A expressão pessoal de médicos frente à bioética, qualidade de vida no trabalho e relação médico paciente / Physicians' personal expression regarding bioethics, quality of life at work and the doctor-patient relationship / Expresión personal de los médicos respecto a la bioética, la calidad de vida en el trabajo y la relación médico-paciente

Foi realizada uma pesquisa de opinião nacional na qual cada médico foi capaz de expressar seus sentimentos, compreensão e opinião pessoal no contexto da qualidade de vida no trabalho e bioética. Foi utilizado um questionário estruturado com tópicos relevantes, enviado pelo Departamento de TI do Conselho Federal de Medicina aos 95.022 endereços de e-mail registrados válidos, e foram obtidas 426 respostas completas. Houve manifestações negativas; em média, mais de 50% das respostas específicas, que mostraram que a falta de qualidade de vida no trabalho age negativamente sobre o entendimento e a opinião dos médicos sobre bioética e a relação médico-paciente, e não necessariamente que esta manifestação se materialize através de suas ações. Houve médicos receptivos que, através de suas respostas, conseguiram demonstrar que a falta de qualidade de vida no trabalho pode alterar e desconstruir esta relação no contexto da bioética.

A nationwide opinion survey was applied, in which each physician was able to express his or her feelings, understanding and personal opinion in the context of quality of life at work and bioethics. A structured questionnaire with relevant topics was used, sent by the Informatics Department of the Federal Council of Medicine to the 95,022 valid e-mails registered, and 426 complete responses were obtained. There were negative manifestations; on average, more than 50% of the specific responses, which evidenced that the lack of quality of life at work acts negatively on the understanding and opinion of physicians on bioethics and the doctor-patient relationship, and not necessarily that this manifestation is materialized through their actions. There were responsive physicians who, through their responses, were able to demonstrate that a lack of quality of life at work can alter and deconstruct this relationship in the context of bioethics.

Se aplicó una encuesta de opinión, de ámbito nacional, en la que cada médico pudo expresarse plasmando sus sentimientos, comprensión y opinión personal en el contexto de la calidad de vida en el trabajo y la bioética. Se utilizó un cuestionario estructurado con temas pertinentes, enviado por el Departamento de Informática del Consejo Federal de Medicina a los 95.022 correos electrónicos válidos registrados, y se obtuvieron 426 respuestas completas. Hubo manifestaciones negativas; en promedio, más del 50% de las respuestas específicas, lo que evidenció que la falta de calidad de vida en el trabajo actúa negativamente en la comprensión y opinión de los médicos sobre la bioética y la relación médico-paciente, y no necesariamente que esa manifestación se materialice a través de sus acciones. Hubo médicos receptivos que, a través de sus respuestas, pudieron demostrar que la falta de calidad de vida en el trabajo puede alterar y deconstruir esta relación en el contexto de la bioética.

La prevención universal del consumo de drogas en el entorno escolar: el valor de la monitorización continua / Universal prevention of substance use in school settings: the need for continuous monitoring

Este trabajo presenta la experiencia de gestión por los servicios de salud pública de la ciudad de Barcelona de dos programas de prevención universal del consumo de sustancias adictivas ofrecidos en educación secundaria, revisando el periodo de 1989-1990 a 2016-2017. Ambos programas mostraron su efectividad en evaluaciones con grupo de comparación, se promueven desde los servicios de salud pública de forma gratuita y son impartidos por los/las docentes usando manuales estandarizados, con material de apoyo y formación. La cobertura alcanzada en los últimos años ha bajado del 40% al 25% de las escuelas. Se observan cambios en la aceptación y la realización de los programas que podrían relacionarse con aspectos de seguimiento y logística de los servicios de salud pública, los cambios en la disponibilidad de sustancias psicoactivas y los recortes presupuestarios en educación. La monitorización de los programas efectivos por los servicios de salud pública es fundamental para preservar su realización. (AU)

This paper documents the management of two programs for the universal prevention of substance use offered in secondary schools by the public health services of the city of Barcelona, reviewing the period from 1989–1990 to 2016–2017. Both programs had proven effectiveness in evaluations with a comparison group, they are promoted by the public health agency free of cost, and are taught by teachers, using standardized manuals with support materials and training. The coverage achieved over recent years declined from 40% to 25%. Changes observed in the acceptance and implementation of these programs could be related with logistics and follow-up by the public health services, changes in substance availability, and with budget cuts in education. The monitoring of effective programs by public health services is essential to preserve their actual implementation. (AU)

Capacidad estructural, recursos humanos tecnológicos y requerimientos de ventilación mecánica en 58 unidades de cuidados intensivos en argentina durante la pandemia por SARS-CoV-2. Estudio SATICOVID-19 / Structural capacity, technological human resources and mechanical ventilation requirements in 58 intensive care units in Argentina during the SARS-CoV-2 pandemic. A SATICOVID-19 Study

Resumen Durante la pandemia por SARS-CoV-2 hubo un marcado requerimiento de camas de cuidados críticos, insumos y profesionales entrenados para asistir a pacientes con insuficiencia respiratoria grave. La Sociedad Argentina de Terapia Intensiva (SATI) diseñó un estudio para caracterizar estos aspectos en las Unidades de Cuidados Intensivos (UCIs). Estudio multicéntrico, de cohorte prospectiva; las UCIs participantes completaron un formulario al final del estudio (31/10/2020) sobre características hospitalarias, número de camas de áreas críticas pre- e intra-pandemia, incorporación de profesionales, insumos y recursos tecnológicos, y carga de trabajo. Participaron 58 UCIs; 28(48%) de Provincia de Buenos Aires, 22(38%) de Ciudad Autónoma de Bue nos Aires, 10(17%) de otras; 31(53%) UCIs pertenecían al sector público; 23(47%) al privado-seguridad social. En 35/58(60%) hospitales las camas de cuidados críticos aumentaron de 902 a 1575(75%); 37% en UCI y 63% principalmente en Unidad Coronaria y Emergencias-shock room. En 41/55(75%) UCIs se incorporó personal: 27(49%) médicos/as (70% intensivistas), 36(65%) enfermeros/as, 28(51%) kinesiólogos/as, 20(36%) personal de limpieza, y 1(2%) otros/as; 96% de las UCIS reportaron disponer de respiradores suficientes, y 95%, insumos y EPP suficientes. De todos los pacientes en ventilación mecánica invasiva, 55% [43-64] presentaron COVID-19. Se requirió oxigenoterapia como soporte no invasivo en 14% [8-24] de los ingresos por COVID-19. Se registró una importante expansión de las áreas críticas operativas, secundariamente al aumento de camas, personal, y adecuada disponibilidad de respiradores e insumos esenciales. La carga de la enfermedad crítica por COVID-19 fue intensa, constituyendo más de la mitad de los pacientes en ventilación mecánica.

Abstract During the SARS-CoV-2 pandemic, there was a marked requirement for critical care beds, supplies and trained professionals to assist patients with severe respiratory failure. The Argentine Society of Intensive Care (SATI) designed a study to characterize these aspects in intensive care units (ICUs). Multicenter, prospective cohort study; the participating ICUs completed a form at the end of the study (31/10/2020) on hospital characteristics, number of beds in pre- and intra-pandemic critical areas, incorporation of professionals, technological resources, and workload. Fifty-eight ICUs participated; 28(48%) were located in Buenos Aires Province, 22(38%) in Buenos Aires Autonomous City and 10 (17%) in other provinces; 31 (53%) of UCIs belonged to the public sector; 23 (47%) to the private-social security. In 35/58 (60%) of the hospitals critical care beds increased from 902 to 1575 (75%), 37% in ICU and 63% mainly in Coronary Care Unit and Emergency-shock room. In 41/55 (75%) UCIs, staff were incorporated: 27(49%) physicians (70% intensivists), 36 (65%) nurses, 28 (51%) respiratory therapists, 20(36%) cleaning staff, and 1(2%) others. A 96% of the ICUS reported having sufficient ventilators and 95% enough sup plies and PPE. Of all patients on invasive mechanical ventilation, 55% [43-64] had COVID-19. Oxygen therapy was required as noninvasive support in 14% [8-24] of COVID-19 admissions. There was a significant expansion of critical operational areas, secondary to the increase in beds, staff, and adequate availability of ventilators and essential supplies. The burden of critical illness from COVID-19 was intense, with more than half of patients on mechanical ventilation.

Reinventando una organización de salud pública / Reinventing a public health organization

Las organizaciones más avanzadas son descentralizadas, colaborativas y adaptativas. Esto les proporciona una capacidad de gestión de las situaciones complejas. A estas organizaciones, Laloux las llama Teal. El objetivo de este manuscrito es describir el proceso de implementación del modelo de gestión Teal en la Agència de Salut Pública de Barcelona (ASPB). Existe una triple oportunidad para innovar en la ASPB: el cambio político hacia un gobierno progresista, la organización está en un momento de renovación masiva de su personal con un cambio generacional que facilita la comprensión del modelo Laloux, y las personas directivas tienen un bagaje técnico con una larga trayectoria en la organización, lo que las hace conocedoras de las capacidades de esta. El proceso se pone en marcha empezando con la implicación de un grupo reducido de personas (Grupo Llavor) para después ser ampliado (Grupo Planter). Además de discutir las bases del modelo Laloux, se forman seis grupos de trabajo (Cómo organizar reuniones más eficaces, Espacios físicos, Espacios de reflexión/confianza, Banco del tiempo, Jornada anual del personal de la ASPB y Espacio para escuchar la voz de las personas trabajadoras de la ASPB) y se organizan talleres informativos dirigidos a toda la organización, en los que participan 67 personas. En total, unas 120 personas de la organización han participado en actividades del Grupo Planter. El éxito de las primeras iniciativas deberá servir para que los valores y principios cultivados vayan traspasando las fronteras de los proyectos para convertirse en un estilo generalizado de gestión. (AU)

The most advanced organizations are decentralized, collaborative and adaptive. This gives them the ability to manage complex situations. Laloux calls these organizations Teal. The aim of this manuscript is to describe the process of implementation of the Teal management model in the Agència de Salut Pública de Barcelona (ASPB). There is a triple opportunity for innovation at the ASPB: political change towards a progressive government, the organisation is in a moment of massive renewal of its staff and there is a generational change that facilitates understanding the Laloux model, and the managers have a technical background with a long history in the organisation, which makes them aware of the organisation's capabilities. The process starts with the involvement of a small group of people (Llavor group) and it is then expanded (Planter group). As well as discussing the bases of the Laloux model, six working groups are formed (How to organise more effective meetings, Physical spaces, Spaces for reflection/trust, Time bank, Annual ASPB staff day, and Space for listening to the voice of ASPB workers) and informative workshops are organised for the whole organisation in which 67 people participated. In total, some 120 people from the organisation have participated in Planter group activities. The success of the first initiatives should help to ensure that the values and principles cultivated go beyond the frontiers of the projects to become a generalised style of management. (AU)

[Reinventing a public health organization]. / Reinventando una organización de salud pública.

The most advanced organizations are decentralized, collaborative and adaptive. This gives them the ability to manage complex situations. Laloux calls these organizations Teal. The aim of this manuscript is to describe the process of implementation of the Teal management model in the Agència de Salut Pública de Barcelona (ASPB). There is a triple opportunity for innovation at the ASPB: political change towards a progressive government, the organisation is in a moment of massive renewal of its staff and there is a generational change that facilitates understanding the Laloux model, and the managers have a technical background with a long history in the organisation, which makes them aware of the organisation's capabilities. The process starts with the involvement of a small group of people (Llavor group) and it is then expanded (Planter group). As well as discussing the bases of the Laloux model, six working groups are formed (How to organise more effective meetings, Physical spaces, Spaces for reflection / trust, Time bank, Annual ASPB staff day, and Space for listening to the voice of ASPB workers) and informative workshops are organised for the whole organisation in which 67 people participated. In total, some 120 people from the organisation have participated in Planter group activities. The success of the first initiatives should help to ensure that the values and principles cultivated go beyond the frontiers of the projects to become a generalised style of management.

[Universal prevention of substance use in school settings: the need for continuous monitoring]. / La prevención universal del consumo de drogas en el entorno escolar: el valor de la monitorización continua.

This paper documents the management of two programs for the universal prevention of substance use offered in secondary schools by the public health services of the city of Barcelona, reviewing the period from 1989-1990 to 2016-2017. Both programs had proven effectiveness in evaluations with a comparison group, they are promoted by the public health agency free of cost, and are taught by teachers, using standardized manuals with support materials and training. The coverage achieved over recent years declined from 40% to 25%. Changes observed in the acceptance and implementation of these programs could be related with logistics and follow-up by the public health services, changes in substance availability, and with budget cuts in education. The monitoring of effective programs by public health services is essential to preserve their actual implementation.

Investigaciones sobre calidad en trabajos de terminación de la Especialidad Organización y Administración de Salud / Research about quality in residence completion works for the specialty of health management and organization

Introducción: El esfuerzo de las universidades por mejorar la calidad de los servicios sanitarios conlleva a elevar la cultura de calidad, y a implementar estrategias de investigación y reingeniería de procesos. Objetivo: Caracterizar la investigación de la mejora continua de la calidad en los trabajos de terminación de la Especialidad de Organización y Administración de Salud. Métodos: Revisión integrativa de los trabajos finales de la residencia en el período 2015-2018 en la Escuela Nacional de Salud Pública. En la búsqueda se utilizaron las palabras clave: satisfacción, calidad en salud, trabajos de terminación de la especialidad y Especialidad Organización y Administración de Salud. Resultaron seleccionadas 31 investigaciones, sometidas a un análisis de calidad metodológica. Resultados: El mayor número de trabajos correspondió a 2018, concentrados fundamentalmente en Cienfuegos y Camagüey. La categoría evaluación de la calidad del proceso de atención médica resultó la más recurrente. Se utilizaron diversos enfoques de calidad y predominó el sistémico de estructura, proceso y resultados. Conclusiones: La calidad de los servicios de salud constituye un tema de investigación de interés para los egresados; sin embargo, es escasa la utilización de otros enfoques de calidad que no estén relacionados con el enfoque sistémico. Las investigaciones realizadas permitieron identificar dificultades e insatisfacciones de los usuarios externos y de los prestadores de salud, relacionadas fundamentalmente con la dimensión estructura(AU)

Introduction: The effort of universities to improve the quality of health services leads to building up a culture of quality, and to implementing strategies oriented to research and process reengineering. Objective: To carry out an integrative review of the completion works of the specialty Health Management and Organization and which investigate the quality of health services in Cuba. Methods: Integrative review of the final works of the residence in the period 2015-2018 in the National School of Public Health. In the search, the following keywords were used: satisfacción [satisfaction], calidad en salud [quality in health], trabajos de terminación de la especialidad [residence completion works], and especialidad Organización y Administración de Salud [specialty Health Management and Organization]. 31 investigations were selected and subjected to a methodological quality-based analysis. Results: The largest number of works corresponded to 2018, which were mainly concentrated in the provinces of Cienfuegos and Camagüey. The category evaluation of the quality of the medical care process was the most recurrent. Various quality-based approaches were used, while the systemic approach of structure, process and results predominated. Conclusions: The quality of health services constitutes a research topic of interest to graduates; however, the use is scarce of other quality-based approaches not related to the systemic approach. The research carried out allowed to identify difficulties and dissatisfactions of external users and health providers, mainly related to the structural dimension(AU)

[Public health services: reading their available reports]. / Los servicios de salud pública: una lectura de los informes disponibles.

The objective of this study is to analyze the performance of regional public health services in Spain using the information accessible in their annual reports. A search of these was conducted, and 9 were obtained from the 17 Autonomous Communities. Their analysis shows some variation in the structure of the organizations providing public health services, as well as in the published contents and in the indicators used for management. The service portfolio, annual objectives and resources allocated are not always detailed. If the evaluation of public services and its dissemination are basic for transparency and quality management, there is much room for improvement. The compilation of annual reports by public health services is not systematic, and those that exist provide insufficient information for a comparative analysis of their activity, effectiveness and efficiency.

[Adapting the service portfolio of a public health organisation to shrinking resources]. / Adaptación de los servicios de una organización de salud pública a la disminución de los recursos.

This paper describes the review process of the Agency of Public Health of Barcelona's service portfolio in response to the budget cuts introduced since 2010 in the public administrations in Spain. A working group reviewed the different business activities, taking into account their costs and generated revenue and their justification, assessing factors such as the existence of legal constraints, tied funding, explicit demands from the founding administrations and other actors that may be capable of undertaking particular activities. The changes and their consequences are described. The new service portfolio has been consolidated and is considered ratified by the Agency board, which was renewed after political changes. We conclude that this is because it was based on professional consensus and management criteria, which are key for the smooth operation of a public autonomous executive organisation.

[Health reports as the centrepiece of public health services]. / Los informes de salud como eje de los servicios de salud pública.

The main objective of health reports is to contribute to the health improvement of a specific population. They are an essential support tool for the design and planning of health policies and can also be used for accountability and evaluation. This study assesses various types of health report, including that used by the City of Barcelona (Spain), with a focus on social determinants, as well as an international health report more centred on the impact of health services. Some suggestions are proposed about the appropriateness and best use of these documents, including: the need for effective communication between technical professionals and politicians through meetings and dialogue; commitment to transparency, both authors (by means of the declaration of interests) and in terms of the information reported and with the maximum level of participation; to promote the use of a conceptual framework of social determinants of health; a focus on health inequalities; the inclusion of information relevant to policy action; the organisation of information in such a way that it allows comparison or benchmarking with similar areas and prospectively; presenting the information in an attractive way using elements such as rankings, maps or other tools; and the design of communication strategies adapted to key stakeholders.

Contribuições da enfermagem para aprimoramentos no gerenciamento da assistência domiciliar à saúde / Nursing's contributions to improvements in home healthcare management

Objetivo: apresentar possibilidades de aprimoramento a partir das dificuldades e lacunas no gerenciamento da assistência domiciliar apontadas pelos gerentes dos setores público e privado. Método: pesquisa qualitativa utilizando a teoria fundamentada nos dados. Coletaram-se os dados por meio de entrevistas semiestruturadas com nove gerentes que atuavamem instituições públicas e privadas que realizavam assistência domiciliar em um município de grande porte da região sul do Brasil. Para análise utilizou-se codificação aberta, axial e seletiva. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa, registro: 631.168.08.10, CAAE: 0062.0.091.000-08. Resultados:foram elencados aspectos paraoaprimoramento da gestão em assistência domiciliar em relação à formação acadêmica e educação permanente; auxílio de redes sociais de apoio; infraestrutura; e recursos humanos. Conclusão:os aspectos citados vislumbram a possibilidade de um melhor trabalho para os gerentes em saúde, de forma a contribuir com a satisfação das necessidades da população na assistência domiciliar.(AU)

Objective: to discuss improvement possibilities from the difficulties and deficiencies in home healthcare management pointed out by managers of the public and private sectors. Method: qualitative research using grounded theory. The data were collected through semistructured interviews with nine managers who worked in public and private institutions that provided home healthcare in a large municipality of southern Brazil. Open, axial, and selective coding was used for the analysis of the data. The research was approved by the Research Ethics Committee, registration: 631.168.08.10, CAAE: 0062.0.091.000-08. Results: the aspects for improvement of home healthcare management found were related to: higher and continuing education; aid of social support networks; infrastructure; and human resources. Conclusion: the aspects mentioned reveal the possibility of better work for healthcare managers, so as to contribute to meeting the needs of the population in home healthcare.(AU)

Objetivo: presentar las posibilidades de mejora de las dificultades e insuficiencias en la administración de la atención domiciliaria señaladas por gerentes de los sectores público y privado. Método: investigación cualitativa a través de la teoría fundamentada en los datos. Los datos fueron recogidos por medio de entrevistas semiestructuradas con nueve gerentes que actuaban en instituciones públicas y privadas que realizaban atención domiciliaria en un gran municipio del sur de Brasil. Para el análisis se utilizó codificación abierta, axial y selectiva. La investigación fue aprobada por el Comité de Ética en Investigación, registro: 631.168.08.10, CAAE: 0062.0.091.000-08. Resultados: fueron enumerados aspectos para la mejora de la administración de asistencia domiciliar relacionados con: la educación superior y continua; ayuda de las redes sociales de apoyo; infraestructura; y recursos humanos. Conclusión: los temas citados dejan ver la posibilidad de un mejor trabajo para gerentes de la salud, con el fin de contribuir a satisfacer las necesidades de la población en atención domiciliaria. (AU)

Evolución del marco normativo de la salud ambiental en Colombia / Environmental health: the evolution of Colombia's current regulatory framework

Este ensayo presenta un análisis sobre la evolución del manejo de la salud ambiental en el país desde el Código Sanitario nacional (1979) hasta la ley 100 y Ley 99 de 1993 y la Política de Salud Ambiental de Bogotá D.C. Propone un modelo conceptual para el manejo de la salud ambiental en tres niveles: a) proximal (ambiente físico, químico y biológico), b) intermedio (ambiente natural y cultural) y c) distal (estructuras de poder económico, político y social) y se analizan aspectos relevantes de la Política Distrital de Salud Ambiental con base en el modelo propuesto.

This essay presents an analysis of the evolution of environmental health management in Colombia, covering the period from the introduction of the Colombian Healthcare Code (1979) to laws 99 and 100 in 1993 and the introduction of Environmental Health Policy in Bogotá DC (2011). It proposes a conceptual model for environmental health management at three levels: proximal (physical, chemical and biological setting), intermediate (natural and cultural environment) and distal (economic, political and social structures). Relevant aspects of environmental health policy in Bogotá are analysed based on the proposed model.

La especialidad en Organización y Administración de Salud Pública y la Escuela Cubana de Salud Pública / The public health organization and management specialty and the National School of Public Health

Se realiza un recorrido histórico que abarca el desarrollo de la Escuela Cubana de Salud Pública, pasando por la etapa de la Escuela de Higienistas Cubanos con el Dr. Carlos J. Finlay al frente, hasta llegar al momento actual. Se destaca la negativa repercusión de la extinción de la especialidad de Organización y Administración de Salud Pública dentro de los estudios de posgrado en Cuba desde hace más de 20 años. Se hace hincapié en que hoy más que nunca en el Sistema Nacional de Salud de Cuba resulta imposible ignorar la necesidad de la existencia de la especialidad, surgida en la práctica y desarrollada desde hace más de 200 años, que si bien se ha llamado de diversos modos en el mundo, ha sido y es el diario quehacer de un sin número de profesionales que intentan dirigir sobre bases científicas las tareas propias de los sistemas de salud. Disponer de profesionales de la salud pública competentes es una prioridad absoluta para el buen desempeño y perfeccionamiento constante del Sistema Nacional de Salud y que en la consecución de este noble propósito, la especialidad de Organización y Administración de Salud Pública, una vez que surja de nuevo con este nombre o con otro, se consolide en el tiempo y cumpla su encargo social coherentemente, podrá ser de suma utilidad

A historical review covering the development of the Cuban School of Public Health, the stage of the Cuban School of Hygienists led by Dr. Carlos J. Finlay, and the present time was made. Emphasis was made on the negative impact of the elimination of the public health organization and management specialty from the graduate studies in Cuba for more than 20 years. It is stressed that today more than ever, it is not longer possible to ignore the need for this over 200 years-old specialty to be rescued; even though it has been called differently worldwide, it has been and it is the daily work of a number of professionals who attempt to lead the tasks inherent to the health systems on a scientific basis. The availability of competent professionals in public health is a priority for good performance and constant improvement of the national health systems, and to accomplish this, the public health organization and management specialty could be very useful, once it re-emerges under the same or a new name, becomes stronger and coherently fulfils its social task

La especialidad en Organización y Administración de Salud Pública y la Escuela Cubana de Salud Pública / The public health organization and management specialty and the National School of Public Health

Se realiza un recorrido histórico que abarca el desarrollo de la Escuela Cubana de Salud Pública, pasando por la etapa de la Escuela de Higienistas Cubanos con el Dr. Carlos J. Finlay al frente, hasta llegar al momento actual. Se destaca la negativa repercusión de la extinción de la especialidad de Organización y Administración de Salud Pública dentro de los estudios de posgrado en Cuba desde hace más de 20 años. Se hace hincapié en que hoy más que nunca en el Sistema Nacional de Salud de Cuba resulta imposible ignorar la necesidad de la existencia de la especialidad, surgida en la práctica y desarrollada desde hace más de 200 años, que si bien se ha llamado de diversos modos en el mundo, ha sido y es el diario quehacer de un sin número de profesionales que intentan dirigir sobre bases científicas las tareas propias de los sistemas de salud. Disponer de profesionales de la salud pública competentes es una prioridad absoluta para el buen desempeño y perfeccionamiento constante del Sistema Nacional de Salud y que en la consecución de este noble propósito, la especialidad de Organización y Administración de Salud Pública, una vez que surja de nuevo con este nombre o con otro, se consolide en el tiempo y cumpla su encargo social coherentemente, podrá ser de suma utilidad(AU)

A historical review covering the development of the Cuban School of Public Health, the stage of the Cuban School of Hygienists led by Dr. Carlos J. Finlay, and the present time was made. Emphasis was made on the negative impact of the elimination of the public health organization and management specialty from the graduate studies in Cuba for more than 20 years. It is stressed that today more than ever, it is not longer possible to ignore the need for this over 200 years-old specialty to be rescued; even though it has been called differently worldwide, it has been and it is the daily work of a number of professionals who attempt to lead the tasks inherent to the health systems on a scientific basis. The availability of competent professionals in public health is a priority for good performance and constant improvement of the national health systems, and to accomplish this, the public health organization and management specialty could be very useful, once it re-emerges under the same or a new name, becomes stronger and coherently fulfils its social task(AU)

O ensino da gestão do sistema de saúde: avaliação de estudantes de enfermagem e medicina / The teaching of health system management: evaluation of Nursing and medical students

O desenvolvimento desta pesquisa focaliza as questões relacionadas ao Ensino da Gestão do Sistema de Saúde, mais especificamente, no que refere à relevância da temática na formação dos profissionais de Enfermagem e Medicina. O estudo tem como objetivos analisar as experiências dos estudantes dos cursos focalizados, com o ensino de gestão do sistema de saúde; identificar o nível de desenvolvimento do ensino da gestão do sistema de saúde nestes cursos e propor para o processo de mudanças no seu respectivo ensino, quanto à gestão do sistema de saúde, na perspectiva da autogestão. A fundamentação na Análise Institucional como marco teórico-metodológico, busca articular um instrumental de análise e intervenção em instituições, com objetivo de potencializar grupos e comunidades para processos de mudanças. Trata-se de uma pesquisa de natureza qualitativa, de caráter descritivo exploratório de campo, com a participação de 24 sujeitos, assim distribuídos: 12 estudantes do curso de Enfermagem e 12 de Medicina de uma universidade do interior do Rio de Janeiro. A coleta de dados adotada se deu por meio de entrevista em grupo focal. A análise e interpretação dos dados foram subsidiadas pela técnica de análise do discurso. Os resultados destacam que os estudantes avaliam entre os aspectos fundamentais para a sua formação, a diversificação dos cenários de ensino e aprendizado e das práticas de saúde; desenvolvimento do conceito ampliado de saúde e a integração numa perspectiva interdisciplinar. Nesse sentido, novas possibilidades de desenvolvimento de práticas educativas mais participativas devem ser adotadas, sendo fundamental a vontade e articulação das instituições formadoras, serviços de saúde, comunidade e diversos setores da sociedade civil, em conjunto com compromisso dos docentes para implementar a transformação, com o fim de possibilitar a participação de todos os envolvidos no processo de autogestão

The development of this research focuses the questions about the teacher of management of health system, specifically in relation the thematic relevance at formation professionals in nursing and medicine. The knowledge has with objectives analyze the experience of students in the course focuses with the management of health system; recognize the level of development at the management of health system in nursing and medicine curses and propose for the change process in your respective teaching about the management health system from the perspective of self-management. The foundation in institutional analysis how mark theoretical -methodological , search articulate a analyses instrumental and intervention in institutions, with the objective to potentiate the groups and communities for the change process. It´s a research of qualitative nature and exploratory character decrypted in field, with participation of 24 subjects, 12 students of medicine and 12 students of nursing at the university in country of Rio de Janeiro. The data collection adopted was made with a interview in a focal group. Analysis and interpretation of data are being subsidized by the technique of discourse analysis. The results show that the students assess between fundamental aspects for your formation, the diversification of teaching and learning scenarios and health practices; development of the expanded concept of health and wholeness from an interdisciplinary perspective. Accordingly, new possibilities for developing more participatory educational practices should be adopted will be fundamental and articulation of educational institutions, health services, community and various sectors of civil society, together with the commitment of teachers to implement the transformation, in order to enable participation of all involved in the process of selfmanagement

El desarrollo de esta investigación se centra en temas relacionados con la Educación para la Salud Sistema de Gestión, más específicamente, con respecto a la relevancia del tema en la formación de enfermería y medicina. El estudio tiene como objetivo examinar las experiencias de los estudiantes de enfoque, con la educación de gestión del sistema de salud, identificando el nivel de desarrollo de la educación en la gestión del sistema de salud en estos cursos y proponer cambios en el proceso de enseñanza en sus respectivos, en relación con la gestión del sistema de salud desde la perspectiva de la autogestión. El análisis de lógica institucional como marco teórico-metodológico, busca articular un análisis instrumental y la intervención en las instituciones, con el fin de empoderar a los grupos y comunidades a los procesos de cambio. Se trata de una investigación cualitativa y el campo exploratorio descriptivo, con la participación de 24 personas, distribuidas de la siguiente manera: 12 estudiantes de Enfermería y Medicina, 12, una universidad en el interior de Río de Janeiro. La recolección de datos se adoptó hace a través de entrevistas con grupos focales. Análisis e interpretación de los datos están siendo subsidiadas por la técnica del análisis del discurso. Los resultados ponen de manifiesto que los estudiantes evaluar los aspectos fundamentales de su formación, la diversificación de la enseñanza y el aprendizaje de los escenarios y las prácticas de salud, el desarrollo del concepto ampliado de salud y la integridad de una perspectiva interdisciplinaria. En este sentido, las nuevas posibilidades para el desarrollo de las prácticas educativas más participativo debe ser aprobada, será fundamental y la articulación de las instituciones educativas, los servicios de salud, la comunidad y los diversos sectores de la sociedad civil, junto con el compromiso de los docentes para implementar la transformación, con fin de permitir la participación de todos los interesados en el proceso de auto-gestión

Efectos de la reforma en salud en las acciones de control de tuberculosis en el Valle del Cauca, Colombia

Se describen efectos de la implementación del Sistema General de Seguridad Social en Salud - SGSSS, en la década de los noventa, sobre las acciones de control de tuberculosis en el Valle del Cauca, Colombia. El estudio se llevó a cabo en siete municipios del departamento mediante un abordaje complementario de técnicas de recolección y análisis de información cualitativa y cuantitativa. Se presentó una reducción en el papel de planeación, control y regulación de las acciones de tuberculosis por parte de las entidades estatales. Los nuevos actores y las nuevas fuentes de financiación no produjeron los efectos positivos esperados en las acciones de control de tuberculosis; la cantidad y calidad de las acciones de tuberculosis se redujeron por el efecto de la reforma sectorial. Se concluye que la implementación del SGSSS afectó de manera negativa las acciones de control de tuberculosis.

Effects of the health sector reform upon tuberculosis control interventions in Valle del Cauca, Colombia Implementation of the General System of Social Security in Health (GSSSH) was initiated for the control of tuberculosis (TBC) in the state of Valle del Cauca, Colombia, between 1991- 2000. A study of its effects was centered in 7 municipalities of Valle del Cauca with a complementary set of qualitative and quantitative techniques for data collection and analysis. A reduction in planning, control and regulation of TBC activities by state agencies was observed. New administrative structures and new funding sources did not produce the expected positive effects on tuberculosis control. Instead, the quantity and quality of tuberculosis control activity were reduced as a consequence of the health sector reform. In conclusion, GSSSH implementation affected negatively tuberculosis control activity.