Family Health Strategy Service Research Articles

Associations between primary healthcare and infant health outcomes: a cohort analysis of low-income mothers in Rio de Janeiro, Brazil

Expanding primary healthcare to urban poor populations is a priority in many low-and middle-income countries and is essential to achieve universal health coverage (UHC). Between 2008 and 2016 the city of Rio de Janeiro undertook an ambitious programme to rapidly expand primary care to low-income areas through the family health strategy (FHS). Infant health impacts of this roll out are unknown. This study examines associations between maternal FHS utilisation and birth outcomes, neonatal and infant mortality. A cohort of 75,339 live births (January 2009-December 2014) to low-income mothers in Rio de Janeiro was linked to primary care, birth, hospital and death records. The relationship between maternal FHS use and infant health outcomes was assessed through logistic regression with inverse probability treatment weighting and regression adjustment. Socioeconomic inequalities in the associations between FHS use and outcomes were explored through interactions. Primary outcomes were neonatal and infant death. Thirteen secondary outcomes were also examined to explore other important health outcomes and potential mechanisms. A total of 9002 (12.0%) infants were born to mothers in the cohort who used FHS services either before pregnancy or in the first two trimesters. There was a total of 527 neonatal and 893 infant deaths. Maternal FHS usage during the first two trimesters was associated with substantial reductions in neonatal [adjusted odds ratio (aOR): 0.527, 95% confidence interval (95% CI): 0.345; 0.806] and infant mortality (aOR: 0.672, 95% CI: 0.48; 0.924). Infants born to lower-income mothers and those without formal employment had larger reductions in neonatal and infant mortality associated with FHS use. Maternal FHS in the first two trimesters use was also associated with more antenatal care consultations and a lower risk of low birth weight and preterm birth. Expanding primary care to low-income populations in Rio de Janeiro was associated with improved infant health and health equity benefits. DFID/MRC/Wellcome Trust/ESRC.

English

Ethnobotanical surveys have proved plant usage in the treatment of oral diseases; however, in areas where cocoa farming influenced socioeconomic reality there is a lack of information about preservation of traditional knowledge related to oral conditions treatment. Family Health Strategy (FHS) users and community experts were interviewed with socioeconomic characteristics and ethnobotanical information being obtained through a semi-structured questionnaire. Plants informed by participants were harvested and lower socioeconomic conditions were statistically associated with medicinal plant usage. Lower level of education showed a tendency to influence medicinal plant use. Religious belief, gender or ethnicity and indigenous ancestry were not associated with medicinal plant usage. Of the 66 medicinal plants informed by interviewees from the FHS services, 12 were confirmed by experts for use in oral conditions. Leaves root and bark were used as decoction infusion or crushing/grinding for mouthwash ingestion or gargle. The most cited indications of oral conditions were inflammation and toothache. Plants most mentioned were Dysphania ambrosioides, Schinus terebinthifolius, Plantago major, Piper hayneanum, Anacardium occidentale, Zingiber officinale, Punica granatum, Mimosa pudica, Gossypium barbadense, Cajanus cajan, Bidens pilosa and Hyptis pectinata. Fifty-four species were recorded on the virtual information system. Overall, the results indicated that in the municipality studied the community is able to withstand exclusionary factors and pass on the ability to meet their own health needs with medicinal plants to future generations. The information herein may support public policies establishment in the region and bring benefits to excluded communities in relation to oral diseases. Key words: Municipality of Una, oral diseases, ethnobotany surveys, medicinal plants.

TEMPO DE CONTATO COM INTERVENÇÕES EDUCATIVAS E AUTOCUIDADO DE PESSOAS COM DIABETES MELLITUS

Objetivo: verificar a relação entre o tempo de contato com intervenções educativas e as variáveis de autocuidado em usuários com diabetes mellitus.Método: estudo quase experimental do tipo antes e depois. Os dados foram coletados entre agosto e dezembro de 2019, em dois momentos distintos: no primeiro dia de intervenção educativa (momento inicial) e o no último dia (momento final). Na análise, utilizou-se o t-student pareado para comparar as médias dos escores no momento inicial e no momento final.Resultados: participaram do estudo 57 pessoas que viviam com diabetes mellitus tipo 2. A análise demonstrou melhora nos escores de autocuidado entre o momento inicial (4,15) e o momento final (4,81), com significância estatística (p<0,001).Conclusão: verificou-se uma relação positiva entre o tempo de contato com intervenções educativas e as variáveis de autocuidado em usuários acompanhados na estratégia de saúde da família que vivem com diabetes mellitus.

Impact of the Brazilian Family Health Strategy on child oral health-related quality of life: a cohort study.

Most of the Brazilian population is covered by the Family Health Strategy (FHS), however no longitudinal study has assessed the impact of the FHS on child oral health-related quality of life (OHRQoL). The objective of the study was to evaluate the longitudinal impact of the FHS on the OHRQoL. This study followed up 459 children aged 2 to 5 years for 2 years. OHRQoL was assessed by the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) at baseline (April to November 2016) and follow-up (April to December 2018). Children's parents answered a questionnaire regarding sociodemographic information, FHS service, and dental service. Participants were clinically examined for dental caries. Multilevel Poisson regression was used to assess the associations between FHS variables at baseline and overall/domain-specific of the ECOHIS scores over time. A total of 365 children were reassessed for OHRQoL (follow-up rate: 79.5%). The absence of FHS coverage from the child's first year of age was associated with higher scores in the family function domain [rate ratio (RR) = 2.42; 95% confidence interval (CI) 1.28-4.58)]. Home visits by the FHS team members were associated with higher psychological domain scores (RR = 1.60; 95%CI 1.01-2.57). Children not covered by the FHS since the first year of age reported worse OHRQoL over time. This fact highlights the importance of an integrated health approach to promote children's health.

Primary healthcare expansion and mortality in Brazil's urban poor: A cohort analysis of 1.2 million adults.

BackgroundExpanding delivery of primary healthcare to urban poor populations is a priority in many low- and middle-income countries. This remains a key challenge in Brazil despite expansion of the country’s internationally recognized Family Health Strategy (FHS) over the past two decades. This study evaluates the impact of an ambitious program to rapidly expand FHS coverage in the city of Rio de Janeiro, Brazil, since 2008.Methods and findingsA cohort of 1,241,351 low-income adults (observed January 2010–December 2016; total person-years 6,498,607) with linked FHS utilization and mortality records was analyzed using flexible parametric survival models. Time-to-death from all-causes and selected causes were estimated for FHS users and nonusers. Models employed inverse probability treatment weighting and regression adjustment (IPTW-RA).The cohort was 61% female (751,895) and had a mean age of 36 years (standard deviation 16.4). Only 18,721 individuals (1.5%) had higher education, whereas 102,899 (8%) had no formal education. Two thirds of individuals (827,250; 67%) were in receipt of conditional cash transfers (Bolsa Família). A total of 34,091 deaths were analyzed, of which 8,765 (26%) were due to cardiovascular disease; 5,777 (17%) were due to neoplasms; 5,683 (17%) were due to external causes; 3,152 (9%) were due to respiratory diseases; and 3,115 (9%) were due to infectious and parasitic diseases. One third of the cohort (467,155; 37.6%) used FHS services. In IPTW-RA survival analysis, an average FHS user had a 44% lower hazard of all-cause mortality (HR: 0.56, 95% CI 0.54–0.59, p < 0.001) and a 5-year risk reduction of 8.3 per 1,000 (95% CI 7.8–8.9, p < 0.001) compared with a non-FHS user. There were greater reductions in the risk of death for FHS users who were black (HR 0.50, 95% CI 0.46–0.54, p < 0.001) or pardo (HR 0.57, 95% CI 0.54–0.60, p < 0.001) compared with white (HR 0.59, 95% CI 0.56–0.63, p < 0.001); had lower educational attainment (HR 0.50, 95% CI 0.46–0.55, p < 0.001) for those with no education compared to no significant association for those with higher education (p = 0.758); or were in receipt of conditional cash transfers (Bolsa Família) (HR 0.51, 95% CI 0.49–0.54, p < 0.001) compared with nonrecipients (HR 0.63, 95% CI 0.60–0.67, p < 0.001).Key limitations in this study are potential unobserved confounding through selection into the program and linkage errors, although analytical approaches have minimized the potential for bias.ConclusionsFHS utilization in urban poor populations in Brazil was associated with a lower risk of death, with greater reductions among more deprived race/ethnic and socioeconomic groups. Increased investment in primary healthcare is likely to improve health and reduce health inequalities in urban poor populations globally.

Assessment of public oral healthcare services in Curitiba, Brazil: a cross-sectional study using the Primary Care Assessment Tool (PCATool)

ObjectivesTo compare two different models of public oral health in primary care services, a so-called family health strategy (FHS), as opposed to non-FHS services designated as ‘conventional’ healthcare (CHC), regarding...

Integration of health services in the care of people living with aids: an approach using a decision tree.

The care offer to people living with HIV/AIDS must transcend specialized outpatient services and include the participation of the Family Health Strategy. By understanding the importance of integration between these two points in the care network, the study aimed to build a decision support model to assist professionals of specialized health services in identifying behavior patterns in the use of Family Health Strategy services by people living with HIV/AIDS attended in the outpatient clinic. Thus, was proposed a model called decision tree, created from a database of 141 people with AIDS, users of a specialized outpatient clinic. The decision-making variable was the use of Family Health Strategy services by evaluating the integration of care. The model enabled the establishment of 23 rules with 80.1% hit percentage, what may support the decision-making of professionals in identifying situations in which it is necessary to stimulate the use of the Family Health Strategy by users.

Evaluation of prenatal care in unit with family health strategy.

We analyzed prenatal care (PN) provided at a unit of the Family Health Strategy Service in São Paulo, according to the indicators of the Program for the Humanization of Prenatal and Birth (PHPB). We compared adequacy of PN in terms of sociodemographic variables, procedures, examinations and maternal and perinatal outcomes. Cross-sectional study with data from records of 308 pregnant women enrolled in 2011. We observed early initiation of PN (82.1%), conducting of a minimum of six consultations (84.1%), puerperal consultation (89.0%); to the extent that there is a sum of the actions, there is a significant drop in the proportion of adequacy. Prenatal care was adequate for 67.9%, with a significant difference between adequacy groups in relation to gestational age and birth weight. Prenatal care deficiencies exist, especially in regards to registration of procedures, exams and immunization. The difference between adequacy groups with respect to perinatal outcomes reinforces the importance of prenatal care that adheres to the parameters of the PHPB.

The network of mental health care from the family health strategy service

The Family Health Strategy Service (FHSS) is an important ally in the mental health system, contributing to the completeness and effectiveness of care. This study aimed to discuss the mental health care network as compared to the daily routine of an FHSS. It is an evaluative study with a qualitative methodological approach. It was developed in an FHSS in Porto Alegre-RS, Brazil. Data was collected between July and December of 2010 through interviews with 16 workers and ten relatives. We identified important resources in primary health care, such as partnerships with academia. However, the constitution of this care is still based on specialty, following the logic of patient referral. Our intention for this study was to contribute to the operationalization of the mental health care network, consolidating the partnership with the FHSS and developing activities in the territorial space, raising awareness, demystifying health care service in the area, and countering the perception that it is uniquely specialized.

The Flower Workshop: A social self-organizing practice in mental health nursing

Aims: We depart from the theory of Self-Organizing Systems applied to the practice of mental health nursing in open, public health care services. The present study aimed at understanding how the participants evaluate the importance of the Flower Workshop for their lives. Methods: It is an investigation of qualitative nature that took place in two units of the Brazilian Family Health Strategy service, using semi-structured interviews and thematic analysis. Results: The subjects valued the workshop as a facilitating event, promoting the feeling of belonging, enhancement of interpersonal relations and integration of emotional, ideative and corporal experiences in a psychosocial rehabilitation context. Conclusion: We analysed the reports of participants in three categories, which indicate that the workshop provided: a) An extended care and search for meaning; b) Changes in conduct; and c) An augmented social network.

Acesso e utilização dos serviços na Estratégia Saúde da Família na perspectiva dos gestores, profissionais e usuários

Questionnaires adapted to the Brazilian reality (Primary Care Assessment Tool) to evaluate access to and use of services were distributed to 30 managers, 80 professionals and a random sample of 882 Family Health Strategy (FHS) users in São Luís in the state of Maranhão. The differences between the evaluations of managers, professionals and users were identified by the Kruskal-Wallis test and Dunn's post test. Users faced difficulties in access to and use of the services, which were also considered unsatisfactory by managers and professionals. Access was the dimension with the worst evaluation, and non-functioning of units after 6 p.m. and at weekends were the main difficulties. The evaluations of the managers and professionals were almost always divergent from those of the users, with the evaluation of the managers being more favorable. The fact that the service was free of charge, the use of preventive services and the FHS services before the specialized care were well evaluated. The operation of units should attend users' needs, especially that of the working population. Strengthening social participation in local management of the FHS may assist in identifying these needs, thereby reducing the divergent opinions of the players involved.

Avaliação do autocuidado em portadores de diabetes na maturidade de uma Estratégia Saúde da Família de Teresina-PI*

Introdução: Diabetes Mellitus é uma síndrome de etiologia múltipla com prevalência de 10,3% em idosos, que requer do portador ações de autocuidado. Objetivo: Avaliar o autocuidado de diabéticos na maturidade em uma Estratégia Saúde da Família (ESF) de Teresina (PI). Método: Realizou-se estudo transversal com 55 diabéticos, de 60 a 85 anos, ambos os sexos, cadastrados no Programa de Hipertensão e Diabetes Mellitus de uma ESF. Os dados foram coletados por meio de formulário estruturado, e analisados pelo programa Epi Info. Resultados: Os idosos acompanhavam a taxa de glicemia de jejum (98,20%), procuravam o serviço de saúde (96,40%) e usavam hipoglicemiante oral (89,00%). Na dieta seguida por 78,20% dos participantes, havia carnes, frutas, arroz e feijão; contudo, 30,90% da amostra consumiam açúcares, guloseimas e refrigerantes, alimentos contraindicados para o diabético. Conclusão: Os idosos diabéticos apresentavam uma adesão significativa ao autocuidado, aparentando preocupação nas medidas de controle e nas estratégias alimentares.

Avaliação da síndrome de burnout em profissionais da Estratégia Saúde da Família da capital paraibana

This study evaluated whether the professionals who work at the Family Health Strategy Service in Joao Pessoa, Paraiba have burnout syndrome. It was used a random sample of 337 servers using the Burnout Characterization Scale which investigates the following factors: (a) Emotional exhaustion (α= .94); (b) Dehumanization (α= .70); and (c) Deception (α= .70). In data processing, descriptive statistics, factor analysis, clusters analysis and sample comparison tests were performed. The results showed that 37.09% of the professionals scored high and medium rates (developed burnout), and 70.45% of the professionals who have other jobs do not have the syndrome. It is concluded the need for mental health care to those who work in the front of the Brazilian Single Health System.

A terapia comunitária como estratégia de promoção à saúde mental: o caminho para o empoderamento

Na contemporaneidade, a mulher tem exercido uma diversidade de papéis culturais, seja como cuidadora e mantenedora do lar, ou como empresária administradora e provedora de serviços. O processo saúde doença da mulher é marcado por situações de sofrimento caracterizado pelo estresse constante, independente do papel que ela ocupa socialmente. Experiências da Terapia Comunitária, com mulheres tem sido uma estratégia adotada pelas equipes de saúde da família para enfrentar sofrimentos emocionais originados no cotidiano. O objetivo deste estudo foi conhecer as contribuições da Terapia Comunitária no cuidado com mulheres usuárias dos serviços da Estratégia saúde da Família. Trata-se de um estudo exploratório realizado no município de Vila Flor, Rio Grande do Norte, com 13 mulheres que participaram das rodas de terapia, durante o período de maio a agosto de 2008. O material empírico foi produzido por meio entrevistas seguido da análise dos discursos. Os dados permitem a afirmação de que as mulheres ao compartilharem seus problemas receberam apoio do grupo, refletindo no alívio do sentimento de dor que estava associado à perda de pessoas queridas. Pode-se inferir que os encontros promoveram o resgate do atributo resiliente, contribuindo para empoderamento, intensificando a autonomia e auto-estima, fortalecendo vínculos familiares, sociais, comunitários e espirituais.