Access to primary care is limited in rural communities across the United States. Evidence supports primary care as the cornerstone of healthcare. The purpose of this project was to explore community perceptions of barriers to primary care access with the aim of learning about ideas for possible interventions that could improve primary care access for Mifflin County residents. Penchansky and Thomas's model of healthcare access provided the theoretical framework for this qualitative phenomenological study. Using a community-based research approach, semistructured, open-ended telephone interviews and qualitative surveys were conducted with 26 participants, including physicians, nurses, and residents. Data were analyzed using Edward and Welch's extension of Colaizzi's 7-step method for qualitative data analysis. Key findings included perceptions that (a) primary care access is limited in Mifflin County due to inadequate health services emanating from insufficient community health centers, provider shortages, health insurance issues; (b) high cost and poor choice of services discourage residents from seeking preventative care; (c) distance from services reduce residents' ability to access primary care; (d) service problems impact the quality of care received, such as a lack of provider training in opiate addiction; and (e) providers and residents should be involved in primary care service planning since they can provide valuable information to help improve access to services. Positive social change could occur through improvement in access to primary care using a collaborative approach and community involvement, in policy formation and service planning.

Typ 2 diabetes är den vanligaste diabetesformen i Sverige och har samband med vår vällevnad. Tidigare studier visar att sjukdomen är mer vanlig bland fysiskt inaktiva och bland människor med ett ökat energiintag. Syftet med studien var att kartlägga sjuksköterskans hälsofrämjande arbete i primärvården vid typ 2 diabetes. En kvalitativ intervjustudie användes för att samla data. Fem sjuksköterskor från olika vårdcentraler i gamla Skaraborgs län deltog. Analysen av intervjuerna resulterade i ett huvudtema och fem underteman. Resultatet visar på att sjuksköterskorna aktivt arbetar med att motivera patienterna till att ändra kostvanor och öka den fysiska aktiviteten i den icke- farmakologiska behandlingen. Sjuksköterskorna använde information, patientrelation, konkret arbete, patientens villkor och mål som verktyg för att få patienterna motiverade. Att förespråka kost och fysisk aktivitet anses vara mycket viktig uppgift för sjuksköterskorna och utgör en central del i deras arbete. / Type 2 diabetes is the most common form of diabetes in Sweden today and is related to our lifestyle. Previous studies indicate that the disease is more common among physical inactive people and in people with increased energy intake. The aim of this study was to survey how nurses´ in primary health care promote lifestyle change in patients with type 2 diabetes. A qualitative interview study was used for data collection. Five nurses from different primary health care settings in old Skaraborgs county participated. The analyses of the interviews resulted in one major theme and five sub themes. The result shows that nurses work actively to motivate patients to change dietary habits and start with daily physical activity as a part of non-drug therapy. The nurses´ used information, nurse- patient relationship, concrete work, goals and the patient terms as tools to get patients motivated. Promoting diet and physical activity is a central part of the nurses’ daily work.

Enligt Socialstyrelsen (2011) avlider cirka 1 500 människor årligen i Sverige på grund av vårdrelaterade infektioner. Den viktigaste åtgärden för att förebygga vårdrelaterade infektioner är att arbeta utifrån basala hygienrutiner (Socialstyrelsen, 2006). Det är idag oklart hur följsamheten till basala hygienrutiner ser ut inom primärvården i Sverige och bland distriktssköterskor. Syftet med studien var att undersöka distriktssköterskors följsamhet till basala hygienrutiner inom primärvården. Studien var baserad på strukturerade observationer och en enkät. Observationerna utfördes av distriktssköterskestudenter och genomfördes vid nio vårdcentraler i Uppsala. Observationsstudien visade att distriktssköterskorna hade god följsamhet till rådande hygienrutiner gällande klädregler, att hålla långt hår uppfäst och fingernaglar kortklippta samt till att inte använda färgat nagellack, lösnaglar och att inte bära ring. Det finns behov av förbättring av distriktssköterskornas följsamhet till handdesinfektion, att inte bära armbandsur samt korrekt användning av handskar och skyddskläder. Enkätstudien visade att distriktssköterskor inte har tillräckliga kunskaper om basala hygienrutiner. Det finns behov av förbättring inom den enskilda distriktssköterskans hygienarbete och inom arbetsgivarnas ansvarsområden gällande hygien. För att distriktssköterskan skall kunna arbeta med att förebygga smittspridning, behövs uppdaterade kunskaper och mer utbildning inom området. Arbetet med hygien bör lyftas fram och uppmuntras inom primärvården, i större utsträckning än vad som görs idag. / Approximately 1500 people dies, every year in Sweden, as a result of healthcare associated infections (Socialstyrelsen, 2011). The most important action for preventing healthcare associated infections is compliance to hygiene routines (Socialstyrelsen, 2006). Today there is scarce knowledge about the compliance to hygiene routines within the area of primary healthcare and among district nurses in Sweden. This study aimed to examine the compliance to hygiene routines among district nurses in primary healthcare. Data was collected through observations and a questionnaire. The observations were carried out by nurses currently studying to become district nurses and were implemented on nine primary healthcare centers in Uppsala. The study showed that the district nurses had good compliance to the prevailing hygiene regulations concerning, clothing, hair, finger nails and to not carrying fingerings. There are however needs of improvement in the district nurses compliance to handdesinfection, not carrying wristwatches and correct use of gloves and protective aprons. Data from the questionnaire shows that district nurses don’t have sufficient knowledge about basic hygiene routines. There are needs of improvement within the individual district nurse's hygiene work and within the employers' area of responsibility concerning hygiene. In order to making it possible for the district nurse to work with preventing transmission of infectious diseases, more education within the area is needed. The work with hygiene routines should be encouraged within primary healthcare, in a bigger extent than its done today.

Darbo tikslas. Įvertinti burnos higienos paslaugų poreikį ir prieinamumą 18 ir vyresniems pacientams, besigydantiems Ignalinos pirminės sveikatos priežiūros centre ,,Ignalinos sveikatos centras“. Tyrimo metodika. Atlikta ,pirminės sveikatos priežiūros centro ,,Ignalinos sveikatos centras“ pacientų (nuo 18 ir vyresnių), anoniminė anketinė apklausa. Respondentai buvo suskirstyti į dvi grupes: I – besikreipiantys atitinkamo amžiaus pacientai į priminės sveikatos priežiūros gydytoją dėl kitų priežasčių (ne dėl odontologinių problemų) ir II – besikreipiantys į gydytoją odontologą/ burnos higienistą dėl odontologinių problemų. Išdalinta 240 anketų (abiems respondentų grupėms buvo išdalinta po 120 anketų), atsako dažnis 91,6 %. Gautų duomenų analizė buvo atlikta naudojant SPSS 16.0 programinį paketą, MS Excel 2010 programą ir grafinius vaizdavimo metodus. Rezultatai. Analizuojant respondentų žinias apie profesionalią burnos higieną ir šios procedūros poreikį, šio tyrimo rezultatai atskleidė, kad 38,6 proc. respondentų nežino, kas tai yra profesionali burnos higiena, 47 proc. trūksta informacijos apie profesionalios burnos higienos procedūrą bei jos svarbą, trečdalis respondentų retai ar visai neatlieka profesionalios burnos higienos, nes jiems trūksta žinių. 61 proc. respondentų nurodė, kad profesionali burnos higienos procedūra yra reikalinga, 64,9 proc. nurodė, kad pirminės sveikatos priežiūros centre ,,Ignalinos sveikatos centras“ yra reikalingas burnos higienistas. Tyrimo... [toliau žr. visą tekstą] / Aim of the study. To evaluate demand and access of oral hygiene services for adolescent patients of Ignalina primary healthcare centre “Ignalinos sveikatos centras“. Methods. An anonymous survey of adolescent patients of Ignalina primary healthcare centre “Ignalinos sveikatos centras“. Respondents have been divided into two groups as follows: I – adolescent patients, contacting primary healthcare doctor for other reasons (except odontology problems) and II – adolescent patients, contacting odontologist/oral hygiene specialist for odontology reasons. 240 questionnaires have been delivered to the both groups of respondents (120 per a group); reply frequency 91.6 %. Received data has been analyzed using SPSS 16.0 program package, MS Excel 2010 program and graphic visualization methods. Results. The results of analysis of awareness in the sphere of professional oral hygiene and a demand of the mentioned procedure have revealed 38.6 % of respondents is not acknowledged with a professional oral hygiene, 47 % suffers from a lack of information on professional oral hygiene procedure and its importance, one third of the respondents applies professional oral hygiene procedures rarely or does not apply at all due to a lack of awareness. 61 % of respondents has mentioned that professional oral hygiene procedure is necessary, 64.9 % of respondents has noted a necessity of oral hygiene specialist in Ignalina primary healthcare centre “Ignalinos sveikatos centras“. The results of the... [to full text]

<p>Typ 2 diabetes är den vanligaste diabetesformen i Sverige och har samband med vår vällevnad. Tidigare studier visar att sjukdomen är mer vanlig bland fysiskt inaktiva och bland människor med ett ökat energiintag. Syftet med studien var att kartlägga sjuksköterskans hälsofrämjande arbete i primärvården vid typ 2 diabetes. En kvalitativ intervjustudie användes för att samla data. Fem sjuksköterskor från olika vårdcentraler i gamla Skaraborgs län deltog. Analysen av intervjuerna resulterade i ett huvudtema och fem underteman. Resultatet visar på att sjuksköterskorna aktivt arbetar med att motivera patienterna till att ändra kostvanor och öka den fysiska aktiviteten i den icke- farmakologiska behandlingen. Sjuksköterskorna använde information, patientrelation, konkret arbete, patientens villkor och mål som verktyg för att få patienterna motiverade. Att förespråka kost och fysisk aktivitet anses vara mycket viktig uppgift för sjuksköterskorna och utgör en central del i deras arbete.</p> / <p>Type 2 diabetes is the most common form of diabetes in Sweden today and is related to our lifestyle. Previous studies indicate that the disease is more common among physical inactive people and in people with increased energy intake. The aim of this study was to survey how nurses´ in primary health care promote lifestyle change in patients with type 2 diabetes. A qualitative interview study was used for data collection. Five nurses from different primary health care settings in old Skaraborgs county participated. The analyses of the interviews resulted in one major theme and five sub themes. The result shows that nurses work actively to motivate patients to change dietary habits and start with daily physical activity as a part of non-drug therapy. The nurses´ used information, nurse- patient relationship, concrete work, goals and the patient terms as tools to get patients motivated. Promoting diet and physical activity is a central part of the nurses’ daily work.</p>

Bakgrund: Vårdcentraler är första instans vid vårdbehov om patientens tillstånd inte är akut. Av alla läkarbesök på vårdcentral utgörs 23 % av barn 0-18 år. Barn kommer sällan själva utan har med sig föräldrar eller vårdnadshavare. Därmed behöver vårdpersonalen förhålla sig till två individer i vårdsituationen. Föräldrar är en resurs för barnet och behöver ges möjlighet att tillsammans med barnet vara delaktiga i vårdsituationer. Vårdrelationen påverkar hur mötet mellan föräldrar, barn och vårdpersonal blir. Syfte: Att beskriva vårdpersonals reflektioner kring möten med föräldrar som söker vård för sina barn på vårdcentral. Metod: En kvalitativ innehållsanalys med en induktiv ansats. Det analyserade materialet utgörs av vårdpersonals reflektioner ur ett tidigare forskningsprojekt om barns delaktighet. Resultat: Att möta föräldrar som söker vård för sina barn på vårdcentral innebär att vårdpersonal balanserar mellan skilda perspektiv och förväntningar. Detta beskrivs som: Att ha föreställningar om föräldrars föreställningar och förväntningar; Att möta föräldrar och barn som en enhet och unika individer och Att vägleda föräldrar. Slutsats: Distriktssköterskans förutsättning för att upprätta en vårdande relation med föräldrar och barn i en vårdsituation innebär att försöka förstå och möta föräldrars och barns perspektiv och förväntningar. Genom en vårdande relation gynnas vårdsituationen, barnets hälsa och förälderns förtroende för vårdpersonalen. / Background: Primary Healthcare Centers (PHC) are the first instance to seek care for patients who are not acutely ill. Children between 0-18 years account for 23 % of all doctor visits at PHC. These children rarely arrive by themselves; they are accompanied by parents or guardians. Thereby the health care professionals (HCP) need to relate to two individuals in the care situation. Parents are a resource for their child and they should be given the opportunity to participate with the child in caring situations. The care relation influences the outcome of the encounter between parent, child and HCP. Aim: To describe HCP' reflections about the encounters with parents seeking care for their children at the PHC. Method: A qualitative content analysis with inductive approach was used. The analyzed material consists of HCP's reflections derived from a prior research project regarding children's involvement. Results: Encountering parents who seek care for their children at PHC means that HCP's in these care situations balance between different perspectives and expectations. This balance includes reflections that are described as: To have beliefs about parent's perceptions and expectations; To encounter parents and children as a unit and unique individuals and To guide parents. Conclusion: The prerequisite for district nurses to create a caring relationship with parents and children in a care situation involves understanding and encountering parents and childrens perspectives. A caring relationship benefits the care situation, the child's health and parent's trust in the HCP's.

p. 1-153 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-05-06T18:14:36Z No. of bitstreams: 1 555555555555.pdf: 2140950 bytes, checksum: 75ae01f0e60e228c7558f0ab793c9b63 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-13T13:53:40Z (GMT) No. of bitstreams: 1 555555555555.pdf: 2140950 bytes, checksum: 75ae01f0e60e228c7558f0ab793c9b63 (MD5) / Made available in DSpace on 2013-05-13T13:53:40Z (GMT). No. of bitstreams: 1 555555555555.pdf: 2140950 bytes, checksum: 75ae01f0e60e228c7558f0ab793c9b63 (MD5) Previous issue date: 2011 / Este é um trabalho de caráter exploratório e descritivo, resultado de uma investigação de cunho etnográfico, com objetivo de compreender as concepções de gênero no cotidiano de trabalho de uma Unidade de Saúde da Família (USF) em um bairro de Salvador. Analisa-se as potencialidades de ‘Atenção Integral à Saúde da Mulher’ (AISM), tal qual propõem o PAISM (Programa de Atenção Integral à Saúde da Mulher) e a PNAISM (Política Nacional de Atenção Integral à Saúde das Mulheres). Estes documentos sinalizam mudanças na atenção à saúde da mulher e direcionam ações preferencialmente na Atenção Básica (AB) para fortalecer este nível de atenção. A idéia de AISM envolve um olhar frente à mulher como um sujeito integral, sob a perspectiva da cidadania, garantindo-lhe seus direitos e promovendo sua autonomia. A AISM, assim como a noção de integralidade, necessita da integração em rede de todos os níveis de serviços do SUS, bem como medidas e ações intersetoriais (entre o setor saúde e outros setores governamentais e não governamentais), de modo que sejam criadas condições básicas para melhorar os níveis de vida e saúde da população. Aqui foram relatados os passos percorridos durante a pesquisa e as reflexões decorrentes desta, sinalizando que a idéia de AISM não se traduz nas práticas e discursos cotidianos, na sistemática de integração dos serviços de saúde, nem mesmo na intersetorialidade – aspectos constituintes da noção de integralidade, que se encontra articulada à idéia de AISM. Os limites referem-se às debilidades do Sistema Único de Saúde (SUS) na organização da AB de Salvador, à falta de medidas de capacitação profissional e dificuldade das profissionais em incorporar nova perspectiva baseada no enfoque de gênero, reorientando o olhar sobre as mulheres. Ao mesmo tempo aponto o empenho com o qual as profissionais procuravam executar suas atividades para a consolidação de vínculos e promoção da saúde da população, apesar dos limites observados (internos e externos). / Salvador

In a descriptive survey, the accessibility of primary healthcare services in Molemole was explored and factors impacting on accessibility were identified. The research sample consisted of 134 community members who visited one of five clinics (one a mobile clinic) in Molemole. Questionnaires, information lists, observations and field notes were used as research instruments. Ethical principles were adhered to, and validity and reliability maintained. Findings indicated that geographical, financial and cultural accessibility were satisfactory. Functional accessibility seemed problematic. The main reasons for dissatisfaction were attitudes, shortages of staff, unavailability of treatment, dysfunctional hours and fragmented services. Recommendations included optimal utilisation of staff and resources, improvements on infrastructure and support systems, community involvement in decision-making, as well as reassessing service point locations and policies on medications, supplies and equipment. / Health Studies / M. A. (Health Studies)

Cárie Precoce da Infância (CPI) é uma doença prevalente de etiologia complexa, que pode afetar a qualidade de vida da criança acometida. A Entrevista Motivacional (EM) é uma abordagem para mudança de comportamento que encoraja os pacientes a tomarem suas próprias decisões e que tem demonstrado ser efetiva na prevenção de CPI. O objetivo do estudo foi avaliar a efetividade da EM na prevenção de CPI em comparação com a Educação Convencional em Saúde (EC) no contexto da Atenção Primária à Saúde (APS). Esse foi um ensaio comunitário randomizado por cluster com grupos paralelos. Doze Unidades de Saúde do sul do Brasil foram alocadas aleatoriamente em dois grupos de seis, e os profissionais das Equipes de Saúde Bucal (ESB), cirurgiões-dentistas (CD) e técnicos em saúde bucal (TSB), de um dos grupos receberam treinamento para EM, enquanto os profissionais do grupo EC não receberam nenhum treinamento. As mães/crianças e os examinadores externos foram cegados para a intervenção. Os dados foram coletados por examinadores calibrados através de um questionário socioeconômico e de um exame clínico com utilização dos critérios do International Caries Detection and Assessment System (ICDAS), o qual foi transformado em índice de superfícies cariadas, com extração indicada ou obturados por cárie (ceo-s) modificado para inclusão de lesões de cárie não cavitadas. Das 674 crianças nascidas no território de abrangência no ano 2013, 469 receberam a intervenção (224 do grupo EC, 245 do grupo EM) e 320 foram examinadas ao final do estudo (145 no grupo EC, 175 no grupo EM), com um acompanhamento final de 68%. A média do ceo-s para a amostra total no final do estudo foi de 1,34 (IC95% 0,97-1,71). A taxa de cárie por 100 superfície-ano no grupo EC foi 1,74 (IC95%: 1,14-2,34) e no grupo EM foi 0,92 (IC95% 0,63-1,20). Para corrigir o efeito do cluster e as variáveis desbalanceadas, foi realizada uma regressão multinível de Poisson e o efeito da EM foi IRR= 0,40 (IC95%: 0,21-0,79). Uma abordagem baseada nos princípios da EM foi mais efetiva na redução de superfícies afetadas pela CPI quando comparado com a EC. / Early childhood caries (ECC) is a prevalent and complex disease, which can affect the quality of life. Motivational interviewing (MI) is an approach to change behavior that encourages patients to make their own decisions and has been shown to be effective in preventing ECC. The aim of the study was to evaluate the effectiveness of MI in preventing ECC in comparison to conventional oral health education (EC) in the context of primary healthcare (PHC). This was a community-based randomized cluster trial with parallel groups. Twelve Health Care Services in southern Brazil were randomly allocated in two groups of six, and professionals of the Oral Health Team (OHT), dental surgeons (DS) and dental hygienists (DH), in one group were trained in MI, while the professionals in the EC group received no training. The mothers/children and external examiners were blinded to the intervention. The data were collected by calibrated examiners using socioeconomic questionnaire and a clinical examination based on the International Caries Detection and Assessment System (ICDAS) criteria and transformed into decayed, missing, and filled surfaces (dmfs) modified for inclusion of non-cavitated caries lesions. Of the 674 children born in the catchment area in the year 2013, 469 received the intervention (224 in the CE group, 245 in the MI group) and 320 were examined by the end of the study (145 in the CE group, 175 in the MI group), with final follow-up of 68%. Mean dmfs at the end of the study period for the whole sample was 1.34 (95%CI: 0.97-1.71). The caries rate per 100 surface-year in the CE group was 1.74 (95%CI: 1.14-2.34) and in the MI group it was 0.92 (95%CI 0.63-1.20). To correct clustering effect and unbalanced factors, multilevel Poisson regression was fitted and the effect of MI was IRR= 0.40 (95%CI: 0.21-0.79). An approach based on the principles of MI was more effective in reducing the number of surfaces affected by ECC when compared to CE.

Cárie Precoce da Infância (CPI) é uma doença prevalente de etiologia complexa, que pode afetar a qualidade de vida da criança acometida. A Entrevista Motivacional (EM) é uma abordagem para mudança de comportamento que encoraja os pacientes a tomarem suas próprias decisões e que tem demonstrado ser efetiva na prevenção de CPI. O objetivo do estudo foi avaliar a efetividade da EM na prevenção de CPI em comparação com a Educação Convencional em Saúde (EC) no contexto da Atenção Primária à Saúde (APS). Esse foi um ensaio comunitário randomizado por cluster com grupos paralelos. Doze Unidades de Saúde do sul do Brasil foram alocadas aleatoriamente em dois grupos de seis, e os profissionais das Equipes de Saúde Bucal (ESB), cirurgiões-dentistas (CD) e técnicos em saúde bucal (TSB), de um dos grupos receberam treinamento para EM, enquanto os profissionais do grupo EC não receberam nenhum treinamento. As mães/crianças e os examinadores externos foram cegados para a intervenção. Os dados foram coletados por examinadores calibrados através de um questionário socioeconômico e de um exame clínico com utilização dos critérios do International Caries Detection and Assessment System (ICDAS), o qual foi transformado em índice de superfícies cariadas, com extração indicada ou obturados por cárie (ceo-s) modificado para inclusão de lesões de cárie não cavitadas. Das 674 crianças nascidas no território de abrangência no ano 2013, 469 receberam a intervenção (224 do grupo EC, 245 do grupo EM) e 320 foram examinadas ao final do estudo (145 no grupo EC, 175 no grupo EM), com um acompanhamento final de 68%. A média do ceo-s para a amostra total no final do estudo foi de 1,34 (IC95% 0,97-1,71). A taxa de cárie por 100 superfície-ano no grupo EC foi 1,74 (IC95%: 1,14-2,34) e no grupo EM foi 0,92 (IC95% 0,63-1,20). Para corrigir o efeito do cluster e as variáveis desbalanceadas, foi realizada uma regressão multinível de Poisson e o efeito da EM foi IRR= 0,40 (IC95%: 0,21-0,79). Uma abordagem baseada nos princípios da EM foi mais efetiva na redução de superfícies afetadas pela CPI quando comparado com a EC. / Early childhood caries (ECC) is a prevalent and complex disease, which can affect the quality of life. Motivational interviewing (MI) is an approach to change behavior that encourages patients to make their own decisions and has been shown to be effective in preventing ECC. The aim of the study was to evaluate the effectiveness of MI in preventing ECC in comparison to conventional oral health education (EC) in the context of primary healthcare (PHC). This was a community-based randomized cluster trial with parallel groups. Twelve Health Care Services in southern Brazil were randomly allocated in two groups of six, and professionals of the Oral Health Team (OHT), dental surgeons (DS) and dental hygienists (DH), in one group were trained in MI, while the professionals in the EC group received no training. The mothers/children and external examiners were blinded to the intervention. The data were collected by calibrated examiners using socioeconomic questionnaire and a clinical examination based on the International Caries Detection and Assessment System (ICDAS) criteria and transformed into decayed, missing, and filled surfaces (dmfs) modified for inclusion of non-cavitated caries lesions. Of the 674 children born in the catchment area in the year 2013, 469 received the intervention (224 in the CE group, 245 in the MI group) and 320 were examined by the end of the study (145 in the CE group, 175 in the MI group), with final follow-up of 68%. Mean dmfs at the end of the study period for the whole sample was 1.34 (95%CI: 0.97-1.71). The caries rate per 100 surface-year in the CE group was 1.74 (95%CI: 1.14-2.34) and in the MI group it was 0.92 (95%CI 0.63-1.20). To correct clustering effect and unbalanced factors, multilevel Poisson regression was fitted and the effect of MI was IRR= 0.40 (95%CI: 0.21-0.79). An approach based on the principles of MI was more effective in reducing the number of surfaces affected by ECC when compared to CE.