A qualitative study of nurses' perspective about the impact of end-of-life communication on the goal of end-of-life care in nursing home.

BACKGROUND: With a growing nursing home population suffering from chronic progressive illnesses and evolving patterns of comorbidities, end-of-life communication takes on a critical role to enable healthcare professionals to gather information about the resident's wishes for care at the end-of-life and organise the care plan accordingly. AIM: To explore nurses' perspective about the process by which end-of-life communication impacts on the goal of end-of-life care in nursing home residents. DESIGN: A qualitative descriptive research design based on thematic analysis was performed. Fourteen nurses involved in the care of residents during their last week of life were recruited across 13 Italian nursing homes and accounted for 34 semi-structured interviews. A combined approach of analysis that incorporated a data-driven inductive approach and a theory-driven one was adopted. RESULTS: Twelve themes described how end-of-life communication may contribute to adjust the care plan in nursing home according to the nurses' perspective. Five antecedents (i.e. life crisis or transitions, patient-centered environment, arising the question of possible dying, quality of relationships and culture of care) influenced the establishment and quality of communication, and five attributes depicted the characteristics and potential mechanisms of end-of-life communication (i.e. healthcare professional-resident and healthcare professional-family carers communication, knowledge of family carers' preferences, knowledge of residents' preferences, family carers and residents understanding, and shared decision-making), while curative-oriented and palliative-oriented care goals emerged as consequences. CONCLUSION: This study provides insight into the nursing perspective of end-of-life communication between healthcare professionals and bereaved family carers of nursing home residents. Several factors influenced the occurrence and quality of end-of-life communication, which contributed to the transition towards palliative-oriented care by using and improving knowledge about family cares' and resident's preferences for end-of-life care, promoting family carers and residents understanding about prognosis and treatments available, and fostering shared decision-making.

Ethical challenges in end-stage dementia: Perspectives of professionals and family care-givers.

BACKGROUND: In Israel, caring for people with end-stage dementia confined to home is mainly done by home care units, and in some cases by home hospice units, an alternative palliative-care service. Because life expectancy is relatively unknown, and the patient's decision-making ability is poor, caring for this unique population raises ethical dilemmas regarding when to define the disease as having reached a terminal stage, as well as choosing between palliative and life-prolonging-oriented care. OBJECTIVES: Exploring and describing differences and similarities of professional staff members' (PSMs') and family caregivers' perceptions of caring for people with end-stage dementia in two different settings. DESIGN: Qualitative research, using semi-structured interviews analyzed through a thematic content-analysis approach. PARTICIPANTS: Sixty-four interviews were conducted (24 PSMs and 40 family caregivers) in two care-settings-home hospice unit and home care unit. ETHICAL CONSIDERATIONS: The study was approved by the Ethics Committee (BBL00118-17). FINDINGS: We found dilemmas regarding palliative care to be the main theme, including definition of the disease as terminal, choosing "comfort" over "life-prolonging," clarifying patients' wishes and deciding whether or not to use artificial feeding. DISCUSSION: Both PSMs and family caregivers deal with ethical dilemmas and have reached different conclusions, both legitimate. Comprehending dementia as a terminal disease influenced participants' perceptions of the relevancy of palliative care for people with end-stage dementia. Discrepancies between PSMs and family caregivers in caring for people with end-stage dementia were found in both home hospice unit and home care unit environments, raising potential conflicts regarding decisions for end-of-life care. CONCLUSIONS: Communication between PSMs and family caregivers is crucial for the discussion about the discrepancies regarding the unique dilemmas of caring for people with end-stage dementia and bridging the gap between them. Lack of communication and resources can hamper the provision of an acceptable solution for quality and equality of care in the best interest of people with end-stage dementia.

Social Support and Psychological Capital Mediate the Effect of Personalities on the Mental Health of Professional Staff in China During COVID-19 Pandemic.

Objective: COVID-19-related lockdown can lead to mental health problem, which displays heterogeneous between individuals. The aim of this study was to explore the association between mental health, social support and psychological capital state of professional staff with different personalities during the COVID-19 pandemic in China. Methods: A cross-section study was conducted via online survey using the questionnaires of General Health Questionnaire (GHQ-12), Multidimensional Scale of Perceived Social Support (MSPSS), Psychological Capital Questionnaire (PCQ), Eysenck Personality Questionnaire-Revision Short Scale of China (EPQ-RSC). A total of 626 employees were included. Multiple regression analysis was performed to investigate the association of psychological capital, perceived social support, EPQ-N and EPQ-E and their interactions in general mental health. Results: About 2.7% of professionals had mental health. The married had a higher mental health score than the single (P<0.05). The regular exercising workers had the lowest mental health score (P<0.05), and higher psychological capital and social support scores than the non-exercising ones (P<0.01). Multivariate analysis showed that the interaction between social support, psychological capital and neuroticism was statistically significant (ß=-0.161, P<0.001) in general mental health with neuroticism ranking the top (ß=0.352, P<0.001). Mediation analysis showed that social support modified the effect of psychological capital on mental health, accounting for 25.5% of the total effect, and that both social support and psychological capital mediated the effect of neuroticism or extroversion differentially on mental health. Conclusion: Neuroticism is an influencing factor on mental health of professional staff. Social support and psychological capital played a partial mediating role in the effect of neuroticism or extroversion differentially on mental health in China. The findings suggest that during the COVID-19 pandemic, more social support and psychological capital are needed for the professional individuals with neuroticism to alleviate their stress and improve mental health.

Exploring the Effectiveness and Challenges of Community Rehabilitation Service Programs for Children with Developmental Delays: A Qualitative Study from the Perspective of Early Intervention Service Providers in Taiwan.

This qualitative study aimed to investigate the effectiveness of community rehabilitation programs for children with developmental delays from the perspective of early intervention service providers in Taiwan. Adopting a single-case experimental design (ABM design), this study examined the immediate and sustained effects of interventions on individualized goals during baseline, intervention, and maintenance phases. Additionally, data from interviews with parents, special education teachers, and other participants were collected to understand the challenges and improvement strategies of community rehabilitation programs. Results revealed that community rehabilitation programs for children with developmental delays exhibited both immediate and sustained effectiveness. Challenges faced by parents and professionals differed, with parents having less contact and communication with administrative systems, while professionals experienced more pronounced implementation difficulties during interventions. Moreover, strategies for improving community rehabilitation programs for children with developmental delays should vary for parents and professionals to address inconsistencies in attitudes and strategies among parents and administrative obstacles encountered by professionals.

Cross-sectional study on the epidemiological investigation ability of professional staff from Centers for Disease Control and Prevention in Guizhou Province.

Introduction: This study aims to evaluate the qualifications and identify skill enhancement areas for epidemiological investigators in Centers for Disease Control and Prevention (CDCs) in Guizhou's, informing future training and policy initiatives to strengthen public health responses. Methods: A cross-sectional survey was conducted in August 2022, and an online, self-designed questionnaire on the Epidemiological Dynamic Data Collection platform was administered to evaluate the professional staff in CDCs. The responses were scored and presented using descriptive statistical methods, and the factors influencing the total score were analyzed by one-way ANOVA and linear regression. Results and discussion: A total of 1321 questionnaires were collected, yielding an average score of 14.86±3.49 and a qualification rate of 29.9%. The scoring rate of ability of individual protection and coordination in epidemic control was high (87.25%). Meanwhile, improvements in further training were needed in areas such as data analysis ability (23.67%), knowledge of site disinfection (40.40%), and epidemiological investigation skills (42.50%). No significant difference was observed between the scores of city and county CDCs, (t = 1.071, p =0.284). The effects of gender and age could be disregarded, and the experience in epidemiological work and training (including investigation on COVID-19 cases and contacts), educational background, and professional title partially explained the survey outcome (R Square of the linear regression model was 0.351). The survey indicated the need for additional well-trained epidemiologic investigators in Guizhou. Specified training was effective in improving epidemiologic investigation, and enhancement in data analysis ability and knowledge of field disinfection are recommended in professional staff cultivation.

Exploration of health professional stakeholders' views and experiences regarding minor ailments services' education, training and assessment.

Background Minor ailments services are structured pharmacy-based primary health care services that manage minor conditions. Limited training, education and assessment exists to promote the delivery of minor ailments services by pharmacy staff and it is unclear if the existing training and education processes meet professional requirements. Objective To explore the views and experiences of health professional stakeholders such as community pharmacists, intern pharmacists, medicines counter assistants and general medical practitioners with regards to minor ailments services education, training and assessment practices and preferences. Setting This study explored the views and experiences of health professional stakeholders in Australia. Method Semi-structured interviews were conducted, audio recorded, transcribed verbatim and then coded thematically using QSR Nvivo12. Main outcome measure Stakeholders' views and experiences regarding minor ailments services education, training and assessment practices and preferences. Results Twenty-eight interviews were conducted (community pharmacists n = 12; medicines counter assistants n = 4; intern pharmacists n = 9; general medical practitioners n = 3). Thematic analysis generated three themes: (1) pharmacy staff who require minor ailment service training; (2) acceptability and willingness to complete additional training; (3) learning preferences and approaches. Stakeholders reported considerations for the diverse roles in service delivery and fit for purpose tailored training. Conclusion Detailed practice guidelines may facilitate clarity of an individual staff member's role. Education and training in both clinical and non-clinical aspects of the service may be beneficial and may improve minor ailments service uptake and outcomes.

Inter-professional perspectives of dementia services and care in England: Outcomes of a focus group study.

Many people living with dementia are supported at home using a variety of health and social care services. This paper reports the findings from a focus group study undertaken with staff in community mental health teams to explore areas for improvement in relation to national policies and recommendations for dementia care. Two focus groups were held with staff (n = 23) in 2011 to discuss topics including service delivery, information and communication, and provision of health and community care for people with dementia. Respondents identified problems with information sharing and incompatible electronic systems; inflexibility in home care services; and poor recognition of dementia in hospital settings. General practitioners had developed a greater awareness of the disease and some community services worked well. They felt that budgetary constraints and a focus on quality indicators impeded good dementia care. Key areas suggested by staff for improvements in dementia care included the implementation of more flexible services, dementia training for health and social care staff, and better quality care in acute hospital settings.

Futebol de mulheres liderado por homens: uma análise longitudinal dos cargos de comissão técnica e arbitragem / Male leadership in womens football: a longitudinal analysis of coaching and referee positions / Fútbol femenino liderado por hombres: un análisis longitudinal de los cargos de comisión técnica y arbitraje

O objetivo deste estudo foi analisar a participação das mulheres nos cargos de comissão técnica e de arbitragem no Campeonato Brasileiro de Futebol Feminino desde a primeira edição da competição, em 2013, até o ano de 2019. Analisamos a quantidade de mulheres atuantes como treinadoras, auxiliares técnicas, preparadoras físicas, massagistas, treinadoras de goleiras, fisioterapeutas e médicas. Também coletamos informações sobre o quarteto de arbitragem. Verificamos um predomínio (~86%) de homens em cargos de comissão técnica com um lento aumento da participação de mulheres. As mulheres parecem ter maior inserção nos cargos de comissão de arbitragem. Encontramos 39% de mulheres atuando como árbitras principais e 59% como árbitras assistentes. Verificamos que a participação de mulheres nos cargos de comissão técnica e de arbitragem no Campeonato Brasileiro de Futebol Feminino aumentou vagarosamente nos últimos anos, mas que a situação permanece de desigualdade.

This study analyzes female participation in coaching and referee positions in the Brazilian Women's Football Championship since its first edition in 2013 until 2019. We analyzed the number of women coaches, assistant coaches, physical trainers, massage therapists, goalkeeper coaches, physiotherapists, and doctors. We also collected data about referees. We found male predominance (~86%) in coaching positions with a slow increase in the number of women over the years. Female presence seemed to be higher in referee positions. We found 39% of women working as referees and 59% as assistant referees. We noted that their participation in coaching and referee positions in the Brazilian Women's Football Championship has been slowly increasing in recent years, but gender inequality remains in leadership and visibility positions.

El objetivo de este estudio fue analizar la participación de las mujeres en los cargos de comisión técnica y arbitraje en el Campeonato Brasileño de Fútbol Femenino desde su primera edición, en 2013, hasta el año 2019. Analizamos el número de mujeres que actúan como entrenadoras, auxiliares técnicas, preparadoras físicas, masajistas, entrenadoras de porteras, fisioterapeutas y médicas. También recopilamos informaciones sobre el cuarteto de arbitraje. Encontramos un predominio (~86%) de hombres en cargos de comisión técnica, con un lento aumento de la participación de mujeres. Las mujeres parecen tener mayor inserción en los cargos de comisión de arbitraje. Encontramos un 39% de mujeres que actúan como árbitras principales y un 59% como árbitras asistentes. Constatamos que la participación de mujeres en los cargos de comisión técnica y arbitraje en el Campeonato Brasileño de Fútbol Femenino ha aumentado lentamente en los últimos años, pero que la situación aún es de desigualdad en lo que se refiere a la ocupación de posiciones de liderazgo y visibilidad.

Perfil e funcionamento de comitês municipais de prevenção da mortalidade materna, infantil e fetal / Perfil y funcionamiento de los comités municipales de prevención de la mortalidad materna, infantil y fetal / Profile and operation of city committees for prevention of maternal, infant and fetal mortality

Objetivo: Analisar os comitês municipais de prevenção da mortalidade materna, infantil e fetal das regiões de saúde de Sete Lagoas e Curvelo- Minas Gerais quanto ao perfil dos seus membros e funcionamento. Método: Estudo de corte transversal em 35 comitês dos municípios jurisdicionados à Superintendência Regional de Saúde de Sete Lagoas. Foram aplicados questionários para as referências técnicas e secretários municipais de saúde, sendo a análise dos dados realizada por meio de estatística descritiva. Resultados: Encontrou-se formação predominante em enfermagem, média de idade acima de 30 anos e tempo no cargo superior a quatro anos. A maioria dos municípios possui comitê implantado, oficializado e atuante, mas muitos não realizam cronograma, nem registro das reuniões. Foram encontradas fragilidades no funcionamento, como inexistência de discussão entre os membros, não correção da causa básica do óbito, falta de divulgação dos dados e dos relatórios e ausência de atividades de mobilização social. Dentre os entraves, os mais citados foram: dificuldade de acesso a documentos para a investigação, falta de suporte da Superintendência Regional de Saúde e necessidade de capacitação. Conclusão: Existe a necessidade de qualificação das ações dos comitês, objetivando o aumento da sua efetividade na redução da mortalidade materna, infantil e fetal.( AU)

Objective: to analyze the city committees for prevention of maternal, fetal and infant mortality in the health regions of Sete Lagoas and Curvelo - Minas Gerais, regarding the profile of their members and operation process. Method: cross-sectional study in 35 committees of the cities under the jurisdiction of the Regional Health Superintendence of Sete Lagoas. Questionnaires were applied to the technical references and municipal health secretaries. Data analysis was performed through descriptive statistics. Results: nursing education was predominant, mean age above 30 years and time in the post over four years. Most participants have an established, official and active committee. Nevertheless, many of them do not schedule or record meetings. There were weaknesses in the operation process, such as no discussion among members, no correction of cause of death, lack of disclosure of data and reports, absence of social mobilization activities. The most cited obstacles are difficult access to documents for investigation, lack of support from Regional Health Superintendence and the need for training. Conclusions: There is a need to qualify the actions of the committees, aiming to increase their effectiveness in reducing mortality.(AU)

Objetivo: analizar los comités municipales para la prevención de la mortalidad materna, infantil y fetal en las regiones de salud de Sete Lagoas y Curvelo - Minas Gerais con respecto al perfil de sus miembros y su funcionamiento. Método: estudio transversal en 35 comités de los municipios dentro de la jurisdicción de la Superintendencia Regional de Salud de Sete Lagoas. Se aplicaron cuestionarios a las referencias técnicas y secretarios de salud municipales, y el análisis de datos se realizó mediante estadística descriptiva. Resultados: hubo una capacitación predominante en enfermería, edad promedio de más de 30 años y tiempo en el cargo de más de cuatro años. La mayoría de los municipios tienen un comité establecido, oficial y activo, pero muchos no programan ni graban reuniones. Se encontró debilidad en el funcionamiento, ya que no hubo discusión entre los miembros, no se corrigió la causa básica de la muerte, falta de divulgación de datos e informes y ausencia de actividades de movilización social. Entre las barreras, las más citadas fueron la dificultad de acceso a documentos para investigación, la falta de apoyo de la Superintendencia Regional de Salud y la necesidad de capacitación. Conclusión: es necesario calificar las acciones de los comités, con el objetivo de aumentar su eficacia en la reducción de la mortalidad materna, infantil y fetal.(AU)

The differences in perception of wheelchair performance between direct care and professional staff on a residential unit for individuals with severe developmental disabilities.

A pilot study was conducted on a residential unit in an institution for individuals with severe multiple physical and mental disabilities in order to compare the perceptions of direct care and professional staff members on the functional performance of wheelchairs. The study was a part of a collaborative research project with the OMRDD and School of Education, New York University that focused on enhancing the quality of life of those disabled individuals through the application of assistive technology. The results of the study showed a considerable discrepancy in the perceptions of wheelchair functional performance between two categories of care providers on the unit. The members of the direct care staff perceived the wheelchairs as low functioning in contrast to the members of the professional staff who perceived the same wheelchairs to be close to fully functional. The possible causes of the differences between the members of both categories of care providers on the unit regarding the functional performance of wheelchairs and their accommodation to the specific needs of the clients are discussed.

Construction of an evaluation index system for the response capacity of universities to public health emergencies / 中国学校卫生

Objective@#To construct an evaluation index system to assess the response capacity of universities to public health emergencies, so as to provide a basis for improvements the response capacity.@*Methods@#In November 2019, in order to develop an evaluation system based on literature review and expert discussions, 15 experts were invited to conduct a subjective evaluation used hierarchical analysis. The objective evaluation was conducted in 120 universities in Jiangsu Province used the inverse entropy weighting method, and the final evaluation employed the joint subjective and objective weighting method.@*Results@#The indicator system consisted of four primary indicators, nine secondary indicators, 32 tertiary indicators and 67 quaternary indicators. The analysis of the combined weighting method showed that the primary indicators, in descending order, included incident handling capability ( 0.666 ), incident detection capability (0.203), prior preparation capability (0.101) and post event recovery capability ( 0.031 ). The top three secondary indicator weights were emergency response (0.480), monitoring and reporting (0.203) and command and coordination (0.151). The results of the evaluation of the consistency indicators showed that the expert authority coefficient was 0.909 and the Kendall s W coordination coefficient was 0.836 ( P <0.01), with all consistency scale values < 0.1.@*Conclusion@#The evaluation system is highly scientific and credible, and provides basis for evaluating the response capability of universities to public health emergencies.

O processo de análise da evitabilidade dos casos de óbito infantil e fetal: estudo de caso único / El proceso de análisis de la evitabilidad de los casos de óbito infantil y fetal: estudio de caso único / The analysis process of preventable cases of child and fetal death: single-case study

RESUMO Objetivo: evidenciar o processo de análise da evitabilidade dos casos de óbito infantil e fetal realizado por um Comitê municipal de uma capital do Sul do Brasil. Método: estudo de caso único com duas unidades integradas de análise, realizado com nove representantes institucionais de um comitê de prevenção de óbito infantil e fetal. A coleta dos dados ocorreu de forma triangulada por entrevista focada, observação direta não participante e pesquisa documental durante janeiro e abril de 2016. A análise foi realizada com técnica de construção da explanação. Resultados: o resumo do caso de óbito infantil e fetal evidencia-se como um instrumento de discussão. Os fatores que contribuem para a ocorrência do óbito infantil e fetal e as situações que desencadeiam os óbitos sintetizam o processo de análise do caso de óbito na perspectiva da evitabilidade. No processo de análise são utilizadas informações sobre percurso da gestante e da criança dentro da rede e nos três níveis de atenção à saúde. Conclusão: o processo de análise da evitabilidade dos casos de óbito infantil e fetal permite a compreensão dos fatores e situações que levam à sua ocorrência, possibilitando propor ações de saúde que possam contribuir para redução das taxas de mortalidade.

RESUMEN Objetivo: demostrar el proceso de análisis de la evitabilidad de los casos de muerte infantil y fetal realizado por un Comité municipal de una capital del Sur de Brasil. Método: estudio de caso único con dos unidades integradas de análisis, realizado con nueve representantes institucionales de un comité de prevención de muerte infantil y fetal. La recolección de datos ocurrió de forma triangulada por entrevista enfocada, observación directa no participante e investigación documental durante enero y abril de 2016. El análisis fue realizado con técnica de construcción de la explicación. Resultados: el resumen del caso de muerte infantil y fetal se evidencia como un instrumento de discusión. Los factores que contribuyen a la ocurrencia del óbito infantil y fetal y las situaciones que desencadenan las muertes sintetizan el proceso de análisis del caso de óbito en la perspectiva de la evitabilidad. En el proceso de análisis se utilizan informaciones sobre el recorrido de la gestante y del niño dentro de la red y en los tres niveles de atención a la salud. Conclusión: el proceso de análisis de la evitabilidad de los casos de muerte infantil y fetal permite la comprensión de los factores y situaciones que llevan a su ocurrencia, posibilitando proponer acciones de salud que puedan contribuir a la reducción de las tasas de mortalidad.

ABSTRACT Objective: to demonstrate the analysis process of preventable cases of infant and fetal death performed by a municipal committee of a capital city in Southern Brazil. Method: a single case study with two integrated units of analysis, performed with nine institutional representatives from the committee of the prevention of infant and fetal death. The data collection was triangulated by a focused interview, direct non-participant observation, and documentary research during January and April 2016. An explanatory construction technique was used for data analysis. Results: the case summary of infant and fetal death is shown as a discussion tool. The factors that contribute to the occurrence of infant and fetal death and the situations that provoke the deaths synthesize the analysis process regarding the death from the perspective of preventability. In the analysis process, information is used regarding the pregnant woman and the child in the network and at the three levels of health care. Conclusion: the analysis process of preventable cases of infant and fetal death allow us to understand the factors and situations that lead to their occurrence and allow for the proposal of health care actions that may contribute to the reduction of mortality rates.

Transfusion Practices Committee of a public blood bank network in Minas Gerais, Brazil.

OBJECTIVE: This study aimed to verify the performance of blood transfusion committees in transfusion services linked to the public blood bank network of the state of Minas Gerais. METHODS: A cross-sectional observational study was conducted between 2007 and 2008 using questionnaires and proficiency tests to evaluate the reporting and investigation of transfusion reactions comparing transfusion services with and without transfusion committees in the public transfusion services of the state of Minas Gerais. RESULTS: Nineteen of Hemominas own transfusion services and 207 that contracted the services of the foundation located in 178 municipalities were visited between 2007 and 2008. Established transfusion committees were present in 63.4% of the services visited. Transfusion incidents were reported by 53 (36.8%) transfusion services with transfusion committees and by eight (9.6%) without transfusion committees (p < 0.001) with 543 (97.5%) and 14 (2.5%) notifications, respectively. Of the reported transfusion incidents, 40 (75.5%) transfusion services with transfusion committees and only two (25%) of those without transfusion committees investigated the causes. CONCLUSION: The incidence of notification and investigation of the causes of transfusion reactions was higher in transfusion services where a transfusion committee was present. Despite these results, the performance of these committees was found to be incipient and a better organization and more effective operation are required.

Ethical Issues and Countermeasures for the Management of Professional Staff in Hospital / 中国医学伦理学

In view of the present hospital professional and technical personnel in the making , performance e-valuation , salary management , personal development , health management , department management , as well as on the management of some of the ethical issues , analyzes its reason: hospital professional and technical personnel management ethics idea misunderstanding , hospital professional and technical personnel subject ethics value status unclear , hospital professional and technical personnel managers′ethical level is not high .And put forward the con-crete solving measures:strengthen dominated by social responsibilities of ethical supervision and management , es-tablish the principle of fairness , justice , ethics of competition system , director of the department , carried out by both efficiency and fair ethics idea of performance and salary rank management activities , to achieve individual all-round development as the goal of ethical career management , to strengthen the management of managers ethical education .

Training needs of the health emergency professionals in centers for disease control and prevention / 重庆医学

Objective To investigate the training needs of health emergency professionals in centers for disease control and prevention (CDC) ,and to provide evidence for making training plan .Methods Totally 66 health emergency professionals who par‐ticipated in health emergency training class of CDC were surveyed with questionnaires in July ,2014 .The items included training content ,mode ,time ,teachers ,assessment forms and graduation way .Results Forty one persons (62 .12% of all subjects) selected health emergency disposal of all kinds of emergencies as the training contents ,and case analysis as the training mode .There were no statistical significances for the differences of the proportions of the professional staffs between different genders ,education levels ,ti‐tles ,categories and agencies (P>0 .05) .52 persons (78 .79% ) considered that training frequency of 1-2 times per year was appro‐priate ,and 53 persons (80 .30% ) considered that the most appropriate duration for each training was 2 -3 days .Domestic experts as a training teacher had the highest proportion (56 .06% ) ,followed by health emergency management cadres (34 .85% ) ,and foreign experts (6 .06% ) .The proportion of selecting university professor as a training teacher was lowest (3 .03% ) .71 .21% (47 persons) selected analog dealing with practical problems as assessment form ,and 71 .21% (47 persons) selected granting credits as graduation way .Gender and agencies were two important influencing factors for selecting different graduation ways (P< 0 .05) . Conclusion Training program of health emergency should be made according to the training needs .Appropriate training content and form should be selected in order to improve the quality and effectiveness of training ,and to improve the ability of the health e‐mergency professionals .

Investigação dos óbitos infantil e fetal no Vale do Jequitinhonha, Minas Gerais, Brasil / Investigation of infant and foetal deaths in the Jequitinhonha Valley, Minas Gerais, Brazil / Investigación de la mortalidad infantil y fetal en el Valle del Jequitinhonha, Minas Gerais, Brasil

OBJETIVO: analisar os fatores relacionados à não investigação dos óbitos fetal e infantil ocorridos no Vale do Jequitinhonha, Minas Gerais. MÉTODOS: trata-se de estudo ecológico que teve, como unidades de análise, todos os 33 municípios da Região Ampliada de Saúde Jequitinhonha, Minas Gerais. Nesses municípios foi aplicado um questionário a um membro do Comitê de Prevenção do Óbito Infantil e Fetal com questões sobre a composição dos comitês, mecanismos de investigação do óbito infantil, fatores dificultadores para a investigação dos óbitos e critérios de evitabilidade entre os anos 2007 e 2012. Foi feita análise descritiva com frequências simples, com o intuito de descrever o perfil dos municípios estudados. RESULTADOS: dos 598 óbitos infantis e 477 fetais registrados, apenas 22,2 e 18,4% foram investigados, respectivamente. Constatou-se a existência de problemas de infraestrutura, técnico-operacionais e políticos que interferiram na prática de investigação. CONCLUSÃO: a operacionalização da investigação do óbito infantil e fetal, apesar de exigido por lei, apresenta deficiências, o que acarreta elevado número de óbitos não investigados no período do estudo, o que poderá comprometer as ações para a redução da mortalidade infantil e fetal e a qualidade da assistência infantil.

This study aims to analyse aspects related to the lack of investigation of foetal and infant deaths in the Jequitinhonha Valley, State of Minas Gerais. This is an ecological study whose unit of analysis were the 33 municipalities in the Extended Jequitinhonha Health Region. A questionnaire was applied to a member of the Infant and Foetal Death Prevention Committee of each municipality. The questions were related to the committees' structure, mechanisms of infant death investigation, difficulties related to the investigation of deaths, and avoidable criteria between 2007 and 2012. A descriptive analysis with simple frequencies aiming at profiling the studied municipalities was performed. Of the 598 infant and 477foetal deaths registered, only 22.2% and 18.4%, respectively, were investigated. The researchers detected that infrastructure, technical, operational and policy issues interfered with the investigation. Although required by law, the investigation over infant and foetal deaths is deficient. This led to a large number of deaths being left uninvestigated. Such situation may hinder programmes for the reduction of infant and foetal mortality and the quality of childcare.

OBJETIVO: Evaluar los factores relacionados con la falta de investigación de las muertes fetales y neonatales en el Vale de Jequitinhonha, Minas Gerais. MÉTODOS: Se trata de un estudio ecológico, las unidades de análisis fueron los 33 municipios de la Región de Salud extendido Jequitinhonha, Minas Gerais. En estos municipios se aplicó un cuestionario a un miembro de la Prevención del Nino y el Comité de Muerte Fetal. Como instrumentos de recolección, se utilizó un cuestionario con preguntas sobre la composición de los comités, los mecanismos de investigación de muerte infantil, dificuladoresfactores para la investigación de las muertes evitables, entre otros criterios, entre los anos 2007-2012, elaborado en base a la literatura y con la ayuda de expertos e investigadores en el área. El análisis se realizó mediante estadística descriptiva, con frecuencias simples, con el fin de describir el perfil de los municipios estudiados. RESULTADOS: De los 598 ninos y 477 muertes fetales registradas, sólo el 22,2% y 18,4%, respectivamente, fueron investigados. Encontrado la existencia de problemas de infraestructura, técnica-operativa y política interfirió con la práctica de la investigación. CONCLUSIÓN: la puesta en práctica de la investigación en los ninos y la muerte fetal, si bien exige la ley, presenta deficiencias que lleva un gran número de muertes no investigadas en el período de estudio, lo que puede comprometer las acciones para la reducción de la mortalidad infantil y fetal y la calidad del cuidado infantil.

Transfusion practices committee of a public blood bank network in Minas Gerais, Brazil

OBJECTIVE: This study aimed to verify the performance of blood transfusion committees in transfusion services linked to the public blood bank network of the state of Minas Gerais. METHODS: A cross-sectional observational study was conducted between 2007 and 2008 using questionnaires and proficiency tests to evaluate the reporting and investigation of transfusion reactions comparing transfusion services with and without transfusion committees in the public transfusion services of the state of Minas Gerais. RESULTS: Nineteen of Hemominas own transfusion services and 207 that contracted the services of the foundation located in 178 municipalities were visited between 2007 and 2008. Established transfusion committees were present in 63.4% of the services visited. Transfusion incidents were reported by 53 (36.8%) transfusion services with transfusion committees and by eight (9.6%) without transfusion committees (p < 0.001) with 543 (97.5%) and 14 (2.5%) notifications, respectively. Of the reported transfusion incidents, 40 (75.5%) transfusion services with transfusion committees and only two (25%) of those without transfusion committees investigated the causes. CONCLUSION: The incidence of notification and investigation of the causes of transfusion reactions was higher in transfusion services where a transfusion committee was present. Despite these results, the performance of these committees was found to be incipient and a better organization and more effective operation are required.

Aspectos da mortalidade infantil, conforme informações da investigação do óbito / Aspects of infant mortality, according to an investigation of death / Aspectos de la mort alidad infantil, conforme informaciones de la investigación del óbito

OBJETIVO: Analisar algumas características da mortalidade infantil de residentes na área da 15º Regional de Saúde do Paraná, de 2005 a 2008. MÉTODOS: Estudo descritivo exploratório que abrangem 397 óbitos investigados pelo Comitê de Prevenção da Mortalidade Infantil, utilizando os dados das fichas de investigação. RESULTADOS: Para 82,3 por cento das famílias, a renda mensal foi de até três salários mínimos; 65,1 por cento das mães realizaram o pré-natal em rede pública; 83,4 por cento dos partos foram financiados pelo Sistema Único de Saúde e 59,2 por cento das mulheres iniciaram o pré-natal no primeiro trimestre. Das mães, 68,5 por cento tiveram complicações durante a gestação, 18,2 por cento tiveram trabalho de parto prematuro; 18,2 por cento infecção urinária e 16,5 por cento hipertensão arterial. CONCLUSÃO: A baixa renda, a utilização do serviço público para o pré-natal e parto evidenciam que as instituições públicas, as equipes de saúde e o enfermeiro devem aprimorar o atendimento à gestante, com atribuição do risco gestacional, para contribuir com a continuidade da redução da mortalidade infantil.

OBJECTIVE: To analyze some characteristics of infant mortality of residents in the area of the 15th Health Region of Paraná, from 2005 to 2008. METHODS: A descriptive exploratory study covering 397 deaths investigated by the Committee for the Prevention of Infant Mortality, using data from the research data sheets. RESULTS: In 82.3 percent of families, monthly income was up to three times the minimum wage; 65.1 percent of the mothers received prenatal care through the public network; 83.4 percent of births were financed by the National Health System; and, 59 2 percent of women began prenatal care in the first trimester. Of the mothers, 68.5 percent had complications during pregnancy: 18.2 percent had preterm labor; 18.2 percent had a urinary tract infection, and 16.5 percent had arterial hypertension. CONCLUSION: Low income, the use of public services for prenatal care and childbirth shows that public institutions, public health workers and nurses are improving the care of pregnant women with attributes of gestational risk, and contribute to the continued reduction of infant mortality.

OBJETIVO: Analizar algunas características de la mortalidad infantil de residentes en el área de la 15º Región de Salud de Paraná, del 2005 al 2008. MÉTODOS: Estudio descriptivo exploratorio que abarcan 397 óbitos investigados por el Comité de Prevención de la Mortalidad Infantil, utilizando los datos de las fichas de investigación. RESULTADOS: Para el 82,3 por ciento de las familias, el ingreso mensual fue de hasta tres salarios mínimos; el 65,1 por ciento de las madres realizaron el prenatal en una red pública; el 83,4 por ciento de los partos fueron financiados por el Sistema Único de Salud y el 59,2 por ciento de las mujeres iniciaron el prenatal en el primer trimestre. De las madres, el 68,5 por ciento tuvieron complicaciones durante la gestación, el 18,2 por ciento tuvieron trabajo de parto prematuro; el 18,2 por ciento infección urinaria y el 16,5 por ciento hipertensión arterial. CONCLUSIÓN: El bajo ingreso, la utilización del servicio público para el prenatal y parto evidencian que las instituciones públicas, los equipos de salud y el enfermero deben perfeccionar la atención a la gestante, con atribución del riesgo gestacional, a fin de contribuir con la continuidad de la reducción de la mortalidad infantil.

Atividades de extensão universitária em comitê de prevenção de mortalidade infantil e estatísticas de saúde / Actividades de extensión universitaria en comité de prevención de la mortalidad infantil y estadísticas en salud / Activities of university extension in an infant mortality prevention committee and health statistics

São descritas atividades de extensão no Comitê de Prevenção da Mortalidade Infantil da 15ª Regional de Saúde do Paraná e a aproximação com estatísticas de saúde. O projeto articula parceria entre o Departamento de Enfermagem da Universidade Estadual de Maringá e Secretaria de Saúde do Estado com inserção de alunos de enfermagem. São apresentadas as atribuições do Comitê, avanços desde o inicio do projeto, como a compreensão dos sistemas de informação e importância da investigação do óbito infantil, mas existem desafios, como melhorar a qualidade do preenchimento da ficha de investigação. A parceria ensino/serviço aprimora a qualidade do trabalho, dos Sistemas de Informação, amplia a visão do aluno sobre desigualdades intraurbanas e acesso, incentivando seu comprometimento com a saúde coletiva.

Extra classes' activities with the Committee of Infant Mortality Prevention of the 15th Paraná Health Office (15th HO) and some approaches to health statistics, are described. Those activities articulate a partnership between the Nursing Department of the State University of Maringá and the 15th HO. A description of the Committee's attributions, the advances since the partnership start, the importance of the infant mortality investigations as well as understanding the information systems are presented. There are still challenges such as to improve the quality of the inquiry form. The partnership University -15th HO improves the quality of the Information Systems, provides the students a wider perspective of the intra-urban inequalities to access to health services, stimulating their commitment with public health.

Son descriptas actividades desarrolladas al Comité Regional de Prevención de la Mortalidad Infantil de la 15ª Regional de Salud de Paraná (15ª RS) y los Sistemas de Información (SI). El proyecto articula sociedad del Departamento de Enfermería de la Universidad Estadual de Maringá y la 15ª RS. Son presentadas atribuciones del Comité, dificultades en la investigación del óbito infantil, manoseo y comprensión, por los participantes, de los SI. Son presentados avances, pero existen desafíos como la calidad de la ficha de investigación del óbito. La sociedad enseñanza/servicio perfecciona la calidad del trabajo del Comité, de los SI y amplia la visión del alumno sobre desigualdades intra urbanas y acceso a servicios incentivando su formación más comprometida con la salud colectiva.

Implantação de uma comissão de cuidados com a pele em hospital de ensino / Implementation of a skin care commission in a teaching hospital

O tema segurança do paciente alcançou, na atualidade, um espaço muito importante nos modelos de gestão das instituições de saúde, nas discussões em encontros e no campo da pesquisa. Despertando o interesse dos profissionais da área da saúde no desenvolvimento de programas de qualidade dos serviços, visando prestar uma assistência ao paciente baseada na segurança e na eficácia. Monitorar a ocorrência de lesões de pele em pacientes internados evidencia-se como um fator importante no gerenciamento de risco, colaborando para a segurança do paciente com relação à prevenção e à redução dos eventos adversos decorrentes do cuidado à saúde. Nesta perspectiva, os objetivos deste estudo foram: realizar diagnóstico situacional da instituição quanto à prevenção e tratamento de lesões de pele; descrever as fases de implantação da Comissão de Cuidados com a Pele em um Hospital de Ensino de Curitiba. Trata-se de pesquisa descritiva dividida em duas etapas. Na primeira etapa, de natureza diagnóstica, realizou-se um diagnóstico situacional da notificação e do acompanhamento, ações de prevenção e tratamento das lesões de pele, e da existência de capacitação dos profissionais de enfermagem. Nesta etapa foram entrevistados 25 enfermeiros, sendo um representante de cada unidade de internação. Os dados foram analisados e agrupados em: caracterização das unidades; prática do enfermeiro relacionada a lesões de pele; conhecimentos sobre ferramentas de gestão da qualidade e segurança do paciente e conhecimentos e práticas relacionadas às lesões de pele. Os resultados apontam que a medida mais realizada para a prevenção de lesões de pele é a mudança de decúbito. A instituição possui gestão de risco e da qualidade, mesmo assim, somente 16% dos participantes referiram utilizar a úlcera por pressão (UP) como indicador de qualidade para a gestão de risco e 52% não realizou nenhuma notificação de lesões. Com relação a programas de educação, 88% relataram que não existe capacitação sobre o tema cuidados com a pele na instituição. A segunda etapa denominada intervenção, cuja proposta foi de pesquisa documental, visou à implantação da comissão de cuidados com a pele (CCP) a fim de sistematizar o cuidado de prevenção e tratamento das lesões de pele aos pacientes internados na instituição local do estudo. A comissão foi implantada em quatro passos sendo eles: negociação; estruturação; documentação e implementação, e foi oficializada por portaria em outubro de 2012. Tem caráter normativo e consultivo para desenvolver atividades relacionadas à assistência, educação permanente e pesquisa no que se relaciona a prevenção e tratamento de lesões de pele, cuidados com estomias, cateteres e drenos. No período de outubro/2012 a julho/2013 foram realizados 402 atendimentos pela CCP. Dentre as etiologias tratadas a mais prevalente foi a UP (36%). Os cuidados relacionados às lesões de pele são essenciais em uma instituição de grande porte e o seu controle exige um conjunto de medidas por parte dos profissionais e da instituição, como o cuidado baseado em evidências científicas, políticas de gestão, capacitação e uso de tecnologias adequadas para o cuidado com qualidade.

Currently the theme security of patients has reached an important place in the management of heath institutions, in congresses discussions and in the research area. Provoking the interest of health professionals in the quality development of services programs, with the aim to provide assistance to the patient based on security and efficiency. Monitoring skin injuries in hospitalized patients is an important procedure in the risk management, contributing in the patient's security related to the prevention and reduction of unfavorable events from health care. In this perspective, objectives of this study were diagnose the current situation of the institution's prevention and treatment of skin injuries; describe the phases of the development of the Skin Care Commission in a University Hospital from Curitiba. The research, divided in two parts is quantitative and qualitative. In the first part, that was a diagnostic survey, the current situation of notification and prevention actions for the skin injuries treatment was diagnosed and also the existence of training courses for nursing professionals was researched. Twenty-five nurses were interviewed, one from each admission unit from the institution. The data was analyzed and divided in: units' characteristics, the nurses' practice related to skin injuries, quality and security management supplies knowledge, and practice and knowledge related to skin injuries. The results show that repositioning the patient is the most used method for prevention of skin injuries. The institution has quality and risk management; even so, only 16% of the participants referred to use the pressure ulcer as a quality indicator for risk management and 52% don't report the injuries. 88% of them related that the institution doesn't have any training courses about skin care. The second part a documentary research, in which the proposition is to introduce the skin care commission to systematize skin injury prevention and treatment care for hospitalized patients, in the institution where the study was placed. The commission was introduced in four steps: negotiation, structuralize, documentation and implementation. It became official by a decree in October 2012. The development of activities related to assistance, permanent education and research of skin injuries, ostomy catheters and drains prevention, permanent treatment and research have regulations. From October 2012 until July 2013 402 patients were attended by the commission. Pressure ulcer was the most predominant between the etiologies treated (36%). The care related to skin injuries in a big sized institution is essential. The control demands a series of measures by the professionals and the institution as the care based on scientific evidences, political management, training courses and technologies for the quality care.