Research and reference on the classification management system of prescription drugs and non-prescription drugs in Canada / 中国药房

OBJECTIVE To provide reference for improving the classification management of prescription drugs and non- prescription drugs in China by learning from the classification management system of prescription drugs and non-prescription drugs in Canada. METHODS The content and experience of classification management system of prescription drugs and non-prescription drugs in Canada were analyzed， and the thinking of the classification management of prescription drugs and non-prescription drugs in China was proposed. RESULTS ＆＆CONCLUSIONS According to the classification of prescription drugs and non-prescription drugs， drugs can be divided into class Ⅰ drugs， class Ⅱ drugs， class Ⅲ drugs， unclassified drugs in Canada. Specific evaluation factors and management requirements have been established for drug classification. Canada has established a set of systematic management systems and technical standards， which has reference value for improving the classification management system in China. It is suggested to further improve the drug classification management system and supporting policies， strengthen fine classification management of prescription drugs and non-prescription drugs and improve classification registration and transformation review standards in China， by learning from Canadian prescription drug and non-prescription drug system and management model.

Current status of acupunctiure in British Columbia, Canada / 全日本鍼灸学会雑誌

This paper gives an overview of acupuncture and moxibustion usage in British Columbia (BC), Canada. In Canada, acupuncture and moxibustion are handled and regulated differently in each province; in BC, it is managed and supervised through the Health Regulatory Colleges under the Health Profession Act. In the field of oriental medicine and acupuncture, the College of Traditional Chinese Medicine Practitioners and Acupuncturists of BC (CTCMA) has been established to manage and supervise doctors of Traditional Chinese Medicine and oriental medicine practitioners, with specific duties that include public protection and the registration, examination, and evaluation of the quality of services of practitioners. The CTCMA is characterized by a centralization of operations that in Japan are carried out by several government agencies.Next, I will describe my impressions of acupuncture and moxibustion from those who I met in Vancouver, where I live, at the school I attended, at the clinic that I practice, etc. Although there are many Chinese immigrants, I did not feel that acupuncture and moxibustion are particularly widespread, but I got the impression that they are well recognized as a common treatment. Finally, I will briefly touch on the examinations and visa requirements for acupuncture and moxibustion practitioners who are considering immigration to Canada. Five years of education is required to take the examination, and although there are cases in which the content of education received in Japan can be transferred, it is better to receive acupuncture and moxibustion education in Canada. As health professionals, acupuncture and moxibustion practitioners can also earn points toward permanent residency. Canada's regulatory system for medical care is new in its institutional design and appears to be consistent throughout the health care system, as it comprehensively regulates all health professionals. The impression I gained is that acupuncture and moxibustion are recognized as effective treatments. Canada, a country of immigrants, has a national character that likes "new things" and accepts change flexibly, and there is much potential for acupuncture and moxibustion treatments to increase in the field of health care in the future.

Canadian-brazilian insights for transcultural nursing: an exploration of community health nursing contexts / Perspectivas canadiense-brasileñas para la enfermería transcultural: una exploración de los contextos de enfermería en salud comunitaria / Introspecções canadenses-brasileiras para a enfermagem transcultural: uma exploração dos contextos da enfermagem de saúde comunitária

ABSTRACT Objective: to analyze the distinct features, incongruencies, and harmony between the features of Canadian-Brazilian community health nursing as well their practices. Method: ethnographic research conducted in primary healthcare clinics (city of João Pessoa, Brazil). Data collection unfolded from July to September 2018 and included direct, unstructured participant observation of collective social and professional-clientele interactions, with a structured personal digital log and reports of the researcher's observations, as well as social immersion in community settings. The fieldwork log was thematically analyzed to build the meaning of the comparative nursing practice. Results: analysis of observations' reports identified challenges and opportunities to promote sustainable changes and create a supportive environment. Nurses' competencies to promote health are in consonance with conceptual, political, and ethical sounding perspectives. Among the distinctive practices observed was that in Brazil, the prescribing practice has been well-established because legally the registered nurses are allowed to prescribe within the primary healthcare programs. In Canada, registered nurses have been granted authority to do so, upon receipt of specific training and under certain scope of advanced practice. Thematic analysis revealed uniqueness of the grasped information, incongruence between community health nursing practices and harmony between contextual practices of Brazil-Canada community health nursing composed the empirical evidence. Conclusions: this research uncovered the compatibility between Canadian and Brazilian practice as well as intricate features of Brazilian community health nurses. Unquestionably, the evidence sums up to the consolidation of the well-established Brazil-Canada cooperation in the field of primary health care. This evidence addresses the political perspective of cooperation for global health.

RESUMEN Objetivo: analizar las características distintivas, incongruencias y armonía entre las características de los enfermeros de salud comunitaria canadiense-brasileños y sus prácticas. Método: estudio etnográfico realizado en centros de atención primaria (ciudad de João Pessoa, Brasil). La recolección de datos se desarrolló de julio a septiembre de 2018 e incluyó la observación participante directa y no estructurada de las interacciones sociales colectivas y profesional-clientela, con un registro digital personal estructurado e informes de las observaciones del investigador, así como la inmersión social en entornos comunitarios. El registro de trabajo de campo se analizó temáticamente para construir el significado de la práctica de enfermería comparada. Resultados: el análisis de los informes de observaciones identificó desafíos y oportunidades para promover cambios sostenibles y crear un entorno de apoyo. Las competencias de los enfermeros para promover la salud están en consonancia con las perspectivas conceptuales, políticas y éticas. Entre las prácticas distintivas observadas, la práctica de prescripción ha sido bien establecida en Brasil porque legalmente las enfermeras están autorizadas a prescribir dentro de los programas de atención primaria de salud. En Canadá, a las enfermeras se les ha otorgado autoridad para hacerlo al recibir capacitación específica y bajo cierto alcance de práctica avanzada. El análisis temático reveló singularidad de la información captada, incongruencia entre las prácticas de enfermería en salud comunitaria y armonía entre las prácticas contextuales de enfermería en salud comunitaria Brasil-Canadá que compusieron la evidencia empírica. Conclusiones: esta investigación demostró que existe compatibilidad entre las prácticas canadiense y brasileña, así como las características de la enfermería comunitaria brasileña. Incuestionablemente, la evidencia resume la consolidación de la cooperación bien establecida entre Brasil y Canadá en el campo de la salud primaria. Esta evidencia aborda la perspectiva política de la cooperación para la salud global.

RESUMO Objetivo: analisar as características distintas, as incongruências e a harmonia entre as características da Enfermagem de saúde comunitária canadense e brasileira bem como suas respectivas práticas. Método: pesquisa etnográfica realizada em unidades básicas de saúde (cidade de João Pessoa, Brasil). A coleta de dados ocorreu no período de julho a setembro de 2018 e incluiu observação participante direta, não estruturada de interações sociais coletivas e entre profissionais e clientela. Houve registro digital estruturado de relatos das observações de campo pela pesquisadora, assim como imersão social em ambientes comunitários. O diário de campo foi analisado tematicamente para construir o significado da prática comparativa de Enfermagem. Resultados: a análise dos relatos das observações identificou desafios e oportunidades para promover mudanças sustentáveis e criar um ambiente de apoio. As competências dos enfermeiros para a promoção da saúde estão em consonância com perspectivas conceituais, políticas e éticas. Entre as práticas diferenciadas observadas destaca-se que, no Brasil, a prática de prescrição tem sido bem estabelecida, pois, legalmente, os enfermeiros estão autorizados a prescrever dentro dos programas de atenção primária à saúde. No Canadá, os enfermeiros receberam autorização para fazê-lo, após um treinamento específico e sob certo escopo da prática avançada. A análise temática revelou singularidades nas informações apreendidas, incongruência entre as práticas de Enfermagem de saúde comunitária Brasil-Canadá e harmonia entre tais práticas contextuais que compuseram as evidências empíricas. Conclusões: esta pesquisa revelou a compatibilidade entre a prática canadense e brasileira, assim como características próprias dos enfermeiros brasileiros nessa prática. Inquestionavelmente, as evidências resumem-se à consolidação da bem estabelecida cooperação Brasil-Canadá no campo da atenção primária à saúde. Essas evidências abordam a perspectiva política de cooperação para a saúde global.

Unveiling the evolution of fetal death in pregnancy in different cultures / Desvelando em diferentes culturas a evolução da gestação em óbito fetal

Abstract Objectives: to describe the identification of fetal death during pregnancy in Brazilian and Canadian women. Methods: clinical-qualitative study with women who experienced the outcome of fetal death in their pregnancies, living in Maringá (Brazil) and participating in the Center d'intervention familiale (Canada). Data collection was performed through a semi-structured interview with the question: How did you find out about your baby's death? Readings were performed and the relevant aspects were categorized into themes according to the places where the death was confirmed. Results: in both countries, the main causes of death were the same, related to complications in pregnancy and childbirth, and health problems of the pregnant woman or fetus. Brazilian women had a higher frequency of deaths in the third trimester and Canadian women experienceda majority of deaths in the second trimester. The stillbirthswere found in different places, times and moments categorized at prenatal routine consultation, emergency care, expected death from congenital malformations of poor prognosis and labor. Conclusions: the determination of fetal death during pregnancy was due to possible intrinsic intercurrences of the pregnancy period. Based on the women's experiences, it was possible to demonstrate the clinical practice of identifying fetal death according to the cultural scenario. Continuous studies on prenatal care for women who had stillbirths are necessary for early detection of pathological conditions and appropriate interventions.

Resumo Objetivos: descrever a identificação do óbito fetal durante a gestação em brasileiras e canadenses. Métodos: estudo clínico-qualitativo com mulheres que vivenciaram o desfecho do óbito fetal nas suas gestações, residentes em Maringá (Brasil) e participantes do Centre d'Intervention Familiale (Canadá). A coleta de dados foi realizada por meio de entrevista semidirigida com a pergunta: Como ficou sabendo da morte do seu bebê? Foram realizadas leituras e os aspectos relevantes foram categorizados em temas conforme os locais da confirmação do óbito. Resultados: nos dois países, as principais causas dos óbitos foram relacionadas às complicações na gravidez e parto, problemas de saúde da gestante ou do feto. As brasileiras com frequência maior dos óbitos no terceiro trimestre e as canadenses, no segundo trimestre. As categorias foram identificadas nos consultórios na rotina pré-natal, nos serviços de emergência, e nos serviços de imagem, ao detectar o óbito esperado nos casos de malformações congênitas de prognóstico ruim. Conclusão: a determinação óbito fetal durante a gestação foi em razão das possíveis intercorrências intrínsecas do período gravídico. A partir das experiências das mulheres, foi possível mostrar a prática clínica da identificação do óbito fetal de acordo com o cenário cultural. Contínuos estudos, sobre a assistência pré-natal das mulheres que tiveram óbito fetal, são necessários para detecção precoce das condições patológicas e intervenções adequadas.

História oral e ética: um olhar comparativo entre Brasil, Canadá e Itália / Oral history and ethics: a comparative gaze on Brazil, Canada, and Italy

Resumo O artigo apresenta um diálogo entre as experiências brasileiras, canadenses e italianas quanto aos desafios colocados por avaliações éticas "externas" (feitas por comitês de ética e órgãos correlatos) e "internas" (resultante dos debates dos/as próprios/as pesquisadores/as) à história oral. Pretende demonstrar as diferentes maneiras de lidar com as imposições estranhas à área, revelar as estratégias de ação colocadas em prática e destacar questões centrais para o trabalho responsável com história oral. O espírito que anima a escrita é o de repensar as próprias experiências e de aprender com as alheias.

Abstract This article presents a dialogue between the experiences of Brazil, Canada, and Italy in addressing the challenges posed by ethical evaluations, both "external" (by ethics committees and related bodies) and "internal" (in debates among researchers themselves), of oral history. It attempts to demonstrate the different ways impositions from outside the area have been handled, the action strategies adopted, and issues central to responsible work in the sphere of oral history. It is written with the spirit of rethinking one's own experiences and learning from those of others.

Interpretation and reflection of Traditional Chinese Medicine registration evidence system in Canada / 国际中医中药杂志

Traditional Chinese Medicine (TCM) products could be registered as natural health products (NHPs) in Canada. Its registration process could be mainly divided into simple-application, traditional-application and non-traditional application. By analyzingi the TCM registration evidence system and its safety, effectiveness and quality required by different registration categories in Canada, we found that "simple-application" procesure needs to submit evidence based on the parameters of a component in the monograph. As for "traditional application", TCM products need to be used at least 50 years with, traditional material or Pharmacopoeia can be used as evidence; As for non-traditional application, TCM products need to provide evidence according to the disease risk level, and most of them need to provide scientific experiment evidence. Therefore, from the experience of TCM registration evidence system in Canada, the registration of TCM products should pay attention to improve the its classification method, refining its evidence requirements and data types, promoting the formulation of monograph of TCM, realizing the scientific evaluation and rapid review of classic famous prescriptions, and promoting the inheritance and innovative development of TCM in China.

Introduction and analysis of the registration process of Traditional Chinese Medicine as a natural health product in Canada / 国际中医中药杂志

At present, the registration process of Traditional Chinese Medicine (TCM) in Canada is refering to the requirements of Natural Health Products (NHPs). In terms of registration material, both NHPs and TCM include plants, animals and minerals with medicinal components, but the fundamental difference between them is that TCM is guided by the basic theory of TCM. As for the registration classification of TCM in Canada, first of all, judge whether the product to be applied for is NHPs; Secondly, we should clarify the types and ways of registration, mainly including simple application, traditional application and non-traditional application, and provide application forms, label texts, summary reports, evidence, animal tissue forms, finished product specifications and other materials according to different requirements. At present, the successful registration experience of TCM products in Canada mainly mainly includes applying for superior varieties, selecting appropriate application channels, communicating with local health management units and providing sufficient scientific evidence and good clinical application records. The regulations on the registration of NHPs in Canada have not fully considered the particularity of TCM and the registration of TCM products is still facing some difficulties. In the future, we can learn from the registration process and requirements of the Health Canada, promote the interconnection and mutual recognition of the Pharmacopoeia of the People's Republic of China and the NNHPD monographs in Canada, reduce the obstacles to the local application for registration of TCM, and promote the further improvement of the international standards of TCM.

Analysis of Traditional Chinese Medicine regulation in Canada / 国际中医中药杂志

This paper analyzes the laws, regulations and concre measures of Traditional Chinese Medicine (TCM) in Canada, so as to provide reference for TCM products to enter Canada, and for the establishment of TCM regulation system and the improvement of its detailed rules in China. The regulation of TCM in Canadian, on the one hand, supervision is to provide guidance for the protection of consumers' rights and interests, including the guidance of rational drug use and rational purchase for consumers; on the other hand, it is to supervise enterprises, including the safety, effectiveness and quality certification of TCM products, labeling and packaging requirements, as well as the site certification of product manufacturing, packaging, labeling and import. The Ministry of health of Canada takes evidence as the core of evaluation, and ensures the safe and effective use of TCM products in Canada through product and site licensing evaluation. In the supervision of TCM, relevant departments in China should further strengthen the protection of consumers' drug rights and interests, strengthen the construction of TCM registration evidence system, and pay attention to the risk management of drug production quality.

Analysis on the registration of Chinese patent medicines in Canada and its referantial significance to the international registration of Traditional Chinese Medicines / 国际中医中药杂志

By searching for the Canadian Licensed Natural Health Products Database, (LNHPD), this paper analyzed the characteristics and current status of 92 Chinese patent medicines successfully registered and listed in Canada, and found that the enterprises of successfully registered enterprises are mainly located in areas with better development condition of Traditional Chinese Medicine (TCM) such as Beijing, Guangdong and Tianjin; The successfully registered Chinese patent medicines include 64 kinds of single medicine or medicine with single active ingredient (69.6%) and 28 kinds of compound medicine (30.4%), the forms of the dosage are mainly tablets and capsules, which have the characteristics of accuracy in dosage and stable physicochemical properties. There are also granules, solutions, powders and other dosage forms, which can be preserved for a long time and have low requirements on technic and environment. These Chinese patent medicines are mainly used to treat respiratory and circulatory system diseases, some are used to treat urogenital and digestive system diseases, and few are used to treat difficuilt diseases like tumors, diabetes. There are some other health care products. It is suggested to strengthen the connection between domestic standards of TCM registration and international standards, and promote the scientific and technological capacity of relevant enterprises, and encourage enterprises to strengthen international registration of advantageous products, so as to accelerate the speed of international development of TCM in China.

Role of stakeholders in Canadian oncology drug review and its enlightenment / 中国药房

OBJECTIVE To prov ide reference for improving the participation mechanism of stakeholders in the process of medical insurance negotiation for oncology drug in China. METHODS Based on the stakeholder theory ，combined with literature research，case analysis （taking the review of reimbursement of Bentuximab as an example ）and other methods ，analysis and research were conducted on the Canadian oncology drug review process and the participation mechanism and role of stakeholders. The suggestions were put forward for our country. RESULTS & CONCLUSIONS Canadian oncology drug reimbursement review process was composed of four stages ：the pre-submission planning stage ，the formal submission stage of application，the review stage，and the stage of forming reimbursement recommendations. As the role of stakeholders ，drug manufacturers ，patient representative advisory group ， clinical review expert advisory groups and provincial advisory groups participated in the reimbursement review process of oncology drug by providing suggestions and feedback to CADTH. The participation of stakeholders had improved the transparency of the review of oncology drugs in Canada and made the reimbursement results of oncology drugs more scientific ，reasonable and accurate. In China ，it is recommended to define rights ，responsibilities and interests as well as the participation mechanism of stakeholders in the medical insurance negotiation process ，attach importance to the role of patients in the medical insurance negotiation process of oncology drug ，improve information disclosure and increase the transparency of the negotiation mechanism and process so as to increase the participation of stakeholders.

Ups and downs of hypertension control in Canada: critical factors and lessons learned / Altibajos en el control de la hipertensión en Canadá: factores críticos y lecciones aprendidas / Altos e baixos no controle da hipertensão no Canadá: fatores críticos e lições aprendidas

ABSTRACT As the leading risk for death, population control of increased blood pressure represents a major challenge for all countries of the Americas. In the early 1990's, Canada had a hypertension control rate of 13%. The control rate increased to 68% in 2010, accompanied by a sharp decline in cardiovascular disease. The unprecedented improvement in hypertension control started around the year 2000 when a comprehensive program to implement annually updated hypertension treatment recommendations started. The program included a comprehensive monitoring system for hypertension control. After 2011, there was a marked decrease in emphasis on implementation and evaluation and the hypertension control rate declined, driven by a reduction in control in women from 69% to 49%. A coalition of health and scientific organizations formed in 2011 with a priority to develop advocacy positions for dietary policies to prevent and control hypertension. By 2015, the positions were adopted by most federal political parties, but implementation has been slow. This manuscript reviews key success factors and learnings. Some key success factors included having broad representation on the program steering committee, multidisciplinary engagement with substantive primary care involvement, unbiased up to date credible recommendations, development and active adaptation of education resources based on field experience, extensive implementation of primary care resources, annual review of the program and hypertension indicators and developing and emphasizing the few interventions important for hypertension control. Learnings included the need for having strong national and provincial government engagement and support, and retaining primary care organizations and clinicians in the implementation and evaluation.

RESUMEN La hipertensión arterial representa el principal riesgo de muerte; controlarla a nivel de la población constituye un desafío importante para todos los países de la Región de las Américas. A principios de la década de 1990, Canadá presentaba una tasa de control de la hipertensión del 13%. La tasa de control aumentó al 68% en el 2010, lo que vino acompañado por una disminución importante de las enfermedades cardiovasculares. Esta mejora sin precedentes en el control de la hipertensión empezó alrededor del año 2000 cuando se inició un programa integral para aplicar las recomendaciones sobre el tratamiento de la hipertensión, actualizadas anualmente. El programa incluyó un sistema de monitoreo integral para el control de la hipertensión. Después del 2011, hubo una marcada disminución del énfasis en la implementación y la evaluación, y la tasa de control de la hipertensión disminuyó, impulsada por una reducción en el control en las mujeres, que pasó del 69% al 49%. En el 2011, se formó una coalición de organizaciones científicas y de salud con la prioridad de elaborar una campaña de defensa y promoción de las políticas alimentarias para prevenir y controlar la hipertensión. Para el año 2015, esta postura fue adoptada por la mayoría de los partidos políticos federales, aunque la implementación ha sido lenta. En este artículo se revisan los factores clave de éxito y las lecciones aprendidas. Algunos factores clave de éxito fueron tener una amplia representación en el comité directivo del programa; el compromiso multidisciplinario con la participación sustantiva del sector de la atención primaria; unas recomendaciones creíbles, imparciales y actualizadas; el desarrollo y la adaptación activa de recursos educativos basados en la experiencia en el terreno; la amplia implementación de los recursos de la atención primaria; la revisión anual del programa y de los indicadores de hipertensión; y el desarrollo y el énfasis en unas pocas intervenciones importantes para el control de la hipertensión. Entre las lecciones aprendidas se encontró la necesidad de contar con un fuerte compromiso y apoyo del gobierno nacional y provincial, y de mantener a las organizaciones de atención primaria y al personal médico en la implementación y la evaluación.

RESUMO O controle populacional da hipertensão arterial - o maior fator de risco de morte - representa um grande desafio para todos os países das Américas. No início da década de 1990, o Canadá tinha uma taxa de controle de hipertensão de 13%. Esse índice aumentou para 68% em 2010, acompanhado por um declínio acentuado das doenças cardiovasculares. A melhoria sem precedentes no controle da hipertensão começou por volta do ano 2000, quando teve início um programa abrangente para implementar recomendações de tratamento de hipertensão atualizadas anualmente. O programa incluía um sistema integral de monitoramento do controle da hipertensão. Após 2011, houve uma acentuada redução da ênfase na implementação e avaliação, e a taxa de controle de hipertensão caiu, principalmente às custas de uma redução deste controle em mulheres (de 69% para 49%). Uma coalizão de organizações científicas e de saúde formou-se em 2011 com a prioridade de desenvolver posições de defesa de políticas alimentares para prevenir e controlar a hipertensão. Até 2015, essas posições haviam sido adotadas pela maioria dos partidos políticos federais, mas a implementação tem sido lenta. Este manuscrito examina fatores-chave de sucesso e aprendizados. Alguns fatores-chave de sucesso incluíram uma ampla representatividade no comitê diretor do programa, engajamento multidisciplinar (com envolvimento significativo da atenção primária), recomendações imparciais e confiáveis, elaboração e adaptação ativa de recursos didáticos com base na experiência de campo, ampla implementação dos recursos da atenção primária, revisão anual do programa e dos indicadores de hipertensão e desenvolvimento e ênfase das poucas intervenções realmente importantes para o controle da hipertensão. As lições aprendidas incluíram a necessidade de ter forte envolvimento e apoio dos governos nacional e subnacionais e manter organizações e médicos da atenção primária engajados na implementação e avaliação.

Práticas clínicas relacionadas a cânulas nasais de alto fluxo em terapia intensiva pediátrica no Brasil em comparação com as de outros países: um inquérito brasileiro / Clinical practices related to high-flow nasal cannulas in pediatric critical care in Brazil compared to other countries: a Brazilian survey

RESUMO Objetivo: Descrever as práticas clínicas atuais relacionadas à utilização de cânula nasal de alto fluxo por intensivistas pediátricos brasileiros e compará-las com as de outros países. Métodos: Para o estudo principal, foi administrado um questionário a intensivistas pediátricos em países das Américas do Norte e do Sul, Ásia, Europa e Austrália/Nova Zelândia. Comparou-se a coorte brasileira com coortes dos Estados Unidos, Canadá, Reino Unido e Índia. Resultados: Responderam ao questionário 501 médicos, dos quais 127 eram do Brasil. Apenas 63,8% dos participantes brasileiros tinham disponibilidade de cânula nasal de alto fluxo, em contraste com 100% dos participantes no Reino Unido, no Canadá e nos Estados Unidos. Coube ao médico responsável a decisão de iniciar a utilização de uma cânula nasal de alto fluxo segundo responderam 61,2% dos brasileiros, 95,5% dos localizados no Reino Unido, 96,6% dos participantes dos Estados Unidos, 96,8% dos médicos canadenses e 84,7% dos participantes da Índia; 62% dos participantes do Brasil, 96,3% do Reino Unido, 96,6% dos Estados Unidos, 96,8% do Canadá e 84,7% da Índia relataram que o médico responsável era quem definia o desmame ou modificava as regulagens da cânula nasal de alto fluxo. Quando ocorreu falha da cânula nasal de alto fluxo por desconforto respiratório ou insuficiência respiratória, 82% dos participantes do Brasil considerariam uma tentativa com ventilação não invasiva antes da intubação endotraqueal, em comparação com 93% do Reino Unido, 88% dos Estados Unidos, 91,5% do Canadá e 76,8% da Índia. Mais intensivistas brasileiros (6,5%) do que do Reino Unido, Estados Unidos e Índia (1,6% para todos) afirmaram utilizar sedativos com frequência concomitantemente à cânula nasal de alto fluxo. Conclusão: A disponibilidade de cânulas nasais de alto fluxo no Brasil ainda não é difundida. Há algumas divergências nas práticas clínicas entre intensivistas brasileiros e seus colegas estrangeiros, principalmente nos processos e nas tomadas de decisão relacionados a iniciar e desmamar o tratamento com cânula nasal de alto fluxo.

ABSTRACT Objective: To describe current clinical practices related to the use of high-flow nasal cannula therapy by Brazilian pediatric intensivists and compare them with those in other countries. Methods: A questionnaire was administered to pediatric intensivists in North and South America, Asia, Europe, and Australia/New Zealand for the main study. We compared the Brazilian cohort with cohorts in the United States of America, Canada, the United Kingdom, and India Results: Overall, 501 physicians responded, 127 of which were in Brazil. Only 63.8% of respondents in Brazil had a high-flow nasal cannula available, in contrast to 100% of respondents in the United Kingdom, Canada, and the United States. The attending physician was responsible for the decision to start a high-flow nasal cannula according to 61.2% respondents in Brazil, 95.5% in the United Kingdom, 96.6% in the United States, 96.8% in Canada, and 84.7% in India. A total of 62% of respondents in Brazil, 96.3% in the United Kingdom, 96.6% in the United States, 96.8% in Canada, and 84.7% in India reported that the attending physician was responsible for the decision to wean or modify the high-flow nasal cannula settings. When high-flow nasal cannula therapy failed due to respiratory distress/failure, 82% of respondents in Brazil would consider a trial of noninvasive ventilation before endotracheal intubation, compared to 93% in the United Kingdom, 88% in the United States, 91.5% in Canada, and 76.8% in India. More Brazilian intensivists (6.5%) than intensivists in the United Kingdom, United States, and India (1.6% for all) affirmed using sedatives frequently with high-flow nasal cannulas. Conclusion: The availability of high-flow nasal cannulas in Brazil is still not widespread. There are some divergences in clinical practices between Brazilian intensivists and their colleagues abroad, mainly in processes and decision-making about starting and weaning high-flow nasal cannula therapy.

The main strategies adopted by the Toronto government in the COVID-19 pandemic: epidemiology / Las principales estrategias adoptadas por el gobierno de Toronto en la pandemia de COVID-19: estudio de epidemiología

ABSTRACT Objetive To analyze the epidemiological data and the main government measures adopted against the COVID-19 pandemic. Methods Epidemiologic study built with data from the integrated Public Health Information System (iPHIS) and the official Government of Canada website in a time frame from January to July 2020. Results Toronto presents the first case of COVID 19 on January 23rd and until July 1st, 2020, it records a number of 14 468 cases, 12.574 recovered cases, 1.100 deaths and 171 institutional outbreaks. About 53,04% of the cases were female, aged 40-59 years (29,81%), followed by 20-39 years (28,37%). Contagion forms were analyzed: 56,40% had close contact with a case, 24,23% in the community, 10,30% in health services, 5,58% while traveling and 3,49% in institutions. Economic and financial actions, travel measures, support for Canadians abroad, public education, research and technology were developed. Conclusion The COVID-19 is a serious threat to public health around the world. Canada has a strong history of pandemic planning and has worked together with public health for its developed actions to become adaptable based on evolution, outbreak containment and prevention of further spread.

RESUMEN Objetivo Analizar los datos epidemiológicos y las principales medidas gubernamentales adoptadas contra la pandemia de COVID-19. Métodos Estudio epidemiológico construido con datos del Sistema de Información de Salud Pública integrado (iPHIS) y el sitio web oficial del Gobierno de Canadá en un período de tiempo de enero a julio de 2020. Resultados Toronto presentó el primer caso de COVID-19 el 23 de enero y hasta el 1 de julio de 2020 registró 14 468 casos; 12 574 casos recuperados, 1 100 muertes y 171 brotes institucionales. Aproximadamente el 53,04% de los casos fueron de mujeres entre los 40 y 59 años (29,81%), seguidas de las de 20 a 39 años (28,37%). Se analizaron formas de contagio: 56,40% tuvo contacto cercano con un caso, 24,23% en la comunidad; 10,30%, en servicios de salud; 5,58%, en viajes, y 3,49% en instituciones. Se desarrollaron acciones económicas y financieras, medidas de viaje, apoyo a los canadienses en el exterior, educación pública, investigación y tecnología. Conclusión El COVID-19 es una grave amenaza para la salud pública en todo el mundo. Canadá tiene una sólida historia de planificación para pandemias y ha trabajado junto con la salud pública para que sus acciones desarrolladas se vuelvan adaptables en función de la evolución, la contención de brotes y la prevención de una mayor propagación.

Estresores de aculturación de los inmigrantes hispanos en Estados Unidos de América. Revisión sistemática exploratoria / Stressors during the process of culture adaptation of hispanic migrants in the United States of America: An exploratory systematic review / Estressores de aculturação de imigrantes hispânicos nos Estados Unidos da América. Revisão sistemática exploratoria

RESUMEN Introducción: Los inmigrantes hispanos que se desplazan hacia Estados Unidos experimentan una transición migratoria altamente estresante, padeciendo alteraciones en la salud que continúan después de su llegada, lo que puede dificultar su adaptación a la nueva cultura. Identificar los factores más estresantes en el inmigrante hispano en su proceso de aculturación es primordial para el diseño de intervenciones puntuales y oportunas, donde el personal de enfermería es un elemento central para ello. Objetivo: Identificar los estresores de aculturación que presentan los inmigrantes hispanos en Estados Unidos. Desarrollo: Mediante un análisis numérico de los datos cuantitativos y el análisis temático de los hallazgos cualitativos, sugerido por metodología para revisiones sistemáticas exploratorias, se identificaron estresores personales, del entorno, sociales y globales, que enfrentan los inmigrantes hispanos. De igual manera, se describen las principales repercusiones a la salud tales como: angustia, ansiedad, depresión, ideación suicida, riesgo de consumo de alcohol, conductas sexuales de riesgo, entre otras, que se derivan de dicho proceso de transición. Conclusiones: Los encuentros más comunes entre el profesional de enfermería se dan durante momentos de transición de las personas, por ello es importante resaltar que la transición cultural de los inmigrantes hispanos es acompañada de estresores que afectan directamente su salud. El presente estudio muestra y clasifica los estresores más comunes, evidencia la necesidad de la creación de estrategias encaminadas a la adaptación social del inmigrante hispano y el involucramiento de la enfermería tanto en el diseño como liderazgo de estas.

ABSTRACT Introduction: Hispanic migrants who settle in the United States experience a highly stressful transition period, which not only has an impact on their process of adaptation to the new culture but also on their health. Therefore, identifying stressing factors which influence the hispanic migrants during their process of culture adaptation is a key goal in the design and implementation of timely interventions led by nursing professionals. Objective: To identify stressing factors which have an influence on the process of culture adaptation of hispanic migrants in the United States. Development: Based on the numeric analysis of quantitative data, and the thematic analysis of the qualitative data which was informed by an exploratory systematic review methodology, personal, social, global stressors were identified influencing hispanic migrants in the United States. Among the identified health issues were: anguish, anxiety, depresion, suicide thoughts, alcohol consumption, and risky sexual behaviors. Conclusions: The present study showed some important stressors influencing the hispanic migrants in the United States in their process of culture adaptation. These factors can be considered by the nursing professionals who are addressing the process of social adaptation of these populations.

RESUMO Introdução: Os imigrantes hispânicos que se mudam para os Estados Unidos passam por uma transição migratória altamente estressante, sofrendo alterações de saúde que continuam após sua chegada, o que pode dificultar sua adaptação à nova cultura. Identificar os fatores mais estressantes para os imigrantes hispânicos em seu processo de aculturação é essencial para a concepção de intervenções oportunas, nas quais o pessoal de enfermagem é um elemento central para isso. Objetivo: Identificar os estressores de aculturação entre os imigrantes hispânicos nos Estados Unidos. Desenvolvimento: Através de uma análise numérica dos dados quantitativos e análise temática dos resultados qualitativos, sugeridos pela metodologia de revisões sistemáticas exploratórias, foram identificados os estresses pessoais, ambientais, sociais e globais enfrentados pelos imigrantes hispânicos. Da mesma forma, são descritas as principais repercussões na saúde, tais como: angústia, ansiedade, depressão, ideação suicida, risco de consumo de álcool, comportamentos sexuais de risco, entre outros, que são derivados deste processo de transição Conclusões: Os encontros mais comuns entre os profissionais de enfermagem ocorrem durante os momentos de transição das pessoas, portanto é importante salientar que a transição cultural dos imigrantes hispânicos é acompanhada por fatores de estresse que afetam diretamente sua saúde. Este estudo mostra e classifica os fatores de estresse mais comuns, demonstra a necessidade da criação de estratégias voltadas para a adaptação social do imigrante hispânico e o envolvimento da enfermagem tanto no desenho quanto na liderança dessas estratégias.

Reflections on Canadian Family Doctor Training: Observation of Postgraduate Family Medicine Education with a Focus on Digital Review for Trainee Development / 日本プライマリ・ケア連合学会誌

In 2019, a team composed of medical and health economics educators and a family medicine trainee from the Department of Community and Family Medicine, Fukushima Medical University, and the School of International and Public Policy, Hitotsubashi University, Japan, embarked on a study tour to Toronto, Canada, a leading country in family medicine education and training. During this tour, the team visited the Department of Family and Community Medicine at the University of Toronto and affiliated hospitals to observe family medicine training in practice, which included video review and feedback for trainee development. In addition, they visited a practice attached to a legal clinic, with subsequent learning about the medico-legal interface and responsibilities of Canadian family doctors. The team gained first-hand insight into family medicine training along with an understanding of a healthcare system that values primary care.

Professional practice in caring for maternal grief in the face of stillbirth in two countries / Práctica profesional en el cuidado del duelo materno ante la muerte fetal en dos países / Prática profissional no cuidado ao luto materno diante do óbito fetal em dois países

ABSTRACT Objective: to understand professional care for maternal grief in the puerperium of stillbirth. Methods: a clinical-qualitative study with all the women who had stillbirths living in Maringá (Brazil) and participating in the Center d'Études et de Recherche in Family Intervention at the University of Quebec in Outaouais in Gatineau (Canada). Semi-structured interviews were carried out and the relevant aspects were categorized into themes. Results: the identified categories were: Assistance received in the puerperium with a focus on grief: hospital and outpatient environment, and Professional support in coping with maternal grief after fetal loss: with contact and memories, without contact and without memories and impossibilities of contact with the baby. Final considerations: the need for a multidisciplinary support and monitoring network for women who experienced fetal loss was evident. From this study, a routine of care for grief can be implemented in Brazil based on experiences in Canada.

RESUMEN Objetivo: comprender la atención profesional al duelo materno en el puerperio de los partos sin vida. Métodos: estudio clínico-cualitativo con todas las mujeres que tuvieron muerte fetal, residentes en Maringá (Brasil) y participantes en el Centre d'Études et de Recherche en Intervention Familiale de la Universidad de Quebec en Outaouais en Gatineau (Canadá). Se realizaron entrevistas semiestructuradas y se categorizaron los aspectos relevantes por temas. Resultados: las categorías identificadas fueron: Asistencia recibida en el puerperio con enfoque de duelo: ambiente hospitalario y ambulatorio y Apoyo profesional en el afrontamiento del duelo materno tras la pérdida fetal: con contacto y recuerdos, sin contacto y sin recuerdos e imposibilidades de contacto con el bebé. Consideraciones finales: la necesidad de una red de apoyo y monitoreo multiprofesional para mujeres que experimentaron pérdida fetal fue evidente. A partir de este estudio, se puede implementar una rutina de atención al duelo en Brasil a partir de las experiencias de Canadá.

RESUMO Objetivo: compreender o cuidado profissional ao luto materno no puerpério de nascimentos sem vida. Métodos: estudo clínico-qualitativo com todas as mulheres que tiveram óbito fetal, residentes em Maringá (Brasil) e participantes do Centre d'Études et de Recherche en Intervention Familiale na Universidade do Quebec em Outaouais no Gatineau (Canadá). Foi realizada entrevista semiestruturada, e os aspectos relevantes foram categorizados em temas. Resultados: as categorias identificadas foram Assistência recebida no puerpério com enfoque no luto: ambiente hospitalar e ambulatorial e Apoio profissional no enfrentamento ao luto materno após a perda fetal: com contato e lembranças, sem contato e sem lembranças e impossibilidades de contato com o bebê. Considerações finais: ficou evidente a necessidade de uma rede de apoio e o acompanhamento multiprofissional para mulheres que vivenciaram perda fetal. A partir deste estudo, uma rotina de atendimento de cuidados ao luto poderá ser implantada no Brasil com base nas experiências do Canadá.

Professional practice in caring for maternal grief in the face of stillbirth in two countries / Práctica profesional en el cuidado del duelo materno ante la muerte fetal en dos países / Prática profissional no cuidado ao luto materno diante do óbito fetal em dois países

ABSTRACT Objective: to understand professional care for maternal grief in the puerperium of stillbirth. Methods: a clinical-qualitative study with all the women who had stillbirths living in Maringá (Brazil) and participating in the Center d'Études et de Recherche in Family Intervention at the University of Quebec in Outaouais in Gatineau (Canada). Semi-structured interviews were carried out and the relevant aspects were categorized into themes. Results: the identified categories were: Assistance received in the puerperium with a focus on grief: hospital and outpatient environment, and Professional support in coping with maternal grief after fetal loss: with contact and memories, without contact and without memories and impossibilities of contact with the baby. Final considerations: the need for a multidisciplinary support and monitoring network for women who experienced fetal loss was evident. From this study, a routine of care for grief can be implemented in Brazil based on experiences in Canada.

RESUMEN Objetivo: comprender la atención profesional al duelo materno en el puerperio de los partos sin vida. Métodos: estudio clínico-cualitativo con todas las mujeres que tuvieron muerte fetal, residentes en Maringá (Brasil) y participantes en el Centre d'Études et de Recherche en Intervention Familiale de la Universidad de Quebec en Outaouais en Gatineau (Canadá). Se realizaron entrevistas semiestructuradas y se categorizaron los aspectos relevantes por temas. Resultados: las categorías identificadas fueron: Asistencia recibida en el puerperio con enfoque de duelo: ambiente hospitalario y ambulatorio y Apoyo profesional en el afrontamiento del duelo materno tras la pérdida fetal: con contacto y recuerdos, sin contacto y sin recuerdos e imposibilidades de contacto con el bebé. Consideraciones finales: la necesidad de una red de apoyo y monitoreo multiprofesional para mujeres que experimentaron pérdida fetal fue evidente. A partir de este estudio, se puede implementar una rutina de atención al duelo en Brasil a partir de las experiencias de Canadá.

RESUMO Objetivo: compreender o cuidado profissional ao luto materno no puerpério de nascimentos sem vida. Métodos: estudo clínico-qualitativo com todas as mulheres que tiveram óbito fetal, residentes em Maringá (Brasil) e participantes do Centre d'Études et de Recherche en Intervention Familiale na Universidade do Quebec em Outaouais no Gatineau (Canadá). Foi realizada entrevista semiestruturada, e os aspectos relevantes foram categorizados em temas. Resultados: as categorias identificadas foram Assistência recebida no puerpério com enfoque no luto: ambiente hospitalar e ambulatorial e Apoio profissional no enfrentamento ao luto materno após a perda fetal: com contato e lembranças, sem contato e sem lembranças e impossibilidades de contato com o bebê. Considerações finais: ficou evidente a necessidade de uma rede de apoio e o acompanhamento multiprofissional para mulheres que vivenciaram perda fetal. A partir deste estudo, uma rotina de atendimento de cuidados ao luto poderá ser implantada no Brasil com base nas experiências do Canadá.

Frailty significantly associated with a risk for mid-term outcomes in elderly chronic coronary syndrome patients: a prospective study

Abstract Introduction: Frailty is a condition of elderly characterized by increased vulnerability to stressful events. Frail patients are more likely to have adverse events. The purposes of this study were to define frailty in patients aged ≥ 70 years with chronic coronary syndrome (CCS) and to evaluate mortality and prognostic significance of frailty in these patients. Methods: We included 99 patients, ≥ 70 years old (mean age 74±5.3 years), with diagnosis of CCS. They were followed-up for up to 12 months. The frailty score was evaluated according to the Canadian Study of Health and Aging (CSHA). All patients were divided as frail or non-frail. The groups were compared for their characteristics and clinical outcomes. Results: Fifty patients were classified as frail, and 49 patients as non-frail. The 12-month Major Adverse Cardiac Events (MACE) rate was 69.4% in frail patients and 20% in non-frail patients. Frailty increases the risk for MACE as much as 3.48 times. Two patients died in the non-frail group and 11 patients died in the frail group. Frailty increases the risk for death as much as 6.05 times. When we compared the aforementioned risk factors by multivariate analysis, higher CSHA frailty score was associated with increased MACE and death (relative risk [RR] = 22.94, 95% confidence interval [CI] 3.33-158.19, P=0.001, for MACE; RR = 7.41, 95% CI 1.44-38.03, P=0.016, for death). Conclusion: Being a frail elderly CCS patient is associated with worse outcomes. Therefore, frailty score should be evaluated for elderly CCS patients as a prognostic marker.

The existing scenario of haemophilia care in Canada and China - A review

ABSTRACT Hemophilia is an X-linked recessive genetic disorder which affects approximately 400,000 people globally. Differing healthcare reimbursement systems, budgetary constraints and geographical and cultural factors make it difficult for any country to fully deliver ideal care. Although developed countries have sufficient treatment products available, they are burdened by the higher expectation of outcomes, coupled with insufficient supportive care to monitor adherence and outcomes and to implement regular follow-up. In contrast, developing regions may not have ready access to factor replacement, but have developed excellent physiotherapy and rehabilitation programs. Although there are multiple studies that have attempted to assess country-specific variations in hemophilia care, very few compare hemophilia care between economically unequal countries and the challenges in achieving optimal hemophilia care. This literature review tries to bridge this gap and throws light on the country-specific differences in epidemiology, standard of hemophilia care and challenges faced in Canada and China. Data sources resulted in 20 studies (11 from Canada and 9 from China), which were reviewed. In a developed country, the main advantages are: the early treatment of bleeding episodes and the presence of a specialized interdisciplinary and comprehensive treatment concept. This is not the case in most developing countries, where the government does not have the resources to buy the necessary quantities of coagulation factors in the face of more urgent health priorities and hardly a few patients can afford to pay for their own treatment, even the on-demand home therapy.

O(s) Sistema(s) Primário(s) de Saúde Canadense sob uma perspectiva brasileira: discutindo os Atributos Starfield / The Canadian Primary Health Care Systems from a Brazilian perspective: discussing Starfield's Attributes

Resumo Os pilares Starfield são revistos assim como o sistema de saúde canadense. Avaliação objetiva e subjetiva são aplicadas ao sistema sob as lentes do acesso, longitudinalidade, integralidade e coordenação de cuidados. Discutem-se as vulnerabilidades do sistema e as ações e propostas que estão em curso para tentar melhorar esses aspectos, tanto nacionalmente como na província de Ontário. Destaque para a oportunidade de se criar um sistema gratuito de medicamentos e os diversos desafios para avançar a agenda de reformas.

Abstract This paper reviews the Starfield pillars and the Canadian health system. An objective and subjective evaluation are applied to the system through the lenses of access, longitudinality, integrality, and coordination of care. System vulnerabilities, actions, and proposals that are underway to improve these aspects, both nationally and in the province of Ontario, are discussed. Worth highlighting is the opportunity to establish a national free drug system, and the several challenges to advance the agenda of reforms.