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In this interview, public health physician Antônio Carlile Holanda Lavor with 57-year career and long and broad experience in the Brazilian Unified Health System (SUS) management, especially in primary health care, talks about his management at the head of the Oswaldo Cruz Foundation unit in Ceará (Fiocruz-CE), from 2008 to the present moment. Known internationally for institutionalizing the Health Worker Program in Ceará in 1987, he discusses the process of implementing Fiocruz-CE and the role of research in guiding the work of the Family Health Strategy during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

This study aimed to describe the prevalence of leprosy and verify the factors associated with multibacillary clinical types in a Family Health Strategy priority setting to control and monitor the disease in northeastern Brazil. This cross-sectional study used data from the Notifiable Diseases Information System related to leprosy cases notified in Imperatriz, Maranhão, between 2008 and 2017. The prevalence was determined yearly and for the period. Poisson regression models with a significance level of 5% were employed to associate the variables and the multibacillary clinical types. Most of the 2,476 leprosy cases analyzed referred to multibacillary clinical types. The prevalence ranged from 7.8 and 15.6/10,000 inhabitants, with high and very high endemicity levels. The variables male, age groups between 30 and 59 years and ≥60 years, schooling <8 years, level 2 physical disability, types 1 and 2 reactive episodes, and urban residence area showed significant associations (p≤0.05) with multibacillary clinical types. Such findings can serve as a basis for elaborating and implementing leprosy control and surveillance measures, gearing actions to the most vulnerable groups, and becoming more effective. [ABSTRACT FROM AUTHOR]

This paper aims to describe the indicators related to planning and support in the work process reported by the Family Health Teams, from the 3rd cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ-AB) in the Brazilian Northeast. This cross-sectional study employed secondary data from the external evaluation of the 3rd cycle of the PMAQ-AB. Sixteen indicators were used to ascertain the teams' work process actions, and 14,489 family health teams that adhered to the program were evaluated. Among the indicators assessed, we found that the teams held a meeting and planned actions and self-evaluated, monitored, and analyzed health indicators to reorganize the work process, highlighting the determining and conditioning factors. Health surveillance and the Extended Family Health Center (NASF) stand out in the indicators of institutional support and multidisciplinary support for solving complex cases. We identified improvements in the work process of the teams in the Northeast region, but the reality of fragmented and vertical work still requires a change to promote an outlook of shared teamwork, directly influencing the work process. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The LARIISA collaborators group has been conducting research and development of technological solutions to support decision-making in health systems since 2009. GISSA, a cloud system resulting from the scientific and technological evolution of the LARIISA project, is among the solutions produced. This paper aims to describe the developing trend of GISSA©, a technological tool supporting the Family Health Strategy in northeastern Brazil, pointing out challenges, paths, and potentialities. This is a descriptive and exploratory study, based on secondary sources from the IBGE, INMET, SINAN, SIM, and SINASC, with quantitative analysis based on machine-learning techniques applied to create digital health microservices. Operating in the northeast and southeast regions, GISSA© provides information that qualifies health managers' decision-making process, improving the municipal health system's management. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the perception of doctors about the different hiring methods and their influence on the performance of the PHC essential attributes to analyze the formats that best contribute to its implementation and strengthening. This is a quantitative, crosssectional research using a semi-structured form with 268 doctors from the ESF in Fortaleza, Ceará, Brazil. A unique sociodemographic profile was identified for each group evaluated, influencing the work process and opinions about hiring formats. The development of the essential PHC attributes was positively evaluated, but different perceptions were observed by professional hiring method assessed. The work performed by doctors in the ESF is influenced by how they are hired (p<0.001). Better performance of the statutory (4.4) was noted, followed by scholarship holders of the Mais Médicos Program/Primary Care Valorization Program (3.7), Consolidated Labor Laws (3.5), and, finally, those working with Self-Employed Payment Receipt (RPA) (2.4). We analyzed that hiring through the Brazilian Statutory Regime and RPA are, respectively, the best (85%) and the worst (96.6%) hiring formats. [ABSTRACT FROM AUTHOR]

The work of Community Health Workers (ACS) was analyzed in light of Communities of Practice (CP) theory. This is a qualitative crosssectional study carried out in four municipalities in Ceará. Six focus groups and six interviews were carried out with 45 Community Health Workers (ACS), observing ethical aspects. The data corpus was analyzed using the content analysis technique. The results show that ACS participation in the ESF is marked by experience in the community, and the main focus is monitoring priority groups. The practices put them before the diverse social and family complexities, generating reflections and building new meanings for themselves and their work process. The ACS CPs engage and share challenges and unique learning from work, characterized by close contact and relationships with the families of the territory, which reveals needs hardly perceived by other ESF professionals. The meaning of being ACS as one who listens, embraces, and perceives the needs of families invisible to services, is evident in the reification processes. The ACS better exercise their role as ESF articulators in the territories the greater the spaces for dialogue between them, the other team members, and management. [ABSTRACT FROM AUTHOR]

This study assessed the Family Health Strategy (ESF) health care accessibility in the municipal system, which is the health macro-region headquarters in Bahia. It consisted of two levels of analysis: the municipal management and the local organization of ESF teams. Data production combined documentary analysis, non-participant observation, and interviews with managers, professionals, and users. Goal-image was used with evaluative criteria and dimensions of the accessibility in Primary Care. Family Health Teams (EqSF) still do not entirely fulfill the role of preferential contact in municipal health services, and the health care accessibility reflects the interdependence of municipal and local factors. Rural and peripheral teams performed better in organizational accessibility, and central urban teams performed better in geographic accessibility. The assessment focused on geographic and organizational criteria, combining different sources of evidence and health system players using analysis levels considering the municipal and local PHC management are relevant contributions of this study, which can be extended to other municipal systems with similar characteristics. [ABSTRACT FROM AUTHOR]

Sea people are culturally differentiated by their way of life intertwined with sea fishing and their social and symbolic production. In northeastern Brazil, these people have been changing their living conditions. The Family Health Strategy (ESF) should strengthen links with different cultures to meet its basic principles. We aimed to reflect on the challenges of the ESF in the context of sea people. We conducted ethnographic research in the community of Redonda, Icapuí, State of Ceará, using dense descriptions constructed through the narratives of small-scale fishers and their families. We analyzed from the theoretical approach of studies in traditional communities. The results are shown in five themes: 1) The family has an extended dimension in communities established with relatives; 2) Fishing life temporalities govern the common acts of the land-sea dyad; 3) The shifts between being "native" and "outsider" create border areas that dialogue with the rituals of belonging; 4) Sea territorialization and the knowledge of experience; 5) The ESF in the arenas of struggles for environmental justice. Here, the production of health is reaffirmed as the production of sea people's life. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos de Ciências da Saúde da UNIPAR is the property of Associacao Paranaense de Ensino e Cultura and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Avances en Enfermería is the property of Editorial Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To identify the association of Metabolic Syndrome (MS) and sociodemographic factors, life habits, eating habits, anthropometric measures and clinical factors of climacteric women assisted in primary care. Methods: Cross-sectional and analytical epidemiological study, with a sample composed of 874 climacteric women selected by means of a simple random sampling. The evaluation of the MS was performed according to National Cholesterol Education Program Adult Treatment Panel III. We used the statistical analysis by the chi-square test, considering p

Care for people diagnosed with schizophrenia and delusional disorders involves many challenges, especially in territorial contexts of pronounced social vulnerability. In Rio de Janeiro, the two decades after the passing of Federal Law 10,216 on Psychiatric Reform in 2001 have been characterized by the transition from a hospital-centered model to one based on community services. Taking the case of a community in Rio de Janeiro, data was extracted from the medical records of 94 patients diagnosed with schizophrenia, schizotypal disorders, and delusional disorders (ICD-10 codes F20 to F29) in five public health services. Covering the period from 2003 to 2016, indicators of the quality of treatment provided were analyzed. As a result of this transition, psychiatric hospitals have all but emptied and a low number of currently untreated patients can be observed. In addition, crisis care and long-term hospitalizations have been replaced by territorial care, and clinical comorbidities are monitored and treated at Family Health Units.

ABSTRACT Objectives: to compare health promotion actions carried out by Family Health teams in Ceará, linked to the School Health Program. Methods: a cross-sectional study involving the first and second cycles of an external assessment of 910 and 1,626 teams from 184 municipalities, which joined the Brazilian National Program for Improvement of Access and Quality of Primary Care. Eight clinical assessment and seven health promotion indicators were assessed, together with health professionals working in schools. Results: the interviewees were nurses (95.6% and 98.3%). Between the cycles, there was an increase in clinical assessment (78.7% and 91.3%), health promotion and disease prevention (82.5% and 89.3%) and survey of students for follow-up (41.4% and 66.4%) in schools. Conclusions: health actions at school advanced between cycles, with nurses as protagonists in school health, which can reduce vulnerabilities in children and adolescents and qualify Primary Care.

ABSTRACT Nasal carriage of Staphylococcus aureus by healthcare workers is of great clinical importance as it facilitates the contamination of medical devices and cross-transmission. However, studies regarding the epidemiology and dissemination of S. aureus and Methicillin-resistant S. aureus (MRSA) within the Primary Health Care in Brazil are scarce. The current study aimed to detect and characterize S. aureus and MRSA strains from the nasal cavities of 63 healthcare working in primary health care units in order to determine the prevalence of S. aureus and MRSA, biofilm formation and resistance profile of these isolates. PCR reactions were performed for detecting mecA, icaA and icaD genes. The phenotypic antimicrobial susceptibility was assessed by the disk diffusion method and biofilm formation by the Congo Red Agar (CRA) method. The MRSA isolates were typed for the Staphylococcal Cassette Chromosome mec (SCCmec). The prevalence of nasal carriage of S. aureus was 74.6%, of which 72.3% were MRSA carrying SCCmec type I (24.4%), III (34.1%), IV (36.6%). Two (4.9%) isolates presented a non-typeable cassette by the performed technique. The antimicrobial susceptibility evaluation evidenced penicillin resistance in 66.1% of S. aureus, erythromycin resistance in 49.2%, while 37.3% were resistant to oxacillin, 28.8% to cefoxitin, 5.1% to levofloxacin and 5.1% to clindamycin. All isolates were biofilm producers and 96.6% of the strains contained the ica biofilm-forming genes (icaA and/or icaD). We have demonstrated a high prevalence of S. aureus and MRSA carriage among health care working in Primary Health Care units, the presence of SCCmec types I, III and IV, in addition to their high ability to form biofilm, factors that possibly contribute to the dissemination and persistence of these pathogens within the primary care services. These observations highlight the importance of broadening the perspective of Health Care-Associated Infections prevention, including all health care levels, which are currently little explored. In addition, the dynamics and resistance mechanisms of S. aureus transmission still need to be further clarified to enable the implementation of more effective prevention measures.

Objectives: to develop and analyze the psychometric properties of a questionnaire to assess community health workers' knowledge on breastfeeding.. Methods: this is a methodological study for the development of an instrument and analysis of validity and reliability. For the elaboration of items and identification of dimensions, a literature review was conducted. The items were submitted to the evaluation of a committee of judges, for apparent and content analysis. Construct validation was conducted through hypothesis test, with the participation of 282 community health workers and 19 pediatricians and obstetric nurses. For analysis and comparison of scores, the Mann-Whitney U test was used, assuming a significance level of 5%. Reliability was assessed using Cronbach's alpha coefficient and temporal consistency of the instrument was assessed using test-retest and Kappa analysis.. Results: the final instrument presented a favorable opinion from the committee of judges. The hypothesis test showed that the questionnaire has discriminatory power to assess professionals with a higher level of knowledge (p<0.001). The Kappa test revealed that 63% of the items showed substantive to almost perfect agreement. The 32-item questionnaire showed a Cronbach's alpha of 0.794. Conclusion: the instrument developed was valid and reliable, allowing effective measurement of community health workers' knowledge on breastfeeding. [ABSTRACT FROM AUTHOR]

Background: Given that a considerable amount of care is provided in primary health care settings, a better understanding of patient safety at this level of care is essential. Objective: To explore the perceptions of patient safety among healthcare professionals working in family health teams. Methodology: An exploratory study, using a qualitative approach, was carried out with 23 health professionals (nurses, nurse technicians, physicians, and community health agents) from 6 family health strategy teams in Brazil. Data were collected through semi-structured interviews and analyzed using Bardin's thematic content analysis method. Results: Two thematic categories emerged from the data analysis: (Lack of) Knowledge about patient safety principles and Professionals' actions and strategies for promoting patient safety. Conclusion: Patient safety in primary health care is an issue still poorly understood among the study participants. The nurses were the only professionals who highlighted its current impact. [ABSTRACT FROM AUTHOR]

Background: Given that a considerable amount of care is provided in primary health care settings, a better understanding of patient safety at this level of care is essential. Objective: To explore the perceptions of patient safety among healthcare professionals working in family health teams. Methodology: An exploratory study, using a qualitative approach, was carried out with 23 health professionals (nurses, nurse technicians, physicians, and community health agents) from 6 family health strategy teams in Brazil. Data were collected through semi-structured interviews and analyzed using Bardin's thematic content analysis method. Results: Two thematic categories emerged from the data analysis: (Lack of) Knowledge about patient safety principles and Professionals' actions and strategies for promoting patient safety. Conclusion: Patient safety in primary health care is an issue still poorly understood among the study participants. The nurses were the only professionals who highlighted its current impact. [ABSTRACT FROM AUTHOR]

Background: The assessment of child food intake is essential for health promotion measures. Objective: To evaluate markers of food consumption in children under 5 years of age assisted at the Family Health Strategy and verify their association with social context. Method: The study was conducted in the municipalities of the state of Paraíba, Brazil, considered as priority for actions aimed to prevent childhood obesity, with a probabilistic and representative sample composed of 909 children (893 studied). Results: The following prevalence rates were observed: exclusive and complementary breastfeeding (40.4 and 56.8%, respectively), food diversity (18.2%), fruit consumption (74.9%), consumption of vegetables (61.2%), and consumption of ultra-processed foods by children aged <2 and 2-5 years (51.1 and 25.8%, respectively). The following associations between social context and markers of food intake were found: socioeconomic status - interruption of breastfeeding and fruit consumption; social support - exclusive breastfeeding and interruption of breastfeeding and fruit consumption; social assistance - interruption of breastfeeding, consumption of ultra-processed foods, food diversity, and consumption of main meals; food and nutrition security - food diversity and fruit consumption. Conclusion: The use of markers of food consumption allowed the identification of inadequate food practices and factors associated with social context. [ABSTRACT FROM AUTHOR]

Background: Educational actions are fundamental to produce care, and are part of the activities of communitybased health workers (CHWs). Objective: Evaluate the knowledge of CHWs about oral health (OH) and associated factors. Method: This is a cross-sectional, quantitative study. All 481 CHWs linked to the municipalities belonging the 10th Health Management Section of the state of Pernambuco, Brazil, were invited to participate in the study. Data collection was performed in 2017 during the monthly sectional meetings by means of a validated, self-administered questionnaire. The associations were tested by multiple logistic regression, estimating the crude odds ratio with 95% confidence intervals. Results: 72.9% (351) of the CHWs participated in the study. They were mostly women, aged =40 years, with complete high school, monthly income of up to one Brazilian minimum wage, and with more than 10 years of work experience. 23.6% of the CHWs stated that the team frequently attended meetings, and 12.0% of them said that the dentists underwent training. As for the source of knowledge acquisition, 68.1% answered that it accrued from life experience. Female CHWs and those who did not mention the source of their knowledge about OH were 1.90 (95% CI: 1.10-3.28) and 3.59 (95% CI: 1.46-8.79) times more likely, respectively, to present a lower OH score (p<0.05). Conclusion: The knowledge about OH of CHWs was satisfactory, but negatively influenced by gender and absence of report on the source of acquisition of OH information. [ABSTRACT FROM AUTHOR]

Background: The Brazilian Primary Health Care (PHC) system had advances in its coverage through the Family Health Strategy (FHS) program, a unique experience that has inspired many countries. Objective: To evaluate the presence and extent of essential and derived attributes of PHC from the perspective of professionals, adult users, and caregivers of child users in the services provided by the FHS program. Method: Cross-sectional evaluative survey conducted from June to September 2015 in 21 municipalities in the interior of the state of São Paulo, Brazil, with 102 professionals, 629 caregivers of children aged <2 years, and 690 adult users through application of the Primary Care Assessment Tool (PCAT). Results: The PHC attributes are present in the municipalities; however, First Contact Access - accessibility from the perspective of adult users and professionals - is not, since it obtained PCAT scores <6.6 and, from the perspective of caregivers of child users, needs to be extended. Changes in the organizational aspects of the FHS program and intensification of continuing education for professionals are required, seeking to ensure, in addition to comprehensive population coverage, qualified assistance and presence of all the PHC attributes in the services provided to its users. [ABSTRACT FROM AUTHOR]

The work process of nurses in Family Health Strategy teams is analyzed. Current case study, foregrounded on qualitative approach and based on Symbolic Interactionism, was conducted with nine nurses. Data were collected between March and June 2016 by a semi-structured interview. Thematic content analysis was employed. Work object is identified by spontaneous demand, several activities have a scheduled agenda, besides management issues. Relational and hard technologies were acknowledged as working tools. The developed activities are still focused on the cure model, but an approach to health promotion and disease prevention is acknowledged. Facilitating factors comprised teamwork and Nursing Residence, whereas incomplete staffs made up the difficulties. Care reproduces the biomedical model and professionals acknowledge the need for change. [ABSTRACT FROM AUTHOR]

Cross-sectional study that assessed the satisfaction of people with hypertension about the attributes of Primary Health Care. Data collection took place in the first semester of 2016, using a developed and validated instrument, specific for the population with hypertension, which assessed access to diagnosis and treatment; adhesion / bond; list of services; coordination of care; family focus; and community guidance. Descriptive and inferential statistics were used in the treatment of variables. 417 people with hypertension participated in the study, who evaluated the eight dimensions of primary care as satisfactory. The multivariate regression analysis showed that those with inadequate blood pressure control had more chances of evaluating the list of services and coordination of care as unsatisfactory. It is concluded that the services offered were evaluated as satisfactory in most of the dimensions evaluated, however, people with pressure inadequacy point out the need for improvement in the coordination of care and in the integrality of the services provided. [ABSTRACT FROM AUTHOR]

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Atencao Primaria a Saude is the property of Revista de Atencao Primaria a Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Atencao Primaria a Saude is the property of Revista de Atencao Primaria a Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Bioetica is the property of Conselho Federal de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The study aimed to describe sociodemographic and clinical characteristics of eldery with mellitus diabetes and/or arterial hypertension in the District Health Strategy follow-up and its relation to therapy adherence. Cross-sectional study developed with 99 elderly with mellitus diabetes and/or arterial hypertension in drug treatment. Data collection occurred in District Health Strategies in a city in the Extreme West of Santa Catarina. A characterization questionnaire and Morisky's Therapeutic Adherence Scale were used. As for the characterization, most of the elderly were female, completed elementary school, received up to 2 minimun wage, considered their healthy eating and did not smoke. As for therapeutic adherence, 71 were adherent and 28 non adherent. Greater levels of therapeutic adherence to arterial hypertension and/or diabetes are related to having a formal study level, healthy eating and non-smokers and those who did not live with someone who smoked. [ABSTRACT FROM AUTHOR]

The literature does not clearly define the assignments of Community Health Workers (CHW) in the field of oral health. This study aimed to redefine the main assignments of CHW regarding their work processes in oral health in basic health care. A theoretical-logical model based on an official publication from the Brazilian Ministry of Health, with six dimensions of work, was used. The model was built based on the assignments of CHW in Dentistry and sent to 30 experts chosen intentionally for the consensual study, using the Delphi technique. The matrix presented the following dimensions: registration of families, mapping the coverage area, home visits, work with community health education, participation in the community, and intersectoral work. These dimensions were detailed with sub-dimensions and measurable criteria. After the study participants analyzed the dimensions, two criteria were excluded. Fourteen experts concluded the study. The final matrix showed the need for CHW to be trained in several oral health topics. This study provides an objective framework of the work process of CHW in oral health and shows their ability to perform oral health promotion, surveillance, prevention, and education actions. [ABSTRACT FROM AUTHOR]

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Many countries employ strategies that rest on the use of an explicitly defined set of criteria to identify underserved communities. Yet, we know relatively little about the performance of community-level targeting in large-scale health programmes. To address this gap, we examine the performance of community targeting in the More Doctors Programme (MDP). Our analysis covers all 5570 municipalities in the period between 2013 and 2017 using publicly available data. We first calculate the rate at which vulnerable municipalities enrolled in the MDP. Next, we consider two types of mistargeting: (1) proportion of vulnerable municipalities that did not have any MDP physicians (i.e. under-coverage municipalities) and (2) proportion of MDP enrolees that did not fit the vulnerability criteria (i.e. non-target municipalities). We found that almost 70% of vulnerable municipalities received at least one MDP physician between 2013 and 2017; whereas non-target municipalities constituted 33% of beneficiaries. Targeting performance improved over time. Non-target municipalities had the highest levels of socioeconomic development and greater physician availability. The poverty rate among under-coverage municipalities was almost six times that in non-target municipalities. Under-coverage municipalities had the lowest primary care physician availability. They were also smaller and more sparsely populated. We also found small differences in the political party alignments of mayors and the President between under-coverage and non-target municipalities. Our results suggest that using community-level targeting approaches in large-scale health programmes is a complex process. Programmes using these approaches may face substantial challenges in beneficiary targeting. Our results highlight that policymakers who consider using these approaches should carefully study various municipal characteristics that may influence the implementation process, including the level of socioeconomic development, health supply factors, population characteristics and political party alignments. [ABSTRACT FROM AUTHOR]

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Scire Salutis is the property of CBPC - Companhia Brasileira de Producao Cientifica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: to understand the development of moral sensitivity in the practice of Family Health Strategy professionals. Methods: a unique case study, of qualitative approach, conducted with thirty-five professionals from the family health teams. Data collection occurred through interviews guided by semi-structured script and observation. The data was analyzed through Thematic Content Analysis. Results: the analysis revealed that factors related to work organization, interpersonal relationships and personal values influence the development of the moral sensitivity of professionals in family health teams. Conclusion: the development of the moral sensitivity of Family Health Strategy professionals is influenced by enabling and hindering factors that present themselves in daily work.

Globally, cardiovascular diseases are the leading cause of disease burden and death. Timely and appropriate provision of primary care may lead to sizeable reductions in hospitalizations for a range of chronic and acute health conditions. In this paper, we study the impact of Brazil's More Doctors Program (MDP) on hospitalizations due to cerebrovascular disease and hypertension. We exploit the geographic variation in the uptake of the MPD and combine coarsened exact matching and difference-in-difference methods to construct valid counterfactual estimates. We use data from the Hospital Information System in Unified Health System, the MDP administrative records, the Brazilian Regulatory Agency, the Ministry of Health, and the Brazilian Institute of Geography and Statistics, covering the years from 2009 to 2017. Our analysis resulted in estimated coefficients of −1.47 (95%CI: −4.04,1.10) for hospitalizations for cerebrovascular disease and −1.20 (95%CI: −5.50,3.11) for hypertension, suggesting an inverse relationship between the MDP and hospitalizations. For cerebrovascular disease, the estimated MDP coefficient was −0.50 (95%CI: −2.94,1.95) in the year of program introduction, −5.21 (95%CI: −9.43,-0.99) and −8.21 (95%CI: −13.68,-2.75) in its third and fourth year of implementation, respectively. Our results further suggest that the beneficial impact of MDP on hospitalizations due to cerebrovascular disease became discernable in urban municipalities starting from the fourth year of implementation. We found no evidence that the MDP led to reductions in hospitalizations due to hypertension. Our results highlight that increased investment in resources devoted to primary care led to improvements in hospitalizations for selected cardiovascular conditions. However, it took time for the beneficial effects of the MDP to become discernable and the Program did not guarantee declines in hospitalizations for all cardiovascular conditions, suggesting that further improvements may be needed to enhance the beneficial impact of the MDP on the level and distribution of population health in Brazil.

ABSTRACT OBJECTIVE To characterize the access and use of health services considered reference among the older rural population from a municipality in southern Brazil, whose rural area has full coverage of the Family Health Strategy (FHS), investigating factors associated with the choice of the Basic Family Health Unit (BFHU) as reference. METHODS This is a cross-sectional study conducted in 2017 with systematic sampling of rural households in the municipality of Rio Grande (RS) using a standardized in-house questionnaire. We performed descriptive analyses of sociodemographic profile, type of reference service chosen, and reasons for choosing/using the prime-choice service and the nearest BFHU. Poisson regression was used to investigate factors associated with the type of reference service chosen. RESULTS Among the 1,030 older adults who participated in the study, 61.4% considered the BFHU a prime choice/reference service mostly due to its proximity (82.6%); the others sought other places due to a greater ease (34.6%) and resoluteness (52.6%). Almost ⅔ of the respondents sought care at the BFHU during the last year, and the reasons differed among those who considered the unit as reference (chronic disease) and those who sought another place (procedures). We also found that the lower the age, income, education, and household-unit distance, the greater the likelihood of the older adult considering the nearest BFHU as reference service. CONCLUSIONS The FHS has reached the vulnerable older rural population, approaching an equitable public health system. However, further evaluations are necessary to verify the quality and adequacy of care, given that social structure, enabling factors (such as economic condition), and possible beliefs regarding health still establish the standards for choosing a service.

ABSTRACT Objectives: to identify and analyze possibilities for recognizing health needs in the nurses’ work at Family Health Strategy. Methods: a qualitative study with interviews and observation of the nurses’ work in the countryside of São Paulo. The empirical material was subjected to thematic content analysis and interpreted in the light of the health work process. Results: two themes emerged: Possibilities utilized and Possibilities neglected to recognize health needs. Careful observation, welcoming, attention, listening, bonding and dialogue developed by nurses, in live work in action with users, touched on the possibilities, which, taken advantage of, were evidenced in care in spontaneous demand, scheduled consultation, examination gynecological and group activities. Final Considerations: nurses are able to recognize health needs, which can expand their clinical practice and interprofessionality in Family Health.

ABSTRACT OBJECTIVE To monitor the number of oral health teams implemented in the Family Health Strategy after National Primary Care Policy 2017. METHODS This is a study of quantitative, descriptive and analytical nature that used the data from the public reports of the history of oral health coverage available in the e-Manager platform of Primary Care of the Ministry of Health of all Brazilian municipalities (5,570). The survival rate of the municipalities that did not reduce the number of oral health teams was analyzed according to the region of the country, human development index, Gini inequality index and population size. Cox regression was used to analyze the factors associated with the decrease in the number of teams implanted after 1, 3, 6, 9, 12, 15, 18 and 21 months of publication of the 2017 national policy ordinance, considering the hazard ratio (HR) and p < 0.05. RESULTS After 21 months of publication of the policy, 6.7% of Brazilian municipalities reduced the number of oral health teams. This reduction was higher in the South (6.7%) and Northeast (4.8%), in municipalities with the highest human development index, i.e., greater than or equal to 0.7 (5.6%), more unequal in terms of income distribution (Gini index > 0.62) and larger population size (more than 100,000 inhabitants). Municipalities in the Northeast (HR = 1.220) and South (HR = 1.771) regions had a higher chance of reducing the number of teams compared with those in the North region. More unequal municipalities (HR = 6.405) and with larger population size (HR = 4.273) were also more likely to reduce the coverage of oral health teams. CONCLUSION The municipalities that reduced the number of oral health teams in the Family Health Strategy are from the South and Northeast regions, with greater social inequality and larger population size. This scenario can significantly affect the population’s access to dental health services in the Unified Health System, especially among those in need.

Care for people diagnosed with schizophrenia and delusional disorders involves many challenges, especially in territorial contexts of pronounced social vulnerability. In Rio de Janeiro, the two decades after the passing of Federal Law 10,216 on Psychiatric Reform in 2001 have been characterized by the transition from a hospital-centered model to one based on community services. Taking the case of a community in Rio de Janeiro, data was extracted from the medical records of 94 patients diagnosed with schizophrenia, schizotypal disorders, and delusional disorders (ICD-10 codes F20 to F29) in five public health services. Covering the period from 2003 to 2016, indicators of the quality of treatment provided were analyzed. As a result of this transition, psychiatric hospitals have all but emptied and a low number of currently untreated patients can be observed. In addition, crisis care and long-term hospitalizations have been replaced by territorial care, and clinical comorbidities are monitored and treated at Family Health Units. [ABSTRACT FROM AUTHOR]

Objective: to relate the coverage by the FHS and the availability of respirators with the transmission and mortality rate of COVID-19 in the state of Santa Catarina, Brazil. Materials and methods: this is an ecological study, which uses computational models of geospatial analysis on the progress of COVID-19 to the 295 cities in Santa Catarina. The correlation between the FHS coverage and the number of respirators grouped in the mesoregions was calculated with the COVID-19 transmission and mortality rates. Results: the state had low infection rates of 0.07% and mortality of 1.72%, when compared to Brazil. There was an increase in cases in smaller municipalities, indicating the interiorization of the pandemic. There was no correlation between FHS coverage with infection and mortality. However, respirators are associated with lower mortality. Conclusion: regional disparity was found in the presence of respirators in the state’s micro-regions, suggesting an imbalance in the quality of care for critically ill patients during the pandemic. [ABSTRACT FROM AUTHOR]

Objective: to analyze the perceptions of people with physical disabilities living in the rural context about the welcoming provided by the Family Health Strategy teams. Method: qualitative study, developed in six cities in Rio Grande do Sul, Brazil, whose participants were 13 people with physical disabilities. The production of information took place from January to May 2019 through semi-structured interviews, analyzed by thematic modality. Results: welcoming was related to fondness, affection, relationship of trust, dialogue and closeness with professionals, as well as resolvability of demands or referral to other services. Nevertheless, they listed difficulties regarding the availability of medications, exams, medical care and scheduling of care. Conclusion: despite the efforts of the professionals working in the teams to welcome people with physical disabilities living in the rural context and meet their demands, the centralization of care in biological issues and the limitations of accessibility and access to health services are revealed. [ABSTRACT FROM AUTHOR]

Objective: to understand the organization of the production of health care in Primary Care. Method: qualitative study, carried out with 23 participants of the family health team by means of interview and systematic observation in seven Family Health Units of the central northern region of Bahia, between May and July 2017; data analysis oriented by Gadamerian hermeneutics. Results: the entrance door is selective; service flows are regulated by offering focused on some services, with long waiting and difficulties in scheduling appointments, besides being disjointed and insufficient for continuity of care. A lack of materials and precarious working conditions was observed. The evaluation is invisible, with insufficient actions to corroborate user satisfaction. Conclusion: there is an evident need for improvement in the organization of primary care and composition of primary care as an organizer of integral and resolute practices in the attention network. [ABSTRACT FROM AUTHOR]

Objective: to understand the care for the frail elderly provided by family-related inpatient caregivers, as well as their interaction with the Family Health Strategy, from the perspective of caregivers. Method: exploratory-descriptive, qualitative study conducted with 17 informal family-related caregivers of frail elderly from a Family Health Strategy in Minas Gerais, Brazil. Data collected between September/2019 and February/2020, through an interview with semi-structured script and questionnaire. Content analysis was performed, thematic type. Results: most caregivers were women, 26-79 years old, white and brown, married and low schooling. Effective communication between the health team and the family/elderly caregiver, to the detriment of high turnover of professionals of the Family Health Strategy, excessive demand for functions and lack of training and technical ability of the caregiver. Final thoughts: care for the frail elderly belonged to the female universe and aroused a mixture of feelings. Interaction between caregivers and family health strategy was generally mediated by the Community Health Agent. [ABSTRACT FROM AUTHOR]

Objective: identifying, in the perception of nurses, the intervening factors and strategies used to approach child violence in the Family Health Strategy. Method: a qualitative study with 22 nurses from Teresina, Piaui. Data were collected in October 2019, through individual interviews guided by a semi-structured script, submitted to Thematic Content Analysis. Results: nurses revealed inability to deal with situations of child violence. They sought to approach these cases through strategies based on dialogue, interprofessional work and intersectoriality. Final thoughts: there were intervening factors for the approach of child violence in the Family Health Strategy, the (non-recognition of signs of child abuse), the barriers to establishing bonds with families and difficulties in interlocution in the care network. The strategies for coping with child violence were interprofessional work, holistic care, articulation with the intersectoral network and dialogue with the family. [ABSTRACT FROM AUTHOR]

Objective: to analyze national and international scientific evidence that addresses the perception of nursing students of nurses' role in Primary Health Care. Method: this is an integrative review using the Virtual Health Library database and analysis performed by Classical Textual Statistics and Descending Hierarchical Classification from the conclusions or final thoughts, using the IRAMUTEQ® Software. Results: Of the 83 articles found, five were selected, and the analysis resulted in three classes: Scarcity of nurses to work in Primary Health Care; University education linked to Primary Health Care; and Students' perception about the nursing profession. Conclusion: the process of nursing knowledge education and/or production still links the profession to subjective characteristics, pointing to the need to advance towards evidence-based nursing. Furthermore, the research revealed scarcity of primary studies addressing the theme of this production. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the consumption of ultra-processed foods among children, and to investigate associations with socioeconomic and demographic factors. Methods: An analytical cross-sectional study with 599 children aged 6 months to 2 years, and listed as users of Family Health Units, in a medium-size city. Mothers were approached at home by researchers and community health workers from the Family Health Units, for data collection. Two questionnaires were used: the socioeconomic and demographic questionnaire, and the form Sistema de Vigilância Alimentar e Nutricional of Ministério da Saúde do Brasil, for children aged 6 months to 2 years. Ultra-processed food consumption and socioeconomic and demographic factors were defined as dependent and independent variables, respectively. Multiple regression analysis with a significance level of 5% was used to test associations between ultra-processed food consumption and socioeconomic and demographic variables. Results: Ultra-processed food consumption was associated with child age between 1 and 2 years (OR=3.89; 95%CI: 2.32-6.50 and OR=3.33; 95%CI: 2.00-5.56, respectively), number of people living in the same household (OR=1.94; 95%CI: 1.23-3.05), and recipients of government benefits (OR=1.88; 95%CI: 1.15-3.04). Conclusion: Ultra-processed food consumption among children undergoing complementary feeding may be influenced by socioeconomic and demographic factors. [ABSTRACT FROM AUTHOR]

Introduction: The Family Health Strategy (FHS) is the main strategy of Primary Health Care and reinforces the renovation of strategies to the, once used, hegemonic and fragmented model. The family is the focus of care in this field and as a way of reaching it, it is essential to use family approach tools, as they allow to view the composition, organization and family dynamics. Objective: Approach a family registered in an FHS in the city of Montes Claros/MG using family access tools. Methods: This is a case report, with an exploratory feature, with a qualitative approach, carried out with a family registered in the area covered by an FHS in the city of Montes Claros/MG. For data collection, five shared and semi-structured interviews were conducted, based on the family approach tools: Genogram, Ecomap, Family Life Cycle, F.I.R.O and P.R.A.C.T.I.C.E. As a form of intervention, a shared appointment was held with the index patient. The GenoPro programs were used to archetype the Genogram and the Powerpoint was used to assemble the Ecomapa. Results: This research allowed the team to convince that family to build a personalized care, creating some flexibility in a rigid attitude inside the family, using strategies not used by them before. Concluding Remarks: The familiar approach, through the use of the acesses tools, allows the team of Family Health interventions compatibles with the reality of each family, in a particular way. [ABSTRACT FROM AUTHOR]

Community Health Agents (CHAs) are important collaborators in combating illnesses related to poor eating habits. The objective of this work was to verify the knowledge of the community health workers of Cajamar city about food and the main diseases related to bad eating habits. This is a cross-sectional study, conducted from August to September 2011, in Cajamar city, São Paulo by trained interviewers. 57 HCWs were interviewed who answered two questionnaires, the first to characterize them and the second to obtain data on basic knowledge about food and the main diseases related to poor eating habits. 96.5% of the CHA were female, had an average of 34 years, 88.1% had two children, predominance of complete high school (56.1%; n=32). They had the function of CHAs as the main source of income, receiving up to three minimum wages and exercising it for at least six months (52.6%). When the subject was food, 94.5% report that they are the first to address the issue. The main difficulties were that people did not follow the guidelines (43%) and lack of knowledge (40%). There was a good performance in the issues regarding chronic diseases (76.6% of hits) and risk groups (97%). In questions about food groups and food security, there was low performance (rate of hits of 55.2% and 55.3%, respectively). The qualification of CSAs is fundamental for the improvement of the work performed, being important the use of educational strategies that provide continuous learning. [ABSTRACT FROM AUTHOR]