Research on the supply efficiency and influencing factors of provincial medical and health services in China / 中华医院管理杂志

Objective:To analyze the supply efficiency and influencing factors of medical and health services in 31 provinces in China from 2011 to 2020, providing reference for rational allocation of medical and health resources and improving service efficiency.Methods:The data related to the input-output indicators of China′s medical and health services from 2011 to 2020 were collected from China Health Statistical Yearbook, China Statistical Yearbook and China Social Statistical Yearbook. Data envelopment analysis was used to calculate the static efficiency of China′s medical and health service supply, the Malmquist index method was used to analyze the dynamic efficiency of China′s medical and health service supply, and the Tobit model was used to analyze the factors affecting the efficiency. Results:In 2020, the comprehensive efficiency of medical and health service supply in 15 provinces (Tianjin, Shanghai, Zhejiang, etc.) was 1.000, and the scale benefit remained unchanged. The comprehensive efficiency in 16 provinces (Heilongjiang, Jilin, Inner Mongolia, etc.) was less than 1.000. Among them, 15 provinces showed a decreasing scale benefit, while 1 province showed an increasing scale benefit.From 2011 to 2020, the total factor production efficiency index of China′s healthcare service supply increased from 0.988 to 1.036. The factors affecting the efficiency included number of people with a college degree or above per 10 000 people, the utilization rate of hospital bed rate, population density, asset liability ratio, and average length of stay ( P<0.05). Conclusions:In recent years, the efficiency of healthcare service supply in China showed a growth trend featuring regional differences and multiple influencing factors. It is suggested to further narrow the regional differences of the efficiency, reasonable control the scale of medical institutions, optimize medical service technology and management levels, shorten the average transfer day and improve bed utilization to improve the overall efficiency of medical and health service supply.

La educación en salud como una importante estrategia de promoción y prevención / Health education as an important promotion and prevention strategy

La educación para la salud se define como la disciplina encargada de orientar y organizar procesos educativos con el propósito de influir positivamente en conocimientos, prácticas y costumbres de individuos y comunidades en relación con su salud. A través de la construcción de este manuscrito se buscó desarrollar una revisión actual sobre la educación en salud, con un enfoque en la promoción y prevención, abordando igualmente la importancia y el impacto de estas acciones en la población. Se realizó una búsqueda en las bases de datos PubMed, ScienceDirect, Scielo y Lilacs empleando palabras clave en español e inglés y se seleccionaron los artículos para la construcción del manuscrito. La medicina preventiva es un concepto que ha sido olvidado, sin embargo, es importante comprender la relevancia que tiene la promoción y prevención sobre la salud del paciente y el curso de la enfermedad; parte importante de esto, radica en la educación en salud que se brinda, que debería convertirse en un eje fundamental en la práctica médica..Au

Health education is defined as the discipline responsible for guiding and organizing educational processes with the purpose of positively influencing knowledge, practices and custom of individuals and communities in relation to their health. Through the construction of this manuscript we sought to develop a current and concrete review on health education, with a focus on promotion and prevention, also addressing the importance and impact of these actions on the population. A search made in the PubMed, ScienceDirect, Scielo and Lilacs databases using the key words in Spanish and English and articles were selected for the construction of the manuscript. Preventive medicine is a concept that has been forgotten, however, it is very important to understand the great importance of promotion and prevention in the patient's health and the course of the disease; An important part of this lies in the health education that is provided, which should become a fundamental axis in medical practice..Au

Problemas en la práctica clínica: los retos de la medicina basada en la evidencia / Problems in clinical practice: the challenges of evidence-based medicine

Resumen El desarrollo de este artículo de reflexión surge tras el análisis de la práctica médica cotidiana donde se evidencian discrepancias entre estudiantes de medicina, docentes clínicos, médicos generales y especialistas en áreas médicas, en lo que corresponde a la marcada variabilidad en los enfoques terapéuticos en el personal clínico asistencial. Adicionalmente los conflictos derivados de la no aplicación de la medicina basada en evidencia por resistencia de ciertos profesionales de la salud, junto a las limitaciones de aplicabilidad de la misma en nuestro contexto socio-económico en particular, conduce al desarrollo de conflictos que dificultan la atención de los pacientes, distancian el personal médico, limitan el aprendizaje en las áreas clínicas, además de producir una perspectiva no integral ya que en la mayoría de las ocasiones se impone la decisión clínica sobre los valores y preferencias de los usuarios, cuestión además poco explorada dentro del ámbito académico. MÉD.UIS.2020;33(1): 59-65.

Abstract The development of this reflexion article emerges after the analysis of everyday medical praxis, where disagreements between medical students, clinical teachers, general practitioners and specialists in clinical areas are noted, which corresponds to the strong variability between therapeutic approaches from the clinical assistance personnel. Additionally, the conflicts deriving from the non-application of the Evidence-based Medicine due to the resistance of certain health professionals, along with the limitations in its applicability in our particular socioeconomic context, drives to the development of conflicts that make difficult the patient's attention, create distances between the medical staff, limit learning in clinical areas, and produce a non-integral perspective, because in the majority of occasions, clinical decision is imposed over the values and preferences of users, a matter that is rarely explored inside the academic scope. MÉD. UIS.2020;33(1): 59-65.

The incidence of diabetes among the non-diabetic residents in Kawauchi village, Fukushima, who experienced evacuation after the 2011 Fukushima Daiichi nuclear power plant disaster

OBJECTIVES@#After the Fukushima Daiichi nuclear power plant disaster in 2011, residents of Kawauchi village who experienced evacuation had a high risk of suffering from diabetes and metabolic syndrome compared with non-evacuees. In addition to evacuation, lifestyle characteristics can be important factors influencing the development and prognosis of diabetes or glucose tolerance. The current study aimed to evaluate the effects of evacuation (i.e., lifestyle changes) on the incidence of diabetes among the non-diabetic residents of Kawauchi village.@*METHODS@#Design is retrospective cohort study. Annual health examination data of residents of Kawauchi village and control area (Ono town) in Fukushima prefecture from 2008 to 2017, as available from the Japanese National Health Insurance system. Participants were classified into three groups: "Diabetes (DM)" (FBG ≥ 126 mg/dL or HbA1c ≥ 6.5% or hospital visit for DM or usage of diabetic medication), "Borderline DM" (126 mg/dL > FBG ≥ 110 mg/dL or 6.5% > HbA1c ≥ 6.0%, and without hospital visit, and without diabetic medication), and "Normoglycemic" (FBG < 110 mg/dL and HbA1c < 6.0%, and without hospital visit, and without diabetic medication). New onset of diabetes was evaluated and the events or missing data were occurred at health checkup. For this survival analysis, 339 residents in Kawauchi and 598 residents in Ono were included. Average follow-up periods after 2010 were 3.9 years in Kawauchi village and 3.6 years in Ono town.@*RESULTS@#Compared with the normoglycemic group, incidence of DM was much greater in the borderline DM group, where DM occurred among 38.2% of the group in 2012 and increased to over 60% cumulatively through 2017 in Kawauchi village. DM had a prevalence of 16.3% in 2012, and below 30% in 2017 in borderline DM group of Ono town. Cox proportional hazard regression analysis was applied to non-DM groups at both study sites separately to evaluate the effects of lifestyle changes at each site. While BMI, BMI change, and the lack of regular exercise (HR = 1.29, 1.72, and 5.04, respectively) showed significant associations with the onset of diabetes in Ono town, only BMI and late-night dinner (HR = 1.21 and 4.86, respectively) showed significant associations with diabetes onset in Kawauchi village.@*CONCLUSIONS@#The current results confirmed that diabetes incidence was increased 6 years after the Daiichi nuclear power plant disaster in Kawauchi. We also found changes in lifestyle habits, suggesting that diabetes prevention with promotion of healthy lifestyle behaviors is an urgent priority.

Do saber ao ser: reflexões sobre a formação do médico de família e comunidade em serviço territorial de base comunitária / From knowing to being: reflections on the training of family and community physician in territorial community based service / Del saber al ser: reflexiones sobre la formación del médico de familia y comunidad en servicio territorial de base comunitaria

Objetivos: O presente estudo buscou a partir das reflexões sobre o processo de execução e manutenção de um grupo para a promoção de saúde em uma unidade de atenção primária em saúde no município de Fortaleza, CE, sistematizar a experiência de organização, execução e manutenção de um grupo para a promoção da saúde em uma unidade de atenção primária em saúde no município de Fortaleza, CE correlacionando a experiência do processo grupal com os referenciais teóricos da Atenção Primária em Saúde (APS) e da Abordagem Sistêmica Comunitária (ASC), apontar desafios e potencialidades dessa abordagem no contexto da APS e seu potencial impacto sobre a saúde das comunidades e sobre a formação de especialistas em Medicina de Família e Comunidade. Métodos: Utilizou-se uma metodologia de sistematização de experiências em diálogo com as narrativas autobiográficas e o círculo de cultura. Resultados: A recuperação do processo vivido evidenciou o potencial da integração entre ferramentas da ASC, da Educação Popular e do Processo Grupal, ancorados no conhecimento e na aplicação dos princípios norteadores da Medicina de Família e Comunidade para a produção de mudanças no processo de trabalho do profissional médico e no seu contexto de atuação. Conclusão: Ao sistematizar o processo vivido e confrontá-lo com a teoria da implicação do sujeito vieram à tona aspectos do fazer médico na APS que de outra forma permaneceriam restritos e implícitos no modo de Ser Médico de Família e Comunidade. A narrativa propõe questionamentos quanto ao impacto do desse fazer médico sobre a saúde das populações, individual e coletivamente e sobre o próprio profissional enquanto ser humano passível de adoecimento e dotado de infinitas potencialidades. Caminhos possíveis e as possibilidades de mudança e superação do modelo médico-assistencialista hegemônico e vigente foram propostos a partir desta narrativa plena de signos e significados.

Objectives: The present study sought from the reflections on the process of execution and maintenance of a group for health promotion in a primary health care unit in the city of Fortaleza, CE, to systematize the experience of organization, execution and maintenance of a group for the promotion of health in a primary health care unit in the city of Fortaleza, CE, correlating the experience of the group process with the theoretical frameworks of Primary Health Care (PHC) and the Community Systemic Approach (CSA), pointing out challenges and potentialities of this approach in the context of PHC and its potential impact on the health of communities and on the training of specialists in Family and Community Medicine. Methods: A methodology of experience systematization was used in dialogue with the autobiographical narratives and the circle of culture. Results: The recovery of the experienced process evidenced the potential of the integration between ASC, Popular Education and Group Process tools, anchored in the knowledge and application of the guiding principles of Family and Community Medicine for producing changes in the work process of the medical professional and in its context of action. Conclusion: By systematizing the experienced process and confronting it with the theory of subject implication, aspects of medical practice in APS that would otherwise remain restricted and implicit in the mode of Family and Community Medical Being emerged. The narrative proposes questions about the impact of this medical practice on the health of populations, individually and collectively, and about the professional himself as a human being that can be endured and endowed with infinite potentialities. Possible paths and the possibilities of change and overcoming of the hegemonic and current medical model were proposed from this narrative full of signs and meanings.

Objetivos: El presente estudio buscó a partir de las reflexiones sobre el proceso de ejecución y mantenimiento de un grupo para la promoción de salud en una unidad de atención primaria en salud en el municipio de Fortaleza, CE, sistematizar la experiencia de organización, ejecución y mantenimiento de un grupo para la promoción de la salud en una unidad de atención primaria en salud en el municipio de Fortaleza, CE, correlacionando la experiencia del proceso grupal con los referentes teóricos de la Atención Primaria en Salud (APS) y del Enfoque Sistémico Comunitario (ASC), señalar desafíos y potencialidades de este enfoque en el contexto de la APS y su potencial impacto sobre la salud de las comunidades y sobre la formación de especialistas en Medicina de Familia y Comunidad. Métodos: Se utilizó una metodología de sistematización de experiencias en diálogo con las narrativas autobiográficas y el círculo de cultura. Resultados: La recuperación del proceso vivido evidenció el potencial de la integración entre herramientas de la ASC, de la Educación Popular y del Proceso Grupal, anclados en el conocimiento y en la aplicación de los principios orientadores de la Medicina de Familia y Comunidad para la producción de cambios en el proceso de trabajo del profesional médico y en su contexto de actuación. Conclusión: Al sistematizar el proceso vivido y confrontarlo con la teoría de la implicación del sujeto surgieron aspectos del hacer médico en la APS que de otra forma permanecerían restringidos e implícitos en el modo de Ser Médico de Familia y Comunidad. La narrativa propone cuestionamientos en cuanto al impacto del de hacer médico sobre la salud de las poblaciones, individual y colectivamente y sobre el propio profesional como ser humano pasible de enfermedad y dotado de infinitas potencialidades. Se propusieron caminos posibles y las posibilidades de cambio y superación del modelo médico-asistencialista hegemónico y vigente a partir de esta narrativa llena de signos y significados.

The Willingness of Community Pharmacists in Collaborative Care of Frail Elderly in Nursing Homes

@#An increase in the number of residents in nursing homes has become a significant concern due to the rise in medication demand and subsequently medicationrelated issues, especially in frail elderly. Community pharmacists are the closest healthcare professionals available that can contribute to this population to allow optimal utilization of the prescribed drugs and to prevent drug-related problems. The present study aimed to investigate the awareness of community pharmacists on issues regarding frail elderly and to determine their willingness in collaborative care of frail elderly in nursing homes and the services they are willing to offer. This was a cross-sectional study utilising a set of questionnaire that was delivered to practicing community pharmacists in Peninsular Malaysia from June 2018 until December 2018. Majority of the participants agreed to the fact that aging is the primary cause of frailty (n=98, 88.3%), and that chronic disease is also a cause of frailty (n=96, 86.5%). Most of the community pharmacists were also keen to participate in the collaborative care of frail elderly, and were willing to provide their pharmacy service to the frail elderly. There was a positive correlation between the awareness of community pharmacists on issues regarding frail elderly and their willingness on collaborative care of frail elderly in nursing homes (r=0.374, n=111, p=0.01). Majority of the pharmacists were aware of the issues regarding the frail elderly, and were willing to participate in the collaborative care of frail elderly in nursing home.

Statistics and management of hospital medical records from the perspective of big data of medical health / 中华医学教育探索杂志

Hospital medical record is not only the summary of clinical practice, but also the legal basis for exploring the original data of disease law and dealing with medical troubles. The author discussed the statistics and management of medical records from the perspective of big medical data through on-the-spot investigation and literature review, explained the significance of using big data in statistical management of medical records, introduced the current situation and existing problems of information management of medical records in hospitals, and explored the development of statistical information from the perspective of big medical data. It is pointed out that informationized means are necessary for increasing the specialized institutions for information management of medical record and managing medical record rooms. And also, the cultivation of quality of staff in the hospital is a problem to be solved, and the prospects of development have been predicted.

Statistics and management of hospital medical records from the perspective of big data of medical health / 中华医学教育探索杂志

Hospital medical record is not only the summary of clinical practice, but also the legal basis for exploring the original data of disease law and dealing with medical troubles. The author discussed the statistics and management of medical records from the perspective of big medical data through on-the-spot investigation and literature review, explained the significance of using big data in statistical management of medical records, introduced the current situation and existing problems of information management of medical records in hospitals, and explored the development of statistical information from the perspective of big medical data. It is pointed out that informationized means are necessary for increasing the specialized institutions for information management of medical record and managing medical record rooms. And also, the cultivation of quality of staff in the hospital is a problem to be solved, and the prospects of development have been predicted.

The choice of demand, supply, utilization and health promotion strategy of migrant popula-tion:A perspective of behavioral model of medical service utilization / 中国卫生政策研究

With the continuous expansion of the domestic population flow,the medical and health services is-sues of migrant population are becoming more and more serious. Based on the three aspects of the demand,supply, and utilization of health services,this article explores and analyzes the utilization of health services for migrant popu-lation in Beijing in 2015 on the basis of behavioral models. The results showed that the prevalence of chronic diseases and the frequency of disease in migrant population are relatively low. The migrant population has low efficiency and overall evaluation of public health services. From the point of view of convenience and diversity of services,the sup-ply of public health services needs to be further improved. In terms of the active utilization of medical and health services,the proportion of respondents who did not participate in any medical insurance still have a large proportion, while the proportion of regular physical examination was lower. In terms of passive utilization,both outpatient and in-patients service use are low. Family income and medical insurance have influenced patients'choice of medical institu-tions to some extent. The health promotion strategy is proposed from the perspective of supply side and utilization.

Research Progress of Measurement and Evaluation System of Physician Professionalism / 中国医学伦理学

This paper analyzed the foreign measurement and evaluation system of physician professionalism,from the perspectives of the evaluation of occupation behavior,the multi sources of evaluation,the evaluation of empathy,and the cross-cultural background.It also discussed the basic condition of the development of domestic evaluation and evaluation system,and analyzed it from the diversity and comprehensiveness of evaluation perspectives,the specific and objectivity of evaluation items,the clarity and quantitative feature of evaluation indexes,as well as the openness and feedback of evaluation system.In addition,this paper reviewed the domestic and foreign measurement and evaluation methods of physician professionalism in recent years and pointed out that the construction of good measurement and evaluation system is the only way to deepen the research of physician professionalism.

Discussion on the Dilemma and Countermeasure of Medical Ethics Education on Medical Targeted-area Student / 中国医学伦理学

Starting from the characteristics of medical targeted-area student,the cultivation should not only strengthen the general medical knowledge,but also the ethics education.Based on this,this paper pointed out the dilemma of the students in the educational subject,educational object and educational process.Also,it put forward the countermeasures:enhancing the cognition,perfecting the curriculum system,intensifying the resources of teachers,optimizing the content of courses and innovating the teaching methods.

Research progress on application of wearable devices in diagnosis and treatment of hospital / 中国医学装备

Medical and health equipment are rapidly developing in the direction of intelligence and portability. As a representative of them, wearable devices are playing an more and more important role in medical service. To this end, this review discussed the development process of wearable devices, and defined the concept of wearable devices. The existing wearable devices were divided into four categories according to their shapes: hand wear, head wear, lower limb wear and trunk wear. The application of them in medical service were particularly introduced. The 4 future development trends of wearable device, included adding fashionable element, focusing on a particular area, new interactive model and invisible portability, were analyzed and reviewed. Based on above analysis, we could got a comprehensive understanding for the application of current wearable device in medical treatment, and could hold the development direction of wearable device in medical treatment of hospital. While, for above products, there were some differences in technique level between domestic manufacturer and developed country, and there is a larger potential in the relevant products and arithmetic aspects.

Percepção da população brasileira sobre a assistência prestada pelo médico. Brasil, 2013 / Perception of the Brazilian population on medical health care. Brazil, 2013

Resumo O objetivo foi analisar a percepção dos usuários sobre a consulta médica, utilizando as informações da Pesquisa Nacional de Saúde, 2013. Entre os que se consultaram com médico nos últimos 12 meses, foram analisados 12 aspectos relacionados aos serviços de saúde e à consulta médica, segundo o local de atendimento (público/privado). Por meio de regressão logística multivariada, foram estabelecidos os fatores associados à insatisfação com o atendimento recebido. Para a redução de dimensionalidade dos aspectos avaliados, utilizou-se análise de componentes principais. A PNS revelou que 74,2% se consultou com médico. Entre as diferenças por local de atendimento, destacaram-se a forma de obtenção da consulta, o tipo de médico, o tempo de espera, e o motivo da consulta. Os escores medianos se concentraram em 80 (bom), com exceção do tempo de espera entre os usuários do SUS. Proporções de avaliação muito boa foram, porém, maiores entre os usuários do setor privado. O atendimento por médicos generalistas foi significativamente associado à insatisfação. Apesar da avaliação positiva em ambos os setores, público e privado, a configuração das Unidades da Federação no plano formado pelos dois eixos principais seguiu um padrão de marcantes desigualdades regionais.

Abstract The objective was to analyze the perception of the Brazilian population on the medical health care, using data from the National Health Survey, 2013. Among those who have consulted with doctor in the 12 months prior to the survey, we analyzed 12 aspects related to health services and medical consultation, according to type of care (public/ private). By multivariate logistic regression, factors associated with dissatisfaction with the care received were investigated. For the dimensionality reduction of the assessed aspects, we used principal component analysis. The survey revealed that 74.2% of the adult Brazilian population consulted a doctor. Among the differences by type of care, stood out the way of getting an appointment, the type of doctor, the waiting time for service, and the reason for consultation. Median scores were concentrated in 80 (good), except for the waiting time between SUS users. Proportions of very good evaluation were, however, higher among users of the private sector. Despite the positive evaluation in both sectors, public and private, the configuration of the Federative Units in the plane formed by the two principal component axes followed a pattern of striking regional differences.

Application of medical cooperation health education after conservative surgery placed Mirena treatment with uterine gland myopathy / 中国实用护理杂志

Objective To explore the effect of medical cooperation health education after conservative surgery placed Mirena treatment with uterine gland myopathy.Methods 30 patients were collected and divided into general group and cooperation group by random number table method,with each group including 15 cases.General group accepted regular health education,while cooperation group received medical cooperation health education.6 months of home visits and telephone follow-up of two groups,statistical comparisons of menstruation,menstrual days,life satisfaction,adverse symptoms and satisfaction of diseases,Mirena,nursing methods between the two groups before and after the treatment.Results Patients' satisfaction and disease knowledge,Mirena knowledge,nursing knowledge the cooperation group scored higher than the conventional group (x2=2.184-6.184,P ＜0.05 or 0.01);the number of higher anxiety level was lower than the conventional group (x2=13.258,P ＜ 0.05);after treatment,dysmenorrhea severity score,menstrual flow,menstrual days,the quality of life the cooperation group were (0.35±0.08) points,(14.20±16.54) ml,(4.21±1.14) d,(9.01±1.36) points while the conventional group were (1.37±0.34) points,(39.64±8.62) ml,(6.74±1.07) d,(7.81±1.30) points,and the difference was statistically significant (t =2.47-11.31,P ＜0.01).the number of adverse symptoms of cooperation group was lower than that of the conventional group (x2=13.594,P ＜ 0.01).Conclusions Compared with single health education,cooperative medical health education has more advantage after conservative surgery placed Mirena treatment uterine gland myopathy which should be promoted in clinic.

"Influence and Impact of "" Internet Plus Healthcare"" on the Traditional Healthcare Industry" / 医学信息学杂志

The Internet +healthcare is the deep integration ofInternet +and the healthcare industry.The paper introduces main characteristics of Internet+ andInternet + Healthcare,analyzes the core contents of the new online healthcare mode,and summarizes the opportunities and challenges to be faced by medical institutions under the new situation of Internet + Healthcare.

Panorama de definição e implementação da Política Nacional de Informação e Informática em Saúde / An overview of the definition and implementation of the Brazilian National Policy on Health Data and Information Technology / Definición general y aplicación de la Política Nacional de Información e Informática en Salud

O Estudo de abordagem qualitativa que teve como objetivo analisar o contexto atual de definição e implementação da Política Nacional de Informação e Informática em Saúde (PNIIS). Realizaram-se pesquisa documental e aplicação de um formulário online aos envolvidos com a definição da PNIIS no cenário nacional. Os dados coletados foram analisados por meio da Análise de Conteúdo, modalidade Temático Categorial. Verificou-se que a PNIIS em construção é alvo de debates e proposições em diversas instâncias. Normativas emergem em paralelo para regulamentar ações de informação e informática em saúde. A participação da população na construção desta política e a convergência das leis, normas, resoluções e instâncias para a formulação de uma política comum, reconhecida, legitimada e implementada são desafios, bem como articulação entre o público e o privado. Conclui-se que o panorama da PNIIS no cenário nacional avança lentamente, predominantemente em debates teóricos, revisões e atualizações. Há muitos desafios para sua implementação e prevalece a necessidade de legitimação.

The This qualitative study aimed to analyze the development and implementation of the Brazilian National Policy on Health Data and Information Technology (NPIIH). We analyzed documents and applied an online questionnaire to the experts involved in developing the policy. The data were submitted to content analysis using the categorical thematic modality. The PNIIS is the target of debate and proposals at various levels. Provisions have appeared in parallel to regulate measures on health data and information technology. Community participation in developing this policy and the convergence of laws, standards, resolutions, and policy-making levels in a common and broadly acknowledged and enforced policy are challenges, in addition to linking the public and private sectors. The study concludes that the National Policy on Health Data and Information Technology is making gradual progress, predominantly in theoretical debates, revisions, and updates. There are numerous challenges for its implementation and a prevailing need for legitimation.

Este estudio cualitativo tuvo como objetivo analizar el contexto actual de la definición e implementación de la Política Nacional de Información e Informática en Salud (PNIIS). Hemos llevado a cabo la investigación documental y la aplicación de un formulario en línea para los que participan en la definición de PNIIS en la escena nacional. Los datos obtenidos fueron analizados mediante análisis de contenido, modalidad temática categórica. La PNIIS en construcción es objeto de debates y propuestas en varios casos. Las normas emergen en paralelo para regular las acciones de información y de la informática de la salud. La participación popular en la construcción de esta política y la convergencia de las leyes, reglamentos, resoluciones y órganos para la formulación de una política común, reconocida así como la interacción entre lo público y lo privado. Se concluye que las perspectivas para PNIIS en la escena nacional avanza lentamente, sobre todo en los debates teóricos, revisiones y actualizaciones. Hay muchos retos para su implementación, pero sigue siendo una necesidad legítima.

¿Manejamos con eficiencia la salud mental en la atención primaria? / Do we properly manage Mental Health in primary care?

La elevada prevalencia, la alteración de la calidad de vida y la escasez de estudios descriptivos y de intervención, hacen de la salud mental una prioridad en investigación mundial. En el Perú y en Lambayeque, son una prioridad las investigaciones para mejorar la salud mental y conocer los factores de riesgo asociados; el objetivo de éste artículo es remarcar la importancia del personal de atención primaria que el enfoque y manejo de la salud mental; ésta, no es tarea exclusiva de psiquiatras y psicólogos.En los países del tercer mundo en los que existe un aumento significativo de las patologías de orden mental, neurológico y de abuso de sustancias, la ineficacia y escasez de formación en salud mental, es apremiante. Tres enfoques podrían explicar ésta realidad: el bajo nivel de conocimientos en salud mental en atención primaria; la escasa cantidad y deficiente distribución del recurso humano a nivel nacional y el déficit en formación en tópicos de salud mental en las Universidades.(AU)

The high prevalence, the impairment of quality of life and the lack of descriptive and intervention studies, make mental health a priority in global research. In Peru and in Lambayeque, the investigations to analyze mental health problems and define the associated risk factors are a priority; the main objective of this study is to note the importance of primary care in the diagnosis and initial treatment of mental health problems. These are not the sole responsibility of psychiatrists and psychologists. In third world countries there is a significant increase of mental, neurological and substance abuse pathologies. Inefficiency and lack of training in mental health in third world countries, is desperating. Three approaches could explain this fact: the low level of knowledge in mental health topics among primary care staff, the small number and poor distribution of human resources and the deficit in training on mental health topics at universities.(AU)

ASSOCIATION WITH THE US FEDERAL MEDICAL HEALTH SYSTEM / 现代医院

Issues of Chinese medical health reform are analyzed and approached associated with the US federal medical health system. We made the suggestions that establish the public health service system covering both urban and country residents, push on the reform of medical insurance, drug circulation and medical system. We advocate that implement the scientific development view and hold the opportunity, impel the medical health reform in general.

Medical Health Care for Foreign Residents - In an Era of Multiculturalism / 国際保健医療

<b>Introduction</b><br> The era of “International Migration” has arrived in Japan, where communities are becoming multicultural and multiethnic. We cannot talk about the Japanese society without mentioning the coexistence that brings the symbiosis of different people. It has become obvious that diverse people of different races, nationalities, backgrounds, cultures and languages have to live altogether in mutual respect. At this point, when we think of “Medical health care for foreign residents”, we ought to first think that without a sound, harmonious community, there is no way to secure the health of foreign residents. In the materialization of a multicultural society it can be said that the medical health care of foreign residents is absolutely necessary, as indispensable as soil is for plants.<br><b>Objectives</b><br> This workshop intends to answer to the following questions: What is the appropriate social framework for foreign residents and citizens to live safely and securely? What kind of medical health care system would allow foreign residents to exert their right to health? from different points of view and a discussion with the participation of all the attendants.<br><b>Contents</b><br> Ms. Y. Kojima will speak on the problems of foreign children school unattendance, concrete support and policy building to solve the problem. Mr. Y. Nakamura will make a presentation on how a sound society should be considering community multiculturalism and the dramatic speed at which Japanese society is facing internationalization. Ms. L. Herrera will speak about the medical interpretation problem. Mr. R. Khaled will address the topic of the health needs of foreign residents' medical health care from his experience in the field. Mr. D. Arudo, author of “Japanese Only-The Otaru Hot Springs Case and Racial Discrimination in Japan” (Akashi Bookstore 2003) will talk about the reality of the internationalization in Japan from his own experience, a topic to which he has devoted many years. We will listen to the meaning of living as a foreign resident in the community. In addition, we have asked Mr. T. Sawada to appoint any questions from the floor. This workshop approaches diversity and decision in the Japanese society, aiming to contribute to a society which is kind to all its members. We are looking forward to your attendance.

Saúde ocupacional: controle médico e riscos ambientais / Occupational health: medical control and environmental risks

O Programa de Controle Médico de Saúde Ocupacional (PCMSO), da Universidade Federal do Triângulo Mineiro, tem como diretrizes a prevenção, o rastreamento e o diagnóstico precoce dos agravos à saúde relacionados ao trabalho. O objetivo deste estudo é descrever a adesão dos trabalhadores ao Programa, segundo riscos ambientais. Trata-se de um estudo retrospectivo e do tipo ecológico, utilizando-se dados secundários dos registros do PCMSO. Nos anos de 2005 e 2006, foram convocados 3.078 trabalhadores, entretanto, destes, 52,05% não compareceram para o controle médico. O maior percentual de trabalhadores que não compareceram foram com risco físico e biológico (56,78%). O fato de o PCMSO estabelecer os riscos ambientais para cada trabalhador e convocá-los periodicamente não indica, necessariamente, adesão ao Programa. É preciso estabelecer mecanismos mais convincentes de aproximação entre o trabalhador e o Programa, na perspectiva de contribuir para a qualidade de vida no trabalho.

The Occupational Health Medical Control Program (PCMSO) from the Universidade Federal do Triângulo Mineiro has as its main directives: the prevention, tracking and advanced diagnosis of work-related health injuries. This study aims to describe worker enrollment in the program, according to environmental risks. A retrospective analysis was conducted using secondary data registered in the PCMSO. According to it, 3,078 workers were summoned from 2005 to 2006, of which 52.05% did not attend periodic examinations. The greatest percentile of workers who did not attend was related to physical and biological risks (56.78%). The simple fact that the PCMSO sets environmental risks for each worker does not necessarily translate into program affiliation. It is necessary to establish more persuasive approaching mechanisms for the worker, in order to contribute to their well-being.