Análise qualitativa sobre a atuação e as experiências dos enfermeiros na gestão hospitalar frente à COVID-19 / Qualitative analysis of nurses' performance and experiences in hospital management in the face of COVID-19

Resumo Objetivou-se analisar a atuação dos enfermeiros na gestão hospitalar frente à COVID-19. O estudo teve uma abordagem qualitativa, do tipo descritivo e exploratório. O cenário foi um hospital que se transformou totalmente para atendimento de pacientes com COVID-19. No momento da coleta de dados, dez enfermeiros estavam à frente da gestão dos serviços, e todos participaram da entrevista semiestruturada. Os dados, após análise temática, foram apresentados em três categorias representativas dos elementos da tríade de Donabedian, ou seja, estrutura, processo e resultado. A categoria 1 realçou a reconfiguração da estrutura hospitalar a partir da gestão de materiais e das pessoas; a categoria 2 abordou a reestruturação do processo de trabalho para alcance das metas com segurança e qualidade; e a categoria 3 focou nas experiências dos enfermeiros na descrição dos resultados alcançados e esperados. A análise evidenciou a importância do trabalho em equipe, do envolvimento e da adaptação do gestor diante dos desafios da doença nova e ameaçadora da vida, dos recursos escassos e da complexidade das relações humanas na crise. Na liderança transformacional esses enfermeiros incentivaram a mudança de comportamento, o crescimento profissional, e resiliência.

Abstract This study aimed to analyze the role of nurses in hospital management in the face of COVID-19. The study had a qualitative, descriptive, and exploratory approach. The setting was a hospital that was completely transformed to care for patients with COVID-19. At the time of data collection, ten nurses managed the services, and all participated in the semi-structured interview. After thematic analysis, the data were presented in three categories, representing the elements of Donabedian's triad: structure, process, and result. Category 1 highlighted the hospital structure reconfiguration based on material and people management; category 2 addressed the work process restructuring to achieve goals with safety and quality; and category 3 focused on nurses' experiences in describing the results achieved and expected. The analysis highlighted the importance of teamwork, involvement, and adaptation of managers in the face of the challenges of a new and life-threatening disease, scarce resources, and the complexity of human relationships in the crisis. In transformational leadership, these nurses encouraged behavior change, professional growth, and resilience.

Ruas de Lazer em Pelotas: Modelo lógico e descrição dos processos de planejamento e execução / Open streets in Pelotas: Logical model and description of the planning and execution process

O objetivo do estudo foi desenvolver o modelo lógico do projeto Ruas de Lazer na cidade de Pelotas em 2022, assim como descrever os processos de planejamento, pactuação e execução. Trata-se de um estudo qualitativo, que utilizou a técnica de observação participante e o emprego de modelo lógico. O projeto possui características de gestão compartilhada que demarcam potencial relevante na criação de vínculo entre universidade, gestão pública e população local. Em 2022, sete eventos foram realizados com proposição de atividades culturais com música e dança, atividades físicas e esportivas e de educação em saúde. O projeto está em permanente construção e evolução, apostando na ampliação de investimentos para atingir os objetivos imediatos de oferta de atividades de lazer e de ampliação da democratização de acesso aos espaços públicos para o uso da população.

The aim of this study was to develop a logical model of the Ruas de Lazer project in the city of Pelotas, Rio Grande do Sul, Brazil, in 2022, as well as to describe the processes of planning, agreement, and execution. This is a qualitative study that employed the technique of participant observation and the use of a logical model. The project has characteristics of shared management that mark a relevant potential in creating a bond between the university, public management, and the local population. In 2022, seven events were held, proposing cultural activities with music and dance, physical and sports activities, and health education. The project is in permanent construction and evolution, betting on the expansion of investments to achieve the immediate objectives of offering leisure activities and expanding the democratization of access to public spaces for the use of the population.

Las misiones médicas al Policlínico PAMS en Chincha: evolución del modelo de misión / The medical missions to the PAMS Polyclinic in Chincha: evolution of the mission's model

RESUMEN Presentamos la experiencia del Policlínico de la Peruvian American Medical Society (PAMS) en Chincha, en la ejecución de misiones médico-educativas en la región Chincha. El Policlínico PAMS presta atención médica general y especializada a la población de la zona, seis días a la semana. Además, recibe misiones médicas que vienen generalmente de los EE. UU. Desde 2011, se han recibido 43 misiones médicas. La composición y la naturaleza de las misiones han cambiado con el tiempo. Los primeros años se atraía a especialistas con el énfasis de traer equipos e insumos para mejorar la infraestructura del Policlínico. Ahora estamos limitados por la renuencia de voluntarios de venir al Perú en parte debido a que el gobierno americano considera que viajes al Perú son de alto riesgo. Esta limitación nos ha brindado la oportunidad de hacer misiones médicas juntamente con dos excelentes universidades peruanas. La experiencia ha sido positiva.

ABSTRACT We present the experience of the Polyclinic of the Peruvian American Medical Society (PAMS) in Chincha, in the execution of medical educational missions in the Chincha region. The PAMS Polyclinic provides general and specialized medical care to the population of the area, six days a week. In addition, the Polyclinic receives medical missions generally coming from the EE.UU. Since 2011, we have received 43 medical missions. The composition and nature of the missions have changed over time. The first years attracted specialists with the emphasis on bringing equipment and supplies to improve the infrastructure of the Polyclinic. We are now limited by the reluctance of volunteers to come to Peru in part because the U.S. government considers travel to Peru to be high-risk. This limitation has given us the opportunity to do medical missions together with two excellent Peruvian universities. This experience has been positive.

Syndromic surveillance, early warning and management of mycoplasma pneumoniae pneumonia in school / 中国学校卫生

Abstract@#Mycoplasma pneumoniae pneumonia (MPP) refers to pulmonary inflammation caused by mycoplasma pneumoniae (MP) infection, commonly seen in children aged 5 and above, with fever and cough as the main clinical symptoms. As the primary transmission is through direct contact and respiratory droplets, MPP is prone to cause cross infections in schools and homes. To improve school based prevention and control of MPP, the article proposes comprehensive and multi link technical requirements for the organization and management system of MPP syndromic surveillance and early warning, monitoring contents and methods, information report and disposal. A set of MPP syndromic surveillance, early warning and management plans in school is formulated to strictly prevent and control clustered epidemics on campus.

Standard for the management of hyperkalemia—whole-process management mode of multi- department cooperation / 中华肾脏病杂志

Hyperkalemia is one of the common ion metabolism disorders in clinical practice. Hyperkalemia is defined as serum potassium higher than 5.0 mmol/L according to the guidelines at home and abroad. Acute severe hyperkalemia can cause serious consequences, such as flaccid paralysis, fatal arrhythmia, and even cardiac arrest. The use of renin-angiotensin- aldosterone system inhibitors, β-blockers and diuretics, low-sodium and high-potassium diets, and the presence of related comorbidities increase the occurrence of hyperkalemia. Hyperkalemia risk exist in all clinical departments, but there is a lack of a standardization in the management of multi- department cooperation in hospital. Therefore, a number of domestic nephrology and cardiology department experts have discussed a management model for multi-department cooperation in hyperkalemia, formulating the management standard on hospital evaluation, early warning, diagnosis and treatment, and process. This can promote each department to more effectively participate in nosocomial hyperkalemia diagnosis and treatment, as well as the long-term management of chronic hyperkalemia, improving the quality of hyperkalemia management in hospital.

Building an integrated mental health education system in schools / 中国学校卫生

Abstract@#The psychological development of students is characterized by continuity and discontinuity. At the same time, the psychological development of students in different academic stages is interrelated and gradual. To promote mental health of children and adolescents, considering the widespread, high prevalence and frequent occurrence of students psychological problems and lack of integrated connection of mental health education in different school stages, it is urgent to build a "five integration" mental health education system intergrating kindergarten, primary school, secondary school and university, which includes cognition integration, system integration, information integration, research integration, and management integration, aiming to unify our notion, goal, content and action, provide students with timely, professional and effective mental health services, prevent the occurrence of mental illnesses, as well as create positive psychological qualities.

Current status of regional school health work in Tianjin during 2019-2023 / 中国学校卫生

Objective@#To explore the current status and progress of regional school health work to provide policy reference for school health improvement.@*Methods@#Survey data on school health work in Tianjin from 2019, 2021 and 2023 was used. School health staff allocation and expenditure of the health administrative department, CDC and education department, as well as the annual implementation of health education, prevention and control of common diseases and infectious diseases, sports activities and food nutrition in primary and secondary schools were analyzed. Statistical analysis was conducted using KruskalWallis test, Chisquare test, and Fishers exact test.@*Results@#The number of school health staff in the health commissions and education departments from 2019, 2021 and 2023 was relatively stable. Parttime staffs were often employed by health commissions while fulltime staffs were mainly employed by education departments. The number of school health staff at CDCs increased gradually (H=12.65, P<0.01). School health expenditure of administrative departments and schools in 2021 and 2023 increased significantly compared with that in 2019 (H=22.28, 23.75, P<0.05). More than 95% of schools set up clinics or health care rooms, and about 97% of schools had school health technicians or health teachers. More than 90% of schools had health education courses over 4 hours per semester. The rate of mental health education increased by year (86.87%, 89.91%, 96.30%, Z=2.40，P<0.05). Lack of courses regarded safety emergency and risk avoidance, growth and development, and adolescent health education. The provision rate of psychological counseling services (89.00%, 97.25%, 100.00%) and psychological problem prevention and control (56.12%, 71.56%, 81.48%) also increased by year (Z=3.83, 3.96, P<0.01). The implementation rates of prevention and control of poor vision, dental caries, overweight and obesity were all higher than 80%, and the prevention and control rate of abnormal spinal curvature showed an increasing trend (38.78%, 77.06%, 72.22%, Z=4.87, P<0.01). More than 90% of schools met the standard for physical education class hours, and the proportion of schools conducting at least 30 minutes of recess physical activities every day increased year by year (65.00%, 80.73%, 85.98%, Z=3.59, P<0.01). All schools did not have shops.@*Conclusions@#School health work in Tianjin is effective and constantly developing. It is necessary to continue to increase the investment of human resources and expenditure in school health, explore the approaches of cooccurrence and prevention of common diseases, and improve the school sports and nutrition environment.

Progress in research on health literate schools / 中国学校卫生

Abstract@#Health literate schools (HeLit-Schools) play a significant role in fostering students health literacy. The paper elucidates the background and conceptual connotations of HeLit-Schools, and analyzes how HeLit-Schools effectively integrate and enhance the health literacy of schools in three aspects: philosophy and core drivers, strategy and method implementation, as well as evaluation mechanisms and standard setting. Furthermore, the paper explores the implications of foreign HeLit-Schools research and practice for China under the context of "Healthy China" construction, as well as the key strategies for Chinese schools in the implementation of HeLit-Schools, aiming to provide a new perspective and theoretical support for Chinese schools to practice the "Healthy China initiative" and strengthen school construction from the perspective of health literacy.

Strengthening the health management of children and adolescents to promote high quality development of school health work / 中国学校卫生

Abstract@#As an important component of school health, child and adolescent health management is critical to maintaining physical and mental health development. The article focuses on exploring the connotation and importance of health management for children and adolescents, and specifically highlights the core themes, namely comprehensive health management. Comprehensive health management emphasizes the comprehensive consideration of the physical, psychological, social, and environmental factors affecting children and adolescents, refers to the interrelationships between various health issues, and addresses multiple health problems by applying comprehensive intervention measures. The study aims to provide useful ideas and suggestions for child and adolescent health management, so as to nurture a favorable environment for healthy development and promote an overall improvement of their health level.

Current status of health education faculty and paths to improvement in Yuzhong District of Chongqing / 中国学校卫生

Objective@#To understand the current status of health education faculty in Yuzhong District of Chongqing, so as to explore the implementation path to improve the construction of health education faculty.@*Methods@#In August 2023, stratified random sampling was used to directly select a total of 555 teachers and school doctors from 17 schools in 11 streets of Yuzhong District, who were invited to conduct a questionnaire survey. A total of 409 fulltime or parttime health education teachers were included in the analysis of the results. Both χ2 test and Fisher exact probability method were analyzed for compare the differences in the frequency of conducting health education courses and specializing in specializing areas among different plant health education teachers in Yuzhong District.@*Results@#Health education course faculty were mainly female teachers, accounting for 81.66%. The proportions of physical education (PE) teachers, school doctors, head teachers and teachers from other disciplines were 14.67%, 8.31%, 62.84%, 14.18%, and the class teachers (81.33%) and school doctor (80.95%) were found of the highest proportion of providing health education courses, and the teaching section was mainly elementary school (first to third grade: 42.30%, fourth to sixth grade: 44.74%). Among the teachers, school doctors had the highest proportion (88.24%) of receiving training related to health education courses. And there was a significant stastical difference in the frequency of conducting health education classes among PE teachers, school doctor, head teachers and the teachers of other courses (χ2=54.46, P<0.01). The results of Fisher exact probability method showed that the differences in selfassessment of the most and least skilled areas among PE teachers, school doctor, head teachers and teachers of other courses were statistically significant (P<0.01).@*Conclusions@#Health education faculty in Yuzhong District is mainly composed of PE teachers, school doctor, head teachers and teachers of other courses. The standardized training and assessment of teaching for school doctor could promote the school nurse group developing into specialized health education faculty.

Countermeasures and the development dilemmas of college hospitals in Shandong Province / 中国学校卫生

Objective@#To understand the current development status and challenges of college hospitals in Shandong and to seek scientific countermeasures, so as to promote the development of college hospitals.@*Methods@#A total of 178 college hospitals in Shandong Province were surveyed by a questionnaire in December 2022. Additionally, 30 university hospital directors were selected for field investigations and telephone interviews by direct selection method. The survey covered aspects such as management and operation, human resources, departmental staffing and hospital functions.@*Results@#About 65.73% of college hospitals were affiliated with the logistics department of their respective colleges. Tier 1 hospital accounted for 28.09% of the total. Personnel shortage in university hospitals was evident, and there were 109(61.24%) hospitals where the number of nonpermanent staff exceeded that of permanent staff. About 143 university hospitals (80.34%) had requirements for the promotion of professional and technical personnel. A total of 102(57.30%) college hospitals had incomplete departmental configurations. A survey of 30 college hospitals showed that 7 schools set up health professionals with a ratio of 600∶1. The number of people aged 40 and above was the highest, accounting for 53.12%; and the professional titles were mainly junior and intermediate, accounting for 83.95%. The department settings mainly included internal medicine (96.67%), preventive health care (63.33%) and surgery (60.00%). A total of 12 schools offered public health education courses.@*Conclusions@#There are deficiencies in the management and operation, hardware facilities, personnel department allocation and functional performance of college hospitals in Shandong Province. It is necessary to clarify the functional positioning of the college hospitals, improve both software and hardware facilities, strengthen talent construction, innovate health education, in order to effectively improve the service level of college hospitals.

Estructura conceptual de la competencia gestión de desechos radiactivos para tecnólogos de Medicina Nuclear / Conceptual structure of the radioactive waste management competency for Nuclear Medicine technologists

Introducción: la Medicina Nuclear es una especialidad médica que trata o diagnostica diferentes afecciones mediante imágenes de tipo funcional-molecular, a partir del empleo de fuentes no selladas. Un aspecto importante en el desempeño profesional es la adecuada gestión de sustancias que puedan resultar nocivas. Objetivo: fundamentar la estructura conceptual de la competencia gestión de desechos radiactivos. Métodos: se realizó una revisión bibliográfica con un análisis crítico reflexivo, se consideraron documentos normativos de la actividad en Medicina Nuclear, tesis, artículos y libros, publicados a partir del 2018 en español e inglés. La búsqueda fue realizada en las bases de datos SciELO durante el periodo comprendido de enero a mayo del 2023. Las palabras clave utilizadas fueron: competencias, gestión y desechos radiactivos. Fueron revisados 73 textos y se seleccionaron 20 para conformar el texto final. Resultados: se delimitaron cuatro núcleos temáticos: pertinencia de formar competencias profesionales, base teórico-metodológica, base legal y riesgos e implicaciones. Resulta evidente el insuficiente tratamiento teórico-metodológico a la gestión de desechos como actividad de los tecnólogos de Medicina Nuclear. Se propone la definición de la competencia, los problemas contextuales que aborda, ejes procesuales, criterio de desempeño y evidencias requeridas. Conclusiones: el estudio de las competencias profesionales en los tecnólogos de la salud es un campo de notable vigencia encaminado a desarrollar su profesionalización. La evidente relación establecida entre la competencia gestión de desechos radiactivos y la reducción de riesgos y accidentes, conlleva la responsabilidad de formar profesionales preparados para desempeñarse con éxito en la Medicina Nuclear.

Introduction: Nuclear Medicine is a medical specialty that treats or diagnoses different conditions through functional-molecular images, using unsealed sources. An important aspect in professional performance is the proper management of substances that may be harmful. Objective: to support the conceptual structure of the radioactive waste management competence. Methods: a bibliographic review was carried out with a reflective critical analysis, normative documents of the activity in Nuclear Medicine, theses, articles, and books, published since 2018 in Spanish and English, were considered. The search was carried out in the SciELO databases from January to May 2023. The keywords used were competencies, management and radioactive waste. 73 texts were reviewed and 20 were selected to make up the final text. Results: four topic cores were defined: relevance of training professional competencies, theoretical-methodological base, legal base and risks and implications. The insufficient theoretical-methodological treatment of waste management as an activity of Nuclear Medicine technologists is evident. The definition of the competence, the contextual problems it addresses, procedural axes, performance criteria and required evidence are proposed. Conclusions: the study of professional competencies in health technologists is a field of notable validity aimed at developing their professionalization. The evident relationship established between radioactive waste management competence and the reduction of risks and accidents entails the responsibility of training professionals prepared to perform successfully in Nuclear Medicine.

Organização da atenção primária à saúde de municípios de São Paulo, Brasil: modelo de atenção e coerência com as diretrizes do Sistema Único de Saúde / Organización de la atención primaria de salud de municipios de São Paulo, Brasil: modelo de atención y coherencia con las directrices del Sistema Único de Salud / Primary health care organization in municipalities of São Paulo, Brazil: a model of care aligned with the Brazilian Unified National Health System's guidelines

Resumo: Este trabalho tem como objetivo analisar os principais padrões de organização das redes municipais de serviços de atenção primária à saúde (APS) e avaliá-los segundo os indicadores de interface entre gestão e gerenciamento local. Trata-se de pesquisa avaliativa que analisou 461 municípios de São Paulo, Brasil, que participaram do Inquérito de Avaliação da Qualidade de Serviços de Atenção Básica (QualiAB) em 2017/2018, classificados segundo a composição dos arranjos organizacionais de 2.472 serviços de APS. Para avaliar os padrões identificados, foram selecionados oito indicadores de gestão e gerenciamento local. Os resultados apontam dois grupos de municípios: homogêneos, com serviços de um mesmo arranjo (43,6%); e heterogêneos, com diferentes arranjos (56,4%). Os grupos foram subdivididos em sete padrões que variaram entre homogêneo-tradicional, homogêneo-Estratégia Saúde da Família, homogêneo-misto e diferentes combinações no grupo heterogêneo. Todos os indicadores apontaram diferenças significativas entre os grupos (p < 0,001), com destaque para o grupo homogêneo-tradicional, com padrão organizacional distante do modelo desejado para uma APS abrangente e resolutiva, enquanto aqueles com unidades de saúde da família (USF), e com unidades básicas com agentes comunitários de saúde e/ou equipes de saúde da família (UBS/USF) demonstraram um padrão mais aproximado desse modelo - com ações de planejamento e avaliação comprometidos com a realidade local e com a qualificação do trabalho. Discute-se a importância das políticas implementadas pela gestão federal e estadual e seu poder de indução na definição do modelo de atenção à saúde na APS dos municípios.

Resumen: El trabajo tiene el objetivo de analizar los principales patrones de organización de las redes municipales de servicios de atención primaria de salud (APS) y evaluarlos conforme los indicadores de interfaz entre la dirección y gestión local. Se trata de una investigación evaluativa que analizó 461 municipios de São Paulo, Brasil, que participaron de la Encuesta de Evaluación de la Calidad de los Servicios de Atención Primaria (QualiAB) en 2017/2018, clasificados según la composición de los arreglos organizativos de 2.472 servicios de APS. Para evaluar los patrones identificados, se seleccionaron ocho indicadores de dirección y gestión local. Los resultados indican dos grupos de municipios: homogéneos, con servicios de un mismo arreglo (43,6%) e heterogéneos, con arreglos diferentes (56,4%). Los grupos se subdividieron en siete patrones que iban desde homogéneo-tradicional, homogéneo-Estrategia de Salud de la Familia, homogéneo-mixto y diferentes combinaciones en el grupo heterogéneo. Todos los indicadores señalaron diferencias significativas entre los grupos (p < 0,001), con destaque para el grupo homogéneo-tradicional, con patrón organizativo alejado del modelo deseado para una APS completa y resolutiva, mientras aquellos con unidades de salud de la familia (USF), y con unidades básicas con agentes comunitarios de salud y/o equipos de salud de la familia (UBS/USF) demostraron un patrón más cercano a este modelo -con acciones de planificación y evaluación comprometidas con la realidad local y con la calificación del trabajo. Se discute la importancia de las políticas implementadas por la gestión federal y la gestión estatal y su poder de inducción para definir el modelo de atención a la salud en la APS de los municipios.

Abstract: This study analyzes the main organization patterns used by primary health care (PHC) services in municipal networks and evaluates them according to indicators of local management-administration interface. Evaluative research analyzed 461 municipalities in São Paulo, Brazil, that participated in the Primary Care Services Quality Assessment Survey (QualiAB) in 2017/2018, classified according to the organizational arrangements composition of 2,472 PHC services. Eight indicators of local management and administration were selected to evaluate the identified patterns. Results indicate two groups of municipalities: homogeneous, with services presenting the same arrangement (43.6%); and heterogeneous, with different arrangements (56.4%). These were subdivided into seven patterns that ranged from homogeneous-traditional, homogeneous-Family Health Strategy, homogeneous-mixed, and different combinations in the heterogeneous group. All indicators showed significant differences between groups (p < 0.001), especially the homogeneous-traditional group, which presented an organizational pattern far from the desired model of a comprehensive and problem-solving PHC. Those integrated with family health units (FHU) and basic health units with community health workers and/or family health teams (BHU/FHU) showed a pattern closer to a comprehensive model - with planning and evaluation actions committed to the local reality and qualification of care. Implementation of federal and state policies are essential for defining the PHC health care model adopted by municipalities.

Stock, composition and distribution of the nursing workforce in Brazil: a snapshot / Estoque, composição e distribuição da força de trabalho de enfermagem no Brasil: uma fotografia / Número, composición y distribución de la fuerza de trabajo de enfermería en Brasil: una fotografía

Abstract Objective: to analyze the availability (in terms of stock and composition) and accessibility (in terms of geographical distribution) of the nursing workforce in Brazil. Method: this is a descriptive, cross-sectional study with retrospective data collection, identified by combining databases available on institutional websites and structured according to indicators from the World Health Organization's "National Health Workforce Accounts". The study considered nursing professionals at senior level (nurses) and middle level (nursing auxiliaries and technicians). Indicators of stock, composition, distribution (by age group and gender) and the ratio of nurses to doctors were included. Results: there was an increase in the number of personnel between 2005 and 2010, mainly in middle and technical level professionals. There are more personnel aged between 36 and 55, with a predominance of women in all categories, despite the increase in men. There was an uneven distribution of personnel across the country's regions, with the Southeast having the largest number of professionals. The ratio of nurses to doctors is less than one in the South and Southeast. Conclusion: despite the large number of nurses, their distribution is uneven. The growth of nursing technicians has significantly outstripped that of nurses, indicating more intensive technical training policies than those found in higher education.

Resumo Objetivo: analisar a disponibilidade (estoque e composição) e acessibilidade (distribuição geográfica) da força de trabalho de enfermagem no Brasil. Método: estudo descritivo e transversal, com coleta retrospectiva de dados, identificados por meio da combinação de bancos de dados disponíveis em sites institucionais e estruturados de acordo com indicadores das "Contas Nacionais da Força de Trabalho em Saúde" da Organização Mundial da Saúde. Consideraram-se, para o estudo, profissionais de enfermagem de nível superior (enfermeiros) e nível médio (auxiliares e técnicos de enfermagem). Indicadores de estoque, composição, distribuição (por faixa etária e sexo) e razão de enfermeiros para médicos foram incluídos. Resultados: houve aumento no número de profissionais, entre 2005 e 2010, principalmente nos profissionais de nível médio e técnico. Há mais profissionais entre 36 e 55 anos, com predominância do sexo feminino em todas as categorias, apesar do aumento do sexo masculino. Observou-se distribuição desigual de profissionais nas regiões do país, sendo a região Sudeste a com maior número de profissionais. A razão de enfermeiros por médico é inferior a um nas regiões Sul e Sudeste. Conclusão: apesar do elevado contingente de enfermeiros, sua distribuição é desigual. O crescimento de técnicos de enfermagem superou significativamente o de enfermeiros, indicando políticas de formação técnica mais intensivas que as encontradas no ensino superior.

Resumen Objetivo: analizar la disponibilidad (en términos de número y composición) y accesibilidad (en términos de distribución geográfica) de la fuerza de trabajo de enfermería en Brasil. Método: estudio descriptivo y transversal, con recolección retrospectiva de datos, identificados a través de una combinación de bases de datos disponibles en sitios web institucionales y estructurados en función de los indicadores de las "Cuentas Nacionales del Personal de Salud" de la Organización Mundial de la Salud. La población del estudio fueron profesionales de enfermería de nivel superior (enfermeros) y nivel medio (auxiliares y técnicos en enfermería). Se incluyeron indicadores de número, composición, distribución (por franja etaria y sexo) y razón entre enfermeros y médicos. Resultados: aumentó el número de personal entre 2005 y 2010, principalmente la de nivel medio y técnico. La mayoría del personal tiene entre 36 y 55 años y predomina el sexo femenino en todas las categorías, pese a que aumentó la cantidad de trabajadores do sexo masculino. Se observó que la distribución de personal en las diferentes regiones de Brasil era desigual y la región Sudeste es la que tiene la mayor cantidad de profesionales. La proporción de enfermeros por médico es inferior a uno en las regiones Sur y Sudeste. Conclusión: a pesar de que la cantidad de enfermeros es elevada, la distribución es desigual. El aumento de la cantidad de técnicos en enfermería superó significativamente al de enfermeros, lo que indica que las políticas de formación técnica son más intensivas que las observadas en la educación superior.

Promoción de la salud en América Latina: Coherencia en su implementación* / Health promotion in Latin America: Coherence in its implementation / Promoção da saúde na América Latina: coerência em sua implementação

Resumen Objetivo: a la luz de los enfoques y estrategias de promoción de la salud propuesto en la Carta de Ottawa, avalados por la Organización Mundial de la Salud, se analizó cómo las autoridades sanitarias nacionales de Colombia, Brasil y México, que tienen sistemas de salud estructurados de manera distinta, conceptualizan y orientan la promoción de la salud. Metodología: análisis documental de información oficial de las dependencias encargadas de promoción de la salud en cada país; posteriormente, se hizo un análisis de coherencia en torno a ese concepto. Resultados: hay distintos niveles de coherencia respecto a la promoción de la salud: en Colombia el concepto se transmuta en gestión del riesgo individual a través de los documentos que implementan el Plan Decenal de Salud Pública; en Brasil el concepto de promoción de la salud se aplica coherentemente, aunque las prioridades operativas están enfocadas en aspectos individuales, además, cada Estado y municipio lo implementa de acuerdo con sus necesidades y capacidades; en México la promoción de la salud está institucionalizada, pero el acceso de los ciudadanos al servicio depende del aseguramiento y la agencia individual. Conclusiones: la promoción de la salud se hace en un marco de prestación de servicios de salud enfocados en el control del riesgo individual. Oficialmente los tres países evidenciaron coherencia con los postulados de promoción de la salud expuestos en la Carta de Ottawa, sin una adecuada coherencia en su implementación.

Abstract Objective: In light of the health promotion approaches and strategies proposed in the Ottawa Charter, endorsed by the World Health Organization, it was analyzed how the national health authorities of Colombia, Brazil and Mexico, which have health systems structured differently, conceptualize and guide health promotion. Methodology: Documentary analysis of official information from the agencies in charge of health promotion in each country. Subsequently, a coherence analysis around this concept was carried out. Results: There are different levels of coherence regarding health promotion: in Colombia the concept is transmuted into individual risk management through the documents that implement the Ten-Year Public Health Plan; in Brazil, the concept of health promotion is applied coherently although operational priorities are focused on individual aspects, and each state and municipality implements it according to their needs and capabilities; in Mexico, health promotion is institutionalized, but the access of citizens to the service depends on insurance and individual agency. Conclusions: Health promotion is done within a framework of health service provision focused on individual risk control. Officially, the three countries showed coherence with the health promotion postulates set out in the Ottawa Charter, without adequate coherence in its implementation.

Resumo Objetivo: À luz dos enfoques e estratégias de promoção da saúde propostas na Carta de Ottawa, endossada pela Organização Mundial da Saúde, foi analisado como as autoridades nacionais de saúde da Colômbia, Brasil e México, que possuem sistemas de saúde estruturados de forma diferenciada, conceituam e orientam promoção de saúde. Metodologia: Análise documental de informações oficiais dos órgãos responsáveis pela promoção da saúde de cada país; posteriormente, foi feita uma análise de coerência em torno desse conceito. Resultados: Há diferentes níveis de coerência em relação à promoção da saúde: na Colômbia o conceito se transmuta em gestão de risco individual por meio dos documentos que implementam o Plano Decenal de Saúde Pública; No Brasil, o conceito de promoção da saúde é aplicado de forma consistente, embora as prioridades operacionais sejam focadas em aspectos individuais, além disso, cada estado e município implementa de acordo com suas necessidades e capacidades; No México, a promoção da saúde é institucionalizada, mas o acesso dos cidadãos ao serviço depende de seguro e agência individual. Conclusões: A promoção da saúde é feita dentro de uma estrutura de prestação de serviços de saúde com foco no controle de risco individual. Oficialmente, os três países mostraram-se coerentes com os postulados de promoção da saúde previstos na Carta de Ottawa, sem a devida coerência em sua implementação.

Gestão regional no enfrentamento à pandemia da Covid-19: estudo de casos em São Paulo / Regional management in the face of the COVID-19 pandemic: case study in São Paulo

RESUMO Ao final do ano de 2019 o mundo foi surpreendido pela Covid-19, que chegou ao Brasil no início de 2020, fazendo com que o Sistema Único de Saúde (SUS) adotasse estratégias imediatas para atender as necessidades de saúde da população, colocando em evidência todos os obstáculos que o sistema de saúde vinha enfrentando nos últimos anos. O estado de São Paulo não foi diferente do restante do País em relação ao enfrentamento. Este estudo objetivou identificar as principais estratégias adotadas em 5 regiões de saúde de São Paulo, com foco na gestão regional, analisando os processos e práticas adotados para o enfrentamento à pandemia da Covid-19. Tratou-se de um estudo qualitativo, realizado através de estudo de casos múltiplos, com abordagem exploratória, a partir de pesquisa de campo e realização de oficinas regionais. As regiões de saúde deste estudo puderam comprovar a importância da intersetorialidade nas ações de saúde como um todo. Notou-se o grande papel dos municípios nestas ações e a união destes, fortalecendo o papel da regionalização e ampliando a importância da governança em saúde. Ademais, as regiões de saúde saíram fortalecidas porque exerceram seu papel de liderança e organizaram ações junto aos municípios.

ABSTRACT At the end of 2019 the world was surprised by COVID-19, which arrived in Brazil at the beginning of 2020, causing the Unified Health System (SUS) to adopt immediate strategies to meet health needs, as well as putting in check all the obstacles that the health system has been facing in recent years. In the state of São Paulo it was not different from the rest of the country in relation to the confrontation. This study aimed to identify the main strategies adopted in 5 health regions of São Paulo, focusing on regional management, analyzing the processes and practices adopted to face the COVID-19 pandemic. It was a qualitative study, carried out through a multiple case study, with an exploratory approach, based on field research and regional workshops. In this study, the health regions were able to prove the importance of intersectoral actions in the health system. It was noted the great role of municipalities in these actions and their union, strengthening the role of regionalization and expanding the importance of governance in health. In addition, the health regions were strengthened because they exercised their leadership role and organized actions with the municipalities.

Modelo de gestión del cuidado de enfermería en servicios hospitalario / Nursing care management model in hospital services

RESUMEN Objetivo: Describir el modelo de gestión del cuidado de enfermería en servicios hospitalarios. Metodología: La metodología desarrollada en este estudio se basó en la perspectiva cuantitativa, utilizando tipologías documental-bibliográficas que ayudan a establecer el análisis del objeto de investigación. El material abordado se conformó por tesis de grado, investigaciones científicas, trabajos arbitrados y, con ello, descubrir características y relaciones entre los elementos. En conclusión: El rol de enfermería en el desarrollo de los modelos de gestión del cuidado en los servicios hospitalarios, es de gran importancia ya que establecen los mecanismos de comunicación para su implementación en conjunto con el resto del equipo de salud, que hace vida en los centros hospitalarios.

ABSTRACT Objective: To describe the nursing care management model in hospital services. Methodology: The methodology developed in this study is based on the quantitative perspective using documentary-bibliographic typologies that help to establish the analysis of the research object. The material approached consisted of degree theses, scientific research, refereed works and thus discovering characteristics and relationships between the elements. In conclusion: The role of nursing in the development of care management models in hospital services is of great importance since it is necessary to establish the communication mechanisms for its implementation together with the rest of the health team that works in the hospital centers.

Modelo de gestión del cuidado de enfermería en servicios hospitalario / Nursing care management model in hospital services

Describir el modelo de gestión del cuidado de enfermería en servicios hospitalario. Metodología: La metodología desarrollada en este estudio se basó en la perspectiva cuantitativa utilizando tipologías documental-bibliográficos que ayudan a establecer el análisis del objeto de investigación. El material abordado se conformó por tesis de grado, investigaciones científicas, trabajos arbitrados y con ello descubrir características y relaciones entre los elementos. En conclusión: El rol de enfermería en el desarrollo de los modelos de gestión del cuidado en los servicios hospitalarios, es de gran importancia ya que establecen los mecanismos de comunicación para su implementación en conjunto con el resto del equipo de salud, que hace vida en los centros hospitalarios.

To describe the nursing care management model in hospital services. Methodology: The methodology developed in this study is based on the quantitative perspective using documentary-bibliographic typologies that help to establish the analysis of the research object. The material approached consisted of degree theses, scientific research, refereed works and thus discovering characteristics and relationships between the elements. In conclusion: The role of nursing in the development of care management models in hospital services is of great importance since it is necessary to establish the communication mechanisms for its implementation together with the rest of the health team that works in the hospital centers.

Implementing the special action plan to comprehensively strengthen and improve students mental health work / 中国学校卫生

Abstract@#In recent years, mental health issues have gradually expanded from adults and professional groups to the primary and secondary school students, and are showing a trend of younger age. The article analyzes the "Special Action Plan for Comprehensively Strengthening and Improving the Mental Health Work of Students in the New Era (2023-2025)" jointly issued by 17 departments including the Ministry of Education. It explores the current situation, overall concept, key tasks, and other aspects to further improve the "four in one" student mental health work system of health education, monitoring and warning, consulting services, intervention disposal, and improve students mental health literacy.

A consensus on the management of allergy in kindergartens and primary schools / 中国学校卫生

Abstract@#Allergic diseases can occur in all systems of the body, covering the whole life cycle, from children to adults and to old age, can be lifelong onset and even fatal in severe cases. Children account for the largest proportion of the victims of allergic disease, Children s allergies start from scratch, ranging from mild to severe, from less to more, from single to multiple systems and systemic performance, so the prevention and treatment of allergic diseases in children is of great importance, which can not only prevent high risk allergic conditions from developing into allergic diseases, but also further block the process of allergy. At present, there is no consensus on the management system of allergic children in kindergartens and primary schools. The "Consensus on Allergy Management and Prevention in Kindergartens and Primary Schools", which includes the organizational structure, system construction and management of allergic children, provides evidence informed recommendations for the long term comprehensive management of allergic children in kindergartens and primary schools, and provides a basis for the establishment of the prevention system for allergic children.