Curso de investigación en Atención Primaria de la Salud: experiencia sobre módulo de búsqueda bibliográfica y gestores de citas / Research course in Primary Health Care: experience with the bibliographic search module and citation managers

La Federación Argentina de Medicina Familiar y General apoyó el desarrollo, la difusión y la implementación de una propuesta educativa sobre investigación en atención primaria. Consiste en 4 módulos independientes, destinado para miembros interesados/as, con 2 encuentros virtuales teórico-prácticos, que favorecieran el intercambio de opiniones y experiencias entre colegas. El objetivo del primer módulo fue proporcionar conocimiento, brindar pautas y ofrecer herramientas para la búsqueda bibliográfica y el uso de gestores de citas. Se realizó difusión mediante sociedades y redes sociales. Se incluyó una evaluación individual, que diera cuenta de lectura complementaria y la aplicación práctica de los contenidos. Se llevó a cabo en Junio, con 39 preinscripto/as, mayoritariamente residentes. Hubo 24 participantes efectivos (61%), asistieron 17 y 20 personas respectivamente, y 11 (46%) obtuvieron el certificado de aprobación por responder la consigna en tiempo y forma. En cuanto a los/as asistentes, hubo predominio de mujeres (79%), provenientes de Asociación Metropolitana de Medicina Familiar (25%), Asociación Cordobesa de Medicina Familiar y Comunitaria (16%), Asociación Misionera de Medicina General/Familiar y del Equipo de Salud (16%), Asociación Tucumana de Medicina Familiar, General y Comunitaria (12%), y otras minorías. Expresaron satisfacción, agradecimiento y reconocimiento por la actividad, destacando la buena predisposición de organizadores y equipo docente, la utilidad práctica de la temática, la evidente planificación, y el apoyo político-económico. Esta valiosa experiencia educativa (planteada como necesidad pendiente) resultó exitosa, ya que los/as participantes demostraron un alto nivel de interés, de asistencia de diferentes provincias, y de compromiso. Los certificados emitidos otorgan créditos educativos válidos para la recertificación (AU)

The Federación Argentina de Medicina Familiar y General supported the development, dissemination and implementation of an educational proposal on research in primary care. It consists of 4 independent modules, intended for interested members, with 2 virtual theoretical-practical meetings, which favored the exchange of opinions and experiences among colleagues. The objective of the first module was to provide knowledge, guidelines and tools for bibliographic search and the use of citation managers. Dissemination was carried out through societies and social networks. An individual evaluation was included, to account for complementary reading and the practical application of the contents. It was carried out in June, with 39 pre-registered participants, mostly residents. There were 24 effective participants (61%), 17 and 20 people attended respectively, and 11 (46%) obtained the certificate of approval for answering the instructions in due time and form. As for the attendees, there was a predominance of women (79%), coming from Asociación Metropolitana de Medicina Familiar (25%), Asociación Cordobesa de Medicina Familiar y Comunitaria (16%), Asociación Misionera de Medicina General/Familiar y del Equipo de Salud (16%), Asociación Tucumana de Medicina Familiar, General y Comunitaria (12%), and other minorities. They expressed satisfaction, gratitude, and recognition for the activity, highlighting the good predisposition of the organizers and teaching team, the practical usefulness of the subject matter, the evident planning, and the political-economic support. This valuable educational experience (raised as a pending need) was successful since the participants showed a high level of interest, attendance from different provinces, and commitment. The certificates issued grant educational credits valid for recertification (AU)

Fatores que atraem, fixam, frustram ou afastam médicos de família da atenção primária de Florianópolis / Factors that attract, fix, frustrate or pull away family physicians from primary care in Florianópolis / Factores que atraen, fijan, frustran o alejan a los médicos de familia de la atención primaria en Florianópolis

Introdução: Um dos principais desafios da atenção primária no Brasil é a falta de fixação de profissionais médicos nas equipes de Saúde da Família, causando prejuízos à longitudinalidade, atributo essencial da atenção primária. Objetivo: Identificar os fatores que influenciam na atração de médicos de família e comunidade (MFC) para a atenção primária de Florianópolis, bem como fatores que os mantêm, os frustram ou os afastam. Métodos: Pesquisa qualitativa por meio de entrevistas em profundidade analisadas por análise de conteúdo convencional. Sorteamos 30 médicos de família de um painel amostral composto de três grupos: a) MFC estatutários e ativos na atenção primária de Florianópolis; b) MFC exonerados a partir de 2021; e c) médicos que prestaram, mas não assumiram, o concurso público de 2019, concurso que exigia título de especialista em MFC e foi o último realizado até o momento. Resultados: Entrevistamos 12 MFC, todos com residência médica. Deles, cinco compunham o grupo de profissionais que se exoneraram; três estavam atuantes na rede; e quatro compunham o grupo de MFC que foram aprovados no último concurso ofertado em 2019, porém não assumiram o cargo. Em síntese, os MFC são atraídos para trabalhar em Florianópolis por aspectos da cidade e pela possibilidade de desempenhar plenamente o trabalho de médico de família. Entretanto, as fragilidades do sistema de saúde público, agravadas nos últimos cinco anos e acentuadas no período crítico da pandemia de COVID-19 frustram os médicos de família a ponto de eles desejarem abandonar a atenção primária ou manter-se trabalhando às custas de sua saúde mental. Os motivos que mantêm ou mantiveram os médicos na atenção primária de Florianópolis foram principalmente a redução da carga horária assistencial e seus vínculos com família e amigos na cidade. A decisão final de exonerar-se partiu do sofrimento psíquico associado ao sentimento de sobrecarga no trabalho e/ou do salário menor que o desejado. Conclusões: Apoiados na análise dos dados, supomos que algumas estratégias, se adotadas, amenizariam a frustração de quase todos os entrevistados: a redução da carga horária com salário proporcional; a contratação de MFC volantes para cobrir ausências; a implementação de um registro eletrônico de saúde que integrasse todas as plataformas digitais utilizadas rotineiramente; o remanejamento das questões burocráticas para um profissional administrativo.

Introduction: One of the main challenges in primary care in Brazil lies in retaining medical professionals in Family Health teams, which affects the attribute of longitudinality, an essential aspect of primary care. Objective: This study aimed to identify the factors that influence the attraction of family physicians (FP) to primary care in Florianópolis, as well as the factors that keep them engaged, frustrate them, or lead to their disengagement. Methods: A qualitative research design was employed, using in-depth interviews analyzed through conventional content analysis. Thirty family physicians were randomly selected from three groups: a) Statutory and active FP in primary care in Florianópolis; b) FP dismissed from service starting in 2021; and c) physicians who applied for the public competition held in 2019, which required a specialist title in Family Practice and was the last competition held to date. Results: Twelve FP were interviewed, all with medical residency. Among them, five belonged to the group of professionals who were dismissed, three were actively working in the primary care network, and four were among those who passed the last competition held in 2019 but did not assume the position. In summary, family physicians are attracted to work in Florianópolis due to certain aspects of the city and the opportunity to fully carry out their role as family doctors. However, weaknesses in the public health system, exacerbated over the past five years and further intensified during the critical period of the COVID-19 pandemic, have frustrated family physicians to the point of considering leaving primary care or continuing to work at the expense of their mental health. The factors that keep or have kept physicians in primary care in Florianópolis are mainly the reduction of clinical workload and their personal ties with family and friends in the city. Conversely, the final decision to resign stemmed from the psychological distress associated with work overload and/or receiving a lower salary than desired. Conclusions: Based on data analysis, it is inferred that the adoption of certain strategies could alleviate the frustration experienced by almost all participants: reducing workload with proportional salary adjustments, hiring mobile FP to cover absences, implementing an electronic health record integrating all routinely used digital platforms, and assigning bureaucratic tasks to an administrative professional.

Introducción: Uno de los principales desafíos en la atención primaria en Brasil radica en la retención de profesionales médicos en los equipos de Salud de la Familia, lo cual afecta la longitudinalidad, un atributo esencial del cuidado primario. Objetivo: El propósito de este estudio fue identificar los factores que inciden en la atracción de médicos de familia y comunidad (MFC) hacia la atención primaria en la ciudad de Florianópolis, así como los aspectos que influyen en su permanencia, desmotivación o alejamiento. Métodos: Se llevó a cabo una investigación cualitativa mediante entrevistas en profundidad, las cuales fueron analizadas mediante el método de análisis de contenido convencional. Se seleccionó aleatoriamente a 30 médicos de familia provenientes de tres grupos: a) MFC estatutarios y activos en la atención primaria de Florianópolis; b) MFC destituidos a partir del año 2021; y c) médicos que se presentaron al concurso público de 2019, el cual exigía el título de especialista en MFC y representó el último concurso realizado hasta la fecha. Resultados: Se entrevistaron a 12 MFC, todos con residencia médica. De ellos, cinco pertenecían al grupo de profesionales que fueron destituidos; tres estaban ejerciendo en la red de atención primaria; y cuatro integraban el grupo de MFC que aprobaron el último concurso ofrecido en 2019, aunque no asumieron el cargo. En resumen, los médicos de familia son atraídos a trabajar en Florianópolis debido a ciertos aspectos relacionados con la ciudad y a la posibilidad de desempeñar plenamente su labor como médicos de familia. No obstante, las debilidades del sistema de salud público, agravadas en los últimos cinco años y acentuadas durante el período crítico de la pandemia de COVID-19, generan frustración en los médicos de familia al punto de considerar abandonar la atención primaria o continuar trabajando a expensas de su salud mental. Los factores que motivan o motivaron a los médicos a permanecer en la atención primaria de Florianópolis fueron principalmente la reducción de la carga horaria asistencial y sus vínculos con familiares y amigos en la ciudad. Por otro lado, la decisión final de destituirse provino del sufrimiento psíquico asociado a la sobrecarga laboral y/o a un salario menor al deseado. Conclusiones: A partir del análisis de los datos, se infiere que la adopción de ciertas estrategias podría mitigar la frustración en la mayoría de los entrevistados: la reducción de la carga horaria con un salario proporcional; la contratación de MFC móviles para cubrir ausencias; la implementación de un registro electrónico de salud que integre todas las plataformas digitales utilizadas rutinariamente; y la asignación de cuestiones burocráticas a un profesional administrativo.

Nosological profile of dermatological diseases in primary health care and dermatology secondary care in Florianópolis (2016-2017)

Abstract Background Dermatology encompasses the management of many disorders of the skin and cutaneous appendages, making the analysis of epidemiological profiles relevant for health planning. Objective The study aims to describe the nosological profile of dermatological diseases in Florianopolis, analyzing the interrelation among the primary health care and dermatology services, from January 2016 to December 2017. Method Descriptive study from records of medical visits from the primary health care and dermatology services, as well as records of reports issued by the teledermatology service. Results In primary health care, from 55,265 medical visits - 28,546 in 2016 and 26,719 in 2017, there was a higher prevalence of "Atopic dermatitis" (6.38%), "other disorders of skin and subcutaneous tissue" (5.10%), and "Scabies" (4.55%). In dermatology secondary care, from 19,964 visits - 10,068 in 2016 and 9626 in 2017, the most prevalent diagnoses were "Other malignant neoplasms of the skin" (14.75%) and "Skin changes due to chronic exposure to nonionizing radiation" (10.20%). Study limitations Some dermatological consultations in primary health care may have been under-registered due to the attribution of non-specific or overly broad diagnoses. Conclusion This study presents different nosological profiles of skin diseases in primary health care and dermatology secondary care, reinforcing the importance of primary health care's role in the management of less complex conditions, referring more complex cases that require more specialized experience to dermatology services..

Factores de atracción y expulsión de médicos migrantes. Estudio de caso de Pedro Aguirre Cerda / Attraction and expulsion factors that affect physician migration. The Pedro Aguirre Cerda case study

Introducción: La migración es un fenómeno a nivel mundial que involucra a los trabajadores de las diferentes áreas como son los profesionales de la salud. Objetivo: Determinar factores de atracción-expulsión que han motivado a los médicos extranjeros a migrar escogiendo a Chile como destino, desde la perspectiva de los encargados de salud en Atención Primaria de Salud. Materiales y métodos: Estudio de caso teórico-explicativo con abordaje cualitativo en epidemiología crítica, realizado en la municipalidad de Pedro Aguirre Cerda (Chile). Se aplicó entrevistas individuales semiestructuradas a actores tomadores de decisión en la APS. Resultados: Se identificó como factores de atracción la permanencia del médico extranjero en APS, se reconoce a Chile como su hogar, relación oferta y demanda de trabajo con alta rotación. Factores expulsión: ausencia de una política de incorporación e incentivo para los médicos al servicio de APS, formación profesional diferenciada en el extranjero. Conclusiones: La identificación de factores que influyen en la atracción y expulsión de médicos en Chile, permite generar políticas públicas que mejoren las condiciones laborales de estos profesionales.

Introduction: Migration is a worldwide phenomenon that affects workers from different areas, including health professionals. Objective: To determine the attraction-expulsion factors that have motivated foreign medical doctors to migrate to Chile, this study analyzed the perspective of those who are responsible for health care in the Primary Health Care model. Materials and methods: A theoretical-explanatory case study was carried out in the municipality of Pedro Aguirre Cerda (Chile), using a qualitative approach in critical epidemiology. Individual semi-structured interviews were administered to decision-making personnel in the Primary Health Care model. Results: The following were identified as attraction factors: (i) job stability of foreign physicians at the PHCs; (ii) recognition of Chile as their home; and (iii) the supply-demand relationship seen in high-rotation jobs. On the other hand, the absence of policies of inclusion and incentives for physicians working at PHCs, and differences in medical professional training abroad were characterized as expulsion factors. Conclusions: The identification of factors that influence the attraction and expulsion of medical doctors to/from Chile contributes to generating public policies that improve the working conditions of these health professionals.

Evaluación de síntomas no motores y descontrol de impulsos en usuarios con enfermedad de Parkinson por el médico en atención primaria

Background: Nonmotor symptoms of Parkinson disease significantly hamper the quality of life of patients and have prognostic significance. Aim: To evaluate the presence of nonmotor symptoms in patients with Parkinson disease. Material and Methods: A structured interview was carried out in 32 patients aged 74 ± 9 years (53% men) with Parkinson disease asking specifically for impulse control disorders and dopaminergic dysregulation. The following scales were also applied: Hoehn & Yahr scale, Montreal Cognitive Assessment, Geriatric depression scale, Nonmotor symptom scale and REM sleep scale. Results: A high frequency of nonmotor symptoms was recorded, specially mood, sleep, urinary and gastrointestinal problems and impulse control disorders. Conclusions: Nonmotor symptoms must be actively sought and managed in patients with Parkinson disease.

Resultados del examen periódico de salud en adultos mayores / Results of Periodic Health Examination of Older Adults

RESUMEN Fundamento: el examen periódico de salud constituye una herramienta que emplea el médico de familia para iniciar el proceso de evaluación en adultos mayores. Objetivo: describir los resultados del examen periódico de salud en el Policlínico Universitario Pedro Borrás Astorga de Pinar del Río. Métodos: se realizó un estudio transversal en el Policlínico Universitario Pedro Borrás Astorga de Pinar del Río durante el año 2018. La muestra de estudio estuvo constituida por 7 337 adultos mayores. Los datos fueron obtenidos a partir de las historias clínicas, así como los resultados de los exámenes periódicos de salud realizados. Las variables utilizadas en el estudio fueron: datos generales del paciente, grupo dispensarial, número de exámenes periódicos de salud según año, afectaciones según escala geriátrica y estado global. El procesamiento estadístico de los datos se realizó utilizando frecuencias absolutas y porcentajes. Resultados: predominó el sexo femenino con 54,6 %, así como el grupo de edad de 65 y más años con 68,6 %. Prevaleció el grupo dispensarial III con 82,6 % fundamentalmente en féminas. El número de exámenes periódicos de salud fueron superiores en el 2016 con 3 885 respecto a los años anteriores, donde las afectaciones según escala geriátrica se evidenciaron en el uso de fármacos con 52,2 %. El estado global funcional fue superior al frágil en un 72,6 %. Conclusiones: se evidenció un predominio del sexo femenino, así como el grupo de edad de 65 y más años. Prevaleció el grupo dispensarial III y el número de exámenes periódicos de salud en el 2016 respecto a los años anteriores, las afectaciones según escala geriátrica se evidenciaron en el uso de fármacos, además de la superioridad del estado funcional global.

ABSTRACT Foundation: periodical health examination is a tool the family doctor uses to begin the process of evaluation in older adults. Objective: to describe the results of periodical health examinations in the University Polyclinic Pedro Borrás Astorga. Method: a cross study was conducted at the University Polyclinic Pedro Borrás Astorga in Pinar del Río during in 2018. The sample was 7 337 older adults. Data were collected from clinical histories so as from the health periodical examinations realized. The variables under study were: patient general information, dispense group, number of periodical health exams according to the year, affections regarding geriatric scale and general state. Data statistic processing was done using absolute frequency and percentages Results: female sex predominated with 54,6 %, so as the age group of 65 or more 68,6 %. Despense group III prevailed 82,6 % mainly in women. The number of health periodical exams was higher in 2016, 3 885 compared to previous years where affections according to the geriatric scale showed use of drugs in 52,2 % of the patients. Global functional state was higher to the fragile level in 72,6 %. Conclusion: there was a preponderance of the female sex so as the age group of 65 and more. Dispense group III predominated and the number of periodical health exams in 2016 regarding previous years, affections with respect to the geriatric scale evidenced the use of drugs so as a superiority of the global functional state.

Older adults with dementia: knowledge and attitudes of physicians in health units / Idosos com demência: conhecimentos e atitudes dos médicos nas unidades de saúde

ABSTRACT OBJECTIVE: To describe the knowledge and attitudes of general practitioners of the basic health network of the city of São Paulo in relation to patients with dementia and identify patterns of attitudes. METHODS: A total of 10% of the basic health units in the city of São Paulo (n = 45) were randomly distributed into six regional health coordination centers. Up to two general practitioners were interviewed in each unit, with a total of 81 physicians interviewed. They answered the translated and cross-culturally adapted version for Brazil of two British questionnaires, the knowledge quiz (knowledge about dementias) and the attitude quiz (attitude towards the patient afflicted with dementia), as well as a sociodemographic and occupational questionnaire to understand the profile of general practitioners working in primary care. Descriptive data analysis, factor analysis of the main components of the attitude quiz and study of association between attitudes and knowledge were performed, in addition to the multiple linear regression test to determine the relationship between occupational profile and knowledge about attitude patterns in dementia. RESULTS: The physicians interviewed had a median of five-year graduation time; 35.8% worked exclusively with primary care, and less than 40% had completed, or were attending, medical residency or specialization. Physicians showed a lower knowledge about the diagnosis of dementia than about the epidemiology of the disease and its therapeutic management. Their attitudes towards patients afflicted with dementia resulted in four factors: proactive optimism, delegated optimism, implicit dismay, and explicit dismay. The regression study showed that the attitude of explicit dismay decreases the longer the weekly working hours of the physician in the units, and that the delegated optimistic attitude of the physician decreases in the same situation. CONCLUSION: Investment in training is essential to improve physicians' performance in the field of dementia in primary care.

RESUMO OBJETIVO: Descrever os conhecimentos e atitudes dos médicos generalistas da rede básica de saúde da cidade de São Paulo em relação a pacientes com demência e identificar padrões de atitudes. MÉTODOS: Foram sorteadas aleatoriamente 10% das unidades básicas de saúde da cidade de São Paulo (n = 45), distribuídas proporcionalmente em seis coordenadorias regionais de saúde. Foram entrevistados até dois médicos generalistas em cada unidade, obtendo-se ao todo 81 médicos entrevistados. Eles responderam à versão traduzida e adaptada transculturalmente para o Brasil de dois questionários britânicos, o knowledge quiz (conhecimentos sobre demências) e o attitude quiz (atitudes frente ao paciente dementado), além de um questionário sociodemográfico e ocupacional para o entendimento do perfil dos médicos generalistas que atuam na atenção primária. Realizaram-se análise descritiva dos dados, análise fatorial dos principais componentes do attitude quiz e estudo de associação entre atitudes e conhecimentos, além do teste de regressão linear múltipla para determinar a relação entre o perfil ocupacional e de conhecimento em demência sobre os padrões de atitudes. RESULTADOS: Os médicos entrevistados tinham mediana de tempo de formado de cinco anos; 35,8% trabalhavam exclusivamente com atenção primária, e menos de 40% tinham concluído, ou estavam cursando, residência médica ou especialização. Os médicos mostraram um conhecimento menor sobre diagnóstico de demência do que sobre a epidemiologia da doença e seu manejo terapêutico. Suas atitudes em relação a pacientes dementados resultaram em quatro fatores: otimismo proativo, otimismo delegador, desalento implícito e desalento explícito. O estudo de regressão mostrou que a atitude de desalento explícito diminui quanto maior for a jornada de trabalho semanal do médico nas unidades, e que a atitude otimista delegadora do médico diminui na mesma situação. CONCLUSÕES: O investimento em capacitação é fundamental para melhorar o desempenho do médico no campo da demência na atenção primária.

Elaboração e validação de uma medida para avaliar o conhecimento de médicos de atenção primária do Brasil sobre recomendação nutricional para controle da hipertensão / Elaboration and validation of a measure to evaluate the knowledge of primary care physicians in Brazil about nutritional recommendation for hypertension control

Resumo Introdução Médicos da Atenção Primária à Saúde têm papel primordial no aconselhamento nutricional para reduzir a morbidade e a mortalidade relacionadas à hipertensão. A literatura é escassa em instrumentos validados para o Brasil que avaliam o conhecimento com base em evidências desses profissionais. Objetivo Elaborar uma medida para avaliar o nível de conhecimento de médicos de atenção primária do Brasil sobre recomendação nutricional para o controle de hipertensão arterial. Método Utilizou-se de um instrumento validado para a língua inglesa como base para elaboração da medida, a qual foi testada de acordo com os fundamentos da Teoria de Resposta ao Item. A dimensionalidade do questionário foi realizada na matriz de correlação policórica. Para estimar os parâmetros dos itens, foi utilizado o modelo logístico de dois parâmetros (discriminação e dificuldade). Resultados A maioria dos itens foi considerada fácil, e o poder discriminativo variou entre valores altos, moderados e baixos. A ausência de itens difíceis contribuiu para a imprecisão da medida entre aqueles com níveis superiores de conhecimento. Conclusão Os resultados mostram uma medida que mensura com melhor precisão médicos com baixo nível de conhecimento, sendo uma ferramenta útil para identificar profissionais que precisam melhorar seu conhecimento nutricional.

Abstract Background Primary health care physicians play a leading role in nutritional counseling to reduce hypertension related to morbidity and mortality. The literature is scarce on instruments validated for Brazil that evaluate the evidence based on knowledge of these professionals. Objective To elaborate a measure to evaluate the level of knowledge about nutritional recommendation for the control of hypertension for primary care physicians in Brazil. Method A validated instrument for the English language was used as the basis for the questionnaire elaboration, which was tested according to the fundamentals of the Item Response Theory. The dimensionality of the questionnaire was performed on the polychoric correlation matrix. For the estimation of the parameters of the items, the two Parameters Logistic Model (discrimination and difficulty) was used. Results Most of the items were considered easy, the discriminative power varied between high, moderate and low values. The absence of difficult items contributed to the imprecision of the measure among those with higher levels of knowledge. Conclusion The results show a measure that accurately measures physicians with a low level of knowledge, being a useful tool to identify professionals who need to improve their nutritional knowledge.

Impacto de la universalización en la formación y desempeño de profesionales de la salud / Impact of universalization on the training and performance of health professionals

RESUMEN Fundamento: el proceso de universalización de la enseñanza en la formación de profesionales de la salud posibilitó la educación médica en escenarios diversos donde antes solo se realizaba la atención primaria. Objetivo: valorar el impacto de la universalización en la formación y desempeño de los profesionales de la salud en la sede universitaria del municipio de Santo Domingo en Villa Clara. Métodos: se realizó un estudio de intervención en el proceso de universalización del período 2009-2017, las unidades de observación fueron el total de profesores activos categorizados para impartir la docencia y los estudiantes de la carrera de Medicina matriculados en los dos primeros cursos. Se utilizaron métodos teóricos: análisis-síntesis, inducción-deducción e histórico-lógico; y empíricos: el análisis documental de informes que ofrecieron los datos de comparación. Resultados: las cifras encontradas posibilitaron apreciar avances en los educadores en cuanto al tránsito de categorías docentes inferiores hasta profesores auxiliares, aumento de grados académicos y científicos concretados en mayor número de másteres, especialistas de segundo grado e investigadores agregados, y se incrementaron las publicaciones y la participación en eventos científicos nacionales e internacionales. La mayoría de los estudiantes se graduaron, y se mantienen en el sistema de salud aportando buenos resultados en la atención a la población, incluso algunos han cumplido misiones internacionalistas. Conclusiones: el proceso de universalización se valoró de forma positiva porque elevó de forma considerable las competencias en los profesionales del territorio y el desempeño de los graduados formados en esa modalidad de estudios universitarios.

ABSTRACT Background: the process of universalization of education in the training of health professionals enabled medical education in diverse settings where primary care was only performed before. Objective: to assess the impact of universalization in the training and performance of health professionals in Santo Domingo Municipality University branch in Villa Clara. Methods: an intervention study was carried out in the universalization process from 2009 to 2017, the observation units were the total number of active ranked teaching professors and the students of the medical degree enrolled in the first two courses. Theoretical methods were used: analysis-synthesis, induction-deduction and historical-logical; and empirical ones: the documentary analysis of reports that offered the comparison data. Results: the figures found made it possible to appreciate advances in educators in terms of the transition from lower teaching ranks to associate professors, increase in academic and scientific degrees specified in a greater number of masters, second degree specialists and assistant researchers, and publications and Participation in national and international scientific events. Most of the students graduated, they remain in the health system providing good results in the care of the population, and even some of them have completed internationalist missions. Conclusions: the universalization process was valued in a positive way because it significantly increased the competencies in the professionals of the territory and the performance of graduates trained in this modality of university studies.

Capacitação, conhecimentos e crenças de médicos da Atenção Primária à Saúde relacionados ao envelhecimento / Professional education, knowledge and beliefs of Primary Health Care physicians related to aging / Capacitación, conocimiento y creencias de los médicos de Atención Primaria relacionados con el envejecimiento

O aumento da população idosa, com os complexos problemas de saúde que a envolvem, evidencia a necessidade do uso da Atenção Primária à Saúde (APS), que deve ser a porta de entrada para a atenção à saúde dos idosos. Espera-se que a APS exerça ações curativas e, principalmente, de prevenção e promoção à saúde para este grupo etário. O objetivo deste estudo foi avaliar, em 49 médicos que atuam na APS de Anápolis, estado de Goiás, a formação profissional na área do envelhecimento, os conhecimentos básicos sobre a velhice e as crenças relacionadas aos idosos. Foram aplicados os seguintes questionários: formação acadêmica na área do envelhecimento; Questionário Palmore-Neri-Cachioni, a fim de avaliar os conhecimentos básicos sobre a velhice; e Escala de Neri, para verificar as crenças relacionadas aos idosos. Os médicos mostraram carecer de formação acadêmica e conhecimentos básicos na área gerontológica. Entre eles, 22,4% deles não cursaram a disciplina Geriatria e Gerontologia na graduação, 71,4% não tinham qualquer tipo de especialização, 91,8% não fizeram residência médica. Nos últimos cinco anos, somente 38,8% participaram de cursos de Geriatria e Gerontologia, 10,2% fizeram pesquisa na área, e 59,2% leram algum artigo sobre envelhecimento. Na avaliação dos conhecimentos básicos sobre a velhice, os maiores números de acertos, 91,8% e 83,7%, surgiram nas duas questões que tratam de aspectos físicos do envelhecimento. A questão que recebeu menor número de acertos (6,1%) aborda o aspecto social do envelhecimento; e as duas questões que tratam de aspectos psicológicos tiveram menos de 20% de acertos. Quanto às crenças relacionadas à velhice, a tendência geral das respostas foi negativa. O domínio com avaliação mais positiva foi Agência e o com avaliação mais negativa foi Relacionamento Social. O item com crença mais positiva foi o relacionado à sabedoria. Concluiu-se que é necessária educação continuada para os médicos que atuam na APS, focada nos diferentes aspectos do envelhecimento, incluindo os psicossociais, assim como a adoção de crenças positivas relacionadas aos idosos.

The increase in the elderly population, with the complex health problems that involve it, evidences the need to use Primary Health Care (APS), which should be the gateway to health care for the elderly. It is expected that the APS will carry out curative actions and, mainly, of prevention and health promotion in this age group. The objective of this study was to evaluate the professional training, basic knowledge and beliefs related to the area of aging, in 49 physicians who worked in APS of Anápolis, Goiás, Brazil. The following questionnaires were used: one to verify the professional training in the area of aging; the Palmore-Neri-Cachioni Questionnaire, in the evaluation of basic knowledge about old age; and the Neri Scale, to know the beliefs related to the elderly. The physicians showed lack of professional training and basic knowledge in the gerontological area. Among them, 22.4% did not attend Geriatrics / Gerontology discipline at graduation, 71.4% did not have any type of specialization and 91.8% did not obtain medical residency. In the last five years, only 38.8% participated in Geriatrics courses, 10.2% did research in the area and 59.2% read some article about aging. In the evaluation of basic knowledge about old age, the highest numbers of correct answers, 91.8% and 83,7%, have arisen in the two questions that deal with the physical aspects of aging. The issue that received fewer correct answers (6.1%) addresses the social aspect of aging and two issues dealing with psychological aspects had less than 20% of correct answers. As to the beliefs related to old age, the general tendency of the answers was negative. The domain with the most positive evaluation was Agency and the one with the most negative evaluation was Social Relationship. The item with the most positive belief was that of wisdom. It was concluded that continuous education of these professionals is necessary, focused on the different aspects of aging including the psychosocial, as well as the adoption of positive beliefs related to the elderly.

El aumento de la población de ancianos, con los complejos problemas de salud que lo rodean, resalta la necesidad del uso de Atención Primaria de Salud (APS), que debería ser la puerta de entrada a la atención de la salud de los ancianos. Se espera que PHC realice acciones curativas y, principalmente, prevención y promoción de la salud para este grupo de edad. El objetivo de este estudio fue evaluar, en 49 médicos que trabajan en APS de Anápolis, estado de Goiás, Brasil, la formación profesional en el área del envejecimiento, los conocimientos básicos sobre la vejez y las creencias relacionadas con los ancianos. Se aplicaron los siguientes cuestionarios: educación académica en el área del envejecimiento; Cuestionario Palmore-NeriCachioni para evaluar los conocimientos básicos sobre la vejez; y Escala Neri para verificar las creencias relacionadas con los ancianos. Los médicos mostraron falta de antecedentes académicos y conocimientos básicos en gerontología. Entre ellos, el 22.4% de ellos no asistió al curso de pregrado de Geriatría y Gerontología, el 71.4% no tenía especialización, el 91.8% no tenía residencia. En los últimos cinco años, solo el 38.8% asistió a cursos de Geriatría y Gerontología, el 10.2% investigó en el área y el 59.2% leyó algún artículo sobre el envejecimiento. En la evaluación de los conocimientos básicos sobre la vejez, el mayor número de respuestas correctas, 91.8% y 83.7%, surgió en las dos preguntas que tratan con los aspectos físicos del envejecimiento. La pregunta que recibió el menor número de visitas (6,1%) aborda el aspecto social del envejecimiento; y las dos preguntas que tratan aspectos psicológicos tenían menos del 20% de respuestas correctas. En cuanto a las creencias relacionadas con la vejez, la tendencia general de las respuestas fue negativa. El dominio con la calificación más positiva fue Agencia y el dominio con la calificación más negativa fue Relación Social. El artículo con la creencia más positiva estaba relacionado con la sabiduría. Se concluyó que se requiere educación continua para los médicos que trabajan en APS, centrados en diferentes aspectos del envejecimiento, incluido el psicosocial, así como la adopción de creencias positivas relacionadas con los ancianos.

Current status and training requirement of rural doctors in Hebei Province / 中华全科医师杂志

Objective To survey the current status and training requirement of rural doctors in Hebei province.Methods A questionnaire survey was conducted among1 200 rural doctors selected from 11 cities of Hebei province by stratified sampling from October to December 2017.The self-designed questionnaire included general condition,job satisfaction,impact of medical reform policies,training needs of rural doctors.Results A total of 1 200 questionnaires were distributed and 1 170 valid ones were retrieved with a recovery rate of 97.5％.Among the 1 170 responders,there were 726 males(62.1％) and 444 females (37.9％);748 (63.9％) were aged more than 40 years;612 (52.3％) hold secondary school degree;826 (70.6％) had been working in the village for more than 10 years,and the overall job satisfaction rate was 30.8％ (360/1 170).Among all responders,73.8％ (864/1 170) worked in the standardized village clinics,and 72.0％ (842/1 170) were contracted with local residents as family doctors;52.8％ (618/1 170) responders believed that the reform policy improved the health care for villagers.In all responders,98％ (1 147/1 170)thought they needed training,93.6％ (1 095/1 170) had received training.The training contents they most needed werethe management of common diseases (904,77.3％),followed by medical humanities(650,55.6％)and first aid knowledge (492,42.1％).The influencing factors for training were lack of time,no energy (656,54.3％),lack of appropriate training forms (510,43.6％),economic reasons (476,40.3％) and so on.Conclusion The working status of rural doctors need to befurther improvedand the training need to be strengthened to increase their job satisfaction.

Avaliação da implantação do Programa de Valorização do Profissional da Atenção Básica no estado da Bahia / Evaluation of the implementation of the Primary Care Professional Valorization Program in the state of Bahia

RESUMO O Programa de Valorização do Profissional da Atenção Básica foi criado no Brasil, em 2011, para apoiar a atuação de profissionais de saúde, sob supervisão, em municípios com carência de profissionais. Este estudo avaliou o grau de implantação do programa no estado da Bahia. Foram realizadas entrevistas semiestruturadas com membros da Comissão Coordenadora Estadual do programa e utilizadas fontes documentais para a produção dos dados. Os elementos críticos do processo de implantação foram analisados mediante o uso do triângulo de governo proposto por Matus. O programa, no estado da Bahia, alcançou 82,39% do grau de implantação de acordo com o modelo lógico elaborado a partir das normativas federais. O grupo de gestão executou as atividades do programa com êxito, em função de sua capacidade de governo e do apoio político e administrativo da Secretaria Estadual de Saúde, ainda que não tenha havido incremento de recursos financeiros para potencializar os componentes do programa. Evidenciou-se o envolvimento dos atores da coordenação da supervisão e da supervisão médica na tentativa de reorientar a formação médica, apostando em dispositivos pedagógicos e outros recursos educacionais.

ABSTRACT The Primary Care Professional Valorization Program was created in Brazil, in 2011, to support the performance of health professionals, under supervision, in municipalities with a shortage of professionals. This study evaluated the degree of implementation of the program in the state of Bahia. Semi-structured interviews were conducted with members of the State Coordinating Committee of the program and documentary sources were used to produce the data. The critical elements of the implementation process were analyzed through the use of the governance triangle proposed by Matus. The program, in the state of Bahia, reached 84% of the degree of implementation according to the logical model elaborated from the federal regulations. The management group successfully implemented the program's activities, due to its governance capacity and the political and administrative support of the State Health Secretariat, although there has been no increase in financial resources to leverage the components of the program. It was evidenced the involvement of the actors of the coordination of medical supervision and supervision in an attempt to reorient medical training, betting on pedagogical devices and other educational resources.

Análise das emendas parlamentares ao Programa Mais Médicos: o modelo de formação médica em disputa / Analysis of the parliamentary amendments to the Mais Médicos Program: the medical training model in dispute

RESUMO Pesquisa documental qualiquantitativa que analisa o processo legislativo e atos normativos do Programa Mais Médicos. O estudo categoriza 575 emendas apresentadas e as alterações na Medida Provisória. Evidencia o conjunto dos interesses e disputas envolvidos no processo, seja aperfeiçoando ou desvirtuando. Ressalta os confrontos nas emendas que atendem a interesses corporativos e aquelas aliadas ao princípio constitucional da universalidade, resultando em mudanças principalmente no Capítulo da Formação Médica. Conclui que a polêmica e o acirramento entre posições ideológicas não comprometeram a iniciativa governamental de diminuir a carência de médicos e fixá-los em áreas prioritárias do Sistema Único de Saúde (SUS).

ABSTRACT Qualitative-quantitative documentary research, which aimed to analyze the Mais Médicos (More Doctors) Program legislative process and normative acts. The study categorizes the 575 amendments submitted and the changes in the Provisional Measure. It shows the set of interests and disputes involved in the process, resulting in changes mainly in the Medical Education Chapter. It highlights the clashes in the amendments that serve corporate interests and those allied to the constitutional principle of universal health. It concludes that the controversy, interests and dispute among ideological positions did not compromise the governmental initiative to reduce the shortage of doctors for the Public Health System (SUS).

Current Epidemiological Data on Asthma Management in South Korea from Qualitative Assessment of Asthma Management by Health Insurance Review and Assessment Service (HIRA) / 결핵및호흡기질환

Since 2015, the Health Insurance Review and Assessment Service (HIRA) has performed annual qualitative assessments of asthma management provided by all medical institutions that care for asthma patients in Korea. According to the third report of qualitative assessment of asthma management in 2017, the assessment appears to have contributed to improving the quality of asthma care provided by medical institutions, especially primary clinics. However, there is still a gap between the ideal goals of asthma management and actual health care policies/regulations in real clinical settings, which leads to the state of standstill with respect to the quality of asthma management despite considerable efforts such as the qualitative assessment of asthma management by national agencies such as the HIRA. At this point, a harmonized approach is needed to raise the level of asthma management among several components including medical policies, efforts of academic associations such as education and distribution of the guideline for management, and reliable financial support by the government.

Modelo TOPIC: tareas orientadas a los procesos ambulatorios en el primer nivel de atención / The TOPIC model: tasks oriented for outpatient processes in the first level of healthcare

Los médicos del primer nivel de atención deben emplear herramientas que permiten hacer una adecuada gestión del tiempo y recursos en cada encuentro clínico, debido a que las necesidades de salud que abordan, son variadas y complejas. El modelo TOPIC (Tareas orientadas a los procesos de atención ambulatoria), categoriza las consultas en cinco prototipos y establece un conjunto de tareas y procesos estandarizados para reconocer las necesidades existentes en cada tipo de visita, y en consecuencia responder ordenadamente a cada tipo de persona. Tiene una utilidad concreta para la práctica ambulatoria por orientar un abordaje más costoefectivo y de mayor impacto en la salud de la población

Primary care doctors must use tools that may allow them to adequately manage time and resources in each clinical encounter, because the health needs that they face are varied and complex. The TOPIC (Tasks-oriented processes in care) model categorizes each encounter in five prototypes and it establishes a set of tasks and standardized processes for recognizing the needs for each type of visit; and, consequently, to respond in an orderly fashion to each type of person. It has a particular utility for the outpatient practice since it allows a cost-effective approach and a greater impact on the health of the population

Effects of Educational Interventions for Chronic Airway Disease on Primary Care

Education has been known to essential for management of chronic airway diseases. However the real benefits remain unclear. We evaluated the effectiveness of an organized educational intervention for chronic airway diseases directed at primary care physicians and patients. The intervention was a 1-month education program of three visits, during which subjects were taught about their disease, an action plan in acute exacerbation and inhaler technique. Asthma control tests (ACT) for asthma and, chronic obstructive pulmonary disease (COPD) assessment tests (CAT) for COPD subjects were compared before and after education as an index of quality of life. Educational effectiveness was also measured associated with improvement of their knowledge for chronic airway disease itself, proper use of inhaler technique, and satisfaction of the subjects and clinicians before and after education. Among the 285 participants, 60.7% (n = 173) were men and the mean age was 62.2 ± 14.7. ACT for asthma and CAT in COPD patients were significantly improved by 49.7% (n = 79) and 51.2% (n = 65) more than MCID respectively after education (P < 0.05). In all individual items, knowledge about their disease, inhaler use and satisfaction of the patients and clinicians were also improved after education (P < 0.05). This study demonstrates the well-organized education program for primary care physicians and patients is a crucial process for management of chronic airway diseases.

Management of long-term gastric cancer survivors in Korea

The incidence of gastric cancer is high, and gastric cancer has one of the highest survival rates of any type of cancer in Korea. With increased long-term survival in a growing number of patients, more patients suffer from health problems such as treatment-related symptoms, malnutrition, chronic diseases, anxiety, and depression. Gastric cancer survivors also have a higher risk of developing a second primary cancer and recurrence. Therefore, survivorship care guidelines for gastric cancer survivors that address surveillance for recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term effects of cancer and its treatment, health promotion, and care coordination are needed. The role of primary care physicians is essential for providing continuous care to gastric cancer survivors and their family.

Management of long-term thyroid cancer survivors in Korea

Recently, thyroid cancer survivors are rapidly increasing in Korea, up to 21% of 1,234,879 total cancer survivors in 2012. The survival rate after thyroid cancer treatment is high, but many of the survivors suffer from fatigue, depressive mood and anxiety. Rarely, thyroid cancer treatment can result in long-term complications such as voice change and hypocalcemia. Thyroid-stimulating hormone suppression for preventing recurrence of thyroid cancer might lower bone density and increase risk of cardiovascular diseases including atrial fibrillation. For thyroid cancer survivorship care-management of such long-term complications, comorbid conditions and psychosocial problems, second primary cancer screening, promotion of healthy behaviors, support for family caregivers, role of primary care physicians is important. Systematic shared care between oncologists and primary care physicians is expected. And further research to generate evidence regarding effective management of thyroid cancer survivors is needed.

Tensión, malestares y posición institucional de los profesionales de atención primaria / Institutional position of primary care physicians: dissatisfaction and tensions

Introducción: Los conflictos relacionados con la implementación de la reforma sanitaria española en la década de 1980 impregnaron profundamente los procesos de construcción y consolidación de los equipos de atención primaria. Éstos arrastran desde su nacimiento una indefinición estructural que, aun en el momento actual, es una fuente de conflicto interprofesional y de malestar institucional para los profesionales sanitarios. Objetivo: Explorar las experiencias de malestar profesional e institucional de losprofesionales de la medicina que desarrollan su labor en el ámbito de la atención primaria de la salud.Sujetos y métodos: Estudio cualitativo, basado en una aproximación sociosubjetiva, a través de entrevistas en profundidad (ocho entrevistas a médicos de atención primaria de la Comunidad de Madrid). El material discursivo se analizó desde una perspectiva pragmatista. Resultados y discusión: La figuradel médico de atención primaria se encuentra en la intersección de lógicas profesionales-institucionales contradictorias: entre la lógica de la asistencia y la lógica de la gestión; entre el modelo de atención primaria y el modelo asistencial clásico, y entre el papel del profesional de la medicina como poseedor de saber y su papel como proveedor de servicios. El cruce de estas líneas de tensión en la figura del médico de atención primaria genera niveles altos de malestar profesional

Background: The conflicts that emerged during the implementation of the Spanish Health Reform in the eighties have deeply influenced the creation and consolidation of primary health care teams. The structure of these teams was poorly defined from the outset, a situation that continues in the present and causes confrontation within the trade and a deep sense of institutional unease. With this situation as backdrop, the study aims at exploring the vocational and institutional dissatisfaction experienced by primary health care professionals. Subjectsand methods: This qualitative study is based on a socio-subjective approach. Eight qualitative in-depth interviews have been conducted with primary health care physicians and the resulting data was analyzed from a pragmatic perspective. Results and discussion:The figure of the primary health care physician is being pulled in different directions by contradictory institutional and professional rationales: care versus financial management, a traditional care model versus a primary health care model, and the physician’s role as knowledge repository versus caregiver. This juxtaposition of contrary interests generates high levels of vocational dissatisfaction.

Survey on awareness rate of knowledge about vascular cognitive impairment in community physicians in Beijing / 中华全科医师杂志

Objective To survey the awareness rate of knowledge about vascular cognitive impairment (VCI) in community physicians.Methods A questionnaire survey on the awareness of knowledge about VCI was conducted in 87 community physicians from 4 community hospitals in Beijing Chaoyang District from October to December 2012.Among all participants there were 27 males and 60 females with an average age of (39 ± 11) years,85％ (74/87)had college or university degrees,90％ (78/87) held primary or middle-level professional titles,41％ (36/87),of them were internists.Results All participants completed the questionnaire.The awareness rate about minor and major neurocognitive disorder was 39％ (60/87) ; the rates of various causes of dementia were 51％ (44/87)-100％ (87/87) and various symptoms of cognitive impairment were 79％ (69/87)-99 ％ (86/87),respectively.The awareness rate of cognitive impairment as initial symptom displayed in stroke was 54 ％ (47/87).The awareness rates of knowledge related to diagnosis and treatment of dementia were 57％ (50/87)-97％ (84/87) and 80％ (70/87)-100％ (87/87),respectively.The awareness rates about that Alzheimer's disease and dementia with Lewy bodies were not reversed by early treatment were 46％ (40/87)and 37％ (32/87),respectively.The awareness rates of vascular risk factors were 20％ (17/87)-100％ (87/87)and those about the mode of health education were 52％ (45/87)-95 ％ (83/87).There was 36％ (31/87) community physicians who thought that they possessed VCI-related knowledge.Conclusions The results of survey suggest that community physicians shall upgrade their knowledge of diagnosis and treatment for vascular cognitive impairment.