From Public Health Policy to Impact for COVID-19: A Multi-Country Case Study in Switzerland, Spain, Iran and Pakistan.

Objectives: With the application of a systems thinking lens, we aimed to assess the national COVID-19 response across health systems components in Switzerland, Spain, Iran, and Pakistan. Methods: We conducted four case studies on the policy response of national health systems to the early phase of the COVID-19 pandemic. Selected countries include different health system typologies. We collected data prospectively for the period of January-July 2020 on 17 measures of the COVID-19 response recommended by the WHO that encompassed all health systems domains (governance, financing, health workforce, information, medicine and technology and service delivery). We further monitored contextual factors influencing their adoption or deployment. Results: The policies enacted coincided with a decrease in the COVID-19 transmission. However, there was inadequate communication and a perception that the measures were adverse to the economy, weakening political support for their continuation and leading to a rapid resurgence in transmission. Conclusion: Social pressure, religious beliefs, governance structure and level of administrative decentralization or global economic sanctions played a major role in how countries' health systems could respond to the pandemic.

Impact of the COVID-19 Pandemic on the Diagnosis of Tuberculosis in Brazil: Is the WHO End TB Strategy at Risk?

Background: In 2014, the World Health Organization (WHO) launched the "post-2015 End TB strategy", that aims to end the global tuberculosis (TB) epidemic by 2030. However, the COVID-19 pandemic has severely impacted global public health and the strict measures to control the coronavirus spread can affect the management of other diseases, such as TB. Herein, we aimed to assess the impact of the COVID-19 pandemic on the diagnosis of TB in Brazil, during 2020. Methods: We carried out an ecological and population-based study, using spatial analysis techniques. The variables used were the new cases of TB, pulmonary tuberculosis (PTB), and also baciloscopy-positive (BP) cases in Brazil between 2015 and 2020. The percentage of changes (% change) was calculated to verify if there was an increase or decrease of TB cases in 2020, along with time trend analyses given by Joinpoint regression model. Also, interrupted time series analyses were used to assess the trend of TB diagnosis before and after the onset of the COVID-19 in Brazil. Spatial distribution maps were elaborated, considering the % change of each Brazilian state. Findings: Data analyses showed a reduction in the diagnosis of TB (-8.3%) and PTB (-8.1%) in Brazil after the irruption of the COVID-19 pandemic. Likewise, 22 states depicted a reduction in TB diagnosis. An expressive reduction of BP cases (-17.1%) was also observed. Interestingly, interrupted time series analysis showed decline in TB and PTB diagnoses from March 2020. Spatial analyses revealed that all states had a progressive reduction of TB, PTB and PB cases, from March on, with the highest percentages of reduction in December (-100% to -75%). Interpretation: Taken together, our analyses demonstrated a reduction in TB diagnosis after the irruption of the COVID-19 pandemic in Brazil and its regions, signaling a serious impact on the WHO "End TB Strategy" global plan.

Dilemas éticos no direito de acesso aos cuidados paliativos na pandemia da COVID-19 / Dilemes ètics sobre el dret d'accés a les cures pal·liatives durantla pandèmiade laCOVID-19 / Dilemas éticos sobre el derecho de acceso a los cuidados paliativos en la pandemiade laCOVID-19 / Ethical dilemmas on the right of access to palliative care in the COVID-19 pandemic

La revisió del tema té com a objectiu enumerar alguns dilemes ètics que involucren l'equitat, relacionats amb el dret d'accés a les cures pal·liatives(CP) en el context de la pandèmia causada per la COVID-19. Aquesta és una reflexió teòrica que pren com a referència l'enfocament de Norman Daniels a Accountability for Reasonableness. Els dilemes ètics sorgits per l'assignació d'escassos recursos als pacients de CP van involucrar el dret a l'accés: respiradors artificials, tractament de diàlisi, analgèsics, tractament psicosocial i accés a llocs per a l'exercici de l'espiritualitat. És fonamental discutir els dilemes assenyalats perquè el procés de deliberació en l'assignació dels recursos de salut es realitzi de manera equitativa, en la direcció del principi d'equitat, podent utilitzar referències bioètiques per a dotar de major transparència a les decisions i que la població pugui valorar-les com a justes i justificades.(AU)

A revisão do tema objetiva elencar alguns dilemas éticos, envolvendo à equidade, relacionados ao direito de acesso aos Cuidados Paliativos (CP) no contexto da pandemia da COVID-19. Trata-se de uma reflexão teórica, utilizando-se como referencial a abordagem de “Responsabilização pela Razoabilidade”, de Norman Daniels. Os dilemas éticos levantados na alocação de recursos escassos a pacientes em CP envolveram o direito ao acesso a: respiradores artificiais, tratamento dialítico, medicações para alívio da dor, tratamento psicossocial e acesso aos locais para o exercício da espiritualidade. É imprescindível a discussão dos dilemas apontados de modo que o processo de deliberação na alocação de recursos em saúde seja feito de maneira equitativa, como direciona o princípio da equidade, que possa se utilizar de referenciais bioéticos para dar maior transparência às decisões e que a populaçãopossa entendê-las como justas e justificadas.(AU)

The review of the topic aims to list some ethical dilemmas, involving equity, relatedto the right of access to Palliative Care (PC) in the context of the COVID-19 pandemic. This is a theoretical reflection, using the Accountability for Reasonableness approach, by Norman Daniels, as a reference. The ethical dilemmas raised in the allocation of scarce resources to PC patients involved the right to access artificial respirators, dialysis treatment, pain relief medications, psychosocial treatment and access to places for the exercise of spirituality. It is essential to discuss the dilemmas pointed out so that the deliberation process in the allocation of health resources is carried out in an equitable manner, as directed by the principle of equity, which can use bioethical references to give greater transparency to decisions and that the population can understand them as just and justified.(UA)

La revisión del tema tiene como objetivo enumerar algunos dilemas éticos, que involucran la equidad, relacionados con el derecho de acceso a los Cuidados Paliativos (CP) en el contexto de la pandemia de COVID-19. Esta es una reflexión teórica, tomando como referencia el enfoque de Accountability for Reasonableness, de Norman Daniels. Los dilemas éticos planteados en la asignación de escasos recursos a los pacientes de CP involucraron el derecho al acceso: respiradores artificiales, tratamiento de diálisis, analgésicos, tratamiento psicosocial y acceso a lugares para el ejercicio de la espiritualidad. Es fundamental discutir los dilemas señalados para que el proceso de deliberación en la asignación de los recursos de salud se realice de manera equitativa, en la dirección del principio de equidad, que puede utilizar referencias bioéticas para dar mayor transparencia a las decisiones y que la la población puede entenderlos como justos y justificados.(AU)

Long COVID Through a Public Health Lens: An Umbrella Review.

Objectives: To synthesize existing evidence on prevalence as well as clinical and socio-economic aspects of Long COVID. Methods: An umbrella review of reviews and a targeted evidence synthesis of their primary studies, including searches in four electronic databases, reference lists of included reviews, as well as related article lists of relevant publications. Results: Synthesis included 23 reviews and 102 primary studies. Prevalence estimates ranged from 7.5% to 41% in non-hospitalized adults, 2.3%-53% in mixed adult samples, 37.6% in hospitalized adults, and 2%-3.5% in primarily non-hospitalized children. Preliminary evidence suggests that female sex, age, comorbidities, the severity of acute disease, and obesity are associated with Long COVID. Almost 50% of primary studies reported some degree of Long COVID-related social and family-life impairment, long absence periods off work, adjusted workloads, and loss of employment. Conclusion: Long COVID will likely have a substantial public health impact. Current evidence is still heterogeneous and incomplete. To fully understand Long COVID, well-designed prospective studies with representative samples will be essential.

O cuidado na saúde mental: importância do acolhimento na Unidade de Saúde / Mental health care: importance of embracement in the Health Unit / Atención en salud mental: el valor de la recepción en la Unidad de Salud

Este estudo teve como objetivo identificar o acolhimento de enfermagem à pessoa com transtorno mental na Rede de Atenção Primária no município de Joinville/SC. Trata-se de uma pesquisa de abordagem qualitativa com os enfermeiros atuantes em Unidades Básicas de Saúde. A análise dos dados trouxe duas categorias temáticas: acolhimento e sua relação com escuta qualificada às pessoas e os desafios no atendimento. Também abordou-se o preparo profissional e a prática de atividades em rede de saúde. Conclui-se que a atuação do enfermeiro melhora o manejo da pessoa com transtorno mental por meio de comunicação terapêutica e as modificações relacionadas ao cuidado do sofrimento mental.

This study aimed to identify the nursing embracement of people with mental disorders in the Primary Care Network in the city of Joinville/SC. This is a qualitative approach study with nurses working in Basic Health Units. Data analysis presented two thematic categories: embracement and its relation with the qualified listening to the people and the challenges in attendance. Professional preparation and the practice of activities in the health network were also addressed. It is concluded that the role of nurses improves the management of people with mental disorders through therapeutic communication and the changes related to care of mental suffering.

Este estudio tuvo como objetivo identificar la recepción de enfermería de personas con trastornos mentales en la Red de Atención Primaria en la ciudad de Joinville/SC. Se trata de una investigación cualitativa con enfermeros que actúan en Unidades Básicas de Salud. El análisis de los datos presentó dos categorías temáticas: la recepción y su relación con la atención a las personas y los desafíos en la atención. También se abordó la preparación profesional y la práctica de actividades en la red de salud. Se concluye que el papel de las enfermeras en el manejo de las personas con trastornos mentales a través de la terapia terapéutica y como mejora en el cuidado del sufrimiento psíquico.

Prevalence and Correlates of Mental Health Outcomes During the SARS-Cov-2 Epidemic in Mexico City and Their Association With Non-adherence to Stay-At-Home Directives, June 2020.

Objectives: To describe the prevalence and correlates of depressive symptoms, generalized anxiety disorder (GAD), and perceived negative mental health impact during the SARS-Cov-2 pandemic in Mexico City and evaluate their association with adherence to stay-at-home directives. Methods: Baseline data from a cohort study of 2,016 Mexico City government employees were analyzed using multivariable logistic regression models. Results: Among participants, 17.2% had clinically significant depressive symptoms, 21.6% had probable GAD, and 15.2% reported that the pandemic has had a major impact on their mental health. Factors including the presence of COVID-19 symptoms, self-isolation, and economic difficulties were associated with poor mental health. The presence of depressive symptoms and general anxiety were associated with non-adherence to public health directives, particularly among those who might have experienced these symptoms for the first time during the pandemic. Conclusion: Our study is one of the first to document the population mental health burden during the SARS-CoV-2 pandemic in Mexico and to provide evidence of the potential role of mental health in the adherence to public health measures.

Reliability and Validity of the Korean Version of Somatic Symptom Scale-8.

OBJECTIVE: Somatic symptoms in psychiatry include underlying depression, anxiety, or other psychiatric disorders. This study aimed to conduct a validation study of a Korean version of the Somatic Symptom Scale-8 (K-SSS-8), and to utilize the K-SSS-8 effectively in clinical settings. METHODS: For reliabilty, test-retest reliability and internal consistency were analyzed. For construct validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted. Known-group validity was verified, Jonckheere-Terpstra test (J-T statistic) were used. RESULTS: Maternal Cronbach's alpha was 0.85 and r value of test-retest reliability was 0.777. In the EFA, 2-, 3- and 4-factor model showed cumulative percentile for variance of 60% or more. In the CFA, the 3-factor model was found to be the most appropriated and simplest (χ2=10.992, df=17, CFI=1.000, TLI=1.022, RMSEA=0.000). The verifying the difference in K-SSS-8 also showed significant difference. (J-T statistic=-2.510, p<0.05). CONCLUSION: K-SSS-8 can be useful for exploring symptoms such as panic symptoms, physical pain, and physiological symptoms experienced by patients in a short time. In addition, the K-SSS-8 is expected to be very useful for determining the current severity by using the severity categories and for establish additionally required assessment plans for depression and anxiety symptoms.

Relação entre o nível de dependência de cuidados e a qualidade de vida do cuidador informal no contexto da atenção primária à saúde / Relationship between level of care dependency and life quality of informal caregiver in the context of Primary Health Care

O expressivo aumento de indivíduos dependentes de cuidados tem afetado significativamente a estrutura e as relações familiares, e capacidade de resposta das famílias a essa situação. Nesse contexto, destaca-se a figura do cuidador familiar, indivíduo que é responsável pelo cuidado contínuo ao dependente, ainda que não possua formação específica para tal. Reconhecendo o cenário de transformações e sabendo da importância do papel que o cuidador familiar exerce na família e sociedade, consideramos necessário aprofundar o conhecimento sobre os impactos que o cuidado informal exerce na vida e saúde do cuidador. OBJETIVO: Analisar a relação entre o nível de dependência de cuidados e a qualidade de vida (QV) do cuidador familiar no contexto da atenção primária à saúde. MÉTODO: Trata-se de um estudo transversal, desenvolvido com uma população de 139 cuidadores de indivíduos dependentes de cuidados, adstritos a duas Unidades Básicas de Saúde de Belo Horizonte – MG. A coleta de dados foi realizada por meio de visitas domiciliares entre outubro de 2016 e agosto de 2017. Foi utilizado um questionário para caracterização sociodemográfica do cuidador e indivíduo dependente; o Índice de Barthel, instrumento que afere o nível de dependência; e o WHOQOL-bref para avaliação da QV do cuidador. Os dados foram analisados por meio do software Stata (versão 13.1). A análise estatística constou de análise descritiva incluindo todas as variáveis do estudo, análise bivariada por meio de testes paramétricos e não paramétricos, e multivariada por meio da regressão linear múltipla. As análises bi e multivariadas tiveram como desfecho a QV em todos os seus domínios. RESULTADOS: Houve predomínio de cuidadores do sexo feminino, com baixo nível de escolaridade e renda, sem atividade remunerada, filho/filha do dependente, sedentários e portadores de alguma doença ou agravo...

The significant increase in care-dependent individuals has been significantly affecting family structure, its relations, and families' ability to deal with this situation. In this context, the figure of the informal caregiver stands out, an individual who is responsible for the continuous care of the dependent, even though he/she does not have specific training for it. Recognizing the scenario of transformations and knowing the importance of the role of the informal caregiver in the family and society, we considered necessary to deepen the knowledge about the impacts that informal care has on the life and health of the caregiver. OBJECTIVE: To analyze the relationship between level of care dependency and the quality of life (QoL) of the informal caregiver in the context of the primary health care. METHOD: This is a cross-sectional, conducted with a population of 139 caregivers of care-dependent individuals assigned to two Public Primary Health Units of Belo Horizonte - MG. Data collection was performed through home visits between October 2016 and August 2017. A questionnaire was used for socio-demographic characterization of the caregiver and dependent individual; the Barthel Index, instrument that defines the level of dependence; and the WHOQOL-bref to assess the QoL of the caregiver. The data was analyzed by the Stata software (version 13.1). Statistical analysis consisted of descriptive analysis including all variables in this study, bivariate analysis using parametric and non-parametric tests, and multivariate analysis using multiple linear regression. The bivariate and multivariate analyzes had QoL outcome in all their domains. RESULTS: There was a predominance of female caregivers, with a low level of education and income, without paid activity, dependent’s son/daughter, sedentary and with some non-communicable disease or injury. It should be noted, however, that few caregivers had taken a course to practice this activity. The WHOQOL-bref domain...

Understanding the prevalence of lifetime abstinence from alcohol: An ecological study.

BACKGROUND: The level of alcohol consumption and related burden in a country are strongly impacted by the prevalence of abstinence from alcohol use. The objective of this study was to characterize the association of lifetime abstinence from alcohol use with economic wealth (as measured in the gross domestic product [GDP]) and Muslim religion on a country level. METHODS: An ecological study was performed using aggregate data of 183 countries for the year 2010. Lifetime abstinence among men and women was predicted using fractional response regression models with the natural logarithm of GDP-PPP (purchasing power parity) and the proportion of Muslim population as predictors. The models were further adjusted by the country's median age and World Health Organization region. Precision of prediction was investigated. RESULTS: Descriptive analyses showed a strong negative association between GDP-PPP and lifetime abstinence in countries without a Muslim majority and a GDP-PPP up to 20,000 international dollars. Regression models confirmed the negative association with GDP-PPP and showed a strong positive association between lifetime abstinence and the proportion of Muslim population. Stratified sensitivity analyses showed that in countries without a Muslim majority only GDP-PPP showed a statistically significant association whereas in Muslim majority countries only the proportion of Muslims was associated with the prevalence of lifetime abstinence. CONCLUSIONS: Particularly in countries with a lower GDP and without Muslim majority the prevalence of lifetime abstinence from alcohol use is strongly negatively associated with GDP-PPP. Future research should analyze the accordance in trends of GDP and lifetime abstinence over time.

Racionalização e Construção de Sentido na Gestão do Cuidado: uma experiência de mudança em um hospital do SUS / Rationalization and sensemaking in care management: an experience of change in a hospital of the SUS (Unified Health System)

Resumo Este estudo buscou analisar processos organizacionais de mudança na gestão do cuidado hospitalar empregando avaliação qualitativa desenvolvida por estudo de caso. A pesquisa foi desenvolvida no Hospital Fornecedores de Cana de Piracicaba, no Estado de São Paulo, Brasil, em setembro e outubro de 2012. Foram realizadas 25 entrevistas com membros da alta direção do hospital, gestores e profissionais de saúde ligados à atenção ao paciente adulto, além da análise de documentos de gestão e observações de algumas atividades. Neste artigo é analisada parte dos resultados, recortando a mudança organizacional através de três eixos: processo de planejamento realizado nos setores assistenciais; a protocolização/criação de rotinas assistenciais buscando maior eficiência e segurança para o paciente; e o trabalho de médicos hospitalistas. O estudo evidencia a complexidade dos processos de mudança na esfera da gestão do cuidado em hospitais e o dinamismo entre uma dada concepção de gestão e suas ferramentas racionalizadoras e os sujeitos e grupos que buscam, nos processos micropolíticos e intersubjetivos, sentidos para suas práticas.

Abstract This study aimed to analyze organizational processes of change in the hospital care management by using qualitative evaluation developed in the case study. The study was developed at the Hospital Fornecedores de Cana de Piracicaba, in São Paulo State, Brazil, in September and October of 2012. There were 25 interviews with members of the senior board of directors of the hospital, managers and health professionals linked to healthcare of adults, in addition to the analysis of managerial documents and observations of some activities. In this article it is analyzed part of the results, dividing the organizational change in three axes: the planning process developed in the healthcare sectors; The protocol/creation of assisted routines in order to obtain better efficiency and safety for the patient; and the work of hospitalist physicians. The study highlights the complexity of the processes of change in the care management sphere in hospitals and the dynamism between a given management concept and its rational tools and the subjects and groups that seek, in the micropolitic and intersubjective processes, meanings to their practices.

É o Sistema Único de Saúde-SUS para os pobres? / Is the Unified Health System-UHS for the poor people? / És lo Sistema Único de Salud-SUS para el pueblo pobre?

objetivo: Discutir os princípios que norteiam o SUS, especialmente o da universalidade e o da igualdade que evoluíram em um processo histórico no curso do qual, apropriados pela reforma sanitária brasileira, foram positivados na Constituição Federal e nas leis que os regulamentam. Contudo, contrariamente a esses princípios, subsiste em todas as instâncias da federação brasileira, uma clientela exclusiva beneficiária de ações e serviços públicos de saúde ou, ainda de verbas públicas aplicadas em sua aquisição: os servidores públicos. Metodologia: mediante uma revisão de literatura, do arcabouço legal, da hermenêutica constitucional e de levantamento de dados orçamentários, verifica-se que os resultados revelam a inconstitucionalidade das leis orçamentárias que autorizam prover essas ações e serviços. Resultados: a discussão do tema autoriza a dizer que, politicamente e juridicamente, é muito difícil reverter tal situação em prol da credibilidade do SUS o que leva à conclusão, título do presente trabalho

objective: Discuss about the Brazilian Unified Health System (SUS) systematic, the principles of universality and equality came from a historical process, included in Brazilian Federal Constitution when recognized in the legal sanitary reform. However, in contrary to these principles, there is an exclusive clientele in public health actions, in all instances of the Brazilian federation: public servants are being benefited with exclusive public funds on their own health care. Methods: This paper makes a review of the literature, of the law, of the jurisprudence and of empirical data, to shows that the budged laws are unconstitutional when authorize to finance specific health care to public servants. Results: This discussion authorizes to say, in the political and legal instances, it is very difficult to reverse this situation in favor of SUS's credibility, which leads to the conclusion in the title of the present work

objective: discutir los principios que orientan el SUS, especialmente sobre la universalidad y la igualdad que evolucionaron en un proceso histórico en el curso del cual, apropiados por la reforma sanitaria brasileña, fueron estipulados en la Constitución Federal y en las leyes que los reglamentan. Pero, contrariamente a esos principios subsiste en todas las instancias de la federación brasileña, una clientela exclusiva beneficiaria de acciones y servicios públicos de salud o, aún de presupuestos públicos aplicadas en su adquisición: los funcionarios públicos. Metodología: mediante una revisión de literatura, del acervo legal, de la hermenéutica constitucional y de recopilación de datos presupuestarios, se verifica que los resultados revelan la inconstitucionalidad de las leyes presupuestarias que autorizan proveer esas acciones y servicios. Results: La discusión del tema autoriza a decir que política y jurídicamente es muy difícil revertir tal situación en pro de la credibilidad del SUS lo que lleva a la conclusión, título del presente trabajo.

Reflexiones sobre el concepto de salud comunitaria y consideraciones para su aplicación / Reflections on the concept of community health and considerations for application

Aproximarse a la salud comunitaria exige precisar conceptos como salud y comunidad, sus relaciones, y el contexto en el que ocurren, pues estos conceptos condicionan formas específicas de intervención. La medicina moderna está estructurada sobre las ciencias positivistas que se han desarrollado a partir de la revolución científica de los siglos XV y Las intervenciones de promoción de la salud también están condicionadas por los conceptos clásicos de enfermedad, transmisión y riesgo, los cuales orientan las intervenciones comunitarias. Los sistemas de atención sanitaria están llamados a pasar de un enfoque asistencialista y curativo, hacia un enfoque preventivo y promotor de la salud y la vida, como lo menciona la estrategia de Atención Primaria en Salud. Para ello es crucial revisar el concepto de salud imperante, a la luz de una flexibilización o apertura epistemológica.

Approaching community health requires to clarify concepts such as health and community, its relationships, and the context in which they occur, as these concepts determine specific forms of intervention. Modern medicine is structured on the positivist science developed from the scientific revolution of the fifteenth and sixteenth centuries. The interventions of health promotion are also conditioned by the classical concepts of disease, transmission and risk, which guide community interventions. The health care systems are called to move from a welfare and curative approach to a preventive approach and promoting health and life, as mentioned by the strategy of Primary Health Care. It is crucial to review the concept of health prevailing, in the light of an easing or epistemological opening.

Conhecimento acerca da política nacional de atenção integral à saúde do homem na estratégia de saúde da família / Knowledge about the National Politic on Men's comprehensive health care in the family health strategy

Pesquisa de estímulo à discussão da assistência primária à saúde em questões de gênero, à luz da Política Nacional de Atenção Integral a Saúde do Homem ? PNAISH. Esta política prioriza a assistência de forma a integralizar os serviços, garantindo por lei o acesso universal e igualitário ao usuário do sexo masculino. Objetivou-se analisar o entendimento dos profissionais de saúde sobre o conteúdo e a aplicabilidade da PNAISH na Estratégia de Saúde da Família (ESF), bem como compreender, a partir dos profissionais de saúde, como se dá o processo de inserção da população masculina nos serviços e quais estratégias são utilizadas para implementar esta política. Trata-se de uma pesquisa de cunho analítico com abordagem qualitativa, colocando em prática os procedimentos metodológicos da pesquisa social, desenvolvido em uma Unidade de Saúde da Família do município de Mossoró, tendo como amostra duas equipes da ESF. A procura tímida dos serviços de saúde por parte da população masculina ainda se justifica por questões culturais e sociais, além dos fatores trabalhistas, caminho que pode ser trilhado à medida em que se consolidam as ações de prevenção e promoção à saúde para esta clientela. Há ainda um longo caminho a se percorrer a fim de que os profissionais de saúde se libertem do ranço machista e atendam a esta clientela de forma mais adequada no sentido de ofertar uma escuta e um acolhimento dignos aos usuários do gênero masculino

Research for stimulating discussion of gender issues in primary health care, from the perspective of the National Policy on Men's Comprehensive Health Care - PNAISH. This policy prioritizes assistance aimed at integrating the services, guaranteeing by law the universal and equal access for male users. The objective was to analyze the understanding of health professionals about the content and applicability of the PNAISH in the Family Health Strategy (FHS), as well as to understand, from health professionals, how the process of including the male population in the services is working, and what strategies are used to implement this policy. This is an analytical study, with a qualitative approach, that puts into practice the methodological procedures of social research, and was developed in a Family Health Unit in the municipality of Mossoró, with two FHS teams as its sample. The limited demand for health services by the male population is still being justified by cultural and social issues, besides work-related factors, a path that can be investigated as the prevention and health promotion actions for this clientele are consolidated. There is still a long road toward ensuring that health professionals are freed from rank machismo and treat this clientele in a more adequate manner, in the sense of listening and offering a reception appropriate for male users.

Aplicação multimídia interativa e educativa sobre saúde bucal orientada a idosos / Multimedia oriented to the education on oral health of the elderly

Diante do quadro delineado pelos levantamentos epidemiológicos, bem como pelos diversos estudos a respeito da saúde bucal do idoso brasileiro, e considerando-se: a ineficiência das políticas públicas existentes, em melhorar essa realidade; a escassez de materiais educacionais apropriados, que se adaptem às necessidades, dificuldades e características da população idosa, foi desenvolvida uma aplicação de multimídia educativa orientada a idosos sobre saúde bucal, para ser utilizada como instrumento de disseminação de conhecimentos nessa área. Para tal, para a apresentação do conteúdo, elegeu-se o CD como mídia, o qual poderá ser utilizado em um monitor que suporte resolução de 1024 x 768 ou proporcional, com mouse, ou em um touchscreen, a opção sugerida como mais adequada diante de algumas dificuldades inerentes à terceira idade. Após pesquisa na literatura, determinou-se um roteiro que contemplasse temas do interesse e da necessidade dessa população. Dividiu-se o conteúdo final elaborado em módulos, subdivididos em tópicos. A interface e a navegação foram desenvolvidas respeitando-se o perfil do idoso e para isso determinou-se que fossem simples e acessíveis, para facilitar a interação do computador com o idoso. A aplicação dispõe de recursos de navegação para que os usuários possam ver o conteúdo em ritmo próprio de aprendizagem, avançando nos módulos e tópicos conforme o próprio interesse. Para facilitar o entendimento, utilizou-se uma linguagem fácil e informal e as informações são transmitidas acompanhadas predominantemente de imagem de vídeo, áudio, fotos e desenhos gráficos estáticos e animados, utilizando-se também de analogias. As legendas e textos adicionados foram elaborados com letras grandes e as informações da aplicação são transmitidas, simultaneamente, em forma de texto ou legenda, acompanhados de som e imagens, com recursos que permitem que o volume do som seja regulado segundo necessidades particulares de cada um. Desta forma, abre-se a...

Facing the framework outlined by epidemiological surveys and by several studies regarding the oral health of the elderly population, and considering: the inefficiency of the existing public policies, in improve this situation, the shortage of appropriate educational materials, suited to the needs, difficulties and characteristics of the elderly population, it was developed a multimedia oriented to the education on oral health of the elderly, to be used as a tool for dissemination of knowledge in this area. To this end, for the presentation of content, the CD was chosen as media, it can be used in a monitor that supports resolutions of 1024 x 768 or proportional, with a touchscreen or mouse, the option suggested as the most appropriate based on some inherent difficulties for the elderly. After researching the literature, it was determined a guide that encompassed topics of interest and need of this population. Divided the final content developed in modules, divided into topics. The interface and navigation have been developed respecting the profile of the elderly and it was determined that they were simple and accessible to facilitate computer interaction with the elderly. The application comes with navigation features so that users can view content at their own pace of learning, advancing in the modules and topics as self-interest. To facilitate understanding, it was used a simple and informal language and the information is transmitted predominantly followed by video image, audio, photos drawings and static and animated graphics, using analogies also. The captions and added texts have been prepared with large letters and the application information is transmitted simultaneously in text or legend form, followed by sound and images, with features that allow the sound volume to be regulated according to the particular needs of each one. Thus, it opens the opportunity for older people with a visual, hearing, cognitive disability and illiterates and / or...