Social and individual vulnerability factors associated with syphilis among populations living on islands in the Brazilian Amazon.

BACKGROUND: The repercussions of the syphilis epidemic differ according to populations. Identifying and acknowledging the differences and specificities of populations is fundamental in the design and implementation of policies aimed at assisting the groups most vulnerable to syphilis. OBJECTIVE: To estimate the prevalence of antibodies against Treponema pallidum and associated vulnerability factors among riverside populations of a capital city in the Brazilian Amazon. METHODS: Cross-sectional study was conducted among residents of the periurban islands in Belém, northern Brazil, from August 2020 to January 2021. The inclusion criterion was being a resident of the riverside communities of the Combú Environmental Protection Area, aged 18 years or over. The participants responded to questionnaire and were tested for syphilis using rapid test. Data were analyzed using multiple logistic regression by Minitab version 20® software. RESULTS: Overall, a total of 325 riverine were included. Age varied from 18 to 91 years (average 40 years). Prevalence of markers for syphilis was 5.9% (95% CI: 3.3%-8.4%). The multiple regression showed that as age increases, the chances of having syphilis also increase (p = 0.001; aOR: 1.04) and riverside dwellers with more than one sexual partner in the last 6 months had more than four chances of having syphilis compared to people who had only one sexual partner (p = 0.007; aOR: 4.20). CONCLUSION: Syphilis circulates among traditional populations in the Amazon and is associated with factors of social and individual vulnerability.

The HIV epidemic in Colombia: spatial and temporal trends analysis.

BACKGROUND: Colombia has the fourth highest incidence rate of HIV/AIDS among all Latin American countries and it has been increasing since the 1980s. However, the number of studies that addresses this trend is limited. Here, we employed spatial and temporal trend analyses to study the behaviour of the epidemic in the Colombian territory. METHODS: Our sample included 72,994 cases of HIV/AIDS and 21,898 AIDS-related deaths reported to the National Ministry of Health between 2008 and 2016. We employed the joinpoint regression model to analyse the annual HIV/AIDS incidence and AIDS mortality rates. In the spatial analysis, we used univariate autocorrelation techniques and the Kernel density estimator. RESULTS: While the HIV/AIDS incidence had an increasing trend in Colombia, the AIDS mortality rate was stable. HIV/AIDS incidence and AIDS mortality showed a downward trend in the 0-14 age group. An upward trend was observed for HIV/AIDS incidence in people older than 15 years and with the highest trend in the 65 years and above group. AIDS mortality showed an increasing trend among people aged 65 years or older. The comparison between the sexes showed an upward trend of HIV/AIDS incidence in all age groups and AIDS-mortality rates in 65 years and above in men, while in women, the incidence was upward among those aged 45 years and above, and concerning the AIDS-mortality rate in the 45-64 group. The high-high clusters of HIV/AIDS incidence and AIDS mortality were located in the Andean and Caribbean regions. CONCLUSION: Our study found an upward trend in HIV/AIDS incidence and a stable trend in the AIDS mortality rate in Colombia. The downward trend in HIV/AIDS incidence and AIDS mortality rate in the 0-14 age group reflects the downwards mother-to-child HIV transmission. The upward trend in HIV/AIDS incidence in older women and AIDS mortality in younger women rates, compared with men, may be due to late diagnosis and treatment. The Caribbean and the 'coffee belt' regions were the most impacted by the HIV epidemic, most likely due to sexual tourism. Our results provide crucial information that may help Colombian health authorities fight HIV transmission.

Burnout Syndrome in Selectable Athletes for the Brazilian Handball Team-Children Category.

To investigate the presence of burnout syndrome in child athlete tryouts for the Brazilian Handball Team, before and after the National Development and Technical Improvement Camp is of great interest. A correlational study, with longitudinal design of the before-and-after type, carried out with 64 male athletes in the children's category, immersed in the National Camp for Development and Improvement of Handball Technique, in the municipality of São Bernardo do Campo, São Paulo, Brazil, in December 2018. To evaluate burnout syndrome, we used the Athlete Burnout Questionnaire (ABQ). There was a statistically significant increase of the mean scores for burnout and dimensions (Physical and Emotional Exhaustion = 1.5 to 1.6; p-value < 0.001; Reduced Sense of Accomplishment = 2.7 to 2.9; p-value < 0.001; Sports Devaluation = 1.4 to 1.6; p-value < 0.001; and General Burnout = 1.9 to 2.0; p-value < 0.001). The athletes selected for the national team had lower mean scores for general burnout and dimensions (Physical and Emotional Exhaustion = 1.5; Reduced Sense of Accomplishment = 2.7; Sports Devaluation = 1.5; General Burnout = 1.9). The National Camp for Development and Technical Improvement can have a negative impact on the mental health of athletes. This event is important to select the competitors with greater ability to face the pressure and adversities present in the sport environment.

Advanced Practice Nursing in Brazil: how are we and what is missing?

OBJECTIVE: To reflect on the role and initiatives of the Brazilian Nursing Association (ABEn) and the Federal Nursing Council (Cofen) in the development, recognition, and regulation necessary to implement advanced practice nursing (APN) in Brazil. METHOD: This is a theoretical-reflective essay resulting from the roundtable discussion entitled "Regulation and recognition of advanced nursing practices in Brazil: how are we and what is missing" held in May 2021, at the III International Symposium on Adult Health. RESULTS: ABEn and Cofen are strategic partners to define the areas of activity of this specialization in Brazil. Nursing organizations are responsible for defining professional profiles and curricula, advanced practice nursing conditions, and adequacy of existing graduate courses aiming at technical support, political leadership, regulation, and construction of an APN foundation in Brazil. CONCLUSION: Brazil must broaden the national debate on APN, define a training model for it, and articulate efforts with all its strategic partners to build a theoretical, political, and labor framework for advanced practice nurses' full professional practice.

The National Student Performance Examination and the quality of Brazilian higher education in health. / Exame Nacional de Desempenho dos Estudantes e a qualidade do ensino superior em saúde brasileiro.

OBJECTIVE: to analyze higher education in the health area in Brazil according to the results of the students' performance in the 2019 National Student Performance Examination. METHOD: a cross-sectional and retrospective study with a quantitative approach and online data referring to 192,715 students from 3,712 health courses, collected in 2020. The students' performance was expressed in concepts, ordered on a scale of one to five. Box-plots were prepared, prevalence values of the concepts were estimated, and the differences were evaluated through statistical tests (α=5%) according to the administrative and management characteristics, as well as those of the cities where the courses were offered. RESULTS: there was a satisfactory level of higher education in health (70.0% with a score ≥3). The Medicine courses were the most satisfactorily evaluated while Speech Therapy and Nursing obtained the worst scores. Public, face-to-face and university education were associated with better teaching quality. Lower levels were found in the North region states, in small towns, outside metropolitan areas and in those under private management. CONCLUSION: heterogeneity in the quality of higher education across the health courses was verified, indicating its association with the characteristics of the teaching institutions and with the infrastructure of the cities where the courses are offered, pointing out challenges to the quality of health education in Brazil.

Seroprevalence of Chlamydia trachomatis and Associated Factors among Vulnerable Riverine in the Brazilian Amazon.

Due to social and individual conditions and access to health services, Amazonian riverside populations are highly vulnerable to sexually transmitted infections, including Chlamydia trachomatis. The aim is to estimate the seroprevalence of Chlamydia trachomatis and analyze the associated factors among riverside dwellers in a capital city in the Brazilian Amazon. A cross-sectional study was carried out with residents of the Combu Island, Belém. The study sample was calculated using the population survey technique in the EPI INFO. Only people aged 18 and over were included. ELISA serology was performed to detect antibodies against Chlamydia trachomatis. For data collection, a form containing vulnerability factor questions was applied. Binary regression analysis was performed using the Minitab 20 program. The study sample consisted of 325 participants. The prevalence of IgG/IgM antibodies against Chlamydia trachomatis was 22.2% and 5.5%, respectively. In the multiple regression, only participants with a broken condom were more likely to have antibodies against the bacteria (OR: 1.90; 95% CI: 1.01; 3.37; p = 0.046). Seroprevalence was associated with condom breakage. This factor demonstrates that despite having an attitude towards condom use, probably, they may have inadequate knowledge about the correct practice of introduction.

Analysis of the Coping Strategies of Primary Health Care Professionals: Cross-Sectional Study in a Large Brazilian Municipality.

Objective: To analyze the coping strategies used by primary healthcare (PHC) professionals. Methods: A cross-sectional, descriptive-analytical study realized with professionals working in primary healthcare units in São José do Rio Preto, a large city in the interior of São Paulo, Brazil. For data collection, we used an instrument developed by the researchers containing sociodemographic and professional variables, as well as the Problem Coping Modes Scale (EMEP). Results: We evaluated 333 PHC professionals. A difference was observed between the scores of the four coping strategies (p < 0.001), with the highest score for the problem-focused strategy (3.8) and the lowest score for the emotion-focused strategy (2.4). Physicians had the lowest scores in coping strategies focused on religious practices/fantastical thinking (p < 0.001) and pursuit of social support (p = 0.045), while community health agents had the highest scores in these coping strategies. Conclusions: Professionals working in PHC have different coping strategies for the problems and stressful situations experienced in the work environment. These strategies can involve more positive attitudes focused on confrontation and problem solving, and on emotional responses that involve attitudes of avoidance and denial of the problem.

Nursing in Brazil: socioeconomic analysis with a focus on the racial composition.

OBJECTIVES: to analyze the socioeconomic characteristics of nurses and nursing technicians living in Brazil according to color/race. METHODS: based on the 2010 Demographic Census sample, 62,451 nursing professionals (nurses and technicians) living in Brazil were selected. Differences in monthly income were estimated by multivariate models, stratified by color or race groups (white, brown, and black). RESULTS: the majority were technicians (61.9%) of white color (54.3%). The income of white nurses exceeded that of brown and black nurses by more than a quarter; among technicians, white professionals had an income approximately 11% higher than brown and black nurses. CONCLUSIONS: differences between incomes of nursing workers were associated with ethnic/racial background, revealing situations in which white professionals systematically presented more favorable job and income conditions than black and brown professionals.

Career commitment and career entrenchment among Primary Health Care workers.

OBJECTIVE: Assess levels of career commitment and career entrenchment among Primary Health Care workers. METHODS: This Cross-sectional study addressed 393 workers using the Brazilian versions of the Career Commitment Measure (CCM) and Career Entrenchment Measure (CEM). RESULTS: Levels of Career commitment [75.5-77.5] were higher (p<0.001) than Career Entrenchment [66.7-69.2]. Identity levels [82.7-85.5] were higher (p<0.001) than Investment levels [60.4-65.0]. Career resilience levels [75.1-79.2] were higher (p<0.001) than Emotional costs [69.0-72.1]. Planning levels [64.2-67.1] were lower (p<0.001) than levels of limitedness of career alternatives [68.1-71.0]. CONCLUSION: The highest scores were obtained in Career commitment, showing the workers' identification and positive relationship with their careers, that is, these workers remain in Primary Health Care services because they identify themselves with their professions.

The association between knowledge about HIV and risk factors in young Amazon people.

OBJECTIVES: analyze the association between the level of HIV knowledge among young people from Amazonas region, their sociodemographic profile and infection risk factors. METHODS: cross-sectional analytical study, which used a structured questionnaire containing questions about sociodemographic, behavioral aspects and HIV knowledge. Data were grouped by sex and underwent ordinal and binary logistic regression analysis. RESULTS: the students had an HIV knowledge deficit, associated with a low educational level of their parents and low family income. The most frequent risk factors were lack of knowledge on the part of female students regarding proper male condom use, their infrequent use in sexual relations and failure to do HIV testing. There was an association between level of knowledge and use of dating apps by female students. CONCLUSIONS: there was no association between level of knowledge and the preponderant risk factors, but the students' knowledge deficit rendered them more vulnerable to infection.

[Private health plans and the health of workers in Brazil]. / Planos privados de saúde e a saúde dos trabalhadores do Brasil.

The scope of this paper was to compare the changes in coverage patterns by health insurance plans among public servants, the military and other employees in Brazil and verify if the purchase of such health plans is reflected in the respective self-reported prevalence of Systemic Arterial Hypertension (SAH) and Diabetes Mellitus (DM) in the country. For this purpose, workers in the public sector (federal, state, municipal or military) and other workers aged ≥18 who were included in the 1998, 2003 and 2008 campaigns of the National Household Sample Survey (PNAD) and in the 2013 National Survey were studied. Over the years of the study, it was observed that Brazil's public service employees, both civilian and military, have presented a high and increasing proportion of health insurance purchase compared to other workers. The prevalence of SAH and DM has always been higher among employees with health insurance. The special status of public servants and the military as regards the double access to both public and private healthcare systems is reflected in the increasing self-reported prevalence of SAH and DM, increasing health inequities in a public health system that was constituted in a universal and equitable way.

O presente estudo objetivou comparar as mudanças nos padrões de cobertura por planos privados de saúde entre servidores públicos, militares e demais trabalhadores no Brasil e verificar se a vinculação a planos de saúde repercute nas respectivas prevalências autorreferidas de Hipertensão Arterial Sistêmica (HAS) e Diabetes Mellitus (DM) no país. Para isso, foram utilizados os trabalhadores do setor público (federal, estadual, municipal ou militar) e, outros trabalhadores, com ≥ 18 anos de idade incluídos na Pesquisa Nacional de Amostra de Domicílios dos anos de 1998, 2003, 2008 e na Pesquisa Nacional de Saúde de 2013. Observou-se que ao longo dos anos de estudo, os servidores públicos civis e militares do Brasil apresentaram elevada e crescente proporção de adesão aos planos privados de saúde em relação aos demais trabalhadores. As prevalências de HAS e DM sempre foram maiores e cresceram entre os servidores com planos de saúde do que entre os sem planos. O status diferenciado aos servidores públicos e militares, no que se refere ao duplo acesso aos serviços públicos e privados de saúde, refletiu-se nas crescentes prevalências autorreferidas de HAS e DM, aumentando as iniquidades em saúde diante de um sistema público constituído de modo universal e equânime.

Educação permanente para qualidade e segurança do paciente em hospital acreditado / Educación permanente para calidad y seguridad del paciente en hospital acreditado / Permanent education for quality and patient safety in an accredited hospital

Resumo Objetivo Compreender os desafios enfrentados pela educação permanente para o alcance da melhoria da qualidade e da segurança do paciente em um hospital público submetido à acreditação hospitalar. Métodos Estudo descritivo, transversal e com abordagem qualitativa. Realizaram-se entrevistas semiestruturadas com 22 profissionais, durando, em média, 22 minutos, as quais posteriormente foram analisadas e interpretadas por meio da análise de conteúdo temática de Bardin. Adotaram-se os softwares Iramuteq para a análise de corpus textual, e o BioEstat 5.3, para análise do perfil dos participantes. A coleta de dados ocorreu em junho de 2022, após aprovação nos Comitês de Ética em Pesquisa. Resultados Aplicou-se a análise de classificação hierárquica descendente, gerada pelo Iramuteq. Obtiveram-se três categorias: Desafios da Educação Permanente mediante o Processo de Melhoria Contínua; Educação Permanente para a Promoção da Qualidade e da Segurança do Paciente no Contexto da Acreditação Hospitalar; e Estratégias Educativas para a Melhoria da Qualidade e da Segurança do Paciente. Conclusão Identificaram-se desafios inerentes às ações de educação permanente em saúde, tais como resistência à mudança de cultura, adesão às atividades, alta rotatividade de profissionais e dificuldade para liberação da equipe de enfermagem para participar das atividades relacionadas à demanda de trabalho.

Resumen Objetivo Comprender los desafíos enfrentados por la educación permanente para lograr mejorar la calidad y la seguridad del paciente en un hospital público sometido a acreditación hospitalaria. Métodos Estudio descriptivo, transversal y con enfoque cualitativo. Se realizaron entrevistas semiestructuradas a 22 profesionales, con duración promedio de 22 minutos, que luego se analizaron e interpretaron mediante el análisis de contenido temático de Bardin. Se utilizaron los softwares Iramuteq para el análisis de corpus textual y BioEstat 5.3 para el análisis del perfil de los participantes. La recopilación de datos se llevó a cabo en junio de 2022, después de la aprobación de los Comités de Ética en Investigación. Resultados Se aplicó el análisis de clasificación jerárquica descendente, generado por Iramuteq. Se obtuvieron tres categorías: Desafíos de la educación permanente mediante el proceso de mejora continua, Educación permanente para la promoción de la calidad y de la seguridad del paciente en el contexto de la acreditación hospitalaria, y Estrategias educativas para la mejora de la calidad y la seguridad del paciente. Conclusión Se identificaron desafíos inherentes a las acciones de educación permanente en salud, tales como resistencia a cambios de cultura, adherencia a las actividades, alta rotación de profesionales y dificultad de autorizar al equipo de enfermería para participar en las actividades relacionadas con la demanda de trabajo.

Abstract Objective To understand the challenges faced in terms of permanent education in health, for achieving quality improvements and patient safety at a public hospital undergoing hospital accreditation. Methods This was a descriptive, cross-sectional study with a qualitative approach. Semi-structured interviews were conducted with 22 professionals, lasting an average of 22 minutes. The interviews were subsequently analyzed and interpreted using Bardin's thematic content analysis. The software Iramuteq was used to analyze the textual corpus, and BioEstat 5.3 was used to analyze the profile of the participants. The data collection took place in June 2022, following approval by the Research Ethics Committees. Results The descending hierarchical classification analysis, generated by Iramuteq, was applied, resulting in three categories: Challenges of Permanent Education through the Continuous Improvement Process, Permanent Education for the Promotion of Quality and Patient Safety in the Context of Hospital Accreditation, and Educational Strategies for Improving Quality and Patient Safety. Conclusion Challenges inherent to the actions of permanent education in health were identified, such as resistance to cultural change, adherence to activities, high turnover of professionals, and difficulty in releasing the nursing team to participate in activities, due to work demand.

Precarização do trabalho de enfermeiras: uma análise na Atenção Primária à Saúde brasileira / Precarization of nurses' work: an analysis in the Brazilian Primary Health Care / Precarización del trabajo de las enfermeras: un análisis en la Atención Primaria de Salud Brasileña

Resumo Este artigo teve como objetivo analisar os tipos de vínculos de trabalho das enfermeiras da Atenção Primária à Saúde no Brasil. Tratou-se de um estudo transversal de abordagem quantitativa e descritiva. Utilizaram-se os microdados secundários referentes ao desdobramento da pesquisa de avaliação externa do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica. Quanto ao tipo de vínculo, com exceção da Região Norte (33,70%), todas as outras regiões apresentaram como principal respondente servidoras públicas estatutárias: Sul (66,20%), Centro-Oeste (56,50%), Nordeste (40,33%), Sudeste (36,69%). Enfermeiras com contrato temporário pela administração pública e contrato temporário por prestação de serviço tiveram participação importante no Nordeste (29,51% e 19,33%) e Centro-Oeste (16,03% e 17,86%). Contrato e empregado via Consolidação das Leis do Trabalho tiveram mais expressão no Sudeste (23,54% e 8,27%) e no Sul (5,93% e 19,31%). No Sudeste, foi expressiva a participação de trabalhadoras contratadas por organizações sociais de saúde. Notou-se a presença crescente de vínculos precários de trabalho em detrimento dos vínculos estáveis. As novas formas de organização flexível das relações de trabalho trazem impacto significativo ao processo de trabalho, sobrecarregam as enfermeiras, em condições de trabalho inadequadas, e comprometem a qualidade da assistência, reduzindo a resolutividade da Atenção Primária.

Abstract This article aimed to analyze the types of work bond of nurses from Primary Health Care in Brazil. This was a cross-sectional study of a quantitative and descriptive approach. Secondary microdata related to the breakdown of the external evaluation research of the Access Improvement Program and the Quality of Basic Care were used. As for the type of bond, except for the Northern Region (33.70%), all other regions presented as the main respondent for statutory public servants: South (66.20%), Central-West (56.50%), Northeast (40.33%), Southeast (36.69%). Nurses with temporary contracts for public administration and temporary service contracts had important participation in the Northeast (29.51% and 19.33%) and Central-West (16.03% and 17.86%). Contract and employee through Consolidation of Labor Laws had more expression in the Southeast (23.54% and 8.27%) and in the South (5.93% and 19.31%). In the Southeast, the participation of workers employed by social health organizations was expressive. The growing presence of precarious labor links was noted, to the detriment of stable bonds. The new forms of flexible organization of work relationships bring significant impact to the work process, overload nurses in inadequate working conditions, and compromise the quality of care, reducing the resolubility of Primary Care.

Resumen El presente artículo tuvo como objetivo analizar los tipos de vínculos laborales de las enfermeras de Atención Primaria de Salud en Brasil. Se trata de un estudio transversal de enfoque cuantitativo y descriptivo. Se utilizaron microdatos secundarios relacionados con la división de la investigación de evaluación externa del Programa de Mejora del Acceso y la Calidad de la Atención Básica. En cuanto al tipo de vínculo, a excepción de la Región Norte (33,70%), todas las demás regiones se presentaron como principal demandado para los funcionarios públicos estatutarios: Sur (66,20%), Centro Oeste (56,50%), Noreste (40,33%), Sureste (36,69%). Las enfermeras con contratos temporales de administración pública y contratos temporales de servicios tuvieron una participación importante en el Nordeste (29,51% y 19,33%) y Centro Oeste (16,03% y 17,86%). Contrato y empleado a través de la Consolidación de Las Leyes Laborales tuvieron más expresión en el Sudeste (23,54% y 8,27%) y en el Sur (5,93% y 19,31%). En el Sudeste, la participación de los trabajadores empleados por las organizaciones de salud social fue expresiva. Se observó la creciente presencia de vínculos laborales precarios, en detrimento de vínculos estables. Las nuevas formas de organización flexible de las relaciones laborales tienen un impacto significativo en el proceso de trabajo, sobrecargan a las enfermeras en condiciones laborales inadecuadas y comprometen la calidad de la asistencia, reduciendo la solubilidad de la Atención Primaria.

A consulta de enfermagem no pré-natal sob a ótica da teoria do cuidado de kristen swanson / The prenatal nursing consultation from the perspective of kristen swanson's theory of care / La consulta de enfermería prenatal desde la perspectiva de la teoría de los cuidados de kristen swanson

RESUMO Objetivo: compreender os significados atribuídos pelas mulheres amazônidas quanto à consulta de Enfermagem pré-natal. Método: estudo descritivo, exploratório e qualitativo, realizado por meio de entrevista semiestruturada com a participação de 14 gestantes numa unidade básica de saúde do Estado do Pará, Brasil, entre os meses de agosto a novembro de 2020. Os dados foram transcritos e submetidos à análise de conteúdo e sustentados com base na ótica da Teoria do Cuidado de Kristen Swanson. Resultados: o pré-natal deve ser voltado para a criação de vínculo e da singularidade da mulher amazônica, permitindo a sua compreensão a fim de que atenda às especificidades das mulheres, articulando a atenção a saúde integral, uma relação de conhecer e estar com a mulher e família, para relações de troca e envolvimento, fornecendo um elo à saúde materna. Conclusão: conceitos da teoria do cuidado permitem que o enfermeiro esteja com a mulher e forneça um cuidado individualizado, singular, particularizado dentro do contexto no pré-natal.

ABSTRACT Objective: to understand the meanings attributed by Amazonian women regarding the prenatal nursing consultation. Method: descriptive, exploratory, and qualitative study, conducted through semi-structured interviews with the participation of 14 pregnant women in a basic health unit in the State of Pará, Brazil, between the months of August and November 2020. Data were transcribed and submitted to content analysis and supported based on the optics of Kristen Swanson's Theory of Care. Results: prenatal care must be focused on creating a bond and the Amazonian woman's singularity, allowing for her understanding to meet the women's specificities, articulating integral health care, a relationship of knowing and being with the woman and her family, for relationships of exchange and involvement, providing a link to maternal health. Conclusion: concepts from the theory of care allow the nurse to be with the woman and provide individualized, singular, particularized care within the context of prenatal care.

RESUMEN Objetivo: comprender los significados atribuidos por las mujeres amazónicas sobre la consulta de enfermería prenatal. Método: estudio descriptivo, exploratorio y cualitativo, realizado a través de entrevistas semiestructuradas con la participación de 14 gestantes en una unidad básica de salud del Estado de Pará, Brasil, entre los meses de agosto y noviembre de 2020. Los datos fueron transcritos y sometidos a un análisis de contenido y sustentados en la teoría del cuidado de Kristen Swanson. Resultados: la atención prenatal debe centrarse en la creación de un vínculo y la singularidad de la mujer amazónica, lo que permite su comprensión con el fin de satisfacer las especificidades de las mujeres, la articulación de la atención de salud integral, una relación de conocer y ser con la mujer y la familia, para las relaciones de intercambio y la participación, proporcionando un vínculo con la salud materna. Conclusión: los conceptos de la teoría del cuidado permiten a la enfermera estar con la mujer y proporcionarle un cuidado individualizado, singular y particularizado dentro del contexto en el cuidado prenatal.

Advanced Practice Nursing in Brazil: how are we and what is missing? / Enfermería de Práctica Avanzada en Brasil: ¿cómo vamos y qué nos falta? / Práticas Avançadas em Enfermagem no Brasil: como estamos e o que falta?

ABSTRACT Objective: To reflect on the role and initiatives of the Brazilian Nursing Association (ABEn) and the Federal Nursing Council (Cofen) in the development, recognition, and regulation necessary to implement advanced practice nursing (APN) in Brazil. Method: This is a theoretical-reflective essay resulting from the roundtable discussion entitled "Regulation and recognition of advanced nursing practices in Brazil: how are we and what is missing" held in May 2021, at the III International Symposium on Adult Health. Results: ABEn and Cofen are strategic partners to define the areas of activity of this specialization in Brazil. Nursing organizations are responsible for defining professional profiles and curricula, advanced practice nursing conditions, and adequacy of existing graduate courses aiming at technical support, political leadership, regulation, and construction of an APN foundation in Brazil. Conclusion: Brazil must broaden the national debate on APN, define a training model for it, and articulate efforts with all its strategic partners to build a theoretical, political, and labor framework for advanced practice nurses' full professional practice.

RESUMEN Objetivo: Reflexionar sobre el papel y las iniciativas de la Asociación Brasileña de Enfermería (ABEn) y del Consejo Federal de Enfermería (Cofen) en el desarrollo, reconocimiento y regulación necesarios a la puesta en práctica de Enfermería de Práctica Avanzada (EPA) en Brasil. Método: Ensayo teórico-reflexivo a partir de la mesa redonda titulada "Regulación y reconocimiento de la enfermería de práctica avanzada en Brasil: ¿Cómo vamos y qué nos falta?", celebrada en mayo de 2021 en el III Simposio Internacional de Salud del Adulto. Resultados: Es evidente que la ABEn y el Cofen son socios estratégicos para definir las áreas de actuación de esta especialización en el país. Las responsabilidades de las organizaciones de Enfermería consisten en definir el perfil profesional, el currículo, las condiciones para el ejercicio de las enfermeras de práctica avanzada, la adecuación de los cursos de posgrado existentes, con miras al apoyo técnico, liderazgo político, regulación y construcción de bases para la EPA en el país. Conclusión: Es necesario ampliar el debate sobre la EPA en Brasil, definir el modelo de formación y articular esfuerzos con todos los socios estratégicos, con el fin de construir un marco teórico, político y laboral para el pleno ejercicio profesional de los enfermeros de práctica avanzada.

RESUMO Objetivo: Refletir sobre o papel e as iniciativas da Associação Brasileira de Enfermagem (ABEn) e do Conselho Federal de Enfermagem (Cofen) no desenvolvimento, reconhecimento e regulamentação necessários à implantação da Enfermagem de Prática Avançada (EPA) no Brasil. Método: Ensaio teórico-reflexivo resultante da mesa-redonda intitulada "Regulamentação e reconhecimento das práticas avançadas em enfermagem no Brasil: Como estamos e o que falta?", realizada em maio de 2021, no III Simpósio Internacional de Saúde do Adulto. Resultados: Fica evidenciado que a ABEn e o Cofen são parceiros estratégicos para definição das áreas de atuação desta especialização no país. As responsabilidades das organizações da Enfermagem consistem em definir o perfil profissional, o currículo, as condições para o exercício dos enfermeiros de prática avançada, adequação dos cursos de pós-graduação existentes, com vistas ao apoio técnico, liderança política, regulação, regulamentação e construção de bases para EPA no país. Conclusão: É preciso ampliar o debate sobre a EPA no Brasil, definir o modelo de formação e articular esforços com todos os parceiros estratégicos, no intuito de construir um arcabouço teórico, político e laboral para o pleno exercício profissional do enfermeiro de prática avançada.

Nursing in Brazil: socioeconomic analysis with a focus on the racial composition / Enfermería en Brasil: análisis socioeconómicas con enfoque en la composición racial / Enfermagem no Brasil: análises socioeconômicas com foco na composição racial

ABSTRACT Objectives: to analyze the socioeconomic characteristics of nurses and nursing technicians living in Brazil according to color/race. Methods: based on the 2010 Demographic Census sample, 62,451 nursing professionals (nurses and technicians) living in Brazil were selected. Differences in monthly income were estimated by multivariate models, stratified by color or race groups (white, brown, and black). Results: the majority were technicians (61.9%) of white color (54.3%). The income of white nurses exceeded that of brown and black nurses by more than a quarter; among technicians, white professionals had an income approximately 11% higher than brown and black nurses. Conclusions: differences between incomes of nursing workers were associated with ethnic/racial background, revealing situations in which white professionals systematically presented more favorable job and income conditions than black and brown professionals.

RESUMEN Objetivos: analizar características socioeconómicas de enfermeros y técnicos de enfermería residentes en Brasil segundo color/raza. Métodos: con base en la muestra del Censo Demográfico 2010, fueron seleccionados 62.451 profesionales de enfermería (enfermeros y técnicos) residentes en Brasil. Diferencias de la renta mensual fueron estimadas por modelos multivariados, estratificados por grupos de color o raza (blanca, mestiza y negra). Resultados: la mayoría eran técnicos (61,9%) de color blanca (54,3%). La renta de enfermeros blancos superó en más de » a de los mestizos y negros; entre los técnicos, blancos tenían renta aproximadamente 11% mayor que la de mestizos y negros. Conclusiones: diferencias entre rendimientos de los trabajadores de la enfermería estaban relacionadas al pertenecer étnico-racial, revelando situaciones en las cuales profesionales de color/raza blanca presentaron, sistemáticamente, condiciones más favorables de trabajo y renta, en relación a los negros y mestizos.

RESUMO Objetivos: analisar características socioeconômicas de enfermeiros e técnicos de enfermagem residentes no Brasil segundo cor/raça. Métodos: com base na amostra do Censo Demográfico 2010, foram selecionados 62.451 profissionais de enfermagem (enfermeiros e técnicos) residentes noBrasil. Diferenças da renda mensal foram estimadas por modelos multivariados, estratificados por grupos de cor ou raça (branca, parda e preta). Resultados: a maioria eram técnicos (61,9%) de cor branca (54,3%). A renda de enfermeiros brancos superou em mais de » a dos pardos e pretos; entreos técnicos, brancos tinham renda aproximadamente 11% maior do que a de pardos e pretos. Conclusões: diferenças entre rendimentos dos trabalhadores da enfermagem estavam associadas ao pertencimento étnico-racial, revelando situações nas quais profissionais de cor/raça branca apresentaram, sistematicamente, condições mais favoráveis de trabalho e renda, em relação aos pretos e pardos.

Career commitment and career entrenchment among Primary Health Care workers / Compromiso y afianzamiento con la carrera del personal de la Atención Primaria de Salud / Comprometimento e entrincheiramento com a carreira em trabalhadores da Atenção Primária à Saúde

ABSTRACT Objective: Assess levels of career commitment and career entrenchment among Primary Health Care workers. Methods: This Cross-sectional study addressed 393 workers using the Brazilian versions of the Career Commitment Measure (CCM) and Career Entrenchment Measure (CEM). Results: Levels of Career commitment [75.5-77.5] were higher (p<0.001) than Career Entrenchment [66.7-69.2]. Identity levels [82.7-85.5] were higher (p<0.001) than Investment levels [60.4-65.0]. Career resilience levels [75.1-79.2] were higher (p<0.001) than Emotional costs [69.0-72.1]. Planning levels [64.2-67.1] were lower (p<0.001) than levels of limitedness of career alternatives [68.1-71.0]. Conclusion: The highest scores were obtained in Career commitment, showing the workers' identification and positive relationship with their careers, that is, these workers remain in Primary Health Care services because they identify themselves with their professions.

RESUMEN Objetivo: Evaluar los niveles de compromiso y afianzamiento con la carrera del personal de la Atención Primaria de Salud. Métodos: Se trata de un estudio transversal, realizado entre 393 trabajadores, en el que se utilizaron las versiones brasileras de las Escalas de Compromiso con la Carrera (ECC) y de Afianzamiento con la Carrera (EEC). Resultados: Los niveles de Compromiso [75,5 - 77,5] eran superiores (p<0,001) a los de Afianzamiento [66,7 - 69,2]. Los niveles de Identidad [82,7 - 85,5] eran superiores (p<0,001) a los de Inversión [60,4 - 65,0]. Los niveles de Resiliencia con la carrera [75,1 - 79,2] eran superiores (p<0,001) a los de Costo emocional [69,0 - 72,1]. Los niveles de Planificación [64,2 - 67,1] eran inferiores (p<0,001) a los de Limitación de alternativas [68,1 - 71,0]. Conclusión: Predominó el vínculo de compromiso con la carrera, lo que demuestra una identificación y relación positiva de los trabajadores con la misma y permanecen en la Atención Primaria de Salud porque se identifican con la profesión.

RESUMO Objetivo: Avaliar os níveis de comprometimento e entrincheiramento com a carreira de trabalhadores da Atenção Primária à Saúde. Métodos: Estudo transversal com 393 trabalhadores, utilizando as versões brasileiras das Escalas de Comprometimento com a Carreira (ECC) e de Entrincheiramento na Carreira (EEC). Resultados: Os níveis de Comprometimento [75,5 - 77,5] foram superiores (p<0,001) aos de Entrincheiramento [66,7 - 69,2]. Os níveis de Identidade [82,7 - 85,5] foram superiores (p<0,001) aos níveis de Investimentos [60,4 - 65,0]. Os níveis de Resiliência com a carreira [75,1 - 79,2] foram superiores (p<0,001) aos níveis de Custos emocionais com a carreira [69,0 - 72,1]. Os níveis de Planejamento [64,2 - 67,1] foram inferiores (p<0,001) aos níveis de Limitação de alternativas [68,1 - 71,0]. Conclusão: Predominou o vínculo de comprometimento com a carreira, evidenciando identificação e relação positiva dos trabalhadores com a carreira, os quais permanecem na Atenção Primária à Saúde porque se identificam com a profissão.

Exame Nacional de Desempenho dos Estudantes e a qualidade do ensino superior em saúde brasileiro / The National Student Performance Examination and the quality of Brazilian higher education in health / Examen Nacional de Rendimiento Estudiantil y calidad de la educación superior brasileña en salud

Resumo Objetivo: analisar o ensino superior da área da saúde no Brasil segundo os resultados do desempenho dos estudantes no Exame Nacional de Desempenho dos Estudantes de 2019. Método: estudo transversal, retrospectivo, de abordagem quantitativa com dados on-line referentes a 192.715 estudantes de 3.712 cursos da saúde, coletados em 2020. O desempenho dos estudantes foi expresso em conceitos, ordenados em escala de um a cinco. Foram elaborados box-plot e estimadas prevalências dos conceitos e avaliadas diferenças segundo as características administrativas, de gestão e das cidades sede dos cursos por meio de teste estatísticos (α=5%). Resultados: observou-se nível satisfatório do ensino superior de saúde (70,0% com conceito ≥3). Cursos de medicina foram os mais satisfatoriamente avaliados, fonoaudiologia e enfermagem os piores. O ensino público, presencial e em universidades estiveram associados à maior qualidade do ensino. Níveis mais baixos foram verificados nos estados da região Norte, nas cidades pequenas e fora de áreas metropolitanas e naqueles sob gestão privada. Conclusão: verificou-se heterogeneidade na qualidade do ensino superior entre os cursos de saúde, indicando sua associação com características das instituições de ensino e à infraestrutura das cidades sedes dos cursos, apontando desafios para a qualidade da formação em saúde no Brasil.

Abstract Objective: to analyze higher education in the health area in Brazil according to the results of the students' performance in the 2019 National Student Performance Examination. Method: a cross-sectional and retrospective study with a quantitative approach and online data referring to 192,715 students from 3,712 health courses, collected in 2020. The students' performance was expressed in concepts, ordered on a scale of one to five. Box-plots were prepared, prevalence values of the concepts were estimated, and the differences were evaluated through statistical tests (α=5%) according to the administrative and management characteristics, as well as those of the cities where the courses were offered. Results: there was a satisfactory level of higher education in health (70.0% with a score ≥3). The Medicine courses were the most satisfactorily evaluated while Speech Therapy and Nursing obtained the worst scores. Public, face-to-face and university education were associated with better teaching quality. Lower levels were found in the North region states, in small towns, outside metropolitan areas and in those under private management. Conclusion: heterogeneity in the quality of higher education across the health courses was verified, indicating its association with the characteristics of the teaching institutions and with the infrastructure of the cities where the courses are offered, pointing out challenges to the quality of health education in Brazil.

Resumen Objetivo: analizar la educación superior en el área de la salud en Brasil en función de los resultados del desempeño de los estudiantes en el Examen Nacional de Rendimiento de los Estudiantes de 2019. Método: estudio transversal, retrospectivo con enfoque cuantitativo con datos online referentes a 192.715 estudiantes de 3.712 carreras de salud, recolectados en 2020. El desempeño de los estudiantes se expresó en conceptos, ordenados en una escala de uno a cinco. Se elaboraron box-plots y se estimaron y las prevalencias de los conceptos y se evaluaron las diferencias según las características administrativas, de gestión y de las ciudades sede de las carreras a través de pruebas estadísticas (α=5%). Resultados: se observó un nivel satisfactorio de educación superior en salud (70,0% con concepto ≥3). Las carreas de Medicina obtuvieron las mejores calificaciones, las de Fonoaudiología y Enfermería las peores. Se asoció la educación pública, presencial y universitaria con una educación de mayor calidad. Los niveles más bajos se encontraron en los estados de la región Norte, en los pueblos pequeños y fuera de las áreas metropolitanas, y en las carreras de gestión privada. Conclusión: se verificó que había heterogeneidad en la calidad de la educación superior en las carreras de salud, lo que indica que hay una asociación entre las características de las instituciones educativas y la infraestructura de las ciudades donde se dictan las carreras, y señala que la calidad de la educación en salud en Brasil enfrenta desafíos.

Avaliação dos processos organizacionais da atenção primária à saúde / Evaluation of organizational processes of primary health care / Evaluación de procesos organizativos de la atención primaria de salud

Objetivo: Avaliar os processos organizacionais das equipes de Atenção Básica do estado do Pará, segundo seus componentes referentes à organização de prontuários, organização da agenda e acolhimento à demanda espontânea. Métodos: Pesquisa de natureza avaliativa, por meio de um estudo transversal com abordagem quantitativa, utilizando dados do terceiro ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. Resultados: A organização de prontuários possui 82,4% de adesão eficiente do modelo por núcleos familiares, com baixo percentual de uso de prontuários eletrônicos (11,1%). A organização da agenda é realizada em sua totalidade na modalidade presencial (100%), com garantia da consulta de retorno ao usuário (90,1%). O acolhimento à demanda espontânea é realizado (99%), com o acesso aos serviços de saúde pelo usuário apenas para renovação de receitas de medicamentos (97,3%). Conclusão: Os dados revelaram fragilidades pertinentes em relação à organização dos prontuários, devido questões materiais e estruturais. Encontram-se potencialidades na organização da agenda e acolhimento à demanda espontânea, garantindo a integralidade do acesso e longitudinalidade do cuidado. (AU)

Objective: Evaluate the organizational processes of Primary Care teams in the state of Pará, according to their components regarding the organization of medical records, organization of the agenda and acceptance of spontaneous demand. Methods: Research of an evaluative nature, through a cross-sectional study with a quantitative approach, using data from the third cycle of the Program National for Improving Access and Quality in Primary Care. Results: The organization of medical records has 82.4% efficient adherence of the model by family nuclei (82.4%), with a low percentage of use of electronic medical records (11.1%). The organization of the agenda is carried out in its entirety in the face-to-face modality (100%), with guaranteed return consultation to the user (90.1%). Welcoming spontaneous demand is performed (99%), with access to health services by the user only for renewing medication prescriptions (97.3%). Conclusion: The data revealed pertinent weaknesses in relation to the organization of medical records, due to material and structural issues. There are potentialities in organizing the agenda and welcoming spontaneous demand, guaranteeing the integrality of access and longitudinality of care. (AU)

Objetivo: Evaluar los procesos organizativos de los equipos de Atención Primaria en el estado de Pará, según sus componentes en cuanto a la organización de la historia clínica, organización de la agenda y aceptación de la demanda espontánea. Métodos: Investigación de carácter evaluativo, mediante un estudio transversal con enfoque cuantitativo, utilizando datos del tercer ciclo del Programa Nacional de Mejoramiento del Acceso y la Calidad en Atención Primaria. Resultados: La organización de historias clínicas tiene 82,4% de adherencia eficiente del modelo por núcleos familiares, con un bajo porcentaje de uso de historias clínicas electrónicas (11,1%). La organización de la agenda se realiza en su totalidad en la modalidad presencial (100%), con consulta de retorno garantizada al usuario (90,1%). Se realiza la acogida de la demanda espontánea (99%), con acceso a los servicios de salud por parte del usuario solo para la renovación de prescripción de medicamentos (97,3%). Conclusión: Los datos revelaron debilidades pertinentes en relación con la organización de las historias clínicas, debido a cuestiones materiales y estructurales. Se pueden encontrar potencialidades en la organización de la agenda y la acogida de la demanda espontánea, garantizando la integralidad del acceso y la longitudinalidad de la atención. (AU)