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The World Health Organization (WHO) recommends a companion of choice during labor and birth, to improve maternal and perinatal outcomes and women's satisfaction with health services. To better understand the status of companion of choice in Latin America and the Caribbean (LAC), an online survey was conducted with members of a midwifery virtual community of practice and with key informants, aiming to identify: 1) existing regulatory instruments related to companion of choice in the countries where the members are practicing; and, 2) key characteristics of implementation of companion of choice, where regulation exists. Responses (n = 112) were received from representatives of 20 of the 43 countries of LAC. Respondents reported existence of a national policy or legislation in seven countries, ministerial norms or institutional protocols in five countries, and no existing policy/protocol in eight countries. Respondents from the same country often provided contradictory responses. Responses differed from information provided by ministries of health in a WHO-led global policy survey in 11 instances. These variations may reflect that midwives were not always aware of the national policy/guideline in their country. We propose that a more robust effort should be undertaken to understand the status of companion of choice for labor and birth in LAC countries, at national, regional, and local level, in public and private facilities. It is important to know if policies exist, at what level of the system, and if key stakeholders, maternity-care health providers, and women are aware of their existence. Efforts should also be made to understand barriers to implementing companion of choice. [ABSTRACT FROM AUTHOR]

Objective. To validate an instrument to evaluate the level of satisfaction of hypertensive adults with hypertension control services in the context of primary health care in Brazil. Methods. The study was carried out in 2009, in two municipalities located in Northeast Brazil. A probabilistic sample of 725 adults was selected among participants of the Ministry of Health hypertension control program (Hiperdia). Sixty-five Likert-like items were initially developed guided by the Primary Care Assessment Tool (PCATool), distributed in eight primary care dimensions (health status of confirmed hypertension case, access to diagnosis, access to treatment, adherence, services provided, coordination, focus on family, and community guidance). The process of validation covered consultation with specialists, validation of the Likert-like choices, exploratory factorial analysis, analysis of internal consistency, and confirmatory factorial analysis. Results. Forty-five items that satisfied all criteria were confirmed and used in the final scale. The instrument's validation study revealed high overall internal consistency (Cronbach α = 91.5%) and high internal consistency in each of the eight dimensions (> 70%). All reliability and validity indicators show that the evaluation of user satisfaction level with the proposed instrument is valid and reliable. Conclusions. The proposed instrument can be reproduced and used with adult hypertensive individuals receiving primary health care in other regions of Brazil. [ABSTRACT FROM AUTHOR]

Objective. To assess the perception of patients with chronic hemiplegia regarding the use of assistive walking devices (AWD). Methods. Twenty-three individuals who met the inclusion criteria and used AWD were recruited from a database of 360 stroke survivors. Their mean age was 58.4 years, mean time since stroke was 80.8 months, and mean time using AWD was 67.6 months. To assess the participantsf perception, was used a standardized questionnaire covering the impact of AWDs on five aspects: weight-bearing on the paretic limb; ability to move the paretic limb; confidence; safety; and walking style. Possible answers were "improved", "unchanged", or "decreased". Results. Fourteen individuals used canes and nine used elbow crutches; 21 (91.3%) used AWDs on public roads and only two (8.7%) used AWDs at home. The perception regarding the use of AWDs were positive in the first four questions (6.87 < X2 < 29.83; 0.0001 < P ≤ 0.03), with reports of improvement in weight-bearing (82.6%), ability to move the paretic limb (39.1%), confidence (82.6%), and safety (86.9%). No significant differences were found in terms of walking style (X2 = 1.09; P = 0.30). Conclusions. The perception of chronic hemiplegic subjects regarding the use of AWD were positive, suggesting that these devices can improve mobility and independence in activities of daily living. [ABSTRACT FROM AUTHOR]

In recent decades, the international scientific community has become increasingly interested in the concept of quality of life. One of the most important implications of the focus on quality of life is a shift from "cure" to "a guarantee of a better life" as a health care goal, as well as the inclusion of individuals' preferences for certain health states in the decision-making process associated with treatments, diagnostic strategies, and health spending. This is especially important as the prevalence of chronic diseases increases as a result of the aging of the population. This piece describes the main concepts and applications related to this new health paradigm, including quality of life itself, utility measures, quality-adjusted life years (QALYs), and health decision analysis. [ABSTRACT FROM AUTHOR]