Avaliação de usuários da atenção básica sobre a implantação de protocolo de assistência integral odontológica

Objective: To evaluate the perception of basic attention healthcare users as to the implantation of the Integral Dental Assistance Protocol (PAIO, in Portuguese) and the effect of this program on the oral health condition, oral hygiene, access to and resolubility of the service, in a public basic health unit of João Pessoa-PB. Method: The sample was composed of 32 volunteers, for whom a sixphase intervention was programed: diagnosis of dental needs; resolution of urgencies; restorative interventions; application of promotional measures; evaluation of the health level obtained; and periodic follow-up visits. Data were collected by means of a semistructured interview and a questionnaire, applied before and after PAIO implantation. The interviews were transcribed and analyzed according to the content analysis technique. The effect of PAIO implantation was evaluated by using an increasing scoring system ranging from 1 to 10. The Wilcoxon test was applied with a confidence level of 95%. Results: For the participants that attended the PAIO (n=20), the program contributed to improve oral health condition (100%) and knowledge (100%). The users reported satisfaction (n=12) and had a positive evaluation (n=12), achieved by means of the improvement of oral health condition (n=8), faster and easier access to treatment (n=7), scheduling of dental appoints and warrant of being treated (n=6), welcoming (n=5), motivation for oral care (n=5), and perspective of continuity of PAIO (n=6). The initial evaluation of the users received scores between 5.7 and 7.6. After PAIO implantation, the users' perception was improved (p<0.01), with scores between 9.6 and 9.9. Conclusion: According to the users, the implantation of PAIO contributed to the qualification of health service and oral health care, being a favorable aspect to increase the access to and resolubility of the service.

Estatuto da criança e do adolescente: a proteção integral e suas implicações político-educacionais

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Uma experiência baseada no Apoio Matricial em Saúde Mental: estratégia para um atendimento integral

Pós-graduação em Psicologia - FCLAS

A influência da escola de tempo integral sobre a qualidade de vida infantil

This study aims to evaluate the quality of life of students aged 7 to 12 years in two municipal schools in the municipality of Minas Gerais. One offers full-time care to their students with extracurricular activities and other school offers only the normal. We used the questionnaire AUQEI, Autoquestionnaire Qualité de Vie Enfant Image. The questionnaire was administered to 232 children. Through this study, we observed that the proportion of children with a good Quality of Life was higher in school full time (81%), compared to the normal school hours (58%). Therefore, it is concluded that the school offers an extended workday, is set in an area rich able to develop the maximum potential of children and their personal skills, which will reflect positively on their quality of life.

K-41(n, gamma)K-42 thermal and resonance integral cross section measurements

We measured the K-41 thermal neutron absorption and resonance integral cross sections after the irradiation of KNO3 samples near the core of the IEA-R1 IPEN pool-type research reactor. Bare and cadmium-covered targets were irradiated in pairs with Au-Al alloy flux-monitors. The residual activities were measured by gamma-ray spectroscopy with a HPGe detector, with special care to avoid the K-42 decay beta(-) emission effects on the spectra. The gamma-ray self-absorption was corrected with the help of MCNP simulations. We applied the Westcott formalism in the average neutron flux determination and calculated the depression coefficients for thermal and epithermal neutrons due to the sample thickness with analytical approximations. We obtained 1.57(4) and 1.02(4) b, for thermal and resonance integral cross sections, respectively, with correlation coefficient equal to 0.39.

Nurses and care delivery to elderly women: a social phenomenological approach

OBJECTIVE: To understand how nurses see care delivery to elderly women. METHODS: In this phenomenological study, ten nurses working at Primary Health Care Units were interviewed between September 2010 and January 2011. RESULTS: In care delivery, nurses consider the elderly women's knowledge background and biographical situation, and also value the family's participation as a care mediator. These professionals have the acuity to capture these women's specific demands, but face difficulties to deliver care to these clients. Nurses expect to deliver qualified care to these women. CONCLUSION: The theoretical and methodological approach of social phenomenology permitted revealing that the nurse designs qualified care to elderly women, considering the possibilities in the context. This includes the participation of different social actors and health sectors, assuming collective efforts in action strategies and professional training, in line with the particularities and care needs of elderly women nurses identify.

International palliative care experts' view on phenomena indicating the last hours and days of life

BACKGROUND Providing the highest quality care for dying patients should be a core clinical proficiency and an integral part of comprehensive management, as fundamental as diagnosis and treatment. The aim of this study was to provide expert consensus on phenomena for identification and prediction of the last hours or days of a patient's life. This study is part of the OPCARE9 project, funded by the European Commission's Seventh Framework Programme. METHOD The phenomena associated with approaching death were generated using Delphi technique. The Delphi process was set up in three cycles to collate a set of useful and relevant phenomena that identify and predict the last hours and days of life. Each cycle included: (1) development of the questionnaire, (2) distribution of the Delphi questionnaire and (3) review and synthesis of findings. RESULTS The first Delphi cycle of 252 participants (health care professionals, volunteers, public) generated 194 different phenomena, perceptions and observations. In the second cycle, these phenomena were checked for their specific ability to diagnose the last hours/days of life. Fifty-eight phenomena achieved more than 80% expert consensus and were grouped into nine categories. In the third cycle, these 58 phenomena were ranked by a group of palliative care experts (78 professionals, including physicians, nurses, psycho-social-spiritual support; response rate 72%, see Table 1) in terms of clinical relevance to the prediction that a person will die within the next few hours/days. Twenty-one phenomena were determined to have "high relevance" by more than 50% of the experts. Based on these findings, the changes in the following categories (each consisting of up to three phenomena) were considered highly relevant to clinicians in identifying and predicting a patient's last hours/days of life: "breathing", "general deterioration", "consciousness/cognition", "skin", "intake of fluid, food, others", "emotional state" and "non-observations/expressed opinions/other". CONCLUSION Experts from different professional backgrounds identified a set of categories describing a structure within which clinical phenomena can be clinically assessed, in order to more accurately predict whether someone will die within the next days or hours. However, these phenomena need further specification for clinical use.

Undergraduate palliative care teaching in Swiss medical faculties: a nationwide survey and improved learning objectives

BACKGROUND In 2007, a first survey on undergraduate palliative care teaching in Switzerland has revealed major heterogeneity of palliative care content, allocation of hours and distribution throughout the 6 year curriculum in Swiss medical faculties. This second survey in 2012/13 has been initiated as part of the current Swiss national strategy in palliative care (2010 - 2015) to serve as a longitudinal monitoring instrument and as a basis for redefinition of palliative care learning objectives and curriculum planning in our country. METHODS As in 2007, a questionnaire was sent to the deans of all five medical faculties in Switzerland in 2012. It consisted of eight sections: basic background information, current content and hours in dedicated palliative care blocks, current palliative care content in other courses, topics related to palliative care presented in other courses, recent attempts at improving palliative care content, palliative care content in examinations, challenges, and overall summary. Content analysis was performed and the results matched with recommendations from the EAPC for undergraduate training in palliative medicine as well as with recommendations from overseas countries. RESULTS There is a considerable increase in palliative care content, academic teaching staff and hours in all medical faculties compared to 2007. No Swiss medical faculty reaches the range of 40 h dedicated specifically to palliative care as recommended by the EAPC. Topics, teaching methods, distribution throughout different years and compulsory attendance still differ widely. Based on these results, the official Swiss Catalogue of Learning Objectives (SCLO) was complemented with 12 new learning objectives for palliative and end of life care (2013), and a national basic script for palliative care was published (2015). CONCLUSION Performing periodic surveys of palliative care teaching at national medical faculties has proven to be a useful tool to adapt the national teaching framework and to improve the recognition of palliative medicine as an integral part of medical training.

Understanding causes of hospitalization and access to care among newly diagnosed HIV patients in Houston, TX

More than a quarter of patients with HIV in the United States are diagnosed in hospital settings most often with advanced HIV related conditions.(1) There has been little research done on the causes of hospitalization when the patients are first diagnosed with HIV. The aim of this study was to determine if the patients are hospitalized due to an HIV related cause or due to some other co-morbidity. Reduced access to care could be one possible reason why patients are diagnosed late in the course of the disease. This study compared the access to care of patients diagnosed with HIV in hospital and outpatient setting. The data used for the study was a part of the ongoing study “Attitudes and Beliefs and Steps of HIV Care”. The participants in the study were newly diagnosed with HIV and recruited from both inpatient and outpatient settings. The primary and the secondary diagnoses from hospital discharge reports were extracted and a primary reason for hospitalization was ascertained. These were classified as HIV-related, other infectious causes, non–infectious causes, other systemic causes, and miscellaneous causes. Access to care was determined by a score based on responses to a set of questions derived from the HIV Cost and Services Utilization Study (HCSUS) on a 6 point scale. The mean score of the hospitalized patients and mean score of the patients diagnosed in an outpatient setting was compared. We used multiple linear regressions to compare mean differences in the two groups after adjusting for age, sex, race, household income educational level and health insurance at the time of diagnosis. There were 185 participants in the study, including 78 who were diagnosed in hospital settings and 107 who were diagnosed in outpatient settings. We found that HIV-related conditions were the leading cause of hospitalization, accounting for 60% of admissions, followed by non-infectious causes (20%) and then other infectious causes (17%). The inpatient diagnosed group did not have greater perceived access-to-care as compared to the outpatient group. Regression analysis demonstrated a statistically significant improvement in access-to-care with advancing education level (p=0.04) and with better health insurance (p=0.004). HIV-related causes account for many hospitalizations when patients are first diagnosed with HIV. Many of these HIV-related hospitalizations could have been prevented if patients were diagnosed early and linked to medical care. Programs to increase HIV awareness need to be an integral part of activities aimed at control of spread of HIV in the community. Routine testing for HIV infection to promote early HIV diagnosis can prevent significant morbidity and mortality.^

ASSISTÊNCIA DE SAÚDE ÀS MULHERES MUÇULMANAS NO BRASIL: UMA ANÁLISE DA RELAÇÃO ENTRE O SISTEMA RELIGIOSO ISLÂMICO E A POLÍTICA NACIONAL DE ATENÇÃO INTEGRAL À SAÚDE DA MULHER.

A presente dissertação tem por objetivo analisar os aspectos religiosos islâmicos e as implicações das relações de gênero no islam sobre a assistência de saúde às mulheres muçulmanas, e através disto, discutir a importância do conhecimento prévio do islamismo pelos profissionais de saúde para propor uma assistência de saúde congruente a estas mulheres, tendo por referência a Política Nacional de Atenção Integral à Saúde da Mulher. Esta pesquisa tem abordagem qualitativa, com o desenvolvimento de pesquisa de campo e aplicação de um roteiro de perguntas semi-estruturado, com questões relacionadas ao islamismo e à saúde das mulheres. Ao todo, foram entrevistadas dez pessoas, sendo estas: quatro mulheres revertidas ao islam, três mulheres de família muçulmana, dois sheiks e uma assistente social. As entrevistas foram realizadas no Centro de Divulgação do Islam para a América Latina e o Caribe (CDIAL) e na Assembléia Mundial da Juventude Islâmica na América Latina (WAMY).

Factors predictive of intravenous fluid administration errors in Australian surgical care wards

Background: Intravenous (IV) fluid administration is an integral component of clinical care. Errors in administration can cause detrimental patient outcomes and increase healthcare costs, although little is known about medication administration errors associated with continuous IV infusions. Objectives: ( 1) To ascertain the prevalence of medication administration errors for continuous IV infusions and identify the variables that caused them. ( 2) To quantify the probability of errors by fitting a logistic regression model to the data. Methods: A prospective study was conducted on three surgical wards at a teaching hospital in Australia. All study participants received continuous infusions of IV fluids. Parenteral nutrition and non-electrolyte containing intermittent drug infusions ( such as antibiotics) were excluded. Medication administration errors and contributing variables were documented using a direct observational approach. Results: Six hundred and eighty seven observations were made, with 124 (18.0%) having at least one medication administration error. The most common error observed was wrong administration rate. The median deviation from the prescribed rate was 247 ml/h (interquartile range 275 to + 33.8 ml/ h). Errors were more likely to occur if an IV infusion control device was not used and as the duration of the infusion increased. Conclusions: Administration errors involving continuous IV infusions occur frequently. They could be reduced by more common use of IV infusion control devices and regular checking of administration rates.

Health care professionals' views of paediatric outpatient non-attendance:implications for general practice

Background. Non-attendance at paediatric hospital outpatient appointments poses potential risks to children's health and welfare. Prevention and management of missed appointments depends on the perceptions of clinicians and decision makers from both primary and secondary care, including general practitioners (GPs) who are integral to non-attendance follow-up. Objectives. To examine the views of clinical, managerial and executive health care staff regarding occurrence and management of non-attendance at general paediatric outpatient clinics. Methods. A qualitative study using individual semi-structured interviews was carried out at three English Primary Care Trusts and a nearby children's hospital. Interviews were conducted with 37 staff, including GPs, hospital doctors, other health care professionals, managers, executives and commissioners. Participants were recruited through purposive and 'snowball' sampling methods. Data were analysed following a thematic framework approach. Results. GPs focused on situational difficulties for families, while hospital-based staff emphasized the influence of parents' beliefs on attendance. Managers, executives and commissioners presented a broad overview of both factors, but with less detailed views. All groups discussed sociodemographic factors, with non-attendance thought to be more likely in 'chaotic families'. Hospital interviewees emphasized child protection issues and the need for thorough follow-up of missed appointments. However, GPs were reluctant to interfere with parental responsibilities. Conclusion. Parental motivation and practical and social barriers should be considered. Responsibilities regarding missed appointments are not clear across health care sectors, but GPs are uniquely placed to address non-attendance issues and are central to child safeguarding. Primary care policies and strategies could be introduced to reduce non-attendance and ensure children receive the care they require. © The Author 2013.

The effects of the ethic of care in an all-boys school from 1903 to 1974

Nel Noddings’ 1984 publication, Caring: A Feminine Approach to Ethics and Moral Education was the first formal introduction of the concept of an “ethic of care”. It is a concept that stresses the importance of compassion in any relationship. For the purpose of this dissertation, the ethic of care was studied in a specific educational community. ^ This research focused on the role of care ethics in a secondary school (The Ransom School for Boys) from 1903 to 1974. The researcher identified this school as one that operated with an ethic of care and collected and analyzed data from historical school documents as well as from 60–90 minute individual interviews with six alumni, five retired faculty, and two administrators. ^ The case study addressed how students and faculty experienced care ethics within the school and how it has been maintained throughout the adult lives of alumni. An a priori coding rubric was used to examine the presence of care ethics at the Ransom School for Boys and in the adult lives of its alumni. This rubric was generated using information taken from the literature review and encompasses 36 different words to identify the presence of care ethics. ^ The primary research question was: How have alumni incorporated care ethics into their personal and professional lives? Secondary questions included: (1) How did the ethic of care present itself over the span of 71 years? (2) Was character education part of the formal curriculum at the Ransom School? (3) Was character education part of the hidden curriculum at the Ransom School? (4) Did the presence of care ethics support the values being taught in the home? ^ While there has been research done on the importance of care ethics in an educational institution, the research is void of direct evidence associated with care ethics in a school community, specifically, an all-boys, private school. Through deductive analysis, care ethics was found to be present and utilized at the school. The interviews and historical documents suggested that moral education was an integral part of the informal curriculum and helped to integrate the ethic of care within the community.^

Commodification of health care systems: The Catalan case

Commodification of the public healthcare system has been a growing process in recent decades, especially in universal healthcare systems and in high-income countries like Spain.  There are substantial differences in the healthcare systems of each autonomous region of Spain, among which Catalonia is characterized by having a mixed healthcare system with complex partnerships and interactions between the public and private healthcare sectors.  Using a narrative review approach, this article addresses various aspects of the Catalan healthcare system, characterizing the privatization and commodification of health processes in Catalonia from a historical perspective with particular attention to recent legislative changes and austerity measures.  The article approximates, the eventual effects that commodification and austerity measures will have on the health of the population and on the structure, accessibility, effectiveness, equity and quality of healthcare services.

Challenges to improve inter-professional care and service collaboration for people living with psychiatric disabilities in ordinary housing

The aim of this study was to describe health care- and social service professionals' experiences of a quality-improvement program implemented in the south of Sweden. The focus of the program was to develop inter-professional collaboration to improve care and service to people with psychiatric disabilities in ordinary housing. Focus group interviews and a thematic analysis were used. The result was captured as themes along steps in process. (I) Entering the quality-improvement program: Lack of information about the program, The challenge of getting started, and Approaching the resources reluctantly. (II) Doing the practice-based improvement work: Facing unprepared workplaces, and Doing twice the work. (III) Looking backevaluation over 1 year: Balancing theoretical knowledge with practical training, and Considering profound knowledge as an integral part of work. The improvement process in clinical practice was found to be both time and energy consuming, yet worth the effort. The findings also indicate that collaboration across organizational boundaries was broadened, and the care and service delivery were improved.