Roteiro para Elaboração de Ato Normativo para a Categorização dos Serviços de Alimentação Prático / Script for the Elaboration of a Normative Act for the Categorization of Practical Food Services

A Categorização dos serviços de alimentação possibilita que os consumidores escolham os serviços de alimentação que se preocupam com a qualidade sanitária. A Agência Nacional de Vigilância Sanitária (Anvisa) decidiu criar um sistema semelhante para os serviços de alimentação no Brasil. Este sistema teve a preocupação de minimizar o risco para Doenças Transmitidas por Alimentos (DTA). Para o projeto-piloto de Categorização da Copa do Mundo FIFA® em 2014, foi desenvolvido um instrumento chamado de lista de avaliação. Esta lista tem como base a RDC nº216/2004 e dos 177 itens de verificação ficaram 51 itens de verificação com foco no risco sanitário para DTA. Esta lista foi aplicada na avaliação dos serviços de alimentação, de forma voluntária, em 11 cidades-sede dos jogos da Copa do Mundo FIFA®/2014. Para realizar a Categorização dos serviços de alimentação, como um projeto de governo, faz-se necessário um ato normativo que oficialize e oriente não somente a adesão a Categorização, mas todas as etapas de sua implantação. Este roteiro não tem caráter normativo e sim orientativo. As informações nele contidas são proposições com a finalidade de orientar e subsidiar estados e municípios na atuação regulatória para a Categorização de serviços de alimentação, podendo ser utilizado na íntegra ou parcialmente.

Boletim Epidemiológico dos Casos de Covid-19 no Estado do Rio de Janeiro 2020 - 2021 / Epidemiological Bulletin of Covid-19 Cases in the State of Rio de Janeiro 2020 - 2021

Esta edição do boletim apresenta a análise do total de casos confirmados de COVID-19 de residentes no estado do Rio de Janeiro e suas nove regiões de saúde, incluindo os casos de Síndrome Gripal (SG) ou casos leves, as internações ou casos de Síndrome Respiratória Aguda Grave (SRAG) e os óbitos, ocorridos desde o início da pandemia em 2020 até 26 de fevereiro de 2022 (8ª Semana Epidemiológica).

Evaluation of the pharmaceutical assistance structure in Maranhão State, Brazil

Assessment instruments can measure the effectiveness of health policy organizations. This research is a descriptive diagnostic study the Pharmaceutical Assistance structure in Maranhão State, Brazil. The methodology consisted of obtaining secondary data from institutions related to the Pharmaceutical Assistance in the State. Structure indicators were calculated using methodology adapted from the World Health Organization (WHO), and pharmacists perception about the structure of the Pharmaceutical Assistance was analysed through questionnaires. There are 3,003 pharmacists and 3,410 healthcare establishments registered in the Regional Pharmacy Council CRF-MA, particularly in the capital area. Two main problems were identified by pharmacists: the "ineffective management of the public health system" and the "amount of available medicine is insufficient to meet the rising demands of the population" (23.08%; 18 each). We concluded that the Pharmaceutical Assistance organization in Maranhão State is in a precarious situation that requires an investment of resources to improve the physical structures, expand the amount and improve the qualifications of human resources, and procure medicines in sufficient quantities to meet the population's needs.

No common understanding of profession terms utilized in health services research : An add-on qualitative study in the context of the QUALICOPC project in Austria.

BACKGROUND: Health services research, especially in primary care, is challenging because the systems differ widely between countries. This study aimed to explore the different understanding of the terminology used, particularly, regarding the professions nursing and medical secretaries. METHODS: The study was an add-on study to the Quality and Costs in Primary Care (QUALICOPC) project in Austria and designed as qualitative research. The qualitative phase was conducted by using semi-structured telephone interviews with general practitioners (GP). and17 GPs participated in the study. RESULTS: No uniform meaning of the terms commonly utilized for the abovementioned health professions could be found among Austrian GPs. For example, under the profession term practice assistants, nurses as well as literal medical secretaries with and without special education and related work competencies and responsibilities were subsumed. CONCLUSIONS: Our study results show that no uniform meaning of the terms commonly utilized for above described health profession could be found even within one country by GPs. These findings are highly relevant, especially, when trying to compare results with similar data from other countries or negotiating about workforce issues. Our findings implicate several action points for health services research and health policy. We propose the development of a harmonized terminology in Europe for the health profession based on standards of undergraduate and postgraduate education, competencies and continuous education commitments. This would not only benefit comparative health system research but also patient safety across Europe.

Clinical Outcome Assessments: Conceptual Foundation-Report of the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force.

An outcome assessment, the patient assessment used in an endpoint, is the measuring instrument that provides a rating or score (categorical or continuous) that is intended to represent some aspect of the patient's health status. Outcome assessments are used to define efficacy endpoints when developing a therapy for a disease or condition. Most efficacy endpoints are based on specified clinical assessments of patients. When clinical assessments are used as clinical trial outcomes, they are called clinical outcome assessments (COAs). COAs include any assessment that may be influenced by human choices, judgment, or motivation. COAs must be well-defined and possess adequate measurement properties to demonstrate (directly or indirectly) the benefits of a treatment. In contrast, a biomarker assessment is one that is subject to little, if any, patient motivational or rater judgmental influence. This is the first of two reports by the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force. This report provides foundational definitions important for an understanding of COA measurement principles. The foundation provided in this report includes what it means to demonstrate a beneficial effect, how assessments of patients relate to the objective of showing a treatment's benefit, and how these assessments are used in clinical trial endpoints. In addition, this report describes intrinsic attributes of patient assessments and clinical trial factors that can affect the properties of the measurements. These factors should be considered when developing or refining assessments. These considerations will aid investigators designing trials in their choice of using an existing assessment or developing a new outcome assessment. Although the focus of this report is on the development of a new COA to define endpoints in a clinical trial, these principles may be applied more generally. A critical element in appraising or developing a COA is to describe the treatment's intended benefit as an effect on a clearly identified aspect of how a patient feels or functions. This aspect must have importance to the patient and be part of the patient's typical life. This meaningful health aspect can be measured directly or measured indirectly when it is impractical to evaluate it directly or when it is difficult to measure. For indirect measurement, a concept of interest (COI) can be identified. The COI must be related to how a patient feels or functions. Procedures are then developed to measure the COI. The relationship of these measurements with how a patient feels or functions in the intended setting and manner of use of the COA (the context of use) could then be defined. A COA has identifiable attributes or characteristics that affect the measurement properties of the COA when used in endpoints. One of these features is whether judgment can influence the measurement, and if so, whose judgment. This attribute defines four categories of COAs: patient reported outcomes, clinician reported outcomes, observer reported outcomes, and performance outcomes. A full description as well as explanation of other important COA features is included in this report. The information in this report should aid in the development, refinement, and standardization of COAs, and, ultimately, improve their measurement properties.

Action research: changing nursing practice.

This article describes action research as a methodology and gives two examples of its application to nursing and health services research. Action research is cyclical in nature and involves the development, evaluation and redefining of an action plan using four basic steps: planning, action, observation and reflection. These cycles of action continue until the research group is satisfied that its objectives have been met. Data generation and analysis are iterative processes that occur continuously throughout the project, which is usually time-limited. Factors that should be taken into account to ensure success include: engaging the community, consideration of 'insider' versus 'outsider' perspectives, competing agendas, expectations not being met and the integrity of the research methodology.

Núcleos y ámbitos de investigación sobre adicciones: necesidad de una visión más amplia / Core research areas on addiction: the need for a broader view

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Building a common pediatric research terminology for accelerating child health research.

Longitudinal observational clinical data on pediatric patients in electronic format is becoming widely available. A new era of multi-institutional data networks that study pediatric diseases and outcomes across disparate health delivery models and care settings are also enabling an innovative collaborative rapid improvement paradigm called the Learning Health System. However, the potential alignment of routine clinical care, observational clinical research, pragmatic clinical trials, and health systems improvement requires a data infrastructure capable of combining information from systems and workflows that historically have been isolated from each other. Removing barriers to integrating and reusing data collected in different settings will permit new opportunities to develop a more complete picture of a patient's care and to leverage data from related research studies. One key barrier is the lack of a common terminology that provides uniform definitions and descriptions of clinical observations and data. A well-characterized terminology ensures a common meaning and supports data reuse and integration. A common terminology allows studies to build upon previous findings and to reuse data collection tools and data management processes. We present the current state of terminology harmonization and describe a governance structure and mechanism for coordinating the development of a common pediatric research terminology that links to clinical terminologies and can be used to align existing terminologies. By reducing the barriers between clinical care and clinical research, a Learning Health System can leverage and reuse not only its own data resources but also broader extant data resources.

Actualización del diagnóstico de situación de la investigación en salud en el ámbito del Ministerio de Salud de la Nación y 19 Ministerios Provinciales / Update of Diagnosis of Health Research Situation in the Field of Argentine National and 19 Provincial Ministries of Health

Dado los escasos antecedentes de estudios sobre los sistemas de investigación para la salud en Argentina, el Ministerio de Salud de la Nación decidió realizar un diagnóstico de las actividades de investigación en el subsector público de salud. OBJETIVO: Describir las actividades de gestión, producción y difusión de la investigación realizadas por los ministerios de Salud y sus organismos dependientes entre 2010 y 2012. MÉTODOS: Estudio descriptivo transversal. Se estudiaron 20 ministerios (Nación, Ciudad Autónoma de Buenos Aires y provincias de Buenos Aires, Córdoba, Chaco, Corrientes, Chubut, Formosa, Jujuy, La Pampa, La Rioja, Mendoza, Misiones, Neuquén, Río Negro, San Juan, Santa Cruz, Santiago del Estero, Tierra del Fuego y Tucumán). Se efectuó una encuesta estructurada a funcionarios responsables de organismos ministeriales de nivel central, descentralizados y servicios de salud. RESULTADOS: Se relevaron 299 organismos y 1.070 investigaciones; el 80% de las cuales se había realizado en servicios de salud. El 61,3% del total recibió financiamiento. CONCLUSIONES: La magnitud de las investigaciones halladas en este estudio evidencia la importancia que las actividades de investigación tienen en los ministerios de Salud estudiados, en consonancia con el apoyo que se le ha dado en los últimos años a esta actividad como política de Estado...

Considering the few background of studies about the health systems in Argentina, the National Ministry of Health decided to make a diagnosis of the research activities in the public health subsector. OBJECTIVE: To describe the activities of research management, production and dissemination conducted by health ministries and their agencies between 2010 and 2012. METHODS: Descriptive cross-sectional study. A total of 20 health ministries (National, Autonomous City of Buenos Aires and the provinces of BuenosAires, Córdoba, Chaco, Corrientes, Chubut, Formosa, Jujuy, La Pampa, La Rioja, Mendoza, Misiones, Neuquén, Río Negro, San Juan, Santa Cruz, Santiago del Estero, Tierra del Fuegoa nd Tucumán) was studied. A structured survey to responsible officials of central level structures, decentralized institutionsand health services was conducted. RESULTS: 299 dependent agencies and 1070 research projects were surveyed, 80% of which had been conducted in health services and 61.3% of total had received financing. CONCLUSIONS: The magnitude of the research found in this study shows the importance that the research activities have in the ministries of health studied, in line with the support that has been given in recent years to this activity as state policy...

7° Encuentro de la Red de Unidades de Investigación en Enfermería ENEO/UNAM, Instituciones e Institutos Nacionales de Salud / 7th Meeting of the Network of Nursing Research Units ENEO/UNAM, Institutions, and National Institutes of Healt

El término red tiene dos usos como un campo social constituido por relaciones entre personas. La palabra campo hace referencia a un concepto espacial que va asociado a cada punto o “integrante” como un valor determinado.

Mapping global health research investments, time for new thinking--a Babel Fish for research data.

Today we have an incomplete picture of how much the world is spending on health and disease-related research and development (R&D). As such it is difficult to align, or even begin to coordinate, health R&D investments with international public health priorities. Current efforts to track and map global health research investments are complex, resource-intensive, and caveat-laden. An ideal situation would be for all research funding to be classified using a set of common standards and definitions. However, the adoption of such a standard by everyone is not a realistic, pragmatic or even necessary goal. It is time for new thinking informed by the innovations in automated online translation - e.g. Yahoo's Babel Fish. We propose a feasibility study to develop a system that can translate and map the diverse research classification systems into a common standard, allowing the targeting of scarce research investments to where they are needed most.

Measured radiofrequency exposure during various mobile-phone use scenarios.

Epidemiologic studies of mobile phone users have relied on self reporting or billing records to assess exposure. Herein, we report quantitative measurements of mobile-phone power output as a function of phone technology, environmental terrain, and handset design. Radiofrequency (RF) output data were collected using software-modified phones that recorded power control settings, coupled with a mobile system that recorded and analyzed RF fields measured in a phantom head placed in a vehicle. Data collected from three distinct routes (urban, suburban, and rural) were summarized as averages of peak levels and overall averages of RF power output, and were analyzed using analysis of variance methods. Technology was the strongest predictor of RF power output. The older analog technology produced the highest RF levels, whereas CDMA had the lowest, with GSM and TDMA showing similar intermediate levels. We observed generally higher RF power output in rural areas. There was good correlation between average power control settings in the software-modified phones and power measurements in the phantoms. Our findings suggest that phone technology, and to a lesser extent, degree of urbanization, are the two stronger influences on RF power output. Software-modified phones should be useful for improving epidemiologic exposure assessment.

Methods of qualitative research in dentistry: a review.

UNLABELLED: Over the last decade, researchers in health services research started using qualitative research methods. This has led to a corresponding rise in the reporting of the qualitative research studies in medical and related journals, including dental journals. Qualitative research is often contrasted with quantitative research as a set of 'non quantitative methods', since it does not deal with numbers and enumerate phenomena. It interprets the information people bring to research, which helps us to understand social phenomena in natural settings like their own territory, in their own language and on their own terms, giving emphasis to the meaning, experience and view of all the participants. CLINICAL RELEVANCE: This article will help the clinician to understand the importance of in-depth knowledge of behaviour and social phenomena around the patient.

Reducing the rate of unregistered studies.

The aim of this audit cycle is to measure the extent to which unregistered or wrongly classified studies (research, clinical audit, satisfaction surveys/service evaluations) are conducted within a National Health Service (NHS) Trust, and to ascertain whether promotion of the correct processes can improve the results. An anonymous questionnaire was sent to staff in a single NHS Trust via internal post and email concerning unregistered or wrongly classified studies being conducted. An information sheet was attached to the questionnaire, which gave a brief description and information relating to conducting different types of study. The audit was conducted before and after the introduction of a variety of promotional activities within the Research and Development (R&D) department. The percentage of unregistered research was shown to be 45.8% in audit 1, with audit 2 showing a reduction in unregistered studies to 5.2% (P = 0.005). For clinical audits the results were similar between audits (with no additional promotion) (2.3-2.4%). Satisfaction surveys which were included in the promotion of the research department reduced its level of unregistered studies from 46% to 5% (P = 0.0084). With the targeted and persistent promotion of the relevant departments a dramatic reduction in unregistered studies can be achieved (P = 0.01).

Compreensão, pelos acompanhantes, do conteúdo da receita médica nos atendimentos pediátricos em postos de saúde pública em Tubarão, SC / Comprehension level of the medical prescription s by the companions of children attended in public health ambulatories located in Tubarão, SC

Objetivo: Conhecer a compreensão que os acompanhantes de pacientes, atendidos por pediatras, têm doconteúdo da receita médica. Método: Qualitativo. A coleta de dados deu-se através da observação participante e de entrevista semi-estruturada, realizada logo após a consulta médica, com20 acompanhantes de crianças atendidas por pediatras em duas unidades públicas de saúde do município de Tubarão-SC. Resultados: A compreensão da receita médica, emalgumas situações, foi satisfatória, com bom entendimento do conteúdo da receita, que era adequadamente legível.Em outras situações houve dificuldade de compreender a letra do profissional, bem como de algumas abreviaturasutilizadas por ele, ocasionando falha na comunicação. Criamos três categorias para mostrar a realidade observada: compreensão adequada da receita médica; dificuldade de compreensão da receita médica; e, compreensão equivocada da receita médica. A categoria “dificuldade de compreensão da receita médica” foi dividida em três sub-categorias: caligrafia inadequada,utilização de abreviaturas e analfabetismo. Conclusões: A comunicação adequada mostrou-seum meio necessário para que ocorresse interação entre médico e aaciente/ acompanhante, influindo diretamente na qualidade do atendimento. A análise dos dados mostrou que há necessidade de melhor treinamento do médico na arte da comunicação, em especial para aqueles que prestam atendimento no setor público. Sugere-se que se façam outras pesquisas abordando temas relacionados à comunicação médica e à relação médico-paciente, propicie-se melhor capacitação dos médicos queatuam nas comunidades, e que se ensine, nos cursos de medicina, a utilização de ferramentas para uma adequada comunicação.

Objective: To verify the comprehension level that those accompanying patients attended by pediatricians have of the content of medical prescriptions.Method: Qualitative. Data were collected through participant observation and semi-structured interviews. Twenty companions of children attended by pediatriciansin two public health units located in Tubarão, Santa Catarina, were interviewed just after the doctor’s appointment. Results: The comprehension level of the medicalprescriptions was satisfactory, with individuals showing a good understanding of the content of the prescriptions which were written in a readable way. In some situations,the doctors’ handwriting, as well as the abbreviations they used, caused communication problems. To show the observed reality three categories were created: (a) adequate comprehension of the medical prescription; (b) difficulty in understanding the medical prescription; and (c) medical prescription misunderstanding. Category (b)was divided into three subcategories: (i) inadequate handwriting;(ii) use of abbreviations; and (iii) companions’ illiteracy. Conclusions: Adequate communication betweenphysicians and patient companions has a direct impact on the quality of attendance. Data analysis revealed thatphysicians, specially those involved in the public sector attendance, should be trained to develop communicationsskills. Suggestions include further research on communication techniques between physicians and patients,better training programs for physicians who work within the community, and better teaching in medical schoolson how to use communication tools.

[Healthcare research and regional programming in Umbria (Italy)]. / Ricerca scientifica in campo sanitario e Programmazione regionale: l'esperienza dell'Umbria.

This paper discusses the relationship between regional programming and national health research policy, and in particular evaluates the role that intellectual capital plays in innovation processes of knowledge-based organizations. The concepts of intellectual capital and knowledge-based organization are defined in the paper, as these are especially useful when speaking of university, healthcare systems and research and development companies. The paper also examines the various types of healthcare research (basic research, clinical trial, epidemiological research, valutative research) and the role that each type of research plays in healthcare programming at the national and regional levels.