[Evolution of the presence of women in decision-making bodies of the Spanish national health system]. / Evolución de la presencia de mujeres en los órganos de decisión del Sistema Nacional de Salud en España.

OBJECTIVE: To examine the presence of women in the organs of the Interterritorial Council of the Spanish National Health System (CISNS). METHOD: Annual reports of the CISNS from 2005 to 2022 were analyzed. Artificial intelligence was used to assign gender, and percentages of women's participation were calculated. Temporal evolution, vertical segregation, and horizontal segregation were analyzed. RESULTS: Between 2005 and 2022, there were 14,308 participations in 85 organs, with 52% women, rising from 42% in 2005 to 61% in 2022. There was a higher participation of women in propositional organs (54%), followed by executive ones (50%), and plenary sessions (40%). The General State Administration had 61% women compared to 48% in autonomous communities. Women's participation varied by topic, being higher (82%) in gender violence and lower (35%) in inspection. CONCLUSIONS: Although there is a slight reduction in the participation gap between women and men, inequalities persist. Women have less presence in higher hierarchical levels (plenary sessions), maintaining vertical segregation. Additionally, women's representation in certain topics remains low, maintaining horizontal segregation. Concrete actions must be taken to continue advancing equality and improving health outcomes in society as a whole.

[Quality of health information in Mexico in the OECD context: 2017-2021]. / Calidad de la información en salud de México en el contexto de la OCDE: 2017-2021.

OBJECTIVE: To evaluate the health information system (HIS) of Mexico according to the information reported to the Organization for Economic Co-operation and Development (OECD). The ultimate goal is to identify the improvements that should be considered. METHOD: Health indicators published by the OECD (2017 to 2021) are analyzed according to 11 thematic groups. Coverage (quantity and type of indicators reported by thematic group) and quality of information were assessed, according to OECD guidelines. RESULTS: Mexico reported annually 14 of 378 indicators (3.7%), and discontinuously 204. In no group were all indicators reported annually, except for the two on COVID-19. Three out of 88 were reported annually on use of services; and none on health status, quality of care and pharmaceutical market. Twelve indicators (5.5% of those reported by Mexico, 3.2% of the full OECD set) had optimal quality and annual reporting. 57.7% of the reported indicators had at least one quality defect. CONCLUSIONS: Within the framework of the standards set by the OECD, of which Mexico is a member, the Mexican HIS presents significant deficits in coverage and quality of information. These results should be considered to implement improvement initiatives.

Comparative study on anthropogenic impacts on soil PAHs: Accumulation and source apportionment in tourist and industrial cities in Hebei Province, China.

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous organic contaminants in urban soils. The accumulation and source identifications of PAHs within a city have been frequently studied. However, impacts of urbanization development modes on PAHs accumulation patterns by taking a city as a whole have been seldom reported. Four cities with two development modes in Hebei province, Chengde and Zhangjiakou (tourist cities) and Handan and Tangshan (industrial cities), were selected. The concentrations of 16 priority PAHs in soils in the study areas were investigated. The results showed that the average concentrations of Σ16PAHs in Handan (2517 µg/kg) and Tangshan (2256 µg/kg) were more than twice of those in Chengde (696 µg/kg) and Zhangjiakou (926 µg/kg) approximately. Lines of evidence, provided by a combination of diagnostic ratios, pairwise correlation, and PMF methods, revealed that the dominant sources of PAHs in either city were industrial emission, vehicle emission, and petrogenic/biogenic process but with different proportions. Linear fittings based on Bayesian kernel machine regression analysis (BKMR) were constructed to illustrate the impact of industrialization on PAHs accumulation. The probability of excessing the 10 % (376 µg/kg) and 50 % (1138 µg/kg) of current ∑16PAHs would be higher than 90 % given the gross industrial production per unit area >5.00 × 106 and 20.5 × 106 CNY/km2, respectively. The proposed threshold values of industrialization are of significance for determining industrial structure and proportion in urban management.

Calidad de la información en salud de México en el contexto de la OCDE: 2017-2021 / Quality of health information in Mexico in the OECD context: 2017-2021

Objetivo Evaluar el sistema de información en salud (SIS) de México según la información reportada a la Organización para la Cooperación y el Desarrollo Económicos (OCDE). El fin último es evidenciar las mejoras que se deberían considerar. Método Se analizan indicadores sobre salud publicados por la OCDE (2017 a 2021) según 11 grupos temáticos. Se valoraron cobertura (cantidad y tipo de indicadores reportados por grupo temático) y calidad de la información, según lineamientos de la OCDE. Resultados México reportó anualmente 14 de 378 indicadores (3,7%) y de forma discontinua 204. En ningún grupo se reportaron anualmente todos los indicadores, excepto los dos sobre COVID-19. Se reportan anualmente tres de 88 sobre utilización de servicios y ninguno sobre estado de salud, calidad de la atención y mercado farmacéutico. Con calidad óptima y reporte anual fueron 12 indicadores (5,5% de los reportados por México, 3,2% del set completo OCDE). El 57,7% de los indicadores reportados tuvieron al menos un defecto de calidad. Conclusiones En el marco de los estándares marcados por la OCDE, de la cual México es miembro, el SIS mexicano presenta déficits importantes de cobertura y de calidad de la información. Estos resultados deberían considerarse para implementar iniciativas de mejora. (AU)

Objective To evaluate the health information system (HIS) of Mexico according to the information reported to the Organization for Economic Co-operation and Development (OECD). The ultimate goal is to identify the improvements that should be considered. Method Health indicators published by the OECD (2017 to 2021) are analyzed according to 11 thematic groups. Coverage (quantity and type of indicators reported by thematic group) and quality of information were assessed, according to OECD guidelines. Results Mexico reported annually 14 of 378 indicators (3.7%), and discontinuously 204. In no group were all indicators reported annually, except for the two on COVID-19. Three out of 88 were reported annually on use of services; and none on health status, quality of care and pharmaceutical market. Twelve indicators (5.5% of those reported by Mexico, 3.2% of the full OECD set) had optimal quality and annual reporting. 57.7% of the reported indicators had at least one quality defect. Conclusions Within the framework of the standards set by the OECD, of which Mexico is a member, the Mexican HIS presents significant deficits in coverage and quality of information. These results should be considered to implement improvement initiatives. (AU)

Manutenção dos serviços de média e alta complexidade em contexto de alta transição de usuários: um estudo ecológico de séries temporais no Estado do Rio de Janeiro, Brasil / Maintenance of medium- and high-complexity health services in the context of high patient transition: a time series ecological study of the state of Rio de Janeiro, Brazil

Resumo O estudo explora as históricas disparidades regionais na distribuição da rede de média e alta complexidade e os limites impostos para a o remanejamento dos tetos de financiamento entre o município do Rio de Janeiro e municípios limítrofes da Região Metropolitana 1. Foi realizado um estudo ecológico com dados referentes à cidade do Rio de Janeiro, escolhido por ter uma grande rede de assistência e limites com territórios vulneráveis e carentes de serviços de saúde, caracterizando um lócus representativo das situações enfrentadas em todo o país. Foi observado um decréscimo dos valores brutos das cotas programadas em todos os municípios do Rio de Janeiro a partir de 2016. A tendência temporal das cotas programadas se manteve estacionária para todos os municípios da Região Metropolitana 1, mesmo com aumentos significativos nas cotas para municípios limítrofes. A resultante sobrecarga no aporte local de recursos impede o aumento da capacidade para antecipar flutuações de demanda, tanto conhecidas quanto inesperadas, comprometendo a responsividade do sistema de saúde no que respeita seu funcionamento regular, bem como a capacidade de ajuste para lidar com eventos extraordinários, características essenciais da resiliência.

Abstract The study addresses the historical disparities in the distribution of the medium- and high-complexity health network and the limits to budget adjustments between the municipality of Rio de Janeiro and its neighboring municipalities of the Metropolitan region 1. An ecological study was conducted with data related to the municipality of Rio de Janeiro, chosen because it has a large assistance network, while located on the borders of vulnerable and underprivileged areas, characterizing a locus that is representative of the situations faced throughout the country. A decrease in the gross values of the programmed quotas in all municipalities of Rio de Janeiro was observed from 2016 onwards. The temporal trend of the programmed quotas remained stable for all municipalities in the Metropolitan Region 1, even with significant increases in the accomplished quotas for neighboring municipalities. The resulting overload in local expenditure prevents the increase of capacity to anticipate fluctuations in demand, both known and unexpected ones, compromising the responsiveness of the health system regarding its regular operation, as well as the ability to adjust to cope with extraordinary events, essential characteristics of resilience.

Legalización del consumo de cannabis recreativo en adultos y problemas de salud mentales / Legalization of recreational cannabis use in adults and mental health problems

Los problemas de salud mental hacen parte de las enfermedades no trasmisibles y se les atribuye, con otras enfermedades asociados al bienestar, hasta un 21 % de las muertes mundiales. Por ello, es necesario analizar y establecer la relación riesgo/beneficio de políticas relacionadas con la salud mental, caso de la legalización del consumo de cannabis recreativo en adultos. El cannabis es la droga “ilícita” de mayor consumo en los países occidentales, en esencia por incrementar la sociabilidad y la euforia. En la última década, varios países han promulgado normas orientadas a legalizar la comercialización de cannabis recreativo en adultos. En este sentido, existe controversia del efecto de este tipo de iniciativas, en el porcentaje de personas que consumen esta sustancia y en la salud de los mismos. Sin embargo, se podría esperar que este tipo de iniciativas favorezca un aumento en el porcentaje de personas que consumen esta sustancia. El aumento del consumo de marihuana puede favorecer una mayor prevalencia de problemas de salud mental, incluyendo psicosis y esquizofrenia. Se acepta la existencia de una asociación entre consumo de cannabis y psicosis (incluyendo esquizofrenia). En este marco, reconociendo los beneficios de las políticas de legalización del consumo de cannabis recreativo en adultos, orientadas a superar el enfoque prohibicionista y a buscar la reducción del daño, es conveniente evaluar y definir el efecto de las mismas. Además, estas iniciativas se deben acompañar de programas informativos y educativos, orientados a sintetizar los riesgos del consumo, incluyendo, la dependencia y problemas de salud mentales. (AU)

Mental health problems are included in the non-communicable diseases and together to other problems associated with well-being, they are attributed up to 21 % of global deaths. Therefore, it is necessary to analyze and establish the risk/benefit ratio of policy related to mental health, for example, in the case of the legalization of recreational cannabis use in adults. Cannabis is the most widely used “illicit” drug in Western countries, essentially because it increases sociability and euphoria. In the last decade, several countries have endorsed policies aimed at legalizing the commercialization of recreational cannabis in adults. In this sense, there is controversy about the effect of this type of policy on the percentage of people who consume this substance and on their health. However, it could be expected that this type of initiative will improve the percentage of people who consume this substance. Increased marijuana use may lead to a higher prevalence of mental health problems, including psychosis and schizophrenia. The existence of an association between cannabis use and psychosis (including schizophrenia) is accepted. In this framework, recognizing the benefits of policies to legalize the use of recreational cannabis in adults, advancing from a drug prohibition approach to one focused on harm reduction, it is convenient to evaluate and define the effect of this type of policies. Also, this kind of policies should be linked to informative and educational programs to clarify the risks of consumption, including, dependence and mental health problems. (AU)

Descripción de actividad asistencial en las Unidades de Hospitalización a Domicilio de Osakidetza – Servicio Vasco de Salud / Description of care activity in the Hospital at Home Units of Osakidetza - Servicio Vasco de Salud (Basque Health Service)

Introducción: Las Unidades de Hospitalización a Domicilio (HaD) presentan diferencias en su contenido y condiciones de asistencia. La Sociedad Vasca de HaD inició en 2018 un proyecto de investigación para definir indicadores que permitan comparar la actividad de equipos que tienen contenidos asistenciales diferentes. Una fase del proyecto implicó el registro de características de los episodios atendidos y la atención prestada. Dar a conocer el resultado del registro es de interés.Método: Entre 1 y 31 de mayo de 2021, 9 Uni-dades registraron ciertas características de los pacientes atendidos, así como tipo, frecuencia y duración de las visitas realizadas. Se muestran los descriptivos de estas variables en la serie global y en cada Unidad.Resultados: Se analizaron 1171 episodios y 8363 visitas en 14458 estancias. (82% de es-tancias reales). De media, en laborable se vi-sitó al 65% de los pacientes y en no laborable al 42%. El porcentaje de casos en cada tipo clínico varió según Unidades: patología aguda entre 12 y 48%; cuidados paliativos entre 20% y 40%; patología quirúrgica entre 2.3 y 30 %. Se apreciaron también diferencias en edad, sexo y dispersión geográfica. Mortalidad y reenvío al hospital variaron entre Unidades y también entre patologías. La duración de la atención direc-ta varió entre Unidades entre 24,4 y 35.9 min, y la del desplazamiento para cada visita entre 11.9 y 25 min, en probable relación con el tipo de patología y la dispersión geográfica respectivamente.Conclusiones: Se constata que existen diferencias en el contenido y condiciones de trabajo de las distintas Unidades de H a D. Es necesario analizar cómo influyen en las medidas de actividad y de resultado para disponer de indicadores ajustados. (AU)

Introduction: Hospitalization at Home (HaH) Units present differences in their content and conditions of care. The Basque HaH Society initiated a research project in 2018 to define useful indicators to compare the activity of teams with different care content. One phase of the project involved recording characteristics of episodes attended and care provided. It is of interest to disclose the results of the registry. Method: Between May 1 and May 31, 2021, 9 Units recorded certain characteristics of the patients seen, as well as type, frequency and duration of visits performed. Descriptive data on these variables are shown for the overall series and for each unit. Results: 1171 episodes and 8363 visits in 14458 stays were analysed (82% of actual stays). On average, 65% of patients received a visit during working days and 42% during non-working days. The percentage of cases in each clinical type varied according to Units: acute pathology between 12 and 48%; palliative care between 20% and 40%; surgical pathology between 2.3 and 30%. There were also differences in age, sex and geographical dispersion. Mortality and hospital referral varied between Units and also between pathologies. The duration of direct care varied between Units from 24.4 to 35.9 min, and the duration of travel for each visit from 11.9 to 25 min, probably related to the type of pathology and geographical dispersion, respectively. Conclusions: There are indeed differences in the content and working conditions of the different HaH Units. It is necessary to analyse how much they influence the activity and outcome measures in order to have adjusted indicators. (AU)

Effects of perceived physical and aesthetic quality of urban blue spaces on user preferences-A case study of three urban blue spaces in Japan.

Blue spaces, especially as important urban natural environments, provide various benefits. Despite the increasing number of relevant papers, most recent studies have focused on the association between blue space environmental quality and health, with limited research assessing the environmental quality and user preferences of urban blue spaces. This study establishes a relationship between preference and environmental quality by investigating visitors' perception of the environmental quality of urban blue spaces (physical and aesthetic). For this purpose, 296 questionnaires were collected from three urban blue spaces and a multiple linear regression analysis was executed. Model results indicated that six of nine environmental quality components had a significant effect on preference scores, with "harmony" demonstrating the highest and "visual spaciousness & diversity" the lowest effect. The current study shown that two scales provided were used to measure users' perceived levels of the physical and aesthetic quality of the Urban Blue Spaces were acceptable. These results can help in the effective use of these natural capitals in cities and provide guidance for the environmental design of blue spaces.

Users' preferences and perceptions towards urban green spaces in rapidly urbanized cities: The case of Debre Berhan and Debre Markos, Ethiopia.

Urban green spaces are essential elements of cities that play an important role in urban sustainability and human health. This study analyzed the users' preferences and perceptions towards urban green spaces. A total of five parks were purposively selected from Debre Berhan and Debre Markos cities. A questionnaire survey was administered to 350 park users in both cities. Data were analyzed with descriptive statistics, and the independence of variables was tested using a chi-square test using IBM SPSS 20. The chi2 test shows that visits' purpose depended on the users' age, gender, and education level (P < 0.05). 26.1% and 13.8% of the users visit the parks "always" to chill with friends and to enjoy nature, respectively. The existence of fences, safety and security, and spaciousness of the park were the major encouraging factors, with the average Likert value of 3.04, 3.01, and 2.72, respectively. Alcoholic drinks and chewing Khat (stimulant green leafy plant) within the parks, lack of comfortable sitting areas, absence of safety and security, and improper park management were the main discouraging factors. There was a very strong statistical association between perceptions of users to the benefits of green spaces and occupation (χ2 (95, N = 350) = 158.908, p < 0.001), age (χ2 (76, N = 350) = 175.135, p < 0.001), gender (χ2 (19, N = 350) = 68.226, p < 0.001), and education level (χ2 (114, N = 350) = 240.798, p < 0.001). The "highly" perceived benefits of green spaces were recreational, aesthetic, and pollution protection. 50% of the respondents "never" participated in any green space development activities. Therefore, rapidly urbanized cities in Africa and Asia could take a lesson from this study about the importance of incorporating citizens' preferences for green spaces and public participation in urban green space development and management.

No-free-lunch-theorem: a page taken from the computational intelligence for water resources planning and management.

The long pursuit to alleviate the global water crisis has been riddled with revolutionary decision-making paradigms, forward-thinking theoretical concepts, and even ground-breaking technologies. This journey, however, is centered around the expectation of discovering what could be seen as the ultimate solution to all water-related problems. These nuances, revolutionary ideas, and cutting-edge technologies raise an ostensibly simple but fundamentally crucial question: Is there or can there ever be a singular universal ideal solution to address the water resources crisis that can potentially ensure the ideas of the sustainable development paradigm? This paper tends to take inspiration from the well-established no-free-lunch theorem (NFLT) to refute the possibility of such a solution in the context of water resources management. Such an interpretation also emphasizes that any remedy intended to address water resources issues must be tailored to the particular circumstances of each case. However, it should be noted that these findings are not intended to undermine the importance of current approaches but rather to emphasize how these concepts or technologies should be used as an inspiration to curate an ad hoc version of the said solution that can reflect local requirements or constraints.

Wetland Park Planning and Management Based on the Valuation of Ecosystem Services: A Case Study of the Tieling Lotus Lake National Wetland Park (LLNWP), China.

The valuation of wetland ecosystem services and the construction of environmental landscapes are generally recognized as contributing to the sustainable development of human wellbeing. The valuation of ecosystem services plays an important role in planning for the recovery of degraded wetlands and in urban wetland park management; however, the role of the valuation of ecosystem services is always ignored. To bring more intuitive awareness to the importance of the ecological functions of wetlands and to rationally plan wetland parks, the Lotus Lake National Wetland Park (LLNWP), an urban wetland park in Northeast China, was selected as the study area. We referred to the millennium ecosystem assessment (MA) method and calculated the valuation of this park using the market value, benefit transfer, shadow engineering, carbon tax, and travel cost. ArcGIS was used for remote sensing interpretation. The research results were as follows. LLNWP was classified under seven types of land-use. The functions of the ecosystem services included provisioning, regulating, supporting, and cultural services, and their total value in LLNWP was 11.68×108 CNY. Regarding the per-unit area value of the ecological service functions of different land types, it was found that forest swamp > herbaceous swamp > artificial wetland > permanent river > floodplain wetland. Combined with the characteristics of the functions of its ecosystem's services, LLNWP was divided into ecological and socio-cultural functions. Then, according to the main service functions of the different land types, we propose that the space in LLNWP can be reused, and proposal planning and management suggestions can be made with the aim of preserving the basic functions.

Safety and prevention of sports injuries in popular ice and snow sports / Segurança e prevenção de lesões esportivas em esportes populares no gelo e neve / Seguridad y prevención de lesiones deportivas en los deportes populares de hielo y nieve

ABSTRACT Introduction: Following the development of ice and snow sports tourism projects, the hidden dangers of early extensive construction have gradually emerged. It mainly manifests itself in the sports safety of ice and snow sports tourism projects. Objective: Explore the management strategy of sports safety under the snow and ice sports tourism landscape. Methods: Literature research, interviews, and questionnaires were used to analyze the development in the study area of ice and snow tourism, the tourists themselves, and regional site construction. Finally, the paper analyzes strategies to improve sports safety management in related areas from the landscape manager's point of view. Results: The development of snow and ice sports tourism projects in the study area is satisfactory; however, due to the epidemic's impact, the current situation is relatively low, showing a trend of slow improvement. In terms of sports injury risk, after optimal training and safety management, the proportion of climatic characteristics of the site was 24.81%; the proportion of the population on the ski slopes was 40.92%; the proportion of equipment cleaning and maintenance was 59.23%; the degree of congestion on the ski slopes was 41.30%; the proportion of public safety was 34.42%; the proportion of basic emergency medical treatment was 32.30%; epidemics and other infectious diseases accounted for 83.13% of the total. Follow-up is done before the start, in the process, and after the occurrence of multiple managements. Conclusion: The safety management strategy of snow and ice sports tourism combines the factors of tourists and managers, and has great practical significance, so it is worthy of promotion. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Com o desenvolvimento de projetos de turismo esportivo no gelo e na neve, os perigos ocultos da construção extensiva precoce têm surgido gradualmente. Ele se manifesta principalmente na segurança esportiva de projetos de turismo de esportes de gelo e neve. Objetivo: Explorar a estratégia de gestão da segurança esportiva sob o panorama do turismo esportivo de neve e gelo. Métodos: Pesquisa bibliográfica, entrevistas e questionários foram usados para analisar o desenvolvimento na área de estudo do turismo de gelo e neve, e dos próprios turistas bem como a construção de locais regionais. Finalmente, do ponto de vista do gerente de paisagens, o trabalho analisa as estratégias para melhorar a gestão da segurança esportiva em áreas relacionadas. Resultados: O desenvolvimento de projetos de turismo esportivo de neve e gelo na área de estudo é satisfatório, porém, devido ao impacto da epidemia, a situação atual é relativamente reduzida, mostrando uma tendência de lenta melhoria. Em termos de risco de lesões esportivas, após treinamento otimizado e gerenciamento da segurança, a proporção de características climáticas do local foi de 24,81%; a proporção de população nas pistas de esqui foi de 40,92%; a proporção de limpeza e manutenção dos equipamentos foi de 59,23%; o grau de congestionamento das pistas de esqui foi de 41,30%; a proporção de segurança pública foi de 34,42%; a proporção de tratamento médico básico de emergência foi de 32,30%; epidemias e outras doenças infecciosas representaram 83,13% do total. O acompanhamento é feito antes do início, no processo, e após a ocorrência de múltiplas gestões. Conclusão: A estratégia de gerenciamento de segurança do turismo esportivo de neve e gelo combina os fatores de turistas e gerentes, e tem grande significado prático, por isso é digna de promoção. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Con el desarrollo de los proyectos turísticos de deportes de hielo y nieve, han ido apareciendo gradualmente los peligros ocultos de la construcción extensiva temprana. Se manifiesta principalmente en la seguridad deportiva de los proyectos turísticos de deportes de hielo y nieve. Objetivo: Explorar la estrategia de gestión de la seguridad deportiva en el marco del paisaje turístico de los deportes de nieve y hielo. Métodos: Se utilizó la investigación bibliográfica, entrevistas y cuestionarios para analizar el desarrollo en la zona de estudio del turismo de hielo y nieve, y a los propios turistas, así como la construcción de emplazamientos regionales. Por último, desde el punto de vista del gestor del paisaje, se analizan estrategias para mejorar la gestión de la seguridad deportiva en ámbitos afines. Resultados: El desarrollo de proyectos de turismo deportivo de nieve y hielo en la zona de estudio es satisfactorio, sin embargo, debido al impacto de la epidemia, la situación actual es relativamente baja, mostrando una tendencia de lenta mejora. En cuanto al riesgo de lesiones deportivas, tras optimizar la formación y la gestión de la seguridad, la proporción de características climáticas del lugar fue del 24,81%; la proporción de población en las pistas de esquí fue del 40,92%; la proporción de limpieza y mantenimiento del equipo fue del 59,23%; el grado de congestión de las pistas de esquí fue del 41,30%; la proporción de seguridad pública fue del 34,42%; la proporción de tratamiento médico básico de urgencia fue del 32,30%; las epidemias y otras enfermedades infecciosas representaron el 83,13% del total. El seguimiento se realiza antes del inicio, en el proceso y después de que se produzcan múltiples gestiones. Conclusión: La estrategia de gestión de la seguridad del turismo deportivo de nieve y hielo combina los factores de los turistas y los gestores, y tiene una gran importancia práctica, por lo que merece ser promovida. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Regionalização da saúde no Rio Grande do Sul: olhar dos gestores estaduais / Health regionalization in Rio Grande do Sul, Brazil: view of state managers

Resumo Este artigo teve como objetivo analisar, através da perspectiva dos gestores estaduais, como ocorreu a implementação do processo da regionalização da saúde no Rio Grande do Sul, a partir dos anos 2000. Trata-se de um estudo qualitativo descritivo, desenvolvido na Secretaria da Saúde do Estado do Rio Grande do Sul. As informações foram obtidas através de dez entrevistas semiestruturadas. Para a interpretação dos dados levantados, utilizou-se análise de conteúdo, modalidade temática. Como resultados, destacaram-se a melhoria na qualidade da atenção à saúde, o progresso na organização do sistema de saúde do estado, a mudança na função da gestão estadual, o desenvolvimento da tecnologia e o reconhecimento das instâncias de pactuação para a tomada de decisão. Identificou-se que a governança regional foi dificultada pela fragmentação do sistema e a histórica insuficiência de planejamento. Concluiu-se que se faz necessário implementar uma cultura de gestão estratégica, amparada pela alocação adequada de recursos e qualificação da governança nas regiões de saúde.

Abstract This article aims to analyze, from the perspective of state administrators, the implementation of the health regionalization process in Rio Grande do Sul, beginning in the 2000s. This is a qualitative-descriptive study, conducted in the State Health Department. We obtained information from ten semi-structured interviews with state administrators from the central level. We interpreted the data using content analysis, thematic method. As results, we highlight the improvement in healthcare quality, the progress in the organization of the state's health system, the change in the role of the state administration, the development of the technology and the acknowledgment of pact-making spaces for decision-making. We note that the system's fragmentation and the historical planning insufficiency hamper regional governance. In conclusion, implementing a culture of strategic management is necessary, with the backing of adequate resource allocation and enhancement of governance in the health regions.

Abordagem de narrativas como método de pesquisa em saúde pública: aproximações conceituais e contribuições da psicanálise / Narrative research in public health: conceptual approximations and contributions from psychoanalysis / Enfoque en narrativas como método de investigación en salud pública: aproximaciones conceptuales y aportaciones del psicoanálisis

Este artigo refere-se à parte de uma pesquisa de doutorado, realizada em hospital de alta complexidade do Sistema Único de Saúde, cujos participantes são os profissionais de saúde. O objetivo deste artigo é analisar o potencial da abordagem das narrativas como método de pesquisa e intervenção nos serviços de saúde, traçando aproximações com a teoria psicanalítica. Sua relevância no campo da Saúde Pública está calcada no reconhecimento do papel do sujeito como agente de mudanças. O texto divide-se em duas partes: na primeira, explora as especificidades do trabalho na área da saúde, o paradigma da saúde pública no que concerne à gestão e possíveis contribuições da clínica ampliada para esse modelo. Na segunda parte, analisa o uso das narrativas como método de pesquisa nesse campo e as aproximações conceituais entre a narrativa em Walter Benjamin e a psicanálise em Freud. Busca na literatura referências sobre experiências análogas que fundamentem a proposta ora realizada e conclui pela importância de, no momento atual, apostar na força germinativa das narrativas como fonte criativa de novas formas de cuidar.(AU)

This article derives from a PhD research conducted with health professionals at a high-complexity public hospital from the Brazilian Unified Health System (SUS). It analyzes the potential of the narrative as a research and intervention method in health services, outlining approximations with psychoanalysis. In the field of Public Health, the narrative approach acknowledges the individual as an agent of change. The text is divided into two parts. The first presents an overview of the peculiarities involved in healthcare, the Public Health paradigm regarding service management and possible contributions from the expanded clinic to this model. The second analyzes the use of narratives as a research method in this field and the conceptual approximations between Benjamin's narrative and Freud's psychoanalysis. It searches the literature for references on similar experiences to support the present proposal and concludes by highlighting the importance of betting on the creative power of narratives as a source for new ways to care.(AU)

Este artículo es parte de una investigación doctoral, realizada con los profesionales de la salud de un hospital de alta complejidad del Sistema Único de Salud de Brasil. Su propósito es analizar el potencial del enfoque en narrativas como método de investigación e intervención en los servicios de salud, esbozando aproximaciones entre las narrativas y la teoría del psicoanálisis. Su relevancia en el campo de la salud pública se basa en el reconocimiento del rol del sujeto como agente de cambio. El texto se divide en dos partes: La primera investiga las especificidades del trabajo en el área de la salud, el paradigma de la salud pública en la gestión de los servicios y las posibles contribuciones de la clínica ampliada a este modelo. En la segunda parte, analiza el uso de narrativas como método de investigación en este campo y las aproximaciones conceptuales entre la narrativa de Walter Benjamin y el psicoanálisis de Freud. Este estudio busca en la literatura referencias sobre experiencias similares que apoyen la propuesta ahora realizada y concluye con la importancia de, en el momento actual, apostar por el poder de las narrativas como fuente creadora de nuevas formas de cuidar.(AU)

Integrated water quality modeling in a river-reservoir system to support watershed management.

Water resources planning and management are dependable on an adequate integration of physical, chemical, biological, and socio-economic realities of multiple water users. The dynamic of water quantity and quality in rivers are affected by several conditions, such as land use, soil characteristics, and meteorological and hydrological processes. Among these, the presence of hydraulic structures, such as dams and reservoirs, are often responsible for hydrodynamic and geomorphological alterations, leading to impacts on water quality and ecological behavior. In this context, this study presents the combination of a solution of the one-dimensional flow and transport and fate of contaminants in rivers (SihQual model) with a continuously stirred tank reactor (CSTR) to represent the reservoir. The first model solves the hydrodynamic and water quality equations under unsteady state, while the second approach considers the reservoir as a complete mixed system with inputs that vary over time. The main goal is to provide an integrated analysis for planning and management in a watershed where water has multiple purposes of use. The case study is the Iguaçu watershed, where the main river is affected by several dams for hydroelectric power generation. The simulation covers 542 km of the Iguaçu River and the Foz do Areia reservoir (flooded area of 139.5 km2), using data from 12 monitoring stations. The region also has issues of water quality impairment and water scarcity events due to deforestation, and urban and agricultural activities, exemplifying challenges throughout the world. Results show that the integrated models can reproduce the expected variability in different systems, although calibration challenges arise in multiscale modeling. The data indicate that, overall, the lentic environment is able to deplete organic matter and phosphorus, in comparison to levels in the fluvial flow. Nonetheless, experiments show that the river-reservoir system may be highly sensible to external and internal changes, such as water availability throughout time and pollution from the main tributary, as well as outlet discharges and transformation processes in the water column, leading to a possibility of critical events. Therefore, the study highlights how planning and managing actions in the watershed can benefit from an integrated river-reservoir analysis.

Implementation and evaluation of a preceptor educational development programme involving the health cluster colleges at Qatar University.

BACKGROUND: 'The Practice Educators' Academy Programme' is an innovative educational intervention developed following a preceptor-focussed needs assessment. The primary aim of this study was to evaluate the programme's effect on self-efficacy and knowledge amongst multi-disciplinary clinical preceptors who precept students across the Health Cluster in Qatar University. The secondary aim was to assess the preceptors' satisfaction with the programme's comprehensiveness, appropriateness, and relevance. METHODS: This is a longitudinal study, with the same participants followed at different time points (i.e., pretest-posttest interventional design). The sample size was calculated to represent 10% of the sample expected for the main study, utilising a stratified convenience sampling technique. Preceptor self-efficacy was assessed using the Preceptor Self-Efficacy Questionnaire, a validated 21-item questionnaire. Preceptor knowledge was assessed through a 25-item multiple-choice question test. Satisfaction with programme content and delivery was assessed through a 14-item questionnaire with open comments. RESULTS: Thirty pretest-posttest respondents for the PSEQ assessment, and 26 pretest-posttest respondents for the knowledge assessment were appropriately matched and analysed. Participation in the self-efficacy questionnaire resulted in a statistically significant increase in their posttest median score (pretest-to-posttest: 3.3-to-3.6, p = 0.001). Participation in the knowledge assessment resulted in a statistically significant increased posttest mean score (pretest-to-posttest: 10.2-to-15.7, p < 0.001). Participants indicated high levels of satisfaction with the programme (average score = 4.42/5). CONCLUSIONS: Our findings suggest the programme is effective as demonstrated through a significant improvement in preceptors' self-efficacy and knowledge. Recommendations for future iterations include placing greater focus on active learning strategies, and inter-disciplinary interactions.

A landscape-scale framework to identify refugia from multiple stressors.

From a conservation perspective, quantifying potential refugial capacity has been predominantly focused on climate refugia, which is critical for maintaining the persistence of species and ecosystems. However, protection from other stressors, such as human-induced changes in fire and hydrology, that cause habitat loss, degradation, and fragmentation is also necessary to ensure that conservation efforts focused on climate are not undermined by other threats. Thus, conceptual and methodological advances for quantifying potential refugia from multiple anthropogenic stressors are important to support conservation efforts. We devised a new conceptual approach, the domains of refugia, for assessing refugial capacity that identifies areas where exposure to multiple stressors is low. In our framework, patterns of environmental variability (e.g., increased frequency of warm summers), thresholds of resilience, and extent and intensity of stressors are used to identify areas of potential refugia from a suite of ongoing anthropogenic stressors (e.g., changes in fire regime). To demonstrate its utility, we applied the framework to a Southern California landscape. Sites with high refugial capacity (super-refugia sites) had on average 30% fewer extremely warm summers, 20% fewer fire events, 10% less exposure to altered river channels and riparian areas, and 50% fewer recreational trails than the surrounding landscape. Our results suggest that super-refugia sites (∼8200 km2 ) for some natural communities are underrepresented in the existing protected area network, a finding that can inform efforts to expand protected areas. Our case study highlights how considering exposure to multiple stressors can inform planning and practice to conserve biodiversity in a changing world.

Marco Conceptual a para Identificar Refugios de Múltiples Amenazas a Escala de Paisaje Resumen Desde la perspectiva de la conservación, la cuantificación de la capacidad potencial de refugio se ha enfocado principalmente en los refugios climáticos, los cuales son críticos para mantener la persistencia de las especies y los ecosistemas. Sin embargo, la protección ante otros factores estresantes, como los cambios inducidos por los humanos en los incendios y la hidrología, que causan la pérdida, degradación y fragmentación del hábitat, también son necesarios para asegurar que los esfuerzos de conservación enfocados en el clima no sean afectados por otras amenazas. Por lo tanto, los avances conceptuales y metodológicos para cuantificar los refugios potenciales ante múltiples factores estresantes causados por el humano son importantes para asegurar que los esfuerzos de conservación logren sus objetivos. Diseñamos una nueva estrategia conceptual, los dominios de los refugios, para evaluar la capacidad de refugio de un paisaje donde la exposición a múltiples factores estresantes es baja. En nuestro marco conceptual usamos los patrones de variabilidad ambiental (p. ej.: incremento en la frecuencia de veranos cálidos), los umbrales de resiliencia y la extensión e intensidad de los factores estresantes para identificar las áreas de refugios potenciales a partir de un conjunto de factores antropogénicos persistentes (p. ej.: cambios en el régimen de incendios). Para demostrar su utilidad, aplicamos el marco conceptual a un paisaje del sur de California. Los sitios con una alta capacidad de refugio (sitios de súper-refugios) tuvieron en promedio un 30% menos veranos extremadamente cálidos, 20% menos eventos de incendios y 50% menos senderos recreativos que el paisaje circundante. Nuestros resultados sugieren que los sitios de súper-refugios (∼ 8,200 km2 ) para algunas comunidades naturales están subrepresentados en la red existente de áreas protegidas, un resultado que puede orientar los esfuerzos por expandir las áreas protegidas. Nuestro estudio de caso resalta que considerar la exposición a múltiples amenazas puede guiar la planificación y la práctica de la conservación de la biodiversidad en un mundo cambiante.

Convergências entre planejamento de atenção primária à saúde e os Objetivos de Desenvolvimento Sustentável: uma avaliação de planos municipais de saúde do Brasil e Chile / Convergences between primary health care planning and the Sustainable Development Goals: an evaluation of municipal health plans in Brazil and Chile

Resumo O objetivo deste estudo é explorar a importância da Atenção Primária à Saúde (APS) para a consecução dos Objetivos de Desenvolvimento Sustentável (ODS), avaliando as convergências entre duas agendas municipais de APS e a Agenda global 2030. Para tanto, utilizou-se a técnica de análise de conteúdo nas ações de APS previstas nos planos municipais de saúde dos municípios de Santiago do Chile e São Paulo, Brasil. A análise de conteúdo de ambos os planos mostrou que as ações previstas pela APS de Santiago contribuíam com 14 ODS, enquanto em São Paulo foram identificadas ações que contribuíam com a totalidade da Agenda 2030, ainda quando em ambos os planos houve algumas faltas de referência aos ODS. Conclui-se que as ações previstas pela APS em um nível municipal demostram ser essenciais à consecução dos ODS. Porém, esta relação não é informada adequadamente, o que pode comprometer a injeção de maiores incentivos neste setor. Logo, se requer maior alinhamento dos planos e políticas locais, nacionais e globais de ação, uma formação integrada e continuada nas comunidades e para as equipes de saúde, e maior uso e difusão de tecnologias já disponibilizadas em abordagem territorial e intersetorial dos planos municipais de saúde.

Abstract This study addresses the importance of Primary Health Care (PHC) to achieve the Sustainable Development Goals (SDGs), assessing convergences between two municipal PHC agendas and the 2030 Global Agenda. For this purpose, the PHC actions included in the municipal health plans of Santiago, Chile, and São Paulo, Brazil, were evaluated by content analysis. Results showed that the PHC actions planned in Santiago contributed to 14 SDGs while in São Paulo, the actions contributed to the entire 2030 Agenda, although both plans lacked references to the SDGs. Thus, the PHC actions provided in municipal agendas are essential to achieve the SDGs. However, this relationship is not adequately reported, which can compromise the investment of greater resources in this sector. Therefore, a greater alignment between local, national, and global action plans and policies is required, as well as integrated and continuous training for communities and health teams and a greater use and diffusion of technologies already available in regional and intersectoral approaches to municipal health plans.

A Cost Analysis of Cardiac Magnetic Resonance Imaging in the Diagnostic Pathway of Patients Presenting With Unexplained Acute Myocardial Injury and Culprit-Free Coronary Angiography.

Aims: To determine financial implications of implementing cardiac magnetic resonance imaging (CMR) in the diagnostic pathway of a population with unexplained acute myocardial injury and normal coronary angiography. Methods and Results: We performed a focused cost-benefit analysis using a hypothetical population of 2,000 patients with unexplained acute myocardial injury and normal coronary angiography divided into two groups to receive either standard or CMR guided management over a 10-year period. As healthcare practice and costs considerably vary geographically and over time, an algorithm with 15 key variables was developed to permit user-defined calculations of cost-benefit and other analyses. Using current UK costs, routine use of CMR increases healthcare spending by 14% per patient in the first year. After 7 years, CMR guided practice is cost neutral, reducing cost by 3% per patient 10 years following presentation. In addition, CMR -guided therapy results in 7 fewer myocardial infarctions and 14 fewer major bleeding events per 1,000 patients over a 10-year period. The three most sensitive variables were, in decreasing order, the cost of CMR, the cost of ticagrelor and the percentage of the population with MI requiring DAPT. Conclusion: Routine use of CMR in patients with unexplained acute myocardial injury and normal coronary angiography is associated with cost reductions in the medium to long term. The initial higher cost of CMR is offset over time and delivers a more personalized and higher quality of care.

The impact of coronavirus disease 2019 pandemic on working dynamics of junior and middle grade doctors in the United Kingdom: Learning from their experience requires immediate improvement in health care planning and management-An outcome analysis of a nationwide survey.

OBJECTIVES: Severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) pandemic had an unprecedented impact on health services across the world resulting in increased demand of intensive care capacity, opening Nightingale hospitals, and mass movement of doctors across various specialities. This unplanned redeployment raised concerns among various health care workers. The objective of the current study is to explore working dynamics and experience of junior and middle grade doctors during current pandemic. METHODS: We organised a nationwide cross-sectional survey of junior and middle grade doctors working in the United Kingdom. The survey was aimed to study their level of participation during coronavirus disease 2019 pandemic and its impact on their clinical practices and well-being. RESULTS: In total, 1564 completed questionnaires with representations from all regions of the United Kingdom were included. The mean age of respondents was 30.64 years (95% confidence interval +1.025; standard deviation = 9.9057). There were 51.5% females with significantly more participants from Black, Asian, and minority ethnic group (n = 835, p = 0.0073); 963 (61.6%, p ⩽ 0.0001) doctors were redeployed outside their primary speciality. The major redeployments were from other specialities to Intensive Therapy Units (41.8%, p ⩽ 0.001); 63.3% of respondents spend more than 8 weeks in redeployed speciality (p ⩽ 0.0001). There was a significant impact of coronavirus disease 2019 on personal, mental, and physical well-being of doctors. The major areas requiring immediate attention include proper leadership and clinical support (64.1%), pre-redeployment planning and induction (48.5%), redeployment according to the skills and/or in familiar specialities (44.6%), and regular mental and physical well-being checks (37%). CONCLUSION: The outcome of the survey concluded with four major recommendations, including the need to have a named supervisor for these doctors, structured induction program, regular well-being checks, and involving them in crisis planning. These recommendations will help to shape future health care policies and management particularly when it is related to redeployment of doctors during any crisis or pandemic.