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Developing and implementing an epidemiological surveillance plan was necessary during the COVID-19 pandemic to ensure safe dental practice. This was due to the high risk faced by this occupational group during the COVID-19 pandemic. This study aimed to determine the factors associated with COVID-19 diagnosis in a Peruvian dental school's integrated teaching and care service. A cross-sectional study was conducted with a population made up of the records of students, teachers, and administrative personnel in a COVID-19 epidemiological surveillance plan of a dental school during the years 2021 to 2022. The year 2022 was positively associated with a positive diagnosis of COVID-19 (aPR: 1.51; 95% CI: 1.10-2.07; p = 0.010) and not having had contact with a patient with COVID-19 was negatively associated with being diagnosed with that disease (aPR: 0.20; 95% CI: 0.14-0.27; p < 0.001). In conclusion, 2022 was positively associated with having a positive COVID-19 diagnosis. In addition, not having had contact with a COVID-19 patient was negatively associated with the disease diagnosis and with the development of moderate to severe COVID-19.

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OBJECTIVES: The National Registry of Healthcare Facilities is a system with the registry of every healthcare facility in Brazil with information on the capacity building and healthcare workforce regarding its public or private nature. Despite being publicly available, it can only be accessed in separated disjoint tables, with different primary units of analysis. The objective is to offer an interoperable dataset containing monthly data from 2005 to 2021 with information on healthcare facilities, including their physical and human resources, services and teams, enriched with municipal information. DATA DESCRIPTION: Database with historical data and geographic information for each health facility in Brazil. It is composed by 5 distinct tables, organized according to combinations of time, space, and types of resources, services and teams. This database opens up a range of possibilities for research topics, from case studies in a single health facility and period, analysis of a group of health facilities with characteristics of interest, to a broader study using the entire dataset and aggregated data by municipality. Furthermore, the fact that there is a row for each health facility/month/year facilitates the integration with other datasets from the Brazilian healthcare system. In addition to being a potential object of study in the health area, the dataset is also convenient in data science, especially for studies focused on time series.

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Primary health care is at the core of health systems that aim to ensure equitable health outcomes. With an estimated 36% of rural population, Ecuador has a service year programme (created in 1970) for recently graduated doctors to provide primary care services in rural and remote communities. However, little has been done to monitor or evaluate the programme since its inception. The aim of this study was to assess Ecuador's rural medical service implementation with a focus on equitable distribution of doctors across the country. For this purpose, we analysed the distribution of all doctors, including rural service doctors, in health-care facilities across rural and remote areas of Ecuador in the public sector at the canton level for 2015 and 2019, by level of care (primary, secondary and tertiary). We used publicly available data from the Ministry of Public Health, the Ecuadorian Institute of Social Security and the Peasant Social Security. Our analyses show that two of every three rural service doctors are concentrated at the secondary level, while almost one in five rural service doctors, at the tertiary level. Moreover, cantons concentrating most rural service doctors were in the country's major urban centres (Quito, Guayaquil, Cuenca). To our knowledge, this is the first quantitative assessment of the mandatory rural service year in Ecuador in its five-decade existence. We provide evidence of gaps and inequities impacting rural communities and present decision makers with a methodology for placement, monitoring and support of the rural service doctors programme, provided that legal and programmatic reforms come into place. Changing the programme's approach would be more likely to fulfill the intended goals of rural service and contribute to strengthening primary health care.

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Objective: To compare and contrast the characteristics of the accreditation process for health care facilities in Canada, Chile, the Autonomous Community of Andalusia (Spain), Denmark, and Mexico, in order to identify shared characteristics, differences, and lessons learned that may be useful for other countries and regions. Methods: An observational, analytical, retrospective study using open-access secondary sources on the accreditation and certification of health care facilities in 2019-2021 in these countries and regions. The general characteristics of the accreditation processes are described and comments are made on key aspects of the design of these programs. Additionally, analytical categories were created for degree of implementation and level of complexity, and the positive and negative results reported are summarized. Results: The operational components of the accreditation processes are country-specific, although they share similarities. The Canadian program is the only one that involves some form of responsive evaluation. There is a wide range in the percentage of establishments accredited from country to country (from 1% in Mexico to 34.7% in Denmark). Notable lessons learned include the complexity of application in a mixed public-private system (Chile), the risk of excessive bureaucratization (Denmark), and the need for clear incentives (Mexico). Conclusions: The accreditation programs operate in a unique way in each country and region, achieve varying degrees of implementation, and have an assortment of problems, from which lessons can be learned. Elements that hinder their implementation should be considered and adjustments made for the health systems of each country and region.

Objetivo: Comparar as características do processo de acreditação de estabelecimentos de saúde no Canadá, Chile, Comunidade Autônoma da Andaluzia, Dinamarca e México, a fim de identificar elementos comuns e diferenças, bem como lições aprendidas que podem ser úteis para outros países e regiões. Métodos: Estudo observacional, analítico e retrospectivo usando fontes secundárias de livre acesso sobre acreditação e certificação de estabelecimentos de saúde durante o período 2019-2021 nos países e regiões supracitados. As características gerais do processo de acreditação e suas respostas a pontos-chave no delineamento de tais programas foram descritas. Além disso, foram geradas categorias de análise para o andamento de sua implantação e seu grau de complexidade, e os desfechos favoráveis e desfavoráveis relatados foram resumidos. Resultados: Os componentes operacionais do processo de acreditação são peculiares a cada país, embora compartilhem certas semelhanças. O programa canadense é o único que contempla algum tipo de avaliação responsiva. Houve grande variação entre países no percentual de estabelecimentos acreditados (de 1% no México a 34,7% na Dinamarca). Entre as lições aprendidas, destacam-se a complexidade da aplicação do sistema misto público-privado (Chile), o risco de burocratização excessiva (Dinamarca) e a necessidade de incentivos claros (México). Conclusões: Os programas de acreditação operam de forma peculiar em cada país ou região, têm diferentes escopos e também apresentam diversos problemas a partir dos quais podemos aprender. É preciso considerar os elementos que dificultam a implementação e realizar as adequações necessárias para os sistemas de saúde de cada país ou região.

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Abstract Background and objectives: Contribution margin per hour (CMH) has been proposed in healthcare systems to increase the profitability of operating suites. The aim of our study is to propose a simple and reproducible model to calculate CMH and to increase cost-effectiveness. Methods: For the ten most commonly performed surgical procedures at our Institution, we prospectively collected their diagnosis-related group (DRG) reimbursement, variable costs and mean procedural time. We quantified the portion of total staffed operating room time to be reallocated with a minimal risk of overrun. Moreover, we calculated the total CMH with a random reallocation on a first come-first served basis. Finally, prioritizing procedures with higher CMH, we ran a simulation by calculating the total CMH. Results: Over a two-months period, we identified 14.5 hours of unutilized operating room to reallocate. In the case of a random ''first come -first serve'' basis, the total earnings were 87,117 United States dollars (USD). Conversely, with a reallocation which prioritized procedures with a high CMH, it was possible to earn 140,444 USD (p < 0.001). Conclusion: Surgical activity may be one of the most profitable activities for hospitals, but a cost-effective management requires a comprehension of its cost profile. Reallocation of unused operating room time according to CMH may represent a simple, reproducible and reliable tool for elective cases on a waiting list. In our experience, it helped improving the operating suite cost-effectiveness.

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BACKGROUND AND OBJECTIVES: Contribution margin per hour (CMH) has been proposed in healthcare systems to increase the profitability of operating suites. The aim of our study is to propose a simple and reproducible model to calculate CMH and to increase cost-effectiveness. METHODS: For the ten most commonly performed surgical procedures at our Institution, we prospectively collected their diagnosis-related group (DRG) reimbursement, variable costs and mean procedural time. We quantified the portion of total staffed operating room time to be reallocated with a minimal risk of overrun. Moreover, we calculated the total CMH with a random reallocation on a first come-first served basis. Finally, prioritizing procedures with higher CMH, we ran a simulation by calculating the total CMH. RESULTS: Over a two-months period, we identified 14.5 hours of unutilized operating room to reallocate. In the case of a random "first come-first serve" basis, the total earnings were 87,117 United States dollars (USD). Conversely, with a reallocation which prioritized procedures with a high CMH, it was possible to earn 140,444 USD (p < 0.001). CONCLUSION: Surgical activity may be one of the most profitable activities for hospitals, but a cost-effective management requires a comprehension of its cost profile. Reallocation of unused operating room time according to CMH may represent a simple, reproducible and reliable tool for elective cases on a waiting list. In our experience, it helped improving the operating suite cost-effectiveness.

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Resumo: Este artigo analisa o processo de transformação estrutural no mercado privado de serviços de saúde brasileiro a partir dos anos 2000, com ênfase na crescente participação de fundos financeiros e do capital estrangeiro no processo de expansão e consolidação do setor. A análise do movimento de ingresso do capital estrangeiro nos serviços e planos de saúde no Brasil foi desenvolvida a partir da construção de uma base dados com um total de 297 operações patrimoniais envolvendo empresas com atividades em serviços de saúde, inclusive operadoras de planos e seguros de saúde e administradoras de benefícios em saúde. A análise dessas operações evidencia que o afluxo de capital estrangeiro foi fundamental para viabilizar a centralização de capital em determinadas empresas e catalisar o processo de concentração e transformação estrutural do setor de serviços de saúde ao longo das últimas duas décadas. Conclui-se que o acirramento da disputa intercapitalista no mercado de serviços de saúde levou à emergência de grandes corporações no mercado e a novos modelos de negócio, com destaque especial para o surgimento de redes verticalizadas de atendimento (operação de planos, serviços hospitalares, ambulatoriais, de diagnóstico e tratamento e de atenção básica).

Abstract: This article analyzes the process of structural transformation within the Brazilian private health services market since the 2000s, with emphasis on the growing participation of financial funds and foreign capital in the process of expansion and consolidation of the sector. The analysis of the movement of foreign capital into health services and plans in Brazil was developed from the construction of a database with a total of 297 equity operations involving companies with activities in health services, including companies operating health plans and insurance and companies administering health benefits. The analysis of these operations shows that the influx of foreign capital was fundamental to enable the centralization of capital in certain companies and catalyze the process of concentration and structural transformation of the health services sector over the last two decades. We concluded that the intensification of the intercapitalist dispute within the health services market led to the emergence of large corporations and new business models, with special emphasis on the emergence of verticalized care networks (operation of plans, hospital services, outpatient services, diagnosis and treatment, and primary care).

Resumen: Este artículo analiza el proceso de transformación estructural en el mercado privado de servicios de salud brasileño, a partir de los años 2000, con énfasis en la creciente participación de fondos financieros y del capital extranjero en el proceso de expansión y consolidación del sector. El análisis del movimiento de ingreso del capital extranjero en los servicios y planes de salud en Brasil fue desarrollado a partir de la construcción de una base datos con un total de 297 operaciones de capital de empresas con actividades en servicios de salud; inclusive las empresas operadoras de planes y seguros de salud y las empresas administradoras de beneficios en salud. El análisis de esas operaciones muestra que la entrada de capital extranjero fue fundamental para viabilizar la centralización de capital en determinadas empresas y catalizar el proceso de concentración y transformación estructural del sector de servicios de salud a lo largo de las últimas dos décadas. La conclusión que el recrudecimiento de la disputa intercapitalista dentro del mercado de servicios de salud llevó a la emergencia de grandes corporaciones en el mercado y nuevos modelos de negocio, con destaque especial para surgimiento de redes verticalizadas de atención (operación de planes, servicios hospitalarios, ambulatorios, de diagnóstico y tratamiento y de atención básica).

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ABSTRACT The introduction of chatbots has been one of the most intriguing advances in artificial intelligence. There are numerous potential uses for artificial intelligence in clinical research. However, there are also some issues that require attention. Everyone agrees that AI requires a more stable foundation and that a cutting-edge approach is necessary for AI to operate effectively.

RESUMO A introdução de chatbots foi um dos avanços mais intrigantes da inteligência artificial. Existem inúmeros usos potenciais para a inteligência artificial (IA) na pesquisa clínica. No entanto, há também outras questões que requerem atenção. Todos concordam que a IA precisa de uma base mais estável. Todos podemos concordar que uma abordagem de ponta é necessária para que a IA opere de forma eficaz.

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ABSTRACT Introduction Gratitude has several implications. Over time, a logical relationship has been established between gratitude and well-being. In addition, researchers aimed to establish associations between gratitude and other factors of positive feelings using scientific methods. We conducted a systematic review and meta-analysis of interventions to develop gratitude and its benefits to human beings. Objective This study aimed to evaluate and quantify the available scientific evidence on interventions to acquire knowledge on gratitude as a quantifiable causal factor of benefit to human beings. Methods A systematic literature search was conducted to identify studies that investigated the effects of gratitude interventions. MEDLINE, Embase, and Central Cochrane databases were searched in addition to gray (Google Scholar) and manual search. Two authors independently evaluated the titles and abstracts, and selected the studies that met the inclusion criteria. The searches were conducted between January and July 2022. Results Sixty-four randomized clinical trials were included. The meta-analysis demonstrated that patients who underwent gratitude interventions experienced greater feelings of gratitude, better mental health, and fewer symptoms of anxiety and depression. Moreover, they experienced other benefits such as a more positive mood and emotions. Conclusion The results demonstrate that acts of gratitude can be used as a therapeutic complement for treating anxiety and depression and can increase positive feelings and emotions in the general population. Prospero database registration: (www.crd.york.ac.uk/prospero) under the number CRD42021250799.

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RESUMEN Objetivo. Contrastar las características del proceso de acreditación de establecimientos de salud en Canadá, Chile, la Comunidad Autónoma de Andalucía, Dinamarca y México, con el fin de identificar elementos comunes y diferencias, y las lecciones aprendidas que puedan ser de utilidad para otros países y regiones. Métodos. Estudio observacional, analítico y retrospectivo en el que se usaron fuentes secundarias de libre acceso sobre acreditación y certificación de establecimientos de salud durante el período 2019-2021 en estos países y regiones. Se describen las características generales del proceso de acreditación y sus respuestas a puntos clave del diseño de estos programas. Además, se generaron categorías de análisis para el avance en su implementación y su nivel de complejidad, y se resumen los resultados favorables y desfavorables informados. Resultados. Los componentes operativos del proceso de acreditación son peculiares de cada país, aunque comparten similitudes. El programa de Canadá es el único que contempla algún tipo de evaluación responsiva. Hay una amplia variación en la cobertura de establecimientos acreditados entre países (desde 1% en México a 34,7% en Dinamarca). Entre las lecciones aprendidas, se destacan la complejidad de aplicación del sistema mixto público-privado (Chile), el riesgo de una excesiva burocratización (Dinamarca) y la necesidad de incentivos claros (México). Conclusiones. Los programas de acreditación operan de forma peculiar en cada país o región, logran alcances diferentes y presentan problemáticas también diversas, de las que podemos aprender. Es necesario considerar los elementos que obstaculizan la implementación y generar adecuaciones para los sistemas de salud en cada país o región.

ABSTRACT Objective. To compare and contrast the characteristics of the accreditation process for health care facilities in Canada, Chile, the Autonomous Community of Andalusia (Spain), Denmark, and Mexico, in order to identify shared characteristics, differences, and lessons learned that may be useful for other countries and regions. Methods. An observational, analytical, retrospective study using open-access secondary sources on the accreditation and certification of health care facilities in 2019-2021 in these countries and regions. The general characteristics of the accreditation processes are described and comments are made on key aspects of the design of these programs. Additionally, analytical categories were created for degree of implementation and level of complexity, and the positive and negative results reported are summarized. Results. The operational components of the accreditation processes are country-specific, although they share similarities. The Canadian program is the only one that involves some form of responsive evaluation. There is a wide range in the percentage of establishments accredited from country to country (from 1% in Mexico to 34.7% in Denmark). Notable lessons learned include the complexity of application in a mixed public-private system (Chile), the risk of excessive bureaucratization (Denmark), and the need for clear incentives (Mexico). Conclusions. The accreditation programs operate in a unique way in each country and region, achieve varying degrees of implementation, and have an assortment of problems, from which lessons can be learned. Elements that hinder their implementation should be considered and adjustments made for the health systems of each country and region.

RESUMO Objetivo. Comparar as características do processo de acreditação de estabelecimentos de saúde no Canadá, Chile, Comunidade Autônoma da Andaluzia, Dinamarca e México, a fim de identificar elementos comuns e diferenças, bem como lições aprendidas que podem ser úteis para outros países e regiões. Métodos. Estudo observacional, analítico e retrospectivo usando fontes secundárias de livre acesso sobre acreditação e certificação de estabelecimentos de saúde durante o período 2019-2021 nos países e regiões supracitados. As características gerais do processo de acreditação e suas respostas a pontos-chave no delineamento de tais programas foram descritas. Além disso, foram geradas categorias de análise para o andamento de sua implantação e seu grau de complexidade, e os desfechos favoráveis e desfavoráveis relatados foram resumidos. Resultados. Os componentes operacionais do processo de acreditação são peculiares a cada país, embora compartilhem certas semelhanças. O programa canadense é o único que contempla algum tipo de avaliação responsiva. Houve grande variação entre países no percentual de estabelecimentos acreditados (de 1% no México a 34,7% na Dinamarca). Entre as lições aprendidas, destacam-se a complexidade da aplicação do sistema misto público-privado (Chile), o risco de burocratização excessiva (Dinamarca) e a necessidade de incentivos claros (México). Conclusões. Os programas de acreditação operam de forma peculiar em cada país ou região, têm diferentes escopos e também apresentam diversos problemas a partir dos quais podemos aprender. É preciso considerar os elementos que dificultam a implementação e realizar as adequações necessárias para os sistemas de saúde de cada país ou região.

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Os pacientes com síndrome pós-COVID-19 se beneficiam de programas de promoção de saúde e sua rápida identificação é importante para a utilização custo efetiva desses programas. Técnicas tradicionais de identificação têm fraco desempenho, especialmente em pandemias. Portanto, foi realizado um estudo observacional descritivo utilizando 105.008 autorizações prévias pagas por operadora privada de saúde com aplicação de método não supervisionado de processamento de linguagem natural por modelagem de tópicos para identificação de pacientes suspeitos de infecção por COVID-19. Foram gerados seis modelos: três utilizando o algoritmo BERTopic e três modelos Word2Vec. O modelo BERTopic cria automaticamente grupos de doenças. Já no modelo Word2Vec, para definição dos tópicos relacionados a COVID-19, foi necessária análise manual dos 100 primeiros casos de cada tópico. O modelo BERTopic com mais de 1.000 autorizações por tópico sem tratamento de palavras selecionou pacientes mais graves - custo médio por autorizações prévias pagas de BRL 10.206 e gasto total de BRL 20,3 milhões (5,4%) em 1.987 autorizações prévias (1,9%). Teve 70% de acerto comparado à análise humana e 20% de casos com potencial interesse, todos passíveis de análise para inclusão em programa de promoção à saúde. Teve perda importante de casos quando comparado ao modelo tradicional de pesquisa com linguagem estruturada e identificou outros grupos de doenças - ortopédicas, mentais e câncer. O modelo BERTopic serviu como método exploratório a ser utilizado na rotulagem de casos e posterior aplicação em modelos supervisionados. A identificação automática de outras doenças levanta questionamentos éticos sobre o tratamento de informações em saúde por aprendizado de máquina.

Los pacientes con síndrome pos-COVID-19 pueden beneficiarse de los programas de promoción de la salud. Su rápida identificación es importante para el uso efectivo de estos programas. Las técnicas de identificación tradicionales no tienen un buen desempeño, especialmente en pandemias. Se realizó un estudio observacional descriptivo, con el uso de 105.008 autorizaciones previas pagadas por un operador de salud privado mediante la aplicación de un método no supervisado de procesamiento del lenguaje natural mediante modelado temático para identificar a los pacientes sospechosos de estar infectados por COVID-19. Se generaron 6 modelos: 3 con el uso del algoritmo BERTopic y 3 modelos Word2Vec. El modelo BERTopic crea automáticamente grupos de enfermedades. En el modelo Word2Vec para definir temas relacionados con la COVID-19, fue necesario el análisis manual de los primeros 100 casos de cada tema. El modelo BERTopic con más de 1.000 autorizaciones por tema sin tratamiento de palabras seleccionó a pacientes más graves: costo promedio por autorizaciones previas pagada de BRL 10.206 y gasto total de BRL 20,3 millones (5,4%) en 1.987 autorizaciones previas (1,9%). Además, contó con el 70% de aciertos en comparación con el análisis humano y el 20% de los casos con potencial interés, todos los cuales pueden analizarse para su inclusión en un programa de promoción de la salud. Hubo una pérdida significativa de casos en comparación con el modelo tradicional de investigación con lenguaje estructurado y se identificó otros grupos de enfermedades: ortopédicas, mentales y cáncer. El modelo BERTopic sirvió como un método exploratorio para ser utilizado en el etiquetado de casos y su posterior aplicación en modelos supervisados. La identificación automática de otras enfermedades plantea preguntas éticas sobre el tratamiento de la información de salud mediante el aprendizaje de máquina.

Patients with post-COVID-19 syndrome benefit from health promotion programs. Their rapid identification is important for the cost-effective use of these programs. Traditional identification techniques perform poorly especially in pandemics. A descriptive observational study was carried out using 105,008 prior authorizations paid by a private health care provider with the application of an unsupervised natural language processing method by topic modeling to identify patients suspected of being infected by COVID-19. A total of 6 models were generated: 3 using the BERTopic algorithm and 3 Word2Vec models. The BERTopic model automatically creates disease groups. In the Word2Vec model, manual analysis of the first 100 cases of each topic was necessary to define the topics related to COVID-19. The BERTopic model with more than 1,000 authorizations per topic without word treatment selected more severe patients - average cost per prior authorizations paid of BRL 10,206 and total expenditure of BRL 20.3 million (5.4%) in 1,987 prior authorizations (1.9%). It had 70% accuracy compared to human analysis and 20% of cases with potential interest, all subject to analysis for inclusion in a health promotion program. It had an important loss of cases when compared to the traditional research model with structured language and identified other groups of diseases - orthopedic, mental and cancer. The BERTopic model served as an exploratory method to be used in case labeling and subsequent application in supervised models. The automatic identification of other diseases raises ethical questions about the treatment of health information by machine learning.

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Purpose of Review: Our aim is to provide a historical review of the implementation of a cancer rehabilitation center in Brazil, active since 2008. We expect this data to support the implementation of other centers both in Brazil and worldwide. Recent Findings: Cancer rehabilitation delivery is fragmented and punctuated in most cases, and cancer rehabilitation centers are rare. Data on how to establish rehabilitation centers could facilitate the implementation of new centers. We provide data on what was our strategy for hiring, establishing treatment protocols, barriers, and facilitators. We also provide figures on the number of each rehabilitation specialist, as well as the general standard operating procedures of our rehabilitation center, among other features. Summary: Establishing cancer rehabilitation centers in a middle-income country is feasible. We expect that our experience may facilitate the establishment of new cancer rehabilitation services and the improvement of current ones.

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RESUMO Objetivo: Descrever e comparar a estrutura das unidades de terapia intensiva argentinas que responderam ao inquérito de autoavaliação de unidades de terapia intensiva desenvolvido pela Sociedad Argentina de Terapia Intensiva. Métodos: Foi realizado um estudo transversal observacional com uso de um inquérito voluntário online por meio do banco de dados de membros da Sociedad Argentina de Terapia Intensiva e outras publicações em mídias sociais. Foram analisadas as respostas recebidas entre dezembro de 2018 e julho de 2020. Foram utilizados testes não paramétricos e estatística descritiva. Resultados: Foram recebidos 392 inquéritos, sendo 244 considerados para a análise. Eram de unidades de terapia intensiva adulto 77% (187/244), e 23% (57/244) eram de unidades de terapia intensiva pediátrica. A taxa de participação foi de 76%. A amostra incluiu 2.567 leitos de unidades de terapia intensiva (1.981 adulto e 586 pediátrica). Observamos nítida concentração de unidades de terapia intensiva nas regiões Centro e Buenos Aires, Argentina. A mediana de leitos foi de dez (intervalo interquartil 7 - 15). A mediana de monitores multiparamétricos, ventiladores mecânicos e oxímetros de pulso foi de um por leito, sem diferenças regionais ou de tipo de unidade de terapia intensiva (adulto ou pediátrica). Embora nossa amostra tenha evidenciado que as unidades de terapia intensiva pediátrica apresentaram proporção de ventilação mecânica/leito maior do que as unidades de terapia intensiva adulto, esse achado não foi linearmente correlacionado. Conclusão: A Argentina tem concentração notável de leitos de cuidados intensivos e complexidade estrutural superior nas regiões de Buenos Aires e Centro, tanto de unidades de terapia intensiva adulto quanto pediátrica. Além disso, observou-se ausência de dados precisos informados sobre a estrutura e os recursos de unidades de terapia intensiva. São necessárias mais opções de melhoria para alocar os recursos de unidades de terapia intensiva nos níveis institucional e regional.

ABSTRACT Objective: To describe and compare the structure of Argentinean intensive care units that completed the "self-assessment survey of intensive care units" developed by the Sociedad Argentina de Terapia Intensiva. Methods: An observational crosssectional study was conducted using an online voluntary survey through the Sociedad Argentina de Terapia Intensiva member database and other social media postings. Answers received between December 2018 and July 2020 were analyzed. Descriptive statistics and nonparametric tests were used. Results: A total of 392 surveys were received, and 244 were considered for the analysis. Seventy-seven percent (187/244) belonged to adult intensive care units, and 23% (57/244) belonged to pediatric intensive care units. The overall completion rate was 76%. The sample included 2,567 ICU beds (adult: 1,981; pediatric: 586). We observed a clear concentration of intensive care units in the Central and Buenos Aires regions of Argentina. The median number of beds was 10 (interquartile range 7 - 15). The median numbers of multiparameter monitors, mechanical ventilators, and pulse oximeters were 1 per bed with no regional or intensive care unit type differences (adult versus pediatric). Although our sample showed that the pediatric intensive care units had a higher mechanical ventilation/bed ratio than the adult intensive care units, this finding was not linearly correlated. Conclusion: Argentina has a notable concentration of critical care beds and better structural complexity in the Buenos Aires and Centro regions for both adult and pediatric intensive care units. In addition, a lack of accurate data reported from the intensive care unit structure and resources was observed. Further improvement opportunities are required to allocate intensive care unit resources at the institutional and regional levels.

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Resumen Desde su surgimiento, la utilización de las tecnologías de la información y la comunicación ha logrado mayores ventajas competitivas en las empresas y organismos públicos, incluyendo el sector salud, aunque sobre este hay poca evidencia científica. El objetivo de la investigación fue validar un cuestionario para la medición del desempeño competitivo de las instituciones de salud del estado de Baja California, mediante el uso de las tecnologías de la información y la comunicación. El enfoque del estudio es cuantitativo, con alcance descriptivo de tipo retrospectivo y diseño no experimental de corte transversal. El cuestionario elaborado con base en la revisión de literatura se aplicó entre septiembre de 2020 y mayo de 2021 a una muestra de profesionales de la salud (n = 203). Constó de 59 ítems, como resultado de la medición de 9 dimensiones, en donde su índice de validez de contenido para n = 13 expertos fue catalogado como adecuado (0.79). La fiabilidad obtenida en la prueba piloto fue alta (alfa de Cronbach = 0.86). Para evaluar la validez de constructo se llevó a cabo un análisis factorial exploratorio, que determinó 9 factores que explican el 84.5 % de la varianza total y una fuerte correlación entre las variables. El instrumento obtenido presentó adecuadas propiedades psicométricas de confiabilidad y validez, que a su vez permitieron medir el impacto que tienen las tecnologías de la información y comunicación sobre el desempeño competitivo de las instituciones de salud.

Abstract Since their emergence, the use of information and communication technologies has achieved greater competitive advantages in companies and public organizations, including the health sector, although there is little scientific evidence about it. The objective of the research was to validate a questionnaire to measure the competitive performance of health institutions in the state of Baja California, through the use of information and communication technologies. The study approach is quantitative, with a retrospective descriptive scope and a non-experimental cross-sectional design. The questionnaire developed based on the literature review was administered between September 2020 and May 2021 to a sample of health professionals (n = 203). It consisted of 59 items, as a result of measuring 9 dimensions, where its content validity index for n = 13 experts was classified as adequate (0.79). The reliability obtained in the pilot test was high (Cronbach's Alpha = 0.86). To evaluate the construct validity, an exploratory factor analysis was carried out, which determined 9 factors that explain 84.5 % of the total variance and a strong correlation between the variables. The obtained instrument presented adequate psychometric properties of reliability and validity, which in turn made it possible to measure the impact of information and communication technologies on the competitive performance of health institutions.

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In the information units that make up the Instituto Mexicano del Seguro Social (IMSS) Library System, the task of guiding and training users on the use of information is a complex process, due to the specificity of the users' information needs. The information systems that are used in the Institute require the personal librarian to have specific information skills for access, evaluation, organization and use of information through information technologies. However, there are important challenges, such as the lack of definition of the professional profile of the medical librarian, because it is essential for the staff to efficiently satisfy the demands and needs of users according to their various profiles.

En las unidades de información que integran el Sistema Bibliotecario del Instituto Mexicano del Seguro Social (IMSS), la tarea de orientar y formar a los usuarios sobre el uso de información es un proceso complejo, debido a la especificidad de las necesidades de información de los usuarios. Los sistemas de información que son utilizados en el Instituto exigen al personal bibliotecario contar con competencias informativas específicas para el acceso, evaluación, organización y uso de la información por medio de las tecnologías de la información. Sin embargo, existen grandes retos, como la carencia de la definición del perfil profesional del bibliotecario médico, ya que es indispensable para que el personal logre satisfacer de forma eficiente las demandas y necesidades de los usuarios de acuerdo con sus diversos perfiles.

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En las unidades de información que integran el Sistema Bibliotecario del Instituto Mexicano del Seguro Social (IMSS), la tarea de orientar y formar a los usuarios sobre el uso de información es un proceso complejo, debido a la especificidad de las necesidades de información de los usuarios. Los sistemas de información que son utilizados en el Instituto exigen al personal bibliotecario contar con competencias informativas específicas para el acceso, evaluación, organización y uso de la información por medio de las tecnologías de la información. Sin embargo, existen grandes retos, como la carencia de la definición del perfil profesional del bibliotecario médico, ya que es indispensable para que el personal logre satisfacer de forma eficiente las demandas y necesidades de los usuarios de acuerdo con sus diversos perfiles.

In the information units that make up the Instituto Mexicano del Seguro Social (IMSS) Library System, the task of guiding and training users on the use of information is a complex process, due to the specificity of the users' information needs. The information systems that are used in the Institute require the personal librarian to have specific information skills for access, evaluation, organization and use of information through information technologies. However, there are important challenges, such as the lack of definition of the professional profile of the medical librarian, because it is essential for the staff to efficiently satisfy the demands and needs of users according to their various profiles.

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Introducción: Para enfermería, el confort es un objetivo de cuidado en los múltiples escenarios del actuar disciplinario, lleva a la formulación de teorías con perspectiva holística y logra aplicar el confort desde una mirada física, psicoespiritual, ambiental y social. Objetivo: Identificar los atributos del concepto confort entendido por enfermería en los diferentes escenarios de cuidado. Métodos: Revisión integrativa, con estrategia de búsqueda: "Confort" AND "Nursing", en las bases de datos Scopus, Google Académico, BVS, EBSCO, Cochrane, Ovid y Medline. Los criterios de elegibilidad fueron: estudios primarios, a texto completo, publicados entre 2009-2019, en español, inglés y portugués. Se utilizó el diagrama prisma para el análisis crítico de diseños experimentales, revisiones y cualitativos, se emplearon las plantillas del Critical Appraisal Skills Programme (Caspe). Para los demás diseños se aplicaron las listas de chequeo del Joanna Briggs Institute, quedaron incluidos 16 artículos. Conclusión: El confort está ligado a temas que enmarcan la realidad física, social, psíquica y ambiental de la persona, determinado por los atributos: 1. Alivio físico del dolor mediante intervenciones farmacológicas y de elementos externos en contacto con el cuerpo. 2. Soporte social con cercanía de los familiares, lo que facilita la adaptación al ambiente hospitalario y reduce la ansiedad. 3. Relaciones con el personal sanitario de acompañamiento y acceso a información sobre la condición del paciente. 4. Ambiente adaptado para favorecer la recuperación y alivio. 5. Descanso que incluye reposo y sueño, generando alivio; y 6. Salud mental con alivio de ansiedad, estrés y adecuada recuperación mental(AU)

Introduction: For nursing, comfort is a care-related objective in the multiple settings of professional performance; it leads to the formulation of theories with a holistic perspective and manages to be applied from a physical, psychospiritual, environmental and social point of view. Objective: To identify the attributes of the concept of comfort understood by nursing in different care settings. Methods: Integrative review carried out in the Scopus, Google Scholar, VHL, EBSCO, Cochrane, Ovid and Medline databases, using the following search strategy: "Comfort" AND "Nursing". The eligibility criteria considered primary studies, full texts, published between 2009 and 2019, in Spanish, English or Portuguese. The PRISMA diagram was used for the critical analysis of experimental, review and qualitative studies, using the templates of the Critical Appraisal Skills Program (Caspe). For the other designs, the checklists of the Joanna Briggs Institute were applied and sixteen articles were included. Conclusion: Comfort is related to issues that enclose the physical, social, psychic and environmental reality of a person, determined by the following attributes: physical relief of pain through pharmacological interventions and external elements in contact with the body; social support with the closeness of family members, which facilitates adaptation to the hospital environment and reduces anxiety; relationships with the accompanying health personnel and access to information on the patient's condition; an adapted environment to favor recovery and relief; rest including sleep and generating relief; and mental health with relief of anxiety, stress and adequate mental recovery(AU)

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O estudo descreve o histórico da legislação, analisa a trajetória e dimensiona o capital estrangeiro no sistema de saúde no Brasil. A Lei Orgânica da Saúde restringiu a participação do capital estrangeiro, legislações setoriais permitiram o posterior ingresso na assistência médica suplementar e, em 2015, uma nova lei promoveu a abertura irrestrita, inclusive em hospitais e serviços de saúde. O estudo analisou documentos, legislação e dados de bases secundárias públicas ou obtidos via Lei de Acesso à Informação. Foram considerados investimentos diretos e atos de fusões e aquisições no setor privado da saúde. Foram identificadas cinco fases: ordenamento inaugural, expansão regulada, restrição legal, liberação setorizada e abertura ampliada. De 2016 a 2020, ingressaram no país quase dez vezes mais recursos estrangeiros em serviços de saúde que no quinquênio anterior. Foram identificadas 13 empresas ou fundos, a maioria originária dos Estados Unidos. Normas que permitiram a abertura do capital estrangeiro foram antecedidas por lobbies empresariais e interações público-privadas que podem afetar a qualidade das políticas públicas e a integridade do processo legislativo. O capital aportado busca empresas já constituídas e mais rentáveis, em diversos segmentos de atividade. O ingresso ocorre em redes assistenciais privadas não universais, que atendem clientelas específicas, concentradas geograficamente. Conclui-se que o capital estrangeiro, elemento do processo de financeirização da saúde, se expressa como possível vetor da ampliação de desigualdades de acesso da população aos serviços de saúde e como um obstáculo adicional à consolidação do Sistema Único de Saúde.

The study describes the history of legislation, analyzes the trajectory and the amount of foreign capital in the Brazilian health system. The Organic Health Law restricted the participation of foreign capital; sectoral legislation, however, allowed its subsequent entry into supplementary medical care and, in 2015, a new law promoted unrestricted openness, including in hospitals and healthcare services. Our study analyzes documents, legislation, and data obtained from secondary public bases or via the Law on Access to Information. Direct investments and merger and acquisition acts in the private health sector were considered. Five phases were identified: inaugural planning, regulated expansion, legal restriction, sectorized release, and expanded opening. From 2016 to 2020, the amount of foreign resources entering the country's healthcare services was almost ten times more than the previous five-year period. Thirteen companies or funds were identified, most of them from the United States. Regulation allowing for the opening of foreign capital were preceded by business lobbies and public-private interactions that can affect the quality of public policies and the integrity of the legislative process. The invested capital seeks established and profitable companies in various segments of activity. Admission occurs in non-universal private care networks, which serve specific, geographically concentrated clientele. We conclude that foreign capital, an element of health financialization process, is expressed as a possible vector of the expansion of inequalities in the population's access to health services and as an additional obstacle to the consolidation of the Brazilian Unified National Health System.

Este estudio describe la historia de la legislación, analiza la trayectoria y dimensiona el capital extranjero en el sistema de salud en Brasil. La Ley Orgánica de Salud restringió la participación de capital extranjero, las legislaciones sectoriales permitieron el posterior ingreso a la asistencia médica complementaria y, en el 2015, una nueva ley promovió la apertura sin restricciones, incluso en hospitales y servicios de salud. El estudio analizó documentos, legislación y datos de bases públicas secundarias u obtenidos por medio de la Ley de Acceso a la Información. Se consideraron inversiones directas y actos de fusiones y adquisiciones en el sector privado de la salud. Se identificaron cinco etapas: ordenamiento inaugural, expansión regulada, restricción legal, liberación sectorizada y apertura ampliada. Del 2016 al 2020 ingresaron al país casi diez veces más recursos extranjeros en servicios de salud que en el quinquenio anterior. Se identificaron 13 empresas o fondos, la mayoría con origen en los EE.UU. Las reglas que permitieron la apertura al capital extranjero fueron precedidas por cabildeos empresariales e interacciones público-privadas que pueden afectar la calidad de las políticas públicas y la integridad del proceso legislativo. El capital aportado busca empresas ya consolidadas y más rentables, en diversos segmentos de actividad. El ingreso se da en redes asistenciales privadas no universales, que atienden a una clientela específica y geográficamente concentrada. Se concluye que el capital extranjero, elemento del proceso de financiarización de la salud, se expresa como un posible vector de la ampliación de desigualdades en el acceso de la población a los servicios de salud y como un obstáculo adicional para la consolidación del Sistema Único de Salud.

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Introducción: Las infecciones asociadas a la asistencia sanitaria son aquellas que aparecen durante la hospitalización del paciente, pueden estar presentes o ausentes en el período de incubación en el momento del ingreso, independientemente de que se manifieste o no durante su estancia en el hospital. Objetivo: Caracterizar las infecciones asociadas a la asistencia sanitaria en la provincia Camagüey. Métodos: Se realizó un estudio observacional descriptivo, transversal y retrospectivo, sobre el comportamiento de las infecciones asociadas a la asistencia sanitaria en la provincia Camagüey, desde el 1ro de enero de 2016 hasta el 31 de diciembre de 2020. El universo de estudio abarcó 500 949 pacientes ingresados en los hospitales de más de 100 camas. La muestra a discreción la conformaron los 6 542 pacientes atendidos con el diagnóstico de las infecciones asociadas a la atención sanitaria. Resultados: Tendencia decreciente a nivel provincial de las infecciones asociadas a la asistencia sanitaria dentro del indicador nacional que es hasta un 3 %, el Hospital Universitario Manuel Ascunce Domenech y el Hospital Psiquiátrico René Vallejo. En cuanto a la letalidad, no se cumplió con el indicador nacional en los años 2016, 2018 y 2019. El Servicio de Hemodiálisis, mostró la mayor tasa de incidencia y Escherichiacoli fue el microorganismo más aislado. Conclusiones: Los aspectos fundamentales para reducir las infecciones asociadas a la atención sanitaria son las medidas de prevención y vigilancia, entre las que la higiene de las manos se considera la medida más eficaz.

Introduction: Health care-associated infections are those that appear during the patient's hospitalization and may be present or absent in the incubation period, at the time the patient is admitted to the hospital, regardless of whether or not it manifests itself during their stay at the hospital. Objective: To characterize the infections associated with health care in the province of Camagüey. Methods: A descriptive, cross-sectional and retrospective observational study was carried out on the behavior of infections associated with health care in the province of Camagüey, during the period from January 1st, 2016 to December 31st, 2020. The study universe comprised 500,949 patients admitted to hospitals with more than 100 beds. The discretionary sample was made up of 6,542 patients treated with a diagnosis of Health care-associated infections. Results: Decreasing trend at the provincial level of infections associated with health care within the national indicator that is up to 3%, the Manuel Ascunce Domenech University Hospital and the René Vallejo Psychiatric Hospital. Regarding lethality, the national indicator was not met in 2016, 2018 and 2019. The Hemodialysis Service showed the highest incidence rate and Escherichia coli was the most isolated microorganism. Conclusions: The fundamental aspects to reduce Health care-associated infections are prevention and surveillance measures, among which hand hygiene is considered the most effective measure.