Cuidado em saúde à criança na atenção primária em região de fronteira / Atención de salud infantil en atención primaria en una región fronteriza / Child health care in primary care in a border region

Resumo Objetivo identificar o cuidado em saúde à criança de zero a 24 meses na atenção primária em uma região de fronteira. Método estudo qualitativo realizado na Atenção Primária à Saúde, com 14 mães e cinco enfermeiras, com o uso de entrevistas semiestruturadas, de março de 2018 a junho de 2019. A análise temática de conteúdo orientou a análise dos dados. Resultados identificaram-se visitas domiciliares escassas no seguimento da criança cujos problemas comuns da infância condicionam o acesso aos serviços de saúde para a consulta médica, o uso de práticas populares ou a indicação de medicações por farmacêuticos/atendentes de farmácia; o acesso às Unidades de Pronto Atendimento em detrimento das unidades de Atenção Primária por carência de pediatras neste nível de atenção, além de carência de especialistas e morosidade para a realização de exames na rede de saúde. Conclusão a carência de profissionais de saúde, de especialistas na rede e de recursos materiais são obstáculos a serem superados para o cuidado da criança em região de fronteira. O seguimento da criança brasileira residente no Paraguai requer planejamento.

Resumen Objetivo identificar la atención de salud para niños de cero a 24 meses en atención primaria en una región fronteriza. Método estudio cualitativo realizado en Atención Primaria de Salud, con 14 madres y cinco enfermeras, mediante entrevistas semiestructuradas, de marzo de 2018 a junio de 2019. El análisis de contenido temático guió el análisis de datos. Resultados se identificaron escasas visitas domiciliarias en el seguimiento de los niños cuyos problemas comunes de la infancia afectan el acceso a los servicios de salud para la consulta médica, el uso de prácticas populares o la indicación de medicamentos por parte de los farmacéuticos / asistentes de farmacia; el acceso a las Unidades de Urgencias en detrimento de las Unidades de Atención Primaria por la falta de pediatras en este nivel de atención, además de la falta de especialistas y retrasos en la realización de pruebas en la red sanitaria. Conclusión la falta de profesionales de la salud, especialistas en la red y de recursos materiales son obstáculos a superar para el cuidado del niño en la región fronteriza. El seguimiento de los niños brasileños que residen en Paraguay requiere planificación.

Abstract Objective to identify the health care provided to children from zero to 24 months of age in primary care in a border region. Method a qualitative study conducted in Primary Health Care, with 14 mothers and five nurses, with the use of semi-structured interviews, from March 2018 to June 2019. Thematic content analysis guided the data analysis. Results scarce home visits were identified in the follow-up of children whose common childhood problems condition access to health services for medical consultation, the use of popular practices or the indication of medications by pharmacists/pharmacy assistants; access to Emergency Care Units instead of Primary Care units due to the lack of pediatricians in this level of care, in addition to the lack of specialists and slowness to perform exams in the health network. Conclusion the lack of health professionals, of specialists in the network, and of material resources are obstacles to be overcome for the care of children in the border region. The follow-up of Brazilian children living in Paraguay requires planning.

Salud

Población por tipo de cobertura médica; gráfico de hospitales con internación por tipo y especialidad, y de centros de salud; y promedio diario de niños y adolescentes beneficiados por distintas dependencias de la Dirección General de Niños/as y Adolescentes.

Impact of COVID-19 on diagnosis and management of paediatric inflammatory bowel disease during lockdown: a UK nationwide study.

BACKGROUND: COVID-19 has impacted on healthcare provision. Anecdotally, investigations for children with inflammatory bowel disease (IBD) have been restricted, resulting in diagnosis with no histological confirmation and potential secondary morbidity. In this study, we detail practice across the UK to assess impact on services and document the impact of the pandemic. METHODS: For the month of April 2020, 20 tertiary paediatric IBD centres were invited to contribute data detailing: (1) diagnosis/management of suspected new patients with IBD; (2) facilities available; (3) ongoing management of IBD; and (4) direct impact of COVID-19 on patients with IBD. RESULTS: All centres contributed. Two centres retained routine endoscopy, with three unable to perform even urgent IBD endoscopy. 122 patients were diagnosed with IBD, and 53.3% (n=65) were presumed diagnoses and had not undergone endoscopy with histological confirmation. The most common induction was exclusive enteral nutrition (44.6%). No patients with a presumed rather than confirmed diagnosis were started on anti-tumour necrosis factor (TNF) therapy.Most IBD follow-up appointments were able to occur using phone/webcam or face to face. No biologics/immunomodulators were stopped. All centres were able to continue IBD surgery if required, with 14 procedures occurring across seven centres. CONCLUSIONS: Diagnostic IBD practice has been hugely impacted by COVID-19, with >50% of new diagnoses not having endoscopy. To date, therapy and review of known paediatric patients with IBD has continued. Planning and resourcing for recovery is crucial to minimise continued secondary morbidity.

Care use and its intensity in children with complex problems are related to varying child and family factors: A follow-up study.

BACKGROUND: There is little evidence on the child and family factors that affect the intensity of care use by children with complex problems. We therefore wished to identify changes in these factors associated with changes in care service use and its intensity, for care use in general and psychosocial care in particular. METHODS: Parents of 272 children with problems in several life domains completed questionnaires at baseline (response 69.1%) and after 12 months. Negative binominal Hurdle analyses enabled us to distinguish between using care services (yes/ no) and its intensity, i.e. number of contacts when using care. RESULTS: Change in care use was more likely if the burden of adverse life events (ALE) decreased (odds ratio, OR = 0.94, 95% confidence interval, CI = 0.90-0.99) and if parenting concerns increased (OR = 1.29, CI = 1.11-1.51). Psychosocial care use became more likely for school-age children (vs. pre-school) (OR = 1.99, CI = 1.09-3.63) if ALE decreased (OR = 0.93, CI = 0.89-0.97) and if parenting concerns increased (OR = 1.26, CI = 1.10-1.45). Intensity of use (>0 contacts) of any care decreased when ALE decreased (relative risk, RR = 0.95, CI = 0.92-0.98) and when psychosocial problems became less severe (RR = 0.38, CI = 0.20-0.73). Intensity of psychosocial care also decreased when severe psychosocial problems became less severe (RR = 0.39, CI = 0.18-0.84). CONCLUSIONS: Changes in care-service use (vs. no use) and its intensity (>0 contacts) are explained by background characteristics and changes in a child's problems. Care use is related to factors other than changes in its intensity, indicating that care use and its intensity have different drivers. ALE in particular contribute to intensity of any care use.

Unmet Health Needs in Early Childhood in South Korea.

This study aimed to evaluate child health needs in South Korea and the country's healthcare system capacities to meet them. A comprehensive needs assessment was performed by reviewing child health programs in Korea, followed by focus group discussions and individual interviews with multiple health experts and practitioners. Analysis of the meeting and interview transcripts were identified seven major domains of child health needs and healthcare system capacities. Comparison of child health needs and healthcare system capacities revealed that a much-needed linkage system between child health resources and preventive healthcare services is lacking. A new government policy to integrate current child health programs with high-quality preventive care is required.

Supply of Certified Applied Behavior Analysts in the United States: Implications for Service Delivery for Children With Autism.

OBJECTIVE: The rising prevalence of autism spectrum disorder (ASD) underscores the importance of access to evidence-based interventions such as applied behavior analysis (ABA). Anecdotal evidence suggests limitations in the supply of ABA providers, but data remain scarce. The authors provide the first known examination of the supply of certified ABA providers in the United States. METHODS: Using 2018 data from the Behavior Analyst Certification Board, the authors compared the per capita supply of certified ABA providers in each state with a benchmark established using the Board's guidelines. Additionally, the authors examined state and regional variations in the supply of certified ABA providers. RESULTS: The per capita supply of certified ABA providers fell below the benchmark in 49 states and was higher in the Northeast than in other regions (p<0.001). CONCLUSIONS: New workforce policies are needed to increase the supply of certified ABA providers to meet the needs of youths with ASD.

[COVID-19 and mental health services in Europe]. / COVID-19 e servizi di salute mentale in Europa.

The area of mental health is directly affected by the pandemic and its consequences, for various reasons: 1-the pandemic triggered a global lockdown, with dramatic socioeconomic and therefore psychosocial implications; 2-mental health services, which treat by definition a fragile population from the psychological, biological and social points of view, have a complex organizational frame, and it was expected that this would be affected (or overwhelmed) by the pandemic; 3-mental health services should, at least in theory, be able to help guide public health policies when these involve a significant modification of individual behaviour. It was conducted a narrative review of the publications produced by European researchers in the period February-June 2020 and indexed in PubMed. A total of 34 papers were analyzed, which document the profound clinical, organizational and procedural changes introduced in mental health services following this exceptional and largely unforeseen planetary event.Among the main innovations recorded everywhere, the strong push towards the use of telemedicine techniques should be mentioned: however, these require an adequate critical evaluation, which highlights their possibilities, limits, advantages and disadvantages instead of simple triumphalist judgments. Furthermore, should be emphasized the scarcity of quantitative studies conducted in this period and the absence of studies aimed, for example, at exploring the consequences of prolonged and forced face-to-face contact between patients and family members with a high index of "expressed emotions".

Salud

Cobertura de atención de salud de la población; gráfico de hospitales con internación por tipo y especialidad, y de centros de salud y acción comunitaria; y datos de atención social a niños, niñas y adolescentes

Availability of emergency obstetric and newborn care services at public health facilities of Sindh province in Pakistan.

BACKGROUND: Basic and comprehensive emergency obstetric care services in Pakistan remain a challenge considering continued high burden of maternal and newborn mortality. This study aimed to assess the availability of emergency obstetric and newborn care in Sindh Province of Pakistan. METHODS: This cross-sectional survey was conducted in twelve districts of the Sindh province in Pakistan. The districts were selected based on the maternal neonatal and child health indicators. Data were collected from 63 public-sector health facilities including district, Taluka (subdistrict) headquarters hospitals and rural health centers. Basic and comprehensive emergency obstetric newborn care services were assessed through direct observations and interviews with the heads of the health facilities by using a World Health Organization pretested and validated data collection tool. Participants interviewed in this study included the managers and auxiliary staff and in health facilities. RESULTS: Availability of caesarean section (23, 95% C.I. 14.0-35.0) and blood transfusion services (57, 95% CI. 44.0-68.0), the two components of comprehensive emergency obstetric and newborn care, was poor in our study. However, assessment of the seven components of basic emergency obstetric and newborn services showed that 92% of the health facilities (95% C.I. 88.0-96.0) had parenteral antibiotics, 90%, (95% C.I. 80.0-95.0) had oxytocin, 92% (95% CI 88.0-96.0) had manual removal of the placenta service, 87% (95%, C.I. 76.0-93.0) of the facilities had staff who could remove retained products of conception, 82% (95% C.I. 71.0-89.0) had facilities for normal birth and 80% (95% C.I. 69.0-88.0) reported presence of neonatal resuscitation service. CONCLUSION: Though the basic obstetric and newborn services were reasonably available, comprehensive obstetric and newborn services were not available as per the World Health Organization's standards in the surveyed public health facilities. Ensuring the availability of caesarean section and blood transfusion services within these facilities may improve population's access to these essential services around birth.

Evaluation of at-risk infant care: comparison between models of primary health care.

OBJECTIVES: To analyze the health care network for at-risk infants in the western region of the city of São Paulo, with the primary health care as coordinator, and to compare the presence and extension of attributes of primary health care in the services provided, according to the service management model (Family Health Strategy and traditional basic health units). METHODS: A survey was conducted with all at-risk infants born in the western region of São Paulo between 2013 and 2014. The children were then actively searched for a later application of the PCATool - child version. The total of 233 children were located in the territory; 113 guardians agreed to participate, and 81 composed the final sample. RESULTS: Regarding the results of PCATool for overall and essential scores, the units with Family Health Strategy were better evaluated by users, when compared with traditional basic health units, showing a statistically significant difference. However, these scores were low for both management models. Regarding attributes, the Family Health Strategy presented better performance compared with traditional basic health units for most of them, except for coordination of information systems. Of ten assessed attributes, seven reached values ≥6.6 for Family Health Strategy and two for the traditional basic health unit. CONCLUSIONS: Regardless of the type of management model, low overall and essential scores were found, indicating that guardians of at-risk infants rated some attributes as unsatisfactory, with emphasis on accessibility, integrality and family guidance. Such a performance may have negative consequences for the quality and integrality of these infants' health care.

Salud

Tipo de cobertura de la atención medica de la población de la Ciudad de Buenos Aires, gráfico de la distribución de hospitales con internación y centros de salud comunitarios, y datos de la atención social a niños, niñas, y adolescentes.

The Demand and Supply Side Determinants of Access to Maternal, Newborn and Child Health Services in Malawi.

Objectives In order to improve maternal and neonatal outcomes, it is important to understand how to maximise the utilisation of MNCH services. The supply side (service-driven) factors affecting access to MNCH services are more commonly studied and are better understood than the demand side (community led) factors. The aim of this study was to identify demand and supply determinants of access to MNCH services in Malawi. Methods Research was conducted in two districts of the Central Region of Malawi (Nkhotakota & Mchinji). Qualitative interviews (n = 85) and focus group discussions (n = 20) were conducted with a range of community members, leaders and health workers. Data were managed in NVivo (v10) and analysed using framework analysis, using Levesque et al. (2013) access framework. Results Community members clearly recognise their need for and seek out MNCH care from the formal health system. Women experience difficulties reaching health services and when reached find them limited, characterised by many indirect costs. There are many technical and interpersonal deficits, which results in poor satisfaction and reportedly poor outcomes for women. Conclusions for practice Women are seeking and utilising MNCH services which they find under-resourced and unwelcoming. Utilising the Levesque et al. (2013) framework, a granular analysis of demand and supply factors has identified the many challenges that remain to achieving equitable access to MNCH services in Malawi. Community members experience lack of availability, acceptability and appropriateness of these essential services.

Association of Home Respiratory Equipment and Supply Use with Health Care Resource Utilization in Children.

OBJECTIVE: To compare health care use and spending in children using vs not using respiratory medical equipment and supplies (RMES). STUDY DESIGN: Cohort study of 20 352 children age 1-18 years continuously enrolled in Medicaid in 2013 from 12 states in the Truven Medicaid MarketScan Database; 7060 children using RMES were propensity score matched with 13 292 without RMES. Home RMES use was identified with Healthcare Common Procedure Coding System and International Classification of Diseases codes. RMES use was regressed on annual per-member-per-year Medicaid payments, adjusting for demographic and clinical characteristics, including underlying respiratory and other complex chronic conditions. RESULTS: Of children requiring RMES, 47% used oxygen, 28% suction, 22% noninvasive positive-pressure ventilation, 17% tracheostomy, 8% ventilator, 5% mechanical in-exsufflator, and 4% high-frequency chest wall oscillator. Most children (93%) using RMES had a chronic condition; 26% had ≥6. The median per-member-per-year payments in matched children with vs without RMES were $24 359 vs $13 949 (P < .001). In adjusted analyses, payment increased significantly (P < .001 for all) with mechanical in-exsufflator (+$2657), tracheostomy (+$6447), suction (+$7341), chest wall oscillator (+$8925), and ventilator (+$20 530). Those increased payments were greater than the increase associated with a coded respiratory chronic condition (+$2709). Hospital and home health care were responsible for the greatest differences in payment (+$3799 and +$3320, respectively) between children with and without RMES. CONCLUSION: The use of RMES is associated with high health care spending, especially with hospital and home health care. Population health initiatives in children may benefit from consideration of RMES in comprehensive risk assessment for health care spending.

Apostar a la primera infancia: propiciando encuentros desde un centro de salud / Betting on early childhood: promoting meetings from a health center

Ateneo de la Residencia de Psicopedagogía del CESAC Nº 15, del Área Programática del Hospital General de Agudos Cosme Argerich, de la Ciudad de Buenos Aires. A partir del Dispositivo de Crecimiento y Desarrollo, que funciona en el Centro de Salud desde hace más de veinte años, y trabaja con bebés de 0 a 18 meses, y sus madres, padres, o adultos referentes; se plantean distintas preguntas sobre el contexto de la infancia, y sobre estrategias de Atención Primaria en Salud. Se detalla la normativa y programas vigentes, para Nación y CABA; así como el tipo de intervención que se propone desde el Centro de Salud. En el último apartado se abordan diferentes aspectos constitutivos de la infancia, como el vínculo, el juego y el aprendizaje