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Palmas, TO; Secretaria da Saúde; 23 março 2021. 48 p. ilus.
Monografia em Português | LILACS, Coleciona SUS, CONASS, SES-TO | ID: biblio-1151469


Trata de parâmetros da Educação Permanente em Saúde e a humanização sob a perspectiva do apoio institucional na escola de Saúde pública do Tocantins (Etsus-TO). Trata ainda a organização do coletivo EPS/Humanização no contexto da pandemia da covid-19, as competências da GEPSUS e objetivos da assessoria de humanização, o apoio institucional, a produção de coletivos e de redes, os caminhos e pistas metodológicas para a estruturação do PMA bem como seus objetivos e arranjo de gestão além da modalidade e dinâmica do trabalho no contexto da pandemia da covid-19 e da matriz de planejamento 2021. Traz o diagnostico de estratégias de planejamento, monitoramento e avaliação, o percurso proposto para o PMA na dinâmica dos coletivos do plano de 2020 e a indissociabilidade entre planejamento, monitoramento e avaliação para o plano 2021. Mostra ainda os instrumentos de monitoramento e avaliação e as reflexões acerca do trabalho colaborativo.

It deals with parameters of Permanent Education in Health and humanization from the perspective of institutional support in the public health school of Tocantins (Etsus-TO). It also deals with the organization of the EPS / Humanization collective in the context of the covid-19 pandemic, the skills of GEPSUS and objectives of humanization assistance, institutional support, the production of collectives and networks, the methodological paths and tracks for structuring the PMA as well as its objectives and management arrangement in addition to the modality and dynamics of work in the context of the pandemic of the covid-19 and the planning matrix 2021. It brings the diagnosis of planning, monitoring and evaluation strategies, the proposed route for the PMA in the dynamics of the 2020 plan collectives and the inseparability between planning, monitoring and evaluation for the 2021 plan. It also shows the monitoring and evaluation instruments and reflections on collaborative work.

Se trata de parámetros de Educación Permanente en Salud y humanización desde la perspectiva del apoyo institucional en la escuela de salud pública de Tocantins (Etsus-TO). También se ocupa de la organización del colectivo EPS / Humanización en el contexto de la pandemia del covid-19, las competencias del GEPSUS y los objetivos de la humanización asistencial, el apoyo institucional, la producción de colectivos y redes, los caminos y pistas metodológicas para estructurar PMA así como sus objetivos y arreglo de gestión además de la modalidad y dinámica de trabajo en el contexto de la pandemia del covid-19 y la matriz de planificación 2021. Trae el diagnóstico de estrategias de planificación, seguimiento y evaluación, la ruta propuesta para el PMA en la dinámica de los colectivos del plan 2020 y la inseparabilidad entre planificación, seguimiento y evaluación para el plan 2021. También muestra los instrumentos de seguimiento y evaluación y reflexiones sobre el trabajo colaborativo.

Il traite des paramètres de l'Education Permanente à la Santé et à l'humanisation dans la perspective de l'appui institutionnel à l'école de santé publique de Tocantins (Etsus-TO). Il traite également de l'organisation du collectif EPS / Humanisation dans le cadre de la pandémie de covid-19, des compétences de GEPSUS et des objectifs d'aide à l'humanisation, de soutien institutionnel, de la production de collectifs et de réseaux, des pistes méthodologiques et des pistes de structuration du PMA ainsi que ses objectifs et son dispositif de gestion en plus de la modalité et de la dynamique de travail dans le cadre de la pandémie du covid-19 et de la matrice de planification 2021. Il apporte le diagnostic des stratégies de planification, de suivi et d'évaluation, le tracé proposé pour le PMA dans la dynamique des collectifs du plan 2020 et l'inséparabilité entre planification, suivi et évaluation pour le plan 2021. Il montre également les instruments de suivi-évaluation et les réflexions sur le travail collaboratif.

Humanos , Regionalização/organização & administração , Relatório Anual , Educação Continuada , Avaliação Educacional , Humanização da Assistência
BMJ Open ; 11(1): e041536, 2021 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-33414147


OBJECTIVES: To develop a regional model of COVID-19 dynamics for use in estimating the number of infections, deaths and required acute and intensive care (IC) beds using the South West England (SW) as an example case. DESIGN: Open-source age-structured variant of a susceptible-exposed-infectious-recovered compartmental mathematical model. Latin hypercube sampling and maximum likelihood estimation were used to calibrate to cumulative cases and cumulative deaths. SETTING: SW at a time considered early in the pandemic, where National Health Service authorities required evidence to guide localised planning and support decision-making. PARTICIPANTS: Publicly available data on patients with COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES: The expected numbers of infected cases, deaths due to COVID-19 infection, patient occupancy of acute and IC beds and the reproduction ('R') number over time. RESULTS: SW model projections indicate that, as of 11 May 2020 (when 'lockdown' measures were eased), 5793 (95% credible interval (CrI) 2003 to 12 051) individuals were still infectious (0.10% of the total SW population, 95% CrI 0.04% to 0.22%), and a total of 189 048 (95% CrI 141 580 to 277 955) had been infected with the virus (either asymptomatically or symptomatically), but recovered, which is 3.4% (95% CrI 2.5% to 5.0%) of the SW population. The total number of patients in acute and IC beds in the SW on 11 May 2020 was predicted to be 701 (95% CrI 169 to 1543) and 110 (95% CrI 8 to 464), respectively. The R value in SW was predicted to be 2.6 (95% CrI 2.0 to 3.2) prior to any interventions, with social distancing reducing this to 2.3 (95% CrI 1.8 to 2.9) and lockdown/school closures further reducing the R value to 0.6 (95% CrI 0.5 to 0.7). CONCLUSIONS: The developed model has proved a valuable asset for regional healthcare services. The model will be used further in the SW as the pandemic evolves, and-as open-source software-is portable to healthcare systems in other geographies.

/epidemiologia , Cuidados Críticos/estatística & dados numéricos , Número de Leitos em Hospital/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Regionalização , Capacidade de Resposta ante Emergências , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Tomada de Decisões , Inglaterra/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Medicina Estatal , Adulto Jovem
BMC Med ; 19(1): 2, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33397366


BACKGROUND: Through a combination of strong routine immunization (RI), strategic supplemental immunization activities (SIA) and robust surveillance, numerous countries have been able to approach or achieve measles elimination. The fragility of these achievements has been shown, however, by the resurgence of measles since 2016. We describe trends in routine measles vaccine coverage at national and district level, SIA performance and demographic changes in the three regions with the highest measles burden. FINDINGS: WHO-UNICEF estimates of immunization coverage show that global coverage of the first dose of measles vaccine has stabilized at 85% from 2015 to 19. In 2000, 17 countries in the WHO African and Eastern Mediterranean regions had measles vaccine coverage below 50%, and although all increased coverage by 2019, at a median of 60%, it remained far below levels needed for elimination. Geospatial estimates show many low coverage districts across Africa and much of the Eastern Mediterranean and southeast Asian regions. A large proportion of children unvaccinated for MCV live in conflict-affected areas with remote rural areas and some urban areas also at risk. Countries with low RI coverage use SIAs frequently, yet the ideal timing and target age range for SIAs vary within countries, and the impact of SIAs has often been mitigated by delays or disruptions. SIAs have not been sufficient to achieve or sustain measles elimination in the countries with weakest routine systems. Demographic changes also affect measles transmission, and their variation between and within countries should be incorporated into strategic planning. CONCLUSIONS: Rebuilding services after the COVID-19 pandemic provides a need and an opportunity to increase community engagement in planning and monitoring services. A broader suite of interventions is needed beyond SIAs. Improved methods for tracking coverage at the individual and community level are needed together with enhanced surveillance. Decision-making needs to be decentralized to develop locally-driven, sustainable strategies for measles control and elimination.

Erradicação de Doenças , Programas de Imunização , Imunização Secundária , Sarampo , Regionalização/organização & administração , Cobertura Vacinal/tendências , África/epidemiologia , Ásia Sudeste/epidemiologia , /prevenção & controle , Criança , Erradicação de Doenças/métodos , Erradicação de Doenças/estatística & dados numéricos , Humanos , Programas de Imunização/métodos , Programas de Imunização/organização & administração , Imunização Secundária/métodos , Imunização Secundária/estatística & dados numéricos , Sarampo/epidemiologia , Sarampo/prevenção & controle , Vacina contra Sarampo/uso terapêutico , Região do Mediterrâneo/epidemiologia
Global Health ; 17(1): 9, 2021 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-33422092


Since COVID-19 was first discovered, it exploded into a pandemic resulting in devastating effects on human lives and a global recession. While there have been discussions that COVID-19 will accelerate the 'end of globalization and multilateralism', we have already seen the high costs of non-cooperation in responding to the virus resulting in sub-optimal use of resources, rapid spread of the virus between countries, and, ultimately, significant loss of life. In spite of their favorable demographic structures and relatively young populations, countries in the Global South are still harshly affected in both epidemiological and economic terms. Nations must find innovative ways to address health concerns and regional bodies are possible mechanisms for facilitating international cooperation on health. We delineate how regional organizations can support how countries address health threats namely by serving as a bridge between the global and national policy levels; strengthening disease surveillance; mobilizing supply chains and facilitating trade; supporting the production and procurement of medicines and supplies; and coordinating policies and work with other actors. We finalize by arguing that mechanisms for regional cooperation must be strengthened themselves in order to effectively contribute to positive health outcomes within member states.

Saúde Global , Cooperação Internacional , Regionalização/organização & administração , /epidemiologia , Países em Desenvolvimento , Política de Saúde , Humanos
BMJ ; 371: m4704, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33323388


OBJECTIVE: To provide global, regional, and national estimates of target population sizes for coronavirus disease 2019 (covid-19) vaccination to inform country specific immunisation strategies on a global scale. DESIGN: Descriptive study. SETTING: 194 member states of the World Health Organization. POPULATION: Target populations for covid-19 vaccination based on country specific characteristics and vaccine objectives (maintaining essential core societal services; reducing severe covid-19; reducing symptomatic infections and stopping virus transmission). MAIN OUTCOME MEASURE: Size of target populations for covid-19 vaccination. Estimates use country specific data on population sizes stratified by occupation, age, risk factors for covid-19 severity, vaccine acceptance, and global vaccine production. These data were derived from a multipronged search of official websites, media sources, and academic journal articles. RESULTS: Target population sizes for covid-19 vaccination vary markedly by vaccination goal and geographical region. Differences in demographic structure, presence of underlying conditions, and number of essential workers lead to highly variable estimates of target populations at regional and country levels. In particular, Europe has the highest share of essential workers (63.0 million, 8.9%) and people with underlying conditions (265.9 million, 37.4%); these two categories are essential in maintaining societal functions and reducing severe covid-19, respectively. In contrast, South East Asia has the highest share of healthy adults (777.5 million, 58.9%), a key target for reducing community transmission. Vaccine hesitancy will probably impact future covid-19 vaccination programmes; based on a literature review, 68.4% (95% confidence interval 64.2% to 72.6%) of the global population is willing to receive covid-19 vaccination. Therefore, the adult population willing to be vaccinated is estimated at 3.7 billion (95% confidence interval 3.2 to 4.1 billion). CONCLUSIONS: The distribution of target groups at country and regional levels highlights the importance of designing an equitable and efficient plan for vaccine prioritisation and allocation. Each country should evaluate different strategies and allocation schemes based on local epidemiology, underlying population health, projections of available vaccine doses, and preference for vaccination strategies that favour direct or indirect benefits.

/uso terapêutico , Densidade Demográfica , Regionalização/métodos , Cobertura Vacinal , /virologia , Saúde Global , Prioridades em Saúde , Humanos , Programas de Imunização , Organização Mundial da Saúde
Nat Commun ; 11(1): 5106, 2020 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-33037190


The COVID-19 epidemic hit Italy particularly hard, yielding the implementation of strict national lockdown rules. Previous modelling studies at the national level overlooked the fact that Italy is divided into administrative regions which can independently oversee their own share of the Italian National Health Service. Here, we show that heterogeneity between regions is essential to understand the spread of the epidemic and to design effective strategies to control the disease. We model Italy as a network of regions and parameterize the model of each region on real data spanning over two months from the initial outbreak. We confirm the effectiveness at the regional level of the national lockdown strategy and propose coordinated regional interventions to prevent future national lockdowns, while avoiding saturation of the regional health systems and mitigating impact on costs. Our study and methodology can be easily extended to other levels of granularity to support policy- and decision-makers.

Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Regionalização/métodos , Betacoronavirus , Simulação por Computador , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Itália/epidemiologia , Modelos Teóricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
Plast Reconstr Surg ; 146(2): 437-446, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740603


The coronavirus disease 2019 (COVID-19) pandemic has confronted the U.S. health care system with unprecedented challenges amidst a tenuous economic environment. As inpatient hospitals across the country prepare for an overwhelming influx of highly contagious COVID-19 cases, many nonemergent procedures have been cancelled or indefinitely postponed without guidance regarding eventual safe accommodation of these procedures in the future. Given the potentially prolonged impact of the COVID-19 pandemic on health care use, it is imperative for plastic surgeons to collaborate with other medical and surgical specialties to develop surge capacity protocols that allow continuation of safe, high-quality, nonemergent procedures. The purpose of this article is to provide necessary and timely public health information relevant to plastic surgery and also share a conceptual framework to guide surge capacity protocols for nonemergent surgery.

Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Regionalização/organização & administração , Capacidade de Resposta ante Emergências/organização & administração , Cirurgia Plástica/organização & administração , Procedimentos Cirúrgicos Ambulatórios/normas , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Procedimentos Cirúrgicos Eletivos/normas , Humanos , Controle de Infecções/normas , Colaboração Intersetorial , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Reconstrutivos/normas , Regionalização/normas , Cirurgia Plástica/normas , Centros Cirúrgicos/organização & administração , Centros Cirúrgicos/normas , Telemedicina/organização & administração , Telemedicina/normas , Estados Unidos
Sante Publique ; Vol. 32(1): 69-86, 2020 Jun 18.
Artigo em Francês | MEDLINE | ID: mdl-32706228


BACKGROUND: The Regional Health Project (RHP) is an important lever to build a health producing system. The RHP serves as the reference for health policies in the French regions. It is developed in three main stages, preparation, diagnosis and priorities. Different institutional actors are involved: managers, administrators, leaders for democracy and medico-social services as well as primary care professionals. How have all of these actors been involved in the three main stages of preparation of the RHP? AIM: The aim of this article is to analyze the implementation of the RHP in two French regions and how the actors in those regions perceived that implementation. METHOD: The analysis of the implementation of the RHP focused on the definition of the implementation process, the diagnosis and the identification of the problems. This later one included the development of the priorities and the objectives while taking into account the resources and the evaluation. This analysis was conducted in two medium-sized regions in France between 2011 and 2015. RESULTS: The formulation of the problems in the RHP is rather general. Priorities and objectives are poorly justified. Resources and evaluation are not taken into account. We attribute these weaknesses to the difficulty of crossing the administrative, managerial and democratic representations with care practices in the regions. CONCLUSIONS: A method and process that integrates the two public policy representations should be specified in a detailed document established prior to formally engaging the planning process. Therefore, the harmonization of methodology and terms is first needed as well as the development of training and research.

Regionalização/organização & administração , Participação dos Interessados , França , Política de Saúde , Humanos
J Vasc Surg ; 72(4): 1178-1183, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32561268


We established the Co-Operative Vascular Intervention Disease (COVID) Team of Greater Philadelphia because national guidelines may not apply to different geographic areas of the United States owing to varying penetrance of the virus. On April 10, 2020, a 10-question survey regarding issues and strategies dealing with COVID-19 was e-mailed to 58 vascular surgeons (VSs) in the Greater Philadelphia area. Fifty-four VSs in 18 surgical groups covering 28 hospitals responded. All groups accepted transfers because of continued availability of intensive care unit beds. Thirteen groups were asked to "redeploy" if the need arose to function outside of the usual duties of a VS. None imposed age restrictions regarding older VSs continuing clinical hospital work. The majority restricted noninvasive vascular laboratory studies to those studies for which findings might mandate intervention within 2 or 3 weeks, restricted dialysis access operations to urgent revisions of arteriovenous fistulas or grafts that were failing or had ulcerations, converted from in-person to telemedicine clinic interactions, and experienced moderate-severe anxiety or fear about personal COVID-19 exposure in the hospital. The majority of VSs in the Philadelphia area dramatically adjusted their clinical practices before the COVID-19 crisis reached peak levels experienced in other metropolitan areas.

Comportamento Cooperativo , Infecções por Coronavirus/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Controle de Infecções/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/terapia , Regionalização/organização & administração , Procedimentos Cirúrgicos Vasculares/organização & administração , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Pesquisas sobre Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde/organização & administração , Interações Hospedeiro-Patógeno , Humanos , Comunicação Interdisciplinar , Saúde do Trabalhador , Pandemias , Segurança do Paciente , Philadelphia/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia
BMC Public Health ; 20(1): 814, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32498676


BACKGROUND: While reducing the burden of mental and substance use disorders is a global challenge, it is played out locally. Mental disorders have early ages of onset, syndromal complexity and high individual variability in course and response to treatment. As most locally-delivered health systems do not account for this complexity in their design, implementation, scale or evaluation they often result in disappointing impacts. DISCUSSION: In this viewpoint, we contend that the absence of an appropriate predictive planning framework is one critical reason that countries fail to make substantial progress in mental health outcomes. Addressing this missing infrastructure is vital to guide and coordinate national and regional (local) investments, to ensure limited mental health resources are put to best use, and to strengthen health systems to achieve the mental health targets of the 2015 Sustainable Development Goals. Most broad national policies over-emphasize provision of single elements of care (e.g. medicines, individual psychological therapies) and assess their population-level impact through static, linear and program logic-based evaluation. More sophisticated decision analytic approaches that can account for complexity have long been successfully used in non-health sectors and are now emerging in mental health research and practice. We argue that utilization of advanced decision support tools such as systems modelling and simulation, is now required to bring a necessary discipline to new national and local investments in transforming mental health systems. CONCLUSION: Systems modelling and simulation delivers an interactive decision analytic tool to test mental health reform and service planning scenarios in a safe environment before implementing them in the real world. The approach drives better decision-making and can inform the scale up of effective and contextually relevant strategies to reduce the burden of mental disorder and enhance the mental wealth of nations.

Técnicas de Apoio para a Decisão , Recursos em Saúde/organização & administração , Serviços de Saúde Mental/organização & administração , Formulação de Políticas , Regionalização , Tomada de Decisões , Reforma dos Serviços de Saúde , Política de Saúde , Humanos , Saúde Mental , Análise de Sistemas
Artigo em Inglês | MEDLINE | ID: mdl-32341221


Pandemic influenza preparedness has contributed significantly to building, strengthening and maintaining countries' core capacities to prepare for health emergencies. The Pandemic influenza preparedness framework for the sharing of influenza viruses and access to vaccines and other benefits (the PIP framework) was adopted by the World Health Assembly in 2011. The experiences and lessons learnt from the implementation of the PIP framework have provided insights that can be used to strengthen preparedness for epidemics of other priority high-threat pathogens in the World Health Organization (WHO) South-East Asia Region in line with obligations under the International Health Regulations, 2005 (IHR). Implementation has established policies, strategies, action plans, strengthened systems and operational readiness to promptly diagnose influenza virus strains with pandemic potential and ensure timely event notifications and management in compliance with the IHR. WHO collaborating centres and the annual bi-regional meeting of national influenza centres and influenza surveillance have strengthened the influenza laboratory diagnostic knowledge network in the region. After action reviews following influenza outbreaks have documented best practices, strengths, constraints and areas for improvement in pandemic preparedness. The pandemic in 2009 and recent seasonal influenza outbreaks have offered real-life scenarios for testing national pandemic influenza preparedness plans and deploying vaccines. The successful implementation of the PIP framework, along with strengthening of health systems and operational procedures and continued technical collaboration with global centres of excellence, should be tapped into to strengthen preparedness to respond to epidemics of other high-threat pathogens based on the influenza model. The political commitment reflected in the Delhi Declaration on Emergency Preparedness, signed by all ministers of health in September 2019 and supported by the Five-year regional strategic plan to strengthen public health preparedness and response - 2019-2023, should be a catalyst for guidance and support in developing a broad, long-term strategic plan for preparedness and response to high-threat pathogens in the region.

Influenza Humana/prevenção & controle , Modelos Organizacionais , Pandemias/prevenção & controle , Regionalização/organização & administração , Ásia Sudeste/epidemiologia , Humanos , Influenza Humana/epidemiologia , Organização Mundial da Saúde