Patients' attitudes towards switching to national volume-based procurement (NVBP) Drugs-a qualitative investigation in Wuhan, China.

BACKGROUND: The implementation of the NVBP policy has generated considerable reductions in drug procurement prices and an increase in the market share of the NVBP drugs.This study aimed to investigate patients' attitudes towards switching to drugs of national volume-based procurement (NVBP) and identify their underlying influencing factors in Wuhan, China. METHODS: A total of 21 eligible patients from the Wuhan Union Hospital who were switched to NVBP drugs between January 2022 and May 2022 were included in our study. Semi-structured face-to-face interviews were conducted to collect interview information and the interview data was analyzed by the Colaizzi seven-step method. RESULTS: Twenty-one semi-structured face-to-face interviews were conducted. The duration of each interview was 25-35 min and three themes related to patients' attitudes and their influencing factors were extracted, including (1) Patients' perception of the NVBP drugs; (2) Family and social influence to patients; (3) Medication habits of patients. This study found: 1) 71.4% patients (15/21) showed a positive attitude towards switching to NVBP medicines; 2)80.9% patients (17/21) have felt a significant reduction in their medication cost after the implementation of the NVBP policy; 3)Advices from healthcare professionals and health insurance reimbursement policies showed great impacts on patients' attitude towards switching to NVBP drugs; 4)Attitudes towards switching to NVBP drugs varied considerably among patients with different severities of disease. CONCLUSION: The implementation of the NVBP policy has significantly reduced the cost of healthcare for patients and has been supported by71.4% (15 of 21) patients. However, some issues have been identified in the implementation of the policy in this study. Health professionals in general need to contribute more efforts to improve patients' preconceptions about the NVBP drugs and boost their confidence in the NVBP drugs.

Significado de los trastornos de voz. Un estudio cualitativo desde la mirada de profesores de enseñanza básica / Meaning of Voice Disorders. A Qualitative Study from the Perspective of Elementary School Teachers

Objetivo. El objetivo del presente estudio fue describir el significado que le otorgan a los trastornos de voz los profesores y cuáles son las motivaciones que los llevan a no consultar con un especialista. Método. Para tal propósito, se realizó un estudio cualitativo en el que participa-ron 16 profesores de enseñanza básica. La información fue obtenida mediante una entrevista semiestructurada, la cual fue grabada y luego transcrita para su posterior análisis. El estudio contó con la aprobación del comité de ética y el consentimiento informado de cada uno de los participantes. Resultados. En cuanto a los resultados, surgieron cinco categorías: Conocimiento de los problemas de voz; Entrenamiento formal y recursos vocales; Sintomatología vocal experimentada a lo largo de la carrera docente; Afectación de la calidad de vida; Tratamiento y abordaje de los problemas de voz. Todos los participantes tienen alguna noción de los problemas de voz, asociándolos principalmente con algún síntoma o molestia experimentada. La gran mayoría declara nunca haber recibido formación en cuanto al uso de la voz y expresan sentir que su voz ha ido cambiando a lo largo de los años de ejercicio profesional, volviéndose más grave o ronca. Destaca que en cuanto al tratamiento, quince de los participantes nunca han consultado con especialistas, sino que recurren a remedios caseros o populares. Conclusión. En conclusión, los profesores corresponden a uno de los grupos donde se presenta una alta prevalencia de trastornos de voz. Sin embargo, esto contrasta con la baja preocupación y el desconocimiento respecto al abordaje de este tipo de problemas

Aim. The objective of the present study was to describe the significance teachers give to voice disorders, and the reasons that dissuade them from consulting a specialist. Method. To achieve this objective, a qualitative study was carried out with the participation of 16 elementary school teachers. The information was obtained by semi-structured interviews, which were recorded and then transcripts were prepared for analysis. The study was approved by the Ethics Committee and an informed con-sent was signed by each of the participants. Results. Five categories emerged from the results: Knowledge of voice problems; Formal training and voice resources; Vocal symptoms experienced throughout the teaching career; Effects on quality of life; Treatment of and approach to voice prob-lems. All the participants had some notion of voice problems, which they associated mainly with some symptom or discomfort experienced. The great majority stated they had never received training in voice use; they felt that their voices had changed over the years of their professional careers, becoming deeper or hoarser. A striking finding was that fifteen of the participants had never consulted a specialist, but only used home or popular remedies. Conclusion. In conclusion, teachers form a group with a high prevalence of voice disorders; however, this contrasts with a low level of concern and a lack of knowledge about addressing such problems

Identificación de necesidades de los cuidadores informales: estudio exploratorio / Identification of the needs of informal caregivers: an exploratory study

Introducción: El envejecimiento de la población es uno de los principales retos de la salud pública en los países desarrollados. Los cuidadores informales emergen como uno de los principales actores en este escenario, y esto puede afectarlos de forma negativa. Objetivo: El presente estudio tiene como objetivo identificar las necesidades de los cuidadores informales relacionadas con el cuidado de una persona dependiente de una zona básica de salud. Método: Estudio cualitativo y fenomenológico. Participaron en él cuatro cuidadores informales de pacientes no institucionalizados, a quienes se le realizó una entrevista semiestructurada. Posteriormente se realizó un análisis deductivo del discurso. Resultados: El análisis mostró tres temas clave: efecto del cuidar (cuidar tiene efectos negativos en la salud global de los cuidadores), dificultades relacionadas con el cuidado (relacionadas con las adaptaciones en el domicilio, la prevención de heridas, accidentes y movilizaciones) y estrategias de aprendizaje del cuidar (por lógica, observación y formación) Conclusiones: Cuidar tiene un efecto negativo sobre la salud global de los cuidadores. Estos presentan dificultades a la hora de cuidar, y manifiestan utilizar diferentes metodologías para el aprendizaje de los cuidados. Las intervenciones dirigidas a los cuidadores informales deberían incluir aspectos relacionados con la mejoría de su salud y su formación en cuidados. (AU)

Introduction: Population aging is one of the main issues in public health within developed countries. Informal caregivers play a central role in this scenario, which can affect them negatively. Objective: The aim of this study is to identify the needs of informal caregivers related to the care of dependent persons of a Basic Health Area. Method: Qualitative and phenomenological study. Four informal caregivers in charge of non-institutionalized patients took part. These patients expressed their opinions in a semi-structured interview, that was deductively analyzed afterwards. Results: The analysis showed three key subjects: the effects of caregiving (how this task negatively affects the global health of the caregivers); difficulties related to care (related to the process of adaptation once at home, prevention of wounds, accidents and mobility issues), and caregiving learning strategies (by deductive reasoning, observation and formation). Conclusions: Caregiving has a negative effect on the caregivers’ global health. They show some difficulties in the execution of their tasks, and they declare that they are using various caregiving learning methods. Interventions directed at informal caregivers should include aspects related to health improvement and caregiving training. (AU)

Older Adults' Perspectives on Voluntary Assisted Death: An In-Depth Qualitative Investigation in Australia.

Interest in voluntary assisted death (VAD) has been growing among researchers, policy makers and the public. This study aimed to explore older adults' perspectives on VAD in Australia. Using purposive sampling, 15 adults ≥65 years participated in in-depth semi-structured interviews. Interpretative phenomenological analysis identified four themes: cultural reflections; beliefs and worldviews; health aspects; and fabric of life. Participants expressed a desire to have control over end-of-life options, challenged by religious beliefs. Participants expressed concern that VAD legislation could leave people vulnerable to coercion and saw a need for safeguards. Reasons for and against supporting and utilising VAD were discussed. Physical illness was seen a more compelling reason for VAD than mental ill-health. Finally, connections to life and other were discussed, and being able to do the things one loved were named aspects of what it meant to live a good life. Implications are discussed along with future research directions.

An Investigation into the Physical Activity Experiences of People Living with and beyond Cancer during the COVID-19 Pandemic.

This study investigated the physical activity experiences of people living with and beyond cancer (PLWBC) during the COVID-19 pandemic. Participants attended the cancer and rehabilitation exercise (CARE) programme delivered by a football community trust. Staff (n = 2) and participants (n = 9) attended semi-structured interviews investigating the PA participation and experiences of attending/delivering different modes of CARE, including exercise classes delivered outdoors and delivered online. Interviews also investigated participant aspirations for returning to CARE sessions delivered in person indoors. The findings show that the COVID-19 pandemic and government restrictions impacted on PA participation, yet exercise sessions provided via CARE offered participants an important opportunity to arrest their inactivity, keep active and maintain their fitness and functionality. Barriers to participation of CARE online included access to IT infrastructure, internet connectivity and IT skills and comfort using IT. Regarding CARE outdoors, the weather, range of equipment, variety of exercises and the lack of toilets and seats were barriers. In the different CARE modes, the skills of delivery staff who were sensitive to the needs of participants, social support, and the need for participants to maintain good mental and social health were important facilitators for engagement and are considerations for programme delivery. CARE helped PLWBC to keep physically active.

Sufferings of its consequences; patients with Type 2 diabetes mellitus in North-East Ethiopia, A qualitative investigation.

BACKGROUND: The burden of diabetes in Ethiopia is exponentially increasing with more than 68% of people with it being undiagnosed and a death rate of 32%. It is a disease impacting patients with negative somatic, psychological, social, and economic consequences. Patients in Ethiopia have very low awareness about chronic complications, which is very worrying. The study aimed to explore the consequences of their disease experienced by type 2 diabetes patients in North-East Ethiopia. METHODS: The study employed a phenomenological approach informed by the consequences dimension of the Common-Sense Model. It was conducted from July 2019 to January 2020 using purposive sampling with face-to-face in-depth interviews, for about three weeks, until reaching theoretical saturation. The data were collected from twenty-four type 2 diabetes patients, who were selected to include various socio-demographic characteristics. The data were organized by QDA Miner Lite v2.0.8 and analyzed thematically using narrative strategies. RESULTS: Using Common-Sense Model as a framework, the diabetes consequences experienced by the participants were categorized as complications and impacts. While the most common complications were cardiovascular disorders (hypertension, erectile dysfunction, heart and kidney problems, hyperlipidemia, edema, stroke, and fatigue) and ocular problems; the most common impacts were psychosocial (dread in life, suffering, family disruption, hopelessness, dependency, and craving), and economic (incapability and loss of productivity) problems. CONCLUSION: The patients here were bothered by diabetes complications as well as its psycho-social, economic and somatic consequences; being the psycho-social impacts the most common. As a result, the patients have been suffering in the dread of "what can come next?" This dictates that holistic care, based on Common-Sense Model, is needed in providing special emphasis to psycho-social issues.

Nurturing Grandchildren With Down Syndrome: A Qualitative Study on Grandparents' Needs Using Digital Tools†.

Grandparents who have grandchildren with disabilities are an underrepresented group in existing research related to the field. This qualitative phenomenological study's general purpose is to analyze, from a personal perspective, the situations and needs of grandparents who have grandchildren with Down syndrome. The participants' ages range from 65 to 85, and the ages of their grandchildren with Down syndrome range from 3 to 21 years. All participants had one grandchild with a disability, except for two, who each had two. A sociodemographic questionnaire was administered, and individual interviews were conducted, using open questions, through phone and/or video calls. An analysis of the participants' speech was carried out, which implied the development of a system of meta-categories and categories. This analysis was developed manually, given the COVID-19 environment. The results indicate a substantial change from negative feelings caused by the knowledge of the diagnosis to feelings related to positive experiences expressed currently. The participants see themselves as a fundamental source of support (informal, instrumental, practical, social, emotional, and economic) for their families and, mainly, for their grandchildren with Down syndrome. A need for information and training was observed when the grandparents talked about first being informed of the diagnosis and their concerns about the future of these grandchildren and their siblings. They made social demands, such as greater government involvement or more significant opportunities to access resources and rights for their grandchildren. The results are discussed, as are possible future research directions.

Factors Impeding Health-Care Professionals to Effectively Treat Coronavirus Disease 2019 Patients in Pakistan: A Qualitative Investigation.

The coronavirus disease 2019 (COVID-19) pandemic, first reported in late December 2019, is regarded as the most significant public health emergency of the century. According to the World Health Organization (WHO), the current outbreak of COVID-19 has affected millions of people and killed hundreds of thousands in more than 200 countries, including Pakistan. Health-care professionals (HCPs) cannot minimize human interactions or isolate themselves from patients due to their jobs and moral duties. Hence, the outbreak needed HCPs to work in adverse and challenging conditions with possible mental health problems. In light of the stated background, this study aims to explore and understand the factors that impede HCPs to effectively treat COVID-19 patients in Karachi, Pakistan. Based on qualitative methods, a phenomenological approach was considered to record the true experiences of HCPs. Twelve doctors and nurses were recruited from five COVID-19 designated hospitals in Karachi, Sindh Province, using purposive and snowball sampling. Semi-structured in-depth telephone interviews were conducted from April 6 to 14, 2020, and analyzed through thematic analysis. The findings suggest that there were two types of constraints, institutional and personal, which were impeding HCPs to treat COVID-19 patients effectively. Institutional constraints include the poor condition of isolation wards, inadequate availability of personal protective equipment (PPE), excessive and uneven workload, and absence of emotional and psychological support in hospitals. Besides, personal constraints include nervousness due to the novel virus, a constant fear of becoming infected, fear of taking virus to family, extreme isolation and loneliness, and feeling of powerlessness. The study found that HCPs in Pakistan have been dealing with a high risk of infection, causing mental health problems such as stress, anxiety, and depressive symptoms. These mental health problems not only affect attention, understanding, and decision-making capacity of HCPs, which could hinder the fight against COVID-19, but they could also have a continuous effect on their overall well-being on a long-term basis. Therefore, the present study outlines important clinical and policy strategies that are needed to support HCPs as the pandemic continues.

Hereditary hemorrhagic telangiectasia and health-related quality of life: a qualitative investigation.

OBJECTIVE: The purpose of the study was to arrive at an accurate description of health-related quality of life of hereditary hemorrhagic telangiectasia patients. METHODS: Thirteen semi-structured interviews were conducted in patients with hereditary hemorrhagic telangiectasia. RESULTS: Qualitative grounded theory analyses were performed using the participants' transcripts and revealed the following six categories: Impact of physical symptoms on daily life, Quality of family and social life, Emotional and psychological outcomes related to the disease, Knowledge having a severe disease and coping strategies to manage such disease, Recognition of the disease by professional colleagues and superiors, and Knowledge and understanding from health professionals in medical care. CONCLUSION: The definition of quality of life that emerged from the participants' transcripts was essentially related to health. Individuals with hereditary hemorrhagic telangiectasia mainly focused on the physical, psychological and emotional impacts of the symptoms and their consequences on professional life and social activities. Family relationships were also highlighted in the participants' transcripts. As such, HHT patients used coping strategies to manage their disease. Finally, a particularly salient issue referred to the lack of knowledge concerning the rare nature of this disease and the ensuing inherent sense of misunderstanding.

Moral and Contextual Dimensions of "Inappropriate" Antibiotic Prescribing in Secondary Care: A Three-Country Interview Study.

Overuse of broad-spectrum antibiotics in secondary care is a key contributor to the emergence and spread of antimicrobial resistance (AMR); efforts are focused on minimizing antibiotic overuse as a crucial step toward containing the global threat of AMR. The concept of overtreatment has, however, been difficult to define. Efforts to address the overuse of medicine need to be informed by an understanding of how prescribers themselves understand the problem. We report findings from a qualitative interview study of 46 acute care hospital prescribers differing in seniority from three countries: United Kingdom, Sri Lanka and South Africa. Prescribers were asked about their understanding of inappropriate use of antibiotics. Prescriber definitions of inappropriate use included relatively clear-cut and unambiguous cases of antibiotics being used "incorrectly" (e.g., in the case of viral infections). In many cases, however, antibiotic prescribing decisions were seen as involving uncertainty, with prescribers having to make decisions about the threshold for appropriate use. Decisions about thresholds were commonly framed in moral terms. Some prescribers drew on arguments about their duty to protect public health through having a high threshold for prescribing, while others made strong arguments for prioritizing risk avoidance for the patients in front of them, even at a cost of increased resistance. Notions of whether prescribing was inappropriate were also contextually dependent: high levels of antibiotic prescribing could be seen as a rational response when prescribers were working in challenging contexts, and could be justified in relation to financial and social considerations. Inappropriate antibiotic use is framed by prescribers not just in clinical, but also in moral and contextual terms; this has implications for the design and implementation of antibiotic stewardship interventions aiming to reduce inappropriate use of antibiotics globally.

Azoro y silencio. La huella en los afectos del sujeto de la experiencia de violencia escolar / Astonishment and silence. The imprint on the subject affections of the experience of school violence

Resumen El estudio analiza las consecuencias en los afectos de estudiantes de 5° y 6° grado de primaria víctimas de violencia escolar. El trabajo es de tipo cualitativo interpretativo, realizado a partir de entrevistas individuales y grupos focales. Su análisis permitió la construcción de cuatro bloques categoriales: "Afectos ante la vivencia de violencia", "Consecuencias académicas y malestar al ser víctima de violencia", "Tipología de la violencia de la que el menor es víctima", y "Características generales de la víctima de violencia". En estos se detalla la respuesta afectiva de los escolares, sus dificultades de desempeño académico e interaccional, las características de las situaciones de agresividad de los que son objeto y los elementos del cuerpo o psicosociales en que se focaliza la expresión de violencia.

Abstract The study analyzes the consequences in the students' affections of 5° and 6° grades of primary victims of school violence. The work is of qualitative interpretive type realized from individual interviews and to focal groups. His analysis allowed the construction of four thematic blocks: Affections before the experience of violence, Academic consequences and discomfort on having been a victim of violence, Typology of the violence of which the child is victim and Characteristic personal of the victim of violence, in which it is detailed from the affective response of the students, his difficulties of academic performance and interactional, the characteristics of the situations of aggressiveness of which they are an object and body or psycho social elements in that the expression of violence is focused.

Utilidad de un material didáctico sobre Investigación Cualitativa en Salud / Usefulness of a didactic material on Qualitative Investigation in Health

Se realizó un estudio descriptivo y transversal de 139 estudiantes de segundo año de la carrera Licenciatura en Enfermería, pertenecientes a la Facultad de Enfermería-Tecnología de la Salud de Santiago de Cuba, desde septiembre de 2017 hasta enero de 2018, a fin de evaluar la utilidad de un material didáctico sobre Investigación Cualitativa como herramienta de apoyo a la asignatura Elementos de Investigación Cualitativa en Salud. Se obtuvo un elevado nivel de aceptación en los estudiantes, quienes confirmaron la claridad con que se exponen los contenidos, el nivel de profundidad y la importancia de contar con un texto que ejemplifique y vincule el contenido de metodología de la investigación con situaciones de su práctica diaria. Este material favoreció la calidad del proceso de enseñanza - aprendizaje, dada en la promoción alcanzada, que resultó cualitativamente superior a la de cursos anteriores(AU)

A descriptive and cross-sectional study of 139 students of 2nd year of Licentiate in Nursing, belonging to the Health Nursing-Technology Faculty in Santiago de Cuba was carried out from September, 2017 to January, 2018, in order to evaluate the usefulness of a didactic material on Qualitative Investigation as a support tool to the subject Elements of Qualitative Investigation in Health. A high level of acceptance was obtained in the students who confirmed the clarity with which the contents and their quality are exposed and the importance of having a text that exemplifies and links the content of the investigation methodology with situations of the daily practice. This material favored the quality of the teaching - learning process, given the high marks, which were qualitatively higher to those of previous courses(AU)

Utilidad de un material didáctico sobre Investigación Cualitativa en Salud / Usefulness of a didactic material on Qualitative Investigation in Health

Se realizó un estudio descriptivo y transversal de 139 estudiantes de segundo año de la carrera Licenciatura en Enfermería, pertenecientes a la Facultad de Enfermería-Tecnología de la Salud de Santiago de Cuba, desde septiembre de 2017 hasta enero de 2018, a fin de evaluar la utilidad de un material didáctico sobre Investigación Cualitativa como herramienta de apoyo a la asignatura Elementos de Investigación Cualitativa en Salud. Se obtuvo un elevado nivel de aceptación en los estudiantes, quienes confirmaron la claridad con que se exponen los contenidos, el nivel de profundidad y la importancia de contar con un texto que ejemplifique y vincule el contenido de metodología de la investigación con situaciones de su práctica diaria. Este material favoreció la calidad del proceso de enseñanza - aprendizaje, dada en la promoción alcanzada, que resultó cualitativamente superior a la de cursos anteriores.

A descriptive and cross-sectional study of 139 students of 2nd year of Licentiate in Nursing, belonging to the Health Nursing-Technology Faculty in Santiago de Cuba was carried out from September, 2017 to January, 2018, in order to evaluate the usefulness of a didactic material on Qualitative Investigation as a support tool to the subject Elements of Qualitative Investigation in Health. A high level of acceptance was obtained in the students who confirmed the clarity with which the contents and their quality are exposed and the importance of having a text that exemplifies and links the content of the investigation methodology with situations of the daily practice. This material favored the quality of the teaching - learning process, given the high marks, which were qualitatively higher to those of previous courses.

Developing Value-Orientations in Family Therapy Trainees: A Three-Year Investigation.

Family therapy has advanced as an important therapeutic approach in Europe and, in Germany, future family therapists enter a three-year-training programme every year. Family therapist trainees (FTTs) have hardly been studied in terms of their value-orientations (VOs) and how they see the world. This study aims at researching the value-orientation developments in FTTs during the three-year training period and based on the Schwartz value model. A longitudinal study was carried out over a three-year period. The sample consisted of 65 FTTs. VOs were investigated using open questions in self-developed questionnaires. The findings show that FTTs focus mainly on VOs in the Schwartz value domain of "benevolence", followed by "self-direction" and "universalism". This shows that the well-being of others is in the centre of interest in FTTs. However, VOs which indicate a freedom to make decisions and be self-directed are also extremely important. The least-mentioned value domains include "power" and "stimulation", showing that FTTs are neither focused on status, wealth or richness, nor on excitement or a varied life. With regard to the Schwartz value dimensions, the dimension of "self-transcendence" was the most frequently mentioned, followed by "conservation", "openness to change" and "self-enhancement". Self-transcendence includes the value domains of benevolence and universalism and shows that the preservation and enhancement of welfare of other individuals are highly important, as well as VOs such as understanding, appreciation, tolerance and protection of human beings and the environment. So-called collectivist VOs seem to be more important to German FTTs than individualistic VOs: they focus on the needs of the social group and their VOs show that the systemic view is inherent in their social VOs. Findings further show that FTTs develop their professional identity while consciously strengthening their VOs. This study contradicts previous research which claims that FTs are, to a large extent, unconscious in respect of their VOs. The study shows that FTTs are aware of their VOs and this supports them in facilitating client-centred approaches and develop themselves as FT professionals. Recommendations for future research and practice are provided.

Traditional healing practices in rural Bangladesh: a qualitative investigation.

BACKGROUND: Traditional healing practice is an important and integral part of healthcare systems in almost all countries of the world. Very few studies have addressed the holistic scenario of traditional healing practices in Bangladesh, although these serve around 80% of the ailing people. This study explored distinctive forms of traditional healing practices in rural Bangladesh. METHODS: During July to October 2007, the study team conducted 64 unstructured interviews, and 18 key informant interviews with traditional healers and patients from Bhabanipur and Jobra, two adjacent villages in Chittagong district, Bangladesh. The study also used participatory observations of traditional healing activities in the treatment centers. RESULTS: Majority of the community members, especially people of low socioeconomic status, first approached the traditional healers with their medical problems. Only after failure of such treatment did they move to qualified physicians for modern treatment. Interestingly, if this failed, they returned to the traditional healers. This study identified both religious and non-religious healing practices. The key religious healing practices reportedly included Kalami, Bhandai, and Spiritual Healing, whereas the non-religious healing practices included Sorcery, Kabiraji, and Home Medicine. Both patients and healers practiced self-medication at home with their indigenous knowledge. Kabiraji was widely practiced based on informal use of local medicinal plants in rural areas. Healers in both Kalami and Bhandari practices resorted to religious rituals, and usually used verses of holy books in healing, which required a firm belief of patients for the treatment to be effective. Sorcerers deliberately used their so-called supernatural power not only to treat a patient but also to cause harm to others upon secret request. The spiritual healing reportedly diagnosed and cured the health problems through communication with sacred spirits. Although the fee for diagnosis was small, spiritual healing required different types of treatment instruments, which made the treatment implicitly expensive. CONCLUSIONS: Traditional healing was widely practiced as the means of primary healthcare in rural areas of Bangladesh, especially among the people with low socioeconomic status. The extent of services showed no decline with the advancement of modern medical sciences; rather it has increased with the passage of time.

Disaster nursing experiences of Chinese nurses responding to the Sichuan Ya'an earthquake.

AIM: The aim of this study was to investigate the disaster experiences of nurses called to assist survivors one month after the 2013 Ya'an earthquake. BACKGROUND: China has experienced an increasing number of earthquake disasters in the past four decades. Although a health and disaster management system was initiated after the 2008 Wenchuan earthquake, nurses' roles and experiences in a disaster have been overlooked. METHODS: The researchers used qualitative descriptive design that included 16 participants. Data were collected using semi-structured interviews and observation notes, after which a qualitative content analysis was conducted. FINDINGS: Three major themes emerged: the process of being dispatched from hospitals to the disaster zone, the effort involved in getting to and working in the affected site and reflecting on the challenges they encountered. DISCUSSION: About half of the participants had received disaster nursing training before deploying to the disaster site, but they consistently expressed a lack of physical and psychological preparedness regarding the process of being dispatched from their hospitals to the disaster zone. LIMITATIONS: This was a single-incident experience. Caution should be taken when trying to extend the findings to other parts of China. CONCLUSION: These findings highlighted the need for disaster in-service training as well as for having disaster plans in place. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Hospital and nursing leaders should provide disaster training opportunities that included topics such as compiling resource inventories, formulating disaster drills and simulations, managing emergencies, and using emergency communication methods. Health policy-makers should be required to prioritize capacity-building training for front-line nurses as well as to develop and implement disaster management plans to better prepare nurses for future disasters.

El lugar del sujeto en el campo de la salud: enseñanzas de la investigación cualitativa / The place of the individual in the field of health: lessons from qualitative investigation

En este artículo se cuestiona la exclusión de la subjetividad derivada de los ideales de objetividad y neutralidad del paradigma científico moderno. Se exponen algunas de sus consecuencias en lo que atañe a la construcción de la salud y el cuidado de la enfermedad. Se discuten cinco nudos problemáticos en los que la investigación cualitativa tiene valiosos aportes qué ofrecer para la recuperación del lugar del sujeto: la salud y la enfermedad como experiencias subjetivamente percibidas y significadas; la brecha que separa a la visión de los expertos y de quienes no lo son; los desencuentros entre los profesionales de la salud y la población, tanto en el frente curativo como en el preventivo; el silenciamiento de la voz del enfermo sobre su vivencia de la enfermedad; y la esterilización de la creatividad subjetiva en la construcción de rutas más diversas para el cuidado de la salud. Se postula que, con todos los retos implicados, ciertas corrientes de la investigación cualitativa cuyos fundamentos se ubican en el polo más avanzado de la reflexión epistemológica, ética e incluso estética de nuestros días, pueden ayudar a abrir nuevas rutas hacia alternativas más ricas e imaginativas para el cuidado de la salud y la atención de la enfermedad en las sociedades latinoamericanas.

This article addresses some questions regarding the exclusion of the subjectivity derived from the ideals of objectivity and neutrality that characterize the modern scientific parade gm. Several consequences of this exclusion with respect to health care and illness are considered. Five problem areas are discussed, emphasizing the contributions of qualitative inquiry for the recovery of the importance of the individual. These include health and disease as subjective experiences, the gap between the experts' perspective and that of the layman, as well as disagreements among health professionals and common people, both in the preventive and in the curative fields. They also include the omission of the patients' voice when dealing with their illness and the sterilization of subjective creativity to establish new avenues to health care. The paper concludes by pointing out that, despite the challenges involved, certain currents of qualitative research whose foundations are located in the most advanced area of current epistemological, ethical and aesthetic reflection, can help to open new routes towards richer alternatives for health care and illness in Latin American societies.

Estrategia didáctica para el desarrollo del trabajo independiente de la asignatura Metodología de la Investigación Cualitativa en Salud / Teaching strategy for the self-employment development in the subject Methodology of Qualitative Research in Health

Introducción: La asignatura Metodología de la Investigación Cualitativa en Salud se imparte a los estudiantes de tercer año de la Licenciatura en Enfermería en la modalidad de clase teórico-práctica como forma organizativa de la docencia. Ello recalca la importancia del trabajo independiente. Las insuficiencias con relación a éste inciden directamente en la asimilación y apropiación de los conocimientos de la asignatura. Objetivo: Elaborar una estrategia didáctica que contribuya al desarrollo del trabajo independiente correspondiente a la asignatura Metodología de la Investigación Cualitativa en Salud.Material y métodos: Se realizó una investigación de desarrollo, encaminada a perfeccionar el proceso docente educativo en la Facultad de Enfermería, de la Universidad de Ciencias Médicas de Camagüey, durante el curso escolar 2011-2012. Para el diagnóstico inicial se procedió al análisis de documentos: los planes de estudio y el programa de la asignatura. También se aplicaron encuestas a un grupo de estudiantes y al colectivo de profesores que imparten la asignatura. Una vez elaborada la estrategia se evaluó por criterio de expertos. Resultados y discusión: La estrategia pone a disposición de la comunidad académica un software educativo que relaciona los contenidos de la asignatura, lo que permitirá al estudiantado realizar las tareas docentes que se orientan en clases así como asimilar, consolidar y sistematizar los conocimientos con mayor facilidad.

Introduction: The subject Methodology of Qualitative Research in Health is taught to the students of the third year of the Bachelor in nursing in the form of theoretical and practical lesson as organizational way of teaching. This underscores the importance of self-employment. The shortcomings in relation to this affect directly the assimilation and appropriation of knowledge in the subject. Objective: To develop a teaching strategy that contributes to the development of self-employ ment for the subject Methodology of Qualitative Research in Health. Material aids and methods: A development research was made which aims at improving the educational teaching process in the Faculty of nursing from the University of Medical Sciences in Camagüey, during the 2011-2012 course. For an initial diagnosis the analyses of documents was made: the curriculum and the program of the course. Surveys were also applied to a group of students and the staff of teachers of the subject. Once the strategy was made it was evaluated through criteria of experts. Results and discussion: Strategy makes available to the academic community educational software that relates to the contents of the course, allowing students to perform teaching tasks which are assigned in lessons as well as assimilate, consolidate and systematize the knowledge easiest.

Usos del celular en jóvenes chilenos de bajos recursos / Cellphone usage among poor Chilean teenagers / Usos de celular por jovens chilenos de baixa renda

En este trabajo analizamos los significados que los jóvenes y las jóvenes de Chile de bajos recursos atribuyen a la compra, uso y tenencia de un celular. La investigación cualitativa utilizada no sólo nos permitió descubrir las necesidades que los sujetos jóvenes buscan satisfacer con la compra y/o uso de un celular, sino también los factores socioculturales que determinan este comportamiento de compra. La importancia del presente no es sólo por la pretensión de ser un estudio sociológico sobre la conducta de compra, uso y tenencia de celular por parte de los jóvenes y las jóvenes de Chile de menores recursos, sino también porque constituye una poderosa herramienta para comprender los problemas sociales relacionados con este hecho.

This study examines the value that Chilean teenagers low socio-economic status give to the purchase, use and possession of a cell phone. The qualitative approach used in this paper doesn't just allow an understanding of the needs that teenager are trying to satisfy, but also allows the identification of the socio-cultural factors behind their purchasing behavior. This paper is worthy because it is not just a sociological characterization of the purchasing behavior of teenagers of low socio-economic status in Chile, but it also provides a powerful tool to understand the social problems related to this issue.

Este trabalho analisaos significados que os jovens chilenos de baixa renda atribuem à compra, uso e possede um celular. A pesquisa qualitativa realizada, não só permitiu descobriras necessidades que os jovens buscam satisfazer com a compra e/ou uso de um celular, mas também os fatores socioculturais que determinam o seu comportamento de compra. A importância da presente pesquisa não está somente naintenção de ser um estudo sociológico sobre o comportamento de compra, uso e possede celular pelos jovens chilenos de baixa renda, mas também consiste em uma poderosa ferramenta para compreender os problemas sociais relacionados a esse fato.

Analysis of the construction and development of overseas information platforms for regional health services / 中华医院管理杂志

A comparison is made on the healthcare systems,economy,informationization environment,developers,investment and compensation mechanisms in nine countries featuring early startup,rich experiences,and relatively higher ratio of success in their development projects.This lead to a discussion focusing on the construction steps and development strategies for regional health informationization,and an analysis of the present regional health informationization overseas,common measures taken,and key factors for successful regional health informationization.Based on these,recommendations were made on development of regional health informationization compliant to China's circumstances.