Primary Health Attention Research Articles

Access to primary health attention during the covid-19 pandemic in a town in Bahia

A universalização do acesso à saúde no Brasil trouxe consigo a necessidade de reorganização e ampliação dos serviços de saúde. Nesse contexto, a Atenção Primária à Saúde (APS) tornou-se uma prioridade governamental na reorientação das políticas de saúde em nível local, com a finalidade de facilitar o acesso às ações e serviços de saúde no Sistema único de Saúde (SUS). Assim, este estudo teve como objetivo analisar do acesso a ações e serviços da APS durante a pandemia da Covid-19 (2020-2022), em um município do interior da Bahia, que integra o território de identidade do Sisal, fazendo parte da microrregião de Serrinha. Trata-se de um estudo qualitativo, de caráter exploratório, que utilizou como instrumento de coleta de dados a entrevista semiestruturada. O método de análise de dados foi a análise de conteúdo temática. Os participantes foram gestores e trabalhadores de saúde vinculados à Secretaria Municipal de Saúde, compondo um total de quatro pessoas. Os resultados mostraram que o fluxo de acesso, antes da pandemia, se dava quase que exclusivamente por demanda espontânea e, durante a pandemia, mediante agendamento, realizado com o apoio do Agente Comunitário de Saúde (ACS). As ações e serviços que tiveram oferta restrita foram: atendimentos a usuários portadores de hipertensão e diabetes e as consultas de pré-natal. As estratégias utilizadas pelos trabalhadores de saúde para manter/ampliar o acesso aos serviços da APS foram o redimensionamento de horários de atendimentos; o uso de telessaúde e redes sociais e a capacidade de articulação dos ACS com a comunidade. Tais achados mostram a capacidade da APS enquanto reordenadora da atenção à saúde no intuito de ampliar a universalidade e a integralidade no SUS.

Dengue Fever

This paper provides an updated review of the dengue situation in the Latin-American countries, focusing on Colombia as a highly and historically affected nation. In first instance, it presents a scientific overview about the biology, clinical progress, transmission mode and epidemiology of the disease. Secondly, it describes the different outbreaks in the region during the past five decades. Thirdly, as an illustration of historical trends in most provinces and Colombian territories, early detection and predictive value of a dengue epidemic is inadequate and how a surveillance system should work. Based on these, the document proposes to provide a framework for a pilot model of a sustained and integrated epidemiological surveillance system in Colombia, focused on early detection, prediction (turning point) of outbreaks and recommendation of a model to be implemented by the Colombian local health units of each affected territory. It emphasizes that a vector-borne disease such as dengue must be addressed locally, having the individual, all the way through a primary health care and population-based approach, at the center of the system. It also highlights a new approach for returning to the basics in primary health attention in which the community health promoter be again one of the main participants. The paper concludes that without a primary health care approach, particularly under the existing decentralized local and regional governments, it will be so difficult to achieve real control over this kind of cyclical public health issues.

AB0912-HPR AMIGOS DE FIBRO (FIBRO FRIENDS): EDUCATIONAL PROGRAM TO PROMOTE THE HEALTH OF PEOPLE WITH FIBROMYALGIA IN BRAZIL

Background:Health education is pointed out as the front line in non-pharmacological approaches in fibromyalgia.Objectives:To develop an interdisciplinary educational program to promote the health of individuals with fibromyalgia in Brazil.Methods:This is a qualitative study, through a focus group, carried out in a Basic Health Unit in the city of São Paulo, SP. The guiding questions were about the needs and demands exposed by patients with fibromyalgia and health professionals who work in primary health care. 12 individuals with fibromyalgia and 10 health professionals participated. The data were analyzed using the content analysis method proposed by Bardin, specifically the thematic content analysis.Results:Amigos de Fibro (Fibro Friends) should be conducted through lectures, dynamics and conversation circles. The educational program must include 15 meetings with weekly frequency. The meetings are: 1st to present the program and socialization activities. 2nd: Doctor presents the concepts of fibromyalgia. 3rd: Nurse informs about practices and environments that favor self-care. 4th: Social Worker shows the importance of support. 5th: Physiotherapist shows the main body practices and physical activity. 6th: Nutritionist presents an adequate and healthy diet. 7: Psychologist shows mental health practices. 8th: Pharmacist informs about medicines. 9, 11 and 13: participants perform activities at home. 10: Naturologist presents integrative and complementary practices. 12th: Occupational Therapist encourages methods to save energy. Day 14: Speech therapist helps in the quality of sleep. 15: closing activity.Conclusion:Amigos de Fibro is a program that presents interdisciplinary educational information for individuals with fibromyalgia, being considered a trend of care for the future. The next step is to conduct a clinical trial to verify the effect of this intervention and then implement it in the health service in Brazil. Fibro Friends was created from the conjunct action of patients and healthcare professionals, it can be an effective educational tool to be implemented at primary health attention centers, promoting the self-care, life quality and the promotion of health in individuals with Fibromyalgia. Fibro Friends is an excellent tool for patient education and counseling in Brazil.

CONOCIMIENTOS EN PROFESIONALES DE ENFERMERÍA SOBRE LESIONES NO INTENCIONALES EN LA INFANCIA TEMPRANA

Introducción: Las lesiones no intencionales en la infancia temprana son un problema de salud en el mundo. Así se demuestra en el informe del 2012 de la Organización Mundial de la Salud y el Fondo de las Naciones Unidas para la Infancia explican que cada día mueren más de 2000 niños debido a lesiones no intencionales, y cada año ingresan decenas de millones con lesiones que a menudo los dejan discapacitados para toda la vida. 
 Objetivos: Identificar el nivel de conocimientos en enfermeros sobre lesiones no intencionales en la infancia temprana, en profesionales de enfermería y diseñar una capacitación según las necesidades de aprendizajes identificadas.
 Métodos: Se realizó un estudio observacional de febrero a abril de 2016, para la identificación de conocimientos a 45 profesionales de enfermería que laboran en los consultorios médicos de la familia de los policlínicos área V, VI y VI del municipio Cienfuegos. Las necesidades de aprendizaje identificadas permitieron la elaboración y aplicación de un curso. 
 Resultados: De los 45 evaluados el 82.5% no alcanzan los conocimientos necesarios sobre lesiones no intencionales en la infancia temprana. Después de realizado el curso los resultados fueron satisfactorios. 
 Conclusiones: Se identifica la necesidad de la formación continuada en un tema necesario en la Atención Primaria de Salud, alternativa como las de este estudio son factibles para demostrar esta necesidad.

Understanding science in the service and care of mental health and disorders.

Caring for mental health and mental disorders, from primary health attention, is a prime right. The objective of this study was to examine the testimonies of health attention services users regarding the assistance attitudes and practices. This was a hermeneutic qualitative study of several cases. Findings: It can be inferred that there exists a relative crisis in the feeble application of a public policy and in the capacity to encourage meaningful learnings in function of higher or lower potentials, linked to the construction of subjectivities. Conclusions: it is necessary to make a profound reflection on the mutation of meaning and the senses of the service and care of mental health and mental disorders, especially for the re-signification of the patient's human and psychoaffective domains in behalf of the actors involved in providing services from a comprehensive and systematic perspective. This should be encompassed with the pharmaceutical service in the intersectorial team, searching for an alternative cognitive training of the brain, as an endogenous substances generator, to strengthen the balance between the mind-emotions and the organic, in favor of the individual and social well-being, while maintaining the use of psychopharmacological drugs only when strictly necessary.

Coping Action Oriented to Early Stimulation of Children with Congenital Zika Virus Infection in Rio de Janeiro State

New health care demands directed at children with chronic conditions have been demanded mainly after the Zika virus epidemic. Given this, the Brazilian states have produced plans to cope with this congenital infection. In the state of Rio de Janeiro, the elaborated plan had as one of its actions a training proposal for physiotherapists, speech therapists and occupational therapists, focusing on early stimulation and focused on the health care network, especially primary care and specialized rehabilitation centers. Thus the purpose of this article is to describe the impact of a response strategy to Zika virus congenital infection, based on the multi-professional training proposal in earlier stimulation in the public health attention network of Rio de Janeiro State. Descriptive study, observational from the earlier stimulation training course to the public health attention network of Rio de Janeiro State as a coping action to the health care of children with Zika virus congenital infection. At the time of writing, partial results are available after 11 classes were performed. Based on the analysis of the evaluation form of the 11 courses taught by professionals of a referral hospital in Rio de Janeiro and student form, using the Excel program, 299 health network professionals were qualified, from 56 different municipalities of RJ, mostly females (n = 259; 86.82%). 175 physiotherapists (59%), 88 speech therapists (29%), 32 occupational therapists (11%) and 4 academics or other professional backgrounds (1%). The articulation between the different levels of public assistance, specifically: primary, secondary and tertiary, in this context assumes a fundamental action for good practices being undertaken considering the population’s health demands. Especially in relation to childhood chronic disease conditions, this action permited the building of lines of care that meet the population’s health demands so that in any of a child’s entry points on the assistance network, either prevention or treatment of the aggravated cases, there is integration of the actions and a better resolving response. It could be also identified that the strategy covered both the primary health attention team and the specialized rehabilitation team equally, composing one more important dialogue point to build an articulated and integrated assistance network.

Nivel de conocimientos de las enfermeras y el médico de la familia sobre la visita al hogar y los cuidados paliativos domiciliarios

En la visita al hogar se presta una atención integral, continuada y personalizada a los pacientes y su familia, es el lugar donde se alimentan, descansan, ocupan el tiempo de ocio, y se relacionan con su núcleo primario y es donde deben existir las mejores condiciones para satisfacer las necesidades biológicas, psicológicas, espirituales, sociales y culturales. Siendo necesario que las enfermeras/os y médicos de la atención primaria de salud, cuenten con las herramientas necesarias para atender tanto personas sanas como a pacientes tributarios de cuidados paliativos. Objetivo: El objetivo de este trabajo es determinar el nivel de conocimientos de las enfermeras y médicos de familia sobre la visita al hogar y los cuidados paliativos domiciliarios. Metodología: Se realizó un estudio descriptivo de corte transversal en el periodo comprendido de febrero a septiembre del año 2016, en el Policlínico Vedado. El universo estuvo formado por todos los médicos y enfermeras/os de los 40 consultorios que conforman nuestro policlínico, y te tomó una muestra de 40 enfermeras y 18 médicos a los que se les aplicó una encuesta con preguntas abiertas y cerradas. Resultados: Se constata que las enfermeras y los médicos deben trabajar aún más sobre los aspectos relacionados con al paciente y los cuidados al final de la vida. Conclusiones: Se concluye que se debe trabajar más sobre los aspectos relacionados con el paciente y los cuidados paliativos domiciliarios

Trends in hospitalization due to cardiovascular conditions sensitive to primary health care.

To analyze the trend in hospitalizations for primary care-sensitive cardiovascular conditions for residents of the state of Paraná, Brazil, from 2000 to 2011. Ecological, time series study of the rates of hospitalization for cardiovascular diseases in residents aged 35-74 years old by sex, age and main diagnosis for hospitalization. Data from the Hospital Information System of the Unified Health System (SIH-SUS) and polynomial regression models for trend analyses were used. Hospitalization rates for cardiovascular conditions decreased during the period (r2 = 0.96; p < 0.001), with similar decreasing patterns for males and females, in all age ranges, although always higher for males. Although hospitalization trends for hypertension, heart failure and cerebrovascular disease decreased, angina remained stable for males and females. A downward trend in hospital admissions due to primary care-sensitive cardiovascular conditions in the state of Paraná between 2000 and 2011 may have resulted from the expansion of the health network of and the access to primary health attention, as well as other factors that influence this set of diseases, such as improved socioeconomic conditions of the population, organization of primary care services for higher age ranges and women and decrease in risk factors.

Pain magnitude at the preferential “gateway” of the Single Health System

BACKGROUND AND OBJECTIVES: Since the dawn of civilization, pain was and still is a major concern for humankind. It is estimated that 80% of the world population look for the health system due to pain complaints. American epidemiological studies show that 20% of adults assisted by primary health attention services suffer from chronic pain. This study aimed at identifying the incidence of pain in adults in the Primary Health Attention. METHODS: Documental research carried out in a family health unit of the city of Tupanatinga/PE. Sample was made up of medical charts of users (adults) registered in the Unit. A total of 1071 charts they analyzed. A verbal scale was used to evaluate the incidence of pain. RESULTS: According to the verbal scale, the prevalence of pain among users of the family health unit was 42%. Associating pain to gender, it was observed that there has been statistically significant association (p<0.001), where the presence of pain in women (69.1%) was more frequent as compared to males (30.9%). CONCLUSION: The results of this study show us the “scenario” of pain at the preferential “Gateway” of the Single Health System. The high incidence of pain in Primary Attention warns for the magnitude of the problem, making imperative to treat pain as a severe public health problem with social relevance.

The construction of ethical competence in the perception of primary care nurses

The study intended to understand the perception of nurses of Primary Care Services about the construction of ethical competence on their formation and practices. This is a qualitative study, with an interpretative phenomenological approach and interviews with ten nurses of the community health services of Porto Alegre, RS. The results showed that the interviewed professionals had already experienced situations with ethical conflicts and knew what ethical competence means. The central themes point out three fundamental issues in the construction of the ethical competence: personal values, education and practice. Taking into account that ethical competence is in permanent construction, the study shows the importance to promote organizational and educational activities in a transversal manner, as a tool to cope the moral stress and contribute in improving the quality of care in the primary health attention.

Cluster sampling in health surveys

Describing how the cluster sampling statistical technique can be applied to health surveys. The article describes the most important aspects for each methodological step, emphasising cluster sampling's foundations. It was applied to a population of around 100,000 inhabitants from commune 18 in Cali. The sample covered 30 city blocks and 3,026 people were interviewed. The information was gathered using the Community-based Information System for Primary Health Attention. The sampling technique produced precise and reliable information for estimating population health event prevalence in a cross-sectional study. Sampling error was 2.5 % in the general population, 10% in children aged less than 5 years, 5.7% in children aged 5 to 14, around 3.0% in those aged 10 to 59 and 7.2% in the population aged more than 60. The method guaranteed a 2.5% sampling error in estimating general population prevalence and less than 10% sampling errors for established population groups.

Acesso às ações de saúde bucal versus indicadores do SIAB/SIASUS: um diálogo

Despite the improved global health indicators obtained in the millennium, many countries are still underdeveloped in this area and present health disparities. The PSF Strategy is to emphasize prevention and rehabilitation both from individuals and their families, through government health indicators. The aim of the present study was to describe the indicators accepted for Mesquita Municipality and for Rio de Janeiro State, and to compare them with the oral health offered by the PSF Strategyto families in Mesquita. Indicators were not good in both. It is important to bring oral health to primary health attention in order to create and reinforce programs or strategies capable of improving health.

Comunidades protagonistas en el logro de estilos de vida saludables

Background The promotion of health and nutrition is aimed to improve life conditions and the development of societies, where the communities have the leading role towards change. The Centro de Atención Nutricional Infantil Antímano (Antímano Center for the Attention to Child Nutrition), implements from the preventive care, a program for Community Nutrition in a suburban zone of Caracas for the purpose of turning the community into the leaders to attain a healthy lifestyle. Methods The strategic guidelines are oriented towards: increasing population awareness, training community health promoters (PCS), seeking to incorporate teachers, parents, children and teenagers, nursery and preschool personnel and workers from primary health attention centers. Results 96% of the community has been involved, 4,991 persons motivated into action; 297 organizations; 63 productive alliances; 327 PCS's; 83% of school participation, 66% implementing adequate breakfasts; nutritional counseling and education in 68% of preschools and 100% in nurseries; diagnosis improvement (39 to 100%) in referrals from outpatient clinics to CANIA. Conclusiones The action is based on exchange of knowledge and increase of awareness about reality and the orientations, on how to do what must be done from the perspective of each actor within its context.

O FARMACEUTICO NO CONTEXTO DA ESTRATÉGIA EM SAÚDE DA FAMÍLIA, QUE REALIDADE É ESTA?

O presente artigo relata a experiência do profissional farmacêutico no âmbito da Atenção Primária, no contexto da Estratégia de Saúde da Família (ESF). Resgata seu histórico até a sua inserção em uma unidade de saúde, discute onde se insere o farmacêutico na proposta de transitoriedade do perfil da assistência e as possíveis abordagens dentro do campo da saúde coletiva. Aponta as dificuldades encontradas durante o período de residência em Unidades de Saúde da Família (USF), as necessidades na formação desse profissional para atuar na Atenção Primária à Saúde e, as diferentes configurações que o medicamento assume perante o indivíduo, bem como o trabalho integrado à equipe multiprofissional, em especial ao profissional médico e ao nutricionista.

O AGENTE COMUNITÁRIO DE SAÚDE NO PROCESSO DE MUNICIPALIZAÇÃO DA SAÚDE

SUMMARY: The community health agent in the health services municipalization process. This study is about the role of the health community agent in the context of municipalization, considering the Brazilian sanitary reform and the present tendencies of public and Government politics concerning the globalization process. It narrates the appearance of the health agent in Brazil, initially considering the Health Agent Program (PAS) in State of Ceará, Brazil and the Health Community Agent Program (PACS) of the National Health Ministry, the primary attention of health and the municipalization as a possibility of getting closer to the population and power through many instances. One of them, the most important, is the Municipal Health Council, having as mediator the health agent, due to the characteristics of his actions. We conclude that the health agent, as a component of one health team, has important participation in the health democratization process and citizenship construction. Key words: health community agent, municipalization, globalization, popular participation, citizenship.

Child and adolescent psychiatry in primary health attention: A decade

Child and adolescent psychiatry in primary health attention: A decade

Community participation and appropriate technology in the early diagnosis of human hydatidosis

The basic strategy for development of hydatid struggle programs is in the actuality: Primary Attention of Health. In the present work and in this instance, it's arm a precocious detection system of hydatid disease, fixed in immunologic diagnostic by means of ELISA technical beginning with blood capillary samples, taken in filter paper by teachers and sanitary agents from official services of Rio Negro Province. 177 teachers and 45 sanitary agents were trained, correspondent to 25 schools, 3 lodging schools and 9 Hospitals all of them from rural area. 890 blood samples during the training were obtained. Lastly, the trained personal armed the system and they obtained 728 samples in the beginning of the Program. It hadn't statistical differences in the reactivity of both samples. The serological prevalence found was 1.32%. The activity displayed by teachers and sanitary agents permitted to detect 21 new cases it was the 20% of new cases diagnosed in this area in the period of work. The viability and the importance of the incorporation of non traditional effectors into the Hydatid Control Programs is discussed.