Impacto de la recolección de residuos domésticos de gran tamaño sobre potenciales criaderos de mosquitos transmisores del dengue en Asunción, Paraguay

Introducción: Los brotes recurrentes de dengue subrayan la necesidad de abordajes más efectivos en la prevención y control de vectores. A menudo, las intervenciones se centran en un enfoque biomédico y de promoción de la salud desde un enfoque individual, sin integrar factores socioambientales ni ser evaluados científicamente Objetivo: Evaluar el impacto de la recolección de residuos domésticos de gran tamaño sobre potenciales criaderos de mosquitos transmisores del dengue en Asunción, Paraguay durante los años 2017 a 2021. Material y métodos: Estudio cuasiexperimental, longitudinal, donde se encuestaron 350 hogares, como línea de base durante el 2017 y una línea de cierre en 108 hogares en 2021. Se utilizó el método de Diferencia en Diferencia (DID) para comparar la presencia de criaderos antes y después de la intervención en 43 hogares intervenidos y 65 no intervenidos. Resultados: La recolección diferenciada fue utilizada principalmente por aquellos hogares que tenían una gran cantidad de residuos sólidos de gran tamaño, pero no para deshacerse de todos estos objetos, sino sólo de una parte (DID de -52% en el número total de criaderos y DID de 1% en número de hogares con criaderos). Encontramos una reducción significativa en el número de total de criaderos de gran tamaño, pero no observamos diferencias en el número total de hogares con criaderos. Factores subjetivos, como la creencia de que los objetos en desuso podrían llegar a ser útiles en el futuro explicaban en gran medida su presencia en los hogares, incluso con el servicio disponible. Conclusiones: El enfoque de la gestión municipal en los residuos voluminosos puede contribuir a la prevención del dengue por el hecho de que no constituyen residuos de generación rápida en los hogares, y su eliminación puede tener un impacto relativamente duradero. El factor subjetivo relacionado con la presencia de estos criaderos en los hogares debe ser objeto de mayores estudios.

Introduction: Recurrent dengue outbreaks underscore the need for more effective approaches to vector prevention and control. Often, interventions focus on a biomedical and health promotion approach from an individual approach, without integrating socio-environmental factors or being scientifically evaluated. Objetive: To evaluate the impact of large household waste collection on potential breeding sites of dengue-transmitting mosquitoes in Asuncion, Paraguay during the years 2017 to 2021. Material and methods: Quasi-experimental, longitudinal study, where 350 households were surveyed, as a baseline during 2017 and a closing line in 108 households in 2021. The Difference-in-Difference (DID) method was used to compare the presence of breeding sites before and after the intervention in 43 intervened and 65 non-intervened households. Results: Differentiated collection was mainly used by those households that had a large amount of large solid waste, but not to dispose of all these objects, but only part of them (DID of -52% in the total number of breeding sites and DID of 1% in the number of households with breeding sites). We found a significant reduction in the total number of large breeding sites but did not observe differences in the total number of households with breeding sites. Subjective factors, such as the belief that disused objects could become useful in the future, were largely responsible for the reduction in the number of large breeding sites. Conclusions: The municipal management approach to bulky waste can contribute to dengue prevention because it does not constitute rapidly generated waste in households, and its disposal can have a relatively long-lasting impact. The subjective factors related to the presence of these breeding sites in households warrant further study.

Internet interventions and therapies for addressing the negative impact of digital overuse: a focus on digital free tourism and economic sustainability.

BACKGROUND: The excessive use of information technologies (IT) and online digital devices are causing symptoms of burnout, anxiety, stress and dependency that affect the physical and mental health of our society, extending to leisure time and work relationships. Digital free tourism (DFT) is a phenomenon that emerges as a solution to technostress and pathologies derived from digital hyperconnection. The objective of this research is to advance the knowledge of new structures of motivational factors that can understand the decision of a tourist to make a DFT trip. To this end, it is investigated whether family and social engagement and health and relaxation have a positive impact on the behavioral intention of the potential tourist and whether this influences sustainability due to the importance of DFT in the new economic framework. METHODS: With a quantitative approach, the methodology used consisted of an online questionnaire among potential travelers. IBM SPSS Statistics 22.0 statistical software was used to evaluate the data obtained and confirm the relationships of the model and the research hypotheses. RESULTS: The results of the questionnaire assessed the contribution of each construct to the tourist's behavioral intention and the tourist's decision to make the decision to undertake a DFT experience. CONCLUSIONS: DFT can be a driver of economic sustainability and health therapy in tourism in the digital age. This study aims to expand the lines of research on DFT and determine the complex factors that can lead a tourist to participate in the DFT experience. The results obtained can help managers of companies in the sector to offer more efficient and sustainable services that contribute to the health and wellbeing of tourists as a differentiating factor.

Latin America and the Caribbean Code Against Cancer 1st edition: Formative research on the comprehension and persuasiveness of the recommendations by the general population.

BACKGROUND: Cancer prevention is the most efficient and cost-effective strategy in cancer control. One prevention strategy is giving credible, clear, and evidence-based recommendations to the individual; however, it is key that these messages are accepted and understood properly by the public. This study aimed to pilot the draft recommendations developed as part of the Latin America and the Caribbean (LAC) Code Against Cancer 1st edition, in terms of comprehension and persuasion of each message. METHODS: A mixed method two-wave study, in which two versions of the messages were presented to the general population in five LAC countries. We used an ad-hoc questionnaire and interviews that followed the cognitive-pretesting methodology. RESULTS: Findings suggest that the messages were generally well understood, especially in Spanish speaking countries, and that the messages were generally more understandable than persuasive. We adapted and revised the recommendations based on the findings of the first Wave and held a second iteration in the Spanish speaking countries. We observed a better understanding of most messages in Wave 2. CONCLUSION: The LAC Code Against Cancer is a valuable tool of well understood messages for the public, with concrete actions everyone can take to prevent cancer. Further research should assess particularities of the region for further efficient dissemination of these important health messages, identify key messages for certain population groups and future interventions that strengthen health literacy in rural and less educated populations to increase behavior change.

Design and Content Validation using Expert Opinions of an Instrument Assessing the Lifestyle of Adults: The 'PONTE A 100' Questionnaire.

Lifestyle, a major determinant of health status, comprises a number of habits and behaviours that form a part of daily life. People with healthy lifestyles have a better quality of life, suffer less disease, and have a longer life expectancy. This work reports the design and content validation of a questionnaire-the 'PONTE A 100' questionnaire-assessing the lifestyle of adults. This collects information across five dimensions-'Eating Habits', 'Physical Activity', 'Smoking and use of Alcohol and other Drugs', 'Emotional Wellbeing', and 'Safety and Non-intentional Injuries'-via the answering of a total 33 items. Psychometric validation of the instrument's content was obtained via expert opinions. This was performed by two rounds of assessment and involved 34 experts representing different health science disciplines (mean experience, 27.4 ± 9.4 years). At the end of each round, adjustments were made according to their recommendations. Agreement between the experts was examined using the Aiken V test. A final V value of 0.95 (95% CI, 0.90-1.00) was obtained for the questionnaire as a whole, highlighting the validity of its content. The questionnaire would therefore appear to be an appropriate instrument for assessing the lifestyle of adults.

The alcohol industry-A commercial determinant of poor health for Rainbow communities.

BACKGROUND: Alcohol use is an area of challenge for health promotion internationally. The alcohol industry operates as a key commercial determinant of health in that its actions contribute to alcohol misuse, resulting in a range of health and social harms to individuals, families and communities. Rainbow people (including those who identify as lesbian, gay, bisexual, transgender or gender diverse) are one group experiencing considerable harm from alcohol use. METHODS: Data from 24 focus groups involving 131 people held in six cities in New Zealand during 2018, were used to explore local understandings of the ways in which the alcohol industry operates as a commercial determinant of health for Rainbow communities. The focus group discussions were analysed thematically. RESULTS: Three key themes were identified. First, the alcohol industry was identified as present in the 'everyday', through targeted alcohol promotion to Rainbow people, and due to the centrality of bars to their social and cultural landscapes. Second, participants recognised the benefits of alcohol industry support for Rainbow communities. Last, an opposing view was articulated, with the alcohol industry and its commercial activities viewed negatively. CONCLUSIONS: These findings highlight that alcohol as a commodity and the alcohol industry are successfully and firmly embedded within Rainbow communities. Overall, given alcohol is widely regarded in a positive way, this is likely to create difficulties for health promotion efforts to reduce alcohol related harm in these communities.

Hypertension from the patient's perspective: contributions to the care offered by health professionals and self-care - a qualitative study

ABSTRACT BACKGROUND: Hypertension is the most common disease in primary care settings. Only 30% of cases were adequately controlled. OBJECTIVES: To analyze the knowledge and understanding of patients with hypertension regarding the factors that facilitate and limit adherence to treatment and, based on the results, build specific guidelines on hypertension self-care and control. DESIGN AND SETTING: This qualitative study was conducted in a primary healthcare setting. METHODS: Patients with hypertension who were followed at a primary healthcare unit were interviewed through focus groups, and a qualitative interpretation of their statements according to Bardin's content analysis was performed. RESULTS: Three focus groups were formed (21 participants), from whose analysis emerged 74 core ideas related to the concept of hypertension, causes of increase in blood pressure, clinical consequences of hypertension, and possible patients' contributions to help control blood pressure, arising from eating habits, psychosocial conditions, and lifestyle. Patients tend to accept the concept of "high blood pressure" as an inherent condition of the disease in their lives. Eating habits are strongly related to life history and self-perception of health. The association between high blood pressure and nervousness or stress appears to be strong. CONCLUSION: The experience of having "pressure problem" is unique for each person. It is necessary to optimize listening, recognizing that, for the patient to understand what hypertension is and its management, there must be understanding and convergence of proposals, adjustments, and changes in a positive and personalized way. As a result of this study, we implemented educational actions in primary healthcare units.

Reliability and Validity of the Positive Mental Health Literacy Scale in Turkish Adolescents.

Background: The present study aims to determine the reliability and validity of the Positive Mental Health Literacy Scale in the Turkish language. Methods: The sample of the present methodological study included 457 adolescents. The data were collected between February 10, 2019, and May 31, 2019, with a socio-demographic data form and the Positive Mental Health Literacy Scale. The scale was first translated to the Turkish language, expert opinion was obtained, and a pilot scheme was conducted. The content validity index was employed to test the validity of the scale, confirmatory and exploratory factor analyses were conducted to test the construct validity, item analysis was conducted to test the reliability of the scale, Cronbach's alpha analysis was employed to determine internal consistency, and the test-retest scores were compared to determine time invariance. Results: The scale is unidimensional. The content validity analysis of the scale was 0.97. Scale item loads varied between 0.56 and 0.72 based on the confirmatory factor analysis. The Cronbach's alpha coefficient of the scale was 0.87, and the test-retest score was intraclass correlation coefficient = 0.739 (P < . 001). The mean participant score on the positive mental health literacy scale was 2.9 (SD=0.9). Conclusion: The validity and reliability findings in the study that was conducted to adapt the Positive Mental Health Literacy Scale to the Turkish language revealed that the scale could be used to measure the mental health literacy of adolescents. The Turkish version of the scale could be used in programs that aim to identify positive mental health literacy levels of adolescents in Turkish society.

[Use of a Guidebook for Stroke Patients to Promote Health and Employment Support].

When stroke patients consider a return to work, several difficulties are encountered regarding the promotion of support for both their health and employment due to the different perspectives of the patients, their families, and medical institutions. The Japanese Ministry of Health, Labour and Welfare has published a guideline for medical institutions and offices, but not for stroke patients or their families. As a result, patients and their families do not know how to process both medical treatments and their work after the occurrence of a stroke. We have therefore published the "Guidebook for Stroke Patients to Promote Health and Employment Support" based on the concept of the previously published "Guidebook for Cancer Patients for Promoting Health and Employment Support". This publication offers an overview of stroke and the flow from stroke onset to return to work. Patients can confirm how they should be handled at different phases of stroke. A stroke affects the patient, their family, and the individuals providing support, so this publication offers an information tool to facilitate the participation of stroke patients in society. The guide can thus be expected to contribute to an increased rate of return to work by stroke patients.

Videolaryngoscopy Findings of the Vocal Health Program in Dysphonic Teachers in the Federal District, Brazil

Abstract Introduction The high phonatory demand required of teachers is a direct cause of the onset of vocal symptoms and of the development of laryngeal disorders. Objective To describe the findings of the laryngeal screening performed as part of the Vocal Health Program held in the Federal Distrcit of Brazil in 2014 and 2015. Methods The study was performed with 361 dysphonic teachers from public schools who attended the laryngeal screening (videolaryngoscopy) part of the program. Data on anamnesis, the degree of dysphonia, the findings of the laryngeal screening, the referrals made after the laryngeal screening, and the result of the assessment of vocal aptitude for work were analyzed from the forms of each participating teacher. Results The sample of the present study (N= 361) represents 18.23% of the 1,980 teachers that went through the vocal screening of the program in 2014 and 2015. In total, 98 (27.15%) teachers presented mild dysphonia, 221 (61.22%), moderate dysphonia, and 42, (11.63%) severe dysphonia. Regarding the laryngeal screening (videolaryngoscopy exam), 269 teachers (74.52%) presented laryngeal disorders, and the main ones found were vocal nodules (43.87%), signs of laryngopharyngeal reflux (37.17%), hourglass chink (18.22%), vascular dysgenesis (18.22%), midposterior triangular chink (9.67%), and double chink (8.55%). Conclusion Laryngeal screening through videolaryngoscopy and auditory-perceptual screening of the voice as part of vocal health programs are essential to define the diagnosis and therapeutic conduct for teachers with dysphonia. Together with intervention activities, continuing education and adequate and accessible treatment, the periodic evaluation of vocal health can contribute to reduce absenteeism and improve the quality of life and of the voice of teachers.

Videolaryngoscopy Findings of the Vocal Health Program in Dysphonic Teachers in the Federal District, Brazil.

Introduction The high phonatory demand required of teachers is a direct cause of the onset of vocal symptoms and of the development of laryngeal disorders. Objective To describe the findings of the laryngeal screening performed as part of the Vocal Health Program held in the Federal Distrcit of Brazil in 2014 and 2015. Methods The study was performed with 361 dysphonic teachers from public schools who attended the laryngeal screening (videolaryngoscopy) part of the program. Data on anamnesis, the degree of dysphonia, the findings of the laryngeal screening, the referrals made after the laryngeal screening, and the result of the assessment of vocal aptitude for work were analyzed from the forms of each participating teacher. Results The sample of the present study ( N = 361) represents 18.23% of the 1,980 teachers that went through the vocal screening of the program in 2014 and 2015. In total, 98 (27.15%) teachers presented mild dysphonia, 221 (61.22%), moderate dysphonia, and 42, (11.63%) severe dysphonia. Regarding the laryngeal screening (videolaryngoscopy exam), 269 teachers (74.52%) presented laryngeal disorders, and the main ones found were vocal nodules (43.87%), signs of laryngopharyngeal reflux (37.17%), hourglass chink (18.22%), vascular dysgenesis (18.22%), midposterior triangular chink (9.67%), and double chink (8.55%). Conclusion Laryngeal screening through videolaryngoscopy and auditory-perceptual screening of the voice as part of vocal health programs are essential to define the diagnosis and therapeutic conduct for teachers with dysphonia. Together with intervention activities, continuing education and adequate and accessible treatment, the periodic evaluation of vocal health can contribute to reduce absenteeism and improve the quality of life and of the voice of teachers.

Exploring awareness of age-related changes among over 50s in the UK: findings from the PROTECT study.

OBJECTIVES: Older people describe positive and negative age-related changes, but we do not know much about what contributes to make them aware of these changes. We used content analysis to categorize participants' written comments and explored the extent to which the identified categories mapped onto theoretical conceptualizations of influences on awareness of age-related change (AARC). DESIGN: Cross-sectional observational study. PARTICIPANTS: The study sample comprised 609 UK individuals aged 50 years or over (mean (SD) age = 67.9 (7.6) years), enrolled in the PROTECT study. MEASUREMENTS: Between January and March 2019, participants provided demographic information, completed a questionnaire assessing awareness of age-related change (AARC-10 SF), and responded to an open-ended question asking them to comment on their responses. RESULTS: While some of the emerging categories were in line with the existing conceptual framework of AARC (e.g. experiencing negative changes and attitudes toward aging), others were novel (e.g. engagement in purposeful activities or in activities that distract from age-related thoughts). Analysis revealed some of the thought processes involved in selecting responses to the questionnaire items, demonstrating different ways in which people make sense of specific items. CONCLUSIONS: Results support the ability of the AARC questionnaire to capture perceived age-related changes in cognitive functioning, physical and mental health, and engagement in social activities and in healthy and adaptive behaviors. However, findings also suggest ways of enriching the theoretical conceptualization of how AARC develops and offer insights into interpretation of responses to measures of AARC.

Toward a Better Understanding of the Intention to Use mHealth Apps: Exploratory Study.

BACKGROUND: An increasing number of mobile health (mHealth) apps are becoming available for download and use on mobile devices. Even with the increase in availability and use of mHealth apps, there has still not been a lot of research into understanding the intention to use this kind of apps. OBJECTIVE: The purpose of this study was to investigate a technology acceptance model (TAM) that has been specially designed for primary health care applications. METHODS: The proposed model is an extension of the TAM, and was empirically tested using data obtained from a survey of mHealth app users (n=310). The research analyzed 2 additional external factors: promotion of health and health benefits. Data were analyzed with a PLS-SEM software and confirmed that gender moderates the adoption of mHealth apps in Spain. The explanatory capacity (R2 for behavioral intention to use) of the proposed model was 76.4%. Likewise, the relationships of the external constructs of the extended TAM were found to be significant. RESULTS: The results show the importance of healthy habits developed by using mHealth apps. In addition, communication campaigns for these apps should be aimed at transferring the usefulness of eHealth as an agent for transforming attitudes; additionally, as more health benefits are obtained, ease of use becomes greater. Perceived usefulness (PU; ß=.415, t0.001;4999=3.442, P=.001), attitude toward using (ß=.301, t0.01;499=2.299, P=.02), and promotion of health (ß=.210, t0.05;499=2.108, P=.03) were found to have a statistically significant impact on behavior intention to use eHealth apps (R2=76.4%). Perceived ease of use (PEOU; ß=.179, t0.01;499=2.623, P=.009) and PU (ß=.755, t0.001;499=12.888, P<.001) were found to have a statistically significant impact on attitude toward using (R2>=78.2%). Furthermore, PEOU (ß=.203, t0.01;499=2.810, P=.005), health benefits (ß=.448, t0.001;499=4.010, P<.001), and promotion of health (ß=.281, t0.01;499=2.393, P=.01) exerted a significant impact on PU (R2=72.7%). Finally, health benefits (ß=.640, t0.001;499=14.948, P<.001) had a statistically significant impact on PEOU (R2=40.9%), while promotion of health (ß=.865, t0.001;499=29.943, P<.001) significantly influenced health benefits (R2=74.7%). CONCLUSIONS: mHealth apps could be used to predict the behavior of patients in the face of recommendations to prevent pandemics, such as COVID-19 or SARS, and to track users' symptoms while they stay at home. Gender is a determining factor that influences the intention to use mHealth apps, so perhaps different interfaces and utilities could be designed according to gender.

Variações linguísticas e seus efeitos na saúde:: reflexões para a clínica fonoaudiológica / Linguistic variations and their effects on health:: reflections for the speech therapy clinic / Variaciones lingüísticas y sus efectos sobre la salud:: reflexiones para la clínica de logopedia

Introdução: As variações linguísticas não correspondem a distúrbios de comunicação, entretanto a sua valoração, constitui fonte de preconceito linguístico e discriminação social, chegando a processos de "patologização". Falantes de variações linguísticas não prestigiadas, supondo algum distúrbio, procuraram o serviço de saúde com queixa de sofrer discriminação por preconceito linguístico. Experimentavam sensação de inferioridade, retraimento social, até rebaixamento da autoestima; levando a crises de ansiedade ou a episódios depressivos. Objetivo: Analisar as repercussões das variações linguísticas em um grupo de sujeitos, estabelecer indicações à reflexão sobre essa problemática no campo da saúde, especialmente no manejo dessas repercussões no âmbito da clínica fonoaudiológica. Método: Estudo de natureza descritiva, caracterizado, em seu desenho, como estudo de caso. Utilizou-se a metodologia do Grupo de Discussão, que consiste em favorecer e promover a construção de discurso grupal; sendo este o objeto da pesquisa. Resultados e Discussão: As variações linguísticas são constituídas em função de origem, extração sociocultural e condição socioeconômica e foram percebidas como variável significativa da discriminação e exclusão social. As categorias analíticas depreendidas do discurso grupal: preconceito e bullying; comunidade de fala e exclusão social; expectativas frente à norma prestigiada. O trabalho fonoaudiológico deverá: - reconhecer e valorizar o sofrimento das vítimas; - promover o trânsito pelas variações linguísticas, entender nuances fonético-fonológicas, sintáticas, semânticas e prosódicas, avaliando os usos e contextos sociais dos gêneros discursivos orais. Conclusão: Indicar à Fonoaudiologia para acolher e atender as vítimas de preconceito linguístico, no âmbito da ação clínica de prevenção de agravos e de promoção da saúde.

Introduction:  Linguistic variations do not correspond to communication disorders; however, their valuation constitutes a source of linguistic prejudice and social discrimination, reaching processes of "pathologization". Speakers of non-prestigious linguistic variations, assuming some speech disorder, sought the health service with a complaint of suffering discrimination due to linguistic prejudice. They experienced a sensation of inferiority, social withdrawal, even lowering of self-esteem; leading to bouts of anxiety or depressive episodes. Objective: To analyze the repercussions of linguistic variations in a group of people, establish indications for reflection on this problem in the field of health, especially in the management of these repercussions in the field of speech therapy. Methods: 'Descriptive Research' characterized, in it's design, as a case study. The 'Focus Group Discussion' methodology was used, which consists in favoring and promoting the construction of a group discourse; this being the object of the research. Results: The linguistic variations are constituted in function of origin, socio-cultural extraction and socioeconomic condition and were perceived as a significant variable of discrimination and social exclusion. The analytical categories inferred from the focus group: prejudice and bullying; the speech community and social exclusion; expectations in relation to the prestigious norm. The Speech therapy work should: - recognize and value the suffering of victims; - promote the transit through linguistic variations, understanding phonetic-phonological, syntactic, semantic and prosodic nuances, evaluating the uses and social contexts of oral discourse genders. Conclusion: To indicate the Speech therapy to welcome and assist the victims of linguistic prejudice, in the scope of the clinical action of prevention and health promotion.

Introduccion: Las variaciones lingüísticas no corresponden a los trastornos de la comunicación, sin embargo su valoración es fuente de prejuicios lingüísticos y de discriminación social, lo que conduce a procesos de "patologización". Los hablantes de variaciones lingüísticas no prestigiosas, asumiendo algún trastorno del habla, buscaron el servicio de salud quejándose de discriminación por prejuicios lingüísticos. Experimentaban una sensación de inferioridad, de retraimiento social, incluso de disminución de la autoestima; lo que provocaba crisis de ansiedad o episodios depresivos. Objetivo: Analizar las repercusiones de las variaciones lingüísticas en un grupo de sujetos, establecer indicaciones para la reflexión sobre este problema en el campo de la salud, especialmente en el manejo de estas repercusiones en el campo de la logopedia. Metodos:  Un 'Estudio Descriptivo', caracterizado en su diseño como un estudio de caso. Se utilizó la metodología del 'Grupo de Discusión', que consiste en favorecer y promover la construcción de un discurso grupal, siendo éste el objeto de la investigación. Resultados: Las variaciones lingüísticas se constituyen en función del origen, la extracción sociocultural y la condición socioeconómica y se perciben como una variable significativa de discriminación y exclusión social. Las categorías analíticas deducidas del discurso de grupo: prejuicios e intimidación; la comunidad de discurso y la exclusión social; expectativas en relación con la norma de prestigio. El trabajo logopedista debería: - reconocer y valorar el sufrimiento de las víctimas; - promover el tránsito por las variaciones lingüísticas, comprendiendo los matices fonético-fonológicos, sintácticos, semánticos y prosódicos, evaluando los usos y contextos sociales de los géneros del discurso oral. Conclusión: Indicar a Logopedia que acoja y asista a las víctimas de los prejuicios lingüísticos, en el ámbito de la acción clínica de prevención y promoción de la salud.

The relationship of hospital stay and readmission with employment status.

The Inpatient Clinico-Occupational Survey collected data from 3.76 million patients, showing that the average length of stay declined by 16.1 d in FY2008 and by 14.1 d in FY2015. In this study, we assessed the length of hospital stay and readmission, stratified by ICD-10 and employment status. A cross-sectional study was conducted on data from FY2008, including those from 65,806 first hospitalizations and 16,653 readmissions in FY2008, where 62,260 first admissions and 29,242 readmissions in FY 2015. The length of hospital stay was longest in those admitted due to external influences (24.8 d), followed by musculoskeletal disorders (22.5 d). This remained unchanged in FY2015, however, lengths of stay of those were reduced by 20.1 and 20.0 d, respectively. The length of hospital stay for most diseases was longer upon readmission than on first admission, and longer for those who were unemployed. It is necessary to give attention to patients who need to be discharged early due to work, or plan for frequent hospitalization in order to reduce the length of each hospital stay because of the expected increase in the number of elderly workers brought on by a declining birth rate and an aging population.

Factores del desarrollo de intersectorialidad para la promoción de salud bucodental en niños de preescolar / Factors in the development of intersectorality for oral health promotion in preschool children

RESUMEN Introducción: la promoción de salud se puede definir como un proceso político-social, o una estrategia, que contribuye a mejorar la calidad de vida de los hombres. La intersectorialidad es una solución para lograr esas transformaciones necesarias. Objetivo: caracterizar los factores del desarrollo de la intersectorialidad para la promoción de salud bucodental en niños de grado preescolar. Métodos: Se realizó una investigación descriptiva transversal, con enfoque cuanti-cualitativo, en el municipio Sagua la Grande, Villa Clara, en el período 2017-2018. Se trabajó con toda la población de niños preescolares (326). Para la recolección de la información se emplearon: análisis documental, entrevistas, cuestionarios y observación en escuelas primarias. Resultados: se determinó la presencia de los siguientes factores determinantes: deficientes acciones sobre promoción de salud bucal, desconocimiento sobre salud bucal de niños, docentes y familias, inadecuados hábitos de salud bucal, bajo nivel socio-económico de la familia, y no existencia de áreas para el cepillado dental. También se encontraron otros factores condicionantes: ausencia de capacitación y acciones de promoción de salud bucal, y escasa motivación intersectorial para llevar a cabo estas acciones. Los factores desencadenantes fueron: ausencia de programas y proyectos que sustenten la promoción de salud bucal, carencia de una estrategia metodológica sobre salud bucal en el sistema de trabajo metodológico del sector educacional y análisis del aspecto bucal. Conclusiones: se evidenció la presencia de factores determinantes, condicionantes y desencadenantes de la intersectorialidad para la promoción de salud preescolar.

ABSTRACT Introduction: health promotion can be defined as a sociopolitical process, or a strategy, that contributes to improve people's quality of life. Intersectorality is a solution to achieve these necessary transformations. Objective: to characterize the developmental factors of intersectorality for oral health promotion in preschool children. Methods: a cross-sectional descriptive research, with a qualitative-quantitative approach, was carried out in Sagua la Grande municipality, Villa Clara, from 2017 to 2018. We worked with the entire preschool population (326). The following methods were used to collect information: documentary analysis, interviews, questionnaires and observation in primary schools. Results: the presence of the following determining factors was determined: deficient actions on oral health promotion, lack of knowledge of children, teachers and families on oral health, inadequate oral health habits, low socio-economic level of the family, and non-existence of areas for dental brushing. Other conditioning factors were also found: lack of training and actions on oral health promotion, and low intersectoral motivation to carry out these actions. Triggering factors were: absence of programs and projects that support oral health promotion, lack of a methodological strategy on oral health in the methodological work system of the educational sector, and analysis of the oral appearance. Conclusions: the presence of determining, conditioning and triggering factors of the intersectoriality for health promotion in preschool children was evidenced.

Ageing and COVID-19: What is the Role for Elderly People?

Italy is one of the oldest countries in Europe and in the world and now it is also one of the first countries that are fighting against COVID-19. In our country, the increasing life expectancy (80.5 for males and 84.9 for females, with a total life expectancy of 82.9) has led to very positive consequences for health and the well-being of elderly people: a very high number of older adults lives and acts independently in their daily life, even if they have one or more than one chronic disease. In the time of COVID-19's outbreak in Italy, the focus of the media was on elderly people for two main reasons. First, many older people demonstrated a very high civic sense and they were helping society to fight against the pandemic. Second, also in Italy, like in China, the older adults are at higher risk in being infected with COVID-19 and if they get ill, they have a higher risk of death. The balance previously achieved between age-related disorders and a good quality of life and good health is now under high pressure. It is very important to protect elderly people from infection, but also it is important to respect them and to support them in this complex situation. There is a great risk of "ageism". In agreement with Lloyd-Sherlock and colleagues (2020), in this editorial we propose some hints of analysis, starting from the ongoing experience in Italy.

Análise do trabalho em equipe multiprofissional para ações de alimentação e nutrição na atenção básica / Analysis of the multiprofessional teamwork for actions regarding diet and nutrition in primary health care / Análisis del trabajo en equipo multiprofesional para acciones de alimentación y nutrición en la atención básica

Resumo O estudo analisou o processo de trabalho de profissionais de um Núcleo Ampliado de Saúde da Família na Atenção Básica na implantação de atividades educativas coletivas de promoção da alimentação adequada e saudável. Foi utilizado o método de abordagem qualitativa, com base em um estudo-piloto de um ensaio comunitário controlado e randomizado, com a participação de seis profissionais. As entrevistas seguiram roteiro semiestruturado. A análise de conteúdo foi empregada para desvelar significados das falas dos participantes. Emergiram três categorias: integração da equipe como eixo propulsor do processo de trabalho; educação libertadora e comprometimento como eixos norteadores para a implantação das atividades coletivas de alimentação saudável; e desafios à implementação das atividades educativas de alimentação saudável. Os resultados demonstram que a metodologia de grupo proposta pelo Ministério da Saúde é uma boa estratégia para a organização e condução do processo de trabalho. Ademais, favoreceu a integração de forças de trabalho de profissionais de distintas categorias, resultando no fortalecimento da equipe no exercício da interdisciplinaridade e na criação de espaços coletivos de trocas, de cuidado e de empoderamento dos indivíduos assistidos.

Abstract This The study assessed the work process of the professionals of an Extended Health of the Family Center (Núcleo Ampliado de Saúde da Família, in Portuguese) in Primary Health Care regarding the establishment of collective educational activities for the promotion of a healthy and proper diet. We used the qualitative approach method, based on a pilot study of a randomized and controlled community trial, with the participation of six professionals. The interviews followed a semi-structured script. Content analysis was employed to reveal the meanings of the speeches of the participants. Three categories emerged: integration of the team as the driving force of the work process; liberating education and engagement as the guiding axes for the implementation of collective activities regarding healthy eating; and challenges to the implementation of educational activities on healthy eating. The results show that the group methodology recommended by the Brazilian Ministry of Health is a good strategy for the organization and management of the work process. Moreover, it boosted the integration of the work force of professionals from different categories, resulting in the strengthening of the team in the practice of interdisciplinarity and in the development of collective spaces for exchanges, care and empowerment of the assisted individuals.

Resumen El estudio analizó el proceso de trabajo de los profesionales de un Núcleo Ampliado de Salud de la Familia en la Atención Básica en la implantación de actividades educativas colectivas de promoción de la alimentación adecuada y sana. Utilizamos el método del abordaje cualitativo, basado en un estudio piloto de un ensayo comunitario controlado y aleatorizado, con la participación de seis profesionales. Las entrevistas siguieron un guion semiestructurado. Se empleó el análisis de contenido para revelar los discursos de los participantes. Tres categorías han emergido: integración del equipo como el eje propulsor del proceso de trabajo; educación liberadora y compromiso como ejes norteadores para la implantación de las actividades colectivas de alimentación sana; y los retos a la implementación de las actividades educativas de alimentación sana. Los resultados demuestran que la metodología de grupo propuesta por el Ministerio de Salud es una buena estrategia para la organización y conducción del proceso de trabajo. Además, favoreció la integración de fuerzas de trabajo de profesionales de distintas categorías, resultando en el fortalecimiento del equipo en el ejercicio de la interdisciplinaridad y en la creación de espacios colectivos de intercambios, de cuidado y de empoderamiento de los individuos asistidos.

Práticas de consumo de álcool, tabaco e outras drogas entre estudantes em contexto universitário / Consumer practices of Alcohol, Tobacco and Other Drugs between students in University

O objetivo deste estudo foi descrever o perfil do consumo de álcool, tabaco e outras drogas entre estudantes universitários em contexto recreativo e em mobilidade internacional. Trata-se de uma revisão integrativa da literatura que teve 11 publicações como amostra final de quatro países diferentes. Como resultado, os estudos mostram um alto consumo de drogas, sendo o álcool a droga mais consumida em contextos recreativos, especialmente em instituições acadêmicas e não acadêmicas. Em relação ao consumo de tabaco e outras drogas, foram encontrados dados nos artigos analisados, mas o aumento na venda de cachimbo de água é notável. A mobilidade internacional foi citada nos estudos como influenciadora para a prática do uso de substâncias, a saber, o álcool. Identificou-se a relevância do tema, no entanto, faltam estudos no âmbito da pesquisa sobre estudantes universitários em mobilidade internacional e sobre o uso do cachimbo de água, enfatizando a necessidade de estudos a serem realizados nesse contexto.

The aim of this study was to describe the profile of alcohol, tobacco and other drugs consumption among university students in recreational context and in international mobility. This is an Integrative Review of Literature that had 11 publications as the final sample from four different countries. As result the studies show a high consumption of drugs, with alcohol being the most consumed drug in recreational contexts, especially at academic and non­academic parties. Regarding the tobacco and other drugs consumption, data were found in the analyzed articles, but the increase in the sale of hookah is notable. International mobility was cited in the studies as an influencer for the practice of substance use, namely alcohol. It was identified the relevance of the subject, however, a shortage of studies in the scope of research on university students in international mobility and on the use of hookah, emphasizing the need for studies to be carried out in this context.

Digital Recruitment and Acceptance of a Stepwise Model to Prevent Chronic Disease in the Danish Primary Care Sector: Cross-Sectional Study.

BACKGROUND: During recent years, stepwise approaches to health checks have been advanced as an alternative to general health checks. In 2013, we set up the Early Detection and Prevention project (Tidlig Opsporing og Forebyggelse, TOF) to develop a stepwise approach aimed at patients at high or moderate risk of a chronic disease. A novel feature was the use of a personal digital mailbox for recruiting participants. A personal digital mailbox is a secure digital mailbox provided by the Danish public authorities. Apart from being both safe and secure, it is a low-cost, quick, and easy way to reach Danish residents. OBJECTIVE: In this study we analyze the association between the rates of acceptance of 2 digital invitations sent to a personal digital mailbox and the sociodemographic determinants, medical treatment, and health care usage in a stepwise primary care model for the prevention of chronic diseases. METHODS: We conducted a cross-sectional analysis of the rates of acceptance of 2 digital invitations sent to randomly selected residents born between 1957 and 1986 and residing in 2 Danish municipalities. The outcome was acceptance of the 2 digital invitations. Statistical associations were determined by Poisson regression. Data-driven chi-square automatic interaction detection method was used to generate a decision tree analysis, predicting acceptance of the digital invitations. RESULTS: A total of 8814 patients received an invitation in their digital mailbox from 47 general practitioners. A total of 40.22% (3545/8814) accepted the first digital invitation, and 30.19 % (2661/8814) accepted both digital invitations. The rates of acceptance of both digital invitations were higher among women, older patients, patients of higher socioeconomic status, and patients not diagnosed with or being treated for diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular disease. CONCLUSIONS: To our knowledge, this is the first study to report on the rates of acceptance of digital invitations to participate in a stepwise model for prevention of chronic diseases. More studies of digital invitations are needed to determine if the acceptance rates seen in this study should be expected from future studies as well. Similarly, more research is needed to determine whether a multimodal recruitment approach, including digital invitations to personal digital mailboxes will reach hard-to-reach subpopulations more effectively than digital invitations only.

Sentidos atribuídos pelos alunos com deficiência e pelos professores às aulas de educação física escolar / Meanings conferred by impaired students and teachers to physical education classes in schools

A educação física relaciona-se com a promoção de saúde no âmbito escolar. Foi verificado que ainda faltam estudos que visam o levantamento dos sentidos atribuídos pelos alunos com deficiência e professores de Educação Física às aulas de EFE, principalmente a partir das políticas de inclusão de crianças com deficiência em escolas regulares. Trata-se de um estudo qualitativo de caráter exploratório, com o objetivo de analisar como as aulas de educação física em que participam alunos com deficiência são significadas pelos professores de Educação física e pelos alunos com deficiência destes professores. O estudo foi realizado em cinco escolas públicas municipais em uma cidade do interior de São Paulo, por meio de entrevistas semiestruturadas, com oito professores de Educação Física e dez alunos com deficiência. Os resultados evidenciaram que os professores gostam de desenvolver aulas com crianças com deficiência, pois para eles isto se torna muito compensador ao ver estes alunos com deficiência estão conseguindo realizar as atividades. Por outro lado, poucos professores tiveram acesso aos conteúdos sobre o trabalho com a criança com deficiência na sua formação inicial ou tiveram oportunidades de formação continuada. Assim, o sentido da realização do trabalho desenvolvido pelo professor de Educação Física na escola com crianças com deficiência acaba sendo predominantemente o de falta: falta de formação, falta de recursos educacionais adaptados, falta de auxiliares. Em relação às condições de trabalho, ainda faltam melhorias que poderiam facilitar o trabalho do professor de educação física em vários aspectos, sendo eles, espaço físico, materiais, uma maior parceria com as famílias, maior apoio da rede de ensino, principalmente na oferta de uma formação direcionada ao trabalho com crianças com deficiência. Um aspecto fragilizador no trabalho destes professores se refere ao planejamento, visto que os professores participantes não trazem muitos detalhes deste planejamento ou fazem um planejamento geral que pode não estar indo ao encontro das reais necessidades destes alunos com deficiência, com uma intencionalidade de tornar sua aula mais inclusiva e trabalhando com a zona de desenvolvimento proximal dos alunos com deficiência. Para as crianças com deficiência entrevistadas, os sentidos da aula de educação física estão ligados ao bem estar, possibilidade de jogar e de brincar, o que evidencia também que os sentidos para as crianças com deficiência podem ser diferentes dos sentidos para os professores

Physical Education is related to the promotion of health in the school environment. In addition, studies aiming at surveying the meanings impaired students and teachers confer to Physical Education classes are scarce, especially with the implementation of inclusion policies for impaired children in regular schools. This is a qualitative exploratory study which aimed at analyzing how Physical Education classes in which participate impaired students are meant by Physical Education teachers and by their impaired students. This study was conducted in five public municipal schools in the countryside of São Paulo, by means of semistructured interviews, with eight Physical Education teachers and ten impaired students. Results showed that the teachers like to develop classes with impaired children, because it is very rewarding for them to realize that these students are able to perform the proposed activities. In contrast, few teachers had access to contents regarding the work with impaired children during their initial formation, or continuous training opportunity. Thus, the meaning of the work developed by these teachers is, predominantly, the lack of formation, lack of adapted educational resources, lack of helpers. Regarding the work conditions, some improvement which could facilitate the theachers' work is still missing concerning physical space, materials, a better partnership with families, better support of the educational network, mainly by offering a formation directed to working with impaired children. A debilitating aspect regarding the work of these teachers is related to planning, since the participant teachers do not provide details of this planning, or conduct a general planning which may not meet the real needs of these impaired students, aiming at making their classes more including and also working with the zone of proximal development of the impaired students. For the interviewed impaired children, the meanings of the Physical Education classes are linked to the well-being and the possibility of playing, which also highlights that the meanings for impaired children may be different from the teachers'