Breastfeeding interventions and programmes conducted in Portuguese-speaking sovereign states: A scoping review.

AIM: This scoping review aimed to identify and appraise the effectiveness and impact of breastfeeding promotion interventions conducted across Portuguese-speaking sovereign countries. METHODS: Using the PRISMA-ScR guidelines, we searched 14 electronic databases for publications published through 31 July 2023. The search terms were designed to find studies promoting breastfeeding or exclusive breastfeeding in pre-defined Portuguese-speaking countries. RESULTS: Of the 5263 papers initially retrieved, 30 interventional studies on breastfeeding met the inclusion criteria across three countries: Brazil (N = 26), Portugal (N = 2) and Guinea Bissau (N = 2). Participants ranged from pregnant women, mothers, mother-infant pairs, healthcare professionals, and school children. Overall, the interventions increased exclusive breastfeeding and better breastfeeding practices, such as a higher duration of breastfeeding. The interventions positively affected maternal breastfeeding self-efficacy, knowledge and perception. Only four studies used a theoretical framework. CONCLUSION: While the results were often statistically significant, no study had an outcome close to the recommended UNICEF and WHO goal of 70% breastfeeding at six months. The need to determine what works for the recommended six months postpartum period is critical for maximising children's health in Portuguese-speaking countries.

Determinantes de la gestión del riesgo en salud en el Régimen Subsidiado en Colombia: estudio cualitativo

Introducción: El Régimen Subsidiado (RS) del sistema de salud colombiano tiene problemáticas estructurales que no han sido solucionadas y son pocos los estudios que profundizan en la explicación de estas. Objetivo: Explorar la experiencia en la dirección estratégica y gestión operativa y financiera de este régimen, sus aspectos operativos y de gestión del riesgo en esta población, así como las diferencias percibidas frente al Régimen Contributivo. Metodología: Estudio cualitativo. Se utilizó el análisis del discurso desde la perspectiva sociohermenéutica como técnica analítica. Se entrevistaron diez participantes, entre directivos de aseguradoras del RS y gestores del sistema de salud. Las entrevistas fueron grabadas y anonimizadas, previo consentimiento informado. Resultados: Emergen tres patrones discursivos que explican la gestión del riesgo en el RS y su diferenciación con el contributivo. Estos patrones se conectan por medio del rol de los determinantes sociales de la salud como ordenador principal de los procesos de salud-enfermedad y de atención en este régimen. A su vez, estas condiciones de vida son las que determinan de manera importante el perfil epidemiológico, acceso, costo de la atención y en general la forma cómo se consumen los servicios de salud por la población afiliada. Discusión: La literatura del aseguramiento en salud reporta que la gestión del riesgo es una función central y supone un ejercicio estratégico para el adecuado manejo de la siniestralidad para optimizar el uso de la Unidad de Pago por Capitación (UPC) asignada. Los hallazgos muestran que los determinantes sociales de la salud no están siendo tenidos en cuenta como ordenador para la atención, por lo tanto, la gestión del riesgo se centra en la atención de patologías en estados avanzados. Conclusiones: los actores perciben que en general, la situación de salud de los afiliados en este régimen es más grave, más complicada y con mayor carga, lo cual genera una tensión en materia de suficiencia de la unidad per cápita. Existe una ausencia discursiva sobre el rol del modelo de atención y su correlación con las necesidades de esta población.

Introduction: The subsidized regime (SR) of the Colombian health system has structural problems that have not yet been resolved and there is a lack of studies that allow the understanding of most of them. The aim of this study was to explore with stakeholders of the subsidized regime the experience about strategic, financial, and health risk management and the differences perceived with the contributory regime. Methods: A qualitative study was performed; the analytic technique used was the discourse analysis under socio-hermeneutic perspective. 10 participants were interviewed, among them directors of insurance companies of SR and health care system managers. The interviews were recorded, prior informed consent, and analyzed according to the discourse analysis. Finding: Three discursive patterns emerged that explain risk management in SR and its differentiation from contributory regime. These patterns are connected through the role of the social determinants of health as the main axis that explain the health-disease and care processes in this regimen. At the same time, these living conditions are what determine the epidemiological profile, access, cost of care and, in general, the way in which health services are consumed by the affiliated population. Discussion: The health insurance literature reports that risk management is a central function, and it is a strategic exercise for the proper management of claims to optimize the use of resources, however, the findings show that the social determinants of health are not being taken into account as a key element for healthcare organization, therefore, risk management focuses on care for pathologies in advanced stages. Conclusions: The actors perceive that the health situation in this regime is more severe, more complicated and with a greater burden disease, which generates a tension in terms of sufficiency of the Per Capita Unit. There is a discursive absence on the role of the care model and its correlation with the needs of this population.

Effectiveness and safety of probiotics as adjuvants in the eradication of Helicobacter pylori. Systematic review and meta-analysis / Efectividad y seguridad del uso de probióticos como adyuvantes en la erradicación de Helicobacter pylori. Revisión sistemática y metaanálisis

Abstract Introduction: Adding probiotics to triple and quadruple therapies has been proposed to improve their effectiveness in the eradication of Helicobacter pylori, but there is controversy about their usefulness. Objective: To assess the effectiveness and safety of probiotics as adjuvants in triple or quadruple therapies for H. pylori eradication in adults. Materials and methods: Systematic review and meta-analysis. Randomized clinical trials (RCTs) assessing the effectiveness and safety of probiotics as adjuvant therapy in combination with triple and quadruple therapies for the eradication of H. pylori in adults and published in English or Spanish between January 2010 and May 2020 were searched in the Embase, Ovid Medline, Cochrane Library, and LILACS databases. Regarding the meta-analysis, a fixed-effects model was used to calculate the pooled measure (OR and RR) of the effectiveness and safety of using adjuvant probiotics in triple and quadruple therapy. Results: Twelve RCTs were included (1 091 patients in total): 9 assessed triple therapy, 2 assessed quadruple therapy, and 1 assessed both triple and quadruple therapy. In the case of triple therapy, the use of adjuvant probiotics was more effective than placebo: 79.4% vs. 71.1%, (OR=1.42; 95%CI: 1.05-2.09), but in the case of quadruple therapy, their use did not increase effectiveness. The most widely used probiotic was Lactobacillus reuteri, with an eradication rate of 77.9% (95%CI: 70.5-84.19) versus 66.8% (95%CI: 58.8-74.2) for placebo. Probiotics decreased the occurrence of adverse effects in both triple therapy (OR=0.50; 95%CI: 0.28-0.90) and quadruple therapy (OR=0.26; 95%CI: 0.09-0.74). Conclusions. Adjuvant probiotics improve the effectiveness of triple therapy to eradicate H. Pylori by 8.5%, but the final effectiveness is <90%. Furthermore, their use does not increase the effectiveness of quadruple therapy. However, the use of these microorganisms reduces the adverse effects of these therapies.

Resumen Introducción. Se ha propuesto agregar probióticos a las terapias triples y cuádruples para mejorar su efectividad en la erradicación de Helicobacter pylori, pero existe controversia sobre su utilidad. Objetivo. Evaluar la efectividad y seguridad del uso adyuvante de probióticos en la terapia triple o cuádruple para la erradicación de H. pylori en adultos. Materiales y métodos. Revisión sistemática y metaanálisis. Se realizó una búsqueda en Embase, Ovid Medline, Cochrane Library y LILACS de ensayos clínicos aleatorizados (ECA) publicados en inglés o español entre enero de 2010 y mayo de 2020 que evalúan la efectividad y seguridad de usar probióticos como terapia coadyuvante en combinación con la terapia triple o cuádruple en la erradicación de H. pylori en adultos. En el metaanálisis se utilizó un modelo de efectos fijos para calcular la medida combinada (OR y RR) de efectividad y seguridad de los probióticos coadyuvantes en terapia triple y cuádruple. Resultados: Se incluyeron 12 ECA (1 091 pacientes en total): 9 evaluaron terapia triple; 2, terapia cuádruple, y I, terapia triple y cuádruple. En la terapia triple el uso coadyuvante de probióticos fue más efectivo que el uso de placebo: 79.4% vs. 71.1% (OR=1.42; IC95%: 1.05-2.09), pero en la terapia cuádruple, su uso no aumentó la efectividad. El probiótico más utilizado fue Lactobacillus reuteri, con una tasa de curación de 77.9% (IC95%: 70.5-84.19) versus 66.8% (IC95%: 58.8-74.2) del placebo. Los probióticos disminuyeron la ocurrencia de efectos adversos tanto en terapia triple (OR=0.50; IC95%: 0.28-0.90) como en cuádruple (OR=0.26; IC95%: 0.09-0.74). Conclusiones. El uso coadyuvante de probióticos mejora la efectividad de la terapia triple para erradicar H. Pylori en un 8.5%, pero la efectividad final es <90%. Además, su uso no aumenta la efectividad de la terapia cuádruple. No obstante, el uso de estos microorganismos disminuye los efectos adversos de estas terapias.

Ansiedad ante exámenes en universitarios: papel de engagement, inteligencia emocional y factores asociados con pruebas académicas / Test Anxiety university students: role of engagement, emotional intelligence and factors associated to academic test solving

Resumen Introducción: La ansiedad ante los exámenes (AE) es común entre universitarios e implica manifestaciones cognitivas, motoras y fisiológicas de tensión y preocupación permanente ante la evaluación que puede afectar su desempeño académico. Objetivo: Evaluar si el engagement, la inteligencia emocional y los factores asociados con la realización de pruebas académicas predicen las manifestaciones de AE en una muestra de 400 estudiantes universitarios. Método: Mediante un diseño predictivo transversal se evaluó el engagement (Vigor, Dedicación, Absorción), la inteligencia emocional (Atención, Claridad, Reparación) y diversos factores relacionados con pruebas académicas, analizando su relación con las manifestaciones de AE, y se construyeron modelos de regresión categórica para definir el nivel predictivo de las variables. Resultados: Se descartó la relación entre engagement y AE (p>0,05) mientras que Claridad y Reparación se asociaron inversamente con las manifestaciones de AE, excepto las fisiológicas. Diferentes factores asociados con la realización de exámenes como control docente, temor a la evaluación y tipo de preguntas predicen las respuestas de ansiedad fisiológica (R2=0,10, p<0,01), motora (R2=0,09, p<0,01) y cognitiva (R2=0,12, p<0,01). La Claridad predice negativamente la ansiedad motora (β=-0,131, p<0,01). Conclusiones: Engagement académico y AE se registran como variables independientes una de la otra, entre tanto, la Claridad emocional regula débilmente la ansiedad motora. Factores cognitivos y situacionales al momento de realizar exámenes son relevantes en el desencadenamiento de la respuesta ansiosa.

Abstract Introduction: Test Anxiety (TA) is common among university students and involves cognitive, motor, and physiological manifestations of tension and permanent concern about exams that may affect their academic performance. Objective: Assess whether engagement, emotional intelligence and factors associated with academic test solving predict the manifestations of TA in a sample of 400 university students. Method: Using a cross-sectional predictive design, engagement (Vigor, Dedication, Absorption), emotional intelligence (Attention, Clarity, Repair) and several factors related to academic test solving were evaluated, analyzing their relationship with the manifestations of TA, and categorical regression models were constructed to define the predictive level of the variables. Results: The relationship between engagement and TA was discarded (p>0,05) while Clarity and Repair were inversely associated with TA manifestations, except the physiological ones. Different factors associated with exams such as professor control, fear of exams and the question type predict physiological (R2=0,10, p<0,01), motor (R2=0,09, p<0,01) and cognitive (R2=0,12, p<0,01) anxiety responses. Clarity predicts motor anxiety (β=-0,131, p<0,01) negatively. Conclusions: Academic engagement and TA are registered as independent variables of each other; meanwhile, emotional Clarity regulates motor anxiety weakly. Cognitive and situational factors at the time of exams are relevant in the triggering of the anxious response.

Síndrome de burnout: conhecimento da equipe saúde do trabalhador / Burnout syndrome: occupational health team's knowledge / Síndrome de Burnout: conocimiento del equipo de la salud de el trabajador

Objetivo: investigar o conhecimento da equipe de Saúde do Trabalhador, sobre a Síndrome de Burnout. Métodos: pesquisa exploratória, qualitativa, realizada com nove trabalhadores de um hospital universitário. Aplicaram-se para a coleta de dados, um questionário e um roteiro de entrevista semiestruturado, analisados por meio da técnica de Análise de conteúdo. Resultados: emergiram-se, pelo material empírico oriundo das entrevistas, as seguintes categorias: Conhecimento sobre a Síndrome de Burnout; Sinais e sintomas do burnout; Vulnerabilidade ocupacional para o desenvolvimento de Burnout; Consequências do burnout para a saúde do trabalhador. Conclusão: é imprescindível disseminar o conhecimento sobre o burnout entre os trabalhadores, para se propor estratégias eficazes de prevenção e promoção de saúde em um hospital universitário

Objective: to evaluate the knowledge of an occupational health team about Burnout Syndrome of a university hospital. Method: exploratory research, qualitative, perfomed with nine workers. A questionnaire and a semistructured interview script were used for data collection, analyzed through the technique of Content Analysis. Results: empirical material from the interviews emerged as follows: Knowledge about Burnout Syndrome; Signs and symptoms of burnout; Occupational vulnerability for the development of Burnout; Consequences of burnout for occupational health. Conclusion: it is imperative to disseminate knowledge about burnout among workers in order to propose effective strategies for prevention and health promotion in a university hospital

Objetivo: evaluar el conocimiento del equipo de enfermería obstétrica acerca del Síndrome de Burnout. Método: Investigación exploratoria, cualitativo, realizada con nueve trabajadores de un hospital universitário. Se aplicaron para la recolección de datos, un cuestionario y un guión de entrevista semiestructurado, analizados por medio de la técnica de Análisis de contenido. Resultados: se surgieron, por el material empírico oriundo de las entrevistas, las siguientes categorías: Conocimiento sobre el síndrome de Burnout; Signos y síntomas del burnout; Vulnerabilidad ocupacional para el desarrollo de Burnout; Consecuencias del burnout para la salud del trabajador. Conclusión: es imprescindible diseminar el conocimiento sobre el burnout entre los trabajadores, para proponer estrategias eficaces de prevención y promoción de salud en un hospital universitario

Diagnóstico diferencial dentro del espectro del síndrome de Sjögren / Differential diagnosis within the spectrum of Sjögren's syndrome

RESUMEN El síndrome de Sjögren es una enfermedad autoinmune sistémica caracterizada clínicamente por ojo y boca secos, acompañados de manifestaciones extraglandulares como edema de glándulas submandibulares y parotidomegalia. La prevalencia varía en diferentes estudios epidemiológicos del 5 al 30%, dependiendo de la población estudiada. La xeroftalmia es más común en mujeres y su frecuencia incrementa con la edad. Cuando evaluamos un paciente con síndrome de Sjögren, debemos tener en cuenta diagnósticos diferenciales que pueden simular esta patología, como causas locales, sistémicas que incluyen metabólicas, infecciosas, medicamentosas, infiltrativas y malignas. Es necesario el estudio de otras causas para decidir si la terapia dirigida puede ser benéfica y evitar riesgos de eventos adversos en pacientes con síndrome sicca no autoinmune. Se realizó una revisión narrativa sobre los diagnósticos diferenciales en el espectro de paciente con síndrome seco a través de búsqueda de la literatura en las bases de datos PubMed y Google Scholar.

ABSTRACT Sjögren's syndrome is a systemic autoimmune disease clinically characterised by dry eye and mouth accompanied by extra-glandular manifestations such as oedema of the sub-mandibular glands and parotidomegaly. The prevalence of dry eye varies from 5% to 30% in different epidemiological studies, depending on the studied population. Xerophthalmia is more common in women and its frequency increases with age. When evaluating a patient with Sjogrens syndrome, differential diagnoses with disease that can simulate this pathology must be taken into account, such as local, systemic causes that include metabolic, infectious, medicinal, infiltrative, and malignancy. The study of other causes is necessary to decide whether targeted therapy can be beneficial and avoid risks of adverse events in patients with non-autoimmune sicca syndrome. A narrative review was conducted on the differential diagnoses in the spectrum of patients with 'dry syndrome' using a literature search in the PubMed and Google Scholar databases.

Human Papillomavirus (HPV) and the quadrivalent HPV Vaccine among Brazilian adolescents and parents: Factors associated with and divergences in knowledge and acceptance.

BACKGROUND: Low national immunization coverage (44.64%) requires strengthening the vaccination campaign to improve knowledge about HPV and its vaccine among adolescents and parents/guardians. Our aim is to evaluate factors related to knowledge about HPV, its vaccine, acceptability and divergences among Brazilian adolescents and parents/guardians. METHODS: A cross-sectional study was performed at a health unit of Sao Paulo University, Brazil, from 2015 to 2016. The convenience sample comprised 1047 individuals, including 74% (n = 776) adolescents and 26% (n = 271) parents/guardians, who answered a survey (knowledge about HPV, its vaccine, barriers and acceptability). RESULTS: The main source of information for adolescents was school (39%, n = 298); for parents/guardians, it was health professionals (55%, n = 153). Parents/guardians were 2.48 times more likely than adolescents to know that HPV caused changes in the Pap smear test [RR 2.48, 95% CI 2.03-3.01 (p < 0.001)], 1.43 times likely to be aware that HPV was a sexually transmitted infection [RR 1.43, 95% CI 1.22-1.68 (p < 0.001)], and 2.77 times likely to be informed that the HPV vaccine decreased the chance of having genital warts [RR 2.77, 95% CI 2.22-2.47 (p < 0.001)]. Girls knew more about the topic than boys (RR 1.67; 95% CI 1.10-2.60); education increased parents' knowledge [(RR 3.38; 95% CI 1.71-6.69)]. CONCLUSION: Female adolescents and parents/guardians with a higher level of education are factors related to suitable knowledge about HPV and its vaccine among Brazilian respondents. There were differences between parents/guardians and adolescents in HPV awareness, clinical implications, vaccine knowledge and vaccine acceptance.

Ingestão acidental de crack por cão - relato de caso / Dog acidental ingestion of crack - case report / Ingesta accidental de crack por perro - informe de caso

O crack é uma potente droga ilícita que traz grave sintomatologia. A ingestão não é a forma habitual de utilização da droga, e sim pelo fumo. Quando o sistema nervoso é estimulado por essa substância ocorre vasoconstrição, aumento da pressão arterial, taquicardia e pode haver arritmias ventriculares, mas os efeitos no organismo são agravados quando ocorre a ingestão, devido a ação ionizante do suco gástrico no estômago. As consequências para o intestino podem ser de isquemia por conta da vasoconstrição e consequentemente necrose, por diminuição do fluxo sanguíneo. Esse artigo tem como objetivo relatar o caso de um cão da raça Bull Terrier com três anos de idade que ingeriu duas pedras da droga acidentalmente e foi submetido ao tratamento clínico de suporte, medicamentos adsorventes, protetores gástricos e hepáticos, associado a fármacos anticonvulsivos, promovendo o restabelecimento de sua saúde.

Crack is a powerful and illegal drug which causes a severe symptomatology. Its ingestion is not the common way of its use, which is through smoking. When the nervous system is stimulated by this substance, there are vasoconstriction, increase of arterial pressure, tachycardia and there might be ventricular arrhythmia, but the effects on the organism are worse when there is drug ingestion, because of the stomach gastric juice’s ionizing action. The consequences for the stomach may be ischemia caused by vasoconstriction and, later then, necrosis caused by low blood irrigation. This paper has the goal to relate the case of a three-year-old Bull Terrier, who accidently ingested two rocks of the drug and was submitted to clinical support treatment, adsorbent drugs, gastric and hepatic protective drugs, associated to antiseizure’s drugs, providing the dog’s health improvement.

El crack es una droga ilegal de gran alcance que trae síntomas graves. La ingestión no es la forma habitual de usar el medicamento, pero a través del humo. Cuando el sistema nervioso es estimulado por la sustancia se produce vasoconstricción, aumento de la presión sanguínea, taquicardia y arritmias ventriculares, pero los efectos en el cuerpo se agravan cuando la ingesta se produce por la acción ionizante de los jugos gástricos en el estómago. El efecto sobre la isquemia intestinal puede ser debido a la vasoconstricción y de este modo necrosis, por disminución del flujo sanguíneo. Este artículo tiene como objetivo informar el caso de un perro de raza Bull Terrier con tres años de edad que ingirió dos piedras de la droga accidentalmente y fue sometido a un tratamiento doctor de apoyo, adsorbentes medicamentos, protectores gástricos y hepáticos, asociados con los fármacos anticonvulsivos, promoviendo la restauración de su salud.

Ingestão acidental de crack por cão - relato de caso / Dog acidental ingestion of crack - case report / Ingesta accidental de crack por perro - informe de caso

O crack é uma potente droga ilícita que traz grave sintomatologia. A ingestão não é a forma habitual de utilização da droga, e sim pelo fumo. Quando o sistema nervoso é estimulado por essa substância ocorre vasoconstrição, aumento da pressão arterial, taquicardia e pode haver arritmias ventriculares, mas os efeitos no organismo são agravados quando ocorre a ingestão, devido a ação ionizante do suco gástrico no estômago. As consequências para o intestino podem ser de isquemia por conta da vasoconstrição e consequentemente necrose, por diminuição do fluxo sanguíneo. Esse artigo tem como objetivo relatar o caso de um cão da raça Bull Terrier com três anos de idade que ingeriu duas pedras da droga acidentalmente e foi submetido ao tratamento clínico de suporte, medicamentos adsorventes, protetores gástricos e hepáticos, associado a fármacos anticonvulsivos, promovendo o restabelecimento de sua saúde.(AU)

Crack is a powerful and illegal drug which causes a severe symptomatology. Its ingestion is not the common way of its use, which is through smoking. When the nervous system is stimulated by this substance, there are vasoconstriction, increase of arterial pressure, tachycardia and there might be ventricular arrhythmia, but the effects on the organism are worse when there is drug ingestion, because of the stomach gastric juices ionizing action. The consequences for the stomach may be ischemia caused by vasoconstriction and, later then, necrosis caused by low blood irrigation. This paper has the goal to relate the case of a three-year-old Bull Terrier, who accidently ingested two rocks of the drug and was submitted to clinical support treatment, adsorbent drugs, gastric and hepatic protective drugs, associated to antiseizures drugs, providing the dogs health improvement.(AU)

El crack es una droga ilegal de gran alcance que trae síntomas graves. La ingestión no es la forma habitual de usar el medicamento, pero a través del humo. Cuando el sistema nervioso es estimulado por la sustancia se produce vasoconstricción, aumento de la presión sanguínea, taquicardia y arritmias ventriculares, pero los efectos en el cuerpo se agravan cuando la ingesta se produce por la acción ionizante de los jugos gástricos en el estómago. El efecto sobre la isquemia intestinal puede ser debido a la vasoconstricción y de este modo necrosis, por disminución del flujo sanguíneo. Este artículo tiene como objetivo informar el caso de un perro de raza Bull Terrier con tres años de edad que ingirió dos piedras de la droga accidentalmente y fue sometido a un tratamiento doctor de apoyo, adsorbentes medicamentos, protectores gástricos y hepáticos, asociados con los fármacos anticonvulsivos, promoviendo la restauración de su salud.(AU)

Predictores de la ansiedad ante la estadística: Ansiedad ante los exámenes y baja depuración cognitiva / Statistics anxiety is predicted by test anxiety and lack of cognitive depuration

Las competencias en estadística responden al desarrollo de habilidades esenciales para la comprensión de la realidad y la toma de decisiones personales y profesionales. Un gran número de profesiones emplea la estadística como elemento esencial en investigación y análisis de información, pero también es común la respuesta de ansiedad ante estos contenidos. El objetivo de este estudio fue analizar las estrategias metacognitivas implicadas en procesos de ansiedad ante la estadística, así como el papel de la ansiedad ante los exámenes en este fenómeno. Se analizó una muestra de universitarios habituados al tratamiento de información cuantitativa, en ellos se observaron bajos niveles de estrategias metacognitivas para el aprendizaje y niveles moderados de ansiedad. En un modelo de regresión se identificó que la ansiedad estadística se predice débilmente por la falta de depuración y fuertemente por la ansiedad ante los exámenes

Statistics competencies respond to the development of essential skills for understanding reality and making personal and professional decisions. A lot of professions use statistics as an essential element in research and information analysis, but anxiety about statistical content is also common. The objective of this study was to analyze the metacognitive strategies involved in processes of statistics anxiety, as well as the role of test anxiety in this phenomenon. We analyzed a sample of university students accustomed to the treatment of quantitative information, in which low levels of metacognitive strategies for learning and moderate levels of anxiety were observed. In a regression model, it was identified that statistics anxiety is weakly predicted due to the lack of depuration and strongly by test anxiety

Análisis de eficiencia multidireccional en hospitales públicos del Valle del Cauca / Multidirectional Efficiency Analysis in Public Hospitals of Valle Del Cauca / Análise de eficiência multidirecional em hospitais públicos do Valle del Cauca

Resumen La crisis financiera de los hospitales públicos en Colombia conlleva un análisis detallado de cómo funcionan los diferentes servicios de salud, a fin de detectar fallas y generar una mejor utilización de los recursos. En esta investigación se estudiaron los niveles de eficiencia de 44 hospitales públicos del departamento del Valle del Cauca, referente a los servicios de ginecología y obstetricia, odontología y urgencias, entre los años 2007 y 2014. Adoptamos un método determinístico no paramétrico reciente, hasta ahora no aplicado en estudios científicos de salud en Colombia, el cual combina el análisis de eficiencia multidireccional con otras relevantes técnicas para comparar grupos con diferentes niveles de eficiencia. Los resultados indicaron que más del 60 % de los hospitales quedaron en el rango de poco eficientes, lo cual evidencia un inadecuado uso de los insumos (inputs). Esperamos motivar a burócratas a incorporar este tipo de técnicas de evaluación en su proceso de toma de decisiones.

Abstract Financial crises in the Colombian public hospitals call for a detailed analysis on how its different health services work, in order to detect the failures and attain a better use of the resources. This research examined the efficacy levels in 44 public hospitals throughout the Valle del Cauca province, covering the gynecology and obstetrics, dentistry, and emergency services between 2007 and 2014. A recent non-parametric deterministic method was used. Thus far, it has not been applied to health scientific studies in Colombia. It combines the multidirectional efficacy analysis with other relevant techniques in order to compare groups with different efficiency levels. Results showed that more than 60% of the hospitals were in the poor efficiency level, which evinces they are not making an appropriate use of their inputs. This report is expected to encourage the bureaucrats to include evaluation techniques like this in their decision-making processes.

Resumo A crise financeira dos hospitais públicos na Colômbia envolve uma análise detalhada de como funcionam os diferentes serviços de saúde, a fim de detectar falhas e gerar um melhor uso dos recursos. Nesta pesquisa estudaram-se os níveis de eficiência de 44 hospitais públicos do departamento do Valle del Cauca, referente aos serviços de ginecologia e obstetrícia, odontologia e urgências, entre os anos 2007 e 2014. Pegamos um método determinístico não paramétrico recente, até agora não aplicado em estudos científicos de saúde na Colômbia, o qual combina análise de eficiência multidirecional a outras relevantes técnicas para comparar grupos com diferentes níveis de eficiência. Os resultados indicaram que mais de 60 % dos hospitais ficou na faixa de pouco eficientes, o que evidencia um inadequado uso dos insumos (inputs). Esperamos motivar os burocratas para incorporarem este tipo de técnicas de avaliação no seu processo de tomada de decisões.

HPV vacina: conhecer e aceitar para assegurar a eficácia / HPV vaccine: knowledge and acceptance to ensure effectiveness

The new Vaccine technologies against transmissible and non-transmissible diseases, such as cancer, have had an impact on international public health. The human papillomavirus (HPV) vaccine is used on a large scale in immunization programs in more than 58 countries, with resultant efficacy and safety for precursor lesions of cervical cancer, in addition to anogenital lesions. After the introduction of quadrivalent HPV vaccine (6,11,16 and 18) in Brazil in 2014, monitoring the vaccination coverage and the development of HPV prevalence incidence of cervical abnormalities and precancerous lesions must be observed, as well as morbidity and mortality trends from in situ and invasive cancer. Encouraging information, counseling and continuing education is recommended as a strategy to broaden vaccine acceptance in order to sediment its implementation and ensure effectiveness in reducing new cases of cervical cancer in the future.

As novas tecnologias em vacina contra doenças transmissíveis e não transmissíveis como o câncer, tiveram impacto na saúde pública internacional, especificamente a vacina para o papiloma vírus humano (HPV) utilizada em larga escala nos programas de imunização em mais de 58 países, com resultados de eficácia e segurança para lesões precursoras do câncer de colo do útero além de lesões anogenitais. Após a introdução em território Nacional da vacina quadrivalente para o HPV (6,11,16 e 18) desde 2014, ressalta-se a importância do monitoramento da cobertura vacinal e o desenvolvimento de estudos de prevalência de HPV em logo prazo, de incidência de anormalidades cervicais e lesões pré-cancerosas bem como de tendência de morbimortalidade por câncer in situ e invasivo. O incentivo às informações, aconselhamento e educação continuada é recomendado como uma estratégia para ampliar a aceitação da vacina a fim de sedimentar sua implantação e assegurar a eficácia na redução dos novos casos de câncer de colo do útero para o futuro.

Brief Behavioral Intervention to Improve Adolescent Sexual Health: A Feasibility Study in the Emergency Department.

OBJECTIVE: Although emergency department (ED) visits offer an opportunity to deliver brief behavioral interventions to improve health, provision of ED-based interventions targeting adolescent sexual health is uncommon. The objectives for this study were to evaluate the feasibility and preliminary effects of a novel sexual health service intervention for adolescents. METHODS: In this cross-sectional feasibility study, sexually active patients aged 14 to 19 years presenting to a Midwestern pediatric ED were recruited to receive an intervention to improve sexual health. The intervention, based on motivational interviewing (MI), included agenda setting, exploration of behaviors, a decisional balance exercise, tailored feedback, and provision of personalized health services (including condoms, prescription for emergency contraception, urine testing for Chlamydia trachomatis and Neisseria gonorrheae, and referral to the hospital-affiliated adolescent clinic). Data were collected before and after intervention administration and at a 3-month follow-up telephone interview. Surveys assessed sexual risk behaviors, satisfaction with the intervention, health care use, and demographics. Feasibility criteria were (1) subject-rated interventionist fidelity to MI principles (Likert scale 1 [strongly agree] to 4 [strongly disagree]), (2) subject satisfaction (Likert scale 1 [not at all] to 5 [very]), and (3) session duration (minutes, recorded by the interventionist). A secondary outcome was the proportion of subjects who completed at least 1 health service. Services provided at the adolescent clinic were determined by an electronic medical record review. Comparisons of responses between sex subgroups were analyzed using Χ test. RESULTS: From August to November 2012, 69 adolescents were approached, 66 (96%) completed the screening survey, and 24 (37%) reported previous sexual activity. Of those, 20 (83%) agreed to participate. The mean (SD) age was 16.2 (1.4) years; 60% were female. Most (78%) reported that the interventionist maintained high fidelity to MI principles and most (80%) were very satisfied with the intervention. Mean (SD) intervention length was 15.7 (2.2) minutes. Most subjects (65%) accepted 1 or more health services, including 42% who completed clinic follow-up. In the ED or the referral clinic, the following services were provided to the subjects: condoms (n = 11), emergency contraception prescription (n = 5), C. trachomatis/N. gonorrheae testing (n = 4), hormonal birth control provision (n = 2), and human immunodeficiency virus testing (n = 3). Fifteen subjects (75%) were reached for the 3-month follow-up, and condom use was maintained by 67% of those reporting sexual activity. CONCLUSIONS: This study demonstrated the feasibility and potential utility of an MI-based service navigation intervention to connect youth with point-of-care services as well as resources for ongoing sexual health needs.

Imagined anatomy and other lessons from learner verification interviews with Mexican immigrant women.

OBJECTIVE: To identify clearer, learner-preferred, educational approaches for aspects of cervical cancer education found to be difficult to understand for low-literacy, Mexican, immigrant women. SETTING: Kansas City, Kansas; Garden City, Kansas; San Antonio, Texas. PARTICIPANTS: Forty-five Mexican immigrant women in the United States for 5 years or less, ninth grade education or less, and predominantly Spanish speaking. METHODS: Interviews were conducted to evaluate preference and best comprehension among options for specific cervical cancer educational elements, including reproductive system terminology, the purpose of Pap tests and meaning of results, Human Papilloma Virus (HPV), and illustrations of anatomy and Pap procedure. RESULTS: We identified terminology, translation, content, and illustrations preferred by participants and areas of inadequate existing knowledge needed for comprehension of concepts being taught. Analogies, illustrations, and introduction of medical terms in conjunction with equivalent common Spanish terms were effective ways of building bridges from existing knowledge to new knowledge. Participants desired detailed information and shared new information with others CONCLUSION: We learned the importance of assessing patients' existing body knowledge. The detail desired by participants challenged common simplification approaches to teaching low-literacy learners. Participant willingness to share information challenged ideas of cultural taboo. Results provide evidence for more effective delivery of women's health education and call for further research on best approaches to teaching low-literacy learners.

Clinician perceptions of providing natural family planning methods in Title X funded clinics.

INTRODUCTION: Natural family planning (NFP) methods are effective for contraception with proper and consistent use. However, only 1% of patients at federally funded Title X family planning clinics select NFP as a contraceptive method. The goal of this study was to understand from clinicians' perspectives the barriers and facilitators to providing NFP methods. METHODS: Six telephone focus groups were conducted with 29 clinicians from Title X clinics across the United States and Puerto Rico. A hermeneutic method was used to analyze data for related themes. RESULTS: The overarching theme from the study was that participants had a strong desire to teach their patients how their bodies work and to empower them to learn to control fertility. Four subthemes emerged: patient misinformation and misunderstanding about fertility; provider ideas about ideal types of candidates for NFP; inconsistent patient teaching strategies; and lack of time to teach NFP methods. DISCUSSION: There is a need for increased NFP training for providers and efficient NFP patient teaching strategies to meet the needs of patients with limited knowledge about fertility.

Atividade física habitual de crianças e adolescentes mensurada por pedômetro e sua relação com índices nutricionais / Usual physical activity in children and adolescents measured by pedometer and its association with nutritional indicators

A monitoração dos níveis de prática de atividade física em segmentos da população jovem tem se tornado importante tema de interesse entre especialistas da área. O Objetivo do estudo foi verificar o nível de atividade física de escolares, baseando-se em duas recomendações vigentes, e analisar a existência de associações entre a quantidadede passos/dia e diferentes indicadores de adiposidade corporal. A casuística foi composta por 162 indivíduos de dez a 18 anos (65 do sexo masculino e 97 do sexo feminino). Foram calculados o Índice de Massa Corporal e o percentual de gordura por impedância bioelétrica. O nível de atividade física habitual foi mensurado por meio de ?pedômetro? (NewLifestyles modelo NL-2000) e analisado de acordo com duas recomendações internacionais: Duncan et al. (masculino: 16.000 passos/dia e feminino: 13.000 passos/dia) e Tudor-Locke et al. (masculino: 15.000 passos/dia e feminino: 12.000 passos/dia). O teste t de Student e a ANOVA One-Away (Post Hoc ? LSD) compararam os grupos formados. O nível de significância adotado foi de 5% (p£0,05). Dos resultados, apenas 18,5% da amostra cumpriu as recomendações propostas por Duncan e 25,9% cumpriram os pontos de corte propostospor Tudor-Locke et al.. Os adolescentes que não cumpriram as recomendações propostas por Duncan et al., apresentaram valores percentuais de gordura corporal maiores quando comparados aos jovens que cumpriram (p<0,05). Pode-se concluir que uma elevada taxa dejovens não cumpriu as duas recomendações analisadas, bem como, apenas um indicador de adiposidade associou-se com o cumprimento de umas das recomendações.

Monitoring physical activity levels in segments of the young population has become an important topic among specialists. The objective of this study was to analyze the physical activity level of schoolchildren based on two current recommendations and to examine the association between the number of steps/day and different indicators of adiposity. The sample consisted of 162 subjects aged 10 to 18 years (65 boys and 97 girls). Body mass index and body fat percentage were calculated. The level of physical activity was quantified with a pedometer (New LifestylesNL-2000) based on the following recommendations: Duncan et al. (male: 16,000 steps/day and female: 13,000 steps/day) and Tudor-Locke et al. (male: 15,000 steps/day and female: 12,000 steps/day). The Student t-test and one-way ANOVA (LSD post hoc test) were used forcomparison between groups. A level of significance of 5% was adopted (p £ 0.05). Only 18.5% of the sample met the recommendations proposed by Duncan et al. and 25.9% met the cutoff proposed by Tudor-Locke et al. Adolescents who did not meet the cutoff proposed by Duncan had higher body fat percentages than those who did (p < 0.05). In conclusion, a high rate of the youngsters did not meet the recommendations analyzed and only one indicator of adiposity was associated with meeting one of the recommendations

Atitudes sobre medicina da família entre estudantes brasileiros de medicina / Actitudes sobre medicina de familia entre estudiantes médicos brasileños / Attitudes about family medicine among brazilian medical students

Contexto e Objetivos: Sendo o Brasil o maior país da América Latina, o cuidado de saúde e os sistemas de educação para a saúde no país têm uma importância que vai além de suas fronteiras. Embora a Medicina da Família não seja parte do currículo em escolas médicas brasileiras, o sistema de saúde gira em torno do ”Programa de Saúde da Família”. Métodos: Estudantes assistentes de conferências em 6 escolas de medicina de São Paulo responderam a duas perguntas sobre o que consideraram interessante na Medicina da Família e quais os desafios a esta no Brasil. 167 respostas foram codificadas e classificaram segundo técnicas de análise qualitativas. Resultados: Os aspectos positivos da Medicina da Família identificados foram o caráter da relação paciente-médico, o caráter da prática, e a filosofia e os valores da Medicina da Família. Os obstáculos foram a falta de conhecimento da Medicina da Família pelos pacientes, a falta percebida do status dessa especialidade e sua ausência das escolas de medicina e da estrutura de residência. Conclusões: Os respondentes deram maior ênfase às características humanísticas e de relacionamento da Medicina da Família e menor ao conteúdo médico. Essa informação é útil para educadores brasileiros da área de Medicina da Família e pode sugerir que os esforços para aumentar o interesse estudantil nos EUA considerem a possibilidade de dar maior ênfase a esses aspectos da disciplina.

Contexto y Objetivos: Como el país más grande en América Latina, la asistencia médica de Brasil y sus sistemas de educación para la salud tienen una importancia más allá de sus fronteras. Mientras la medicina de familia no ha sido del plan de estudios en facultades de medicina brasileñas, el sistema de salud es construido alrededor del “Programa de Salud de la Familia”. Métodos: Estudiantes que asisten a conferencias en 6 facultades de medicina del área de São Paulo respondieron a dos preguntas sobre qué ellos juzgaran interesante en la medicina de familia y cuáles son los desafíos en Brasil a esta especialidad. 167 respuestas fueron cifradas y clasificadas según técnicas de análisis cualitativo. Resultados: los aspectos positivos de la medicina de la familia identificados fueran el carácterde la relación paciente-doctor, el carácter de la práctica, y la filosofía y los valores de la medicina de la familia. Los obstáculos incluyeron la ignorancia de parte de los pacientes a cerca de la medicina de la familia, la carencia percibida del status de la especialidad,y su ausencia de las facultades de medicina e de las estructuras de residencia. Conclusiones: Los demandados hicieron mayor hincapié en las características humanísticas y las características relacionales de la medicina de la familia, y menos en el contenido médico. Esas informaciones deberían ser útiles a educadores de medicina de la familia brasileños, y puede sugerir que los esfuerzos para aumentar el interés de los estudiantes en los EE.UU, consideren el mayor énfasis en estos aspectos de la disciplina.

Background and Objectives: As the largest country in Latin America, Brazil’s health care and health education systems have importance beyond its borders. While Family Medicine has not been part of the curriculum in Brazilian medical schools, the health system is built around the “Family Health Program”. Methods: Students attending lectures at 6 São Paulo area medical schools responded to two questions asking what they found interesting about and what the challenges were to Family Medicine in Brazil. 167 responses were coded and sorted using qualitative analysis techniques. Results: Positive aspects of Family Medicine identified were the character of the doctor-patient relationship, the character of the practice, and the philosophy and values of Family Medicine. Obstacles included the lack of knowledge by patients of Family Medicine, the perceived lack of specialty status, and its absence in the medical school and residency structure. Conclusions: The respondents placed greater emphasis on the humanistic and relationship characteristics of Family Medicine, and less on the medical content. This information should be useful to Brazilian Family Medicine educators, and may suggest that efforts to increase student interest in the US consider greater emphasis on these aspects of the discipline.

A prospective randomized controlled trial of an interpersonal violence prevention program with a Mexican American community.

Using methods of community-based participatory research, a prospective randomized controlled trial of a violence prevention program based on Latino cultural values was implemented with elementary school children in a Mexican American community. Community members participated in intervention program selection, implementation, and data collection. High-risk students who participated in the program had greater nonviolent self-efficacy and demonstrated greater endorsement of program values than did high-risk students in the control group. This collaborative partnership was able to combine community-based participatory research with a rigorous study design and provide sustained benefit to community partners.

Mexican-American neighborhood's social capital and attitudes about violence.

Measurement of the effectiveness of violence prevention interventions is in a developmental phase. Social capital provides a framework within which to examine this topic from a community perspective. The purpose of this study was to examine the relationships among three measures of social capital and attitudes about violence among Mexican-Americans. A cross-sectional survey was conducted of households randomly selected by block in two adjacent Mexican-American communities. Demographics, attitudes about and experiences with violence, and three measures of social capital (collective efficacy, neighborhood block conditions, community integration) were assessed. Descriptive, bivariate, and logistic regression analyses were used to examine indicators of violence attitudes and experiences. Of the 473 respondents who completed the survey, 323 (68%) were female, 393 (83%) were Mexican-American, 395 (84%) were born in the US, and 346 (72%) owned their own homes. Participants with high measures of collective efficacy were 1.68 times more likely to have negative attitudes about violence (CI 1.06-2.65) and 15.25 times more likely to have negative attitudes about couple violence (CI 9.05-25.74). Participants with high scores on neighborhood block conditions were 2.33 times more likely to have negative attitudes about couple violence (CI 1.40-3.87). Scores on community integration were not significant indicators of participants' tolerance and experiences with violence. Two measures of social capital were positively associated with and predictive of negative attitudes toward violence. The results suggest that primary violence prevention programs in Mexican-American communities should focus on strengthening a sense of collective efficacy and improving neighborhood conditions.