Anticipated Stigma and Social Barriers to Communication Between Transgender Women Newly Diagnosed with HIV and Health Care Providers: A Mediation Analysis.

Purpose: We assessed whether anticipated stigma (i.e., fear of public mistreatment due to gender identity) impacts communication between transgender women (TGW) living with HIV and health care providers. Methods: This is a secondary analysis of baseline data from Trans Amigas, a study conducted in Brazil, 2018. The study population consisted of TGW living with HIV, older than 18 years, residing in the São Paulo metropolitan area. We used multivariable logistic regression (α = 0.05), mediation, and bootstrapping for the analysis. Results: One hundred and thirteen participants completed the study. Fear of public mistreatment had an adjusted odds ratio (aOR) of 7.42 (p = 0.003) for difficulty reporting new symptoms to providers. Concerning fear of public mistreatment, we found that unemployment had an aOR of 3.62 (p = 0.036); sex work, an aOR of 2.95 (p = 0.041); and issues related to name change in documents, an aOR of 2.71 (p = 0.033). For the indirect effect on difficulty reporting new symptoms, mediated by fear of public mistreatment, unemployment had an aOR of 1.52 (confidence interval [CI] = 0.88-2.24); sex work, an aOR of 1.48 (CI = 0.81-2.52); and name change issues, an aOR of 1.47 (CI = 0.96-2.43). Conclusions: Anticipated stigma was associated with communication difficulties between TGW living with HIV and providers. Our data suggest that structural factors associated with anticipated stigma could indirectly impact on difficulty reporting new symptoms. These findings indicate the importance of considering social contexts that intersect with individual experiences when analyzing communication barriers between providers and patients, and the need to strengthen social policies for TGW in Brazil. Clinical Trial Registration number: R34MH112177.

Provider-Initiated HIV Testing in Puerto Rico from Data of the National HIV Behavioral Surveillance-Heterosexual Cycle (NHBS-HET) 2016: National Cross-sectional Survey.

BACKGROUND: According to the Centers for Disease Control and Prevention and World Health Organization guidelines, all individuals aged 13-64 years should get screened for HIV infection as part of their routine medical examinations. Individuals at high risk should get tested annually. OBJECTIVE: This study aimed to identify the sociodemographic, health care, and sexual behavioral characteristics of provider-initiated HIV testing using data from the Puerto Rico National HIV Behavioral Surveillance 2016 cycle, directed toward heterosexual individuals at increased risk of HIV infection. METHODS: A sample of 358 eligible participants were recruited through respondent-driven sampling, where sociodemographic characteristics, health care use, and HIV test referral were used to assess a description of the study sample. Pearson chi-square and Fisher tests were used to evaluate proportional differences. Multivariate logistic regression models were performed to determine the association between independent variables and HIV test referral. Adjusted prevalence ratios by sex and age with their 95% CIs were determined using a statistical significance level of .05. RESULTS: Despite 67.9% (243/358) of participants showing high-risk sexual behavioral practices and 67.4% (236/350) reporting a low perceived risk of HIV infection among those who visited a health care provider within the last 12 months, 80.7% (289/358) of the study sample did not receive an HIV test referral at a recent medical visit. Multivariate analysis showed that the estimated prevalence of the participants who received an HIV test referral among those who reported being engaged in high-risk sexual behaviors was 41% (adjusted prevalence ratio .59, 95% CI .39-.91; P=.02) lower than the estimated prevalence among those who did not engage in high-risk sexual behavior. CONCLUSIONS: This sample of Puerto Rican adults reported a significantly lower prevalence of receiving an HIV test referral among heterosexual individuals at increased risk of HIV infection who engaged in high-risk behaviors. This study further emphasizes the need for health care providers to follow recommended guidelines for HIV test referrals in health care settings. Promotion practices in the future should include enhancing referral and access to HIV tests and implementing preventive measures to counteract the HIV epidemic in Puerto Rico.

Análise de custo-efetividade de um painel genético no câncer de mama precoce na saúde suplementar brasileira / Cost-effectiveness analysis of a genetic panel in early breast cancer in Brazilian supplementary health

Objetivo: Avaliar o custo-efetividade do uso de um painel genético de 21 genes em pacientes adultas diagnosticadas com câncer de mama em estádio inicial em uma operadora de saúde com mais de 500.000 vidas. Métodos: Foi utilizada uma coorte prospectiva seguida de um estudo de custo-efetividade entre os pacientes que utilizaram Oncotype DX® em 2020. Calcularam-se as despesas totais de cada esquema de quimioterapia (QT), somando-se os custos dos produtos e taxas de infusão. Resultados: Das 35 pacientes que utilizaram o teste de 21 genes no período avaliado, 60% (n = 21) não necessitaram de QT. Quando aplicadas simulações, houve custo evitado de R$ -1.945.448,88 (custos incrementais potenciais de R$ -6.488.207,56 até R$ 443.485,26, dependendo do esquema de QT escolhido). Conclusão: A inserção do teste de 21 genes na jornada do tratamento de câncer de mama na saúde suplementar evidenciou significativa relevância, pois contribuiu com o uso adequado da terapêutica, garantindo a sustentabilidade do sistema de saúde. Apresentando-se como uma opção custo-efetiva para a maioria dos esquemas de QT em comparação com a sua não utilização no tratamento, para a saúde suplementar brasileira

Objective: To evaluate the cost-effectiveness of the use of a genetic panel of 21 genes in adult patients diagnosed with early stage breast cancer in a healthcare provider with more than 500,000 lives. Methods: A prospective cohort study was conducted, followed by cost-effectiveness, among patients who used Oncotype DX® , in 2020. The total costs of each chemotherapy scheme (QT) were calculated, adding the costs of the products and infusion fees. Results: Of the 35 patients who used 21 gene tests in the evaluation period, 60% (n = 21) did not require QT. When simulations were applied, there was an avoided cost of R$ -1.945.448,88 (Potentials incremental costs from -R$ 6.488.207,56 to +R$ 443.485,26, depending on the chosen QT scheme). Conclusion: The insertion of 21-Gene recurrence score in the breast cancer treatment journey in supplementary health showed significant relevance, as it contributes to the appropriate use of therapy, guaranteeing the sustainability of the health system. Presenting itself as a cost-effective option for most QT schemes compared to not being used in treatment, for Brazilian supplementary health System

Availability of Diagnostic Services and their Impact on Patient Flow in Two Brazilian Referral Centres of Breast Cancer Treatment.

BACKGROUND: System delay (SD) is a leading cause of advanced stage of disease and poor prognosis among Brazilian breast cancer patients. METHODS: Cox regression and Kaplan-Meier analysis were used to identify variables that contributed to SD among 128 breast cancer patients. Time intervals between first medical consultation and treatment initiation were compared among patients of two referral centres: Patients of a referral centre with outsourced (FAP), respectively, integrated (HNL) diagnostic services. RESULTS: Women who used a specialized private clinic at the beginning of patient flow had an 2.32 fold increased chance (95% CI: 1.17 - 4.60; p = 0.016) of hospital admission within 90 days after first medical consultation, compared to women who used a public health care provider (HCP). Of 73 and 34 patients of the FAP hospital and the HNL, respectively, 10 (13.7%) and 11 (32.5%) used one HCP prior to hospital admission (p = 0.000). The median time between first medical consultation and treatment initiation was 150 days. The median time between first medical consultation and hospital admission was 136.0 and 52.0 days for patients of the FAP hospital, respectively the HNL (p < 0.050). The median time between first medical consultation and diagnostic mammography was 36.5 and 23.0 days for patients from the FAP hospital and the HNL (p < 0.050). CONCLUSIONS: Usage of public diagnostic services was associated with increased SD, whereas the usage of private diagnostic services diminished it. The usage of a lower number of HCPs accelerated patient flow.

Seasonal Influenza Vaccination Patterns Among Pregnant Women in New Mexico.

INTRODUCTION: Seasonal influenza vaccination is recommended for pregnant women, but half of the pregnant women in the United States remain unvaccinated. Vaccine coverage in U.S.-Mexico border states has not been examined in depth even though risk factors for low vaccine coverage exist in these states, especially in the counties bordering Mexico. METHOD: Using 2012-2014 New Mexico (NM) Pregnancy Risk Assessment and Monitoring System data, this study examined the weighted annual seasonal influenza vaccination rates and the relationship of various factors to vaccination among NM residents with a live birth during those years. RESULTS: Among respondents, 53.8% were Hispanic, 15.7% were Native American, and 30.5% were non-Hispanic White. The vaccination rate in NM increased from 49.0% in 2012 to 64.8% in 2014. The adjusted odds of vaccination were higher among women whose health care provider recommended/offered vaccination during the year prior to delivery compared to women whose provider did not (AOR = 11.92, 95% confidence interval [CI: 9.86, 14.42]) and among those living in the U.S.-Mexico nonborder counties compared to those living in the border counties (AOR = 1.23, 95% CI [1.18, 1.25]). CONCLUSION: Efforts to increase the vaccination rate among pregnant women in border states should concentrate on health care providers and the highest risk women, such as those resident in the border region.

Judicialization of health arising from prepaid insurance plans and health law: an integrative review / Judicialización de la salud resultante de los planes de prepago y el derecho sanitario: revisión integrativa / Judicialização da saúde decorrente dos planos de pré-pagamento e o direito sanitário: revisão integrativa

ABSTRACT Objective: To analyze publications regarding judicial demands related to the violation of the rights of the client who uses private health insurance in Brazil. Method: Integrative review, from September to October 2017, of national character, with complete texts online, in Portuguese and English, published between 2012 and 2017 in the Virtual Health Library portal, excluding studies that were duplicated or with indiscriminate methodology. Results: The judicial demands were for: medication (32%); ward hospitalization (11%); surgical procedures (9%); orthosis, prothesis and special materials (9%); others (9%); and diagnostic procedures, outpatient service, hospitalization in Intensive Care Units, food formulas and disposable diapers (30%). Conclusion: The prevalence of legal disputes arising from the failure in providing health service by private health insurances was observed, which makes it easier for the administrators to identify the sought health products and services in order to reorganize the administrative sphere and provide quality care.

RESUMEN Objetivo: Analizar las publicaciones acerca de las demandas judiciales relacionadas con la infracción a los derechos del usuario que utiliza un plan privado de salud en Brasil. Método: Revisión integrativa realizada entre septiembre y octubre de 2017, en ámbito nacional en los idiomas portugués e inglés, con textos completos y publicados en línea de 2012 a 2017 en el Portal de la Biblioteca Virtual en Salud, con la exclusión de los duplicados y de metodología indiscriminada. Resultados: Las demandas judiciales fueron: un 32% por medicamentos; un 11% por internación en enfermería; un 9% por procedimientos quirúrgicos; un 9% por ortesis, prótesis y materiales especiales; un 9% por otros; y un 30% por procedimientos diagnósticos, de atención ambulatoria, de internación en un Centro de Terapia Intensiva, de fórmulas alimentarias y pañales desechables. Conclusión: Se demostró una prevalencia de los litigios judiciales resultantes de una falla en la prestación del servicio de salud por los planes privados, lo que les facilita a los gestores identificar los productos y servicios de salud necesarios para reorganizar la esfera administrativa y la prestación de una asistencia con calidad.

RESUMO Objetivo: Analisar as publicações a respeito de demandas judiciais relacionadas à infração aos direitos do usuário que utiliza plano privado de saúde no Brasil. Método: Revisão integrativa de setembro a outubro de 2017, com caráter nacional em português e inglês, textos online completos e publicados entre 2012 e 2017 no Portal da Biblioteca Virtual em Saúde, excluindo os duplicados e com metodologia indiscriminada. Resultados: As demandas judiciais foram: 32% medicamentos; 11% internação em enfermaria; 9% procedimentos cirúrgicos; 9% órtese, prótese e materiais especiais; 9% outros; e 30% de procedimentos diagnósticos, atendimento ambulatorial, internação em Centro de Terapia Intensiva, fórmulas alimentares e fraldas descartáveis. Conclusão: Demonstra-se a prevalência dos litígios judiciais decorrentes da falha na prestação do serviço de saúde pelos planos privados, o que facilita aos gestores identificar produtos e serviços de saúde pleiteados para reorganização da esfera administrativa e prestação de assistência com qualidade.

Evaluation of Educational intervention on Standard Precautions among Healthcare Provider Based on Health Belief Model

Background and objective: Occupational exposure makes healthcare provider at risk of a variety of infections such as AIDS, Hepatitis B, and Hepatitis C. This study investigated the effect of educational intervention on standardized precautionary behaviors in healthcare provider based on health belief model, in Jam city, Iran during 2016. Methods: This experimental study was carried out on Tohid hospital staff and health care provider of Jam`s health center. Random stratified sampling based on different occupation designated into two groups, intervention (n=50) and control (n=50). After confirming the validity and reliability of the data collection tool, the educational intervention was examined before and after the intervention. Data were analyzed using descriptive statistical methods, independent t-test and one-way ANOVA (SPSS 20). Results: The results revealed that the healthcare provider did not have any previous educational background on standardized precautionary (34.3%). Furthermore, the history of needle stick injuries (42.5%) and contact with patients' body fluids (17.5%) were reported. Educational intervention regarding to standardized precautions in the intervention group was significantly increased the mean score of knowledge constructs, perceived sensitivity, perceived severity, perceived benefits, perceived barriers and behaviors. However, no significant changes were observed in increasing the self-efficacy the score. Conclusion: The results indicate the effectiveness of educational intervention on standard precautionsamong healthcare provider based on health belief model. Educational program based on promotion behavioral pattern in relation to standard precautionsis recommended to the healthcare provider

Prácticas de atención del parto en una institución prestadora de servicios de salud en la ciudad de Bogotá / Delivery practices at a health care provider in the city of Bogota / Práticas de atendimento do parto numa instituição prestadora de serviços da saúde na cidade de Bogotá

Resumen Objetivos: Analizar las prácticas del personal de salud durante la atención del parto en una institución prestadora de servicios de salud en la ciudad de Bogotá, desde dos perspectivas, género y humanización del parto, teniendo en cuenta que en Colombia se adelanta, desde 2016, la implementación de la Ruta Integral de Atención en Salud Materno Perinatal como parte del nuevo modelo de atención en salud propuesto por el Ministerio de Salud y Protección Social. Métodos: Estudio cualitativo, descriptivo e interpretativo realizado entre junio y agosto de 2017, que incluyó observación no participante en salas de parto y entrevistas semiestructuradas a las mujeres a quienes se les observó el parto y al personal de salud que las atendió. Se codificaron los diarios de campo y las entrevistas, se realizó análisis de contenido y se trianguló la información. Resultados: La atención de parto se fundamenta en una atención medicalizada, que subordina a las mujeres y que coincide con un trabajo realizado rutinariamente, sumado a fallas en la comunicación entre estas y el personal de salud. Se evidenciaron aspectos que vulneran los derechos de las mujeres en trabajo de parto y en parto, y que son legitimados por el personal de salud y justificados por ellas. Conclusiones: Este trabajo es un aporte a la salud pública, dado que visibiliza un fenómeno normalizado en la práctica médica que amerita una intervención desde la perspectiva de la humanización de los servicios de salud.

Abstract Objectives: To analyze the practices of healthcare personnel during deliveries at a healthcare provider institution in the city of Bogota from two perspectives: gender and humanization of the delivery. Taking into account that in Colombia there has been an integral implementation, since 2016, of a comprehensive route to provide maternal perinatal Health Care as a part of a new healthcare model proposed by the Ministry of Health and Social Protection. Methodology: Qualitative, descriptive and interpretive study conducted between June and August 2017; it included non-participative observation in delivery rooms and semi-structured interviews of women whose delivery had been observed, and the healthcare Personnel that attended them. Field journals and interviews were coded. Content analysis was conducted and the information was triangulated Results: Delivery care is based on medicalized care, which subordinates women and coincides with a routine job, including a lack of communication between women and the healthcare personnel. The research showed aspects that violate women's rights during labor and delivery, which are legitimized by healthcare personnel and justified by women themselves. Conclusions: This study is a contribution to Public Health, for it evidences a phenomenon normalized in medical practice, which deserves an intervention from the perspective of humanizing Health Care Services.

Resumo Objetivos: Analisar as práxis do pessoal da saúde durante a atenção do parto numa instituição prestadora dos serviços da saúde na cidade de Bogotá, desde duas perspectivas, género e humanização do parto, levando em conta que na Colômbia se adianta, desde 2016, a implementação da Rota Integral de Atendimento em Saúde Materno Perinatal como parte dum novo modelo de atenção em saúde proposto pelo Ministério de Saúde e Proteção Social. Metodologia: Estudo qualitativo, descritivo e interpretativo realizado entre junho e agosto do 2017, que incluiu observação não participante nas salas de parto nem entrevistas semiestruturadas nas mulheres nas quais se observou o parto e ao pessoal da saúde que as atendeu. Se codificaram os diários de campo e as entrevistas, se realizou análise de conteúdo e se triangulou a informação. Resultados: A atenção do parto se fundamenta numa atenção medicadora, que subordina as mulheres e que coincide com um trabalho realizado rotineiramente, somado as falhas na comunicação entre estas e o pessoal da saúde. Se evidenciaram aspectos que vulneram os direitos das mulheres em trabalho de parto e no parto, e que são legitimados pelo pessoal da saúde e justificados por elas. Conclusões: Este trabalho é uma verba pra saúde pública, dado que visibiliza um fenómeno normalizado na práxis médica que decorre numa intervenção desde a perspectiva da la humanização dos serviços da saúde.

HPV Vaccination Recommendation Practices among Adolescent Health Care Providers in 5 Countries.

STUDY OBJECTIVE: To assess adolescent health care providers' recommendations for, and attitudes towards human papillomavirus (HPV) vaccination in 5 countries. DESIGN: In-depth interviews of adolescent health care providers, 2013-2014. SETTING: Five countries where HPV vaccination is at various stages of implementation into national programs: Argentina, Malaysia, South Africa, South Korea, and Spain. PARTICIPANTS: Adolescent health care providers (N = 151) who had administered or overseen provision of adolescent vaccinations (N = Argentina: 30, Malaysia: 30, South Africa: 31, South Korea: 30, Spain: 30). MAIN OUTCOME MEASURES: Frequency of HPV vaccination recommendation, reasons providers do not always recommend the vaccine and facilitators to doing so, comfort level with recommending the vaccine, reasons for any discomfort, and positive and negative aspects of HPV vaccination. RESULTS: Over half of providers 82/151 (54%) recommend HPV vaccination always or most of the time (range: 20% in Malaysia to 90% in Argentina). Most providers 112/151 (74%) said they were comfortable recommending HPV vaccination, although South Korea was an outlier 10/30 (33%). Providers cited protection against cervical cancer 124/151 (83%) and genital warts 56/151 (37%) as benefits of HPV vaccination. When asked about the problems with HPV vaccination, providers mentioned high cost 75/151 (50% overall; range: 26% in South Africa to 77% in South Korea) and vaccination safety 28/151 (19%; range: 7% in South Africa to 33% in Spain). Free, low-cost, or publicly available vaccination 59/151 (39%), and additional data on vaccination safety 52/151 (34%) and efficacy 43/151 (28%) were the most commonly cited facilitators of health provider vaccination recommendation. CONCLUSION: Interventions to increase HPV vaccination should consider a country's specific provider concerns, such as reducing cost and providing information on vaccination safety and efficacy.

Barriers and opportunities in recalls management at the health care provider level / Barreras y oportunidades en la gestión de retiro de productos farmacéuticos en las instituciones proveedoras de salud / Barreiras e oportunidades na gestão de lembranças no nível do provedor de cuidado da saúde

Abstract One of the operational risks to which a Health Care Provider (HCP) is exposed is the receiving and use of products such as pharmaceuticals and medical devices that could become subject to a health alert. This patient safety issue has to be managed in order to prevent and mitigate adverse events at the last echelon of the supply chain. This article aims to expose a characterization of the alerts response process at the HCP level based on a review of the literature. Additionally, local regulations, strengths and weaknesses were identified. Finally, the study allowed for the identification of the principal opportunities and barriers that should be addressed in order to integrate the recall management process within and outside the HCP. Among these opportunities is traceability along the supply chain, and among the barriers is the high investment in the technology required to facilitate supply chain integration.

Resumen Uno de los riesgos operacionales a los que está expuesto un Proveedor de Atención Médica (HCP por sus siglas en inglés) es la recepción y uso de productos farmacéuticos y dispositivos médicos que podrían estar sujetos a una alerta de salud. Este problema de seguridad del paciente tiene que ser manejado con el fin de prevenir y mitigar los eventos adversos en el último escalón de la cadena de suministro. Este artículo pretende exponer una caracterización del proceso de respuesta de alertas desde el HCP basado en una revisión de la literatura. Además, se identificaron la normativa local, fortalezas y debilidades. Finalmente, el estudio permitió identificar las principales oportunidades y barreras que se deben abordar para integrar el proceso de gestión de retiro de productos dentro y fuera del HCP. Entre estas oportunidades está la trazabilidad a lo largo de la cadena de suministro, y entre las barreras está la alta inversión en la tecnología requerida para facilitar la integración de la cadena de suministro.

Resumo Um dos riscos operacionais aos que está exposto um Provedor de Atenção Médica (HCP) é a recepção e o uso de produtos como produtos farmacêuticos e dispositivos médicos que poderiam estar sujeitos a uma alerta de saúde. Este problema de segurança do paciente tem que ser manejado com o fim de prevenir e mitigar os eventos adversos no último degrau da cadeia de fornecimento. Este artigo pretende expor uma caracterização do processo de resposta de alertas a nível do HCP baseado numa revisão da literatura. Ademais, identificaram-se as regulações locais, fortalezas e debilidades. Finalmente, o estudo permitiu identificar as principais oportunidades e barreiras que devem-se abordar para integrar o processo de gestão de produtos dentro e fora do HCP. Entre estas oportunidades está a traçabilidade ao longo da cadeia de fornecimento, e entre as barreiras está o alto investimento na tecnologia requerida para facilitar a integração da cadeia de fornecimento.

Knowledge, attitudes, and practices among health care providers regarding complementary and alternative medicine in Trinidad and Tobago.

BACKGROUND: Health care providers are often ill prepared to interact about or make acceptable conclusions on complementary and alternative medicine (CAM) despite its widespread use. We explored the knowledge, attitudes, and practices of health care providers regarding CAM. METHODS: This cross-sectional study was conducted between March 1 and July 31, 2015 among health care providers working mainly in the public sector in Trinidad and Tobago. A 34-item questionnaire was distributed and used for data collection. Questionnaire data were analysed using inferential and binary logistic regression models. RESULTS: Response rate was 60.3% (362/600). Responders were 172 nurses, 77 doctors, 30 pharmacists, and 83 other health care providers of unnamed categories (mainly nursing assistants). Responders were predominantly female (69.1%), Indo-Trinidadian (55.8%), Christian (47.5%), self-claimed "very religious" (48.3%), and had <5 years of working experience (40.6%). The prevalence of CAM use was 92.4% for nurses, 64.9% for doctors, 83.3% for pharmacists, and 77.1% for other health care providers. The majority (50-75%) reported fair knowledge of herbal, spiritual, alternative, and physical types of CAM, but had no knowledge of energy therapy and therapeutic methods. Sex, ethnicity, and type of health care provider were associated with both personal use and recommendation for the use of CAM. Predictors of CAM use were sex, religion, and type of health care provider; predictors of recommendation for the use of CAM were sex and type of health care provider. About half of health care providers (51.4%) and doctors (52%) were likely to ask their patients about CAM and <15% were likely to refer patients to a CAM practitioner. However, health care providers expressed interest in being educated on the subject. Doctors (51.9%) and pharmacists (63.3%) said that combination therapy is superior to conventional medicine alone. Less than 10% said conventional medicine should be used alone. CONCLUSION: Knowledge about CAM is low among health care providers. The majority engages in using CAM but is reluctant to recommend it. Predictors of CAM use were sex, religion, and profession; predictors of recommendation for the use of CAM were sex and profession. Health care providers feel the future lies in integrative medicine.

Atenção primária à saúde como ordenadora de um modelo de integração assistencial na rede de urgência e emergência / Primary health care as coordinator of a caring integration model for the emergency care network

Esta pesquisa teve como objetivo geral: Elaborar uma proposta de modelo assistencial de intervenção com vistas à melhoria da integração entre a Unidade de Saúde e a Unidade de Pronto Atendimento, tendo a Atenção Primária à Saúde como ordenadora da Rede de Urgência e Emergência. Como objetivos específicos buscou-se: analisar os fluxos entre a US e a UPA; e, identificar como os profissionais das US, da UPA e os gestores definem as funções de cada equipamento que compõe a rede de atenção à urgência/emergência do município. Trata-se de uma pesquisa de abordagem qualitativa, do tipo descritivo e exploratório. A pesquisa compôs-se das seguintes etapas: etapa de aproximação com o campo de pesquisa; coleta de dados principal; elaboração do modelo assistencial de integração entre as US e a UPA. A coleta de dados da etapa de aproximação com o campo de pesquisa foi realizada com 17 usuários que aguardavam atendimento em uma UPA, durante duas rodas de conversa no mês de outubro de 2014; e, com 16 enfermeiros, 12 médicos e 21 gestores da Secretaria Municipal de Saúde do município de Curitiba -PR na etapa de coleta de dados principal por meio de entrevistas com roteiro semiestruturado, posteriormente gravadas e transcritas. O processamento e análise dos dados da etapa prévia foram feitos a partir dos registros das rodas de conversas transcritos pelas observadoras e sistematizados pela pesquisadora, que conduziu a análise a partir dos temas identificados, classificando-os em duas categorias: dificuldade de acesso à US e compreensões sobre as atribuições da US e UPA. Para processamento dos dados das entrevistas foi utilizado o software IRAMUTEQ, que faz cálculos estatísticos sobre dados qualitativos. Em função da frequência dos vocábulos e do valor do qui-quadrado igual ou superior a 3.84, os dados foram classificados em quatro classes: comunicação formal e informal na organização do sistema de saúde, acesso da população aos serviços de saúde, a integração entre a US e UPA e funções da US e da UPA na rede de atenção à saúde. A elaboração do Modelo Assistencial de Integração entre a US e a UPA apresenta duas propostas: a primeira proposta está relacionada à mudança no processo de trabalho da US e UPA, e a segunda proposta envolve maior mudanças estruturais, ambos assumem a APS como ordenadora do cuidado. Conclui-se que a integração entre US e a UPA encontra-se frágil, fragmentada e desarticulada; o processo de trabalho da APS organiza-se de forma rígida, seletiva e com barreiras de acesso aos usuários, que procuram pela UPA quando necessitam de atendimento. Os resultados permitem visualizar que a dificuldade de comunicação e integração entre a APS e UPA está relacionada a uma sobreposição de funções e que é necessário reorganizar o modelo da rede de atenção à saúde, considerando os atributos da APS e as necessidades dos usuários.

This research study had as general objective: to elaborate a proposal of a caring intervention model in order to improve the integration between the Health Care Unit and the Emergency Care Unit (ECU) with the Primary Health Care as coordinator for the Emergency Care Network. As specific objectives, it aimed: to analyze flows between the Health Care Unit and the ECU; and to apprehend how Health Care Unit as well as ECU professionals and managers define the functions of each unit that comprises emergency health care network in the municipality. It is a descriptive-exploratory, qualitative research study. The study encompasses the following steps: approaching step with the research field; main data collection; elaboration of a health care integration model between the health care units and the ECU. Data collection in the approaching step with the research field was held with 17 users waiting for care delivery at an ECU, during two rounds of conversation in October, 2014; and with 16 nurses, 12 doctors and 21 managers of the Municipal Secretary of Health from the municipality of Curitiba -Paraná State, Brazil, during the main data collection by means of semi-structured interviews, recorded and further transcribed. Data process and analysis of the first step were carried out from records of the conversation rounds transcribed by the observers and systematized by the researcher, who carried out the analysis from the identified themes, classifying them in two categories: access difficulty to a Health Care Unit and understandings on the attributions of Health Care Units and ECUs. IRAMUTEQ software, which performs statistical calculations of qualitative data, was used for processing the data from the interviews. Due to the word frequency and chi-square ? 3.84, data were classified in four classes: formal and informal communication in the health system organization, population access to health care services, integration between Health Care Unit and ECU, and Health Care Unit and ECU functions in the health care network. The elaboration of the Health Care Integration Model between the Health Care Unit and the ECU features two proposals: the first proposal is related to the change in Health Care Unit and ECU work process, and the second proposal entails major structural changes, both assuming Primary Health Care as the care manager. It can be concluded that the integration between the Health Care Unit and the ECU is fragile, fragmented and disarticulated; Primary Health Care work process is organized in a rigid, selective way, with access hurdles to the users who reach for the ECU for care delivery. Results enable to apprehend that the difficulty of communication and integration between the Primary Health Care and ECU is related to a function overlap, being necessaryto reorganize the heath care network model by considering Primary Health Care attributes as well as users' needs.

Expectations of pregnant women of Mexican origin regarding their health care providers.

OBJECTIVE: To explore the expectations of pregnant women of Mexican origin regarding trust and communication with their health care providers. DESIGN: Qualitative, descriptive inquiry. SETTING: A large metropolitan area community clinic in Texas that provided services to predominately Hispanic women. PARTICIPANTS: The sample consisted of 13 women between ages 19 and 36 (mean = 29) who received prenatal health care at a community clinic that offers care to Hispanic women. METHODS: Semistructured interviews were conducted with open-ended starter questions and follow-up questions based on the participant responses. Based on the women's language preference nine interviews were conducted in Spanish and four in English. RESULTS: Themes emerged from the beginning interviews, and after five interviews, saturation was reached. Data were arranged by the emerged themes of the model of trust and communication (Figure 1). The themes reflected the perception of trust, communication, patient centeredness, and satisfaction with health care providers. CONCLUSION: These women wanted their providers to provide them with "everything," to be direct, to speak their language, and to present information as friends. Health care providers need to be able to provide communication not only in the participant's preferred language, but also in a way that is culturally sensitive.

La empatía en l relacion médico-paciente como anifestacion del respeto por la dignidad de la persona: una aportación de edith stinn / Empathy i the phhysician-atient relationship as a demonstration of respeect for the dignity of the individual: a contribution by edith stein / A empatia narelaação médico-paciente como manifestação do repeito pela dignnidade da pessoa: uma contribuição de edith stein

Una medicina altamente tecnificada, con una certeza diagnóstica sin precedentes y con resultados bastante eficientes pero, a su vez, con una elevada tasa de desconfianza por parte de los usuarios, lo que da como resultado una medicina defensiva, es una realidad que se repite habitualmente en el ámbito sanitario. Al parecer, el poderío de la técnica sobre la vida ha dejado de lado lo eminentemente humano en el acto de curar, ocasionando una inevitable fractura en la esencia misma de la profesión. Frente a ello se plantea rehumanizar la relación clínica a través del uso de la empatía, para contribuir de este modo a la superación del excesivo positivismo en el que ha caído la medicina.

A high-tech medicine, with unprecedented diagnostic certainty and quite efficient outcomes but, at the same time, with a high level of distrust from the users, which results in a defensive medicine, is a reality that is often repeated in healthcare. Apparently, the power of technique over life has left aside the eminent humaneness in the act of healing, causing an inevitable split in the very essence of the profession. In the presence of this, the issue arises of re-humanizing the clinical relationship through the use of empathy, thus contributing to overcoming the excessive positivism in which medicine has fallen.

Uma medicina altamente tecnificada, com uma certeza diagnóstica sem precedentes e com resultados eficientes, mas, ao mesmo tempo, com uma elevada taxa de desconfiança por parte dos usuários, o que resulta numa medicina defensiva, é uma realidade que se repete habitualmente no âmbito sanitário. Ao que tudo indica, o poder da técnica sobre a vida tem deixado de lado o eminentemente humano no ato de curar, o que tem ocasionado uma inevitável fratura na essência em si da profissão. Diante disso, propõe-se reumanizar a relação clínica por meio do uso da empatia, para contribuir, desse modo, para a superação do excessivo positivismo no qual a medicina tem caído.

Factores asociados al no control de la presión arterial en pacientes inscritos al programa de hipertensión de una Entidad Promotora de Salud en Cali-Colombia, 2004 / Factors associated with lack of blood pressure control in patients enrolled in a hypertension control program of a private primary Health Care Organization in Cali, Colombia, in 2004

Objetivos: determinar los factores asociados al no control de la presión arterial en pacientes inscritos al programa de control de la hipertensión de una Entidad Promotora de Salud en Cali-Colombia, en el año 2004. Métodos: estudio descriptivo de corte transversal, en el que se seleccionaron de manera aleatoria 356 pacientes mayores de 18 años de los inscritos en el programa de control de la hipertensión arterial. Se clasificó como paciente no controlado en hipertensión arterial a quien presentó presión arterial sistólica superior a 139 mm Hg o presión arterial diastólica superior a 89 mm Hg. Se consideraron como variables independientes: factores de riesgo no modificables, comportamentales, biológicos y administrativos. Mediante un análisis bivariado y multivariado se identificaron factores asociados al no control de la presión arterial. Resultados: la prevalencia del no control fue 30,1% (IC 95% 25,3-34,8), siendo mayor en el género masculino (c2= 9,368; p=0,002). La adherencia al tratamiento farmacológico fue 56,2% (IC 95%: 51,0% - 61,3%). El riesgo relativo indirecto (OR) de no control de la tensión arterial ajustada por género y según el uso de inhibidores de la enzima convertidora de angiotensina solos o en combinación con medicamentos hipolipemiantes, fue de 1,71 (IC 95%: 1,0-2,94); según el tipo de Institución Prestadora de Salud donde se lleva a cabo el programa de hipertensión arterial adscrita a la Entidad Promotora de Salud en comparación con los que asisten a Instituciones Prestadoras de Salud propias, el OR fue 2,13 (IC 95%: 1,3- 3,5). Conclusiones: la prevalencia de hipertensión arterial no controlada en un programa de una Entidad Promotora de Salud fue de 30,1%. Los factores asociados fueron: tipo de Institución Prestadora de Salud, género masculino y uso de inhibidores de la enzima convertidora de angiotensina y la interacción del medicamento con antecedentes de dislipidemia.

Objectives: to determine the factors associated to the lack of control of arterial blood pressure in patients enrolled in a hypertension control program of a private primary health care organization in Cali, Colombia in 2004. Methods: descriptive cross-sectional study. 356 patients >18 years were randomly chosen from the hypertension control program. Those patients with systolic blood pressure >139 mm Hg or diastolic blood pressure >89 mm Hg were classified as patients with lack of blood pressure control. Risk factors that could not be modified, behavioral, biological and administrative factors, were considered independent variables. Through a bivariate and multivariate analysis, factors associated to lack of blood pressure control were identified. Results: the prevalence of lack of blood pressure control in this health care organization was 30,1% (95% CI, 25,3-34,8), being higher in males (c2= 9,368; p=0,002). Adherence to pharmacological treatment was 56,2% (95% CI: 51,0% - 61,3%). Odds ratio (OR) for lack of blood pressure control adjusted by gender and according to hypolipemic drugs combination was 1,71 (95% CI: 1,0-2,94); OR according to the contracted health care organization in comparison with the institutional health care was 2.13 (95% CI: 1.3 - 3.5). Conclusions: the prevalence of lack of blood pressure control in a hypertension control program of a private health care organization was 30,1%. Associated factors were: type of health care organization, male gender, use of inhibitors on angiotensing-converting enzyme and drug interaction with concomitant use of hypolipemis.