Validation of the Brazilian Version of the Screening Tool for Psychosocial Distress (Stop-D) for Cardiac Patients

Distress has a potentiating effect on complications of heart disease. Early identification of distress and psychosocial management could help patients to deal with the disease and improve their quality of life. However, in Brazil, there is no specific instrument for evaluation of distress in cardiac patients. Objectives: To describe the validation process of the Screening Tool for Psychosocial Distress (STOP-D) for the Brazilian population. Methods: Cross-sectional, observational study with a quantitative approach. A total of 144 patients (including outpatients and inpatients) were interviewed at the waiting room of the outpatient cardiology clinic or in cardiology wards. Sociodemographic and clinical data were collected, and distress was assessed using two instruments - the Brazilian version of the STOP-D and the Hospital Anxiety and Depression Scale (HADS). First, we performed an exploratory factor analysis and analysis of the accuracy of the STOP-D score by the receiver operating characteristic (ROC) curvet. Results: The factorability analysis of the correlation matrix did not detect any factor that made the factorial solution unfeasible. The instrument showed a single-factor nature, confirmed by the criterion of eigenvalues, with an 85% accuracy in predicting distress. A cut-off point of 15.5 was chosen for distress using the ROC curve. Conclusions: The Brazilian version of the STOP-D is an adequate instrument for the screening of heart disease patient for distress. It can be easily used by any health professional and would contribute to the promotion of a comprehensive support to cardiac patients

Allende y la realidad médico-social, a 75 años / Allende and medical social reality: 75 year later

A 75 años de la publicación del libro ‘La Realidad Médico-Social Chilena’, escrito en 1939 por el Dr. Salvador Allende (Presidente de Chile, 1970-73) en su condición de Ministro de Salud del Presidente P. Aguirre Cerda, se re-visita con detalle, parte por parte, los diferentes capítulos de la Salubridad, vistos por el ojo del especialista que luego dirigiese la República, haciendo una breve relación con su vigencia actual. El articulista concluye que el Dr. Allende debió recibir un grado académico honorario en Salud Pública (no existía entonces en el país) y que su análisis, -con las adecuaciones epidemiológicas y políticas del caso-, podría ser el eje de un nuevo Programa de gobierno en el siglo XXI.

75 years later, a re-visiting of the book ‘The medical and social reality of Chile’, finds that it could still be the back-bone of a government policy and plan for the XXI century, given that suitable epidemiological and political upgradings are introduced. The book, written by Dr. Allende in 1939 when he was Minister of Health for President P. Aguirre Cerda, is a thorough and systematic presentation of all factors involved in the diagnosis and planning of health and medical services. The reviewer concludes that Dr. Allende would have deserved an honorary degree in Public Health (none existed at the time in the country).

Uso da rede de serviços de Juiz de Fora: a opinião do usuário / Use of the health care net work of Juiz de Fora: the opinion of the user

As mudanças no perfil demográfico e epidemiológico ocorridas nas últimas décadas adquirem características particulares no Brasil e impõem a redefinição das políticas públicas, em especial da saúde, o que culmina com a implantação da Estratégia de Saúde da Família (ESF) em 1994. Espera-se com essa estratégia uma mudança de paradigma, em que se faça valer os princípios do SUS de universalidade, eqüidade e integralidade por meio do cuidado continuado, da prevenção de agravos e da promoção da saúde, principalmente nas populações mais vulneráveis. Para funcionar dessa forma, porém, é necessária a existência de uma rede de serviços que garanta a assistência nos casos onde a ESF não consiga resolver, estabelecendo-se um fluxo de referência e contra-referência. Usando como método a entrevista não-estruturada aplicada em quatro unidades básicas de saúde funcionando com a ESF em regiões distintas de Juiz de Fora, nós nos propomos a discutir, a partir das percepções dos usuários inscritos no PSF, o funcionamento desta rede de serviços, em uma tentativa de encontrar alguns pontos de gargalo e propor estratégias que possibilitem melhorias no acesso do usuário.

The demographic and epidemiological changes occurred over the last decades assume particular characteristics in Brazil and demand for a redefinition of public policies, in special as refers to the health policies. In 1994, this process culminates in the implantation of the Family Health Strategy (FHS) as a new paradigm following the basic principles of the Unified Health System, integrality, equity and universality, by means of continued care, disease prevention and health promotion principally for the more vulnerable populations. For meeting this demand, the strategy depends on a service network capable of delivering care in cases the FHS cannot resolve, establishing a reference and counter-reference system. Data were collected by means of semi-structured interviews in four basic healthcare units of the Family Health Program. Based on the view of the users enrolled in the Family Health Program we discuss the performance of this service network in an attempt to identify some bottlenecks and suggest strategies for granting better access to the users.

Model designing of population health-targeted national health delivery system / 第二军医大学学报

Objective:To reveal the behavior characteristics of health delivery system(HDS) and the dynamical mechanism by which HDS promoting population health,so as to provide theoretical and methodological evidences for the decision-making of national macro health system.Methods: The macro model of HDS was constructed by using the theory of complex system and the method of system dynamics.Results: The principle of "high coverage and reasonable quality" was put forward as developmental strategy of national health service.The improvement of population health was taken as the system objective of HDS;meanwhile,HDS was community-centered and city-country integrative.The macro model of HDS was constructed based on the above objectives.Conclusion: Modeling based on system dynamics is effective to reveal the complexity of health delivery system.The HDS complex system model constructed in this article can be used to analyze and interpret the behavior characteristics of HDS and the dynamic mechanism by which HDS promoting population health.

Development and Evaluation of Home Doctor Registration Program

BACKGROUND: Ministry of Health and Welfare offered' Home Doctor Registration Program' to rein force primary care and to increase the efficiency of national health delivery system. But, it failed because it was not supported by doctors and nations. We designed this study to develope and evaluate apractical version of 'Home Doctor Registration Program'. METHODS: We invited primary care doctors who were concerned with 'Home Doctor Registration Program' via PC-communication and developed a practical version of this program. After 6 monte of this program, surveys on participated docters and patients were done. RESULTS: 8 primary care doctors and 285 patients have participated in this study. All the 8 doctors have offered the 4 obligatory services and 3 doctors have offered telephone counselling and no doctor has offered visiting examination. After 6 months of this program, CCPQ score was increased significantly and all the health risk factors of participated patients were decreased. Doctors have thought that Family Chart Service, Health Risk Appraisal, Vaccination and Screening Test are more necessary in this program. But Patients have thought that Telephone Counselling and Visiting Examination are more important in this program. CONCLUSION: Almost of participated doctors and patients have been satisfied with this practical version of 'Home Doctor Registration Program'. But, subjective feeling about which service was more necessary in this program was different between doctors and patients.