Understanding the impacts of the COVID-19 response measures on deaf adults in Cape Town

Background: International literature has evidenced that Deaf people have been disadvantaged during the COVID-19 pandemic; however, there is currently little research published within the South African context. Objectives: This study investigated the ways in which the COVID-19 pandemic and its consequent response measures impacted Deaf adults in Cape Town. Method: Using a descriptive approach, semi-structured, qualitative interviews were held with 15 Deaf adults in Cape Town, South Africa. Participants were purposively selected through a local Deaf organisation. Data were analysed using thematic analysis. Results: Data revealed the challenges experienced when accessing information, the impact of communication barriers on daily life, and how the response measures impacted access to healthcare. Conclusion: The findings of this study demonstrate how the needs of the Deaf community were overlooked and their voices disregarded during the planning of the national pandemic response, ultimately having detrimental consequences. Therefore, the authors argue for greater inclusion of Deaf representatives to ensure equal access to information and resources, especially during a crisis. Contribution: This study contributes to the growing body of knowledge on the consequences of the COVID-19 pandemic in the field of disability and insights can inform both future research and interventions to promote equity and inclusion for Deaf people.

A cross-sectional study on the impact of children's Intelligence quotient on their behavior and anxiety in a dental setting

Aim: This study examined the relationship between children's intelligence quotient (IQ) and their levels of dental fear and anxiety(DFA) during their first dental visit. It also evaluated the influence of parental general anxiety on children's anxiety during this visit.Materials and methods: Eighty-eight children, aged 6­12 years, who had never visited a dentist before were conveniently recruited. Recruited children were subjected to the Wechsler Intelligence Scale for Children III (WISC III) and the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) to examine their IQ and dental fear and anxiety, respectively. Concerning parental general anxiety, General Anxiety Disorder-7 (GAD-7) was utilized. Children's behavior at their first dental visit was assessed utilizing Frankl's behavior rating scale. The Arabic-validated versions of WISC III, CFSS-DS, and GAD-7 were used. The correlations were examined using Spearman's rank-order correlation coefficient (P<0.05). Results: There was a negative correlation between children's IQ score and their DFA levels. There was a positive association between children's DFA and their parent's general anxiety levels. There was a favorable positive correlation between the degree of cooperation and the children's IQ scores during their first dental visit. Conclusion: This study reveals the common occurrence of fear and anxiety in children during dental visits between the ages of 6 and 12. The findings highlight the complex interplay between cognitive abilities, parental influence, and dental experiences in children. It emphasizes the importance of addressing both child and parental anxiety to promote positive dental visits.

Factors influencing data quality in routine health information systems in Maridi county, South Sudan

Background: Health system planning and monitoring rely on routine data collection, analysis and utilisation. However, underdeveloped countries need more data for decision-making. South Sudan's data management framework only partially functions, with delayed data collection and inaccurate data. The study examined the factors affecting data quality in Maridi County, South Sudan, aiming to improve resource forecasting and equitable health service delivery. Objective: The study sought to identify the obstacles and opportunities for improving data quality in health information systems (HIS) in Maridi County, Western Equatoria State, South Sudan. Methods: A cross-sectional study involving 106 respondents was conducted on 12 healthcare facilities in Maridi County. Statistical Package for the Social Sciences (SPSS) version 25 was used for descriptive, factor and thematic analysis to understand data quality, focussing on behavioural, organisational and technical aspects. Result: The study revealed that insufficient motivation, negative staff attitudes, excessive workloads, a lack of cooperation, personnel insufficiency, inadequate supervision, feedback and training influenced data quality. These factors were interrelated, with over 50% of variables showing weak to strong correlations. Set of standard indicators correlated with the presence of standard data collection tools (r = 0.51). Regular feedback from the County Health Department linked with completeness (r = 0.63) and the training of personnel on health management information systems (HMIS) and completeness resulted in moderate association (r = 0.488). Conclusion: Staff motivation, optimal staffing, training, regular feedback, and continuous supervision are crucial for maintaining the appropriate skill set for data quality. Contribution: Data quality can be achieved when standard tools and human resources are maintained and are evenly distributed.

Trial of an mHealth intervention to improve HIV prophylaxis for female sex workers, United Republic of Tanzania

Objective To evaluate the effect of a mobile health (mHealth) intervention on early retention of female sex workers in human immunodeficiency virus (HIV) pre-exposure prophylaxis services in the United Republic of Tanzania. Methods The study involved 783 female sex workers: 470 from Dar es Salaam who were given the Jichunge mHealth application (app) in addition to standard HIV pre-exposure prophylaxis (intervention arm), and 313 from Tanga who received pre-exposure prophylaxis alone (control arm). Participants were recruited using respondent-driven sampling and followed up for 12 months. Early retention was defined as attending a pre-exposure prophylaxis follow-up clinic within 28 days of an appointment scheduled for 1 month after starting treatment. To assess if the Jichunge app led to higher retention, we conducted intention-to-treat and per-protocol analyses using a regression model adjusted by inverse probability weighting. Findings Early retention in HIV pre-exposure prophylaxis care was observed in 27.6% (130/470) of participants in the intervention arm and 20.1% (63/313) in the control arm. In the adjusted, intention-to-treat analysis, early retention was observed in 29.4% in the intervention arm and 17.7% in the control arm (risk difference: 11.8 percentage points; 95% confidence interval: 5.3­18.3). Conclusion Early retention in HIV pre-exposure prophylaxis care was significantly greater among female sex workers in the United Republic of Tanzania who used the Jichunge app than in those who did not. Nevertheless, more than two thirds of sex workers using the application did not attend follow-up services after 1 month, suggesting that additional interventions are needed.

Objectif Évaluer l'impact d'une intervention de santé mobile (mHealth) sur l'adhésion précoce des travailleuses du sexe vis-à-vis des services de prophylaxie préexposition pour le virus de l'immunodéficience humaine (VIH) en République-Unie de Tanzanie. Méthodes Cette étude a été menée auprès de 783 travailleuses du sexe: 470 d'entre elles étaient à Dar es Salaam et ont eu accès à l'application mHealth (app) Jichunge en complément d'une prophylaxie préexposition standard pour le VIH (volet d'intervention), tandis que les 313 autres provenaient de Tanga et n'ont bénéficié que d'une prophylaxie préexposition (volet de contrôle). Les participantes ont été sélectionnées par le biais d'un échantillonnage fondé sur les répondants, puis suivies pendant 12 mois. Une adhésion précoce signifiait assister à une consultation de suivi de la prophylaxie préexposition dans les 28 jours suivant un rendez-vous fixé un mois après le début du traitement. Enfin, pour déterminer si l'app Jichunge améliorait le taux d'adhésion, nous avons effectué des analyses selon l'intention de traiter et selon le respect du protocole, à l'aide d'un modèle de régression ajusté en fonction d'une pondération par l'inverse de la probabilité. Résultats Nous avons observé une adhésion précoce au traitement de prophylaxie préexposition pour le VIH chez 27,6% (130/470) des participantes dans le volet d'intervention, contre 20,1% (63/313) dans le volet de contrôle. L'analyse ajustée selon l'intention de traiter a permis de constater une adhésion précoce de 29,4% dans le volet d'intervention et de 17,7% dans le volet de contrôle (différence de risque: 11,8 points de pourcentage; intervalle de confiance de 95%: 5,3-18,3). Conclusion En République-Unie de Tanzanie, l'adhésion précoce au traitement de prophylaxie préexposition pour le VIH s'est révélée sensiblement plus élevée parmi les travailleuses du sexe ayant utilisé l'app Jichunge que parmi celles n'y ayant pas eu recours. Cependant, plus des deux tiers des travailleuses du sexe utilisant l'application ne se sont pas présentées aux services de suivi un mois plus tard, ce qui indique que d'autres mesures sont requises.

Dental care for children in a tertiary hospital

Aim: To evaluate the profile of pediatric onco-hematological patients and the outpatient dental care provided to these individuals from January 2016 to December 2019 by the Pediatric Dentistry division of the Dentistry and Stomatology Service of a tertiary hospital. Methods: Data were collected from the medical records of 179 pediatric patients undergoing treatment for onco-hematological diseases, aged between 0 and 19 years, regarding their profile and the outpatient dental care provided by the Pediatric Dentistry Service of the Dentistry and Stomatology Service of a tertiary hospital. Data were tabulated and subjected to descriptive statistical analysis. Results: The majority of the patients were male, with a mean age of 12. Anemia and leukemia were the most prevalent diseases in this study. During the evaluation period, 1548 dental appointments were performed, 696 of which were clinical evaluations. The remaining appointments involved various dental procedures. The most common procedures included the topical application of fluoride and dental prophylaxis, followed by extractions, laser therapy, tooth decay removal, and restorations/sealants. Conclusion: Assessing patient profiles and the dental care provided are important tools for improving dental care protocols and enhancing the quality of life for pediatric onco-hematological patients

Regulação do acesso ao tratamento do câncer de boca no estado do Rio de Janeiro / Study of the regulation system for access to oral cancer treatment in the state of Rio de Janeiro

Objetivos: Descrever o perfil das solicitações de vaga para tratamento do câncer de boca e analisar o tempo entre a solicitação e o agendamento. Métodos. Pesquisa com dados secundários do Sistema Estadual de Regulação do Estado do Rio de Janeiro, entre setembro de 2015 e junho de 2018. Incluiu-se as solicitações para "Oncologia Ambulatório de 1ª vez- Cirurgia de Cabeça e Pescoço" classificadas como câncer de boca e excluiu-se as com status "cancelada". Resultados. Foram exportados 5802 registros, sendo 1663 elegíveis. A idade média foi de 61 anos, com um desvio padrão de 12,3 anos. O tempo médio de espera foi de 19 dias com um desvio padrão de 16,6 dias. 19% dos agravos referiram-se as "Neoplasia maligna de outras partes e partes não especificadas da língua". Conclusão. O perfil dos pacientes corrobora o encontrado na literatura e o tempo de espera para o atendimento é considerado aceitável.

Objectives: To describe the profile of vacancy requests for treatment of oral cancer and to analyze the time between the request and the schedule. Methods. Research with secondary data from the State Regulation System of the State of Rio de Janeiro, between September 2015 and June 2018. Included were requests for "First-time Ambulatory Oncology - Head and Neck Surgery" classified as oral cancer and those with "canceled" status were excluded. Results. 5,802 records were exported, of which 1663 were eligible. The average age was 61 years, with a standard deviation of 12.3 years. The average waiting time was 19 days with a standard deviation of 16.6 days. 19% of the complaints referred to "Malignant neoplasm from other parts and unspecified parts of the tongue". Conclusion. The profile of patients corroborates that found in the literature and the waiting time for care is considered acceptable.

Suspensiones quirúrgicas: un desafío para la gestión clínica post Covid 19 / Surgical cancellation: a challenge for clinical management post Covid 19

Objetivo: Determinar la frecuencia, las causas y los factores asociados de suspensión de cirugías programadas en un hospital de alta complejidad en un periodo de 5 años. Materiales y Método: Se realizó un estudio descriptivo transversal, en un hospital terciario del sur de Chile durante los años 2014 a 2018. Se describe la frecuencia de suspensión quirúrgica del establecimiento y por especialidad, especificando sus principales causas. Además, se identificaron aquellas suspensiones evitables y sus factores asociados mediante regresión logística. Resultados: La tasa de suspensión en los 5 años de estudio fue de 11,2%. Neurocirugía y Traumatología tuvieron la mayor tasa de suspensión (18,8% y 13,9%, respectivamente), mientras que Ginecología y Obstetricia la menor (4,1%). Las causas más frecuentes fueron la inasistencia del paciente (16,9%), la prolongación de la cirugía anterior (16,4%) y la paralización de actividades por motivos gremiales (7,9%). Un 80,1% de las causas fueron evitables. La especialidad quirúrgica y la edad del paciente fueron los factores asociados más relevantes. Discusión: Se evidenció una alta tasa de suspensiones quirúrgicas y la mayoría por causas evitables. Su disminución puede ser la intervención más costo efectiva para contribuir a reducir las extensas listas de espera quirúrgica posterior a la crisis sanitaria por COVID 19, ya que sólo requiere optimizar los recursos existentes. Conclusiones: La suspensión quirúrgica es un problema frecuente en el proceso quirúrgico. Nuestros resultados permiten identificar a los grupos de mayor riesgo de suspensión, asignar responsabilidades a los equipos quirúrgicos y desarrollar estrategias efectivas para su prevención.

Aim: To determine the frequency, the causes and the associated factors of the surgical cancellation of scheduled surgeries at the Hospital Base Valdivia between the years 2014 and 2018. Materials and Method: A descriptive cross-sectional study was carried out. Were described the frequency of suspension of scheduled surgeries of the establishment, by specialty and their main causes, identifying those that can be avoided. In addition, the factors associated with suspension were identified by logistic regression. Results: The suspension rate in the 5 years of study was 11.2%. Neurosurgery and Traumatology had the highest frequency of surgical cancellation (18.8% y 13.9%, respectively), Obstetrics, and Gynecology the lowest (4.1%). The most frequent causes of suspension were the absence of the patient (16.9%), the prolongation of the previous surgery (16.4%) and the suspension of activities due to Union reasons (7.9%). 80.1% of the causes were avoidable. The age and surgical specialty were the most relevant associated factorsm Discussion: A high rate of surgical suspensions and most for avoidable reasons were evident. Reducing surgical cancellations can be the most cost effective intervention to help reduce the extensive post-health crisis surgical waiting lists by COVID 19, as it only requires optimizing existing resources. Conclusions: Surgical suspension is a common problem in the surgical process. Our results allow to identify the groups most at risk of suspension, assign responsibilities to surgical teams and develop effective strategies for their prevention.

Epidemiology of corneal transplantation before achieving the Zero Queue / Epidemiologia do transplante de córnea antes de atingir a Fila Zero

ABSTRACT Objective: To outline the epidemiological profile of cornea donors and recipients before reaching queue zero. Methods: Epidemiological study, of quantitative approach, with transversal, analytical design, analyzing database records from the Health Secretary of the State of Ceará, from 2013 to 2015. Results: We obtained 1,558 cornea donors and 2,287 cornea recipients from 2013 to 2015. Most donors were male, capital residents, from 21 to 40 years old. Of donated eyeballs, 14.52% were disposed, due to poor condition, infiltration or positive serology. The recipients were predominantly women over 60 years old. The procedures were mostly elective, due to bullous keratopathy (28%). Regarding emergency transplants, ulcer (38.51%) and retransplant (35.14%) were most prevalent. Predominantly, transplants were funded by the Unified Health System. Conclusion: The majority of patients who were submitted to corneal transplantation are senile, especially females, therefore should be cautiously observed. On the other hand, donors are mainly male and young, reflecting the high number of tragic accidents. The surgery for bullous keratopathy is the most frequent among elective transplants, while the ulcer surgery is the main cause of emergency procedures. The fact that most surgeries were financed by the Unified Health System reflects the importance of this system.

RESUMO Objetivo: Traçar o perfil epidemiológico dos doadores e receptores de córnea antes de atingir a Fila Zero. Métodos: Estudo epidemiológico, de abordagem quantitativa, com delineamento transversal e analítico, analisando registros da base de dados da Secretaria de Saúde do Estado do Ceará, de 2013 a 2015. Resultados: Foram obtidos 1.558 doadores de córnea e 2.287 receptores de córnea, de 2013 a 2015. A maioria dos doadores era homem, procedente da capital, de 21 a 40 anos. Dentre os globos oculares doados, 14,52% foram descartados por má condição, infiltração ou sorologia positiva. Os receptores eram predominantemente mulheres acima de 60 anos de idade. Os procedimentos foram majoritariamente eletivos, devido à ceratopatia bolhosa (28%). Já para transplantes de emergência, a úlcera (38,51%) e o retransplante (35,14%) foram os mais prevalentes. Em geral, os transplantes foram custeados pelo Sistema Único de Saúde. Conclusão: A maioria dos pacientes submetidos a transplantes de córnea foram do grupo etário senil, principalmente do sexo feminino, devendo esse grupo ser observado com cautela. Em contrapartida, os doadores eram, principalmente, homens e jovens, refletindo o alto número de pessoas que morrem devido a acidentes trágicos. A cirurgia de ceratopatia bolhosa foi a mais frequente dentre os transplantes eletivos; já a de úlcera foi a principal causa dos procedimentos de emergência. O fato de a maioria das cirurgias ter sido financiada pelo Sistema Único de Saúde reflete a importância desse sistema.

Impacto do isolamento social pela pandemia da COVID-19 nas consultas odontopediátricas: uma revisão sistemática e meta-análise / Impact of social isolation caused by the COVID-19 pandemic on pediatric dentistry appointments: a systematic review and meta-analysis

Objetivo: Avaliar estudos que mostraram o impacto do isolamento social pela pandemia da COVID-19 nas consultas odontopediátricas. Métodos: Estudos originais que tenham mostrado o impacto do isolamento social nas consultas de crianças e adolescentes com um(a) odontopediatra foram incluídos. Buscas no Web ofScience, Scopus, Embase e PubMed foram realizadas. A seleção dos estudos foi feita por dois autores. O risco de viés foi avaliado com a escala Universidade de Adelaide. Resultados das meta-análises foram fornecidos em razão de chances (RC) e intervalo de confiança (IC). Resultados:Setecentas e noventa e quatro referências foram avaliadas e quatro estudos foram incluídos. A proporção de consultas realizadas em 2019 (antes da pandemia) para tratamento restaurador (RC = 22,65; IC = 20,57­24,93), extração de dentes (RC = 15,96; IC = 14,78­17,23) e tratamento endodôntico (RC = 9,21; IC = 7,72­10,98) foi significativamente maior que a proporção de consultas realizadas em 2020 (após o início da pandemia). A proporção de pais/responsáveis que não levariam seus(suas) filhos(as) à uma consulta com o odontopediatra foi significativamente maior entre indivíduos com mais medo durante a pandemia (escore 6 a 10) do que entre indivíduos com menos medo durante a pandemia (escore 0 a 5) (RC = 8,41; IC = 5,06­13,98). A proporção de pais/responsáveis que não levariam seus(suas) filhos(as) à uma consulta com o odontopediatra em regiões com mais de 100 casos de COVID-19 foi significativamente maior do que em regiões com até 100 casos (RC = 2,45; IC = 1,55­3,88). A avaliação do risco de viés variou de baixo a alto. Uma limitação dessa revisão foi o número restrito de estudos incluídos. Conclusão: O isolamento social pode ter contribuído para uma redução no número de consultas odontopediátricas devido à insegurança dos pais de levarem seus(suas) filhos(as) ao consultório odontológico. Esses resultados podem ser importantes para os clínicos e os organizadores de serviços de saúde.

Aim: To evaluate studies that showed the impact of social isolation caused by the COVID-19 pandemic on pediatric dentistry appointments. Methods: This work included original studies that have evaluated the impact of social isolation in children's and adolescents' appointments with a pediatric dentist. Searches were conducted in Web of Science, Scopus, Embase, and PubMed databases. Study selection was carried out by two authors. Risk of bias was assessed using the University of Adelaide scale. Results of meta-analyses were provided in odds ratio (OR) and confidence interval (CI). Results: Our study evaluated 794 references, of which four studies were included. The proportion of dental appointments performed in 2019 (before the pandemic) for restorative treatment (OR = 22.65; CI = 20.57­24.93), tooth extraction (OR = 15.96; CI = 14.78­17.23), and endodontic treatment (OR = 9.21; CI = 7.72­10.98) was significantly higher than the proportion of dental appointments performed in 2020 (after the onset of the pandemic). The proportion of parents/guardians who would not take their children to an appointment with a pediatric dentist was significantly higher among individuals who were more afrais during the pandemic (score 6 to 10) than among individuals who were less afraid during the pandemic (score 0 to 5) (OR = 8.41; CI = 5.06­13.98). The proportion of parents/guardians who would not take their children to an appointment with a pediatric dentist in regions with more than 100 cases of COVID-19 was significantly higher than in regions with up to 100 cases (OR = 2,45; CI = 1.55­3.88). Risk of bias assessment ranged from low to high. A limitation of this review was the restricted number of included studies. Conclusion: Social isolation caused a decline in the number of appointments with a pediatric dentist due to parents' insecurity about taking their children to the dental office. These results are important for both dental clinicians and healthcare decision-makers.

Sistema de gestión TO-BE: garantizar el derecho a la salud de pacientes con ITS en Perú / TO-BE management system: guaranteeing the right to health of patients with STIs in Peru

Se realizó una investigación de campo para conocer la gestión de los procesos de solicitud y admisión de citas médicas, considerando la estigmatización y discriminación de las personas ITS, con el fin de garantizar el derecho a la salud de estos pacientes en Perú. Se ejecutó la sistematización de la información sobre los procesos y mecanismos de exigibilidad, bajo los lineamientos y manuales de los cuatro procesos estratégicos del MINSA contemplados para el otorgamiento de citas médicas, siguiendo los lineamientos de Gob.Pe, Adicionalmente, mediante verificación de los procesos se construyeron la matriz entidad-relación de la gestión por procesos del SSP, y el flujograma del proceso de solicitud y otorgamiento de citas AS-ISS. Se consideraron aspectos tecnológicos-médicos-legales con la participación de 201 pacientes independientemente del motivo o patología a consultar, identificando incidentes en la eficiencia del proceso misional. Por último, se implementó el flujograma de procesos de reserva de citas médicas a través de la aplicación ejecutable para smartphones, tabletas y otros dispositivos móviles (APP) TO-BE la cual conlleva a 10 pasos desde el registro de usuario hasta la emisión de comprobante de otorgamiento de cita médica. Se analizaron las preferencias de los usuarios sobre las causas superables en el proceso misional, mediante una encuesta estructura a 170 usuarios de SSP(AU)

A field investigation was carried out to learn about the management of the processes of request and admission of medical appointments, considering the stigmatization and discrimination of STI people, in order to guarantee the right to health of these patients in Peru. The systematization of the information on the processes and mechanisms of enforceability was carried out, under the guidelines and manuals of the four strategic processes of the MINSA contemplated for the granting of medical appointments, following the guidelines of Gov. Pe, Additionally, through verification of the processes The entity-relationship matrix of the management by processes of the SSP, and the flowchart of the process of request and granting of appointments AS-ISS were constructed. Technological-medical-legal aspects were considered with the participation of 201 patients regardless of the reason or pathology to be consulted, identifying incidents in the efficiency of the missionary process. Finally, the flowchart of medical appointment reservation processes was implemented through the executable application for smartphones, tablets and other mobile devices (APP) TO-BE, which entails 10 steps from user registration to issuance of voucher of granting a medical appointment. Users' preferences regarding causes that can be overcome in the missionary process were analyzed through a structured survey of 170 SSP users(AU)

O direito à saúde no território: o olhar dos usuários para Atenção Primária à Saúde / The right to health in the territory: service users' perceptions of Primary Health Care

Resumo A Atenção Primária à Saúde (APS) é considerada imprescindível para a efetividade dos sistemas de saúde. O objetivo deste estudo foi avaliar a qualidade da assistência prestada na APS em um município de Pernambuco. Realizou-se um estudo exploratório através da escuta a 525 usuários utilizando questionários estruturados. A avaliação da qualidade considerou as dimensões: acessibilidade, assistência clínica, relação profissional-usuário, atividades comunitárias e estrutura. Os resultados apontam para um contexto de perpetuação das vulnerabilidades sociais e o desafio em alcançar um atendimento equitativo e universal. Os principais aspectos de insatisfação foram: dificuldade de acesso a consultas e exames especializados, tempo de espera para atendimento e possibilidade de apresentar reclamações. Por outro lado, os entrevistados apresentaram-se satisfeitos com o atendimento médico e de enfermagem, principalmente quanto ao respeito, privacidade, escuta e confidencialidade. Verificou-se que apesar dos profissionais de saúde se empenharem na prestação de um atendimento humanizado, foi evidente a fragmentação do cuidado na rede estudada, o que dificulta o seguimento adequado e oportuno ao paciente, refletindo negativamente na qualidade da assistência prestada.

Abstract Primary health care is an essential component of effective health systems. The aim of this study aim was to evaluate the quality of primary care in a city in the state of Pernambuco, Brazil. We conducted an exploratory study with 525 service users using structured questionnaires. The quality of primary care was assessed across five dimensions: accessibility, clinical care, professional-user relations, community activities and structure. The findings point to the perpetuation of social vulnerabilities and challenges in achieving equitable universal care. Dissatisfaction rates were highest in the following categories: access to specialist appointments and exams, appointment wait time, and opportunity to make complaints. However, respondents were satisfied with medical and nursing care, particularly in relation to respect, privacy, listening and confidentiality. The findings show that, although health professionals were committed to providing humanized care, fragmentation of care is evident, hampering the provision of adequate and timely follow-up and negatively affecting the quality of care.

Sistema de agendamento online: uma ferramenta do PEC e-SUS APS para facilitar o acesso à Atenção Primária no Brasil / PEC e-SUS APS online appointment scheduling system: a tool to facilitate access to Primary Care in Brazil

Resumo A existência de barreiras nos serviços de demanda agendada resulta no elevado índice de absenteísmo. O objetivo deste manuscrito é apresentar as principais características do Sistema de Agendamento Online da estratégia e-SUS APS no Brasil. O Sistema de Agendamento Online desenvolvido pelo Laboratório Bridge da Universidade Federal de Santa Catarina, o qual também desenvolve o sistema de Prontuário Eletrônico do Cidadão (PEC e-SUS APS), e permite o agendamento de consultas através do aplicativo Conecte SUS Cidadão. O PEC e-SUS APS possui, entre outros, o módulo de agenda do profissional onde são realizadas as marcações e cancelamentos de consultas, permitindo a visualização de seus horários e disponibilidades. Embora o uso de sistemas de agendamento online seja capaz de fornecer benefícios, infelizmente eles têm sido pouco explorados na APS. Os principais motivos estão relacionados com a falta de informação e capacitação dos profissionais sobre o sistema e os impactos nos serviços prestados pelos estabelecimentos de saúde da APS. A fim de garantir a maior adoção e utilização do Sistema de Agendamento Online, é necessário ampliar a divulgação do sistema de modo a instituí-lo na rotina dos serviços como um instrumento facilitador do acesso à APS.

Abstract Barriers faced by health services providing scheduled care result in high no-show rates. This article describes the main characteristics of an online appointment scheduling system incorporated into the citizens' electronic health record system (PEC e-SUS APS). Developed by the Bridge Laboratory, Federal University of Santa Catarina, which also developed the PEC e-SUS APS, the system allows patients to schedule appointments using the national patient communications hub, Conecte SUS Cidadão. The PEC e-SUS APS includes a professional's agenda module that allows patients to view available time slots and book and cancel appointments. Unfortunately, despite the benefits of online scheduling systems, their potential has been poorly exploited in Brazil. The main reasons for this include lack of information and training of health professionals on how to use the system and its potential benefits for Primary Health Care (PHC) services. Wider dissemination is needed to improve the adoption of the system and promote the routine use of this tool in health services in order to facilitate access to primary health care.

Surgery remember@: an innovation to reduce surgical cancellations / Surgery remember@: uma inovação para reduzir os cancelamentos cirúrgicos

ABSTRACT The use of mobile phones has dramatically increased all over the world. Such revolution in the communication amongst individuals has a great impact in patient care, supporting their self-management and promoting shared responsibility with health services. Given that improved communication facilitates compliance with scheduled procedures and reduces surgical cancellations, the current work aims to develop a communication tool named Surgery Remember@ to mitigate surgical suspensions due to patient absenteeism. The present article is a study of technological production divided into four chapters: literature review; analysis of the hospital administrative profile; software development; and process mapping for software implementation. Taking into account that in the last three years the problem of absenteeism was the main cause of institutional surgical cancellations; the development of Surgery Remember@ endeavours to reduce surgery cancellations, improving efficiency and reducing costs. It is known that sending messages three days before the surgical procedure makes it possible to replace patients in the event of cancellations, optimizing the human and material resources in the operating room. The confirmation of the pre-aesthetic consultation is also positive, for it allows the verification of perioperative assistance improvement. Hence, besides being viable and easy to implement, the software developed allows the addition of other features based on user requirements, proving to be an asset to reduce surgery cancellations.

RESUMO O uso de telefones celulares aumentou dramaticamente em todo o mundo. Essa revolução na comunicação entre os indivíduos tem impacto no cuidado ao paciente, apoiando sua autogestão e promovendo a responsabilidade compartilhada com os serviços de saúde. Tendo em vista que a melhoria da comunicação facilita o cumprimento dos procedimentos programados e reduz os cancelamentos cirúrgicos, o presente trabalho tem como objetivo desenvolver uma ferramenta de comunicação denominada Surgery Remember@ para mitigar as suspensões cirúrgicas por absenteísmo do paciente. O presente artigo é um estudo da produção tecnológica dividido em quatro capítulos: revisão de literatura; análise do perfil administrativo do hospital; desenvolvimento de software; e mapeamento de processos para implementação de software. Tendo em conta que nos últimos três anos o problema do absenteísmo foi a principal causa de cancelamentos cirúrgicos institucionais o desenvolvimento do Surgery Remember@ se apresenta como esforço para reduzir os cancelamentos de cirurgias, melhorando a eficiência e reduzindo custos. Sabe-se que o envio de mensagens três dias antes do procedimento cirúrgico possibilita a reposição de pacientes em caso de cancelamentos, otimizando os recursos humanos e materiais da sala cirúrgica. A confirmação da consulta pré-anestésica também é positiva, pois permite verificar a melhora da assistência perioperatória. Assim, além de viável e de fácil implementação, o software desenvolvido permite agregar outros recursos de acordo com a necessidade do usuário, mostrando-se uma ferramenta para redução de cancelamentos cirúrgicos.

Comportamento faltoso em serviços de saúde materno-infantil: revisão integrativa da literatura / Non-attendance in maternal-child health services: an integrative literature review

Objetivo: identificar evidências científicas acerca dos motivos de não comparecimento em consultas nos serviços de saúde materno-infantil. Método: revisão integrativa conduzida nas bases CINAHL, BDENF, Scopus, Web of Science, PubMed, EMBASE, Science Direct e BVS, sem limitação do ano de publicação, seguindo a ferramenta PRISMA. Definiu-se como população os pacientes faltosos nas consultas agendadas. Resultados: identificaram-se 308 estudos, destes selecionaram-se 63 para a leitura na íntegra e três para amostra final. Os principais motivos relacionados ao comportamento faltoso, envolveram condições socioeconômicas, acessibilidade geográfica e a compreensão dos usuários quanto à importância do comprometimento com a saúde, todas situações que podem favorecer um desfecho desfavorável ao binômio. Conclusão: concluiu-se que a escassez de artigos acerca do tema justifica a realização de novos estudos voltados ao aprofundamento acerca das dificuldades encontradas pelas famílias, a fim de traçar estratégias que auxiliem a minimizar os efeitos deletérios da falta de acompanhamento.

Objective: to identify scientific evidence about the reasons for not attending appointments at maternal and child health services. Method: integrative review conducted at the bases CINAHL, BDENF, Scopus, Web of Science, PubMed, EMBASE, Science Direct and VHL databases, without limitation of the year of publication, following the PRISMA tool. The population was defined as patients who missed scheduled appointments. Results: 308 studies were identified, 63 were selected for full reading and three for the final sample. The main reasons related to defaulting behavior involved socioeconomic conditions, geographic accessibility and users' understanding of the importance of health commitment, all situations that can favor an unfavorable outcome for the binomial. Conclusion: it was concluded that the scarcity of articles on the topic justifies further studies aimed at deepening the difficulties encountered by families, in order to devise strategies that help to minimize the harmful effects of lack of follow-up.

Coordenando grupos em sala de espera: analisando o processo / Coordinating groups in a waiting room: analyzing the process / La coordinación de grupos en la sala de espera: analizando el proceso

Este artigo se propõe a discutir os desafios na formação para o trabalho com grupos e o papel dos coordenadores, com base na experiência de coordenação de grupos de sala de espera realizado em uma Unidade Básica de Saúde, a partir de um estágio de graduação em Psicologia. Através de recortes do diário de campo, buscamos discutir a mediação grupal nesse contexto de intervenção, ressaltando possibilidades, expectativas e dificuldades vivenciadas. Considerando a escassez de trabalhos publicados com relação à temática de grupos em sala de espera e ênfase em grupos informativos, o presente trabalho buscou ampliar a discussão para grupo enquanto processo, expondo reflexões sobre nossa postura e intervenções, discussões ampliadas para pensar coordenação de grupos e formação profissional.

This article proposes to discuss the challenges in training for group work and the role of coordinators, based on the experience of coordinating groups in a waiting room held in a Basic Health Unit, from a graduation internship in Psychology. Through field diary clippings, we sought to discuss group mediation in this context of intervention, highlighting possibilities, expectations, and difficulties experienced. Considering the scarcity of studies regarding the theme of groups in the waiting room, besides an emphasis on informative groups, this study aimed to expand the discussion to the group as a process, exposing reflections on our posture and interventions, extended discussions to think coordinating groups and professional qualification.

Este artículo se propone discutir los desafíos en la formación para el trabajo con grupos y el papel de los coordinadores, con base en la experiencia de coordinación de grupos de sala de espera realizado en una Unidad Básica de Salud, a partir de una etapa de graduación en Psicología. A través de recortes del diario de campo, buscamos discutir la mediación grupal en ese contexto de intervención, resaltando posibilidades, expectativas y dificultades vivenciadas. Considerando la escasez de trabajos publicados con relación a la temática de grupos en sala de espera y énfasis en grupos informativos, el presente trabajo buscó ampliar la discusión para grupo en cuanto proceso, exponiendo reflexiones sobre nuestra postura e intervenciones, discusiones ampliadas para pensar coordinación de grupos y formación profesional.

Acquisition of responses with different effort requirements after exposure to noncontingent stimuli / Aquisição de respostas de diferentes custos após exposição a estímulos não contingentes / Adquisición de respuestas de diferentes costos después de la exposición a estímulos no contingentes

This experiment investigated whether noncontingent appetitive stimuli exposure has effects in a subsequent response acquisition with different efforts. On the first phase, rats were exposed to contingent events to nose poke response, noncontingent events, or no exposition. On the second phase, the bar press response of the animals was continuously reinforced or submitted to a FR3 schedule. The time and number of reinforcers to response acquisition varied among subjects, and none relation was identified between first phase exposition with response acquisition of different efforts on phase 2. The longest time in response acquisition identified in some subjects occurred due to competitive responses on the first phase followed by appetitive stimuli. Possibilities for future studies and possible implications for the applied context are discussed.

Este experimento investigou se a exposição a estímulos apetitivos não contingentes tem efeitos sobre a aquisição de respostas de diferentes custos. Na fase 1, ratos foram expostos a eventos contingentes às respostas de focinhar, eventos não contingentes ou não foram expostos. Na fase 2, a resposta de pressão à barra dos animais foi reforçada continuamente ou em esquema FR 3. O tempo e o número de reforçadores para aquisição de respostas variaram entre os sujeitos, não sendo identificada relação entre a exposição na fase 1 e o custo da resposta a ser adquirida na fase 2. O maior tempo para aquisição da resposta ocorreu possivelmente por causa de respostas competitivas acidentalmente seguidas por estímulos apetitivos na fase 1. Discutem-se possibilidades para estudos futuros e possíveis implicações para o contexto aplicado.

Este experimento investigó si la exposición a estímulos apetitivos no contingentes tiene efectos en la adquisición de respuestas a diferentes costos. En la fase 1 se expusieron ratones a eventos contingentes a las respuestas del hocico, eventos no contingentes o no fueron expuestos. En la fase 2 la respuesta de presión a palanca de los sujetos se reforzó continuamente o en FR 3. El tiempo y el número de reforzadores para adquirir respuestas variaron entre los sujetos de las diferentes condiciones sin que se identificara ninguna relación entre la exposición de la fase 1 y el costo de la respuesta a ser adquirida. El tiempo más largo para obtener la respuesta de algunos sujetos posiblemente se debió a respuestas competitivas que, en la fase 1, fueron seguidas por estímulos apetitivos. Se discuten posibilidades para estudios futuros y posibles implicaciones para el contexto aplicado.

Acesso e regulação ao cuidado especializado no Rio Grande do Sul: a estratégia RegulaSUS do TelessaúdeRS-UFRGS / Access and regulation of specialized care in Rio Grande do Sul: the RegulaSUS strategy of TelessaúdeRS-UFRGS

Resumo Na Atenção Primária à Saúde (APS) acesso e integralidade são fortemente influenciados pela coordenação do cuidado, que por sua vez recebe impacto positivo da articulação de ações de telessaúde para a telerregulação da assistência. Criamos uma metodologia de telerregulação (Projeto RegulaSUS) baseada em protocolos específicos firmemente alicerçados em evidências. A partir de dados do sistema de regulação e do TelessaúdeRS exploramos os efeitos do RegulaSUS na APS e no acesso ao cuidado especializado. A metodologia foi capaz de criar protocolos abrangentes, com expressiva redução média da fila de consultas especializadas de 30% em 360 dias. Reduziu o tempo de espera na marcação de consultas em especialidades clínicas (mediana de 66 dias), mas não em cirúrgicas. Tempos de espera nos casos mantidos em fila variaram de forma inversa, aumentado em especialidades clínicas e diminuindo em cirúrgicas. O uso de teleconsultorias espontâneas aumentou com a exposição dos profissionais ao RegulaSUS. A intervenção tem potencial na integração de sistemas de saúde, principalmente em países de baixa e média renda, e faz com que a telessaúde atue como metasserviço, construindo redes eficientes, qualificadas e equânimes.

Abstract In Primary Health Care (PHC), access, and integrality are strongly influenced by the coordination of care, which in turn receives a positive impact from the articulation of telehealth actions for teleregulation of care. We created a teleregulation method (RegulaSUS Project) based on specific protocols firmly grounded in scientific evidence. From data of the regulatory system and TelessaúdeRS, we explored the effects of RegulaSUS on PHC and access to specialized care. This method set comprehensive protocols, with a significant mean reduction of 30% in the specialized visits queue over 360 days. It reduced waiting time for medical clinical visits (median of 66 days) but not for surgical appointments. Waiting times for queued cases varied inversely, increasing for clinical and declining for surgical specialties. The use of teleconsultations unrelated to regulation increased with the exposure of professionals to RegulaSUS. The intervention evidence potentiality in the integration of health systems, mainly among low- and middle-income countries, and makes telehealth act as a meta-service, building efficient, qualified, and equitable networks.

Desarrollo de un sistema informático para el registro y seguimiento de los controles médicos de niños y niñas de 0 a 10 años atendidos por las unidades de salud de la Zona Oriental de El Salvador: en asocio con Unidad de Salud de Conchagua / Development of a computerized system for the registration and monitoring of medical check-ups of boys and girls from 0 to 10 years old attended by the health units of the Eastern Zone of El Salvador: in association with Unidad de Salud de Conchagua

El software desarrollado en este proyecto tiene como propósito controlar y ejecutar medidas de prevención hacia enfermedades definidas. Por medio del estudio de gestión de controles médicos, se diseñó la automatización de los procesos de la Unidad de Salud de Conchagua. El software cuenta con un módulo de gestión de citas en el cual se pueden agendar las consultas y controles de los pacientes, permitiendo además reprogramarlas en casos de ser requerido. De igual forma le permite al médico contar con una vista a manera de agenda en la que puede verificar si un día en concreto tiene pacientes ya registrados para atender. Con la implementación del sistema, la Unidad de Salud de Conchagua, La Unión, contará con una plataforma que incluirá la información del niño o la niña como nombre completo, edad, residencia, entre otros datos importantes, además tendrá la capacidad de almacenar más de 1,000,000 de expedientes clínicos.

The software developed in this project was made with the purpose to control and execute preventive measures towards defined diseases. Through the study of management of medical controls, the automation of the processes of Unidad de Salud de Conchagua was designed. The software has an appointment management module in which patient consultations and controls can be scheduled, also allowing them to be reprogrammed when necessary. In the same way, it allows the doctor to have a view in the way of an agenda in which he can verify if a specific day has patients already registered to attend. With the implementation of the system, the Unidad de Salud de Conchagua, will have a platform that will include the child's information such as full name, age, residence, among other important data, and will also have the capacity to store more than 1,000,000 clinical records.

Physiological and Behavioral Manifestations of Children and Teenagers with Down Syndrome During the Dental Appointment: A Comparative Cross-Sectional Study

Abstract Objective: To measure the heart rate (HR) and the behavior of children and teenagers with Down Syndrome (DS) during the dental appointment. Material and Methods: Two groups (n = 52), of both genders, aged 2-14 years, matched by age group were formed: study group (SG) - individuals with DS and control group (CG) - normotypical school children. The participants were submitted to clinical examination and prophylaxis. An oximeter was used to measure the HR at five moments of the dental consultation: before entering the practice room (T0), when sitting in the dental chair (T1), during the clinical examination (T2), during prophylaxis (T3) and immediately after prophylaxis (T4). Behavior, classified according to the Frankl Scale, was observed at T3. Mann Whitney, Kruskal-Wallis, Dunn and Pearson's Chi-square tests were used to analyze and compare variables (significance level at 5%). Results: In SG, a significant difference in HR was observed according to the moment of dental appointment (p<0.001 SG; 0.3385 CG). The highest HR value in SG was observed at T3 (median 110.00; IIQ 96.00-124.00), the only moment significantly different (p<0.001) from HR values for CG. A difference in behavior between groups (p<0.001) was also observed. Conclusion: HR of individuals with DS varied throughout the dental appointment, and they also had a higher prevalence of uncooperative behavior.