Objetivo: identificar os modelos assistenciais desenvolvidos pelas equipes dos Núcleos de Apoio à Saúde da Família (NASF) em uma região do interior de São Paulo. Métodos empregados: Trata-se de uma pesquisa qualitativa realizada através de estudo de caso em quatro municípios da mesorregião de Ribeirão Preto - SP. Como métodos de pesquisa foram utilizados entrevista aberta e questionário semiestruturado. A definição dos sujeitos de pesquisa foi realizada por amostragem por conveniência. Os dados sobre o perfil sociodemográfico e perfil profissional foram tabulados com o auxílio de planilhas eletrônicas. Para o estudo das informações coletadas nas entrevistas abertas foi utilizado o método de análise de conteúdo. Resultados e discussões: Participaram do estudo 29 sujeitos, sendo destes quatro com cargos de gestão, seis profissionais do NASF e 19 profissionais da Estratégias de Saúde da Família (ESF), sendo estes médicos, enfermeiros, técnicos de enfermagem, agentes comunitários de saúde e psicólogo. 82,1% dos sujeitos está pela primeira vez vinculado à Atenção Básica e todos os profissionais do NASF estavam pela primeira vez na área de saúde da família. Foram constatados dificuldades e desafios para consolidação do trabalho do NASF e até mesmo da ESF na região, que apresenta fraca orientação à Atenção Primária à Saúde, com predomínio dos modelos médico e sanitário. Com isso, identificou-se a demanda e a necessidade de Educação Permanente (EP) na região, em que há poucas ofertas públicas de ensino, como uma possível alternativa para reflexões dos profissionais sobre o próprio trabalho. Tal fato resultou na construção de uma proposta de EP como produto desta pesquisa, que será apresentada para a Diretoria Regional de Saúde para ser realizada através de parceria da pesquisadora com a instituição. A proposta de EP visa ampliar e implantar o uso de ferramentas propostas pelo Ministério da Saúde e identificadas por diferentes autores como meios de promoção de saúde pautados na integralidade. Conclusões: O NASF reproduz o modelo assistencial já instituído a partir de uma leitura biomédica ou sanitarista, seja por falta de conhecimento sobre o tema ou por falta de apoio das gestões locais. Assim, tornou-se uma estratégia municipal para ampliação da rede de assistência especializada com financiamento do Ministério da Saúde e é utilizado para este fim, sem estar orientado pela lógica do apoio matricial. Embora a criação da modalidade 3 do NASF tenha possibilitado a implantação dessas equipes em pequenos municípios, e que a proposta favoreça mudanças parciais nos serviços municipais de saúde, isso ainda é insuficiente diante da variedade e complexidade da Atenção Básica. Portanto, repensar o modelo, o financiamento de saúde e a formação desses profissionais é relevante para a transformação do cenário de saúde. Dessa forma, a EP dos trabalhadores da saúde surge como alternativa para o abismo entre a formação acadêmica e a prática em saúde, contribuindo para a viabilização e implementação de ações e projetos concomitantes às propostas do SUS. / Objective: this study aims to identify care models used by teams of the Family Health Support Centers (NASF) in a region from the countryside of the São Paulo State. Methods: this is a qualitative research performed with study cases in four municipalities from the Brazilian mesoregion Ribeirão Preto - SP. Open interviews and semi-structured questionnaires were used as research methods. The definition of the research subjects was made by sampling for convenience. Data regarding the sociodemographic profile were tabulated using spreadsheets. As for the information collected in the open interviews, the content analysis method was used. Results and discussions: 29 subjects took part of the study, in which four have management positions, six are professionals from the NASF and 19 are professionals from the Family Health Strategy (ESF), being doctors, nurses, nursing technicians and psychologists. 82.1% of the subjects are for the first time linked to the Basic Healthcare and all professionals from the NASF are also for the first time in the family health area. Difficulties and challenges to the consolidation of the NASF\'s work have been found as well, as it presents a weak orientation to the primary healthcare, with the predominance of the medical and sanitary models. In this way, the demand and necessity of continuing education in the region have been identified as an alternative to the professionals\' reflections on their own works, as there are few public offers of education available. So, this resulted in a Continuing Education Proposition as a product of this research, that will be presented to the Regional Health Board to be realized by a partnership between the researcher and the institution. The continuing education proposition consists of the enlargement and implantation of tools proposed by the Brazilian Ministry of Health and that are identified by different authors in the literature as means of health promotion based on integrality. Conclusions: the NASF reproduces the care model already instituted by a medical or sanitary reading, being it because of the lack of knowledge regarding the theme or by the lack of support by local management. In this way, it seems to have become municipal strategies to the enlarge the specialized healthcare network using funds from the Ministry of Health, which is used to this end, but not being oriented by the matrixial support logic. Although the creation of the NASF 3 modality have allowed the implantation of these teams in small municipalities, and its proposition lead to partial changes in municipal healthcare services, this is still insufficient due to the variety and complexity of the Basic Healthcare. So, rethinking the model, health funding and formation of these professionals is relevant to the transformation of the health scenario. In this way, the continuing education of the health professionals is an alternative to the abyss between academic training and health practice, contributing to the feasibility and implementation of actions and projects concomitants to the Unified Health System (SUS) proposals.

Iniciamos a construção desta investigação o durante o processo de acolhimento vivenciado em um serviço de pronto-atendimento (PA) da Unidade Básica Distrital da Saúde do Centro de Saúde Escola da Faculdade de Medicina de Ribeirão Preto - USP (UBDS oeste), onde pudemos perceber que os mesmos usuários procuravam com grande frequência o serviço, sem o caráter de urgência ou emergência, resultando em uma demanda maior do que suporta o serviço, e sem uma efetiva resolutividade da atenção. Podemos pensar que nas UBSs o usuário não encontrou a resolução do seu problema; não fez vínculo com a equipe; não teve acesso ao serviço ou o cuidado não foi integral, entre outras possibilidades. A partir destes pressupostos, supomos que a acessibilidade aos serviços de saúde pode ser uma das causas disparadoras para a justificativa da procura pelo PA e mesmo sendo serviço de urgência, o serviço atende a prontidões e também atende os usuários considerados não urgentes, resultando no aumento da demanda do PA. Isto pode trazer dificuldades para a equipe que não consegue proporcionar um atendimento acolhedor por meio de orientações sobre a existência de outros serviços disponíveis na rede básica de atenção para seguimento de saúde. Objetivamos com este estudo analisar a procura pelo PA do distrito oeste de saúde do município de Ribeirão Preto, na ótica dos usuários. Trata-se de uma abordagem quantiqualitativa sobre os usuários que procuraram o PA. Coletamos dados de 330 fichas de atendimento do PA, a fim de caracterizar os usuários atendidos no PA quanto ao sexo, à faixa etária, ao bairro de procedência, à justificativa para a procura, à conduta e aos encaminhamentos realizados. Fizemos entrevista semiestruturada com 23 usuários do PA abordando questões relativas à acessibilidade, ao acesso e acolhimento aos serviços de saúde, aos aspectos relativos ao atendimento, à resolução das necessidades de saúde, ao motivo da procura do PA e à integralidade da atenção à saúde. Como resultados, encontramos que a demora pelo atendimento e agendamento das consultas na rede básica de atenção constituem uma das principais razões para a procura ao PA; o acesso mais facilitado à tecnologia e aos medicamentos no PA também justificou a preferência por este serviço. O horário de funcionamento coincidindo com a jornada de trabalho dos usuários também trouxe dificuldades para agendar ou procurar atendimento na rede básica. A obtenção de atendimento médico ainda pode ter forte influência na satisfação que o usuário tem por um serviço de saúde. Concluímos que diversas foram as justificativas para a procura pelo PA e entendemos que, se estes usuários fossem acolhidos e tivessem acesso aos atendimentos nas UBSs e USFs, consequentemente, a demanda pelo PA tenderia a diminuir e atenderia com maior tranquilidade às urgências e emergências. / Began this investigation during the reception experienced in an emergency care (PA) Basic Unit of district health, health center´s medical school , Ribeirão Preto- USP, Where we could see that the same users looking at higher frequency service, without the character of urgency or emergency, resulting in a greater demand service that supports and without the effective outcomes of primary health. we think that the basic health unit the users did not find the resolution of your problem, did not link with the team, did not have access to the service or the care was not fully, between other possibilities. From these assumptions ,we assume that accessibility to health services may be one of the cause triggering to the justification for seeking emergency care and even if the emergency service, the service meets the users considered non- urgent, resulting in increased demand for emergency care. This can cause difficulties for the team that can not provide a friendly service through orientations about the existence of other services available in the basic attention to health monitoring. We ain with this study to analyze to demand for emergency care at the west of the district health the municipality of Ribeirao Preto, the viewpoint of users. It is a quantitative and qualitative approach about the users who sought emergency care. We collect data from 330 medical records of emergency care , in order to characterize users assisted in the emergency care , about whether a man or woman, will age , the neighborhood of provenance, the justification for seeking, will conduct and referrals. We semistructured interview with 23 users of emergency care addressing questions related to accessibility access to care and health services, and aspects of the care, the resolution of health needs of the reason for seeking emergency care and comprehensive health care to health. As results ,found that the delay for serving and scheduling of consultations in the primary care are a major reason for seeking emergency care to; easier access to technology and medication in the emergency room also justified the preference for this service. .Opening hours coinciding with the day´s work also brought difficulties of users to schedule or seek care in the primary. Obtaining medical care can still have a strong influence on satisfaction that the user is a health service. Conclude that there have been several reasons for the demand for emergency care and understand that, if these users were welcomed and had access to basic care unit, (USF) health and, consequently, the demand for emergency care would tend to decrease with greater peace and meet urgencies and emergencies.

Magister Pharmaceuticae - MPharm / The global movement towards enhancing inter-professional collaboration in patient care is in light of the increasing potency of drugs and complexity of drug regimens, particularly in the chronically ill where poly-pharmacy is rife, collaborative patient management by general practitioners and community pharmacists, in particular, has the potential to enhance patient therapeutic outcomes in primary healthcare. Literature from other parts of the world has enumerated the advantages of collaboration. South Africa with its unusual quadruple burden of disease and human resource deficient public healthcare system would benefit from collaboration between general practitioners and community pharmacists through expanded roles for community pharmacists to enable them to make more meaningful contributions to primary healthcare regimens. Particularly with the introduction of the National Health Insurance (NHI) programme. This dissertation aims to assess from general practitioners‟ perspectives: the current level and stage of collaboration (using the collaborative working relationship (CWR) model proposed by McDonough and Doucette, 2001) between general practitioners and community pharmacists in patient care, if general practitioners‟ perceptions of the professional roles of community pharmacists in patients‟ care can influence desired collaboration (prospects of enhanced future collaboration) and how do general practitioners envision enhanced future collaboration between them and community pharmacists in patient care, possible barriers to the envisioned collaboration between the two practitioners, and how general practitioners‟ demographic characteristics influence inter-professional collaboration with community pharmacists. Sixty randomly selected consenting general practitioners in private practice participated in a cross-sectional, face- to-face questionnaire study. The questionnaire contained a range of statements with Likert scale response options. Data was initially entered into Epi Info (version 3.5.1., 2008) and then exported to IBM SPSS Statistical software for analysis (version19, 2010). Medians were used to summarize descriptive data and Spearman‟s correlation coefficient, Mann-Whitney U Test and Kruskal-Wallis Test was used for bivariate analysis. Ethical approval was granted by the Senate Research and International Relations Committee, University of the Western Cape (Ethical Clearance Number: 10/4/29). The results indicated low-levels of current collaboration at stage 0 of the CWR model between general practitioners and community pharmacists. A statistically significant correlation was observed between general practitioners‟ perceptions of the professional roles of community pharmacists and desired collaboration (prospects of enhanced future collaboration), [p=0.0005]. Good prospects of enhanced future collaboration between general practitioners and community pharmacists were observed. General practitioners identified barriers to collaboration to include: the lack of remuneration for collaboration, absence of a government mandate or policy supporting collaboration, inability of general practitioners to share patients‟ information with community pharmacists and questionable professional ethics exhibited by community pharmacists particularly over financial gains. Most general practitioners agreed that joint continuing professional education organized by pharmaceutical companies or other groups will increase interaction and enhance collaboration. Enhanced Inter-professional collaboration between general practitioners and community pharmacists‟ can be possible in the future but hindrances need to be eliminated for this to be achieved. Future research can be aimed at exploring the perspectives‟ of community pharmacists to inter-professional collaboration in South Africa and interventions that will enhance collaboration.

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.

Bakgrund: En förutsättning för att ambulanssjuksköterskan ska kunna hänvisa patienter till primärvård på ett patientsäkert sätt är följsamhet mot lokala riktlinjer, triageringssystem, och en tydlig och strukturerad journalanteckning där det framgår vilka vårdhandlingar som utförts. Syfte: Syftet med studien var att göra en systematisk journalgranskning för att få en bild av hur ambulanssjuksköterskor dokumenterar hänvisningar av patienter till primärvård med fokus på patientsäkerhet. Hur följer ambulanssjuksköterskan triageringssystem och regionens lokala riktlinjer vid hänvisning till primärvård? Metod: Studien är en kvantitativ retrospektiv systematisk journalgranskning med en explorativ ansats. Resultat: Resultatet visar på hög följsamhet mot triageringssystem och lokala riktlinjer överlag. Samtidigt som vikten av identitetskontroll behöver diskuteras och förstås. Av den anledningen finns ett fortsatt behov av kontinuerlig utbildning för att följsamheten ska fortsätta vara hög. Slutsats: Resultatet är positivt och visar på att ambulanssjuksköterskor i regionen är följsamma mot lokala riktlinjer och triageringsverktyg. / Background: A prerequisite for the ambulance nurse with specialist competence to be able to refer patients to primary health care in manner that is patient safe is the compliance with local guidelines and triage systems. In order for the transfer to be as patient safe as possible. Aim: The aim of the study was to conduct a systematic journal review to understand how ambulance nurses with specialist competence document referrals of patients to primary care with focus on patient safety. How is the decision on referral of patients to primary health care documented? How compliant is the ambulance nurse with specialist competence with regard to triage systems and local guidelines when referring to primary health care? Method: The study is a quantitative retrospective systematic journal review with an explorative approach. Result: The result shows high compliance with triages system and local guidelines in general. There is a need for a discussion and understanding why identification control is important. There are also a need for continuous education so that the compliance will stay high. Conclusion: The result are positive and shows that ambulance nurses with specialist competence in the region are compliant with the guidelines and triage system.

Bakgrund: Förändringsarbete är något de flesta företag behöver arbeta med för att kunna anpassa sig till en föränderlig omvärld och fortsatt vara konkurrenskraftiga på marknaden. Den ständiga utvecklingen i samhället har även medfört att företag behöver vidta informationsteknologiska förändringar vilket i sin tur även inbegriper ett arbete med digitalisering. Den svenska vården, både såväl offentlig som privat, står inför en pågående förändring av digitalisering där bland annat digitala vårdmöten är något som prioriteras och implementeras i verksamheterna. Syfte: Studiens syfte är att i en jämförelse undersöka hur svensk offentlig respektive privat verksamhet arbetar vid digital verksamhetsförändring i form av implementering av digitala vårdmöten. Detta både i form av vad för skäl de har till sin förändring samt hur de går tillväga vid implementeringen av digitala vårdmöten. Genomförande: En komparativ studie har utförts gällande en privat samt en offentlig organisation tillhörande den svenska hälso- och sjukvården. Studien följer en kvalitativ forskningsstrategi tillsammans med en abduktiv forskningsdesign. Litteratur samt vetenskapliga artiklar är den data som ligger till grund för studiens teoretiska referensram. Studiens empiriska material har samlats in genom intervjuer samt viss data även inhämtats från dokument utgivna av studiens deltagande organisationer. Slutsatser: Vad som driver organisationerna till implementering av digitala vårdmöten förklaras av en anpassning till omvärldens utveckling och konkurrerande aktörer. Olikheter i drivande faktorer kan uppstå mellan den offentliga och privata sektorn i form av ekonomiska aspekter då den privata verksamheten är vinstdrivande till skillnad från den offentliga verksamheten. Tillvägagångssättet att implementera förändringen i organisationerna är likartat och ett stort fokus riktas mot vårdgivares egna kompetens i bedömning av de digitala vårdmötenas möjligheter. Det finns därmed mer som förenar än skiljer den offentliga respektive den privata organisationen åt i deras arbete med implementering av digitala vårdmöten. / Background: The process of adaptation is something most companies need to work on to be able to adjust to a changing environment and continue to be competitive in the market. The constant development of society has also meant that companies need to change the way they utilize information technology, which in turn also includes working with digitalisation. Swedish healthcare, both public and private, is facing an ongoing change in digitalisation where digital healthcare meetings are among the priorities that are beeing implemented in the operations. Purpose: The purpose of this study is to, through a comparison, examine how companies in Swedish public and private sectors work on altering their digital business operations by implementing digital healthcare meetings. This both in terms of what reasons they have for their change as well as how they are going to approach implementing digital healthcare meetings. Method: A comparative study has been performed regarding a private and a public organization belonging to the Swedish healthcare system. The study follows a qualitative research strategy together with an abductive research design. Literature as well as scientific articles form the basis of the study's theoretical frame of reference. The empirical material of the study has been collected through interviews, and some data has also been collected from documents published by the organizations participating in this study. Conclusions: What drives organizations to implement digital healthcare meetings is explained by having to adapt to the development of the outside world and competing companies. Differences in driving factors between the public and private sectors can occur in the shape of economic aspects as the private organizations are profit-driven, unlike the public organizations. The approach to implementing change in these organizations is similar, and a major focus is directed at the healthcare providers' own competence in assessing the possibilities of digital healthcare meetings. Thus, there is more that unites than separates the public and private organizations when it comes to implementing digital healthcare meetings.

Magister Pharmaceuticae - MPharm / Tuberculosis and mv Tuberculosis (TB) is a major contributor to the disease burden in developing countries resulting in the deaths of approximately 2 million people a year. South Africa (SA) has one ( of the highest annual TB incidences with an estimate of 558 per 100 000 population (2003) and the situation shows no sign of abating. TB remains the most common opportunistic infection and cause of death amongst HIV- infected patients. Both TB and HIV treatment depends exclusively on multi-drug regimens that require close monitoring among health care professionals. With increasing workload due to staff shortage and high patient load, the quality of care in nurse-led primary care clinics may be compromised. Existing clinic staff may overlook drug-drug interactions, side effects and may not be aware of the consequences when a formulation is modified during multi-drug therapy administration. As the custodian of medicines, pharmacists are ideally placed to monitor therapy. Clinic-based training programs that are offered to nurses provide an opportunity to work alongside clinic staff and engage in patient-centered care where the pharmacotherapeutic the outcome of TB and HIV drug regimens could be closely monitored. XVll Aims The primary and secondary aims of the study were to: • Assess current practice patterns of TBIHIV at primary healthcare clinics in the Western Cape, • Assess the need for a clinic-based TBIHIV training among final year pharmacy students in UWC. http://uwc.ac.za Objectives To achieve the primary aim the researcher; 1. Conducted a baseline study at Ravensmead Community Health Centre(CHC) to assess current TBIHIV practice among HCP's and co-infected patients, 2. Assessed current practice patterns at Delft South ARV clinic and Elsies River TB clinic (pre-intervention), 3. Designed and implemented a clinic-based TBIHIV intervention tool for potential use by pharmacists at Delft South and Elsies River clinics (intervention phase), 4. Evaluated patient receptivity of the intervention tool amongst patients at Delft South and Elsies River clinics (post-intervention phase). XVlll To achieve the secondary aim the researcher; 5. Introduced a clinic-based training for seven final year pharmacy students, 6. Designed and administered an assessment to both control and experimental students, 7. Assessed scores between students who received the training (experimental group) with those who did not receive the training (control group). Results and discussion Findings from the baseline study indicate the need for the involvement of a trained pharmacist in TB and HIV management. Even though three-quarters (77.8%; 14) of the patients preferred receiving their TB information from the clinic nurse, almost two-thirds (63.2%; 12) of the patients believed that pharmacists assisted with their treatment provision. Patient data obtained from the clinic record card showed that almost two-thirds of the patients reported that they had experienced side effects (64.4%); the therapy of more than one-quarter (26.4%) showed drug-drug interactions and onset of adverse effects (1.1 %). Post-intervention, the data showed that patients' viewed the pharmacist's role more positively. Almost all responses (97.5%; 39) favored the services of a pharmacist in the clinic. In conclusion, findings from the post-intervention patient study underpin that a clinic-based role for the pharmacist is imminent. All seven (100%) of the experimental students passed the assessment and had scores in the range between 26 and 45 and more than three-quarters (78.4 %; 29) of the control students passed with marks within this range. Conclusion A trained pharmacist would be competent to work alongside nursing staff in optimizing care provision in the clinical management of TB and HIV in patients. The existing clinic-based TB/HIV program could be supplemented with theoretical concepts in the final year of undergraduate pharmacy training.

Bakgrund: Den 11 mars 2020 bekräftade World Health Organisation att världen drabbats av en pandemi. Tidigare forskning visade att distriktssköterskan ställdes inför en utmaning genom nya riktlinjer dagligen och omorganisationer av arbetsuppgifter med en ökad arbetsbelastning som följd. Syfte: Syftet med studien var att beskriva distriktssköterskans upplevelser av arbetskrav och resurser under Covid-19 pandemin inom primärvården. Metod: Kvalitativ design med induktiv ansats valdes som metod. Semistrukturerade intervjuer låg till grund för datainsamlingen. Tio distriktssköterskor som var verksamma inom primärvården Region sydöstra Sverige intervjuades. Insamlade data analyserades via kvalitativ innehållsanalys. Resultat: Resultatet mynnade ut i ett tema: ”En tillvaro präglad av konstant förändring och att befinna sig i ett sammanhang” och två huvudkategorier: ”Stress, otrygghet och osäkerhet när arbetet blir oförutsägbart” samt ”stabilitet och trygghet med inre och yttre resurser för att hitta nya lösningar”. De väsentligaste fynden av arbetskrav som framkom i studien var osäkerheten och otryggheten som uppstod på grund av ovissa och oförutsägbara förändringar som Covid-19 innebar. Resurserna fanns i den stabilitet som stöd av kollegor, ledning och inre personliga resurser gav för att ta sig vidare. Detta bidrog till en känsla av trygghet och stabilitet i arbetsmiljön, trots ovisshet och oförutsägbarhet. Slutsats: Chefer inom Region Kalmar måste ta ett övergripande ansvar för distriktssköterskans arbetsmiljö när distriktssköterskan ställs inför extraordinära händelser som en pandemi. Pandemier skapar stress, otrygghet och en känsla av att tappa kontrollen, där ett aktivt och tydligt ledarskap hjälper distriktssköterskan till en trygg och stabil arbetsmiljö. / Background: On March 11, 2020, the World Health Organization declared a world pandemic. Previous research showed that the district nurse was faced with challenges through new daily guidelines and reorganizations of tasks with an increased workload as a result.  Purpose: The purpose of the study is to describe the district nurse's experiences of work requirements and resources during the Covid-19 pandemic in primary care.  Method: The method was qualitative with inductive approach. Semi-structured interviews formed the basis for the data collection. Ten district nurses active in the Primary Care Region in south-eastern Sweden were interviewed. Collected data were analyzed in a qualitative content analysis.  Results: Resulted in a theme: "A life characterized by constant change and being in a context" and two main categories: “Stress, insecurity and uncertainty when work becomes unpredictable and stability” and “security with internal and external resources to find new solutions”. The most significant findings of work requirements that emerged in the study were the uncertainty and insecurity that arose due to uncertain and unpredictable changes that Covid-19 entailed. The resources were in the stability that support from colleagues, management and internal personal resources provided to move forward. This contributed to a feeling of security and stability in the work environment, despite uncertainty and unpredictability.  Conclusion: Managers within Regions must take overall responsibility for the district nurses work environment when district nurses are faced with extraordinary events such as a pandemic. Pandemics create stress, insecurity and a feeling of losing control, where active and clear leadership helps the district nurse to a safe and stable work environment.

MPH / Department of Public Health / See the attached abstract below

Magister Economicae - MEcon / The provision of health care in South Africa is undergoing major restructuring. The aim is to achieve substantial, visible and sustainable improvements to the efficiency and accessibility of primary healthcare (PHC) services for all South Africans. One of the country's most critical problems is the weak and fragmented public sector PHC system. The most critical problems contributing to this are the maldistribution of resources (financial, physical and human) between hospitals and the primary care system, and between rural and urban areas. The health sector, therefore, faces the challenge of a complete restructuring and transformation of the national health care delivery system and related institutions. Choices need to be made about which services to cut, which to streamline and where savings can be made. Ways need to be found to use ALL of South Africa's resources optimally. This process of restructuring would be facilitated by the availability of accurate information on resource utilisation in the health sector. This study estimates the difference in the cost of primary diabetes treatment at dayhospitals and a provincial hospital in the Western Cape in 1992/93. Health economics is in its infancy in South Africa and serious data limitations exist. This study is therefore a pioneering effort in many ways. An appropriate methodological framework in which to conduct the costing had to be developed. The South African health sector, health spending arid the cost of primary diabetes treatment at day-hospitals and the provincial hospital are reviewed. Theoretical perspectives of the health care market and the methodologies of cost analysis are discussed. The cost analysis method of study is chosen, and arguments are advanced for its suitability in the South African context. A simple method of calculating the direct costs to obtain the average cost is proposed for the purpose of the study. Direct costs consist of staff costs and other related costs, such as medical supplies, non-medical supplies, building operations, equipment etc. These costs are then used to calculate the average costs per diabetic patient at the day-hospitals and the provincial hospital. The average cost per diabetic patient at day-hospitals amounted to R18.76, while at the provincial hospital the cost was R59.60.