunto de expertos, en colaboración con instituciones públicas, integramos un grupo con el objetivo de actualizar las guías que permitan a las ICLP hacer frente a la pandemia y que contribuyan a la generación de ese Sistema Nacional de Cuidados.

Abstract Since the emergence of the COVID-19 pandemic, the most affected population group has been that of older people living in long-term care facilities (LTCFs), which has accumulated between 30 and 60 % of total number of deaths in the world. In Mexico, outbreaks have been reported in LTCFs of at least eight states. Various factors make this population group and LTCFs susceptible to COVID-1 outbreaks, mainly due to coexistence in common spaces, shared bedrooms and permanent physical contact with the personnel who work there, coupled with a lack of protocols and standards of care of mandatory observance, as well as personnel training limitations. There is evidence of the need to formally develop a National Care System that provides support to those in need of care and their families, and that includes LTCFs. In view of the challenges due to the lack of information and competencies in infection prevention and control at LTCFs, a group of experts, in collaboration with different public institutions, joined efforts with the purpose to update the guidelines in order to allow LTCFs face the pandemic and to contribute to the generation of said National Care System.

Issues Related to the Establishment of Comprehensive Community Care for Neurology Medical Clinic Nurses: Focusing on Regional Cooperation and Individual Support / 日本プライマリ・ケア連合学会誌

Introduction: The purpose of this study was to clarify the issues for nurses in neurology departments of medical clinics in building a comprehensive community care system based on the implementation status of regional cooperation and individual support for hospitalized patients. We selected neurology as the subject of our study because patients who visit the neurology department are in the medical clinic for an extended period, and we believe that regional cooperation and individual support are implemented more than in other departments.Methods: A self-administered questionnaire survey was conducted by mail in February 2020 among nurses at 1,052 clinics, which were randomly selected from 2,104 clinics with neurology departments among medical institutions designated for intractable diseases.Results: We collected 174 responses (16.5% collection rate), 164 of which were valid (15.5% valid response rate). The regional cooperation rate was 71.3% and individual support by nurses was implemented at 29.9% of the clinics in the past year. Clinical physicians often sought "patient support in collaboration with related parties" and "patient guidance". Free descriptions included five categories such as [strengthening the awareness and abilities of nurses who are responsible for community healthcare] and [training nurses who can promote comprehensive community care].Conclusion: Regional cooperation and individual support are necessary as nursing activities linked to the functions of family physicians.

Acesso e uso de medicamentos sob a perspectiva da pessoa em situação de rua / Access and use of medication from the perspective of homeless people

INTRODUÇÃO: As pessoas em situação de rua representam uma parcela da população diretamente interligada às desigualdades. As condições culturais, socioeconômicas e políticas em que estão inseridos os usuários, interferem diretamente no acesso à saúde, no processo de prescrição e, principalmente, na utilização dos medicamentos. OBJETIVOS: Descrever o acesso e o uso de medicamentos de pessoas em situação de rua, as estratégias e a frequência de acesso a medicamentos, o entendimento dos usuários sobre o modo de uso e de armazenamento; a identificação dos medicamentos mais consumidos e as indicações mais frequentes. METODOLOGIA: Trata-se de uma pesquisa com abordagem mista, qualitativa/quantitativa, de caráter descritivo. Os sujeitos de pesquisa foram pessoas em situação de rua no município de Porto Alegre/RS. A coleta de dados foi realizada através de entrevistas semi-estruturadas. O conteúdo foi analisado a partir da análise de conteúdo proposta por Bardin. RESULTADOS: Doze pessoas foram incluídas neste estudo, sendo a maioria homens (83%), pretos ou pardos, com idade entre 25 e 59 anos (67%). O local de maior procura para atendimentos foram as Unidades Básicas e o Consultório na Rua foi o mais citado, demonstrando a importância do vínculo desta população com a equipe. Assim como o acesso à saúde foi limitado ao SUS, o acesso a medicamentos também foi em farmácias públicas. A maioria apontou o uso de medicamentos para patologias agudas e os que relataram medicamentos de uso contínuo não apresentavam adesão ao tratamento. Automedicação e formas alternativas de acesso aos medicamentos foram citadas, além do abuso de álcool e o uso de substâncias psicoativas. CONCLUSÃO: Apesar de referirem não observar dificuldades para acessar serviços ou recursos de saúde, ao longo de seus discursos, diversas barreiras foram identificadas, seja em relação à disponibilidade de atendimento, demora e discriminação, ou ainda ao acesso, uso e armazenamento dos medicamentos. Contudo, a interação exitosa entre equipe e usuários não só deve beneficiar o acesso, mas também oportunizar que usuários possam integrar-se dos recursos de saúde oferecidos de maneira mais clara e acessível.

CONTEXT: Homeless people represent a quota of the population directly linked to inequalities. The cultural, socioeconomic and political conditions in which the users are inserted directly interfere in the access to health, in the prescription process and, mainly, in the use of medicines. OBJETIVES: describe the access and the use of medications by homeless people, the tactics and the frequency of access to medications, the knowledge of how it should be taken and storage; the identification of the most taken drugs. METODOLOGY: It is a research with a mixed approach, quantitative and qualitative method, with descriptive character. The subjects were homeless people in the city of Porto Alegre/RS. The data collection was taken through interviews that were recorded and transcripted. Data analyses were based on content analysis proposed by Bardin. RESULTS: Twelve people were included in this study, being the major mens (83%), dark or brown skin, with age between 25 and 59 years old (67%). The local with more demand were the basic health units and Homeless Clinic as the most cited demonstrates the importance of the bond between population and the team. Access to health was limited to the Sistema Único de Saúde (SUS ­ Single Health Care System), access to medicines was also available in public pharmacies. Most pointed to the use of drugs for acute pathologies and those who reported continuous use of drugs did not show adherence to treatment. Self-medication and alternative forms of access to medicines were mentioned, in addiction to alcohol abuse and the use of psychoactive substances. CONCLUSIONS: Although they reported not seeing difficulties in accessing health services or resources, throughout their speeches, several barriers were identified, whether in relation to the availability of care, delay and discrimination or even access, use and storage of medicines. However, successful interaction between staff and users should not only benefit access, but also provide opportunities for users to integrate the health resources offered in a clearer and more accessible way.

A enfermeira gestora de casos na Espanha: enfrentando o desafio da cronicidade por meio de uma prática integral / Case management nurse in Spain: facing the challenge of chronicity through a comprehensive practice

Resumo Em fins da década de 1990, instituiu-se um novo tipo de atuação para a enfermeira no sistema de saúde espanhol, denominada atualmente de enfermeira gestora de casos, com vistas à garantia do acesso aos recursos necessários para o enfrentamento das condições de cronicidade e atendimento integral no domicílio. O objetivo do artigo é o de apresentar essa figura e discutir aspectos de sua atuação. A metodologia baseou-se em revisão bibliográfica de artigos e publicações normativas e entrevistas com enfermeiras de Atenção Primária de Saúde, docentes de enfermagem e enfermeiras gestoras de casos. Apresenta-se um breve histórico de implantação da enfermeira gestora de casos e as bases conceituais e operacionais de sua prática em três comunidades autônomas espanholas: Andaluzia, Comunidade Valenciana e País Basco, discutindo potencialidades e questões a respeito dessa atuação dentro de um sistema de saúde de características universais. Nas conclusões, são tecidas algumas considerações a respeito das possibilidades para a implantação da figura da enfermeira gestora de casos no sistema brasileiro de saúde.

Abstract A new type of nurse role was established in the Spanish health care system in the late 1990s, currently called case manager nurse, to ensure access to resources needed to cope with chronic conditions and comprehensive home care. This paper aims to present this figure and discuss aspects of its work. The methodology was based on the bibliographic review of papers and normative publications and interviews with primary health care nurses, nursing faculty, and case management nurses. We present a brief history of the implementation of the case manager nurse role and the conceptual and operational bases of her practice in three autonomous Spanish communities: Andalusia, Valencian Community, and Basque Country, discussing potentialities and issues concerning this practice. In the conclusions, we make some considerations on the possible implementation of the case manager nurse in the Brazilian health system.

Perspectives on the Continuous Medication Monitoring Function of Pharmacies in the Community Health Care System: A Nationwide Survey in Japan / 日本補完代替医療学会誌

Objective: The objective of this study was to identify the perceived importance of various pharmacy functions among residents in the community health care system.Methods: We conducted an online survey of nationwide panelists enrolled by a research company to assess the perceived degree of importance of having a pharmacy that performs various functions in the community health care system (i.e., “comprehensive importance”).Results: “Comprehensive importance” was compared among 2,400 respondents disaggregated into several groups. The results revealed that “encouragement for medical consultations at medical institutions” had a strong effect on “comprehensive importance”.Conclusion: The results of this survey highlight the need for preventive medical care and a further expansion of the consultation function at pharmacies in the future.

Evidence-based construction of index system for postoperative care of patients with colorectal cancer / 中国实用护理杂志

Objective@#To construct a nursing care service index system for postoperative ostomy patients with colorectal cancer based on Omaha system, which is used to guide nursing practice.@*Methods@#Using the Omaha system as the conceptual framework, using literature search method, expert group discussion, Delphi expert correspondence method, screening indicators to establish a system of postoperative care services for patients with colorectal cancer.@*Results@#The two rounds of expert letters asked that the effective recovery rate of the volume was 100%(28/28). The coefficient of expert authority of the two rounds of letters was 0.88 and 0.89 respectively, and the coordination coefficients of the expert opinions were 0.476 and 0.501 respectively. The finalized indicator system for care services includes 4 first-level indicators, 13 secondary indicators, and 61 third-level indicators.@*Conclusion@#The results of this study are scientific and reliable, and the formation of postoperative ostomy patients with colorectal cancerThe indicator system can provide a reference for clinical practice.

A Survey of the Opioid Consumption and Palliative Care System at General Hospitals in Southern and Southwestern wards, Tokyo

Objectives: This study aimed to clarify the present system of palliative care at general hospitals, and to examine the factors contributing to the opioid consumption. Methods: We surveyed the palliative care system using a self-administered questionnaire, which was mailed to 37 general hospitals in Southern and Southwestern wards, Tokyo. Multiple regression analyses were used to identify the associations between explanatory variables and the opioid consumption. Results: Valid responses were obtained from 18 hospitals (response rate: 48.6%). 35% of the general hospitals didn’t have a palliative care team and most hospitals had no specialists. In multivariate analyses, factors associated with the opioid consumption were pharmacists with speciality of pharmaceutical palliative care, physicians joined the palliative care education program based on the Cancer Control Act of Japan, and the number of physicians’ correct answers of questions regarding palliative care. Conclusion: The survey showed that the higher consumption of opioids is significantly associated with the number of health care workers who have knowledge of palliative care. Our study suggested that the arrangement of palliative care experts might decrease the differences in the opioid consumption between general hospitals.

Challenges in the work process in the Family Health Strategy / Desafio do processo de trabalho na Estratégia Saúde da Família

ABSTRACT Purpose: to analyze the work process of the Family Health teams in the municipality of Caxias do Sul, in Rio Grande do Sul State, Brazil. Methods: this is a qualitative, descriptive and exploratory research conducted in four Family Health Strategy (FHS) units, with the participation of 22 health professionals. The data were collected through a semi-structured interview and analyzed through the theme content analysis, aided by the Atlas.ti software. Results: the results were organized in three categories: (1) Roles, reality and idealization of working in the FHS, in which health prevention and curative practices appeared as the focus of the work process; (2) Elements of working in the FHS, which dealt with the purpose of the work connected to health prevention, related instruments, hard technologies and work object, in relation to professional specificities; and (3) Challenges and perspectives of working in the FHS, which emphasizes the fragilities, due to the shortage of professionals and the need for managerial improvement, as well as commitment and teamwork as potentialities. Conclusion: in the work process in health, the preventive professional actions with curative focus were predominant. The challenges were centered on redirecting the work process toward the Family Health approach.

RESUMO Objetivo: analisar o processo de trabalho das equipes de Saúde da Família no município de Caxias do Sul, RS, Brasil. Métodos: trata-se de uma pesquisa qualitativa, descritiva e exploratória. O estudo foi realizado em quatro Estratégia Saúde da Família (ESF) e participaram 22 profissionais de saúde. Os dados foram coletados por entrevista semiestruturada e analisados pela análise de conteúdo temática, com auxílio do software Atlas.ti. Resultados: foram organizados em três categorias: (1) Funções, realidade e idealização do trabalho na ESF, sendo a prevenção a saúde e as práticas curativistas apareceram como foco do processo de trabalho; (2) Elementos do trabalho na ESF, contemplou a finalidade do trabalho ligada à prevenção das doenças, os instrumentos vinculados as tecnologias duras e objeto de trabalho, relacionada as especificidades profissionais; e, (3) Desafios e perspectivas do trabalho na ESF, os quais enfatizam as fragilidades pela falta de profissionais e a necessidade de melhorias na gestão, bem como, o comprometimento e o trabalho em equipe como potencialidades. Conclusão: no processo de trabalho em saúde predominaram as ações profissionais preventivas com foco curativista, com desafios centrados no redirecionamento do processo de trabalho na lógica da Saúde da Família.

Violência relacionada ao trabalho e apropriação da saúde do trabalhador: sofrimento anunciado no Sistema Único de Assistência Social / Work-related violence and appropriation of workers' health: suffering announced in the Unified Social Care System

Resumo O estudo teve como objetivo pesquisar a violência no trabalho vivenciada no Sistema Único de Assistência Social (SUAS) e suas repercussões na saúde psíquica do trabalhador. Trata-se de estudo descritivo, qualitativo e com referencial metodológico na fenomenologia. Após a coleta dos dados, através de entrevistas semiestruturada com os trabalhadores do SUAS, a análise seguiu as seguintes etapas: leitura global dos dados; divisão dos dados em unidade de significação; organização e enunciação dos dados brutos na linguagem do referencial teórico - saúde mental e trabalho - e a síntese dos resultados. Relatos sobre a violência que emerge do local, da organização e das relações de trabalho, assim como a violência indireta, a institucional e a patrimonial, demonstraram repercussões na saúde dos trabalhadores entrevistados. Possibilidades que foram confirmadas pela perda de sentido do trabalho que realizam, sofrimentos psíquicos, comprometimento da qualidade do trabalho ofertado, além das licenças médicas, rotatividade e absenteísmo. Recomendam-se intervenções sistematizadas do poder público no sentido de modificar e melhorar as condições de trabalho e de saúde para os trabalhadores no SUAS.

Abstract The study aimed to research the violence at work experienced in the Unified Social Care System (SUAS) and its repercussions on the psychic health of the worker. This is a descriptive, qualitative study with a methodological framework in phenomenology. After data collection, through semi-structured interviews with SUAS workers, the analysis followed the following steps: global data reading; dividing the data into units of meaning; organization and enunciation of raw data in the language of the theoretical framework - mental health and work and synthesis of results. Reports about the violence that emerges from the place, organization and work relationships, as well as the indirect, institutional and patrimonial violence, showed repercussions on the health of the interviewed workers. Possibilities that were confirmed by the loss of sense of the work they do, psychological suffering, compromised quality of the work offered, in addition to medical leave, turnover and absenteeism. Systematic interventions by the government are recommended in order to modify and improve working and health conditions for workers at SUAS.