Hur blir vi bättre på att rädda liv? Hur förbättrar vi kvalitén på mötena med våra patienter? Kvalitetssystem inom sjukvården är ett svar på de ovannämnda frågorna. Kvalitetssystem i vården inkluderar verktyg som tillåter användaren utföra analyser på patientdata i syfte att förbättra vårdkvalitén. Detta gör man genom att leta efter mönster i patientdata som lett till negativa utfall. År 2019 implementerade Region Dalarna ett kvalitetssystem med namnet Medrave M4. Sedan dess har regionen inte utvärderat användning av systemet. För att ernå nya perspektiv kring fördelar och nackdelar med kvalitetssystem i vården redogörs användningen avMedrave M4 i Region Dalarna i denna rapport, detta utifrån vårdpersonalens perspektiv. Syftet med studien är att ta reda på vilka styrkor, svagheter, möjligheter och hot som föreligger med ett kvalitetssystem. Således avgöra om kvaliteten på vården har ändrats sedan RegionDalarna implementerade Medrave M4. Studiens frågeställning har kunnat besvaras genom att granska tidigare forskning, analysera insamlade data, intervjuer, utför en fallstudie och observera kvalitetssystemet Medrave. Resultatet visar att det finns fördelar med att använda kvalitetssystem i vården. Exempelvis kunde Region Dalarnas primärvård genomföra vaccinationer av Covid – 19 mer effektivt med hjälp av kvalitetssystemet. Systemet möjliggjorde för personalen att enkelt identifiera patienter i mest behov av vaccin. Vidare gör ett kvalitetssystem även det möjligt för verksamheter att jämföra resultat med andra verksamheter, vilket har visat sig gynna organisationsutveckling. Kvalitetssystem kan också fungera som ett verktyg för forskning inom vården. Man har sett att enheter som använder kvalitetssystem har mindre förskrivning av onödiga läkemedel till patienter. Nackdelarna med användandet av systemet är att man har sett att det finns en liten risk att patientdata läcker ut. Studien visade också att kvalitetssystemet inte interagerade optimalt med andra system, vilket kan försvåra arbetet för personalen. Det går även att se att de råder brist på kunskap gällande kvalitetssystemets fördelar bland vårdpersonal. Detta kan i sin tur leda till att systemet avskaffas i onödan av verksamheter. / How do we become better at saving lives? How do we improve the quality of the encounters with our patients? Quality systems in the healthcare are functioned and designed to answer the above-mentioned questions. They include tools that allow the user to perform analysis on patients’ data to improve the quality of care. One does this, by looking for patterns in the data that results in negative outcomes. In the year of 2019, Region Dalarna implemented a quality system named Medrave M4. Since then, an evaluation on the use of this quality system within this region has yet not been done. As a way of getting new perspectives on the benefits and cons of quality systems in the healthcare, this thesis chose to evaluate the use of Medrave M4in Region Dalarna. The purpose was to find out what the strengths, weaknesses, opportunities, and threats were with the system. And to determine if the quality of care has improved since Region Dalarna implemented the system. The study's questions have been answered by reviewing previous research, analysing collected data, interviewing relevant people, and observing the Medrave quality system. These parameters have been compared and have been analysed to answer the questions in depth. By analysing the collected data from these sources, the results are that the benefits of utilizing quality systems in the healthcare are diverse and many. The primary care of Region Dalarna managed the vaccinations of Covid–19 much better because of the quality system. It allowed them to easily identify patients in most need of the vaccinations. The quality system has also allowed comparison of results with other organisations. It also supports research and made it possible to reduce unnecessary prescription of medicine to the patients. The disadvantages of using the system are that there is a risk of patient data being leaked. The study also showed that the quality system did not interact optimally with other systems, which can make the work for the staff more difficult. It has also been seen that there is a lack of knowledge within the staff regarding the benefits of the quality system, this in turn can lead to the business unnecessarily abolishing the system.

SAMMANFATTNINGBakgrund: Hjärtsvikt är i Sverige en folksjukdom där cirka 200 000 personer beräknas lida av symtom och lika många till lever utan några symtom. Under de nästkommande 25 åren beräknas inläggningar att öka med 50% då prevalensen av hjärtsvikt ökar på grund av befolkningstillväxten, åldrande och den ökade förekomsten av samsjuklighet. Sjuksköterskeledda hjärtsviktsmottagningar inom primärvården verkar vara effektiva för att tillhandahålla högkvalitativ personcentrerad vård och därmed minska behovet av sjukhusvård. Personcentrering är en process att ta tillvara patientens resurser med hänsyn till individens förutsättningar och hinder. Ett partnerskap som bygger på ömsesidig respekt, är jämbördig och inbjuder till delaktighet och att vårdtagaren får den information som behövs för att kunna fatta rätt beslut. Syfte: Att belysa sjuksköterskors erfarenheter av hur de arbetar utifrån ett personcentrerat förhållningssätt med personer med hjärtsvikt i primärvården.Metod: En kvalitativ semistrukturerad intervjustudie med induktiv ansats där nio sjuksköterskor deltog som arbetade på hjärtsviktsmottagningar. En kvalitativ innehållsanalys användes och det teoretiskt ramverk utgick från ett personcentrerat förhållningssätt. Resultat: Innehållsanalysen resulterade i fyra huvudkategorier holistisk människosyn, individuellt bemötande, partnerskap och delegering av läkemedel. Slutsats: I resultatet framkom att alla sjuksköterskor ansåg sig lyssna till personens berättelseoch att de utgick delvis från en helhetssyn, men det fanns brister i att tillgodo se de existentiella behoven. De tyckte sig erbjuda individanpassad vård och behandling efter personens förutsättningar och behov och de upplevde att det var en viktig del i arbetet att motivera till delaktighet i egenvård samt kunskap och förståelse om sjukdomen. Sjuksköterskorna önskade bli bättre på att inkludera anhöriga. Få sjuksköterskor hade delegering av läkemedel och några få tyckte att det hade betydelse för omhändertagandet. / ABSTRACTBackground: In Sweden, heart failure is a common disease, where approximately 200,000 people are estimated to suffer from symptoms and the same number live without any symptoms. Over the next 25 years, admissions are projected to increase by 50% as the prevalence of heart failure increases due to population growth, aging and the increased prevalence of comorbidities. Nurse-led heart failure clinics in primary care appear to be effective in providing high-quality person-centred care and thereby reducing the need for hospitalisation. Person-centredness is a process of making use of the patient's resources, taking into account the individual's conditions and obstacles. A partnership that is based on mutual respect, is equal and invites participation and that the care recipient receives the information needed to be able to make the right decision.Aim: To shed light on nurses' experiences of how they work based on a person-centred approach with people with heart failure in primary care.Method: A qualitative semi-structured interview study with an inductive approach in which nine nurses who worked in heart failure wards participated. A qualitative content analysis was used and the theoretical framework was based on a person-centred approach.Results: The content analysis resulted in four main categories: holistic view of people, individual treatment, partnership, delegation of medicines.Conclusion: The results showed that all nurses considered themselves to listen to the person's story and that they partly started from a holistic view, but there were shortcomings in satisfying the existential needs. They seemed to offer individually tailored care and treatment according to the person's conditions and needs, and they felt that it was an important part of the work to motivate participation in self-care as well as knowledge and understanding of the disease. The nurses wanted to be better at including relatives. Few nurses had delegation of medicines and a few thought it was important for care.

Introduction The differential accessibility of healthcare services in the Nordic region can be drawn along socioeconomic and sociodemographic lines. Previous literature has established the association between the processes of marginalisation and inequitable healthcare access outcomes. This study contributes to existing knowledge by exploring the association with regard to primary healthcare service accessibility.     Methods Logistic regression assessed the association between perceived marginalisation and medical consultation barriers. A multinomial regression further analysed the specific type of systemic primary healthcare barriers marginalised respondents were more likely to encounter in comparison to non-marginalised respondents. This analysis used data from 5,689 respondents residing in the Nordic region from the 7th round of the European Social Survey.   Results After adjusting for health problems, socioeconomic, sociodemographic, and sociocultural factors, respondents who reported perceived marginalisation were more likely to face healthcare access barriers (OR = 2.87, 95 % CI = 2.28 – 3.64, p < 0.001). Additionally, marginalised respondents were more likely to report facing systemic access barriers pertaining to long wait times in comparison to non-marginalised respondents (RRR = 3.69, 95% CI = 2.52– 5.40, p < 0.001).    Conclusion This thesis observes that individuals who see themselves as marginalised invariably encounter amplified systemic obstacles when seeking primary healthcare services. Public health policies in the Nordics aimed at increasing accessibility have not conclusively resulted in an improved accessibility among marginalised communities. Thus, a re-evaluation of policies aimed at improving primary healthcare access is necessary.

This study addresses the healthcare needs of employees and their families living in the Kruger National Park (KNP). A quantitative, explorative, descriptive research design was used to interview respondents who comprised of 75 male and female employees with children of various ages. The findings revealed that physical, psychological, environmental, socio-cultural, and behavioural needs of the employees and their families living in the KNP is probably unattainable as healthcare services are poorly distributed throughout the KNP, being mostly concentrated in the main camp of Skukuza. A number of respondents indicated that they required consultations about psychological and socio-cultural stresses in their lives. These services are not available in the KNP. / Health Studies / M.A. (Health Studies)

Résumé : Objectif : Identifier les facteurs associés avec le succès d’une intervention multidisciplinaire de prise en charge et de prévention des maladies chroniques dans un contexte de soins de santé de première ligne. Devis : Étude corrélationnelle prédictive d’analyse secondaire des données du projet PR1MaC, un essai randomisé contrôlé analysant les effets d’une intervention intégrant un programme de prise en charge et de prévention Contexte : Huit cliniques de soins de première ligne de la région Saguenay-Lac-Saint-Jean. Participants : un échantillon de 160 patients (52,5% d’hommes) référés par des professionnels de première ligne. L’analyse a porté sur le groupe intervention seulement. Mesure de résultats primaire : Mesure d’amélioration significative dans les huit domaines du «Health Education Impact Questionnaire». Résultat : L’analyse de régression multivariée a démontré qu’être plus jeune, être célibataire et avoir un salaire plus bas a mené à plus d’amélioration au niveau du domaine « Bien-être émotionnel »; avoir de bonnes habitudes alimentaires et cibler moins de facteurs de risque durant l’intervention a mené à plus d’amélioration au niveau du domaine « Approches et attitudes constructives »; être plus jeune, avoir plus de temps de contact avec les professionnels et avoir une concertation des professionnels a mené à plus d’amélioration dans le domaine « Approches et attitudes constructives »; avoir plus de temps de contact avec les professionnels a aussi eu une influence sur l’amélioration du domaine « Engagement positif et actif dans la vie » et avoir un plus grand nombre de professionnels intervenant chez une même personne a démontré plus d’amélioration dans le domaine « Acquisition des techniques et habiletés ». Aucun facteur prédictif n’a pu être identifié pour les domaines « Comportements de santé », « Intégration sociale et soutien » et « Auto-surveillance et discernement ». Seulement les résultats statistiquement significatifs sont présentés (valeur p ≥ 0,05). La petite taille de l'échantillon ainsi que la possibilité d'une perte de signification des résultats après certains ajustements statistiques suggèrent que ces observations devraient faire l'objet d'une validation plus approfondie dans d'autres études. Conclusion : La tentative d’identification des facteurs prédictifs de résultats de cette recherche contribue à la compréhension des mécanismes complexes de l’efficacité et offre des pistes quant à l’optimisation des programmes de prévention et de gestion des maladies chroniques. // Abstract : Context : Research on the factors associated with the successes of chronic disease prevention and management (CDPM) interventions is scarce. Objectives : To identify the factors associated with the successes of an interprofessional CDPM intervention among adult patients in primary healthcare (PHC) settings. Design : Secondary analysis of data from the PR1MaC project; a pragmatic randomized controlled trial looking at the effects of an intervention involving the integration of CDPM services in PHC. Settings : Eight PHC practices in the Saguenay - Lac - Saint - Jean region of Quebec, Canada. Participants : A sample of 160 patients (84 males) referred by PHC providers constituted the sample (mean age 52.66 ± 11.5 years); 98.5% presented two or more chronic conditions analysis focused on the intervention arm sample only. Main and secondary outcome measures : Dichotomic substantive improvement in the eight domains of the Health Education Impact questionnaire (hei Q) measured at baseline and three months later. Results : Multivariate logistic regression analysis showed that being younger, being single and having a lower family income led to a better improvement in the emotional wellbeing domain; having healthy eating habits and less objectives during the intervention led to improvement in the constructive attitudes and approaches domain; being younger, a longer intervention and a consensus of professionals led to improvement in the health services navigation domain; a longer intervention led to improvement in the positive and active engagement in life domain and having more professionals involved led to improvement in the Skills and techniques acquisition domain. No predictive factors were identified for the Health - directed behaviour, Social interaction and support and S elf - monitoring and insight domains. Only significant results are presented here (p - value ≥ 0.05). The small sample and the lost of significance after statistical adjustments suggest that observations should be validated by other studies. Conclusion: In an attempt to make causal inferences in regards to improvement, this research contributes to the understanding of the complex mechanisms of efficiency and provides information about the optimisation of CDPM program delivery.

Introdução: A Vigilância Alimentar e Nutricional (VAN) é um conjunto de estratégias de Vigilância em Saúde, incluindo o Sistema Nacional de Vigilância Alimentar e Nutricional (SISVAN), para monitorar e analisar continuamente as condições alimentares e nutricionais da população usuária do Sistema Único de Saúde (SUS), com o objetivo de subsidiar ações, programas e políticas. Objetivos: Descrever a produção científica brasileira recente sobre VAN e analisar em que medida a concepção presente nos trabalhos se aproxima do conceito estabelecido na Política Nacional de Alimentação e Nutrição (2012); e descrever as coberturas da avaliação do estado nutricional e do consumo alimentar da população usuária de serviços públicos de saúde registrada no SISVAN Web, entre 2008 e 2013. Métodos: O presente estudo está organizado em dois eixos metodológicos: uma revisão bibliográfica sobre o conceito de VAN presente na produção científica brasileira recente e dois estudos originais ecológicos com descrição das coberturas da avaliação do estado nutricional e do consumo alimentar a partir dos dados do SISVAN Web. Resultados: Na revisão bibliográfica, foram identificados artigos majoritariamente voltados para a análise de inquéritos populacionais, com menor contribuição sobre sistemas de informação em saúde e avaliação de serviços de saúde. Nos estudos originais, a cobertura total média do estado nutricional no Brasil variou de 9,78 por cento a 14,92 por cento ; e a do consumo alimentar variou de 0,13 por cento a 0,41 por cento . Ambas apresentaram tendência estatisticamente significativa de aumento e diferenças entre as unidades da federação e macrorregiões. Verificou-se a priorização da VAN voltada para o público materno-infantil, a proveniência dos dados de estado nutricional relacionada ao público prioritário do Programa Bolsa Família, e de consumo alimentar relacionada à presença de nutricionistas na Atenção Básica. Conclusão: Apresenta-se um panorama da produção científica recente sobre VAN e do acompanhamento do estado nutricional e do consumo alimentar nos serviços de saúde brasileiros, desvelando contextos em que recursos precisam ser mobilizados para melhoria da VAN. / Introduction: The Food and Nutrition Surveillance (FNS) is a set of surveillance strategies within the Health Surveillance, which includes the National Food and Nutrition Surveillance System (Sistema Nacional de Vigilância Alimentar e Nutricional - SISVAN), that aims at continuously monitoring and analyzing the food and nutritional status of the population attended by the Brazilian National Health System (Sistema Único de Saúde - SUS) and supporting actions, programs and policies. Objectives: to describe the Brazilian scientific literature on FNS and analyze to what extent the studies approach is linked/associated to the concept of the National Food and Nutrition Policy (2012); to analyze the coverage of the assessment of the nutritional status and the food intake of the users of the public health services registered on the Web SISVAN between 2008 and 2013. Methods: This study is organized in two methodological axes: a literature review on the concept of FNS present in recent Brazilian scientific production and two original ecological studies describing the assessment of the coverage of the nutritional status and food intake from the Web SISVAN data. Results: In the literature review, we found that the papers were mainly focused on the analysis of population surveys with smaller contribution of studies on health information systems and evaluation of health services. In the original studies, the average full coverage in Brazil ranged from 9.78 per cent to 14.92 per cent for the nutritional status and from 0.13 per cent to 0.41 per cent for the food intake. Both showed statistically significant trends of increase and differences between the Brazilian Federal Units and macro-regions. The FNS was prioritized for mother-child pairs, priority public of the Bolsa Familia Program, in the case of nutrition status data, and related to the presence of nutritionists in the primary healthcare services, in the case of food intake data. Conclusion: We presented an overview of recent scientific literature on FNS and of the monitoring of nutritional status and food intake in the Brazilian health services, revealing contexts where resources need to be mobilized to improve the FNS.

Analisamos a possibilidade de oferta de ações integrais em saúde em um serviço de Atenção Primária na região oeste do município de São Paulo. Esse serviço atende à uma comunidade indígena da etnia Pankararu, residente na favela Real Parque no bairro do Morumbi, através de uma equipe específica da Estratégia Saúde da Família (ESF). Verificamos em que medida o exame de relatos de profissionais e usuários indígenas deste serviço básico de saúde poderia identificar a atenção integral às necessidades de uma comunidade específica. Utilizamos a metodologia qualitativa e examinamos 05 entrevistas realizadas a sujeitos chave, contendo profissionais e usuários indígenas, liderança indígena e profissionais não indígenas. Estas entrevistas foram realizadas por pesquisadores da pesquisa \"Caminhos da Integralidade\" e sua utilização foi autorizada para nosso estudo. Na análise e interpretação dos dados utilizamos a análise de conteúdo segundo BARDIN. Classificamos o material em quatro categorias pré-definidas segundo os sentidos atribuídos à noção de Integralidade: 1) como boa Medicina, 2) como modo de organizar as práticas de saúde, 3) como demandas específicas e 4) como construção de projetos de felicidade. Identificamos nos relatos expressões favoráveis e desfavoráveis para uma atenção integral à saúde em cada categoria. Destacamos como variáveis favoráveis: o acesso \"diferenciado\" dos indígenas aos serviços de saúde; a importância da formação profissional e o interesse individual de aproximação com a cultura indígena; e a possibilidade de articulação entre serviços de atendimento ao indígena nos diferentes níveis de atenção. Como variáveis desfavoráveis: a equipe de saúde indígena tomada como \"privilégio\"; a falta de abertura para expressões culturais no encontro entre profissional e usuário indígena e na relação entre profissionais indígenas e não indígenas; a falta de conhecimento sobre a etnia assistida; dificuldades entre as especificidades da equipe indígena e os protocolos seguidos pela equipe Estratégia Saúde da Família. Constatamos um paradoxo essencial em nossa pesquisa: a presença da equipe de saúde indígena facilitou o acesso dos Pankararu às ações de saúde, mas nem sempre, os profissionais consideraram a diversidade cultural na abordagem individual/coletiva ou a inclusão do sistema tradicional indígena de cura (Encantados) na assistência a esse grupo étnico. Percebemos também que os profissionais dessa equipe não dispunham de protocolos e de uma padronização específica da rotina de trabalho para a atenção ao indígena. Defendemos que identificar variáveis que apontam distanciamento das práticas de saúde da ideia de integralidade é essencial para investirmos nas mudanças necessárias para uma boa prática em saúde. Concluímos que a integração e a coordenação de diferentes saberes é um bom caminho para construir projetos de felicidade e encontros interativos em serviços de saúde. / In this study we analyzed the possibility of offering comprehensive healthcare in a primary healthcare service in the western area of São Paulo city. This service assists an indigenous community of the Pankararu ethnicity residing in Real Parque slum, in Morumbi neighborhood. We analysed the extent to which the assessment of reports given by health professionals and indigenous users of a basic healthcare center may identify the comprehensive attention dedicated to the needs of a specific community. We used qualitative methods and analyzed five interviews given by key subjects, namely professionals and indigenous users, indigenous leaders and non-indigenous professionals. Those interviews were conducted by a research group called \"Paths to Comprehensiveness, which has authorized the use of their material for this study. We used a content analysis method known as BARDIN to interpret the data. In doing so, we classified the material in four pre-defined categories, which relate to the meanings attributed to the notion of comprehensiveness: (1) as good practice of Medicine; (2) as a way of organizing healthcare practices; (3) as specific demands; and (4) as the development of happiness projects. We identified in the reports both favorable and unfavorable attitudes towards a comprehensive healthcare assistance for each category. We highlight as favorable variables: the \"differentiated\" access to indigenous users to the healthcare services; the importance of the professional\'s background and their personal interest in the indigenous population; and the possibility of communication among service providers specialised in indigenous users in different degrees of attention. As unfavorable variables: the indigenous health team seen as a\"privilege; the lack of communication channels for cultural concerns during meetings between a professional and an indigenous user and in the relationships between indigenous and non-indigenous professionals; the lack of knowledge about the assisted ethnical group; and difficulties between the specialties of the indigenous team and the protocols followed by the Health Strategy of the Family team. We found an essential paradox in our research: the presence of the indigenous healthcare team facilitated the access of the Pankararus to healthcare services, but the professionals did not always take into consideration the cultural diversity in the process of providing individual or collective care; neither did they consider the inclusion of the traditionally indigenous system of cure (the Enchanted) when assisting that ethnic group. We further noticed that the professionals of that team did not use any protocols or a specific standardization of their practices when assisting the indigenous. We defend the notion that identifying variables that broaden the gap between healthcare practices and the idea of Comprehensiveness is essential for us to invest in the changes that will be necessary for good healthcare practices. Our conclusion is that the integration and the coordination of different knowledge is a good way to build projects of happiness and integrative encounters in healthcare services.

Analisamos a possibilidade de oferta de ações integrais em saúde em um serviço de Atenção Primária na região oeste do município de São Paulo. Esse serviço atende à uma comunidade indígena da etnia Pankararu, residente na favela Real Parque no bairro do Morumbi, através de uma equipe específica da Estratégia Saúde da Família (ESF). Verificamos em que medida o exame de relatos de profissionais e usuários indígenas deste serviço básico de saúde poderia identificar a atenção integral às necessidades de uma comunidade específica. Utilizamos a metodologia qualitativa e examinamos 05 entrevistas realizadas a sujeitos chave, contendo profissionais e usuários indígenas, liderança indígena e profissionais não indígenas. Estas entrevistas foram realizadas por pesquisadores da pesquisa \"Caminhos da Integralidade\" e sua utilização foi autorizada para nosso estudo. Na análise e interpretação dos dados utilizamos a análise de conteúdo segundo BARDIN. Classificamos o material em quatro categorias pré-definidas segundo os sentidos atribuídos à noção de Integralidade: 1) como boa Medicina, 2) como modo de organizar as práticas de saúde, 3) como demandas específicas e 4) como construção de projetos de felicidade. Identificamos nos relatos expressões favoráveis e desfavoráveis para uma atenção integral à saúde em cada categoria. Destacamos como variáveis favoráveis: o acesso \"diferenciado\" dos indígenas aos serviços de saúde; a importância da formação profissional e o interesse individual de aproximação com a cultura indígena; e a possibilidade de articulação entre serviços de atendimento ao indígena nos diferentes níveis de atenção. Como variáveis desfavoráveis: a equipe de saúde indígena tomada como \"privilégio\"; a falta de abertura para expressões culturais no encontro entre profissional e usuário indígena e na relação entre profissionais indígenas e não indígenas; a falta de conhecimento sobre a etnia assistida; dificuldades entre as especificidades da equipe indígena e os protocolos seguidos pela equipe Estratégia Saúde da Família. Constatamos um paradoxo essencial em nossa pesquisa: a presença da equipe de saúde indígena facilitou o acesso dos Pankararu às ações de saúde, mas nem sempre, os profissionais consideraram a diversidade cultural na abordagem individual/coletiva ou a inclusão do sistema tradicional indígena de cura (Encantados) na assistência a esse grupo étnico. Percebemos também que os profissionais dessa equipe não dispunham de protocolos e de uma padronização específica da rotina de trabalho para a atenção ao indígena. Defendemos que identificar variáveis que apontam distanciamento das práticas de saúde da ideia de integralidade é essencial para investirmos nas mudanças necessárias para uma boa prática em saúde. Concluímos que a integração e a coordenação de diferentes saberes é um bom caminho para construir projetos de felicidade e encontros interativos em serviços de saúde. / In this study we analyzed the possibility of offering comprehensive healthcare in a primary healthcare service in the western area of São Paulo city. This service assists an indigenous community of the Pankararu ethnicity residing in Real Parque slum, in Morumbi neighborhood. We analysed the extent to which the assessment of reports given by health professionals and indigenous users of a basic healthcare center may identify the comprehensive attention dedicated to the needs of a specific community. We used qualitative methods and analyzed five interviews given by key subjects, namely professionals and indigenous users, indigenous leaders and non-indigenous professionals. Those interviews were conducted by a research group called \"Paths to Comprehensiveness, which has authorized the use of their material for this study. We used a content analysis method known as BARDIN to interpret the data. In doing so, we classified the material in four pre-defined categories, which relate to the meanings attributed to the notion of comprehensiveness: (1) as good practice of Medicine; (2) as a way of organizing healthcare practices; (3) as specific demands; and (4) as the development of happiness projects. We identified in the reports both favorable and unfavorable attitudes towards a comprehensive healthcare assistance for each category. We highlight as favorable variables: the \"differentiated\" access to indigenous users to the healthcare services; the importance of the professional\'s background and their personal interest in the indigenous population; and the possibility of communication among service providers specialised in indigenous users in different degrees of attention. As unfavorable variables: the indigenous health team seen as a\"privilege; the lack of communication channels for cultural concerns during meetings between a professional and an indigenous user and in the relationships between indigenous and non-indigenous professionals; the lack of knowledge about the assisted ethnical group; and difficulties between the specialties of the indigenous team and the protocols followed by the Health Strategy of the Family team. We found an essential paradox in our research: the presence of the indigenous healthcare team facilitated the access of the Pankararus to healthcare services, but the professionals did not always take into consideration the cultural diversity in the process of providing individual or collective care; neither did they consider the inclusion of the traditionally indigenous system of cure (the Enchanted) when assisting that ethnic group. We further noticed that the professionals of that team did not use any protocols or a specific standardization of their practices when assisting the indigenous. We defend the notion that identifying variables that broaden the gap between healthcare practices and the idea of Comprehensiveness is essential for us to invest in the changes that will be necessary for good healthcare practices. Our conclusion is that the integration and the coordination of different knowledge is a good way to build projects of happiness and integrative encounters in healthcare services.

Introdução: A Vigilância Alimentar e Nutricional (VAN) é um conjunto de estratégias de Vigilância em Saúde, incluindo o Sistema Nacional de Vigilância Alimentar e Nutricional (SISVAN), para monitorar e analisar continuamente as condições alimentares e nutricionais da população usuária do Sistema Único de Saúde (SUS), com o objetivo de subsidiar ações, programas e políticas. Objetivos: Descrever a produção científica brasileira recente sobre VAN e analisar em que medida a concepção presente nos trabalhos se aproxima do conceito estabelecido na Política Nacional de Alimentação e Nutrição (2012); e descrever as coberturas da avaliação do estado nutricional e do consumo alimentar da população usuária de serviços públicos de saúde registrada no SISVAN Web, entre 2008 e 2013. Métodos: O presente estudo está organizado em dois eixos metodológicos: uma revisão bibliográfica sobre o conceito de VAN presente na produção científica brasileira recente e dois estudos originais ecológicos com descrição das coberturas da avaliação do estado nutricional e do consumo alimentar a partir dos dados do SISVAN Web. Resultados: Na revisão bibliográfica, foram identificados artigos majoritariamente voltados para a análise de inquéritos populacionais, com menor contribuição sobre sistemas de informação em saúde e avaliação de serviços de saúde. Nos estudos originais, a cobertura total média do estado nutricional no Brasil variou de 9,78 por cento a 14,92 por cento ; e a do consumo alimentar variou de 0,13 por cento a 0,41 por cento . Ambas apresentaram tendência estatisticamente significativa de aumento e diferenças entre as unidades da federação e macrorregiões. Verificou-se a priorização da VAN voltada para o público materno-infantil, a proveniência dos dados de estado nutricional relacionada ao público prioritário do Programa Bolsa Família, e de consumo alimentar relacionada à presença de nutricionistas na Atenção Básica. Conclusão: Apresenta-se um panorama da produção científica recente sobre VAN e do acompanhamento do estado nutricional e do consumo alimentar nos serviços de saúde brasileiros, desvelando contextos em que recursos precisam ser mobilizados para melhoria da VAN. / Introduction: The Food and Nutrition Surveillance (FNS) is a set of surveillance strategies within the Health Surveillance, which includes the National Food and Nutrition Surveillance System (Sistema Nacional de Vigilância Alimentar e Nutricional - SISVAN), that aims at continuously monitoring and analyzing the food and nutritional status of the population attended by the Brazilian National Health System (Sistema Único de Saúde - SUS) and supporting actions, programs and policies. Objectives: to describe the Brazilian scientific literature on FNS and analyze to what extent the studies approach is linked/associated to the concept of the National Food and Nutrition Policy (2012); to analyze the coverage of the assessment of the nutritional status and the food intake of the users of the public health services registered on the Web SISVAN between 2008 and 2013. Methods: This study is organized in two methodological axes: a literature review on the concept of FNS present in recent Brazilian scientific production and two original ecological studies describing the assessment of the coverage of the nutritional status and food intake from the Web SISVAN data. Results: In the literature review, we found that the papers were mainly focused on the analysis of population surveys with smaller contribution of studies on health information systems and evaluation of health services. In the original studies, the average full coverage in Brazil ranged from 9.78 per cent to 14.92 per cent for the nutritional status and from 0.13 per cent to 0.41 per cent for the food intake. Both showed statistically significant trends of increase and differences between the Brazilian Federal Units and macro-regions. The FNS was prioritized for mother-child pairs, priority public of the Bolsa Familia Program, in the case of nutrition status data, and related to the presence of nutritionists in the primary healthcare services, in the case of food intake data. Conclusion: We presented an overview of recent scientific literature on FNS and of the monitoring of nutritional status and food intake in the Brazilian health services, revealing contexts where resources need to be mobilized to improve the FNS.

Improving the quality of newborn care services and accelerating the service utilization of sick young infants is required to contribute to the reduction of neonatal mortality and improve the wellbeing of the newborns. The purpose of this study was to explore the effectiveness of neonatal healthcare services in the primary healthcare units in the north-west of Ethiopia and develop guideline for effective neonatal care. A mixed method approach with a sequential explanatory design was employed to explore factors affecting the effectiveness of the neonatal healthcare services. Interviewer-administered questionnaires were administered to 221 health workers and health extension workers in 142 health facilities; and service statistics abstracted for 767 sick young infants’ from the sick young infant registers. Data was entered in the EpiData 3.1, exported to SPSS and STATA for analysis. In the qualitative study, twenty-six participants from the health centers and health posts were interviewed through focus group discussions. Thematic analysis was undertaken to explore factors affecting neonatal healthcare services. Results: The quality of newborn care with the domains of newborn resuscitation, follow-up care after resuscitation and thermal care; immediate care and breastfeeding advice for very low birthweight babies were found to be moderate at primary hospitals and urban health centres; low at rural health centres and health posts. The availability of essential equipment is significantly associated with the quality of neonatal care provision in the health facilities (p < 0.05). More than forty percent of health facilities were not meeting the quality of case management tasks for sick young infants, and the newborn care knowledge of health providers is significantly associated with the quality of sick young infants’ management (p < 0.05). The sick young infants’ service utilisation was only 6.3 percent from the expected sick young infants’ population. Overall, the effectiveness of the neonatal healthcare services has a significant association with the health facilitates readiness [95%CI: 0.134-0.768]. Conclusion: The quality of neonatal healthcare provision is low to moderate; and the service utilization of sick young infants is very low. Thus, the rural health centers and health posts should be prioritised for the effective neonatal care. / Health Studies / D. Litt. et Phil. (Health Studies)