Adaptation and applicability of the "mistreatment" component in Integrated Management of Childhood Illness in Brazil

OBJETIVOS: descrever o processo de adaptação ao contexto brasileiro e da aplicabilidade do conteúdo do módulo de maus-tratos no âmbito da estratégia Atenção Integrada às Doenças Prevalentes na Infância (AIDPI), a partir do original proposto pela Organização Pan-Americana da Saúde. MÉTODOS: O protocolo original foi traduzido para o português, retro-traduzido e revisado de forma independente. Foram incorporados aspectos relativos à legislação, contexto de saúde e organização dos serviços brasileiros. O material foi discutido por especialistas de diferentes áreas até obter consenso a respeito de compreensão e correspondência sobre os conceitos e os instrumentos propostos. A versão preliminar foi testada com grupo de monitores da estratégia AIDPI. Sugestões foram incorporadas ao texto. O módulo final foi aplicado com sucesso em treinamento para monitores em AIDPI na Região Nordeste. RESULTADOS: o material mostrou-se útil, claro e coerente. A classificação de gravidade para maus tratos psicológicos e negligência, além de textos com orientações aos profissionais e pais sobre o desenvolvimento psicomotor e emocional normais da criança foram incluídos. CONCLUSÕES: A incorporação desse módulo de maus-tratos em treinamentos formais na estratégia AIDPI pode preencher uma lacuna na educação do profissional de saúde na atenção primária, onde problemas relacionados à violência contra a criança são frequentes. _________________________________________________________________________________________ ABSTRACT: OBJECTIVES: to describe the process of adaptation to the Brazilian context and the applicability of the "mistreatment" module in the Integrated Mana-gement of Childhood Illness (IMCI) strategy, based on the Pan American Health Organization (PAHO) proposal. METHODS: the original protocol was translated into Portuguese, back-translated and reviewed by an independent observer. Features relating to legislation, the health context and the way Brazilian services are organized were incorporated. The materials were discussed by specialists from various areas until consensus was achieved with regard to the comprehensibility of the text and the correspondence between the wording and the intentions. The preliminary version was tested with a group of IMCI strategy monitors and suggestions arising from this were incorporated into the text. The final module was successfully applied during training of IMCI monitors in the Northeast region of the country. RESULTS: the material was found to be useful, clear and coherent. The ranking of degrees of severity of psychological mistreatment and negligence and texts providing guidelines for health workers and parents on the normal psychomotor and emotional deve-lopment of children were included. CONCLUSIONS: the incorporation of this module on mistreatment in the IMCI strategy's formal training sessions may fill a gap in the education of primary care health workers, who encounter problems relating to violence against children on a regular basis

A group randomized trial of a complexity-based organizational intervention to improve risk factors for diabetes complications in primary care settings: study protocol

<p>Abstract</p> <p>Background</p> <p>Most patients with type 2 diabetes have suboptimal control of their glucose, blood pressure (BP), and lipids – three risk factors for diabetes complications. Although the chronic care model (CCM) provides a roadmap for improving these outcomes, developing theoretically sound implementation strategies that will work across diverse primary care settings has been challenging. One explanation for this difficulty may be that most strategies do not account for the complex adaptive system (CAS) characteristics of the primary care setting. A CAS is comprised of individuals who can learn, interconnect, self-organize, and interact with their environment in a way that demonstrates non-linear dynamic behavior. One implementation strategy that may be used to leverage these properties is practice facilitation (PF). PF creates time for learning and reflection by members of the team in each clinic, improves their communication, and promotes an individualized approach to implement a strategy to improve patient outcomes.</p> <p>Specific objectives</p> <p>The specific objectives of this protocol are to: evaluate the effectiveness and sustainability of PF to improve risk factor control in patients with type 2 diabetes across a variety of primary care settings; assess the implementation of the CCM in response to the intervention; examine the relationship between communication within the practice team and the implementation of the CCM; and determine the cost of the intervention both from the perspective of the organization conducting the PF intervention and from the perspective of the primary care practice.</p> <p>Intervention</p> <p>The study will be a group randomized trial conducted in 40 primary care clinics. Data will be collected on all clinics, with 60 patients in each clinic, using a multi-method assessment process at baseline, 12, and 24 months. The intervention, PF, will consist of a series of practice improvement team meetings led by trained facilitators over 12 months. Primary hypotheses will be tested with 12-month outcome data. Sustainability of the intervention will be tested using 24 month data. Insights gained will be included in a delayed intervention conducted in control practices and evaluated in a pre-post design.</p> <p>Primary and secondary outcomes</p> <p>To test hypotheses, the unit of randomization will be the clinic. The unit of analysis will be the repeated measure of each risk factor for each patient, nested within the clinic. The repeated measure of glycosylated hemoglobin A1c will be the primary outcome, with BP and Low Density Lipoprotein (LDL) cholesterol as secondary outcomes. To study change in risk factor level, a hierarchical or random effect model will be used to account for the nesting of repeated measurement of risk factor within patients and patients within clinics.</p> <p>This protocol follows the CONSORT guidelines and is registered per ICMJE guidelines:</p> <p>Clinical Trial Registration Number</p> <p>NCT00482768</p

VILNIAUS MIESTO ŠEŠKINĖS POLIKLINIKOS PACIENTŲ APKLAUSA APIE SVEIKATOS PRIEŽIŪROS PASLAUGŲ PRIEINAMUMĄ – NUOMONĖ PAGAL PACIENTŲ AMŽIŲ IR IŠSILAVINIMĄ

Tyrimas atliktas 2014.05–2014.06 laikotarpiu. Buvo apklausinėjami 18 metų sulaukę respondentai. Iš pradžių 450 anketų buvo išskirstytos į registratūras, iš jų 442 anketos grįžo (grįžtamumas 98,2 proc.). Anketa buvo duodama kas dešimtam pirmą kartą besikreipiančiam pacientui. Daugiau respondentų (60,7 proc.), turinčių aukštąjį/ nebaigtą aukštąjį išsilavinimą, nei respondentų (4,4 proc.), turinčių nebaigtą vidurinį išsilavinimą, 21–40 m. amžiaus nei 41–60 m. amžiaus respondentų, nurodė, kad buvo patenkinti poliklinikos darbo laiku. Apklausoje dalyvavusių pacientų nuomone, poliklinikos registratūroje, norint užsiregistruoti pas gydytoją sugaištama nuo 5 iki 10 minučių. Dauguma tyrime dalyvavusių 21–40 m. (47,1 proc.) ir 41–60 m. (34,8 proc.) pacientų nurodė, kad pas savo šeimos gydytoją vizito teko laukti apie 1–5 dienas. Daugiausia respondentų (66,7 proc.), nurodžiusių, kad juos šeimos gydytojas priima per 1–5 dienas, buvo respondentai, turintys aukštąjį/nebaigtą aukštąjį išsilavinimą, o mažiausiai taip teigusių buvo respondentai (5,7 proc.), turintys nebaigtą vidurinį išsilavinimą. Daugiau jaunesnio (42,3 proc.) nei vyresnio (15,5 proc.) amžiaus respondentų nurodė, kad pas neurologą jiems teko laukti apie mėnesį, o daugiau vyresnio (44,4 proc.) nei jaunesnio (34,7 proc.) amžiaus respondentų nurodė, kad jiems teko laukti ilgiau kaip mėnesį. Išanalizavus tyrimo duomenis nustatyta, jog 40,6 proc. 21–40 m. respondentų į gydytojo kabinetą buvo pakviesti paskirtu laiku, o 45,2 proc. 41–60 m. amžiaus respondentų teigė, kad jiems teko laukti ilgiau kaip 30 minučių. Daugiau respondentų (53,7 proc.), turinčių aukštąjį/ nebaigtą aukštąjį išsilavinimą, nei respondentų (3,3 proc.), turinčių nebaigtą vidurinį išsilavinimą, nurodė, kad jiems poliklinika priminė apie profilaktines programas.The study was conducted during the 2014.05–2014.06 period. It was questioned respondents 18 years of age. Initially, 450 questionnaires were distributed to the registries of the 442 questionnaires returned (98.2 percent reversibility.). The questionnaire was administered to every tenth referring a patient for the first time. More respondents (60.7 percent), with higher / incomplete higher education than respondents (4.4 percent), with incomplete secondary education 21–40 years than 41–60 years the respondents indicated that they were satisfied with the clinic working hours. The surveyed patients opinion, clinic reception, to register with a doctor wasted 5 to 10 minutes. Many study participants 21–40 years. (47.1 percent) and 41–60 years. (34.8 percent) reported that with your family doctor‘s visit had to wait for about 1–5 days. The majority of respondents (66.7 percent) indicated that they adopt a family doctor within 1–5 days were respondents with higher / incomplete higher education, at least as contention was the respondents (5.7 percent) with incomplete secondary education. Upon analysis of the data showed that 40.6 percent 21–40 years respondents to the doctor‘s office was called at the scheduled time while 45.2 percent. 4 –60 years age of the respondents said that they had to wait longer than 30 minutes. More respondents (53.7 percent), with higher / incomplete higher education than respondents (3.3 percent) with incomplete secondary education, said the surgery is that they are reminded of preventive programs

Repeated dose inhaled budesonide versus placebo in the treatment of croup

Objective: To investigate the efficacy and tolerance of 12-hourly dosing with 2 mg 4 mL–1 of inhaled budesonide versus placebo in patients admitted to hospital with moderate/severe croup. Method: Eighty-two children hospitalised with croup received either 2 mg 4 mL–1 of budesonide or placebo 12 hourly (maximum four doses) via Ventstream® nebuliser in a randomised, double-blind manner. Croup scores were performed at 0, 2, 6, 12, 24, 36 and 48 h from initial nebulisation whilst the patient remained hospitalised. Follow-up assessments were made 1 and 3 days after discharge. Results: Improvement was observed in the budesonide group over the 12-h dosing interval when compared to placebo (P = 0.04). Time to attain a significant clinical improvement was superior in the budesonide group (P = 0.01). Three days after discharge seven of 32 placebo-treated patients and one of 34 budesonide-treated patients had sought further medical follow-up (P = 0.02). Conclusion: Twelve-hourly dosing with inhaled budesonide significantly improved symptoms of croup as well as decreased relapse rates when compared with placebo.GW Roberts, VV Master, RE Staugas, JV Raftos, DW Parsons, KP Coulthard and AJ Marti