Oral health approach in universal health coverage.

OBJECTIVE: This study aimed to map how oral health is addressed within the universal health coverage (UHC). METHODS: This scoping review followed the Joanna Briggs Institute methodology. Searches included the WHO Library and PubMed, Scopus, Embase, LILACS, and Cochrane databases. Quantitative and qualitative studies were included without publication date and language restrictions. RESULTS: A total of 486 studies were retrieved, of which 292 were excluded in the title and abstract screening phase; 121 full-texts were assessed. After the removal of duplicates and unavailable documents, 50 studies were included in the review and categorized according to the level of scientific evidence. CONCLUSION: Few studies discussed oral health within the UHC, mostly because this coverage does not include oral health adequately. When offered, oral health packages are limited and include specific populations. Access and use of oral health services remain guided by economic factors, exposing the theoretical financial protectionism that perpetuates health inequalities.

Advancements in reperfusion rates and quality of care for ST-segment elevation myocardial infarction: a ten-year evaluation of Salvador's STEMI network.

Background: Continuous investment and systematic evaluation of program accomplishments are required to achieve excellence in ST-segment elevation myocardial infarction (STEMI) care, especially in resource-limited settings. Therefore, this study evaluates the impact of problem-driven interventions on reperfusion use rate in a long-term operating STEMI network from a low- to middle-income country. Methods: This is a healthcare improvement evaluation study of Salvador's public STEMI network in a quasi-experimental design, comparing data from 2009 to 2010 (pre-intervention) and 2019-2020 (post-intervention). There were evaluated all confirmed STEMI cases assisted in both periods. The interventions, implemented since 2017, included: expanding the support team, defining criteria to be a spoke, and initiating continuous education activities. The primary outcome was the rate of patients undergoing reperfusion, with secondary outcomes being time from door-to-ECG (D2E) and ECG-to-STEMI-team trigger (E2T). Results: Over ten years, the network's coverage increased by 300,000 individuals, and expanded by 1,800 km2. A total of 885 records were analyzed, 287 in the pre-intervention group (182 men [63·4%]; mean [SD] age 62·1 [12·5] years) and 598 in the post-intervention group (356 men [59·5%]; mean [SD] age 61.9 [11·8] years). It was noticed a substantial increase in reperfusion delivery rate (90 [31%] vs. 431 [73%]; P = 001) and reductions in time from D2E (159 [83-340] vs. 29 [15-63], P = 001), and E2T (31 [21-44] vs. 16 [6-40], P = 001). Conclusion: The strategies adopted by Salvador's STEMI network were associated with significant improvements in the rate of patients undergoing reperfusion and in D2E and E2T. However, the mortality rate remains high.

Litigation in access to universal health coverage for children and adolescents in Brazil.

Background: Brazil's Unified Health System (SUS) ensures universal, equitable, and excellent quality health coverage for all. The broad right to health, supported by the Constitution, has led to excessive litigation in the public sector. This has negatively impacted the financial stability of SUS, created inequality in children and adolescents' access to healthcare, and affected communication between the healthcare system and the judiciary. The enactment of Law Number 13.655 on 25 April 2018, proposed significant changes in judicial decisions. This study aimed to investigate decision-making changes in health litigation involving children and adolescents following the implementation of the new normative model. Methods: The study is cross-sectional, analyzing 3753 national judgment documents from all State Courts of Brazil, available on their respective websites from 2014 to 2020. It compares regional legal decisions before and after the promulgation of Law Number 13.655/2018. Data tabulation, statistical analysis, textual analysis, coding, and counting of significant units in the collected documents were performed. The results of data cross-referencing are presented in tables and diagrams. Results: The majority (96.86%) of legal claims (3635 cases) received partial or total provision of what was prescribed by the physician. The Judiciary predominantly handled these cases individually. The analysis indicates that the decisions made did not adhere to the norms established in 2018. Conclusion: Regional heterogeneity in health litigation was observed, and there was no significant variability in decisions during the studied period, even after the implementation of the new normative paradigm in 2018. Technical-scientific support was undervalued by the magistrates. Prioritizing litigants undermines equity in access to Universal Health Coverage for children and adolescents.

Expansion of national surgical, obstetric, and anaesthesia plans in Latin America: can Brazil be next?

On the sidelines of the 75th Session of the Regional Committee of the World Health Organization for the Americas, the Republic of Ecuador hosted an event to expand on National Surgical, Obstetric, and Anaesthesia Plans (NSOAPs). NSOAPs are policy frameworks that offer governments a pathway to incorporate surgical planning into their overall health strategies. In Latin America, Ecuador became the first country to lead the development of an NSOAP and is fostering regional efforts for other Latin American countries to have sustainable surgical strengthening plans. Brazil is a prominent candidate for enrolling in an NSOAP process to enhance its public health system's functionality. An NSOAP in Brazil can help mitigate social disparities, promote greater efficiency in allocating existing resources, and optimise public health system financing. This process can also encourage the creation of resources and distinct NSOAP vocabulary in Portuguese to facilitate the development of NSOAPs in other Portuguese-speaking and low- and middle-income countries. In this viewpoint, we explore why an NSOAP can benefit Brazil's surgical system, national features that enable surgical policymaking, and how multiple stakeholder engagement can contribute to the country's planning, validation, and implementation of an NSOAP.

High Uptake of Respiratory Syncitial Virus Prevention for Neonates in a Military Treatment Facility.

We investigated the uptake of nirsevimab for infants and the bivalent respiratory syncytial virus prefusion F (RSVPreF) vaccine for pregnant persons as measures for RSV prevention during an infant's birth hospitalization in a military treatment facility. We found >85% uptake between October 2023 to February 2024. These data may aid health systems plan for future RSV seasons.

The Legacy of President Lázaro Cárdenas for Health Care Reform in Today's Mexico.

Mexican President Andrés Manuel López Obrador's historic election victory in 2018 marked a sharp break from past decades of neoliberal socioeconomic policies. López Obrador campaigned on the promise of deep reform, with health care high on his agenda. The public health care sector had been decimated by decades of budget cuts, eroding workers' morale and patients' confidence, and crippling all aspects of the system. This article looks back to the creation of the nation's public health care system in the early twentieth century during the administration of President Lázaro Cárdenas (1934-1940). This "universal" system was designed to implement a central social justice goal of the Mexican Revolution of health care for all. The program rested on two pillars: providing care to the nation's vast, impoverished rural population and actively engaging communities in their own health care. Our objective is to critically assess the two presidents' health care initiatives within the distinct historical contexts of their administrations.

Management of pharmaceutical services in the fight against COVID-19 in universal public health systems: a rapid review.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic brought new challenges and lessons were learnt for health services. In the field of pharmaceutical care, several interventions have been proposed to optimize and expand the response capacity of services. OBJECTIVE: To identify and characterize interventions performed in the management of pharmaceutical services during the COVID-19 pandemic in universal public health systems. METHODS: A rapid literature review was conducted and registered in PROSPERO (CRD42022360902). Systematic searches in the MEDLINE (PubMed), Embase, and Virtual Health Library databases were conducted to identify interventions and practices adopted for the management of pharmaceutical care during the COVID-19 pandemic. RESULTS: Thirteen articles reporting interventions developed in six countries were included. The interventions were summarized under three major themes: actions for continuous access to medicines, logistical measures for acquisition and storage, and organizational strategies. Telepharmacy services stand out as a typical action adopted in different services, which highlights the use and consolidation of digital technologies in these services. Strategies for process management were described and focused on the reorganization of the internal service of pharmacies, flow of services, and people management. CONCLUSIONS: Many interventions were developed during the pandemic, some of which have already been incorporated into routine service delivery. Although the studies did not measure the effect of each intervention, the strategies developed are a source of information for the future delivery of care. Studies should be conducted to evaluate the potential of similar interventions in other health emergency contexts.

Overview of global healthcare policies for patients with chronic kidney disease: an integrative literature review

ABSTRACT Introduction Chronic kidney disease is a progressive and irreversible loss of kidney function and considerably affects the lives of patients and their families. Its high incidence necessitates efficient public policies for prevention and treatment. However, policies for chronic kidney disease education and awareness are scarce. Objective To evaluate global public policies for the prevention and treatment of chronic kidney disease adopted in various regions, aiming to comprehend the differences between various models. Methods This integrative review followed PRISMA recommendations and included papers published between 2016 and 2021 across several databases. Results The 44 selected articles were categorized into three themes: structural and financial aspects of the organization of renal healthcare, access to renal healthcare or management of chronic kidney disease, and coping strategies for chronic kidney disease or kidney health. Critical analysis of the papers revealed global neglect of kidney disease in political agendas. Considerable policy variations exist between different countries and regions of the same country. Our research highlighted that free and universal health coverage, especially for the most vulnerable patients, is crucial for accessing treatment owing to the prohibitively high treatment costs. Conclusion Social, economic, and ethnic inequalities strongly correlate with disease occurrence, primarily affecting minority groups who lack health support, especially for the prevention and treatment of chronic kidney disease.

"'It is very difficult in this business if you want to have a good conscience': pharmaceutical governance and on-the-ground ethical labor in Ghana": a letter to editors.

Establishing effective pharmaceutical governance is a challenge for government agencies, private enterprises, and professionals working on the ground, demanding complex ethical decisions from the actors involved, especially in a lower-middle-income country like Ghana. This letter aims to share the author's perspectives and additional considerations on the analyses of the reports in the paper "It is very difficult in this business if you want to have a good conscience": pharmaceutical governance and on-the-ground ethical labor in Ghana by Hampshire et al. The letter's authors discuss the need to advance universal health coverage in Ghana, the everyday ethics, and the disparities between the collective and individual moral consciousness of the participants, as well as other aspects of governance in the pharmaceutical sector.

Incidents in the context of pre-hospital care by ambulances: contributions to patient safety / Incidentes en el contexto de la atención prehospitalaria por ambulancias: contribuciones a la seguridad del paciente / Incidentes no contexto da assistência pré-hospitalar por ambulâncias: contribuições para a segurança do paciente

ABSTRACT Objectives: to analyze the occurrence of incidents in the context of mobile terrestrial pre-hospital care. Methods: a descriptive research was carried out through the observation of 239 treatments performed by 22 healthcare professionals at the Mobile Emergency Care Service, located in Baixada Fluminense, Rio de Janeiro, Brazil. Fisher's exact test and chi-square test were used for data analysis. Results: the total time dedicated to patient care was 439.5 hours, during which 2386 security incidents were observed. The most notable ones were related to written communication (235), patient identification through bracelets (238), and safety in medication preparation (81). Conclusions: the need to promote and implement initiatives aimed at patient safety is evident, with special focus on international safety goals within the scope of mobile pre-hospital care services.

RESUMEN Objetivos: analizar la ocurrencia de incidentes en el contexto de la atención prehospitalaria móvil terrestre. Métodos: se realizó una investigación descriptiva a través de la observación de 239 atenciones realizadas por 22 profesionales de la salud en el Servicio de Atención Móvil de Urgencia, ubicado en la Baixada Fluminense, Río de Janeiro, Brasil. Para el análisis de los datos, se emplearon la prueba exacta de Fisher y la prueba de chi-cuadrado. Resultados: el tiempo total dedicado a la atención al paciente fue de 439,5 horas, durante las cuales se observaron 2386 incidentes de seguridad. Los más destacados fueron relacionados con la comunicación escrita (235), la identificación del paciente a través de pulseras (238) y la seguridad en la preparación de medicamentos (81). Conclusiones: se evidencia la necesidad de promover e implementar iniciativas que apunten a la seguridad del paciente, con un enfoque especial en las metas internacionales de seguridad, en el ámbito de los servicios de atención prehospitalaria móvil.

RESUMO Objetivos: analisar a ocorrência de incidentes no contexto do atendimento pré-hospitalar móvel terrestre. Métodos: realizou-se uma pesquisa descritiva através da observação de 239 atendimentos efetuados por 22 profissionais de saúde no Serviço de Atendimento Móvel de Urgência (SAMU), situado na Baixada Fluminense, Rio de Janeiro, Brasil. Para a análise dos dados, empregaram-se o teste exato de Fisher e o teste qui-quadrado. Resultados: o tempo total dedicado ao atendimento ao paciente foi de 439,5 horas, durante o qual se observaram 2386 incidentes de segurança. Os mais notáveis foram relativos à comunicação escrita (235), identificação do paciente através de pulseiras (238) e à segurança na preparação de medicamentos (81). Conclusões: evidencia-se a necessidade de promover e implementar iniciativas que visem a segurança do paciente, com foco especial nas metas internacionais de segurança, no âmbito dos serviços de atendimento pré-hospitalar móvel.

Percurso formativo e necessidades de aprendizagem de trabalhadores de um serviço de atendimento móvel de urgência / Training path and learning needs of workers of a mobile emergency care service

INTRODUÇÃO: No Brasil, a formação de recursos humanos para o Sistema Único de Saúde (SUS) tem avançado na última década com a disseminação da Política Nacional de Educação Permanente em Saúde (PNEPS). Neste contexto, está inserido o Serviço de Atendimento Móvel de Urgência (SAMU), tendo em vista que a qualificação de suas ações depende de uma equipe que aprimora suas competências técnicas baseada nas evidências da literatura e consciente de suas responsabilidades ético-sociais. Um dos desafios da gestão do SAMU é a implantação de um processo de trabalho que possa integrar no seu cotidiano atividades de educação, que favoreçam as mudanças da prática profissional que se fizerem necessárias frente aos problemas identificados. Atividades que deverão ser construídas por meio do diálogo democrático entre os profissionais, gestores e usuários a partir de problemas identificados, bem como de necessidades de aprendizagem da equipe. OBJETIVO: Analisar o percurso formativo de trabalhadores de um Serviço de Atendimento Móvel de Urgência e suas percepções sobre as necessidades de aprendizagem para qualificação do seu processo de trabalho na unidade. MÉTODO: Trata-se de uma pesquisa descritiva de caráter qualitativo realizada com trabalhadores de saúde do Serviço de Atendimento Móvel de Urgência de um município do interior do Estado de São Paulo à luz da Política Nacional de Educação Permanente em Saúde e o referencial teórico-metodológico de Paulo Freire; a coleta de dados foi realizada a partir de encontros dialógicos on-line com 20 trabalhadores do local pesquisado (4 técnicos de enfermagem, 4 enfermeiros, 4 médicos, 3 técnicos auxiliares de regulação médica [TARM] e 3 condutores), que foram transcritos e analisados segundo a temática dos conteúdos identificados. RESULTADOS: Participaram deste estudo: seis (37,5%) técnicos em enfermagem, quatro (80%) enfermeiros, quatro (21,05%) médicos, três (13,04%) condutores e três (13,63%) TARM. No mapa temático construído as principais categorias dos assuntos trazidos pelos participantes foram as seguintes: a formação dos trabalhadores e a necessidade do conhecimento teórico-prático no Atendimento Pré-Hospitalar (APH); a necessidade de atualização do conhecimento teórico-prático e a compreensão da Educação Permanente em Saúde no APH; a internet enquanto ferramenta na busca de informações atualizadas e a necessidade do diálogo na construção coletiva do conhecimento; a necessidade de atualização do conhecimento técnico-científico na pandemia e a conscientização sobre a importância das normas regulamentadoras; a percepção do processo de trabalho e a necessidade de compreensão do trabalho de equipe. CONSIDERAÇÕES FINAIS: Os profissionais do SAMU enfrentam grandes dificuldades com os processos formativos. Apesar da heterogeneidade da formação inicial e os cursos que foram desenvolvidos, as iniciativas foram interrompidas ou suprimidas e, atualmente, ocorrem de forma assistemática e pontual. Constata-se também que há a necessidade de aprimorar as estratégias de aprendizado para essa população e que os Núcleos de Educação Permanente, fundamentados pelos círculos de cultura, podem contribuir para favorecer tal prática. Além disso, a pandemia da COVID-19 dificultou ainda mais o trabalho desses profissionais

BACKGROUND: In Brazil, the training of human resources for the Unified Health System (SUS) has advanced, in the last decade, with the dissemination of the National Policy for Permanent Education in Health (PNEPS). The Mobile Emergency Care Service (SAMU) is inserted in this context, considering that the qualification of its actions depends on a team that improves its technical competencies based on the evidence of the literature and awareness of its ethical-social responsibilities. One of the challenges of SAMU management is the implementation of a work process that could integrate into their daily lives educational activities, which could favor the changes in professional practice that are necessary to face the problems identified. These activities should be built from the democratic dialogue between professionals, managers and users based on identified problems, as well as on the learning needs of the team. OBJECTIVE: To analyze the training path of workers of a mobile emergency care service and their perceptions about the learning needs for qualification of their work process in the unit. METHOD: This is a descriptive research study of qualitative nature carried out with health workers of mobile emergency care service of a municipality in the Northeast region of the state of São Paulo in the light of the National Policy of Permanent Education in Health and the theoretical-methodological framework of Paulo Freire; data collection was performed through online meetings with 20 workers from the researched site (4 nursing technicians, 4 nurses, 4 physicians, 3 auxiliary technicians of medical regulation [TARM], and 3 drivers), meetings were transcribed and analyzed according to the theme. RESULTS: In the research context, according to professional categories, participated in this study: six (37.5%) nursing technicians, four (80%) nurses, four (21.05%) physicians, three (13.04%) drivers, and three (13.63%) TARMs. As a result, a thematic map was obtained containing the main categories of the themes brought by participants; training of workers and the need for theoretical and practical knowledge in Pre-Hospital Care (PHC); need to update theoretical and practical knowledge and understanding of Permanent Education in Health in PHC; internet as a tool in the search for updated information and the need for dialogue in the collective construction of knowledge; need to update technical-scientific knowledge in the pandemic and raise awareness of the importance of regulatory standards; perception of the work process and the need to understand teamwork. CONCLUSION: Through this research, it is possible to observe that SAMU professionals face great difficulties with the educational processes, it also points out that, despite the heterogeneity of initial training and the courses that were developed, the initiatives were interrupted or suppressed, and they currently occur in an unsystematic and punctual way. It is also noticed that there is a need to improve the forms of learning strategies for this population, and that the Permanent Education Centers based on cultural circles contribute to favor this practice. In addition, the COVID-19 pandemic has made the work of these professionals even more difficult

Evaluación de disponibilidad y preparación de servicios de salud en el primer nivel de atención de cinco regiones sanitarias del Paraguay durante el 2022

Paraguay definió como prioridad lograr acceso y cobertura universal basado en Atención Primaria de Salud, incorporando a las Unidades de Salud de la Familia (USF) en las comunidades. El objetivo del estudio fue proporcionar métricas para gestionar mejoras en la red asistencial nacional analizando el grado de preparación del primer nivel de atención para proveer servicios de salud integrales. El diseño fue no experimental, cuantitativo, transversal, descriptivo con componente analítico. Incluyó a 216 establecimientos de las Regiones Sanitarias de Concepción, Amambay, Caaguazú, Canindeyú e Itapúa que representaban el 88% del total de USF de estas regiones. Se adaptó el método de evaluación SARA de la OMS con 82 indicadores trazadores, aplicando un cuestionario en línea dirigido a profesionales de salud en julio de 2022. El índice de preparación se midió de 0 a 1 y resultó que el 66,2% de las USF eran rurales y 33,8% urbanas. La mediana de preparación general fue 0,655 mientras que la mediana de la capacidad de diagnóstico fue 0,500, de disponibilidad de medicamentos esenciales 0,625, de infraestructura 0,650, de capacidad para prevenir infecciones 0,667 y de disponibilidad de equipamiento básico 0,833. Sólo el 13,89% tuvo una preparación suficiente, 75,0% intermedia y 11,11% baja. Hubo menor desempeño en las áreas rurales y el 31,02% carecía de personal completo según la norma. Se concluyó que las USF presentaron limitaciones para proveer servicios de salud integrales a las comunidades y que se requiere mejorar el desempeño con base en evaluaciones y ajustes periódicos.

Paraguay defined as a priority to achieve universal access and coverage based on Primary Health Care, incorporating the Family Health Units (FHU) in the communities. The objective of the study was to provide metrics to manage improvements in the national healthcare network by analyzing the degree of preparation of the first level of care to provide comprehensive health services. The design was non-experimental, quantitative, cross-sectional, descriptive with an analytical component. It included 216 establishments from the Sanitary Regions of Concepción, Amambay, Caaguazú, Canindeyú and Itapúa that represented 88% of the total FHU of these regions. The WHO SARA evaluation method was adapted with 82 tracer indicators, applying an online questionnaire addressed to health professionals in July 2022. The preparedness index was measured from 0 to 1 and it turned out that 66.2% of the FHU were rural and 33.8% urban. The overall readiness median was 0.655 while the median diagnostic power was 0.500, the availability of essential medicines 0.625, the infrastructure 0.650, the capacity of preventing infections 0.667 and the availability of basic equipment 0.833. Only 13.89% had sufficient preparation, 75.0% intermediate and 11.11% low. There was lower performance in rural areas and 31.02% lacked full staff according to the standard. It was concluded that the FHU presented limitations to provide comprehensive health services to the communities and that it is necessary to improve performance based on periodic evaluations and adjustments.

Lessons for Developing Countries From Outlier Country Health Systems.

Building good health systems is an important objective for policy makers in any country. Developing countries which are just starting out on their journeys need to do this by using their limited resources in the best way possible. The total health expenditure of a country exerts a significant influence on its health outcomes but, given the well-understood failures of price-based market-mechanisms, countries that spend the most money do not necessarily end-up building the best health systems. To help developing country policy makers gain a deeper insight into what factors matter, in this study the contribution of per-capita total, out-of-pocket, and pooled health expenditures, to the cross-country variation in Disability Adjusted Life Years lost per 100,000 population (DALY Rates), a summary measure of health outcomes, is estimated. The country-specific residuals from these analyses are then examined to understand the sources of the rest of the variation. The study finds that these measures are able to explain between 40 and 50% of the variation in the DALY Rates with percentage increases in per-capita out-of-pocket and pooled expenditures being associated with improvements in DALY Rates of about 0.06% and 0.095%, respectively. This suggests that while increases in per-capita total health expenditures do matter, moving them away from out-of-pocket to pooled has the potential to produce material improvements in DALY Rates, and that taken together these financial parameters are able to explain only about half the cross-country variation in DALY Rates. The analysis of the residuals from these regressions finds that while there may be a minimum level of per-capita total health expenditures (> $100) which needs to be crossed for a health system to perform (Bangladesh being a clear and sole exception), it is possible for countries to perform very well even at very low levels of these expenditures. Colombia, Thailand Honduras, Peru, Nicaragua, Jordan, Sri Lanka, and the Krygyz Republic, are examples of countries which have demonstrated this. It is also apparent from the analysis that while very high rates (> 75%) of pooling are essential to build truly high performing health systems (with DALYRates < 20, 000), a high level of pooling on its own is insufficient to deliver strong health outcomes, and also that even at lower levels of pooling it is possible for countries to out-perform their peers. This is apparent from the examples of Ecuador, Mexico, Honduras, Malaysia, Vietnam, Kyrgyz Republic, and Sri Lanka, which are all doing very well despite having OOP% in the region of 40-60%. The analysis of residuals also suggests that while pooling (in any form) is definitely beneficial, countries with single payer systems are perhaps more effective than those with multiple payers perhaps because, despite their best efforts, they have insufficient market power over customers and providers to adequately manage the pulls and pressures of market forces. It can also be seen that countries and regions such as Honduras, Peru, Nicaragua, Jordan, Sri Lanka, Bangladesh, Kerala, and the Kyrgyz Republic, despite their modest levels of per-capita total health expenditures have delivered attractive DALY Rates on account of their consistent prioritization of public-health interventions such as near 100% vaccine coverage levels and strong control of infectious diseases. Additionally, countries such as Turkey, Colombia, Costa Rica, Thailand, Peru, Nicaragua, and Jordan, have all delivered low DALY Rates despite modest levels of per-capita total health expenditures on account of their emphasis on primary care. While, as can be seen from the discussion, several valuable conclusions can be drawn from this kind of analysis, the evolution of health systems is a complex journey, driven by multiple local factors, and a multi-country cross-sectional study of the type attempted here runs the risk of glossing over them. The study attempts to address these limitations by being parsimonious and simple in its approach toward specifying its quantitative models, and validating its conclusions by looking deeper into country contexts.

Overcoming the health systems' segmentation to achieve universal health coverage in Mexico.

Health is a human right that everyone should be able to exercise. Yet health systems segmentation and fragmentation are a major challenge to advancing universal health coverage (UHC) and achieving health equity. Between 2019 and 2020, Mexico launched a profound restructuration of its health system claiming its aim was to attain UHC, free healthcare services and drugs and to combat corruption. We analyse the implications of the modifications of the Mexican Constitution and the dismantling of the Seguro Popular de Salud (Popular Health Insurance) in relation to segmentation. We argue that, instead of advancing towards UHC and equality, these changes reinforce inequalities and that transforming health systems must respect human rights.

Estudios mamográficos en un centro metropolitano de referencia en imágenes mamarias: Chile 2008-2018 ¿Vamos por el camino correcto? / Analysis of mammograms performed in a public imaging center in Santiago, Metropolitan Region Chile 2008-2018

BACKGROUND: Mammograms are one of the most effective preventive means for the early detection of breast cancer. OBJECTIVE: To describe the features of patients and results of mammograms performed at a public breast imaging service of the Santiago Metropolitan Area. MATERIAL AND METHODS: We reviewed the reports of mammograms performed on 174,017 women and 18 men, between 2008 and 2018 in an Imaging Center. The BI-RADS classification was used in the reports. RESULTS: Forty-six percent of mammograms (75,781) were reported as BI-RADS 2. The high proportion of BI-RADS 4 reports (674 reports) was seen in patients aged 40 to 49 years, corresponding to 30% of reports in this age range. Among patients aged 50 to 59 years, there were 779 BI-RADS 4 reports (35%). BI-RADS 5 reports were more common among patients aged 50 to 59 years (50 reports, 30%) and among patients aged 70 years or older (83 reports, 28%). CONCLUSIONS: The presence of a significant number of women between 40 and 49 years of age with a BI-RADS 4 mammography result stands out; being an opportunity to develop new clinical research and public health strategies within the framework of the Universal Health Care policy for breast cancer in Chile.

Continuidade do cuidado a partir do hospital: interdisciplinaridade e dispositivos para integralidade na rede de atenção à saúde / Continuity of care from the hospital: interdisciplinarity and devices for integrality in health care networks

RESUMO O objetivo deste estudo foi analisar a produção científica sobre a continuidade do cuidado e a integralidade da atenção, identificando dispositivos utilizados para essa construção a partir do hospital. A presente investigação é uma revisão integrativa realizada nos meses de junho e julho de 2021. Assim, para a seleção dos artigos, utilizou-se das bases de dados PubMed/Medline, Lilacs, BDENF e Lis. Foram analisados 36 artigos. Da análise, emergiram três categorias: Cuidado em saúde e integralidade dentro do hospital; O enlace e as conexões na continuidade do cuidado; Redes de atenção à saúde no Sistema Único de Saúde e a continuidade do cuidado. A análise permitiu identificar estratégias/ferramentas sobre a organização do trabalho na dimensão micropolítica da produção do cuidado em saúde. Os principais dispositivos encontrados foram: alta segura, corridas de leitos, gestão da clínica, discussão de casos, linhas de cuidado, enfermeira de enlace, complexos reguladores, educação permanente e multidisciplinaridade. Concluiu-se que, embora alguns estudos se refiram a uma prática na rede de atenção à saúde ainda fragmentada, os dispositivos mencionados constituem-se em avanços em direção a um modelo de atenção baseado em linhas de cuidado dentro do hospital e para fora, buscando articulação com a rede de atenção à saúde.

ABSTRACT The aim of this study is to analyze the scientific production on the continuity and comprehensiveness of care, identifying devices used for this construction starting from the hospital. This research is an integrative review carried out in June and July 2021. Thus, PubMed/Medline, Lilacs, BDENF, and Lis databases were used for the selection of articles. Thirty-six articles were analyzed. Three categories emerged from the analysis: Health care and comprehensiveness within the hospital; The linkage and connections in the continuity of care; Health care networks in the Unified Health System and continuity of care. The analysis allowed identifying strategies/tools on the organization of work in the micropolitical dimension of health care production. The main devices found were: safe discharge, bed races, clinic management, case discussion, care lines, liaison nurses, regulatory complexes, continuing education, and multidisciplinarity. It was concluded that, although some studies are related to a practice in the still fragmented health care network, the mentioned devices constitute advances towards a model of care based on lines of care within and outside the hospital seeking articulation with the health care network.

A Recommended Package of Long-Term Care Services to Promote Healthy Ageing Based on a WHO Global Expert Consensus Study.

OBJECTIVES: To reach consensus on a minimum list of long-term care (LTC) interventions to be included in a service package delivered through universal health coverage (UHC). DESIGN: A multistep expert consensus process. SETTING AND PARTICIPANTS: Multinational and multidisciplinary experts in LTC and ageing. METHODS: The consensus process was composed of 3 stages: (1) a preconsultation round that built on an initial list of LTC interventions generated by a previous scoping review; (2) 2-round surveys to reach consensus on important, acceptable, and feasible interventions for LTC; (3) a panel meeting to finalize the consensus. RESULTS: The preconsultation round generated an initial list of 117 interventions. In round 1, 194 experts were contacted and 92 (47%) completed the survey. In round 2, the same experts contacted for round 1 were invited, and 115 (59%) completed the survey. Of the 115 respondents in round 2, 80 participated in round 1. Experts representing various disciplines (eg, geriatricians, family doctors, nurses, mental health, and rehabilitation professionals) participated in round 2, representing 42 countries. In round 1, 81 interventions achieved the predetermined threshold for importance, and in round 2, 41 interventions achieved the predetermined threshold for acceptability and feasibility. Nine conflicting interventions between rounds 1 and 2 were discussed in the panel meeting. The recommended list composed of 50 interventions were from 6 domains: unpaid and paid carers' support and training, person-centered assessment and care planning, prevention and management of intrinsic capacity decline, optimization of functional ability, interventions needing focused attention, and palliative care. CONCLUSIONS AND IMPLICATIONS: An international discussion and consensus process generated a minimum list of LTC interventions to be included in a service package for UHC. This package will enable actions toward a more robust framework for integrated services for older people in need of LTC across the continuum of care.

How Universal Is Palliative Care in Colombia? A Health Policy and Systems Analysis.

Colombia's health sector reform has been recognized for its universal health (UHC) coverage scheme. However, this reform evolved without palliative care (PC), thereby omitting a core element of UHC. In this paper, we analyze the Colombian health system reform and health policies in relation to PC. We present the history, innovations, successes, and shortcomings of the reform and summarize the lessons learned to strengthen efforts leading to PC integration. Our analysis is based on the WHO public health framework for PC (policy, access to medicines, education, service provision). For several years and especially during the last decade, the government enacted laws and regulations to improve access to essential medicines and to integrate PC. Relative to other countries in Latin America, Colombia was the first to launch a PC service and to accredit palliative medicine as a specialty, the second to establish a national PC association and one of the few countries with a specific PC law. However, data shows that there are still too few services to meet the PC needs of approximately 250,000 adult patients annually. Our analysis shows that the country's failure to integrate PC most likely is a result of limited health worker education. Advocacy efforts should include deans of schools and provosts, in addition to policy makers and regulators. Other possible factors affecting uptake and implementation of existing national policies are civil unrest and limited collaboration between government offices. Additional research is needed to evaluate the impact of these and other related factors on PC integration in Colombia.

The Waiting Game - How Cooperation Between Public and Private Hospitals Can Help Reduce Waiting Lists.

Prolonged waiting to access health care is a primary concern for nations aiming for comprehensive effective care, due to its adverse effects on mortality, quality of life, and government approval. Here, we propose two novel bargaining frameworks to reduce waiting lists in two-tier health care systems with local and regional actors. In particular, we assess the impact of 1) trading patients on waiting lists among hospitals, the 2) introduction of the role of private hospitals in capturing unfulfilled demand, and the 3) hospitals' willingness to share capacity on the system performance. We calibrated our models with 2008-2018 Chilean waiting list data. If hospitals trade unattended patients, our game-theoretic models indicate a potential reduction of waiting lists of up to 37%. However, when private hospitals are introduced into the system, we found a possible reduction of waiting lists of up to 60%. Further analyses revealed a trade-off between diagnosing unserved demand and the additional expense of using private hospitals as a back-up system. In summary, our game-theoretic frameworks of waiting list management in two-tier health systems suggest that public-private cooperation can be an effective mechanism to reduce waiting lists. Further empirical and prospective evaluations are needed.