Factors affecting utilization of an urban community health center: A cross-sectional study

Background@#The local health center (LHC) is the locus of public health service delivery in the barangays of Makati City. It should be the first-line for consultation and should be able to address most health concerns of the community. Considering the many services offered in the LHC, one must study the reasons why constituents opt to consult in the city hospital or in private institutions rather than the LHC. @*Objective@#This study sought to determine the correlation between community perception of the LHC and utilization of the LHC in Barangay Rizal and Barangay Southside, and the correlation between demographic variables and the utilization of the LHC in Barangay Rizal and Barangay Southside. @*Methods@#This is an observational study that utilized a cross-sectional survey. Utilization of the Local Health Center was operationally defined as any consultation in the local health center in the past year, regardless of occurrence of illness. The survey questionnaire had a 5-point Likert Scale and utilized the Patient Satisfaction Questionnaire-18 and added other possible factors affecting utilization based on related literature. @*Results@#Utilization of the LHC had a weak correlation with barangay (Rizal versus Southside), older age, and having more co-morbid illnesses. Community perception of General Satisfaction, Availability of doctors, and Availability of free medications had a weak correlation with consulting in the LHC and had good community perception ratings.@*Conclusion@#Patient-Doctor Relationship also showed a weak correlation with consulting in the LHC but merits attention because it had a somewhat low community perception rating.

Perceptions and experiences of infant massage among caregivers of infants 2-6 months old consulting at two public health centers in Quezon City, Philippines, before and after infant massage training

Background@#The benefits of infant massage in hospital and community settings have been documented in literature: better weight gain of preterm and low birthweight infants, shortened hospital stay, slightly better scores on developmental tests, fewer postnatal complications, and effects on physical and mental health. @*Objectives@#This study described the perceptions and experiences of infant massage among caregivers of infants 2-6 months old consulting in two public health centers in Quezon City before and after infant massage training. @*Methods@#This qualitative study assessed perceptions and experiences at baseline and after infant massage training of mothers and caregivers taking care of infants 2-6 months old. Pre-training interviews were conducted, as well as immediately after, and seven days after training on infant massage delivered by the Philippine League of Government and Private Midwives, Inc. (PLGPMI). Training consisted of lectures and demonstrations, after which mothers/caregivers gave their babies the massage under the trainer's supervision. Post-training interviews were conducted immediately after the training and seven days after. Responses to the interviews were transcribed. The transcripts and interview notes were analyzed independently by two research team members. Qualitative Content Analysis (QCA) was done. Disagreements were settled by discussion. @*Results@#The infant’s mother was identified as the best person to perform infant massage. Infant massage was a new concept to many participants before the training. In general, the perception was positive. It was believed to promote the baby's physical development and bonding with the mother/caregiver. These same benefits were reported after the training. Post-training, all 11 participants who returned for follow-up interviews reported having massaged their babies at home. They were also able to describe the process and timing of massage as taught to them. The participants’ responses centered on seven (7) identified themes, identified at baseline and after training: 1) general concepts of infant massage, 2) benefits of infant massage, 3) methodologies, materials, and considerations, 4) persons credible to perform infant massage, 5) application/performance of infant massage, 6) intentions and 7) infant massage as a public health measure. @*Conclusion@#There was a positive perception of infant massage among mothers and caregivers of infants 2-6 months old, whether or not they had prior knowledge. The sharing of information and the training given enhanced this. Participants showed good reception and retention of infant massage's basic concepts and process and improved their confidence in handling their babies and massaging them.

Ateneo General de la Residencia de Psicopedagogía: ¡Atención! Adultxs aprendiendo / Psicopedagogic Residente General atheneaum: Attention! Adults learning

El Equipo de Psicopedagogía y residentes de esa especialidad del Centro de Salud Nº 15, de la Ciudad de Buenos Aires, desarrolló actividades relacionadas con el aprendizaje en y con adultos, durante la pandemia de Covid-19. En un primer eje, se presentan diferentes aristas del concepto de educación, y el de aprendizaje. En un segundo eje, se describe el proceso que realizan los adultos en diversas instancias de aprendizaje, así como sus motivaciones y deseos.

Effectiveness of dental emergency services in a community health center in Santiago, Chile / Efectividad de los servicios de urgencias odontológicas en un centro de salud comunitario de Santiago de Chile

Objective: Describe the demographic characteristics of the population attending the dental emergency services in health Center Juan Petrinovic, located in Santiago, Chile, and examine the effectiveness of dental treatment given to this population. Material and Methods: Before-after study, where 45 patients were surveyed twice, first, before their dental care and then in phone call follow-up. Patients completed interviewer-administered surveys that asked about patients' self-reported pain level, oral health-related quality of life, and demographic information. Demographic information collected included age, sex, educational level, type of health insurance, and municipal district where patients lived. Self-reported pain level was measured using a Visual Analogue Scale (VAS), and oral health quality of life was measured using the Dental Health Status Quality of Life Questionnaire (DS-QoL). Statistical descriptive analyses were performed, and statistical tests were applied to determine if the care given was effective on pain relief and increased quality of life status. Results: Most of the patients seeking care at the dental emergency service were female (67%), adults (average age 46 years), with high school education (58%), and FONASA health insurance (98%). The most common reason for using dental emergency services was pain (51%). Dental treatment given to the patients was effective in relieving pain (reduction in VAS score was 34.34 between pre and post attention) and improving their oral health status (reduction in DS-QoL score was 3.18 between pre and post attention). Conclusion: This dental emergency service was effective in reducing pain and improving the quality of life of the patient.

Objetivo: Describir las características demográficas de la población que asiste a los servicios de emergencia odontológica en el Centro de Salud Juan Petrinovic, ubicado en Santiago de Chile, y examinar la efectividad del tratamiento odontológico que se le brinda a esta población. Material y Métodos: Estudio antes-después, donde se encuestó a 45 pacientes en dos ocasiones, primero, antes de su atención odontológica y luego en seguimiento telefónico. Los pacientes completaron encuestas administradas por el entrevistador que preguntaban sobre el nivel de dolor autoinformado por los pacientes, la calidad de vida relacionada con la salud bucal y la información demográfica. La información demográfica recopilada incluyó edad, sexo, nivel educativo, tipo de seguro médico y distrito municipal donde vivían los pacientes. El nivel de dolor autoinformado se midió mediante una escala analógica visual (EVA) y la calidad de vida de la salud bucal se midió mediante el Cuestionario de calidad de vida del estado de salud dental (DS-QoL). Se realizaron análisis estadísticos descriptivos y se aplicaron pruebas estadísticas para determinar si la atención brindada fue efectiva para aliviar el dolor y mejorar el estado de la calidad de vida. Resultados: La mayoría de los pacientes que acudieron al servicio de urgencias odontológicas fueron mujeres (67%), adultos (edad promedio 46 años), con estudios secundarios (58%) y seguro médico FONASA (98%). La razón más común para utilizar los servicios de emergencia dental fue el dolor (51%). El tratamiento dental administrado a los pacientes fue eficaz para aliviar el dolor (la reducción de la puntuación EVA fue de 34,34 entre la atención previa y posterior) y la mejora de su estado de salud bucal (la reducción de la puntuación DS-QoL fue de 3,18 entre la atención previa y posterior). Conclusión: Este servicio de urgencias odontológicas fue eficaz para reducir el dolor y mejorar la calidad de vida del paciente.

El lado B de la pandemia: Equipo de Psicopedagogía CeSAC N°10 / Side B of the pandemic: Psychopedagogy team at CeSAC Nº 10

Ante el aislamiento decretado por la pandemia por Covid-19, el equipo de residentes de Psicopedagogía con sede en el Centro de Salud Nº 10, de la Ciudad de Buenos Aires, reorganizó sus actividades y la modalidad de atención de sus pacientes. Ante la situación de emergencia sanitaria, el centro de salud fue adoptando otra modalidad de atención, y el equipo de residentes se adaptó a realizar otras actividades, que aquí se describen, así como los nuevos espacios de atención implementados.

Experiencias de fonoaudiólogos/as en hospitales y Centros Comunitarios de Rehabilitación: ¿se modifica la práctica de atención? / Experiences of speech therapist in hospitals and Community Rehabilitation Centers: is the care practice changed?

El presente trabajo busca caracterizar las prácticas fonoaudiológicas en dos contextos de atención de la salud pública chilena (hospitalario y atención primaria -centros comunitarios de rehabilitación). Es un estudio cualitativo con enfoque micro-sociológico, que implicó la realización de entrevistas en profundidad y observaciones no participantes a dos fonoaudiólogos/as insertos en Centros Comunitarios de Rehabilitación (CCR) y dos fonoaudiólogos/as insertos en hospitales públicos. Los datos obtenidos se analizaron con herramientas de la Teoría Fundamentada y se propuso una conceptualización basada en semejanzas y diferencias de las prácticas fonoaudiológicas utilizando el software computacional ATLAS-ti. Del análisis surgen las siguientes categorías: rol del profesional, sujeto de atención, relación terapeuta-usuario/a, espacio físico y organización de la sesión, los/las participantes. Además, el principal hallazgo refiere a que todos/as los/las profesionales mencionan la relevancia de incorporar matices psicosociales en el abordaje que realizan. Sin embargo, en la práctica de todos/as los/las fonoaudiólogos/as durante la observación participante no se evidencia dicha incorporación. Los resultados permiten concluir que la conceptualización del quehacer fonoaudiológico se construye mayormente a partir del contexto laboral. Asimismo, los modelos de atención a la base (biomédico-biopsicosocial) se encuentran actualmente en un proceso de hibridación, siendo la práctica de los/las fonoaudiólogos/as situada y también influida por el contexto laboral.

The present work seeks to characterize speech therapy practices in two Chilean public health care contexts (hospital and primary care -community rehabilitation centers). It is a qualitative study with a micro-sociological approach, which involved conducting in-depth interviews and non-participant observations with two speech therapists inserted in Community Rehabilitation Centers (CCR) and two speech therapists enrolled in public hospitals. The data obtained were analyzed with Grounded Theory tools and a conceptualization based on similarities and differences of speech therapy practices was proposed using ATLAS-ti computational software. The following categories emerge from the analysis: role of the professional, subject of care, therapist-user relationship, physical space and organization of the session, the participants. In addition, the main finding refers to the fact that all the professionals mention the relevance of incorporating psychosocial nuances in the approach they carry out. However, in the practice of all speech therapists during participant observation, such incorporation is not evidenced. The results allow us to conclude that the conceptualization of speech therapy is built mostly from the work context. Likewise, the models of care at the base (biomedical-biopsychosocial) are currently in a process of hybridization, the practice of speech therapists being situated and also influenced by the work context.

Analysis of prescription and rationality of anti-hypertensive medication among community health centers in Beijing / 中华心血管病杂志

Objective: Explore the usage of anti-hypertension drugs and the rationality of hypertension prescription among the primary health centers in Dongcheng District, Beijing. Method: This cross-sectional and retrospective study was applied to analyze the hypertension prescriptions from the 8 community health centers in Dongcheng District. The anatomical, therapeutic and chemical classification (ATC) codes were used to determine the drug category. ATC information was used to filter data containing antihypertensive drugs, and group the number and proportion of ATC categories. The type of drug was judged by its generic name. According to the diagnosis information in the prescription, the prescription containing the Western medicine diagnosis of hypertension was screened out. The comorbidities of hypertension in the study included 7 types of diseases including diabetes, chronic kidney disease, coronary heart disease, heart failure, atrial fibrillation, stroke, and dyslipidemia. The analysis of prescription rationality included rationality of combination medication, rationality of drug dosage and rationality of drug price. The agreed daily dose (DDD) method was used to analyze the rationality of drug dosage. The drug utilization index (DUI) was used as a quantitative indicator to estimate the rationality of medication, and overdose was expressed by DUI>1. The reasonableness of the drug price was judged based on the price of the drug and whether it was a drug in the "4+7" plan. Results: A total of 658 140 prescriptions were extracted as the final data set, involving 7 categories and 60 commonly used anti-hypertensive drugs, and the corresponding cost of medication was ￥96.58 million. Drugs were prescribed according to comorbidities, and the choice followed the international guidelines. Calcium channel blockers (CCB) were the most prescribed drugs in the prescriptions of patients with comorbidities, and α-adrenergic receptor antagonists were the least prescribed drugs. The proportion of diuretics prescribed in hypertensive patients complicating with heart failure was 21.17% (505/2 385), which was much higher than that of patients complicating with other comorbidities (P<0.05). The proportion of diuretics prescribed in hypertension patients complicating with dyslipidemia was lower than that of patients with other comorbidities (2 639 (0.94%), P<0.05), and β-blockers (BB) or angiotensin Ⅱreceptor blockers (ARB) were more likely to be selected (BB: 59 348 (21.08%), ARB: 51 356 (18.24%))in these patients. The proportion of BB in prescriptions for hypertension patients with chronic kidney disease was lower than that of patients with other comorbidities (P<0.05). The proportion of BB in prescriptions for hypertension patients with coronary heart disease was higher than that of other comorbidities (P<0.05). Hypertension patients with atrial fibrillation or stroke accounted for a higher proportion of CCB prescriptions (P<0.05). Single antihypertensive drug prescriptions accounted for the highest proportion, 61.19% (402 745/658 140). Two-combination prescriptions accounted for the highest proportion of combination prescriptions, 72.19% (184 392/255 395). CCB based two-combination prescriptions accounted for the highest proportion, 122 350(66.36%). ARB-based tri-combination prescriptions accounted for the highest proportion, 48 915(89.50%),followed by CCB based tri-combination prescriptions (44 732(81.85%)).There were 2 174 (0.33%) prescriptions with unreasonable combination therapies and DUI>1 were found in 48 out of 60 commonly used drugs. In all possible antihypertensive drugs, only 40.92% (109 227/266 993)followed the "4+7" plan. Conclusions: The anti-hypertensive agents from these prescriptions in the primary health centers are diverse, and the choice is generally complied with the guidelines, but some unreasonable situations existed, especially on the combined anti-hypertensive medication, overdose, and"4+7"plan is not followed completely.

Competencias disciplinares de la psicopedagogía en las comisiones interdisciplinarias del primer nivel de atención que se constituyeron a partir del Aislamiento Social Preventivo y Obligatorio por COVID-19 en el Centro de Salud y Acción Comunitaria N° 10 según el equipo de salud interviniente / Disciplinary competencies of psychopedagogy in interdisciplinary commissions of the first level of care that were constituted from the Social Isolation Preventive and Mandatory by COVID-19 at the CESAC N° 10 according to the health team involved

El presente trabajo de investigación se enmarca dentro del Sistema de Residencias y Concurrencias del Ministerio de Salud de la Ciudad Autónoma de Buenos Aires. Las autoras del presente escrito son residentes de psicopedagogía cursando su último año en el Centro de Salud y Acción Comunitaria Nº 10 que depende del Hospital General de Agudos José María Penna, de la Ciudad de Buenos Aires. Su objetivo es describir las competencias transversales de los profesionales que integran las comisiones interdisciplinarias que se constituyeron en el CeSAC N° 10 a partir del ASPO, desde la perspectiva de los profesionales que integran las mismas; caracterizar las competencias disciplinares de psicopedagogía en las comisiones interdisciplinarias que se constituyeron a partir del ASPO desde la perspectiva del equipo interviniente; y analizar las competencias disciplinares atribuidas a la psicopedagogía a la luz de las competencias transversales a todo el equipo de salud y del perfil profesional esperado para psicopedagogía. (AU)

Representaciones de niños y niñas de 8 a 12 años sobre el tratamiento virtual de psicopedagogía durante el contexto de pandemia 2020-2021: Cesac N°15 y Hospital Durand / Representations of children aged 8 to 12 on the virtual treatment of psychopedagogy during the context of pandemic 2020-2021: Cesac N°15 and Hospital Durand

La presente investigación pretende abordar una temática actual surgida en el contexto de pandemia por COVID19 bajo las regulaciones nacionales en relación al aislamiento preventivo y obligatorio vivenciado a lo largo del año 2020. En la misma se indaga sobre las representaciones de los niños y niñas en relación a los tratamientos psicopedagógicos virtuales, entendidos estos como un vínculo estable prolongado en un cierto tiempo entre un niño/a o adolescente (NNA) y un/una profesional de la psicopedagogía con el fin de acompañar o ayudar a disminuir su malestar en torno al aprendizaje en alguna de sus aristas. Estos encuentros desde el inicio de la pandemia se vieron enmarcados en aplicaciones digitales - como zoom o videollamada de Whatsapp debido al contexto de emergencia sanitaria mundial. El objetivo fundamental será investigar las características particulares del tratamiento psicopedagógico bajo la modalidad virtual a partir de las voces de los niños y las niñas que presentan dificultades en sus procesos de aprendizaje, es decir teniendo como eje central a los actores principales del espacio de tratamiento y sus representaciones sobre el mismo. (AU)

De Alma-Ata a Astana: o percurso dos Cuidados de Saúde Primários em Portugal, 1978-2018 e a génese da Medicina Familiar / From Alma-Ata to Astana: the path of Primary Health Care in Portugal, 1978-2018 and the genesis of Family Medicine

Resumo Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.

Abstract Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.

Delays in accessing antenatal care services in a developing nation tertiary health center

Background: Delay in seeking medical care is common and constitutes a major unresolved public health problem. It could contribute immensely to maternal mortality, especially in developing countries, where access and availability of functional health­care facility have remained a challenge. Objective: This study aimed at identifying the forms of delays encountered by pregnant women seeking antenatal care (ANC) services and also factors responsible for such delays. Materials and Methods: This was a cross­sectional study among women attending antenatal care clinic of our hospital. Data were obtained through an interviewer­administered questionnaire and were analyzed by the Statistical Package for the Social Sciences version 17. Results: The mean age of the respondents was 28.6 (standard deviation [SD] ± 5.44) years. About a third (31.5%) experienced Type II delays due to inaccessibility to the mode of transportation and traffic deadlock; while majority (77.1%) experienced intrahospital delays due to delay in retrieving cases notes, seeing an obstetrician, inadequate health personnel, and consulting rooms. The average waiting time was 3.1 ± 0.91 SD hours (188 min). The waiting time was not statistically associated with time of arrival to the clinic. Conclusion: Most women experience intrahospital delays while seeking ANC. Intervention by policymakers and adequate staffing coupled with provision of necessary health­care amenities will go a long way in reducing patients waiting time

Blessés de guerres dans un centre de santé de cercle au Mali : profil épidémio-clinique et prise en charge

But : Décrire les aspects épidémiologiques, cliniques et thérapeutiques des blessures de guerres au centre de santé de référence de Douentza. Patients et Méthode : Il s'agissait d'une étude descriptive incluant les patients pris en charge entre le 1er Décembre 2017 et le 31 Décembre 2018 au centre de santé de référence du district sanitaire de Douentza. La stratégie de prise en charge des blessés adoptée était celle de MARCHE et selon les principes de la chirurgie de guerre. Résultats Au total nous avons reçu 71 blessés de guerre au centre de santé de Douentza. Cette série était composée de 66 hommes, de 34 (48%) militaires et représentait 63% des urgences chirurgicales (n=113) et 30% des interventions chirurgicales réalisées dans l'établissement. Les lésions siégeaient sur les membres dans 53% des cas; 23% sur l'abdomen (traumatismes abdominaux pénétrant et/ou perforants) et 15% sur la région dorso-lombaire. Elles étaient causées par des engins explosifs improvisés (48%), des balles (37%) et des armes blanches (15%). Il s'agissait de plaies abdominales dans 11 cas (16%) dont 4 plaies perforantes et 7 plaies non pénétrantes, de plaies vasculaires dans 7 cas (10%), de délabrements cutanéo-musculaires dans 21 cas (30%), de broiements de la main dans 1 cas et d'écrasement également dans 1 cas (1%). Les lésions étaient infectées à l'admission dans 25% des cas et un état de choc était retrouvé chez 15% des patients. 68% des patients étaient référés dans une structure plus équipée pour prise en charge appropriée. L'échographie seul examen para clinique disponible, était utilisée 33 fois (46%) pour explorer l'abdomen. Elle était contributive au diagnostic 11 fois (33%). Sur le plan thérapeutique, le parage chirurgical était d'emblée réalisé chez 53 patients (75%). 16 décès (23%) ont été déplorés, suites à des traumatismes cranio-cérébraux (n=2), plaie cervicale (n=1), péritonites (n=3), polytraumatisme (n=1) et 9 décès ont été constatés à l'admission. Conclusion Les blessés de guerre sont des urgences chirurgicales graves menaçant le pronostic vital immédiat et/ou fonctionnel à long terme. Leur prise en charge exige une organisation et des équipements spécifiques. Le centre de santé de Douentza à l'instar des autres centres de santé du Mali, disposant d'un faible plateau technique et sans plan d'urgence s'est trouvé confronté à l'accueil d'un nombre croissant de blessés de guerre pour lesquels, il n'était pas préparé. La gestion de ces blessés a été difficile d'où la nécessité de repenser les missions des centres de santé de cercle et le niveau de leur plateau technique

Psicopedagogía: criterios de derivación / Psychopedagogy: derivation criteria

Trabajo de investigación en el marco del Sistema de Residencias y Concurrencias del Ministerio de Salud de la Ciudad Autónoma de Buenos Aires, realizado por residentes de tercer año con sede en el Centro de Salud Comunitaria Nº 10. Se analizan los criterios que sostienen las psicopedagogas de segundo y tercer año de la residencia de Psicopedagogía, jefas e instructoras de la misma y psicopedagogas de planta que se desempeñan en las diferentes sedes de la residencia durante marzo de 2018 a junio de 2019, para indicar exclusivamente atención psicológica a niños de escolaridad primaria que se encuentran en diagnóstico psicopedagógico, los criterios para indicar exclusivamente el inicio de tratamiento psicopedagógico y los que sostienen las profesionales para proponer la atención en ambas disciplinas.

"Nacer en determinado lugar te condiciona". Salud, derecho a la ciudad, crisis y participación en un barrio reubicado / "Being born in a certain place conditions you". Health, right to the city, crisis and participation in a relocated neighborhood

Resumen Este artículo analiza, en el marco de una relocalización de asentamientos, la participación y las tácticas de los/as habitantes de Barrio Nuevo y médicos/as de un Centro de Salud de La Plata (Argentina) ante la crisis acontecida a partir de la aplicación de políticas de austeridad.El supuesto del que partimos es que la participación comunitaria y en el campo de la salud (entendida en un sentido holístico) posibilita identificar e incidir en los condicionantes sociales, como el derecho a la ciudad, para favorecer transformaciones de la situación de salud del territorio. Para ello, indagaremos la crisis, las políticas actuales y los modos de participación. En particular, desarrollaremos la experiencia de un Análisis de Situación de Salud (ASIS) en el barrio y analizaremos la relación entre derecho a la salud y derecho a la ciudad.Se empleó una metodología etnográfica. Se realizaron observaciones participantes, entrevistas en profundidad, un taller de salud y se participó en el ASIS.Concluimos que hay una relación dialéctica entre derecho a la ciudad y a la salud y ésta es una construcción colectiva. Toda participación barrial fortalece las intervenciones en salud. Ello es indispensable en contextos de crisis para luchar por derechos vulnerados.

Abstract The present paper analyzes, in the context of a settlements' relocation, the participation and tactics developed by the Barrio Nuevo inhabitants and doctors of a Health Centre in La Plata (Argentina), to face the crisis that is taking place in the country from the application of austerity policies. Our assumption is that community participation and in health issues (understood in a holistic sense) makes it possible to identify and intervene in social conditions, such as the right to the city, to produce changes in the health situation of the territory. For this, we will investigate the crisis, the current public policies and the modes of participation. Specifically, we will develop the experience of a Health Situation Analysis (ASIS) held in the territory and we will analyze the relationship between the right to health and the right to the city.The methodology used is ethnography. We carried out participant observations, in-depth interviews, a health workshop and participated in the ASIS.We conclude that there is a dialectical relationship between the right to the city and to health and this is a collective construction. All community participation strengthens health interventions. This is essential in crisis contexts to fight for violated rights.

Eficiencia de la actividad de enfermería en policlínicos / Nursing efficiency in polyclinics

Introducción: La actividad de enfermería en los policlínicos es fundamental para alcanzar los resultados de salud que se desean en la población. Brindar estos servicios con eficiencia es un reto y un encargo actual en aras de lograr una mejor utilización de los recursos asignados. Objetivo: Evaluar la eficiencia del trabajo de enfermería en policlínicos de La Habana. Método: Se desarrolló una investigación descriptiva transversal en la totalidad de los policlínicos del municipio Diez de Octubre. Se tomó como base metodológica el algoritmo para el estudio de la eficiencia en unidades del primer nivel de atención de salud en Cuba que emplea el Análisis Envolvente de Datos. Se utilizaron cuatro indicadores de resultados y uno de recursos. Resultados: De los ocho policlínicos, solo cuatro resultaron eficientes. Dos resultaron unidades de mejor práctica y fueron par de referencia para la mayoría de los ineficientes. Las principales reservas de la eficiencia están en el cumplimiento insuficiente de las actividades de seguimiento a pacientes priorizados. Las unidades con mayor nivel de calificación del personal no alcanzaron la eficiencia. Conclusiones: Se determinaron niveles altos de eficiencia técnica pura para la actividad de enfermería en los policlínicos, no obstante, dada la presencia de unidades ineficientes se debe continuar investigando en esta temática. Existen unidades para las cuales hay un nivel de ineficiencia estructuralmente determinada, que para resolverla es necesario un análisis de la distribución y consumo de recursos en el municipio(AU)

Introduction: Nursing activity in polyclinics is fundamental to achieve the expected health results in the population. Offering those services with efficiency is both a challenge and a current endeavor aimed at achieving a better use of the resources allocated. Objective: Evaluate nursing efficiency in Havana polyclinics. Method: A cross-sectional descriptive study was conducted of all the polyclinics in the municipality of Diez de Octubre. The methodological foundation of the study was the algorithm for efficiency assessment in Cuban primary health care units, based on data envelopment analysis. Use was made of four indicators for results and one for resources. Results: Of the eight polyclinics, only four were found to be efficient. Two were best practice units and served as reference for most of the inefficient polyclinics. The main efficiency reserves had to do with poor compliance with follow-up activities for priority patients. The units with the most highly qualified personnel did not achieve the desired efficiency. Conclusions: High levels of pure technical efficiency were determined for nursing activity in the polyclinics. However, given the existence of inefficient units, further research should be conducted about the topic. In a number of units there is a structurally determined level of inefficiency to solve which it is necessary to perform an analysis of the distribution and consumption of resources in the municipality(AU)

Permanence of professionals who work in the Tuberculosis Control Program / Permanencia de profesionales que actúan en el Programa de Control de la Tuberculosis / Permanência de profissionais que atuam no programa de controle da tuberculose

ABSTRACT Objective: To analyze the length of stay of the professionals who work in the Tuberculosis Control Program in Basic Health Units of the city of Rio de Janeiro/RJ. Method: Sectional study, developed in eight Health Units of the Maré Complex/RJ. Physicians, nurses, nursing technicians and Community Health Agents of the Family Health Teams were interviewed. The Kruskal-Wallis test was used to verify the existence of groups with the same distribution, and Dunn's multiple comparison test with Bonferroni correction, to identify which group presented a difference. Results: Among Health Units, a significant difference was observed in the length of work (p-value = 0.0005909) and in the dwell time (p-value = 0.0003598). Conclusion: It was observed low length of stay of the professionals that work in the Basic Health Units. This result points to challenges inherent in the control of tuberculosis at the local level.

RESUMEN Objetivo: Analizar el tiempo de permanencia de los profesionales que actúan en el Programa de Control de la Tuberculosis en Unidades Básicas de Salud del municipio de Río de Janeiro/RJ. Método: Estudio seccional, desarrollado en ocho Unidades de Salud del Complejo de la Maré/RJ. Entrevistaron médicos, enfermeros, técnicos de enfermería y Agentes Comunitarios de Salud de los Equipos de Salud de la Familia. Se optó por la prueba de Kruskal-Wallis para verificar la existencia de grupos con la misma distribución, y prueba de comparaciones múltiples de Dunn, con corrección de Bonferroni, para identificar qué grupo presentaba diferencia. Resultados: Entre las Unidades de Salud, se comprueba diferencia significativa en el tiempo de ejercicio de la función (p-value = 0,0005909) y en el tiempo de permanencia (p-value = 0,0003598). Conclusión: Se constató bajo tiempo de permanencia de los profesionales que actúan en las Unidades Básicas de Salud. Este resultado apunta a desafíos inherentes al control de la tuberculosis a nivel local.

RESUMO Objetivo: Analisar o tempo de permanência dos profissionais que atuam no Programa de Controle da Tuberculose em Unidades Básicas de Saúde do município do Rio de Janeiro/RJ. Método: Estudo seccional, desenvolvido em oito Unidades de Saúde do Complexo da Maré/RJ. Entrevistaram-se médicos, enfermeiros, técnicos de enfermagem e Agentes Comunitários de Saúde das Equipes de Saúde da Família. Optou-se pelo teste de Kruskal-Wallis para verificar a existência de grupos com a mesma distribuição, e teste de comparações múltiplas de Dunn, com correção de Bonferroni, para identificar qual grupo apresentava diferença. Resultados: Entre as Unidades de Saúde, comprova-se diferença significativa no tempo de exercício da função (p-value = 0,0005909) e no tempo de permanência (p-value = 0,0003598). Conclusão: Constatou-se baixo tempo de permanência dos profissionais que atuam nas Unidades Básicas de Saúde. Esse resultado aponta para desafios inerentes ao controle da tuberculose em nível local.

Factores que Afectan la Duración de los Tratamientos de Ortodoncia en un Servicio Público de Salud / Factors that Affect the Duration of Orthodontic Treatment in Public Health Services

RESUMEN: La duración de los tratamientos de ortodoncia siempre ha sido una de las mayores preocupaciones, tanto en los pacientes como en los Ortodoncistas. El proposito de esta investigacion fue determinar la magnitud de las inasistencias a los controles por parte de los pacientes y como estas y otras variables, influyen en la duración de los tratamientos de Ortodoncia en el Centro de Salud Familiar (CESFAM) Dr. Victor Manuel Fernandez, Servicio de Salud de Concepcion, Chile. Se realizo un estudio descriptivo, de tipo transversal, retrospectivo, en el que se utilizaron las fichas clínicas de todos los pacientes que fueron dados de alta por los Ortodoncistas del CESFAM Dr. V. M. F. durante el año 2017. La tabulación se realizó en Microsoft Excel y el análisis estadístico se hizo en InfoStat 17. Se incluyeron 246 pacientes, con una edad de ingreso promedio de 13,6 años. La maloclusion predominante fue la Clase I de Angle (71 %). Estos pacientes tuvieron una duracion de tratamiento promedio de 33,9 meses. Se concluyó que a mayor cantidad de inasistencias, el tratamiento de ortodoncia tuvo una duración mayor.

ABSTRACT: The duration of orthodontic treatments has always been one of the biggest concerns, both in patients and for orthodontists. The purpose of this investigation was to determine the magnitude of the absences to the controls of the patients and how they influence the duration of the orthodontic treatments in the CESFAM Dr. Victor Manuel Fernandez, Concepcion, Chile. A descriptive, cross-sectional, retrospective study was carried out, in which the clinical records of all patients discharged by the Orthodontists of CESFAM Dr. V.M.F. during the year 2017 were analyzed. The tabulation was performed in Microsoft Excel and the statistical analysis was carried out in InfoStat 17. In total, 246 patients were included, with an average age of admission of 13.6 years. The predominant malocclusion was Class I of Angle (71 %). These patients had an average treatment duration of 33.9 months. It was further concluded that the length of orthodontic treatment, was also affected by the increased number of times patients failed to show for treatment.

Graduação em saúde: oferta e estratégias para o fortalecimento da regionalização do Sistema Único de Saúde / Undergraduate studies in health: supply and institutional strategies in the context of the Brazilian Unified National Health System regionalization / Grado en salud: oferta y estrategias institucionales contextualizadas respecto a la regionalización del Sistema Único de Salud brasileño

Resumo: Este artigo objetiva descrever o panorama de distribuição territorial da oferta de formação em saúde, bem como identificar as estratégias para o fortalecimento da regionalização adotadas pelas instituições de ensino que ofertam cursos de saúde e as mudanças verificadas no entorno regional em função dessas instituições. Trata-se de estudo descritivo-exploratório, do tipo estudo de casos múltiplos, desenvolvido em âmbito nacional no período de dezembro de 2015 a setembro de 2016. Foram analisados dados secundários de oferta de formação em saúde e foram entrevistados 68 gestores de ensino de cursos de graduação em saúde, cujos depoimentos foram submetidos a análise de conteúdo. Percebe-se um aumento de equipamentos para formação em saúde em regiões e municípios de menor porte, não obstante a concentração em locais com maior desenvolvimento socioeconômico. Políticas de acesso ao ensino superior de estudantes vêm sendo empreendidas, na perspectiva de promover a provisão e fixação profissional do entorno onde se localizam os cursos da saúde. Constata-se que a presença da universidade promove desenvolvimento regional e tem potencial para o fortalecimento da regionalização da saúde.

Abstract: This article aims to provide an overview of the territorial distribution of health training supply and to identify the strategies for strengthening regionalization adopted by teaching institutions that offer health courses and the changes in the regional surroundings as a function of these institutions. This is a descriptive-exploratory multiple-case study conducted at the national level in Brazil from December 2015 to September 2016. The study analyzed secondary data on health training supply and interviewed 68 administrators of undergraduate health courses, whose commentary was submitted to content analysis. There was an increase in health training institutions in smaller regions and municipalities (counties), although such institutions were still concentrated mainly in more socioeconomically developed regions. Policies have been implemented for access and enrollment in higher education from the perspective of promoting provision and professional retention in the region where the health course is located. The university's presence promotes regional development and has the potential to strengthen health regionalization.

Resumen: El objetivo de este artículo es describir el panorama de la distribución territorial, en cuanto a la oferta de formación en salud, e identificar estrategias para el fortalecimiento de la regionalización, adoptadas por las instituciones de enseñanza que ofrecen cursos de salud, además de analizar los cambios verificados en el entorno regional, en función de estas instituciones. Se trata de un estudio descriptivo-exploratorio, de casos múltiples, desarrollado en el ámbito nacional de Brasil durante el período de diciembre de 2015 a septiembre de 2016. Se analizaron datos secundarios de oferta de formación en salud, y se entrevistaron a 68 gestores de enseñanza de cursos de grado en salud, cuyas declaraciones fueron sometidas a análisis de contenido. Se percibe un aumento de equipamientos para la formación en salud en regiones y municipios de menor porte, pese a la concentración en lugares con mayor desarrollo socioeconómico. Se están emprendiendo políticas de acceso e ingreso en la enseñanza superior de estudiantes, desde la perspectiva de promover la provisión y emplazamiento del profesional en el entorno donde se localizan los cursos de salud. Se constata que la presencia de la universidad promueve el desarrollo regional y tiene potencial para el fortalecimiento de la regionalización de la salud.

As Regiões de Saúde no Brasil segundo internações: método para apoio na regionalização de saúde / Health Regions in Brazil based on hospital admissions: a method to support health regionalization / Las Regiones de Salud en Brasil según internamientos: método para el apoyo de la regionalización en salud

Este estudo aborda as regionalizações da saúde em várias escalas espaciais com base no fluxo de pacientes. Para isso, foram analisados dados por meio do relacionamento das informações de origem e destino das interações realizadas em nível municipal no Brasil em 2016. A análise tem como base a teoria dos grafos e utiliza um algoritmo de modularidade que busca agrupar municípios em comunidades que detêm grande número de conexões entre si. O algoritmo otimiza o número de entradas e saídas, levando em consideração o fluxo de pacientes. Os resultados são apresentados considerando diferentes estruturas espaciais político-administrativas. Levando-se em conta o fluxo de pacientes sem restrições espaciais foram constituídas 29 comunidades no país, 64 comunidades quando respeitados os limites das grandes regiões e 164 considerando os deslocamentos apenas dentro dos estados. Os resultados demonstram a importância de regiões historicamente constituídas, desconsiderando limites administrativos, para a efetivação do acesso a serviços de saúde. Também revelam a aderência aos limites administrativos em muitas Unidades da Federação, demonstrando a importância dessa escala espacial no contexto do acesso às internações. A metodologia usada traz contribuições relevantes para o planejamento regional em saúde.

This study addressed health regionalization on various spatial scales based on patient flow. The article analyzed data through data linkage on the origin and destination of admissions at the municipal level in Brazil in 2016. The analysis is based on graph theory and uses a modularity algorithm that seeks to group municipalities in communities with a large number of interlinks. The algorithm optimizes the number of hospital admissions and discharges, taking patient flow into account. The results are shown, considering different political and administrative spatial structures. Considering patient flow without spatial restrictions, 29 communities were created in the country, compared to 64 communities when the boundaries of the major geographic regions were respected, and 164 when considering only patient flows within the respective states. The results show the importance of historically constituted regions, ignoring formal administrative boundaries, in order to implement access to health services. They also reveal adherence to administrative boundaries in many states of Brazil, demonstrating this spatial scale's importance in the context of access to hospital admissions. The methodology makes relevant contributions to regional health planning.

Este estudio aborda las regionalizaciones en salud dentro de varias escalas espaciales, basadas en el flujo de pacientes. Para tal fin, se analizaron datos a través de la relación existente entre la información de origen y destino, procedente de interacciones realizadas a nivel municipal en Brasil durante 2016. El análisis está basado en la teoría de los grafos y utiliza un algoritmo de modularidad que busca agrupar municipios en comunidades que cuentan con un gran número de conexiones entre sí. El algoritmo optimiza el número de entradas y salidas, teniendo en consideración el flujo de pacientes. Los resultados se presentan considerando las diferentes estructuras espaciales político-administrativas. Considerando el flujo de pacientes sin restricciones espaciales, se constituyeron 29 comunidades en el país, 64 comunidades respetando los límites de las grandes regiones, y 164 considerando desplazamientos sólo dentro de los estados. Los resultados demuestran la importancia de las regiones históricamente constituidas, desconsiderando límites administrativos, para hacer efectivo el acceso a servicios de salud. También revelan la adherencia a los límites administrativos en muchas Unidades Federales, demostrando la importancia de esta escala espacial en el contexto del acceso a los internamientos. La metodología utilizada aporta contribuciones relevantes para la planificación regional en salud.

The integration challenge in Canadian regionalization / O desafio da integração na regionalização: o caso do Canadá / El reto de la integración en la regionalización canadiense

In the 1990s, regionalization was introduced in Canada through administrative delegation in order to achieve a number of reform objectives, but among the most important was to improve the integration of services across diverse health sectors. Despite the failure of regionalization in fulfilling its promise of integration, regionalization still provides a foundation for achieving system-wide integration. For this to occur, however, regional and provincial health authorities need to be given the effective accountability for primary care. Given that primary healthcare physicians provide the majority of primary care in Canada, the funding for primary care physicians should be returned from provincial ministries of health to regional (or provincial) authorities in order to allow them the opportunity to become responsible for coordinating health services for their patient populations across the continuum of care, and to contract providers with the necessary incentives and penalties.

Na década de 1990, a regionalização foi introduzida no Canadá através da delegação administrativa, a fim de realizar uma série de objetivos de reforma, entre os quais o mais importante era a melhoria dos serviços entre os diversos setores da saúde. Embora a regionalização tenha deixado de cumprir plenamente a promessa da integração, ainda serve como base para alcançar uma integração sistêmica. Para tanto, as autoridades sanitárias regionais e provincianas devem assumir a responsabilidade efetiva pela atenção primária. Uma vez que os médicos de atenção primária prestam a maioria dos cuidados primários no Canadá, o financiamento deles deve ser devolvido pelas secretarias de saúde das províncias para as autoridades regionais (ou provincianas) para que assumam a responsabilidade pela coordenação dos serviços de saúde para suas populações de pacientes em toda a rede de cuidados, além de realizar contratos com prestadores, com os incentivos e penalidades que se façam necessários.

En los años 1990, se introdujo la regionalización en Canadá mediante la cesión de competencias administrativas; el fin de la misma era un número de objetivos de reforma, pero entre los más importantes estaba mejorar la integración de los servicios de salud a través de diversos sectores. A pesar del fracaso de la regionalización para llevar a cabo su promesa de integración, consiguió proporcionar las bases para alcanzar la integración en todo el sistema. No obstante, para que esto ocurra las autoridades regionales y provinciales necesitan un sistema eficaz de rendición de cuentas en el ámbito de la atención primaria. Debido a que los médicos se encargan de la mayor parte de la atención primaria en Canadá, la financiación para la misma se debería transferir desde los ministerios de salud provinciales hacia las autoridades regionales (o provinciales), con el fin de permitirles la oportunidad de convertirse en responsables de coordinar los servicios de salud para su población de pacientes, a través del continuum del cuidado, así como para contratar a proveedores con los necesarios incentivos y sanciones.