Uso dos serviços de saúde por pessoas idosas em áreas rurais e urbanas do Brasil / Health services utilization by older adults in rural and urban areas of Brazil

Resumo Objetivo Avaliar o uso dos serviços de saúde por pessoas idosas residentes em áreas urbanas e rurais do Brasil. Método Estudo transversal que analisou dados da Pesquisa Nacional de Saúde 2019, referentes aos moradores idosos (≥60 anos) selecionados nos domicílios, totalizando 22.728 entrevistas (3.300 em área rural e 19.426 em área urbana). Foram estimadas para as áreas rurais e urbanas as prevalências de cadastro na Estratégia Saúde da Família, intervalo de tempo da última consulta médica e odontológica, procura do serviço nas últimas duas semanas, última aferição da pressão arterial e da glicemia e avaliados os fatores associados à utilização dos serviços de saúde médicos e odontológicos nos últimos 12 meses. Resultados A autopercepção da saúde como 'muito boa' ou 'boa' foi maior na área urbana (47,32%), assim como a proporção de pessoas idosas que relataram consulta médica e odontológica nos últimos 12 meses (90,54%). Evidenciou-se menor frequência do acompanhamento da aferição de pressão arterial (81,30%) e da glicemia (45,83%) em áreas rurais. As pessoas idosas que possuem baixa escolaridade, residem em áreas rurais, na região Norte são as que possuem menor chance de utilização dos serviços. Conclusão A população idosa residente em área rural apresenta piores condições de saúde em relação à população residente em área urbana.

Abstract Objective To assess health services utilization by older adults in urban and rural areas of Brazil. Method A cross-sectional study was conducted analyzing data from the 2019 National Health Survey on older adults (≥60 years) selected from households based on 22,728 interviews (3,300 in rural and 19,426 in urban areas). For rural and urban areas, the prevalence of Family Health Strategy enrolment, time since last medical and dental visit, service use in past 2 weeks, and last blood pressure and blood glucose measurements were estimated. Also, the factors associated with medical and dental health services utilization in the past 12 months were explored. Results Self-rated health of "Very good" or "Good" was greater in urban areas (47.32%), as was the proportion of older adults reporting a medical or dental visit within the last 12 months (90.54%). Rates of blood pressure (81.30%) and glucose (45.83%) monitoring were lower in rural areas. Older individuals that had low education, resided in rural areas, and the North region, had a lower likelihood of using health services Conclusion The older population living in rural areas had poorer health status compared with the urban population.

Arranjos assistenciais em uma rede atenção psicossocial no sul do Brasil / Arreglos asistenciales en una red de apoyo psicosocial en sur de Brasil / Care arrangements on a psychosocial care network in southern Brazil

RESUMO. A implementação da reforma psiquiátrica é tema de recorrentes discussões no campo da saúde mental. Essa implementação não é padrão para todas as localidades brasileiras, uma vez que depende dos recursos materiais, humanos e aspectos culturais de cada região. A esta singularidade retoma-se a noção de arranjo assistencial. Este trabalho se propôs a conhecer a implementação numa regional de saúde da região Sul. Foi realizado um mapeamento descritivo, seguindo método empírico-fenomenológico. Descrevem-se serviços que acolhem todos os públicos, mas que encontram dificuldades no trabalho com a população usuária de álcool e outras drogas. Foram elencados sete dispositivos assistenciais: acolhimento, grupos terapêuticos, oficinas, atendimentos individuais, uso da medicação, encaminhamentos e reuniões de equipe. Expõe-se a ideia de que a estrutura de um serviço de saúde mental não pode ser estanque. Os arranjos assistenciais estão relacionados às vivências e soluções criativas e humanas como também práticas irrefletidas e normatizadoras na atenção do sofrimento mental.

RESUMEN. La implementación de la reforma psiquiátrica no se encuentra estandarizada para todas las regiones brasileras, una vez que eso depende de recursos materiales, humanos y de aspectos culturales. Por cuenta de esta singularidad, se retoma la noción de arreglo asistencial. En este trabajo se propone conocer la implementación en una regional de salud de sur de Brasil. Se realizó un mapeo descriptivo, siguiendo el método empírico-fenomenológico. Se describen servicios que acogen a todos los públicos, pero que encuentran dificultades en el trabajo con usuarios de alcohol y drogas. Fueran enumerados siete dispositivos asistenciales: Acogimiento, grupos terapéuticos, talleres, atendimientos individuales, uso de medicación, encaminamientos y reuniones de equipo. Se expone la idea de que la estructura de un servicio de Salud Mental no puede ser hermética. Los arreglos asistenciales están relacionados con las vivencias y soluciones creativas y humanas como también prácticas irreflexivas y normalizadoras en la atención del sufrimiento mental.

ABSTRACT. The psychiatric reform is not standard in all Brazilian places, as it depends on different factors such as material, human and cultural aspects of each region. As for its singularity, it is seen as a care arrangement. This article aims to study the psychosocial care network on a regional health department in south Brazil. A descriptive mapping has been performed, following the empirical-phenomenological method. The services described welcome the entire community, people from all walks of life, but when it comes Drug and Alcohol addicted, the approach becomes more challenging. There have been seven care services listed: Hosting, Therapeutic Groups, Workshops, Individual Treatment, Medication usage, Referrals and Support Group Meetings. The approach for care arrangement is related to the creative experiences and human solutions as well as thoughtless and normative practices in the attention of mental suffering.

A cross-sectional study of contraceptive use and healthcare status among women at different times in the postpartum period / 上海预防医学

ObjectiveTo investigate the use of contraceptive methods， and to evaluate maternal healthcare services utilization among women within 2 years in Pudong New Area of Shanghai. MethodsA cross-sectional survey was conducted using a questionnaire for women at different postpartum periods who visited a community health clinic with their children from June to November 2021. Data were analyzed using χ2 test and binary logistic regression. ResultsAmong the 1 946 postpartum women surveyed， 1 934 were either married or cohabiting， and1 430 had resumed their sexual life. Among women at 4， 6， 12， 18 and 24 months postpartum， the contraceptive prevalence rates （CPR） were 92.34% （193/209）， 92.16% （235/255）， 87.31% （282/323）， 91.95% （297/323） and 90.00% （288/320）， respectively. The modern contraceptive prevalence rates （mCPR） were 87.08% （182/209）， 87.06% （222/255）， 82.04% （265/323）， 83.09% （271/323） and 85.31% （273/320）， respectively， while the unmet contraceptive needs （UMNs） were 7.66% （16/209）， 7.84% （20/255）， 11.46% （37/323）， 6.81% （22/323） and 10.00% （32/320）， respectively. The use rates of long-acting reversible contraceptive （LARC） methods among women at 6， 12， 18 and 24 months postpartum period were 0.39% （1/255）， 2.17% （7/323）， 0.31% （1/323）， and 2.81% （9/320）， respectively. Among all surveyed subjects， 32.17% （626/1 946） had received postpartum contraceptive services only once， while 27.85% （542/1 946） had not received any postpartum contraceptive services. Binary logistic regression analysis indicated that the use of contraceptive methods among postpartum women was associated with whether relevant educational services were received after childbirth and during postpartum home visits （all P<0.05）. ConclusionPostpartum women have unmet needs for contraception. Contraceptive guidance at the 42-day postnatal healthcare visit needs to be further strengthened and postpartum contraceptive education could be integrated into the pregnancy care. The quality and effectiveness of contraceptive education during delivery and postpartum home visits， and even at the 42-day postnatal healthcare visit need to be further explored.

Outpatient health service utilization and its influencing factors among pneumoconiosis patients combined with tuberculosis / 环境与职业医学

Background Tuberculosis is the most common complication of pneumoconiosis, which accelerates the progression of pneumoconiosis. Pneumoconiosis combined with tuberculosis is a major health risk. Objective To understand the outpatient health service utilization for patients of pneumoconiosis combined with tuberculosis and its main influencing factors. Methods A stratified random sampling combined with non-random sampling was used to select 11181 pneumoconiosis patients in 27 provincial administrative regions (excluding Shanghai, Tianjin, Hainan, Tibet Autonomous Region, Taiwan, Hongkong and Macao Special Administrative Regions) from December 2017 to June 2021. A self-constructed questionnaire, i.e. Health Seeking Behaviors of Pneumoconiosis Patients and Their Influencing Factors, was used, which included basic information, outpatient and inpatient service utilization, and influencing factors of medical treatment behaviors of pneumoconiosis patients. The effective recovery rate of the questionnaire was 90.7%. All patients of pneumoconiosis combined with tuberculosis (n=762) were included as the study subjects. The difference of outpatient utilization in the past two weeks, choosing medical institutions, and the reasons of not seeking medical treatment between urban and rural areas, and the influencing factors of outpatient service utilization were analyzed. Results The study subjects were mainly silicosis combined with tuberculosis (502 cases, 65.9%) and coal workers' pneumoconiosis combined with tuberculosis (232 cases, 30.5%), aged (58.6±12.5) years old. The main region was Western China (45.1%), followed by Eastern China (22.1%), Centeral China (20.2%), and Northeastern China (12.6%). The outpatient utilization rate in the past two weeks was 38.5% (293/762), and the main medical institutions consulted were municipal or provincial hospitals (32.0%), district or county hospitals (28.6%), and township hospitals or health service centers (17.5%). Short distance (20.7%), the availability of specialist outpatient services (16.7%), high level of medical care (14.8%), and low medical cost (12.3%) were the main reasons in choosing medical institutions. Higher proportion of patients seeking medical services due to acute exacerbation in rural areas was reported than in urban areas in the past two weeks (P<0.01). In addition to being hospitalized (113 cases, 41.4%) and self-purchasing medicine (46 cases, 16.8%), the reasons for not seeking medical treatment were self-perceived mild symptoms (15.0%) and high medical cost without reimbursement (9.5%). The multiple regression results showed that outpatient rate for patients of pneumoconiosis combined with tuberculosis in the western region was higher than that in the eastern region (OR=1.66, 95%CI: 1.03, 2.68); patients with an annual personal income of 10000-35500 yuan had a higher outpatient rate than the > 35500 yuan income group (OR=2.54, 95%CI: 1.49, 4.36); the outpatient rate of silicosis patients was higher than that of coal workers' pneumoconiosis (OR=1.83, 95%CI: 1.23, 2.72); the outpatient rate of patients with clinically diagnosed cases (no classified stage of pneumoconiosis) was higher than that of patients with stage I pneumoconiosis (OR=2.32, 95%CI: 1.24, 4.31). Exacerbation of pneumoconiosis-related symptoms in past two weeks (OR=4.26, 95%CI: 2.89, 6.28), occupational injury insurance (OR=0.49, 95%CI: 0.30, 0.80), and hospitalization in past one year (OR=2.37, 95%CI: 1.41, 3.97) were the main factors influencing the outpatient health service utilization among patients of pneumoconiosis combined with tuberculosis. Conclusion The outpatient rate of patients of pneumoconiosis combined with tuberculosis is higher than that of patients of pneumoconiosis without tuberculosis. The utilization of outpatient services is related with disease factors and socio-economic security factors.

Desafios para o suporte à amamentação em homens transgêneros sob à luz da interseccionalidade / Intersectionality and challenges in support for chest-feeding transgender men

Resumo O objetivo deste artigo é apreender os desafios nas vivências dos usuários e profissionais de Banco de Leite Humano no atendimento a homens transgêneros no contexto da amamentação sob à luz da Interseccionalidade. Estudo qualitativo descritivo-exploratório a partir de entrevistas realizadas com seis profissionais do Banco de Leite Humano, que atenderam previamente homens trans no contexto de amamentação, e dois homens trans bissexuais, que amamentaram ao peito. Os dados foram tratados pela Análise Temática com auxílio do software Atlas.ti versão 9.0. Observam-se lacunas nas esferas educacionais, institucionais e na gestão, associadas a questões pessoais e sociais, que reproduzem um modelo pré-concebido normativo, desconsiderando as singularidades requeridas no atendimento à população trans no contexto da amamentação. A cisheteronormatividade e a supremacia do profissional operam em âmbitos pessoais, sociais e institucionais para a segregação de homens transgêneros nos serviços de suporte à amamentação. A análise interseccional destes desafios permite uma visão global dos fatores de segregação e a implementação de políticas públicas promotoras da justiça social.

Abstract This article tried, from an intersectional standpoint, to grasp the challenges experienced by health professionals and service users of human milk banks in provision of care for transgender men chestfeeding. This exploratory, descriptive qualitative study drew on interviews of six human milk bank staff, who had previously assisted trans men in relation to chestfeeding and two bisexual trans men, who chestfed. The data was treated by thematic analysis, supported by Atlas.ti software, version 9.0. Lacunas in the educational, institutional and management spheres, associated with personal and social issues, reproduce a pre-conceived normative model and disregard the special demands of providing chestfeeding care for the trans population. Cisheteronormativity and "professional supremacy" operate in personal, social and institutional respects to segregate transgender men in lactation support services. Intersectional analysis of these challenges affords an overall view of segregative factors and enables public policies to be introduced to promote social justice.

Cuidado compartilhado em Saúde Mental: o que dizem os trabalhadores? / Shared Mental Health care: what do worker say? / Cuidado compartido en Salud Mental: ¿qué dicen los trabajadores?

A conjunção da Reforma Psiquiátrica e da Reforma Sanitária torna o Brasil um cenário único na superação do Paradigma Biomédico hegemônico e na radicalidade da desinstitucionalização no território. Este artigo objetiva analisar a percepção dos trabalhadores da Atenção Básica e da Atenção Especializada sobre o compartilhamento do cuidado em Saúde Mental em um município paulista de médio porte. Constitui-se como uma pesquisa qualitativa, de abordagem hermenêutico-dialética, cujos dados foram produzidos por narrativas de grupos focais narrativo-hermenêuticos realizados em 2022, com 15 trabalhadores. A Educação Permanente, a formação profissional, a integração da rede, a Saúde Mental do trabalhador e o enfrentamento das políticas de desmonte foram considerados fundamentais para o cuidado compartilhado. Mostra-se imperativo que o campo da Saúde Mental seja priorizado e não faltem recursos para que, cada vez mais, as práticas possam se orientar pelo Paradigma Psicossocial.

The conjunction of the mental health reform and health reform make Brazil a unique setting in overcoming hegemonic biomedical paradigm and in the radicality of deinstitutionalization across the territory. The aim of this study was to analyze the perceptions of primary and specialist care workers about sharing mental health care in a medium-sized municipality in the state of São Paulo. We conducted a qualitative study using the hermeneutic-dialectic method of inquiry based on data from the narratives of focus group meetings with 15 workers held in 2022. Permanent education, professional training, network integration, worker's mental health and confronting the dismantling of policies were considered essential to shared care. It is imperative that the field of mental health is prioritized and sufficient resources are made available so that practices are increasingly oriented towards the psychosocial paradigm.

La conjunción de la Reforma Psiquiátrica y de la Reforma Sanitaria hace que Brasil sea un escenario único en la superación del Paradigma Biomédico hegemónico y en la radicalidad de la desinstitucionalización en el territorio. El objetivo de este artículo es analizar la percepción de los trabajadores de la Atención Básica y de la Atención Especializada sobre la compartición del cuidado en salud mental en un municipio de mediano porte del estado de São Paulo. Se constituye como una investigación cualitativa, de abordaje hermenéutico-dialéctico, cuyos datos se produjeron a partir de narrativas de grupos focales narrativos-hermenéuticos realizados en 2022 con quince trabajadores. La educación permanente, la formación profesional, la integración de la red, la salud mental del trabajador y el enfrentamiento de las políticas de desmonte se consideraron fundamentales para el cuidado compartido. Se muestra imperativo que se priorice el Campo de Salud Mental y que no falten recursos para que, cada vez más, las prácticas puedan orientarse hacia el Paradigma Psicosocial.

Percepciones y experiencias de adultos mayores sobre sexualidad y servicios de salud sexual en Colombia

Introducción: Aunque a nivel mundial se ha demostrado que la población adulta mayor mantiene una vida sexual activa, es limitada por estereotipos, cambios fisiológicos resultados del proceso de envejecimiento y la ausencia de estrategias de salud integral para la sexualidad. Objetivo: Documentar la experiencia sexual de los adultos mayores en el país y entender los motivos que promueven o limitan la búsqueda de atención en salud sexual. Metodología: Estudio cualitativo en el que se realizaron 39 entrevistas y 4 talleres virtuales con hombres y mujeres de 50 años y más en Barranquilla, Bogotá, Cali, Medellín, sin excluir personas de otras ciudades. Resultados: Entre los principales hallazgos se evidencia que la población adulta mayor tiene valoraciones positivas frente a la sexualidad y el sexo, pero su desarrollo se ve limitado, especialmente para las mujeres, por los roles de género. La sexualidad en las personas mayores está atravesada por la educación inicial, la transformación de ideas sobre la sexualidad a lo largo de sus trayectorias de vida, las transformaciones del cuerpo, el estado de salud, las prácticas y experiencias sexuales recientes y la manera en la que se aproximan a la dimensión salud sexual con profesionales de la salud. Conclusiones: La heterogeneidad de experiencias, prácticas y valores dados a la sexualidad y al sexo en la vejez requieren de la generación de políticas y programas de atención integral basadas en investigaciones empíricas que superen las concepciones edadistas de la sexualidad. Este estudio es una contribución a la literatura local sobre sexualidad y vejez, así como al diseño de servicios de atención de salud y bienestar de acuerdo con las necesidades, identidades y circunstancias específicas de la población adulta mayor en materia de sexualidad.

Introduction: Although worldwide has been demonstrated that the older adult population maintains an active sexual life, this is limited by stereotypes, physiological changes resulting from the aging process and the absence of comprehensive health strategies for sexuality. Objective: To document the sexual experience of older adults in the country and to understand the reasons that promote or limit the search for sexual healthcare. Methodology: Qualitative study. Thirty-nine interviews and four virtual workshops were conducted with men and women 50 years of age and older in Barranquilla, Bogotá, Cali, and Medellín, although people from other cities were not excluded. Results: Among the main findings, it is evident that this population has positive evaluations of sexuality and sex, but its development is limited, especially for women, by gender roles. Sexuality in the elderly is formed by their initial education, the transformation of ideas about sexuality throughout their life trajectories, the transformations of their bodies, their state of health, recent sexual practices and experiences, and the way in which they approach this topic with health professionals. Conclusions: The heterogeneity of experiences, practices and values given to sexuality and sex in old age require policies and programs based on empirical research that overcome the ageist conception of sexuality. This study is a contribution to the national literature on sexuality and aging, and to the design of health care and well-being services according to the specific needs, identities and circumstances of the older adult population in terms of sexuality.

Women's health access in the context of forced migration in portugal: vulnerabilities and adaptation / Acesso à saúde de mulheres em contexto de migração forçada em Portugal: vulnerabilidades e adaptação / Acceso a la salud de las mujeres en el contexto de la migración forzada en Portugal: vulnerabilidades y adaptación

This article presents, the vulnerabilities related with regarding access to health services facedby refugee women, of a research project conducted in Portugal between 2020 and 2022 as part of the Masters in Intercultural Relations program at Universidade Aberta. Objective: The overall goal was to gain a better understanding of the psychosocial reality of women who arrived in Portugal as a result of forced migration, focusing on the main difficulties of the migratory and adaptation journey -highlighting vulnerabilities related to health and access to health services at the present article -and the protective factors that facilitated their processes of resilience, adaptation, and social integration. Methodology:The meaningsof the protagonists' experiences were disclosed through nine semi-structured and in-depth interviews with a woman from Iraq, seven from Syria, and one from Libya, which were conducted separately, recorded and transcribed. Following the transcription and translation of the interviews, the content analysis began with the coding and categorization of the obtained data. Results:The investigationuncovered a number of vulnerabilities triggered by the migratory experience and gender belonging, such as prejudice, social isolation, and cultural shock (mostly linked to religion and clothing), which validated the intersectional analysis. The findings highlight a number of obstacles in the host nation, including access to health care, the quality of institutional interactions, and knowledge of the Portuguese language.Conclusions:The current investigation led to theconclusion that there are flawsin Portugal in terms of ensuring full access to health care for forced migrant women, highlighting as major obstacles: a lack of information in languagesother than Portuguese, a lack of offers tolearn and masterthe Portugueselanguage, a lack of knowledge about how health institutions work, and a lack of sensitivity and intercultural skills inhealthcareservices (AU).

Este artigo apresenta as vulnerabilidades relacionadas no acesso aos serviços de saúde sentidas por mulheres refugiadas, de um projeto de investigação realizado em Portugal entre 2020 e 2022 no âmbito do Mestrado em Relações Interculturais da Universidade Aberta. Objetivo:O objetivo geral foi conhecer melhor a realidade psicossocial das mulheres que chegaram a Portugal como resultado da migração forçada, focando as principais dificuldades do percurso migratório e de adaptação,destacando as vulnerabilidades relacionadas com a saúde e acesso aos serviços de saúde, além dos fatores de proteção que facilitaram seus processos de resiliência, adaptação e integração social. Metodologia:Os significados das vivências das protagonistasforam relevados por meio de nove entrevistas semiestruturadas e em profundidade, realizadas individualmente, gravadas e transcritas, com umamulher do Iraque, seteda Síria e umada Líbia. Após transcrição e tradução das entrevistas, a análise de conteúdopartiu da codificação e categorização da informação recolhida.Resultados:A investigação desvelou uma série de vulnerabilidadescausadas pela experiência migratória epertença de gênero,como a discriminação sentida sob a forma de preconceitos, o isolamento social e o choque cultural (sobretudo relacionado com a religião e o vestuário utilizado), o que justificou a análise intersecional. Os resultados revelam umconjuntode desafiosno país de acolhimento, como o acesso à saúde, a qualidade das relações institucionais e o domínio da língua portuguesa.Conclusões: A presente investigação permitiu concluir que existem algumas carências em Portugal no que diz respeito à garantia do pleno acesso aos cuidados de saúde sentidas pelasmulheres migrantes forçadas, destacando-se como principais obstáculos: a falta de informação numa língua que não o português, a falta de domínio da língua portuguesa, o desconhecimento sobre o funcionamento das instituições de saúde e falta de sensibilidade e de competências interculturais nos cuidados de saúde (AU).

Este artículo presenta, las vulnerabilidades relacionadasconen el acceso a los servicios de salud que sienten las mujeres refugiadas, de un proyectorealizado en Portugal entre 2020 y 2022 en el ámbito del Máster en Relaciones Interculturales de la Universidade Aberta.Objetivo: El objetivo fue comprender la realidad psicosocial de las mujeres que llegaron a Portugal como resultado de la migración forzada, centrándose en las principales dificultades del viaje de migración y adaptación, destacandovulnerabilidades relacionadas con la salud y el acceso a los servicios de salud, además de los factores de protección que facilitaron sus procesos de resiliencia, adaptación e integración social. Metodología: Los significados de las experiencias fueron revelados através de nueve entrevistas semiestructuradas y en profundidad, realizadas individualmente, grabadas y transcritas, con una mujer de Irak, siete de Siria y una de Libia. Luego de la transcripción y traducción, se inició el análisis de contenido con la codificación y categorización de la información.Resultados: La investigación reveló vulnerabilidades provocadas por la experiencia migratoria y la pertenencia de género,como la discriminación sentida en forma de prejuicio, el aislamiento social y el choque cultural (principalmente relacionado con la religión y la vestimenta), que justificaron el análisis interseccional.Los resultados revelan desafíos en Portugal,como el acceso a la salud, la calidad de las relaciones institucionales y el dominio de la lengua portuguesa.Conclusiones: La presente investigación llevó a la conclusión de que existen fallas en Portugal en cuanto a garantizar el pleno acceso a la atención de la salud de las refugiadas,destacándose: falta de información en un idioma diferenteal portugués, falta de dominio de la lengua portuguesa, falta de conocimiento sobre el funcionamiento de las instituciones de salud y falta de sensibilidad y habilidades interculturales en la atención de la salud (AU).

Prevalencia de infección tuberculosa latente e incidencia de viraje tuberculínico en contactos escolares mayores de 5 años en la Ciudad Autónoma de Buenos Aires / Prevalence of latent tuberculosis infection and incidence of tuberculin conversion among school contacts older than 5 years in the City of Buenos Aires

Introducción. La tuberculosis continúa siendo un problema frecuente en contextos de vulnerabilidad socioeconómica. El objetivo principal fue establecer la prevalencia de infección latente y viraje tuberculínico en contactos escolares de casos de tuberculosis. Población y métodos. En un área programática del sur de la ciudad, se evaluó la prevalencia de infección y viraje tuberculínico de 691 niñas, niños y adolescentes utilizando la prueba cutánea de tuberculina. Se investigó la asociación entre pérdida de seguimiento por parte del equipo de salud y características demográficas, escolares y asistencia inicial, y se describió el grado de adherencia cuando la quimioprofilaxis con isoniacida fue indicada. Resultados. Según las definiciones consideradas, la prevalencia de infección latente fue entre el 3,4 % (IC95 %: 2,3-5,2) y el 11,6 % (IC95 %: 9,3-14,4) de los 610 contactos con al menos una prueba cutánea aplicada. La incidencia de viraje tuberculínico se encontró entre el 0,3 % y el 6,8 % de los 294 evaluados. La edad mayor de 18 años, la mayor prevalencia de necesidades básicas insatisfechas en la comuna escolar, la pertenencia al turno escolar vespertino, la negatividad en la baciloscopia del caso índice y la ausencia de aplicación de la prueba cutánea inicial se asociaron con pérdida de seguimiento del contacto. Conclusiones. La incidencia de viraje tuberculínico en contactos escolares fue baja. La adherencia a isoniacida continúa siendo limitada. Se identificaron factores asociados con la pérdida de seguimiento de contactos que podrían orientar estrategias necesarias para mejorar este proceso.

Introduction. Tuberculosis continues to be a common problem in settings of socioeconomic vulnerability. Our primary objective was to establish the prevalence of latent infection and tuberculin conversion among school contacts of tuberculosis cases. Population and methods. In a programmatic area in the south of the City of Buenos Aires, the prevalence of latent infection and tuberculin conversion was assessed in 691 children and adolescents using the tuberculin skin test. The association between loss to follow-up by the health care team and the demographic, school, and baseline care characteristics was studied, and the level of adherence when isoniazid chemoprophylaxis was indicated was described. Results. According to established definitions, the prevalence of latent infection was between 3.4% (95% confidence interval [CI]: 2.3­5.2) and 11.6% (95% CI: 9.3­14.4) in the 610 contacts with at least one skin test. The incidence of tuberculin conversion was between 0.3% and 6.8% in the 294 assessed participants. Age older than 18 years, a higher prevalence of unmet basic needs in the school district, attending the afternoon school shift, negative sputum smear results in the index case, and absence of baseline skin test were associated with contact lost to follow-up. Conclusions. The incidence of tuberculin conversion among school contacts was low. Adherence to isoniazid treatment remains limited. Factors associated with loss of contact tracing were identified, which may guide strategies necessary to improve this process.

Direito Sanitário: coletânea em homenagem à Profa. Dra. Maria Célia Delduque / Health Law: collection in honor of Professor Dr. Maria Célia Delduque / Derecho Sanitario: colección en homenaje a la Profa. Dra. Maria Célia Delduque

Esta resenha tem por objetivo expor tópicos substanciais que compõe a coletânea de artigos elaborada em homenagem à Profa.Dra. Maria Célia Delduque, pesquisadora de grande referência no Brasil e no mundo, em especial no âmbito do Direito Sanitário. O livro contou com a contribuição especialistas nessa área do conhecimento. Sendo o Direito Sanitário grande fio condutor dos trabalhos reunidos nessa obra, os artigos buscam discutir a saúde como um direito social, abordando conceitos e elementos dessa ciência jurídica, que contribuem para a efetividade do direito à saúde como uma garantia fundamental em diversas perspectivas, tanto no panorama nacional como internacional.

This review presents the main topics of the collection of articles written in honor of Professor Dr. Maria Célia Delduque, a researcher recognized in Brazil and worldwide, especially in the field of health law. The book contains contributions from specialists in the field. Since health law is the main subject of the works gathered in this book, the articles discuss health as social law and approach the concepts and elements of this jurisprudence that contribute to the effectiveness of the right to health as a fundamental guarantee in different perspectives, both in the national and international panorama.

El propósito de esta reseña es presentar temas importantes de la colección de artículos dedicados a la Profesora Dra. Maria Célia Delduque, investigadora destacada in Brasil y en todo el mundo, especialmente en el ámbito del Derecho Sanitario. El libro contó con la contribución de especialistas en esta área del conocimiento. Siendo el Derecho de la Salud el hilo conductor de los trabajos reunidos en esta obra, los artículos buscan discutir la salud como derecho social, abordando conceptos y elementos de esta ciencia jurídica, que contribuyen para la efectividad del derecho a la salud como garantía fundamental en diversas perspectivas, tanto a nivel panorama nacional como internacional.

La gestión de la calidad de cuidados en enfermería y la seguridad del paciente / Quality management in nursing care and patient safety

RESUMEN Objetivo: Describir la gestión de la calidad de cuidados en enfermería y la seguridad del paciente. Metodología: La investigación se desarrolla desde el enfoque cuantitativo con una metodología descriptiva con diseño no experimental, la cual se apoya en el análisis documental y bibliográfico. Se organizó un proceso investigativo en donde la población de estudio se basó, primordialmente, en documentos escritos como tesis y artículos científicos. Lo analítico-sintético, radicó en descomponer mentalmente el tema estudiado en diversos elementos para poder conseguir nuevos conocimientos. En conclusión: La enfermería es el profesional que está en el centro del cuidado directo de las personas, familias y comunidad, prestando la colaboración al equipo de salud, desde una acción dinámica y responsable, donde resaltan los valores humanos con la finalidad de brindar bienestar a la población con calidad y constancia, desde los pacientes leves hasta los más críticos, cumpliendo con los protocolos de cuidados para su pronta recuperación.

ABSTRACT Objective: To describe the management of quality of care in nursing and patient safety. Methodology: The research is developed from the quantitative approach with a descriptive methodology with non-experimental design, which is supported by documentary and bibliographic analysis. A research process was organized in which the study population was based primarily on written documents such as theses and scientific articles. The analytical-synthetic aspect was based on mentally decomposing the subject studied into different elements in order to obtain new knowledge. In conclusion: Nursing is the professional who is at the center of the direct care of people, families and community, providing collaboration to the health team, from a dynamic and responsible action where human values stand out and provide welfare to the population with quality and constancy. From the mildest to the most critical patients, complying with the care protocols for their prompt recovery.

Gestión del cuidado en obstetricia y ginecología: Una mirada integral / Care management in obstetrics and gynecology: A comprehensive look

RESUMEN Objetivo: Describir la gestión del cuidado en obstetricia y ginecología: Una mirada integral. Metodología: La investigación se desarrolló desde el paradigma cuantitativo, además se enmarcó desde un diseño documental-bibliográfico, mediante la indagación, recolección y análisis crítico documental y referencial bibliográfico, basándose en la exploración metódica, rigurosa y profunda de diversas fuentes documentales tales como investigaciones científicas, artículos y trabajos arbitrados, tesis, describiendo los hallazgos encontrados y permitiendo desarrollar el cuerpo teórico en relación al tema de estudio. Resultados: Se puede observar los múltiples factores que son considerados por las mujeres que acuden a los centros asistenciales, por ello deben ser orientadas de forma integral. En conclusión: La integración de los cuidados en obstetricia y ginecología, es una acción que contribuirá a un mejor desempeño y desarrollo de la mujer en estado de gestación, tanto de ella como del niño, en tal sentido de forma integral deben ser llevadas a cabo sus cuidados y consultas.

ABSTRACT Objective: To describe the management of care in obstetrics and gynecology: A comprehensive view. Methodology: The research was developed from the quantitative paradigm, also framed from a documentary-bibliographic design, through inquiry, collection and critical documentary analysis and bibliographic reference, based on the methodical, rigorous and deep exploration of various documentary sources such as scientific research, articles and refereed papers, theses, describing the findings found, allowing the development of the theoretical body in relation to the subject of study. Results: It is possible to observe the multiple factors that are considered by the women who come to the health care centers, for this reason they should be oriented in an integral way. In conclusion: The integration of care in obstetrics and gynecology is an action that will contribute to a better performance and development of the pregnant woman, both for her and the child, and her care and consultations should be carried out in an integral manner.

Variables, indicadores y criterios de evaluación del servicio médico como escenario de formación de especialistas

La calidad de la educación de posgrado concebida estratégicamente como la integración de la pertinencia social y la excelencia académica, deviene esencial en la gestión de las instituciones docente-asistenciales del sector salud. Sus múltiples dimensiones deben ser contextualizadas y son susceptibles de análisis y perfeccionamiento en cada servicio médico donde se desarrolla el proceso de formación de especialistas. Se utilizaron métodos teóricos y empíricos, para la identificación de las dificultades y la elaboración de la nueva propuesta. Se obtuvieron criterios sobre los servicios médicos como escenarios de formación, en los que se identificaron los problemas relativos a la actividad de posgrado. La propuesta consideró las directrices estratégicas, la población objeto de atención y los diferentes ámbitos temporales y espaciales identificados, con lo que pretende el fortalecimiento y desarrollo de la formación de posgrado en las Universidades de Ciencias Médicas en Cuba.

The quality of postgraduate education, strategically conceived as the integration of social relevance and academic excellence, becomes essential in the management of teaching-assistance institutions in the health sector. Its multiple dimensions must be contextualized and are susceptible to analysis and improvement in each medical service where the specialist formation process takes place. Theoretical and empirical methods were used, for the identification of the difficulties and the elaboration of the new proposal. Criteria on medical services were obtained as training scenarios, in which problems related to postgraduate activity were identified. The objective of the work is to expose a proposal of variables, indicators and evaluation criteria in the service as a scenario the specialist's formation. The proposal was considered the strategic guidelines, the target population and the different temporal and spatial areas identified, with which it intends to strengthen and develop postgraduate training in the Medical Sciences Universities in Cuba.

Potencialidades e limitações do Prontuário Eletrônico do Cidadão (PEC) enquanto ferramenta de gestão de cuidado e planejamento: avaliação a nível nacional e local / Potentials and limitations of the Electronic Citizen Record (PEC) as a care management and planning tool: assessment at national and local level

O objetivo desse estudo foi analisar as potencialidade e limitações do Prontuário Eletrônico do Cidadão (PEC) e comparar com os indicadores assistenciais de saúde bucal da Atenção Básica a nível nacional e de um município no interior do estado da Paraíba. A coleta de dados foi dividida em dois momentos: primeiro foram coletadas informações dos relatórios do e-SUS PEC presentes no site eletrônico e-Gestor do Departamento da Atenção Básica do Ministério da Saúde, referentes às equipes de saúde bucal das USF e em seguida a aplicação de um questionário estruturado para avaliar a aceitação, a facilidade e o uso do Prontuário Eletrônico do Cidadão (PEC) pelos cirurgiões dentistas cadastrados no município. Nos resultados, as regiões do Norte e Nordeste apresentaram os menores coeficientes de resolutividade (46,6 e 50,6) e com maior cobertura de primeira consulta odontológica (9,5 e 9,3), entretanto com maiores valores para exodontias (14,2 e 13,1); quanto à proporção de procedimentos preventivos observados, nota-se que o grau de priorização de cuidados de prevenção é alto em todas as regiões. Em nível local foram observadas variações significativas entre as USF; quanto ao uso do PEC 73,1% concordam que encontram mais rápido o prontuário no formato eletrônico e 61,5% concordam que o PEC otimiza seu processo de trabalho, já em relação ao manuseio do sistema 76,9% concordaram ser fácil. Portanto, existe uma disparidade de primeira consulta odontológica com a conclusão dos tratamentos e apesar de ser alta a cobertura de primeiro atendimento, mesmo assim, não é suficiente para evitar agravos dos problemas de saúde bucal, bem como o PEC é uma importante ferramenta que proporciona melhor assistência ao paciente, auxilia no atendimento, ajuda no planejamento de cuidados em saúde, facilita o acesso de dados (AU).

The objective of this study was to analyze and compare the potentialities and limitations of the Citizen's Electronic Record (PEC) with the oral health care indicators of Primary Care at national level and of a municipality in the interior of the state of Paraíba. Data collection will take place in two stages: first, information will be collected from the e-SUS PEC reports present on the e-Gestor website of the Department of Primary Care of the Ministry of Health, referring to the USF oral health teams, and then to application of a specific and objective questionnaire to assess acceptance, ease and use of the Citizen's Electronic Record (PEC) by dentists registered in the municipality. The results show that the Northeast and North have the lowest resolubility coefficients (46.6 and 50.6) and the highest coverage of the first dental appointment (9.5 and 9.3), however with higher values for extractions (14.2 and 13.1); as for the proportion of preventive procedures observed, it is noted that the degree of prioritization of preventive care is high in all regions and at the local level, significant variations were observed between USF; regarding the use of the PEC, 76.9% did not receive qualification or training, 23.1% always experience difficulties when handling it and 46.2% are sometimes able to operate all the functions of the system. Therefore, there is a disparity between the first dental visit and the completion of treatments and, despite the high coverage of the first visit, even so, it is not enough to avoid worsening oral health problems, as well as the PEC is an important tool that provides better patient care, assist with care, help with health care planning, facilitate data access (AU).

La gestión de la calidad de cuidados en enfermería y la seguridad del paciente / Quality management in nursing care and patient safety

Describir la gestión de la calidad de cuidados en enfermería y la seguridad del paciente. Metodología: La investigación se desarrolla desde el enfoque cuantitativo con una metodología descriptiva con diseño no experimental, la cual se apoya en el análisis documental y bibliográfico. Se organizó un proceso investigativo en donde la población de estudio, se basó primordialmente en documentos escritos como tesis, artículos científicos. Lo analítico­sintético, radicó en descomponer mentalmente el tema estudiado en diversos elementos para poder conseguir nuevos conocimientos. En conclusión: La enfermería es el profesional que está en el centro de los cuidados directo de las personas, familias y comunidad, prestando la colaboración al equipo de salud, desde una acción dinámica y responsable donde resaltan los valores humanos y brindar bienestar a la población con calidad y constancia. Desde los pacientes leves hasta los más críticos cumpliendo con los protocolos de cuidados para su pronta recuperación.

To describe the management of quality of care in nursing and patient safety. Methodology: The research is developed from the quantitative approach with a descriptive methodology with non-experimental design, which is supported by documentary and bibliographic analysis. A research process was organized in which the study population was based primarily on written documents such as theses and scientific articles. The analytical-synthetic aspect was based on mentally decomposing the subject studied into different elements in order to obtain new knowledge. In conclusion: Nursing is the professional who is at the center of the direct care of people, families and community, providing collaboration to the health team, from a dynamic and responsible action where human values stand out and provide welfare to the population with quality and constancy. From the mildest to the most critical patients, complying with the care protocols for their prompt recovery.

Gestión del cuidado en obstetricia y ginecología: Una mirada integral / Care management in obstetrics and gynecology: A comprehensive look

Describir la gestión del cuidado en obstetricia y ginecología: Una mirada integral. Metodología: La investigación se desarrolló desde el paradigma cuantitativo, además se enmarcó desde un diseño documental-bibliográfico, mediante la indagación, recolección y análisis crítico documental y referencial bibliográfico, basándose en la exploración metódica, rigurosa y profunda de diversas fuentes documentales tales como investigaciones científicas, artículos y trabajos arbitrados, tesis.Describiendo los hallazgos encontrados, permitiendo desarrollar el cuerpo teórico en relación al tema de estudio. Resultados: Se puede observar los múltiples factores que son consideradas por las mujeres que acuden a los centros asistenciales, por ello deben ser orientadas de forma integral. En conclusión: La integración de los cuidados en obstetricia y ginecología, es una acción que contribuirá a un mejor desempeño y desarrollo de la mujer en estado de gestación, tanto de ella como del niño, de forma integral debe ser llevadas a cabo sus cuidados, consultas.

To describe the management of care in obstetrics and gynecology: A comprehensive view. Methodology: The research was developed from the quantitative paradigm, also framed from a documentary-bibliographic design, through inquiry, collection and critical documentary analysis and bibliographic reference, based on the methodical, rigorous and deep exploration of various documentary sources such as scientific research, articles and refereed papers, theses, describing the findings found, allowing the development of the theoretical body in relation to the subject of study. Results: It is possible to observe the multiple factors that are considered by the women who come to the health care centers, for this reason they should be oriented in an integral way. In conclusion: The integration of care in obstetrics and gynecology is an action that will contribute to a better performance and development of the pregnant woman, both for her and the child, and her care and consultations should be carried out in an integral manner

Psychological-behavioral health services and its outcome based on World Health Organization health-promoting school framework: a systematic review of systematic reviews / 中国康复理论与实践

ObjectiveTo review the effect of school-based psychological and behavioral health services based on the World Health Organization (WHO) health-promoting school (HPS) framework on the psychological and behavioral health of children and adolescents. MethodsSystematic reviews on school-based psychological and behavioral health services based on WHO HPS framework and the health outcome, published from 2013 to June, 2023, were searched from Medline, EBSCO, PubMed, Web of Science. A systematic review of the systematic reviews was conducted. ResultsSeven articles were included, involving 261 studies, from six countries, from the journals in the fields of children's psychological health, HPS and school health, published mainly from 2013 to 2022. School-based psychological and behavioral health services involved school health education curriculum and school health services. School health education curriculum included psychological health courses and health education provided by trained teachers. School health services involved various services provided by professionals in school settings, including psychological screening, preventive interventions for psychological and behavioral health issues, clinical assessment, management services, promotion, and supportive services. The health benefits of school-based psychological and behavioral health services included relieving symptoms and incidence of anxiety and depression, alleviating the negative impact of stress, decreasing negative mood, enhancing positive attitudes and resilience, increasing happiness, improving positive psychological well-being, enhancing cognitive functions (such as sustained attention, fluid intelligence, information processing speed and executive functions), fostering correct attitudes and awareness of psychological health, helping students develop interest in learning, enhancing psychological health literacy, knowledge of psychological disorders, awareness of prevention, ability to recognize signs and symptoms, eliminating stigma related to psychological health, promoting social interaction, and improving help-seeking behaviors for psychological health issues. ConclusionThe school-based psychological and behavioral health services based on the WHO HPS framework mainly encompass school health education curriculum and school health services. The health benefits of school-based psychological and behavioral health services are reflected in psychological and behavioral health, overall psychological well-being, and quality of life, as well as social behavior and academic performance.

School health services and effectiveness based on World Health Organization health-promoting school framework: a scoping review / 中国康复理论与实践

ObjectiveTo review the studies related to school health services and their outcomes based on the World Health Organization health-promoting school framework, to synthesize and analyze the main research scopes and related evidence in this field. MethodsLiterature about the interventions and outcomes of implementing health-promoting school health services were retrieved from PubMed, Web of Science, EBSCO and CNKI, from the establishment to June, 2023, and a scoping review was conducted. ResultsSeven papers were eventually included, involving 76 researches, more than 20 interventions, from five countries, published mainly from 2014 to 2021. The interventions included asthma education training curriculum, oral health education, menstrual management interventions, cognitive anxiety prevention programs, physical activity curriculum, cooking and nutrition curriculum, exercise and fitness interventions, mental health education programs, health-promoting diets curriculum and health education curriculum, and health skills training curriculum. The school health services programs included health screening and monitoring, disease prevention and control, and safety and first aid training for teachers and students. The health benefits of health-promoting school for students included improving health education outcomes and grades in health services elective courses; improving health condition and qualities of learning and life at school, reducing prevalence of chronic diseases and frequency of visiting the emergency room, and alleviating asthma; improving self-esteem, communication skills and social cohesion of the group, alleviating the influence of anxiety and other negative emotion, and increasing awareness of autonomy; improving activities related to healthy living, and positively affecting behaviors, attitudes and action. The health benefits of health-promoting school for teachers included improving pedagogical abilities and skills in teaching physical activity-related curriculum content, and increasing professional support for staff such as knowledge of first aid and participation in the school health service. The health benefits of health-promoting school for schools included promoting the incorporation of health education courses into regular teaching activities and increasing the school's financial investment in the construction of health-related psychosocial environments; promoting the plan and implementation of the health service in the schools. ConclusionThe school-based health services in health-promoting school consisted of two main categories: school curriculum and school health services. The health-promoting school may improve the health conditions, health behaviors and health services for the students, teachers and schools.

School-based physical activity-related health services and their health benefits within the World Health Organization health-promoting school framework: a systematic review of systematic reviews / 中国康复理论与实践

ObjectiveTo systematically review the types of health-promoting school (HPS) curriculum and physical activity-related health services based on the WHO-HPS framework, and their impact on health of children and adolescents. MethodsThe databases of EBSCO, PubMed, Web of Science, and CNKI were searched on school-based physical activity-related services and their health benefits based on the WHO-HPS framework from 2017 to June, 2023. A systematic review of systematic reviews was conducted. ResultsA total of seven English articles were included, covering 147 studies from five countries including Switzerland, the United States, Italy, the United Kingdom and Sweden. The systematic reviews were published in the journals related to child physical education and health, HPS, and school-based physical activity. Based on the WHO-HPS framework, HPS curriculum implemented in schools primarily involved physical education classes (such as incorporating specialized sports programs like yoga and dance, increasing physical activity time) and health education programs related to physical activity. Additional activities included extracurricular programs (such as implementing children's sports, recreational and leisure programs, lunchtime enjoyment activities, and game plans, increasing physical activity time within regular school hours, creating opportunities for physical activity during breaks and after school, and providing daily physical activity plans) and integration of physical activity in other subjects. Physical activity-related health services mainly included health screening and monitoring related to physical activity, adolescent health management, and health promotion activities. The health benefits of the interventions included improvement in aerobic capacity, body mass index, cardiorespiratory function, overall physical health, and significant increases in muscle endurance and strength. They also contributed to the cessation or reduction of prolonged sedentary behavior, increased levels of all-day physical activity and moderate-to-vigorous physical activity, increased physical activity participation, significant increases in physical activity during school hours, increased proportion of moderate to vigorous physical activity during school time, increased physical activity time, improved leisure and recreational time related to physical activity, enhanced vitality, school quality of life, and energy, improved academic performance, reduced television viewing time, decreased obesity risk, reduced anxiety, improved adaptability and happiness, and promoted positive mental health. Furthermore, there was a significant improvement in students' health-related knowledge on physical activity. ConclusionImplementing HPS curriculum and physical activity-related services in schools may improve various aspects of students' health, including physical fitness, physical activity and sedentary behavior, behavioral health related to physical activity, and health literacy related to physical activity.

Mental health services for children with intellectual and developmental disabilities: a WHO-FICs-based study / 中国康复理论与实践

ObjectiveTo systematically analyze the typical mental health conditions and psychological disorders of children with intellectual and developmental disabilities (IDD), to construct a mental health service system and psychological interventions to these mental health conditions of children with IDD . MethodsBased on the framework of the World Health Organization Family International Classifications (WHO-FICs), the mental health conditions and related functioning were analyzed, and the mental health service framework and proposed mental health interventions were constructed.There were six main categories of mental health conditions for children with IDDConclusionThis study systematically analyzed the typical mental health status and related psychological functional impairments of children with IDD. Based on the World Health Organization health service system, a mental health service framework for children with IDD was constructed. Referring to the WHO's continuum of health services, a system of psychological intervention methods for children with IDD was established. Furthermore, the WHO-FICs were used to describe and code the functions of children with IDD, and the ICHI-β3 was applied to code and analyze the related psychological interventions. Resultsmood disorders (anxiety and depression), behavioral disorders (disruptive disorders and challenging behaviors, aggressive behaviors), traumatic disorders (post-traumatic stress disorder), mental disorders (schizophrenia), suicide and self-harm, and learning disabilities (developmental learning disabilities, attention deficit hyperactivity disorder). Mental health services for children with IDD involved in six dimensions: leadership and governance, fundraising, human resources, service delivery, mental health technologies, and information and research. Mental health services went through the continuum of health services from prevention, treatment, rehabilitation to health promotion. We delivered mental health services for children with IDD in three aspects: identifying and diagnosing mental health problems or conditions, analyzing the main factors caused mental health problems, and analyzing the environmental factors. Mental health service interventions mainly covered five categories: antidepressants, psychotherapy, stress management training, physical exercise training, healthy lifestyle education, consultation and support. Children with IDD may obtain the mental health services in hospitals, rehabilitation institutions, community and school settings.