Quality of child health care in the family health strategy

OBJECTIVE: to verify the quality of child health care in the Family Health Strategy (FHS) in a state capital of Northeastern Brazil. METHODS: a descriptive study using a quantitative approach was carried out in 2010 with 66 primary care (PC) teams represented by their doctors and nurses. The survey used part of the Evaluation for Quality Improvement of the Family Health Strategy² (AMQ), a self-rating instrument of the Brazilian Ministry of Health which evaluates the FHS actions and services and classifies them by the following quality-based standards of care: Elementary, undergoing development, Consolidated, Good or Advanced. RESULTS: 84.1% of the FHS-teams rated themselves as providing "Elementary" actions and services, and 47.7% of them considered that they provided "Advanced" ones. The health teams with less than four years of implementation rated themselves better. CONCLUSION: these findings suggest that most of the FHC-teams are providing care with an elementary standard of quality, and indicate that better quality child care is apparently delivered with by teams with less time of implementation

Qualidade da Atenção à Saúde da Criança na Estratégia Saúde da Família

AbstractObjective: to verify the quality of child health care in the Family Health Strategy (FHS) in a state capital of Northeastern Brazil. Methods: a descriptive study using a quantitative approach was carried out in 2010 with 66 primary care (PC) teams represented by their doctors and nurses. The survey used part of the Evaluation for Quality Improvement of the Family Health Strategy² (AMQ), a self-rating instrument of the Brazilian Ministry of Health which evaluates the FHS actions and services and classifies them by the following quality-based standards of care: Elementary, undergoing development, Consolidated, Good or Advanced. Results: 84.1% of the FHS-teams rated themselves as providing “Elementary” actions and services, and 47.7% of them considered that they provided “Advanced” ones. The health teams with less than four years of implementation rated themselves better. Conclusion: these findings suggest that most of the FHC-teams are providing care with an elementary standard of quality, and indicate that better quality child care is apparently delivered with by teams with less time of implementation.ResumoObjetivo: verificar a qualidade da atenção à saúde da criança pelas equipes da Estratégia Saúde da Família (ESF) em Capital do Nordeste do Brasil. Método: trata-se de um estudo transversal, descritivo, com abordagem quantitativa, realizado durante o ano de 2010, por meio de inquérito com os profissionais médicos e enfermeiros de 66 equipes da ESF de Maceió-AL, estratificadas por tempo de funcionamento em anos. Utilizou-se parte do instrumento de auto-avaliação denominado Avaliação para Melhoria da Qualidade da Estratégia Saúde da Família (AMQ) do Ministério da Saúde, especificamente as questões referentes às ações e atividades realizadas no campo de atenção à “saúde da criança”, dentro da dimensão “atenção à saúde”. Resultados: os padrões elementares de qualidade foram encontrados em 84,1% das ações realizadas. Os padrões considerados avançados apresentaram o menor percentual de conformidade entre todas as equipes (47,7%). Quanto ao tempo de implantação da ESF, as equipes com menos de quatro anos tenderam a relatar melhores padrões de qualidade. Conclusões: os achados sugerem que as ações de saúde da criança estão sendo realizadas em melhor conformidade nas equipes com menos tempo de implantação, e que a grande maioria das equipes ainda estão atendendo a padrões considerados menos avançados em termos de qualidade

Doñana. Acta vertebrata. vol 17 (2)

Tres ejemplos de aplicación de métodos indirectos para la estimación de parametros poblacionales en cérvidoAlimentación de la garza real (Ardea cinerea) en la cuenca del Duero (España) durante el periodo reproductoDistribución y tamaño de colonias de buitre leonado (Gyps fulvus) en el alto Ebro y zona Cantábrica próximaDistribución y hábitat del visón americano (Mustela vison Schreber) en el sistema CentraRégimen alimentario del erizo (Erinaceus europaeus L.) durante verano y otoño en setos de la provincia de León (NO de España)Señales sociales de la espátula (Platalea leucorodia) durante el periodo reproductivoVariación del peso corporal en Arvicola terrestris (Rodentia, Arvicolidae) del nordeste ibéricoSobre el dimorfismo sexual en el cráneo del gato montés Felix silvestris Schreber, 1777 del sudoeste ibéricoUn nuevo núcleo poblacional de Apodemus flavicollis (Melchior, 1834) en la Península Ibérica.Selección de la lechuza común (Tyto alba) sobre el topillo común (Microtus duodecimcostatus)Importancia de la vegetación emergente en el comportamiento alimenticio de la fochaObservaciones sobre el papel del lagarto ocelado (Lacerta lepida Daudin), el erizo (Erinaceus europaeus L.) y el tejón (Meles meles L.) en la dispersión de semillasComentarios sobre los estimadores empleados en el método de la batida.El uso de la batida como método de censo: una replicaPeer reviewe

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Health centers in the city of Rio de Janeiro: a historical view of a bureaucratic organization: 1927-1997

Os Centros de Saúde do Rio de Janeiro são analisados enquanto uma organização estruturada para desempenhar, na área da saúde, parte das funções do aparato burocrático do Estado brasileiro. Seu papel institucional vincula-se à emergência de novos problemas sanitários numa sociedade em processo de urbanização e de consolidação de um Estado nacional. Ao longo de usa trajetória histórica passou por situações distintas, no que se refere ao seu papel no Sistema de Saúde, articuladas a determinantes de natureza técnica e política. Enquanto fenômeno burocrático, esta organização sobreviveu às diversas conjunturas históricas interpondo resistências, que se manifestaram, principalmente, pela lentidão com que eram processadas as mudanças internas propostas.The Health Centers in the city of Rio de Janeiro are analyzed as organizations that have been structured to execute parto of the bureaucratic duties petaining to the brazilian State, as far as health care is concerned. Their role, as institutions, is related to the solution of new problems, in their sanitary aspects, that are emerging in a society in processo f increasing urbanization and inside a process of organizing a National State. Along the course of their history, these organization have overcome various distinctive situations, dependind on technical and political determinants. As bureaucratic phenomena, this organization have survived many historical conjuntures, presenting itself as resistant to the proposed changes, mainly by slow ways of implementing these propositions