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Introdução: A Medicina de Família e Comunidade, como forma de cuidado mais próxima ao paciente, pode ofertar cuidados paliativos (CP) de modo integral e individualizado. Assim, torna-se relevante caracterizar a população atendida de modo a favorecer o desenvolvimento e implementação de estratégias para a ampliação da assistência de CP na Rede de Atenção à Saúde. Objetivo: Apresentar um panorama do perfil epidemiológico dos pacientes em CP domiciliares, no período de janeiro de 2018 a outubro de 2021, assistidos pelo Serviço de Atenção Domiciliar (SAD), vinculado ao Hospital Municipal de São José (HMSJ), na cidade de Joinville (SC). Métodos: Série de casos retrospectiva, incluindo os participantes do SAD que evoluíram a óbito no período da pesquisa. Os critérios de exclusão foram os participantes vivos no período da pesquisa; aqueles registrados, mas não atendidos pela equipe médica; os que receberam alta do programa; pacientes com prontuário incompleto; prontuários duplicados e menores de 18 anos. Os dados coletados incluíram número identificador do prontuário, idade, sexo, estado civil, diagnóstico, data de entrada no SAD, data de óbito, tempo de permanência no SAD, desfecho de óbito e via pela qual foi atestado o óbito, se recebeu analgesia com opioides e se fez uso de mais de um opioide, e se recebeu analgesia em bomba de infusão contínua (BIC) e/ou sedação paliativa. Os dados foram coletados pelos pesquisadores de prontuários médicos, codificados e conferidos duplamente. Foram realizadas então média e mediana das variáveis, bem como correlação dos dados e análise dos resultados. Resultados: Duzentos e oito pacientes foram incluídos; a média de idade foi 66,8 anos; as doenças neoplásicas foram as mais prevalentes (94,2%), destacando-se as neoplasias de trato gastrointestinal (21,1%), pulmonares (12,5%) e de mama (9,5%). A maior parte dos pacientes (37,9%) permaneceu sob os cuidados do SAD por mais de 30 dias e 75,9% da população analisada veio a óbito em ambiente domiciliar, e 45,67% desses indivíduos foram atestados via Serviço de Verificação de Óbitos e 30,2% via SAD. Quanto ao manejo da dor, 87,1% fizeram uso de opioides, mais frequentemente a morfina. Quanto à sedação paliativa, esta esteve presente em apenas 25,48%, prevalecendo o uso de midazolam. Conclusões: Neste estudo, encontrou-se maior prevalência de pacientes acometidos por doenças neoplásicas em fase final de vida, com necessidade de controle de dor adequado contexto no qual o SAD possibilita o atendimento especializado ao paciente e seus familiares em um ambiente de maior conforto.
Introduction: Family Practice, being closer to the patient, can offer comprehensive and individualized Palliative Care (PC). Therefore, characterizing the population served becomes essential to support the development and implementation of strategies to expand PC services in the Health Care Network. Objective: Present an overview of the epidemiological profile of patients receiving home-based palliative care from January 2018 to October 2021, supported by Home Care Services (HCS) affiliated with Hospital Municipal São José (HMSJ) in the city of Joinville (SC). Methods: Retrospective case series with Participants in HCS who passed away during the study period were included. Exclusion criteria comprised living participants, those registered but not attended by the medical team, program discharges, incomplete medical records, duplicates, and individuals under 18 years of age. Collected data included record identifier, age, gender, marital status, diagnosis, entry and death dates, duration of HCS stay, death outcome and certification method, opioid analgesia use, use of multiple opioids, and use of continuous infusion pump (CIP) analgesia and/or palliative sedation. Researchers collected and double-checked the coded data, performed average and median calculations, correlated data, and analyzed results. Results: Two hundred and eight patients were included; average age was 66.8 years; neoplastic diseases were most prevalent (94.2%), particularly gastrointestinal (21.1%), pulmonary (12.5%), and breast cancers (9.5%). The majority of patients (37.9%) remained under HCS care for over 30 days, and 75.9% of the analyzed population passed away at home, with 45.67% certified by the Death Verification Service and 30.2% by HCS. Regarding pain management, 87.1% used opioids, most commonly morphine. Palliative sedation was present in only 25.48%, predominantly using midazolam. Conclusions: This study found a higher prevalence of patients with end-stage neoplastic diseases requiring adequate pain control, an area where HCS provides specialized care in a more comfortable environment.
Introducción: La Medicina Familiar y Comunitaria, como forma de atención más cercana al paciente, puede ofrecer Cuidados Paliativos (CP) de forma integral e individualizada. Por lo tanto, resulta relevante caracterizar la población atendida con el fin de favorecer el desarrollo e implementación de estrategias para ampliar la asistencia en CP en la red de Atención a la Salud. Objetivo: Presentar una visión general del perfil epidemiológico de los pacientes que recibieron cuidados paliativos domiciliarios, de enero de 2018 a octubre de 2021, atendidos por el Servicio de Atención de Salud a Domicilio (SAD), vinculado al Hospital Municipal São José (HMSJ), de la ciudad de Joinville (SC). Método: Serie de casos retrospectiva, incluyendo participantes del SAD que fallecieron durante el período de investigación. Los criterios de exclusión fueron participantes vivos durante el período de investigación; pacientes registrados pero no atendidos por el equipo médico; los que tuvieron alta del programa; con historial médico incompleto, historial médico duplicado y menores de 18 años. Los datos recogidos incluyeron número de identificación del historial médico, edad, sexo, estado civil, diagnóstico, fecha de ingreso al SAD, fecha de fallecimiento, tiempo de estancia en el SAD, desenlace de la muerte y vía por la que se certificó la muerte; si recibió analgesia con opioides y si usaron más de un opioide, y si recibieron analgesia con bomba de infusión continua (BIC) y/o sedación paliativa. Los datos fueron recopilados por investigadores de registros médicos, codificados y verificados dos veces. Luego se realizó la media y mediana de las variables, así como la correlación de datos y el análisis de los resultados. Resultados: Se incluyeron doscientos ocho pacientes; la edad promedio fue de 66,8 años; las enfermedades neoplásicas fueron las más prevalentes (94,2%), destacándose las neoplasias del tracto gastrointestinal (21,1%), pulmón (12,5%) y mama (9,5%). La mayoría de los pacientes (37,9%) permanecieron bajo atención del SAD más de 30 días y el 75,9% de la población analizada falleció en su domicilio, de los cuales el 45,67% fue certificado a través del Servicio de Urgencias de Verificación de Defunciones y el 30,2% a través del SAD. En cuanto al manejo del dolor, el 87,1% utilizaba opioides, con mayor frecuencia morfina. En cuanto a la sedación paliativa, estuvo presente solo en el 25,48%, prevaleciendo el uso de midazolam. Conclusiones: En este estudio se encontró una mayor prevalencia de pacientes afectados por enfermedades neoplásicas en la etapa final de la vida, que necesitan un control adecuado del dolor, un contexto en el que el SAD permite una atención especializada a los pacientes y sus familias en un ambiente más confortable.
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Humanos , Cuidados Paliativos , Derecho a Morir , Servicios de Atención a Domicilio Provisto por Hospital , Servicios de Atención de Salud a DomicilioRESUMEN
BACKGROUND: In the European Union and peripheral countries, the availability of physicians working in primary health care services (PHCS) varies greatly and all countries report shortages and difficulties in recruiting more. The broad consensus that giving access to PHCS to all is a policy priority, reinforced by the lessons learned during the COVID-19 pandemic, implies that a sufficient fit-for-purpose workforce is available. This article focuses on physicians and reports on what countries have done, and with what success, to attract more medical students to a career in PHCS. METHODS: We conducted a scoping review of articles in PubMed and Cochrane Library, and of grey literature in websites of international agencies, think-tanks, international non-governmental organizations, and European Commission-funded projects, published between January 2018 and February 2024. RESULTS: The search retrieved 1,143 records, of which 45 were eligible for the scoping review; 25 focused on medical students. The documents report interventions in 12 countries, 14 by individual education institutions, mostly in the form of exposure of diverse duration to general/family practice in the medical curriculum (specific modules, residencies, rotations, placements, mentorship), and 11 policy interventions at national level, such as increases in the number of training places for primary health care (PHC) specialties and improvement of working conditions. CONCLUSION: Accessible PHCS require the availability of a fit-for-purpose workforce of multiprofessional teams, in which specially trained physicians play a central role. To address shortages, many countries increased training opportunities, a necessary step, but not sufficient. More students must accept to opt for a PHC specialty, in a context of competition with other fields of practice also in need of more students, such as public health, geriatrics, or mental health. Success requires the collaboration of numerous actors, including professional councils and organizations, and regulation bodies that specialists tend to dominate. By making PHCS a political and policy priority, decision-makers can help make attraction more effective, but to do so, they need access to convincing evidence and information on good practices that only research can produce.
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COVID-19 , Selección de Profesión , Unión Europea , Atención Primaria de Salud , Estudiantes de Medicina , Humanos , SARS-CoV-2RESUMEN
BACKGROUND: Risk perception varies greatly among individuals, affecting their behavior and decision-making in risky situations. The COVID-19 pandemic affected worldwide, but the role of risk perception related to COVID-19 in ethnic minorities in Mexico is unclear. This study quantifies the impact of COVID-related risk perception (susceptibility and severity) and perceived fear on the utilization of antenatal care services among indigenous women in San Cristobal de las Casas, Chiapas, Mexico. METHODS: We conducted a retrospective crossover study between June and December 2021, interviewing 98 women from San Cristóbal de las Casas, Chiapas. In a crossover design, each subject acts as their own control, so we required the participants to have a previous pregnancy experience. A logistic model was used to calculate the odds ratio for the outcome of having an adequate number of antenatal care visits. The analysis considered the period (during or before the pandemic) as well as perceived severity and susceptibility levels as independent variables. RESULTS: COVID-19 reduced antenatal care utilization by 50%. During the pandemic, the adjusted odds ratio for attending health antenatal care services was 0.83 (95% CI: 4.8, 14.5) compared to pre pandemics. Adjusted for fear of contagion, the mother's perception of severity was associated with an increased likelihood of an insufficient number of antenatal visits. OR = 0.25 (95% CI: 0.10, 0.65). CONCLUSION: The risk perception for COVID-19 decreased the likelihood of receiving an adequate number of antenatal care visits.
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COVID-19 , Aceptación de la Atención de Salud , Atención Prenatal , SARS-CoV-2 , Humanos , Femenino , COVID-19/psicología , COVID-19/epidemiología , Atención Prenatal/estadística & datos numéricos , Atención Prenatal/psicología , Embarazo , Adulto , Aceptación de la Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/psicología , México/etnología , Estudios Retrospectivos , Pueblos Indígenas/psicología , Pueblos Indígenas/estadística & datos numéricos , Estudios Cruzados , Adulto Joven , Percepción , Miedo/psicología , Medición de RiesgoRESUMEN
Resumen Introducción : Los adultos mayores con enfermedades crónicas avanzadas y necesidad de cuidados paliativos están más expuestos a la polifarmacia y a consumir medicación potencialmente inapropiada, la cual genera un alto riesgo de eventos adversos y alteración de la calidad de vida. El objetivo de este estudio fue describir la frecuencia de consumo de medicación potencialmente inapropiada de adultos mayores con necesidad de cuida dos paliativos que ingresaron a cuidados domiciliarios luego de una hospitalización. Métodos : Estudio de corte transversal observacional de registros de dispensación e historias clínicas electró nicas, de adultos mayores en un sistema de cuidados domiciliarios y con necesidades de cuidados paliativos según el rastreo con la herramienta NECPAL, los índices PROFUND y/o PALIAR. Se analizó el consumo de fárma cos durante los 180 días posteriores al ingreso a cuidados domiciliarios. Se clasificaron los fármacos como poten cialmente inapropiados según criterios de LESS-CHRON. Resultados : Se incluyeron 176 pacientes, edad prome dio 87.4 años, 67% mujeres; 78% eran pluripatológicos y 22% presentaban una enfermedad única crónica progre siva. La mortalidad a los 6 meses fue 73%. La mediana de consumo de fármacos por paciente fue 9.1 (RIC = 4-9.7). El 87% consumía medicación potencialmente inapropia da, principalmente antihipertensivos, benzodiacepinas y antipsicóticos. Conclusión : Este estudio observó que los adultos ma yores, con necesidad de cuidados paliativos en cuidados domiciliarios, tienen un alto consumo de medicación potencialmente inapropiada. Esto refuerza la necesidad de implementar intervenciones efectivas centradas en el paciente, para prevenir la prescripción inadecuada y estimular la de-prescripción.
Abstract Introduction : Older adults with advanced chronic diseases and palliative care needs are more exposed to polypharmacy and use of potentially inappropriate medication, which generates a high risk of adverse events and impaired quality of life. The objective of this study was to describe the frequency of potentially inappropriate medication use among older adults with palliative care needs receiving home care services after hospital discharge. Methods : Observational cross-sectional study of pharmacy dispensing and electronic health records, of older adults in a home care system and with palliative care needs according to the screening with the NECPAL tool or the PROFUND and/or PALIAR indexes. Dispensed medications during 180 days after admission to home care were analyzed. Medications were classified as po tentially inappropriate according to the LESS-CHRON criteria. Results : We included 176 patients, mean age 87.4 years, 67% were women; 73% were pluripathologic pa tients and 22% had one chronic progressive disease. Mortality at 6 months was 73%. Median frequency of dispensed medications per patient was 9.1 (IQR = 4-9.7). The frequency of potentially inappropriate medication dispensation among patients was 87%, mainly antihy pertensives, benzodiazepines and antipsychotics. Conclusion : This study observed that dispensation of potentially inappropriate medication among older adults with palliative care needs and home care services is very high. This emphasizes the need for effective patient-centered interventions to prevent inadequate prescription and stimulate de-prescription.
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Introducción: En el Perú las mujeres en los establecimientos penitenciarios carecen de acceso a la salud ante la falta de políticas públicas que conduce a una brecha de desigualdad en dicho acceso. La investigación tiene por objetivo diagnosticar la situación del acceso a los servicios de la salud en los establecimientos penitenciarios de mujeres del Perú durante el año 2021. Métodos: Se realizó un estudio descriptivo, transversal, con datos de los 13 establecimientos, que constituyen la totalidad de los establecimientos penitenciarios de mujeres en el Perú. Resultados: Los resultados señalan que las atenciones en salud se concentraron en la región penitenciaria de Lima, se encontró que las regiones que no presentaban profesionales de la salud permanentes carecían de atención adecuada. Discusión: el Estado peruano no ha cumplido con su rol como garante en relación con el derecho fundamental al acceso a los servicios de salud por parte de las entidades penitenciarias en beneficio de todas las mujeres internas que integran los Establecimientos Penitenciarios de Mujeres en el Perú. Se recomienda, bajo los principios de razonabilidad y proporcionalidad, es más que urgente definir nuevas directrices de acceso a la salud femenina, coadyuvando a que el personal de salud desempeñe un enfoque preventivo, con la capacidad de integrar la buena cultura de la institución penitenciaria.
Introduction: In Peru, women in prisons lack access to health due to the lack of public policies that lead to an inequality gap in said access. The objective of the research is to diagnose the situation of access to health services in women's penitentiary establishments in Peru during the year 2021. Method: A descriptive, cross-sectional study was carried out with data from the 13 establishments, which constitute all of the women's penitentiary establishments in Peru. The results indicate that health care was concentrated in the prison region of Lima; it was found that regions that did not have permanent health professionals lacked adequate care. Results: Therefore, the importance of placing permanent health professionals in penitentiary centers is accentuated to guarantee care for women. Discussion: The peruvian state has not fulfilled its role as guarantor in relation to the fundamental right of access to health services by penitentiary entities for the benefit of all female inmates who make up the Women's Penitentiary Establishments in Peru. It is recommended, under the principles of reasonableness and proportionality, that it is more than urgent to define new guidelines for access to women's health, helping health personnel to carry out a preventive approach, with the ability to integrate the good culture of the penitentiary institution.
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INTRODUCTION: Home care provided by dentists is crucial for ensuring adequate oral care. However, oral health professionals face challenges in delivering treatment at patients' residences due to a lack of resources. Our objective was to explore dentists' perspectives and experiences of dental home care and potential challenges for its implementation. METHODS: The study took a qualitative approach. Guided by a semi-structured interview schedule, data were gathered using recorded interviews with 22 dental professionals. After transcription, data were analysed thematically using the Discourse of the Collective Subject (DCS) method, using Qualiquantisoft. RESULTS: The majority of participants were female (n = 20), aged between 30 and 40 years old, and predominantly specialising in primary care (n = 6) or endodontics (n = 6). All participants provided home care, performing general dental procedures, normally responding to requests from the work team (n = 13) or family (n = 7). Six main categories on to the topic emerged: importance and access to home care, procedures performed during home visits, discussions about post-home care, professional competence and patient-centred care, positive aspects of home care, and negative aspects and challenges faced in this type of care. CONCLUSION: This study highlights the fundamental, yet complex, role of home care in dentistry. Continuity of treatment through adaptability and a patient-centred approach are important.
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BACKGROUND: Informal home care is prevalent among Mexican American stroke survivors, but data on the impact on caregivers are not available. The aim was to assess ethnic differences in informal stroke caregiving and caregiver outcomes at 90 days poststroke. METHODS: Informal caregivers were recruited from the population-based Brain Attack Surveillance in Corpus Christi Project (2019-2023), conducted in a bi-ethnic community in Texas. Caregivers of community-dwelling stroke survivors who were not cognitively impaired and not employed by a formal caregiving agency were interviewed. Interviews included sociodemographics, dyad characteristics, Modified Caregiver Strain Index (range 0-26, higher more positive), Positive Aspects of Caregiving scale (range, 5-45, higher more), Patient Health Questionnaire-8 (range, 0-30, higher worse), and PROMIS (Patient-Reported Outcomes Measurement Information System)-10 physical (range, 16.2-67.7, higher better) and mental health (range, 21.2-67.6, higher better) summary scores. Stroke survivor data was from interviews and medical records. Propensity score methods were used to balance caregiver and patient factors among Mexican American and Non-Hispanic White caregivers by fitting a model with ethnicity of caregiver as the outcome and predictors being caregiver sociodemographics, patient-caregiver dyad characteristics, and patient sociodemographics and functional disability. Propensity scores were included as a covariate in regression models, considering the association between ethnicity and outcomes. RESULTS: Mexican American caregivers were younger, more likely female, and more likely a child of the stroke survivor than Non-Hispanic White caregivers. Mexican American caregiver ethnicity was associated with less caregiver strain (ß, -1.87 [95% CI, -3.51 to -0.22]) and depressive symptoms (ß, -2.02 [95% CI, -3.41 to -0.64]) and more favorable mental health (ß, 4.90 [95% CI, 2.49-7.31]) and positive aspects of caregiving (ß, 3.29 [95% CI, 1.35-5.23]) but not associated with physical health. CONCLUSIONS: Understanding the mechanisms behind more favorable caregiver outcomes in Mexican American people may aid in the design of culturally sensitive interventions to improve both caregiver and stroke survivor outcomes, potentially across all race and ethnic groups.
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Cuidadores , Americanos Mexicanos , Accidente Cerebrovascular , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidadores/psicología , Americanos Mexicanos/psicología , Accidente Cerebrovascular/etnología , Accidente Cerebrovascular/enfermería , Accidente Cerebrovascular/psicología , Texas/epidemiología , BlancoRESUMEN
Objetivo: construir y validar un folleto educativo enfocado en la atención domiciliaria de lesiones por presión. Método: estudio metodológico realizado en tres etapas: elaboración de los temas, construcción del folleto y validación del contenido por parte de los jueces. El folleto fue elaborado en la plataforma digital de diseño gráfico Canva®, con un enfoque dinámico y autoexplicativo, adecuado al público objetivo, con una apariencia ligera, atractiva y con un lenguaje sencillo. La validación del contenido se realizó utilizando el Índice de Validez de Contenido (IVC). Resultados: El folleto se tituló "Lesión por presión y cuidados domiciliarios: ¿Hablemos de eso?", validado por 8 jueces con un índice de validez de contenido global superior a ≥0,78. Teniendo en cuenta la preocupación de accesibilidad lingüística por parte de los jueces, se llevó a cabo una revisión de contenido y adecuación textual para la versión final. Conclusión: La tecnología construida y validada demostró potencial para ser utilizada y generar mejoras en la atención domiciliaria de las personas con lesiones por presión. Investigaciones futuras deberían centrarse en validar la usabilidad de la tecnología por parte de los usuarios. (AU)
Objective: To create and validate an educational pamphlet focused on home care for pressure injuries. Method:This methodological study was conducted in three stages: topic development, pamphlet creation, and content validation by experts. The pamphlet was designed using the Canva® digital graphic design platform, considering a dynamic, self-explanatory approach suitable for the target audience, featuring a light and attractive appearance with simple language. For content validation, the Content Validity Index (CVI) was used. Results: The pamphlet, titled "Pressure Injuries and Home Care: Let's Talk About It?", was validated by eight experts with an overall CVI above ≥ 0.78. Due to concerns raised by the experts regarding linguistic accessibility, a content review and textual adjustments were made for the final version. Conclusion: The constructed, validated pamphlet has demonstrated potential for use and improvement in home care for people with pressure injuries. Future research should focus on validating the usability of the technology by users. (AU)
Objetivo:Construir e validaruma cartilha educativa voltada ao cuidado domiciliar com lesão por pressão. Método:estudo metodológico realizado em três etapas: elaboração dos assuntos, construção da cartilha e validação de conteúdo por juízes.A cartilha foi elaborada na plataforma digital de design gráfico Canva®, considerando abordagem dinâmica, autoexplicativa, adequada ao público-alvo; contendo uma aparência leve, atrativa e linguagem simples. Para validação de conteúdo, utilizou o Índice de Validade de Conteúdo (IVC). Resultados: A cartilha foi intitulada "Lesão por pressão e cuidados domiciliares: Vamos falar sobre isso?", validada por oito juízes com índice de validade de conteúdo geral acima de ≥ 0,78. Considerando a preocupação por parte dos juízes, diante da acessibilidade linguística, foi realizada uma revisão do conteúdo e adequação textual para a versão final. Conclusão: A tecnologia construída e validada demonstrou potencial para ser utilizada e gerar melhoria dos cuidados domiciliares às pessoas que convivem com lesões por pressão. Como perspectiva para pesquisas futuras, ressalta-se a validação da usabilidade da tecnologia pelos usuários. (AU)
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Humanos , Tecnología Biomédica , Servicios de Atención de Salud a Domicilio , Tecnología Educacional , Úlcera por Presión , EstomaterapiaRESUMEN
RESUMOObjetivo: compreender as masculinidades de homens em cuidados domiciliares a partir da construção do ethos masculino. Método: pesquisa qualitativa tendo o referencial teórico-metodológico de Norman Fairclough para análise crítica de discurso e a concepção teórica de masculinidades segundo Raewyn Connell. Entrevistou-se 58 usuários entre pacientes e cuidadores de um serviço público de atenção domiciliar. Resultados: identificou-se duas centralidades discursivas: masculinidade hegemônica e suas ideologias e o novo ethos masculino: a admissão da dependência. Percebeu-se a presença de uma masculinidade não hegemônica entre os homens em cuidados domiciliares, cujas circunstâncias específicas do domicílio favorecem mudanças histórico-sociais e culturais, fazendo emergir novos conceitos, sentidos e experiências. Conclusão: o ethos masculino dos homens cuidados no domicílio é marcado pela condição de diferenciação, alinha-se a uma masculinidade subordinada, embora se referenciem em ideologias dominantes. Esse novo ethos masculino permite, em outras análises, reconhecer as necessidades e o comportamento de homens em atenção domiciliar.
ABSTRACTObjective: to understand the masculinities of men in home care based on male ethosconstruction. Method: qualitative research aligned with Raewyn Connell's conception of masculinities and critical discourse analysis based on Norman Fairclough's theoretical-methodological framework. A total of 58 users were interviewed between patients and caregivers of a home care public service. Results: two discursive centralities were identified: hegemonic masculinity and its ideologies; and the new male ethos: the admission of dependency. The presence of a non-hegemonic masculinity is perceived among the men in home care, whose particular home experiences favor historical, social, and cultural changes, giving rise to new concepts, meanings, and experiences. Conclusion: the masculine ethosof men cared for at home is marked by the condition of differentiation, it is aligned with a subordinate masculinity, although it is based on dominant ideologies. This new masculine ethos allows, in other analyses, to recognize the needs and the behavior of men in home care.
RESUMENObjetivo: comprender las masculinidades de los hombres en la atención a domicilio a partir de la construcción del ethos masculino. Método: investigación cualitativa basada en el marco teórico-metodológico de Norman Fairclough para realizar el análisis del discurso y en el concepto de masculinidades de Raewyn Connell. Se realizaron entrevistas a 58 usuarios entre pacientes y cuidadores de un servicio público de atención domiciliaria. Resultados: se identificaron dos centralidades discursivas: la masculinidad hegemónica y sus ideologías; y el Nuevo ethos masculino: la admisión de la dependencia. Se constató que hay una masculinidad no hegemónica entre hombres en atención domiciliaria cuyas circunstancias específicas del hogar proporcionan cambios históricos, sociales y culturales, lo que permite surgir nuevos conceptos, significados y vivencias. Conclusión: el ethos masculino de los hombres en atención a domicilio está marcado por la condición de diferenciación y se alinea con una masculinidad subordinada, aunque se asiente en ideologías dominantes. Este nuevo ethos masculino permite reconocer, en análisis futuras, las necesidades y el comportamiento de los hombres en atención a domicilio
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Humanos , Masculino , Cuidadores , Salud del Hombre , Masculinidad , Servicios de Atención de Salud a Domicilio , Atención Domiciliaria de SaludRESUMEN
BACKGROUND: Guided by Andersen's Behavioral Model of Health Services Use (BMHSU), this study aimed to identify determinants of post-migration healthcare use among a sample of Mexican immigrants in a US-Mexico border region in Southern Arizona, while considering pre-migration health and healthcare experiences. METHODS: A non-probabilistic convenience sample of 300 adult Mexican immigrants completed a telephone survey to assess healthcare practices. Multivariable logistic regressions were fitted to determine adjusted relationships between frequency of care and predisposing, enabling, need, and contextual factors as well as personal health practices. RESULTS: Overall, participants had a 79% probability of receiving healthcare "at least once a year" after migrating to Southern Arizona. Receiving post-migration healthcare was associated with predisposing, enabling, need, contextual factors, and personal health practices (p < 0.05). DISCUSSION: Consistent with BMHSU, our findings suggest that frequency of healthcare is not only a function of having post-migration health insurance but is also shaped by a complex array of other factors. The results of this study shed light onto potential areas to be leveraged by multifactorial sociocultural interventions to increase Mexican immigrants' frequency of healthcare services use.
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OBJECTIVES: Due to the increase in the prevalence of non-communicable diseases and the Colombian demographic transition, the necessity of palliative care has arisen. This study used accessibility and coverage indicators to measure the geographic barriers to palliative care. METHODS: Population-based observational study focused on urban areas and adult population from Colombia, which uses three measurements of geographic accessibility to services: a) density of palliative care services per 100,000 inhabitants, b) analysis of geographic distribution by territorial nodes of the country, and c) spatial analysis of palliative care services using Voronoi diagrams. ArcGIS Pro software was used to map services' locations and identify geographic disparities. RESULTS: A total of 504 palliative care services were identified, of which 77% were primary health care services. The density of palliative care services in Colombia is 1.8 primary care services per 100,000 inhabitants and 0.4 specialized services per 100,000 inhabitants. The average palliative care coverage is 41%, two regions of the country have a coverage below 30%. Twenty-eight percent of the services provide care for a population greater than 50,000 inhabitants within their coverage area, exceeding the acceptable limit by international standards. CONCLUSIONS: Palliative care services are concentrated in three main regions (Bogotá D.C., the Center, and the Caribbean) and are limited in the Orinoquia and Amazonia nodes. Density of specialized palliative care services is extremely low and there are regions without palliative services for adults with palliative needs.
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Accesibilidad a los Servicios de Salud , Cuidados Paliativos , Colombia , Humanos , Cuidados Paliativos/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Adulto , Disparidades en Atención de Salud , Atención Primaria de Salud/estadística & datos numéricos , Análisis EspacialRESUMEN
INTRODUCTION: Older adults with advanced chronic diseases and palliative care needs are more exposed to polypharmacy and use of potentially inappropriate medication, which generates a high risk of adverse events and impaired quality of life. The objective of this study was to describe the frequency of potentially inappropriate medication use among older adults with palliative care needs receiving home care services after hospital discharge. METHODS: Observational cross-sectional study of pharmacy dispensing and electronic health records, of older adults in a home care system and with palliative care needs according to the screening with the NECPAL tool or the PROFUND and/or PALIAR indexes. Dispensed medications during 180 days after admission to home care were analyzed. Medications were classified as potentially inappropriate according to the LESS-CHRON criteria. RESULTS: We included 176 patients, mean age 87.4 years, 67% were women; 73% were pluripathologic patients and 22% had one chronic progressive disease. Mortality at 6 months was 73%. Median frequency of dispensed medications per patient was 9.1 (IQR = 4-9.7). The frequency of potentially inappropriate medication dispensation among patients was 87%, mainly antihypertensives, benzodiazepines and antipsychotics. CONCLUSION: This study observed that dispensation of potentially inappropriate medication among older adults with palliative care needs and home care services is very high. This emphasizes the need for effective patient-centered interventions to prevent inadequate prescription and stimulate de-prescription.
Introducción: Los adultos mayores con enfermedades crónicas avanzadas y necesidad de cuidados paliativos están más expuestos a la polifarmacia y a consumir medicación potencialmente inapropiada, la cual genera un alto riesgo de eventos adversos y alteración de la calidad de vida. El objetivo de este estudio fue describir la frecuencia de consumo de medicación potencialmente inapropiada de adultos mayores con necesidad de cuidados paliativos que ingresaron a cuidados domiciliarios luego de una hospitalización. Métodos: Estudio de corte transversal observacional de registros de dispensación e historias clínicas electrónicas, de adultos mayores en un sistema de cuidados domiciliarios y con necesidades de cuidados paliativos según el rastreo con la herramienta NECPAL, los índices PROFUND y/o PALIAR. Se analizó el consumo de fármacos durante los 180 días posteriores al ingreso a cuidados domiciliarios. Se clasificaron los fármacos como potencialmente inapropiados según criterios de LESS-CHRON. Resultados: Se incluyeron 176 pacientes, edad promedio 87.4 años, 67% mujeres; 78% eran pluripatológicos y 22% presentaban una enfermedad única crónica progresiva. La mortalidad a los 6 meses fue 73%. La mediana de consumo de fármacos por paciente fue 9.1 (RIC = 4-9.7). El 87% consumía medicación potencialmente inapropiada, principalmente antihipertensivos, benzodiacepinas y antipsicóticos. Conclusión: Este estudio observó que los adultos mayores, con necesidad de cuidados paliativos en cuidados domiciliarios, tienen un alto consumo de medicación potencialmente inapropiada. Esto refuerza la necesidad de implementar intervenciones efectivas centradas en el paciente, para prevenir la prescripción inadecuada y estimular la de-prescripción.
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Servicios de Atención de Salud a Domicilio , Prescripción Inadecuada , Cuidados Paliativos , Lista de Medicamentos Potencialmente Inapropiados , Humanos , Femenino , Masculino , Estudios Transversales , Anciano de 80 o más Años , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Anciano , Lista de Medicamentos Potencialmente Inapropiados/estadística & datos numéricos , Prescripción Inadecuada/estadística & datos numéricos , Polifarmacia , Enfermedad Crónica/tratamiento farmacológicoRESUMEN
Introducción. El descenso de las coberturas de vacunación fue muy significativo en la última década. Los pediatras son una pieza fundamental para recuperar coberturas y aumentar la confianza en la vacunación. Objetivos. Describir la percepción de los pediatras acerca del conocimiento y prácticas sobre vacunas, e identificar barreras en el acceso. Métodos. Estudio analítico observacional, mediante encuesta en línea. Se incluyeron variables del perfil del profesional, capacitación y barreras en inmunizaciones. Resultados. Participaron 1696 pediatras (tasa de respuesta: 10,7 %), media de 50,4 años. El 78,7 % fueron mujeres. El 78,2 % contaba con ≥10 años de ejercicio profesional. El 78,4 % realizaba atención ambulatoria y el 56,0 % en el subsector privado. El 72,5 % realizó una capacitación en los últimos 2 años. Se manifestaron "capacitados" para transmitir a sus pacientes los beneficios de las vacunas: 97,2 %; objetivos de campañas: 87,7 %; contraindicaciones: 82,4 %; efectos adversos: 78,9 %; recupero de esquemas: 71,2 %; notificación de ESAVI: 59,5 %. La proporción fue estadísticamente superior, en todos los aspectos, en pediatras con ≥10 años de ejercicio y en aquellos con capacitación reciente (p ≤ 0,01). Barreras identificadas en el acceso a la vacunación: falsas contraindicaciones (62,3 %); falta temporaria de vacunas (46,4 %); motivos culturales (41,4 %); horario restringido del vacunatorio (40,6 %). Conclusiones. La percepción del grado de capacitación fue variable según el aspecto de la vacunación. Aquellos con mayor tiempo de ejercicio profesional y con actualización reciente se manifestaron con mayor grado de capacidad. Se identificaron múltiples barreras frecuentes asociadas al acceso en la vacunación.
Introduction. The decline in vaccination coverage has been very significant in the past decade. Pediatriciansplay a key role in catching-up coverage and increasing confidence in vaccination. Objectives. To describe pediatricians' perceptions of vaccine knowledge and practices and to identify barriers to access. Methods. Observational, analytical study using an online survey. Variables related to professional profile, training and barriers to vaccination were included. Results. A total of 1696 pediatricians participated (response rate: 10.7%). Their mean age was 50.4 years; 78.7% were women; 78.2% had ≥ 10 years of experience; 78.4% provided outpatient care and 56.0%, in the private subsector; and 72.5% received training in the past 2 years. Respondents described themselves as "trained" in convey the following aspects to their patients: benefits of vaccines: 97.2%; campaign objectives: 87.7%; contraindications: 82.4%; adverse effects: 78.9%; catchup vaccination: 71.2%; reporting of events supposedly attributable to vaccination or immunization: 59.5%. The proportion was statistically higher in all aspects, among pediatricians with ≥ 10 years of experience and those who received training recently (p ≤ 0.01). The barriers identified in access to vaccination were false contraindications (62.3%), temporary vaccine shortage (46.4%), cultural reasons (41.4%), and restricted vaccination center hours (40.6%). Conclusions. The perception of the level of training varied depending on the vaccination-related aspect. Pediatricians with more years of professional experience and those who received recent updates perceivedthemselves as more trained. Multiple barriers associated with access to vaccination were identified.
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Humanos , Persona de Mediana Edad , Vacunas , Vacunación , Percepción , Argentina , Encuestas y Cuestionarios , PediatrasRESUMEN
O objetivo da pesquisa foi apresentar uma revisão narrativa de literatura sobre as principais dificuldades enfrentadas por cirurgiões-dentistas no atendimento domiciliar na Estratégia Saúde da Família (ESF). Realizou-se um levantamento bibliográfico com base nos bancos de dados eletrônicos (Google Acadêmico, SCIELO, BVS), com captação de documentos do Ministério da Saúde e artigos de língua inglesa e portuguesa, nos anos de 2000 a 2021. Elegeu-se 21 artigos que apresentaram o objeto de estudo com visão crítica. Foi realizada pesquisa e descrição sobre a Estratégia Saúde da Família, sobre o atendimento domiciliar e também sobre os profissionais de saúde bucal que participam do atendimento domiciliar na Estratégia Saúde da Família. O atendimento domiciliar é usado pela equipe da Estratégia Saúde da Família com foco nos usuários que não se deslocam até a Unidade Básica de Saúde (UBS) por motivos físicos, mentais e/ou sociais. Após o acréscimo da Equipe de Saúde Bucal (ESB) na Estratégia Saúde da Família, os mesmos também passaram a realizar atendimentos domiciliares. Os principais afazeres realizados pela equipe em domicílio são com foco na promoção, prevenção e tratamento. Contudo os cirurgiões-dentistas enfrentam dificuldades que atrapalham os atendimentos domiciliares, podendo-se citar: vias urbanas precária; violência; tráfico de drogas; falta de transporte; demanda de equipamentos e instrumentai; biossegurança e ergonomia que são difíceis alcançar em domicílio.
The objective of the research was to present a narrative review of the literature on the main difficulties faced by dentists in home care in the Family Health Strategy (ESF). A bibliographical survey was carried out based on electronic databases (Google Academic, SCIELO, BVS), with collection of documents from the Ministry of Health and articles in English and Portuguese, in the years 2000 to 2021. 21 articles were chosen that presented the object of study with a critical view. A research and description was carried out on the Family Health Strategy (ESF). Home care is usedby the Family Health Strategy team, focusing on users who do not go to the Basic Health Unit (UBS) for physical, mental and/or social reasons. After the addition of the Oral Health Team (ESB) to the ESF, They also began to provide home care. The main tasks performed by the theam at home are focused on promotion, prevention and treatment. However, dentists face difficulties that hinder home care, such as: prearious urban roads; violence; drug trafficking; lack of trasportation; demand for equipment and instruments; biosafety and ergonomics that are difficult to achieve at home.
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Estrategias de Salud Nacionales , Odontólogos , Habilidades de Afrontamiento , Servicios de Atención de Salud a Domicilio , Visita DomiciliariaRESUMEN
Objetivo: Analisar as práticas de cuidado desenvolvidas para atender às necessidades de saúde de homens em atenção domiciliar. Métodos: Pesquisa observacional e qualitativa, realizada com 34 cuidadores e 24 homens assistidos pelo serviço de atenção domiciliar do município de João Pessoa. A coleta de dados foi realizada por meio de um roteiro com variáveis sociodemográficas e perguntas abertas. A Análise Crítica do Discurso foi utilizada como método de análise, com destaque para os significados representacional e identificacional dos discursos. Resultados: As práticas de cuidado e necessidades de saúde foram apontadas com base na relação hegemônica entre os atores do cuidado, associação do cuidado ao processo de trabalho informal, atuação da família, da atividade corresponsabilizada, e prática da autonomia e autocuidado. Conclusão: Evidenciou-se um cuidado multifacetado e executado por diversos atores com suporte de equipes multiprofissionais de atenção domiciliar. (AU)
Objective: To analyze the care practices developed to meet the health needs of men in home care. Methods: Observational and qualitative research, carried out with 34 caregivers and 24 men assisted by the home care service in the city of João Pessoa. Data collection was performed through a script with sociodemographic variables and open questions. Critical Discourse Analysis was used as a method of analysis, with emphasis on the representational and identificational meanings of the discourses. The research was approved according to the opinion number 1.829.326. Results: Care practices and health needs were identified based on the hegemonic relationship between the care actors, association of care with the informal work process, family activities and co-responsibility activities, and the practice of autonomy and self-care. Conclusion: There was evidence of a multifaceted care performed by different subjects with the support of multidisciplinary home care teams. (AU)
Objetivo: Analizar las prácticas asistenciales desarrolladas para satisfacer las necesidades de salud de los hombres en la atención domiciliaria. Métodos: Investigación observacional y cualitativa, realizada con 34 cuidadores y 24 hombres asistidos por el servicio de atención domiciliaria en la ciudad de João Pessoa. La recolección de datos se realizó mediante un guión con variables sociodemográficas y preguntas abiertas. Se utilizó el Análisis Crítico del Discurso como método de análisis, con énfasis en los significados representativos e identificativos de los discursos. La investigación fue aprobada de acuerdo al dictamen número 1.829.326. Resultados: Se identificaron prácticas de cuidado y necesidades de salud a partir de la relación hegemónica entre los actores del cuidado, la asociación del cuidado con el proceso de trabajo informal, las actividades familiares y de corresponsabilidad, y la práctica de la autonomía y el autocuidado. Conclusión: Se evidenció una atención multifacética realizada por diferentes sujetos con el apoyo de equipos multidisciplinares de atención domiciliaria. (AU)
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Salud del Hombre , Conocimientos, Actitudes y Práctica en Salud , Cuidadores , Conocimiento , Servicios de Atención de Salud a Domicilio , Atención Domiciliaria de SaludRESUMEN
This study investigated the impact of home care, health status, and cognition. A qualitative and quantitative approach was employed through a cross-sectional study with a sample of 60 elderly individuals in need of home care in the municipality of Itatiba, São Paulo, Brazil. The analysis utilized the Discourse of the Collective Subject (DCS), EQ-5D, EQ VAS, and Mini-Mental State Examination (MMSE). The sample consisted of 40.0% male and 60.0% female individuals. The majority (61.6%) received weekly visits, mainly from community health agents, who were responsible for the majority of the care (45%). Positive considerations were highlighted, with 36.6% emphasizing the contribution to treatment continuity. The EQ VAS assessment indicated a moderately good perception of health. The EQ-5D analysis revealed significant differences between genders in personal care (p = 0.04). There were significant differences between clinical characteristics and EQ-5D dimensions, such as neoplasia and reduced mobility (p = 0.04), and arthritis/osteoarthritis/rheumatism and a limitation in common activities (p = 0.01). The presence of anxiety/depression was significant in cases of neoplasia (p = 0.006), arthritis/osteoarthritis/rheumatism (p = 0.01), and stroke (p = 0.04). The logistic regression analysis showed associations between usual activities and arthritis, osteoarthritis, rheumatism (p = 0.034), pain/malaise and arthritis, osteoarthritis, rheumatism (p = 0.038), and anxiety/depression and stroke (p= 0.028). The average MMSE scores (17.52) suggested a mild cognitive impairment, with no statistical differences between genders. Based on these results, it can be concluded that home care can provide a comprehensive approach and continuous assistance, emphasizing the importance of personalized care based on perceived and clinical differences.
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Cognición , Servicios de Atención de Salud a Domicilio , Calidad de Vida , Humanos , Masculino , Femenino , Anciano , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Estudios Transversales , Anciano de 80 o más Años , Brasil , Estado de Salud , Persona de Mediana Edad , PercepciónRESUMEN
BACKGROUND: Centralized management of queues helps to reduce the surgical waiting time in the publicly funded healthcare system, but this is not a reality in the Brazilian Unified Healthcare System (BUHS). We describe the implementation of the "Patients with Surgical Indication" (PSI) in a Brazilian public tertiary hospital, the impact on waiting time, and its use in rationing oncological surgeries during the COVID-19 Pandemic. METHODS: Retrospective observational study of elective surgical requests (2016-2022) in a Brazilian general, public, tertiary university hospital. We recovered information regarding the inflows (indications), outflows and their reasons, the number of patients, and waiting time in queue. RESULTS: We enrolled 82,844 indications in the PSI (2016-2022). The waiting time (median and interquartile range) in days decreased from 98(48;168) in 2016 to 14(3;152) in 2022 (p < 0.01). The same occurred with the backlog that ranged from 6,884 in 2016 to 844 in 2022 (p < 001). During the Pandemic, there was a reduction in the number of non-oncological surgeries per month (95% confidence interval) of -10.9(-18.0;-3.8) during Phase I (January 2019-March 2020), maintenance in Phase II (April 2020-August 2021) 0.1(-10.0;10.4) and increment in Phase III (September 2021-December 2022) of 23.0(15.3;30.8). In the oncological conditions, these numbers were 0.6(-2.1;3.3) for Phase I, an increase of 3.2(0.7;5.6) in Phase II and 3.9(1,4;6,4) in Phase III. CONCLUSION: Implementing a centralized list of surgical indications and developing queue management principles proved feasible, with effective rationing. It unprecedentedly demonstrated the decrease in the median waiting time in Brazil.
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Pandemias , Listas de Espera , Humanos , Brasil/epidemiología , Procedimientos Quirúrgicos Electivos , Hospitales Públicos , Estudios RetrospectivosRESUMEN
Resumo Objetivo: descrever a experiência no desenvolvimento e integração de tecnologias educativas digitais em saúde em um website voltado para os cuidados domiciliares com recém-nascidos. Método: relato de experiência sistematizado em cinco tempos (ponto de partida, perguntas iniciais, recuperação do processo vivido, reflexão de fundo e pontos de chegada), no período de 2020 a 2024. Concentrou-se no desenvolvimento de tecnologias educativas digitais em um projeto de pesquisa e desenvolvimento tecnológico e social vinculado à extensão universitária. Resultados: o desenvolvimento das tecnologias digitais envolveu a construção, validação e avaliação de dois vídeos animados, dois aplicativos móveis, uma cartilha, vinte e dois podcasts e um website que integrou as 28 tecnologias produzidas. Conclusão: a experiência foi inovadora, promissora e relevante. A abordagem multifacetada e integradora reflete uma diversidade de estratégias para atender às necessidades educativas das famílias, demonstrando ser efetiva na disseminação de informações.
Resumen Objetivo: describir la experiencia en el desarrollo e integración de tecnologías digitales educativas en salud en un sitio web enfocado a la atención domiciliaria del recién nacido. Método: relato de experiencia sistematizado en cinco etapas (punto de partida, preguntas iniciales, recuperación del proceso vivido, reflexión de antecedentes y puntos de llegada), en el periodo 2020 a 2024. Enfocado al desarrollo de tecnologías educativas digitales en un proyecto de desarrollo tecnológico e investigación y desarrollo social vinculado a la extensión universitaria. Resultados: el desarrollo de tecnologías digitales implicó la construcción, validación y evaluación de dos videos animados, dos aplicaciones móviles, un folleto, veintidós podcasts y un sitio web que integró las 28 tecnologías producidas. Conclusión: la experiencia fue innovadora, prometedora y relevante. El enfoque multifacético e integrador refleja una diversidad de estrategias para satisfacer las necesidades educativas de las familias, demostrando ser eficaz en la difusión de información.
Abstract Objective: to describe the experience in the development and integration of digital educational technologies in health on a website focused on home care for newborns. Method: experience report systematized in five stages (starting point, initial questions, recovery of the lived process, background reflection and arrival points), from 2020 to 2024. It focused on the development of digital educational technologies in a technological and social research and development project linked to university outreach activities. Results: the development of digital technologies involved the construction, validation and evaluation of two animated videos, two mobile applications, a booklet, twenty-two podcasts and a website that integrated the 28 technologies produced. Conclusion: the experience was innovative, promising and relevant. The multifaceted and integrative approach reflects a diversity of strategies to meet the educational needs of families, demonstrating to be effective in disseminating information.
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ABSTRACT This article analyzes the state of social participation in health in the Region of the Americas, framing it within the regional context and commitments assumed by the Member States of the Pan American Health Organization. It aims to provide regional input to the discussion of a resolution on social participation for universal health coverage, health, and well-being at the 77th World Health Assembly in 2024. In the Americas, social participation has evolved from a utilitarian approach to a fundamental aspect of health system governance, enshrined within legal frameworks and recognized as a citizen's right. Regional resolutions emphasize inclusive policies and intersectoral action to tackle health inequities, meanwhile the World Health Organization handbook on social participation underscores the need for inclusive governance mechanisms and addressing power imbalances. Informed by Member States' recommendations and scientific literature, the article emphasizes the importance of addressing power imbalances, strengthening legal frameworks, and enhancing capacities of governments and populations. It stresses adapting social participation mechanisms to diverse cultural contexts and ensuring meaningful community involvement in decision-making. Finally, the article advocates for a comprehensive approach to social participation grounded in principles of equity, democracy, and human rights; and fundamentally as an essential component of the primary health care approach. It calls for integrating social participation into health system governance, policy dialogues, capacity-building, and evaluation to ensure effective participatory processes.
RESUMEN En este artículo se analiza el estado de la participación social en materia de salud en la Región de las Américas dentro del marco del contexto regional y los compromisos asumidos por los Estados Miembros de la Organización Panamericana de la Salud. El objetivo es proporcionar aportes regionales para las deliberaciones en torno a una resolución sobre la participación social para la cobertura universal de salud, la salud y el bienestar en la 77.a Asamblea Mundial de la Salud en el 2024. En la Región de las Américas, la participación social ha evolucionado de un enfoque utilitarista a ser considerada un aspecto fundamental de la gobernanza de los sistemas de salud, consagrado en los marcos jurídicos y reconocido como un derecho ciudadano. Las resoluciones regionales hacen hincapié en las políticas inclusivas y las medidas intersectoriales para abordar las inequidades en materia de salud, mientras que el manual de la Organización Mundial de la Salud sobre participación social destaca la necesidad de mecanismos de gobernanza inclusivos y el abordaje de los desequilibrios de poder. Basándose en las recomendaciones de los Estados Miembros y la bibliografía científica, el artículo subraya la importancia de abordar los desequilibrios de poder, fortalecer los marcos jurídicos y mejorar las capacidades de los gobiernos y las poblaciones. Hace hincapié en adaptar los mecanismos de participación social a contextos culturales diversos y garantizar una participación trascendente de la comunidad en la toma de decisiones. Por último, el artículo aboga por un enfoque integral de la participación social basado en principios de equidad, democracia y derechos humanos; y, fundamentalmente, como un componente esencial del enfoque de atención primaria de salud. Insta a integrar la participación social en la gobernanza del sistema de salud, los diálogos sobre las políticas, la creación de capacidad y la evaluación para garantizar procesos participativos eficaces.
RESUMO Este artigo analisa a situação da participação social em saúde na Região das Américas tendo em conta o contexto regional e os compromissos assumidos pelos Estados Membros da Organização Pan-Americana da Saúde. O objetivo é oferecer contribuições regionais para a discussão de uma resolução sobre participação social para cobertura universal de saúde, saúde e bem-estar na 77ª Assembleia Mundial da Saúde, em 2024. Na Região das Américas, a participação social evoluiu, deixando de ser uma abordagem utilitarista para se tornar um aspecto fundamental de governança do sistema de saúde, consagrada por marcos legais e reconhecida como um direito dos cidadãos. As resoluções regionais enfatizam políticas inclusivas e ações intersetoriais para combater iniquidades em saúde, e o manual da Organização Mundial da Saúde sobre participação social ressalta a necessidade de contar com mecanismos inclusivos de governança e abordar desequilíbrios de poder. Com base nas recomendações dos Estados Membros e na literatura científica, o artigo destaca a importância de abordar desequilíbrios de poder, reforçar marcos legais e fortalecer as capacidades dos governos e das populações. Além disso, enfatiza a necessidade de adaptar mecanismos de participação social a diversos contextos culturais e assegurar um envolvimento significativo da comunidade na tomada de decisões. Por fim, o artigo defende uma abordagem abrangente de participação social com base em princípios de equidade, democracia e direitos humanos e, fundamentalmente, como um componente essencial da abordagem de atenção primária em saúde. O artigo urge a integração da participação social na governança do sistema de saúde, em diálogos sobre políticas, no desenvolvimento de capacidades e na avaliação, a fim de assegurar processos participativos efetivos.
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ABSTRACT Objectives: to analyze the profile and clinical outcomes of patients who developed Ventilator-Associated Pneumonia (VAP) in private home care and to compare the incidence with national data. Methods: this was a retrospective study with data collected from July 2021 to June 2022 from patient records at a private clinic. Patients using intermittent ventilation or without ventilatory support were excluded. Results: the utilization rate of mechanical ventilation was 15.9%. The incidence density of pneumonia in pediatrics was 2.2 cases per 1000 ventilation-days and in adults was 1.7 cases per 1000 ventilation-days, figures lower than those reported by the National Health Surveillance Agency. There were 101 episodes of pneumonia in 73 patients, predominantly male (65.8%), adults (53.4%), and those with neurological diseases (57.5%). The treatment regimen predominantly took place at home (80.2%), and there was one death. Conclusions: patients in home care showed a low incidence and mortality rate from ventilator-associated pneumonia.
RESUMEN Objetivos: analizar el perfil y el desenlace clínico de pacientes que desarrollaron Neumonía Asociada a la Ventilación en Asistencia Domiciliaria privada y comparar la incidencia con datos nacionales. Métodos: estudio retrospectivo, con recolección de datos entre julio de 2021 y junio de 2022 en registros médicos de una clínica privada, excluyendo la ventilación intermitente y la ausencia de soporte ventilatorio. Resultados: la tasa de utilización de ventilación mecánica fue del 15,9%. La densidad de neumonía en pediatría fue de 2,2 casos por 1000 ventilaciones-día y en adultos de 1,7 casos por 1000 ventilaciones-día, datos inferiores a los reportados por la Agencia Nacional de Vigilancia Sanitaria. Se registraron 101 episodios de neumonía en 73 pacientes, en su mayoría varones (65,8%), adultos (53,4%) y con enfermedades neurológicas (57,5%). El régimen de tratamiento prevaleció en el domicilio (80,2%) y se registró un deceso. Conclusiones: los pacientes en Asistencia Domiciliaria presentaron baja incidencia y mortalidad por neumonía asociada a la ventilación mecánica.
RESUMO Objetivos: analisar o perfil e o desfecho clínico de pacientes que desenvolveram Pneumonia Associada à Ventilação em Assistência Domiciliar privada e comparar a incidência com dados nacionais. Métodos: estudo retrospectivo, com coleta entre julho de 2021 e junho de 2022 em prontuários de pacientes de uma instituição privada, sendo excluídos a ventilação intermitente e a ausência de suporte ventilatório. Resultados: a taxa de utilização de ventilação mecânica foi de 15,9%. A densidade de pneumonia na pediatria foi de 2,2 casos por 1000 ventilações-dia e em adultos de 1,7 casos por 1000 ventilações-dia, dados inferiores aos reportados pela Agência Nacional de Vigilância Sanitária. Ocorreram 101 episódios de pneumonia em 73 pacientes, em sua maioria do sexo masculino (65,8%), adultos (53,4%) e com doenças neurológicas (57,5%). O regime de tratamento prevaleceu no domicílio (80,2%) e ocorreu um óbito. Conclusões: os pacientes em Assistência Domiciliar apresentaram baixa incidência e mortalidade por pneumonia associada à ventilação mecânica.