Comprehensive eye care - Issues, challenges, and way forward.

As we move from a disease-specific care model toward comprehensive eye care (CEC), there is a need for a more holistic and integrated approach involving the health system. It should encompass not only treatment, but also prevention, promotion, and rehabilitation of incurable blindness. Although a few models already exist, the majority of health systems still face the challenges in the implementation of CEC, mainly due to political, economic, and logistic barriers. Shortage of eye care human resources, lack of educational skills, paucity of funds, limited access to instrumentation and treatment modalities, poor outreach, lack of transportation, and fear of surgery represent the major barriers to its large-scale diffusion. In most low- and middle-income countries, primary eye care services are defective and are inadequately integrated into primary health care and national health systems. Social, economic, and demographic factors such as age, gender, place of residence, personal incomes, ethnicity, political status, and health status also reduce the potential of success of any intervention. This article highlights these issues and demonstrates the way forward to address them by strengthening the health system as well as leveraging technological innovations to facilitate further care.

[The Pharmacy Combining Convenience Store with Care Consulting Services].

The primary pharmacy system and health support pharmacy system were established in 2016. However, local pharmacies need to get closer to the community. To this end, each pharmacy is making efforts to contribute locally. Here, we introduce various initiatives in our region. Akakabe Pharmacy has 66 stores in Osaka Prefecture, mainly in the northeastern part of Osaka, where the elderly population is growing. We are implementing a dominant strategy: cooperation with the city and administration is strong, and we hold many related events directed towards the public. For example, two thousand participants gathered in an event sponsored by the city aimed at the improvement of beauty and health. At such events, participants can easily consult with pharmacists. Dispensing pharmacy stores-pharmacies that combine the features of a convenience store with care consulting services-were established in 2016. Care consultations are potentially highly advantageous to the users. In the consultation space of a pharmacy, a care worker conducts various events every month, such as on dementia prevention, body composition measurement, and more. We believe that this type of combined pharmacy and convenience store has the potential to become a regional comprehensive care center. We intend to share the possibility of a new pharmacy system, centered on this pharmacy/store/consultation model, as a basis to revamp the pharmacy industry.

Mientras haya vida, hay todo: una mirada en la sexualidad del adulto mayor / While there is life, there is everything: a look at the elderly sexuality

Introducción.Desde un punto de vista integral, la sexualidad comprende aspectos de orden biopsicosocial. Los prejuiciosy el desconocimiento llevan a evitar hablar sobre este tema en la consulta con el adulto mayor (AM).Objetivo.Profundizar en la vivencia de la sexualidad del AM.Metodología.Estudio cualitativo, fenomenológico, realizado en dos centros de actividades recreativas para AM en SanMiguel de Tucumán, que incluyó 13 entrevistas semiestructuradas en profundidad a pacientes mayores de 60 años, 11 desexo femenino, seleccionados en forma intencional y por conveniencia en Agosto de 2018.Resultados.Existe una dicotomía entre quienes hablan del tema y quienes no; sin embargo, todos expresan el deseode naturalizarlo tanto en su círculo social como en la consulta médica. Los AM aceptan el proceso de envejecimiento,tienen una autopercepción positiva de su imagen y pese a los prejuicios, experiencias, comorbilidades y adversidades, seadaptan buscando formas para sentirse bien y disfrutar de una sexualidad plena.Conclusión.El envejecimiento y la sexualidad son conceptos dinámicos que confluyen con las experiencias de vida.Creemos que como médicos de familia es importante brindar una atención integral, abordando las diferentes dimensionesdel ser humano, incluyendo su sexualidad. (AU)

Introduction.Sexuality from an integral point of view includes aspects of biopsychosocial order. Prejudice and ignorancelead to avoid talking about this topic in the medical consultation with the Eldery.Objective.To deepen the experience of the sexuality of the Eldery.Methodology.Qualitative, phenomenological study, conducted in two centres of recreational activities for Senior Citizensin San Miguel de Tucumán, which included 13 in-depth semi-structured interviews to patients over 60 years of age, 11female, selected intentionally and for convenience in August 2018.Results.There is a dichotomy between those who talk about the subject and those who do not; however, all of themexpress the desire to naturalize it in both, their social circle and the medical consultation. The eldery patients acceptthe ageing process, have a positive self-perception of their image and despite prejudices, experiences, comorbidities andadversities, they adapt looking for ways to feel good and enjoy a full sexuality.Conclusion.Aging and sexuality are dynamic concepts that converge with life experiences. We believe that, as familydoctors, it is important to provide comprehensive care, addressing the different dimensions of the human being, wheresexuality is included. (AU)

El Feng Shui de la atención integral y centrada en la persona como un proceso clave transversal / The Feng Shui of an integral and person-centered attention as a key transversal process

No disponible

Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents.

As a traditionally underserved population that faces numerous health disparities, youth who identify as transgender and gender diverse (TGD) and their families are increasingly presenting to pediatric providers for education, care, and referrals. The need for more formal training, standardized treatment, and research on safety and medical outcomes often leaves providers feeling ill equipped to support and care for patients that identify as TGD and families. In this policy statement, we review relevant concepts and challenges and provide suggestions for pediatric providers that are focused on promoting the health and positive development of youth that identify as TGD while eliminating discrimination and stigma.

[Paradigm Shift in the Quality of Regional Medical Care: Cooperative Treatment of Onychomycosis].

　In a superaging society, the medical paradigm should include both less coverage of medical-care work flow by human resources and high-quality care for patients. Strategies such as establishing medical-care teams and community medicine systems mainly for home medical care should be implemented. However, a well-organized system for home-based medical treatment of elderly patients is not yet in place, as evidenced by the lack of care, problems with long-term polypharmacy resulting from visits to multiple healthcare providers, and declines in their physical strength. It is assumed that care might not be provided in association with treatment because planning based on the paradigm of "home medical care" has not been fully established. Therefore, in this study, we aimed to determine the "paradigm shift in home medical care" based on the treatment of onychomycosis. We also hoped to identify the types of medical support required to improve the general well-being of individuals and what needs to be done to ensure a high quality of life for patients. All those (including patients themselves) involved in patient care should together formulate a protocol for medical treatment and cooperate based on the role each can play. Although it may be difficult to maintain cooperation among healthcare workers, improvements in the medical quality of an entire region can be achieved by planning a life design including medical treatment for each patient.

Evolving Federal and State Health Care Policy: Toward a More Integrated and Comprehensive Care-Delivery System for Children With Medical Complexity.

Irrespective of any future changes in federal health policy, the momentum to shift from fee-for-service to value-based payment systems is likely to persist. Public and private payers continue to move toward alternative payment models that promote novel care-delivery systems and greater accountability for health outcomes. With a focus on population health, patient-centered medical homes, and care coordination, alternative payment models hold the potential to promote care-delivery systems that address the unique needs of children with medical complexity (CMC), including nonmedical needs and the social determinants of health. Notwithstanding, the implementation of care systems with meaningful quality measures for CMC poses unique and substantive challenges. Stakeholders must view policy options for CMC in the context of transformation within the overall health system to understand how broader health system changes impact care delivery for CMC.

Abordaje integral de un caso complejo de continuidad de cuidados a un paciente cistectomizado / No disponible

El manejo inefectivo del régimen terapéutico es uno de los diagnósticos que con más frecuencia se le presenta al profesional enfermero durante su desarrollo profesional. Es fundamental que el enfermero desarrolle un plan de cuidados de forma óptima para que el paciente adquiera una correcta adhesión al tratamiento terapéutico y mejore su calidad de vida, así como prevenir las posibles complicaciones ante el no cumplimiento de tal tratamiento. Atendimos en nuestra unidad a un paciente de 56 años con diagnóstico de carcinoma infiltrante de vejiga que iba a ser intervenido de cistectomía. Controla su diabetes sin seguir con el plan terapéutico de su médico de familia, tampoco ha conseguido dejar su hábito tabáquico. Esto nos pone alerta de los posibles problemas posquirúrgicos y al alta

Nursing staff is exposed to ineffective management of therapeutic regimen during their professional development. It is essential for the nursing staff to develop an optimum self-care plan so that the patient can adhere to treatment and improve his quality of life. This will help the patient to anticipate possible complications related to non-compliance for treatment of the disease. A 56 years old patient with an infiltrating bladder cancer was admitted to our unit. The patient poorly controls diabetes, does not follow an appropriate treatment plan and has not stopped smoking. This is putting the patient at great danger due to post-operative complications and problems as a result of discharge from hospital

Concepción sociocultural del climaterio en Occidente / Concepção sociocultural do climatério no Ocidente / Sociocultural conception of climacteric in the West

Introducción: Incluir la perspectiva socio-cultural en el cuidado de las mujeres es clave para alcanzar una buena salud integral. El modelo biomédico ha obviado estos factores en el estudio del climaterio, de modo que se ha creado una nueva patología femenina, el Síndrome Climatérico. Objetivo principal: Reflexionar desde la perspectiva feminista, sobre la dimensión sociocultural Occidental del climaterio. Metodología: Se presenta un artículo original de reflexión teórica basado en la Teoría Feminista del Paradigma holístico de salud que entiende el género como una variable. Conclusiones: Otras culturas nos muestran una mujer climatérica que no padece los signos y síntomas que encontramos en las mujeres Occidentales, lo cual nos hace pensar en la importancia de la sociedad de referencia como factor que influye en la vivencia del climaterio. La menopausia marca un punto de inflexión en la mujer que pasa de la madurez a la senectud por medio de un rito de paso facilitador, pero éste en Occidente está diluido y la mujer vive esta etapa de modo negativo (AU)

Introdução: Integrar a perspectiva socio-cultural no cuidado das mulheres é fundamen-tal para alcançar uma boa saúde. O modelo biomédico tem ignorado esses fatores no estu-do do climatério, de modo que criou uma nova patologia feminina, síndrome climatérica. Principal objetivo: Para refletir a partir de uma perspectiva feminista na dimensão socio-cultural ocidental do climatério. Metodologia: um artigo original de refle-xão teórica baseada na teoria feminista de paradigma de saúde holística que entende gênero como uma variável é apresentado. Conclusões: Outras culturas mostram uma mulher na menopausa que não tem os sinais e sintomas encontrados nas mulheres ocidentais, que nos faz pensar sobre a importância da sociedade de referência como um fator que influencia o climatério. A menopausa marca um ponto de viragem em mulheres que passam de maturidade para a senescência através de um rito de passagem facilitador, mas este no Ocidente é diluído e mulheres vivem nesta fase de uma forma negativa (AU)

Introduction: Including the sociocultural perspective in the care of women is key to at-taining good health. The biomedical model has obviated these factors in the study of climacteric, so that a new female pathology, Climatérico Syndrome, has been created. Main objective: To reflect from the feminist perspective, on the western sociocultural dimension of the climacteric. Methodology: We present an original article of theoretical reflection based on the Feminist Theory of the Holistic Health Paradigm that understands gender as a variable. Conclusions: Other cultures show us a climacteric woman who does not suffer from the signs and symptoms that we find in Western women, which makes us think of the importance of the society of reference as a factor that influences the experience of the climacteric. Menopause marks a turning point in the woman who passes from maturity to senescence through a facilitating rite of passage, but this in the West is diluted and the woman lives this stage in a negative way (AU)

Determinantes sociales, económicos y ambientales de envejecimiento activo en ancianos atendidos en un centro de atención integral a la salud / Determinantes sociais, econômicos e ambientais de envelhecimento ativo em idosos atendidos em um centro de atenção integral à saúde / Social, economic and environmental determinants of active aging in the elderly attended in a center of integral health care

Se ha partido del objetivo de evaluar los determinantes sociales, económicos y ambien tales de envejecimiento activo entre ancianos asistidos en un Centro de Atención Integral a la Salud del Anciano en João Pessoa-Paraíba. Estudio descriptivo, transversal, con planteamiento cuantitativo. La población incluyó todos los ancianos atendidos en el mencionado servicio. La muestra estaba compuesta por 224 ancianos. Los datos fueron recolectados mediante entrevistas estructuradas, efectuadas entre octubre y diciembre 2014. Se encontró un predominio del grupo de edad de 60 a 69 años, en su mayoría mujeres. El promedio de años de escolaridad fue de 4 a 8, la mayoría no tiene trabajo remunerado, posee un ingreso mensual de 1 a 3 salarios mínimos, y la jubilación fue la fuente de beneficio social más prevalente. El robo fue la violencia más experimentada. La mayoría habitaba en sus propias viviendas con buena cobertura de saneamiento básico, pero con condiciones favorables para la ocurrencia de caídas. Así, los resultados encontrados constituyen un producto valioso para la reflexión y la toma de actitud de profesionales volcadas hacia la atención con el fin de promover la autonomía del anciano y una mejor comprensión de las necesidades individuales, señalando los factores sociales, económicos y ambientales del envejecimiento activo (AU)

Objetivouse avaliar os determinantes sociais, econômicos e ambientais de envelhecimento ativo entre idosos assistidos em um Centro de Atenção Integral à Saúde do Idoso no município de João Pessoa-Paraíba. Estudo descritivo, transversal, de abordagem quantitativa. A população compreendeu todos os idosos atendidos no referido serviço. A amostra foi composta por 224 idosos. Os dados foram coletados mediante entrevista estruturada, realizado no período de outubro a dezembro de 2014. Verificou-se predominância da faixa etária de 60 a 69 anos, sendo a maioria do sexo feminino. A média de anos de estudo foi 4 a 8, a maioria não exerce trabalho remunerado, possui renda mensal de 1 a 3 salários mínimos, sendo a aposentadoria a fonte de benefício social mais prevalente. O roubo foi o tipo de violência mais vivenciado. A maioria residia em casas próprias com boa cobertura de saneamento básico, e condições favoráveis para ocorrência de quedas. Deste modo, os resultados deste estudo, constituem valioso produto para reflexão e tomada de atitude de profissionais voltadas para o cuidado que vise a promoção da autonomia do idoso e melhor compreensão das necessidades individuais enfatizando os determinantes sociais, econômicos e ambientais do envelhecimento ativo (AU)

The aim of this study is to evaluate social, economic, and environmental determinants of active aging in older adults assisted at the Center for Integrated Health Care to elderly in João Pessoa, Paraiba. It is a descriptive, transversal study, with a qualitative approach. The target population consisted all older adults (n=224) assisted at the Center for Integrated Health Care. Data collection was conducted through semi-structured interview guide in the period from October to December of 2014. The majority of older adults were among the age group of 60 to 69 years old, and the most of them were female. A number of years of study were between 4 to 8. The vast majority of this population does not have a paid work, and they receive a monthly income between 1 to 3 minimum wage. The most predominant source of social benefit was retiring. The theft was the type of violence the most experienced. The most of them live in their own house with a good physical structure and basic sanitation, but these homes have risks to cause accidental fall. This study is important for reflection and attitude towards of health professionals to improve care for the elder population. Therefore, the care for elderly can understand their necessities and promote autonomy emphasizing social, economic, and environmental determinants of active aging (AU)

Current Risk Adjustment and Comorbidity Index Underperformance in Predicting Post-Acute Utilization and Hospital Readmissions After Joint Replacements: Implications for Comprehensive Care for Joint Replacement Model.

OBJECTIVE: To compare the performances of 3 comorbidity indices, the Charlson Comorbidity Index, the Elixhauser Comorbidity Index, and the Centers for Medicare & Medicaid Services (CMS) risk adjustment model, Hierarchical Condition Category (HCC), in predicting post-acute discharge settings and hospital readmission for patients after joint replacement. METHODS: A retrospective study of Medicare beneficiaries with total knee replacement (TKR) or total hip replacement (THR) discharged from hospitals in 2009-2011 (n = 607,349) was performed. Study outcomes were post-acute discharge setting and unplanned 30-, 60-, and 90-day hospital readmissions. Logistic regression models were built to compare the performance of the 3 comorbidity indices using C statistics. The base model included patient demographics and hospital use. Subsequent models included 1 of the 3 comorbidity indices. Additional multivariable logistic regression models were built to identify individual comorbid conditions associated with high risk of hospital readmissions. RESULTS: The 30-, 60-, and 90-day unplanned hospital readmission rates were 5.3%, 7.2%, and 8.5%, respectively. Patients were most frequently discharged to home health (46.3%), followed by skilled nursing facility (40.9%) and inpatient rehabilitation facility (12.7%). The C statistics for the base model in predicting post-acute discharge setting and 30-, 60-, and 90-day readmission in TKR and THR were between 0.63 and 0.67. Adding the Charlson Comorbidity Index, the Elixhauser Comorbidity Index, or HCC increased the C statistic minimally from the base model for predicting both discharge settings and hospital readmission. The health conditions most frequently associated with hospital readmission were diabetes mellitus, pulmonary disease, arrhythmias, and heart disease. CONCLUSION: The comorbidity indices and CMS-HCC demonstrated weak discriminatory ability to predict post-acute discharge settings and hospital readmission following joint replacement.

Oral health and quality of life in the municipal senior citizen social clubs for people over 65 of Valencia, Spain

BACKGROUND: The world population is aging considerably. The state of elderly's dentition is poor. Many authors agree that the oral health status influence the elderly's quality of life. The objective of our study was to analyze the relation between the oral health status and the general health status through the quality of life of elderly people aged 65 years or more in Valencia, Spain. MATERIAL AND METHODS: A cross-sectional oral health survey and an oral examination have been designed to study an elderly population. There were 202 adults (103 men and 99 women). Age: 65 years of age and over. Randomly selected senior citizen's social clubs. The Oral Health Impact Profile (OHIP-14) has been used to obtain the health survey. Moreover, the EuroQol-5d and a Visual Analogue Scale (VAS) have been the tools to obtain the general health status. Finally, sociodemographic and oral health questions have been needed. RESULTS: Descriptive and inferential results have been done and the main results are the following, the mean additive score of the OHIP-14 was 8.88, the mean value of the EuroQol-5d was 0.58 and of the VAS, 72.90. The OHIP-14 was consistently and significantly correlated with the index EuroQol-5d and with variables such as number of teeth, missing teeth, DMFT, dental status (being or not edentulous) and occupation. The EuroQol-5d was related to dental habits, sex, income, systemic pathologies and filled teeth. CONCLUSIONS: The oral health has a high impact on quality of life. The oral health and the general health are closely related. The oral hygiene and getting toothless influence negatively on the quality of life of elderly people

[Comprehensiveness and healthcare technologies: a narrative on conceptual contributions to the construction of the comprehensiveness principle in the Brazilian Unified National Health System]. / Integralidade e tecnologias de atenção à saúde: uma narrativa sobre contribuições conceituais à construção do princípio da integralidade no SUS.

Comprehensiveness is the most challenging principle for building health reform in the Brazilian Unified National Health System (SUS). This study aims to identify critical moments in the conceptual debate on comprehensiveness and its contributions to reflection on healthcare technologies in the SUS. The essay addresses some conceptual constructs that approach comprehensiveness as an underlying principle in health programs and actions at various levels and in various dimensions of the healthcare organization - from intersubjective interactions to the organization of regional networks. The study was based on a non-systematic literature review on comprehensiveness and related themes in the Brazilian public health field in the last five decades. The study proposed a chronology/typology spanning the 1960s to the 2010s, divided into four significant periods or categories. The narrative is not intended to be exhaustive, but to build a comprehensive reference base capable of contributing to analyses, assessments, and debates on healthcare organization in the SUS according to the comprehensiveness principle.

Efectividad del uso del Registro de Evaluación Integral al paciente afectado de pie diabético (REIPD) / Effectiveness of the Use of the Comprehensive Evaluation Record on The Affected Patient With Diabetic Foot (REIPD in Spanish)

Introducción: el tratamiento del pie diabético con Heberprot-P requiere de una informatización creciente de sus procesos. En Cuba hasta la fecha solo se tiene el antecedente del Registro de Evaluación Integral al Pie Diabético (REIPD), de la misma autoría, pero no es específico para este tratamiento. Objetivo: confirmar la utilidad del Registro de Evaluación Integral al paciente tratado con Heberprot-P (REIPROT). Métodos: el instrumento se elaboró a partir de las siguientes etapas: búsqueda y análisis de instrumentos internacionales y nacionales, revisión de los principales factores de riesgo, conformación de la estructura y determinación de la propuesta de clasificación. Se estudió la relación funcional del instrumento mediante la medida de adecuación muestral de Kaiser-Meyer-Okin, la prueba de esfericidad de Bartlett y el modelo de regresión lineal simple. Se empleó el criterio de expertos en las tres últimas etapas. La informatización requirió de un patrón Modelo Vista Controlador. Se utilizó C# como lenguaje de programación, Sharp Developer 4.2 como IDE de desarrollo y Postgre SQL 9.2 como gestor de base de datos. Resultados: en las pruebas paramétricas realizadas se constató la imposibilidad de realizar una reducción de variables. En el Test de Wilcoxon se obtuvo valores Z cercanos a -7, con un elevado grado de significación. El índice de correlación de Pearson y el coeficiente de determinación en relación al valor total con la dosis de Heberprot-P y la intervención quirúrgica fueron considerados satisfactorios, especialmente esta última, aspecto que demostró una correlación favorable entre el valor del instrumento y el riesgo de amputación. Conclusión: la integración del (REIPROT) al Programa de Atención Integral al Paciente con Úlcera de Pie Diabético (PAIPUPD), debe favorecer la eficacia del proceso de diagnóstico y tratamiento del pie diabético con Heberprot-P, logrando así, una disminución del riesgo de amputación(AU)

Introduction: The treatment of diabetic foot with Heberprot-P requires an increasing information input of its processes. In Cuba, so far, there is only the antecedent of Registry for Diabetic Foot Comprehensive Evaluation (REIPD), by the same authors, but it is not specific for Heberprot-P treatment. Objective: Confirm the usefulness of the Comprehensive Evaluation Record of patients treated with Heberprot-P (REIPROT). Methods: The instrument was elaborated from the following stages: search and analysis of international and national instruments, revision of the main risk factors, and formation of the structure and determination of the classification proposal. The functional relationship of the instrument was studied using the Kaiser-Meyer-Okin sampling adequacy measure, the Bartlett sphericity test and the simple linear regression model. Expert judgment was used in the last three stages. Information Input required a Model Vista Controller pattern. C # was used as programming language, Sharp Developer 4.2 as development IDE and Postgre SQL 9.2 as database manager. Results: The performed parametric tests found impossible to perform a reduction of variables. In Wilcoxon test, Z values were obtained close to -7, with high degree of significance. Pearson correlation index and the coefficient of determination in relation to the total value with Heberprot-P dose and the surgical intervention were considered satisfactory, especially the latter, which showed a favorable correlation between the value of the instrument and the amputation risk. Conclusion: The integration of REIPROT into the Comprehensive Care Program for Patients with Diabetic Foot Ulcer (PAIPUPD) should favor the efficacy of the diabetic foot diagnosis and treatment process with Heberprot-P, thus reducing the risk of amputation(AU)

Integralidade e tecnologias de atenção à saúde: uma narrativa sobre contribuições conceituais à construção do princípio da integralidade no SUS / Comprehensiveness and healthcare technologies: a narrative on conceptual contributions to the construction of the comprehensiveness principle in the Brazilian Unified National Health System / Integralidad y tecnologías de atención a la salud: una narrativa sobre contribuciones conceptuales a la construcción del principio de la integralidad en el Sistema Único de Salud brasileño

Resumo: Dentre os princípios do SUS, o de integralidade talvez seja o mais desafiador na construção da Reforma Sanitária. É objetivo deste estudo identificar momentos críticos do debate conceitual em torno da integralidade e suas contribuições para a reflexão acerca de tecnologias de atenção à saúde no âmbito do SUS. O ensaio percorre algumas construções conceituais que se aproximam da questão da integralidade como princípio norteador de programas e ações de saúde em diversos planos e dimensões da organização da atenção à saúde - das interações intersubjetivas à organização de redes regionais. O estudo se baseou em revisão não sistemática da literatura sobre o tema da integralidade e afins na produção do campo da Saúde Coletiva brasileira nas últimas cinco décadas. Propõe-se uma cronologia/tipologia que se estende dos anos 1960 à década de 2010, dividindo-a em quatro períodos/categorias julgados significativos. A narrativa não pretende ser exaustiva, mas construir uma referência compreensiva capaz de contribuir para análises, avaliações e debates acerca da organização da atenção à saúde no SUS conforme o princípio da integralidade.

Abstract: Comprehensiveness is the most challenging principle for building health reform in the Brazilian Unified National Health System (SUS). This study aims to identify critical moments in the conceptual debate on comprehensiveness and its contributions to reflection on healthcare technologies in the SUS. The essay addresses some conceptual constructs that approach comprehensiveness as an underlying principle in health programs and actions at various levels and in various dimensions of the healthcare organization - from intersubjective interactions to the organization of regional networks. The study was based on a non-systematic literature review on comprehensiveness and related themes in the Brazilian public health field in the last five decades. The study proposed a chronology/typology spanning the 1960s to the 2010s, divided into four significant periods or categories. The narrative is not intended to be exhaustive, but to build a comprehensive reference base capable of contributing to analyses, assessments, and debates on healthcare organization in the SUS according to the comprehensiveness principle.

Resumen: Entre los principios del Sistema Único de Salud brasileño (SUS), el de integralidad tal vez sea el que más desafíos supone de todos los presentes en la construcción de la Reforma Sanitaria. El objetivo de este estudio es identificar momentos críticos del debate conceptual, en torno a la integralidad y sus contribuciones, para la reflexión acerca de tecnologías de atención a la salud en el ámbito del SUS. El ensayo recorre algunas construcciones conceptuales que se aproximan a la cuestión de la integralidad, como un principio director de programas y acciones de salud en diversos planos y dimensiones de la organización de la atención a la salud, desde las interacciones intersubjetivas, a la organización de redes regionales. El estudio se basó en una revisión no sistemática de la literatura sobre el tema de la integralidad y cuestiones afines en la producción del campo de la Salud Colectiva brasileña durante las últimas cinco décadas. Se propone una cronología/tipología que se extiende desde los años 60 a la década de 2010, dividiéndola en cuatro períodos/categorías considerados como significativos. La narrativa no pretende ser exhaustiva, sino construir una referencia comprensiva capaz de contribuir a análisis, evaluaciones y debates, a cerca de la organización de la atención a la salud en el SUS, según el principio de la integralidad.

Servicio de Pediatría del Hospital de Basurto 1903-2015: desde una atención de beneficiencia a un Servicio de Pediatría especializado, innovador y con estándares de calidad / Pediatrics Department of the Hospital of Basurto 1903-2015: from charity care to a department of specialized, innovating pediatrics with quality standards

El Servicio de Pediatría del Hospital de Basurto fue fundado en el año 1903 por lo que tiene una larga trayectoria histórica. Su evolución ha ido paralela con la del propio Hospital, un líder precursor de la formación médica especializada con la creación del cuerpo de alumnos internos de doctorado en el año 1918. El Servicio de Pediatría ha ido adaptándose en cada momento a las circunstancias históricas y los recursos disponibles. En el momento actual es el centro de referencia para la población infantil de la ciudad de Bilbao, tiene una amplia oferta de especialidades y tecnología, dispone de un sistema de gestión de la calidad basado en procesos asistenciales prevalentes. Está fuertemente orientado hacia el niño y la niña y sus familias, lo que es reconocido por éstas a través de los indicadores de percepción (AU)

Pediatrics Department of the Hospital Basurto was founded in 1903 by which has a long history. Its evolution has been parallel with the own Hospital, a pioneer leader of medical education specializing in 1918 with the creation of the internal PhD students body. Pediatrics service has been adapting constantly to historical circumstances and available resources. At the present time is the center of reference for the child population of the city of Bilbao, has a wide range of specialties and technology, it has a processes and indicators-based quality management system, and is immersed in innovative management projects such as the integrated care processes for prevalent conditions. It is strongly oriented towards the boys and girls and their families, what is recognized by them as the perception indicators demonstrate (AU)

The impact of comprehensive stroke care capacity on the hospital volume of stroke interventions: a nationwide study in Japan: J-ASPECT study.

BACKGROUND: The association between comprehensive stroke care capacity and hospital volume of stroke interventions remains uncertain. We performed a nationwide survey in Japan to examine the impact of comprehensive stroke care capacity on the hospital volume of stroke interventions. METHODS: A questionnaire on hospital characteristics, having tissue plasminogen activator (t-PA) protocols, and 25 items regarding personnel, diagnostic, specific expertise, infrastructure, and educational components recommended for comprehensive stroke centers (CSCs) was sent to 1369 professional training institutions. We examined the effect of hospital characteristics, having a t-PA protocol, and the number of fulfilled CSC items (total CSC score) on the hospital volume of t-PA infusion, removal of intracerebral hemorrhage, and coiling and clipping of intracranial aneurysms performed in 2009. RESULTS: Approximately 55% of hospitals responded to the survey. Facilities with t-PA protocols (85%) had a significantly higher likelihood of having 23 CSC items, for example, personnel (eg, neurosurgeons: 97.3% versus 66.1% and neurologists: 51.3% versus 27.7%), diagnostic (eg, digital cerebral angiography: 87.4% versus 43.2%), specific expertise (eg, clipping and coiling: 97.2% and 54% versus 58.9% and 14.3%, respectively), infrastructure (eg, intensive care unit: 63.9% versus 33.9%), and education (eg, professional education: 65.2% versus 20.7%). On multivariate analysis adjusted for hospital characteristics, total CSC score, but not having a t-PA protocol, was associated with the volume of all types of interventions with a clear increasing trend (P for trend < .001). CONCLUSION: We demonstrated a significant association between comprehensive stroke care capacity and the hospital volume of stroke interventions in Japan.