Curso de investigación en Atención Primaria de la Salud: experiencia sobre módulo de búsqueda bibliográfica y gestores de citas / Research course in Primary Health Care: experience with the bibliographic search module and citation managers

La Federación Argentina de Medicina Familiar y General apoyó el desarrollo, la difusión y la implementación de una propuesta educativa sobre investigación en atención primaria. Consiste en 4 módulos independientes, destinado para miembros interesados/as, con 2 encuentros virtuales teórico-prácticos, que favorecieran el intercambio de opiniones y experiencias entre colegas. El objetivo del primer módulo fue proporcionar conocimiento, brindar pautas y ofrecer herramientas para la búsqueda bibliográfica y el uso de gestores de citas. Se realizó difusión mediante sociedades y redes sociales. Se incluyó una evaluación individual, que diera cuenta de lectura complementaria y la aplicación práctica de los contenidos. Se llevó a cabo en Junio, con 39 preinscripto/as, mayoritariamente residentes. Hubo 24 participantes efectivos (61%), asistieron 17 y 20 personas respectivamente, y 11 (46%) obtuvieron el certificado de aprobación por responder la consigna en tiempo y forma. En cuanto a los/as asistentes, hubo predominio de mujeres (79%), provenientes de Asociación Metropolitana de Medicina Familiar (25%), Asociación Cordobesa de Medicina Familiar y Comunitaria (16%), Asociación Misionera de Medicina General/Familiar y del Equipo de Salud (16%), Asociación Tucumana de Medicina Familiar, General y Comunitaria (12%), y otras minorías. Expresaron satisfacción, agradecimiento y reconocimiento por la actividad, destacando la buena predisposición de organizadores y equipo docente, la utilidad práctica de la temática, la evidente planificación, y el apoyo político-económico. Esta valiosa experiencia educativa (planteada como necesidad pendiente) resultó exitosa, ya que los/as participantes demostraron un alto nivel de interés, de asistencia de diferentes provincias, y de compromiso. Los certificados emitidos otorgan créditos educativos válidos para la recertificación (AU)

The Federación Argentina de Medicina Familiar y General supported the development, dissemination and implementation of an educational proposal on research in primary care. It consists of 4 independent modules, intended for interested members, with 2 virtual theoretical-practical meetings, which favored the exchange of opinions and experiences among colleagues. The objective of the first module was to provide knowledge, guidelines and tools for bibliographic search and the use of citation managers. Dissemination was carried out through societies and social networks. An individual evaluation was included, to account for complementary reading and the practical application of the contents. It was carried out in June, with 39 pre-registered participants, mostly residents. There were 24 effective participants (61%), 17 and 20 people attended respectively, and 11 (46%) obtained the certificate of approval for answering the instructions in due time and form. As for the attendees, there was a predominance of women (79%), coming from Asociación Metropolitana de Medicina Familiar (25%), Asociación Cordobesa de Medicina Familiar y Comunitaria (16%), Asociación Misionera de Medicina General/Familiar y del Equipo de Salud (16%), Asociación Tucumana de Medicina Familiar, General y Comunitaria (12%), and other minorities. They expressed satisfaction, gratitude, and recognition for the activity, highlighting the good predisposition of the organizers and teaching team, the practical usefulness of the subject matter, the evident planning, and the political-economic support. This valuable educational experience (raised as a pending need) was successful since the participants showed a high level of interest, attendance from different provinces, and commitment. The certificates issued grant educational credits valid for recertification (AU)

Monitor sanitario: experiencia de gestión y monitoreo de líneas de cuidado priorizadas en Córdoba / Health monitor: management and monitoring experience of prioritized lines of care in Córdoba

Para la gestión en salud, fortalecer la Atención Primaria como estrategia es un desafío. Esto implica coordinar los esfuerzos entre los distintos niveles de atención. En el caso de Argentina, la organización del sistema de salud divide las responsabilidades sobre cada nivel de atención en distintas jurisdicciones, quedando el primer nivel en la órbita de los municipios. En el caso de Córdoba, este escenario es particularmente complejo, ya que la descentralización del primer nivel de atención trajo consecuencias adversas, dificultando la integración de información sanitaria producida en los municipios. El Ministerio de Salud de la Provincia ha desarrollado una herramienta de monitoreo (el Monitor Sanitario) que construye indicadores de evaluación aprovechando los datos reportados por 754 efectores de salud públicos al programa Sumar. Estos indicadores se organizan por líneas de cuidado, y ya se encuentran en marcha los tableros que muestran los resultados para la línea de cuidado de personas gestantes y la de cuidado de personas con diabetes. La medición periódica de los desempeños por municipio de estas líneas se asocia a un pago por desempeño. Consideramos que esta experiencia permite mostrar la integración de esfuerzos para impactar en los tres componentes del sistema: en el modelo de atención (por definir priorización de cuidados y estimular la proactividad), en el modelo de financiamiento (al indicar las posibilidades de reporte al programa Sumar y al establecer un pago por resultados) y en el modelo de gestión (al orientar las gestiones locales a los resultados) (AU)

For health management, strengthening Primary Care as a strategy is a challenge. This implies coordinating efforts between the different levels of health care. In the case of Argentina, the health system assigns the responsibilities for each level of care to different jurisdictions, leaving the primary level of care in the orbit of the local governments. In the case of Córdoba, this scenario is particularly complex, considering the decentralization of the primary level of care brought adverse consequences, making it difficult to integrate health information produced in local governments.The Ministry of Health of the Province has developed a monitoring tool (the Health Monitor) that builds evaluation indicators taking advantage of the data reported by 754 public health effectors to Sumar program. These indicators are organized by lines of care, and there are two boards that already shows the results for pregnancy care and for people with diabetes. The periodic measurement of the performance of each local government in these lines is associated with a payment for performance.This experience shows how the integration of efforts impacts on the three components of the system: in the care model (by defining care prioritization and stimulating proactivity), in the financing model (by indicating the possibilities of reporting to Sumar program and establishing a payment for results) and in the management model (by directing local managements to results) (AU)

El cuidado prenatal y los determinantes sociales: estudio ecológico en Argentina / Prenatal care and social determinants: ecological study in Argentina

Resumen Introducción: el cuidado prenatal es un aspecto clave de salud pública, con gran impacto en la salud materna y perinatal, así como en otras etapas del ciclo vital. Sus características pueden ser variables entre y al interior de los países, y vincularse a ciertos determinantes sociales. El objetivo de este estudio fue identificar escenarios sociosanitarios del cuidado prenatal y analizar asociaciones entre determinantes sociales e indicadores sintéticos seleccionados del cuidado prenatal en Argentina (2010-2018). Metodología: se desarrolló un estudio ecológico de grupos múltiples (n = 24 jurisdicciones). Los datos se obtuvieron a partir de fuentes secundarias: última información disponible del Sistema Informático Perinatal (2018) y censo nacional (2010). Se realizó un análisis de conglomerados de tipo jerárquico y aglomerativo (método de Ward). Se ilustró la distribución espacial de los escenarios identificados y se valoraron las diferencias entre ellos mediante la prueba ANOVA. Para estimar asociaciones entre indicadores sociales e indicadores del cuidado prenatal se propusieron modelos de regresión lineal. Resultados: se identificaron cinco escenarios sociosanitarios del cuidado prenatal, que revelan heterogeneidades en la distribución de indicadores de cuidado prenatal y sociales a nivel provincial. Además, el porcentaje de hogares en situación de pobreza presentó una asociación directa, en tanto el índice de desarrollo humano y la esperanza de vida al nacer una inversa con el control prenatal insuficiente. Conclusiones: existen diferentes escenarios sociosanitarios del cuidado prenatal en Argentina y ciertas características sociales de los contextos en que residen las personas podrían subyacer a su configuración.

Abstract Introduction: the prenatal care is a key aspect in public health, with great impact in maternal and perinatal health, as well as in other stages of the life cycle. The features of the prenatal care could be variable between and within countries, and be related to social determinants. The aim of this study was to identify socio-sanitary scenarios of prenatal care, and to analyze associations between social determinants and selected synthetic indicators of prenatal care in Argentina (2010-2018). Methodology: A multi-group ecological study (n=24 jurisdictions) was developed. The data were obtained from secondary sources: the latest available data of the Perinatal Informatics' System (2018) and national census (2010). A hierarchical and agglomerative cluster analysis was carried out (Wards method). The spatial distribution of the scenarios was illustrated by a map. ANOVA test was applied to assess the differences between the identified scenarios. To estimate associations between social indicators and indicators of prenatal care, linear regression models were applied. Results: five socio-sanitary scenarios of prenatal care were identified, which reveal heterogeneities in the distribution of prenatal and social care indicators. In addition, the percentage of households living in poverty presented a direct association, and the human development index and life expectancy at birth an inverse association with insufficient prenatal care. Conclusions: different socio-sanitary scenarios exist in Argentina, and some social characteristics of the contexts in which people live might underlie its configuration.

Evolution of Lymphedema in an Obese Diabetic Patient Using Grosgrain Stockings as Monotherapy

The objective of this study was to show the evolution of lymphedema in an obese diabetic patient using grosgrain stockings as monotherapy. A 51-year-old obese male with diabetes since childhood did not perform adequate control of the condition, progressing to vision loss and diabetic neuropathy. About 10 years ago, he began to have edema in the left leg, which progressed. Therefore, bioimpedance analysis was used, which demonstrated generalized lymphedema. The use of compression stockings made of grosgrain fabric was proposed to which the patient presented good tolerability for 1 year. At one of the evaluations, the generalized edema had returned but subsequently improved again. However, the lymphedema of the trunk and lower limbs remained, despite the weight loss. Systemic clinical lymphedema evaluated by electrical bioimpedance analysis was reduced with the weight loss of the patient throughout treatment.

Expansión de la medicina familiar en América Latina: desafíos y líneas de acción / Expansion of family medicine in Latin America: challenges and lines of action / Expansão da medicina familiar na América Latina: desafios e linhas de ação

RESUMEN Este documento tiene por objetivos resumir los desafíos actuales de la medicina familiar en América Latina y proponer posibles líneas de acción para consolidar su desarrollo. En los últimos 40 años, los sistemas de salud de la Región de las Américas han encarado reformas cuyos resultados fueron negativos en términos de equidad, y la atención primaria de la salud, lejos de ser aquella estrategia destinada a reducirla, se restringió a una política focal y selectiva. En este contexto, las propuestas técnicas de expansión de las plazas de formación en medicina familiar y su inserción en las carreras de Medicina, han carecido de coherencia y de una dirección política clara, por lo que su falta de eficacia puede leerse como un síntoma de estas reformas incompletas. Al respecto, la Confederación Iberoamericana de Medicina Familiar realizó recomendaciones sobre el compromiso político de los gobiernos para asegurar la estructura y el financiamiento necesarios, consolidar el modelo de medicina familiar como mecanismo de instrumentación de la atención primaria de la salud, la jerarquización de los programas de formación, las condiciones laborales de los médicos de familia y la certificación profesional, entre otras. Estas recomendaciones técnicas, sin acción política coherente y oportuna, no serán más exitosas que los intentos previos.

ABSTRACT This article summarizes the current challenges of family medicine in Latin America and proposes possible lines of action to consolidate its development. In the last 40 years, the health systems of the Region of the Americas have faced reforms whose results were negative in terms of equity, and primary health care, far from being a strategy designed to reduce it, was restricted to a selective and focal policy. In this context, the technical proposals for expansion of training positions in family medicine and their insertion in medical careers have lacked consistency and a clear political direction, and thus their lack of effectiveness can be considered a symptom of these incomplete reforms. In this regard, the Ibero-American Confederation of Family Medicine made recommendations on the political commitment of governments to ensure the necessary structure and funding, consolidate the model of family medicine as a mechanism for the implementation of primary health care, the hierarchy of programs of training, the working conditions of family doctors and professional certification, among others. These technical recommendations, without a consistent and timely political action, will not be more successful than previous attempts.

RESUMO Este documento tem como objetivo resumir os desafios atuais da medicina familiar na América Latina e propor possíveis linhas de ação para consolidar seu desenvolvimento. Nos últimos 40 anos, os sistemas de saúde da Região das Américas encararam reformas cujos resultados foram negativos em termos de igualdade, e a atenção primária à saúde, longe de sê-la aquela estratégia destinada a reducir-la, restringiu-se a uma política focal e seletiva. Neste contexto, as propostas técnicas de expansão das praças de formação em medicina familiar e sua inserção nas carreiras de Medicina, não dispuseram de coerência e de uma direção política clara, razão pela qual sua falta de eficácia se pode ler como um sintoma destas reformas incompletas. Neste sentido, a Confederação Ibero-americana de Medicina Familiar realizou recomendações sobre o compromisso político dos governos a fim de assegurar a estrutura e o financiamento necessários, consolidar o modelo de medicina familiar como mecanismo de instrumentação da atenção primária à saúde, a hierarquização dos programas de formação, as condições laborais dos médicos de família e a certificação profissional, entre outras. Estas recomendações técnicas, sem ação política coerente e oportuna, não serão mais exitosos que as tentativas prévias.

"Hasta que mejore la cosa": reflexiones sobre un abordaje terapéutico desde el primer nivel de atención en personas con padecimiento mental severo / Until it gets better”: reflections from the primary health care level on a therapeutic approach in a person with severe mental suffering

En Argentina, el desarrollo de la Atención Primaria de la Salud (APS) y su vinculación con la salud mental han ido de la mano de los movimientos históricos y políticos. Tanto así que la reglamentación de la Ley Nacional de Salud Mental Nº 26.657 pretende afianzar ese vínculo. Relatamos el caso de una mujer con padecimiento mental severo que irrumpe en un centro de APS solicitando ayuda económica, y cómo esto dispara un plan de trabajo integral para su atención. Reflexionamos sobre el rol que ocupan los efectores de APS, así como dificultades y potencialidades.

In Argentina, the development of Primary Health Care (PHC) and its relation with mental health has been tied to historical and political movements. So much to that the passing of Act 26,657 on Mental Health intends to strengthen this link. We report the case of a woman with severe mental illness who breaks into a PHC center requesting financial help, and how this triggers a comprehensive work plan for her care. We reflect on the role of PHC providers, as well as some difficulties and potentialities.

Godoy & Godoy Compression Sleeve in the Treatment of Arm Lymphedema: New Concepts for Materials

ABSTRACT The aim of this work was to study on a new low-elastic textile that fulfilled the criteria of fabrics for the manufacture of compression garments to treat lymphedema. The evolution of Godoy & Godoy compression sleeves was performed by following the patients treated for arm lymphedema. Sixty-six patients with ages ranging from 35 to 83 years and a mean of 58.8 years were included in this study. Diagnosis, by the clinical evaluation confirmed by the volumetry, was defined as a volume difference of more than 200 mL between the arms. All the participants were submitted to treatment sessions once, or two times weekly in an outpatient setting. The material used for the compression sleeve in this study was commercialized in Brazil under the name of Gorgurão(r). When high alterations in the pattern of sleeves were made, the patients were monitored by weekly volumetric assessments. The criterion to maintain the modifications in the design was that the hand did not present with edema. By the end of the study, the design of the sleeve was changed so as not to use compression therapy of the hands in 81.8% of the cases; 12.2% continued with compression of the hand, 3.0% stopped using compression completely and 3.0% used only a glove. Thus, Godoy & Godoy compression sleeves could be an efficient option for compression in the treatment of arm lymphedema as they provided better independence in day-to-day activities.

A systematic review and meta-analysis of gestational weight gain recommendations and related outcomes in Brazil

Worldwide, different guidelines are used to assess the adequacy of gestational weight gain. This study identified the recommendations for gestational weight gain in Brazilian women. We also determined the proportion of women with adequate weight gain in accordance with these recommendations and the associated perinatal outcomes. A systematic review was performed. A computerized search was conducted utilizing the following databases: PubMed, MEDLINE, Web of Science, Embase, SciELO and Google Scholar. Observational studies of healthy, Brazilian, pregnant women were included. Studies were excluded if they did not provide pregestational weight and gestational weight gain or if they studied women with comorbid conditions. A meta-analysis was performed to evaluate the odds ratio of inadequate (insufficient or excessive) gestational weight gain. Seventeen studies were included in the systematic review and four studies were included in the meta-analysis. The most widely used recommendations were from the Institute of Medicine. Excessive gestational weight gain was associated with fetal macrosomia and high rates of cesarean delivery. Overweight women had a higher risk of excessive gestational weight gain than eutrophic women (OR=2.80, 95%CI=2.22-3.53). There are no standardized recommendations concerning gestational weight gain based on Brazilian population-based data. Many Brazilian women are overweight or obese at the beginning of pregnancy. Overweight pregnant women have a higher risk of excessive gestational weight gain. Excessive gestational weight gain was associated with cesarean delivery and fetal macrosomia.

Cuidados prenatales y de puerperio en el primer nivel de atención de Bahía Blanca en el año 2013 / Prenatal and postpartum care in the primary care of Bahia Blanca in 2013

Introducción: Los cuidados prenatales son una prioridad para el Primer Nivel de Atención y deben ser mejorados. Objetivos: Describir el perfil de las consultas de embarazadas y puérperas en el primer nivel de atención de Bahía Blanca durante 2013. Material y Métodos: estudio descriptivo, observacional, análisis cuantitativo. Resultados: Se analizaron 4697 consultas: 4288 por control de embarazo y 409 por puerperio. El 21,5 % fueron menores de 19 años, 69% entre 20 y 34, y 9.2% mayores de 35. El 2,5% presento anemia, 1.74% problemas tiroideos, 1.38% infección urinaria, 0.94% vulvovaginitis, 0.43% hipertensión arterial, 0.18% diabetes, 0.11% violencia de género, 0.14% tabaquismo. Discusión: La distribución de edad es similar a la media nacional. Son escasos los controles de puerperio. Las enfermedades asociadas son menos que la media nacional. Conclusiones: deben propiciarse los controles de puerperio. Los datos son útiles para la gestión local. Deben mejorarse los registros. Palabras Clave: Atención Prenatal. Atención Primaria de Salud. Complicaciones del Embarazo.

Introduction: Prenatal care is a priority for the primary care level ands hould be improved. Objectives: To describe the profile of pregnant and postpartum consultations in primary care Bahia Blanca during 2013. Material and Methods: A descriptive, observational study, quantitative analysis. Results: 4697 consultations were analyzed by birth control 4288 and 409 by puerperium. 21.5% were under 19, 69% between 20 and 34, and 9.2% over 35. The 2.5% showed anemia, thyroid problems 1.74%, 1.38% UTI, vulvovaginitis 0.94%, 0.43% hypertension pressure, diabetes 0.18%, 0.11% GBV, 0.14% smoking. Discussion: The age distribution is similar to the national average. There are few controls puerperium. Associated diseases are less than the national average. Conclusions: there should be focus controls puerperium. The data are useful for local management. Records should be improved. Key words: Prenatal Care. Primary Health Care. Complications of Pregnancy.

Los cuidados en el hogar en la posta de salud domiciliaria: Caracterización de un modelo de atención desde el análisis de tres casos. Bahía Blanca. 2014 / Os cuidados no lar no posto de saúde domiciliário:caracterização de um modelo de atenção a partir daanálise de três casos. Bahia Blanca, de 2014 / Home care in the home health post: characterization of a care model from the analysis of three cases. Bahia Blanca, 2014

La Posta de Salud Domiciliaria (Posad) es un dispositivode un modelo de atención integral y humano. Trabajaambulatoriamente, en domicilios de usuarios de una zonadelimitada. Tiene siete ejes de acción, uno es de “Controlesde Enfermedades Crónicas”, en la Posta Rural, una de lascuatro que funciona hace un año, conformado por psicólogo,promotora de salud, trabajadora social y médica de familia.Se describe un modelo de atención desde el relato de tresproyectos terapéuticos (PT) que tienen en común: lógica decuidados paliativos, abordaje interdisciplinario, genogramafuncional y encuesta social, identificación de necesidades,articulación con hospital, elaboración de PT, co-construcciónde salud con los usuarios.Posad fortalece la APS, permitiendo desarrollar PT endonde el vínculo es la herramienta principal, desafiándonosa un reposicionamiento subjetivo como trabajadores. Laintegralidad y la co- construcción definen esta propuestade cuidados, donde el poder es compartido entre usuariosy trabajadores.

The Home Health Post (Posad, for its abbreviation in Spanish) is a device from a modelof integral, human care. It works on outpatient basis, at users´ homes in a delimited area.It has seven action axes; one of them is “Control of Chronic Diseases”, in the Rural Post,one of the four which have been working for a year, consisting of a psychologist, a healthpromoter, a social worker and a family doctor.We describe a model of attention from the report of three therapeutic projects (TP)which share: logic of palliative care, interdisciplinary approach, functional genogram andsocial survey, identification of needs, articulation with hospital, TP elaboration and cobuildingof health with the users.Posad strengthens Primary Health Care, allowing the development of PT in whichthe bond is the main tool, challenging us to a subjective repositioning as workers.Comprehensiveness and co-building define this care proposal, in which power is sharedbetween users and workers.

Recomendações para a prática de exercício físico na gravidez: uma revisão crítica da literatura / Recommendations for physical exercise practice during pregnancy: a critical review

Os exercícios físicos podem e devem ser recomendados para todas as gestantes saudáveis. Sua prática regular durante a gestação pode promover inúmeros benefícios físicos e psicológicos, além de não haver evidências de desfechos adversos para o feto e/ou recém-nascido, quando realizados em intensidade leve a moderada. No entanto, poucas gestantes aderem a essa prática e muitas ainda têm receios e dúvidas quanto à segurança da sua realização. Este artigo teve como objetivo a informação e a disseminação entre profissionais de saúde, que assistem às gestantes no Brasil, das atuais recomendações sobre exercício físico durante a gestação, baseadas nas melhores evidências científicas disponíveis. Diante da percepção de existirem poucos modelos sistematizados a respeito, e após a realização de vários estudos nesta área específica, reunimos informações práticas de interesse para os profissionais e gestantes. Ademais, incluímos recomendações quanto às indicações, contraindicações, modalidades (exercícios aeróbicos, treinamento de resistência muscular, alongamento e exercícios do assoalho pélvico), frequência, intensidade e duração dos exercícios para cada trimestre gestacional. Abordamos recomendações de exercícios físicos tanto para as gestantes de baixo risco quanto para populações especiais de mulheres, como atletas, hipertensas, diabéticas e obesas. A conscientização dos benefícios auferidos por um estilo de vida mais saudável durante e após a gestação deve ser sempre lembrada e estimulada pela equipe atendente. Por estarem as gestantes muito próximas dos especialistas e altamente motivadas, oportunizam-se exames de rotina, retornos frequentes e supervisão para uma série de novas orientações que podem refletir em sua saúde e na de seu bebê a longo prazo.

Physical exercise is recommended for all healthy pregnant women. Regular practice of exercises during pregnancy can provide many physical and psychological benefits, with no evidence of adverse outcomes for the fetus or the newborn when exercise is performed at mild to moderate intensity. However, few pregnant women engage in this practice and many still have fears and doubts about the safety of exercise. The objective of the present study was to inform the professionals who provide care for Brazilian pregnant women about the current recommendations regarding physical exercise during pregnancy based on the best scientific evidence available. In view of the perception that few systematic models are available about this topic and after performing several studies in this specific area, we assembled practical information of interest to both the professionals and the pregnant women. We also provide recommendations about the indications, contraindications, modalities (aerobics, resistance training, stretching and pelvic floor training), frequency, intensity and duration indicated for each gestational trimester. The review addresses physical exercise recommendation both for low risk pregnant women and for special populations, such as athletes and obese, hypertensive and diabetic subjects. The advantages of an active and healthy lifestyle should be always reinforced during and after gestation since pregnancy is an appropriate period to introduce new habits because pregnant women are usually more motivated to adhere to recommendations. Thus, routine exams, frequent returns and supervision are recommended in order to provide new guidelines that will have long-term beneficial effects for both mother and child.

Posta de Salud Stella Maris: una apuesta por un modelo de atención más humano, integral y democrático / . Stella Maris post health: A commitment for a more human, more integrative and more democratic care model

Posta de Salud Stella Maris es un dispositivo de cuidados en domicilio, que trabaja pensando la accesibilidad como encuentro entre usuarios, donde lo vincular supera otras barreras. Hemos puesto a las personas delante de las enfermedades, acercando un plan de cuidados integral para las familias en sus hogares y su barrio. Trabajamos desde 2012 en el barrio Stella Maris. Cuentan con un hospital interzonal y tres unidades sanitarias en un radio de 1 km. Los vecinos describen dificultades para acceder a la atención dado el gran tamaño poblacional, que es de 370 familias. La posta realiza visitas domiciliarias de primer contacto y de Seguimiento familiar. Además, se llevan a cabo jornadas especiales de promoción de la salud. Creemos que hemos podido revalorizar la visita domiciliaria y el espacio en el barrio como espacio de trabajo de los equipos de salud del como lugar más idóneo que el centro de salud para abordar el Proceso Salud Enfermedad.

The Stella Maris post health care is a device that works at home thinking about accesibility as the meeting betwen health workers and users, where linking it overcome the barriers of accessibility. We had put the people before disease, approaching a plan of integral cares in their home and in their neighborhood. Since 2012 we are working in Stella Maris neighborhood, where we canfind an intezone hospital and three health units around a mile. Neighbors decribed difficuties in accesing the care given to the large population size, that is 370 families. The post makes home visits and familiy first contact monitoring. The post also conducts special sessions of health promotion We believe we could reassess the home visits and the space in the neighborhood as workspace health team as more appropriate that the health center place to address the process of health - disease.

Censo 2013 de Residencias de Medicina Familiar y General de la República Argentina / 2013 Census of Residencies of Family and General Medicine of the Argentine Republic

La puesta en marcha de los Planes Federales de Salud propuso al Primer Nivel de Atención como el nivel organizador del sistema de salud, y promovió la formación de recursos humanos apropiados en cantidad y competencias. A fin de medir el impacto de los mismos se realizó un censo que incluyó el recuento de las residencias públicas existentes, el censado de los residentes y el relevamiento del contexto de aprendizaje predominante en cada residencia. Se identificaron 146 residencias y 926 residentes...

The implementation of the Federal Health Plans proposed the First Level of Care as the organizing level of the health system, and promoted the training of appropriate human resources in quantity and competencies. In order to measure their impact, a census was carried out that included the recount of the existing public residences, the census of the residents and the survey of the predominant learning context in each residence. 146 residences and 926 residents were identified...