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OBJECTIVES: To estimate the coverage of newborn pulse oximetry screening (POS) in Brazil, as well as identifies associated factors and the proportion of positive screening results. METHODS: Coverage was estimated based on the most recent National Health Survey (2019). Adjusted marginal prevalence ratios were estimated via poisson regression model with robust variance. RESULTS: The POS coverage was 66.3 % (95 %CI: 65.5-67.1; N = 3,140,023) and was higher in children born in privately funded hospitals (PFHs) than in the Unified Health System (SUS): 78.1 % (76.7-79.5) versus 61.1 % (60.2-62.1). In the North region, the POS coverage in PFHs (64.9 %, 59.7-70.1) was lower than that in the South (82.5 %, 79.4-85.6) and the Southeast (81.5 %, 79.3-83.6); it was even lower in SUS in the North (44.0 %; 42.4-45.6). After a federal ordinance providing financial resources to postscreening diagnostic, the screening coverage in SUS increased from 57.6 % (56.2-59.1) to 64.6 % (63.3-65.9). The proportion of positive screening tests was 9.2 % (8.9-9.5) in SUS and 7.8 % (7.3-8.3) in PFHs, of which 40.8 % (40.5-41.1) underwent complementary exams in SUS and 57.2 % (56.7-57.7) in PFHs. In the multivariate model, the main independent predictors of POS were the coverage of other newborn screening tests. CONCLUSIONS: Inequalities were found between major regions and healthcare systems. Government financial incentives have reduced this inequality, although the percentage of postscreening complementary exams remains insufficient and unequal. The main independent predictors of screening prevalence were those related to the organization of health services.

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INTRODUCTION: The use of teleneuropsychology (TeleNP) increased as a result of the COVID-19 pandemic; however, there have been no studies of the benefits and difficulties with this modality in middle-income countries. This study aimed to assess the current use of TeleNP in Mexico. METHOD: Mexican neuropsychologists were invited to participate in an online survey regarding the use of TeleNP during the COVID-19 pandemic. The survey was based on issues from a literature review and consisted of 36 questions requiring yes/no, multiple choice, or ordinal answers. The survey was created using Google Forms and asked respondents to provide informed consent. A total of 107 clinical neuropsychologists completed the survey. RESULTS: 82% of participants currently use TeleNP, and most reported learning about TeleNP through personal experience, literature research, and colleagues. Brief evaluations, delivery of results, and intervention were the principal services provided, most frequently on a home-to-home basis. Almost 30% of clinicians reported not requiring informed consent for use of the modality. Consultations included children, adolescents, and adults in similar numbers; older adults were less frequent. Technological limitations were the most frequent reason for ruling out the modality with particular patients. Perceived benefits included the ability to continue consultations despite social distancing measures, lesser risk of COVID-19 infection, and the possibility of seeing patients with limited access to neuropsychological services. Reasons for not using TeleNP included a lack of standardized instruments, not feeling comfortable with the modality, and lack of technological resources and skills. CONCLUSIONS: Despite the socioeconomic differences between Mexico and high-income countries, most of our findings were similar to reports from those countries. However, technological limitations were common, and smartphones were commonly used, contrary to recommendations in the literature. The future use of TeleNP in Mexico should include formal training and ethical guidelines.

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Resumo Introdução Os Centro de Atenção Psicossocial (CAPS) foram criados como parte do processo de reforma psiquiátrica. Objetivo O objetivo deste estudo foi avaliar a influência das assembleias realizadas no Centro de Atenção Psicossocial CAPS II de Boa Vista (RR) na humanização em saúde mental. Método Esta pesquisa qualitativa avaliou 10 indivíduos dentre os 22 que preencheram os critérios de inclusão. O estudo utilizou a técnica de análise de conteúdo e um roteiro de entrevista contendo 07 perguntas abertas sobre a efetivação da humanização em meio à realização de assembleias. Resultados A relação paciente, profissional e gestor melhorou após a realização das assembleias. Quanto ao trabalho desenvolvido pela gestão, os participantes atribuíram organização e humanização. O trabalho da equipe profissional foi considerado excelente pela maioria dos entrevistados, e o CAPS atua de forma humanizada no atendimento à pessoa em sofrimento psíquico. Conclusão As assembleias influenciaram a humanização em saúde mental em face das mudanças de comportamento e relacionamento propiciadas pelo vínculo que se fez presente durante as mencionadas reuniões, tangenciando assim para lógica da reforma psiquiátrica e substituição de práticas hospitalocêntricas com vistas na ressocialização dos indivíduos e familiares.

Abstract Background The Psychosocial Care Center was created as part of the psychiatric reform process. Objective The objective of this study was to evaluate the influence of the assemblies held at the CAPS II Psychosocial Care Center of Boa Vista RR on the humanization of mental health. Method This qualitative study evaluated 10 individuals from the 22 who met the inclusion criteria. The study used a content analysis methodology applying an interview script containing 7 open questions regarding the effectiveness of humanization in the context of the assemblies. Results The relationship between patient, professional and manager improved after the assemblies were held. Regarding the work undertaken by the management, participants highlighted the organization and humanization. The work of the professional team was considered excellent by most of the interviewees and the CAPS acts in a humanized way when assisting people in psychological distress. Conclusion The assemblies influenced the humanization of mental health in the face of behavioural changes through the relationship established during the aforementioned meetings. This reflected the logic of psychiatric reform and the substitution of hospital-centered practices with the re-socialization of individuals and families.

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Abstract Objectives: To describe the management, to compare treatment at initial referral vs. during specialized follow-up, and to describe outcomes of children with functional constipation (FC) referred to a Brazilian tertiary care center. Methods: Retrospective study, including children (4-18 years) with FC followed at a single center from 2006 to 2019. Demographics, treatments, time of follow-up, and outcomes were analyzed. The management of FC followed an institutional protocol. Results: 104 patients were identified, 79 were eligible and included in the analysis: 59% male, mean age at referral was 6.4 years, and mean duration of symptoms was 4.4 years. There were significant changes in the therapy(ies) used at the time of referral compared to during follow-up, with a noticeable increase in the frequency of the use of polyethylene glycol, enemas, magnesium hydroxide, and bisacodyl; 5.1% received trans-anal irrigation, and 3.8% underwent surgery. Outcomes were favorable in more than half of the cases: 31% improved; 19.5% had complete resolution and 2.5% were transferred back to primary care. Symptoms remained unchanged in 30.4%, and no patients experienced worsening of symptoms. The mean duration of follow-up was 2.8 years. When comparing patients with favorable vs. unfavorable outcomes, the authors did not identify significant differences in gender, age, therapies used, duration of symptoms, or length of follow-up. Conclusions: Children with FC are often referred to specialized care not receiving optimal therapy. Many patients whose FC was labeled "refractory" may be treated successfully with a well-established plan of care, and do not truly present intractable constipation.

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The current health situation caused by the COVID-19 pandemic has prompted a reconfiguration of the doctor-patient relationship. We performed a systematic review to comparatively evaluate the instruments most used to study communication in the doctor-patient relationship. We identified 43 instruments assessing different aspects of the doctor-patient relationship, of which 34 correspond to Anglo-Saxon literature and nine to Latin American texts. The psychometric evidence for many of these instruments is incipient. Most of these instruments contemplate a unidirectional design and address similar dimensions of the doctor-patient relationship, particularly in the Latin American context where the relationship is mostly studied in a unidimensional way. We propose recommendations for the development, revision, or refinement of instruments that measure communication in the doctor-patient relationship.

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Background: Analysis of health inequalities by ethnicity is critical to achieving the Sustainable Development Goals. In Ecuador, similar to other Latin American countries, indigenous and afro-descendant populations have long been subject to racism, discrimination, and inequitable treatment. Although in recent years, Ecuador has made progress in health indicators, particularly those related to the coverage of Reproductive, Maternal, Neonatal and Child Health (RMNCH) interventions, little is known as to whether inequalities by ethnicity persist. Methods: Analysis was based on two nationally representative health surveys (2004 and 2012). Ethnicity was self-reported and classified into three categories (Indigenous/Afro-Ecuadorian/Mixed ancestry). Coverage data for six RMNCH health interventions were stratified for each ethnic group by level of education, area of residence and wealth quintiles. Absolute inequality measures were computed and multivariate analysis using Poisson regression was undertaken. Findings: In 2012, 74.4% of women self-identifying as indigenous did not achieve the secondary level of education and 50.7% were in the poorest quintile (Q1); this profile was relatively unchanged since 2004. From 2004 to 2012, the coverage of RMNCH interventions increased for all ethnic groups, and absolute inequality decreased. However, in 2012, regardless of education level, area of residence and wealth quintiles, ethnic inequalities remained for almost all RMNCH interventions. Indigenous women had 24% lower prevalence of modern contraceptive use (Prevalence ratio [PR] = 0.76; 95% IC: 0.7-0.8); 28% lower prevalence of antenatal care (PR = 0.72; 95% IC: 0.6-0.8); and 35% lower prevalence of skilled birth attendance and institutional delivery (PR = 0.65; 95% IC: 0.6-0.7 and PR = 0.65; 95% IC: 0.6-0.7 respectively), compared with the majority ethnic group in the country. Interpretation: While the gaps have narrowed, indigenous people in Ecuador continue in a situation of structural racism and are left behind in terms of access to RMNCH interventions. Strategies to reduce ethnic inequalities in the coverage services need to be collaboratively redesigned/co-designed. Funding: This paper was made possible with funds from the Bill & Melinda Gates Foundation [Grant Number: INV-007,594/OPP1148933].

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OBJECTIVES: To describe the management, to compare treatment at initial referral vs. during specialized follow-up, and to describe outcomes of children with functional constipation (FC) referred to a Brazilian tertiary care center. METHODS: Retrospective study, including children (4-18 years) with FC followed at a single center from 2006 to 2019. Demographics, treatments, time of follow-up, and outcomes were analyzed. The management of FC followed an institutional protocol. RESULTS: 104 patients were identified, 79 were eligible and included in the analysis: 59% male, mean age at referral was 6.4 years, and mean duration of symptoms was 4.4 years. There were significant changes in the therapy(ies) used at the time of referral compared to during follow-up, with a noticeable increase in the frequency of the use of polyethylene glycol, enemas, magnesium hydroxide, and bisacodyl; 5.1% received trans-anal irrigation, and 3.8% underwent surgery. Outcomes were favorable in more than half of the cases: 31% improved; 19.5% had complete resolution and 2.5% were transferred back to primary care. Symptoms remained unchanged in 30.4%, and no patients experienced worsening of symptoms. The mean duration of follow-up was 2.8 years. When comparing patients with favorable vs. unfavorable outcomes, the authors did not identify significant differences in gender, age, therapies used, duration of symptoms, or length of follow-up. CONCLUSIONS: Children with FC are often referred to specialized care not receiving optimal therapy. Many patients whose FC was labeled "refractory" may be treated successfully with a well-established plan of care, and do not truly present intractable constipation.

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O estudo teve como objetivo analisar a utilização do Programa Nacional Telessaúde Brasil Redes, no âmbito da atenção primária à saúde no Brasil, identificando os fatores relacionados. Estudo transversal a partir da base de dados do segundo ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). A amostra foi composta por 29.756 equipes de saúde que, voluntariamente, aderiram ao programa. As variáveis independentes abrangeram características contextuais (região e porte populacional), da unidade de saúde (tipo, acesso a telefone, banda larga, número de médicos e enfermeiros, consultórios, sala de agentes comunitários de saúde (ACS), sala de reuniões, existência de telessaúde) e da equipe de saúde (apoio institucional). Análises bruta e ajustada por meio de regressão de Poisson avaliaram quais variáveis são associadas ao maior uso do telessaúde. A prevalência de utilização do telessaúde foi de 32,7% no total da amostra e 73,3% entre equipes com o programa implantado. Teleducação foi a modalidade mais frequentemente usada. Maiores prevalências de utilização foram encontradas das regiões Sul e Sudeste, em municípios com até 30 mil habitantes, com telessaúde implantado na unidade, presença de pelo menos um médico e disponibilidade de pelo menos um telefone no estabelecimento. O apoio institucional teve impacto positivo em 40% na prevalência de utilização do telessaúde. Variáveis de estrutura, como Internet e disponibilidade de salas com distintas finalidades, parecem não impactar significativamente a utilização dessas tecnologias, sinalizando que fatores como apoio institucional e a própria implantação do telessaúde na unidade são mais importantes para aumentar a adesão ao programa.

The study aimed to analyze the Brazil Networks Telehealth Program in the context of primary healthcare (PHC) in Brazil and to identify related factors. This cross-sectional study used data from the second cycle of the Program for Improvement of Access and Quality of Basic Healthcare (PMAQ-AB). The sample consisted of 29,756 healthcare teams who joined the program voluntarily. Independent variables included contextual characteristics (region and population size), healthcare unit (type, telephone access, broadband, number of physicians and nurses, consultation offices, community health workers' room, meeting room, existence of telehealth) and health team characteristics (institutional support). Crude and Poisson regression-adjusted analyses assessed which variables are associated with greater use of telehealth. Prevalence of use of telehealth was 32.7% in the total sample and 73.3% among teams with the Program implemented. Tele-education was the most frequently used modality. Higher rates of prevalence of use were found in the South and Southeast of Brazil, in municipalities with up to 30,000 inhabitants, with telehealth implemented in the unit, with presence of at least one physician, and with at least one telephone available in the service. Institutional support had a 40% positive impact on prevalence of use of telehealth. Infrastructure variables such as Internet and availability of rooms with different purposes appeared not to significantly impact the use of these technologies, indicating that institutional support and the implementation of telehealth itself in the unit are more important for increasing adherence to the Program.

El estudio tuvo como objetivo analizar la utilización del Programa Nacional Telesalud Brasil Redes, en el ámbito de la atención primaria en salud en Brasil, identificando los factores relacionados. Estudio transversal a partir de la base de datos del 2º ciclo del Programa Nacional de Mejoría de Acceso y Calidad de la Atención Básica (PMAQ-AB). La muestra estuvo compuesta por 29.756 equipos de salud que voluntariamente se adhirieron al programa. Las variables independientes abarcaron características contextuales (región y tamaño poblacional), de la unidad de salud (tipo, acceso a teléfono, banda ancha, número de médicos y enfermeros, consultorios, sala de agentes comunitarios de salud, sala de reuniones, existencia de telesalud) y del equipo de salud (apoyo institucional). El análisis bruto y ajustado mediante regresión de Poisson evaluaron qué variables se asocian a un mayor uso de telesalud. La prevalencia de utilización de telesalud fue de un 32,7% en el total de la muestra y un 73,3% entre equipos con el programa implantado. Teleducación fue la modalidad más frecuentemente usada. Se encontraron mayores prevalencias de utilización en las regiones Sur y Sudeste, en municipios con hasta 30.000 habitantes, con telesalud implantada en la unidad, presencia de por lo menos un médico y disponibilidad de por lo menos un teléfono en el establecimiento. El apoyo institucional tuvo un impacto positivo en un 40% de la prevalencia de utilización de la telesalud. Variables de estructura como Internet y disponibilidad de salas con distintas finalidades parecen no impactar significativamente en la utilización de estas tecnologías, señalando que los factores como el apoyo institucional y la propia implantación de la telesalud en la unidad son más importantes para aumentar la adhesión al programa.

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Therapeutic drug monitoring (TDM) and continuous infusion strategies are effective interventions in clinical practice, but these practices are still largely unknown in Colombia, especially in the critical care setting. This study aims to describe the practices involved in the administration and TDM of ß-lactams and vancomycin reported by specialists in critical care in Colombia and to explore the factors that are related to the use of extended infusion. An online nationwide survey was applied to 153 specialists, who were selected randomly. A descriptive, bivariate analysis and a logistic regression model were undertaken. In total, 88.9% of the specialists reported TDM availability and 21.57% reported access to results within 6 h. TDM was available mainly for vancomycin. We found that 85.62% of the intensivists had some type of institutional protocol; however, only 39.22% had a complete and socialized protocol. The odds of preferring extended infusions among those who did not have institutional protocols were 80% lower than those with complete protocols, OR 0.2 (95% CI: 0.06-0.61). The most important perceived barriers to performing continuous infusions and TDM were the lack of training and technologies. This pioneering study in Colombia could impact the quality of care and outcomes of critically ill patients in relation to the threat of antimicrobial resistance.

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Background: Legumes are low cost and high-quality nutritional foods. In Chile, a twice per week legume consumption is recommended to promote health and prevent disease. Aim: To characterize the consumption of legumes according to sociodemographic and anthropometric variables in the Chilean adult population. Material and Method: Analysis of data from 5,473 participants of the 2016-2017 National Health Survey. The compliance with legume consumption was studied in population groups, according to sociodemographic and anthropometric characteristics, through logistic regression analyses. Results: Only 24% of all participants (51.4% of women) fulfilled legume intake recommendations. After adjusting for sociodemographic variables, the participants who were less likely to comply with the recommendation were widowers (Odds Ratio (OR): 0.58 [95% confidence intervals (CI): (0.40; 0.85]). On the contrary, people between 70-80 years (OR: 1.78 [95% CI: 1.11; 2.88]), those who resided in rural areas (OR: 1.62 [95% CI: 1.25; 2.10]) and those who resided in the Maule region (OR: 2.11 [95% CI: 1.37, 3.25]) had a higher likelihood of compliance. Conclusions: One out of four Chileans complied with the recommendations of legume consumption. Even though the results differed when stratified by sex, it is highlighted that living in rural areas increased the probabilities of an adequate legume consumption.

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INTRODUÇÃO: A Osteoartrite (OA) é a forma mais prevalente de artrite e requer intervenção terapêutica adequada. A Fisioterapia desempenha um importante papel no manejo desta doença. No entanto, pouco se sabe sobre as crenças e intervenções de fisioterapeutas que tratam OA no Brasil e fatores relacionados às decisões clínicas. OBJETIVO: Determinar se existe associação entre a qualificação profissional de fisioterapeutas na região Norte do Brasil e a percepção de eficiência ou ineficiência de intervenções terapêuticas para OA de joelho. MATERIAIS E MÉTODOS: Uma pesquisa transversal online foi realizada com fisioterapeutas de cinco estados do Norte do Brasil e a percepção sobre 20 intervenções foi avaliada por meio de um caso hipotético de OA de joelho. O teste qui-quadrado e regressão logística binária com nível de significância de 5% foram utilizados para a análise estatística. RESULTADOS: 370 profissionais com média de idade de 32,16 ± 6,89 responderam a pesquisa. Houve associação significativa entre qualificação e percepção de eficiência das intervenções. Fisioterapeutas apenas graduados apresentaram menos chances de reconhecer ultrassom, ondas curtas, neuroestimulação elétrica transcutânea e estimulação elétrica, crioterapia, calor, fortalecimento muscular, kinesio taping e repouso como intervenções ineficazes. O mesmo ocorreu com as intervenções ultrassom, fortalecimento muscular e kinesio taping para especialistas. CONCLUSÃO: O menor grau acadêmico leva à uma chance menor de perceber como pouco eficientes ou ineficientes algumas intervenções não recomendadas para OA de joelho.

INTRODUCTION: Osteoarthritis (OA) is the most prevalent form of arthritis, which requires appropriate therapeutic intervention. Physical therapy plays a central role in its management. However, little is known about the beliefs and interventions of physical therapists who treat OA in Brazil and factors related to clinical decisions. OBJECTIVE: To determine whether there is an association between the professional qualification of physical therapists in the North Region of Brazil and their perception of efficiency or inefficiency of therapeutic interventions for knee OA. METHODS: A cross-sectional online survey was conducted with physical therapists from five states in northern Brazil, and their perception about 20 interventions was assessed through a hypothetical case of knee OA. Statistical analyses were performed using the chi-square test and binary logistic regression with a significance level of 5%. RESULTS: 370 professionals with a mean age of 32.16 ±6.89 responded to the survey. There was a significant association between qualification and perceived efficiency of interventions. Graduated physiotherapists were less likely to recognize ultrasound, short waves, transcutaneous electrical neurostimulation and electrical stimulation, cryotherapy, heat, muscle strengthening, kinesio taping, and rest as ineffective interventions. The same occurred for ultrasound, muscle strengthening, and kinesiology tape for specialists. CONCLUSION: The lower academic degree leads to a lower chance to perceive as poorly efficient or inefficient some not recommended interventions for knee OA.

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BACKGROUND: Latin America (LA) has experienced constant economic and political crises that coincide with periods of greater inequality. Between 1996 and 2007 Ecuador went through one of the greatest political and socio-economic crises in Latin America, a product of neo-liberal economic growth strategies. Between 2007 and 2012 it regained political stability, promoted redistributive policies, and initiated greater social spending. To understand the possible influence on the political and economic context, we analyzed the coverage and inequalities in five Reproductive, Maternal, and Child Health (RMNCH) and two water and sanitation interventions using survey data from a broad time window (1994-2012), at a national and subnational level. METHODS: The series cross-sectional study used data from four representative national health surveys (1994, 1999, 2004 and 2012). Coverage of RMNCH and sanitary interventions were stratified by wealth quintiles (as a measure of the socio-economic level), urban-rural residence and the coverage for each province was mapped. Mean difference, Theil index and Variance-weighted least squares regression were calculated to indicate subnational and temporal changes. RESULTS: From 1994 to 2004, Ecuador evidenced large inequalities whose reduction becomes more evident in 2012. Coverage in RMNCH health service-related interventions showed a rather unequal distribution among the socioeconomic status and across provinces in 1994 and 2004, compared to 2012. Sanitary interventions on the contrary, showed the most unequal interventions, and failed to improve or even worsened in several provinces. While there is a temporary improvement also at the subnational level, in 2012 several provinces maintain low levels of coverage. CONCLUSIONS: The remarkable reduction of inequalities in coverage of RMNCH interventions in 2012 clearly coincides with periods of regained political stability, promoted redistributive policies, and greater social spending, different from the former neo-liberal reforms which is consistent with observations made in other Latin American countries. Territorial heterogeneity and great inequalities specially related with sanitation interventions persists. It is necessary to obtain high quality information with sharper geographic desegregation that allows to identify and understand local changes over time. This would help to prioritize intervention strategies, introduce multisectoral policies and investments that support local governments.

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OBJECTIVE: The objective of this study is to evaluate the actions taken by obstetricians when faced with postpartum hemorrhage (PPH). MATERIALS AND METHODS: A standardized open-ended survey was applied to 235 physicians at five hospitals and at an obstetrics and gynecology conference, inquiring about which actions are recommended in the initial stages of PPH. We calculated the frequency and confidence intervals of the actions mentioned and correlated the number of actions with the number of clinicians mentioning them using Spearman's rho test. RESULTS: Asking for help was mentioned by 45% of the respondents and 38% asked for vital signs. Only one-fifth of those surveyed asked for blood count, coagulation testing, arterial blood gas, or urinary catheter. Very few mentioned hypothermia prevention, oxygen administration, or blood transfusion. A total of 80% of those interviewed only mentioned 3 of the 16 recommended actions. CONCLUSION: Postpartum hemorrhage training should include instructions on initial steps in order to improve treatment comprehension and outcomes.

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OBJECTIVE: To compare pediatric overweight and obesity prevalence among non-Hispanic white, Mexican American, and non-Hispanic black US youths before and after adjusting body mass index (BMI) for pubertal status, as assessed by Tanner stage. STUDY DESIGN: We analyzed cross-sectional anthropometric and pubertal data from non-Hispanic white, Mexican American, and non-Hispanic black youths in the National Health and Nutrition Examination Survey (NHANES) III. We developed specialized Tanner stage and chronological age-adjusted models to establish Tanner-stage adjusted BMI z-scores, which were then used to determine adjusted overweight/obesity prevalence. We compared pediatric overweight/obesity prevalence before and after pubertal status adjustment. RESULTS: Among 3206 youths aged 8-18 years (50% male; 26% non-Hispanic white, 35% Mexican American, 39% non-Hispanic black), adjusting BMI for Tanner stage significantly reduced overweight (males, from 29% to 21%; females, from 29% to 17%) and obesity (males, from 14% to 7%; females, from 11% to 5%) prevalence across all races/ethnicities. The obesity prevalence reduction was more pronounced in Mexican Americans (males, 11% reduction; females, 9% reduction) and non-Hispanic blacks (males and females, 10% reduction) compared with non-Hispanic whites (males, 6% reduction; females, 5% reduction). Similar patterns were seen in overweight prevalence. CONCLUSIONS: Adjusting for pubertal status reduced the prevalence of overweight/obesity in non-Hispanic white, Mexican American, and non-Hispanic black youth. This suggests that adjusting for puberty incorporates changes otherwise not captured when only considering the age of a child. Adjusting BMI for pubertal status may be important when interpreting a youth's weight status and consideration for obesity management, as well as when interpreting pediatric overweight/obesity prevalence data.

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RESUMEN Objetivo: Identificar las prácticas habituales de uso y titulación del modo presión soporte (PC-CSV - pressure control continuous spontaneous ventilation) en pacientes bajo ventilación mecánica y analizar las formas de reconocimiento de sobreasistencia y subasistencia. Secundariamente, comparar las respuestas según profesión en relación al diagnóstico de sobreasistencia y subasistencia. Métodos: Se realizó una encuesta online utilizando la herramienta Survey Monkey. Se incluyeron a médicos, enfermeros y kinesiólogos de Argentina que tuvieran acceso al uso de PC-CSV en su práctica habitual. Resultados: Se recolectaron 509 encuestas desde octubre a diciembre 2018. El 74,1% de ellas correspondió a kinesiólogos. Un 77,6% refirió utilizar PC-CSV para iniciar la fase de soporte parcial. Un 43,8% selecciona el valor de presión de soporte inspiratorio basándose en volumen corriente. El principal objetivo de la selección de PEEP fue disminuir el trabajo respiratorio. El volumen corriente alto fue la variable primordial de detección de sobreasistencia, mientras que el uso de músculos accesorios fue la más elegida para subasistencia. Se observaron diferencias entre médicos y kinesiólogos en relación a las formas de detección de sobreasistencia. Conclusión: El modo más utilizado para la fase de soporte parcial es PC-CSV. La variable más elegida para titular la presión de soporte inspiratorio es volumen corriente y el principal objetivo de la PEEP es disminuir el trabajo respiratorio. La sobreasistencia es detectada prioritariamente por un volumen corriente elevado, mientras que la subasistencia mediante el uso de músculos accesorios. Se halló diferencias entre profesiones en relación a los criterios de detección de sobreasistencia.

ABSTRACT Objective: To identify common practices related to the use and titration of pressure-support ventilation (PC-CSV - pressure control-continuous spontaneous ventilation) in patients under mechanical ventilation and to analyze diagnostic criteria for over-assistance and under-assistance. The secondary objective was to compare the responses provided by physician, physiotherapists and nurses related to diagnostic criteria for over-assistance and under-assistance. Methods: An online survey was conducted using the Survey Monkey tool. Physicians, nurses and physiotherapists from Argentina with access to PC-CSV in their usual clinical practice were included. Results: A total of 509 surveys were collected from October to December 2018. Of these, 74.1% were completed by physiotherapists. A total of 77.6% reported using PC-CSV to initiate the partial ventilatory support phase, and 43.8% of respondents select inspiratory pressure support level based on tidal volume. The main objective for selecting positive end-expiratory pressure (PEEP) level was to decrease the work of breathing. High tidal volume was the primary variable for detecting over-assistance, while the use of accessory respiratory muscles was the most commonly chosen for under-assistance. Discrepancies were observed between physicians and physiotherapists in relation to the diagnostic criteria for over-assistance. Conclusion: The most commonly used mode to initiate the partial ventilatory support phase was PC-CSV. The most frequently selected variable to guide the titration of inspiratory pressure support level was tidal volume, and the main objective of PEEP was to decrease the work of breathing. Over-assistance was detected primarily by high tidal volume, while under-assistance by accessory respiratory muscles activation. Discrepancies were observed among professions in relation to the diagnostic criteria for over-assistance, but not for under-assistance.

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Abstract Objective: To verify factors associated with early newborn access to biological neonatal screening. Method: A cross-sectional quantitative study was carried out with all newborns who underwent tests in healthcare units, hospitals, and laboratories of a city in the state of São Paulo, Brazil, with programs linking healthcare information. The following variables were investigated: child's age at collection (dependent); place of collection; date of collection; and type of user (independent). Descriptive and inferential statistics were applied. Results: Records of 15,652 screenings were found in the two years analyzed. In the first year analyzed, 7,955 births and 7,640 (96.0%) tests were recorded, of which 5,586 (73.1%) were undertaken with newborns between three and five days old. In the next year analyzed, 8,316 births and 8,012 (96.3%) screenings were recorded, of which 7,025 (87.6%) were undertaken with newborns in the same age group. A statistically significant association was found between the variables "child's age" and "type of user" in one year, and between the variables "child's age" and "place of collection" in both years. Conclusion: Early access to these tests enables the screening of diseases and referral for treatment. The present study contributes to the management of child care programs by presenting strategies linking data and actions to improve access to biological neonatal screening.

Resumo Objetivo: verificar fatores associados ao acesso precoce de recém-nascidos à triagem neonatal biológica. Método: estudo transversal, quantitativo, com todos os bebês que realizaram exame em unidades de saúde, hospitais ou laboratórios de um município do estado de São Paulo, Brasil, com programas que vinculam informações de atenção à saúde. Foram investigadas as variáveis: idade da criança na coleta (dependente), local da coleta, data da coleta, tipo de usuário (independentes). Aplicou-se estatística descritiva e inferencial. Resultados: há registro de 15.652 triagens nos dois anos analisados. No primeiro ano analisado, ocorreram 7.955 nascimentos e 7.640 (96,0%) exames, 5.586 (73,1%) deles em recém-nascidos de três a cinco dias de vida. Para 8.316 bebês nascidos no ano seguinte, foram registradas 8.012 (96,3%) triagens, 7.025 (87,6%) delas na mesma faixa etária. Encontrou-se associação estatisticamente significativa entre as variáveis "idade da criança" e "tipo de usuário" em um ano, e entre "idade da criança" e "local da coleta" em ambos os anos. Conclusão: o acesso precoce ao exame oportuniza a triagem de doenças e o encaminhamento para tratamento. O estudo contribui com a gestão de programas de atenção à criança, ao apresentar estratégias que articulam informações e ações para melhoria do acesso à triagem neonatal biológica.

Resumo Objetivo: verificar factores asociados al acceso precoz del recién nacido al tamizaje neonatal biológico. Método: estudio transversal, cuantitativo, con todos los bebés examinados en unidades de salud, hospitales o laboratorios de un municipio del estado de São Paulo, Brasil; con programas integradores de información de atención de salud. Fueron investigadas las variables: edad del niño en la recolección (dependiente), lugar de recolección, fecha de recolección y tipo de usuario (dependientes). Se aplicó estadística descriptiva e inferencial. Resultados: existen registrados 15.652 triajes en los dos años estudiados. Durante el primero, ocurrieron 7.955 nacimientos y 7.640 (96,0%) análisis, 5.586 (73,1%) en recién nacidos de tres a cinco días de vida. Hubo 8.316 nacimientos en el año siguiente, se registraron 8.012 triajes, 7.025 (87,6%) para la misma faja etaria. Se encontró asociación estadísticamente significante entre las variables "edad del niño" y "tipo de usuario" en un año, y entre "edad del niño" y lugar de recolección" en ambos años. Conclusión: el acceso precoz al análisis permite el tamizaje de enfermedades y la derivación para tratamiento. El estudio contribuye a la gestión de programas de atención infantil, presentando estrategias que articulan información y acciones para mejorar el acceso al tamizaje neonatal biológico.

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Introducción: La obesidad es una enfermedad considerada como problema de salud pública que afecta a un gran número de personas y que requiere políticas de gobierno que enfrenten esta situación. Objetivo: Determinar las variaciones en las frecuencias de obesidad no mórbida (ONM) y obesidad mórbida (OM) de acuerdo a diferentes encuestas nacionales en función de variables socio-demográficas. Métodos: Estudio descriptivo secundario de datos de cinco encuestas nacionales: Evaluación Nutricional del Poblador Peruano (ENPPE 1975), Encuesta Nacional de Indicadores Nutricionales, Bioquímicos, Socio-económicos y Culturales (CENAN 2005), Encuesta Nacional de Hogares (ENAHO 2009-2010) y Encuesta Nacional de Hogares (ENAHO 2012-2013). La ONM se identificó por un IMC de 30 a 39,99 kg/m² y para la OM con un IMC igual o mayor de 40 kg/m². Resultados: La frecuencia de la ONM se incrementó de 8,5% en 1975 a 18,5% en el 2013, mientras la OM de 0,5 a 0,9% en el mismo periodo. La presencia de OM fue mayor en el género femenino (1,3%) frente al masculino (0,4%), con un incremento promedio en mujeres de 0,6% (0,7% en 1975 y 1,3% en 2013) y en varones de 0,2%. La presencia de obesidad fue mayor en el grupo de 50 a 59 años, en quienes viven en regiones costeras, áreas urbanas y ciudades ubicadas por debajo de 1000 msnm. Conclusiones: La ONM y la OM, presentes desde hace muchos años en nuestro país, tuvieron tendencia al incremento progresivo en los años de estudio, a predominio del género femenino.

Introduction: Obesity is a chronic disease, which is considered as a public health problem. It affects a large number of people and requires governmental policies that encourage this situation. Objective: To determine the variations in the frequencies of non-morbid obesity (NMO) and morbid obesity (MO) according with different national surveys, and in function of socio-demographic variables. Methods: A descriptive study with data of five national surveys: Nutritional Evaluation of the Peruvian Population (ENPPE 1975), National Survey of Nutritional, Biochemical, Socio-economic and Cultural Indicators (CENAN 2005), National Household Survey (ENAHO 2009-2010) and National Household Survey (ENAHO 2012-2013). NMO was identified by a BMI of 30 to 39.99 kg/m² and MO was defined by a BMI equal to or greater than 40 kg/m². Results: The frequency of NMO has increased from 8,5% in 1975 to 18,5% in 2013, and the MO increased from 0,5 to 0,9% in the same period. OM is most presented in females (1,3%) with an average increasing of 0,6% (0,7% in 1975 and 1,3% in 2013) while in men it was 0,2%. Similarly, the frequency of MO was higher in the age group of 50 to 59 years, in those who live in coastal regions, urban areas and cities located below 1000 meters above sea level. Conclusions: ONM and OM, present for many years in our country, had a tendency to the progressive increase in the years of study, with a predominance of the female gender.

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Resumen Introducción: En los procesos de atención que requieren seguimiento, como el control prenatal, la satisfacción de la usuaria puede contribuir a su resultado. La percepción de la calidad, estimada mediante la satisfacción de las usuarias, aproxima a la medición de la calidad de la atención prenatal. Objetivo: Establecer el nivel de satisfacción con el control prenatal en una institución prestadora de servicios de salud en Montería (Colombia). Metodología: Estudio transversal con componente analítico, utilizando el programa Epidat 3.1. Se estimaron promedios, medianas y proporciones según fuesen las variables cuantitativas o cualitativas. Se exploró la asociación estadística la prueba t de Student para las variables continuas y la prueba x2 para las variables categóricas, y se estimaron los OR (IC 95%) asumiendo como caso la satisfacción con el control prenatal. Resultados: De las 178 mujeres entrevistadas 96% manifestaron sentirse satisfechas con el control prenatal. Recibieron información sobre: la prueba del Virus de Inmunodeficiencia Humana 83,7%, exámenes de laboratorio 85,4%, signos de alarma 93,8%, nutrición 86,5%, lactancia 76,4%, planificación 64%, cuidados del recién nacido 71,9%. Los promedios de edad (22,7 versus 25,1 años) y de semanas de gestación (11,1 versus 14,9 semanas) son menores en las mujeres satisfechas con el control prenatal (valor p<0,001). Otras variables asociadas con la satisfacción en el control prenatal: entrega completa de medicamentos formulados (OR 8,6 IC 95% 1,6-46,2), oportunidad en la entrega de resultados de los exámenes (OR 6 IC 95% 1,2-28,9), e información suministrada sobre los signos de alarma (OR 20,3 IC 95% 3,7-112) y nutrición (OR 5,3 IC 95% 1,16-25,6). Conclusión: Además de la influencia de las variables demográficas y obstétricas y de los atributos de la calidad de la atención, es importante denotar cómo la información y la educación para la salud se asocian con la satisfacción con el control prenatal.

Abstract Introduction: In the care health processes that require follow-up, such as prenatal care, users satisfaction can contribute to its outcome. The perceived quality, estimated through users satisfaction, approximates the measurement of prenatal care quality. Objective: To establish the level of satisfaction among pregnant women with prenatal care in a health institution in Montería (Colombia). Methodology: Cross-sectional study with descriptive and analytical, using the Epidat 3.1 program. Averages, medians and proportions were estimated according to the quantitative or qualitative variables. The statistical association was explored using the Student's t test for the continuous variables and the x2 test for the categorical variables, and OR was estimated (95%CI) assuming as a case the satisfaction with the prenatal control. Results: Of the 178 women interviewed, 96% reported feeling satisfied with antenatal consultation. They received information on: Human Immunodeficiency Virus test 83.7%, laboratory tests 85.4%, obstetric danger signs 93.8%, maternal nutrition 86.5%, breastfeeding 76.4%, family planning 64%, newborn care 71.9%. The average of age (22.7 versus 25.1 years) and gestational age (11.1 versus 14.9 weeks) are lower in women satisfied with antenatal consultation (p<0.001). Other variables associated with satisfaction in antenatal care: complete medication delivery (OR 8.6 95%CI 1.6-46.2), timely laboratory results (OR 6 95%CI 1.2-28.9), and information provided on obstetric danger signs (OR 20.3 95%CI 3.7-112) and maternal nutrition (OR 5.3 95%CI 1.16-25.16). Conclusion: In addition to the influence of demographic and obstetric variables and attributes of quality care health, it is important to note how information and health education are also associated with women's satisfaction with antenatal care.

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Abstract: This study aimed to reassess the psychometric properties of the Hospital Survey on Patient Safety Culture (HSOPSC) adapted to Portuguese for use in the Brazilian context. An observational, cross-sectional study was performed in a large, private, non-profit, acute care hospital, reference in patient safety, in a major Brazilian metropolis. Participants were selected from a non-probability sample of all eligible personnel in the various hospital departments invited to participate in the study. Reliability of the HSOPSC was assessed by estimating Cronbach's alpha for each dimension. confirmatory factor analysis (CFA), a matrix of correlations between the dimensions, and exploratory structural equation modelling (ESEM) were used in exploratory and confirmatory analyses of the structural validity of the construct. The overall response rate was 18.7% (n = 1,439). Four dimensions ("overall perceptions of patient safety"; "staffing"; "teamwork across units"; and "non-punitive response to error") returned problems of internal consistency. CFA returned acceptable fit with the original 12-dimension model. Correlations between the dimensions of the original 12-dimension model indicated discriminant validity problems, while residual variance was greater than 0.70 in 13 items. The ESEM of the original 12-dimension model returned good fit, with the following indices: CFI = 0.985; TLI = 0.968, and RMSEA = 0.026 (90%CI: 0.024-0.029). Although better than those of the first evaluation, the results obtained in this validity and reliability reassessment of the Brazilian version of the HSOPSC require further research.

Resumo: O estudo teve como objetivo reavaliar as propriedades psicométricas da versão do Hospital Survey on Patient Safety Culture (HSOPSC) adaptada para o português, para uso no contexto brasileiro. Foi realizado um estudo observacional, transversal, em um hospital particular sem fins lucrativos, referência em segurança do paciente, localizado em uma metrópole brasileira. Os participantes foram selecionados a partir de uma amostra não-probabilística de todos os funcionários elegíveis de diversos departamentos hospitalares, convidados a participar no estudo. A confiabilidade do HSOPSC foi avaliada pela estimativa do alfa de Cronbach para cada dimensão. Foram usadas análise fatorial confirmatória (AFC), uma matriz de correlações entre as dimensões e modelagem de equações estruturais (MEE) na análise exploratória e confirmatória da validade estrutural do construto. Houve uma taxa global de resposta de 18,7% (n = 1.439). Quatro dimensões ("percepção geral de segurança do paciente"; "recursos humanos"; "trabalho de equipe entre unidades" e "resposta não-punitiva aos erros") apresentaram problemas de consistência interna. A AFC mostrou um ajuste aceitável em relação ao modelo original de 12 dimensões. As correlações entre as dimensões do modelo original de 12 dimensões indicaram problemas de validade discriminante, enquanto a variância residual foi maior de 0,70 em 13 itens. A MEE do modelo original de 12 dimensões mostrou bom ajuste, com os seguintes índices: CFI = 0,985; TLI = 0,968 e RMSEA = 0,026 (IC90%: 0,024-0,029). Embora tenham superado a primeira avaliação, os resultados obtidos nesta reavaliação da validade e confiabilidade da versão do questionário traduzida e adaptada para o contexto brasileiro indicam a necessidade de mais estudos.

Resumen: El estudio tuvo como objetivo revisar las propiedades psicométricas de la versión del Hospital Survey on Patient Safety Culture (HSOPSC) adaptado al portugués, para su uso en el contexto brasileño. Se realizó un estudio transversal observacional, en un hospital grande con cuidados intensivos, privado, sin ánimo de lucro, punto de referencia en seguridad del paciente, situado en una de las mayores metrópolis brasileñas. Los participantes se seleccionaron de un muestreo no probabilístico entre todo el personal elegible de los diversos departamentos hospitalarios invitados a participar en el estudio. La fiabilidad del HSOPSC se evaluó estimando el alfa de Cronbach para cada dimensión. Se utilizaron tanto el análisis factorial confirmatorio (AFC), como la matriz de correlaciones entre las dimensiones y los modelos de ecuaciones estructurales exploratorios (ESEM) en el análisis exploratorio y confirmatorio para la validez estructural del constructo. El porcentaje general de respuesta fue de un 18,7% (n = 1,439). Hubo cuatro dimensiones ("percepciones generales de seguridad del paciente"; "dotación de personal"; "trabajo en equipo en las unidades"; y "respuesta al error no-punitiva"), problemas recurrentes de consistencia interna. El AFC mostró un ajuste aceptable con el modelo original de 12-dimensiones. Las correlaciones entre las dimensiones del modelo original de 12-dimensiones indicaron problemas de validez discriminante, mientras que varianza residual era mayor a 0,70 en 13 ítems. Los ESEM del modelo original de 12-dimensiones tuvieron un buen ajuste con los siguientes índices: CFI = 0,985; TLI = 0,968 y RMSEA = 0,026 (90%CI: 0,024-0,029). A pesar de que eran mejores que los de la primera evaluación, los resultados obtenidos en esta revisión de la validez y fiabilidad de la versión del cuestionario, traducido y adaptado al contexto brasileño, es necesario que haya más investigaciones al respecto sobre este asunto.

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Resumen Introducción. El cólera es una enfermedad infecciosa de comportamiento epidémico, que sigue amenazando la salud pública. En 2010 estalló un brote en Haití cuya letalidad inicial fue de 6,4%, posiblemente por falta de conocimientos del personal médico sobre su manejo. La letalidad se estabilizó alrededor del 1%, pero existe el riesgo que la epidemia llegue a Colombia y haya médicos sin adecuado conocimiento para su intervención. Objetivo. Determinar el nivel de conocimientos sobre el cólera que tienen los estudiantes de Medicina de una universidad en Colombia. Materiales y métodos. Estudio observacional de corte transversal. Previo consentimiento informado, se aplicó una encuesta sobre conocimientos del cólera a estudiantes de Medicina que ya habían aprobado los cursos de ciencias básicas, infecciosas y epidemiología. Resultados. Participaron 323 estudiantes, con promedio de edad de 22 años, 50,8% hombres. Los niveles de conocimiento fueron independientes de edad y sexo, pero aumentan con el nivel académico (p=0,031). Los conocimientos sobre signos clínicos, vía de transmisión y población vulnerable, fueron acertados por más del 90% de los participantes; mientras que saberes sobre configuración del brote, uso de antibióticos y comportamiento reciente del cólera, fueron respondidos adecuadamente por menos del 23% de ellos. Conclusión. Los estudiantes de Medicina tienen conocimientos insuficientes para garantizar un adecuado manejo de un brote de cólera, sobre todo en lo concerniente al uso de antibióticos y la prevención de la trasmisión de la enfermedad.

Abstract Introduction. Cholera is an infectious disease with epidemic behavior. Despite scientific advances, it stills a threat for public health. In 2010, an outbreak exploded in Haiti, its initial lethality was as high as 6.4% and then stabilized near of 1%, possibly because lack of knowledge about management by medical staff. There is a risk that epidemic arrives to Colombia and finds a similar scenery.- Objective. To determine the knowledge level about cholera in medical students of an University of Colombia. Materials and methods. This is an observational, analytical, cross sectional study. Prior informed consent, we applied a survey about cholera knowledge to medical students who had already approved the basic sciences, infectology and epidemiology courses. Results. The participants were 323 students whose average age was 22 years, 50.8 % were men. Knowledge levels had nothing to do with age and sex, but increase with academic level (p=0,031). Knowledge about clinical signs, transmission via and populations at risk, were correct in more than 90% of participants; as long as knowledge about outbreak configuration, use of antibiotics and recent behavior of cholera were answered appropriated by less of 23% of them. Conclusion. Medical students have not enough knowledge to guarantee an adequate management of a cholera outbreak, antibiotics use, and prevention of disease.

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