Implementación de un modelo de complementación público-privado (AMSJ - ASSE) de Asistencia Paliativa en el departamento de San José, Uruguay

Introducción: En inicios del año 2015 se implementa el convenio de complementación público-privado entre los dos principales prestadores del Departamento de San José - Uruguay: AMSJ y ASSE San José, conformándose así la Unidad Departamental de Medicina Paliativa de San José (UDMP). El convenio tiene como principal objetivo asegurar la asistencia paliativa a todos los usuarios de los prestadores involucrados con los principios fundamentales de calidad, equidad y accesibilidad, siguiendo los lineamientos del Plan Nacional de Cuidados Paliativos del Ministerio de Salud Pública de Uruguay. El objetivo es describir y analizar la experiencia de la implementación del primer modelo de complementación público-privado del país en Cuidados Paliativos (CP). Metodología: Estudio descriptivo analítico, retrospectivo que incluye datos de los primeros siete años de funcionamiento del convenio. Resultados: El convenio de complementación público-privado en el Departamento de San José, permitió la creación de un equipo interdisciplinario que asistió en forma continua a 1422 pacientes provenientes de zonas urbanas y rurales, portadores de diversas patologías. La cobertura departamental de CP aumentó de forma significativa, pasando de 24 % en 2014 a 57% en 2021. Estos resultados se lograron implementando un modelo de asistencia paliativa que asegura la continuidad asistencial en internación, consultorio y domicilio, que permitió respetar la autonomía del paciente, logrando el fallecimiento de 67% de los pacientes en su hogar. La satisfacción de usuarios y familiares de la asistencia brindada fue evaluada como muy buena. Conclusiones: El convenio de complementación resultó ser una herramienta eficiente para favorecer el acceso a CP, evitando la superposición de equipos en la asistencia domiciliaria en todo el departamento de San José.

Introduction: At the beginning of 2015, the public-private complementarity agreement was implemented between the two main providers of the Department of San José Uruguay: AMSJ and ASSE San José, thus forming the Departmental Unit of Palliative Medicine of San José (UDMP). The main objective of the agreement is to ensure palliative care to all users of the providers involved, with the fundamental principles of quality, equity and accessibility, following the guidelines of the National Palliative Care Plan of the Ministry of Public Health of Uruguay. The objective is describe and analyze the experience of implementing the country's first public-private complementation model in Palliative Care (PC). Methodology: Descriptive, analytical, retrospective study that includes data from the first seven years of operation of the agreement. Results: The public-private complementation agreement in the Department of San José allowed the creation of an interdisciplinary team that continuously assisted 1,422 patients from urban and rural areas, with various pathologies. Departmental CP coverage increased significantly, from 24% in 2014 to 57% in 2021. These results were achieved by implementing a palliative care model that ensures continuity of care in hospitalization, office and home, which allowed the patient's autonomy to be respected, achieving the death of 67% of patients at home. The satisfaction of users and family members with the assistance provided was evaluated as very good. Conclusions: The complementation agreement turned out to be an efficient tool to promote access to CP, avoiding the overlap of teams in home care throughout the department of San José.

Introdução: No início de 2015, foi implementado o acordo de complementaridade público-privado entre os dois principais prestadores do Departamento de San José Uruguai: AMSJ e ASSE San José, formando assim a Unidade Departamental de Medicina Paliativa de San José (UDMP). O principal objetivo do acordo é garantir cuidados paliativos a todos os usuários dos prestadores envolvidos, com os princípios fundamentais de qualidade, equidade e acessibilidade, seguindo as diretrizes do Plano Nacional de Cuidados Paliativos do Ministério de Saúde Pública do Uruguai. El objetivo es descrever e analisar a experiência de implementação do primeiro modelo de complementação público-privada em Cuidados Paliativos (CP) do país. Metodologia: Estudo descritivo, analítico, retrospectivo que inclui dados dos primeiros sete anos de vigência do convênio. Resultados: O acordo de complementação público-privada no Departamento de San José permitiu a criação de uma equipe interdisciplinar que atendeu continuamente 1.422 pacientes de áreas urbanas e rurais, com diversas patologias. A cobertura departamental do CP aumentou significativamente, de 24% em 2014 para 57% em 2021. Estes resultados foram alcançados através da implementação de um modelo de cuidados paliativos que garante a continuidade dos cuidados no internamento, no consultório e no domicílio, o que permitiu respeitar a autonomia do doente, atingindo a morte de 67% dos doentes no domicílio. A satisfação dos usuários e familiares com a assistência prestada foi avaliada como muito boa. Conclusões: O convênio de complementação revelou-se uma ferramenta eficiente para promover o acesso à CP, evitando a sobreposição de equipes na atenção domiciliar em todo o departamento de San José.

Evaluation and comparison of the oral health status of children in government and private schools between 6 to 9 years of age in Sangli city

Background: To evaluate and compare the Oral health status of children in Government and Private schools between 6 TO 9 years of age in Sangli City Methods: Subjects were selected by Cluster Random Sampling and all students between 6 to 9 years of age from the selected schools were examined. Screening was done on the basis of WHO oral health assessment form for children (2013). Consent was taken from the parents or the concerned authorities prior to the examination of the children. The examination was carried out by one trained and calibrated investigator using a mouth mirror and CPI probe under natural daylight. Results: A total of 1000 children (500 governments and 500 private) were examined in the study. The estimates of non-carious teeth, carious teeth, enamel fluorosis and dental trauma between private and government school children were compared. There was significant difference found in non- carious tooth estimate (p=0.003) and carious teeth estimate (p=0.005). The children in private school had more non carious teeth (mean: 16.45) when compared to government children (mean: 15.89). Similarly, the children in private school had less amount of carious teeth (mean: 3.31) when compared to government children (mean: 3.84). There was no significant difference found with respect to fluorosis (p=0.683) and dental trauma (0.319) in the children of government and private schools. Conclusions: The prevalence of oral diseases was relatively less among children from private schools in comparison with those from government schools.

Etiología bacteriana en teléfonos celulares del personal de salud de una clínica de Chiclayo / Bacterial etiology in cell phones of health personnel from a clinic in Chiclayo

RESUMEN El estudio buscó describir la etiología y frecuencia bacteriana en los teléfonos celulares del personal de salud en el Hospital de Clínicas de Chiclayo, Perú, de marzo a agosto de 2022. Se analizaron 30 teléfonos de médicos, enfermeros y técnicos en áreas de hospitalización y Unidad de Vigilancia Intensiva (UVI). Se tomaron muestras de las pantallas, se cultivaron y se identificaron las bacterias mediante pruebas bioquímicas. Se registró y analizó la información con Microsoft Excel 2013. El 56,7 % de los teléfonos presentó colonización bacteriana: Gram positivas en 33,3 % y Gram negativas en 23,3 %. Predominaron Staphylococcus coagulasa negativa (35,3 %) y Escherichia coli (23,5 %) en hospitalización, y Staphylococcus aureus (23,5 %) en UVI. El 66,7 % desinfectaba los teléfonos poco y el 40 % lavaba las manos con poca frecuencia. Staphylococcus coagulasa negativa, S. aureus y E. coli fueron los agentes más frecuentes, sugiriendo deficiencias en la higiene hospitalaria

ABSTRACT The study aimed to describe the etiology and bacterial frequency on the cell phones of healthcare personnel at the Hospital de Clínicas de Chiclayo, Peru, from March to August 2022. Thirty phones from doctors, nurses, and technicians in hospitalization areas and the Intensive Vigilance Unit (IVU) were analyzed. Samples were taken from the phone screens, cultured, and bacteria were identified using biochemical tests. The data was recorded and analyzed with Microsoft Excel 2013. Bacterial colonization was found on 56.7% of the phones: Gram-positive bacteria on 33.3% and Gram-negative bacteria on 23.3%. Staphylococcus coagulase-negative (35.3%) and Escherichia coli (23.5%) predominated in hospitalization, while Staphylococcus aureus (23.5%) predominated in the IVU. 66.7% of the personnel rarely disinfected their phones, and 40% washed their hands infrequently. Staphylococcus coagulase-negative, S. aureus, and E. coli were the most frequent agents, suggesting deficiencies in hospital hygiene practices.

Research on Patients’ Trust Risk Points and Promotion Path from the Perspective of Online Health Community / 中国医学伦理学

Online health community is a new medical treatment mode combining the Internet and medical treatment. Patients can get medical services through the network. However, it cannot be ignored that patients’ trust will be affected by the uncertainty of online medical information, the unsafe factors of patients’ private information, the insufficient standardization of the diagnosis and treatment process, and other issue in the process of using this new medical treatment mode. By taking measures such as improving the information quality in online health community, enhancing patients’ cognitive ability of health information, perfecting privacy protection measures in online health community, advancing patients’ participation in online health community and ensuring the standardization of diagnosis and treatment process, patients’ trust can be improved.

Application of SPOC-based hybrid scenario simulation teaching method in undergraduate clinical teaching of pediatric dentistry / 中华医学教育探索杂志

Objective:To investigate the effects of the hybrid scenario simulation teaching method based on small private online courses (SPOC) in undergraduate clinical teaching of pediatric dentistry.Methods:A total of 44 students of dentistry practicing in the Department of Pediatric Dentistry, The Third Affiliated Hospital, The Air Force Military Medical University, from January 2020 to December 2021 were selected, with 23 students practicing from January to December 2020 in control group (receiving traditional teaching) and 21 students practicing from January to December 2021 in experimental group (employing SPOC-based hybrid scenario simulation teaching method). At the end of the internship, an exam was given to assess the students' doctor-patient communication and standardized operation, and parental satisfaction and students' satisfaction were scored. SPSS 20.0 software was used to perform the independent samples t test for data analysis. Results:Compared with the control group, the experimental group had significantly higher scores of doctor-patient communication [(82.83±2.09) points vs. (88.40±2.22) points] and standardized operation [(82.26±4.38) points vs. (86.67±2.62) points] as well as significantly higher scores of parental satisfaction and students' satisfaction [(18.85±1.73) points vs. (20.71±0.85) points] and [(17.37±0.98) points vs. (20.57±0.66) points; all P<0.05]. Conclusions:The SPOC-based hybrid scenario simulation teaching method can effectively improve the quality of clinical teaching for undergraduate internships in pediatric dentistry, especially for cultivating doctor-patient communication ability.

Computed tomography and magnetic resonance imaging in Brazil: an epidemiological study on the distribution of equipment and frequency of examinations, with comparisons between the public and private sectors / Tomografia computadorizada e ressonância magnética no Brasil: estudo epidemiológico sobre distribuição dos equipamentos, frequência de realização dos exames e comparação entre setores público e privado

Abstract Objective: To compare information on highly complex radiological procedures—computed tomography (CT) and magnetic resonance imaging (MRI)—between the public and private health care systems, across the five regions of Brazil, in terms of the numbers of radiological devices and examinations performed, between 2015 and 2021. Materials and Methods: This was a descriptive time series analysis of secondary data in the public domain, available from the Information Technology Department of the Brazilian Unified Health Care System, an entity of the Brazilian National Ministry of Health (NMH) that is responsible for collecting and storing health-related information in Brazil. The analysis included the numbers of CT and MRI scanners; the volumes and types of examinations; the type of institution (public or private); the regions of the country; and the years (2015 to 2021). Results: Progressive increases in the numbers of CT and MRI devices, as well as in the volumes of examinations, were observed over the years in all regions of the country. The private sector showed higher rates of equipment acquisition and of growth in the number of examinations. However, the public health care system did not reach the equipment targets set by the NMH, whereas the private health care system surpassed those targets. A greater number of examinations were performed in the private sector than in the public sector. Conclusion: During the period evaluated, the public health care system did not meet the equipment or examination targets recommended by the NMH, in any of the regions of the country, unlike the private health care system, which exceeded both in all of the regions.

Resumo Objetivo: Comparar informações sobre procedimentos radiológicos de alta complexidade - tomografia computadorizada (TC) e ressonância magnética (RM) -, considerando o número de aparelhos e o quantitativo de exames nas esferas pública e privada nas cinco regiões brasileiras entre 2015 e 2021. Materiais e Métodos: Trata-se de um estudo descritivo de série temporal que utilizou dados secundários do Departamento de Informática do Sistema Único de Saúde, órgão do Ministério da Saúde (MS) responsável pela coleta e armazenamento das informações relacionadas à saúde no Brasil. Analisamos os números de aparelhos e de exames de TC e RM, considerando os tipos de aparelhos e exames, instituição (pública ou privada), região brasileira e ano (2015 a 2021). Resultados: Houve aumento de aparelhos e exames de TC e RM em todas as regiões ao longo dos anos. A esfera privada apresentou maior aquisição desses aparelhos e crescimento no número de exames. O sistema público não atingiu o número de aparelhos preconizado pelo MS, enquanto o sistema privado superou a recomendação. Observou-se maior número de exames na esfera privada quando comparada à pública. Conclusão: O sistema público não atendeu aos números de aparelhos e exames realizados preconizados pelo MS, diferentemente da esfera privada, em todas as regiões no período estudado.

Pensando comunidade: a questão social do cuidado / Thinking community: the social question of care

Resumo: O artigo discute a importância da coletivização do cuidado. O método é materialista-histórico, partindo da compreensão marxiana da condição de ser social. O artigo analisa a condição de propriedade privada de si a que é alçado o indivíduo na sociedade capitalista. Em seguida, analisa a formação da cultura do inimigo como impeditivo à coletivização do cuidado. Como resultado, apresenta práticas de coletivização que já vêm sendo adotadas com sucesso.

Abstract: The article discusses the importance of collectivizing care. The method is historical materialist, based on the Marxian understanding of the condition of social being. The article analyzes the condition of private property of the self to which the individual is elevated in capitalist society. It then looks at the formation of the culture of the enemy as an impediment to the collectivization of care. As a result, it presents collectivization practices that have already been successfully adopted.

Taxa e custos médicos diretos de cesáreas em beneficiárias da saúde suplementar no estado de São Paulo, Brasil: 2015 a 2021 / Rate and direct medical costs of cesarean sections among supplementary health plan holders living in the state of São Paulo, Brazil: 2015-2021

Resumo O Brasil tem a segunda maior taxa de cesárea do mundo. Há diferença dessas taxas nos setores públicos e privados. Foram utilizados dados de internação de beneficiárias residentes no estado de São Paulo, internadas entre 2015 e 2021, com idades entre 10 e 49 anos, para verificar as taxas e custos das cesáreas no setor privado. Foi realizado estudo parcial de avaliação econômica em saúde na perspectiva da saúde suplementar considerando custos médicos diretos de internação. Foram analisadas 757.307 internações, com gasto total de R$ 7,701 bilhões. As taxas de cesáreas foram de 80% no período. São menores nas gestantes mais novas (69%) e maiores nas mais velhas (86%), e sempre superiores a 67%. Essa população tem taxas 71% maiores do que aquelas do SUS. Há maior proporção de internações com uso de unidade de terapia intensiva nas cesáreas. O custo mediano da cesárea é 15% maior do que o parto normal e são duas vezes maiores nas seguradoras do que nas cooperativas médicas. Há oportunidade de aplicação de políticas públicas de saúde amplamente utilizadas no Sistema Único de Saúde visando a redução das taxas, dos custos diretos da internação e dos planos de saúde.

Abstract Brazil has the second largest cesarean section rate in the world. Differences in rates exist between the public and private health sectors. This study used data on admissions of supplementary health plan holders aged between 10 and 49 years living in the state of São Paulo admitted between 2015 and 2021 to determine cesarean section rates and costs in the private health sector. We conducted a partial economic analysis in health from a supplementary health perspective focusing on the direct medical costs of admissions. A total of 757,307 admissions were analyzed with total costs amounting to R$7.701 billion. The cesarean section rate over the period was 80%. Rates were lowest in young women (69%) and highest in the oldest age group (86%), exceeding 67% across all groups. The rate was 71% higher than in public services. The proportion of admissions with use of the intensive care unit was higher among cesarian deliveries. The median cost of a cesarean was 15% higher than that of a normal delivery and twice as high in insurance companies than healthcare cooperatives. There is an opportunity to apply policies that are widely used in public services to the private sector with the aim of reducing cesarean rates in private services, direct costs of admission, and the cost of supplementary health plans.

A assistência à saúde no governo militar (1964-1985) e sua herança para o SUS: o híbrido público-privado / Health care under the military government (1964-1985) and its legacy for the SUS: the public-private hybrid Unified Health System

Resumo O artigo analisa a política de assistência à saúde desenvolvida durante o governo militar no Brasil (1964-1985), com foco principal na relação do setor público com o privado na produção de serviços de saúde, nas diversas modalidades em que isso ocorreu, e suas repercussões. O objetivo, a partir de uma perspectiva institucionalista e histórica, que considera os mecanismos por meio dos quais políticas prévias afetam o processo decisório posterior e colocam limites às possibilidades de mudanças, é identificar os efeitos dessa política na configuração da reforma da política de saúde, produzida no processo de democratização, que levou à criação de um sistema de saúde universal e integral. Entre esses, destacam-se os efeitos políticos na configuração da arena da saúde; efeitos cognitivos relativos à percepção da política de saúde, e efeitos na capacidade governamental de produção e regulação de serviços. O resultado foi a manutenção de uma dualidade do sistema de saúde, garantindo a convivência de um setor privado vigoroso com um sistema público pretensamente universal e que colocou/coloca dificuldades ao SUS, mas não impediu sua implantação e institucionalização. O artigo é extraído de livro publicado anteriormente.

Abstract This article analyzes the health care policy developed during the military government in Brazil (1964-1985), with a core focus on the relationship between the public and private sectors in the provision of health services, in the different modalities in which this occurred, and its repercussions. The objective, from an institutionalist and historical perspective, which considers the mechanisms by means of which prior policies affect the subsequent decision-making process and impose limits on the possibilities for change, is to identify the effects of this policy on the configuration of health policy reform, implemented in the democratization process, which led to the creation of a universal and comprehensive health system. Among these, the political effects on the configuration of the health area stand out; cognitive effects related to the perception of health policy, and effects on the government's capacity to provide and regulate services. The result was the continuation of a duality in the health system, resulting in the coexistence of a vigorous private sector with an allegedly universal public system which posed/poses difficulties for the SUS, but did not prevent its implementation and institutionalization. The article is taken from a previously published book.

Legislações do ensino superior e a privatização da educação no Brasil / Higher education legislation and the privatization of education in Brazil / La legislación de enseñanza superior y la privatización de la educación en Brasil

RESUMO: O objetivo deste trabalho foi analisar a trajetória das legislações relativas ao ensino superior no Brasil e suas contribuições para o processo de privatização do ensino, além de descrever os principais grupos empresariais no ramo da educação superior no país. Para isso, realizou-se um estudo exploratório de análise documental das legislações e documentos disponíveis on-line, publicados entre 1961 e 2023. Desde a década de 1960, editou-se um conjunto de 29 atos normativos (leis, projetos de leis, decretos, portarias e medidas provisórias) referentes à educação. Ao longo dos anos, todos os governos brasileiros implementaram atos que favoreceram o processo de privatização e o surgimento de grandes conglomerados econômicos de ensino. A intensa privatização do ensino superior se relaciona intimamente com a trajetória dos instrumentos normativos editados por diferentes governos. As legislações moldaram o sistema educacional do país e permitiram a flexibilização dos processos de criação e expansão de instituições, cursos e vagas. Por conseguinte, surgiram grandes grupos empresariais no ramo da educação, detentores de crescentes capitais financeiros que atuam em todas as áreas de formação e, em alguns casos, até se especializando na educação em saúde.

ABSTRACT: The objective of this study was to analyze the trajectory of legislation related to higher education in Brazil and its contributions to the privatization of education, in addition to describing the leading business groups in the field of higher education in the country. For this, an exploratory study of documentary analysis of the legislation and online documents was carried out and published between 1961 and 2023. Since the 1960s, a set of 29 normative acts (laws, bills, decrees, ordinances and provisional measures) related to education have been issued. Over the years, all Brazilian governments have implemented acts that favored the privatization process and the emergence of large economic education conglomerates. The intense privatization of higher education is closely related to the trajectory of normative instruments issued by different governments. Legislation shaped the country's educational system and allowed the flexibility of the processes of creation and expansion of institutions, courses and vacancies. Therefore, large business groups have emerged in the field of education, with growing financial capital working in all areas of training and, in some cases, even specializing in health education.

RESUMEN: El objetivo de este estudio fue analizar la historia de la legislación sobre educación superior en Brasil y sus contribuciones al proceso de privatización de la educación, así como describir los principales grupos empresariales en el ámbito de la educación superior en el país. Para ello, se realizó un estudio de carácter exploratorio con el análisis documental de la legislación y los documentos disponibles en línea, publicados entre 1961 y 2023. Desde la década de 1960, se han promulgado una serie de 29 actos normativos (leyes, proyectos de ley, decretos, ordenanzas y medidas provisorias) relativos a la educación. A lo largo de los años, los gobiernos brasileños han implementado medidas que han favorecido el proceso de privatización y el surgimiento de grandes conglomerados económicos de la educación. La intensa privatización de la enseñanza superior está estrechamente relacionada con los instrumentos normativos dictados por los diferentes gobiernos. La legislación ha moldeado el sistema educativo del país y ha permitido flexibilizar los procesos de creación y ampliación de instituciones, cursos y puestos. El resultado ha sido la aparición de grandes grupos empresariales en el campo de la educación, con un capital financiero creciente, que operan en todos los ámbitos de la formación y, en algunos casos, incluso se especializan en la educación sanitaria.

Use of Sealants in Permanent Molars by Brazilian Dentist: A Comparative Study of Public versus Private

Abstract Objective: To compare the use of sealants in permanent molars between public and private dentists in Brazil. Material and Methods: This was a cross-sectional and analytical web survey study. The convenience sample consisted of dentists in Brazil who answered a pre-tested online form released via social media between July and October 2021. Descriptive analysis was performed using absolute and relative frequencies (%) and associations using the Chi-square test (p<0.05). Results: Brazilian professionals participated in the study (n=2,244). Comparing the professionals from the public service with those from the private service, the former had a higher positive perception of the use of sealants as a preventive (92.4% vs. 81.1%, p<0.00l) and therapeutic procedure (90.7% vs. 82.4%, p=0.00l), higher percentage of non-invasive (91.7% vs. 83.8%, p<0.00l) and invasive (22.8% vs. 12.0%, p< 0.001) techniques. Professionals from the private service reported more frequently that they did not use sealants than those from the public service (14.0% vs. 4.8%, p<0.00l). Resin sealant (97.7% vs. 94.9%, p=0.0l5) and Flow resin (62.0% vs. 54.3%, p=0.013) were the most used by professionals in the private service. The use of glass ionomer cement was not associated with the type of service (75.1% vs. 77.2%, p=0.172), nor was the use of adhesives (0.6% vs. 1.4%, p=0.195) or resin with Giomer technology (1.9% vs. 2.2%, p=0.856) (p>0.05). Conclusion: The percentage of use of sealants among dentists in Brazil is high, especially among professionals in the public service, and the most used materials were resinous sealants and glass ionomer cement.

Clínicas Populares de Saúde a partir da perspectiva de empresários e de representantes da classe médica / Popular Health Clinics from the perspective of entrepreneurs and representatives of the medical profession

Resumo Este artigo pretende compreender a perspectiva de empresários de Clínicas Populares de Saúde (CPS) e representantes da classe médica sobre serviços ofertados pelo setor; impactos decorrentes da pandemia covid-19; e futuro do mercado de trabalho médico. Trata-se de pesquisa qualitativa, da área de saúde coletiva, com enfoque nas representações sociais. Foram realizadas entrevistas semiestruturadas, entre março e julho de 2021, com quatro empresários locais e três representantes de classe médica de uma cidade da região Nordeste do Brasil. As CPS ofertam serviços assistenciais restritos a consultas e exames e com estratégias de lógica financeirizada; se apresentam como "alternativa" ao SUS, uma suposta "lacuna" entre planos de saúde privados e serviços públicos, e como "novo" trabalho médico. As empresas ofertam consultas com especialistas a preços "populares" e sem fila de espera. A assistência prestada é restrita e os profissionais não têm garantia de direitos trabalhistas. Para os entrevistados, o acesso à saúde representa acessibilidade geográfica e temporal de serviço a preço reduzido. O direito universal à saúde e princípios do SUS são confrontados com a defesa da autonomia dos clientes e dos profissionais visando suas necessidades: saúde e trabalho.

Abstract The objective is to understand the perspective of entrepreneurs from Popular Health Clinics (PHC) and representatives of the medical profession on services offered by the sector; impacts resulting from the COVID-19 pandemic; and future of the medical job market. This is a qualitative research, in the area of collective health, focused on social representations. Semi-structured interviews were carried out, from March to July 2021, with four local entrepreneurs and three representatives of the medical profession from a municipality in the Northeast region of Brazil. PHC offer assistance services restricted to consultations and exams and with financialized logic strategies. The PHC are presented as an "alternative" to the SUS, a supposed "gap" between private health plans and public services, and as a "new" medical work. Companies offer consultations with specialists at "popular" prices and without a waiting list. The assistance provided is restricted and professionals have no guarantee of labor rights. For those interviewed, access to healthcare represents geographic and temporal accessibility of services at a reduced price. The universal right to health and SUS principles are confronted with the defense of the autonomy of clients and professionals targeting their needs: health and work.

Facilitating quality improvement by implementing quality accreditation standards at primary health care centre in Panvel taluka of Raigad district Maharashtra

Background: The Indian public health standard and Kayakalp guidelines are the main driver for continuous improvement in quality and bench mark for assessing the functional and cleanliness status of health facilities. Objectives were to assess PHC on IPHS and Kayakalp standard for continuous quality improvement. To conduct baseline and peer assessment of quality parameters using Indian public health standards and Kayakalp standard at primary health centre. To perform gap analysis and suggest quality improvement measures for meeting accreditation standards. To establish public private partnership for strengthening health services at PHC level. Methods: Descriptive observational study was conducted from September 2022 to June 2023 at Ajiwali PHC-Panvel taluka was selected using simple random sampling technique. Sample size of 83 patients was calculated as per the monthly case load of PHC. IPHS and Kayakalp assessment checklist, patient satisfaction forms were used for the survey. Various statistical tests like frequency, mean, percentage, S.E of difference between two proportions and two means were applied. Results: Kayakalp checklist baseline assessment score was 52.5% while post assessment score 72.5% showing significant improvement. Patient satisfaction survey pre and post assessment shows significant improvement where p value was <0.001 which was highly significant. IPHS survey shows partial improvement in training and quality parameters while other indicator remained the same. Conclusions: Regular quality assessment and accreditation leads to continuous quality improvement. Training and capacity building of PHC staff should be undertaken at regular intervals. Public private partnership modelling for various departments or service delivery components should be undertaken.

Como as professoras em escolas privadas vivenciaram o trabalho durante a pandemia? / How did female teachers in private schools experience their work during the pandemic?

A pandemia de COVID-19 teve consequências graves também para o mundo do trabalho. Exemplo disso, foi a pressão que as professoras de escolas privadas tiveram por rapidamente transporem as atividades de ensino para o modelo remoto. O objetivo desta pesquisa foi analisar como as professoras de escola privada vivenciaram o seu trabalho docente durante a pandemia de COVID-19. Partindo da Psicologia Histórico-Cultural, realizamos 12 entrevistas em profundidade com professoras de escolas privadas da cidade de Natal-RN, sendo esses dados analisados quanto aos seus núcleos de significação. Encontramos cinco núcleos de significação: significações sobre o trabalho de professora; dificuldades do dia a dia de trabalho; consequências da pandemia; agravamentos gerados pela pandemia; e enfrentamentos diante dos desafios. Concluímos que a pandemia operou como um catalizador de problemas que as professoras já enfrentavam, decorrente da exploração do trabalho, machismo e neoliberalismo. Diante desse cenário, consideramos que as formas de enfrentamento e resistência passem por estratégias coletivas e que visem a superação desses processos históricos de precarização do trabalho.

The pandemic COVID-19 had serious consequences for the world of work as well. One example of this was the pressure that private school teachers were under to quickly transition their teaching activities to the remote learning model. The aim of this research was to analyze how private school teachers experienced their teaching work during the pandemic COVID-19. Based on Cultural-Historical Psychology, we carried out 12 in-depth interviews with private school teachers from the city of Natal-RN, and these data were analyzed according to their Nuclei of Meaning. We found five nuclei of meaning: meanings about working as a teacher; difficulties in daily work; consequences of the pandemic; aggravations generated by the pandemic; and confrontations with the challenges. We concluded that the pandemic acted as a catalyst for problems that women teachers were already facing, resulting from labor exploitation, sexism, and neoliberalism. Facing this scenario, we believe that the forms of confrontation and resistance go through collective strategies aimed overcoming these historical processes of precarization of work.

Fatores associados ao estresse ocupacional entre cirurgiões-dentistas do setor privado no primeiro ano da pandemia de COVID-19 / Factors related to occupational stress among private sector dentists in the first year of the COVID-19 pandemic

Resumo O objetivo deste estudo transversal foi analisar os fatores associados ao estresse ocupacional entre cirurgiões-dentistas atuantes no setor privado no primeiro ano da pandemia de COVID-19 no Brasil. Incluiu 384 profissionais do estado do Paraná, cujos dados foram obtidos entre agosto e outubro de 2020 por meio de formulário online. Dois desfechos compuseram proxy de estresse ocupacional: (1) ansiedade e preocupação e (2) preparo e segurança para o trabalho durante a pandemia. As variáveis independentes foram agrupadas segundo modelo teórico explicativo em fatores individuais, organizacionais e extraorganizacionais. As associações foram testadas por regressão logística bi e multivariada. Apesar de preparados e seguros, os profissionais se sentiam ansiosos e preocupados para o atendimento clínico. Mulheres, mais jovens e que não receberam orientações sobre as medidas de segurança apresentaram maiores chances de relatar insegurança e despreparo. Profissionais mais jovens, que não participavam da tomada de decisões e que às vezes dispunham de auxiliar para o trabalho a quatro mãos, tiveram maiores chances de se sentirem ansiosos e preocupados. Além dos fatores individuais, fatores organizacionais do trabalho estão associados ao estresse ocupacional entre cirurgiões-dentistas no primeiro ano da pandemia.

Abstract This cross-sectional study examined factors associated with occupational stress among 384 dentists working in the private sector in the first year of the COVID-19 pandemic in Brazil. Data were collected from August to October 2020 through an online form. Two outcomes - (1) anxiety and worry and (2) preparation and safety for work during the pandemic - constituted a proxy for occupational stress. The independent variables were grouped according to the explanatory theoretical model into individual, organisational and extra-organisational factors. Associations were tested by bivariate and multivariate logistic regression. Although prepared and confident, dentists felt anxious and worried about providing clinical care. Women, younger respondents and those who received no guidance on safety measures were more likely to report insecurity and unpreparedness. Younger professionals, those who did not participate in decision-making and who only sometimes had an assistant for four-hand work, were more likely to feel anxious and worried. In addition to individual factors, work organisation factors were associated with occupational stress among dentists in the first year of the pandemic.

Impact of patient provider support agency on private sector engagement in Tuberculosis care in Eastern India

Background: India is the country with the world’s largest burden of tuberculosis, with a large proportion of patients seeking care from the private healthcare sector, which is fragmented and unregulated. There are significant gaps across the patient care cascade in the private sector on account of underreporting, diagnostic delays, irrational and non-standardized regimens, and catastrophic health expenditures to patients. Considering the gaps, Jharkhand state of India had implemented patient provider support agency scheme under National TB elimination programme to improve private sector engagement, operational since 27 September 2019. PPSA is giving end-to-end NTEP TB service packages to patients seeking care in the private sector. Methods: This is a retrospective cross-sectional descriptive study using secondary data attained from the Nikshay web portal for Jharkhand and analyzed using Excel. Results: After the introduction of PPSA, the proportion of private sector notifications in Jharkhand increased from 22.9 percent in 2019 to 33.5 percent in 2020. The Private sector notification rate in the state showed an increase from 34 per lakh population to 39 per lakh population. Conclusions: Private sector engagement through PPSA has improved TB notification in Jharkhand. PPSA could sustain the provision of TB care in the private sector even during the COVID-19 pandemic. The access to quality data on patients seeking TB care in the private sector in the Nikshay web portal has improved since the implementation of the scheme resulting in better patient support and program monitoring.

Estratégias de inovação em medicamentos e vacinas no âmbito do Ceis - modelos, mecanismos e expectativas / Innovation strategies in medicines and vaccines within the scope of CEIS - models, mechanisms, and expectations

RESUMO O artigo objetivou apresentar informações relevantes e originais sobre as estratégias de inovação utilizadas por Laboratórios Farmacêuticos Oficiais (LFO) para redução das vulnerabilidades do Sistema Único de Saúde (SUS) e capacitação produtiva e tecnológica do Complexo Econômico-Industrial da Saúde. Como métodos, foram utilizadas a revisão da literatura e a análise de dados primários oriundos de entrevistas realizadas em dois dos maiores LFO do País. Foram identificados e analisados os seus esforços e resultados em Pesquisa e Desenvolvimento (P&D) assim como a incorporação de tecnologias de medicamentos e vacinas, com destaque para as Parcerias para Desenvolvimento Produtivo (PDP). Conclui-se que, apesar de as atividades de P&D ainda precisarem avançar, benefícios foram trazidos pelos acordos de transferência de tecnologia, especialmente pelas PDP. No entanto, a capacidade industrial e tecnológica dos Institutos ainda é limitada e carente de investimentos, dificultando a acumulação e a difusão tecnológica. Dessa forma, melhorias são necessárias para que as estratégias de inovação para o SUS apresentem resultados mais efetivos e possam ser revertidos para o bem-estar da sociedade.

ABSTRACT The article aimed to present relevant and original information about the innovation strategies used by Official Pharmaceutical Laboratories (LFO) to reduce the vulnerabilities of the Brazilian Unified Health System (SUS) and the productive and technological capacity of the Health Economic-Industrial Complex. The methods used included a literature review and the analysis of primary data from interviews conducted in two of the largest LFOs in the country. Their efforts and results in Research and Development (R&D) and incorporation of medicines and vaccine technologies were identified and analyzed, with emphasis on Productive Development Partnerships (PDP). Although R&D activities still need to advance, benefits were brought about by technology transfer agreements, especially by PDPs. However, the industrial and technological capacity of the Institutes is still limited and lacks investments, which hinders technological accumulation and diffusion. Thus, improvements are necessary so that the innovation strategies for the SUS present more effective results and can be reversed to the welfare of society.

How can internal marketing practices help achieve organizational success? / ¿Cómo las prácticas de marketing interno pueden ayudar a lograr el éxito organizacional? / Como as práticas de marketing interno podem ajudar a alcançar o sucesso organizacional?

Abstract Internal marketing is a concept still little recognized and disseminated, with most of the research on this area of marketing focusing on the service sector and well-consolidated and industrialized markets. This article sheds light on the importance of internal marketing practices by identifying their impact on workers' proactive behavior and life satisfaction while observing the effects of affective commitment and job satisfaction. The study collected 428 valid questionnaires from Portuguese workers (218 in the private sector and 210 in the public sector) and applied structural equation modeling to test the hypotheses. The results showed how adopting an internal marketing perspective can contribute to successful organizational and human resource management. It was observed that internal marketing practices lead to affective commitment and job satisfaction in both the private and public sectors, although more pronounced in the private sector. Also, the findings pointed out that the workers' affective commitment leads to adopting proactive behavior and life satisfaction only in the public sector and that job satisfaction leads to proactive behavior and life satisfaction for workers of both the private and public sector. This study contributes to increasing understanding of internal marketing, its applicability, and its importance for workers and organizations. Additionally, comparing the private and public sectors helps understand and show how this practice matches the workers' expectations.

Resumen Este artículo tiene como objetivo arrojar luz sobre la importancia de las prácticas de marketing interno, identificando su impacto en el comportamiento proactivo y en la satisfacción con la vida de los trabajadores, a través de los efectos del compromiso afectivo y la satisfacción laboral. El marketing interno sigue siendo un concepto poco reconocido y difundido. Esta investigación compara estos efectos entre los trabajadores del sector público y privado para reforzar la importancia de dicho concepto. En total, se recogieron 428 cuestionarios válidos de trabajadores portugueses (218 del sector privado y 210 del sector público). Se utilizó el modelo de ecuaciones estructurales para testar las hipótesis de estudio. Esta investigación muestra cómo la adopción de una perspectiva de marketing interno puede contribuir a una gestión organizacional y gestión de personas exitosa. Los resultados mostraron que las prácticas de marketing interno generan compromiso afectivo y satisfacción laboral, tanto en el sector privado como en el público, aunque de forma más acentuada en el sector privado. También se constató que el compromiso afectivo conduce a la adopción de conductas proactivas y a la satisfacción con la vida de los trabajadores del sector público únicamente, y que la satisfacción laboral conduce a la adopción de esta conducta y a la satisfacción con la vida para ambos, sector público y privado. Este trabajo contribuye a una mejor comprensión del concepto de marketing interno y su aplicabilidad e importancia para los trabajadores y las organizaciones. Además, al comparar los sectores público y privado, ayuda a comprender y mostrar cómo esta práctica coincide con las expectativas de los trabajadores de estos dos sectores.

Resumo Este estudo pretende evidenciar a importância das práticas de marketing interno, identificando o seu impacto no comportamento proativo e na satisfação com a vida dos trabalhadores, através dos efeitos do compromisso afetivo e da satisfação no trabalho. O marketing interno continua a ser um conceito com pouco reconhecimento e divulgação, uma vez que a maioria das pesquisas relacionadas com esse campo de marketing é direcionada para o setor de serviços e concentra-se predominantemente em mercados bem estabelecidos e industrializados. Esta pesquisa compara esses efeitos entre trabalhadores do setor privado e público para reforçar a importância deste conceito, sendo que, no total, foram recolhidos 428 questionários válidos junto de trabalhadores portugueses (218 no setor privado e 210 no setor público). O modelo de equações estruturais foi utilizado para testar as hipóteses de investigação. Esta pesquisa mostra como a adoção do marketing interno pode contribuir para o sucesso da gestão organizacional e da gestão de pessoas. Os resultados mostraram que as práticas de marketing interno levam ao comprometimento afetivo e à satisfação no trabalho, tanto no setor privado como no público, embora mais pronunciadas no setor privado. Constatou-se também que o comprometimento afetivo leva à adoção de comportamentos proativos e leva à satisfação com a vida dos trabalhadores, mas apenas do setor público, e que a satisfação no trabalho leva à adoção desse comportamento e à satisfação com a vida para ambos, setor privado e público. Este trabalho contribui para uma melhor compreensão do conceito de marketing interno, da sua aplicabilidade e importância, quer para os trabalhadores, como para as organizações. Além disso, ao comparar os setores privado e público, ajuda a entender e mostrar como essa prática atende às expectativas dos trabalhadores desses dois setores.

Perceptions of Private Practitioners Regarding Revised National Tuberculosis Control Program- A Cross-sectional Study in Sonepat, Haryana

Background: A substantial proportion of tuberculosis patients either take treatment from private care providers or first-time visit private hospitals to diagnose tuberculosis. Hence the role of private providers is too essential to ignore to realize the ambition of tuberculosis elimination in India. Aim and Objectives: To understand the perception of private practitioners of Sonepat district of Haryana state regarding. Setting and Design: A cross-sectional study was done among the private practitioners of the Sonepat district of Haryana Methods and Material: 78 randomly selected practitioners from the list provided by the district health authority were interviewed using a pretested semi-structured questionnaire. The ethics committee of the study institute approved the study. Statistical analysis used: Descriptive analysis in terms of proportion and percentages was conducted. Results: One-third of the study participants were in the age group of 30-40 years. Half of the practitioners were reportedly practicing medicine for less than twenty years. A significant proportion agreed that the government could not single-handedly eliminate tuberculosis without collaborating with private providers. Mostly agreed on the effectiveness of Tuberculosis regimens under the program; however, over-relying on the sputum examination was perceived as a negative component of the program. Conclusions: Private providers understand their pivotal role in tuberculosis-related programs. However, their full participation has not been realized in the program.

ROLE OF MARKETING MIX IN THE EFFICACY OF BANKS AFTER EMERGENCE OF COVID-19: AN EMPIRICAL STUDY OF PUBLIC AND PRIVATE BANKS OPERATING IN UDAIPUR

Purpose – The study aims to identify role of marketing mix with regard to Public and Private sector Banks of Udaipur after the emergence of COVID-19. A total of 200 respondents from the city of Udaipur Design/methodology/approach – provided the primary data. Structured questionnaires were used by the researcher. Initially, 230 participants were polled, but only 200 of them offered insightful responses, and the other 30 were unresponsive, incomplete responses that were removed for research purposes. The Findings – results revealed that there are differences among the respondents on building up of marketing mix in private and public sector banks in Udaipur city. The degree of change can be seen more in Private banks than in Public ones. Research limitations/implications – With a small sample size and a constrained sample area, data from the public and private sector banks were collected; a larger sample size and expanded sample area would have produced more accurate results. Practical implications – The study offers information aboutmarketing mix creation, emergence of COVID-19, its combination and effect on respondents, which on itself is a crucial subject. The write-up is based on the Originality/value – researcher's personal opinion and the findings from the data collection, which was done on a primary basis.