Pharmaceutical Care in Primary Care: an Experience with Hypertensive Patients in the North of Brazil

Abstract Background: Uncontrolled blood pressure has been associated with poor adherence to drug treatment. Objectives: To assess blood pressure control in hypertensive patients attending primary health centers after implementation of a pharmaceutical follow-up program in a city of the north of Brazil. Methods: Observational, cross sectional, descriptive study with 163 hypertensive patients attending public primary health care centers - one located on the riverside and one in the urban area of the city of Santarem, western Pará, Brazil. Adherence to the anti-hypertensive treatment was assessed using the eight-item Morisky test. Pharmacotherapy follow-up (Dader method) of patients with uncontrolled hypertension and non-adherent to anti-hypertensive treatment was performed. Results of the normality test showed that the data did not follow a normal distribution. Continuous variables were then compared using the Wilcoxon signed-rank test, and categorical variables by the likelihood ratio and the McNemar tests. Statistical significance was set at 5%. Results: Of the total sample, 94.5% were not adherent to anti-hypertensive drug therapy and 77.2% had uncontrolled hypertension. Adherence rate was higher in men than women (p=0.006). Pharmacotherapy follow-up improved blood pressure levels, particularly systolic blood pressure (p<0.001). Conclusion: An individualized pharmacotherapeutic follow-up, considering regional and cultural specificities, can contribute to the treatment of hypertensin in the primary care.

Aparelhos de amplificação sonora individual: quais são as queixas mais recorrentes dos usuários e suas possíveis relações com ajustes finos? / Hearing aids: what are the most recurrent complaints from users and their possible relationship with fine tuning?

RESUMO Objetivo identificar as queixas mais recorrentes dos usuários de aparelhos de amplificação sonora individual (AASI) e estabelecer possíveis relações que auxiliem a busca de soluções de problemas no processo de adaptação desses dispositivos. Métodos estudo transversal, descritivo e quantitativo, realizado mediante questionário on-line, respondido por 176 fonoaudiólogos. Após computação e organização das respostas, realizou-se uma codificação e foram descritos 30 termos mais recorrentes, referentes às queixas dos usuários. Foram estabelecidas quatro categorias para verificar cada termo relatado e sua correspondência com o problema apontado em cada questão. Para o direcionamento das possíveis relações entre as queixas e suas resoluções, os termos foram divididos nos seguintes aspectos principais do processo de adaptação de AASI: adaptação física, ajuste das características eletroacústicas e características intrínsecas do usuário. Resultados foram descritos 30 termos representativos das queixas, com maior número de ocorrências para o termo "Aparelho muito alto/Som muito alto", que apareceu 223 vezes. O termo "Não escuta nada" apareceu com menor número de ocorrências, 25 vezes. No total, foram encontradas seis queixas relacionadas a aspectos físicos, 17 a ajustes de características eletroacústicas, quatro que poderiam estar relacionadas a ambos os aspectos e duas a características intrínsecas do indivíduo. Conclusão foi possível elencar as queixas mais referidas pelos usuários de AASI. Observou-se que é viável, a partir de uma queixa, direcionar um suposto aspecto relacionado à adaptação e auxiliar os fonoaudiólogos a levantar soluções, apesar de ser clara a necessidade de um olhar individualizado para cada paciente e situação.

ABSTRACT Purpose To identify the most frequent complaints from hearing-aid users and establish possible relationships that might help audiologists solve some problems. Methods Cross-sectional, descriptive and quantitative study, carried out through an online questionnaire, answered by 176 audiologists. After analyzing the responses and computing the terms, coding was performed and the 30 most frequent complaints were described. Four categories were established to verify each reported term and its correspondence with the problem pointed out in each question. To address the possible relationships between complaints and their solutions, the terms were divided into the following main aspects of the hearing aid fitting process: physical adaptation, adjustment of electroacoustic characteristics and user's intrinsic characteristics. Results 30 representative terms of complaint were described due to their high number of occurrences : the term "very loud device / very loud sound" appeared 223 times whereas the term "I cannot hear anything" had the fewest number of occurrences, 25 appearances. In total, there were six complaints related to physical aspects, 17 to adjustments of electroacoustic characteristics, four that could be related to both aspects and two to intrinsic characteristics of the individual. Conclusion It was possible to identify the most frequently reported complaints of hearing aid users. . It was observed that it is feasible, based on a complaint, to address a supposedly related aspect of adaptation and help audiologists find solutions. However, each particular patient and situation must be given individualized attention.

Recurrent acute otitis media: a survey of current management in England.

OBJECTIVE: Recurrent acute otitis media is common in children. The preferred treatment measures for recurrent acute otitis media have a mixed evidence base. This study sought to assess baseline practice across ENT departments in England. METHODS: A national telephone survey of healthcare staff was conducted. Every ENT centre in England was contacted. A telephone script was used to ask about antibiotic and grommet use and duration in recurrent acute otitis media cases. RESULTS: Ninety-six centres (74 per cent) provided complete information. Recurrent acute otitis media treatment across England by ENT departments varied. The antibiotic first- and second-line prophylaxis offered varies, with trimethoprim used in 33 centres and 29 centres not offering any antibiotics. The timing or choice about when to use grommets also varies, but 87 centres (91 per cent) offer grommet surgery at one stage. CONCLUSION: The treatments received by children in England for recurrent acute otitis media vary by centre; collaborative research in this area is advised.

Relationship between satisfaction with mental health services, personal recovery and quality of life among service users with psychosis: a cross-sectional study.

BACKGROUND: Mental health policy internationally emphasizes patient centredness and personal recovery. This study investigated the relationship between satisfaction with mental health services among service users with psychosis in Norway, and personal recovery, perceived support for personal recovery, and quality of life. METHODS: Cross-sectional data were collected from 292 service users diagnosed with psychosis from 39 clinical sites across Norway. Satisfaction with services was assessed using the Client Satisfaction Questionnaire-8. A linear mixed model was estimated to explore the relationship between satisfaction with services and preselected covariates, and to control for confounding factors. RESULTS: A large majority of participants (89%) reported moderate-to-high levels of satisfaction. Satisfaction with services was positively associated with perceived support for personal recovery, but not with personal recovery or quality of life. In addition, service users under a Community Treatment Order (CTO) were significantly less satisfied than those who were not. CONCLUSIONS: Satisfaction levels among service users were higher compared with similar, international studies. Those who feel supported in their personal recovery were more satisfied with the care they receive, which support the need for implementation of recovery-oriented practices for service users with psychosis. However, satisfaction with services was not related to service user-rated quality of life or level of personal recovery; thus, more follow-up studies are needed. The lower satisfaction of service users placed under CTOs shows the importance of targeted interventions to improve satisfaction with services among this group. TRIAL REGISTRATION: NCT03271242 , date of registration: 5 sept. 2017.

Management of patients diagnosed or suspected with Covid-19 in cardiorespiratory arrest: a scoping review / Manejo de pacientes diagnósticos o sospechosos de Covid-19 en la parada cardiorrespiratoria: revisión de alcance / Manejo de pacientes diagnosticados ou com suspeita de Covid-19 em parada cardiorrespiratória: scoping review

ABSTRACT Objective: to map the production of knowledge about the recommendations that can be applied in managing patients diagnosed or suspected with COVID-19 in cardiorespiratory arrest. Method: a scoping review, according to the Joanna Briggs Institute (2020) guidelines. Search was performed in ten data sources, and two electronic search engines were used; from 2001 to 2020. Results: of the 547 studies found, 14 met the inclusion and exclusion criteria. Most studies were published in 2020 (35.7%), and most studies were conducted in Canada (21.4%). It is observed the use of a systematized care to identify the possible means of care that should be provided to patients who suffer a cardiorespiratory arrest in hospitals, such as the monitoring of suspected cases by assessing the victim's breathing and pulse and identifying arrhythmias and shockable rhythms quickly. Personal protective equipment must be used to protect against droplets and aerosols and respiratory etiquette. Conclusion: managing patients in cardiorespiratory arrest suspected or diagnosis with COVID-19 requiring cardiopulmonary resuscitation should be performed in isolation areas and with the use of adequate protective equipment. There are gaps in scientific productions so that they address more clearly and instructively management when performing cardiopulmonary resuscitation in patients suspected or diagnosed with COVID-19.

RESUMEN Objetivo: mapear la producción de conocimiento sobre las recomendaciones que se pueden aplicar en el manejo de un paciente diagnosticado o sospechoso de tener COVID-19 en paro cardíaco. Método: se trata de una revisión de alcance, de acuerdo con las directrices del Instituto Joanna Briggs (2020). La búsqueda se realizó en diez fuentes de datos y se utilizaron dos buscadores electrónicos; período de tiempo de 2001 a 2020. Resultados: de las 547 publicaciones encontradas, 14 cumplieron los criterios de inclusión y exclusión. La mayoría de los estudios se publicaron en el año 2020 (35,7%) y la mayoría de los estudios se realizaron en Canadá (21,4%). Se observa el uso de una atención sistemática para identificar las posibles vías de asistencia que se deben brindar a los pacientes que sufren una parada cardiorrespiratoria en el ámbito hospitalario, como monitorear los casos sospechosos de la enfermedad mediante la evaluación de la respiración y el pulso de la víctima e identificar rápidamente arritmias y ritmos desfibrilables. Cabe mencionar el uso de equipo de protección personal para protegerse de gotitas y aerosoles y conductas respiratorias específicas para estos casos. Conclusión: el manejo de pacientes en parada cardiorrespiratoria con COVID-19 sospechado o diagnosticado que requieran reanimación cardiopulmonar debe realizarse en áreas de aislamiento y con el uso de equipo de protección adecuado. Se observó que existen lagunas en las producciones científicas, por lo que se abordan de forma más clara e instructiva sobre el manejo al realizar reanimación cardiopulmonar en pacientes con sospecha o diagnóstico de COVID-19.

RESUMO Objetivo: mapear a produção de conhecimento sobre as recomendações que podem ser aplicadas no manejo de paciente diagnosticado ou com suspeita de COVID-19 em Parada Cardiorrespiratória. Método: trata-se de uma revisão de escopo, de acordo com as orientações do Instituto Joanna Briggs (2020). Realizada busca em dez fontes de dados, e utilizados dois buscadores eletrônicos; recorte temporal de 2001 a 2020. Resultados: das 547 publicações encontradas, 14 atenderam aos critérios de inclusão e exclusão. A maior parte dos estudos foi publicada no ano de 2020 (35,7%), e a maioria dos estudos foi realizada no Canadá (21,4%). Observa-se o uso de um cuidado sistematizado para identificação das possíveis vias de assistência que deverão ser prestadas a pacientes que sofrem uma parada cardiorrespiratória no ambiente hospitalar, como o monitoramento de casos suspeitos da doença através da avaliação da respiração e pulso da vítima e identificação das arritmias e de ritmos chocáveis de forma rápida. Vale salientar o uso de equipamentos de proteção individual para proteção contra gotículas e aerossóis e condutas respiratórias específicas para estes casos. Conclusão: o manejo do paciente em parada cardiorrespiratória com suspeita ou diagnóstico de COVID-19 que necessita de reanimação cardiopulmonar deve ser realizado em áreas de isolamento e com a utilização de equipamentos de proteção adequados. Foi visto que existem lacunas nas produções científicas, para que abordem de maneira mais clara e instrutiva sobre o manejo ao realizar ressuscitação cardiopulmonar em pacientes com suspeita ou diagnóstico de COVID-19.

Protocolo de atención a viajeros que entran y salen del país en vuelos especiales: Guía Técnica / Protocol of attention to travelers entering and leaving the country on special flights: Technical Guide

El documento contiene los procedimientos de atención para los viajeros que ingresan y salen del país en vuelos especiales en el contexto de la emergencia sanitaria por COVID-19 a nivel nacional declarada por el Decreto Supremo N° 008-2020. El documento fue derogado de baja con R.M. N°493-2023-MINSA del 26 de mayo de 2023.

Exploring access to government-led support for children with disabilities in Bangladesh.

While access to support for individuals with disabilities has attracted international attention, children with disabilities and their families continue to face a range of barriers that limit their timely access to the needed support, including health service. This is even worse for children with disabilities living in resource poor settings like Bangladesh. The objective of this study was to determine the extent to which families of children with disabilities have knowledge about and access to government support for their children with disabilities in Bangladesh. We employed a cross-sectional study among 393 families of children with disabilities who sought services from the Centre for the Rehabilitation of the Paralysed for their children with disabilities in Bangladesh. We used chi-square test to measure the association between categorical variables and, Mann-Whitney U-test to compare mean across different sub-groups. Overall, family members of children with disabilities have limited knowledge about and access to government support. We found a significant association between knowledge and access to government support (p<0.001). Family members with children with disabilities aged younger than six years had less access to government support (p<0.001). We thus concluded with an urgent call on government agencies and service providers to provide relevant and timely information to families of children with disabilities to enable them to access the needed support.

Performance management: a qualitative study of relational boundaries in personal assistance.

Personal assistance (PA) is a model of support where disabled people take control of recruiting, training and managing the people that support them. Personal assistance differs from other forms of care, such as domiciliary or informal care, because the disabled person is in control of how, when and by whom they are supported. With the advent of personal health budgets, PA is no longer limited to social care but is also central to future NHS services and funding arrangements. The aims of this study were to gain a deeper understanding of PA relationships, and to explore how both parties manage interpersonal challenges. We report on data from 58 qualitative interviews with disabled employers and personal assistants. Applying concepts from Goffman's (1959) scheme of impression management, we present an analysis of the relational dynamics that occur when two people cooperate in shared endeavours. Goffman's concepts of team members and non-persons, in addition to the themes of regions and information control, aid a more fundamental understanding of the relational dynamics that occur between disabled employers and their PAs.

Análise do perfil sociodemográfico, motivos de adesão, rotina de treinamento e acompanhamento profissional de praticantes de corrida de rua / Analysis of sociodemographic profile, adhesion reasons and characteristics of training of street running practitioners

A corrida de rua é considerada um fenômeno sociocultural contemporâneo em ampla expansão no Brasil e no mundo. No entanto, há uma carência de informações a respeito do perfil sociodemográfico dos praticantes de corridas de rua, assim como os seus motivos de adesão e rotina de treinamento. Essas informações são essenciais para a elaboração de estratégias de intervenção profissional voltadas para os praticantes de corrida de rua. O presente estudo teve como objetivo analisar o perfil sociodemográfico, os motivos de adesão, a rotina de treinamento e acompanhamento profissional de corredores de rua. Participaram da pesquisa 214 praticantes de corrida de rua, do sexo masculino e feminino, idade entre 18 e 58 anos (M = 36,4 ± 10,3), devidamente inscritos em provas que fazem parte do calendário oficial de corridas. Os praticantes responderam um questionário composto por 18 questões organizadas em 3 categorias: perfil ciodemográfico, motivos de adesão e rotina de treinamento/acompanhamento profissional. Os resultados evidenciaram que a maioria dos praticantes de corrida de rua são do sexo masculino (62,1%), com faixa etária predominante entre 20 e 40 anos, elevado nível de escolaridade e que buscam essa atividade especialmente por motivos de saúde (91,1%) e prazer (69,1%). Apesar de 43,9% dos praticantes não receberem acompanhamento profissional, 96,6% consideram importante ou muito importante a supervisão profissional durante a prática. Os achados indicam que, em geral, os adeptos da corrida de rua optam pela prática devido a busca pela melhora da qualidade de vida e a socialização, bem como a redução do estresse...(AU)

Running is considered a contemporary sociocultural phenomenon in a wide expansion in Brazil and in the world. However, there is a lack of information regarding the sociodemographic profile of street racing practitioners, as well as their reasons for joining this practice and the characteristics of training. This information is essential for the development of strategies for professional intervention aimed at street racing practitioners. The present study sought to analyze the sociodemographic profile, the reasons of adhesion and the characteristics of training of street racing practitioners. A total of 214 male and female street racing practitioners, aged between 18 and 58 years (M = 36.4 ± 10.3), duly enrolled in races that are part of the official racing calendar, participated in the study. The practitioners answered a questionnaire composed of 18 questions organized in 3 categories: sociodemographic profile, reasons of adhesion and training characteristics. The results showed that most of the street racing practitioners are male (62.1%), with a predominant age group between 20 and 40 years of age, a high level of schooling and who seek this activity especially for health reasons (91, 1%) and pleasure (69.1%). Although 43.9% of the practitioners did not receive professional support, 96.6% considered it important hat, in general, the street racing practitioners choose this practice because of the quest for improving quality of life and socialization as well as for reducing stress...(AU)

A Survey on Health Care and Health Concerning Workers for Considering Appropriate Personal Health Record Service.

To prevent worsening of diabetes mellitus, we conducted a developmental research of personal health record (PHR), whereby affected individuals, medical staff and an insurer cooperate and manage effective treatment. Medical expenses can be suppressed by preventing the onset of lifestyle-related diseases. Companies can benefit from improved employee productivity by promoting healthy and efficient working styles. We conducted a health and medical consciousness survey to examine PHR models that are attractive for both employers and employees.

[Chronicle of a century of public health in Mexico: from public health to social protection in health.] / Crónica de un siglo de salud pública en México: de la salubridad pública a la protección social en salud.

This paper describes the creation of the legal framework and the origin, growth and consolidation of the institutions and interventions (initiatives, programs and policies) that nourished public health in Mexico in the past century. It also discusses the recent efforts to guarantee universal social protection in health. This quest, which lasted a century, developed through three generations of reform that gave birth to a health system that offers protection against sanitary risks, protection of health care quality and financial protection to all the population in the country.

En este artículo se describen la creación de los marcos legales y el origen, crecimiento y consolidación de las instituciones e intervenciones (iniciativas, programas, políticas) que han conformado la salud pública moderna en México. También se discuten los esfuerzos recientes por hacer universal la protección social en salud. Esta gesta, que duró un siglo, se fue abriendo paso a través de tres generaciones de reformas que dieron lugar a un sistema de salud que hoy ofrece protección contra riesgos sanitarios, protección de la calidad de la atención y protección financiera a los habitantes de todo el país.

Crónica de un siglo de salud pública en México: de la salubridad pública a la protección social en salud / Chronicle of a century of public health in Mexico: from public health to social protection in health

Resumen: En este artículo se describen la creación de los marcos legales y el origen, crecimiento y consolidación de las instituciones e intervenciones (iniciativas, programas, políticas) que han conformado la salud pública moderna en México. También se discuten los esfuerzos recientes por hacer universal la protección social en salud. Esta gesta, que duró un siglo, se fue abriendo paso a través de tres generaciones de reformas que dieron lugar a un sistema de salud que hoy ofrece protección contra riesgos sanitarios, protección de la calidad de la atención y protección financiera a los habitantes de todo el país.

Abstract: This paper describes the creation of the legal framework and the origin, growth and consolidation of the institutions and interventions (initiatives, programs and policies) that nourished public health in Mexico in the past century. It also discusses the recent efforts to guarantee universal social protection in health. This quest, which lasted a century, developed through three generations of reform that gave birth to a health system that offers protection against sanitary risks, protection of health care quality and financial protection to all the population in the country.

Percepción del usuario sobre la relación médico-paciente en un servicio público / Perception of user on the medical-patient relationship in a public service

Introducción: Se presenta un análisis sobre la relación que establece el médico con su paciente, en el servicio de salud pública más importante de la provincia de Chimborazo. Es posible evidenciar claramente el trato inadecuado del profesional al paciente, determinar si repercute de manera negativa sobre la salud de estos, y el efecto sobre la cobertura del profesional y por ende de la unidad de salud a la que se pertenece, son las interrogantes de investigación. Metodología: Es un estudio de campo, descriptivo, de corte transversal, con una muestra de 1200 personas que acuden al servicio de consulta externa en el Hospital General Docente de Riobamba. Esta presentación se deriva de un estudio con más de 2600 individuos involucrados en tres servicios de salud privados y públicos. Se trabaja sobre variables específicas como respeto, sensibilidad, capacidad profesional, explicación del procedimiento, consejería del médico, y conformidad de la atención por parte del paciente. Además, se recolectan datos generales del paciente y del médico como sexo, edad y número de consultas que determinan el tipo de relación entre el profesional y la población. Resultados: De manera general existe un alto grado de satisfacción de pacientes atendidos. No obstante, existe evidencia sobre la falta de comprensión del paciente, poca sensibilidad del profesional y la inadecuada explicación sobre procedimientos, lo cual lleva a una atención insuficiente. Conclusión: La relación médico paciente es un conjunto de actividades que van, desde contacto visual, empatía, respeto y conocimiento adecuado hasta la manera de agendar una nueva cita.

Introduction: An analysis is presented on the relationship established by the doctor with his patient, in the most important public health service in the province of Chimborazo. It is possible to clearly demonstrate the inadequate treatment of the professional to the patient, determine if it negatively affects their health, and the effect on the coverage of the professional and therefore of the health unit to which it belongs, are the questions of investigation. Methodology: This is a cross-sectional, descriptive field study with a sample of 1200 people who attend the outpatient service in the General Teaching Hospital of Riobamba. This presentation is derived from a study with more than 2,600 individuals involved in three private and public health services. We work on specific variables such as respect, sensitivity, professional capacity, explanation of the procedure, doctor's advice, and compliance of the patient's care. In addition, general data of the patient and the doctor are collected as sex, age and number of consultations that determine the type of relationship between the professional and the population. Results: In general there is a high degree of satisfaction of patients attended. However, there is evidence of lack of understanding of the patient, poor sensitivity of the professional and inadequate explanation of procedures, which leads to insufficient attention. Conclusion: The patient doctor relationship is a set of activities ranging from eye contact, empathy, respect and adequate knowledge to the way of scheduling a new appointment.

[Reasons for non-acceptance and non-use of a home telemonitoring application by multimorbid patients aged 65 years and over]. / Motive für die Nichtakzeptanz und Nichtnutzung einer Telemonitoring-Anwendung im häuslichen Umfeld durch multimorbide Patienten über 65 Jahre.

BACKGROUND: User acceptance is a key indicator and driver for the use and implementation of telemonitoring applications (TMA) in healthcare. Despite various positive effects that previous studies have revealed for users of TMA, there are always patients who discontinue their participation in a telemedicine study or even decline participation. There is little evidence for the reasons for non-acceptance and non-use of TMA, especially in multimorbid patients at the age of 65 and over in their home environment. To close this research gap, this sub-study focuses on patient-reported reasons for non-acceptance and non-use of TMA in the home environment. METHODS: This study follows a mixed-method approach and focuses on patients' perspective. Quantitative data collection took place via computer-assisted telephone interviews among all drop-outs and non-participants. Qualitative data were collected via semi-structured interviews with drop-out patients and non-users. Eligible patients were recruited consecutively by general practitioners, informed and included in the study according to the inclusion criteria. Amongst others, patients measured their vital signs (blood pressure, heart frequency, oxygen saturation, weight) via telemedical measures and sent them via tablet to a Care Coordination Center to ascertain the need for intervention. Collected data on non-acceptance and non-use of TMA were analyzed quantitatively and qualitatively. RESULTS: Nine general practices in two German cities included a total of 177 patients according to the inclusion criteria. During the study, 61 study participants (34.5 %) dropped out, 80 patients (31.1 %) declined participation in the study. Drop-outs and non-participants were significantly older than active participants (p=.004 and p=.001, respectively). Predominant reasons for drop-out were the lack of the perceived added value and the content-related variety of the program on the patient's tablet, the missing interest/need for telemedical monitoring as well as the time spent participating in the study. Patients living alone, single and widowed patients reported significantly more difficulties in handling the hardware (tablet) (p=.040) and the program (Motiva) (p=.013) than married and cohabiting patients. These reasons were also reported mainly by female patients, patients aged 75 years and over, and those with a low level of education. CONCLUSION: In order to increase the acceptance and the added value of TMA for patients, the individual needs of the future target group should be analyzed at the beginning of the development. To ensure maximum user centricity, individual development steps should be continuously evaluated by the target group. TMA should be adapted to the functional abilities of elderly, multimorbid patients through, e. g., an appropriate design of the content, which is tailored to patients' individual needs. TMA should be used to an appropriate degree to avoid overburdening and should fit unobtrusively into patients' usual daily routine. For patient-specific acceptance of TMA, easy handling of the telemedical measuring and input devices is as important as the variety of offers on the platform and personal contact for technical queries. Special attention should be paid to patients who live alone, women, elderly patients over 75 years of age, and poorly educated patients in order to ensure full and easy access to technology-based telemonitoring for their own healthcare.

Perspectives from practice: complexities of personal care workers.

Personal care workers (PCWs) make up the bulk of the workforce in residential and community care services. The knowledge and skill set needed for safe and effective practice in care settings is extensive. A diverse range of registered training organisations (RTOs) offering Certificate III and IV in Individual Support (aging, home and community) are tasked with producing job-ready PCWs. However, the curricula of these programs vary. Additionally, a national code of conduct for healthcare workers became effective in October 2015 as a governance framework for PCWs. The language of the code statements is ambiguous making it unclear how this framework should be translated by RTOs and applied in the preservice practice preparation of PCWs. Employers of PCWs need to feel confident that the content of the preservice education of PCWs satisfactorily prepares them for the diverse contexts of their practice. Likewise, the health professionals who supervise PCWs must be assured about the knowledge and skills of the PCW if they are to safely delegate care activities. The perspectives presented in this discussion make it clear that investigation into the nebulous nature of PCW education, regulation and practice is needed to identify the shortcomings and enable improved practice.

Percepção de mulheres sobre o parto e o papel da doula / On how women perceive childbirth and the role of doula / Percepción de mujeres sobre el parto y el papel de la doula

Os cuidados oferecidos pela doula, profissional que orienta e assiste a mulher na gestação, no parto e no pós-parto, são considerados como acolhedores e tendem a promover o bem-estar emocional da parturiente, auxiliando-a no enfrentamento das situações de desconforto. O objetivo dessa pesquisa foi analisar a percepção de mulheres sobre o parto e sobre a figura da doula no processo de parturição. Foram entrevistadas nove mulheres, com idades entre 19 a 35 anos, que tiveram uma gestação de baixo risco e que foram acompanhadas por doulas durante a gestação, parto e/ou no período pós-parto. Os relatos foram transcritos na íntegra e emergiram três categorias finais: Práticas Institucionais e Ambiência; Enfrentamento da Dor; e Presença da Doula e Importância da Equipe. Concluiu-se que a doula cumpre um papel importante ao proporcionar confiança e ao utilizar técnicas para o alívio da dor, entretanto, cabe ressaltar que apenas a sua presença não garante o respeito pelos direitos e individualidade das mulheres e um parto humanizado.

The care offered by the doula, a professional who guides and assists the woman during pregnancy, childbirth and postpartum, is considered to be nurturing and tends to foster the emotional wellbeing of the parturient, helping her to cope with possible discomfort. The aim of this research was to analyze how women perceive childbirth and the doula figure in the parturition process. Nine women, aged 19-35 years, who were experiencing low-risk pregnancies and were attended to by doulas during gestation, delivery and / or in the postpartum period, were interviewed. The reports were transcribed in full and three final categories emerged: Institutional Practices and ambience; Coping with Pain; Doula Presence and Team Importance. It was concluded that the doula plays an important role in providing confidence and on in the usage of pain relief, techniques however, it should be emphasized that relying solely on this professional presence does not guarantee the respect for the mother-to-be's rights and individuality and more importantly, humanized childbirth.

Los cuidados ofrecidos por la doula, profesional que orienta y asiste a la mujer durante el embarazo, en el parto y en el posparto, son considerados como acogedores y tienden a promover el bienestar emocional de la gestante, auxiliándola a enfrentar situaciones de incomodidad. El objetivo de esta investigación fue analizar la percepción de mujeres sobre el parto y sobre la figura de la doula en ese proceso. Nueve mujeres fueron entrevistadas, con edades entre 19 y 35 años, las cuales tuvieron un embarazo de bajo riesgo y fueron acompañadas por doulas durante la gestación, parto y / o en el período posparto. Los relatos fueron totalmente transcritos, del cual surgieron tres categorías finales: Prácticas Institucionales y ambientación hospitalaria; Enfrentamiento del dolor; Y Presencia de la Doula e Importancia del Equipo. Se concluyó que la doula cumple un papel importante al proporcionar confianza y al utilizar técnicas para el alivio del dolor, sin embargo, cabe resaltar que sólo su presencia no garantiza el respeto por los derechos e individualidad de las mujeres y un parto humanizado.

A iniciação e abuso de drogas na adolescência: revisão narrativa / Drug initiation and abuse during adolescence: a narrative review / Iniciación y la drogadicción en la adolescencia: revisión narrativa

Objetivo: Conhecer as produções cientificas nacionais referentes a iniciação e abuso de drogas e substancias psicoativas na adolescência. Método: pesquisa narrativa com abordagem qualitativa, não foi utilizada delimitação temporal devido à escassez de referências sobre o tema proposto. Resultados: Percebeu-se com o estudo a delimitação de 2 (duas) categorias que permeiam a iniciação e abuso drogas, sendo indicadas significativamente nos estudos que norteiam o assunto. Conclusão: Com o estudo percebeu-se que a iniciação de jovens usuários de drogas é gradativa e delimitada por fatores intrínsecos do jovem, preocupando a sociedade como um todo. Para tanto, as políticas públicas não estão sendo suficientes para instrumentalizar os profissionais de saúde e os familiares de usuários de drogas, permanecendo uma lacuna na assistência em saúde, e como consequência, problemas sociais e familiares graves

Objective: To know the national scientific productions referring to the initiation and abuse of drugs and psychoactive substances in adolescence. Method: Narrative research with qualitative approach, temporal delimitation was not used because of the scarcity of references about the proposed theme. Results: The study identified the delimitation of two categories that permeate drug initiation and abuse, being indicated significantly in the studies that guide the subject. Conclusion: With the study it was noticed that the initiation of young drug users is gradual and limited by intrinsic factors of the young, worrying society as a whole. To that end, public policies are not enough to instrumentalize health professionals and family members of drug users, remaining a gap in health care, and as a consequence, serious social and family problems

Objetivo: Conocer la producción científica nacional relativa a la iniciación y el abuso de drogas y sustancias psicoactivas en la adolescencia. Método: Investigación narrativa con un enfoque cualitativo no se utilizó la delimitación temporal debida a la escasez de referencias sobre el tema. Resultados: Se observó a estudiar la delimitación de dos (2) categorías que subyacen en la iniciación y el abuso de drogas, e indicó de manera significativa en los estudios que la guían. Conclusión: En el estudio se observó que la iniciación de los jóvenes usuarios de drogas es gradual y limitada por factores intrínsecos de los jóvenes, el cuidado sociedad en su conjunto. Por lo tanto, las políticas públicas no son suficientes para permitir a los profesionales de la salud y los consumidores de drogas de la familia, que queda un hueco en el cuidado de la salud, y como resultado, los problemas sociales y familiares graves