Novas conformações do apoio matricial em tempos de pandemia de COVID-19 / New configurations of matrix support in times of the COVID-19 pandemic

Resumo O presente artigo buscou analisar as diferentes conformações do apoio matricial a partir das mudanças engendradas pela pandemia de SARS-CoV-2, tendo como referência o processo de trabalho do Núcleo Ampliado de Saúde da Família (NASF) neste contexto, do município de Maricá, Rio de Janeiro, Brasil. Utilizou-se como método de investigação a pesquisa qualitativa e de análise a hermenêutica dialética, subsidiada por técnicas definidas em função do cenário pandêmico - websurvey, entrevista semiestruturada, análise documental e busca nos sistemas de informações do Sistema Único de Saúde. Como principais resultados, a pesquisa evidenciou: aumento de queixas associadas à saúde mental, em usuários e trabalhadores; necessidade de mobilização das redes de apoio socioassistenciais; ampliação do apoio remoto, sobretudo junto aos profissionais das equipes vinculadas; menor circulação dos especialistas pelos territórios. A pesquisa identificou que o processo de trabalho foi se tornando mais individualizado, dentro dos consultórios, e que as equipes mínimas reuniram poucas condições para a atenção aos agravos decorrentes da COVID-19, confirmando o NASF como uma equipe essencial da Atenção Primária à Saúde.

Abstract The aim of this study was to analyze the different configurations of matrix support stemming from changes prompted by the COVID-19 pandemic by investigating the work process of an Expanded Family Health Center (NASF) in Maricá, Rio de Janeiro, Brazil. We conducted a qualitative study using data collection methods selected according to the circumstances of the pandemic: web survey, semi-structured interviews, document analysis and searches of health information systems. The data were analyzed using the hermeneutic-dialectic method. The findings show an increase in mental health problems among both patients and health workers, the need to mobilize sociopsychological support networks, an expansion of remote support, especially for professionals from supported teams, and reduced presence of specialists in the community. The study shows that work processes became more individualized and focused inside clinics, and that minimum teams had limited capacity to care for the health problems related to COVID-19, confirming that NASFs play an essential role in primary health care.

Construção do referencial histórico-normativo do Núcleo Ampliado de Saúde da Família / Construction of the historical-regulatory standard of the Expanded Family Health Center

Resumo Este artigo discute a construção histórica do Núcleo Ampliado de Saúde da Família (NASF), a partir da análise de 17 documentos editados pelo Ministério da Saúde entre os anos de 2005 e 2021. Trata-se de um estudo qualitativo de revisão documental que busca compreender como as normativas, cadernos instrutivos e notas técnicas oficiais vêm dando contorno ao modo de operar das equipes do NASF. Propõe-se a divisão do processo de construção do NASF em cinco períodos: movimentos antecedentes (2003 a 2007); diretrizes do apoio (2008 a 2011); universalização do NASF (2012 a 2015); ampliação do apoio (2016 a 2018); e o desmonte do NASF? (2019 a 2021). Os resultados apontam mudanças de orientação ao longo dos anos de existência da equipe, especialmente em relação ao conceito do apoio matricial e suas duas dimensões, técnico-pedagógica e clínico assistencial. O estudo demonstra ainda os efeitos do Programa Previne Brasil sobre o NASF, que se materializaram na redução de 379 equipes nos anos de 2020 e 2021. Soma-se a esse cenário a pandemia do SARS-CoV-2, que pode reposicionar as intervenções do NASF no Sistema Único de Saúde.

Abstract This paper discusses the historical construction of the Expanded Family Health Center (NASF, in Portuguese), based on the analysis of 17 documents edited by the Ministry of Health (MH) between 2005 and 2021. This is a qualitative study of documental review that seeks to understand how the regulations and official instructive manuals have been shaping the way NASF teams operate. It proposes to divide the NASF construction process into five periods: previous movements (2003 to 2007); support guidelines (2008 to 2011); the universalization of nasf (2012 to 2015); expansion of support (2016 to 2018); and the dismantling of NASF? (2019 to 2021). The results show changes in guidelines over the years of the team's existence, especially in relation to the matrix support concept and its two dimensions: technical-pedagogical and clinical care. This study also demonstrates the effects of the Previne Brasil Program on the NASF, which resulted in the reduction of 379 teams in 2020 and 2021. Added to this scenario is the SARS-CoV-2 pandemic, which may be repositioning NASF interventions in the Brazilian Unified Health System (SUS, in Portuguese).

Results of the study of citizens’ attitudes toward public health care and services / Монголын Анагаах Ухаан

Introduction@#Among the population of Mongolia, cardiovascular diseases (34.2%), cancer (24.3%), accidents and external causes (16.9%) are highly prevalent, and risk factors such as alcohol and tobacco use, unhealthy diet, lack of exercise have increased dramatically, and more than half of people aged 45-64, or 53.2% are at high risk of contracting non-communicable diseases. When comparing the demand for health care and services according to the level of healthcare institutions, it was determined that 70% of the demand is in the primary healthcare institution, 20% at the secondary level, and 10% at the tertiary level. Therefore, in order to prevent these diseases and provide health education to the population, it is necessary to study the attitude of the citizens who visit primary healthcare institutions about public health care and services.@*Material and Methods@#In this study, a cross-sectional research design was used to determine citizens’ attitudes toward public health care and services. In collecting data, a total of 291 people from each of Dornod and Khovd provinces, from the capital of provinces, and 3 soums were included in the target sampling method. When evaluating the attitudes of the respondents, they were rated on a scale of 1-5 for each question. The SPSS-20 software was used to analyze the data.@*Ethics@#The methodology was approved by the Medical Ethics Sub-Committee of the Ach medical university on the 30th of June, 2022 (Decision #22/05/04).@*Results@#51% (148) of respondents rated their health status as good and 42.1% (122) rated it as moderate, and 57.6% (167) of all respondents answered that they visit the primary health center when they have symptoms. Also, the status of visiting a primary health center for prevention is better in the following groups: 45-54 age group, among people with complete secondary and higher education, and soum healthcare center. </br>The attitudes of the participants towards public health care and services were evaluated in 4 groups, which are the demand for organizing preventive measures, the dependence of health on the individual, and the dependence of health on social and economic conditions, with an average of 4 points which means the demand is great. In addition, the healthcare institution’s organization of measures to promote and prevent the health of citizens is an average of 3.87 points, and the general score of the respondents’ attitude is 3.98 points, which indicates that there is a great demand for public health care and services. @*Conclusions@#Despite the low number of visits to primary health centers for preventive purposes among the respondents, attitudes toward public health care and services were good.

Desarrollo psicomotor y cortisol salival en niños que viven juntos a sus madres privadas de libertad / Psychomotor development and cortisol salivary levels in infants that live with their inmate mothers

INTRODUCCIÓN: En Chile el sistema penitenciario cuenta con un programa que permite que las madres privadas de libertad vivan con sus hijos menores de 2 años. Esta modalidad podría implicar que los niños estén más expuestos a condiciones de estrés y a mayor riesgo de retraso en su desarrollo psicomotor (DSM). OBJETIVO: Comparar el DSM y la concentración de cortisol en saliva de los niños que viven en la cárcel junto a sus madres y comparar los resultados con los observados en niños que no están bajo este régimen. SUJETOS Y MÉTODO: Estudio transversal en 42 lactantes, 12 de ellos hijos de madres reclusas en el centro penitenciario de Santiago (CPF), y 30 controles provenientes de un Centro de Salud Familiar de Atención Primaria (CESFAM). Se evaluó DSM de los lactantes mediante la encuesta ASQ-3 y se realizó medición de cortisol salival mediante radioinmunoensayo a los lactantes y madres. RESULTADOS: La mediana de cortisol salival de los hijos de madres del CPF y CESFAM fue de 2,3 ng/ml (IQR 1,1 a 2,7) y de 2,1 ng/ml (IQR 1,6 a 2,9) respectivamente. El cortisol materno fue 4,6 ng/ml (IQR 3,8 a 7,3) en el CPF y 3,7 ng/ml (IQR 2,4 a 4,7) en el CESFAM. El déficit del DSM fue 2,3% y 28,5% para los niños del CPF y del CESFAM, respectivamente, sin diferencia estadística (p = 0,06). CONCLUSIONES: No hubo diferencia en el DSM y tampoco en el cortisol salival entre los niños de ambos grupos.

INTRODUCTION: In Chile, the prison system has a program that allows inmate mothers to live with their children un der two years of age. This could imply that these children are more exposed to stress conditions and a higher psychomotor developmental delay (PDD) risk. OBJECTIVE: To compare the PDD and salivary cortisol concentrations (SCC) of children living in prison with their mothers and to compare the results with control children. SUBJECTS AND METHOD: Cross-sectional study in 42 infants, 12 of them are children of inmate mothers in the penitentiary center (CPF) of Santiago, and 30 controls from a Primary Care Family Health Center (CESFAM). PDD of infants was assessed through the ASQ-3 questionnaire and salivary cortisol was measured in infants and mothers using radioimmunoassay. RESULTS: The median salivary cortisol level of the children of CPF and CESFAM mothers was 2.3 ng/ ml (IQR 1.1 to 2.7) and 2.1 ng/ml (IQR 1.6 to 2, 9) respectively. Maternal cortisol was 4.6 ng/ml (IQR 3.8 to 7.3) in the CPF and 3.7 ng/ml (IQR 2.4 to 4.7) in the CESFAM. The PDD deficit was 2.3% and 28.5% for children from the CPF and the CESFAM respectively, without statistical difference (p = 0.06). CONCLUSIONS: There was no difference in the PDD and salivary cortisol between children of both groups.

Some issues relating to the family health center, family doctors care and health services / Монголын Анагаах Ухаан

Background. The main target of this research paper on “Some issues relating to the family healthcenter, family doctors care and health services” is for the young doctors, and specifically family doctorsand to help their daily work routine. This paper focused on giving analyses on the principle of somescholars research paper about the general structure of family health center, and its practical activities.There are many issues related to social medical service, an example is the basic health service fromthe family health center. There must a model or classic form for providing medical service at the statefamily health center, general medical center and the first care of medical center. This research paperalso proposed a number of current issues in order to improve the quality, such as family health centerand its management structure.Goal. The reference of this paper is to define family health center service and financial management,based on the research survey. Moreover, it concludes the idea of improving and refreshing the healthsector from the smallest branch and implementing health care marketing in the public. This researchpaper contains followings: the structure of family health center, health insurance, medical service costper person in the family, training for family health center doctor and nurse, the history of family healthcenter origin and its development, home visit service, foreign countries experience on this sector, andthe system to simplifying II, III level medical service etc.Materials and Methods. In our country Mo.Shagdarsuren has changed section hospitals into familyhealth hospital who is doctor, one of the famous manager of health protection who is firstly managed cityUlaanbaatar to committee and district. In early 1990s doctor Ts.Mukhar organized control system of familyhealth in some sub cities who helps people to get better health program. He organized small hospitalitysystems of each sub cities and moved kids doctors to family health system. Since its establishment,the system was rapidly extending throughout the country. Researches for changing the management ofFamily Health Center (Udval.D, Bat Ochir.D) and for the future development of family hospital (Mukhar.Ts, Orgil.B) are proven to be useful in practical environment.Result. The importance of this advisory article is considering in improving the Family Health Careservice sufficiency and its quality coordinating with the writings or publications written by ourcountryfamous scientists. Health Sector reformation strategy and other materials to clarify the importanceprimary health care importance of the family health care and its doctors and it is necessary to hire thebest and most experienced doctors and social health figure in hospital primary service in modernsociety.Conclusion. In conclusion, the scholars believe that in this society, the doctors who are the best, mostexperienced, well- educated on general and family health center service, and trained well, work fromtheir bottom of heart, number of accident, and disease rate will gradually decrease. Therefore, thefacilities of the health center must be improved such as providing proper workplace with well equippedmedical facilities and medical diagnosing cameras etc.Additionally, known as “The left hand of a physician“ in other words, there is a high demand to preparewell educated, professionally independent and knowledgeable nurses for the family health center

Role of family health centres in prevention, screening and addressing risk factors of cardiovascular diseases, cancer and diabetes, methodological support / Монголын Анагаах Ухаан

IntroductionProvide evidence necessary for effective implementation of the National Programme on Prevention and Control of NCDs by studying the services delivered by family health centers for prevention, screening and reduction of risk factors of cardiovascular diseases, cancer and diabetes, problems encountered and professional support.GoalStudy the role of family health centers in prevention, screening and reduction of risk factors of cardiovascular diseases, cancer and diabetes and the methodological and professional support they are receiving.Materials and MethodsThe study covered 30.7% of family health centres of UB city and 18.9% of family health centres in rural areas, which are together 19.7% of all family health centres.Results and conclusions18 family health centres from Central, Dornogobi, Orkhon aimags and 25 family health centres from Bayanzurkh, Sukhbaatar, Nalaikh districts of Ulaanbaatar city as well 258 doctors and 18 managers who provide with qualified methodology were involved in the survey. Informal training activities such as lecture, discussions, memo printed on the reverse side of the check-up numbers, e-mails, SMS messages and advice during visits need to be used to promote healthy behaviour and healthy lifestyle. There are no incentives for promoting health, and preventing non-contagious diseases, the budget for these activities is really minimal around 60,000-200,000 tugrugs per annum. Cooperation with international organizations can be enhanced in order to receive financial support for these activities. The staffs of family health centres consists in average of 11-15 personnel, they are overloaded with the treatment of patients and less time is available for them to work for prevention, screening, and addressing risk factors. The instructing and counselling skills of medical staff are low.