Price setting in the Brazilian private health insurance sector.

Brazil's private health insurance market is the second largest in the world, behind only the United States, making it a valuable source of real-world evidence. This paper documents how physicians' inpatient reimbursement fees vary in the country and explores the relationship between these fees and the market share of health providers and health insurance companies. We implement a fixed-effects panel regression and take advantage of an unprecedented database that contains national administrative records of inpatient procedures paid by health insurance companies in 2016. We find a positive correlation between reimbursement for ICU procedures and provider market share. Conversely, we observe a negative correlation with insurers' market share. Additionally, we document substantial variation in procedure prices, both across and within Brazilian states, and observe that more competitive markets in Brazil tend to have higher population and GDP levels. Overall, our research enhances our understanding of the price setting dynamics of physician reimbursement fees in the context of a developing country. The insights gained from this study can assist policymakers in formulating appropriate regulations to ensure appropriate access to healthcare services.

Exposure to marketing of breastmilk substitutes in Mexican women: Sources and scope.

BACKGROUND: Aggressive and unregulated marketing of breastmilk substitutes (BMS) results in increased child morbidity and mortality. Unregulated BMS marketing is a major public health concern because it encourages formula consumption at the expense of breastfeeding. This study aimed to identify the sources and characterize the nature of exposure to marketing of BMS among Mexican mothers of children under 18 months of age. As a secondary objective we explored potential association between exposure to BMS marketing and infant feeding practices. METHODS: Cross-sectional study, comprising a pre-piloted survey, was conducted between February 2020 to February 2021 with Mexican mothers of children under 18 months of age (n = 754), in two major cities in Mexico. Mothers were selected according to their current infant feeding practices (Breastfeeding only vs. Mixed feeding). We characterized the different BMS marketing sources and scope, and related them with infant feeding practices. In addition, we used logistic regression models to estimate the odds ratio for infant feeding practices by BMS marketing exposure or recommendation. RESULTS: Mothers reported different sources of exposure to BMS promotion, including BMS advertisements in diverse media channels (41.6%), recommendation by a healthcare professional and/or relative (76.2%), and receiving a BMS sample at a hospital (18.6%). By contrast, only 36.5% recalled hearing or seeing breastfeeding information the previous year. The odds of mixed feeding were substantially higher, compared to breastfeeding, when mothers were recommended to use a BMS by doctors/pediatricians (OR: 3.96, 95% CI: 2.00, 7.83). Having seen or heard breastfeeding information in the previous year was associated with a lower risk of mixed feeding compared to breastfeeding only (OR: 0.59, 95% CI: 0.35, 0.99). CONCLUSIONS: Mexican mothers of young children in the metropolitan areas studied were highly exposed to BMS marketing and through different mass media channels and inter-personal sources. Health care professionals, particularly doctors/pediatricians, are a source of BMS promotion that are likely to have a strong influence on maternal decisions about infant feeding practices. There is an urgent need to protect mothers and their families against unregulated BMS promotion through mass media channels and directly by influential individuals, including health care providers.

Preventable risk factors of dementia: Population attributable fractions in a Brazilian population-based study.

Background: Knowledge regarding the modifiable risk factors of dementia is fundamental to guide public health policy. We aimed to estimate the population attributable fraction of modifiable risk factors of dementia among adults from a nationwide epidemiological study. Methods: We used the public database of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) to calculate the Population Attributable Fraction (PAF) for ten risk factors, including education level, hearing loss, hypertension, alcohol consumption, obesity, active smoking, depression, social isolation, physical inactivity, and diabetes. PAF was estimated for this sample after accounting for the communality of each risk factor. Findings: The ten preventable risk factors for dementia accounted for 50·5% of the Population Attributable Fraction in Brazil. Hearing loss (14·2%), physical inactivity (11·2%), and hypertension (10·4%) accounted for the highest PAF among all the risk factors. Considerable variation in the relative contribution of the different risk factors was found in different regions. Interpretation: This study might provide an opportunity to change the impact of dementia in Brazil. By targeting modifiable risk factors of dementia, the health of individuals in Brazil might be considerably improved. Funding: This study did not receive any funding.

Occupational Stress and Mental Health Among Healthcare Workers Serving Socially Vulnerable Populations During the COVID-19 Pandemic.

The purpose of this study was to analyze occupational and personal stressors, mental health indicators, perceived discrimination and help-seeking behaviors among healthcare workers and providers (HCWPs) serving socially vulnerable groups such as immigrants, refugees, farmworkers, homeless individuals, people living in poverty, and other disadvantaged populations in the United States (U.S.) during the COVID-19 pandemic. Using a cross-sectional descriptive approach, we gathered information between July and September 2020, from a sample of 407 affiliates of two national organizations of clinic-based HCWPs who worked at federally funded and community safety-net clinics. Informed consent was obtained from all participants who completed a self-administered online survey available in English and Spanish. Our results indicated that the HCWPs serving vulnerable groups in the midst of the pandemic experienced high levels of occupational and personal stressors as well as anxiety and depressive symptomology. Major occupational stressors were excessive workload, long working-hours, and institutional barriers to refer and follow-up on their clients' access to needed social services. High-rated personal stressors included sleep disorders, lack of and child-care, partner's loosing job, and other family related situations. Our findings suggest that HCWPs working with vulnerable populations need specialized interventions that bolster their mental health and well-being as the pandemic continues to unfold. We recommend implementing initiatives that encourage HCWPs' to be actively involved in clinic decisions regarding employee safety and protection as well as in management decisions to improve work place infrastructure and capacity to respond to the social needs of their clients. Lessons learned from the pandemic are useful tools in designing protocols for addressing the mental-health needs of HCWPs in health-care organizations that attend to socially underprivileged populations.

Knowledge, attitudes and practices on influenza vaccination during pregnancy in Quito, Ecuador.

BACKGROUND: Vaccination is the most effective way to prevent infection and severe outcomes caused by influenza viruses in pregnant women and their children. In Ecuador, the coverage of seasonal influenza vaccination in pregnant women is low. The aim of this study was to assess the knowledge, attitudes, and practices (KAP) of pregnant women toward influenza vaccination in Quito-Ecuador. METHODS: A cross-sectional study enrolled 842 women who delivered at three main public gynecological-obstetric units of the Metropolitan District of Quito. A questionnaire regarding demographics, antenatal care, risk conditions and knowledge, attitudes and practices related to influenza vaccination was administered. We examined factors associated with vaccination using log-binomial regression models. RESULTS: A low vaccination rate (36.6%) against influenza was observed among pregnant women. The factors associated with vaccination included the recommendations from health providers (adjusted PR: 15.84; CI 95% 9.62-26.10), belief in the safety of the influenza vaccine (adjusted PR: 1.53; CI 95% 1.03-2.37) and antenatal care (adjusted PR: 1.21; CI 95% 1.01-1.47). The most common reasons for not vaccinating included the lack of recommendation from health care providers (73.9%) and lack of access to vaccine (9.0%). CONCLUSIONS: Health educational programs aimed at pregnant women and antenatal care providers have the most potential to increase influenza vaccination rates. Further studies are needed to understand the barriers of health care providers regarding influenza vaccination in Ecuador.

Formação dos profissionais de saúde para o atendimento de LGBTQI+ / Formación de los profesionales de salud para la atención de LGBTQI+ / Training of health professionals to care for LGBTQI+

A saúde é um direito de todos. As investigações têm considerado, entre outros aspectos, a qualificação de profissionais da saúde voltada ao atendimento de minorias sociais, incluindo as identidades LGBTQI+ (lésbicas, gays, bissexuais, transexuais, queer, intersexuais, +), na tratativa da integralidade do ser humano. Dessa forma, o estudo busca, por meio de uma revisão sistemática de literatura, identificar as lacunas e potencialidades existentes no processo de formação dos profissionais de saúde no atendimento de LGBTQI+'s. Com abordagem qualitativa, descritiva e exploratória, após a análise verificou-se que profissionais da área da Saúde não estão preparados para atender a essas identidades, tornando-se essencial, para a promoção da saúde e do bem-estar no cerne do atendimento de LGBTQI+, a comunicação por meio de materiais informativos, políticas públicas, reestruturação curricular nos cursos de Saúde, e, ainda, uma desconstrução cultural operando em prol da equidade social. (AU)

La salud es un derecho de todos. Las investigaciones han considerado, entre otros aspectos, la calificación de profesionales de la salud, enfocado a la atención de minorías sociales, incluyendo las identidades LGBTQI+ (lesbianas, gais, bisexuales, transexuales, queer, intersexuales, +), en la tratativa de la integralidad del ser humano. De esa forma, el estudio busca, por medio de una revisión sistemática de la literatura, identificar las lagunas y potencialidades existentes en el proceso de formación de los profesionales de salud en la atención de LGBTQI+'s. Con un abordaje cualitativo, descriptivo y exploratorio, después del análisis se verificó que los profesionales del área de la salud no están preparados para atender a esas identidades, siendo esencial para la promoción de la salud y del bien estar en el núcleo de la atención de LGBTQI+ la comunicación por medio de materiales informativos, políticas públicas, reestructuración curricular en los cursos de salud y también una desconstrucción cultural operando en pro de la equidad social. (AU)

Health is everyone's right. Most research have considered, among other aspects, the health professionals' improvement of capacities, aimed at serving minorities, including LGBTQI+ (lesbian, gays, bisexual, transsexual, queer, intersex, +) identities, in comprehensively dealing with the human being as a whole. Thus, this study aimed identifying the gaps and potentialities in the process of training health professionals that care for LGBTQI+'s, through a systematic literature review. It is a qualitative, descriptive and exploratory approach, and the analysis showed that health professionals are not prepared to deal with these identities, being essential for the promotion of health and well-being at the heart of LGBTQI+'s care, to improve communication through informative materials, public policies, curricular restructuring in health courses, and additionally a cultural deconstruction operating in favor of social equity. (AU)

Obstáculos e facilitadores para o cuidado de mulheres em situação de violência doméstica na atenção primária em saúde: uma revisão sistemática / Obstáculos y facilitadores para el cuidado de mujeres en situación de violencia doméstica en la atención primaria de la salud: una revisión sistemática / Obstacles and facilitators to primary health care offered to women experiencing domestic violence: a systematic review

Trata-se de uma revisão sistemática da produção bibliográfica sobre obstáculos e facilitadores para o cuidado de mulheres em situação de violência doméstica na atenção primária à saúde (APS) no Brasil. O levantamento bibliográfico encontrou 1.048 referências. Analisamos 39 artigos, conforme critérios de inclusão e exclusão. A produção centrou-se em representações e crenças dos profissionais. Os principais obstáculos foram a constituição da violência doméstica contra a mulher (VDM) como questão do escopo da saúde, traduzida em dificuldades na identificação do problema e manejo no encontro assistencial, ausência de treinamento, trabalho em equipe, rede intersetorial, medo e falta de tempo. Os facilitadores focaram-se na introdução da perspectiva de gênero e direitos humanos, vínculo, acolhimento e trabalho em equipe e multisetorial. Apesar da potencialidade da APS para trabalhar com VDM, houve raros estudos que consideraram a perspectiva da gestão e financiamento, fundamental para a superação dos problemas apontados.(AU)

Revisión sistemática de la producción bibliográfica sobre obstáculos y facilitadores para el cuidado de mujeres en situación de violencia doméstica (VDM) en la atención primaria de la salud (APS) en Brasil. La revisión bibliográfica encontró 1.048 referencias. Analizamos 39 artículos, conforme criterios de inclusión y exclusión. La producción se concentró en representaciones y creencias de los profesionales. Los principales artículos fueron la constitución de la VDM como cuestión del alcance de la salud, traducida en dificultades en la identificación del problema y el manejo en el encuentro asistencial, ausencia de capacitación, trabajo en equipo, red intersectorial, miedo y falta de tiempo. Los facilitadores se enfocaron en la introducción de la perspectiva de género y derechos humanos, vínculo y acogida, trabajo en equipo y multisectorial. A pesar de la potencialidad de la APS para trabajar con VDM, fueron raros los estudios que consideraron la perspectiva de la gestión y financiación, fundamental para la superación de los problemas señalados.(AU)

Systematic review of the literature addressing obstacles and facilitators for the care of women, in situations of domestic violence (DV) in primary health care (PHC) in Brazil. The bibliographic review found 1,048 references. The analysis encompassed 39 articles complying with the inclusion and exclusion criteria. The material was centered on representations and beliefs of practitioners. The main obstacles were related to: conceptualizing DV as a health issue, resulting into difficulties to identify the problem and managing care encounters; lack of training and teamwork; scarce intersectoral network, fear and lack of time. The facilitators were mainly: introducing a gender and human rights perspective, bonding and embracement, teamwork and multisectoral work. Despite the potential of PHC to address the issue, few studies considered perspectives of management and financing, considered as key to overcome the problems pointed out.(AU)

Institutional context and VCT practitioner narratives: possibilities and limitations for HIV prevention in Rio de Janeiro, Brazil.

BACKGROUND: Voluntary Counseling and Testing (VCT) is an HIV prevention strategy that promotes the principles of confidentiality and informed consent. International research has highlighted VCT counselors' isolation from service planning and the contradictions they negotiate between local values and global testing recommendations. In Brazil, studies have identified many limitations, including counselors' difficulties to implement a vulnerability approach to HIV prevention as recommended in the country's national guidelines. These studies, however, have not considered the particularities of the institutional contexts where counselors work. This research addresses these gaps in the VCT literature by exploring how VCT services are organized and how counselors perceive and perform their practices in the state of Rio de Janeiro, Brazil. METHODS: This is a case study of VCT services in the state of Rio de Janeiro. The research design included individual structured interviews with seven VCT service coordinators and twenty individual semi-structured interviews with VCT counselors. Participants were sampled according to gender, undergraduate degree and work trajectory to capture a diverse range counselor narratives. RESULTS: The VCT services were relatively homogenous in terms of functioning and had a similar restricted roll of activities including individual counseling and occasional external prevention activities with groups vulnerable to HIV. All VCT services reported reductions in staff size. Some counselors used dialogical practices to build trust, guarantee confidentiality and adjust their practices in accordance with their clients' values and practices. Others emphasized imperative messages or focused on risk and individual responsibility. Connections between how counselors perceive their practices and the organization of their work environment were observed. CONCLUSIONS: Due to the importance of counseling as a prevention strategy we recommend rethinking the relationship between counselors' practices and the organization of VCT services. The challenges brought about by the expansion of "test and treat" programs globally and other social and symbolic aspects of the HIV epidemic, such as gender inequalities, must also be taken into account. Further reflection is also needed on the relationship between counseling guidelines and practices within the vulnerability approach to HIV prevention.

Efectividad de una estrategia educativa dirigida a adultos mayores diabéticos tipo 2 y proveedores de salud / Effectiveness of an educational strategy aimed at older adults suffering from type 2 diabetes and at health providers

Objetivo: Evaluar la efectividad de la estrategia educativa dirigida a adultos mayores diabéticos tipo 2 y proveedores de salud. Métodos: Investigación cuasi experimental que evaluó un antes-después con grupo control. El universo de estudio estuvo constituido por adultos mayores diabéticos dispensarizados en los policlínicos Hermanos Cruz (U= 1 369) y Pedro Borrás (U= 1 528), del primero se seleccionó el grupo experimental y en el segundo el grupo control, ambos del municipio y provincia Pinar del Río. Para determinar la muestra se utilizó un Muestreo por Conglomerados Bietápico con probabilidades proporcionales al tamaño de las Unidades de Primera Etapa quedando conformada para ambos grupos por 123 adultos mayores diabéticos tipo 2. Se trabajó con el universo de prestadores del GBT uno (U= 84) del policlínico Hermanos Cruz. La estrategia fue aplicada en el grupo experimental, y evaluada de forma inmediata, a los seis meses y al año. Resultados: Las comparaciones de los grupos en los momentos relacionados con la aplicación de la estrategia estuvieron dentro de lo esperado, generalmente se produjeron cambios significativos en los adultos mayores diabéticos tipo 2 en cuanto a los resultados globales y en cada una de las preguntas examinadas a favor del grupo experimental e igualmente en los proveedores de salud. Conclusiones: La mejoría detectada en los resultados de las variables de respuesta principal y secundarias, en el grupo experimental, dan una medida de la efectividad de la estrategia. Al mismo tiempo su estabilidad a los seis meses y al año considerado como horizonte temporal de evaluación, avalan su sostenibilidad(AU)

Objective: To evaluate the effectiveness of the educational strategy aimed at type 2 diabetic older adults and at health providers. Method: A quasi experimental research study to evaluate the situation before and after the application of this strategy in a control group. The study population consisted of diabetic old patients recruited at Hermanos Cruz (U= 1 369) and Pedro Borrás Astorga (U= 1 528) polyclinics. The experimental group was chosen from the first group and the control group from the second one, both in Pinar del Río municipality in Pinar del Rio province. A two-staged cluster was used with proportional probabilities according to the size of the first stage units and the final sample was 123 type 2 diabetic older adults for both groups. All the basic working team health providers from Hermanos Cruz polyclinics were involved in the study. The strategy was applied in the experimental group and immediately evaluated after six months and after a year. Results: The comparisons of the groups made at the time of the implementation of the strategy were within the expectations; there were significant changes in type 2 diabetics in terms of overall outcomes and each of the analyzed questions, which favored the experimental group along with the health providers. Conclusions: The improvement observed in the results of the answer variables of the experimental group shows the strategy effectiveness. At the same time, the stability of results after six months and a year endorses the strategy sustainability(AU))

Diseño de un curso sobre diabetes mellitus dirigido a profesionales del nivel primario de atención / Design of a course on diabetes mellitus directed to primary health care professionals

Introducción: la experiencia demuestra que es indispensable mantener actualizado de forma permanente el conocimiento en los avances de la medicina a los profesionales de la salud para optimizar la calidad de la atención médica. Objetivo: diseñar un curso de posgrado dirigido a proveedores de salud que aporte los conocimientos más actualizados sobre diabetes mellitus en el nivel primario de atención. Métodos: se realizó una investigación descriptiva y se emplearon métodos del nivel teórico y del nivel empírico. La población de profesionales de la salud estuvo constituida por la totalidad de 84 profesionales del Policlínico "Hermanos Cruz", cuya distribución es la siguiente: médicos (N1= 29), enfermeras (N2= 30), podólogos (N3= 8), psicólogas (N4= 2), nutricionista (N5= 1), especialista en Educación y Promoción para la Salud (N6= 1) y profesores de Cultura Física (N7= 13). Estos últimos no forman parte de la plantilla del policlínico, pero por convenio de trabajo Minsap-INDER, prestan servicios en el nivel primario de atención. Resultados: fue necesario diseñar un curso a prestadores de salud, basado en la educación sobre temas de diabetes mellitus (DM), que incluye contenidos de promoción y EpS. La identificación de necesidades de aprendizaje en proveedores seleccionados arrojó déficit de conocimiento en esas temáticas. Conclusiones: se elaboró y propuso un programa de superación profesional teniendo en cuenta los resultados de la investigación. Se ofrecieron herramientas teóricas prácticas para la educación al diabético tipo 2 adulto mayor(AU)

Introduction: experience proves that medical advances knowledge strongly needs to be permanently updated for health professionals in order to optimize health care quality. Objective: to design a postgraduate course for health care providers, in order for them to apply, in the primary health care level, the most updated knowledge on diabetes mellitus.Methods: descriptive research using methods of the theoretical and empirical levels, carried out at Hermanos Cruz University Outpatient Polyclinic of Pinar del Río. The health professional population consisted of the totality (84 professionals from the Polyclinic) and is distributed as it follows: physicians (N1=29), nurses (N2=30), chiropodists (N3=8), psychologists (N4=2), nutritionist (N5=1), health promotions and education specialist (N6=1), and physical education professors (N7=13). The latter ones do not belong to the Polyclinic's staff, but under a work agreement between the Health Ministry and the National Institute of Sports they pay services in the primary health care level. Results: health providers were necessarily designed a course based on diabetes mellitus education, including contents of health promotion and education, because the identification of the learning needs in the selected providers showed knowledge deficit regarding these topics. Conclusions: a professional self-improvement plan was elaborated and proposed considering the research outcomes, and theoretical-practical tools were offered for education of type 2 diabetic senior adults(AU)

Healthcare system responses to intimate partner violence in low and middle-income countries: evidence is growing and the challenges become clearer.

The damage to health caused by intimate partner violence demands effective responses from healthcare providers and healthcare systems worldwide. To date, most evidence for the few existing, effective interventions in use comes from high-income countries. Gupta et al. provide rare evidence of a nurse-delivered intimate partner violence screening, supportive care and referral intervention from a large-scale randomised trial in Mexican public health clinics. No difference was found in the primary outcome of reduction in intimate partner violence. There were significant short-term benefits in safety planning and mental health (secondary outcomes) for women in the intervention arm, but these were not sustained.This important study highlights the challenges of primary outcome choices in such studies, and further challenges for the sustainability of healthcare systems and healthcare provider interventions. These challenges include the role of theory for sustainability and the risk that baseline measures of intimate partner violence can wash out intervention effects. We emphasise the importance of studying the processes of adaptation, integration and coordination in the context of the wider healthcare system.Please see related article: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0880-y.

Delivery of Community-Based Care Through Inter-professional Teams in Brazil's Unified Health System (UHS): Comparing Perceptions Across Community Health Agents (CHAs), Nurses and Physicians.

Given the shortage of medical providers and the need for medical decisions to be responsive to community needs, including lay health providers in health teams has been recommended as essential for the successful management of global health care systems. Brazil's Unified Health System (UHS) is a model for delivering community-based care through Family Health Strategy (FHS) interdisciplinary teams comprised of medical and lay health providers-Community Health Agents (CHAs), nurses, and physicians. This study aims to understand how medical and lay health providers' perceptions and attitudes could impact the delivery of community-based care. The study compares perceptions and attitudes of 168 CHAs, 62 nurses, and 32 physicians across their job context, professional capacities, professional skills, and work environment. Descriptive and bivariate analysis were performed. CHAs reported being the most efficacious amongst the providers. Physicians reported incorporating consumer-input to a lesser degree than nurses and CHAs. CHAs reported using a lesser variety of skills than physicians. A significant proportion of physicians compared to CHAs and nurses reported that they had decision-making autonomy. Providers did not report differences that lack of resources and poor work conditions interfered with their ability to meet consumer needs. This study offers technocratic perspectives of medical and lay health providers who as an inter-professional team provide community-based primary health care. Implications of the study include proposing training priorities and identifying strategies to integrate lay health providers into medical teams for Brazil's Unified Health System and other health systems that aim to deliver community-based care through inter-professional health teams.

Cuidado e autocuidado em oncologia: significados para profissionais e usuários / Care and self-care in oncology: meaning for health providers and patients

O objetivo deste trabalho foi compreender os significados do cuidado para profissionais e usuários de um serviço de oncologia. Foi realizado um estudo qualitativo, de cunho exploratório e descritivo. Para coleta de informações o instrumento de complemento de frases juntamente com um roteiro de entrevista semiestruturada. As informações foram submetidas à análise do Discurso do Sujeito Coletivo proposta por Lefèvre e Lefèvre. Doze sujeitos participaram do estudo, sendo cinco usuários e sete profissionais. O estudo avaliou três eixos temáticos, Cuidado e autocuidado, Serviço e Sugestões. Como resultado, o cuidado foi associado à atenção a si próprio e ao outro, já o autocuidado foi associado à atitude de se ter atenção consigo mesmo, vinculada a prática de hábitos saudáveis e atividades prazerosas. O segundo eixo explorou a necessidade de cuidado à pessoa com câncer, emergindo a importância do atendimento humanizado, e das tecnologias relacionais; e também a necessidade do cuidado para o profissional de saúde. O último eixo apresenta sugestões dos participantes para a instituição, que incluem a criação de espaços de acolhimento e escuta para todos os protagonistas do sistema. Sugere-se a implantação dos princípios da Política Nacional de Humanização, tais como a clínica ampliada, o acolhimento e o controle social para a construção de um espaço que favoreça atender as demandas subjetivas dos atores sociais da saúde.

The objective of this study was to understand the meaning of care for health providers and patients from an oncology service. A qualitative, exploratory and descriptive study was conducted in a Brazilian Hospital. Semi-structured interviews and a complementing phrases tool were used to gather information which that was analysed using Collective Subject Discourse proposed by Lefèvre and Lefèvre. Twelve participants were enrolled in the study (five patients andseven health providers). The study analysed three categories, care and self-care, service and Suggestions to enhance quality at services. The care was associated with attention to himself and to the other, self-care was associated with the attitude of paying attention to yourself thru healthy habits and pleasurable activities. The second area explored wasthe need to care for the person with cancer, emerging the importance of humanized care, and relational technologies; and also the need of caring for the health providers as well. The last axis shows suggestions of the participants to theinstitution, including the creation of spaces of welcome and listen to all protagonists. It is suggested to implementthe principles of the National Policy of Humanization, such as amplified clinic, openness and social protagonism to build an environment that fosters meet the subjective demands of all stakeholders.

Cuidado e autocuidado em oncologia: significados para profissionais e usuários / Care and self-care in oncology: meaning for health providers and patients

O objetivo deste trabalho foi compreender os significados do cuidado para profissionais e usuários de um serviço de oncologia. Foi realizado um estudo qualitativo, de cunho exploratório e descritivo. Para coleta de informações o instrumento de complemento de frases juntamente com um roteiro de entrevista semiestruturada. As informações foram submetidas à análise do Discurso do Sujeito Coletivo proposta por Lefèvre e Lefèvre. Doze sujeitos participaram do estudo, sendo cinco usuários e sete profissionais. O estudo avaliou três eixos temáticos, Cuidado e autocuidado, Serviço e Sugestões. Como resultado, o cuidado foi associado à atenção a si próprio e ao outro, já o autocuidado foi associado à atitude de se ter atenção consigo mesmo, vinculada a prática de hábitos saudáveis e atividades prazerosas. O segundo eixo explorou a necessidade de cuidado à pessoa com câncer, emergindo a importância do atendimento humanizado, e das tecnologias relacionais; e também a necessidade do cuidado para o profissional de saúde. O último eixo apresenta sugestões dos participantes para a instituição, que incluem a criação de espaços de acolhimento e escuta para todos os protagonistas do sistema. Sugere-se a implantação dos princípios da Política Nacional de Humanização, tais como a clínica ampliada, o acolhimento e o controle social para a construção de um espaço que favoreça atender as demandas subjetivas dos atores sociais da saúde. (AU)

The objective of this study was to understand the meaning of care for health providers and patients from an oncology service. A qualitative, exploratory and descriptive study was conducted in a Brazilian Hospital. Semi-structured interviews and a complementing phrases tool were used to gather information which that was analysed using Collective Subject Discourse proposed by Lefèvre and Lefèvre. Twelve participants were enrolled in the study (five patients andseven health providers). The study analysed three categories, care and self-care, service and Suggestions to enhance quality at services. The care was associated with attention to himself and to the other, self-care was associated with the attitude of paying attention to yourself thru healthy habits and pleasurable activities. The second area explored wasthe need to care for the person with cancer, emerging the importance of humanized care, and relational technologies; and also the need of caring for the health providers as well. The last axis shows suggestions of the participants to theinstitution, including the creation of spaces of welcome and listen to all protagonists. It is suggested to implementthe principles of the National Policy of Humanization, such as amplified clinic, openness and social protagonism to build an environment that fosters meet the subjective demands of all stakeholders. (AU)

Cross-National Analysis of Beliefs and Attitude Toward Mental Illness Among Medical Professionals From Five Countries.

This quantitative study sought to compare beliefs about the manifestation, causes and treatment of mental illness and attitudes toward people with mental illness among health professionals from five countries: the United States, Brazil, Ghana, Nigeria, and China. A total of 902 health professionals from the five countries were surveyed using a questionnaire addressing attitudes towards people with mental illness and beliefs about the causes of mental illness. Chi-square and analysis of covariance (ANCOVA) were used to compare age and gender of the samples. Confirmatory factor analysis was employed to confirm the structure and fit of the hypothesized model based on data from a previous study that identified four factors: socializing with people with mental illness (socializing), belief that people with mental illness should have normal roles in society (normalizing), non-belief in supernatural causes (witchcraft or curses), and belief in bio-psycho-social causes of mental illness (bio-psycho-social). Analysis of Covariance was used to compare four factor scores across countries adjusting for differences in age and gender. Scores on all four factors were highest among U.S. professionals. The Chinese sample showed lowest score on socializing and normalizing while the Nigerian and Ghanaian samples were lowest on non-belief in supernatural causes of mental illness. Responses from Brazil fell between those of the U.S. and the other countries. Although based on convenience samples of health professional robust differences in attitudes among health professionals between these five countries appear to reflect underlying socio-cultural differences affecting attitudes of professionals with the greater evidence of stigmatized attitudes in developing countries.