Introduction The prevalence of prediabetes in adults aged 18 or older was as high as 38% between 2017-2020. Youth-onset T2DM is a more aggressive phenotype than T2DM that occurs later in life. Young adults with T2DM have poorer health outcomes, lose an average of 15 years of life, all resulting in significant economic burden impacting the person. Current self-management interventions do not improve health outcomes in young adults with T2DM. Purpose The purpose of this research was to explore the self-care experiences of young adults living with T2DM. Methods Existential hermeneutic phenomenology informed the research. Inclusion criteria as follows: adults aged 18 to 30 with a self-reported diagnosis of T2DM, physical presence in the United States, English proficiency. Purposive and snowball sampling were used. Nineteen participants were interviewed: 16 self-identified as Black, 2 as White, and 1 as Latino. Interviews were transcribed verbatim. Transcripts were analyzed using an iterative approach for meaning units and themes. Thematic meanings were identified from the data. Results The grand theme my journey and two themes: finding out and navigating, three subthemes include distress, around me, and my duties. The second subtheme, around me, included two micro themes: support and juggling. The third subtheme, my duties, included three micro themes: exercise, education, and trigger surveillance. Several factors were unique to young adults' perception of self-care. Perceptions of time, support networks, novel coping strategies, and search for disease literacy impacted self-care perceptions and understanding. Results suggest the need for future person-centered, self-care intervention research with young adults that could result in improved health outcomes.

No / OBJECTIVES: Legislation and health policy enabling nurses and pharmacists to prescribe a comprehensive range of medicines has been in place in the UK since 2006. Our objective was to evaluate the clinical appropriateness of prescribing by these professionals. METHODS: A modified version of the Medication Appropriateness Index (MAI) was used by 10 medical, seven pharmacist and three nurse independent raters to evaluate a sample of 100 audio-recorded consultations in which a medicine was prescribed by a nurse or pharmacist. Raters were current prescribers with recognized experience in prescribing. Consultations were recorded in nine clinical practice settings in England. RESULTS: Raters' analysis indicated that, in the majority of instances, nurses and pharmacists were prescribing clinically appropriately on all of the ten MAI criteria (indication, effectiveness, dosage, directions, practicality, drug-drug interaction, drug-disease interaction, duplication, duration, cost). Highest mean 'inappropriate' ratings were given for correct directions (nurses 12%; pharmacists 11%) and the cost of the drug prescribed (nurses 16% pharmacists 22%). Analysis of raters' qualitative comments identified two main themes: positive views on the overall safety and effectiveness of prescribing episodes; and potential for improvement in nurses' and pharmacists' history-taking, assessment and diagnosis skills. CONCLUSIONS: Nurses and pharmacists are generally making clinically appropriate prescribing decisions. Decisions about the cost of drugs prescribed and assessment and diagnostic skills are areas for quality improvement.

Background: Bipolar disorder (BD) is a significant cause of perinatal morbidity and mortality. Because BD is hard to detect and treat, these individuals often go without care. This dissertation was designed to: (1) identify the prevalence rates of BD and bipolar-spectrum mood episodes in perinatal individuals, (2) understand pertinent barriers to mental healthcare, and (3) elucidate how to bridge healthcare gaps. Methods: Data sources included: primary qualitative and quantitative data from obstetric clinicians, encounter data from Massachusetts Child Psychiatry Access Program (MCPAP) for Moms, a program aimed at helping clinicians to provide mental healthcare to perinatal patients. Analyses included: descriptive statistics, systematic review and meta-analysis, qualitative data analyses, longitudinal regression analyses, and group-based trajectory modeling. Results: The prevalence of BD in perinatal individuals was 2.6% (95% CI: 1.2 to 4.5%). Twenty to 54.9% were found to have a bipolar-spectrum mood episode. Barriers to mental healthcare for perinatal patients with BD included the paucity of psychiatric resources, difficulties in assessing BD, and stigma towards pharmacotherapy. Obstetric clinicians reported that MCPAP for Moms has helped them feel more comfortable in treating patients with BD. Longitudinal analyses of encounter data corroborated these findings - utilization of the program predicted increased clinician capacity to treat BD. Conclusion: Clinicians for perinatal individuals are being called upon and stepping up to care for complex illnesses like BD. Programs like MCPAP for Moms can help them feel more confident in this role, helping to bridge gaps in perinatal mental healthcare and ensuring that individuals with BD are able to receive appropriate care.

The benefits of using electronic medical records (EMRs) have been well documented; however, despite numerous financial benefits and cost reductions being offered by the federal government, some healthcare professionals have been reluctant to implement EMR systems. In fact, prior research provides evidence of failed EMR implementations due to resistance on the part of physicians, nurses, and clinical administrators. In 2010, only 25% of office-based physicians have basic EMR systems and only 10% have fully functional systems. One of the hindrances believed to be responsible for the slow implementation rates of EMR systems is resistance from healthcare professionals not truly convinced that the system could be of substantive use to them. This study used quantitative methods to measure the relationships between six constructs, namely computer self-efficacy (CSE), perceived complexity (PC), attitude toward EMR (ATE), peer pressure (PP), anxiety (AXY), and resistance to use of technology (RES), are predominantly found in the literature with mixed results. Moreover, they may play a significant role in exposing the source of resistance that exists amongst American healthcare professionals when using Electronic Medical Records (EMR) Systems. This study also measured four covariates: age, role in healthcare, years in healthcare, gender, and years of computer use. This study used Structural Equation Modeling (SEM) and an analysis of covariance (ANCOVA) to address the research hypotheses proposed. The survey instrument was based on existing construct measures that have been previously validated in literature, however, not in a single model. Thus, construct validity and reliability was done with the help of subject matter experts (SMEs) using the Delphi method. Moreover, a pilot study of 20 participants was conducted before the full data collection was done, where some minor adjustments to the instrument were made. The analysis consisted of SEM using the R software and programming language. A Web-based survey instrument consisting of 45 items was used to assess the six constructs and demographics data. The data was collected from healthcare professionals across the United States. After data cleaning, 258 responses were found to be viable for further analysis. Resistance to EMR Systems amongst healthcare professionals was examined through the utilization of a quantitative methodology and a cross-sectional research measuring the self-report survey responses of medical professionals. The analysis found that the overall R2 after the SEM was performed, the model had an overall R2 of 0.78, which indicated that 78% variability in RES could be accounted by CSE, PC, ATE, PP, and AXY. The SEM analysis of AXY and RES illustrated a path that was highly significant (β= 0.87, p < .001), while the other constructs impact on RES were not significant. No covariates, besides years of computer use, were found to show any significance differences. This research study has numerous implications for practice and research. The identification of significant predictors of resistance can assist healthcare administrators and EMR system vendors to develop ways to improve the design of the system. This study results also help identify other aspects of EMR system implementation and use that will reduce resistance by healthcare professionals. From a research perspective, the identification of specific attitudinal, demographic, professional, or knowledge-related predictors of reference through the SEM and ANCOVA could provide future researchers with an indication of where to focus additional research attention in order to obtain more precise knowledge about the roots of physician resistance to using EMR systems.

The purpose of the present study was to investigate the influence of pain causal attributions on patient pain-related functioning, treatment engagement, and clinical outcomes. Additionally, the impact of discordant pain causal attributions between patients and their providers as well as between interdisciplinary providers was examined. Patients rated their pain functioning and causal pain attributions during a regular clinic visit. Following the patient’s visit both the behavioral medicine provider and internal medicine resident provided ratings of similar pain-related functioning domains and causal attributions. Follow-up data were collected from the electronic medical record three months following that clinic visit. Overall, results revealed that patients’ chronic pain attributions did influence pain-related functioning, however the impact was relatively small. There was insufficient evidence to conclude that chronic pain attributions influence a patient’s readiness to adopt self-management coping strategies and their subsequent treatment engagement. Additionally, results confirmed that different health care disciplines attribute the cause of patients’ chronic pain in distinct ways and these unique perspectives can lead to discrepant pain-related functioning assessments between providers. Discordant ratings between providers were shown to influence referring patterns for interdisciplinary services and the patient’s overall opioid dose. Similarly, discrepancies between patients and their providers influenced subsequent referral for behavioral health services, the patient’s attendance at those visits, and their overall morphine equivalent doses. Together the results indicate the important role pain attributions can play in chronic pain management and highlight the central role of the patient-provider and provider-provider relationship.

Introdução: O emprego da terapia antirretroviral (TARV) proporcionou dramático impacto na mortalidade por aids e aumento na sobrevida. Entretanto, esse panorama depende da manutenção de altas taxas de adesão ao tratamento medicamentoso. A relevância da adesão tem sido reconhecida pelo Programa Nacional de DST e Aids desde o final dos anos 1990. Em que pese o destaque que o plano propositivo do Programa tem dado para a questão, ainda não dispõe de estudo atualizado sobre o número e tipo das atividades que estão em curso nos serviços. Este estudo teve por objetivo descrever as atividades de adesão em curso nos serviços de HIV/aids do Estado de São Paulo. Métodos: Foi enviado um questionário semi-estruturado para todos os 179 ambulatórios de HIV/aids do Estado, com perguntas sobre o tipo de serviço, pessoas sob TARV, formas e frequências de avaliação de adesão, atividades desenvolvidas (individuais, coletivas e para grupos específicos) e parcerias com organizações não governamentais. Para testar associação entre variáveis categóricas utilizou-se o teste Qui-quadrado de Pearson ou os testes exato de Fisher ou teste da razão de verossimilhanças, no nível de significância de p<0,05. A análise de agrupamento foi utilizada para investigar cada uma das associações de cada resposta com as variáveis: tamanho do município, tipo e tamanho das clínicas. Resultados: 136 dos ambulatório (76%) responderam à pesquisa. Quase todos (96,3%) relataram incentivar a adesão na prática clínica, predominantemente nas consultas de médicos (94,1%) e enfermeiros (67,6%). A maioria (78,7%) relatou avaliar a adesão através de registros da farmácia. Grupos (38,2%) e palestras (28,7%) foram as atividades de grupo mais conduzidas. A análise de agrupamento identificou três grupos de ambulatórios, dois deles muito distintos. Grupo 1 (27 ambulatórios) foi composto predominantemente por unidades de saúde básica, com menos de 100 pacientes, apresentaram a menor freqüência de avaliação da adesão e menos atividades individuais e em grupo. Grupo 2 (51 ambulatórios) foi constituído principalmente por ambulatórios especializados em HIV/aids, com mais de 500 pacientes, com maior freqüência de avaliação da adesão, maior participação de psicólogos, assistentes sociais e farmacêuticos e mais atividades individuais e em grupo. Grupo 3 (56 ambulatórios) foi composto em sua maioria por ambulatórios de especialidades e de médio porte, com a maioria das atividades semelhantes ao Grupo 2, exceto pela ausência de atividades para grupos específicos e menos envolvimento multidisciplinar. Conclusão: Dado o amplo reconhecimento da importância da adesão por parte das clínicas, ainda há poucas atividades específicas de adesão no Estado. As clínicas maiores e mais especializadas tendem a oferecer mais atividades individuais e em grupo, utilizando abordagens multidisciplinares. Maior atenção deve ser dada para a descentralização do atendimento às pessoas vivendo com HIV para assegurar cuidados de qualidade mais homogêneos em toda a rede ambulatorial. / Introduction: The use of antiretroviral therapy (HAART) has provided dramatic impact on AIDS mortality and improved survival. However, this scenario depends on maintaining high rates of adherence to HAART. The relevance of adherence has been recognized by the National STD/AIDS Program since the late 1990s. Despite the emphasis that the Program has given to the issue, there have been no study to date on the number and type of activities that are underway in the services. This study aimed to describe the HAART adherence support activities in Sao Paulo State HIV/AIDS clinics. Methods: We sent a semi structured questionnaire to all 179 HIV/AIDS clinics with questions about type of clinic, people on HAART, adherence assessment, activities (individual, group and for specific groups). To test association between categorical variables used the chi-square test or Fisher exact test or likelihood ratio test at a significance level of p <0.05. Cluster analysis was used to investigate each association of each answer with the variables: municipality size, type and size of the clinics. Results: 136 clinics (76%) answered the survey. Almost all (96.3%) reported encouraging adherence in clinical practice, particularly in the medical (94.1%) and nurse (67.6%) visits. Most (78,7%), reported assessing adherence by pharmaceutical records. Groups (38.2%) and lectures (28.7%) were the group activities most developed. Cluster analysis identified three groups of clinics; two of them were too different. Group 1 (27 clinics) was predominately composed by primary care clinics, with less than 100 patients, the lowest frequency of assessing adherence and fewer individual and group activities. Group 2 (51 clinics) predominately composed by HIV specialized clinics specializing, HIV/AIDS, with more than 500 patients, assessing adherence more frequently, with greater involvement of psychologists, social workers and pharmacists developing more individual and group activities. Group 3 (56 clinics) was predominately composed by medium size specialized clinics, with majority of activities similar to Group 2, except by the absence of activities to specific groups and less multidisciplinary involvement. Conclusion: Given the broad recognition of the adherence importance by the clinics, there are still few specific adherence activities. The larger and more specialized clinics tend to provide more individual and group activities, using multidisciplinary approaches. Greater attention should be given to the decentralization of care offered to people living with HIV to ensure more homogeneous quality care across the ambulatory network.

O movimento de reafirmação da importância da Atenção Primária à Saúde (APS) nas primeiras décadas deste século ressaltou a necessidade de qualificação dos serviços deste nível de atenção, impulsionando iniciativas de avaliação e monitoramento. No Brasil, correspondeu à implantação da Estratégia Saúde da Família (ESF). No Estado de São Paulo, implantou-se a ESF em uma rede de APS já organizada segundo Programas de saúde. A convivência entre esses dois modos de organizar e operar os serviços gerou grande diversidade de estruturação assistencial da APS.O objetivo desse estudo foi avaliar a capacidade de resposta de serviços do interior do Estado de São Paulo, a necessidades de saúde classicamente reconhecidas como próprias da APS. Os dados utilizados são provenientes do banco de respostas de 2.735 serviços ao questionário QualiAB - Avaliação da Qualidade e Monitoramento da Atenção Básica, composto por 85 questões de múltipla escolha. O quadro avaliativo Capacidade de resposta em APS resultou de determinadas questões do QualiAB, organizadas em 3 domínios: Disponibilidade de recursos (4 subdomínios: 59 indicadores), Operação direta da assistência (4 subdomínios: 50) e Gerenciamento Trabalho (3 subdomínios:25), cujo total resultou em 122 indicadores. Toda resposta positiva correspondeu ao valor 1. A média geral obtida foi 56,6%. Pelos testes de Friedman e Dunn, o domínio Disponibilidade de recursos teve maior contribuição no desempenho, seguido dos domínios Gerenciamento técnico do trabalho e Operação direta da assistência. Os três domínios mostraram correlação positiva (teste de Spearman). As k-médias dos subdomínios constituíram dois grupos de desempenho: Capacidade Satisfatória de resposta (CS), com 39% (1065) dos serviços estudados e o grupo Capacidade Insuficiente (CI), com 61% (1658). Para analisar a distribuição dos serviços nos grupos utilizou-se modelo de regressão logística que considerou como variáveis possivelmente associadas: população e índice de desenvolvimento humano (IDH) do município de localização do serviço, número de consultas do serviço, apoio técnico da gestão estadual, apoio financeiro da gestão estadual e arranjo organizativo, este último a partir daquelas formas de estruturação assistencial dos serviços. Os resultados mostraram que serviços de arranjo organizativo do tipo Mix Centro de Saúde - ESF, que realizam 800 ou mais consultas mensais, localizados em municípios com mais de 100 mil habitantes, que receberam apoio técnico adicional do Estado e de maior IDH mostraram maior chance de pertencer ao grupo de Capacidade Satisfatória de resposta. O apoio financeiro adicional do Estado não mostrou associação. Quando estas variáveis foram ajustadas apenas para serviços localizados em municípios com menos de 100 mil habitantes, o apoio financeiro contínuo desde 2000 mostrou associação, enquanto o IDH não mais se mostrou associado. Diante disto, conclui-se que a capacidade de resposta obtida foi baixa, comprometendo o papel esperado da APS. Arranjos organizativos que mesclem distintos modos de organizar e operar os serviços podem ser mais promissores. Medidas que busquem mitigar as desigualdades devem ser reafirmadas como políticas públicas, especialmente no caso de municípios de menor porte populacional / The movement to reaffirm the importance of Primary Health Care (PHC) in the first decades of this century highlighted the need for qualification in the services of this level of care, fostering assessment and monitoring initiatives. In Brazil, this has corresponded to the implementation of Family Health Strategy (FHS). In the State of São Paulo, FHS was implemented within a PHC network already established according to heath Programs. The coexistence of these two ways of organizing and operating the services generated great diversity in care structuring within PHC. The objective of this study was to evaluate the response capacity of the services located on the countryside of the State of São Paulo to health needs classically regarded as being typical of PHC. The data utilized have come from a response bank to the QualiAB questionnaire - Primary Care Quality and Monitoring Evaluation comprising 85 multiple choice questions, from 2.735 services. The evaluative framework \'Response Capacity\' in PHC resulted from certain questions from QualiAB, organized in 3 dominions: Availability of resources (5 sub dominions: 51 indicators), direct assistance Operation (5 sub dominions: 50 indicators) and Work Management (4 sub dominions: 21 indicators), totaling 122 indicators. Every positive response corresponded to score 1. The overall average was 56,6%. According to Friedman e Dunn\'s tests, dominion Availability of resources had greater performance contribution, followed by dominions work\'s technical Management and direct assistance Operation. The three dominions showed positive correlations (Spearman\'s test). The sub dominions k-means comprised two performance groups: Satisfactory Capacity of response (SC), with 39% (1065) of services studied, and the Insufficient Capacity group (IC), with 61% (1658). In order to analyze the distribution of the services in the groups, a logistics regression model was utilized. This model considered the following variables as being possibly associated: population and human development index (HDI) of the service municipality, number of appointments in the services, technical support from the state government, financial support from state government, and an organizational arrangement based on models of care previously structured. Results showed that services whose organizational arrangements were Health Center-FHS mixed-type, with 800 or more monthly appointments, located in municipalities with more than 100 thousand inhabitants, receiving additional technical support from the state, and with a higher HDI showed higher probability of belonging to the Satisfactory Response group response. Additional financial support from the state did not show association. When those variables were adjusted only to the services located in municipalities with less than 100 thousand inhabitants, a continuous financial support since 2000 showed association, whereas HDI did not show association any longer. Therefore, it was concluded that the response capacity obtained was low, which compromised the expected role of PHC. Organizational arrangements combining different modes of organizing and operating the services might prove more promising. Measures seeking to mitigate inequalities must be reaffirmed as public policies, especially in the case of municipalities with smaller populations

Background: India has the highest number of undernourished children worldwide. Understanding trends, predictors, and consequences of child undernutrition is important to inform strategy for addressing this public health crisis. Methods: We used data from four National Family Health Surveys (1992-93, 1998-99, 2005-6, 2015-16 NFHS) to examine trends of undernutrition before and after the 2005 implementation of the National Rural Health Mission, India’s flagship public health initiative (Aim 1). We used the 2016 NFHS to build a predictive model that identifies infants at-risk for child undernutrition (Aim 2). Lastly, we used data from the 2005 and 2012 India Human Development Surveys to investigate the consequences of early childhood undernutrition (Aim 3). Results: NRHM was more effective at addressing acute than chronic undernutrition but its prioritization on high focus states resulted in an increase of acute undernutrition among children living in normal focus states. We demonstrate that it is feasible to predict 5-year risk of child undernutrition at the time of birth. Child undernutrition is associated with adverse physical and cognitive outcomes during pre-adolescent years, with female undernourished children experiencing the worst outcomes. Higher female education in the household helps overcome gender and nutrition-based disadvantage among Indian children. Conclusion: There is an urgent need to reduce nutrition-related disparities among Indian children. Short-term strategy could include a predictive model that can be used to more effectively provide resources and intervention to the most disadvantaged population. Long term strategy should focus on elevating women’s status through improved female education in India.

INTRODUÇÃO: Os Centros de Referência para Imunobiológicos Especiais (CRIEs) são unidades de vacinação públicas e gratuitas que disponibilizam vacinas e imunoglobulinas não disponíveis na rotina do Programa Nacional de Imunizações (PNI), para indivíduos que necessitam de imunobiológicos específicos, mediante prescrição médica. Também realizam atendimento de pessoas com eventos adversos pós-vacinação (EAPV). É um subprograma do PNI, criado em 1993. OBJETIVO: Avaliar a implantação dos CRIEs quanto ao cumprimento de diretrizes e regulamentações formais. MÉTODOS: Foi realizada uma avaliação de programa do tipo pesquisa avaliativa e para isso, desenvolvido um questionário on-line, contendo 170 questões, envolvendo as dimensões \"estrutura\", \"recursos humanos\" e \"atividades desenvolvidas\". Os responsáveis pelos 42 CRIEs existentes em 2011 participaram do estudo. A fim de agrupar serviços com características semelhantes, foi aplicado o método de agrupamento para dados binários, utilizando a Distância Euclidiana Quadrática (pelo método do vizinho mais distante - complete linkage). RESULTADOS: Foi evidenciada uma grande diversidade entre os serviços nas três dimensões analisadas. Treze CRIEs (31%) estavam localizados em instituição universitária; 29 (69%) possuíam o mínimo de salas preconizado; 29 (69%) relataram insuficiência de equipamentos para armazenamento de imunobiológicos; 22 (52%) não realizavam manutenção preventiva da rede de frio; 30 (71%) possuíam gerador elétrico; 24 (57%) tinham fonte de oxigênio. O número de funcionários variou de três a 21; quatro serviços não tinham enfermeiros e nove não tinham médicos; 23 (55%) possuíam médico em período maior ou igual à metade do expediente; 27 (64%) tinham recursos humanos treinados para atender emergências. O número de doses de imunobiológicos administrados aumentou 66% de 2006 a 2010. Trinta e cinco serviços (83%) funcionavam 40 horas semanais ou mais. Acerca do atendimento de EAPV, 28 (67%) CRIEs contavam com retaguarda laboratorial, 36 (86%) com retaguarda hospitalar e 36 (86%) com retaguarda de especialistas. A análise estatística resultou em cinco \"perfis\" de serviços, denominados de acordo com suas características. 1) \"Melhor estrutura\": 12 CRIEs com a maior porcentagem de serviços com o mínimo de salas preconizado, câmaras de vacinas, manutenção preventiva da rede de frio e fonte de oxigênio. 2) \"Dispensador de imunobiológicos\": 6 CRIEs que mais dispensavam do que aplicavam imunógenos; nenhum serviço tinha médico mais da metade do expediente; nenhum serviço possuía câmaras de vacinas. 3) \"Implantação incipiente\": 5 CRIEs com estrutura mais precária, com baixos índices de câmaras de vacinas, manutenção preventiva e fonte de oxigênio; nenhum possuía computador. 4) \"Sala de vacinas\": 13 CRIEs, todos faziam imunização de rotina e a maioria participava de campanhas de vacinação. 5) \"Ensino e pesquisa\": 6 serviços, todos inseridos em hospitais de ensino, desenvolviam pesquisas e recebiam estagiários. Quase todos possuíam médicos em mais da metade do expediente e tinham manutenção preventiva da rede de frio. CONCLUSÃO: Diante da variabilidade de situações, a avaliação de implantação dos CRIEs foi avaliada por perfil: \"melhor estrutura\" e \"ensino e pesquisa\" foram considerados implantados; \"dispensador de imunobiológicos\" e \"sala de vacinas\", parcialmente implantados; \"implantação incipiente\", não implantados / INTRODUCTION: The Reference Centers for Special Immunobiologicals (Centros de Referência para Imunobiológicos Especiais, CRIEs) are public vaccination clinics that provide vaccines and immunoglobulins not routinely available in the National Immunization Program (NIP) to persons with special needs, free of charge, by medical prescription. These centers also provide medical assistance for persons with adverse events following immunization (AEFI). The CRIEs were established in 1993, by the Brazilian NIP. OBJECTIVE: To evaluate the implementation of CRIEs on its compliance to formal policies and regulations. METHODS: This is a program evaluation, type \"evaluative research\". We developed an on-line questionnaire, with 170 questions, involving the dimensions: \"structure\", \"human resources\" and \"developed activities\". The persons in charge of the 42 CRIEs in activity in 2011 were invited to participate in this study. A statistical analysis was performed to group services with similar characteristics, applying the binary data\'s grouping method, by using the Quadratic Euclidean Distance (by the method of the farthest neighbor - complete linkage). RESULTS: A great diversity was observed among services, in the three dimensions. Thirteen (31%) CRIEs were in university premises; 29 (69%) had the minimum recommended spaces; 29 (69%) reported insufficiency of equipment for immunobiologicals storage; 22 (52%) did not conduct preventive maintenance of the cold chain; 30 (71%) had power generator; 24 (57%) had oxygen supply. The number of professionals varied from three to 21; four services did not have nurses and nine did not have doctors; 23 (55%) had doctors for at least half of working hours; 27 (64%) had human resources trained in emergency. The number of administered doses of immunobiologicals increased 66% from 2006 to 2010. Thirtyfive (83%) CRIEs were open at least 40 hours/week. Regarding care to AEFI, 28 (67%) CRIEs had laboratory support, 36 (86%) had hospital reference, and 36 (86%) had reference experts. The statistical analysis showed five service profiles, nominated according to their characteristics. 1) \"Best structure\": 12 CRIEs with the best index of the minimal recommended spaces, vaccine storage chambers, preventive maintenance of the cold chain and oxygen supply. 2) \"Distribution centers\": 6 CRIEs that, mainly, delivered immunobiologicals to be administered in other services; none with a physician for at least half of the opening hours; none with vaccine storage chamber. 3) \"Incipient implementation\": 5 CRIEs with an overall poorer infrastructure; only some had vaccine storage chambers, preventive maintenance of the cold chain and oxygen supply; none of them had computer. 4) \"Vaccination Room\": These 13 CRIEs administered routine immunization; most of them participated in immunization campaigns. 5) \"Teaching and research\": 6 CRIEs in teaching hospitals, performed research and received trainees; almost all of them had physicians for at least half of the working hours and preventive maintenance of the cold chain. CONCLUSION. Considering the services\' diversity, the implementation of CRIES was evaluated according to the different profiles: \"Best structure\" and \"Teaching and research\" were considered implemented; \"Distribution centers\" and \"Vaccination Rooms\", partially implemented; and \"Incipient implementation\", not implemented

Estudo qualitativo do tipo exploratório-descritivo acerca da aplicabilidade do resultado da pesquisa de satisfação como ferramenta de avaliação da qualidade dos serviços de saúde. O objetivo geral do estudo consistiu em analisar a utilização dos resultados da pesquisa de satisfação dos usuários pelas chefias de enfermagem das unidades de internação de um hospital universitário. Os objetivos específicos foram relatar os resultados da pesquisa de satisfação dos usuários das unidades de internação; descrever a opinião das chefias acerca da contribuição que a pesquisa de satisfação implantada no hospital traz para o atendimento ao usuário; conhecer as estratégias utilizadas pelas chefias de enfermagem a fim de ter acesso aos resultados da pesquisa de satisfação, bem como o modo pelo qual os resultados são transmitidos à sua equipe de trabalho; e, por fim, identificar as ações implementadas nas unidades a partir dos resultados da pesquisa de satisfação. Os dados foram coletados em duas etapas no Hospital de Clínicas de Porto Alegre. A primeira consistiu em análise documental, com base em consulta dos dados do sistema de informações gerenciais do referido hospital, que possibilitaram conhecer os resultados da pesquisa de satisfação das unidades de internação, objetos de investigação, no período de outubro de 2011 a março de 2012. Os achados demonstram que os usuários estão, em geral, satisfeitos com os cuidados de enfermagem e com o atendimento prestado durante a sua internação. A outra etapa da coleta consistiu em entrevistas semiestruturadas, realizadas em maio e junho de 2012, com 14 enfermeiras, cujos dados obtidos foram submetidos à técnica de análise de conteúdo temática e agrupadas em quatro categorias: a comunicação como forma de transmissão das informações para a equipe de enfermagem; a contribuição da pesquisa de satisfação do usuário para o atendimento em saúde; mudanças implementadas nas unidades a partir dos resultados da pesquisa; a influência da pesquisa de satisfação na avaliação de desempenho da equipe de enfermagem. Os resultados apontam que a pesquisa de satisfação do usuário é verificada de diversas formas pelas enfermeiras, as quais procuram também repassar à sua equipe de trabalho. A comunicação tem uma função primordial, pois favorece a troca de informações e a interlocução dentro da equipe de enfermagem. A pesquisa é entendida pelas enfermeiras como uma ferramenta de escuta, que continuamente capta a voz do usuário. Quanto às mudanças já implementadas nas unidades, as enfermeiras relataram que já foram realizadas modificações advindas de reinvindicações, as quais envolvem o ambiente, a estrutura e outros aspectos relacionados à rotina da unidade. Um ponto levantado pelas enfermeiras refere-se à influência do resultado da pesquisa de satisfação na gestão de desempenho da equipe de enfermagem, a qual é utilizada para identificar como está sendo a atuação de cada profissional no trabalho, gerenciando os elogios e críticas vinculados à equipe. Acredita-se que os estudos sobre a satisfação do usuário são fundamentais para garantir a avaliação da qualidade do serviço oferecido pelas instituições, além de auxiliar gestores na tomada de decisões, bem como fornecer um panorama do serviço. / This is a descriptive, exploratory, qualitative study about the applicability of satisfaction survey results as a tool for evaluating the quality of health service. The general objective of this study consisted in analyzing the use of the satisfaction survey results by chief nurses from the intern units of a university hospital. The specific objectives were: to report intern unit user’s satisfaction survey results; to describe the chief nurses’ opinions about the contribution that the satisfaction survey implanted in the hospital brings to user service; to know the strategies used by the chief nurses in having access to the satisfaction survey results, as well as the way the results are transmitted to the work team; and, finally, to identify the actions implemented in the units, based on the satisfaction survey results. Data collection was carried out at the Clinics Hospital of Porto Alegre/Hospital de Clínicas de Porto Alegre in two stages. The first consisted of documental analysis, based on consulting the hospital’s managerial information data, which made it possible to know the satisfaction survey results of the intern units, objects of investigation, during the period of October 2011 to March 2012. The findings demonstrate that users are, in general, satisfied with the nursing services and with the attendance given them while admitted to the hospital. The other stage of data collection consisted of semi-structured interviews, given in May and June of 2012, with 14 nurses, whose obtained data were submitted to the technique of thematic analysis and grouped in four categories: communication as a form of transmitting information to the nursing team; the contribution that the user satisfaction survey has on health services; alterations based on survey results, implemented in the units; influence that the satisfaction survey has upon the evaluation of the nursing team’s performance. The results show that the user satisfaction survey is checked in a variety of ways by the nurses, whom also seek to repass these results to their immediate team. The communication has a main function since it favors the exchange of information and dialogue within the nursing team. Nurses understand the survey to be a listening device, that continuously captures the user’s voice. In reference to the changes already implemented in the units, the nurses reported that they were made in result of the claims involving environment, structure and other aspects related to the unit’s routine. A point raised by the nurses refers to the influence that the satisfaction survey results have on the nursing team’s performance management, which uses it to identify the ongoing performance of each working professional, administering compliments and criticisms related to the team. It is believed that the studies about user satisfaction are fundamental to guarantee the evaluation of service quality offered by the institutions, besides to assist supervisors on making decisions, as well as to provide a service panorama. / Estudio cualitativo del tipo exploratorio-descriptivo sobre la aplicabilidad del resultado de la encuesta de satisfacción como herramienta de evaluación de la calidad de los servicios de salud. El objetivo general del estudio consistió en analizar el uso de los resultados de la encuesta de satisfacción de los usuarios por las jefaturas de enfermería de las unidades de hospitalización de un hospital universitario. Los objetivos específicos fueron los de relatar los resultados de la encuesta de satisfacción de los usuarios de las unidades de hospitalización; describir la opinión de las jefaturas sobre la contribución que ésta trae para la atención al usuario; conocer las estrategias usadas por las jefaturas de enfermería con el propósito de tener acceso a los resultados de la encuesta de satisfacción, así como el modo por el cual los resultados se transmiten a su equipo de trabajo; y, por fin, identificar las acciones implementadas en las unidades a partir de los resultados de la encuesta de satisfacción. Los datos fueron colectados en dos etapas en el Hospital de Clínicas de Porto Alegre. La primera consistió en un análisis documental, basado en consulta a datos del sistema de informaciones gerenciales del referido hospital, que posibilitaron conocer los resultados de la encuesta de satisfacción de las unidades de hospitalización objetos de investigación, en el período de octubre del 2011 a marzo del 2012. Los descubrimientos demuestran que los usuarios están, por lo general, satisfechos con los cuidados de enfermería y con la atención prestada durante su hospitalización. La otra etapa de la colecta consistió en entrevistas semiestructuradas, realizadas en mayo y junio del 2012, con 14 enfermeras, cuyos datos obtenidos se sometieron a la técnica de análisis de contenido temático y agrupadas en cuatro categorías: la comunicación como forma de transmisión de las informaciones para el equipo de enfermería; la contribución de la encuesta de satisfacción del usuario para la atención en la salud; cambios implementados en las unidades a partir de los resultados de la encuesta; la influencia de ésta en la evaluación del desempeño del equipo de enfermería. Los resultados apuntan que la encuesta de satisfacción del usuario se ve de distintas formas por las enfermeras, las cuales también buscan repasar su equipo de trabajo. La comunicación tiene una función primordial, ya que favorece el intercambio de informaciones y la interlocución dentro del equipo de enfermería. La encuesta es entendida por las enfermeras como una herramienta de escucha, que continuamente capta la voz del usuario. En relación a los cambios ya implementados en las unidades, las enfermeras relataron que ya se han realizado modificaciones a partir de reinvindicaciones, las cuales involucran el ambiente, la estructura y otras relacionadas a la rutina de la unidad. Un punto levantado por las enfermeras se refiere a la influencia del resultado de la encuesta de satisfacción en la gestión de desempeño del equipo de enfermería, la cual se usa para identificar como está siendo la actuación de cada profesional en el trabajo, administrando los elogios y críticas vinculados al equipo. Se cree que los estudios sobre la satisfacción del usuario sean fundamentales para garantizar la evaluación de la calidad del servicio ofrecido por las instituciones, además de ayudar a los gestores en la toma de decisiones, así como proveer un panorama sobre el servicio.