Intermittent fasting for health care, a review / El ayuno intermitente, ¿un éxito o una desventaja para el cuidado de la salud?

The incidence of obesity and overweight in the world has been increasing in recent years due to poor diet and lack of physical activity; people suffering obesity and overweight, related with malnutrition due to excess, often resort to calorie restriction diets that are usually not very effective. In this context, intermittent fasting (IF) has become popular due to the possibilities for weight loss that it offers. This diet consists of alternating periods of fasting with unrestricted eating; however, its effectiveness and consequences are unknown to most users. This narrative review analyzes whether intermittent fasting contributes to the improvement of body and metabolic composition. The purpose of the review was to examine the available data on the contribution of intermittent fasting to the improvement of body and metabolic composition, in order to provide information and to define the parameters that condition safe achievement of its benefits. IF dieting triggers adaptive cell responses that cause a decrease in lipid oxidative stress markers in individuals with obesity and prediabetes. Metabolic alterations have been found to go hand in hand with the alteration of circadian rhythms; if IF contributes to this effect, it may assist in treating and preventing obesity and associated diseases. However, there are also disadvantages, such as the loss of lean muscle mass by wasting, and increased hypoglycemia(AU)

La incidencia de obesidad y sobrepeso en el mundo ha ido en aumento en los últimos años debido a la mala alimentación y la falta de actividad física; Las personas que padecen obesidad y sobrepeso, relacionadas con la desnutrición por exceso, suelen recurrir a dietas de restricción calórica que suelen ser poco efectivas. En este contexto, el ayuno intermitente (AI) se ha popularizado debido a las posibilidades de pérdida de peso que ofrece. Esta dieta consiste en alternar períodos de ayuno con alimentación sin restricciones; sin embargo, su eficacia y consecuencias son desconocidas para la mayoría de los usuarios. Esta revisión narrativa analiza si el ayuno intermitente contribuye a la mejora de la composición corporal y metabólica. El objetivo de la revisión fue examinar los datos disponibles sobre la contribución del ayuno intermitente a la mejora de la composición corporal y metabólica, con el fin de aportar información y definir los parámetros que condicionan la consecución segura de sus beneficios. Se ha encontrado que las alteraciones metabólicas van de la mano con la alteración de los ritmos circadianos; si AI contribuye a este efecto, puede ayudar a tratar y prevenir la obesidad y las enfermedades asociadas. Sin embargo, también existen desventajas, como la pérdida de masa muscular magra por atrofia y el aumento de la hipoglucemia(AU)

O papel da informação e da comunicação em situações de emergência: a crise sanitária e humanitária no território Yanomami / The role of information and communication in emergency situations: the health and humanitarin crisis in the Yanomani territory / El papel de la información and de la comunicación en situaciones de emergencia: la crisis sanitaria y humanitaria en el territorio Yanomani

A crise humanitária no território Yanomami, agravada nos últimos anos com a invasão de atividades de garimpo, revela uma trama de fatores sociais, ambientais e políticos, que resultaram numa 'emergência' sanitária e humanitária, em seus diversos sentidos. O fluxo contínuo de levantamento de dados, a análise da situação e a comunicação de riscos é que podem revelar o contexto em que essa emergência ocorre e permitir a intervenção oportuna na crise. Nesta nota, procuramos identificar potencialidades e limitações dos dados existentes, informações e estratégias de comunicação voltadas para emergências de saúde.

The humanitarian crisis in the Yanomami territory, exacerbated in recent years by the invasion of mining activities, reveals a set of social, environmental and political factors that resulted in a health and humanita-rian 'emergency' in its various meanings. Only the continuous flow of data collection, situation analysis and risk communication can unveil the context in which this emergency occurs and allow appropriate interven-tion in the crisis. In this note, we seek to identify the potential and limitations of available data, information and communication strategies related to health emergencies.

La crisis humanitaria en el territorio Yanomami, agudizada en los últimos años por la invasión de las ac-tividades de minerías, revela un conjunto de factores sociales, ambientales y políticos, que resultan en la 'emergencia' sanitaria y humanitaria, en sus diversas acepciones. El flujo continuo de recopilación de datos, el análisis de la situación y la comunicación de riesgos es que pueden desvelar el contexto en el que se produce esta emergencia y permitir la intervención oportuna en la crisis. En esta nota, buscamos iden-tificar el potencial y las limitaciones de los datos existentes, informaciones y estrategias de comunicación relacionadas con las emergencias sanitarias.

Strategic plan for health 2016-2025

Government has accepted the fact that HEALTH is much more than the prevention or reduction of disease, but is a resource for national productivity and development. As such investments in ensuring, a healthy population is an asset for national development. It is for this reason that Government re-affirms its strong commitment to providing better health care to all Grenadians. The National Strategic Plan for Health 2016-2025 provides the framework that will guide the efforts of the Ministry of Health and Social Security (MOHSSSSSS) and its partners over the next ten years. It reflects the Ministry's fundamental belief that health is a basic human right and as a result no one should be denied access to health care. Consequently, one of the overarching goals of this strategic plan is ensure that health services are made available, accessible and affordable to all people without discrimination. Like many other developing countries, Grenada continues to be challenged by meeting the demands for health care services to its citizens. Chronic non-communicable diseases are the leading cause of morbidity and mortality. Life style and food choices are the main contributing factors of the disease profile and pose a significant challenge to the delivery of secondary care due to the escalating cost associated with the management of these diseases. This requires the Ministry of Health to place greater emphasis on prevention and health promotion. Notwithstanding the fact, every citizen must however accept responsibility for his/her individual health outcomes. Recently, Grenada has also been experiencing the outbreaks of new and re-emerging communicable diseases, which have been linked to climate change factors. It behooves us therefore to take necessary steps to protect and maintain our environment for our future generations. The Plan further reflects the belief that health fundamentally affects individual productivity and is therefore a critical input for long-term development of the country. To this end, we have set out our major priorities and therefore in concert with the private sector, we will heighten our focus and continue to promote health and wellness among our citizens.

Conhecimento dos estudantes de enfermagem sobre medidas preventivas e controlo de infecção: protocolo scoping review / Knowledge of nursing students on infection prevention and control measures: scoping review protocol

OBJETIVO: mapear o conhecimento dos estudantes de enfermagem relativo às medidas de prevenção e controlo de infecção associada aos cuidados de saúde. MÉTODO: scoping review segundo a metodologia de Joanna Briggs Institute. A busca foi realizada nas seguintes bases de dados: PubMed, CINAHL® Plus with Full Text, Nursing & Allied Health Collection, Cochrane Plus Collection, MedicLatina (via EBSCOhost). Serão considerados para inclusão nesta revisão estudos escritos em português, inglês e espanhol publicados nos últimos cinco anos e extraídos para a plataforma Rayyan QCRI®. Dois revisores independentes procederam à análise de relevância dos artigos, extração e síntese dos dados, com elaboração do respectivo fluxograma.

OBJECTIVE: to map the knowledge of nursing students regarding infection prevention and control measures associated with health care. METHOD: scoping review according to the Joanna Briggs Institute methodology. The search was conducted in the following databases: PubMed, CINAHL® Plus with Full Text, Nursing & Allied Health Collection, Cochrane Plus Collection, MedicLatina (via EBSCOhost). Studies written in Portuguese, English and Spanish published in the last five years and extracted for the Rayyan QCRI platform will be considered for inclusion in this review®. Two independent reviewers carried out the analysis of the relevance of the articles, extraction and synthesis of the data, with preparation of the respective flowchart.

Homeopatía: una breve descripción de esta especialidad médica / Homeopathy: a brief description of this medical specialty

La homeopatía es una forma de medicina con 200 años de historia. A lo largo de este tiempo, ha demostrado su capacidad para resolver problemas, a bajo costo, con un amplio alcance y con una aceptación social incuestionable. Según las estimaciones, aproximadamente 500 millones de personas utilizan la homeopatía en todo el mundo, lo que corresponde a alrededor del 7% de la población mundial. Sin embargo, aún existen obstáculos para su integración en la medicina convencional, los cuales deben ser puestos en perspectiva y eliminados. El propósito del presente artículo es contextualizar la homeopatía como una ciencia y un arte tanto en Brasil como en el resto del mundo. Analizamos algunos aspectos relevantes, como el perfil de sus usuarios, las razones para elegir la homeopatía, así como los contextos históricos y sociales para su inclusión en los sistemas educativos y de atención médica. Concluimos que la homeopatía es un sistema medico ético que ofrece un tratamiento sistémico y seguro a los pacientes, con una optima relación costo-beneficio. La homeopatía debe incluirse en las universidades, escuelas de medicina, así como en todos los niveles del sistema de atención médica, asegurando así su naturaleza histórica como especialidad médica.

Homeopathy is a medical approach with 200 years of history. Along this time it demonstrated its ability to solve problems, with low cost, broad scope and unquestionable social acceptance. According to estimates, approximately 500 million people use homeopathy worldwide, corresponding to about 7% of the world population. However, there are still hindrances to its integration into conventional medicine which need to be put into perspective and removed. The aim of the present article is to contextualize homeopathy as a science and an art in Brazil and worldwide. We analyzed some relevant aspects, such as the profile of users, their reasons to choose homeopathy, and historical and social contexts for the inclusion of homeopathy into health care and educational systems. We conclude that homeopathy is an ethical medical system that provides systemic and safe treatment to patients with optimal costbenefit ratio. Homeopathy should be included in universities, schools of medicine and at all levels of the healthcare system, thus ensuring its historical nature as a medical specialty.

Medidas de autocuidado para prevenção da recidiva de úlceras venosas: protocolo de revisão de escopo / Self-care measures to prevent venous ulcer recurrence: a scoping review protocol

OBJETIVO: Mapear as medidas de autocuidado para prevenção de recidiva de úlceras venosas nos diversos cenários de atenção à saúde. MÉTODO: Protocolo de revisão de escopo, tendo como pergunta de pesquisa: quais as medidas de autocuidado para prevenção de recidiva de úlceras venosas nos diversos cenários de atenção à saúde? Serão utilizados como bases de dados: Banco de Dados em Enfermagem (BDENF), CINAHL, LILACS, MEDLINE (via PUBMED), SCIELO, SCOPUS, Cochrane Library, EMBASE e Web of Science, além da literatura cinzenta. O processo de busca, a avaliação, seleção e extração de dados serão realizados por pares cegados e, em caso de divergência, um terceiro revisor será consultado. Os resultados serão apresentados na íntegra, em formato de narrativa e diagramas de fluxo, de forma a se alinhar à questão de pesquisa proposta. Protocolo registrado na Open Science Framework (OSF): osf.io/y7ckp.

OBJECTIVE: To map self-care measures to prevent venous ulcer recurrence in different healthcare settings. METHOD: Scoping review protocol, with the following research question: What are the self-care measures to prevent the recurrence of venous ulcers in different healthcare settings? The following databases will be used: Nursing Database (BDENF), CINAHL, LILACS, MEDLINE (via PUBMED), SCIELO, SCOPUS, Cochrane Library, EMBASE, and Web of Science, in addition to the grey literature. Blinded peers will carry out the search process, evaluation, selection, and data extraction, and in case of disagreement, a third reviewer will be consulted. The results will be presented in narrative format and using flow diagrams aligned with the proposed research question. The protocol was registered in the Open Science Framework (OSF): osf.io/y7ckp.

Internações por condições sensíveis à atenção primária no município de Gramado/RS / Hospitalizations due to ambulatory care sensitive conditions in the municipality of Gramado, Rio Grande do Sul ­ Brazil / Hospitalización por condiciones sensibles a la atención primaria en el municipio de Gramado, Rio Grande do Sul - Brasil

Introdução: A Atenção Primária à Saúde é a responsável pela coordenação do cuidado e por realizar a atenção contínua da população que está sob sua responsabilidade. Por sua proximidade e vinculação com a comunidade e conhecimento sobre os principais problemas do território, a Estratégia Saúde da Família apresenta maior resolutividade das demandas de saúde, reduzindo, assim, a sobrecarga nos serviços de média e alta complexidade. Para avaliar se a Atenção Primária à Saúde tem desempenhado seu papel com efetividade e qualidade, são necessários instrumentos capazes de verificar de maneira simples e concisa tal situação. Um deles é o de Internações por Condições Sensíveis à Atenção Primária. Objetivo: Analisar os motivos de internação por condições sensíveis à Atenção Primária à Saúde em Gramado, Rio Grande do Sul, no período de 2015 a 2021. Métodos: Estudo ecológico de série temporal, com abordagem quantitativa e característica descritiva. Os dados foram coletados do Sistema de Internações Hospitalares do SUS e utilizou-se o programa Pacote Lista Brasileira de Internações por Condições Sensíveis à Atenção Primária no programa R, o qual faz a conversão dos dados de todas as internações por município de referência por meio da Autorização de Internação Hospitalar. Para análise dos dados, a pesquisa foi dividida em dois eixos: clínico-epidemiológico e aspectos demográficos. As causas de internações por condições sensíveis à atenção primária foram baseadas na lista do Ministério da Saúde. Resultados: As internações sensíveis à atenção primária representaram 22% (14.083) do total de internações do município de Gramado. Houve mais internações do sexo feminino (54,1%), quando comparado ao masculino (45,9%). Os três principais grupos com maior porcentagem de internação por condições sensíveis à atenção primária foram as doenças pulmonares (18,4%), seguidas de insuficiência cardíaca (17,6%), infecção no rim e trato urinário (14,7%). A faixa etária com maior prevalência foi a de usuários com 60 anos ou mais (57,6%), seguida à de 20 a 59 anos (30,7%) e à de 0 a 4 anos (6,7%). Conclusões: Os resultados do comportamento das internações em Gramado nos anos analisados apontam uma redução da proporção delas em relação ao total de internações no município, mas quando avaliadas as taxas padronizadas por sexo e população do município, há uma estabilidade dessas taxas ao longo dos anos analisados.

Introduction: Primary Health Care is responsible for coordinating care and providing continuous care for the population under its responsibility. Due to its proximity and connection with the community and knowledge of the territory's main problems, the Family Health Strategy presents greater problem-solving capacity of health demands, thus reducing the burden on medium- and high-complexity services. To assess whether Primary Health Care has performed its role with effectiveness and quality, instruments capable of verifying this situation in a simple and concise way are necessary. One of them is the Hospitalizations due to Ambulatory Care Sensitive Conditions. Objective: To analyze the reasons for hospitalization due to ambulatory care sensitive conditions in Gramado, state of Rio Grande do Sul ­ Brazil, from 2015 to 2021. Methods: Ecological time series study, with a quantitative approach and descriptive characteristic. Data were collected from the Hospital Information System from SUS and the Brazilian List of Ambulatory Care Sensitive Conditions package program was used in the R program, which converts the data of all hospitalizations by municipality of reference through the Inpatient Hospital Authorization. For data analysis, the research was divided into two axes: clinical-epidemiological and demographic aspects. The causes of hospitalizations due to ambulatory care sensitive conditions were based on the list of the Brazilian Ministry of Health. Results: Hospitalizations due to ambulatory care sensitive conditions accounted for 22% (14,083) of the total number of hospitalizations in the city of Gramado. There were more hospitalizations of women (54.1%) compared with men (45.9%). The three main groups with the highest percentage of hospitalization due to ambulatory care sensitive conditions were pulmonary diseases (18.4%), followed by heart failure (17.6%), and kidney and urinary tract infection (14.7%). The age group with the highest prevalence was users aged 60 years or older (57.6%), followed by those aged 20 to 59 years (30.7%), and 0 to 4 years (6.7%). Conclusions: The results of the behavior of hospitalizations in Gramado in the analyzed years point to a reduction in their proportion in relation to the total number of hospitalizations in the city, but when evaluating the standardized rates by sex and city population, these rates are stable throughout the assessed years.

Introducción: La Atención Primaria de Salud es la encargada de coordinar la atención y realizar la atención continua a la población bajo su responsabilidad. Por su proximidad y conexión con la comunidad y el conocimiento de los principales problemas del territorio, la Estrategia Salud de la Familia presenta mayor resolución de demandas de salud, reduciendo, así, la sobrecarga en los servicios de mediana y alta complejidad. Para evaluar si la Atención Primaria de Salud ha cumplido su función con eficacia y calidad, se necesitan instrumentos capaces de verificar esta situación de forma sencilla y concisa. Uno es el de Internaciones por Condiciones sensibles a la Atención Primaria. Objetivo: Analizar los motivos de internación por condiciones sensibles a la Atención Primaria a la Salud en Gramado, Rio Grande do Sul, en el periodo de 2015 a 2021. Métodos: Estudio ecológico de serie temporal, con abordaje cuantitativo y carácter descriptivo. Los datos fueron recolectados del Sistema de Internaciones Hospitalarias del Sistema Único de Salud y se utilizó el programa Paquete Lista Brasileña de Internaciones por Condiciones Sensibles a la Atención Primaria en el programa R, lo cual hace la conversión de los datos de todas las internaciones por municipio de referencia a través de la Autorización de Internación Hospitalaria. Para el análisis de los datos, la investigación se dividió en dos ejes: clínico-epidemiológico y aspectos demográficos. Las causas de internaciones por condiciones sensibles a la atención primaria se basaron en la lista del Ministerio de Salud. Resultados: Las internaciones sensibles a la atención primaria representaron el 22% (14.083) del total de internaciones en la ciudad de Gramado. Hubo más internaciones por personas del sexo femenino (54,1%), en comparación con las personas de sexo masculino (45,9%). Los tres principales grupos con mayor porcentaje de internación por condiciones sensibles a la atención primaria fueron las enfermedades pulmonares (18,4%), seguidas de insuficiencia cardiaca (17,6%), infección renal y del tracto urinario (14,7%). La franja etaria con mayor prevalencia fue la de usuarios con 60 años o más (57,6%), seguida de 20 a 59 años (30,7%) y la de 0 a 4 años (6,7%). Conclusiones: Los resultados del comportamiento de las hospitalizaciones en Gramado en los años analizados apuntan a una reducción de su proporción con relación al total de hospitalizaciones del municipio, pero cuando se evalúan las tasas estandarizadas por sexo y población del municipio, hay una estabilidad de estas tasas a lo largo de los años analizados.

Saúde bucal e condições sistêmicas em idosos da Baixada Fluminense: coorte retrospectivo / Oral health and systemic conditions in elderly people from Baixada Fluminense: retrospective cohort

O equilíbrio sistêmico e a saúde bucal são condições clínicas que estabelecem entre si uma relação multidimensional capaz de exercer grande impacto sobre o bem-estar cotidiano do indivíduo. As disfunções metabólicas associadas ao estado nutricional e a perda da capacidade muscular geram uma maior necessidade de cuidados em pessoas idosas. Sob o ponto de vista odontológico a presença de dentes naturais bem como o grau de doença periodontal, estão associados a competência mastigatória e, desta forma, são fatores determinantes na saúde da população acima dos 60 anos de idade. O presente estudo teve como objetivo avaliar, através da análise retrospectiva dos últimos 05 anos, a relação entre a saúde bucal e as condições sistêmicas de indivíduos acima de 60 anos residentes na Baixada Fluminense (Rio de Janeiro/Brasil) com evidente crescimento demográfico populacional. Para isso foram analisados 11.390 prontuários de pacientes usuários da Clínica Odontológica da Universidade Iguaçu/RJ sendo selecionados 1.125 que atendiam aos critérios de inclusão. Os resultados destacam a presença de doença periodontal em cerca de 56% dos indivíduos diabéticos, além de 43% com quadro hipertensivo no momento do atendimento apontando para uma importante relação entre a atenção com a saúde bucal da população assistida nessa região e suas condições sistêmicas.

Systemic balance and oral health are clinical conditions that establish a multidimensional relationship capable of having a great impact on the individual's daily well-being. Metabolic dysfunctions associated with nutritional status and loss of muscle capacity generate a greater need for care in the elderly. From the dental point of view, the presence of natural teeth, as well as the degree of periodontal disease, are associated with masticatory competence and, thus, are determining factors in the health of the population over 60 years of age. The present study aimed to describe descriptively, through the retrospective analysis of the last 05 years, the relationship between oral health and the systemic conditions of individuals over 60 years old living in the Baixada Fluminense (Rio de Janeiro / Brazil) with evident population demographic growth. For that purpose, 11,390 medical records of patients who were users of the Clínica Odontológica of Universidade Iguaçu / RJ were analyzed, 1,125 who met the inclusion criteria were selected. The results highlight the presence of periodontal disease in about 56% of diabetic individuals, in addition to 43% with the hypertensive condition at the time of care, pointing to an important relationship between the attention to the oral health of the assisted population in this region and their systemic conditions.

Regulação do acesso ao tratamento do câncer de boca no estado do Rio de Janeiro / Study of the regulation system for access to oral cancer treatment in the state of Rio de Janeiro

Objetivos: Descrever o perfil das solicitações de vaga para tratamento do câncer de boca e analisar o tempo entre a solicitação e o agendamento. Métodos. Pesquisa com dados secundários do Sistema Estadual de Regulação do Estado do Rio de Janeiro, entre setembro de 2015 e junho de 2018. Incluiu-se as solicitações para "Oncologia Ambulatório de 1ª vez- Cirurgia de Cabeça e Pescoço" classificadas como câncer de boca e excluiu-se as com status "cancelada". Resultados. Foram exportados 5802 registros, sendo 1663 elegíveis. A idade média foi de 61 anos, com um desvio padrão de 12,3 anos. O tempo médio de espera foi de 19 dias com um desvio padrão de 16,6 dias. 19% dos agravos referiram-se as "Neoplasia maligna de outras partes e partes não especificadas da língua". Conclusão. O perfil dos pacientes corrobora o encontrado na literatura e o tempo de espera para o atendimento é considerado aceitável.

Objectives: To describe the profile of vacancy requests for treatment of oral cancer and to analyze the time between the request and the schedule. Methods. Research with secondary data from the State Regulation System of the State of Rio de Janeiro, between September 2015 and June 2018. Included were requests for "First-time Ambulatory Oncology - Head and Neck Surgery" classified as oral cancer and those with "canceled" status were excluded. Results. 5,802 records were exported, of which 1663 were eligible. The average age was 61 years, with a standard deviation of 12.3 years. The average waiting time was 19 days with a standard deviation of 16.6 days. 19% of the complaints referred to "Malignant neoplasm from other parts and unspecified parts of the tongue". Conclusion. The profile of patients corroborates that found in the literature and the waiting time for care is considered acceptable.

Estrés laboral y salud mental del personal de primera línea en la atención de la COVID-19 / Occupational stress and mental health on frontline healthcare workers during COVID-19 pandemic

El estrés laboral significó un riesgo importante para la presencia de alteraciones de salud mental en trabajadores de salud, durante la pandemia de Coronavirus 2019. Objetivo. Determinar la relación del nivel de estrés laboral y salud mental en el personal asignado en primera línea de atención contra el COVID-19. Metodología. Se realizó un estudio transversal analítico en las áreas de emergencias y hospitalización del Hospital Nacional San Juan de Dios de San Miguel, de septiembre a diciembre de 2020. Participaron en total 121 trabajadores. Se utilizaron las escalas de estrés laboral de la Organización Internacional del Trabajo y la escala de Gilbert abreviada. El análisis de correlación de variables se realizó por el coeficiente de Spearman. Resultados. El 59,5 % de los estudiados son mujeres y el 44,6 % era personal de enfermería. El 89,3 % tenía bajo nivel de estrés y 79,3 % nivel intermedio de alteración en salud mental con predominio de ansiedad (51,2 %), sobre depresión (8,3 %) en enfermeras y personal de servicios generales entre 21 a 40 años. El análisis de la correlación Spearman determinó una correlación positiva entre el estrés laboral y la presencia de alteración de salud mental (R2 0,218; p = 0,016) en el personal de primera línea. Conclusión. El estudio demostró un nivel de estrés laboral bajo e intermedio en salud mental; con relación positiva, lo que significa que el aumento de estrés puede favorecer la presencia de alteraciones al estado de salud mental del trabajador

Occupational stress posed a relevant risk for mental health disturbances in healthcare workers during the 2019 Coronavirus pandemic. Objective. To determine the relationship between the level of occupational stress and mental health in front-line healthcare personnel against COVID-19. Methodology. An analytical cross-sectional study was carried out in the emergency and hospitalization areas of the San Juan de Dios National Hospital in San Miguel, from September to December 2020. A total of 121 workers participated. The occupational stress scales of the International Labor Organization and the abbreviated Goldberg scale were used. Variable correlation analysis was performed using Spearman's coefficient. Results. 59.5 % were female and 44.6 % were the nursing staff. 89.3 % had a low level of stress and 79.3 % had an intermediate level of alteration in mental health with a predominance of anxiety (51.2 %) over depression (8.3 %) in nurses and general services personnel between 21 and 40 years. The analysis of the Spearman correlation determined a positive correlation between occupational stress and mental health disorders (R2 0.218; p = 0.016) in workers. Conclusion. The study showed a low and intermediate level of occupational stress in mental health; with a positive correlation, which means that the increase in stress can favor the presence of alterations in the mental health status of the worker

O papel da educação permanente em saúde na implementação da linha de cuidado para o sobrepeso e obesidade nas ações da atenção primária: um estudo de caso na região do Grande ABC / The role of permanent health education in the implementation of the line of care for overweight and obesity in primary care actions: a case study in the Greater ABC region of São Paulo

Introdução - A obesidade é um importante problema de saúde pública no Brasil. A linha de cuidado para o sobrepeso e obesidade é uma das ofertas tecnológicas inovadoras do Sistema Único de Saúde, visando superar a fragmentação da atenção e gestão à saúde e propondo diretrizes para organização da prevenção e do tratamento do sobrepeso e obesidade como linha de cuidado prioritária nas redes de atenção à saúde. A qualificação da força de trabalho para o enfrentamento da obesidade é uma das diretrizes propostas pela linha de cuidado, tendo como premissa as práticas de educação permanente em saúde (EPS). A EPS tem sido apontada como ferramenta essencial para a produção de mudanças de práticas e organização dos processos de trabalho. Objetivo - Compreender, na perspectiva de profissionais de saúde, o papel da EPS na implementação da linha de cuidado para o sobrepeso e obesidade nas ações da atenção primária. Métodos- Trata-se de pesquisa de abordagem qualitativa a partir de estudo de caso. Foram realizadas dezoito entrevistas semiestruturadas com profissionais de saúde com nível superior, atuantes na atenção primária dos municípios do Grande ABC Paulista no estado de São Paulo. Realizou-se análise de conteúdo com abordagem indutiva. O estudo foi aprovado pelo Comitê de Ética da Faculdade de Saúde Pública da USP (Parecer Nº 3.366.472; CAAE Nº 12785719.9.0000.5421). Resultados - A partir da análise emergiram cinco categorias temáticas: Organização do cuidado às pessoas com sobrepeso e obesidade; Percepções sobre a temática de sobrepeso e obesidade; Concepções acerca dos processos educativos; Potencialidades associadas às práticas de EPS; e Desafios relacionados com as práticas de EPS. Conclusões - A obesidade foi concebida pelos profissionais de saúde como fenômeno multifatorial, sendo a vigilância alimentar e nutricional, a abordagem coletiva para o manejo da obesidade e uso de práticas integrativas e complementares práticas estabelecidas para o cuidado de indivíduos com sobrepeso e obesidade. Entretanto, ainda coexistem práticas assistenciais unidimensionais, com orientações focadas na perda de peso e responsabilização individual, nas quais os usuários com obesidade são vistos de maneira negativa e sofrem atitudes estigmatizantes. Os profissionais sentem-se inseguros frente à temática de obesidade e há reconhecimento da necessidade de processos de qualificação profissional. Evidenciou-se concepções dos processos educativos que ora convergem com princípios de EPS, ora com de educação continuada. A EPS foi concebida pelos profissionais como componente essencial para a produção e organização do cuidado para pessoas com excesso de peso, contribuindo para a implementação da linha de cuidado para sobrepeso e obesidade e propiciando transformação nas práticas e nos processos de trabalho. Contudo, as ações educativas relacionadas à temática obesidade ainda estão aquém do esperado e foram elencados fatores desafiadores para o desenvolvimento de ações de EPS, como a pandemia da COVID-19, alta demanda assistencial, ações desconexas com a realidade do serviço, problemáticas relacionadas a integração entre as equipes multiprofissionais e estratégia saúde da família, desvelando a necessidade de aprimoramento das ações estabelecidas e sensibilização da gestão local para ampliação do apoio aos processos educativos.

Introduction - Obesity is a significant public health problem in Brazil. The line of care for overweight and obesity is one of the innovative technological offers of the Unified Health System. It aims to overcome the fragmentation of health care and management and proposes guidelines to organize the prevention and treatment of overweight and obesity as a priority line of care in health care networks. The qualification of the workforce to face obesity is one of the guidelines proposed by the line of care, based on permanent health education practices (EPS). EPS has been identified as an essential tool to generate changes in practices and organize work processes. Goal - To understand, from the perspective of health professionals, the role of EPS in the implementation of the line of care for overweight and obesity in primary care actions. Methods - This is a research with a qualitative approach based on a case study. Eighteen semi-structured interviews were carried out with health professionals with higher education, working in primary care in the municipalities of the Greater ABC Paulista in the state of São Paulo. Content analysis was carried out with an inductive approach. The study was approved by the Ethics Committee of the Faculdade de Saúde Pública at USP (Opinion Nº 3.366.472; CAAE Nº 12785719.9.0000.5421). Outcomes - From the analysis, five thematic categories emerged: Organization of care for people with overweight and obesity; Perceptions about overweight and obesity; Conceptions about educational processes; Potentialities associated with EPS practices; and Challenges related to EPS practices. Conclusions - Obesity was conceived by health professionals as a multifactorial phenomenon. Food and nutrition surveillance, collective approaches and the use of integrative and complementary practices were the strategies established to care for overweight and obese individuals. However, one-dimensional care practices still coexist, with guidelines focused on weight loss and individual accountability, in which users with obesity are viewed negatively and suffer stigmatizing attitudes. Professionals feel insecure regarding the issue of obesity and there is recognition of the need for professional qualification processes. Conceptions of educational processes were evidenced, sometimes converging with EPS principles, sometimes converging with continuing education. EPS was conceived by professionals as an essential component to generate and organize care for overweight people, contributing to the implementation of the care line for overweight and obesity and providing transformation in work practices and processes. However, educational actions related to obesity are still below expectations. Challenging factors for the development of EPS actions were listed, such as the COVID-19 pandemic, high demand for care, actions disconnected from the reality of the service, problems related to the integration between multidisciplinary teams and the family health strategy, revealing the need to improve established actions and the awareness of local management in order to increase support for educational processes.

Impact of COVID-19 on the antenatal care services utilization in the region of Guelmim Oued Noun, Morocco

Background: Globally, the covid-19 pandemic has seriously impacted access to healthcare facilities across the world, although there is little evidence on how the pandemic affects the use of essential healthcare in the world. Objective: This study sought to evaluate the impact of the covid-19 pandemic on antenatal indicators in the region of Guelmim Oued Noun, Morocco. Methods: The aggregated data was delivered by regional health authorities covering the period from January 2017 to December 2020. The interrupted time series was mobilized to conduct statistical analysis. Results: The descriptive results revealed a steady decline after the Covid-19 pandemic in Antenatal indicators. The results of the regression model showed a negative impact of the pandemic on the antenatal recruitment rate (ß2 = - 16.14; p < 0.01), recruitment rate of women in antenatal visits the 1st quarter of pregnancy (ß2 = -2.09; p < 0.01), antenatal visit completion rate (ß2 = -18.10, p>0.05), average number of visits/pregnancies (ß2 = -15.65, p<0,05). Conclusion: The effect of the covid-19 pandemic on antenatal rates was significant for almost the indicators studied. Future studies should be focused on the impact of the pandemic on postnatal and immunization services on the national scale.

Knowledge and practices toward COVID-19 preventive measures and symptoms: A case-control study in Benin

Introduction. Following communication and awareness actions related to COVID-19, we assessed the knowledge and practices about COVID-19 in Benin. Methods. A case-control survey was conducted from 14 September to 20 October 2020 in Benin. Questions relatingto knowledge and practices on COVID-19 were collected through a questionnaire survey. A total of 312 respondents (104 cases and 208 controls) were included in the study. Logistic regression and Spearman correlation tests were used to examine the relation between participants knowledge and practice at a 5% significance level. Results. From the survey, 65.4% of cases and 68.3% of controls knew about COVID-19 transmission via air droplets. Most of the cases (67.31%) and control (79.81%) participants reported cough as a symptom of COVID-19. Handwashing with soap and water was the most protective measure known by 87.5% of cases and 90.87% of controls. Concerning practice, the cloth mask was the type mostly worn by cases (54.81%) and controls (58.65%). Wearing a face mask in public areas was significantly associated with the COVID-19 health status of respondents (OR = 2.98, CI95% [1.16-7.67]; p = 0.022). Furthermore, a significantly positive correlation exists between knowledge of the COVID-19 protective measures and hand hygiene practices when leaving a public place (r = 0.184, p=0.001). Conclusion. Through this study, we observed some discrepancies between the knowledge and practices related to COVID-19 among cases and controls surveyed. Therefore, efforts should be directed toward raising awareness about the disease to improve their knowledge and practices

Exploring a community's understanding of HIV vaccine-induced seropositivity in a South African research setting

Background. The high HIV prevalence and incidence in South Africa makes it suitable for recruitment of participants for large-scale HIV preventive vaccine trials. However, fear of vaccine-induced seropositivity (VISP) may be a barrier for community acceptability of the trial, for volunteers to participate in HIV preventive vaccine trials and for uptake of an efficacious vaccine. Prior to 2015, when the first phase 1 safety HIV vaccine trial was undertaken at Setshaba Research Centre, Soshanguve, the local community stakeholders and healthcare workers were naive about HIV vaccine research and HIV preventive vaccines. Objective. To explore knowledge and perceptions regarding VISP among community stakeholders and healthcare workers in peri-urban Soshanguve, Tshwane.Methods. Using a quantitative-qualitative mixed-methods study design, surveys (n=50) and in-depth interviews (n=18) were conducted during July - August 2015. Participants included community stakeholders, community advisory board members and healthcare workers, who were >18 years old and had attended community educational workshops during September 2014 - May 2015. Audio recordings of interviews were transcribed verbatim and coded using content thematic analysis. Data were further analysed by sex, age and educational level.Results. Of a maximum score of 2 on knowledge on VISP, the 50 survey participants (mean age 33.78 years; 45 females) obtained an average of 0.88 (44%). Of 17 in-depth interviewees (one interview could not be transcribed; mean age 30.9 years; 12 females), 8 (47%) displayed some knowledge about VISP, of whom only 5 defined VISP correctly. Women were more knowledgeable about VISP than men; 5 of 12 women (42%) came close to defining VISP correctly, while none of the 5 men did so. The main fear of trial participation expressed by most participants (n=6) was testing HIV-positive as a result of the vaccine. While some participants believed that the community's perceptions of VISP would negatively affect HIV vaccine trial support and recruitment efforts, others noted that if trial participants understand the concept of VISP and are part of support groups, then they would have the information to combat negative attitudes within their community. Conclusion. Most participants had an inaccurate and incomplete understanding of VISP. Many feared testing HIV-positive at clinics; therefore, education on improving a basic understanding of how vaccines work and why VISP occurs is essential. In addition, assessing participant understanding of HIV testing, transmission and VISP is critical for recruitment of participants into HIV vaccine trials and may improve acceptability of an HIV preventive vaccine

A doctor at a PHC clinic: A 'must-have' or 'nice-to-have'?

Background. Many patients have their healthcare needs met at primary healthcare (PHC) clinics in KwaZulu-Natal (KZN), without having to travel to a hospital. Doctors form part of the teams at many PHC clinics throughout KZN, offering a decentralised medical service in a PHC clinic. Objectives. To assess the benefit of having a medical doctor managing patients with more complex clinical conditions at PHC clinic level in uMgungundlovu District, KZN. Two key questions were researched: (i) were the patients whom the clinic doctors managed of sufficient clinical complexity that they warranted a doctor managing them, rather than a PHC nurse clinician? and (ii) what was the spectrum of medical conditions that the clinic doctors managed? Methods. Doctors collected data at all medical consultations in PHC clinics in uMgungundlovu during February 2020. A single-page standardised data tool was used to collect data at every consultation. Results. Thirty-five doctors were working in 45 PHC clinics in February 2020. Twenty-six of the clinic doctors were National Health Insurance (NHI)-employed. The 35 doctors conducted 7 424 patient consultations in February. Staff in the PHC clinics conducted 143 421 consultations that month, mostly by PHC nurse clinicians. The doctors concluded that 6 947 (93.6%) of the 7 424 doctor consultations were of sufficient complexity as to warrant management by a doctor. The spectrum of medical conditions was as follows: (i) consultations for maternal and child health; n=761 (10.2%); (ii) consultations involving non-communicable diseases (NCDs), n=4 372 (58.9%) ­ the six most common NCDs were, in order: hypertension, diabetes, arthritis, epilepsy, mental illness and renal disease; (iii) consultations involving communicable diseases constituted 1 745 (23.5%) of cases; and (iv) consultations involving laboratory result interpretation 1 180 (15.9%).Conclusion. This research showed that at a PHC clinic the more complex patient consultations did indeed require the skills and knowledge of a medical doctor managing these patients. These data support the benefit of a doctor working at every PHC clinic: the doctor is a 'must-have' member of the PHC clinic team, offering a regular, reliable and predictable medical service.

Improving outcomes in co-morbid diabetes and COVID-19: A quasi-experimental study

Background: High-risk people living with diabetes (PLWD) have increased risk for morbidity and mortality. During the first coronavirus disease 2019 (COVID-19) wave in 2020 in Cape Town, South Africa, high-risk PLWD with COVID-19 were fast-tracked into a field hospital and managed aggressively. This study evaluated the effects of this intervention by assessing the impact of this intervention on clinical outcomes in this cohort. Methods: A retrospective quasi-experimental study design compared patients admitted pre- and post-intervention. Results: A total of 183 participants were enrolled, with the two groups having similar demographic and clinical pre-Covid-19 baselines. Glucose control on admission was better in the experimental group (8.1% vs 9.3% [p = 0.013]). The experimental group needed less oxygen (p < 0.001), fewer antibiotics (p < 0.001) and fewer steroids (p = 0.003), while the control group had a higher incidence of acute kidney injury during admission (p = 0.046). The median glucose control was better in the experimental group (8.3 vs 10.0; p = 0.006). The two groups had similar clinical outcomes for discharge home (94% vs 89%), escalation in care (2% vs 3%) and inpatient death (4% vs 8%). Conclusion: This study demonstrated that a risk-based approach to high-risk PLWD with COVID-19 may yield good clinical outcomes while making financial savings and preventing emotional distress. Contribution: We propose a risk-based approach to guide clinical management of high risk patients, which departs significantly from the current disease-based model. More research using randomised control trial methodology should explore this hypothesis.

COVID-19 impact on newly initiated and restarted antiretroviral treatment patients in the Eastern Cape, South Africa

Background: Initiating newly diagnosed people living with human immunodeficiency virus (HIV) onto antiretroviral treatment (ART) and retaining patients on treatment are vital to South Africa's ART programme. In 2020, coronavirus disease 2019 (COVID-19) and its accompanying containment (lockdown) measures presented unprecedented challenges to achieving these objectives. Aim: This study describes the impact of COVID-19 and related restrictions on district-level numbers of newly diagnosed people living with HIV and defaulting ART patients. Setting: Buffalo City Metropolitan Municipality (BCMM) in the Eastern Cape of South Africa. Methods: Mixed-methods approach: Monthly aggregated electronic patient data (newly initiated and restarted on ART) from 113 public healthcare (PHC) facilities were analysed (December 2019 to November 2020) across varying levels of COVID-19 lockdown regulation periods; telephonic in-depth interviews at 10 rural BCMM PHC facilities were conducted with facility staff, community health workers (CHWs) and intervention personnel. Results: The number of newly initiated ART patients decreased dramatically compared with pre-COVID-19 levels. The overall number of restarted ART patients increased in response to fears of co-infection with COVID-19. Facility-level communications and community outreach promoting HIV testing and treatment were disrupted. Novel approaches to providing services to ART patients were developed. Conclusion: Programmes for identifying undiagnosed people living with HIV and services aimed at retaining ART patients in care were profoundly impacted by COVID-19. The value of CHWs was highlighted, as were communication innovations. Contribution: This study describes the impact of COVID-19 and related regulations on HIV testing, ART initiation and adherence to treatment in a District of the Eastern Cape of South Africa.

Factors associated with COVID-19 vaccine hesitancy among health personnel in Yaounde, Cameroon

Background. Health care personnel constitute a group at high risk of contracting COVID-19. However, the vaccination rate in this group in our context remains low. The objective of our study was to determine the factors associated with COVID-19 vaccine hesitancy among health care workers in Yaounde. Methods.We conducted a cross-sectional study of 360 health personnel in three hospitals in the city of Yaounde from January to March 2022, i.e., 3 months. All health personnel who gave their free consent were included. Ethical clearance was obtained from the Institutional Ethics and Research Committee of the Faculty of Medicine and Biomedical Sciences of the University of Yaounde I. A logistic regression was performed to search for factors associated with reluctance to vaccinate, with a significance level of 0.05. Results.The vaccination rate against COVID-19 was 34% (123). Factors associated with vaccine hesitancy were female gender (OR [95% CI] =3.5[2.2-5.5]; p<0.001), working outside a COVID-19 management unit (OR [95% CI]=6, [2.1-18.5]; p=0.001), fear of the harmfulness of COVID-19 vaccines (OR [CI 95%] =2.7[1.7-4.2]; p<0.001), and doubt of vaccine efficacy (OR [CI 95%] =4.0[2.5-6.4]; p<0.001). Conclusion:Health personnel are still reluctant to vaccinate in our context. Factors associated with hesitancy to vaccination against COVID-19 could help deconstruct apprehensions.

Introduction. La pandémie de la COVID-19 a ajouté un fardeau supplémentaire dans les pays aux systèmes de santé déjà fragiles. Objectif : déterminer la prévalence et la séroprévalence de la COVID-19 en cas de suspicion du paludisme au cours de la deuxième vagueà Yaoundé. Méthodologie. Une étude transversale descriptive a été menée au Centre Médical le Jourdain pendant 8 semaines du 19 Avril au 13 Juin 2021 soit durant la deuxième vague au Cameroun. Pour les 86 patients avec suspicion de paludisme, des prélèvements nasopharyngé et sanguins ont été réalisés pour la recherche d'antigène du SRAS- CoV 2 et des IgG et IgM anti-SARS-CoV-2 grâce aux kits STANDARDTM Q COVID-19 Ag de SD BIOSENSOR, Corée, 2020 et StandardTM Q COVID 19 Ac IgG/IgM de SD BIOSENSOR, Corée, 2020 respectivement. La confirmation du paludisme a été faite grâce à l'examen microscopique des étalements de sang colorés. Résultats. Le paludisme était confirmé dans 20,9% (18) des cas. Les prévalences de la COVID-19 et de la coïnfection COVID19/Paludisme étaient de 8,1% et de 0,9% respectivement. Sur les 25,6% (54) des patients avec des IgM anti-COVID-19, aucun cas de microscopie positive n'a été retrouvé. Par ailleurs un peu plus de la moitié des patients avaient des anticorps IgG anti-COVID-19 qu'ils aient une goutte épaisse positive ou pas soit 56,0% (42/75) et 52,2% (71/136) respectivement. Conclusion. En cas de suspicion du paludisme en zone impaludée, il parait non négligeable de considérer la COVID-19 comme un diagnostic différentiel.

Facteurs de demande de services de santé préventifs en contexte épidémique (Dengue et COVID 19), Côte d'Ivoire, 2020 / NA

Introduction : L'une des missions de l'Institut National d'Hygiène est de prévenir et contrôler les maladies transmissibles et autres urgences de santé publique à travers ses services compétents. En situation de crises sanitaires comme une épidémie, les besoins augmentent et alors les bénéficiaires sont exemptés de paiement pour toute intervention préventive de masse. Le paiement rentre en vigueur lorsque la demande est exprimée dans une perspective individuelle. L'objectif de l'étude était d'analyser les facteurs de la demande des prestations du service de lutte anti-vectorielle (LAV) en période épidémique de Dengue et de COVID-19. Méthodes : Une étude transversale a été réalisée de janvier 2018 à décembre 2020 dans une antenne communale, celle d'Abobo. La collecte des données a été effectuée à travers une revue documentaire et l'administration d'un questionnaire auprès du gestionnaire et des techniciens du centre. L'analyse des données a été réalisée avec le tableur Excel. Résultats : La recette cumulée du service LAV pour ces trois dernières années s'élèvait à 57 708 100 F CFA (≈ 88 103 €) avec une accentuation de l'ordre de 65,6% en 2020, année de pandémie à Covid-19. Les ménages ont été pour les trois années, les principaux demandeurs du service LAV. Leurs recettes cumulées s'élevaient à 22 663 120 FCFA (≈ 34 600 €). Les facteurs de la demande pour le service LAV étaient le lieu de résidence, le niveau d'instruction, le niveau de revenu et la source d'information. Conclusion: La pandémie à COVID 19 a favorisé une augmentation plus importante des recettes. Les gestionnaires du centre devront ajuster les objectifs de recettes en tenant compte des facteurs de la demande en service de soins préventifs.

Introduction: The National Institute of Hygiene's mission is to prevent communicable diseases andother public health emergencies. During health crises, beneficiaries are exempt from payment. The study's objective was to analyze the factors that influence the demand for vector control services during Dengue and COVID-19 epidemics. Methods: This was a cross-sectional study from January 2018 to december 2020 at the Abobo public health unit. Data collection was done through a literature review and the administration of a questionnaire. Data analysis was performed using Excel software. Results: The cumulative revenue of the LAV service for the last three years amounted to 57,708,100 F CFA (≈ 88,103 €). Households were the principal applicants for the LAV service for the three years. Their cumulative revenue amounted to 22,663,120 FCFA (≈ 34 600 €). Factors influencing demand for the LAV service were residence, level of education, income level, and source of information. Conclusion: Center managers will need to adjust revenue targets by considering demand factors for preventive care services.

Exploring key-stakeholder perceptions on non-communicable disease care during the COVID-19 pandemic in Kenya

Introduction: over one third of total Disability-Adjusted-Life-Years lost in Kenya are due to non-communicable diseases (NCD). In response, the Government declared significant commitment towards improving NCD care. The COVID-19 pandemic increased the burden on the already overstretched health systems in Kenya. The aims of this study are to assess whether health care providers perceived NCD care to be optimal during the pandemic and explore how to improve responses to future emergencies. Methods: this cross-sectional online survey included healthcare personnel with non-clinical roles (public health workers and policy-makers) and those delivering health care (doctors and nurses). Respondents were recruited between May and September 2021 by random sampling, completed by snowball sampling. Results: among 236 participants (42% in clinical, 58% in non-clinical roles) there was an overall consensus between respondents on NCD care being disrupted and compromised during the pandemic in Kenya. Detracted supplies, funding, and technical resources affected the continuity of NCDs response, despite government efforts. Respondents agreed that the enhanced personnel capacity and competencies to manage COVID-19 patients were positive, but noted a lack of guidance for redirecting care for chronic diseases, and advocated for digital innovation as a solution. Conclusion: this paper explores the perceptions of key stakeholders involved in the management of NCDs in Kenya to improve planning for future emergency responses. Gaps were identified in health system response and preparedness capacity during the pandemic including the perceived need to strengthen NCD services, with solutions offered to guide resilience efforts to protect the health system from disruption.