Basic life support training with high schools’ teachers in Bahia, Brazil: an experimental study

Background

Early performing of cardiopulmonary resuscitation is the cornerstone of survival in out-of-hospital cardiac arrest, doubling the odds of survival when correctly performed. The American Heart Association and the European Resuscitation Council advocate for training the entire population in order to enable a quick and effective response to out-of-hospital cardiac arrests, improving its outcomes. In primary healthcare settings the health workers can act as trainers, using the family and territorial approach to deliver basic life support (BLS) basis to general population, assuring that key social actors are skilled enough to aid community when needed. This study aims to compare the knowledge and practice skill of high school teachers before and after a BLS training delivered by health workers and students in a primary healthcare setting.

Methods

Teachers of three public high schools in Bahia, Brazil were assessed by a test for theoretical and practical skill in BLS and then trained by a group of primary care workers and students. Training included a 20min lecture and 40min practice session in a simulated scenario. After the training the teachers were assessed with the same test for theoretical and practical skill. A paired-samples T test was used to detect the difference in the mean total score before and after the training, with a significance level of 0.05 (two-sided test) and 95% confidence interval.

Results

The mean total score after the BLS training (8.2 ± 1.5) was significantly higher (p < 0.000) from before training (4.5 ± 1.7).

Conclusions

The high school teachers were unable to deliver proper cardiopulmonary resuscitation before the intervention. Following a BLS training a significant immediate improvement in the knowledge and practical skill was detected. Health workers were able to achieve these results in a primary healthcare setting. Further studies should assess this outcome with larger samples, evaluating the retention of knowledge and skills provided.

Key messages

Basic life support training can be delivered to general population by health workers in primary healthcare settings in order to improve the outcomes to out-of-hospital cardiac arrests. Teachers and health workers can act as key actors in intersetorial health-education initiatives, promoting the health of their communities.

Funding models and expenditures with primary healthcare in Salvador, Bahia, Brazil metropolitan area

Background

The government investments in quality primary healthcare are the basis to strengthening the health systems and monitoring the public expenditure in this area is a way to assess the effectiveness and efficiency of the public health policies. The Brazil Ministry of Health changed, in 2017, the method of onlending federal resources to states and cities seeking to make the public funds management more flexible. This change, however, suppressed mandatory investments in primary healthcare. This research aims to determine the difference of expenditures on primary healthcare in Salvador, Bahia, Brazil metropolitan area before and after this funding reform, seeking to verify how it can impact the quality of primary healthcare services and programs.

Methods

This is an ecological time-series study that used data obtained in the Brazil Ministry of Health budget reports. The median and interquartile range of expenditures on primary healthcare (set as the percentage of total public health budget applied in primary care services and programs) of the 13 cities in the Salvador metropolitan area were compared two years before and after the reform.

Results

The median of expenditures on primary healthcare in Salvador metropolitan area was 25.5% (13,9% - 32,2%) of total public health budget before and 24.8% (20.8% - 30.0%) of total public health budget after the reform (-0.7% difference). Seven cities decreased the expenditures on primary healthcare after the reform, ranging from 1.2% to 10.8% reduction in the primary healthcare budget in five years.

Conclusions

Expenditures on primary healthcare in Salvador metropolitan area decreased after the 2017 funding reform. Seven of 13 cities reduced the government investments on primary healthcare services and programs in this scenario. Although the overall difference was -0.7%, the budget cuts ranged from 1.2% to 10.8% in the analyzed period and sample. More studies should assess these events in wide areas and with long time ranges.

Key messages

Public health funding models can impact the primary healthcare settings regardless of the health policy. Reforms in the funding models should consider the possible benefits before implementation. Funding models and methods that require mandatory investments in primary healthcare may be considered over more flexible ones.

Mechanisms of security based on digital certificates applied in a telemedicine network

The medical patient's information is private and extremely sensitive. This information has to be stored and transmitted carefully because it can be exposed to a series of threats and it is necessary to be protected. This research contemplates the security mechanisms based on digital certificates applied to a pilot telemedicine network, that guarantees the confidentiality, integrity and availability of the medical information of the patients for the hospitable centers involved. The prototype telemedicine network will interconnect hospitals in the municipalities of Baruta and Hatillo Miranda State, in Venezuela by Internet, to provide and support a health care system in inaccessible areas, and the transmission of patient's biomedical signals and the health education to people through secure mechanisms such as digital certificates.

Telemedicine network physical connection design for remote areas. Case Baruta--El Hatillo

The telemedicine has increased mostly over recent years. Especially in developing countries where a high proportion of the population lives in rural areas or difficult to access. However it is successful implementation is closely connected with an appropriate design of the telecommunications network, part essential when deploying a network and the selection of appropriate communications technologies, realistic and sustainable according to the characteristics of the context in which it is deployed. This paper explain the situation of health centers in the municipalities Baruta and Hatillo in Venezuela, it proposes the design of a telemedicine network to allow interconnect the outpatient units with the referral hospital. Then it describes wireless technologies studied and finally it presents the entire design process of the network physical connection.