A 3 4 7 -A 7 6 6 cialized attention and to apply this classification in the analysis of the integration between the care complexity levels on Brazil's health system. Methods: Transversal study with data from 17.202 family health teams that answered the external evaluation questionnaire of the National Program to Access and Quality Improvement of Basic Attention (PMAQ), 2012. In order to estimate the team's integration level, the answers of 19 selected questions from PMAQ were fitted with the Gradual Response Model of the Item Response Theory (IRT). Based on the results, the usual IRT scale was categorized in three levels of integration: low, medium and high. Results: The assumption of unidimensionality was considered valid. Cronbach's alpha indicated high internal consistency (0.85). Southeast region has got the lowest percentages of teams with low integration and the highest percentages in the high integration, similarly to the South region. From the selected questions, twelve carried a greater amount of information about team's integration to the network. Of these, we highlight matricial support actions (medical appointment; case discussions; shared clinical actions; joined construction of therapeutic projects; permanent education activities; discussion of work processes; interventions on territory and visits with a basic attention professional). In high integration level was recorded frequency of positive answers referred to communication (institutional flow, communication channel and contact list). Nine questions presented negative answers frequency around 50%. ConClusions: According to the proposed integration levels, matricial support actions improved the team's performance. Communication devices between them reinforce this understanding. However, in order to consolidate integral care, a need to qualify the integration between the actions of basic and specialized attention was observed.objeCtives: In universal health systems, integral care management is considered the structural axis in overcoming health care fragmentation of services. This research intends to propose a classification for the integration level between basic and spe-
Obstetric medicine is an emerging area of interest within Internal Medicine in Europe. Despite that, “OM” is still an unpopular concept and an unrecognised subspecialty in South Europe. A considerable number of internists and medical specialists deal with maternal medical problems in association with obstetricians and other specialists on a daily basis. Due to their interest and mostly part-time dedication to maternal care, a growing mass of physicians are getting specific training in the field either locally or, less frequently, abroad, and are also building specific clinics, inpatient care services and other new bonds with obstetricians in numerous tertiary care centres. In this article, we aim to describe the state of the growing field of obstetric medicine in Portugal, Italy, France and Spain, the particular clinical, educational and academic efforts and steps that have recently been developed by internists in each country, as well as planned initiatives for the future.
The objective was to analyze factors associated with planned initiation of dialysis in diabetic patients in the city of Belo Horizonte, Minas Gerais State, Brazil. This was a cross-sectional study of 250 diabetic patients who began dialysis between January 2006 and December 2007. Initiating dialysis with an arteriovenous fistula or in peritoneal dialysis was classified as planned initiation. The study targeted socio-demographic, clinical, and health services use variables using a semi-structured interview. Multivariate analysis used Poisson regression. Seventy per cent of the patients began dialysis on an unplanned basis, and 67% of those consulted had been referred to a nephrologist more than four months previously. Attending a health center, not having the first nephrology appointment paid for by the Brazilian Unified National Health System, and having a choice of treatment for the kidney disease were associated with planned initiation of dialysis. Unplanned initiation of dialysis is common in the city of Belo Horizonte and occurs regardless of the time since referral to the nephrologist.
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