The Global Shortage of School Nurses.

Calzolari and colleagues invited others to have an "open…professional dialogue" on how Italy can introduce school nurses into their system. This editorial is a response to that invitation. Although factors such as a broader nursing shortage and limited health resources definitely contribute to a global shortage of school nurses, three foundational reasons continue to challenge the demand for school nursing globally. The three reasons are traditional views and lack of understanding of the role of school nurses to address modern days challenges, inadequate system support and integration within education, and lack of data to illustrate value. These challenges must be addressed when discussing the inclusion of school nurses in education.

Designing and implementing an educational framework for advanced paramedic practitioners rotating into primary care in North Wales.

BACKGROUND: Rotational working has been offered as a solution to bridge the retention crises faced by ambulance services in the United Kingdom due to the inception of paramedics working in primary care. One project in North Wales examines the viability of rotating Advanced Paramedic Practitioners employed by Welsh Ambulance Services NHS Trust into primary care. As part of this project, an educational framework was developed to prepare and support Advanced Paramedic Practitioners in the provision of clinical care in primary care settings. This educational framework was evaluated to determine how it supported the development of Advanced Paramedic Practitioners in the primary care setting. METHODS: Semi-structured focus groups were undertaken with Advanced Paramedic Practitioners (n = 7) and GP trainers (n = 4). OUTCOME: A narrative analysis of the information collected highlighted three overarching themes concerning the need for clinical supervision and feedback in primary care, and the usefulness of the education framework in regard to a tailored curriculum and recording progression. DISCUSSION: Despite the upcoming workforce changes, there is currently no standard education framework to support the development of Advanced Paramedic Practitioners in primary care. This evaluation offers insight into the educational needs of Advanced Paramedic Practitioners working in this setting and suggests an education structure that can best support their learning, whilst meeting regulatory requirements for paramedic professional development. Formal research is required to determine any link between provision of education for Advanced Paramedic Practitioners in primary care and patient outcome and safety.

Educational program for middle-level public health nurses to develop new health services regarding community health needs: protocol for a randomized controlled trial.

BACKGROUND: Developing health services is a key strategy for improving the community health provided by public health nurses. However, an effective educational program for improving their skills in planning such services has not been developed. To describe our program and its evaluation protocol for the education of middle-level public health nurses to improve their skills in developing new health services to fulfil community health needs in Japan. METHODS: In this randomized control trial, eligible participants in Japan will be randomly allocated to an intervention group and a control wait-list group. We will provide 8 modules of web-based learning for public health nurses from July to October 2018. To ensure fairness of educational opportunity, the wait-list group will participate in the same program as the intervention group after collection of follow-up data of the intervention group. The primary outcomes will be evaluated using the scale of competency measurement of creativity for public health nurses at baseline, immediately after the intervention. Secondary outcomes will be knowledge and performance regarding program development of public health nurses. DISCUSSION: This study will enable the analysis of the effects of the educational program on public health nurses for improving their competency to develop new health services for fulfilling community health needs and enriching health care systems. TRIAL REGISTRATION: We registered our study protocol to the University hospital Medical Information Network- Clinical Trials Registry approved by International Committee of Medical Journal Editors (No. UMIN000032176, April, 2018).

Demonstrating the Relationship Between School Nurse Workload and Student Outcomes.

This article describes how one very large, diverse school district developed a Student Acuity Tool for School Nurse Assignment and used a logic model to successfully advocate for additional school nurse positions. The logic model included three student outcomes that were evaluated: provide medications and procedures safely and accurately, increase the number of students with a medical home, and increase the number of students with chronic illness that receive case management. Pairing a staffing formula with an evaluation plan that focuses on student outcomes and the priorities of the school district provides a strong case that school nurses are essential and that they contribute to student success.

The Development and Evaluation of the Interprofessional Education Facilitation Program for Health Professionals Using the Attention, Relevance, Confidence, and Satisfaction (ARCS) Model of Instructional Design.

Background It is important to learn interprofessional education (IPE) facilitation skills to promote interprofessional collaboration in healthcare. Nonetheless, to date, only a handful of IPE facilitation programs have been developed through research. Objective The objective of this study was to create an IPE facilitation program for healthcare professionals who wanted to promote interprofessional collaboration in their organizations based on the tenets of instructional design and evaluate its effectiveness. Methods This study's methodology was a mixed method based on relative subjectivism. We developed a two-day IPE facilitation program to learn IPE facilitation skills and promote interprofessional collaboration in the participants' own organizations. The program was developed based on the instructional design principles of the attention, relevance, confidence, and satisfaction (ARCS) model, measuring the participants' Interprofessional Facilitation Scale (IPFS) scores at three time points: before the first day, after the second day, and approximately one year after the course was completed. A one-way analysis of variance test was used to compare IPFS means at the three time points, and open-ended statements were qualitatively analyzed using thematic analysis. Results Twelve healthcare providers (four physicians, two pharmacists, one nurse, one rehabilitation worker, one medical social worker, one clinical psychologist, one medical secretary, and one other) participated in the completed IPE facilitation program. Their IPFS scores increased significantly from 17.4 ± 16.1 before the program to 38.1 ± 9.4 after the program and remained at 35.1 ± 11.7 for one year (p = 0.008). In addition, qualitative analysis suggested that the knowledge and skills learned in the program could be applied in the participants' workplaces, which helped them maintain their IPE facilitation skills. Conclusion We developed a two-day IPE facilitation program based on the ARCS instructional design model, and the participants' IPE facilitation skills scores increased and were maintained one year later.

Empowered patient: A program to improve people with Parkinson's communication with health care professionals.

Background: Communication breakdown between patients and health care professionals poses an accessibility gap preventing adequate health care. The Empowered Patient Program was developed to support people with Parkinson's in improving their health communication skills/strategies and thus facilitate the accessibility gap in their care. Objective: Our pilot study aimed to test the feasibility and preliminary effect of the Empowered Patient Program within a small cohort of individuals with Parkinson's disease. Methods: We completed a pre-test-post-test pilot study. Eight participants completed the Empowered Patient Program for this pilot study. Data collection was completed by administering a questionnaire prior to the program, immediately after program completion, and three months post-completion. We additionally conducted two telephone interviews with the participants to qualitatively gather feedback on the program. Results: The program elucidated statistically significant improvement across domains/areas of knowledge (p = 0.01) and self-perceived communication skills (p = 0.04) among the participants. Through feedback from the patient interviews, it was confirmed that these significant improvements were owed largely to the high level of organization, intuitive user interface, and suitable content of the program for this cohort. Conclusions: The Empowered Patient Program pilot resulted in a desired outcome indicating its satisfactory development. The next steps are to test the Empowered Patient program in a larger sample.

Achievements and challenges during the development of an advance care planning program.

A nationwide program to promote preparation of advance care plans (AC Plans) was introduced in Canterbury, New Zealand, in 2013. The program was developed by local facilitators who provided support and organised education seminars and an accredited training program for health-care professionals. Information and templates for an AC Plan were available to these professionals and the community on local health-care websites and secure online systems designed to allow plans to be viewed across all health-care sectors. The number of AC Plans prepared has increased steadily, although people in minority ethnic populations or in the most deprived socioeconomic quintile are less likely to have a plan. While nurses have become the predominant group guiding people through the process of preparing an AC Plan, the involvement of staff in residential care homes has remained low. Local audit showed that 82% of people with an AC Plan died in a community setting, frequently their preferred place of death.

Design and Development of a Digital Program for Training Non-Specialist Health Workers to Deliver an Evidence-Based Psychological Treatment for Depression in Primary Care in India.

BACKGROUND: Digital technologies hold promise for building capacity of non-specialist health workers towards scaling up depression care in low-resource settings. The purpose of this study was to describe the systematic approach to designing a digital program for training non-specialist health workers to deliver an evidence-based brief psychological treatment for depression, called the Healthy Activity Program, in primary care in rural India. METHODS: The design and development of the training program involved 5 steps: 1) develop program blueprint; 2) create instructional content; 3) digitize content for a smartphone app; 4) develop a platform for uploading and hosting the digital content; and 5) user-testing and refinements to ensure program functioning. This was followed by field-testing and focus group discussions with non-specialist health workers recruited from primary care facilities in Madhya Pradesh, India, to inform further modifications and improvements to the digital training program. RESULTS: Training program development occurred over 12-months, and the final digital training consisted of 16 modules with videos, role-plays, and digital content tailored to the local culture and context. Focus group discussions with 19 non-specialist health workers generated three key action items and modifications to the digital training in response to participant feedback: 1) addressing technical challenges by making the digital content available offline; 2) account for low digital literacy by including a comprehensive orientation session about navigating the smartphone app; and 3) addition of remote coaching to support participants in completing the training. CONCLUSIONS: This study illustrates a step-wise approach to combine evidence-based content with iterative feedback from stakeholders to develop a digital training program tailored to the context in a low-resource setting. Further research is needed to validate this approach and to evaluate the effectiveness of the final modified digital training program, while considering whether this approach can be adopted and replicated in other settings.

Creation and Implementation of a Pediatric Advanced Practice Nurse Critical Care Fellowship Program.

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Recommendations for planning short-term nursing student mission trips.

BACKGROUND: Cultural immersion and service learning are effective pedagogical tools to support the development of cultural competence among nursing students. An international mission trip incorporates these concepts and provides an opportunity for students to broaden their understanding and skills. PROBLEM: A review of the literature demonstrates a significant gap surrounding the process used to successfully plan such a trip. APPROACH: Within the context of a small private college, data from an exemplar project help to identify protocols for planning a successful short-term international mission trip. CONCLUSIONS: An appropriately planned short-term cultural immersion mission trip allows nurse educators and participants to achieve their personal and educational goals for the trip, while providing much-needed healthcare aid to residents and staff in impoverished and underserved areas.

Bottom-up approach to strengthen community-based malaria control strategy from community health workers' perceptions of their past, present, and future: a qualitative study in Palawan, Philippines.

BACKGROUND: Microscopists have active roles in bringing malaria diagnosis and treatment closer to households in Palawan, the highest malaria-endemic province in the Philippines. To accelerate the elimination of malaria in Palawan, we performed a study based on the bottom-up approach to provide profound data to strengthen this community-based malaria control from the microscopists' point of view. METHODS: We performed a qualitative cross-sectional study in Palawan. Four focus group discussions with 50 microscopists were conducted in Palawan from November 2010 to February 2011. During the discussions, the following open-ended questions were addressed: motivation for applying to be microscopists in the "Past" category; job satisfaction, role, problems, and saddest and happiest experiences working as microscopists in the "Present" category; and willingness towards task shifting in the "Future" category. Data were transcribed and analyzed by framework analysis using the NVivo software program. RESULTS: The present study innovatively proposed the following strategies: reinforcement strategy (adequate supplies and settings), highly prioritized additional strategies (improving social status of microscopists, issuing a travel budget, and including indigenous populations), regional additional strategies (additional malaria control in the southern region and task shifting in the northern region), and less prioritized additional strategies (employment policy and health checkup). CONCLUSION: A bottom-up approach using microscopists' perceptions would be a valuable method to propose practical and effective additional strategies for strengthening community-based malaria control.

Realistic manpower planning for primary health care: practical considerations.

PIP: Adequate objective data for health manpower planning are often lacking, as are commonly accepted assumptions about the quantity or mix of health professionals and distribution patterns that will assure adequate and accessible care. Several methods can be used to estimate need and demand for health manpower, including: techniques using provider/population ratios, approaches based on professionally defined criteria, methods based on current, population specific utilization rates, and economic methods. A more efficient approach would be based on task analysis of needed jobs, where the provision of health care services is focused on utilizing the most appropriate health personnel. Although no single model for planning primary health care (PHC) programs has universal application, an approach which addresses common health care delivery problems would be beneficial. Problems face health planners in much of the developing world: lack of clear national health policy; shortages and maldistribution of manpower, facilities, equipment, supplies and finances; inadequate coverage; underutilization of services; inappropriate use of health education; insufficient community participation; inappropriate training systems; and inadequate attention to environmental sanitation. A service delivery model that has been effective in developing countries is based on new manpower configurations, relying on the services of mid-level and community health workers to increase the availability of care. New methods and technology for training these personnel are being developed. In planning the strengthening of a PHC program, adequate attention must be given to: analysis and projection of health needs and demand for services; enumeration of existing health workers and task analyses; estimation of future manpower needs and expected supply; assessment and strengthening of the manpower infrastructure; and regional utilization of resources. Based on the experiences of several PHC programs using a multitiered health manpower infrastructure, several suggestions are offered to facilitate the development and enhance the effectiveness of this type of program. Broad based support and national commitment is necessary to assure the program's significant and lasting impact. A positive operating framework must be created where workers are adequately compensated and accepted in the medical and local community. Community selection of workers is advised. Special attention must be given to management capability, including supervision and support. Doctors must be involved in developing training curricula, direct training, and supervision to secure their support for the program. Training programs must be problem oriented, reflecting task analyses and competency based. A modular program can allow curricular flexibility and be modified to address country specific needs. An additional advantage of a modular program, such as MEDEX, is the creation of a training and supervision interlock between the manpower levels and the multiplier effect of 1 person training several on the next tier, maximizing service expansion.^ieng

Integrating gerontological content across advanced practice registered nurse programs.

PURPOSE: Faculty members across the country are faced with integrating gerontological content and competencies across advanced practice registered nurse (APRN) programs that focus on the adult-gerontology population. The purpose of this initiative was to effectively and efficiently integrate gerontological content into the adult management courses for several APRN programs in acute and primary care at one university's college of nursing. DATA SOURCES: Current literature, resources for integrating adult-gerontology content, course evaluations, and end of program surveys were used in this project. CONCLUSION: This curricular update effectively utilized resources and engaged faculty across programs to infuse gerontological content into the adult management courses. Students from multiple programs sharing these courses benefited from gerontological lecturers, content, and learning activities. The content gaps were integrated into existing courses rather than developing a new course. Current outcome data reflect this was an effective curricular change. IMPLICATIONS FOR PRACTICE: In conjunction with meeting national requirements for integrating adult-gerontology content into APRN curriculum, APRNs prepared with enhanced gerontological knowledge and skills build a workforce that is competent to improve care for older adults across the continuum of care.

Necessidades de enfermagem de saúde mental: intervenção na doença mental após desastre ou situação de emergência / Mental health nursing needs: intervention in mental disease after disaster or emergency situation / Necesidades de enfermería de salud mental: intervención en la enfermedad mental después de desastre o situación de emergencia

RESUMO CONTEXTO: O enfermeiro especialista em enfermagem de saúde mental e psiquiátrica deve ter a sua intervenção assente nas necessidades em saúde mental que identifica, com atividades de promoção de saúde, prevenção da doença e auxílio nos processos de reabilitação em todos os contextos. As situações de desastres causam enumeras alterações na pessoa com doença mental havendo maior risco de manifestações da doença após a vivência de uma situação de stresse, tendo este profissional um papel preponderante. OBJETIVO: Verificar as necessidades em enfermagem de saúde mental das pessoas com doença mental após situação de stresse associada a um desastre. MÉTODO: Revisão sistemática da literatura através da pesquisa em diversas bases de dados, utilizando os descritores em língua Portuguesa e Inglesa. Os critérios de inclusão foram os seguintes: pessoas com mais de 18 anos, experiência de situação de desastre, artigos originais com data de publicação compreendida entre os anos de 2014 e 2018. RESULTADOS: Obtiveram-se 6 estudos: 5 apresentavam metodologia quantitativa e 1 metodologia qualitativa transversal. CONCLUSÕES: Com os estudos desta revisão foi possível constatar que as pessoas apresentam inúmeras respostas ao nível da saúde mental, especificamente da ansiedade, stresse pós traumático e sintomas de depressão após uma situação de stresse, no entanto não foi possível perceber as reais necessidades em enfermagem de saúde mental por apenas um estudo ser centrado num programa de saúde mental comunitária, mas que não foi eficaz. Há necessidade da realização de mais estudos para que se tenha conhecimento científico nesta área.

ABSTRACT BACKGROUND: The nurse specialist in mental and psychiatric health nursing should have the intervention based on the needs in mental health identified, with health promotion activities, disease prevention and rehabilitation assistance in all contexts. Disaster situations cause a number of changes in the person with mental illness and there is a greater risk of changes after the experience of a stress situation, and this professional has a preponderant role. AIM: To verify the mental health nursing needs of people with mental illness after disaster-related. METHODS: Systematic review of the literature was done through the research in several databases, using the descriptors in Portuguese and English. The criteria for inclusion in the selection of articles were as follows: people over 18 years of age, experience of a disaster situation, original articles with a publication date between 2014 and 2018. RESULTS: Six studies were obtained: 5 presented quantitative methodology and a cross-sectional qualitative methodology. CONCLUSIONS: With the studies of this review it was possible to verify that people present numerous responses to mental health, anxiety, post-traumatic stress and symptoms of depression after a stress situation, however, it was not possible to perceive the real needs in mental health nursing because only one study was centered on a community mental health program, but it was not effective. There is a need for more studies to be made available in this area.

RESUMEN CONTEXTO: El enfermero especialista en enfermería de salud mental y psiquiátrica debe basar su intervención en las necesidades en salud mental que identifica, con actividades de promoción de la salud, prevención de la enfermedad y auxilio en los procesos de rehabilitación en todos los contextos. Las situaciones de desastres causan numerosas alteraciones en la persona con enfermedad mental habiendo mayor riesgo de alteraciones tras la vivencia de una situación de estrés, teniendo este profesional un papel preponderante. OBJETIVO: Verificar las necesidades en enfermería de salud mental de las personas con enfermedad mental después de una situaciónde estrés asociada a un desastre. MÉTODO: Realizada larevisión sistemática de la literatura a través de la búsqueda en diversas bases de datos, utilizando los descriptores en lengua portuguesa e inglesa. Los criterios de inclusión fueron los siguientes: personas con más de 18 años, experiencia de situación de desastre, artículos originales con fechade publicación comprendida entre 2014 y 2018. RESULTADOS: Se obtuvieronseis estudios: cinco presentaronunametodología cuantitativa y un estudio, metodología cualitativa transversal. CONCLUSIONES: Con los estudios de esta revisión se pudo constatar que las personas presentan numerosas respuestas con respecto a la salud mental, a la ansiedad, al estrés postraumático y a los síntomas de depresión después de una situación traumática. Sin embargo, no se percibieron las necesidades reales en enfermería de salud mental porque solo uno de los estudios se centró en un programa de salud mental comunitaria, pero que no fue eficaz. Son necesarios más estudios para aumentar el conocimiento científico en esta temática.

La Medicina de Desastres en el plan de estudios del médico general / The Medicine of Disasters in the study plan of general practitioners in Villa Clara

El presente trabajo describe el programa de la asignatura Medicina de Desastres que se imparte a los estudiantes de Medicina de Villa Clara, procedentes de la Escuela Latinoamericana de Medicina desde el año 2003 como experiencia única en el mundo. Consta de 120 horas lectivas distribuidas en dos estancias que se desarrollan durante el cuarto y quinto años de la carrera, con un carácter teórico-práctico. Sus contenidos están orientados a la familiarización con la temática de los factores causantes de desastres, sus efectos sobre la salud y la dinámica de la sociedad y las comunidades, así como a la incorporación de conocimientos propios acerca del riesgo y la vulnerabilidad, además de los procedimientos vinculados a su disminución; donde priman el trabajo preparatorio a la población y la interrelación de sectores para el enfrentamiento a las adversidades.

The current work describes the program of the Medicine of Disasters subject that is imparted to the future physicians of the Latin American School of Medicine in Villa Clara since 2003, as an exclusive experience in the world. It consists of 120 teaching hours distributed in two rotations that are developed during the fourth and fifth years of the career, with a theoretical-practical character. Its contents are guided to the familiarization with the topic of the disasters-causing factors, their effects upon health and the dynamics of society and the communities, as well as to the incorporation of knowledge about risks and vulnerability, besides the associated procedures to diminish them; where the preparatory work with the population and the interrelation among sectors to face adversities are predominant.

Superación para el perfeccionamiento de las competencias docentes en profesores de las ciencias básicas biomédicas / Upgrading for the improvement of the teaching competences in professors of the biomedical basic sciences

Fundamento: el perfeccionamiento de las competencias docentes de los profesores de las ciencias básicas biomédicas constituye una necesidad para garantizar la calidad del proceso enseñanza aprendizaje. Objetivo: incrementar las competencias docentes de los profesores de las ciencias básicas biomédicas en la formación y desarrollo de habilidades intelectuales en los estudiantes de Medicina. Métodos: se realizó una investigación descriptiva transversal en la Facultad de Medicina de la Universidad de Ciencias Médicas de Villa Clara, en el período comprendido de septiembre 2012 a junio 2013. Se utilizaron métodos teóricos y entre los empíricos: análisis documental, observación a actividades docentes de pregrado en la disciplina Morfofisiología, aplicación de cuestionario a profesores y técnica de grupo nominal. Resultados: se constató que existen insuficiencias en los programas de las asignaturas estudiadas que afectan su carácter orientador en la dirección del proceso enseñanza aprendizaje, poca claridad conceptual de las habilidades intelectuales e insuficientes acciones y operaciones efectivas durante las clases, para su desarrollo. Se identificaron cuatro áreas temáticas de mayor interés y se diseñó un programa de superación en forma de curso teórico-práctico, que fue impartido posteriormente. Conclusiones: existen evidencias suficientes sobre la necesidad de diseñar e implementar acciones de superación a corto y mediano plazos, encaminadas a alcanzar niveles de competencias docentes que garanticen una mayor calidad en la enseñanza y aprendizaje de los contenidos básicos biomédicos; a la vez que se crearían mejores condiciones en los profesores para participar activa y conscientemente en los procesos internos de evaluación curricular de los programas que imparten.

Backgroung: the improvement of the teaching competences of the professors of the biomedical basic sciences constitutes a necessity to guarantee the quality of the teaching-learning process. Objective: to increase the teaching competences of the professors of the biomedical basic sciences in the formation and development of intellectual abilities in the Medicine students. Methods: it was carried out a cross-sectional descriptive research work in the Medicine faculty of Villa Clara University of Medical Sciences, from September 2012 to June 2013. Theoretical methods were used and among the empiric ones: documental analysis, observation to teaching activities of undergraduate students in the Morpho-physiology discipline, questionnaire application to professors and the technique of nominal group. Results: it was verified that inadequacies exist in the syllabuses of the studied subjects which affect their guiding character in the management of the teaching-learning process, little conceptual clarity of the intellectual abilities and insufficient actions and effective operations during the classes, for their development. Four thematic areas of more interest were identified and an upgrading program was designed in form of theoretical-practical course; that it was subsequently imparted. Conclusions: enough evidences exist about the necessity to design and to implement upgrading actions at short and medium terms, guided to reach levels of teaching competences that guarantee a bigger quality in the teaching and learning of the biomedical basic contents; at the same time that better conditions would be created in the professors to participate actively and consciously in the inner processes of the curricular assessment of the programs that they impart.

Experiencias sobre salud comunitaria y familiar: primera cohorte de la formación de médicos en Venezuela / Experiences on community and family health: first cohort of the formation of doctors in Venezuela

Fundamento: el Programa Nacional de Formación en Medicina Integral Comunitaria surge para garantizar la formación del médico que requiere la nueva sociedad venezolana, eliminar los elevados niveles de exclusión existente en la atención de salud, con la calidad, la cobertura y atención adecuadas para la totalidad de la población del país. Objetivo: caracterizar el comportamiento de la disciplina Salud Comunitaria y Familiar compuesta por una serie de asignaturas o unidades curriculares: las sociomédicas, incluyendo el Servicio Comunitario Estudiantil que se introduce en sexto año. Métodos: se realiza una investigación descriptiva sobre la primera cohorte de estudiantes graduados en el Programa Nacional de Formación de Medicina Integral Comunitaria, comprende desde el curso 2005-2006 hasta el 2010-2011. Se emplearon métodos teóricos: histórico-lógico, inductivo-deductivo y analítico-sintético y empíricos: análisis documental del programa, y matemáticos para los resultados en números absolutos y porcientos. Resultados: en el programa están contemplados los contenidos correspondientes a la salud comunitaria y familiar desde el primer año de la carrera, los resultados de promoción son satisfactorios, con algunas insatisfacciones sobre las evaluaciones frecuentes, en la ejecución del servicio comunitario estudiantil los resultados cuantitativos son buenos. Conclusiones: se apreció un buen diseño en cuanto a distribución de asignaturas por año y número de horas, debilidades en el componente evaluativo, que motivaron la propuesta de cambio en el sistema de evaluación final y la importancia del Servicio Comunitario Estudiantil a través de la interacción de los estudiantes con la comunidad evidenciada en la defensa de los proyectos presentados.

Background: the National Formation Program in Community comprehensive Medicine arises to guarantee the doctor's formation that requires the new Venezuelan society, to eliminate the current high exclusion levels in health care, with the quality, spreading and attention for the whole population of the country. Objective: to characterize the behavior of the Community and family Health discipline composed by a series of subjects or curricular units, and the social-medical, including the Student Community Service that is introduced in the sixth year. Methods: it is carried out a descriptive investigation on the first cohort of graduated students in the National Formation Program in Community comprehensive Medicine, from the academic year 2005-2006 up to 2010-2011. Theoretical methods were used: historical-logical, inductive-deductive and analytic-synthetic, empiric ones: documental analysis of the program, and mathematics for the results of absolute values and percents. Results: the contents corresponding to the community and family health are contemplated in the program since the first year of the career, the promotion results are satisfactory, with dissatisfactions on the frequent evaluations, and the quantitative results are good in the work with the student community service. Conclusions: a good design was observed in regard to distribution of subjects per year and numbers of hours, weaknesses in the assessment component have motivated the change proposal in the system of final assessment and the importance of the Student Community Service through the interaction of the students with the community evidenced in the defense of the presented projects.

[Human resources for local health systems]. / Recursos humanos para los sistemas locales de salud.

PIP: The economic and social crises affecting Latin America have had a profound social and political effect on its structures. This paper analyzes this impact from 2 perspectives: 1) the impact on the apparatus of the state, in particular on its health infra-structures; and 2) the direction of the democratic process in the continent and the participatory processes of civil societies. The institutionalization of the Local Health Systems (SILOS) is an effort to analyze the problem from within the health sector and propose solutions. This paper discusses the issues of human resource development in health systems; training in human resource development and human resource development in local health care systems. There are 3 strategies used to change health systems: 1) The judicial-political system: The state's apparatus 2) The political-administrative system: the national health care system; and 3) the political-operative system: local health care systems. To assure implementation of SILOS there are 4 steps to be followed: 1) create political conditions that allow the transformation and development of local health systems; 2) development of high-level institutional and political initiatives to develop health care networks; 3) offer key players institutional space and social action to develop the SILOS process; 4) rapidly develop SILOS in regions to assure its integration with other development efforts. The labor force in the health sector and organized communities play critical roles in proposing and institutionalizing health programs.^ieng