Avanzamos en salud gracias a la aplicación salud infantil papi: programa de actividades preventivas de la infancia y adolescencia / We advance in health thanks to the PAPI children's health application

Introducción: La estructura familiar y la crianza están cambiando en la sociedad, se incrementa el sedentarismo, el uso de pantallas y de redes sociales. Las familias y los profesionales sanitarios deben aprender a educar, adaptando sus consejos de salud al nuevo entorno social y digital. Material y métodos: Para renovar el Programa de Salud Infantil (PSI) de la Asociación Española de Pediatría de Atención Primaria (AEPap) se envió una encuesta a los representantes de más de 5.000 pediatras. Se incorporaron aportaciones de los programas preventivos de Andalucía, Baleares y Asturias. Se distribuyeron las diferentes intervenciones y consejos en 9 grupos etarios. Resultados: Parte de las recomendaciones están basadas en el trabajo del grupo PrevInfad, llevadas a cabo con metodología de medicina basada en la evidencia, mediante la evaluación y la síntesis de la evidencia de las actividades preventivas propuestas. La AEPap considera que el PSI debe realizarse por el equipo de pediatría: pediatra y enfermera/o, potenciándose así las competencias específicas. La OMS considera primordial empoderar a las personas, familias y comunidades para que optimicen su salud al convertirlas en cuidadoras de sí mismas y de otros, dotándolas de herramientas que protegen el bienestar. Conclusiones: Por todo ello se decide plasmar el PSI en formato de app para dispositivos móviles gratuita, como método innovador y asequible de divulgación de salud infantojuvenil. Se informa sobre consejos de crianza para los familiares, para los niños/as y adolescentes y describe las revisiones de salud para los sanitarios. (AU)

Introduction: The family structure and parenting are changing in society, sedentary lifestyle, the use of screens and social networks is increasing. Families and health professionals must learn to educate, adapting their health advice to the new social and digital environment. Materials and methods: A survey was sent to the representatives of more than 5000 paediatricians to renew the Well Child Visits Program of the Spanish Association of Primary Care Paediatrics (AEPap). Contributions from preventive programs from Andalusia, the Balearic Islands and Asturias were incorporated. The different interventions and advice were distributed in nine age groups. Results: Part of the recommendations are based on the work of the PrevInfad group. It uses the methodology of evidence-based medicine and performs the evaluation and synthesis of the evidence in the proposed preventive activities. The AEPap considers that the Well Child Program should be carried out by the paediatric team: the paediatrician and the nurse, thus enhancing specific skills. The WHO considers it is essential to empower individuals, families, and communities to optimize their health by making them caretakers of themselves and others, equipping them with tools that protect their well-being. Conclusions: Hence, it was decided to capture the Well Child Program in the format of a free APP for mobile devices, as an innovative and affordable method of disseminating child and adolescent health. Information is given on parenting advice for family members, for children and adolescents and describes health check-ups for health workers. (AU)

We advance in health thanks to the PAPI children's health application.

INTRODUCTION: The family structure and parenting are changing in society, sedentary lifestyle, the use of screens and social networks is increasing. Families and health professionals must learn to educate, adapting their health advice to the new social and digital environment. MATERIALS AND METHODS: A survey was sent to the representatives of more than 5000 paediatricians to renew the Well Child Visits Programme of the Spanish Association of Primary Care Paediatrics (AEPap). Contributions from preventive programmes from Andalusia, the Balearic Islands and Asturias were incorporated. The different interventions and advice were distributed in nine age groups. RESULTS: Part of the recommendations are based on the work of the PrevInfad group. It uses the methodology of evidence-based medicine and performs the evaluation and synthesis of the evidence in the proposed preventive activities. The AEPap considers that the Well Child Programme should be carried out by the paediatric team: the paediatrician and the nurse, thus enhancing specific skills. The WHO considers it essential to empower individuals, families, and communities to optimize their health by making them caretakers of themselves and others, equipping them with tools that protect their well-being. CONCLUSION: Hence, it was decided to capture the Well Child Programme in the format of a free APP for mobile devices, as an innovative and affordable method of disseminating child and adolescent health. Information is given on parenting advice for family members, for children and adolescents and describes health check-ups for health workers.

The association among the consumption of ultra-processed food and body image, nutritional status and physical activity of pregnant women at the primary health care / Associação entre o consumo de alimentos ultraprocessados e imagem corporal, estado nutricional e atividade física de gestantes na Atenção Primária à Saúde

Abstract Objectives: to analyze the consumption of ultra-processed food and its association with body image, physical activity, nutritional status and self-assessment on food of pregnant women enrolled in the Primary Health Care. Methods: this is a cross-sectional study carried out with pregnant women enrolled in the Family Health Strategy in the city of Montes Claros, Minas Gerais. Data were collected through a questionnaire. The dependent variable was the consumption of ultra-processed food, and the independent ones addressed body appearance, physical activity, nutritional status, self-assessment on food and food consumption. Descriptive analysis was carried out and for association of analysis, the linear regression model was used with crude and adjusted associations. Results: 1,185 pregnant women participated in the study. Caloric intake from ultra-processed food represented 32.0% of these women's daily diet. There was an association between consumption of ultra-processed food and physical activity (β=-0.08; p<0.01), pre-gestional nutritional status (β=-0,12; p<0.01) and body image (β =0.08; p=0.01). Conclusion: the pregnant women presented high consumption of ultra-processed food. Having a negative body image, the lowest level of physical activity, and high pre-gestational nutritional status are conditions that influenced the consumption of these food.

Resumo Objetivos: analisar o consumo de alimentos ultraprocessados e sua associação com imagem corporal, atividade física, estado nutricional e autoavaliação alimentar de gestantes cadastradas na Atenção Primária à Saúde. Métodos: trata-se de um estudo transversal, realizado com gestantes cadastradas na Estratégia Saúde da Família do município de Montes Claros, Minas Gerais. Os dados foram coletados por meio de um questionário. A variável dependente foi consumo de alimentos ultraprocessados, e as independentes abordaram aspecto corporal, atividade física, estado nutricional, autoavaliação alimentar e consumo alimentar. Realizou-se análise descritiva e para análise de associação, utilizou-se o modelo de regressão linear com associações brutas e ajustadas. Resultados: participaram do estudo 1.185 gestantes. O consumo calórico proveniente dos ultraprocessados representou 32,0% da dieta diária dessas mulheres. Verificou-se associação entre consumo de ultraprocessados com atividade física (β=-0,08; p<0,01), estado nutricional pré-gestacional (β=-0,12; p<0,01) e imagem corporal (β=0,08; p=0,01). Conclusão: as gestantes apresentaram alto consumo de alimentos ultraprocessados. Ter imagem corporal negativa, menor nível de atividade física, estado nutricional pré-gestacional elevado são condições que influenciaram o consumo desses alimentos.

Drug-Related Problems of Children With Chronic Diseases in a Chinese Primary Health Care Institution: A Cross-Sectional Study.

Introduction: Drug-related problems (DRPs) refer to events or circumstances involving drug therapy that actually or potentially interfere with desired health outcomes. DRPs might be severe for children with chronic diseases managed at primary health care institutions, but the relevant research is scarce. Objective: In this cross-sectional study, we aimed to explore the prevalence, types, causes, and influencing factors of DRPs in children with chronic diseases in a Chinese primary health care institution. Methods: We recruited children with chronic diseases who visited the pediatric outpatient department in a primary health care institution from July 1 to 12 October 2021. Clinical pharmacists identified DRPs through medication therapy reviews, classified the types and causes of DRPs, and distinguished the manifested DRPs that affected the outcome and potential DRPs that were going to affect the outcome. Results: A total of 188 children with chronic diseases was included, and 584 DRPs were identified in 89.89% of participants. The most common type of DRPs was "treatment effectiveness" (a manifested problem or potential problem with the effect of the pharmacotherapy; 83.56%), of which 67.29% were potential DRPs. The second common type was "treatment safety" (patient suffers or could suffer from an adverse drug event; 14.21%), of which 89.16% were potential DRPs. The most common cause of DRPs was related to the process of use (42.24%), such as "patient uses/takes less drug than prescribed or does not take the drug at all," "patient stores drug inappropriately," and "patient administers/uses the drug in a wrong way." The second common cause was related to the process of dispensing (29.83%), such as "necessary information not provided or incorrect advice provided" and "prescribed drug is not available." The third common cause was related to the process of prescribing (26.21%), such as "drug dose is too low" and "no or incomplete drug treatment despite an existing indication." The number of combined medications was an influencing factor for the frequency of DRPs (p < 0.05). Conclusion: This cross-sectional study showed that the current situation regarding DRPs among children with chronic diseases managed in the primary health care institution was serious. The types of DRPs were mainly related to treatment effectiveness, and improper usage of medications was one of the main causes of DRPs. The number of combined drugs was the influencing factor for the frequency of DRPs. In the future, pharmacists should consider formulating pharmaceutical intervention strategies for this specific group according to the characteristics of DRPs.

Medicamentos potencialmente inapropriados prescritos para idosos atendidos na Atenção Primária / Potentially Inappropriate Medications Prescribed for Assisted Elderly in Primary Care

O objetivo do presente estudo foi determinar o perfil dos medicamentos prescritos para pacientes idosos em atenção primária, buscando a ocorrência de medicamentos potencialmente inapropriados (MPI), segundo critérios de Beers e fatores associados. O método consistiu em estudo observacional retrospectivo no período de setembro a outubro de 2015, cujos critérios de inclusão foram prescrições de medicamentos de uso contínuo para pacientes com idade igual ou superior a 60 anos. Foram analisadas prescrições de 820 pacientes. A presença de MPI ocorreu em 35,4% das prescrições. Estas apresentaram maior ocorrência para o gênero feminino OR: 1,33 (0,97 - 1,80), pacientes com idade igual ou superior a 80 anos OR: 2,36 (1,62 - 3,43) e uso concomitante de 5 ou mais medicamentos OR: 4,74 (3,47 - 6,45). A glibenclamida foi o MPI mais prescrito para os idosos (36,6%), seguido do clonazepam (22,7%) e do ácido acetilsalicílico (10,2%). Assim, faz-se necessária a revisão periódica das listas de medicamentos padronizados, nessas unidades assistenciais, considerando o consenso brasileiro de medicamentos potencialmente inapropriados para os idosos, bem como investigações sistemáticas, a fim de detectar precocemente e evitar a ocorrência de prescrição de MPI nos grupos de maior vulnerabilidade para que se possa melhorar a qualidade da assistência ofertada.

The objective of the present study was to determine the profile of medications prescribed for elderly patients in primary care, seeking the occurrence of Potentially Inappropriate Medications (MPI), according to Beers' criteria and associated factors. The method consisted of a retrospective observational study from September to October in 2015 whose inclusion criteria were prescriptions of continuous medication for patients aged 60 years or older. The prescriptions of 820 patients were analyzed. The presence of MPI occurred in 35.4% of the prescriptions. These had the highest occurrence for the female gender OR: 1.33 (0.97 -1.80), patients aged 80 years and over OR: 2.36 (1.62 - 3.43) and concomitant use of 5 or more drugs OR: 4.74 (3.47-6.45). Glibenclamide was the most prescribed MPI for the elderly (36.6%), followed by clonazepam (22.7%) and acetylsalicylic acid (10.2%) of the prescriptions. Thus, it is necessary to periodically review the lists of standardized drugs in these assistential units, considering the Brazilian consensus on the list of inappropriate drugs for the elderly. As well as systematic investigations, in order to detect early and to prevent the occurrence of MPI prescription in the groups of greater vulnerability so that the quality of the offered assistance can be improved.

Overseas GP recruitment: comparing international GP training with the UK and ensuring that registration standards and patient safety are maintained.

BACKGROUND: Ambitious overseas recruitment targets have been set by the UK government to help alleviate the current GP shortage. European Economic Area (EEA) doctors can join the UK's GP register under European law. Non-EEA doctors must obtain a Certificate of Eligibility for General Practice Registration (CEGPR), demonstrating equivalence to UK-trained doctors. CEGPR applications can be time-consuming and burdensome. To meet overseas recruitment targets, it is important to facilitate the most efficient route into UK general practice while maintaining registration standards and patient safety. AIM: To develop a methodology to map postgraduate GP training and healthcare contextual data from an overseas country to the UK. DESIGN & SETTING: Desk-based research and stakeholder interviews. METHOD: Four stages were undertaken: 1) developing a data collection template; 2) conducting a case study (using Australia as a test case); 3) refining the data collection template; and 4) creating a mapping framework. The case study used the 2016 curricula for the UK and Australia. RESULTS: Five 'domains' were identified: healthcare context, training pathway, curriculum, assessment, and continuing professional development (CPD) and revalidation. The final data collection template comprised 49 mapping items across the domains. The methodology incorporated the application of a red, amber, or green (RAG) rating to indicate similarity of data across the five domains. Australia was rated 'green' for training pathway, curriculum, and assessment, and 'amber' for healthcare context and CPD and revalidation. The overall rating was 'green'. CONCLUSION: Implementing this systematic methodology for mapping GP training between countries may support the UK's ambitions to recruit more GPs, and alleviate current GP workforce pressures.

Cuidado clínico e sobremedicalização na atenção primária à saúde / Clinical care and overmedicalization in primary health care / Cuidado clínico y sobremedicalización en la atención primaria de la salud

Resumo Este ensaio analisa a sobremedicalização (medicalização desnecessária e indesejável) gerada no cuidado médico aos adoecidos na atenção primária à saúde, discute como ocorre e como evitá-la. Articula na análise três grupos de concepções/saberes: concepções de doença (dinâmicas/ontológicas); concepções de causação (ascendente/multidirecional); eixos conceituais estruturantes do saber médico (anatomopatológico, fisiopatológico, semiológico, epidemiológico). A sobremedicalização deriva dos movimentos cognitivos dos profissionais na elaboração diagnóstica e terapêutica. Ela nasce da associação da concepção ontológica de doença com causação ascendente (fluxo causal que vai dos elementos materiais mais simples a dimensões e níveis mais complexos), em articulação com sobrevalorização do eixo anatomopatológico, geradora de excessivas intervenções diagnósticas e farmacoterapêuticas. Para evitar a sobremedicalização, propomos a associação virtuosa da concepção dinâmica de doença, com causação multidirecional e uso equilibrado dos eixos conceituais das doenças. Isso facilita: escuta qualificada; contextualização dos casos; mais criterioso uso de exames complementares; reconhecimento dos limites diagnósticos biomédicos; superação da razão metonímica (que despreza tudo o que não é saber cientificamente consagrado); amplificação da interpretação para além das 'doenças' e dos tratamentos para além dos fármacos/cirurgias, explorando os saberes dos usuários e profissionais, práticas complementares e a devolução de problemas para o manejo autônomo apoiado.

Abstract This essay analyzes the overmedicalization (unnecessary and unwanted medicalization) generated in the medical care to the ill in primary health care, and discusses how it happens and how to avoid it. The analysis combines three sets of conceptions/knowledge: conceptions of illness (dynamic/ontological); conceptions of causation (ascending/multidirectional); key conceptual and structuring ideas about medical knowledge (anatomopathological, physiopatological, semiological, epidemiological). Overmedicalization is due to the cognitive movements of the professionals in the development of diagnoses and therapies. It originates from the ontological conception of illness with ascending causation (causal flow that goes from the simplest material elements to more complex levels and dimensions), in combination with the overestimation of the anatomopathological key idea, which generates excessive diagnostic and pharmacotherapeutic interventions. In order to avoid overmedicalization, we propose the virtuous association of the dynamic conception of illness, with multidirectional causation and balanced used of the key conceptual ideas of the illnesses. This facilitates: a qualified listening; the contextualization of the cases; a more rigorous use of complementary exams; the recognition of the limits of the biomedical diagnoses; the overcoming of the metonymical reasoning (which disregards anything that is not scientifically-established knowledge); an expansion of the interpretation that goes beyond the 'illnesses' and treatments that go beyond drugs/surgeries, exploring the knowledge of the users and professionals and the return of the problems to autonomous supported management.

Resumen Este ensayo analiza la sobremedicalización (medicalización innecesaria e indeseable) generada en el cuidado médico de los enfermos en la atención primaria de la salud, y discute cómo ocurre y cómo evitarla. El análisis articula tres grupos de concepciones/conocimientos: concepciones de enfermedad (dinámicas/ontológicas); concepciones de causación (ascendente/multidireccional); ejes conceptuales estructurales del conocimiento médico (anatomopatológico, fisiopatológico, semiológico, epidemiológico). La sobremedicalización se deriva de los cambios cognitivos de los profesionales en la elaboración diagnóstica y terapéutica. Esta nace de la asociación de la concepción ontológica de enfermedad con causación ascendente (flujo causal que va desde los elementos materiales más simples a las dimensiones y niveles más complejos), en articulación con la sobrevaloración del eje anatomopatológico, provocadora de excesivas intervenciones diagnósticas y farmacoterapéuticas. Para evitar la sobremedicalización proponemos la asociación virtuosa de la concepción dinámica de enfermedad, con causación multidireccional y el uso equilibrado de los ejes conceptuales de las enfermedades. Esto facilita: escucha de calidad; contextualización de los casos; uso más riguroso de los exámenes complementarios; reconocimiento de los límites de los diagnósticos biomédicos; superación de la razón metonímica (que desprecia todo lo que no es conocimiento científicamente consagrado); ampliación de la interpretación más allá de las 'enfermedades' y de los tratamientos más allá de los fármacos/cirugías, aprovechando los conocimientos de los usuarios y profesionales, prácticas complementarias y la devolución de problemas para el manejo autónomo con apoyo.

Frailty assessment in primary health care and its association with unplanned secondary care use: a rapid review.

BACKGROUND: The growing frail, older population is increasing pressure on hospital services. This is directing the attention of clinical commissioning groups towards more comprehensive approaches to managing frailty in the primary healthcare environment. AIM: To review the literature on whether assessment of frailty in primary health care leads to a reduction in unplanned secondary care use. DESIGN & SETTING: A rapid review involving a systematic search of Medline and Medline In-Process. METHOD: Relevant data were extracted following the iterative screening of titles, abstracts, and full texts to identify studies in the primary or community healthcare setting which assessed the effect of frailty on unplanned secondary care use between January 2005-June 2016. RESULTS: The review included 11 primary studies: nine observational studies; one randomised controlled trial (RCT); and one non-randomised controlled trial (nRCT). Eight out of nine observational studies reported a positive association between frailty and secondary care utilisation. The RCT and nRCT reported conflicting findings. CONCLUSION: Older people identified as frail in a primary healthcare setting were more likely to be admitted to hospital. Based on the limited and equivocal trial evidence, it is not possible to draw firm conclusions regarding appropriate tools for the identification and management of frail older people at risk of hospital admission.

An extension of the Alma-Ata vision for primary health care in light of twenty-first century evidence and realities.

This paper builds upon and extends the definition of primary health care in the 1978 Declaration of Alma-Ata. The definition proposes a stronger role for community-based delivery of services and community mobilization, participation and empowerment. It calls for a stronger integration with vertical, disease-specific programs. And, finally, it calls for a strong role for certain curative services (including basic and essential surgery) that many today would not consider as part of primary health care. There is growing evidence that communities can and should play a stronger role than has traditionally been the case, that community-level workers who are properly trained and supported can provide effective services outside of health facilities, and that primary health centers staffed with non-specialist physicians and even non-physician clinicians can perform many of the lower-level inpatient services now performed at first-level referral hospitals. An approach to primary health care that is appropriate to the local context and that merges local epidemiological priorities with the communities' perceived priorities will make it possible to engage communities as partners. Currently, essential and basic health care services are available to only one-half of the world's population. The full development of primary health care as envisioned here will accelerate progress in achieving Health for All as envisioned at the International Conference on Primary Health Care in 1978.

Educação permanente: discursos dos profissionais de uma unidade básica de saúde / Continuing education: speeches by professionals of one Basic Health Unit

Objective: To analyze the speeches of health professionals about continuing education in the daily life of a basic health unit. Method: Qualitative study developed at a primary health care unit of Belo Horizonte, based on the theory of Agnes Heller's daily life with critical discourse analysis. In-depth interviews with 25 professionals were developed. Results: Recycling, updating, institutional responsibility, continuous learning, discomfort and transformation, revealed by vocabulary, interdiscourse, temporality, modality, evaluation and institutional social practice. Professionals blame the institution, but value continuing education for the transformation in work processes and attention to users. Final considerations and implications for practice: The discomfort provides action-reflection and changes in the attention to users. Recycle and update relates the professional's adaptation to technological updating, without necessarily producing changes. To expand discussion with professionals about daily potential, for recognition and appreciation of continuing education in daily life, as an instrument of change in social practices.

Objetivo: Analizar los discursos de profesionales de salud acerca de la Educación Permanente en el cotidiano de una unidad básica de salud. Método: Cualitativo. Escenario: una unidad básica de Belo Horizonte. Referencial: cotidiano de Agnes Heller con análisis crítica de discurso. Entrevistas en profundidad con 25 profesionales. Resultados: Reciclaje, actualización, responsabilidad institucional, aprendizaje continuo, desacomodación y transformación, reveladas por el vocabulario, interdiscurso, temporalidad, modalidad, evaluación y práctica social institucional. Responsabilizan a la institución, pero valoran la educación permanente para la transformación en los procesos de trabajo y atención a los usuarios. Consideraciones finales e Implicaciones para la práctica: La desacomodación proporciona acción-reflexión y cambios en la atención a los usuarios. Reciclar y actualizar relaciona readecuación del profesional a la actualización tecnológica, sin necesariamente provocar cambios. Ampliar discusión sobre potencia de lo cotidiano, para reconocimiento y valorización de la Educación Permanente como instrumento de cambio en las prácticas sociales.

Objetivo: Analisar os discursos dos profissionais de saúde acerca da Educação Permanente no cotidiano de uma unidade básica de saúde. Método: Qualitativo. Cenário: uma unidade básica de Belo Horizonte. Referencial: cotidiano de Agnes Heller com análise crítica de discurso. Entrevistas em profundidade com 25 profissionais. Resultados: Reciclagem, atualização, responsabilidade institucional, aprendizado contínuo, desacomodação e transformação, reveladas pelo vocabulário, interdiscurso, temporalidade, modalidade, avaliação e prática social institucional. Responsabilizam a instituição, mas valorizam a educação permanente para a transformação nos processos de trabalho e atenção aos usuários. Considerações finais e Implicações para a prática: A desacomodação proporciona ação-reflexão e mudanças na atenção aos usuários. Reciclar e atualizar relaciona readequação do profissional à atualização tecnológica, sem necessariamente provocar mudanças. Ampliar discussão com os profissionais sobre potência do cotidiano, para reconhecimento e valorização da educação permanente no cotidiano, como instrumento de mudança nas práticas sociais.

Conhecimento e prática dos enfermeiros sobre hanseníase: ações de controle e eliminação / Conocimiento y práctica de enfermeros acerca de hanseniasis: acciones de control y eliminación / Knowledge and practice of the nurse about leprosy: actions of control and elimination

RESUMO Objetivo: avaliar o conhecimento e a prática de enfermeiros da atenção primária de saúde quanto às ações de controle e eliminação da hanseníase. Método: estudo avaliativo, com abordagem qualitativa, utilizando o Discurso do Sujeito Coletivo, cujos dados foram obtidos por meio de entrevista semiestruturada, realizada com 16 enfermeiros. Resultados: os dados coletados revelaram que os profissionais de saúde possuem conhecimento suficiente sobre a Política Nacional de Controle e Eliminação da Hanseníase (PNCEH) e que as principais ações preconizadas foram executadas, porém, a notificação de casos suspeitos ou confirmados e a reinserção social do doente não foram citadas. Conclusão: manter os doentes em tratamento, sobrecarga de trabalho, falta de interdisciplinaridade e tratamento realizado em outros locais fora da comunidade foram dificuldades relatadas pelos profissionais. Os enfermeiros conhecem as ações direcionadas à assistência ao hanseniano, entretanto, o estudo aponta para a necessidade de uma prática mais alinhada ao que preconiza a PNECH. .

RESUMEN Objetivo: evaluar el conocimiento y la práctica de los enfermeros que trabajan en la atención primaria de salud como las acciones de control y eliminación de la hanseniasis. Método: es un estudio evaluativo con enfoque cualitativo, utilizando el Discurso del Sujeto Colectivo, cuyos datos fueron recolectados a través de entrevistas semi-estructuradas con 16 enfermeros. Resultados: los datos obtenidos revelaron que los profesionales de la salud tienen el conocimiento suficiente sobre la Política Nacional de Control y Erradicación de la Hanseniasis (PNCEH) y que las principales acciones recomendadas se han implementado, pero la notificación de los casos sospechosos o confirmados y reinserción social del paciente no fue mencionado. Conclusión: mantener a los pacientes en tratamiento, exceso de trabajo, falta de interdisciplinariedad y tratamiento realizado en otros lugares fuera de la comunidad fueron problemas reportados por el personal de salud. Los enfermeros conocen las acciones destinadas a ayudar a los pacientes con hanseniasis, sin embargo, el estudio apunta la necesidad de una practica más direccionado a lo que defiende la PNECH. .

ABSTRACT Objective: to assess the knowledge and practice of primary health care nurses about control and elimination actions of leprosy. Method: evaluation study with qualitative approach, using the Discourse of the Collective Subject, data were collected through semi-structured interviews conducted with 16 nurses. Results: the data collected revealed that health professionals have suffi cient knowledge about the National Policy on Control and Elimination of Leprosy (NPCEL) and that the main actions preconized were applied, however, notifi cation of suspected or confi rmed cases and social reintegration of the patient were not mentioned. Conclusion: keeping patients in treatment, overload of work, lack of interdisciplinarity and treatment performed at other locations outside of the community were diffi culties reported by professionals. Nurses know the actions addressed at assistance of leprosy patients, however, the study points to the need for a practice which is more aligned to what advocates NPCEL. .

Organizing your practice for screening and secondary prevention among adults.

Prevention plays an important role in achieving the triple aim of decreasing per capita health care costs, improving the health of populations, and bettering the patient experience. Primary care is uniquely positioned to provide preventive services. External forces are aligning to support the transition of primary care from traditional models focused on disease-specific, acute episodes of care to new ways of organizing that are more patient centered, team based, and quality driven. By aligning leadership, building change capacity, and selectively choosing relevant processes to change, those practicing primary care can successfully organize their practice environment to deliver preventive services.

Percepção dos usuários de um centro de saúde acerca de sua participação no grupo de ginástica chinesa Lian Gong: uma análise compreensiva / Perception of users of a health center about their participation in the group of chinese gymnastics Lian Gong: a comprehensive analysis / Percepción de los usuarios de um puesto de salud sobre su participación em um grupo de gimnasia China- Lian Gong: un análisis global

Trata-se de uma pesquisa qualitativa, que teve como objetivo compreender os significados da prática do Lian Gong para os participantes do grupo de ginástica terapêutica chinesa do Centro de Saúde São Paulo, Belo Horizonte, Minas Gerais. Como trajetória metodológica, utilizamos a fenomenologia que, como um caminho, permitiu apreender a essência do fenômeno a partir dos discursos de nove usuárias. A coleta de dados foi realizada por meio de entrevista guiada pela pergunta: "Conte para nós o que é, para você, participar da ginástica chinesa". Os discursos das participantes convergiram para duas categorias de análise: a) melhoria da saúde física e mental; b) convivência em grupo. Acredita-se que esta pesquisa possa contribuir para fortalecer e sedimentar essa atividade nas unidades de saúde, em especial na atenção primária, visando cumprir os preceitos da promoção à saúde também por meio de práticas complementares e integrativas.

This was a qualitative research that aimed to understand the meanings of practicing Lian Gong for participants in the group of therapeuticChinese gymnastics at the São Paulo Health Center, Belo Horizonte, Minas Gerais. We used Phenomenology as the methodological trajectory,which as a pathway, allowed capturing the essence of the phenomenon from the speeches of nine users. The data were collected through aninterview guided by the question: “Tell us what it is for you to participate in the Chinese gymnastics?” The participants’ speeches convergedinto two categories of analysis: a) improvement of physical and mental health; b) coexistence in a group. It is believed that this research willhelp to strengthen and settle this activity in health units, especially in primary care, aiming to fulfill the precepts of health promotion throughcomplementary and integrative practices.

Se trata de una investigación cualitativa con el objetivo de comprender los significados de la práctica de Lian Gong para los participantes de ungrupo de gimnasia terapéutica china del puesto de Salud São Paulo, Belo Horizonte, Minas Gerais. Como trayectoria metodológica, usamos la fenomenologia que, como camino, nos permitió captar la esencia del fenomeno a partir de los discursos de nueve usuarias. La recogida de datos fue realizada por medio de una entrevista guiada por la pregunta: “Cuéntenos qué significa para usted participar en la gimnasia china”. Los discursosde las participantes se agruparon en dos categorías de análisis: 1. Mejora de la salud física y mental; y 2. Convivencia en grupo. Creemos que esta investigación pueda ayudar a fortalecer y sedimentar aun más esta actividad en las unidades de salud, en especial en atención básica, con mirasa cumplir con los preceptos de la promoción de la salud a través de prácticas complementarias e integradas.

Nacer y crecer en plenitud: Dispositivos de salud mental para el acompañamiento de niños y adolescentes y familias / To be born and grow to the fullest: mental health devices to go along with children, adolescents, their families and expectant families. Metropolitan health district of the province of Neuquén / Nascer e crescer em plenitude: dispositivos de saúde mental para o acompanhamento de crianças e adolescentes, suas famílias e famílias gestantes. Área sanitária metropolitana na província de Neuquén

El presente artículo caracteriza los dispositivos de atención en salud mental a niños y adolescentes, sus familias y familias gestantes que se desarrollan, desde el ámbito de la salud pública, en la Zona Sanitaria Metropolitana de la Provincia del Neuquén (período 2008-2012). Dicha caracterización surge de una investigación descriptiva cualitativa en la que se utilizaron como instrumentos de recolección de datos la revisión de los registros sanitarios existentes y la aplicación de encuestas y entrevistas a los profesionales intervinientes. Los dispositivos así descriptos cobran relevancia bajo el concepto de “buenas prácticas” en salud desde el cual se buscan sistematizar experiencias exitosas que puedan ser aplicables y transferibles a otras realidades. “Buenas prácticas” que, en este caso, se dirigen a acompañar etapas claves en la estructuración psíquica del ser humano teniendo, por ello, un alto potencial preventivo y de promoción de la salud a nivel de salud mental

In This paper we describe mental health care devices for children and adolescents, their families and expectant families that are developed from the field of public health, in the Metropolitan Health District of the Province of Neuquén (2008-2012). This characterization comes from a qualitative descriptive research in which the revision of existing health records and the use of surveys and interviews with the professionals involved were used as data collection instruments. The devices described this way become relevant under the concept of “good practices” in health from which they seek to systematize successful experiences that may be applicable and transferable to other realities. “Good practices” that, in this case, aim at accompanying key stages in the psychic structure of human beings having, therefore, a high preventive potential and a health promotion potential as regards mental health level

Nacer y crecer en plenitud: Dispositivos de salud mental para el acompañamiento de niños y adolescentes y familias / To be born and grow to the fullest: mental health devices to go along with children, adolescents, their families and expectant families. Metropolitan health district of the province of Neuquén / Nascer e crescer em plenitude: dispositivos de saúde mental para o acompanhamento de crianþas e adolescentes, suas famílias e famílias gestantes. Area sanitária metropolitana na província de Neuquén

El presente artículo caracteriza los dispositivos de atención en salud mental a niños y adolescentes, sus familias y familias gestantes que se desarrollan, desde el ámbito de la salud pública, en la Zona Sanitaria Metropolitana de la Provincia del Neuquén (período 2008-2012). Dicha caracterización surge de una investigación descriptiva cualitativa en la que se utilizaron como instrumentos de recolección de datos la revisión de los registros sanitarios existentes y la aplicación de encuestas y entrevistas a los profesionales intervinientes. Los dispositivos así descriptos cobran relevancia bajo el concepto de ôbuenas prácticasö en salud desde el cual se buscan sistematizar experiencias exitosas que puedan ser aplicables y transferibles a otras realidades. ôBuenas prácticasö que, en este caso, se dirigen a acompañar etapas claves en la estructuración psíquica del ser humano teniendo, por ello, un alto potencial preventivo y de promoción de la salud a nivel de salud mental(AU)

In This paper we describe mental health care devices for children and adolescents, their families and expectant families that are developed from the field of public health, in the Metropolitan Health District of the Province of Neuquén (2008-2012). This characterization comes from a qualitative descriptive research in which the revision of existing health records and the use of surveys and interviews with the professionals involved were used as data collection instruments. The devices described this way become relevant under the concept of ôgood practicesö in health from which they seek to systematize successful experiences that may be applicable and transferable to other realities. ôGood practicesö that, in this case, aim at accompanying key stages in the psychic structure of human beings having, therefore, a high preventive potential and a health promotion potential as regards mental health level(AU)

Subnotificação e (in)visibilidade da violência contra mulheres na atenção primária à saúde / Primary healthcare and underreporting and (in)visibility of violence against women / Subnotificación e (in)visibilidad de la violencia contra las mujeres en la atención primaria a la salud

Esta pesquisa teve por objetivo mapear indicadores de violências contra mulheres em unidades básicas de saúde de Belo Horizonte, Minas Gerais, Brasil, e identificar as dificuldades experimentadas por profissionais de saúde na notificação de violências. Dados epidemiológicos sobre esse tipo de notificação foram levantados no sistema de informações da Secretaria Municipal de Saúde. Dados qualitativos foram produzidos com questionário semiestruturado e três sessões de grupos focais, com a participação de 270 profissionais da atenção primária à saúde. Os dados foram submetidos à análise de conteúdo, sendo codificados, categorizados e discutidos à luz da revisão de literatura. Um eixo analítico central foi denominado (in)visibilidade da violência contra mulheres. Emergem dos dados tanto o reconhecimento da violência como problema de saúde pública quanto a invisibilidade que impede o seu enfrentamento. Observa-se que a notificação é frequentemente tomada como denúncia, o que dificulta o avanço nas discussões e ações concernentes ao problema.

This study aimed to map indicators of violence against women as recorded by primary healthcare services in Belo Horizonte, Minas Gerais State, Brazil, and to identify difficulties experienced by health professionals in reporting such violence. Epidemiological data on this type of notification were collected in the information system of the Municipal Health Department. Data were produced with a semi-structured questionnaire and three focus group sessions with participation by 270 primary care professionals. The data were submitted to content analysis and were coded, categorized, and discussed in light of a literature review. A central analytical axis was called (in)visibility of violence against women. The data revealed both the recognition of violence as a public health problem and the invisibility that prevents dealing with it properly. Notification of such violence is often viewed as a fuss or commotion, which hampers progress in discussing and acting on the problem.

Esta investigación tiene como objetivo mapear indicadores de violencia contra las mujeres en las unidades básicas de Belo Horizonte, Minas Gerais, Brasil, e identificar las dificultades observadas por los profesionales de sanidad en la notificación de la violencia. Datos epidemiológicos sobre ese tipo de notificación fueron recogidos en el sistema de información de la Secretaría Municipal de Salud. Se consiguieron datos cualitativos mediante un cuestionario semiestructurado y tres sesiones de grupos focales, con la participación de 270 profesionales de atención primaria a la salud. Los datos fueron sometidos a un análisis de contenido, fueron codificados, categorizados y discutidos a la luz de la revisión de la literatura. Un eje analítico central fue denominado (in)visibilidad de la violencia contra las mujeres. Emergen dos datos, tanto el reconocimiento de la violencia como un problema de salud pública, como la invisibilidad que impide su enfrentamiento. Se observa que la notificación es frecuentemente entendida como denuncia, lo que dificulta el avance en las discusiones y acciones concernientes al problema.

É muito dificultoso: etnografia dos cuidados a pacientes com hipertensão e/ou diabetes na atenção básica, em Manaus, Amazonas, Brasil / It sure ain't easy: an ethnographic study of primary health care for patients with hypertension and/or diabetes in Manaus, Amazonas State, Brazil

O texto analisa os resultados de pesquisa avaliativa da Atenção Básica à Saúde do paciente com hipertensão e/ou diabetes em Manaus, Amazonas, Brasil. A abordagem etnográfica utilizou, como categorias analíticas centrais, o acesso aos serviços e a integralidade do cuidado, comparando-se as práticas sanitárias desenvolvidas em unidade do Programa Saúde da Família (PSF) e em unidade básica de saúde não-PSF. A facilitação do acesso à unidade de saúde da família implantada em comunidade carente é limitada pela precariedade de infra-estrutura urbana do seu entorno. A unidade básica de saúde tem, nas grandes distâncias, a sua principal barreira de acesso. A inexistência de sistema de referência entre os distintos níveis de complexidade compromete o acesso dos pacientes a exames e especialistas. O cuidado oferecido nas duas unidades é restrito às queixas físicas passíveis de abordagem farmacológica, comprometendo a integralidade. Há baixa capacidade de escuta dos profissionais para problemas distintos do foco da ação programática. Destacam-se as potencialidades da utilização da etnografia na pesquisa avaliativa de sistemas e serviços de saúde.

This paper analyzes the results of an evaluative study in the city of Manaus, Amazonas State, Brazil, on primary health care for patients with hypertension and/or diabetes. The ethnographic approach used access to services and comprehensiveness of health care as core analytical categories, comparing the health practices developed by Family Health Program (FHP) units with traditional non-FHP primary care units. Access to family health care units in low-income communities is limited by the precarious surrounding urban infrastructure. The main barrier to access to primary care units is distance. The lack of a referral system between the various levels of complexity jeopardizes patients' access to tests and specialists. The care supplied by the two units is limited to patient conditions that can be treated pharmacologically, thus compromising the comprehensiveness of care. The health professionals display a limited capacity to hear problems outside the immediate focus of the program activity. The paper highlights the potential for using ethnography in evaluative research on health systems and services.

Acesso e acolhimento na atenção básica: uma análise da percepção dos usuários e profissionais de saúde / Primary health care access and receptivity to users: an analysis of perceptions by users and health professionals

Este artigo é parte da pesquisa avaliativa do Projeto de Expansão e Consolidação da Estratégia Saúde da Família, desenvolvida pelo Núcleo de Estudos em Saúde Coletiva da Universidade Federal do Rio Grande do Norte entre março e dezembro de 2005. Trata-se de avaliação de acesso e acolhimento na atenção básica, a partir de percepções de usuários e profissionais de saúde de unidades básicas de saúde e unidades de saúde da família, em três capitais do Nordeste brasileiro. Foi utilizada técnica de grupo focal com análise temática. Nos resultados, identificou-se ampliação do acesso, com desproporções entre oferta potencial, atendimento à demanda e dificuldades de referência. O acolhimento como tecnologia operacional é um processo em construção, variando nas unidades de saúde da família em níveis de concepção e estratégias de reorganização cotidiana do trabalho, e inexistente nas unidades básicas de saúde. A partir da realização deste estudo, recomenda-se incluir análises qualitativas em avaliação em saúde, por possibilitar maior valor explicativo aos aspectos subjetivos dos atores envolvidos.

This article is part of the evaluation study on the Project for Expansion and Consolidation of the Family Health Strategy, conducted by the Center for Public Health Research at the Federal University in Rio Grande do Norte, Brazil, from March to December 2005. The study presents an assessment of primary health care access and receptivity from the perspective of patients and health professionals, comparing traditional primary care units and family health units in three State capitals in Northeast Brazil. The methodology included focus groups with content analysis. The results identified increased access, but there is still a disproportion between potential supply, capacity to meet the demand, and difficulties with referral in both the family health units and traditional primary care units. As an operational technology, receptivity is still under construction in the family health units, with varying levels of adherence to both the concept and the strategies for reorganizing daily work practices. Meanwhile, receptivity is totally absent from the traditional primary care units. The study suggests that qualitative analyses be included in health assessment in order to better explain the subjective aspects of the various actors.

A atenção primária à saúde e o Programa de Saúde da Família: perspectivas de desenvolvimento no início do terceiro milênio

O artigo discute o potencial e os limites do programa de Saúde da Família (PSF) como estratégia e opção política para a reestruturação do Sistema Único de Saúde no Brasil, à luz dos conceitos e do desenvolvimento histórico da Atenção Primária a Saúde (APS). O autor aponta a necessidade de se superarem os obstáculos da política de focalização em cuidados básicos e seletivos, bem como de se investir na formação de recursos humanos para que o programa atinja seus propósitos.

This article discusses the Brazilian Family Heath Program potencial and limitacions as an strategy and political option to reshape the public heath system. it takes, as a starting pont, the historical evolution and definition of Primary Health Care,. The author concludes for the necessity to overcomo the focus in basic, selectives actions turned to the poorest and to invest in the development of personel, as essential conditions to Health Family strategies succeed.