Best Nursing Practice: Safe and Inclusive Healthcare Environments for Transgender People: A Systematic Review.

(1) Background: The aim of this study was to review the scope of the existing scientific literature on creating safe and inclusive healthcare environments for transgender people and provide an overview of the resources and nursing skills required to do so. (2) Methods: With the research question in mind, an exploratory search of six databases was conducted to identify all relevant primary studies. After screening and selection of articles based on the inclusion and exclusion criteria, a total of 41 articles were included and reviewed. (3) Results: The results were classified under four headings: the training of health professionals, the creation of safe spaces, the nurse as facilitator, and best care practice. Most of the evidence indicates that it is essential for nurses and other healthcare staff to be trained in specific skills to provide comprehensive, high-quality care to transgender people; however, there is a lack of material and human resources to do so. (4) Conclusions: The trans-inclusive care competent nurse should use neutral language that respects the person's preferred name and pronouns in a safe healthcare environment that offers and ensures warmth, respect, and inclusivity in the care provided. This study was registered with the Open Science Framework (OSF) on 9 January 2024 (osf.io/rpj6a).

Immunization as an entry point for primary health care and beyond healthcare interventions-process and insights from an integrated approach in Lebanon.

Integrated healthcare systems are continually pitched as major contributors towards better distribution of health outcomes and enhanced well-being. Under emergency conditions, integrated healthcare services can guarantee better access to the target population. In recent years, several crises, i.e., economic collapse, the fuel crisis, the Beirut blast, a large refugee population, and the COVID-19 pandemic, in Lebanon have led to a major shift in the health-seeking behavior of the communities, with preventive services being downprioritized despite being available and curative healthcare services being sought out as late as possible. An extensive drop in immunization coverage and an overstretched public health system presents the risk of Vaccine-Preventable Disease outbreaks and urgent intervention is needed to bridge the immunity gap. The Ministry of Public Health, Lebanon, and UNICEF Lebanon successfully demonstrated the use of an immunization platform as an entry point to reach communities for service delivery, identification and referral, screening, awareness generation, and a host of other services that can be copied for other programs including but not limited to those for Maternal and Child health, nutrition, early childhood development, COVID-19, children with disabilities, social protection, education, health emergencies like cholera, etc., and these can provide bi-directional support to each other. UNICEF along with the MoPH (Ministry of Public Health) has been working towards reaching the most vulnerable population with a bouquet of services through existing immunization touchpoints for favorable healthcare outcomes.

Management of diabetes patients with comorbidity in primary care: a mixed-method study in Odisha, India.

BACKGROUND: Diabetes patients with comorbidities need regular and comprehensive care for their disease management. Hence, it is essential to assess the primary care preparedness for managing diabetes patients and the perspectives of the diabetes patients on the care received at the primary care facilities. METHODS: All 21 Urban Primary Health Centres (UPHCs) in Bhubaneswar city of Odisha, India, were assessed using the modified Primary Care Evaluation Tool and WHO Package of Essential Non-communicable disease interventions questionnaire. Additionally, 21 diabetes patients with comorbidities were interviewed in-depth to explore their perception of the care received at the primary care facilities. RESULTS: All the UPHCs had provisions to meet the basic requirements for the management of diabetes and common comorbidities like hypertension. There were few provisions for chronic kidney illness, cardiovascular disease, mental health, and cancer. Diabetes patients felt that frequent change in primary care physicians at the primary care facilities affected their continuity of care. Easy accessibility, availability of free medicines, and provisions of basic laboratory tests at the facilities were felt to be necessary by the diabetes patients. CONCLUSION: Our study highlights the existing gaps in India's healthcare system preparedness and the needs of diabetes patients with comorbidity. The government of India's Health and Wellness (HWC) scheme aims to deliver comprehensive healthcare to the population and provide holistic care at the primary care level for NCD patients. It is imperative that there is an early implementation of the various components of the HWC scheme to provide optimal care to diabetes patients.

The language models in healthcare and the role of chatgpt: comments / Os modelos de linguagem em saúde e o papel do chatgpt: comentários

ABSTRACT The introduction of chatbots has been one of the most intriguing advances in artificial intelligence. There are numerous potential uses for artificial intelligence in clinical research. However, there are also some issues that require attention. Everyone agrees that AI requires a more stable foundation and that a cutting-edge approach is necessary for AI to operate effectively.

RESUMO A introdução de chatbots foi um dos avanços mais intrigantes da inteligência artificial. Existem inúmeros usos potenciais para a inteligência artificial (IA) na pesquisa clínica. No entanto, há também outras questões que requerem atenção. Todos concordam que a IA precisa de uma base mais estável. Todos podemos concordar que uma abordagem de ponta é necessária para que a IA opere de forma eficaz.

Systemic and oral health status of older adult inpatients in an intensive care unit / Avaliação da condição sistêmica e oral de idosos internados em uma unidade de terapia intensiva

Objective: To assess the systemic and oral health status of geriatric patients hospitalized in an intensive care unit (ICU). Methods: A cross-sectional descriptive study of a convenience sample of 78 older ICU inpatients. A single calibrated examiner collected demographic and clinical data by analyzing patients' records and assessing their oral cavities. Descriptive data analysis was performed to a 5.00% significance level. All patients provided informed consent and were conscious during the oral health assessment. Results: The mean age was 77.69 years and 51.28% of the sample were male. The main reasons patients were admitted to the ICU investigated were postoperative conditions (23.08%) and cardiac abnormalities (20.51%). Systemic arterial hypertension (69.23%) was the most prevalent comorbidity and patients were being treated with anticoagulants (57.69%) and antimicrobials (53.85%). Most patients did not receive oral care (64.10%), while 29.49% of them received it only once, and 57.69% were denture users. The mean decayed, missing, and filled teeth index was 23.74 (17.44 missing teeth, on average) and majorities had tongue biofilm (71.79%) and unsatisfactory oral hygiene during their time in hospital (84.62%). Conclusion: The oral status of hospitalized geriatric patients was characterized by poor hygiene and edentulism

Objetivos: Avaliar o estado de saúde sistêmica e oral de pacientes geriátricos internados em uma unidade de terapia intensiva (UTI). Metodologia: Estudo transversal descritivo, com amostra de conveniência de 78 idosos internados na UTI. Um único examinador calibrado coletou dados demográficos e clínicos, analisando os registros dos pacientes e avaliando as suas cavidades orais. A análise descritiva dos dados foi realizada com nível de significância de 5,00%. Todos os pacientes forneceram consentimento informado e estavam conscientes durante a avaliação da saúde oral. Resultados: A média de idade foi de 77,69 anos e 51,28% da amostra era do sexo masculino. Os principais motivos de internação dos pacientes na UTI investigados foram condições pósoperatórias (23,08%) e alterações cardíacas (20,51%). A hipertensão arterial sistêmica (69,23%) foi a comorbidade mais prevalente, e os pacientes estavam sendo tratados com anticoagulantes (57,69%) e antimicrobianos (53,85%). A maioria dos pacientes não recebeu cuidados orais (64,10%), enquanto 29,49% deles os receberam apenas uma vez e 57,69% eram usuários de próteses dentárias. O índice médio de dentes cariados, perdidos e obturados foi de 23,74 (17,44 dentes ausentes, em média) e a maioria apresentou biofilme lingual (71,79%) e higiene oral insatisfatória durante a internação (84,62%). Conclusão: A condição oral dos pacientes geriátricos hospitalizados foi caracterizada por má higiene e edentulismo.

Multidisciplinary Team Care of Patients with Hemophilic Arthropathy: A Qualitative Assessment of Contemporary Practice in the UK and Canada : Canada/UK: MDT Practices for Hemophilia.

We used a structured interview to explore approaches to comprehensive hemophilia and arthropathy care among 24 healthcare professionals (HCPs) from multidisciplinary teams (MDTs) in Canada and the UK. Represented MDTs typically comprise a hematologist, nurse, physiotherapist, and sometimes an orthopedic surgeon; pediatric (and some adult) MDTs also include a social worker/psychologist. HCPs emphasized the centrality of a team approach, facilitated through MDT meetings and involvement of all MDT members in patient care. In both countries, nurses and physiotherapists play critical, multifaceted roles. Respondents agreed that MDTs are crucial for successful transitioning, which can be facilitated by close collaboration between pediatric and adult MDTs, even when they are not co-located. Physiotherapists are instrumental in providing non-pharmacological pain relief. Hematologists or physiotherapists typically make orthopedic referrals, with the nurse, physiotherapist and hematologist working together in patient preparation for (and follow-up after) surgery. MDT best practices include a non-hierarchical team approach, ensuring that all MDT members know all patients, and regular MDT meetings. Together, these real-life insights from the MDT perspective emphasize the value of the MDT approach in comprehensive hemophilia care.

Online access to spine care: do institutions advertise themselves as multidisciplinary?

Background: The primary aim of our study is to assess the extent to which healthcare systems advertise their spine care programs as multidisciplinary and furthermore clarify whether these institutions accurately reflect this description in their online access to spine care. The secondary aim of our study is to determine what proportion of institutions enable patients to self-schedule appointments online and select providers. Methods: Newsweek's 2021 list entitled "Best Hospitals 2021-United States" was utilized to obtain an extensive list of top-rated hospitals in the country. Institutions were considered to be advertising themselves as multidisciplinary if they used this term or similar wording (such as "care encompassing broad range of specialties", "interdisciplinary", "multidisciplinary"). Each institution's website was additionally assessed for the existence of: (I) a standard overview website or multiple individual sites for respective spine-focused divisions (i.e., orthopaedic surgery, neurosurgery, physical medicine and rehabilitation, anesthesiology); (II) online self-scheduling; (III) triage questions prior to requesting appointments; and (IV) selection choice for specific providers. Results: In total, 334 institutions were included in analysis, with 66% utilizing multidisciplinary terminology in describing their institution on their website. However, most institutions only had a standard overview website with no separate websites for respective divisions (54%). Institutions described as multidisciplinary were more likely to have a link on a central page to each division (31% vs. 4%, P<0.001). No significant differences were found between institutions described as multidisciplinary and those not described as such when considering triage questions, online self-scheduling, and choice of provider. Conclusions: Though the majority of spine care centers are described as multidisciplinary, the patient experience when navigating websites online does not always meet this standard. Further progress in website design, automated triaging, and online scheduling are needed to truly achieve multidisciplinary care.

Aumento nas reclamações de idosos sobre a saúde suplementar no Brasil / Increase in the complaints of the elderly about supplemental health in Brazil

Resumo O objetivo foi descrever as reclamações de idosos brasileiros recebidas pela Agência Nacional de Saúde Suplementar. Trata-se de um estudo ecológico, com dados secundários provenientes do Sistema Integrado de Fiscalização. Realizou-se análise de tendência das reclamações recebidas pela Agência Nacional de Saúde Suplementar de beneficiários idosos de todo o Brasil, no período de 2008 a 2017. Analisaram-se 111.497 reclamações realizadas por idosos beneficiários da saúde suplementar. Identificou-se aumento das taxas de reclamações para todas as regiões do país, com destaque para a região Nordeste, que apresentou a maior taxa média de reclamações (27,07) e o maior aumento médio anual (7,79; r2=0,97), e a região Sul, com a menor taxa média para o período (7,11) e o menor aumento médio anual observado (1,84; r2=0,92). A maior taxa de reclamações foi relacionada à cobertura do plano, entre idosos de 70 a 79 anos e beneficiários de planos individuais ou familiares. A crescente insatisfação de idosos com o sistema de saúde suplementar refletiu no grande número de reclamações recebidas pela Agência Nacional de Saúde Suplementar ao longo de nove anos.

Abstract The scope of this study was to describe the complaints of elderly Brazilians received by the National Supplemental Health Agency. It is an ecological study, with secondary data from the Integrated Inspection System. A trend analysis of the complaints received by the National Supplemental Health Agency of elderly beneficiaries from all over Brazil was conducted between 2008 and 2017. A total of 111,497 complaints were filed by elderly beneficiaries of the supplemental health system. The highest number of complaints (27.07) and the highest average annual increase (7.79, r2=0, 97), and the South region, with the lowest average rate for the period (7.11) and the lowest observed mean annual increase (1.84; r2=0.92) were identified. The highest rate of complaints was related to the coverage of the plan, between the elderly aged 70 to 79 and beneficiaries of individual or family plans. Growing dissatisfaction among older people with the supplemental health system reflected the large number of complaints received by the National Supplemental Health Agency over a period of nine years.

Redundancy within hospital-related harm prediction tools.

The predictive ability and efficiency of inpatient harm screening tools is unclear. We performed a retrospective analysis of approximately 25 000 people admitted to our hospital in 2019. We found that the discriminatory ability of the harm screening tools was at best moderate and could be attributed to one or two questions that overlapped with each other in the harm they predicted.

Diabetes self-care practices and resilience in the Brazilian COVID-19 pandemic: results of a web survey: DIABETESvid.

BACKGROUND: The world guidance on the measures of social distancing for prevention of COVID-19 has changed the daily habits of great part of the population, and this could influence the care and resilience with diabetes during situations of adversity. This study aimed at assessing the characteristics of diabetic individuals and self-care practices and resilience with diabetes in the context of the COVID-19 pandemic in Brazil. METHODS: This is a cross-sectional web survey study carried out among adults with diabetes, in which a structured 43-item questionnaire was conducted on the REDCap plataform, including the Diabetes Self-Care Activities Questionnaire and Connor-Davidson Resilience Scale, to measure socio-demographic and clinical characteristics. The web survey was disseminated through the main social media and data were collected from September 1st to October 19th, 2020. Data analysis was performed according to type of diabetes mellitus (DM) and at a significance level of 5% (p < 0.05). RESULTS: Of the 1633 participants, 67.5% were women, 43.2% aged between 35 and 59 years old, 68.0% lived in the south-eastern region of Brazil, 57.1% had a high education level, 49% reported to have DM1 and 140 participants reported to have had COVID-19. Diabetes care mostly involved the use of medications (93%), whereas the least used ones were physical activity (24.6%) and examination of the shoes (35.7%). About 40% of the participants reported to be followed up by telemedicine, 61.5% monitored the glycaemic levels, 61.2% followed a healthy diet and 43.4% left home only to go to the supermarket and drugstore. The mean resilience was 25.4 (SD = 7.7). CONCLUSIONS: In Brazil, individuals with diabetes followed social distancing and maintained their medication treatment for DM. However, practice of physical activity and foot examination was little followed by the participants, who also had a low level of resilience. These findings showed the importance of patient follow-up in the healthcare services, meaning that telemedicine should be improved and support provided for adaptation in view of the therapeutic setbacks.

Rediseño en el abordaje de personas con multimorbilidad crónica: desde la fragmentación al cuidado integral centrado en las personas / Redesign in the approach of people with multimorbidity chronic: from fragmentation to comprehensive care people-centered

En Chile, el 70% de la población de 15 años y más vive con multimorbilidad, es decir, con la presencia de dos o más condiciones crónicas de forma simultánea. El abordaje clásico de la cronicidad por programas en atención primaria de salud, con foco en la enfermedad, se expresa en cuidados fragmentados, ineficaces y muy alejados de los principios de centralidad en la persona, integralidad y continuidad del cuidado impulsados desde el modelo de atención integral de salud familiar y comunitario (MAIS). La estrategia de cuidado integral centrado en las personas para la promoción, prevención y manejo de la cronicidad en contexto de multimorbilidad (ECICEP), se constituye en una respuesta a esta problemática.La multimorbilidad representa un desafío de gran envergadura en el rediseño desde una atención fragmentada hacia el cuidado integral centrado en la persona. Implica un proceso de gestión del cambio, en donde es necesario sensibilizar en la urgencia y sentido del cambio, estratificar a la población según riesgo, capacitar a los equipos de salud, reorganizar los procesos administrativos (agendamiento, registro clínico) y clínicos (ingreso y control integral, planes de cuidado consensuados, gestión del cuidado, seguimiento a distancia, automanejo), así como favorecer el liderazgo y acompañamiento del cambio y el trabajo colaborativo en red.Este proceso requiere voluntad política, con sentido de urgencia del cambio y gradualidad, para que su instalación sea eficiente y respetuosa. Por ello, se inicia el proceso con las personas de alta complejidad, que son quienes tienen más riesgo de hospitalizaciones evitables y otras complicaciones

In Chile, 70% of the population aged 15 years and over lives with multimorbidity, that is, with the presence of two or more chronic conditions simultaneously. The classic approach to chronicity by programs in primary health care, with a focus on the disease, is expressed in fragmented care, ineffective and far removed from the principles of person-centeredness, comprehensiveness and continuity of care promoted by the Comprehensive Family and Community Health Care Model (MAIS). The People-Centered Integrated Care Strategy for the Promotion, Prevention and Management of Chronicity in the Context of Multimorbidity (ECICEP) is a response to this problem. Chronic multimorbidity represents a major challenge in the redesign from fragmented care to comprehensive person-centered care. It implies a process of change management, in which it is necessary to raise awareness of the urgency and sense of change, stratify the population according to risk, train health teams, reorganize administrative (scheduling, clinical records) and clinical processes (admission and comprehensive control, consensual care plans, care management, remote follow-up, self-management), as well as promoting leadership and accompaniment of change, networking and intersectoral coordination. This process requires political will, with a sense of urgency of change and gradualness, so that its installation is efficient and respectful. For this reason, the process begins with highly complex patients, who are at the greatest risk of avoidable hospitalizations and other complications.

Design and preliminarily validation of a tool to assess the impact of chronic non-cancer pain on people's daily life in Spanish-language: PAIN_Integral Scale©.

AIM: To build and preliminarily validate a Spanish-language instrument to assess the impact that CNCP has on the daily lives of people who suffer from it. BACKGROUND: The experience of pain is multifactorial and a correct assessment of it helps to control the intensity of pain. Although there are instruments that evaluate areas on which Chronic Non-Cancer Pain impacts, it would be necessary to include other aspects that scientific literature identifies as relevant. DESIGN: Instrument and construct cross-sectional study for psychometric validation. METHODS: A total of 157 items based on items from validated questionnaires were evaluated by a group of 21 chronic pain experts using Delphi methodology in three evaluation rounds. A final questionnaire of 55 items with a 5-point Likert-type scale was formed. This questionnaire was piloted on a total of 30 patients to assess their understanding of the items and the psychometric validation process was carried out (January to March 2020) on a subsequent sample of 395 people, all of whom attended Pain Units and Primary Care Centres of the Public Health System in Spain. RESULTS: The PAIN_Integral Scale© showed acceptable internal consistency scores measured by Cronbach's alpha. Exploratory Factor Analysis indicated a structure of nine factors that explain 71.02% of the total variance, from 157 to a final total of 36 items. Confirmatory Factor Analysis showing adequate values confirmed this structure. The effect size was used to calculate the cut-off points for the overall scale, setting them at scores of 130 and 135. CONCLUSION: This instrument would allow to assess other constructs and dimensions not included in the instruments previously available such as treatment compliance, proactivity, resilience, hopelessness due to pain and pain catastrophizing. However, despite the fact that the preliminary analysis shows good results, it is necessary to continue with its validation process in subsequent studies. IMPACT: The PAIN_Integral Scale© , once the validation process is finished, could be a complete enough instrument to allow a comprehensive healthcare assessment of Chronic Non-Cancer Pain's impact on daily nursing clinical practice and other healthcare professionals.

Hospitais gerais: inserção nas redes de atenção à saúde e fatores condicionantes de sua atuação / General hospitals: inclusion in the healthcare networks, and factors that determine their performance

Resumo Este estudo objetivou analisar a inserção dos hospitais gerais nas Redes de Atenção à Saúde e os fatores condicionantes de seu modo de participação nas mesmas. Realizou-se um "scoping review", com a seleção de 14 artigos publicados de janeiro de 2011 a junho de 2018. Com o mapeamento dos resultados constituiu-se as categorias de análise: Hospital, regionalização e economia de escala, Fragilidade de organização da rede e hospitais como primeira escolha, e Hospital e evidências de (des)integração da Redes de Atenção à Saúde. Os dados mostraram fatores que condicionam a maneira como os Hospitais atuam nas RAS, tendo destaque a inadequada distribuição destes serviços e de seus níveis de escala nos territórios; um número considerável de Hospitais de Pequeno Porte; as fragilidades da organização dos serviços em rede, com pouca articulação entre os pontos de atenção; e a hegemonia do modelo biomédico. Concluiu-se que a melhor inserção dos hospitais gerais nas redes dependerá do enfrentamento de desafios relacionados ao planejamento e implementação de ações nos diversos componentes da rede, disponibilização regional de serviços de saúde, aprimoramento dos mecanismos regulatórios e de comunicação entre os serviços.

Abstract The scope of this study was to analyze the inclusion of general hospitals in Healthcare Networks and the factors that determine their participation in these networks. A "scoping review" was conducted with the selection of 14 articles published between January 2011 and June 2018. From the mapping of the results the categories of analysis were constituted: Hospital, regionalization and economy of scale; Fragility of network organization and hospital as first choice; and Hospital and evidence of (dis) integration of the Healthcare Networks. The data revealed factors that determine the performance of the hospitals in the networks, highlighting the inadequate distribution of these services and their levels of scale in the territories; a considerable number of small-scale hospitals; the weaknesses of the organization of networked services, with little integration between the healthcare outlets; and the hegemony of the biomedical model. The conclusion drawn is that the optimal inclusion of general hospitals in Healthcare Networks will depend on the resolution of challenges related to the planning and implementation of actions in the various components of Healthcare Networks, regional availability of health services, improvement of regulatory mechanisms and of communication between the services.

Hospital at Home: An Evolving Model for Comprehensive Healthcare.

Hospital at Home (HaH) is a sustainable, innovative, and next-generation model of healthcare. From the healthcare management point of view, this model provides cost benefits and quality improvement, and from the physicians' point of view, it helps in providing patient-centered medical care and keeps patients away from hospital admission and its complications. The HaH model was first introduced at John Hopkins in the United States in 1995, which showed very promising results in context to the length of stay, readmission rates, patient satisfaction, and hospital-acquired infections. The HaH model of care provides acute critical care to patients at home and reduces unnecessary hospitalization and related complications. The identified patients for this model of care are elderly patients with chronic conditions and multiple comorbidities. The emergence of technology in today's world and the impact of coronavirus disease 2019 (COVID-19) have increased the demand for the HaH model of care. Although there are many benefits and advantages, the HaH model of care has significant barriers and limitations, such as reimbursement for payment, physician and patient resistance, patient safety, and lack of quantifying research data to support the use of this model. Specific training for the physician, nursing, and other members of the HaH multidisciplinary team is necessary for HaH treatment protocols, along with patient and family caregiver education for those who elect the HaH model of care. HaH is the future of comprehensive healthcare services and helps in achieving the triple aim of access to healthcare, improved quality of care, and reduced cost for healthcare.

Effect of a comprehensive eRehabilitation intervention alongside conventional stroke rehabilitation on disability and health-related quality of life: A pre-post comparison.

OBJECTIVE: To compare the effect on disability and quality of life, of conventional rehabilitation (control group) with individualized, tailored eRehabilitation intervention alongside conventional rehabilitation (Fast@home; intervention group), for people with stroke. METHODS: Pre-post design. The intervention comprised cognitive (Braingymmer®) and physical (Telerevalidatie®/Physitrack®) exercises, activity-tracking (Activ8®) and psycho-education. Assessments were made at admission (T0) and after 3 (T3) and 6 months (T6). The primary outcome concerned disability (Stroke Impact Scale; SIS). Secondary outcomes were: health-related quality of life, fatigue, self-management, participation and physical activity. Changes in scores between T0-T3, T3-T6, and T0-T6 were compared by analysis of variance and linear mixed models. RESULTS: The study included 153 and 165 people with stroke in the control and intervention groups, respectively. In the intervention group, 82 (50%) people received the intervention, of whom 54 (66%) used it. Between T3 and T6, the change in scores for the SIS subscales Communication (control group/intervention group -1.7/-0.3) and Physical strength (-5.7/3.3) were significantly greater in the total intervention group (all mean differences< minimally clinically important differences). No significant differences were found for other SIS subscales or secondary outcomes, or between T0-T3 and T0-T6. CONCLUSION: eRehabilitation alongside conventional stroke rehabilitation had a small positive effect on communication and physical strength on the longer term, compared to conventional rehabilitation only.

Delays in obstetric care increase the risk of neonatal near-miss morbidity events and death: a case-control study.

BACKGROUND: To evaluate the association between delays in obstetric care and neonatal near-miss mortality events and death in a public maternity referral center. METHODS: This case-control study enrolled 142 neonates, meeting the near-miss criteria of 5-min Apgar < 7, weight < 1500 g, gestational age < 32 weeks, and use of mechanical ventilation or congenital malformation, as well as 284 controls (without the near-miss criteria), at a ratio of 1:2. After follow-up, the following outcomes were reclassified: survival of the neonatal period without the near-miss criteria (true "controls"), "near-miss," and "neonatal death." Maternal sociodemographic characteristics, prenatal care, and pregnancy resolution were evaluated. Pearson's chi-square and Fisher's exact tests were used. Simple logistic regression was performed to determine the association between the three delay factors with near-miss outcomes and/or neonatal death. The variables that had maintained values of p < 0.05 were subjected to multinomial logistic regression. RESULTS: Comparisons revealed the following associations: for controls and near-miss events, delayed access to health services due to a lack of specialized services (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.8-5.1) and inappropriate conduct with the patient (OR, 12.1; 95% CI, 1.3-108.7); for controls and death, absent or inadequate prenatal care (OR, 3.3; 95% CI, 1.6-7.1) and delayed access to health services due to a lack of specialized services (OR, 2.5; 95% CI, 1.1-5.6); and for near-miss events and death, absent or inadequate prenatal care (OR, 2.2; 95% CI, 1.0-5.0). Logistic regression for the combined outcome (near-miss plus neonatal deaths) revealed absent or inadequate prenatal care (OR, 1.9; 95% CI, 1.2-2.8), lack of specialized services (OR, 2.8; 95% CI, 1.7-4.5), and improper conduct with the patient (OR, 10.6; 95% CI, 1.2-91.8). CONCLUSIONS: The delays in obstetric care associated with the presence of near-miss and/or neonatal death included absent or inadequate prenatal care, delayed access to health services due to a lack of specialized services, and inappropriate conduct with the patient.

Regulação assistencial ou cada um por si? Lições a partir da detecção precoce do câncer de mama em redes regionalizadas do Sistema Único de Saúde (SUS) / Healthcare regulation or every man for himself? Lessons learned from the early detection of breast cancer in regionalized networks of the Brazilian National Health System (SUS) / ¿Reglamentación asistencial o cada uno por sí? Lecciones a partir de la detección precoz del cáncer de mama en redes regionalizadas del Sistema Brasileño de Salud (SUS)

Buscou-se analisar os processos de regulação assistencial a partir das ações para detecção precoce do câncer de mama em perspectiva regional. Foi realizado estudo qualitativo e descritivo em uma região de saúde por meio de entrevistas semiestruturadas com gerentes/gestores da Atenção Básica (AB) e da Regulação Assistencial. Na região, convivem modelos de AB tradicionais e Estratégia Saúde da Família (ESF). As centrais de regulação eram heterogêneas quanto à informatização, com predomínio dos envios das referências via malote desde a AB. Identificou-se multiplicidade de sistemas regulatórios, sob gestão estadual, municipal e regional. A implantação do Sistema de Informação de Câncer não foi efetivada, comprometendo o monitoramento das ações e coordenação do cuidado. Foram identificados esforços para qualificar os processos regulatórios empreendidos pelos municípios, embora permanecessem ações automizadas e paralelas, sem atuação do gestor estadual na coordenação e articulação das redes regionalizadas.(AU)

The aim of this article was to analyze healthcare regulation processes based on actions for the early detection of breast cancer in a regional perspective. A qualitative and descriptive study was carried out in a health region by means of semi-structured interviews with Primary Care and Healthcare Regulation managers. In the region, traditional Primary Care models co-exist with the Family Health Strategy. The regulation centers were heterogeneous concerning computerization, with referrals being predominantly sent by Primary Care in pouches. Multiple regulation systems were identified, under state, municipal and regional management. The implementation of the Cancer Information System was not concluded, which hindered the monitoring of actions and the coordination of care. Efforts to qualify the regulatory processes performed by municipalities were identified, although they remained atomized and parallel actions, without the state manager coordinating and articulating the regionalized networks.(AU)

Se buscó analizar los procesos de regulación asistencial a partir de las acciones para detección precoz del cáncer de mama desde una perspectiva regional. Se realizó un estudio cualitativo, descriptivo, en una región de salud, por medio de entrevistas semiestructuradas con gerentes/gestores de la Atención Básica (AB) y de la Regulación Asistencial. En la región conviven modelos de AB tradicionales y Estrategia Salud de la Familia. Las centrales de regulación eran heterogéneas en lo que se refiere a la informatización, con predominio de los envíos de las referencias vía valija desde la AB. Se identificó la multiplicidad de sistemas regulatorios, bajo gestión estatal, municipal y regional. La implantación del Sistema de Información de Cáncer no se hizo efectiva, comprometiendo el monitoreo de las acciones y coordinación del cuidado. Se identificaron esfuerzos para calificar los procesos regulatorios realizados por los municipios, aunque permanecieran como acciones atomizadas y paralelas, sin actuación del gestor estatal en la coordinación y articulación de las redes regionalizadas.(AU)

An Integrated Health-System Specialty Pharmacy Model for Coordinating Transitions of Care: Specialty Medication Challenges and Specialty Pharmacist Opportunities.

Adherence and persistence to specialty medications are necessary to achieve successful outcomes of costly therapies. The increasing use of specialty medications has exposed several unique barriers to certain specialty treatments' continuation. Integrated specialty pharmacy teams facilitate transitions in sites of care, between different provider types, among prescribed specialty medications, and during financial coverage changes. We review obstacles encountered within these types of transitions and the role of the specialty pharmacist in overcoming these obstacles. Case examples for each type of specialty transition provide insight into the unique complexities faced by patients, and shed light on pharmacists' vital role in patient care. This insightful and real-world experience is needed to facilitate best practices in specialty care, particularly in the growing number of health-system specialty pharmacies.

Ampliando horizontes na interface Práticas Integrativas com Epistemologia do Sul / Ampliar horizontes en la interfaz Prácticas Integradoras con Epistemología del Sur / To Broadening Horizons in the Interface Integrative Practices with the Epistemology of the South

RESUMO Introdução: A Epistemologia do Sul valoriza a pluralidade e o diálogo entre os diversos saberes. Na saúde, valoriza as diversas práticas do cuidar, abrindo espaço para a inserção das Práticas Integrativas e Complementares. Objetivo: Refletir sobre a dimensão das Práticas Integrativas e Complementares para o cuidado de enfermagem sob perspectiva da Epistemologia do Sul. Métodos: Trata-se de um ensaio reflexivo acerca das Práticas Integrativas e Complementares, embasado no referencial teórico da Epistemologia do Sul. Estruturou-se quatro categorias reflexivas: Desvelando a Epistemologia do Sul; O caminhar histórico das Práticas Integrativas e Complementares; A Epistemologia do Sul e o transitar entre o saber popular e o saber científico no uso das plantas medicinais; e O entrelaço das Práticas Integrativas e Complementares com a enfermagem, frente à Epistemologia do Sul. Conclusão: As Práticas Integrativas e Complementares, sob o olhar da Epistemologia do Sul, é mais uma ferramenta utilizada no processo de trabalho do enfermeiro capaz de ampliar a assistência em saúde, com valorização de conhecimentos e das práticas de cuidado adotadas pelos usuários dos serviços(AU)

RESUMEN Introducción: La epistemología del Sur valora la pluralidad y el diálogo entre los diversos saberes. En la salud, valoriza las diversas prácticas del cuidar, abriendo espacio para la inserción de las Prácticas Integrativas y Complementarias. Objetivo: Reflexionar sobre la dimensión de las Prácticas Integrativas y Complementarias para el cuidado de enfermería bajo perspectiva de la epistemología del Sur. Métodos: Se trata de un ensayo reflexivo acerca de las Prácticas Integrativas y Complementarias, basadas en el referencial teórico de la epistemología del Sur. Se estructuraron cuatro categorías reflexivas: Desvelando la epistemología del Sur; El caminar histórico de las Prácticas Integrativas y Complementarias; La epistemología del Sur y el transitar entre el saber popular y el saber científico en el uso de las plantas medicinales; y el entrelazamiento de las Prácticas Integrativas y Complementarias con la enfermería, frente a la epistemología del Sur. Conclusiones: Las Prácticas Integrativas y Complementarias, bajo la mirada de la epistemología del Sur, son una herramienta utilizada en el proceso de trabajo del enfermero capaz de ampliar la asistencia en salud, con valorización de conocimientos y las prácticas de cuidado adoptadas por los usuarios de los servicios(AU)

ABSTRACT Introduction: The epistemology of the south values plurality and dialogue between the different instances of knowledge. In health, it values the various care practices, opening space for the inclusion of integrative and complementary practices. Objective: To reflect on the dimension of integrative and complementary practices for nursing care from the perspective of the epistemology of the south. Methods: This is a reflective essay about integrative and complementary practices, based on the theoretical reference of the epistemology of the south. Four reflexive categories were structured: unveiling the epistemology of the south, the historical evolution of integrative and complementary practices; the epistemology of the south and the transit between popular knowledge and scientific knowledge in the use of medicinal plants, and the intertwining of integrative and complementary practices with nursing compared to the epistemology of the south. Conclusions: The integrative and complementary practices, under the view of the epistemology of the south, are a tool used in the nurse's work process as being capable of extending health care, with the valorization of knowledge and care practices adopted by the users of services(AU)

Possibilidades para a integralidade do cuidado da criança na atenção básica / Posibilidades para la integralidad de la atención del niño en la atención primaria / Possibilities for the Integrality of Care the Child in Primary Care

RESUMO Introdução: A atenção à saúde da criança compreende ações de promoção da saúde e prevenção de doenças e agravos, a qual busca reduzir a mortalidade infantil e, sobretudo, proporcionar qualidade de vida a essa população, através do cuidado integral e de qualidade. Objetivo: Analisar como os enfermeiros da estratégia Saúde da Família desenvolvem a integralidade do cuidado na consulta de enfermagem à criança. Métodos: Estudo descritivo, qualitativo, realizado em janeiro e abril de 2015 por meio da técnica de entrevista para a coleta de dados. Participaram 14 enfermeiras da atenção básica de Teresina-PI. Para a análise dos dados foi utilizada a técnica de análise do conteúdo. Resultados: A integralidade é entendida como o olhar para a totalidade do ser, como o cuidado prestado ao indivíduo observando o seu contexto e compartilhado com outros profissionais de diversos níveis de atenção. Além disso, observou-se que alguns problemas dificultam o desenvolvimento da integralidade do cuidado à criança na atenção básica. Conclusão: A integralidade do cuidado beneficia e qualifica a assistência prestada à criança, produzindo ações de saúde embasadas em linhas de cuidado(AU)

RESUMEN Introducción: La atención a la salud del niño abarca acciones de promoción de salud y prevención de enfermedades, la cual busca reducir la mortalidad infantil y, sobre todo, proporcionar calidad de vida a esa población a través de una atención integral y de calidad. Objetivo: Analizar la forma en que las enfermeras de la Estrategia de Salud Familiar desarrollan la integralidad de la atención durante la consulta de enfermería al niño. Métodos: Estudio descriptivo, cualitativo, efectuado entre enero y abril de 2015, por medio de la técnica de entrevista para recopilar los datos. Los participantes fueron 14 enfermeras de la atención primaria de Teresina-PI. Para el análisis de los datos, se utilizó la técnica de análisis de contenido. Resultados: La integralidad se entiende como una mirada hacia la totalidad del ser, como la atención dispensada a la persona, observando su contexto y compartida con otros profesionales de diferentes niveles de atención. Se observó que algunos problemas obstaculizaban el desarrollo de la integralidad de la atención del niño en el ámbito de la atención primaria. Conclusión: La integralidad de la atención beneficia y califica la asistencia ofrecida al niño, produciendo acciones de salud basadas en las líneas de atención(AU)

ABSTRACT Introduction: Child healthcare includes actions for health promotion and prevention of diseases and grievances, which seeks to reduce infant mortality and, above all, provide quality of life to that population through comprehensive and high quality care. Objective: To analyze the way in which the nurses of the Family Health Strategy develop comprehensive care during the nursing consultation to the child. Methods: Descriptive, qualitative study carried out between January and April 2015, using the interview technique for fathering the data. The participants were 14 primary care nurses from Teresina-PI. For the analysis of the data, the content analysis technique was used. Results: Comprehensive care is understood as a look towards the totality of being, as the attention given to the person considering context and shared with other professionals of different levels of healthcare. In addition, it was noted that some problems impeded the development of comprehensive child care in the primary care scenario. Conclusion: Comprehensive care benefits and qualifies the assistance offered to the child, producing health actions based on the care guidelines(AU)