Public Primary Care Services Research Articles

The impact of devolution on local health systems: Evidence from Greater Manchester, England

Devolution and decentralisation policies involving health and other government sectors have been promoted with a view to improve efficiency and equity in local service provision. Evaluations of these reforms have focused on specific health or care measures, but little is known about their full impact on local health systems. We evaluated the impact of devolution in Greater Manchester (England) on multiple outcomes using a whole system approach.We estimated the impact of devolution until February 2020 on 98 measures of health system performance, using the generalised synthetic control method and adjusting for multiple hypothesis testing. We selected measures from existing monitoring frameworks to populate the WHO Health System Performance Assessment framework. The included measures captured information on health system functions, intermediatory objectives, final goals, and social determinants of health. We identified which indicators were targeted in response to devolution from an analysis of 170 health policy intervention documents.Life expectancy (0.233 years, S.E. 0.012) and healthy life expectancy (0.603 years, S.E. 0.391) increased more in GM than in the estimated synthetic control group following devolution. These increases were driven by improvements in public health, primary care, hospital, and adult social care services as well as factors associated with social determinants of health, including a reduction in alcohol-related admissions (−110.1 admission per 100,000, S.E. 9.07). In contrast, the impact on outpatient, mental health, maternity, and dental services was mixed.Devolution was associated with improved population health, driven by improvements in health services and wider social determinants of health. These changes occurred despite limited devolved powers over health service resources suggesting that other mechanisms played an important role, including the allocation of sustainability and transformation funding and the alignment of decision-making across health, social care, and wider public services in the region.

Assessing the Scalability of a Community-Based Self-Management Intervention for Older Adults with Diabetes and other Chronic Conditions – The Aging, Community and Health Research Unit Community Partnership Program (ACHRU-CPP)

Background: A multi-pronged approach was undertaken to assess the scalability of the Aging, Community and Health Research Unit – Community Partnership Program (ACHRU-CPP), a complex, integrated 6-month self-management program for community-living older adults with diabetes and multimorbidity and their caregivers, in two Canadian provinces. The ACHRU-CPP was co-designed by patients, caregivers, home and community-care providers, and researchers, in response to a gap identified by older adults in the self-management of their diabetes and other conditions. The intervention was tested in a feasibility study and an earlier pragmatic trial found that older adults who received the ACHRU-CPP experienced greater improvements in quality of life and self-management, and greater reduction in depressive symptoms, compared to those who received usual diabetes care, at no additional cost to society. Delivered by a collaborative team of primary care providers (registered nurses, registered dietitians) and a community program coordinator, key components include home visits, group wellness sessions, team-based case conferences, caregiver support, interprofessional collaboration, and nurse-led care coordination. Scalability assessment is an integral phase of the current research program, which evaluated the effectiveness and implementation of the ACHRU-CPP in four settings in Ontario (ON) and Prince Edward Island (PEI).
 Methods: Multiple methods were used to assess scalability of the ACHRU-CPP in ON and PEI: an environmental scan, individual key informant interviews, and qualitative and quantitative data from both the foundational studies and the current trial of ACHRU-CPP implementation and effectiveness. The Intervention Scalability Assessment Tool (ISAT) guided data collection and analysis. The environmental scan was conducted with strategic input from Scalability Working Groups in ON and PEI. These groups were comprised of members of the program’s governance structure, including patient and public research partners, researchers, primary care and community service providers and administrators, and policy- and decision-makers. These partners advised on relevant research and policy documents, identified potential key informants (i.e., policy- and decision-makers at the local, provincial, and national levels), and will participate in scalability assessment workshops in ON and PEI in late 2022, to finalize the scalability assessment, and identify components of the intervention to be strengthened, and barriers to be addressed to enhance the scalability of the program, in each province.
 
 Results: To date, the results of the scalability assessment have identified areas of strength and limitations within the program, most notably issues with health human resources, mixed results regarding the effectiveness of the program, and other resource gaps.
 Conclusion: This study has evaluated the scalability of a community-based program for older adults with diabetes and multiple chronic conditions that integrates primary and community care. It also provides valuable insight on the usefulness and feasibility of the ISAT for assessing scalability, as well as strategies to engage strategic practice, policy, and public partners in the process. 
 Next steps: While scale-up of the ACHRU-CPP may be merited due to the prevalence of diabetes and multimorbidity among older adults, and alignment of this program with health policy, several barriers need to be addressed before scale-up can be recommended.

Mobile Application Increased Nutrition Knowledge Among Brazilian Physicians

ObjectiveTo assess whether using a Dietary Approaches to Stop Hypertension (DASH) diet recommendation application increases primary care physicians’ knowledge and dietary counseling skills. DesignA randomized controlled trial. SettingBrazilian public primary care service. ParticipantsTwo hundred and twenty-two physicians (intervention group: n = 111; control group: n = 111). InterventionThirty days of using the Dieta Dash application. The application provides information about nutritional recommendations for hypertension management. Main Outcome MeasuresNutrition knowledge score. Secondary outcomes: self-assessment of knowledge, self-confidence, assessment of eating habits, and barriers to dietary counseling. AnalysisLinear mixed-effects models for repeated measures and generalized estimating equations for comparing changes between groups. ResultsA total of 66.2% of participants completed the follow-up. There was no significant difference between the groups regarding the mean knowledge score (P = 0.15). The prevalence of high knowledge increased by 12% (prevalence ratio [PR] = 1.12; 95% confidence interval [CI], 1.00–1.25) in the intervention group and showed an improvement in the self-confidence assessment (PR = 1.21; 95% CI, 1.02–1.44), and increased assessment of eating habits (PR = 1.26; 95% CI, 1.10–1.55). Conclusions and ImplicationsThe Dieta Dash application helped address dietary counseling, improving knowledge and self-confidence. However, innovative strategies are needed to minimize the primary care barriers.

Voting with their feet: Primary care provider choice and its implications for public sector primary care services in India

Expanding networks of government primary health centers (PHCs) to bring health services closer to communities is a longstanding policy objective in LMICs. In pluralistic health systems, where public and private providers compete for patients, PHCs are often not the preferred source for care. This study analyzes the market for primary care services in the Indian state of Bihar to understand how choice of primary care provider is influenced by distance, cost and quality of care. This study is based on linked surveys of rural households, PHCs, and private primary care providers conducted in 2019 and 2020. Most rural residents lived in proximity to a primary care provider, though not a qualified one. Within a 5-km distance, 60% of villages had a PHC, 90% had an informal provider, 35% an Indian systems of medicine practitioner, and 10% a private MBBS doctor. Most patients sought care from informal providers irrespective of PHC distance; only 25% of patients living in the PHC's vicinity sought care there. Reducing distance to the PHC by 1 km marginally increased the likehood of the PHC being selected, and reduced the likelihood of private clinics being selected. Reducing patient's costs at PHCs increased the likelihood of the PHC being selected and reduced the likelihood of private clinics and private hospitals being selected. Improved clinical quality at PHCs had no effect on patient selection of PHCs, private clinics, or hospitals. Illness severity reduced the likelihood of PHCs or private clinics being selected, and increased the likelihood of private hospitals selected. Wealthier patients were marginally more likely to use PHCs, substantially more likely to use private hospitals, and less likely to use private clinics. Expanding PHC network coverage or improving their quality of care is not sufficient to make PHCs more relevant to local health needs. An orientation towards essential public health functions, as well as, a community-centered approach to the organization of primary health care system is necessary.

How can public health agencies support the adoption of a population health management approach in PHC? The case of SVN

Abstract Slovenia has a longstanding tradition of providing accessible and comprehensive PHC services. Established in 1927, Slovenian PHC strongly emphasizes addressing health equity and reaching out to vulnerable populations in local communities to identify environmental, social and behaviour-related risk factors and diagnose disease in its early stage of development. Through a cross-sectoral cooperation based on a community based approach and a strong collaboration of public health and primary care services, Slovenia has improved health and reduced health inequality over the last decades. Registered nurses in family medicine teams conduct regular screening and follow-up for people with noncommunicable diseases to reduce family doctors’ growing burden and workload. Each family medicine practice has a list of registered patients (a capitation list), managed in defined groups of healthy individuals; those with risk factors; and those with the most common chronic diseases. Financial incentives are given for meeting target values in screening check-ups. The National Public Health Institute manages and leads the noncommunicable disease prevention and control programme at the national level.

Territorial Coordination Centres and Telenursing: innovation and digitalisation of home care in Italy

Abstract Issue After Covid-19, Italy approved the National Recovery and Resilience Plan (NRRP) to boost public health, sustainability and digital innovation, which promotes ecological and digital transition reforms. The strategic health reform redesigned territorial healthcare network by introducing new models of proactive care, as Territorial Coordination Centres (TCCs) and Telenursing. Description of the problem TCC is an innovative organisational model, that coordinates taking care by linking services and professionals involved in different care settings. In TCCs are involved nursing staff, that performs a telemedicine service called Telenursing, a way of delivering nursing care directly to the patient's home, through digital health tools. How will TCCs be implemented, using NRRP funds? How will Telenursing impact on home care? Results By 2024, 600 TCCs are planned to be implemented and fully operational, across the Country, financed by NRRP (280 bln €). The standard set by the NRRP reform is 1 TCC each 100,000 inhabitants, with 4-6 primary nurses involved (2,400-3,600 nationally). TCCs are organised to be interconnected with every healthcare network setting, including home care. Telenursing, within the TCCs, aims to guarantee proactive, personalised and proximity care, enhancing the home as a privileged place of care. Nurses of TCCs perform health monitoring, assessment, promotion, prevention and education by Telenursing, in order to reduce inappropriate hospital admissions and to increase patient satisfaction, safety and empowerment. By 2026, at least 200,000 people will be assisted through telemedicine tools, as planned in NRRP reform (funding 1 bln €). Lessons Italy, pursuing better health outcomes for the population, is investing in strengthening public primary care services and digitalization of services. New strategy aims to improve health of population and decrease health inequalities, while reducing geographical variations. Key messages • Telenursing performed by nurses working in TCCs is aimed at improving proactive, personalised and proximity care, supporting patients and caregivers at home. • By 2024, TCCs will be fully operating to guarantee an innovative system of public primary care, that uses digital tools to manage population in home care, reducing inappropriate hospitalization.

Population Preferences for Primary Care Models for Hypertension in Karnataka, India

Hypertension contributes to more than 1.6 million deaths annually in India, with many individuals being unaware they have the condition or receiving inadequate treatment. Policy initiatives to strengthen disease detection and management through primary care services in India are not currently informed by population preferences. To quantify population preferences for attributes of public primary care services for hypertension. This cross-sectional study involved administration of a household survey to a population-based sample of adults with hypertension in the Bengaluru Nagara district (Bengaluru City; urban setting) and the Kolar district (rural setting) in the state of Karnataka, India, from June 22 to July 27, 2021. A discrete choice experiment was designed in which participants selected preferred primary care clinic attributes from hypothetical alternatives. Eligible participants were 30 years or older with a previous diagnosis of hypertension or with measured diastolic blood pressure of 90 mm Hg or higher or systolic blood pressure of 140 mm Hg or higher. A total of 1422 of 1927 individuals (73.8%) consented to receive initial screening, and 1150 (80.9%) were eligible for participation, with 1085 (94.3%) of those eligible completing the survey. Relative preference for health care service attributes and preference class derived from respondents selecting a preferred clinic scenario from 8 sets of hypothetical comparisons based on wait time, staff courtesy, clinician type, carefulness of clinical assessment, and availability of free medication. Among 1085 adult respondents with hypertension, the mean (SD) age was 54.4 (11.2) years; 573 participants (52.8%) identified as female, and 918 (84.6%) had a previous diagnosis of hypertension. Overall preferences were for careful clinical assessment and consistent availability of free medication; 3 of 5 latent classes prioritized 1 or both of these attributes, accounting for 85.1% of all respondents. However, the largest class (52.4% of respondents) had weak preferences distributed across all attributes (largest relative utility for careful clinical assessment: β = 0.13; 95% CI, 0.06-0.20; 36.4% preference share). Two small classes had strong preferences; 1 class (5.4% of respondents) prioritized shorter wait time (85.1% preference share; utility, β = -3.04; 95% CI, -4.94 to -1.14); the posterior probability of membership in this class was higher among urban vs rural respondents (mean [SD], 0.09 [0.26] vs 0.02 [0.13]). The other class (9.5% of respondents) prioritized seeing a physician (the term doctor was used in the survey) rather than a nurse (66.2% preference share; utility, β = 4.01; 95% CI, 2.76-5.25); the posterior probability of membership in this class was greater among rural vs urban respondents (mean [SD], 0.17 [0.35] vs 0.02 [0.10]). In this study, stated population preferences suggested that consistent medication availability and quality of clinical assessment should be prioritized in primary care services in Karnataka, India. The heterogeneity observed in population preferences supports considering additional models of care, such as fast-track medication dispensing to reduce wait times in urban settings and physician-led services in rural areas.

What is the NCD service capacity and disruptions due to COVID-19? Results from the WHO non-communicable disease country capacity survey in the Americas region

ObjectiveThis article presents the Americas regional results of the WHO non-communicable diseases (NCDs) Country Capacity Survey from 2019 to 2021, on NCD service capacity and disruptions from the COVID-19 pandemic.SettingInformation...

The Impact of COVID-19 Outbreak on Health Emergency and Disaster in Japan

The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of health emergency and disaster risk management (EDRM) to reduce the risks and impacts of infectious disease outbreaks. We investigated Japan’s response to the COVID-19 pandemic, focusing on changes made to the current health EDRM. Findings from document analysis and semi-structured interviews with six experts were integrated to provide insights into Japan’s health EDRM to improve outcomes in future health emergencies. Relevant information was extracted from COVID-19 policy documents published by the Japanese government, and the interviews validated and expanded on the data already collected. Challenges faced in the country’s response to COVID-19 and the changes made to the health EDRM framework are summarised. Findings were grouped into human resource topics (including essential health EDRM positions and safety of personnel), health service delivery topics (including public health and hospital primary care services), and logistical topics (including vaccination, personal protective equipment, patient transport, and telecommunications). These responses to the pandemic could serve as an example of good practice for other countries developing strategies for future health emergencies and disasters.

Implementation of health promotion in prenatal care at a public health service in Brazil

Prenatal care is the assistance to women throughout pregnancy, birth and puerperium which is an important tool of primary care in the prevention of maternal and child injuries. Prenatal care programs must be horizontal and multidisciplinar according to Ministry of Health's protocols in order to achieve improvements in maternal and child morbidity and mortality indicators. This study is an original interventional project that occurred at a public primary care service in a town of Bahia, Brazil. It was noted some aspects that could be adapted to the Ministry of Health protocols such as shared appointments based on scientific evidence, introduction of prenatal dental care and education actions carried out in a multidisciplinary way. All strategies were implemented in the prenatal care using very low cost tools such as conversation wheels and physical activity schedule. Conversation wheels between pregnant women and caregivers are included in the health humanization policy in Brazil. They are strategies for permanent education in health. Conversation wheels aimed to valorize pregnant women and their life experience in order to build an environment rich in learning and approached them to the health service. The encouragement of physical activity promotes well-being, a sense of belonging and improvements in risk factors for prevalent diseases during pregnancy. Continuing education promotes autonomy's pregnant women. Finally, the involvement of primary care professionals who address different aspects of health promotes co-responsibility and commitment to the adequacy of services offered to the population. The integration of health prevention and promotion actions should be seen as a stimulus to build relationships of trust and bond between users, managers and health professionals. Thus, the implementation of primary care actions during pregnancy expands the woman's connection with the health service at this stage of life and can contribute to better maternal and neonatal outcomes.

Comparative performance of public and private primary care service delivery in Malaysia: An analysis of findings from QUALICOPC

Primary care services are essential in achieving universal health coverage and Malaysia is looking into public-private partnership to overcome resource constraints. The study aims to compare the performance of primary care service delivery dimensions between public and private sector. This cross-sectional study used the data from the Malaysian International Quality and Costs of Primary Care (QUALICOPC) study conducted in 2015-2016. The relative performance of each sector in four dimensions was compared using multi-level linear regression by incorporating a dummy variable indicating public sector in the model. The public sector was shown to have higher performance in comprehensiveness and coordination, while the private sector was better in continuity. There was no significant difference in accessibility. The public primary care services were better in serving primary care sensitive conditions, better informational continuity, and with better skill-mix and inter- and intra- professional relationship. Meanwhile, the private sector was stronger in referral decision making process, specialist feedback and greater out of hours facilities access. The public and private sectors differ in their strengths, which the government may tap into to strengthen primary care services. Other areas for improvement include seamless care strategies that promote good referral, feedback, and information continuity.

People's care seeking journey for a chronic illness in rural India: Implications for policy and practice

Drawing on interviews conducted in 2019–2020, across twenty villages in India, this paper unpacks how people with chronic illness navigate complex care-seeking terrain. We show how the act of seeking care involves navigating through personal, family, social, economic, cultural, and most importantly, difficult health systems spaces—and entails making difficult social, moral, and financial choices. We show how the absence of reliable and accessible points of first contact for primary care results in people running from pillar to post, taking wrong turns, and becoming disappointed, frustrated, and, sometimes, impoverished. We reveal the complex individual and social dynamics of hope and misplaced and misguided expectations, as well as social obligations and their performance that animate the act of navigating care in rural India. We shine light on how a health system with weak primary care and poor regulation amplifies the medical, social, and financial consequences of an otherwise manageable chronic illness, and how these consequences are the worst for those with the least social, network and economic capital. Crucially we highlight the problematic normalisation of the absence of reliable primary care services for chronic illness in India, in rural India specifically. We signpost implications for research, and for policy and practice in India and similar health system contexts, i.e. those with weak primary care and poor regulation of the private sector.We argue that in India, having in place accessible, good quality, and trustworthy sources of advice and care for chronic illness at the first point of call, for all, is critical. We contend that this first point of call should be quality, public primary care services. We conclude that if such arrangements are in place in public services, people will use them.

Impact of an Interactive Health Corner Using the Culinary Education Approach in Promoting Long-Term Dietary Changes among Patients Who Seek Public Primary Care Services.

An unhealthy diet is a major risk factor for chronic diseases. Although nutrition education and cooking demonstrations have resulted in favourable dietary changes, it is unclear whether this is sustainable for longer periods. This study aims to evaluate the long-term impact of a nutrition-led cooking intervention using the culinary education approach on dietary patterns based on My Healthy Plate (MHP). This was a quasi-experimental study involving patients who sought public primary care services in two polyclinics (mean age 59.3 years old). A self-administered survey was done at baseline, 6 months, and 1 year for both the intervention and the comparison groups. Participants in the intervention group were exposed to the health corner, which provided nutrition education and cooking demonstrations using the culinary education approach. A total of 216 participants completed the study at 1 year with a follow-up rate of 86%. Adjusted risk ratios (aRR) were obtained from negative binomial regression. Compared with the comparison group, participants in the intervention group were more likely to report adhering to the requirements of MHP at 6 months (aRR 1.83, 95% CI 1.12–2.99) and 1 year (aRR 1.54, 95% CI 1.10–2.16). Participants in the intervention group were less likely to add salt or sauces to food at 6 months (aRR 0.29, 95% CI 0.12–0.75) and 1 year (aRR 0.21, 95% CI 0.07–0.61) and more likely to remove fat when eating meat at 1 year (aRR 0.30, 95% CI 0.13–0.67) than the comparison group. The interventions at the health corner had a positive impact in helping patients achieve MHP recommendations, not adding salt and sauces to their food, and removing animal fat before eating. There is potential for expanding this initiative to improve healthy eating practices in other polyclinics.

¿Boca sana o boca enferma? Representaciones de la salud bucal en sectores vulnerables

Background: The society and the State must provide dental care and help prevent oral health problems by implementing public policies with cultural relevance that allow society to address and improve the inequity in health care that systematically affects people's well-being. The present study seeks to understand the representations of dental health in people who attend primary care services in vulnerable urban and rural areas of the central zone of Chile. Specifically, the representations of the causes, morbidities, and symptoms attributed to the healthy and diseased mouth. Material and Methods: A qualitative study based on the Grounded Theory was conducted, analyzing the social representations of oral health in a sample of 161 adult people receiving treatment at public primary care services and dental emergency units in rural and urban communes. Empirical saturation and triangulation by time, place, and subjects give reliability to the study. Results: The data obtained show that dental health is mainly valued for its implications for self-esteem and social integration. A naturalization of dental health problems is evidenced as an adaptive strategy to traditional access barriers, which is counterproductive with preventive strategies. Conclusion: The results of the study suggest the need to reinforce education in dental health implemented in a transversal manner, having aesthetic values and the population's expectations of sociability as the key to action.

Strengthening Health Systems for Climate Adaptation and Health Security: Key Considerations for Policy and Programming.

Strengthening Health Systems for Climate Adaptation and Health Security: Key Considerations for Policy and Programming.

Impact of the COVID-19 pandemic on surgical treatment of colon cancer in a University Hospital

Background: The SARS-CoV-2 pandemic has caused over 3.8 million deaths and more than 184 million reported cases across the world from December 2019 to June 2021, thus deeply changing healthcare services organization and workflow. Public primary care services, the main provider of preventive medicine and entry point in the Portuguese National Health System were reorganized due to the sudden need of follow-up of mild cases of SARS-CoV-2 infections which were being treated at home, delaying population-level screening.

Impacts of the 2017 Brazilian National Primary Care Policy on public primary health care in Rio de Janeiro, Brazil.

In 2017, in a scenario of financial restrictions caused by an economic crisis in Brazil, a new primary health care policy promoted changes in the way different primary health care models were prioritized and implemented, with possible negative effects on the access to primary health care. This study aims to investigate if the 2017 Brazilian National Primary Care Policy (PNAB) negatively affected the primary care organization based on the Family Health Strategy (FHS) model and on the access to public primary care services in the city of Rio de Janeiro. The annual averages and the pre- and post-2017 averages of 15 variables were analyzed to identify possible trend breaks in 2017. A Bayesian structural time series model was used to determine the differences between actual and predicted post-2017 averages of each variable. The data were obtained via the Brazilian Health Informatics Department (DATASUS), the Department of Informatics of the Brazilian Unified National Health System. The annual average of family health teams was 1,179.9 teams, in 2017, and 788.8 teams in 2020, while the annual average of equivalent family health teams was 163.6, in 2017, and 125.4, in 2020. The actual post-2017 average of 989.3 family health teams (p = 0.004) was 16.7% lower than the predicted post-2017 average of 1,187.4 teams. In total, 62.6% and 40.5% of the population in Rio de Janeiro were covered by the FHS in 2017, and 2020, respectively. The provision of public primary care services decreased after 2017. Results show a deterioration of the FHS in Rio de Janeiro after 2017 and no increase in the traditional primary care model. Access to public primary care services reduced in the same period.

Essential public healthcare services utilization and excess non-COVID-19 mortality in Greece

ObjectivesEnsuring access to care for all patients—especially those with life-threatening and chronic conditions—during a pandemic is a challenge for all healthcare systems. During the COVID-19 pandemic, many countries faced excess mortality partly attributed to disruptions in essential healthcare services provision. This study aims to estimate the utilization of public primary care and hospital services during the COVID-19 epidemic in Greece and its potential association with excess non-COVID-19 mortality in the country. Study designThis is an observational study. MethodsA retrospective analysis of national secondary utilization and mortality data from multiple official sources, covering the first nine months of the COVID-19 epidemic in Greece (February 26th to November 30th, 2020), was carried out. ResultsUtilization rates of all public healthcare services during the first nine months of the epidemic dropped significantly compared to the average utilization rates of the 2017–19 control period; hospital admissions, hospital surgical procedures, and primary care visits dropped by 17.3% (95% CI: 6.6%–28.0%), 23.1% (95% CI: 7.3%–38.9%), and 24.8% (95% CI: 13.3%–36.3%) respectively. This underutilization of essential public services—mainly due to supply restrictions such as suspension of outpatient care and cancelation of elective surgeries—is most probably related to the 3778 excess non-COVID-19 deaths (representing 62% of all-cause excess deaths) that have been reported during the first 9 months of the epidemic in the country. ConclusionsGreece's healthcare system, deeply wounded by the 2008–18 recession and austerity, was ill-resourced to cope with the challenges of the COVID-19 epidemic. Early and prolonged lockdowns have kept COVID-19 infections and deaths at relatively low levels. However, this “success” seems to have been accomplished at the expense of non-COVID-19 patients. It is important to acknowledge the “hidden epidemic” of unmet non-COVID-19 needs and increased non-COVID-19 deaths in the country and urgently strengthen public healthcare services to address it.

Prevalence of oral HPV infection in unvaccinated young adults in Brazil

ObjectivesThis study aimed to report the national prevalence of oral HPV infection among unvaccinated women and men aged 16–25 years who utilized the public primary care services. MethodsPOP-Brazil is a cross-sectional, multicentric, nationwide survey conducted between September 2016 and November 2017. Recruitment was based in 119 public primary care practices in 26 state capitals and the Federal District of Brazil. Trained health professionals conducted face-to-face interviews. Oral samples were collected with mouthwash and gargle cycles. Genotyping was performed using the Roche PCR-based linear array genotyping test. Sampling weights by sex and age were applied. ResultsValid oral HPV samples were collected from 5071 (96.88%) participants; 4005 women and 1066 men. Mean participant age was 21.63 years. Overall HPV prevalence was 1.69% (n = 73, 95% CI 1.05–2.32). Thirty individuals presented at least one high-risk HPV type [0.57% (95% CI, 0.29–0.85)]. There were no associations between age, sex, sociodemographic characteristics, drug use or sexual behavior and oral HPV prevalence. ConclusionThe prevalence of oral HPV infection in Brazilian teenagers and young adults is low, with no sociodemographic or behavioral correlates.

Laboratory for innovation in Primary Health Care: implementation and results.

This article presents and problematizes innovation actions aimed at improving the quality of Primary Health Care (PHC), describing an experience that can be adapted to different contexts, considering diverse sociodemographic, economic, cultural and epidemiological realities. We conducted an exploratory study using documentary sources referring to the implementation of the Campo Grande Laboratory for Innovation in Primary Health Care (INOVAAPS). The project proposes the reorientation of the care model adopted in the municipality's public primary care services, redefining work processes and improving the quality of practice. We identified product, process and organizational innovations that have the potential to transform and tailor health care practices to the population's health needs. It is concluded that the proposals implemented by the project focus on the consolidation and expansion of access to primary care, recruitment and training of adequately qualified health professionals, adoption of resolutive technologies, regulatory improvement, and strengthening the mediating role of primary health care.