AbstractHistorically, self-regulation has provided some professions with power and market control. Currently, however, governments have scrutinized this approach, and priorities have shifted toward other mandates. This study examines the case of paramedics in Ontario, Canada, where self-regulation is still the dominant regulatory model for the healthcare professions but not for paramedics. Instead, paramedics in Ontario are co-regulated by government and physician-directed groups, with paramedics subordinate to both. This paper, which draws on interviews with paramedic industry leaders analyzed through the lens of institutional work, examines perspectives on the relevance of self-regulation to the paramedic professionalization project. Participants had varying views on the importance of self-regulation in obtaining professional status, with some rejecting its role in professionalization and others embracing regulatory reform. Because paramedics disagree on what being a profession means, the collective professionalization project has stalled. This research has implications for understanding the impact of intraprofessional relationships and conflict on professionalization projects.
BACKGROUND: Being responsive and adaptive to local population needs is a key principle of integrated care, and traditional top-down approaches to health system governance are considered to be ineffective. There is need for more guidance on taking flexible, complexity-aware approaches to governance that foster integration and adaptability in the health system. Over the past two decades, paramedics in Ontario, Canada have been filling gaps in health and social services beyond their traditional mandate of emergency transport. Studying these grassroots, local programs can provide insight into how health systems can be more integrated, adaptive and responsive. METHODS: Semi-structured interviews were conducted with people involved in new, integrated models of paramedic care in Ontario. Audio recordings of interviews were transcribed and coded inductively for participants' experiences, including drivers, enablers and barriers to implementation. Thematic analysis was done to ascertain key concepts from across the dataset. RESULTS: Twenty-six participants from across Ontario's five administrative health regions participated in the study. Participants described a range of programs that included acute, urgent and preventative care driven by local relationship networks of paramedics, hospitals, primary care, social services and home care. Three themes were developed that represent participants' experiences implementing these programs in the Ontario context. The first theme, adapting and being nimble in tension with system structures, related to distributed versus central control of programs, a desire to be nimble and skepticism towards prohibitive legal and regulatory systems. The second theme, evolving and flexible professional role identity, highlighted the value and challenges of a functionally flexible workforce and interest in new roles amongst the paramedic profession. The third theme, unpredictable influences on program implementation, identified events such as the COVID-19 pandemic and changing government ...
A imunização vacinal é um dos meios mais eficazes na redução de morbimortalidade por doenças consideradas imunopreveníveis, sendo importante para a biossegurança de estudantes de Medicina. O objetivo deste estudo foi realizar o levantamento epidemiológico referente às imunizações contra hepatite B e tétano de estudantes de Medicina de Volta Redonda, RJ. Foi aplicado um questionário validado em 202 estudantes, sendo os mesmos distribuídos entre o 2º, 6º, 9º e 11º semestres do curso de Medicina de Volta Redonda, regularmente matriculados no ano de 2018. Foi constatado que 38,1% do total de alunos desconheciam sua situação vacinal quanto à vacinação contra hepatite B. O desconhecimento dessa vacinação foi reduzido no decorrer do curso, sendo o valor de 58% dos alunos do segundo semestre contra 11% no décimo primeiro semestre. A porcentagem de alunos com o reforço da vacina contra o tétano desatualizada (última dose há mais de 10 anos) variou de 20% no nono semestre a 11% no sexto e décimo primeiro semestres. Os resultados obtidos são consistentes com a literatura e mostram um notável desconhecimento dos estudantes quanto à atualização das vacinas contra hepatite B e tétano. Faz-se necessário o planejamento de ações de saúde nas instituições médicas de educação, principalmente, através da obrigatoriedade legal de controle do estado de saúde dos estudantes, visando à maximização da cobertura imunológica. Palavras-chave: Vacinação. Cobertura Vacinal. Tétano. Hepatite Viral Humana. AbstractVaccine immunization is one of the most effective means of reducing morbidity and mortality by diseases considered to be immunopreventable and is important for the biosafety of Medicine students. Objective to carry out the epidemiological survey regarding immunizations against hepatitis B and tetanus of Medicine students from Volta Redonda, RJ. Methods: A validated questionnaire was applied to 202 students, being distributed among the 2nd, 6th, 9th and 11th semesters of the Medicine course of Volta Redonda, regularly enrolled in 2018. Results: It was found that 38.1% of the total number of students did not know their vaccination status regarding hepatitis B vaccination. The lack of knowledge about this vaccination was reduced during the course, with 58% of the students in the second semester being 11% in the eleventh semester. The percentage of students with the outdated tetanus booster (last dose for more than 10 years) ranged from 20% in the ninth semester to 11% in the sixth and eleventh semesters. Discussion: Our results are consistent with the literature and show a notable lack of knowledge of the students regarding the update of hepatitis B and tetanus vaccines. Conclusion: It is necessary to plan health actions in medical educational institutions, mainly through the legal obligation to control the students' health status, aiming at maximizing immunological coverage. Keywords: Vaccination. Vaccination Coverage. Tetanus. Viral Human Hepatitis.
Objetivo: investigar o perfil epidemiológico e clínico das pessoas com feridas complexas na Atenção Primária à Saúde em uma região no Norte do Brasil. Método: estudo observacional, transversal, realizado com 42 participantes, em uma unidade básica de saúde no Norte, Amazônia, Brasil. Foram utilizados dois instrumentos, um sociodemográfico e outro clínico para caracterização da amostra e acompanhamento da lesão. Resultado: predomínio de pessoas do sexo masculino, média de idade de 53,2 (±11) anos, residentes em bairros distantes da unidade básica; 18 (42,9%) declaram ter diagnóstico de diabetes e hipertensão e 14 (33,3%) diabetes. Sobre a cicatrização, 11 tiveram área reduzida da lesão em 80 a 99% no período de 45 dias. Conclusão: predomínio de Úlcera de Pé Diabético. Na avaliação das características clínicas, constatou-se redução significativa na área da ferida. A investigação do perfil de pessoas com feridas complexasesfera da Atenção Primária à Saúde contribui para o planejamento de ações, subsidiando o seguimento nesse serviço, a prática cuidativa do (a) enfermeiro (a) e demais profissionais da equipe.
