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Background: Matrix Support (MS) is a strategy that can be used to improve integration between Primary Health Care (PHC) and other levels of care. Objective: The aim of this study was to investigate the association between MS carried out in Brazilian Dental Specialty Centers (CEOs) (secondary level of oral health care) and aspects of the integrated work process with PHC, as well as contextual variables. Methods: A quantitative cross-sectional study was conducted using data from the Program for Quality Improvement and Access to CEOs (PMAQ-CEO). Secondary data from the External Evaluation of the second cycle of PMAQ-CEO were analyzed, including contextual variables obtained from sources such as the Unified Health System (SUS) and official research institutions. Descriptive analyses were performed, and four multiple models were adjusted to investigate the association between the variables. Results: The results showed that about half of the CEOs did not carry out therapeutic projects developed with the oral health teams of PHC. It was found that the lack of therapeutic projects developed with the teams was associated with the lack of discussion of complex cases by the team, lack of discussion of individual therapeutic project, absence of joint continuing education activities, lack of construction and discussion of clinical protocols, and lack of belief in the importance of planning and periodic evaluation. The results suggest that the articulation between PHC and secondary oral health care still presents weaknesses within the scope of SUS. Comprehensive care needs to be strengthened, requiring greater intervention from management. Conclusion: It was concluded that the individual factors of CEOs, related to the work process, have a greater influence on the lack of integration with oral health teams of PHC, compared to the contextual variables of municipalities. [ABSTRACT FROM AUTHOR]

Introduction: The elderly correspond to the most medicalized group in society. Therefore, studies related to the use of medicines are important to improve policies that guarantee comprehensive care. The objective of this study was to investigate the polypharmacy among elderly individuals attending an educational program in the Federal District of Brazil and estimate the prevalence and associated variables. Method: This is a cross-sectional study with 150 elderly individuals whose data were collected in the period from December 2022 to April 2023 by means of telephone calls. Results: The prevalence of polypharmacy was estimated in 18.7%. The variables showing a positive association with polypharmacy were the following: health self-perceived as bad or very bad (PR = 8.9; 95 % CI 4.78 – 16.70), smoking (PR = 2.50; 95 % CI 1.06 – 5.89), systemic arterial hypertension (PR = 3.55; 95 % CI 1.40 – 9.00), diabetes mellitus (PR = 3.46; 95 % CI 1.67 – 7.18), depression (PR = 3.32; 95 %CI 1.58 – 6.75), multi-morbidity (PR = 8.97; 95 % CI 1.26 – 64.10) and Charlson Comorbidity Index equal to or greater than 3 (PR = 7.21; 95 % CI 1.14 – 26.17). Conclusions: The prevalence of polypharmacy and associated variables are corroborated by other Brazilian studies. Therefore, it is pointed out that healthcare teams should pay attention to this aspect of geriatric pharmacotherapy to favour the responsible use of medications and yield positive clinical outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Matrix Support (MS) is a strategy that can be used to improve integration between Primary Health Care (PHC) and other levels of care. Objective The aim of this study was to investigate the association between MS carried out in Brazilian Dental Specialty Centers (CEOs) (secondary level of oral health care) and aspects of the integrated work process with PHC, as well as contextual variables. Methods A quantitative cross-sectional study was conducted using data from the Program for Quality Improvement and Access to CEOs (PMAQ-CEO). Secondary data from the External Evaluation of the second cycle of PMAQ-CEO were analyzed, including contextual variables obtained from sources such as the Unified Health System (SUS) and official research institutions. Descriptive analyses were performed, and four multiple models were adjusted to investigate the association between the variables. Results The results showed that about half of the CEOs did not carry out therapeutic projects developed with the oral health teams of PHC. It was found that the lack of therapeutic projects developed with the teams was associated with the lack of discussion of complex cases by the team, lack of discussion of individual therapeutic project, absence of joint continuing education activities, lack of construction and discussion of clinical protocols, and lack of belief in the importance of planning and periodic evaluation. The results suggest that the articulation between PHC and secondary oral health care still presents weaknesses within the scope of SUS. Comprehensive care needs to be strengthened, requiring greater intervention from management. Conclusion It was concluded that the individual factors of CEOs, related to the work process, have a greater influence on the lack of integration with oral health teams of PHC, compared to the contextual variables of municipalities.

Abstract Background In Latin America, interventions aimed at adolescents’ health suffer from a shortfall of investment and lack of sustainability. Nurses, as an integral part of health services and systems, can lead the implementation and development of public health policies to improve adolescent health. Objective To identify and analyze the role of nurses in the development and implementation of public policies and in the provision of health care to adolescents in Colombia, Ecuador, and Peru. Methods The research was carried out in three phases: a documentary analysis, an online survey, and semi-structured focus groups. A total of 48 documents were analyzed, 288 nurses participated in the survey, and 29 nurses participated in the focus groups. Results State policies aim to guarantee rights, with special protection for children and adolescents. It is an incremental process, with greater involvement of civil society and governments. Participants reported a lack of synergy between law and practice, as well as differences in regulatory compliance in rural areas and in populations of different ethnicities and cultures. Their perception was that the protection of adolescents is not specifically enshrined in the legal bases and regulatory structures of the countries, meaning that there are both protective factors and tensions in the regulatory framework. While nurses are highly committed to different actions aimed at adolescents, their participation in policy development and implementation is low, with barriers related to a lack of specialized training and working conditions. Conclusions Given nurses’ involvement in different actions aimed at adolescents, they could play a fundamental role in the development of policies for adolescents and ensure their effective implementation. Policymakers should consider revising the budget to make compliance viable, incorporating and using monitoring indicators, and increasing the involvement of educational institutions and the community.

Abstract Positive Health is a field of Positive Psychology that measures the biological, subjective, and functional state of health. The article aims to present a theoretical review of the subjective aspects of Positive Health, understanding well-being as one of its health assets and relating it to the knowledge of Health Psychology. The article initially reviews the Positive Psychology approach, followed by an in-depth look of the different theoretical models of well-being and their relevance to Positive Health. Finally, it integrates this knowledge with the Health Psychology approach. It is concluded that Positive Health is a field in broad development and studies should be encouraged to assess the direct and indirect effects of positive interventions for promoting people’s health.

Quilombolas are ethnic-racial groups, of black ancestry, and had their territories consolidated in Brazil in regions with difficult access and far from large centers. The objective of this study is to know the therapeutic itinerary (IT) adopted by quilombola women in traditional communities located in the North of the state of Minas Gerais. This is a qualitative study with the theoretical model using the Arthur Kleinman health care system. The study scenario was 23 quilombola communities in northern Minas Gerais. Forty quilombola women aged between 25 and 89 years were interviewed. Data analysis was performed following the IT. Units of analysis emerged that were grouped into three categories: quilombola women and the meaning of health and care; the professional care system in quilombola communities; and route of care in situations experienced by women. The therapeutic itinerary of the communities is mainly related to the actions of popular medicine. It was also possible to observe that there are weaknesses in relation to health care due to factors such as difficulty of access to institutionalized services. [ABSTRACT FROM AUTHOR]

Copyright of Gerokomos is the property of Indemm Farma SL and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACT Objectives: to understand the role of Primary Health Care teams in caring for people with stroke after hospital discharge. Methods: single case study, with integrated units of analysis, with a qualitative approach. Data triangulation occurred through interviews with professionals and family caregivers involved in transition of care, in addition to direct observations in rounds and document analysis. For the analyses, the analytical strategies of theoretical propositions and construction of explanations were used, with the help of ATLAS.ti®. Results: the importance of counter-referral, the role of community health workers and the multidisciplinary team, health promotion, secondary prevention, home visits as a visceral attribute and nurses as care managers are evident. Final Considerations: the high demand on teams and the Social Determinants of Health interfere with adequate continuity of care. Transitional care programs that enable continuity of care are recommended.

Background Down syndrome is the most commonly genetic cause of developmental delay and intellectual disability, affecting 1:700 live births. It is associated with heart disease and recurrent infections, among other complications that greatly impair the patient's quality of life.

Objective: To identify perceptions of primary care health professionals regarding the conceptual aspects of child development and propose strategies to address difficulties. Methods: This descriptive-analytical study was conducted in a small municipality in the countryside of the State of São Paulo, Brazil. The primary health care in this region is comprised of Family Health Units and Basic Health Units. The sample included 52 participants, consisting of doctors and primary care nurses. A questionnaire with open and closed questions was utilized, covering knowledge and practices related to child development. For this study, the first question of the questionnaire, which asked for a descriptive response about participants’ understanding of child development, was employed. The responses were transcribed, and content analysis using the thematic approach was conducted. Results: Among the participants, 54% were nurses, and the average duration of working with the pediatric population was ten years. 80% reported never having undergone training in child development. The analysis of the responses revealed heterogeneity in the professionals’ understanding of the conceptual dimension of child development. Additionally, there was an insufficient grasp of the theoretical and practical aspects and a scarcity of resources to support comprehensive care for children. A predominant biomedical model focusing on disease and biological aspects of child health was evident in defining the understanding of the subject. Conclusions: The findings underscore the necessity of implementing health education initiatives and service projects in primary care settings. It is crucial to strengthen a comprehensive perspective of child health within the biopsychosocial model of the health-disease process. [ABSTRACT FROM AUTHOR]

Copyright of Alerta (San Salvador) - Revista Cientifica del Instituto Nacional de Salud is the property of Instituto Nacional de Salud and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: The thrombectomy-capable stroke center (TSC) is a recently introduced intermediate tier of accreditation for hospitals at which patients with acute ischemic stroke receive care. The comparative quality and clinical outcomes of reperfusion therapies at TSCs, primary stroke centers (PSCs), and comprehensive stroke centers (CSCs) have not been well delineated. METHODS: We conducted a retrospective, observational, cohort study from 2018 to 2020 that included patients with acute ischemic stroke who received endovascular thrombectomy (EVT) and intravenous thrombolysis reperfusion therapies at CSCs, TSCs, or PSCs. Participants were recruited from Get With The Guidelines--Stroke registry. Study end points included timeliness of intravenous thrombolysis and EVT, successful reperfusion, discharge destination, discharge mortality, and functional independence at discharge. RESULTS: Among 84 903 patients, 48 682 received EVT, of whom 73% were treated at CSCs, 22% at PSCs, and 4% at TSCs. The median annual EVT volume was 76 for CSCs, 55 for TSCs, and 32 for PSCs. Patient differences by center status included higher National Institutes of Health Stroke Scale score, longer onset-to-arrival time, and higher transfer-in rates for CSCs, TSCs, and PSCs, respectively. In adjusted analyses, the likelihood of achieving the goal door-to-needle time was higher in CSCs compared with PSCs (odds ratio [OR], 1.39 [95% CI, 1.17--1.66]) and in TSCs compared with PSCs (OR, 1.45 [95% CI, 1.08--1.96]). Likewise, the odds of achieving the goal door-to-puncture time were higher in CSCs compared with PSCs (OR, 1.58 [95% CI, 1.13--2.21]). CSCs and TSCs also demonstrated better clinical efficacy outcomes compared with PSCs. The odds of discharge to home or rehabilitation were higher in CSCs compared with PSCs (OR, 1.18 [95% CI, 1.06--1.31]), whereas the odds of in-hospital mortality or discharge to hospice were lower in both CSCs compared with PSCs (OR, 0.87 [95% CI, 0.81--0.94]) and TSCs compared with PSCs (OR, 0.86 [95% CI, 0.75--0.98]). There were no significant differences in any of the quality-of-care metrics and clinical outcomes between TSCs and CSCs. CONCLUSIONS: In this study representing national US practice, CSCs and TSCs exceeded PSCs in key quality-of-care reperfusion metrics and outcomes, whereas TSCs and CSCs demonstrated a similar performance. With more than one-fifth of all EVT procedures during the study period conducted at PSCs, it may be desirable to explore national initiatives aimed at facilitating the elevation of eligible PSCs to a higher certification status. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Salud Pública is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Objectives: Two types of medicinal systems are available in Korea: Western and oriental. These exist as separate services that independently provide medical care to patients. We determined the utility and benefits of compressive and integrated medical services (CIMS) comprising 12 sessions of acupuncture and healing programs over 6 weeks. Methods and Methods: In this two-group parallel single-center randomized controlled assessor-blinded trial, 25 participants were assigned to either the experimental (conventional medical treatment plus CIMS, n = 12) or control (conventional medical treatment, n = 13) group. Spinal nerve root block was performed on the compressed spinal nerve root (identified using magnetic resonance imaging) when no improvement was observed after the initial treatment. The experimental group received 12 cycles of acupuncture and manual therapy for 6 weeks; the control group received conventional medical treatment alone. Results: The average age of participants in the experimental and control groups was 70.73 ± 5.95 and 67.33 ± 8.89 years, respectively. There were no significant differences between the groups in terms of age, body mass index, Leeds Assessment of Neuropathic Symptoms and Signs, sex, and current medical history. We found high compliance for both programs (acupuncture and healing). On exclusion of between-group effects, the visual analog scale (VAS) score improved significantly over time (p = 0.045). Further, comparison of the groups after excluding the effects of visits revealed significantly lower VAS scores in the experimental group than in the control group (p = 0.000). Conclusions: Patients with degenerative lumbar spinal stenosis who mainly complain of radiating pain in the lower leg may benefit from CIMS after spinal nerve root block for ≤3 months after treatment. Our study findings suggest that this treatment improves spinal function and Oswestry Disability Index score. However, CIMS did not improve QoL. [ABSTRACT FROM AUTHOR]

Cleft lip and/or palate is a congenital malformation with a wide range of presentations, and its effective treatment necessitates sustained, comprehensive care across an affected child's life. Early diagnosis, ideally through prenatal imaging or immediately postbirth, is paramount. Access to longitudinal care and long-term follow-up with a multidisciplinary approach, led by the recommendations of the American Cleft Palate Association, is the best way to ensure optimal outcomes. Multiple specialties including plastic surgery, otolaryngology, speech therapy, orthodontists, psychologists, and audiologists all may be indicated in the care of the child. Primary repair of the lip, nose, and palate are generally conducted during infancy. Postoperative care demands meticulous oversight to detect potential complications. If necessary, revisional surgeries should be performed before the child begin primary school. As the child matures, secondary procedures like alveolar bone grafting and orthognathic surgery may be requisite. The landscape of cleft care has undergone significant transformation since early surgical correction, with treatment plans now tailored to the specific type and severity of the cleft. The purpose of this text is to outline the current standards of care in children born with cleft lip and/or palate and to highlight ongoing advancements in the field. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Enfermagem e Atenção à Saúde (REAS) is the property of Revista de Enfermagem e Atencao a Saude - Reas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACT Objective: To identify perceptions of primary care health professionals regarding the conceptual aspects of child development and propose strategies to address difficulties. Methods: This descriptive-analytical study was conducted in a small municipality in the countryside of the State of São Paulo, Brazil. The primary health care in this region is comprised of Family Health Units and Basic Health Units. The sample included 52 participants, consisting of doctors and primary care nurses. A questionnaire with open and closed questions was utilized, covering knowledge and practices related to child development. For this study, the first question of the questionnaire, which asked for a descriptive response about participants’ understanding of child development, was employed. The responses were transcribed, and content analysis using the thematic approach was conducted. Results: Among the participants, 54% were nurses, and the average duration of working with the pediatric population was ten years. 80% reported never having undergone training in child development. The analysis of the responses revealed heterogeneity in the professionals’ understanding of the conceptual dimension of child development. Additionally, there was an insufficient grasp of the theoretical and practical aspects and a scarcity of resources to support comprehensive care for children. A predominant biomedical model focusing on disease and biological aspects of child health was evident in defining the understanding of the subject. Conclusions: The findings underscore the necessity of implementing health education initiatives and service projects in primary care settings. It is crucial to strengthen a comprehensive perspective of child health within the biopsychosocial model of the health-disease process.

ABSTRACT BACKGROUND: Viral hepatitis is a major public health concern worldwide. OBJECTIVES: This study aimed to analyze the factors that facilitate access to care for viral hepatitis. DESIGN AND SETTING: Using a sequential mixed method, this evaluation research was conducted in the state of Mato Grosso, Brazil. METHODS: Mapping of references and selection of regions were made based on the quantity and heterogeneity of services. The stakeholders, including the managers of the State Department of Health and professionals from reference services, were identified. Nine semi-structured interviews were conducted using content analysis and discussions guided by the dimensions of the analysis model of universal access to health services. RESULTS: In the political dimension, decentralizing services and adhering to the Intermunicipal Health Consortium are highly encouraged. In the economic-social dimension, a commitment exists to allocate public funds for the expansion of referral services and subsidies to support users in their travel for appointments, medications, and examinations. In the organizational dimension, the availability of inputs for testing, definition of user flow, ease of scheduling appointments, coordination by primary care in testing, collaboration following the guidelines and protocols, and engagement in extramural activities are guaranteed. In the technical dimension, professionals actively commit to the service and offer different opening hours, guarantee the presence of an infectious physician, expand training opportunities, and establish intersectoral partnerships. In the symbolic dimension, professionals actively listen to the experiences of users throughout their care trajectory and demonstrate empathy. CONCLUSIONS: The results are crucial for improving comprehensiveness, but necessitate managerial efforts to enhance regional governance.

Head and neck cancers may lead to malnutrition in patients because of the natural course of the disease and treatment-related complications. A 36-year-old patient who experienced pain and nutritional difficulties due to mucositis after combined chemoradiotherapy for nasopharyngeal cancer was found to be at risk for malnutrition. To prevent the development of malnutrition, it was decided to feed him through a percutaneous endoscopic gastrostomy (PEG) tube, and sufficient calorie intake was provided. The PEG tube was removed after alleviation of symptoms and achieving adequate nutritional performance that could meet all calorie needs with oral nutrition. It should be kept in mind that early recognition of the malnutrition risk in patients with malignancy and a proactive approach to nutrition will contribute to the regression of existing complaints in a short time and the patients' regaining their former performance.

The Integrated Home Assistance Service (IHAS) was created to provide integral home care for elderly people who are unable to go to the health care units of the Brazilian Navy. A cross-sectional, quantitative, and descriptive study was carried out to evaluate the general health and dental hygiene profile of these patients. The study included elderly people aged 60 years or older who were assisted between February 2017 and December 2022. Most of them were long-lived, with a mean age of 82.52 (±8.66) years, women (63.52%) and totally dependent on performing basic activities of daily living (88.9%). The most common diagnosis among them was dementia syndrome, accounting for 44.3% of cases. Additionally, a large portion of the elderly had associated comorbidities (71.9%), with Systemic Arterial Hypertension (59.2%) and Diabetes Mellitus (28.9%) as the most recurrent conditions. The study found a high prevalence of elderly with unsatisfactory (34.7%) or irregular (57.2%) oral hygiene. Nevertheless, there was no significant association between dental hygiene and comorbidities or the degree of dependence. Therefore, it is imperative that elderly people living at home receive guidance and undergo meticulous and ongoing monitoring, in conjunction with their caregivers to promote improvements in the oral hygiene of these patients.

Abstract This observational study aimed to describe and analyze data from two external evaluations of the National Program for Improving Access to and Quality of Dental Specialty Centers (PMAQ CEO), held in 2014 and 2018 in Brazil, which evaluated Dental Specialty Centers (CEO) using a national and census approach. We selected questions through a search in the microdata of the first and second evaluations. The groups were analyzed independently. To compare the groups, nonparametric tests were performed (Mann Whitney U). The formulated hypotheses were: there would be no differences between the data of these groups (h0) and there would be differences between the data of these groups (h1). For qualitative nominal variables, frequency distribution was verified and association tests were performed (chi-square test). The significance level for this study was set at 5%. We observed that orthodontic treatments were found in about 13% of the CEO. Regarding human resources, most professionals were specialists or had MSc or PhD degrees; were civil servants; had been hired by direct administration; or had been hired via public tender. Regarding the work process and inclusion of the CEO in the health care network, we observed a greater number of services that use single and electronic medical records, greater presence of services monitoring and analyzing goals, greater knowledge about monthly average of absenteeism (for 2018); and larger number of services with referrals from primary health care centers (for 2014). Expanding the view on orthodontics and including preventive, interceptive, and corrective treatments at different points in health care networks are essential strategies for achieving comprehensive care in universal health systems.

OBJECTIVES: Since Pediatric Palliative Care is based on holistic and comprehensive care for pediatric patients and their families, Physical Education is an essential health area for complete interdisciplinary care. Therefore, the objective of this article is to reflect on the insertion of the Physical Education Professional in Pediatric Palliative Care. METHODS: This is a critical literature review. A theoretical and documentary research was carried out, based on the bibliographic survey in files available in the MEDLINE (via Pubmed) and SciELO databases in the last 5 years. A secondary capture was carried out from the references of the selected articles, in addition to the addition of the authors experience. RESULTS: Only 4 articles were selected in the main search, with an addition of 1 article in the secondary capture. As much as some studies suggest that increased physical activity can alleviate some symptoms, there is still a lack of robust evidence related to children. The strategies used by Physical Education Professionals must take into account the environment and the patients clinical status. The relevance of plays and games, even in the hospital setting, has been increasingly studied. CONCLUSIONS: Physical Education is an area of ??health that envisions the integrality of care, considering the inseparability of actions, both promotional and preventive, treatment and rehabilitation, which are essential aspects in Pediatric Palliative Care. Important gaps are still found, which must be addressed by education and research.

Copyright of Arquivos de Ciências da Saúde da UNIPAR is the property of Associacao Paranaense de Ensino e Cultura and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Saúde e Sociedade is the property of Universidade de Sao Paulo, Faculdade de Saude Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: In Brazil, a relevant portion and children suffer without receiving adequate control of their symptoms. Failures in pediatrician training may contribute to this problem. Objective: The goal was to characterize the educational failures perceived by pediatric residents for pediatric palliative care throughout their training. Methods: A cross-sectional study was carried out, with the application of the Pediatric Palliative Care Questionnaire (QCPP) to residents of three pediatrics and specialties of public limits at the Escola de Saúde Pública do Estado do Ceará (ESP-CE), Brazil. Results: The response rate was 68 out of 123 residents (55%). It was reported that they did not consider the specialty as patient care or death. He also feels comfortable explaining the physiological process of dying to his family. The time devoted to CPP teaching, as well as medical residency, was considered reduced. For those who attended a subspecialty, the number they signaled was "0 hours" at 82.40%. Conclusion: It can be said that the main flaws in the teaching-learning process of pediatric residents were the number of hours of training in teaching, communication skills training (through participation in conferences) and guidance on the practice of teaching suspension of invasive measures. It was observed that less time reserved for this learning is related to lesser knowledge and greater barriers to the use of palliative care. Those who declared themselves able to take care of children with life-organizing conditions received some teaching in CPP. [ABSTRACT FROM AUTHOR]

Abstract Background Cardiac rehabilitation (CR) is an essential component in secondary prevention of cardiovascular diseases. Current guidelines recommend that the program should be comprehensive including multidisciplinary behavioral intervention, not only exercise training. While the utilization of CR is gradually increasing, the comprehensiveness of the program has not been systemically evaluated in Korea. Methods During the year 2020, nation-wide survey was done to evaluate the current status of CR in Korea. Survey was done by web-based structured questionnaire. Survey was requested to 164 hospitals performing percutaneous coronary intervention. Results Among 164 hospitals, 47 (28.7%) hospitals had CR programs. In hospitals with CR, multidisciplinary intervention other than exercise-based program was provided only partially: nutritional counseling (63%), vocational counseling for return to work (39%), stress management (31%), psychological evaluation (18%). Personnel for CR was commonly not dedicated to the program or even absent: (percentage of dedicated, concurrent with other work, absent) physical therapist (59, 41, 0%), nurse (31, 69, 0%), dietician (6, 65, 29%), clinical psychologist (0, 37, 63%). Conclusion Comprehensiveness of CR in Korea is suboptimal and human resource for it is poorly disposed. More awareness of current status by both clinicians and health policy makers is needed and insurance reimbursement for educational program should be improved.

Background/objectivesAlthough nurse practitioner dementia care co-management has been shown to reduce total cost of care for fee-for-service (FFS) Medicare beneficiaries, the reasons for cost savings are unknown. To further understand the impact of dementia co-management on costs, we examined acute care utilization, long-term care admissions, and hospice use of program enrollees as compared with persons with dementia not in the program using FFS and managed Medicare claims data.DesignQuasi-experimental controlled before-and-after comparison.SettingUrban academic medical center.ParticipantsA total of 856 University of California, Los Angeles (UCLA) Alzheimer's and Dementia Care program patients were enrolled between July 1, 2012, and December 31, 2015, and 3,139 similar UCLA patients with dementia not in the program. Comparison patients were identified as having dementia using International Classification of Diseases-9 codes and natural language processing of clinical notes. Coarsened exact matching was used to reduce covariate imbalance between intervention and comparison patients.InterventionDementia co-management model using nurse practitioners partnered with primary care providers and community organizations.MeasurementsAverage difference-in-differences per quarter over the 2.5-year intervention period for all-cause hospitalization, emergency department (ED) visits, intensive care unit (ICU) stays, and number of inpatient hospitalization days; admissions to long-term care facilities; and hospice use in the last 6 months of life.ResultsIntervention patients had fewer ED visits (odds ratio [OR] = .80; 95% confidence interval [CI] = .66-.97) and shorter hospital length of stay (incident rate ratio = .74; 95% CI = .55-.99). There were no significant differences between groups for hospitalizations or ICU stays. Program participants were less likely to be admitted to a long-term care facility (hazard ratio = .65; 95% CI = .47-.89) and more likely to receive hospice services in the last 6 months of life (adjusted OR = 1.64; 95% CI = 1.13-2.37).ConclusionComprehensive nurse practitioner dementia care co-management reduced ED visits, shortened hospital length of stay, increased hospice use, and delayed admission to long-term care.

Access to comprehensive dementia care is limited. Recent changes in billing for professional services, including new physician fee schedule codes, encourage clinicians to provide new services; however, current reimbursement does not cover costs for all needed elements of dementia care. The Payment Model for Comprehensive Dementia Care Conference convened more than 50 national experts from diverse perspectives to review promising strategies for payment reform including ways to accelerate their adoption. Recommendations for reform included payments for services to family caregivers; new research to determine success metrics; education for consumers, providers, and policymakers; and advancing a population health model approach to tier coverage based on risk and need within a health system.

Background/objectivesAlthough several approaches have been developed to provide comprehensive care for persons living with dementia (PWD) and their family or friend caregivers, the relative effectiveness and cost effectiveness of community-based dementia care (CBDC) versus health system-based dementia care (CBDC) and the effectiveness of both approaches compared with usual care (UC) are unknown.DesignPragmatic randomized three-arm superiority trial. The unit of randomization is the PWD/caregiver dyad.SettingFour clinical trial sites (CTSs) based in academic and clinical health systems.ParticipantsA total of 2,150 English- or Spanish-speaking PWD who are not receiving hospice or residing in a nursing home and their caregivers.InterventionsEighteen months of (1) HSDC provided by a nurse practitioner or physician's assistant dementia care specialist who works within the health system, or (2) CBDC provided by a social worker or nurse care consultant who works at a community-based organization, or (3) UC with as needed referral to the Alzheimer's Association Helpline.MeasurementsPrimary outcomes: PWD behavioral symptoms and caregiver distress as measured by the Neuropsychiatric Inventory Questionnaire (NPI-Q) Severity and Modified Caregiver Strain Index scales.Secondary outcomesNPI-Q Distress, caregiver unmet needs and confidence, and caregiver depressive symptoms. Tertiary outcomes: PWD long-term nursing home placement rates, caregiver-reported PWD functional status, cognition, goal attainment, "time spent at home," Dementia Burden Scale-Caregiver, a composite measure of clinical benefit, Quality of Life of persons with dementia, Positive Aspects of Caregiving, and cost effectiveness using intervention costs and Medicare claims.ResultsThe results will be reported in the spring of 2024.ConclusionD-CARE will address whether emphasis on clinical support and tighter integration with other medical services has greater benefit than emphasis on social support that is tied more closely to community resources. It will also assess the effectiveness of both interventions compared with UC and will evaluate the cost effectiveness of each intervention.

Access to comprehensive dementia care is limited. Recent changes in billing for professional services, including new physician fee schedule codes, encourage clinicians to provide new services; however, current reimbursement does not cover costs for all needed elements of dementia care. The Payment Model for Comprehensive Dementia Care Conference convened more than 50 national experts from diverse perspectives to review promising strategies for payment reform including ways to accelerate their adoption. Recommendations for reform included payments for services to family caregivers; new research to determine success metrics; education for consumers, providers, and policymakers; and advancing a population health model approach to tier coverage based on risk and need within a health system.

Head and neck cancers may lead to malnutrition in patients because of the natural course of the disease and treatment-related complications. A 36-year-old patient who experienced pain and nutritional difficulties due to mucositis after combined chemoradiotherapy for nasopharyngeal cancer was found to be at risk for malnutrition. To prevent the development of malnutrition, it was decided to feed him through a percutaneous endoscopic gastrostomy (PEG) tube, and sufficient calorie intake was provided. The PEG tube was removed after alleviation of symptoms and achieving adequate nutritional performance that could meet all calorie needs with oral nutrition. It should be kept in mind that early recognition of the malnutrition risk in patients with malignancy and a proactive approach to nutrition will contribute to the regression of existing complaints in a short time and the patients' regaining their former performance. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives: to analyze the factors associated with the time to surgical treatment for breast cancer in patients seen at a reference mastology outpatient clinic in the State of Ceará. Methods: analytical, longitudinal study with medical charts from the Mastology Outpatient Clinic of Assis Chateaubriand Maternity School. We used 140 medical charts of breast cancer patients with surgeries performed during the pandemic. Results: the study evidenced associations between schooling and shorter time to treatment in patients who underwent biopsy before the first outpatient visit (p = 0.026; OR: 0.16; CI = 0.03-0.85); in the group who had the biopsy performed by the outpatient clinic, was associated the type of tumor (p = 0.019) and neoadjuvant therapy (p = 0.000). Conclusions: the lesser educational level, tumor type, and use of neoadjuvant therapy were factors associated with the time to treatment during the pandemic period.

Objective: to evaluate clinical follow-up after hospital discharge of preterm newborns discharged from NICU located in the city of Pelotas. Method: quantitative, longitudinal and prospective study, held from October 2022 to March 2023. A questionnaire on sociodemographic and health conditions was applied during the intra-hospital period. After discharge, follow-up occurred through telephone calls to family members, at intervals of 30, 60 and 90 days, respectively. The outcome was associated with the maternal and health characteristics of PTNB using chi-square, considering p< 0.05. Results: eighty-seven children who were discharged from neonatal intensive care units were followed-up. A total of 60.9% of the children had their first consultation in the outpatient follow-up clinics. After consultation in the follow-up clinic with a pediatrician, 13.2%, were referred to other specialized professionals. For those treated in other health units, no subsequent referral was identified (p<0.001). Conclusion: clinical follow-up of premature babies occurs in a fragmented manner and does not follow the standard discharge flow, which can delay interventions and end up damaging growth and development. [ABSTRACT FROM AUTHOR]

First Aid is defined as actions that are performed on an individual in the face of a situation that may cause suffering or risk to life. The school environment is considered a favorable place for accidents to occur, since the interaction activities developed there and the high number of children and adolescents present in the same space and for a long period of stay, are factors that drive this reality. In view of this, this study aims to know the strategies of care and assistance of teachers regarding first aid in the school environment. This is a qualitative, descriptive-exploratory research, carried out with 17 teachers who worked in the municipal education system of a municipality in the interior of the state of Rio Grande do Sul. The focus group was used for data collection, and the analysis the data was guided through thematic analysis that made it possible to group the data into the following categories: First aid in the school context; Practice of first aid in the school environment: facilities and difficulties and Knowledge and Learning about First Aid. It was observed that the injuries witnessed by the educators indicate that urgent and emergency situations are part of the reality of the school routine, many needing first aid actions. It is concluded that the strategies of care and assistance for the prevention of accidents in the school environment must be incorporated through health promotion actions, since the school is considered the ideal space for the implementation of knowledge that involves the practice of first aid. [ABSTRACT FROM AUTHOR]

Copyright of Investigaciones ANDINA is the property of Fundacion Universitaria del Area Andina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Médica de Risaralda is the property of Universidad Tecnologica de Pereira and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal Public Administration & Social Management / Administração Pública e Gestão Social is the property of Administracao Publica e Gestao Social and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To assess the effect of a multidisciplinary approach on patients with diabetic foot ulcer (DFU) in a Hospital in Chile from 2017 to 2020. Material and Method: The study is observational, comparative, and retrospective. The data from 111 patients were analyzed anonymously during 2017-2020. It was compared with old data from a group of 121 patients treated in the same hospital but without a multidisciplinary approach. To gather the data the Chi-square test, Fisher’s exact test, the U of Mann Whitney, and the Kruskal Wallis were used. Results: It was found that the rate of major re-amputations in patients undergoing treatment with a multidisciplinary approach was 2.7%. Furthermore, 91.2% of patients treated with a multidisciplinary approach improved the clinical condition of the wound. However, During the SARCOV-2 pandemic, the improvement rate was reduced to 78.2%. The complete wound healing rate was 77.8% in patients treated with a multidisciplinary approach versus 31.4% without a multidisciplinary approach (p < 0.0001). The overall re-amputation rate on patients without a multidisciplinary approach was 47.1% versus 12.6% on patients with a multidisciplinary approach (< 0.0001). The recurrence rate was 11.7% in patients with a multidisciplinary approach versus 100% in patients without a multidisciplinary approach (p < 0.0001). Conclusion: We observed finally, we observed that a multidisciplinary approach helped the DFU patients to achieve better intervention effectiveness rates, showing better rates of wound healing, higher re-amputation rate, and recurrence rate. Therefore, a multidisciplinary approach could contribute significantly to the improvement of the affected limb. [ABSTRACT FROM AUTHOR]

Copyright of Enfermagem Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Childhood tuberculosis continues to be a major public health problem. Although the visibility of the epidemic in this population group has increased, further research is needed. Objective To design, implement and evaluate an integrated care strategy for children under five years old who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients in Medellín and the Metropolitan Area. Methods A quasi-experimental study in which approximately 300 children who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients from Medellín and the Metropolitan Area will be evaluated and recruited over one year. A subgroup of these children, estimated at 85, who require treatment for latent tuberculosis, will receive an integrated care strategy that includes: some modifications of the current standardized scheme in Colombia, with rifampicin treatment daily for four months, follow-up under the project scheme with nursing personnel, general practitioners, specialists, professionals from other disciplines such as social work, psychology, and nutritionist. Additionally, transportation and food assistance will be provided to encourage treatment compliance. This strategy will be compared with isoniazid treatment received by a cohort of children between 2015 and 2018 following the standardized scheme in the country. The study was approved by the CIB Research Ethics Committee and UPB. ClinicalTrials.gov identifier NCT04331262. Discussion This study is expected to contribute to the development of integrated care strategies for the treatment of latent tuberculosis in children. The results will have a direct impact on the management of childhood tuberculosis contributing to achieving the goals proposed by the World Health Organization's End TB Strategy. Trial registration ClinicalTrials.gov identifier NCT04331262 . Implementation of an Integrated Care Strategy for Children Contacts of Patients with Tuberculosis. Registered 2 April 2020.

BackgroundChronic kidney disease (CKD) is a global public health problem, exhibiting sharp increases in incidence, prevalence, and attributable morbidity and mortality. There is a critical need to better understand the demographics, clinical characteristics, and key risk factors for CKD; and to develop platforms for testing novel interventions to improve modifiable risk factors, particularly for the CKD patients with a rapid decline in kidney function.MethodsWe describe a novel collaboration between two large healthcare systems (Providence St. Joseph Health and University of California, Los Angeles Health) supported by leadership from both institutions, which was created to develop harmonized cohorts of patients with CKD or those at increased risk for CKD (hypertension/HTN, diabetes/DM, pre-diabetes) from electronic health record data.ResultsThe combined repository of candidate records included more than 3.3 million patients with at least a single qualifying measure for CKD and/or at-risk for CKD. The CURE-CKD registry includes over 2.6 million patients with and/or at-risk for CKD identified by stricter guide-line based criteria using a combination of administrative encounter codes, physical examinations, laboratory values and medication use. Notably, data based on race/ethnicity and geography in part, will enable robust analyses to study traditionally disadvantaged or marginalized patients not typically included in clinical trials.DiscussionCURE-CKD project is a unique multidisciplinary collaboration between nephrologists, endocrinologists, primary care physicians with health services research skills, health economists, and those with expertise in statistics, bio-informatics and machine learning. The CURE-CKD registry uses curated observations from real-world settings across two large healthcare systems and has great potential to provide important contributions for healthcare and for improving clinical outcomes in patients with and at-risk for CKD.

Background/objectivesPersons with Alzheimer disease and related dementias (ADRDs) require comprehensive care that spans health systems and community-based organizations. This study examined the clinical outcomes of a comprehensive dementia care program and identified subgroups who were more likely to benefit.DesignObservational, baseline and 1 year after intervention.SettingUrban, academic medical center.ParticipantsA total of 554 persons with dementia and their caregivers who had 1-year follow-up evaluations and data on clinical outcomes.InterventionHealth system-based comprehensive dementia care management program using nurse practitioner dementia care managers.MeasurementsPatient measures included the Mini-Mental State Examination (MMSE), the Functional Activities Questionnaire, Basic and Instrumental Activities of Daily Living scales, the Cornell Scale for Depression in Dementia, and the Neuropsychiatric Inventory Questionnaire (NPI-Q) Severity. Caregiver measures included the Modified Caregiver Strain Index, the Patient Health Questionnaire-9, NPI-Q Distress, and the Dementia Burden Scale-Caregiver). We used established minimal clinically important differences and lowest tertiles of baseline symptoms to define improving symptoms and maintaining low symptoms as clinical benefit for patients and caregivers.ResultsAt year 1, persons with ADRD improved on all scales, except MMSE and functional status measures; caregivers improved on all scales. Using validated instruments, 314/543 (58%) of patients, 282/447 (63%) of caregivers, and 376/501 (75%) of patients or caregivers demonstrated clinical benefit. In adjusted multivariate models, at year 1, more behavioral symptoms and fewer depression symptoms at baseline were associated with patient improvement; and fewer baseline depression symptoms were associated with maintaining low behavioral symptoms. Male caregiver sex, higher baseline caregiver burden, and caring for patients with fewer baseline depression symptoms were associated with caregiver improvement. Male caregiver sex and patients with fewer depression symptoms, fewer behavioral symptoms, and more functional impairment at baseline were associated with caregivers maintaining low burden at 1 year.ConclusionsHealth system-based comprehensive dementia care management is a promising approach to improving clinical outcomes, with benefits for both patients and caregivers. J Am Geriatr Soc 67:2267-2273, 2019.

As life expectancy increases, women with bleeding disorders can expect to live for decades after their menopause – potentially with a range of comorbidities including cardiovascular (CV) disease, cancer and osteoporosis. Menstrual bleeding around the menopause may be heavy and unpredictable for women with bleeding disorders (WBD). Hormone replacement therapy (HRT) remains the gold standard for those with debilitating menopausal symptoms and for osteoporosis prevention. Levels of endogenous von Willebrand factor (VWF) increase with age in the general population without bleeding disorders, with an associated rise in levels of Factor VIII (FVIII). Evidence also suggests age-related increases in VWF in people with von Willebrand disease (VWD), with limited but potentially associated evidence for increases in FVIII in those with mild or moderate haemophilia A. However, it appears that age-related changes in factor levels do not correlate completely with bleeding episodes, and more data are needed to fully understand the picture. New models of comprehensive care are needed that take account of age-related comorbidities in both women and men with bleeding disorders, including the impact of polypharmacy and its potential for causing adverse effects and impaired treatment adherence. Consideration will also be needed for bleeding cover during interventions such as surgery, radiotherapy and chemotherapy that become more likely with age. Protocols and care pathways need to be updated as the implications of ageing in women and men with bleeding disorders become better understood.

Abstract This case study analyses the challenges to providing specialized care in Brazilian remote rural municipalities (RRM). Interviews were conducted with managers from two Brazilian states (Piauí and Bahia). We identified that the distance between municipalities is a limiting factor for access and that significant care gaps contribute to different organizational arrangements for providing and accessing specialized care. Physicians in all the RRMs offer specialized care by direct disbursement to users or sale of procedures to managers periodically, compromising municipal and household budgets. Health regions do not meet the demand for specialized care and exacerbate the need for extensive travel. RRM managers face additional challenges for the provision of specialized care regarding the financing, implementation of cooperative arrangements, and the provision of care articulated in networks to achieve comprehensive care, seeking solutions to the locoregional specificities.

Pedro Santos-Moreno,1 Guillermo Sánchez-Vanegas,2 Angélica Monterrosa-Blanco,3 Gabriel-Santiago Rodríguez-Vargas,1 Manuel Rivero,1 Pedro Rodriguez,1 Omar-Javier Calixto,4 Adriana Rojas-Villarraga,5 Carlos Alberto Castro3 1Rheumatology Department, Biomab IPS, Bogotá, Colombia; 2Scientific Direction Department, Hospital Universitario Mayor Mederi, Universidad del Rosario, Bogotá, Colombia; 3Research and Health Education Department, Comprehensive Solutions for Health Research and Education-SIIES, Bogotá, Colombia; 4Rheumatology and Immunology Department, Hospital Militar Central, Bogotá, Colombia; 5Research Institute, Fundación Universitaria de Ciencias de la Salud–FUCS, Bogotá, ColombiaCorrespondence: Pedro Santos-Moreno, Rheumatology Department, Biomab IPS, Calle 48 &num; 13-86, Bogotá, Colombia, Tel +57 320 8094232, Email pedrosantosmoreno@hotmail.comPurpose: To assess, in a cohort of patients with rheumatoid arthritis (RA) treated with subcutaneous antitumor necrosis factor drugs (anti-TNFs), the levels of treatment adherence before and after implementing a comprehensive care model (CCM).Patients and Methods: An observational study including RA patients under treatment with subcutaneous anti-TNFs (adalimumab, etanercept, and golimumab) selected at convenience was performed; a sample size of 125 patients was calculated. The outcome variable was adherence assessed with the Compliance Questionnaire on Rheumatology (CQR19), measured before and after implementing a CCM. Descriptive and bivariate analyses were performed comparing adherence before and after applying the model (Wilcoxon and McNemar’s Chi2 test). For multivariate analysis, a generalized linear model adjusted for covariates was performed, where the difference in the proportion of adherence was the outcome measure.Results: A total of 131 RA patients were followed-up for 24 months; average age was 62 years, and 83.9% were women. The median of DAS28 at the beginning of the follow-up was 2.32, and the HAQ was 0.25. At baseline, 87.8% were adherent; after 24 months, 96.2% were adherent according to CQR19. At the end of follow-up, adherence increased with the three types of anti-TNFs treatment. In a matched model adjusted for clinical variables, the CCM was estimated to produce a 9.4% increase in the total percentage of adherent patients. Additionally, a statistically significant increase of 4.5% in the percentage of adherent patients treated with golimumab compared with etanercept and adalimumab was found.Conclusion: A CCM produced an important increase in the percentage of patients with rheumatoid arthritis adherent to treatment after 24 months of follow-up. It is noteworthy that Golimumab patients were more adherent when compared with other current anti-TNFs treatments.Keywords: rheumatoid arthritis, treatment adherence, comprehensive health care, antirheumatic agents, controlled before–after studies

Introducción. En este artículo se presenta una reflexión sobre la necesidad de tener una visión holística en la problemática de la prematurez, para que los equipos del área de salud puedan tener una comprensión de la multiplicidad de factores presentes en el parto prematuro, y sus consecuencias para el menor, la madre, los familiares y el personal de salud involucrado. Tema de reflexión. El tema se sustenta en dos investigaciones realizadas con las madres, los padres y los niños beneficiarios del Programa Madre Canguro en un hospital del Estado, en dos momentos, 2012 y 2014, con algunos de los autores del presente artículo. Conclusiones. Además de la revisión de la literatura científica relacionada con el tema y la problemática, se concluye que, bajo una mirada holística, se comprende de manera integral la problemática y se propicia una mejor comunicación con los padres; con el equipo de la atención en salud, se logra un manejo transdisciplinario, superando los objetos de estudios aislados. Se da así un abordaje integrador y significativo en la cotidianidad de cada actor, desde la piel, con el Programa Madre Canguro, hasta la racionalidad de la ciencia. Introduction. This article presents a reflection on the need for a holistic view of the problem of premature births, so that healthcare teams can understand the multiplicity of factors present in premature births, and its consequences for the minor, the mother, the family members, and the healthcare staff involved. Topic of reflection. The topic is based on two investigations carried out with mothers, fathers, and children’s beneficiaries of the Mother Kangaroo Program in a State hospital, at two moments, 2012 and 2014, with some of the authors of this article. Conclusions. In addition to the review of the scientific literature related to the topic and the problem, it is concluded that, under a holistic view, the problem is understood in a comprehensive way and better communication with the parents is encouraged. With the healthcare team, cross-disciplinary handling is achieved, overcoming the objects of isolated studies. As such, there is an integrative and significant approach in the daily life of each actor, from the skin, with the Mother Kangaroo Program, to the rationality of science. Introdução. Este artigo apresenta uma reflexão sobre a necessidade de se ter uma visão holística da problemática da prematuridade, para que as equipes da área da saúde possam ter uma compreensão da multiplicidade de fatores presentes no parto prematuro, e suas consequências para a criança, a mãe, os familiares e o pessoal de saúde envolvido. Tópico de reflexão. O tema é baseado em duas pesquisas realizadas com mães, pais e filhos beneficiários do Programa Mãe Canguru em um hospital estadual, em dois momentos, 2012 e 2014, com alguns dos autores deste artigo. Conclusões. Além da revisão da literatura científica relacionada ao tópico e ao problema, conclui-se que, sob uma visão holística, o problema é plenamente compreendido e incentiva-se uma melhor comunicação com os pais; com a equipe de saúde, consegue-se uma gestão transdisciplinar, superando os objetos de estudos isolados. Isto proporciona uma abordagem integradora e significativa no cotidiano de cada ator, desde a pele, com o Programa Mãe Canguru, até a racionalidade da ciência.

Background: Cardiac rehabilitation (CR) is an essential component in secondary prevention of cardiovascular diseases. Current guidelines recommend that the program should be comprehensive including multidisciplinary behavioral intervention, not only exercise training. While the utilization of CR is gradually increasing, the comprehensiveness of the program has not been systemically evaluated in Korea. Methods: During the year 2020, nation-wide survey was done to evaluate the current status of CR in Korea. Survey was done by web-based structured questionnaire. Survey was requested to 164 hospitals performing percutaneous coronary intervention. Results: Among 164 hospitals, 47 (28.7%) hospitals had CR programs. In hospitals with CR, multidisciplinary intervention other than exercise-based program was provided only partially: nutritional counseling (63%), vocational counseling for return to work (39%), stress management (31%), psychological evaluation (18%). Personnel for CR was commonly not dedicated to the program or even absent: (percentage of dedicated, concurrent with other work, absent) physical therapist (59, 41, 0%), nurse (31, 69, 0%), dietician (6, 65, 29%), clinical psychologist (0, 37, 63%). Conclusion: Comprehensiveness of CR in Korea is suboptimal and human resource for it is poorly disposed. More awareness of current status by both clinicians and health policy makers is needed and insurance reimbursement for educational program should be improved. [ABSTRACT FROM AUTHOR]