Construcción de Perfiles de Usuario para el Modelo Integral de Salud Familiar y Comunitario en la Comuna de Alto Hospicio, Región de Tarapacá / User Profiles for the Integrated Family and Community Health Care Model in the Alto Hospicio, a commune of a northern region of Chile

INTRODUCCIÓN: El estudio presenta perfiles integrales para usuarios de los Centros de Salud primaria de la comuna de Alto Hospicio. OBJETIVO: Conocer los perfiles de usuarios inscritos en los Centros de Salud de la comuna de Alto Hospicio desde una perspectiva integral e incorporando indicadores de satisfacción y conocimiento acerca del Modelo de Atención Integral de Salud Familiar y Comunitaria (MAIS). MATERIAL Y MÉTODO: Se elaboró un instrumento conformado por ocho dimensiones y 73 ítems, el cual se aplicó en cuatro centros de Atención de Salud Primaria de la comuna. Se realizó un muestreo aleatorio simple por cada Centro. En total se encuestaron a 1.124 personas, se obtuvo una representatividad de entre 95% y 93% de confianza, con niveles de significación que van de 5% a 7%. RESULTADOS: La caracterización usuaria pone en relevancia la diversidad de perfiles atendidos en cada Centro de Salud y revela problemáticas generales como la escasa información recibida respecto del modelo de atención familiar, el desconocimiento de los servicios prestados por los Centros de Salud y la dificultad de enfrentar situaciones de salud mental en el contexto de la pandemia COVID-19. CONCLUSIONES: Aquellos Centros de Salud que transmiten mayor información del MAIS presentan mejores indicadores respecto al conocimiento de los servicios de salud y de satisfacción usuaria. En el marco de la implementación del Modelo de Salud Familiar, es relevante conocer los perfiles de usuarios según las características de cada Centro de Salud, su población y territorio, y compartir buenas prácticas entre los Centros.

BACKGROUND: The study presents comprehensive profiles of Primary Health Care Centers of the Alto Hospicio Commune users. OBJECTIVE: To characterize users registered in the Health Centers of Alto Hospicio Commune from a comprehensive perspective, including satisfaction indicators and knowledge about the Comprehensive Family and Community Health Care Model (MAIS). METHODS: A questionnaire of 8 dimensions and 73 items was designed and applied in 4 Primary Health Care Centers in the commune. Four simple random samplings were applied. In total, 1,124 users were surveyed. The confidence and significance levels were between 95%-93% and 5%-7%, respectively. RESULTS: The user profile highlights the diversity in each Health Care Center and reveals general problems such as the lack of information regarding the family care model and services provided by the Health Care Centers and the difficulty of facing mental health situations in the context of the COVID-19 pandemic. CONCLUSIONS: Those Health Centers that provide more information about MAIS show better indicators regarding knowledge of health services and user satisfaction. The changes in public health policies and the implementation of the Comprehensive Family and Community Health Care Model require clarifying user profiles according to the characteristics of each health center, its population, and the territory, as well as sharing best practices between health centers.

Componente de software para el proceso de solicitudes de evaluación de estudios neurofisiológicos para el Sistema XAVIA HIS / Software component for the process of requests for evaluation of neurophysiological studies in the XAVIA HIS System

Introducción: la especialidad de neurofisiología se ocupa del estudio, la evaluación del sistema nervioso (central y periférico), su modificación funcional, de los órganos sensoriales y musculares, tanto en condiciones normales como patológicas. La normalización de la información sobre esta especialidad es compleja, porque cada institución hospitalaria cubana tiene sus propias fuentes de gestión. Esta situación dificulta la homogeneización de los datos, la recopilación de información estadística y su inclusión en el registro médico digital único del paciente cubano. Objetivo: presentar un componente de software que informatiza las solicitudes de estudios neurofisiológicos para las instituciones de salud cubanas, que utilizan el Sistema de Información Hospitalaria XAVIA HIS. Método: se entrevistaron a especialistas del Centro Cubano de Neurociencias CNEURO, para definir el proceso de gestión de las solicitudes de estudios neurofisiológicos. Se aplicó la entrevista semiestructurada, que permitió la adaptación a los entrevistados para aclarar términos, identificar ambigüedades y reducir los formalismos. Para el desarrollo se utilizaron herramientas de software libre (JBoss Developer Studio como entorno integrado de desarrollo, Java como lenguaje de programación orientado a objetos, JBoss como servidor de aplicaciones y PostgreSQL v9.4 como sistema de gestión de bases de datos), que garantizan las políticas de desarrollo de software y soberanía tecnológica de Cuba. Resultados: las solicitudes de estudios neurofisiológicos en el sistema XAVIA HIS, se informatizaron a partir de un componente de software, basado en el estándar HL7-CDA para documentos clínicos. Conclusiones: los especialistas en neurofisiología disponen de funcionalidades para la estandarización, almacenamiento y gestión de la información de la especialidad, lo cual conduce al enriquecimiento de la historia clínica digital del sistema XAVIA HIS(AU)

Introduction: The Neurophysiology specialty deals with the nervous system (central and peripheral) study and assessment and its functional modification and the sense and muscular organs, both in normal and pathological conditions. Information standardization on this specialty is complex because each Cuban hospital institution has its own management sources. This situation makes it difficult to homogenize the data, gather statistical information and include it in the Cuban patient unique digital medical record. Objective: Describe a software component that computerizes neurophysiological studies requests for Cuban health institutions that use the XAVIA HIS Hospital Information System. Method: Specialists from the Cuban Neuroscience Center CNEURO were interviewed to define the neurophysiological studies requests management process. The semi-structured interview was applied, which allowed the adaptation to the interviewees in order to clarify terms, identify ambiguities and reduce formalisms. Free software tools were used for development (JBoss Developer Studio as an integrated development environment, Java as an object-oriented programming language, JBoss as an application server and PostgreSQL v9.4 as a database management system) that guarantee the Cuban software development and technological sovereignty policies. Results: Neurophysiological studies requests in the XAVIA HIS system were computerized using a software component, based on the HL7-CDA standard for clinical documents. Conclusions: Neurophysiology specialists have functionalities for the specialty information standardization, storage, and management, which leads to the XAVIA HIS system digital medical record enrichment(AU)

Términos de referencia de llamado a concurso de profesionales de salud comunitaria para el abordaje del COVID-19 en territorios indígenas de Costa Rica / Terms of reference of the call for the contest of community health professionals to address the COVID-19 in indigenous territories of Costa Rica

Con la intención de abordar la emergencia a nivel de los Territorios Indígenas, el Gobierno de la República convocó a un equipo de trabajo en asuntos indígenas y salud. El equipo está conformado por funcionarias y funcionarios del Ministerio de Salud, la Caja Costarricense de Seguro Social, la Comisión Nacional de Emergencia, la Comisión Nacional de Asuntos Indígenas, el Ministerio de Justicia y Paz y el Viceministerio de la Presidencia en Asuntos Políticos y Diálogo Ciudadano. Asimismo, cuenta con el apoyo de Sistema de Naciones Unidas en Costa Rica. A partir del trabajo de este equipo, se elabora el "Plan de acción para el abordaje del Covid19 en territorios indígenas", el cual considera como objetivo general implementar acciones estratégicas para la contención, prevención y atención de la emergencia del Covid-19, en los 24 territorios indígenas de Costa Rica, de acuerdo con los lineamientos técnicos para la prevención del Covid-19 en territorios indígenas. Para apoyar integralmente la implementación de este plan, la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS), agencia técnica en las temáticas de salud del Sistema de Naciones Unidas, ha iniciado un proceso de contratación de profesionales comunitarios de salud que apoyen el abordaje de la Covid-19 en los territorios indígenas del país.

Análisis del sistema de salud cubano y del modelo atención primaria orientada a la comunidad / Analysis of the Cuban Health System and the Model of Community-Oriented Primary Care

La integración del cuidado de la salud individual con el de la población a través de la salud pública se ha podido llevar a cabo de forma efectiva a partir del modelo de la atención primaria orientada a la comunidad. En Cuba, la atención primaria es la base del sistema nacional de salud, con acceso universal y cuidado de los individuos, sus familias y la comunidad. El sistema nacional de salud y la atención primaria orientada a la comunidad contribuyen a la mejora de la salud y a la disminución de desigualdades en salud e iniquidades en la provisión de servicios. Este artículo presenta su descripción y análisis(AU)

Individual healthcare integrated with population healthcare through public health has been effective and possible through the model of community-oriented primary care. In Cuba, primary healthcare is the supporting structure of the national health system, including universal coverage and the care for individuals, their families, and the community. The national health system and community-oriented primary care contribute with health improvement and the decrease in health inequalities and in inequities of provided care. This article presents their comprehensive description and analysis(AU)

Índice de Cobertura Assistencial da Rede de Atenção Psicossocial (iRAPS) como ferramenta de análise crítica da reforma psiquiátrica brasileira / Healthcare Coverage Index in the Psychosocial Care Network (iRAPS) as a tool for critical analysis of the Brazilian psychiatric reform / Índice de Cobertura Asistencial de la Red de Atención Psicosocial (iRAPS) como herramienta de análisis-crítico de la reforma psiquiátrica brasileña

Resumo: Passados quase vinte anos de implantação da reforma psiquiátrica no Brasil, o país conta com uma assistência à saúde mental híbrida, na qual os serviços asilares são parte da própria rede que deveria substituí-los. Este estudo buscou analisar criticamente a oferta dos serviços de assistência à saúde mental no país, no intuito de identificar se efetivamente decorre um processo de substituição dos serviços de ênfase asilar pelos comunitários. Para alcançar o objetivo, foi realizado um estudo longitudinal retrospectivo da oferta de serviços de assistência à saúde mental no Brasil, no período de 2008 a 2017, com a elaboração de uma base de dados única com informações dos 5.570 municípios. Como ferramenta auxiliar da análise crítica da reforma psiquiátrica, foi construído o Índice de Cobertura Assistencial da Rede de Atenção Psicossocial (iRAPS), considerando-se a parametrização legal dos serviços. Foi verificado o avanço da oferta dos serviços comunitários e a redução dos asilares. Porém, com o iRAPS identificou-se que 77% da população brasileira habitam localidades com cobertura de serviços comunitários baixa ou inexistente. As pequenas cidades, que concentram 16% da população nacional, foram as que mais impulsionaram o avanço do iRAPS em nível nacional. Apenas 439 cidades, 7,9% do total, apresentam cobertura assistencial total da Rede de Atenção Psicossocial (RAPS), expressando apenas 6,69% da populacional nacional. As metrópoles, que concentrarem 46% da população brasileira, não apresentaram avanço na cobertura de serviços comunitários. A análise da oferta de serviços de saúde mental com base no iRAPS permiti-nos afirmar que o avanço dos serviços comunitários ocorreu de forma não homogênea entre as localidades.

Abstract: Nearly 20 years after the implementation of Brazil's psychiatric reform, the country has a hybrid model of mental health care, in which asylum services are part of the network that should replace them. This study aimed to critically analyze the supply of mental health services in Brazil in order to verify whether there is actually a replacement of asylum-based services by community-based services. A retrospective longitudinal study was performed on the supply of mental health services in Brazil from 2008 to 2017, building a single database on 5,570 municipalities (counties). As an ancillary tool for critical analysis of the psychiatric reform, we developed the Health Coverage Index for the Psychosocial Care Network (iRAPS, in Portuguese), considering the services legal parametrization. The results showed an increase in the supply of community-based services and a reduction in asylum services. However, the iRAPS tool found that 77% of the Brazilian population lives in areas with low or nonexistent coverage of community services. Small towns, with 16% of the Brazilian population, were those with the greatest increase in iRAPS. Only 439 cities, 7.9% of the total, showed total coverage by the Psychosocial Care Network (RAPS, in Portuguese), expressing only 6.69% of the national population. The metropolises, with 46% of the Brazilian population, did not show an increase in community services. The analysis of the supply of mental health services based on the iRAPS tool showed that the increase in community services did not occur homogeneously across the country.

Resumen: Transcurridos casi veinte años desde la implantación de la reforma psiquiátrica en Brasil, el país cuenta con una asistencia a la salud mental híbrida, en la que los servicios de acogida a enfermos mentales son parte de la propia red que debería substituirlos. Este estudio buscó analizar críticamente la oferta de los servicios de asistencia a la salud mental del país, con el fin de identificar si, efectivamente, deriva en un proceso de sustitución de los servicios de acogida por parte de los comunitarios. Para alcanzar el objetivo, se realizó un estudio longitudinal retrospectivo de la oferta de servicios de asistencia a la salud mental en Brasil, durante el período de 2008 a 2017, con la elaboración de una base de datos única con información de los 5.570 municipios. Como herramienta auxiliar del análisis-crítico de la reforma psiquiátrica, se creó el Índice de Cobertura Asistencial de la Red de Atención Psicosocial (iRAPS), considerando la parametrización legal de los servicios. Se verificó el avance de la oferta de los servicios comunitarios y la reducción de los de acogida. No obstante, con el iRAPS se identificó que un 77% de la población brasileña vive en localidades con cobertura de servicios comunitarios baja o inexistente. Las ciudades pequeñas, que concentran a un 16% de la población nacional, fueron las que más impulsaron el avance del iRAPS a nivel nacional. Apenas 439 ciudades, 7,9% del total, presentan cobertura asistencial total de la Red de Atención Psicosocial (RAPS), suponiendo solamente un 6,69% de la poblacional nacional. Las metrópolis, que concentraron un 46% de la población brasileña, no presentaron un avance en la cobertura de los servicios comunitarios. El análisis de la oferta de servicios de salud mental a partir del iRAPS nos permitió afirmar que el avance de los servicios comunitarios se produjo de forma no homogénea entre las localidades.

Performance of nurses/nursing team in the dispensing of materials for users of home care services / Performance del enfermero/equipo de enfermería en la dispensación de materiales para asistencia al usuario en el domicilio / Performance do enfermeiro/equipe de enfermagem na dispensação de materiais para assistência ao usuário no domicílio

ABSTRACT Objective: To contextualize the performance of nurses/nursing team in the dispensing of materials to assist users in home visits, in primary care. Methods: Dialectical qualitative study conducted between March and April 2018 in which 24 nurses from primary health care units in the Gloria/Cruzeiro/Cristal District of Porto Alegre, Rio Grande do Sul, completed the self-administered questionnaire, whose data were treated by thematic content analysis. The study was approved by the Research Ethics Committee. Results: Two categories emerged from the empirical corpus: logistic chain of material management for home user assistance; production of services and capacity of the team. Conclusion: The work processes related to materials management for home user assistance and the resulting health services production require a look at specificities such as workload and technologies involved, as they move the performance of the nurse/nursing staff.

RESUMEN Objetivo: Contextualizar el desempeño del enfermero/equipo de enfermería en la dispensación de materiales para asistencia al usuario en el domicilio, en la atención básica. Métodos: Estudio dialéctico cualitativo. Entre marzo y abril de 2018, 24 enfermeros de unidades de salud del Distrito Gloria/Cruzeiro/Cristal, Porto Alegre, Rio Grande do Sul, respondieron al cuestionario autoadministrado, cuyos datos fueron tratados mediante Análisis de Contenido Temático. El estudio fue aprobado por el Comité de Ética en Investigación. Resultados: Del corpus empírico resultaron dos categorías: cadena logística de la gestión de materiales para asistencia al usuario en el domicilio; la producción de servicios y la capacidad del equipo. Conclusión: Los procesos de trabajo relacionados con la gestión de materiales para la asistencia al usuario doméstico y la producción de servicios de salud resultantes requieren un análisis de las especificidades carga de trabajo y tecnologías involucradas, a medida que mueven el desempeño de la enfermería/enfermería.

RESUMO Objetivo: Contextualizar a performance do enfermeiro/equipe de enfermagem na dispensação de materiais para assistência ao usuário no domicílio, na atenção básica. Métodos: estudo qualitativo dialético. Entre março e abril de 2018, 24 enfermeiros de unidades de saúde da atenção básica do Distrito Gloria/Cruzeiro/Cristal, de Porto Alegre, Rio Grande do Sul, responderam ao questionário autoadministrado, cujos dados foram tratados mediante Análise de Conteúdo Temática. O estudo foi aprovado por Comitê de Ética em Pesquisa. Resultados: Do corpus empírico resultaram duas categorias: cadeia logística do gerenciamento de materiais para assistência ao usuário no domicílio; produção de serviços e a capacidade da equipe. Conclusão: Os processos de trabalho referentes ao gerenciamento de materiais para assistência ao usuário no domicílio e a produção de serviços em saúde decorrentes requerem um olhar para especificidades como carga de trabalho e tecnologias envolvidas, por moverem a performance do enfermeiro/equipe de enfermagem.

Community-based approaches for malaria case management in remote communities in the Brazilian Amazon

Abstract INTRODUCTION Malaria case management is a pivotal intervention in malaria elimination. However, many remote areas in Brazil still lack access to basic health services. This study describes a community-based approach (CBA) for malaria case management in the large remote area of the Jaú National Park (JNP), Amazonas, Brazil. METHODS In 2001, a general health CBA was initiated with a motor group (MG); a participative community health diagnosis (PCHD) was subsequently implemented between 2001 and 2005. In 2006, a CBA for malaria case management started with an expanded MG including all sectors with a stake in malaria control, from the local residents to the federal government. In 2008, community microscopists were selected and trained to diagnose hemoparasites. A full malaria strategy was implemented in 2009 with subsequent quality control follow-up. RESULTS Two educational materials were co-created with local communities. The MG identified malaria as a major health problem and the malaria MG planned the control activities. Ten communities selected a resident to become malaria microscopists, and ten solar-operated health centers were built. The number of slide readings increased from 923 in 2006 to 1,900 in 2009, while malaria infections decreased from 354 cases in 2005 to 20 cases in 2015. The excess time (≥ 48 hours) between first symptoms and diagnosis/treatment decreased from 68.9% of cases in 2005 to 14.3% in 2010. CONCLUSIONS While many factors were likely involved in the reduction of malaria transmission in the JNP, the CBA played an important role in the sustained success of the initiative.

Community-based rehabilitation (CBR) in primary care centers in Chile / Rehabilitación basada en la comunidad (RBC) en centros de atención primaria en Chile

ABSTRACT OBJECTIVE To describe the implementation status of the Community-Based Rehabilitation in Chile. METHODS Quantitative, transversal and descriptive study. The scope was constituted by the 66 community-based rehabilitation centers in the Chilean Metropolitan Region that implemented Community-Based Rehabilitation until December 2016. The sampling was based on a census method, so all the community centers were contacted. A self-administered questionnaire designed based on the Community-Based Rehabilitation matrix defined by the World Health Organization was applied. The questionnaire was answered on-line by the coordinators of the strategy in their respective centers. The data analysis was performed using descriptive statistics. RESULTS A heterogeneous level of implementation of Community-Based Rehabilitation was identified, specifically in terms of the components of the matrix described by the World Health Organization. The most implemented component was Health; the Social, Livelihood and Empowerment components were moderately implemented; and the Education component was the least implemented. CONCLUSION The implementation of Community-Based Rehabilitation is mainly based on the Health component. The level implementation of the other components of the matrix needs to be increased, as well as interdisciplinary and intersectoral strategies to achieve greater social inclusion of people with disabilities.

RESUMEN OBJETIVO Describir el estado de implementación de la Rehabilitación Basada en la Comunidad en Chile. MÉTODOS Estudio cuantitativo, transversal y descriptivo. El universo estuvo conformado por los 66 centros comunitarios de rehabilitación de la Región Metropolitana de Chile que implementaron la Rehabilitación Basada en la Comunidad hasta diciembre de 2016. El muestreo tuvo intención censal, por lo que se contactaron todos los centros comunitarios. Se aplicó un cuestionario autoadministrado diseñado con base a la matriz de Rehabilitación Basada en la Comunidad definida por la Organización Mundial de la Salud. El cuestionario fue respondido on-line por los coordinadores de la estrategia en sus respectivos centros. El análisis de datos se realizó utilizando estadígrafos descriptivos. RESULTADOS Se identificó un nivel heterogéneo de implementación de la Rehabilitación Basada en la Comunidad, específicamente en cuanto a los componentes de la matriz descrita por la Organización Mundial de la Salud. El componente más implementado fue Salud; los componentes Social, Subsistencia y Fortalecimiento fueron medianamente implementados; y el componente Educación fue el menos implementado. CONCLUSIÓN La implementación de la Rehabilitación Basada en la Comunidad se basa principalmente en el componente Salud. Se requiere aumentar el nivel de implementación de los otros componentes de la matriz, así como de estrategias interdisciplinarias e intersectoriales para lograr una mayor inclusión social de las personas con discapacidad.

Desafíos de la Red Asistencial Pública de Chile en la Especialidad de Trastornos Temporomandibulares y Dolor Orofacial / Challenges of the Chilean Public Health Care System Network in the Temporomandibular Disorders and Orofacial Pain Specialty

RESUMEN: Los Trastornos Temporomandibulares (TTM) son un conjunto de patologías musculares y articulares que afectan al sistema masticatorio. Según estadísticas nacionales, la prevalencia de al menos un diagnóstico de TTM en la población adulta corresponde al 49,6 %, mientras que el 19,6 % padece de un dolor temporomandibular severo. La atención de pacientes afectados por estos trastornos corresponde al odontólogo especialista en trastornos temporomandibulares y dolor orofacial (TTM y DOF), especialidad reconocida legalmente desde el año 2013 por el decreto 8 del Ministerio de Salud. Estas patologías no están incorporadas a las prestaciones de salud oral de las Garantías Explícitas en Salud (GES) y recientemente se han comenzado a establecer protocolos de derivación a la especialidad desde la Atención Primaria Odontológica. En el presente estudio se realiza un análisis de la situación actual de la especialidad de TTM y DOF en la red pública de atención y se plantean posibles soluciones y mejoras a los problemas encontrados.

ABSTRACT: Temporomandibular Disorders (TMD) comprise a heterogenous group of muscle and joint disorders that affect the masticatory system. According to national statistics, the prevalence of at least one diagnosis of TMD in the adult population is 49.6 %, while 19.6 % suffers from severe temporomandibular pain. Care of patients affected by these disorders corresponds to the dentist specialized in temporomandibular disorders and orofacial pain (TMD and OFP); these particular disorders and the specialty were incorporated by the Ministry of Health in 2013.. The pathologies are not incorporated in the Explicit Health Care Guarantees (GES) and only recently protocols for a referral program were established for Primary Dental Care in this area. In this study, the present situation of the specialty of TMD and OFP in the public health care network is analyzed, as well as possible solutions and improvements to the difficulties encountered therein.

Conhecimento, atitudes e práticas de agentes comunitários de saúde sobre tuberculose pulmonar em uma capital do Nordeste do Brasil / Knowledge, attitudes and practices of community health agents regarding pulmonary tuberculosis in a capital city in northeastern Brazil

Resumo Esse artigo analisa o conhecimento, atitudes e práticas sobre tuberculose de agentes comunitários de saúde (ACS) no Recife, município com altas taxas de incidência e de abandono do tratamento no Brasil. O estudo transversal foi conduzido em uma amostra representativa dos ACS utilizando questionário padronizado. Descreveram-se as frequências das variáveis referentes ao conhecimento, atitudes e práticas e analisou-se a associação do conhecimento satisfatório e práticas adequadas com características dos ACS. Dos 401 ACS elegíveis, 385 (96,0%) foram entrevistados. A maioria era composta por mulheres (87,5%), com idade ≥ 40 anos (66,0%) e desempenhando a função há mais de nove anos (74,5%). Um percentual de 61,7% tinha conhecimento satisfatório e esse conhecimento (75,8%) esteve associado às práticas adequadas (p = 0,008). Quanto às atitudes, 97,1% dos ACS acreditavam estar sob risco de contrair tuberculose e 53,2% atribuíram o risco à função. Parcela significativa dos ACS apresentou conhecimento satisfatório sobre tuberculose e esse conhecimento esteve associado às práticas adequadas. Esse resultado sugere a necessidade de investimentos em ações de capacitação que podem contribuir para a melhoria dos indicadores de tuberculose no município.

Abstract This article analyses the knowledge, attitudes and practices of community health agents (CHAs) regarding tuberculosis in Recife, a municipality with a high incidence of tuberculosis and high treatment dropout rates in Brazil. The cross-sectional study was conducted with a representative sample of CHAs and a standardized questionnaire. The frequencies of the variables related to knowledge, attitudes and practices were described, and the association between satisfactory knowledge and appropriate practices of CHAs was analysed. Of the 401 eligible CHAs, 385 (96.0%) were interviewed. The majority were women (87.5%) aged ≥ 40 years (66.0%) and had been on the job for more than nine years (74.5%). A large percentage (61.7%) had satisfactory knowledge about tuberculosis, and this knowledge (75.8%) was associated with appropriate practices (p = 0.008). Regarding attitudes, 97.1% of CHAs were believed to be at risk of contracting tuberculosis, and 53.2% attributed this risk to their job. The results suggest the need for investment in training actions that may help improve tuberculosis indicators in the municipality.

Impacto de un programa comunitario para la malnutrición infantil / Impact of a community program for child malnutrition

OBJETIVO: Evaluar el impacto de un programa comunitario destinado a mejorar la malnutrición de niños y niñas de una comunidad rural del Estado de Chiapas, México, 2013. MATERIAL Y MÉTODO: Estudio descriptivo de la evaluación de un programa a partir de una base de datos secundaria con datos nutricionales en 113 niños menores de cinco años de una zona rural de México. La intervención y el relevamiento se realizaron durante el 2013. Se registraron mediciones basales y a los 4 meses. Para el cálculo de indicadores del estado nutricional se utilizó el Software Anthro de la Organización Mundial de la Salud (OMS). Se estimaron: Peso para edad (P/E); Talla para edad (T/E); Peso para talla (P/T); Índice de masa corporal para la edad (IMC/E), según los lineamientos de la OMS. Se calcula ron medidas de posición y dispersión, prueba T de Student, Kruskal-Wallis, test de MacNemar para datos pareados y regresión lineal simple. RESULTADOS: Entre el inicio y final la mediana del Z Peso/ talla pasó de -0,7 (p25 -1,24; p75 -0,01) a -0,62 (p25 -1,09; p75 -0,15). La prevalencia de bajo peso descendió de 5,31% (IC 2,38-11,44) a 4,42 % (IC 1,83-10,32) (Z Score IMC/edad). El peso adecuado según Z Score Peso/talla aumentó de 78,76% (IC 70,12-85,43) a 84,96% (76,98-90,51). En el subgrupo con bajo peso inicial la media de Z IMC/edad y Z Peso/talla aumentó 0,4 (p = 0,003). El cambio en la media de Z Peso/talla fue de 0,02 puntos en el subgrupo que recibió programa de trasferencia directa y de -0,3 en el que no (p = 0,020). CONCLUSIONES: Se concluye que el programa comunitario durante los 4 meses de implementación contribuyó a mejorar algunos indicadores antropométricos; aunque no se encontraron efectos aparentes en indicadores relacionados a la desnutrición crónica.

OBJECTIVE: To evaluate the impact of a community program aimed at improving the children mal nutrition in a rural community of the State of Chiapas, Mexico, 2013. MATERIAL AND METHOD: Des criptive study of the evaluation program from a secondary database of nutritional data registry of 113 children under five years of age in a rural area of Mexico. The intervention and the survey were carried out during 2013. Baseline and 4-month measurements were recorded. The World Health Organization (WHO) Anthro software was used to calculate nutritional status indicators. According to WHO guidelines, the following data were estimated: weight for age (W/A), height for age (H/A), weight for height (W/H), and Body mass index for age (BMI/A). Position and dispersion measures were calculated; Student's T-test, Kruskal-Wallis, and MacNemar test were used for paired data and linear regression. RESULTS: Between the beginning and the end, the median of the Z W/H went from -0.7 (p25 -1.24, p75 -0.01) to -0.62 (p25 -1.09, p75 -0.15). The prevalence of low weight decreased from 5.31% (CI 2.38-11.44) to 4.42% (CI 1.83-10.32) (Z BMI/A). The appropriate weight according to Z score W/H increased from 78.76% (CI 70.12-85.43) to 84.96% (76.98-90.51). In the subgroup with low initial weight, the mean of Z BMI/A and Z W/H increased 0.4 (p = 0.003). The change in the mean of Z W/H was 0.02 points in the subgroup that received the direct transfer program and of -0.3 in which it did not (p = 0.020). CONCLUSIONS: It is concluded that the community program during the four months of implementation contributed to improve some anthropometric indicators, although no apparent effects were found in indicators related to chronic malnutrition.

Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project / Promover una alianza entre la atención primaria y las organizaciones comunitarias para aumentar las pruebas de detección de cáncer colorrectal: el proyecto HAPPI

Abstract: Objective: The Healthy Aging Partnerships in Preven tion Initiative (HAPPI) aims to increase the use of clinical preventive services (CPS) among underserved Latinos and African Americans in South Los Angeles who are 50+ years old. Materials and methods: HAPPI uses an evidence-based model, SPARC, to leverage existing resources and link community resources. HAPPI's multi-sectoral partnerships include local non-governmental organizations (NGOs), community health centers (CHCs), aging and public health agencies serving the City and County of Los Angeles, and a university. Activities include CHC capacity assessment and training, and community capacity-building that included a small grants program. Results: We engaged five CHCs in quality improvement activities and eight NGOs in networking and programming to increase awareness and receipt of CPS. We discuss barriers and facilitators including the success of trainings conducted with CHC providers and NGO re presentatives. Conclusion: Multi-sectoral collaborations hold promise for increasing awareness and use of CPS in underserved communities.

Resumen: Objetivo: HAPPI se propone aumentar el uso de servicios clínicos preventivos (SCP) en personas mayores de 50 años en Los Ángeles. Material y métodos: HAPPI es una colaboración intersectorial e incluye organizaciones no gu bernamentales (ONG) locales, centros de salud comunitarios (CSC), centros de servicios para personas mayores, agencias de salud pública que dan servicio a la ciudad y al condado de Los Ángeles, y una universidad pública para movilizar recur sos comunitarios y promover lazos entre las asociaciones. Sus actividades incluyen asesorar y aumentar la capacitación de CSC y la comunidad, además de un programa de becas. Resultados: Se colaboró con cinco CSC para la mejora de calidad y con ocho ONG para abrir conciencia de los SCP. Se presentaron barreras y facilitadores incluyendo el éxito de las enseñanzas con proveedores de CSC y representantes de las ONG. Conclusión: Las colaboraciones multi-sectoriales son prometedoras para amplificar conciencia del uso de SCP en personas mayores.

Autorización de jornadas médicas o de salud: norma técnica No. 35-2019 / Authorization of medical or health conferences: technical standard No. 35-2019

El objetivo del documento es la regularización del proceso para la autorización de jornadas médicas, por lo que es de carácter obligatorio para los responsables de establecimientos públicos, privados e instituciones sociales o profesionales individuales. Contiene además, las definiciones de los conceptos relacionados al tema principal, además de la infraestructura que deberá tener cada clínica, incluidos el equipo y recurso humano y técnico.

Effect of intervention programs regarding community "5+1" staged diabetes target management on patients with type 2 diabetes mellitus / 中华流行病学杂志

Objective: To analyze the effect of intervention programs and influencing factors regarding the community "5+1" staged diabetes target management on patients with type 2 diabetes mellitus (T2DM) and to provide evidence for improving the quality of life (QOL). Methods: A total of 12 community health service centers from Shanxi province, Jiangsu province, and Ningxia Hui autonomous region were selected as intervention group and control group, by stratified cluster sampling method. "5+1" model was used in intervention groups and basic public health services model was applied in control groups for this two-year follow-up. Data was collected through a questionnaire on demographic and disease-related information, while the QOL was measured with SF-36. Multiple linear regression and conducted by SAS 9.4. Results: A total of 2 467 subjects were included at baseline and 1 924 had completed a two-year-long management service. After intervention programs being implemented, the net effect of PCS score between the intervention and the control groups was 13.6, with the net effect of MCS score as 29.8. Results from the multiple linear regression showed that the main factors affecting PCS scores included age, type of medical insurance, baseline PCS score and regions of residency. Main factors related to MCS score included age, type of medical insurance, baseline MCS score, hypertension, and region of residency. Conclusion: Community "5+1" staged diabetes target management model presented favorable effect of improving the QOL on T2DM patients.

Assessment on the capacity for prevention and control programs for chronic non-communicable diseases in China, in 2014 / 中华流行病学杂志

Objective: To assess the capacity of prevention and control on chronic non- communicable diseases (NCDs) in China. Methods: On-line questionnaire survey was adopted by 3 395 CDCs at provincial, municipal and county (district) levels and 3 000 primary health care units, and assess on capacity of policy, infrastructure, capacity of training and guidance, cooperation, surveillance, intervention and management, assessment and scientific research from September 2014 to March 2015. Results: (1) Capacity of policy: 23 (71.9%) provincial, 139 (40.6%) municipal and 919 (31.2%) county (district) governments or health administrative departments had existing plans for prevention and control of NCDs. (2) Capacity of infrastructure: 25 (78.1%) provincial, 136 (39.8%) municipal and 529 (18.0%) county (district) CDCs had set up departments dedicated to the prevention and control of NCDs, with 9 787 staff members, accounting for 5.0% of the total CDC personnel, working on NCDs prevention and control programs. 68.1% of the CDCs had special funding set for NCDs prevention and control. (3) Capacity of training and guidance: 2 485 CDCs (74.9%) held all kinds of training on prevention and control of NCDs. 2 571 (87.3%) CDCs at the county (district) level provided technical guidance for primary health care units. (4) Capacity of cooperation: 42.0% of the CDCs had experiences collaborating with the mass media. (5) Capacity of surveillance: 73.8% of the CDCs had set up programs for death registration while less than 50.0% of the CDCs had implemented surveillance programs on major NCDs and related risk factors. In terms of primary health care units, 32.4% of them had set up reporting system for newly developed stroke case and 29.9% of them having programs on myocardial infarction case reporting. (6) Capacity of intervention and management: 69.1% and 68.2% of the CDCs conducted individualized intervention programs on hypertension and diabetes, while less than 40.0% CDCs conducting intervention programs on other NCDs and risk factors. More than 90.0% of the primary health care units carried out follow-up surveys on hypertension and diabetes. However, only 17.4% and 13.7% of the CDCs working on hypertension and diabetes patient management programs while 83.7% and 80.4%, of them following the standardized guidelines for management, with successful rates of control as 59.2% and 55.2%, respectively. (7) Capacity of assessment: 32.4% of the CDCs or health administrations carried out evaluation programs related to the responses on NCDs. (8) Capacity of scientific research: the capacity on scientific research among provincial CDCs was apparently higher than that at the municipal or county (district) CDCs. Conclusions: Compared with the results of previous two surveys, the capacity on policies set for the prevention and control programs improved continuously, at all level NCDs, but remained relatively weak, especially at both county (district) and primary health care units.

Modelo integral comunitario para prevenir y abordar problemáticas de salud adolescente / A comprehensive community model to prevent and address adolescent health problems

RESUMEN En este artículo presentamos una modelización que tiene como meta la construcción de una respuesta integral y comunitaria frente a problemáticas de salud adolescente. Desde un abordaje integral, que incluye acciones de prevención y promoción, asistencia y protección, y que involucra a diferentes sectores y áreas del Estado y de la comunidad, describimos las bases conceptuales del modelo, los ejes y los principios que recuperamos de los debates de la promoción de la salud, la salud colectiva y de las experiencias de trabajo del equipo de investigación en distintas comunidades a lo largo de los últimos 15 años en Argentina. Posteriormente, damos cuenta de los pasos desarrollados para facilitar la realización de intervenciones y retomamos algunos nudos teóricos, políticos y prácticos que se encuentran en su gestación, en una apuesta por vincular la reflexión crítica con el desarrollo de tecnologías sociales. Este modelo da cuenta de la reflexión sobre cómo llevar adelante acciones de promoción de la salud que busquen transformar las realidades particulares, respetando sus singularidades y recuperando lo que las conecta con otras.

ABSTRACT This article presents a model for building a comprehensive community response to adolescent health problems. The approach is comprehensive in that it includes prevention and promotion, assistance and protection, and involves different sectors and areas of the State and the community. We describe the conceptual framework and principles of the model, developed based on debates regarding health promotion and collective health as well as the work experiences of the research team in different communities in Argentina over the last 15 years. We then present the steps developed to help facilitate interventions and analyze certain theoretical, political and practical issues underlying the management of such a model, in an attempt to link critical reflection with the development of social technologies. This model takes into account reflections regarding how to carry out health promotion actions that seek to transform particular realities, respecting their singularities but at the same time acknowledging their connections to others.

Haití, la nueva comunidad inmigrante en Chile / Haiti, new immigrant community in Chile

Las migraciones constituyen un fenómeno creciente en América Latina, influido por factores económicos, laborales, búsqueda de bienestar social, educación y salud, entre otros. Chile presenta una tasa neta de migración positiva, y en el último tiempo ha destacado el gran número de inmigrantes haitianos que han llegado a nuestro país, especialmente luego del terremoto que le afectó el 2010. Provenientes de una cultura diferente, donde el estilo de crianza y las características de atención en salud, entre otros aspectos, difieren a la de nuestro país, conocer la cultura haitiana y su situación de salud es relevante para una mejor apreciación de sus necesidades y enfrentar de mejor forma la programación de la atención sanitaria de esta población que busca en Chile un lugar de acogida y mayor bienestar. Para profundizar los esfuerzos de integración en trabajo, salud, educación y en la comunidad parece aconsejable actualizar la legislación referente a migraciones, tal que permita abordar los problemas actuales a través de una ley migratoria que data de 1975.

Migration is a growing phenomenon in Latin America influenced by several factors such as economic stability, employment, social welfare, education and health system. Currently Chile has a positive migration flow rate. Particularly, a significant number of Haitian immigrants has been observed du ring the last years, especially after earthquake of 2010. These immigrants present a different cultural background expressed in relevant aspects of living including parenting and healthcare. Knowing the Haitian culture and its health situation is relevant for a better understanding of their health needs. Haitian people come to Chile looking for a cordial reception and willing to find a place with better perspectives of wellbeing in every sense. Immigration represents a major challenge for Chilean health system that must be embraced. Integration efforts in jobs, health, education system and community living should be enhanced to ensure a prosper settlement in our country. A new immigration law is crucial to solving major problems derived from current law created in 1975.

Trajetória em narrativas: loucuras e a cidade de Belo Horizonte, Brasil / Trajectory in narratives: experiences of mental illness and the city of Belo Horizonte

Resumo O artigo busca compreender as relações estabelecidas entre portadores de sofrimento mental assistidos em um serviço aberto e comunitário e a cidade de Belo Horizonte (BH), capital do Estado de Minas Gerais. Compreende-se que a experiência da loucura é capaz de gerar narrativas que buscam atribuir sentido ao sofrimento e auxiliam as pessoas a negociar as decisões cotidianas. O método biográfico foi utilizado para a construção das narrativas de trajetórias de vida dos três participantes do estudo. Cada pessoa atribuiu um sentido diferente à experiência da loucura, contudo, percebe-se a existência de trajetórias e sociabilidades marginais às convenções da ordem, da família e do trabalho. Verifica-se uma ruptura com a invisibilidade marcante nos manicômios, uma vez que os serviços abertos proporcionam a circulação social e a manipulação de códigos sociais que entremeiam os deslocamentos, criando novas territorialidades e codificações. Contudo, evidencia-se a necessidade de estudos empíricos que contemplam temáticas como as relações familiares e as condições de moradia e renda dessa população, para, então, ampliar as discussões do direito à saúde para o direito à moradia, ao trabalho, enfim, o direito e o cabimento na cidade.

Abstract The article seeks to understand the relationships established between mentally ill patients cared for in the open community service network and the city of Belo Horizonte, state capital of Minas Gerais. It is understood that the experience of mental illness is capable of generating narratives that seek to give meaning to suffering and help people to negotiate everyday decisions. The biographical method was used for the construction of narratives of life trajectories of the three participants of the study. The biographical narratives revealed diverse experiences associated with mental illness as well as different meanings attributed to this condition. However, interestingly, these stories have a common pattern, often associated with marginal convivialities with the conventions of order, family and work. There is a break with the striking invisibility in asylums, as open services provide the social movement and manipulation of social codes, creating new territorial delimitations and interpretations. However, the need for empirical studies that address themes such as family relations, housing conditions and income of this population is paramount in order to broaden the right to health discussions for the right to housing, work, the right and to a place in the city.

Desarrollo de un sistema georreferenciado para la gestión, movilidad y monitoreo de atención primaria de la salud comunitaria / Development of a georeferenced system for the management, mobility and monitoring of primary care in community health

RESUMEN Los agentes de salud comunitaria en terreno practican acciones de fuerte impronta territorial, tanto en relación con prevención y asistencia, como a partir de un acercamiento de los servicios de salud a las familias. Estas prácticas en terreno, construyen un permanente mapeo colectivo basado en el conocimiento que los agentes poseen del territorio de actuación. A partir de un intenso trabajo de campo iniciado en el año 2012, en conjunto con organizaciones sociales locales e instituciones de salud de Brasil y Argentina, se inició el proyecto binacional App+Salud, que tiene como objetivo el desarrollo de un sistema de monitoreo y georreferencia para la gestión de la salud comunitaria, en formato de aplicación, para celular o tablet y acceso web, que considere la condiciones básicas, de ambiente y movilidad histórica de los usuarios, y que vincule metodologías de actualización cartográfica a partir de cartografía social con plataformas de mapeos colaborativos libres. Como resultado, se ha obtenido el desarrollo del sistema App+Salud, en nivel beta, para lo cual se profundizó en un trabajo de intercambio de saberes interdisciplinares.

ABSTRACT Community health agents carry out significant actions on the ground to provide prevention and care and bring health services to families. These practices in the field constitute a constant collective mapping process using the knowledge of the territory that the agents possess. Based on intensive fieldwork starting in 2012 in conjunction with local social organizations and health institutions in Brazil and Argentina, the binational project App+Health (App+Salud in Spanish and App+Saúde in Portugués) was initiated. The project's objective was to develop a monitoring and georeferencing system for community health management in the form of an application for cell phones or tablets with internet access, which would take into account the basic conditions of the environment and movement history of users and connect map updating methodologies using social cartography with free collaborative mapping platforms. As a result, the beta version of App+Health was developed, through a heightened process of exchange of interdisciplinary knowledge.