Etude du paiement électronique des agents de santé: cas de la campagne de vaccination contre la rougeole et la rubéole en Côte d'Ivoire / NA

La motivation des agents de santé à travers le paiement à temps et complet constitue l'un des éléments clés pour atteindre de bonne couverture vaccinale. Notre objectif était de décrire le paiement électronique utilisé lors de la campagne rubéole-rougeole et d'apprécier la satisfaction du personnel de santé. Nous avons réalisé une étude transversale à visée analytique qui s'est déroulée en Côte d'Ivoire du 15 janvier au 18 février 2019. La population d'étude était constituée des acteurs impliqués à la fois dans la campagne de vaccination contre la rougeole- rubéole en 2018 et dans le paiement électronique. Une recherche documentaire et des entretiens structurés ont permis le recueil des données. Les données ont été analysées à partir du logiciel R studio© version 2021. Le système assurant le paiement électronique se composait des autorités sanitaires, d'un opérateur privé de téléphonie mobile, d'un partenaire technique et financier et des agents de santé bénéficiaires. Un système de critères d'identification, des listes de validation et de vérification à plusieurs niveaux de la pyramide sanitaire a été mis en place. Un peu moins de trois quarts des acteurs du niveau primaire ont été satisfaits par ce mode de paiement. Le paiement électronique constitue un procédé pour améliorer le paiement des agents de santé durant les campagnes de vaccination. Des leçons d'un tel système de paiement devraient être tirées pour un déploiement à grande échelle.

Motivating healthcare workers through timely and complete payment is one of the key elements to achieve high vaccination coverage. Our objective was to describe the use of electronic payment during the measles-rubella campaign and assess the satisfaction of healthcare personnel. We conducted a cross-sectional analytical study in Côte d'Ivoire from January 15 to February 18, 2019. The study population consisted of individuals involved in both the measles-rubella vaccination campaign in 2018 and electronic payment. Data collection was done through documentary research and structured interviews. The data were analyzed using R Studio© software version 2021. The electronic payment system involved health authorities, a private mobile network operator, a technical and financial partner, and the beneficiary healthcare workers. A system of criteria for identifying lists, validation, and multilevel verification within the healthcare pyramid was established. Just under three-quarters of primarylevel actors were satisfied with this payment method. Electronic payment presents an opportunity to improve healthcare worker payment during vaccination campaigns. Lessons from such a payment system should be drawn for large-scale deployment.

Leadership development training for brazilian orthopedic surgeons / Treinamento de desenvolvimento de liderança para cirurgiões ortopédicos brasileiros

ABSTRACT Objective: To report on the experience and impressions of the Brazilian orthopedic trauma surgeons attending the Leadership Development Program (LDP) hosted by the Sociedade Brasileira do Trauma Ortopédico (SBTO) in Sao Paulo, Brazil on November 4, 2022. Methods: Forty-eight orthopedic trauma surgeons from five different regions throughout Brazil were provided a link to complete The Big Five Test, a validated online personality assessment. The questionnaire was available in Portuguese and was intended to provide a background on individual personality traits and their influence on interpersonal interactions. The LDP integrated content from literature reviews specific to Latin America, established leadership programs from leading business schools, and various subject matter experts. Prior to the start of the LDP, participants received a pre-course survey evaluating demographic information, a needs assessment, and the prioritization of leadership topics utilizing a 5-point Likert-scale. Attendees participated in the one-day, interactive LDP focusing on the fundamental principles of leadership development, communication, personal development, emotional intelligence and negotiation. Following the LDP, a post-course evaluation was administered to determine the participants' overall experience, and suggestions for LDP improvement. Results: Forty-one of the forty-eight course participants completed the pre-course evaluation, whereas forty-six of the forty-eight participants completed the post-course evaluations. Overwhelmingly, the lack of opportunity was most prevalently reported as the main obstacle to attending a leadership course, as cited by 56% of respondents. Conclusion: Expanding the accessibility, diversity, and customizability of leadership programs can facilitate the development of personal tools needed to move healthcare forward. Critical topics include emotional intelligence and other differentiating leadership qualities that distinguish true transformational and servant leaders. Advancing leadership skills can stimulate networking, expose learners to experiential learning styles, inspire others to create positive change, and engender creative solutions for systematic improvements and health outcomes. Level of Evidence III; Individual Case-Control Studies.

RESUMO Objetivo: Relatar a experiência e as impressões de cirurgiões de trauma ortopédico brasileiros participantes do Programa de Desenvolvimento de Liderança (PDL), organizado pela Sociedade Brasileira do Trauma Ortopédico (SBTO), em São Paulo, Brasil, em 4 de novembro de 2022. Métodos: Quarenta e oito cirurgiões de trauma ortopédico de cinco regiões diferentes do Brasil receberam um link para preencher o The Big Five Test, uma avaliação de personalidade on-line validada. O questionário estava disponível em português e pretendia fornecer informações básicas sobre traços de personalidade individuais e sua influência nas interações interpessoais. O PDL integrou conteúdo de análises de literatura específicas da América Latina, e programas de liderança estabelecidos pelas principais escolas de negócios e por vários especialistas no assunto. Antes do início do PDL, os participantes receberam uma pesquisa pré-curso solicitando informações demográficas, uma avaliação de necessidades e a priorização de tópicos de liderança utilizando uma escala Likert de 5 pontos. Os participantes participaram do PDL interativo de um dia com foco nos princípios fundamentais de desenvolvimento de liderança, comunicação, desenvolvimento pessoal, inteligência emocional e negociação. Após o PDL, foi realizada uma avaliação pós-curso para determinar a experiência geral dos participantes e sugestões para melhoria do PDL. Resultados: Quarenta e um dos quarenta e oito participantes do curso concluíram a avaliação pré-curso, enquanto quarenta e seis dos quarenta e oito participantes concluíram a avaliação pós-curso. A falta de oportunidade foi relatada com maior prevalência como o principal obstáculo para frequentar um curso de liderança, conforme citado por 56% dos entrevistados. Conclusão: Expandir a acessibilidade, a diversidade e a personalização dos programas de liderança podem facilitar o desenvolvimento de ferramentas pessoais necessárias para fazer avançar os cuidados de saúde. Os tópicos críticos incluem inteligência emocional e outras qualidades de liderança diferenciadas, que distinguem verdadeiros líderes transformacionais e servidores O avanço das competências de liderança pode estimular o networking, expor os alunos a estilos de aprendizagem experiencial, inspirar outros a criar mudanças positivas e gerar soluções criativas para melhorias sistemáticas dos resultados na saúde. Nível de Evidência III; Estudos de caso-controle individuais.

O que a Pesquisa Nacional de Saúde tem a dizer sobre a influência do gasto com cigarro no rendimento domiciliar? / What does the Brazilian National Health Survey have to say about the influence of cigarette spending on household income? / ¿Qué dice la Encuesta Nacional de Salud brasileña sobre la influencia del gasto en cigarrillos en los ingresos del hogar?

Em um Brasil no qual os indicadores de empobrecimento da população seguem aumentando, preocupa o fato de que indivíduos gastem dinheiro para comprar cigarro em vez de usarem esse recurso em ações que fortaleçam aspectos do bem-estar de suas jornadas de vida e de suas famílias. Estimou-se, a partir da Pesquisa Nacional de Saúde de 2019, a influência que o gasto com cigarro industrializado teve no orçamento familiar nos domicílios com pelo menos um fumante, estratificada por características sociodemográficas. Os fumantes brasileiros destinaram cerca de 8% do rendimento médio mensal domiciliar per capita para a compra de cigarros industrializados. O percentual do gasto médio mensal chegou a quase 10% desse rendimento, entre os fumantes de 15 a 24 anos, e foi ainda maior para aqueles com Ensino Fundamental incompleto (aproximadamente 11%). Nas regiões Norte e Nordeste do país, esse gasto ultrapassou os 9%. O estado com o maior comprometimento da renda domiciliar foi o Acre (13,6%), seguido por Alagoas (11,9%), Ceará, Pará e Tocantins (todos com aproximadamente 11%). Nossos achados reforçam, portanto, a importância de fortalecer a implementação de medidas efetivas de redução da proporção de fumantes, tal como a política tributária. Dessa forma, o dinheiro que atualmente é destinado pelos indivíduos à compra de cigarros poderá ser revertido no atendimento de suas necessidades básicas, contribuindo para a promoção da saúde e melhoria da qualidade de vida.

In a country whose indicators of population impoverishment continue to increase, it is concerning that individuals spend money to buy cigarettes instead of using this resource in actions that strengthen aspects of the well-being of their lives and that of their families. Based on the Brazilian National Health Survey conducted in 2019, the influence of spending on manufactured cigarettes on the family budget in households with at least one smoker was estimated, stratified by sociodemographic characteristics. Brazilian smokers allocated around 8% of their average per capita monthly household income to the purchase of manufactured cigarettes. The percentage of average monthly expenditure on cigarettes reached almost 10% of this income among smokers aged 15 to 24 and was even higher for those with incomplete elementary education (approximately 11%). In the North and Northeast regions of the country, this expenditure exceeded 9%. The state with the most significant impact on household income was Acre (13.6%), followed by Alagoas (11.9%), Ceará, Pará, and Tocantins (all with approximately 11%). Our findings, therefore, reinforce the importance of strengthening the implementation of effective measures, such as tax policy, to reduce the proportion of smokers. Thus, the money that individuals currently allocate to purchase cigarettes can be used to meet their basic needs, contributing to the promotion of health and improving the quality of life.

En un Brasil donde los indicadores de empobrecimiento de la población siguen aumentando, es preocupante el hecho de que las personas gasten dinero para comprar cigarrillo en lugar de usarlo en acciones para fortalecer los aspectos del bienestar de sus vidas y la de sus familias. A partir de la Encuesta Nacional de Salud brasileña realizada en 2019, se estimó la influencia del gasto en cigarrillo industrializado en el presupuesto familiar de los hogares donde vivía al menos un fumador, estratificado por características sociodemográficas. Los fumadores brasileños destinaron alrededor del 8% del ingreso per cápita mensual promedio del hogar para la compra de cigarrillos industrializados. El porcentaje del gasto mensual promedio en cigarrillos alcanzó casi el 10% de este ingreso entre los fumadores de 15 a 24 años y fue aún mayor para los que tenían educación primaria incompleta (aproximadamente el 11%). En el Norte y Nordeste del país, ese gasto superó el 9%. El estado con un mayor compromiso con los ingresos del hogar fue Acre (el 13,6%), seguido por Alagoas (el 11,9%), Ceará, Pará y Tocantins (todos con aproximadamente el 11%). Por lo tanto, nuestros resultados resaltan la importancia de fortalecer la implementación de medidas efectivas para reducir la proporción de fumadores, tal como la política tributaria. Así, el dinero que actualmente las personas destinan a la compra de cigarrillos podría utilizarse en la atención de sus necesidades básicas, contribuyendo a promover la salud y la mejora de la calidad de vida.

Tempo de tela, qualidade da dieta de adolescentes e características do entorno escolar / Screen time, quality of the adolescent diet, and profile of the school environment

Resumo Objetivou-se investigar a associação entre o tempo de uso excessivo de diferentes telas, a qualidade da dieta em adolescentes e características do entorno escolar. Adolescentes de 30 escolas estaduais de Curitiba/PR relataram tempo de tela: televisão, videogame e portáteis. A qualidade da dieta foi avaliada pela frequência de consumo de alimentos. A renda do entorno escolar foi obtida do Censo. O ambiente construído para atividade física investigado por observação sistemática do entorno escolar. A regressão de Poisson multinível foi empregada para estimar associações com as variáveis de exposição. Entre 1.200 adolescentes, 50,9% do sexo masculino, 74,4% tiveram tempo excessivo de tela. O tempo excessivo de TV (56,5%) esteve associado à pior qualidade da alimentação. O tempo excessivo de videogame (22,0%) foi menor no sexo feminino (RP 0,25; IC95% 0,18;0,36), associado à pior qualidade da alimentação, à menor renda do entorno escolar, e à pior classificação do ambiente construído para atividade física. O tempo excessivo de telas portáteis (53,2%) apresentou tendência de aumento com a renda do entorno escolar. O uso excessivo de TV e telas portáteis foi amplamente praticado por adolescentes, com diferentes variáveis demográficas e contextuais associadas de acordo com o tipo de dispositivo utilizado.

Abstract Adolescents from 30 state schools in Curitiba, State of Paraná, reported total screen time, namely television, video games and laptops. Diet quality was assessed by the frequency of food consumption. The income of the school environment was taken from the Census. The built environment for physical activity was investigated by systematic observation of the school surroundings. Multilevel Poisson Regression was used to estimate associations with the exposure variables. Among 1,200 adolescents, 50.9% being male, and 74.4% were found to be exposed to excessive screen time. Excessive TV screen time (56.5%) was associated with poor diet quality. Excessive video game time (22.0%) was lower among females (PR 0.25; 95%CI 0.18;0.36), associated with poor diet quality, lower school environment income, and the worst classification of the built environment for physical activity. Excessive use of portable screens (53.2%) tended to increase with the income of the school environment. Excessive use of TV and laptops was widespread among adolescents, with different demographic and contextual variables associated according to the type of device used.

Demanda de servicios de salud de la población adulta mayor de bajos ingresos en Colombia

Objetivo: Analizar los determinantes de la demanda de servicios de salud del adulto mayor entre los segmentos más pobres de Colombia. Materiales y métodos: Estudio de datos panel a partir de datos de riesgo individualizado de una aseguradora del régimen subsidiado en Colombia. Se elaboraron modelos de regresión lineal para determinar la demanda de salud bajo dos escenarios. Resultados: El hacinamiento, la exposición al humo y roedores mantienen una relación positiva con la demanda de servicios de salud. Por el contrario, la educación, ocupación, realizar actividad física y el no consumo de alcohol son factores protectores. Conclusión: La transición demográfica y epidemiológica que experimenta Colombia trae consigo retos para el sistema de salud. La identificación de determinantes de la demanda contribuye al establecimiento de estrategias para el mejoramiento del sistema de salud vigente y futuro.

Objective: To analyze the determinants of the demand for health services of the elderly among the poorest segments in Colombia. Materials and methods: Panel data study based on individualized risk data from an insurer of the subsidized regime in Colombia. Linear regression models were developed to determine health demand under two scenarios. Results: Overcrowding, exposure to smoke and rodents maintain a positive relationship with the demand for health services. On the contrary, education, occupation, physical activity, and non-alcohol consumption are protective factors. Conclusion: The demographic and epidemiological transition that Colombia is experiencing brings challenges to the health system. The identification of determinants of demand contributes to the implementation of strategies to improve the current and future health system.

Concerns About Inequality in Health, Education and Income Jointly Predict Collective Actions

Introduction: Income inequality is often tolerated and justified, but when it brings about disparities in other domains of life (e.g., health or education), it may be seen with different eyes. In this research, we aimed to explore concerns regarding economic inequality in health, education, and income, and its relationship to supporting collective actions to reduce inequality. Method: We used survey data (N = 20,204, 18 countries) from the Latinobarometer 2020. We conducted descriptive analyses, latent class analyses, and analyses of multilevel linear regression to test our hypothesis. Results: We found that people were more concerned about health access and education opportunities than income inequality. We also identified two classes of people: one class concerned about education and health and the other unconcerned about inequality in any domain. In addition, results showed that all concerns and class membership predicted greater support of collective actions to reduce inequality. Conclusions: These preliminary findings suggest that concerns about education and health disparities may serve to increase awareness of overall inequality and mobilise the public.

Introducción: La desigualdad de ingresos a menudo se tolera y justifica, pero cuando esta conlleva desigualdades en otros ámbitos de la vida (e.g., salud o educación), puede que se vea con ojos diferentes. En este artículo tratamos de explorar la preocupación por la desigualdad económica en salud, educación e ingresos, así como su relación con el apoyo a acciones colectivas para reducir la desigualdad. Método: Usamos datos secundarios (N = 20 204, 18 países) del Latinobarómetro 2020. Llevamos a cabo análisis descriptivos, análisis de clases latentes y análisis de regresión multinivel. Resultados: Encontramos que la gente estaba más preocupada por el acceso a la salud y las oportunidades en educación que por la desigualdad en el ingreso. También identificamos dos perfiles de personas: unas preocupadas por la educación y la salud, y otras poco preocupadas por la desigualdad en ninguno de los ámbitos. Además, los resultados mostraron que todas las preocupaciones y los distintos perfiles predecían un mayor apoyo a las acciones colectivas para reducir la desigualdad. Conclusiones: Estos hallazgos preliminares sugieren que la preocupación por las desigualdades en salud y educación podrían servir para aumentar la conciencia sobre la desigualdad general y movilizar al público.

Gasto de bolsillo en salud en la familia con diabetes-hipertensión durante la pandemia del covid-19 / Out-of-pocket health spending in the family with diabetes-hypertension during the covid-19 pandemic

Determinar el gasto de bolsillo en salud en las familias con diabetes mellitus y/o hipertensión arterial y el porcentaje del ingreso familiar durante la pandemia del Covid-19. Estudio de gasto de bolsillo en salud que incluyó muestreo consecutivo de 268 familias de México. El ingreso trimestral familiar se definió como la suma de ingresos de cada uno de los integrantes de la familia, el gasto en salud se definió como el total de erogaciones que tuvo la familia para cubrir los diferentes servicios de salud, y porcentaje de gasto en salud se definió como la relación del gasto total trimestral y el gasto corriente del hogar, valores expresados en pesos mexicanos. El promedio trimestral del gasto de bolsillo en salud en la familia con diabetes mellitus y/o hipertensión arterial en la dimensión consulta fue $975,82 y en la dimensión medicamentos $1,371.22; el gasto promedio total trimestral fue $3,133.08. El ingreso trimestral de la familia después de la pandemia del covid-19 fue $85,348.86 lo que representa 5,93% menos del ingreso trimestral antes de la pandemia. El gasto trimestral en salud fue $3,133.08, lo cual corresponde a 3,45% y 3,67% del ingreso trimestral familiar antes y después de la pandemia del Covid-19 respectivamente (AU)

Determine out-of-pocket health spending in families with diabetes mellitus and/or high blood pressure and the percentage of family income during the Covid-19 pandemic. Study of out-of-pocket health spending that included consecutive sampling of 268 families in Mexico. The quarterly family income was defined as the sum of income of each of the family members, health spending was defined as the total expenses that the family had to cover the different health services, and percentage of health spending. It was defined as the relationship between total quarterly expenditure and current household expenditure, values expressed in Mexican pesos. The quarterly average of out-of-pocket health expenditure in the family with diabetes mellitus and/or arterial hypertension in the consultation dimension was $975.82 and in the medication dimension $1,371.22; The average total quarterly expense was $3,133.08. The family's quarterly income after the covid-19 pandemic was $85,348.86, which represents 5.93% less than the quarterly income before the pandemic. The quarterly health expenditure was $3,133.08, which corresponds to 3.45% and 3.67% of the family's quarterly income before and after the Covid-19 pandemic respectively (AU)

Economic and Professional Impact of The Covid-19 Pandemic and Prevalence of Depression and Anxiety on Shoulder and Elbow Surgeons in Brazil / Impacto econômico e profissional da pandemia de COVID-19 e prevalência de depressão e ansiedade nos cirurgiões de ombro e cotovelo do Brasil

Abstract Objective To assess the economic and professional impact (including teaching and training) during the covid-19 pandemic, as well as the prevalence of major depressive episode and generalized anxiety disorder, on shoulder and elbow surgeons in Brazil. Methods Cross-sectional study carried out with surgeons who are members of the Brazilian Society of Shoulder and Elbow Surgery (SBCOC). Sampling was non-probabilistic for convenience. The information was obtained through a self-administered online questionnaire, through the SBCOC members' registered e-mails, using structured questions and the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) instruments to screening for major depressive episode and generalized anxiety disorder, respectively. Results 119 participants were evaluated. The commitment in teaching was affirmed by 87.7% of the surgeons, there was a reduction above 50% of the surgical volume for about 4 out of 10 surgeons and reduction of the income above 50% for about 17.3%, due to the fact that 55.5% of professionals did not have professional stability. The major depressive episode had a prevalence of 26.7% in the sample, and generalized anxiety disorder was presented by 20% of the surgeons. Conclusion The combination of the negative impact on professional and financial factorsmay have affected shoulder and elbow surgeons in Brazil, generating high rates of anxiety and depression.

Resumo Objetivo Avaliar o impacto econômico e profissional (incluindo ensino e treinamento) durante a pandemia de covid-19, bem como a prevalência de episódio depressivo maior e de transtorno de ansiedade generalizada, nos cirurgiões de ombro e cotovelo do Brasil. Métodos Estudo transversal realizado com os cirurgiões membros titulares da Sociedade Brasileira de Cirurgia de Ombro e Cotovelo (SBCOC). A amostragem foi não probabilística por conveniência. As informações foram obtidas por meio de questionário online autoaplicado, através de divulgação pelo e-mail cadastrado dos membros da SBCOC, utilizando questões estruturadas e os instrumentos Patient Health Questionnaire (PHQ-9) e Generalized Anxiety Disorder-7 (GAD-7) para rastreio de episódio depressivo maior e transtorno de ansiedade generalizada, respectivamente. Resultados Foram avaliados 119 participantes. O comprometimento no ensino foi afirmado por 87,7% dos cirurgiões, houve redução acima de 50% do volume cirúrgico para cerca de 4 em cada 10 cirurgiões e redução da renda acima de 50% para cerca de 17,3%, sendo que 55,5% dos profissionais não apresentavam estabilidade profissional. O episódio depressivo maior apresentou uma prevalência de 26,7% na amostra, e o transtorno de ansiedade generalizada foi apresentado por 20% dos cirurgiões. Conclusão A combinação do impacto negativo sobre fatores profissionais e financeiros pode ter afetado os cirurgiões de ombro e cotovelo do Brasil, gerando elevados índices de ansiedade e depressão.

Sobrepeso y obesidad en Chile: Consideraciones para su abordaje en un contexto de inequidad social

Con 3 de cada 4 personas viviendo con sobrepeso u obesidad, la prevalencia de IMC elevado en Chile es de las más altas del continente, mostrando un patrón de distribución inequitativo mediado por determinantes estructurales que modelan el comportamiento en salud (seguridad social, nivel socioeconómico, educación, género, entre otros). Las características socioeconómicas del país, nación de ingresos altos con marcada inequidad, son poco comunes y representan un desafío adicional a la hora de diseñar intervenciones en salud. Una alta concentración de riqueza permite ser clasificado como país de ingresos altos aun cuando la mayor parte de la población pertenecería a una clase social vulnerable, cuyos ingresos se ven acompañados de recursos sociales y simbólicos que dificultan doblemente la adopción de un "estilo de vida" saludable. A pesar de las múltiples estrategias nutricionales implementadas, la prevalencia de sobrepeso y obesidad continúa en aumento. Se postula como gran responsable al insistente uso de modelos basados en elección y responsabilidad individual, que buscan modificar factores de riesgo conductuales (sedentarismo y alta ingesta calórica) sin neutralizar los determinantes estructurales que predisponen esa conducta. Favorablemente, la última Política Nacional de Nutrición reconoce la "determinación social de la alimentación", representando un cambio de paradigma que confiere cierto optimismo y cuya eficacia deberá ser evaluada en los próximos años.

With 3 out of 4 people living with overweight or obesity, the national prevalence of high BMI is among the highest on the continent, thus showing an inequitable distribution pattern mediated by structural determinants that shape health behavior (social security, socioeconomic status, education, gender, among others). The socioeconomic features of the country, a high-income nation with marked inequity, are unusual and represent an additional challenge when designing health interventions. A high concentration of wealth allows it to be classified as a high-income country even though most of the population would belong to a vulnerable social class, whose income is accompanied by social and symbolic resources that make it doubly challenging to adopt a healthy "lifestyle". Despite the multiple nutritional strategies implemented, the prevalence of overweight and obesity continues to increase. The insistent use of models based on individual choice and responsibility, which seek to modify behavioral risk factors (sedentary lifestyle and high caloric intake) without neutralizing the structural determinants predisposing this behavior, is postulated as highly responsible. Favorably, the latest National Nutrition Policy recognizes the "social determination of food", representing a paradigm shift that confers some optimism and whose effectiveness has to be evaluated in the coming years.

Mulheres de Bairros Populares em Caxias-MA: Vidas que (Re)Existem / Women From Low-Income Neighborhoods in Caxias-MA: Lives that Exist / Mujeres de Barrios Populares de Caxias-MA: Vidas que (Re) Existen

O presente estudo parte das experiências das mulheres nos bairros populares de uma cidade do interior do Maranhão, Caxias. Objetivou-se conhecer as histórias de vida das mulheres desses bairros, os seus modos de vida e resistência em suas vivencias diárias. Trata-se de uma pesquisa qualitativa que tem como base a produção de sentido no cotidiano. Participaram cinco mulheres de quatro bairros populares do município. Foram utilizadas a observação no cotidiano, conversas no cotidiano e entrevista semiestruturada. Para a análise foi utilizado o mapa dialógico de produção de sentidos. Percebeu-se que as mulheres atuam enquanto sujeitas ativas em seus bairros buscando por melhores condições de vida, em prol de educação e infraestrutura, a partir da formação de uma rede de sociabilidade e solidariedade, à frente de clube de mães, associação de moradores e grupo de dança enquanto formas de resistência. Logo, entende-se que esse estudo pode contribuir com a literatura e discussões sobre mulheres de contextos periféricos de regiões não metropolitanas.

The present study is based on the experiences of women from the low-income neighborhoods of Caxias, a country town in the Brazilian State of Maranhão. The purpose was to investigate the life stories of women who live in that neighborhoods, their ways of life, and resistance in their daily experiences. This is a qualitative research that is based on the production of meaning in everyday life. We have researched five women from four low-income neighborhoods in the city through daily observation, daily conversations, and semi-structured interviews. We have used the dialogic map of production of meaning for this analysis. It was noticed that women act as active subjects in their neighborhoods, looking for better living conditions towards education and infrastructure. They do it building a network of sociability and solidarity which includes a front of mothers' club, community association, and dance group as forms of resistance. Therefore, we realize that this study can contribute to the literature and to the discussion about women from peripheral contexts of non-metropolitan regions.

El presente estudio se basa en las experiencias de mujeres en los barrios populares de una ciudad del interior de Maranhão, Caxias. El objetivo fue conocer las historias de vida de mujeres que viven en barrios populares de Caxias do Maranhão, sus formas de vida y resistencia en sus experiencias cotidianas. Se trata de una investigación cualitativa que se fundamenta en la producción de sentido en la vida cotidiana. Participaron cinco mujeres de cuatro barrios populares de la ciudad. Se utilizó la observación diaria, conversaciones diarias y entrevistas semiestructuradas. Para el análisis se utilizó el mapa dialógico de producción de sentido. Se percibió que las mujeres actúan como sujetos activos en sus barrios buscando mejores condiciones de vida, a favor de la educación e infraestructura, a partir de la formación de una red de sociabilidad y solidaridad, al frente del club de madres, asociación de vecinos y grupo de baile como formas de resistencia. Por lo tanto, se entiende que este estudio puede contribuir a la literatura y discusiones sobre mujeres de contextos periféricos de regiones no metropolitanas.

Impact of COVID-19 containment measures on children with cancer in Indonesia

Introduction: Containment measures to limit COVID-19 spreading profoundly impact children around the globe, especially in low- and middle-income countries such as Indonesia. The aim of this case series study is to uncover the impact that COVID-19 measures have on Indonesian children with cancer and their families. Materials and Methods: A case series study was conducted in July 2021. Investigators identified three children diagnosed with cancer at an Indonesian referral hospital and studied their medical records. Caretakers were interviewed inside the hospital by an independent interviewer using a semi-structured questionnaire. Results: This study presents three children with cancer and their families. Access to proper healthcare was hindered during the COVID-19 pandemic due to mobility restrictions, medical staff shortage, limited chemotherapy and blood products availability, postponed medical procedures, and delayed or modified treatment administration. Financial hardships resulted because caretakers lost their jobs due to lockdowns and medication costs were no longer fully covered by health-insurance. Children and their relatives suffered from mental health issues. Anxiety, depression, stress, and loneliness were caused by the fear of receiving suboptimal cancer treatment, serious concerns about financial difficulties, and restricted social interactions. All families believed that COVID-19 measures worsened their children’s survival chances. Conclusion: COVID-19 measures adversely impact children with cancer and their families in Indonesia, and most likely in other low- and middle-income countries as well. Disruptions in timely and adequate childhood cancer treatment administration may importantly deteriorate survival chances. Governments and policymakers should take these indirect effects into account to protect vulnerable children and their families.

Early Identification of Autism Spectrum Disorder (ASD): Strategies for Use in Local Communities

Early diagnosis of autism spectrum disorder (ASD) is essential for improved outcomes. There is a paucity of data on the prevalence of ASD in low- and middle-income countries (LMIC), but early identifcation may be further delayed in those communities. In this paper, recent studies on strategies for the early detection of ASD, and the prevalence of ASD in LMIC are reviewed. The limitations that can arise in the early identifcation of ASD in LMIC communities are discussed, and screening tools and strategies that can be helpful are identifed. The goal is to recommend models that are culturally appropriate and scientifcally valid, easily integrated within community settings while strengthening community systems and reducing disparities in the early identifcation of ASD. Starting locally by simplifying and demystifying the ASD identifcation process and building community connections will inform global researchers and policymakers while making a diference in the lives of the children and families afected by ASD.

Evaluation of functionality and socioeconomic status of patients with chronic pain

SUMMARY OBJECTIVE: This study aimed to evaluate the influence of chronic pain on functionality and its consequences on work and patient income. METHODS: A total of 103 patients from the Multidisciplinary Pain Center of the Clinics Hospital of Universidade Federal de Minas Gerais were interviewed between January 2020 and June 2021, applying questionnaires on mobile devices. Socioeconomic data, multidimensional characterization of pain, and instruments for assessing pain functionality and intensity were analyzed. Pain intensity was categorized as mild, moderate, or intense for comparative analysis. Ordinal logistic regression was used to identify risk factors and variables that jointly influence the outcome of pain intensity. RESULTS: The patients had a median age of 55 years, were predominantly female, married or in a stable relationship, white race, and completed high school. The median family income was R$2,200. Most patients were retired due to disability and pain-related causes. Functionality analysis showed severe disability directly associated with pain intensity. The financial impacts observed were correlated with the pain intensity of the patients. Age was a risk factor for pain intensity, while sex, family income, and duration of pain served as protective factors. CONCLUSION: Chronic pain was associated with severe disability, decreased productivity, and exit from the labor market, with a negative impact on financial condition. Age, sex, family income, and duration of pain were directly associated with pain intensity.

Non-compliance for wearing spectacles: Prevalence and determinants in school-going children in South India

Purpose: To study the prevalence and determinants of compliance with spectacle wear among school?age children in South India who were given spectacles free of charge under a school vision screening program. Methods: A cross?sectional, descriptive study was performed. The participants were recruited from the school from Tirunelveli and Tuticorin districts of Tamil Nadu, where a school vision screening camp was conducted between January 2012 and October 2012. The school screening was performed under “Lavelle Pediatric Eye Care Project”. Of the 129,720 children examined of 249 schools, 4253 of children had refractive error and 3333 were prescribed and dispensed spectacles. A total of 683 children were interviewed, who were not wearing glasses on follow?up. Results: About 20% of the participants (683/3333) were not wearing their spectacles at examination. The most common reasons given for non?wear were lost (44.9%) or broken (35.3%) spectacles. There was no gender preference on compliance to spectacles. Conclusion: Compliance with spectacle wear is less even when spectacles are provided free of cost, particularly in children among the age group of 5–15 years. Because factors such as type of school, area (urban or rural), parent’s income, occupation, and their education were not significantly affecting the compliance of spectacle wear, proper encouragement and counseling of the parents and the child become extremely important.

Impact of individual counseling on the knowledge and attitudes of type 2 diabetics regarding diabetic retinopathy: The Aditya Jyot Diabetic Retinopathy in Urban Mumbai Slums Study – Report 3

Purpose: Baseline knowledge and attitudes regarding diabetic retinopathy (DR) have not been previously reported for type 2 diabetes mellitus adults (T2DM) in Dharavi, one of the largest slums in Mumbai. Furthermore, a pre? and post?intervention survey study regarding this topic has not been conducted to date in Dharavi. This pre? and post?intervention survey study analyzes the impacts of DR counseling sessions administered individually on the knowledge and attitudes of T2DM participants recruited from Dharavi. Methods: Potential subjects (>30 years old) from Dharavi were enrolled by community workers and screened for T2DM. Those with confirmed T2DM were each registered for an individual DR counseling session. A survey was distributed to participants before the counseling session to determine their baseline knowledge and attitudes. The same survey was distributed after the counseling session, and changes in pre? and post?survey responses were analyzed. Results: Exactly 1718 T2DM study participants were given pre? and post?surveys. Before the counseling, T2DM participants showed low baseline knowledge and attitudes regarding DR, with only 30.8% (530/1718) participants being aware that diabetes can affect the eye. Participants showed significant improvements after the counseling session, with more participants showing willingness to attend DR screenings (pre: 38.3.%, post: 56.8%; P < 0.0001) and more becoming aware that diabetes can affect the eye (90.4%, 1553/1718; P < 0.0001). Conclusion: Targeted educational interventions for T2DM individuals from the slums of western India, such as Dharavi, can lead to significant improvements in knowledge and attitudes, representing a promising avenue in tackling the burden of avoidable blindness caused by DR in India.

Expected Benefits and Challenges of Using Economic Evaluations to Make Decisions About the Content of Newborn Screening Programs in Vietnam: A Scoping Review of the Literature

Abstract Screening newborns for genetic and other diseases is one of the most effective ways to improve health and reduce disease in a population. In developed countries, newborn screening has been a cornerstone of public health for decades. In many developing countries, however, newborn screening is still in its infancy. Many countries still lack screening programs. When a program is available, it generally lacks well-defined criteria on which decision-makers can justify the choice of diseases screened for and the methods used. One of the reasons put forward to understand this observation is the fact that little consideration is given by decision-makers to economic evaluations as a pillar of decision-making, as is the case in industrialized countries. This article provides a brief description of the challenges of using economic evaluation of newborn screening in developing countries. This will be illustrated by the example of the national newborn screening program in Vietnam.

Affordances in the home environment of children at risk of developmental delay / Oportunidades de ação no ambiente domiciliar de lactentes e crianças com risco de atraso do desenvolvimento

Abstract Objective: The aim of this study was to verify the adequacy of affordances in the home environment of children at risk of developmental delay and to identify factors associated with their frequency. Methods: The cross-sectional study included 97 families who responded to the Affordances in the Home Environment for Motor Development — Infant Scale (AHEMD-IS) for 3-18 months (n=63), or AHEMD - Self-Report (AHEMD-SR) for 18-42 months (n=34). The Mann-Whitney U test was used to identify the differences between the frequencies of affordances between the groups. Multiple linear regression was used to verify the association between the child's sex, mother's marital status, education, socioeconomic level, child and mother's ages, house residents' number, per capita income, and AHEMD scores (α=0.05). Results: The home affordances' frequency in the AHEMD-IS ranged from less than adequate to excellent, while in the AHEMD-SR, the highest predominance was medium. The offer of stimuli in the AHEMD-IS was significantly higher. Higher socioeconomic level and house residents' number were associated with greater affordances. Conclusions: The higher the socioeconomic level and house residents' number, the greater the affordances in the homes of children at risk of delay. It is necessary to provide families with some alternatives to make their home environments richer in affordances that favor child development.

RESUMO Objetivo Verificar a adequação das oportunidades de ação no ambiente doméstico de crianças em risco de atraso no desenvolvimento e identificar fatores associados à sua frequência. Métodos Este estudo transversal incluiu 97 famílias que responderam ao Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS) para 3-18 meses (n=63) ou o Self Report (AHEMD-SR) para 18-42 meses (n=34). O teste de Mann-Whitney foi utilizado para identificar as diferenças entre as frequências de oportunidades de ação entre os grupos. A regressão linear múltipla foi utilizada para verificar a associação entre o sexo da criança, o estado civil, a escolaridade e nível socioeconômico da mãe, as idades da criança e da mãe, o número de residentes da casa, a renda per capita e os escores do AHEMD (α=0,05). Resultados A frequência das oportunidades de ação dos domicílios no AHEMD-IS variou de menos do que adequado a excelente; enquanto, no AHEMD-SR, a maior predominância foi de média frequência. A oferta de estímulos no AHEMD-IS foi significativamente maior. O maior nível socioeconômico e o número de moradores da casa foram associados a maiores oportunidades de ação. Conclusões Quanto maior o nível socioeconômico e o número de moradores, maiores são as oportunidades de ação nos domicílios das crianças em risco de atraso. É necessário oferecer às famílias algumas alternativas para tornar os seus ambientes domésticos mais ricos em oportunidades de ação que favoreçam o desenvolvimento infantil.

Ethiopian Health Extension Workers' Training Status and Perceived Competency

BACKGROUND: Training and work experience are critical inputs for delivering quality health services. However, no nationwide assessment has been conducted on the status of training and the competency of Health Extension Workers (HEWs). Therefore, this study aimed to assess HEWs' pre service training status and perceived competency in Ethiopia. METHODS: The study was conducted in all regions and all HEWs training institutions in Ethiopia. We used cross sectional study design with a mixed method approach that included 585 HEWs, 1,245 HEW trainees, 192 instructors, and 43 key informants. Descriptive statistics and thematic analysis were used to analyse quantitative and quantitative data respectively. RESULT: Twenty-six percent of the HEWs said that they were competent to deliver all the HEP activities, and 73% of the HEWs said that they could confidently deliver 75% of the HEP activities. Receiving in-service training and having level III/IV qualifications are positively associated with the competency of HEWs. Similarly, HEP trainees perceived themselves as highly competent in executing their professional work, except in using computer and mobile health technology. Both instructors and trainees rated the quality of the curriculum and course materials positively. However, basic services and facilities in most training institutions were perceived to be inadequate. Additionally, individual learning, problem-solving, case-analysis, and assessment methods such as project work and portfolios were rarely practiced. CONCLUSIONS: Although the perceived competence of HEW trainees is high, the HEWs' training is not provided as per the curriculum because of limited resources. All the necessary resources should be made available to produce competent HEWs

Depression and Burnout among Health Extension Workers in Ethiopia: A Cross-Sectional Study

BACKGROUND: Depression and burnout are common among healthcare workers (HCWs) and negatively affect their well being and the quality of the service they provide. However, the burden of depression and burnout among health extension workers (HEWs) in Ethiopia and their relationship has not been documented well. The objective of this study was to estimate the prevalence of depression and burnout among HEWs in Ethiopia and to investigate the relationship between these conditions. MATERIALS AND METHODS: We used a cross-sectional study design and collected data from 584 rural and 581 urban HEWs in Ethiopia, as part of the 2019 national health extension program assessment. The Patient Health Questionnaire (PHQ-9) and Burnout Self-Test were used to screen HEWs for depression and burnout, respectively. We used descriptive statistics to estimate the magnitude of depression and burnout, and logistic regression to examine their relationship. RESULT: Based on PHQ-9 cutoff scores of 10, the prevalence of major depression was 16.5% among rural and 8.9% among urban HEWs, whereas burnout risk was 39.8% among rural and 12.6% among urban HEWs. The odds of having depression among HEWs with burnout risk was relatively higher compared to those without burnout risk [For rural HEWs, the adjusted odds ratio (AOR) is 11.88 at a 95% confidence interval (CI; 5.27, 26.80), and for urban HEWs, the AOR is 11.49 at a 95% CI (5.35, 24.63)]. CONCLUSION: The prevalence of depression and burnout is high among HEWs in Ethiopia, with a significant rural­urban difference, and burnout is a significant predictor of depression. Mental health interventions that enable prevention, early detection, and management are needed especially for rural HEWs who are in charge of preventive health service delivery for the disadvantaged rural communities

Development trend of physical examination volume and revenue in health-checkup institutions in China from 2010 to 2019 / 中华健康管理学杂志

Objective:To investigate the development trend of physical examination volume and revenue in health-checkup institutions in China from 2010 to 2019.Methods:In this longitudinal study, the annual income, annual physical examination volume and other indicators reflecting institutional size were collected with questionnaire from 374 health-checkup institutions in the year of 2010, 2015 and 2019. The geometric mean method is used to calculate the compound annual growth rate (CAGR) of the annual physical examination volume, annual income, mean per capita cost from 2010 to 2015 and 2015 to 2019.Results:The annual physical examination volume of health-checkup institutions increased from 1.81 (1.00, 3.20) ×10 4 person times in 2010 to 5.08(3.50, 7.28)×10 4 person times in 2019; the CAGR of the physical examination volume from 2010 to 2015 was 14.04%(8.14%, 23.78%), and it was 9.49%(3.39%, 19.07%) from 2015 to 2019. The annual revenue increased from 768.73 (350.00, 1 623.75) ×10 4 yuan in 2010 to 3 500.00 (1 997.73, 6 818.54) ×10 4 yuan in 2019; the CAGR of annual revenue from 2010 to 2015 was 25.75% (15.17%, 35.09%), and it was 15.67% (8.78%, 26.11%) from 2015 to 2019. The mean per capita cost increased from 434.26 (278.82, 666.66) yuan in 2010 to 755.80 (506.90, 1 005.42) yuan in 2019; the CAGR of the mean per capita cost was 9.82% (1.71%, 17.10%) from 2010 to 2015, and it was 5.37% (0.95%, 10.46%) from 2015 to 2019. Conclusion:From 2010 to 2019, health-checkup institutions in China developed rapidly, and the CAGR of the annual physical examination volume, annual revenue, mean per capita cost are high.