Inclusión social de persona con trastorno mental en situación de calle: una intervención comunitaria

Introducción: Experiencia de una comunidad de barrio capitalino (Asunción-Paraguay), movilizada por la grabación de un corto documental a cargo de estudiantes de cinematografía, que inician un proceso de participación para mejorar la calidad de vida de una persona con trastornos mentales y discapacidad psicosocial en situación de calle, logrando su inclusión social. Objetivo : Identificar los elementos claves que favorecieron la participación comunitaria, derivando en el proceso de reinserción social de una persona con trastorno mental y discapacidad psicosocial para contribuir con estrategias innovadoras de modelos de atención basados en la comunidad con enfoque de derechos humanos. Materiales y métodos: Estudio cualitativo de diseño narrativo, utilizando datos de la historia de una persona y la experiencia de una comunidad para describir, analizar e identificar elementos que se consideran claves para los resultados logrados. La experiencia comunitaria fue observada y registrada de cerca durante más de 4 años. Resultado: Participación comunitaria activa en torno a un objetivo colectivo impulsado por un proyecto cinematográfico logrando la reinserción social de una persona con trastorno mental o discapacidad psicosocial que se encontraba en situación de calle. Conclusión : El cine o arte generan un impacto emocional y sensibilizador que acompañados con estrategias sostenibles; facilitación, tecnología, recursos económicos, lugares de residencia o acogida, acompañamiento; permiten aprovechar y movilizar recursos comunitarios, con participación y enfoque de derechos humanos. El resultado en este caso es la inclusión social de una persona con trastornos mentales y discapacidad psicosocial, que se encontraba en el extremo de exclusión social: vida en calle por más de 20 años.

Introduction : Experience of a community from a neighborhood of the Capital City (Asunción-Paraguay), mobilized by the recording of a Short Documentary by cinematography students, who begin a process of participation to improve the quality of life of a person with mental disorders and psychosocial disabilities who are homeless, achieving their social inclusion. Objective : Identify the key elements that allowed community participation and the social reintegration process of a person with a mental disorder or psychosocial disability to contribute with innovative strategies of community-based care models with a human rights approach. Materials and Methods : A qualitative type study of narrative design, using data from a person's story and the experience of a community to describe, analyze and identify the key elements to the results achieved. The community experience was closely observed and recorded for more than 4 years. Results : active community participation around a collective objective driven by a film project, achieving the reintegration and social rehabilitation of a person with mental disorder who was in street situation. Conclusion : Cinema or art generates an emotional and sensitizing impact that, accompanied by sustainable strategies; facilitation, technology, economic resources, places of residence or reception, support; allows taking advantage of and mobilizing community resources, with participation and a human rights approach. The result in this case is the social inclusion of a person with mental disorders or psychosocial disabilities who was at the extreme of social exclusion; street life for more than 20 years.

A Framework of Utility for Creating a Place for Interprofessional Continuous Dialogue: Focusing on the Community Care Conference / 日本プライマリ・ケア連合学会誌

Introduction: To clarify the utility of a community care conference that incorporated continuous dialogue between multiple professions.Methods: Group interviews were conducted with nine facilitators in March 2019, and the data were qualitatively, inductively analyzed.Results: Six categories of utility were extracted: "the changing atmosphere of the community care conference," "new groups of people participating," "getting to know people from other professions," "building relationships with people from other professions," "changing perspectives on the case study," and "changing the quality of assistance. " Conclusion: A conceptual framework of utility of these meetings was identified, which is transformed qualitatively through the following three stages: "transforming the location," "transforming interprofessional relationships and perspectives," and "transforming assistance."

The Report on Toyama City Care Prevention Center in These 10 Years / 日本温泉気候物理医学会雑誌

  This center was established at its downtown in 2011. In order to either maintain or promote health-welfare status at the elderly life stage, the center has been providing regular physical exercise courses using hot spring water pumped up there. These activities have been performed cooperating with all 32 community general support centers covered whole the city.  Main findings and indication from our activities in these10 years were as follows:  1．Total number of attendants increased from around 60 to 90 thousands a year. About one fourth of them were the QOL (Quality of Life) tour member aged 65 years or more attending twice a week in every 3-month by the courtesy bus, and the others aged 40 years or more attended with their own ways.   The attendants aged 75 years or more has gradually increased to 70〜80% of QOL tour member. For the other member, it has been in 20〜30% these 10 years.  In addition to the physical exercise in 33〜36°C hot spring water consisted of walking, stretch & flex, aquatic exercise for joint-musculoskeletal pain and others, power-up rehabilitation, exercise for joint-musculoskeletal pain and others were performed on floor, too. The grade of these exercise consisted of 30, 40 and 50% of maximum heart rates depending on physical examination results of 5 m-walk, timed up & go test (TUG), the 30 seconds chair-stand test (CS30), hand grip, functional reach and posture forward bending, and doctors’ inspection.  2．On the follow-up of the physical examinations measured every 3-month, 5 m-walk, hand grip and CS30 were shown to be suitable items due to the availability as the routine examination. The results are substantially useful for reviewing each attendant status in longitudinal course, and indicate our treatments for them.  3．The attendants increased and distributed over the whole city in these 10 years. However, as the proportion of new ones is several percentages each year, the exchange of attendants was less than we expected. This indicates that we should have closer communication with community general support centers in order to distribute our activities to people who need health-welfare promotion, but have never been in the center. On top of that, the usage of our center should be increased for people of middle ages for ideal prevention.

Application and research progress of different chronic disease management models in rheumatoid arthritis in China / 中国实用护理杂志

The chronic disease management of rheumatoid arthritis has been popularized and applied in China. This article will review the application and research progress of different chronic disease management models, including chronic care mode, chronic disease self-management, transitional care mode, community-based chronic disease management, and "internet + chronic disease management" in rheumatoid arthritis patients in China, and compare the advantages and disadvantages of different intervention models, in order to provide a theoretical basis for exploring the chronic management of rheumatoid arthritis under different regional medical resources.

La integración de cuidados de enfermería en el anciano en estado de necesidad desde la perspectiva comunitaria / Integration of Nursing Care in the Elderly in Need from the Community Perspective

Introducción: El cuidado en enfermería se aborda desde una perspectiva holística que permita cubrir las necesidades reales de los pacientes en su entorno, que tienen entre sus funciones la de ayudar al anciano enfermo o sano a realizar las actividades que contribuyen a su salud, recuperación o una muerte tranquila en la comunidad. Objetivo: Exponer algunas consideraciones sobre la integración de los cuidados de enfermería en el anciano en estado de necesidad desde la perspectiva comunitaria. Métodos: Se realizó una revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo sobre la integración cuidados de enfermería en el anciano en estado de necesidad desde la perspectiva comunitaria, en documentos, artículos originales y de revisión disponible en Google Académico y Medline en el período de marzo a junio de 2018, las palabras clave utilizadas fueron Cuidado de enfermería; cuidados comunitarios; Enfermería; integración de cuidados de enfermería, identificadas a través del DECs o de MeSH. Se utilizaron los métodos de análisis, síntesis y sistematización, que posibilitaron la interpretación y la organización de los conocimientos. Tras la identificación de los estudios preseleccionados se llevó a cabo la lectura de los títulos, resumen y palabras clave, y se comprobó la pertinencia con el estudio. Conclusiones: La integración de los cuidados de enfermería permitió contextualizar este fenómeno desde la perspectiva de la comunidad, mediante el aporte de elementos puntuales en el manejo, seguimiento y control de los ancianos en estado de necesidad(AU)

Introduction: Nursing care is approached from a holistic perspective that allows meeting the real needs of patients in their settings, whose functions include helping the sick or healthy elderlies carry out activities that contribute to their health, recovery or having a quiet death in the community. Objective: To present some considerations about the integration of nursing care in the elderly in need from the community perspective. Methods: A systematic bibliographic review was carried out to develop a critical-reflective analysis about the integration of nursing care in the elderly in need from the community perspective, using documents, original articles and review available in Google Scholar and Medline, in the period from March to June 2018. The keywords used were Cuidado de enfermería [Nursing care], cuidados comunitarios [community care], Enfermería [Nursing] and integración de cuidados de enfermería [integration of nursing care], identified through DECs or MeSH. Analysis, synthesis and systematization methods were used, which made the interpretation and organization of knowledge possible. After the identification of the preselected studies, the titles, abstract and keywords were read, and the relevance to the study was checked. Conclusions: The integration of nursing care allowed contextualizing this phenomenon from the community perspective, through the contribution of specific elements to the management, follow-up and control of the elderly in need(AU)

The Report on Toyama City Care Prevention Center in These 10 Years / 日本温泉気候物理医学会雑誌

  This center was established at its downtown in 2011. In order to either maintain or promote health-welfare status at the elderly life stage, the center has been providing regular physical exercise courses using hot spring water pumped up there. These activities have been performed cooperating with all 32 community general support centers covered whole the city.  Main findings and indication from our activities in these10 years were as follows:  1．Total number of attendants increased from around 60 to 90 thousands a year. About one fourth of them were the QOL (Quality of Life) tour member aged 65 years or more attending twice a week in every 3-month by the courtesy bus, and the others aged 40 years or more attended with their own ways.   The attendants aged 75 years or more has gradually increased to 70〜80% of QOL tour member. For the other member, it has been in 20〜30% these 10 years.  In addition to the physical exercise in 33〜36°C hot spring water consisted of walking, stretch & flex, aquatic exercise for joint-musculoskeletal pain and others, power-up rehabilitation, exercise for joint-musculoskeletal pain and others were performed on floor, too. The grade of these exercise consisted of 30, 40 and 50% of maximum heart rates depending on physical examination results of 5 m-walk, timed up & go test (TUG), the 30 seconds chair-stand test (CS30), hand grip, functional reach and posture forward bending, and doctors’ inspection.  2．On the follow-up of the physical examinations measured every 3-month, 5 m-walk, hand grip and CS30 were shown to be suitable items due to the availability as the routine examination. The results are substantially useful for reviewing each attendant status in longitudinal course, and indicate our treatments for them.  3．The attendants increased and distributed over the whole city in these 10 years. However, as the proportion of new ones is several percentages each year, the exchange of attendants was less than we expected. This indicates that we should have closer communication with community general support centers in order to distribute our activities to people who need health-welfare promotion, but have never been in the center. On top of that, the usage of our center should be increased for people of middle ages for ideal prevention.

Application effect of extended nursing service in improving malnutrition status of patients undergoing maintenance hemodialysis combined with peritoneal dialysis / 中国实用护理杂志

Objective@#To explore the effect of extended nursing service on malnutrition in patients undergoing maintenance hemodialysis combined with peritoneal dialysis.@*Methods@#According to the formula, 124 patients with malnutrition in maintenance hemodialysis combined with peritoneal dialysis were divided into intervention group and control group by lottery, 62 in intervention group and 62 in control group. The control group received routine specialist nursing and health education during hospital dialysis, while the intervention group received extended nursing services for 6 months, including telephone follow-up, knowledge lectures and Wechat interaction. The nutritional status of two groups of patients was assessed by modified subjective comprehensive nutrition assessment (MQSGA) one day before the implementation of extended nursing service, three months and six months after the implementation of extended nursing service, and the body mass index(BMI), albumin, prealbumin, hemoglobin, serum calcium and serum phosphorus were measured at the same time.@*Results@#There was no significant difference in nutritional status, BMI and blood index between the two groups before intervention (P > 0.05). After 3 months and 6 months of intervention, MQSGA scores of intervention group were (13.28±3.99), (10.17±3.43) respectively, which were significantly lower than those of control group (15.32±3.52), (14.37±3.73). There were significant differences between the two groups (t=2.946, 6.336, P<0.01). After 3 months and 6 months of intervention, BMI was (18.29±2.27), (20.27±2.09) kg/m2, respectively, which were significantly higher than those of control group (16.41±2.32), (16.49±2.26) kg/m2. The difference between the two groups was significant (t=-4.430, -9.372, P <0.01). After 3 months of intervention, albumin, preaalbumin, hemoglobin, serum calcium, and serum inorganic phosphorus in intervention group were (35.63±4.24) g/L, (277.57±29.52) mg/L, (102.03±11.21) g/L,(2.01±0.19) mmol/L, (1.74±0.37) mmol/L; and the control group were (33.19±4.89) g/L, (216.81±24.06) mg/L, (92.58±13.79) g/L, (1.91±0.21) mmol/L, (2.05±0.49) mmol/L, respectively. After 6 months of intervention, the intervention groups were (41.49±6.14) g/L, (344.60±30.56) mg/L, (111.34±10.09) g/L, (2.28±0.18) mmol/L, (1.45±0.33) mmol/L, the control group were (34.16±4.71) g/L, (218.63±24.85) mg/L, (94.36±11.21) g/L, (1.99±0.24) mmol/L, (1.95±0.41) mmol/L. There were significant differences between the two groups (t=-24.484-7.220, P<0.01).@*Conclusions@#Extended nursing service can significantly improve the nutritional status of patients undergoing maintenance hemodialysis combined with peritoneal dialysis.

Community care for diabetic retinopathy and glaucoma in India: A panel discussion

Diabetic retinopathy (DR) and glaucoma are emerging causes of blindness and visual impairment in India and the world. Both diseases do not have any early warning symptoms, and once the symptoms appear, the diseases are reasonably advanced. Because of the long-standing nature of the diseases, one cannot adopt the cataract detection and treatment model so successfully developed in India. It requires an altogether different approach for screening and related infrastructure including human capital development. The solutions developed to reduce the burden of DR/glaucoma should be customized to urban, semi-urban, and rural areas. Greater advocacy, improving the health-seeking behavior, development of infrastructure and skilled personnel appropriate for the points of care, and an emphasis in comprehensive eye care are some of the solutions.

Serviços residenciais terapêuticos na cidade do Rio de Janeiro: uma análise da estrutura e do processo de cuidado

Objetivo: O objetivo do estudo é analisar a estrutura e o processo de cuidado nos Serviços Residenciais Terapêuticos (SRTs) existentes no município do Rio de Janeiro. Método: Trata-se de um estudo transversal e de caso, que se concentrou na coleta de informações primárias para descrever a estrutura e o processo de cuidado nos módulos residenciais (Residências Terapêuticas) sob a gestão da Secretaria Municipal de Saúde (SMS) do município. A pesquisa foi realizada em todos os dispositivos públicos em funcionamento no mês dezembro de 2016. Resultados e discussão: No Rio de Janeiro, os SRTs estavam em expansão e cumpriam a função de propiciar o convívio comunitário para pacientes com transtorno mental grave que se encontravam institucionalizados em hospitais psiquiátricos, e era a principal estratégia dedes institucionalização adotada pela SMS. As casas tinham caráter de moradia permanente e quanto ao processo de cuidado, se fazia necessária articulação mais próxima entre os serviços de saúde a fim de garantir a continuidade longitudinal do cuidado a esta clientela vulnerável. Os moradores apresentavam baixa frequência nos CAPSs e as casas eram ambientes altamente medicalizados. Os SRTs são dispositivos de cuidados intensivos dos pacientes, pois são casas com processo de reabilitação interno e com grande oferta de vagas nas 24 horas do dia. Ainda assim, os dispositivos residenciais são fundamentais para a sustentação de pacientes com transtorno mental grave na comunidade.

Aim: The study aims to analyze the structure and the process of care in the Residential Therapeutic Services (SRTs) existing in the city of Rio de Janeiro. Method: This is a cross-sectional and case study, with focused on the collection of primary information to describe the structure and care process in the Residential Modules (Therapeutic Residences) under the management of the Municipal Health Department (SMS) of the municipality. The research was carried out in all public facilities in operation in december 2016. Results and discussion: In Rio de Janeiro the SRTs are expanding and fulfill the function of providing community living for patients with severe mental disorder who were institutionalized in psychiatric hospitals and was the main deinstitutionalization strategy adopted by SMS. The houses had the character of permanent housing and the care process, a closer articulation between the health services was necessary in order to guarantee the longitudinal continuity of care to this vulnerable clientele. Residents had low frequency in the CAPSs and the houses are highly medicalized environments. SRTs are intensive care devices for patients, as they are houses with internal rehabilitation processes and with a large number of vacancies 24 hours a day. Yet, residential devices are critical to sustaining patients with severe mental disorders in the community.

The Role of Pharmacists in the Japanese Integrated Community Care System / 社会薬学

<p>Aging society has been progressed in Japan, so that it is projected that one in four is an elderly person and that demands of medical and nursing care show a marked increase in the near future. The Japanese Ministry of Health, Labor and Welfare (MHLW) targets to create the Integrated Community Care System (ICCS) in each community to realize every person can live a life with dignity even in the progressive aging society by 2025 when the demands of medical and nursing care will be jumped up caused by the baby boom generation will reach their age of 75. In the ICCS, the function and role of pharmacies/pharmacists are expected to be different from the current ones. Therefore, pharmacies/pharmacists have to find their appropriate function and role in the ICCS, and also have to adapt themselves smoothly to the progressive aging society even though no one in the world has an experience.The MHLW introduced Pharmacy Vision for Patients on October of 2015, and also has established the new pharmacy reimbursement program “Your Pharmacist Reimbursed Program” on April of 2016 as the first step to cope with the progressive aging society at 2025. In this manuscript, I will introduce the new MHLW policies for Pharmacies/pharmacists. And also I will consider the needs for pharmacies/pharmacists and the function and role that they have to fulfill in the ICCS.</p>

The development, reform and implications of purchasing community care services in the Unit-ed Kingdom / 中国卫生政策研究

The United Kingdom is the longest-serving community in the welfare states, and has been serving for more than sixty years so far. The construction of community care service supply model in the United Kingdom is deeply influenced by the neo-liberalism and neo-managerialism, which dominated the reform and development of pur-chasing community care services. Presently, China is actively promoting the government to purchase pension services of public health care combined with the long-term care, especially policy and determination of community-based de-velopment of an elders' service model. Based on the purchased services experience of the United Kingdom combined with the situation in China, this paper puts forward some suggestions such as the repositioning the role of the govern-ment, actively supporting the development of civil service organizations and perfecting the legal system of care serv-ices to be purchased, supporting the development of proposals to reduce the burden on the government and enhance the efficiency of care services through improving their quality.

Analysis of the status quo and needs of community care for disabled elderly in Beijing / 中国卫生政策研究

Objective:To study the current status and needs of Community Care for disabled elderly in Beijing and put forward the suggestions for improving the elderly Community Care system. Methods:Descriptive statistical a-nalysis, Chi-square test and Multivariate logistic analysis were adopted to analyze the situation of Community Care for Disabled elderly using data from the community survey of elderly population in Beijing. Results:The status of health is not optimistic for Disabled elderly, there are high demands for the community health services and welfare facilities for elderly and the needs for services provided by part-time home care, day care and volunteers are high, but those services and facilities provided by communities were found to be inadequate. Conclusion:China has a large popula-tion base of Disabled elderly and its number grows fast, but community care supply is in shortage and cannot meet the needs of those people. It is therefore urgent to improve community health services and community care system.

Percepción de la experiencia clínica de la asignatura de Atención Comunitaria, por los estudiantes de enfermería de una Universidad Chilena / Nursing students perception on clinical experience in a Nursing in Community Care course in a Chilean university

Resumen:

Introducción: “Enfermería en atención comunitaria” es una asignatura teórico-práctica que cursan durante el sexto semestre de la carrera, esta práctica se desenvuelve en centros de salud, donde los estudiantes junto con el docente, planifican la atención de enfermería a usuarios y/o familia a lo largo del ciclo vital para la promoción y/o prevención de la salud. Objetivo: comprender la percepción de la experiencia clínica comunitaria, a partir del relato de los estudiantes de una universidad chilena.

Metodología: estudio cualitativo, con diseño basado en la teoría fundamentada en los datos, técnica de recolección de la información: entrevistas semiestructuradas; técnica de análisis: método de comparación constante. Estuvo conformada por siete estudiantes de sexto semestre de la carrera de Enfermería de una universidad privada de Santiago de Chile. Resultados: se revelan fortalezas y obstáculos percibidos por los estudiantes durante la práctica clínica de enfermería comunitaria que parece ser reflejo de la transición de modelos educativos por la institución.

Discusión: la transición del modelo educativo en la institución genera dificultades en el proceso de enseñanza y, por ende, de aprendizaje en los estudiantes.

Conclusión: la percepción de los estudiantes nos reveló fortalezas en la práctica clínica. Sin embargo, la transición de modelo educativo dificulta el proceso de enseñanza del docente y, por tanto, el aprendizaje del estudiante, motivo por el cual se evidencia la necesidad de intervención del equipo docente en todas las fases del rediseño curricular, para una mayor coherencia y pertinencia en la actuación de este.

Abstract:

Introduction/purpose: “Nursing in community care” is a theoretical-practical subject included in the sixth-semester curriculum. Practice activities are performed in health centers with students and teachers planning nursing care for users and/or families over the life cycle in health promotion and/or prevention. We aimed at understanding perceptions on clinical experience, based on students’ reports in a Chilean university. Methods: a qualitative study with design being based on a theory using data, information collecting techniques: semi-structured interviews; method of analysis: a constant comparison method. Participants were seven sixth-semester nursing students in a private university in Santiago de Chile. Results: strength and barriers perceived by students in clinical nursing practice in community care appear to reflect the transition in educational models in the institution. Discussion: the transition in educational models in the institution results in difficulties in the educational processes and learning by students. Conclusion: although students' perception revealed some strengths in clinical practice, the transition in educational models results in difficulties in the educational processes and learning by students, which shows the need for the teaching team to be involved in curriculum design, in order to reach a higher coherence and relevance to teaching actions.

Introdução: enfermagem em atenção de comunitária, é uma disciplina teórica-prática que cursam durante o sexto semestre da profissão, esta prática desenvolve-se em centros de saúde, onde os estudantes junto com o professor planejam assistência de enfermagem aos usuários e ou família ao longo do ciclo vital para a promoção e ou prevenção da saúde. Objetivo: compreender a percepção da experiência clínica de Comunitária, a partir da história dos estudantes de uma universidade chilena. Metodologia: estudo qualitativo, baseado em Grounded Theory, técnica de coleta de dados: entrevistas semi-estruturadas, técnica de análise: método comparativo constante. Participaram sete estudantes de sexto semestre da profissão de Enfermagem de uma universidade privada em Santiago do Chile. Resultados: revela-se fortalezas e obstáculos percebidos pelos estudantes durante a prática clínica da enfermagem comunitária parece ser um reflexo da transição de modelos educativos pela instituição. Discussão: a transição do modelo educacional na instituição gera dificuldades no processo de ensino e também a aprendizagem dos estudantes. Conclusão: a percepção dos estudantes, embora seja verdade que revelou fortalezas na prática clínica no entanto, a transição do modelo educativo dificulta o processo de ensino do professor e portanto, a aprendizagem do aluno, motivo pelo qual evidencia-se a necessidade de intervenção do equipe academico em todas as fases da mudança currícular para uma maior coerência e relevância do desempenho docente.

Población infanto-juvenil alojada en hogares de la Ciudad Autónoma de Buenos Aires que transitó por un programa de atención comunitaria durante 2010 / Children and youth population living in institutions in Buenos Aires City and covered by a community care program in 2010

INTRODUCCIÓN: los niños y adolescentes institucionalizados representan un grupo vulnerable. Es importante conocer su situación y necesidades específicas, así como losrecursos requeridos para su adecuada atención. OBJETIVOS: Explorar las características y la trayectoria institucional de los niños y adolescentes institucionalizados en hogares convivenciales, terapéuticos y maternales de la Ciudad Autónoma de Buenos Aires (CABA). Explorar el abordaje que recibieron desde el campode la salud mental, en particular en el Programa de Atención Comunitaria (PAC) durante 2010. MÉTODOS: Se utilizó un diseño descriptivo-exploratorio de tipo cualitativo. Se analizaron variables vinculadas a la trayectoria institucional y al abordaje recibido desde el campo de la salud mental, a partir de la exploración de lashistorias clínicas y de entrevistas semiestructuradas a trabajadores de hogares. RESULTADOS: Se analizaron 29 casos de niños y adolescentes alojados en hogares de CABA. El estudio evidenció prolongados períodos de permanencia, insuficiencia de recursos para la adecuada atención, obstáculos para la inserción social/comunitaria, dificultades en el trabajo de vinculación familiar y en el logro del egreso, situaciones de tensión y conflicto entre las diversas instituciones intervinientes y barreras de accesibilidad a los servicios de salud mental, pero un abordaje eficaz en el PAC. CONCLUSIONES: La restitución de los derechos vulnerados es una cuenta pendiente. Es indispensable adecuar las prácticas a la legislación local y a los postulados de la Convención sobre los Derechos del Niño. También resulta prioritario capacitar al recurso humano que asiste a esta población.

INTRODUCTION: children and adolescents living in institutions represent a vulnerable group. It is important to know their situation and specific needs, as well as theresources required for a proper care. OBJECTIVES: To explore the characteristics and institutional path of children and adolescents living in cohabiting, therapeutic and maternalhomes in Buenos Aires city. To explore the approach they received from the field of mental health particularly in theCommunity Care Program (CCP) in 2010. METHODS: A qualitative, descriptive and exploratory design was used, with an intentional non-probabilistic sample. The institutionaltrajectory and the approach received from the field of mental health were analyzed by exploring medical records and conducting semi-structured interviews to workers homes. RESULTS: A total of 29 cases of children and adolescents living in Buenos Aires Dwelling Homes were analyzed. The study showed long periods of institutionalization, insufficient resources for the proper care, obstacles for social/communityintegration, difficulties regarding family bonds and exit from the institution, tension and conflicts between institutions involved, and barriers to mental health services, but an efficient approach in the CCP. CONCLUSIONS: The restitution of violated rights is still an ongoing issue. Practices should be established according to local law and to the principles set forth by the Convention on the Rights of the Child. Thetraining of human resources devoted to this population is also a priority.

La psiquiatría comunitaria en Cuba / Community psychiatry in Cuba

Se presenta el desarrollo de la psiquiatría comunitaria en Cuba, los factores que han contribuido a ello, y se propone cómo articular un nuevo paradigma basado en el modelo de atención comunitaria de salud mental, un modelo de organización de los servicios de salud mental más avanzado. Dicho modelo se materializa en los centros comunitarios de salud mental, con una base teórico y práctica que integra todos los aspectos que debe contemplar la atención integral al proceso salud-enfermedad, como forma de abordar este complejo sistema.

An overview is presented of the development of community psychiatry in Cuba and its contributing factors. A proposal is made about how to build a new paradigm based on the community primary health care model, a more advanced organization model for mental health services that takes shape in mental health community centers, based on a theoretical and practical foundation that integrates all the aspects of a comprehensive approach to the health-disease process as a way to deal with such a complex system.

Survey on health status and community care needs of the elderly in Chongqing urban area / 重庆医学

Objective To learn the health status and community care needs of the elderly in Chongqing urban area ,and provide a basis for the future development of geriatric nurse in community .Methods SF‐36 scales and a self‐designed questionnaire were used to know the health status and community care needs of 1 005 elderly in Chongqing .Results The incidence rate of chronic com‐munity elderly was 79 .69% .SF‐36 scale total score was (71 .76 ± 12 .85) ,physical health was (72 .46 ± 17 .56) ,and mental health was (73 .29 ± 16 .87) .Multiple regression showed that number of chronic cases ,economic status ,age ,lifestyle were unhealthy situa‐tion factors .Community care needs of the top five in turn were regular inspection ,care and community experts ,high‐quality commu‐nity nurses ,health lectures ,and first aid care .Multivariate Logistic regression analysis of elderly community care needs revealed that sex (X1 ) ,occupation (X2 ) ,economic conditions (X3 ) ,inspection (X4 ) ,community care to understand the situation(X5 ) were fac‐tors ,Regression predict model:P=1/[1+Exp∑ (-2 .155+0 .612X1 -0 .121X2 +0 .173X3 +0 .211X4 +1 .107X5 )] .Conclusion Communities need to strengthen regular physical check for the elderly ,pay more attention to elderly male ,strengthen chronic dis‐ease management ,pension and health ,nutrition and health promotion ,enhance the training of personnel for community aged care , and change community care models .

Calidad de la ejecución del subprograma de atención comunitaria al adulto mayor del Policlínico Universitario "José Martí" / Quality of implementation of the community care subprogram for older adult at "José Martí" University Polyclinic

Se realizó una investigación en sistemas y servicios de salud para evaluar la calidad de la ejecución del Subprograma de Atención Comunitaria al Adulto Mayor en el área de salud correspondiente al Policlínico Universitario "José Martí Pérez" de Santiago de Cuba, desde noviembre del 2010 hasta igual mes del 2011. El universo estuvo constituido por 72 profesionales y 63 ancianos frágiles del área antes citada. Se evaluaron los elementos estructura (recursos humanos, materiales), proceso (competencia profesional) y resultados (satisfacción de los proveedores y usuarios e indicadores del programa). La calidad de la ejecución del subprograma fue inadecuada, debido a la insuficiente competencia e insatisfacción de los profesionales de la salud evaluados, por lo cual se evidenciaron dificultades tanto en el proceso como en los resultados. Por tales razones se recomendó efectuar un estudio de intervención relacionado con las deficiencias encontradas en la evaluación de la calidad de la ejecución del subprograma.

A research in health systems and services was made to assess the quality of implementation of the Community Care Subprogram for Older Adult in the health area corresponding to "José Martí Pérez" University Polyclinic of Santiago de Cuba, from November 2010 to the same month of 2011. The sample was formed by 72 professionals and 63 fragile elderly of that area. Elements such as structure (human resources, material), process (professional competence) and outcomes (satisfaction of users and providers and program indicators) were assessed. Implementation quality of the subprogram was inadequate due to insufficient competence and dissatisfaction of health professionals evaluated, thus difficulties were evident in both the process and the outcomes. For these reasons it was recommended to make an intervention study related to the deficiencies in the quality assessment of the subprogram implementation.

Detección extramuros de enfermedades de la piel / Extramural detection of skin diseases

RESUMEN: Se informa la frecuencia de patologías de la piel obtenida de la atención durante varias jornadas y consultorios, realizada por el Servicio de Dermatología del Hospital Nacional, en localidades próximas a esta institución. Material y Métodos: Se evaluaron 948 sujetos, con predominio del sexo femenino (65%). Resultados: El grupo etario más frecuente fue el de 30 a 39 años. Se detectaron patologías graves: Cáncer de piel, lesiones precursoras de cáncer de piel, pénfigo, genodermatosis y lepra.

ABSTRACT: We report of the frequency of skin conditions made by a Dermatology Service for several days in adjacent communities of the National Hospital. Material and Methods: We evaluated 948 subjects, with predominance of female gender (65%). Results:The most common age group was between 30 to 39 years. Serious diseases were detected: skin cancer, precursor lesions for skin cancer, pemphigus, genodermatosis and leprosy.

Study on the existing problems and countermeasures of community care for diabetic patients / 国际中医中药杂志

In this paper, the needs of community care for diabetic patients were studied, and the existing problems were summarized and analyzed. "Four drawbacks" on community care were pointed out, namely, lack of knowledge, insufficient service resources, deficiency of professional nursing staff, and inadequate management. There were also "four lacks" on diabetic patients, namely, lack of confidence, lack of attention, lack of knowledge and lack of compliance. Seven measures of community health care for diabetic patients were pointed out in this paper, which were to enhance the quality of personnel, to strengthen health education, to emphasize on psychological counseling, to enhance behavioral modification, to carry out medical consulting, and to implement the specific medical care and comprehensive intervention.

Home-based newborn care: How effective and feasible.

Neonatal mortality in developing countries is one of the most important problems that need immediate attention in order to achieve Millennium Development Goals. About 4 million newborns die in the world every year, 90% of them in the developing world. Most of these deaths are preventable by simple interventions in the community. However, in most of the target countries, the implementation of essential newborn care has been very poor. The home based or community care packages include maternal care, essential newborn care, improving the behavior change communication of the community, resuscitation of newborn babies at the time of home delivery, and management of sick newborns with antibiotics at home. Studies have reported one-third to two-third reduction of mortality among newborns after home based care interventions. However, when translated into scaling up of home based newborn care in the worst affected districts of the country, the results are not very rewarding. Identification of limiting factors and effective up scaling of the home-based packages will prove to be of enormous benefit in reducing neonatal mortality.