Inclusão da atenção à saúde masculina de caminhoneiros a partir do Cartão de Saúde do Caminhoneiro e da Caminhoneira na Atenção Primária à Saúde / Inclusion of male health care for truck drivers from the Truck Driver and Truck Driver Health Card in Primary Health Care / Inclusión de la atención médica masculina para conductores de camiones de la Tarjeta de Salud de Camioneros y Camioneros en la Atención Primaria de Salud

Objetivo: identificar o avanço da implantação do Cartão de Saúde do Caminhoneiro e da Caminhoneira na Atenção Primária à Saúde desses profissionais. Método: estudo descritivo exploratório, por meio de entrevistas estruturadas. O público-alvo foram os profissionais de saúde das unidades de saúde localizadas próximas ao Pontos de Parada e Descanso certificados pelo o Ministério da Infraestrutura e caminhoneiros do sexo masculino presentes nestes mesmos Pontos. Resultados: 50% dos responderam que em sua rota de trabalho já tiveram alguma necessidade de atendimento de saúde, porém 100% responderam que não foram atendidos com o CSCC. 58% dos profissionais de saúde entrevistados não tiveram capacitação sobre PNAISH, 75% responderam que desconhecem a política e 83% a Nota Técnica n° 08/2020. Na avaliação de 25% (n=3) dos profissionais de saúde, o CSCC facilitou o acesso a busca de atendimento na Atenção Primária pelos caminhoneiros. Foram considerados dificuldades ou obstáculos para a implementação do CSCC: a questão de desconhecimento do CSCC por parte da equipe(75%), a falta de capacitação(83%) e a baixa procura dos profissionais caminhoneiros(58%). Conclusão: esta pesquisa resultou em uma proposta de Projeto Piloto de implementação ao acesso à Atenção Primária à Saúde com a prática do Cartão de Saúde do Caminhoneiro e da Caminhoneira

Objective: to identify the progress of the implementation of the Trucker's and Trucker's Health Card in the Primary Health Care of these professionals. Method: exploratory descriptive study, through structured interviews. The target audience was the health professionals of the health units located near the Stop and Rest Points certified by the Ministry of Infrastructure and male truck drivers present in these same Points. Results: 50% of the respondents answered that in their work route they had already had some need for health care, but 100% answered that they were not attended with the CSCC. 58% of the health professionals interviewed did not have training on PNAISH, 75% answered that they are unaware of the policy and 83% the Technical Note No. 08/2020. In the evaluation of 25% (n=3) of the health professionals, the CSCC facilitated the access to seek care in Primary Care by truck drivers. The following were considered difficulties or obstacles to the implementation of the CSCC: the issue of lack of knowledge of the CSCC by the team (75%), the lack of training (83%) and the low demand of professional truck drivers (58%). Conclusion: this research resulted in a proposal for a Pilot Project to implement access to Primary Health Care with the practice of the Trucker's and Trucker's Health Card.

Objetivo: identificar los avances de la implementación de la Tarjeta de Salud del Camionero y Camionero en la Atención Primaria de Salud de estos profesionales. Método: estudio descriptivo exploratorio, a través de entrevistas estructuradas. El público objetivo fueron los profesionales de la salud de las unidades de salud ubicadas cerca de los Puntos de Parada y Descanso certificados por el Ministerio de Infraestructura y los conductores de camiones varones presentes en estos mismos Puntos. Resultados: 50% de los encuestados respondieron que en su ruta de trabajo ya habían tenido alguna necesidad de atención médica, pero 100% respondieron que no fueron atendidos con el CSCC. El 58% de los profesionales de la salud entrevistados no tenía capacitación sobre PNAISH, el 75% respondió que desconoce la política y el 83% la Nota Técnica Nº 08/2020. En la evaluación de 25% (n=3) de los profesionales de salud, el CSCC facilitó el acceso a buscar atención en Atención Primaria por parte de camioneros. Se consideraron dificultades u obstáculos para la implementación del CSCC: el problema de la falta de conocimiento del CSCC por parte del equipo (75%), la falta de capacitación (83%) y la baja demanda de conductores de camiones profesionales (58%). Conclusión: esta investigación resultó en una propuesta de Proyecto Piloto para implementar el acceso a la Atención Primaria de Salud con la práctica de la Tarjeta de Salud del Camionero y Camionero.

Quality of Telehealth Services in Primary Care in the State of Minas Gerais.

Objective: Telemedicine is seen as an important tool to face contemporary health challenges. The factors that help improve quality in these services must be studied. The objective of this work was to assess the quality of telehealth primary care services offered in the State of Minas Gerais -Brazil, based on the ISO 13131 standard. Methods: This cross-sectional analytical study with a quantitative approach was conducted in the cities in the state of Minas Gerais that use telehealth services. A stratified sample composed of 385 cities was used. A questionnaire, based on ISO 13131 on the quality of telehealth services, was prepared, used, and verified for its consistency. Quality levels in telehealth were built from the data. To analyze the quality of care, data from the Ministry of Health's quality improvement program were used, involving 366 surveyed cities. Logistic regression was performed to verify the association between quality of telehealth and quality of care. Results: The research identified that 64% of the cities had records of telehealth activities, and 51% of cities had high quality telehealth services. There was no association between quality of telehealth and quality of care; only the dimensions of Quality and Risk Management were associated with quality of care. Conclusion: The developed instrument enabled the quality of telehealth actions to be verified. The State of Minas Gerais has high-quality telehealth services.

Contribuições técnicas e socioculturais da prevenção quaternária para a atenção primária à saúde: caminhos e desafios / Technical and socio-cultural contributions of quaternary prevention for primary health care: paths and challenges / Contribuciones técnicas y socioculturales de prevención cuaternaria para la atención primaria de salud: caminos y desafíos

Introdução: No contexto do Sistema Único de Saúde, o conceito da prevenção quaternária adentra timidamente os níveis de atenção à saúde, no entanto, sofre expansão significativa no âmbito da atenção primária à saúde. Objetivo: Identificar por meio da sistematização de evidências científicas, as contribuições técnicas e socioculturais da prevenção quaternária no âmbito da atenção primária à saúde no Brasil. Métodos: Trata-se de uma revisão integrativa de estudos presentes nas bases de dados científicas da Scientific Electronic Library Online, Biblioteca Virtual em Saúde, biblioteca virtual da Comissão de Aperfeiçoamento de Pessoal do Nível Superior e MEDLINE via PubMed com a utilização dos descritores "prevenção quaternária" e "atenção primária à saúde", em inglês e português. Resultados: O corpus de análise foi composto por 22 artigos, sendo que a produção científica sobre o tema se deu de forma mais intensa a partir do ano de 2015 e, em sua maioria, possuíam como abordagem metodológica ensaios teóricos. Dentre as contribuições técnicas destacaram-se a introdução do ensino da prevenção quaternária de modo continuado aos graduandos e profissionais; a construção de protocolos e documentos de amparo profissional; a utilização de modelos explicativos dinâmicos na socialização do quadro clínico; a conduta profissional com os usuários e as contribuições socioculturais envolvendo mudanças na percepção profissional e comunitária sobre o fenômeno saúde-doença, assim como o incentivo a práticas de desmedicalização sociocultural em relação à dor, incapacidade, desconforto, envelhecimento, nascimento e morte. Conclusão: Apesar do reconhecimento das potencialidades da prevenção quaternária, faz-se necessário fortalecer estratégias que possibilitem o desenvolvimento de políticas públicas para fomentar e gerenciar alianças estratégicas com tomadores de decisão, profissionais de saúde e cidadãos, para fomentar a redução de diagnósticos e tratamentos excessivos, contribuindo com a qualidade do cuidado.

Introduction: In the context of the Unified Health System, the concept of quaternary prevention shyly enters the levels of health care, however, undergoes significant expansion in the scope of primary health care. Objective: To identify, through the systematization of scientific evidence, the technical and socio-cultural contributions of quaternary prevention within the scope of primary health care in Brazil. Methods: This is an integrative review of studies present in the scientific databases of the Scientific Electronic Library Online, Regional Portal of the Virtual Health Library of the Latin American and Caribbean Center on Health Sciences Information of the Pan American Health Organization, virtual library of the Higher Education Personnel Improvement Commission, and MEDLINE through PubMed using the descriptors "quaternary prevention" and "primary health care", in English and Portuguese. Results: The corpus of analysis consisted of 22 articles, and the scientific production on the topic took place more intensively from the year 2015 and, for the most part, had theoretical essays as methodological approach. Among the technical contributions, we highlight the introduction of teaching on quaternary prevention in a continuous way to undergraduates and professionals; the construction of protocols and documents of professional support; the use of dynamic explanatory models in the socialization of the clinical picture and professional conduct with users and socio-cultural contributions involve changes in the professional and community perception about the phenomenon of illness and health conception, as well as the incentive to practices of socio-cultural demedicalization in relation to pain, disability, discomfort, aging, birth, and death. Conclusion: Despite the recognition of the potential of quaternary prevention, it is necessary to strengthen strategies that enable the development of public policies to foster and manage strategic alliances with decision makers, health professionals and citizens, to promote the reduction of excessive diagnoses and treatments, contributing to the quality of care.

Introducción: En el contexto del Sistema Único de Salud, el concepto de prevención cuaternaria entra tímidamente en los niveles de atención de salud, sin embargo, experimenta una expansión significativa en el alcance de la Atención Primaria de Salud. Objetivo: Identificar, a través de la sistematización de evidencia científica, las contribuciones técnicas y socioculturales de la prevención cuaternaria en el ámbito de la Atención Primaria de Salud en Brasil. Métodos: Esta es una revisión integradora de estudios presentes en las bases de datos científicas de la Biblioteca Electrónica Científica en línea, Portal Regional de la Biblioteca Virtual en Salud del Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud de la Organización Panamericana de la Salud, biblioteca virtual de la Comisión de Mejoramiento del Personal de Educación Superior y MEDLINE a través de PubMed utilizando los descriptores de prevención cuaternaria y atención primaria de salud, en inglés y portugués. Resultados: El corpus de análisis estuvo conformado por 22 artículos, siendo la producción científica sobre el tema más intensiva desde 2015 y, en su mayor parte, tuvo ensayos teóricos como abordaje metodológico. Entre los aportes técnicos, destacamos la implantación de la docencia en prevención cuaternaria de forma continua a estudiantes de pregrado y profesionales; construcción de protocolos y documentos de apoyo profesional, uso de modelos explicativos dinámicos en la socialización del cuadro clínico y conducta profesional con los usuarios y los aportes socioculturales implican cambios en la percepción profesional y comunitaria sobre el fenómeno de la enfermedad y la concepción de la salud, así como el incentivo a prácticas de desmedicalización sociocultural en relación al dolor, discapacidad, malestar, envejecimiento, nacimiento y muerte. Conclusión: A pesar del reconocimiento del potencial de la prevención cuaternaria, es necesario fortalecer estrategias que permitan el desarrollo de políticas públicas para fomentar y gestionar alianzas estratégicas con los tomadores de decisiones, profesionales de la salud y ciudadanos, para promover la reducción de diagnósticos y tratamientos excesivos, contribuyendo a la calidad de la atención.

Conhecimento e percepção dos nutricionistas da atenção primária sobre plantas medicinais e fitoterápicos / Knowledge and perception of primary care nutritionists about medicinal plants and phytotherapeutics

Objetivo: Analisar o conhecimento e percepção de nutricionistas sobre plantas medicinais e fitoterápicos. Metodologia: Trata-se de uma pesquisa qualitativa, onde utilizou-se um questionário eletrônico para a coleta de dados de nutricionistas que atuam na atenção primária da saúde da zona leste do município de São Paulo. Para avaliação dos dados foi utilizado a análise de conteúdo de Bardin, para gerar e analisar as categorias emergentes dos discursos colhidos. Resultados: Foram analisados 21 questionários de nutricionistas. Verificou-se que mais de 90% sabem o que são as práticas integrativas e complementares em saúde, 61,9% não tem conhecimento da política pública de plantas medicinais e 70% sabem a diferença entre plantas medicinais e os fitoterápicos, 80% da amostra demonstrou insegurança profissional em orientar sobre o uso das plantas medicinais e 52,4% não tem conhecimento sobre a resolução do conselho federal de nutrição sobre prescrição de plantas medicinais e fitoterápicos. Conclusão: O estudo levanta o questionamento acerca da ineficiência dos cursos de graduação em nutrição no ensino sobre fitoterapia, bem como a insegurança dos profissionais acerca da prescrição e orientação na prática clínica, frente ao grande avanço de uso de plantas medicinais e fitoterápicos relatados pelos pacientes em consultas ou grupos. Palavras chave: plantas medicinais e fitoterápicos, nutrição em saúde pública e atenção primária à saúde.

Atención primaria de salud en angiología y cirugía vascular en Cuba / Primary health care in Angiology and vascular surgery in Cuba

En la década del sesenta del siglo xx, la Revolución Cubana a través de su Ministerio de Salud Pública crea las áreas y los policlínicos integrales de salud. En 1964 la especialidad de angiología y cirugía vascular fue la primera en participar en acciones de promoción, prevención y atención médica especializada en los policlínicos y en la comunidad. El objetivo de esta breve comunicación es el de exhortar a nuestros especialistas y residentes en angiología y cirugía vascular de nuestro país, a mantener, incrementar y reforzar cuantitativa y cualitativamente, las consultas en los policlínicos integrales de salud de sus provincias, en la medida de sus posibilidades y continuar así el accionar histórico de esta especialidad(AU)

In the 1960´s decade, the Cuban Revolution through its Ministry of Public Health created the comprehensive health areas and Policlinics. In the year 1964, Angiology and Vascular Surgery specialty was the first in participating in promotion, prevention and specialized medical care actions in the policlinic and in the community. The objective of this brief communication is exhorting the specialists and residents in Angiology and Vascular Surgery of our country to maintain, increase and reinforce quantitative and qualitatively the consultations in the integral policlinics of health of their provinces continuing with the historical development of this specialty(AU)

Satisfacción de usuarios y calidad de atención en unidades primarias de Salud de Milagro / Satisfaction of the users and quality of attention In Primary Health Care Units-Milagro

Introducción: Uno de los problemas con mayor relevancia dentro del sistema de Salud Pública del Ecuador es la satisfacción de los usuarios ante los servicios recibidos, los que se relacionan con la efectividad, eficiencia y percepción del paciente a la atención brindadaal dolor que le aqueja, así como la sensación del bienestar físico y mental. Objetivo: Se planteó como objetivo identificar la satisfacción de los usuarios y la calidad de la atención que se brinda en las unidades operativas de atención primaria de Salud en la ciudad deMilagro.Metodología: La metodología utilizada se basó en un enfoque cuantitativo, de tipo no experimental, transversal-descriptivo; el instrumento de medición para la satisfacción de usuarios se alineó a los parámetros del modeloSERVQUAL. Resultados: El 77 % de los usuarios se encuentra satisfecho con el equipamiento e infraestructura respectiva en los centros de salud; de la misma forma, el 81 % señala estar satisfecho con la atención del personal que labora en dichas dependencias, mientras que el 80 % considera que la cantidad de las camillas cumple con sus expectativas. Conclusión: Con el estudio de estas dimensiones a través de la percepción del usuario se determinó que la calidad de la atención es media y en igual forma la variable satisfacción delusuario

Introduction: One of the problems with greater relevance within the Public Health System of Ecuador is the satisfaction of the users with the services received, which are related to the effectiveness, efficiency and patient perception to the attention given to the pain that afflicts, as well as the sensation of the physical and mental well-being. Objective the objective of the research it is based on identifies the user's satisfaction and quality of care that is provided in the Operational Units of Primary Health Care in the city of Milagro. Methods this study was based on a quantitative approach, non-experimental, cross-sectional-descriptive; the measuring instrument for the satisfaction of users was aligned to the parameters of the Servqual model. Results: The process data showed that 77 % of users are satisfied with the respective equipment and infrastructure in the health centers; in the same way, the 81 % reported being satisfied with the attention of the personnel working in these units, While 80 % believe that the quantity of the stretchers meet their expectations. Conclusion: With the study of these dimensions through the user's perception, it was determined that the quality of care is average and in the same way asthe user satisfactionvariable.

"Survey of Wellbeing of Young Children (SWYC)": how does it fit for screening developmental delay in Brazilian children aged 4 to 58 months?

OBJECTIVE: To replicate the original normative study of the SWYC's Milestones Questionnaires for children in Brazil. Our goals were to compare the performance of Brazilian and North American children using this screening tool and to verify the reliability and validity of the Brazilian version. STUDY DESIGN AND SETTING: Cross-sectional study with children aged 1-65 months and their guardians, recruited in southern Brazil. Parents were interviewed using the Developmental Milestones questionnaire, which contains 10 questions about cognitive, motor, social, and language abilities. Item response theory was used to examine item validity. RESULTS: We interviewed 415 parents. SWYC provided the most information on the children's development between 10 and 30 months. The performance of Brazilian and North American children was quite similar when children are younger than 36 months old. Above 36 months, North American children performed almost all items earlier than Brazilians. Convergent validity was 0.73 and internal consistency 0.97. CONCLUSION: The Brazilian version of the Developmental Milestones questionnaire presented acceptable measurement qualities that support the SWYCs potential as a developmental screening tool. As we found important differences between North American and Brazilian children in achieving the milestones, especially among the oldest children, additional normative studies are needed.

The effects of the Norwegian Coordination Reform on the use of rehabilitation services: panel data analyses of service use, 2010 to 2013.

BACKGROUND: In 2012 the Norwegian Coordination Reform was implemented. The main motivation was to encourage municipalities to expand local, primary health care services. From 2012 to 2014, under the Municipal Co-Financing regime, municipalities were obliged to cover 20 % of the costs of health services provided at the specialist (hospital) level. Importantly, use of rehabilitation services in private institutions was not part of the cost-sharing mechanism of Municipal Co-Financing. Rehabilitation services may be seen as quite similar in nature whether they be provided by municipalities, hospitals or private institutions. Thus, with rehabilitation patients readily "transferrable" between levels, the question is whether the reform brought with it a sought after shift towards more municipal rehabilitation and less specialist rehabilitation. METHODS: Data from the Norwegian Patient Register and from Statistics Norway/KOSTRA were utilized to gauge annual expenditures and inputs in specialist, municipal and private institution rehabilitation services respectively. Fixed effects and first difference regression analyses for the period 2010-2013 were carried out to account for certain time-invariant traits of municipalities and/or hospital regions, and results were adjusted for contemporaneous trends in local needs. RESULTS: Expenditures in specialist rehabilitation services declined sharply (typically by 8-10 %) from 2011 (pre-reform) to 2012 (post-reform), while expenditures in private rehabilitation services rose markedly in the same period (typically by 42-44 %). The results do not suggest any general expansion of municipal rehabilitation services. CONCLUSIONS: The results of the analyses suggest that municipalities shift away from the use of specialist rehabilitation services and towards the use of rehabilitation services in private institutions since the latter becomes relatively cheaper (free-of charge) than both municipal and specialist services in post-reform periods (as specialist services come at a cost to municipalities post-reform). While the main goal of the reform has not materialized the results nevertheless suggest that incentives (of cost-shifting) do play a significant role in rehabilitation service use.

Predicción de riesgo coronario y cardiovascular global en la atención primaria de salud / Prediction of Coronary and Global Cardiovascular Risk in Primary Health Care

Introducción: la tendencia actual es hacia una visión global del riesgo cardiovascular, las funciones de riesgo cardiovascular son instrumentos de clasificación, útiles para determinar las prioridades de intervención preventiva, estos deben actualizarse y perfeccionarse. Objetivo: determinar el riesgo de enfermedad coronaria y el riesgo cardiovascular global en pacientes de la atención primaria. Métodos: se realizó estudio transversal en un universo de 1 200 pacientes con edades entre 34 y 75 años, sin antecedente de enfermedad cardiovascular, del Policlínico Docente José Ávila Serrano, en el periodo enero-junio de 2011. Se seleccionaron 308 casos mediante muestreo aleatorio simple. Para la determinación del riesgo coronario se utilizó la tabla de predicción de enfermedad cardiaca coronaria de Framingham-Wilson (1998) y para el riesgo cardiovascular global, la tabla de predicción de riesgo cardiovascular global de Framingham- D´Agostino (2008). Resultados: según tabla de referencia de enfermedad coronaria, se halló con bajo riesgo (<10 %) el 51,6 % de la población, el 30,8 % con riesgo intermedio (10-20 %) y el 17,6 % con alto riesgo (>20 %). Según tabla de riesgo cardiovascular global, se encontró el 39,6 % con bajo riesgo, el 27,6 % con riesgo intermedio y el 32,8% con alto riesgo. El valor de concordancia de la tabla de riesgo de enfermedad coronaria comparado con la tabla de riesgo cardiovascular global fue 0,54 (IC 95% 0,46-0,62). Conclusiones: el uso de tablas de predicción es una herramienta útil para estimar el riesgo coronario y cardiovascular global en la atención primaria de salud.

Introduction: the current trend is toward a comprehensive view of cardiovascular risk, cardiovascular risk functions are instruments for classification that are useful in prioritizing preventive intervention and the risk functions should be update and improved. Objective: to determine the coronary heart disease risk and global cardiovascular risk in patients of primary health care. Methods: a cross sectional survey was carried out, the population were 1 200 patients with age between 34-75 years, without history of cardiovascular disease, of the Velasco Teaching Polyclinic during January to June 2011, a random sample of 308 cases were taken, for the prediction of coronary risk the Framingham-Wilson coronary risk prediction score(1998) was used as well as the Framingham- D´Agostino general cardiovascular risk score(2008) for the prediction of the global cardiovascular risk. Results: the coronary heart disease reference table determined as low risk(<10 %) 51.6 % of the population, 30.8 % as intermediate risk ( 10-20 %) and 17.6 % as high risk(>20 %), the global cardiovascular risk table determined 39.6 %, 27.6 % and 32.8 % as low, intermediate and high risk respectively. Concordance value of coronary heart disease risk table compared to global cardiovascular risk table was 0.54 (IC 95 % 0.46-0.62). Conclusion: the use of prediction tables is a useful tool to determine coronary and global cardiovascular risk in primary health care.