Previne brasil e financiamento da atenção primária: facilidades e dificuldades de gestores municipais de saúde / Previne Brasil and primary care financing: facilities and difficulties for municipal health managers / Previne Brasil y financiamiento de la atención primaria: facilidades y dificultades para los gestores municipales de salud

Objetivo: compreender as facilidades e dificuldades enfrentadas por gestores municipais de saúde com o novo modelo de financiamento da Atenção Primária à Saúde. Método: estudo qualitativo, tipo Pesquisa Convergente Assistencial, fundamentado na Política Nacional de Atenção Básica. Participaram 77 gestores ou seus representantes, de 47 municípios de uma Macrorregião de saúde de Santa Catarina, Brasil. Foram realizadas três oficinas nas Gerências Regionais de Saúde, em agosto e setembro de 2022. Os dados foram analisados pela análise de conteúdo. Resultados: apresentam-se como facilidades do Previne Brasil informatização, comprometimento dos profissionais, e qualificação do cuidado. Foram descritas como dificuldades falta de informações, sistema informatizado e denominador estimado e, equipe de trabalho. Conclusão: o programa apresenta facilidades que qualificam o processo de trabalho e cuidado à saúde da população. Contudo, persistem dificuldades que devem ser consideradas pela gestão municipal para avanços na atenção integral e no financiamento da Atenção Primária à Saúde.

Objective: understand the facilities and difficulties faced by municipal health managers with the new Primary Health Care financing model. Method: this is a qualitative study, of the Convergent Care Research type, based on the National Primary Care Policy. The participants were 77 managers or their representatives from 47 municipalities in a health Macroregion in Santa Catarina, Brazil. Three workshops were held in the Regional Health Departments in August and September 2022. The data was analyzed using content analysis. Results: Previne Brasil's facilities include computerization, commitment of professionals, and qualification of care. Difficulties were described as lack of information, computerized system and estimated denominator, and work team. Conclusion: the program offers facilities that improve the work process and health care for the population. However, there are still difficulties that must be considered by municipal management in order to make progress in comprehensive care and Primary Health Care financing.

Objetivo: comprender las facilidades y dificultades que enfrentan los gestores municipales de salud con el nuevo modelo de financiamiento de la Atención Primaria de Salud. Método: estudio cualitativo, tipo Investigación Convergente Asistencial, basado en la Política Nacional de Atención Primaria. Participaron 77 gestores o sus representantes, de 47 municipios de una Macrorregión de salud de Santa Catarina, Brasil. Se realizaron tres talleres en las Gerencias Regionales de Salud, en agosto y septiembre de 2022. Los datos fueron analizados mediante análisis de contenido. Resultados: las instalaciones de Previne Brasil incluyen informatización, compromiso de los profesionales y calificación de la atención. Las dificultades fueron descritas como falta de información, sistema informatizado y denominador estimado y equipo de trabajo. Conclusión: el programa presenta facilidades que cualifican el proceso de trabajo y la atención de la salud de la población. Sin embargo, aún hay dificultades que la gestión municipal debe considerar para lograr avances en la atención integral y el financiamiento de la Atención Primaria de Salud.

Efectos de la COVID-19 en la calidad de la atención de los servicios de salud en Colombia: Revisión de literatura / Effects of COVID-19 on the quality of health care services in Colombia: a literature review / Efeitos da covid-19 na qualidade dos serviços de saúde na colômbia: revisão da literatura

Introducción: La pandemia por COVID-19 ha afectado significativamente la calidad de los servicios de cuidado de la salud. Objetivo: Analizar los efectos en los atributos de la calidad en salud de los servicios de atención de enfermedades diferentes a la COVID-19 en Colombia, durante el periodo 2020-2022. Materiales y métodos: Se analizaron 24 artículos de alcance nacional y otros específicos de departamentos como Antioquia, Córdoba, Santander y Cundinamarca. Resultados: La pandemia por COVID-19 impactó la calidad de los servicios en la atención de enfermedades como cáncer, accidentes cerebrovasculares y de eventos como la interrupción voluntaria del embarazo. Conclusión: La calidad de la salud se vio afectada en todas sus dimensiones durante las fases de la pandemia, especialmente en la población con enfermedades crónicas y relacionadas con la salud infantil y materna. Además, se destacaron respuestas como el uso de la telemedicina y de la atención domiciliaria para contribuir a la calidad de la salud en Colombia.

Introduction: The COVID-19 pandemic has significantly affected the quality of health care services. Objective: To analyze the effects of COVID-19 on the quality of health care services focused on treating diseases other than COVID-19 in Colombia during the 2020-2022 period. Materials and methods: 24 articles were analyzed, which included some studies focused on national issues and others specific to the departments of Antioquia, Cordoba, Santander, and Cundinamarca. Results: The COVID-19 pandemic affected the quality of health services caring for diseases such as cancer, strokes, and critical circumstances like voluntary termination of pregnancy. Conclusion: All dimensions of health care were affected during the pandemic, especially impacting populations with chronic diseases and diseases related to child and maternal health. It is important to highlight that telemedicine and home care contributed to improving the quality of health in Colombia.

Introdução: A pandemia de COVID-19 afetou significativamente a qualidade dos serviços de saúde. Objetivo: Analisar os efeitos da COVID-19 nos atributos de qualidade em saúde dos serviços de atenção a outras doenças além da COVID-19 na Colômbia, durante o período 2020-2022. Materiais e métodos: foram analisados 24 artigos de âmbito nacional e outros específicos de departamentos como Antioquia, Córdoba, Santander e Cundinamarca. Resultados: A pandemia da COVID-19 impactou a qualidade dos serviços no cuidado de doenças como câncer, acidente vascular cerebral e eventos como a interrupção voluntária da gravidez. Conclusão: A qualidade da saúde foi afetada em todas as suas dimensões durante as fases da pandemia, especialmente na população com doenças crônicas e doenças relacionadas à saúde infantil e materna. Além disso, foram destacadas respostas como o uso da telemedicina e do atendimento domiciliar para contribuir para a qualidade da saúde na Colômbia.

Incorporation of human-wildlife interactions in ecosystem-based management to enhance conservation of endangered guitarfish.

Growing human use of the marine environment increases the proximity of humans to marine wildlife and thus likely increases human-wildlife interactions. Such interactions influence perceptions of nature and promote or undermine conservation. Despite their importance, human-wildlife interactions are rarely considered in ecosystem-based marine spatial planning (MSP). Ideally, these interactions should be identified and considered in ecosystem-based management (EBM), which is often purported to be the basis for MSP. We used Marxan software and data from a citizen science project documenting location, species, age, sex, and activity type to identify regions along Israel's coast with a high probability of encounters between people and 2 species of guitarfish. We considered the geographic distribution of these encounters and the various activities undertaken by the reporting observers. We ran 4 scenarios in Marxan. Two had conservation goals of 30% and 50% guitarfish habitat protection. In the third and fourth scenarios, we added a 50% conservation goal of human leisure activities to each guitarfish conservation goal. We also conducted a gap analysis between our guitarfish conservation goals and the Israel Nature and Parks Authority's master plan for marine protected areas. We found the park authority was close to meeting the 30% goal but was far from meeting the conservation goal of 50% of guitarfish habitat conservation. Different human uses were more likely to interact with different life stages of guitarfish, and different recreational activities occurred in different areas. Identifying areas of specific human use showed which activities should be addressed in conservation management decisions. Our addition of certain recreational uses to the model of habitat conservation showed how enhancing human dimensions in conservation planning can lead to more holistic ecosystem-based conservation necessary for effective marine planning.

Incorporación de las interacciones humano­fauna dentro de la gestión basada en el ecosistema para mejorar la conservación del pez guitarra en peligro Resumen El uso creciente que el humano le da al mar incrementa la cercanía de las personas con la fauna marina, lo que probablemente incrementa las interacciones humano­fauna. Dichas interacciones influyen sobre las percepciones que se tienen de la naturaleza y promueven debilitan la conservación. A pesar de su importancia, pocas veces se consideran las relaciones humano­fauna dentro de la planeación espacial basada en ecosistemas marinos (PEM). Lo ideal debería ser la identificación y consideración de estas interacciones dentro de la gestión basada en el ecosistema (GBE), la cual con frecuencia se considera como la base de la PEM. Usamos software Marxan y datos de un proyecto de ciencia ciudadana que documenta la ubicación, especie, edad, sexo y tipo de actividad para identificar las regiones de la costa de Israel con una alta probabilidad de encuentros entre las personas y dos especies de pez guitarra. Consideramos la distribución geográfica de estos encuentros y las diferentes actividades que realizan los observadores. En Marxan corrimos cuatro escenarios. Dos de los escenarios contaban objetivos de conservación del 30% y 50% de la protección del hábitat del pez guitarra. En los otros dos escenarios, añadimos un objetivo de conservación de 50% de las actividades humanas de recreación a los objetivos uno y dos. También realizamos un análisis de brecha entre los objetivos de conservación del pez guitarra y el plan maestro para las áreas marinas protegidas de la Autoridad de Parques y Naturaleza de Israel. Descubrimos que esta autoridad estaba cerca de lograr el objetivo del 30% pero lejos del de 50% de la conservación del hábitat del pez guitarra. Fue más probable que los diferentes usos humanos interactuaran con diferentes estadios de vida del pez guitarra y las diversas actividades recreativas ocurrieron en áreas distintas. La identificación de las áreas con un uso humano específico mostró cuáles actividades deberían abordarse en las decisiones de gestión de la conservación. La suma de ciertos usos recreativos al modelo de conservación del hábitat mostró cómo aumentar las dimensiones humanas en la planeación de la conservación puede derivar en una conservación basada en el ecosistema más holística, necesaria para la planeación marina eficiente.

Adaptive spatiotemporal management to reduce shark bycatch in tuna fisheries.

Purse-seine tropical tuna fishing in the eastern tropical Pacific Ocean (EPO) results in the bycatch of several sensitive species groups, including elasmobranchs. Effective ecosystem management balances conservation and resource use and requires considering trade-offs and synergies. Seasonal and adaptive spatial measures can reduce fisheries impacts on nontarget species while maintaining or increasing target catches. Identifying persistently high-risk areas in the open ocean, where dynamic environmental conditions drive changes in species' distributions, is essential for exploring the impact of fisheries closures. We used fisheries observer data collected from 1995 to 2021 to explore the spatiotemporal persistence of areas of high bycatch risk for 2 species of oceanic sharks, silky shark (Carcharhinus falciformis) and oceanic whitetip shark (Carcharhinus longimanus), and of low tuna catch rates. We analyzed data collected by fisheries scientific observers onboard approximately 200 large purse-seine vessels operating in the EPO under 10 different flags. Fishing effort, catch, and bycatch data were aggregated spatially and temporally at 1° × 1° cells and monthly, respectively. When areas of high fishing inefficiency were closed the entire study period and effort was reallocated proportionally to reflect historical effort patterns, yearly tuna catch appeared to increase by 1-11%, whereas bycatch of silky and oceanic whitetip sharks decreased by 10-19% and 9%, respectively. Prior to fishing effort redistribution, bycatch reductions accrued to 21-41% and 14% for silky and oceanic whitetip sharks, respectively. Our results are consistent with previous findings and demonstrate the high potential for reducing elasmobranch bycatch in the EPO without compromising catch rates of target tuna species. They also highlight the need to consider new dynamic and adaptive management measures to more efficiently fulfill conservation and sustainability objectives for exploited resources in the EPO.

Gestión espaciotemporal adaptativa para reducir la captura incidental de tiburones en la pesca del atún Resumen La pesca con cerco del atún tropical en el Pacífico Tropical Oriental (PTO) resulta en la captura incidental de varios grupos de especies sensibles, incluidos los elasmobranquios. La gestión eficiente del ecosistema equilibra la conservación y el uso de recursos y requiere que se consideren las compensaciones y las sinergias. Las medidas espaciales adaptativas y estacionales pueden reducir el impacto de las pesquerías sobre las especies accesorias mientras mantienen o incrementan la captura intencional. La identificación de las áreas con alto riesgo persistente en mar abierto, en donde las condiciones ambientales dinámicas causan cambios en la distribución de las especies, es esencial para explorar el impacto del cierre de las pesquerías. Usamos datos de observadores de las pesquerías recolectados entre 1995 y 2021 para explorar la persistencia espaciotemporal de las áreas con alto riesgo de captura incidental para dos especies de tiburón (Carcharhinus falciformi y C. longimanus) y con tasas bajas de captura de atún. Analizamos los datos recolectados por los observadores científicos de las pesquerías a bordo de aproximadamente 200 embarcaciones grandes de pesca con cerco que operaban en el PTO bajo diez banderas diferentes. Agregamos los datos sobre el esfuerzo de pesca, captura y la captura incidental de forma espacial y temporal en celdas de 1° x 1° y mensual, respectivamente. Cuando las áreas con gran ineficiencia pesquera se encontraban cerradas durante toda la investigación y el esfuerzo se reasignaba proporcionalmente para reflejar los patrones históricos de esfuerzo, el esfuerzo anual de captura de atún parecía incrementar en un 1­11%, mientras que la captura incidental de las dos especies de tiburones disminuía en un 10­19% (C. falciformi) y 9% (C. longimanus). Antes de que de redistribuyera el esfuerzo de pesca, la reducción de la captura incidental se acumuló hasta el 21­41% (C. falciformi) y 14% (C. longimanus). Nuestros resultados son congruentes con resultados previos y demuestran el gran potencial de reducción de la captura incidental de elasmobranquios en el PTO sin poner en peligro las tasas de captura de las especies de atún. Los resultados también enfatizan la necesidad de considerar medidas adaptativas nuevas y dinámicas para cumplir de forma más eficiente los objetivos de conservación y sustentabilidad para la explotación de recursos en el PTO.

Efficiency, planning and good management, determining factors for a greater equity on health care expenses: the experience from the program family health strategy in Brazil

The present work presents as a research problem the importance of efficiency, planning, and principles of good management aiming at capillarity and equity to generate greater access and quality of services. The objective of this article was to identify the expansion of the Family Health Strategy in Brazil between 2007 and 2020, and which variables may explain this evolution. This is a descriptive, ecological research, developed between 2007 and 2020 in Brazil; its variable of interest was the estimated population coverage of this strategy (%). An increase in the coverage of the Family Health Strategy was observed in all regions of Brazil between 2007 and 2020, especially in the Northeast region. At the state level, this coverage showed a significant positive relationship with the following variables: towns with fewer than 40,000 inhabitants and monthly income inferior to half a minimum salary. The Brazilian version of the Family Health Strategy seeks inspiration from the best and most successful health models to achieve high performance and efficiency to provide equity and access to health services.

El presente trabajo aborda como problema de investigación la importancia de la eficiencia, la planificación y los principios de buena gestión que apuntan a la capilaridad y la equidad para generar un mayor acceso y calidad de los servicios. El objetivo de este artículo fue identificar la expansión de la Estrategia Salud de la Familia en Brasil entre 2007 y 2020 y las variables que pueden explicar esta evolución. Se trata de una investigación descriptiva y ecológica, desarrollada entre 2007 y 2020 en Brasil; su variable de interés fue la cobertura demográfica estimada de esta estrategia (%). Se observó un aumento de la cobertura de la Estrategia Salud de la Familia en todas las regiones de Brasil entre 2007 y 2020, especialmente en la región noreste. A nivel estatal, esta cobertura mostró una relación positiva significativa con las siguientes variables: municipios con menos de 40.000 habitantes e ingresos mensuales inferiores a medio salario mínimo. La versión brasileña de la Estrategia de Salud de la Familia busca su inspiración en los mejores y más exitosos modelos de salud para alcanzar un alto rendimiento y eficiencia para proporcionar equidad y acceso a los servicios de salud.

O presente trabalho apresenta como um problema de pesquisa a importância da eficiência, planejamento e princípios de boa gestão objetivando capilaridade e eqüidade para gerar maior acesso e qualidade dos serviços. O objetivo desse artigo foi identificar a expansão da Estratégia de Saúde da Família no Brasil entre 2007e 2020 e quais variáveis podem explicar essa evolução. Esse é uma pesquisa descritiva, ecológica, desenvolvida entre 2007 e 2020 no Brasil: sua variável de interesse foi a cobertura estimada da população dessa estratégia (%). Um aumento na cobertura da Estratégia de Saúde da Família foi observada em todas as regiões do Brasil entre 2007 e 2020, especialmente na região Nordeste. A nível estadual, essa cobertura mostrou uma relação significante positiva com as seguintes variáveis: cidades com menos de 40.000 habitantes e renda mensal inferior a metade do salário mínimo. A versão brasileira da Estratégia de Saúde da Família busca inspiração nos melhores e mais bem sucedidos modelos de saúde para alcançar alto desempenho e eficiência no fornecimento de eqüidade e acesso a serviços de saúde.

Vivencias y estrategias comunitarias de manejo del riesgo dentro de las prácticas chemsex: un estudio cualitativo / Community experiences and strategies of risk management within chemsex practices: a qualitative study

Resumen El auge en el estudio del uso sexualizado de drogas entre hombres gais, bisexuales u otros hombres que tienen sexo con hombres (HSH), conocido como chemsex, ha generado una multiplicidad de datos que contribuyen a su problematización en tanto cuestión de salud pública a través del vínculo con el VIH y las adicciones. El estudio de estas prácticas, desde un paradigma biomédico, se ha centrado en el riesgo y ha contribuido a su reducción como fenómeno único y cuantificable. Este estudio tiene como objetivo explorar la vivencia del riesgo en el transcurso de las prácticas, para conocer qué estrategias de manejo emplean frente a éste y de qué manera son generadas. Se realizaron entrevistas semiestructuradas a cinco practicantes de chemsex en el Área Metropolitana de Barcelona y, posteriormente se aplicó un análisis temático. Los hallazgos muestran cómo estos hombres detectan, asumen y enfrentan los riesgos presentes en estas prácticas, donde toman relevancia el tipo de relaciones que allí se dan y el círculo social del que disponen. Este estudio destaca también la creación de estrategias basadas en la experiencia y cómo la transmisión de estos saberes entre participantes facilita la toma de decisiones y el manejo del riesgo.

Abstract The rise in the study of sexualised drug use among gay, bisexual and other men who have sex with men (MSM), known as chemsex, has generated a multiplicity of data that contribute to its problematisation as a public health issue through the link with HIV and addictions. The study of these practices, from a biomedical paradigm, has focused on risk and has contributed to its reduction as a unique and quantifiable phenomenon. This study aims to explore the experience of risk in the course of the practices, to find out what management strategies they employ in the face of risk and how they are generated. Semi-structured interviews were conducted with five chemsex practitioners in the Metropolitan Area of Barcelona and, subsequently, a thematic analysis was applied. The findings show how these men detect, assume and confront the risks present in these practices, where the type of relationships that take place and the social circle available to them are relevant. This study also highlights the creation of strategies based on experience and how the transmission of this knowledge among participants facilitates decision-making and risk management.

A Nationwide Online Tracking System of pediatric ICU demand and capacity during a respiratory epidemic in Uruguay / Desarrollo de un Sistema Nacional de Monitoreo En Línea de Capacidad y Demanda de las Unidades de Cuidados Intensivos Pediátricas Durante Una Epidemia Respiratoria

Monitoring national capacity of pediatric intensive care (PICU) beds is important for resource allocation. We describe the development and application of an online tool for bed occupancy monitoring during the respiratory epidemic of 2023 in Uruguay. A 5-minute survey was sent out daily to each PICU designated staff utilizing an instant messaging application, throughout the 12-week of 2023 winter season. The survey gathered information on staffed bed capacity, occupancy rates, invasive mechanical ventilation (IMV) demand and number of children admitted for lower respiratory tract infections (LRTIs). Data was manually entered using the REDcap Software platform. A comparison between PICUs from the capital city Montevideo (MVD) and the inland region (INN) was performed. Participating PICUs had access to a daily dashboard with nationwide data. We collected data from 100% (n=20) of Uruguayan PICUs, 68% in MVD (2.72 PICU beds per-10,000 <18 years) and 32% in the INN (0.86 PICU beds per-10,000 <18 years). National average bed occupancy rate was 55.5%, without differences between MVD and INN. However, LRTI admissions and IMV incidence were notably higher among INN PICUs compared with MVD PICUs, 83.0% vs. 71% (P<0.01) and 19.9% vs. 14.7% (P<0.01) respectively. During one week occupancy exceeded 80% without differences between MVD and INN. The implementation of a nationwide PICU bed monitoring tool was possible. Although occupancy rates did not reach critical levels at a national grade, regional differences were found that merit further study to improve vital PICUs resource allocation.

Monitorear la capacidad nacional de camas de cuidados intensivos pediátricos (UCIP) es importante para la asignación de recursos. Describimos el desarrollo y aplicación de una herramienta online para el seguimiento de la ocupación de camas durante la epidemia respiratoria de 2023 en Uruguay. Se envió diariamente una encuesta de 5 minutos a cada personal designado de la UCIP mediante una aplicación de mensajería instantánea, durante las 12 semanas de la temporada de invierno de 2023. La encuesta recopiló información sobre la capacidad de camas con personal, las tasas de ocupación, la demanda de ventilación mecánica invasiva (IMV) y el número de niños admitidos por infecciones del tracto respiratorio inferior (LRTI). Los datos se ingresaron manualmente utilizando la plataforma del software REDcap. Se realizó una comparación entre UCIP de la capital Montevideo (MVD) y del interior (INN). Las UCIP participantes tuvieron acceso a un panel diario con datos a nivel nacional. Se recolectaron datos del 100% (n=20) de las UCIP uruguayas, el 68% en MVD (2,72 camas UCIP por 10.000 <18 años) y el 32% en el INN (0,86 camas UCIP por 10.000 <18 años). La tasa de ocupación de camas promedio nacional fue del 55,5%, sin diferencias entre MVD e INN. Sin embargo, los ingresos por LRTI y la incidencia de IMV fueron notablemente mayores entre las UCIP INN en comparación con las UCIP MVD, 83,0% frente a 71% (P<0,01) y 19,9% frente a 14,7% (P<0,01), respectivamente. Durante una semana la ocupación superó el 80% sin diferencias entre MVD y INN. Fue posible implementar una herramienta de monitoreo de camas UCIP a nivel nacional. Aunque las tasas de ocupación no alcanzaron niveles críticos a nivel nacional, se encontraron diferencias regionales que merecen más estudios para mejorar la asignación de recursos vitales de las UCIP.

[Staff hebdomadaire qualité et gestion des risques en gériatrie: un outil d'appropriation de la démarche qualité pour le management des unités]. / Staff hebdomadaire qualité et gestion des risques en gériatrie : un outil d'appropriation de la démarche qualité pour le management des unités.

The quality approach has become essential in geriatric hospital services, but also in the medico-social sector. This process is continuous and shared by all those in charge of the care units, to facilitate unit management and support caregivers in this approach. The weekly structured quality staff meeting is a relevant tool to facilitate the understanding and appropriation of this approach by the medical and nursing managers of the care units.

Simulating the efficacy of wolf-dog hybridization management with individual-based modeling.

Introgressive hybridization between wolves and dogs is a conservation concern due to its potentially deleterious long-term evolutionary consequences. European legislation requires that wolf-dog hybridization be mitigated through effective management. We developed an individual-based model (IBM) to simulate the life cycle of gray wolves that incorporates aspects of wolf sociality that affect hybridization rates (e.g., the dissolution of packs after the death of one/both breeders) with the goal of informing decision-making on management of wolf-dog hybridization. We applied our model by projecting hybridization dynamics in a local wolf population under different mate choice and immigration scenarios and contrasted results of removal of admixed individuals with their sterilization and release. In several scenarios, lack of management led to complete admixture, whereas reactive management interventions effectively reduced admixture in wolf populations. Management effectiveness, however, strongly depended on mate choice and number and admixture level of individuals immigrating into the wolf population. The inclusion of anthropogenic mortality affecting parental and admixed individuals (e.g., poaching) increased the probability of pack dissolution and thus increased the probability of interbreeding with dogs or admixed individuals and boosted hybridization and introgression rates in all simulation scenarios. Recognizing the necessity of additional model refinements (appropriate parameterization, thorough sensitivity analyses, and robust model validation) to generate management recommendations applicable in real-world scenarios, we maintain confidence in our model's potential as a valuable conservation tool that can be applied to diverse situations and species facing similar threats.

Simulación de la eficiencia de la gestión de híbridos de perro y lobo con modelos basados en individuos Resumen La hibridación introgresiva entre perros y lobos es un tema de conservación por las posibles consecuencias evolutivas deletéreas a largo plazo. Las leyes europeas requieren que estos híbridos se mitiguen mediante una gestión efectiva. Desarrollamos un modelo basado en individuos (MBI) para simular el ciclo de vida del lobo gris que además incorpora los aspectos sociales de los lobos que afectan las tasas de hibridación (p. ej.: la disolución de las manadas después de la muerte de uno o ambos reproductores) con el objetivo de guiar las decisiones de gestión de estos híbridos. Aplicamos nuestro modelo con la proyección de las dinámicas de hibridación en una población local de lobos bajo diferentes selecciones de pareja y escenarios de inmigración y contrastamos los resultados de la extirpación de individuos mezclados con su esterilización y liberación. En varios escenarios, la falta de gestión llevó a una mezcla completa, mientras que las intervenciones de gestión reactiva redujeron de forma efectiva la mezcla en las poblaciones de lobos. Sin embargo, la eficiencia de la gestión dependió en su mayoría de la selección de pareja y el número y nivel de mezcla de los individuos inmigrantes a la población de lobos. La inclusión de la mortalidad antropogénica que afecta a los individuos parentales y mezclados (p. ej.: la cacería) incrementó la probabilidad de que se disolviera la manada y por lo tanto incrementara la probabilidad del entrecruzamiento con perros o individuos mezclados, además de que aumentó la hibridación y las tasas de introgresión en todos los escenarios de simulación. Reconocemos la necesidad de refinar el modelo (parametrización adecuada, análisis detallados de sensibilidad y validación del modelo robusto) para generar recomendaciones de gestión aplicables en escenarios reales y mantenemos la confianza en el potencial de nuestro modelo como una herramienta valiosa de conservación que podría aplicarse a diferentes situaciones y especies que enfrentan amenazas similares.

E-consults between primary care and internal medicine: implementation, accessibility, benefits, and implications.

AIM: This work aims to evaluate whether electronic consultations (e-consults) are a clinically useful, safe tool for assessing patients between primary care and internal medicine. METHODS: This is a retrospective cohort study of all e-consults ordered by the Primary Care Department to the Internal Medicine Department between September 2019 and December 2023. The results of initial consultations, emergency department visits and subsequent admissions, and survival were assessed and complaints and claims filed were reviewed. RESULTS: A total of 11,434 e-consults were recorded (55.4% women) with a mean age of 62.1 (SD19.4) years and a wide range (15-102 years). The mean response time was 2.55 (SD 1.6) days. As a result of the e-consults, 5645 patients (49.4%) were given an in-person appointment. For the remaining 5789 (50.6%), a written response was provided. Among those given appointments, the time between the response and in-person appointment was less than five days (95% of cases). Compared to those not given appointments, in-person appointments were older (p < 0.0001), visited the emergency department more times (one month: p = 0.04; three months: p = 0.001), were admitted to the hospital more times (one month: p = 0.0001; three months: p = 0.0001), and had higher mortality at one year (12.7% vs. 9.8% p = 0.0001). In the Cox analysis, only in-person appointments (RR = 1.11; p = 0.04)) and age (RR = 1.09; p < 0.01) were independent factors of mortality. No complaints or claims of any kind were registered. CONCLUSIONS: These data suggest that e-consults are a clinically useful, safe tool for assessing patients referred from primary care to internal medicine departments.

[Setting up a training program in a geriatric short-stay department]. / Mise en place d'un programme de formations au sein d'un service de court séjour gériatrique.

As the department's team had been renewed in less than two years, it was necessary to invent a method to improve cohesion and communication, and to enhance the skills of professionals. This led to the creation of a training program using a variety of methods (theoretical training, care approaches and quality coffees).

Gerenciamento do protocolo de prevenção de lesão por pressão: construção de painel de bordo informatizado / Management of the pressure injury prevention protocol: construction of a computerized dashboard / Gestión del protocolo de prevención de lesiones por presión: construcción de panel informatizado

Objetivo: Relatar a construção e implantação de painel de bordo, desenvolvido por enfermeiros e profissionais da tecnologia da informação, para gerenciamento do Protocolo de Prevenção de Lesão por Pressão. Métodos: Trata-se de um relato de experiência sobre a construção e implantação de painel de bordo informatizado para gerenciamento de protocolo em um hospital privado universitário, localizado no interior do estado de São Paulo. Resultados: A construção do painel de bordo foi dividida nas seguintes etapas: revisão e atualização do protocolo, construção do modelo eletrônico e implementação. A divulgação foi realizada pela Comissão de Prevenção de Lesão por Pressão. Conclusão: O painel de bordo possibilitou a visualização rápida e em tempo real dos riscos dos pacientes, intervenções propostas e efetividade das medidas de prevenção, além de promover a integração e empoderamento dos profissionais na gestão do cuidado. (AU)

Objective: To report the construction and implementation of a dashboard, developed by nurses and information technology professionals, to manage the Pressure Injury Prevention Protocol. Methods: This is an experience report on the construction and implementation of a computerized dashboard for protocol management in a private university hospital, located in the interior of the state of São Paulo. Results: The construction of the dashboard was divided into the following steps: review and update of the protocol, construction of the electronic model and implementation. The Pressure Injury Prevention Commission disclosed the tool. Conclusion: The dashboard enabled the quick and real-time visualization of patient risks, proposed interventions and effectiveness of prevention measures, in addition to promoting the integration and empowerment of professionals in the management of care. (AU)

Objetivo: Informar la construcción e implementación de un panel, desarrollado por enfermeras y profesionales de tecnologías de la información, para gestionar el Protocolo de Prevención de Lesiones por Presión. Métodos: Se trata de un informe de experiencia sobre la construcción e implementación de un panel computarizado para la gestión del protocolo en un hospital universitario privado, en el interior del estado de São Paulo. Resultados: La construcción del panel se dividió en los siguientes pasos: revisión y actualización del protocolo, construcción del modelo electrónico e implementación. La divulgación fue realizada por la Comisión de Prevención de Lesiones por Presión. Conclusión: El panel permitió la visualización rápida y en tiempo real de los riesgos del paciente, las intervenciones propuestas y la efectividad de las medidas de prevención, además de promover la integración y el empoderamiento de los profesionales en la gestión del cuidado. (AU)

Functional outcomes of canalicular laceration repair with self-retaining masterka stent in a tertiary eye care center in France: A retrospective study of 30 patients.

PURPOSE: To evaluate the long-term functional outcomes of canalicular laceration repair using the Masterka® monocanalicular intubation system. METHODS: this interventional case series included the data from 30 patients who underwent canalicular laceration repair with a 30-mm pushed monocanalicular stent (Masterka®) and suturing of the lacerated canaliculus with 8/0 Vicryl interrupted sutures. Operative details and complications were meticulously noted. Stent removal took place as early as 3 months post-surgery, with functional success defined as the absence of epiphora four years after surgery. RESULTS: The average age of patients was 28.5±26.3 years, with 20 out of 30 patients (66.6%) being male. Lower canaliculus involvement was noted in 23 patients (76.6%), while the upper canaliculus was affected in 7 patients (23.4%). On average, patients presented for medical attention within approximately one day of sustaining with injuries, and all underwent successful repairs. Notably, functional success was observed in all 30 cases, constituting a 100% success rate. Stent-related complications were encountered in two patients (6.6%). One patient reported stent removal after an average follow-up period of one month, while the other developed a punctal granuloma one-month post-surgery, which regressed following one month of topical steroid treatment. CONCLUSION: Repairing canalicular lacerations using the self-retaining Masterka® monocanalicular intubation system demonstrated a notable achievement in long-term functional success while presenting minimal complications. To further substantiate these promising results, an interventional study that includes a comparison analysis with other types of intubation methods is warranted.

Comprehensive medication management (CMM): Application of a new pharmaceutical practice in onco-hematology.

The integration of a large number of drugs, such as antineoplastic agents and cancer-related supportive care drugs, into the management of cancer patients exposes them to an increased number of drug-related problems (DRP). Clinical pharmacists contribute to drug management by actively intervening in detected DRP. The aim of this study is to assess the impact of the applying a clinical pharmacist-driven comprehensive medication management (CMM) service to onco-hematology patients. This prospective interventional study was carried out over six-month duration, specifically from November 06, 2022 to April 5, 2023 in the oncology and hematology departments of the EHU Oran. The adherence to treatment was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS). Whereas data related to the patient's general condition and medication history was assessed using the Pharmaceutical Care Network Europe (PCNE) Classification for Drug-Related Problems V9.1. Among the 130 patients included in the study, a total of 879 DRP were identified, with a mean of 6.78 (±1.72) DRP/patient, half of which were related to efficacy (51%). Almost half of our sample (44.6%) did not adhere to their treatment. The most frequent cause of DRP, accounting for (19.9%) of the cases, was the inappropriate administration by a health professional. A total of 875 pharmaceuticals interventions (PI) were proposed, 67.2% of which were focused at the drug level. The PI acceptance rate was 94.1%. The integration of CMM services in onco-hematology played an important role in optimizing dosing regimen and treatment administration methods, as well as preventing iatropathology in the management of cancer patients.

Blockchain en salud: transformando la seguridad y la gestión de datos clínicos / Blockchain in health: Transforming security and clinical data management

Introducción Los avances tecnológicos continúan transformando la sociedad, incluyendo el sector de la salud. La naturaleza descentralizada y verificable de la tecnología blockchain presenta un gran potencial para abordar desafíos actuales en la gestión de datos sanitarios. Discusión Este artículo indaga sobre cómo la adopción generalizada de blockchain se enfrenta a importantes desafíos y barreras que deben abordarse, como la falta de regulación, la complejidad técnica, la salvaguarda de la privacidad y los costos tanto económicos como tecnológicos. La colaboración entre profesionales médicos, tecnólogos y legisladores es esencial para establecer un marco normativo sólido y una capacitación adecuada. Conclusión La tecnología blockchain tiene potencial de revolucionar la gestión de datos en el sector de la salud, mejorando la calidad de la atención médica, empoderando a los usuarios y fomentando la compartición segura de datos. Es necesario un cambio cultural y regulatorio, junto a más evidencia, para concluir sus ventajas frente a las alternativas tecnológicas existentes. (AU)

Introduction Technological advances continue to transform society, including the health sector. The decentralized and verifiable nature of blockchain technology presents great potential for addressing current challenges in healthcare data management. Discussion This article reports on how the generalized adoption of blockchain faces important challenges and barriers that must be addressed, such as the lack of regulation, technical complexity, safeguarding privacy, and economic and technological costs. Collaboration between medical professionals, technologists and legislators is essential to establish a solid regulatory framework and adequate training. Conclusion Blockchain technology has the potential to revolutionize data management in the healthcare sector, improving the quality of medical care, empowering users, and promoting the secure sharing of data, but an important cultural change is needed, along with more evidence, to reveal its advantages in front of the existing technological alternative. (AU)

[Recruitment, selection and retention of health professionals in indirect management and private management entities]. / Captación, selección y retención de profesionales sanitarios en entidades de gestión indirecta y de gestión privada. Informe SESPAS 2024.

The recruitment and retention of professionals in indirectly managed and privately managed health care institutions is governed by a different regulatory framework than in directly managed institutions. That legal framework is the Workers' Statute, which contains its own regulatory elements in terms of bargaining power and general basic conditions, among others. The regulatory framework of the Workers' Statute allows for a broad capacity for management, negotiation and agreement in the field of human resources management, and specifically in the processes of recruitment, selection and retention, but for some years now basic legislation and interventions by public control bodies have been incorporated which have modified this discretionarily for indirect management entities, bringing them closer and closer to the system of administrative management for civil servants/statutory employees, and consequently limiting the capacity for decision making and adaptation typical of business/private management. This article attempts to explain the similarities and differences between the different areas of management and to explore the weaknesses and opportunities of each of them in terms of recruitment, selection, and retention policies, offering a specific reflection on the selection of executives and managers, as well as an analysis and assessment of the retention of professionals in healthcare institutions.

Deductive Care Methodology: Describing and testing modes of care research.

OBJECTIVE: Define the modes of procedure of the Deductive Care Methodology (DCM) in the generation of knowledge about person's health care. METHODOLOGY: Design and test of the DCM modes based on three phases: mapping of the DCM, generation of models from this methodology and testing of the models through studies in a clinical context. RESULTS: The DCM presents five levels of abstraction with three modes broken down to 16 types. The modes are: Philosophical Mode to conceptualize and obtain generalities about reality, Mathematical Mode to operate with generalities, and Physical Mode to operationally verify, validating the results and the predictive capacity of the model. This MDC allows the creation of three models: Knowledge Model about Person Care, an ontology of care, Vulnerability Model about the person and Taxonomic Triangulation Model for knowledge management. All models generate products for computational knowledge management. In addition, the models are applied in teaching and generate research with more than a hundred participations in conferences and journals, of which five impact publications (from 2008 to 2022) classified in the categories of Nursing and Informatics are analysed. CONCLUSIONS: The DCM collects prior knowledge to work with certainties, evidence and applying inferences that do not depend on the number of cases or inductive designs. This research presents a formal structure of the DCM with an interdisciplinary orientation between Health Sciences and Computer Sciences.