Effects of the Integrated Stress Management Program on Stress and Depression in Psychiatric Inpatients / 정신간호학회지

PURPOSE: The purpose of this study was to test the effects on stress and depression by developing and implementing an integrated stress management program for inpatients in the psychiatric closed ward. METHODS: The study was a one-group pretest-posttest design. A total of 36 patients in the closed ward participated in this study. Data were collected through self-report questionnaires to measure hospital stress and depression. Data were analyzed by using t-tests and one-way ANOVA with SPSS/WIN 21.0. RESULTS: Integrated stress management program was designed based on Lazarus and Folkman stress-appraisal-coping model. Total of eight 1-hour sessions were delivered for four weeks in the group. There were significant differences in the inpatient stress scores before and after the intervention. However, the integrated stress management program showed some reduction in depression but did not show signifiant differences statistically. CONCLUSION: Our study findings confirm that the use of the integrated stress management program can reduce stress of the patients, that enable them to stabilize their minds at hospitalization. However, further study is needed to confirm the effects on depression. Thus, it would be beneficial to provide psychiatric nursing intervention tailored to psychiatric patients' symptoms, especially for reducing inpatient stress.

Planes de salud en sistemas de aseguramiento: realidades y prospectivas, estudio de evaluación / Plans health insurance systems: realities and prospects, an assessment study

Objetivo: explorar experiencias internacionales en la utilización de planes de beneficios en salud y la situación y perspectivas de estos después de igualar los servicios sanitarios para toda la población en Colombia, 2013-2014. Materiales y Métodos: se realizó un estudio de evaluación. Mediante opinión de expertos y búsqueda bibliográfica se seleccionaron nueve(9) sistemas nacionales, de aseguramiento y mixtos para comparar. Se buscó información de la existencia de planes de cobertura en salud,los enfoques y mecanismos utilizados en su construcción. Se discutió con expertos la situación en Colombia y las implicaciones de los hallazgos de la revisión. Finalmente se hizo una reconstrucción desde la perspectiva analítica de los autores. Resultados: algunos sistemas optan por listas positivas que explicitan las coberturas del sistema, mientras que la mayoría recurre a listas negativas, las cuales precisan las exclusiones, ya sea con base en las personas, las patologías o los servicios. En Colombia, se utilizan simultáneamente ambos mecanismos, sin embargo los usuarios y agentes del sistema los perciben como inapropiados, por lo que se recurre a herramientas judiciales que dificultan su aplicación, evidenciándose tensión entre el derecho individual,la sostenibilidad y equidad de sistema. Conclusiones: como factor esencial para el ejercicio real del derecho a la salud es importante garantizar un plan de servicios de salud que goce de aceptación social, documente calidad en la atención, sea sostenible.

Objective: explore international experiences in the use of health benefit plans and the status and prospects of these after equalizing health services for the population in Colombia, 2013-2014. Materials and Methods: an assessment study was conducted. Through expert opinion and literature search to compare nine (9) national systems, assurance and mixed to compare. Information on the existence of health coverage plans and approaches and mechanisms used in its construction was sought. Experts discussed the situation in Colombia and the implications of the findings. Eventually became a reconstruction from the perspective of the authors. Results: some systems choose which one positive lists that specify the coverage of the system, while mostuses negative lists, which require exclusions, either based on people, pathologies orservices. In Colombia, both mechanisms are used simultaneously, how ever users and system agents are perceived as inappropriate, so it resorts to legal tools, which hamperits implementation, demonstrating tension between individual rights and sustainabilit yand equity of the system. Conclusions: as essential for the effective exercise of theright to health factor is important to ensure a health care plan that enjoys social acceptance, document quality care and sustainable and universal.

Senior Managed Care System for Hip Fracture in the United States

BACKGROUND: It is debatable whether a managed care model would affect the quality of care and length of hospital stay in the treatment of hip fractures in elderly patients. METHODS: This prospective study was undertaken to determine whether or not a managed care critical pathway tool shortened hospital stay in a group of 102 senior patients with fractures of the hip during follow-up. We compared our study findings with two equivalent populations of senior hip fracture patients not treated using a critical care pathway concerning specific markers of quality. RESULTS: The managed care group had a 9% mortality rate, 95% return to prefracture living and 63% return to ambulatory status. The rates compared favorably with previous studies. The quality of care provided before and after the critical pathway was equivalent, while the post-pathway length of stay dropped 30%. CONCLUSIONS: The proposed care protocol is recommended to shorten hospital stay in elderly patients with hip fractures.

North Korean refugee doctors' preliminary examination scores / 한국의학교육

PURPOSE: Although there have been studies emphasizing the re-education of North Korean (NK) doctors for post-unification of the Korean Peninsula, study on the content and scope of such re-education has yet to be conducted. Researchers intended to set the content and scope of re-education by a comparative analysis for the scores of the preliminary examination, which is comparable to the Korean Medical Licensing Examination (KMLE). METHODS: The scores of the first and second preliminary exams were analyzed by subject using the Wilcoxon signed rank test. The passing status of the group of NK doctors for KMLE in recent 3 years were investigated. The multiple-choice-question (MCQ) items of which difficulty indexes of NK doctors were lower than those of South Korean (SK) medical students by two times of the standard deviation of the scores of SK medical students were selected to investigate the relevant reasons. RESULTS: The average scores of nearly all subjects were improved in the second exam compared with the first exam. The passing rate of the group of NK doctors was 75%. The number of MCQ items of which difficulty indexes of NK doctors were lower than those of SK medical students was 51 (6.38%). NK doctors' lack of understandings for Diagnostic Techniques and Procedures, Therapeutics, Prenatal Care, and Managed Care Programs was suggested as the possible reason CONCLUSION: The education of integrated courses focusing on Diagnostic Techniques and Procedures and Therapeutics, and apprenticeship-style training for clinical practice of core subjects are needed. Special lectures on the Preventive Medicine are likely to be required also.

Moral Challenges in Managed Care

Managed health care in South Africa is faced with complex moral challenges; where different stakeholders appeal to different ethics principles to guide decision making. The traditional bio-medical ethics principles of beneficence; non-maleficence and respect for autonomy are typically emphasised in clinical practice; while third party funders appeal to the principle of justice to guide the allocation of limited; pooled resources. Health care professionals working in managed care are particularly exposed to these conflicts; vis-a-vis incongruence between the ethics guidelines from their professional bodies and the legislation pertaining to managed care. Common understanding of the claims and responsibilities of each of the stakeholders may promote a more coherent; sustainable health care system

Evaluation de la prise en charge intégrée du paludisme, de la diarrhée et de la pneumonie chez les enfants de 0 à 5 ans en milieu communautaire : Cas du district sanitaire de Dosso

Au Niger, la lutte contre les maladies de l'enfant au niveau communautaire occupe une place de choix parmi les priorités en matière de santé publique. L'Etat du Niger a introduit une nouvelle initiative visant à renforcer la prise en charge intégrée de la pneumonie, de la Diarrhée et du Paludisme chez les enfants de moins de 5 ans au niveau communautaire par des relais communautaires. Cette nouvelle initiative est pilotée par l'ONG World Vision dans le District sanitaire de Dosso. Après un (1) an de mise en œuvre de cette stratégie, il est important d'évaluer et d'analyser les progrès accomplis à fin de déterminer le degré de satisfaction des mères ; des relais communautaires ; des responsables des CSI Cases de santé et des autorités coutumières. Il s'agit d'une étude transversale. La population de notre étude est composée :  Des mères/ gardiennes d'enfants de 0 à 5 ans dans les villages du district sanitaire de Dosso;  Les chefs coutumiers ;  Les responsables des CSI ;  Les responsables des Cases de santé du District sanitaire de Dosso ;  Les relais communautaires du District sanitaire de Dosso. ⇨Pour le choix des mères/ gardiennes d'enfants âgés de 0 à 5 ans, nous avons combiné la méthode d'échantillonnage en grappe à quatre (4) degrés avec la méthode de commodité. ⇨Pour le choix des relais communautaires ; des chefs coutumiers, les responsables CSI/CS et les membres des Comités de Gestion de santé villageois c'est la technique d'échantillonnage exhaustive. Les données ont été saisies ; traitées et analysées à l'aide du logiciel Epi_info et Excel, ensuite transférées sur le logiciel STATA 12 pour faire certaines analyses. MS Word est utilisé pour la rédaction du rapport. La présente étude, nous a permis d'aboutir aux principaux 95% de mères/gardiennes d'enfant enquêtées sont satisfait des messages véhiculés par les relais communautaires 98% de mères/gardiennes d'enfant enquêtées sont satisfait des traitements administrés par les relais communautaires ; 89,1% des enfants pris en charge par les relais communautaire sont guéris après le traitement ; 83,6% des mères/gardiennes d'enfants enquêtées n'ont jamais été référées. 100% des relais communautaires enquêtés ont un niveau d'instruction secondaire; 81% des relais communautaires enquêtés ont reçu 3 à 4 formations pendant les 12 mois précédents ; 93% des relais sont satisfait des services qu'ils rendent pour la communauté ; 75% des agents de santé du CSI/CS enquêtés ont affirmés que les services offerts par les relais sont bonnes. Pour améliorer cette prise en charge, il est recommandé de :  Résoudre les problèmes de gestion logistique, en particulier les ruptures de stock en médicaments ;  Renforcer activement les séances de sensibilisation ;  Assurer une supervision formative des relais communautaires ;  Revoir le système de motivation des relais communautaire

A organização de processos regulatórios na gestão municipal de saúde e suas implicações no acesso aos serviços: um estudo de caso do município de Guarulhos / The organization of regulatory processes in municipal health management and implications in accessing services a case study in Guarulhos

Esta dissertação se propõe a produzir uma reflexão sobre as implicações da macropolítica nacional e da micropolítica local na organização de processos regulatórios no âmbito municipal. Para análise dos aspectos da macropolítica que interferem nos processos regulatórios municipais foi realizada uma revisão da literatura sobre o tema. Para compreender os processos da micropolítica que envolvem a regulação foi utilizada a metodologia de casos traçadores, na qual foram selecionados dois casos envolvendo serviços de saúde do município e a intermediação do Complexo Regulador. Foram realizadas entrevistas com profissionais e os usuários envolvidos explorando as situações vividas e analisando os seus percursos pelo sistema. A partir desse material foi realizada uma análise da construção e implantação dos processos regulatórios em saúde no município de Guarulhos e suas implicações na organização da rede de serviços, no acesso da população aos serviços e na gestão do cuidado. Observou-se a necessidade de ampliar o diálogo entre a regulação, outros serviços e profissionais da rede no campo da micropolítica das organizações e da produção do cuidado. Reconhecer que a organização da assistência é produto da interação entre os atores sociais e políticos envolvidos no ato do cuidado é um importante passo na busca da integralidade. Para ampliar a possibilidade de resposta às necessidades do usuário é necessário buscar dispositivos de cogestão que propiciem espaços permanentes de diálogo e identifiquem potencialidades para novos arranjos

This dissertation aims to produce a reflection on the implications of the national macropolitics and local micropolitics on the organization of regulatory processes at municipal level. For analysis of the macropolitics aspects that interfere in municipal regulatory processes, a literature review of the topic was conducted. To understand the processes that involve micropolitics and regulatory processes the methodology of adjustment was used in selected cases, which were selected in two cases involving the municipal health services and intermediation of the Complexo Regulador. Interviews were conducted with professionals and users involved exploring the lived situations and analyzing their paths through the health system. From this material, an analysis of the construction and implementation of the regulatory processes in health was performed in the city of Guarulhos and its implications for the organization of the network services, the population\'s access to healthcare services and care management. There is a need to expand the dialogue between the regulation, other healthcare services and network professionals, organizations and care production in the field of micropolitics. Recognize that the organization of care is the product of the interaction between social and political actors involved in the act of care is an important step towards integrality. To enlarge the ability to meet the needs of the user is necessary to seek co-management devices that provide permanent spaces for dialogue and identify potential new arrangements

Choice of providers for treating a neglected tropical disease: an empirical analysis of kala azar in Nepal

OBJECTIVE@#To examine the choice of healthcare providers for treating kala azar (KA) in Nepal.@*METHODS@#Information was collected from clinically diagnosed KA patients seeking care from public hospitals located in KA endemic districts. The survey collected information from more than 25 percent of total KA cases in the country. For empirical estimation of probability of choosing a provider-type as a first contact healthcare provider, a multinomial logit model was defined with five alternative options with self care as the reference category.@*RESULTS@#The empirical model found that price of medical care services, income of households, knowledge of patients on KA and KA treatment, borrowing money, age of patient, perceived quality of provider types, etc. determine the likelihood of seeking care from the alternative options considered in the analysis. All variables have expected signs and are consistent with earlier studies. The price and income elasticity were found to be very high indicating that poorer households are very sensitive to price and income changes, even for a severe disease like KA. Using the empirical models, we have analyzed two policy instruments: demand side financing and interventions to improve the knowledge index about KA.@*CONCLUSIONS@#Due to high price elasticity of KA care and high spillover effects of KA on the society, policy makers may consider demand side financing as an instrument to encourage utilization of public hospitals.

Estrategia educativa en pro de la salud y calidad de vida en las comunidades / Health education strategy in support of life quality in communities

Se muestran estrategias sanitarias educativas para modificar, mediante un enfoque integrador intersectorial y multisectorial, estilos de vida inadecuados y factores de riesgo, entre otras condiciones favorecedoras de daño a la salud. Se acentúa la importancia del Consejo de Salud en todos sus niveles de ejecución: provincial, municipal y comunitario (área de salud y circunscripción) como eje catalizador de las acciones mancomunadas en pro de la salud y la calidad de vida, particularmente a través del movimiento cubano denominado Municipios por la salud

Health education strategies are shown to modify, through an intersectoral and multisectoral integrative approach, inappropriate lifestyles and risk factors among other conditions contributing to health damage. It is emphasized the importance of the Health Council in all its implementation levels: provincial, municipal and community (health area and district) as a catalyst for concerted efforts towards the health and quality of life, particularly through the Cuban movement called Municipalities for Health

Revisión epidemiológica de la oncocercosis en América Latina / Epidemiological review of the onchocerciasis in Latin America

La oncocercosis es una enfermedad exclusiva del ser humano, caracterizada por prurito intenso, lesiones dérmicas y daño ocular que llegar a ceguera. Las regiones endémicas están limitadas a zonas con latitud, relieve, temperatura y humedad relativa óptimas para el desarrollo del parásito y el insecto vector. Estas zonas se encuentran en el oeste de África, Yemen y algunos países de América Latina. El parásito es transmitido a través de la mordedura de una mosca del género. Simulium, que al alimentarse de sangre deposita larvas del parásito. En América se creó el Programa de Oncocercosis en las Américas (OEPA), cuya estrategia es la administración de ivermectina y la nodulectomía para eliminar la oncocercosis como amenaza de salud pública en la región.

The onchocerciasis is a disease that affects only beings. It is characterized by itching, skin lesions and ocular damage which can lead to blindness. The endemic areas are limited to zones with optimum latitude, temperature and humidity for the parasite and vector insect. Those zones are found in west Africa, Yemen and some Latin America countries, with Mexico among them. The parasite is transmitted through the bite of a blackfly of the genus Simulium, which inoculates parasite larvae while feeding with blood. The Onchocersiasis Elimination Program of the Americas (OEPA) was created in order to eliminate onchocerciasis as a public health problem. Its strategy is by means of administrating ivermectina and nodulectomy.

Análise da gestão do cuidado no Programa de Saúde da Família: referencial teórico-metodológico / Análisis de la gestión de la atención en el Programa de Salud de la Familia: referencial teórico-metodológico / Analysis of managed-care in the Family Health Program: the methodologic and theory referential

Nesta reflexão, questiona-se que referencial teórico-metodológico pode ser utilizado para analisar o potencial para autonomia do cuidado no processo de trabalho do PSF. Parte-se da premissa de que a análise do processo de trabalho em saúde centrado nas contradições da gestão do cuidado contribui para o desvelamento de potencialidades emancipatórias. Objetivos: discutir as contradições, possibilidades e desafios às mudanças da gestão do cuidado no Progrma de Saúde da Família/Atenção Básica/Sistema ùnico de Saúde e propor um referencial teórico-metodológico para análise da gestão do cuidado no processo de trabalho do Programa de Saúde da Família. Conclui-se pelo uso de referenciais que explicitem se o cuidado em saúde tende mais para o domínio autoritário ou para o partilhamento de poderes entre os sujeitos, entendendo-os complementares.

The theoretical-methodological referential is questioned on the possibility of its use to analyze the potential of the Care autonomy in the working process of the Family Health Program. The premise is that the analysis of the health working process, centered on the contradictions of care management contributes for unveiling emancipating potentialities. Objectives: to discuss contradictions, possibilities and challenges to the care management changes in the Family Health Program/Primary Care/National Health System, and to propose a theoretical-methodological referential for the analysis of the care management in the working process of Family Health Program. It is concluded that there should be used referential which explain if the health care tends more to the authoritarian dominium or to power sharing among the subjects, understanding them as complementary.

En esta reflexión, se cuestiona cuál referencial teórico-metodológico puede ser utilizado para analizar el potencial para autonomía del cuidado en el proceso de trabajo del Progrma de Salud de la Familia. Se parte de la premisa de que el análisis del proceso de trabajo en salud, centrado en las contradicciones de la gestión del cuidado, contribuye para la identificación de potencialidades emancipadoras. Objetivos: discutir las contradicciones, posibilidades y desafíos en los cambios de la gestión del cuidado en Progrma de Salud de la Familia/Atención Primaria/Sistema Unico de Salud y proponer un referencial teórico-metodológico para análisis de la gestión del cuidado en el proceso de trabajo del Progrma de Salud de la Familia. Se concluye mediante el uso de referenciales que expliciten si el cuidado en salud tiende más para el dominio autoritario o para la división de poderes entre los sujetos, entendiéndolos como complementares.

[General practitioner supply: family physician program and medical workforce]

Iranian Ministry of Health and Medical Education [MOHME] decided to implement Family Physician Program [FPP] all across the country in 2005. Workforce supply is among essential factors in most implementation projects. The aims of this study were to estimate General Practitioner Supply in Iran, and workforce adequacy analysis of FPP. This study estimates [General Practitioner Supply] based on stocks and flow model and [Required General Practitioner] based on the policies, health care delivery programs and population. Implementation of FPP for whole population of Iran requires 32769 practitioners while according to the results of this study supply of general practitioners while according to the results of this study supply of general practitioners are about 28200. General practitioner supply is especially important in implementation of FPP. Currently, the program is implemented at rural level and in the cities with less than 20000 populations and the following step is expanding it throughout the country. The results of this study show that there is an obvious shortage around 4600 in general practitioners. Moreover the current experiences demonstrate that the recruiting and maintaining of general practitioners have not been successful in recent years. However, FPP expansion needs reassessment of population patterns receiving the service, and requires innovations to recruit and maintain practitioners

Procedimentos e percepções de profissionais e grupos atuantes em mercados de planos de saúde no Brasil / Procedures and perceptions of professionals and groups acting in the Brazilian health plan market

O objetivo do estudo é analisar o modo como, no Brasil, operadoras de planos e seguros de saúde, serviços hospitalares e médicos organizam o acesso aos serviços de saúde, e que mecanismos utilizam para economia de custos e de decisões. A análise faz uso da literatura de regulação em saúde e da estratégia do managed care. A partir de uma seleção intencional de operadoras baseada em número de beneficiários, modalidade organizacional e abrangência geográfica, foram selecionadas amostras probabilísticas de médicos e de serviços hospitalares. Os dados foram obtidos através de questionários com representantes das operadoras, médicos e hospitais a elas credenciados. Os resultados sugerem que as relações entre operadoras, médicos e hospitais se estabeleceram em bases herdadas do antigo sistema previdenciário, com pagamento predominante de serviços por tabelas fixas e contas abertas. Mecanismos mais complexos de financiamento, de compartilhamento de riscos e de busca pela eficiência são pouco experimentados. São frágeis os mecanismos de redução de agravos, assim como os incentivos ao uso adequado das tecnologias. Fatores moderadores de consumo ou barreiras de acesso são o meio mais comum de controle de custos. Pode-se concluir que a agenda do managed care é incipiente no caso brasileiro.

This study analyzes the mechanisms used in Brazil by health plan and insurance operators, hospitals and physicians for organizing the access to health care services and their strategies towards cost reduction and decision-making. The study is based on the literature about regulation of the health services, with special focus on micro-management and managed care. From an intentional sample of health care organizations selected according to the number of beneficiaries, organizational modality and geographic criteria we selected probabilistic samples of doctors and hospital services. Data were collected through questionnaires applied to key informants from health care operators and affiliated doctors and hospitals. Results suggest that the relationships between health care organizations, physicians and hospitals follow basically patterns inherited from the former social security system, mainly with fixed pricing and open account payments. More complex financing mechanisms, risk sharing and efficiency strategies are of minor interest. Mechanisms for risk reduction and encouragement of adequate use of technologies are weak. Cost control is mainly based on co-payment and barriers to access to the services. We conclude that in Brazil managed care is still in its beginning.

Case Management Process identified from Experience of Nurse Case Managers

PURPOSE: The purpose of this study was to develop a substantive theory of case management (CM) practice by investigating the experience of nurse case managers caring for Medical Aid enrollees in Korea. METHODS: A total of 12 nurses were interviewed regarding their own experience in CM practice. Data were recorded and analyzed using grounded theory. RESULTS: Empowerment was the core category of CM for Medical Aid enrollees. The case managers engaged in five phases as follows, phase of inquiring in advance, building a relationship with the client, giving the client critical mind, facilitating positive changes in the client's use of healthcare services, and maintaining relationship bonds. These phases moved gradually and were circular if necessary. Also, they were accelerated or slowed depending on factors including clients' characteristics, case managers' competency level, families' support level, and availability of community resources. CONCLUSION: This study helps understand what CM practice is and how nurses are performing this innovative CM role. It is recommended that nurse leaders and policy makers integrate empowerment as a core category and the five critical CM phases into future CM programs.

A assistência domiciliar privada em saúde e suas estratégias (aparentes e ocultas) / Private home healthcare and its strategies (apparent and hidden)

O trabalho analisa os resultados de uma investigação sobre a assistência domiciliar privada em saúde. Entendida como a manifestação mais visível do modelo da Atenção Gerenciada, vem-se desenvolvendo mediante a oferta de múltiplos serviços. Seu ideário se apóia em um conjunto de princípios - a desospitalização, a redução dos riscos de infecção, o favorecimento do convívio da pessoa doente com o núcleo familiar - todos eles dirigidos à estratégia da redução de custos. São discutidos, ainda, alguns aspectos relativos às relações de trabalho que estão alicerçando o desenvolvimento dessa modalidade assistencial.

This paper analyses the findings of an investigation into private home healthcare. Considered the most visible model of Managed Healthcare, it is being developed through the supply of multiple services. This concept is based on a set of principles - out-of-hospital care, lower infection risks, family-based benefits for patients - all linked to a cost-cutting strategy. Some labor relations aspects are also discussed that underpin the development of this type of care.