Rural Zambian Oral Health Transition: A Long-Term Retrospective Examination of an Outreach Program's Progress and Impact.

Objective: This study aimed to (a) describe an annual prevention-focused, community-based oral health outreach program in rural Zambia, (b) assess its oral health outcomes using demographic and oral health variables, and c) identify milestones resulting from program activities. Methods: A retrospective analysis of demographic and oral health data from a single site between 2007-2014 and 2018-2019 was conducted. Demographic variables included sex and age, while clinical outcomes encompassed pain, untreated caries, and treatment urgency. Bivariate and multivariable analyses were performed, adjusting for sex and age categories. Information on community development was obtained from the Ministry of Health and local community representatives. Results: Data from 5,791 subjects were analyzed. The prevalence of pain, untreated caries, and highest treatment urgency category decreased consistently across year categories. Both bivariate and multivariable analyses showed statistically significant differences in clinical outcomes between year categories (p < 0.001). In addition, the percentage of male participants and younger age categories increased during the study period. Key program milestones included the installation of two boreholes for clean water, the development of a local community oral health volunteer program, the establishment of an educational pipeline by the Dental Training School for residents, and the construction of a maternal/oral health center with district and ministry oversight. Conclusion: The observed decrease in treatment urgency scores, presence of pain, and untreated caries are consistent with the prevention-seeking behavior of program participants. The increasing participation and changing demographic patterns over time suggest a growing demand for oral health services among males and younger individuals. The positive oral health outcomes and development of a maternal child/oral health facility exemplify a program design aligned with community needs and appropriate care delivery.

Avaliação dos atributos da atenção primária à saúde sob a ótica dos profissionais médicos / Assessment of attributes of primary health care from the perspective of physicians / Evaluación de los atributos de la atención primaria de salud desde el punto de vista del profesional médico

Introdução: A presença e a extensão dos atributos da Atenção Primária à Saúde são fatores determinantes na efetividade da assistência em serviços de atenção primária. Objetivo: Avaliar a aplicação dos atributos da Atenção Primária à Saúde na perspectiva dos profissionais médicos das unidades básicas de saúde. Métodos: Trata-se de estudo transversal, realizado por meio da aplicação de questionário Primary Care Assessment Tool (PCATool-Brasil), na versão profissionais de saúde, e de questionário sociodemográfico para caracterizar o perfil de formação, experiência profissional e atuação na Atenção Primária à Saúde. Participaram da pesquisa os médicos de unidades da Estratégia Saúde da Família, tradicionais e mistas, do município de Juiz de Fora. Resultados: As médias dos escores gerais, essenciais e derivados dos atributos da Atenção Primária à Saúde exibiram pontuação considerada como satisfatória (≥6,6), contudo o atributo de acessibilidade foi avaliado como insatisfatório. Além disso, os atributos de longitudinalidade e coordenação/integração do cuidado obtiveram avaliação insatisfatória entre os médicos com menor tempo de atuação na Atenção Primária à Saúde, enquanto os atributos de longitudinalidade e orientação familiar receberam avaliação insatisfatória dos médicos que não cursaram pós-graduação em medicina de família e comunidade ou áreas afins. Conclusões: O estudo aponta para a necessidade de ampliação da acessibilidade aos serviços de atenção primária, da busca de alternativas para a valorização e a fixação do profissional médico na Atenção Primária à Saúde e o estímulo à formação e à qualificação desses profissionais de saúde, com a finalidade de propiciar o aumento da resolutividade e da qualidade dos serviços prestados.

Introduction: The presence and extent of the attributes of Primary Health Care are determining factors in the effectiveness of primary healthcare services. Objective: To evaluate the implementation of Primary Health Care attributes from the perspective of physicians working in Health Centers (UBS). Methods: This is a cross-sectional study, carried out using the health professionals' version of the Primary Care Assessment Tool (PCATool-Brasil) and a sociodemographic questionnaire to characterize education profile, professional experience, and performance at the Primary Health Care. The study participants were physicians from units of the Family Health Strategy, traditional, and mixed Health Centers, in the city of Juiz de Fora, state of Minas Gerais, Brazil. Results: The means in the general, essential, and derivative scores of the attributes of Primary Health Care presented a score deemed satisfactory (≥6.6). However, the professionals evaluated the accessibility attribute as unsatisfactory. Moreover, the continuity and coordination/integration attributes achieved unsatisfactory evaluation among physicians with shorter time of activity in Primary Health Care, whereas the attributes of continuity and family orientation had an unsatisfactory evaluation from physicians who have not attended graduate courses in Family and Community Medicine or related areas. Conclusions: The study points to the need for expansion of accessibility to the services of primary health care, for the search for alternatives to appreciate and maintain physicians at Primary Health Care, in addition to promoting the education and training of health professionals, seeking to provide an increase in the problem-solving capacity and quality of services

Introducción: La presencia y la extensión de atributos de Atención Primaria a la Salud (APS) son factores determinantes en la efectividad de la asistencia en servicios de atención primaria. Objetivo: Este artículo tiene como objetivo evaluar la aplicación de los atributos de la Atención Primaria a la Salud desde la perspectiva de los profesionales médicos situados en las unidades básicas de salud. Métodos: Consiste en un estudio transversal, realizado a partir de la aplicación de un cuestionario Primary Care Assessment Tool ­ Brasil, versiones profesionales de salud, y de cuestionario sociodemográfico para caracterizar el perfil de formación, experiencia profesional y actuación en la Atención Primaria a la Salud. Han participado del estudio médicos de unidades de estrategia de salud de la familia, tradicionales y mezcladas, del municipio de Juiz de Fora, Minas Gerais. Resultados: Las medias de puntuaciones generales, esenciales y derivadas de los atributos de la Atención Primaria a la Salud han exhibido puntuación considerada satisfactoria (≥6,6), sin embargo, el atributo de accesibilidad ha sido evaluado como insatisfactorio. Además, los atributos de longitudinalidad y coordinación/integración del cuidado han obtenido evaluación insatisfactoria entre los médicos con menos tiempo de actuación en la Atención Primaria a la Salud, mientras los atributos de longitudinalidad y orientación familiar han recibido evaluación insatisfactoria de los médicos que no han cursado posgrado en medicina de familia y comunidad o de áreas relacionadas. Conclusiones: El estudio apunta para la necesidad de ampliación de la accesibilidad a los servicios de atención primaria, de búsqueda por alternativas para valorización y establecimiento del profesional médico en la Atención Primaria a la Salud y del estímulo a la formación e calificación de estos profesionales de salud, con fines de proporcionar el aumento de la capacidad de resolución y de la calidad de los servicios ofrecidos.

Proceso de definición de prioridades institucionales de investigación en el Seguro Social de Salud del Perú, 2020-2022 / Process of defining institutional priorities for research in the Peruvian Social Health Insurance, 2020-2022

Introducción: La definición de prioridades de investigación en salud dirige los esfuerzos de investigación para promover ciencia, tecnología e innovación en salud. Material y Métodos: La definición de estas en el Seguro Social de Salud peruano para el periodo 2020-2022 se realizó en cuatro etapas y de forma sistemática, estructurada, participativa y secuencial. Resultados: Primero, se evaluó el avance de investigación en las prioridades del periodo 2017-2019. En la segunda etapa, se consultó diversas fuentes y se identificó necesidades de investigación orientadas a enfermedades y se estableció el marco para prioridades orientadas a sistemas de salud e intervenciones sanitarias. La tercera etapa consistió en una consulta ampliada para seleccionar los temas prioritarios orientados a enfermedades. Finalmente, se desarrolló un taller participativo y multidisciplinario para seleccionar temas, subtemas y áreas prioritarias de investigación. Conclusión: El producto final fue la definición de 11 temas prioritarios, siete para enfermedades y cuatro para sistemas de salud e intervenciones sanitarias.

Introduction: Health research priorities definition address research efforts to the promotion of health science, technology, and innovation. Material and Methods: Health research priorities in the Peruvian Social Security for the period 2020-2022 was carried out in four stages using a systematic, structured, participatory and sequential process. Results: First, the progress of the research in the priorities of the period 2017-2019 was evaluated. In the second stage, various sources were consulted to identify disease-oriented research needs and the framework for priorities oriented to health systems and health interventions. The third stage consisted of an expanded consultation to select priority disease-oriented topics. Finally, a participatory and multidisciplinary workshop was developed to select themes, subtopics, and priority areas for research. Conclusion: The final product was the definition of 11 priority themes, seven for diseases and four for health systems and health interventions

Bioética em Angola: experiência da Faculdade de Medicina de Malanje / Bioethics in Angola: experience of the Malanje Medical School / Bioética en Angola: experiencia de la Facultad de Medicina de Malanje

Resumo O desenvolvimento da bioética e da ética na investigação científica em África é relativamente incipiente, mas vem crescendo o interesse público pelo tema. Este artigo relata a experiência da Faculdade de Medicina de Malanje da Universidade Lueji A'Nkonde. São abordados eventos ocorridos na faculdade para o desenvolvimento integral da bioética, com destaque para a Conferência Internacional Sub-Regional sobre Ética da Investigação Científica, que deu origem à Declaração de Malanje, e a criação do Comitê de Bioética em Pesquisa. Enfim, conclui-se que os passos em prol desse campo do conhecimento representam indícios de sua implantação em Angola. No entanto, urgem ações governamentais de países das redes em Bioética na América Latina e Caribe para efetivar a cooperação Sul-Sul e cumprir todas as recomendações da Declaração de Malanje.

Abstract The current development of Bioethics and Ethics in scientific research in Africa is relatively incipient, but public interest in the subject is growing. We address the experience of the Malanje Medical School in the field of Bioethics in Angola. We summarize events at the Malanje Medical School of the Lueji A'Nkonde University for the Integral Development of Bioethics. One of its results was the Malanje Declaration. Another one was the creation of the Research Bioethics Committee of the Malanje Medical School. Finally, we consider the steps towards the Integral Development of Bioethics as evidence of its implantation in that country. However, there is need for governmental action in the countries involved in the mediation of Bioethics networks for Latin America and the Caribbean for the South-South cooperation objective and fulfilment of all the recommendations of the Malanje Declaration.

Resumen El desarrollo actual de la bioética y de la ética en la investigación científica en África es relativamente incipiente, pero viene creciendo el interés público en el tema. Este artículo relata la experiencia de la Facultad de Medicina de Malanje de la Universidad Lueji A'Nkonde. Se abordan los eventos que tuvieron lugar en la facultad para el desarrollo integral de la bioética, destacándose la Conferencia Internacional Subregional sobre Ética de la Investigación Científica, que dio origen a la Declaración de Malanje, y a la creación del Comité de Bioética en Investigación. Finalmente, se concluye que los pasos en pro de este campo del conocimiento representan indicios de su implantación en Angola. No obstante, urgen acciones gubernamentales de los países involucrados con las redes de Bioética en América Latina y el Caribe para efectivizar la cooperación Sur-Sur y cumplir todas las recomendaciones de la Declaración de Malanje.

Perspectiva de profesionales de salud sobre la violencia de la pareja en el embarazo / Perspective of the Health Professionals on the Partner Violence during Pregnancy / Perspectiva dos profissionais da saúde sobre a violência do casal na gravidez

Introducción: la violencia de pareja (VP) durante el embarazo afecta los derechos de las gestantes y causa serias complicaciones para la madre o su hijo por nacer. El personal de salud puede enfrentar esta realidad mediante un adecuado proceso de detección y atención. Objetivo: explorar la perspectiva de profesionales de salud de la Unidad de Servicios de Salud Usaquén, de Bogotá, sobre la VP en el embarazo. Método: estudio cualitativo, entre marzo y diciembre de 2016. Se realizaron cuatro grupos focales con la participación de 38 profesionales. El análisis se desarrolló con apoyo del software ATLAS.ti 7. Resultados: la corta edad y la carencia de recursos y redes de apoyo perpetúa la VP. Los participantes sugieren la intervención de equipos multidisciplinarios coordinados en la detección y atención biopsicosocial de la problemática, construir ambientes de contención emocional a las usuarias, empoderarlas para el ejercicio de derechos y capacitar al personal de salud en el manejo de la problemática. Discusión: para el personal de salud es imperioso saber enfrentar esta realidad, de manera que las mujeres salgan fortalecidas. La inclusión de una mirada de género y derechos es una necesidad a la hora de abordar la VP en los contextos de la salud. Conclusiones: para un cambio de condiciones se requiere: a) trabajo multidisciplinario coordinado, b) ambientes amigables, c) atención humanizada a la gestante, d) reducción de la revictimización y e) capacitación al personal de salud para la intervención en VP.

Introduction: Intimate partner violence (IPV) during pregnancy undermines the pregnant woman's rights and brings about serious complications both to the mother and the unborn child. Health professionals will have to cope with this reality through an appropriate process of detection and care. Objective: To explore the perspective by the health professionals in the health center 'Unidad de Servicios de Salud Usaquén' in Bogotá, regarding the IPV during pregnancy. Method: A qualitative study was conducted between March and December 2016. Four focus groups were carried out with 38 health professional taking part in them. The analysis was developed by using the software ATLASti 7. Results: Being young, financial shortfalls and the lack of support feed into the IPV. The participants propose the intervention by coordinated multidisciplinary teams for the detection and bio-psychosocial care to people with this problem, to build emotional containment environments for the users, to empower the women so that they enforce their rights, and to train the health professionals for managing this problem. Discussion: It is a must that the health professionals become able to cope with this reality, so that they can strengthen the women in this situation. There is a need to provide them with a gender-oriented view and rights awareness when it comes to face the IPV in the contexts of health issues. Conclusions: To do a change in the conditions requires: a) coordinated multidisciplinary work; b) friendly environments; c) humanized care to pregnant women; d) to reduce the re-victimization; and e) to train the health workers in IPV intervention.

Introdução: A violência de casal (VC) durante a gravidez afeta os direitos das gestantes e ocasiona complicações fortes para mãe e filho ainda não nascido. O pessoal de saúde pode enfrentar essa realidade mediante um adequado processo de triagem e atendimento. Objetivo: Explorar a perspectiva dos profissionais da saúde da Unidade de Serviços de Saúde Usaquén, de Bogotá, sobre a VC na gravidez. Método: foi realizado um estudo qualitativo entre marco e dezembro de 2016. Foram realizados quatro grupos focais com participação de 38 profissionais. A análise desenvolveu-se com suporte do software ATLASti 7. Resultados: A pouca idade e a carência de recursos e redes de apoio perpetuam a VC. Os participantes sugerem a intervenção de equipes multidisciplinares coordenadas na detecção e atendimento biopsicossocial da problemática, construir ambientes de contenção emocional às usuárias, empoeirá-las para o exercício de direitos e treinar o pessoal de saúde na gestão da problemática. Discussão: Para o pessoal de saúde é imperativo saber enfrentar essa realidade, de jeito tal que as mulheres saírem fortalecidas. A inclusão de um olhar de gênero e direitos é uma necessidade à hora de abordar a VC nos contextos da saúde. Conclusões: Para uma mudança de condições é preciso: a) trabalho multidisciplinar coordenado b) ambientes amigáveis c) atendimento humanizado à gestante, d) redução da revitimização e e) treinamento ao pessoal de saúde para a intervenção em VC.

Collaborative research and actions on both sides of the US-Mexico border to counteract type 2 diabetes in people of Mexican origin.

BACKGROUND: Type 2 Diabetes (T2D) is now a massive epidemic in both California and Mexico, with serious consequences for social and economic well-being. A large proportion of these populations share common ethnic backgrounds. Yet diverse environmental and social conditions across regions create unique opportunities to explore the ways that T2D risk, incidence, management and outcomes manifest. MAIN TEXT: An action-oriented research consortium headed up by the University of California and Universidad Nacional Autónoma de Mexico was constituted to set priorities for bi-national translational research, in an attempt to implement and evaluate clinical, public health and policy actions to decrease the burden of T2D for people of Mexican origin. In this paper, we describe the epidemiology of T2D in Mexico and California, review current efforts to combat the epidemic, highlight gaps in knowledge and identify urgent areas of opportunity for collaboration. The group has developed a common research agenda and funding has been obtained to evaluate biological samples from the 2016 Mexican Health Survey, collaborate in a telemedicine-based retinopathy project, implement interventions in food banks, promote a communications campaign, and design a large-scale diabetes prevention effectiveness trial. CONCLUSIONS: T2D has caused a state of emergency in Mexico and is a major health problem among Mexican populations on both sides of the border. Understanding the commonalities and differences between California and Mexico for those of Mexican origin with respect to T2D, when combined with a sharing of knowledge and advances, can produce a bi-national translational research agenda to inform relevant policy and practice. Amidst economic and political uncertainty and limited healthcare budgets, this collaboration can contribute to the development of scientific evidence to inform policies and interventions. This may provide a promising collaborative model that could be expanded to other health conditions and regions of the world.

Respuesta doméstica a las recomendaciones sanitarias de intervención sobre ambiente y perros en una localidad con transmisión de leishmaniasis visceral (Pto. Iguazú, Argentina, 2014­2016) / Domestic response to intervention based on health recommendations on the environment and dogs in a locality with transmission of visceral leishmaniosis (Pto. Iguazú, Argentina, 2014-2016)

Introducción: La leishmaniasis visceral (LV) es una enfermedad parasitaria emergente en Argentina. En Puerto Iguazú, frontera con Brasil y Paraguay, en 2010 se registró presencia del vector y casos caninos; y en 2014-2015 dos casos humanos. Objetivo: Este artículo tiene como objetivo analizar los cambios en el nivel micro escala después de dar a conocer a los convivientes el diagnóstico de LV canina (LVC), informándoles estrategias de manejo ambiental para reducir el contacto con el vector. Método: Es una investigación descriptiva, que indagó en dos momentos (2014 y 2016) una muestra no probabilística distribuida en base al criterio de mejor escenario para la presencia del vector (n = 55) en la que se seleccionaron, luego de un primer rastrillaje entomológico y de diagnóstico veterinario, puntos de muestreo con presencia de vectores y al menos un perro con LVC (n = 6/55). Resultados: Un único hogar implementó las modificaciones sugeridas. Esos cambios no resultaron suficientes para controlar la transmisión. La hipótesis es que las medidas de control requieren intervención a meso escala (el vecindario y no el domicilio), atendiendo al radio real de dispersión de vectores. Conclusiones: El riesgo de infección humana por LV se relaciona con el modo de vida, incluyendo las relaciones interespecie. Las relaciones humano-perro combinan especismo y poshumanismo, acotando la efectividad de la "tenencia responsable" como modelo de vínculo saludable.

Introduction: Visceral leishmaniasis (VL) is an emerging parasitic disease in Argentina. In Puerto Iguazú, border with Brazil and Paraguay, vector and canine cases were registered in 2010; and in 2014 and 2015 there were two human cases. Objective: The objective of this article is to analyze changes at the micro-scale level after informing the cohabitants of the diagnosis of canine LV (LVC), letting them know the environmental management strategies to reduce contact with the vector. Method: It is a descriptive researh, which investigated in two moments (2014 and 2016) a non-probabilistic sample distributed based on the criterion of the best scenario for the presence of the vector (n = 55). Sampling points with the presence of vectors and at least one dog with LVC (n = 6/55) were selected, after a first entomological and veterinary diagnosis raking. Results: A single household implemented the suggested modifications. The changes were not enough to control the transmission. The hypothesis is that the control measures require intervention at a meso-scale (the neighborhood instead of the home), taking into account the real radius of vector dispersion. Conclusions: The risk of human infection due to VL is related to the way of life, including interspecies relationships. The human-dog relationships combine speciesism and post-humanism, which limits the effectiveness of "responsible ownership" as model of a healthy bond.

Reflexões sobre a formação para o SUS e sua articulação com a pesquisa e a in(ter)venção nos cenários das práticas e dos serviços / Reflections on Public Health training and its articulation with research and in(ter)vention within the set of practices and services

A partir da experiência dos autores em suas diferentes inserções no Sistema Único de Saúde (SUS), o artigo tem como objetivo refletir sobre alguns pontos da formação em saúde, consi­ derando suas fronteiras com a pesquisa e a intervenção nos cenários dos serviços. As propo­ sições de mudança e a insistência na permanência do modelo biomédico hegemônico coabitam o cotidiano dos atores envolvidos com a saúde pública, fazendo emergir a contradi­ ção entre os diferentes paradigmas que sustentam os modelos das práticas e fazeres de saú­ de. Desse modo, surge a importância estratégica da Universidade, com seus diferentes âmbitos de atuação (ensino, pesquisa e extensão), como indutora de uma formação crítica e voltada para as necessidades da população e produtora de conhecimentos por meio de ações/ ofertas de integração entre ensino-serviço-comunidade. Nestes tempos de ataque ao SUS, sua sustentação e defesa necessitam de reflexões e ações que produzam uma formação atenta à realidade da população e uma pesquisa como um dispositivo para produção de conhecimento que modifiquem os modos como trabalhadores, usuários e gestores usam, percebem e ope­ ram a saúde de um modelo biomédico para uma perspectiva que contemple diferentes dimen­ sões e a saúde como produção da vida.(AU)

Based on the authors' experiences working within the Brazilian National Health System (SUS) this paper aims to reflect on educational actions in health, considering its intersection with re­ search and intervention in the set of practices and services. In daily practices, the propositions of change and, at the same time, the insistence on the permanence of the hegemonic biomedi­ cal model are present, and contradictions among competing paradigms that support different models in the Public Health field arise. The strategic importance of the University surfaces with its various scopes of action (research, teaching and extension programs) as a place for le­ arning experiences based on critical thinking and directed to community needs. In addition, we expect that knowledge may be produced through integration strategies between teaching-he­ alth services-community. In times of funding cuts that jeopardize the SUS's future, supporting and defending universal health care require reflections and actions oriented towards educatio­ nal processes that take into account the reality of the population, and research methods that act as an apparatus to produce knowledge capable of changing the way health is perceived by workers, users and managers from a biomedical model towards a perspective that contempla­ tes various dimensions and understands health as the production of life.(AU)

Doctors' opinion on the contribution of coordination mechanisms to improving clinical coordination between primary and outpatient secondary care in the Catalan national health system.

BACKGROUND: Clinical coordination is considered a health policy priority as its absence can lead to poor quality of care and inefficiency. A key challenge is to identify which strategies should be implemented to improve coordination. The aim is to analyse doctors' opinions on the contribution of mechanisms to improving clinical coordination between primary and outpatient secondary care and the factors influencing their use. METHODS: A qualitative descriptive study in three healthcare networks of the Catalan national health system. A two-stage theoretical sample was designed: in the first stage, networks with different management models were selected; in the second, primary care (n = 26) and secondary care (n = 24) doctors. Data were collected using semi-structured interviews. Final sample size was reached by saturation. A thematic content analysis was conducted, segmented by network and care level. RESULTS: With few differences across networks, doctors identified similar mechanisms contributing to clinical coordination: 1) shared EMR facilitating clinical information transfer and uptake; 2) mechanisms enabling problem-solving communication and agreement on clinical approaches, which varied across networks (joint clinical case conferences, which also promote mutual knowledge and training of primary care doctors; virtual consultations through EMR and email); and 3) referral protocols and use of the telephone facilitating access to secondary care after referrals. Doctors identified organizational (insufficient time, incompatible timetables, design of mechanisms) and professional factors (knowing each other, attitude towards collaboration, concerns over misdiagnosis) that influence the use of mechanisms. DISCUSSION: Mechanisms that most contribute to clinical coordination are feedback mechanisms, that is those based on mutual adjustment, that allow doctors to exchange information and communicate. Their use might be enhanced by focusing on adequate working conditions, mechanism design and creating conditions that promote mutual knowledge and positive attitudes towards collaboration.

Evidências no desenvolvimento da liderança em enfermagem com o uso da pesquisa-ação: revisão integrativa / Evidence in nursing leadership development through action research: an integrative review

Este estudo teve como objetivo identificar as evidências sobre os efeitos do uso da pesquisa-ação no desenvolvimento da liderança em enfermagem. Revisão integrativa da literatura realizada no ano de 2016, orientada pelos descritores "Action Research" and "Nursing", na qual foram incluídos um total de oito artigos. Evidenciou-se que a maioria das pesquisas foram desenvolvidas no contexto hospitalar, compreendendo estudos descritivos de abordagem qualitativa, que apresentaram como objetivo o processo de mudança na prática do enfermeiro. Quanto às evidências no desenvolvimento da liderança em enfermagem, os artigos apontaram para a importância do processo de tomada de decisão compartilhada como sendo a habilidade fundamental para a liderança. A construção conjunta de ferramentas de gestão mostrou-se essencial para alicerçar os processos de mudanças na prática, principalmente, no que se refere para a continuidade e permanência de qualificação dos profissionais para a liderança.

This study's goal was to identify evidence of the effects of using action research in nursing leadership development. This is an integrative review of the literature conducted in 2016, guided by the descriptors action research and nursing, which included a total of eight articles. Most studies were conducted in the hospital context, including descriptive qualitative studies whose objective was to analyze the process of changes in the practice of nurses. Regarding the evidence in nursing leadership development, the articles indicated the importance of a shared decision-making process as a critical skill for leadership. The joint construction of management tools proved to be essential to support changes in practice, especially regarding the continuity and maintenance of qualification of leadership professionals.

Oman Vision 2050 for Health Research: A Strategic Plan for the Future Based on the Past and Present Experience.

Health care delivery in Oman has attained great heights since the modern renaissance in 1970. Although the health service had the main impetus all these years, the importance of health research began to take place by mid 1990's and is now gaining momentum as an important responsibility and activity of the Ministry of Health (MoH). Although there has been progressively increasing investment and commitment to research activities in the recent Five Year Plan for Health Development, it still lags behind in the quality and quantity of research output. Lack of factors like adequate infrastructure, dedicated human resources, empowerment of existing systems, and societal support for research have adversely affected research output. Centre of Studies and Research in MoH has proposed a strategic plan, the 'Health Vision 2050 for Health Research' with aim of making Oman the regional leader and a research hub of world standards in health research. The mission is to promote, facilitate, and conduct high quality health research addressing national health priorities to improve health care services and enhance the efficiency and effectiveness of the health system, reduce health inequity, and contribute to socioeconomic development. The strategy includes setting health research priorities, strengthening the health research capacity, defining and implementing norms and standards, developing health research (quality and quantity), translating evidence into policy, strategy and practice, monitoring and coordinating research, financing health research, and evaluating the effectiveness of the health research system. It should generate a multifold increase in the quality and quantity of health research in Oman, positively impacting the health system and health care service.

Text to Quit China: An mHealth Smoking Cessation Trial.

PURPOSE: To assess the feasibility, acceptability, and efficacy of a text message-based smoking cessation intervention in China. DESIGN: Study design was a randomized control trial with a 6-month follow-up assessment of smoking status. SETTING: Zhejiang, Heilongjiang, and Shaanxi provinces in China provided the study setting. SUBJECTS: A total of 8000 adult smokers in China who used Nokia Life Tools and participated in phase 2 (smoking education via text message) of the study were included. INTERVENTION: The high-frequency text contact (HFTC) group received one to three messages daily containing smoking cessation advice, encouragement, and health education information. The low-frequency text contact (LFTC) group received one weekly message with smoking health effects information. MEASURES: Our primary outcome was smoking status at 0, 1, 3, and 6 months after intervention. Secondary outcomes include participant perceptions of the HFTC intervention, and factors associated with smoking cessation among HFTC participants. ANALYSIS: Descriptive and χ2 analyses were conducted to assess smoking status and acceptability. Factors associated with quitting were assessed using multiple logistic regression analyses. RESULTS: Quit rates were high in both the HFTC and LFTC groups (HFTC: 0 month, 27.9%; 1 month, 30.5%; 3 months, 26.7%; and 6 months, 27.7%; LFTC: 0 month, 26.7%; 1 month, 30.4%; 3 months, 28.1%; and 6 months, 27.7%), with no significant difference between the two groups in an intent-to-treat analysis. Attitudes toward the HFTC intervention were largely positive. CONCLUSION: Our findings suggest that a text message-based smoking cessation intervention can be successfully delivered in China and is acceptable to Chinese smokers, but further research is needed to assess the potential impact of this type of intervention.

Realidad de la investigación en salud en Chile: participación de los médicos en el Fondo Nacional de Investigación (FONIS) en la última década / Reality of health research in Chile: participation of doctors in the National Research Fund (FONIS) in the last decade

Chile es uno de los países de la OCDE que menos invierte en ciencia y tecnología, y la investigación en salud no está exenta de este problema. Existe evidencia reportada en publicaciones nacionales de que la participación de médicos en la investigación ha experimentado un marcado retroceso en las últimas décadas. El objetivo de este artículo es analizar específicamente la participación de los médicos como investigadores responsables en proyectos financiados por el Fondo Nacional de Investigación en Salud (FONIS). Este programa fue diseñado para promover investigaciones que resuelvan problemas prioritarios de salud y de esa manera entregar enfoques diagnósticos y terapéuticos a la medida del fenotipo local. Nuestros análisis muestran un estancamiento real y una disminución porcentual, misma tendencia que estudios previos. La implementación de recomendaciones internacionales en el campo de la medicina rasnacional en las políticas de salud nacionales podría revertir el aparente proceso de retirada de los médicos de las actividades de I+D, lo que beneficiaría la salud de los pacientes y reduciría los costos para el sistema, de, por ejemplo, la importación de la terapéutica.(AU)

Chile is one of the OECD countries that invests less in science and technology, and health research is not exempt from this problem. Evidence reported in national publications shows that the participation of physicians in research has experienced a marked decline in recent decades. The objective of this article is to specifically analyze the participation of physicians as responsible researchers in projects funded by the National Fund for Health Research (FONIS). This program was designed to promote research that addresses priority health issues and thereby delivers diagnostic and therapeutic approaches tailored to the local phenotype. Our analyzes show a real stagnation and a percentage decrease, same trend as previous studies. The implementation of international recommendations in the field of translational medicine in national health policies could reverse the apparent process of withdrawal of physicians from R&D activities, which would benefit the health of patients and reduce the costs for the system, for instance, in the ones implied of importing therapeutics.(AU)

Análise do Projeto de Lei do Senado (PLS) n° 200, de 2015, em face do Princípio da Proibição do Retrocesso Social / Senate Bill (PLS) No. 200, de 2015, analysis versus the Principle of the Prohibition of Social Regression / Análisis de proyecto de ley del Senado (PLS) nº 200, de 2015, delante del Principio de la Prohibición del Retroceso Social

O Projeto de Lei do Senado (PLS) n° 200, de 2015, propõe a edição de uma lei que dispõe sobre pesquisas clínicas envolvendo seres humanos. O objetivo deste estudo foi realizar uma análise crítica do PLS 200/2015, tendo como base o Princípio da Proibição do Retrocesso Social. Para tanto, foi realizada uma pesquisa descritiva, documental e normativa, com levantamento de normas sanitárias e éticas relacionadas à pesquisa clínica e pareceres relacionados ao PL 200/2015. O PLS 200/2015 e as informações a ele relacionadas também foram consultados no endereço eletrônico do Senado Federal. A regulamentação da matéria por lei demonstrou não ser um problema nos pareceres consultados. Os principais conflitos estavam relacionados à criação de um comitê de ética independente (CEI), que não vincula a revisão ética a um órgão estatal; ao uso de placebo, cuja flexibilização é contrária a todos os esforços realizados para assegurar que os participantes tenham as melhores opções terapêuticas; e ao acesso pós-estudo, cuja restrição é contrária às regulamentações existentes que determinam o acesso gratuito e por tempo indeterminado. A análise das principais disposições especificadas no PLS 200/2015 não identificou avanço social ou de desenvolvimento técnico-científico. O Princípio da Proibição do Retrocesso Social pode ser utilizado, assim, para garantir os preceitos constitucionais já realizados e efetivados, em especial o direito à saúde, à dignidade da pessoa humana e à inviolabilidade do direito à vida.

The Senate Bill (PLS) number 200, of 2015, proposes the edition of a law for the conduction of clinical trials involving human subjects. This study aimed to perform a critical analysis of the PLS 200/2015, based on the Principle of the Prohibition of Social Regression. Thus, a descriptive, documentary and normative research was conducted, with survey of the ethical and sanitary standards related to clinical research and findings related to the PL 200/2015. The PLS 200/2015 and the information regarding was also consulted on the website of the Senate. The regulation of the matter by law demonstrated not to be a problem in the research. The main conflicts were related to the creation of Independent Ethics Committee (IEC), that does not link the ethic review to an State Agency; the use of placebo, in which flexibility is contrary to all efforts to ensure that participants have the best treatment options; and post-study access, which restriction is contrary to the existing regulations that determine the free and unlimited access. The analysis of the main settings specified in the PLS 200/2015 did not identify social or scientific improvements. The Principle of the Prohibition of Social Regression can be used, thus, to ensure the constitutional provisions already undertake and accomplished, mainly the right to health, human dignity and the inviolability of the right to live.

El proyecto de ley del Senado (PLS) Nº 200, de 2015, se propone emitir una ley para la realización de estudios clínicos en seres humanos. El objetivo de este estudio fue la realización de un análisis crítico del PLS 200/2015, basado en el Principio de la Prohibición del Retroceso Social. Para ello, se llevó a cabo un estudio descriptivo, documental y normativo, así como también una pesquisa de las normas sanitarias y éticas y opiniones relacionadas con el PL 200/2015. El PLS 200/2015 y las informaciones relacionadas con él, también se consultaron en el sitio web del Senado Federal. La regulación de la materia por la ley no resultó ser un problema en las opiniones de consulta. Los principales conflictos se relacionan con la creación de un comité de ética independiente (CEI), que no vincula la revisión ética a una agencia estatal; al uso de placebo, cuya flexibilidad es contraria a todos los esfuerzos realizados para asegurar que los participantes tengan las mejores opciones de tratamiento; y el acceso a un estudio posterior, cuya restricción es contraria a las normas existentes que determinan el acceso libre y de forma indefinida. El análisis de las disposiciones principales especificadas en el PLS 200/2015 no identificó el avance social o de desarrollo técnico-científico. El principio de la prohibición del retroceso social se puede utilizar, de esta forma, para garantizar las disposiciones constitucionales ya realizadas y logradas, en particular el derecho a la salud, a la dignidad humana y a la inviolabilidad del derecho a la vida.

A "Child's Rights Perspective": The "Right" of Children and Young People to Participate in Health Care Research.

As all human beings are consumers of health care provision across the life span and in receipt of care delivered by accountable health care professionals, all should have the right to be involved in shaping the future of their own health care. Rights-based participation, when applied successfully, has the potential to inform and influence the delivery of child health care, the child's experience of health care, plus children's nursing education (Coyne & Gallagher, 2011). The "right" of every child and young person to participate in research that relates to their own health care is also sustained by the author's lead position as a Senior Lecturer in Higher Education for pre-registration children's nursing in Northern Ireland and the appreciation of their voice when practicing as a registered children's nurse and ward sister. The report provides an insight into seminal work on human and child rights; the historical context of children in Western society, and the evolution of children's nursing amid the child's right to participate in shaping their own health care.

Apontamentos sobre ética na pesquisa: tensões da educação no encontro com a saúde / Notes about research ethics: tensions of education in the encounter with the health

Esta escritura foi disparada com o seminário avançado sobre Ética na pesquisa, que envolvia questões e proposições para a Educação e para a Saúde Coletiva, realizado no primeiro semestre letivo de 2014, na Universidade Federal do Rio Grande do Sul - uma promoção dos Programas de Pós-Graduação em Educação e em Saúde Coletiva. Trouxemos, neste artigo, apontamentos sobre a vida e os encontros, tomando-os como tarefa ética quando se investiga em ciência e na produção de conhecimento em saúde. Pensamos, aí, uma Ética "da educação" no cuidado em saúde. Sugerimos a potência de permanentemente aprender, durante a pesquisa, porque se pesquisa. Pesquisar é aceitar o imprevisível, é se deixar ser afetado, é a capacidade de suportar o que não para de diferir. Pesquisar exige Ética para com o que pede passagem, com a densidade da vida e com a labilidade das formas. Propomos que "parafernálias do encontro" - e não as tralhas tecnológicas - sejam disparadoras de potência para a afirmação da vida

This writing was triggered by the advanced seminar on Ethics in research involving issues and propositions for Education and Collective Health. The seminar was held in the first semester of 2014, in the Federal University of Rio Grande do Sul, promoted by the programs of Graduate Studies in Education and Collective Health. We brought, in this article, notes on life and encounters, taking them as an ethical task when investigating in science and in knowledge production in health. We think, there, an "education" Ethics in health care. We suggest the potency of learning permanently, during the research, why we research. Researching is accepting the unpredictable; is to letting yourself be affected; it is the ability to endure what does not stop from differ. Researching requires Ethics to what asks for passage, to the density of life and to the lability of the forms. We propose that "paraphernalia of encounter" ­ and not the technological junk - be the trigger of the potency to the affirmation of life.

Comparison of national health research priority-setting methods and characteristics in Latin America and the Caribbean, 2002 - 2012 / Comparación de los métodos de establecimiento de prioridades de investigación nacional de salud y sus características en América Latina y el Caribe, 2002 al 2012

OBJECTIVE: To compare health research priority-setting methods and characteristics among countries in Latin America and the Caribbean during 2002 - 2012. METHODS: This was a systematic review that identified national health research policies and priority agendas through a search of ministry and government databases related to health care institutions. PubMed, LILACS, the Health Research Web, and others were searched for the period from January 2002 - February 2012. The study excluded research organized by governmental institutions and specific national strategies on particular disease areas. Priority-setting methods were compared to the "nine common themes for good practice in health research priorities." National health research priorities were compared to those of the World Health Organization's Millennium Development Goals (MDG). RESULTS: Of the 18 Latin American countries assessed, 13 had documents that established national health research priorities; plus the Caribbean Health Research Council had a research agenda for its 19 constituents. These 14 total reports varied widely in terms of objectives, content, dissemination, and implementation; most provided a list of strategic areas, suggestions, and/or sub-priorities for each country; however, few proposed specific research topics and questions. CONCLUSIONS: Future reports could be improved by including more details on the comprehensive approach employed to identify priorities, on the information gathering process, and on practices to be undertaken after priorities are set. There is a need for improving the quality of the methodologies utilized and coordinating Regional efforts as countries strive to meet the MDG.

OBJETIVO: Comparar los métodos de establecimiento de prioridades de investigación de salud y sus características en los países de América Latina y el Caribe durante el período del 2002 al 2012. MÉTODOS: Se llevó a cabo una revisión sistemática que determinó las políticas nacionales de investigación de salud y los programas prioritarios mediante una búsqueda de bases de datos ministeriales y gubernamentales relacionadas con instituciones de atención de salud. Se llevó a cabo una búsqueda ajustada al período de enero del 2002 a febrero del 2012 en PubMed, LILACS, Health Research Web y otras fuentes. El estudio excluyó las investigaciones organizadas por instituciones gubernamentales y estrategias nacionales específicas sobre áreas de enfermedades particulares. Se compararon los métodos de establecimiento de prioridades con los "nueve temas comunes para unas prácticas adecuadas en materia de prioridades de investigación de salud". Se compararon las prioridades nacionales de investigación de salud con las de los Objetivos de Desarrollo del Milenio (ODM) de la Organización Mundial de la Salud. RESULTADOS: De los 18 países latinoamericanos evaluados, 13 disponían de documentos que establecían las prioridades nacionales de investigación de salud; además, el Consejo del Caribe de Investigación de Salud disponía de un programa de investigaciones dirigido a sus 19 integrantes. Estos 14 informes variaban ampliamente en cuanto a objetivos, contenido, difusión y ejecución; la mayor parte de ellos proporcionaban una lista de áreas estratégicas, sugerencias o subprioridades para cada país, sin embargo, eran pocos los que proponían temas y cuestiones específicos de investigación. CONCLUSIONES: Se podrían mejorar los informes futuros mediante una descripción más detallada del método integral empleado para determinar las prioridades, del proceso de recopilación de información y de las prácticas que deben emprenderse una vez fijadas las prioridades. Es necesario mejorar la calidad de los métodos utilizados y coordinar las iniciativas regionales a medida que los países tratan de cumplir los ODM.

Research at IMU: achievements, thrust areas and future challenges

There have been significant achievements in research at IMU as indicated by the increasing amount of external funds obtained, and number of publications and postgraduate students produced since it started its research activities in the year 2000. However, it is a great challenge indeed to ensure sustainability of our research, which is currently heavily dependent on internal funding. There is a need to realign our strategies to further enhance our competitiveness in securing external funding for research. In line with this, the Institute for Research, Development and Innovation (IRDI) was officially established on 18 September 2012. The Institute will serve as a platform to support all research activities at IMU. There are four Centres of Excellence based on the identified thrust areas under IRDI, namely 1) Centre for Bioactive Molecules and Drug Discovery; 2) Centre for Environmental and Population Health; 3) Centre for Cancer and Stem Cell Research, and 4) Centre for Health Professional Education Research. Major findings based on research in these four thrust areas are reviewed in this paper. With the strategic planning and establishment of IRDI, it is our aspiration to bring research at IMU to a higher level.