Cancer-related information behavior among Black and Hispanic populations in an NCI-designated comprehensive cancer center catchment.

OBJECTIVE: This study aims to better understand health behaviors, particularly health information seeking, and how this impacts cancer care within underserved minority populations in a specific catchment area in Florida. METHODS: We conducted an analysis of survey data from a 2019 community health survey conducted by the Moffit Cancer Center (MCC). We utilized the Comprehensive Model of Information Seeking (CMIS) as a framework and performed structural equation modeling (SEM) and related statistical analyses. RESULTS: Our findings confirm that characteristics and demographics present a positive relationship to Online Health Information Seeking (OHIS). We also found that Utility had a negative significant relationship to OHIS. CONCLUSIONS: We concluded that the CMIS is a useful framework for studying cancer-related information seeking, and that when properly executed in the confines of a study, can lend itself to in-depth statistical analyses as found in SEM. IMPLICATIONS: The SEM revealed the CMIS to be promising with results in our analysis worthy of further investigation of cancer care and healthcare information access considering undeserved and minority populations. PRACTICE IMPLICATIONS: Models such as the CMIS can be useful for understanding information seeking behaviors and to design information and communication interventions to improve access and health outcomes.

A invenção de um setting on-line para atendimento psicológico remoto / The invention of an online environment for remote psychological care / La invención de un entorno en línea para la atención psicológica remota

Com o advento da covid-19, foi declarado estado de emergência de saúde pública e decretadas medidas de isolamento e distanciamento social para conter a propagação da doença. O Conselho Federal de Psicologia, considerando a importância do acolhimento seguro durante a pandemia, publicou a Resolução CFP nº 4/2020, permitindo que serviços psicológicos aconteçam de maneira remota. O presente estudo visa, através do Método da Cartografia, apresentar a construção de um setting on-line para intervenções grupais e os desafios na oferta de acolhimento e atendimento remoto. Foram ofertados grupos terapêuticos, por meio da plataforma Google Meet, para estudantes da Universidade Federal Rural do Rio de Janeiro. Um diário de bordo foi produzido para acompanhar as forças que atravessavam e constituíam o território e a experiência grupal remota. Compreendemos que o território-espaço-grupal-on-line era composto pelo espaço virtual em que nos reuníamos, pelos espaços individuais de cada integrante e pelas forças que os atravessavam. Observamos que nem sempre os participantes dispunham de um lugar privado, mas estiveram presentes no encontro com câmeras e áudios abertos e/ou fechados e/ou através do chat da videochamada. A participação no grupo funcionou como alternativa no momento de distanciamento social, sendo uma possibilidade para o atendimento psicológico em situações de dificuldade de encontros presenciais; entretanto, se mostrou dificultada em diversos momentos, pela falta de equipamentos adequados e instabilidade na internet, fatores que interferiram nas reuniões e impactaram na possibilidade de falar e escutar o que era desejado.(AU)

With the advent of COVID-19, a state of public health was declared, and measures of isolation and social distance to contain the spread of the disease was decreed. The Federal Council of Psychology, considering the importance of safe reception during the pandemic, published CFP Resolution No. 4/2020, allowing psychological services to happen remotely. This study narrates, via the Cartography Method, the experience of inventing an Online Setting for group reception. Therapeutic groups were offered, via Google Meet Platform, to students at the Federal Rural University of Rio de Janeiro. A logbook was produced to accompany the forces that crossed and constituted the territory and the remote group experience. We understand that the territoryspace-group-online was composed by the virtual-space that we gathered, by the individualspaces of each member and by the forces that crossed them. We observed that the participants did not always have a private place, but they were present at the meeting with open and/or closed cameras and audio and/or through the video call chat. Participation in the group worked as an alternative at the time of social distancing, being a possibility for psychological care in situations of difficulty in face-to-face meetings, however, it proved to be difficult at various times, due to the lack of adequate equipment and instability on the internet, factors that interfered in meetings and impacted the possibility of speaking and listening to what was desired.(AU)

La llegada de la COVID-19 produjo un estado de emergencia de salud pública, en el que se decretaron medidas de confinamiento y distanciamiento físico para contener la propagación de la enfermedad. El Consejo Federal de Psicología, considerando la importancia de la acogida segura durante la pandemia, publicó la Resolución CFP nº 4/2020, por la que se permite la atención psicológica remota. Este estudio tiene por objetivo presentar, mediante el método de la Cartografía, la elaboración de un escenario en línea para la intervención grupal y los desafíos en la oferta de acogida y atención remota. Grupos terapéuticos se ofrecieron, en la plataforma Google Meet, a estudiantes de la Universidad Federal Rural de Río de Janeiro. Se elaboró un diario para acompañar a las fuerzas que atravesaron y constituyeron el territorio y la experiencia remota del grupo. Entendemos que el territorio-espacio-grupo-en línea estaba compuesto por el espacio-virtual que reunimos, por los espacios individuales de cada integrante y por las fuerzas que los atravesaban. Observamos que los participantes no siempre tenían un lugar privado y que estaban presentes en la reunión con cámaras y audio abiertos y/o cerrados y/o por el chat de la videollamada. La participación en el grupo funcionó como una alternativa en el momento del distanciamiento físico y revela ser una posibilidad de atención psicológica en situaciones de dificultad en los encuentros presenciales, sin embargo, se mostró difícil en varios momentos, ya sea por la falta de medios adecuados o por inestabilidad en Internet, factores que interferían en las reuniones e impactaban en la posibilidad de hablar y escuchar lo que se deseaba.(AU)

The biological effects of different LED wavelengths in the health field. A review / Os efeitos biológicos de diferentes comprimentos de onda de LED na área da saúde. Uma revisão

Introduction: the use of light emitting diodes (LED) in domestic and public vias have increased in the last 20 years. In addition, the LED light has been used as a light source for medical applications. Objective: since humans are increasingly exposed to LEDs, there is an urgency to investigate the possible biological effects on tissues caused by this exposure. So, researchers have been focused their investigations in the application of this light in the health field. Material and method: in this review, a search in important databases was performed on the biological effects caused after application of different LED light protocols in in vitro and in vivo studies. Result: although most published papers have shown positive results, some of them reported negative biological effects of light LEDs technology on humans' cells/tissues. Conclusion: therefore, the comprehension of the biological effects caused by light LEDs will provide a better assessment of the risks involved using this technology.

Introdução: o uso de diodos emissores de luz ("LED") em vias domésticas e públicas tem aumentado nos últimos 20 anos. Além disso, a luz LED tem sido usada para aplicações médicas. Objetivo: pelo fato de seres humanos estarem cada vez mais expostos aos LEDs, há urgência em investigar os possíveis efeitos biológicos nos tecidos causados por esta exposição. Assim, pesquisadores têm focado suas investigações no uso desta luz na área da saúde. Material e método: nesta revisão foi realizada uma pesquisa em bancos de dados conceituados sobre os efeitos biológicos causados após aplicação de diferentes protocolos de luz LED em estudos in vitro e in vivo. Resultado: embora a maioria dos artigos publicados tenham mostrado resultados positivos, alguns deles relataram efeitos biológicos negativos da tecnologia de LEDs nas células/tecidos humanos. Conclusão: portanto, a compreensão dos efeitos biológicos causados pela luz LED proporcionará uma melhor avaliação dos riscos envolvidos no uso desta tecnologia.

Supplemental findings of the 2019 National Blood Collection and Utilization Survey.

INTRODUCTION: Supplemental data from the 2019 National Blood Collection and Utilization Survey (NBCUS) are presented and include findings on donor characteristics, autologous and directed donations and transfusions, platelets (PLTs), plasma and granulocyte transfusions, pediatric transfusions, transfusion-associated adverse events, cost of blood units, hospital policies and practices, and implementation of blood safety measures, including pathogen reduction technology (PRT). METHODS: National estimates were produced using weighting and imputation methods for a number of donors, donations, donor deferrals, autologous and directed donations and transfusions, PLT and plasma collections and transfusions, a number of crossmatch procedures, a number of units irradiated and leukoreduced, pediatric transfusions, and transfusion-associated adverse events. RESULTS: Between 2017 and 2019, there was a slight decrease in successful donations by 1.1%. Donations by persons aged 16-18 decreased by 10.1% while donations among donors >65 years increased by 10.5%. From 2017 to 2019, the median price paid for blood components by hospitals for leukoreduced red blood cell units, leukoreduced apheresis PLT units, and for fresh frozen plasma units continued to decrease. The rate of life-threatening transfusion-related adverse reactions continued to decrease. Most whole blood/red blood cell units (97%) and PLT units (97%) were leukoreduced. CONCLUSION: Blood donations decreased between 2017 and 2019. Donations from younger donors continued to decline while donations among older donors have steadily increased. Prices paid for blood products by hospitals decreased. Implementation of PRT among blood centers and hospitals is slowly expanding.

Analyzing Cost-Effectiveness of Allocating Neurointerventionist for Drive and Retrieve System for Patients with Acute Ischemic Stroke.

OBJECTIVES: There are regional disparities in implementation rates of endovascular thrombectomy due to time and resource constraints such as endovascular thrombectomy specialists. In Hokkaido, Japan, Drive and Retrieve System (DRS), where endovascular thrombectomy specialists perform early endovascular thrombectomies by traveling from the facilities where they normally work to facilities closer to the patient. This study analyzed the cost-effectiveness of allocating a endovascular thrombectomy specialist for DRS to treat stroke patients. MATERIALS AND METHODS: he number of ischemic stroke patients expected to receive endovascular thrombectomy in Hokkaido in 2015 was estimated. It was assumed that an additional neutointerventionist was allocated for DRS. The analysis was performed from the government's perspective, which includes medical and nursing-care costs, and the personnel cost for endovascular thrombectomy specialist. The analysis was conducted comparing the current scenario, where patients received endovascular thrombectomy in facilities where endovascular thrombectomy specialists normally work, with the scenario with DRS within 60 min drive distance. Patient transport time was analyzed using geographic information system, and patient severity was estimated from the transport time. The primary outcome was incremental cost-effectiveness ratio (ICER) in each medical area which was calculated from the incremental costs and the incremental quality-adjusted life years (QALYs), estimated from patient severity using published literature. The entire process was repeated 100 times. RESULTS: DRS was most cost-effective in Kamikawachubu area, where the ICER was $14,173±16,802/QALY, significantly lower than the threshold that the Japanese guideline suggested. CONCLUSIONS: Since DRS was cost-effective in Kamikawachubu area, the area should be prioritized when a endovascular thrombectomy specialist for DRS is allocated as a policy.

The "Flying Intervention Team": A Novel Stroke Care Concept for Rural Areas.

BACKGROUND: Endovascular treatment of large vessel occlusion in acute ischemic stroke patients is difficult to establish in remote areas, and time dependency of treatment effect increases the urge to develop health care concepts for this population. SUMMARY: Current strategies include direct transportation of patients to a comprehensive stroke center (CSC) ("mothership model") or transportation to the nearest primary stroke center (PSC) and secondary transfer to the CSC ("drip-and-ship model"). Both have disadvantages. We propose the model "flying intervention team." Patients will be transported to the nearest PSC; if telemedically identified as eligible for thrombectomy, an intervention team will be acutely transported via helicopter to the PSC and endovascular treatment will be performed on site. Patients stay at the PSC for further stroke unit care. This model was implemented at a telestroke network in Germany. Fifteen remote hospitals participated in the project, covering 14,000 km2 and a population of 2 million. All have well established telemedically supported stroke units, an angiography suite, and a helicopter pad. Processes were defined individually for each hospital and training sessions were implemented for all stroke teams. An exclusive project helicopter was installed to be available from 8 a.m. to 10 p.m. during 26 weeks per year. Key Messages: The model of the flying intervention team is likely to reduce time delays since processes will be performed in parallel, rather than consecutively, and since it is quicker to move a medical team rather than a patient. This project is currently under evaluation (clinicaltrials NCT04270513).

The Practice of Home Visiting by Community Health Nurses as a Primary Healthcare Intervention in a Low-Income Rural Setting: A Descriptive Cross-Sectional Study in the Adaklu District of the Volta Region, Ghana.

BACKGROUND: Home visit is an integral component of Ghana's PHC delivery system. It is preventive and promotes health practice where health professionals render care to clients in their own environment and provide appropriate healthcare needs and social support services. This study describes the home visit practices in a rural district in the Volta Region of Ghana. Methodology. This descriptive cross-sectional study used 375 households and 11 community health nurses in the Adaklu district. Multistage sampling techniques were used to select 10 communities and study respondents using probability sampling methods. A pretested self-designed questionnaire and an interview guide for household members and community health nurses, respectively, were used for data collection. Quantitative data collected were coded, cleaned, and analysed using Statistical Package for Social Sciences into descriptive statistics, while qualitative data were analysed using the NVivo software. Thematic analysis was engaged that embraces three interrelated stages, namely, data reduction, data display, and data conclusion. RESULTS: Home visit is a routine responsibility of all CHNs. The factors that influence home visiting were community members' education and attitude, supervision challenges, lack of incentives and lack of basic logistics, uncooperative attitude, community inaccessibility, financial constraint, and limited number of staff. Household members (62.3%) indicated that health workers did not adequately attend to minor ailments as 78% benefited from the service and wished more activities could be added to the home visiting package (24.5%). CONCLUSION: There should be tailored training of CHNs on home visits skills so that they could expand the scope of services that can be provided. Also, community-based health workers such as community health volunteers, traditional birth attendants, and community clinic attendants can also be trained to identify and address health problems in the homes.

Práticas Integrativas e Complementares em saúde na formação em Educação Física: avanços, desafios, velhos e novos embates / Complementary and integrative medicine in the higher education of physical education: advances, challenges, old and new debates

Resumo A entrada das Práticas Integrativas e Complementares (PICS) nos currículos da área de saúde tem se dado de maneira insatisfatória, e na Educação Física não é diferente. Esse estudo se propõe a analisar a presença dessa temática atualmente na formação superior em Educação Física das universidades públicas federais e estaduais brasileiras, na perspectiva de elucidar quais os desafios, lacunas e avanços que a área enfrenta. Para isso, foi realizada a análise de 172 grades curriculares de graduações na área, os programas de 52 disciplinas em PICS encontradas e as linhas de pesquisa em Programas de Pós-Graduação e Grupos de Pesquisa liderados por profissionais da área. Os resultados evidenciam pouca inserção do tema nos currículos de graduação e, quando presente, se dão através de ofertas majoritariamente optativas, tecnicista e sem diálogos com o Sistema Único de Saúde. Ainda foi encontrada uma pouca participação da área na produção científica e pós-graduação em PICS.

Abstract The introduction of Complementary and Alternative Medicine (CAM) into undergraduate health programs has been unsatisfactory and this is not different in Physical Education. This study proposes an analysis of the presence of this theme in higher education in Physical Education at Brazilian federal and state public universities, aiming to elucidating the challenges, gaps and advances that the area faces. Thus, an analysis of 172 curriculum grades for undergraduate courses in the area was conducted. The programs of 52 disciplines in CAM and the research lines of Postgraduate Programs and Research Groups led by professionals in the area were also analyzed. The results show little insertion of the theme in the graduation curricula, and when present, they occur in elective and technical subjects, without dialogues with the Brazilian Unified Health System (SUS). There was still a small participation of the area in scientific production and post-graduation in CAM.

Facteurs associés au faible niveau de fréquentation du centre de santé intégré de Pondila en 2021 / Factors associated with low levels of attendance of the integrated health center of Pondila in 2021

Le système de santé de la République du Congo est caractérisé par un important gap dans l'offre des services de santé entre le milieu urbain et le milieu rural. La communauté rurale de Pondila, dans le département du Kouilou n'échappe pas à cette description, avec un faible taux de fréquentation du CSI de Pondila de 34,22%. Objectif: Cette étude avait pour objectif d'étudier les facteurs associés au faible taux de fréquentation du CSI de Pondila en 2021. Méthodologie : Il s'agit d'une étude transversale analytique qualitative et quantitative sur un échantillon probabiliste représentatif de 347 ménages dans toute l'aire de santé de Pondila. Un modèle de régression logistique a été construit par la méthode de sélection pas à pas descendante avec une probabilité d'entrée de 0,05 et IC à 95%. Résultats : 30,84% des enquêtés ont rapporté ne pas avoir consulté le CSI de Pondila dans les 03 mois précédant l'enquête dans de mauvaises conditions d'accès géographiques et financières. La régression logistique a permis d'établir le faible niveau de fréquentation du CSI et le chômage (OR=16,67 [14,67 à 18,67], p=0,000), le mauvais accueil des bénéficiaires par le personnel soignant (OR=3,15 [1,00 à 9,95], p=0,050) et l'absence de médicaments lors des consultations (OR=3,21 [0,26 à 39,24], p=0,000). Conclusion : Le faible niveau de fréquentation du CSI de Pondila est associé au chômage, au mauvais accueil et à la non disponibilité des médicaments au CSI, au coût élevé des soins et au mauvais état des routes.

Intervenção psicológica grupal e psicossomática: uma revisão integrativa / Psychological group and psychosomatic intervention: an integrative review / Intervención psicológica grupal y psicosomática: una revisión integrativa

A psicossomática busca compreensão dos sintomas físicos de origem psíquica e a intervenção psicológica grupal surge como ferramenta possibilitando espaço para a reflexão em grupo acerca deste adoecimento. Este estudo objetiva levantar produções científicas que integram a psicologia grupal e a psicossomática. Utilizou-se como metodologia a revisão integrativa, no período de 2011 a 2016, por meio de base de dados eletrônicas, os periódicos da CAPES, Scielo, Pepsic e LILACS. Utilizados os descritores: grupos e psicossomática como filtros. Dentre os resultados notou-se a carência de produções científicas entre os descritores no tocante a serviços na área da saúde. Verificou-se também que pesquisas nesta área estão voltadas para orientação diagnóstica, sem efetivo interesse na promoção de saúde e no empoderamento do usuário.

The psychosomatic seeks understanding of physical symptoms of psychic origin and the group psychological intervention appears as a tool allowing space for group reflection about this illness. This study aims make a survey of the scientific productions that integrate group and psychosomatic psychology. Used the integrative review from 2011 to 2016 through the electronic database the CAPES, Scielo, Pepsic and LILACS scientific journals. Used the descriptors: groups and psychosomatic as research filters. Among the results it was observed the lack of scientific productions between the descriptors in relation to the health área. It was also verified that researchs in this area are geared towards diagnostic orientation without an effective interest in health promotion and in user empowerment.

La psicosomática busca la comprensión de los síntomas físicos de origen psíquico y la intervención psicológica grupal surge como herramienta posibilitando espacio para la reflexión en grupo acerca de este enfermo. Este estudio objetiva levantar producciones científicas que integran la psicología grupal y la psicosomática. Se utilizó como metodología la revisión integrativa, en el período de 2011 a 2016, por medio de base de datos electrónicos, los periódicos de CAPES, Scielo, Pepsic y LILACS.Utilizados los descriptores: grupos y psicosomática como filtros. Entre los resultados se notó la carencia de producciones científicas entre los descriptores en cuanto a servicios en el área de la salud.Se verificó también que investigaciones en esta área están orientadas hacia orientación diagnóstica, sin efectivo interés en la promoción de la salud y en el empoderamiento del usuario.

Enhanced dispatch and rendezvous doubles the catchment area and number of patients treated on a mobile stroke unit.

INTRODUCTION: Mobile Stroke Units (MSUs) deliver acute stroke treatment on-scene in coordination with Emergency Medical Services (EMS). One criticism of the MSU approach is the limited range of a single MSU. The Houston MSU is evaluating MSU implementation, and we developed a rendezvous approach as an innovative solution to expand the range and number of patients treated. METHODS: In addition to direct 911 dispatch of our MSU to the scene within our 7-mile catchment area, we empowered more distant EMS units to activate the MSU. We also monitored EMS radio communications to identify possible patients. For these distant patients, the MSU met the EMS unit en route to the stroke center and treated the patient at that intermediate location. The distribution of the distance from MSU base station to site of stroke and time from 911 alert to tissue plasminogen activator (tPA) bolus were compared between patients treated on-scene and by rendezvous using Wilcoxon rank sum test. RESULTS: Over 4 years, 338 acute ischemic stroke patients were treated with tPA on our MSU. Of these, 169 (50%) were treated on-scene after MSU dispatch at a median of 6.4 miles (IQR 6.4 miles) from MSU base station. 169 (50%) were treated by 'rendezvous' pathway with assessment and treatment of stroke a median of 12.4 miles from base (IQR 5.5 miles) (p< 0.0001). Time (min) from MSU alert to tPA bolus did not differ: 36.0 ± 10.0 for on-scene vs 37.0 ± 10.0 with rendezvous (p=0.65). 13% of patients alerted via direct 911 dispatch were treated vs 44% of rendezvous patients. CONCLUSION: Adding a rendezvous approach to an MSU dispatch pathway doubles the range of operations and the number of patients treated by an MSU in an urban area, without incurring delay.

Causes of death in clozapine-treated patients in a catchment area: a 10-year retrospective case-control study.

Uncertainty regarding the excess of mortality in patients treated with clozapine persists. A decrease in all-cause mortality, and perhaps also in suicide, after clozapine initiation has been reported, but there are no studies in which preventable causes were ascertained in those taking medication in the long term. Here, we aimed to assess a decade of causes of deaths in a catchment area in patients with schizophrenia chronically treated with clozapine and compared them to a clozapine-treated control cohort. Causes of deaths were classified as suicide, expected (e.g. cancer), and unexpected deaths (encompassing causes of death potentially due to clozapine side effects, and unexplained sudden death). We used descriptive statistics for comparing socio-demographic and clinical factors between the three groups. Logistic regression models were used to examine risk factors associated with unexpected death compared to the control group. We found that the overall mortality was similar to that in previous studies (at 0.8% yearly on average) with unexpected deaths accounting for 52% of total deaths. The unexpected deaths group was on average treated with higher clozapine doses (mean 460 mg/day). A small but significant peak of unexpected deaths was found during the 2018 summer heat wave, which might have exacerbated dose-dependent side effects of clozapine. We suggest increased monitoring for those on higher doses of clozapine as one potential intervention to decrease mortality in this population.

Hematological malignancies in East Africa-Which cancers to expect and how to provide services.

BACKGROUND: Sub-Saharan Africa (SSA) has an increasing non-communicable disease burden. Tanzania has an incidence of more than 35,000 cancer cases per year with an 80% mortality rate. Hematological malignancies account for 10% of these cases. The numbers will double within the next 10 years due to demographic changes, better diagnostic capabilities and life style changes. Kilimanjaro Christian Medical Centre established a Cancer Care Centre (CCC) in December 2016 for a catchment area of 15 million people in Northern Tanzania. This article aims to display the hematological diagnosis and characteristics of the patients as well as to describe the advancements of hematologic services in a low resource setting. METHODS: A cross-sectional analysis of all hematological malignancies at CCC from December 2016 to May 2019 was performed and a narrative report provides information about diagnostic means, treatment and the use of synergies. RESULTS: A total of 209 cases have been documented, the most common malignancies were NHL and MM with 44% and 20%. 36% of NHL cases, 16% of MM cases and 63% of CML cases were seen in patients under the age of 45. When subcategorized, CLL/SLL cases had a median age was 56.5, 51 years for those with other entities of NHL. Sexes were almost equally balanced in all NHL groups while clear male predominance was found in HL and CML. DISCUSSION: Malignancies occur at a younger age and higher stages than in Western countries. It can be assumed that infections play a key role herein. Closing the gap of hematologic services in SSA can be achieved by adapting and reshaping existing infrastructure and partnering with international organizations.

Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States.

Background We aimed to determine if there is an association between hospital quality and the likelihood of a given hospital being a preferred transfer destination for stroke patients. Methods and Results Data from Medicare claims identified acute ischemic stroke transferred between 394 northeast US hospitals from 2007 to 2011. Hospitals were categorized as transferring (n=136), retaining (n=241), or receiving (n=17) hospitals based on the proportion of acute ischemic stroke encounters transferred or received. We identified all 6409 potential dyads of sending and receiving hospitals, and categorized dyads as connected if ≥5 patients were transferred between the hospitals annually (n=82). We used logistic regression to identify hospital characteristics associated with establishing a connected dyad, exploring the effect of adjusting for different quality measures and outcomes. We also adjusted for driving distance between hospitals, receiving hospital stroke volume, and the number of hospitals in the receiving hospital referral region. The odds of establishing a transfer connection increased when rate of alteplase administration increased at the receiving hospital or decreased at the sending hospital, however this finding did not hold after applying a potential strategy to adjust for clustering. Receiving hospital performance on 90-day home time was not associated with likelihood of transfer connection. Conclusions Among northeast US hospitals, we found that differences in hospital quality, specifically higher levels of alteplase administration, may be associated with increased likelihood of being a transfer destination. Further research is needed to better understand acute ischemic stroke transfer patterns to optimize stroke transfer systems.

Regionalization of Congenital Heart Surgery in the United States.

The objective of this study is to simulate regionalization of congenital heart surgery (CHS) in the United States and assess the impact of such a system on travel distance and mortality. Patients ≤18 years of age who underwent CHS were identified in 2012 State Inpatient Databases. Operations were stratified by the Risk Adjustment for Congenital Heart Surgery, version 1 (RACHS-1) method, with high risk defined as RACHS-1 levels 4-6. Regionalization was simulated by progressive closure of hospitals, beginning with the lowest volume hospital. Patients were moved to the next closest hospital. Analyses were conducted (1) maintaining original hospital mortality rates and (2) estimating mortality rates based on predicted surgical volumes after absorbing moved patients. One hundred fifty-three hospitals from 36 states performed 1 or more operation (19,064 operations). With regionalization wherein, all hospitals performed >310 operations, 37 hospitals remained, from 12.5% to 17.4% fewer deaths occurred (83-116/666), and median patient travel distance increased from 38.5 to 69.6 miles (P < 0.01). When only high-risk operations were regionalized, 3.9-5.9% fewer deaths occurred (26-39/666), and the overall mortality rate did not change significantly. Regionalization of CHS in the United States to higher volume centers may reduce mortality with minimal increase in patient travel distance. Much of the mortality reduction may be missed if solely high-risk patients are regionalized.

A transferência da política de controle da tuberculose na população indígena em região de fronteira / Transfer of tuberculosis policy control in the indigenous population from border regions

A tuberculose (TB) é um problema de saúde pública e em especial em grupos em situação de vulnerabilidades, sendo uma das mais importantes causas de morbimortalidade na população indígena. Estudo qualitativo com o objetivo de analisar a transferência de política de controle da tuberculose na população indígena em região de fronteira, no estado do Paraná. Participaram da pesquisa 36 profissionais entre gestores e trabalhadores das equipes por meio de entrevista semiestruturada, com questões relacionadas à transferência da política de controle da TB em população indígena. A coleta dos dados primários foi realizada nos meses de fevereiro e março de 2019. Foram utilizados ainda dados secundários extraídos do período de 2001 a 2018 do Sistema de Informação de Agravos de Notificação via Sistema Eletrônico do Serviço de Informação ao Cidadão. Os dados qualitativos foram organizados e categorizados por meio do software Atlas.ti 7.0, a partir do referencial de análise de conteúdo, modalidade temática, e os quantitativos analisados por meio da estatística. Os resultados revelaram que dos 36 sujeitos da pesquisa, 34 (94.4%) tinham formação na área da saúde, 11 (30,6%) atuavam na assistência à saúde do indígena, 25 (69,4%) ocupavam cargos de gestão, e do total de participantes, 25 (69,4%) eram profissionais da enfermagem. Os municípios do estudo detiveram 50% do número de notificação por tuberculose em indígenas na faixa de fronteira do Estado. A tuberculose tem atingido indígenas residentes na zona rural (74%), sexo masculino (59,3%), economicamente ativos (45,8%) e com ausência ou baixa escolaridade (68,8%). A tuberculose pulmonar esteve presente em (88,5%) dos casos diagnosticados e o desfecho por cura não alcançou a meta de 85% dos casos. A fase qualitativa revelou que a enfermagem tem assumido o controle da tuberculose nos indígenas; identificaram-se dificuldades da gestão à integração do sistema de saúde; manutenção de insumos e infraestrutura; garantia das diretrizes gerais da política. A alta rotatividade, déficit de profissionais, falta de educação permanente e precarização das relações trabalhistas têm comprometido a prática assistencial e do acompanhamento dos casos de tuberculose junto às equipes. Conclui-se que modelos de transferência da política e controle da tuberculose, adotados em populações indígenas em região de fronteira ainda é um dos entraves à garantia da assistência resolutiva, equânime e do estado de direito. O contexto fronteiriço requer melhor compreensão das especificidades regionais, modo de organização social e dos aspectos de determinam a vida das populações indígenas, permeados por um ambiente intercultural e de vulnerabilidades. É preciso repensar a transferência das políticas e de proteção social, e em especial é preciso combater a discriminação negativa sobre os indígenas que culturalmente vem sendo construída na sociedade.

Tuberculosis (TB) is a public health problem and especially in vulnerable groups, being one of the most important causes of morbidity and mortality in the indigenous population. Qualitative study with the objective of analyzing the transfer of tuberculosis control policy in the indigenous population in a border region, in the state of Paraná. 36 professionals participated in the research, including managers and team workers, through semi-structured interviews, with questions related to the transfer of the TB control policy in an indigenous population. The collection of primary data was carried out in the months of February and March 2019. Secondary data extracted from the period 2001 to 2018 from the Information System for Notifiable Diseases via the Electronic System of the Citizen Information Service were also used. Qualitative data were organized and categorized using the Atlas.ti 7.0 software, based on the content analysis framework, thematic modality, and the quantitative data analyzed using statistics. The results revealed that of the 36 research subjects, 34 (94.4%) had training in health, 11 (30.6%) worked in health care for the indigenous, 25 (69.4%) held management positions, and of the total participants, 25 (69.4%) were nursing professionals. The municipalities in the study held 50% of the tuberculosis notification number among indigenous people in the state's border strip. Tuberculosis has affected indigenous people living in rural areas (74%), male (59.3%), economically active (45.8%) and with no or low education (68.8%). Pulmonary tuberculosis was present in (88.5%) of diagnosed cases and the outcome for cure did not reach the goal of 85% of cases. The qualitative phase revealed that nursing has taken control of tuberculosis in indigenous people; difficulties in management and integration of the health system were identified; maintenance of inputs and infrastructure; guarantee of general policy guidelines. The high turnover, deficit of professionals, lack of permanent education and precarious labor relations have compromised the care practice and the monitoring of tuberculosis cases with the teams. It is concluded that models of transfer of tuberculosis policy and control, adopted in indigenous populations in the border region, are still one of the obstacles to guaranteeing resolutive, equitable and rule of law assistance. The border context requires a better understanding of regional specificities, mode of social organization and the aspects that determine the lives of indigenous populations, permeated by an intercultural and vulnerable environment. It is necessary to rethink the transfer of policies and social protection, and especially it is necessary to combat the negative discrimination against indigenous people that has been culturally constructed in society.

Estratégias para retomada do ensino superior em saúde frente a COVID-19 / Strategies for resuming higher education in health in relation to covid-19

Refletir sobre a adoção de estratégias a serem implementadas pelas Instituições de Ensino Superior que oferecem cursos da área de saúde para continuidade das suas atividades acadêmicas durante a pandemia pela COVID-19, primando pela saúde física e mental dos seus docentes e discentes. Método: Trata-se de um estudo teórico reflexivo estruturado em três eixos temáticos, cujo levantamento bibliográfico abrangeu livros, documentos oficiais do Ministério da Saúde do Brasil, artigos científicos nacionais e internacionais presentes nas bases de dados da PUBMED/MEDLINE, Web of Science, LILACS e SciELO. Foram selecionados mediante o uso de combinações de palavras-chave relacionadas ao tema"COVID-19", "ensino online", "biossegurança", "aprendizado online", "estresse", "práticas integrativas e complementares em saúde". Resultados: O primeiro eixo destaca a adoção de estratégias virtuais para evitar aglomerações e o risco de contaminação pela COVID-19; o segundo, a utilização de medidas de biossegurança para a realização de atividades acadêmicas presenciais; e o terceiro, as ações de enfrentamento do estresse emocional experimentado pelos docentes e discentes nesse mesmo contexto. Conclusões: Evidencia-se imprescindível adoção de estratégias pedagógicas na tentativa de encontrar soluções criativas e responsáveis pelas Instituições de Ensino Superior em Saúde a fim de minimizar o comprometimento do ensino-aprendizagem e evitar danos à saúde física e mental daqueles que são protagonistas desse processo

To reflect on the adoption of strategies to be implemented by Higher Educational Institutions that offer courses in the health field to continue their academic activities during the COVID-19 pandemic, focusing on the physical and mental health of their professors and students. Methods: This is a reflective theoretical study structured in three thematic axes, whose bibliographic survey covered books, official documents from the Ministry of Health of Brazil, national and international scientific articles from the databases of PUBMED/MEDLINE, Web of Science, LILACS and SciELO. The selection was conducted using combinations of keywords related to the issue: "COVID-19", "online teaching", "biosafety", "online learning", "stress", "integrative and complementary healthcare practices". Results: The first axis highlights the adoption of virtual strategies to avoid agglomerations and the risk of contamination by COVID-19; the second, the use of biosafety measures to carry out on-site academic activities; and the third, actions to cope with the emotional stress experienced by professors and students in this context. Conclusions: It is essential to adopt pedagogical strategies in an attempt to find creative and responsible solutions for Higher Educational Institutions in Health in order to minimize teaching-learning weakening and avoid damage to the physical and mental health of those who are protagonists of this process.

Do patients of integrative anthroposophic pediatric inpatient departments differ? Comparative analysis to all pediatric inpatients in Germany considering demographic and clinical characteristics.

BACKGROUND: Integrative medicine (IM) is a patient-centered, evidence-based, therapeutic paradigm which combines conventional and complementary approaches. The use of IM in pediatrics has increased in the past two decades and parents' demand for it is growing. An IM whole systems approach is anthroposophic medicine. Considering the growing demand for integrative approaches in children, it is relevant from a public health perspective to find out which kind of children use IM in Germany and whether they differ from the entirety of pediatric inpatients in Germany. Moreover, it would be interesting to known, whether these patients are willing to travel a longer distance to gain integrative treatment. METHODS: The present study investigates the standard ward documentation datasets of 29,956 patients of all German integrative anthroposophic pediatric inpatient wards from 2005 to 2016 and compares them systematically to collect data of the entirety of all pediatric inpatient wards in Germany. Apart from patients' age and gender, and the ICD-10 admission diagnoses, the geographical catchment area of the hospitals were analyzed. RESULTS: Sociodemographic characteristics of pediatric inpatients in the integrative anthroposophic departments (IAH) did not differ from the entirety of all pediatric inpatients. Regarding clinical characteristics, higher frequencies were found for endocrine, nutritional and metabolic diseases (IAH: 7.24% vs. 2.98%); mental, behavioral, and neurodevelopmental disorders (IAH: 9.83% vs. 3.78%) and nervous diseases (IAH: 8.82% vs. 5.16%) and lower frequencies for general pediatric diseases such as respiratory diseases (IAH: 17.06% vs. 19.83%), digestive diseases (IAH: 3.90% vs. 6.25%), and infectious and parasitic diseases (IAH: 12.88% vs. 14.82%) in comparison to the entirety of all pediatric inpatients in Germany. The IAH showed a broad catchment area, with most patients being from former, Western federal republic of Germany. Large catchment areas (> 100 km) for the IAH are merely covered by severe and chronic diseases. CONCLUSION: Pediatric inpatients of IAH do not differ from the entirety of pediatric inpatients in Germany regarding sociodemographic characteristics but show differences regarding clinical characteristics. Parents are willing to travel further distance to get specialized integrative anthroposophic medical care for children with severe and chronic diseases.

Effect of Birth Preparedness on Institutional Delivery in Semiurban Ethiopia: A Cross-Sectional Study.

BACKGROUND: Ethiopia has one of the lowest rates of facility delivery and is promoting birth preparedness among pregnant women through its community health services to increase the rate of institutional delivery and reduce maternal mortality. Observational studies of birth preparedness in Ethiopia have thus far only reported the marginal effect of birth preparedness when controlling for other factors, such as parity and education. OBJECTIVES: In this cross-sectional study, we use propensity score modeling to estimate the average population-level effect of birth preparedness on the likelihood of delivering at a facility. METHODS: We conducted secondary analysis of household survey data collected from 215 women with a recent live birth within the catchment areas of 10 semi-urban health centers. A mother was considered well prepared for birth if she reported completing four of the following six actions: identified a skilled provider, identified an institution, saved money, identified transport, prepared clean delivery materials, and prepared food. We performed unadjusted and multivariate logistic regression analyses, with and without propensity score weighting, to assess the relationship between birth preparedness and institutional delivery. FINDINGS: One hundred respondents (47%) delivered in an institution, and over two-thirds (151, 71%) were considered well prepared for birth. Institutional delivery was more common among women who were considered well prepared (57%) versus those who were considered not well prepared (19%). In the model with propensity score weighting, women who were well prepared for birth had 3.83 times higher odds of delivering at a facility (95% CI: 1.41-10.40, p-value = 0.010). CONCLUSIONS: This study contributes to existing evidence supporting the inclusion of antenatal birth preparedness counseling as a part of an antenatal care package for promoting institutional delivery. Important gaps remain in operationalizing the definition of birth preparedness and understanding the pathway from exposure to outcome.

Endovascular Clot Retrieval by Hub-and-Spoke Service Delivery is Feasible Compared with Direct-to-Mothership.

BACKGROUND: Endovascular clot retrieval (ECR) improves outcomes for acute ischaemic stroke with large artery occlusion. However, the provision of ECR requires resource-intensive comprehensive stroke centres (CSC), which are impractical to establish in regional hospitals. An alternative is a "hub-and-spoke" model, whereby ischaemic strokes are triaged at the regional primary centres and where eligible, transferred to a CSC. We aimed to compare the outcomes of patients directly admitted to a CSC with patients treated in the "hub-and-spoke" model. We hypothesize that there are no significant differences in clinical outcomes between the 2 systems. METHODS: We included patients undergoing ECR at a CSC. Patients were categorised into 2 groups; the first group included patients directly admitted to the CSC and the second group included patients in the "hub-and-spoke" model. Good clinical outcome was defined as modified Rankin Scale 0-2 and the difference between the 2 groups was tested by logistic regression. RESULTS: Of 178 patients, 50 (28%) presented directly to CSC and 128 (72%) were transferred from a referring hospital. The median age was 70 (interquartile range 58-77) and 61% were male. Thrombolysis in ischaemic cerebral-infarction 2b/3 recanalisation was achieved in 79% of patients. Of the direct group, 63% (95% CI 48-77%) achieved good clinical outcomes compared to 52% (95% CI 43-61%) in the "hub-and-spoke" group (p = 0.233). CONCLUSION: This state-wide service model demonstrates comparable clinical outcomes to that described in clinical trials. We found no significant difference in outcome between patients directly admitted to CSC and those with "hub-and-spoke" service delivery.