Exploring the association between social isolation and utilization of primary health services by older adults: evidence from China.

Objective: This study aims to investigate the impact of social isolation on the utilization of primary health services among older adults in China. Methods: Data from the China Longitudinal Aging Social Survey (CLASS) conducted in 2018 were utilized. A binary logistic regression model was established, and propensity score matching (PSM) was employed for analysis. Results: The results of the binary logistic regression showed that family isolation within social isolation had a significant negative impact on the utilization of primary health services for older adults. In contrast, there was no significant association between friend isolation, community isolation, and the utilization of primary health services. Furthermore, the PSM results, using three matching methods (nearest neighbor matching, radius matching, and kernel matching), confirmed that family isolation significantly reduced older adults' utilization of primary health services, consistent with the baseline regression findings. Conclusion: Reducing the occurrence of family isolation among older adults may be a cost-effective intervention measure. Efforts should be directed toward improving family support for older adults, promoting the utilization of primary health services, and strengthening disease prevention.

Sociodemographic factors and use of pain medication are associated with health-related quality of life: results from an adult community mental health service in Norway.

PURPOSE: Health-related quality of life (HRQoL) is an important aspect of mental health outcomes. There are few studies on HRQoL in heterogeneous patient populations seeking help at community mental health services. The aims of the study were to compare how HRQoL, measured by the EuroQol five dimensions with five levels (EQ-5D-5L), was distributed compared to other samples from national and international studies, and to explore what factors are associated with HRQoL. METHODS: In a cross-sectional study, 1379 Norwegian outpatients reported their HRQoL before starting treatment. Associations with demographic variables, job status, socio-economic status, and use of pain medication were examined using multiple regression analysis. RESULTS: Most of the sample, 70% to 90%, reported problems with usual activities, pain/discomfort, and anxiety/depression; 30% to 65% reported that these problems were of a moderate to extreme degree. Forty percent reported problems with mobility, and about 20% reported problems with self-care. The sample's HRQoL was considerably lower than the general population, and comparable to patient-groups from specialist mental health services. Originating from a developing country, lower level of education, lower yearly household income, being on sick leave or unemployed, and using pain medication were associated with lower HRQoL. Age, gender, and relationship status were not associated with HRQoL. This is the first study to simultaneously examine the unique contribution of these variables in one study. CONCLUSION: The most impacted domains of HRQoL were pain/discomfort, anxiety/depression, and usual activities. Lower HRQoL was associated with several socio-demographic factors and use of pain medication. These findings might have clinical implications and suggest that mental health professionals should routinely measure HRQoL in addition to symptom severity, to identify areas that should be targeted to improve HRQoL.

Evidence for "Whole Family Approach" in accelerating uptake of COVID-19 and routine immunizations among integrated primary health services in Nigeria.

The family is the simplest unit but possesses the strongest bond in society. These qualities - bond and proximity - that exist both within and across neighboring families, according to our research, can be instrumental in shaping a new kind of health promotion strategy that can transform health behaviors in communities. The Whole Family Approach (WFA) is a government-sanctioned approach to increase uptake of COVID-19 vaccines in Nigeria. The approach entails leveraging the high family-based demand for some primary health services, such as malaria, diabetes, hypertension, and reproductive services, to generate demand for COVID-19 and routine immunizations. However, since the announcement in 2021, there has been no available evidence to show the impact of the approach on COVID-19 vaccine uptake, though global literature generally favors family-centered health approaches. This study tests the effectiveness of the approach in increasing the utilization of target services in a Nigerian community and further provides a theoretical framework for the strategy. Two primary healthcare facilities were selected in two communities located in Abuja in a quasi-experimental design. After a small-sample landscape assessment of the communities and the facilities, family-targeting health promotion activities were facilitated in the intervention community (integrated health education by trained community health influencers) and facility (opportunistic health promotion through in-facility referrals) for one month. Anonymized service utilization data were acquired from both facilities over a period of four months to analyze their respective month-by-month service utilization trends. Time trend analysis was conducted and revealed that WFA significantly increased service utilization (N = 5870; p < 0.001, α = 0.01, 99% CI) across all the package services provided at the intervention facility. A supplementary Pearson's correlation analysis further presented a positive relationship (r = 0.432-0.996) among the services which favored the result. It can therefore be concluded that the "Whole Family Approach" of health promotion is efficacious in accelerating uptake of priority health services such as COVID-19 and routine immunizations. While there is more to be understood about this interesting approach, we recommend the improvement of communication and capacity gaps in Nigeria's primary healthcare system to ensure that promising strategies such as the WFA are adequately implemented at the community and facility levels.

Experiences and Expectations of the Characteristics of Friendly Primary Health Services from the Perspective of Men: A Phenomenological Qualitative Study.

Inadequate men's engagement with health services may be influenced by unmet needs and demands of the local men's community. This study aimed to explore men's experiences with primary health services and their expectations of the characteristics of friendly primary health services, from the perspective of men in Kelantan, Malaysia. A qualitative study using in-depth interviews was conducted with 15 men from six primary health facilities in Kelantan, Malaysia, who were selected based on maximum variation sampling. The data were transcribed and analyzed using the thematic analysis method. The study found that experiences with the existing primary health services were categorized into four subthemes: provision of health services, health promotion delivery, attributes of healthcare providers, and the physical environment of the health facilities. Meanwhile, the expectations of the characteristics of friendly primary health services were categorized into four subthemes: meeting the needs of men in primary health services, approaching men through effective health promotion strategies, standards of a healthcare provider from the viewpoint of men, and a comfortable physical environment for men. Prior experiences hugely influenced men's expectations of friendly primary health services. Men want these health service characteristics customized to meet their needs, allowing them to use health services with confidence and comfort. Thus, to strengthen primary health services for men, it is essential to comprehend their prior experiences with and expectations of the services.

Nurse leaders' changing roles over 25 years: a qualitative study.

PURPOSE: The purpose of this study is to emphasise nurses' experiences of nurse leaders' changing roles over 25 years. DESIGN/METHODOLOGY/APPROACH: A qualitative study was performed with individual interviews of eight nurse managers. From Norway and Finland, all nurse managers with more than 25 years of experience and working in specialist health care and primary health care were included in the study. FINDINGS: These nurse managers have a lot of knowledge and resolved conflicts using improved methods and have experienced continuous change. The role of nurse manager ranges from bedside to exclusive administrative work. The organisations have become more extensive, and the staff has grown. These changes have led to many challenges and more complex organisations. RESEARCH LIMITATIONS/IMPLICATIONS: Nurse managers who have worked for over a 25-year period had useful experience and could handle many new challenges. They can change themselves and their organisation tasks over time and follow the development of society. ORIGINALITY/VALUE: Based on their experiences as novices at the beginning of their career, the informants demonstrate their development to the level of expert manager.

Costs and Outcomes of Integrated Human African Trypanosomiasis Surveillance System Using Rapid Diagnostic Tests, Democratic Republic of the Congo.

We integrated sleeping sickness case detection into the primary healthcare system in 2 health districts in the Democratic Republic of the Congo. We replaced a less field-friendly serologic test with a rapid diagnostic test, which was followed up by human African trypanosomiasis microscopic testing, and used a mixed costing methodology to estimate costs from a healthcare provider perspective. We screened a total of 18,225 persons and identified 27 new cases. Average financial cost (i.e., actual expenditures) was US $6.70/person screened and $4,464/case diagnosed and treated. Average economic cost (i.e., value of resources foregone that could have been used for other purposes) was $9.40/person screened and $6,138/case diagnosed and treated. Our study shows that integrating sleeping sickness surveillance into the primary healthcare system is feasible and highlights challenges in completing the diagnostic referral process and developing a context-adapted diagnostic algorithm for the large-scale implementation of this strategy in a sustainable and low-cost manner.

User evaluation of a therapist-guided internet-delivered treatment program for anxiety disorders: A qualitative study.

Therapist-guided internet-based cognitive behaviour therapy (ICBT) has been proposed as a potential means to increase individuals' access to quality mental health care and effective treatment. Guided ICBT aims to increase a patient's knowledge and competence to better cope with their disorder. Despite the growing evidence supporting the effects of guided ICBT, there is remarkably little research on the different factors that are important for patients to achieve effects from using such digital treatment interventions. Thus, the aim of this study was to conduct a user evaluation of a therapist-guided ICBT program using the updated DeLone and McLean (D&M) model for measuring information systems (IS) success or effectiveness. This model includes the following six dimensions: system quality, information quality, service quality, intention to use and use, user satisfaction, and net benefits (impacts or effect). Ten users of a Norwegian therapist-guided ICBT program for treating anxiety disorders named 'Assisted Self-Help' (Assistert Selvhjelp) participated in phone-based individual interviews. Data were analysed using directed content analysis. Results showed that the participants were quite satisfied with the program's system quality and information quality. However, participants suggested improvements, including in-program instruction, improved visibility of system status, more flexibility regarding automated measurement surveys, and the inclusion of more videos with patient stories. Further, the results indicated a need for improvement in the service quality of guided ICBT introduction, instruction, follow-up, guidance, and support from therapists. The results showed that user friendliness and high educational content might not be sufficient for a therapist-guided ICBT program to be perceived as effective. It might also be necessary for therapists to provide follow-up, guidance, and support that are more in line with individual patient needs. Thus, the results suggest that guided ICBT requires active participation from all involved in the process, including the therapist.

Chronic conditions in the community: Preventative principles and emerging practices among Maori health services providers.

ISSUE: The pressing chronic conditions prevention needs of Maori (the Indigenous peoples of Aotearoa New Zealand) are yet to be adequately addressed using mainstream approaches. This study investigated how Maori health service providers (MHSP) are positioning themselves to better meet the chronic conditions prevention needs of Maori. METHODS: Kaupapa Maori methodology underpinned a three-phase research project that investigated three Maori health service provider-based chronic conditions prevention cases, in different regions of Aotearoa New Zealand, using an instrumental case study design. Two small group interviews with seven participants and 44 individual key informant interviews were conducted. All participants were associated with one of the three MHSP. Document reviews and observations were also carried out. Following the identification of a prevention case study, within each provider, in-depth investigation of prevention practices was undertaken. RESULTS: Achieving well-being through health service delivery is challenging for the three providers which are largely reliant on state funding to support their work through defined contract outputs. The drivers of service delivery norms impacting providers include the dominant medical conditions focused discourse and addressing the high levels of acute need characteristic of provider communities. There are examples of shifts in organisational structure and delivery configurations that demonstrate challenging and reframing these norms. We identified emerging approaches to prevention that move beyond being "the ambulance at the bottom of the cliff" to "building a fence at the top." CONCLUSION: Consolidation of provider prevention approaches, increased resources and a broader health services systems level response that prioritises prevention are required. SO WHAT?: MHSP are reframing services to better meet the well-being needs of the communities they serve.

The Effect of Multimorbidity Patterns and the Impact of Comorbid Anxiety and Depression on Primary Health Service Use: The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study.

This study sought to determine patterns of multimorbidity and quantify their impact on use of primary health services in the presence and absence of anxiety and depression among a cohort of urban community-dwelling men in Australia. The analytic sample consisted of men (n = 2039; age 38-85) from the follow-up wave of a prospective cohort study of all participants of the Florey Adelaide Male Ageing Study (FAMAS; Stage 2 [2007-2010]) and age-matched men from the North-West Adelaide Health Study (NWAHS; Stage 3 [2008-2010]). Self-reported data and linkage with a national universal health coverage scheme (Medicare) provided information on the prevalence of eight chronic conditions and health service utilization information (including annual GP visits). Obesity and cardiovascular disease (CVD) were associated with the highest number of comorbid conditions. Two nonrandom multimorbidity "clusters" emerged: "CVD, Obesity, Diabetes" and "CVD, Obesity, Osteoarthritis." Participants with conditions comorbid with CVD were more likely to have 10 or more annual GP visits, compared to multimorbidity involving other conditions. In comparison to participants without CVD, the presence of CVD increased the chance of having 10 or more annual GP visits (adjusted risk ratio: 3.7; 95% CI [2.8, 4.8]). When CVD was comorbid with anxiety and depression, having 10 or more annual GP visits was more common (adjusted risk ratio: 1.8; 95% CI [1.2, 2.5]). Multimorbidity patterns involving CVD, especially for multimorbidity that includes CVD with comorbid anxiety and depression, should be considered in developing clinical trials to better inform medical decision-making and care for patients with CVD and comorbid conditions.

Passive Screening and Diagnosis of Sleeping Sickness with New Tools in Primary Health Services: An Operational Research.

INTRODUCTION: The integration of human African trypanosomiasis (HAT) activities into primary health services is gaining importance as a result of the decreasing incidence of HAT and the ongoing developments of new screening and diagnostic tools. In the Democratic Republic of Congo, this integration process faces multiple challenges. We initiated an operational research project to document drivers and bottlenecks of the process. METHODS: Three health districts piloted the integration of HAT screening and diagnosis into primary health services. We analysed the outcome indicators of this intervention and conducted in-depth interviews with health care providers, seropositives, community health workers and HD management team members. Our thematic interview guide focused on factors facilitating and impeding the integration of HAT screening. RESULTS: The study showed a HAT-RDT-positive rate of 2.2% in Yasa Bonga, 2.9% in Kongolo and 3% in Bibanga, while the proportion of reported seropositives that received confirmatory examinations was 76%, 45.6% and 68%, respectively. Qualitative analyses indicated that some seropositives were unable to access the confirmation facility. The main reasons that were given included distance, RDT rupture, lack of basic screening equipment and financial barriers (additional hospital fees not included in free treatment course), fear of lumbar puncture and the perception of HAT as a disease of supernatural origin. CONCLUSION: Passive screening using HAT RDTs in primary health services inevitably has some limitations. However, regarding the epidemiological context and some obstacles to integrated implementation, this cannot on its own be a relevant alternative to the elimination of HAT by 2020. FUNDING: We acknowledge the agency that provided financial support for this study, the Belgian Development Cooperation. The funder had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. Philippe Mulenga received financial support thanks to a doctoral grant from the Belgian Development Cooperation under the FA4 agreement. Funding for the study and Rapid Service Fees was provided by the Epidemiology and Tropical Diseases Unit of the Institute of Tropical Medicine, Antwerp.

Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017.

AIM: To examine rates of contact with primary and mental health care prior to suicide in men and women and across a range of age categories. METHOD: The authors performed a systematic review of 44 studies from 2000 to 2017 of which 36 reported rates on contact with primary health care and 14 reported on contact with mental health care prior to suicide. RESULTS: Contact with primary health care was highest in the year prior to suicide with an average contact rate of 80%. At one month, the average rate was 44%. The lifetime contact rate for mental health care was 57%, and 31% in the final 12 months. In general, women and those over 50 years of age had the highest rates of contact with health care prior to suicide. CONCLUSIONS: Contact with primary health care prior to suicide is common even in the final month before death. The findings presented in this study highlight the importance of placing suicide prevention strategies and interventions within the primary health care setting.

Implementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative study.

BACKGROUND: In order to tackle the considerable treatment gap for epilepsy in many low- and middle-income countries (LMICs), a task sharing model is recommended whereby care is integrated into primary health services. However, there are limited data on implementation and impact of such services in LMICs. Our study aimed to explore the perspectives of service users and caregivers on the accessibility, experience and perceived impact of epilepsy treatment received in a task-shared model in a rural district of Ethiopia. METHODS: A qualitative study was carried out using interviews with purposively sampled service users (n = 13) and caregivers (n = 3) from a community-ascertained cohort of people with epilepsy receiving integrated services in primary care in rural Ethiopia. Interviews followed a topic guide with questions regarding acceptability, satisfaction, barriers to access care, pathways through care and impact of services. Framework analysis was employed to analyse the data. RESULTS: Proximity of the new service in local primary health centers decreased the cost of transportation for the majority of service users thus improving access to services. First-hand experience of services was in some cases associated with a willingness to promote the services and inform others of the existence of effective biomedical treatment for epilepsy. However, most service users and their caregivers continued to seek help from traditional healers alongside biomedical care. Most of the care received was focused on medication provision with limited information provided on how to manage their illness and its effects. Caregivers and service users spoke about the high emotional and financial burden of the disease and lack of ongoing practical and emotional support. The majority of participants reported clinical improvement on medication, which in over half of the participants was associated with ability to return to money generating activities. CONCLUSIONS: Task-sharing improved the accessibility of epilepsy care for services users and caregivers and was perceived as having a positive impact on symptoms and productivity. Nonetheless, promotion of self-management, holistic care and family engagement were highlighted as areas requiring further improvement. Future work on implementing chronic care models in LMIC contexts is warranted.

Exploring Systems That Support Good Clinical Care in Indigenous Primary Health-care Services: A Retrospective Analysis of Longitudinal Systems Assessment Tool Data from High-Improving Services.

BACKGROUND: Continuous Quality Improvement is a process for raising the quality of primary health care (PHC) across Indigenous PHC services. In addition to clinical auditing using plan, do, study, and act cycles, engaging staff in a process of reflecting on systems to support quality care is vital. The One21seventy Systems Assessment Tool (SAT) supports staff to assess systems performance in terms of five key components. This study examines quantitative and qualitative SAT data from five high-improving Indigenous PHC services in northern Australia to understand the systems used to support quality care. METHODS: High-improving services selected for the study were determined by calculating quality of care indices for Indigenous health services participating in the Audit and Best Practice in Chronic Disease National Research Partnership. Services that reported continuing high improvement in quality of care delivered across two or more audit tools in three or more audits were selected for the study. Precollected SAT data (from annual team SAT meetings) are presented longitudinally using radar plots for quantitative scores for each component, and content analysis is used to describe strengths and weaknesses of performance in each systems' component. RESULTS: High-improving services were able to demonstrate strong processes for assessing system performance and consistent improvement in systems to support quality care across components. Key strengths in the quality support systems included adequate and orientated workforce, appropriate health system supports, and engagement with other organizations and community, while the weaknesses included lack of service infrastructure, recruitment, retention, and support for staff and additional costs. Qualitative data revealed clear voices from health service staff expressing concerns with performance, and subsequent SAT data provided evidence of changes made to address concerns. CONCLUSION: Learning from the processes and strengths of high-improving services may be useful as we work with services striving to improve the quality of care provided in other areas.

Association between perceived social stigma against mental disorders and use of health services for psychological distress symptoms in the older adult population: validity of the STIG scale.

OBJECTIVES: To document the reliability, construct and nomological validity of the perceived Social Stigmatisation (STIG) scale in the older adult population. DESIGN: Cross-sectional survey. SETTING: Primary medical health services clinics. PARTICIPANTS: Probabilistic sample of older adults aged 65 years and over waiting for medical services in the general medical sector (n = 1765). MEASUREMENTS: Perceived social stigma against people with a mental health problem was measured using the STIG scale composed of seven indicators. RESULTS: A second-order measurement model of perceived social stigma fitted adequately the observed data. The reliability of the STIG scale was 0.83. According to our results, 39.6% of older adults had a significant level of perceived social stigma against people with a mental health problem. RESULTS showed that the perception of social stigma against mental health problems was not significantly associated with a respondent gender and age. RESULTS also showed that the perception of social stigma against the mental health problems was directly associated with the respondents' need for improved mental health (b = -0.10) and indirectly associated with their use of primary medical health services for psychological distress symptoms (b = -0.07). CONCLUSION: RESULTS lead us to conclude that social stigma against mental disorders perceived by older adults may limit help-seeking behaviours and warrants greater public health and public policy attention. Also, results lead us to conclude that physicians should pay greater attention to their patients' attitudes against mental disorders in order to identify possible hidden mental health problems.

Análisis del cumplimiento de la atención fonoaudiológica de la guía clínica GES, en pacientes con enfermedad de Parkinson en centros de atención primaria de salud de Talca / Analysis of compliance phonoaudiologic care of clinical guide GES in patients with Parkinson's disease in primary care centers health Talca

Since 2010 the Chile's Ministry of Health includes Parkinson's disease (PD) pathology in AUGE. Accordingly, this unit produced a clinical guideline wherein stipulates a specific procedure for assessment and intervention in Primary Care Health Centers. In that guideline, the speech therapy intervention is indicated as fundamental, applicable in a given amount of annual sessions depending on the phase of the disease for each person. Currently there are 518 cases in control in the province of Talca. Therefore, the present investigation aims to establish the level of accomplishment of speech therapy services in Parkinson's disease as required by GES law in Primary Care Health centers of the city of Talca...

Desde el año 2010 el Ministerio de Salud incorpora la Enfermedad de Parkinson (EP) en las patologías AUGE . Para ello elaboró una Guía Clínica en donde se estipula un determinado procedimiento de evaluación e intervención para Centros de Atención Primaria de Salud. En ella, se indica la intervención fonoaudiológica como fundamental, aplicable en una determinada cantidad de sesiones anuales según el estadio de la patología en que se encuentra el sujeto. Actualmente en la provincia de Talca se encuentran 518 casos en control. Por consiguiente, la presente investigación tiene como objetivo establecer el nivel de cumplimiento de la atención fonoaudiológica en la Enfermedad de Parkinson según lo establecido por la ley GES en Centros de Atención Primaria de Salud de la ciudad de Talca...

Saúde da Família no Brasil: estratégia de superação da desigualdade na saúde? / Family Health in Brazil: a strategy to overcome inequality in health?

Visa-se a analisar a implantação do Programa de Saúde da Família (PSF), no que se refere ao acesso aos serviços básicos de saúde, no âmbito do Sistema Único de Saúde. O estudo foi realizado nos 12 municípios pioneiros de sua implantação (1994), e a análise foi norteada pela hermenêutica dialética utilizando a técnica do Discurso do Sujeito Coletivo. Foram realizadas entrevistas junto a gestores (federais, estaduais e municipais), bem como grupos focais com usuários e membros das equipes. Abordaram-se as dimensões política (motivações dos gestores), técnico-financeira (expansão da cobertura do PSF e governança) e simbólica (a percepção dos usuários sobre acesso). Quanto à motivação, enfatizou-se a possibilidade de reduzir as desigualdades de acesso aos serviços de saúde. A expansão do PSF foi concebida como uma proposta de universalização e não de focalização; foram implementados processos de organização e institucionalização. Contudo, houve flutuação e hesitação nos apoios político, técnico e científico ao PSF, bem como na estratégia de desenvolvimento de pessoal. Quanto aos incentivos financeiros para sua expansão, os discursos dos gestores federais contradizem os dos gestores municipais quanto ao volume e prioridades de recursos para os investimentos nessa estratégia. A percepção dos usuários permanece permeada por visões funcionalistas centralizadas na doença. Nas conclusões, analisam-se as dificuldades em manter a estratégia como política de Estado que contribui à redução das iniquidades em saúde; enfatiza-se a necessidade de corrigir assimetrias no financiamento e ampliar as parcerias na implantação dos polos de formação, capacitação e educação permanente.

The aim is to examine the implementation of the Family Health Program (FHP), as regards access to basic health services under the Unified Health System The study was conducted in 12 pioneer municipalities that implemented the program (1994 ), and analysis was guided by dialectic hermeneutic using the technique of the Collective Subject Discourse. Interviews were conducted with managers (federal, state and municipal), as well as focus groups with users and team members. The political (motivation of managers), technical and financial (expansion of coverage of the PSF and governance) and symbolic (the users' perception on access) dimensions were addressed. Regarding motivation, the possibility of reducing inequalities in access to health services was emphasized. The expansion of the PSF was conceived as a plan for universalization rather than focalization; processes of organization and institutionalization were implemented. However, there were oscillations and hesitation on the political, scientific and technical support to PSF, and also on the permanent education strategies. The financial incentives for its expansion, the speeches of the federal managers contradict those of city managers on the volume of resources and priorities for investment in this strategy. The perception of users is still permeated by functionalist views centered on the disease. As conclusion, we analyze the difficulties in maintaining the strategy and state policy which helps reduce health inequities; we emphasize the need to correct disparities in funding and expanding partnerships in the implementation of the poles of training, training and continuing education.

Unmet Mental Health Service Needs Among Norwegian Children and Adolescents.

BACKGROUND: The Norwegian 10 year mental health plan identifies important roles for public health nurses in the early identification, care and referral of children and adolescents with mental health problems. This study aims to identify the extent to which public health nurses are meeting these needs. METHOD: Over a 4 week period the mental health needs of 3065 children who were seen by publich health nurses were identified. RESULTS: Achieving the ongoing Norwegian mental health plan may require better access to trained professionals in the public health sector, further expansion of specialised mental health services, and efforts to improve inter-agency collaboration.

Revitaliser les services de santé par l’approche des soins de santé primaires dans la Région africaine : rapport du Directeur régional

1. La mise en œuvre des Soins de Santé primaires (SSP) dans la Région africaine a d’abord entraîné des améliorations en ce qui concerne la santé des populations. Le déclin ultérieur de la performance des SSP a été attribué à un certain nombre de contraintes liées à la collaboration intersectorielle, à la participation communautaire, au développement des ressources humaines, aux capacités gestionnaires, à la mobilisation des ressources, et aux bases factuelles et capacités de recherche. Cependant, un examen de la stratégie des SSP, 25 ans après Alma-Ata, a révélé que celle-ci était toujours pertinente.2. L’accès universel aux soins de santé exige des systèmes de santé de district performants, capables de dispenser, à temps et à un coût abordable, des interventions essentielles aux communautés, aux familles et aux individus. La stratégie des Soins de Santé primaires constitue un cadre approprié pour l’accès aux soins de santé essentiels, à condition d’être adaptée au contexte actuel et futur.3. La démarche proposée dans le présent document consiste à redynamiser les services de santé par le biais des Soins de Santé primaires, en s’appuyant sur des interventions prioritaires destinées à promouvoir la participation communautaire, à renforcer les capacités gestionnaires, à améliorer la production et l’utilisation des données, à renforcer la collaboration et les partenariats, et à améliorer la qualité des services de santé essentiels et la couverture par ces services.4. Le Comité régional est prié d’examiner et d’adopter les orientations proposées dans le présent document, ainsi que le projet de résolution joint.

O Aluno de Medicina em Serviços Docente-Assistenciais da Rede Básica

Resumo: Investiga-se o ensino da Saúde Coletiva na graduação em Medicina, por meio de um estudo de caso do projeto pedagógico do Departamento de Medicina Social e Preventiva da PUC-Campinas. Analisa-se a disciplina Programa Integrado em Saúde Coletiva, a qual é ministrada ao quinto ano em serviços básicos da rede municipal. Para avaliar o cumprimento de objetivos e possíveis mudanças de atitudes, realizou-se uma análise qualitativa dos depoimentos de alunos que haviam cursado a disciplina no ano anterior à pesquisa. Observou-se que, a cada turma, o estágio adquire características próprias, tendo, em geral, superado as expectativas, possibilitando o reconhecimento do papel do atendimento primário na ordenação de um sistema de saúde resolutivo e de qualidade. Os conteúdos relativos às relações com os pacientes, à integralidade, à interdisciplinaridade e ao contato com a realidade social Foram considerados proveitosos por se tratar de conhecimentos "novos" e por permitirem mudanças de atitude. Entre as conclusões, registra-se a importância da inserção da escola médica junto aos serviços da rede e a necessidade da integração vertical e horizontal do curso para a superação da dicotomia teórico-prática.

Summary: This research intends to verify the assessment of learning of Social Medicine in Medical Education. It's focused the teaching plain of the Preventive and Social Medicine Department of PUC­Campinas and the discipline what is to be ministered during the fifth year class in Primary Health Care Services. Aiming to evaluate the information retained by students and their performance, a qualitative approach was chosen through interviews with students who had finished the training in the previous year. We could verify that in each group training acquired its own character. In general, the training has surpassed expectations, also making clear that primary health services can be effective and with resolution. Some contents about: doctor­patient relationship, integral attention, interdisciplinary work and the approach to social reality have been emphasized for the students. They considered this knowledge new and enable to review altitudes. For conclusion it is important that the medicine school integrate into health services and modify the curriculum structure for overcome the theoretical /practice dichotomy.