Additional compensation for health care professionals in COVID-19 pandemic: an essay in the light of health law.

This theoretical-critical assay is intended to perform a detailed reflection on the mandatory payment of an additional compensation to health care professionals during the pandemic caused by COVID-19. For this consideration, academic and opinion articles, as well as national and state legislative proposals, were searched in dialogue with Regulatory Standard 15, which provides for unhealthy activities and operations. After reflection, the position taken is that payment is due for the duration of the pandemic, to all health care professionals working in the frontline against COVID-19.

Regional health care profiles - an improved method for generating case studies on the catchment areas of envisaged primary health care units in Austria: a report to the InfAct Joint Action.

BACKGROUND: The recent Austrian Primary Care Act established new primary health care units (PHCUs) and obliged them to draw up a "care strategy" specifying their focal care tasks and objectives and emphasizing the health care needs of the population in their catchment area with its specific local health and epidemiological profile. The main purpose of these care strategies is thus to ensure that care-providers meet the local needs, but they also provide a rationale for evaluation and organizational development. To assist new PHCUs in establishing care strategies it was necessary to develop a method for automatically generating comprehensive local case studies for any freely definable location in Austria. RESULTS: We designed an interactive report generator capable of producing location-specific regional health care profiles for a PHCU located in any of Austria's 2122 municipalities and of calculating the radius of its catchment area (defined by different levels of maximum car-travelling times). The reports so generated, called "regional health care profiles for primary health care" (RHCPs/PHC), are in comprehensive PDF report format. The core of each report is a set of 35 indicators, classified under five health and health service domains. The reports include an introductory text, definitions, a map, a graphic and tabular presentation of all indicator values, including information on local, supra-regional and national value distribution, a ranking, and numbers of service providers (e.g. pharmacies, surgeries, nursing homes) located within the catchment area. CONCLUSIONS: The RHCPs/PHC support primary health care planning, efforts to improve care-effectiveness, and strategic organizational development by providing comprehensive information on the health of the population, the utilization of health services and the health care structures within the catchment area. In addition to revealing the scope and nature of the health care needed, they also provide information on what public health approaches are necessary. RHCPs/PHC for different locations have already been distributed to numerous stakeholders and primary health care providers in Austria.

[Institutional greatness]. / Grandeza institucional.

After 78 years of having been founded, the Mexican Institute of Social Security has undergone several changes in its structure and dimension, secondary to both population growth and epidemiological and social transitions, in such a way that its growth has been exponential. The institute safeguards the welfare of its beneficiaries through medical, economic and social benefits. Currently, it provides health coverage to more than 60% of the Mexican population through the physical infrastructure and workforce of its 440 000 employees.

Tras 78 años de haber sido fundado, el Instituto Mexicano del Seguro Social ha pasado por diversos cambios en su estructura y dimensión, secundarios tanto al incremento poblacional como a las transiciones epidemiológicas y sociales, de tal manera que su crecimiento ha sido exponencial. El Instituto salvaguarda el bienestar de sus derechohabientes a través de prestaciones médicas, económicas y sociales. En la actualidad brinda una cobertura en salud a más del 60% de la población mexicana a través de la infraestructura física y la fuerza de trabajo de sus 440 mil trabajadores.

What do patients with urothelial cancer know about the association of their tumor disease with smoking habits? Results of a German survey study.

Purpose: Smoking represents a primary risk factor for the development of urothelial carcinoma (UC) and a relevant factor impacting UC-specific prognosis. Data on the accordant knowledge of UC-patients in this regard and the significance of physicians in the education of UC-patients is limited. Materials and Methods: Eighty-eight UC-patients were enrolled in a 23-items-survey-study aimed to analyse patient knowledge and awareness of their tumor disease with smoking along with physician smoking cessation counselling. Results: The median age of the study patients was 69 years; 26.1% (n=23), 46.6% (n=41), and 27.3% (n=24), respectively, were non-smokers, previous, and active smokers. Exactly 50% of active smokers reported a previous communication with a physician about the association of smoking and their tumor disease; however, only 25.0% were aware of smoking as main risk factor for UC development. Merely 33% of the active smokers had been prompted directly by their physicians to quit smoking. About 42% of active smokers had received the information that maintaining smoking could result in a tumor-specific impairment of their prognosis. Closely 29% of active and about 5% of previous smokers (during the time-period of active smoking) had been offered support from physicians for smoking cessation. No association was found between smoking anamnesis (p=0.574) and pack-years (p=0.912), respectively, and tumor stage of UC. Conclusions: The results of this study suggest that the medical conversation of physicians with UC-patients about the adverse significance of smoking is limited. Implementation of structured educational programs for smoking cessation may be an opportunity to further enhance comprehensive cancer care.

Reduction of Neonatal Mortality Requires Strengthening of the Health System: A Situational Analysis of Neonatal Care Services in Ballabgarh.

Background: Planning a comprehensive program addressing neonatal mortality will require a detailed situational analysis of available neonatal-specific health infrastructure. Methods: We identified facilities providing essential and sick neonatal care (ENC, SNC) by a snowballing technique in Ballabgarh Block. These were assessed for infrastructure, human resource and equipment along with self-rated competency of the staff and compared with facility-based or population-based norms. Results: A total of 35 facilities providing ENC and 10 facilities for SNC were identified. ENC services were largely in the public-sector domain (68.5% of births) and were well distributed in the block. SNC burden was largely being borne by the private sector (66% of admissions), which was urban-based. The private sector and nurses reported lower competency especially for SNC. Only 53.9% of government facilities and 17.5% of private facilities had a fully equipped newborn care corner. Conclusions: Serious efforts to reduce neonatal mortality would require major capacity strengthening of the health system, including that of the private sector.

Vulnerable Populations in Hospital and Health Care Emergency Preparedness Planning: A Comprehensive Framework for Inclusion.

INTRODUCTION: As attention to emergency preparedness becomes a critical element of health care facility operations planning, efforts to recognize and integrate the needs of vulnerable populations in a comprehensive manner have lagged. This not only results in decreased levels of equitable service, but also affects the functioning of the health care system in disasters. While this report emphasizes the United States context, the concepts and approaches apply beyond this setting. OBJECTIVE: This report: (1) describes a conceptual framework that provides a model for the inclusion of vulnerable populations into integrated health care and public health preparedness; and (2) applies this model to a pilot study. METHODS: The framework is derived from literature, hospital regulatory policy, and health care standards, laying out the communication and relational interfaces that must occur at the systems, organizational, and community levels for a successful multi-level health care systems response that is inclusive of diverse populations explicitly. The pilot study illustrates the application of key elements of the framework, using a four-pronged approach that incorporates both quantitative and qualitative methods for deriving information that can inform hospital and health facility preparedness planning. CONCLUSIONS: The conceptual framework and model, applied to a pilot project, guide expanded work that ultimately can result in methodologically robust approaches to comprehensively incorporating vulnerable populations into the fabric of hospital disaster preparedness at levels from local to national, thus supporting best practices for a community resilience approach to disaster preparedness.

Atención Primaria en Salud y Redes Integradas en una institución de salud de primer nivel, Tauramena (Casanare, Colombia): propuesta de Mejoramiento / Proposal to Improve Primary Health Care and Integrated Health Services Delivery Networks in a primary care level, Tauramena (Casanare, Colombia)

Este artículo realiza la reflexión y presenta la propuesta de mejoramiento en Atención Primaria en Salud (APS) y Redes Integradas de Servicios de Salud (RISS) del municipio de Tauramena (Casanare, Colombia), como parte del proceso de formación en APS y RISS en Colombia 2014-15. Inicia con la revisión teórica de APS y RISS y específica su relación con la normativa en salud en Colombia; posteriormente se describe la situación de Tauramena, de la cual resulta una propuesta de mejoramiento en salud; al finalizar se presentan las conclusiones y recomendaciones de la propuesta. La propuesta de mejoramiento en APS para Tauramena se formuló en 7 ejes: 1. Diagnóstico, 2. Participación comunitaria, 3. Formación en APS y RISS, 4. Liderazgo en salud, 5. Servicios de Salud, 6. Vigilancia y evaluación, y 7. Apoyo de la comunidad y líderes políticos. Se concluye que Tauramena tiene las condiciones políticas para impulsar iniciativas basadas en APS, y se recomienda fortalecer las RISS, la participación de la comunidad y el acercamiento de diversos actores para el desarrollo óptimo de la APS.

This article makes reflection and presents the proposal to improve Primary Health Care (PHC) and Integrated Health Service Delivery Networks (IHSDNs) in Tauramena (Colombia), as part of the training process in PHC and IHSDNs in Colombia 2014-15. The article begins with a theoretical review of PHC and IHSDNs and its relationship to specific legislation on health in Colombia, then describes the situation of Tauramena, generating a proposal to improve health, to finalize the conclusions and recommendations described of the proposal. The proposed to improve PHC in Tauramena was formulated in 7 axes: 1. Community diagnosis, 2. Community Participation, 3. Training in PHC and IHSDNs, 4. Leadership in health services, 5. Health services, 6. Monitoring and evaluation, and 7. Support of community and political leaders. Its concludes that Tauramena has the political conditions for promoting initiatives based on PHC, recommended strengthening the participation of the community, functional IHSDNs and integration of many actors for the optimal development of the PCH.

Práticas de planejamento em uma unidade de saúde da família: um relato de experiência / Practice planning on a family health unit: an experience report

Para a garantia da saúde enquanto direito de todos e dever do Estado, énecessário planejar e organizar os serviços. Com o objetivo de conhecer sobre o planejamentoe a operacionalização do serviço de atenção à saúde, este estudo é resultado de um relato deexperiência a partir da vivência das práticas de planejamento em saúde em uma Unidadede Saúde da Família (USF) do município de Santo Antônio de Jesus (BA). Buscou-sea identificação dos problemas enfrentados pela equipe e das estratégias utilizadas para aresolução local das adversidades, utilizando-se da extensão das atividades para a populaçãocoberta, interagindo com a equipe e a comunidade diante de uma didática problematizadora.Assim, foi possível perceber a relevância de se planejar em saúde para que haja uma melhoreficácia na oferta de serviços...

To guarantee health as a right of all and duty of the State, it is necessary to theplanning and organization of services. Aiming to know about planning and operation of healthcare services, this study it is an experience report from practical experience in health planningin a family health unit in Santo Antônio de Jesus (BA). We sought to identify the problemsfaced by the team and the strategies used to solve the same location, using the extension ofthe activities for the covered population, interacting with staff and the community before adidactic problematical. Thus, it was possible to realize the importance of planning in health sothere is greater efficiency in service delivery...

Para garantizar la salud como un derecho y un deber del Estado, es necesariola planificación y organización de los servicios. Con el objetivo de conocer acerca de laplanificación y operación del servicio de atención de la salud, este estudio es un relato deexperiencia a partir de la vivencia en práctica de planificación de la salud en una unidadde salud de la familia en Santo Antônio de Jesus - Bahia. Hemos tratado de identificar losproblemas que enfrentó el equipo y las estrategias utilizadas para resolverlos en el mismolocal, con la extensión de las actividades de la población cubierta, interactuando con elpersonal y la comunidad ante una didáctica problematizadora. Por lo tanto, fue posible darsecuenta de la importancia de la planificación en materia de salud para que haya una mayoreficiencia en la prestación de servicios...

Práticas de planejamento em uma unidade de saúde da família: um relato de experiência / Práctica de la planificación de una unidad de salud de la familia: un relato de experiencia / Practice planning on a family health unit: an experience report

Para a garantia da saúde enquanto direito de todos e dever do Estado, é necessário planejar e organizar os serviços. Com o objetivo de conhecer sobre o planejamento e a operacionalização do serviço de atenção à saúde, este estudo é resultado de um relato de experiência a partir da vivência das práticas de planejamento em saúde em uma Unidade de Saúde da Família (USF) do município de Santo Antônio de Jesus (BA). Buscou-se a identificação dos problemas enfrentados pela equipe e das estratégias utilizadas para a resolução local das adversidades, utilizando-se da extensão das atividades para a população coberta, interagindo com a equipe e a comunidade diante de uma didática problematizadora. Assim, foi possível perceber a relevância de se planejar em saúde para que haja uma melhor eficácia na oferta de serviços.

To guarantee health as a right of all and duty of the State, it is necessary to the planning and organization of services. Aiming to know about planning and operation of health care services, this study it is an experience report from practical experience in health planning in a family health unit in Santo Antônio de Jesus (BA). We sought to identify the problems faced by the team and the strategies used to solve the same location, using the extension of the activities for the covered population, interacting with staff and the community before a didactic problematical. Thus, it was possible to realize the importance of planning in health so there is greater efficiency in service delivery.

Para garantizar la salud como un derecho y un deber del Estado, es necesario la planificación y organización de los servicios. Con el objetivo de conocer acerca de la planificación y operación del servicio de atención de la salud, este estudio es un relato de experiencia a partir de la vivencia en práctica de planificación de la salud en una unidad de salud de la familia en Santo Antônio de Jesus - Bahia. Hemos tratado de identificar los problemas que enfrentó el equipo y las estrategias utilizadas para resolverlos en el mismo local, con la extensión de las actividades de la población cubierta, interactuando con el personal y la comunidad ante una didáctica problematizadora. Por lo tanto, fue posible darse cuenta de la importancia de la planificación en materia de salud para que haya una mayor eficiencia en la prestación de servicios.

Avaliação da oferta e uso de serviços odontológicos públicos e o impacto das equipes de saúde bucal da estratégia saúde da família no aumento da produção ambulatorial nos municípios brasileiros entre 1999 e 2011 / Assessment of the supply and use of dental services and the impact of oral health teams from the family health strategy in increasing outpatient services in Brazilian municipalities between 1999 and 2011

Em 2001, as equipes de Saúde Bucal passaram a ser incorporadas à Estratégia Saúde da Família no Brasil, aumentando progressivamente a sua quantidade ao longo dos anos. Além disso, estudos têm demonstrado melhora no acesso da população aos serviços odontológicos. Entretanto, a relação entre oferta e uso de serviços de saúde não está bem esclarecida. O objetivo deste trabalho é descrever e analisar a associação entre a cobertura de equipes de saúde bucal da Estratégia Saúde da Família (ESB/ESF) e o uso de serviços odontológicos públicos nos municípios brasileiros de 1999 a 2011. É um estudo ecológico longitudinal, cuja amostra contou com todos os 5507 municípios brasileiros. Foram utilizados dados secundários oriundos principalmente do DATASUS, e procedeu-se à análise multivariada de regressão logística. Observou-se que 85% dos municípios possuíam ESB/ESF em 2011 e houve aumentos nas taxas de recursos físicos, humanos e financeiros. A produção odontológica aumentou 49,5% no período. Os municípios que incorporaram >3 ESB/10mil habitantes tiveram mais chances de aumentar as taxas de procedimentos coletivos (OR=1.61, IC95%: 1.23-2,11), preventivos (OR=2.05, IC95%: 1.56-2,69), restauradores (OR=2.07, IC95%: 1.58-2,71), e de extração (OR=1.53, IC95%: 1.19-1.97), após controle por fatores sócio-demográficos e relacionados à variação de recursos físicos, humanos e financeiros. Conclui-se que a incorporação de ESB à Saúde da Família parece mais eficiente para o aumento do acesso da população aos serviços odontológicos...

Abstract In 2001, the oral health teams began to be incorporated into the Family Health Strategy in Brazil, progressively increasing its amount over the years. Furthermore, studies have shown improvement in the population's access to dental services. However, the relationship between supply and use of health services is not well established. The objective of this study is to describe and analyze the association between coverage of oral health teams of the Family Health Strategy (OHT) and the use of dental services in Brazilian municipalities from 1999 to 2011. It is a longitudinal ecological study, whose sample included all 5507 municipalities. Data were collated from information systems and analyzed with logistic regression for the increase in rates of dental procedures. Secondary data were derived from information systems, and proceeded to the multivariate logistic regression analysis. It was observed that 85 % of municipalities had OHT in 2011 and there were increases in the rates of equipments, human and financial resources. The rates of dental procedures increased 49.5% in the period. Municipalities that incorporated >3 OHT/10 thousands inhabitants were more likely to increase rates of collective procedures (OR=1.61, 95% CI: 1.23-2,11) , preventive (OR=2.05, 95% CI: 1.56-2,69 ) restorations (OR=2.07, 95% CI: 1.58-2,71), and extractions (OR=1:53, 95% CI: 1.19-1.97) after adjusting for socio-demographic factors and increased in equipments, human and financial resources. It is concluded that the incorporation of OHTs are a more efficient way to increase the population's access to dental services...

Learning to pull in one direction to improve Kosovo's health.

PIP: In response to the need of a health policy in Kosovo, the UN Mission in Kosovo produced their blueprint for a new health system--the Interim Health Policy Guidelines and Six-Month Action Plan. The document seeks not only to provide a framework for emergency work but also to bring about sustained reform in the current health care system. It also aimed to shift the focus of the whole health care system around giving primary care to Kosovars. Targeted areas are antenatal care and children's and mental health care which are currently falling well below European standards. Although a shift in the system will have huge effects on the health of Kosovars, a problem of changing the attitudes of doctors and of patients to accept general practice as real medicine is seen. However, without a policy framework, emergency activities can skew services dramatically. It can offer unsustainable levels of care and bring in uneven donations to different regions, which would encourage movement in the population.^ieng

Integrated management of childhood illness: a summary of first experiences.

The strategy of Integrated Management of Childhood Illness (IMCI) aims to reduce child mortality and morbidity in developing countries by combining improved management of common childhood illnesses with proper nutrition and immunization. The strategy includes interventions to improve the skills of health workers, the health system, and family and community practices. This article describes the experience of the first countries to adopt and implement the IMCI interventions, the clinical guidelines dealing with the major causes of morbidity and mortality in children, and the training package on these guidelines for health workers in first-level health facilities. The most relevant lessons learned and how these lessons have served as a basis for developing a broader IMCI strategy are described.

PIP: This article delineates the experience of the first countries to adopt and implement the Integrated Management of Childhood Illness (IMCI) strategy in reducing child mortality and morbidity through the combination of improved management of common childhood illnesses and proper nutrition and immunization. The strategy includes intervention schemes involving improving the skills of health workers, the health systems, and the family and community practices. IMCI implementation proceeds in three phases. The first phase involves activities for the introduction of IMCI, in which clinical guidelines involving the review of child health policies and reorganization of services and interventions are discussed. The second phase is the initial implementation, in which each country adapts the generic IMCI clinical guidelines to suit its own epidemiological and cultural characteristics and begins implementing them in a limited number of districts. The third phase involves expanding of IMCI through increasing access to its programs and broadening the range of its interventions. In this phase, problems identified during the early implementation are addressed, priorities are identified, and strategies for expanding access while maintaining quality are developed. The introduction of the IMCI strategy helped develop and update national policies in the management of sick children. The implementation of IMCI brings together a broader range of programs and national medical expertise relating to child health. The program serves as a catalyst for the identification of substantial weaknesses in public health systems.

Developing a plan for primary health care facilities in Soweto, South Africa. Part I: Guiding principles and methods.

The new political era in South Africa offers unique opportunities for the development of more equitable health care policies. However, resource constraints are likely to remain in the foreseeable future, and efficiency therefore remains an important concern. This article describes the guiding principles and methods used to develop a coherent and objective plan for comprehensive primary health care facilities in Soweto. The article begins with an overview of the context within which the research was undertaken. Problems associated with planning in transition are highlighted, and a participatory research approach is recommended as a solution to these problems. The article goes on to describe how the research methods were developed and applied in line with the principles of participatory research. The methods were essentially rapid appraisal techniques which included group discussions, detailed checklists, observation, record reviews and the adaptation of international and local guidelines for service planning. It is suggested that these methods could be applied to other urban areas in South Africa and elsewhere, and that they are particularly appropriate in periods of transition when careful facilitation of dialogue between stakeholders is required in tandem with the generation of rapid results for policy-makers.

PIP: This paper describes the guiding principles and methods used to develop a coherent and objective plan for comprehensive primary health care facilities in Soweto. An overview of the context within which the research was conducted is first presented. Problems associated with planning in transition are then outlined and a participatory research approach recommended to solve them. The authors describe how the research methods were developed and applied according to the principles of participatory research. The methods used were largely the rapid appraisal techniques of group discussion, detailed checklists, observation, record reviews, and the adaptation of international and local guidelines for service planning. These methods could be applied to other urban areas in South Africa and elsewhere. They are especially appropriate during periods of transition when the careful facilitation of dialogue between stakeholders is required together with the generation of rapid results for policymakers.

Developing a plan for primary health care facilities in Soweto, South Africa. Part II: Applying locational criteria.

This article is the second of a two-part series describing the development of a ten-year plan for primary health care facility development in Soweto. The first article concentrated on the political problems and general methodological approach of the project. This second article describes how the technical problem of planning in the context of scanty information was overcome. The reasoning behind the various assumptions and criteria which were used to assist the planning of the location of facilities is explained, as well as the process by which they were applied. The merits and limitations of this planning approach are discussed, and it is suggested that the approach may be useful to other facility planners, particularly in the developing world.

PIP: The first part of this two-part series described the context and general research approach to planning primary health care facility development in Soweto during 1992 and 1993. The purpose of this second article is to present the step-by-step process by which the size, number, and location of clinics were determined. The process involves attempting to integrate objective planning procedures with the more subjective opinions of stakeholders. How to overcome the technical problem of planning in the context of very limited information is explained. The authors then offer the reasoning behind the various assumptions and criteria used to help the planning of facility location. The application of these assumptions and criteria is discussed, followed by consideration of the pros and cons of this planning approach. This approach may be useful to other facility planners, particularly in the developing world.

Principles of health infrastructure planning in less developed countries.

This article proposes a number of key principles for health infrastructure planning, based on a literature review on the one hand, and on a process of internal deduction on the other. The principles discussed are the following: an integrated health system; a thrifty planning of tiers within that health system; a specificity of tiers; a homogeneity of the tiers' structures; a minimum package of activities; a territorial responsibility and/or an explicit and discrete responsibility for a well-defined population; a necessary and sufficient population basis; a partial separation of administrative and public health planning bases; and, finally, rules for a geographical division and integration of non-governmental organizations. The definition of two strategies, primary health care and district health systems, is also revisited.

PIP: The authors propose some principles for health infrastructure planning, based upon a literature review and internal deduction. The following principles are discussed: an integrated health system, a thrifty planning of tiers within that health system, a specificity of tiers, a homogeneity of the tiers' structures, a minimum package of activities, a territorial responsibility and/or an explicit and discrete responsibility for a well-defined population, a necessary and sufficient population basis, a partial separation of administrative and public health planning bases, and rules for a geographical division and integration on nongovernmental organizations. The definitions of primary health care and district health systems are also revisited.

Implications of population growth on prevalence of diabetes. A look at the future.

The purpose of this study was to present projections of the future population of diabetes patients, to discuss policy implications of these projections, and to suggest ways that these projections might be made more useful to medical professionals. Under the assumption that the incidence of diabetes in four age-groups will remain constant in future years, previous estimates of the incidence of diabetes will be applied to Bureau of the Census population projections to project the number of new cases of diabetes that can be expected in future years in each of these age-groups. The prevalence of diabetes will remain relatively constant at approximately 1 million patients in younger populations (less than 45 yr old) through the middle of the next century. As the post-World War II baby boom ages, the number of older diabetes patients (45 and older) will almost double from 6.5 million in 1987 to an estimated 11.6 million in the year 2030. Although there is little doubt that the aging of the population will increase the number of diabetes patients, the assumption of constant incidence rates is a very limiting one. These projections would be more useful for the planning of research and training if the incidence of diabetes could be estimated for more refined categories of demographic and medical characteristics.

PIP: A 1987 US study cited the prevalence of diabetes as 26.8 patients/1000 population. Using the Census Bureau's population projections of these same age groups until the year 2050 based on their middle mortality assumptions, projections of the number of diabetes patients by age-group are obtained by multiplying with the prevalence rates. These projections indicate that the number of diabetes patients 25 years of age will remain almost constant in the next 1/2 century, whereas the number between 25 and 45 will decline from a high of 983,000 in 1995 to a low of 870,000 in 2040. The number of patients in the 45-64 age group is projected to rise from 2.4 million in 1990 to 4.1 million in 2015, i.e., about 69,000 additional patients/year for the next 25 years. Those aged or= 65 years with the highest prevalence are projected to increase by an average of 55,000 new patients/year. For the following period of 2015-35 this oldest group of patients is projected to increase by an average of 120,000 patients/year. This is under the overly pessimistic assumption that there will be no scientific or medical discoveries to reduce the prevalence of diabetes. There are some implications for the diabetes community if the population of patients increases by over 1 million in the next decade and by over 3.7 million by 2020. Although the number of diabetes patients 65 will grow steadily for the next 20 years, the highest growth rates will be in the 45-64 age group. This implies that the number of qualified professionals may have to be increased and more emphasis directed to initial diagnosis and treatment. After the year 2010, the rate of growth of diabetes patients age 65 or older can be expected to accelerate compared with other age groups. These projections stress the importance of prevention and education. The requisite change in life style, exercise, or nutrition habits will be more difficult than if a drug is developed for treatment.

People's Community Clinic: collaboration in the Third World.

A West African government undertook to improve primary health care (PHC) training of mid-level health workers. In partnership with a neighboring squatter settlement, the premiere local training institution created a community-sponsored clinic, providing low-cost, PHC services, and a birthing center, as well as student experiences. Their collaboration in mobilization, research, planning and operations are described. Their success should encourage other educational and training institutions to consider a similar approach.

PIP: The planning of a Primary Health Care Clinic in a squatter community, in association with a West African nation's training program for mid-level health workers, is described. The allied health training faculty initiated the project, in an effort to expand their student clinical experiences, with a tour of rural health facilities. As a result, a planning committee selected the neighboring squatter community as the site of a primary health care (PHC) project. The planning team met with community leaders, and they agreed to provide PHC services, sanitation, and student training. Community meetings were held to plan their input: the community would provide and maintain a building, a health committee, and volunteers. A consultant was hired to do a community survey, map the population of 2500 and its 490 households and 176 houses. It was found that there were 20 pit latrines, 32 water sources, no garbage handling, and problems with insects, rodents, and snakes. The community had an infant mortality rate of 120/1000, 11% of the women were pregnant; only 12% used family planning, but 40% wished to do so. The People's United Community Clinic was to be operated by faculty, students, and community members. Memberships were offered for 50 cents. After 4 months of planning, the clinic opened with 900 members. 1458 patient visits and 10 deliveries were accomplished within 6 months. Fees were charged for visits and drugs. Accounting was done by a Peace Corps volunteer. This model of a partnership between a training institution and the community has potential for replication in a wide variety of settings in both developing and developed countries.

Consensus on infection prevention guidelines.

PIP: An expert meeting on infection prevention was held in Baltimore on June 8-11, 1991, to establish consensus guidelines on infection control at family planning service delivery sites. Present were representatives of the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO), the WHO, IPPF, USAID and cooperating agencies. It was decided that instruments that penetrate the blood stream, such as needles, syringes, trocars and scalpels, should be sterile. High level disinfection (HLD), which kills everything except bacterial endospores, is satisfactory when sterilization is not available. HLD is the only way to disinfect a laparoscope, the endoscope of which cannot tolerate heat. The standard conditions for autoclaving instruments were set at 121 degrees Celsius (250 degrees Fahrenheit) of temperature, 15 lb/square inch (106 KPa) pressure, for 20 minutes for unwrapped, of 30 minutes for wrapped items. Sterilization by dry heat means 170 degrees Celsius for 1 hour, or 160 degrees Celsius for 2 hours, with added time for reaching temperature and cooling. Boiling is only acceptable as a method of HLD, not for sterilization. Boiling at a rolling boil for 20 minutes was recommended, with no correction for altitude. In the absence of an autoclave, surgical drapes are best prepared by ironing, since hanging them to dry would contaminate them after boiling.^ieng

Auckland revisited. Baby boom.

PIP: Inaccurate birthrate projections have resulted in a severe shortage of maternity services in Auckland, New Zealand. In many Auckland hospitals, deliveries are 15% above levels projected. The number of live births in the Auckland region has increased from 16,068 in 1988 to 17,094 in 1989. The highest rate of increase has been recorded among Pacific Island Polynesians, and it is the lack of accurate statistics on this population group that has produced problems in birthrate projections. Since funding for the Auckland Area Health Board is based on birthrate projections, the board is asking the Government for additional allotments to cope with the current crisis. In addition, maternity services are being reorganized to handle the unexpected influx. One hospital has been designated as an emergency-only obstetrics facility and the average postnatal stay has been reduced to 2.8 days. Options such as private postnatal care and a hotline for mothers at home with new babies are being considered. The maternal health care system continues to suffer from a severe shortage of midwives, however, and the low morale created by conditions of overcrowding has made it difficult to relating existing personnel.^ieng

Acquired immunodeficiency syndrome (AIDS)

PIP: Prostitutes from Madras were found seropositive for HIV infection in 1986, and are the 1st such cases identified in India. A national serosurveillance program and reference centers were subsequently created, finding a total 44 known AIDS cases through March 31, 1990. While this number of cases may seem small in the general context of India's large population size, increasing levels of seropositivity are being detected, and give cause for concern. Where recent studies of seropositivity in IV-drug users have created serious concern, serosurveillance has nonetheless been largely limited to prostitutes, STD patients, pregnant women, blood donors, and contacts of seropositive individuals. Ignorance and stigmatization of seropositive individuals and persons with AIDS persist both in the general public and the medical community. Doctors, nurses, and staff therefore are in special need of proper orientation to treat and counsel such clients. Indian health authorities are overwhelmingly challenged by how to care for AIDS cases, and do not know what to do with those who are seropositive. Hospitals and facilities for supportive treatment will be identified. Seropositive individuals especially need psychological support and counseling. Guidelines for counseling are therefore greatly needed. Those identified as seropositive must also be ensured that their status will remain confidential. Introductory comments are made regarding the seriousness of AIDS as a global pandemic, its initial identification and description, and the various patterns of epidemic spread observed throughout the world.^ieng