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The aim of this paper is to present the evolution of Digital Health (DH) in Brazil, in relation to the adoption of DH as a basis for the development of public policies, with a focus on improving the delivery of health care to patients and expanding its coverage. Data from the ICT in Health survey from the Regional Centre for Studies on the Development of the Information Society (Cetic.br) were analysed. The main challenges identified are related to gaps in patient information, which requires interaction between different facilities and to more complex functionalities related to guidelines and guidance in patient care.

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Abstract The latest statistics show that COVID-19 is still very active, and cases are on the rise across various countries and regions. On the other hand, statistics from Pakistan show a declining trend, especially during the first wave of the COVID-19 pandemic. To understand this declining trend and answering our established question, "What are the reasons behind the decline of the COVID-19 cases in Pakistan - public healthcare facilities or government smart lockdown policy?" narrative literature-based evidence collected from government official websites, reports and also Google Scholar. Our findings suggest that the government's innovative smart lockdown strategy and its execution at the right time with the consensus of all stakeholders accompanied with the observing of COVID-19 standard operation procedures resulted in controlling the pandemic. Effective smart lockdown policy allows the government to identify shortcomings of and improve the capabilities of healthcare for the continuation of balanced socio-economic activities to avoid future spread-out of the pandemic in the time of crisis under national and World Health Organization guidelines.

Resumo As últimas estatísticas mostram que a COVID-19 ainda está muito ativa, e os casos estão aumentaando em vários países e regiões. Por outro lado, as estatísticas do Paquistão mostram uma tendência decrescente, em especial durante a primeira onda da pandemia de COVID-19. Para compreender esta tendência decrescente e responder à nossa pergunta estabelecida, "Quais são as razões por detrás do declínio do caso COVID-19 no Paquistão - instalações públicas de saúde ou política de encerramento inteligente do governo?" - foi compilada evidências narrativas baseadas em literatura recolhida de websites oficiais do governo, relatórios e também no Google Scholar. As nossas conclusões sugerem que a estratégia inovadora de encerramento inteligente do governo e a sua execução no momento certo, com o consenso de todos os interessados acompanhados pela observação dos procedimentos de operação padrão da COVID-19, resultou no controle da pandemia. Uma política eficaz de encerramento inteligente permite ao governo identificar deficiências e melhorar as capacidades dos cuidados de saúde para a continuidade de atividades socioeconômicas equilibradas, a fim de evitar a propagação futura da pandemia em tempo de crise, sob as diretrizes nacionais e da Organização Mundial de Saúde.

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AIMS: During the COVID-19 pandemic the search for complementary methods to enhance manual disinfection in dental and medical practices raised relevance. We sought evidence for the addition of ultraviolet-C (UV-C) disinfection to manual cleaning protocols -and whether it improves the logarithmic (log) reduction of surface pathogen colonies. METHODS: This review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD420200193961. Six electronic sources were consulted looking for clinical trials performed in healthcare environments in which pathogens were quantified by colony-forming unit (CFU)-enumeration before and after interventions, all databases were last consulted on May 2021. We assessed the risk of bias using an adapted Revised Cochrane Risk of Bias Tool (RoB 2). The certainty of the evidence was qualified according to the Classification of Recommendations, Evaluation, Development, and Evaluation (GRADE) approach. RESULTS: We identified 1012 records and 12 studies fulfilled the inclusion criteria. All included studies reported enhanced disinfection in the UV-C arm; most of them reported 1-log to 2-log reduction in approximately 10 to 25 min. Only three studies reached a 5-log and 6-log reduction. When manual cleaning was performed alone, only two studies reported a 1-log reduction using a chlorine-based disinfectant. We detected a high risk of bias in 1 study. Certainty of evidence was classified as moderate and low. CONCLUSIONS: The evidence points out the effectiveness of UV-C technology in reducing manual cleaning failures, enhancing the logarithmic reduction of surface pathogen colonies. However, the safety and success of these devices will depend on several physical and biological factors. A judicious project must precede their use in clinical and medical offices under the supervision of a physicist or other trained professional.

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PURPOSE: To present an overview of the status of Medical Physics practice in Mexico, promote the legal recognition of Medical Physics high-end training, and provide information that will potentially improve the Mexican healthcare system. METHODS: For the purpose of this research, the concept of "Medical Physics Professional/s" (MPP) is introduced to refer to any person/s executing the role of a clinical medical physicist (cMP) in whole or in part independent of academic profile, training or experience. A database of MPP in Mexico was built from official sources and personal communication with peers. Database records included the following fields: employer/s, specialty, academic profile, and annual income (when available). RESULTS: 133 centers in Mexico employ MPP, 49% of which are public institutions. 360 positions involving cMP roles were identified at the National Healthcare System (occupied by 283 MPP), 77% of which corresponded to radiation therapy. Public healthcare services hold 65% of the reported positions. Only 40% of MPP hold a graduate degree in Medical Physics, 46% of whom were located in the most densely populated region of Mexico. Of all MPP, 32% were women. CONCLUSIONS: This work allowed to clearly identify the current challenges of Medical Physics practice in Mexico, such as: insufficiency and uneven geographical distribution of qualified manpower, gender imparity, multishifting and wage gap. The products derived from this work could be used to guide the efforts to improve the Mexican healthcare system.

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Trauma/stroke centres optimise acute 24/7/365 surgical/critical care in high-income countries (HICs). Concepts from low-income and middle-income countries (LMICs) offer additional cost-effective healthcare strategies for limited-resource settings when combined with the trauma/stroke centre concept. Mass casualty centres (MCCs) integrate resources for both routine and emergency care-from prevention to acute care to rehabilitation. Integration of the various healthcare systems-governmental, non-governmental and military-is key to avoid both duplication and gaps. With input from LMIC and HIC personnel of various backgrounds-trauma and subspecialty surgery, nursing, information technology and telemedicine, and healthcare administration-creative solutions to the challenges of expanding care (both daily and disaster) are developed. MCCs are evolving initially in Chile and Pakistan. Technologies for cost-effective healthcare in LMICs include smartphone apps (enhance prehospital care) to electronic data collection and analysis (quality improvement) to telemedicine and drones/robots (support of remote regions and resource optimisation during both daily care and disasters) to resilient, mobile medical/surgical facilities (eg, battery-operated CT scanners). The co-ordination of personnel (within LMICs, and between LMICs and HICs) and the integration of cost-effective advanced technology are features of MCCs. Providing quality, cost-effective care 24/7/365 to the 5 billion who lack it presently makes MCCs an appealing means to achieve the healthcare-related United Nations Sustainable Development Goals for 2030.

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ABSTRACT Objective: To identify patient-related factors that act as barriers to hypertension control. Methods: A cross-sectional study of 365 patients who were diagnosed with primary hypertension and attended primary healthcare facilities in western Jamaica was carried out. A pretested questionnaire was administered, and the patients ' blood pressure and body mass index were taken and calculated. Inferential statistics were used to interpret the data. Chi-square and Fischer's exact tests were used to analyse the differences in dichotomous variables. A p-value of ≤ 0.05 was regarded as statistically significant. Two focus group discussions and 10 in-depth interviews provided qualitative data. Results: Of the 365 participants, only 30.1% had blood pressure readings within normal limits. The blood pressure was statistically significantly higher in those who last smoked under one year (p = 0.018), those who consumed alcohol (p = 0.021), those who reported high stress levels (p = 0.020) and those with a weak support system (p = 0.012; Spearman's rank correlation coefficient = 0.131). Knowledge deficit was also statistically significant where 55.1% believed that hypertension could be cured or were unsure and 27.5% denied personal responsibility in achieving control. Patients who had been diagnosed 11 years or more were more likely to be uncontrolled (p = 0.010). Medication adherence (p = 0.056), alternative medicine (p = 0.476), diet (p = 0.108), exercise (p = 0.568) and obesity (p = 0.941) showed no statistically significant relationship. Conclusion: Smoking, alcohol consumption, stress, level of awareness and support system were significant modifiable determinants of blood pressure control. Clinicians often place much emphasis on medication adherence, diet and exercise. However, these modifiable contributing factors are often overlooked in the management of hypertension. Addressing these issues could result in a significant improvement in blood pressure control.

RESUMEN Objetivo: Identificar factores relacionados con el paciente que actúan como barreras al control de la hipertensión. Métodos: Se realizó un estudio transversal de 365 pacientes que fueron diagnosticados con hipertensión primaria y atendidos en centros de salud de atención primaria en el occidente de Jamaica. Se administró un cuestionario previamente probado, y se tomaron y calcularon los índices de presión arterial e índice de masa corporal de los pacientes. Se utilizaron estadísticas inferenciales para interpretar los datos. Se utilizaron las pruebas exactas de Chi-cuadrado y Fischer para analizar las diferencias en las variables dicotómicas. Un valor p de ≤ 0.05 se consideró estadísticamente significativo. Dos discusiones de grupos focales y 10 entrevistas en profundidad proporcionaron datos cualitativos. Resultados: De los 365 participantes, sólo el 30.1% tuvo lecturas de presión arterial dentro de los límites normales. La presión arterial fue estadísticamente significativamente mayor en aquellos que fumaron por última vez menos de un año (p = 0.018), los que consumían alcohol (p = 0.021), los que reportaron altos niveles de estrés (p = 0.020), y aquellos con un sistema de apoyo débil (p = 0.012; coeficiente de correlación de rango de Spearman = 0.131). El déficit de conocimiento también fue estadísticamente significativo en el 55.1% que creía que la hipertensión podía ser curada o no estaba seguro, y en el 27.5% que negaba la responsabilidad personal de lograr el control. Los pacientes que habían sido diagnosticados 11 años o más, eran más propensos a ser descontrolados (p = 0.010). El cumplimiento de la medicación (p = 0.056), la medicina alternativa (p = 0.476), la dieta (p= 0.108), los ejercicios (p = 0.568) y la obesidad (p = 0.941) no mostraron ninguna relación estadísticamente significativa. Conclusión: El tabaquismo, el consumo de alcohol, el estrés, el nivel de conciencia, y el sistema de apoyo, fueron factores determinantes modificables significativos del control de la presión alterial. Los clínicos a menudo ponen mucho énfasis en el cumplimiento de la medicación, la dieta y el ejercicio. Sin embargo, los mencionados factores contribuyentes modificables a menudo se pasan por alto en el tratamiento de la hipertensión. Abordar estos problemas podría traer consigo una mejoría significativa en el control de la presión arterial.

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This document highlights the major achievement of the Ministry of Health for the period 2016-2017. Contains information about compassionate care, the strengthening of the health system , treatment of non-communicable diseases, combating communicable diseases, protecting the health of mothers and children, rehabilitation and new investment in critical health infrastructure.

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Objetivo: identificar el nivel de conocimiento de los empleados acerca de las políticas de investigación en las instituciones de salud de mediana y alta complejidad en el Valle de Aburrá, Colombia. Metodología: investigación de corte transversal, con aplicación de encuestas a 224 empleados en las instituciones prestadoras de servicios salud de alta (52) y mediana complejidad (322), públicas y privadas en el 2011. Resultados: en referencia al conocimiento de la existencia de políticas de investigación, se encontró que este es mayor en los empleados de las instituciones de alta complejidad (p=0,000). Más del 70% de los empleados encuestados manifestaron su interés en trabajar en proyectos de investigación. Conclusión: las instituciones de salud de alta complejidad y públicas tuvieron más desarrollos en investigación y se percibió gran interés por la investigación en los empleados del sector salud, con independencia del nivel de complejidad, del tipo de institución y del nivel de formación.

Objective: identifying the knowledge level of the employees regarding the research policies of mid and high complexity healthcare facilities in the Aburra Valley, Colombia. Methodology: cross-section research, with surveys for 224 employees of the healthcare providing institutions of high (52) and mid (322) complexity, both public and private, in 2011. Results: regarding the knowledge about the existence of research policies, we found that it is higher in the employees of high complexity institutions (p = 0.000). Over 70% of the employees surveyed showed their interest in working on research projects. Conclusion: public high complexity healthcare facilities showed more developments on research and we found great interest of the employees of the health sector on research, regardless of the complexity level, the type of facility, and education level.

Objetivo: identificar o nivel de conhecimento dos empregados sobre as políticas de pesquisa nas instituicoes de saúde de mediana e alta complexidade no Valle de Aburrá, Colombia. Metodologia: pesquisa de corte transversal, com aplicação de inquéritos a 224 empregados de instituicoes prestadoras de servicos de saúde de alta (52) e mediana complexidade (322), públicas e privadas no ano 2011. Resultados: no que diz respeito do conhecimento sobre a existencia de políticas de pesquisa, encontrou-se que é maior em empregados de instituicoes de alta complexidade (p = 0,000). Mais de 70 % dos empregados indagados manifestaram interesse por trabalhar em projetos de pesquisa. Conclusão: as instituicoes de saúde de alta complexidade públicas tiveram maior desenvolvimento de pesquisa e percebeu-se grande interesse dos empregados do sector saúde pela pesquisa, com independencia do nível de complexidade, do tipo de instituicao e do nível de formação.

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Aponta desafios para aprofundar a relação nem sempre evidente entre história da assistência em saúde e arquitetura, expressa de forma mais clara na construção dos espaços para tratamento médico, sobretudo os hospitais e os sanatórios. Estamos diante da constituição de um campo de conhecimento pouco explorado, que vem animando pesquisadores das ciências humanas e sociais aplicadas no Brasil, sobretudo nas últimas décadas.

The relationship between the history of health assistance and architecture is not always obvious. The article points to some challenges in investigating this relation, which is most readily visible in the construction of medical facilities, especially hospitals and sanitariums. In Brazil, this fledgling field has begun drawing the attention of researchers from the applied human and social sciences, especially in more recent decades.

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Observa-se na academia a discussão sobre os resíduos sólidos urbanos (RSU), sendo os oriundos de serviços de saúde (RSS) parte integrante dos RSU, não necessariamente pela quantidade gerada, mas pelo potencial de risco que afeta à saúde coletiva e ambiental. Objetivou-se verificar a vulnerabilidade do manejo dos RSS, nos estabelecimentos de atenção primária, secundária e terciária de João Pessoa - PB. Foi uma pesquisa quantitativa, exploratória e descritiva do manejo dos RSS, tendo como instrumentos de coleta de dados checklist e avaliação analítica da vulnerabilidade do manejo dos RSS. Percebeu-se que 21,05 por cento dos estabelecimentos não realizam segregação, 26,34 por cento não padronizam os sacos plásticos e 47,37 por cento dos trabalhadores responsáveis pela coleta não possuem treinamento para o manuseio dos RSS. Conclui-se que a vulnerabilidade do manejo dos RSS de João Pessoa - PB foi significativo 48,02 por cento, podendo contribuir para a deterioração da saúde ambiental e coletiva, acarretando problema de saúde pública.

The discussion in the academy on solid urban waste residues (UWR) is analyzed, with health service waste (HSW) being an integral part of UWR, not necessarily in terms of the amount generated, but due to the risk potential to collective and environmental health. The scope of the study was to verify the vulnerability of UWR handling in primary, secondary and tertiary healthcare units in João Pessoa in the state of Paraíba. This involved a quantitative, exploratory and descriptive investigation of the handling of UWR, using a checklist and analytical evaluation of the vulnerability of HSW handling for data collection. It was detected that 21.05 percent of the establishments failed to separate hazardous waste, 26.34 percent did not standardize plastic disposal bags, and 47.37 percent of the workers responsible for collection were not trained to handle HSW. It was concluded that the vulnerability of HSW handling in João Pessoa in the order of 48.02 percent, was significant, potentially contributing to the deterioration of environmental and collective health and leading to a public health problem.

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