Disfunção sexual em mulheres na atenção primária de Florianópolis: um estudo transversal / Sexual dysfunction in women in primary health care in Florianópolis, Brazil: a cross-sectional study / Disfunción sexual en mujeres en atención primaria en Florianópolis: un estudio transversal

Introdução: A disfunção sexual é mais frequente entre as mulheres, com prevalências entre 25 e 63% naquelas acima de 18 anos. Por meio do questionário Female Sexual Function Index, este estudo busca estimar a frequência de disfunções sexuais em mulheres adultas de duas Equipes de Saúde da Família em Florianópolis, Santa Catarina. Objetivo: O objetivo deste estudo é avaliar a prevalência de disfunção sexual feminina (DSF) nessas populações e investigar a relação entre variáveis sociodemográficas e os domínios representados no escore FSFI. Métodos: Utilizamos o questionário FSFI para avaliar a frequência de disfunções sexuais e realizamos uma análise das variáveis sociodemográficas entre as unidades de saúde. Foram incluídas mulheres adultas atendidas em duas Equipes de Saúde da Família em Florianópolis. Resultados: A prevalência geral de DSF encontrada foi de 67,8%, com uma distribuição homogênea entre as diferentes unidades de saúde e variáveis sociodemográficas. Observamos associações entre anos de estudo e maiores índices de DSF, especialmente nos domínios de desejo, excitação e lubrificação, e entre maior idade e melhor desempenho nos domínios de desejo e excitação. Conclusões: A alta prevalência de distúrbios sexuais femininos em Florianópolis, distribuída de maneira homogênea entre as variáveis sociodemográficas estudadas, destaca a importância da capacitação dos profissionais de saúde na abordagem dessas questões na Atenção Primária

Introduction: Sexual dysfunction is more common among women, with prevalence ranging from 25 to 63% in those over 18 years of age. Through the Female Sexual Function Index (FSFI) questionnaire, in this study we aim to estimate the frequency of sexual dysfunctions in adult women from two Family Health Teams in Florianópolis, state of Santa Catarina, Brazil. Objective: The objective of this study is to evaluate the prevalence of female sexual dysfunction (FSD) in these populations and investigate the relationship between sociodemographic variables and the domains represented in the FSFI score. Methods: The FSFI questionnaire was used to assess the frequency of sexual dysfunctions, and an analysis of sociodemographic variables among the health units was performed. Adult women seen at two Family Health Teams in Florianópolis were included. Results: The overall prevalence of FSD was 67.8%, with a homogeneous distribution among different health units and sociodemographic variables. We observed associations between years of formal education and higher rates of FSD, especially in the domains of desire, arousal, and lubrication, and between older age and better performance in the domains of desire and arousal. Conclusions: The high prevalence of female sexual disorders in Florianópolis, homogeneously distributed among the sociodemographic variables studied, underscores the importance of training healthcare professionals in addressing these issues in Primary Health Care.

Introducción: La disfunción sexual es más común entre las mujeres, con prevalencias que oscilan entre el 25 y el 63% en aquellas mayores de 18 años. A través del cuestionario del Índice de Función Sexual Femenina (FSFI, por sus siglas en inglés), este estudio tiene como objetivo estimar la frecuencia de disfunciones sexuales en mujeres adultas de dos Equipos de Salud Familiar en Florianópolis, Santa Catarina. Objetivo: El objetivo de este estudio es evaluar la prevalencia de la disfunción sexual femenina (DSF) en estas poblaciones e investigar la relación entre variables sociodemográficas y los dominios representados en la puntuación FSFI. Métodos: Utilizamos el cuestionario FSFI para evaluar la frecuencia de disfunciones sexuales y realizamos un análisis de variables sociodemográficas entre las unidades de salud. Se incluyeron mujeres adultas atendidas en dos Equipos de Salud Familiar en Florianópolis. Resultados: La prevalencia general de DSF fue del 67.8%, con una distribución homogénea entre diferentes unidades de salud y variables sociodemográficas. Observamos asociaciones entre años de estudio y mayores índices de DSF, especialmente en los dominios de deseo, excitación y lubricación, y entre mayor edad y mejor desempeño en los dominios de deseo y excitación. Conclusiones: La alta prevalencia de trastornos sexuales femeninos en Florianópolis, distribuida homogéneamente entre las variables sociodemográficas estudiadas, subraya la importancia de capacitar a los profesionales de la salud en abordar estas cuestiones en la Atención Primaria.

Rates of adverse events of antiretroviral therapy in women living with HIV/AIDS: a systematic review and meta-analysis.

OBJECTIVE: There is limited information regarding the incidence of treatment-related adverse events (AE) following antiretroviral therapy (ART) in women. So, this review aimed to describe the incidence of AE of ART in women living with HIV/AIDS. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, Cochrane Library, Epistemonikos, Lilacs and Who Index, from inception to 9 April 2023. ELIGIBILITY CRITERIA: We included randomised controlled trials with at least 12 weeks of follow-up and evaluated AE of ART in women at any age living with HIV/AIDS, without restrictions on status, year or language of publication. We excluded post hoc or secondary analyses and open-label extensions without comparator, and trials involving pregnant or breastfeeding women or with a focus on coinfection with tuberculosis, hepatitis B or C. The primary outcomes were the incidence rate of participants with any clinical and/or laboratory AE related or not to ART and treatment discontinuation. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed the risk of bias using Cochrane's risk of bias tool 2. We used Bayesian random-effects meta-analysis to summarise event rates. Results were presented as event rates per 1000 person-years (95% credibility intervals, 95% CrI). The pooled incidence rate per 1000 person-years adjusted for duration and loss to follow-up was estimated. We assessed the certainty of the evidence using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS: A total of 24 339 studies were identified for screening, of which 10 studies (2871 women) met the eligibility criteria, with 11 different antiretrovirals (ARVs) regimens. Seven studies included exclusively women, while in the remaining three, the proportion of women ranged from 11% to 46%. Nine studies received industry funding. The pooled analysis showed a mean incidence rate of ART-related clinical and laboratory AE of 341.60 events per 1000 person-years (95% CrI 133.60-862.70), treatment discontinuation of 20.78 events per 1000 person-years (95% CrI 5.58-57.31) and ART-related discontinuation of 4.31 per 1000 person-years (95% CrI 0.13-54.72). Summary estimates were subject to significant uncertainty due to the limited number of studies and sparse data. The certainty of the evidence was graded as very low for all outcomes assessed. CONCLUSION: Existing randomised trials do not provide sufficient evidence on the incidence rates of safety outcomes from antiretroviral treatment in women living with HIV/AIDS. Large comparative studies in well-characterised populations are needed to provide a more comprehensive landscape of the safety profile of these ARV therapies in women with HIV/AIDS. PROSPERO REGISTRATION NUMBER: CRD42021251051.

Teleconsulta por médicos e enfermeiros da Atenção Primária de Florianópolis durante a pandemia de Covid-19: um estudo retrospectivo / Teleconsultations by doctors and nurses from Primary Care in Florianópolis during the Covid-19 pandemic: a retrospective study

Introdução: As teleconsultas só foram permitidas pelos conselhos de classe no Brasil após o início da pandemia de Covid-19. A Atenção Primária (AP) de Florianópolis reunia as condições necessárias para realizar teleconsultas e foi a primeira capital a adotar esse modelo de atendimento em grande escala. Objetivo: Comparar as condições de atendimento e as características dos profissionais de saúde nas consultas realizadas na AP de Florianópolis por médicos e enfermeiros entre as teleconsultas e consultas presenciais. Metodologia: Estudo retrospectivo com todas as consultas realizadas por médicos e enfermeiros da AP no período de 15/04/2020 a 27/07/2020. Resultados: Analisamos 225.507 consultas realizadas por 436 médicos e enfermeiros. Profissionais, médicos e enfermeiros, que realizaram ao menos uma teleconsulta apresentaram maiores números de consultas, tempo médio de consulta pouco maior, bem como média de encaminhamentos e de exames solicitados por consulta discretamente maiores. Porém, as teleconsultas foram mais rápidas, tiveram menos exames solicitados, medicamentos prescritos e encaminhamentos realizados. As condições menos avaliadas por teleconsulta foram: rastreamento de câncer de colo uterino, cerume impactado, amigdalite e puericultura. As condições mais avaliadas, por médicos e enfermeiros, nas teleconsultas foram: hipotireoidismo, dispepsia, contracepção e dor não classificados. Conclusões: A teleconsulta é uma ferramenta útil para realização de atendimentos na AP e permite o atendimento de uma ampla gama de condições. É importante a realização de estudos dessa tecnologia neste período de exceção para embasar decisões futuras quando a sua manutenção após a pandemia (AU).

Introduction: Teleconsultations were only allowed by class councils in Brazil after the start of the Covid-19 pandemic. The Primary Care (PC) of Florianópolis met the conditions to make teleconsultations and was the first capital to adopt this model of assistance on a large scale. Objective: Compare the conditions of care and the characteristics of health professionals in consultations held at the Florianópolis PC by doctors and nurses between teleconsultations and face-to-face consultations. Methodology: Retrospective study with all consultations carried out by doctors and nurses of the PC from 04/15/2020 to 07/27/2020. Results: We analyzed 225,507 consultations performed by 436 doctors and nurses. Professionals, doctors and nurses, who performed at least one teleconsultation had a higher number of consultations, a slightly longer average consultation time, as well as a slightly higher average number of referrals and tests requested per consultation. Teleconsultations were faster, had fewer tests requested, medications prescribed and referrals made. The conditions least evaluated by teleconsultation were: cervical cancer screening, impacted cerumen, tonsillitis and childcare. The conditions most evaluated by doctors and nurses in teleconsultations were: hypothyroidism, dyspepsia, contraception and unclassified pain. Conclusions: Teleconsultation is a useful tool for providing care in the PC and allows the care of a wide range of conditions. It is important to carry out studies of this technology in this period of exception to support future decisions when maintaining it after the pandemic (AU).

Sex differences and adverse events of antiretrovirals in people living with HIV/AIDS: a systematic review and meta-analysis protocol.

INTRODUCTION: Antiretroviral therapy (ART) for HIV/AIDS is associated with adverse events (AEs). However, little is known about the differences in the risk of AEs between women and men living with HIV/AIDS. This study aims to determine (1) whether there are sex differences in the risk of AEs in people with HIV/AIDS treated with ART and (2) the prevalence of AEs to the reproductive system and bone mineral density in women. METHODS AND ANALYSIS: This systematic review (SR) will include randomised trials evaluating ART in people living with HIV/AIDS with at least 12 weeks of duration follow-up. Searches will be conducted in Medline, Embase, Cochrane Library, Epistemonikos, Lilacs, trial registries and grey literature databases, without restriction on publication status, year of publication and language. The primary outcome will be the risk of ART discontinuation or drop-outs/withdrawals of ART due to AEs and the number of any treatment-emergent AE. The secondary outcomes are the incidence of serious clinic or laboratory (grade 3 and/or 4) treatment-emergent AEs, hospitalisation, death and AEs specific to the reproductive system and bone mineral density (osteoporosis, osteopenia and fractures) of women. Selection, data extraction and quality assessment will be performed by pairs of reviewers. Cochrane collaboration tools will be used to assess the risk of bias. If appropriate, a meta-analysis will be conducted to synthesise results. The overall quality of the evidence for each outcome will be determined by the Grades of Recommendation, Assessment, Development and Evaluation. ETHICS AND DISSEMINATION: The results of this SR will assist the formulation of public policies aimed at the management and monitoring of AEs of ART in people living with HIV/AIDS. A deliberative dialogue will be scheduled with the Department of Chronic Conditions and Sexually Transmitted Infections of Brazil's Ministry of Health to align the project with policymakers' interests. PROSPERO REGISTRATION NUMBER: CRD42021251051.

A utilização da atenção primária à saúde por imigrantes em Florianópolis / The use of primary health care by immigrants in Florianopolis / La utilización de la atención primaria a la salud por inmigrantes en Florianópolis

Objetivo: Conhecer o perfil do imigrante que utiliza a atenção primária de Florianópolis. Métodos: Estudo transversal de base populacional com dados cadastrais de estrangeiros moradores de Florianópolis, que utilizaram a Atenção Primária à Saúde entre os anos de 2014 e 2016. As variáveis utilizadas foram: nacionalidade, sexo, idade, nível de escolaridade, raça, endereço de moradia e tipos de serviços utilizados. Resultados: Um total de 10.108 estrangeiros utilizaram a atenção básica em Florianópolis no período do estudo, com predomínio de adultos, brancos, com ensino médio ou superior, predominância de argentinos, uruguaios e haitianos, utilizando predominantemente serviços da farmácia e consultas médicas, distribuídos em todas unidades de saúde da capital. Houve maior nível de escolaridade e maior proporção de crianças e idosos na população provinda de países desenvolvidos, além de uma menor utilização dos serviços. Discussão: Estudo pioneiro no Brasil. O perfil dos imigrantes estudados é comparável à população de estudos europeus, com predomínio de latino-americanos e caribenhos, com faixa etária prevalecendo população economicamente ativa, utilizando consultas médicas e com alta escolaridade entre imigrantes de países desenvolvidos.

Objective: To know the immigrant's profile who use primary care in Florianopolis. Methods: Cross-sectional populational-based study with register data from foreigners who used Primary Health Care in Florianopolis between 2014 and 2016. The variables were nationality, sex, age, level of education, race and service used. Results: A total of 10,108 immigrants accessed primary care in Florianopolis during the study period, with a predominance profile of adults, Caucasian, with medium/high level of education, Latin Americans, mainly using pharmacy and medical consultations, distributed in all primary care units at Florianopolis. We observed a higher level of schooling and a greater proportion of children and elderly people in the population coming from developed countries, in addition to a lower use of services. Discussion: The profile of immigrants in the study population is comparable to the immigrant population in some European studies, with a predominance of Latin Americans and Caribbean, with a high frequency of economically active age group, using medical consultations and high education among immigrants from developed countries.

Objetivo: Conocer el perfil del inmigrante que utiliza la atención primaria a la salud de Florianópolis. Métodos: Estudio transversal de base poblacional con datos de registro de extranjeros que utilizaron la Atención Primaria a la Salud de Florianópolis entre los años 2014 y 2016. Las variables utilizadas fueron: nacionalidad, sexo, edad, nivel de escolaridad, raza, dirección de vivienda y residencia tipos de servicios utilizados. Resultados: Total de 10.108 inmigrantes utilizaron la atención básica en Florianópolis en el período del estudio, con un perfil de predominio de adultos, blancos, con enseñanza media o superior de escolaridad, predominio de argentinos, uruguayos y haitianos, utilizando predominantemente servicios de la farmacia y consultas médicos, distribuidos en todas las unidades de salud de la capital. Se observó un mayor nivel de escolaridad y mayor proporción de niños y ancianos en la población proveniente de países desarrollados, además de una menor utilización de los servicios. Discusión: Estudio pionero en Brasil, el perfil de los inmigrantes en la población del estudio es comparable a la población de estudios europeos, con predominio de latinoamericanos y caribeños, con rango de edad prevaleciendo población económicamente activa, utilizando consultas médicas y con alta escolaridad entre inmigrantes de países desarrollados.

Condutas em Atenção Primária: desenvolvendo um sumário online, em português, de prática clínica baseada em evidências / Condutas em Atenção Primária: developing an online evidence-based clinical practice summary in Portuguese / Condutas em Atenção Primária: desarrollo de un sumario en línea, en portugués, de la práctica clínica basada en evidencias

Introdução: Embora existam internacionalmente diversos sumários online baseados em evidências, a maioria é de língua inglesa, pago ou com restrições de acesso internacional. Desta forma, estamos desenvolvendo um sumário de prática clínica baseado em evidências, em português, gratuito, transparente e livre de insumos da indústria farmacêutica. Métodos: Selecionamos 28 tópicos para a primeira fase do projeto. Estes tópicos compõem problemas que abrangem 50% da demanda em atenção primária, são desenvolvidos sob a metodologia de revisões rápidas e submetidos à revisão por pares. A busca por evidência é realizada de forma discricionária, dando preferência às revisões sistemáticas. O website é financiado pelos autores, os quais não possuem conflitos de interesse. O conteúdo do site está sob licença Creative Commons BY-NC-SA. Resultados: Criamos um manual para o desenvolvimento dos tópicos e o site www.condutas.com.br está disponível para acesso, com três tópicos desenvolvidos: resfriado comum, hipertensão arterial e pré-natal. Conclusão: O Condutas em Atenção Primária possui qualidade editorial e metodologia baseada em evidências adequada, se comparada a outros sumários online, o que é um avanço para a prática clínica nacional. Seu perfil inovador democratiza o acesso a informações atuais, consistentes e diversas, antes restritas ao leitor de língua inglesa, contudo, ao mesmo tempo enfrenta as limitações por seu pioneirismo e inerente amadorismo.

Introduction: While there are, internationally, several evidence-based online summaries most are English-language, paid or internationally restricted. Thus, we are developing an online evidence-based point-of-care summary, in Portuguese, free of charge, transparent and free of pharmaceutical industry inputs. Methods: We selected 28 topics for the first phase of the project. These topics comprise problems that cover 50% of the demand in primary care, are developed under the methodology of rapid reviews, and are peer reviewed. We conduct the search for evidence in a discretionary manner, giving preference to systematic reviews. The authors, who have no conflicts of interests, fund the website. The content of the site is under Creative Commons BY-NC-SA license. Results: We created a manual for the development of the topics and the website www.condutas.com.br is available for access with three topics developed: resfriado comum (common cold), hipertensão arterial (hypertension) and pré-natal (antenatal care). Conclusion: The Condutas em Atenção Primária has editorial quality and adequate evidence-based methodology, compared to other online summaries, which is an advance for the Brazilian clinical practice. Its innovative profile democratizes access to current, consistent and diverse information previously restricted to the English-language reader, yet, at the same time, it faces the limitations of its pioneering and inherent amateurism.

Introducción: Aunque existan internacionalmente diversos sumarios en línea basados en evidencias, la mayoría es de lengua inglesa, pago o con restricciones de acceso internacional. Así, estamos desarrollando un sumario de medicina basada en evidencias, accesible desde internet, en portugués, gratis, transparente y sin humus industriales. Métodos: Seleccionamos 28 temas para la primera fase del proyecto. Estos temas comprenden problemas que cubren el 50% de la demanda en atención primaria, se desarrollan bajo la metodología de revisiones rápidas y son sometidos a revisión por pares. Llevamos a cabo la búsqueda de pruebas de manera discrecional, dando preferencia a las revisiones sistemáticas. El sitio web es financiado por los autores, que no tienen conflictos de intereses. El contenido del sitio está bajo la licencia Creative Commons BY-NC-SA. Resultados: Creamos un manual para el desarrollo de los temas y el sitio www.condutas.com.br está disponible para el acceso con tres temas desarrollados: resfriado comum (resfriado común), hipertensão arterial (hipertensión arterial) y pré-natal (prenatal). Conclusión: El Condutas em Atenção Primária tiene calidad editorial y metodología basada en evidencias adecuada si se compara a otros sumarios en línea, lo que es un avance a la práctica clínica brasileña. Su perfil innovador democratiza el acceso a informaciones actuales, coherentes y diversas, antes restringidas al lector en idioma inglés, sin embargo, al mismo tiempo enfrenta las limitaciones por su pionerismo e inherente inexperiencia.

Relapse of congenital thrombotic thrombocytopenic purpura, after spontaneous remission, in a second-trimester primigravida: case report and review of the literature / Recidiva, após remissão espontânea, de púrpura trombocitopênica trombótica congênita em primigesta no segundo trimestre de gestação: relato de caso e revisão da literatura

ABSTRACT CONTEXT: Thrombotic microangiopathy syndrome or thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) describes distinct diseases sharing common pathological features: microangiopathic hemolytic anemia and thrombocytopenia, without any other apparent cause. CASE REPORT: An 18-year-old second-trimester primigravida presented with a history of fifteen days of intense weakness, followed by diarrhea over the past six days. She reported having had low platelets since childhood, but said that she had never had bleeding or menstrual abnormalities. Laboratory investigation showed anemia with schistocytes, thrombocytopenia and hypohaptoglobulinemia. Red blood cell concentrate and platelet transfusions were performed. The hypothesis of TTP or HUS was put forward and ADAMTS13 enzyme activity was investigated. The patient evolved with increasing platelet counts, even without specific treatment, and she was discharged. One month afterwards, she returned presenting weakness and swollen face and legs, which had developed one day earlier. The ADAMTS13 activity was less than 5%, without presence of autoantibodies. Regarding the two previous admissions (at 9 and 16 years of age), with similar clinical features, there was spontaneous remission on the first occasion and, on the second, the diagnosis of TTP was suspected and plasmapheresis was performed, but ADAMTS13 activity was not investigated. CONCLUSION: To date, this is the only report of congenital TTP with two spontaneous remissions in the literature This report reveals the importance of suspicion of this condition in the presence of microangiopathic hemolytic anemia and thrombocytopenia without any other apparent cause.

RESUMO CONTEXTO: A síndrome de microangiopatia trombótica, ou púrpura trombocitopênica trombótica-síndrome hemolítico urêmica (PTT-SHU), descreve doenças diversas com clínica e achados patológicos comuns: anemia hemolítica microangiopática e trombocitopenia, na ausência de outra causa aparente. RELATO DO CASO: Primigesta de 18 anos no segundo trimestre apresenta-se com quadro de 15 dias de fraqueza intensa seguida por diarreia há seis dias. Relata ter plaquetas baixas desde a infância e nega sangramentos e anormalidades menstruais. Investigação laboratorial identificou anemia com esquizócitos, plaquetopenia e hipo-haptoglobulinemia. Foi realizada transfusão de plaquetas e concentrado de hemácias. A hipótese de PTT ou SHU foi aventada e realizou-se pesquisa da atividade da enzima ADAMTS13. A paciente evoluiu com elevação das plaquetas, mesmo sem tratamento específico, tendo alta. Retornou após um mês da alta com queixa de fraqueza há um dia e inchaço de face e pernas. A atividade da ADAMTS13 foi menor que 5%, sem autoanticorpos. Nas duas internações anteriores (aos 9 e 16 anos), com quadros similares, houve remissão espontânea na primeira internação e, na segunda, o diagnóstico de PTT foi suspeitado e foi realizada plasmaférese, porém sem a pesquisa da atividade da ADAMTS13. CONCLUSÃO: Até esta data, este é único relato de TTP congênita com duas remissões espontâneas na literatura. Este relato revela a importância da suspeição desta patologia na presença de anemia hemolítica microangiopática e trombocitopenia sem outra causa aparente.

Relapse of congenital thrombotic thrombocytopenic purpura, after spontaneous remission, in a second-trimester primigravida: case report and review of the literature.

CONTEXT: Thrombotic microangiopathy syndrome or thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) describes distinct diseases sharing common pathological features: microangiopathic hemolytic anemia and thrombocytopenia, without any other apparent cause. CASE REPORT: An 18-year-old second-trimester primigravida presented with a history of fifteen days of intense weakness, followed by diarrhea over the past six days. She reported having had low platelets since childhood, but said that she had never had bleeding or menstrual abnormalities. Laboratory investigation showed anemia with schistocytes, thrombocytopenia and hypohaptoglobulinemia. Red blood cell concentrate and platelet transfusions were performed. The hypothesis of TTP or HUS was put forward and ADAMTS13 enzyme activity was investigated. The patient evolved with increasing platelet counts, even without specific treatment, and she was discharged. One month afterwards, she returned presenting weakness and swollen face and legs, which had developed one day earlier. The ADAMTS13 activity was less than 5%, without presence of autoantibodies. Regarding the two previous admissions (at 9 and 16 years of age), with similar clinical features, there was spontaneous remission on the first occasion and, on the second, the diagnosis of TTP was suspected and plasmapheresis was performed, but ADAMTS13 activity was not investigated. CONCLUSION: To date, this is the only report of congenital TTP with two spontaneous remissions in the literature This report reveals the importance of suspicion of this condition in the presence of microangiopathic hemolytic anemia and thrombocytopenia without any other apparent cause.

Expanding health access in the more vulnerable region in the state of São Paulo, Brazil: is this a reflection of the Mais Médicos (More Doctors) Program? / Ampliação do acesso à saúde na região mais vulnerável do estado de São Paulo, Brasil: reflexo do Programa Mais Médicos?

The Mais Médicos (More Doctors) Program seeks to broaden access to health by providing medical professionals, investments in health units and multi-professional integration geared to the Family Health Strategy. Vale do Ribeira includes 25 cities and is among the most vulnerable regions in São Paulo. It has been allocated 41 physicians from the Program. This study is to evaluate access to health, comparing health indicators before and after the Program. We collected data from DATASUS, SIAB, and the Ministry of Health. There was a marked increase in the number of appointments for infants under one year of age, adults, the elderly, STD/HIV patients and group patient care. There was a decrease in appointments outside the catchment area, as well as hospital admissions for other causes, mothers exclusively breastfeeding their infants up to four months. We concluded that after deployment of the Program, there was an increase in health access and health promotion focused on an area that presents an enormous challenge for Primary Health Care (PHC). It would seem that, since this is a high vulnerability area with a large area for care, hospital admissions for PHC care-sensitive conditions, as well as referrals for secondary services, did not decrease.

Ampliação do acesso à saúde na região mais vulnerável do estado de São Paulo, Brasil: reflexo do Programa Mais Médicos? / Expanding health access in the more vulnerable region in the state of São Paulo, Brazil: is this a reflection of the Mais Médicos (More Doctors) Program?

Resumo O Programa Mais Médicos visa ampliar o acesso à saúde em áreas provendo profissionais médicos, investimentos nas unidades de saúde e integração multiprofissional voltada à Estratégia de Saúde da Família. O Vale do Ribeira abriga 25 municípios e figura entre as regiões mais vulneráveis do estado e recebeu 41 médicos do PMM. O objetivo deste estudo é avaliar o acesso à saúde, comparando indicadores de produção, marcadores e situação de saúde antes e depois da implementação do PMM. Foram coletados dados do DATASUS, SIAB e Ministério da Saúde. Houve aumento em número de consultas de crianças menores de um ano, adultos, idosos, DST/AIDS e atendimento em grupos. Houve redução no número de consultas fora de área de abrangência, de hospitalizações por outras causas e no aleitamento materno exclusivo até quatro meses. Concluímos que após a implementação do programa houve melhora no acesso à saúde e no trabalho de promoção de saúde focado no território, um grande desafio na Atenção Primária à Saúde (APS). Supõe-se que por se tratar de área de alta vulnerabilidade e pressão assistencial, as internações por causas sensíveis à APS, assim como o encaminhamento aos serviços secundários, não tenham sido reduzidas a curto prazo.

Abstract The Mais Médicos (More Doctors) Program seeks to broaden access to health by providing medical professionals, investments in health units and multi-professional integration geared to the Family Health Strategy. Vale do Ribeira includes 25 cities and is among the most vulnerable regions in São Paulo. It has been allocated 41 physicians from the Program. This study is to evaluate access to health, comparing health indicators before and after the Program. We collected data from DATASUS, SIAB, and the Ministry of Health. There was a marked increase in the number of appointments for infants under one year of age, adults, the elderly, STD/HIV patients and group patient care. There was a decrease in appointments outside the catchment area, as well as hospital admissions for other causes, mothers exclusively breastfeeding their infants up to four months. We concluded that after deployment of the Program, there was an increase in health access and health promotion focused on an area that presents an enormous challenge for Primary Health Care (PHC). It would seem that, since this is a high vulnerability area with a large area for care, hospital admissions for PHC care-sensitive conditions, as well as referrals for secondary services, did not decrease.