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Background: Spain healthcare system is decentralized, with seventeen autonomous regions overseeing healthcare. However, penitentiary healthcare is managed nationally, except in Catalonia, the Basque Country, and Navarra. These variations impact mental health care provision for inmates with serious mental illness (SMI). Objective: To delineate differences between regions in terms of mental health care provision for individuals with SMI, available resources, and the perspectives of healthcare professionals operating in the Spanish prison environment. Methods: Employing an explanatory sequential mixed-method approach, the study conducted an extensive literature review, quantitative data collection through structured questionnaires, and qualitative data collection via focus groups and four in-depth interviews. Analysis involved calculating percentages and ratios for quantitative data and thematic analysis for qualitative data interpretation to comprehensively understand mental healthcare provision. Results: In December 2021, about 4% of inmates in Spain had SMI. There are three distinct models of mental healthcare within the Spanish prison system. The traditional penitentiary model, representing 83% of the incarcerated population, operates independently under the General Secretariat of Penitentiary Institutions at a national level. This model relies on an average of 5.2 penitentiary General Practitioners (pGP) per 1,000 inmates for psychiatric and general healthcare. External psychiatrists are engaged for part-time psychiatric assessment. Acute psychiatric hospitalization occurs in general nursing modules within penitentiary centers or in Restricted Access Units (RAUs) in reference hospitals. Two penitentiary psychiatric hospitals provide care to unimputable SMI inmates from all over Spain. Innovative penitentiary models, constituting 17% of the prison population, integrate penitentiary healthcare within regional public health systems. The Basque Country features a Mental Health Unit with full-time care teams within the penitentiary center. Catalonia emphasizes community care, providing full-time dedicated psychiatric services within and outside prisons, ensuring continued care in the community. Both models prioritize personnel with specialized mental health training and compensation akin to non-prison healthcare settings. Conclusions: Regional disparities in penitentiary mental healthcare models in Spain result in resource inequalities, impacting specialized care for inmates with SMI and opportunities for healthcare professionals. The models in the Basque Country and Catalonia offer valuable experiences for penitentiary healthcare.

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Resumo A presente revisão integrativa tem por objetivo identificar os arranjos de cuidado em saúde mental que foram implementados no enfrentamento à pandemia de COVID-19. Realizou-se busca em três bases de dados (SciELO, PubMed e LILACS), em português, inglês e espanhol, com os descritores "SAÚDE MENTAL" or "SALUD MENTAL" or "MENTAL HEALTH" AND "COVID-19", no período de 2020 a 2021. Foram encontrados 3.451 artigos, sendo 43 selecionados para análise. Em relação ao cuidado em saúde mental, os principais arranjos identificados foram os digitais, de natureza pública, desenvolvidos na esfera municipal e com integração com a rede de saúde. Os modelos de cuidado em saúde mental para o enfrentamento da pandemia são discutidos a partir dos tipos de arranjo produzidos nesse contexto sanitário emergencial e crítico. Apresenta-se, ainda, um recorte da realidade encontrada no Sistema Único de Saúde (SUS), reiterando sua resiliência. Concluiu-se que os arranjos digitais foram os mais usados e que há necessidade de investigar a acessibilidade deste modelo para populações com maior vulnerabilidade social. Reafirma-se a importância do SUS para o enfrentamento da COVID-19 e no acesso a informações de saúde.

Abstract This integrative review aims to identify the mental health care measures that were produced during the COVID-19 pandemic. This research was conducted on three databases (SciELO, PubMed, and LILACS) with the following descriptors in Portuguese, English, and Spanish: "SAÚDE MENTAL" or "SALUD MENTAL" or "MENTAL HEALTH" AND "COVID-19" from 2020 to 2021. In total, 3,451 articles were found, 43 of which were analyzed. Most measures were digital, stemmed from public institutions, focused on the local perspective, and were integrated with the public health care system. This study discusses the models of care in mental health based on measures to cope with the COVID-19 pandemic. It also discusses the Brazilian health care system, reiterating its resilience. In conclusion, digital measures occurred most often. This study suggest the evaluation of the accessibility of this mental health care model for most vulnerable groups. Finally, this research reinforces the importance of the Brazilian health care system for public health and access to information to cope with the COVID-19 pandemic.

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The concept of concierge medicine, established in 1996, stands out for its focus on enhancing accessibility to healthcare providers and customized medical services. It is centered on key principles such as giving priority to quality and individualized care, managing a smaller group of patients to ensure improved service accessibility, and nurturing enhanced continuity in personalized treatment. This review explores various aspects of how concierge medicine impacts healthcare, encompassing areas such as patient satisfaction and involvement, health outcomes, preventive care, healthcare expenses, and ethical and legal considerations. While the affirmative influence of concierge medicine on individual healthcare has been evidenced in terms of patient contentment, active patient participation, preventive care, and early identification of illnesses, there remains a dearth of research data to firmly establish the correlation between concierge medicine and health-related outcomes. Moreover, comprehensive longitudinal studies focusing specifically on the economic and policy implications of concierge medicine are currently lacking. Therefore, further research, particularly in the domain of health economics, is crucial to comprehensively comprehend the implications of this approach. Similarly, there is a necessity for studies that can conduct a comparative analysis between the concierge medicine model and traditional healthcare models, aiming to draw more robust and definitive conclusions.

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BACKGROUND: The "Adequate Childbirth Program" (PPA) is a quality improvement project that aims to reduce the high rates of unnecessary cesarean section in Brazilian private hospitals. This study aimed to analyze labor and childbirth care practices after the first phase of PPA implementation. METHOD: This study uses a qualitative approach. Eight hospitals were selected. At each hospital, during the period of 5 (five) days, from July to October 2017, the research team conducted face to face interviews with doctors (n = 21) and nurses (n = 28), using semi-structured scripts. For the selection of professionals, the Snowball technique was used. The interviews were transcribed, and the data submitted to Thematic Content Analysis, using the MaxQda software. RESULTS: The three analytical dimensions of the process of change in the care model: (1) Incorporation of care practices: understood as the practices that have been included since PPA implementation; (2) Adaptation of care practices: understood as practices carried out prior to PPA implementation, but which underwent modifications with the implementation of the project; (3) Rejection of care practices: understood as those practices that were abandoned or questioned whether or not they should be carried out by hospital professionals. CONCLUSIONS: After the PPA, changes were made in hospitals and in the way, women were treated. Birth planning, prenatal hospital visits led by experts (for expecting mothers and their families), diet during labor, pharmacological analgesia for vaginal delivery, skin-to-skin contact, and breastfeeding in the first hour of life are all included. To better monitor labor and vaginal birth and to reduce CS without a clinical justification, hospitals adjusted their present practices. Finally, the professionals rejected the Kristeller maneuver since research has demonstrated that using it's harmful.

Brazil has high Cesarean Section (CS) rates, with rates far from the ideal recommended by the World Health Organization and a model of care that does not favor women's autonomy and empowerment. In 2015, a quality improvement project, called "Projeto Parto Adequado" (PPA), was implemented in Brazilian private hospitals to reduce unnecessary cesarean section, in addition to encouraging the process of natural and safe childbirth. One of the components of this project was to reorganize the model of care in hospitals to prepare professionals for humanized and safe care. The data were collected in 8 hospitals with interviews with 49 professionals, approximately two years after the beginning of the project in the hospitals. There were changes in the hospital routine and in the care of women after the project. The professionals incorporated practices such as skin-to-skin contact and breastfeeding; diet during labor; non-invasive care technologies, especially to relieve pain during labor; birth plan; pregnancy courses with guided tours in hospitals (for pregnant women and family); and analgesia for vaginal labor. There was adaptation of existing practices in hospitals to reduce CS that had no clinical indication; better monitoring of labor, favoring vaginal delivery. And finally, the professionals rejected the practice that presses the uterine fundus, for not having shown efficacy in recent studies. We can conclude that the hospitals that participated in this study have made an effort to change their obstetric model. However, specific aspects of each hospital, the organization of the health system in Brazil, and the incentive of the local administration influenced the implementation of these changes by professionals in practice.

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In recent decades, body practices and physical activities (PCAF) have become part of the public health agenda. Actions to combat sedentary lifestyle in primary care are developed through body practices, physical exercises, physical activities and guided walks. The main objective of this study is to verify which interventions are being carried out by the Physical Education Professional (PEF) in primary care. This study comprises an integrative review. After consulting the databases and applying the search strategies, studies that were duplicated between the databases were identified and excluded. To compose this study, 7 articles were selected. With regard to the types of exercises found in the articles, 3 studies performed only resistance exercise, in which it was the Pilates method and Chinese gymnastics Liang Gong. Still, 4 studies combined aerobic and resistance exercises. Other important findings of this study, that the elderly population are the ones that most participated in the interventions and that the interventions were concentrated in the South and Southeast regions. In the interventions portrayed in this review, the diversification of physical exercises offered in Primary Care was noticed. All interventions brought positive health benefits at the physiological, social and/or psychological levels. This fits into the perspective of health promotion among the population that performs physical activity and/or physical exercise in Primary Care programs. (AU)

Nas últimas décadas as práticas corporais e atividades físicas (PCAF) passaram a compor a agenda da saúde pública. As ações para aumentar a prática de atividade física na Atenção Primária, são orientadas e desenvolvidas por meio de práticas corporais, exercícios físicos, atividades físicas e caminhadas. O presente estudo tem como objetivo principal verificar quais intervenções realizadas pelo Profissional de Educação Física (PEF) na Atenção Primária à Saúde. Este estudo compreende uma revisão integrativa. Após a consulta às bases de dados e a aplicação das estratégias de busca, foram identificados e excluídos estudos que apresentavam duplicidade entre as bases e foram selecionados sete artigos para compor este estudo. No que se refere aos tipos de exercícios físicos encontrados nos artigos, o exercício Resistance foi o mais prevalente (OU utilizado) nas intervenções, seguido pelas práticas integrativas e exercícios aeróbicos. Outros achados importantes neste estudo, foi a maior participação da população idosa nas intervenções, concentradas nas regiões do Sul e Sudeste. Nas intervenções retratadas nesta revisão percebeu-se a diversificação dos exercícios físicos oferecidos na Atenção Básica. Todas as intervenções trouxeram benefícios positivos para a saúde, nos níveis fisiológicos, sociais e/ou psicológicos, bem como o ponto de maior destaque foi a utilização do exercício Resistance. O que se enquadra numa perspectiva de promoção da saúde junto à população que realiza atividade física e/ou exercício físico nos programas da Atenção Primária à Saúde. (AU)

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Las intercurrencias dermatológicas agudas son un motivo de consulta frecuente a las centrales de emergencias, y generalmente los médicos de atención primaria se ocupan del primer nivel de atención. Puede ser necesaria una interconsulta con expertos, aunque no siempre estén disponibles. Ante la necesidad de facilitar dicha interacción a distancia, en Julio 2022 se implementó una herramienta de teledermatología en un hospital de alta complejidad en Buenos Aires, Argentina. Este servicio se limitó a días hábiles con horario restringido, permitiendo la comunicación entre médicos del departamento de emergencias y dermatólogos, a través de WhatsApp institucional. El dermatólogo podía verificar datos de salud relacionados al paciente (ej: comorbilidades y medicación crónica) mediante revisión de la historia clínica electrónica, para decidir sobre un plan de acción. Se evaluó la perspectiva de los usuarios a través de un formulario electrónico tras 3 meses de implementación. Los resultados evidenciaron que la mayoría (85%) de los profesionales conocía la herramienta, y el 57% la había usado al menos una vez. Se obtuvo una mediana de 9 puntos (de una escala de Likert del 1 al 10) sobre la recomendación hacia otro profesional. El teletriage dermatológico resultó beneficioso y fue aceptado, tanto por médicos de guardia como por especialistas. Ante las demoras en la atención ambulatoria, ha resultado una alternativa útil para evitar derivaciones innecesarias y/o acelerar aquellas que verdaderamente lo ameritan. Sin embargo, representa una forma de comunicación informal desde el punto de vista de almacenamiento de datos. Será necesario reflexionar sobre estos tópicos pendientes de esta experiencia asistencial como legalidad, seguridad y confidencialidad (AU)

Acute skin conditions are a frequent reason for consultation in emergency departments, and primary care physicians generally handle them. They might require referrals to experts, who are not always readily available. Recognizing the need to facilitate such interactions remotely, a teledermatology triage tool was implemented in July 2022 at a high-complexity hospital in Buenos Aires, Argentina. The service was limited to business days with restricted hours, enabling communication between emergency department physicians and dermatologists through institutional WhatsApp. Dermatologists could access patient-related health data (e.g., comorbidities and chronic medication) through the electronic medical record to determine an appropriate course of action. The perspective of users was evaluated through an electronic questionnaire after three months of application. Results showed that most professionals were aware of the tool (85%), and 57% used it at least once. The median rating for recommending the tool to other professionals was 9 points (on a Likert scale from 1 to 10). Dermatological teletriage proved beneficial and was well-received by emergency physicians and specialists. In the face of delays in outpatient care, it has been a useful alternative to avoid unnecessary referrals and expedite those that are warranted. However, it represents an informal method of communication with regard to data storage. It will be necessary to rethink on improvements in pending topics such as legal limitations, security, and confidentiality of this healthcare experience (AU)

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In certain healthcare settings, such as emergency or critical care units, where quick and accurate real-time analysis and decision-making are required, the healthcare system can leverage the power of artificial intelligence (AI) models to support decision-making and prevent complications. This paper investigates the optimization of healthcare AI models based on time complexity, hyper-parameter tuning, and XAI for a classification task. The paper highlights the significance of a lightweight convolutional neural network (CNN) for analysing and classifying Magnetic Resonance Imaging (MRI) in real-time and is compared with CNN-RandomForest (CNN-RF). The role of hyper-parameter is also examined in finding optimal configurations that enhance the model's performance while efficiently utilizing the limited computational resources. Finally, the benefits of incorporating the XAI technique (e.g. GradCAM and Layer-wise Relevance Propagation) in providing transparency and interpretable explanations of AI model predictions, fostering trust, and error/bias detection are explored. Our inference time on a MacBook laptop for 323 test images of size 100x100 is only 2.6 sec, which is merely 8 milliseconds per image while providing comparable classification accuracy with the ensemble model of CNN-RF classifiers. Using the proposed model, clinicians/cardiologists can achieve accurate and reliable results while ensuring patients' safety and answering questions imposed by the General Data Protection Regulation (GDPR). The proposed investigative study will advance the understanding and acceptance of AI systems in connected healthcare settings.

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Background: In 2019, the São Paulo State Cancer Institute (ICESP) implemented a novel model integrating Oncology with Palliative Care specialists. We evaluated the impact of this model on healthcare resource utilization and costs. Methods: We analyzed data from all patients who passed away in February (1 month prior to implementation) and November (8 months after model implementation group) at ICESP, Brazil. Healthcare utilization data, including emergency department visits, hospital and intensive care unit admissions, chemotherapy, and radiotherapy use, were retrieved from Electronic Medical Records. Unit cost values were obtained from the administrative database. Results: A total of 198 patients who died in February and 196 in November were included in the analysis. Groups exhibited similarities in sex, age, ECOG, cancer type, previous outpatient palliative care consultations, and place of death (ward: 56.6% pre-intervention, 50% post-intervention). The mean cost per patient was US$13,226.29 pre-intervention and US$11,445.82 post-intervention (P = .007). Statistically significant differences were noted in days hospitalized in the surgical ward (227 vs 115), emergency department visits (233 vs 45), chemotherapy sessions (140 vs 26), and radiotherapy sessions (146 vs 10). Excluding outpatient treatments, the total costs for chemotherapy and radiotherapy in the last 30 days of life were US$16,924.45 pre-intervention and US$7851.65 post-intervention. Reductions were more pronounced in patients with ECOG 3-4 (P = .039). Conclusion: Our data suggests that the integration model was associated with a reduction in potentially inappropriate treatments during the last month of life, leading to decreased healthcare utilization and costs.

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BACKGROUND: Extreme obesity is a global health issue impacting health and related health outcomes. Although extreme obesity is prevalent across all geographical settings, the condition is more common in geographically isolated locations. The success of mainstream weight loss strategies such as surgery, exercise, and dietary information within these communities remains unknown, and it is unclear if isolation facilitates or hinders treatment for weight management. AIM: This review aimed to identify common themes around weight loss and health and social impacts for extremely obese adults living in rural, remote, and regional locations. METHODS: A systematic literature review of peer-reviewed publications from May 2013 to May 2023 was undertaken and appraised using the Mixed Method Appraisal Tool (MMAT). Sequential synthesis was thematically analysed and described within a narrative account. Earlier dates were not included as initial research indicated a global surge in obesity within the early 2010s (Wang, Y., Beydoun, M. A., Min, J., Xue, H., Kaminsky, L. A., & Cheskin, L. J. (2020). Has the prevalence of overweight, obesity and central obesity levelled off in the United States? Trends, patterns, disparities, and future projections for the obesity epidemic. International Journal of Epidemiology, 49(3), 810-823) and a surge in bariatric treatments for the management of extreme obesity was noted around the same time (Mocanu, V., Dang, J. T., Sun, W., Birch, D. W., Karmali, S., & Switzer, N. J. (2020). An evaluation of the modern North American bariatric surgery landscape: current trends and predictors of procedure selection. Obesity Surgery, 30, 3064-3072). RESULTS: This review identified 13 studies that reported negative trends in extreme obesity for isolated locations linked to gender, culture, and poor mental health. Individualised and community models of weight loss support can be positive for certain demographic groups, specifically females, through the promotion of cost-effective, and locally available traditional food choices. CONCLUSION: Living with extreme obesity within geographically isolated locations and losing weight is challenging for women, Indigenous peoples, and people with low literacy and those from lower socio-economic backgrounds. Generalised advice about weight loss is often unsuccessful; however, weight loss is achievable with consumer engagement which considers the influence and impact of rurality. Further research focusing on individualised nursing models for managing morbid obesity within isolated locations is required.

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Este estudio tiene como objetivo describir y analizar el pluralismo médico y el tipo de relaciones de hegemonía-subalternidad entre diversas formas o saberes de atención, que se desarrollaron en el itinerario terapéutico de una padeciente de glaucoma, para mostrar el proceso articulatorio y transaccional entre distintos recursos terapéuticos, así como comprender qué elementos estructurales configuraron el itinerario y la elección terapéutica. La investigación es cualitativa, un estudio de caso en el cual se utilizó el enfoque narrativo. Para la reconstrucción de la narrativa se realizó una entrevista semiestructurada, dirigida por una guía temática previamente determinada por un conjunto de categorías apriorísticas, para posteriormente transcribir la entrevista y realizar un proceso de triangulación hermenéutica. Los resultados mostraron, en este caso, que la hegemonía en el pluralismo médico se constituyó mediante relaciones de equivalencia, así, la padeciente sustituyó el uso de medicamentos farmacológicos por terapias de medicina alternativa, no obstante, el proceso relacional de equivalencia se desarrolló en un contexto de significación biomédica, en el cual tratar o controlar la presión intraocular fue la premisa del remplazo. Asimismo, los procesos que desencadenaron la presencia de relaciones hegemónicas se constituyeron por diversos factores sociales, culturales y económicos como el desempleo, la seguridad social y el género, que desempeñaron un papel fundamental durante la búsqueda de la atención y del cuidado.

This study aims to describe and analyze the medical pluralism and the type of hegemony-subordination relation between forms of care or knowledge in the treatment of a patient with glaucoma to show the articulatory and transactional process between several therapeutic resources and understand which structural elements shaped the treatment itinerary and option. This is a qualitative research that used a narrative case study. To reconstruct the narrative, a semi-structured interview was conducted based on a thematic script previously established by a set of a priori categories to later transcribe the data and perform hermeneutic triangulation. Results showed that the hegemony in medical pluralism was based on equivalence relations, so that the patient replaced the use of pharmacological drugs with alternative medicine treatments. However, the relational process of equivalence developed itself in a context of biomedical significance, in which the treatment or control of intraocular pressure configured the substitution premise. Thus, the processes that triggered the hegemonic relations were constituted by various social, cultural, and economic factors such as unemployment, social security, and gender, which played a fundamental role during the search for care.

Este estudo visa descrever e analisar o pluralismo médico e o tipo de relação de hegemonia-subalternidade entre diversas formas de atendimento ou conhecimentos, que ocorreram no tratamento de um paciente com glaucoma, com a finalidade de mostrar o processo articulatório e transacional entre diferentes recursos terapêuticos, bem como entender quais elementos estruturais moldaram o itinerário e a opção de tratamento. Trata-se de uma pesquisa qualitativa, que utilizou um estudo de caso com abordagem narrativa. Para a reconstrução da narrativa, foi realizada uma entrevista semiestruturada, com base em um roteiro temático previamente estabelecido por um conjunto de categorias a priori, para posteriormente transcrever os dados e realizar a triangulação hermenêutica. Os resultados mostraram que a hegemonia no pluralismo médico esteve baseada em relações de equivalência, de modo que o paciente substituiu o uso de medicamentos farmacológicos por tratamentos da medicina alternativa; no entanto, o processo relacional de equivalência desenvolveu-se em um contexto de significância biomédica, na qual o tratamento ou controle da pressão intraocular foi a premissa para a substituição. Desse modo, os processos que desencadearam a presença de relações hegemônicas foram constituídos por fatores sociais, culturais e econômicos diversos como desemprego, previdência social e gênero, os quais tiveram papel fundamental durante a busca por atendimento e cuidado.

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RESUMO Em abril de 2022, o Ministério da Saúde publicou a Portaria GM/MS nº 715, que altera a Portaria de Consolidação GM/MS nº 3, de 28 de setembro de 2017, com o objetivo de instituir a Rede de Atenção à Saúde Materna e Infantil (Rami). Tendo em vista a preexistência da Rede Cegonha, também voltada a essa parcela da população, objetivou-se analisar os modelos de atenção ao ciclo gravídico-puerperal intrínsecos a cada um dos métodos de estruturação organizacional adotados. Para tanto, utilizou-se, como referencial teórico-metodológico, a pesquisa com práticas discursivas, o que possibilitou identificar os repertórios relativos a três categorias predefinidas: os sujeitos, os locais e os agentes da assistência. Na análise, puderam-se observar diferenças paradigmáticas entre as duas redes de atenção. A partir de tais distinções, concluiu-se que a Rede Cegonha está fundamentada em uma concepção de gestação e parto como eventos normais da vida sexual e reprodutiva, enquanto a Rami se estrutura por meio da ênfase no risco, propondo um modelo centrado no hospital e na figura do médico.

ABSTRACT In April 2022, the Ministry of Health published the Ordinance No 715, aiming to establish the new Maternal and Infant Health Care Network (RAMI). Having in mind the pre-existence of an organized network to protect and promote maternal and infant health (Rede Cegonha), we aimed to analyze the models of care intrinsic to each of them. For this purpose, we used the research with discursive practices as a theoretical-methodological framework, identifying repertoires regarding three predefined categories: subjects, places, and agents of care. In our analysis, we could observe paradigmatic differences between the two health care networks. From such distinctions, we conclude that the 'Rede Cegonha' is based on a conception of pregnancy and childbirth as normal events of sexual and reproductive life, whereas 'RAMI' is structured through an emphasis on risk, which results in a model of care centered on the doctor and the hospital as a privileged location for childbirth.

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Resumo: Trata-se de uma pesquisa documental, exploratória, descritiva, partindo de um estudo multicêntrico e internacional entre Brasil, Espanha, Itália e Portugal sobre sistemas nacionais de saúde com modelo de atenção baseado na atenção primária à saúde e financiado pelo Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) do Brasil. Tem como objetivo identificar as legislações de base da saúde, o direito à saúde e os princípios doutrinários e organizativos de cada país selecionado com ênfase no impacto dos determinantes sociais de saúde sobre os sistemas nacionais de saúde. Os resultados revelaram países com legislações e princípios doutrinários semelhantes, com direito à saúde constitucional, ancorados na atenção primária à saúde, e com modelo assistencial de acesso do tipo saúde da família. Os desafios encontrados foram a baixa natalidade e elevada expectativa de vida ao nascer em países europeus e critérios para acesso a medicamentos e financiamento assistencial. Com base nos nossos achados, os países que tiveram maior investimento em base estrutural, perpassando por assegurar condições socioeconômicas e sanitárias mais dignas, sólidas e vigilantes, garantiram importante diferenciação na capacidade de resposta e sustentabilidade do sistema nacional de saúde e no impacto direto na qualidade de vida das pessoas.

Abstract: This is a documentary, exploratory, descriptive study, which is part of a multicenter international study assessing the national health systems with a care model based on primary health care of Brazil, Spain, Italy, and Portugal, funded by the Brazilian National Research Council (CNPq, acronym in Portuguese). It aims to identify the basic health legislation, the right to health, and the doctrinal and organizational principles of each country with a focus on the impact of social determinants of health on the national health systems. The results showed these countries have similar legislation and doctrinal principles, with a constitutional right to health, based on primary health care, and with a care model of the family health type. The challenges identified were low birth rate and high life expectancy at birth in European countries and criteria for access to medication and care financing. Based on our findings, the countries with higher investment in a structural basis, ensuring more dignified, solid, and vigilant socioeconomic and sanitary conditions, provide an important differentiation in responsiveness and sustainability of the national health system and direct impact on the quality of life.

Resumen: Se trata de una investigación documental, exploratoria, descriptiva, parte de un estudio multicéntrico, internacional entre Brasil, España, Italia y Portugal sobre los Sistemas Nacionales de Salud con un modelo de atención basado en la atención primaria de salud y financiado por el Consejo Nacional de Desarrollo Científico y Tecnológico (CNPq) de Brasil. Tiene como objetivo identificar la legislación de base de la salud, el derecho a la salud y los principios doctrinales y organizativos de cada país seleccionado con énfasis en el impacto de los determinantes sociales de la salud sobre los sistemas nacionales de salud. Los resultados revelaron países con legislaciones y principios doctrinales similares, con derecho a salud constitucional, anclados en la atención primaria de salud y con un modelo asistencial de acceso del tipo salud de la familia. Los desafíos encontrados fueron la baja tasa de natalidad y la alta esperanza de vida al nacer en países europeos y criterios para el acceso a medicamentos y financiación asistencial. Con base en nuestros hallazgos, los países que tuvieron mayor inversión en base estructural, asegurando condiciones socioeconómicas y sanitarias más dignas, sólidas y vigilantes, garantizan una diferenciación importante en la capacidad de respuesta y sostenibilidad del sistema nacional de salud y en el impacto directo en la calidad de vida de las personas.

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Fundamento: el desarrollo exitoso de la comprensión-expresión posibilita la efectividad del proceso comunicativo, y consecuentemente, el objetivo de la atención médica en el cumplimiento de sus deberes funcionales, expresados en el perfil del profesional. Objetivo: valorar la funcionalidad de un modelo didáctico desde la asignatura Historia de Cuba para favorecer la comprensión-expresión de los estudiantes de Medicina. Métodos: se desarrolló una investigación cualitativa, con enfoque dialéctico materialista, en la Facultad "Manuel Fajardo" de la Universidad de Ciencias Médicas de la Habana, en el período 2019-2021. Se emplearon métodos teóricos: histórico- lógico, inductivo-deductivo y análisis-síntesis; empíricos: revisión documental y observación; las técnicas: taller y tormenta de ideas; e instrumentos: diario de observación y autorreporte de estudiantes. Se realizó la consulta a especialistas y triangulación metodológica. Resultados: en el diagnóstico inicial: 37 estudiantes iniciaron en el nivel bajo, 19 en el nivel medio y 11 en el nivel alto de comprensión-expresión. Durante la aplicación del modelo, se modificaron los resultados: 8 en nivel bajo; 35 en nivel medio y 24 en nivel alto. Tras culminar la asignatura: solo 2 quedaron en el nivel bajo, 4 en el nivel medio y 61 en el nivel alto. Conclusiones: el modelo didáctico es funcional, flexible, participativo, abierto y colaborativo, con sustentos filosóficos, psicológicos, pedagógicos y didácticos, dialécticamente relacionados. Con su aplicación, se estrechó la brecha entre las exigencias del perfil del profesional y el déficit de comprensión-expresión de los estudiantes.

Background: the successful development of understanding-expression enables the effectiveness of the communicative process, and consequently, the objective of medical care in the fulfillment of its functional duties, expressed in the professional's profile. Objective: assess the functionality of a didactic model from the subject History of Cuba to promote the understanding-expression of medical students. Methods: a qualitative investigation was developed, with a materialist dialectical approach, at the "Manuel Fajardo" Faculty of Havana University of Medical Sciences, from 2019 to 2021. Theoretical methods were used: historical-logical, inductive-deductive and analysis-synthesis; empirical ones: documentary review and observation; the techniques: workshop and brainstorming; and instruments: observation diary and student self-report. Consultation with specialists and methodological triangulation were carried out. Results: in the initial diagnosis: 37 students started at the low level, 19 at average level and 11 at the high level of comprehension-expression. During the application of the model, the results were modified: 8 at a low level; 35 at average level and 24 at high level. After completing the subject: only 2 remained at the low level, 4 at the average level and 61 at the high level. Conclusions: the didactic model is functional, flexible, participatory, open and collaborative, with philosophical, psychological, pedagogical and didactic foundations, dialectically related. With its application, the gap between the demands of the professional profile and the students' comprehension-expression deficit was shortened.

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Resumo: Este trabalho tem como objetivo analisar os principais padrões de organização das redes municipais de serviços de atenção primária à saúde (APS) e avaliá-los segundo os indicadores de interface entre gestão e gerenciamento local. Trata-se de pesquisa avaliativa que analisou 461 municípios de São Paulo, Brasil, que participaram do Inquérito de Avaliação da Qualidade de Serviços de Atenção Básica (QualiAB) em 2017/2018, classificados segundo a composição dos arranjos organizacionais de 2.472 serviços de APS. Para avaliar os padrões identificados, foram selecionados oito indicadores de gestão e gerenciamento local. Os resultados apontam dois grupos de municípios: homogêneos, com serviços de um mesmo arranjo (43,6%); e heterogêneos, com diferentes arranjos (56,4%). Os grupos foram subdivididos em sete padrões que variaram entre homogêneo-tradicional, homogêneo-Estratégia Saúde da Família, homogêneo-misto e diferentes combinações no grupo heterogêneo. Todos os indicadores apontaram diferenças significativas entre os grupos (p < 0,001), com destaque para o grupo homogêneo-tradicional, com padrão organizacional distante do modelo desejado para uma APS abrangente e resolutiva, enquanto aqueles com unidades de saúde da família (USF), e com unidades básicas com agentes comunitários de saúde e/ou equipes de saúde da família (UBS/USF) demonstraram um padrão mais aproximado desse modelo - com ações de planejamento e avaliação comprometidos com a realidade local e com a qualificação do trabalho. Discute-se a importância das políticas implementadas pela gestão federal e estadual e seu poder de indução na definição do modelo de atenção à saúde na APS dos municípios.

Resumen: El trabajo tiene el objetivo de analizar los principales patrones de organización de las redes municipales de servicios de atención primaria de salud (APS) y evaluarlos conforme los indicadores de interfaz entre la dirección y gestión local. Se trata de una investigación evaluativa que analizó 461 municipios de São Paulo, Brasil, que participaron de la Encuesta de Evaluación de la Calidad de los Servicios de Atención Primaria (QualiAB) en 2017/2018, clasificados según la composición de los arreglos organizativos de 2.472 servicios de APS. Para evaluar los patrones identificados, se seleccionaron ocho indicadores de dirección y gestión local. Los resultados indican dos grupos de municipios: homogéneos, con servicios de un mismo arreglo (43,6%) e heterogéneos, con arreglos diferentes (56,4%). Los grupos se subdividieron en siete patrones que iban desde homogéneo-tradicional, homogéneo-Estrategia de Salud de la Familia, homogéneo-mixto y diferentes combinaciones en el grupo heterogéneo. Todos los indicadores señalaron diferencias significativas entre los grupos (p < 0,001), con destaque para el grupo homogéneo-tradicional, con patrón organizativo alejado del modelo deseado para una APS completa y resolutiva, mientras aquellos con unidades de salud de la familia (USF), y con unidades básicas con agentes comunitarios de salud y/o equipos de salud de la familia (UBS/USF) demostraron un patrón más cercano a este modelo -con acciones de planificación y evaluación comprometidas con la realidad local y con la calificación del trabajo. Se discute la importancia de las políticas implementadas por la gestión federal y la gestión estatal y su poder de inducción para definir el modelo de atención a la salud en la APS de los municipios.

Abstract: This study analyzes the main organization patterns used by primary health care (PHC) services in municipal networks and evaluates them according to indicators of local management-administration interface. Evaluative research analyzed 461 municipalities in São Paulo, Brazil, that participated in the Primary Care Services Quality Assessment Survey (QualiAB) in 2017/2018, classified according to the organizational arrangements composition of 2,472 PHC services. Eight indicators of local management and administration were selected to evaluate the identified patterns. Results indicate two groups of municipalities: homogeneous, with services presenting the same arrangement (43.6%); and heterogeneous, with different arrangements (56.4%). These were subdivided into seven patterns that ranged from homogeneous-traditional, homogeneous-Family Health Strategy, homogeneous-mixed, and different combinations in the heterogeneous group. All indicators showed significant differences between groups (p < 0.001), especially the homogeneous-traditional group, which presented an organizational pattern far from the desired model of a comprehensive and problem-solving PHC. Those integrated with family health units (FHU) and basic health units with community health workers and/or family health teams (BHU/FHU) showed a pattern closer to a comprehensive model - with planning and evaluation actions committed to the local reality and qualification of care. Implementation of federal and state policies are essential for defining the PHC health care model adopted by municipalities.

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En la actualidad, el modelo de asistencia sanitaria a la población infantojuvenil en Atención Primaria es variable en todo el territorio nacional. La Atención Primaria es el primer contacto del paciente pediátrico y su familia, atención que mayoritariamente recaía sobre el pediatra y que debe ser abordada de forma integral por las categorías profesionales implicadas en la promoción, educación para la salud y atención integral del menor, como son el pediatra, la enfermería pediátrica y la enfermería referente de centro educativos. El pediatra y el enfermero de Pediatría son los profesionales formados adecuadamente para atender a la población infantojuvenil en la Atención Primaria y una buena atención requiere de la interdependencia de ambos profesionales y de la cooperación con otras figuras profesionales del centro educativo y del centro de salud. Son necesarias actividades de salud comunitaria y trabajar con los activos de la comunidad para conseguir una atención sanitaria basada en la equidad y en la calidad desde una perspectiva global del niño en su naturaleza biopsicosocial. (AU)

Currently, the health care model for the paediatric and juvenile population in primary care varies throughout Spain. Primary care is the first contact for paediatric patients and their families, care that was mainly provided by paediatricians and which must be addressed in an integrated manner by the professional categories involved in the promotion, health education and comprehensive care of children, such as paediatricians, paediatric nurses and nurses in charge of educational centres. The paediatrician and the paediatric nurse are the professionals adequately trained to care for the paediatric population in primary care and good care requires the interdependence of both professionals and cooperation with other professional figures in the educational centre and the health centre. Community health activities are necessary, working with the assets of the community to achieve health care based on equity and quality from a global perspective of the child in his or her biopsychosocial nature. (AU)

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Abstract Objective: to synthesize the care provided by health professionals, at different care levels, to the families of children with Autism Spectrum Disorders. Method: a qualitative study, based on the Family-Centered Care philosophical theoretical framework and developed with 22 professionals from three multidisciplinary teams from the Health Care Network of a municipality in the state of Mato Grosso do Sul, Brazil. The data were collected through two focus groups with each team, organized with the support of the Atlas.ti 8 Qualitative Data Analysis® software and submitted to Thematic Content Analysis. Results: the findings show actions centered on specific situations, especially on the demands and needs arising from the child's care and atypical behavior. Influencing factors for family care, such as work overload and little professional experience, show the weakness of multiprofessional care and the invisibility of the family as a care unit. Conclusion: the need is highlighted to review functioning of the network for the multiprofessional care of children and their families and how such network is organized. It is recommended to offer permanent education actions that contribute to the qualification of multiprofessional teams in the care of families of children in the autism spectrum.

Resumo Objetivo: sintetizar o cuidado prestado por profissionais de saúde, nos diferentes níveis de atenção, às famílias de crianças com Transtornos do Espectro Autista. Método: estudo qualitativo, baseado no referencial teórico filosófico do Cuidado Centrado na Família, desenvolvido com 22 profissionais de três equipes multidisciplinares de serviços da Rede de Atenção à Saúde de um município do estado de Mato Grosso do Sul, Brasil. Os dados foram coletados por meio de dois grupos focais com cada equipe, organizados com apoio do software Atlas.ti 8 Qualitative Data Analysis e submetidos à Análise Temática de Conteúdo. Resultados: as descobertas mostram ações centradas em situações pontuais, principalmente nas demandas e necessidades advindas do cuidado da criança e de seu comportamento atípico. Fatores influenciadores para o cuidado à família, como a sobrecarga de trabalho e a pouca experiência profissional, evidenciam a fragilidade da assistência multiprofissional e a invisibilidade da família enquanto unidade de cuidado. Conclusão: destaca-se a necessidade de rever o funcionamento e modo como a rede para o cuidado multiprofissional da criança e sua família está organizada. Recomenda-se a oferta de ações de educação permanente que contribuam com a qualificação das equipes multiprofissionais no cuidado às famílias de crianças no espectro do autismo.

Resumen Objetivo: resumir la atención que brindan los profesionales de la salud, en los diferentes niveles de atención, a las familias de niños con Trastornos del Espectro Autista. Método: estudio cualitativo, basado en el marco teórico filosófico de la Atención Centrada en la Familia, desarrollado con 22 profesionales de tres equipos multidisciplinarios de servicios de la Red de Atención de la Salud en un municipio del estado de Mato Grosso do Sul, Brasil. Los datos fueron recolectados a través de dos grupos focales con cada equipo y organizados con la ayuda del software Atlas.ti 8 Qualitative Data Analysis ® y sometidos al Análisis de Contenido Temático. Resultados: los hallazgos muestran acciones enfocadas en situaciones específicas, principalmente en las demandas y necesidades que genera el cuidado del niño y su comportamiento atípico. Factores que influyen en la atención a la familia, como la sobrecarga de trabajo y la poca experiencia profesional, revelan las falencias que tiene la asistencia multidisciplinaria y la invisibilidad de la familia como unidad de atención. Conclusión: es necesario examinar el funcionamiento y la forma en que está organizada la red para la atención multidisciplinaria de los niños y sus familias. Se recomienda implementar acciones de educación continua que contribuyan a la capacitación de los equipos multidisciplinarios para la atención a las familias de niños con espectro autista.

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A atenção primária à saúde tem papel preponderante na coordenação do cuidado e na ordenação da rede de atenção. Objetivou-se analisar a configuração da atenção primária na rede, as estratégias e desafios da gestão municipal no processo de expansão de sua cobertura. Realizou-se um estudo de caso, de abordagem qualitativa, em um município da região médio norte mato-grossense, Brasil, combinando dados primários e secundários. Entrevistas com sete informantes-chave da gestão e serviços de saúde analisadas na vertente temática, por meio do referencial analítico da rede de atenção à saúde, compondo três categorias: Contexto e organização da atenção primária na rede de atenção, Estratégias para organizar a coordenação da atenção na expansão da atenção primária e Desafios para a gestão da rede de atenção. Os resultados evidenciaram um sistema de saúde hierarquizado, com estratégias de investimento no sistema de informação, orientação à população quanto ao fluxo assistencial e forte integração ensino-serviço. Os desafios concentram-se no compartilhamento da assistência na rede e no baixo investimento na atenção secundária, com o uso de serviços privados. Conclui-se que há necessidade de fortalecimento da gestão, da coordenação da rede de saúde e da formação de recursos humanos.

Primary health care plays a preponderant role in the coordination of care and in the ordering of the care network. This study aimed to analyze the configuration of primary care in the network, the strategies and challenges of municipal management in the process of expanding its coverage. A case study with a qualitative approach was carried out in a municipality in the middle northern region of Mato Grosso, Brazil, combining primary and secondary data. Interviews with seven key informants of health management and services analyzed in the thematic aspect, through the analytical framework of the health care network, composing three categories: Context and organization of primary care in the care network, Strategies to organize the coordination of care in the expansion of primary care and Challenges for the management of the care network. The results showed a hierarchical health system, with investment strategies in the information system, orientation to the population regarding the flow of care and strong teaching-service integration. The challenges focus on the sharing of care in the network and the low investment in secondary care, with the use of private services. It is concluded that there is a need to strengthen management, coordination of the health network and training of human resources.

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The Russo-Ukrainian Conflict has had significant repercussions on Ukraine's healthcare system, resulting in civilian casualties and damage to healthcare institutions. The disruption of personnel, medical supplies, and patient transportation has created considerable challenges for healthcare services. However, there are successful approaches from comparable contexts that can serve as a catalyst for post-conflict healthcare reformation in Ukraine. Key strategies include improving healthcare accessibility for marginalized populations through standardized essential health and surgical care packages, rehabilitating damaged facilities, strengthening primary care provisions, and supporting war survivors with disabilities. By adopting these proven practices, Ukraine can strengthen its healthcare system and facilitate a sustainable recovery, contributing to the country's resilience and ensuring essential healthcare services for its population.

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The global healthcare landscape is fraught with quality, cost, equity, and innovation challenges. Despite this, successful healthcare interventions have emerged from unexpected locations. In India, the eradication of certain communicable diseases, the expansion of access to primary care, and the implementation of innovative methods such as telemedicine have demonstrated the potential for community-centered care. In the United States (US), improvements in healthcare quality, accessibility, and the utilization of medical technology, such as the incorporation of telehealth and artificial intelligence, have highlighted opportunities for technological innovation in healthcare delivery. This manuscript reviews the history and development of healthcare systems in India and the US, highlighting each system's strengths, weaknesses, lessons learned, and opportunities for improvement. By examining both systems, we strive to promote a healthcare model that incorporates lessons from each country to improve community-centered care and ultimately provide equitable access to all.