Demographic, social, and clinical aspects associated with access to COVID-19 health care in Pará province, Brazilian Amazon.

Internal social disparities in the Brazilian Amazon became more evident during the COVID-19 pandemic. The aim of this work was to examine the demographic, social and clinical factors associated with access to COVID-19 health care in Pará Province in the Brazilian Amazon. This was an observational, cross-sectional, analytical study using a quantitative method through an online survey conducted from May to August 2023. People were eligible to participate if they were current residents of Pará, 18-years-old or older, with self-reported diagnoses of COVID-19 through rapid or laboratory tests. Participants completed an electronic survey was developed using Research Electronic Data Capture (REDCap) software-The adapted questionnaire "COVID-19 Global Clinical Platform: Case Report Form for Post-COVID Condition". Questions focused on access to COVID-19 treatment, demographic characteristics, COVID-19 vaccine and clinical characteristics. Respondent-driven sampling was applied to recruit participants. Multiple logistic regression was utilized to identify the associated factors. Overall, a total of 638 participants were included. The average age was 31.1 years. Access to COVID-19 health care was 68.65% (438/638). The participants most likely to access health care were those with moderate or severe COVID-19 (p = 0.000; OR: 19.8) and females (p = 0.001; OR: 1.99). Moreover, participants who used homemade tea or herbal medicines were less likely to receive health care for COVID-19 in health services (p = 0.002; OR: 0.54). Ensuring access to healthcare is important in a pandemic scenario.

Práticas de Enfermagem na Coordenação do Cuidado na Atenção Primária à Saúde / Nursing Practices In Coordination Care In Primary Health Care / Prácticas de Enfermería Coordinación Del Cuidado En La Atención Primaria da Salud

Objetivo: analisar as características das equipes e as práticas associadas ao acompanhamento e coordenação do cuidado no Pará e compreender como ocorre essa prática executada pelo enfermeiro como membro da equipe na Atenção Primária à Saúde. Métodos: estudo de métodos mistos. Os participantes foram enfermeiros da atenção básica do Pará. A coleta ocorreu entre novembro de 2019 a agosto de 2021, através de um formulário eletrônico e entrevista. A análise integrativa dos dados foi feita pela conexão dos métodos qualitativos e quantitativos. Resultados: A proporção de enfermeiros que acompanha e coordena os usuários que estão em uso de outros serviços foi de 50% (90/180). Houve associação significativa (p <0,05) entre o acompanhamento e coordenação do cuidado e o tipo de equipe, carga horária de trabalho, regulação das demandas locais na perspectiva da rede, articulação com profissionais de saúde de outros níveis de atenção, trabalhos com profissionais de outras formações e a condução da clínica ampliada/ matriciamento. As categorias temáticas "relação da Atenção Primária à Saúde com a rede de atenção" e "práticas de coordenação e continuidade do cuidado horizontal e vertical" apresentaram convergência com os dados quantitativos e a categoria temática "Práticas de coordenação do cuidado sob a forma do trabalho em equipe" converge com os dados quantitativos, mas divergem no apoio matricial. Conclusão: Os enfermeiros realizam o acompanhamento e coordenação do cuidado, porém enfrentam dificuldades que resultam em sobrecarga e realização de atribuições que não são da categoria profissional. (AU)

Objective: to analyze the characteristics of the teams and the practices associated with the monitoring and coordination of care in Pará and to understand how this practice is carried out by the nurse as a member of the team in Primary Health Care. Methods: study of mixed methods. The participants were primary care nurses in Pará. The collection took place between November 2019 and August 2021, through an electronic form and interview. The integrative data analysis was performed by connecting qualitative and quantitative methods. Results: The proportion of nurses who monitor and coordinate users who are using other services was 50% (90/180). There was a significant association (p <0.05) between monitoring and coordination of care and the type of team, workload, regulation of local demands from the perspective of the network, articulation with health professionals from other levels of care, work with professionals from other backgrounds and conducting the expanded clinic/matrix support. The thematic categories "relationship between Primary Health Care and the care network" and "practices of coordination and continuity of horizontal and vertical care" showed convergence with the quantitative data and the thematic category "Practices of coordination of care in the form of work in a team" converges with the quantitative data, but differs in matrix support. Conclusion: Nurses carry out monitoring and coordination of care, but they face difficulties that result in overload and carrying out tasks that are not of the professional category. (AU)

Objetivo: analizar las características de los equipos y las prácticas asociadas al seguimiento y coordinación del cuidado en Pará y comprender cómo esa práctica es realizada por el enfermero como miembro del equipo en la Atención Primaria de Salud. Métodos: estudio de métodos mixtos. Los participantes eran enfermeros de atención primaria de Pará. La recolección se realizó entre noviembre de 2019 y agosto de 2021, a través de formulario electrónico y entrevista. El análisis integrador de datos se realizó conectando métodos cualitativos y cuantitativos. Resultados: La proporción de enfermeros que acompañan y coordinan usuarios que utilizan otros servicios fue del 50% (90/180). Hubo asociación significativa (p<0,05) entre el seguimiento y coordinación de la atención y el tipo de equipo, carga de trabajo, regulación de las demandas locales desde la perspectiva de la red, articulación con profesionales de salud de otros niveles de atención, trabajo con profesionales de otros antecedentes y dirigiendo el apoyo clínico/matriz ampliado. Las categorías temáticas "relación entre la Atención Primaria de Salud y la red de atención" y "prácticas de coordinación y continuidad del cuidado horizontal y vertical" mostraron convergencia con los datos cuantitativos y la categoría temática "Prácticas de coordinación del cuidado en la forma de trabajo en un team" converge con los datos cuantitativos, pero difiere en el soporte de la matriz. Conclusión: Los enfermeros realizan seguimiento y coordinación de los cuidados, pero enfrentan dificultades que resultan en sobrecarga y realización de tareas que no son de categoría profesional. (AU)

Práticas coletivas e individuais associadas à dificuldade dos enfermeiros da atenção primária à saúde / Collective and individual practices associated with the difficulty of primary health care nurses / Prácticas coletivas e individuais asociadas a la dificultad de las enfermeras de atención primaria de salud

Objetivo: analisar as práticas individuais e coletivas que estão associadas as dificuldades dos enfermeiros que atuam na Atenção Primária à Saúde da região Norte. Métodos: observacional de prevalência e analítico. Foram incluídos enfermeiros da atenção básica. A coleta ocorreu entre novembro de 2019 a agosto de 2021, nos sete estados do Norte, através de um formulário eletrônico, analisados pelos testes binomial, quiquadrado e G no programa Bioestat. Resultados: Entre os 626 enfermeiros do estudo, 15,7% (98/626) afirmaram ter dificuldade no exercício de suas práticas, quanto à autonomia das suas responsabilidades normativas legais. O Amapá teve menor proporção (8,3%; 9/108) de enfermeiros com dificuldade em relação a região. As práticas associadas a dificuldade foram: a não participação do enfermeiro no gerenciamento dos insumos (p=0,03), realizar consulta eventualmente (p=0,03) e nunca prescrever medicamentos (p=0,02); resolutividade insuficiente na consulta pré-natal (p=0,000), acompanhamento de crescimento e desenvolvimento infantil (p=0,001); planejamento familiar (p=0,000); hanseníase (p=0,005); tuberculose (p=0,031); hipertensão arterial (p<0,0001); diabetes (p<0,0001). Conclusão: As dificuldades quanto à autonomia das responsabilidades normativas legais estão associadas a práticas individuais e coletivas que são privativas do enfermeiro e estão regulamentadas nos programas de saúde pública. (AU)

Objective: to analyze the individual and collective practices that are associated with the difficulties of nurses who work in Primary Health Care in the North region. Methods: observational of prevalence and analytical. Primary care nurses were included. The collection took place between November 2019 and August 2021, in the seven states of the North, through an electronic form, analyzed by the binomial, chi-square and G tests in the Bioestat program. Results: Among the 626 nurses in the study, 15.7% (98/626) stated that they had difficulty in exercising their practices, regarding the autonomy of their legal normative responsibilities. Amapá had a lower proportion (8.3%; 9/108) of nurses with difficulties in relation to the region. The practices associated with the difficulty were: the non-participation of nurses in the management of supplies (p=0.03), occasional consultations (p=0.03) and never prescribing medication (p=0.02); insufficient resolution in the prenatal consultation (p=0.000), monitoring of child growth and development (p=0.001); family planning (p=0.000); leprosy (p=0.005); tuberculosis (p=0.031); arterial hypertension (p<0.0001); diabetes (p<0.0001). Conclusion: Difficulties regarding the autonomy of legal normative responsibilities are associated with individual and collective practices that are exclusive to nurses and are regulated in public health programs. (AU)

Objetivo: analizar las prácticas individuales y colectivas que están asociadas a las dificultades de los enfermeros que actúan en la Atención Primaria de Salud de la región Norte. Métodos: observacional de prevalencia y analítico. Se incluyeron enfermeras de atención primaria. La colecta se realizó entre noviembre de 2019 y agosto de 2021, en los siete estados del Norte, a través de un formulario electrónico, analizado por las pruebas binomial, chi-cuadrado y G en el programa Bioestat. Resultados: Entre los 626 enfermeros del estudio, 15,7% (98/626) afirmaron tener dificultad en el ejercicio de sus prácticas, en cuanto a la autonomía de sus responsabilidades normativas legales. Amapá tuvo menor proporción (8,3%; 9/108) de enfermeros con dificultades en relación a la región. Las prácticas asociadas a la dificultad fueron: la no participación de los enfermeros en la gestión de los insumos (p=0,03), consultas ocasionales (p=0,03) y nunca recetar medicamentos (p=0,02); resolución insuficiente en la consulta prenatal (p=0,000), seguimiento del crecimiento y desarrollo infantil (p=0,001); planificación familiar (p=0,000); lepra (p=0,005); tuberculosis (p=0,031); hipertensión arterial (p<0,0001); diabetes (p<0,0001). Conclusión: Las dificultades en cuanto a la autonomía de las responsabilidades normativas legales están asociadas a las prácticas individuales y colectivas, exclusivas de los enfermeros y reguladas em los programas de salud pública. (AU)

Autonomia do enfermeiro no exercício das práticas de enfermagem na atenção primária à saúde / Nurses autonomy in the exercise of nursing practices in primary health care / Autonomía de las enfermeras en el ejercicio de las prácticas de enfermería en la atención primaria de salud

Objetivo: Compreender a autonomia do enfermeiro quanto as suas responsabilidades normativas legais no exercício das práticas de enfermagem na Atenção Primária à Saúde (APS) do Pará. Métodos: Estudo observacional, de delineamento transversal qualitativo, realizado em três municípios do estado do Pará. A coleta de dados foi realizada de outubro de 2020 a janeiro de 2021. Os participantes foram os enfermeiros da Atenção Primária à Saúde. Foi realizada entrevista, com roteiro semiestruturado. Foi realizada análise temática dos conteúdos, com auxílio da ferramenta IRaMuTeq Resultados: Emergiram cinco categorias temáticas: 1) Autonomia do enfermeiro no contexto da prescrição de outro profissional na APS; 2) Autonomia para prescrição nos programas e exames na APS; 3) Áreas de identificação da autonomia profissional na APS; 4) As práticas preventivas na APS e suas dificuldades; e 5) Limites da prática profissional do enfermeiro na APS. Conclusão: Os enfermeiros da APS do Pará têm práticas de enfermagem individuais com diferentes tipos de autonomia, cujos cuidados colocam em prática com o respaldo dos protocolos e regulamentos técnicos. Contudo, há necessidade de ampliar e fortalecer parcerias com outros atores sociais municipais. (AU)

Objective: To understand the autonomy of nurses regarding their legal regulatory responsibilities in the exercise of nursing practices in Primary Health Care (PHC) in Pará. Methods: Observational study with qualitative cross-sectional design, conducted in three municipalities of the state of Pará. Data collection was carried out from October 2020 to January 2021. The participants were Primary Health Care nurses. Interviews were conducted, with a semi-structured script. A thematic analysis of the contents was performed, with the help of the IRaMuTeq tool. Results: Five thematic categories emerged: 1) Nurses' autonomy in the context of another professional's prescription in PHC; 2) Autonomy for prescription in programs and exams in PHC; 3) Areas of identification of professional autonomy in PHC; 4) Preventive practices in PHC and their difficulties; and 5) Limits of nurses' professional practice in PHC. Conclusion: PHC nurses in Pará have individual nursing practices with different types of autonomy, whose care they put into practice with the support of protocols and technical regulations. However, there is a need to expand and strengthen partnerships with other municipal social actors. (AU)

Objetivo: Comprender la autonomía de los enfermeros en cuanto a sus responsabilidades normativas legales en el ejercicio de las prácticas de enfermería en la Atención Básica a la Salud (APS) en Pará. Métodos: Estudio observacional, con diseño transversal cualitativo, realizado en tres municipios del estado de Pará. La recolección de datos se realizó de octubre de 2020 a enero de 2021. Los participantes fueron enfermeros de la Atención Primaria de Salud. Se realizó una entrevista, con un guión semiestructurado. Se realizó un análisis temático de dos contenidos, con la ayuda de la herramienta IRaMuTeq. Resultados: Emergieron cinco categorías temáticas: 1) Autonomía del enfermero en el contexto de la prescripción de otro profesional en la APS; 2) Autonomía para prescribir programas y exámenes en la APS; 3) Áreas de identificación de la autonomía profesional en APS; 4) Prácticas preventivas en APS y sus dificultades; y 5) Límites del ejercicio profesional de enfermería en la APS. Conclusión: Los enfermeros de la APS de Pará tienen prácticas de enfermería individuales con diferentes tipos de autonomía, cuyo cuidado está sustentado por dos protocolos y normas técnicas. Sin embargo, existe la necesidad de ampliar y fortalecer las alianzas con otros socios municipales. (AU)

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

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

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

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

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

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

LEARNHIV: development and validation of a mobile application for primary health care nurses focused on HIV care/prevention.

INTRODUCTION: Human immunodeficiency virus (HIV) infection is a relevant public health problem is worldwide. From the change in the health care of people living with HIV (PLHIV) in Primary Health Care (PHC), nurses gained autonomy in their workflow, which requires a significant technological arsenal for the planning, organization and functioning of services. It is believed that the development of a mobile application for the care/prevention of HIV will contribute to the strengthening of care, resulting in greater autonomy and empowerment of nurses in Primary Health Care. OBJECTIVE: To develop and validate a content script for a mobile application for nurses in PHC containing information about PLHIV management/care in PHC. METHODS: This is a methodological study developed in three phases: exploratory study, content elaboration process and validation by the 16 judges. RESULTS: The application was evaluated and validated satisfactorily in terms of content and appearance, with an average Content Validity Index (CVI) of 0.99 (99%), Item Content Validity Index (I-CVI) and Medium Content Validity (S-IVC/AVE) also obtained satisfactory levels. CONCLUSIONS: The construction of the prototype of an application called LearnHIV, is considered a valid instrument in terms of content and appearance, according to the judges. TRIAL REGISTRATION: None because it is not an intervention study.

Hospitalizations for congenital syphilis in children under one year old in the state of Pará, Brazilian Amazon: ecological study.

BACKGROUND: The high incidence of congenital syphilis shows flaws in the resolution of primary health care, being a predictor of greater use of hospital services, whose regional differences in access to health actions and services may be reflected in health inequalities. OBJECTIVE: to investigate hospitalizations due to congenital syphilis in children under one year of age, in the state of Pará, Brazilian Amazon. METHODS: an ecological study was carried out, using hospitalization, lethality and mortality rates related to congenital syphilis in children under one year of age. Temporal analysis and mapping of hospitalization flows were carried out using Joinpoint®, version 4.7.0.0, Terraview 4.2.2, Tabwin 4.1.5. RESULTS: A total of 6,487 hospitalizations were recorded. For the ten years of the study period (2009 to 2018), the lethality rate showed a decreasing trend of - 13.5% (p = 0.01). The crude hospitalization rate showed an increasing trend of 12.8% (p < 0.000. The regression analysis demonstrated that there was a change point in the trend with a significant growth of 12.8% until 2016 (p = 0.0006). In the mortality rate the trend was stable (p = 0.56). The analysis of hospitalization care flows made it possible to identify that most hospitalizations due to congenital syphilis occurred in the municipalities of residence, but 1,378 (21.2%) had to move. Two large care gaps were highlighted in Metropolitan health regions II and III, belonging to macroregion II. The hospitalizations of residents of these regions were carried out by the assistance networks of Belém (capital) and Marituba, both of which are part of Metropolitana I. Residents of macroregions III and IV had the greatest distances traveled to access hospital care. CONCLUSIONS: The increase in the rate of hospitalizations with an increasing trend demonstrates the impact that syphilis still causes in Brazil, not being resolved even after national government interventions in primary health care, but there was a decreasing trend in the fatality rate. The results demonstrate a heterogeneous organization of health care networks in the state's health regions and macroregions.

Human immunodeficiency virus epidemic scenery among brazilian women: a spatial analysis study.

BACKGROUND: Approximately 37.7 million people worldwide are infected with human immunodeficiency virus (HIV). Although HIV detection among women, they still representing 53% of population living with the virus. Spatial analysis techniques are powerful tools for combating HIV allowing the association of the phenomenon with socioeconomic and political factors. Therefore, the main goal of this study was to spatially analyze HIV prevalence among Brazilian women from 2007 to 2020. METHODS: ecological study was conducted using secondary databases of the Notifiable Diseases Information System (SINAN) for HIV and Acquired Immunodeficiency Syndrom (AIDS) in Brazilian women 15 years old and over. Age-adjusted HIV/AIDS incidence rates were analyzed using spatial distribution, autocorrelation, and spatiotemporal risk analysis techniques. RESULTS: During the study period, 119,890 cases of HIV/AIDS were reported among Brazilian women. The southeastern region had a higher age-adjusted HIV/AIDS incidence than other Brazilian regions. Hotspot HIV/AIDS incidence rates decreased in all Brazil. Piauí, Paraná, and Minas Gerais were the only states with an increased number of cold spots. Previous spatiotemporal risk zones were observed in the states of São Paulo, Rio Grande do Sul, and Rio de Janeiro. Belém was a risk zone with a later spatiotemporal risk. CONCLUSIONS: The efficiency of public policies fighting HIV has not been uniform among municipalities, although HIV/AIDS cases have decreased among Brazilian women. The social determinants of health in each municipality should be considered when local health authorities implement policies. Women empowerment should be promoted, and access to preventive, diagnostic, and treatment healthcare places should be expanded and guaranteed.

Práticas de enfermagem na atenção primária à saúde: acesso a informação pelos enfermeiros / Nursing practices in primary health care: acess to information by nurses / Prácticas de enfermería en la atención primaria de salud: acceso a la información por parte del enfermero

Os avanços nas pesquisas científicas e na disseminação não é garantia da utilização das evidências nos cenários reais, principalmente pelo acesso à informação técnico-científica e como o conhecimento é traduzido. Este estudo tem como objetivo conhecer a prevalência de Enfermeiros da atenção primária à saúde do Pará com acesso a informação técnico-científica, para comparar a prevalência nacional e identificar os fatores sociodemográficos e de formação associados a este acesso. Trata-se de um estudo transversal de prevalência e analítico realizado no estado do Pará entre novembro de 2019 e agosto de 2021, com Enfermeiros da atenção primária à saúde. Os dados foram coletados por formulário eletrônico e analisados pelos testes do qui-quadrado, exato de Fischer e binomial para duas proporções. Participaram 193 Enfermeiros. A prevalência de acesso a informação técnico-científica foi de 88,6% (171/193), com diferença na proporção desse acesso em relação ao Brasil (95,1%; p= 0,000). Há diferença estatisticamente significativa na proporção de Enfermeiros que participaram de encontros/seminários (97%; p=0,000) e curso de atualização (100%; p= 0,000) de acordo com o acesso a informação. Um maior percentual de Enfermeiros utiliza sua residência para acessar a informação como fontes governamentais, revistas científicas e mídias sociais. O estudo concluiu que há disparidade no acesso a informação pelos Enfermeiros do Pará quando comparado ao Brasil. Há necessidade de ampliar a participação em cursos de atualização e seminários, sendo as estratégias de digitais ferramentas que podem contribuir para esse alcance e que são utilizadas pelos Enfermeiros. (AU)

Advances in scientific research and dissemination do not guarantee the use of evidence in real scenarios, mainly due to access to technical-scientific information and how knowledge is translated. This study aims to determine the prevalence of primary health care nurses in Pará with access to technical-scientific information, in order to compare the national prevalence and identify the sociodemographic and training factors associated with this access. This is a cross-sectional prevalence and analytical study carried out in the state of Pará between November 2019 and August 2021, with nurses from primary health care. Data were collected using an electronic form and analyzed using chi-square, Fisher's exact and binomial tests for two proportions. 193 nurses participated. The prevalence of access to technical-scientific information was 88.6% (171/193), with a difference in the proportion of this access in relation to Brazil (95.1%; p=0.000). There is a statistically significant difference in the proportion of nurses who participated in meetings/seminars (97%; p=0.000) and refresher courses (100%; p=0.000) according to access to information. A higher percentage of nurses use their residence to access information such as government sources, scientific journals and social media. The study concluded that there is disparity in access to information by nurses in Pará when compared to Brazil. There is a need to expand participation in refresher courses and seminars, and digital strategies are tools that can contribute to this reach and are used by nurses. (AU)

Los avances en la investigación y divulgación científica no garantizan el uso de la evidencia en escenarios reales, principalmente por el acceso a la información técnico-científica y la forma en que se traduce el conocimiento. Este estudio tiene como objetivo determinar la prevalencia de enfermeros de atención primaria de salud en Pará con acceso a la información técnico-científica, con el fin de comparar la prevalencia nacional e identificar los factores sociodemográficos y de formación asociados a este acceso. Se trata de un estudio transversal analítico y de prevalencia realizado en el estado de Pará entre noviembre de 2019 y agosto de 2021, con enfermeros de la atención primaria de salud. Los datos fueron recolectados mediante un formulario electrónico y analizados mediante pruebas de chi-cuadrado, exacta de Fisher y binomial para dos proporciones. Participaron 193 enfermeras. La prevalencia de acceso a la información técnico-científica fue del 88,6% (171/193), con diferencia en la proporción de ese acceso en relación a Brasil (95,1%; p=0,000). Hay diferencia estadísticamente significativa en la proporción de enfermeros que participaron de reuniones/seminarios (97%; p=0,000) y cursos de actualización (100%; p=0,000) según el acceso a la información. Un mayor porcentaje de enfermeras utiliza su residencia para acceder a información como fuentes gubernamentales, revistas científicas y redes sociales. El estudio concluyó que existe disparidad en el acceso a la información por parte de los enfermeros de Pará en comparación con Brasil. Existe la necesidad de ampliar la participación en cursos de actualización y seminarios, y las estrategias digitales son herramientas que pueden contribuir para ese alcance y son utilizadas por los enfermeros. (AU)

AIDS-related mortality in Pará Province, Brazilian Amazon region: Spatial and temporal analysis.

Despite considerable therapeutic advances in the care of people living with human immunodeficiency virus (HIV) and with the acquired immunodeficiency syndrome (AIDS) and an overall reduction of 47% in the AIDS mortality rate in the last decade, the AIDS-mortality rates remains high. The social determinants of health (SDH) have a direct influence on the dynamics of this phenomenon. However, changes in SDH caused by the implemented policies against HIV have been poorly investigated. Moreover, the Brazilian rainforest has had the highest and continuously increasing AIDS mortality rate in Brazil since the 1980s. In this study, AIDS mortality in a province of the Brazilian rainforest was examined by using temporal and spatial analyses. METHODS: In this ecological study, data from 2007 to 2018 were extracted from the Mortality Information System provided by the State Department of Public Health of Pará. For the temporal analysis, the integrated autoregressive model of moving average (ARIMA) and locally weighted polynomial regression (STLF) were used to forecast AIDS mortality from 2019 to 2022. For the spatial analysis, spatial autocorrelation and geographically weighted regression (GWR) analyses were employed. RESULTS: The samples consisted of 6,498 notifications for AIDS-related deaths. From 2007 to 2013, the AIDS mortality rates showed an upward trend, followed by a stabilization until 2018 and an upward forecasted trend from 2019 to 2022. High mortality rates and high-high clusters were found in economic pole municipalities. Furthermore, AIDS mortality risk was directly associated with per capita income and demographic density, except in the southwestern region of Pará, which exhibited an inverse association with population density. CONCLUSION: Although the policies against HIV may have contributed to the stabilization of AIDS mortality rates from 2013 in Pará, the upward forecasted trend until 2022 raises an alert and concern to health authorities to provide reinforcement of the policies. The geographic variability of AIDS mortality promoted by SDH provides subsidies to health authorities to implement SDH-focused strategies for AIDS mortality reduction.

The Family Health Strategy Influence on the Human Papillomavirus Vaccine Acceptance in a Peripheral Community of the Brazilian Amazon Region.

Introduction: The coverage of the human papillomavirus (HPV) vaccine remains low worldwide. The Family Health Strategy (FHS) in Brazil has an important role in health promotion in communities. Given the FHS's close contact with assisted communities, the coverage of the HPV vaccine should be high in children. This study aims to investigate the acceptance of the HPV vaccine of parents or guardians of a peripheral community of the Brazilian Amazon region assisted by the FHS and influencing factors. Methods: A cross-sectional community-based study recruiting the residents of a subnormal agglomerate of Belém (Pará-Brazil) and covered by the FHS was conducted. Data were collected from September 30 to November 5, 2019. The questionnaire "Knowledge and Acceptability of HPV and Its Vaccine" was used. Data were analyzed through binary and multiple regression analyses. Results: A total of 247 participants were included in this study, and 85 of which (34.4%) declared that they did not vaccinate their children. Hesitation to vaccinate was related to few years of schooling (odds ratio [OR]: 0.79, p=0.008), having sons (OR: 3.14, p=0.000), inadequate knowledge about doses of the HPV (OR: 2.44, p=0.015), and knowledge of anyone who received the HPV vaccine (OR: 7.07, p=0.000). Conclusion: Results suggested the low efficiency of FHS in increasing the HPV vaccination coverage in the assisted communities. A strategy involving a dialog with assisted families and continuous health education to health professionals should be implemented to combat fake news and increase HPV vaccination coverage.

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

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

Prevalence and Vulnerability Factors Associated with HIV and Syphilis in Older People from Subnormal Agglomerate, Brazilian Amazon.

BACKGROUND: This study aimed to estimate the prevalence of HIV and syphilis and associated factors among elderly people from subnormal agglomerations in a city in the Brazilian Amazon. METHODS: An observational, cross-sectional study was carried out in a subnormal agglomerate from the Brazilian Amazon. Data collection was conducted from August 2021 to February 2022, using a structured questionnaire. Whole blood samples were collected to perform a rapid test for HIV and syphilis. People aged 50 and over were included in the study, and the sample consisted of 213 participants. The odds ratio was calculated by multiple logistic regression. RESULTS: A total of 203 participants with a mean age of 63.5 years were considered (95% CI: 62.4; 64.6; standard deviation: 8.1; minimum age: 50 years and maximum age: 94 years). The prevalence of either HIV or syphilis was 16.4% (35/213; 95% CI: 0.11; 0.21); syphilis was 15.5% (33/213) and HIV was 1.40% (3/213). One coinfection (0.46%; 1/213) was registered. In the final multiple logistic regression, the elderly with an education level of illiterate/elementary were two times more likely to have a positive rapid test result for HIV or syphilis. CONCLUSIONS: Testing for HIV and syphilis identified that STI represented a burden on populations affected by socioeconomic inequality.

Determinants of gestational syphilis among women attending prenatal care programs in the Brazilian Amazon.

Background: There was a high proportion of pregnant women who were attending prenatal care who were not tested for syphilis or tested but not treated, among priority countries. The coverage for prenatal care visits, syphilis screening, and treatment are priority indicators for monitoring of the elimination of syphilis. The aim was to determine the factors associated with gestational syphilis among postpartum women who were in a prenatal care program in the Brazilian Amazon. Methods: An unmatched case-control study was conducted at the hospital in Brazil. Data collection was carried out from November 2020 to July 2021 during hospitalization using a pretested structured questionnaire. The criteria for selection of cases and control followed the guidelines established by the Ministry of Health of Brazil; postpartum women with a laboratory diagnosis based on treponemal and/or nontreponemal tests, symptoms of syphilis or asymptomatic, treatment or not treated, and in a prenatal care program. Gestational syphilis cases were identified as women who tested positive for syphilis, and those who tested negative were controls, at minimally one prenatal care visit, childbirth, and/or the puerperium. The sample size encompassed 59 cases and 118 controls (1: 2 ratio of cases to controls). Data were analyzed using Minitab 20® and BioEstat 5.3® software. The odds ratio was calculated by multiple logistic regression. Results: One hundred and seventy-seven postpartum women were included in the study, 59 cases and 118 controls. Among all participants, 95.5% (169) were tested for syphilis in any trimester during pregnancy and at the delivery and 4.5% (8) were tested in the maternity only, at the time childbirth and/or puerperium. The final multiple logistic regression model evidenced that cases had higher odds compared to controls if they had past history of sexually transmitted infections (AOR: 55.4; p: 0.00), difficulty talking about condom use with their sexual partner (AOR: 4.92; p: 0.01), one to six prenatal care visits (AOR: 4.93; p: 0.01), had not received a sexually transmitted infections test result in the maternity hospital (AOR: 4.09; p: 0.04), lower monthly income (AOR: 4.32; p: 0.04), or one to three miscarriages (AOR: 4.34; p: 0.01). Conclusion: The sociodemographic, programmatic, obstetric, and sexual factors are associated with gestational syphilis among postpartum women.

The Temporal and Spatial Epidemiology Employed in the Elimination of the HIV Epidemic in the Largest Capital of the Brazilian Rainforest.

BACKGROUND: The main goal of this study was to analyze the human immunodeficiency virus (HIV) epidemic temporally and spatially in Belém from 2007 to 2018. METHODS: The incidence rates were analyzed according to time using autoregressive integrated moving-average models, as well as spatially using spatial autocorrelation, Kernel density, scan statistics, and regression techniques. RESULTS: During the study period, 6007 notifications of new cases of HIV/AIDS were reported. The time series analysis revealed a stabilized trend of incidence from 2007 to October 2016, followed by irregular fluctuations until the end of December 2018. Seasonal behavior was observed from 2019 to 2022. The high-high incidence clusters were found in the central and transition areas. An expansion of the number of new reported cases was observed in the central area. Three spatial risk zones were observed. The higher relative risk zone was concentrated in the transition area. The spatial regression showed that the incidence rates were positively correlated with the Family Health Strategy (FHS) coverage. CONCLUSIONS: To eliminate HIV in Belém, it will be necessary to decentralize testing and ART and expand the coverage of FHS to ensure universal access to healthcare for citizens.

HIV epidemic among Brazilian women who have sex with women: An ecological study.

The influences of public policies fighting HIV among women who have sex with women is scarcely studied. This study aimed to analyse the time series of human immunodeficiency virus (HIV) epidemic, between 2007 and 2020, among Brazilian women who have sex with women, in order to evaluate the effect of Brazilian policies for fighting HIV in this subpopulation compared to women who have sex with men (WSM). This ecological study employed HIV and acquired immunodeficiency syndrome (AIDS) new cases among women who have sex strictly with women (WSW), women who have sex with men and women (WSMW), and WSM reported to the Sistema de Informação de Agravos de Notificação from 2007 to 2020. Crude Brazilian and regional annual age-adjusted HIV/AIDS population-level incidence rates were calculated for WSW, WSMW and WSM. The rates were then analyzed using the Joinpoint regression model. A total of 102,890, 757, and 1,699 notifications of WSW, WSMW, and WSM living with HIV/AIDS were reported during the study period, respectively. South Brazilian region had the greatest HIV/AIDS incidence rates among WSM and bisexual women while the North region had the greatest incidence among WSW. In the WSM population, the temporal trends showed at least one stable or an increasing trend period from 2007 to 2013 or 2014, followed by one decreasing trend in all Brazilian regions. While among the WSMW most of the regions had a stable trend period from 2007 to 2020, in WSW group most of the trends had only one decreasing period. The decreasing trends were faster in WSM than in WSW. These results suggest a low efficiency of Brazilian policies for fighting HIV among WSW and WSMW and show the necessity of implementing new policies specific to this population.

Temporal and Spatial Analysis Techniques as Potential Tools for Combating the HIV Epidemic among Young Brazilian Amazonian People: An Ecological Study.

BACKGROUND: The main goal of this study was to analyze the HIV epidemic temporally and spatially among young people living in Pará, Brazil, from 2007 to 2018. METHODS: For the temporal analysis, we employed an integrated autoregression of moving averages model associated with the seasonal trend using the LOESS decomposition method, which allowed for predictions to be made. In the spatial analysis, the techniques of autocorrelation, spatial and spatio-temporal risk analysis, and geographically weighted regression were used. RESULTS: During the study period, there were 8143 notifications of HIV/AIDS cases. The temporal prediction indicated a trend of growth in the incidence rate in the 20-24-year-old group from January 2019 to December 2022 and a trend of stability in the 15- to 19-year-old and 25- to 29-year-old groups. There was a territorial expansion of the HIV epidemic in Pará. Novo Progresso and the Metropolitan Region of Belém (RMB) were the zones with the highest spatial and spatio-temporal risk for HIV. Social determinants including the Basic Education Development Index, the number of physicians per 10,000 inhabitants, and the municipal high school abandonment rate in the municipalities were associated with the risk of HIV/AIDS among young people in Pará. CONCLUSIONS: To eliminate HIV among young people in Pará, the access to treatment, diagnosis, and preventive healthcare services should be expanded. Sexual and reproductive health education should be reinforced in schools and communities. Furthermore, it is necessary to promote social equity and fight HIV stigma.

Análise da atenção primária à saúde no Estado do Pará / Analysis of primary health care in the State of Pará

A Atenção Primária é sabidamente o pilar de todo sistema de atenção à saúde que aspira à eficiência e à cobertura universal. No Brasil, o Sistema Único de Saúde (SUS), embora operando com um padrão de financiamento ainda restritivo, garante esse horizonte de trabalho com uma capilaridade, cobertura multidisciplinar e resultados que o tornam referência para muitas outras nações. Seu desenvolvimento depende, dentre tantos fatores, de um trabalho contínuo de diagnóstico da realidade do país, ou mais precisamente das realidades diversas do país, e da avaliação da execução de seus programas e ações. Neste ponto, entre outros, o SUS e as Universidades atuam de modo convergente e integrado. A experiência acumulada do trabalho executado no sistema público de saúde gera uma agenda de investigações para pesquisadores e a pesquisa científica realizada no âmbito das instituições acadêmicas torna-se insumo para o aperfeiçoamento das políticas públicas em diferentes contextos. Este livro consolida contribuições de estudos da Atenção Básica à Saúde no estado do Pará, conduzidos no contexto do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) por docentes, discentes e técnicos (as) da Universidade Federal do Pará (UFPA), participantes do Grupo de Estudo e Pesquisa em Saúde Coletiva na Amazônia (GEPESCA/UFPA). A realidade investigada é complexa e diversa, como o território e o perfil populacional amazônicos e suas correspondentes demandas por serviços de saúde. O retrato produzido informa sobre as exigências peculiares a que estão expostos os profissionais da saúde, assim como alguns dos obstáculos frequentes ao atendimento de qualidade na região. Nestes tempos de crise sanitária, humanitária, econômica, social sem precedentes, com mais de 620 mil mortes por Covid-19 no Brasil, em grande parte decorrentes da ação de um governo negacionista e neoliberal que promoveu a disseminação do vírus e da discórdia, debruçar-se sobre estes resultados de um trabalho dedicado ao fortalecimento do SUS é um alento.