Working conditions in primary health care in the COVID-19 pandemic: an overview of Brazil and Portugal. / Condições de trabalho na atenção primária à saúde na pandemia de COVID-19: um panorama sobre Brasil e Portugal.

The COVID-19 pandemic has put pressure on public health systems worldwide since 2020. This article aims to discuss working conditions in Primary Health Care (PHC) in Brazil, while dialoguing with primary health care (CSP, Cuidados de Saúde Primários) in Portugal in the pandemic scenario. For that purpose, data from the study "Working conditions of health professionals in the context of COVID-19 in Brazil" are presented, for further discussion with the report produced by "Family Health Units - National Association (USF-AN, Unidades de Saúde Familiar - Associação Nacional)" on the CSP in Portugal. In Brazil, regarding the sample of 3,895 PHC health professionals, it was observed: multiple employment relationships, lack of institutional support and specific training, living with fake news and the lack of political cohesion between health authorities, with significant changes in these workers' mental health. In Portugal, the increase in the workload and the presence of Burnout Syndrome among FHU professionals was emphasized. The pandemic had a significant impact on the health and daily work of health professionals in PHC and CSP. However, the Brazilian context was more adverse due to fake news and divergences regarding conducts related to the fight against the pandemic, due to the actions and denialism by the federal government.

A pandemia de COVID-19 pressiona os sistemas públicos de saúde no mundo desde 2020. Este artigo pretende discutir as condições de trabalho na atenção primária à saúde (APS) no Brasil, dialogando também com os cuidados de saúde primários (CSP) em Portugal no cenário pandêmico. Para isso, apresentam-se dados da pesquisa "Condições de trabalho dos profissionais de saúde no contexto da COVID-19 no Brasil", para posterior discussão com o relatório das Unidades de Saúde Familiar - Associação Nacional (USF-AN) sobre os CSP em Portugal. No Brasil, no recorte amostral de 3.895 profissionais de saúde da APS, foram percebidos: múltiplos vínculos trabalhistas, falta de apoio institucional e de treinamentos específicos, convívio com fake news e falta de coesão política entre as autoridades sanitárias, com alterações significativas na saúde mental desses trabalhadores. Em Portugal, destacaram-se o aumento da carga horária de trabalho e presença de síndrome de burnout entre os profissionais das USFs. A pandemia impactou de forma significativa a saúde e o cotidiano de trabalho dos profissionais de saúde na APS e nos CSP. Porém, o contexto brasileiro foi mais adverso devido às fake news e às divergências na condução do combate à pandemia, pela atuação e negacionismo do governo federal.

Condições de trabalho na atenção primária à saúde na pandemia de COVID-19: um panorama sobre Brasil e Portugal / Working conditions in primary health care in the COVID-19 pandemic: an overview of Brazil and Portugal

Resumo A pandemia de COVID-19 pressiona os sistemas públicos de saúde no mundo desde 2020. Este artigo pretende discutir as condições de trabalho na atenção primária à saúde (APS) no Brasil, dialogando também com os cuidados de saúde primários (CSP) em Portugal no cenário pandêmico. Para isso, apresentam-se dados da pesquisa "Condições de trabalho dos profissionais de saúde no contexto da COVID-19 no Brasil", para posterior discussão com o relatório das Unidades de Saúde Familiar - Associação Nacional (USF-AN) sobre os CSP em Portugal. No Brasil, no recorte amostral de 3.895 profissionais de saúde da APS, foram percebidos: múltiplos vínculos trabalhistas, falta de apoio institucional e de treinamentos específicos, convívio com fake news e falta de coesão política entre as autoridades sanitárias, com alterações significativas na saúde mental desses trabalhadores. Em Portugal, destacaram-se o aumento da carga horária de trabalho e presença de síndrome de burnout entre os profissionais das USFs. A pandemia impactou de forma significativa a saúde e o cotidiano de trabalho dos profissionais de saúde na APS e nos CSP. Porém, o contexto brasileiro foi mais adverso devido às fake news e às divergências na condução do combate à pandemia, pela atuação e negacionismo do governo federal.

Abstract The COVID-19 pandemic has put pressure on public health systems worldwide since 2020. This article aims to discuss working conditions in Primary Health Care (PHC) in Brazil, while dialoguing with primary health care (CSP, Cuidados de Saúde Primários) in Portugal in the pandemic scenario. For that purpose, data from the study "Working conditions of health professionals in the context of COVID-19 in Brazil" are presented, for further discussion with the report produced by "Family Health Units - National Association (USF-AN, Unidades de Saúde Familiar - Associação Nacional)" on the CSP in Portugal. In Brazil, regarding the sample of 3,895 PHC health professionals, it was observed: multiple employment relationships, lack of institutional support and specific training, living with fake news and the lack of political cohesion between health authorities, with significant changes in these workers' mental health. In Portugal, the increase in the workload and the presence of Burnout Syndrome among FHU professionals was emphasized. The pandemic had a significant impact on the health and daily work of health professionals in PHC and CSP. However, the Brazilian context was more adverse due to fake news and divergences regarding conducts related to the fight against the pandemic, due to the actions and denialism by the federal government.

Autoclassificação da saúde e autovaliação da assistência para seu cuidado segundo moradores de assentamentos rurais / Self-classification of the health of residents belonging to rural settlements and their evaluation of the healthcare received

Moradores de assentamentos rurais enfrentam dificuldades de acesso aos serviços de saúde. Isso é determinado pelas condições socioeconômicas destas populações. É possível que essas pessoas classifiquem insatisfatoriamente a própria saúde e a qualidade dos serviços públicos que têm acesso. Este estudo objetivou analisar a autoclassificação da saúde entre moradores de assentamentos rurais e sua avaliação aos serviços de saúde que utilizam. Pesquisa transversal, que entrevistou, através de um instrumento semiestruturado, moradores de dois assentamentos rurais localizados em Uberlândia, Minas Gerais, Brasil. O instrumento buscou analisar o perfil epidemiológico, a autoclassificação da saúde desses moradores, utilizando uma escala avaliativa. Foi também analisado como eles avaliam a qualidade dos serviços de saúde que acessam. Foram entrevistados 24 moradores de dois assentamentos. 54.2% deles (n=13) possuíam doenças crônicas. As mais relatadas foram Hipertensão Arterial Sistêmica e Diabetes Mellitus. Entre os moradores, 45.8% (n=11) auto classificaram a própria saúde como fraca ou razoável e 45.8% como boa. A análise dos discursos indicou insatisfação com a qualidade do serviço de saúde utilizado. Os índices de doenças crônicas encontradas entre os moradores dos assentamentos rurais podem ser decorrentes da baixa cobertura de Atenção Primária à Saúde próximos de suas residências. A melhoria da qualidade do serviço prestado pelas Unidades Básicas de Saúde da Família próximas aos assentamentos rurais pode reduzir os índices de doenças cardiovasculares futuras entre essa população.

Residents of rural settlements face difficulties in accessing health services. This is determined by the socioeconomic conditions of these populations. It is possible that these people rate their own health and the quality of public services they have access to as unsatisfactory. This study aimed to analyze the self-evaluation of health among residents of rural settlements and their assessment of the health services they use. This was a cross-sectional study, which interviewed, through a semi-structured instrument, residents of two rural settlements located in Uberlândia, Minas Gerais, Brazil. The instrument sought to analyze the epidemiological profile, the self-evaluation of the health of these residents, using an evaluative scale. Moreover, their assessment of the quality of the health services they access was evaluated. Twenty-four residents of two settlements were interviewed. 54.2% of them (n=13) had chronic diseases. The most reported were Systemic Arterial Hypertension and Diabetes Mellitus. Among residents, 45.8% (n=11) evaluated their own health as poor or fair and 45.8% as good. The analysis of the speeches indicated dissatisfaction with the quality of the health services used. The chronic disease rates found among residents of rural settlements may be due to the low coverage of Primary Health Care close to their homes. Improving the quality of the service provided by the Basic Family Health Units closest to rural settlements can reduce future cardiovascular disease rates among this population.

Contextual determinants of intimate partner violence: a multi-level analysis in six European cities.

OBJECTIVES: To assess whether city-level characteristics influence the risk of intimate partner violence (IPV) victimization across six European cities. METHODS: The DOVE study included 3496 participants from Athens-Greece, Budapest-Hungary, London-UK, Östersund-Sweden, Porto-Portugal and Stuttgart-Germany. IPV victimization was assessed using the Revised Conflict Tactics Scales, and several contextual variables were included: GINI coefficient, gender equality index, an index of social support, unemployment rate and proportion of residents with tertiary education. Multilevel models were fitted to estimate the associations (odds ratio, 95% confidence intervals) between each type of victimization and contextual and individual-level variables. RESULTS: 62.3% of the participants reported being a victim of IPV during the previous year, with large between-city differences (53.9%-72.4%). Contextual variables accounted for a substantial amount of this heterogeneity. Unemployment rates were associated with psychological (1.05, 1.01-1.08) and physical IPV (1.07, 1.01-1.13). GINI coefficient showed a positive association with any form of IPV (1.06, 1.01-1.11) and sexual coercion (1.13, 1.01-1.25). CONCLUSIONS: We found significant associations between contextual determinants and IPV, which emphasizes the importance of considering contextual socioeconomic conditions when policy measures are designed to address IPV.

Intimate Partner Violence and Use of Primary and Emergency Care: The Role of Informal Social Support.

Social support may encourage victims to disclose their experiences of intimate partner violence (IPV), but also to seek the appropriate help and care in the social and health services. Using data from a multicenter European project, DOVE (Domestic Violence Against women/men in Europe-prevalence, determinants, effects, and policies/practices), the present study aimed at measuring the frequency of primary care and emergency use according to IPV types of victimization, and to investigate whether victims receiving different levels of informal social support are using health care differently. Results suggested a significant association between IPV types and use of emergency services, and no association was found regarding primary care services. Victims of physical abuse and sexual coercion went to the emergency department (ED) more frequently (more than once a year). Also, victims of physical abuse receiving low social support visited an ED more frequently than those with high social support, whereas victims of sexual coercion with high informal social support went more often to the ED compared with victims of sexual coercion with low social support, even after controlling for other covariates. These results seem to suggest that social support has a significant role in the decision to use health care among victims of IPV.

Social support and the intimate partner violence victimization among adults from six European countries.

BACKGROUND: Social support may buffer the negative effects of violence on physical and mental health. Family medicine providers play an essential role in identifying the available social support and intervening in intimate partner violence (IPV). OBJECTIVE: This study aimed at assessing the association between social support and the IPV victimization among adults from six European countries. METHODS: This is a cross-sectional multi-centre study that included individuals from Athens (Greece), Budapest (Hungary), London (UK), Östersund (Sweden), Porto (Portugal) and Stuttgart (Germany). Data collection was carried out between September 2010 and May 2011. The sample consisted of 3496 adults aged 18-64 years randomly selected from the general population in each city. The revised Conflict Tactics Scales was used to assess IPV victimization. Social support was assessed with the Multidimensional Scale of Perceived Social Support. RESULTS: Participants reporting physical assault victimization experienced lower social support (mean ± SD) than their counterparts, 66.1 ± 13.96 versus 71.7 ± 12.90, P < 0.001, for women; and 67.1 ± 13.69 versus 69.5 ± 13.52, P = 0.002 for men. Similar results were found regarding sexual coercion victimization, 69.1 ± 14.03 versus 71.3 ± 12.97, P = 0.005 for women and 68.0 ± 13.29 versus 69.3 ± 13.62, P = 0.021 for men. This study revealed lower levels of social support among participants reporting lifetime and past year victimization, independent of demographic, social and health-related factors. CONCLUSION: Results showed a statistically significant association between low social support and IPV victimization. Although the specific mechanisms linking social support with experiences of violence need further investigation, it seems that both informal and formal networks may be associated with lower levels of abusive situations.

O desafio da mudança: a transformação curricular de um Programa de Residência de Medicina de Família e Comunidade / El desafío del cambio: la transformación curricular de un Programa de Residencia de Medicina de Familia y Comunidad / The challenge of change: the curricular transformation of Family a and Community Medicine Residency Program

Introdução: Um dos eixos centrais do Programa Mais Médicos para o Brasil prevê a reestruturação nas residências de Medicina de Família e Comunidade do país, de modo que elas estejam adequadas à nova legislação, sendo pré-requisito para as demais residências médicas do país. Para esta mudança, é necessário que os programas existentes adaptem os seus programas de modo que estes estejam em consonância com o que se espera de um Médico de Família e Comunidade. Objetivo: Analisar a experiência da Universidade Federal de Uberlândia e a metodologia utilizada na reforma curricular do Programa de Residência em Medicina de Família e Comunidade. Métodos: Estudo de caso com análise documental sobre o produto, atas e demais documentos construídos durante as três oficinas de reforma curricular executadas, além dos marcos regulatórios. Resultados: A metodologia utilizada nestas oficinas englobou o Arco de Maguerez como estratégia problematizadora que dialoga com a Pedagogia Progressista de Paulo Freire. Para participar das oficinas, foram convidados residentes, gestor, preceptores e docentes. Trabalhou-se com a matriz de planejamento estratégico Análise FOFA (Fortaleza, Oportunidade, Fraqueza e Ameaça) para realizar o diagnóstico situacional do programa; elencaram-se ainda os estágios a serem desenvolvidos, bem como os princípios pedagógicos utilizados e as ferramentas avaliativas. Conclusão: Observou-se uma mudança significativa no programa da residência com envolvimento principalmente de preceptores e residentes engajados na implementação desta nova proposta. Os desafios encontrados foram parcialmente superados, porém ainda existem questões relacionadas principalmente à dinâmica ensino-serviço que precisa ser melhor estruturada para a efetivação do novo programa.(AU)

Introduction: One of the central axes provided by the Mais Médicos (More Doctors) Program to Brazil foresee the restructuring of Family and Community Medicine residencies in the country, so they could fit the new legislation, being a prerequisite for other medical residencies in the nation. For this change, existing programs need to tailor their programs so that they are in line with what is expected of a Family and Community Physician. Objective: To analyze the experience of the Federal University of Uberlândia and the methodology used in the curriculum reform of the Residency Program in Family and Community Medicine. Methods: Case Study with documental analysis about the product, minutes and other documents built during the three workshops of curriculum reform implemented, beyond the regulatory milestones. Results: The methodology used in these workshops embodied the Arch of Maguerez as a problematizing strategy that dialogues with the Progressive Pedagogy of Paulo Freire. In order to participate in the workshops, residents, managers, preceptors and teachers were invited. We worked with the strategic planning matrix Analysis SOWT (Strength, Opportunity, Weakness and Threat) to carry out the situational diagnosis of the program; the stages to be developed, as well as the pedagogical principles used and the evaluation tools were also mentioned. Conclusion: There was a significant change in the residency program, mainly involving preceptors and residents engaged in the implementation of this new proposal. The challenges encountered were partially overcome, but there are still issues related mainly to the teaching-service dynamics that needs to be better structured for the implementation of the new program.(AU)

Introducción: Uno de los ejes centrales del Programa Mais Médicos para Brasil prevé la reestructuración de las residencias de Medicina de Familia y Comunidad en el país, de modo que ellas sean adecuadas a la nueva legislación, siendo requisito previo para acceder a las demás residencias médicas del país. Para este cambio, es necesaria una adaptación de los programas existentes para que estén en consonancia con lo que se espera de un Médico de Familia y Comunidad. Objetivo: Analizar la experiencia de la Universidade Federal de Uberlândia y la metodología utilizada en la reforma curricular del Programa de Residencia en Medicina de Familia y Comunidad. Métodos: Estudio de caso con análisis documental sobre el producto, actas y demás documentos construidos durante los tres talleres de reforma curricular ejecutados, además de los marcos regulatorios. Resultados: La metodología utilizada en estos talleres englobó el Arco de Maguerez como estrategia problematizadora que dialoga con la Pedagogía Progresista de Paulo Freire. Para los talleres fueron invitados residentes, gestores, preceptores y docentes y se trabajó con la matriz de planificación estratégica Análisis FODA (Fortaleza, Oportunidad, Debilidad y Amenaza), para realizar el diagnóstico situacional del programa, se enumeraron las etapas a ser desarrolladas así como los principios pedagógicos utilizados y las herramientas de evaluación. Conclusión: Se observó un cambio significativo en el programa de la residencia con envolvimiento principalmente de preceptores y residentes comprometidos en la implementación de esta nueva propuesta. Los desafíos encontrados fueron parcialmente superados, pero todavía existen cuestiones relacionadas principalmente con la dinámica enseñanza-servicio que necesita ser mejor estructurada para la efectuación del nuevo programa.(AU)