[Doing, planning, "planning-doing:" a case of municipal pragmatism in collaboration with a university during the COVID-19 pandemic]. / Haciendo, planeando, "planhaciendo": una experiencia de pragmatismo municipal en la pandemia del Covid-19 en cooperación con la universidad.

This article critically analyzes local governments' abilities to face the COVID-19 pandemic by examining an instance of technical-scientific cooperation between a municipality and a university located in the northern Rio de Janeiro (state) beginning in April 2020. This collaboration included: the implementation of a situation room, data processing and analysis for decision making and for public communication, a telemonitoring center, ongoing training with territorial healthcare teams, and an epidemiological study of COVID-19 in the municipality, among other actions. We situate our analysis within a conceptual framework that adopts a micropolitical view of concepts such as experience, pragmatism, "live work in action," and desire. The notion of "planning-doing" is deployed as an inventive form of planning that is only narrated a posteriori, as an imperative act, a live government in action that depends on the movement of desire oriented by life, and that only takes place in collective spaces of management practices and health care.

Este artículo problematiza las posibilidades municipales de hacer frente a la pandemia de COVID-19, a partir de la cooperación técnico-científica entre un municipio y una universidad del norte del estado de Rio de Janeiro, a partir de abril de 2020, que involucró la implementación de una sala de situación, procesamiento y análisis de datos para la toma de decisiones y de información para la población, centro de televigilancia, educación permanente con equipos territoriales de atención y estudio epidemiológico de COVID-19 en el municipio, entre otras acciones. En este análisis se utilizó como soporte conceptual una visión micropolítica de los conceptos de experiencia, pragmatismo, trabajo vivo en acto y deseo. La noción de "planhaciendo" se retomó como una planificación inventiva que solo puede ser narrada a posteriori, un acto imperativo, un gobierno vivo en acto que depende de un movimiento anhelante orientado por la vida, y que solo se da en espacios colectivos de prácticas de gestión y de atención a la salud.

Policy and vision for community pharmacies in Finland: a roadmap towards enhanced integration and reduced costs

Finland's community pharmacy system provides an example of a privately-owned regulated system being proactively developed by the profession and its stakeholders. Community pharmacists have a legal duty to promote safe and rational medicine use in outpatient care. The development of professionally oriented practice has been nationally coordinated since the 1990s with the support of a national steering group consisting of professional bodies, authorities, pharmacy schools and continuing education centers. The primary focus has been in patient counseling services and public health programs. The services have extended towards prospective medication risk management applying evidence-based tools, databases and digitalization. Research has been essential in informing progress by indicating high-risk patients, medications, practices and processes needing improvement. Despite the commitment of the profession and pharmacy owners, large-scale implementation of services has been challenging because of lack of remuneration, the pharmacy income still consisting primarily of sale of prescription and nonprescription medicines. Policy documents by the Ministry of Social Affairs and Health have supported the extension of the community pharmacists' role beyond traditional dispensing to promote rational pharmacotherapy. The current roadmap by the Ministry of Social Affairs and Health emphasizes ensuring adequate regional availability and accessibility of medicines, regardless of the future pharmacy system. It also emphasizes the importance of strong regulation on pharmacy business operations and sale of medicines to ensure medication safety. At the same time, the roadmap requires that the regulation must enable implementation of new patient-oriented services and procedures, and further promote digitalization in service provision. Competition and balance of funding should be enhanced, e.g., through price competition, but the risk of pharmaceutical market concentration should be managed. The regulation should also consider influence of the new social and health care system on drug delivery. Year 2021 will be crucial for making long-term political decisions on the future direction of tasks and finances of Finnish community pharmacies in this framework. Government-funded studies are underway to guide decision making. Ongoing Covid-19 crisis has demonstrated the readiness of Finnish community pharmacies to adapt fast to meet the changing societal needs

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[Bringing in equity to health. An analysis of the autonomous communities health plans.] / Incorporando la equidad a la salud. Un análisis de los planes autonómicos sanitarios.

OBJECTIVE: The debate on equity in health, with long history and wide understanding, is more relevant today when considering the transcendence of this area. In the context of our system, it is appropriate to know the approach adopted by the autonomous communities. By analysing regional health plans in Spain it was intended to detect the perspectives applied in the search for equity, as well as to know the main goals of the plans and those groups or circumstances they try to deal with. METHODS: Based on the procedure of constant comparative analysis and content analysis, whose statistical treatment was conducted with Nvivo software (v12) and the analysis of Jaccard and Pearson correlation indexes, along with the triangulation of methods, data and researchers, the most recent regional health plans in progress (fourth quarter of 2019) were screened. RESULTS: Analized plans brought out that the search for equity is not given sufficient relevance. However, there are specific circumstances that standed out among the references to equity in the plans. Accessibility arised as a key category to understand the setup of health care as a public policy. CONCLUSIONS: The main paradigm found in regional health plans is that of equality or equity in access to health. To a lesser extent, it is also present a search for equal opportunities for various specific groups, such as people suffering from mental illness, people with functional diversity or who face some of the barriers or difficulties associated with the gender gap. Other items or groups considered by the regional administrations in a more reduced way, but also in a different manner, are immigration, rural habitat and infrastructures and elderly people.

OBJETIVO: El debate sobre la equidad en salud, con amplia trayectoria e interpretaciones, cobra más vigencia en la actualidad al considerar la trascendencia de esta área. En el contexto de nuestro sistema, resulta pertinente conocer la aproximación adoptada por las comunidades autónomas. Mediante el análisis de los planes de salud autonómicos se persiguió el objetivo de detectar las perspectivas que se habían aplicado a la búsqueda de la equidad en España, así como conocer sus principales metas y los colectivos o condiciones tomados en consideración. METODOS: Mediante el análisis comparativo constante y del análisis de contenido, cuyo tratamiento estadístico se realizó con el software Nvivo (v12) y el análisis de los índices de correlación de Jaccard y Pearson, junto con la triangulación de métodos, datos e investigadores, fueron examinados los planes generales de salud autonómicos más recientes a fecha del cuarto trimestre de 2019. RESULTADOS: Los planes analizados revelaron que no se otorga a la búsqueda de la equidad suficiente importancia, si bien se detectaron circunstancias específicas que destacan entre las referencias a la equidad recogidas por los planes. La accesibilidad emergió como categoría clave a la hora de entender la configuración de la sanidad como política pública. CONCLUSIONES: El principal paradigma presente en los planes de salud autonómicos es el de la igualdad o equidad en cuanto al acceso a la salud, seguido del de la búsqueda de igualdad de oportunidades para colectivos concretos, como son las personas que padecen enfermedades mentales, personas con diversidad funcional o que presentan alguna de las barreras o dificultades asociadas a la brecha de género. Otros ítems o colectivos contemplados en menor medida, pero de forma desigual entre las comunidades autónomas, son la inmigración, el hábitat rural e infraestructuras y el colectivo de personas mayores.

Cuidados enfermeros para el abordaje de la salud comunitaria en población indígena de la Amazonia peruana / Nursing care to address community health of the indigenous population in the Peruvian Amazon

La comunidad nativa Shonori la componen familias asháninkas de la Amazonia peruana. Este trabajo aborda la salud comunitaria mediante una valoración y plan de cuidados de enfermería basado en el modelo de competencia cultural de Purnell y la taxonomía estandarizada enfermera (NANDA, NIC, NOC). La valoración se sustenta en 12 dominios relacionados con la herencia y ecología biocultural, comunicación, roles y organización familiar, conductas de riesgo, nutrición, embarazo, rituales de muerte y espiritualidad y prácticas y proveedores de cuidados de salud. Se detecta como diagnóstico una «salud deficiente de la comunidad relacionada con recursos insuficientes y manifestada por problemas de salud padecidos por la comunidad». Los criterios de resultados esperados en el plan de cuidados son: competencia social, estado de salud de la comunidad y control del riesgo social relacionado con las enfermedades transmisibles. Las intervenciones consisten en fomentar la salud comunitaria, analizar e identificar la situación de salud y riesgos, y controlar y proteger de enfermedades transmisibles y de riesgos ambientales. Intervenciones de la red pública de abastecimiento de agua y subvenciones para el apoyo agrícola y a las viviendas permitieron disminuir vectores, sufragar gastos del abastecimiento de agua segura y comprar alimentos para mejorar la nutrición infantil. El uso de la medicina tradicional fue potenciado y se desarrollaron campañas de salud y educación sexual en coordinación con el sistema oficial de salud. Se hizo un seguimiento durante 40 días, que corroboró la mejora de la salud comunitaria y la necesidad de un abordaje grupal con todos los actores

The native community Shonori is made up of Ashaninka families of the Peruvian Amazon. This paper addresses community health through an assessment and nursing care plan based on the Purnell cultural competency model and the standardized nurse taxonomy (NANDA, NIC, NOC). The assessment is based on 12 domains related to inheritance and biocultural ecology, communication, roles and family organization, risk behaviours, nutrition, pregnancy, death and spirituality rituals, and health care providers and practices. A diagnosis of «Poor health of the community r /t insufficient resources m/b health problems suffered by the community» is detected. The expected results criteria in the care plan are: social competence, community health status and control of social risk related to communicable diseases. The interventions consist of promoting community health, analyzing and identifying the health situation and risks, and controlling and protecting from communicable diseases and environmental risks. Interventions of the public water supply network and subsidies for agricultural and housing support, allowed vectors to be reduced, costs of safe water supply to be covered, and food to be bought to improve child nutrition. The use of traditional medicine was enhanced and health and sexual education campaigns were carried out in coordination with the official health system. A follow-up was carried out for 40 days, corroborating the improvement of community health, and the need for a group approach with all actors

Haciendo, planeando, "planhaciendo": una experiencia de pragmatismo municipal en la pandemia del Covid-19 en cooperación con la universidad / Doing, planning, "planning-doing": a case of municipal pragmatism in collaboration with a university during the COVID-19 pandemic

RESUMEN Este artículo problematiza las posibilidades municipales de hacer frente a la pandemia de COVID-19, a partir de la cooperación técnico-científica entre un municipio y una universidad del norte del estado de Rio de Janeiro, a partir de abril de 2020, que involucró la implementación de una sala de situación, procesamiento y análisis de datos para la toma de decisiones y de información para la población, centro de televigilancia, educación permanente con equipos territoriales de atención y estudio epidemiológico de COVID-19 en el municipio, entre otras acciones. En este análisis se utilizó como soporte conceptual una visión micropolítica de los conceptos de experiencia, pragmatismo, trabajo vivo en acto y deseo. La noción de "planhaciendo" se retomó como una planificación inventiva que solo puede ser narrada a posteriori, un acto imperativo, un gobierno vivo en acto que depende de un movimiento anhelante orientado por la vida, y que solo se da en espacios colectivos de prácticas de gestión y de atención a la salud.

ABSTRACT This article critically analyzes local governments' abilities to face the COVID-19 pandemic by examining an instance of technical-scientific cooperation between a municipality and a university located in the northern Rio de Janeiro (state) beginning in April 2020. This collaboration included: the implementation of a situation room, data processing and analysis for decision making and for public communication, a telemonitoring center, ongoing training with territorial healthcare teams, and an epidemiological study of COVID-19 in the municipality, among other actions. We situate our analysis within a conceptual framework that adopts a micropolitical view of concepts such as experience, pragmatism, "live work in action," and desire. The notion of "planning-doing" is deployed as an inventive form of planning that is only narrated a posteriori, as an imperative act, a live government in action that depends on the movement of desire oriented by life, and that only takes place in collective spaces of management practices and health care.

Provision of COVID-19 Convalescent Plasma in a Resource-Constrained State.

BACKGROUND: Arkansas is a rural state of 3 million people. It is ranked fifth for poverty nationally. The first case of coronavirus disease 2019 (COVID-19) in Arkansas occurred on 11 March 2020. Since then, approximately 8% of all Arkansans have tested positive. Given the resource limitations of Arkansas, COVID-19 convalescent plasma (CCP) was explored as a potentially lifesaving, therapeutic option. Therefore, the Arkansas Initiative for Convalescent Plasma was developed to ensure that every Arkansan has access to this therapy. STUDY DESIGN AND METHOD: This brief report describes the statewide collaborative response from hospitals, blood collectors, and the Arkansas Department of Health (ADH) to ensure that CCP was available in a resource-limited state. RESULTS: Early contact tracing by ADH identified individuals who had come into contact with "patient zero" in early March. Within the first week, 32 patients tested positive for COVID-19. The first set of CCP collections occurred on 9 April 2020. Donors had to be triaged carefully in the initial period, as many had recently resolved their symptoms. From our first collections, with appropriate resource and inventory management, we collected sufficient CCP to provide the requested number of units for every patient treated with CCP in Arkansas. CONCLUSIONS: The Arkansas Initiative, a statewide effort to ensure CCP for every patient in a resource-limited state, required careful coordination among key players. Collaboration and resource management was crucial to meet the demand of CCP products and potentially save lives.

Using an Integrated Conceptual Framework to Clarify Health Problems and Assess A Community Health Planning Process: A Mid-Western USA Case Study.

Within a case study design, this paper clarifies community problems, and assesses a Community Health Improvement Plan development process using a framework of explanatory models and change theories that links the macro social model, the materialistic model, social cognitive theory, theory of fundamental causes, and community organizing theory. Properties of demographic and health status artifacts are consistent with the core constructs in both the macro social and the materialistic models. The constructs in social cognitive theory and the theory of fundamental causes seem to influence program strategies even as socio-economic factors were only minimally addressed. At the organizing level, the Plan excelled in locality development and social planning but was short on social action. The findings suggest a need for social action as a model of practice in solving persistent social and health problems, and for research that investigates if social action practice can predict success in resolving these problems.

Prioritizing the Potential Applications of Mobile-Health in the Iranian Health System.

BACKGROUND: Access and the use of information and communication technology, especially mobile phones, have expanded significantly in recent years; therefore, we aimed to rank the potential applications of mobile apps in the Iranian health system. STUDY DESIGN: A multi-attribute decision making design. METHODS: First, the main applications of apps and also the related attributes for prioritization were extracted from a systematic and comparative review of studies. Then, the weight of these attributes was extracted using the Shannon Entropy method. The values of attributes for each application were questioned by the 11 experts. By having the decision matrix and the weight of attributes, the applications were separately weighted and ranked using four MADM techniques. Finally, using the Copeland technique, the results of different techniques were combined, and a final ranking was achieved. RESULTS: Based on the results extracted from the studies and the opinions of experts, 8 main applications, and, 14 attributes were determined and entered into the modeling phase. The most significant weight obtained was related to "the feasibility of monitoring activities" (weight=0.220), and the least was related to "the feasibility of access to apps in any location" (weight=0.017). CONCLUSION: The apps related to the physicians' access to patients' health information had the highest priority, and the apps related to the selection of proper health behavior patterns had the least priority.

Why communities must be at the centre of the Coronavirus disease 2019 response: Lessons from Ebola and human immunodeficiency virus in Africa.

As the Coronavirus disease 2019 (COVID-19) pandemic has spread globally, with no effective treatment or vaccine yet available, governments in many countries have put in place social interventions to control the outbreak. The various lockdown measures may have devastating impacts on economies and livelihoods. This approach risks undermining public trust in government responses and therefore undermines efforts to promote behaviour change, which is key to the success of social interventions. Important lessons can be drawn from past Ebola outbreaks and the human immunodeficiency virus pandemic on how communities should be central to COVID-19 responses. Communities are complex and only their members can inform public health experts about their lived realities, the community's understanding of the outbreak and what will work locally to reduce transmission. The public should be encouraged to take positive actions to ensure their own health and well-being, rather than made to feel powerless. Communities should be supported to develop their own response plans, community leaders should be recognised as vital assets, community representatives should have equal inclusion in strategic meetings and greater empathy should be built into decision-making processes.

Identifying and combating the impacts of COVID-19 on malaria.

BACKGROUND: The COVID-19 pandemic has resulted in millions of infections, hundreds of thousands of deaths and major societal disruption due to lockdowns and other restrictions introduced to limit disease spread. Relatively little attention has been paid to understanding how the pandemic has affected treatment, prevention and control of malaria, which is a major cause of death and disease and predominantly affects people in less well-resourced settings. MAIN BODY: Recent successes in malaria control and elimination have reduced the global malaria burden, but these gains are fragile and progress has stalled in the past 5 years. Withdrawing successful interventions often results in rapid malaria resurgence, primarily threatening vulnerable young children and pregnant women. Malaria programmes are being affected in many ways by COVID-19. For prevention of malaria, insecticide-treated nets need regular renewal, but distribution campaigns have been delayed or cancelled. For detection and treatment of malaria, individuals may stop attending health facilities, out of fear of exposure to COVID-19, or because they cannot afford transport, and health care workers require additional resources to protect themselves from COVID-19. Supplies of diagnostics and drugs are being interrupted, which is compounded by production of substandard and falsified medicines and diagnostics. These disruptions are predicted to double the number of young African children dying of malaria in the coming year and may impact efforts to control the spread of drug resistance. Using examples from successful malaria control and elimination campaigns, we propose strategies to re-establish malaria control activities and maintain elimination efforts in the context of the COVID-19 pandemic, which is likely to be a long-term challenge. All sectors of society, including governments, donors, private sector and civil society organisations, have crucial roles to play to prevent malaria resurgence. Sparse resources must be allocated efficiently to ensure integrated health care systems that can sustain control activities against COVID-19 as well as malaria and other priority infectious diseases. CONCLUSION: As we deal with the COVID-19 pandemic, it is crucial that other major killers such as malaria are not ignored. History tells us that if we do, the consequences will be dire, particularly in vulnerable populations.

Natural Language Processing Improves Detection of Nonsevere Hypoglycemia in Medical Records Versus Coding Alone in Patients With Type 2 Diabetes but Does Not Improve Prediction of Severe Hypoglycemia Events: An Analysis Using the Electronic Medical Record in a Large Health System.

OBJECTIVE: To determine if natural language processing (NLP) improves detection of nonsevere hypoglycemia (NSH) in patients with type 2 diabetes and no NSH documentation by diagnosis codes and to measure if NLP detection improves the prediction of future severe hypoglycemia (SH). RESEARCH DESIGN AND METHODS: From 2005 to 2017, we identified NSH events by diagnosis codes and NLP. We then built an SH prediction model. RESULTS: There were 204,517 patients with type 2 diabetes and no diagnosis codes for NSH. Evidence of NSH was found in 7,035 (3.4%) of patients using NLP. We reviewed 1,200 of the NLP-detected NSH notes and confirmed 93% to have NSH. The SH prediction model (C-statistic 0.806) showed increased risk with NSH (hazard ratio 4.44; P < 0.001). However, the model with NLP did not improve SH prediction compared with diagnosis code-only NSH. CONCLUSIONS: Detection of NSH improved with NLP in patients with type 2 diabetes without improving SH prediction.

Lessons learned about co-creation: developing a complex intervention in rural Peru.

Background: Co-creation is the process of involving stakeholders in the development of interventions. Although co-creation is becoming more widespread, reports of the process and lessons learned are scarce.Objective: To describe the process and lessons learned from using the COHESION manual, a co-creation methodology to develop interventions aimed at the improvement of diagnosis and/or management of chronic diseases at the primary healthcare level in a low-resource setting in Peru.Methods: Observational study to describe the use of the COHESION manual 'Moving from Research to Interventions: The COHESION Model' developed for a multi-country project in low- and middle-income countries for co-creation and the adaptations needed to customize it to the local context of rural communities in northern Peru.Results: The actual process of co-creation in Peru included co-creation-related questions in the formative research; an initial consultation with stakeholders at the micro, meso, and macro levels (e.g. community members, health workers, and policy-makers); the analysis of the collected data; a second consultation with each stakeholder group; the prioritization of intervention options; and finally the design of a theory of change for all activities included in the complex intervention. The complex intervention included: 1) offer training in specific diseases and soft skills to health workers, 2) create radio programs that promote chronic disease prevention and management plus empower patients to ask questions during their visits to primary health care (PHC) facilities, and 3) provide a small grant to the PHC for infrastructure improvement. Small adaptations to the COHESION manual were necessary for this co-creation process.Conclusion: This study provides a practical example of the process of co-creating complex interventions to increase access and quality of health care in a low-resource setting. The process, components, challenges and opportunities identified could be useful for other researchers who want to co-create interventions with beneficiaries in similar settings.

Volunteer responsibilities, motivations and challenges in implementation of the community-based health planning and services (CHPS) initiative in Ghana: qualitative evidence from two systems learning districts of the CHPS+ project.

BACKGROUND: Community volunteerism is essential in the implementation of the Community-based Health Planning and Services (CHPS) in Ghana. We explored the responsibilities, motivations and challenges of community health management committees (CHMCs) in two CHPS+ Project districts in Ghana. METHODS: We used a qualitative approach to collect data through 4 focus group discussions among a purposive sample of community health volunteers in December 2018 and analysed them thematically. RESULTS: Community health management committees (CHMCs) were found to provide support in running the CHPS programme through resource mobilisation, monitoring of logistics, assisting the Community Health Officers (CHO) in the planning of CHPS activities, and the resolution of conflicts between CHOs and community members. The value, understanding and protective functions were the key motivations for serving on CHMCs. Financial, logistical and telecommunication challenges, lack of recognition and cooperation from community members, lack of motivation and lack of regular skill development training programmes for CHMC members who serve as traditional birth attendants (TBAs) were major challenges in CHMC volunteerism. CONCLUSION: Community health volunteerism needs to be prioritised by the Ghana Health Service and other health sector stakeholders to make it attractive for members to give off their best in the discharge of their responsibilities.

Rushing the Value Cockpit.

The 2015 merger of health authorities in Nova Scotia was aggressive in pursuit of greater value. The goal was to create an integrated, accountable care network across the entire province. Years of pent-up frustration, death by a thousand cuts, declining service and growing expectations merged into a slow, insidious bleeding of support for change. The lessons learned from Nova Scotia are vital to achieving a value-based health system. The article describes some of the barriers to progress and the steps needed to achieve the goal of a value-based healthcare system for Canadians.

DOHaD in low- and middle-income countries: a systematic review exploring gaps in DOHaD population studies.

Low- and middle-income countries (LMICs) are disproportionately affected by non-communicable diseases (NCDs), accounting for more than 80% of NCD-related deaths globally. Research into early-life influences on these diseases via the developmental origins of health and disease (DOHaD) paradigm has informed health promotion interventions and policies focused on optimising early-life health. However, little is known about where this research occurs and whether it reaches and reflects the countries most affected by NCDs. This review searched for DOHaD studies that investigated relationships between factors during pregnancy and at birth, with later-life NCD incidence, risk and related mortality. The aim of this review was to identify where DOHaD research has been conducted and whether this focus is appropriate and relevant, given the differential burden of NCDs. Embase, MEDLINE and Scopus were searched, and eligibility screening processes identified 136 final articles. This review found that 49.7% of DOHaD research was conducted on populations within Western Europe, 15.9% in East Asia, 12.7% in North America, 8.3% in Latin America and the Caribbean, and fewer in Australasia, South Asia, the Middle East, the Africas, and Central Asia. When categorised by income, this review found that 76.4% of studies were based in high-income countries, 19.1% in upper-middle-income and 4.5% in lower-middle-income countries. No studies were based in low-income countries. There is therefore a marked disconnect between where DOHaD research is undertaken and where the greatest NCD disease burden exists. Increasing DOHaD research capacity in LMICs is crucial to informing local strategies that can contribute to reducing the incidence of NCDs.

La atención comunitaria en Castilla-La Mancha: una propuesta formativa / No disponible

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