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Background: Countries of the Caribbean Community signed the Declaration of Port of Spain in 2007 with the vision to stop the epidemic of non-communicable diseases (NCDs). The adoption of the Declaration by member states represented a regional effort, challenging governments, the private sector, and civil society to act together. Multisectoral actions in Guyana aimed at achieving this goal are the focus of this article, demonstrating the work of different actors in addressing the burden of NCDs in the country. Objective: To analyze multisectoral actions developed among five ministries for the implementation of the Declaration of Port of Spain 2007 in Guyana. Methods: This qualitative study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist and conducted in five ministries (Agriculture, Education, Finance, Health, and Trade) in Georgetown, Guyana. The thematic analysis was guided by a framework consisting of four elements: context (why the policy is needed), content (what the policy is mainly about), process (how the policy was brought forward and implemented), and actors (who participates in and influences the formulation and implementation of the policy). The framework considers how these elements interconnect to shape policy development and implementation processes. Findings: Data analysis provided the researchers with insights into possible topic areas and codes for consideration during the analysis, hence a deductive approach to data analysis was used. The results highlighted the importance of coordination among government entities, national and international agencies, private actors, industry players, and civil society. Participants did not mention the use of responsibility metrics but cited mechanisms that facilitated collaboration. Conclusion: The results showed limitations in transforming multisectoral initiatives into intersectoral collaboration to achieve real integration among the different actors involved, considering the actual context and content. Actions could be more effectively implemented with significant outcomes for NCD control in Guyana.
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Política de Saúde , Doenças não Transmissíveis , Pesquisa Qualitativa , Guiana , Humanos , Doenças não Transmissíveis/prevenção & controle , Governo , Formulação de PolíticasRESUMO
In 2018, an outbreak of human rabies caused by the hematophagous bat Desmodus rotundus hit the Brazilian Amazon Basin community of Melgaço, Brazil, resulting in the death of 10 people, 9 of them children. The incidence of rabies has been on the rise among populations in conditions of vulnerability in this ecosystem due to human expansion into sylvatic environments and limited access to public health services. To address this issue, in September 2019, a collaborative effort from national, local, and international institutions promoted and executed a pilot for pre-exposure prophylaxis of a population in high-risk areas for hematophagous bat-mediated rabies. This measure is usually only implemented in response to outbreaks. The pilot was conducted in Portel, in a nearby location to the previous outbreak, with the use of fluvial transportation, and 2987 individuals in 411 dwellings were successfully vaccinated. It established a methodology for pre-exposure prophylaxis for populations in conditions of vulnerability, identifying logistics and costs, as well as characterizing the target riverine population regarding risk factors associated with bites by hematophagous bats. This approach offers a proactive measure to prevent future outbreaks and provides valuable insights into how to address the issue of rabies in remote and difficult-to-reach areas.
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BACKGROUND AND RATIONALE: Dental care systems have the potential to influence population oral health and patterns of socioeconomic inequalities. Therefore, understanding the impact of the ways in which countries fund, provide, and organize their dental care services is key in the analysis of determinants of oral health. In this commentary we offer a synopsis of recent typologies of healthcare systems, based on a rapid review, and highlight that none of them fit dental care services given the separation of dental care from general healthcare provision in many countries. The paper also summarizes evidence on dental care systems as determinants of population oral health and argues why a new typology of dental care systems is needed. CHALLENGES AND WAYS FORWARD: We argue that a typology must consider institutional arrangements, structures, and processes behind the provision of dental care, and that specific dimensions/variables that inform the typology should result from a process of discussion and consensus. Some methodological considerations for developing typologies are also discussed, including the challenges in the collection and analysis of data followed by an advanced cluster analysis. Despite their limitations, typologies have evolved into an essential tool for comparing the similarities and differences of healthcare systems across countries. Therefore, a dental specific typology for health systems will be useful for researchers, policymakers, and dental professionals to characterize the provision of dentalcare services in different countries. This will also enable examining their potential role as determinants of population oral health and inequalities.
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Background: This study examined cancer mortality trends in Brazil from 1979 to 2021, emphasizing breast and prostate cancers. Methods: Utilizing data from the Brazilian Mortality Information System and the Brazilian Institute of Geography and Statistics, it analyzed cancer deaths nationally and regionally, highlighting gender-specific and regional disparities. Results: The research finds that cancer death rates have been growing at an average of 12% per year, contrasting with the population growth rate of 2.2%. This trend is more pronounced in the southern and southeastern regions of Brazil. A comparison of cancer mortality rates between Brazil, the USA, and China reveals that while the Brazilian and Chinese rates exhibit slower growth, the US rate shows a continuous decline since the 1990s. Conclusions: The study adopts a novel approach by focusing on growth rates and employing polynomial interpolation, revealing a deceleration in cancer death growth over the last 15 years across all malignant neoplasms. The study also contextualizes these findings within Brazil's cancer control policies, tracing the evolution of preventive measures and treatment advancements. It highlights the significant role of the National Cancer Institute and the Unified Health System in implementing effective strategies. The decreasing trend in cancer mortality rates in Brazil, despite population growth, illustrates the effectiveness of comprehensive cancer control and prevention measures, underlining their importance in public health policy.
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OBJECTIVE: Examine the key elements that characterise social media advertisements targeted at adolescents by asking adolescents which features of Instagram ads promoting ultra-processed products make them designed to appeal to adolescents. DESIGN: Instagram ads promoting ultra-processed products and brands were selected from a database in which ads had been classified regarding whether they were primarily targeted at adolescents from an adult perspective. Adolescents completed a sorting task in small groups and were requested to reach a consensus through discussions and sticky notes regarding whether sixty ads were designed to appeal to them. The sorting task was analysed using content analysis based on inductive coding. SETTING: One private secondary school and two after-school clubs. PARTICIPANTS: Convenience sample of 105 Uruguayan adolescents aged 11-17 years. RESULTS: Ten categories were identified regarding the reasons for sorting ads as (not) designed to appeal to adolescents: product type, graphic design, explicit references to age groups, language, activities or themes, memes, celebrities, characters, promotions and novelty. Product type emerged as a key element, with adolescents perceiving ads as designed to appeal to them simply because they promoted specific products. CONCLUSIONS: This research contributes to the validation of criteria defined in previous studies and can be used for the development of tools to monitor the prevalence and power of adolescent-targeted digital marketing. However, the importance attributed to type of product suggests that regulations should not exclusively focus on exposure to digital marketing specifically targeted at adolescents but also on exposure to marketing in general.
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Comportamento do Adolescente , Mídias Sociais , Adulto , Humanos , Adolescente , Publicidade , Marketing , TelevisãoRESUMO
Abstract Introduction: cystic fibrosis newborn screening must enable its earlier diagnosis, which may enhance outcomes. This study was a series case of delayed-diagnosis children submitted to cystic fibrosis newborn screening. Description: fourteen children were included; eight (57.1%) were due to false-negative screening, while six (42.9%) were due to processing errors. Two samples collected after 30 days of life were incorrectly classified as negative, and four infants with a positive test could not be located due to screening processing errors. Cystic fibrosis diagnosis was confirmed at a median (IQR) age of 5.3 (4.2-7.4) months. Poor nutritional status was the most prevalent clinical sign at diagnosis, being present in 78.6% of infants. The mean (SD) weight-for-length and length-for-age Z-scores were -3.46 (0.84) and -3.99 (1.16), respectively. Half of the children had Pseudo-Bartter syndrome, and 42.9% had breathing difficulties. Twelve children (85.7%) required hospitalization, with a median (IQR) length of stay of 17.0 (11.5-26.5) days. Discussion: newborn screening had some faults, from incorrect collections to inefficient active search. Early identification of these children in which screening was unsatisfactory is essential, emphasizing the importance and efforts to not miss them. In the case of a failed test, healthcare professionals must be prepared to recognize the main symptoms and signs of the disease.
Resumo Introdução: a triagem neonatal para fibrose cística deve contribuir para diagnóstico precoce e melhor prognóstico da doença. O estudo é uma série de casos com lactentes submetidos à triagem, porém com diagnóstico tardio da doença. Descrição: quatorze crianças foram incluídas; oito (57,1%) com triagem falso-negativo e seis (42,9%) com erros processuais na triagem neonatal. Duas amostras foram coletadas tardiamente, sendo incorretamente classificadas como negativas e quatro lactentes com triagem positiva não foram localizados, por erros na busca ativa. Confirmou-se o diagnóstico da fibrose cística com idade mediana (IIQ) de 5,3 (4,2-7,4) meses. O Comprometimento nutricional precoce foi o sinal clínico mais prevalente ao diagnóstico, presente em 78,6% das crianças. Os Z escores médios (SD) do peso para altura e altura para idade foram -3,46 (0,84) e -3,99 (1,16), respectivamente. Metade das crianças teve síndrome de Pseudo-Bartter e 42,9% dificuldade respiratória. Doze crianças (85,7%) precisaram hospitalização com tempo mediano de permanência de 17 dias. Discussão: a triagem neonatal para fibrose cística apresentou falhas, desde testes falso-negativos, coletas incorretas, até problemas com a busca ativa. Entretanto, o diagnóstico ágil é essencial e os profissionais de saúde devem reconhecer os sintomas e sinais precoces da doença, mesmo quando a triagem neonatal não for satisfatória.
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Humanos , Recém-Nascido , Lactente , Triagem Neonatal , Fibrose Cística/diagnóstico , Erros de Diagnóstico , Diagnóstico Tardio/estatística & dados numéricos , Brasil , Programas Nacionais de SaúdeRESUMO
Resumo Este artigo procurou contribuir para a literatura e para o debate nacional e global sobre a superação de uma polarização relacionada ao aspecto jurídico e administrativo do processo de inovação, procurando se concentrar nas patentes como um fator condicionante das trajetórias tecnológicas que viabilizam o aprendizado em âmbito produtivo. Baseou-se em um arcabouço teórico e político relacionado à inovação e ao acesso a medicamentos, especialmente quanto aos direitos de Propriedade Intelectual, e na análise crítico-reflexiva de instrumentos de Propriedade Intelectual utilizados em Parcerias para o Desenvolvimento Produtivo (PDP), desenvolvidas por um instituto de tecnologia em fármacos sintéticos, público e nacional. Os resultados demonstram a relevância da compatibilização dos direitos de patentes com a construção de uma capacidade tecnológica e de inovação no país, vinculada ao acesso universal, especialmente quando envolverem produtos que se destinam ao tratamento de doenças graves, de alta complexidade tecnológica e de alto custo. Conclui-se que, para superação da dependência tecnológica e ampliação do acesso a medicamentos no Brasil, o Estado deve buscar o equilíbrio entre os interesses públicos e privados na área da saúde, a articulação entre os instrumentos jurídicos legais existentes e o alinhamento entre suas políticas de saúde, industriais, de CT&I e Propriedade intelectual.
Abstract This article aims to contribute to the literature and to the national and global debate on overcoming the polarization related to the legal and administrative aspect of the innovation process, seeking to focus on patents as a conditioning factor of the technological trajectories that enable learning in the productive scope. It was based on a theoretical and political framework related to innovation and access to medicines, especially regarding Intellectual Property rights, and on a critical-reflexive analysis of Intellectual Property instruments used in Productive Development Partnerships (PDP), developed by a public national institute for synthetic drug technology. The results demonstrate the importance of making patent rights compatible with the construction of technological and innovation capacities in the country, which are linked to universal access, especially when they involve products that are intended to treat serious, technologically complex and high-cost diseases. In conclusion, to overcome technological dependence and expand access to medicines in Brazil, the State must seek a balance between public and private interests in the healthcare area, articulate the existing legal instruments and align its health, industry, ST&I and intellectual property policies.
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Propriedade Intelectual , Política Nacional de Ciência, Tecnologia e Inovação , Complexo Econômico-Industrial da Saúde , BrasilRESUMO
Background: In Brazil, the Ministry of Health (MH) monitors leprosy using 15 indicators, with the aim of implementing and evaluating evidence-based public policies. However, an excessive number of variables can complicate the definition of objectives and verification of epidemiological goals. Methods: In this paper, we develop the Global Leprosy Assessment Index (GLAI), a composite measure that integrates two key dimensions for the control the disease: epidemiological and operational. Using a confirmatory factor analysis model to examine 2020 state-level data, we have standardized GLAI to a range of 0 to 1. Results: Higher values within this range indicate a greater severity of the disease. The mean value of the GLAI was 0.67, with a standard deviation of 0.22. Roraima has the highest value, followed by Paraíba with 0.88 while Tocantins records the lowest value of the indicator, followed by Mato Grosso with 0.14. The epidemiological and operational indicators have a positive but statistically insignificant correlation (r = 0.25; p-value = 0.20). Conclusions: The development of evidence-based public policies depends on the availability of valid and reliable indicators. The GLAI presented in this paper is easily reproducible and can be used to monitor the disease with disaggregated information. Furthermore, the GLAI has the potential to serve as a more robust parameter for evaluating the impact of actions designed to eradicate leprosy in Brazil.
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Objectives: This study aimed to analyze the relevance of investigation committees in eliminating mother-to-child transmission of syphilis in Brazil. Methods: Questionnaires and interviews were conducted with health managers of 25 Brazilian Federative Units and Brazil's Federal District. Data were analyzed using Bardin's content analysis technique and subsequently compared with the global prescriptions for syphilis response of the Pan American Health Organization, World Health Organization, and recent research publications examining the course of syphilis in Brazil, in Brazilian regions, and globally. Results: While the investigation committees drew on the successful experience of those in reducing maternal mortality, which helped the country achieve the Millennium Development Goals, they are not demonstrated to be sufficient for preventing mother-to-child transmission of syphilis. The committees' systematic and bureaucratic agenda has not been efficient in managing avoidable factors for syphilis, nor do they operate in the scope of the integration of surveillance and care actions, as recommended by the health policy. Conclusion: The committees' model needs to be reviewed in the context of Brazil's National Health System. The research process should be rescaled in order to remain a cornerstone for the induction of health policy that integrates surveillance and healthcare across Brazilian Federative Units. The advancement toward an automated case management model becomes relevant for the country to meet global commitments to eliminate congenital syphilis transmission and achieve the goals outlined in the 2030 Agenda.
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BACKGROUND: Cervical cancer (CC) is globally ranked fourth in terms of incidence and mortality among women. Vaccination against Human Papillomavirus (HPV) and screening programs can significantly reduce CC mortality rates. Hence, executing cost-effective public health policies for prevention and surveillance is crucial. However, defining policies that make the best use of the available resources is not easy, as it requires predicting the long-term costs and results of interventions on a changing population. Since the simpler task of predicting the results of public health policies is difficult, devising those that make the best usage of available resources is an arduous challenge for decision-makers. METHODS: This paper proposes a fine-grained epidemiological simulation model based on differential equations, to effectively predict the costs and effectiveness of CC public health policies that include vaccination and screening. The model represents population dynamics, HPV transmission within the population, likelihood of infection clearance, virus-induced appearance of precancerous lesions and eventually CC, as well as immunity gained with vaccination and early detection with screening. RESULTS: We offer a compartmentalized modeling approach that separates population, epidemics, and intervention concerns. We instantiate models with actual data from a Colombian case study and analyze their results to show how our modeling approach can support CEA studies. Moreover, we implement models in an open-source software tool to simultaneously define and evaluate multiple policies. With the support of the tool, we analyze 54 policies within a 30-year time horizon and use as a comparator the CC policy that has been used until recently. We identify 8 dominant policies, the best one with an ICER of 6.3 million COP (Colombian Pesos) per averted DALY. We also validate the modeling approach against the available population and HPV epidemic data. The effects of uncertainty in the values of key parameters (discount rate, sensitivity of screening tests) is evaluated through one-way sensitivity analysis. CONCLUSIONS: Our modeling approach can provide valuable support for healthcare decision-makers. The implementation into an automated tool allows customizing the analysis with country-specific data, flexibly defining public health policies to be evaluated, and conducting disaggregate analyses of their cost and effectiveness.
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Infecções por Papillomavirus , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero , Feminino , Humanos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Análise Custo-Benefício , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/epidemiologia , Colômbia/epidemiologia , Vacinação , Política Pública , Papillomavirus Humano , Política de Saúde , Vacinas contra Papillomavirus/uso terapêuticoRESUMO
BACKGROUND: Cancer is a public health issue in Brazil. To mitigate exposure to risk factors, change habits and ensure access to cancer care, an increasing number of bills are presented every year. This article analyzes the changes proposed in these bills, portraying how the representatives perceive and respond to the challenges imposed by cancer on the healthcare system and society. METHODS: Through a systematic search on the Brazilian House of Representatives website, this exploratory study examines cancer-related bills presented up to 2022. RESULTS: Of 1311 bills identified, 310 met the inclusion criteria and were categorized based on their content. The increasing annual number of cancer bills reflects the interest of representatives on the topic. The cancer types addressed correspond to the most prevalent ones, except for the colorectal. The most common strategy is primary prevention (n: 129), proposing the reduction of risk factors exposure or the promotion of protective ones, followed by tertiary (n: 106) and secondary (n: 36) strategies, targeting, respectively, cancer treatment/management and its early diagnosis/detection. On the nature of proposed changes, most seek to implement increased healthcare access (n: 125), production/sale (dis)incentives for goods containing carcinogens (n: 60), and fiscal/financial (dis)incentives (n: 53). CONCLUSION: The identified gaps - such as the limited use of data and evidence to support what is proposed, overlapping but fragmented efforts with previous bills, scarce efforts directly addressing the determinants of health, and the low rate of conversion to law - entails opportunities to advance the Legislative propositions. POLICY SUMMARY: To effectively respond to cancer-related challenges, is essential that the Legislative branch takes into account what is already being proposed or being left out, inputs from society, real-world data, and the results produced by the multisectoral policies in place.
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Política de Saúde , Neoplasias , Brasil/epidemiologia , Saúde Pública , Fatores de Risco , Acessibilidade aos Serviços de Saúde , Neoplasias/diagnósticoRESUMO
RESUMEN Objetivo: Describir los modelos de gestión del cuidado de enfermería en servicios de atención primaria en salud. Metodología: Se empleó el paradigma positivista desde la perspectiva cuantitativa, apoyada en la revisión documental-bibliográfica, lo que contribuyó a la recolección de la información mediante la indagación exhaustiva y critica de artículos arbitrados, tesis y bibliografías especializadas, logrando cumplir los objetivos planteados por los investigadores, contribuyendo a la generación de conocimiento. Resultados: Se describen la Gestión Integral de Riesgo, Gestión Clínica, Modelos Comunitarios de Salud Familiar, Adaptación de Sor Callista Roy. En conclusión: La atención primaria de salud juega un rol de gran importancia en los diferentes países del mundo, ya que mediante la gestión de políticas públicas en materia de salud, se previenen en gran medida las enfermedades y su complicación, se destaca la función de los profesionales de enfermería como los principales promotores del cuidado, de forma integral, de las personas sanas y enfermas.
ABSTRACT Objective: To describe the models of nursing care management in primary health care services. Methodology: The positivist paradigm was used from the quantitative perspective, supported by the documentary-bibliographic review, which contributed to the collection of information through the exhaustive and critical inquiry of refereed articles, theses and specialized bibliography, achieving the objectives set by the researchers, contributing to the generation of knowledge. Results: Integrated Risk Management, Clinical Management, Community Models Family Health, Adaptation of Sister Callista Roy are described. In conclusion: Primary health care plays a role of great importance in the different countries of the world, since through the management of public health policies, diseases and their complications are largely prevented, and the role of nursing professionals as the main promoters of comprehensive care for healthy and sick people is emphasized.
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This study aimed to exhaustively explore the characteristics of food advertising on TV in Guatemala and Costa Rica. The International Network for Food and Obesity Non-Communicable Diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) methodology was applied. In 2016, we recorded 1440 h of video among 10 TV channels. We used the Pan American Health Organization (PAHO) Nutrient Profile (NP) Model to identify 'critical nutrients', whose excessive consumption is associated with NCDs. We created a nutritional quality score (0 if the product did not exceed any critical nutrient, 1 if the product exceeded one and 2 if it exceeded ≥2). We classified food ads as permitted (score = 0) and not-permitted (score 1 or 2) for marketing. Persuasive marketing techniques were classified as promotional characters (e.g. Batman), premium offers (e.g. toys), brand benefit claims (e.g. tasty) and health-related claims (e.g. nutritious). In Guatemala, foods that exceeded one critical nutrient were more likely to use persuasive marketing techniques, and in Costa Rica were those with an excess of ≥2 critical nutrients, compared with foods without any excess in critical nutrients [Guatemala: promotional characters (odds ratio, OR = 16.6, 95% confidence interval, CI: 5.8, 47.3), premium offers (OR = 3.4, 95% CI: 1.4, 8.2) and health-related claims (OR = 3.5, 95% CI: 2.2, 5.7); Costa Rica: health-related claims (OR = 4.2, 95% CI: 2.0, 8.5)]. In conclusion, Guatemalan and Costa Rican children are exposed to an overabundance of not-permitted food ads on TV. This justifies implementing national policies to reduce exposure to not-permitted food for marketing, including on TV and other media.
This study aimed to exhaustively explore the characteristics of food advertising on TV in Guatemala and Costa Rica. In 2016, we recorded 1440 h of video among 10 TV channels. We used the PAHO Nutrient Profile Model to identify 'critical nutrients' (e.g. sodium) whose excessive consumption is associated with Non-Communicable Chronic Diseases (e.g. hypertension). We created a nutritional quality score (0 if the product did not exceed any critical nutrient, 1 if the product exceeded one and 2 if it exceeded ≥2). We classified food ads as permitted (score = 0) and not-permitted (score 1 or 2) for marketing. Persuasive marketing techniques were classified as promotional characters, premium offers, brand benefit claims and health-related claims. In Guatemala, foods that exceeded one critical nutrient had a high probability of using promotional characters, premium offers and health-related claims than foods without any excess in critical nutrients. However, in Costa Rica health-related claims had a high probability of appearing with foods that exceeded ≥2 critical nutrients. In conclusion, Guatemalan and Costa Rican children are exposed to an overabundance of not-permitted food ads on TV. This justifies implementing national policies to reduce exposure to not-permitted food for marketing.
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Publicidade , Alimentos , Criança , Humanos , Costa Rica , Marketing/métodos , Televisão , Valor Nutritivo , Indústria Alimentícia , BebidasRESUMO
Describir los modelos de gestión del cuidado de enfermería en servicios de atención primaria en salud. Metodología: Se empleó el paradigma positivista desde la perspectiva cuantitativa, apoyada en la revisión documental-bibliográfica, lo que contribuyó a la recolección información mediante la indagación excautiva y critica de artículos arbitrados, tesis y bibliografía especializada, logrando cumplir los objetivos planteados por los investigadores, contribuyendo a la generación de cocimiento. Resultados: Se describen el Gestión Integral de Riesgo, Gestión Clínica, Modelos Comunitarios Salud Familiar, Adaptación de Sor Callista Roy. En conclusión: La atención primaria de salud juega un rol de gran importancia en los diferentes países del mundo, ya que mediante la gestión políticas públicas en materia de salud se previenen en gran medida las enfermedades y su complicación, se desataca la función de los profesionales de enfermería como los principales promotores del cuidado de forma integral de las personas sanas y enfermas.
To describe the models of nursing care management in primary health care services. Methodology: The positivist paradigm was used from the quantitative perspective, supported by the documentary-bibliographic review, which contributed to the collection of information through the exhaustive and critical inquiry of refereed articles, theses and specialized bibliography, achieving the objectives set by the researchers, contributing to the generation of knowledge. Results: Integrated Risk Management, Clinical Management, Community Models Family Health, Adaptation of Sister Callista Roy are described. In conclusion: Primary health care plays a role of great importance in the different countries of the world, since through the management of public health policies, diseases and their complications are largely prevented, and the role of nursing professionals as the main promoters of comprehensive care for healthy and sick people is emphasized.
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ABSTRACT Objective: Low birth weight (LBW) is a public health problem strongly associated with infant mortality. This study aimed to identify the spatial distribution of infant mortality in newborns with LBW (750-2,500 g) at term (≥37 weeks of gestation), due to their being small for gestational age, analyzing its association with mother-related determinants, as well as to identify priority areas of mortality in the State of São Paulo, 2010-2019. Methods: Infant mortality rate was analyzed in the division of neonatal mortality and postneonatal mortality of newborns with LBW at term. The empirical Bayesian method smoothed the rates, the univariate Moran index was used to measure the degree of spatial association between the municipalities, and the bivariate Moran index was employed to identify the existence of a spatial association between the rates and the selected determinants. Thematic maps of excess risk and local Moran were prepared to identify spatial clusters, adopting 5% as a significance level. Results: The excess risk map showed that more than 30% of the municipalities had rates above the state rate. High-risk clusters were identified in the southwest, southeast, and east regions, mainly among more developed municipalities. The determinants of adolescent mothers, mothers over 34 years of age, low education, human development index, social vulnerability index, gross domestic product, physicians, and pediatric beds showed a significant association with the rates evaluated. Conclusions: Priority areas and significant determinants associated with reduced mortality in newborns with LBW were identified, suggesting the need for intervention measures to achieve the Sustainable Development Goal.
RESUMO Objetivo: O baixo peso ao nascer (BPN) é um problema de saúde pública e está fortemente associado à mortalidade infantil. Este estudo teve como objetivo identificar a distribuição espacial da mortalidade infantil em recém-nascidos com BPN (750-2.500 g) a termo (≥37 semanas de gestação), por serem pequenos para a idade gestacional, analisando sua associação com determinantes relacionados à mãe, bem como identificar áreas prioritárias de mortalidade no Estado de São Paulo, 2010-2019. Métodos: A taxa de mortalidade infantil foi analisada na divisão da mortalidade neonatal e mortalidade pós-neonatal de recém-nascidos com BPN a termo. O método bayesiano empírico alisou as taxas, o índice de Moran univariado foi utilizado para medir o grau de associação espacial entre os municípios e o índice de Moran bivariado foi empregado para identificar a existência de associação espacial entre as taxas e os determinantes selecionados. Mapas temáticos de excesso de risco e Moran local foram elaborados para identificar aglomerados espaciais, adotando-se 5% como nível de significância. Resultados: O mapa de excesso de risco mostrou que mais de 30% dos municípios apresentaram taxas acima da taxa estadual. Aglomerados de alto risco foram identificados nas regiões sudoeste, sudeste e leste, principalmente entre os municípios mais desenvolvidos. Os determinantes mães adolescentes, mães acima de 34 anos, baixa escolaridade, índice de desenvolvimento humano, índice de vulnerabilidade social, produto interno bruto, médicos e leitos pediátricos apresentaram associação significativa com as taxas avaliadas. Conclusões: Foram identificadas áreas prioritárias e determinantes significativos associados à redução da mortalidade em recém-nascidos com BPN, sugerindo a necessidade de medidas de intervenção para atingir o Objetivo de Desenvolvimento Sustentável.
RESUMO
Abstract Estimates from 2022 showed that in the last 5 years, more than 102,000 amputation surgeries were performed by the Sistema Único de Saúde - SUS (Unified Health System, Brazil). An amputation requires adequate rehabilitation process with support network, allowing autonomy and social inclusion. The aim of this paper is to present and discuss the Brazilian Guidelines on Amputee Health Care and other Brazilian public health policies that dialogue with their recommendations. Eight documents were identified that narrow dialogue with the Guidelines: National Health Policy for People with Disabilities, National Health Plan 2012-2015, Guidelines for the Care of People with Chronic Diseases in Health Care Networks and Priority Lines of Care, National Plan for the Rights of Persons with Disabilities - Living Without Limits, Convention on the Rights of Persons with Disabilities, National Health Policy for the Elderly. Brazil has been discussing the need to implement legal mechanisms to ensure full citizenship of people with disabilities. Among the documents presented, the following guidelines were observed in common with the Amputee Health Care Guidelines: providing support and specialized services within the SUS, the need for training of the multidisciplinary team, supply of assistive technology equipment, prevention of injuries and promoting the inclusion of the amputated person. The main challenges and current perspectives involve the articulation of the various levels of health care for this population, and training of the team for comprehensive care for the full rehabilitation of these individuals.
Resumo Estimativas de 2022 mostraram que nos últimos cinco anos mais de 102.000 cirurgias de amputação foram realizadas pelo Sistema Único de Saúde - SUS, Brasil. Uma amputação requer um processo de reabilitação adequado com rede de apoio, permitindo autonomia e inclusão social. O objetivo deste documento é apresentar e discutir as Diretrizes Brasileiras sobre Cuidados de Saúde de Amputados e outras políticas de saúde pública brasileiras que dialogam com as suas recomendações. Foram identificados oito documentos que estabelecem um diálogo estreito com as Diretrizes: Política Nacional de Saúde para Pessoas com Deficiência, Plano Nacional de Saúde 2012-2015, Diretrizes para os Cuidados de Pessoas com Doenças Crónicas em Redes de Saúde e Linhas de Cuidados Prioritários, Plano Nacional para os Direitos das Pessoas com Deficiência - Viver sem Limites, Convenção sobre os Direitos das Pessoas com Deficiência, Política Nacional de Saúde para os Idosos. O Brasil vem discutindo a necessidade de implementar mecanismos legais para assegurar a plena cidadania das pessoas com deficiência. Entre os documentos apresentados, foram observadas as seguintes diretrizes em comum com as Diretrizes de Cuidados de Saúde dos Amputados: prestação de apoio e serviços especializados dentro do SUS, necessidade de formação da equipa multidisciplinar, fornecimento de equipamento tecnológico de assistência, prevenção de lesões e promoção da inclusão da pessoa amputada. Os principais desafios e perspectivas atuais envolvem a articulação dos vários níveis de cuidados de saúde para esta população e a formação da equipa para cuidados abrangentes para a plena reabilitação destes indivíduos.