Desafios e mudanças no processo de trabalho das equipes de saúde da família no cenário pandêmico: relato de experiência / Challenges and changes in the work process of family health teams in the pandemic scenario: experience report

O presente estudo tem por objetivo realizar um relato de experiência demonstrando a percepção de discentes do curso de odontologia na sua participação na prática da atenção primária à saúde (APS), vivenciadas em um cenário pandêmico e com base no combate a enfrentamentos e desafios impostos no processo de trabalho das equipes de saúde da família. Este estudo trata - se de relato de experiência, de caráter descritivo e retrospectivo, associado à uma pesquisa bibliográfica para que trousse o embasamento teórico necessário para a descrição do relato de experiência vivenciado. No decorrer da pandemia, a Equipe de saúde da família exerceu importante papel e atuou na linha de prevenção e controle desta, sendo uma das maiores ferramentas de apoio. Na odontologia, a atuação da equipe de saúde bucal devido a fatores de risco inerentes à esta modalidade de ocupação, ficou limitada em seu exercício. O conhecimento de muitos dos profissionais da rede pública foi colocado em questão, assim como sua vivência, limitações e o medo de contrair a doença. Os profissionais da equipe de saúde, mostraram que o trabalho interprofissional e um bom relacionamento aumentou o incentivo e a responsabilidade de equipe.

This study aims to carry out an experience report demonstrating the perception of students of the dentistry course in their participation in the practice of primary health care (PHC), experienced in a pandemic scenario and based on the fight against confrontations and challenges imposed on the work process of family health teams. This study is an experience report, descriptive and retrospective, associated with bibliographical research to bring the necessary theoretical basis for the description of the lived experience report. During the pandemic, the Family Health Team played an important role and acted in the line of prevention and control of this, being one of the greatest support tools. In dentistry, the performance of the oral health team, due to risk factors inherent to this type of occupation, was limited in its exercise. The knowledge of many public health professionals was questioned, as well as their experience, limitations and fear of contracting the disease. Health team professionals showed that interprofessional work and a good relationship increased team incentive and responsibility.

Programa de controle do tabagismo em Mato Grosso do Sul: oferta, adesão e efetividade / Smoking control program in Mato Grosso do Sul: offer, adherence and effectiveness / Programa de control del tabaquismo en Mato Grosso do Sul: oferta, adherencia y efectividad

Objetivo: O estudo teve por objetivo avaliar o Programa Nacional de Controle do Tabagismo (PNCT) em Mato Grosso do Sul, taxas de cobertura, abandono, cessação, uso de medicamentos, rede de serviços de saúde e as razões pelas quais algumas Equipes de Saúde da Família de Campo Grande ainda não aderiram ao programa. Métodos: Trata-se de uma pesquisa descritiva, com abordagem quantitativa, baseada em dados primários e secundários sobre o PNCT em Mato Grosso do Sul. Os dados primários foram obtidos por meio de questionário aplicado aos profissionais das Equipes de Saúde da Família (ESF) de Campo Grande, sem oferta do programa e avaliados quanto à frequência e presença de correlação entre as variáveis analisadas utilizando V de Cramer e teste de χ2. Os dados secundários foram obtidos do consolidado do Instituto Nacional de Câncer José Alencar Gomes da Silva com os registros produzidos pelos serviços. Resultados: As taxas de adesão, efetividade e apoio farmacológico na capital e interior foram: 66,80 e 59,79%; 20,58 e 34,91%; 32,14 e 99,86%, respectivamente. A oferta do programa ocorreu em 49,37% municípios e 43,85% das Unidades Básicas de Saúde (UBS) estimadas. Houve correlações entre ser capacitado e implantar o programa; treinamento de ingresso e oferta na UBS. As dificuldades relatadas pelos profissionais foram a pandemia de COVID-19, a sobrecarga e/ou equipe pequena e/ou falta de tempo e a ausência de capacitação/treinamento. Conclusões: O PNCT em Mato Grosso do Sul apresenta baixa cobertura e oferta restrita na rede de saúde, além do desempenho mediano de assistência aos tabagistas. Evidencia-se a necessidade de investimento em capacitação/treinamento, prioritariamente para as ESF de Campo Grande, dando-lhes condições de responder às necessidades de promoção da saúde, reconhecendo o programa como de maior custo-efetividade.

Objective: The objective of this study was to evaluate the National Tobacco Control Program (PNCT) in Mato Grosso do Sul, coverage rates, dropout, cessation, use of medication, the health services network and the reasons why Family Health Teams in Campo Grande have not yet joined the program. Methods: This was a descriptive study with a quantitative approach, based on primary and secondary data on the PNCT in Mato Grosso do Sul. The primary data were obtained by means of a questionnaire administered to Family Health Teams (ESF) in Campo Grande, which did not offer the program and evaluated the frequency and presence of correlation between the variables analyzed using Cramer's V test and the χ2 test. The secondary data were obtained from the consolidated records of the José Alencar Gomes da Silva National Cancer Institute with the records produced by the services. Results: The rates of adherence, effectiveness and pharmacological support in the capital and interior were: 66.80 and 59.79%; 20.58 and 34.91%; and 32.14 and 99.86%, respectively. The program was offered in 49.37% of the municipalities and 43.85% of the Basic Health Units (UBS) estimated. There were correlations between being trained and implementing the program and entry training and provision in the UBS. The difficulties reported by professionals were the COVID-19 pandemic, overload and/or a small team and/or lack of time and the absence of training. Conclusions: The PNCT in Mato Grosso do Sul has low coverage and restricted supply in the health network, in addition to average performance in assisting smokers. There is a clear need to invest in capacitation/training, primarily for the ESF in Campo Grande, enabling them to respond to the needs of health promotion, recognizing the program as more cost-effective.

Objetivo: El objetivo de este estudio fue evaluar el Programa Nacional de Control del Tabaco (PNCT) en Mato Grosso do Sul, las tasas de cobertura, el abandono, la cesación, el uso de medicamentos, la red de servicios de salud y las razones por las que los Equipos de Salud de la Familia en Campo Grande aún no se han unido al programa. Métodos: Se trata de un estudio descriptivo con abordaje cuantitativo, basado en datos primarios y secundarios sobre el PNCT en Mato Grosso do Sul. Los datos primarios se obtuvieron por medio de un cuestionario aplicado a los Equipos de Salud de la Familia (ESF) de Campo Grande, que no ofrecían el programa y evaluaron la frecuencia y la presencia de correlación entre las variables analizadas utilizando la V de Cramer y la prueba de la χ2. Los datos secundarios se obtuvieron de los registros consolidados del Instituto Nacional del Cáncer José Alencar Gomes da Silva con los registros producidos por los servicios. Resultados: Las tasas de adherencia, eficacia y apoyo farmacológico en la capital y en el interior fueron: 66,80 y 59,79%; 20,58 y 34,91%; 32,14 y 99,86%, respectivamente. El programa fue ofrecido en el 49,37% de los municipios y en el 43,85% de las Unidades Básicas de Salud (UBS) estimadas. Hubo correlación entre estar capacitado e implementar el programa; capacitación de entrada y oferta en las UBS. Las dificultades relatadas por los profesionales fueron la pandemia del COVID-19, la sobrecarga y/o un equipo pequeño y/o la falta de tiempo y la ausencia de capacitación. Conclusiones: El PNCT en Mato Grosso do Sul tiene baja cobertura y oferta restringida en la red de salud, además de un desempeño medio en la asistencia a los fumadores. Hay una clara necesidad de invertir en la creación de capacidad / formación, principalmente para la ESF en Campo Grande, lo que les permite responder a las necesidades de promoción de la salud, reconociendo el programa como más rentable.

A importância dos cuidados paliativos exercidos por médicos de família e comunidade na Atenção Primária à Saúde: uma revisão narrativa / The importance of palliative care performed by family practice doctors in primary health care: a narrative review / La importancia de los cuidados paliativos realizados por médicos de familia y comunitario en la Atención Primaria de Salud: una revisión narrativa

Introdução: A terminalidade é uma situação cada vez mais vivenciada nos serviços de saúde em razão da progressão da expectativa de vida da população e, consequentemente, do incremento de pacientes com doenças crônicas graves. No Brasil, os serviços de cuidados paliativos ainda se encontram centralizados nos serviços de atenção terciária. Entretanto, em diversos países, a Atenção Primária à Saúde tem sido a grande prestadora e coordenadora de cuidados paliativos dos usuários, em prol da descentralização dessa assistência e da promoção do cuidado integral. Objetivo: Realizar uma revisão narrativa da literatura, a fim de identificar a relação dos médicos de família e comunidade na atuação de cuidados paliativos na Atenção Primária à Saúde. Métodos: Revisão bibliográfica por meio do acesso às bases de dados: Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO) e PubMed. Foram selecionados 16 artigos, os quais foram submetidos a análise temática e posterior discussão das principais características que colaboram para a maior atuação dos médicos de família e comunidade em cuidados paliativos. Resultados: Observou-se a importância da atuação dos médicos de família e comunidade em cuidados paliativos no âmbito da Atenção Primária à Saúde, bem como a interligação entre as duas especialidades, os desafios existentes nesse caminho e os benefícios dessa prática. Conclusões: A oferta de cuidados paliativos pelos médicos de família e comunidade na atenção primária favorece o acesso e acompanhamento dos pacientes. Entretanto, a atuação dos profissionais das Equipes de Saúde da Família nessa linha de cuidado ainda é insuficiente em razão da escassa capacitação na área.

Introduction: Terminality is a situation increasingly experienced in healthcare services due to the progression of the population's life expectancy and, consequently, the increase in patients with serious chronic diseases. In Brazil, Palliative Care services are still centralized in tertiary care services. However, in many countries, Primary Health Care has been the major provider and coordinator of Palliative Care for users, in favor of decentralizing this assistance and promoting comprehensive care. Objective: To carry out a narrative literature review to identify the relationship of Family Practice Doctors in the performance of Palliative Care in Primary Health Care. Methods: Bibliographic review through access to databases: CAPES, LILACS, SciELO, and PUBMED. Sixteen articles were selected, which were submitted to thematic analysis and subsequent discussion of the main characteristics that contribute to the greater performance of Family Practice Doctors in Palliative Care. Results: The importance of Family Practice Doctors in Palliative Care within the scope of Primary Health Care was observed, as well as the interconnection between the two specialties, the challenges along this path, and the benefits of this practice. Conclusions: The offer of Palliative Care by Family Practice Physicians in Primary Care favors the access and monitoring of patients. However, the performance of the professionals in Family Health Teams in this line of care is still insufficient due to the lack of training in the area.

Introducción: La terminalidad es una situación cada vez más experimentada en los servicios de salud debido a la progresión de la esperanza de vida de la población y, en consecuencia, al aumento de pacientes con enfermedades crónicas graves. En Brasil, los servicios de Cuidados Paliativos todavía están centralizados en los servicios de atención terciaria. Sin embargo, en varios países, la Atención Primaria de Salud ha sido la principal proveedora y coordinadora de los Cuidados Paliativos para los usuarios, a favor de descentralizar esta asistencia y promover la atención integral. Objetivo: Realizar una revisión narrativa de la literatura, con el fin de identificar la relación de los Médicos de Familia y Comunitarios en la actuación de los Cuidados Paliativos en la Atención Primaria de Salud. Métodos: Revisión bibliográfica mediante acceso a bases de datos: Portal CAPES, LILACS, SciELO y PubMed. Fueron seleccionados dieciséis artículos, que fueron sometidos al análisis temático y posterior discusión de las principales características que contribuyen para una mayor actuación de los Médicos de Familia y Comunidad en Cuidados Paliativos. Resultados: Se constató la importancia del trabajo de los Médicos de Familia y Comunitarios en Cuidados Paliativos en el ámbito de la Atención Primaria de Salud, así como la interconexión entre las dos especialidades, los desafíos que existen en este camino y los beneficios de esta práctica. Conclusiones: La oferta de Cuidados Paliativos por Médicos de Familia y Comunitario en Atención Primaria favorece el acceso y seguimiento de los pacientes. Sin embargo, la actuación de los profesionales de los Equipos de Salud de la Familia en esta línea de atención aún es insuficiente debido a la falta de formación en el área.

Experiência no uso das ferramentas de abordagem familiar por uma equipe da Estratégia Saúde da Família / Experiencia en el uso de herramientas de abordaje familiar por un equipo de Estrategia de Salud de la Familia / Family Health Strategy team's experience in the use of family approach tools

Problema: Experiência da intervenção de uma equipe multiprofissional da Estratégia Saúde da Família (ESF) em uma família por meio das ferramentas de abordagem familiar. Entre os problemas identificados no caso estão a sobrecarga de trabalho da paciente índice, diagnóstico de Transtorno do Espectro Autista (TEA) nos filhos dela, etilismo crônico do esposo e relacionamento hostil no ciclo familiar. Método: Estudo descritivo, qualitativo, de relato de experiência, desenvolvido em uma família da área de abrangência da equipe da ESF no segundo semestre de 2019, escolhida em razão da hiperutilização do serviço pela paciente índice. As ferramentas aplicadas foram o genograma, ecomapa, Fundamental Interpersonal Relations Outcome (FIRO), problem, roles, affect, communication, time in life, illness, coping with stress, environment/ecology (PRACTICE) e ciclo de vida familiar. Resultados: Com a aplicação das ferramentas foram identificadas as estruturas e modos de compartilhamento das relações familiares, os problemas de saúde presentes, os possíveis vínculos identificados e o estágio no ciclo de vida. Como modos de intervenção, a equipe propôs consultas de cuidado em saúde, assistência psicológica e escutas qualificadas. Além disso, por meio de reuniões intersetoriais, foi solucionado o problema escolar que afetava a condição de saúde da paciente. Conclusão: A aplicação das ferramentas foi um excelente método para realizar o estudo, pois permitiu uma visão global da família, além de identificar fragilidades a serem corrigidas ou minimizadas com recurso a intervenções pela equipe de saúde.

Problem: Intervention experience of a multidisciplinary team of the Family Health Strategy (ESF) through family approach tools. Among the problems identified in the case are the work overload of the index patient, diagnosis of autism spectrum disorder (ASD) in her children, husband's chronic alcoholism and hostile relationship within the family circle. Method: Descriptive and qualitative experience report. Developed by an ESF team in a family in the coverage area. Experience conducted in the second half of 2019. The tools applied were the genogram, ecomap, FIRO, PRACTICE and the family life cycle. The tools were chosen because of the index patient's frequent use of the ESF's services. Results: Through the application of the tools, the structures and ways of sharing family relationships, the health problems, the possible bonds identified and the stage in the life cycle were identified. As modes of intervention, the team proposed health care consultations, psychological assistance and qualified listening. In addition, through intersectional meetings, a school problem that affected the patient's health condition was solved. Conclusion: The application of the tools was an excellent method to carry out the study. It allowed a global view of the family, in addition to identifying weaknesses to be corrected or minimized, through interventions by the health team.

Problema: Experiencia de la intervención de un equipo multidisciplinario de la Estrategia Salud de la Familia (ESF) en una familia a través de herramientas de abordaje familiar. Entre los problemas identificados en el caso están la sobrecarga de trabajo de la paciente índice, diagnóstico de Trastorno del Espectro Autista (TEA) en sus hijos, alcoholismo crónico del marido y relación hostil dentro del ciclo familiar. Método: Estudio descriptivo, cualitativo de relato de experiencia desarrollado en una familia de la zona de cobertura del equipo de la ESF en el segundo semestre de 2019. Las herramientas aplicadas fueron el genograma, ecomapa, F.I.R.O., P.R.A.C.T.I.C.E. y el ciclo de vida familiar, elegido por la sobreutilización del paciente índice de los servicios de la ESF. Resultados: Mediante la aplicación de las herramientas se identificaron las estructuras y formas de compartir las relaciones familiares, los problemas de salud presentes, los posibles vínculos identificados y la etapa del ciclo de vida. Como modos de intervención, el equipo propuso la consulta de salud, la asistencia psicológica y la escucha cualificada. Además, a través de reuniones intersectoriales se solucionó un problema escolar que afectaba el estado de salud del paciente. Conclusión: La aplicación de las herramientas fue un método excelente para la realización del estudio, ya que permitió una visión global de la familia, además de identificar debilidades a ser corregidas o minimizadas, a través de intervenciones del equipo de salud.

Informação e prevenção não farmacológica da COVID-19 no território de uma unidade de saúde da família em Pernambuco / Information and non-pharmacological prevention of COVID-19 in the territory of a family health unit in Pernambuco / Información y prevención no farmacológica del COVID-19 en el territorio de una unidad de salud de la familia en Pernambuco

Introdução: O conhecimento da magnitude em que a população implementa medidas de proteção emitidas pelas autoridades de saúde pública é essencial na prevenção da doença do novo coronavírus (COVID-19). A eficácia de medidas não farmacológicas de prevenção e das políticas públicas destinadas a reduzir o contágio pela COVID-19 depende de quão bem os indivíduos são informados sobre as consequências da infecção e as medidas que devem adotar para reduzir sua propagação. O entendimento, as atitudes e as práticas das pessoas em relação à COVID-19 e sua prevenção são basilares para a compreensão da dinâmica epidemiológica, demandando a realização de pesquisas sobre o cumprimento de medidas não farmacológicas de prevenção do contágio em diversos territórios. Para isso, em 2020, medidas não farmacológicas contra a COVID-19 foram divulgadas por fontes diversas, estatais e privadas, para a maior parte da população brasileira, com a finalidade de orientar comportamentos para conter a crise sanitária. As equipes da Estratégia Saúde da Família têm um papel fundamental neste processo de educação em saúde, pois compreendem elementos socioculturais das suas comunidades, alcançando-as tanto em capilaridade quanto em adequação local da informação técnico-científica. Este artigo abrange uma pesquisa de campo, parte de um projeto multicêntrico nacional. Objetivo: Avaliar se a população do território de uma unidade da Estratégia Saúde da Família da cidade de Condado-PE entende e aplica as informações que recebeu sobre medidas não farmacológicas de prevenção em suas práticas de proteção contra a COVID-19. Mais especificamente, a pesquisa visou determinar que informações foram recebidas pelos respondentes, quais as suas fontes, o grau de confiabilidade atribuído a estas, além da adesão deles às medidas não farmacológicas e sua relação com variáveis sociodemográficas. Métodos: O modelo do estudo foi observacional e descritivo, com abordagem quantitativa, a partir da coleta de dados primários com 70 usuários por entrevista presencial com questionário estruturado. Resultados: Os resultados mostraram que a população recebeu vasta informação sobre prevenção da doença. Conclusão: Com níveis variados de confiabilidade das fontes, atribuindo importância relevante às medidas de prevenção e adotou a maioria delas, com exceção do isolamento social total.

Introduction: Knowledge of the magnitude to which the population implements protective measures issued by public health authorities is essential in preventing coronavirus disease 2019 (COVID-19). The effectiveness of non-pharmacological prevention measures (NPM) and public policies aimed at reducing the spread of COVID-19 depends on how well individuals are informed about the consequences of the infection and the measures they must adopt to reduce its spread. The understanding, attitudes, and practices of people in relation to COVID-19 and its prevention are fundamental for understanding the epidemiological dynamics, demanding research on compliance with NPM to prevent contagion in different territories. To this end, in 2020, NPM against COVID-19 were released by various sources, state and private, for most of the Brazilian population, with the aim of guiding behaviors to contain the health crisis. The Family Health Strategy (FHS) teams play a key role in this health education process, as they comprise sociocultural elements of their communities, reaching them both in capillarity and in local adequacy of technical-scientific information. This article covers field research, part of a national multicenter project. Objective: To evaluate whether the population of the territory of an FHS unit in the city of Condado, Pernambuco, understands and applies the information it received about NPM prevention in their practices to protect against COVID-19. More specifically, the research aimed to determine what information was received by the respondents, what are their sources, the degree of reliability attributed to these, in addition to their adherence to the NPM and their relationship with sociodemographic variables. Methods: The study model was observational and descriptive, with a quantitative approach, based on the collection of primary data with 70 users through face-to-face interviews with a structured questionnaire. Results: The results showed that the population received extensive information on disease prevention. Conclusion: With varying levels of reliability of the sources, attributing relevant importance to prevention measures and adopted most of them, with the exception of total social isolation.

El conocimiento de la magnitud con la que la población implementa las medidas de protección emitidas por las autoridades de salud pública es fundamental en la prevención de la enfermedad por coronavirus 2019 (COVID-19). La efectividad de las medidas de prevención no farmacológicas (MFN) y de las políticas públicas dirigidas a reducir la propagación de la COVID-19 depende de qué tan bien se informe a las personas sobre las consecuencias de la infección y las medidas que deben adoptar para reducir su propagación. La comprensión, actitudes y prácticas de las personas con relación al COVID-19 y su prevención son fundamentales para comprender la dinámica epidemiológica, exigiendo investigaciones sobre el cumplimiento de las MNF para prevenir el contagio en diferentes territorios. Con ese fin, en 2020, MNF contra el COVID-19 fueron divulgados por diversas fuentes, estatales y privadas, para la mayoría de la población brasileña, con el objetivo de orientar comportamientos para contener la crisis sanitaria. Los equipos de la Estrategia de Salud de la Familia (ESF) juegan un papel fundamental en este proceso de educación en salud, ya que integran elementos socioculturales de sus comunidades, alcanzándolas tanto en la capilaridad como en la adecuación local de la información técnico-científica. Este artículo aborda una investigación de campo, parte de un proyecto multicéntrico nacional, con el objetivo de evaluar si la población del territorio de una unidad de la ESF en la ciudad de Condado-PE comprende y aplica la información recibida sobre la prevención de MNF en sus prácticas de protección contra el COVID -19. Más específicamente, la investigación tuvo como objetivo determinar qué información recibieron los encuestados, cuáles son sus fuentes, el grado de confiabilidad atribuido a estas, además de su adherencia al MNF y su relación con variables sociodemográficas. El modelo de estudio fue observacional y descriptivo, con enfoque cuantitativo, basado en la recolección de datos primarios con 70 usuarios a través de entrevistas cara a cara con un cuestionario estructurado. Los resultados mostraron que la población recibió amplia información sobre prevención de la enfermedad, con diversos niveles de confiabilidad de las fuentes, atribuyendo importancia relevante a las medidas de prevención y adoptando la mayoría de ellas, con excepción del aislamiento social total.

Representações sociais sobre o planejamento reprodutivo entre mulheres em gravidez não planejada / Social representations of reproductive planning among women with unplanned pregnancies / Representaciones sociales sobre la planificación reproductiva de las mujeres con embarazo no planificado

Objetivo: conhecer as representações sociais sobre o planejamento reprodutivo entre mulheres em gravidez não planejada na Estratégia Saúde da Família. Método: estudo qualitativo, orientado pela Teoria das Representações Sociais, realizado com 15 gestantes, entre abril e maio de 2019. Utilizou-se a entrevista semiestruturada. Os dados foram organizados por meio do Discurso do Sujeito Coletivo, com auxílio do software DSCsoft©. Protocolo de pesquisa aprovado pelo Comitê de Ética em Pesquisa. Resultados: as representações sociais das mulheres em gravidez não planejada evidenciadas pelo Discurso do Sujeito Coletivo foram representadas por oito ideias centrais, a saber: "eu não me preveni, nem ele", "nós nos prevenimos", "eu comprava", "pegava no posto", "construir uma família", "ter esse acesso", "estou por fora" e "eu sei que é disponível". Conclusão: as representações sociais nos discursos das mulheres em gravidez não planejada estavam pautadas no desconhecimento acerca do planejamento reprodutivo, dos anticoncepcionais disponíveis e seu uso correto.

Objective: to understand the social representations of reproductive planning among women with unplanned pregnancies in the Family Health Strategy. Method: qualitative study, guided by the Theory of Social Representations, carried out with 15 pregnant women between April and May 2019. Semi-structured interviews were used. The data was organized using the Discourse of the Collective Subject, with the aid of DSCsoft© software. Research protocol approved by the Research Ethics Committee. Results: the social representations of women with unplanned pregnancies as evidenced by the Collective Subject Discourse were represented by eight central ideas, namely: "I didn't prevent myself, nor did he", "we prevented ourselves", "I would buy it", "I would get it at the health center", "build a family", "have this access", "I am not aware" and "I know it is available". Conclusion: the social representations in the women's speeches about unplanned pregnancies were based on a lack of knowledge about reproductive planning, the contraceptives available and their correct use.

Objetivo: conocer las representaciones sociales sobre la planificación reproductiva de las mujeres con embarazo no planificado en la Estrategia Salud de la Familia. Método: estudio cualitativo, basado en la Teoría de las Representaciones Sociales, realizado con 15 mujeres embarazadas, entre abril y mayo de 2019. Se utilizaron entrevistas semiestructuradas. Los datos fueron organizados mediante el Discurso del Sujeto Colectivo, con ayuda del software DSCsoft©. El protocolo de investigación fue aprobado por el Comité de Ética en Investigación. Resultados: las representaciones sociales de las mujeres con embarazo no planificado reveladas por el Discurso del Sujeto Colectivo fueron representadas por ocho ideas centrales, a saber: "yo no me cuidé y él tampoco", "nos cuidamos", "yo los compraba", "los buscaba en el centro de salud", "construir una familia", "tener acceso", "no participo" y "sé que está disponible". Conclusión: las representaciones sociales en los discursos de las mujeres con embarazo no planificado se basaron en la falta de conocimiento sobre la planificación reproductiva, en los anticonceptivos disponibles y su uso correcto.

The chain mediating role of family health and physical activity in the relationship between life satisfaction and health-promoting lifestyles among young adults in China.

Background: Unhealthy lifestyles during adolescence are significant factors leading to chronic diseases in the future. Enhancing health-promoting lifestyles among young adults in China is crucial for preventing and reducing the risk factors of chronic diseases. Objective: This study aims to explore the relationships between life satisfaction, family health, physical activity, and health-promoting lifestyles among young adults in China. It also seeks to confirm the chain mediation role of family health and physical activity in the influence of life satisfaction on health-promoting lifestyles in this population. Methods: This study, conducted from August 2023 to November 2023, employed a random sampling method to recruit young adult participants aged 18-40 in the southwestern region of China. Variables were measured using the Satisfaction with Life Scale (SWLS), the Family Health Scale-Short Form (FHS-SF), the Physical Activity Rating Scale-3 (PARS-3), and the Health-Promoting Lifestyle Profile II Revised (HPLP-IIR). Data analysis was performed using SPSS 27.0 and the PROCESS macro version 4.1. Results: The results indicated that life satisfaction was positively correlated with family health (r = 0.225), physical activity (r = 0.245), and health-promoting lifestyles (r = 0.506). Family health was positively correlated with physical activity (r = 0.320) and health-promoting lifestyles (r = 0.312). Physical activity was positively correlated with health-promoting lifestyles (r = 0.429). Additionally, life satisfaction could influence health-promoting lifestyles directly (effect = 0.369) and through three mediation pathways: (a) family health (effect = 0.033); (b) physical activity (effect = 0.050); (c) family health and physical activity (effect = 0.020). Conclusion: This study supports the mediating role of family health and physical activity in the influence of life satisfaction on health behaviors among young adults in China. Therefore, we recommend that future public health initiatives place greater emphasis on family health and create conditions that facilitate physical activity for this group. This could be an important direction for further enhancing health-promoting lifestyles among young adults in China.

Cluster sampling methodology to evaluate immunization coverage.

BACKGROUND: Immunization is a key component of primary health care and an indisputable human right. Vaccines are critical to the prevention and control of infectious disease outbreaks. The coronavirus disease 2019 (COVID-19) pandemic and associated disruptions over the past two years have strained the health systems, with many children missing out on essential childhood vaccines. AIM: To evaluate the immunization coverage among 12-23-month-old children in the rural areas of Community Health Centre (CHC) Dighal and to determine the factors influencing the existing immunization coverage. METHODS: A coverage evaluation survey was conducted according to the 30-cluster sampling technique, which is the standard methodology for such surveys devised by World Health Organization. A total of 300 children aged 12-23 months were included, whose immunization details were noted from their immunization cards. RESULTS: Full immunization rate was noted in 86.7% of the children, with partial and non-immunized children accounting for 9% and 4.3% respectively. The full immunization dropout rate was 4.2%. The common reasons for partial or non-immunization were family problem including illness of mother, vaccine not being available and child being ill. Place of birth (P = 0.014) and availability of immunization card (P < 0.001) were significant predictors of the immunization status. Since the study was conducted in 2020/2021, health services were disrupted due to the COVID-19 lockdown. CONCLUSION: Due to the coverage being higher than the national average, it was concluded that the immunization coverage was optimal and not affected by the COVID-19 pandemic.

Prevalence and risk factors associated with undiagnosed hypertension among adults aged 15-49 years in India: insights from the National Family Health Survey (NFHS-5).

OBJECTIVES: To estimate the prevalence and identify the factors associated with undiagnosed hypertension in India. STUDY DESIGN: A secondary data analysis using the National Family Health Survey (NFHS-5) covering the period 2019-2021. METHODS: Information on hypertension among individuals aged 15-49 years was extracted from the survey dataset. We estimated the prevalence of undiagnosed hypertension using physical measurements along with self-reported data from the survey. A log-binomial model with survey-adjusted Poisson regression was used to estimate the prevalence ratio between undiagnosed and diagnosed hypertension. Multinomial logistic regression analysis examined the factors associated with diagnosed hypertension (vs healthy) and undiagnosed hypertension (vs healthy). All the analyses were survey-weight adjusted and stratified by gender. RESULTS: The survey-adjusted prevalence of undiagnosed hypertension was 8.75% (8.62%-8.87%) and was higher among males [13.56% (13.03%-14.12%)] than in females [8.14% (8.03%-8.25%)]. The proportion of individuals with undiagnosed hypertension among total hypertension was 44.99% (44.44%-45.55%) and was higher in males [65.94% (64.25%-67.60%)] than in females [42.18% (41.66%-42.71%)]. CONCLUSIONS: Our findings revealed that age, higher body mass index, no access to health care, and having no comorbidities were risk factors for undiagnosed hypertension. One in twelve people had undiagnosed hypertension, and of those with hypertension, one in two were undiagnosed, with males being disproportionately affected. Targeted public health interventions are crucial to improve hypertension screening, particularly among middle-aged and obese individuals without comorbidities.

Influences of role models and other factors on physical activity amongst 6 to 16 years overweight and obese students.

Background: Physical activity is an essential aspect of living a healthy lifestyle, which offers a myriad of benefits for both the body and the mind. Nonetheless, a family history of obesity can pose significant challenges to achieving and maintaining a healthy weight, which is further exacerbated by the academic stress. Individuals who have a role model that prioritizes physical activity are more likely to develop positive and healthy habits in their lives. Objectives: The study aimed to examine how role models affect physical activity and its impact on addressing challenges of family obesity history and academic stress in school children. Methods: This cross-sectional study was conducted from October 2019 to April 2020 in three schools in Amritsar district selected by lottery method of simple random sampling. Out of 4226 students, 355 overweight and obese students were interviewed regarding their physical activity. An informed written assent and consent was taken from the children and guardians respectively. Mothers of 6 to 11-year-old students and students aged 12 to 16 were interviewed using a pre-designed, validated, semi-structured questionnaire. Results: 51.3% had a family history of obesity while 14.9% and 14.6% of parents of overweight students had hypertension and diabetes, respectively. Over half (52.7%) lacked interest in physical activity and almost 33.5% of males were inactive. Students who chose movie actors as role models (71.1%) and those who found their role models' information reliable (83.2%) were more likely to participate in physical activity. Of the 247 students who were knowledgeable about healthy living, a significant majority of 70.4% engaged in physical activity while 76% of overweight/obese students reported academic stress as a barrier. Conclusions: Study shows majority engage in physical activity regardless of gender. Over 70% have family history of obesity and healthy lifestyle knowledge. Stress reduces physical activity and students with movie/sports/fitness role models have better activity levels. Reasons for not engaging included dislike for sports and lack of time.

Unveiling Responses in Times of Crisis: A Portrait of Primary Health Care Amidst theCOVID-19 Pandemic in Lavras-MG / Desvendando Respostas em de Crise: Um Retrato da Atenção Primária à Saúde Frente à COVID-19 em Lavras-MG

A COVID-19 é um vírus infeccioso de alta transmissibilidade. Sendo a Atenção Primária à Saúde (APS) a porta de entrada do SUS, houve a necessidade de reorganização das unidades durante o período da pandemia. Diante desse fato, o presente estudo teve como objetivo caracterizar a estrutura da APS, para entender como ocorreu tal reorganização no município de Lavras-MG. Foi mapeada a rede de serviços da APS, bem como espetacular entre os registros de COVID-19 e a área de abrangência da Estratégia Saúde da Família (ESF). Além de entrevistas com membros-chave da APS para conhecer e entender como a pandemia foi enfrentada. Elas foram gravadas, transcritas e comprovadas. A distribuição espacial dos casos de COVID-19 foi dispersa e as áreas com maior concentração de casos foram cobertas pela ESF. Havia 17 equipes da ESF e cobertura de aproximadamente 60% da população total. As equipes se viram obrigadas a realizar reconfigurações significativas, que vão desde mudanças estruturais até revisões em protocolos operacionais. O presente estudo reforça a necessidade de uma abordagem integral, interdisciplinar e ininterrupta para o enfrentamento da COVID-19, destacando que a APS se coloca como um ambiente propício às declarações desses princípios quando inseridos na prática da assistência à saúde.

A COVID-19 é uma virose infecciosa de alta transmissibilidade. Visto que a Atenção Primária à Saúde (APS) é uma porta de entrada para o SUS, houve a necessidade de reorganização das unidades no período pandêmico. Mediante o fato, o presente estudo objetivou caracterizar a estrutura da APS, para entender como ocorreu tal reorganização no município de Lavras-MG. Foi realizado o mapeamento da rede de serviços da APS, um esclarecimento entre os registros de COVID-19 e a área de abrangência da Estratégia Saúde da Família (ESF). Além de entrevistas com peças-chave da APS para conhecer e entender como se deu o enfrentamento à pandemia. Elas foram gravadas, transcritas e comprovadas. A distribuição espacial dos casos de COVID-19 ocorreu de forma dispersa e as áreas de maior concentração dos casos foram cobertas pela ESF. Havia 17 equipes da ESF e cobertura de aproximadamente 60% da população total. As equipes se viram obrigadas a realizar reconfigurações importantes, abandonando desde alterações estruturais até revisões nos protocolos operacionais. O presente estudo reforça a necessidade de uma abordagem integral, interdisciplinar e ininterrupta para enfrentar a COVID-19, destacando que a APS se erige como um ambiente propício para a afirmação desses princípios quando inseridos na prática do cuidado à saúde.

"It spreads like wildfire": mothers' gatherings for vaccine acceptance.

This case study describes the design, implementation, and evaluation of an initiative to increase COVID-19 vaccine confidence and uptake among refugee and immigrant women in Clarkston, Georgia. Applying the principles and practices of human-centered design, Mothers x Mothers was co-created by Refugee Women's Network and IDEO.org as a series of gatherings for refugee and immigrant mothers to discuss health issues, beginning with the COVID-19 vaccine. The gatherings included both vaccinated and unvaccinated mothers and used a peer support model, with facilitation focused on creating a trusting environment and supporting mothers to make their own health decisions. The facilitators for Mothers x Mothers gatherings were community health workers (CHWs) recruited and trained by Refugee Women's Network. Notably, these CHWs were active in every phase of the initiative, from design to implementation to evaluation, and the CHWs' professional development was specifically included among the initiative's goals. These elements and others contributed to an effective public health intervention for community members who, for a variety of reasons, did not get sufficient or appropriate COVID-19 vaccine information through other channels. Over the course of 8 Mothers x Mothers gatherings with 7 distinct linguistic/ethnic groups, 75% of the unvaccinated participants decided to get the COVID-19 vaccine and secured a vaccine referral.

Development of a computer-based tool to obtain a family health history in Vietnam.

Background: Family health history (FHH) is central to human genomic profiling construction; however, there is no protocol for documenting FHH in a pedigree format in Vietnam.Aim: A "Gia Su Suc Khoe" (GSSK) tool was developed to create a user-friendly interface for collecting FHH and offering diseases' risk assessment.Results: A tool was described (https://giasusuckhoe.vn/) with good feedback from genetic counselors and family-medicine doctors. Among 20 surveys, 100% of respondents noted that the report accurately reflected their FHH and were satisfied with the tool's display. About 74% of familial conditions were covered. Overall, all constructive feedback has been adapted into the updated version.Conclusion: Gia Su Suc Khoe has the potential to significantly improve healthcare delivery and outcomes in Vietnam.

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Screening for familial disease presence in first-degree relatives of Behçet's disease patients: Is measurement of common femoral vein wall thickness valuable for the diagnosis?

OBJECTIVES: We aimed to assess first degree relatives (FDRs) of BD patients for the presence of clinical symptoms and signs of BD and evaluate common femoral vein (CFV) wall thickness measurement for the diagnosis. METHODS: Patients with BD(n=129) and FDRs(n=230) of these patients were included. FDRs were questioned in terms of BD symptoms by phone. Pathergy test and CFV wall thickness measurement were performed among 111 FDRs who accepted the clinical assessment. Clinical assessment group were classified according to the criteria sets for BD. FDRs who did not meet the criteria sets and had at least one clinical finding in addition to oral aphthae(OA) were categorized as the "suspected BD". RESULTS: :We observed increased frequency of isolated BD manifestations in FDRs. Ten FDRs were diagnosed with BD during clinical evaluation. Significantly increased CFV wall thickness was observed in FDRs of BD patients fulfilling diagnostic BD criteria (p<0.001 for both sides) and also in those with suspected BD group (p<0.05 for both sides). Presence of OA, genital ulcer, folliculitis or erythema nodosum were associated with increased CFV wall thickness (p<0.05). CONCLUSION: . Our results suggest that CFV wall thickness measurement can be used in diagnosis of familial BD.

Telebehavioral Health for Caregivers of Children With Behavioral Health Needs to Address Caregiver Strain: Cohort Study.

BACKGROUND: Behavioral health conditions among children have worsened over the past decade. Caregivers for children with behavioral health conditions are at risk for two types of caregiver strain: (1) an objective strain, that results directly from the child's condition and (2) subjective strain, that arises from the caregiver's feelings regarding these events. OBJECTIVE: This study aimed to evaluate the impact of a technology-enabled pediatric and family behavioral health service on caregivers' strain among a commercially insured population. We also explore the common symptom clusters of caregiver strain to better understand the caregiver presentation to inform future care planning. METHODS: We examined changes in caregiver strain using the Caregiver Strain Questionnaire-Short Form 7 over the course of their child's web-based behavioral health care between 2021 and 2023 using a pre-post study design. Common caregiver strain symptom clusters were identified using Ward hierarchical agglomerative clustering. RESULTS: The majority of children were White 60.8% (1002/1647), female 53.6% (882/1647), and aged between 5 and 9 years (33.7%, 555/1647). Families fall broadly into 4 groups based on what drives caregiver strain the most, namely those experiencing (1) disrupted family relationships and time interruption, (2) missed work, (3) worried about their child's future and feeling tired and sad, and (4) financial strain. Caregiver strain, which was associated with the child's disease severity (P<.001), decreased significantly in all therapeutic groups. CONCLUSIONS: Web-based family-oriented behavioral health care can improve caregiver strain and reduce family and time disruptions, missed work, and financial strain. Sources of caregiver strain vary and may be overlooked when relying on the conventional scoring of the Caregiver Strain Questionnaire-Short Form 7.

Hidden care: a qualitative exploration of the roles and responsibilities of language brokers.

This qualitative study explored language brokers' conceptualizations of their roles and responsibilities within the family in Sydney, Australia. Semi-structured interviews were carried out to obtain retrospective accounts of language brokering experiences from 14 self-identified language brokers, 10 females and four males aged between 19 to 49 years (Mean age = 31) who started brokering between ages 7 to 16 (M = 11). Participants were from varied ethnic and socio-cultural backgrounds (Turkish, Lebanese, Filipino, Vietnamese, Chinese and Greek/German). Thematic analysis identified three primary themes: "Hidden Carers: When Parent-Child Roles are Reversed"; "Lost Childhoods: Personal Sacrifice for the Good of the Family"; and "Protecting Parents: Language Brokers as Custodians of Information." Findings revealed that language brokering constitutes a form of hidden caregiving that carries with it several ramifications for the individual and their family. These findings have important implications for future research and policymakers working towards developing culturally responsive interventions that improve the health and wellbeing of language brokers and the resettlement experiences of migrants and their families.

Mobility and sexually transmitted infections: Exploring intersectional axes of alcohol consumption and risky sexual behavior among Indian men.

OBJECTIVE: Studies in India and other low-income countries find an inconsistent association between mobility/migration and sexually transmitted infections (STIs) among men. This study comprehensively examined the association between mobility and STIs among men in India. It also assessed heterogeneous associations of mobility, alcohol consumption, and risky sexual behavior with STIs using interaction analysis. METHODS: We utilized a sample of 71,128 sexually active men aged 15-54 years from the 2019-21 National Family Health Survey-5. Binary logistic regression models were employed to study the associations. RESULTS: Among the study participants, 16% were mobile and away from home for a month or more in the last 12 months. Around 29% of men reported alcohol consumption and 6% had risky sexual behavior (sexual intercourse with a non-marital/non-cohabitating partner). Regression results suggest that mobility (AOR: 1.41, 95% CI: 1.29-1.55 [short-duration]; AOR: 1.95, 95% CI: 1.77-2.13 [long-duration]) and alcohol consumption (AOR: 1.32, 95% CI: 1.24-1.40) were significantly associated with an increased risk of STIs, even after controlling for socio-demographic covariates. Interaction analysis further reveals that mobile men who consumed alcohol and engaged in risky sexual behavior had a significantly higher likelihood of contracting an STI-twice as high in cases of short-duration mobility and three times higher in cases of long-duration mobility. CONCLUSION: Our study indicates that both short and long-duration mobility are significantly associated with an increased risk of STIs among men. Alcohol consumption and risky sexual behavior further exacerbate the risk of STIs in mobile men. Initiatives for STI/HIV prevention among men must pay particular attention to temporary mobile men for both short and long durations.

Knowledge about childhood autism among nurses in family health centers in southeast Turkey.

Objective: This study was carried out to determine the knowledge levels of nurses working in Family Health Centers (FHCs) about childhood autism. Methods: This study is a descriptive and cross-sectional study. The sample of the study consisted of 361 nurses working in FHCs in the province with the highest child population rate in Turkey. Data were obtained using the personal information form and the Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire. Results: The findings show that the mean score for the KCAHW questionnaire was 10.95 ± 3.7. Gender, education level, previous employment in a mental health clinic, the presence of a person with autism in their environment or family, their previous participation in any autism-related education program, and knowledge of the autism screening and follow-up program conducted by the Ministry of Health significantly affected the scores that were obtained from the KCAHW questionnaire (p < 0.05). Conclusion: Educational practices that will increase the knowledge and awareness of nurses about autism can contribute to the diagnosis of children with autism at an earlier age.

Family Health Clinical Officers: Key professionals to strengthen primary healthcare in Kenya.

Primary healthcare (PHC) is recognised as the means to achieve universal health coverage, a national priority for Kenya. With only approximately 200 family physicians for a population of over 54 million, innovative solutions for providing quality PHC are needed. Clinical Officers, as mid-level health workers, already provide much of the primary care across Kenya, but without specialised training. To provide highly trained Family Health practitioners, a Higher Diploma in Family Health for Clinical Officers (FHCO) was launched by the government in 2018. With experience in delivering innovative and strategic higher diplomas, AIC Kijabe Hospital has been involved in curriculum development of this new diploma since its inception, and in October 2021 the first cohort of FHCO trainees was admitted to Kijabe College of Health Science, graduating in 2023. The second cohort is underway with plans for an annual intake. The FHCO graduates are running Family Medicine clinics at AIC Kijabe Hospital and its satellite clinics and are heavily involved in teaching. They are well-trained to deliver comprehensive, evidence-based, cost-effective and holistic care. As the programme expands, we expect graduates to be working across the country and leading efforts in enhancing the health and well-being of individuals, families and communities within primary healthcare networks (PCNs). By training FHCOs, this higher diploma is an efficient and cost-effective way to improve PHC, particularly for underserved Kenyans, and thus is a key part of enabling the Kenyan Government to achieve universal health coverage. This model of training could easily be replicated in other countries.

Perceções dos tutores sobre o papel do cão na dinâmica familiar durante a pandemia / Guardians' perceptions of the benefits of dogs in family dynamics during the pandemic

Resumo Com o confinamento imposto pelo SARS-CoV-2, houve mudanças na dinâmica familiar. Para os estudantes de enfermagem este foi um assunto que gerou interesse em investigar. Partindo da questão: Qual o papel do cão na dinâmica familiar em tempo de pandemia? e do objetivo: identificar as perceções dos tutores sobre o papel do cão na dinâmica familiar num período de confinamento, enveredámos por um estudo qualitativo, descritivo, com recurso a focus group e amostra de seis membros de famílias diferentes. O tratamento e análise de dados seguiu o protocolo de Bardin. Identificámos que a existência de cão numa família influencia a sua dinâmica através dos benefícios obtidos quer a nível da saúde mental e bem-estar psicológico, quer a nível da saúde física. Igualmente, destacaram-se vantagens, apesar de algumas desvantagens. O vínculo afetivo entre cão e família, advém da reflexão sobre legislação portuguesa, proteção dos direitos dos animais, responsabilidades dos tutores e configuração familiar. Concluímos que na enfermagem, é necessário relevar a presença do cão na família uma vez que traz benefícios para a sua dinâmica. Esta torna-se uma visão inovadora quando pretendemos contribuir para a manutenção da saúde familiar focada nas necessidades de cada indivíduo, família e comunidade.

Abstract During the pandemic, there were a lot of lockdowns that brought changes to the population's daily routine, reducing social interactions, changing work and study methods, isolating the family at their home, which brought changes to family dynamics. These changes sparked the interest of nursing students in carrying out a research study. Starting from the question: What is the role of the dog in the family dynamics in times of pandemic? and the objective: identify the guardians' perceptions about the role of the dog in the family dynamics in a period of confinement, a qualitative, exploratory, and descriptive study was carried out, collecting data through a focus group with six guardians from different families. Bardin's protocol was used to analyze and process the data. Three categories emerged in this study, highlighting the benefits in terms of mental health, physical and psychological well-being of the family with the presence of the dog, its importance in strengthening family ties and the lessons learned from adopting the dogs. We conclude that, in nursing, it is necessary to highlight the presence of the dog in the family since it brings benefits to its dynamics.