Strengthening primary health care in low- and middle-income countries: furthering structural changes in the post-pandemic era.

Strengthening primary health care (PHC) is the most cost-effective approach in low- and middle-income countries (LMICs) to achieve sustainable universal health coverage (UHC), protect against health shocks, and promote health and wellbeing for all people. It has been 45 years since PHC was put on the global agenda followed by multiple efforts to advocate for more funding and improved performance of PHC. Yet, investment in PHC is still insufficient and overall performance of PHC systems is weak in LMICs, resulting in increased vulnerability and poor health outcomes especially among marginalized populations. As countries recover from the COVID-19 pandemic, which exposed the fragility of PHC platforms, it is imperative to go beyond advocacy for PHC investments and make systemic changes to strengthen PHC as the foundation of resilient and equitable health systems. We propose five gamechangers to facilitate structural changes for strengthening PHC through a focused health systems approach: (i) integration of client-centered health services at PHC level; (ii) digitization of PHC services; (iii) efficiency gains invested in essential health services; (iv) strengthening management practices for PHC at district and facility levels; and (v) advancing community engagement for PHC. To be successful, the implementation of the gamechangers must be contextualized and focus on achieving sustainable health outcomes, and therefore use implementation approaches that link essential health services to health outcomes. Through this way countries will maximize the possibility of achieving UHC and attaining the ambitious health targets of the Sustainable Development Goals (SDGs) by 2030.

Agitación/agresividad en la demencia de tipo Alzheimer / Agitation/aggresiveness in Alzheimer's disease

INTRODUCCION: La demencia de tipo Alzheimer (DTA) es una patología degenerativa con síntomas neuropsicológicos y neuropsiquiátricos. OBJETIVOS: Describir un trastorno conductual: agitación/agresividad con sus distintas manifestaciones. Evaluar el impacto de las alteraciones de conductas sobre el bienestar de los cuidadores principales (CP). MÉTODO: 42 pacientes con DTA de severidad moderada, con una media de 78,25 años fueron evaluados con el Inventario Neuropsiquiátrico (NPI) y sus CP respondieron también al autocuestionario "Quejas familiares de los enfermos con DTA". RESULTADOS Y CONCLUSIONES: Las conductas de agitación/agresividad son bastante frecuentes (55,1 por ciento de los casos), pero de severidad moderada. El signo más frecuente fue el del rechazo o resistencia a la ayuda/cuidado que el CP ofrecía al paciente (34,8 por ciento). Además, estas conductas son los trastornos comportamentales más perturbadores para el bienestar de los CP (35,4 por ciento) (AU)