Search

This article analyzes the state of social participation in health in the Region of the Americas, framing it within the regional context and commitments assumed by the Member States of the Pan American Health Organization. It aims to provide regional input to the discussion of a resolution on social participation for universal health coverage, health, and well-being at the 77th World Health Assembly in 2024. In the Americas, social participation has evolved from a utilitarian approach to a fundamental aspect of health system governance, enshrined within legal frameworks and recognized as a citizen’s right. Regional resolutions emphasize inclusive policies and intersectoral action to tackle health inequities, meanwhile the World Health Organization handbook on social participation underscores the need for inclusive governance mechanisms and addressing power imbalances. Informed by Member States’ recommendations and scientific literature, the article emphasizes the importance of addressing power imbalances, strengthening legal frameworks, and enhancing capacities of governments and populations. It stresses adapting social participation mechanisms to diverse cultural contexts and ensuring meaningful community involvement in decision-making. Finally, the article advocates for a comprehensive approach to social participation grounded in principles of equity, democracy, and human rights; and fundamentally as an essential component of the primary health care approach. It calls for integrating social participation into health system governance, policy dialogues, capacity- building, and evaluation to ensure effective participatory processes.

ABSTRACT Objectives: to understand the experiences of indigenous women regarding the pregnancy-puerperal cycle. Methods: qualitative, exploratory and descriptive research, carried out between May and August 2023 with 27 pregnant women from Indigenous Villages in Mato Grosso, Brazil, through open individual interviews. The data was analyzed using Reflexive thematic analysis. Results: data analysis resulted in the following themes: Cultivation of labor and birth in its natural and sacred path; Unique practices and beliefs associated with breastfeeding; Evolved or reductive thinking? The participants suggest inviolable practices and beliefs, which must be welcomed, respected and enhanced by indigenous health teams. Final Considerations: the experiences of indigenous women regarding the pregnancy-puerperal cycle are unique and motivated by inviolable cultural and religious beliefs, which transcend scientific knowledge, certainties and the linearity of contemporary approaches, normally established as order.

Note from the Editors: This article by Drs. Borroto Cruz and Salas Perea was published in the Fall 2008 edition of MEDICC Review. We will be publishing a Spanish translation this month in Medicina Social. We present here the abstract of the article. We encourage readers to read the English original which is available at: www.medicc.org/mediccreview/. The issue is entitled: Teaching for Health Equity: Changing Paradigms of Medical Education. National Training Program for Comprehensive Community Physicians, Venezuela Introduction: Through the 1990s, wide disparities in health status were recorded in Venezuela, a mirror of poor social conditions, decreasing investment in the public health sector and a health workforce distribution unable to meet population health needs or to staff effective, accessible public health services. Venezuelans’ health status deteriorated as a result. In 2003-2004, the Venezuelan government launched Barrio Adentro, a new national public health model aimed at assuring primary health care coverage for the entire population of an estimated 26 million. Cuban physicians staff Barrio Adentro clinics, mainly in poor neighborhoods, until enough Venezuelan physicians can be trained to fill the posts. Intervention: Cuban experience with community-oriented medical education and global health cooperation was drawn upon to develop curriculum and provide faculty for the new National Training Program for Comprehensive Community Physicians, begun in 2005 in cooperation with six Venezuelan universities. The program differs from previous Venezuelan medical education models by adopting a stated goal of training physicians for public service, recruiting students who had no previous opportunity for university-level education, and concentrating the weight of their training on a service- and community-based model of education, relying on practicing physician-tutors. Results: Over 20,000 students have been enrolled in three years. The six-year program has been extended to all 24 Venezuelan states, relying mainly on Cuban faculty who are practicing Barrio Adentro doctors and who receive postgraduate training in medical education. This “university without walls” has accredited 5,131 Barrio Adentro clinics as teaching institutions; its infrastructure includes other health care delivery facilities plus 855 multipurpose classrooms throughout the country. For the 2006-2007 academic year, the pass rate was 82% for first-year students and 94% for second-year students. Some difficulties persist in student selection, pre-medical preparation, and achieving optimum use of existing resources. Academic, institutional, and external evaluations are ongoing. Conclusion: This is the most ambitious example of scaling up of physician training in a single country. The program has been made possible by considerable political will from the Venezuelan and Cuban governments; by the experience acquired through development of the Cuban health system and medical education programs; by the individual commitment of Cuban curriculum developers and physician-tutors; and by ever-more-organized Venezuelan communities. The size of the undertaking, coupled with significant innovations in curriculum, present challenges. The Venezuelan experience — emphasis on training physicians for a revitalized public health sector, accompanied by a paradigm shift in primary care — warrants attention from the international community in the context of the global shortage of health workers and efforts to achieve a more equitable distribution of health services worldwide. Keywords: medical education, human resources for health, community-based medical education, primary care, health equity, Venezuela

RESUMO A educação pode agir como um fator transformador da prática de saúde ao promover encontros de sujeitos, da assistência à gestão. Ao intermediar a realidade assistencial, o gestor passa a integrar o espaço onde se produz saúde e educação, permitindo o aprendizado e a construção conjunta de respostas aos problemas inerentes à rotina de trabalho. Com objetivo de analisar a perspectiva dos gestores acerca de uma proposta de educação permanente em cuidado paliativo para capacitação de médicos e enfermeiros da Atenção Primária à Saúde, foi realizada uma pesquisa-ação, com abordagem qualitativa, na atenção primária da região Médio Paraíba do estado do Rio de Janeiro. Através da análise das entrevistas semiestruturadas, realizadas com oito gestoras e a representante da Comissão de Integração Ensino-Serviço da região de saúde, emergiram quatro dimensões temáticas: necessidades, aplicabilidade, equipe de saúde e acesso. Identificou-se que a proposta educacional elaborada, ao agregar educação permanente em saúde e cuidado paliativo, possibilitou à gestão vislumbrar uma estratégia dinâmica e capaz de transformar as práticas de serviço da atenção primária. Envolver a gestão ampliou o escopo do modelo proposto, potencializando sua apropriação não só no nível local, mas de forma integrada à rede de atenção à saúde.

ABSTRACT OBJECTIVE To confirm the diagram of the program’s impact pathways and Estratégia Amamenta e Alimenta Brasil (EAAB - Brazilian Breastfeeding and Complementary Feeding Strategy) core functions, and to determine indicators for evaluating EAAB. METHODS This is a qualitative study within the field of implementation research. Data collection included two focus groups with EAAB implementers, document analysis, and literature review. The analysis included a review of the participants’ suggestions and two stages of reviewing the diagram and the names of the impact pathways and core functions. Questions for evaluating the EAAB were then constructed based on the confirmed diagram. The indicators of the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance) were adapted to the EAAB context. The evaluation questions were revised according to the RE-AIM domains and, finally, indicators were determined for each evaluation question. RESULTS This study advanced the analysis of EAAB implementation, defining 22 indicators for its monitoring and evaluation. Most of the indicators are already used in implementation, however, the analysis with the RE-AIM framework allowed the indicators to be updated to be more specific, measurable, and relevant to the desired objectives. CONCLUSION The results of the study support the pragmatic application of RE-AIM evaluation in health programs and encourage the planning of evaluation indicators for other child health and development programs in primary care.

Abstract Objective This study aimed to evaluate the psychometric properties of the Brazilian version of the Maternal-Fetal Attachment Scale applied to pregnant women in Primary Health Care. Method This is a methodological study conducted with 937 pregnant women assisted in the Family Health Strategy in Montes Claros, Minas Gerais, Brazil. Psychometric sensitivity, construct and criterion validity, and reliability were evaluated. Results The instrument achieved adequate psychometric sensitivity (skewness < 3 and kurtosis < 7). Quality fit indicators of the model were obtained: x2/gl = 4.72, CFI = 0.89, GFI = 0.90, TLI = 0.87, RMSEA = 0.063 (90% CI = 0.059-0.067, p = 0.000). Hypothesis testing indicated associations with marital status (p = 0.036), income (p= 0.030), trimester (p < 0.001), planned pregnancy (p = 0.003), social support (p < 0.001), and family APGAR score (p < 0.001). Significant correlations (p < 0.001) with stress (r = -0.12) and depressive symptoms (r = -0.17) demonstrated divergent criterion validity. Cronbach’s α of 0.874 was recorded. Conclusion The scale showed adequate psychometric evidence for application to pregnant women in the Primary Health Care setting.

ABSTRACT Objective: Develop and validate the content of an instrument for patient risk classification in emergency services of Primary Health Care. Method: The study included two stages: item generation and content validity. A literature review and retrospective analysis of medical records were conducted to create the instrument items. The Content Validity Ratio (CVR) was used to assess agreement among judges during content validation. Results: In the first and second rounds, 75 and 71 judges validated the risk classification instrument, respectively. The minimum adherence score for the latent variable item based on the final number of judges was 0.22 and 0.18; thus, 52 items, divided into three classification categories (red, orange, and yellow), were retained. Conclusion: The instrument was considered valid regarding clarity, relevance, pertinence, and agreement regarding the severity indicated in the item.

Abstract Objective: to map nurses’ skills for nursing teleconsultation in Primary Health Care. Method: this is a scoping review guided by the recommendations of the Joanna Briggs Institute Reviewer’s Manual, carried out in seven databases and repositories of theses and dissertations. The selection of studies was carried out in Rayyan by two independent, blind reviewers. Data analysis was carried out descriptively. Results: 23 studies were selected, which showed that the skills necessary for nursing teleconsultation in primary care were: communication, clinical, technological and ethical. The lack of digital infrastructure was identified as one of the main barriers to the implementation of teleconsultation. The lack of access to information and communications technology and/or the internet, the severity of the clinical condition and the patient’s non-adherence to the remote consultation were also identified. Conclusion: nursing teleconsultation in primary care is an emerging way of providing health care. However, for its implementation it is necessary to train nurses in the following skills: communication, clinical, technological, ethical and those related to the infrastructure of the teleconsultation environment.

Resumen: Objetivo: Identificar las barreras y los facilitadores en el acceso y la utilización de los centros de atención primaria para las personas en situación de sinhogarismo. Diseño: Estudio cualitativo, enfoque teórico-metodológico fenomenológico. Entre el 19 de mayo y el 27 de julio de 2023. Emplazamiento: Centro de Atención Primaria Besòs y Menjador Solidari Gregal (Barrio del Besòs i el Maresme, Barcelona). Participantes: Personas en situación de sinhogarismo que acuden al Menjador Solidari Gregal y profesionales del Centro de Atención Primaria Besòs. Método: Muestreo intencionado teórico. Entrevistas semiestructuradas individuales, grupales y observación no participante abierta. Análisis temático del contenido, triangulación por análisis independiente de tres miembros del equipo investigador y triangulación de métodos. La saturación del discurso se alcanzó a través de la variabilidad del discurso y de las técnicas. Resultados: Once entrevistas individuales, tres entrevistas grupales y dos observaciones. Se identificaron diferentes barreras y facilitadores. Las mismas se clasifican en cinco categorías: 1) concepto e identificación de las personas en situación de sinhogarismo; 2) factores personales de las personas en situación de sinhogarismo; 3) conductas y actitudes de los profesionales; 4) factores estructurales relacionados con la normativa del sistema sanitario, y 5) factores organizativos internos de los centros de atención primaria. Conclusiones: Las personas en situación de sinhogarismo enfrentan múltiples barreras para acceder a la atención primaria, si bien también existen facilitadores, como las relaciones de confianza y el trabajo multidisciplinar e intersectorial, que pueden potenciarse desde los centros de atención primaria para contribuir a la equidad en salud. Abstract: Objective: To identify barriers and facilitators for the access and use of primary care centers for people experiencing homelessness. Design: Qualitative study, phenomenological theoretical-methodological approach. Between May 19 and July 27, 2023. Location: Besòs Primary Health Care Center and Gregal social dining (Besòs and Maresme neighborhood, Barcelona). Participants: People experiencing homelessness attending the Gregal social dining and professionals from the Besòs Primary Health Care Center. Method: Theoretical purposive sampling. Individual and group interviews and open non-participant observation. Thematic content analysis, triangulation by independent analysis of three members of the research team and triangulation of methods. Discourse saturation was achieved through variability of discourse and techniques. Results: Eleven individual interviews, three group interviews and two observations. Different barriers and facilitators were identified. These were classified into five categories: (1) concept and identification of people experiencing homelessness; (2) personal factors of people experiencing homelessness; (3) behaviors and attitudes of professionals; (4) structural factors related to health system regulation, anf (5) internal organizational factors of primary health care centers. Conclusions: People experiencing homelessness face multiple barriers to access primary health care, although there are also facilitators such as trusting relationships and multidisciplinary and intersectoral work that can be enhanced from primary health care centers to contribute to health equity.

ABSTRACT Objective: To understand the bioethical issues involved in the care management of nurses working in the Family Health Strategy. Method: A qualitative study was conducted through five focus groups with 36 nurses selected in the sample. Thematic content analysis was performed based on the bioethical framework, and the synthesis was presented in a conceptual map. Results: Bioethical issues were identified in the nursing care practice, related to both specific bioethical themes and the peculiarities of the work. Additionally, challenges and facilitators that interfere with addressing these issues were identified. Final considerations: Understanding the bioethical issues involved in the care management of nurses was possible with the theoretical support of different bioethical perspectives. The identified issues relate to persistent and current themes in the field of bioethics. However, some aspects intrinsic to daily practice are still imperceptible to professionals, contributing to the difficulty of discussing bioethics in this care model.

ABSTRACT Objectives: to map the educational actions conducted with primary health care professionals during the COVID-19 pandemic. Methods: a scoping review conducted in August 2023, which covered databases such as CINAHL, Medline, LILACS, IBECS, BDENF, and Web of Science. In total, 32 publications were analyzed through content analysis. Results: the primary beneficiaries of the educational actions included 69% physicians, 56% nurses, 25% pharmacists, 13% social workers and dentists, 9% psychologists, community health agents, and laboratory professionals, and 6% nursing technicians, nutritionists, and physical educators. The predominant educational interventions were training sessions (mentioned in 19 publications), followed by Continuing Health Education (10 publications) and Continuing Education (three publications). Final Considerations: the educational interventions demonstrated positive impacts on professional practice, particularly the Continuing Health Education actions, which were notable for stimulating critical problem-solving among professionals.

Abstract Objective: to analyze the frequency and associated risk factors for COVID-19 infection and the availability of Personal Protective Equipment used by primary healthcare workers. Method: a cross-sectional study was conducted over six months in Rio Grande do Sul. Descriptive analysis was performed, with the comparison of independent samples using Pearson’s Chi-square test and Fisher’s Exact test (p

Introduction: the primary health care system in Cuba is based on a preventive and community approach. It is based on well-established guidelines and principles with emphasize on the importance of nutrition education at all stages of life, from childhood to adulthood. Objective: to analyze the primary care specialist's professional mode of action and their role in nutritional education. Method: the literature review was carried out using a hermeneutical approach that followed the stipulated cycle and was aimed at collecting and analyzing sources of particular relevance. The methodology was developed in several stages and facilitated the analysis and interpretation of the data to construct the fundamental themes. Results: the results highlight that the primary care specialist plays a fundamental role in nutritional education. His professional conduct is based on ethical principles, including responsibility, respect, confidentiality, integrity, and honesty. In addition, they assume the role of educators and health promoters, acting as facilitators of change. Its primary goal is to empower patients, their families, and communities to make informed decisions that promote positive changes in their eating habits and lifestyles. Conclusions: the nutritional education these specialists provide enables any person to make correct decisions regarding their diet and lifestyle, positively impacting their health and well-being. It is essential to strengthen the education and training of primary care specialists in nutrition to guarantee comprehensive and effective care.

Resumen: Objetivo: Diseñar y validar el contenido de una herramienta de valoración enfermera, basada en los patrones funcionales de salud de Gordon, por un comité de expertos y aplicando una técnica Delphi. Diseño: Se ha diseñado un instrumento de valoración con 53 ítems. Sitio: Se realiza en el marco de una tesis doctoral, por matronas de Atención Primaria de Salud. Participantes: El panel ha estado formado por 16 profesionales con experiencia clínica, docente e investigadora que en su totalidad han participado en todo el proceso de validación planteado. Intervención: Se ha validado el contenido del instrumento en su conjunto y de cada ítem, a través de cuatro rondas de consultas, estableciéndose una valoración positiva de más del 60% para aceptar cada ítem, así como incorporando las sugerencias aportadas por el comité. La versión final tenía que llegar a un consenso unánime. Principales mediciones: Todos los ítems fueron aceptados con una puntuación superior al 60%. Resultados: No hubo contradicciones entre las aportaciones de los expertos, por lo que todas ellas se integraron en la versión final que cuenta con una aprobación del 100% por parte del comité. Conclusión: Tras este proceso, se presenta una nueva herramienta de valoración para ser aplicada por matronas de Atención Primaria en el seguimiento del embarazo. El cuestionario ha sido pilotado con 50 embarazadas, determinando los diagnósticos de enfermería más prevalentes, estableciendo la carga de trabajo para la matrona de su implementación de planes de atención individualizados para mejorar algunos indicadores de salud de las gestantes. Abstract: Objective: This research aims to develop a nursing assessment tool, based on Gordon's Health Functional Patterns, through a content validation by a committee of experts, applying a Delphi technique. Design: An assessment instrument with 53 items has been designed. Site: It is carried out within the framework of a doctoral thesis, for its implementation by midwives of Primary Health Care. Participants: The committee was made up of 16 professionals with a hide clinical, teaching and research experience who all participated in the entire validation process. Intervention: It has been assessed as a whole and in each of the items through four rounds of consultations, establishing a positive assessment of more than 60% to accept each item, as well as incorporating the suggestions provided by the committee. The final version had to reach a unanimous consensus. Main measurements: All items were accepted with a score higher than 60%. Results: There were no contradictions between the inputs provided by the experts, so all of them were integrated into the final version that has a 100% approval by the committee. Conclusion: After this process, a new assessment tool is presented to be applied by primary care midwives in the pregnancy monitoring. The questionnaire has been piloted with 50 pregnant women, determining the most prevalent nursing diagnoses, establishing the workload for the midwife of her implementation of individualized care plans to improve some health indicators of pregnant women.

Objectives. To validate the implementation drivers scale among first-level mental health care professionals in Colombia. The scale is designed as a tool to guide the implementation of strategies that effectively reduce gaps in mental health care. Methods. The Active Implementation Framework was adopted, which is a widely used model for measuring implementation. The participants included 380 individuals (55.56% men) – 349 health personnel trained in the Mental Health Gap Action Programme (mhGAP) and 31 territorial personnel in charge of planning mental health strategies at the territorial level in Colombia. To assess the critical dimensions of mhGAP implementation, we developed a scale of 18 items based on the active implementation framework. We conducted content validity assessments and exploratory factor analysis to evaluate the scale. We used the Organizational Readiness for Knowledge Translation scale as a comparative standard. Results. The implementation drivers scale identified four dimensions: system enablers for implementation, accessibility of the strategy, adaptability and acceptability, and strategy training and supervision. These dimensions had Cronbach alpha values of 0.914, 0.868, 0.927, and 0.725, respectively, indicating high internal consistency. In addition, all dimensions demonstrated adequate correlation with the Organizational Readiness for Knowledge Translation scale. Conclusion. The implementation drivers scale effectively determines the adaptability and implementation of various components of mental health programs, particularly those focusing on community-based approaches and primary care settings. As such, this scale can contribute to the more effective implementation of strategies outlined by global and local political frameworks, thus improving mental health care.

ABSTRACT Objective: To understand the practices developed by nurses in primary care in southern Brazil. Method: Qualitative study, with data collection via online interviews, conducted between October 2020 and May 2021, and recorded. 174 nurses from 24 municipalities in southern Brazil participated. Data analysis used inductive thematic analysis. Results: The activity that stood out among nurses was the nurse consultation, for all age groups and health conditions, especially when dealing with chronic disease, prenatal care, attention to women and children, mental health, home visits, and the management of the nursing team and the health unit. Final considerations: This study demonstrated that an excess of responsibilities associated to care and management, added to a lack of balance in the activities common to the team make it difficult for nurses to develop clinical practices.

ABSTRACT Objective: To map the competencies of Primary Health Care nurses in border regions of Brazil and Paraguay. Method: Exploratory qualitative studyconducted between February and July 2020, with 64 nurses from six Brazilian municipalities bordering Paraguay. It was conducted in three stages: 1. Documentary study: analysis of legal documents to identify the nurse’s competencies. 2. Application of instrument to the study population .3. Mapping of competencies, through the competencies expressed by nurses analyzed using the collective subject discourse technique. Results: Twenty-eight general competencies were identified, categorized as assistance and management, and five specific competencies required to work in border regions: conducting a situational diagnosis of the border community; attending to foreign users with active and humanized listening; communicating appropriately with foreign users; identifying the epidemiological profile of the border; and, understanding the health policies of the neighboring country. The competencies required for the work from the participants' perspective were included in the mapping. The competence gap identified in the mapping refers to educational practices in communities. Final considerations: The study identified the necessary competencies for nurses to work in border regions, but pointed out gaps in the training and continuing education of these professionals.

ABSTRACT Objective: To understand the practices of nurses working in Primary Health Care in caring for people in psychological distress. Method: Qualitative study conducted with 30 nurses working directly in Primary Health Care. Data were collected from January to March 2023 through semi-structured interviews, which were fully transcribed. The resulting material was organized in the IRaMuTeQ® software and subjected to the thematic content analysis, anchored in the precepts of Eric Cassell’s Theory of the Nature of Human Suffering. Results: Five categories emerged: 1. Causes of Psychological Distress (14.65%), 2. Needs of the person in psychological distress (31.3%), 3. Team case discussions (26.5%), 4. Care network for the person in psychological distress (15.99%) and 5. Care instruments (11.57%). Final considerations: The practices that nurses perform involve listening spaces to express feelings, case discussions within the team and matrixing and the understanding that psychological distress is the result of environmental, social, and family factors. However, they report a lack of training to assess individuals experiencing psychological distress and request the development of institutional protocols and training to support care.

ABSTRACT Objectives: to understand the role of Primary Health Care teams in caring for people with stroke after hospital discharge. Methods: single case study, with integrated units of analysis, with a qualitative approach. Data triangulation occurred through interviews with professionals and family caregivers involved in transition of care, in addition to direct observations in rounds and document analysis. For the analyses, the analytical strategies of theoretical propositions and construction of explanations were used, with the help of ATLAS.ti®. Results: the importance of counter-referral, the role of community health workers and the multidisciplinary team, health promotion, secondary prevention, home visits as a visceral attribute and nurses as care managers are evident. Final Considerations: the high demand on teams and the Social Determinants of Health interfere with adequate continuity of care. Transitional care programs that enable continuity of care are recommended.

ABSTRACT Objectives: to contribute to the change in understandings and knowledge of the popular system among riverine women about female intimate self-care before and after the application of an educational dynamic. Methods: a qualitative-participative study based on the Sunrise Model. Twenty women registered at a Basic Health Unit on the Combu island, state of Pará, Brazil, participated in the second half of 2022. Semi-structured interviews were conducted before and after the educational dynamic; followed by reflective inductive analysis. Results: these are pointed out: a female mechanism of generational education; the cultural act of bathing as synonymous with intimate self care and disease prevention; intimate care with medicinal herbs; lack of professional system approach to the topic; fear of using “muddy water”; and lack of financial resources to purchase specific products for genitourinary care. Final Considerations: companionship and social factors drive intimate self-care; however, riverine women experience taboos, ignorance, and poverty.

ABSTRACT Objectives: to validate the content of an instrument for assessing leprosy care in individuals under 15 years old in the context of Primary Health Care. Methods: methodological study of content validation, based on the evaluation of essential and derived attributes in primary care, in the professional version. For data analysis, the Content Validation Index (CVI ≥ 0.8) and Cronbach’s Alpha were calculated. Results: a higher percentage of judges among nurses (61.5%) was observed; with a doctorate (46.2%), and engaged in teaching and research (77%). The overall Content Validation Index of the instrument was 0.98. In the analysis of Cronbach’s Alpha of the instrument, the assigned value was 0.717. Conclusions: the instrument represents an advancement in the measurement of health evaluation policies and can significantly contribute to improving the quality of care provided to children and adolescents with leprosy.

ABSTRACT Objectives: to identify, in the scientific literature, the care that should be provided to individuals with drug-resistant tuberculosis by nurses in primary health care. Methods: integrative review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses study selection flowchart. Data collection was conducted in November 2022, across ten databases. Results: six studies emphasized that nurses should perform directly observed treatment; two highlighted the importance of integrated care management between tuberculosis and human immunodeficiency virus; two demonstrated comprehensive nursing consultation using the nursing process; one emphasized person-centered care, with discharge planning and improved hospital communication with primary health care services. Final Considerations: the care that nurses should provide to individuals with drug-resistant tuberculosis in primary health care, for care resolution, is evidence-based.

ABSTRACT Objectives: to validate the Brazilian version of the Modified Scale for Delineating Advanced Practice Nursing Roles. Methods: this was a methodological study for the clinical validation of an instrument, conducted with 207 nurses working in primary care. Exploratory and confirmatory factor analysis, Cronbach’s alpha test, and z-test for proportion comparison were used. Results: the internal reliability of the scale was 0.944, with alpha greater than 0.80 in most domains, except for Education (0.786). In the exploratory factor analysis, considering the criterion of eigenvalue greater than one, eight factors were identified, explaining 79.38% of the variance. In the comparison of proportions, the adequate responses (≥ 2) in the domain of Comprehensive Direct Care, in both analyzed groups, were statistically equal. This domain had the highest score of adequate responses, followed by Education and Systems Support. Insufficient scoring was observed in the domains of Publication and Professional Leadership. Conclusions: the instrument demonstrated stability and reliability to be used in the evaluation of advanced nursing practice.

Introduction: This research was based on the essential components of palliative care provided by the American Society of Clinical Oncology (ASCO). Objective: To find out the knowledge primary care physicians and nurses have on palliative care in oncology and to identify the educational needs and perspectives related to the integration of this practice in primary care. Method: Semi-structured in-depth interviews were carried out with 17 primary care health professionals from the National Health System in eight Brazilian municipalities from Médio Paraíba, State of Rio de Janeiro, Brazil, between March and August 2022. Results: The results were analyzed along five axes: palliative care, welcoming in health, communication, health networking and learning. These axes corresponded to the main aspects detected in the research and revealed that professionals expressed a strong need for an adapted training program. Conclusion: The need for an educational process in palliative care capable of combining patient and family centered care with strengthening and valuing primary care professionals was highlighted.

Resumen: La cirugía bariátrica (CB) ha demostrado su eficacia y eficiencia, pero solo el 1% de los pacientes seleccionados llegará a recibirla.En comparación con el tratamiento médico de la obesidad, la CB, ha demostrado una mayor pérdida ponderal mantenida a largo plazo, una reducción de la mortalidad tanto total como cardiovascular (CV), mejoría o remisión de los factores de riesgo CV y de otras comorbilidades asociadas a la obesidad, así como mejor movilidad y calidad de vida.Presenta riesgos similares a otras intervenciones quirúrgicas abdominales, con la obesidad como factor de riesgo añadido. No obstante, la mortalidad después de este tipo de cirugía es menor al 1%, siendo en centros especializados incluso inferior al 0,3%, con una morbilidad menor al 7%.Los procedimientos quirúrgicos más comúnmente realizados en el momento actual son la gastrectomía vertical (GV) y el bypass gástrico en Y de Roux (BGYR), preferiblemente mediante abordaje laparoscópico. Abstract: Bariatric surgery (BS) has been shown to be effective and efficient, but only 1% of selected patients will ever receive it.Compared to medical treatment of obesity, BS has demonstrated greater long-term sustained weight loss, a reduction in both total and cardiovascular (CV) mortality, improvement or remission of CV risk factors and other comorbidities associated with obesity, as well as improved mobility and quality of life.BS presents similar risks to other abdominal surgeries, with obesity as an added risk factor. However, mortality after this type of surgery is less than 1%, being in specialised centres even lower than 0.3%, with a morbidity of less than 7%.The most commonly performed surgical procedures at present are vertical gastrectomy and Roux---Y gastric bypass, preferably by laparoscopic approach.

Resumen: Objetivo: El objetivo fue describir las características del uso de la ecografía clínica en dos centros de salud (CS) del área VII de Salud de la Región de Murcia (CS Murcia-Sur y CS Floridablanca). Diseño: Estudio observacional, descriptivo, longitudinal, prospectivo y multicéntrico. Sitio: CS Murcia-Sur y CS Floridablanca (Área VII de Salud de la Región de Murcia). Participantes: Se incluyeron 135 pacientes. Intervenciones: Realización de ecografía clínica en la consulta de Atención Primaria (AP). Medidas principales: Se recogieron variables demográficas (edad, sexo), así como variables clínicas (motivo de consulta, tipo de ecografía, resultados, derivaciones a segundo nivel hospitalario, grado de acuerdo diagnóstico). Resultados: Se incluyeron 135 pacientes, más del 50% pertenecen al sexo femenino. El principal motivo de consulta fue la sintomatología musculoesquelética y de partes blandas (44,4%), seguida de la sintomatología digestiva (21,5%). El 44,4% de las ecografías fueron catalogadas como normales, mientras que en el 55,6% se encontraron hallazgos patológicos. Se solicitaron pruebas de confirmación en un 43,7% y en el 67% de los pacientes se confirmaron los hallazgos. Conclusiones: El uso de la ecografía en AP, permite poner de manifiesto la elevada prevalencia de hallazgos patológicos en la exploración de los pacientes. Es una técnica que ayuda al clínico en su proceso diagnóstico-terapéutico. La integración de la ecografía clínica en la consulta de AP puede ahorrar estudios complementarios y derivaciones a segundo nivel asistencial. Su implantación en AP requiere una correcta formación de los profesionales. Abstract: Objective: The objective was to describe the characteristics of the use of clinical ultrasound in two health centers (SC) of Health Area VII of the Region of Murcia (CS Murcia-Sur and CS Floridablanca). Design: Observational, descriptive, longitudinal, prospective and multicenter study. Site: CS Murcia-Sur and CS Floridablanca (Health Area VII of the Region of Murcia). Participants: One hundred and thirty-five patients were included. Interventions: Performance of clinical ultrasound in the primary care (PC) consultation. Main measurements: Demographic variables (age, sex), as well as clinical variables (reason for consultation, type of ultrasound, results, referrals to the second hospital level, degree of diagnostic agreement) were collected. Results: One hundred and thirty-five patients were included, more than 50% were female. The main reason for consultation was musculoskeletal and soft tissue symptoms (44.4%), followed by digestive symptoms (21.5%). 44.4% of the ultrasounds were classified as normal, while pathological findings were found in 55.6%. Confirmatory tests were requested in 43.7% and the findings were confirmed in 67% of the patients. Conclusions: The use of ultrasound in PC allows to show the high prevalence of pathological findings in the examination of patients. In a technique that helps the clinician in his diagnostic-therapeutic process. The integration of clinical ultrasound in the PC consultation can save complementary studies and referrals to a second level of care. Its implementation in PC requires proper training of professionals.

Resumen: Objetivos: Se trata de determinar la enfermedad renal crónica (ERC) oculta y su relación con la aparición de los eventos cardiovasculares (ECV) y mortalidad. Además, se pretende identificar los factores de riesgo cardiovascular (FRCV) y calcular el grado de control de diabetes mellitus (DM) tipo 2 y dislipidemia (DLP) previa al ECV. Material y métodos: Consiste en un estudio de cohortes retrospectivo realizado en las zonas básicas de salud (ZBS) de San Agustín (33.321 usuarios), que consta de los centros de salud San Agustín, Illes Columbretes y los consultorios auxiliares de Borriol y Raval; y por otra parte la ZBS de Almassora (25.831 usuarios), basándose en analíticas entre enero de 2015 y diciembre de 2018. Las principales variables fueron ERC, ECV, mortalidad y los FRCV. Resultados: Muestra final de 243 pacientes de 2 cohortes de 135 sin ERC y 99 con ERC (36,4% ERC oculta). El HR de desarrollar ECV era de 4,28 y la mortalidad del 12,3 en el grupo con ERC respecto con el grupo sin ERC. En cuanto a la relación de los FRCV previos a la aparición de ECV, en la cohorte con ERC la hipertensión, la DLP y la DM tipo 2 tuvieron resultados significativos respecto a la cohorte sin ERC. Asimismo, en la cohorte con ERC el porcentaje de control de la DLP fue inferior al 50% y mayor del 66,66% en la DM tipo 2. Conclusiones: Se objetiva que un tercio de los pacientes no están diagnosticados de ERC, lo cual tienen una probabilidad elevada de desarrollar ECV o muerte. Dada la falta de diagnóstico las intervenciones en el control de la DLP y DM tipo 2 son más bajas. Abstract: Objectives: The aim is to determine hidden chronic kidney disease (CKD) and its relationship with the appearance of cardiovascular events (CVD) and mortality. Furthermore, the aim is to identify cardiovascular risk factors (CVRF) and calculate the degree of control of diabetes mellitus (DM) type 2 and dyslipidemia (DLP) prior to CVD. Material and methods: It consists of a retrospective cohort study carried out in the Basic Health Zones (BHZ) of San Agustín, (population of 33,321 users) which consists of the health centers San Agustín, Illes Columbretes, and the auxiliary clinics of Borriol and Raval; and on the other hand, the BHZ of Almassora (25,831 users), calculated in analysis between January 2015 and December 2018. The main variables were CKD, CVD, mortality and CVRFs. Results: Final sample of 243 patients from two cohorts of 135 without CKD and 99 with CKD (36.4% occult CKD). The HR of developing CVD was 4.28 and mortality was 12.3 in the group with CKD compared to the group without CKD. Regarding the relationship of CVRFs prior to the appearance of CVD, in the cohort with CKD, hypertension (HTA), DLP, and type 2 DM had significant results, compared to the cohort without CKD. Likewise, in the CKD cohort the percentage of DLP control was less than 50.0%, and greater than 66.66% in DM type 2. Conclusions: It is observed that a third of patients are not diagnosed with CKD, which has a high probability of developing CVD or death. Given the lack of diagnosis, interventions in the control of DLP and DM type 2 are lower.

Resumen: La entrevista clínica a pacientes inmigrantes requiere una competencia cultural que garantice una buena comprensión y una correcta comunicación, además de recoger información específica diferente a pacientes autóctonos, como origen y ruta migratoria o identidad cultural.Se recomienda el cribado de infección tuberculosa latente (ITL) en ciertos casos, y el cribado de otras infecciones, tanto cosmopolitas con mayor prevalencia en migrantes (VIH, lúes, VHB, VHC), como importadas (Chagas, parásitos intestinales, estrongiloidiasis, esquistosomiasis), según procedencia.Es clave comprobar el estado de vacunación y completar la pauta vacunal adaptándola al calendario vigente, priorizando vacunas como sarampión, rubéola y poliomielitis.Proponemos actividades preventivas a realizar ante viajes a países de origen, por sus características y riesgos especiales: consejos generales, explorar riesgo de malaria, valorar vacunaciones específicas, consejo respecto a infecciones de transmisión sexual (ITS) y consideraciones especiales si tienen enfermedades crónicas; y abordaje, si es pertinente, de riesgos de mutilación genital femenina (MGF). Abstract: The clinical interview of immigrant patients requires cultural competence to ensure good understanding and correct communication, in addition to collecting specific information that differs from that of native patients, such as origin and migratory route or cultural identity.Screening for latent tuberculosis infection is recommended in certain cases and screening for other infections, both cosmopolitan with a higher prevalence in migrants (HIV, syphilis, hepatitis B and C) and imported (Chagas, intestinal parasites, strongyloidiasis, schistosomiasis), depending on origin.It is essential to check the vaccination status and complete the vaccination schedule, adapting it to the current calendar, prioritizing vaccines such as measles, rubella and poliomyelitis.We propose preventive activities to be carried out when traveling to countries of origin, due to their special characteristics and risks: general advice, exploring the risk of malaria, assessing specific vaccinations, advice regarding sexually transmitted infections and special considerations if they have chronic diseases; and addressing, if appropriate, the risks of female genital mutilation.

ABSTRACT Objectives: to describe the validity process of the TBApp mobile application for self-care management for people with tuberculosis linked to Primary Health Care. Methods: methodological research developed with ten expert judges, carried out virtually. The application was assessed in relation to content and technology quality in seven domains (objectivity; structure and appearance; relevance; functionality; reliability; usability; and efficiency), using an instrument with a Likert scale. Results: TBApp was considered valid, relevant, functional, reliable and effective by expert judges. The objectives, structure and presentation and relevance domains presented an overall Content Validity Index of 0.93, and the functionality, reliability, usability and efficiency domains presented characteristics and sub-characteristics values greater than 0.80. Conclusions: TBApp is a creative and innovative tool that can be used by people with TB and disseminated in the scientific community.

ABSTRACT Objectives: to identify Primary Health Care professionals’ practice in the face of leprosy. Methods: a scoping review, carried out between November 2022 and January 2023, conducted according to the methodological structure proposed by JBI and checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews in six databases and additional literature. Results: the sample consisted of 11 articles, published between 2008 and 2022. The findings were synthesized into three categories: Early diagnosis and timely treatment; Physical disability prevention; and Household and social contact surveillance. Final Considerations: there is a need to align the practices carried out with those recommended by the Brazilian National Program for Leprosy Control and Elimination, as some were not identified in studies, which implies losses to qualified assistance directed to patient demands, with a view to control and elimination of leprosy.

Objective: to describe the process of developing a terminological subset for the International Classification of Nursing Practice in Diabetes Mellitus, based on Horta’s Basic Human Needs Theory and Bandura’s Social Cognitive Theory. Method: a methodological study based on the identification in the literature of 313 statements of nursing diagnoses pertinent to diabetes care, selected and validated by a consensus of nurses from different states of Brazil, specialists in diabetes, using the nominal group technique. Results: 156 nursing diagnosis/result statements were selected, of which 111 (71.15%) related to psychobiological needs, 42 (26.92%) to psychosocial needs and three (1.92%) to psychospiritual needs. A total of 433 nursing interventions were developed. The diagnostic statements were validated on the basis of a consensus among the experts, with an average content validity index of 0.89: 0.87 for psychobiological needs, 0.93 for psychosocial needs, and 0.77 for psychospiritual needs. Conclusion: the study validated the terminological subset for the International Classification of Nursing Practice in Diabetes, favoring clinical reasoning, the qualification of the Nursing Process, and the improvement of self-care practices in diabetes. It has made it possible to use nursing’s own language based on a globally recognized classification.

Introducción. La incontinencia urinaria (IU) es un síntoma derivado de una disfunción del patrón de eliminación definido como la pérdida de orina de manera involuntaria. En España se estima su prevalencia en un 16%, afectando mayoritariamente a mujeres. El objetivo principal es conocer el abordaje de la IU en las consultas de Enfermería de Atención Primaria en la OSI Araba. Los objetivos secundarios pretenden determinar el nivel de evaluación del área de eliminación, analizar la prevención y actuación precoz ante la IU, examinar el cumplimiento del registro del dominio de eliminación, evaluar el nivel de formación de Enfermería e identificar las dificultades para su abordaje. Metodología. Se realizó un estudio transversal descriptivo en los centros de salud urbanos de la OSI Araba. Resultados. Se analizó el registro de 4728 personas, el 13% de ellas presentaban IU, siendo el 73% mujeres. La valoración completa del área de eliminación se realizó en el 17% de los casos, la intervención adecuada en solo el 4.7% y el registro fue adecuado en el 15% del total. Discusión. El estudio reveló que la IU es el síntoma urinario más común en la población estudiada, sin embargo, la evaluación del área de eliminación es parcial y existe una brecha de género en la valoración, intervención y registro, en detrimento de las mujeres. Más de la mitad de las enfermeras consideran tener una formación "escasa" en este tema y un tercio encuentra difícil abordarlo. La falta de formación es la principal dificultad, seguida de la limitación de tiempo en consulta. ABSTRACT Introduction. The urinary incontinence is a symptom resulting from a dysfunction in the elimination pattern, defined as the involuntary loss of urine. In Spain its prevalence is estimated at 16%, affecting mostly women. The main objective is to investigate how urinary incontinence is addressed in Primary Care Nursing consultations within the Araba Health Service. Secondary objectives include determining the level of assessment in the elimination domain, analyzing prevention and early intervention practices for urinary incontinence, examining the compliance with record-keeping in the elimination domain, assessing the level of training among primary care nursing professionals, and identifying the challenges faced in addressing this issue. Methodology. To address these objectives, a descriptive cross-sectional study was conducted in urban healthcare centers within the Araba Health Service. Results. The analysis involved 4,728 individuals, with 13% of them presenting urinary incontinence, of which 73% were women. Complete assessments of the elimination domain were conducted in only 17% of the cases, appropriate interventions were observed in just 4.7% of cases, and adequate record-keeping was found in 15% of the total. Discussion. The study revealed that urinary incontinence is the most common urinary symptom in the studied population; however, the assessment, intervention, and record-keeping related to the elimination domain are limited, with a gender gap disadvantaging women. More than half of the nursing professionals perceive their training in this area as "scarce," and one-third find it challenging to address urinary incontinence. The lack of training and time constraints during consultations were identified as the primary difficulties encountered in addressing this issue.

Resumen: La transformación digital es una realidad. Afecta a los procesos de las organizaciones y también desarrolla servicios para los usuarios. Esta innovación debe seguir las directrices de la Organización Mundial de la Salud (OMS) para todas las personas, en todas las partes del mundo. Tener en cuenta los determinantes sociales de salud (DSS) y considerar los nuevos determinantes digitales en salud (DDS) es básico. También lo es disponer de una legislación adecuada y dotar a las infraestructuras necesarias. La tecnología permite un mejor autocuidado y participación en la toma de decisiones. Por ello, es necesario disminuir la brecha digital y la mejor forma de hacerlo consiste en contar con los ciudadanos, las comunidades, las entidades y los profesionales en el diseño de soluciones. Las campañas nacionales y supranacionales deben desarrollar planes y estrategias comunes. Esto conlleva unas necesidades de formación y creación de programas para profesionales y usuarios, que deberían contemplar sus necesidades y remarcar la importancia de incorporar conocimientos digitales. Abstract: In the last years, the digital transformation, has become a reality influencing organizational processes and advancing services for users. This transformation must align with WHO guidelines, addressing the needs of individuals globally and acknowledging Social Determinants of Health and emerging Digital Determinants of Health and the digital divide thas has been created. To accomplish this, the appropriate legislation and infrastructures are required. Correspondingly technology enables enhanced self-care and increased participation in decision-making across various levels, consequently, addressing the digital divide must not be an exception, and needs to include citizens, communities, entities, and professionals to work on how to diminish it and solve it. As a result of this national and supranational campaigns should formulate unified plans and strategies, that include training requirements and establishing programs for both professionals and users, highlighting the significance of incorporating digital knowledge on both groups.

Resumen: Objetivos: Evaluar el efecto de una intervención de terapia ocupacional en usuarios diagnosticados recientemente de síndrome del declive, con una disminución en el índice de Barthel y/o Lawton en el último mes y susceptible de mejora según criterio clínico. Diseño: Estudio cuasiexperimental longitudinal no controlado. Intervención pre-post. Emplazamiento: Centro de salud Sant Hipòlit de Voltregà. Osona, Barcelona. Participantes: Pacientes remitidos por el profesional de enfermería, trabajo social o medicina de familia del centro con diagnóstico reciente de síndrome del declive que pueda beneficiarse de una intervención con terapia ocupacional. Intervenciones: Tras la visita inicial de valoración se llevaron a cabo cuatro sesiones de capacitación para mejorar la independencia funcional, la movilidad y adaptación del entorno doméstico, ofreciendo formación a los cuidadores principales. Mediciones principales: Se valoró la autonomía del paciente a través de la escala de Barthel y Lawton, la calidad de vida a través del cuestionario EuroQol (EQ-5D) y la adecuación del hogar a través del cuestionario de valoración de adecuación del hogar. Resultados: Se observaron mejoras en la autonomía en las actividades de la vida diaria (p = 0,003), la movilidad (p = 0,001) y la adaptación de la vivienda (p

ABSTRACT After hospital discharge, it is recommended that post-stroke individuals receive follow-up by a physical therapist throughout all the stages of recovery. Despite clinical recommendations, few studies have investigated physical therapy care to community-dwelling individuals with stroke. This study aimed to describe physical therapy care to community-dwelling individuals with stroke in primary care setting and identify clinical-functional and sociodemographic characteristics that determined physical therapy assistance. This is an exploratory cross-sectional study. Community-dwelling individuals with stroke who were assisted by the primary healthcare team from an important Brazilian metropolis were included. Their medical records were analyzed to identify the care provided by physical therapists. Individuals who received and did not receive physical therapy care were compared (α=0.05). Out of the 100 included individuals, 55% received assistance from the multidisciplinary primary healthcare team and 44% from physical therapists. Physical therapy approaches consisted mainly of general orientations (89%) and assessments (75%). Only 45% of the individuals who received physical therapy care were followed-up, and those who received this type of care had significantly more stroke events and higher levels of disability (p

Abstract: This study is a systematic literature review of the association between lists of potentially inappropriate medications (PIM) in clinical practice and health outcomes of older adults followed up in primary health care. For this purpose, the PRISMA protocol was used to systematize the search for articles in the PubMed, Web of Science, Scopus, Cochrane Central, LIVIVO and LILACS databases, in addition to the gray literature. Studies with randomized clinical trials were selected, using explicit criteria (lists) for the identification and management of PIM in prescriptions of older patients in primary care. Of the 2,400 articles found, six were used for data extraction. The interventions resulted in significant reductions in the number of PIM and adverse drug events and, consequently, in potentially inappropriate prescriptions (PIP) in polymedicated older adults. However, there were no significant effects of the interventions on negative clinical outcomes, such as emergency room visits, hospitalizations and death, or on improving the health status of the older adults. The use of PIM lists promotes adequate medication prescriptions for older adults in primary health care, but further studies are needed to determine the impact of reducing PIM on primary clinical outcomes.

ABSTRACT OBJECTIVE To identify the spatial patterns of the quality of the structure of primary health care services and the teams’ work process and their effects on infant mortality in Brazil. METHODS An ecological study of spatial aggregates, using the 5,570 municipalities in Brazil as the unit of analysis. Secondary databases from the Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB – National Program for Improving Access and Quality of Primary Care), the Mortality Information System (SIM), and the Live Birth Information System (SINASC) were used. In 2018, the infant mortality rate was the outcome of the study, and the exposure variables were the proportion of basic health units (BHU) with adequate structure and work processes. Global and local Moran’s indices were used to evaluate the degree of dependence and spatial autocorrelation. Spatial linear regression was used for data analysis. RESULTS In 2018, in Brazil, the infant mortality rate was 12.4/1,000 live births, ranging from 10.6/1,000 and 11.2/1,000 in the South and Southeast, respectively, to 14.1/1,000 and 14.5/1,000 in the Northeast and North regions, respectively. The proportion of teams with an adequate work process (β = −3.13) and the proportion of basic health units with an adequate structure (β = −0.34) were associated with a reduction in the infant mortality rate. Spatial autocorrelation was observed between smoothed mean infant mortality rates and indicators of the structure of primary health care services and the team’s work process, with higher values in the North and Northeast of Brazil. CONCLUSIONS There is a relationship between the structure of primary health care services and the teams’ work process with the infant mortality rate. In this sense, investment in the qualification of health care within the scope of primary health care can have an impact on reducing the infant mortality rate and improving child health care.

Objective: to develop and validate a mobile application for teaching undergraduates about the first nursing visit to a newborn in primary care. Method: methodological study with an Instructional Design framework; content drawn up from scientific documents on caring for newborns and their families, supported by the results of an integrative review on the subject. The Integrated Development Environment Android Studio 4.0.1 tool and the IntelliJ IDEA platform were used to build the digital technology. Experts validated content and students evaluated navigability. Results: the final version of the mobile application contains 67 screens grouped into 12 sections with random access. The device is presented on the introductory screen; this is followed by content on the physical examination, neonatal screening, nutrition, oral health, the vaccination calendar, growth, development, danger signs, and accident prevention; at the end, there is a fact sheet and references. Audiovisual resources (texts, images, and videos) complement the application; experts presented a Content Validity Index (CVI) = 1.00; for nursing students all the items had a CVI = 1.00; only the item “layout and presentation” had a CVI = 0.95. Conclusion: the digital technology received a satisfactory evaluation from experts and students. It is innovative in child health care, with the potential to be used in the teaching-learning process of nursing students.

ABSTRACT Objective: To identify perceptions of primary care health professionals regarding the conceptual aspects of child development and propose strategies to address difficulties. Methods: This descriptive-analytical study was conducted in a small municipality in the countryside of the State of São Paulo, Brazil. The primary health care in this region is comprised of Family Health Units and Basic Health Units. The sample included 52 participants, consisting of doctors and primary care nurses. A questionnaire with open and closed questions was utilized, covering knowledge and practices related to child development. For this study, the first question of the questionnaire, which asked for a descriptive response about participants’ understanding of child development, was employed. The responses were transcribed, and content analysis using the thematic approach was conducted. Results: Among the participants, 54% were nurses, and the average duration of working with the pediatric population was ten years. 80% reported never having undergone training in child development. The analysis of the responses revealed heterogeneity in the professionals’ understanding of the conceptual dimension of child development. Additionally, there was an insufficient grasp of the theoretical and practical aspects and a scarcity of resources to support comprehensive care for children. A predominant biomedical model focusing on disease and biological aspects of child health was evident in defining the understanding of the subject. Conclusions: The findings underscore the necessity of implementing health education initiatives and service projects in primary care settings. It is crucial to strengthen a comprehensive perspective of child health within the biopsychosocial model of the health-disease process.

ABSTRACT Objectives: to understand health and education professionals’ perceptions regarding children’s learning difficulties in public schools. Methods: qualitative research, of the participatory action type, linked to Paulo Freire’s Research Itinerary. Forty-five professionals participated, through interviews and a Virtual Culture Circle. The analysis was developed through careful reading, reflection and interpretation of highlighted topics. Results: professionals discussed the (in)visibility of learning difficulties, strategies and resources in the educational sector and the search for solutions in the health sector. It was found that the production of complaints related to school learning is attributed predominantly as an individual problem of children or their family, exempting the educational institution from this process. Final Considerations: greater investment in professional training and development policies is urgently needed to facilitate coordination between sectors, with a view to overcoming outdated pedagogical and health models.

ABSTRACT OBJECTIVE To describe the functional clinical profile of elderly people linked to primary health care, using the Functional Clinical Vulnerability Index (IVCF-20) and to spatialize those with the greatest functional decline by primary health care units in the municipality of Uberlândia, in the state of Minas Gerais (MG), in the year 2022. METHODS A cross-sectional study with secondary data from the Municipal Health Department of Uberlândia-MG. The variables were compared using Student’s t-test, Mann Whitney test, Pearson’s chi-square, and multinomial logistic regression to obtain the independent effect of each variable. The significance level adopted was 5% (p < 0.05). The georeferenced database in ArcGIS® was used. RESULTS 47,182 older adults were evaluated with a mean age of 70.3 years (60 to 113 years), 27,138 of whom were women (57.52%), with a clear predominance of low-risk or robust older adults (69.40%). However, 11.09% are high-risk older adults and 19.52% are at risk of frailty. Older men had independently lower odds of moderate and high risk compared to older women (OR = 0.53; p < 0.001). A high prevalence of polypharmacy was observed, 21.40% of the older adult population, particularly in frail older adults, with a prevalence of 63.08%. There was a greater distribution of frail older adults around the central region of the municipality and in health units with a larger coverage area. The IVCF-20 made it possible to screen frailty in primary health care. CONCLUSION The instrument is capable of stratifying the risk of older adults in health care networks through primary health care, enabling the application of individualized preventive, promotional, palliative, or rehabilitative interventions, according to the clinical functional stratum of the older adult and the compromised functional domains. Risk stratification and spatial distribution of the frailest older adults can be a good strategy for qualifying health professionals with the aim of maximizing the autonomy and independence of the older adults.

ABSTRACT OBJECTIVE To recognize elements that facilitated or hindered the PlanificaSUS implementation stages. METHODS A multiple case study was carried out in four pre-selected health regions in Brazil—Belo Jardim (PE), Fronteira Oeste (RS), Sul-Mato-Grossense (MT) and Valença (BA) using systemic arterial hypertension and maternal and child care as tracer conditions. Participant observation (in regional interagency commissions) and in-depth interviews with key informants from state and municipal management and primary health care and specialized outpatient care service professionals within the project were carried out in these four regions. Analysis was built according to political, technical-operational, and contextual dimensions. RESULTS The political dimension evinced that the regions found the project an opportunity to articulate states and municipalities and an important political bet to build networks and lines of care but that there remained much to be faced in the disputes related to building the Unified Health System (SUS). In the technical operational dimension, it is important to consider that primary health care stimulated a culture of local planning and favored traditional tools to organize and improve it, such as organizing registrations, agendas, and demands. However, centralized training and planning-inducing processes fail to always respond to local needs and can produce barriers to implementation. CONCLUSIONS It is worth considering the central and regional role of state managers in the commitment related to the project and the effect of mobilizing primary health care and expanding its power. There remains much to be faced in the disputes at stake in bullring SUS.

ABSTRACT OBJECTIVE Describe the implementation of a digital diagnostic and territorial monitoring tool in primary healthcare. METHODS Quantitative and qualitative study, developed in 14 basic healthcare units in São Paulo, with community health workers, coordinators, nurses, and physicians. Data collection occurred in four phases: analysis of the instruments used by the team for territory management; development of the digital tool; training and implementation; and evaluation after 90 days using focus groups. Descriptive analyses were conducted by calculating absolute and relative frequencies to treat quantitative data. Qualitative data were subjected to content analysis. RESULTS Three hundred thirty-four professionals participated in the study. In the first step, territory management’s main challenges were filling out various instruments, system failures, data inconsistency, internet infrastructure/network, and lack of time. Therefore, a digital tool was developed consisting of 1) a spreadsheet recording the number of family members and markers of health conditions, date of visit, and number of return visits; 2) a spreadsheet with a summary of families visited, not visited, and refusals; and 3) a panel with a summary of the data generated instantly. In the evaluation, after the initial use of the tool, the themes that emerged were integration of the tool into daily work, evaluation of the digital tool implementation process, and improvement and opportunities for improvement. CONCLUSIONS Faced with the challenges faced by family healthcare teams when filling out systems and managing the territory, the tool developed provided greater reliability and agility in data visualization, reduced the volume of instruments, and optimized the work process.

ABSTRACT OBJECTIVE To analyze knowledge about priority topics in mental health care of strategic actors who work in regions where the Health Care Planning (PAS) methodology is used. METHODS This is a quantitative, descriptive, cross-sectional, and observational study carried out with professionals from six health regions, distributed in three Brazilian states (Goiás, Rondônia and Maranhão) and linked to the project “Saúde mental na APS” (Mental health in PHC) of the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (Proadi-SUS – Institutional Development Support Program of the Brazilian Unified Health System). The sample was made up of professionals who participated in the intervention guide multiplier training stage for mental, neurological and alcohol and other drug use disorders in the primary health care network, from July to September 2022. Data collection was through a self-administered instrument, in electronic format, consisting of a block with socioeconomic items and a structured questionnaire to assess participants’ knowledge about priority topics in mental health. Descriptive analyses and comparison of proportions were conducted to analyze the data. RESULTS A total of 354 health professionals participated in the study. Regarding the percentage of correct answers in the questionnaire on priority topics in mental health, the highest medians were identified in the “Depression” module. On the other hand, the content referring to the modules “Essential care and practices” and “Other important complaints” presented the lowest values. Furthermore, some participant characteristics were found to be associated with the percentage of correct answers in the questionnaire modules. CONCLUSIONS The findings reveal opportunities for improvement, mainly in knowledge related to communication skills and the approach to emotional and physical distress without diagnostic criteria for a specific disease, offering support for planning actions aimed at intensifying the consideration of these themes during the operational stages of PAS.

ABSTRACT OBJECTIVE This study aimed to evaluate evidence of validity of internal structure of the Brazilian Dental Vulnerability Scale (EVO-BR) when applied in Brazil. METHODS This is a psychometric study that seeks to validate a scale elaborated by evidence of internal structure. Data collection was conducted in 18 basic health units that implement the Brazilian Healthcare Planning (PAS) methodology, across the five regions of Brazil. The initial version of the EVO-BR contained 41 items that measured dental vulnerability and was applied to users of the Brazilian Unified Health System (SUS) aged 18 years or older who were in basic health units for consultation with higher education professionals. To evaluate the evidence, the following statistical analyses were performed: exploratory factor analysis, confirmatory factor analysis, and network analysis. RESULTS A total of 1,753 users participated in the study. To adjust the sample, we considered the factorability obtained from Kaiser-Meyer-Olkin (KMO) test = 0.65, Bartlett sphericity test = 8019.7, and a matrix determinant of 0.008. The initial parallel analysis indicated a four-dimensional model and had the items adjusted according to factor loading (ranging from 0.38 to 0.99), common factors (0.13 to 0.89), and Pratt’s measure, until the model presented congruence in the statistical and interpretative principles simultaneously. The final model contained 15 items, maintaining the four dimensions indicated by the parallel analysis, and held an explained variance of 68.56%. CONCLUSIONS The EVO-BR is a validated scale to measure dental vulnerability and, thus, can contribute to the organization of access to the oral health team in primary health care (PHC) by stratifying the population, as recommended in the Brazilian Healthcare Planning.

ABSTRACT OBJECTIVE To investigate validity evidence of the Brazilian Scale for Evaluation of Mental Health Care Needs (CuidaSM). METHODS This is a psychometric study, which seeks additional evidence of internal structure. Data collection was carried out in 11 Primary Health Care (PHC) services , which implement the Health Care Planning (HCP) methodology, distributed across the five Brazilian regions. The preliminary version of CuidaSM, containing a block self-referred by the user and another block evaluated by PHC professionals, was applied to users aged 18 or over who attended the PHC services for consultation with a higher education professional. The techniques of confirmatory factor analysis and network analysis were used to investigate validity evidence. For the primary data of the confirmatory factor analysis, the factorial loads and the item’s predictive power (R2) were used. Six model adjustment indices were adopted and reliability was measured by three indicators using Bayesian estimation. RESULTS A total of 879 users participated in the study. By confirmatory factor analysis, factorial loads ranged from 0.43 to 0.99 and R2 from 0.19 to 0.98. Both the primary indicators and the model adequacy indices were established at satisfactory and consistent levels. The network analysis showed that the items were appropriately associated with their peers, respecting the established dimensions, which again indicates the sustainability and stability of the proposed model. CONCLUSIONS The study findings confirm a consistent and reliable model of the instrument, through a combination of techniques. Considering the importance of using solid instruments in clinical practice, CuidaSM is a promising tool for population-based management and network care organization, aligned with HCP proposals.

Introduction: Primary Health Care (PHC) has acquired different meanings for different people, at specific times and places, which poses important challenges for its understanding. Objective: To analyze the meaning(s) and sense(s) of Primary/Basic Health Care in the academic views on Nursing/Health in the context of undergraduate Nursing courses offered at two public Higher Education Institutions. Materials and methods: Qualitative study with an exploratory approach. Semi-structured interviews and documentary analysis were used as data collection techniques. Results: The senses/meanings of Primary Health Care converge with the population's gateway to the health system at the first care level and with the first contact of a person with the health service. However, it is still considered as a less important service within the care network. Conclusion: Primary Health Care means a relevant possibility for Nursing/Health care through health promotion and disease prevention actions, with a commitment to respond to most of the population's health needs.