Pratiques de prise en charge de l'hypertension artérielle au Centre Hospitalier et Universitaire d' Abomey-Calavi au Bénin / NA

L'hypertension artérielle est une maladie à forte progression reste un problème de santé publique. Mais, les pratiques de sa prise en charge se heurtent à différents obstacles. Cette recherche questionne les problèmes qui caractérisent les pratiques de prise en charge de l'hypertension artérielle au Centre Hospitalier et Universitaire d'Abomey-Calavi au Bénin. Pour y parvenir, nous avons opté pour une analyse basée sur les méthodes quantitatives et qualitatives. L'échantillon est constitué de 130 personnes enquêtées. De l'analyse des résultats collectés, des difficultés éprouvées entre patients et agents de santé dans la prise en charge de l'hypertension artérielle, se caractérise par le manque de relation soignant-soigné. De même, 90% des enquêtés estiment avoir peu de ressources humaines qualifiées et du faible pouvoir d'achat des patients pour faire face aux coûts élevés du traitement de l'hypertension (86,75%). Ainsi, le manque de plateau technique et les frais de consultations spécialisées posent problèmes y compris les suivis de l'éducation hygiéno-diététique. Cet état de fait compromet les pratiques de prise en charge et les formations globales que le système soin est supposé assurer aux usagers qui le fréquentent. Ces résultats suggèrent l'urgence de formations pour le renforcement des capacités pour repérer la précarité et la réorganisation des mesures de prise en charge de l' hypertension artérielle dans le périmètre sanitaire béninois.

Arterial hypertension remains a rapidly growing public health problem. However, management practices face a number of obstacles. This research questions the problems that characterize arterial hypertension management practices at the Centre Hospitalier et Universitaire d'Abomey-Calavi in Benin. To achieve this, we opted for an analysis based on quantitative and qualitative methods. The sample consisted of 130 respondents. From the analysis of the results collected, of the difficulties experienced between patients and health workers in the management of arterial hypertension, most of those surveyed claimed to have a complexity that characterizes the training of health workers. Similarly, 90% of respondents felt that they had few non-cardiologist practitioners, and that patients had little purchasing power to meet the high costs of treating hypertension (86.75%). As a result, the cost of specialized consultations and complementary examinations poses a problem, including follow-up health and diet education. This state of affairs compromises management practices and the comprehensive training that the healthcare system is supposed to provide for its users. These results suggest the urgent need for training to identify precariousness, and the reorganization of hypertension management measures within the Beninese health perimeter.

Comorbidades e saúde mental dos trabalhadores da saúde no Brasil. O impacto da pandemia da COVID-19 / Comorbities and mental health among healthcare workers in Brazil. The impact of the COVID-19 pandemic

Resumo Trata-se de um artigo original que aborda a força de trabalho (FT) em saúde no Brasil, suas comorbidades e alterações da saúde mental na pandemia da COVID-19. O estudo conduzido pela Fundação Oswaldo Cruz coletou dados por meio de questionário on-line com um total de 36.612 participantes: profissionais de saúde (PS, formação de nível superior), e trabalhadores invisíveis (TI, nível técnico). A prevalência de comorbidades no Brasil foi de 26,1% e 23,9%, a maior foi hipertensão arterial (27,4% e 31,9%), seguida da obesidade (18,4% e 15,1%), doenças crônicas respiratórias (15,7% e 12,9%), diabetes mellitus (10,3% e 10,4%), e depressão/ansiedade (9,1% e 11,7%), nos PS e TI, respectivamente. A região com maior frequência foi a sudeste onde concentra-se o maior contingente de trabalhadores. A FT acometida com alta carga de doenças crônicas não transmissíveis e exposta ao SARS-CoV-2, torna-se vulnerável para o adoecimento e morte. Sintomas mentais e intenso sofrimento psíquico foram relatados. Os resultados deste estudo nos permitem estimar o impacto na saúde física e mental, e nas condições de vida e de trabalho da FT. A saúde e a vida dos trabalhadores, protagonistas no enfrentamento dos desafios da pandemia, são prioridade nas políticas públicas.

Abstract This is an original article that addresses the healthcare workforce (HW) in Brazil, as well as comorbidities and mental health changes during the COVID-19 pandemic. This study was conducted by the Oswaldo Cruz Foundation and collected data through an online questionnaires from a total of 36,612 participants, health professionals (HP, with higher education level), and invisible healthcare workers (IHW, with a technical mid-level education). The overall prevalence of comorbidities in Brazil was 26.1% and 23.9%; the highest was arterial hypertension (27.4% and 31.9%), followed by obesity (18.4% and 15.1%), chronic respiratory diseases (15.7% and 12.9%), diabetes mellitus (10.3% and 10.4%), and depression/anxiety (9.1% and 11.7%), in the HW and IHW, respectively. The region with the highest frequency was the southeast, where the largest contingent of workers is located. The HW, affected with a high burden of non-communicable chronic diseases and exposed to SARS-CoV-2, proved to be vulnerable to illness and death. Mental symptoms and intense psychological suffering have been reported. These results allow us to estimate the impacts upon physical and mental health, as well as upon living and working conditions of the HW. The health and life of workers, leading role in facing health challenges of the pandemic, are a high priority in public policies.

EFFECTIVENESS OF SIMULATION BASED TEACHING PROGRAM ON KNOWLEDGE AND SKILL REGARDING BASIC NEONATAL RESUSCITATION PROCEDURES AMONG FEMALE HEALTH WORKERS OF SELECTED AREAS: A STUDY PROTOCOL

Background Of The Study: Worldwide, 136 million babies are born annually. 10 million require some stimulation at birth to breathe, while 6 million require basic resuscitation with a bag and mask. Evidence shows that 1 million neonatal deaths occur yearly on the day of birth. Near about 2 million babies die in the rst week of life and 4 million die in the neonatal period, which accounts for 46% of under-ve mortality. This mortality is estimated to increase to 52% in 2030 unless strategic interventions are implemented. To assess the effect of a simulation-based teaching Objective: program on knowledge and skill regarding basic neonatal resuscitation procedures among female health workers of selected areas. Pre-experimental one group pre-test post-test research design will be used. The duration of the study will Methodology: be one month. 60 female health workers from selected primary health centres and sub-health centres of Nagpur district will be selected as a sample through the simple random sampling technique. The structured questionnaire and standardized observational checklist will be used to assess the knowledge and skill respectively. Validity and reliability of the tool will be determined with appropriate standardized methods. Enhance knowledge and skill after simulation-based Expected Result: teaching program. Female health workers working in primary health centres and sub-health centres of Nagpur Limitation: district will be included in this study. The study ndings will reect the need for simulation based education to Conclusion: enhance the knowledge and skill of female health workers to identify birth asphyxia and its potential complications leading to neonatal mortality during the rst few hours after birth.

Análise dos indicadores de prazer e sofrimento no trabalho associados a ansiedade e depressão entre agentes comunitários de saúde / Analysis of indicators of pleasure and suffering at work associated with anxiety and depression among community health agents

RESUMO Objetivo Analisar os indicadores de prazer e sofrimento no trabalho associados a depressão e ansiedade entre agentes comunitários de saúde (ACSs). Métodos Estudo transversal, no qual variáveis dependentes foram a presença de sintomas de ansiedade e depressão, avaliadas com o Patient Health Questionnaire (PHQ-9) e com o Inventário de Ansiedade de Traço-Estado (IDATE). As variáveis independentes foram avaliadas com um questionário sociodemográfico e a Escala de Indicadores de Prazer e Sofrimento no Trabalho (EIPST) do Inventário do Trabalho e Riscos de Adoecimento (ITRA). As associações entre as variáveis foram testadas com o uso de regressão logística multinominal. Resultados Participaram do estudo 675 ACSs, sendo a maioria mulheres (83,7%), com até 40 anos (51,3%). As chances de apresentar sintomas de ansiedade foram maiores entre ACSs efetivos (1,61 [1,10-2,36]), e avaliações críticas ou graves nos fatores realização (Crítica 1,87 [1,30-2,68]; Grave 4,16 [2,06-8,40]) e esgotamento profissional (Crítica 2,60 [1,78-3,80]; Grave 3,97 [2,53-6,21]). Sexo feminino (2,12 [1,03-4,40]), idade de até 40 anos (1,741 [1,05-2,89]), tempo de serviço superior a cinco anos (1,88 [1,18-2,99]), avaliações crítica ou grave nos fatores realização (Crítica 2,53 [1,55-4,10]; Grave 6,07 [2,76-13,38]), esgotamento profissional (Crítica 5,21 [2,30-11,80]; Grave 15,64 [6,53-37,44]) e falta de reconhecimento (Crítica 1,93 [1,13-3,28]) estiveram associados a maiores chances de sintomas depressivos. Conclusões Apesar de se tratar de estudo transversal, que não permite inferir causalidade, os achados sugerem importante associação entre aspectos laborais dos ACS e os sintomas de ansiedade e depressão. Sexo feminino e possuir 40 anos ou menos também mostraram relação com o aumento dos sintomas de depressão.

ABSTRACT Objective To analyze indicators of pleasure and suffering at work associated with depression and anxiety among community health workers (CHW). Methods Crosssectional study in which the dependent variables were the presence of anxiety and depression symptoms, assessed using the Patient Health Questionnaire (PHQ-9) and State-Trait Anxiety Inventory (STAI). The independent variables were evaluated using the Scale of Indicators of Pleasure and Suffering at Work (EIPST) of the Inventory of Work and Risks of Illness (ITRA). Associations between dependent and independent variables were tested using multinomial logistic regression. Results 675 CHW participated in the study, the majority being women (83.7%), aged up to 40 years (51.3%). The chances of presenting anxiety symptoms were higher among effective CHW (OR=1.61; 95%CI: 1.10-2.36), and critical or severe assessments in the achievement factors (Critical OR=1.87; 95%CI: 1.30-2.68; Severe OR=4.16; 95%CI: 2.06-8.40) and professional exhaustion (Critical OR=2.60; 95%CI: 1.78-3.80; Severe OR=3.97; 95% CI: 2.53-6.21). Female gender (OR=2.12; 95%CI: 1.03-4.40), age up to 40 years (OR=1.74; 95%CI: 1.05-2.89), length of service greater than five years (OR=1.88; 95%CI: 1.18-2.99), critical or severe ratings on achievement factors (Critical OR=2.53; 95%CI: 1.55-4.10; Severe OR= 6.07; 95%CI: 2.76-13.38), professional exhaustion (Critical OR=5.21; 95%CI: 2.30-11.80; Severe OR=15.64; 95%CI: 6.53 -37.44) and lack of recognition (Critical OR=1.93; 95%CI: 1.13-3.28) were associated with greater chances of depressive symptoms. Conclusions Despite being a cross-sectional study, which does not allow inferring causality, the findings suggest an important association between the work aspects of the CHW and the symptoms of anxiety and depression. Female gender and being 40 years old or younger also showed a relationship with increased symptoms of depression.

Mortalidad de médicos por COVID-19 de acuerdo con su especialidad en la primera y segunda ola de la pandemia en el Perú

Introducción : El COVID-19 es una enfermedad infecciosa, declarada pandemia por la OMS en marzo 2020. Ha causado millones de muertes, incluidos médicos en el mundo. El objetivo fue determinar las características de la mortalidad de médicos por COVID-19 y la tasa de mortalidad específica por especialidad durante la pandemia del COVID-19 en el Perú. Material y métodos: Estudio descriptivo que evalúo la totalidad de médicos fallecidos reportados por el Colegio Médico del Perú hasta noviembre 2021 y que cumplieron con tener su certificado de defunción. Se definió tres grupos: médicos especialistas con alto (EMACC) y bajo contacto (EMBCC) con pacientes COVID-19 y médicos sin especialidad. Resultados: La edad >60 años y tener el sexo masculino en los EMACC mostraron un p=0,003 y 0,016 respectivamente. El 69,4% de médicos fallecieron en Lima y donde más fallecieron fue Hospital Rebagliati Martins (21%). La mayor tasa de mortalidad específica por especialidad (TME) fue 29,7 y 25,0 en epidemiología y administración de salud respectivamente. En la ciudad de Lima, fallecieron 69,4% de médicos, principalmente el grupo de EMBCC. Conclusión: Los médicos varones y >60 años son los que murieron con mayor frecuencia, sobre todo en la ciudad de Lima y en el grupo de EMACC. Las mayores tasas de mortalidad por el COVID-19 ha sido en el grupo de EMBCC.

Introduction: COVID-19 is an infectious disease declared a pandemic by the WHO in March 2020. It has caused millions of deaths, including among doctors in the world. The objective was to determine the characteristics of physician mortality from COVID-19 and the specific mortality rate by specialty during the COVID-19 pandemic in Peru. Material and methods: Descriptive study that evaluated all deceased physicians reported by the Medical College of Peru until November 2021 and who complied with having their death certificate. Three groups were defined: specialist physicians with high (EMACC) and low (EMBCC) contact with COVID-19 patients and physicians without a specialty. Results: Age >60 years and males in the EMACC showed p=0.003 and 0.016, respectively. 69.4% of doctors died in Lima, and most died at Rebagliati Martins Hospital (21%). The highest specialty-specific mortality rate was 29.7 and 25.0 in epidemiology and health administration, respectively. In Lima, 69.4% of physicians died, mainly in the EMBCC group. Conclusion: Male physicians >60 years old are the ones who die more frequently, especially in the city of Lima and in the EMACC group. The highest mortality rates from COVID-19 were in the EMBCC group.

Modos de vida e organização do trabalho de agentes comunitários de saúde de unidades fluviais na Amazônia / Ways of life and work organization of community health workers of river units in the Amazon, Brazil / Formas de vida y organización del trabajo de los agentes de salud comunitaria de las unidades fluviales en la Amazonía, Brasil

RESUMO: O artigo analisa modos de vida e organização do trabalho de agentes comunitários de saúde que atuam em comunidades rurais atendidas por Unidade Básica de Saúde Fluvial, no município de Manaus. Foram investigados atividades e desafios cotidianos desses profissionais, interação com as famílias atendidas, vínculos com as comunidades e com o ambiente natural. Pesquisa qualitativa exploratória realizada em 17 comunidades rurais ribeirinhas distribuídas na margem esquerda do Rio Negro, ao longo de 190 quilômetros. A coleta de dados em 2021 e 2022 abrangeu entrevista semiestruturada, questões escalonadas de apego ao lugar e observação participante da atuação dos agentes comunitários de saúde. Os resultados mostraram que a qualificação dos agentes atende às principais demandas do trabalho cotidiano em meio rural. O tempo de experiência mostrou-se relevante no cargo, indicando robusto conhecimento da natureza e apego ao lugar/comunidade, estabelecido por vínculos de parentesco, identificação e conhecimento do ambiente natural. Eles reconstroem práticas intersetoriais, priorizando intervenções associadas aos determinantes sociais, micropolíticos e culturais do processo saúde-doença e à participação na vida comunal em domicílios acessados exclusivamente por deslocamento fluvial e espalhados num vasto território. O trabalho administrativo intramuros foi interpretado como desvio de função e afastamento das interações cotidianas nos domicílios gerando insatisfação e desmotivação desses trabalhadores.

ABSTRACT: The article analyzes ways of life and organization of work of community health workers working in rural communities served by Basic Fluvial Health Unit, in the city of Manau, Brazil. Daily activities and challenges of these professionals were investigated, interaction with the families served, links with the communities and with the natural environment. Exploratory qualitative research conducted in 17 rural riverside communities distributed on the left bank of Rio Negro, along 190 kilometers. Data collection in 2021 and 2022 covered semi-structured interviews, staggered issues of attachment to the place and participant observation of the performance of community health workers. The results showed that the qualification of these workers meets the main demands of daily work in rural areas. The time of experience was relevant in the position, indicating robust knowledge of nature and attachment to the place/community, established by kinship links, identification and knowledge of the natural environment. They rebuild intersectoral practices, prioritizing interventions associated with social, micropolitical and cultural determinants of the health-disease process and participation in communal life in households accessed exclusively by river displacement and spread across a vast territory. The intramural administrative work was interpreted as deviation of function and removal of daily interactions in households, generating dissatisfaction and demotivation of these workers.

RESUMEN: El artículo analiza las formas de vida y organización del trabajo de los agentes comunitarios de salud que trabajan en comunidades rurales atendidas por la Unidad Básica de Salud Fluvial, en la ciudad de Manaus, Brasil. Se investigaron las actividades cotidianas y los desafíos de estos profesionales, la interacción con las familias atendidas, los vínculos con las comunidades y con el entorno natural. Investigación cualitativa exploratoria realizada en 17 comunidades ribereñas rurales distribuidas en la margen izquierda del Río Negro, a lo largo de 190 kilómetros. La recolección de datos en 2021 y 2022 abarcó entrevistas semiestructuradas, temas escalonados de apego al lugar y observación participante del desempeño de los agentes comunitarios de salud. Los resultados mostraron que la calificación de los agentes cumple con las principales demandas del trabajo diario en las zonas rurales. El tiempo de experiencia fue relevante en la posición, indicando un sólido conocimiento de la naturaleza y el apego al lugar/comunidad, establecido por vínculos de parentesco, identificación y conocimiento del medio natural. Reconstruyen las prácticas intersectoriales, priorizando las intervenciones asociadas a los determinantes sociales, micropolíticos y culturales del proceso salud-enfermedad y la participación en la vida comunal en los hogares a los que se accede exclusivamente por desplazamiento fluvial y que se extienden por un vasto territorio. El trabajo administrativo intramuros fue interpretado como desviación de función y eliminación de interacciones diarias en los hogares, generando insatisfacción y desmotivación de estos trabajadores.

Implementation and evaluation of a pilot WHO community first aid responder training in Kinshasa, DR Congo: A mixed method study

Introduction: Prehospital care in many low- and middle-income countries is underdeveloped and needs strengthening for improved outcomes. Where formal prehospital care systems are under development, integration of a layperson first responder programme may help improve access for those in need. The World Health Organization recently developed the Community First Aid Responder (CFAR) learning program in support of this system, providing that it may require adaptation to be contextually suitable and sustainably implemented at country level. This study assesses a pilot WHO CFAR course in Kinshasa, Democratic Republic of Congo, to inform future rollouts and related research. Methods: We conducted a 3-day in-person pilot CFAR training with 42 purposively selected community health workers. Data collection involved quantitative and qualitative phases. The first consisted of structured pre- and post-training surveys, and a course evaluation by participants. The second consisted of two focus group discussions involving purposively selected community health workers in one group, and a convenience sample of course instructors and organisers in the other. Perceptions regarding course content, perceived knowledge acquisition and self-confidence gain were analysed using descriptive statistics for the quantitative data and content analysis for qualitative data. Results: Course participants were predominantly male (76.3 %) with a median age of 42 years and most (80.5 %) had no prior first aid training. Most were satisfied that the learning objectives were reached, the logistics were adequate, and that the content and teaching language were appropriately tailored to local context. The majority (94.7 %) found the 3-day duration insufficient. There was a significant self-confidence gain regarding first aid skills (average 17.9 % in pre- to 95.3 % in post-training, p < 0.001). Favourable opinions on the course structure, content, logistics and teaching methods were noted. Conclusion: A CFAR course pilot was successfully conducted in Kinshasa. The course is appropriate for context and well received by participants. It can form a key component of developing prehospital care systems in resource-constrained settings.

National Assessment of the Health Extension Program in Ethiopia: Study Protocol and Key Outputs

BACKGROUND: The Health Extension Program (HEP) was introduced in 2003 to extend primary health care services by institutionalizing the former volunteer-based village health services.However, this program is not comprehensively evaluated.MATERIALS AND METHODS: The 2019 comprehensive national assessment of HEP involved (1) assessment through quantitative and qualitative primary data, (2) a thorough systematic review of the HEP literature, and (3) a synthesis of evidence from the two sources. The assessment included household survey(n=7122), a survey of health extension workers (HEWs) (n=584)_, and an assessment of health posts (HPs)(n=343) and their supervising health centers (HCs)(n=179)from 62 randomly selected woredas. As part of the comprehensive assessment.OUTPUT AND RESULTS: The outputs were (a) full and abridged reports, (b) 40 posters, (c) seven published, three under review scientific papers and (d) seven papers in this special issue. During the one-year period preceding the study, 54.8% of women, 32.1% of men, and 21.9% of female youths had at least a one-time interaction with HEWs. HPs and HEWs were universally available. There were critical gaps in the skills and motivation of HEWs and fulfillment of HP standards: 57.3% of HEWs were certified, average satisfaction score of HEWs was 48.6%, and 5.4% of HPs fulfilled equipment standards. CONCLUSIONS: The findings informed policy and program decisions of the Ministry of Health, including the design of the HEP Optimization Roadmap 2020­2035 and the development Health Sector Transformation Plan II. It is also shared with global community through published papers

Ethics and professionalism of a community health worker: A virtue ethics approach

Community health workers are the link between the community and the health system, delivering primary care services at the frontline. Every profession has its own ethics and professional values, and there is a need to formulate the ethics of community health work which should be informed by their rich experiential wisdom. In one such effort, we interviewed a senior community health worker in the Tamil Nadu health system and present it here as a virtue ethics case study. Several situations of ethical conflict arising in her work, and her process for resolving these conflicts were discussed during the interview. The worker discussed some ethical principles: doing good, not doing any harm, maintaining justice, being honest, providing respectful care, maintaining self-respect, being accessible, earning the community's trust, and building solidarity. This interview confirms the assumption that ethics and professionalism are inherent in this community health worker, and emphasises the need for systematic research to document the experiences of such frontline workers, and to frame relevant standards of ethics and professionalism in the local context.

Desigualdade em meio à crise: uma análise dos profissionais de saúde que atuam na pandemia de COVID-19 a partir das perspectivas de profissão, raça e gênero / Inequality in the middle of a crisis: an analysis of health workers during the COVID-19 pandemic from the profession, race, and gender perspectives

Resumo Estudos mostram que pessoas em condições de vulnerabilidade têm sofrido de forma mais intensa os impactos da pandemia de COVID-19, assim como alguns grupos sociais, como mulheres e negros. Essa expressão de desigualdade também se manifesta entre os trabalhadores da saúde, com maior exposição de alguns grupos específicos. Este artigo analisa a incidência da COVID-19 sobre os trabalhadores da saúde a partir das perspectivas de profissão, gênero e raça. Os dados foram coletados por uma survey online com 1.829 trabalhadores da saúde, realizada no mês de março de 2021. Encontramos que, efetivamente, há desigualdades nas experiências dos trabalhadores da saúde durante a crise sanitária gerada pela COVID-19. Essas desigualdades estão marcadas pela profissão de cada trabalhador e são atravessadas por suas características de gênero e raça.

Abstract Studies show that people in vulnerable conditions and some social groups such as women and black people have suffered more intensely from the COVID-19 pandemic impacts. This expression of inequality also manifests itself among healthcare workers, with greater exposure of some specific groups. This paper analyzes the effect of COVID-19 on health care workers and the working conditions in the Brazilian public health system, analyzed from professional, gender, and race perspectives. Data were collected from an online survey of 1,829 health workers conducted in March 2021. Indeed, we identified inequalities in health workers' experiences during the health crisis generated by COVID-19, which are marked by the profession of each worker and are traversed by their gender and race traits.

Desafos à atuação dos trabalhadores de Vigilância Sanitária nos serviços de saúde / Challenges to the performance of health surveillance workers in health services

Introdução: A vigilância sanitária é uma função precípua do Estado para proteção da saúde individual e coletiva mediante ações de controle de riscos, atuais ou potenciais, presentes na produção de bens e serviços, e integra o Sistema Único de Saúde. A vigilância sanitária de serviços de saúde é parte do escopo de atuação da Vigilância Sanitária (Visa) para o controle dos riscos e iatrogenias nos serviços de saúde. Objetivo: Analisar desafios à atuação dos trabalhadores de Visa nos serviços de saúde. Método: O estudo, de abordagem qualitativa, integra uma pesquisa financiada pelo CNPQ para análise do controle sanitário realizado pelas Visa em serviços de saúde da atenção básica e especializada. Utilizou-se a técnica de Grupo Focal com trabalhadores da Visa de oito estados brasileiros. As falas foram transcritas e analisadas segundo a técnica de análise de conteúdo temática, sistematizadas em duas categorias: Gestão e Organização dos Serviços e Condições de Trabalho. Resultados: Identificou-se problemas e desafios, tais como: incipiente planejamento das ações; dificuldades na organização do trabalho decorrentes da rotatividade de gestores, da falta de recursos humanos e tecnológicos, da ausência de coordenação e da integração dos níveis do Sistema Nacional de Vigilância Sanitária. Emergiram insatisfações e desafios sobre condições de trabalho, precarizações dos vínculos, baixos salários, equipes incompletas e necessidade de concursos públicos e de valorização do trabalho. Conclusões: A atuação da Visa em serviços de saúde requer a superação de múltiplos desafios, que perpassam a integração das ações nos distintos níveis de gestão e questões de capacitação, incorporação de tecnologias e de readequação de processos de trabalho.

Introduction: Health surveillance (Visa) is a primary function of the State for the protection of individual and collective health through risk control actions, current or potential, present in the production of goods and services, and is part of SUS (Brazilian Universal Health System). Health surveillance of health services is part of Visa's scope of action for the control of risks and iatrogenic diseases in health services. Objective: To analyze challenges to the performance of Visa in health services. Method: The study, with a qualitative approach, integrates research funded by CNPq to analyze the sanitary control carried out by Visa in health services of primary and specialized care; the Focus Group technique was used with Visa workers from 8 Brazilian states. The speeches were transcribed and analyzed according to the thematic content analysis technique, systematized in two categories: Management and Organization of Services, and Working Conditions. Results: Problems and challenges were identifed, such as: incipient planning of actions; difculties in the organization of work, resulting from the turnover of managers, the lack of human and technological resources, and the lack of coordination and integration of the levels of the National Health Surveillance System. Dissatisfactions and challenges about working conditions, precarious employment conditions, low wages, incomplete teams and the need for public tenders and work valorization emerged. Conclusions: Visa's performance in health services requires overcoming multiple challenges, which permeate the integration of actions at different levels of management and training issues, incorporation of technologies and readjustment of work processes.

Barriers to the Delivery and Uptake of Water Sanitation and Hygiene (WASH) Promotion and Infant Diarrhea Prevention Services: A Case Study in Rural Tribal Banswara, Rajasthan

Objective: We aimed to identify key barriers to Water Sanitation and Hygiene (WASH) promotion and infant diarrhea prevention services delivered by Accredited Social Health Activists (ASHAs) in rural India. Methods: A case-study was conducted across nine tribal villages in Banswara district (Rajasthan), where in-depth observational and qualitative data was collected from frontline health workers and infant caregivers. Results: ASHAs’ prioritization of their incentive-based link-worker tasks over their health activist roles, limited community mobilization, and lack of monitoring of such activities hindered the delivery of WASH promotion and infant diarrhea prevention services. Caregivers’ lack of trust in ASHA’s health knowledge and preference for private providers and traditional healers also hindered the uptake of ASHA’s health promotion services. Conclusions: Strengthening ASHAs’ health activism roles and building trust on frontline health workers’ knowledge among tribal communities will be the key to address the determinants of child malnutrition and stunting and accelerate progress towards the national development agenda.

Implementing active surveillance for tuberculosis: The experiences of healthcare workers at four sites in two provinces in South Africa

The high burden of tuberculosis (TB) in South Africa (SA) is associated with uncontrolled transmission in communities and delayed diagnosis of active cases. Active surveillance for TB is provided by community-based services (CBS). Research is required to understand key factors influencing TB screening services in the CBS. This study explored the implementation of active surveillance for TB where community-oriented primary care (COPC) had been successfully implemented to identify these factors.Methods: This was a qualitative study of four established COPC sites across two provinces in SA where active surveillance for TB is implemented. Semi-structured interviews were conducted with purposively selected healthcare workers in the CBS and citizens in these communities. The recorded interviews were transcribed for data analysis using ATLAS.tisoftware.Results: The factors influencing active surveillance for TB were directly related to the major players in the delivery of CBS. These factors interacted in a complex network influencing implementation of active surveillance for TB. Building effective relationships across stakeholder platforms by community health workers (CHWs) was directly influenced by the training, capacity building afforded these CHWs by the district health services; and acceptability of CBS. Each factor interplayed with others to influence active surveillance for TB.Conclusion: Community health workers were central to the success of active surveillance for TB. The complex interactions of the social determinants of health and TB transmission in communities required CHWs to develop trusting relationships that responded to these issues that have impact on TB disease and linked clients to healthcare.Keywords: tuberculosis; active case finding; community-oriented primary care; community health worker (CHW); community-based services; active surveillance.

Challenges to paediatric tuberculosis care as perceived by health workers in Kano, North-western Nigeria

uberculosis (TB) remains the world's deadliest infectious disease that affects a third of the world's population and newly infected an estimated 10 million people in 2018. The number of TB infected Nigerians ranks sixth in the world and first in Africa. Kano State has the highest Nigerian TB prevalence. I aimed to identify Paediatric TB care challenges as perceived by Kano Medical and DOT health care providers. The study design was prospective, descriptive and cross sectional involving structured questionnaire interviews of 43 healthcare providers, during TB supervision visits of 10 Health facilities in Kano. Generated data was entered, validated and analysed using the STATA 13 statistical software package. The sample size was convenient, since it is the number of all the health providers working in the facilities assigned to the author for supervision under a supervision contract with KNCV in 2017. Of the 43 respondents, there were 26 males, with a M: F ratio of 1.5: 1. Those health workers aged from 30 and 40 years constituted 58% of respondents. The staff cadre of respondents comprised of Community Health Extension Workers [CHEW] (40%), doctors (30%) and nurses (3%). Up to 51% of respondents had over 10 years health worker experience and greater than 36 months Child TB DOT care provision. The most commonly identified challenges to paediatric TB care included poor health knowledge (97.7%), poor health seeking behaviour (95.4%), poverty (95.4%), the inability of children to cough up sputum 95.4%, late presentation (90.7%), contact tracing logistics (90.7 %), patient and community factors of stigma and discrimination (86%) and poor health worker paediatric TB knowledge (70%). Perceived health worker challenges to effective Paediatric TB care were the adult orientation of the TB programme and its contact tracing logistic challenges, inadequate health worker Paediatric TB knowledge, children's inability to cough up sputum, poverty, poor patient TB health knowledge, community stigma and discrimination, poor health seeking behaviour and late presentation.

Rural community health workers’ readiness for mobile-phone based telemedicine uptake in India / Journal of Rural Medicine

Objective: Healthcare services using mobile-phone based telemedicine provide simple technology that does not require sophisticated equipment. This study assessed community health workers’ knowledge, attitude, and practice (i.e., their readiness) at the village level for uptake of mobile-phone based telemedicine.Materials and Methods: This cross-sectional study was conducted among 80 community health workers, including Auxiliary Nurse Midwives, Multipurpose Health Workers and Accredited Social Health Activists working in a rural health block of India. A pre-tested, semi-structured, interviewer-assisted, self-administered questionnaire was used to assess their mobile-phone based telemedicine readiness.Results: Sixty (75.0%) health workers owned mobile phones. The median readiness score for mobile-phone based telemedicine was 109.0. The Accredited Social Health Activists showed a better attitude toward mobile-phone based telemedicine than others. There was a significant moderate positive correlation (r=0.67) between knowledge and practice domains. Community health workers who had smartphones showed a significantly better attitude than those who did not.Conclusion: Training programs on telemedicine service delivery, focused on Auxiliary Nurse Midwives/ Multipurpose Health Workers, can improve their attitudes towards telemedicine. A better attitude of the Accredited Social Health Activists must be leveraged to initiate mobile-phone based telemedicine services on a pilot basis initially and later scaled up in other settings.

Principales características clínicas y epidemiológicas de trabajadores de la salud diagnosticados con COVID-19 en Santiago de Cuba / Main clinical and epidemiologic characteristics of health workers diagnosed with COVID-19 in Santiago de Cuba

Introducción: La COVID- 19 tiene repercusión en el sistema de salud pública del país y en personal sanitario. Objetivo: Describir algunas características clínicas y epidemiológicas del personal de salud diagnosticado con COVID-19 en un área de salud de Santiago de Cuba. Métodos: Se realizó un estudio descriptivo y retrospectivo de 19 trabajadores de la salud del Policlínico Docente Ramón López Peña de Santiago de Cuba, diagnosticados con la COVID-19 en el período febrero-abril de 2021. Las variables descritas fueron: edad, sexo, categoría ocupacional, comorbilidades, fuente de infección, síntomas y evolución. Resultados: Predominaron las féminas entre 40 y 59 años de edad (36,8 %), la fuente de infección comunitaria (52,6 %), los médicos como el personal más afectado (47,3 %) y las manifestaciones respiratorias (47,3 %); asimismo, 94,7 % de los afectados egresaron vivos y hubo un solo fallecido. Conclusiones: A pesar de la baja prevalencia de la COVID-19 en el personal de salud, se deben extremar las medidas de bioseguridad implementadas en cada institución para evitar nuevos contagios.

Introduction: The COVID-19 has repercussion in the public health system of the country and in health personnel. Objective: To describe some clinical and epidemiologic characteristics of the health personnel diagnosed with COVID- 19 in a health area of Santiago de Cuba. Methods: A descriptive and retrospective study of 19 health workers of Ramón López Peña Teaching Polyclinic in Santiago de Cuba was carried out. They were diagnosed with the COVID-19 during February-April, 2021. The described variables were: age, sex, occupational category, comorbidities, infection source, symptoms and clinical course. Results: There was a prevalence of the females between 40 and 59 years (36.8 %), community source of infection (52.6 %), doctors as the most affected health staff (47.3 %) and respiratory signs (47.3 %); also, 94.7 % of the affected patients were alive when discharged from the hospital and there was only one dead patient. Conclusions: In spite of the low prevalence of the COVID-19 in the health staff, the biosecurity measures implemented in each institution to avoid new infections should be maximized.

Estrés laboral: una revisión de las principales causas consecuencias y estrategias de prevención / Work Stress: A Review of the Main Causes, Consequences, and Prevention Strategies / O estresse no trabalho: uma revisão das principais causas, consequências e estratégias de prevenção

Introducción: El estrés laboral es una enfermedad peligrosa que altera el estado psicológico de la persona, porque genera reacciones y respuestas de tipo emocional, cognitivo, fisiológico y del comportamiento frente a situaciones con alta demanda laboral que sobrepasa los recursos personales y del trabajo. Se considera una problemática de tipo social y económica asociada con factores de riesgo psicosocial y con desencadenantes. Por ello, es fundamental su detección precoz, para evitar sus secuelas y para emplear estilos de afrontamiento. Objetivo: Analizar los referentes teóricos del estrés laboral, teniendo en cuenta sus principales causas, consecuencias y estrategias de prevención en el ámbito laboral. Metodología: Revisión documental disponible en las bases de datos Epistemonikos, ProQuest, Frontiers in Psychology, Academy, Biblioteca Digital, Elsevier, Redalyc, Dialnet, SciELO y Science Direct, de estudios publicados entre 2015 y 2020 que incluyeran conceptos de estrés laboral, causas, consecuencias y estrategias de prevención. Se revisaron 60 artículos, y para seleccionar la información se aplicó búsqueda, organización, categorización y análisis de 5554 documentos electrónicos. Se excluyeron 6 estudios relacionados con temas específicos del síndrome de burnout. Conclusiones: El estrés es una problemática prevalente en el contexto organizacional que se genera por múltiples factores asociados con las condiciones laborales y personales y origina en el individuo consecuencias fisiológicas y mentales que afectan su desempeño y productividad. De ahí que sea necesario incentivar una cultura preventiva que fomente la salud de los colaboradores.

Introduction: The labor stress is dangerous disease that alters the psychological state of the person, by generating emotional, cognitive, physiological and behavioral reactions and responses to situa-tions with high work demand that exceeds personal and work resources. It is considered as a social and economic problem associated with psychosocial risk factors and triggers, which, it is essential to attach importance to its early detection and thus avoid its consequences, as well as the use of coping styles. Objective: To analyze the theoretical references of work stress, considering the main causes, conse-quences and prevention strategies in the workplace. Methodology: Documentary review available in the databases Epistemonikos, ProQuest, Frontiers in Psychology, Academy, Bibliotheca Digital, Elsevier, Redalyc, Dialnet, SciELO and Science Direct. Inclusion criteria: works published between 2015 and 2020 that include concepts of work stress, causes, consequences and prevention strategies. 60 articles were reviewed to select the information, a search, organization, categorization and analysis of 5554 electronic documents were applied, 6 studies related to specific topics of Burnout syndrome were excluded. Conclusions: Stress is a prevalent problem in the organizational context that is generated by multiple factors associated with the work and personal conditions, originating in the individual consequences of physiological and mental type affecting the performance and the productivity, being necessary to stimulate a preventive culture that promotes the health of the collaborators.

Introdução: O estresse relacionado ao trabalho é uma doença perigosa que altera o estado psicoló-gico da pessoa, pois gera reações emocionais, cognitivas, fisiológicas, comportamentais e respostas a situações com altas exigências de trabalho que excedem os recursos pessoais e de trabalho. É conside-rado um problema social e econômico associados a fatores de risco psicossociais e desencadeadores. É, portanto, essencial detectá-lo cedo, para evitar suas consequências e usar estilos de enfrentamento. Objetivo: Analisar as referências teóricas do estresse relacionado ao trabalho, levando em conta suas principais causas, consequências e estratégias de prevenção no local de trabalho. Metodologia: revisão documental disponível nas bases de dados Epistemonikos, ProQuest, Frontiers in Psychology, Academy, Digital Library, Elsevier, Redalyc, Dialnet, SciELO e Science Direct, de estudos publicados entre 2015 e 2020 que incluíam conceitos de estresse relacionado ao trabalho, causas, consequências e estratégias de prevenção. Sessenta artigos foram revisados, e para selecionar as informações, foi aplicada uma pesquisa onde foram organizados, categorizados e analisados 5554 documentos eletrônicos. Foram excluídos seis estudos relacionados a questões específicas da Síndro-me de Burnout. Conclusões: O estresse é um problema predominante no contexto organizacional que é gerado por múltiplos fatores associados às condições de trabalho e pessoais, e causa consequências fisiológicas e mentais no indivíduo que afetam seu desempenho e produtividade. Portanto, é necessário incentivar uma cultura preventiva que promova a saúde dos funcionários.Palavras-chave: estresse ocupacional; psicossocial; saúde ocupacional; trabalhadores.

Fatores associados à pré-hipertensão e hipertensão arterial em trabalhadores de saúde que atuam em serviços de alta complexidade / Factors associated with prehypertension and hypertension among healthcare workers working in high-complexity services

Resumo Objetivou-se estimar a prevalência e fatores associados à pré-hipertensão e hipertensão arterial entre trabalhadores de saúde que atuam em setores de alta complexidade para pacientes críticos e crônicos. Foi realizado um estudo epidemiológico, transversal com 490 trabalhadores de saúde da macrorregional do norte de Minas Gerais, Brasil. A variável dependente pressão arterial foi categorizada em normal, pré-hipertensão e hipertensão. Para análise múltipla, foi utilizada a Regressão Logística Multinomial. A prevalência da hipertensão arterial foi de 21,8% e da pré-hipertensão foi de 25,9%. As chances de se desenvolver a hipertensão arterial e a pré hipertensão foram maiores nos profissionais do sexo masculino, com idade ≥40 anos, em trabalhadores com vínculo empregatício concursado e naqueles obesos ou com sobrepeso. O uso de medicamento contínuo e o trabalho no turno noturno estiveram associados à hipertensão e pré-hipertensão, respectivamente. A prevalência de hipertensão arterial no grupo de trabalhadores foi menor do que a da população brasileira. São necessários estudos com trabalhadores desse grupo e investimentos em medidas preventivas e que incentivem a mudança para um estilo de vida saudável.

Abstract The objective was to estimate the prevalence and factors associated with prehypertension and hypertension among health workers who work in high-complexity services for critically-ill and chronic patients. An epidemiological, cross-sectional study was carried out with 490 health workers in the macroregional region of Northern Minas Gerais, Brazil. The dependent variable blood pressure (BP) was categorized as normal BP, prehypertension and hypertension. Multinomial Logistic Regression was used for the multiple analysis. The prevalence of arterial hypertension was 21.8% and that of prehypertension was 25.9%. The chances of developing arterial hypertension and prehypertension were higher in male professionals, aged ≥40 years, in civil servant workers and those who were obese or overweight. The use of continuous medication and night shift work were associated with hypertension and prehypertension, respectively. The prevalence of arterial hypertension in the group of workers was lower than that of the Brazilian population. It is necessary to carry out studies with workers from this group and investments are required in preventive measures that encourage a change to a healthy lifestyle.

Disminución del índice de masa corporal al sustituir bebidas endulzadas por agua simple / Decrease in body mass index when substituting sweetened beverages for plain water

Background: Health professionals recommend increasing your water intake, to 8 cups per day to reduce weight. Despite the widespread adoption of this advice, the evidence for its efficacy is limited. Objective: To evaluate the substitution of sweetened beverages for plain water as an intervention to decrease the body mass index (BMI) in health workers. Materials and methods: An analytical, quasi-experimental, longitudinal and prospective study was carried out at the HGZ MF #1 from October 15, 2019 to April 15, 2020. A collection instrument was developed to collect information to evaluate water intake in IMSS workers, recommending the consumption of simple water at 8 cups per day and determined anthropometric measurements at the beginning and at the end of the study. Results: Data collection was carried out on 150 healt workers who agreed to participate. The age was 40.1 ± 8.4 years, with a greater distribution in women with 60.0%, the majority belonged to the morning shift (46.0%). After the intervention, we found that only 9.3% had an intake of less than 1 l/day, 23.3% from 1 to 1.5 l/day, and 67.3% had the recommended intake of 1.6 to 2 l/day. The initial weight was 87.0 ± 17.4 kilograms vs. 84.1 ± 15.4 kilograms at the end. For its part, the initial BMI was 31.1±4.8 kg/m2 and the final BMI was 30.1 ± 4.4 kg/m2 . Inferential analysis using the test of differences for paired samples identified a statistically significant difference in favor of the intervention for BMI with a mean reduction of 1.004 kg/m2 (95% CI 0.776-1.232, p < 0.001). Conclusions: The substitution of sweetened beverages for plain water as an intervention to decrease the BMI in IMSS workers with statistically significant results that adopt our working hypothesis.

Antecedentes: Los profesionales de la salud recomiendan aumentar el consumo de agua a 8 tazas por día para reducir el peso. A pesar de la adopción de este consejo, la evidencia de su eficacia es limitada. Objetivo: Evaluar la sustitución de bebidas edulcoradas por agua simple como intervención para disminución del índice de masa corporal (IMC) en trabajadores sanitarios. Materiales y métodos: Se llevó a cabo un estudio analítico, cuasiexperimental, longitudinal y prospectivo, en el Hospital General de Zona / Medicina Familiar N° 1, de La Paz, México, del 15 de octubre de 2019 al 15 de abril de 2020. Se desarrolló un instrumento de recolección para recopilar información para evaluar la ingesta de agua en trabajadores de la salud, recomendando el consumo de agua simple de 8 tazas por día; se determinaron medidas antropométricas al inicio y al final del estudio. Resultados: Se realizó la recolección de los datos de 150 trabajadores del Instituto Mexicano del Seguro Social (IMSS) que aceptaron participar. La edad fue de 40.1 ± 8.4 años, con una distribución mayor en mujeres, con 60.0%; la mayoría pertenecía al turno matutino (46.0%). Luego de la intervención, encontramos que solo el 9.3% tenía ingesta de menos de 1 l/día, el 23.3% de 1 a 1.5 l/día y el 67.3% presentó la ingesta recomendada de 1.6 a 2 l/día. El peso inicial fue de 87.0 ± 17.4 kg vs. 84.1 ± 15.4 kg al final. Por su parte, el IMC inicial fue 31.1 ± 4.8 kg/m2 y final de 30.1 ± 4.4 kg/m2 . El análisis inferencial mediante la prueba de diferencias para muestras emparejadas identificó una diferencia estadísticamente significativa en favor de la intervención para el IMC, con una reducción media de 1.004 kg/m2 (IC 95%: 0.776 a 1.232, p < 0.001). Conclusiones: La sustitución de bebidas edulcoradas por agua simple como intervención para disminución del IMC en trabajadores del IMSS, logró resultados estadísticamente significativos, que confirman nuestra hipótesis de trabajo.

O trabalho dos agentes comunitários de saúde à luz da teoria comunidades de prática / The work of community health workers in light of communities of practice theory

Resumo Analisou-se o trabalho dos Agentes Comunitários de Saúde (ACS), à luz da teoria das Comunidades de Prática (CdP). Estudo qualitativo transversal, realizado em quatro municípios do Ceará. Realizaram-se seis grupos focais e seis entrevistas com 45 ACS, respeitando os aspectos éticos. O corpus de dados foi analisado pela técnica de análise de conteúdo. Os resultados apontaram que a participação dos ACS na ESF é marcada pela vivência na comunidade, sendo o foco principal o acompanhamento dos grupos prioritários. As práticas os colocam diante das diversas complexidades sociais e familiares, gerando reflexões e construções de novos significados para si e o processo de trabalho. As CdP dos ACS se engajam e compartilham desafios e aprendizados singulares do trabalho, caracterizado pelo contato e relacionamento íntimo com as famílias do território, que revelam necessidades pouco percebidas pelos demais profissionais da ESF. Quanto aos processos de reificação, evidenciou-se o significado de ser ACS como aquele que escuta e acolhe, além do que, percebe as necessidades das famílias invisíveis aos serviços. Os ACS exercem melhor o papel de articulador da ESF nos territórios, quanto maior forem os espaços de diálogo entre eles, os demais membros da equipe e a gestão.

Abstract The work of Community Health Workers (ACS) was analyzed in light of Communities of Practice (CP) theory. This is a qualitative cross-sectional study carried out in four municipalities in Ceará. Six focus groups and six interviews were carried out with 45 Community Health Workers (ACS), observing ethical aspects. The data corpus was analyzed using the content analysis technique. The results show that ACS participation in the ESF is marked by experience in the community, and the main focus is monitoring priority groups. The practices put them before the diverse social and family complexities, generating reflections and building new meanings for themselves and their work process. The ACS CPs engage and share challenges and unique learning from work, characterized by close contact and relationships with the families of the territory, which reveals needs hardly perceived by other ESF professionals. The meaning of being ACS as one who listens, embraces, and perceives the needs of families invisible to services, is evident in the reification processes. The ACS better exercise their role as ESF articulators in the territories the greater the spaces for dialogue between them, the other team members, and management.