A evolução da legislação da saúde em Portugal e os novos desafios para a gestão a partir de 2024 / The evolution of the Portuguese health legislation and the new challenges for management from 2024 onwards / La evolución de la legislación de la salud en Portugal y los nuevos desafíos para la gestión a partir de 2024

Resumo Nos últimos 40 anos, o Serviço Nacional de Saúde (SNS) gerou ganhos que colocaram Portugal num lugar cimeiro no que se refere à qualidade de vida de milhões de cidadãos e reduziu muitas das desigualdades na sociedade portuguesa. Revisitar a criação do Serviço Nacional de Saúde Português e todas as profundas alterações legislativas introduzidas após a publicação da nova Lei de Bases da Saúde, a definição dos eixos estratégicos da política de recursos humanos do SNS e a criação dos respetivos mecanismos de operacionalização, a aprovação do novo Estatuto do SNS e a aprovação da Orgânica e dos Estatutos da Direção Executiva do SNS e a criação, com natureza de entidades públicas empresariais, das Unidades Locais de Saúde. Estas alterações legislativas poderão ser um passo fundamental para o reforço da construção de um SNS mais justo e inclusivo, que responda melhor às necessidades da população mediante as necessárias reformas estruturais.

Abstract In the last 40 years, the National Health Service (SNS) has generated health gains that have placed Portugal at the top regarding quality of life for millions of citizens and reduced many of the inequalities in Portuguese society. We revisit the establishment of the Portuguese National Health Service and all the profound legislative changes introduced after the publication of the new Health Basic Law, the definition of the strategic axes of the SNS human resources policy and the establishment of the respective operationalization mechanisms, the approval of the new SNS Statute and the approval of the Organic and Statutes of the Executive Board of the SNS and the creation of Local Health Units (ULS) as public business entities. These legislative changes could be a fundamental step towards strengthening the construction of a fairer and more inclusive SNS, which better responds to the population's needs through the necessary structural reforms.

Resumen En los últimos 40 años, el Servicio Nacional de Salud (SNS) ha generado beneficios en salud que han posicionado a Portugal en un lugar destacado en cuanto a la calidad de vida de millones de ciudadanos y ha reducido muchas de las desigualdades en la sociedad portuguesa. Revisitar la creación del Servicio Nacional de Salud Portugués y todos los profundos cambios legislativos introducidos tras la publicación de la nueva Ley de Bases de la Salud, la definición de los ejes estratégicos de la política de recursos humanos del SNS y la creación de los respectivos mecanismos de operacionalización, la aprobación del nuevo Estatuto del SNS y la aprobación de la Orgánica y de los Estatutos de la Dirección Ejecutiva del SNS y la creación, con naturaleza de entidades públicas empresariales, de las Unidades Locales de Salud. Estos cambios legislativos podrán ser un paso fundamental para el fortalecimiento de la construcción de un SNS más justo e inclusivo, que responda mejor a las necesidades de la población mediante las necesarias reformas estructurales.

Stigma kills

@#Stigma due to an HIV diagnosis is a well-known phenomenon and is a major barrier to accessing care.1 Over the last forty years, HIV has been transformed from a fatal disease to a manageable one, thanks to the remarkable success of antiretroviral (ARV) medication.2 When people living with HIV (PLHIV) start ARV treatment early, their life expectancy is almost completely restored. Moreover, a suppressed viral load means that PLHIV are no longer able to infect other people.3 They can have children naturally without risk to their seronegative partner or their child. PLHIV nowadays are more likely to die with HIV, not of HIV. While a cure remains elusive, the successful global rollout of ARVs means that there is no good reason for a PLHIV to die of AIDS and its complications due to lack of access to proper treatment. The Philippine AIDS Law Republic Act 8504 and its successor, Republic Act 11116 explicitly states that the State should “ensure access to HIV and AIDS-related services by eliminating the climate of stigma and discrimination that surrounds the country’s HIV and AIDS situation, and the people directly and indirectly affected by it.” Unfortunately, despite this admonition, stigma remains a significant cause of delayed HIV testing and of not seeking treatment in our country. In this issue of the journal, Dr. De Los Santos and her colleagues examine the effect of healthcare facility stigma on PLHIV accessing care in the Philippines.4 They report that 81% of their Filipino PLHIV respondents experienced stigma, which is an unacceptably high number. They identify which facilities are more likely to be correlated with stigma and make suggestions on how to address this problem. This study is very timely and comes at a time when the Department of Health is shifting first line antiretrovirals to dolutegravir-based regimens.5 Dolutegravir-based treatment is associated with fewer side effects than efavirenz-based regimens and is much more durable against resistance.6 With an HIV transmitted-drug resistance rate of 11.7%, it is imperative that PLHIV are started on more durable regimens which they are less likely to discontinue.7 Properly addressing stigma means that more people will access care. Better regimens will ensure that people stay in care. This will go a long way towards minimizing the impact of HIV and AIDS on Filipino PLHIV. Stigma among PLHIV is a complicated subject matter. Aside from the stigma associated with diagnosis, there is also stigma associated with the mode of acquisition of the disease. The most-at-risk populations are highly stigmatized. Men who have sex with men, people who inject drugs, and female sex workers experience additional stigma on top of the stigma from an HIV diagnosis.8 Aside from societal stigma, PLHIV are also prone to self-stigma.9 This phenomenon occurs when PLHIV believe they no longer deserve to live since they contracted the disease from deviant or sinful behavior. High rates of depression are found among these self-stigma sufferers. This significantly impacts the entire HIV healthcare cascade, starting from early diagnosis, to accessing treatment, and staying in care. The finding that Public Rural Health Units are the most stigmatizing healthcare facilities is very concerning since these are usually the only facilities available to PLHIV in far-flung areas. This needs to be addressed with better sensitivity training as well as concrete guidelines on avoiding stigma. It is very troubling that facilities that are supposed to cater to vulnerable populations inadvertently make it difficult for them to access care.10 Unfortunately, even facilities in urban areas are not immune to discrimination and stigmatizing behavior. I recall the experience of one of my early PLHIV patients who developed and eventually succumbed to a disseminated fungal infection.11 He told me that he had tried getting tested several years earlier but he had a traumatic experience in the government health facility that he accessed. He made a wrong turn and entered a different clinic in that hospital and when he asked for an HIV test, people recoiled from him in horror. Because of that terrible experience, he put off getting his HIV test for years until he started developing the fungal infection that eventually killed him. Had he been started on proper treatment earlier, he could have been saved. For me, it wasn’t just the fungus that killed him but it was the delay in diagnosis and care as a direct result of stigma. Addressing HIV-related stigma in our country entails a whole-of-society and a whole-of-nation approach. Mental health services to address self-stigma and depression should be standard of care not just among confirmed PLHIV but among the most-at-risk populations. Proactive education of all members of society, especially healthcare workers in facilities that diagnose and care for PLHIV is essential for ensuring sustained linkage to care. Ensuring that the majority of the PLHIV population are properly diagnosed, enrolled in treatment hubs, and have suppressed viral loads will ultimately lead to fewer transmissions and less AIDS-related deaths.

Perfil dos atendimentos do serviço de atendimento móvel de urgência no município de Gurupi, Tocantins / Profile of mobile emergency service services in the municipality of Gurupi, Tocantins / Perfil de los servicios de urgencia móvil en el municipio de Gurupi, Tocantinas

O estudo objetivou descrever o perfil dos atendimentos realizados pelo SAMU-192 do município de Gurupi-TO. Estudo documental, epidemiológico, exploratório, transversal, retrospectivo e descritivo, com abordagem quantitativa. A amostra estratificada foi de 881 boletins de atendimentos do SAMU-192, referente ao período de janeiro a junho de 2022. A análise foi feita através do programa Microsoft Excel. Os usuários atendidos foram constituídos pelo sexo masculino (54,48%) com média de idade de 45,7 anos e idosos (31,1%). A maior parte das ocorrências foi de natureza clínica (61,6%) e traumática (24,1%). Quanto aos bairros que mais solicitaram o SAMU-192 foram o centro e o São José. A maioria dos atendimentos foi realizado pela Unidade de Suporte Básico (84%) e nos turnos da manhã (31,7%) e noite (26,1%). Tiveram como principal desfecho o atendimento no local e remoção dos usuários para um serviço de saúde (88%), sendo a UPA (67,5%) o principal destino. Destacam-se a descompensação de doenças crônicas, principalmente HAS e DM, como razão de demandas sucessivas que utilizam o SAMU-192. Caso essas enfermidades não sejam controladas na Atenção Primária em Saúde (APS) poderão acarretar complicações e incapacidades, demandando cada vez mais os serviços do SAMU.

The study aimed to describe the profile of the care provided by SAMU- 192 of the municipality of Gurupi-TO. Documentary, epidemiological, exploratory, cross-sectional, retrospective and descriptive study with quantitative approach. The stratified sample was 881 bulletins of the SAMU-192, referring to the period from January to June 2022. The analysis was done through the Microsoft Excel program. The users attended were male (54.48%) with average age of 45.7 years and elderly (31.1%). The majority of the occurrences were of a clinical nature (61.6%) and traumatic (24.1%). As for the neighborhoods that most requested the SAMU-192 were the center and the São José. The majority of services were provided by the Basic Support Unit (84%) and in the morning (31.7%) and evening (26.1%) shifts. The main outcome was on-site care and removal of users to a health service (88%), with the UPA (67.5%) being the main destination. Among the highlights are the decompensation of chronic diseases, mainly HAS and DM, as a reason for successive demands that use SAMU-192. If these diseases are not controlled in Primary Health Care (PHC), they may lead to complications and disabilities, increasingly requiring the services of SAMU.

El estudio tenía por objeto describir el perfil de las visitas realizadas por SAMU-192 en el municipio de Gurupi-TO. Estudio documental, epidemiológico, exploratorio, transverso, retrospectivo y descriptivo con enfoque cuantitativo. La muestra estratificada fue de 881 boletines de servicio del SAMU-192, referidos al período comprendido entre enero y junio de 2022. El análisis se realizó a través del programa Microsoft Excel. Los usuarios atendidos fueron varones (54,48%) con una edad media de 45,7 años y ancianos (31,1%). La mayoría de los casos fueron de naturaleza clínica (61,6%) y traumática (24,1%). En cuanto a los distritos que más solicitaron SAMU-192, estaban en el centro y en São José. La mayoría de las visitas se realizaron por la Dependencia de Apoyo Básico (84%) y por turnos de mañana (31,7%) y de tarde (26,1%). El principal resultado fue la atención in situ y la eliminación de usuarios para un servicio de salud (88%), siendo la UPA (67,5%) el destino principal. La clara compensación por las enfermedades crónicas, principalmente las abejas y el DM, se destaca como razón de las sucesivas demandas que utilizan el SAMU-192. Si estas enfermedades no están controladas en la Atención Primaria de Salud (APS), pueden llevar a complicaciones y discapacidades, exigiendo cada vez más los servicios de SAMU.

Projeto de ação integrativa serviço-academia para testagem para IST/HIV em unidades móveis em Niterói, Rio de Janeiro / Service-academy integrative action project for STI/HIV testing in mobile units in Niterói, Rio de Janeiro

RESUMO O conhecimento precoce da sorologia do HIV/IST favorece a adoção de medidas preventivas. Estruturas móveis de atendimento conseguem ampliar as testagens, principalmente em populações de difícil acesso. Neste artigo, apresentamos informações básicas coletadas em uma ação de testagem móvel para HIV, sífilis e hepatites virais realizada entre 02/2016 e 06/2017 em Niterói, Rio de Janeiro, descrevemos alguns desafios da implementação e discutimos a importância da interdisciplinaridade no enfrentamento das IST/HIV. A soroprevalência do HIV foi de 1,6%, variando com o mês e a localização da unidade móvel. A maior parte da população atendida era de homens (2.323/58,4%), de raça negra (2.375/60,1%) e com faixa etária entre 20-29 anos (1.706/42,9%). A prevalência total de sífilis foi de 12,8% (20,5% no Jardim São João). Cerca de 21% dos/as usuários/as já haviam testado para o HIV antes e quase 40% referia uma exposição para a testagem atual (97,5% sexual). IST prévia era referida por 9,6% das pessoas atendidas. Nossos dados parecem indicar que a ação atingiu uma população com maior risco para adquirir o HIV. A relação de horizontalidade entre as três esferas de governo que pautou a experiência permitiu a valorização dos diferentes saberes, ampliando as perspectivas para identificar e propor soluções.

ABSTRACT Early knowledge of HIV/STI serology favors the adoption of preventive measures. Mobile service structures are able to expand testing, especially in hard-to-reach populations. In this article, we present basic information collected in a mobile testing action for HIV, syphilis and viral hepatitis carried out between 02/2016 and 06/2017 in Niterói, Rio de Janeiro, we describe some implementation challenges and discuss the importance of interdisciplinarity in facing the challenges of STI/HIV. HIV seroprevalence was 1.6%, varying with the month and location of the mobile unit. Most of the included population was male (2,323/58.4%), black (2,375/60.1%) and aged between 20-29 years (1,706/42.9%). The total prevalence of syphilis was 12.8% (20.5% in Jardim São João). About 21% of users had tested for HIV before and almost 40% reported a current exposure for testing (97.5% sexual). Previous STI was reported by 9.6% of the people assisted. Our data seem to indicate that the action reached a population most at risk of acquiring HIV. The horizontal relationship between the three spheres of government that guided the experience allowed the appreciation of different knowledge, expanding perspectives to identify and propose solutions.

Reasons for no-show to referrals at a university eye clinic after eye examination via a mobile ophthalmic unit in a Brazilian region / Razão de não comparecimento à clínica oftalmológica da universidade após triagem em uma unidade móvel oftalmológica em uma região brasileira

ABSTRACT Purpose: This study aimed to identify patient's reason for no-show at a university eye clinic after ophthalmic examination via a mobile ophthalmic unit, which provides comprehensive ophthalmic care to underserved communities in a region of Brazil. Methods: In 2017/2018, this prospective observational study searched for no-shows at referrals to a university eye clinic after an outreach program screening via a mobile ophthalmic unit in 10 municipalities in the central-western region of São Paulo, Brazil. A total of 1,928 patients underwent a comprehensive eye examination at no cost, and 37.1% of them needed referral to a university eye clinic for specialized examinations or surgeries. We used the following two main tools: (1) comparative analysis between patients who attended the referral and those who did not; (2) active search using a questionnaire to assess reasons for no-show. Results: Attendance to referrals was not influenced by age, gender, distance from the university hospital, number of ophthalmologists in the municipality, average family income, and visual acuity. The main cause for referrals was cataract (350 cases). No-show was most common among glaucoma/suspected glaucoma (54.1%) cases, followed by strabismus (45%) and anterior segment disease (33.6%) cases. Many patients who did not attend the referral sought another service. Conclusion: Patient's issues and lack of knowledge regarding their ophthalmic condition are the main reasons for no-show at referrals for free ophthalmic care. Thus, educational campaigns are needed to achieve consistently high attendance to prevent avoidable blindness.

RESUMO Objetivo: Avaliar as razões para não comparecimento à clínica oftalmológica da universidade após triagem oftalmológica realizada usando uma unidade móvel oftalmológica que fornece exame oftalmológico para comunidades não assistidas em uma região do Brasil. Métodos: Foi realizado um estudo observacional prospectivo no ano de 2017/2018 para avaliar as razões que fizeram com que os indivíduos triados usando uma unidade móvel oftalmológica e referenciados para a clínica oftalmológica da universidade não comparecessem à consulta agendada. A triagem foi feita em 10 municípios da região centro-oeste do estado de São Paulo, Brasil. Todos os 1.928 participantes fizeram o exame oftalmológico sem custo e 37,1% deles necessitaram de encaminhamento para a clínica oftalmológica da universidade para exames especializados ou cirurgias. O estudo usou duas ferramentas: (1) análise comparativa entre os dados dos indivíduos encaminhados que compareceram ao agendamento com os que não compareceram; (2) busca ativa dos indivíduos que não compareceram à consulta agendada, aplicando-se um questionário para avaliar os motivos para o não comparecimento. Resultados: Fatores como idade, sexo, distância entre a cidade de origem e o hospital universitário, número de oftalmologistas na cidade de procedência, renda familiar média e acuidade visual não influenciaram no comparecimento ao encaminhamento. Catarata foi a maior causa para o encaminhamento (350 casos). O não comparecimento foi maior nos portadores de glaucoma/glaucoma suspeitos (54,1%), estrabismo (45%) e afecções do segmento anterior (33,6%). Muitos indivíduos que não compareceram ao serviço de referência procuraram por outro local para o atendimento oftalmológico. Conclusão: O não comparecimento para tratamento oftalmológico sem custo depende de fatores relacionados ao paciente ou à falta de conhecimento das próprias condições oftalmológicas. Campanhas educativas nas comunidades assistidas devem ser feitas para alcançar maior comparecimento às consultas e melhor prevenir a cegueira evitável.

Perfil dos acidentes de trânsito atendidos por Serviço de Atendimento Móvel de Urgência / Profile of traffic accidents served by the mobile emergency care service / Perfil de accidentes de tráfico atendidos por el servicio móvil de emergencias

Objetivo: descrever o perfil dos acidentes de trânsito e das vítimas assistidas pelo Serviço de Atendimento Móvel de Urgência. Método: estudo epidemiológico descritivo. A coleta dos dados foi realizada em 633 fichas de atendimento do Serviço de Atendimento Móvel de Urgência de uma cidade do interior do Brasil. Os dados foram transferidos para o programa estatístico Statistical Package for Social Sciences e realizada uma análise descritiva dos dados. Resultados: 74% das vítimas foram do sexo masculino, com idade mais prevalente de 20 a 29 anos (37%). As motocicletas estiveram mais envolvidas nos acidentes e ocorreram em maior parte nos dias de finais de semana. Todos os óbitos registrados por esse serviço envolviam motos. Conclusão: os dados apresentados neste estudo são semelhantes com as características do perfil de acidentes de trânsito encontradas em outras pesquisas realizadas no país, principalmente em relação a motociclistas. (AU)

Objective: To describe the profile of traffic accidents and victims assisted by the Mobile Emergency Care Service. Methods: Descriptive epidemiological study. Data collection was carried out on 633 medical charts of the Mobile Emergency Care Service in a city in the Brazilian countryside. The data were transferred to the statistical program Statistical Package for Social Sciences, and then a descriptive analysis was performed. Results: A total of 74% of the victims were male, with the most prevalent age between 20 and 29 years old (37%). Motorcycles were more involved in accidents, which occurred mostly on weekends. All deaths recorded by this service involved motorcycles. Conclusion: It is concluded that the data presented in this study are similar to the characteristics of the profile of traffic accidents found in other surveys conducted in the country, mainly in relation to motorcyclists. (AU)

Objetivo: Describir el perfil de accidentes de tráfico y víctimas atendidas por el Servicio Móvil de Emergencias. Método: Estudio epidemiológico descriptivo. La recolección de datos se realizó sobre 633 expedientes de atención del Servicio Móvil de Emergencia en una ciudad del interior de Brasil. Los datos fueron transferidos al programa estadístico Statistical Package for Social Sciences y se realizó un análisis descriptivo de los datos. Resultados: El 74% de las víctimas eran hombres, siendo la edad más prevalente entre 20 y 29 años (37%). Las motocicletas estuvieron más involucradas en accidentes y ocurrieron principalmente los fines de semana. Todas las muertes registradas por este servicio involucraron motocicletas. Conclusión: Se concluye que los datos presentados en este estudio son similares a las características del perfil de accidentes de tránsito encontrados en otras encuestas realizadas en el país, principalmente en relación a motociclistas. (AU)

Impact of a mobile unit on access to eye care in São Paulo, Brazil / Impacto do uso de unidade móvel no acesso à saúde ocular em São Paulo, Brasil

ABSTRACT Purpose: The goal of this study was to determine the impact of a mobile eye health unit on access to eye care and to generate a profile of the population requiring ophthalmic care by age, nature of their ophthalmic diseases, and optimal management. Methods: The study was conducted in 14 cities in the southwest region of São Paulo, Brazil. Subjects included individuals who participate in the Brazilian Unified Health System who were in need of eye care. There were no restrictions on age, gender or socioeconomic status. Data was transferred to an Excel table for statistical analyses. Results: We evaluated 6,878 participants in this survey with mean age of 44 years (range 4 months to 96 years); 65.5% were female. Among the diagnoses, 78.6% presented with refractive errors, 9.6% presented with cataracts and 8.3% presented with pterygium. New corrective lenses were prescribed for 60.9% of the participants; 10% retained their existing lenses, ~28% required counseling only and18.1% of the participants were referred to a tertiary facility for specialized exams and/or surgical procedures. Of the participants who required outside referrals, 36.4% required oculoplastic/external eye surgery and 31.8% required cataract surgery. Conclusion: The vast majority of patients presenting to a mobile eye health unit required prescriptions for corrective lenses. The rate of detection of ocular disorders was relatively high and the mobile unit provided effective treatment of refractive errors and referrals for specialized ophthalmic examinations and procedures. A mobile eye health unit can be an effective alternative method for improving access to basic eye care, for promoting eye health education and preventing blindness.

RESUMO Objetivo: Determinar o impacto do uso de unidade móvel no acesso à saúde ocular e avaliar o perfil da população que necessita de cuidados oftalmológicos, as doenças oculares mais frequentes e o tratamento. Métodos: Estudo transversal realizado em 14 municípios da região sudoeste do Estado de São Paulo utilizando uma unidade móvel oftalmológica. Os participantes eram usuários do Sistema Único de Saúde que procuraram atendimento oftalmológico, sem restrição quanto a idade, gênero ou condição socioeconômica. Os dados foram transferidos para a tabela Excel para análise estatística. Resultados: Participaram do estudo 6.878 pessoas, com média de idade de 44 anos (variação de 4 meses a 96 anos) e 65,5% eram mulheres. Erros refrativos estavam presentes em 78,6% dos participantes, catarata em 9,6% e pterígio em 8,3%. Para 60% foram prescritos óculos, para 10% foi mantida a correção óptica em uso e para 28% foram necessárias apenas orientações. Exames especializados ou procedimentos cirúrgicos foram indicados para 18,1% dos casos que foram encaminhados para tratamento em serviço terciário. Dentre os pacientes referenciados, 36,4% necessitavam de cirurgia oculoplástica ou para tratar afecções externas do olho e 31,8%, de cirurgia de catarata. Conclusão: A grande maioria dos pacientes que procurou atendimento na unidade móvel necessitava de prescrição de óculos. A unidade móvel oftalmológica possui alto grau de resolutividade para os problemas oculares, com oportunidade de tratar os erros refrativos e referenciar os pacientes que necessitam de atendimento espe­cializado, geralmente relacionado a condições cirúrgicas. Unidades móveis podem ser uma alternativa aos cuidados oftalmológicos básicos, melhorando o acesso, atuando na promoção da saúde ocular e prevenindo a cegueira.

Estrategia de superación para la utilización de proxmox y pfSense en las instituciones de salud / Training Strategy for the Use of Proxmox and PfSense in Health Institutions

Proxmox Virtual Environment es un entorno de virtualización de código abierto para servidores, mientras que pfSense es un potente cortafuego, enrutador, que permite brindar seguridad a la información, aplicar reglas e instalar servicios de red. En la provincia existen insuficiencias en la implementación de estos sistemas por parte de los administradores de red e informáticos. Además, no se explotan herramientas de software libre en servidores. En consecuencia, esta investigación tiene como objetivo diseñar una estrategia de superación para la adquisición de conocimientos teórico-prácticos sobre Proxmox y pfSense, que permita la estandarización de los servidores y servicios en las unidades de salud del territorio en función del acceso a internet por parte de los profesionales. Se realizó un estudio exploratorio en 43 informáticos y administradores de redes, para lo cual se utilizaron métodos teóricos, empíricos y estadísticos que permitieron detectar las problemáticas existentes en el territorio. La valoración aportada por los participantes sobre el taller parte de la estrategia reflejó que 98,0 por ciento lo consideraron excelente. El 93,0 por ciento expresa haber adquirido conocimientos teórico-prácticos sobre Proxmox y pfSense. La estrategia de superación permitió la implementación de los sistemas Proxmox y pfSense en las unidades de salud del territorio y a su vez creo una comunidad de especialistas en estos sistemas(AU)

Proxmox Virtual Environment is an open source virtualization environment for servers, whereas pfSense is a powerful router firewall which provides security information, it has a web interface for its configuration, it apply rules and installs network services such as DNS, DHCP, Squid, among others. The aim was to design a training strategy for acquiring theoretical skills and practice on proxmox and pfSense, installation and configuration that allows the standardization of servers and services in health units of the territory based on the internet access of professionals. In the exploratory study with 43 network administrators and computer specialists, theoretical, empirical and statistical methods were used. The implemented strategy allowed to develop a provincial workshop with topics related with computer networks with favorable results. Strategy allowed the implementation of the Proxmox and pfSense systems in the health units of the territory(AU)

Síndrome de burnout entre profissionais de um serviço de atendimento móvel de urgência do paraná / Síndrome de burnout entre profesionales de un servicio de atendimiento móvil de urgencia de paraná / Burnout syndrome in professionals of a mobile emergency service in the state of paraná

RESUMO Objetivo: identificar o risco para o desenvolvimento da Síndrome de Burnout em profissionais do Serviço de Atendimento Móvel de Urgência (SAMU). Metodologia: estudo transversal, não probabilístico, realizado entre agosto e outubro de 2017 com 101 profissionais atuantes em um SAMU do Paraná, utilizando questionário autoaplicável - Maslach Burnout Inventory. A análise de dados envolveu os testes de associação Qui-quadrado, Wilcoxon e Mann-Whitney. Resultados: observa-se que o risco para desenvolvimento e manifestação da síndrome de Burnout foi identificado em 52 profissionais (51,9%) e foi mais frequente entre médicos e teleatendentes, indivíduos do sexo feminino, com mais de 40 anos, sem companheiro, sem filhos, que tinham outro vínculo empregatício e renda superior a 10 salários mínimos. Porém, só os que trabalhavam durante o dia apresentaram risco significativamente maior (p=0,0075). Conclusão: as características do processo de trabalho no SAMU geram sobrecarga aos profissionais, sendo importante a implementação de estratégias que possam minimizar os efeitos estressores desta atuação.

RESUMEN Objetivo: identificar el riesgo para el desarrollo del Síndrome de Burnout en profesionales del Servicio de Atendimiento Móvil de Urgencia (SAMU). Metodología: estudio trasversal, no probabilístico, que se realizó entre agosto y octubre de 2017 con 101 profesionales que actúan en un SAMU de Paraná, utilizando cuestionario auto aplicable - Maslach Burnout Inventory. El análisis de datos abarcó las pruebas de asociación Chi cuadrado, Wilcoxony Mann-Whitney. Resultados: se identificó riesgo para desarrollo y manifestación del síndrome de Burnout en 52 profesionales (51,9%), siendo éste más frecuente entre médicos y profesionales que operan el teléfono, individuos del sexo femenino, con más de 40 años, sin pareja, sin hijos, que tenían otro vínculo laboral y renta superior a 10 sueldos mínimos. Sin embargo, solamente aquellas personas que trabajaban durante el día presentaron riesgo significativamente mayor (p=0,0075). Conclusión: las características del proceso de trabajo en SAMU generan sobrecarga a los profesionales, siendo importante la implementación de estrategias que puedan minimizar los efectos estresores de esta actuación.

ABSTRACT Objective: To identify the risk for the development of Burnout Syndrome in professionals of the Mobile Emergency Care Service (SAMU). Methodology: Cross-sectional non-probabilistic study conducted between August and October 2017 with 101 professionals of a Mobile Emergency Care Service (SAMU) of the State of Paraná, through the self-administered questionnaire - Maslach Burnout Inventory. Data analysis was performed using Chi-square, Wilcoxon and Mann-Whitney association tests. Results: The risk for the development and manifestation of Burnout syndrome was identified in 52 professionals (51.9%) and was more frequent among physicians and telephone operators, females over 40 years old, without partners, without children, who had another employment and income of more than 10 minimum wages. However, only those who worked in the day shift were at a significantly higher risk for the syndrome (p = 0.0075). Conclusion: The daily process of work at the SAMU mobile emergency generates overload of work to health professionals. Therefore, strategies aimed to minimize the stressful effects of their work activities should be implemented.

Mobile health technology for gestational care: evaluation of the GestAção's app / Uso de tecnología móvil para el cuidado gestacional: evaluación de la aplicación GestAção / Uso de tecnologia móvel para o cuidado gestacional: avaliação do aplicativo GestAção

ABSTRACT Objective: to evaluate the GestAção application, based on the experience of pregnant women use. Method: an evaluative, applied, methodological, quantitative-qualitative study. This tool was evaluated by 13 pregnant women through questionnaires for sociodemographic profile characterization and Likert scale use to calculate Content Validity Index (CVI); and semi-structured interview, with analysis based on Semiotics. Results: the study evidenced a significant level of satisfaction of pregnant women with the application use, considering the objectives (CVI = 0.92), structure and presentation (CVI = 0.86), and relevance (CVI = 0.92). Final considerations: the GestAção application obtained an overall CVI of 0.90, evidencing it as a facilitating and supporting technology in the empowerment of pregnant women interested in obtaining knowledge about pregnancy. It has been proved to be a powerful tool to qualify good practices in nursing consultation.

RESUMEN Objetivo: evaluar la aplicación GestAção basada en la experiencia de uso de las gestantes. Método: estudio de naturaleza evaluativa, aplicada, metodológica, con abordaje cuantitativo. La herramienta tecnológica fue evaluada por 13 gestantes por medio de cuestionarios para la caracterización del perfil sociodemográfico y el uso de la escala de Likert, para calcular el Índice de Validez de Contenido (IVC) de la aplicación; y entrevista semiestructurada, con análisis fundamentado en la Semiótica. Resultados: el estudio evidenció un significativo nivel de satisfacción de las gestantes con el uso de la aplicación, considerando los objetivos (IVC = 0,92), estructura y presentación (IVC = 0,86), y relevancia (IVC = 0,92). Consideraciones finales: la aplicación GestAção obtuvo IVC general de 0,90, evidenciándolo como tecnología facilitadora y coadyuvante en el empoderamiento de las gestantes interesadas en obtener conocimientos sobre el período gravídico. Se mostró una potente herramienta para calificar las buenas prácticas en la consulta de enfermería.

RESUMO Objetivo: avaliar o aplicativo GestAção, com base na experiência de uso das gestantes. Método: estudo de natureza avaliativa, aplicada, metodológica, com abordagem quanti-qualitativa. A ferramenta tecnológica foi avaliada por 13 gestantes por meio de questionários para a caracterização do perfil sociodemográfico e o uso da escala de Likert, para calcular o Índice de Validade de Conteúdo (IVC) do aplicativo; e entrevista semiestruturada, com análise fundamentada na Semiótica. Resultados: o estudo evidenciou significativo nível de satisfação das gestantes com o uso do aplicativo, considerando os objetivos (IVC= 0,92), estrutura e apresentação (IVC= 0,86), e relevância (IVC= 0,92). Considerações finais: o aplicativo GestAção obteve IVC geral de 0,90, evidenciando-o como tecnologia facilitadora e coadjuvante no empoderamento das gestantes interessadas em obter conhecimentos sobre o período gravídico, mostrando-se uma potente ferramenta para qualificar as boas práticas na consulta de enfermagem.

Development of the IMB Model and an Evidence-Based Diabetes Self-management Mobile Application / 대한의료정보학회지

OBJECTIVES: This study developed a diabetes self-management mobile application based on the information-motivation-behavioral skills (IMB) model, evidence extracted from clinical practice guidelines, and requirements identified through focus group interviews (FGIs) with diabetes patients. METHODS: We developed a diabetes self-management (DSM) app in accordance with the following four stages of the system development life cycle. The functional and knowledge requirements of the users were extracted through FGIs with 19 diabetes patients. A system diagram, data models, a database, an algorithm, screens, and menus were designed. An Android app and server with an SSL protocol were developed. The DSM app algorithm and heuristics, as well as the usability of the DSM app were evaluated, and then the DSM app was modified based on heuristics and usability evaluation. RESULTS: A total of 11 requirement themes were identified through the FGIs. Sixteen functions and 49 knowledge rules were extracted. The system diagram consisted of a client part and server part, 78 data models, a database with 10 tables, an algorithm, and a menu structure with 6 main menus, and 40 user screens were developed. The DSM app was Android version 4.4 or higher for Bluetooth connectivity. The proficiency and efficiency scores of the algorithm were 90.96% and 92.39%, respectively. Fifteen issues were revealed through the heuristic evaluation, and the app was modified to address three of these issues. It was also modified to address five comments received by the researchers through the usability evaluation. CONCLUSIONS: The DSM app was developed based on behavioral change theory through IMB models. It was designed to be evidence-based, user-centered, and effective. It remains necessary to fully evaluate the effect of the DSM app on the DSM behavior changes of diabetes patients.

Qualidade de vida e características associadas: aplicação do WHOQOL-BREF no contexto da Atenção Primária à Saúde / Quality of life and associated characteristics: application of WHOQOL-BREF in the context of Primary Health Care

Resumo O objetivo deste estudo foi identificar as características associadas à qualidade de vida (QV) em usuários de quatro Unidades Básicas de Saúde (UBS) de Belo Horizonte, Minas Gerais. Delineou-se um estudo transversal com 930 usuários adultos e cadastrados nas UBS selecionadas. Utilizou-se o um questionário contendo o instrumento WHOQOL-bref e perguntas sobre características sociodemográficas, estilo de vida e condições de saúde. Após análise descritiva, realizou-se regressão linear simples e múltipla para avaliar a associação entre as variáveis de exposição e os domínios da QV. As maiores médias de QV foram observadas no domínio relações sociais. No domínio ambiente foram observadas as menores médias, com diferença estatisticamente significante entre algumas das UBS. As piores percepções de QV relacionaram-se com piores condições de saúde, habitação, educação e renda, além de problemas nas relações sociais e condições psicológicas. São necessários esforços para a melhoria da QV em usuários da Atenção Primária, por meio de ações promovidas tanto por profissionais de saúde quanto por gestores públicos.

Abstract This study aimed to identify the characteristics associated to quality of life (QOL) in users of four Basic Health Units (Unidades Básicas de Saúde, UBS) in Belo Horizonte, Minas Gerais. We conducted a cross-sectional study with 930 adult users enrolled in the selected UBS, using a questionnaire containing the WHOQOL-bref instrument and questions about sociodemographic characteristics, lifestyle and health conditions. Following descriptive analysis, we performed simple and multiple linear regression to evaluate the association between the exposure variables and the QOL domains. The highest mean values of QOL were observed in the social relationships domain. The lowest means were observed in the environment domain, with a statistically significant difference between some of the UBS. The worst perceptions of QOL were related to worse health, housing, education and income conditions, as well as problems in social relationships and psychological conditions. Actions are needed to improve QOL in Primary Health Care users through actions promoted by both health professionals and public managers.

Noninvasive Medical Tools for Evaluating Voiding Pattern in Real Life / 대한배뇨장애요실금학회지

Voiding dysfunction is a common disease that contributes to a lower quality of life and has an increased prevalence in the elderly population. Noninvasive and objective methods such as uroflowmetry (UFM) and voiding diaries (VDs) are essential for exact diagnosis and effective treatment of this condition because patients with different causes of voiding dysfunction can complain of the same lower urinary tract symptoms. Further, different treatment options can be determined based on the diagnosis made from these symptoms. In order to improve the quality of UFM and VDs and to provide a convenient testing environment, several advances have been made by previous investigators. In this study, we investigate the history and technological mechanisms of UFM and VDs. We also aim to review UFM from the viewpoint of clinical and at-home uses, including the recently proposed toilet-shaped UFM and electronic VDs.

Medical information service for grass-root PLA health units / 中华医学图书情报杂志

After a description of the demand for medical information in grass-root PLA health units, the experiences of Medical Library of Chinese PLA in providing medical information service for grass-root PLA health units were summarized, and suggestions were proposed for medical library and information institutions to provide information service for them.

Factors Affecting Acceptance of Smartphone Application for Management of Obesity / 대한의료정보학회지

OBJECTIVES: The factors affecting the acceptance of mobile obesity-management applications (apps) by the public were analyzed using a mobile healthcare system (MHS) technology acceptance model (TAM). METHODS: The subjects who participated in this study were Android smartphone users who had an intent to manage their weight. They used the obesity-management app for two weeks, and then completed an 18-item survey designed to determine the factors influencing the acceptance of the app. Three questions were asked pertaining to each of the following six factors: compatibility, self-efficacy, technical support and training, perceived usefulness, perceived ease of use, and behavior regarding intention to use. Cronbach's alpha was used to assess the reliability of the scales. Pathway analysis was also performed to evaluate the MHS acceptance model. RESULTS: A total of 94 subjects participated in this study. The results indicate that compatibility, perceived usefulness, and perceived ease of use significantly affected the behavioral intention to use the mobile obesity-management app. Technical support and training also significantly affected the perceived ease of use; however, the hypotheses that self-efficacy affects perceived usefulness and perceived ease of use were not supported in this study. CONCLUSIONS: This is the first attempt to analyze the factors influencing mobile obesity-management app acceptance using a TAM. Further studies should cover not only obesity but also other chronic diseases and should analyze the factors affecting the acceptance of apps among healthcare consumers in general.

Development of a Smartphone Application for Clinical-Guideline-Based Obesity Management / 대한의료정보학회지

OBJECTIVES: The purpose of the study was to develop and evaluate a clinical-guideline-based smartphone application ('app') for obesity management. METHODS: Obesity-related knowledge and functional requirements were extracted from clinical practice guidelines, a literature review, and consultations with experts. The extracted knowledge was used to design obesity-management algorithms, and the functions of the developed app are presented through a use case diagram and activity diagrams. The database and user interface were designed and then an app was developed. The proficiency and efficiency of the algorithm were evaluated using scenarios, while the user interface was assessed using a mobile heuristics evaluation tool, with its usability determined using the Post-Study System Usability Questionnaire. RESULTS: In total, 131 obesity-related knowledge statements and 11 functions for the app were extracted, and 5 algorithms (comprising 1 main algorithm and 4 subalgorithms) were developed. The database comprised 11 tables and 41 screens. The app was developed using the Android SDK platform 4.0.3, JDK 1.7.0, and Eclipse. The overall proficiency and efficiency scores of the algorithm were 88.0 and 69.1, respectively. In heuristics tests, 57 comments were made, and the mean usability score was 3.47 out of 5. Thirteen usability problems were identified by the heuristics and usability evaluations. CONCLUSIONS: The app developed in this study might be helpful for weight management because it can provide high-quality health information and intervention without spatial or temporal constraints. However, the clinical effectiveness of this app still requires further investigation.

Medicamentos Utilizados na Enxaqueca: Rotina em Unidades Básicas de Saúde e em Hospital / Drugs Used To Treat Migraine: The Routine Of Basic Healthcare Units And Hospitals

A cefaleia é um dos sintomas mais comuns naprática clínica e é responsável por um percentualconsiderável do atendimento em Unidades Básicas de Saúde(UBS) e em Hospitais. A enxaqueca (cefaleia migrânea), umsubtipo de cefaleia primária, é um dos diagnósticos maiscomuns no que se refere a cefaleias em geral. Por essemotivo, torna-se importante um estudo sobre os manejosclínicos, de caráter farmacológico, realizados no cuidardessa patologia. Objetivo: O objetivo do trabalho é fazeruma revisão bibliográfica de artigos que tratam da enxaqueca,e o tratamento farmacológico mais comum em UBS e Hospitais.Materiais e métodos: Para esta revisão foram utilizadosartigos indexados, publicados entre o período de 2002 a2012, nas bases de dados online Scielo e Pubmed, usandoos descritores: “cefaléia migrânea”, “fármacos e enxaqueca”,“enxaqueca e Unidades Básicas de Saúde” e “enxaqueca eemergências hospitalares”. Resultados: Devido à migrâneacausar um enorme desconforto ao paciente é necessáriouma abordagem rápida do problema para conferir a este,condições de manter as suas atividades diárias de formasatisfatória. Para isso, a terapêutica correta se destinaráaos episódios de crise – uso de medicamento para minimizaro sofrimento do paciente - e a profilaxia – uso demedicamentos a fim de reduzir o número de crises e aintensidade das mesmas. Conclusão: As UBS utilizam-se,para crises leves a moderadas, os analgésicos e antiinflamatórios;para as crises moderadas a intensa, osanalgésicos mais potentes e os triptanos. Enquanto que, nosHospitais, os corticoesteroides são as drogas de escolha,embora as aplicações de Diidroergotamina Endovenosa oude Clorpromazina também são alternativas...

Headache is one of the most common symptomsin clinical practice, which accounts for a considerablepercentage of appointments in Basic Healthcare Units (BHUs)and Hospitals. Migraine (migraine headache), a subtype ofprimary headache, is one of the most common diagnosesregarding headaches in general. Therefore, it becomesimportant to study the clinical pharmacological managementof this condition. Objective: This study aimed to review theexisting literature about migraine and the pharmacologicaltreatment performed in BHUs and hospitals. Material andMethods: Bibliographical searches were carried out in thedatabases Scielo and Pubmed of articles published between2002 and 2012, using the following descriptors: “migraineheadache”, “drugs and migraine”, “migraine and Basic HealthUnits”, “migraine and hospital emergencies”. Results: Asmigraine causes a strong discomfort to the patient, there is aneed for a quick approach to solve the problem andsatisfactorily maintain their daily activities. Therefore, anappropriate therapy should target episodes of crisis – use ofmedication to minimize patient suffering – and prophylaxis –use of medication to reduce the number and intensity ofseizures. Conclusions: BHUs prescribe analgesics and antiinflammatorydrugs in case of mild to moderate episodes,and potent analgesics and triptans in case of moderate tosevere episodes. Corticosteroids are the drugs of choice inthe hospital setting, although intravenous dihydroergotamineor chlorpromazine are also considered...

Diseño e implementación de un software para la administración de expedientes de pacientes en la Unidad de Salud de Perquín, Departamento de Morazán / Design and implementation of a software for the administration of patient records at Unidad de Salud de Perquin, department of Morazán

Este artículo contiene información concerniente al proyecto de investigación aplicada de la carrera Técnico en Sistemas Informáticos, realizado por docentes en colaboración con estudiantes del Centro Regional de San Miguel. El proyecto ejecutado se denomina "Diseño e Implementación de un Software para administrar expedientes de pacientes en la Unidad de Salud de Perquín, Departamento de Morazán". El objetivo principal del proyecto fue diseñar e implementar un software capaz de agilizar los procesos administrativos y de consultas en la unidad de salud. En este artículo se hace referencia a los progresos y alcances de las organizaciones con la utilización de los sistemas de información.

This article contains information related to the applied research project of the Computer Systems Technician career, carried out by teachers in collaboration with students from the San Miguel Regional Center. The executed project is called "Design and implementation of a software to manage patient records in the Health Unit of Perquín, Department of Morazán". The main objective of the project was to design and implement software capable of streamlining administrative and consultation processes in the health unit. This article refers to the progress and scope of organizations with the use of information systems.

Gestantes tardias de baixa renda: dados sociodemográficos, gestacionais e bem-estar subjetivo / Low-income late-age pregnant women: sociodemographic, gestational data and subjective well-being / Embarazadas tardías de bajos ingresos: datos sociodemográficos, gestacionales y bienestar subjetivo

Estudo transversal descritivo e correlacional cujos objetivos foram traçar o perfil sociodemográfico e gestacional, avaliar o bem-estar subjetivo (BES) e relacionar os indicadores do BES com as variáveis idade, escolaridade e renda. Participaram 80 gestantes com 35 anos ou mais (grávidas tardias) de baixa renda. Os instrumentos de pesquisa foram questionário estruturado e escala de bem-estar subjetivo. Os dados são apresentados na forma de análises descritivas e correlacionais, conforme a natureza das variáveis. A maioria das gestantes vivia com o companheiro, não tinha renda pes­soal, pois tratava-se de donas de casa, e não planejou a gestação; e o bem-estar subjetivo apresentou valores equivalentes às médias para cada indicador (afetos positivos, afetos negativos e satisfação com a vida), enquanto as correlações significativas obtidas foram fracas. Conclui-se que, para o grupo avaliado, a baixa escolaridade e a baixa renda familiar foram variáveis associadas à satisfação com a vida das gestantes entrevistadas.

Descriptive and correlational cross-sectional study whose objectives were to delineate sociodemographic and gestational profile, to assess the subjective well-being (SWB) and to relate the indicators of SWB with the variables age, education and income. The study included 80 low-income with 35 or more years old (late-age pregnant women). The research tools were structured questionnaire and the subjective well-being scale. Data are presented as correlation and descriptive analysis according to the nature of the variables. The majority of pregnant women lives with a partner and has no personal income. They are housewives and did not plan the pregnancy; the subjective well-being index was equivalent values to the mean for each indicator (posi­tive emotions, negative emotions and life satisfaction), while significant correlations were weak. The conclusion is that low scholarship and low familiar income were varia­bles associated to the life satisfaction in the assessed pregnant women.

Estudio descriptivo y correlacional de corte transversal que tuvo como objetivos delinear el perfil sociodemográfico y embarazos anteriores, evaluar el bienestar subjetivo (BS) y relacionar los indicadores de lo BS con las variables: edad, nivel de educación e ingreso. Participaron 80 mujeres embarazadas con 35 años o más (tardías) de bajos ingresos. Los instrumentos de investigación fueron cuestionario estructurado y escala de bienestar subjetivo. Los datos son presentados como análisis descriptivas y correlaciones, de acuerdo con la naturaleza de las variables. La mayoría de las mujeres embarazadas vivían con el compañero, no tenía ingresos personales, porque eran amas de casa y no planearan lo embarazo; y el bienestar subjetivo tuve valores equivalentes a las medias para cada indicador (afectos positivos, afectos negativos y satisfacción con la vida), mientras las correlaciones significativas fueran débiles. La conclusión es que para el grupo evaluado el bajo nivel de educación y bajos ingresos fueron variables asociadas a la satisfacción con la vida de las embarazadas entrevistadas.

Cost of Ambulatory Care by Mobile Health Clinic Run by a Medical College in India for the Year 2008-09.

Background: The feasibility of using mobile health clinics (MHCs) to deliver health services in urban poor areas has to be explored as the health needs of the residents are not sufficiently addressed by the existing primary health care delivery system in India. Objective: To estimate the cost of providing primary health care services and the out of pocket expenditure (OOPE) incurred, while utilizing these services provided through the MHC based Urban Health Program of a Medical College in North India for the year 2008-2009. Materials and Methods: A cross-sectional study to estimate OOPE was conducted among 330 subjects selected from patients attending the mobile health care facility. For estimation of provider cost, 5 steps process involving identification of cost centres, measurement of inputs, valuing of inputs, assigning of inputs to cost centers, and estimation of unit cost were carried out. Results: Total annual cost of providing services under Urban Health Program in the year 2008-2009 was Rs. 7,691,943 Unit cost of providing outpatient curative care, antenatal care, and immunization were Rs. 107.74/visit, Rs. 388/visit and Rs. 66.14 per immunization, respectively. The mean OOPE incurred was Rs. 29.50/visit, while utilizing outpatient curative services and Rs. 88.70/visit for antenatal services. Conclusion: The MHC can be considered as a viable option to provide services to urban poor.