A formulação de uma plataforma eletrônica para a saúde: inovação a partir de uma encomenda tecnológica / The formulation of a healthcare electronic platform: innovation based on a technological order / La formulación de una plataforma electrónica para la salud: innovación basada en una encomienda tecnológica

Este artigo analisa o processo de formulação de uma plataforma eletrônica para a saúde, derivada de uma encomenda tecnológica, considerando os fatores que influenciaram a trajetória dessa formulação e o formato com o qual ela foi implementada. A análise documental, bibliográfica e a realização das entrevistas semiestruturadas com informantes-chave foram trabalhadas na perspectiva metodológica de um estudo de caso com uso do process tracing e de recursos da teoria da mudança institucional gradual. Destacam-se como resultados a identificação dos principais fatores relacionados à atuação da Fundação Estatal Saúde da Família na área de ciência, tecnologia e inovação e à realização da encomenda tecnológica. Bem como os fatores relacionados à formulação de cada uma das três inovações que caracterizam a experiência em análise: o Registro Eletrônico de Saúde, a plataforma que serviu de base para o ecossistema de inovação e o modelo jurídico-administrativo da organização criada para implementar e desenvolver as soluções necessárias

This article analyzes the formulation process of an electronic platform for health, derived from a technological order, considering the factors that influenced the trajectory of this formulation and the format in which it was implemented. A documentary and bibliographic analysis and semi-structured interviews with key informants were carried out from the methodological perspective of a case study using process tracing and resources from theories of gradual institutional change. The identification of the main factors related to the integration of the Fundação Estatal Saúde da Família (State Family Health Foundation) into the science, technology and innovation area and the achievement of the technological order stand out from other results. As well as the factors related to the formulation of each of the three innovations that characterize the experience under analysis: the Electronic Health Record, the basic platform of the innovation ecosystem and the legal-administrative model of the organization created to implement and develop the necessary solutions

Este artículo analiza el proceso de formulación de una plataforma electrónica para la salud, derivada de una encomienda tecnológica, considerando los factores que influyeron en la trayectoria de esa formulación y el formato en que fue implementada. Se realizó análisis documental, bibliográfico y entrevistas semiestructuradas a informantes-clave desde la perspectiva metodológica de un estudio de caso utilizando process tracing y recursos de las teorías del cambio institucional gradual. Se destacan como resultados la identificación de los principales factores relacionados con la integración de la Fundação Estatal Saúde da Família (Fundación Estatal Salud de la Familia) en el área de ciencia, tecnología y innovación y la realización de la encomienda tecnológica. Así como los factores relacionados con la formulación de cada una de las tres innovaciones que caracterizan la experiencia en análisis: el registro electrónico de salud; la plataforma base del ecosistema de innovación y el modelo jurídico-administrativo de la organización creada para implementar y desarrollar las soluciones necesarias.

Song recordings suggest feeding ground sharing in Southern Hemisphere humpback whales.

The Atlantic sector of the Southern Ocean (ASSO) has one of the highest densities of Antarctic krill (Euphausia superba) compared to other polar and subpolar regions, which attracts migratory baleen whale species to aggregate in this area for feeding. Humpback whales (Megaptera novaeangliae) also sing extensively while on the Southern Ocean feeding grounds which allows for the exploration of song similarity between feeding grounds and breeding populations which helps to understand population mixing. The results of comparative song analyses between the ASSO and the Ecuadorian and Brazilian breeding populations and recordings from the Chilean, South African and Namibian migration routes/mid-latitude feeding grounds revealed that individuals from at least three humpback whale breeding populations most likely migrate to shared feeding grounds in the ASSO. Humpback whales from different populations potentially mix at different times (i.e., years) at feeding hotspots in variable locations. The ASSO seems to provide sufficient prey resources and seems to present an important area for both cultural and maybe even genetic exchange between populations supporting the maintenance of large gene pools. Assuming that multi-population feeding hotspots are also suitable habitat for krill and other krill-dependent predators, these areas in the ASSO should be carefully managed integrating population, ecosystem and fisheries management.

Beneficios de los espacios verdes y actividad física en el bienestar y salud de las personas / Benefits of green spaces and physical activity for the well-being and health of people

BACKGROUND: Physical environment can influence well-being, quality of life and health and population health in several ways. Exposure to green spaces improves the physical and mental health of individuals. Chile has privileged conditions for outdoor activities that could benefit millions of people. However, a small percentage of the Chilean population is exposed to green spaces in the recommended amounts to promote health. AIM: To describe the benefits of green spaces on physical and mental health and their relationship with the practice of physical activity. MATERIAL AND METHODS: Review of the scientific literature in English in the Web of Science (WoS) electronic database published between 2006-2019. RESULTS: In addition to the direct benefits of green spaces, there are synergistic effects of performing physical activities in these environments such as feelings of good health, satisfaction with life and pleasure, increased physiological relaxation, positive emotions, mental well-being, restoration of attention, decreased perceived stress and a reduction negative affections. CONCLUSIONS: This review supports strategies for improving access to green spaces in urban areas coupled with physical activity promotion in these settings. Health and urban planning stakeholders should consider these aspects in future programs.

Abundance and distribution patterns of cetaceans and their overlap with vessel traffic in the Humboldt Current Ecosystem, Chile.

The Humboldt Current Ecosystem (HCE) is one of the most productive marine ecosystems, sustaining one of the largest fishing industries in the world. Although several species of cetaceans are known to inhabit these productive waters, quantitative assessments of their abundance and distribution patterns are scarce and patchy. Here, we present the first abundance and distribution estimates for fin whale (Balaenoptera physalus), southeast Pacific blue whales (Balaenoptera musculus), sperm whale (Physeter macrocephalus), dusky dolphin (Lagenorhynchus obscurus), and common dolphin (Delphinus spp.) in the entire Chilean portion of the HCE. Line transect surveys were conducted during 2016-2021 between 18° S and 41° S and up to ~ 200 km offshore, and data were analyzed using distance sampling methods. Group counts were modelled as a function of environmental variables using single step Bayesian Binomial N-mixture model (BNMM), which allows full uncertainty propagation between model components. By using spatially explicit predictions of cetacean densities and observed vessel densities in the HCE, we provide quantitative assessments on the relative probability of cetaceans encountering vessels (RPCEV). Dusky dolphin and fin whale showed the largest distribution overlap with industrial and artisanal fishery fleets. Our results highlight areas where effort should be prioritized to address the extant but unquantified negative interactions between vessels and cetaceans in Chilean HCE.

[Benefits of green spaces and physical activity for the well-being and health of people]. / Beneficios de los espacios verdes y actividad física en el bienestar y salud de las personas.

BACKGROUND: Physical environment can influence well-being, quality of life and health and population health in several ways. Exposure to green spaces improves the physical and mental health of individuals. Chile has privileged conditions for outdoor activities that could benefit millions of people. However, a small percentage of the Chilean population is exposed to green spaces in the recommended amounts to promote health. AIM: To describe the benefits of green spaces on physical and mental health and their relationship with the practice of physical activity. MATERIAL AND METHODS: Review of the scientific literature in English in the Web of Science (WoS) electronic database published between 2006-2019. RESULTS: In addition to the direct benefits of green spaces, there are synergistic effects of performing physical activities in these environments such as feelings of good health, satisfaction with life and pleasure, increased physiological relaxation, positive emotions, mental well-being, restoration of attention, decreased perceived stress and a reduction negative affections. CONCLUSIONS: This review supports strategies for improving access to green spaces in urban areas coupled with physical activity promotion in these settings. Health and urban planning stakeholders should consider these aspects in future programs.

Implementation of the e-SUS Primary Care system: Impact on the routine of Primary Health Care professionals.

OBJECTIVE: to understand how the implementation of the e-SUS Primary Care system has been processed and its impact on the daily life of the health teams. METHOD: a qualitative research study, conducted in a municipality in the inland of the state of São Paulo with professionals who work in Primary Health Care and use the e-SUS Primary Care system as a work tool. Semi-structured interviews and thematic data analysis were used with Kotter's three-phase approach. RESULTS: a total of 17 professionals, nurses, physicians, dentists and community agents were interviewed. The implementation of e-SUS Primary Care and its impact on the daily life of health teams were understood in terms of mandatory implementation; weaknesses for implementation, such as absence of material resources and implicit imposition for the use of the system; fragile training for deployment and learning from experience. CONCLUSION: a harmful incentive process was observed, conducted from the perspective of institutional pressure, use of the system to justify the work performed and, on the other hand, there was the creation of collaborative learning mechanisms between the teams.

[Primary Healthcare e-SUS: determinant attributes for the adoption and use of a technological innovation]. / e-SUS Atenção Primária: atributos determinantes para adoção e uso de uma inovação tecnológica.

The study aimed to analyze the adoption and use of the Primary Healthcare e-SUS (PHC e-SUS) as a technological innovation from the perspective of workers in primary healthcare (PHC). This was a sequential exploratory mixed-methods study (QUAN → qual) in municipalities in the interior of São Paulo state, Brazil, drawing on Diffusion of Innovation Theory. The quantitative component was analytical cross-sectional, applying a validated questionnaire to 114 PHC workers. The model was tested by applying partial least squares structural equation modeling (PLS-SEM) using SmartPLS 2.3.0. The qualitative study was descriptive-exploratory, using interviews (n = 10) with thematic content analysis, aimed at understanding the attributes that did not influence the adoption and use of PHC e-SUS. The attributes "experimentation", "ease of use", "relative advantage", and "compatibility" did not display statistical significance, indicating that they were not determinant attributes for the adoption and use of PHC e-SUS. Integration of the data evidenced failures in connectivity; lack of time to feed the system in real time and training; lack of prior experimentation; abrupt presentation of the system; and lack of skill with the technology. The results can assist other municipalities in Brazil with the implementation of the PHC e-SUS in relation to the importance of the organizational infrastructure, as well as training in the technology's use and handling. The study contributes to reflections and proposals for interventions in the problems faced in daily work with the adoption and use of a technological innovation such as the PHC e-SUS.

O estudo objetivou analisar a adoção e o uso do e-SUS Atenção Primária (e-SUS APS) como inovação tecnológica na perspectiva dos profissionais da atenção primária à saúde (APS). Trata-se de um estudo de método misto explanatório sequencial (QUAN → qual) realizado em municípios do interior de São Paulo, Brasil, utilizando a Teoria da Difusão de Inovação. O estudo quantitativo foi do tipo transversal analítico, aplicando-se um questionário validado a 114 profissionais da APS. Para testar o modelo do estudo, aplicou-se a modelagem de equações estruturais de mínimos quadrados parciais (PLS-SEM) por meio do software SmartPLS 2.3.0. O estudo qualitativo teve caráter descritivo-exploratório, por meio de entrevistas (n = 10) analisadas por análise temática de conteúdo, visando entender os atributos que não influenciaram a adoção e o uso do e-SUS APS. Os atributos "experimentação", "facilidade de uso", "vantagem relativa" e "compatibilidade" não apresentaram significância estatística, indicando não serem atributos determinantes para adoção e uso do e-SUS APS. Na integração dos dados, evidenciaram-se: falhas de conectividade; ausência de tempo para alimentação do sistema em tempo real e de capacitação; não experimentação prévia; apresentação abrupta do sistema e ausência de habilidade com a tecnologia. Os resultados podem auxiliar os demais municípios do Brasil na implantação e/ou efetivação do e-SUS APS, no que tange à importância da infraestrutura organizacional, bem como na capacitação para utilização e manuseio da tecnologia. Este estudo contribui para reflexões e propostas de intervenções aos problemas enfrentados no cotidiano do trabalho quanto à adoção e ao uso de uma inovação tecnológica, como o e-SUS APS.

El objetivo del estudio fue analizar la adopción y uso del e-SUS Atención Primaria (e-SUS APS), como innovación tecnológica, desde la perspectiva de los profesionales de la atención primaria en salud (APS). Se trata de un estudio de método mixto secuencial explicativo (CUAN → Cual) realizado en municipios del interior de São Paulo, utilizando la Teoría de la Difusión de Innovación. El estudio cuantitativo fue de tipo transversal analítico, aplicándose un cuestionario validado a 114 profesionales de la APS. Para probar el modelo del estudio se aplicó el modelado de ecuaciones estructurales de mínimos cuadrados parciales (PLS-SEM), a través del software SmartPLS 2.3.0. El estudio cualitativo tuvo carácter descriptivo-exploratorio, mediante entrevistas (n = 10), analizadas por análisis de contenido temático, con el objetivo de entender los atributos que no influenciaron en la adopción y uso de la e-SUS APS. Los atributos "probar", "facilidad de uso", "ventaja relativa" y "compatibilidad" no presentaron significación estadística, indicando no ser atributos determinantes para la adopción y uso de la e-SUS APS. En la integración de los datos se evidenciaron: fallos de conectividad; ausencia de tiempo para alimentación del sistema en tiempo real y de capacitación; no pruebas previas; presentación abrupta del sistema y ausencia de habilidad con la tecnología. Los resultados pueden ayudar a los demás municipios de Brasil en la implantación y/o efectuación de la e-SUS APS, en lo que atañe a la importancia de la infraestructura organizativa, así como la capacitación para la utilización y manejo de la tecnología. Este estudio contribuye a las reflexiones y propuestas de intervenciones, respecto a los problemas enfrentados en el día a día del trabajo, en cuanto a la adopción y uso de una innovación tecnológica, como la e-SUS APS.

Instrumento para avaliar o uso do prontuário eletrônico do cidadão da estratégia e-SUS Atenção Primária à Saúde / Instrumento para evaluar el uso de la historia clínica electrónica de la estrategia e-sus Atención Primaria de Salud / Instrument to assess the use of the electronic health record of the e-SUS Primary Health Care strategy

Objetivo: descrever a construção e a validação de um instrumento para avaliar o uso do Prontuário Eletrôni-co do Cidadão da Estratégia e-SUS Atenção Primária (e-SUS APS). Materiais e métodos:Trata-se de um estudo metodológico no qual foi construído um Modelo Lógico do Prontuário Eletrônico do Cidadão da Estratégia e-SUSAPS, que eviden-cia a necessidade de descrever a Estratégia e-SUS APS, possibilitan-do observar de maneira ampliada a assistência na Atenção Primária à Saúde, e compreender o Prontuá-rio Eletrônico do Cidadão. O Mode-lo Lógico baseou-se em: gestão do e-SUS APS e Prontuário Eletrônico do Cidadão. O Modelo foi essencial para subsidiar a elaboração das questões avaliativas. Na sequência, foi elabo-rado um instrumento e realizada a validação de conteúdo e de aparência, considerando os critérios de relevân-cia, objetividade e clareza, por meio da Técnica Delphi. Para a análise dos dados, foram calculados o Índice de Validade de Conteúdo e a Razão de Validade de Conteúdo das questões. Resultados:a validade foi realiza-da por 16 juízes, em duas rodadas. O instrumento final consta de 30 ques-tões ­ seis referentes ao perfil pessoal; duas, ao perfil da unidade de saúde e 22 questões de avaliação do Prontuá-rio Eletrônico do Cidadão e-SUS APS. Conclusões: conclui-se que o instrumento foi considerado apro-priado. Satisfação, facilidade do uso, suporte técnico, capacitação e utili-zação dos relatórios gerados foram os itens elencados como os mais impor-tantes nas questões. O instrumento poderá promover melhor articulação da equipe multiprofissional por meio das informações inseridas no sistema.

Objetivo: describir la construcción y validación de un instrumento para evaluar el uso de la historia clínica electrónica de la estrategia e-SUS Atención Primaria (e-SUS APS). Materiales y métodos: estudio metodológico en el que se construyó un modelo lógico de la historia clínica electrónica de la estrategia e-SUS APS, señalando la necesidad de describir dicha estrategia a fin de observar de una manera más amplia la asistencia a servicios de atención primaria de salud y además comprender la historia clínica electrónica del ciudadano. El modelo lógico se basó en la gestión de la e-SUS APS y la historia clínica electrónica del ciudadano, convirtiéndose en una herramienta esencial para apoyar la elaboración de preguntas de evaluación. Además, se elaboró un instrumento y se realizó la validación de su contenido y apariencia ­considerando criterios de relevancia, objetividad y claridad­ por medio del método Delphi. Para el análisis de datos, se calcularon el índice de validez de contenido y la razón de validez de contenido de las preguntas. Resultados: la validez del instrumento fue evaluada por 16 jueces, en dos rondas. El instrumento final contiene 30 preguntas, de las cuales seis se refieren al perfil personal, dos al perfil de la unidad de salud y 22 a la evaluación de la historia clínica electrónica e-SUS APS. Conclusiones: el instrumento es considerado apropiado, siendo la satisfacción, la facilidad de uso, el soporte técnico, la capacitación y el uso de los informes generados los elementos considerados como los más importantes. Esta herramienta puede promover una mejor articulación del equipo multiprofesional a través de la información introducida en el sistema.

Objective: To describe the construction and validation of an instrument to evaluate the use of the electronic health record of the e-SUS Primary Care (e-SUS APS). Materials and methods: Methodological study that involved the construction of a logical model of the electronic health record of the e-SUS APS Strategy. Said model highlights the need to describe the e-SUS APS Strategy in order to observe primary health assistance in a broader scope and also understand users' electronic health records. The logical model was built based on the operation of the e-SUS APS and users' electronic health records, becoming an essential input to support the elaboration of evaluation questions. An instrument was elaborated from such model, evaluating its content and appearance ­considering the criteria of relevance, objectivity and clarity­ through the Delphi technique. Content validity index and content validity ratio of questions were calculated prior to data analysis. Results: The validity of the instrument was assessed by 16 judges in two rounds. The final instrument contains 30 questions, six of them referring to the personal profile, two to the profile of the health unit, and 22 to the evaluation of the electronic health record of the e-SUS APS. Conclusions: The instrument was considered appropriate, with satisfaction, ease of usage, technical support, training, and the use of reports being the most important elements. This tool could promote better articulation of multi-professional teams through the use of the information inserted in the system.

Defining priority areas for blue whale conservation and investigating overlap with vessel traffic in Chilean Patagonia, using a fast-fitting movement model.

Defining priority areas and risk evaluation is of utmost relevance for endangered species` conservation. For the blue whale (Balaenoptera musculus), we aim to assess environmental habitat selection drivers, priority areas for conservation and overlap with vessel traffic off northern Chilean Patagonia (NCP). For this, we implemented a single-step continuous-time correlated-random-walk model which accommodates observational error and movement parameters variation in relation to oceanographic variables. Spatially explicit predictions of whales' behavioral responses were combined with density predictions from previous species distribution models (SDM) and vessel tracking data to estimate the relative probability of vessels encountering whales and identifying areas where interaction is likely to occur. These estimations were conducted independently for the aquaculture, transport, artisanal fishery, and industrial fishery fleets operating in NCP. Blue whale movement patterns strongly agreed with SDM results, reinforcing our knowledge regarding oceanographic habitat selection drivers. By combining movement and density modeling approaches we provide a stronger support for purported priority areas for blue whale conservation and how they overlap with the main vessel traffic corridor in the NCP. The aquaculture fleet was one order of magnitude larger than any other fleet, indicating it could play a decisive role in modulating potential negative vessel-whale interactions within NCP.

e-SUS Atenção Primária: atributos determinantes para adoção e uso de uma inovação tecnológica / Primary Healthcare e-SUS: determinant attributes for the adoption and use of a technological innovation / e-SUS Atención Primaria: atributos determinantes para la adopción y uso de una innovación tecnológica

Resumo: O estudo objetivou analisar a adoção e o uso do e-SUS Atenção Primária (e-SUS APS) como inovação tecnológica na perspectiva dos profissionais da atenção primária à saúde (APS). Trata-se de um estudo de método misto explanatório sequencial (QUAN → qual) realizado em municípios do interior de São Paulo, Brasil, utilizando a Teoria da Difusão de Inovação. O estudo quantitativo foi do tipo transversal analítico, aplicando-se um questionário validado a 114 profissionais da APS. Para testar o modelo do estudo, aplicou-se a modelagem de equações estruturais de mínimos quadrados parciais (PLS-SEM) por meio do software SmartPLS 2.3.0. O estudo qualitativo teve caráter descritivo-exploratório, por meio de entrevistas (n = 10) analisadas por análise temática de conteúdo, visando entender os atributos que não influenciaram a adoção e o uso do e-SUS APS. Os atributos "experimentação", "facilidade de uso", "vantagem relativa" e "compatibilidade" não apresentaram significância estatística, indicando não serem atributos determinantes para adoção e uso do e-SUS APS. Na integração dos dados, evidenciaram-se: falhas de conectividade; ausência de tempo para alimentação do sistema em tempo real e de capacitação; não experimentação prévia; apresentação abrupta do sistema e ausência de habilidade com a tecnologia. Os resultados podem auxiliar os demais municípios do Brasil na implantação e/ou efetivação do e-SUS APS, no que tange à importância da infraestrutura organizacional, bem como na capacitação para utilização e manuseio da tecnologia. Este estudo contribui para reflexões e propostas de intervenções aos problemas enfrentados no cotidiano do trabalho quanto à adoção e ao uso de uma inovação tecnológica, como o e-SUS APS.

Abstract: The study aimed to analyze the adoption and use of the Primary Healthcare e-SUS (PHC e-SUS) as a technological innovation from the perspective of workers in primary healthcare (PHC). This was a sequential exploratory mixed-methods study (QUAN → qual) in municipalities in the interior of São Paulo state, Brazil, drawing on Diffusion of Innovation Theory. The quantitative component was analytical cross-sectional, applying a validated questionnaire to 114 PHC workers. The model was tested by applying partial least squares structural equation modeling (PLS-SEM) using SmartPLS 2.3.0. The qualitative study was descriptive-exploratory, using interviews (n = 10) with thematic content analysis, aimed at understanding the attributes that did not influence the adoption and use of PHC e-SUS. The attributes "experimentation", "ease of use", "relative advantage", and "compatibility" did not display statistical significance, indicating that they were not determinant attributes for the adoption and use of PHC e-SUS. Integration of the data evidenced failures in connectivity; lack of time to feed the system in real time and training; lack of prior experimentation; abrupt presentation of the system; and lack of skill with the technology. The results can assist other municipalities in Brazil with the implementation of the PHC e-SUS in relation to the importance of the organizational infrastructure, as well as training in the technology's use and handling. The study contributes to reflections and proposals for interventions in the problems faced in daily work with the adoption and use of a technological innovation such as the PHC e-SUS.

Resumen: El objetivo del estudio fue analizar la adopción y uso del e-SUS Atención Primaria (e-SUS APS), como innovación tecnológica, desde la perspectiva de los profesionales de la atención primaria en salud (APS). Se trata de un estudio de método mixto secuencial explicativo (CUAN → Cual) realizado en municipios del interior de São Paulo, utilizando la Teoría de la Difusión de Innovación. El estudio cuantitativo fue de tipo transversal analítico, aplicándose un cuestionario validado a 114 profesionales de la APS. Para probar el modelo del estudio se aplicó el modelado de ecuaciones estructurales de mínimos cuadrados parciales (PLS-SEM), a través del software SmartPLS 2.3.0. El estudio cualitativo tuvo carácter descriptivo-exploratorio, mediante entrevistas (n = 10), analizadas por análisis de contenido temático, con el objetivo de entender los atributos que no influenciaron en la adopción y uso de la e-SUS APS. Los atributos "probar", "facilidad de uso", "ventaja relativa" y "compatibilidad" no presentaron significación estadística, indicando no ser atributos determinantes para la adopción y uso de la e-SUS APS. En la integración de los datos se evidenciaron: fallos de conectividad; ausencia de tiempo para alimentación del sistema en tiempo real y de capacitación; no pruebas previas; presentación abrupta del sistema y ausencia de habilidad con la tecnología. Los resultados pueden ayudar a los demás municipios de Brasil en la implantación y/o efectuación de la e-SUS APS, en lo que atañe a la importancia de la infraestructura organizativa, así como la capacitación para la utilización y manejo de la tecnología. Este estudio contribuye a las reflexiones y propuestas de intervenciones, respecto a los problemas enfrentados en el día a día del trabajo, en cuanto a la adopción y uso de una innovación tecnológica, como la e-SUS APS.

Inter-annual decrease in pulse rate and peak frequency of Southeast Pacific blue whale song types.

A decrease in the frequency of two southeast Pacific blue whale song types was examined over decades, using acoustic data from several different sources in the eastern Pacific Ocean ranging between the Equator and Chilean Patagonia. The pulse rate of the song units as well as their peak frequency were measured using two different methods (summed auto-correlation and Fourier transform). The sources of error associated with each measurement were assessed. There was a linear decline in both parameters for the more common song type (southeast Pacific song type n.2) between 1997 to 2017. An abbreviated analysis, also showed a frequency decline in the scarcer southeast Pacific song type n.1 between 1970 to 2014, revealing that both song types are declining at similar rates. We discussed the use of measuring both pulse rate and peak frequency to examine the frequency decline. Finally, a comparison of the rates of frequency decline with other song types reported in the literature and a discussion on the reasons of the frequency shift are presented.

El sistema de información sanitaria en Atención Primaria de Brasil. Soporte para la gestión local / The Primary Care Health Information System in Brazil. Support for local management

OBJETIVO: analizar las experiencias del uso del sistema e-SUS AB (Estrategia del Sistema única de Salud de la Atención Básica) en un municipio brasileño, y explorar si da soporte al proceso de trabajo y a la gestión local. MÉTODO: investigación cualitativa, efectuada en el estado de São Paulo, a través de entrevistas semiestructuradas a 17 profesionales de la Atención Primaria de Salud que utilizan el Sistema e-SUS AB. Se realizó análisis temático empleando el conjunto de elementos de la lógica procesual DICCA (Dato, Información, Conocimiento, Comunicación y Acción). RESULTADOS: fueron obtenidos cinco temas: Uso restringido de los Sistemas de Información en Salud (SIS) (falta de habilidad de los profesionales sobre el uso de las herramientas del sistema, limitándose a la introducción de datos); Necesidad de entender para poder utilizar (los profesionales no identifican de manera inmediata el valor que tiene registrar y usar los SIS en el proceso de cuidado de la salud); Fallos en la comunicación interprofesional (son percibidos privilegios de uso del sistema para profesionales de medicina, lo que interfiere en la prestación de cuidados interdisciplinares); Fortalezas del sistema e-SUS AB (los elementos de calidad del sistema, como es el aumento de información accesible, repercuten positivamente en la organización del trabajo); y Debilidades del sistema e-SUS AB (deficiencias tecnológicas, el registro en los múltiples sistemas y la falta de herramientas para facilitar la sistematización de la atención enfermera, hacen que el trabajo no sea eficiente). CONCLUSIONES: aunque se han producido importantes avances con la Estrategia e-SUS AB, el colapso en la comunicación y la permanencia de los profesionales en hábitos relacionados a SIS normativos dificultan la necesaria visión ampliada para completar los procesos decisorios que se precisan en el ámbito local

OBJECTIVE: to analyze the experiences of use with the e-SUS AB system (Unified Health System Strategy for Primary Care) in a Brazilian district, and to explore whether it supports the work process and local management. METHOD: a qualitative research conducted in the state of São Paulo, through semi-structured interviews with 17 Primary Care health professionals using the e-SUS AB system. Thematic analysis was conducted, using the set of elements from the DIKCA procedural logic (Data, Information, Knowledge, Communication and Action). RESULTS: five subjects were retrieved: Restricted use of the Health Information Systems (HIS) (lack of ability by professionals to use the tools of the system, and merely entering data); Need to understand in order to use (professionals cannot identify immediately the value to record and use HIS in the healthcare process); Failures in communication between professionals (the perception of privileges for using the system by medical professionals, which interferes in interdisciplinary patient care); Strengths of the e-SUS AB system (the quality elements of the system, such as the increase in accessible information, have a positive impact in the organization of work); and Weaknesses of the e-SUS AB system (technological deficiencies, recording in multiple systems, and lack of tools to facilitate the systematization of nursing care, leading to lack of work efficiency). CONCLUSIONS: even though there have been major advances with the e-SUS AB strategy, the collapse in communication and the permanence of professionals in habits associated with regulatory HIS prevents the wider vision necessary in order to complete the decision-making processes required at local level

Informatização do processo de enfermagem na Atenção Primária à Saúde / Computerized nursing process in Brazilian Primary Health Care

A implementação e expansão do uso do Sistema e-SUS Atenção Básica com Prontuário Eletrônico do Cidadão (PEC), desencadeou discussões nos conselhos de enfermagem acerca do cumprimento da normativa do Conselho Federal de Enfermagem a respeito da Sistematização da Assistência de Enfermagem e a implementação do Processo de Enfermagem na Atenção Primária à Saúde (APS). Desta forma, o objetivo do estudo foi definir um modelo de informatização de Processo de Enfermagem adequado ao contexto da APS no Brasil. Para respondê-lo foi desenvolvida uma pesquisa avaliativa com proposta de intervenção, em três etapas complementares: a primeira etapa avaliou a versão atual do PEC, por meio de observação em unidades de saúde; a segunda propôs melhorias no sistema, utilizando um estudo metodológico; e a última etapa validou a proposta por método de consenso, centrada no processo de enfermagem e na resolução das fragilidades encontradas no uso do sistema, por meio da técnica de grupo nominal. Para construir o modelo usou-se a teoria de enfermagem completa, de Bárbara Barnum, sobre a tríade contexto, conteúdo e processo. Esta, estruturada pelo contexto da APS no Brasil, a Teoria de Necessidade Humanas Básicas de Wanda Horta, acomodada sobre a Classificação Internacional para a Prática de Enfermagem (CIPE), como conteúdo, e sustentando o processo, a estruturação por Necessidades Humanas e Sociais, em sintonia com o modelo de Registro Clínico Orientado por Problemas (RCOP). A proposta foi validada, por meio de protótipos de sistema, com uma taxa de 96,20%, por especialistas, profissionais de saúde, que atuam no campo de desenvolvimento de sistema com prontuário eletrônico na APS, enfermeiros da academia, com amplo conhecimento em processo de enfermagem na APS e terminologias padronizadas de enfermagem, bem como, enfermeiros da assistência, que usam prontuário eletrônico no dia-a-dia, nas cinco regiões do país. Os requisitos e recomendações apresentadas, permitem planejar um processo de desenvolvimento, ancorado na perspectiva de um modelo de desenvolvimento evolucionário, que atenda às necessidades de um sistema já em uso no Brasil. Ao mesmo tempo, lança um desafio sobre como fazer a gestão da mudança, permitindo ao enfermeiro explorar os novos recursos que potencializam o processo de enfermagem, sem ruptura com a cultura de uso do PEC, dentro de um desenho de capacidade bastante diverso da APS no Brasil. O estudo permitiu compreender que o processo de enfermagem não deve ser estruturado de forma isolada, característica que tem sido encontrada em outras propostas. Por outro lado, também fica claro que a ciência da enfermagem necessita ser aplicada com maior protagonismo no desenvolvimento de sistemas com prontuário eletrônico na APS. Ciência que traz as Necessidades Humanas e Sociais, na perspectiva holística do cuidado como eixo central, o qual se alinha perfeitamente às novas diretrizes da APS, colaborando para romper barreiras do modelo médico hegemônico. Este estudo aponta para um processo de desenvolvimento desafiador, demandando um grande projeto nacional, articulado pelas instituições responsáveis pela infoestrutura necessária para sustentar e concretizar a proposta do modelo de informatização do processo de enfermagem, inovador, validado para o contexto da APS no Brasil

The implementation and expansion of the use of the e-SUS Primary Care System with Electronic Medical Record (EMR), triggered discussions in nursing care about complying with the regulations of the Federal Board of Nursing with respect to the Nursing Care Systematization and the implementation of the Nursing Process at Primary Health Care (PHC). Therefore, the objective of the study was to define a computerized model for the Nursing Process / Consultation appropriate to the context of PHC in Brazil. To answer this question, an evaluative investigation was developed with a proposal for intervention, in three complementary stages: the first stage evaluating the current version of the EHR, through observation in health units; the second best proposal in the system, using a methodological study; and the last step to validate the proposal by consensus method, centered on the nursing process and on the resolution of the weaknesses found in the use of the system, using the nominal group technique. To build the model, Bárbara Barnum's complete nursing theory of was used, based on the context, content and processes. This is structured by the context of PHC in Brazil, the Wanda Horta's Theory of Basic Human Needs, on the International Classification for Nursing Practice (ICNP), as content and supporting the process, the structure by human and social needs, online with the Problem-Oriented Clinical Record (POCR) model. The proposal was validated, through prototypes of the system, with a 96.20% menu, by specialists, health professionals, who work in the field of systems development with EMR in PHC, nurse researchers, with wide knowledge in nursing process in PHC and standardized nursing terminology, as well as nursing assistants, who use EMR daily, in the five regions of the country. The requirements and recommendations presented, allow to plan a development process, based on the perspective of an evolutionary development model, which satisfies the needs of a system in use in Brazil. At the same time, it launches a challenge on how to manage change, which allows the nurse to explore new resources that improve the nursing process, without breaking with the culture of using the EMR, considering the variability of capacity in PHC in Brazil. This study allowed us to understand that the nursing process should not be structured in an isolated way, a characteristic that has been found in other proposals. On the other hand, it is also clear that the nursing science must apply with the greatest importance in the development of systems with EMR in PHC. Science that brings together human and social needs, in a holistic perspective of attention as a central theme, which aligns perfectly with the new PHC guidelines, collaborating to break the barriers of the hegemonic medical model. This study is part of a challenging development process, which requires a national project, articulated by the institutions responsible for the infostructure needed to support and materialize the proposal for the innovative model of computerized nursing process, validated for the PHC context in Brazil

Ontogeny and taxonomy of the hadrosaur (Dinosauria, Ornithopoda) remains from Basturs Poble bonebed (late early Maastrichtian, Tremp Syncline, Spain).

The lower Maastrichtian site of Basturs Poble (southern Pyrenees, Spain) is the first hadrosaur bonebed reported from Europe. It is an accumulation of disarticulated lambeosaurine skeletal elements, possibly belonging to Pararhabdodon isonensis. The sample shows high intraspecific morphological variability among many skeletal elements, suggesting the need for caution in choosing characters for phylogenetic analyses. Juvenile to adult individuals are represented in the sample, while hatchling remains are absent. Bone histology reveals that juveniles are over-represented and that the youngest individuals represented by tibia specimens were two years old. Adult individuals, with tibiae 550-600 mm long, were 14-15 years old when they died. However, individual variation in tibia length at skeletal maturity occurs within the sample, so individual maturity cannot be assumed on the basis of bone size alone. The Basturs Poble bonebed occurs within the upper part of the C31r magnetochron. Thus, lambeosaurine hadrosaurids were already present and abundant in the Ibero-Armorica Island at the end of the early Maastrichtian and P. isonensis spans the upper part of the lower Maastrichtian to the upper part of the upper Maastrichtian (upper part of C31r-lower part of C29r).

From Chilean Patagonia to Galapagos, Ecuador: novel insights on blue whale migratory pathways along the Eastern South Pacific.

BACKGROUND: The most traditional scheme for migration among baleen whales comprises yearly migrations between productive waters at high latitude summer feeding grounds and warmer waters at lower latitudes where whales calve and mate, but rarely feed. Evidence indicates, however, that large departures from this scheme exist among populations and individuals. Furthermore, for some populations there is virtually no information on migratory pathways and destinations. Such is the case of Chilean blue whales throughout the Eastern South Pacific; hence, the goal of this study was to assess its migratory behavior. METHODS: Dedicated marine surveys and satellite tagging efforts were undertaken during the austral summer and early autumn on blue whale feeding grounds off Chilean Northern Patagonia (CNP) during 2013, 2015 and 2016. Positional data derived from satellite tags regarding movement patterns and behavior were analyzed using Bayesian switching first-difference correlated random walk models. RESULTS: We instrumented 10 CNP blue whales with satellite transmitters and documented individual variation in departure time, northbound migratory routes and potential wintering grounds. The onset of migration occurred from mid/late austral autumn to well into the austral winter. Blue whales moved in various directions, but ultimately converged toward a general NW movement direction along a wide corridor exceeding 2,000 km. Area-Restricted Search behavior was exhibited within fjords and channels of CNP and also South of Galapagos Archipelago (GA) and northern Peru, but never during migration. Interestingly, dive profiles for one whale that reached GA showed a sharp and consistent increase in depth north of 5°S and extreme deep dives of up to 330 m. DISCUSSION: Information derived from satellite tagged blue whales in this study is the first of its kind off the Eastern Southern Pacific. Our results provide valuable information on their migratory timing, routes and behavior on their northbound migration, particularly regarding the varied migratory plasticity for this particular population. Our results also highlight the first record of two complete migratory paths between CNP and GA and strengthen the hypothesis that GA waters correspond to a potential wintering destination for CNP blue whales. We further hypothesize that this area might be selected because of its biological productivity, which could provide feeding opportunities during the breeding season. Our results suggest that special efforts should be put forward to identify blue whale critical areas and understand key behavioral aspects in order to provide the basis for their conservation on a regional context (i.e., reducing potential ship strike and promote Marine Protected Area (MPA) implementation in Chile, Ecuador and Peru). Indeed, we suggest joint blue whale conservation efforts at the regional level in order to identify and determine potential threats and impacts and, most importantly, implement prospective management actions.

High genetic diversity in a small population: the case of Chilean blue whales.

It is generally assumed that species with low population sizes have lower genetic diversities than larger populations and vice versa. However, this would not be the case for long-lived species with long generation times, and which populations have declined due to anthropogenic effects, such as the blue whale (Balaenoptera musculus). This species was intensively decimated globally to near extinction during the 20th century. Along the Chilean coast, it is estimated that at least 4288 blue whales were hunted from an apparently pre-exploitation population size (k) of a maximum of 6200 individuals (Southeastern Pacific). Thus, here, we describe the mtDNA (control region) and nDNA (microsatellites) diversities of the Chilean blue whale aggregation site in order to verify the expectation of low genetic diversity in small populations. We then compare our findings with other blue whale aggregations in the Southern Hemisphere. Interestingly, although the estimated population size is small compared with the pre-whaling era, there is still considerable genetic diversity, even after the population crash, both in mitochondrial (N = 46) and nuclear (N = 52) markers (Hd = 0.890 and Ho = 0.692, respectively). Our results suggest that this diversity could be a consequence of the long generation times and the relatively short period of time elapsed since the end of whaling, which has been observed in other heavily-exploited whale populations. The genetic variability of blue whales on their southern Chile feeding grounds was similar to that found in other Southern Hemisphere blue whale feeding grounds. Our phylogenetic analysis of mtDNA haplotypes does not show extensive differentiation of populations among Southern Hemisphere blue whale feeding grounds. The present study suggests that although levels of genetic diversity are frequently used as estimators of population health, these parameters depend on the biology of the species and should be taken into account in a monitoring framework study to obtain a more complete picture of the conservation status of a population.

The latest succession of dinosaur tracksites in Europe: Hadrosaur ichnology, track production and palaeoenvironments.

A comprehensive review and study of the rich dinosaur track record of the Tremp Formation in the southern Pyrenees of Spain (Southwestern Europe) shows a unique succession of footprint localities prior to the end-Cretaceous mass extinction event. A description of some 30 new tracksites and data on sedimentary environments, track occurrence and preservation, ichnology and chronostratigraphy are provided. These new track localities represent various facies types within a diverse set of fluvial environments. The footprint discoveries mostly represent hadrosaurian and, less abundantly, to sauropod dinosaurs. The hadrosaur tracks are significantly smaller in size than, but morphologically similar to, those of North America and Asia and are attributable to the ichnogenus Hadrosauropodus. The track succession, with more than 40 distinct track levels, indicates that hadrosaur footprints in the Ibero-Armorican region occur predominantly in the late Maaastrichtian (at least above the early Maastrichtian-late Maastrichtian boundary). The highest abundance is found noticeably found in the late Maastrichtian, with tracks occurring in the C29r magnetochron, within about the latest 300,000 years of the Cretaceous.

Diversity, relationships, and biogeography of the lambeosaurine dinosaurs from the European Archipelago, with description of the New Aralosaurin Canardia garonnensis.

We provide a thorough re-evaluation of the taxonomic diversity, phylogenetic relationships, and historical biogeography of the lambeosaurine hadrosaurids from the European Archipelago. Previously published occurrences of European Lambeosaurinae are reviewed and new specimens collected from upper Maastrichtian strata of the south-central Pyrenees are described. No support is found for the recognition of European saurolophines in the available hadrosaurid materials recovered so far from this area. A new genus and species of basal lambeosaurine, Canardia garonnensis, is described on the basis of cranial and appendicular elements collected from upper Maastrichtian strata of southern France. C. garonnensis differs from all other hadrosaurids, except Aralosaurus tuberiferus, in having maxilla with prominent subrectangular rostrodorsal flange; it differs from A. tuberiferus in a few maxillary and prefrontal characters. Together with A. tuberiferus, C. garonnensis integrates the newly recognized tribe Aralosaurini. Inference of lambeosaurine interrelationships via maximum parsimony analysis indicates that the other three known European lambeosaurines are representatives of two additional subclades (tribes) of these hadrosaurids: Tsintaosaurini (Pararhabdodon isonensis) and Lambeosaurini (the Arenysaurus ardevoli-Blasisaurus canudoi clade). The tribes Aralosaurini, Tsintaosaurini, Lambeosaurini, and Parasaurolophini are formally defined and diagnosed for the first time. Three event-based quantitative methods of ancestral range reconstruction were implemented to infer the historical biogeography of European lambeosaurines: Dispersal-Vicariance Analysis, Bayesian Binary MCMC, and Dispersal-Extinction-Cladogenesis. The results of these analyses, coupled with the absence of pre-Maastrichtian lambeosaurines in the Mesozoic vertebrate fossil record of Europe, favor the hypothesis that aralosaurins and tsintaosaurins were Asian immigrants that reached the Ibero-Armorican island via dispersal events sometime during the Maastrichtian. Less conclusive is the biogeographical history of European lambeosaurins; several scenarios, occurring sometime during the Maastrichtian, are possible, from vicariance leading to the splitting of Asian or North American from European ranges to a dispersal event from North America to the European Archipelago.