Acesso ampliado ao dispositivo intrauterino: impacto de um processo de trabalho promotor da autonomia na anticoncepção / Expanded access to intra-uterine devices: impact of a work process promoting autonomy in contraception / Acceso ampliado al dispositivo intrauterino: impacto de un proceso de trabajo que promueve la autonomía en la anticoncepción

Introdução: O dispositivo intrauterino (DIU) é uma das estratégias contraceptivas mais eficazes. Porém, apesar de ser amplamente distribuído pelo Sistema Único de Saúde (SUS), há baixa adesão ao método. São constatadas diversas barreiras para esse quadro, tais como desconhecimento acerca do dispositivo, além da reduzida oferta para inserção do contraceptivo por parte das Equipes de Saúde da Família (eSF). Tendo em vista que a ampliação do acesso ao DIU pode contribuir para a diminuição das gravidezes não planejadas, bem como para a autonomia e para o empoderamento das mulheres, algumas estratégias foram desenvolvidas por uma eSF para facilitar o acesso ao DIU. Objetivo: Refletir a respeito do impacto da incorporação de estratégias de educação em saúde para divulgar o método dentro da própria equipe, de sua área de cobertura e da diminuição de barreiras para a inserção, na ampliação do acesso ao DIU, no quantitativo de dispositivos inseridos, no número de gestações não planejadas e na possibilidade de aumento do empoderamento feminino. Métodos: Os dados coletados foram extraídos das informações presentes em planilhas e relatórios produzidos pela própria eSF. Utilizou-se da estatística descritiva para apresentar e analisar os dados obtidos, a partir de ferramentas de formulação de gráficos e tabelas. Resultados: Após mudança no processo de trabalho, visando ao acesso ampliado à inserção do DIU, observou-se um aumento no quantitativo do procedimento assim como na percentagem de gravidezes desejadas. Conclusões: O DIU surge como um instrumento para possibilitar o exercício dos direitos sexuais e reprodutivos e para alavancar atitudes emancipatórias das mulheres. Quanto menos barreiras as mulheres encontram para a inserção do DIU, maior é a escolha por este método, sendo a inserção por demanda espontânea, ou seja, no momento em que a mulher procura a eSF para fazê-la. Nesse sentido, as atividades de educação continuada tornam-se potentes ferramentas para possibilitar maior acesso ao método. Fazem-se necessários estudos de longa duração para que essas hipóteses sejam avaliadas, todavia, parece haver uma ligação positiva entre essas duas variáveis.

Introduction: Intrauterine device (IUD) is one of the most effective contraceptive strategies. Despite being widely distributed by the Brazilian Unified Health System (Sistema Único de Saúde ­ SUS), there is low adherence to the method. There are several barriers to this situation, such as lack of knowledge about the device, in addition to the reduced offer for contraceptive insertion by primary health care providers. Given that increased access to the IUD can contribute to reducing unplanned pregnancies, as well as empowering women, some strategies have been developed by a primary health care team to facilitate access to IUDs. Objective: This research reflected on the impact of incorporating health education strategies to disseminate the method and reduction of barriers to insertion, broadening IUD access, the number of devices inserted, the number of unplanned pregnancy and the possibility of increased female empowerment. Methods: Data were extracted from information present in spreadsheets and reports produced by the team itself. Descriptive statistics were used to present and analyze the data obtained, using tools for formulating graphics and tables. Results: After changing the work process to expanded access to IUD insertion, an increase in the number of procedures and the percentage of planned pregnancies was observed. Conclusions: The IUD appears as an instrument to enable the exercise of sexual and reproductive rights and to leverage women's emancipatory attitudes. The fewer barriers women encounter when inserting an IUD, the greater the choice for this method, with insertion being on spontaneous demand and continuing education activities, powerful tools to enable greater access to it. Long-term studies are necessary for these hypotheses to be evaluated, however, there appears to be a positive link between these two variables.

Introducción: El dispositivo intrauterino (DIU) es una de las estrategias anticonceptivas más efectivas. Sin embargo, a pesar de su amplia distribución a través del Sistema Único de Salud, existe una baja adhesión a este método. Se han identificado diversas barreras para esta situación, como el desconocimiento sobre el dispositivo y la oferta limitada de su inserción por parte de los equipos de salud familiar (eSF). Con el objetivo de ampliar el acceso al DIU y reducir los embarazos no deseados, así como promover la autonomía y empoderamiento de las mujeres, algunos equipos de eSF han desarrollado estrategias para facilitar su acceso. Objetivo: Reflexionar sobre el impacto de la incorporación de estrategias de educación en salud para difundir el método dentro del propio equipo y su área de cobertura, así como la eliminación de barreras para la inserción, en la ampliación del acceso al DIU, en la cantidad de dispositivos insertados, en el número de embarazos no planeados y en la posibilidad de aumentar el empoderamiento femenino. Métodos: Los datos recopilados se extrajeron de las hojas de cálculo e informes producidos por el propio eSF. Se utilizó estadística descriptiva para presentar y analizar los datos obtenidos mediante herramientas de creación de gráficos y tablas. Resultados: Después de un cambio en el proceso de trabajo destinado a ampliar el acceso a la inserción del DIU, se observó un aumento en la cantidad de procedimientos realizados. También se registró un aumento en el porcentaje de embarazos deseados. Conclusiones: El DIU se presenta como una herramienta que permite el ejercicio de los derechos sexuales y reproductivos y promueve actitudes emancipatorias en las mujeres. Cuantas menos barreras encuentren las mujeres para la inserción del DIU, mayor será la elección de este método, con la inserción a demanda, es decir, cuando la mujer lo solicita al eSF, y las actividades de educación continua como poderosas herramientas para facilitar un mayor acceso. Se necesitan estudios a largo plazo para evaluar estas hipótesis, aunque parece existir una relación positiva entre estas dos variables.

Empoderamento estrutural: potencializando as competências dos enfermeiros de um hospital de alta complexidade / Structural empowerment: enhancing the skills of nurses in a high-complexity hospital / Empoderamiento estructural: potenciar las competencias de los enfermeros en un hospital de alta complejidad

Objetivo: analisar o empoderamento estrutural de enfermeiros em um hospital de alta complexidade. Métodos: estudo quantitativo, analítico e transversal, realizado com 93 enfermeiros, utilizando um questionário sociodemográfico e ocupacional e o Questionário de Condições de Eficácia no Trabalho II. Os dados foram coletados entre fevereiro e março de 2023. A análise dos dados deu-se por meio de estatística descritiva, teste de Kolgomorov-Smirnov, teste do qui-quadrado e regressão de Poisson. Resultados: os enfermeiros apresentaram nível moderado de empoderamento estrutural, com média de 20,67 (p<0,000). O componente mais pontuado foi a oportunidade (4,22 dp±0,80). Não foram encontradas diferenças significativas nos níveis de empoderamento estrutural relacionadas às unidades de trabalho (p-Valor 0,381), vínculo empregatício (p-Valor 0,352) e grau de instrução (p-Valor 0,839). O modelo de regressão de Poisson indica que tanto pode haver altos ou baixos níveis de empoderamento a depender do setor. Conclusão: os enfermeiros demonstraram possuir níveis moderados de empoderamento estrutural.

Objective: to analyze the structural empowerment of nurses in a high-complexity hospital. Methods: a quantitative, analytical, cross-sectional study was carried out with 93 nurses, using a sociodemographic and occupational questionnaire and the Questionnaire of Conditions of Effectiveness at Work II. The data was collected between February and March 2023. The data was analyzed using descriptive statistics, the Kolgomorov-Smirnov test, the chi-square test, and Poisson regression. Results: the nurses had a moderate structural empowerment level, with a mean of 20.67 (p<0.000). The highest scoring component was opportunity (4.22 sd±0.80). No significant differences were found in the structural empowerment levels related to work units (p-Value 0.381), employment relationship (p-Value 0.352) and education level (p-Value 0.839). The Poisson regression model indicates that there can be either high or low empowerment levels depending on the sector. Conclusion: nurses showed moderate structural empowerment levels.

Objetivo: analizar el empoderamiento estructural del enfermero en un hospital de alta complejidad. Métodos: estudio cuantitativo, analítico y transversal, realizado con 93 enfermeros, utilizando un cuestionario sociodemográfico y ocupacional y el Cuestionario de Condiciones de Efectividad en el Trabajo II. Los datos se recolectaron entre febrero y marzo de 2023. El análisis de los datos se realizó mediante estadística descriptiva, prueba de Kolgomorov-Smirnov, prueba de chi-cuadrado y regresión de Poisson. Resultados: los enfermeros presentaron un nivel moderado de empoderamiento estructural, la media fue de 20,67 (p<0,000). El componente con mayor puntaje fue oportunidad (4,22 DE±0,80). No se encontraron diferencias significativas en los niveles de empoderamiento estructural relacionados con las unidades de trabajo (valor p 0,381), la relación laboral (valor p 0,352) y el nivel de formación (valor p 0,839). El modelo de regresión de Poisson indica que pueden existir niveles altos o bajos de empoderamiento dependiendo del sector. Conclusión: los enfermeros demostraron niveles moderados de empoderamiento estructural.

Percepções e significados de doulas na atenção obstétrica e neonatal no processo de parturição / Perceptions and meanings of doulas in obstetric and neonatal care in the parturition process

Objetivo: Compreender percepções e significados de doulas na Atenção Obstétrica e Neonatal no processo de parturição. Método: Pesquisa qualitativa, descritiva, realizada entre outubro de 2021 a maio de 2022, com dez doulas. Utilizou-se a técnica de Snowball Sampling para composição amostral. Para coleta de dados foram utilizadas entrevistas semiestruturadas, analisadas por meio da técnica de análise textual discursiva. Resultados: Emergiram quatro categorias: porque escolher atuar como doula; a doula como fonte de conhecimento e empoderamento feminino; o trabalho da doula para a garantia de uma assistência digna à mulher; e as barreiras impostas à atuação da doula pela equipe multiprofissional. Conclusão: A doula causa uma ruptura no universo obstétrico hegemônico, pois ao mesmo tempo que sua prática remete ao apoio entre mulheres no processo de parturição, a sua ascensão representa uma frente contra o modelo atual de saúde centrado na doença, no profissional de saúde, em intervenções e no hospital.(AU)

Objective: Understand perceptions and meanings of doulas in Obstetric and Neonatal Care in the parturition process. Method: Qualitative, descriptive research, carried out between October 2021 and May 2022, with ten doulas. The Snowball Sampling technique was used for sample composition. Semi-structured interviews were used to collect data, analyzed using the discursive textual analysis technique. Results: Four categories emerged: why choose to work as a doula; the doula as a source of knowledge and female empowerment; the work of the doula to guarantee dignified assistance to women; and the barriers imposed on the doula's performance by the multidisciplinary team. Conclusion: The doula causes a rupture in the hegemonic obstetric universe, because at the same time that its practice refers to support among women in the parturition process, its rise represents a front against the current health model centered on the disease, on the health professional, in interventions and in the hospital.(AU)

Objetivo: Comprender percepciones y significados de las doulas en Atención Obstétrica y Neonatal en el proceso del parto. Método: Investigación cualitativa, descriptiva, realizada entre octubre de 2021 y mayo de 2022, con diez doulas. Se utilizó la técnica de la bola de nieve. Muestreo para composición de muestras. Se utilizaron entrevistas para recopilar datos. semiestructurado, analizado mediante la técnica de análisis textual discursivo. Resultados: Surgieron cuatro categorías: por qué elegir trabajar como doula; la doula como fuente de conocimiento y empoderamiento femenino; el trabajo de la doula para garantía de asistencia digna a las mujeres; y las barreras impuestas al trabajo de la doula por el equipo multidisciplinario. Conclusión: La doula provoca una ruptura en el universo obstétrica hegemónica, porque al mismo tiempo que su práctica refiere al apoyo entre mujeres en proceso de parto, su ascenso representa un frente contra la modelo de salud actual centrado en la enfermedad, el profesional de la salud, las intervenciones y en el hospital.(AU)

Gestión del recurso hídrico en la ruralidad, mediante estrategias de fortalecimiento comunitario / Water resource management in rural areas, through community strengthening strategies / Gestão de recursos hídricos em áreas rurais por meio de estratégias de fortalecimento da comunidade

RESUMEN El fortalecimiento comunitario a partir de estrategias participativas es un proceso que organiza, promueve y genera transformaciones para el mejoramiento de la gestión del recurso hídrico en zonas rurales. Objetivo: Evidenciar las estrategias de fortalecimiento comunitario bajo los principios de Apropiación Social del Conocimiento, con el fin de mejorar la gestión del recurso hídrico en una zona rural específica del departamento del Cauca. Metodología: Se llevó a cabo un estudio exploratorio de investigación cualitativa a través de la implementación de estrategias de fortalecimiento comunitario rural para la gestión del recurso hídrico, orientada bajo los cinco principios de la Política Nacional de Apropiación Social del Conocimiento. Resultados: El reconocimiento de contextos mediante el trabajo con grupos focales y cartografía social, evidenció problemáticas ambientales y sociales, resaltando el conflicto intercultural entre poblaciones indígenas y campesinas. Las herramientas de participación utilizadas permitieron la creación conjunta de una agenda de acción para la transformación a nivel de microcuenca, sistema de acueducto, escuelas y hogares. Conclusión: La participación comunitaria es un componente esencial que permitió una priorización efectiva de los desafíos asociados al recurso hídrico. Además, facilitó la planificación de acciones transformadoras y la implementación de soluciones sostenibles mediante la construcción colectiva del conocimiento. Estos hallazgos resaltan la importancia de integrar la participación comunitaria y los principios de Apropiación Social del Conocimiento para abordar de manera integral y efectiva los retos en la gestión del agua en entornos rurales.

ABSTRACT Community strengthening based on participatory strategies is a process that organizes, promotes, and generates transformations to improve water resource management in rural areas. Objective: Show the community strengthening strategies based on the principles of social appropriation of knowledge for the improvement of water resource management in a specific rural area of the department of Cauca. Methodology: An exploratory qualitative research study was carried out by implementing rural community strengthening strategies for water resource management, oriented under the five principles of the National Policy for Social Appropriation of Knowledge. Results: The survey of contexts through work with focus groups and social mapping evidenced environmental and social problems, highlighting the intercultural conflict between indigenous and peasant populations. The participation strategies used allowed the co-creation of an action agenda for transformation at the watershed, aqueduct system, school, and household levels. Conclusion: Community participation is an essential component that allows effective prioritization of the challenges associated with water resources. In addition, it facilitated the planning of transformative actions and the implementation of sustainable solutions through the collective construction of knowledge. These findings highlight the importance of integrating community participation and the principles of Social Appropriation of Knowledge to comprehensively and effectively address water management challenges in rural territories.

RESUMO O fortalecimento da comunidade com base em estratégias participativas é um processo que organiza, promove e gera transformações para a melhoria da gestão de recursos hídricos em áreas rurais. Objetivo: Demonstrar estratégias de fortalecimento comunitário sob os princípios da Apropriação Social do Conhecimento, a fim de melhorar a gestão dos recursos hídricos em uma área rural específica do departamento de Cauca. Metodologia: Foi realizado um estudo exploratório de pesquisa qualitativa por meio da implementação de estratégias de fortalecimento comunitário rural para a gestão de recursos hídricos, orientadas pelos cinco princípios da Política Nacional de Apropriação Social do Conhecimento. Resultados: O reconhecimento de contextos por meio do trabalho com grupos focais e mapeamento social revelou problemas ambientais e sociais, destacando o conflito intercultural entre populações indígenas e camponesas. As ferramentas participativas utilizadas permitiram a criação conjunta de uma agenda de ação para transformação em nível de microbacia hidrográfica, sistema de aqueduto, escola e familia. Conclusão: a participação da comunidade é um componente essencial que permitiu a priorização efetiva dos desafios associados aos recursos hídricos. Ela também facilitou o planejamento de ações transformadoras e a implementação de soluções sustentáveis por meio da construção de conhecimento coletivo. Essas descobertas destacam a importância de integrar a participação da comunidade e os princípios da Apropriação Social do Conhecimento para abordar de forma abrangente e eficaz os desafios da gestão da água em ambientes rurais.

Possibilidades para promover a saúde na percepção de mulheres lésbicas / Possibilities to promote health in the perception of lesbian women / Posibilidades de promover la salud en la percepción de las mujeres lesbianas

Objetivo: Compreender as percepções das mulheres lésbicas quanto às suas possibilidades para promover saúde diante das vulnerabilidades que as permeiam. Métodos: Pesquisa qualitativa, do tipo ação participante, articulada ao Itinerário de Pesquisa de Paulo Freire, que se constitui de três momentos dialéticos e interdependentes: Investigação Temática; Codificação e Descodificação; e Desvelamento Crítico, ocorrido por meio de Círculos de Cultura, no mês de julho de 2020, dos quais participaram 10 mulheres lésbicas. Resultados: Durante os diálogos, as participantes desvelaram duas temáticas: promoção da saúde individual e promoção da saúde coletiva. As mulheres lésbicas revelaram que promovem sua saúde diante dos contextos de vulnerabilização, buscando ampliar a discussão sobre políticas públicas eficazes e contribuir positivamente para maior visibilidade da mulher lésbica. Conclusão: As mulheres lésbicas promovem a sua saúde buscando estarem bem consigo, desenvolver o autoconhecimento e a espiritualidade, praticar atividades físicas e manter uma rede de amigos e momentos de lazer. Também promovem saúde no aspecto coletivo, sugerindo maior representatividade da mulher lésbica, dentro dos cenários políticos e sociais. (AU)

Objective: Understand the perceptions of lesbian women about their possibilities as concerns to promote health in front of the vulnerabilities that permeate them. Methods: Qualitative research, participatory action type, articulated to the Research Itinerary of Paulo Freire, which consists of three dialectical and interdependent moments: Thematic Investigation; Encoding and Decoding; and Critical Unveiling, which was occurred through Culture Circles, in July 2020, in which 10 lesbian women participated. Results: During the dialogues, the participants unveiled two themes: individual health promotion and collective health promotion. The lesbian women revealed that they promote their health in front of context of vulnerabilization, seeking to broaden the discussion on effective public policies and positively contribute to greater visibility for lesbian women. Conclusion: Lesbian women promote their health by trying to feel good about themselves, developing self-knowledge and spirituality, practice physical activities and maintaining a network of friends and leisure time. They also promote health in the collective, suggesting greater representation of lesbian women within political and social scenarios. (AU)

Objetivo: Comprender las percepciones de las mujeres lesbianas cuanto a sus posibilidades de promover la salud ante las vulnerabilidades que las permean. Métodos: Investigación cualitativa, tipo acción participante, articulada al Itinerario de Investigación de Paulo Freire, que se constituye de tres momentos dialécticos e interdependientes: Investigación Temática; Codificación y decodificación; y Desvelamiento Crítico, que se ocurrió a través de Círculos de Cultura, en julio de 2020, donde participaron 10 mujeres lesbianas. Resultados: Durante los diálogos, las participantes dieron a conocer dos temas: promoción de la salud individual y promoción de la salud colectiva. Las mujeres lesbianas revelaron que promueven su salud frente a contextos de vulnerabilidad, buscando ampliar la discusión sobre políticas públicas eficaces y contribuir positivamente a una mayor visibilidad de la mujer lesbiana. Conclusión: Las mujeres lesbianas promueven su salud buscando sentirse bien consigo mismas, desarrollando el autoconocimiento y la espiritualidad, practicar actividades físicas y mantener una red de amistades y tiempo de ocio. También promueven salud en el aspecto colectivo, sugiriendo mayor representación de las mujeres lesbianas en los escenarios políticos y sociales. (AU)

Assessing the effect of women’s empowerment on their dietary intake: a cross-sectional study

Background: Women empowerment is an important strategy to reduce maternal and child undernutrition, which continues to be a major health burden in low- and middle-income countries. The present study aimed to assess the effect of women empowerment on their dietary intake in the two selected blocks of Sultanpuri urban slums, West Delhi. Methods: The baseline was conducted using a cross-sectional research method with girls and women (15-35 years). The research was conducted through a predesigned, pretested, semi-structured questionnaire to capture the information on socio-demographic profiles along with knowledge on social skills, self-esteem, and decision-making. The data were collected on the consumption of food groups in the last 24 hours from 2402 girls and women. We employed unadjusted and adjusted step-wise regression models to assess the effect of domains of women empowerment on dietary intake. Results: The median (interquartile range) age of the women was 27 (22-31) years. We found a 0.17-point increase in the dietary diversity score per one-unit increase in the self-esteem score of the women. Similarly, there was a 0.06-unit increase in the dietary diversity score per one-unit increase in the social skills score of the women. The association remained statistically significant even after adjustments for co-variates like age, education status, and socio-economic status. Conclusions: The present study recommends that focusing on women's empowerment dimensions, particularly social skills, self-esteem, and decision-making power, can be an effective strategy for improving dietary intake among women.

Need of rural communities to be engaged and empowered for global health and wellness

For health and wellness rural communities do many things with whatever they have, use various modalities of actions for prevention, therapy of disorders, maintenance, promotion of health. Also, for everyday life they do various activities which affect their health. Present article is based on observations, information in context of activities by rural people for their health and wellness. Personal observations, experiences were added to information about actions by rural communities for health and wellness. Rural communities use their own wisdom, do many things with whatever they have for living a healthy life. They use various modalities during pregnancy, birth for mother, new born, persons of all ages. Therapies are used for pregnancy care, birth, post birth, other illnesses, injuries and so on. In modern day practice it has become essential to priorities modes of actions for best therapy, best outcome without harmful effects. In addition to various actions for prevention, therapy, maintenance and promotion of health and wellness, communities do other activities which impact their health. This needs sharing for best of global health. Communities use many modalities for therapy, prevention of disorders, rehabilitation and health promotion. Need is of learning from them, adding science to such modes if needed, robust evaluation of community actions with long term outcomes, cost-effectiveness, in various settings globally. World needs to know and use for healthy life and make communities aware of modern medicine, technology wherever essential for global health.

Empoderamiento sexual, reproductivo, derechos sexuales y conducta sexual segura en jóvenes mexicanos / Sexual and reproductive, empowerment, sexual rights, and sexual safe behaviors in mexican young people

Resumen Objetivo: Determinar la relación entre el empoderamiento sexual y reproductivo, el conocimiento sobre derechos sexuales con la conducta sexual segura en jóvenes mexicanos. Materiales y métodos: El estudio fue descriptivo, correlacional y transversal. La muestra fue de 111 jóvenes de Chihuahua, México, los cuales se seleccionaron a conveniencia. La información se recolectó mediante una encuesta en línea. Resultados: Se encontró diferencia significativa del empoderamiento sexual y reproductivo entre hombres y mujeres (p < 0.001), los hombres presentaron puntajes más altos (Mdn= 92.39) comparados con las mujeres (Mdn= 79.34). No se encontró relación entre el empoderamiento sexual y reproductivo, el conocimiento sobre derechos sexuales con la conducta sexual segura de estos jóvenes. Conclusión: Los jóvenes presentaron un alto nivel de conocimiento sobre los derechos sexuales. Con relación al empoderamiento sexual y reproductivo, los hombres presentaron mayores puntuaciones que las mujeres. La conducta sexual segura fue menor que en otros estudios en poblaciones similares. Además, no se encontró relación entre el empoderamiento sexual y reproductivo, y el conocimiento sobre derechos sexuales con la conducta sexual segura en esta población, por lo que se enfatiza la necesidad de continuar estudiando estas variables debido a los escasos estudios en esta población.

Abstract Objective: To determine the relationship between sexual and reproductive empowerment, knowledge of sexual rights and safe sexual behavior in young Mexicans. Materials and methods: The study was descriptive, correlational and cross-sectional. The sample consisted of 111 young people from Chihuahua, Mexico, who were selected at convenience. The information was collected through an online survey. Results: A significant difference in sexual and reproductive empowerment was found between men and women (p < 0.001), with men presenting higher scores (Mdn= 92.39) compared to women (Mdn= 79.34). No relationship was found between sexual and reproductive empowerment, knowledge about sexual rights and safe sexual behavior of these young people. Conclusion: The young people presented a high level of knowledge about sexual rights. In relation to sexual and reproductive empowerment, males presented higher scores than females. Safe sexual behavior was lower than in other studies in similar populations. In addition, no relationship was found between sexual and reproductive empowerment and knowledge of sexual rights and safe sexual behavior in this population, which emphasizes the need to continue studying these variables due to the scarcity of studies in this population.

Eyesight to insight: evidence from urban eye health programme

India, with a population exceeding 1.486 billion, faces substantial challenges in urban eye health, particularly in densely populated states like Uttar Pradesh. This study delves into real-world impact of urban eye health programme, implemented in Kanpur and Prayagraj, Uttar Pradesh, aiming to identify success factors and examine the tangible effects of interventions through comprehensive endline study. Utilizing a hub-and-spoke model, the programme established base hospitals as hubs and vision centres as spokes, creating a network for affordable and accessible eye care. The project significantly improved accessibility, with over 85% in Kanpur and 97% in Prayagraj reporting easy access to vision centres. A shift in community behaviour was observed, with a preference for vision centres for eye examinations increasing from 5.6-64.6% in Kanpur and 10.6-57.1% in Prayagraj. The programme empowered women to prioritize their eye health, reaching 53% of women for eye screening. Community perception shifted positively, with over 82% in Prayagraj recognizing the programme's pivotal role. In Kanpur, 87.5% of women actively take charge of their eye health decisions, while 99.1% do so in Prayagraj. This empowerment underscores programme commitment to providing equal access to eye care and demonstrates a strong focus on inclusivity and gender equality.

The effect of empowerment management mode on radiation protection in patients after 125I seed implantation / 介入放射学杂志

Objective To discuss the role of empowerment management mode in radiation protection after 125I seed implantation.Methods A total of 66 patients,who received first-time 125I seed implantation at the authors'hospital from October 2020 to October 2022,were randomly divided into control group(n=33)and study group(n=33).The patients of the control group received traditional health education,while the patients of the study group received the empowerment management mode on the basis of the traditional health education.The self-efficacy,health education effect,and protection compliance were compared between the two groups.Results The self-efficacy,health education effect,and protective compliance of patients in the study group were better than those in the control group,and the differences were statistically significant(P＜0.05).Conclusion The implementation of health education by empowerment management mode can improve the effect of health education in patients after 125I seed implantation,and the patients can get better understanding about 125I seed therapy,which can strengthen their sense of self-efficacy and improve postoperative protection compliance,ensuring the safety of the surrounding crowd.The empowerment management mode is worthy of clinical promotion.(J Intervent Radiol,2024,32:82-85)

The application of family empowerment model on the primary caregivers of first-episode stroke dysphagia patients / 中国实用护理杂志

Objective:To explore the effect of family empowerment model on the improvement of swallowing care ability and care preparedness of primary caregivers of first-episode stroke dysphagia patients, further to explore its impact on patients′s wallowing function and life quality.Methods:This study was a randomized controlled study. From January 2021 to December 2022, 80 main caregivers of patients with dysphagia caused by manual stroke admitted to the Department of Acupuncture and Moxibustion, Shenzhen Hospital of Traditional Chinese Medicine were selected as the research objects, and 40 cases in the control group and 40 cases in the observation group were selected by random number table method. The control group were treated with conventional nursing care of first-episode stroke dysphagia patients in the acupuncture and moxibustion Department. On the basis of the conventional care in the control group, the observation group were treated with family empowerment model intervention for 14 days and was followed up for 28 days. Primary caregivers′ swallowing care ability, Caregiver Preparedness Scale (CPS), patients′ swallowing function rate, Swallowing Related Quality of Life (SWALQOL) were used to evaluate the effects before intervention and at the end of intervention.Results:There were 18 males and 19 females primary caregivers in the control group, aged (55.61 ± 7.43) years old. There were 18 males and 21 females primary caregivers in the observation group, aged (58.23 ± 8.22) years old. The swallowing care ability score showed a statistically significant difference between the observation group (143.47 ± 3.96) and the control group (107.74 ± 1.43) ( t=-26.76, P<0.05). After intervention, the caregiver preparedness scale was (26.11 ± 3.81) in the observation group, and (18.35 ± 4.54) in the control group, and the difference was statistically significant ( t=-4.11, P<0.05).The patients′ swallowing function rate and SWALQOL score were respectively 97.44% (38/39) and (91.41 ± 8.08) points in the observation group, and 72.97% (27/37) and (80.33 ± 4.21) points in the control group, and the difference was both statistically significant ( χ2=10.76, t=-2.54, both P<0.05). Conclusions:The implementation of family empowerment model could enhance the swallowing care ability and care preparedness of primary caregivers of the first-episode stroke dysphagia patients, which could further improve patients′ swallowing function and life quality.

Analysis of health empowerment status and related influencing factors in patients with hypertension / 沈阳医学院学报

Objective:To explore the status quo and related influencing factors of health empowerment in patients with hypertension.Methods:A total of 80 patients with hypertension admitted to our hospital from Aug 2021 to Aug 2022 were selected,their health empowerment level was evaluated by chronic disease health empowerment scale,self-made baseline data questionnaire and social support rating scale,and relevant data were collected to compare the health empowerment scores of hypertension patients with different characteristics.The influencing factors of health empowerment level of hypertension patients were analyzed by linear regression analysis.Results:The health empowerment score of 80 patients was(97.58±9.56),which was at a medium level.There were statistically significant differences in health empowerment scores of hypertension patients with different ages,hypertension grades,education levels,psychological resilience and social support(P＜0.05).There was no significant difference in health empowerment scores of hypertension patients with different genders,payment methods and places of residence(P＞0.05).Linear regression analysis showed that age≥60 years old,hypertension grade 3,high school or below,poor mental resilience and low social support were the risk factors for low health empowerment level in hypertension patients(P＜0.05).Conclusions:The health empowerment level of patients with hypertension is medium.Age≥60 years old,hypertension grade 3,high school and below,poor mental resilience and low social support are the risk factors for low health empowerment level of these patients.In clinical practice,we should strengthen the observation and care of elderly and severe hypertensive patients,actively carry out hypertension-related health knowledge education and psychological counseling,and guide patients'family members to giving more support to patients,so as to promote the improvement of patients'health empowerment level.

Organizational Operation and Realization Path of Digitally Empowered Health Insurance Governance un-der TOE Framework:the Example of Nanjing's Health Insurance Highspeed Rail Platform / 中国医院管理

Digital transformation is driving the repositioning of government work and the reshaping of public ser-vice models.It uses TOE theory combined with a technology analysis framework as a theoretical perspective and a single-case study approach to explore the operational mechanism and optimization path of health insurance gover-nance modernization.The findings show that the digital transformation of health insurance is in line with the three-stage path of"structuring the enabling mechanism-forming digital service capacity-enabling value creation".The next stage is to promote the implementation of digital coding standards,accelerate the application of technology integration,respond to the needs of the insured,improve the supporting measures for the linkage of the three health care systems,and bring into play the effectiveness of modern governance of health care.It expands the scope of government governance modernisation research and has both theoretical and practical value.

Narrative Empowerment for Medical Students in Narrative Medicine Education in Public Health Crises / 中国医学伦理学

Narrative competence is one of the factors to reflect humanistic literacy of doctors and nurses. According to the advice of many experts, the narrative competence should be improved from the stage of medical students through the two major tools including close reading of text and reflective writing. Based on the background of prevention and control of COVID-19 outbreak, this paper aimed to clarify the focus and methodology of close reading and reflective writing, that was, close reading was supposed to focus on the analysis of disease metaphors in classic literature and narrative function in clinical works and realism works, and writing tended to focus on the the differentiation of writing purpose and the writing guidance in different texts. The proper guidance plus solid training in close reading and writing will definitely lay a strong foundation for medical students in achieving humanistic quality.

“Lusog-linang”: Utilizing community-engaged research towards capacity building in health of an underserved community

@#<strong>BACKGROUND AND OBJECTIVES</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">Nurses have a pivotal role in nurturing the capabilities of individuals, families, and population groups for better health. However, underserved communities in the Philippines, such as those with socioeconomic inadequacies, geographic isolation, and service access problems, have significant limitations in attaining the highest possible level of health. Hence, a community extension service (Project “Lusog-Linang”), employing community-engaged research, was launched with the residents of an underserved locality in Central Luzon. The current paper aimed to describe the engagement of the community residents in describing their current health situation and related priority problems, as well as explore appropriate initiatives to manage the identified problems.</p><strong>METHODS</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">Community-engaged research was utilized to enable the residents of Barangay San Vicente, Bamban, Tarlac to participate in health capacity building. Particularly, records review and focus group discussions were conducted to assess the community’s health needs and to identify the residents’ perceived problems. The findings were presented in a community assembly, where residents further discussed their priority health concerns and potential interventions to address them. Quantitative data were summarized through descriptive statistics, while qualitative information was synthesized via content analysis.</p><strong>RESULTS</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">The priority community health problems included healthcare inaccessibility (trained staff, health equipment, and facility access), food insecurity, water supply limitations, and environmental sanitation. Moreover, there was inadequate knowledge and skills among the residents in health promotion, disease prevention, and illness management. While Barangay San Vicente had limited socioeconomic resources to optimize their health capacities, the sense of community among the residents is a vital resource towards empowering them to improve their health.</p><strong>CONCLUSION</strong><p style="text-align: justify;" data-mce-style="text-align: justify;">The results could be utilized as a launching pad for developing appropriate health programs for the residents of Barangay San Vicente. Hence, the next steps in Project “Lusog-Linang” should include the identification and training of core group members toward community mobilization, and further exploring collaborative and sustainable partnerships across organizations to ensure that the community will have long-term solutions to their problems. Consequently, this project could guide public health workers in ensuring the active involvement and participation of the community members in managing their own health.</p>

Effect of digital empowerment techniques on physical activity and health for children with intellectual and developmental disabilities: a systematic review / 中国康复理论与实践

ObjectiveTo systematically review the benefits of digital empowerment technologies (DET) in promoting physical activity and health among children with intellectual and developmental disabilities (IDD). MethodsLiterature was retrieved from PubMed, Embase, Web of Science, PsycINFO and CNKI, for randomized controlled trials (RCT) published from 2014 to 2023 on the application of DET in physical activity among children with IDD. The quality was assessed, and high-quality RCT was systematically reviewed. ResultsEight high-quality RCT were included, originating from four countries, namely China, the United States, Italy and South Korea, with 376 children with IDD, main published in the journals about intellectual disability applications, developmental disability research and clinical medicine, from 2018 to 2023. The children aged seven to 18 years, suffered from intellectual disabilities (including Down syndrome), autism and other developmental disabilities. The technologies could be summarized in wearable technology, cloud computing guided and monitored by mobile health, virtual reality and augmented reality, and active video gaming technologies. The devices involved active video games, Fitbit smart devices, Wii Fit balance games, Stepmania rhythm video games, Xbox Kinect system, VZFit sensors and CoTras cognitive rehabilitation computer games. The virtual physical activities included boxing, track and field, bowling, table tennis, beach volleyball, football, baseball, skiing, tennis, golf, darts, American football, shooting, jumping, jogging and jump rope; 20 to 45 minutes a time, one to five times a week, for four to twelve weeks. The interventions could be conducted in homes, special education schools and rehabilitation institutions. The health benefits mainly reflected in improved levels of physical activity, enhanced motor function and increased motor and daily life capacity. ConclusionApplication of DET in physical activity may increase the participation of children with IDD in virtual environments, schools, communities and rehabilitation institutions; improve upper and lower limb motor function, gross motor function, and muscle strength; enhance static balance, motor coordination and sensorimotor function; reduce the sedentary behavior; and improve cognitive, daily living skills and social abilities.

Characteristics of health empowerment, perceived control and experiential avoidance in coronary heart disease patients with type D and non-type D personality / 中国康复理论与实践

ObjectiveTo investigate the differences in health empowerment, perceived control and experiential avoidance between patients with coronary heart disease (CHD) with type D personality and non-type D personality. MethodsFrom January to October, 2022, using the convenient sampling method, a questionnaire survey was conducted on 195 patients with CHD from Affiliated Hospital of Shandong Second Medical University. Assessment tools included Type D Personality Scale, Chinese Version of Patient Perception Empowerment Scale (CV-PPES), Control Attitudes Scale-Revised (CAS-R) and Acceptance Action Questionnaire-II (AAQ-II). ResultsA total of 185 effective questionnaires were returned, and 68 patients with type D personality. Compared with the patients with non-type D personality, the scores of negative affectivity and social inhibition were higher (|t| > 9.783, P < 0.001), the total score of CV-PPES and the scores of four dimensions (information, decision, individual and self-management) were lower (t > 5.843, P < 0.001), the score of CAS-R was lower (t = 2.858, P = 0.005), and the score of AAQ-II was higher (t = -9.414, P < 0.001) in CHD patients with type D personality. ConclusionCompared with non-D-type patients, CHD patients with D-type personality exhibit lower levels of health empowerment and perceived control, and higher level of experiential avoidance, which may negatively impact on health behaviors.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: History and scenario of patient blood management in the world and in Brazil

Abstract Patient Blood Management (PBM) is a multidimensional approach that seeks to optimize the use of blood and its components in patients. This matter emerged as a response to the need to reduce unnecessary exposure to blood transfusions and their potential risks. In the past, blood transfusion was often overused resulting in complications and high costs. The advent of Patient Blood Management has caused a paradigm shift, highlighting anemia prevention, bleeding control and maximizing the production of blood cells by the organism itself. Patient Blood Management guidelines include the early identification of anemia, strategies to minimize blood loss during surgery, intraoperative blood conservation techniques, preoperative hemoglobin optimization and evidence-based approaches to the rational use of blood transfusions. Aiming to improve clinical outcomes, decrease transfusion-related complications and reduce associated costs, this multidisciplinary approach counts on doctors, nurses, pharmacists and other healthcare professionals. Based on research and clinical evidence, Patient Blood Management continues to evolve thereby promoting safer, more effective patient-centered practices. Its implementation has proven beneficial in various medical contexts thereby contributing to improvements in the quality of care provided to patients. Our goal with this Consensus is to present readers with a broad and diverse view of Patient Blood Management so that they have the building blocks to implement this new technique.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Definition of Patient Blood Management

Abstract Managing the patient's blood and hematopoietic system is like managing any of the other organs and organ systems during patient care. Specialists control the heart, kidneys, endocrine system, etc. and the patient's blood requires similar clinical treatment. The hematopoietic system and its circulatory products are fundamental for the healthy functioning of the human body. In simple terms, Patient Blood Management (PBM) is an organized, patient-centered approach in which the entire healthcare team coordinates efforts to improve outcomes by managing and preserving the patient's own blood. By reducing dependence on blood transfusions, PBM seeks to improve clinical outcomes, reduce the risks and costs associated with transfusions, and improve the safety and quality of patient care. Essentially, the concept of PBM is about the holistic management and preservation of the patient's own blood in the medical and surgical context.

Prevenção, emancipação social e transição paradigmática: uma trajetória interdisciplinar de 40 anos no Brasil sobre acidentes e desastres / Prevención, emancipación social y transición paradigmática: una trayectoria interdisciplinaria de 40 años en Brasil sobre accidentes y desastres / Prevention, social emancipation, and paradigmatic transition: a 40-year interdisciplinary Brazilian trajectory on accidents and disasters

Resumo: O artigo, na forma de ensaio, sistematiza uma trajetória profissional de experiências interdisciplinares e socialmente engajadas em torno da análise e prevenção de acidentes e desastres nos últimos 40 anos. O trabalho acadêmico se desenvolveu principalmente no âmbito da pesquisa e pós-graduação na saúde pública brasileira impulsionado pelo movimento sanitarista e a construção do Sistema Único de Saúde (SUS) em sua busca por democracia, justiça social e sanitária. A base empírica envolveu ações de vigilância em saúde dos trabalhadores e ambiental organizadas em redes protagonizadas pelo SUS em conjunto com universidades, sindicatos, movimentos sociais, organizações não governamentais (ONG) ambientalistas e Ministérios Públicos. Eventos de maior complexidade socioambiental em setores como siderurgia, petroquímico, mineração, agronegócio e energia forjaram a busca por novos referenciais epistêmicos e interdisciplinares que abarcam duas novas justiças: a ambiental e a cognitiva. Este artigo apresenta essa trajetória de contribuições conceituais em três movimentos a partir da década de 1980 até os dias atuais, cada qual correspondendo a um contexto sociopolítico e institucional, para pensar movimentos de transição paradigmática na análise e prevenção de acidentes e desastres numa perspectiva interdisciplinar. Finaliza-se com a sugestão de prevenção abissal e emancipatória para enfrentar diferentes crises da atualidade, como a ambiental, a sanitária, a democrática e a civilizatória.

Resumen: El artículo, en forma de ensayo, sistematiza una trayectoria profesional de experiencias interdisciplinarias y socialmente comprometidas en torno al análisis y la prevención de accidentes y desastres en los últimos 40 años. El trabajo académico se desarrolló principalmente en el ámbito de la investigación y postgrado en Salud Colectiva brasileña, impulsado por el movimiento sanitario y la construcción del Sistema Único de Salud (SUS) en su búsqueda por democracia, justicia social y sanitaria. La base empírica involucró acciones de vigilancia en salud y ambiental de los trabajadores, organizadas en redes protagonizadas por el SUS en conjunto con universidades, sindicatos, movimientos sociales, organizaciones no gubernamentales ambientalistas y Ministerios Públicos. Los acontecimientos de mayor complejidad socioambiental en sectores como la siderurgia, el petroquímico, la minería, el agronegocio y la energía han llevado a la búsqueda de nuevas referencias epistémicas e interdisciplinarias que abarcaron dos nuevas formas de justicia, la ambiental y la cognitiva. El artículo sistematiza esa trayectoria de contribuciones conceptuales en tres movimientos a partir de la década de 1980 hasta los días actuales, cada cual, correspondiendo a un contexto sociopolítico e institucional, para pensar movimientos de transición paradigmática en el análisis y prevención de accidentes y desastres desde una perspectiva interdisciplinaria. Se finaliza con la sugerencia de prevención abisal y una prevención emancipadora para enfrentar diferentes crisis de la actualidad, como la ambiental, la sanitaria, la democrática y la de civilización.

Abstract: The article, in the form of an essay, systematizes a 40-year-long professional trajectory of interdisciplinary and socially engaged experiences around the analysis and prevention of accidents and disasters. This study was mainly developed within the scope of research and postgraduate studies in Public Health in Brazil, driven by the sanitarian movement and the construction of Brazilian Unified National Health System (SUS) in its search for democracy and social and health justices. Its empirical basis involved workers' health and environmental surveillance actions organized in networks led by SUS in conjunction with universities, unions, social movements, environmental nongovernmental organizations (NGO), and Public Prosecutors' Offices. Events of greater socio-environmental complexity in sectors such as steel, petrochemicals, mining, agribusiness, and energy forged the search for new epistemic and interdisciplinary references that encompassed two new justices, i.e., environmental and cognitive. This essay systematizes this trajectory of conceptual contributions in three movements from the 1980s to the present day (each corresponding to a socio-political and institutional context) to reflect on paradigmatic transition movements in the analysis and prevention of accidents and disasters from an interdisciplinary perspective. It ends by suggesting abyssal and emancipatory prevention to face different current crises, including environmental, health, democratic, and civilizing ones.