Ruta metodológica para prácticas interdisciplinarias integradas en Atención Primaria en Salud

Introducción: A formación interdisciplinar en el marco de la atención primaria en salud (APS) permite la apertura a nuevos conocimientos, un abordaje integral a realidades complejas en los territorios y la articulación entre actores. Esto posibilita mejores resultados tanto para las comunidades, en la resolución de sus necesidades y problemas, como para los profesionales que vinculan a su formación el concepto y práctica de la APS. Objetivo: Diseñar una ruta metodológica para la implementación de prácticas interdisciplinarias integradas con enfoque territorial, en el marco de la APS. Metodología: Es un proyecto de interacción social, cualitativo, basado en los postulados del paradigma crítico social y bajo las premisas de la educación popular y la acción participativa, cuyo proceso de desarrollo estuvo enmarcado en la construcción colectiva con estudiantes y docentes de las diferentes unidades académicas participantes, así como con líderes sociales, comunitarios, institucionales y políticos de los territorios vinculados. Por ello, la construcción de la ruta privilegia la participación de estos, de forma horizontal en cada uno de los momentos del proyecto: diagnóstico, sistematización y validación. Resultados: Se creó una ruta metodológica en cuatro fases: aprestamiento, planeación, ejecución y evaluación, cada una con diferentes momentos. Discusión: Pese a que no se encontraron otros referentes de rutas metodológicas de prácticas interdisciplinarias integradas, la discusión se centra en los conceptos de educación para la salud, APS e interdisciplinariedad y sus implicaciones, tanto para los procesos de formación como para el abordaje interdisciplinario de las necesidades en los territorios. Conclusiones: La cogestión de actores comunitarios, institucionales de los territorios y de la universidad son cruciales para desarrollar los propósitos de formación y aportar a la resolución de necesidades y problemas priorizados, en el marco de la APS, entendiendo la comunidad como un sujeto de acompañamiento mediante prácticas interdisciplinarias integradas y no como un objeto de intervención para lograr propósitos formativos.

Introduction: Interdisciplinary training within the framework of primary health care (PHC) allows the opening to new knowledge, a comprehensive approach to complex realities in the territories and the articulation among actors. This enables better results both for the communities in the resolution of their needs and problems and for the professionals who link the concept and practice of PHC to their training. Objective: To design a methodological route for the implementation of integrated interdisciplinary practices with a territorial approach, within the PHC framework. Methodology: It is a social interaction project, qualitative, based on the postulates of the critical social paradigm and under the premises of popular education and participatory action, whose development process was framed in the collective construction with students and professors of the different participating academic units, as well as with social, community, institutional and political leaders of the linked territories. For this reason, the construction of the route privileges their participation horizontally in each of the moments of the project: diagnosis, systematization and validation. Results: a methodological route was created in 4 phases: preparation, planning, execution and evaluation, each with different moments. Discussion: Although no other references of methodological routes of integrated interdisciplinary practices were found, the discussion focuses on the concepts of health education, PHC and interdisciplinarity and their implications both for training processes and for the interdisciplinary approach to the needs in the territories. Conclusions: The co-management of community and institutional actors of the territories and the University are crucial to develop training purposes and contribute to the resolution of prioritized needs and problems within the framework of PHC; understanding the community as a subject of accompaniment through integrated interdisciplinary practices and not as an object of intervention to achieve training purposes.

Análisis y visualización de datos de infección por SARS-CoV-2 de la población atendida en los establecimientos de salud de atención primaria de la Corporación Municipal de Viña del Mar, durante los años 2021-2022 / Analysis and visualization of data on infection by SARS-CoV-2 the population of the primary care health attended in the establishments of the Corporación Municipal de Viña del Mar, during the years 2021-2022

ntroducción: en Chile, la circulación del virus SARS-CoV-2 se inició el 03 de marzo de 2020, desencadenando un rápido aumento de casos en el país. Los datos epidemiológicos y de movilidad fueron fundamentales, para evitar la propagación y severidad de la infección. Sin embargo, la limitación de ser extrapolados desde niveles de división administrativa mayor a niveles menores, ha dificultado la toma de decisiones. Una forma de resolver esto, es analizar y visualizar los datos de la infección en su contexto local, como los datos recopilados desde la Atención Primaria en Salud. Materiales y Métodos: estudio que analizó y visualizó, mediante Microsoft Excel, Stata y Looker Studio, 173.881 exámenes de SARS-CoV-2 realizados en la Corporación Municipal de Viña del Mar (366.981 beneficiarios), durante los años 2021-2022. Resultados: Se obtuvieron 33.633 casos positivos para SARS-CoV-2, de los cuales 11.084 pertenecen al rango etario entre 30 a 49 años. CESFAM Dr. Jorge Kaplán presentó mayor cantidad de casos positivos (5.838), mientras que CECOSF Villa Hermosa la menor cantidad (628). CECOSF Sergio Donoso y Santa Julia presentaron una cantidad notable de casos positivos entre 0 a 14 y 70 a 79 años, respectivamente. Discusión: existió una relación importante entre la cantidad de muestras y casos positivos según lugar de toma de muestra, jurisdicción, población per cápita atendida por jurisdicción y su distribución espacial. Conclusión: la metodología realizada permitió analizar y visualizar los datos de infección por SARS-CoV-2 por jurisdicción, lo que se puede utilizar para observar tendencias y generar estrategias para la comuna.

Introduction: in Chile, the circulation of the SARS-CoV-2 virus began on March 3, 2020, triggering a rapid increase in cases in the country. Epidemiological and mobility data were essential to prevent the spread and severity of the infection. However, the limitation of being extrapolated from higher levels of administrative division to lower levels has made decision-making difficult. One way to solve this is to analyze and visualize infection data in its local context, such as data collected from Primary Health Care.Materials and Methods: a study that analyzed and visualized, using Microsoft Excel, Stata, and Looker Studio, 173,881 SARS-CoV-2 tests performed in the Viña del Mar Municipal Corporation (366,981 beneficiaries) during 2021-2022.Results: there were 33,633 positive cases for SARS-CoV-2, of which 11,084 were in the age range between 30 and 49 years. CESFAM Dr. Jorge Kaplán had the highest positive cases (5,838), while CECOSF Villa Hermosa had the lowest number (628). CECOSF Sergio Donoso and Santa Julia had a notable number of positive cases between 0 and 14 and 70 to 79 years, respectively. Discussion: there was a significant re lationship between the number of samples and positive cases by sampling site, jurisdiction, population per capita served by jurisdiction, and spatial distribution. Conclusion: The methodology used allowed for the analysis and visualization of SARS-CoV-2 infection data by jurisdiction, which the municipality can use to observe trends and generate strategies.

Integration of Non Alcoholic Fatty Liver Diseases (NAFLD) into NPCDCS programme: A recent initiative in India

Non-alcoholic fatty liver disease (NAFLD) is an emerging public health problem globally. NAFLD is one of the most common liver diseases worldwide and is the most common cause of abnormal liver enzymes in many developed countries. NAFLD is estimated to afflict approximately 1 billion individuals worldwide. An estimated 20-30 % of general population is afflicted from it globally. In India NAFLD could be a silent epidemic with its prevalence ranging from 9-32%. Studies have shown, strong association of NAFLD with major Non Communicable diseases (NCD) like Diabetes, Obesity, CVD, Chronic Kidney diseases, Cancers, etc. Perceiving the threat of NAFLD and the central role of hepatic accumulation of fat in the pathogenesis of other NCD, the Government of India (GoI) has taken steps to include NAFLD in the public health agenda. It has included it in the national NCD programme, i.e., National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 2021. India has become the first country in the world to start a national programme for preventive efforts for NAFLD. The present review describes public health relevance of NAFLD and the process of integration of Non Alcoholic Fatty Liver Diseases (NAFLD) into NPCDCS programme in India.

Clients' Perspective for Quality of Services at One of the Urban Primary Health Centres (U-PHC) at Municipal Corporation Area in One of the cities of Western India

Introduction: Client satisfaction surveys are central to quality improvement at health facility. It helps in identifying areas of low satisfaction and steps to maximize patient satisfaction. Objectives: To assess client satisfaction towards services at Out Patient Department (OPD) of at an U-PHC under Ahmedabad Municipal Corporation (AMC), identify areas of low satisfaction and suggest feasible remedial measures for improvement. Method: Out of 74 U PHCs under AMC, 1 was selected through simple random sampling. Quality of care was evaluated through client's feedback which was gathered through 10 check points (on structure, process and outcome) developed by state level quality team. Responses of 300 adult (> 18 years) subjects and their mean ± standard deviation scores were calculated. These subjects were selected nd thconsecutively as 25 cases (new cases who came first and were willing) on every 2 and 4 Mondays for 6 months (Sep 2019 – Feb 2020). Results: While availability of drugs was perceived as very satisfying that of investigations was relatively an area of concern. Overall, only 1 client rated the services as average while all rest (99.6%) rated services as very good to excellent. Conclusion: Quality of services at this U PHC was good to excellent and had wider acceptability among its client.

Interdisciplinaridade em estágio de vivência acadêmica: reconhecimento da atuação profissional no Sistema de Saúde / Interdisciplinarity in an academic experience internship: recognition of professional performance in the Health System / Interdisciplinaridad en prácticas de experiencia académica: reconocimiento de la actuación profesional en el Sistema de Salud

Objetivo: Descrever a experiência de um estágio acadêmico vivenciado por universitários da área da saúde em um município do Baixo Solimões. Síntese dos dados:Trata-se do relato descritivo de um estágio acadêmico extramuro realizado em Manacapuru, Amazonas, ocorrido no período de outubro de 2019 a fevereiro de 2020. A realização da atividade teve a participação de acadêmicos de Medicina, Enfermagem e Odontologia e contou com a aplicação de práticas em saúde direcionadas à atuação individual e coletiva. Tendo como público-alvo os pacientes atendidos por uma Unidade Básica de Saúde (UBS), os universitários auxiliaram na realização de atendimentos eletivos em suas respectivas áreas de atuação e conduziram atividades de educação em saúde como rodas de conversa, gincanas educativas, palestras interativas e educação continuada à equipe da UBS. Conclusão: As práticas e ações em saúde realizadas no período do estágio extramuro proporcionaram uma integração interdisciplinar satisfatória entre os acadêmicos, possibilitando aos mesmos uma vivência apropriada na atenção básica do Sistema Único de Saúde (SUS).

Objective: To describe the experience of an academic internship completed by university students in the health field in a municipality in Baixo Solimões. Data synthesis: This is a descriptive report of an extramural academic internship carried out in Manacapuru, Amazonas, from October 2019 to February 2020. The activity was carried out with the participation of medical, nursing and dentistry students and included the application of health practices aimed at individual and collective action. Having as a target audience the patients assisted by a Primary Health Care (PHC) center, the university students helped in carrying out elective care in their respective fields and conducted health education activities such as conversation circles, educational scavenger hunts, interactive lectures and continuing education for the PHC center team. Conclusion: The health practices and actions carried out during the extramural internship enabled a satisfactory interdisciplinary integration among the students and allowed them to have an appropriate experience in primary care in the Unified Health System (Sistema Único de Saúde ­ SUS).

Objetivo: Describir la experiencia de una pasantía académica vivida por universitarios del área de la salud en un municipio del Baixo Solimões. Síntesis de los datos: Se refiere al informe descriptivo de una pasantía académica extramuros realizado en Manacapuru, Amazonas, ocurrido entre octubre de 2019 y febrero de 2020. La realización de la actividad tuvo la participación de académicos de medicina, enfermería y odontología y contó con la aplicación de prácticas en salud direccionadas a la actuación individual y colectiva. Teniendo como público meta los pacientes atendidos por una Unidad Básica de Salud (UBS), los universitarios ayudaron en la realización de atendimientos electivos en sus respectivas áreas de actuación y condujeron actividades de educación y en salud como charlas, juegos educativos, conferencias interactivas y educación continuada para el equipo de la UBS. Conclusión: Las prácticas y acciones en salud realizadas en el período de la pasantía extramuros proporcionaron una integración interdisciplinar satisfactoria entre los académicos, posibilitando a los mismos una experiencia apropiada en la atención básica del Sistema Único de Salud (SUS).

Residência de Medicina de Família e Comunidade: percepções de egressos sobre sua formação e processo de trabalho / Residencia de medicina de familia y comunidad: percepciones de egresados sobre su formación y proceso de trabajo / Family and Community Medicine Residency: graduates' insights about their education and work process

Analisou-se como as residências de Medicina de Família e Comunidade (RMFC) de uma capital da região norte do Brasil contribuíram para a formação e o desenvolvimento do atual processo de trabalho de seus egressos. Estudo exploratório, descritivo e transversal, com abordagem qualitativa focada em 31 egressos por meio de aplicação de questionário eletrônico com perguntas abertas. As respostas foram interpretadas por Análise de Conteúdo Temática, constituídas por quatro categorias empíricas: a formação em Medicina de Família e Comunidade (MFC) no processo de trabalho do egresso; reconhecimento e aplicação dos atributos da Atenção Primária à Saúde (APS); potências da formação em RMFC; e os desafios da especialidade. Os programas de RMFC estudados contribuem para a formação da prática profissional e do perfil dos seus egressos por meio do fortalecimento e da efetivação dos atributos da Atenção Primária à Saúde (APS), inclusive estendendo-se para além da especialidade.(AU)

Se analizó cómo las residencias de Medicina de Familia y Comunidad (RMFC) de una capital de la región Norte de Brasil contribuyeron en la formación y el desarrollo del actual proceso de trabajo de sus egresados. Estudio exploratorio, descriptivo y transversal, con abordaje cualitativo enfocado en 31 egresados por medio de la aplicación de cuestionario electrónico con preguntas abiertas. Las respuestas se interpretaron por Análisis de Contenido Temático, constituyéndose cuatro categorías empíricas: la formación en Medicina de Familia y Comunidad (MFC) en el proceso de trabajo del egresado; reconocimiento y aplicación de los tributos de la Atención Primaria de la Salud (APS); potencias de la formación en RMFC y los desafíos de la especialidad. Los programas de RMFC estudiados contribuyen con la formación de la práctica profesional y con el perfil de sus egresados por medio del fortalecimiento y puesta en práctica de los atributos de la APS, incluso ampliándose más allá de la especialidad.(AU)

The article analyzed how the Residency in Family and Community Medicine (RFCM) in a capital of the Northern region of Brazil contributed to the formation and development of the current work process of its graduates. This is an exploratory, descriptive and cross-sectional study, with a qualitative approach focused on 31 graduates, through electronic questionnaires with open questions. The answers were interpreted based on the Content Analysis Thematic technique, constituting four empirical categories: training in Family and Community Medicine (FCM) in the graduate's work process; recognition and application of the attributes of Primary Health Care (PHC); potentials of the FCM training and the challenges of the specialty. The analyzed data show that the studied Programs contribute to the education for professional practice and the profile of its graduates through the strengthening and implementation of the Primary Health Care (PHC) attributes, also extending beyond the specialty.(AU)

Profile of pharmaceutical interventions of a pharmacotherapeutic follow-up model for diabetic patients in a community pharmacy

Abstract The insertion of Pharmaceutical Care in Primary Health Care (PHC) improves patients' clinical outcomes and quality of life. Pharmacotherapeutic follow-up can contribute to the management of chronic diseases such as diabetes, promoting better glycemic control and adherence to therapy. This study aimed to assess the Drug-therapy Problems (DTPs) and Pharmacist Interventions (PIs) on the pharmacotherapeutic management in patients with type 2 diabetes mellitus (T2DM) in a community pharmacy. A quantitative, retrospective, and cross-sectional study was conducted in a Pharmaceutical Care Program within the PHC in Juiz de Fora (Minas Gerais, Brazil). Inclusion criteria were patients with T2DM above 18, who attended at least three pharmaceutical consultations between July 2016 and October 2018 and presented two or more glycated hemoglobin tests. The study group (n = 17) was largely composed of women (65%), elderly (76%), sedentary (72%), and obese people (52%). The resolution was achieved in 79% of the DTPs identified (n = 115). Most of DTPs were related to administration and adherence to pharmacotherapy (46%). 60% of the 437 PIs involved the provision of information and counseling. In other words, accessible interventions lead to high resolvability. Therefore, clinical actuation of pharmacists could improve the prognosis in diabetes treatment

Meta-analysis of Oral Chinese Medicine for Adjuvant Treatment of Primary Hepatic Carcinoma and Screening of Basic Chinese Herbs / 中国实验方剂学杂志

Objective:To systematically evaluate the efficacy of oral Chinese herbal prescriptions combined with transcatheter arterial chemoembolization （TACE） against primary hepatic carcinoma （PHC） and screen the basic Chinese herbs，in order to provide certain reference for clinical medication. Method:The randomized controlled trials concerning the treatment of PHC with oral Chinese herbal prescriptions plus TACE were retrieved from CBM，China National Knowledge Infrastructure （CNKI），Chongqing Weipu Database for Chinese Technical Periodicals （VIP），and Wanfang Data Knowledge Service Platform.The quality of the included trials was evaluated by Cochrane handbook，and the Meta-analysis was performed using RevMan 5.3.The enumeration data were expressed by odds ratio （OR），the measurement data by mean difference （MD） or standardized mean difference （SMD），and the effect size by 95% confidence interval （CI）.The data of oral Chinese herbal prescriptions involved in trials were sorted out and subjected to association rule analysis and frequency analysis based on the Traditional Chinese Medicine Inheritance Support System （TCMISS），for exploring the basic Chinese herbs and their dosages against PHC. Result:A total of 75 randomized controlled trials were included，involving 7 406 cases. As revealed by the Meta-analysis，oral Chinese herbal prescriptions combined with TACE was significantly better than TACE alone in improving the short-term curative effect ［OR=2.05，95%CI（1.83，2.29）］，decreasing alpha fetoprotein （AFP） ［MD=-59.02，95%CI（-79.03，-39.01）］，ameliorating liver function ［SMD=-1.23，95%CI（-1.58，-0.88）］，boosting immunity ［SMD=1.08，95%CI（0.84，1.32）］，adjusting Karnofsky Performance Status （KPS） scale score ［OR=2.7，95%CI（1.11，11.02）］，elevating survival rate ［OR=2.31，95%CI（1.96，2.71）］，and reducing adverse reactions ［OR=0.38，95%CI（0.34，0.43）］.Data mining results showed that the basic Chinese herbs against PHC were Bupleuri Radix，Paeoniae Alba Radix，Atractylodis Macrocephalae Rhizoma，Poria，and Glycyrrhizae Radix et Rhizoma，with their clinical dosages listed as follows：6-15 g for Bupleuri Radix，10-15 g for Paeoniae Alba Radix，9-15 g for Atractylodis Macrocephalae Rhizoma，10-15 g for Poria，and 3-10 g for Glycyrrhizae Radix et Rhizoma. Conclusion:The oral Chinese herbal prescriptions combined with TACE produce better effects in treatment of PHC as compared with TACE alone.These five basic Chinese herbs have anti-cancer effect，and their dosages are within the ranges stipulated in 2020 edition of <italic>Chinese Pharmacopoeia.</italic>This Meta-analysis has provided certain reference for clinical medication.

Potências e desafios na prática de apoio institucional e educação permanente em saúde: experiências em uma região de saúde do estado de São Paulo / Powers and challenges in the practice of institutional support and permanent health education: experiences in a health region in the state of São Paulo

Introdução: O Sistema Único de Saúde (SUS) possui uma rede de atenção cuja Atenção Básica (AB) é o ponto fundamental para ordenar os serviços e coordenar o cuidado. A fim de enfrentar os desafios de implementação do SUS e da AB, o Ministério da Saúde (MS) construiu políticas públicas como diretrizes para a gestão dos serviços e o cuidado. Uma delas é a Política Nacional de Humanização (PNH), que propõe o Apoio Institucional (AI) enquanto um dispositivo de intervenção transformador das práticas, a partir de um "modo de fazer", articulando as unidades da rede de saúde e valorizando o diálogo com as equipes. Uma outra política que se articula a essa é a Política Nacional de Educação Permanente em Saúde (PNEPS), constituindo-se enquanto estratégia para o desenvolvimento das relações e mudança das práticas nos serviços de saúde. No entanto, essas políticas propõem práticas que divergem dos modos tradicionais de se operar junto às equipes e requerem estratégias de acompanhamento do trabalho em saúde que favoreçam processos analíticos voltados para os usuários e suas necessidades de saúde. Há que se produzir dispositivos e práticas para o AI e a Educação Permanente em Saúde (EPS). Desta forma, temos como questão norteadora desta pesquisa: Quais ações têm sido realizadas pelas apoiadoras institucionais do Departamento Regional de Saúde (DRS) de Araraquara para a implementação dessas políticas? Quais facilidades e/ou dificuldades encontradas por estas atoras para exercer suas funções junto às equipes? Objetivo: O objetivo geral desta pesquisa é analisar as ações desenvolvidas pelas profissionais que compõem o quadro de apoiadora de humanização e articuladora de EPS, buscando identificar aspectos (des)favoráveis (potências e desafios) encontrados por estas atoras para o exercício de suas funções. Percurso Metodológico: Trata-se de um estudo de abordagem qualitativa, articulado a um projeto de pesquisa finalizado em 2018, intitulado: "Apoio Institucional e Educação Permanente em Saúde em uma Região de Saúde do interior de São Paulo: uma pesquisa intervenção" (Processo FAPESP N° 2016/15199-5). A pesquisa foi desenvolvida em Araraquara e contou com a participação de 35 profissionais, mediante assinatura do Termo de Consentimento Livre e Esclarecido (TCLE) - Protocolo nº CAEE - 68438217.8.0000.5393. As participantes deste estudo foram as apoiadoras de humanização e as articuladoras de EPS, indicadas pelos gestores municipais e que atuam junto às equipes de saúde da atenção básica dos 24 municípios pertencentes ao DRS III. Para a produção dos dados foram utilizados dois encontros de análise de práticas, gravados em mídia digital, com média de duas horas de duração, e transcritos na íntegra. Estes dados foram sistematizados e codificados automaticamente através do Software: NVivo. O referencial teórico está pautado em autores do campo da saúde coletiva, convergentes com as políticas públicas de saúde que embasam este estudo: a PNH e a PNEPS. Resultados: Na análise dos dados foram identificados dois grandes eixos: As ações desenvolvidas pelas apoiadoras e articuladoras (ações em prol da organização da rede de atenção, ações educativas e ações diagnósticas que norteiam o trabalho); Os aspectos que facilitam (apoio da gestão; o conhecimento e as experiências para a superação das dificuldades encontradas) ou que dificultam (a categoria profissional, os conflitos, realizar reuniões de equipe, despreparo para lidar com grupo, entender o seu papel e o sentimento de estar sozinho) ao realizarem suas funções com as equipes. Considerações Finais: O presente estudo teve o propósito de contribuir para o aprimoramento de práticas que qualifiquem o cuidado e o SUS, por meio do apoio institucional e de ações de EPS, tendo a PNH e a PNEPS como pilares de sustentação para o exercício destas funções. As ações para a organização da rede assistencial dos municípios e de atualização dos profissionais são exercidas pelas apoiadoras institucionais. Há dificuldades na lida com conflitos e na intermediação com a gestão. O AI em conjunto com a EPS revelaram-se como importantes ferramentas para integrar as equipes de saúde e a gestão, por facilitarem a troca de práticas e saberes. Somado a isso, os encontros de análise de práticas se mostraram como outra potente ferramenta de trabalho mobilizadora de mudanças nos diversos contextos. Entendemos que a análise e divulgação de práticas concretas contribui para o avanço de debates e reflexões quanto aos modos de produzir saúde no âmbito do SUS

Introduction: The Unified Health System (UHS) has a care network whose Primary Health Care (PHC) is the fundamental point to order services and coordinate care. In order to face the challenges of implementing UHS and PHC, the Ministry of Health (MH) built public policies as guidelines for the management of services and care. One of them is the National Humanization Policy (NHP), which proposes Institutional Support (IS) as an intervention device that transforms practices, based on a "way of doing", articulating the units of the health network and valuing dialogue with the teams. Another policy that is linked to this is the National Policy on Permanent Education in Health (NPPEH), which constitutes a strategy for the development of relationships and changes in practices in health services. However, these policies propose practices that diverge from the traditional ways of operating with teams and require strategies for monitoring health work that favor analytical processes aimed at users and their health needs. Devices and practices for IS and Permanent Health Education (PHE) must be produced. Thus, the guiding question of this research is: What actions have been taken by institutional supporters of the Regional Department of Health (RDH) of Araraquara for the implementation of these policies? What facilities and/or difficulties did these actors find to exercise their functions with the teams? Objective: The general objective of this research is to analyze the actions developed by the professionals who make up the framework of supporters of humanization and articulators of PHE, seeking to identify (un)favorable aspects (powers and challenges) found by these actors for the exercise of their functions. Methodological Path: This is a study with a qualitative approach, articulated with a research project completed in 2018, entitled: "Institutional Support and Permanent Health Education in a Health Region in the interior of São Paulo: an intervention research" (Process FAPESP No. 2016/15199-5). The research was carried out in Araraquara and had the participation of 35 professionals, who signed the Informed Consent Term - Protocol CAEE 68438217.8.0000.5393. The participants of this study were the supporters of humanization and the articulators of PHE, indicated by the municipal managers and who work with the primary care health teams in the 24 municipalities belonging to the RDH III. For the production of data, two meetings of analysis of practices were used, recorded in digital media, with an average duration of two hours, and transcribed in full. These data were systematized and coded automatically through the Software: NVivo. The theoretical framework is based on authors from the field of collective health, converging with the public health policies that support this study: the NHP and the NPPEH. Results: In the data analysis, two main axes were identified: The actions developed by the supporters and articulators (actions in favor of the organization of the care network, educational actions and diagnostic actions that guide the work); Aspects that facilitate (management support; knowledge and experiences to overcome the difficulties encountered) or that make it difficult (professional category, conflicts, holding team meetings, unpreparedness to deal with a group, understanding their role and feeling of being alone) when carrying out their duties with the teams. Final Considerations: This study aimed to contribute to the improvement of practices that qualify care and the UHS, through institutional support and PHE actions, with the NHP and NPPEH as supporting pillars for the exercise of these functions. Actions for the organization of the healthcare network in the municipalities and for the updating of professionals are carried out by institutional supporters. There are difficulties in dealing with conflicts and in intermediating with management. The IS together with the PHE proved to be important tools to integrate the health and management teams, as they facilitate the exchange of practices and knowledge. Added to this, the practice analysis meetings proved to be another powerful work tool that mobilized changes in different contexts. We understand that the analysis and dissemination of concrete practices contributes to the advancement of debates and reflections on ways to produce health within the scope of the UHS

Cuidados Paliativos na Atenção Primária à Saúde: Percepções de médicos da Estratégia de Saúde da Família sobre o tema na prática / Palliative Care in primaryhealth care: Perceptions of physicians of the family’s health strategy on the subject in practice

O presente Trabalho de Conclusão de Residência multidisciplinar em Saúdepossui o objetivode conhecer a percepção e a prática de profissionais médicos, atuantes na Estratégia de Saúde da Família (ESF), no que concerne aos Cuidados Paliativos (CP) na Atenção Primária à Saúde (APS). Os seis profissionaisdesta amostra estão vinculados aESF de uma Unidade Básica de Saúde (UBS) localizada em Canoas/RS.Oestudo possuimetodologia de natureza qualitativa e abordagem descritiva. Oreferencial teórico utiliza-se deáreas dapsicologia da saúde, medicina paliativa, e do Sistema Único de Saúde (SUS). Os resultados apontamparanecessidade de incluir nas práticas de CPdimensões subjetivasno cuidado e a interdisciplinaridade como método de trabalho.Ademais, identificaram-se lacunas referentes acapacitações e formações especificas em CP,sobrecarga de trabalho e insatisfação profissional. Essa pesquisa pretende ampliar a discussão dos muitos desafios éticos a serem vencidos na APS,referente aos CP.

This article presents the perception and practice in Palliative Care (PC) of physicians working in the Family Health Strategy (FHS), in Primary Health Care (PHC), in connection with the Basic Health Care Unit (UBS) of the city of Canoas/RS. Data were collected between June and August 2019. The analysis followed theoretical-methodological reference in health psychology, palliative medicine, and public policies of the Unified PublicHealth System (SUS). The study points out to the need for comprehensive care of patients in PC, evidencing difficulty in the identification, which makes it impossible to have a proper connection with patient-family-team.The challenge is to find interdisciplinary means of work, including emotional and spiritual dimensions, in addition to clinical practice. Itissuggested trainings, aiming at competenciesthatmeetethicalchallenges in PC. This research aims to subsidies the discussion of PC in public health, and provides information for future studies about this theme.

Adarsh primary health care yojana in Rajasthan

Primary health care (PHC) center is the first point of contact between community and the medical officer at village level. The PHCs have been envisaged to provide an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. The PHCs are established and maintained by the State Governments under the minimum needs programme or basic minimum services programme. At present, a PHC is manned by a medical officer supported by paramedical and other staff. It acts as a referral unit for 4 to 6 sub centres. It has 6 beds for patients. The activities of PHC involve curative, preventive, promotive and family welfare services. There are 2080 PHCs functioning as on March, 2018 in the Rajasthan.

Tecnologia digital como estratégia de educação permanente para melhoria do processo de trabalho e qualidade da assistência na estratégia saúde da família / Digital technology as a permanent education strategy to improve the work process and quality of care in the family health strategy

O estudo em questão tem como objeto de pesquisa os processos avaliativos fomentados pelo Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ) como dispositivos de apoio ao fortalecimento da Educação Permanente no âmbito das equipes de saúde da família no Município de Niterói/RJ. A Educação Permanente em Saúde (EPS) está estreitamente ligada ao processo de avaliação, uma vez que incita discussões e provoca mudanças nas práticas dos gestores e profissionais da Atenção Básica a fim de induzir a melhoria da qualidade das ações de saúde. Este estudo tem como objetivo geral: propor o desenvolvimento de um aplicativo como estratégia de EPS para oportunizar espaços de trocas e integração dos profissionais e da rede de atenção à saúde com vistas à melhoria do processo de trabalho e qualidade da assistência. E como objetivos específicos: descrever as ações de educação permanente desenvolvidas no cotidiano das equipes de saúde da família e como essas se inserem na reorganização do processo de trabalho e analisar os processos avaliativos fomentados pelo PMAQ na perspectiva dos profissionais da ESF. Utiliza como Referencial Político a Política Nacional em Educação Permanente em Saúde e como referencial teórico, os preceitos de Donal Schön. Os conceitos estabelecidos por Donald Schön possibilitam compreender a lógica da Educação Permanente em Saúde, visto a proximidade do referencial com as diretrizes propostas pela PNEPS. Estudo descritivo e exploratório, com abordagem qualitativa, do tipo pesquisa-ação. Como técnica de coleta de dados, foram realizadas oficinas pautadas em metodologias ativas, como a metodologia da problematização com os profissionais de saúde da Atenção Básica do Município de Niterói. Para análise e discussão dos dados, utilizou-se o conceito do ciclo da reflexividade de Valente como recurso metodológico. Através da metodologia utilizada, os participantes do estudo foram convidados a refletirem sobre o processo de avaliação e suas implicações no contexto da Educação Permanente. Verificou-se a premente necessidade de oportunizar espaços de discussão, análise e reflexão das práticas com participação crítica e ativa dos sujeitos e um maior debate acerca das questões referentes à avaliação. Os nós críticos do cotidiano da Saúde da Família foram discutidos pelos profissionais que ressaltaram a importância de se fomentar esse diálogo de forma contínua e permanente de modo a operar mudanças nos cenários de atuação, incorporando assim a EPS nesse contexto. A proposta do produto foi desenvolvida com base nas oficinas realizadas com os profissionais e de acordo com as principais demandas sinalizadas pelos mesmos, pautadas na experiência referente à avaliação externa do PMAQ. Pretende-se através dessa tecnologia digital, propiciar um ambiente em que o profissional exerça ciclos de reflexão e de ação, e que estes possam construir vínculos e pactuar possíveis fluxos com vistas à melhoria do acesso e da qualidade da assistência. Acredita-se que os processos avaliativos possam contribuir para que a EPS seja incorporada de forma sólida e contínua no dia a dia das equipes de saúde da família.

The study in question has as its research object the evaluation processes promoted by the National Program for Improvement of Access and Quality of Primary Care as devices to support the strengthening of Permanent Education within the scope of family health teams in the city of Niterói / RJ. Permanent Health Education (PHE) is closely linked to the evaluation process, since it incites discussions and causes changes in the practices of Primary Care managers and professionals in order to induce an improvement in the quality of health actions. This study has the general objective: to propose the development of an application as an PHE strategy to provide opportunities for exchanges and integration of professionals and the health care network with a view to improving the work process and quality of care. And as specific objectives: to describe the continuing education actions developed in the daily lives of family health teams and how they are inserted in the reorganization of the work process and to analyze the evaluation processes fostered by the National Program for Improvement of Access and Quality of Primary Care from the perspective of the Family health strategy professionals. It uses as a Political Reference the National Policy on Permanent Education in Health and as a theoretical reference, the precepts of Donal Schön. The concepts established by Donald Schön make it possible to understand the logic of Permanent Education in Health, given the proximity of the reference with the guidelines proposed by Political Reference the National Policy on Permanent Education in Health. Descriptive and exploratory study, with a qualitative approach, of an action research type. As a technique of data collection, workshops were conducted based on active methodologies such as the problematization methodology with health professionals in Primary Care in the city of Niterói. For data analysis and discussion, Valente's concept of the cycle of reflexivity was used as a methodological resource. Through the methodology used, the study participants were invited to reflect on the evaluation process and its implications in the context of Permanent Education. There was an urgent need to provide opportunities for discussion, analysis and reflection on practices with critical and active participation of the subjects and a greater debate on issues related to evaluation. The critical nodes of the daily routine of Family Health were discussed by the professionals who stressed the importance of fostering this dialogue on a continuous and permanent basis in order to effect changes in the performance scenarios, thus incorporating the PHE in this context. The product proposal was developed based on the workshops held with the professionals and according to the main demands signaled by them, based on the experience related to the external evaluation of the National Program for Improvement of Access and Quality of Primary Care. It is intended, through this digital technology, to provide an environment in which the professional exercises cycles of reflection and action, and that they can build bonds and agree on possible flows with a view to improving access and quality of care. It is believed that the evaluation processes can contribute for the PHE to be incorporated in a solid and continuous way in the daily routine of the family health teams

Assessment Of Services / Facilities Available At Primary Health Centres Of District Budgam, Kashmir: A Cross Sectional Study

The importance of Primary Health Care was internationally known after Alma Ata Conference in 1978. Primary health care in India is delivered by Sub center and Primary Health Center. Primary Health Center is the first contact with a health care professional of a community. National Rural Health Mission laid standards known as Indian Public Health Standards. This study was done in order to assess the quality of services and to identify any gaps in the health care delivery by Primary Health Centers(PHCs) in the District Budgam.This was a cross–sectional study done in four Primary Health Centers of the district and information regarding the availability of services at Primary Health Center’s was obtained using a pre–structured, pre–tested checklist which was prepared from Indian Public Health Standards. It was found that OPD services were provided by all while only one PHC provided emergency 24*7 services.50% of the Primary Health Centers had laboratory services for routine blood/urine/stool tests and only 25% had facilities for electrography,X–ray, and USG. However, 100% of the PHCs provided rapid tests for pregnancy .Although all Primary Health Centers provided ANC, family planning services but only 25% provided 24 hour delivery facility.New–born care was available at 75% PHCs while MTP services were available at only 25% of the PHCs The services at Primary Health Centers are not up to mark there is deficiencies in the basic services. Indian Public Health Standards should be taken seriously and evaluation should be done as per these standards at regular intervals so that we can improve the service delivery right from Primary health care level.

Psychological Stress among Grassroot Level Workers in a PHC of Bagalkot District

It is important to study the problems of the grassroot level workers and the levels of stress that they encounter. The stressed Anganwadi and ASHA workers are likely to be unhealthy, poorly motivated, less productive, and less efficient in implementing the various national programs. Objective: The objective was to study the level of stress among the grassroot level workers and the various factors related. Materials and Methods: Study design: This was a cross-sectional study. Setting: This was conducted at PHC of Bagalkot district. Study subjects: Grassroot level workers (Anganwadi [n = 46] and ASHA [n = 29] workers) were selected. Sample size: The sample size was 75. Data collection: Date were collected through self-reporting questionnaire schedule consisting of two schedules: (i) Sociodemographic characteristics and (ii) presumptive stressful life events scale questionnaire. Scores used in the study: Fifty-one life events were found to be experienced by the normal Indian population in the past 1 year. For each life event, a mean stress score was given. The total score was obtained for each by adding all the applicable life events scores. Accordingly, they were categorized into no stress, less/moderate stress, and severe stress. Statistical test used: Analysis was performed using Chi-square test. Results: About 61.33% were Anganwadi and 38.67% were ASHA workers. 70.67% had mental stress in the past 1 year. 8% of the subjects had a family history of mental illness and 25.33% of them were practicing yoga/meditation. 66.67% of the study subjects had experienced severe stress and 26.67% has mild/moderate stress. The factors such as past history of mental illness, socioeconomic status of the participants, house construction, unfulfilled commitments, unemployment of family member, loan, beginning of school, and marital conflict are significantly associated with level of stress. Conclusion and Recommendations: Psychological stress was found to be more among Anganwadi and ASHA workers. They are suggested to practice healthy lifestyles such as yoga and meditation to relieve stress.

Barreiras de acesso na atenção primária à saúde à travestis e transexuais na região central de São Paulo / Access barriers in Primary Health Care to transvestites and transsexuals in the central region of São Paulo

Historicamente, no Brasil e no mundo, o setor saúde tem se relacionado de forma ambivalente com travestis e transexuais (TT) promovendo acesso ao processo transexualizador, por um lado, mas condicionando-o ao diagnóstico de Tanstorno de Identidade de Gênero (TIG), patologizando assim a experiência da diversidade de gênero. As medidas preventivas adotadas na década de 80 com a epidemia do HIV, também acentuaram o estigma sofrido por este grupo, segregando o acesso aos serviços de saúde especializados. Pesquisas revelam, no entanto, necessidades de saúde relacionadas, não apenas ao acesso às tecnologias mais especializadas, mas de forma integral, associadas às marcas de opressão sofridas por essa população, à necessidade de vínculo aos serviços de saúde e à possibilidade de desenvolver autonomia. No que diz respeito, especificamente, aos dados epidemiológicos, essa população apresenta altos índices de transtornos mentais, uso de substâncias, violência e uso indiscriminado de hormônio. Apontam, ainda, a invisibilidade no que se refere à Atenção Primária à Saúde (APS) e a população TT. --------|a A Política Nacional de Atenção à Saúde Integral da População Lésbicas, Gays, Bisexuais, Travestis e Transexuais (LGBTT) vem como resposta a estas necessidades de cuidado integral, indo além do estigma patologização. Em consonância com esta política, o presente estudo teve como objetivo geral: elaborar um manual de acolhimento à população travesti e transexual para a APS e objetivos específicos: caracterizar o perfil da população TT; identificar os motivos pelos quais o usuário usa ou deixa de usar a APS; identificar barreiras que dificultam o acesso da população à APS; propor estratégias de superação das barreiras de acesso da população TT à APS. O projeto de pesquisa foi submetido ao Comitê de Ética da Escola de Enfermagem da Universidade de São Paulo (EEUSP) e da Secretaria Municipal de Saúde de São Paulo (SMSSP), bem como à gestão do Centro de Cidadania LGBT (CCLGBT) Luiz Carlos Ruas. Método: trata-se de um estudo qualitativo exploratório que realizou entrevistas semiestruturadas na Unidade Básica de Saúde-Sé (UBS-Sé) e no CCLGBT-Luiz Carlos Ruas, ambos na região central de São Paulo. O conteúdo das entrevistas foi registrado e, posteriormente submetido à diversas leituras para análise temática de conteúdo segundo a proposta de Bardin (2006). Análise dos dados: foram identificadas categorias empíricas a partir do referencial teórico relativo ao acesso enquanto dispositivo transformador da realidade, segundo Abreu de Jesus (2006) e às barreiras no acesso aos serviços de saúde à população LGBTT (Albuquerque et. al, 2016).Com relação aos dados quantitativos estes foram organizados em uma planilha para a análise dos dados. Resultados: Foram entrevistadas vinte pessoas trans, entre elas, treze se identificaram como mulheres trans, uma como travesti e seis como homens trans. Com idade média de 33 anos, em sua maioria solteiros (80%), com baixo grau de escolaridade (40% da amostra, referiram ter ensino médio incompleto ou menor grau de escolaridade) e apenas 30% inseridos no mercado de trabalho formal, evidenciando o panorama de vulnerabilidades da população trans. Com relação às barreiras no acesso à APS foram identificadas barreiras tecnoassistenciais relacionadas: 1) ao paradigma heteronormativo e de gênero como equivalência de sexo na APS; 2) pouca oferta do cartão do SUS com nome social e não uso do nome social; 3) falta de uma escuta qualificada; além de barreiras relacionadas às: 4) implicações da transfobia no acesso do serviço de saúde; 5) educação permanente: desconhecimento dos fluxos e conceitos da rede da pessoa trans; e 6) Transfobia nos serviços da APS. A partir das barreiras identificadas foram elaboradas proposições de superação das mesmas que integraram o Manual de acolhimento de Transexuais e Travestis à Atenção Primária à Saúde. Dentre as propostas de superação com relação às barreiras tecnoassitencias: estratégias de uso correto do nome social, a superação de paradigmas biologizantes e a valorização da dimensão relacional do trabalho em saúde, como o uso de uma comunicação responsiva e do acolhimento. Com relação às barreiras associadas à educação permanente, destaca-se a necessidade de ampliar o conhecimento dos trabalhadores com relação às informações a respeito das características da população TT, tais como: conceitos básicos envolvidos na temática, suas principais demandas e fluxos de apoio na rede. Investindo em metodologias ativas de ensino que se pautem em um modelo de saúde ampliado, evidenciando a visão política transformadora do trabalho no SUS. A superação da transfobia nos serviços de saúde está relacionada à promoção de educação permanente neste contexto. Outros estudos poderão avaliar a compreensão e utilização do Manual pelos profissionais da APS e a satisfação das necessidades da população TT.

Historically, in Brazil and in the world, health has related itself in an ambivalent way with transsexuals and transvestites (TT). Understood as pathology and not as diversity and freedom of gender by international disease manuals, this diagnosis allows access to medical procedures for changes in sexual characteristics. In Brazil, health places attention on the TT population beginning at the HIV/AIDS epidemic in the 80's, increasing this group's stigma and segregation, limiting access to specialized services, marking the ambivalence of the health system. Research describe, however, health care needs that go beyond HIV and physical transformations desired by trans people: high rates of mental disorders, substance use, violence, and indiscriminate use of hormones. Research also point out the invisibility in relation to Primary Health Care (PHC). The National Policy for Attention to Comprehensive Health Care for the Lesbian, Gay, Bi-sexual, Transvestite, and Transsexual (LGBTT) Population comes as a response to these needs for comprehensive care, going beyond the stigma and pathologization of gender identity. In line with this policy, the present study had as general objective: develop a manual for embracing the transvestite and transsexual population in the PHC; and specific objectives: characterize the TT population's profile, identify the reasons why users use or not the PHC, identify barriers that hinder the population's access to the PHC, and propose strategies for overcoming the TT population's access barriers to the PHC. Method: this is a qualitative and exploratory study in which 20 semi-structured interviews were carried out in Sé's Basic Health Unit -(BHU) and in Center for LGBT Citizenship (CLGBTC), both in the downtown area of Sao Paulo. The empirical material was analyzed through thematic analysis. Results: Twenty trans people were interviewed, among them thirteen identified themselves as trans women, one as transvestite and six as trans men. With a mean age of 33 years, mostly unmarried (80%), with a low level of schooling (40% of the sample, reported having incomplete high school or lower education) and only 30% inserted in the formal job market, evidencing the panorama of vulnerabilities of the trans population. Technical-care barriers were identified related to: 1) the paradigm of hetero-normative and gender as sex equivalence in the PHC; 2) offer little of the SUS (Brazilian Public Health Care System) card with social name social printed and the non-use of the social name; 3) lack of qualified listening. In addition to the related barriers: 4) implications of transphobia in access to the health service; 5) permanent education: lack of knowledge of flows and concepts of the trans person's network; 6) Transphobia in the PHC services. Based on the barriers identified, proposals were made to overcome them, which integrated the "Handbook on the reception of Transsexuals and Transvestites for Primary Health Care". Among the proposals for overcoming in relation to the tecnoassitencias barriers: strategies of correct use of the social name, the overcoming of biologizing paradigms and the valorization of the relational dimension of health work, such as the use of a responsive and welcoming communication. Regarding the barriers associated with lifelong education, the need to broaden workers' knowledge regarding information about the characteristics of the TT population, such as: basic concepts involved in the theme, its main demands and support flows in the public health system. Investing in active teaching methodologies that are based on an expanded health model, evidencing the transformative political vision of the SUS work. The overcoming of transphobia in the health services is related to the promotion of permanent education in this context. Other studies may assess the understanding and use of the Manual by PHC professionals and the satisfaction of the needs of the TT population. From the identified barriers, propositions for improvement of these were built, as well as the "Embracing Transvestites and Transsexuals (TT) in Primary Health Care (PHC) Manual".

Expression and clinical significance of CXC chemokine receptors 1 and 2 and CXCL8 in primary hepatocellular carcinoma / 中华微生物学和免疫学杂志

Objective To investigate the expression and clinical significance of CXC chemokine receptors 1 and 2 (CXCR1 and CXCR2) and CXCL8 in peripheral blood mononuclear cells (PBMCs) and liver biopsy tissues from patients with primary hepatocellular carcinoma (PHC).Methods Serum specimens were collected from 36 patients with PHC, 30 patients with liver cirrhosis and 28 healthy subjects.Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to measure the expression of CXCR1, CXCR2 and CXCL8 at mRNA level in PBMCs.Streptavidin-perosidase (SP) immunohistochemistry was used to detect the expression of CXCR1, CXCR2 and CXCL8 at protein level in liver biopsy tissues.Levels of C-reactive protein (CRP), alpha-fetoprotein (AFP) and ferritin (FER) in the serum specimens were detected by chemiluminescence immunoassay.Then the correlations between these markers were analyzed.Results All of the results showed that the expression of CXCR1, CXCR2 and CXCL8 at mRNA level in PBMCs from the PHC group were higher than those of the healthy control group (P<0.01) as well as those of the liver cirrhosis group (P<0.05).Up-regulated expression of CXCR1, CXCR2 and CXCL8 in patients with PHC were associated with the depth of tumor invasion, lymph node or distant metastasis, clinical stage and levels of CRP, AFP and FER in serum (P<0.05).The expression of CXCR1, CXCR2 and CXCL8 at protein level in liver biopsy tissues were also significantly increased in the PHC group in comparison with those of the healthy control group as indicated by the result of SP immunohistochemistry (P<0.05).Conclusion Levels of CXCR1, CXCR2 and CXCL8 in the patients with PHC are significantly increased and positively correlated with the levels of AFP, FER and CRP in serum, suggesting that the signal transduction process mediated by CXCR1, CXCR2 and their common ligand CXCL8 may play a key role in the pathological process of PHC.This study may provide a potential new strategy for immune intervention in hepatocellular cancer.

Cuando la alegría entra al centro de salud: una experiencia de promoción de salud en Buenos Aires, Argentína / When joy enters into the health center: an experience of health promotion in Buenos Aires, Argentina / Quando a alegria entra no centro de saúde: uma experiência de promoção da saúde em Buenos Aires, Argentina

Como parte de una investigación posdoctoral, el presente trabajo describe y analiza una experiencia de promoción y educación para la salud integral desarrollada por un Centro de Salud y Acción Comunitaria en una zona marginal urbana del sur de la Ciudad de Buenos Aires. Se trata de un estudio exploratorio-descriptivo que utiliza técnicas cualitativas para el trabajo de campo y análisis del material. En articulación con las dimensiones de la APS integral, se describe y analiza un dispositivo vincular, centrado en la interdisciplina y la articulación intersectorial como elementos clave de la organización de los cuidados en salud, con la inclusión de la dimensión intercultural y la participación comunitaria. Se incorporan actividades de promoción de salud integral centradas en el arte, creatividad y juego, constituyéndose en una experiencia resistencial al modelo biomédico de atención, con fuerte impacto subjetivo en los profesionales y la comunidad participante.

As part of a postdoctoral research, this paper describes and analyzes an experience of promotion and education for comprehensive health, carried out by a Community Health Center in a slum of the City of Buenos Aires. This is an exploratory and descriptive study based on qualitative research methodologies in the fieldwork and also to examine the results. A linkage artifact is described and analyzed in the perspective of the dimensions of comprehensive PHC, focusing on the interdisciplinary and intersectoral articulation as key elements of the organization of health care, with the inclusion of the intercultural dimension and community participation. This experience incorporates health promotion activities focused on art, creativity and games, becoming an experience of resistance to the biomedical model of services, with a strong subjective impact on the professionals and the participant community.

Como parte da pesquisa de pós-doutorado, o trabalho descreve e analisa uma experiência de promoção e educação para a saúde integral, desenvolvida por um Centro de Saúde e Ação Comunitária em uma zona marginal urbana do sul da Cidade de Buenos Aires. Trata-se de um estudo exploratório-descritivo, que utiliza técnicas qualitativas para o trabalho de campo e análise do material. Articulado com as dimensões da APS integral, descreve-se e se analisa um dispositivo vincular, centralizado na interdisciplina e na articulação intersetorial como elementos-chave da organização dos cuidados com a saúde, com a inclusão da dimensão intercultural e a participação comunitária. Incorporam-se atividades de promoção de saúde integral com o foco na arte, na criatividade e no jogo, constituindo uma experiência resistencial ao modelo biomédico de atenção, com forte impacto subjetivo nos profissionais e na comunidade participante.

Atención primaria en salud y TIC: Una mirada desde la perspectiva de Haberlas / Primary health care and ICT: A view from Habermas’s perspective

En la Atención Primaria en Salud (APS) la relación entre el médico y su paciente ha sido motivo de preocupación y estudio en el campo de las ciencias sociales, ya que de la calidad de este proceso comunicacional podrá o no surgir el nexo necesario para lograr la buena salud individual y colectiva. Se pretende en este escrito hacer un análisis de la conjunción APS -TIC respecto a los tipos y/o niveles de comunicación que pueden llegar a desarrollarse en la relación médico-paciente, tanto desde la simbología intrínseca en el discurso médico, como desde la interacción médico-paciente mediada por las TIC; esto enmarcado en la teoría de la Acción Comunicativa de Habermas y de su visión acerca de la tecnología y los medios de comunicación de masas. Para el desarrollo del presente escrito se realizó una investigación documental, siendo la técnica utilizada el análisis documental. Se concluye que las Tecnologías de Información y Comunicación representan una herramienta de mucha utilidad en los diferentes ámbitos de la Atención Primaria en Salud, sin embargo para que esta combinación realmente dé resultados positivos y duraderos es necesario abordarlo desde el mundo de la vida de cada grupo involucrado. Es esencial mantener una continua comunicación y capacitación del personal de salud, así como de los usuarios, para que de ésta manera se puedan llegar a asumir las TIC como parte productiva de la dinámica social que vivimos y las APS como la clave para tener una sociedad holísticamente más saludable.

In the Primary Health Care (PHC) the relationship between doctor and patient has been of concern and study in the field of social sciences, since from the quality of the communication process may or may not arise the necessary nexus to achieve good individual and collective health. It is intended in this paper to analyze the conjunction ICT-PHC on the types and / or levels of communication that may develop at the doctor-patient relationship, both the symbolism inherent in the medical discourse, as from the interaction mediated by ICT; this framed in the theory of communicative action of Habermas, taking into account his perspective on technology and mass media. For the development of this written was conducted a documentary research, and the technique used was document analysis. It is concluded that the Information and Communication Technologies are a very useful tool in different areas of primary health care, however for this combination to positive and lasting result it is necessary to approach it from the world of the life of each group involved. It is essential to maintain a communication and training continuous of health personnel and users, so that in this way can get to be ICT assumed as a productive part of the social dynamics that we live and the PHC as the key to a society holistically healthier.

APLICACIÓN DE TÉCNICAS DE MINERÍA DE DATOS EN ATENCIÓN PRIMARIA EN SALUD (APS) PARA EL ANÁLISIS DE RIESGOS EN MUJERES GESTANTES DE LA POBLACIÓN MANIZALEÑA ATENDIDA POR ASSBASALUD / APPLICATION OF DATA MINING TECHNIQUES IN PRIMARY HEALTH CARE (PHC) FOR RISK ANALYSIS IN PREGNANT WOMEN IN THE POPULATION OF MANIZALES ATTENDED BY ASSBASALUD

Objetivo: Determinar las relaciones entre los factores de riesgo existentes en las madres gestantes, a través de las técnicas de minería de datos. Materiales y Métodos: Se recolectó una muestra de 15265 registros de mujeres con edades comprendidas entre los 10 y 48 años, datos que pertenecen al período comprendido entre los años 2010 y 2012, incluyéndolos. Los datos se procesaron mediante Microsoft SQL Server 2008 R2 y Microsoft Excel 2007, teniendo en cuenta el proceso KDD y la metodología CRISP DM para la minería de datos usando los algoritmos de k-Means para Clústers, Reglas de Asociación y Métodos de Correlación. Resultados: Mediante los algoritmos de clústers se evidenció que las mujeres con antecedentes de aborto componen el 5% de la población estudiada; las mujeres con partos prematuros tienen mayor presencia en edades anormales, siendo este del 2%, mientras que en edades aptas para la gestación la cifra solo es del 1%; el 1% de las mujeres, sin importar la edad, refiere haber tomado licor durante su embarazo; las mujeres que tuvieron abortos y consumieron alcohol fueron el 20%; las mujeres con partos prematuros con consumo de alcohol fueron el 8%. Las mujeres que aceptaron haber consumido drogas fueron el 2% en edad apta para la gestación y el 3% en edades no aptas, ubicándolas en el clúster que tiene la máxima probabilidad de aborto.

Objective: To determine the relationship between existing risk factors in pregnant mothers through data mining techniques. Materials and Methods: A sample of 15,265 women aged between 10 and 48 years, data pertaining to the period between 2010 and 2012, was collected. Data was processed using Microsoft SQL Server 2008 R2 and Microsoft Excel 2007, taking into account the KDD process and CRISP-DM methodology for data mining using k-Means algorithms for Clusters, Association Rules and Correlation Methods. Results: Using Clustering algorithms it was evident that women with a history of abortion form 5% of the study population; women with premature births have a greater presence in abnormal ages being 2% of the population, while suitable age for gestation is only 1%; 1% of women, regardless of age, reported having consumed liquor during pregnancy; women who had abortions and consumed alcohol were 20%; women with induced labor showed 8% alcohol consumption. Women who admitted having used drugs were 2% in ages suitable for gestation and 3% in ages non suitable for conception, placing them in the cluster having the highest probability of abortion.

A Comparative Study To Analyze The Cost Of Maternal And Child Health programme At Primary Health Center In Ahmedabad, India.

Abstracts: Background: Cost studies are paramount for demonstrating how resources have been spent and identifying opportunities for more efficient use of resources. The aim of this study was to determine the unit cost of maternal and child health (MCH) programme provided at Primary Health Centers (PHCs) and to examine the variation in unit cost in different PHCs. Methodology: The present study was carried out in three PHCs of Ahmedabad district namely Sanathal, Nandej, and Uperdal, between 1 April, 2006 and 31 March, 2007. For estimating the cost of a health program, information on all the physical and human resources that were basic inputs to the PHC services were collected and grouped into two categories, non-recurrent (capital resources vehicles, buildings, etc.) and recurrent resources (salaries, drugs, vaccines, contraceptives, maintenance, etc.). To generate the required data, two types of schedules were developed, daily time schedule and PHC/SC (Subcenter) information schedule. Results: Unit cost for each contact of MCH beneficiaries was Rs. 54.87 at Sanathal PHC, Rs. 87.63 at Nandej PHC and Rs. 70.01 at Uperdal PHC. Conclusion: Even though maternal and child health services are free, utilization of these services at the health centres were low, particularly for delivery, leading to high unit costs.