Os modos de fazer saúde na Amazônia das Águas / Health care delivery in the Amazon of the Waters / Los modos de hacer salud en la Amazonia de las Aguas

Descrevemos como a organização do sistema de saúde é afetada pelas características da várzea amazônica. Elegemos uma região a oeste do estado do Amazonas que bem caracteriza esse cenário. Entrevistamos gestores de saúde e mapeamos os trajetos percorridos pelos usuários para acessar a rede sanitária. Municípios menores são extremamente dependentes da rede de serviço do polo regional e da capital estadual. O transporte de usuários, à exceção de emergências, é feito por via fluvial com maior tempo e maior custo em relação à via terrestre. O ciclo vazante-cheia também interfere no tempo, no custo e nos agravos prevalentes. Identificamos alguns pontos de tensão entre o instituído normativamente para conformação das regiões de saúde e a realidade regional. Promover saúde na Amazônia passa inevitavelmente pela adaptação e pela resiliência do sistema de saúde no diálogo com as características do território e dos fluxos dos usuários.(AU)

This article describes how the characteristics of the Amazon floodplain affect the organization of local health systems. We chose a region in the west of the state of Amazonas which is characteristic of this situation. We interviewed local health managers and mapped the routes taken by users to access health services. Smaller municipalities are extremely dependent on services in the regional hub and capital of the state. Patients, except emergency patients, are transported via waterways, resulting in longer travel times and higher costs than land routes. The seasonal flooding cycle also affects travel times, costs and prevalent health problems. We identified some points of tension between the rules and regulations governing the configuration of local health regions and the regional reality. Promoting health in the Amazon inevitably requires the health system to adapt and be resilient to local geographical characteristics and patient flows.(AU)

Describimos cómo la organización del sistema de salud se ve afectada por las características de la vega amazónica. Elegimos una región del oeste del Estado de Amazonas que caracteriza bien ese escenario. Entrevistamos a gestores de salud y mapeamos los trayectos recorridos por los usuarios para tener acceso a la red sanitaria. Los municipios menores son extremadamente dependientes de la red de servicio del polo regional y de la capital del estado. El transporte de usuarios, a no ser en casos de emergencia, se realiza por vía fluvial con mayor tiempo y costo con relación a la vía terrestre. El ciclo subida y bajada de las aguas también interfiere en el tiempo, costos y problemas prevalentes. Identificamos algunos puntos de tensión entre lo instituido normativamente para conformación de las regiones de salud y la realidad regional. La promoción de la salud en la Amazonia pasa inevitablemente por la adaptación y resiliencia del sistema de salud en el diálogo con las características del territorio y de los flujos de los usuarios.(AU)

Assessmento of the working and living conditions by participants of the Zemsky Doctor Program

The purpose of the present work is to study the satisfaction with the working and living conditions as assessed by participants of the Zemsky Doctor program in rural areas. Materials and methods. The study has been carried out by the Tyumen State Medical University of the Ministry of Health of the Russian Federation in association with the Tyumen Public Health Department based on surveying 288 doctors participating in the Zemsky Doctor program in the Tyumen Region (excluding districts). Main results. As a result of the analysis, it has been revealed that one of the main factors of job satisfaction is opportunities of professional and career development. The analysis has shown that on average the program participants give a rather high assessment of the living conditions, although depending on municipal districts the satisfaction considerably differs. Conclusion. The working and living conditions in the rural areas under the study have been grouped according to the respondents' satisfaction. The main factors of dissatisfaction with the working and living conditions in the rural areas included career opportunities, leisure conditions, opportunity for professional growth, and the need for domiciliary duty. The obtained results can be used by the management of both medical organizations and municipal districts to solve the personnel problems in the area of the rural health care when taking relevant management decisions. Substantiation of the study novelty. The Zemsky Doctor program has been in force in the Russian Federation since 2012. Its implementation showed that the program had only partially solved the personnel problem in the area of the rural health care. Some participants of the Zemsky Doctor program prematurely terminated the concluded contracts. In this regard, it is necessary to carry out studies on the reasons of dissatisfaction with the working and living conditions in the rural areas.

Unmet needs in health training among nurses in rural Chinese township health centers: a cross-sectional hospital-based study / 보건의료교육평가

PURPOSE: Maintaining a sufficient and competent rural nursing workforce is an important goal of the Chinese health delivery system. However, few studies have investigated the health training status or conducted a needs assessment of rural Chinese nurses during this time of great transformations in health policy. This study was conducted to explore the current health training status of nurses working in rural Chinese township health centers (THCs) and to ascertain their perceived needs. METHODS: A cross-sectional survey using a self-administered structured questionnaire was conducted among 240 THC nurses in Guangxi Zhuang Autonomous Region, China from March 2014 to August 2014. The survey questionnaire was adapted from the Second Chinese Survey of Demographic Data and Training Demand for Health Professionals in THCs developed by the Ministry of Education. RESULTS: The nurses in THCs were young, with a low educational level. Their perceived needs for health training included further clinical studies at city-level hospitals to improve their skills and theoretical studies at medical universities in emergency medicine and general practice. Overall, 71.9% of the nurses with a secondary technical school background expected to pursue junior college studies, and 68.5% of the nurses with a junior college education expected to pursue a bachelor's degree. A decentralized program with theoretical studies at medical universities and practical studies at county hospitals was regarded as feasible by 66.9% of the respondents. CONCLUSION: Health-training programs for nurses in Chinese THCs must be improved in terms of coverage, delivery mode, and content. A decentralized degree-linked training program in which medical universities and city hospitals collaborate would be an appropriate mode of delivery.

Effect of Policy Circumstance on the Change from Barefoot Doctor to Village Doctor---A Case Study in Huairou County of Beijing / 中国医学伦理学

Policy circumstance plays a pivotal role in transformation of barefoot doctor to village doctor.The resources support fromregime and economic organizationmanagement system, the workpoint system for income from collective economy and politics culture of serving people under the policy circumstances of the People′s Com-mune, lay a firm foundation for rise and development of barefoot doctors.However, the village self-governance re-gime began with Household Contract Responsibility System changed all elements above and ultimately prompt trans-formation from barefoot doctor to village doctor.

Trend of Occupational Injuries/Diseases in Pakistan: Index Value Analysis of Injured Employed Persons from 2001-02 to 2012-13

BACKGROUND: The present study aimed to analyze the index value trends of injured employed persons (IEPs) covered in Pakistan Labour Force Surveys from 2001-02 to 2012-13. METHODS: The index value method based on reference years and reference groups was used to analyze the IEP trends in terms of different criteria such as gender, area, employment status, industry types, occupational groups, types of injury, injured body parts, and treatment received. The Pearson correlation coefficient analysis was also performed to investigate the inter-relationship of different occupational variables. RESULTS: The values of IEP increased at the end of the studied year in industry divisions such as agriculture, forestry, hunting, and fishing, followed by in manufacturing and construction industry divisions. People associated with major occupations (such as skilled agricultural and fishery workers) and elementary (unskilled) occupations were found to be at an increasing risk of occupational injuries/diseases with an increasing IEP trend. Types of occupational injuries such as sprain or strain, superficial injury, and dislocation increased during the studied years. Major injured parts of body such as upper limb and lower limb found with increasing trend. Types of treatment received, including hospitalization and no treatment, were found to decrease. Increased IEP can be justified due to inadequate health care facilities, especially in rural areas by increased IEP in terms of gender, areas, received treatment, occupational groups and employment status as results found after Pearson correlation coefficient analysis. CONCLUSION: The increasing trend in the IEP% of the total employed persons due to agrarian activities shows that there is a need to improve health care setups in rural areas of Pakistan.

Ethical Strategies for Improving the Construction and Development of Health Personnel in Villages / 中国医学伦理学

This paper summed up the medical professionalism as taking patients'interests first , reshaping the medical good faith , improving business ability and promoting social justice .Also proposed that in order to have rea-sonable human resource allocation , ensure the construction of rural health personnel team and stability , the follow-ings are necessary:medical staff at villages and towns setting up the medical ethics , strengthening the altruism spir-it;changing the traditional model of the doctor -patient relationship , adhering to the principle of patient autonomy;cultivating professional sense of responsibility , building moral education;intensive training and striving to improve the level of medical technology;increasing the doctor -patient communication , restoring patients'interests first , re-shaping medical doctor -patient trust integrity , improving business ability and promoting social justice as well as fully exerting the social , moral and cultural supporting factors etc .

An assessment of rural health care delivery system in some areas of West Bengal-An overview.

A cross sectional observational study was carried out in three districts of West Bengal by following observational, quantitative and qualitative methods during July to December 2006 to find out the extent of utilization, strengths, weaknesses and gap as well as suggest recommendations in connection with health care delivery system for the state of West Bengal, India. A total of 672 episodes of illnesses were reported (2 weeks recall) by the study population of the three selected districts in three geographically separated divisions of West Bengal. None did seek care from any health facilities for treatment in case of 221 (32.89%) episodes; especially from tribal areas where in case of 76.19% none sought any health care from any facilities depended on their home remedies. In rest of episodes the (451), majority preferred government health facilities (38.58%), followed by Unqualified quacks (29.27%) due to low cost as well as living in close proximity, 27.27% preferred qualified Private practitioners and only 4.88% preferred AYUSH, as a first choice. Referral was mostly by self or by close relatives/families (61%) and not by a doctor. Awareness is required to avoid unnecessary referral. Cleanliness of the premises, face-lift, and clean toilet with privacy and availability of safe drinking water facilities could have an improved client satisfaction in rural health care delivery systems. This could be achieved through community participation with the involvement of PRI. However, as observed in the study RCH services including Family Planning as well as immunization services (preventive services) were utilized much better while there was a strong need of improvement of Post Natal Care, otherwise, Neonatal and Maternal mortality and morbidity will continue to be high.

Design of primary health care package for village and township health facilities in Beijing / 中华医院管理杂志

The paper presented the principles and references for identifying services of the primary health care at townships and villages in Beijing, and proposed the screening criteria for primary health care package in rural Beijing. Studies made have identified the screening results for the package applicable to both townships and villages in Beijing, along with analysis for the rationale, applicability and operability of the package. Moreover, it probed into the assurance conditions for offering primary health care as a reference for other regions in the country.

Building Up Health Care System in Rural Areas to Set up a Society in Harmony / 中国医学伦理学

Setting up a society in harmony is one of important abilities of our Party being in power.Right health care system in rural areas is one of important contents of setting up socialist society in harmony.This article argues from three aspects that setting up a society in harmony is mankind's moral ideal,building up health care system in rural areas is to appeal to morality which sets up a society in harmony,and building up health care system must be strengthened.But the writer thinks that there are many lacks now.So we should take some steps to build and complete the health care system in rural areas,it is significant for setting up a society in harmony.