Modelos de preceptoria de residência em medicina de família e comunidade: um estudo Delphi / Models of preceptorship in family and community medicine residence: a Delphi study

Resumo Introdução: A preceptoria na atenção primária à saúde desempenha papel central na formação do residente, já que 70%-80% da carga horária dos programas de residência de medicina de família e comunidade (PRMFC) acontece na unidade de saúde da família. Como preceptor entende-se o professor que ensina na prática clínica. O cenário atual de expansão dos PRMFC, associado a poucos profissionais especializados em preceptoria, fez com que vários modelos fossem praticados. Uma revisão de literatura feita em estágio anterior a este trabalho, além das contribuições da Sociedade Brasileira de Medicina de Família e Comunidade, identificou quatro modelos de preceptoria em MFC: ombro a ombro, preceptor da equipe ao lado, preceptor de unidade e preceptor de campo. Objetivo: Este estudo teve como objetivos validar esses quatro modelos e identificar outros, determinar, sob a ótica da qualidade de formação dos residentes, a aceitabilidade e o grau de recomendação dos modelos, e reconhecer os pontos positivos e negativos. Método: Utilizou-se a técnica Delphi modificada por questionários on-line. O estudo começou com 24 participantes de todo o Brasil na primeira rodada e terminou com 18. Aplicaram-se a técnica de estatística descritiva e a análise de conteúdo. O estudo foi realizado entre fevereiro e abril de 2022. Resultado: Validaram-se os quatro modelos apresentados, e nenhum outro foi identificado. Os modelos ombro a ombro, preceptor da equipe ao lado e preceptor de unidade foram considerados aceitáveis; e o modelo preceptor de campo, inaceitável. Os modelos ombro a ombro e preceptor de unidade foram recomendados. Reconheceram-se 92 aspectos como pontos positivos e negativos, dos quais 81 atingiram consenso. Conclusão: Obteve-se a validação dos quatro tipos de modelos de preceptoria para PRMFC. Como os modelos ombro a ombro e preceptor de unidade foram elencados como aceitáveis e recomendáveis, é importante que sejam priorizados na implantação e manutenção dos PRMFC. Os modelos preceptor da equipe ao lado e preceptor de campo foram julgados como não recomendados e, portanto, devem ser evitados. O conhecimento das fortalezas e fraquezas de cada modelo prepara os PRMFC para as possíveis dificuldades e os auxilia na escolha do modelo adequado às diversas realidades existentes no país.

Abstract Introduction: Medical residency preceptorship in primary healthcare plays a major role in the professional qualification of medical residents, since 70-80% of the workload of the Family and Community Medical Residency Program (PRMFC) takes place in primary care clinics. A preceptor is understood as an experienced practitioner who teaches during clinical practice. The current scenario of expansion of PRMFCs in Brazil, associated with the limited number of professionals specialized in preceptorship, has resulted in the practice of different preceptorship models. A literature review performed in the previous stage of this study, added to the contributions of the Brazilian Society of Family and Community Medicine, pointed out four models of preceptorship in family practice: shoulder-to-shoulder, next-door team, clinic preceptor and field preceptor. Objective: To validate these four models of preceptorship and identify if there are others models; to determine, from the perspective of the quality of training residents, the acceptability and degree of recommendation of the models and recognize the positive and negative points. Method: The Delphi technique modified by online questionnaires was used. It was initiated with 24 participants from all over Brazil in the first round and ended with 18. Descriptive statistics and content analysis method was applied. The study was conducted between February and April 2022. Result: The four models presented were validated and no others were identified. The shoulder-to-shoulder, nextdoor team preceptor and clinic preceptor models were considered acceptable and the field preceptor model, unacceptable. The shoulder-to-shoulder and clinic preceptor models were recommended. Ninety-two aspects were recognized as positive and negative points. Of these, 81 achieved consensus. Conclusion: The shoulder-to-shoulder preceptor and clinic preceptor models were validated as acceptable and recommended, so it is important to prioritize these models in the implementation and maintenance of PRMFCs. The next-door team preceptor and field preceptor models were deemed as not recommended and, therefore, should be avoided. Information about the strengths and weaknesses of each model prepares the PRMFCs for possible implementation difficulties and helps them to select the appropriate model for the different realities existing in the country.

Programa Médicos pelo Brasil: primeiros resultados / Doctors for Brazil Program: first results

Resumo O acesso ao cuidado médico é essencial para o alcance da atenção primária à saúde (APS) de qualidade. No Brasil, ainda persistem dificuldades de acesso. O Programa Médicos pelo Brasil (PMpB) pretende ampliar a oferta de serviços médicos em locais de difícil provimento ou alta vulnerabilidade. Traz como inovações a priorização das menores e mais isoladas cidades; a seleção de profissionais por processo isonômico; a formação em medicina de família e comunidade; e o fato de ser a primeira carreira médica federal na APS, com salários competitivos, progressão e incentivos financeiros que valorizam a longitudinalidade e o desempenho. O PMpB é executado pela Agência para o Desenvolvimento da Atenção Primária à Saúde (Adaps), o que permite mais eficiência na gestão da política pública. Os primeiros nove meses do programa mostram resultados promissores, com aproximadamente 23 mil médicos interessados em ingressar no programa por meio de seu processo seletivo, 97,1% de ocupação das vagas e 95,4% de permanência após o ingresso. Tais resultados sinalizam o avanço de qualidade do PMpB em relação às políticas anteriores, bem como a necessidade de continuar com sua implementação, a fim de que ela atinja todo o seu potencial de cobertura na APS do SUS.

Abstract Access to medical care is essential to achieve quality primary health care (PHC). In Brazil, access difficulties still persist. The Doctors for Brazil Program (PMpB in Portuguese) aims to expand the offer of medical services in places of difficult provision or high vulnerability. It innovates insofar as it prioritizes smaller and rather isolated cities, by selecting professionals through an isonomic process, offering them training in Family and Community Medicine and a chance to build their first federal medical career in PHC. The program offers competitive salaries, progression and financial incentives that value long-term commitment and performance. The PMpB is rolled out by the Agency for the Development of Primary Health Care (Adaps), which allows better management of public policies. The first nine months of the program showed promising results, as approximately 23,000 candidates seeking to join the program through its selection process, i.e., 97.1% vacancies were filled and retention rate after admittance was 95.4%. These results show to what extent PMpB has improved in quality compared to previous policies, as well as how essential it is to keep implementing the program so that it may reach its full PHC coverage potential within the Brazilian public health system.

Genealogia da Prevenção Quaternária: entre o uso da Medicina Baseada em Evidências e a reformulação do cuidado na Atenção Primária à Saúde / Genealogical analysis of Quaternary Prevention: between the use of Evidence-Based Medicine and care reformulation in Primary Health Care

Resumo Realizamos uma análise genealógica da Prevenção Quaternária, instrumento da Atenção Primária à Saúde de enfrentamento à medicalização e a iatrogenia, a partir de seus enunciados e de entrevistas com seus formuladores. Identificamos que a ferramenta tem sido tanto apresentada como uma reformulação do cuidado e da relação médico-paciente, como também reduzida ao cálculo do risco-benefício por meio da aplicação atualizada de evidências científicas. Analisamos os paradoxos da Medicina Baseada em Evidências e problematizamos sua relação com a Prevenção Quaternária e a Atenção Primária à Saúde. Por fim, sugerimos questionar a verdade das evidências para o desenvolvimento de outros paradigmas de saúde.

Abstract We conducted a genealogical analysis of quaternary prevention, an instrument of primary health care to address overmedicalization and iatrogenesis, based on related statements and interviews with the creators of this concept. This tool has been used in the reformulation of care and the doctor-patient relationship, but limited to the risk-benefit assessment by using current scientific evidence. In this study, we analyze the paradoxes of evidence-based medicine (EBM) and discuss the relationship of EBM and quaternary prevention and primary health care (PHC). Finally, we suggest questioning the truth of the evidence for the development of other health paradigms.

Medicina familiar, principios bioéticos y final de la vida en Colombia / Family Medicine, Bioethical Principles and End of Life in Colombia

Introducción: La medicina familiar, dentro de su enfoque biopsicosocial, acoge la valoración integral de cada individuo en su curso de vida, donde es indispensable integrar todos los principios bioéticos para brindar una atención adecuada, oportuna y humanizada. El abordaje del especialista en medicina familiar sobre el final de vida debe estar ligado a estos aspectos, lo que permite ampliar la relación clínica desde el paciente hasta su núcleo familiar y su equipo en salud. Objetivo: Discutir los principios bioéticos desde una perspectiva integrativa a partir de un recorrido por los principales apartados legales que se han desarrollado en Colombia desde la sentencia C-239 de 1997, en relación con el derecho a morir dignamente. Métodos: Se realizó una revisión narrativa mediante la búsqueda en PubMed, Elsevier, Scielo y la normativa del contexto colombiano. Conclusiones: La disponibilidad de la información permite tener claridad sobre los conceptos al final de vida y el quehacer de los profesionales de la salud en esta etapa, que permita brindar al paciente y a su familia información clara y alternativas en su manejo integral, que dignifique la relación médico-paciente-familia-equipo de salud(AU)

Introduction: Family medicine, within its biopsychosocial approach, welcomes the comprehensive assessment of each individual in his or her life course, where it is essential to integrate all bioethical principles to provide adequate, timely and humanized care. The approach of the family medicine specialist at the end of life should be linked to these aspects, which allows extending the clinical relationship of the patient to the family nucleus and the health team. Objective: To discuss bioethical principles from an integrative perspective based on the review of the main legal paragraphs that have been developed in Colombia since the C-239 ruling of 1997 in relation to the right to die with dignity. Methods: A narrative review was carried out through searches in PubMed, Elsevier, SciELO and in the normativity of the Colombian context. Conclusions: The availability of information allows clarity about the concepts at the end of life and the work of health professionals at this stage, which allows providing the patient and family with clear information and alternatives in their comprehensive management, which dignifies the doctor-patient-family-health team relationship(AU)

Current Status and Issues of Cardiovascular Surgery Institution in Community Medicine / 日本心臓血管外科学会雑誌

Lately, there has been a trend towards integration among cardiovascular surgery institutions. However, local institutions continue to play a crucial role in community-based medicine, given the emergent nature of cardiovascular diseases and the challenges involved in transporting patients with such conditions over long distances. We present the results of a questionnaire survey we conducted to examine the current status and issues faced by cardiovascular surgery institutions in community-based medicine.

Rasgos de profesionalidad médica en el ámbito de la atención primaria: respeto por la autonomía / Traits of medical professionalism in the field of primary care: respect for autonomy

Fundamento: el respeto por la autonomía del paciente y una conducta respetuosa en general son rasgos centrales de la profesionalidad médica. Objetivo: indagar la presencia de los rasgos profesionales de respeto por la autonomía de los pacientes y de respeto en general en las expresiones verbales de profesionales del ámbito de atención primaria de la salud durante su interacción con pacientes y estudiantes del último año de la carrera de Medicina. Métodos: se efectuó una investigación cualitativa de carácter exploratorio en contextos de prácticas finales obligatorias en dos Centros de Atención Primaria de la Salud de la ciudad de Tandil, República de Argentina, durante el año 2019. Como métodos teóricos se emplearon: análisis-síntesis, inductivo-deductivo y método de revisión crítica de la literatura y empírico: se realizó el registro grabado de 28 encuentros entre expertos, estudiantes y pacientes. Las sesiones se analizaron mediante triangulación de investigadores. Resultados: las expresiones verbales de los expertos permitieron identificar enunciados relacionados con rasgos de respeto en general y respeto por la autonomía de los pacientes. Estos se evidenciaron en enunciados para construir un ambiente de confianza y confidencialidad, el esfuerzo por brindar explicaciones de forma clara y sencilla, la atención a las dudas de los pacientes y la formulación de explicaciones sobre cómo proceder, en un lenguaje accesible. Conclusiones: se identificó la presencia de los rasgos profesionales de respeto por la autonomía de los pacientes y de respeto en general, tanto en las interacciones con pacientes como con los estudiantes.

Background: respect for the autonomy of the patient and a respectful behavior in general are key features of medical professionalism. Objective: to investigate the presence of professional traits of respect for the autonomy of patients and of respect in general in the verbal expressions of professionals in the field of primary health care during their interaction with patients and students in the last year of the Medicine degree. Methods: a qualitative research of an exploratory nature was carried out in the context of mandatory final practices in two Primary Health Care Centers in the city of Tandil, Republic of Argentina, during the year 2019. The following theoretical methods were used: analysis-synthesis, inductive-deductive and method of critical review of the literature and empirical ones: the recorded record of 28 meetings between experts, students and patients was made. The sessions were analyzed by opposing sources of researchers. Results: the verbal expressions of the experts made it possible to identify statements related to traits of respect in general and respect for the autonomy of the patients. These were evidenced in statements to build an environment of trust and confidentiality, the effort to provide explanations in a clear and simple way, the attention to the patients' doubts and the formulation of explanations on how to proceed, in an accessible language. Conclusions: the presence of professional traits of respect for the autonomy of patients and respect in general was identified, both in interactions with patients and with students.

Dr. Serafín Ruiz de Zárate Ruiz: aportes al ideal médico social desde su gestión ministerial / MD. Serafín Ruiz de Zárate Ruiz: contributions to the social medical ideal from his ministerial management

Fundamento: los años 1959 y 1960 fueron decisivos en las proyecciones y concreción del ideal médico social, como proceso iniciado, a establecerse en Cuba. Objetivo: identificar los aportes más relevantes del Dr. Serafín Ruiz de Zárate Ruiz, en su gestión como ministro de salud pública a la conformación del ideal médico social cubano en la década del sesenta del siglo XX. Métodos: se realizó una investigación documental de corte histórico en el año 2022. Se aplicaron métodos teóricos que permitieron analizar el objetivo de estudio, basado en la interacción de lo histórico y lo lógico y desde las dimensiones temporal y espacial; y empíricos: análisis de contenido y la consulta bibliográfica para procesar en conjunto el producto resultante, se empleó la triangulación para mejorar la validez y confiabilidad de los datos obtenidos. Resultados: la designación y actuación del Dr. Ruiz de Zárate frente al Ministerio de Salud Pública sentó las bases y logró avanzar, bajo una aguda lucha de clases, en el camino de modificar las condiciones higiénico-sanitarias de la población, posible solo por los cambios de concepciones médicas de lo asistencial curativo a lo social. Conclusiones: el Dr. Ruiz de Zárate en su gestión como ministro hizo relevantes aportes a la conformación del ideal médico social. Diversas y amplias fueron las acciones encaminadas para materializarlo, expresadas concretamente en políticas, leyes, planes, medidas, entre otras, que fueron superadas y fortalecidas con el mismo objetivo por el Dr. José Ramón Machado Ventura.

Background: the years 1959 and 1960 were decisive in the projections and concretion of the social medical ideal, as an initiated process, to be established in Cuba. Objective: to identify the most relevant contributions of MD. Serafín Ruiz de Zárate Ruiz, as Minister of Public Health, to the conformation of the Cuban social medical ideal in the sixties of the 20th century. Methods: a historical documentary research was carried out in the year 2022. Theoretical methods were applied that allowed us to analyze the objective of the study, based on the interaction of the historical and the logical and from the temporal and spatial dimensions; and empirical ones: content analysis and bibliographic consultation to jointly process the resulting product, sources contrasting was used to improve the validity and reliability of the data obtained. Results: the appointment and action of MD. Ruiz de Zárate in front of the Ministry of Public Health laid the foundations and managed to advance, under an acute class struggle, in the path of modifying the hygienic-sanitary conditions of the population, possible only because of the Changes in medical conceptions from curative care to social. Conclusions: MD. Ruiz de Zárate as minister of public health made relevant contributions to the conformation of the social medical ideal. Diverse and extensive were the actions aimed at materializing it, specifically expressed in policies, laws, plans, measures, among others, which were overcome and strengthened with the same objective by MD. José Ramón Machado Ventura.

Huellas históricas de la COVID-19 en la asistencia médica de los habitantes de Manicaragua, Cuba / Historical traces of COVID-19 in the medical care of the inhabitants of Manicaragua, Cuba

Fundamento: la pandemia de COVID-19 ha tenido un efecto socioeconómico disruptivo en el mundo; pero ha dejado huellas que constituyen lecciones aprendidas entre la población de numerosos países. Objetivo: describir las huellas históricas de la COVID-19 en el municipio de Manicaragua, Villa Clara, Cuba, como expresión de la reorganización y regionalización de los servicios de salud que demandaba el enfrentamiento a la pandemia. Métodos: se realizó un estudio descriptivo longitudinal cuantitativo sobre el comportamiento de la COVID-19 en Manicaragua desde el inicio de la pandemia, abril 2020 hasta el 2022. Se emplearon métodos teóricos: análitico-sintético e histórico-lógico; empíricos: análisis documental; y matemático-estadísticos: para los valores absolutos y relativos. Resultados: fue analizado el impacto de la COVID-19 a partir de los casos diagnosticados y sus tasas de incidencia por habitantes en las distintas áreas de salud. Se destacan cifras predominantes: el poblado de Manicaragua y el grupo etario de 19 a 64 años como los de mayor presencia de contagiados, la fuente de infección superior fue la intradomiciliaria y Estados Unidos como el país que aportó la mayor cifra de contaminados. Se argumentan algunas formas de indisciplinas sociales como causas de los rebrotes epidemiológicos. Conclusiones: la COVID-19 dejó huellas que pueden considerarse históricas en Manicaragua, pues representó una pausa en su desarrollo social y un reordenamiento de los servicios médicos asistenciales. El incumplimiento de los protocolos y la actuación comunitaria frente a las indisciplinas sociales hoy se consideran lecciones aprendidas frente a próximos eventos epidemiológicos.

Background: the COVID-19 pandemic has had a disruptive socioeconomic effect on the world; but it has left traces that constitute lessons learned among the population of many countries. Objective: to describe the historical traces of COVID-19 in the municipality of Manicaragua, Villa Clara, Cuba, as an expression of the reorganization and regionalization of health services that the confrontation with the pandemic demanded. Methods: a quantitative longitudinal descriptive study was carried out on the behavior of COVID-19 in Manicaragua from the beginning of the pandemic, April 2020 to 2022. Theoretical methods were used: analytical-synthetic and historical-logical; empirical ones: documentary analysis; and mathematical-statistical: for absolute and relative values. Results: the impact of COVID-19 was analyzed based on the diagnosed cases and their incidence rates per population in the different health areas. Predominant figures stand out: the town of Manicaragua and the age group from 19 to 64 years as the ones with the highest presence of infected people, the highest source of infection was intra-domiciliary and the United States as the country that contributed the highest number of infected people. Some forms of social indiscipline are argued as causes of epidemiological outbreaks. Conclusions: COVID-19 left traces that can be considered historical in Manicaragua, since it represented a pause in its social development and a reordering of medical care services. Failure to comply with the protocols and community action against social indiscipline today are considered lessons learned in the face of upcoming epidemiological events.

Nivel de conocimientos sobre bioseguridad en estudiantes de Enfermería durante la pesquisa de COVID-19 / Level of knowledge about biosafety in Nursing students during the COVID-19 screening

Fundamento: la bioseguridad es considerada como una norma preventiva universal para reducir factores de riesgo, está orientada en el ámbito de la salud al fomento de la seguridad, y la protección de profesionales y estudiantes en contextos de riesgo. Objetivo: valorar el nivel de conocimientos en estudiantes de Enfermería sobre las medidas de bioseguridad durante la pesquisa de COVID-19. Métodos: se realizó un estudio descriptivo de corte transversal en el período comprendido de febrero a octubre 2021, en Camagüey, Cuba. Se aplicaron métodos teóricos para la fundamentación de la investigación, y empíricos: la observación participante y encuesta confeccionada por los autores. Se establecieron como variables: área de salud, cifra de estudiantes contagiados, posibles causas de contagio y nivel de conocimientos sobre bioseguridad. Resultados: hubo mayor representación de estudiantes del municipio Santa Cruz (15 %). El área de salud con más contagios fue Previsora con un 6,25 %. Las posibles causas de contagio identificadas se refieren a la conducta higiénico-sanitaria durante la pesquisa: dificultades en el uso de la mascarilla, la distancia física entre estudiantes y con la población objeto de pesquisa, y uso de desinfectante 91,25 %, 87,50 % y 82,50 % respectivamente. Conclusiones: se valoró que el nivel de conocimientos en estudiantes de Enfermería sobre las medidas de bioseguridad durante la pesquisa de COVID-19 fue bajo, a pesar de haber recibido un curso de capacitación previo a la actividad, y su presencia en los programas de estudio.

Background: biosafety is considered a universal preventive norm to reduce risk factors, it is oriented in the field of health to promote safety, and the protection of professionals and students in risk contexts. Objective: to assess the level of knowledge in Nursing students about biosafety measures during COVID-19 screening. Methods: a descriptive cross-sectional study was carried out in the period from February to October 2021, in Camagüey, Cuba. Theoretical methods were applied for the foundation of the research, and empirical ones: participant observation and survey made by the authors. The following variables were established: health area, number of infected students, possible causes of infection, and level of knowledge about biosafety. Results: there was a greater representation of students from the Santa Cruz municipality (15%). The health area with the most infections was Previsora ​​with 6.25%. The possible causes of contagion identified refer to hygienic-sanitary behavior during the investigation: difficulties in the use of the mask, the physical distance between students and with the population under investigation, and the use of disinfectant 91.25%, 87, 50% and 82.50% respectively. Conclusions: it was assessed that the level of knowledge in Nursing students about biosafety measures during the COVID-19 screening was low, despite having received a training course prior to the activity, and their presence in the study programs.

Competencias profesionales del Equipo Básico de Salud en prevención de violencia intrafamiliar / Professional competencies of the Basic Health Team in the prevention of intra-family violence

Fundamento: la violencia intrafamiliar representa un problema de salud y los profesionales de estas ciencias deben reconocer su existencia y estar debidamente preparados para prevenirla. Objetivo: identificar el nivel de competencia de los equipos básicos de salud en el manejo contra la violencia intrafamiliar en la edad pediátrica desde la atención primaria de salud. Métodos: se realizó un estudio descriptivo transversal en el Policlínico Universitario "Mártires del 10 de Abril", municipio Corralillo de enero a abril de 2021. Se utilizaron métodos teóricos y empíricos; para recogida de información se empleó el análisis de documentos y examen de competencia a profesionales de salud. Las variables en estudio fueron: categoría ocupacional, años de graduado, dimensiones cognitivas, procedimentales y actitudinales; y competencias profesionales en la prevención contra la violencia intrafamiliar. Resultados: El 52,94 % de los profesionales encuestados tenía más de 5 años de graduados, hubo predominio de residentes de MGI y licenciados en enfermería, respectivamente 44,12 % y 35,29 %. Las dimensiones de competencias en prevención contra la violencia intrafamiliar fueron evaluadas de medianamente adecuadas: la cognitiva en 18 (52,94 %), la procedimental en 21 (61,76 %) y la actitudinal en 24 (70,59 %). Conclusiones: el nivel de desarrollo de competencias profesionales resultó ser medianamente adecuado, como promedio. El diagnóstico realizado evidenció la necesidad de desarrollar competencias profesionales para la prevención contra la violencia intrafamiliar en edad pediátrica.

Background: intra-family violence represents a health problem and professionals in these sciences must recognize its existence and be properly prepared to prevent it. Objective: to identify the level of competence of the basic health team in the management of intra-family violence in the pediatric age. Methods: a cross-sectional descriptive study was carried out at the "Mártires del 10 de Abril" University Polyclinic, Corralillo municipality from January to April 2021. Theoretical and empirical methods were used; For the collection of information, the analysis of documents and the examination of the competence of health professionals were used. The variables under study were: occupational category, years of graduation, cognitive, procedural and attitudinal dimensions; and professional skills in the prevention of intra-family violence. Results: 52.94% of the surveyed professionals had more than 5 years working experience, there was a predominance of comprehensive General Medicine residents and nursing graduates, respectively 44.12% and 35.29%. The dimensions of competencies in intra-family violence prevention were evaluated as moderately adequate: cognitive in 18 (52.94%), procedural in 21 (61.76%), and attitudinal in 24 (70.59%). Conclusions: the level of development of professional skills turned out to be moderately adequate, on average. The diagnosis made showed the need to develop professional skills for the prevention of intra-family violence in children.

Concepción de la labor educativa desde el consultorio médico en el enfrentamiento a la COVID-19 / Conception of educational work from the doctor´s office while facing COVID-19

Fundamento: es necesario profundizar en los contenidos, formas y métodos de la labor educativa desde el consultorio médico de familia con los estudiantes de las ciencias médicas. Objetivo: caracterizar la concepción de la labor educativa asumida desde el consultorio médico de familia en el enfrentamiento a la COVID-19. Métodos: se realizó una investigación acción participativa, de corte transversal, en el período de marzo de 2020 a septiembre del 2021. El trabajo de campo se hizo con estudiantes de las carreras de Medicina, Enfermería y Estomatología, vinculados a los consultorios 17-17 y 17-37 pertenecientes al policlínico universitario "Chiqui Gómez-Lubián. Los métodos teóricos empleados fueron: analítico-sintético, inductivo-deductivo, histórico-lógico y enfoque de sistema; empíricos: análisis de documentos, observación de tipo participante, entrevista en profundidad y semiestructurada y análisis del producto de la actividad. Resultados: la concepción de la labor educativa empleada facilitó el trabajo de enfrentamiento a la pandemia de la COVID-19 desde el consultorio médico, la formación integral de los estudiantes y contribuyó al trabajo comunitario integrado. Conclusiones: el enfrentamiento a la COVID-19 permitió desplegar un sistema de acciones en la formación de los estudiantes que permitieron conformar una concepción acerca de la labor educativa desde el consultorio médico de familia.

Background: it is necessary to deepen the contents, forms and methods of the educational work from the family doctor's office with the students of medical sciences. Objective: to characterize the conception of the educational work assumed from the family doctor's office while facing COVID-19. Methods: a participatory, cross-sectional action research was carried out from March 2020 to September 2021. The field work was carried out with students from the Medicine, Nursing and Dentistry degrees, linked to clinics 17-17 and 17-37 belonging to the "Chiqui Gómez-Lubián" university polyclinic. Theoretical methods used were: analytical-synthetic, inductive-deductive, historical-logical and system approach; Empirical ones: document analysis, participatory observation and semi-structured interview and analysis of the product of the activity. Results: the conception of the educational work used facilitated the work to face COVID-19 pandemic from the doctor's office, the comprehensive training of students and contributed to integrated community work. Conclusions: the confrontation with COVID-19 allowed us to deploy a system of actions in the training of students that allowed us to form a conception about the educational work from the family doctor's office.

Ambiente escolar: una necesidad de aprendizaje por el médico de familia / School environment: a learning need for the family doctor

El Ministerio de Salud Pública cubano tiene orientada la realización de los controles médicos a los estudiantes y trabajadores que en su centro no cuentan con equipo básico de salud, en el consultorio médico de la comunidad. En el presente artículo los autores se proponen compartir con la comunidad científica los basamentos teóricos concernientes al proceso de superación, el cual responde a las necesidades de aprendizaje y constituye una vía primordial para que, gradualmente, los médicos de familia coadyuven a la solución de las insuficiencias académicas en determinados temas relacionados con el ambiente escolar y favorezcan el bienestar social desde su desempeño profesional y humano.

The Cuban Ministry of Public Health is oriented to carry out medical controls for students and workers who do not have basic health equipment in their center, in the community doctor's office. In this article the authors intend to share with the scientific community the theoretical foundations concerning the improvement process, which responds to the learning needs and constitutes a primary way for Gps to gradually contribute to the solution of the academic insufficiencies in certain topics related to the school environment and favor social well-being from their professional and human performance.

Programa educativo sobre cáncer de mama para mujeres del Consultorio Médico 028-2. Manicaragua / Educational program on breast cancer for women of the Doctor´s Office 028-2. Manicaragua, Cuba

Fundamento: el cáncer de mama representa un problema sanitario mundial por su alta incidencia; en la actualidad este es el de tipo de cáncer más frecuente en las mujeres. Objetivo: desarrollar un programa educativo sobre el cáncer de mama dirigido a las mujeres del Consultorio Médico 028-2, del Policlínico Docente "50 Aniversario", en Manicaragua. Métodos: se desarrolló un estudio prexperimental de intervención educativa evaluado por especialistas, en el Consultorio Médico 028-2, del Policlínico Docente "50 Aniversario" del municipio Manicaragua, entre enero 2021-enero 2022. Se utilizaron métodos teóricos: análisis-síntesis, inductivo-deductivo e histórico-lógico; empírico: análisis documental, encuesta y matemático-estadísticos para el análisis de los datos investigados. Resultados: predominaron las edades de 45 a 54 años, la mayoría no tenían antecedentes patológicos personales y sus conocimientos sobre cómo prevenir la enfermedad eran insuficientes, por lo que se diseñó un programa educativo, el cual fue valorado por criterios de especialistas. Conclusiones: después de ser valorado como adecuado, fue aplicado con muy buenos resultados entre las féminas; este programa se alerta sobre la necesidad de intensificar la labor educativa del médico y demás personal involucrado en la atención a las mujeres para que desarrollen conciencia sobre la importancia de la detección temprana de esta neoplasia.

Background: breast cancer represents a global health problem due to its high incidence; at present this is the most frequent type of cancer in women. Objective: to develop an educational program on breast cancer aimed at the women of the Doctor´Office 028-2, of the "50th Anniversary" Teaching Polyclinic, in Manicaragua. Methods: a pre-experimental study of educational intervention was developed, evaluated by specialists, in the Medical Office 028-2, of the "50 Aniversario" Teaching Polyclinic of the Manicaragua municipality, from January 2021 to January 2022. Theoretical methods were used: analysis-synthesis, inductive -deductive and historical-logical; Empirical ones: documentary, survey and mathematical-statistical for the analysis of the investigated data. Results: the ages of 45 to 54 years predominated, the majority had no past medical history and their knowledge on how to prevent the disease was insufficient, for which an educational program was designed, which was assessed by specialist criteria. Conclusions: after being evaluated as adequate, it was applied with very good results among the females; the need to intensify the educational work of the physician and other personnel involved in caring for women is alerted so that they develop awareness of the importance of early detection of this neoplasm.

Programa educativo para prevenir la leptospirosis en una zona rural de Jibacoa, Manicaragua, Cuba / Educational program to prevent leptospirosis in a rural area of Jibacoa, Manicaragua, Cuba

Fundamento: la leptospirosis es una zoonosis de distribución mundial que puede presentarse en zonas urbanas y rurales cuyo evidente resurgimiento se ilustra en los brotes recientes en todos los continentes. Objetivo: desarrollar un programa educativo sobre la leptospirosis en el Consultorio Médico 036-11, del poblado de Jibacoa, Manicaragua. Métodos: se desarrolló un estudio prexperimental de intervención educativa aprobado por especialistas, en el Consultorio Médico 036-11, de Jibacoa, Manicaragua entre marzo 2020-marzo 2022. Se utilizaron métodos teóricos: análisis-síntesis, inductivo-deductivo e histórico-lógico; empírico: análisis documental y cuestionario; y matemático-estadísticos para el análisis de los datos encontrados. Resultados: en el diagnóstico realizado predominaron los trabajadores del sexo masculino, la mayoría de ellos con riesgos para contraer la leptospirosis, la presencia de animales domésticos y roedores, e inadecuados conocimientos sobre la enfermedad. El análisis de situación de salud permitió caracterizar la comunidad rural con condiciones favorables para la proliferación de las leptospiras, por lo que se diseñó un programa educativo para capacitar a los habitantes del lugar sobre el tema, el cual valorado por criterios de especialistas. Conclusiones: después de valorado como adecuado se aplicó y demostró su efectividad al modificar positivamente los conocimientos de los habitantes en riesgo dentro de esa comunidad rural.

Background: leptospirosis is a zoonosis with worldwide distribution that can occur in urban and rural areas whose evident resurgence is illustrated in recent outbreaks on all continents. Objective: to develop an educational program on leptospirosis in the Doctor´s Office 036-11, in the town of Jibacoa, Manicaragua. Methods: a pre-experimental study of educational intervention approved by specialists was carried out at Doctor´s Office 036-11, in Jibacoa, Manicaragua from March 2020 to March 2022. Theoretical methods were used: analysis-synthesis, inductive-deductive and historical-logical; empirical: documentary analysis and questionnaire; and mathematical-statistical for the analysis of the data found. Results: male workers predominated in the diagnosis, most of them at risk of contracting leptospirosis, the presence of domestic animals and rodents, and inadequate knowledge about the disease. The analysis of the health situation allowed to characterize the rural community with favorable conditions for the proliferation of leptospirosis, for which an educational program was designed to train the inhabitants of the place on the subject, which was valued by specialist criteria. Conclusions: after being assessed as adequate, it was applied and demonstrated its effectiveness by positively modifying the knowledge of the inhabitants at risk within that rural community.

Modelo para capacitar sobre percepción de riesgo en VIH/sida a jóvenes del municipio Manicaragua / Model to train young people from the Manicaragua municipality, Cuba, on risk perception in HIV/AIDS

Fundamento: el VIH/sida es un problema de salud caracterizado por un severo compromiso de la inmunidad; esta entidad constituye factor de riesgo para el desarrollo de las principales causas de muerte a nivel mundial. Objetivo: proponer un modelo para capacitar sobre percepción de riesgo sobre el VIH/sida a jóvenes del Consultorio Médico 41 del área de salud Manicaragua. Métodos: se realizó un estudio observacional, descriptivo, transversal en el Consultorio Médico 41 del área de salud Manicaragua en la provincia de Villa Clara. Se aplicaron métodos teóricos: histórico-lógico, análisis síntesis, inducción-deducción, sistémico-estructural y modelación; empíricos: el cuestionario a jóvenes y la historieta de conflictos; matemáticos-estadísticos para el análisis de los datos. Resultados: las insuficiencias más frecuentes en la percepción de riesgo estuvieron relacionadas con las carencias en la información, la comprensión y la toma de decisiones para la prevención de salud. Se ofrece un modelo para la capacitación en percepción de riesgo ante el VIH/sida el cual fue valorado por criterios de especialistas. Conclusiones: el modelo posibilita la adquisición de conductas promotoras de la salud sexual, comprender y predecir cómo puede responderse a los peligros ante la enfermedad, contribuir al cambio de intención y comportamiento, y a asumir actitudes de protección. Fue valorado como aceptado por los especialistas consultados.

Background: HIV/AIDS is a health problem characterized by a severe compromise of immunity; this entity constitutes a risk factor for the development of the main causes of death worldwide. Objective: to propose a model to train young people from the Doctor´s office 41 in the Manicaragua health area on risk perception on HIV/AIDS. Methods: an observational, descriptive, cross-sectional study was carried out in the Doctor´s office 41 of the Manicaragua health area in the province of Villa Clara. Theoretical methods were applied: historical-logical, analysis synthesis, induction-deduction, systemic-structural and modeling; empirical ones: the questionnaire for young people and the conflict story; mathematical-statisticians for data analysis. Results: the most frequent deficiencies in risk perception were related to deficiencies in information, understanding and decision-making for health prevention. A model for training in risk perception to face HIV/AIDS is offered, which was assessed by specialist criteria. Conclusions: the model enables the acquisition of behaviors that promote sexual health, understanding and predicting how to respond to the dangers of the disease, contributing to the change of intention and behavior, and assuming protective attitudes. It was valued as accepted by the specialists consulted.

Programa educativo para el control de factores de riesgo modificables asociados al embarazo en adolescentes / Educational program for the control of modifiable risk factors associated with pregnancy in adolescents

Fundamento: el embarazo en adolescentes es una preocupación a nivel mundial, sobre todo para las naciones en desarrollo. Objetivo: determinar la efectividad de un programa educativo para el control de factores de riesgo modificables asociados al embarazo en la adolescencia, en el Consultorio Médico 5 de Esperanza entre febrero 2020-febrero de 2022. Métodos: se realizó un estudio de intervención de tipo cuasi experimental sin grupo de control. Se utilizaron métodos teóricos: histórico-lógico, analítico-sintético, inductivo-deductivo y abstracto-concreto. Del nivel empírico; revisión documental y encuesta. Resultados: se constató un predominio significativo de pacientes en etapa tardía de la adolescencia, 54,2 % con nivel preuniversitario, 79,2 % con primeras relaciones sexuales, de 15 años (45,8 %) y el vínculo de parejas de concubinato (29,2 %), sin abortos (58 %), como causa de los abortos forzados las dificultades económicas (17 %), no presencia de antecedentes familiares (54,1 %), la no presencia de infecciones de trasmisión sexual (75 %). Se modificaron los factores: consumo de alcohol, función familiar y uso de anticonceptivos. Se produjeron cambios muy significativos en el nivel de información de forma positiva. Conclusiones: se verificó la efectividad del programa educativo para el control de factores de riesgo modificables asociados al embarazo en la adolescencia.

Background: early pregnancy in adolescents is a global concern, especially for developing nations. Objective: determine the effectiveness of an educational program to control modifiable risk factors associated with teenage pregnancy, at the Esperanza 5 Medical Office from February 2020 to February 2022. Methods: a quasi-experimental intervention study was carried out without a control group. Theoretical methods were used: historical-logical, analytical-synthetic, inductive-deductive and abstract-concrete. From the empirical level; documentary review and survey. Results: a significant predominance of patients in late adolescence was found, 54.2% with pre-university level, 79.2% with first sexual relations, 15 years of age (45.8%) and the bond of cohabiting couples ( 29.2%), without abortions (58%), as the cause of forced abortions: economic difficulties (17%), no family history (54.1%), no presence of sexually transmitted infections (75% ). The factors were modified: alcohol consumption, family function and contraceptive use. There were very significant changes in the level of information in a positive way. Conclusions: the effectiveness of the educational program for the control of modifiable risk factors associated with pregnancy in adolescence was verified.

Improving the Quality of Residency Programs in Family and Community Medicine / Aprimorando a qualidade de Programas de Residência em Medicina de Família e Comunidade

ABSTRACT OBJECTIVE To develop and present an instrument to evaluate and monitor the quality of medical residency programs in residencies in family and community medicine (FCM) based on preceptors and residents, considering the insertion of the health network program. METHOD The instrument was developed in three stages: 1) interview with the preceptors of FCM; 2) literature review; and 3) production, adequacy, and approval of the evaluation instrument by renowned professionals of the Brazilian FCM. The third stage included 9 people and used the Delphi technique with 80% agreement. For the qualitative results, Bardin's Content Analysis was used. RESULTS In all, there were five evaluation cycles to adapt the proposed recommendations, with the elimination of one item and weighting, with a results analysis methodology of 10 resulting items, reaching an expected matrix for organizing residency programs in the health network, divided into 3 domains: Organization of the Unit, Human Resources, and Preceptor-resident relationship. CONCLUSION An instrument for evaluating and monitoring residency programs in family and community medicine can be a tool to facilitate program managers and allow evaluation and monitoring, continuously qualifying them.

RESUMO OBJETIVO Desenvolver e apresentar um instrumento para avaliar e monitorar a qualidade de programas de residência médica em medicina de família e comunidade (MFC) a partir dos preceptores e residentes, considerando a inserção do programa de rede de saúde. MÉTODO A elaboração do instrumento foi desenvolvida em três etapas: 1) entrevista com preceptores em MFC; 2) revisão da literatura; e 3) produção, adequação e aprovação do instrumento avaliativo por profissionais renomados na MFC brasileira. A terceira etapa contou com nove pessoas e utilizou a técnica Delphi com obtenção de 80% de concordância. Para os resultados qualitativos foi utilizada a análise de conteúdo de Bardin. RESULTADOS Ao todo ocorreram cinco ciclos de avaliação para adequação das recomendações propostas, com eliminação de um item e ponderação, e metodologia de análise de resultado de dez itens resultantes. Atingiu-se uma matriz esperada para a organização de programas de residência na rede de saúde, dividida em três domínios: organização da unidade, recursos humanos e relação preceptor-residente. CONCLUSÃO Um instrumento de avaliação e monitoramento de programas de residência em MFC pode ser uma ferramenta para auxiliar gestores de programas e permite a avaliação e monitoramento, qualificando-os continuamente.

Superación del médico general para la atención integral a niños con necesidades educativas especiales / Knowledge improvement of the general practitioner for comprehensive care for children with special educational needs

Fundamento: la superación especializada del médico general integral debe de estar encaminada a elevar su nivel profesional en la atención primaria de salud, particularizando en las características individuales de cada paciente. Objetivo: diagnosticar el estado actual de preparación de los médicos generales de la atención primaria de salud en cuanto al conocimiento para brindar atención integral y especializada a los niños con necesidades educativas especiales, pertenecientes al Policlínico Universitario "Ignacio Agramonte", de Camagüey. Métodos: se realizó un estudio descriptivo transversal entre los meses septiembre-diciembre de 2021. Se aplicaron métodos teóricos: histórico-lógico, análisis-síntesis e inducción-deducción; y empíricos, revisión documental y cuestionario a los médicos que laboran en los consultorios médicos del área. Resultados: el diagnóstico realizado permitió identificar falencias en la formación profesional del médico general desde su programa de formación en la especialidad Medicina General Integral, las que dificultan el trabajo exitoso en cuanto a la atención integral a niños con necesidades especiales, en aras de promover su inclusión social y el beneficio de su desarrollo individual. Conclusiones: las deficiencias encontradas ratifican la necesidad de implementar una estrategia de superación en cuanto al tema para perfeccionar el distintivo trabajo comunitario del médico general integral.

Background: the specialized improvement of the comprehensive general practitioner must be aimed at raising their professional level in primary health care, particularizing the individual characteristics of each patient. Objective: to diagnose the current state of preparation of general practitioners in primary health care in terms of knowledge to provide comprehensive and specialized care to children with special educational needs, belonging to the "Ignacio Agramonte" University Polyclinic in Camagüey. Methods: a cross-sectional descriptive study was carried out between from September to December 2021. Theoretical methods were applied: historical-logical, analysis-synthesis and induction-deduction; and empirical ones, documentary review and questionnaire to the doctors who work in the doctor´s offices of the area. Results: the diagnosis made possible to identify shortcomings in the professional training of the general practitioner from his training program in the Comprehensive General Medicine specialty, which hinder successful work in terms of comprehensive care for children with special needs, in order to promote their social inclusion and the benefit of their individual development. Conclusions: the deficiencies found ratify the need to implement an improvement strategy regarding the subject to improve the distinctive community work of the comprehensive general practitioner.

A preceptoria médica em medicina de família e comunidade: uma proposta dialógica com a andragogia / Medical preceptorship in family and community medicine: a proposal for dialogue with andragogy

Resumo: Introdução: O Brasil está em um amplo processo de fortalecimento das residências médicas nas áreas básicas, porém existe a necessidade de um currículo estruturado para qualificar a formação do preceptor. Objetivo: Este estudo teve como objetivo construir uma matriz dialógica para orientar a formação educacional da preceptoria em medicina de família e comunidade (MFC). Método: Por meio de um estudo qualitativo-analítico, analisaram-se três programas de preceptoria médica no Brasil: Associação Brasileira de Educação Médica, Hospital Sírio-Libanês e Hospital Alemão Oswaldo Cruz. Em seguida, uma proposta formativa foi apresentada contendo macrodiretrizes que possibilitem mudanças nos processos de ensino e aprendizagem para qualificação da prática preceptora em diálogo com a andragogia. Resultado: A matriz construída norteia-se pela aprendizagem do adulto, enfatizando a autonomia do aprendiz, em detrimento do controle da aprendizagem pelo educador. Envolve cinco dimensões: direcionalidade da formação; conteúdo; estratégias pedagógicas; concepções e estrutura formativa; e relação entre saúde, educação e pesquisa. Cada uma delas agrega um conjunto de diretrizes que valorizam o contexto e os princípios da formação em serviço no SUS; o desenvolvimento de competências acerca de conteúdos da atenção, gestão e educação em saúde; concepções e estruturas pautadas pela construção de vínculos significativos entre os sujeitos envolvidos no ato educativo, respeitando seus saberes prévios e experiências; estratégias pedagógicas colaborativas, trabalho com grupos operativos e o uso de tecnologias da informação e comunicação; e o estímulo à pesquisa como princípio educativo. Conclusão: A matriz considerou as necessidades da formação em MFC, baseando-se em aspectos-chave da andragogia. Acredita-se que ela possa promover mudanças nos processos de ensino-aprendizagem dos preceptores, com o objetivo de qualificar sua prática.

Abstract: Introduction: Brazil is in a broad process of strengthening medical residencies in basic areas, but there is a need for a structured curriculum to qualify the training of preceptors. Objective: To build a dialogic matrix to guide the educational training of preceptorship in Family and Community Medicine (FFM). Methodology: Through a qualitative-analytical study, three medical preceptorship programs in Brazil were analyzed, namely: Associação Brasileira de Educação Médica, Hospital Sírio-Libanês and Hospital Alemão Oswaldo Cruz. A training proposal was subsequently presented containing macro-guidelines that allow changes in the teaching and learning processes to qualify preceptor practice in dialogue with andragogy. Results: Based on andragogy, the resulting matrix emphasized the learner's autonomy, to the detriment of the educator's control of learning. It involves five dimensions: directionality of training; contents; pedagogical strategies; training concepts and structure; and the relationship between health, education and research. Each dimension included guidelines that value: the context and principles of in-service training in the SUS; the development of competences about the contents of health care, management and education; conceptions and structures guided by the construction of significant bonds between the subjects involved in the educational act, respecting their previous knowledge and experiences; collaborative pedagogical strategies, work with operative groups and the use of information and communication technologies; and encouraging research as an educational principle. Conclusion: The matrix considered the needs of FCM training, based on key aspects of andragogy. It can promote changes in the teaching-learning processes of preceptors, with the aim of qualifying their practice.

Power of Millets- Critical for addressing Ecological, Agrarian, and Emerging health crisis in Punjab

The state of Punjab is facing a major threat of ecological, agrarian as well as emerging health crisis. Continuously depleting water tables due to unregulated use of irrigation water and increased cultivation of water-thirsty, varieties of rice are posing major threat to water availability in the state. Indiscriminate use of chemicals in farming leading to soil infertility, polluted surface waters and air pollution are contributing to ecological catastrophe and eventually leading to many health problems in the population. Hence there is need to focus on environmentally friendly, economically viable and health benefitting solutions. Millets as climate change compliant crops score highly over other grains in terms of marginal growing conditions and high nutritional value are proposed as a solution for emerging challenges in Punjab.