[Relations with emergency medical care and primary care doctor, home health care].

Medical care for an ultra-aging society has been shifted from hospital-centered to local community-based. This shift has yielded the so-called Integrated Community Care System. In the system, emergency medical care is considered important, as primary care doctors and home health care providers play a crucial role in coordinating with the department of emergency medicine. Since the patients move depending on their physical condition, a hospital and a community should collaborate in providing a circulating service. The revision of the medical payment system in 2014 clearly states the importance of "functional differentiation and strengthen and coordination of medical institutions, improvement of home health care". As part of the revision, the subacute care unit has been integrated into the community care unit, which is expected to have more than one role in community coordination. The medical fee has been set for the purpose of promoting the home medical care visit, and enhancing the capability of family doctors. In the section of end-of-life care for the elderly, there have been many issues such as reduction of the readmission rate and endorsement of a patient's decision-making, and judgment for active emergency medical care for patient admission. The concept of frailty as an indicator of prognosis has been introduced, which might be applied to the future of emergency medicine. As described above, the importance of a primary doctor and a family doctor should be identified more in the future; thereby it becomes essential for doctors to closely work with the hospital. Advancing the cooperation between a hospital and a community for seamless patient-centered care, the emergency medicine as an integrated community care will further develop by adapting to an ultra-aging society.

Rehabilitation in South India.

The article describes the rehabilitation services provided at Christian Medical College Vellore, a tertiary care medical college hospital in South India. The department was started by Dr Mary Verghese, who on completion of her medical training sustained spinal cord injury with resulting paraplegia. Following a section on the initial beginnings of the department, the current status of the department offering comprehensive rehabilitation by the multidisciplinary team is highlighted. The article ends with the challenges faced, including limitations in providing affordable solutions, architectural and attitudinal barriers, and inadequate number of rehabilitation physicians and comprehensive rehabilitation centers in the country.

Global Health: Preparation for Working in Resource-Limited Settings.

Trainees and clinicians from high-income countries are increasingly engaging in global health (GH) efforts, particularly in resource-limited settings. Concomitantly, there is a growing demand for these individuals to be better prepared for the common challenges and controversies inherent in GH work. This is a state-of-the-art review article in which we outline what is known about the current scope of trainee and clinician involvement in GH experiences, highlight specific considerations and issues pertinent to GH engagement, and summarize preparation recommendations that have emerged from the literature. The article is focused primarily on short-term GH experiences, although much of the content is also pertinent to long-term work. Suggestions are made for the health care community to develop and implement widely endorsed preparation standards for trainees, clinicians, and organizations engaging in GH experiences and partnerships.

Changing health professions education in West Virginia.

The education of students in medicine, nursing, pharmacy, and dentistry in the seven health professions schools of the University System of West Virginia has undergone remarkable changes since 1991 to become more responsive to community needs. The changes have also enabled the schools to remain in sync with other anticipated changes in health care delivery. A primary care, community-based academic system has been developed, and students, campus-based faculty, community-based field professors, and lay community members collaborate to identify and resolve problems important to the communities located in the 42 counties designated Under-served Health Professions Service areas, and five additional rural counties. The system is governed by a board consisting of a majority of community members not employed by the health care system, and the deans of the seven health professions school; all members function as equals in reaching decisions. In the new system, all health professions students in the University System of West Virginia are required to complete a rural rotation of 12 weeks. The five-years demonstration project that began the new system started in 1991 with four rural sites. By 1996, the system had expanded greatly and consisted of 13 consortia of communities with a total of over 100 rural primary care centers plus several small rural hospitals, public health departments, and other health and social services agencies. The 1996 West Virginia legislature approved funds for the higher education budget that will support and sustain this primary care, community-based academic system.

An assessment of community health workers in Nicaragua.

In 1981, the Ministry of Health of Nicaragua began a series of health campaigns whose front-line workers were volunteers from the community called 'brigadistas.' These volunteers have since evolved into a type of community health worker with a multi-disciplinary role and are now called 'primary health care brigadistas'. These brigadistas were formed with the intention of encouraging local community involvement in health and as a means of overcoming rural health manpower shortages. However, in field research at two sites, these primary health care brigadistas were found to have rather limited roles and were dependent upon the nurse auxiliary for direction. A current debate in the Ministry of Health centers around the future role of the brigadistas and their degree of accountability to the Ministry of Health and the Popular Organizations. This article suggests that the brigadistas may be underutilized at present and that increasing their training and expanding their role may be necessary to adequately meet rural health care needs.

Space and time in British general practice.

From the novel geography of the health centre to the meticulous concerns of appointment systems and patient records, British general practice, as this paper documents, has reordered its traditional activities over the last 30 years. These changes however suggest a more profound reorganisation of the spatial and temporal features of practice activity and a commensurate reassessment of the nature of illness.

Transforming China's collective health care system: a village study.

This paper examines the establishment of a health care system in Lin Village, Fujian Province, southeast China, under the collective commune organization in 1968, and its transformation since 1978 when the government dismantled rural communal organizations. Based on field data collected in 1984-85, this paper compares the finance, training, and operation of this village-based medical facility during these two time periods. This study also identifies both benefits and problems that may affect the well-being of villagers when collective medicine is turned into individual profit-seeking pursuits.

Women, the welfare state, and their transnational dimension: the case of Mexico's community health worker programs.

Feminist scholarship has shown that the welfare state is not only a set of agencies and policies to distribute services, but is engaged in the promotion of normative concepts of the female through its structural arrangements and the content of its programs and policies. Yet, this scholarship conceptualizes the state as a national entity and free from external influences, ignoring its transnational dimension. States are embedded in an international network consisting of other states, international agencies, and corporations that influence the practices and discursive frame of the welfare state. To uncover the process by which the welfare state institutionalizes and promotes female identities and the transnational dimension of this process, the author analyzes the case of community health worker programs conducted by the Mexican state from the 1970s to the early 1990s. The analysis corroborates the gender practices of the welfare state and suggests a reconceptualization that takes into account the transnational dimension of the state practices. The implications for feminist theories on the welfare state and for analyses of health promotion policies and programs are discussed.

The NHS Five Year Forward View: implications for clinicians.

The Five Year Forward View is a look at what the NHS could achieve, given the range of resources that may be available. It sets out how the health service needs to change, arguing for a more engaged relationship with patients, carers, and citizens to promote wellbeing and prevent ill health. Here, we outline how the Forward View supports clinicians to provide better, higher quality and more integrated care.New models of care are presented, including multispecialty providers, primary and acute care systems, urgent and emergency care networks, viable smaller hospitals, specialised services, modern maternity services, and enhanced care homes. The commitments to support clinicians are discussed, including specific proposals for primary care, initiatives to improve the health of NHS staff, dealing with gaps in the NHS workforce, and the use of technology and innovation to further enable clinicians.