Influências estrangeiras e concretizações nos intentos de regionalização da rede hospitalar em Portugal (1946-1974) / Foreign influence and achievements in the regionalization of Portugal's hospital network (1946-1974) / Influencias extranjeras y concretizaciones en los intentos de regionalización de la red hospitalaria en Portugal (1946-1974)

O presente artigo aborda os propósitos de regionalização da rede hospitalar portuguesa durante o regime ditatorial do Estado Novo (1933-1974), lançados no após Segunda Guerra Mundial. Almejando um sistema hospitalar coordenado com base regional, o governo português limitou-se a comparticipar a construção e a remodelação de edifícios, relegando as múltiplas tarefas envolvidas no funcionamento hospitalar para instituições particulares, o que dificultou o desenvolvimento e o acesso a cuidados de saúde a uma parte significativa da população. Com base na análise de viagens de estudo realizadas por administradores hospitalares e engenheiros sanitários nas décadas de 1940 e 1950, sobretudo a países europeus como Itália, França e Inglaterra, pondera-se acerca da importância dos contatos com redes internacionais de especialistas e da influência exercida pelos exemplos estrangeiros sobre as medidas de organização da assistência hospitalar em Portugal estabelecidas nos anos seguintes. (AU)

This article analyzes the regionalization of Portugal's hospital network during the "New State" dictatorial regime (1933-1974), launched after the second world war. In an attempt to create a regionally-based hospital system, the Portuguese government limited itself to subsidizing the construction and refurbishment of buildings, relegating the multiple tasks involved in hospital management to private organizations, hampering access to health care for a significant part of the population. Through the analysis of study trips made by hospital administrators and sanitary engineers in the 1940s and 1950s, mainly to European countries such as Italy, France and England, this article reflects on the importance of contacts with international networks of experts and influence of foreign experiences on the approach to the organization of hospital care in Portugal adopted in subsequent years. (AU)

El presente artículo aborda los principios de regionalización de la red hospitalaria portuguesa durante el régimen dictatorial del Estado Novo (1933-1974), lanzados después de la Segunda Guerra Mundial. El gobierno portugués, que anhelaba un sistema hospitalario coordinado con base regional, se limitó a coparticipar la construcción y remodelación de edificios, relegando a instituciones particulares las múltiples tareas envueltas en el funcionamiento hospitalario, lo que dificultó el desarrollo y el acceso a cuidados de salud para una parte significativa de la población. Por medio del análisis de viajes de estudio realizados por administradores hospitalarios e ingenieros sanitarios durante las décadas de 1940 y 1950, principalmente a países europeos como Italia, Francia e Inglaterra, se pondera sobre la importancia de los contactos con redes internacionales de especialistas y de la influencia ejercida por los ejemplos extranjeros sobre las medidas de organización de la asistencia hospitalaria en Portugal, establecidas en los años siguientes. (AU)

O conceito de regionalização do Sistema Único de Saúde e seu tempo histórico / The concept of the regionalization of the Sistema Único de Saúde and its historical time

Resumo Este ensaio assume que, de simples diretriz administrativa, a regionalização se tornou hoje o principal conceito de viabilização doutrinária da universalidade equitativa e integral do Sistema Único de Saúde. Na interface de estudos sobre a historicidade dos conceitos com extensas experiências de campo, argumenta-se que o conceito de regionalização tradicional do Sistema Único de Saúde alcançou limites históricos de capacidade produtiva. Sua atualização, entretanto, desafia perspectivas inovadoras para um sistema clínico integrado em redes, inserido numa estratégia intersetorial de complexos produtivos regionais.

Abstract This essay assumes that from a simple administrative guideline, regionalization has become the main concept for enabling the doctrine of equitable and universal coverage behind the Brazilian Sistema Único de Saúde. At the interface between studies of the historicity of the concepts and extensive fieldwork, it is argued that the traditional concept of the regionalization of the Sistema Único de Saúde has reached the historical limits of its productive capacity. However, updating this term challenges novel perspectives for a clinical system integrated in networks within a broader intersectoral strategy of regional production clusters.

La regionalización y la educación bibliotecológica universitarias en Costa Rica: ¿una coincidencia o un cincuentenario convenido? / Regionalization and university library education in Costa Rica: a coincidence or an agreed fiftieth anniversary?

RESUMEN Este ensayo plantea cómo la regionalización de la educación superior y la formación universitaria en Bibliotecología en Costa Rica coinciden al aparecer en un momento histórico en el que la educación se convirtió en una pieza angular del desarrollo nacional. A partir de una revisión e interpretación de los hechos dados entre 1967 y 1997, se concluye que la conjunción de voluntades generadas más de dos décadas después de ocurridos ambos acontecimientos, sirvieron para reconocer el papel que ha jugado la regionalización en el desarrollo de la profesión en las regiones. Este nacimiento de ninguna manera fue una convención, sino, más bien, una hermosa coincidencia guiada por las necesidades del desarrollo nacional de la época.

ABSTRACT This essay proposes how the regionalization of higher education and university education in librarianship in Costa Rica coincide when they appear at a historical moment in which education became an angular piece of national development. From a review and interpretation of the events that occurred between 1967 and 1997 it is concluded that the conjunction of wills that occurred more than two decades after served to recognize the role that has played regionalization in the development of the profession in the Costarican regions. This birth was in no way a convention but a beautiful coincidence guided by the the national development needs.

Regionalização do Sistema Único de Saúde na Região do Juruá,Tarauacá/Envira, Acre, no início do século XXI / Regionalization of the Unified Health System at the Juruá Region, Tarauacá/Envira, Acre, at the beginning of the 21st Century

Introdução A descentralização do Sistema Único de Saúde logrou avanços com a municipalização da saúde, entretanto esta estratégia mostrou esgotamento nos últimos anos do século XX, dentre outros aspectos, pelo desenvolvimento de um sistema de saúde fragmentado. Nesse contexto, a regionalização ganha ênfase, no início do século XXI, sob a perspectiva de articulação dos entes federativos para a organização das ações e serviços de saúde em uma rede regionalizada de atenção à saúde para a garantia da integralidade da atenção. Objetivo Analisar o processo de regionalização no âmbito do Sistema Único de Saúde na Região do Vale do Juruá, Tarauacá/Envira, Acre, nas primeiras décadas do século XXI. Método Realizou-se pesquisa com abordagem qualitativa. Os dados foram coletados nos documentos de gestão e por meio de entrevistas com gestores da saúde, para as quais utilizou-se roteiro. O Discurso do Sujeito Coletivo (DSC) foi utilizado como técnica de processamento de depoimentos. As informações foram analisadas à luz do institucionalismo histórico. Resultados Constatou-se incipiência da regionalização com instrumentos de gestão desatualizados, ausência de planejamento regional integrado e de influência direta dos interesses do setor privado. Conclusão O Sistema Único de Saúde tem incrementado aspectos para sua institucionalidade, entretanto o desenho institucional federativo brasileiro associado as suas características regionais tornam complexa a implementação de seus instrumentos de gestão, requerendo apoio técnico e financeiro adequado aos aspectos de cada território. Este estudo contribui para a compreensão da realidade vivida por entes federativos da Região Amazônica

Introduction The decentralization of the Unified Health System brought advances with the municipalization of healthcare, however, such strategy has shown depletion in the last years of the 20th Century, among other aspects, by the development of a fragmented healthcare system. In this context, regionalization is emphasized, at the beginning of the 21st Century, under the perspective of articulation of federal entities for the organization of health actions and services in a regionalized healthcare network for guaranteeing the full attention. Objective To analyze the regionalization process within the scope of the Unified Health System at the Juruá Region, Tarauacá/Envira, Acre, in the first decades of the 21st century. Method A research was carried out with qualitative approach. Data was collected in the management documents and by means of interviews with health managers, using a script. The Collective Subject Discourse (DSC) was used as technique for processing the testimonies. Information was analyzed in the light of the historical institutionalism. Results It was found incipient regionalization with outdated management tools, absence of integrated regional planning and direct influence of interests of the private sector. Conclusion The Unified Health System has increased aspects for its institutionalization, however, the Brazilian federative institutional design associated with its regional characteristics make the implementation of its management instruments complex, requiring technical and financial support appropriate to the aspects of each territory. This study contributes for the understanding of the reality lived by the federative entities at the Amazon Region

Una educación integral para los médicos de la Universidad de Buenos Aires: las propuestas de José Ramos Mejía y Bernardo Houssay entre 1870 y 1940 / An integral education for the doctors of the Universidad de Buenos Aires: the suggestions of José Ramos Mejía and Bernardo Houssay between 1870 and 1940

Hacia fines del siglo XIX, algunos médicos argentinos que enseñaban en la Facultad de Medicina de la Universidad de Buenos Aires entendían que los estudiantes y futuros médicos debían ser formados en un saber integral, que superara las materias clínicas. De este modo, intentaron inculcarles el conocimiento de las letras y el arte, pero también promovieron las ventajas del desarrollo físico, forjado en las prácticas deportivas, necesario para fortalecer a los alumnos ante una carrera de tal magnitud y para acrecentar los sentimientos de confraternidad y camaradería. Hacia la década de 1920, Bernardo Houssay, célebre médico argentino y ganador del premio Nobel (en 1947), volvía a insistir sobre la necesidad de una educación integral del estudiante de medicina y proponía, para su materialización, el proyecto de una ciudad universitaria en Buenos Aires. Este texto analiza, entonces, el modo en que se buscó formar a los alumnos en diversas prácticas y conocimientos, más allá de los estrictamente médicos, e indaga los distintos proyectos (políticos, sociales) vinculados a tales propósitos que tuvieron lugar durante estas décadas en la Argentina (AU)

At the end of nineteenth century, certain Argentinean doctors who taught medicine at the Universidad de Buenos Aires considered that students had to develop an integral knowledge able to outweigh the medicine subjects. Consequently, not only have they tried to inculcate this wide knowledge into the students -which included literature and art concepts- but have also promoted the advantages of the physical activity -derived from sports- as necessary to strengthen the students, allowing them to face such extensive career and, in this way, increase the feelings of friendship and brotherhood. In 1920, Bernardo Houssay, renowned Argentinean doctor and Nobel Prize winner (in 1947), again insisted on the need of an exhaustive education and a harmonious development for the medicine student, for which he suggested building a University campus in Buenos Aires. Therefore, this paper analyzes the attempts of training the students in different practices and widening their knowledge beyond the strictly medical concepts. It also looks into the different projects (political, social) in connection with the purposes above mentioned which were supported during those years in Argentina (AU)

La historia regional desde la perspectiva de las ciencias médicas / Regional history from the medical sciences perspective

Se realizó una revisión bibliográfica con el objetivo de sistematizar los principales postulados existentes respecto a la Historia Regional como disciplina y su relación con la asignatura Historia de Cuba. La información aportada se procesó según los métodos científicos de análisis y síntesis e histórico lógico. Ello incluyó la interpretación de los criterios vertidos por especialistas que permiten considerar a Camagüey como una región histórica, en estrecho vínculo con las condiciones en las que se imparte la Historia de Cuba en la Universidad de Ciencias Médicas de Camagüey, en la que la escasez de bibliografía sobre este tópico en particular influye sobre el estudio de la asignatura. Ello recalca la necesidad de desarrollar investigaciones de este tipo, con el propósito de que dichos estudios puedan ser empleados como materiales de apoyo a la docencia (AU)

A literature review was made in order to systematize the existing main postulates regarding Regional History as a discipline and its relationship with the subject History of Cuba. The information provided was processed according to scientific methods of analysis. synthesis and historico-logical. This included the interpretation of the criteria stated by specialists that allow to consider Camagüey as a historical region, in close liaison with the conditions in which the history of Cuba is taught at the University of Medical Sciences in Camaguey, where the lack of literature on this topic particularly influences on the study of the subject. This underscores the need to develop research of this type, so these studies can be used as support for teaching materials (AU)

A ten-year history: the Cancer Quality Council of Ontario.

One of the longest-established quality oversight organizations in Canadian healthcare, the Cancer Quality Council of Ontario (CQCO) is an advisory group formed in 2002 by the Ministry of Health and Long-Term Care. Although quasi-independent from Cancer Care Ontario (CCO), the council was established to provide advice to CCO and the ministry in their efforts to improve the quality of cancer care in the province. The council is composed of a multidisciplinary group of healthcare providers, cancer survivors and experts in the areas of oncology, health system policy and administration, governance, performance measurement and health services research. Its mandate is to monitor and report publicly on the performance of the Ontario cancer system and to motivate improvement through national and international benchmarking. Since its formation, the council has played an evolving role in improving the quality of care received by Ontario cancer patients. This article will briefly describe the origins and founding principles of the CQCO, its changing role in monitoring quality and its relationship with CCO.

One step forward, one step back: Quebec's 2003­04 health and social services regionalization policy.

This article focuses on Quebec's most recent reform in the regionalization of health care to understand why the government chose to transform the regional boards into agencies. This case study used interviews and documentary analysis. Rooted in a political science perspective, the conceptual framework is inspired by the work of John Kingdon (1995) and draws on the four variables that influence the choice of policy: ideas, interests, institutions and events. Results of the case study suggest that Quebec's Commission of Study for Health and Social Services (the Clair Commission) in 2000 and the 2002 pre-electoral environment put the issue on the agenda. In 2003, the newly elected Liberal government passed Bill 25 ­ An Act Respecting Local Health and Social Services Network Development Agencies, which represented a political compromise: originally slated for eradication, the regional tier survived but in a new form. The element that sparked reform was the change in government following the elections. Different inquiry reports spread the reform's ideas, while interest groups articulated contrasting visions on the transformation. Above all, regional institutions showed great resilience in the face of change. From a historical perspective, this regionalization policy is a step backward: the regional tier is now stronger from a managerial and technocratic point of view, but it is politically and democratically weakened. This suggests a government intention, at that time, to maintain the regional level as a means of retaining centralized control over Quebec's health-care system.

A regionalização do sistema único de saúde – SUS no fim dos anos 1990: um discurso conservador

A tese apresentada parte da premissa de que o processo de descentralização iniciado na política de saúde brasileira a partir da Constituição Federal de 1988, e que tinha como caminho a municipalização dos serviços de saúde, é uma estratégia de democratização das relações entre as unidades federadas do nosso país. Com o passar do tempo, principalmente os anos 1990, o desenvolvimento necessário do Sistema Único de Saúde houve de abordar um dos princípios organizativos ainda pouco desenvolvido até então: a regionalização e a hierarquização dos serviços de saúde. O dispositivo normativo que veio a ser construído para esse fim foram as Normas Operacionais da Assistência à Saúde – NOAS, dos anos de 2001 e 2002. Porém, esse princípio, da forma como foi construído e sua proposta de operacionalização significou, nesse período estudado, um risco real de retrocesso nos avanços obtidos pelo aprofundamento do principio da descentralização ocorrido anteriormente. Esse risco é manifestado na forma de um discurso pela recentralização de diversas atividades e prerrogativas, até então repassadas aos municípios, para o âmbito da esfera estadual e da federação. Na leitura dos documentos legais, o corpus, bem como nos discursos proferidos pelos principais atores da arena política de negociação é possível localizar quem profere o discurso da regionalização como forma de impedir e/ou retroceder a descentralização, os estados. Estes são representados pelo CONASS..

Systems of care for ST-segment elevation myocardial infarction: impact of different models on clinical outcomes.

ST-segment elevation myocardial infarction (STEMI) is one of the greatest medical emergencies, for which organization of care has a determinant impact on patient outcomes. The purpose of this paper is to review systems of care for STEMI patients. Although primary percutaneous coronary intervention (PCI) is the preferred option for patients with STEMI, offering easy and emergent access to this procedure often remains difficult because of geographic and diverse structural difficulties. intravenous fibrinolysis, especially when administered early after symptom onset and as part of a pharmacoinvasive strategy (i.e., followed by rapid coronary angiography with PCI when necessary), offers a reasonable therapeutic option in selected cases and has yielded satisfactory clinical results. Network organization is central for optimizing patient care at the acute stage of myocardial infarction. This review describes different clinical experiences with network implementation both in Europe and in North America. In all instances, early recognition of STEMI and, particularly in the pre-hospital setting, shortening time delays is central for the achievement of optimal clinical results. Overall, the encouraging results described in the models presented here, as diverse as they might be, should be an encouragement to promote and implement regional protocols according to the specific local constraints and to monitor their effectiveness by recording simple quality indicators in ongoing registries.

Saúde coletiva em debate: a brasilidade de muitos encontros / Collective health in debate: the brasility of many meeting

O Estado, em seus âmbitos econômico, político e social, tem papel decisivo na formulação das ciências. A ciência, que buscava explicar os fenômenos naturais, desenvolveu-se e desdobrou-se em diversas áreas e campos, buscando responder às complexas questões que fazem parte do mundo moderno. A saúde se coloca enquanto um desses campos complexos, que inicialmente compreendia a história das doenças e das condições de vida e teve que ser questionada à medida que somente essa teoria não mais justificava as complexas existências e modos de andar a vida. Especificamente a Saúde Coletiva no Brasil reinventou formas de responder aos inúmeros e complexos questionamentos que se colocam no âmbito da vida e das condições de vida. Assim, buscou-se explorar a trajetória histórico-política-conceitual a constituição do campo da Saúde Coletiva no Brasil apoiado em uma metodologia que se utiliza de elementos analíticos da própria reflexão que o estudo traz, em um movimento de investigação denominado como entre-meios. São apresentadas as falas dos participantes, abordando episódios e reflexões sobre os acontecimentos que marcaram a história da Saúde Coletiva em nosso país, o que deu base para compor uma caixa de ferramenta para o desenvolvimento do estudo. Os diferentes significados da Saúde Coletiva foram apresentados a partir do material empírico, bem como de uma análise considerando outros olhares sobre o mesmo objeto, pela qual se buscou construir um olhar autoral sobre o objeto estudado. Além disso, após a busca de conceitos e teorias sobre os campos, foram apresentadas diferentes abordagens para a conceituação de campo, sendo que a caixa de ferramentas e as análises dos significantes antes expostos foram utilizados para construir algumas considerações e questões...

[The Amazon Sanitation Plan (1940-1942)]. / O Plano de Saneamento da Amazônia (1940-1942).

The article addresses the Amazon Sanitation Plan and the political context in which it was formulated between 1940 and 1941. It examines the role of Getúlio Vargas, the activities of the plan's main protagonists (such as Evandro Chagas, João de Barros Barreto, and Valério Konder), its key proposals, and its demise as of 1942 upon creation of the Special Public Health Service (Sesp), which grew out of cooperation agreements between Brazil and the US following both nations' involvement in World War II. A reproduction of the Plan as published in the Arquivos de Higiene in 1941 is included.

Public health strategies for Mäori.

When the New Zealand Department of Public Health was established in 1900, Maöri health status was compromised to the extent that survival itself was threatened. The remarkable turnaround was unexpected and owes much to pioneer Maöri professionals, especially the first Maöri medical practitioner, Dr. Maui Pomare, who graduated in the United States in 1899. As "Medical Officer to the Maöris," and later as Minister of Health, he made major changes through a five-part strategy: recognizing Maöri community leaders as leaders in health, improving access to societal goods and services (especially housing and education), appealing to cultural practices that were linked to good health, wise use of political power, and developing a skilled Maori health workforce to complement community leadership. Although mental health disorders and lifestyle illnesses have largely replaced infectious diseases, malnutrition, and tuberculosis, Pomare's strategy has continuing relevance and warrants serious consideration as a model for health promotion.

Community control in a world of regional delivery systems.

The pell-mell restructuring of health care into massive regional delivery systems has disrupted long-standing relationships between local leaders and residents and their community health care systems. This diminished role of communities in our new world of health care is ironic. As control within large regions in this country becomes concentrated within the operation of three or four health plans, we become increasingly dependent upon oligopolies for our market solutions. As economic arrangements, all that oligopolies can offer are indeterminate outcomes. Some may be good for consumers, others disastrous. Without the countervailing influence of nonmarket community interests, individuals may find their satisfaction with the health care system greatly diminished.

Neglected roots of regionalism? The Commissioners for the special areas and grants to hospital services in the 1930s.

The inter-war years in the UK were notable for debates about the extent to which an extension of state intervention in hospital provision was desirable and necessary, and about the limits to and future of the voluntary hospital system which relied largely on various forms of private charity. These themes were intertwined in the UK's 'Special Areas', locations recognized as having suffered adversely from the inter-war depression, with consequent effects on their ability to finance desirable investments in social infrastructures. Grant aid was offered to hospitals in these locations under the terms of the Special Areas legislation of 1934, but there were extensive debates about the principle and practice of such subsidies to hospital development. This paper reviews these debates and considers whether the measures taken by the Commissioners can be seen as neglected antecedents of the regionalism detected in British hospital policy by several commentators.

The regional distribution of doctors in Mexico, 1930-1990: a policy assessment.

The results of the doctor distributional policy in Mexico is evaluated. Despite the government's efforts to achieve a better distribution of doctors throughout the country between 1930 and 1990, important disparities still exist among geographic areas. Diverse factors ranging from the underdevelopment of some areas, to the resistance of doctors to leave the urban areas, are related to this unequal distribution. Early programmes aimed at redressing the original distribution in the 1930's had limited effects. In subsequent years, additional programmes were implemented. However, a lack of coordination and the short time span of many programmes produced only minor changes to the distributional pattern. Although in recent years the distribution has improved, southern states still suffer an acute scarcity while northern states have a relative abundance. Finally, the paper discusses how economic, political and social variables, as well as the structure of the health system, have shaped the current distribution of Mexican doctors.