Family Health Strategy Research Articles

Multilevel analysis of social determinants of advanced stage colorectal cancer diagnosis

The advanced stage at diagnosis of colorectal cancer (CRC) may be related to individual factors, socioeconomic conditions, and healthcare service availability. The objective of the study was to analyze the prevalence of advanced stage CRC at the time of diagnosis and its association with individual, contextual, socioeconomic, and healthcare service indicators. An observational, cross-sectional study was conducted, analyzing cases of malignant neoplasms of the colon and rectum in individuals of both sexes, aged between 18 and 99 years, diagnosed between 2010 and 2019 in Brazil (n = 69,047). Data were collected from the Hospital Cancer Registry (HCR), Atlas of Human Development in Brazil, and from the National Registry of Health Institutions (NRHI). A Multilevel Poisson Regression model with random intercept was used. The prevalence of advanced stage CRC at diagnosis was 65.6%. Advanced stage was associated with older age groups prevalence ratio (PR) 4.40 and younger age groups (PR 1.84), low Human Development Index (HDI) (PR 1.22), and low density of family health strategy teams (PR 1.10). The study highlights the unequal distribution of social determinants of health in the diagnosis CRC in Brazil, revealing the need to evaluate and redirect public policies aimed at improving early detection and prevention of CRC in the country.

A Mathematical Model for the Impact of 3HP and Social Programme Implementation on the Incidence and Mortality of Tuberculosis: Study in Brazil.

In this paper, we presented a mathematical model for tuberculosis with treatment for latent tuberculosis cases and incorporated social implementations based on the impact they will have on tuberculosis incidence, cure, and recovery. We incorporated two variables containing the accumulated deaths and active cases into the model in order to study the incidence and mortality rate per year with the data reported by the model. Our objective is to study the impact of social program implementations and therapies on latent tuberculosis in particular the use of once-weekly isoniazid-rifapentine for 12 weeks (3HP). The computational experimentation was performed with data from Brazil and for model calibration, we used the Markov Chain Monte Carlo method (MCMC) with a Bayesian approach. We studied the effect of increasing the coverage of social programs, the Bolsa Familia Programme (BFP) and the Family Health Strategy (FHS) and the implementation of the 3HP as a substitution therapy for two rates of diagnosis and treatment of latent at 1% and 5%. Based of the data obtained by the model in the period 2023-2035, the FHS reported better results than BFP in the case of social implementations and 3HP with a higher rate of diagnosis and treatment of latent in the reduction of incidence and mortality rate and in cases and deaths avoided. With the objective of linking the social and biomedical implementations, we constructed two different scenarios with the rate of diagnosis and treatment. We verified with results reported by the model that with the social implementations studied and the 3HP with the highest rate of diagnosis and treatment of latent, the best results were obtained in comparison with the other independent and joint implementations. A reduction of the incidence by 36.54% with respect to the model with the current strategies and coverage was achieved, and a greater number of cases and deaths from tuberculosis was avoided.

Perception of dental surgeons on multidisciplinary teamwork and preceptorship during the COVID-19 pandemic.

The objective of this work was to verify the perception of dental surgeons (DC) about their professional practice in the family health strategy (ESF), considering aspects related to multidisciplinary action, teamwork and preceptorship during the COVID-19 pandemic. 07 CDs from the Basic Health Units of a Health District (DS) in Recife participated, in the years 2020 to 2021. This was a qualitative study, using a semi-structured interview guide and sociodemographic questionnaire. The data were treated using Bardin's content analysis. The majority of CDs are women (71%), aged between 40 and 50 years old (57%), with more than 20 years of training (57%) and with good professional qualifications, including specialization in the field of activity and a master's degree. Three categories emerged from the qualitative analysis: Daily life before and after the Covid-19 pandemic and comprehensive care; Multidisciplinary teamwork and Influence of the exercise of Preceptorship on the Work Process of the CD in the ESF that recognize dentistry in the ESF is based on teamwork and multidisciplinary action to guarantee comprehensiveness, the pandemic changed the daily routine of services and fragmented care.

Effects of primary health care and socioeconomic aspects on the dispersion of COVID-19 in the Brazilian Northeast: Ecological study of the first pandemic wave.

The COVID-19 pandemic has had a negative impact on socioeconomic and public health conditions of the population. To measure the temporal evolution of COVID-19 cases in cities near the countryside outside metropolitan areas of northeastern Brazil and the impact of the primary care organization in its containment. This is a time-series study, based on the first three months of COVID-19 incidence in northeastern Brazil. Secondary data were used, the outcome was number of COVID-19 cases. Independent variables were time, coverage and quality score of basic health services, and demographic, socioeconomic and social isolation variables. Generalizable Linear Models with first order autoregression were applied. COVID-19 spreads heterogeneously in cities near the countryside of Northeastern Brazilian cities, showing associations with the city size, socioeconomic and organizational indicators of services. The Family Health Strategy seems to mitigate the speed of progression and burden of the disease, in addition to measures such as social isolation and closure of commercial activities. The spread of COVID-19 reveals multiple related factors, which require coordinated intersectoral actions in order to mitigate its problems, especially in biologically and socially vulnerable populations.

The challenges in rebuilding a quality public health in Brazil

In recent years, Brazil has grappled with a denialist approach to its healthcare system, the Unified Health System (SUS), especially during the COVID-19 pandemic. Influential figures, including public personalities, have cast doubt on science, leading to widespread uncertainty. Despite the challenges, Brazil boasts a strong National Immunization Plan (PNI) that has served as a global reference. The country faces the demographic transition, with an aging population requiring healthcare adaptation. Addressing chronic diseases becomes paramount, as does managing the economic implications of an older workforce supporting retirees. Inequalities in access to quality public healthcare persist due to socioeconomic disparities, a divided healthcare system, geographic disparities, ethnic and racial inequalities, education and cultural factors, and long wait times in the public healthcare system. Environmental issues, like deforestation, wildfires, climate change, water pollution, pesticide use, industrial pollution, and food security, impact public health. Sustainable policies and awareness are crucial. Health research in Brazil thrives in universities, institutions, and through international collaboration. Clinical research, epidemiology, public health research, and tropical medicine research are prevalent, but funding challenges and research misconduct persist. Combating infodemia and fake news is essential to ensure that public health decisions are based on reliable information. Fact-checking organizations, healthcare professionals, and education play a vital role. Expanding vaccination coverage is critical to protect against infectious diseases. Brazil employs campaigns, vaccination centers, home visits, school vaccination, partnerships, effective communication, vaccination records, education, and prioritizing high-risk groups. Strengthening the First Level of Health Care through the Family Health Strategy, coverage expansion, professional qualification, electronic health records, prevention programs, management strategies, specialized care, service integration, and community participation can improve healthcare access and coordination. Health education in Brazil focuses on health promotion, disease prevention, child and family health, sexual education, community engagement, school education, information accessibility, and trust in public health policies. The growth of health technology in Brazil can enhance care quality, access, resource management, disease prevention, cost savings, and innovation. However, ethical considerations, equitable access, and data privacy are vital. A democratic environment in public health promotes community participation, accountability, equity, evidence-based decision-making, individual and collective rights, anti-corruption efforts, conflict resolution, and long-term policy planning. SUS funding faces challenges of insufficient resources, budget predictability, dependence on unstable funding sources, regional inequalities, healthcare professional shortages, underfunding of complex services, lack of prevention investment, corruption, and an aging population. Addressing these challenges is vital to maintain SUS as an equitable and effective healthcare system. In conclusion, addressing these healthcare challenges and opportunities is crucial for Brazil's future. It requires ongoing investment in public policies, a multidisciplinary approach, and active community participation. Strengthening primary healthcare and combating misinformation are essential steps toward a healthier and more equitable Brazil.

RISK FACTORS FOR DIABETES MELLITUS ACCORDING TO THE INDIVIDUAL REGISTRATION OF PRIMARY CARE IN A MUNICIPALITY IN THE NORTH OF MINAS GERAIS-MG

Objective: To analyze the completion of the individual e-SUS registration form and identify the completion of the factors that correlate to the onset of diabetes mellitus. Methods: Descriptive study based on documents, in which the individual registration forms of users assigned to an area covered by the Family Health Strategy were used for analysis. Results: It was identified that data such as family history, anthropometric measurements, dietary components, and frequency of physical exercise are not addressed in the registration forms, factors considered predisposing to the disease. There is an underreporting of risk factors for diabetes mellitus since there is no adequate description of them. Conclusion: The individual registration forms of primary care show inconsistencies in the face of factors correlated to the development of metabolic diseases, especially DM, leading to an underreporting of these factors.

Health-related quality of life of oral health workers in primary health care in Salvador, Brazil

This study aimed to determine the level of and identify factors associated with the health-related quality of life (HRQoL) of oral health professionals working in primary health care in Brazil. A cross-sectional survey was carried out among 96 dentists and 65 dental assistants working in the Family Health Strategy in six municipalities in the metropolitan area of Salvador, Brazil. HRQoL was evaluated using the 36-item Short Form Health Survey Questionnaire (SF-36). Higher mean scores in the SF-36 Physical Component Summary were associated with younger age, post-graduate education in public health, and frequent leisure time. The Mental Component Summary was associated with frequent leisure time, >40 weekly working hours, suitable dental offices, satisfaction with colleagues, and satisfaction with working in primary health care. In conclusion, the HRQoL level of oral health professionals working in primary health care in Brazil was comparable to those found in the available literature and associated with several modifiable factors. Incidentally, a literature search found very few studies about the HRQoL of oral health workers that use the SF-36 and those found were produced outside the main scientific centers.

Comparison of four different human papillomavirus genotyping methods in cervical samples: Addressing method-specific advantages and limitations

Since human papillomavirus (HPV) is recognized as the causative agent of cervical cancer and associated with anogenital non-cervical and oropharyngeal cancers, the characterization of the HPV types circulating in different geographic regions is an important tool in screening and prevention. In this context, this study compared four methodologies for HPV detection and genotyping: real-time PCR (Cobas® HPV test), nested PCR followed by conventional Sanger sequencing, reverse hybridization (High + Low PapillomaStrip® kit) and next-generation sequencing (NGS) at an Illumina HiSeq2500 platform. Cervical samples from patients followed at the Family Health Strategy from Juiz de Fora, Minas Gerais, Brazil, were collected and subjected to the real-time PCR. Of those, 114 were included in this study according to the results obtained with the real-time PCR, considered herein as the gold standard method. For the 110 samples tested by at least one methodology in addition to real-time PCR, NGS showed the lowest concordance rates of HPV and high-risk HPV identification compared to the other three methods (67–75 %). Real-time PCR and Sanger sequencing showed the highest rates of concordance (97–100 %). All methods differed in their sensitivity and specificity. HPV genotyping contributes to individual risk stratification, therapeutic decisions, epidemiological studies and vaccine development, supporting approaches in prevention, healthcare and management of HPV infection.

THE NURSE OF THE FAMILY HEALTH STRATEGY AND THE CARE OF PATIENTS WITH PSYCHOLOGICAL DISTRESS

The objective of this research is to understand nurses’ perception of care for patients with psychological distress in the Family Health Strategy (ESF). This is a qualitative and descriptive study. The study population was made up of seven nurses, working for more than six months at the ESF in Montes Claros - MG. The number of participants was defined by theoretical saturation. For data collection, a semi-structured interview was carried out. For data analysis, content analysis with thematic categorization was adopted. The research results showed that mental health care is provided casually by professionals in primary care. The difficulty of planning and executing actions involving new care practices and the multidisciplinary team was verified, and the obstacle is the lack of coordination with the network. The lack of training of professionals who deal with these patients was noted. It was observed that the nurse attributes an important role to the family in the patient’s adherence to therapeutic workshops. It is hoped that this study can contribute to increasing the quality of care for these patients and the need for scientific data, development of programs and other investigations related to this topic.

Avaliação de indicadores sociais e de saúde em municípios de Minas Gerais conforme tipologia rural-urbano

ABSTRACT This article aims to evaluate social and health indicators of municipalities according to the rural-urban typology. This is an ecological study that used official publicly accessible data from the 853 municipalities in the state of Minas Gerais, Brazil. Descriptive and bivariate analysis were carried out using Poisson Regression and Kruskal-Wallis Test. 547 (64.12%) are rural municipalities. The highest average of the Municipal Human Development Index (MHDI) was observed among urban municipalities. The highest average coverage of the Family Health Strategy (FHS) was found among rural municipalities. In these municipalities, the best results were shown for the indicators of infant mortality, premature mortality and mortality from preventable causes, vaccine homogeneity and prevalence of malnutrition. The findings of this study show that greater FHS coverage is associated with the occurrence of better general living and health conditions in the populations served in rural municipalities. It is recommended that health managers encourage the consolidation of the FHS in communities with unfavorable socioeconomic and cultural contexts, such as remote rural locations and urban agglomerations, and the establishment of intersectoral actions with a positive impact on health.

The effect of common mental disorders on suicidal attempts by women, during pregnancy and six to nine years after birth.

There is scarcity of global data on suicide attempts (SA). The higher frequency of mental disorders places women at a higher risk for SA. Mental disorders (MD) are ranked first in the Global Burden of Diseases (GBD) in terms of years lived with disability (YLD) and common mental disorders (CMD) affect women the most. IN this light, the present study aimed to investigate the impact of CMD during pregnancy, as well as 6 to 9 years after birth, on SA in women who were registered in the Family Health Strategy from the town of Recife, Pernambuco, Brazil. This study consisted of two stages of a prospective cohort. 643 adult women were included. The prevalence of CMD in stage I (pregnancy) and in stage III (six to nine years after birth) were, respectively, 19.3% and 12.6%. The incidence of SA was 10.9%. The multivariate analysis demonstrated a cumulative effect of CMD for SA: only during pregnancy (OR 5.4; 95%CI 2.2-13.3); only in the third stage (OR 5.8; 95%CI 2.3-14.9); and in both stages (OR 6.0; 95%CI 2.5-14.4). The increase of CMD in women increases the chances of SA, hence the importance of implementing public policies for women's health, especially for those with a history of mental disorders and unhealthy habits, and those who suffer violence.

Weaknesses in the continuity of care for preterm infants discharged from the neonatal unit.

To identify weaknesses in the continuity of care for preterm infants discharged from a neonatal unit, based on the perspective of professionals in the family health strategy. Qualitative research, carried out with 16 professionals from four health regions in a capital city in the center-west of Brazil. Data collection took place from October to December 2020, through semi-structured, individual, and in-person interviews. Data underwent content analysis, supported by the concept of continuity of care. The analysis consisted of three categories: Challenges for care in the unit and referral to specialized services; weak interactions between the preterm baby's family and health professionals; Information: essential aspect for the connection between health professionals and the family of the preterm newborn. Health services are shown to be fragile in terms of the dimensions of continuity of care, contributing to the discontinuity of care for preterm children.

Efeito dos transtornos mentais comuns na gestação e seis a nove anos pós-parto para a tentativa de suicídio em mulheres

Abstract There is scarcity of global data on suicide attempts (SA). The higher frequency of mental disorders places women at a higher risk for SA. Mental disorders (MD) are ranked first in the Global Burden of Diseases (GBD) in terms of years lived with disability (YLD) and common mental disorders (CMD) affect women the most. IN this light, the present study aimed to investigate the impact of CMD during pregnancy, as well as 6 to 9 years after birth, on SA in women who were registered in the Family Health Strategy from the town of Recife, Pernambuco, Brazil. This study consisted of two stages of a prospective cohort. 643 adult women were included. The prevalence of CMD in stage I (pregnancy) and in stage III (six to nine years after birth) were, respectively, 19.3% and 12.6%. The incidence of SA was 10.9%. The multivariate analysis demonstrated a cumulative effect of CMD for SA: only during pregnancy (OR 5.4; 95%CI 2.2-13.3); only in the third stage (OR 5.8; 95%CI 2.3-14.9); and in both stages (OR 6.0; 95%CI 2.5-14.4). The increase of CMD in women increases the chances of SA, hence the importance of implementing public policies for women’s health, especially for those with a history of mental disorders and unhealthy habits, and those who suffer violence.

Quality of life of older adults in Family Health Strategy: a cross-sectional study.

With the increase in the older adult population, it is essential to identify the living and health conditions that can impact the quality of life of these individuals. To identify the domains and factors associated with the quality of life of older adults under the Family Health Strategy program. This was a cross-sectional analytical study was conducted in the municipality of Palmas, Tocantins, Brazil. We assessed 449 older adults enrolled in the Family Health Strategy program. Data were collected between April and July, 2018. World Health Organization Quality of Life Assessment (WHOQOL-OLD) was used to assess the quality of life (QoL) and multiple linear regression was used to estimate the factors associated with QoL. The QoL domain with the highest score was death and dying (mean = 70.4), and the lowest score was for sensory functions (mean = 61.0 points). The factors associated with QoL were single marital status (β = -4.55; P = 0.014), level of independence for daily living activities (β = 4.92; P < 0.001), self-assessment of regular health (β = 5.35; P < 0.001), and poor health (β = -8.67; P < 0.001). The death and dying domain of QoL presented the highest score. Marital status, impairment in daily activities, and health self-assessment were associated with QoL.

Tendências na qualidade da atenção à saúde da criança na primeira semana de vida na Atenção Primária no Brasil

Abstract The aim of this study was to assess temporal trends in the quality of health care during the first-week child check-up in primary care services stratified by municipal, health team and maternal characteristics. We conducted a cross-sectional study using data from the three cycles of the National Program for the Improvement of Access and Quality (PMAQ) (2012, 2014 and 2018). Adult service users with children aged up to 2 were interviewed. The outcome was “good quality health care in the first week of life”. Descriptive and time trend analyses were performed using variance-weighted least squares regression. The frequency of good quality care during the first-week check-up was 47.9% (95%CI 46.6-49.3) in 2012, 52.5% (95%CI 51.3-53.7) in 2014 and 53.3% (95%CI 52.2-54.4) in 2018, with an annual increase of 0.73 pp (p&lt;0.001). The annual increase was greater in the Northeast (2.06 pp) and in municipalities with very low/low HDI (1.48 pp) and 100% family health strategy coverage (0.98 pp). Trends in the frequency of good quality health care during the first-week child check-up were favorable.

Trends in the quality of child health care in the first week of life in primary care services in Brazil.

The aim of this study was to assess temporal trends in the quality of health care during the first-week child check-up in primary care services stratified by municipal, health team and maternal characteristics. We conducted a cross-sectional study using data from the three cycles of the National Program for the Improvement of Access and Quality (PMAQ) (2012, 2014 and 2018). Adult service users with children aged up to 2 were interviewed. The outcome was "good quality health care in the first week of life". Descriptive and time trend analyses were performed using variance-weighted least squares regression. The frequency of good quality care during the first-week check-up was 47.9% (95%CI 46.6-49.3) in 2012, 52.5% (95%CI 51.3-53.7) in 2014 and 53.3% (95%CI 52.2-54.4) in 2018, with an annual increase of 0.73 pp (p<0.001). The annual increase was greater in the Northeast (2.06 pp) and in municipalities with very low/low HDI (1.48 pp) and 100% family health strategy coverage (0.98 pp). Trends in the frequency of good quality health care during the first-week child check-up were favorable.

Uso dos serviços de saúde por pessoas idosas em áreas rurais e urbanas do Brasil

Abstract Objective To assess health services utilization by older adults in urban and rural areas of Brazil. Method A cross-sectional study was conducted analyzing data from the 2019 National Health Survey on older adults (≥60 years) selected from households based on 22,728 interviews (3,300 in rural and 19,426 in urban areas). For rural and urban areas, the prevalence of Family Health Strategy enrolment, time since last medical and dental visit, service use in past 2 weeks, and last blood pressure and blood glucose measurements were estimated. Also, the factors associated with medical and dental health services utilization in the past 12 months were explored. Results Self-rated health of “Very good” or “Good” was greater in urban areas (47.32%), as was the proportion of older adults reporting a medical or dental visit within the last 12 months (90.54%). Rates of blood pressure (81.30%) and glucose (45.83%) monitoring were lower in rural areas. Older individuals that had low education, resided in rural areas, and the North region, had a lower likelihood of using health services Conclusion The older population living in rural areas had poorer health status compared with the urban population.

[Temporal trend in the evaluation of adequate management for diagnosis and treatment of tuberculosis in primary health care in Brazil (2012-2018)].

This study aimed to analyze the presence of infrastructure and adequate work processes in primary health care (PHC) for the diagnosis, monitoring, and treatment of tuberculosis (TB) in Brazil from 2012 to 2018. This is a temporal trend study carried out with data from basic health units (BHU) evaluated in the cycles I (2012), II (2014), and III (2018) of the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB). Variance-weighted least-squares regression was used to estimate annual changes, in percentage points, of the infrastructure and adequate work process of TB in relation to the macroregion, municipality size, Municipal Human Development Index, and Family Health Strategy coverage. The sample consisted of 13,842 BHU and 17,202 health teams in cycle I; 24,055 BHU and 29,778 teams in cycle II; and 28,939 BHU and 37,350 teams in cycle III. There was a gradual improvement in the proportion of infrastructure and work process for TB care over the three cycles of the PMAQ-AB, but none of the sites is fully adequate. The greatest trend of adequate infrastructure was observed in the South Region, and in 2018, 76.5% of the UBS had all the instruments for TB care. The greatest trend of adequate work process was in the North Region, and in 2018, 50.8% of the teams had all the items for TB care. The Brazilian National Program for Tuberculosis Control and the PMAQ-AB have contributed to these advances, but there is still a need to promote public policies that ensure the continuous improvement of TB care in PHC, the effectiveness of TB control and prevention measures.

Primary Care - A brief summary that every Cephaliatrist should know

Introduction Primary Health Care (PHC) serves as the foundation of the healthcare system, playing a vital role in disease prevention, treatment, and health promotion. It functions as the first point of contact between patients and the healthcare system, offering comprehensive and continuous care. Objectives The primary objective of this review is to provide an in-depth understanding of PHC, with a focus on its structure, processes, services, and projects, as a basis for potential initiatives related to headache disorders. Methodology The literature review encompassed various sources, including Google Scholar, Scielo, Pubmed/Medline, Lilacs, and government sources. Keywords related to PHC, including topics such as structure, functioning, and services, as well as specific areas like Women's Health, Mental Health, vaccination, and child healthcare, were employed. Results PHC is responsible for coordinating the Regionalized Healthcare Network (RAS), which includes Primary Care, communication centers, secondary and tertiary care points, support systems, and governance. PHC serves as the gateway, providing various services, including women's health, mental health, vaccination, child healthcare, and various other medical services. Furthermore, teams, such as the Family Health Strategy and the Family Health Support Center, play distinct roles in health promotion and care coordination. The focus of PHC includes territorialization, vaccination, wound care, women's health, and child healthcare, with a commitment to interventions and projects aimed at improving the quality of care and achieving positive outcomes. Conclusion PHC can play a crucial role in addressing headache disorders, offering early diagnosis, appropriate management, and the promotion of healthy habits. Investing in programs and professional training within PHC can be essential to provide effective care and reduce the demand for emergency care in cases of headache disorders.  

Collective prenatal care facilitated by educational technology: perception of pregnant women.

This article aims to explore the perception of pregnant women regarding collective prenatal care facilitated by educational technology, in the light of complexity thinking. Qualitative, exploratory and descriptive study conducted between August and November 2022. The participants were 19 pregnant women from a Family Health Strategy in the central region of the State of Rio Grande do Sul. Data were collected through individual interviews following prenatal meetings and analyzed using thematic analysis. The analysis of the data revealed three thematic axes: Prenatal care: the necessary reconnection of knowledge; Collective prenatal care: collaborative (re)construction of experiences and practices; and Educational technology: tool to foster self-reflection and self-knowledge. Collective prenatal care, facilitated by educational technology, can promote better practices in the pregnancy-postpartum journey by creating collaborative and shared environments for knowledge construction and enabling autonomous and informed decision-making.