Scale up of implementation of a multidimensional intervention to enhance hypertension and diabetes care at the primary care setting: A protocol for a cluster-randomized study in Brazil.

BACKGROUND: Hypertension and diabetes mellitus (DM) are highly prevalent in low and middle-income countries (LMICs), and the proportion of patients with uncontrolled diseases is higher than in high-income countries. Innovative strategies are required to surpass barriers of low sources, distance and quality of health care. Our aim is to assess the uptake and effectiveness of the implementation of an integrated multidimensional strategy in the primary care setting, for the management of people with hypertension and diabetes mellitus in Brazil. METHODS: This scale up implementation study called Control of Hypertension and diAbetes in MINas Gerais (CHArMING) Project has mixed-methods, and comprehends 4 steps: (1) needs assessment, including a standardized structured questionnaire and focus groups with health care practitioners; (2) baseline period, 3 months before the implementation of the intervention; (3) cluster randomized controlled trial (RCT) with a 12-months follow-up period; and (4) a qualitative study after the end of follow-up. The cluster RCT will randomize 35 centers to intervention (n = 18) or usual care (n = 17). Patients ≥18 years old, with diagnosis of hypertension and/or DM, of 5 Brazilian cities in a resource-constrained area will be enrolled. The intervention consists of a multifaceted strategy, with a multidisciplinary approach, including telehealth tools (decision support systems, short message service, telediagnosis), continued education with an approach to issues related to the care of people with hypertension and diabetes in primary care, including pharmacological and non-pharmacological treatment and behavioral change. The project has actions focused on professionals and patients. CONCLUSIONS: This study consists of a multidimensional strategy with multidisciplinary approach using digital health to improve the control of hypertension and/or DM in the primary health care setting. We expect to provide the basis for implementing an innovative management program for hypertension and DM in Brazil, aiming to reduce the present and future burden of these diseases in Brazil and other LMICs. CLINICAL TRIAL IDENTIFIER: This study was registered in ClinicalTrials.gov. (NCT05660928).

Implementation of a text messaging intervention to patients on warfarin therapy in Brazilian primary care units: a quasi-experimental study.

BACKGROUND: Warfarin remains the most affordable oral anticoagulant in many countries. However, it may have serious side effects, and the success of the therapy depends on the patient's understanding of the medication and their adherence to treatment. The use of short messages services (SMS) is a strategy that can be used to educate patients, but there are no studies evaluating this intervention in patients taking warfarin. Therefore, we aimed to develop, implement, and assess the feasibility of an intervention using SMS to primary care patients taking warfarin in a medium-sized Brazilian city. METHODS: A bank of 79 SMS was drafted and validated by an expert panel. During 6 months, three times a week, patients received messages about anticoagulation with warfarin. At baseline and after 3 months, we assessed their knowledge and adherence with validated instruments. At the end of the follow-up, participants answered a satisfaction questionnaire. Subsequently, a scale-up phase was conducted, with another round of the intervention including 82 participants (29 from the first phase and 53 newly recruited). Seven months after the end of the scale-up, we asked the patients for their insights about the long-term effects of this program. All patients signed informed consent. The study was approved by the Research and Ethics committee of the Universidade Federal de Minas Gerais. RESULTS: In the pilot, 33 (89.2%) patients completed the follow-up. Among the participants who answered the satisfaction questionnaire (n = 29), 86.2% considered that the intervention motivated a healthy lifestyle and improved their understanding of warfarin therapy. All patients were willing to continue receiving the messages. Adherence measured by the Measure of Adherence to Treatment (MAT) test was high in the pre-intervention assessment and remained high (96.7% vs. 93.3%; p = 1.0000). The proportion of patients who achieved > 75% correct answers on the Oral Anticoagulation Knowledge (OAK) test increased from 6.5% to 25.6, p = 0.0703. In the scale-up, 23 patients answered the long-term assessment questionnaire. The main long-term knowledge reported was dietary information. Nine patients received the messages but did not remember their content. CONCLUSION: The intervention was well-accepted and had a positive impact on patient's knowledge about oral anticoagulation therapy. The scale-up assessment reinforced the need to constantly monitor digital interventions.

Orthopedic Asynchronous Teleconsultation for Primary Care Patients by a Large-Scale Telemedicine Service in Minas Gerais, Brazil.

Background: Telemedicine was implemented in Brazil as a way to support primary health care (PHC). Orthopedic complaints are common in PHC, and, because musculoskeletal diseases are the most frequent causes of chronic pain, it is important to explore knowledge gaps of PHC as well as to understand the teleconsultations' impact on reducing referrals to secondary care. Materials and Methods: Observational, retrospective study that analyzed consecutive orthopedic asynchronous teleconsultations from the Telehealth Network of Minas Gerais, a large-scale public telehealth service, performed from September 17, 2013 to June 18, 2020. Teleconsultations were analyzed based on the type of query. Results: Throughout the study, 1,174 teleconsultations from 254 municipalities were analyzed. Most requests for teleconsultations were from nurses (37.8%) and physicians (48.7%). In 58.3%, challenges could be solved by a general practitioner, meanwhile 38.4% needed referral to an orthopedic specialist. Most queries related to a specific case (assistencial teleconsultation, 66.0%), and the others were classified as educational (34%). With regard to the motivation for the assistencial teleconsultations, 72% approached treatment options, 49.5% surrounded possible diagnosis, and 20.1% discussed patient's rehabilitation. In addition, 95.5% of requests could be solved by teleconsultation, without the need for referral to in-person consultation with the specialist. Conclusions: Teleconsultations can help investigate the most frequent queries in PHC. Most of them were solved without the need for referral, showing the potential of teleconsultations in daily practice as a way to manage patients and guarantee better access to first-rate health care. As for the public health system, teleconsultations represent a way to overcome the distance barrier to health care access.

Vulnerabilidades e necessidades de acesso à atenção primária à saúde na adolescência / Vulnerabilities and needs for accessing primary health care in adolescence / Vulnerabilidades y necesidades de acceso a la atención primaria de salud en la adolescencia

Este estudo analisou as vulnerabilidades e as necessidades de acesso à saúde sob a perspectiva de adolescentes escolares. Trata-se de pesquisa de abordagem quantitativa desenvolvida no município de Contagem-MG, com 678 adolescentes escolares entre 14 e 15 anos de idade que responderam a um questionário sobre vulnerabilidades e acesso em saúde na adolescência. Realizou-se análise descritiva estratificada por sexo. Do total de adolescentes participantes do estudo, 81,7% consideraram seu estado de saúde ótimo/bom, 33,8% definiram saúde como bem-estar, 27,1% mencionaram já ter iniciado sua vida sexual, 28,8% informaram nunca/raramente utilizar preservativo, 21,2% declararam utilização de tabaco ou bebida alcoólica. Figuraram como prioridades de acesso à saúde as consultas médica (51,6%) e odontológica (46,8%), seguidas das ações geralmente realizadas pela enfermagem, como avaliação de peso/altura (41,9%), vacinação (37,9%) e grupos educativos (26,4%). Os resultados demonstram a necessidade de ampliar as ações realizadas na Atenção Primária à Saúde, para que seja favorecida uma maior adoção de práticas protetoras entre os adolescentes diante dos contextos de vulnerabilidades à saúde prevalentes nessa faixa etária.

This study analyzed the vulnerabilities and needs for accessing health care from the perspective of adolescent students. This is a research with quantitative approach carried out in the town of Contagem, Minas Gerais, Brazil, with 678 adolescent students between 14 and 15 years of age who answered to a questionnaire on vulnerabilities and health care access in adolescence. One conducted a descriptive analysis stratified by sex. Out of the total number of adolescents participating in the study, 81.7% regarded their health status as excellent/good, 33.8% defined health as well-being, 27.1% mentioned having already started their sexual life, 28.8% reported to have never/rarely used condom, 21.2% stated to use tobacco or alcohol beverage. One observed as priorities in health care access the medical (51.6%) and dentist (46.8%) consultations, followed by actions usually performed by nursing, such as weight/height evaluation (41.9%), vaccination (37.9%), and education groups (26.4%). The results demonstrate that there's a need for expanding the actions undertaken in Primary Health Care, so that greater adoption of protective practices among adolescents is encouraged in face of the health vulnerability contexts prevailing in this age group.

Este estudio analizó las vulnerabilidades y las necesidades de acceso a la salud desde la perspectiva de estudiantes adolescentes. Esta es una investigación con abordaje cuantitativa desarrollada en el municipio de Contagem, Minas Gerais, Brasil, con 678 estudiantes adolescentes entre 14 y 15 años de edad que respondieron a un cuestionario acerca de las vulnerabilidades y del acceso a la salud en la adolescencia. Se realizó un análisis descriptivo estratificado por sexo. Del total de adolescentes participantes en el estudio, 81,7% consideraron su estado de salud óptimo/bueno, 33,8% definieron salud como bienestar, 27,1% mencionaron ya haber iniciado su vida sexual, 28,8% informaron nunca/raramente utilizar preservativo, 21,2% declararon la utilización de tabaco o bebida alcohólica. Figuraron como prioridades de acceso a la salud las consultas médica (51,6%) y odontológica (46,8%), seguidas de las acciones generalmente realizadas por la enfermería, como evaluación de peso/altura (41,9%), vacunación (37,9%) y grupos educativos (26,4%). Los resultados demuestran la necesidad de ampliar las acciones llevadas a cabo en la Atención Primaria de Salud, para que sea favorecida una mayor adopción de prácticas protectoras entre los adolescentes delante de los contextos de vulnerabilidades a la salud prevalentes en esta franja etaria.

Sintomas depressivos no câncer de mama: inventário de depressão de beck - short form / Depressive symptoms in breast cancer: beck depression inventory – short form

OBJETIVOS: Verificar a prevalência de sintomas depressivos em mulheres com câncer de mama e identificar os fatores de risco associados à sua ocorrência. MÉTODOS: Foi realizado um estudo transversal, em que foram entrevistadas 71 mulheres com câncer de mama. Foram empregados dois instrumentos: um questionário para verificar os dados sociodemográficos e clínicos e o Inventário de Depressão de Beck - Short Form (BDI-SF), para avaliação dos sintomas depressivos. Para análise dos dados, utilizaram-se medidas descritivas e o teste de qui-quadrado, que avaliou a associação entre variáveis sociodemográficas e clínicas e os sintomas depressivos. O nível de significância considerado foi de 5 por cento. RESULTADOS: A prevalência de sintomas depressivos foi de 29,6 por cento. Os fatores associados à presença desses sintomas foram o tratamento quimioterápico (p = 0,021), presença de dor (p = 0,018) e limitação do movimento do membro superior (p = 0,010) e pior percepção da saúde (p = 0,018). CONCLUSÃO: Sintomas depressivos são frequentes no câncer de mama, assim a saúde mental das mulheres com esse tipo de câncer deve ser investigada e tratada quando necessário, reduzindo o impacto desses sintomas na vida da mulher.

OBJECTIVES: To verify the prevalence of depressive symptoms in women with breast cancer and identify risk factors associated to its occurrence. METHODS: It was a transversal study where 71 women with breast cancer were interviewed. Two instruments were applied, being one questionnaire used to verify sociodemographic and clinical data, and the Beck Depression Inventory - Short Form to evaluate depressive symptoms. Descriptive methods and chi-square test were utilized to analyze data, evaluating association between depressive symptoms, sociodemographic and clinical data. Significance level was considered of 5 percent. RESULTS: Depressive symptoms prevalence was 29,6 percent. Factors associated to the presence of this kind of symptoms were: chemotherapic treatment (p = 0,021), pain presence (p = 0,018), upper limb movement limitation (p = 0,010) and bad health perception (p = 0,018). CONCLUSION: Depressive symptoms were frequent in association with breast cancer, and this suggests that women mental status with this kind of cancer must be investigated and treated when necessary, lowing the impact of depressive symptoms in women's life.

Mudanças antropométricas e habilidade motora em crianças no início da marcha independente / Anthropometrical changes and motor skill in infants at the onset of independent walking

As mudanças nas proporções corporais durante o desenvolvimento infantil podem impor uma demanda motora diferenciada às crianças durante o início da marcha independente, ou seja, as características antropométricas podem exercer influência em seu desempenho motor grosso. Este estudo visou massa corporal (IMC) com o desempenho motor de crianças com desenvolvimento típico, comparando o desempenho motor entre dois grupos de crianças.

Changes in infant's body dimensions occuring during development may impose specific motor demands at the onset of independent walking. That is, anthropometric features may influence infant's gross motor performance. This study aimed at assessing the association between weight, height, and body mass index (BMI) with motor perfomance of typically developing infants, comparing two groups of infants with different...