Another case of preventable death from asthma.

INTRODUCTION: Asthma prevalence is 262 million globally, with more than 1,000 deaths each day, most of them preventable. We were performing a longitudinal study, in Brazil, with the objective to following up patients who had a severe asthma attack and attended an emergency room (ATTACK Study). Here we present a case of a 28-year-old woman presenting what was considered moderate asthma, enrolled in ATTACK, who subsequently died of asthma. CASE STUDY: The patient was initially evaluated at an emergency room (ER) with uncontrolled asthma and no regular treatment. She had an asthma diagnosis just before this visit to the ER, despite presenting symptoms of asthma since childhood. She was subsequently evaluated by a specialist, who prescribed a treatment with regular inhaled corticosteroid and an inhaled bronchodilator, if necessary. The patient was systematically monitored by telephone for six months. RESULTS: The patient did not adhere to the treatment, in spite of repeated warnings, and 6 months later had an asthma attack resulting in her death. CONCLUSION: It is important to prioritize asthma in primary health care, including building capacity health care professionals for early diagnosis, asthma management, and to educate patients with asthma patients for the identification of worsening and signs of severity, to manage the exacerbations according to a written asthma plan. This may reduce the number of premature and preventable asthma deaths.

The Uniformed Services Constipation Action Plan: An Effective Tool for the Management of Children with Functional Constipation.

OBJECTIVE: To implement and to evaluate the effectiveness of the Uniformed Services Constipation Action Plan (USCAP) in our gastroenterology clinic for children with functional constipation. STUDY DESIGN: This implementation science study included toilet-trained subjects aged 4 years and older who met the Rome IV criteria for functional constipation. Children were block randomized to receive either the USCAP or control. All clinic functional constipation plans recommended subjects continue pharmacotherapy for 4 months. Endpoints measured were clinical outcomes (resolution of functional constipation and achievement of a Pediatric Bristol Stool Form Scale [PBSFS] score of 3 or 4), patient-related outcomes (health-related quality of life [HRQoL] total scale score), and health confidence outcomes (Health Confidence Score [HCS]). RESULTS: Fifty-seven treatment group subjects (44%) received a USCAP (52% male; mean age, 10.9 [4.9] years) compared with 73 controls (56%; 48% male; mean age,10.9 [5.3] years). A PBSFS score of 3 or 4 was achieved by 77% of the treatment group compared with 59% of controls (P = .03). Subjects from the treatment group were more likely than the controls to endorse adherence to the 4-month course of pharmacotherapy (P < .001). Subjects who received a USCAP had greater improvements in HRQoL total scale score by the end of the project (P = .04). CONCLUSIONS: The USCAP is a simple, inexpensive tool that has the potential to improve global outcomes for functional constipation in children and should be recommended as standard clinical practice.

COVID-19 and zoonoses in Brazil: Environmental scan of one health preparedness and response.

The emergence of the COVID-19 pandemic reinforced the central role of the One Health (OH) approach, as a multisectoral and multidisciplinary perspective, to tackle health threats at the human-animal-environment interface. This study assessed Brazilian preparedness and response to COVID-19 and zoonoses with a focus on the OH approach and equity dimensions. We conducted an environmental scan using a protocol developed as part of a multi-country study. The article selection process resulted in 45 documents: 79 files and 112 references on OH; 41 files and 81 references on equity. The OH and equity aspects are poorly represented in the official documents regarding the COVID-19 response, either at the federal and state levels. Brazil has a governance infrastructure that allows for the response to infectious diseases, including zoonoses, as well as the fight against antimicrobial resistance through the OH approach. However, the response to the pandemic did not fully utilize the resources of the Brazilian state, due to the lack of central coordination and articulation among the sectors involved. Brazil is considered an area of high risk for emergence of zoonoses mainly due to climate change, large-scale deforestation and urbanization, high wildlife biodiversity, wide dry frontier, and poor control of wild animals' traffic. Therefore, encouraging existing mechanisms for collaboration across sectors and disciplines, with the inclusion of vulnerable populations, is required for making a multisectoral OH approach successful in the country.

What Will We Do? The Action Plan From a Brazilian Professional Football Club Youth Academy Facing the COVID-19 Pandemic.

In 2020, the world was affected by the COVID-19 pandemic, which remains a major challenge for most countries today. In Brazil, football clubs' youth academies have faced a disruption of their regular activities. In order to study how the learning cultures of a Brazilian professional football club youth academy have been changed, and the alternatives created by the club's staff within this context, this perspective article aims to analyze how they have structured the Under-15 (U15) team learning culture during social isolation due to the COVID-19 pandemic. Through document and thematic analysis on a Brazilian professional football club's youth academy program, we promoted a dialogue between the process of adaptation to remote theoretical-tactical teaching with the learning theory proposed by Hodkinson and collaborators. The main theme of analysis of this study was the remote structure of the theoretical-tactical learning and physical training. Challenged with the need to transpose face-to-face activities into a learning culture based on remote communication, the U15 team coaching staff created a process to prescribe physical training, and to teach and discuss football tactical issues with young players during the period of social isolation. This perspective article shows that it is possible for sports institutions to create programs for the development of young athletes within the social isolation/distancing context, considering both theoretical-tactical learning and physical training processes. The adaptation to remote environments as structures for the learning culture seems a challenge, but is also a good alternative for young players to develop their interpretation and perception of football theoretical-tactical issues.

Implementation of an intervention to improve the adoption of asthma self-management practices in Peru: Asthma Implementation Research (AIRE) randomized trial study protocol.

INTRODUCTION: Asthma is the most common chronic disease among children worldwide, with 80% of asthma-related deaths occurring in low- and middle-income countries (LMICs). While evidence-based guidelines exist for asthma treatment and management, adoption of guideline-based practices is low in high-income country and LMIC settings alike. While asthma prevalence among children and adolescents in Lima, Peru is in the range of 13%-19.6%, our data suggest that < 5% of children in low-resource communities are currently taking guideline-based therapies. There is an urgent need for effective, locally tailored solutions to address the asthma treatment gap in low-income communities in Peru. METHODS: This study aims to develop and test a locally adapted intervention package to improve adoption of self-management practices and utilization of preventive health services for asthma among children in Lima Norte. The intervention package was designed using a systematic, theory-based framework (Capability, Opportunity, Motivation - Behavior Framework) and is rooted in a multi-phased formative research approach. The main study design is an individually randomized implementation-effectiveness hybrid trial enrolling 110 children aged 5-17 years with asthma and their caregivers. Families allocated to the treatment group receive the supported self-management intervention package, while families allocated to the control group receive the standard of care plus asthma education. We will follow participants monthly for six months and evaluate asthma control (Asthma Control Test), healthcare utilization, and medication adherence (Adherence to Refills and Medications Scale). Disease-specific quality of life for children (Pediatric Asthma Quality of Life Questionnaire) and caregivers (Pediatric Asthma Caregiver's Quality of Life Questionnaire) will be evaluated at baseline, 3 months, and 6 months. We will also evaluate acceptability, feasibility, and fidelity of the intervention using mixed methods approaches. DISCUSSION: The long-term goal of this study is to disseminate locally appropriate asthma management strategies in LMIC settings. This study will contribute to the body of knowledge surrounding approaches for developing and evaluating intervention strategies for asthma using systematic, theory-based approaches grounded in local context. Such strategies have the potential to inform the development and adaptation of appropriate and scalable solutions for asthma management in LMIC settings. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03986177. Registered on 14 June 2019.

Seizure Rescue Medication Use among US Pediatric Epilepsy Providers: A Survey of the Pediatric Epilepsy Research Consortium.

OBJECTIVE: To assess how pediatric neurologists prescribe home seizure rescue medications to treat acute prolonged seizures and clusters of seizures in children. STUDY DESIGN: A brief, email survey was sent to the members of the Pediatric Epilepsy Research Consortium assessing seizure rescue medication prescribing practices for patients of different age groups, cognitive abilities, and seizure type. Survey responses were anonymous. RESULTS: Thirty-six respondents (of 76 surveyed; 47% response rate) completed the survey. Rectal diazepam was the most commonly chosen rescue medication for a prolonged convulsive seizure in a severely developmentally delayed 16-year-old (44%) and typical and delayed 7-year-old (44% and 61%, respectively), 3-year-old (78% and 86%, respectively), and 9-month-old (83%) patients. Most responders (69%) indicated that developmentally typical 16-year-olds would be prescribed intranasal midazolam. For clusters of seizures, clonazepam orally disintegrating tablets were the most frequent first-line option in all age groups, except developmentally delayed 3-year-old and 9-month-old children, for whom rectal diazepam was chosen more commonly. Medication dosing generally followed standard dosing guidelines with very few exceptions. CONCLUSIONS: Rectal diazepam remains the most frequently used rescue medication for prolonged seizures for nearly all age groups, except in developmentally typical teenagers, for whom intranasal midazolam is used more often. Clonazepam orally disintegrating tablets are the most frequently used medication for treatment of clusters of seizures, except in younger patients. Further work is necessary to establish best practices for type and administration route of seizure rescue medications.

Asthma Assessment in the School Health Office: Can They Stay or Should They Go?

The Assessment Refresher for School Nurses series will review the health assessment and interventions of common complaints of children in the school health setting, making it easier for school nurses to determine whether children should stay in school or be sent home. Initial topics to be covered include asthma and allergies, immunizations, bullying/depression, and diabetes.

Gestión del conocimiento para mejorar los servicios de salud. Una visión para IMIA-LAC / Knowledge management to improve health services. A vision for IMIA-LAC

Introducción: La generación de mecanismos de aplicación del conocimiento en el desarrollo de nuevos productos y procesos e incluso de nuevas formas de organización social es el recurso fundamental en la Sociedad de la Información -Conocimiento. Objetivo: Proponer tareas para concertar, a través de IMIA-LAC, los atributos de las herramientas informáticas y los procesos que caracterizan la Gestión del Conocimiento. Método: Se revisaron los sitios de IMIA e IMIA-LAC para obtener información sobre el desarrollo de esa organización en el mundo. Utilizando estrategias de búsqueda se obtuvo la información necesaria para vincular la estrategia gerencial de gestión del conocimiento con el desarrollo alcanzado, de las aplicaciones informáticas y de los procesos de informatización de los servicios de salud. Resultados: Se argumenta una propuesta de Planes de Acción para potenciar el desarrollo a través de IMIA-LAC: a) Estrategias dirigidas desde la organización, por ejemplo mejorar la identidad corporativa de esta b) Estrategias dirigidas a la búsqueda de mejoras en los servicios de salud, usando los vínculos efectivos con organizaciones claves en el sector Conclusiones: Se proponen un conjunto de acciones para concertar los procesos que caracterizan la Gestión del Conocimiento a través de IMIA-LAC utilizando las herramientas informáticas(AU)

Introduction: Generating mechanisms for applying knowledge in the development of new products, processes and new forms of social organization is the fundamental resource in the Information-Knowledge Society. Objective: Propose tasks to arrange, through IMIA-LAC, the attributes of IT tools and processes that characterize Knowledge Management. Methods: The IMIA and IMIA-LAC sites were reviewed to obtain information about the work of that organization in the world. Using search strategies the necessary information was obtained to link the managerial strategy of knowledge management with the development achieved of the computer applications and of the computerization processes of the health services. Results: A proposal of Plans of Action is argued to promote the development through IMIA-LAC: a) Strategies directed from the organization, for example to improve the corporate identity of this b) Strategies directed to the search of improvements in the health services, using effective links with key organizations in the sector. Conclusions: A set of actions are proposed to coordinate the processes that characterize the Knowledge Management through IMIA-LAC using the computer tools(AU)

Improving immunization data quality in Peru and Mexico: Two case studies highlighting challenges and lessons learned.

INTRODUCTION: The Global Vaccine Action Plan and the Regional Immunization Action Plan of the Americas call for countries to improve immunization data quality. Immunization information systems, particularly electronic immunization registries (EIRs), can help to facilitate program management and increase coverage. However, little is known about efforts to develop and implement such systems in low- and middle-income countries. We present the experiences of Mexico and Peru in implementing EIRs. METHODS: We conducted case studies of an EIR in Mexico and of a population registry in Peru. Information was gathered from technical documents, stakeholder focus groups, site visits, and semi-structured interviews of national stakeholders. We organized findings into narratives that emphasized challenges and lessons learned. RESULTS: Mexico built one of the world's first EIRs, incorporating novel features such as local-level tracking of patients; however, insufficient resources and poor data registration practices led to the system's discontinuation. Peru created an information system to improve affiliation to social programs, including the immunization program and quality of demographic data. Mexico's experience highlights lessons in failed sustainability of an EIR and a laudable effort to reform a country's information system. Peru's demonstrates that attempts to improve health and other data may strengthen health systems, including immunization data. Major challenges in information system implementation and sustainability in Peru and Mexico related to funding, clear governance structures, and resistance among health workers. DISCUSSION: These case studies reinforce the need for countries to ensure adequate funding, plans for sustainability, and health worker capacity-building activities before implementing EIRs. They also suggest new approaches to implementation, including economic incentives for sub-national administrative levels and opportunities to link efforts to improve immunization data with other health and political priorities. More information on best practices is needed to ensure the successful adoption and sustainability of immunization registries in low- and middle-income countries.

Caring for the Student With Asthma at School: What's Out There to Help the School Nurse?

Asthma is a high impact health issue in the school setting. One in 10 children comes to school with asthma, and it is the leading cause for absenteeism causing 13.8 million missed school days each year. Where can the school nurse turn for help? The following article provides evidence-based resources to assist school nurses in caring for their students with asthma.

Monitorização dos pontos críticos de controle na preparação de lanches tratados termicamente / Monitoring of critical control points in the preparation of heat-treated snacks

A Organização Mundial da Saúde (OMS) refere que, das doenças de origem alimentar, mais de 60% dos casos são decorrentes de técnicas inadequadas de processamento e por alimentos contaminados servidos em restaurantes. O objetivo deste t rabalho foi a elaboração de um plano APPCC, a partir da monitorização da temperatura de alimentos considerados críticos no processo de produção de lanches tratados termicamente em duas Unidades de Alimentação Coletiva, localizadas no estado do RS e SC respectivamente. Trata-se de um estudo de caráter observacional. A monitorização dos Pontos Críticos de Controle (PCC) seguiu os setes princípios básicos estabelecidos pelo Codex Alimentarius. Concluiu- se que os resultados desta pesquisa indicam falhas no controle da temperatura de alguns alimentos durante o processo de produção dos lanches, sendo necessário analisar os PCC e elaborar um plano de ação em busca da solução dos problemas encontrados.

The World Health Organization (WHO) states that the food-borne diseases, over 60% of cases are due to inadequate processing techniques and contaminated food served in restaurants. The objective of this work was the development of a HACCP plan, from the temperature monitoring of food considered critical in snacks production process thermally treated in two Collective Power Units, located in the state of RS and SC respectively. This is an observational study. Monitoring of PCCs followed the seven basic principles established by the Codex Alimentarius. It was concluded that the results of this research indicate failures in the temperature control of some food during the snacks production process, being necessary to analyze the Critical Control Points (CCP) and draw up an action plan seeking the solution of the problems encountered.

Conservação de serpentes nos biomas brasileiros / Snake conservation in Brazilian biomes

Este estudo avaliou o estado atual de conservação das serpentes nos biomas brasileiros. As questões levantadas foram principalmente: quantas e quais são as espécies de serpentes ameaçadas? Quais as principais ameaças e estratégias adotadas para sua conservação? Entre as 392 espécies de serpentes conhecidas no Brasil, 29 constam da Lista Nacional Oficial de Espécies da Fauna Ameaçadas de Extinção, das quais 11 são endêmicas da Mata Atlântica, o bioma mais devastado; 6 espécies ocorrem na Caatinga, 5 no Cerrado, 1 na Amazônia e uma no Pampa, também endêmicas desses biomas. A perda e a degradação de habitats são as principais ameaças às serpentes em decorrência do desmatamento para atividades agropecuárias, expansão urbana, extração de madeira e queimadas. Cinco Planos de Ação Nacionais, voltados para conservação da herpetofauna brasileira, incluem 44 espécies de serpentes como alvo, das quais apenas 9 constam da atual lista nacional de espécies ameaçadas. Para várias espécies de serpentes, há deficiência de dados, evidenciando a necessidade de mais estudos que permitam avaliar o status e implementar medidas de conservação.

This study assessed the current conservation status of snake species in the Brazilian biomes. Our main questions were: how many and what are the endangered species? What are the main threats and which conservation strategies are been adopted? Among the 392 species of snakes known to occur in Brazil, 29 of them are included in the Brazilian Red List of Endangered Species, of which 11 are endemic to the Atlantic Forest, the most devastated biome; 6 species occur in the Caatinga, 5 in Cerrado, 1 in Amazon and 1 in Pampa, all endemic to these biomes. Habitat loss and degradation is the main threat to snakes, as a result of deforestation for agricultural and livestock activities, urban expansion, logging, and fire. At least five National Action Plans for the Brazilian herpetofauna include 44 snake species, of which only 9 are included in the national red list. Several snake species are Data Deficient, highlighting the need for more studies that evaluate their conservation status and the implementation of conservation measures. (AU)

Conservação de serpentes nos biomas brasileiros / Snake conservation in Brazilian biomes

Este estudo avaliou o estado atual de conservação das serpentes nos biomas brasileiros. As questões levantadas foram principalmente: quantas e quais são as espécies de serpentes ameaçadas? Quais as principais ameaças e estratégias adotadas para sua conservação? Entre as 392 espécies de serpentes conhecidas no Brasil, 29 constam da Lista Nacional Oficial de Espécies da Fauna Ameaçadas de Extinção, das quais 11 são endêmicas da Mata Atlântica, o bioma mais devastado; 6 espécies ocorrem na Caatinga, 5 no Cerrado, 1 na Amazônia e uma no Pampa, também endêmicas desses biomas. A perda e a degradação de habitats são as principais ameaças às serpentes em decorrência do desmatamento para atividades agropecuárias, expansão urbana, extração de madeira e queimadas. Cinco Planos de Ação Nacionais, voltados para conservação da herpetofauna brasileira, incluem 44 espécies de serpentes como alvo, das quais apenas 9 constam da atual lista nacional de espécies ameaçadas. Para várias espécies de serpentes, há deficiência de dados, evidenciando a necessidade de mais estudos que permitam avaliar o status e implementar medidas de conservação.

This study assessed the current conservation status of snake species in the Brazilian biomes. Our main questions were: how many and what are the endangered species? What are the main threats and which conservation strategies are been adopted? Among the 392 species of snakes known to occur in Brazil, 29 of them are included in the Brazilian Red List of Endangered Species, of which 11 are endemic to the Atlantic Forest, the most devastated biome; 6 species occur in the Caatinga, 5 in Cerrado, 1 in Amazon and 1 in Pampa, all endemic to these biomes. Habitat loss and degradation is the main threat to snakes, as a result of deforestation for agricultural and livestock activities, urban expansion, logging, and fire. At least five National Action Plans for the Brazilian herpetofauna include 44 snake species, of which only 9 are included in the national red list. Several snake species are Data Deficient, highlighting the need for more studies that evaluate their conservation status and the implementation of conservation measures.

Monitorização dos pontos críticos de controle na preparação de lanches tratados termicamente

A Organização Mundial da Saúde (OMS) refere que, das doenças de origem alimentar, mais de 60% dos casos são decorrentes de técnicas inadequadas de processamento e por alimentos contaminados servidos em restaurantes. O objetivo deste trabalho foi a elaboração de um plano APPCC, a partir da monitorização da temperatura de alimentos considerados críticos no processo de produção de lanches tratados termicamente em duas Unidades de Alimentação Coletiva, localizadas no estado do RS e SC respectivamente. Trata-se de um estudo de caráter observacional. A monitorização dos Pontos Críticos de Controle (PCC) seguiu os setes princípios básicos estabelecidos pelo Codex Alimentarius. Concluiu-se que os resultados desta pesquisa indicam falhas no controle da temperatura de alguns alimentos durante o processo de produção dos lanches, sendo necessário analisar os PCC e elaborar um plano de ação em busca da solução dos problemas encontrados.(AU)

The World Health Organization (WHO) states that the food-borne diseases, over 60% of cases are due to inadequate processing techniques and contaminated food served in restaurants. The objective of this work was the development of a HACCP plan, from the temperature monitoring of food considered critical in snacks production process thermally treated in two Collective Power Units, located in the state of RS and SC respectively. This is an observational study. Monitoring of PCCs followed the seven basic principles established by the Codex Alimentarius. It was concluded that the results of this research indicate failures in the temperature control of some food during the snacks production process, being necessary to analyze the Critical Control Points (CCP) and draw up an action plan seeking the solution of the problems encountered.(AU)

Plan de acción para la preservación documental en la biblioteca del Policlínico Norte del municipio Florida, Camagüey / Action Plan for document preservation at the library of the North Polyclinic in Florida, Camaguey

Objetivo: elaborar un plan de acción que contribuya a la preservación documental en la biblioteca del Policlínico Norte, de Florida, en Camagüey. Métodos: se realizó un estudio de evaluación durante los meses de marzo a junio de 2012. Se aplicó el método de análisis documental a una muestra de 325 documentos monográficos, con el propósito de identificar el grado de deterioro físico de la colección. Resultados: la observación permitió diagnosticar las condiciones de almacenamiento. Se aplicó también una matriz DAFO como instrumento gerencial. El fondo bibliográfico mostró elevados niveles de deterioro. Las condiciones de almacenamiento no propiciaban la preservación documental. Conclusiones: Se constató el predominio de las debilidades sobre las fortalezas, así como de las amenazas sobre las oportunidades, lo que ubica a la unidad en el cuarto cuadrante de la matriz. De acuerdo con esto, se propone un conjunto de acciones que eviten el incremento del deterioro

Objective: to develop an action plan that contributes to the documentary preservation at the Library of North Polyclinic in Florida, Camagüey. Methods: an evaluation study was conducted from March to June 2012. The method of document analysis to a sample of 325 case records was applied in order to identify the degree of physical deterioration of the collection. The observation led to the diagnosis of storage conditions. A SWOT matrix was also applied as a management tool. Results: the bibliographic showed high levels of impairment. Storage conditions were not conducive to documentary preservation. The predominance of the weaknesses of the strengths was found, as well as threats of the opportunities, which placed the unit in the fourth quadrant of the matrix. Accordingly a set of actions that prevent increased deterioration is proposed. The bibliographic showed high levels of impairment. Storage conditions were not conducive to preservation documentary. Conclusions: the predominance of weaknesses over strengths was found, as well as threats over opportunities, which places this unit in the fourth quadrant of the matrix. Accordingly a set of preventing against increased deterioration is proposed

Effectiveness of personalized written asthma action plans in the management of children with partly controlled asthma in Trinidad: a randomized controlled trial.

BACKGROUND: The provision of written asthma action plans (WAAPs) is regarded by regional and international guidelines as an essential component of patient education and self-management. However, the evidence for this practice in children is deficient. AIM: To evaluate the effectiveness of adding a personalized WAAP in the treatment of children with partly controlled asthma. METHODS: Children with partly controlled asthma were randomized to receive a personalized WAAP or no plan, in addition to standard care including education. They were followed up with serial measurement of outcome variables. The primary outcome measured was the number of emergency room (ER) revisits. RESULTS: Ninety-one children participated, 45 in the intervention group and 46 in the control group. Comparison with pretrial data revealed significantly improved outcomes with respect to the numbers of ER visits ( p = 0.005 and 0.0002) and acute asthmatic attacks ( p = 0.0064 and 0.0006) in both arms of the study. Children in receipt of a personalized WAAP had fewer ER visits ( p = 0.78), asthma attacks ( p = 0.84), missed school days ( p = 0.28), night-time awakenings ( p = 0.48) and unscheduled doctor visits ( p = 0.69) than those who did not receive a plan. CONCLUSION: The results of this study suggest that the provision of personalized WAAPs may play a useful role in the management of children with partly controlled asthma but is no better than standard care. Asthma education is a critical component in the prevention of exacerbations in children with partly controlled asthma.

Plan de acciones para potenciar el funcionamiento docente-educativo del Diplomado de Dirección en Salud / An action plan to potentiate the teaching-learning work in the Health Direction Course

Se realizó una investigación cualitativa en el Centro Provincial de la Escuela Nacional de Salud Pública en Villa Clara, curso 2010_2011, para diseñar un plan de acciones que eleve la calidad del Diplomado de Dirección en Salud. La muestra estuvo conformada por 13 profesores del claustro, 20 cursistas y tres profesores experimentados como informantes claves. Se aplicaron encuestas, guías de observación, entrevistas y análisis de documentos, y se aplicó la técnica participativa "lluvia de ideas" a informantes claves para conocer el estado actual del funcionamiento del objeto de estudio. Se comprobó que existen dificultades que atentan contra la ejecución correcta del diplomado y se proponen acciones a partir de objetivos. La planificación, ejecución, evaluación, sistematización y socialización de ellas contribuyen a fomentar elementos medulares en la formación de los directivos del sistema, a fin de propiciar cambios organizacionales para la excelencia en la dirección de los servicios de salud.

A qualitative research work was carried out in the provincial center of the National Health School in Villaclara, in the academic course 2010-2011, to design an action plan to elevate the quality of the Health Direction Course. The sample was comprised by 13 teachers, 20 students and three experienced professors. Different techniques were applied among them we can find surveys, observation guidelines, interviews and review of documents. A brain storming technique was applied to the experienced professors to know about the functioning of the object of study. It was tested that there are difficulties that interfere in the development of the course. That´s why actions are proposed taking into account the objectives stated. The planning, execution, evaluation, systematization and socialization of these actions contribute to spread out key elements in the formation of the managers of the system, so as to apply organizational changes which contribute to excellence in the health services management.

Educación en los programas de rehabilitación respiratoria de los pacientes con enfermedad pulmonar obstructiva crónica / Education in pulmonary rehabilitation programs for patients with chronic obstructive pulmonary disease

Education is considered a core component of pulmonary rehabilitation. Rather than to simply provide didactic education, the recommendation now is to promote self-efficacy through teaching self-management skills (quality evidence B, moderate recommendation). The main components of self-management education are the use of action plan for early treatment of exacerbations, breathing strategies and bronchial hygiene techniques and the adherence to exercise at home. There still need of evidence about which mechanisms of self-management education have the most perdurable effects.

La educación es considerada un componente central de la rehabilitación pulmonar. En vez de entregar educación orientada a la mera entrega de conocimientos la tendencia actual es propiciar la autoeficacia del paciente dando especial énfasis a la enseñanza de las habilidades del autocuidado (calidad de la evidencia B, fuerza de la recomendación moderada). Los principales componentes de la educación en el autocuidado son: el reconocimiento y tratamiento precoz de las exacerbaciones agudas mediante el uso de su propio "plan de acción", las técnicas de respiración y de drenaje bronquial y la enseñanza orientada a fortalecer la adherencia a los programas de ejercicio en el hogar. Aún faltan estudios que demuestren cuales son los mecanismos más efectivos para lograr que la educación en el autocuidado tenga efectos perdurables en el tiempo.

Estrategia FIGO para la prevención del aborto inseguro: experiencia en Colombia / Experience in Colombia regarding the FIGO strategy for preventing unsafe abortion

Objetivo: analizar la situación del aborto inseguro en Colombia para establecer: consecuencias, factores determinantes y calidad de la atención e identificar los puntos susceptibles de intervención, para elaborar un plan de acción tendiente a reducir los embarazos no deseados, abortos provocados y sus consecuencias. Materiales y métodos: estudio cualitativo con un componente de revisión de material bibliográfico y otro de consenso de expertos. Se llevó a cabo en dos fases. En la fase 1, de análisis situacional, se recolectó información mediante el formato elaborado por el grupo de trabajo de FIGO (Federación Internacional de Ginecología y Obstetricia). En la fase 2, de elaboración del plan de acción utilizando un marco lógico, se reunieron los representantes de OPS (Organización Panamericana de la Salud), UNFPA (Fondo de Población de las Naciones Unidas), filiales de IPPF (Federación Internacional de Planificación Familiar), ONG locales y agencias del gobierno. Resultados: el análisis situacional se resume en tres ejes: embarazo no deseado, intervenciones para su prevención y aborto. En el plan de acción se definieron cuatro objetivos específicos: mejorar el acceso a los servicios de salud sexual y reproductiva; facilitar el acceso a la interrupción voluntaria del embarazo acorde con la Sentencia C-355 de 2006; promover el acceso al misoprostol para usos ginecoobstétricos; y mejorar la información sobre tasas y complicaciones asociadas al aborto inseguro. Conclusión: a pesar del avance en Colombia con la Sentencia C-355 de 2006, aún persisten grandes retos, tales como reglamentar opciones de fácil acceso al servicio de interrupción voluntaria del embarazo para mujeres víctimas del conflicto armado, protocolos de investigación al interior de los tribunales de ética médica para los asuntos relacionados con objeción de conciencia, clarificar la autonomía y capacidad de menores de catorce años.

Objective: analyzing the situation regarding unsafe abortion in Colombia for establishing its consequences, determinant factors and the quality of attention as well as identifying susceptible intervention points for preparing a action plan aimed at reducing unwanted pregnancies, provoked abortions and their consequences. Materials and methods: this was a qualitative study, having a bibliographic material review component and another regarding expert consensus. It was carried out in two phases: 1. A situational analysis: information was compiled by using a form drawn up by the International Federation of Gynecology and Obstetrics (FIGO) working group; and 2. Preparing an action plan using a logical framework. A meeting was held with representatives from the Pan-American Health Organization (PAHO), the United Nations Population Fund (UNFPA), International Planned Parenthood Federation (IPPF) affiliates, local NGOs and government agencies. Results: the situational analysis revealed three areas of interest: unwanted pregnancy, prevention interventions and abortion. Four specific objectives were defined in the action plan: a) Improving access to sexual and reproductive health services; b) Facilitating access to voluntary interruption of pregnancy according to ruling C-355/2006; c) Promoting access to misoprostol for gynecobstetric use; and d) Improving information about unsafe abortion associated rates and complications. Conclusion: in spite of advances having been made in Colombia via ruling C-355/2006, there are still great challenges to be faced, such as establishing regulations for female victims of armed conflict, options for gaining easy access to the voluntary interruption of pregnancy service, research protocols within medical ethics’ tribunals for matters related to conscientious objection, clarifying the autonomy and ability of minors aged less than fourteen.