Autonomia de Gestão dos Agrupamentos dos Centros de Saúde

The National Health Service is one of the portuguese social progress pillars and as a key role in terms of health services, organized around a universal service, general and tend to free, provided for the Portuguese Republic Constitution, in order to promote people's access to health care,adequate and adaptively to their needs and expectations, seeking economic efficiency in a control context of public expenditure and budget. Primary Health Care are considered fundamental piece for the National Health Service, as they are the first users accessibility to health care, being the health center a unit to serve and providing the essential first treatments, preventive and/or curative, assuming important functions of promotion of health and prevention of disease, cooperating with other services for continuity of caring. The implementation of the Health Centers Groupings aims to decentralize the management and allow decision making on key resources to the provision of care, absorbing the district offices of the extinct Health Sub-Regions and having the task of ensuring the provision of health care primary the population of a given geographical area, based on a multidisciplinary team with organization and technical autonomy and is guaranteed intercooperation with other functional units. However, these district offices were attached to the Regional Health Administrations following the reverse path, causing dysfunctional positions and making health centers Groupings their dependents. Thus, before the reform of Primary Health Care, all the structural changes were made, except to check the Health Centers Groupings proper management autonomy, currently one of the biggest obstacles to the implementation of such reform. It is intended in this work through a inquiry by forms done at 21 Health Centers Groupings North Regional Health Authority, IP, evidence can the management autonomy in Health Centers Groupings provide greater efficiency in the provision of Primary health Care to citizens and ensure greater sustainability of the National health Service, better managing existing resources, human and financial, showing a growing responsibility in its management and ensuring appropriate practices, more quality in health care and better accessibility, providing the ability to apply more adjusted measures in providing health care to the population of their geographical área.

Emoções, documentos e subjetivação na construção de transexualidades em João Pessoa/PB

This research aims to understand how the affective components involved in transgender relations with documents constitute specific ways in which these people recognize themselves and build their bodies and their paths, their life projects and their relationship with others. We understand that the documents, if the personal identification or those produced by social movements, legal actors and health and the State, are experienced by trans people beyond administrative functions that are initially thought, but also involve a series of emotional experiences mark their subjective processes, in how these people produce themselves and design in the world their sociality networks. We elected as research field two institutions located in the city of João Pessoa (Paraíba State), noting the intense institutional movement, political, social in favor of the rights of transexuals that have occurred in that city in recent years. Thus, the Rights Reference Centre for LGBT and Fight Against Homophobia (Espaço LGBT) and Health Clinic of Transvestites and Transexuals (Ambulatório de Saúde de Travestis e Transexuais) were the spaces where we find our interlocutors and analyze their experiences with the documents noting two key aspects: the search for first name change in the civil registry and the relationship of trans people with documents produced by the health policies and services such as protocols, records, receipts and psychiatric reports. We realized that although there is disagreement about the perception that our interlocutors have on the documentation that regulates health services, all reported experiencing embarrassment in social situations when you have those who make use of a document that is not consistent with the performance and “social face” taken. In addition to the reports of embarrassment, we saw that the discussion of social distress and trauma has grounded the platforms of social movements, public policy, legal processes and become “narratives of pains” that present strong potential micro-political on demand for rights to “trans people”.

Factors associated with self-cutting as a method of self-harm: findings from the Irish National Registry of Deliberate Self-Harm

Background: Research suggests that patients presenting to hospital with self-cutting differ from those with intentional overdose in demographic and clinical characteristics. However, large-scale national studies comparing self-cutting patients with those using other self-harm methods are lacking. We aimed to compare hospital-treated self-cutting and intentional overdose, to examine the role of gender in moderating these differences, and examine the characteristics and outcomes of those patients presenting with combined self-cutting and overdose. Methods: Between 2003 and 2010, the Irish National Registry of Deliberate Self-Harm recorded 42,585 self-harm presentations to Irish hospital emergency departments meeting the study inclusion criteria. Data were obtained on demographic and clinical characteristics by independent data registration officers. Results: Compared with overdose only, involvement of self-cutting (with or without overdose) was significantly more common in males than females, with an overrepresentation of males aged <35 years. Independent of gender, involvement of self-cutting (with or without overdose) was significantly associated with younger age, city residence, repetition within 30 days and repetition within a year (females only). Factors associated with self-cutting as the sole method were no fixed abode/living in an institution, presenting outside 9 a.m. to 5 p.m., not consuming alcohol and repetition between 31 days and 1 year (males only). Conclusion: The demographic and clinical differences between self-harm patients underline the presence of different subgroups with implications for service provision and prevention of repeated self-harm. Given the relationship between self-cutting and subsequent repetition, service providers need to ensure that adequate follow-up arrangements and supports are in place for the patient.

The impact of widowhood on Irish mortality due to suicide and accidents

The impact of widowhood on suicide and accident mortality in Ireland was investigated using Poisson regression analysis applied to routine data relating to all 10 561 suicidal and accidental deaths of married or widowed persons aged at least 35 years in Ireland during 1986–2005. Mortality rates were almost always higher among the widowed and often by a 2-fold, statistically significant difference. The excess mortality was equivalent to 2083 or 57.6% of all suicidal or accidental deaths of widowed persons in 1986–2005. Routine contact with recently widowed persons by public health professionals may be warranted with a view to reducing their excess mortality.

The Art of Change Movement: an anti-oppressive Social Work initiative

This article presents the Art of Change Movement (Movimiento Arte del Cambio), which has developed out of a project of the Association of Social Workers Without Boundaries (Asociación Trabajadores/as Sociales Sin Fronteras), with the collaboration of the Faculty of Social Work at Universidad de Granada and of education professionals, incorporating theatrical creativity and musical expression as pedagogical and social intervention tools. The aim is for the initiative to become another instrument in the fight against oppression. Through a laboratory for collective creativity involving students and professionals from social work and other social science disciplines, the movement seeks social transformation through artistic expression, based on political commitment and sustainable development that empowers participants.

Saúde para todos – especialidades: cooperação em saúde com a República Democrática de São Tomé e Príncipe na área da anatomia patológica

O programa “Saúde para Todos – Especialidades” é um programa de cooperação na área da saúde ancorado em São Tomé e Príncipe (STP), desenvolvido e sustentado pelo Instituto Marquês de Valle Flôr (IMVF) com o apoio principal da Cooperação Portuguesa (através do Camões – Instituto da Cooperação e da Língua) e da Fundação Calouste Gulbenkian e em parceria com o Ministério da Saúde da República Democrática de São Tomé e Príncipe.

In-vitro evaluation of the quality of Paracetamol and Co-trimoxazole tablets used in Malawi based on pharmacopoeial standards

Objectives This study was an in-vitro evaluation of different brands of paracetamol and cotrimoxazole tablets, used or found in Malawi, based on Pharmacopoeia standards, in order to ascertain the existence and extent of substandard medicines in Malawi and to give an overview of their distribution in the public and private sectors. Methodology A cross-sectional analytical study was conducted using 11 samples each of paracetamol and cotrimoxazole tablets. Stratified random sampling was used to collect samples. Samples were analyzed using HPLC and Spectrophometric methods as outlined in the BP-2007 and USP-32 at the National Drug Quality Control Laboratory (NDQCL)-Lilongwe (under Pharmacy Medicines and Poisons Board-PMPB) and Orient Pharma Co. Ltd of Taiwan. The results were analyzed using Epi Info. Results and discussion Fifty percent of samples (n=22) were not registered in the country by the PMPB as required by the PMP Act with the majority of those coming from public health facilities. All paracetamol and cotrimoxazole samples complied with identification tests using spectrophotometric and HPLC method. Overall, 27.3% of samples failed to meet the BP-2007 standards for Active Ingredient content, while 22.7% of the samples failed the Friability test. The results from Malawi are similar in magnitude to those within surrounding countries in Africa. Conclusion This pilot study provides objective evidence to show that substandard and unregistered paracetamol and cotrimoxazole are present and being used in Malawi, and thus posing a considerable hazard to public health in Malawi. PMPB, together with the Ministry of Health, must continue to develop a quality assurance system to ensure that medicines are randomly and routinely checked.

Relatório de estágio de intervenção comunitária

O desenvolvimento da sociedade nos últimos anos contribuiu para um desenvolvimento das condições de vida e dos cuidados de saúde, levando a um aumento da esperança média de vida, e permitindo assim alterações demográficas de entre as quais se destacam o envelhecimento. Este facto provoca alterações profundas a vários níveis, entre os quais económicos, sociais, familiares e de saúde. Numa época em que o progresso científico e o desenvolvimento tecnológico têm proporcionado importantes avanços a todos os níveis, paralelamente têm emergido novas ameaças à saúde de todos nós. O cenário atual em que vivemos não é fácil, os recursos são cada vez mais escassos e as disparidades socioeconómicas começam a acentuar-se. O envelhecimento é um tema que tem suscitado interesse no meio político, social, económico e académico, e há um reconhecimento de que o seu processo pode ser mais ou menos complexo, com mais ou menos pesar para os que o experienciam na primeira pessoa, mas também para aqueles que de perto vivem este fenómeno. Apesar de estar disponível muita informação sobre este assunto, acreditamos que nunca é demais abordar e estudar esta problemática. A sua persistência e aumento significativo, previsivelmente duradouro, merecem todas as soluções, propostas e intervenções que possam ir ao encontro destas necessidades, para que assim, possam ser colmatadas ou minimizadas. Tendo em conta estas premissas, o estágio de intervenção comunitária decorreu no período de 16 de Setembro de 2013 a 31 de Janeiro de 2014, na Freguesia de Tramaga, sendo a população alvo os idosos com 65 ou mais anos. A intervenção comunitária foi desenvolvida com base no planeamento em saúde, mas no âmbito da promoção da saúde todas as atividades foram baseadas na Teoria de Organização Comunitária, uma vez que no decurso das atividades desenvolvidas, o principal objetivo passou pela capacitação dos idosos, incentivando ao empowerment. Enquanto profissionais de saúde, o propósito da intervenção comunitária passou pela transmissão de conhecimentos e sensibilização aos idosos, para que estes possam participar de maneira informada e consciente na tomada de decisão relativamente à sua saúde. O objetivo final será a sensibilização positiva para a mudança de comportamentos, traduzindo ganhos em saúde, ainda que a longo prazo. Este estágio de intervenção comunitária permitiu-nos adquirir a maioria das competências gerais do Enfermeiro Especialista, bem como as competências específicas do Enfermeiro Especialista em Enfermagem Comunitária e de Saúde Pública definidas pela Ordem dos Enfermeiros.

Child Abuse and Mental Disorders in Iranian Adolescents

Background: Child abuse is a serious social health problem all over the world with important adverse effects. Objectives: The aim of this study was to extend our understanding of the relation between mental disorders and child abuse. Materials and Methods: The study was designed as a cross-sectional survey on 700 students in secondary schools using multiple cluster sampling in Yazd, Iran in 2013. We applied 2 self reported questionnaires: DASS (depression anxiety stress scales)-42 for assessing mental disorders (anxiety, stress and depression) and a standard self-reported valid and reliable questionnaire for recording child abuse information in neglect, psychological, physical and sexual domains. The collected data was analyzed using SPSS software. P-values < 0.05 were considered as significant. Results: There was a statically significant correlation between mental disorder and child abuse score (Spearman rho: 0.2; P-value < 0.001). The highest correlations between mental disorders and child abuse were found in psychological domain, Spearman’s rho coefficients were 0.46, 0.41 and 0.36 for depression, anxiety and stress respectively (P-value < 0.001). Based on the results of logistic regression for mental disorder, females, last born adolescents and subjects with drug or alcohol abuser parents had mental disorder odds of 3, 0.4 and 1.9 times compared to others; and severe psychological abuse, being severely neglected and having sexual abuse had odds 90, 1.6 and 1.5 respectively in another model. Conclusions: Programming for mandatory reporting of child abuse by physicians and all health care givers e.g. those attending schools or health centers, in order to prevent or reduce its detrimental effects is useful and success in preventing child abuse could lead to reductions in the prevalence of mental disorders.

Análisis del sistema defensivo en primera línea en voley playa femenino

La técnica de bloqueo se considera como una acción discriminatoria de la victoria en el juego. Por ello, el objetivo principal de este estudio fue analizar las acciones defensivas de primera línea en voley playa femenino. Las principales variables criterio analizadas fueron el sistema de juego defensivo, el nivel juego exhibido por las parejas participantes y su clasificación. La muestra objeto de estudio estuvo compuesta por 38 jugadoras, divididas en función de su nivel de juego, en 13 parejas con nivel de juego nacional, y 6 con nivel internacional (disputan torneos internacionales representando a España). Fueron analizados 15 partidos, registrándose 1.444 secuencias defensivas completas en primera línea defensiva. Se realizó un estudio de confiabilidad, para determinar el grado de concordancia inter e intraobservadores, llegando a alcanzar una concordancia entre los observadores >.80, lo que avala la calidad de los datos. Los resultados del análisis correlacional mostraron, una diferencia en el sistema defensivo utilizado tras el cruce de variables criterio estudiadas, mostrando el test de Chi-cuadrado de Pearson una significación en el cruce (χ² de Pearson <.05). Las parejas mostraron una tendencia clara en las zonas de bloqueo, que junto con los resultados anteriores, permite establecer un patrón de comportamiento en bloqueo relacionado con la zona de golpeo del balón en ataque, lo que supone una ventaja clara en los partidos, a través del movimiento anticipado del jugador bloqueador. Las parejas con un nivel de juego nacional, y clasificadas como no finalistas, cometieron un mayor número de errores en bloqueo.

Virtual knowledge brokering : describing the roles and strategies used by knowledge brokers in a pediatric physiotherapy virtual community of practice

Introduction: Knowledge transfer in pediatric rehabilitation is challenging and requires active, multifaceted strategies. The use of knowledge brokers (KBs) is one such strategy noted to promote clinician behavior change. The success of using KBs to transfer knowledge relies on their ability to adapt to ever-changing clinical contexts. In addition, with the rapid growth of online platforms as knowledge transfer forums, KBs must become effective in virtual environments. Although the role of KBs has been studied in various clinical contexts, their emerging role in specific online environments designed to support evidence-based behavior change has not yet been described. Our objective is to describe the roles of, and strategies used by, four KBs involved in a virtual community of practice to guide and inform future online KB interventions. Methods: A descriptive design guided this study and a thematic content analysis process was used to analyze online KB postings. The Promoting Action on Research in Health Sciences knowledge transfer framework and online andragogical learning theories assisted in the coding. A thematic map was created illustrating the links between KBs' strategies and emerging roles in the virtual environment. Results: We analyzed 95 posts and identified three roles: 1) context architect: promoting a respectful learning environment, 2) knowledge sharing promoter: building capacity, and 3) linkage creator: connecting research-to-practice. Strategies used by KBs reflected invitational, constructivism, and connectivism approaches, with roles and strategies changing over time. Discussion: This study increases our understanding of the actions of KBs in virtual contexts to foster uptake of research evidence in pediatric physiotherapy. Our results provide valuable information about the knowledge and skills required by individuals to fulfill this role in virtual environments.

La posición socio económica en el campo de la actividad física y su relación con la imagen corporal: Aproximación desde el enfoque determinantes/ determinación social de la salud

El presente trabajo analiza la definición de la categoría posición socioeconómica (PSE) y las variables con las cuales se representa en los productos académicos del campo de la actividad física, además de su relación con la categoría de imagen corporal. Para lograr el objetivo, se rastrean elementos que permiten dar cuenta si los documentos de investigación se abordan desde alguno de los dos contextos: determinantes (DDSS) o determinación social de la salud (DSS). Se inicia con un rastreo global por medio de los motores de búsqueda, las bases de datos y los repositorios institucionales. Posteriormente se parametriza la ruta, desde las categorías imagen corporal (IC) y PSE. Las investigaciones pretenden dar cuenta de la evaluación a 15 años del programa "Salud para Todos" de la ONU de 2001, en el marco de los Objetivos Del Milenio. Se revisaron resúmenes de los productos, descartando aquellos donde la categoría PSE o sus descriptores asociados tuvieran un papel secundario. Se limitó a Latinoamérica y España por su tradición histórica colonizadora; con el ánimo de conocer la postura de esta comunidad frente al proceso globalizado de la salud en el mundo. Al grupo final se le aplican criterios parametrizados a partir de la revisión teórica, para responder los interrogantes basados en las implicaciones que tiene la PSE en el pensamiento actual de la producción científica en el campo de la actividad física; y cómo las otras categorías de análisis se ven o no manifiestas. El índice de calidad científica CASPe, determina la pertinencia de los textos. En el aspecto teórico, se encuentra que la categoría PSE, a pesar de ser muy utilizada, tiene una conceptualización difusa. Por tal motivo, se propone una definición de PSE sustentada en el pensamiento sociológico. En el aspecto empírico, al rastrear las variables con que se reemplaza la PSE en las investigaciones, se encuentran grandes diferencias y el uso de múltiples y disímiles subcategorías.

All-Ireland Health Data Inventory. Part 1: Metadata for key data sources, version 1.0

The All-Ireland Health Data Inventory. Part 1 is a catalogue of key sources of health data in the Republic and Northern Ireland. It includes relevant datasets from the major information reviews, conducted in the North and South, in the past few years. Information is essential for informed decision making and service provision. This inventory draws together information sources to facilitate such decision making. The inventory is intended as a resource for health professionals, researchers and the general public, providing the first phase of a ‘one-stop’ catalogue of health data. The datasets have been catalogued using an expanding numbering system which will allow for the inclusion of future resources. The Institute of Public Health in Ireland is in the process of expanding the Inventory to include further data sources.

Cancer Services - A Position Paper for the Professions Allied to Medicine (PDF 175 KB)

A Position Paper for the Professions Allied to Medicine Patients with cancer are living longer due to early diagnosis and better treatment. In recent years there has been increasing attention to issues related to the quality of life of patients with cancer and a recognition of the potential for habilitation and rehabilitation. As a result, PAMs as members of the multi-disciplinary team are now more actively involved with patients diagnosed with cancer during all phases of their disease. Each person’s life possesses a unique blend of psychological, social, economic and physical factors and comprehensive care requires the needs of the whole person to be addressed. This requires patients and carers having timely access to the most appropriate range of professional skills that will allow individual patients and their carers to retain control of their lives and associated circumstances for as long as possible. It also requires professions, in all locations, to work in a collaborative patient centred manner that affords the best outcome for patients. The need has been highlighted for a multi-professional approach to the delivery of cancer services in “Investing for the Future” and “A Framework for the Multi-professional Contribution to Cancer Care in Northern Ireland”. This need has also been highlighted in the PAM Strategy document. åÊ