Health Agents Research Articles

Longitudinal care: factors associated with adherence to postpartum follow-up according to data from PMAQ-AB

The aim was to identify factors of longitudinal care associated with women´s adherence to postpartum consultation in Brazil. This was a cross-sectional study of data from 19,177 postpartum women who participated in the external assessment of the third cycle of the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB), 2017. The dependent variable was postpartum consultation, and the independent variables, grouped hierarchically, were sociodemographic and economic at the distal level and issues analogous to longitudinal care at the proximal level. Multiple logistic regression analysis was performed with hierarchical entry of variables, where sociodemographic and economic variables were used to adjust the model. The results showed that 53% of women had undergone postpartum follow-up. The odds of adherence to postpartum follow-up were higher in women who received a home visit by a community health agents in the first week after childbirth (OR = 4.81), those with seven or more prenatal consultations (OR = 2.74), those who had sought care at the health unit in question (OR = 1.21), and those who had been seen by the same physician (OR = 1.14). In conclusion, the proportion of postpartum consultations was low (53%), and adherence to postpartum follow-up was higher when women received visits by community health agents, were accompanied by the same physician, had regular prenatal care, and had a specific healthcare unit as their regular source of care. Consistent longitudinal care was identified as an attribute of primary care that should be strengthened to improve postpartum care.

The role of biopolymers as candidates for promoting health agents: A review

The role of biopolymers as candidates for promoting health agents: A review

Correlation between Perceived Social Support and Work-Family Conflict in Community Health Agents

Resumo Este estudo tem como objetivo avaliar se existe correlação entre conflito trabalho-família e suporte social percebido em Agentes Comunitários de Saúde (ACS). Ademais, este é um estudo transversal e correlacional com delineamento quantitativo, em que foram ocupadas a Escala Multidimensional de Conflito Trabalho-Família (EMCT-F) e a Escala de Percepção de Suporte Social (2-Way SSS). Os participantes da pesquisa foram 139 ACS atuantes em quatro municípios do interior do Rio Grande do Sul. Para a análise dos dados, foram utilizadas a Estatística Descritiva, Estatística Paramétrica e Correlação de Pearson. Os resultados entre as correlações das escalas foram estatisticamente significativos (p<0,05) nos fatores dar suporte emocional e conflito família-trabalho, e receber suporte instrumental e conflito família trabalho. Assim, o estudo permitiu compreender melhor a relação entre as variáveis destacadas, sendo que esse entendimento poderá subsidiar intervenções baseadas na Psicologia Positiva para os ACS.

Caminhos da população ribeirinha no acesso à urgência e à emergência: desafios e potencialidades

The study aimed to analyze the riverside population’s access to urgent and emergency services in Maués, Amazonas, Brazil, through the methodology of participatory approach and the analysis of talking maps and narratives. The relevance of the Community Health Agent came was highlighted, as well as the importance of mechanisms to deliver care in the riverside territory, such as the Fluvial Primary Care Unit and launches known as ambulanchas. However, challenges also came to light, like transportation in urgent and emergency situations and lack of a professional with a higher education degree to provide initial care in the territory. In addition, articulation and communication between sectors and the referral process are still deficient. Thus, strategies are needed to integrate the different points of the Healthcare Network, enabling communication and articulation. Moreover, new strategies to promote healthcare access must be developed in meetings between management and workers, grounded on reflective dialogue.

Community Health Agents and child health care: implications for continuing education.

To understand the main situations faced by community health agents in relation to children's health in the light of permanent education actions. This is a research of qualitative approach, which used the Arc of Maguerez. Ten community health agents from a Primary Health Care Unit participated in the study. The following steps were addressed: observation of reality; identification of key points, and theorization. The speeches were recorded, transcribed, and their textual content was processed in the IRAMUTEQ software, using the Descending Hierarchical Classification. Five classes were formed, which composed three thematic blocks named as follows: child's social vulnerability in the territory; handling the child's health record, and vaccination schedule. Unveiling situations that influence the work of community health agents is essential for continuing education, as this favors assumptions applicable to daily work with resoluteness in child health.

Advisory teams on the streets: A nurse's experience report.

To report a nurse's work experience with the street medical consultation teams in the city of São Paulo/SP Brazil. Descriptive, experience report study, which describes the care for homeless people, from a nurse's perspective and experience. Among the attributions of the nurses working with the street medical consultation teams, there are the accurate knowledge of the territory, the ability to build bonds, the performance of diagnoses of health and epidemiological conditions, the planning of the team's actions, the establishment of integration flows with the Health Care Network, the knowledge and understanding about the people ending up on the streets, the supervision of the actions of nursing assistants and community health agents. Acting as a nurse on the street medical consultation team is a new and challenging experience that requires dynamic, strategic, creative, and empathic actions. The presence of nurses in the Street Medical Consultation teams contributes to ensuring access to health services and comprehensive care, expanding the possibilities of early detection, treatment, monitoring, and healing of chronic and infectious diseases.

The use of homeopathy to prevent symptoms of human flu and acute respiratory infections: a double-blind, randomized, placebo-controlled clinical trial with 600 children from Brazilian Public Health Service

In Brazil, homeopathy was implemented in the Public Health Service through the National Policy on Complementary and Integrative Practices of the Health Ministry, published in 2006. Homeopathy appears as a very interesting therapy to be used in the Public Health Services since its medicines are compounded at a very low cost. Considering this interesting scenario to develop research in the Public Health, the Family Health Program (FHP) in Petropolis and the Faculty of Pharmacy at UFRJ started a partnership with the Roberto Costa Institute. A homeopathy clinical trial, employing a control protocol (double-blind, randomized, placebo-controlled), was developed as a result of this partnership starting in April 2009 and ending in April 2010. This clinical trial, approved by the Ethics Committee at UFRJ, number 194/08, aimed to evaluate the efficacy of two types of biotherapics to prevent symptoms of both flu and acute respiratory infections, compared to placebo (ethanol 30%). The biotherapics tested were ARI (Acute Respiratory Infection) and InfluBio. ARI is a homeopathic complex containing three different microorganisms related to respiratory infection while InfluBio is a biotherapic compounded from infectious influenza A virus. Before the development of this clinical trial, ARI had been used routinely in FHP, in Petropolis, to prevent acute respiratory infections in patients. The qualitative results obtained from this application suggested that this medicine has a prophylactic potential in the treatment of respiratory diseases. Additionally, we evaluated the antiviral activity of InfluBio using in vitro methodology and the promising results obtained motivated our group to test it in a clinical trial. With this aim, 600 children, from 1 to 5 years of age, were selected by physicians in 21 units of FHP, following the inclusion/exclusion criteria. For 1 month (April 2009), the children received daily, in a blind manner, the test solutions (placebo, ARI, InfluBio) in the posology of 1 drop per year of age. After 30 days, the use of these solutions was interrupted, and the health agents monitored the children for the subsequent twelve months, registering, in a specific questionnaire, symptoms of flu and acute respiratory infections. The respiratory symptoms that were to be reported were: runny nose, fever, prostration, myalgia, cough and headache. In the occurrence of one or more of these symptoms, the health agents evaluated the necessity of intervention by the physician. Of the 600 children, 450 completed the planned monitoring. The main reasons why 150 quit the treatment were change of address and parents’ abandonment. Additionally, no death was recorded and all the children presented good clinical evolution. In the case of the children who received placebo, the frequency of episodes diagnosed as acute respiratory infection/flu was three times higher when compared to those that received the ARI and InfluBio samples, considering the superior limit of the interquartile interval. Moreover, children treated with these biotherapics did not present any or presented only a single episode of ARI/Flu. These results showed that both biotherapics tested were statistically higher (p

Can biological soil crusts be prominent landscape components in rangelands? A case study from New Mexico, USA

To sustainably manage rangelands, it is paramount that all agents of soil health are considered in conservation practices. Yet, our understanding of the extent and importance of biological soil crust (hereafter biocrust) as a component of rangeland health and quality is limited. The objective of this project was to quantify and characterize rangeland biocrusts within a region of New Mexico, USA, for which soil microbes have yet to be considered in rangeland health assessments: the Rio Puerco Watershed. Moreover, we examined the influence of biocrust on soil aggregate stability as key ecosystem service in a landscape prone to erosion. We further assessed the relationships between biocrust abundance and community composition with soil properties. We found that biocrusts covered an average of 41% of plant interspaces throughout all sampling locations (n = 20), with the most abundant types being incipient and light cyanobacterial crusts, which tend to be more cryptic in appearance. Soil surface stability was greater than subsurface stability and biocrust cover was positively related to soil surface stability. Light cyanobacterial and cyanolichen crusts were the primary biocrust types related to soil surface stability, especially on sites with unconsolidated subsurfaces. Physical soil crusts were also a major landscape component covering an average of 21% of the soil and were important for subsurface stability. These findings reflect the importance of biological and physical soil aggregating processes in dryland systems. Several environmental variables were related to biocrust community composition and aggregate stability, with surface soil texture, salt contents, pH, and soil nitrogen ions having the strongest relationships. This study expands the biocrust characterizations of drylands in a region that has received little attention. It further contributes new insights on how biocrust and soil microbial communities may play a role in influencing rangeland health, providing much needed data for a watershed characterized by its high susceptibility to soil loss.

Occupational stressors and work accidents among health workers.

ABSTRACTOBJECTIVE To test the association between occupational stressors and work accidents due to exposure to biological material (ATbio) in health workers, considering the isolated and combined analysis of the dimensions of two models, the demand-control model (DCM) and the effort-reward imbalance model (ERI).METHODS Cross-sectional study in a representative sample of workers with higher, technical and secondary education, including health agents from primary and medium-complexity care units in five cities in Bahia. Random sampling was selected, stratified by geographic area, level of service complexity and occupation. The outcome variable was ATbio; The main exposure was occupational stressors, assessed by the DCM and ERI. Incidences and relative risks were estimated as a function of the acute, short-term nature of the outcome of interest. Associations between ATbio and isolated and combined DCM and ERI dimensions were tested.RESULTS A total of 3,084 workers participated in the study. The global incidence of ATbio was 3.4% and was associated with high psychological demand, high effort and high commitment to work, adjusted for sex, age, education and work shift. High-strain work and a situation of imbalance between efforts and rewards were associated with ATbio. With the combination of the models, an increase in the measure of association with the outcome was observed. Significant associations of greater magnitude were observed in the complete combined models. ATbio’s risk was 5.23 times higher among those exposed in both complete models compared to the absence of exposure in both models.CONCLUSIONS Occupational stressors were associated with ATbio. Advantages in using the combined models were observed. The approach of different psychosocial dimensions has expanded the ability to identify exposed groups, offering a solid basis for interventions for ATbio’s prevention in health.

Comparing ethnobotanical knowledge of medicinal plants between community health workers and local experts in the “Mata da Paraíba” zone, northeastern Brazil

Abstract. Paiva Maia AC, da Costa Ferreira E, Marques de Lucena C, dos Santos Souza A, Dias da Cruz D, Paiva de Lucena RF. 2021. Comparing ethnobotanical knowledge of medicinal plants between community health workers and local experts in the “Mata da Paraíba” zone, northeastern Brazil. Biodiversitas 22: 5606-5616. The use of medicinal plants is an old practice in a society that has been transmitted to this day, with local experts recognized in many communities and being encouraged through public policies. In Brazil, Community Health Agents (CHWs) can be important for the dissemination of this practice, due to their work with the Health System and the community. This study aimed to compare the knowledge of medicinal plants between CHWs and local experts in the community of Timbó, the municipality of Jacaraú (Paraíba, northeastern Brazil). Semi-structured interviews were conducted addressing local names of plants, their indications, parts used, and preparation methods. The data on the species local importance were analyzed through the use value (UV) and relative importance (RI) methods. Local experts cited more species than CHWs. There was great local importance of some species both among local specialists and among CHWs. However, some species were highlighted exclusively among local specialists. Decoction and infusion stood out among the preparation methods and leaf, flower, and seed were the most prominent parts used. The diseases treated with plants are mainly related to the respiratory and digestive systems. Our findings show a correspondence between the CHWs’ knowledge and local experts’ knowledge, which leads us to believe that experts and CHWs may be sharing the same local knowledge in the study community.

Determinants of timely access to Specialized Mental Health Services and maintenance of a link with primary care: a cross-sectional study

BackgroundAlthough access to specialized services is one of the main components of the study of paths to mental health care worldwide, the factors related to the continuity of the patient’s link with Primary Care after admission to a Specialized Mental Health Services still need to be explored in greater depth. Thus, this study aimed to evaluate the determinants of timely access to Specialized Mental Health Services (outcome 1) and maintenance of a link with Primary Care after patients’ admission (outcome 2).MethodsThis is a cross-sectional study, conducted with 341 users of Specialized Mental Health Services at outpatient and community level in a medium-sized city in Brazil between August and November 2019. Associations between the outcomes and the other variables were explored with the use of Poisson regression models with robust variance estimators.ResultsFactors positively associated with timely access were the diagnosis of psychosis or psychoactive substance misuse. The inversely associated factors with this outcome were higher income, having their need for mental health care identified in an appointment for general complaints, having been referred to the current service by Primary Care, having attended the current service for up to 3 years and delay until the first appointment (in a previous service). Regarding the maintenance of a link with Primary Care, factors positively associated were being referred to the current service by Primary Care or private service and receiving visits from Community Health Agents. The inversely associated factors with this outcome were male sex, being employed, having a diagnosis of psychosis or psychoactive substance misuse, and a greater perception of social support.ConclusionsIn addition to individual factors, factors related to the organization of services and the referral between them stood out in influencing both the access and maintenance of the patients’ link with Primary Care. Thus, this study reinforces the idea that integration between Primary Care and Specialized Mental Health Services should be strengthened, both to reduce waiting times for between-service referrals and benefit of care continuity.

PNAB 2017 and the number of community health agents in primary care in Brazil.

ABSTRACTOBJECTIVE:To analyze the effect of the 2017 Basic Primary Care Policy (PNAB) on the number of community health agents per primary health care team.METHODS:This is a cross-sectional, descriptive and analytical study using data available on the Ministry of Health platform called e-Gestor da Atenção Básica, about Brazil's 5,570 towns between October 2017 and December 2019. The survival of the number of towns that did not reduce the number of community health agents was analyzed according to region of the country, the Human Development Index (HDI), the Gini Inequality Index and population size. Cox regression was used to analyze the factors associated with a reduction in the number of CHAs after one month and, from then on, every three months until two years had passed since the publication of the 2017 PNAB Ordinance, considering p < 0.05.CONCLUSIONS:After two years, the greatest reduction was observed in towns in the Midwest and South regions, which presented a high HDI, lower inequality and larger populations. Towns in the Midwest (HR = 1.256) had a higher chance of reducing the number of CHAs compared to the North region. Towns with a higher HDI (HR = 1.053) and larger population size (HR = 1.186) were also more likely to reduc the number of community health agents. Therefore, after the 2017 PNA, the number of towns reducing the amount of community health workers in primary health care increased over the months

Fatores sociodemográficos e ocupacionais associados aos sintomas de ansiedade entre Agentes Comunitários de Saúde

Community Health Agents (CHAs) play a crucial role in assisting the population. Due to the complexity of functions and situations to which they are exposed, they can present with emotional problems. The aim of this article was to verify the prevalence of anxiety symptoms and the association with sociodemographic and occupational factors in community health agents. It is a cross-sectional and populational study that used a questionnaire to collect data on the sociodemographic, economic and occupational conditions and the State Trait Anxiety Inventory (STAI). Descriptive analyses and multiple Poisson regression were performed with robust variation, considering a 5% significance level (p <0.05) for the final model. A total of 673 community health agents were evaluated. The prevalence of anxiety symptoms in the STAI-State was 47.4% and in the STAI-trait, 42.4%. The time working as a CHA longer than five years was associated with the STAI-state (p<0.001) and the STAI-trait (p=0.018), where as the female gender was associated with the STAI-trait (p=0.011). A high prevalence of anxiety symptoms in community health agents was verified. Health promotion strategies aimed at improving and monitoring the mental health of these workers by reducing anxiety disorders is required.

Factors that determine construction health and safety agent collaboration on construction projects: A Delphi study

The construction industry (CI) continues to be the cause of injuries and illnesses to many workers worldwide. Collaboration between the construction health and safety agent (CHSA) and other built environment professionals may improve the impact of the CHSA on health and safety (H&amp;S) performance. However, no study has identified the factors that determine CHSA collaboration on construction sites. A three rounds Delphi study was conducted to identify the factors that determine CHSA collaboration. A panel of 14 experts serving the CI were selected from four continents and were asked to identify additional factors and validate the factors identified from literature. Microsoft Excel 2016 was used to analyse the data; group medians were calculated to reach consensus, and open question responses were summarised qualitatively. The experts confirmed the existence of the factors identified in the literature. The factors that determine CHSA collaboration on construction projects include mutuality, trust, enabling environment, personal characteristics, common purpose, institutional support, and project context. Drawing from the findings, the study suggests that these seven factors can influence CHSA collaboration. The study is limited to 14 experts and more experts could have provided more information. The factors that determine CHSA collaboration identified in this study may not be exhaustive and another study may provide different factors. Further research could adopt other research methods such as the quantitative method, in order to determine the impact of these factors on CHSA collaboration. Factors that determine CHSA collaboration on construction projects should be identified, implemented, and monitored, in order to increase the influence of CHSA on H&amp;S performance.

COVID-19 REINFECTION BETWEEN DOSES OF VACCINATION: CASE REPORT IN A CITY OF BRAZIL’S SOUTHEAST

Vaccination against COVID-19 is happening worldwide, with most vaccines requiring 2 doses to reach its maximum potential. It is the most efficient measure to prevent new cases of COVID-19, both of infection and reinfection. This case reports the reinfection of a female receptionist at an urgent care facility, where the research group was testing and monitoring symptoms of patients with flu syndrome, in the city of Belo Horizonte, Minas Gerais, Brasil, where she reinfected between the two preconized doses. Her initial infection occurred in September 2020 and reinfection in February 2021, 14 days after the first dose - both confirmed by RT-PCR - with reportedly worse symptoms on the latter. We warn for the possibility of reinfection episodes even after the first dose of vaccination, differently from what literature stated so far, so that health agents can organize more effective security measures, in a context of viral mutation and of new strains.&#x0D;

Modeling Users’ Empowerment in E-Health Systems

In conventional e-health initiatives, customers (patients) are mostly perceived as recipients of medical care, where they play little roles in the process of health decision making. Empowerment in e-health enables individuals to access their health data and consult online with medical staff. The proposed concept is intended to improve the existing e-health theory in relation to patient empowerment. The study suggests a model that expands the role of customers (patient) in three dimensions: as an individual health actor, social health agent, and medical partner. This study is theoretically significant because it explores a comprehensive approach of patient empowerment in e-health systems to achieve best practice customer service, establish long-term customer relationships to improve customer satisfaction, and achieve better health literacy of individuals.

A PERMANÊNCIA DOS ESTUDANTES NO PROEJA: HISTÓRIAS DE LUTA E RESISTÊNCIA

This article performs a historical review of Youth and Adult Education and a critical analysis of the permanence and resistance of students from the Technical Course in Community Health Agents at PROEJA of the Federal Institute of the Southeast of Minas Gerais - Campus Rio Pomba (2008-2013). In the research, analysis of documents, legislation and local archives, semi-structured interviews and analysis of empirical material from oral history were carried out. We conclude that students return to school in search of education and personal and professional advancement.

Traditional Communities and Mental Maps: Dialogues between Local Knowledge and Cartography from the Socioenvironmental Atlas of Lençóis Maranhenses, Brazil

The Lençóis Maranhenses region, located in the state of Maranhão in northeastern Brazil, constitutes an area that includes a national park and presents extreme physical, geographic and climatic contrasts in addition to economic diversity and emerging tourism. Scattered throughout this portion of the Brazilian territory are local inhabitants whose traditional lifestyles are characterized by agricultural, extractive, fishing and animal husbandry activities. These local residents use guidance systems and mental maps developed through their long history, interaction with nature, and knowledge of the environment in which they live and work. Based on sketches prepared by residents and by Health Agents serving the communities, and with the support of cartographic-based materials produced by the team of the Socioenvironmental Atlas of Lençóis Maranhenses (ASALM, Portuguese abbreviation for Socioenvironmental Atlas of Lençóis Maranhenses), we present a set of digital and interactive cartographic materials that reproduce the movements, uses and practices of the families of these communities as well as the environmental dynamics of this vast region. Such cartography can serve as an instrument of planning, understanding and action, both to safeguard the rights of the local residents and for the handling and management of natural resources. Based on the dialogue between local knowledge and cartography, we present the methods, processes and results of our research project.

Occurrence of Pharmaceuticals and Endocrine Disrupting Compounds in Brazilian Water and the Risks They May Represent to Human Health.

The risks of pharmaceuticals and endocrine disrupting compounds (P&EDC) to the environment and human health are a current topic of interest. Hundreds of P&EDC may reach the environment, hence, there is a need to rank the level of concern of human exposure to these compounds. Thus, this work aimed at setting a priority list of P&EDC in Brazil, by studying their occurrence in raw and drinking water, calculating health guideline values (GV), and estimating the risks of population exposure to water intake. Data on the Brazilian pharmaceutical market as well as published data of the monitoring of Brazilian natural and drinking water have been collected by means of an exhaustive literature review. Furthermore, many foreign data were also collected to enable a comparison of the values found in Brazilian studies. A list of 55 P&EDC that have the potential to be found in Brazilian water is proposed, and for 41 of these a risk assessment was performed by estimating their margin of exposure (ME), by considering their occurrence in drinking water, and guideline values estimated from reported acceptable daily intake (ADI) data. For seven compounds the risk was deemed high (three estrogens and four anti-inflammatories), whereas for another seven compounds, it was regarded as an ‘alert’ situation. Although such risk analysis is conservative, since it has been calculated based on the highest reported P&EDC concentration in drinking water, it highlights the need to enhance their monitoring in Brazil to strengthen the database and support decision makers. An analysis of the occurrence of antimicrobial resistance agents (antibiotics, resistant bacteria, and resistance genes) in surface waters was also carried out and confirmed that such agents are present in water sources throughout Brazil, which deserves the attention of policy makers and health agents to prevent dissemination of antimicrobial resistance through water use.

Development and evaluation of a multiplex qPCR assay for rapid diagnostics of emerging sporotrichosis.

Sporothrix schenckii and related species are the agents of human and animal sporotrichosis. Routine diagnoses using classical mycological approaches are unspecific due to overlapping phenotypes. As the frequency and prevalence of sporotrichosis increases worldwide, developing specific, sensitive and cost-effective diagnostic tools is essential to understand the distribution patterns, map-affected areas and promote specific public health strategies to mitigate future outbreaks. Polymorphisms among the β-tubulin gene were exploited to speciate S. brasiliensis, S. schenckii and S. globosa in a one-tube multiplex probe-based qPCR assay. A panel of 84 Sporothrix revealed 100% specificity (AUC=1.000, 95% CI=0.971-1.000, p<.0001) without cross-reacting with other medically relevant fungi, human, feline or murine DNA. Speciation via multiplex qPCR matched phylogenetic identification (Kappa=1.0; 95% CI=1.0-1.0; very good agreement), supporting its use as a reliable alternative to DNA sequencing. Remarkably, the lower limit of detection was 3 copies of the target for all species. As a proof of concept, we used swabs of wound exudate of 70 cats suspected of sporotrichosis to reveal an overwhelming occurrence of S. brasiliensis in 69 specimens (sensitivity=98.57%; 95%CI: 92.3-100.0 and specificity=100%; 95% CI=78.2-100). In comparison to culture, qPCR showed a larger area under the curve (AUC=0.993±0.007; 95% CI=0.944-1.000; p<.0001; Youden's index=0.9857), supporting that qPCR is an essential tool for accurately detect Sporothrix DNA directly from clinical samples, thus accelerating the diagnosis of sporotrichosis. Moreover, our multiplex qPCR system has the potential to increase diagnostic capacity in Sporothrix-affected areas, helping the local animal health agent or veterinarian to quickly identify and isolate new cases, which will likely benefit thousands of patients infected every year worldwide.