Beneficios que reciben los pacientes asmáticos tras la aplicación de un tratamiento fisioterapéutico y rehabilitador

El asma bronquial sigue siendo la enfermedad crónica más frecuente en la infancia. Su prevalencia continúa aumentando a pesar de que en la actualidad se disponen de eficaces manuales terapéuticos para el correcto manejo de los principales síntomas de la enfermedad. El tratamiento no farmacológico de este padecimiento se fundamenta en tres pilares esenciales: la educación sobre la enfermedad, las guías para profesionales y pacientes y la fisioterapia respiratoria. Los pacientes que tienen un tratamiento fisioterapéutico y rehabilitador de manera habitual, tienen una mejoría significativa en el control del asma, especialmente si estos se practican bajo la supervisión de un fisioterapeuta. Los beneficios que los pacientes asmáticos logran con la fisioterapia y la rehabilitación son numerosos y uno de los efectos más importante es el impacto positivo sobre la calidad de vida.

Bronchial asthma continues to be the most common chronic disease in childhood. Its prevalence continues to increase despite the fact that effective therapeutic manuals are currently available for the correct management of the main symptoms of the disease. The non-pharmacological treatment of this condition is based on three pillars: education about the disease, guides for professionals and patients, and respiratory physiotherapy. Patients who have regular physiotherapy and rehabilitation treatment have a significant improvement in asthma control, especially if these are practiced under the supervision of a physiotherapist. The benefits that asthmatic patients achieve with physiotherapy and rehabilitation are numerous and one of the most important effects is the positive impact on quality of life.

Correlation between chronic non-communicable disease and falls incidence among the elderly in urban and rural areas in Chongqing / 公共卫生与预防医学

Objective To analyze the correlation between the prevalence of chronic non-communicable diseases (NCDs) and fall incidence among the elderly in urban and rural areas in Chongqing, and to provide evidence for targeted intervention. Methods In 2019, a questionnaire survey was conducted among the elderly aged 65 and over in four districts and counties using multistage stratified cluster random sampling. The difference of NCDs prevalence and fall incidence was compared by Chi-square test. The correlation between NCDs and fall incidence was analyzed by multivariate logistic regression. Results A total of 806 and 801 elderly people aged 65 and above in urban and rural areas，respectively, were investigated The fall incidence among the elderly in rural areas (12.98%) was higher than that in urban areas (7.94%) (χ2=10.916, P=0.001). The multivariable logistic regression analysis showed that the prevalence of heart disease (OR=2.988, 95%CI:1.544-5.785), osteoporosis (OR=2.696, 95%CI:1.527-4.760) and vestibular dysfunction or deafness (OR=3.180, 95%CI:1.142-8.861) was associated with fall incidence among urban elderly people. Factors including need for care (OR=2.315，95%CI：1.130-4.744), diabetes (OR=3.067，95%CI:1.634-5.756), osteoporosis (OR=1.972, 95%CI:1.210-3.214), and arthritis (OR=2.975, 95%CI:1.901-4.657) were associated with fall incidence among rural elderly people. Conclusion The fall incidence among the elderly in rural areas is higher than that in urban areas in Chongqing. The prevalence of NCD is high among the elderly. Timely treatment of NCDs should be provided to reduce fall incidence among the elderly.

Relación entre la obesidad y la COVID-19 / Relationship between obesity and COVID - 19

Existen evidencias crecientes que indican que la obesidad actúa como factor de riesgo independiente para padecer la COVID-19, los pacientes obesos tienen mayor incidencia de complicaciones, tiempo de hospitalización y riesgo de muerte. El objetivo de este trabajo es exponer la relación entre la obesidad y las formas graves de COVID-19, así como exponer los posibles mecanismos implicados. Se realiza una revisión de la literatura mundial y de las publicaciones nacionales referidas a la obesidad y la COVID-19. Se identifican las características que hacen a los obesos más susceptibles a infectarse por SARS-CoV-2 y a tener peor pronóstico. Se concluye que la obesidad constituye un desafío permanente en nuestro medio, que su prevención, tratamiento temprano y oportuno, permitirían reducir los tiempos de hospitalización, evolución desfavorable y mortalidad por COVID-19 grave(AU)

There is growing evidence that obesity acts as an independent risk factor for Covid-19. Obese patients have higher incidence of complications, hospitalization time and risk of death. The objective of this paper is to describe the relationship between obesity and severe forms of COVID 19, as well as to expose the possible mechanisms involved. A review of the world literature and national publications referring to obesity and COVID-19 is carried out. The characteristics that make obese people more susceptible to being infected by SARS-COV-2 and having a worse prognosis are identified. It is concluded that obesity constitutes a permanent challenge in our environment. Early and timely prevention would allow reducing hospitalization times, unfavorable evolution and mortality due to severe Covid-19(AU)

Obesidade e sobrepeso em colaboradores de um Centro Universitário em Fortaleza ­ Ceará - Brasil: há diferença entre os sexos? / Obesity and overweight in collaborators of a University Center in Fortaleza ­ Ceará ­ Brazil: is there a difference between the sexes?

Objetivo: avaliar a prevalência de sobrepeso e obesidade de acordo com o sexo entre os colaboradores de um centro universitário. Métodos: trata-se de um estudo transversal realizado com funcionários de um centro universitário particular, localizado na cidade de Fortaleza ­ Ceará ­ Brasil. Foram coletados, em entrevista presencial, os seguintes dados: pessoais, socioeconômicos e demográficos, além de ter sido realizadas por equipe treinada, medidas antropométricas, tais como, peso, altura, circunferência do pescoço (CP) e circunferência da cintura (CC). Resultados: foram entrevistados 80 funcionários, a maioria do sexo feminino 65% e 40% na faixa etária entre 20 a 29 anos, 40,0% com ensino médio incompleto e 31,3% com renda de até um salário-mínimo mensal. De acordo com a classificação do estado nutricional segundo valores de Índice de Massa Corporal (IMC), 68,7% dos participantes apresentavam excesso de peso, considerando os colaboradores com sobrepeso e obesidade e 78,8% das mulheres apresentaram CC de risco moderado e alto para o desenvolvimento de doenças cardiovasculares (DCV). Os dados de CP mostraram que há uma prevalência elevada 77,5% de sobrepeso e obesidade em ambos os sexos. Do total, 75% das mulheres apresentaram risco nutricional antropométrico para desenvolver DCV, enquanto 60,7 % dos homens apresentaram parâmetros de risco, sem diferença estatística (p = 0,184). Conclusão: foi possível identificar que a maioria da população estudada apresenta excesso de peso segundo o IMC e CP, além de apresentar risco para o desenvolvimento de DCV analisados por meio da CC e RCE, sem diferença significativa entre os sexos. Ressalta, assim, a importância do atendimento nutricional para o diagnóstico precoce de sobrepeso/obesidade, com a finalidade de reduzir a prevalência de excesso de peso no ambiente de trabalho e no setor produtivo, com a realização de ações de conscientização da importância da alimentação e hábitos saudáveis na promoção da saúde e na prevenção de doenças crônicas não transmissíveis, como a obesidade

Objective: To assess the prevalence of overweight and obesity according to sex among employees of a university center. Methods: This is a cross-sectional study carried out with employees of a private university center located in the city of Fortaleza ­ Ceará ­ Brazil. Personal, socioeconomic, and demographic data were collected in a face-to-face interview, in addition to anthropometric measurements such as weight, height, neck circumference (NC), and waist circumference (WC) by a trained team. Results: 80 employees were interviewed, most of them 65% female and 40% aged between 20 and 29 years, 40.0% with incomplete high school education, and 31.3% with an income of up to one minimum monthly wage. According to the classification of nutritional status according to Body Mass Index (BMI) values, 68.7% of the participants were overweight, considering the overweight and obese employees, and 78.8% of the women had moderate-risk WC and high for the development of cardiovascular disease (CVD). The PC data showed that there is a high 77.5% prevalence of overweight and obesity in both sexes. Of the total, 75% of women had an anthropometric nutritional risk for developing CVD, while 60.7% of men had risk parameters, with no statistical difference (p = 0.184). Conclusion: It was possible to identify that the majority of the studied population is overweight according to BMI and LC, in addition to being at risk for the development of CVD analyzed through WC and WHtR, with no significant difference between genders. Thus, it emphasizes the importance of nutritional care for the early diagnosis of overweight/obesity to reduce the prevalence of excess weight in the work environment and the productive sector by carrying out actions to raise awareness of the importance of food and healthy habits in promoting health and preventing chronic non-communicable diseases such as obesity.

Características clínicas, epidemiológicas y terapéuticas de los pacientes que ingresan por crisis de asma bronquial / Clinical, Epidemiological and Therapeutic Characteristics of Patients Admitted for a Bronchial Asthma Attack

RESUMEN Fundamento: el asma bronquial es una de las enfermedades crónicas no transmisibles más prevalentes en la infancia, en su evolución presenta crisis desencadenadas por múltiples factores, relacionados al huésped y a factores ambientales. Objetivo: describir las características clínicas, epidemiológicas y terapéuticas de las crisis de asma bronquial en el Hospital Pediátrico Universitario Paquito González Cueto de Cienfuegos, durante los años 2015 y 2016. Método: se realizó un estudio descriptivo y correlacional sobre una serie de casos en el Hospital Pediátrico Universitario Paquito González Cueto de Cienfuegos en el periodo comprendido desde el 1ero de enero 2015 hasta el 31 diciembre del 2016 en el que fueron incluidos los pacientes que egresaron con el diagnóstico de crisis de asma bronquial. Los datos fueron obtenidos de la historia clínica de los pacientes. Se analizaron las variables: edad, sexo, color de la piel, clasificación de la enfermedad asmática, severidad de la crisis en el ingreso y forma de distribución del medicamento. Se aplicaron los procedimientos de la estadística descriptiva como son la determinación de la frecuencia de ocurrencia y los porcientos. Resultados: el grupo etáreo más afectado fue el menor de 3 años (35,8 %), con ligero predominio del sexo masculino (55 %) y el color de piel blanca (57 %), el mayor número de ingreso correspondió a los meses de alza epidémica, predominó la forma leve persistente (53,6 %) y las crisis moderadas (94,6 %), 64,4 % no tenía tratamiento de control. Conclusiones: la mayor parte de los pacientes recibieron un tratamiento inadecuado para la crisis en cuerpo de guardia y la sala, además el tratamiento de control fue inadecuado en casi la mitad de los pacientes o inexistente.

ABSTRACT Background: bronchial asthma is the prevalent chronic non-communicable disease in childhood, in its evolution it presents crises triggered by multiple factors, related to the host and the environment. Objective: to describe the clinical, epidemiological and therapeutic characteristics of bronchial asthma crises at the Paquito González Cueto University Pediatric Hospital in Cienfuegos, during 2015 and 2016. Method: a descriptive, and correlational study was carried out on a series of cases at the Paquito González Cueto University Pediatric Hospital in Cienfuegos in the period from January 1st, 2015 to December 31st 2016, in which were included the patients who leave with the diagnosis of a bronchial asthma crisis. The data were obtained from the clinical history of the patients. The variables were analyzed: age, sex, skin color, classification of the asthmatic disease, severity of the crisis on admission, and form of drug distribution. Descriptive statistics procedures were applied, such as the determination of the frequency of occurrence and the percentages. Results: the most affected age group was under 3 years old (35.8 %), with a slight predominance of males (55 %) and white skin color (57 %), the highest number of admission corresponded to the months of epidemic rise, the minor persistent form (53.6 %) and the moderate seizures (94.6 %) predominated, the 64.4 % had no control treatment. Conclusions: most of the patients received inadequate treatment for the crisis in the emergency room and the ward; in addition, the control treatment was inadequate or non-existent in almost half of the patients.

Assessment on the capacity for prevention and control programs for chronic non-communicable diseases in China, in 2014 / 中华流行病学杂志

Objective To assess the capacity of prevention and control on chronic non-communicable diseases (NCDs) in China.Methods On-line questionnaire survey was adopted by 3 395 CDCs at provincial,municipal and county (district) levels and 3 000 primary health care units,and assess on capacity of policy,infrastructure,capacity of training and guidance,cooperation,surveillance,intervention and management,assessment and scientific research from September 2014 to March 2015.Results (1) Capacity of policy:23 (71.9％) provincial,139 (40.6％) municipal and 919 (31.2％) county (district) governments or health administrative departments had existing plans for prevention and control of NCDs.(2) Capacity of infrastructure:25 (78.1％) provincial,136 (39.8％)municipal and 529 (18.0％) county (district) CDCs had set up departments dedicated to the prevention and control of NCDs,with 9 787 staff members,accounting for 5.0％ of the total CDC personnel,working on NCDs prevention and control programs.68.1％ of the CDCs had special funding set for NCDs prevention and control.(3) Capacity of training and guidance:2 485 CDCs (74.9％) held all kinds of training on prevention and control ofNCDs.2 571 (87.3％) CDCs at the county (district) level provided technical guidance for primary health care units.(4) Capacity of cooperation:42.0％ of the CDCs had experiences collaborating with the mass media.(5) Capacity of surveillance:73.8％ of the CDCs had set up programs for death registration while less than 50.0％ of the CDCs had implemented surveillance programs on major NCDs and related risk factors.In terms of primary health care units,32.4％ of them had set up reporting system for newly developed stroke case and 29.9％ of them having programs on myocardial infarction case reporting.(6) Capacity of intervention and management:69.1％ and 68.2％ of the CDCs conducted individualized intervention programs on hypertension and diabetes,while less than 40.0％ CDCs conducting intervention programs on other NCDs and risk factors.More than 90.0％ of the primary health care units carried out follow-up surveys on hypertension and diabetes.However,only 17.4％ and 13.7％ of the CDCs working on hypertension and diabetes patient management programs while 83.7％ and 80.4％,of them following the standardized guidelines for management,with successful rates of control as 59.2％ and 55.2％,respectively.(7) Capacity of assessment:32.4％ of the CDCs or health administrations carried out evaluation programs related to the responses on NCDs.(8) Capacity of scientific research:the capacity on scientific research among provincial CDCs was apparently higher than that at the municipal or county (district) CDCs.Conclusions Compared with the results of previous two surveys,the capacity on policies set for the prevention and control programs improved continuously,at all level NCDs,but remained relatively weak,especially at both county (district) and primary health care units.

Assessment on the capacity for prevention and control programs for chronic non-communicable diseases in China, in 2014 / 中华流行病学杂志

Objective To assess the capacity of prevention and control on chronic non-communicable diseases (NCDs) in China.Methods On-line questionnaire survey was adopted by 3 395 CDCs at provincial,municipal and county (district) levels and 3 000 primary health care units,and assess on capacity of policy,infrastructure,capacity of training and guidance,cooperation,surveillance,intervention and management,assessment and scientific research from September 2014 to March 2015.Results (1) Capacity of policy:23 (71.9％) provincial,139 (40.6％) municipal and 919 (31.2％) county (district) governments or health administrative departments had existing plans for prevention and control of NCDs.(2) Capacity of infrastructure:25 (78.1％) provincial,136 (39.8％)municipal and 529 (18.0％) county (district) CDCs had set up departments dedicated to the prevention and control of NCDs,with 9 787 staff members,accounting for 5.0％ of the total CDC personnel,working on NCDs prevention and control programs.68.1％ of the CDCs had special funding set for NCDs prevention and control.(3) Capacity of training and guidance:2 485 CDCs (74.9％) held all kinds of training on prevention and control ofNCDs.2 571 (87.3％) CDCs at the county (district) level provided technical guidance for primary health care units.(4) Capacity of cooperation:42.0％ of the CDCs had experiences collaborating with the mass media.(5) Capacity of surveillance:73.8％ of the CDCs had set up programs for death registration while less than 50.0％ of the CDCs had implemented surveillance programs on major NCDs and related risk factors.In terms of primary health care units,32.4％ of them had set up reporting system for newly developed stroke case and 29.9％ of them having programs on myocardial infarction case reporting.(6) Capacity of intervention and management:69.1％ and 68.2％ of the CDCs conducted individualized intervention programs on hypertension and diabetes,while less than 40.0％ CDCs conducting intervention programs on other NCDs and risk factors.More than 90.0％ of the primary health care units carried out follow-up surveys on hypertension and diabetes.However,only 17.4％ and 13.7％ of the CDCs working on hypertension and diabetes patient management programs while 83.7％ and 80.4％,of them following the standardized guidelines for management,with successful rates of control as 59.2％ and 55.2％,respectively.(7) Capacity of assessment:32.4％ of the CDCs or health administrations carried out evaluation programs related to the responses on NCDs.(8) Capacity of scientific research:the capacity on scientific research among provincial CDCs was apparently higher than that at the municipal or county (district) CDCs.Conclusions Compared with the results of previous two surveys,the capacity on policies set for the prevention and control programs improved continuously,at all level NCDs,but remained relatively weak,especially at both county (district) and primary health care units.

The changing trend of capacity on policy implementation related to the prevention and control of chronic non-communicable disease at the provincial level, from 2011 to 2017 / 中华流行病学杂志

Objective@#To assess the follow-up situstion and changes of policies related to the prevention and control on chronic non-communicable diseases (NCDs), in various provinces from 2011 to 2017.@*Methods@#Three national assessment programs on the prevention and control capacity of NCDs were carried out from September 2012 to March 2013, September 2014 to March 2015, and July to November 2018 respectively. Data related to the capacity on policy implementation among the 31 provinces, autonomous regions, municipality directly under the central government and Xinjiang Production and Construction Corps, were collected through online surveys.@*Results@#The rate of data collection in all the provinces reached 100%, for all three surveys. In 2011, 2013, and 2017, the capacity for policy development special funding was distributed for prevention and control NCDs under the provincial fiscal revenue by 27 provinces (84.4%), 26 provinces (81.3%) and 25 provinces (78.1%), and the numbers of provincial governments leaders attended the local activities related to prevention and control NCDs was 15 (46.9%), 13 (40.6%) and 19(59.4%), respectively. From 2009 to 2011, 14 (43.8%) proposals related to the topics on prevention and control of NCDs, were raised at the provincial People’s Congress and Political Consultative Conference, while from 2011 to 2013 and2014 to 2017, 13 (40.6%) and 12 (37.5%) were respectively raised. In terms of capacity for policy development, numbers of provincial comprehensive plan which targeting prevention and control of NCDs reached 6 (18.8%), 20 (62.5%) and 27 (84.4%) in 2011, 2013, and 2017 respectively. In 2011, 2013 and 2017, numbers of provincial special plans that targeting on NCDs or the risk factors of NCDs prevention and control were 0, 1, and 3, respectively.@*Conclusions@#Under the continuous introduction of international and national policies related to prevention and control on NCDs, capacity for policy formulation in various provinces has been greatly improved. However, a slight progress has been made in the capacity for policy making. The increase of capacity building on policy making regarding prevention and control of NCDs, at the provincial government level, has become a key issue.

Review and prospect of chronic non-communicable disease control and prevention in China / 中华疾病控制杂志

@# With the industrialization, urbanization, population aging and the constant change of disease spectrum, ecological environment and lifestyle, chronic diseases have become the biggest threat to the lives and health of Chinese residents. Since the 1990s, our government, professional institutions, and the whole society have given great attention and made unremitting efforts, thus have made great achievements. This article will comprehensively review the construction of chronic disease control and prevention system, control and prevention policies, surveillance, comprehensive intervention and scientific research to provide a basis for the formulation of future chronic disease control and prevention policies in China.

Progress on salt reduction and prevention of chronic non-communicable disease / 中华预防医学杂志

Salt reduction is one of the effective strategy for chronic non-communicable disease control and prevention recommended by World Health Organization. Research evidences on salt reduction emerge recently and some issues remain controversial. With the aim of providing reference for the future salt reduction action, this article reviewed the current evidence and strategies on the source of salt intake, the relationship between salt and health, the cost-effectiveness of salt reduction, as well as the targets and strategies of salt reduction. It also elaborated the main controversial issues in salt reduction, including salt reduction in population, evaluation method of salt intake, substitute salt, iodine intake, and the effectiveness of salt reduction strategy. The international and internal salt reduction activities were introduced as well.

Gestão do cuidado em saúde centrada no paciente com doença crônica não transmissível no campo da atenção secundária / Health care management focused on the patient with chronic non-communicable disease in the field of secondary care

O objeto deste estudo é a gestão do cuidado em saúde a ser aplicada na unidade de terapia biológica ao paciente com doença crônica não transmissível (DCNT) no campo da atenção secundária. Tem como objetivo geral propor um modelo de gestão do cuidado na atenção secundária em saúde para o paciente com DCNT. Os objetivos específicos são: (i)caracterizar o perfil dos pacientes com DCNT atendidos na unidade de terapia biológica; (ii)explorar o cuidado em saúde prestado ao paciente crônico sob a ótica dos profissionais que atuam na atenção secundária; (iii)avaliar o fluxograma do atendimento da unidade de terapia biológica; (iv)adaptar o fluxograma do atendimento considerando as múltiplas dimensões da gestão do cuidado em saúde; e (v)analisar as possíveis contribuições específicas para o trabalho de Enfermagem. Trata-se de um estudo de abordagem qualitativa, exploratória, realizado na unidade de terapia biológica da Policlínica Piquet Carneiro da Universidade do Estado do Rio de Janeiro, referência no campo da atenção secundária, com 80 pacientes, 14 profissionais de saúde e um funcionário administrativo. O estudo foi aprovado pelo Comitê de Ética em Pesquisa com número CAAE: 70596017.0.0000.5282. A produção dos dados abrangeu grupo focal com os profissionais, e com os pacientes foi utilizado um instrumento de coleta de dados com 32 perguntas fechadas e 2 abertas. Para análise utilizou-se o Epi-Info versão 7.1 e análise descritiva com distribuições de frequências simples e absoluta, onde a maioria era do sexo feminino (68,75%), mais da metade (62,50%) apresentava idade superior a 40 anos e 40% tinham o ensino médio completo. Quase metade (48,75%) declarou ser casada ou conviver com parceiro, ser do ambulatório da gastroenterologia (54%), fazer uso da medicação Infleximabe (55%) e tratar-se há mais de 24 meses (60%). Já para os dados provenientes dos profissionais, recorreu-se à análise de conteúdo, emergindo quatro categorias temáticas, são elas: (i) o impacto da educação em saúde e educação permanente na gestão do cuidado na UTB; (ii) as relações interpessoais entre os pacientes, equipe da UTB e da especialidade; (iii) a sobrecarga dos serviços de saúde no campo da atenção secundária; (iv) a interdisciplinaridade e a influência dos Indicadores de processos de trabalho na gestão do cuidado. Conclui-se que é possível estruturar um modelo de gestão do cuidado em saúde, com base nas análises do processo de trabalho na atenção secundária, pautado no referencial das múltiplas dimensões do cuidado em saúde. Porém, o modelo criado propõe uma sétima dimensão, de caráter epistemológico, que se caracteriza pela interdisciplinaridade. Recomenda-se a elaboração de protocolos clínicos e organizacionais pelos profissionais e gestores do serviço, utilizados como estratégia de enfrentamento de diversos problemas na gestão do cuidado, como foco a padronização de condutas na atenção secundária.

This study was aimed to address the health care management to be applied in the biological therapy unit to the patient with chronic non-communicable disease (CNCD) in the field of secondary care. Its general goal is to propose a model of care management in the secondary care of the patient with CNCD. The specific goals are: (i) to characterize the profile of patients with CNCD served in the biological therapy unit; (ii) to explore the health care provided to the chronic patient from the viewpoint of professionals working in secondary care; (iii) to assess the flow diagram of care in the biological therapy unit; (iv) to adapt the flow diagram of care considering the multiple dimensions of health care management; and (v) to analyze the possible specific contributions to the Nursing work. This study has a qualitative and exploratory approach and was performed in the biological therapy unit of the Policlínica Piquet Carneiro, belonging to the State University of Rio de Janeiro, reference in the field of secondary care, with 80 patients, 14 health professionals and one administrative worker. The study was approved by the Ethics Research Committee with CAAE number: 70596017.0.0000.5282. Data production covered a focus group with professionals, and a data collection instrument was used with 32 closed and 2 open questions with patients. In order to analyze data, we used Epi-Info version 7.1 and descriptive analysis with distributions of simple and absolute frequencies, where most were female (68.75%), more than half (62.50%) were older than 40 years and 40% had completed high school. Almost half (48.75%) reported being married or living with a partner, being assisted in the gastroenterology outpatient clinic (54%), making use of the Infliximabe® medicine (55%) and being treated for more than 24 months (60%). Regarding the data coming from professionals, we used the content analysis technique, giving rise to four thematic categories, namely: (i) the impact of health education and continuing education on care management in BTU; (ii) the interpersonal relationships among the patients, the BTU team and the specialty team; (iii) the overload of health services in the field of secondary care; and (iv) the interdisciplinarity and the influence of the Indicators of work processes in the care management. We can conclude that it is possible to organize a model of health care management, based on the analysis of the work process in secondary care, taking into account the framework of the multiple dimensions of health care. Nevertheless, the model established proposes a seventh dimension, with an epistemological nature, characterized by interdisciplinarity. We recommend the preparation of clinical and organizational protocols by the professionals and managers of the service, which may be used as a strategy to cope with several problems in the care management, focusing on the standardization of behaviors in secondary care.

El objeto de este estudio es la gestión del cuidado en salud que se debe aplicar en la unidad de terapia biológica al paciente con enfermedad crónica no transmisible (DCNT) en el campo de la atención secundaria. Tiene como objetivo general proponer un modelo de gestión del cuidado en la atención secundaria en salud para el paciente con DCNT. Los objetivos específicos son: (i) caracterizar el perfil de los pacientes con DCNT atendidos en la unidad de terapia biológica; (ii) explorar el cuidado en salud ofrecido al paciente crónico bajo la óptica de los profesionales que actúan en la atención secundaria; (iii) evaluar el diagrama de flujo de la atención de la unidad de terapia biológica; (iv) adaptar el diagrama de flujo de la atención considerando las múltiples dimensiones de la gestión del cuidado en salud; y (v) analizar las posibles contribuciones específicas para el trabajo de Enfermería. Se trata de un estudio de enfoque cualitativo, exploratorio, efectuado en la unidad de terapia biológica de la Policlínica Piquet Carneiro, perteneciente a la Universidad del Estado de Río de Janeiro, referencia en el campo de la atención secundaria, con 80 pacientes, 14 profesionales de salud y un funcionario administrativo. El estudio fue aprobado por el Comité de Ética en Investigación con el número de CAAE: 70596017.0.0000.5282. La producción de los datos cubrió un grupo focal con los profesionales, y con los pacientes se utilizó un instrumento de recolección de datos con 32 preguntas cerradas y 2 abiertas. Para el análisis, se utilizó el Epi-Info versión 7.1 y análisis descriptivo con distribuciones de frecuencias simple y absoluta, donde la mayoría era del sexo femenino (68,75%), más de la mitad (62,50%) presentaba edad superior a los 40 años y el 40% tenían la enseñanza media completa. Casi la mitad (48,75%) declararon estar casados o conviviendo con un compañero, ser del ambulatorio de gastroenterología (54%), hacer uso de la medicación Infliximabe® (55%) y tratarse por más de 24 meses (60%). En cuanto a los datos procedentes de los profesionales, se utilizó el análisis de contenido, emergiendo cuatro categorías temáticas, que son: (i) el impacto de la educación en salud y de la educación continua en la gestión del cuidado en la UTB; (ii) las relaciones interpersonales entre los pacientes, equipo de la UTB y de la especialidad; (iii) la sobrecarga de los servicios de salud en el campo de la atención secundaria; y (iv) la interdisciplinaridad y la influencia de los Indicadores de procesos de trabajo en la gestión del cuidado. Se concluye que es posible estructurar un modelo de gestión del cuidado en salud, basándose en los análisis del proceso de trabajo en la atención secundaria y en conformidad con la fundamentación de las múltiples dimensiones del cuidado en salud. Sin embargo, el modelo creado propone una séptima dimensión, de carácter epistemológico, que se caracteriza por la interdisciplinaridad. Se recomienda la preparación de protocolos clínicos y organizacionales por los profesionales y gestores del servicio, que serán utilizados como estrategia de lucha contra los diversos problemas en la gestión del cuidado, con miras a la estandarización de conductas en la atención secundaria.

Parish Prevalence Estimates of Obesity, Diabetes and Hypertension in Jamaica: Is It Now Time for More Targeted Public Health Interventions? / Estimados de la Prevalencia de la Obesidad, la Diabetes y la Hipertensión por Parroquia en Jamaica: ¿Es ya Tiempo de Realizar Intervenciones de Salud Pública Más Específicas?

ABSTRACT Objective: Geographic variation in obesity, Diabetes mellitus (DM) and hypertension (HTN) prevalence at the parish level was examined using the Jamaica Health and Lifestyle Survey 2008 (JHLS II). Methods: Total and sex-specific parish age-adjusted prevalence estimates of obesity, DM and HTN were obtained and ranked. Binary logistic regression models were adjusted for age, urbanicity, educational level, physical activity and diet. Results: Parish prevalence ranges were obesity 19.5-37.8% (1.7-31.0% in men versus 27.39-48.30% in women); DM 5.08-37.82% (0-26.45% in men versus 7.11-14.17% in women) and HTN 19.50-36.02% (10.94-48.39% in men versus 18.85-36.61% in women). The highest parish prevalences were St Elizabeth for obesity, Portland for DM and St Mary for HTN. Men residing in St Elizabeth were 16 times more obese compared to those in Portland [(Odds Ratio) OR = 15.84; 95% CI = 2.00, 125.51, p < 0.01], while women in St Elizabeth had twice the odds of being obese compared to those in St Ann [OR = 2.3; 95% CI, 1.007, 5.3). Men in Portland were eight times more likely to have HTN compared to those residing in St Ann (OR = 7.70; 95% CI = 2.34, 25.40, p = 0.001) whilst women in St Mary were three times more likely to be hypertensive compared to those living in St Thomas (OR = 3.05; 95% CI = 1.63, 5.72, p = 0.001). No significant associations were seen with DM. Conclusion: Significant heterogeneity exists at the parish level in obesity, DM and HTN, with important sex differences. Further analyses are needed to understand the determinants and work toward context-specific prevention and intervention programming.

RESUMEN Objetivo: La variación geográfica de la prevalencia de la obesidad, la diabetes mellitus (DM) y la hipertensión (HT) a nivel parroquia, se examinó usando la Encuesta 2008 sobre Salud y Estilo de Vida de Jamaica (JHLS-2). Métodos: Los estimados totales y específicos por género, ajustados por edad y a nivel de parroquia, de la prevalencia de la obesidad, DM y HT, fueron obtenidos y clasificados. Los modelos de regresión logística binaria fueron ajustados por edad, urbanidad, nivel educacional, actividad física, y dieta. Resultados: Los rangos de prevalencia por parroquia fueron como sigue: obesidad 19.5- 37.8% (1.7-31.0% en hombres versus 27.39-48.30% en mujeres); DM 5.08-37.82% (0- 26.45% en hombres versus 7.11-14.17% en mujeres); y HT 19.50-36.02% (10.94-48.39% en hombres versus 18.85-36.61% en mujeres). Las prevalencias más altas por parroquia fueron: Saint Elizabeth en obesidad, Portland en DM, y Saint Mary en HT. Los hombres de Saint Elizabeth eran 16 veces más obesos en comparación con los de Portland [(Odds Ratio) OR = 15.84; 95% IC = 2.00, 125.51, p < 0.01], mientras que las mujeres de Saint Elizabeth tenían el doble de probabilidades de ser obesas en comparación con las de Saint Ann (OR = 2.3; 95% IC, 1.007, 5.3). Los hombres de Portland eran ocho veces más propensos a padecer de HT en comparación con los residentes en Saint Ann (OR = 7.70; 95% IC = 2.34, 25.40, p = 0.001) en tanto que las mujeres de Saint Mary tenían tres veces más probabilidades de ser hipertensas comparadas con las que viven en Saint Thomas (OR = 3.05; 95% IC = 1.63, 5.72, p = 0.001). No se observaron asociaciones significativas con DM. Conclusión: Existe una heterogeneidad significativa a nivel de parroquias en cuanto a obesidad, DM, y HT, con importantes diferencias de género. Se necesitan más análisis para entender las determinantes y trabajar hacia la programación de intervenciones y prevenciones específicas del contexto.

Investigation on the Payment Methods of 5 kinds of Chronic Diseases in Public Hospitals of Heze / 中国卫生经济

Objective:To investigate the payment methods of 5 kinds of chronic diseases in public hospitals of Heze.Methods:8 383 cases of hypertension,diabetes,coronary heart disease,chronic bronchitis and hepatitis B were enrolled from the Municipal Hospital,the Second People's Hospital,the Third People's Hospital,the City Hospital of Traditional Chinese Medicine and the Infectious Disease Hospital in Heze from January 1,2012 to December 31,2015.The information of medical records and the cost of hospitalization were collected and analyzed.Results:The total hospitalization expense,examination fees and other costs of medicare patients were significantly higher than those of the non-medicare patients(P＜0.05),while the drug expenses were significantly lower than that those of non-medicare patients(P＜0.05).As to the medicare patients,hospitalized expense of male patients was significantly higher than that of female(P＜0.05),hospitalized expense and insurance expense of patients over 45 years old were significantly higher than those of patients under 45 years old(P＜0.05),hospitalized expense and insurance expense of retired patients were significantly higher than those of patients on-the-job(P＜0.05),total expense of urban patients were significantly higher than those of rural patients(P＜0.05).Conclusion:Payment of patients with chronic diseases was in relation with hospitalization expenses,which was also related to the social economic characteristics,but it was worth paying attention to avoiding excessive medical treatment and waste of resources,which needed to take comprehensive measures in combination with social situation.

Adherencia de planes caseros de terapia respiratoria en pacientes con enfermedades crónicas del programa de atención domiciliaria, Cali, 2014 / Adherence to home respiratory therapy plans among patients with chronic diseases from the home care program, Cali, 2014 / A adesão casa planeja fisioterapia respiratória em pacientes com doenças crônicas do programa de atendimento domiciliar, Cali, 2014

Objetivo: Determinar la adherencia de los planes caseros de terapia respiratoria en pacientes con enfermedades crónicas de un programa de atención domiciliaria, cuyos tratamientos incluyen prácticas de terapias respiratorias en la ciudad de Santiago de Cali - Colombia. Metodología: Se realizó un estudio observacional, descriptivo y de corte transversal. La población de estudio correspondió a 83 adultos entre 45 y 85 años con patologías crónicas, no alterara las funciones cognitivas, pertenecientes al programa de terapia respiratoria de la IPS SISANAR. Se diseñó una encuesta dirigida al paciente y cuidadores primarios. Resultados: El comportamiento entre las variables analizadas no fue paralelo, en ambas variables bien sea por factores como el tipo de afiliación, caso que correspondería al Plan casero Vs SGSS, mientras que el segundo de ellos presenta un comportamiento que refleja una diferencia en el número de sesiones realizadas por mes y las actividades registradas en el plan casero. Discusión: Este estudio encontró que los planes caseros muestran que la adherencia es efectiva pero depende del alto grado del manejo que se dé inicialmente desde los Sistemas de Seguridad Social al que pertenezcan los pacientes y al cumplimiento de las actividades.

Objective: to assess the adherence to home respiratory therapy plans in patients with chronic diseases from a home care program whose treatments include respiratory therapy practice in the city of Santiago de Cali, Colombia. This study focused mainly on the patients affiliated to the home care program of the SISANAR health care providing institution. Methodology: an observational, descriptive and cross-sectional study was conducted. The studied population consisted of 83 adults aged 45 to 85 with chronic pathologies which did not alter cognitive functions. These patients were part of the respiratory therapy program of the SISANAR health care providing institution. An interview geared at both patients and primary caregivers was designed. Results: the behavior between the variables analyzed was not parallel for both variables. This was due either to factors such as affiliation type (which is the case of the home care program vs. the General System for Social Security in Health), or to a behavior reflecting a difference in the number of sessions per month and the activities recorded in the home care plan. Discussion: this study found that home plans show that adherence is effective but highly dependent on both compliance with activities and the initial management provided by the patients’ social security system.

Objetivo: determinar a aderência de casa planeja fisioterapia respiratória em pacientes com doenças do programa de assistência domiciliar crónicas cujos tratamentos incluem práticas de fisioterapia na cidade de Santiago de Cali - Colômbia. Metodologia: Estudo observacional, descritivo e transversal foi conduzido. A população de estudo correspondeu a 83 adultos entre 45 e 85 anos com doenças crônicas, não alteram as funções cognitivas pertencentes ao programa de terapia respiratória sisanar ips. um levantamento dos pacientes e cuidadores primários foi projetado. Resultados: O comportamento entre as variáveis analisadas foi nenhum paralelo em ambas as variáveis, quer por factores como a filiação, se isso corresponder ao Plano de casa Vs sgss, enquanto o segundo tem um comportamento que reflete uma diferença no número de sessões por mês e actividades registadas no plano de casa. Discussão: Este estudo revelou que planos de casa mostram que a adesão é eficaz, mas depende muito da gestão inicialmente a partir de sistemas de segurança social pertencentes aos pacientes e atividades de conformidade.

Health self-management group in Shanghai / 上海预防医学

Health self-management group adopts the mode of chronic disease self-management and offers a series of courses for community residents in order to help them carry out health self-management. For healthy people, the program aims at disease prevention by means of improving health literacy, acquiring health knowledge and skills, and developing a healthy lifestyle.While for patients, the program aims to prevent or slow the progression of diseases by means of helping them deal with their condition, achieving disease self-management. By nearly ten years of exploration and practice in Shanghai communities, with the program a working system had been established which was dominated by patriotic health campaign committee office at the levels of city and district, and technologically supported by centers for disease control and prevention with support and cooperation of the town government.The program was implemented by community health service centers and neighborhood ( village ) committee.A large-scale and whole-society promotion had been really achieved in community residents with health self-management. By the end of 2015, health self-management groups had covered all of the city's streets ( town ) and neighborhood ( village ) committee, 26 thousand groups set up and nearly 440 thousand community residents participated in group activities.

Investigation on chronic disease-related lifestyle and behavior in adults in Chengdu / 中华流行病学杂志

Objective To investigate the chronic disease related lifestyle and behavior in adults in Chengdu.Methods 8 324 residents (more than 18 years old) were investigated through random selection and stratified multi-stage cluster sampling method in Chengdu.Distributions on chronic diseases and relevant factors between chronic diseases and lifestyle/behavior were analyzed.Results 1 329 cases were suffered from chronic diseases,with prevalence rate as 16.0％.Smoking,passive smoking,irregular diet,intake smoked or pickled food,hardcore diet and lack of physical exercises were factors significantly related to the prevalence rates on chronic diseases (P＜0.05).Irregular diet,intake smoked and pickled food,hardcore diet and lack of physical exercise belonged to independent risk factors for chronic diseases in adults (P＜0.05).Conclusion The overall prevalence rate of chronic disease was high in adults in Chengdu.The related risk factors were closely related to lifestyle or behavior of the population that called for the development of programs on healthy life style and good habits.

The implication of traditional Chinese medicine sects for the chronic non-communicable disease research / 国际中医中药杂志

This paper reviewed the academic contribution of famous doctor of traditional Chinese medicine belonging to Yishui sects, and analyzed the change of chronic non-communicable disease in the 21st century. On this basis, the paper put forward that we should exert the advantages of traditional Chinese medicine, explore the regularity of treating chronic non-communicable disease, refresh the academic innovation, and generate new ideas and new treatment.

Chronic disease in the Caribbean: strategies to respond to the public health challenge in the region. What can we learn from Jamaica's experience? / Enfermedades crónicas en el Caribe: estrategias para responder a los retos de la salud pública en la región. ¿Qué podemos aprender de la experiencia de Jamaica?

With the advent of the epidemiological transition, chronic non-communicable diseases (CNCDs) have emerged as the leading cause of death globally. In this paper, we present an overview of the burden of CNCDs in the Caribbean region and use Jamaica as a case-study to review the impact of policy initiatives and interventions implemented in response to the CNCD epidemic. The findings show that while Jamaica has implemented several policy initiatives aimed at stemming the tide of the CNCD epidemic, a comparison of data from two national health and lifestyle surveys conducted in Jamaica in 2000/01 and 2007/08 revealed that there was an increase in the prevalence of intermediate CNCD risk factors such as hypertension and obesity. We therefore present recommended strategies which we believe will enhance the current CNCD response and thus reduce, or at least stem, the current epidemic of CNCDs.

Con el advenimiento de la transición epidemiológica, las enfermedades no comunicables crónicas (ENCCs) han emergido como la causa principal de muerte a nivel mundial. En este trabajo, se presenta un panorama general de la carga que las ENCCs representa para la región caribeña. Asimismo, se utiliza Jamaica como estudio de caso para examinar el impacto de las iniciativas en materia de políticas así como las intervenciones, implementadas en respuesta a la epidemia de ENCC. Los hallazgos muestran que si bien Jamaica ha implementado varias iniciativas en cuanto a políticas, dirigidas a detener la marea de la epidemia de ENCC, una comparación de datos de dos encuestas nacionales sobre salud y estilo de vida realizadas en Jamaica en 2000/01 y 2007/08 revelaron que hubo un aumento de la prevalencia de los factores de riesgo intermedios de las ENCC, tales como la hipertensión y la obesidad. Por lo tanto, se presentan estrategias recomendadas, las cuales pueden - a nuestro juicio - mejorar la respuesta actual a las ENCC, y por ende reducir - o al menos frenar - la actual epidemia de ENCCs.