O que é Residência Médica em Rede? / What is Network- Based Medical Residency?

RESUMO Introdução: A Residência Médica em Rede é um novo modelo de formação de médicos especialistas que visa expandir o treinamento médico tradicional, particularmente nas redes de atenção à saúde do Sistema Único de Saúde (SUS). Embora legalmente respaldada, carece de regulamentação específica e definição precisa. Desenvolvimento: Um programa em rede, a nosso ver, opera nas redes temáticas do SUS, é coordenado por uma instituição pública, desenvolvido em cidades com mais de 50 mil habitantes, aprovado pela Comissão Nacional de Residência Médica e tem um programa de educação permanente para preceptores. Os desafios incluem padronização de conteúdo, treinamento contínuo de preceptores e um projeto andragógico sólido. O perfil de competências requer não só habilidades médicas, mas também de gestão, trabalho em equipe, conhecimento profundo do SUS e de atenção primária. Barreiras incluem a coordenação de cenários distintos e avaliações apropriadas. Conclusão: O sucesso do modelo exige regulamentação precisa, padronização e integração efetiva para formar especialistas alinhados com o SUS.

ABSTRACT Introduction: Network-Based Medical Residency is a new model for training specialist doctors that expands traditional education, particularly in the Health Care network of the Unified Health System (SUS). Although with legal foundation, it requires specific regulations and a precise definition. Development: In our view, a Network-Based program has the following characteristics: it is coordenated by a public institution, operates in SUS thematic networks in cities >50,000 inhabitants, it is approved by the National Medical Residency Commission and involves a Continuing Education Program for preceptors. The challenges include content standardization, ongoing preceptor training, and a solid andragogical design. The skills profile not only requires medical skills, but also management knowledge, teamwork, in-depth knowledge of the SUS and Primary Care. The barriers include coordinating diverse practice scenarios and assessments. Conclusion: The success of the model requires precise regulation, standardization and effective integration to train specialists aligned with the SUS.

The effect of re-directed patient flow in combination with targeted infection control measures on the spread of multi-drug-resistant Enterobacteriaceae in the German health-care system: a mathematical modelling approach.

OBJECTIVE: The introduction of multi-drug-resistant Enterobacteriaceae (MDR-E) by colonized patients transferred from high-prevalence countries has led to several large outbreaks of MDR-E in low-prevalence countries, with the risk of propagated spread to the community. The goal of this study was to derive a strategy to counteract the spread of MDR-E at the regional health-care network level. METHODS: We used a hybrid ordinary differential equation and network model built based on German health insurance data to evaluate whether the re-direction of patient flow in combination with targeted infection control measures can counteract the spread of MDR-E in the German health-care system. We applied pragmatic re-direction strategies focusing on a reduced choice of hospitals for subsequent stays after initial hospitalization but not manipulating direct transfers because these are most likely determined by medical needs. RESULTS: The re-direction strategies alone did not reduce the system-wide spread of MDR-E (system-wide prevalence of MDR-E is 18.7% vs. 25.7%/29.9%). In contrast, targeted hospital-based infection control measures restricted to institutions with the highest institutional basic reproduction numbers in the network were identified as an effective tool for reducing system-wide prevalence (system-wide prevalence of MDR-E is 18.7% vs. 9.3%). If these measures were applied to the top one-third of hospitals, the system-wide prevalence could be reduced by approximately 80% (system-wide prevalence of 18.7% vs. 3.5% for one-third of patients subjected to interventions). A combination of this hospital-based intervention and patient re-direction strategies could not improve the effectiveness of the hospital-based approach (system-wide prevalence of MDR-E is 9.3% vs. 14.2%/14.3%). CONCLUSIONS: The pragmatic patient re-direction strategies were not capable of restricting the spread of MDR-E in a simulation of the German health-care system; in contrast, hospital-based interventions focusing on institutions identified based on network transmission patterns seem to be a promising approach for sustainable reduction of the spread of MDR-E through the German population.

Avaliação dos serviços prestados pelos consórcios públicos intermunicipais de Minas Gerais na perspectiva de gestores de saúde / Evaluation of services provided by public intermunicipal consortia in Minas Gerais from the perspective of health managers

Introdução: um dos princípios do Sistema Único de Saúde (SUS) é a descentralização de serviços de saúde, com uma única direção em cada esfera de governo e tendo os estados e municípios responsabilidade compartilhada pela gestão de políticas públicas. A autonomia municipal tornou-se mais factível por meio de acordos de cooperação, entre os entes interessados na realização de um mesmo objetivo. Dessa cooperação, resultam os consórcios interfederativos, que são associações voluntárias seja por meio de municípios, estados e/ou união. Assim como ocorrem em outras regiões do país, os consórcios de saúde em Minas Gerais existem devido a uma necessidade dos municípios de se unirem, já que sozinhos, não conseguiriam prestar determinado tipo de serviço para a sociedade. A avaliação precisa ser pensada não só como um julgamento do serviço que está sendo prestado, mas também como uma oportunidade de mudanças. Objetivo: avaliar os serviços prestados pelos Consórcios Intermunicipais de Saúde em Minas Gerais na perspectiva de gestores municipais. Metodologia: do ponto de vista metodológico trata-se de uma pesquisa de abordagem qualitativa, que foi realizada com os gestores municipais de saúde do estado de Minas Gerais nas 14 Macrorregiões de Saúde. Os dados foram coletados por meio de entrevista com roteiro semiestruturado, de fevereiro a setembro de 2023. O projeto foi submetido ao Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais e a coleta de dados só foi iniciada após aprovação. A realização das entrevistas ocorreu entre março e setembro de 2023, sendo utilizado um roteiro semiestruturado. Considerando que se trata de investigação para um Programa de Mestrado Profissional e do curto tempo para a pesquisa, optou-se pela quantidade pré-definida de 14 participantes. As entrevistas foram gravadas, ouvidas na totalidade, transcritas e submetidas à Análise de Conteúdo, seguindo a modalidade de Análise Temática. Resultados e discussão: foram organizadas três categorias de análise: a primeira aborda a participação dos consórcios na Rede de Atenção à Saúde, a qual foi relacionada com a referência e contrarreferência, Transporte Sanitário Eletivo, atenção especializada e compra de medicamentos. Na segunda categoria, foi apresentado o alcance das finalidades propostas, abordando a atenção especializada e o consórcio de saúde como uma ferramenta importante para os municípios de pequeno porte. Na terceira e última categoria, foram apresentadas as potencialidades e fragilidades, com destaque para a discussão de pontos como a distância do consórcio, o valor dos procedimentos, a variedade de procedimentos e a qualidade do serviço. O estudo revelou que os participantes reconhecem a importância do consórcio para a integração da Rede de Atenção à Saúde. Contudo, mesmo sabendo da importância dos consórcios, nem sempre os serviços são prestados da melhor maneira para os pacientes do SUS. Considerações finais: durante a realização deste estudo, ficou evidente a necessidade de os gestores entenderem a Rede de Atenção à Saúde e saber da importância que os consórcios têm na rede para ajudar os municípios a prestarem os serviços para a população. Cabe ressaltar que o consórcio de saúde representa uma valiosa estratégia que pode auxiliar os municípios a fortalecerem seu fluxo dentro da Rede de Atenção à Saúde.

Introduction: one of the principles of the Unified Health System (UHS) is the decentralization of health services, with a single direction in each sphere of government and states and municipalities having shared responsibility for the management of public policies. Municipal autonomy became more feasible through cooperation agreements between entities interested in achieving the same objective. This cooperation results in interfederative consortia, which are voluntary associations whether through municipalities, states and/or unions. As in other regions of the country, health consortia in Minas Gerais exist due to a need for municipalities to come together, as alone they would not be able to provide a certain type of service to society. Evaluation needs to be thought of not only as a judgment of the service being provided, but also as an opportunity for change. Objective: to evaluate the services provided by Intermunicipal Health Consortia in Minas Gerais from the perspective of municipal managers. Methodology: from a methodological point of view, this is a research with a qualitative approach, which was carried out with municipal health managers in the state of Minas Gerais in the 14 Health Macroregions. Data were collected through interviews with a semi-structured script, from February to September 2023. The project was submitted to the Research Ethics Committee of the Federal University of Minas Gerais and data collection only began after approval. The interviews took place between March and September 2023, using a semi-structured script. Considering that this is research for a Professional Master's Program and the short time for the research, a pre-defined number of 14 participants was chosen. The interviews were recorded, listened to in full, transcribed and submitted to Content Analysis, following the Thematic Analysis modality. Results and discussion: three categories of analysis were organized: the first addresses the participation of consortia in the Health Care Network, which was related to referral and counter-referral, Elective Health Transport, specialized care and purchase of medicines. In the second category, the scope of the proposed purposes was presented, addressing specialized care and the health consortium as an important tool for small municipalities. In the third and final category, the strengths and weaknesses were presented, with emphasis on the discussion of points such as the distance from the consortium, the value of the procedures, the variety of procedures and the quality of the service. The study revealed that participants recognize the importance of the consortium for the integration of the Health Care Network. However, even knowing the importance of consortia, services are not always provided in the best way for SUS patients. Final considerations: during this study, it became evident the need for managers to understand the Health Care Network and know the importance that consortia have in the network to help municipalities provide services to the population. It is worth noting that the health consortium represents a valuable strategy that can help municipalities strengthen their flow within the Health Care Network.

[CIVIL HEALTHCARE IN EASTERN SIBERIA ON THE EVE AND AT THE BEGINNING OF THE GREAT PATRIOTIC WAR].

Eastern Siberia during the Great Patriotic War, being in the deep rear, was one of the key regions where the population and industrial enterprises were evacuated from the front-line zones and west territories of the USSR. Among the arriving population, there were many highly qualified specialists who were sent along with enterprises to resume their work, which, on the one hand, gave preconditions for the development of the region, including as a major industrial and scientific center in the future, but also created an additional burden on the civil health care system of the region "in the moment." Eastern Siberia provided the USSR with healthy human and necessary production resources, making it possible for the Soviet Army to defend the Motherland, which was the main thing in those difficult years, in the face of the sudden invasion of Nazi Germany. The archival materials that give an idea of ​​the state of the civil health care system in the region by the beginning and in the first days of the Great Patriotic War are analyzed, and a comparative analysis of the indicators of both the Eastern Siberia region and its individual republics with the RSFSR as a whole is carried out. This study was carried out as part of the research work "State policy in the field of health protection and medical science in the Russian Empire and the USSR."

Respostas dos pontos de atenção à saúde à pandemia Covid-19: desafios e possibilidades de gestores do Estado do Paraná / Responses from health care points to the Covid-19 pandemic: challenges and possibilities for managers in the State of Paraná

Resumo: Introdução: A pandemia da Covid-19 impôs inúmeros desafios aos gestores de saúde na organização dos serviços da Rede de Atenção à Saúde (RAS), cobrando respostas rápidas, coordenadas e integradas, a fim de promover a atenção de qualidade à população em situações agudas e crônicas, evitando o colapso do sistema de saúde. Objetivo: Identificar os desafios e as possibilidades na resposta dos pontos da RAS no enfrentamento à pandemia da Covid-19, na perspectiva de gestores de saúde do Estado do Paraná. Metodologia: Trata-se de um estudo transversal, descritivo e de abordagem quantitativa, realizado no período de 2020 a 2022. Os participantes foram gestores dos pontos de atenção da RAS do Paraná. O estudo aconteceu em três etapas: elaboração e validação de instrumentos de coleta de dados; coleta de dados, e, sistematização dos desafios e possibilidades na resposta dos pontos da RAS no enfrentamento à Covid-19. Resultados: Os 228 gestores de pontos da RAS que responderam aos instrumentos, caracterizavam-se como mulheres, adultas jovens, com formação de pós-graduação. No domínio governança, as gestoras, apontaram que a maior parte dos serviços estabeleceram comitês locais e regionais e planos de contingência, entretanto apresentaram dificuldades de reconhecer seus representantes no interior das comissões, bem como fragilidades em informar as relações intersetoriais. No domínio modelo de atendimento, os serviços elaboraram ou adequaram fluxos e protocolos, baseado em evidências científicas e, apesar de uma interrupção nos atendimentos em alguns pontos de atenção, ampliaram as atividades e acesso, especialmente na atenção primária à saúde. Identificou-se que os teleatendimentos subsidiaram a atenção à saúde no momento de crise e que a qualificação de recursos humanos e da atenção à saúde foi um desafio contínuo. No que tange ao domínio organização e gestão, ressalta-se as dificuldades em relação à insuficiência do quadro profissional, e planejamento para gestão de pessoas em virtude da ausência de um plano de contingência que considerasse as necessidades da força de trabalho. Destacaram-se a necessidade de estratégias efetivas de educação permanente e monitoramento e avaliação dos processos de trabalho. No que diz respeito ao domínio autoavaliação, apesar das gestoras avaliarem-se positivamente, elas apontaram como principais dificultadores, no enfrentamento da pandemia da Covid-19, os recursos humanos e assistenciais, seguidos dos recursos financeiros, capacidade física insuficiente e falta de qualificação dos profissionais, além da fragilidade na comunicação e na gestão de risco. Considerações finais: A pandemia da Covid-19 ressaltou a importância dos conhecimentos, habilidades e atitudes dos gestores de saúde, que somada a esse estudo, possibilitaram uma perspectiva sistêmica de como se deu a resposta dos pontos da RAS no enfrentamento à Covid-19 no Paraná e de como se planejar para as próximas pandemias com base no fortalecimento dos domínios apresentados neste estudo, buscando respostas efetivas não apenas às ameaças, mas à produção da atenção à saúde com qualidade, eficiência e reduzindo as iniquidades do sistema de saúde.

Abstract: Introduction: The Covid-19 pandemic has imposed numerous challenges on health managers in the organization of the services of the Health Care Network (RAS), demanding quick, coordinated, and integrated responses in order to promote quality care to the population in acute situations and chronic diseases, preventing the collapse of the health system. Objective: Identify the challenges and possibilities in the response of the RAS points in facing the Covid-19 pandemic, from the perspective of health managers in the State of Paraná. Methodology: This is a cross-sectional, descriptive study with a quantitative approach, carried out from 2020 to 2022. The participants were managers of the RAS care points in Paraná. The study took place in three stages: development and validation of data collection instruments; data collection, and systematization of the challenges and possibilities in the response of the RAS points in the fight against Covid-19. Results: The 228 point managers of the RAS who responded to the instruments were characterized as women, young adults, with postgraduate training. In the governance domain, the managers pointed out that most services established local and regional committees and contingency plans, however, they had difficulties in recognizing their representatives within the commissions, as well as weaknesses in informing intersectoral relations. In the care model domain, services developed or adapted flows and protocols, based on scientific evidence and, despite an interruption in care at some care points, expanded activities and access, especially in primary health care. It was identified that teleservices subsidized health care in times of crisis and that the qualification of human resources and health care was a continuous challenge. Regarding the organization and management domain, the difficulties in relation to the insufficiency of the professional staff and planning for people management are highlighted, due to the absence of a contingency plan that considered the needs of the workforce. The need for effective strategies for permanent education and monitoring and evaluation of work processes was highlighted. With regard to the self-assessment domain, despite the managers evaluating themselves positively, they pointed out human and care resources as the main obstacles in the face of the Covid-19 pandemic, followed by financial resources, insufficient physical capacity and lack of qualification of the employees. professionals, in addition to fragility in communication and risk management. Final considerations: The Covid-19 pandemic highlighted the importance of the knowledge, skills and attitudes of health managers, which added to this study allowed a systemic perspective of how the RAS points were responded to in the fight against Covid-19 in Brazil. Paraná and how to plan for the next pandemics based on the strengthening of the domains presented in this study, seeking effective responses not only to threats, but to the production of health care with quality, efficiency and reducing inequities in the health system.

Interaction Empowerment in Mobile Health: Concepts, Challenges, and Perspectives.

In its most trending interpretation, empowerment in health care is implemented as a patient-centered approach. In the same sense, many mobile health (mHealth) apps are being developed with a primary focus on the individual user. The integration of mHealth apps into the health care system has the potential to counteract existing challenges, including incomplete or nonstandardized medical data and lack of communication, especially in the intersectional context (eg, patients, medical forces). However, concerns about data security and privacy, regional differences in regulations, lack of accessibility, and nontransparent apps hinder the successful integration of mHealth into the health care system. One approach to address this is to rethink the interpretation of empowerment. On that basis, we here examine existing approaches of individual empowerment and subsequently analyze a different view of empowerment in digital health, namely interaction empowerment. Such a change of perspective could positively influence intersectoral communication and facilitate secure data and knowledge sharing. We discuss this novel viewpoint on empowerment, focusing on more efficient integration and development of mHealth approaches. A renewed interpretation of empowerment could thus buffer current limitations of individual empowerment while also advancing digitization of the health system.

Gestão regional e a produção singular da Rede de Atenção às Urgências e Emergências / Regional management and singular production of Urgent and Emergency Care Network

Resumo Este estudo tem por objetivo compreender os movimentos de produção da Rede de Atenção às Urgências e Emergências (RUE) em duas regiões de saúde. É caracterizado como estudo de casos múltiplos, de caráter qualitativo, e foi desenvolvido por meio de entrevistas abertas com gestores do Sistema Único de Saúde (SUS) em dois estados brasileiros. O material empírico foi organizado e discutido por meio de categorias identificadas, adotando o esquema analítico dos campos das intervenções organizacionais, que foram: a multiplicidade de movimentos na produção da RUE; o poder dos hospitais; e a fragilidade da regulação governamental. Apesar dos momentos e contextos diferentes nesses estados, ambos os processos deram ênfase aos aspectos organizativos e ao financiamento, havendo baixo investimento na produção de diferentes modos de produção do cuidado em saúde. A governança regional é, portanto, produzida nas complexas relações entre a política nacional e a ação local. A RUE, enquanto política pública induzida nacionalmente pelo Ministério da Saúde, torna-se uma produção singular no campo da gestão regional.

Abstract This study aims to understand the movements of the Urgency and Emergency Care Network production in two health regions. It is characterized as a qualitative multiple case study and was developed through open interviews with managers of the Brazilian Health System, SUS (Sistema Único de Saúde), in two Brazilian states. The empirical material was organized and discussed through identified categories adopting the analytical scheme of the fields of organizational interventions which were: the multiplicity of movements in the production of the RUE, the power of the hospitals; and, the weakness of government regulation. Despite the different times and contexts in these states, both processes emphasized organizational aspects and financing, with low inputs in the production of different modes of health care production. Regional governance is, therefore, produced in the complex relations between national policy and local action. The RUE as a public policy induced nationally by the Ministry of Health becomes a singular production in the field of regional management.

Perfil dos usuários de um centro de atenção psicossocial álcool e outras drogas na zona da mata de pernambuco / Profile of users of a psychosocial care center alcohol and other drugs in the area of the forest of Pernambuco / Perfil de usuarios de un centro psicosocial de alcohol y otras drogas en el bosque Pernambuco

Introdução:A implementação de políticas de saúde para garantia da atenção integral aos usuários de álcool e outras drogas vem sendo realizada há algumas décadas e teve sua garantia normativa fortalecida com o passar dos anos através da criação de leis e dispositivosassistenciais cujo objetivo foi redesenhar o cuidado ofertado a essa população. Na atualidade, persistem desafios para a garantia de acesso a uma demanda crescente de pessoas. A implantação de serviços especializados regionais tem sido uma aposta importante para superar alguns desses desafios. Objetivo:analisar o perfil dos usuários de umCentro de Atenção Psicossocial Álcool e outras drogasda zona da mata de Pernambuco. Metodologia:Estudo descritivo, transversal e quantitativo, realizado entre março ejulho de 2018. Foi realizada coleta de dados primários em prontuários dos usuários do referido centro e analisados a partir da estatística descritiva. Resultados:Os usuários do serviço eram homens (93,8%), da cor parda (46,5%), solteiros (42,3%) e desempregados (43,2%). A maioria foi admitida quando jovem-adulto (46,4%) e por demanda espontânea (64,6%). Apresentam histórico familiar positivo (89,5%) e fazem uso predominante do álcool exclusivo (32,5%). A maioria dos usuários reside no município onde o centro supracitado está sediado. Conclusão:Os dados seguem a tendência dos estudos realizados nos últimos anos em saúde mental sobre os transtornos decorrentes do uso de crack, álcool e outras drogas e evidenciam a necessidade de fortalecer as redes regionalizadas, discutindo desde a infraestrutura como o transporte aos serviços até a necessária articulação entre o centro de atenção psicossocial álcool e outras drogas e a Atenção Básica (AU).

Introduction:The implementation of health policies to guarantee comprehensive care for users of alcohol and other drugs has been carried outfor some decades and had its normative guarantee strengthened over the years through the creation of laws and assistance devices whose objective was to redesign the care offered to this population. Currently, challenges persist to guarantee access to a growing demand of people. The implementation of specialized regional services has been an important bet to overcome some of these challenges. Objective:to analyze the profile of users of a Psychosocial Care Center for Alcohol and other drugs in the forest zone of Pernambuco. Methodology: Descriptive, cross-sectional and quantitative study, carried out between March and July 2018. Primary data was collected from medical records of users of that center and analyzed using descriptive statistics. Results:The service users were men (93.8%), brown (46.5%), single (42.3%) and unemployed (43.2%). Most were admitted as a young adult (46.4%) and by spontaneous demand (64.6%). They have a positive family history (89.5%) and make predominant use of exclusive alcohol (32.5%). Most users live in the municipality where the aforementioned center is based. Conclusion:The data follow the trend of studies carried out in recent years in mental health on disorders resulting from the use of crack, alcohol and other drugs and highlight the need to strengthen regionalized networks, discussing from infrastructure such as transport to services to the necessary articulation betweenthe alcohol and other drugs psychosocial care center and the Primary Care (AU).

Introducción:La implementación de políticas de salud para garantizar la atención integral a los usuarios de alcohol y otras drogas se viene realizando desde hace algunas décadas y ha tenido su garantía normativa fortalecida a lo largo de los años a través de la creación de leyes y dispositivos asistenciales cuyo objetivo fue rediseñar la atención ofrecida. a esta población. Actualmente, persisten los desafíos para garantizar el acceso a una demanda creciente de personas. La implementación de servicios regionales especializados ha sido una apuesta importante para superar algunos de estos desafíos. Objetivo:analizar el perfil de usuarios de un Centro de Atención Psicosocial por Alcohol y otras drogas en la zona forestal de Pernambuco. Metodología:Estudio descriptivo, transversal y cuantitativo, realizado entre marzo y julio de 2018. Se recogieron datos primarios de las historias clínicas de los usuarios de ese centro y se analizaron mediante estadística descriptiva. Resultados:Los usuarios del servicio fueron hombres (93,8%), morenos (46,5%), solteros (42,3%) y desempleados (43,2%). La mayoría ingresó como adulto joven (46,4%) y por demanda espontánea (64,6%). Tienen antecedentes familiares positivos (89,5%) y hacen un uso predominante de alcohol exclusivo (32,5%). La mayoría de usuarios vive en el municipio donde tiene su sede el mencionado centro. Conclusión:Los datos siguen la tendencia de los estudios realizados en los últimos años en salud mental sobre los trastornos derivados del uso de crack, alcohol y otras drogas y destacan la necesidad de fortalecer las redes regionalizadas, discutiendo desde la infraestructura como el transporte hasta los servicios hasta los necesarios. articulación entre el centro de atención psicosocial de alcohol y otras drogas y la Atención Primaria (AU).

Creating an Interprofessional Network in Lifestyle Medicine: The Journey of the Canadian Academy of Lifestyle Medicine.

Canada's population is increasing, and aging. These demographic patterns are accompanied by a growing awareness and evidence base of the benefits to society of leading a healthy and active life. The Canadian Academy of Lifestyle Medicine (CALM) was created to fill a knowledge gap in the Canadian public: how to lead a healthier and more active life. CALM aimed to address these challenges by confronting the lack of assistance modern medicine provides. As a diverse collaborative network using a lifestyle medicine philosophy, CALM's objective was to generate discussions and examine lifestyle medicine approaches to improving overall health and well-being for Canadians. CALM aimed to engage patients whose access to health care is through a physician and provide an innovative platform to support care and healthy decision making. Despite perceived widespread support, intense planning, and extensive development, CALM was slow to gain traction and realize its full potential. This article describes the experiences and lessons learned in creating CALM from the perspective of the leadership team. Although most CALM activities have ceased, virtual space and social media remain active so too does the work of the leadership team, striving to enable Canadians to develop behaviors that will improve their lifestyle, and their overall well-being.

Seguindo os fios que tecem as redes com Eugênio Vilaça Mendes e Luiz Carlos de Oliveira Cecílio / Following the threads that weave the hammocks with Eugênio Vilaça Mendes and Luiz Carlos de Oliveira Cecílio

Este trabalho tem como objetivo discutir as redes de atenção à saúde defendidas por Eugênio Vilaça Mendes e Luiz Carlos Oliveira Cecilio, entendendo que estas não são as únicas formas de se pensar as redes. Para isso foi realizada uma leitura crítica de suas obras no intuito de compreender de que forma eles desenvolveram o seu pensamento sobre o tema. Ademais, discutimos alguns dos conceitos fundamentais para o pensamento de tais autores, como distrito sanitários, redes poliárquicas, necessidades de saúde e agir leigo. Através deste debate procuramos analisar e entender o avanço da discussão das redes no contexto da saúde brasileira. Buscamos ainda debater de que forma o debate sobre as redes de atenção à saúde se desenvolveu no contexto brasileiro, perpassando por alguns momentos centrais da história da política da saúde no país, desde o início do século XX até os principais documentos que consolidaram a política de redes no Brasil.

This paper aims to discuss the health care networks defended by Eugênico Vilaça Mendes and Luiz Carlos Oliveira Cecilio, understanding that these are not the Only ways to think about networks. For this a critical Reading of their works was carried out in order to understand how they developed their thinking on the topic. Futhermore, we discuss some of the fundamental concepts for the thought of such authors, such as health districts, polyarchic networks, health needs and layman' actions. Through this debate, we seek to understand and analyze the progress of the discussion of networks in the context of Brazilian health. We also seek to debate how the debate on health care networks developed in the Brazilian context, passing through some central moments in the history of health policy in the country, from the beginning of the 20th century to the main documents that consolidated the health policy.

Atendimento da Estratégia Saúde da Família: percepções de usuários adultos e cuidadores de crianças / Family Health Strategy Care: Adult users and children caregivers perceptions

O estudo buscou compreender a percepção de usuários da Atenção Primária à Saúde sobre o atendimento da Estratégia Saúde da Família na perspectiva de cuidadores de crianças menores de dois anos e usuários adultos. Trata-se de um estudo descritivo e qualitativo com a participação de 37 usuários adultos e 36 cuidadores de crianças, com média de idade de 38,2 anos, 89,04 % mulheres e 10,96% homens. As respostas passaram pela análise de conteúdo com a construção das temáticas: "Reconhecendo os atributos essenciais da Atenção Primária à Saúde", "Identificando fragilidades na Estratégia Saúde da Família" e "Sugerindo melhorias na Estratégia Saúde da Família". Os usuários da Estratégia Saúde da Família percebem a presença de atributos da Atenção Primária à Saúde como acesso de primeiro contato, integralidade e continuidade do cuidado, mas apresentam insatisfação com o agendamento de consultas para especialistas e exames diagnósticos, falta de medicamentos, falta de coordenação e integralidade na assistência à saúde. (AU)

The study sought to understand the perception of Primary Health Care users regarding the fulfillment of the Family Health Strategy from the perspective of caregivers children of toddlers, infants and adult users.This is a descriptive and qualitative study conducted with 37 adult users and 36 children caregivers, which presented a mean age of 38.2 years, with 89.04% of interviewees being female and 10.96% male. Answers underwent content analysis with the construction of the following themes: "Recognizing the essential attributes of Primary Health Care", "Identifying weaknesses in the Family Health Strategy" and "Suggesting improvements in the Family Health Strategy". Users of the Family Health Strategy perceive the presence of Primary Health Care attributes such as first contact access, integrality and care continuity, but are dissatisfied with scheduling appointments for specialists and diagnostic tests, lack of medication, lack of coordination and integrality in health care. (AU)

The conceptions of health services managers about the network of psychosocial care for crack users

OBJETIVO: El objetivo de este estudio fue conocer las concepciones de los gerentes de servicios de salud sobre la red de atención psicosocial para usuarios de crack. MÉTODOS: encuesta cualitativa y evaluativa utilizando el marco de evaluación de cuarta generación. La encuesta se realizó en un centro de atención psicosocial para los consumidores de alcohol y drogas en un municipio del estado de Rio Grande do Sul, Brasil. Los datos se recopilaron de enero a mayo de 2013, a través de entrevistas guiadas utilizando el círculo dialéctico hermenéutico. RESULTADOS Y DISCUSIÓN: los gerentes revelaron sus concepciones sobre la colaboración entre sectores en la red de atención, reconociendo los servicios prestados por la red de atención psicosocial y la coordinación de esos servicios. También mostraron comprensión de la importancia de asociarse con mecanismos de otros sectores de la sociedad. CONCLUSIONES: los administradores municipales se han esforzado por construir una política de salud mental centrada en el usuario con coordinación entre sectores, abogando por los principios de la reforma psiquiátrica y la atención psicosocial.

OBJECTIVE: The objective of this study was to learn the conceptions of health services managers about the network of psychosocial care for crack users. METHODS: Qualitative and evaluative survey using the Fourth Generation Evaluation framework. The survey was performed at a center for psychosocial care for alcohol and drug abusers in a municipality of the State of Rio Grande do Sul, Brazil. Data were collected from January to May 2013, through guided interviews using the hermeneutic dialectical circle. RESULTS AND DISCUSSION: Managers revealed their conceptions about collaboration between sectors in the care network, recognizing the services provided by the psychosocial care network and the coordination of those services. They also displayed understanding of the importance of partnering with mechanisms from other sectors of society. CONCLUSIONS: Municipal managers have endeavored to build a user-focused mental health policy with coordination between sectors, advocating for the principles of psychiatric reform and psychosocial care.

História da assistência hospitalar em São Paulo: a subvenção do Estado às misericórdias paulistas / History of hospital care in São Paulo: State grants to the misericórdia charitable associations

Resumo O artigo analisa como as santas casas de misericórdia do estado de São Paulo foram subvencionadas pelos governos municipais, provincial e estadual na passagem do século XIX para o XX. Para tanto, são discutidas as dotações orçamentárias realizadas de 1838 a 1915, com o fim de avaliar o repasse e a ampliação de verbas nesse ínterim. É possível notar que foi criada uma rede de assistência fortemente apoiada pelo Estado, mas efetivada pela assistência filantrópica. Essa rede de atendimento hospitalar permanece com o mesmo formato até pelo menos o primeiro terço do século XX, contexto em que se incluíam as misericórdias criadas pelo interior do estado paulista.

Abstract This article investigates how the santas casas de misericórdia charitable associations in the state of São Paulo were subsidized by the municipal, provincial, and state governments at the turn of the twentieth century. Budget appropriations from 1838 to 1915 were examined to evaluate these charitable grants as well as the growth in funding during this period. While a care network created with strong state backing, it was put into action by philanthropic assistance. This network of hospital care retained the same format until at least the first third of the twentieth century, and included misericórdia establishments created within the interior of the state of São Paulo.

Short-term and long-term positive outcomes of the multidisciplinary care implemented by the French health networks for the prevention and care of paediatric overweight and obesity.

BACKGROUND: The nine French regional health networks for the prevention and care of paediatric obesity offer a 2-year program of multidisciplinary primary care (medical, dietetical, psychological, adapted physical activity) based on multicomponent lifestyle interventions. OBJECTIVES: To assess the short-term and long-term impact of care management. METHODS: The impact of the multidisciplinary care was assessed by changes in the body mass index (BMI) Z score during the period of the care, and at least 2 years after the end. Anthropometric data were collected at baseline and at the end of the care either through a digital medical file or through direct phone contacts with the referring. Long-term outcomes were assessed through studies relative to post follow-up evaluation. RESULTS: At the end of the period of the care in a network, 72.9% of 6947 children had decreased their BMI Z score from 3.6 ± 1.0 DS at baseline to 3.3 ± 1.1 DS at the end. The four studies relative to long-term evaluation showed a pursuit of the decrease of BMI Z score during the 5.1 years after the beginning of the care. CONCLUSIONS: The care provided by regional French networks for prevention and care of paediatric obesity induce a reduction of BMI that continues afterwards.

Violence against women: historical trajectory of a care program (Curitiba - 1997-2014) / Violencia contra las mujeres: la trayectoria histórica de un programa de atención (Curitiba - 1997-2014) / Violência contra mulheres: trajetória histórica de um programa de atenção (Curitiba - 1997-2014)

ABSTRACT Objective: To analyze the historical trajectory and the contributions of the Programa de Atenção às Mulheres em Situação de Violência (Program of Care to Women Victims of Violence) of Curitiba. Method: Research with documentary and local approach, inspired by the Dimension of Political History, to unveil power relations, political representations, symbols and discourses. Eighty-eight sources were used for the period 1997-2014. The data collection was performed in May 2016 and presented in the timeline modality. Results: The historical trajectory of the program indicates intersectoral and interinstitutional experience that has been increasing and originating important innovations in care to women based on humanization and from the perspective of comprehensiveness. Final considerations: Historicizing the Program contributed to the reflection on the construction of practices aimed at confronting violence, the need for intersectoral actions and looks that involve its complexity.

RESUMEN Objetivo: Analizar la trayectoria histórica y las contribuciones del Programa de Atención a las Mujeres en Situación de Violencia de Curitiba. Método: Investigación con enfoque documental y local, inspirada en la Dimensión de la Historia Política, para revelar relaciones de poder, representaciones políticas, símbolos y discursos. Se utilizaron 88 fuentes para el período 1997-2014. La recolección de datos fue realizada en mayo de 2016 y presentada en la modalidad línea del tiempo. Resultados: La trayectoria histórica del programa indica una experiencia intersectorial e interinstitucional, que se ha ido ampliando y originando importantes innovaciones en la atención a mujeres pautadas en la humanización y en la perspectiva de la integralidad. Consideraciones finales: Historizar el programa contribuyó a la reflexión acerca de la construcción de prácticas dirigidas al enfrentamiento de la violencia, la necesidad de acciones intersectoriales y miradas que involucren su complejidad.

RESUMO Objetivo: Analisar a trajetória histórica e as contribuições do Programa de Atenção às Mulheres em Situação de Violência de Curitiba. Método: Pesquisa com abordagem documental e local, inspirada na Dimensão da História Política, para descortinar relações de poder, representações políticas, símbolos e discursos. Foram utilizadas 88 fontes referentes ao período de 1997-2014. A coleta de dados foi realizada em maio de 2016 e apresentada na modalidade linha do tempo. Resultados: A trajetória histórica do programa indica experiência intersetorial e interinstitucional que foi se ampliando e originando importantes inovações na atenção às mulheres pautadas na humanização e na perspectiva da integralidade. Considerações finais: Historicizar o Programa contribuiu na reflexão acerca da construção de práticas voltadas ao enfrentamento da violência, a necessidade de ações intersetoriais e olhares que envolvam sua complexidade.

An Internet of Things based physiological signal monitoring and receiving system for virtual enhanced health care network.

BACKGROUND: Wireless physiological signal monitoring system designing with secured data communication in the health care system is an important and dynamic process. OBJECTIVE: We propose a signal monitoring system using NI myRIO connected with the wireless body sensor network through multi-channel signal acquisition method. Based on the server side validation of the signal, the data connected to the local server is updated in the cloud. The Internet of Things (IoT) architecture is used to get the mobility and fast access of patient data to healthcare service providers. METHODS: This research work proposes a novel architecture for wireless physiological signal monitoring system using ubiquitous healthcare services by virtual Internet of Things. RESULTS: We showed an improvement in method of access and real time dynamic monitoring of physiological signal of this remote monitoring system using virtual Internet of thing approach. This remote monitoring and access system is evaluated in conventional value. This proposed system is envisioned to modern smart health care system by high utility and user friendly in clinical applications. CONCLUSION: We claim that the proposed scheme significantly improves the accuracy of the remote monitoring system compared to the other wireless communication methods in clinical system.

In Defence of Moral Pluralism and Compromise in Health Care Networks.

The organisation of health care is rapidly changing. There is a trend to move away from individual health care institutions towards transmural integrated care and interorganizational collaboration in networks. However, within such collaboration and network there is often likely to be a pluralism of values as different health care institutions often have very different values. For this paper, we examine three different models of how we believe institutions can come to collaborate in networks, and thus reap the potential benefits of such collaboration, despite having different moral beliefs or values. A first way is the pragmatic way in which the different health care institutions avoid ethical reflection and focus on solutions. A second possible route is that of consensus where health care institutions base their collaboration on values that they all share. The third, and final, approach is that of compromise. Although moral compromise is often seen in a negative light, we argue that in many cases compromise might be necessary and ethically justified. In a final section, we will shift our focus from discussing various theoretical methods to allow collaboration to the potential content of consensus or compromise.

Coordination between primary and secondary care: the role of electronic messages and economic incentives.

BACKGROUND: In Norway, a government reform has recently been introduced to enhance coordination between primary and secondary care. This paper examines the effects of two newly introduced measures to improve the coordination: an ICT-based communication tool/standard and an economic incentive scheme. METHOD: This qualitative study is based primarily on 27 open-ended interviews. We interviewed nine employees at a hospital (the focal actor), 17 employees from seven different municipalities, and a representative of a Regional Health Authority. RESULTS: ICT-based communication is perceived to facilitate information exchange between primary and secondary care, thus positively affecting coordination. However, the economic incentive scheme appears to have the opposite effect by creating tensions between the two organizations and accentuating power asymmetry in favor of secondary care. CONCLUSIONS: The inter-organizational nature of coordination in health care makes it crucial for policymakers and management of care organizations to conceive incentives and instruments that work jointly across organizations rather than at only one of the health care organizations involved. Such an approach is likely to favor a more symmetrical pattern of collaboration between primary and secondary care.

Study on Satisfaction of Demander on Village Clinics in BeijingSuburbs:Taking M County as an Example / 中国医学伦理学

Objective:To understand the satisfaction of villagers on the service of village clinics,in order to improve the service ability of village clinics.Methods:Choosing M County of Beijing as the research site,we chose five towns and chose 10 villages in each town as the studysites.In the extraction 50 villages,about 5 villagers from each village were selected to conducts questionnaire survey.Results:Of the villagers surveyed,the average age was (55.99 ± 11.71)years old.A total of 75.0％ of the villagers chose to seek medical care in village clinics when they had common diseases.The order of the number of people that villagers were satisfied with the village clinicsin all aspects from high to low was drug quality,basic medical care,public health,the type and quantity of drugs,medical equipment.Conclusion:It should give priority to the introduction of the village talent and weave tertiary health care network bottom tightly;pay attention to hardware equipment at basic level and tamp the service status of village clinics;give consideration to both the benefit and public welfare and improve health service ability.

Application of Classification System for European Medical and Health Care Network in the Drug Related Problems in Oncology Department / 中国药师

Objective:To discuss the application of the classification system for European medical and health care network in the drug related problems in oncology department through the practice of the classification system in clinical cases. Methods:The classifi-cation system (version 8. 0) was used to perform the pharmaceutical care for two patients in oncology department, and the drug related problems ( DRPs) including types, causes, interventions, acceptance degree of interventions and the situation of DRPs were analyzed. Results:DRPs were clearly analyzed by the classification system, which provided scientific and systematic pharmaceutical care for the patients. Clinical pharmacists could find DRPs and provide interventions for the patients, which improved the rationality and safety of medication. Conclusion:Clinical pharmacists establish a perfect pharmacy monitoring system for European medical and health care network, and DRPs can be analyzed by the classification system, which promotes reasonable medication and ensures patients' safety.