338ª Reunião Ordinária - 26 jan. 2023

Na parte da manhã. das 9h às 12h30, na Sala João Neves da Fontoura (Plenarinho) - Assembleia Legislativa do Estado do Rio Grande do Sul, Praça Marechal Deodoro, nº 101, Centro Histórico - Porto Alegre/RS. E no período da tarde, no 26 de janeiro de 2023, das 13h30 às 15h30, no Teatro Dante Barone - Assembleia Legislativa do Estado do Rio Grande do Sul, Praça Marechal Deodoro, nº 101, Centro Histórico - Porto Alegre/RS

332ª RO: Defender a democracia, sempre, todos os dias - 21 jul. 2022

A 332ª Reunião Ordinária do CNS ocorreu nos dias 20 e 21 de julho, em Brasília (DF). A mesa de abertura foi marcada pela manifestação do presidente do CNS, Fernando Pigatto, e dos demais conselheiros e conselheiras nacionais de Saúde sobre o posicionamento do Conselho em defesa total e irrestrita da democracia no país e confiança nas instituições do estado democrático de direito. IX Ato do Direitos Já! Fórum pela Democracia - Em Defesa da Justiça Eleitoral. Na segunda-feira (1/08), o CNS estará presente no IX Ato do Direitos Já! Fórum pela Democracia - Em Defesa da Justiça Eleitoral. A mobilização vai ocorrer no auditório do Clube de Engenharia do Rio de Janeiro, situado na Av. Rio Branco, nº 124 - 25° andar - Centro, Rio de Janeiro - RJ. O ato tem o objetivo de reforçar a confiança da sociedade brasileira na justiça eleitoral.

332ª Reunião Ordinária - 20 jul. 2022

Brasília Imperial Hotel - Setor Hoteleiro Sul (SHS), quadra 3, bloco H - Asa Sul - Brasília/DF.

Behavioral health home impact on transitional care and readmissions among adults with serious mental illness.

OBJECTIVE: To evaluate the impact of Maryland's behavioral health homes (BHHs) on receipt of follow-up care and readmissions following hospitalization among Medicaid enrollees with serious mental illness (SMI). DATA SOURCES: Maryland Medicaid administrative claims for 12 232 individuals. STUDY DESIGN: Weighted marginal structural models were estimated to account for time-varying exposure to BHH enrollment and time-varying confounders. These models compared changes over time in outcomes among BHH and comparison participants. Outcome measures included readmissions and follow-up care within 7 and 30 days following hospitalization. DATA COLLECTION/EXTRACTION METHODS: Eligibility criteria included continuous enrollment in Medicaid for the first two years of the study period; 21-64 years; and use of psychiatric rehabilitation services. PRINCIPAL FINDINGS: Over three years, BHH enrollment was associated with 3.8 percentage point (95% CI: 1.5, 6.1) increased probability of having a mental health follow-up service within 7 days of discharge from a mental illness-related hospitalization and 1.9 percentage point (95% CI: 0.0, 3.9) increased probability of having a general medical follow-up within 7 days of discharge from a somatic hospitalization. BHHs had no effect on probability of readmission. CONCLUSIONS: BHHs may improve follow-up care for Medicaid enrollees with SMI, but effects do not translate into reduced risk of readmission.

VARIABLES INVOLVED IN THE MANAGEMENT OF SCHOOL BULLYING: A BAYESIAN NETWORK ANALYSIS.

OBJECTIVE: To analyze the management of bullying by the managers of elementary schools. METHODS: Descriptive, exploratory research carried out through semi-structured interviews with 17 school counselors from a city in the South of Brazil, randomly selected from different geographical sectors. The interviews were recorded with participants' consent and, after transcription and checking, were discarded. The interviews covered the following subjects: sociodemographic characterization of subjects, school functioning, comprehension, recognition and management of bullying cases by counselors. Data analysis was performed using the Bayesian network associated with content analysis. RESULTS: The majority of subjects were females, between 30 and 50 years old. Fifteen subjects were graduated in pedagogy, and all had postgraduate degrees. Most of them worked as counselor for less than three years. Only two subjects, between 30 and 50 years old, understood the term bullying. Case recognition was lower in this age group. Having a degree influenced positively the recognition of bullying. The higher the number of students in the school, the lower the recognition of cases by managers. All subjects managed cases by addressing children, families, staff, and involving professionals and support groups. CONCLUSIONS: The understanding and recognition of bullying was given by a few interviewees. All managers reported similar management actions in the cases. Given the scarcity of studies on bullying management in schools, more studies in this area could improve the approach of cases and contribute to their reduction.

Embedding a genetic counselor into oncology clinics improves testing rates and timeliness for women with ovarian cancer.

OBJECTIVE: Germline genetic testing is crucial to the care of ovarian cancer patients, and as part of the guideline-based care for ovarian cancer patient's adherence to this recommendation has been low. We sought to determine whether embedding a genetic counselor (GC) within a medical and gynecologic oncology clinic would increase testing rates and improve the timeliness of testing. METHODS: Prospective cohort study of 358 ovarian cancer patients seen by medical and gynecologic oncologists between 2013 and 2015. Rates of referrals, completion of counseling, and genetic testing and timeliness of counseling were abstracted before and after a GC was embedded in the clinic in 2014. An additional year of data (2015) was collected to evaluate sustainability of the intervention. RESULTS: Between 2013 and 2015, 88-92% of women were referred for genetic testing, but in 2013 only 66% completed counseling and 61% were tested. After a GC was embedded in the clinic in 2014, more than 80% of referred women completed counseling and germline genetic testing. Time to genetic counseling also decreased from a median of 107 to 40 days, irrespective of age and cancer family history (p < 0.01). CONCLUSIONS: Embedding a GC into the workflow for ovarian cancer patients is an effective way of improving access to genetic counseling, testing rates, and the timeliness of testing.

Variables involved in the management of school bullying: a bayesian network analysis / Variáveis envolvidas no gerenciamento de conflitos do tipo bullying em escolas: uma análise de rede bayesiana

ABSTRACT Objective: To analyze the management of bullying by the managers of elementary schools. Methods: Descriptive, exploratory research carried out through semi-structured interviews with 17 school counselors from a city in the South of Brazil, randomly selected from different geographical sectors. The interviews were recorded with participants' consent and, after transcription and checking, were discarded. The interviews covered the following subjects: sociodemographic characterization of subjects, school functioning, comprehension, recognition and management of bullying cases by counselors. Data analysis was performed using the Bayesian network associated with content analysis. Results: The majority of subjects were females, between 30 and 50 years old. Fifteen subjects were graduated in pedagogy, and all had postgraduate degrees. Most of them worked as counselor for less than three years. Only two subjects, between 30 and 50 years old, understood the term bullying. Case recognition was lower in this age group. Having a degree influenced positively the recognition of bullying. The higher the number of students in the school, the lower the recognition of cases by managers. All subjects managed cases by addressing children, families, staff, and involving professionals and support groups. Conclusions: The understanding and recognition of bullying was given by a few interviewees. All managers reported similar management actions in the cases. Given the scarcity of studies on bullying management in schools, more studies in this area could improve the approach of cases and contribute to their reduction.

RESUMO Objetivo: Analisar o gerenciamento de conflitos do tipo bullying pelos gestores de escolas de ensino fundamental. Métodos: Pesquisa descritiva e exploratória realizada por meio de entrevistas semiestruturadas com 17 orientadores de escolas escolhidas aleatoriamente de um município do Sul do Brasil, contemplando os diversos setores geográficos locais. As entrevistas foram gravadas mediante consentimento, e, após transcrição e conferência pelos sujeitos, descartadas. As entrevistas abordam: caracterização sociodemográfica dos sujeitos, funcionamento da escola e compreensão, reconhecimento e gerenciamento dos casos de bullying pelos orientadores. A análise dos dados foi feita com base na rede bayesiana associada à análise de conteúdo. Resultados: A maioria dos sujeitos era do sexo feminino e tinha entre 30 e 50 anos. Quinze sujeitos eram formados em pedagogia, e todos possuíam pós-graduação. A maioria atuava na função de orientador havia menos de três anos. A compreensão do termo bullying deu-se apenas por dois sujeitos, com idade entre 30 e 50 anos. Já o reconhecimento dos casos foi menor nessa faixa etária. Ter feito pós-graduação influenciou positivamente o reconhecimento de bullying. Quanto maior o número de alunos na escola, menor o reconhecimento dos casos pelos gestores. Todos os sujeitos gerenciaram os casos abordando as crianças, famílias e equipe e envolvendo profissionais e núcleos de apoio. Conclusões: A compreensão e o reconhecimento do bullying deram-se por poucos entrevistados. Todos os gestores relataram ações de gerenciamento semelhantes diante dos casos. Tendo em vista a escassez de estudos sobre gestão de bullying na escola, mais estudos nessa área poderiam melhorar a abordagem dos casos, contribuindo para sua redução.

"Real-world" effect of a peer counselor on breastfeeding outcomes in an urban prenatal clinic in the United States.

BACKGROUND: One approach for improving breastfeeding support and alleviating breastfeeding disparities is the implementation of a clinic-based peer counselor. Our objective was to assess the "real life" effects of an autonomous peer counselor who provides tailored support to low-income, minority women based on individual needs rather than a pre-determined research protocol. METHODS: This is a secondary analysis of a prospective cohort study of women receiving publicly funded prenatal care during the 6 months before and after introduction of a peer counselor in a single prenatal clinic. The peer counselor provided one-on-one antenatal and postpartum lactation support. Electronic medical record and survey data were collected. The primary outcome was breastfeeding continuation at 6 weeks postpartum. Secondary outcomes included breastfeeding comfort, confidence, and training satisfaction, any breastfeeding, and total breastfeeding duration. Bivariable and multivariable analyses were performed. RESULTS: Peer counselor exposure was not associated with the primary outcome of continued breastfeeding at 6 weeks (55.6% with peer counselor versus 49.1% without; aOR 1.26, 95% CI 0.69-2.31). However, women with peer counselor exposure were more likely to be satisfied with breastfeeding training at the time of delivery (98.2% vs. 83.6%, p = 0.006) and were more likely to have performed any breastfeeding (89.8% vs. 78.9%, p = 0.04), which remained significant on multivariable analysis (aOR 2.85, 95% CI 1.11-7.32). CONCLUSIONS: Peer counselor interventions are a promising approach to increase breastfeeding initiation. Further research is required to inform the most efficacious approach while also allowing peer counselors to operate independently and in line with the specific needs of their clients.

A phenomenographic study: Exploring the variations of registered nurses' perceived roles and experiences as HIV counselors

OBJECTIVES: The study explored the variations of registered nurses' perceived roles and experiences before, during and after HIV counseling. METHODS: The study is anchored on Parse's Human Becoming Theory structured around three abiding themes: meaning, rhythmicity, and transcendence. A qualitative phenomenographical approach was used and the data were collected through semi structured, face-to-face, in-depth interview sessions with ten registered nurses who were eligible under the set criterion: HIV counselors employed in both government and private health facilities with HIV Testing and Counseling facilities and services in Iligan City and Cagayan de Oro City. Verbatim transcriptions were analyzed in iterative process using Jan Larssons and Inger Holmstrom's (2007) seven simple steps of phenomenographic analysis. Triangulation and validation established rigor and trustworthiness of the data. RESULTS: Emergent themes of differences in participants' perceived roles and experiences conveyed in a metaphor: The Employee vs. The Educator; The Professional vs. The Shepherd. CONCLUSION: The variations ascertained the association of perceived roles and experiences of HIV Counselors and posited equally vast challenges as nursing takes the core in collaboration for the care of persons living with HIV toward a dignified death

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Health products' and substance use among pregnant women visiting a tertiary hospital in Belgium: A cross-sectional study.

PURPOSE: To investigate the prevalence and type of health products used among pregnant women visiting a tertiary hospital in Belgium, as well as who advises these products, where women buy these products, which determinants are associated with medication and pregnancy vitamin intake, and preconception lifestyle changes such as folic acid intake and substance use. METHODS: A cross-sectional study was performed at the outpatient obstetrics clinics of the University Hospital Leuven, Belgium between November 2016 and March 2017. All pregnant women 18 years and older and understanding Dutch, French, or English were asked to participate in an online survey. RESULTS: In total, 379 pregnant women participated. Prevalence of medication use during the preceding week was 52%. Paracetamol (14%), levothyroxine (13%), and antacids (9%) were the most frequently used medicines. Pregnancy vitamins were used by 86% of women, and 97% had used a pregnancy vitamin somewhere during pregnancy. Only 56% initiated folic acid supplementation at least 1 month before pregnancy. Preconception use of folic acid among women following assisted reproductive technology was 73%. Inappropriate use of health products was observed among 3% of women. Prevalence of alcohol use and/or smoking during the preceding week was 6%. Alcohol and smoking cessation mainly occurred after pregnancy diagnosis. CONCLUSION: Pregnant women living in Belgium frequently use medicines, pregnancy vitamins, and other health products. Preconception lifestyle changes such as folic acid intake and alcohol and smoking cessation are poorly implemented. Public campaigns and interventions are needed to improve preconception care and counselling.

Health Information Counselors: A New Profession for the Age of Big Data.

Health care is increasingly data driven. Concurrently, there are concerns that health professionals lack the time and training to guide patients through the growing medical "data jungle." In the age of big data, ever wider domains of people's lives are "datafied," which renders ever more information-at least in principle-usable for health care purposes. Turning data into meaningful information for clinical practice-and deciding what data or information should not be used for this purpose-requires a significant amount of time, resources, and skill. The authors argue that academic medicine should lead the way in navigating the use of complex, highly personal data in clinical practice. To make data actionable for both clinicians and patients, the authors propose that the best way to navigate the interface between patients and providers in the era of data-rich medicine would be the creation of a new profession entirely: health information counselors (HICs). HICs would have broad knowledge of various kinds of health data and data quality evaluation techniques, as well as analytic skills in statistics and data interpretation. Trained also in interpersonal communication, health management, insurance systems, and medico-legal aspects of data privacy, HICs would know enough about clinical medicine to advise on the relevance of any kind of data for prevention, diagnosis, and treatment. The creation of this new specialty would help patients and health care professionals to make more informed choices about how increasing amounts of health data and information can or should inform health care.

Overloaded and overlooked: Improving resident advisors' self-care.

OBJECTIVE: The purpose of this viewpoint is to discuss the lack of research on resident advisor (RA) self-care and how behavioral interventions can be used in housing programs to educate and improve RA self-care. It is essential for live-in housing staff (both professional and paraprofessional) to learn how to develop appropriate strategies that target problem behaviors to improve self-care. An overview of the RA position, the effects of increased demands (i.e., burnout), and the research on self-care behavioral interventions are discussed. Lastly, the call to use behavioral interventions within housing programs to educate RAs on self-care awareness and improve and monitor their health behaviors to prevent burnout and psychological distress is provided.

Projecting the Supply and Demand for Certified Genetic Counselors: a Workforce Study.

As of May 2017, there were 4242 Certified Genetic Counselors (CGC) (American Board of Genetic Counseling, Inc. 2017) and 41 graduate-level genetic counseling training programs (Accreditation Council for Genetic Counseling 2017) in North America, and the demand for CGCs continues to increase. In the Fall of 2015 the Genetic Counselor Workforce Working Group, comprised of representatives from the American Board of Genetic Counseling (ABGC), the Accreditation Council for Genetic Counseling (ACGC), the Association of Genetic Counseling Program Directors (AGCPD), the American Society of Human Genetics (ASHG), and the National Society of Genetic Counselors (NSGC) commissioned a formal workforce study to project supply of and demand for CGCs through 2026. The data indicate a shortage of genetic counselors engaged in direct patient care. Assuming two scenarios for demand, supply is expected to reach equilibrium between 2024 and 2030. However, given the rate of growth in genetic counseling training programs in the six months since the study was completed, it is reasonable to expect that the number of new programs may be higher than anticipated by 2026. If true, and assuming that growth in programs is matched by equivalent growth in clinical training slots, the supply of CGCs in direct patient care would meet demand earlier than these models predict.

Working with the Hmong Population in a Genetics Setting: an Interpreter Perspective.

The aim of this pilot qualitative study was to describe the experiences and beliefs of medical interpreters when working with genetic counselors and other genetic providers caring for Hmong patients who are not native English speakers. Specific goals were to identify interpreters' thoughts and perceptions on (a) their roles during sessions, (b) unique challenges in a genetics session, (c) knowledge genetics providers need when working with Hmong patients and interpreters, and (d) supports and training needed to effectively interpret in a genetics setting. Hmong medical interpreters from Wisconsin and Minnesota were invited by email to participate in the study. Six were interviewed by telephone. Participants had worked with a variety of providers including geneticists, genetic counselors, primary care physicians, and oncologists. Factors identified by Hmong interpreters that made interpretation of content difficult in clinical genetics sessions included: time constraints, technical terms, and unique cultural perspectives of Hmong patients. While all respondents felt their primary role was to interpret session content as close to verbatim as possible, there was notable variation in the description of their interpretation style and other perceived roles in the genetic counseling session. Cultural issues genetics providers could consider when working with Hmong patients and different style issues when working with Hmong interpreters are discussed. Ideas for future studies and suggestions to improve communication with Hmong patients are explored.

Impact of "Sambhav" Program (Financial Assistance and Counselor Services) on Hepatitis C Pegylated Interferon Alpha Treatment Initiation in India.

BACKGROUND: Financial constraints, social taboos and beliefs in alternative medicine are common reasons for delaying or not considering treatment for hepatitis C in India. The present study was planned to analyze the impact of non-banking interest free loan facility in patients affected with hepatitis C virus (HCV) in North India. METHODS: This one year observational, retrospective study was conducted in Department of Gastroenterology (January 2012-December 2013), Dayanand Medical College and Hospital Ludhiana, to evaluate the impact of program titled "Sambhav" (which provided non-banking financial assistance and counselor services) on treatment initiation and therapeutic compliance in HCV patients. Data of fully evaluated patients with chronic hepatitis, and/or cirrhosis due to HCV infection who were treated with Peginterferon alfa and ribavirin (RBV) combination during this duration (2012-2013) was collected from patient medical records and analyzed. In the year 2012, eligible patients who were offered antiviral treatment paid for treatment themselves, while in 2013, 'Sambhav' program was launched and this provided interest free financing by non-banking financial company (NBFC) for the treatment of HCV in addition to free counselor services for disease management. The treatment initiation and compliance rates were compared between the patients (n = 585) enrolled in 2013 who were offered 'Sambhav' assistance and those enrolled in 2012 (n = 628) when 'Sambhav' was not available. RESULTS: Introduction of Sambhav program improved the rates of treatment initiation (59% in 2013 vs. 51% in 2012, P=.004). Of the 585 eligible patients offered 'Sambhav' assistance in 2013, 233 patients (39.8%) applied but 106/233 (45.4%) received assistance. Antiviral therapy was started in 93/106 (87.7%) of these patients, while only 52 (42.5%) of 127 patients whose applications were rejected underwent treatment. Compliance to antiviral therapy also improved with the introduction of 'Sambhav' program (87.7% vs. 74.1%, P=.001). CONCLUSION: 'Sambhav' program had significant impact on the initiation of antiviral therapy by overcoming the financial hurdles. The free counselor services helped to mitigate social taboos and imparted adequate awareness about the disease to the patients. Initiatives like 'Sambhav' can be utilized for improving healthcare services in developing countries, especially for chronic diseases.

Working with the Hmong Population in a Genetics Setting: Genetic Counselor Perspectives.

The Hmong language lacks words for many familiar Western medical genetic concepts which may impact genetic counseling sessions with individuals of Hmong ancestry who have limited English proficiency. To study this interaction, a qualitative, semi-structured interview was designed to address genetic counselors' experiences of genetic counseling sessions working with individuals with Hmong ancestry. Genetic counselors in the three states with the largest population of Hmong individuals (California, Minnesota and Wisconsin) were invited via email to participate in a telephone interview. Eleven counselors' interviews were transcribed and analyzed for emergent themes. Each of the counselors had served Hmong patients in a variety of clinics and possessed counseling experience ranging from approximately one to greater than 20 years. Interviews highlighted strengths and challenges in genetic counseling sessions with Hmong patients with limited English proficiency in each of five categories: 1) relevant training during graduate school, 2) session preparation, 3) content of the counseling session, 4) perception of Hmong culture, and 5) reflections on working with Hmong interpreters. Cultural awareness and education in training programs were highlighted by all genetic counselors as valued components to patient care. All interviewees had worked with professional Hmong medical interpreters, but had different expectations for the interpreter with whom they worked. To help improve genetic services for Hmong individuals in the United States, we offer suggestions to improve some of the challenges mentioned, and recommend further studies to investigate the genetic counselor and interpreter relationship.

Controle social e cidadania ativa: a formação de conselheiros / Social control and active citizenship: training of counselors

O presente trabalho objetivou analisar o potencial de contribuição de cursos de capacitação de conselheiros de saúde para o desenvolvimento de uma cidadania ativa, tomando como referência as orientações do Guia do Monitor produzido no âmbito do Programa de Apoio ao Fortalecimento do Controle Social do Sistema Único de Saúde, apoiado pelo projeto REFORSUS do Ministério da Saúde...

A participação social na atuação dos conselhos municipais de Bertioga - SP / Social participation in the Bertioga - SP municipal council's actions

Após a promulgação da Constituição Federal de 1988, os conselhos das áreas sociais se evidenciaram como instrumentos habilitadores no processo de descentralização das políticas sociais no âmbito local, abrindo possibilidades de participação política e superando as modalidades tradicionais vigentes até então. O objetivo deste trabalho foi de identificar a composição dos Conselhos Setoriais do Município de Bertioga/SP, sua forma de atuação e analisar a participação da sociedade civil, utilizando-se a metodologia de estudo de caso na linha qualitativa. Os resultados mostraram que, embora o tempo transcorrido a partir das leis que institucionalizaram seja curto para esperar resultados sedimentados, as conquistas e os obstáculos, na prática, sinalizam uma fragilidade, indicando a necessidade de capacitar seus membros e criar mecanismos para integrá-los, a partir da ação coletiva, para exercer influência sobre o sistema político.(AU)

A participação social na atuação dos conselhos municipais de Bertioga - SP / Social participation in the Bertioga - SP municipal council's actions

Após a promulgação da Constituição Federal de 1988, os conselhos das áreas sociais se evidenciaram como instrumentos habilitadores no processo de descentralização das políticas sociais no âmbito local, abrindo possibilidades de participação política e superando as modalidades tradicionais vigentes até então. O objetivo deste trabalho foi de identificar a composição dos Conselhos Setoriais do Município de Bertioga/SP, sua forma de atuação e analisar a participação da sociedade civil, utilizando-se a metodologia de estudo de caso na linha qualitativa. Os resultados mostraram que, embora o tempo transcorrido a partir das leis que institucionalizaram seja curto para esperar resultados sedimentados, as conquistas e os obstáculos, na prática, sinalizam uma fragilidade, indicando a necessidade de capacitar seus membros e criar mecanismos para integrá-los, a partir da ação coletiva, para exercer influência sobre o sistema político.