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Bull World Health Organ ; 98(11): 801-808, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33177777


Four decades after the Declaration of Alma-Ata, its vision of health for all and strategy of primary health care are still an inspiration to many people. In this article we evaluate the current status of primary health care in the era of the Declaration of Astana, the sustainable development goals, universal health coverage and the coronavirus disease 2019 pandemic. We consider how best to guide greater application of the primary health care strategy, reflecting on tensions that remain between the political vision of primary health care and its implementation in countries. We also consider what is required to support countries to realize the aspirations of primary health care, arguing that national needs and action must dominate over global preoccupations. Changing contexts and realities need to be accommodated. A clear distinction is needed between primary health care as an inspirational vision and set of values for health development, and primary health care as policy and implementation space. To achieve this vision, political action is required. Stakeholders beyond the health sector will often need to lead, which is challenging because the concept of primary health care is poorly understood by other sectors. Efforts on primary health care as policy and implementation space might focus explicitly on primary care and the frontline of service delivery with clear links and support to complementary work on social determinants and building healthy societies. Such efforts can be partial but important implementation solutions to contribute to the much bigger political vision of primary health care.

Infecções por Coronavirus/epidemiologia , Saúde Global , Política de Saúde , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde/organização & administração , Assistência de Saúde Universal , Betacoronavirus , Setor de Assistência à Saúde/organização & administração , Prioridades em Saúde/organização & administração , Humanos , Sistemas de Informação , Pandemias , Direitos do Paciente/normas , Política , Desenvolvimento Sustentável
Rev. bioét. derecho ; (50): 189-203, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-191353


La actual pandemia por la COVID-19 está ocasionado serias amenazas para la salud pública a nivel mundial, especialmente para los grupos de población más vulnerables. Los casos más graves de la enfermedad han sido primeramente atendidos por los profesionales de urgencias y emergencias, los cuales han tenido que tomar decisiones en contextos altamente complejos donde la priorización en la asignación de los recursos sanitarios disponibles les ha generado situaciones éticamente conflictivas. El objetivo del presente artículo es analizar la importancia de implantar la PDA en los servicios de urgencias y emergencias como herramienta de consulta en la resolución de los problemas éticos surgidos durante la pandemia por COVID-19, concretamente, en la atención al paciente crónico complejo o con enfermedad crónica avanzada

The events of the present CoVID-19 pandemic are causing serious threats to Public Health worldwide, specifically at the most vulnerable population groups. Emergency professionals have served as the first responders for the most serious cases of this disease. At the same time, they have made decisions in highly complex contexts where the prioritization of allocated care resources has generated ethically conflictive situations. The aim of this article is to analyze the importance of implementing the ACP as a tool in the emergency services to solve ethical problems that have arisen during the COVID-19 pandemic, particularly in the care of complex chronic patients or those with advanced chronic disease

L'actual pandèmia per la COVID-19 està ocasionat serioses amenaces a la salut pública a nivell mundial, especialment als grups de població més vulnerables. Els casos més greus de la malaltia han estat primerament atesos pels professionals d'urgències I emergències, els quals han hagut de prendre decisions en contextos altament complexos on la priorització en l'assignació dels recursos sanitaris disponibles els ha generat situacions èticament conflictives. L'objectiu d'aquest article va ser analitzar la importància d'implantar la PDA en els serveis d'urgències I emergències com a eina de consulta a la resolució dels problemes ètics sorgits durant la pandèmia per COVID-19, concretament, en l'atenció al pacient crònic complex o amb malaltia crònica avançada

Humanos , Prioridades em Saúde/ética , Prioridades em Saúde/organização & administração , Planejamento de Assistência ao Paciente , Tomada de Decisões/ética , Conflito de Interesses , Serviços Médicos de Emergência/ética , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Doença Crônica
Crit Care Med ; 48(11): 1612-1621, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32804789


OBJECTIVES: There are over 4,000 trials conducted in people with coronavirus disease 2019. However, the variability of outcomes and the omission of patient-centered outcomes may diminish the impact of these trials on decision-making. The aim of this study was to generate a consensus-based, prioritized list of outcomes for coronavirus disease 2019 trials. DESIGN: In an online survey conducted in English, Chinese, Italian, Portuguese, and Spanish languages, adults with coronavirus disease 2019, their family members, health professionals, and the general public rated the importance of outcomes using a 9-point Likert scale (7-9, critical importance) and completed a Best-Worst Scale to estimate relative importance. Participant comments were analyzed thematically. SETTING: International. SUBJECTS: Adults 18 years old and over with confirmed or suspected coronavirus disease 2019, their family members, members of the general public, and health professionals (including clinicians, policy makers, regulators, funders, and researchers). INTERVENTIONS: None. MEASUREMENTS: None. MAIN RESULTS: In total, 9,289 participants from 111 countries (776 people with coronavirus disease 2019 or family members, 4,882 health professionals, and 3,631 members of the public) completed the survey. The four outcomes of highest priority for all three groups were: mortality, respiratory failure, pneumonia, and organ failure. Lung function, lung scarring, sepsis, shortness of breath, and oxygen level in the blood were common to the top 10 outcomes across all three groups (mean > 7.5, median ≥ 8, and > 70% of respondents rated the outcome as critically important). Patients/family members rated fatigue, anxiety, chest pain, muscle pain, gastrointestinal problems, and cardiovascular disease higher than health professionals. Four themes underpinned prioritization: fear of life-threatening, debilitating, and permanent consequences; addressing knowledge gaps; enabling preparedness and planning; and tolerable or infrequent outcomes. CONCLUSIONS: Life-threatening respiratory and other organ outcomes were consistently highly prioritized by all stakeholder groups. Patients/family members gave higher priority to many patient-reported outcomes compared with health professionals.

Betacoronavirus , Infecções por Coronavirus/terapia , Prioridades em Saúde/organização & administração , Pneumonia Viral/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Adulto , Idoso , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/prevenção & controle , Feminino , Acesso aos Serviços de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Projetos de Pesquisa , Avaliação de Sintomas
Lancet Glob Health ; 8(9): e1142-e1151, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32682459


BACKGROUND: COVID-19 is spreading rapidly in India and other parts of the world. Despite the Indian Government's efforts to contain the disease in the affected districts, cases have been reported in 627 (98%) of 640 districts. There is a need to devise a tool for district-level planning and prioritisation and effective allocation of resources. Based on publicly available data, this study reports a vulnerability index for identification of vulnerable regions in India on the basis of population and infrastructural characteristics. METHODS: We computed a composite index of vulnerability at the state and district levels based on 15 indicators across the following five domains: socioeconomic, demographic, housing and hygiene, epidemiological, and health system. We used a percentile ranking method to compute both domain-specific and overall vulnerability and presented results spatially with number of positive COVID-19 cases in districts. FINDINGS: A number of districts in nine large states-Bihar, Madhya Pradesh, Telangana, Jharkhand, Uttar Pradesh, Maharashtra, West Bengal, Odisha, and Gujarat-located in every region of the country except the northeast, were found to have high overall vulnerability (index value more than 0·75). These states also had high vulnerability according to most of the five domains. Although our intention was not to predict the risk of infection for a district or a state, we observed similarities between vulnerability and the current concentration of COVID-19 cases at the state level. However, this relationship was not clear at the district level. INTERPRETATION: The vulnerability index presented in this paper identified a number of vulnerable districts in India, which currently do not have large numbers of COVID-19 cases but could be strongly impacted by the epidemic. Our index aims to help planners and policy makers effectively prioritise regions for resource allocation and adopt risk mitigation strategies for better preparedness and responses to the COVID-19 epidemic. FUNDING: None.

Infecções por Coronavirus/prevenção & controle , Epidemias/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Populações Vulneráveis , Infecções por Coronavirus/epidemiologia , Alocação de Recursos para a Atenção à Saúde/organização & administração , Planejamento em Saúde/organização & administração , Prioridades em Saúde/organização & administração , Humanos , Índia/epidemiologia , Pneumonia Viral/epidemiologia , Medição de Risco/métodos
Health Hum Rights ; 22(1): 199-207, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32669801


We propose that a Right to Health Capacity Fund (R2HCF) be created as a central institution of a reimagined global health architecture developed in the aftermath of the COVID-19 pandemic. Such a fund would help ensure the strong health systems required to prevent disease outbreaks from becoming devastating global pandemics, while ensuring genuinely universal health coverage that would encompass even the most marginalized populations. The R2HCF's mission would be to promote inclusive participation, equality, and accountability for advancing the right to health. The fund would focus its resources on civil society organizations, supporting their advocacy and strengthening mechanisms for accountability and participation. We propose an initial annual target of US$500 million for the fund, adjusted based on needs assessments. Such a financing level would be both achievable and transformative, given the limited right to health funding presently and the demonstrated potential of right to health initiatives to strengthen health systems and meet the health needs of marginalized populations-and enable these populations to be treated with dignity. We call for a civil society-led multi-stakeholder process to further conceptualize, and then launch, an R2HCF, helping create a world where, whether during a health emergency or in ordinary times, no one is left behind.

Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Organização do Financiamento/organização & administração , Saúde Global , Cooperação Internacional , Pneumonia Viral/epidemiologia , Betacoronavirus , Fortalecimento Institucional/organização & administração , Controle de Doenças Transmissíveis/economia , Prioridades em Saúde/organização & administração , Humanos , Pandemias
Health Res Policy Syst ; 18(1): 72, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32571364


BACKGROUND: Health research is important for the achievement of the Sustainable Development Goals. However, there are many challenges facing health research, including securing sufficient funds, building capacity, producing research findings and using both local and global evidence, and avoiding waste. A WHO initiative addressed these challenges by developing a conceptual framework with four functions to guide the development of national health research systems. Despite some progress, more is needed before health research systems can meet their full potential of improving health systems. The WHO Regional Office for Europe commissioned an evidence synthesis of the systems-level literature. This Opinion piece considers its findings before reflecting on the vast additional literature available on the range of specific health research system functions related to the various challenges. Finally, it considers who should lead research system strengthening. MAIN TEXT: The evidence synthesis identifies two main approaches for strengthening national health research systems, namely implementing comprehensive and coherent strategies and participation in partnerships. The literature describing these approaches at the systems level also provides data on ways to strengthen each of the four functions of governance, securing financing, capacity-building, and production and use of research. Countries effectively implementing strategies include England, Ireland and Rwanda, whereas West Africa experienced effective partnerships. Recommended policy approaches for system strengthening are context specific. The vast literature on each function and the ever-growing evidence-base are illustrated by considering papers in just one key journal, Health Research Policy and Systems, and analysing the contribution of two national studies. A review of the functions of the Iranian system identifies over 200 relevant and mostly national records; an analysis of the creation of the English National Institute for Health Research describes the key leadership role played by the health department. Furthermore, WHO is playing leadership roles in helping coordinate partnerships within and across health research systems that have been attempting to tackle the COVID-19 crisis. CONCLUSIONS: The evidence synthesis provides a firm basis for decision-making by policy-makers and research leaders looking to strengthen national health research systems within their own national context. It identifies five crucial policy approaches - conducting situation analysis, sustaining a comprehensive strategy, engaging stakeholders, evaluating impacts on health systems, and partnership participation. The vast and ever-growing additional literature could provide further perspectives, including on crucial leadership roles for health ministries.

Pesquisa Biomédica/organização & administração , Infecções por Coronavirus/epidemiologia , Pesquisa sobre Serviços de Saúde/organização & administração , Liderança , Pneumonia Viral/epidemiologia , Organização Mundial da Saúde/organização & administração , Betacoronavirus , Fortalecimento Institucional/organização & administração , Prática Clínica Baseada em Evidências/organização & administração , Prioridades em Saúde/organização & administração , Humanos , Pandemias , Formulação de Políticas , Pesquisa Médica Translacional/organização & administração
Arch. esp. urol. (Ed. impr.) ; 73(5): 360-366, jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-189692


La pandemia COVID-19 causada por el virus SARS-CoV-2 ha provocado un importante impacto sanitario que ha afectado, entre otras áreas de la urología, al manejo del cáncer renal, tanto en su ámbito diagnóstico como de tratamiento. La elevada suspensión de intervenciones quirúrgicas, incluidas aquellas destinadas al tratamiento de esta patología, ocasionará una inevitable sobrecarga asistencial y quizá un potencial efecto deletéreo sobre sus resultados oncológicos, en especial en el cáncer renal localmente avanzado y en el metastásico. Los escenarios clínicos del carcinoma de células renales son bien distintos en función de su estadiaje, distinguiendo principalmente entre la baja prioridad de la enfermedad localizada o la alta prioridad del localmente avanzado y el metastásico en tratamiento activo. La duraciónin determinada y prevalencia posiblemente oscilante de la pandemia previsiblemente obligue a adaptar el manejo del cáncer renal en los servicios de urología y oncología, debiendo ser idealmente invidualizados según cada caso en el seno de unidades multidisciplinares. Para ello, se presentan algoritmos y tablas de manejo del cáncer renal adaptadas al periodo COVID-19 y estratificados según el estadio de la enfermedad, que puedan ser de utilidad para los especialistas dedicados a esta área de la uro-oncología

The COVID-19 pandemic caused by SARS-CoV-2 virus has caused an important health impact that has affected renal cell carcinoma management, among other urology areas. The high cancellation rate of surgeries, including those related to renal cancer, will cause an inevitable healthcare overload and probably a potential negative impact on its oncological outcomes, especially in locally advanced and metastatic renal cancer. Kidney cancer scenarios are quite different depending on their stage, distinguishing mainly between low priority of localized disease or high priority of locally advanced and metastatic under active treatment. The unknown pandemic duration and possibly fluctuating prevalence of the virus are likely to force an adaptation in the management of renal cell carcinoma among urology and oncology departments, ideally individualized on a case-by-case basis within multidisciplinary units. To this end, we present algorithms and tables regarding renal cell carcinoma management adapted to the COVID-19 period and stratified according to oncological stage, which might be useful for specialists dedicated to this uro-oncology area

Humanos , Neoplasias Renais/terapia , Neoplasias Renais/diagnóstico , Administração Hospitalar , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle , Pandemias , Prioridades em Saúde/organização & administração , Telemedicina , Seguimentos
Rev. Rol enferm ; 43(6): 436-444, jun. 2020. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-192580


La pandemia COVID-19 ha representado un reto hasta ahora desconocido para nuestro sistema sanitario. Una parte significativa de la gestión de la crisis y adaptación durante este periodo ha correspondido a los mandos de enfermería. Este artículo muestra las dificultades y los éxitos de esta gestión, así como las oportunidades futuras que estos cambios pueden suponer para la profesión enfermera. Se realizó una encuesta telemática de 17 preguntas a las responsables de gestionar la adaptación de los servicios hospitalarios a la pandemia COVID-19, mediante la reestructuración de diferentes áreas: la comunicación interna con participación en la toma de decisiones, la formación para la seguridad de los pacientes, la dotación de materiales, la dotación y rotación de los profesionales y la actualización de los protocolos. Mediante el análisis de una encuesta realizada por responsables de enfermería de diversos hospitales públicos y mutuas laborales situados en Cataluña, hemos podido identificar las principales dificultades surgidas y las decisiones tomadas en un tiempo record para poder adaptar nuestros hospitales a la pandemia, preservando la seguridad del personal y dar una respuesta profesional y humana a nuestros pacientes. La crisis sanitaria vivida representa un incentivo para consolidar logros y proponer cambios que afiancen los aciertos, realizar autocrítica de los errores y devolver así a la sociedad, mediante cambios estructurales, aquello que hayamos aprendido. Defender este cambio supone impulsar perspectivas valientes en la redefinición de las enfermeras del futuro

The COVID-19 pandemic has represented a hitherto unknown challenge for our healthcare system. A significant part of management and adaptation during this period has been the responsibility of middle management nursing staff. This article shows the difficulties and successes of this management, in addition to the future opportunities that these changes, if they are known how to take advantage of, may represent for the nursing profession. An online survey was carried out with 17 questions to those responsible for managing the adaptation of various hospital services to the COVID-19 pandemic, through the internal communication redesign, the participation in the decision making process, the education for the patient's safety and the management of personnel, systems and materials. Through the analysis of a survey carried out by nursing managers from various public hospitals and labour mutual societies located in Catalonia, we have been able to identify the main difficulties encountered and the decisions taken in record time to be able to adapt our hospitals to the pandemic, preserving the safety of the staff and give a professional and humane response to our patients. The lived health crisis represents an incentive to consolidate achievements and propose changes that strengthen the successes, carry out self-criticism of mistakes and thus return to society, through structural changes, what we have learned. Defending this paradigm shift means promoting courageous perspectives in redefining the nurses of the future

Humanos , Infecções por Coronavirus/enfermagem , Diagnóstico de Enfermagem/tendências , Governança Compartilhada de Enfermagem/tendências , Controle de Doenças Transmissíveis/organização & administração , Conversão de Leitos/tendências , Planejamento de Instituições de Saúde/métodos , Prioridades em Saúde/organização & administração , Pandemias/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos
J Visc Surg ; 157(3S1): S25-S31, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32387058


The Covid-19 pandemic is profoundly changing the organization of healthcare access. This is particularly so for peritoneal neoplastic diseases, for which curative treatment mobilizes substantial personnel, operating room and intensive care resources. The BIG-RENAPE and RENAPE groups have made tentative proposals for prioritizing care provision. A tightening of the usual selection criteria is needed for curative care: young patients with few or no comorbidities and limited peritoneal extension. It is desirable to prioritize disease conditions for which cytoreduction surgery with or without associated hyperthermic intraoperative peritoneal chemotherapy (HIPEC) is the gold-standard treatment, and for which systemic chemotherapy cannot be a temporary or long-term alternative: pseudomyxoma peritonei, resectable malignant peritoneal mesotheliomas, peritoneal metastases of colorectal origin if they are resectable and unresponsive to systemic chemotherapy after up to 12 courses, first-line ovarian carcinomatosis if resectable or in interval surgery after at most six courses of systemic chemotherapy. Addition of HIPEC must be discussed case by case in an expert center. The prioritization of indications must consider local conditions and the phase of the epidemic to allow optimal peri-operative care.

Infecções por Coronavirus , Prioridades em Saúde/organização & administração , Pandemias , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/terapia , Pneumonia Viral , Humanos
Bull Cancer ; 107(6): 623-628, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32416925
Health Res Policy Syst ; 18(1): 32, 2020 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-32183821


BACKGROUND: The KwaZulu-Natal (KZN) Health Act of 2009 mandates the Provincial Health Research and Ethics Committee to develop health research priorities for the province. During 2013, the KZN Department of Health embarked on a research prioritisation process for the province. Priority research questions were generated by an inclusive process, in which a variety of stakeholders in health research in the province were engaged. The aim of this study was to determine whether research conducted at public health facilities in KZN between 01 January 2014 and 31 March 2017 met the research priorities of the province developed through the provincial research prioritisation process of 2013. METHODS: This was a mixed methods study. Qualitative thematic analysis was used to categorise priority research questions generated in the priority-setting process and the titles of research projects conducted after that process into themes. Quantitative analysis was used to determine the correlation between themes of the priority questions, and those of the research projects conducted after the prioritisation exercise. Statistical Package for Social Science version 25 was used to analyse the data. RESULTS: In 72% of thematic areas, there were disproportionately more priority questions than there were research projects conducted. There is thus a large disjuncture between the priorities developed through the provincial research prioritisation process of 2013 and the research projects conducted after that process in terms of major research areas. CONCLUSIONS: Ensuring that research conducted responds to priority questions raised is important because it ensures that research responds to locally important issues and to the concerns of local actors. Local health managers, communities and researchers should work together to ensure that the research conducted in their areas respond to the research priorities of those areas. Health Research Committees and local ethics committees can play important roles in facilitating the responsiveness to research priorities.

Pesquisa Biomédica/organização & administração , Prioridades em Saúde/organização & administração , Objetivos Organizacionais , Humanos , África do Sul