Community-engaged Research Partnerships as Healing Spaces for Health Professionals and Researchers.

Drawing from collective experiences in our capacity building project: Health Equity Activation Research Team for Inclusion Health, we argue that while community-engaged partnerships tend to focus on understanding health inequities and developing solutions, they can be healing spaces for health professionals and researchers. Data were obtained from a 15-month participatory ethnography, including focus groups and interviews. Ethnographic notes and transcripts were coded and analyzed using both deductive and inductive coding. Practices of radical welcome, vulnerability, valuing the whole person, acknowledging how partnerships can cause harm, and centering lived experience expertise in knowledge creation processes were identified as key characteristics of healing spaces. Ultimately, health professionals and researchers work within the same social, political and economic contexts of populations with the worst health outcomes. Their own healing is critical for tackling larger systemic changes aimed at improving the well-being of communities harmed by legacies of exclusion.

Vulnerabilities mediating the Healthcare encounter: by an intersectional agency. / Vulnerabilidades mediando o encontro do Cuidado em Saúde: por uma agência interseccional.

This essay elucidates the Healthcare and Intersectionality notions to prompt reflections on the interaction between healthcare professionals and individuals referred to as Nanás: elderly, poor, and Black women who represent a historically marginalized profile throughout Brazilian history. By delving into the arguments about the concept of Intersectionality and the multifaceted Care dimensions, it becomes apparent that there is a pressing need to broaden the perspective on women who access healthcare services, as they are inherently shaped by their life experiences. Moreover, it is imperative to acknowledge how the intersecting factors inherent in their profiles can influence the approach taken by those providing Care, which underscores the essentiality of an intersectional agency on the part of the agents involved in this encounter, namely the Nanás and healthcare workers, to effectively uphold the principles of comprehensiveness and equity within the Unified Health System (SUS).

O presente ensaio articula os conceitos de Cuidado em Saúde e Interseccionalidade para suscitar reflexões sobre o encontro entre o/a trabalhador/a de saúde e aquelas que aqui denominamos uma Naná: uma mulher, negra, idosa e periférica, perfil historicamente vulnerabilizado ao longo da história brasileira. Considerando as argumentações que envolvem o conceito de Interseccionalidade e as diferentes vertentes acerca do Cuidado, observamos a necessidade de se ampliar o olhar sobre estas que buscam os serviços de saúde já atravessadas por suas histórias de vida, e ponderar sobre os atravessamentos que seu perfil pode acionar em quem exerce o Cuidado. Aponta ser primordial uma agência interseccional por parte das/os agentes deste encontro, Nanás e profissionais de saúde, para que se concretizem os princípios de integralidade e equidade no Sistema Único de Saúde (SUS).

[The right to health goes through the right to a home.] / Il diritto alla salute passa per il diritto a una casa.

Unhealthy housing is bad for your health. This was recently pointed out by the report Left out in the cold: the hidden health costs of Britain's cold homes by the UCL Institute of Health Equity and a The Lancet editorial. Those who suffer most are the poorest and most disadvantaged households due to determinants of gender, ethnicity or disability. Although the World health organisation guidelines on housing and health promote adequate housing as a key factor to improve health, many governments are slow to act. Supporting policies that restore the right to housing - and to a safe home - should be a priority for governments. Not least because it would be an investment: improving housing conditions reduces inappropriate access to emergency departments and hospital admissions. Health workers can play a key role as privileged observers of the individuals and families who would benefit most from public institutional support.

Improving supportive, palliative and end of life care for teenagers and young adults with cancer in adult haematology services.

PURPOSE OF REVIEW: Adolescents with haematological malignancies within adult services, in the UK from 16 years old, have unique needs and require developmentally targeted services and approaches to care delivery. High-risk intensive treatments are common for this cohort and a better understanding of what individualised supportive and palliative care means in this context is required. RECENT FINDINGS: Being known and understood as an emerging adult, with particular recognition of developmental stage, is an essential component of quality measures and underpins the adolescent, and caregiver, experience when faced with an uncertain or poor cancer prognosis (UPCP). Healthcare professionals (HCPs) can experience increased emotional labour and feelings of professional inadequacy when caring for adolescents with UPCP. Therapeutic alliance improves HCPs understanding of optimum individualised care by improving communication and supported decision making. Access to training and support for HCPs is required to address the emotional impact of therapeutic alliance with teenage/adolescent and young adults (T/AYAs) with advanced cancer. SUMMARY: Investment in therapeutic alliance, alongside robust support mechanisms and targeted training, can improve the skills, confidence and wellbeing for HCPs, and can also ensure optimum individualised care for T/AYAs with UPCP. Evidence for optimum care for adolescents with advanced cancer is relatively scarce, especially for younger T/AYAs (16-24) in the UK who sit within adult services. Further evaluation of the impact of current UK expertise, services and programs are needed to inform future development.

Global health workforce strategies to address the COVID-19 pandemic: Learning lessons for the future.

COVID-19 put unprecedented strain on the health and care workforce (HCWF). Yet, it also brought the HCWF to the forefront of the policy agenda and revealed many innovative solutions that can be built upon to overcome persistent workforce challenges. In this perspective, which draws on a Policy Brief prepared for the WHO Fifth Global Forum on Human Resources for Health, we present findings from a scoping review of global emergency workforce strategies implemented during the pandemic and consider what we can learn from them for the long-term sustainability of the HCWF. Our review shows that strategies to strengthen HCWF capacity during COVID-19 fell into three categories: (1) surging supply of health and care workers (HCWs); (2) optimizing the use of the workforce in terms of setting, skills and roles; and (3) providing HCWs with support and protection. While some initiatives were only short-term strategies, others have potential to be continued. COVID-19 demonstrated that changes to scope-of-practice and the introduction of team-based roles are possible and central to an effective, sustainable workforce. Additionally, the use of technology and digital tools increased rapidly during COVID-19 and can be built on to enhance access and efficiency. The pandemic also highlighted the importance of prioritizing the security, safety, and physical and mental health of workers, implementing measures that are gender and equity-focused, and ensuring the centrality of the worker perspective in efforts to improve HCWF retention. Flexibility of regulatory, financial, technical measures and quality assurance was critical in facilitating the implementation of HCWF strategies and needs to be continued. The lessons learned from COVID-19 can help countries strengthen the HCWF, health systems, and the health and well-being of all, now and in the future.

Headache as the most prevalent post-vaccination adverse event after Covid-19 vaccination / Dor de cabeça como evento adverso pós-vacinação mais prevalente após a vacinação contra Covid-19

BACKGROUND: In 2020, the first vaccines were approved, according to the WHO. However, speculations arose regarding their efficacy and post-vaccination adverse events (AEFV). OBJECTIVE: To evaluate the prevalence of headache as AEFI from the SARSCoV-2 vaccine in Piauí, Brazil. METHODS: This is a quantitative, observational, cross-sectional, and prevalence study. Data were provided by the Post-Vaccination Adverse Event Information System (SI-AEFV), from reported cases from January to September 2021. Data were analyzed, and the research was approved by the UFPI Research Ethics Committee. RESULTS: A total of 2,008 cases were analyzed. Headache was reported in 752 cases (27.99%) as an AEFV after vaccination against SARS-CoV-2. In most cases, patients were from Teresina (67.62%), of brown race/ethnicity (52.67%), female (79.00%), and the majority were not healthcare professionals (54.27%). The most common age of patients, with the original data, was 33 years. After data correction, the most common age was 28 years. The majority of these cases were not severe (96.44%), and the majority of cases were associated with the first dose of the Covid-19-Covishield-Oxford/AstraZeneca vaccine (43.18%).CONCLUSION: Thus, it is concluded from the partial analysis of the results that headache is the most common adverse event after vaccination against SARS-CoV-2. The profile of patients with the most notifications was brown women aged 30 to 40 years who received the first dose of the Covid-19-Covishield-Oxford/AstraZeneca vaccine. Regarding the severity of events, the vast majority were considered non-severe, and no deaths were mentioned, demonstrating the safety of immunobiologicals.

FUNDAMENTO: Em 2020, foram aprovadas as primeiras vacinas, segundo a OMS. No entanto, surgiram especulações quanto à sua eficácia e eventos adversos pós-vacinais (EAPV). OBJETIVO: Avaliar a prevalência de cefaleia como EAPV da vacina SARSCoV-2 no Piauí, Brasil. MÉTODOS: Trata-se de um estudo quantitativo, observacional, transversal e de prevalência. Os dados foram fornecidos pelo Sistema de Informação de Eventos Adversos Pós-Vacinação (SI-AEFV), dos casos notificados no período de janeiro a setembro de 2021. Os dados foram analisados ​​e a pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da UFPI. RESULTADOS: Foram analisados ​​2.008 casos. Cefaleia foi relatada em 752 casos (27,99%) como EAPV após vacinação contra SARS-CoV-2. Na maioria dos casos, os pacientes eram procedentes de Teresina (67,62%), de raça/etnia parda (52,67%), do sexo feminino (79,00%) e a maioria não era profissional de saúde (54,27%). A idade mais comum dos pacientes, com os dados originais, era de 33 anos. Após correção dos dados, a idade mais comum foi 28 anos. A maioria desses casos não foi grave (96,44%), e a maioria dos casos esteve associada à primeira dose da vacina Covid-19-Covishield-Oxford/AstraZeneca (43,18%).CONCLUSÃO: Assim, conclui-se a partir da análise parcial dos resultados de que cefaleia é o evento adverso mais comum após vacinação contra SARS-CoV-2. O perfil dos pacientes com mais notificações foi de mulheres pardas com idade entre 30 e 40 anos que receberam a primeira dose da vacina Covid-19-Covishield-Oxford/AstraZeneca. Quanto à gravidade dos eventos, a grande maioria foi considerada não grave e não foram mencionados óbitos, demonstrando a segurança dos imunobiológicos.

Organização e assistência da atenção primária à saúde no enfrentamento da COVID-19 / Organization and assistance of primary health care facing COVID-19 / Organización y asistencia de la atención primaria de salud en el enfrentamiento al COVID-19

Objetivo: analisar a organização e assistência dos serviços da Atenção Primária à Saúde no enfrentamento da COVID-19. Método: estudo transversal realizado com 49 profissionais da saúde de unidades básicas de saúde e estratégia de saúde da família no município de São Carlos. Os dados foram coletados por meio de questionário auto respondido no período de maio de 2021 a fevereiro de 2022. As associações foram analisadas por teste qui-quadrado e estimadas as razões de prevalência. O protocolo de pesquisa foi aprovado pelo Comite de Ética em Pesquisa. Resultados: a identificação de sinais e sintomas do paciente, orientações sobre as medidas de prevenção e verificação da disponibilidade de leitos em hospitais de referência, foram variáveis que se apresentaram diferentes entre os serviços de saúde. Conclusão: a APS exerce papel central no enfrentamento da pandemia, com necessidade de os gestores identificarem as fragilidades e direcionarem ações de educação permanente diante de novos cenários(AU)

Objective: to analyze the organization and assistance of Primary Health Care services facing COVID-19. Method: cross-sectional study carried out with 49 health professionals from basic health units and family health strategy in the city of São Carlos. Data were collected through a self-answered questionnaire from May 2021 to February 2022. Associations were analyzed using the chi-square test and prevalence ratios were estimated. The research protocol was approved by the Research Ethics Committee. Results: identification of the patient's signs and symptoms, guidance on prevention measures and checking the availability of beds in reference hospitals were variables that differed between health services. Conclusion: Primary Health Care services play a central role facing COVID-19 pandemic, with managers needing to identify weaknesses and direct ongoing education actions in the face of new scenarios(AU)

Objetivo: analizar la organización y asistencia de los servicios de Atención Primaria de Salud en el combate al COVID-19. Método: estudio transversal realizado con 49 profesionales de la salud de unidades básicas de salud y estrategia de salud de la familia de la ciudad de São Carlos. Los datos se recolectaron a través de un cuestionario de auto respuesta desde mayo de 2021 hasta febrero de 2022. Se analizaron las asociaciones mediante la prueba de chi-cuadrado y se estimaron las razones de prevalencia. El protocolo de investigación lo aprobó el Comité de Ética en Investigación. Resultados: la identificación de los signos y síntomas del paciente, las orientaciones sobre medidas de prevención y la verificación de la disponibilidad de camas en los hospitales de referencia fueron variables que difirieron entre los servicios de salud. Conclusión: La APS juega un papel central en el enfrentamiento a la pandemia, siendo necesario que los gestores identifiquen debilidades y orienten acciones educativas continuas ante nuevos escenarios(AU)

Concepções e contribuições de trabalhadores de saúde sobre ambiente de trabalho saudável / Concepciones y contribuciones de trabajadores de la salud sobre ambientes de trabajo saludables / Health workers' conceptions and contributions regarding healthy work environments

Objetivo: discutir concepções e contribuições de trabalhadores de uma instituição hospitalar, acerca de ambientes de trabalho saudáveis. Método: estudo exploratório descritivo, de abordagem qualitativa, que entrevistou 21 trabalhadores do Serviço de Saúde Ocupacional e Segurança do Trabalho e da Comissão Interna de Prevenção de Acidentes de um hospital público de grande porte da região Norte do país. Os dados foram analisados pela Análise de Conteúdo Focal apoiada por recursos do software ATLAS.ti, 9.0. Resultados: quatro categorias foram geradas: condições necessárias: materiais e pessoal; desafios a superar: gestão, reconhecimento, desgaste e acolhimento; sugestões e ferramentas; concepções para um ambiente de trabalho saudável. As contribuições apreendidas na análise indicam componentes que se referem ao bem-estar ao trabalhar, efetiva proteção e controle de riscos, e relações interpessoais positivas. Considerações finais: os trabalhadores de saúde expressam fragilidades e necessidades que podem contribuir para a compreensão, intervenções e melhorias dos ambientes do trabalho.

Objetivo: debatir concepciones y contribuciones de trabajadores de una institución hospitalaria sobre ambientes de trabajo saludables. Método: estudio cualitativo en el que se entrevistó a 21 trabajadores del Servicio de Seguridad y Salud en el Trabajo y de la Comisión Interna de Prevención de Accidentes de un hospital público de gran porte de la región norte del país. Los datos se analizaron mediante análisis de contenido focal compatible con características del software ATLAS.ti, 9.0. Resultados: se generaron cuatro categorías: Condiciones necesarias: materiales y personal; Retos a superar: gestión, reconocimiento, desgaste y aceptación; Sugerencias y herramientas; y (Concepciones) para ambientes de trabajo saludables. Los aportes derivados del análisis señalan componentes que se refieren al bienestar en el trabajo, protección y control de riesgos efectivos, y relaciones interpersonales positivas. Consideraciones finales: los trabajadores de la salud expresan debilidades y necesidades que pueden contribuir a la comprensión, intervenciones y mejoras en los ambientes de trabajo.

Objective to discuss conceptions and contributions of hospital workers about healthy work environments. Method: a qualitative study that interviewed 21 workers from the Occupational Health and Safety Service and the Internal Accident Prevention Commission from a large-sized public hospital in the northern region of the country. The data were analyzed by means of Focal Content Analysis supported by ATLAS.ti, 9.0 software features. Results: four categories were generated: Necessary conditions: materials and personnel; Challenges to overcome: management, recognition, attrition and acceptance; Suggestions and tools; and (Conceptions) for healthy working environments. The contributions seized in the analysis indicate components that refer to well-being at work, effective protection and risk control, and positive interpersonal relationships. Final considerations: health workers express weaknesses and needs that can contribute to understanding, interventions and improvements in work environments.

Construção e validação de ferramenta preventiva sobre incompatibilidade medicamentosa em via Y / Construction and validation of a preventive tool on drug incompatibility in the Y-route / Construcción y validación de una herramienta preventiva de incompatibilidad de medicamentos en la ruta Y

Introdução: A terapia com medicamentos endovenosos é muito utilizada nas unidades hospitalares, porém, possui uma elevada chance de incidentes, principalmente quando os medicamentos são administrados simultaneamente em via Y. Essa prática pode resultar em incompatibilidades medicamentosas classificadas em reações físicas e químicas. Objetivo: Construir e validar uma ferramenta preventiva de incompatibilidade medicamentosa em via Y. Método: Estudo metodológico com abordagem quantitativa. Foi desenvolvido em três etapas: Levantamento bibliográfico, construção e diagramação do material e por fim, a validação da ferramenta preventiva. Para validação, a ferramenta preventiva foi submetida ao processo de validação de face e conteúdo por juízes com expertise na temática. Resultados: Construiu-se e validou-se uma ferramenta preventiva através da busca de dados na literatura com a participação de sete juízes especialistas na temática. Os itens avaliativos referentes a tabela de incompatibilidade medicamentosa quanto aos objetivos, estrutura, apresentação e relevância da ferramenta preventiva foi considerada válida, pois foram julgados como adequado pelos especialistas. Conclusão: A validação de conteúdo, foi considerada válida pelos juízes, portanto, espera-se que o material alcance o seu objetivo ao ser aplicado durante a prática clínica. Dessa forma, será disponibilizado à instituição para que seja utilizado, favorecendo a prevenção de danos e contribuindo para a segurança dos pacientes, bem como melhorando a qualidade da assistência e educação em saúde.

Introduction: Intravenous drug therapy is widely used in hospital units, however, it has a high chance of incidents, especially when drugs are administered simultaneously in a Y route. This practice can result in drug incompatibilities classified into physical and chemical reactions. Objective: To build and validate a preventive tool for drug incompatibility in the Y pathway. Method: Methodological study with a quantitative approach. It was developed in three stages: bibliographic survey, construction and layout of the material and finally, the validation of the preventive tool. For validation, the preventive tool was submitted to the face and content validation process by judges with expertise in the subject. Results: A preventive tool was built and validated through the search for data in the literature with the participation of seven expert judges on the subject. The evaluative items referring to the medication incompatibility table regarding the objectives, structure, presentation and relevance of the preventive tool were considered valid, as they were judged as adequate by the specialists. Conclusion: The content validation was considered valid by the judges, therefore, it is expected that the material reaches its objective when applied during clinical practice. In this way, it will be made available to the institution for use, favoring the prevention of damage and contributing to patient safety, as well as improving the quality of health care and education.

Introducción: La farmacoterapia intravenosa es ampliamente utilizada en las unidades hospitalarias, sin embargo, tiene una alta probabilidad de incidencias, especialmente cuando los fármacos se administran simultáneamente en una vía Y. Esta práctica puede dar lugar a incompatibilidades medicamentosas clasificadas en reacciones físicas y químicas. Objetivo: Construir y validar una herramienta preventiva de incompatibilidad de medicamentos en la vía Y. Método: Estudio metodológico con enfoque cuantitativo. Se desarrolló en tres etapas: relevamiento bibliográfico, construcción y diagramación del material y finalmente, la validación de la herramienta preventiva. Para la validación, la herramienta preventiva fue sometida al proceso de validación facial y de contenido por jueces expertos en el tema. Resultados: Se construyó y validó una herramienta preventiva a través de la búsqueda de datos en la literatura con la participación de siete jueces expertos en el tema. Los ítems evaluativos referentes a la tabla de incompatibilidad de medicamentos en relación a los objetivos, estructura, presentación y relevancia de la herramienta preventiva fueron considerados válidos, pues fueron juzgados como adecuados por los especialistas. Conclusiones: La validación del contenido fue considerada válida por los jueces, por lo tanto, se espera que el material alcance su objetivo al ser aplicado durante la práctica clínica. De esta forma, se pondrá a disposición de la institución para su uso, favoreciendo la prevención de daños y contribuyendo a la seguridad del paciente, además de mejorar la calidad de la atención y educación en salud.

Caminhos do apoio nstitucional no cotidiano das equipes de saúde / Paths of institutional support in the family health strategy / Caminos del apoyo institucional en la estrategia de salud de la familia

Este artigo é sobre o Apoio Institucional como ferramenta para consolidação das práticas no Sistema Único de Saúde (SUS). Com base na análise institucional, esta pesquisa mostra caminhos do trabalho do Apoio Institucional (AI) às equipes de Estratégia de Saúde da Família (ESF), a partir de uma experiência enquanto apoiadora. Refletindo sobre a função de apoio às equipes da ESF de um município do interior do Rio Grande do Sul, a serem avaliadas pela adesão ao Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ), objetivou-se principalmente apresentar a função do AI auxiliando as equipes e; especificamente, mapear as relações de cogestão e autonomia preconizadas pelo SUS, e explorar os discursos e práticas dessa construção. Constitui-se este em um aporte que prioriza saberes que, para além dos acadêmicos, abarca o saber cotidiano dos atores envolvidos, dando voz às experiências dos trabalhadores e gestores nos seus contextos sociais.

This article presents a report about Institutional Support (AI) as a tool for consolidating practices in the UnifiedHealth System (SUS). Based on the concepts of institutional analysis, the experience as a supporter shows ways of working in Institutional Support for Family Health Strategy (ESF) teams. Reflecting the role of support to the FHS teams of a municipality inthe interior of Rio Grande do Sul, to be evaluated by the adhesion to the Access and Quality Improvement Program of Primary Care, the objective was: to present the role of the AI helping the teams and, specifically, to map the co-management and autonomy relationships recommended by the SUS, exploring the practices of this construction. The tool democratized the relationship between workers and managers, promoting greater communication between them, constituting a contribution that prioritized, in addition to academic knowledge, the everyday knowledge of the actors involved, giving voice to their experiences in their social contexts. (AU)

Este artículo presenta un informe sobre el Apoyo Institucional (AI) como herramienta para la consolidación de prácticas en el Sistema Único de Salud (SUS). Con base en los conceptos del análisis institucional, la experiencia como acompañante muestra formas de trabajar en equipos de Apoyo Institucional a la Estrategia de Salud de la Familia (ESF). Reflejando el papel de apoyo a los equipos de la ESF de un municipio del interior de Rio Grande do Sul, a ser evaluado por la adhesión al Programa de Mejora del Acceso y la Calidad de la Atención Básica, el objetivo fue: presentar el papel de la AI ayudar a los equipos y, específicamente, mapear las relaciones de cogestión y autonomía recomendadas por el SUS, explorando las prácticas de esa construcción. La herramienta democratizó la relación entre trabajadores y directivos, promoviendo una mayor comunicación entre ellos, constituyendo un aporte que priorizó, además del conocimiento académico, el conocimiento cotidiano de los actores involucrados, dando voz a sus experiencias en sus contextos sociales. (AU)

Organización y división del trabajo: riesgos para trabajadores de servicios de salud en empresas venezolanas / Organization and division of labor: risks for health services workers in Venezuelan companies

Los modos de producción generan formas de organización y división del trabajo que puede ocasionar la aparición de riesgos psicosociales como la fatiga o el estrés laboral. El objetivo del presente estudio fue, evaluar los factores de riesgo psicosociales, la fatiga y el estrés laboral en profesionales integrantes de Servicios de Seguridad y Salud en el Trabajo, en cuatro empresas venezolanas en el 2020. Estudio de campo, descriptivo, de corte transversal. Participaron 39 trabajadores (muestra censal), 25,6% inspectores, 20,6% enfermeras y 20,6% personal médico. Se usó el cuestionario SUSESO/ISTAS21 versión breve, el cuestionario de Estrés Laboral OIT-OMS, el cuestionario de Síntomas Subjetivos de Fatiga y el cuestionario de Problemas Psicosomáticos. Resultados: Solo el 51% son del sexo masculino, promedio de edad de 35±8,7con antigüedad de 6±4,5años. Todos están bajo el tipo de contratación tercerizada (outsourcing). Resultó un trabajo de alta demanda, pero con alto control (trabajo activo). Niveles de riesgo medio (45%) vinculado al Apoyo Social y Calidad de liderazgo y nivel de riesgo alto (40%) en Compensaciones y Doble presencia. El trabajo es fatigante para el 30,7% y el estresor con mayor puntaje fue la Influencia del Líder. Concluyéndose que en estos servicios hay un número importante de profesionales femeninos, adultos jóvenes, con antigüedad laboral, expuestos a diferentes factores de riesgo psicosociales con importante influencia del líder, generadores de fatiga laboral. Recomendándose la revisión del tipo de contratación, la compensación dineraria, así como evaluaciones periódicas sobre el clima laboral(AU)

The modes of production generate forms of organization and division of labor that can cause the appearance of psychosocial risks such as fatigue or work stress. The objective of this study was to evaluate psychosocial risk factors, fatigue and work stress in professionals who are members of Occupational Health and Safety Services, in four Venezuelan companies in 2020. Descriptive, crosssectional field study. 39 workers (census sample) participated, 25.6% inspectors, 20.6% nurses and 20.6% medical personnel. The SUSESO/ISTAS21 short version questionnaire, the OIT-WHO Work Stress questionnaire, the Subjective Symptoms of Fatigue questionnaire and the Psychosomatic Problems questionnaire were used. Results: Only 51% were male, mean age 35 ± 8.7 with seniority age of 6 ± 4.5 years. All are under the outsourcing type of hiring. It turned out to be a high demand job, but with highly controlled (active work). Medium risk levels (45%) linked to Social Support and Leadership Quality, and high risk level (40%) in Compensations and Double presence. The work is tiring for 30.7% and the stressor with the highest score was the Influence of the Leader. It was concluded that in these services there are a significant number of female professionals, young adults, with seniority, exposed to different psychosocial risk factors with Important Leader Influence, generators of work fatigue. Recommending the review of the type of contract, the monetary compensation, as well as periodic evaluations of the work environment(AU)

COVID-19 vaccine hesitancy and anti-vaxxers - supporting healthcare workers to navigate the unvaccinated: Reflections from clinical practice.

An important step in preparation for the fourth COVID-19 wave is to provide healthcare workers (HCWs) with skills to facilitate behaviour change in vaccine-hesitant patients. Convincing members of the public who are vaccine hesitant rather than anti-vaxxers should be the focus of our efforts. Our experience is that vaccine-hesitant individuals and anti-vaxxers are generally distinct cohorts, with differing reasons for their vaccine reluctance. If we are to truly address hesitancy, we must take time to understand the reasons for an individual's hesitancy. Developing a conceptual framework and skills for HCWs during encounters with unvaccinated individuals will be important not only for shifting some to get vaccinated, but also to manage the complex emotions that HCWs will undoubtedly be forced to confront during the fourth wave.

Healthcare providers experiences with shared medical appointments for heart failure.

Shared medical appointments (SMAs) offer a means for providing knowledge and skills needed for chronic disease management to patients. However, SMAs require a time and attention investment from health care providers, who must understand the goals and potential benefits of SMAs from the perspective of patients and providers. To better understand how to gain provider engagement and inform future SMA implementation, qualitative inquiry of provider experience based on a knowledge-attitude-practice model was explored. Semi-structured interviews were conducted with 24 health care providers leading SMAs for heart failure at three Veterans Administration Medical Centers. Rapid matrix analysis process techniques including team-based qualitative inquiry followed by stakeholder validation was employed. The interview guide followed a knowledge-attitude-practice model with a priori domains of knowledge of SMA structure and content (understanding of how SMAs were structured), SMA attitude/beliefs (general expectations about SMA use), attitudes regarding how leading SMAs affected patients, and providers. Data regarding the patient referral process (organizational processes for referring patients to SMAs) and suggested improvements were collected to further inform the development of SMA implementation best practices. Providers from all three sites reported similar knowledge, attitude and beliefs of SMAs. In general, providers reported that the multi-disciplinary structure of SMAs was an effective strategy towards improving clinical outcomes for patients. Emergent themes regarding experiences with SMAs included improved self-efficacy gained from real-time collaboration with providers from multiple disciplines, perceived decrease in patient re-hospitalizations, and promotion of self-management skills for patients with HF. Most providers reported that the SMA-setting facilitated patient learning by providing opportunities for the sharing of experiences and knowledge. This was associated with the perception of increased comradery and support among patients. Future research is needed to test suggested improvements and to develop best practices for training additional sites to implement HF SMA.

Multidisciplinary Team Care of Patients with Hemophilic Arthropathy: A Qualitative Assessment of Contemporary Practice in the UK and Canada : Canada/UK: MDT Practices for Hemophilia.

We used a structured interview to explore approaches to comprehensive hemophilia and arthropathy care among 24 healthcare professionals (HCPs) from multidisciplinary teams (MDTs) in Canada and the UK. Represented MDTs typically comprise a hematologist, nurse, physiotherapist, and sometimes an orthopedic surgeon; pediatric (and some adult) MDTs also include a social worker/psychologist. HCPs emphasized the centrality of a team approach, facilitated through MDT meetings and involvement of all MDT members in patient care. In both countries, nurses and physiotherapists play critical, multifaceted roles. Respondents agreed that MDTs are crucial for successful transitioning, which can be facilitated by close collaboration between pediatric and adult MDTs, even when they are not co-located. Physiotherapists are instrumental in providing non-pharmacological pain relief. Hematologists or physiotherapists typically make orthopedic referrals, with the nurse, physiotherapist and hematologist working together in patient preparation for (and follow-up after) surgery. MDT best practices include a non-hierarchical team approach, ensuring that all MDT members know all patients, and regular MDT meetings. Together, these real-life insights from the MDT perspective emphasize the value of the MDT approach in comprehensive hemophilia care.

Effectiveness of various cleaning strategies in acute and long-term care facilities during novel corona virus 2019 disease pandemic-related staff shortages.

BACKGROUND: Cleanliness of hospital surfaces helps prevent healthcare-associated infections, but comparative evaluations of various cleaning strategies during COVID-19 pandemic surges and worker shortages are scarce. PURPOSE AND METHODS: To evaluate the effectiveness of daily, enhanced terminal, and contingency-based cleaning strategies in an acute care hospital (ACH) and a long-term care facility (LTCF), using SARS-CoV-2 RT-PCR and adenosine triphosphate (ATP) assays. Daily cleaning involved light dusting and removal of visible debris while a patient is in the room. Enhanced terminal cleaning involved wet moping and surface wiping with disinfectants after a patient is permanently moved out of a room followed by ultraviolet light (UV-C), electrostatic spraying, or room fogging. Contingency-based strategies, performed only at the LTCF, involved cleaning by a commercial environmental remediation company with proprietary chemicals and room fogging. Ambient surface contamination was also assessed randomly, without regard to cleaning times. Near-patient or high-touch stationary and non-stationary environmental surfaces were sampled with pre-moistened swabs in viral transport media. RESULTS: At the ACH, SARS-CoV-2 RNA was detected on 66% of surfaces before cleaning and on 23% of those surfaces immediately after terminal cleaning, for a 65% post-cleaning reduction (p = 0.001). UV-C enhancement resulted in an 83% reduction (p = 0.023), while enhancement with electrostatic bleach application resulted in a 50% reduction (p = 0.010). ATP levels on RNA positive surfaces were not significantly different from those of RNA negative surfaces. LTCF contamination rates differed between the dementia, rehabilitation, and residential units (p = 0.005). 67% of surfaces had RNA after room fogging without terminal-style wiping. Fogging with wiping led to a -11% change in the proportion of positive surfaces. At the LTCF, mean ATP levels were lower after terminal cleaning (p = 0.016). CONCLUSION: Ambient surface contamination varied by type of unit and outbreak conditions, but not facility type. Removal of SARS-CoV-2 RNA varied according to cleaning strategy. IMPLICATIONS: Previous reports have shown time spent cleaning by hospital employed environmental services staff did not correlate with cleaning thoroughness. However, time spent cleaning by a commercial remediation company in this study was associated with cleaning effectiveness. These findings may be useful for optimizing allocation of cleaning resources during staffing shortages.

Current provision and HCP experiences of remote care delivery and diabetes technology training for people with type 1 diabetes in the UK during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has led to the rapid implementation of remote care delivery in type 1 diabetes. We studied current modes of care delivery, healthcare professional experiences and impact on insulin pump training in type 1 diabetes care in the United Kingdom (UK). METHODS: The UK Diabetes Technology Network designed a 48-question survey aimed at healthcare professionals providing care in type 1 diabetes. RESULTS: One hundred and forty-three healthcare professionals (48% diabetes physicians, 52% diabetes educators and 88% working in adult services) from approximately 75 UK centres (52% university hospitals, 46% general and community hospitals), responded to the survey. Telephone consultations were the main modality of care delivery. There was a higher reported time taken for video consultations versus telephone (p < 0.001). Common barriers to remote consultations were patient familiarity with technology (72%) and access to patient device data (67%). We assessed the impact on insulin pump training. A reduction in total new pump starts (73%) and renewals (61%) was highlighted. Common barriers included patient digital literacy (61%), limited healthcare professional experience (46%) and time required per patient (44%). When grouped according to size of insulin pump service, pump starts and renewals in larger services were less impacted by the pandemic compared to smaller services. CONCLUSION: This survey highlights UK healthcare professional experiences of remote care delivery. While supportive of virtual care models, a number of factors highlighted, especially patient digital literacy, need to be addressed to improve virtual care delivery and device training.

Organizational Impact on Healthcare Workers' Moral Injury During COVID-19: A Mixed-Methods Analysis.

OBJECTIVE: The aim of this study was to explore relationships between organizational factors and moral injury among healthcare workers and the impact of perceptions of their leaders and organizations during COVID-19. BACKGROUND: COVID-19 placed healthcare workers at risk for moral injury, which often involves feeling betrayed by people with authority and can impact workplace culture. METHODS: Secondary data from a Web-based survey of mid-Atlantic healthcare workers were analyzed using mixed methods. Data were synthesized using the Reina Trust & Betrayal Model. RESULTS: Fifty-five percent (n = 328/595) of respondents wrote comments. Forty-one percent (n = 134/328) of commenters had moral injury scores of 36 or higher. Three themes emerged: organizational infrastructure, support from leaders, and palliative care involvement. Respondents outlined organizational remedies, which were organized into 5 domains. CONCLUSIONS: Findings suggest healthcare workers feel trust was breached by their organizations' leaders during COVID-19. Further study is needed to understand intersections between organizational factors and moral injury to enhance trust within healthcare organizations.

Teaming: learning, competing, and innovating in the world of reproductive medicine.

Healthcare teams must be deliberately cultivated to reach their full potential. Shifting focus from individual performance to a team's collective competence allows for targeted and evidence-based interventions that support teamwork and improve patient outcomes. We reviewed essential concepts drawn from team science and explored the practical applications of teaming. Reproductive endocrinology and infertility healthcare providers play a pivotal role by teaching, modeling, and fostering teaming attitudes and behaviors. Through teaming, we can maximize our teams' ability to learn, innovate, compete with other teams, and thrive in today's healthcare environment.

El vínculo en la intervención social: un componente paradójico del acompañamiento domiciliario / O vínculo na intervenção social: um componente paradoxico do acompanhamento domiciliar / Relationship bonds in social intervention: a paradoxical component of home accompaniment

RESUMEN. Este estudio4 cualitativo describe las percepciones de profesionales de la salud acerca del componente relacional de un Modelo de Visita Domiciliaria Avanzada (ViDA). La implementación del modelo contempló una fase de capacitación de los profesionales y al mismo tiempo su participación en la puesta en práctica. Los datos cualitativos se obtuvieron de la aplicación de una entrevista telefónica a 12 profesionales, una entrevista en profundidad a 6 profesionales, 3 de ellos directores de centros de salud familiar, y del análisis de 85 reportes individuales de 34 profesionales capacitados en el modelo ViDA, pertenecientes a dos comunas de la Región Metropolitana de Chile. Los datos fueron organizados por temas y analizados usando el análisis de contenido. Los resultados señalan que el componente vincular del modelo es percibido como un aspecto clave en la realización de las visitas, siendo valorado positivamente por las y los profesionales. Desde su percepción este componente favorece la vinculación con las personas visitadas, motiva una actitud más favorable al cambio, genera transformaciones más profundas, facilita el logro de los objetivos de la intervención y promueve el empoderamiento de las mujeres. Asimismo, perciben desafíos que la capacitación no resuelve: la mejora en los registros, la planificación de la intervención y la formulación de objetivos de la visita.

RESUMO. Este estudo qualitativo descreve as percepções dos profissionais da saúde sobre o componente relacional de um Modelo de Visita Domiciliar Avançada (ViDA). A implementação do modelo considerou uma fase de capacitação dos profissionais e ao mesmo tempo a participação deles na práctica. O dados qualitativos foram obtidos através de uma entrevista telefônica à 12 profissionais, uma entrevista em profundidade à 6 profissionais, 3 deles eram diretores de centros de saúde familiar, e da análise de 85 informes individuais de 34 profissionais capacitados no modelo ViDA, que pertencem a duas comunas da Região Metropolitana do Chile. Os dados foram organizados por temas e trabalhados usando a análise de conteúdo. Os resultados mostram que o componente relacional do modelo é percebido como um aspecto central na realização das visitas, sendo valorizado positivamente pelo/as profissionais. A partir da percepção dele/as, este componente favorece a vinculação com as pessoas visitadas, motiva uma atitude mais favorável à mudanças, gera transformações mais profundas, facilita alcançar os objetivos da intervenção e promove o empoderamento das mulheres. Além disso, o/as profissionais também percebem desafios que a capacitação não resolve: a melhora nos registros, a planificaçao da intervenção e a formulação dos objetivos da visita.

ABSTRACT. This qualitative study describes the insights of health professionals on the relationship component of an Advanced Home Visit Model (ViDA). The implementation of this model involved a training stage for professionals together with their participation in the execution stage. Qualitative data were obtained through phone interviews to 12 professionals, in-depth interviews to 6 professionals, being 3 of them directors of family healthcare centers, and the analysis of 85 individual reports from 34 professionals trained in the ViDA model in two districts of the Metropolitan Region of Chile. Data were organized by subject and analyzed through content analysis. Results highlight the relationship component of the model is perceived as a key aspect in the home visit schedule and is also valued by the professionals as a positive aspect. From such point of view, this component favors the bonding of visited people, increases a favorable attitude towards change, generates deeper transformations, facilitated the achievement of goals, and promotes women empowerment. Also, professionals remarked some challenges the training stage is not solving such as improvement in records, planning of interventions and development of visit purposes.

Concepções de jovens educandos sobre sistema e serviços de saúde públicos / Conceptualizaciones de jóvenes educandos sobre sistema y servicios de salud públicos / Conceptions of young students about public health system and services

RESUMO Objetivo: descrever as concepções de jovens educandos sobre o sistema e serviços de saúde públicos, a partir da pesquisa participante. Métodos: pesquisa participante realizada no período de outubro a dezembro de 2017, com 12 educandos de 12 a 16 anos, pertencentes a uma escola pública de Pelotas. A coleta e análise de dados ocorreu por meio do Círculo de Cultura e Photovoice. Resultados: os educandos associam serviços de saúde com doenças e questões biológicas, e sabem que os serviços prestados pelo Sistema Único de saúde são financiados com dinheiro público. A visão dos educandos sobre a Unidade Básica de Saúde foi preocupante pelo desconhecimento sobre o que é este serviço, apesar da proximidade física com a escola e, além disso, referem não frequentar a unidade. Considerações finais: o diálogo permitiu o reconhecimento de concepções dos educandos relativo ao sistema de saúde, porém evidenciou desconhecimento e falta de vivências em serviços públicos. Isto reforça a importância da promoção do diálogo no espaço da escola para que se tenha a formação de cidadãos críticos e atuantes na sociedade, podendo refletir na construção de outros significados e valores e com isso, outras concepções de sociedade, saúde e doença.

RESUMEN Objetivo: describir las conceptualizaciones de jóvenes educandos sobre el sistema y servicios de salud públicos, a partir de la investigación participante. Método: investigación participante realizada en el período de octubre a diciembre de 2017, con 12 educandos de 12 a 16 años, pertenecientes a una escuela pública de Pelotas-RS-Brasil. La recolección y el análisis de datos se llevó a cabo a través del Círculo de Cultura y Photovoice. Resultados: los educandos asocian los servicios de salud con enfermedades y problemas biológicos, y saben que los servicios prestados por el Sistema Único de Salud se financian con dinero público. La visión de los educandos sobre la Unidad Básica de Salud fue preocupante por el desconocimiento sobre qué es este servicio, a pesar de la proximidad física con la escuela y, además, relatan no frecuentar la unidad. Consideraciones finales: el diálogo permitió el reconocimiento de conceptualizaciones de los educandos relativo al sistema de salud, pero evidenció desconocimiento y falta de vivencias en servicios públicos. Esto refuerza la importancia de la promoción del diálogo en el espacio de la escuela para que se tenga la formación de ciudadanos críticos y actuantes en la sociedad, pudiendo reflejar en la construcción de otros significados y valores y con ello, otras conceptualizaciones de sociedad, salud y enfermedad.

ABSTRACT Objective: to describe the conceptions of young students about the public health system and services, based on the participant research. Methods: participant research conducted from October to December 2017, with 12 students aged 12 to 16 years, belonging to a public school in Pelotas. Data collection and analysis occurred through the Circle of Culture and Photovoice. Results: students associate health services with diseases and biological issues, and know that the services provided by the Unified Health System are financed with public money. The students' view of the Basic Health Unit was worrisome because of the lack of knowledge about what this service is, despite the physical proximity to the school and, moreover, they reported not attending the unit. Final considerations: the dialogue allowed the recognition of students' conceptions related to the health system, but showed ignorance and lack of experiences in public services. This reinforces the importance of promoting dialogue in the school space so that critical and active citizens in society are trained, and may reflect on the construction of other meanings and values and thus other conceptions of society, health and disease.