Knowledge, Attitudes, and Perceptions of Maternity Care Providers on the Implementation of Calcium Supplementation during Pregnancy in Three Public Hospitals in Argentina: A Qualitative Study.

The aim of this study was to explore maternity care providers' knowledge, attitudes, and perceptions about the use of calcium supplements during pregnancy for the prevention of preeclampsia in three hospitals from Metropolitan Buenos Aires, Argentina. We conducted semi-structured interviews and followed a thematic analysis framework. Maternity care providers' knowledge, attitudes, and practices regarding calcium supplementation during pregnancy are linked to barriers to the potential implementation of calcium supplementation. Free provision of calcium supplements by the government, coupled with training that reinforces the scientific evidence supporting their use to prevent preeclampsia, along with documented recommendations from credible sources, would be crucial to ensure that health providers adopt the use of calcium supplements in antenatal care. Future studies should assess pregnant women and policymakers' perceptions about calcium supplementation during pregnancy, as well as local infrastructure to provide access to free-of-charge calcium supplements in antenatal care settings. Economic evaluation with local information could inform policymakers and advocate for the implementation of strategies to reduce preeclampsia.

Psychometric properties of the Mexican version of the opening minds stigma scale for health care providers (OMS-HC).

Background: Healthcare providers are one of the main groups that contribute to the stigmatization of people with mental disorders. Apathy, accusation, fatalism, and morbid curiosity are the most common forms of stigmatization encountered, and these are associated with inadequate treatment, reduced treatment adherence, decreased help-seeking behavior, an increased risk of relapse, and complications with other medical conditions. The aim of this study was to examine the psychometric properties of an adapted Spanish version of the Opening Minds Stigma Scale (OMS-HC) for healthcare providers in Mexico and identify certain stigmatizing attitudes within this group. Methods: An ex-post facto cross-sectional observational study was conducted with 556 healthcare providers in Mexico, with an average age of 29.7 years, who were mostly women (80.4%). Validity was examined through confirmatory factor analysis. Differences according to gender, discipline, occupation, and educational level were analyzed using multivariate methods. Results: The factor structure of the OMS-HC, consisting of three subscales identified by the original authors of the instrument (attitudes of healthcare providers towards people with mental illness, secrecy/help-seeking, and social distance), was confirmed. The model demonstrated good fit (x2/df = 2.36, RMSEA = 0.050, CFI = 0.970, TLI = 0.962, SRMR = 0.054, NFI = 0.950, PNFI = 0.742). Internal consistency was found to be adequate (α = 0.73, ω = 0.76) for the scale itself and slightly lower than acceptable for the subscales. Significant differences were found by discipline, educational level, and, for student providers, by academic semester. Higher scores were observed on the OMS-HC scale among nursing and medical professionals, undergraduate students, and those in early semesters. Conclusions: The Spanish version of the OMS-HC has demonstrated adequate psychometric properties and could be a useful tool to facilitate research on this topic in Mexico, and to carry out comparative studies with healthcare personnel in other Spanish-speaking countries.

An evidence-based primary health care intervention to address domestic violence against women in Brazil: a mixed method evaluation.

BACKGROUND: Health systems have a critical role in a multi-sectoral response to domestic violence against women (DVAW). However, the evidence on interventions is skewed towards high income countries, and evidence based interventions are not easily transferred to low-and middle-income countries (LMIC) where significant social, cultural and economic differences exist. We evaluated feasibility and acceptability of implementation of an intervention (HERA-Healthcare Responding to Violence and Abuse) to improve the response to DVAW in two primary health care clinics (PHC) in Brazil. METHODS: The study design is a mixed method process and outcome evaluation, based on training attendance records, semi-structured interviews (with 13 Primary Health Care (PHC) providers, two clinic directors and two women who disclosed domestic violence), and identification and referral data from the Brazilian Epidemiological Surveillance System (SINAN). RESULTS: HERA was feasible and acceptable to women and PHC providers, increased providers' readiness to identify DVAW and diversified referrals outside the health system. The training enhanced the confidence and skills of PHC providers to ask directly about violence and respond to women's disclosures using a women centred, gender and human rights perspective. PHC providers felt safe and supported when dealing with DVAW because HERA emphasised clear roles and collective action within the clinical team. A number of challenges affected implementation including: differential managerial support for the Núcleo de Prevenção da Violência (Violence Prevention Nucleus-NPV) relating to the allocation of resources, monitoring progress and giving feedback; a lack of higher level institutional endorsement prioritising DVAW work; staff turnover; a lack of feedback from external support services to PHC clinics regarding DVAW cases; and inconsistent practices regarding documentation of DVAW. CONCLUSION: Training should be accompanied by system-wide institutional change including active (as opposed to passive) management support, allocation of resources to support roles within the NPV, locally adapted protocols and guidelines, monitoring progress and feedback. Communication and coordination with external support services and documentation systems are crucial and need improvement. DVAW should be prioritised within leadership and governance structures, for example, by including DVAW work as a specific commissioning goal.

Evaluating a wellness intervention including micro-practices for healthcare professionals before and during COVID-19 / Evaluando una intervención de bienestar con micro prácticas para profesionalesde la salud antes y durante el COVID-19

Abstract Objective: To describe, with a mixed design study, healthcare professionals' pre-post descriptive measures of quality of life (subjective wellness) and prolonged fatigue, as well as an improvement in overall wellness and satisfaction regarding micro-practices as a result of participation in a wellness intervention before and during COVID-19. Material and Methods: This study had a mixed design involving two independent groups of healthcare professionals participating in a wellness intervention with micro-practices before and during COVID-19. The intervention contained multimodal presentations with animated cartoon stories, comics, storytelling, readings, breathing, mindfulness and visualization exercises, adapted from second-order factors in the Indivisible Self model. Pre-post descriptive measures of quality of life (subjective wellness), prolonged fatigue, as well as improvement in overall wellness and satisfaction regarding micro-practices were collected. Results: Attending to either wellness interventions before or during COVID-19 had a positive and, in some cases significant, effect on important indicators of quality-of-life and prolonged fatigue among healthcare professionals. A qualitative analysis indicated a subjective improvement in overall wellness and satisfaction regarding the use of micropractices included in the wellness interventions, regardless of whether these were presented in person or virtually. Most participants subjectively indicated that they improved in the targeted indicators, especially achievement of better wellness. Conclusions: During ordinary and extraordinary circumstances, healthcare professionals require specific interventions that act primarily to provide them with strategies that can improve physical, emotional, and spiritual health. Use of micro-practices in multimodal workshops to improve healthcare practitioner wellness is a successful tool for learning or remembering the importance of pausing during daily clinical activities and refocusing their energy.

Resumen Objetivo: Describir, con un estudio de diseño mixto, la medición descriptiva pre-post sobre la calidad de vida (bienestar subjetivo) y la fatiga prolongada entre profesionales de salud, así como su mejora en el bienestar general y satisfacción respecto al uso de micro-prácticas como resultado de participar en una intervención de bienestar antes y durante COVID-19. Material y métodos: Este estudio tuvo un diseño mixto en el que participaron dos grupos independientes de profesionales del sector salud en una intervención de bienestar con micro-prácticas antes y durante el COVID-19. La intervención consistió en presentaciones multimodales con historias con dibujos animados, cómics, narración de cuentos, lecturas, ejercicios de respiración, mindfulness y visualización, adaptados a partir de los factores de segundo orden del modelo del Yo Indivisible. Se recolectaron medidas descriptivas pre-post de calidad de vida (bienestar subjetivo), fatiga prolongada, así como su mejora en el bienestar general y la satisfacción con respecto a las micro-prácticas. Resultados: La asistencia a cualquiera de las intervenciones para el bienestar antes o durante la COVID-19 tuvo un efecto positivo y, en algunos casos, significativo, sobre importantes indicadores de calidad de vida y fatiga prolongada entre los profesionales del ámbito de la salud. El análisis cualitativo indicó una mejoría subjetiva en cuanto a su bienestar general y satisfacción con respecto al uso de las micro-prácticas incluidas en las intervenciones de bienestar, independientemente de si éstas se presentaron en persona o virtualmente. La mayoría de los participantes indicaron subjetivamente que habían mejorado en los indicadores enfocados, especialmente el logro de un mayor bienestar. Conclusiones: Durante circunstancias ordinarias y extraordinarias, los profesionales de la salud requieren intervenciones específicas que actúen principalmente para proporcionarles estrategias que puedan mejorar la salud física, emocional y espiritual. El uso de microprácticas en talleres multimodales para mejorar el bienestar de los profesionales es una herramienta exitosa para aprender o recordar la importancia que tiene hacer una pausa durante las actividades clínicas diarias y reenfocar su energía.

Fertility care expectations: what do PLHIV and health care providers in Jamaica know about assisted reproduction services for safe conception?

Increased life expectancy among persons living with HIV (PLHIV) has increased the desire for parenthood. It is therefore important that PLHIV and health care providers (HCPs) are aware of the available assisted reproduction services (ARS) for PLHIV facing infertility or unsuppressed viremia. Through secondary data analysis we identified PLHIV who were actively trying to conceive and their knowledge of ARS. As specialized fertility care for PLHIV is managed by Obstetrician/Gynecologists (Ob/Gyns), they were surveyed regarding their attitudes towards working with PLHIV and their awareness and knowledge of ARS with a self-administered questionnaire. In this cross-sectional study, 251 PLHIV and 102 Ob/Gyns were recruited and interviewed using a semi-structured questionnaire. Although most Ob/Gyns (81%) reported being supportive of PLHIV having children, 85% counseled against pregnancy, particularly persons in HIV serodifferent relationships. Significantly more PLHIV under 40 years compared to those over 40 years had heard about ARS (59% vs. 43%, p = .007). Ob/Gyns were more knowledgeable of expensive ARS, while PLHIV's knowledge was more restricted to cheaper more accessible ones. In conclusion Ob/Gyns knowledge gaps and underlying stereotypes may present barriers to PLHIV's uptake of ARS. Additionally, virologically unsuppresed persons in HIV serodifferent relationships may be vulnerable as Ob/Gyns were less supportive of them.

Scalability of an ACT-Based strategy for improving well-being in health care providers: A mix-method and preliminary evaluation of efficacy.

The burden of the COVID-19 pandemic has been mainly carried by health care providers. Technology-Mediated Interventions (TMI) seem to be a feasible alternative to increase access to behavioral health resources in this population. However, scaling-up treatments into TMI requires developing user-friendly, accepted, and accessible formats. A two-stage study was conducted to assess scalability of an Acceptance and Commitment Therapy (ACT) based strategy (named FACE COVID) delivered using technology. First, a mix-method design connected qualitative and quantitative data from health providers and ACT experts by which changes were performed to enhance scalability. Second, a pretest-posttest study was conducted to preliminary evaluate the efficacy of FACE COVID intervention on well-being, psychological distress, and psychological flexibility. Results showed a positive impact on well-being, but not distress and psychological flexibility. While this intervention has promising results, changes in dose intensity, social support, and mental health literacy could improve retention as well as increase opportunities to target distress and psychological flexibility in future studies.

Willingness of health care providers to offer HIV self-testing from specialized HIV care services in the northeast of Brazil.

BACKGROUND: The insufficient knowledge regarding the serological status of people affected with human immunodeficiency virus (HIV) is a concern in Brazil. HIV self-testing (HIVST) has been proved to have great potential for increasing testing, especially among vulnerable populations. The large-scale distribution of HIVST by the Brazilian public health system has increased in recent years. We aimed to investigate the awareness of HIVST among health care providers (HCP) from specialized HIV/AIDS care services in the state of Bahia, Northeast Brazil. Further we investigated HCP acceptability and willingness to offer its use. METHODS: A cross-sectional study on HCP from 29 specialized care services (SCS) located in 21 cities in the state of Bahia. HCP working in the service for at least 6 months were included. Sociodemographic, occupational, and behavioral data were collected using a questionnaire. Descriptive statistics were carried out. Bivariate, and multivariate analyses estimating adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) using logistic regression were conducted. RESULTS: The awareness and acceptability of HIVST and the willingness to provide it were 79.8, 55.2, and 47.1%, respectively. Few HCP reported that the SCS where they worked dispensed HIVST (3.6%), and 13.5% received some information or training on HIVST. Factors associated with willingness to offer HIVST were: HIVST acceptability (aOR = 9.45; 95% CI: 4.53-19.71), willingness to use HIVST on themselves (aOR = 4.45; 95% CI: 1.62-12.24), confidence in offering HIVST to clients (aOR = 5.73; 95% CI: 2.26-12.72), and considering everyone eligible for HIVST (aOR = 2.88; 95% CI: 1.25-6.59). CONCLUSIONS: Although most HCP were aware of HIVST, acceptability and willingness to provide it to the clients was moderate. The scale up of HIVST as a mean for the HIV prevention and control policy in Brazil, requires further training of HCP and better implementation of this program.

Mental Health of Doctors Who Treat Patients with covid-19 in Mexico City: An Anthropological Investigation / La salud mental de los médicos que atienden covid-19 en la Ciudad de México: una investigación antropológica / A saúde mental dos médicos que tratam a covid-19 na Cidade do México: uma investigação antropológica

Introduction: The objective of this article was to explore, from an anthropological perspective, the social representations that doctors who treat covid-19 in specialized hospitals in Mexico City have, regarding the relationship between their professional performance and the deterioration of their mental health; as well as their social representations of the existing institutional resources to provide them mental health attention and their care-seeking and self-care strategies. Materials and Methods: For this, a quali-tative investigation was carried out with semi-structured interviews with 35 doctors who treat covid-19. Results: From the points of view of the doctors, various sociocultural and structural causes of mental illness related to their professional performance are documented and analyzed, as well as their repre-sentations about the inadequacy and/or ineffectiveness of the institution, group, or individual resources to provide them mental health attention; and some allopathic and non-biomedical forms of care-seeking and self-care. Conclusions: Recommendations are made to address the etiologies of the disease analyzed in a culturally and structurally appropriate way to the context of the pandemic.

Introducción: el objetivo de este artículo es explorar, desde una perspectiva antropológica, las representaciones sociales de los médicos que atienden covid-19 en hospitales especializados de la Ciudad de México, respecto a la relación entre su desempeño profesional y el deterioro de su salud mental, así como de los recursos institucionales existentes para atenderla y sus estrategias de búsqueda de atención y de autoatención. Materiales y métodos: para ello, se realizó una investigación cualitativa con entrevistas semiestructuradas a 35 médicos que atienden covid-19. Resultados: a partir de sus puntos de vista se documentan y analizan diversas causas socioculturales y estructurales del padecimiento mental relacionado con su desempeño profesional, así como sus representaciones sobre la inadecuación o ineficacia de los recursos institucionales, grupales o individuales, para atenderlo y algunas modalidades de búsqueda de atención y autoatención alopáticas y no biomédicas. Conclusiones: se realizan recomendaciones para abordar institucionalmente las etiologías del padecimiento reportadas por los entrevistados de una forma cultural y estructuralmente adecuada al contexto de la pandemia.

Introdução: O objetivo deste artigo é explorar, a partir de uma perspectiva antropológica, as represen-tações sociais que os médicos que tratam a covid-19 em hospitais especializados na Cidade do México, têm sobre a relação entre seu desempenho profissional e a deterioração de sua saúde mental; bem como os recursos institucionais existentes para cuidar da saúde mental e as estratégias de busca de cuidado e autocuidado. Materiais e métodos: Para isso, foi realizada uma pesquisa qualitativa com entrevistas semiestruturadas com 35 médicos que tratam da covid-19. Resultados: Do ponto de vista dos médicos, são documentadas e analisadas diversas causas socioculturais e estruturais do adoecimento mental relacio-nadas à sua atuação profissional, bem como suas representações sobre a inadequação e/ou ineficiência dos recursos institucionais, grupais ou individuais, disponíveis para atendê-los e algumas modalidades de busca de cuidado e autocuidado alopáticos e não biomédicos. Conclusões: São feitas recomendações para abordar institucionalmente as etiologias da doença relatadas pelos entrevistados de forma cultural e estruturalmente adequada no contexto da pandemia.

Barreras para la atención de las conductas suicidas en Ciudad de México: experiencias del personal de salud en el primer nivel de atención / Barriers to Care of Suicidal Behavior in Mexico City: Health Personnel Experiences at the First Level of Care / Barreiras para a atenção das condutas suicidas na Cidade do México: experiências dos profissionais de saúde na atenção básica

Resumen Objetivo: Identificar las barreras que existen para la atención de las conductas suicidas, desde la perspectiva de las/los profesionales de la salud mental del primer nivel de atención de la Ciudad de México. Metodología: Estudio cualitativo exploratorio, basado en 35 entrevistas semiestructuradas, dirigidas a personal de salud de dos unidades de salud mental de referencia nacional. El análisis de la información se hizo mediante el Framework Analysis. Resultados: Las/los participantes consideraron que las conductas suicidas no han sido definidas como una prioridad dentro de los trastornos de salud mental. La ausencia de políticas públicas, la sobrecarga de trabajo, la falta de seguimiento a las/los pacientes, entre otras, fueron identificadas como barreras para una atención adecuada y oportuna. Conclusiones: Los programas de prevención de las conductas suicidas deben tomar en cuenta el contexto socioeconómico de la población y las características de los servicios de salud, así como las necesidades de las personas prestadoras de servicios de salud. Se requiere ampliar el entrenamiento profesional y mejorar el sistema de referencia y contrarreferencia entre los distintos niveles de atención.

Abstract Objective: To identify the existing barriers to the care of suicidal behavior from the perspective of mental health professionals at the first level of care in Mexico City. Methodology: Qualitative exploratory study based on 35 semi-structured interviews conducted on health personnel from two national reference mental health facilities. The data were analyzed with Framework Analysis. Results: The participants considered that suicidal behavior has not been prioritized among mental health disorders. The absence of public policies, work overload, lack of patient follow-up, among others, were identified as barriers to adequate and timely care. Conclusions: Suicidal behavior prevention programs should consider the socioeconomic context of the population, the characteristics of health services, and the needs of health care providers. Professional training should be enhanced, and the referral and counter-referral system across levels of care should be improved.

Resumo Objetivo: Identificar as barreiras existentes para a atenção das condutas suicidas, desde a perspectiva dos profissionais de saúde mental de atenção básica da Cidade do México. Metodologia: Estudo qualitativo exploratório, baseado em 35 entrevistas semiestruturadas, dirigidas a profissionais de saúde de duas unidades de saúde mental de referência nacional. A análise da informação foi feita através do Framework Analysis. Resultados: Os participantes consideraram que as condutas suicidas não têm sido definidas como uma prioridade dentro dos transtornos de saúde mental. A ausência de políticas públicas, a sobrecarga de trabalho, a falta de seguimento aos pacientes, entre outras, foram identificadas como barreiras para uma atenção adequada e oportuna. Conclusões: Os programas de prevenção das condutas suicidas devem considerar o contexto socioeconômico da população e as características dos serviços de saúde, além das necessidades dos profissionais de saúde. É necessário ampliar o treinamento profissional e melhorar o sistema de referência e contrarreferência entre os diferentes níveis de atenção.

Perspectives of health care providers regarding the levonorgestrel-releasing intrauterine system.

OBJECTIVES: The aims of the study were to assess the number of insertions per month of the 52 mg levonorgestrel-releasing intrauterine system (LNG-IUS) and gauge the knowledge and opinions of health care providers with regard to some of its characteristics and the reasons why women liked using the method. METHODS: An online questionnaire survey was conducted between January and July 2021 at the University of Campinas, Brazil. The survey comprised physicians and nurses from centres that had requested and received donated devices. RESULTS: A total of 65 health care providers answered the questionnaire (41 physicians and 24 nurses). The main misconceptions were related to insertion after an ectopic pregnancy: 60/65 (92.3%) answered that users with previous ectopic pregnancy must have frequent follow-up. Wrong answers were also given on the occurrence of acne (37/65, 56.9%) and depression (32/65, 49.2%). Participants reported that the LNG-IUS was highly effective (100%), long-acting (93.9%) and an appropriate method for controlling uterine bleeding (90.8%) and that it had few side effects (86.2%). CONCLUSION: Our study suggests that health care providers from centres that requested and received LNG-IUS donations, even though they reported adequate knowledge about the device, still had misconceptions with regard to its clinical management.

Good prenatal care practices in teenage pregnancy from the perspective of healthcare professionals / Buenas prácticas en la atención prenatal a adolescentes embarazadas: perspectivas de profesionales de la salud

Objective: To systematize good prenatal care practices in a referral center for pregnant teenagers in Campinas, São Paulo, Brazil, from the perspective of healthcare professionals. Materials and Methods: Qualitative study conducted between June and July 2017 using semi-structured interviews and a focus group with 10 healthcare professionals providing care to pregnant teenagers in a public hospital in the region of Campinas, São Paulo, Brazil. Data were examined using the thematic content analysis technique, which gave rise to new analytical categories. Triangulation of the results was used for validation. The theoretical and practical applicability of the main findings was identified. Results: The study looked into three categories arising from the discourse of the professionals and the evidence found in the literature: 1) comprehensive analysis of pregnant teenagers; 2) professional experiences related to the care of pregnant teenagers reflecting service quality; and 3) strengths and improvement opportunities potentially replicable as a care model. Good practices in prenatal care are those which prioritize comprehensive care for pregnant teenagers, are coordinated by a multidisciplinary team and result in a multidimensional approach, valuing the complexity of motherhood in the teenage years. Conclusions: It is advisable to develop education strategies, strengthen group care and involve the teenager's support network as part of sexual and reproductive health services in order to promote a positive experience during prenatal care when the process of becoming a mother takes place during adolescence.

Objetivo: sistematizar buenas prácticas de atención prenatal en un servicio de referencia para adolescentes embarazadas en Campinas, São Paulo, Brasil, desde la perspectiva de profesionales de la salud. Materiales y métodos: estudio cualitativo desarrollado entre junio y julio de 2017, se emplearon entrevistas semiestructuradas y se realizó un grupo focal con 10 profesionales de la salud que prestaban atención a adolescentes embarazadas en una unidad hospitalaria del sistema público de la región de Campinas, São Paulo, Brasil. Los datos fueron examinados mediante la técnica de análisis de contenido temático de donde surgieron nuevas categorías de análisis. Se hizo validación a través de triangulación de los resultados. Se identificó la aplicabilidad teórica y práctica de los principales hallazgos. Resultados: fueron elaboradas tres categorías emergentes del discurso de los profesionales y de las evidencias en la literatura: 1) análisis integral de las adolescentes en situación de embarazo; 2) experiencias profesionales en la atención a las adolescentes embarazadas que evidencian calidad en el servicio; 3) fortalezas y oportunidades del servicio con posibilidades de replicación como modelo asistencial. Son consideradas buenas prácticas durante el cuidado prenatal aquellas que priorizan la atención integral a las adolescentes embarazadas; estas son coordinadas por un equipo multidisciplinario, y consiguen tener un abordaje multidimensional, sobre todo, valorando la complejidad que supone la maternidad en la adolescencia. Conclusiones: dentro de los servicios de salud sexual y reproductiva es recomendable el desarrollo de estrategias educativas, el fortalecimiento de la atención en grupos y la inclusión de la red de apoyo de las adolescentes en la atención, con el fin de favorecer una experiencia positiva durante el cuidado prenatal cuando el proceso de volverse madre acontece durante la adolescencia.

Consultório na Rua: experiências e sentimentos vivenciados pelos profissionais na assistência em saúde / Street Office: experiences and feelings experienced by health care professionals

2021.176470Introdução: o Consultório na Rua é uma estratégia da Atenção Básica no Sistema Único de Saúde (SUS), que tem como finalidade promover o cuidado às pessoas em situação de rua, sendo o serviço de referência sanitária para esta população. Através de ações que permitam a construção do vínculo de confiança, os profissionais promovem cuidado e assistência de saúde às demandas dos usuários. Objetivo: descrever as experiências, histórias e sentimentos vivenciados pelos profissionais do Consultório na Rua de Maceió-AL. Métodos: trata-se de estudo descritivo-exploratório, com abordagem qualitativa, realizado com 13 profissionais do Consultório na Rua de Maceió, cuja produção de dados ocorreu no período de outubro a dezembro de 2018, através da técnica da entrevista semiestruturada e dos registros em diário de campo. Os dados foram analisados pela técnica da Análise de Conteúdo, na modalidade temática, e discutidos à luz da literatura sobre a temática do Consultório na Rua. Resultados: a partir das entrevistas com os profissionais emergiram as seguintes temáticas: 1) experiências únicas; 2) histórias que marcam; e 3) sentimentos que transformam. Conclusão: pode-se concluir que o Consultório na Rua se mostra como um trabalho que gera ricas experiências e sentimentos para os profissionais, e que permite que os profissionais conheçam as histórias de vida dessa população ao mesmo tempo em que são afetados nesse processo. (AU)

Introduction: The Street Office is a Primary Care strategy in the Unified Health System (SUS), which aims to promote care for homeless people, being the health reference service for this population. Through actions that allow the construction of the bond of trust, professionals promote health care and care to the users' demands. Objective: Describing the experiences, stories and feelings experienced by the professionals of the Street Office of Maceió-AL. Methods: This is a descriptive-exploratory study with a qualitative approach, conducted with 13 professionals from the Street Office of Maceió, whose data production occurred from October to December 2018, through the semi-structured interview technique and records in a field diary. The data were analyzed by the content analysis technique, in the thematic modality, and discussed in the light of the literature on the theme of the Street Office. Results: From the interviews with the professionals emerged the following themes: 1) unique experiences; 2) stories that mark; and 3) feelings that transform. Conclusion: It can be concluded that the Street Office is shown as a work that generates rich experiences and feelings for professionals, allowing professionals to know the life histories of this population while they are affected in this process. (AU)

The impact of Hurricane Maria on Puerto Rico's health system: post-disaster perceptions and experiences of health care providers and administrators.

BACKGROUND: After its landfall in Puerto Rico in 2017, Hurricane Maria caused the longest blackout in United States history, producing cascading effects on a health care system that had already been weakened by decades of public sector austerity and neoliberal health reforms. This article addresses how health care professionals and administrators experienced the health care system's collapse and the strategies used by them to meet their communities' health needs. METHODS: Data were collected between September 2018 and February 2020. Ethnographic observations in health care facilities and semi-structured qualitative interviews with representatives of the health care system were conducted. This paper focuses on data from interviews with health care providers (n = 10) and administrators (n = 10), and an ethnographic visit to a pop-up community clinic. The analysis consisted of systematic thematic coding of the interview transcripts and ethnographic field notes. RESULTS: Results provide insight on how participants, who witnessed first-hand the collapse of Puerto Rico's health care system, responded to the crisis after Maria. The prolonged power outage and lack of a disaster management plan were partly responsible for the death of 3,052 individuals who experienced extended interruptions in access to medical care. Participants reported a sense of abandonment by the government and feelings of mistrust. They also described the health sector as chaotic and lacking clear guidelines on how to provide services or cope with personal crises while working under extreme conditions. In such circumstances, they developed resilient responses to meet communities' health needs (e.g., itinerant acupuncture services, re-locating physicians to local pharmacies). CONCLUSIONS: Participants' narratives emphasize that the management of Hurricane Maria was fraught with political and economic constraints affecting Puerto Rico. Ineffective planning and post-Maria responses of the local and federal governments were determinants of the disaster's impact. The findings contribute to a growing scientific literature indicating that Hurricane Maria revealed 'the collapse before the collapse,' alluding to the structural deficiencies that presaged the catastrophic event. In the context of governmental abandonment, the authors argue for the importance of developing alternative strategies in post-disaster health care provision among health professionals and administrators who work at the front lines of recovery.

Buenas prácticas en la atención prenatal a adolescentes embarazadas: perspectivas de profesionales de la salud / Good prenatal care practices in teenage pregnancy from the perspective of healthcare professionals / Boas práticas no atendimento pré-natal para adolescentes grávidas: perspectivas de profissionais da saúde

Objetivo: sistematizar buenas prácticas de atención prenatal en un servicio de referencia para adolescentes embarazadas en Campinas, São Paulo, Brasil, desde la perspectiva de profesionales de la salud. Materiales y métodos: estudio cualitativo desarrollado entre junio y julio de 2017, se emplearon entrevistas semiestructuradas y se realizó un grupo focal con 10 profesionales de la salud que prestaban atención a adolescentes embarazadas en una unidad hospitalaria del sistema público de la región de Campinas, São Paulo, Brasil. Los datos fueron examinados mediante la técnica de análisis de contenido temático de donde surgieron nuevas categorías de análisis. Se hizo validación a través de triangulación de los resultados. Se identificó la aplicabilidad teórica y práctica de los principales hallazgos. Resultados: fueron elaboradas tres categorías emergentes del discurso de los profesionales y de las evidencias en la literatura: 1) análisis integral de las adolescentes en situación de embarazo; 2) experiencias profesionales en la atención a las adolescentes embarazadas que evidencian calidad en el servicio; 3) fortalezas y oportunidades del servicio con posibilidades de replicación como modelo asistencial. Son consideradas buenas prácticas durante el cuidado prenatal aquellas que priorizan la atención integral a las adolescentes embarazadas; estas son coordinadas por un equipo multidisciplinario, y consiguen tener un abordaje multidimensional, sobre todo, valorando la complejidad que supone la maternidad en la adolescencia. Conclusión: dentro de los servicios de salud sexual y reproductiva es recomendable el desarrollo de estrategias educativas, el fortalecimiento de la atención en grupos y la inclusión de la red de apoyo de las adolescentes en la atención, con el fin de favorecer una experiencia positiva durante el cuidado prenatal cuando el proceso de volverse madre acontece durante la adolescencia.

Objective: To systematize good prenatal care practices in a referral center for pregnant teenagers in Campinas, São Paulo, Brazil, from the perspective of healthcare professionals. Material and methods: Qualitative study conducted between June and July 2017 using semi-structured interviews and a focus group with 10 healthcare professionals providing care to pregnant teenagers in a public hospital in the region of Campinas, São Paulo, Brazil. Data were examined using the thematic content analysis technique, which gave rise to new analytical categories. Triangulation of the results was used for validation. The theoretical and practical applicability of the main findings was identified. Results: The study looked into three categories arising from the discourse of the professionals and the evidence found in the literature: 1) comprehensive analysis of pregnant teenagers; 2) professional experiences related to the care of pregnant teenagers reflecting service quality; and 3) strengths and improvement opportunities potentially replicable as a care model. Good practices in prenatal care are those which prioritize comprehensive care for pregnant teenagers, are coordinated by a multidisciplinary team and result in a multidimensional approach, valuing the complexity of motherhood in the teenage years. Conclusion: It is advisable to develop education strategies, strengthen group care and involve the teenager's support network as part of sexual and reproductive health services in order to promote a positive experience during prenatal care when the process of becoming a mother takes place during adolescence.

Objetivo: Sistematizar as boas práticas de atenção pré-natal em um serviço de referência para adolescentes grávidas em Campinas, São Paulo/Brasil desde a perspectiva dos professionais da saúde. Materiais e métodos: Estudo qualitativo desenvolvido entre junho e julho de 2017. Empregaram-se entrevistas semiestruturadas e grupo focal com 10 profissionais da saúde que prestavam atendimento à adolescentes grávidas em uma unidade hospitalar da rede pública da região de Campinas, São Paulo/Brasil. Os dados foram analisados por meio da técnica de análise de conteúdo temática onde surgiram as categorias de análise. Realizou-se validação através de triangulação dos resultados e foi identificada a aplicabilidade teórica e prática dos principais achados. Resultados: Foram elaboradas três categorias emergentes do discurso dos professionais e das evidências na literatura: 1) análise compreensiva das adolescentes em situação de gravidez; 2) vivências profissionais no cuidado de adolescentes grávidas que mostram a qualidade no atendimento; 3) potencialidades e oportunidades do serviço com possibilidades de replicação como modelo assistencial. No atendimento pré-natal, são consideradas como boas práticas aquelas que priorizam a atenção integral à gestante adolescente; as que são coordenadas por uma equipe multidisciplinar e conseguem ter uma abordagem multidimensional, sobretudo, avaliando a complexidade que supõe a maternidade durante a adolescência. Conclusões: Dentro dos serviços de saúde sexual e reprodutiva, é recomendável o desenvolvimento de estratégias educativas, o fortalecimento da atenção em grupos e a inclusão da rede de apoio das adolescentes na atenção para favorecer uma experiência positiva durante o cuidado pré-natal levando em consideração o processo de tornar-se mãe durante a adolescência.

Occupational exposure to sharp instrument injuries in a federal hospital.

INTRODUCTION: Occupational exposure to potentially contaminated sharp instruments can result in the transmission of several pathogens and diseases. It is therefore necessary to investigate the factors that lead to these events and the interventions that can be used to address them. OBJECTIVES: To assess and describe the frequency of occupational exposure to sharps injury among employees of the Instituto Nacional de Câncer José Alencar Gomes da Silva in 2017 and 2018. METHODS: This was a cross-sectional, exploratory and descriptive study based on the records of occupational accidents involving exposure to biological materials and the reports made to the Institute's Occupational Health Division. RESULTS: A total of 108 incidents were reported, 87 of which involved sharp instruments. Most accidents occurred in the surgical ward, and involved medical staff. The findings revealed low adherence to clinical and laboratory follow-up protocols. There were several errors in data entry and high rates of missing data for important characteristics of the accidents and victims, which prevented a more thorough description of these incidents. CONCLUSIONS: This study revealed several aspects of occupational accidents, victims and follow-up procedures, allowing for the discussion of strategies that could improve the reporting, prevention and management of these events.

Handling of antineoplastic drugs: a health concern among health care workers.

INTRODUCTION: Health care professionals are part of a group that is more exposed to a wide range of sources of risk that are very harmful to their own health. Antineoplastic drugs are widely used to treat many different types of cancer and are very aggressive to both patients and health care professionals. OBJECTIVES: To identify occupational risks and assess knowledge in health care professionals from Porto Alegre whose work involves handling antineoplastic drugs. METHODS: This was a prospective, descriptive, and cross-sectional study with qualitative and quantitative analyses. It was conducted in two stages. A questionnaire containing objective questions was administered in stage one. In stage two, observations were made during regular visits to the sites studied at different times, following a checklist based on the requirements of health regulation standards relating to handling of antineoplastic drugs. RESULTS: A total of 40 health care professionals took part in the study, 11 nurses, 14 pharmacists, and 15 nursing and/or pharmacy technicians. Twenty-seven of them had been involved in some type of accident during their professional practice. It was also observed that the institutions were making efforts to comply with legal requirements, since 32 reported that they took part in the Program for Medical Control of Occupational Health and 29 of the employees stated they had had some type of training in the antineoplastic area. CONCLUSIONS: Exposure to antineoplastic drugs through contact, aerosols, ingestion, and inhalation was detected. Additionally, ergonomic, physical, and biological risks were also present, since working with different pathological organisms and working processes impacts on these workers' health. Assessment of the health care professionals' knowledge identified a lack of knowledge and weaknesses with relation to handling this class of drugs.

Health care providers perspectives about maternal immunization in Latin America.

BACKGROUND: Antenatal care providers have a key role in providing appropriate information and immunization recommendations to improve pregnant women's vaccine uptake. The objective of this study is to describe health care providers' perspectives and experience regarding the implementation of maternal immunization programs in Latin America. METHODS: We conducted 33 in-depth interviews of health care providers from Argentina, Brazil, Honduras, Mexico, and Peru (6-7 per country). Qualitative data analysis was conducted using a combination of both manual techniques and the computer software program NVivo. We identified and coded main themes related to maternal immunization. RESULTS: The main themes identified in this analysis were practices related to maternal immunization, knowledge and training, resource availability and interactions with pregnant women. Healthcare providers knew that recommendations exists but some did not know their content; they expressed concerns about insufficient training. Providers from all five countries expressed the need for additional human resources and supplies. They also expressed a desire for women to be more proactive and ask more questions during the health visits. CONCLUSION: This is the first multi-country study assessing the perspectives of health care providers about maternal immunization practices at the facility level in Latin America. Recommendations based on the results from this study include implementing additional trainings around maternal immunization, especially targeting obstetricians and midwives. These trainings should be conducted in coordination with improvements to supply chain and other structural issues.

Health care providers and people with mental illness: An integrative review on anti-stigma interventions.

BACKGROUND: Health care providers are an important target group for anti-stigma interventions because they have the potential to convey stigmatizing attitudes towards people with mental illness. This can have a detrimental impact on the quality and effectiveness of care provided to those affected by mental illness. AIMS AND METHODS: Whittemore & Knafl's integrative review method (2005) was used to analyze 16 studies investigating anti-stigma interventions targeting health care providers. RESULTS: The interventions predominantly involved contact-based educational approaches which ranged from training on mental health (typically short-term), showing videos or films (indirect social contact) to involving people with lived experiences of mental illness (direct social contact). A few studies focused on interventions involving educational strategies without social contact, such as mental health training (courses/modules), distance learning via the Internet, lectures, discussion groups, and simulations. One study investigated an online anti-stigma awareness-raising campaign that aimed to reduce stigmatizing attitudes among health care providers. CONCLUSION: Anti-stigma interventions that involve social contact between health care providers and people with mental illness, target specific mental illnesses and include long-term follow-up strategies seem to be the most promising at reducing stigma towards mental illness among health care providers.

Human Immunodeficiency Virus: Attitudes and knowledge among health professionals in Santiago, Chile / Virus de Inmunodeficiencia Humana: actitudes y conocimientos de profesionales de salud en Santiago, Chile

Abstract Introduction: Nowadays there a significant increase of HIV cases is in Chile. It is imperative that health professionals have the necessary knowledge to provide adequate healthcare without stigmatizing people living with HIV/AIDS. Objective: Determine health professionals' HIV level of knowledge and their willingness to attend people living with this virus. Methods: This quantitative, cross-sectional study used an online selfadministered survey, that consisted on 15 questions. It evaluated the knowledge and attitudes in health professionals and technicians working in the West Metropolitan Health Centers in Santiago, Chile. Results: The response rate was 32.7% (n=235). 86.8% of participants said they felt safe doing medical procedures to people living with HIV, even though one out of ten said that they related the word fear with HIV; 52.4% were unaware of the clinical guidelines of the local Ministry of Health; and 42.7% incorrectly identified the use of double clinical gloves as a protective measure. Conclusions: The results of this study demonstrate that it is necessary to update and reinforce the knowledge about HIV and universal protective measures in health professionals..

Resumen Introducción: En Chile existe actualmente un aumento significativo de casos de VIH. Es imperativo que los profesionales de la salud tengamos el conocimiento necesario para poder atender adecuadamente y sin estigmatización a las personas que viven con VIH. Objetivos: Determinar nivel de conocimiento y disposición a atender a personas que viven con VIH. Métodos: Estudio transversal en el que se utilizó una encuesta online a profesionales y técnicos de salud que trabajaban en Centros Metropolitanos de Salud Occidente en Santiago, Chile. Resultados: La tasa de respuesta fue 32,7% (n=235). Los resultados mostraron que un 86,8% de los participantes se sentía seguro al realizar procedimientos médicos a personas que viven con VIH, esto a pesar de que uno de cada diez relacionaba la palabra VIH con miedo; 52,4% desconocía las pautas clínicas del Ministerio de Salud local; y el 42,7% identificó incorrectamente el uso de doble guante como medida de protección. Conclusiones: Los resultados de este estudio demuestran que es necesario actualizar y reforzar, en los profesionales y técnicos de la salud, el conocimiento sobre VIH y medidas de protección universales.