Yes / Clinical guidelines are an integral part of healthcare. Whilst much progress has been made in ensuring that guidelines are well developed and disseminated, the gap between routine clinical practice and current guidelines often remains wide. A key reason for this gap is that implementation of guidelines typically requires a change in the behaviour of healthcare professionals – but the behaviour change component is often overlooked. We adopted the Theoretical Domains Framework Implementation (TDFI) approach for supporting behaviour change required for the uptake of a national patient safety guideline to reduce the risk of feeding through misplaced nasogastric tubes.

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.

L’évolution du système de pharmacovigilance au Nigéria a été associée à une croissance modeste et les hôpitaux universitaires ont été identifiés comme des partenaires importants du système de pharmacovigilance. Cependant, aucune étude n'a encore été réalisée sur les performances du système de pharmacovigilance dans les hôpitaux universitaires nigérians. Cette étude visait à évaluer l'état de la pharmacovigilance, en particulier les réactions indésirables aux médicaments dans le sud et le sud du Nigéria, en se référant à des médicaments sélectionnés. Le système de pharmacovigilance ainsi que le schéma posologique des médicaments ont été évalués à l'aide des indicateurs de pharmacovigilance de base de l'OMS et des indicateurs de prescription de base de l'OMS, respectivement. Cela a été suivi d'une intervention éducative avec des messages texte envoyés via le système de messagerie courte (SMS) pour améliorer les connaissances, l'attitude et la pratique de la pharmacovigilance parmi les professionnels de la santé. Le nombre, la qualité et le profil des effets indésirables du médicament ont également été évalués avant et après l'intervention. Les facteurs probables susceptibles de contribuer à une mauvaise notification des problèmes de pharmacovigilance ont été recherchés en effectuant une enquête sur les connaissances, la sensibilisation et les pratiques des professionnels de la santé travaillant dans la zone. Ces faiblesses de la pharmacovigilance étaient essentiellement. Les résultats ont montré que des structures étaient en place pour les activités de pharmacovigilance, même si certaines étaient peu fonctionnelles. Les indicateurs de processus et de résultat / impact ont révélé des systèmes de santé faibles et une attention générale insuffisante à la pharmacovigilance dans les hôpitaux. Il a également montré que, même si le groupe possédait une connaissance modeste et une perception juste de la pharmacovigilance, la pratique était médiocre et peu de réactions indésirables au médicament étaient répertoriées dans les bases de données des hôpitaux locaux. Celles-ci ont été attribuées à une connaissance insuffisante de la pharmacovigilance sur ce qui peut être signalé, à des processus de notification médiocres, à de fausses croyances selon lesquelles leur notification ne fera aucune différence et à la difficulté de déterminer les éléments à signaler. Une perception insuffisante de l’intérêt de la notification des effets indésirables. Les connaissances et les pratiques en matière de pharmacovigilance se sont améliorées, de même que le nombre de déclarations d'effets indésirables au médicament suite à une intervention éducative. Cette étude a également mis en évidence le profil des effets indésirables associés aux médicaments couramment utilisés dans la zone et les problèmes inhérents à la notification spontanée. Il souligne également que la pharmacovigilance, discipline en pleine croissance, peut être améliorée par des évaluations fréquentes du système, la formation des professionnels de la santé et le renforcement général du système de santé nigérian. Des études plus approfondies seraient nécessaires pour mieux évaluer la sécurité des médicaments dans cette population noire homogène. / The evolution of the pharmacovigilance system in Nigeria has been associated with modest growth and teaching hospitals have been identified as important partners in the pharmacovigilance mechanism. However, there have been no studies evaluating the performance of the pharmacovigilance system in Nigerian Teaching hospitals prior to this time. This study set out to evaluate the state of pharmacovigilance specifically adverse drug reactions in South-South Nigeria. The pharmacovigilance system as well as the prescribing pattern of medicines was evaluated using the WHO Core Pharmacovigilance indicators and WHO Core Prescribing indicators respectively. This was followed by an educational intervention with text messages sent via the Short Messaging System (SMS) to improve the knowledge, attitude and practice of pharmacovigilance amongst healthcare professionals. The number, quality and profile of Adverse Drug Reactions (ADRs) were also assessed before and after the intervention. Factors likely to contribute to poor reporting of pharmacovigilance issues were sought by conducting knowledge, awareness, and practice survey of healthcare professionals working in the zone.The findings showed that of the six teaching hospitals assessed, only three could be described as functional or partly functional although all had some structures in place for pharmacovigilance activities. The process and outcome/impact indicators revealed weak health systems and overall insufficient attention to pharmacovigilance in the hospitals as only one centre had committed their ADR reports to the National Pharmacovigilance Centre and there were few documented medicines related admissions ranging from 0.0985/1000 to 1.67/1000 admissions. It further showed that although a modest knowledge and fair perception of pharmacovigilance existed among the group, practice was poor as only 12% of the 811 healthcare Professionals had ever used the national ADR reporting form and there were few adverse drug reaction reports in the local hospital databases. These were attributed to insufficient awareness of pharmacovigilance on what can be reported, poor reporting processes, wrong beliefs that their reporting will not make a difference and difficulty in determining what to report. There was an improvement in the knowledge and practice of pharmacovigilance, with a 31.6% increase in the number of adverse drug reaction reports following an educational intervention. This study also highlighted the ADR profile to commonly used medicines in the zone and the inherent problems associated with spontaneous reporting. It further highlights that the growing discipline of pharmacovigilance can be improved through frequent assessments of the system, training of the healthcare professionals and general strengthening of the Nigerian healthcare system. More in-depth studies would be required to further evaluate the safety of medicines in the Nigerian population.

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.

Face aux problématiques d’accès, de désertification médicale et de qualité des soins, la loi « Hôpital, Patients, Santé, Territoires » (HPST), votée en 2009, représente un socle pour la réorganisation des soins primaires en France. L’accent est mis sur la collaboration entre les professionnels de santé et l’optimisation des compétences de chacun. Le pharmacien d’officine se trouve au coeur de cette loi. Grâce à son accessibilité, sa formation et sa proximité avec les patients sains comme malades, il voit l’opportunité d’étendre ses pratiques au-delà de la simple dispensation des médicaments en fournissant directement des soins au patient. Cette proposition n’est pas une exception française mais s’inspire des expériences internationales et du concept de « soins pharmaceutiques ». Le pharmacien écossais peut désormais être payé à la capitation pour délivrer des consultations pharmaceutiques lors du renouvellement d’ordonnance au patient atteint de maladie chronique; le pharmacien anglais peut prescrire des médicaments dans le cadre d’un plan de gestion clinique et recevoir un honoraire de dispensation; le pharmacien suisse peut organiser des réunions de discussion avec les médecins; et le pharmacien portugais peut vacciner son patient au sein de l’officine. Les illustrations de la diversification des pratiques du pharmacien d’officine sont donc variées et se replacent dans leur contexte national. L’enjeu est aujourd’hui de comprendre les conditions et les effets d’un ensemble d’innovations techniques, organisationnelles et sociales qui pourraient être en faveur du développement des soins pharmaceutiques en France. Ce travail de thèse a pour objectif de nourrir les débats autour de cette problématique. Un état des lieux de la profession en France et une enquête d’opinion auprès des futurs pharmaciens montrent que le contexte sanitaire, professionnel, économique est propice au développement des pratiques du pharmacien et que l’avenir des soins pharmaceutiques trouve un écho favorable auprès des pharmaciens de demain. Cependant, nombreux sont les facteurs qui peuvent constituer des obstacles à leur diffusion (Chapitres 1 et 2). D’un point de vue économique, d’après une revue de littérature systématique sur l’efficience des soins pharmaceutiques en Europe, les services de surveillance médicamenteuse, de médication officinale, de collaboration entre les professionnels de santé et de promotion de la santé pourraient être, dans certaines conditions, des interventions coût-efficaces d’un point de vue collectif (Chapitre 3). Mais qu’en est-il en France ? On ne dispose pas de travaux sur le sujet. Deux travaux originaux - une étude de cohorte (exposés/non exposés) et une analyse coût-efficacité -, que nous avons menés, se focalisant sur l’implication du pharmacien d’officine dans le dépistage d’une maladie chronique (le syndrome d’apnées du sommeil) montrent que les coûts engendrés par la mise en place d’une telle intervention sont sous certaines conditions compensés par les gains générés, et les résultats sont en faveur de l’implantation du service en pratique de routine (Chapitre 4). / Facing the issues of access, quality and proximity, the "Hospital, Patients, Health and Territories" (HPST) law, passed in 2009, constitutes a basis for the reorganization of primary care in France. The healthcare reform emphasizes on the collaboration between healthcare professionals and the optimization of their skills. The community pharmacist is on the forefront of this reform. Through its accessibility, its training and its proximity with healthy and sick patients, community pharmacists have the opportunity to broaden the scope of their practices beyond the merely dispensing of medication by delivering patient care. This proposal is not a French exception but takes inspiration from international experiences and the concept of "pharmaceutical care." The Scottish pharmacist can now be paid by capitation to renew a prescription for a patient with chronic illness; the English pharmacist can prescribe medication as part of a clinical management plan and receive a dispensing fee, the Swiss pharmacist can organize meetings with general practitioners and in Portugal, pharmacists can vaccinate a patient in the pharmacy. Pharmaceutical care practices are diversified and depend on national context. The challenge today is to understand the conditions and consequences of technical, organizational and social innovations that could be in favor of the development of pharmaceutical care in France. The objective of the thesis is to feed into the debates around this problematic. An overview of profession in France and an original opinion survey of future pharmacists show that the healthcare, professional and economic contexts are suitable to develop pharmaceutical care and future pharmacists are in favor of it. However, there are many barriers to their spread in routine practice (Chapters 1 and 2). From an economical perspective, a systematic review of the literature on the efficiency of pharmaceutical care in Europe show that drug monitoring services, prescription for minor ailments, collaboration between health professionals and health promotion interventions could be cost-effective from a collective point of view under certain conditions (Chapter 3). What about France? There is no study on this topic. We conducted two original studies - a cohort study (exposed / unexposed), and a cost-effectiveness analysis which focused on the involvement of the pharmacist in screening for chronic disease (sleep apnea syndrome). We show that the costs of implementing such an intervention are offset by the gains under certain conditions, and the results are in favor of the implementation of the service in routine practice (Chapter 4).

Esta pesquisa foi orientada por dois objetivos. O primeiro foi conhecer e analisar os sentidos atribuídos pelos usuários às mensagens dos cartazes da campanha “Empoderamento dos Pacientes”. O segundo objetivo foi analisar os fatores implicados na produção desses sentidos e sua influência na adesão dos usuários à esperada atitude vigilante frente ao profissional da saúde – no que tange à prática da higienização de mãos. O estudo, de cunho qualitativo, do tipo exploratório-descritivo, foi desenvolvido a partir de uma campanha intitulada “Empoderamento dos Pacientes”.. Essa campanha, intermediada por um cartaz fixado nas enfermarias do Hospital de Clínicas de Porto Alegre, esperava uma atitude de protagonismo dos usuários para demandar dos profissionais a higienização de mãos. A coleta das informações foi realizada por meio de entrevistas, tendo como sujeitos os usuários de uma unidade de internação do Hospital de Clínicas de Porto Alegre. A unidade escolhida foi a destinada à internação de portadores de doenças infecto-contagiosas, em sua maioria portadores de germes multirresistentes (GMR). A análise dos dados foi embasada no referencial teórico dos Estudos Culturais, articulando-se os conceitos de representação cultural e modos de endereçamento. Os resultados obtidos sugerem que a fixação do cartaz da campanha “Empoderamento dos Pacientes” na enfermaria não garante que ele será lido. Outro aspecto importante a destacar é a produção de diversas representações para a higienização de mãos, tanto como expressão quanto como ação. Por meio da análise de informações foi possível argumentar também que, no contexto estudado, os usuários portadores de GMR podem relativizar a importância da higienização de mãos em meio ao conjunto de ações de precaução de contato. A resposta do usuário à esperada atitude vigilante frente ao profissional da saúde é influenciada por diversos fatores, dentre os quais as representações da higienização de mãos, as representações dos profissionais da saúde e das relações entre esses profissionais e os usuários. / This research was driven by two main goals. The first was to find and analyze the meanings understood by users from the messages included in the “Empoderamento dos Pacientes” (Patient Empowerment) campaign posters. The second goal was to analyze the factors involved in the production of those meanings and their influence in engaging users to employ the desired vigilant attitude towards healthcare professionals to sanitize their hands. The research, of a qualitative as well as explanatory-descriptive nature, was developed based on an awareness campaign entitled “Empoderamento dos Pacientes” (Empowering Patients), which through a poster hung in the infirmary encouraged users to take a proactive attitude and demand healthcare professionals to sanitize their hands. Data was collected by means of interviews with users of one of Hospital de Clínicas de Porto Alegre's wards dedicated to the care of patients with contagious infectious diseases, most of them involving multi-resistant germs. Data analysis was based on the Cultural Studies theoretical framework, applying the concepts of cultural representation and ways of address. The results obtained suggest that the fact the "Empoderamento dos Pacientes" campaign poster was on display would not guarantee that people would actually read it. Another aspect worth mentioning is the production of different representations for the term "sanitize hands" as expression and action. After analyzing the data collected, we were able to also argue that, in the context investigated, users infected with multi-resistant germs might relativize the importance of sanitizing hands in the midst of the set of actions applied to prevention. The user response and vigilant attitude expected towards healthcare professionals were influenced by a number of factors, which include different representations of sanitizing hands, healthcare professionals and the relations between these professionals and the users. / Esta encuesta fue orientada por dos objetivos. El primer objetivo fue conocer y analizar los sentidos producidos por los usuarios a los mensajes de los carteles de la campaña “Empoderamiento de los Pacientes”. El segundo objetivo fue analizar los factores implicados en la producción de estos sentidos y su influencia en la adhesión de los usuarios a la esperada de actitud vigilante frente al profesional de la salud, en lo que se refiere a la práctica de la higienización de manos. El estudio, de cuño cualitativo, del tipo exploratoriodescriptivo , fue desarrollados a partir de una campaña titulada “Empoderamiento de los Pacientes” que, intermediada por un cartel fijado en la enfermería, esperaba una actitud de protagonismo de los usuarios para demandar de los profesionales la higienización de manos. La recolección de las informaciones se dio por medio de entrevistas, teniendo como sujetos, los usuarios de una unidad de internación del Hospital de Clínicas de Porto Alegre destinada a la internación de portadores de enfermedades infectocontagiosas, en su mayoría, portadores de gérmenes multirresistentes. El análisis de los datos se embasó en el referencial teórico de los Estudos Culturales, articulando los conceptos de representación cultural y modos de derivación. Los resultados obtenidos sugieren que la fijación del cartel de la campaña “Empoderamiento de los Pacientes” en la enfermería, no garantiza su lectura. Otro aspecto importante por destacar es la producción de diversas representaciones para la higienización de manos, como expresión y acción. Por medio del análisis de informaciones fue posible argumentar también que en el contexto estudiado, los usuarios portadores de GMR pueden relativizar la importancia de la higienización de manos en medio al conjunto de acciones de precaución de contacto. La respuesta del usuario a la esperada actitud vigilante frente al profesional de la salud es influenciada por diversos factores, entre ellos, se puede destacar las representaciones de la higienización de manos, las representaciones de los profesionales de la salud y de las relaciones entre esos profesionales y los usuarios.

This research study explores the perceived impact of multiple sclerosis on “carepartners” in committed caring relationships as the spousal roles change over time. Both quantitative and qualitative methods were used in this study of persons with MS and their spousal carers residing in Australia during ten months of recruitment. Varied recruitment methods were used including the internet. 263 expressions of interest were received, and 203 survey packets were returned with usable data (77%). The demographic instrument and 4 scales measuring mood, reciprocity, life satisfaction and functional wellness were subjected to descriptive statistical analysis. Results from the quantitative phase of the study supported many international epidemiological findings related to gender, age of onset, difficulty in obtaining a diagnosis in the light of vague early symptoms of MS, and high levels of depression in the study sample. The preliminary analysis suggested that these data should be analysed further in dyadic terms (a person with MS and their identified carer). Further inferential statistical analysis examined the data sub-set of ‘pairs only’ which helped to inform formation of a pool of couples in caring relationships from which was selected a sub-sample of 12 spousal dyads residing in Victoria for interview in the second phase of the study. / Emerging themes from narrative analysis (n=24 persons) revealed pressing concerns, personal strengths and coping strategies of interviewees. Two themes of special interest relating to (1) differing perceptions by ‘carepartners’ of the importance of cognitive changes to the dyadic relationship, and (2) expectations of health professionals are explored. Most respondents agreed that their expectations left much to be desired, suggesting that improvements could be made in the area of health care delivery to persons with MS, their carers and their families. There are implications for the development of a multidisciplinary, ongoing assessment, educational and support program for these persons. Further research is needed to define and expand the proposed role of a specialized key contact person to be a valuable ‘advocate’ in the delivery of timely health care resources throughout the disease trajectory.

This research study explores the perceived impact of multiple sclerosis on “carepartners” in committed caring relationships as the spousal roles change over time. Both quantitative and qualitative methods were used in this study of persons with MS and their spousal carers residing in Australia during ten months of recruitment. Varied recruitment methods were used including the internet. 263 expressions of interest were received, and 203 survey packets were returned with usable data (77%). The demographic instrument and 4 scales measuring mood, reciprocity, life satisfaction and functional wellness were subjected to descriptive statistical analysis. Results from the quantitative phase of the study supported many international epidemiological findings related to gender, age of onset, difficulty in obtaining a diagnosis in the light of vague early symptoms of MS, and high levels of depression in the study sample. The preliminary analysis suggested that these data should be analysed further in dyadic terms (a person with MS and their identified carer). Further inferential statistical analysis examined the data sub-set of ‘pairs only’ which helped to inform formation of a pool of couples in caring relationships from which was selected a sub-sample of 12 spousal dyads residing in Victoria for interview in the second phase of the study. / Emerging themes from narrative analysis (n=24 persons) revealed pressing concerns, personal strengths and coping strategies of interviewees. Two themes of special interest relating to (1) differing perceptions by ‘carepartners’ of the importance of cognitive changes to the dyadic relationship, and (2) expectations of health professionals are explored. Most respondents agreed that their expectations left much to be desired, suggesting that improvements could be made in the area of health care delivery to persons with MS, their carers and their families. There are implications for the development of a multidisciplinary, ongoing assessment, educational and support program for these persons. Further research is needed to define and expand the proposed role of a specialized key contact person to be a valuable ‘advocate’ in the delivery of timely health care resources throughout the disease trajectory.

Många patienter med obstruktivt sömnapnésyndrom (OSAS) som behandlas med Continuous Positive Airways Pressure (CPAP) avbryter sin behandling i ett tidigt skede. Att inte vara följsam behandlingen kan innebära olika hälsorisker för patienten som kan få allvarliga konsekvenser. Kommunikationssituationen vid det initiala utprovningsbesöket kan därför påverka huruvida patienten inte blir följsam och fullföljer behandlingen. Syftet med denna studie var att belysa hur vårdpersonal beskriver sina erfarenheter av kommunikationssituationen vid det initiala utprovningsbesöket av CPAP. En kvalitativ intervjustudie genomfördes med 23 personer som alla möter denna grupp av patienter.  Som analysmetod användes induktiv innehållsanalys. Vid analysen av materialet framkom tre kategorier; Bygga en relation, Inta ett pedagogiskt förhållningssätt samt Stödja patientens delaktighet. Dessa tre kategorier mynnade ut i ett tema som visade på hur kommunikationssituationen beskrevs Skapa förutsättning för lärande hos patienten. Studien belyser vikten av en samskapande vård och ett personcentrerat förhållningssätt där patienten ses som en partner i de beslut som tas samt hur vårdpersonalens pedagogiska förhållningssätt påverkar kommunikations-situationen på olika sätt. Erfarenheterna som beskrevs i studien upplevdes påverka patientens möjligheter till lärande i situationen för en ökad följsam till sin CPAP-behandling. / Many patients with obstructive sleep apnea syndrome (OSAS) treated with Continuous Positive Airways Pressure (CPAP) interrupt their treatment at an early stage. Not having adherence to the treatment implies various health risks for the patient that can have serious consequences. Therefore, the communicationsituation at the initial testing visit may affect whether the patient does not follow up and completes the treatment. The purpose of this study was to illustrate how healthcare professionals describe their experiences of the communicationsituation at the initial visit testing CPAP. A qualitative interview study was conducted with 23 people who all meet this group of patients. As an analytical method, inductive content analysis was used. In the analysis of the material three categories was revealed; Build a Relationship, Take an Educational Approach and Support the Patient's Participation. These three categories emerged in a theme that demonstrated how the communication situation was described as Creating a prerequisite for learning for the patient. The study highlights the importance of a person-centered approach, a co-productive care where the patient is seen as a partner in the decisions and how the healthcare professionals' pedagogical approaches affect the communicationsituation in different ways. The experiences described in the study were perceived to affect the patient's ability to learn in the situation for an increased adherence to the CPAP treatment.

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