RESUMO
Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.
Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.
Assuntos
Congressos como Assunto/história , Medicina de Família e Comunidade/história , Reforma dos Serviços de Saúde/história , Atenção Primária à Saúde/história , Academias e Institutos/história , Academias e Institutos/organização & administração , Brasil , Centros Comunitários de Saúde/história , Centros Comunitários de Saúde/legislação & jurisprudência , Centros Comunitários de Saúde/organização & administração , Congressos como Assunto/organização & administração , Europa (Continente) , Medicina de Família e Comunidade/organização & administração , Saúde Global , Reforma dos Serviços de Saúde/organização & administração , História do Século XX , História do Século XXI , Humanos , Cazaquistão , Programas Nacionais de Saúde/história , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/organização & administração , Portugal , Atenção Primária à Saúde/organização & administração , Especialização/históriaRESUMO
Resumo Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.
Abstract Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.
Assuntos
Humanos , Atenção Primária à Saúde/história , Reforma dos Serviços de Saúde/história , Congressos como Assunto/história , Medicina de Família e Comunidade/história , Portugal , Atenção Primária à Saúde/organização & administração , Especialização/história , Brasil , Saúde Global , Cazaquistão , Reforma dos Serviços de Saúde/organização & administração , Centros Comunitários de Saúde/história , Centros Comunitários de Saúde/legislação & jurisprudência , Centros Comunitários de Saúde/organização & administração , Congressos como Assunto/organização & administração , Academias e Institutos/história , Academias e Institutos/organização & administração , Europa (Continente) , Medicina de Família e Comunidade/organização & administração , Programas Nacionais de Saúde/história , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/organização & administraçãoRESUMO
The authors trace the modern history, current landscape, and future prospects for integration between mental health and general medical care in the United States. Research and new treatment models developed in the 1980s and early 1990s helped inform federal legislation, including the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act, which in turn are creating new opportunities to further integrate services. Future efforts should build on this foundation to develop clinical, service-level, and public health approaches that more fully integrate mental, medical, substance use, and social services. [AJP AT 175: Remembering Our Past As We Envision Our Future July 1928: A President Takes Stock Adolf Meyer: "I sometimes feel that Einstein, concerned with the relativity in astronomy, has to deal with very simple facts as compared to the complex and erratic and multicontingent performances of the human microcosmos, the health, happiness and efficiency of which we psychiatrists are concerned with." (Am J Psychiatry 1928; 85(1):1-31 )].
Assuntos
Prestação Integrada de Cuidados de Saúde , Serviços de Saúde Mental , Prestação Integrada de Cuidados de Saúde/história , Prestação Integrada de Cuidados de Saúde/legislação & jurisprudência , Prestação Integrada de Cuidados de Saúde/tendências , Previsões , Reforma dos Serviços de Saúde/história , Reforma dos Serviços de Saúde/legislação & jurisprudência , História do Século XX , História do Século XXI , Humanos , Transtornos Mentais/terapia , Serviços de Saúde Mental/história , Serviços de Saúde Mental/legislação & jurisprudência , Serviços de Saúde Mental/tendênciasRESUMO
The presence of psychology in Brazilian Health Settings is closely related to two socio-political movements: for the creation of the Brazilian Unified Health System in 1990 and for Psychiatric Reform. Each had a multidisciplinary stance closely associated with a socially committed approach to healthcare delivery and connected with prior experiences that influenced its policies, among them the National AIDS Programme. These developments are told as a tale that interlaced autobiographical data and the long road to a universal healthcare system that shaped the relationship between psychology and health in the country.
Assuntos
Medicina do Comportamento/história , Medicina do Comportamento/educação , Medicina do Comportamento/métodos , Brasil , Reforma dos Serviços de Saúde/história , Política de Saúde/história , História do Século XX , História do Século XXI , Humanos , Programas Nacionais de Saúde/históriaRESUMO
This article analyses the illness experiences of male patients from the Heidelberg University Psychiatric Hospital during the protests against Psychiatry in the year 1973. Protest is one of the most important expressions of masculinity in socially disadvantaged men, such as men with mental disorders. The analysis of 100 medical records shows that some patients tried to construct themselves as men in a way that was explicitly motivated by antipsychiatric ideas: They questioned psychiatric authority, behaved "sexually inappropriate", or used drugs. On the eve of psychiatric reform in West Germany those patients were well aware that the alternative--complying with the treatment--would put them at considerable risk. In addition to the usual inference of hegemonic or normative masculinities as risk-factors, the behavior of those ,,rebellious patients" has to be interpreted as individual coping strategies.
Assuntos
Desinstitucionalização/história , Hospitais Psiquiátricos/história , Hospitais Universitários/história , Masculinidade/história , Saúde do Homem/história , Transtornos Mentais/história , Alemanha Ocidental , Reforma dos Serviços de Saúde/história , História do Século XX , Humanos , Masculino , Cura Mental/história , Cooperação do PacienteRESUMO
OBJECTIVE: The article describes care in a psychiatric clinic between 1946 and 1975. This happens against the background of the current psychiatry-historical literature in which this phase of psychiatric care is described often summarily with the destructive words of the report of the 'Psychiatrie-Enquête' of 1975. Improvements achieved in this time were hardly examined up to now though they contributed substantially to the later effects of the 'Psychiatrie-Enquête'. METHODS: The medical annual reports of the psychiatric clinic of Zwiefalten, today ZfP Südwürttemberg, refering to the mentioned period were sighted and evaluated concerning their contents. RESULTS: In the called period evident organizational and structural defects are deplored in the annual reports. Nevertheless, from the late 1940âs on, modern care elements appear, as for example the broadening of the range of the therapeutic offers, multiprofessional treatment, diagnosis-specific concepts for the wards, opening of stations and extensive outpatient care. CONCLUSION: It is shown that already before the appearance of the final report of the Enquête commission clear progress concerning psychiatric care was achieved.
Assuntos
Reforma dos Serviços de Saúde/história , Pesquisa sobre Serviços de Saúde/história , Hospitais Psiquiátricos/história , Transtornos Mentais/história , Psiquiatria/história , Medicina Psicossomática/história , Psicoterapia/história , Qualidade da Assistência à Saúde/história , II Guerra Mundial , Alemanha , História do Século XX , HumanosRESUMO
Are values and social priorities universal, or do they vary across geography, culture, and time? This question is very relevant to Asia's emerging economies that are increasingly looking at Western models for answers to their own outmoded health care systems that are in dire need of reform. But is it safe for them to do so without sufficient regard to their own social, political, and philosophical moorings? This article argues that historical and cultural legacies influence prevailing social values with regard to health care financing and resource allocation, and that the Confucian dimension provides a helpful entry point for a deeper understanding of ongoing health care reforms in East Asia--as exemplified by the unique case of Singapore.
Assuntos
Atitude Frente a Saúde , Confucionismo/história , Reforma dos Serviços de Saúde/organização & administração , Política de Saúde/história , Acessibilidade aos Serviços de Saúde/história , Valores Sociais , Idoso , Características Culturais , Ásia Oriental , Feminino , Reforma dos Serviços de Saúde/ética , Reforma dos Serviços de Saúde/história , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/história , Serviços de Saúde para Idosos/organização & administração , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XXI , História Antiga , História Medieval , Humanos , Masculino , Programas Nacionais de Saúde/ética , Programas Nacionais de Saúde/história , Programas Nacionais de Saúde/organização & administração , Qualidade da Assistência à Saúde/organização & administração , SingapuraRESUMO
Up to 1920 Thuringia was separated into many territories some of which were known for their unorthodox pharmaceutical industries. Gotha was the only famous duchy because one of its princes had married the Queen of England in 1840. The country was backward and the state administration was incapable of solving health issues. It was due to the interest of some physicians that the fragile balance between homeopathy, naturopathy, physicians and pharmacists broke down after 1900. But the state bureaucracy was unable to convince the people of its new healthcare approaches that were just based on scientific medicine.
Assuntos
Cultura , Indústria Farmacêutica/história , Reforma dos Serviços de Saúde/história , Estâncias para Tratamento de Saúde/história , Homeopatia/história , Hospitais de Doenças Crônicas/história , Turismo Médico/história , Naturologia/história , Charlatanismo/história , Automedicação/história , Feminino , Alemanha , História do Século XVIII , História do Século XIX , História do Século XX , Humanos , MasculinoRESUMO
After long periods of activism and policy debate, Ontario and Quebec were the first two provinces to integrate midwifery into their health-care services. Despite its success and growing popularity in the post-legislative era, midwifery was a highly contentious policy issue, with debates emerging at every level of policy development. In this essay, the authors explore how these debates played out in media. Specifically, the authors suggest that the frames produced by newspapers during this period served to align midwifery with broader provincial socio-political discourses, which in turn legitimized state intervention in the area of reproductive health. At the same time, however, the authors demonstrate that where Ontario media representations muted differences between midwives and physicians, representations in Quebec emphasized them. Thus, the authors show that in very different ways, media representations of midwifery in Ontario and Quebec both established a discursive context in which the state had to "act on" midwifery and midwives, and also challenged the potential of midwifery to transform women's birth experiences.
Assuntos
Atenção à Saúde , Serviços de Saúde , Meios de Comunicação de Massa , Tocologia , Política Pública , Serviços de Saúde Reprodutiva , Atenção à Saúde/economia , Atenção à Saúde/etnologia , Atenção à Saúde/história , Atenção à Saúde/legislação & jurisprudência , Governo/história , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/história , Reforma dos Serviços de Saúde/legislação & jurisprudência , Serviços de Saúde/economia , Serviços de Saúde/história , Serviços de Saúde/legislação & jurisprudência , História do Século XX , Meios de Comunicação de Massa/economia , Meios de Comunicação de Massa/história , Meios de Comunicação de Massa/legislação & jurisprudência , Tocologia/economia , Tocologia/educação , Tocologia/história , Tocologia/legislação & jurisprudência , Ontário/etnologia , Opinião Pública/história , Política Pública/economia , Política Pública/história , Política Pública/legislação & jurisprudência , Quebeque/etnologia , Serviços de Saúde Reprodutiva/economia , Serviços de Saúde Reprodutiva/história , Serviços de Saúde Reprodutiva/legislação & jurisprudênciaRESUMO
Author outlines the history of making and of development of public health during the period of enlightenment in Central Europe, with special regards on the Habsurg Empire, on Poland and on Russia. This development--including the foundation or reforms of medical education--was highly influenced by the ideas of the enlightened absolutism and by other international trends of the age as well. The detailed analysis of the factors shaping the history of public health in the three rather different countries shows an interesing parallelism regarding main issues. While re-organization of public health in all these countries was initiated and directed by the government and shaped according to western models, it was strongly influenced by local possibilities, culture and history.
Assuntos
Educação Médica/história , Reforma dos Serviços de Saúde/história , Medicina Militar/história , Saúde Pública/história , Áustria-Hungria , Cirurgiões Barbeiros/história , Características Culturais/história , Educação Médica/organização & administração , Reforma dos Serviços de Saúde/legislação & jurisprudência , Reforma dos Serviços de Saúde/organização & administração , História do Século XVIII , Humanos , Tocologia/história , Medicina Militar/organização & administração , Polônia , Sistemas Políticos/história , Saúde Pública/economia , Saúde Pública/educação , Saúde Pública/legislação & jurisprudência , Administração em Saúde Pública/história , Federação Russa , OcidenteRESUMO
When President Lyndon Johnson signed the Medicare and Medicaid bill into law in 1965, it ended the 46-year campaign to enact a healthcare program for senior citizens and started what is now a 42-year effort by the American Dietetic Association (ADA) and its members to expand its coverage to 'nutrition services' for all appropriate diseases, disorders and conditions. In December 2000, Congress passed a Medicare Part B Medical Nutrition Therapy (MNT) provision, limited to patients with diabetes and/or renal disease, effective January 2002. In December 2003, the Medicare Modernization Act expanded access to MNT benefit and ADA continues to focus on the role of the registered dietician in MNT. Successful expansion of MNT benefits will require that ADA continues to demonstrate the cost-effectiveness and efficacy of nutrition counseling, as performed by the registered dietitian.
Assuntos
Medicare/legislação & jurisprudência , Terapia Nutricional/economia , Análise Custo-Benefício , Dietética , Reforma dos Serviços de Saúde/história , História do Século XX , História do Século XXI , Humanos , Seguro Saúde/história , Reembolso de Seguro de Saúde , Medicare/história , Terapia Nutricional/história , Sociedades Médicas , Estados UnidosRESUMO
UNLABELLED: During the mid 19th century, herbal remedies were the platform for a major health reform movement in America known as the Botanical Medical Movement (BMM). A number of histories have been written on the BMM from the perspectives of physicians and pharmacists. PURPOSE: This article describes the history of nurse-herbalism during the period and the impact that Shaker nurses, in particular, had on the BMM. METHOD: The article traces the history and findings of a triangulated case study. FINDINGS: Shaker nurses used herbs extensively in their caring and curing practices. They applied the botanical remedies recommended by BMM leaders. The nurses were also expert herbal medicine makers who used their own remedies in patient care. CONCLUSIONS: The Shaker infirmary was the nurses' behind-the-scenes research and development laboratory for the Shaker herbal cottage industry, which ultimately developed into an international, entrepreneurial endeavor. The Shaker infirmary was the nurses' organized proving ground for the implementation of the botanical health reforms of the mid 19th century. The nurse-herbalists' contribution to the promotion and production of herbal remedies had a significant impact on the success of botanical health reform in America.
Assuntos
Reforma dos Serviços de Saúde/história , Medicina Herbária/história , Saúde Holística/história , Enfermagem Holística/história , Fitoterapia/história , História do Século XIX , Humanos , Papel do Profissional de Enfermagem/história , Extratos Vegetais/história , Estados UnidosRESUMO
When New Zealand's first Nurse Practitioner was approved by the Nursing Council of New Zealand in December 2001, it was the centenary year of New Zealand nursing registration, but less than a decade after the commencement of New Zealand's first pre-registration nursing degrees. What were the conditions and forces in play that saw nursing achieve a new emphasis on advanced clinical education and practice, culminating in the development of an advanced, expanded scope of nursing practice? This contemporary historical study examines the professional and sectoral milieu of the 1990s and the turn of the 21st century, together with the policy initiatives undertaken to advance nursing in New Zealand during that period.
Assuntos
Educação de Pós-Graduação em Enfermagem/história , Política de Saúde/história , Profissionais de Enfermagem/história , Papel do Profissional de Enfermagem/história , Política , Autonomia Profissional , Comitês Consultivos/história , Prescrições de Medicamentos/história , Reforma dos Serviços de Saúde/história , História do Século XX , História do Século XXI , Humanos , Licenciamento em Enfermagem/história , Programas Nacionais de Saúde/história , Nova Zelândia , Pesquisa em Enfermagem/história , Sociedades de Enfermagem/históriaRESUMO
The study of indigenous health is an emerging specialty and differs from other health disciplines in that the traditions and beliefs of indigenous people must be considered in developing health policy. New Zealand Maori and Australian Aboriginal and Torres Straight Islanders face similar health issues but have followed a different historical path. New Zealand was settled by the Maori from Eastern Polynesia in approximately 1300AD. A structured and settled society had developed by the time of British colonization in the 1800s. Because of Maori's obvious sovereignty over New Zealand the British negotiated a treaty in 1840 (The Treaty of Waitangi) with Maori that gave provision for their rights as British and later New Zealand citizens. Maori health indices suffered after the start of colonization but slowly rebounded in the 1900s linked to a resurgence in Maori culture, sporting and combat achievements. A sustained period of protest in the years following World War II has resulted in the inclusion of the provisions of the Treaty of Waitangi in legislation. Historical grievances of Maori relating to land confiscations and injustice are being addressed with formal apology and compensation. This process has allowed Maori to create their own infrastructure, to begin to develop their own health-care initiatives and to advise health-care authorities and governments on interventions to reduce health disparities between Maori and non-Maori New Zealanders.
Assuntos
Reforma dos Serviços de Saúde/história , Serviços de Saúde do Indígena/história , Havaiano Nativo ou Outro Ilhéu do Pacífico/etnologia , Traumatologia/história , Feminino , Reforma dos Serviços de Saúde/ética , Reforma dos Serviços de Saúde/legislação & jurisprudência , Serviços de Saúde do Indígena/ética , Serviços de Saúde do Indígena/legislação & jurisprudência , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Masculino , Nova Zelândia/etnologia , Traumatologia/ética , Traumatologia/legislação & jurisprudênciaRESUMO
Development of the New Zealand nursing workforce has been shaped by social, political, scientific and interprofessional forces. The unregulated, independent and often untrained nurses of the early colonial period were succeeded in the early 1900s by registered nurses, with hospital-based training, working in a subordinate role to medical practitioners. In the mid/late 1900s, greater specialisation within an expanding workforce, restructuring of nursing education, health sector reform, and changing social and political expectations again reshaped nursing practice. Nursing now has areas of increasing autonomy, expanding opportunities for postgraduate education and leadership roles, and a relationship with medicine, which is more collaborative than in the past. Three current challenges are identified for nursing in New Zealand's rapidly evolving health sector; development of a nursing-focused knowledge culture, strengthening of research capacity, and dissemination of new nursing knowledge.