Notice bibliographique
Résumé
In this issue of Cadernos de Saúde Pública, four articles describe the state of primary care in Portugal 1 , Brazil 2 , Canada 3 and Chile 4 .These papers are timely in view of the 40th anniversary of the 1978 Alma-Ata Declaration 5 .This landmark declaration in the history of primary care asserted that "All governments should formulate national policies, to launch and sustain primary health care as part of a comprehensive national health system", defining universal access to primary care as "the central function and main focus of a country's health system".Against this challenge, how has healthcare in these countries fared?Portugal moved from a system entirely based on private practice to a National Health System in 1979 with increased access to care and improvements in health indicators such as infant and maternal mortality and life expectancy, which the authors describe as "dramatic".Residency programmes in primary care were created in the 1990s, with most primary care physicians working in the public sector and universal coverage for the population.Since then, primary care has become organized into autonomous teams of physicians, nurses and administrators (Family Health Units), described by the authors as a "veritable utopia" for primary care.None of these reforms were established without considerable opposition from entrenched interests, but primary care is identified as one of the stabilizing factors in Portugal, given the country's more recent economic problems.Brazil embarked on equally dramatic reforms in 1990 with the creation of a Brazilian Unified National Health System (SUS), guaranteeing universal access to care, and the creation of Family Health Teams that now cover 90% of the population.These geographically defined teams typically have a family physician and nurses with oral health teams and other disciplines in the larger ones.Community health agents form an important part of these teams, with members drawn from the local community and so particularly well placed to understand the needs of their communities and to provide appropriate health promotion advice.The country has problems to provide enough primary care physicians, and the demand on providing populations with health teams remain high.Indeed, the vision of primary care as a coordinating force is described by the authors as a "distant reality".Nevertheless, the achievement of Brazil in providing a universal model of primary care in a large country with very diverse needs is impressive.More recent problems, also experienced by many other countries, are the entry of the corporate private providers reducing the number of physicians available to work in the public sector, allied to austerity programmes implemented by the central government.A feature of the Brazilian healthcare and the model in several Scandinavian countries is the involvement of municipalities playing a strong role in the finance and delivery of healthcare. years on. Has the vision of Alma-Ata been realized?40 anos depois.A visão de Alma-Ata foi concretizada?Después de 40 años.¿Se ha hecho realidad la visión de Alma-Ata?
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,005 | 0,007 |
| Communication savante | 0,011 | 0,010 |
| Science ouverte | 0,001 | 0,004 |
| Intégrité de la recherche | 0,006 | 0,013 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,021 | 0,007 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».