When innocence is no protection: governance failure of digitization and its impact on local level implementation

Purpose Governance of e-government is rarely discussed in the initial digitization stage, especially in developing countries where the government’s focus is mainly to pursue rapid proliferation of digital adoption rather than to implement governance. This study aims to explore the consequences of this absence of governance at local level conditions. Design/methodology/approach An in-depth exploratory case study is conducted at a municipal health government in a southern city in Kalimantan Island, Indonesia, examining the conditions of local actors in response to various nationwide health digitization imperatives. The postcolonial theory with the critical paradigm is used to interpret and conceptualize the empirical findings. Findings This study identifies two critical failures of digitization governance that represent the mainstream condition: horizontal sectoral ego and vertical asymmetry and misalignment. These failures have resulted in undesirable consequences at the subalterns indicated by diverse ambivalence and de-voiced constructs displayed by the local actors. Practical implications This paper suggests that various issues that emerge from local level implementation in nationwide digitization agenda might not always be issues of local technology adoption, but rather negative impacts due to the absence of governance practice at the strategic level. Originality/value Through a critical perspective, this study unearths the underlying power and structural inequity responsible for generating the various issues and undesirable consequences that emerge at local levels related to the nationwide digitization agenda.

Cryptoccoccal meningitis in post-covid 19 patient in the city of manaus: Case report

Cryptococcosis is a cosmopolitan and opportunistic mycosis, caused mainly by the etiological agent Cryptococcus neoformans, through the inhalation of fungal structures, especially in bird feces. The aim of this study was to report a reported case of cryptococcal meningitis in an immunosuppressed patient due to previous COVID-19 infection in the city of Manaus-AM, as well as to implement health education actions to prevent cryptococcosis in the region of the disease. Information about the case was obtained through access to the database of the Information System for Notifiable Diseases (SINAN), made available by the Center for Control of Zoonoses Dr. Carlos Durand (CCZ), an agency belonging to the Municipal Health Department of Manaus (SEMSA). The case patient, male, presented symptoms such as headache, fever, vomiting, seizures, neck stiffness, petechiae and hemorrhagic suffusions, hearing loss and signs of Kernig and Brudzinski. In a zoosanitary visit to the site of the injury, the presence of pigeon excreta on the walls of the residence was found, and cleaning was carried out without the use of personal protective equipment (PPE’s). The contact with the residents evidenced the lack of information about the zoonosis addressed, including the risk of transmission of cryptococcosis by pigeons, facts that make necessary more sanitary actions on zoonoses among the population of Manaus.

Sex Differences in In-hospital Mortality of Patients With Septic Shock: An Observational Study Based on Data Analysis From a Cover Sheet of Medical Records in Beijing

Background: The goal of our study was to evaluate the association of sex and in-hospital mortality in patients with septic shock in Beijing, China.Materials and Methods: We analyzed 3,643 adult patients with septic shock from January 1, 2019, to Dec 31, 2019, in all secondary and tertiary hospitals in Beijing. Study data were retrospectively extracted from the Quality Control Center of Beijing Municipal Health Commission.Results: There were 2,345 (64.37%) male and 1,298 (35.63%) female patients. Compared to male patients, female patients with septic shock had a higher in-hospital mortality rate (55.54 vs. 49.29%, p < 0.01). The median length of hospitalization stay for male patients was 22.71 days, while that for female patients was 19.72 days (p > 0.01). Male patients had a higher prevalence of pulmonary infection (68.8 vs. 31.2%, p < 0.01). The B values of sex in univariate and multivariate logistic regression were −0.251 and −0.312, respectively. Men had a lower likelihood of hospital mortality than women (OR = 0.732, 95% CI = 0.635–0.844, p = 0.000).Conclusions: Female patients with septic shock had a higher risk of dying in the hospital than male patients.

Implementing welfare technology in palliative homecare for patients with cancer: a qualitative study of health-care professionals’ experiences

Background Introducing welfare technology in home-based palliative care has been suggested to be beneficial for improving access to health care at home and enhancing patients’ feelings of security and safety. However, little is known about the experiences of municipal health-care professionals using welfare technology in palliative home care. The aim of this study was to explore municipal health-care professionals’ experiences regarding the significant challenges, facilitators, and assessments associated with implementing a technological solution named “remote home care” in palliative home care for patients with cancer. Methods A qualitative, descriptive, exploratory design was used. Data were collected through focus-group interviews and individual semi-structured interviews with interdisciplinary health-care professionals who had experience using remote home care in clinical encounters with cancer patients who were in the palliative phase and living at home. Data were analyzed using qualitative content analysis. Results Three themes were identified: 1) shifting from objective measures to assessing priorities for patients, 2) lack of experience and personal distress regarding cancer inhibits professional care, and 3) prominent organizational challenges undermine the premise of remote home care. Conclusion The results showed that shifting from a disease-focused to a person-centered approach enables health-care professionals to assess patients’ personal priorities. However, health-care professionals’ uncertainty and lack of knowledge and experience, along with organizational issues concerning information-sharing, represent great challenges that have the potential to inhibit professional care. The availability of networks through which difficult issues can be discussed was highlighted as being a fundamental resource for facilitating the provision of care.

Prevalence of enteroparasitoses in students of a municipal school in Southwestern bahiano / Prevalência de enteroparasitoses em alunos de uma escola municipal no Sudoeste do bahiano

Introduction: Infections caused by intestinal parasites are a silent disease and their high morbidity and mortality rates, especially in children, have been reported in different studies. The high prevalence of parasites in this public is directly associated with the socioeconomic profile of the population, as well as structural development and climatic conditions of the studied regions. Objective: To describe the prevalence of enteroparasitosis in students of a municipal school in southwestern Bahia in 2019. Materials and Methods: This is a cross-sectional, descriptive and quantitative study conducted by applying a questionnaire and collecting parasitological material from 76 Elementary students from a city in southwest Bahia. Results: Among the studied population, 46 (60.5%) were female. Regarding age, they had an average of 8.7 years (± 1.9 years), and 36 (48%) considered themselves brown. The prevalence of enteroparasitosis was 21.1%, with Endolimax Nana (4.1%), Ascaris Lumbricoides (2.0%), Iodamoeba Butshilli (2.0%), Entamoeba Coli (14.3%), Enterobius Vermiculares (4.1%), Giardia Lamblia (6.1%). Conclusion: It was observed that the prevalence of enteroparasitosis in the children analyzed was low, with a predominance in females. This low rate may be related to factors such as the consumption of treated water and the presence of a sewage system, allied to the helminth control, prevention and monitoring work promoted by the Municipal Health Department.

Periodontal Management during COVID-19 Pandemic: Mini Review

Summary A few cases of pneumonia were reported by Wuhan Municipal Health Commission in Wuhan, Hubei Province, Republic of China and this mysterious pneumonia was recognized as novel coronavirus disease (COVID-19) in the course of time on 31 December 2019. Based on the literature knowledge, COVID-19 outbreak was came into existence through an animal-to-human transmission, then continued human-to-human diffusion. Especially dentists among the medical professionals are at high-risk group of SARS-CoV-2 virus contamination because of several routine dental procedures having the risk to convey the SARS-CoV-2 virus via droplets and close contact. In this mini review, it was aimed to give information about patient management during COVID-19 pandemic for dental practitioners, periodontologists and dental hygienists.

JUDICIALIZATION OF HEALTH IN THE WESTERN AMAZON

The present work addresses the theme of health judicialization and its impacts within the budget. It analyzes the financial effects of court decisions in the Municipal Health Secretariat of Porto Velho, capital of the state of Rondônia. As a temporal delimitation, the period between the years 2014 to 2017 was taken into account. The paper goal is to examine the judicialization phenomenon and which impacts it brings to the administrative scope. The research has a bibliographic and documentary nature, consulting scientific articles, books, websites and especially transparency portals of the entities that institute and gather data on the budget execution of the health area in the Municipality of Porto Velho. The study works with a qualitative approach on the budget, related to the resources that are provided by the municipality of Porto Velho. It is concluded that the financial, structural and intellectual planning is essential for the municipal entity to be able to implement the fundamental social rights to health, as well as the related public policy, which is often affected by excessive judicialization.

Relato da experiência: implementação da metodologia Lean Healthcare no atendimento aos pacientes nas Unidades de Pronto-Atendimentos da Secretaria Municipal de saúde de Belo Horizonte: Projeto Menos Espera, Mais Saúde! / Experience report: implementation of the Lean Healthcare methodology in patient care at Emergency Departments of the Municipal Health Secretariat of Belo Horizonte: Less Waiting, More Health!

O artigo visa apresentar a experiência de implementação da metodologia “Lean” para o atendimento aos pacientes do Sistema Único de Saúde de Belo Horizonte (SUS-BH”) a fim de melhorar o tempo-resposta, a qualidade e a eficiência dos atendimentos em urgência e emergência, por meio de pactuação de fluxos internos. Trata-se de uma propsta que está na carta de projetos estratégicos da Secretaria Municipal de Saúde (SMSA). A melhoria da qualidade da assistência nas UPA’s está diretamente associada à aplicação de ferramentas de gestão de processos, com foco na eliminação dos desperdícios, por meio de um trabalho padronizado, treinamento contínuo e intervenção corretiva imediata frente às não conformidades encontradas.Tratando-se de pacientes em situações de urgência, o tempo é um dos principais recursos que deve ser mensurado cotidianamente, com o objetivo de oferecer ao doente uma intervenção médica ou assistencial, o mais breve possível. Apresentaremos nesse artigo, os resultados e experiências com a implantação do projeto “Menos espera, mais saúde” em algumas UPA’s de Belo Horizonte, com o uso de ferramentas Lean nos processos que tangem o atendimento ao usuário e o que identificamos como possibilidades de melhoria contínua, por meio da gestão à vista e intervenção frente aos indicadores de desempenho operacional. O projeto inovador e transformador “Menos espera, mais saúde” faz interface da gerência de urgência com outros setores da Secretaria municipal de saúde, no objetivo de atender a demanda do usuário, com qualidade, resolutilidade e segurança na espera pelo atendimento, otimizando a permanência desse usuário nas UPA’s de Belo Horizonte.

Barriers and facilitators to the implementation of a structured visual assessment after stroke in municipal health care services

Background Stroke is a leading cause of disability worldwide. Visual impairments (VIs) affect 60% of stroke survivors, and have negative consequences for rehabilitation and post-stroke life. VIs after stroke are often overlooked and undertreated due to lack of structured routines for visual care after stroke. This study aims to identify and assess barriers and facilitators to the implementation of structured visual assessment after stroke in municipal health care services. The study is part of a larger knowledge translation project. Methods Eleven leaders and municipal interdisciplinary health care professionals participated in qualitative interviews. During two workshops, results from the interviews were discussed with 26 participants from municipal health care services and user representatives. Data from interviews and workshops were collected before the intervention was implemented and analyzed using content analysis. Results The analysis identified individual and contextual barriers and facilitators. The individual barriers were related to the participants' experiences of having low competence of visual functions and vision assessment skills. They considered themselves as generalists, not stroke experts, and some were reluctant of change because of previous experiences of unsuccessful implementation projects. Individual facilitators were strong beliefs that including vision in stroke care would improve health care services. If experienced as useful and evidence based, the new vision routine would implement easier. Contextual barriers were experiences of unclear responsibility for vision care, lack of structured interdisciplinary collaboration and lack of formal stroke routines. Time constraints and practical difficulties with including the vision tool in current medical records were also expressed barriers. Contextual facilitators were leader support and acknowledgement, in addition to having a flexible work schedule. Conclusions This study shows that improving competence about VIs after stroke and skills in assessing visual functions are particularly important to consider when planning implementation of new vision routines in municipal health care services. Increased knowledge about the consequences of living with VIs after stroke, and the motivation to provide best possible care, were individual facilitators for changing clinical practice. Involving knowledge users, solutions for integrating new knowledge in existing routines, along with easily accessible supervision in own practise, are essential facilitators for promoting a successful implementation.