Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Introduction: In contexts such as the current one, in which public policies and participatory management spaces have been dismantled, weakened, or extinguished in the national public agenda, the discussion on social participation in the everyday life of services, especially in a capillary strategy such as the Family Health Strategy, becomes even more relevant and necessary. Objectives: In this manuscript, we show the perception of users, managers, and workers of the Family Health Strategy concerning the potential of social participation spaces in Primary Health Care for promoting citizenship and local public policies. Methods: Semi-structured interviews were conducted with 33 participants linked to five Family Health Units in the municipality of João Pessoa (state of Paraíba, Brazil). After organizing and systematizing the information, the content analysis method was employed. Results: The verified dimensions were summarized in five synthesis-ideas: formulation of health policies based on the understanding of community demands, as stated by their protagonists; knowledge sharing and collective formulation between team and users, thus promoting the expansion of local health actions; creating foundations for citizenship from the perspective of community empowerment; strengthening institutionalized spaces of participation consistent with local health demands; weaknesses for effective influence of spaces of social participation on     the promotion of local public policies. Conclusions: Social participation becomes a key  factor   for creating public spaces of representativeness and proactiveness of social groups, in planning, developing, and assessing health policies.

Introduction: The term high user of health services has an extensive interpretation range. Still, in general terms, it refers to a person with a higher frequency of doctor’s visits than expected for their age group or sex. For family health services and teams, considering the complexity of alternative contexts, it is essential to identify a rise in the frequency of a subject’s office visits so that factors that should be reconsidered in care flow can be addressed. Among the responsibilities of primary health care professionals is organizing patient groups. These groups play a significant role in broadening the patient’s understanding of care spaces, demonstrating that care is not confined to individual consultations. In this study, patient groups are viewed as vital tools in creating a safe space for sharing negative experiences and collectively developing coping strategies for common demands. Upon identifying a high user of health services in the Santa Cecília practice and other units of the Hospital de Clínicas de Porto Alegre complex, the team realized its limitations in providing the necessary care. As an alternative, it established a women’s group with a specific objective: to provide comprehensive care and support. Objective: To describe the profile of a high user of health services and the motivation to include them in a group, as well as describe the development of the mentioned group and assess the patient’s perceived effects in terms of health needs and distress manifestations after 6 months of participation. Methods: A case study was conducted on the basis of a single user and her participation in a women’s group for 6 months. We used the participant’s observations, analyzed observation contents, and reviewed her health records to assess her case follow-up and condition. Results: We observed a reduction in the frequency of doctor’s visits, number of complimentary tests, and prescription use in all specialties. Observation records suggested that the group developed a strong support network, which seems to have contributed to the improvement of the user’s clinical and emotional conditions. Conclusions: We could observe the benefits of a women’s group practice on the user’s health. This study contributes to primary health care by providing evidence on how to quantify and qualify this care tool to support the implementation of collective spaces of care for various stakeholders such as public administration, health care teams, and the public.

Introduction: The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) assesses the impact of urinary incontinence on specific quality-of-life aspects in a straightforward manner. Conversely, the invasive urodynamic study serves as a diagnostic tool for identifying the etiology of urinary incontinence. Objective: The aim of this study was to compare the ICIQ-SF questionnaire results with those of the invasive urodynamic study to establish recommendations for clinical conduct. Methods: This cross-sectional, descriptive, and quantitative study employed a simple random sampling methodology. It included 189 women with a clinical diagnosis of urinary incontinence who underwent both the invasive urodynamic study and completed the ICIQ-SF questionnaire. The data from the ICIQ-SF and urodynamic studies were compared to develop a treatment recommendation for urinary incontinence in women. Results: The analysis revealed a higher proportion of detrusor overactivity in the invasive urodynamic study among participants who reported “It leaks before I get to the bathroom” (59.3%) and “It leaks when I am dressing” (43.2%) in response to Question 6. Furthermore, a significant association was found between stress urinary leakage and responses to Question 6, specifically “It leaks when I cough or sneeze” (79.8%) and “It leaks when I am doing physical activity” (67.2%). The ICIQ-SF responses guided the treatment indications for urinary incontinence, categorized into four groups: A) no leakage (respondents answering “never”), B) urgent leakage (Question 6 responses indicating urinary leakage before reaching the bathroom and while dressing), C) stress leakage (Question 6 responses of urinary leakage when coughing or sneezing, and during physical activity), and D) mixed and/or unclassified urinary leakage (more than two varied responses to Questions 3, 4, and 6, not conforming to the patterns of the previous groups). Conclusions: The ICIQ-SF is straightforward to administer and can guide the treatment of urinary incontinence. Meanwhile, the invasive urodynamic study, being invasive, should be reserved for special circumstances.According to the presented recommendations, patients in Group A should be managed by a general practitioner, those in Group B may undergo pharmacological and/or physiotherapy treatment, individuals in Group C may receive physiotherapy and/or surgical treatment, and those in Group D should be evaluated by a specialist and may require the invasive urodynamic study.

Introduction: The availability of medicinal plants and phytotherapeutic compounds is already established in Brazil’s Unified Health System (SUS) and relies on public policies and programs for its implementation. Objective: The aim of this study was to show whether the availability of herbal medicines and medicinal plants actually occurs in the basic health units in the State of Goiás. Methods: An ecological study was carried out on the basis of results of the Program for Improving Primary Care Access and Quality (PMAQ-AB), in its three cycles. Results: There was low availability of phytotherapeutic medicines in the State of Goiás, in all three cycles (<20) of the municipalities in the State, considering that not all the units in the cities had herbal medicines available. In cycle 1, 53.42% (n=39) were available, while in cycle 2 there was a drop to 26.03% (n=19) and a slight increase in cycle 3 to 41.10% (n=30). Conclusions: This study showed that the low availability of herbal medicines and the lack of investment in continuing education for professionals may be a reflection of low government investment in expanding the practice in the state.

Introduction: Access to health refers to the ability of individuals to use necessary services in a timely and continuous manner, being an essential component for the effectiveness of health systems, and Primary Health Care should be the individual’s gateway to the health system. Objective: To analyze the factors associated with access to Primary Health Care in Brazil. Methods: Study with data from the 2019 National Survey of Health, carried out in Brazil. The sample consisted of 7,471 individuals. Individual sociodemographic aspects were investigated in a descriptive and multivariate analysis using Poisson Regression, considering a 5% significance level. Results: Among Brazilians who sought health care, 37% (95% confidence interval [CI] 35.6–38.4) sought the health centers of the Brazilian Unified Health System. Among those who sought this service, the prevalence of access was 72.4% (95%CI 70.3–74.4). Access to Primary Health Care was associated with self- rated health classified as fair, poor or very poor (prevalence ratio [PR]=1.13; 95%CI 1.07–1.18), with being illiterate (PR=1.21; 95%CI 1.10–1.33), living in rural areas (PR=1.09; 95%CI 1.06–1.13), race or skin color (Asian: PR=1.19; 95%CI 1.00–1.41; Indigenous: PR=1.21; 95%CI 1.08–1.36), and the household being registered with the Family Health Strategy (PR=1.16; 95%CI 1.08–1.25). There was a lower prevalence of access to Primary Health Care among those diagnosed with chronic diseases (PR=0.80; 95%CI 0.07–0.84) and who made moderate use (PR=0.88; 95%CI 0.83–0.94) or excessive use (PR=0.88; 95%CI 0.83–0.94) of alcohol. Conclusions: Therefore, it is necessary to implement strategies and public policies to improve access to the public who report chronic illnesses and alcohol consumption.

Introduction: It is essential to properly understand the main signs and symptoms, complementary tests, and therapy most commonly used in cardiology by physicians who work in the gateway to the healthcare system to ensure problem-solving care in most cases, thus avoiding unnecessary referrals to secondary health care and, consequently, overloading the healthcare system. In cardiology, some situations demand rapid diagnosis and treatment, in order to avoid damages that include serious sequelae and death of the patient, which justify care in emergency room. In other cases, the specialist’s evaluation can contribute to diagnosis, indication of the most appropriate complementary tests, a differentiated therapy and, mainly, the confirmation of the measures taken by primary health care physicians. However, for various reasons, including insecurity, there is an excess of referrals to specialists. Objective: In this study we aim to identify the main gaps related to cardiology in primary health care that contribute to or result in unnecessary referrals to cardiologists. Methods: This is a descriptive research on the database of 588 telecardiology sessions of Health Centers of primary health care in Joinville (state of Santa Catarina), Brazil, carried out from January 2020 to March 2021. The need for specialized face-to-face care for patients was evaluated by analyzing the cases. Results: A total of 74.15% cases could be resolved in primary health care. In addition, we identified that the main doubts of the primary health care physicians were related to alterations in signs and symptoms, followed by doubts about heart diseases and results of complementary tests. Other consulting sessions addressed questions about noncardiac diseases, medications, and inquiries that did not fit into any of the previous categories. Conclusions: Teleconsulting can avoid a significant number of unnecessary referrals, preventing specialist’s overload. Likewise, it can contribute to guidance to other professionals that enable the solution of these and future cases in primary health care.

Introduction: Primary Health Care (PHC) is a pillar of health systems, supporting universal coverage and organizing health assistance flows. Thus, Family Medicine (FM) consists of a strategic medical specialty, essentially dedicated to PHC, which supports individuals and families with resolutive, long-term, and holistic care. Objective: The aim of the study was to analyze the perceptions and prospections about PHC of participants of the Preceptorship Training Course (PTC)—Universidade Aberta do Sistema Único de Saúde and Universidade Federal de Ciências da Saúde de Porto Alegre, as well as to describe their professional-academic profile. Methods: The research embraced a mixed method (quantitative and qualitative), which was constituted in three phases: “Population Outlining,” composed of PTC participants’ registration data; “Survey Questionnaire,” a virtual survey applied to enrolled and graduated participants; and “Individual Interview,” in which virtual interviews were conducted with a sample of participants under the guidance of an open-questions script. These research phases were accomplished from October/2020 to April/2021. Results: Throughout its three editions, the PTC had 2,530 participants, evidencing a female predominance with an average age of 33.1 years. In the “Survey Questionnaire” phase, we obtained responses from  232 PTC participants, who were mostly enrolled in residency programs in the southeast region (45.7%) and in municipal institutions (41.4%). In addition, the majority of participants working in PHC reported being very satisfied (24.0%) and satisfied (35.6%) with their work in this healthcare setting. On the other hand, according to 12  interviewed participants, despite the importance of  FM contributions to PHC, this medical specialty faces some difficulties, such as unstable working ties, lack of acknowledgement, and low level of knowledge about the specialty on the part of the population and health managers. Conclusions: In recent years, FM has grown exponentially in Brazil, fostered by the expansion of government initiatives and the engagement of family doctors. However, attracting and retaining new professionals to this medical specialty represents a major challenge for its future and consolidation, requiring the engagement and commitment of health managers and professionals, academic communities, governments, and society.

Introduction: The COVID-19 pandemic has unleashed unprecedented challenges in healthcare systems globally, emphasizing the critical importance of the mental health of healthcare professionals. Accordingly, this study aimed to investigate initiatives focused on addressing the mental health needs of these professionals, with a focus on Brazil and countries in South America, during the pandemic. Objective: To analyze propositions aimed at addressing the mental health of healthcare workers during the COVID-19 pandemic. Methods: We employed a descriptive approach and documentary analysis technique to examine 29 selected publications from official government websites. This documentary analysis allowed us to identify and describe specific propositions for the mental health of healthcare workers, covering individual and organizational aspects. Results: The results revealed a significant emphasis on self-care and organizational justice as key strategies to promote the mental health of healthcare professionals during the pandemic. However, we also identified a shortage of investments and policies targeting the mental health of these workers in the South American region, exacerbated by the pandemic context. Conclusions: This study highlights the urgency of concrete measures to address present and future challenges related to the mental health of healthcare professionals. The lack of investments and specific policies in the South American region underscores the need for effective measures to mitigate adverse impacts on the mental health of these essential professionals.

Introduction: The evaluation of the satisfaction level related to the service quality received requires specific and validated questionnaires that guarantee the provision of a service that meets the needs of geriatric patients. Objective: To demonstrate the relationship between customer (patient) satisfaction levels and the quality of service provided by the company (Solidaridad Salud). Methods: A descriptive, quantitative, cross- sectional, and prospective study was carried out, in which 500 patients aged 65 years old and older. The survey instrument used was divided into two sections: the first section contained 22 items with responses on a Likert scale, with a reliability degree of Cronbach’s alpha equal to 0.954. The second survey was divided into three parts and consisted of 16 questions adjusted to the Likert scale, with a Cronbach’s alpha equal to 0.922. Results: 77.8% of geriatric patients were satisfied with the quality of service provided at SISOL, with the dimensions of empathy, effectiveness, and safety achieving the highest results at 78.9%, 75.2%, and 73.2%, respectively. Conclusions: It was demonstrated that the quality of healthcare services significantly influences user satisfaction levels, with a Pearson correlation coefficient of 0.906, showing a high positive moderate correlation at 90.6%.

Introduction: Alcohol abuse is a public health problem in Brazil. This practice has been present throughout human history, and different meanings and values have been attributed to its consumption. However, with advances in science, the harmful effects of its abuse have become widely recognized, and the homeless population stands out in this context. Accordingly, understanding the context experienced by this group in the city of Olinda (PE), which saw an increase from 250 to 300 people living this way after the COVID-19 pandemic, becomes essential to strengthen health care practices such as harm reduction, as well as to strengthen the link between this population and health services. Objective: To analyze the prevalence of abusive alcohol use and its relationship with sociodemographic data among homeless individuals in the municipality of Olinda (PE) between 2022 and 2023. Methods: This was a cross-sectional, quantitative study involving 46 homeless individuals. The sampling was non-probabilistic and based on convenience, which limited the findings. Data collection occurred through interviews conducted during activities by the Street Clinic team (“Consultório na Rua”). Two instruments were used: a sociodemographic questionnaire and the Alcohol Use Disorder Identification Test (AUDIT). AUDIT consists of ten questions, with total scores ranging from 0 to 40, divided into four risk zones. Results: The study included 46 homeless individuals, predominantly male. Regarding alcohol use in the past three months, most reported consuming alcohol, with cachaça being the most consumed beverage. Family conflicts were among the most cited factors influencing alcohol use. Concerning the risk level associated with alcohol consumption, most participants fell into Zone IV of the AUDIT, indicating probable alcohol dependence. Notably, those classified in Zone IV were mostly males, had been homeless for five years or less, lived on the streets alone, and had some form of employment. Conclusions: Given the sociodemographic characteristics of the studied population and the factors associated with alcohol abuse, there is a clear need for strategies that ensure continuity of care and promote harm reduction. Furthermore, new studies are essential to broaden the discussion on this topic and to strengthen public policies that consider Brazil’s diversity.