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BACKGROUND: The number of people with palliative care needs is projected to increase globally. Chile has recently introduced legislation for universal access to palliative care services for patients with severe and terminal illnesses, including non-cancer conditions. We aimed to estimate the number of people affected by serious health-related suffering and need for palliative care in Chile to 2050. METHODS: We used data on all deaths registered in Chile between 1997-2019 and population estimates for 1997-2050. We used Poisson regression to model past trends in causes of death adjusted by age, sex and population estimates, to project the number of deaths for each cause from 2021 to 2050. We applied the Lancet Commission on Palliative Care and Pain Relief weights to these projections to identify decedents and non-decedents with palliative care needs. RESULTS: Population palliative care needs in Chile are projected to increase from 117 (95% CI 114 to 120) thousand people in 2021 to 209 (95% CI 198 to 223) thousand people in 2050, a 79% increase (IRR 1.79; 95% CI 1.78-1.80). This increase will be driven by non-cancer conditions, particularly dementia (IRR 2.9, 95% CI 2.85-2.95) and cardiovascular conditions (IRR 1.86, 95% CI 1.83-1.89). By 2050, 50% of those estimated to need palliative care will be non-decedents (not expected to die within a year). CONCLUSIONS: Chile will experience a large increase in palliative care needs, particularly for people with dementia and other non-cancer conditions. Improved availability of high-quality services, expanded clinician training and new sustainable models of care are urgently required to ensure universal access to palliative care.

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OBJECTIVES: People with dementia have several unmet needs during the syndrome progression. More unmet needs are related to hospitalizations, injuries, and death. Little is known about the care needs for people living with dementia in Brazil. This study aims to translate and adapt the Johns Hopkins Dementia Care Needs Assessment (JHDCNA 2.0), a tool design to identify the dementia-related needs of people with dementia and their caregivers, to Brazilian Portuguese, and to verify psychometric properties. METHOD: JHDCNA 2.0 underwent a translation, back-translation, and cultural adaptation. Preliminary psychometric testing of the Brazilian version (JHDCNA-Br 2.0) included pilot testing and experts' assessment, analyses of reliability, evidence based on test content and relations to other variables. We conducted 140 in-home interviews to assess several sociodemographic and health aspects and to be able to complete the JHDCNA-Br 2.0. RESULTS: The JHDCNA-Br 2.0 is reliable and has evidence based on test content and on relations to other variables for people living with dementia and caregivers. Preliminary results suggest high prevalence of unmet needs. CONCLUSION: JHDCNA-Br 2.0 is a reliable and valid tool. The availability of this tool brings new opportunities to the study of dementia care, taking into consideration cultural aspects and may help inform future approaches to dementia care delivery to support persons and families affected by these conditions.

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Background: Children with special health care needs including Down Syndrome, Autism Spectrum Disorder and Down Syndrome experience difficulties in receiving dental treatment. Silver Diamine Fluoride (SDF) and Silver Fluoride (SF) are a minimally invasive treatments options to arrest dental caries without sedation; local or general anaesthesia (GA). Aim: Evaluation of Brazilian's parents' acceptance of the use of SF in CSHCN. Methods: After receiving education on SF, 100 Parents of CSHCN completed a questionnaire concerning their acceptance of SF, in different dental situation. Result: Majority of parents (74,5%) agreed to the use of SF for their children. SF was more acceptable on posterior teeth (74,5%) when compared to its use on anterior teeth (43,1%). Parents accepted to use SF in order: to reduce infection and pain (82,4%); to avoid dental injection (72,5%) and treatment under GA (84,3%). The Majority of parents accepted the properties of SF (82,4%) and Silver (80,4%). Conclusion: Silver Fluoride was accepted as a treatment option for caries, by Brazilian parents of CSHCN. SF should be considered as a treatment option for caries limited to dentine for CSHCN, taking into consideration the individual needs and opinions with regard to aesthetics and exposure to fluoride and silver.

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Introduction: Providing conventional, restorative dental care to children with special healthcare needs (CSHCN) often requires sedation using general anesthesia. Saliva consistency, diet, and oral hygiene practice are different for CSHCN, and limited evidence is available on the efficacy of silver fluoride (SF) for the management of carious lesions for this vulnerable population. Methods: Parents of CSHCN were educated about silver fluoride as a treatment option for caries. In total, 550 carious lesions from 100 participants were identified and scored according to the Nyvad Caries criteria. A total of 100 lesions with Nyvad scores 1, 2, and 3 were treated with a single application of silver fluoride and observed postoperatively at 1, 3, and 6 weeks. Result: The results indicate statistically significant (p < 0.05) differences in lesion remineralization over the 6-week follow-up period. At the 6-week follow-up, more than 85% of all lesions were remineralized across all children, regardless of condition or original Nyvad score of 1, 2, or 3. Conclusion: A single application of silver fluoride has demonstrated effectiveness in remineralization and inactivation of carious lesions over 6 weeks among Brazilian CSHCN. Silver fluoride should be considered an option for the management of carious lesions among CSHCN. Further studies are recommended, including larger sample sizes, longer follow-up times, a second application of SF, and different special needs conditions.

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INTRODUCTION: Special care dentistry (SCD) is still developing in XX. This study aimed to clarify whether primary care dentists are treating patients with special health care needs (SHCN), to know if they have had previous education on SCD (on an undergraduate or postgraduate level), whether their training level impacts their confidence when treating patients with SHCN, and to assess their opinion on SCD as a relevant topic in undergraduate education. METHODS: A survey was answered by 149 primary care dentists working for the National Health Service of the XX region in XX, including information on their daily clinical practice, undergraduate, and postgraduate training in SCD, and their opinions on them. RESULTS: Most interviewees would like to complement their training and believed that SCD should be formally incorporated into undergraduate programs. There was a significant association between confidence in treating patients with SHCN and the rating of their undergraduate training, and between confidence and the number of hours of continuous development courses. CONCLUSION: Most primary care dentists treat patients with SHCN regularly. Therefore, including training in the undergraduate curriculum and afterward becomes necessary to increase their confidence when facing this challenging group of patients.

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Children and youth with special healthcare needs (CYSHCN) are at disproportionate risk of harm from widespread disasters and from life-safety emergencies. These risks may be mitigated by providing preparedness training and support to family caregivers. We conducted a scoping review to identify and map the scholarly literature on home-focused preparedness of families with CYSHCN. Our search strategy yielded 22 relevant articles; 13 pertained to life-safety emergencies, 5 centered on widespread disasters, and 4 addressed preparedness on multiple scales. Approaches to measure or attempt to improve emergency preparedness levels in CYSHCN and their families were diverse and included interviews and focus groups; didactic, video-based, or side-by-side instruction; simulated medical crises; and provisioning of emergency kits. For the studies that involved an intervention (n=15, 68%), several proxy indicators of preparedness were used, including caregiver knowledge, skill, or comfort level with managing emergencies that could affect their CYSHCN; completion of preparedness tasks; and reduction in adverse clinical outcomes. Despite the varied methodologies, prevailing themes in the studies were that family caregivers of CYSHCN felt underprepared for emergencies and disasters, desired training to improve their preparedness at home, and benefited from such trainings, at least in the short term, across domains of self-efficacy, skill, and health outcomes of their CYSHCN. Although more research is needed to compare preparedness interventions and evaluate the durability of these interventions in larger, more diverse samples of CYSHCN and their families, our findings support incorporating preparedness training into preventive care encounters and the hospital-to-home transition.

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OBJECTIVE: To compare the characteristics and healthcare use of children with medical complexity who receive paid certified nursing assistant (CNA) care by a family member (family CNA) and by a traditional nonfamily member (nonfamily CNA). STUDY DESIGN: This was retrospective cohort study of children who received CNA care through Colorado's Medicaid paid family caregiving program between 2017 and 2019 by a home healthcare agency. We compared patient characteristics between the family CNA and nonfamily CNA groups. A multivariable Poisson regression model was used to compare hospitalization rates (days in the hospital per year), adjusting for patient age patient sex, nursing care, and complex chronic condition. RESULTS: Of 861 patients, 79% (n = 680) received family CNA care and 21% (n = 181) received nonfamily CNA care. Patient demographics and hospitalization did not differ between the groups, although patients who had family CNAs were less likely to receive additional nursing-level care (42% vs 60%, P < .01). Family and nonfamily CNA caregivers had similar characteristics, except that family CNA caregivers had substantially better 3-year retention (82% vs 9%, P < .01) despite lower average hourly pay ($14.60 vs $17.60 per hour, P < .01). Hospitalizations were rare (<10% of patients). In the adjusted model, patients who received family CNA care experienced 1 more hospitalized day per year, compared with patients who received nonfamily CNA care (P < .001). CONCLUSIONS: Paid family caregivers provided CAN-level care to children with medical complexity with a greater employee retention compared with nonfamily CNA caregivers, with marginally different hospitalization rates using a family-centered approach. This model may help address workforce shortages while also providing income to family caregivers.

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AIMS: This study aimed to identify the association between management and human resource factors with the performance of dental care provided to patients with special health care needs (SHCN) in secondary care in Brazil in the second cycle of the Program for Quality Improvement and Access to Dental Specialty Centers (PMAQ-CEO). METHODS AND RESULTS: This study is a secondary data analysis from the second cycle from PMAQ-CEO, which evaluated 1097 Dental Specialty Centers (DSCs), conducted in 2018. Seventeen independent variables taken from dentists' training, and dental team management characteristics were analyzed to assess their influence on the reported "Performance of care for SHCN patients". An estimated score was generated from their performance on 23 questions related to the physical and human structure and work processes in the oral health care of SHCN patients in the DSCs. Negative binomial regression model with values p ≤ 0.05 were considered significant. Data analysis included residual deviation to the degree of freedom and the chi-square test. The patient care performance score with SHCN increases significantly when the DSC has a manager (RR = 1.019; CI = 1.011-1.026) and goal monitoring and analysis (RR = 1.012; CI = 1.007-1.005). By contrast, the DSCs in which the dentist is a statutory public servant (RR = 0.998; CI = 0.997-1.000) and performs additional unhealthy or hazardous duties (RR = 0.998; CI = 0.996-0.999) are less likely to provide a higher quality care. CONCLUSION: The heterogeneity and low-performance scores for dental care provided to SHCN was identified in Brazilian health services. It was possible to verify that management and human resource factors of the DSCs were associated with the performance of dental care provided to SHCN patients.

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Este estudo visou identificar a associação entre a gestão e os fatores de recursos humanos com o desempenho dos cuidados odontológicos prestados a pacientes com necessidades especiais (PNE) na atenção secundária no Brasil no segundo ciclo do Programa de Melhoria da Qualidade e Acesso a Centros de Especialidades Odontológicas (PMAQ-CEO). Trata-se de uma análise de dados secundários do segundo ciclo do PMAQ-CEO, que avaliou 1.097 Centros de Especialidades Odontológicas (CEOs), realizado em 2018. Foram analisadas 17 variáveis independentes retiradas da formação de cirurgiões-dentistas e as características de gestão de equipes odontológicas para avaliar a sua influência descrito como "Desempenho dos cuidados aos PNE". Foi gerada uma pontuação estimada a partir do seu desempenho em 23 questões relacionadas com a estrutura física e humana e processos de trabalho nos cuidados de saúde bucal de PNE nos CEOs. Foi utilizado o modelo de regressão binomial negativo e valores de p≤0.05 foram considerados significativos. A análise da qualidade do modelo incluiu o desvio residual ao grau de liberdade e o teste do qui-quadrado. A pontuação do desempenho dos cuidados de saúde dos pacientes com PNE aumenta significativamente quando o CEO tem um gestor (RR=1,019; IC=1,011-1,026) e monitorização e análise de objetivos (RR=1.012; IC=1,007-1,005). Pelo contrário, os CEOs que o dentista é funcionário público estatutário (RR=0,998; IC=0,997-1,000) e que recebe adicional de insalubridade ou periculosidade (RR=0,998; IC=0,996-0,999) possui menor probabilidade de prestar cuidados de maior qualidade. A heterogeneidade e a baixa pontuação de desempenho nos cuidados dentários prestados à PNE foi identificada nos serviços de saúde brasileiros. Foi possível verificar que os fatores de gestão e recursos humanos dos CEOs foram associados ao desempenho dos cuidados em saúde bucal prestados aos PNE.

This study aimed to identify the association between management and human resource factors with the performance of dental care provided to patients with special health care needs (SHCN) in secondary care in Brazil in the second cycle of the Program for Quality Improvement and Access to Dental Specialty Centers (PMAQCEO). Secondary data analysis from the second cycle from PMAQ-CEO, which evaluated 1,097 Dental Specialty Centers (DSCs), conducted in 2018. Seventeen independent variables taken from dentists' training, and dental team management characteristics were analyzed to assess their influence on the reported "Performance of care for SHCN patients". An estimated score was generated from their performance on 23 questions related to the physical and human structure and work processes in the oral health care of SHCN patients in the DSCs. Negative binomial regression model with values p≤0.05 were considered significant. Data analysis included residual deviation to the degree of freedom and the chi-square test. The patient care performance score with SHCN increases significantly when the DSC has a manager (RR=1.019; CI=1.011-1.026) and goal monitoring and analysis (RR=1.012; CI=1.007-1.005). By contrast, the DSCs in which the dentist is a statutory public servant (RR=0.998; CI=0.997-1.000) and performs additional unhealthy or hazardous duties (RR=0.998; CI=0.996-0.999) are less likely to provide a higher quality care. The heterogeneity and low performance scores for dental care provided to SHCN was identified in Brazilian health services. It was possible to verify that management and human resource factors of the DSCs were associated with the performance of dental care provided to SHCN patients.

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Objetivo: refletir as necessidades básicas de saúde ao paciente com traqueostomia por câncer de cabeça e pescoço no contexto da pandemia pelo coronavírus, utilizando a Teoria das Necessidades Básicas. Método: estudo teórico-reflexivo. Foram utilizados documentos do Ministério da Saúde e da Organização Pan-Americana de Saúde, assim como uma revisão da literatura na base de dados da PUBMED para que a literatura científica associasse com os documentos consultados. Resultados: as necessidades básicas de saúde afetadas foram: Psicobiológicas de oxigenação e ambiente; Psicossociais de segurança e comunicação e Psicoespirituais de religião, seguidas dos enunciados das Intervenções de Enfermagem (NIC) como oxigenoterapia, aumento da segurança do paciente, estímulo a rituais religiosos. Conclusão: a construção do saber científico na Enfermagem torna-se imperioso, para que as necessidades de saúde afetadas ao paciente com traqueostomia na pandemia da COVID-19 sejam atendidas, para promoção da saúde e da vida.(AU)

Objective: to reflect the basic health needs of patients with tracheostomy for head and neck cancer in the context of the coronavirus pandemic, using the Theory of Basic Needs. Method: This is a reflective study, carried out through a critical reading of official documents from national and international health agencies and other conceptual sources on the subject.Results: the basic health needs affected were: Psychobiological oxygenation and environment; Psychosocial security; communication and health education and Psychospirituals of religion, followed by nursing interventions of NIC activities, oxygen therapy, environmental control, increased safety, improved communication in speech deficits; encouraging religious rituals and facilitating an efficient decision-making process. Conclusion: the construction of scientific knowledge in Nursing becomes imperative, so that the health needs affected by the patient with tracheostomy in the COVID-19 Pandemic are met, to promote health and life.(AU)

Objetivo: reflejar las necesidades básicas de salud de los pacientes traqueostomizados por cáncer de cabeza y cuello en el contexto de la pandemia del coronavirus, utilizando la Teoría de las Necesidades Básicas. Método: Se trata de un estudio reflexivo, realizado a través de una lectura crítica de documentos oficiales de organismos de salud nacionales e internacionales y otras fuentes conceptuales sobre el tema. Resultados: las necesidades básicas de salud afectadas fueron: Oxigenación psicobiológica y medio ambiente; seguridad psicosocial; comunicación y educación para la salud y Psicoespirituales de la religión, seguidas de las intervenciones de enfermería de las actividades NIC, oxigenoterapia, control ambiental, aumento de la seguridad, mejora de la comunicación en los déficits del habla; fomentar los rituales religiosos y facilitar un proceso eficiente de toma de decisiones. Conclusión: la construcción del conocimiento científico en Enfermería se torna imperativa, para que sean atendidas las necesidades de salud afectadas por el paciente con traqueotomía en la Pandemia del COVID-19, para promover la salud y la vida.(AU)

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Abstract Objective To explore the main sexuality complaints of gynecologic cancer survivors after treatment and to identify the care strategies provided. Data Source Searches were conducted in six electronic databases: Scopus, Web of Science, LILACS, MEDLINE, PsychINFO, and EMBASE. Study Selection Articles published between 2010 and 2020 were selected and the following descriptors were used in the English language: female genital neoplasms and gynaecological cancer. The methodological quality of the studies used the Mixed Methods Appraisal Tool (MMAT). Data Collection The primary data extracted were: names of the authors, year of publication, country of origin, objective and type of study, data collection instrument, sample size and age range, types of cancer, and symptoms affected with the strategies adopted. Data Summary A total of 34 out of 2,536 screened articles were included. The main strategies found for patient care were patient-clinician communication, practices for sexuality care, individualized care plan, multiprofessional team support, and development of rehabilitation programs. For sexuality care, the most common practices are pelvic physiotherapy sessions and the use of vaginal gels and moisturizers. Conclusion The main complaints identified in the scientific literature were low libido and lack of interest in sexual activity, vaginal dryness, pain during sexual intercourse, and stenosis. Different care strategies may be adopted, such as follow-up with a multidisciplinary health team and sexual health rehabilitation programs, which could minimize these symptoms and ensure the quality of life of patients.

Resumo Objetivo Explorar as principais queixas da sexualidade com sobreviventes de câncer ginecológico após o tratamento e identificar as estratégias de cuidados prestados. Fonte dos Dados As buscas foram realizadas em seis bases eletrônicas: Scopus, Web of Science, LILACS, MEDLINE, PsychINFO e EMBASE. Seleção dos Estudos Foram selecionados artigos publicados entre 2010 e 2020 e os descritores utilizados (em inglês) foram female genital neoplasms e gynaecological cancer. A qualidade metodológica dos estudos utilizou a ferramenta Mixed Methods Appraisal Tool (MMAT). Coleta de Dados Os principais dados extraídos foram: nomes dos autores, ano de publicação, país de origem, objetivo e tipo de estudo, instrumento para coleta de dados, tamanho da amostra e faixa etária, tipos de câncer, os sintomas acometidos e as estratégias adotadas. Síntese dos Dados Dos 2,536 artigos identificados, 34 foram incluídos. As principais estratégias encontradas para os cuidados aos pacientes foram a comunicação paciente-médico, práticas para os cuidados sexuais, plano de cuidados individualizado, apoio a equipes multiprofissionais e desenvolvimento de programas de reabilitação. Para os cuidados de sexualidade, as práticas mais comuns são sessões de fisioterapia pélvica e o uso de géis vaginais e hidratantes. Conclusão As principais queixas identificadas na literatura científica foram baixa libido e falta de interesse na atividade sexual, secura vaginal, dor durante a relação sexual e estenose. Diferentes estratégias de cuidados podem ser adotadas, como o acompanhamento com uma equipe de saúde multidisciplinar e programas de reabilitação da saúde sexual, as quais poderiam minimizar estes sintomas e garantir a qualidade de vida dos pacientes.

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El avance de las tecnologías de soporte vital ha aumentado la sobrevida de niños con patologías y secuelas graves, categorizados como NANEAS (Niños y Adolescentes con Necesidades Especiales de Atención en Salud) de mediana y alta complejidad. En el Hospital de Niños Dr. Roberto del Río se organizó un equipo de atención para NANEAS en 2014, que realiza visitas domiciliarias desde 2015 a pacientes médicamente complejos. OBJETIVO: Caracterizar la población atendida en domicilio y la modalidad de atención. PACIENTES Y MÉTODO: Estudio retrospectivo descriptivo mediante revisión de registro clínico electrónico y ficha clínica de NANEAS atendidos en domicilio del 2015 al 2018. RESULTADOS: Se analizaron 581 visitas a 81 pacientes, mediana 8 años, 78% hombres, 64% institucionalizados, 78% con patología neurológica de base, 75% de alta y mediana complejidad según clasificación SOCHIPE. De las visitas, 71% fue en comunas rurales, la mediana de tiempo de viaje 60 minutos y de atención 26 minutos. Un 60% de las visitas se realizó a pacientes con dispositivos médicos. En un 99% asistió pediatra, 33% enfermera y 68% otro profesional, que en 61% correspondió al neuropediatra. CONCLUSIONES: La mayor proporción de pacientes atendidos son de alta y mediana complejidad, usuarios de dispositivos médicos y la mayoría con patología neurológica de base, por lo que resulta fundamental contar con un neurólogo en el equipo interdisciplinario. Las visitas se realizan principalmente a comunas distantes por la dificultad de traslado de estos pacientes. Esta modalidad de atención promueve una mejor calidad de vida para niños y niñas médicamente complejos y para sus familias.

The advancement of life support technologies has increased the survival of children with serious pathologies and sequelae, categorized as NANEAS (Children and Adolescents with Special Health Care Needs) of medium and high complexity. At the Hospital de Niños Dr. Roberto del Río, a care team for NANEAS was organized in 2014, which has made home visits to medically complex patients since 2015. OBJECTIVE: To characterize the population attended at home and the care modality. PATIENTS AND METHOD: Retrospective descriptive study by reviewing the clinical file of NANEAS patients seen at home in this period. RESULTS: 581 visits were analyzed in 81 patients, median 8 years, 78% men, 63% institutionalized, 78% with neurological diseases. 75% were of high and medium complexity according to the SOCHIPE classification. Of the visits, 71% were in rural places, median travel time 60 minutes and direct attention 26 minutes. 60% of the visits were made to patients with medical devices, 99% attended by a pediatrician, 33% a nurse and 68% another professional, who in 61% corresponded to the child neurologist. CONCLUSIONS: The highest proportion of patients seen are of high and medium complexity with medical devices and with underlying neurological pathology, so it is important to have a neurologist in the interdisciplinary team. Many of the visits are made in places distant from the hospital center due to the difficulty of transferring these patients. This modality of care promotes a better quality of life for medically complex children and their families.

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PURPOSE: To evaluate educational and health insurance-related inequalities in supportive care (SC) needs and quality of patient-centered care (PCC) for cancer patients in Mexico. METHODS: We conducted a cross-sectional survey in one Mexican Institute of Social Security (IMSS) and one Ministry of Health (MoH) oncology hospital in Mexico City. Formal labor market workers and their families have access to social health insurance that IMSS provides, while unemployed and informal workers receive care at the MoH. The study population comprised breast, colorectal, prostate, and hematologic cancer patients, aged ≥ 18 years, who attended outpatient consultations. Patients responded a short-form SC-needs questionnaire and a quality of PCC questionnaire. We used multiple logistic regression models to determine the independent association between educational attainment and high SC-needs and quality of PCC after controlling for sociodemographic and clinical covariates. RESULTS: We included 1058 IMSS and 606 MoH cancer patients. MoH patients perceived higher SC-needs and lower quality of PCC than IMSS patients. MoH patients with low education had a greater probability of high psychological and health system SC needs and lower likelihood of being informed for treatment decision-making and care for their biopsychosocial needs. IMSS patients with low educational levels had lower probability of receiving timely care and clarity of information than those with high education. Receiving high-quality PCC was associated with decreased SC needs. CONCLUSION: Uninsured cancer patients with low educational attainment have higher SC-needs and receive lower quality of PCC than their counterparts. Health services should face these challenges to reduce inequalities in Mexico.

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OBJECTIVE: To compare the prevalence of depression, supportive care needs (SC-needs), and quality of patient-centered cancer care (PCC-quality) between women with breast cancer and women with cervical cancer and to assess the association of SC-needs and PCC-quality with depression. METHODS: We conducted a cross-sectional survey in a public oncology hospital in Mexico City with 247 breast cancer and 165 cervical cancer ambulatory patients aged ≥18 years with at least one hospitalization and ≤5 years since diagnosis. Participants completed the short-form Supportive Care Needs Survey, the Patient-Centered Quality of Cancer Care Questionnaire, and the Hospital Anxiety and Depression Scale. We performed multiple logistic regression analyses to evaluate the association between SC-needs, PCC-quality, and probable presence of depression. RESULTS: Nearly all women reported SC-needs-mainly health system and information needs, followed by physical and psychological needs. PCC-quality was substandard in both groups. PCC-quality was lowest when addressing biopsychosocial needs, followed by information for treatment decision-making needs. Cervical cancer patients had probable depression more often (41.2%) than those with breast cancer (29.5%). Having unmet psychological and care needs was associated with increased odds of probable depression, while high-quality timely care was associated with reduced odds of probable depression. CONCLUSION: In Mexico, women with cervical and breast cancer face unmet SC-needs, probable depression, and substandard PCC-quality, pointing to priority areas for improvements in cancer care.

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ABSTRACT The study aims to analyze the attention given to low risk emergencies in an area of high socioenvironmental vulnerability in Rio de Janeiro, within the scope of the Family Health Strategy and the local Emergency Care Unit. The methodology used relied on a triangulation of data and sources obtained from medical records, direct observation, interviews, and focal groups with managers, workers and users. The service was analyzed according to diagnosis, type of occurrence, and sociodemographic data; the qualitative data was analyzed through thematic analysis, generating the categories: which urgency for which service; territorial issues; access; positive and negative aspects of services. As a result, the Family Health Strategy takes on the function of answering to urgencies. Previous experiences influence the pattern of users' access. Socio-environmental fragility increases demand, stresses the Strategy's programmatic service, and can generate risks by the fast treatment at the Emergency Care Unit, which has been a place of hospitalization, due to the scarcity of hospital beds. The two services work with partial integration. The conclusion shows that the levels of satisfaction with the Family Health Strategy indicated by the population and its centrality to the care networks are enhanced by the accommodation of urgencies.

RESUMO O estudo objetivou analisar a atenção prestada às urgências de baixo risco em área metropolitana de alta vulnerabilidade socioambiental na cidade do Rio de Janeiro, no âmbito da Estratégia Saúde da Família e da Unidade de Pronto Atendimento local. A metodologia utilizou triangulação de dados obtidos em prontuários, observação direta, entrevistas e grupos focais com gestores, trabalhadores e usuários (108 participantes). Analisaram-se os atendimentos segundo diagnóstico, tipo e horário de ocorrência e dados sociodemográficos; os dados qualitativos, mediante análise temática, geraram as categorias: que urgência para que serviço; questões territoriais; acesso; aspectos positivos e negativos dos serviços. Como resultado, a Estratégia Saúde da Família assume a função de atender às urgências segundo dados de produção. Experiências anteriores influenciam o padrão de acesso de usuários. A fragilidade socioambiental incrementa a demanda, tensiona o atendimento programático da Estratégia e pode gerar riscos pelo atendimento rápido na Unidade de Pronto Atendimento, que tem funcionado como lugar de internação, pela escassez de leitos em hospitais. Os dois tipos de serviços funcionam parcialmente integrados. Conclui-se que o nível de satisfação com a Estratégia Saúde da Família destacado pela população e a centralidade da Estratégia para as redes assistenciais são potencializados pelo acolhimento às urgências.

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PURPOSE: To assess the supportive care needs (SC-needs), quality of patient-centered care (PCC), and factors associated with increased SC-needs of patients with lung cancer (LC) in Mexico. METHODS: We conducted a cross-sectional survey in the main oncology hospital of the Mexican Institute of Social Security in Mexico City. The study included LC ambulatory patients aged ≥18 years with at least one hospitalization before the survey, ≤five years since diagnosis, and without memory loss. Participants answered SC-needs and quality of PCC questionnaires. We performed a multiple negative binomial regression analysis to evaluate the factors associated with an increased number of SC-needs. RESULTS: One hundred twenty-eight LC patients participated. Most participants had adenocarcinoma (61.7%) and were at an advanced disease stage (92.1%). In the month preceding the survey, 3.9% had undergone surgery and 78.9% had been receiving chemotherapy and/or radiotherapy; 28.9% had symptoms of depression and 21.9% had anxiety. All patients reported one or more SC-needs-predominantly physical, daily living, information, and psychological needs. The significant gaps in PCC-quality were in the domains of care that addressed biopsychosocial needs and information for treatment decision-making. Factors that decreased the probability of SC-needs were respectful and coordinated care, high-school education, and older age. The factors increasing the likelihood of SCneeds were the type of LC (adenocarcinoma, mesenchymal tumors), chemotherapy and/or radiotherapy, and anxiety. CONCLUSION: PCC improvement initiatives to address SC-needs of LC patients should be prioritized and focus on: (1) information on physical suffering relief and treatment; (2) psychological support; and (3) SC-needs monitoring.

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Los niños y adolescentes con necesidades especiales de atención en Salud corresponden a un grupo de individuos que presentan distintos problemas de salud de complejidad variable, siendo una de éstas la atención dental exitosa. La alta prevalencia de patologías orales no es la única complicación al atender a pacientes pediátricos con necesidades especiales de atención en Salud, se suman alteraciones del comportamiento y comunicación, afectando el nivel de cooperación en la atención. A pesar de las limitaciones previamente mencionadas, han surgido diversas adaptaciones y técnicas para conseguir realizar un tratamiento odontológico. En este artículo se describe la terapia asistida con animales como un método complementario beneficioso en la atención de odontopediatría. El objetivo es describir la experiencia de la implementación de terapia asistida con animales, en el tratamiento Odontológico de Niños y Adolescentes con Necesidades Especiales de Atención en Salud. El método usado es el estudio descriptivo - retrospectivo del año 2019, revisión de 32 registros clínicos del sistema de atención digital del hospital, de pacientes pediátricos con necesidades especiales de atención en Salud entre 4 y 13 años, atendidos en odontopediatría con apoyo de terapia asistida por animales. Los resultados muestran que 32 pacientes pediátricos que recibieron atención dental, donde en 26 (81.25%) la intervención dental fue exitosa. Se realizaron en total 36 procedimientos odontológicos, 19 invasivos y 17 no invasivos. La implementación de terapia asistida con animales como complemento de la atención odontopediátrica tuvo una gran aceptación y permitió la realización con éxito de procedimientos dentales invasivos o no invasivos en población pediátrica con necesidades especiales de atención en Salud.

Children and youth with special health care needs, belongs to a group of individuals presenting several health issues of variable complexity and special care needs in health, one of them a successful dental treatment. The high prevalence of oral pathologies is not the only complication we found in dental attention; there are also behaviour and communication disorders, affecting the cooperation level in dental treatment. In spite of the limitations previously mentioned, different adaptations and techniques have surged in order to achieve a successful dental treatment. In this article we describe animal assisted therapy as a useful complementary method for pediatric dental treatment.Objective:Describe the experience of animal assisted therapy in pediatric dentistry treatment of children and youth with special health care needs.Methods:Descriptive-retrospective study performed in 2019, revision of 32 clinical digital records of Hospital, of children and youth with special health care needs, ages between 4-13 years old, and their pediatric dentistry treatment records with animal assisted therapy.Results:32 patients with dental treatment, in 26 patients (81.25%) dental treatment was successful; 36 dental procedures were performed, 19 invasive and 17 non invasive.Conclusion:The implementation of animal assisted therapy as a complement of pediatric dentistry treatment had a high acceptance and allowed successful invasive and non invasive dental procedures in children and youth with special health care needs.

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Pessoas que moram sozinhas, idosos, surdos ou cegos precisam de meios adequados para se comunicarem com serviços pré-hospitalares de urgência em situações de risco. Nesse contexto este estudo propõe-se a construir e avaliar um protótipo de média fidelidade de software aplicativo de telefonia móvel para promover acessibilidade comunicativa para a convocação de socorro pré-hospitalar por pessoas surdas, cegas, idosos e ou que estejam sozinhas. Trata-se de estudo metodológico realizado no período de maio a setembro de 2020, em três etapas: 1) Revisão sistemática da literatura utilizando-se as bases de dados PubMed, Web of Science, CINAHL, ISTA, LISA e SCOPUS para localizar estudos primários e sintetizar evidências sobre métodos de desenvolvimento de protótipos de aplicativos de saúde para telefonia móvel, que garantem melhor acessibilidade aos usuários; 2) Definição de requisitos funcionais, construção e disponibilização de protótipo de aplicativo para telefonia móvel para solicitação de atendimento pré-hospitalar e 3) Avaliação do protótipo de aplicativo por peritos por meio de checklist para avaliação heurística de aplicativos para celulares touchscreen, e pela população alvo utilizando a System Usability Scale. A análise e síntese de quatro artigos apontaram para o Design Centrado no Usuário, que foi utilizado na segunda etapa para disponibilizar o protótipo do aplicativo denominado "e-SU". Na terceira etapa participaram cinco peritos, empresários com experiência de desenvolvimento de aplicativos para telefonia móvel, com média de idade de 36,2 anos, que avaliaram o e-SU como de alta usabilidade (média de 58,75 pontos) e; 21 sujeitos da população alvo (cegos, surdos, idosos e pessoas com baixa visão, baixa audição; que vivem só; idoso, cego e surdo que mora sozinho) sendo 71,4% do sexo feminino, com idade média de 44,2 anos, e que indicaram um excelente índice de satisfação do usuário (média de 89,5 pontos).

Persons who live alone, elderly, deaf or blind persons need adequate ways to communicate with emergency pre-hospital services in situations of risk. In this context, this study proposes to build and evaluate a medium fidelity prototype of mobile phone application software to promote communicative accessibility for the call to pre-hospital assistance by deaf, blind, elderly and or those who are alone. This is a methodological study carried out from May to September 2020, in three stages: 1) Systematic literature review using the PubMed, Web of Science, CINAHL, ISTA, LISA and SCOPUS databases to locate primary studies and synthesize evidence on methods of developing prototypes of health applications for mobile telephony, which ensure better accessibility for users; 2) Definition of functional requirements, construction and provision of an application prototype for mobile telephony to request pre-hospital care and 3) Evaluation of the application prototype by experts through a checklist for heuristic evaluation of applications for touchscreen phones, and by the population target using the System Usability Scale. The analysis and synthesis of four articles pointed to User-Centered Design, which was used in the second stage to provide the prototype of the application called "e-SU". In the third stage, five experts participated, entrepreneurs with experience in developing mobile phone applications, with an average age of 36.2 years, who evaluated e-SU as highly usable (average of 58.75 points) and; 21 subjects of the target population (blind, deaf, elderly and people with low vision, low hearing; who live alone; elderly, blind and deaf who live alone) with 71.4% being female, with an average age of 44.2 years , and which indicated an excellent user satisfaction index (average of 89.5 points).

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Formar enfermeiros capazes de responder às demandas da sociedade exige um ensino contextualizado e consistente que os prepare para enfrentar os desafios do dinamismo do mundo moderno e das condições de exercício profissional. A acelerada modernização científica e tecnológica tem garantido maior sobrevivência a muitas crianças, ao passo que faz emergir uma clientela portadora de condições que requerem transformações de vida importantes: as Crianças com Necessidades Especiais de Saúde (CRIANES). Frente ao atual perfil epidemiológico infantil, delineou-se como objeto do estudo: o desenvolvimento de competências no processo de formação do enfermeiro na atenção integral às CRIANES e suas famílias. Definiu-se como objetivo geral: analisar como se organiza o ensino da atenção à saúde da criança nos cursos de graduação em enfermagem com vistas ao desenvolvimento de competências para o cuidado às CRIANES e suas famílias, na perspectiva dos docentes; e específicos: apreender a concepção dos docentes dos cursos de graduação em enfermagem sobre as CRIANES; identificar os conteúdos programáticos e os aspectos metodológicos do ensino referentes à atenção à saúde das CRIANES e suas famílias nos cursos de graduação em enfermagem; descrever, na perspectiva dos docentes, como acontece o ensino da saúde da criança de forma a desenvolver nos alunos as competências necessárias para o cuidado às CRIANES e suas famílias. Pesquisa qualitativa, descritivo-exploratória, com 17 docentes da área de saúde da criança de cursos de graduação em enfermagem de três Instituições de Ensino Superior (IES) públicas federais, na região metropolitana do estado do Rio de Janeiro. Aprovada pelo Comitê de Ética em Pesquisa da instituição proponente e das instituições coparticipantes. A coleta de dados foi realizada através de entrevista semiestruturada. Através da análise de conteúdo temático-categorial de Bardin, construíram-se quatro categorias, interpretadas e discutidas à luz do referencial teórico de Philippe Perrenoud: 1) As CRIANES e suas famílias na perspectiva docente; 2) A abordagem da temática das CRIANES nos cursos de graduação em enfermagem; 3) Estratégias de ensino e o processo de avaliação na abordagem das CRIANES nos cursos de graduação em enfermagem: desenvolvimento de competências; 4) Aspectos valorizados no desenvolvimento da competência de atenção à saúde das CRIANES e suas famílias na formação de enfermeiros. Evidenciou-se um processo de incorporação da temática nos cursos de graduação em enfermagem, reflexo da apropriação do conceito de CRIANES pelos próprios docentes. Tema ainda pouco explorado em seus aspectos particulares, com uma abordagem assistemática e pontual sob a ótica do modelo biomédico e hospitalocêntrico. Entretanto, valorizou-se a abordagem centrada na família e a articulação das redes de atenção à saúde, traduzindo a busca pela atenção integral. Os resultados reforçam o desafio e a importância de incluir a temática nos programas curriculares e nas práticas pedagógicas para ampliar as discussões na graduação de enfermagem. Trouxe subsídios para embasar e auxiliar o planejamento do ensino com relação à problemática das CRIANES e suas famílias, para formar enfermeiros que sejam atores sociais no cenário da saúde da criança no país.

Training nurses capable of responding to the demands of society requires a contextualized and consistent training that prepares them to face the challenges of the dynamism of the modern world and the conditions of professional practice. The accelerated scientific and technological modernization has ensured greater survival for many children, while a clientele with conditions that require important life transformations has risen: Children with Special Health Care Needs (CSHCN). In view of the current epidemiological profile of children, the following object of study was outlined: the development of competences in the process of nursing education in integral care for CSHCN and their families. It was defined as general objective: to analyze how the teaching of child health care is organized in undergraduate nursing courses with a view to developing competencies for the care of children and their families from the professors' perspective; and the specific objetives were: to capture the conception of the professors of undergraduate nursing courses on CSHCN; to identify the program contents and methodological aspects of teaching related to the health care of CSHCN and their families in undergraduate nursing courses; to describe, from the professors' perspective, how child health teaching occurs in order to develop in students the necessary competences for the care of CSHCN and their families. Qualitative, descriptive and exploratory research with 17 professors of child health care from undergraduate nursing courses of three federal public higher education institutions (HEIs) in the metropolitan region of Rio de Janeiro state in Brazil. Approved by the Research Ethics Committee of the proposing institution and co-participating institutions. Data collection was conducted through semi-structured interview. Through the thematic-categorical content analysis of Bardin, four categories were constructed, interpreted and discussed in the light of the theoretical referential of Philippe Perrenoud: 1) CSHCN and their families in the professors' perspective; 2) The approach to the subject of CSHCN in undergraduate nursing courses; 3) Teaching strategies and the evaluation process in the approach to CSHCN in undergraduate nursing courses: competence development; 4) Valued aspects in the development of the competence of attention to the health of CSHCN and their families in the training of nurses. A process of incorporation of this theme in the undergraduate nursing courses was evidenced, reflecting the appropriation of the concept of CSHCN by the professors themselves. This theme is still under explored in its particular aspects, showing an unsystematic and punctual approach from the perspective of the biomedical and hospital-centric model. However, the family-centered approach and the articulation of health care networks were valued, reflecting the search for integral care. The results reinforce the challenge and importance of including the theme in curricular programs and pedagogical practices to broaden discussions in undergraduate nursing. It brought important cobtributions to support and assist the education plannning related to the problem of CSHCN and their families, in order to train nurses who will become social actors in the child health scenario in the country.

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ABSTRACT Congenital hypothyroidism is a metabolic disorder that requires special health care interventions. It has influence in overall growth and oral conditions in pediatric patients, and also can affect child cooperation during dental treatment because this metabolic condition is the most common preventable cause of mental retardation. The aim of this paper is to report the dental treatment of a child with congenital hypothyroidism who is four years and five months old, with many facial and oral characteristics of the metabolic condition, including severe early childhood caries and malocclusion. At first, it was observed a lack of cooperation of the patient with speech and learning impairment, but with the help of the Pedagogy team at the Pediatric Dental Clinic Playroom, he developed confidence and diminished anxiety every appointment. We present the follow-up during 15 months, where we could observe favorable outcomes in oral health and compliance of the child.

RESUMEN El hipotiroidismo congénito es una alteración metabólica que representa una necesidad especial en salud. Tiene influencia en el crecimiento general y las condiciones orales de los pacientes pediátricos, así como también puede afectar en el grado de cooperación del niño durante la consulta porque esta condición metabólica es la causa prevenible más común de retraso mental. El propósito de este artículo es reportar el tratamiento odontológico de un niño con hipotiroidismo congénito de cuatro años y cinco meses de edad, con varias características de la condición metabólica, incluyendo caries de la infancia temprana severa y maloclusión. Al principio se observó una falta de cooperación por parte del paciente, con dificultades para el habla y el aprendizaje, pero con la ayuda del equipo pedagógico de la Sala Lúdica, el niño desarrolló confianza con disminución de la ansiedad en cada cita. Presentamos un seguimiento a lo largo de 15 meses, donde hemos observado resultados favorables en la salud oral y en el comportamiento del paciente.

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