Ao assumir o compromisso com a prevenção e tratamento, baseada no princípio da integralidade, a estratégia brasileira, fez a diferença na resposta nacional à aids nas décadas de 1980/90 e criou um novo paradigma que mostrou-se avançado do ponto de vista técnico, ético e político, contribuindo para a mudança nas recomendações das agências internacionais (OMS\\Banco Mundial) - do \"não tratar e só prevenir\" do início dos anos 1990, para o \"Tratamento como Prevenção\", base da atual proposta dos 90/90/90. Essa estratégia de controle da epidemia concentra responsabilidade na Rede de Serviços, em um período de discussão sobre mudanças no modelo de atenção a ser priorizado no país. Características relevantes dos contextos político e programáticos permitiram uma maior efetivação do cuidado às PVHA no Estado de São Paulo. O objetivo do presente estudo é recuperar a história do Centro de Referência e Treinamento em DST/Aids (CRT) na gestão e organização programática do cuidado em HIV/Aids no Estado de São Paulo, no período de 1988 a 2015, interpretando-a sob a perspectiva dos aspectos facilitadores e limitadores da incorporação prática do princípio da integralidade às ações de saúde. Realizou-se, nesse sentido, uma revisão narrativa da literatura sobre o tema da integralidade no campo da Saúde Coletiva Brasileira nas últimas cinco décadas. Tomando por base o cotejamento com esse desenvolvimento conceitual, a trajetória do CRT foi analisada por meio de entrevistas com atores-chaves no processo da gestão e organização programática do cuidado das PVHA no Estado de São Paulo, e análise dos documentos produzidos no processo. Esta análise foi organizada em torno de dois grandes eixos temáticos: (1) a criação e estruturação do CRT, e (2) as relações entre o CRT, os Programas Municipais de DST/aids e a rede de serviços assistenciais no Estado de São Paulo. Entre os resultados do estudo, destacam-se o resgate e reflexão crítica sobre o desenvolvimento dos discursos tecnocientíficos sobre integralidade no contexto das propostas de reforma da saúde no Brasil; a incorporação desses construtos às propostas desenvolvidas pelo CRT, especialmente em torno aos conceitos de vulnerabilidade, cuidado, clínica ampliada e direitos humanos em saúde; e a identificação de arranjos institucionais, estratégias técnicas e configurações políticas que permitiram ao CRT o exercício articulado de três níveis de gestão do cuidado (das PVHA, dos serviços e da Rede) numa mesma plataforma. Conclui-se apontando alcances e limites na efetivação da integralidade, que se mostraram desiguais nos três níveis de gestão do cuidado. Aponta-se maiores avanços na dimensão gerencial da rede e as maiores dificuldades na efetivação da integralidade no cuidado das PVHA e na gestão dos serviços de saúde / Assuming commitment to the prevention and treatment based on the principle of comprehensiveness (integralidade), the Brazilian strategy made the difference in the national response to AIDS in the decades of 1980/90. Its cutting edge strategy created a new paradigm from technical, ethical and political points of view, contributing to the change in recommendations of international agencies (WHO \\ World Bank) - from \"not to treat and only prevent\" of the early 1990s, to \"treatment as prevention\", basis of the current 90/90/90 proposal. This epidemic control strategy focuses responsibility in Service Network, in a period of discussion of changes in the model of care to be prioritized in the country. Relevant characteristics of the political and programmatic contexts enabled greater effectiveness of care for PLWHA in the state of São Paulo. The aim of this study is to recover the history of the STD / AIDS Reference and Training Center (CRT) in the management and programmatic organization of care in HIV / AIDS in the State of São Paulo, in the period 1988-2015, interpreting it in the prospect of facilitating and limiting factors for practical embodiment of the principle of comprehensiveness in health care. A narrative review of the literature on comprehensiveness care was performed in the Brazilian Public Health field for the past five decades. Based on the comparison with this conceptual development, the trajectory of CRT was analyzed through interviews with key stakeholders in the process of management and organization of programmatic care of PLWHA in the state of São Paulo, and analysis of the documents produced in the process. We organized the analysis around two major themes: (1) the creation and structuring of CRT, and (2) the relationship between the CRT, the STD/AIDS Municipal Program and the network of health care services in São Paulo. Among the study\'s findings, we highlight the rescue and critical reflection on the development of techno-scientific discourses on comprehensiveness in the context of health reform proposals in Brazil; the incorporation of these constructs in the proposals developed by the CRT, especially around the concepts of vulnerability, care, extended clinic and human rights in health; and the identification of institutional arrangements, technical strategies and policy settings that allowed the CRT to articulate three care management levels (of PLWHA, services and network) on the same platform. We conclude pointing advances and limits in the effectuation of comprehensiveness, which proved to be unequally reachable in the three levels of care management. There were major advances noticed in the managerial dimension of the network and higher difficulties to implement comprehensiveness in the care of PLWHA and management of health services

As características e conceitos dos sistemas complexos adaptativos (SCA) e a dinâmica de sistemas podem ser utilizados como ferramentas altamente efetivas para analisar a organização de um sistema de saúde. Várias das propriedades dos SCA são relevantes para este propósito especialmente a emergência de padrões auto-organizativos. Os objetivos são descrever os fluxos intermunicipais de gestantes para a resolução da gravidez visando compreender os fatores que influenciam estes deslocamentos considerando os recursos hierárquicos disponíveis e propor modelos explicativos da regionalização ao cuidado ligado à gravidez e ao parto e à regulação do sistema. Esta pesquisa aplicou conceitos de sistemas complexos adaptativos para estudo dos fluxos de gestantes entre municípios no sistema de atenção ao parto e puerpério na região de Ribeirão Preto- São Paulo determinando as áreas de captação de pacientes e fatores que influenciam deslocamentos. Para isto foram construídas matrizes de origem-destino das gestantes que tiveram a resolução da gravidez na área do Departamento Regional de Saúde XIII (DRS XIII) sediado em Ribeirão Preto no ano de 2012. Foram utilizadas ferramentas ligadas ao fluxo de altas disponíveis no Observatório Regional de Atenção Hospitalar, aplicando modelos de interação espacial e análise de redes para determinar a suficiência das regiões e sub-regiões para a realização dos procedimentos selecionados e explorar os fatores determinantes dos deslocamentos de pacientes. Em 2012, os hospitais de Ribeirão Preto (sede da DRS XIII) receberam 3807 internações por parto de fora do município, das quais 597 foram provenientes de 114 municípios fora da jurisdição do DRS XIII. Observou-se que 25 % das pacientes se deslocaram a outro município para a resolução da gravidez, percorrendo uma distancia média ponderada de 27 km. Os fluxos de pacientes mostram uma alta concentração em Ribeirão Preto e Sertãozinho, embora grande parte dos casos derivados não requeriam serviços de alta complexidade. O DRS XIIII é suficiente como região para a resolução destes casos e se comporta como um importador de pacientes de uma região mais ampla que compreende ao menos 60 municípios. Vários municípios do DRS XIII também têm serviços suficientes para as necessidades de sua população. O sistema de regulação do estado e do DRS XIII e as preferências dos pacientes, famílias e médicos são determinantes mais importantes dos fluxos que as distancias geográficas. A evolução da demografia e epidemiologia, da geografia política e organizacional do SUS, da oferta de serviços e os comportamentos e preferências dos agentes (usuários, médicos e outros) devem ser analisadas em conjunto como sistemas dinâmicos para compreensão dos fluxos de pacientes e assim reformular as redes de serviços para responder melhor às necessidades da assistência materna e puerperal na região coberta pelo DRS III. / The characteristics and concepts of complex adaptive systems (CAS) and system dynamics can be used as highly effective tools to analyze the organization of a health system. Several of the properties of an CAS are relevant to this purpose, especially the emergence of self-organizing patterns. Objectives: To describe the intermunicipal flows of pregnant women at the end of the pregnancy, in order to understand the factors that influence these displacements considering the available hierarchical resources and propose explanatory models of the regionalization of care related to pregnancy, delivery and regulation of the system. This research applied concepts of complex adaptive systems to study the flows of pregnant women among municipalities in the maternal care system in the Ribeirão Preto - São Paulo region, determining the catchment areas of patients and analyzing the factors that influence their displacement. For this purpose, the research gathered origin-destination matrices of the pregnant women who had the pregnancy resolution in the area of the Regional Health Department XIII (DRS XIII), based in Ribeirão Preto, for the year 2012. The tools used for these matrices were built in the discharge-flow utility available at the Hospital Regional Observatory webpage. Using spatial interaction models and network analysis it was possible to determine the sufficiency of regions and sub-regions to perform the selected procedures and to explore the determinants of patient travel. In 2012, maternity hospitals in Ribeirão Preto (headquarters of DRS XIII) received 3807 hospitalizations related to deliveries coming from outside the municipality, of which 597 came from 114 municipalities outside the jurisdiction of DRS XIII. It was observed that 25% of the patients moved to another municipality for the events related to the end of the pregnancy, traveling a weighted average distance of 27 km. Patient flows show a high concentration in Ribeirão Preto and Sertãozinho, although a majority of the derived cases did not require services of high complexity. DRS XIIII is sufficient as a region to resolve these cases and behaves as an net importer of patients from a wider region comprising at least 60 municipalities. Several municipalities of DRS XIII also have sufficient services for the needs of their population. The system of regulation of the state and DRS XIII and the preferences of patients, families and doctors are more important determinants of flows than geographical distances. The evolution of demography and epidemiology, the political and organizational geography of the SUS, the service offerings and the behaviors and preferences of the agents (users, doctors and others) should be analyzed together as dynamic systems for understanding patient flows allowing to redesign the service networks to better respond to the needs of maternal and child care in the region covered by DRS XIII.

Indiana University-Purdue University Indianapolis (IUPUI) / Objectives: To examine the effect of a collaborative care program for late-life depression on risk of diabetes among depressed, older adults. Method: We conducted a 9-year follow-up study of 160 older, primary care patients with a depressive disorder but without diabetes enrolled at the Indiana sites of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial. Results: Surprisingly, the rate of incident diabetes in the collaborative care group (22/80 = 27.5%) was twice the rate observed in the usual care group (11/80 = 13.7%). Cox proportional hazards models adjusted for randomization status (HR = 1.94, p = .076), demographic factors (HR = 1.94, p = .075), and additionally for diabetes risk factors (HR = 1.73, p = .157) indicated that the risk of incident diabetes did not differ between the collaborative care and usual care groups, with collaborative care patients remaining at a nonsignificant increased risk. Conclusions: Our novel findings suggest that depression may not be a casual risk factor for diabetes and that depression treatment may be insufficient to reduce the excess diabetes risk of depressed, older adults.

The comprehensive cancer control approach is used by state, tribes, tribal organizations, territorial and Pacific Island Jurisdiction cancer coalitions to spur local implementation of cancer plans to reduce the burden of cancer in jurisdictions across the country. There is a rich diversity of models and approaches to the development of relationships and scope of planning for cancer control activities between coalitions and advocates in local communities. The national comprehensive cancer control philosophy provides an operational framework while support from the Centers for Disease Control and Prevention enables coalitions to act as catalysts to bring local partners together to combat cancer in communities. This manuscript describes multiple characteristics of cancer coalitions and how they are organized. Two models of how coalitions and local partners collaborate are described. A case study method was used to identify how five different state and tribal coalitions use the two models to organize their collaborations with local communities that result in local implementation of cancer plan priorities. Conclusions support the use of multiple organizing models to ensure involvement of diverse interests and sensitivity to local cancer issues that encourages implementation of cancer control activities.

No description available.

Hintergrund Mit dem ParkinsonNetzwerk Ostsachsen (PANOS) soll ein intersektorales, pfadbasiertes und plattformunterstütztes Versorgungskonzept etabliert werden, um trotz steigender Behandlungszahlen eine flächendeckende Parkinson-Versorgung mit adäquaten Therapien zu unterstützen. Fragestellung Welche Barrieren könnten die Akzeptanz und eine erfolgreiche Verstetigung des PANOS-Behandlungspfades gefährden? Methode Implementierungsbarrieren wurden über eine selektive Literaturrecherche identifiziert und in einer Onlinebefragung von 36 projektassoziierten Neurolog*innen und Hausärzt*innen priorisiert. Die Auswertung der Ergebnisse erfolgte anonymisiert und deskriptiv. Ergebnisse Dreizehn mögliche Implementierungsbarrieren wurden identifiziert. Es nahmen 11 Neurolog*innen und 7 Hausärzt*innen an der Onlineumfrage teil. Die befragten Neurolog*innen sahen in Doppeldokumentationen sowie in unzureichender Kommunikation und Kooperation zwischen den Leistungserbringenden die größten Hindernisse für eine Akzeptanz von PANOS. Hausärzt*innen beurteilten u. a. die restriktiven Verordnungs- und Budgetgrenzen und den möglicherweise zu hohen Zeitaufwand für Netzwerkprozesse als hinderlich. Diskussion Doppeldokumentationen von Patienten- und Behandlungsdaten sind zeitintensiv und fehleranfällig. Die Akzeptanz kann durch adäquate finanzielle Kompensation der Leistungserbringenden erhöht werden. Das hausärztliche Verordnungsverhalten könnte durch die Verwendung interventionsbezogener Abrechnungsziffern positiv beeinflusst werden. Die Ergebnisse zeigen u. a. einen Bedarf an integrativen technischen Systemlösungen und sektorenübergreifenden Dokumentationsstrukturen, um den Mehraufwand für Leistungserbringende zu reduzieren. Schlussfolgerung Eine Vorabanalyse der Einflussfaktoren von PANOS sowie die Sensibilisierung aller mitwirkenden Akteure für potenzielle Barrieren sind entscheidend für die Akzeptanz des Versorgungsnetzwerkes. Gezielte Maßnahmen zur Reduzierung und Vermeidung identifizierter Barrieren können die anwenderseitige Akzeptanz erhöhen und die Behandlungsergebnisse optimieren. / Introduction The ParkinsonNetwork Eastern Saxony (PANOS) aims to establish an intersectoral, path-based and platform-supported care concept in order to support comprehensive care with adequate therapies despite the increasing number of patients to be treated. Objective Which barriers may limit the acceptance and successful implementation of PANOS? Methods Implementation barriers were identified through a selective literature review and prioritized in an online survey of 36 project-associated neurologists and general practitioners. The results were analyzed anonymously and descriptively. Results Thirteen potential implementation barriers were identified. Eleven neurologists and seven general practitioners participated in the online survey. The surveyed neurologists assessed double documentation and inadequate communication and cooperation between the service providers as the biggest obstacles to the acceptance of PANOS. General practitioners rated the restrictions for prescription and budget and the potentially high time expenditure required for network activities as barriers. Discussion Double documentation of patient and treatment data is time consuming and prone to errors. Adequate financial compensation could increase service providers’ willingness to participate in such measures. In addition, the prescribing behavior of general practitioners may be influenced positively by the use of intervention-related accounting numbers. The results indicate a need for integrative technical system solutions and intersectoral documentation structures in order to reduce the additional effort for service providers. Conclusion Analyzing the influencing factors of the PANOS network, and raising the awareness of all participating service providers to potential barriers, are decisive measures for the acceptance of the care network. Targeted measures to reduce and avoid identified barriers can increase user acceptance and optimize treatment results.

Este estudo avaliou a repercussão da implantação Complexo Regulador (CR) do Sistema Público Municipal de Serviços de Saúde para a rede de atenção de Ribeirão Preto-SP. Teve por aporte teórico a avaliação em saúde e como objetivos específicos: avaliar o alcance do CR, de acordo com a dimensão cobertura, nos anos de 2004, 2005 e 2006; avaliar o efeito do CR de acordo com a dimensão efetividade social. Estudo de avaliação normativa e pesquisa avaliativa, sendo adotada abordagem quanti-qualitativa. O cenário foi o CR, em RP/SP, em seu espaço funcional e organizacional de operação das ações regulatórias do sistema de atenção, implantado na Secretaria Municipal da Saúde. As fontes primárias, produzidas junto aos trabalhadores de diferentes categorias profissionais que atuavam na gestão e no nível operacional do CR, foram coletadas por meio de entrevista estruturada tendo como eixo temático: implantação do CR, sua função de ferramenta operacional para atenção básica e a relação entre a intervenção proposta e os resultados alcançados. As fontes secundárias foram: documentos oficiais existentes sobre o CR, Atas do Conselho Municipal de Saúde; artigos de jornais locais, Sistema de Informação Ambulatorial e Hospitalar do DATASUS. Para organização dos indicadores de análise, elaborou-se planilha específica, com dados relativos aos indicadores de cobertura: Indicador de Consultas Básicas; Indicador de Consultas Especializadas, Indicador de Internações de Baixa e Média Complexidade; Indicador de Internações de Alta Complexidade. Na análise dos dados primários, foi realizada a análise temática, sendo articulada à análise dos indicadores produzidos. O estudo mostrou que: o CR provocou alterações na acessibilidade organizacional e eqüidade da rede de saúde, tanto na atenção ambulatorial quanto hospitalar; destacou necessidade de constituição de rede solidária de atenção e apresentou a potência da estratégia em ser ferramenta profícua de avaliação e de gestão. A implantação do CR alterou significativamente o processo de trabalho dos sujeitos. A avaliação ainda apontou que, apesar do pouco tempo de implantação, a estratégia do CR é potencialmente capaz de colaborar na sustentabilidade do SUS, mas se fazem necessários: investimento, divulgação e aperfeiçoamento. / This study aimed to evaluate the publicity of the implementation of the Regulator Complex (CR) of the Municipal Public System of Health Services for the care network of Ribeirão Preto, SP, Brazil. The health evaluation provided the theoretical framework and the specific objectives were: evaluate the CR scope according to the coverage dimension in 2004, 2005 and 2006; evaluate the CR effect in terms of social effectiveness. This is a normative evaluation and an evaluative research with a quantitative qualitative approach. The scenario was the CR in RP/SP in its functional and organizational space of regulatory actions operation of the care system implemented in the Municipal Secretary of Health. The primary sources produced with workers of different professional categories who acted in the CR management and in its operational level were collected through structured interview according to the following thematic axis: implementation of the CR, its function as operational tool for the primary care and the relation between the proposed intervention and the results accomplished. The secondary sources were: CR official documents, Minutes of the Municipal Council of Health; local newspapers, outpatient and hospital DATASUS Information System. For the organization of the analysis indexes, a specific data sheet was elaborated, with data related to the coverage indexes: Primary Consultation index; Specialized Consultation Index, Low and Medium Complexity Hospitalizations Index; High Complexity Hospitalization Index. The thematic analysis was used for the primary data which was coordinated with the indexes produced. The study showed that: the CR caused alterations on the organizational accessibility and equity in the health network, both in the outpatient and the hospital care; highlighted the need of creating a comprehensive care network and presented the power of the strategy as a proficient evaluation and management tool. The CR implementation changed significantly the subjects\' work process. The evaluation also pointed that despite the little time of implementation, the CR strategy has potential to benefit the SUS sustainability, though investment, publicity and improvement are necessary.

<p>Старење становништва је велики изазов са којим се суочава светска популација у XXI веку. Становништво Војводине спада у веома старо становништво, а процењује се да ће до средине овог века чак свака трећа особа бити старија од 60 година. Циљ овог рада је био да се процени здравље, разлике у здрављу и коришћење здравствене заштите, као и да се идентификују предиктори&nbsp; здравља и коришћења здравствене заштите код особа старости 65 и више година на територији Војводине. Истраживање представља део Истраживања здравља становништва Србије из 2013. године које је спровело Министарство здравља Републике Србије. Истраживањем је обухваћено 886 испитаника старости 65 и више година са територије Војводине. Инструмент истраживања су били упитници конструисани у складу са упитником Европског истраживања здравља, а подаци о телесној маси, телесној висини и крвном притиску су добијени мерењем. Резултати су показали да су имали већу шансу да процене своје здравље као лошије жене (OR=2,14; 95%CI=[1,42-3,23]; p&lt;0,001), сиромашни (OR=2,92; 95%CI=[1,18-7,20]; p=0,020), испитаници са умереним до тешким ограничењима у обављању кућних активности (OR=3,33; 95%CI=[1,28-8,69]; p=0,014), са присутним јаким болом (OR=2,81; 95%CI=[1,20-6,60]; p=0,017), благим депресивним симптомима или депресивном епизодом (OR=8,90; 95%CI=[3,71-21,32]; p&lt;0,001), оболели од две или више хроничних болести (OR=13,25; 95%CI=[4,05-43,3]; p&lt;0,001) и испитаници са лошијом социјалном подршком (OR=3,00; 95%CI=[1,08-8,34]; p=0,035). Предиктори посете лекару опште медицине били су виши ниво образовања, боље материјално стање, веће издвајање из сопствених прихода за ванболничку здравствену заштиту и мултиморбидитет, док су чешће били хоспитализовани мушкарци, особе нижег нивоа образовања, испитаници који су процењивали своје здравље као лоше или веома лоше. Истраживање је потврдило да постоје значајне неједнакости у здрављу и коришћењу здравствене заштите код старих особа у Војводини, које је потребно смањити свеобухватним јавноздравственим политикама и интервенцијама.</p> / <p>Starenje stanovništva je veliki izazov sa kojim se suočava svetska populacija u XXI veku. Stanovništvo Vojvodine spada u veoma staro stanovništvo, a procenjuje se da će do sredine ovog veka čak svaka treća osoba biti starija od 60 godina. Cilj ovog rada je bio da se proceni zdravlje, razlike u zdravlju i korišćenje zdravstvene zaštite, kao i da se identifikuju prediktori&nbsp; zdravlja i korišćenja zdravstvene zaštite kod osoba starosti 65 i više godina na teritoriji Vojvodine. Istraživanje predstavlja deo Istraživanja zdravlja stanovništva Srbije iz 2013. godine koje je sprovelo Ministarstvo zdravlja Republike Srbije. Istraživanjem je obuhvaćeno 886 ispitanika starosti 65 i više godina sa teritorije Vojvodine. Instrument istraživanja su bili upitnici konstruisani u skladu sa upitnikom Evropskog istraživanja zdravlja, a podaci o telesnoj masi, telesnoj visini i krvnom pritisku su dobijeni merenjem. Rezultati su pokazali da su imali veću šansu da procene svoje zdravlje kao lošije žene (OR=2,14; 95%CI=[1,42-3,23]; p&lt;0,001), siromašni (OR=2,92; 95%CI=[1,18-7,20]; p=0,020), ispitanici sa umerenim do teškim ograničenjima u obavljanju kućnih aktivnosti (OR=3,33; 95%CI=[1,28-8,69]; p=0,014), sa prisutnim jakim bolom (OR=2,81; 95%CI=[1,20-6,60]; p=0,017), blagim depresivnim simptomima ili depresivnom epizodom (OR=8,90; 95%CI=[3,71-21,32]; p&lt;0,001), oboleli od dve ili više hroničnih bolesti (OR=13,25; 95%CI=[4,05-43,3]; p&lt;0,001) i ispitanici sa lošijom socijalnom podrškom (OR=3,00; 95%CI=[1,08-8,34]; p=0,035). Prediktori posete lekaru opšte medicine bili su viši nivo obrazovanja, bolje materijalno stanje, veće izdvajanje iz sopstvenih prihoda za vanbolničku zdravstvenu zaštitu i multimorbiditet, dok su češće bili hospitalizovani muškarci, osobe nižeg nivoa obrazovanja, ispitanici koji su procenjivali svoje zdravlje kao loše ili veoma loše. Istraživanje je potvrdilo da postoje značajne nejednakosti u zdravlju i korišćenju zdravstvene zaštite kod starih osoba u Vojvodini, koje je potrebno smanjiti sveobuhvatnim javnozdravstvenim politikama i intervencijama.</p> / <p>Aging is the great challenge of the XXI century. Population of Vojvodina is very old, and projections indicate that by 2050 one in three persons will be older than 60 years. The aim of this study was to evaluate health, health differences and health care utilization, as well as to indentify predictors of health and health care utilization in people aged 65 and over in Vojvodina. The study represents part of the National health survey Serbia conducted in 2013 by the Ministry of Health of Republic of Serbia. Study included 886 examinees aged 65 and over who were interviewed on the territory of Vojvodina. The instruments were questionnaires designed according to the European Health Interview Survey questionnaire, and data on body mass, body height and blood pressure were measured. Results showed that the highest odds of assessing their health as poor had women (OR=2.14; 95%CI=[1.42-3.23]; p&lt;0.001), participants who belonged to the poor class (OR=2.92; 95%CI=[1.18-7.20]; p=0.020), who had difficulties with instrumental activities of daily living (OR=3.33; 95%CI=[1.28-8.69]; p=0.014), with severe pain (OR=2.81; 95%CI=[1.20-6.60]; p=0.017), with mild depressive symptoms or depressive episode (OR=8.90; 95%CI=[3.71-21.32]; p&lt;0.001), with 2 or more chronic conditions (OR=13.25; 95%CI=[4.05-43.3]; p&lt;0.001) and with poor social support (OR=3.00; 95%CI=[1.08-8.34]; p=0.035). Predictors of visits to general practitioner were higher educational level, affiliation to advantage classes, more out of pocket payment for outpatients health care, and multimorbidity, while the highest odds of hospitalization had males, participants who had low level of education, who assessed their health as poor or very poor. This study confirmed that there are significant differences in health and health care utilization in elderly in Vojvodina, which need to be reduced by comprehensive public health policies and interventions.</p>

Dissertation (Ph.D.)--University of South Florida, 2006. / Title from PDF of title page. Document formatted into pages; contains 95 pages. Includes vita. Includes bibliographical references.

Text in English / Lack of knowledge and skills among health care providers for provision of integrated TB/HIV activities for better health outcomes for co-infected patients is a public health concern. A qualitative, non-experimental, explorative and descriptive research design based on the phenomenological philosophical tradition by Heidegger to broaden hermeneutics was conducted. The study was conducted at Mopani district to explore and describe the experiences of eligible nurse managers relating to the implementation of the TB/HIV activities at management level. A purposive sample of 14 participants was recruited and consent form obtained. An unstructured interview guide, with a grand tour question, was used to conduct face to face individual interviews. Tesch’s method of analysis was employed until two themes, five categories and ten subcategories emerged from the data. The major findings were on challenges experienced by nurse mangers such as shortage of resources, poor planning, lack of support by management and patient related challenges. Recommendations were based on the findings to encourage staff retention strategies, adequate funding for TB control programs, support by management, co-joint planning, team work and effective tracing strategies. / Health Studies / M.A. (Health Studies)