Risk factors for obsessive-compulsive symptoms. Follow-up of a community-based youth cohort.

Environmental factors are at least as important as genetic factors for the development of obsessive-compulsive symptoms (OCS), but the identification of such factors remain a research priority. Our study aimed to investigate the association between a broad scope of potential risk factors and OCS in a large community cohort of children and adolescents. We evaluated 1877 participants and their caregivers at baseline and after 3 years to assess various demographic, prenatal, perinatal, childhood adversity, and psychopathological factors. Mean age at baseline was 10.2 years (SD 1.9) and mean age at follow-up was 13.4 years (SD 1.9). Reports of OCS at baseline and follow-up were analyzed using latent variable models. At preliminary regression analysis, 15 parameters were significantly associated with higher OCS scores at follow-up. At subsequent regression analysis, we found that eight of these parameters remained significantly associated with higher follow-up OCS scores while being controlled by each other and by baseline OCS scores. The significant predictors of follow-up OCS were: lower socioeconomic status (p = 0.033); lower intelligence quotient (p = 0.013); lower age (p < 0.001); higher maternal stress level during pregnancy (p = 0.028); absence of breastfeeding (p = 0.017); parental baseline OCS (p = 0.038); youth baseline anxiety disorder (p = 0.023); and youth baseline OCS scores (p < 0.001). These findings may better inform clinicians and policymakers engaged in the mental health assessment and prevention in children and adolescents.

Access of the patient to the cancer network under the "Sixty-Day Law": Integrative Review.

OBJECTIVES: to analyze Brazilian scientific production on patient access to the oncology network under the "Sixty-Day Law". METHODS: integrative review of the literature in the databases Lilacs, PubMed and Scielo. The descriptors used were: neoplasms, health services accessibility, early detection of cancer. Articles published from 2015 to March 2019 were included. RESULTS: 17 articles were analyzed and four themes emerged: inequality in access; qualification of Primary Care professionals; time as a determinant factor; information system as limiting factor. CONCLUSIONS: the access to the oncology network is unequal and there are several barriers faced by the users. A continuing education of health professionals is necessary to implement preventive strategies. Treatment initiation is late, showing non-compliance with the law. The health care network is highly fragmented, there is lack of coordination between the services and, consequently, there is a lack of patient follow-up.

Psychosocial care network: managers' perception and tensions of the field.

OBJECTIVE: to analyze the perception of workers and managers about the psychosocial care network in a medium-sized municipality in the inlands of the state of Minas Gerais. METHOD: qualitative, descriptive and exploratory study involving twelve participants from different points of the network. The semi-structured interviews were analyzed in the light of Pierre Bourdieu's framework of constructionist structuralism. RESULTS: the actions offered by the services were based on the perspectives of resocialization, user embracement, group and multiprofessional care, and on approaches to harm reduction, recreation and daily organization. These were configured as the network resources/capital. Tensions were identified in family embracement and in relationships between families and users, as well as in the prejudice towards people with mental disorders. Final considerations: the social agents were willing to contribute to processes of change in order to overcome the focus on specialties, the lack of training of some teams, lack of infrastructure and of some components, especially those related to leisure and community life.

Access of the patient to the cancer network under the "Sixty-Day Law": Integrative Review / Acceso del paciente a la red oncológica en la vigencia de la "Ley de los Sesenta Días": Revisión Integrativa / Acesso do paciente à rede oncológica na vigência da "Lei dos Sessenta Dias": Revisão Integrativa

ABSTRACT Objectives: to analyze Brazilian scientific production on patient access to the oncology network under the "Sixty-Day Law". Methods: integrative review of the literature in the databases Lilacs, PubMed and Scielo. The descriptors used were: neoplasms, health services accessibility, early detection of cancer. Articles published from 2015 to March 2019 were included. Results: 17 articles were analyzed and four themes emerged: inequality in access; qualification of Primary Care professionals; time as a determinant factor; information system as limiting factor. Conclusions: the access to the oncology network is unequal and there are several barriers faced by the users. A continuing education of health professionals is necessary to implement preventive strategies. Treatment initiation is late, showing non-compliance with the law. The health care network is highly fragmented, there is lack of coordination between the services and, consequently, there is a lack of patient follow-up.

RESUMEN Objetivos: analizar la producción científica brasileña sobre la accesibilidad del paciente a la red oncológica, según la vigencia de la "Ley de los Sesenta Días". Métodos: se trata de una revisión integradora llevada a cabo según las bases de datos: Lilacs, PubMed y Scielo. Se utilizaron los descriptores: neoplasias, accesibilidad del servicio de salud y diagnóstico precoz del cáncer. Se incluyeron artículos publicados desde 2015 hasta marzo de 2019. Resultados: se analizaron 17 artículos, de los cuales surgieron cuatro temas: desigualdad en la accesibilidad; capacitación del profesional en la Atención Primaria; el tiempo como factor determinante; el sistema de información como factor limitador. Conclusiones: la accesibilidad de la red oncológica es desigual ya que hay muchas barreras que los usuarios deben enfrentar. La formación continua de los profesionales de la salud es imprescindible para poner en marcha estrategias preventivas. El inicio del tratamiento suele retrasarse, lo que demuestra la fragilidad en la aplicación de la legislación. Se observa la fragmentación de la red asistencial, la falta de articulación entre los servicios y como consecuencia, la falta de seguimiento de los pacientes.

RESUMO Objetivos: analisar a produção científica brasileira sobre o acesso do paciente à rede oncológica na vigência da "Lei dos Sessenta Dias". Métodos: revisão integrativa realizada por meio das bases de dados: Lilacs, PubMed e Scielo. Os descritores utilizados foram: neoplasias, acesso ao serviço de saúde e diagnóstico precoce de câncer. Foram incluídos artigos publicados de 2015 a março de 2019. Resultados: foram analisados 17 artigos, dos quais emergiram quatro temas: desigualdade no acesso; a qualificação do profissional na Atenção Primária; o tempo como fator determinante; o sistema de informação como fator limitante. Conclusões: o acesso à rede oncológica é desigual, há várias barreiras enfrentadas pelos usuários. É necessária a educação permanente do profissional de saúde para lançar estratégias preventivas. O início do tratamento é tardio, demonstrando fragilidade na aplicação da legislação. Percebe-se que há fragmentação da rede de atenção, falta articulação entre os serviços e, consequentemente, há falta de monitoramento do paciente.

Family and community support among older Chilean adults: the importance of heterogeneous social support sources for quality of life.

Family and community social networks act as social resources that promote well-being at advanced ages. In this study, we analyze the association between social support received from personal social networks (social support from various family members and friends) and community social networks (social support from neighbors and the neighborhood, age, ethnic, or religious group peers and formal social support networks) and quality of life (QoL) for a sample of older Chilean persons (n = 777). The results confirm that social support from family (partner, children, and extended family) and friends, integration in the community (neighbors) and social support from informal systems (social groups) are associated with QoL. Moreover, the model including both types of support explains 25.8% of variance in QoL. The results and their possible implications are discussed.

Strategic factors for the sustainability of a health intervention at municipal level of Brazil.

The present study aims to describe the evolution of an intervention, using a methodology that adopts the critical event as the unit of analysis, and to identify strategic factors that facilitate the continuation of the interventions. Six critical events were identified: dispute care models for health; area of advice: dispute field; change policy; break of interorganizational relations; lack of physical structure and turnover of staff; difficulty in organizing practices in the work process. these are developed into strategic factors: enabling network of allies; meetings and educational activities/building capacity; benefits perceived by community members; mobilization of key actors; intervention's compatibility with the government's vision; restoration of interrelationship; and stability of the workforce. These strategic factors form a group of interrelated conditions that provide the strengthened linkages between elements in the intervention, supporting the hypothesis that they collaborate for the sustainability of the interventions in health. Tracking down the transformations of an intervention set by the critical events, it was verified that these factors performed a protective role at times of changes in the intervention process.

Strategic factors for the sustainability of a health intervention at municipal level of Brazil / Fatores estratégicos para a sustentabilidade de uma intervenção na saúde em nível municipal no Brasil / Factores estratégicos para la sostenibilidad de una intervención en el ámbito de la salud a nivel municipal en Brasil

Abstract: The present study aims to describe the evolution of an intervention, using a methodology that adopts the critical event as the unit of analysis, and to identify strategic factors that facilitate the continuation of the interventions. Six critical events were identified: dispute care models for health; area of advice: dispute field; change policy; break of interorganizational relations; lack of physical structure and turnover of staff; difficulty in organizing practices in the work process. these are developed into strategic factors: enabling network of allies; meetings and educational activities/building capacity; benefits perceived by community members; mobilization of key actors; intervention's compatibility with the government's vision; restoration of interrelationship; and stability of the workforce. These strategic factors form a group of interrelated conditions that provide the strengthened linkages between elements in the intervention, supporting the hypothesis that they collaborate for the sustainability of the interventions in health. Tracking down the transformations of an intervention set by the critical events, it was verified that these factors performed a protective role at times of changes in the intervention process.

Resumo: O estudo busca descrever a evolução de uma intervenção, utilizando uma metodologia que adota o evento crítico como unidade de análise, além de identificar fatores estratégicos que facilitam a continuação das intervenções. Foram identificados seis eventos críticos: modelos em disputa na assistência à saúde; área de conselhos: campo de disputa; mudanças de políticas; quebra de relações entre organizações; falta de infraestrutura física e rotatividade de equipes e dificuldade na organização das práticas no processo de trabalho. Os eventos foram desdobrados em fatores estratégicos: potencialização de uma rede de aliados; reuniões e atividades educacionais ou de capacitação; benefícios percebidos pelos membros da comunidade; mobilização de atores-chave; compatibilidade da intervenção com a visão do governo; restauração do inter-relacionamento e estabilidade da força de trabalho. Esses fatores estratégicos formam um grupo de condições inter-relacionadas que fortalecem a articulação entre os elementos da intervenção, sustentando a hipótese de que colaboram com a sustentabilidade das intervenções na saúde. Ao identificar as transformações de uma intervenção relacionadas aos eventos críticos, verificou-se que esses fatores desempenharam papel protetor em momentos de mudanças no processo da intervenção.

Resumen: El estudio busca describir la evolución de una intervención, utilizando una metodología que adopta el evento crítico como unidad de análisis, además de identificar factores estratégicos que facilitan la continuación de las intervenciones. Se identificaron seis eventos críticos: modelos en disputa en la asistencia a la salud; área de consejos: campo de disputa; cambios de políticas; ruptura de relaciones entre organizaciones; falta de infraestructura física y rotatividad de equipos y dificultad en la organización de las prácticas en el proceso de trabajo. Los eventos fueron desdoblados en factores estratégicos: potencialización de una red de aliados; reuniones y actividades educacionales o de capacitación; beneficios percibidos por los miembros de la comunidad; movilización de actores-clave; compatibilidad de la intervención con la visión del gobierno; restauración de la interrelación y estabilidad de la fuerza de trabajo. Estos factores estratégicos forman un grupo de condiciones interrelacionadas que fortalecen la articulación entre los elementos de la intervención, manteniendo la hipótesis de que colaboran con la sostenibilidad de las intervenciones en la salud. Al identificar las transformaciones de una intervención relacionadas con los eventos críticos, se verificó que esos factores desempeñaron un papel protector en momentos de cambios en el proceso de la intervención.

Coalicion de Salud Comunitaria (COSACO): using a Healthy Community Partnership framework to integrate short-term global health experiences into broader community development.

BACKGROUND: There is growing concern that short-term experiences in global health experiences (STEGH), undertaken by healthcare providers, trainees, and volunteers from high income countries in lower and middle income countries, risk harming the community by creating a parallel system of care separate from established community development efforts. At the same time, the inclusion of non-traditional actors in health planning has been the basis of the development of many Healthy Community Partnerships (HCP) being rolled out in Canada and the United States. These partnerships aim to bring all stakeholders with a role to play in health to the table to align efforts, goals and programs towards broad community health goals. RESULTS: This methodology paper reports on the process used in La Romana, Dominican Republic, in applying a modified HCP framework. This project succeeded at bringing visiting STEGH organizations into a coalition with key community partners and supported attempts to embed the work of STEGH within longer-term, established development plans. CONCLUSIONS: In presenting the work and process and lessons learned, the hope is that other communities that encounter significant investment from STEGH groups, and will gain the same benefits that were seen in La Romana with regards to improved information exchange, increased cross-communication between silos, and the integration of STEGH into the work of community partners.

The role of partnerships in addressing childhood asthma: the experiences of the Merck Childhood Asthma Network, Inc. (MCAN) initiative.

Partnerships have taken on added importance in recent years because of their critical role in addressing complex public health problems and translating evidence-based practices to real-world settings. The Merck Childhood Asthma Network, Inc. initiative recognized the importance of partnerships in achieving the program's goals. In this article, case studies of the five Merck Childhood Asthma Network program sites describe the role of partnerships in the development and evolution of the program and its interventions. Three key factors contributed to the success of the partnerships: having common organizational goals, considering context in the selection and engagement of partners, and ensuring that each partnership benefited from the alliance. Over the 4-year program period, all five partnerships evolved, matured, and had an established goal to maintain collaboration.

Assembling the puzzle for promoting physical activity in Brazil: a social network analysis.

BACKGROUND: Physical inactivity is a significant public health problem in Brazil that may be addressed by partnerships and networks. In conjunction with Project GUIA (Guide for Useful Interventions for Physical Activity in Brazil and Latin America), the aim of this study was to conduct a social network analysis of physical activity in Brazil. METHODS: An online survey was completed by 28 of 35 organizations contacted from December 2008 through March 2009. Network analytic methods examined measures of collaboration, importance, leadership, and attributes of the respondent and organization. RESULTS: Leadership nominations for organizations studied ranged from 0 to 23. Positive predictors of collaboration included: south region, GUIA membership, years working in physical activity, and research, education, and promotion/practice areas of physical activity. The most frequently reported barrier to collaboration was bureaucracy. CONCLUSION: Social network analysis identified factors that are likely to improve collaboration among organizations in Brazil.

La reconversión del Hospital Psiquiátrico El Peral en red comunitaria de salud mental y psiquiatría / Conversion of a psychiatric hospital into a community network of mental health and psychiatric care

El artículo reseña el proceso de transformación llevado a cabo en el Hospital Psiquiátrico El Peral en los últimos 15 años y en particular desde 1998. Siendo el segundo hospital psiquiátrico en tamaño del país, ha impulsado un proceso de reconversión de funciones y recursos hacia un modelo comunitario organizado en torno a la red general de salud y con los respectivos apoyos sociales para las personas con discapacidad. Ello en el marco del Plan Nacional de Salud Mental y Psiquiatría del Ministerio de Salud, así como del plan respectivo del Servicio de Salud Metropolitano Sur. El proceso ha transcurrido en tres ejes: 1) creación de programas para el tratamiento intensivo de mediana estadía de los pacientes más graves, con psicosis y trastornos del desarrollo, que vivían en larga estadía orientado a su egreso hospitalario, 2) egreso de pacientes a estructuras residenciales alternativas (en especial hogares protegidos) en la comunidad y 3) transferencia de recursos para la creación de servicios clínicos insertos en la red de salud general. A la fecha, la población de larga estadía se ha reducido en un 50 por ciento, y se cuenta con las respuestas técnicas que permiten asegurar que es posible y deseable prescindir del hospital psiquiátrico como estructura, y convertir sus funciones y recursos en una red territorial de servicios e inserta en la estructura general de salud. Hoy, el principal obstáculo para ello es la brecha de recursos financieros y humanos para la implementación uniforme del modelo, no sólo en los servicios de salud relacionados con el hospital, sino a nivel nacional.

[Social network and social support measures from the Pró-Saúde Study: pre-tests and pilot study]. / Medidas de rede e apoio social no Estudo Pró-Saúde: pré-testes e estudo piloto.

We describe methodological steps in the selection of questions on social networks and support for a cohort study of 4,030 employees from a public university in Rio de Janeiro. First, group discussions with volunteers were conducted to explore the adequacy of related concepts. Next, questions in the Medical Outcomes Study questionnaire were submitted to standard "forward-" and "back-translation" procedures. The questions were subsequently evaluated through five stages of pre-tests and a pilot study. No question had a proportion of non-response greater than 5%. Pearson correlation coefficients between questions were distant from both zero and unity; correlation between all items and their dimension score was higher than 0.80 in most cases. Finally, Cronbach Alpha coefficients were above 0.70 within each dimension. Results suggest that social networks and support will be adequately measured and will allow for the investigation of their associations with health outcomes in a Brazilian population.

Redes de atención, comisiones asesoras de especialidades, sistemas urbanos de salud: Resoluciones de creación

Contiene los textos de las resoluciones de la Secretaría de Salud (GCBA)que establecen el marco normativo de las comisiones de atención en salud urbana. Incluye resoluciones por las que se crearon otras comisiones específicas, hasta el 7 de Abril de 1997