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Objetivo: Adaptar o instrumento norte-americano Survey of Infection Control in Home Health Care para a cultura brasileira. Métodos: Estudo metodológico de adaptação transcultural, seguindo as etapas de tradução, síntese, retro tradução, avaliação por comitê de especialistas e pré-teste com a população alvo. Resultados: Foram realizadas duas rodadas de avaliação pelo comitê de especialistas para alcance da concordância esperada. Nesse processo, três itens foram excluídos por não se adequarem à cultura brasileira. O Índice de Validade de Conteúdo geral foi de 0,97. O pré-teste com a população alvo resultou em um coeficiente de Kappa igual a 0,94 ­ concordância quase perfeita e porcentagem de concordância geral de 95,78%. As etapas desenvolvidas contribuíram para as equivalências semântica, conceitual e cultural em relação ao instrumento original. Conclusão: Obteve-se o questionário "Pesquisa sobre controle de infecção na Atenção Domiciliar", destinado à avaliação da adesão autodeclarada dos profissionais de enfermagem às práticas de controle de infecção na AD, conhecimentos correlatos e atitudes relacionadas. Assim, o instrumento foi adaptado à cultura brasileira e alcançou concordância satisfatória entre os especialistas e entre os membros da população alvo. (AU)

Objective: To adapt the North American instrument "Survey of Infection Control in Home Health Care" to the Brazilian culture. Methods: Methodological study of cross-cultural adaptation, following the steps of translation, synthesis, back translation, evaluation by an expert committee and pre-test with the target population. Results: Two rounds of evaluation were carried out by the expert committee to reach the expected agreement. In this process, three items were excluded because they did not fit the Brazilian culture. The overall Content Validity Index was 0.97. The pre-test with the target population resulted in a Kappa coefficient equal to 0.94 ­ almost perfect agreement and an overall agreement percentage of 95.78%. The developed steps contributed to the semantic, conceptual and cultural equivalence in relation to the original instrument. Conclusion: The questionnaire Pesquisa sobre controle de infecção na Atenção Domiciliar was obtained, aimed at evaluating the self-declared adherence of nursing professionals to the practices of infection control in Home Health Care, related knowledge and attitudes. Thus, the instrument was adapted to the Brazilian culture and achieved satisfactory agreement among experts and among members of the target population. (AU)

Objetivo: Adaptar el instrumento norteamericano Survey of Infection Control in Home Health Care a la cultura brasileña. Métodos: Estudio metodológico de adaptación transcultural, siguiendo las etapas de traducción, síntesis, retrotraducción, evaluación por un comité de expertos y pre-test con la población objetivo. Resultados: Se realizaron dos rondas de evaluación por parte del comité de expertos para llegar al acuerdo esperado. En ese proceso, tres ítems fueron excluidos por no encajar en la cultura brasileña. El Índice de Validez de Contenido general fue de 0,97. El pre-test con la población diana resultó en un coeficiente Kappa igual a 0,94 ­ concordancia casi perfecta y un porcentaje de concordancia global del 95,78%. Los pasos desarrollados contribuyeron a la equivalencia semántica, conceptual y cultural en relación al instrumento original. Conclusión: Se obtuvo el cuestionario Pesquisa sobre controle de infecção na Atenção Domiciliar con el objetivo de evaluar la adhesión autodeclarada de los profesionales de enfermería a las prácticas de control de infecciones en los Servicios de Atención de Salud a Domicilio, los conocimientos y las actitudes relacionados. Así, el instrumento se adaptó a la cultura brasileña y logró un acuerdo satisfactorio entre los expertos y entre los miembros de la población objetivo. (AU)

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Introducción: Los cuidados domiciliarios para los niños con enfermedades neoplásicas, representan costos sociales y económicos, además de posibles riesgos de infección. Por lo que, la importancia del cuidado de los menores ante las infecciones respiratorias virales durante la infancia radica en asegurar las correctas medidas de prevención del contagio. El objetivo de este estudio fue determinar la relación existente entre la competencia para el cuidado domiciliario y la presencia de infecciones respiratorias en los niños con tratamiento oncológico. Método: Estudio de enfoque cuantitativo, diseño correlacional, de corte transversal y descriptivo. La muestra se compone de 75 díadas. La competencia del cuidado domiciliario se midió con el instrumento CUIDAR. El análisis estadístico se realizó con el programa estadístico SPSS versión 25, utilizando estadística descriptiva y estadística inferencial no paramétrica. Resultados: La prevalencia de infecciones respiratorias fue del 4% para los menores con cuidadores con un nivel alto de competencia para el cuidado domiciliario, 12% para el nivel medio y 21.3%para el nivel bajo, mostrando dependencia entre las variables de estudio(X2=14.4, gl= 2, p=0.001). Además, se determinó una asociación (r=-.439, p<.001)entre las mismas. Discusión: La competencia con un nivel alto en los cuidados domiciliarios, supone un adecuado desempeño del rol como cuidador familiar con efecto en calidad de vida de la díada cuidador familiar-persona con cáncer. Conclusiones: A mayor competencia para el cuidado, menor la prevalencia de infecciones respiratorias; existiendo una relación entre la competencia para el cuidado domiciliario y la presencia de infecciones respiratorias en los niños con tratamiento oncológico.

Introduction: Home care for children with neoplastic diseases represents social and economic costs, as well as possible risks of infection. Therefore, the importance of caring for minors in the face of viral respiratory infections during childhood lies in ensuring the correct measures to prevent contagion. The objectiveof this study was to determine the relationship between competence for home care and the presence of respiratory infections in children undergoing cancer treatment. Method: Study of quantitative approach, correlational, cross-sectional and descriptive design. The sample consists of 75 dyads. Home care competence was measured with the CARE instrument. Statistical analysis was performed with the statistical program SPSS version 25.0, using descriptive statistics and non-parametric inferential statistics. Results: The prevalence of respiratory infections was 4% for children with caregivers with a high level of home care competence, 12% for the medium level and 21.3% for the low level, showing dependence between the study variables (X2=14.4, gl= 2, p=0.001). In addition, an association (r=-.439, p<.001) was determined between them. Discussion: The competence with a high level in home care supposes an adequate performance of the role as family caregiver with effect on quality of life of the family caregiver-person with a cancer dyad. Conclusions:The higher the caregiving competence, the lower the prevalence of respiratory infections; there is a relationship between home caregiving competence and the presence of respiratory infections in children undergoing cancer treatment.

Introdução: Os cuidados domiciliares para as crianças com doenças neoplásicas representam custos sociais e econômicos, além dos possíveis riscos de infecção. Por isso, a importância de tomar conta delas no que diz respeito às infecções respiratórias virais durante sua meninice radica em segurar as medidas adequadas para prevenir o contágio. O objetivo deste estúdio foi determinar a relação entre as infecções respiratórias nas crianças sob tratamento contra o cancro e a habilitação para lhes fornecer os cuidados em casa. Método: Estúdio da abordagem quantitativa, desenho correlacional, de corte transversal e descritivo. A amostra se compõe de 75 díades. A habilitação dos cuidados em casa foi medida com o instrumento TOMAR CONTA. A análise estatística se realizou com o programa estatístico SPSS, versão 25. Foi utilizada a estatística descritiva e a estatística inferencial não paramétrica. Resultados: A prevalência de infecções respiratórias foi de 4% para as crianças que receberam os cuidados em casa com um alto nível de efetividade; 12%, quando a efetividade dos cuidados foi intermediária; e para a baixa chegou até 21,3%. Isto demonstra a correlação entre as variáveis de estudo (X2= 14,4; gl= 2; p= 0,001). Além disso, se determinou uma associação (r= -,439; p<,001) entre elas. Discussão:A aptidão adequada para fornecer os cuidados em casa aponta que o responsável pela família desempenhou bem seu papel, o que fez com que houvesse repercussões positivas na qualidade de vida da díade "cuidador familiar-pessoa com câncer". Conclusões: Quanto maior é a proficiência para dar os cuidados, menor é o impacto das infecções respiratórias. Existe uma relação entre a habilitação para os cuidados em casa e a presença de infecções respiratórias nas crianças que recebem tratamentos oncológicos

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BACKGROUND: The quest for improved diagnosis and treatment in home health care models has led to the development of wearable medical devices for remote vital signs monitoring. An accurate signal and a high diagnostic yield are critical for the cost-effectiveness of wearable health care monitoring systems and their widespread application in resource-constrained environments. Despite technological advances, the information acquired by these devices can be contaminated by motion artifacts (MA) leading to misdiagnosis or repeated procedures with increases in associated costs. This makes it necessary to develop methods to improve the quality of the signal acquired by these devices. OBJECTIVE: We aimed to present a novel method for electrocardiogram (ECG) signal denoising to reduce MA. We aimed to analyze the method's performance and to compare its performance to that of existing approaches. METHODS: We present the novel Redundant denoising Independent Component Analysis method for ECG signal denoising based on the redundant and simultaneous acquisition of ECG signals and movement information, multichannel processing, and performance assessment considering the information contained in the signal waveform. The method is based on data including ECG signals from the patient's chest and back, the acquisition of triaxial movement signals from inertial measurement units, a reference signal synthesized from an autoregressive model, and the separation of interest and noise sources through multichannel independent component analysis. RESULTS: The proposed method significantly reduced MA, showing better performance and introducing a smaller distortion in the interest signal compared with other methods. Finally, the performance of the proposed method was compared to that of wavelet shrinkage and wavelet independent component analysis through the assessment of signal-to-noise ratio, dynamic time warping, and a proposed index based on the signal waveform evaluation with an ensemble average ECG. CONCLUSIONS: Our novel ECG denoising method is a contribution to converting wearable devices into medical monitoring tools that can be used to support the remote diagnosis and monitoring of cardiovascular diseases. A more accurate signal substantially improves the diagnostic yield of wearable devices. A better yield improves the devices' cost-effectiveness and contributes to their widespread application.

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OBJECTIVE: In recent years, the use of outpatient parenteral antimicrobial therapy (OPAT) has increased, resulting in the need to ensure its rational and adequate utilization. This article describes the implementation of an antimicrobial stewardship program in the OPAT setting by a Health Maintenance Organization (HMO) and its results. METHOD: An infectious disease (ID) physician made routine assessments of all home care parenteral antimicrobial requests from February to December 2019. Information on diagnosis, renal function, weight, previous antimicrobials, and microbiology were gathered during remote evaluations. Prescription changes recommended by the ID specialist were not mandatory, but implemented by the primary provider as accepted. Antibiotic consumption data was analyzed from January 2018 to December 2019. An active screening was conducted for treatment failures: two or more treatment course requirements, or death within 15 days of the evaluation were reexamined. RESULTS: A total of 506 antimicrobial requests were assessed. The most frequent diagnoses were urinary tract infection, pneumonia, and orthopedic surgical site infection. Six percent of evaluations were not completed due to insufficient information and 12% were requests by the primary physician for initial antimicrobial guidance. Of the 416 completed prescriptions evaluations, 58% had suggested changes, including different antimicrobials (40%), treatment duration (25%), and route of administration (23%). There was an increase in use of teicoplanin and meropenem, and a decrease in ceftriaxone, ertapenem, cefepime, amikacin and daptomycin use. The HMO's overall parenteral antimicrobial outpatient consumption, which had shown an upward trend over the previous year, decreased after program initiation. No major adverse results were detected in patients' clinical outcomes; two treatment failures were detected and promptly corrected; no deaths attributed to antibiotic changes were detected. CONCLUSION: Outpatient antimicrobial stewardship, through remote assessment by an ID specialist, was effective and safe in the OPAT setting.

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Introducción: Los pacientes hospitalizados con altas dependencias tecnológicas respiratorias son cada vez más frecuentes y generan largas estadías en unidades de cuidados intensivos. Las estrategias que mitiguen su impacto han sido escasamente descritas. Objetivo: Describir 6 años de experiencia de una Unidad de Ventilación Mecánica Prolongada Pediátrica.Métodos: Estudio retrospectivo. Se incluyeron todos los niños ingresados a la Unidad entre 10-2012 y 12-2018. Se realizó estadística descriptiva e inferencial, analizando tiempos de hospitalización y reingresos. Se compararon distintas variables según tipo de patología y ventilación mecánica.Resultados: 113 pacientes registraron 310 ingresos a la Unidad. Edad de ingreso: 2,2 años (0,6-8,8); varones: el 60,2 %. Patologías: enfermedad neuromuscular (el 22,1 %), enfermedad pulmonar crónica (el 20,4 %), daño neurológico (el 34,5 %), obstrucción de vía aérea superior (el 9,7 %), cardiopatía (el 3,5 %), síndrome de Down (el 9,7 %). Se utilizaron 10 507 días/cama; con índice ocupacional del 92,6 %, el 54,8 % de traslados a la Unidad de Cuidados Intensivos y el 66,1 % de reingresos. Hospitalización media: 16 días (6,5-49,0); diferencias en edad de ingreso según patologías (p = 0,032). Hubo más reingresos en niños con daño neurológico y síndrome de Down (p = 0,004). Los niños con asistencia ventilatoria invasiva presentaron más días de hospitalización (p < 0,001) y reingresos (p < 0,001).Conclusión: El índice ocupacional fue superior al 90 %; permitió mayor disponibilidad de camas intensivas y egresar a todos los pacientes. Los niños con asistencia ventilatoria invasiva se hospitalizaron más tiempo y reingresaron más

Introduction: Hospitalized patients with high respiratory technology dependency are increasingly common and result in lengthy stays in intensive care units. Strategies mitigating its impact have been scarcely described.Objective: To describe a 6-year experience in a Pediatric Prolonged Mechanical Ventilation Unit.Methods: Retrospective study. All children admitted to the unit between October 2012 and December 2018 were included. Descriptive and inferential statistical methods were used, analyzing lengths of stay and readmissions. Different outcome measures were compared according to the type of pathology and mechanical ventilation.Results: A total of 113 patients had 310 admissions to the unit. Age at admission: 2.2 years (0.6-8.8); males: 60.2 %. Pathologies: neuromuscular disease (22.1 %), chronic lung disease (20.4 %), neurological damage (34.5 %), upper airway obstruction (9.7 %), heart disease (3.5 %), Down syndrome (9.7 %). A total of 10 507 bed-days were used; with a 92.6 % occupancy rate, 54.8 % of transfers to the intensive care unit, and 66.1 % of readmissions. Mean length of stay: 16 days (6.5-49.0); differences in age at admission observed by pathology (p = 0.032). More readmissions were observed in children with neurological damage and Down syndrome (p = 0.004). Children with invasive ventilation were observed to have a longer length of stay (p < 0.001) and more readmissions (p < 0.001).Conclusion: The occupancy rate at the PMVU was over 90 %, which allowed more available intensive care beds and discharging all patients. Children with invasive ventilation had a longer length of stay and more readmissions.

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INTRODUCTION: Hospitalized patients with high respiratory technology dependency are increasingly common and result in lengthy stays in intensive care units. Strategies mitigating its impact have been scarcely described. OBJECTIVE: To describe a 6-year experience in a Pediatric Prolonged Mechanical Ventilation Unit. METHODS: Retrospective study. All children admitted to the unit between October 2012 and December 2018 were included. Descriptive and inferential statistical methods were used, analyzing lengths of stay and readmissions. Different outcome measures were compared according to the type of pathology and mechanical ventilation. RESULTS: A total of 113 patients had 310 admissions to the unit. Age at admission: 2.2 years (0.6-8.8); males: 60.2 %. PATHOLOGIES: neuromuscular disease (22.1 %), chronic lung disease (20.4 %), neurological damage (34.5 %), upper airway obstruction (9.7 %), heart disease (3.5 %), Down syndrome (9.7 %). A total of 10 507 bed-days were used; with a 92.6 % occupancy rate, 54.8 % of transfers to the intensive care unit, and 66.1 % of readmissions. Mean length of stay: 16 days (6.5- 49.0); differences in age at admission observed by pathology (p = 0.032). More readmissions were observed in children with neurological damage and Down syndrome (p = 0.004). Children with invasive ventilation were observed to have a longer length of stay (p < 0.001) and more readmissions (p < 0.001). CONCLUSION: The occupancy rate at the PMVU was over 90 %, which allowed more available intensive care beds and discharging all patients. Children with invasive ventilation had a longer length of stay and more readmissions.

Introducción: Los pacientes hospitalizados con altas dependencias tecnológicas respiratorias son cada vez más frecuentes y generan largas estadías en unidades de cuidados intensivos. Las estrategias que mitiguen su impacto han sido escasamente descritas. Objetivo: Describir 6 años de experiencia de una Unidad de Ventilación Mecánica Prolongada Pediátrica. Métodos: Estudio retrospectivo. Se incluyeron todos los niños ingresados a la Unidad entre 10-2012 y 12-2018. Se realizó estadística descriptiva e inferencial, analizando tiempos de hospitalización y reingresos. Se compararon distintas variables según tipo de patología y ventilación mecánica. Resultados: 113 pacientes registraron 310 ingresos a la Unidad. Edad de ingreso: 2,2 años (0,6-8,8); varones: el 60,2 %. Patologías: enfermedad neuromuscular (el 22,1 %), enfermedad pulmonar crónica (el 20,4 %), daño neurológico (el 34,5 %), obstrucción de vía aérea superior (el 9,7 %), cardiopatía (el 3,5 %), síndrome de Down (el 9,7 %). Se utilizaron 10 507 días/cama; con índice ocupacional del 92,6 %, el 54,8 % de traslados a la Unidad de Cuidados Intensivos y el 66,1 % de reingresos. Hospitalización media: 16 días (6,5-49,0); diferencias en edad de ingreso según patologías (p = 0,032). Hubo más reingresos en niños con daño neurológico y síndrome de Down (p = 0,004). Los niños con asistencia ventilatoria invasiva presentaron más días de hospitalización (p < 0,001) y reingresos (p < 0,001). Conclusión: El índice ocupacional fue superior al 90 %; permitió mayor disponibilidad de camas intensivas y egresar a todos los pacientes. Los niños con asistencia ventilatoria invasiva se hospitalizaron más tiempo y reingresaron más.

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Data sharing is necessary to address communication deficits along the transitions of care among community settings. Evidence-based practice supports home healthcare (HHC) patients to see their primary care team within the first two weeks of hospital discharge to reduce rehospitalization risk. A small subset of patient data collected at HHC admission is mandated to be transmitted to primary care, predominantly by fax. Using qualitative analysis, we assessed completeness of the United States Core Data for Interoperability (USCDI) interoperability standard, as compared to the patient data collected by the primary care team (topics) and HHC (classes) during the initial visit; and offer interoperability recommendations. Findings indicate the USCDI does not cover 74% of the 19 faxed HHC classes that mapped to the primary care topics, and 95% of the 38 not-faxed HHC classes. We offer USCDI recommendations to address these interoperability gaps.

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ABSTRACT Objective: In recent years, the use of outpatient parenteral antimicrobial therapy (OPAT) has increased, resulting in the need to ensure its rational and adequate utilization. This article describes the implementation of an antimicrobial stewardship program in the OPAT setting by a Health Maintenance Organization (HMO) and its results. Method: An infectious disease (ID) physician made routine assessments of all home care parenteral antimicrobial requests from February to December 2019. Information on diagnosis, renal function, weight, previous antimicrobials, and microbiology were gathered during remote evaluations. Prescription changes recommended by the ID specialist were not mandatory, but implemented by the primary provider as accepted. Antibiotic consumption data was analyzed from January 2018 to December 2019. An active screening was conducted for treatment failures: two or more treatment course requirements, or death within 15 days of the evaluation were reexamined. Results: A total of 506 antimicrobial requests were assessed. The most frequent diagnoses were urinary tract infection, pneumonia, and orthopedic surgical site infection. Six percent of evaluations were not completed due to insufficient information and 12% were requests by the primary physician for initial antimicrobial guidance. Of the 416 completed prescriptions evaluations, 58% had suggested changes, including different antimicrobials (40%), treatment duration (25%), and route of administration (23%). There was an increase in use of teicoplanin and meropenem, and a decrease in ceftriaxone, ertapenem, cefepime, amikacin and daptomycin use. The HMO's overall parenteral antimicrobial outpatient consumption, which had shown an upward trend over the previous year, decreased after program initiation. No major adverse results were detected in patients' clinical outcomes; two treatment failures were detected and promptly corrected; no deaths attributed to antibiotic changes were detected. Conclusion: Outpatient antimicrobial stewardship, through remote assessment by an ID specialist, was effective and safe in the OPAT setting.

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As solicitações de cobertura para home care estão entre as mais complexas discussões hoje existentes no universo jurídico dos planos de saúde. A partir de um estudo normativo-jurisprudencial, o presente artigo tem como objetivo examinar os serviços de saúde domiciliares à luz das coberturas dos contratos de planos de saúde. Com esta meta, passa por diversos tópicos inerentes a este assunto, incluindo determinados fenômenos jurídicos e sociais que ajudam a entendê-lo, assim como o regime jurídico que regula a matéria. Na sequência, o artigo foca os serviços domiciliares, com ênfase naqueles que, à luz das normas aplicáveis, são considerados como de cobertura obrigatória. Após, comenta também a complexidade terminológica que envolve o tema. Ao final, passa ao exame da jurisprudência existente sobre planos de saúde e cobertura para serviços domiciliares, com destaque para os recentes precedentes que, na opinião dos autores, adotam uma posição mais aceitável e razoável, capaz de representar um verdadeiro ponto de equilíbrio a esta temática tão controvertida.

Demands for home care coverage are stirring the most complex discussions currently existing in the legal universe of health insurance contracts. Based on a normative-jurisprudential study, this essay's scope examines home health care services in light of the coverage of health insurance contracts. With this goal, several topics on the subject are dealt with, including certain juridical and social phenomena that facilitate its understanding, as well as the legal regime that regulates this matter. It follows focusing on home health care services, with emphasis on those that, in light of the applicable regulatory standards, are considered to be of compulsory coverage. Next, the terminological complexity that involves this subject is also commented. At the end, the existing jurisprudence regarding health care insurances and the coverage for home health care services is examined, highlighting recent precedents that, in the authors' opinion, adopt an acceptable and reasonable position, capable of representing a true balance point for this controversial matter.

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A atenção domiciliar vem sendo ressignificada no contexto das políticas públicas de saúde brasileiras, ancorando-se em um novo modo de conceber e ofertar o cuidado. A trajetória política, jurídica e ideológica da oferta da atenção domiciliar no país tem instigado a realização de estudos. Analisou-se a trajetória política de implantação e implementação da atenção domiciliar no estado de Minas Gerais, Brasil, discutindo os movimentos provocados pela regulamentação da Política Nacional de Atenção Domiciliar publicada no país em 2011. Pesquisa descritivo-exploratória, com abordagem qualitativa, realizada em 19 serviços de atenção domiciliar ofertados em Minas Gerais, que respeitou os aspectos éticos da pesquisa com seres humanos. Os dados foram obtidos de entrevista com 22 coordenadores/gestores de serviços e três informantes-chave, e foram submetidos à análise de conteúdo temática. Os resultados estão organizados em duas categorias: a configuração política da atenção domiciliar; a trajetória de implantação da oferta da atenção domiciliar em Minas Gerais e efeitos da política. Os achados mostram a conformação política da AD no país a partir das normativas federais; e a expansão dos serviços no estado impulsionada pela indução financeira da política nacional. Concluiu-se que a atenção domiciliar é alternativa assistencial que acolhe as demandas dos "velhos" serviços, mas, ao mesmo tempo, ela tem contribuído com avanços na integralidade do cuidado e reestruturação produtiva do trabalho em saúde.(AU)

Home care has been reinterpreted in the context of Brazilian public health policies, anchored in a new way of conceiving and offering care. The political, juridical and ideological trajectory of the home care offer in the country has instigated studies. It was analyzed the political trajectory of the implementation of Home Care in the state of Minas Gerais, Brazil, discussing the movements evoked by the regulation of the National Policy of Home Care published in the country in 2011. Descriptive-exploratory research, with a qualitative approach, carried out in 19 Home Care Services offered in Minas Gerais, which respected the ethical aspects of research with human beings. The data were obtained from an interview with 22 coordinators/service managers and 03 key informants, and were submitted to the Thematic Content Analysis. The results are organized into two categories: the political configuration of Home Care; the path of implementation of the provision of Home Care in Minas Gerais and effects of the Policy. The findings point to the political configuration of HC in the country, based on federal regulations; and the expansion of services in the state driven by the financial induction of the National Policy. It is concluded that home care is an alternative care that welcomes the demands of the "old" services, but at the same time, it has contributed to advances in the comprehensive care provision and productive restructuring of the health work.(AU)

La atención domiciliaria asume nuevos significados dentro del contexto de las políticas públicas de salud brasileñas, basada en una manera nueva de pensar y ofrecer cuidados. La trayectoria política, jurídica e ideológica de la oferta de la atención domiciliaria en el país ha fomentado la realización de estudios. Se analizó la trayectoria política de implantación e implementación de la atención domiciliaria en el estado de Minas Gerais, Brasil, y se discuten los movimientos provocados por la reglamentación de la Política Nacional de Atención Domiciliaria publicada en 2011. Investigación exploratoria, descriptiva, de enfoque cualitativo, llevada a cabo en 19 servicios de atención domiciliaria de Minas Gerais, que respetó los aspectos éticos de la investigación con seres humanos. Los datos se recogieron en entrevistas a 22 coordinadores / gestores de servicios y 3 informantes clave y se analizaron según el contenido temático. Los resultados se organizaron en dos categorías: configuración política de la atención domiciliaria, trayectoria de implantación de la oferta de la atención domiciliaria en Minas Gerais y efectos de la política. Los hallazgos muestran la configuración política de la AD en el país a partir de las regulaciones federales y la expansión de los servicios en el estado impulsada por la inducción financiera de la política nacional. Se concluye que la atención domiciliaria es una alternativa asistencial que incluye las demandas de los "antiguos" servicios y que contribuye a los avances en la integralidad de la atención y en la reestructuración productiva del trabajo en salud.(AU)

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The purposes of this study were to examine the relationships among knowledge of and confidence in health care services (HHCS), acculturation, characteristics of family caregivers of Mexican descent, and differences by caregivers' relationship (spouse or adult child). A sample of Mexican-descent older adults and their caregivers was recruited (n = 74 dyads) in Arizona. Each participant completed questionnaires on knowledge, confidence, and acculturation. There were moderate but significant associations among higher Anglo Orientation with Knowledge and with Confidence. Fear of HHCS was positively associated with higher Anglo Orientation and English Language Preference; and negatively associated with Mexican Orientation and Spanish Language Preference. For Spouse caregivers, Fear of HHCS was positively correlated with higher Anglo Orientation and English Language Preference; for Offspring caregivers, Fear of HHCS was negatively correlated with Mexican Orientation and Spanish Language Preference. Results support assessing caregiver cohort and socio-cultural context to decrease HHCS use disparities by Mexican-descent caregiving families.

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OBJECTIVE: To assess patient- and hospital-level factors associated with home health care (HHC) referrals following nonelective U.S. patient hospitalizations in 2012. DATA SOURCE: The 2012 National Inpatient Sample (NIS). STUDY DESIGN: Retrospective, cross-sectional multivariable logistic regression modeling to assess patient- and hospital-level variables in patient discharges with versus without HHC referrals. DATA COLLECTION: Analysis included 1,109,905 discharges in patients ≥65 years with Medicare. PRINCIPAL FINDINGS: About 29.2 percent of discharges were referred to HHC, which were more likely with older age, female sex, urban location, low income, longer length of stay, higher severity of illness scores, diagnoses of heart failure or sepsis, and hospital location in New England (referent: Pacific). CONCLUSIONS: As health policy changes influence postacute HHC, defining specific diagnoses and regional patterns associated with HHC is a first step to optimize postacute HHC services.

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Objetivo: conhecer as representações sociais construídas pelos cuidadores familiares de pacientes terminais sobre o cuidado no domicílio. Método: estudo qualitativo com referencial teórico-metodológico das representações sociais, realizado com 11 cuidadores familiares de doentes terminais, cadastrados no serviço de internação domiciliar de um hospital universitário do sul do Brasil. Realizaram-se entrevistas narrativas, analisadas por meio de análise de conteúdo. Elaboraram-se quatro categorias: 1) cuidadores homens e mulheres - um olhar diferenciado; 2) a inversão de papéis e trocas a partir do cuidar; 3) experiências como fonte de conhecimento para o cuidado domiciliar; 4) desafios do cuidar. Resultados: para os cuidadores homens, as representações diferem das mulheres, pois o cuidado inclui o ambiente, além do paciente. Eles não atribuem a angústia gerada à sobrecarga, mas ao temor da perda do ente querido. Outras representações remetem-se à falta de escolha para assumir o papel de cuidador e à inversão ou mudança de papéis, o que torna o paciente submisso ao cuidador. Conclusão: esta pesquisa permitiu conhecer como os cuidadores familiares constroem os significados e interpretam o cuidado que realizam no domicílio por meio do programa de hospitalização domiciliar. Destaca-se a função dos profissionais da saúde em orientar o cuidador familiar para realizar o cuidado.

Objetivo: conocer las representaciones sociales construidas por los cuidadores familiares de pacientes terminales sobre el cuidado en el domicilio. Método: estudio cualitativo con once cuidadores familiares de enfermos terminales, registrados en el servicio de internación domiciliaria de un hospital universitario del sur de Brasil. Realizaron entrevistas narrativas, analizadas por medio del análisis de contenido. Se definieron cuatro categorías: cuidadores hombres y mujeres, una visión diferente; la inversión de roles y los cambios en el cuidado; experiencias como fuente de conocimiento para el cuidado en el hogar; y desafíos del cuidado. Resultados: para los cuidadores hombres, las representaciones difieren de las de las mujeres debido a que el cuidado incluye su entorno. Los hombres no atribuyen la angustia a la sobrecarga, pero sí al temor de perder un ser. Otras representaciones remiten a la imposibilidad de elección para asumir el papel de cuidador y a la inversión de roles, lo que vuelve al paciente sometido al cuidador. Conclusión: esta investigación permitió conocer cómo los cuidadores familiares construyen los significados e interpretan el cuidado que realizan en el domicilio por medio del Programa de Hospitalización Domiciliaria. Se destaca la función de los profesionales de la salud en orientar al cuidador familiar para realizar el cuidado.

Objective: To learn about the social representations of home care by family caregivers of terminally ill patients. Method: Qualitative study with eleven family caregivers of terminally ill patients, registered in the home care service of a teaching hospital in southern Brazil. The researchers conducted narrative interviews and used the content analysis method to analyze them. Four categories were established: male and female caregivers, a different perspective; role reversal and changes in care; experiences as a source of knowledge for home care; and healthcare challenges. Results: Representations by male caregivers differ from those of female caregivers because care also includes the context. Male caregivers do not associate distress to excessive burden but to the fear of losing someone. Other representations refer to the impossibility of choice to assume the role of caregiver and to role reversal, which causes patients to be submissive with the caregiver. Conclusion: The research revealed how family caregivers construct meanings and how they interpret the home care provided through the home care program. Particular attention is given to the role of healthcare professionals in guiding family caregivers.

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O estudo teve como objetivo analisar a prática do cateterismo vesical intermitente realizada no domicílio pelo cuidador do usuário cadastrado no Serviço da Atenção Domiciliar de Betim, Minas Gerais. Estudo descritivo-exploratório no qual os dados foram obtidos por meio de entrevistas e observação da técnica de cateterismo durante acompanhamento domiciliar de seis usuários do serviço. Os resultados revelaram as características dos pacientes dependentes do cateterismo vesical intermitente e de seus cuidadores. Prevalecem pacientes do sexo feminino, com idade entre nove e 44 anos, dependentes do cateterismo por acometimento do quadro de bexiga neurogênica secundária a traumatismo raquimedular por acidente, mielomeningolece ou leucemia. Os cuidadores são, a maioria, mulheres (mãe ou irmã) com idade entre 29 e 57 anos. Em relação ao procedimento do cateterismo, os resultados indicam o seguimento das normatizações do protocolo do serviço de atenção domiciliar quanto à higienização das mãos e do meato urinário, uso de luvas e lubrificantes, acondicionamento e reutilização do cateter. Os resultados indicam, ainda, que o apoio oferecido pelos serviços de saúde do SUS-Betim, para o cuidado no domicílio, encontra-se insuficiente como rede assistencial, sendo considerados apenas como fornecedores de materiais. A infecção no trato urinário, na maioria dos usuários, reflete a necessidade de uma educação em saúde para cuidador e não somente um treinamento tecnicista. Conclui-se que o enfermeiro como agente do cuidado deve fundamentar o ensino do cateterismo vesical intermitente em uma atenção integral, que vise à corresponsabilidade da equipe de saúde, do cuidador e do próprio usuário.

This descriptive and exploratory study aims at evaluating intermittent catheterization performed by caregivers to users registered at the Home Care Service in Betim, Minas Gerais. Data was collected through interviews and observation of the catheterization technique during home visits to six patients. The latter were predominantly female, aged between 9 and 44 years, who depended on catheterization due to neurogenic bladder caused by spinal trauma, myelomeningocele or leukaemia. Caregivers were usually female (either mother or sister) aged between 29 and 57 years. With regards to catheterization, results show that caregivers followed standard procedures concerning hands and urinary meatus hygiene, use of gloves and lubricants, storage and reuse of catheters. Public health system offered little support to home care; its main role was to provide nursing supplies. The detection of urinary tract infection in most of the patients indicates the need of health care education rather than only technical training for caregivers. The study concludes that the nurse, as health care agent, must promote IC training and actions that implicate the health care team, the caregiver and the user in the process.

El objetivo del presente estudio fue analizar la práctica del cateterismo vesical intermitente efectuada en el domicilio por el cuidador del usuario registrado en el Servicio de Atención Domiciliaria de Betim, Minas Gerais. Se trata de un estudio exploratorio descriptivo con datos recogidos en entrevistas y durante observación de la técnica de cateterismo en el seguimiento domiciliario de seis usuarios del servicio. Los resultados determinaron las características de los pacientes dependientes del cateterismo y de sus cuidadores. Prevalecían pacientes del sexo femenino, con edad entre 9 y 44 anos, dependientes del cateterismo debido a un cuadro de vejiga neurogénica secundaria a traumatismo raquimedular por accidente, mielomeningocelis o leucemia. La mayoría de los cuidadores eran mujeres (madre o hermana) con edad entre 29 y 57 años. Con relación al procedimiento del cateterismo, los resultados indicaron que se siguieron las normas del protocolo del servicio de atención domiciliaria referentes a higienización de las manos y del meato urinario, uso de guantes y lubricantes, acondicionamiento y reutilización del catéter. También se observó que el apoyo de los servicios del sistema único de salud de Betim no es suficiente como red asistencial y que funciona apenas como suministrador de material. La presencia de infección urinaria en la mayoría de los usuarios señala que, aparte de la capacitación técnica, los cuidadores precisan tener educación en salud. Se concluye que el enfermero como agente del cuidado debe fundamentar la enseñanza del cateterismo vesical intermitente en la atención integral de salud, con miras a la responsabilidad compartida entre el equipo de salud, el cuidador y el propio usuario.

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La atención médica domiciliaria es una estrategia que permite evitar infecciones asociadas al cuidado de la salud en individuos con deficiencias inmunológicas como los adultos mayores. Se realizó una investigación de tipo descriptivo-longitudinal, en la que se tuvieron en cuenta condiciones relacionadas con el dispositivo de micronebulización como: el tiempo de uso, el lavado del dispositivo y su almacenamiento. Con respecto al terapeuta se tuvo en cuenta: lavado de manos y aplicación del protocolo de limpieza y desinfección. Se realizaron dos tomas de muestra a diecisiete dispositivos de micronebulización individual de adultos mayores pertenecientes al programa de hospitalización domiciliaria de Forja Empresas Ltda, a los quince y treinta días de uso después de la entrega del dispositivo en dos momentos: antes y después del procedimiento de la terapia respiratoria. Se identificaron ocho microorganismos en la primera toma de muestra que se clasificaron como flora transitoria y diecinueve microorganismos en la segunda, en la que se encontró flora residente, transitoria y potencialmente patógena. En relación al protocolo de limpieza y desinfección, realizado por los terapeutas, se observó modificaciones al protocolo establecido por Forja Empresas Ltda, sin embargo dicho protocolo no incluye el lavado de manos, punto indispensable para la atención del paciente. Se hace necesario brindarles información oportuna a los pacientes, familiares y/o cuidadores sobre el almacenamiento adecuado del dispositivo con el fin de evitar presencia de microorganismos que pueden afectar la salud de los adultos mayores.

Home health care is a strategy that allows avoiding infections associated with health care of individuals with immune deficiencies such as older adults. A descriptive-longitudinal investigation was conducted, which took into account conditions related to the micro-nebulization equipment device such as: its time of use, cleansing, and storage. With respect to the therapist, it was taken into account: hand washing and implementation of the protocol of cleaning and disinfection. Two different samples were taken to seventeen individual micro-nebulization equipment devices of older adults belonging to the program of home hospitalization of Forging Companies Ltd., after fifteen and thirty days of use after the delivery of the device in two times: before and after the respiratory procedure. Eight microorganisms were identified in the first portion of the sample that were classified as transitory flora and nineteen microorganisms in the second one, where resident, transient, and potentially pathogenic flora was found. In relation to the protocol of cleaning and disinfection carried out by the therapists. Changes to the protocol established by Forging Companies Ltd. were observed; however, this protocol does not include the washing of hands, which is a vital point for patient care. It is necessary to provide patients, family members and/or caregivers with timely information about the proper storage of the device in order to avoid the presence of microorganisms that can affect the health of older adults.

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O objetivo deste estudo é identificar os aspectos abordados sobre a formação para o cuidado domiciliar-CDnas produções científicas brasileiras. Realizou-se uma revisão integrativa que analisou 39 produções, compreendidasentre o período de Janeiro de 1999 e Maio de 2009. Como resultado, emergiram três aspectos relevantes: competênciasnecessárias ao CD, a formação para o CD e limitações na formação dos profissionais que atuam no CD. Constatou-se quesão escassas as produções que tratam exclusivamente da formação para o CD na Enfermagem. É necessário portanto,enfatizar junto às instituições formadoras e empregadoras a necessidade de qualificar quem atuará nessa área.

The aim of this study was to identify issues about home health care (HHC) training in Brazilian nursingscientific production. An integrative revision was developed, which analyzed 39 papers, that were published from January1999 to May 1999; as result, three main aspects emerged: necessary competences to HHC, HHC training, and the limitationson the HHC professionals? training. We stated that there are few scientific production exclusively about HHC training inNursing. It?s necessary to emphasize the importance of training in this area among training entities and HHC agencies.

El objetivo de este estudio es identificar los aspectos abordados sobre la formación para el cuidado domiciliario-CD en las producciones científicas brasileras. Se realizó una revisión integradora que analizó 39 producciones, comprendidasentre el período de Enero de 1999 a Mayo de 2009. Como resultado, surgieron tres aspectos relevantes: competenciasnecesarias al CD, la formación para el CD y limitaciones en la formación de los profesionales que actúan en el CD. Fueconstatado que son escasas las producciones que tratan exclusivamente de la formación para el CD en Enfermería. Esnecesario, por lo tanto, enfatizar junto a las instituciones formadoras y empleadoras la necesidad de cualificar quienactuará en esta área.

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Este estudo discute o Programa de Atenção Domiciliar (PAD) na saúde suplementar, utilizando o caso de uma operadora de medicina de grupo, sediada no Rio de Janeiro. A pesquisa procura perceber o modo como se produz a atenção domiciliar e buscou verificá-lo nas relações de cuidado entre equipe, o beneficiário e familiares, entendendo que o modelo assistencial se realiza no cenário da micropolítica do processo de trabalho, no domicílio enquanto espaço de produção do cuidado. Na análise do Programa, aparecem como aspectos importantes a infra-estrutura e logística utilizadas; os critérios de elegibilidade do beneficiário; a rede de cuidados que se forma em apoio ao PAD; e sobretudo o processo de trabalho. Este por sua vez tem uma alta potência para revelar a assistência e, no caso estudado, se caracteriza por um trabalho fortemente multiprofissional, que opera em redes, com projetos terapêuticos integrais e traz uma importante "implicação" dos profissionais com o significado da atenção domiciliar, enquanto algo inovador e de alto valor para o cuidado. O artigo conclui que o PAD se afirma como um importante dispositivo de reestruturação produtiva na saúde suplementar, configurando assim modos diferentes de produzir o cuidado.

This study discusses the role the Brazilian Home Health Care Program (Programa de Atenção Domiciliar - PAD) plays in supplementary care using the example of a Group Care provider headquartered in Rio de Janeiro. The purpose of the study was to understand how home health care is produced by verifying the interaction between the medical team, beneficiaries and family members considering that the service in this care model is delivered in the micro-political scenery of the process, in the client's own home. The assessment of this program must consider: infrastructure and logistics, beneficiary eligibility criteria, the care-network formed in support of the PAD and above all the work process. Especially the latter is a strong indicator, in the present case characterized by an eminently multi-professional team operating in networks with integrated therapeutic projects. For the professionals, Home Health Care has the meaning of an innovative and highly valuable approach to care delivery. The article concludes considering the PAD an important device for a fruitful restructuring of supplementary care through different ways of care delivery.

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A relação dinâmica da saúde e da sociedade determina modificações nas políticas e sistemas de saúde, de modo a atender às necessidades emergentes de saúde da população. Diante das exigências atuais de saúde popular, a Saúde da Família e o Cuidado Domiciliar à Saúde têm sido utilizados para fundamentar e complementar a assistência hospitalar. O cuidado domiciliar na Estratégia Saúde da Família (ESF) apresenta divergências e dificuldades em sua operacionalização, precisando ser readequado para que atenda os princípios do SUS. Para a atuação em saúde da família e, em especial, em cuidado domiciliar à saúde os profissionais precisam de formação e/ou capacitação adequada para tal. Desse modo, foi realizada a atual pesquisa com profissionais atuantes em uma Unidade de Saúde da ESF em Curitiba/PR visando compreender como operacionalizar avanços nas práticas de cuidado domiciliar dos profissionais da ESF. A metodologia utilizada foi da Pesquisa-ação de acordo com a proposta de Michel Thiollent. Observou-se que nos diferentes momentos de desenvolvimento da pesquisa os profissionais de saúde mostram-se abertos para a reflexão e discussão das práticas de cuidado domiciliar à saúde, correlacionando-a com a ESF, porém possuem dificuldades em sua realização bem como na operacionalização de avanços nas mesmas.

The dynamic relation of the health and the society determines modifications in the politics and systems of health, in order to take care of to the emergent necessities of population health. Ahead of the current requirements of popular health, the Family Health and the home health care have been used to base and to complement the hospital assistance. The domiciliary care in the Family Health Strategy (ESF) presents divergences and difficulties in its development, needing to be readequate with the SUS principles. For the performance in family health and, in special, home health care the professionals need formation and/or qualification adjusted for such. So, the current research with operating professionals in a Unit of Health of the ESF in Curitiba/PR was carried through having aimed at to understand as to get advances in the home health care professional practical. The used methodology was of the Research-action in accordance with the proposal of Michel Thiollent. It was observed that at the different moments of development of the research the health professionals reveal open for the reflection and quarrel of the home health care practical, correlating it with the ESF, however they possess difficulties in its accomplishment as well as in the development of advances in the same ones.

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This article discuss the American history and the evolution of home health care that has taken place over the last few years

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