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

Introducción. La diabetes mellitus (DM) es una enfermedad crónica que incrementa su frecuencia cada año, y la búsqueda de estrategias que sean de ayuda en la prevención o control son el objetivo en diversos estudios. La DM puede disminuir la biodisponibilidad de óxido nítrico (ON) mediante diversos mecanismos, presentándose la disfunción endotelial. Diversos estudios en modelos animales y estudios in vitro sugieren la participación de arginasa en la DM, al ser un competidor directo por el sustrato de la sintasa de óxido nítrico (NOs), disminuyendo la producción de ON.Objetivo. En este estudio, se determinó en pacientes con DM la actividad de la enzima arginasa como un posible marcador del progreso de la enfermedad.Material y Método: Se llevó a cabo un estudio transversal, en el que se utilizaron muestras sanguíneas en ayuno de 12 horas, se determinaron los parámetros antropométricos, los niveles de glucosa, colesterol y se evaluó la actividad de arginasa.Resultados y conclusiones: Participaron 107 pacientes en total, 37 controles y 67 con DM. Los resultados encontrados sugieren que la actividad de la arginasa no tiene un papel como marcador de la enfermedad en pacientes con DM que no presentan signos de enfermedad avanzada.

This article presents some organizational and operational characteristics of UK Primary Health Care (PHC). The objective is to show relevant points in the functioning of PHC clinics that facilitate the dynamic balance between same-day appointments and programmatic health actions. It derives from empirical material of an ethnographic study, conducted in the United Kingdom in the period of 2013/14, which analyzed the pay-for-performance model in the country. The issues covered include: (a) composition of English PHC teams; (b) PHC clinic functional organogram; (c) 10 minute consultation of family physician and clinic opening hours; (d) reception; (e) nursing team; and (f) information technology system. The supporting references allow to simultaneously explore websites and tutorials to better understand some aspects of the English PHC dynamics. The UK has professionalized patients’ access to PHC. This has entailed larger number of administrative personnel, a smaller population/family physician ratio, greater autonomy of the nursing team and a robust information technology system. In Brazil, the Family Health Strategy (FHS) needs to follow a similar path in order to improve the primary healthcare quality in the country.

This editorial presents the new editorial practices and author guidelines for Revista Brasileira de Medicina de Família e Comunidade (Brazilian Journal of Family and Community Medicine – RBMFC) starting in 2019. With them, RBMFC renews its commitment to publishing quality academic papers for family and community physicians and other primary care practitioners, contributing to the improvement of health care.

Introduction: The application of tele-diagnosis in dermatology can present several benefits such as waiting time reduction for secondary care, screening for serious diseases - mainly neoplasia - and continuing education of professionals. Objective: Report the experience of tele dermatology service implantation in the municipality of Florianopolis - Santa Catarina, and its initial impact on access and qualification of care for patients with dermatological disorders. Methods: Observational, cross-sectional and descriptive study. The experience report was based on data from municipal electronic medical record system, database from “Telessaude-SC” platform and Municipal Health Department of Florianopolis public institutional documents, among 2013 and 2017. Results: Tele dermatology service was implemented in Florianopolis in 2015, through adherence to Santa Catarina State Integrated Telemedicine (Telemedicina) and Telehealth (Telessaúde) System. The suitability process occurred through equipment acquisition, structural adaptations and staff training. In the analyzed period, there was a reduction of 52.6% medical referral rate to dermatology, with a significant decrease in waiting time from about 3 years in 2013-2014, for about 20 days in 2017. There is a trend towards the qualification of referrals to the service, with reduction of reports issued with blue classification, handled in Primary Health Care (PHC), and increase of reports with yellow classification, referred to dermatology. Conclusion: Tele dermatology implementation in Florianopolis represented a major advance on Primary Health Care and Specialized Health Care integration process, contributing to waiting times reduction and qualification of referrals, with potential improvement of coordination care and continuing education of professionals.

Objective: To describe the irrational use of antibiotics based on McIsaac criteria (Centor criteria modified by McIsaac), in a primary care facility. Methods: A cross-sectional descriptive study was conducted with the medical record of patients from 3 to 19 years old, treated in the emergency department (246), with the diagnoses of acute pharyngitis, acute tonsillitis, and acute upper respiratory infections from multiple sites and not specified. It was established as an inappropriate prescription if the physician indicated antibiotics with a score less than or equal to 1 out of 5 points or if he did not prescribe antibiotics with a score greater than or equal to 4 out of 5 points. Results: Inadequate use of antibiotics was found in 24.29% of emergency records. Antibiotics were prescribed in 160 patients, of which, amoxicillin was the most used (61.87%); followed by benzathine penicillin (28.12%) and in third place macrolides (8.12%). Conclusion: In the first level unit analyzed, it was found that the inappropriate use of antibiotics is superior to the estimated prevalence of streptococcal pharyngitis for the age group studied. Therefore, it is imperative that the necessary measures are taken at the institutional and community level to achieve its reduction and avoid the complications that result from it.  

Problem: The fundamental rights of transgender people are denied daily. In this scenario, prejudice acts as a social determinant of health impacting on the prevalence of conditions such as mental health and STIs. The objective was to develop a summary of evidence to support clinical care and support the training of Primary Health Care professionals in Florianópolis - SC, in order to improve the health outcomes of this population. Methods: Based on the PACK tool - accessible and intuitive interface in the ask, request, advise and treat model - already implemented in the municipality of Florianópolis. The rapid review method was used to search for evidence, prioritizing clinical practice summaries and international protocols. Primary sources were used when previous data were insufficient or conflicting. The research questions followed the acronym PICO and the recommendation was classified according to the GRADE adaptation of the Center of Excellence for Transgender Health. Results: The Quick Guide for the Health Care Practice of Transgender Population was created according to the Brazilian PACK model. The same is awaiting approval from PACK Brasil and the Ambulatory of Integral Attention to the Transsexual Population of Florianópolis for future incorporation of the material. Conclusion: Despite the lack of quality evidence and studies focused on the specific population, the existence of guidelines in this field legitimizes the need for transgender health care, in addition to assisting health professionals and policy makers on how to address these needs. In the perspective of harm reduction, we must overcome the barrier of social and institutional stigma to produce consensual guidelines in search of equipped for this population that suffers from a lack of equity

Health systems have the challenge of deciding which of the new available technologies should be used and be available as a priority through state coverage. In this way, the World Health Organization (WHO) ratifies the importance of the Health Technology Assessment (HTA), with the aim of strengthening information systems and health research capacity. The process of preparing an HTA report requires an exhaustive searchof the available evidence; for its subsequent synthesis and presentation to those interested in it. This is a crucial step for a technology to be considered for its introduction into a health system; becoming the fourth and final barrier (Quality, Safety, Efficiency and Cost-Effectiveness); for the implementation of new health interventions. However, to better determine the budgetary impact of the interventions, the HTA relies on thetools provided by the Economic Health Assessments (EHA); which can analyze both the costs and the clinical consequences of the use of a certain technology for a particular health problem in a particular context. This information is vital, when we consider principles such as equity, or the opportunity cost (what is spent in one intervention, cannot be used in another), and ultimately the limited health budget of health systems.

Problem: The long queues and the difficulty of care in the Family Health Units (FHU) are a reality known in Brazil. Advanced access represents a new proposal to host and manage the supply of vacancies for consultations. In this context of difficulty of access, was inaugurated in March 2016 in Recife, a new 24-hour Family Health Unit. After 6 months of service in operation, the Alfa team, a fictitious name, felt discouraged by complaints about the difficulty of access. Mobilized by the population dissatisfaction, an intervention was proposed to reorganize the offer of places for consultations and the scheduling model based on advanced access. The objective of this work is to report the experience of reorganization of the agenda and the offer of vacancies for consultations; the changes in the number and type of staff attendance after implementation of this new access model; and the perception of the team members regarding the experience. Methods: The first stage of the initiative included the identification of the viability of the intervention based on the calculation of the daily demand for care. Next, a new calendar template was created that was developed outside of e-SUS and used Google® Drive, and three times were available for the queries: 5 minutes, 10 minutes and 20 minutes, called respectively fast, intermediate and extended. Results: In the third month after the change, the disappearance of the appointments classified as urgency by the old model was observed, the 65% increase in the number of appointments of the Alpha team with transformation of the attendance profile from 70% of scheduled appointments to 70% of consultations of the day. Conclusion: The experience showed that it is possible to increase access by increasing the number of calls from the reorganization of the agenda based on the advanced access model.

WONCA, with the Planetary Health Alliance, issued a declaration calling family doctors of the world to act on planetary health. This commentary discusses environmental changes and the call in relation to the role of the family doctor in the perspective of planetary health.

Objective: The mere dissemination of standard care recommendations has been insufficient to improve clinical results in patients with asthma. The objective of the present study was to evaluate the clinical effectiveness of a multifaceted asthma distance education for primary care providers. Methods: Cluster randomized controlled trial. Full primary care teams were included if they had access to telehealth support and free basic asthma treatment. Before randomization, selected teams indicated asthma patients between 5-45 years old for inclusion. The intervention group received three interactive online sessions, printed educational material, reminders, booklet for patients, and frequent stimulus to use consulting services. The control group received no intervention. Symptomfree days per two weeks was the primary result. Controlled asthma, unscheduled asthma doctor visits, and preventive inhaled corticosteroid use were the secondary results. Six months after intervention, the results were compared with baseline data using generalized estimating equations for repeated measures and clustering effect. Results: Were enrolled 71 primary care teams and 443 individuals. Most patients (60.3%) were female, and 44% were younger than 12 years old. The attendance of interactive sessions by the teams was 50%. The odds ratio (OR) for additional symptom-free day was 1.31 (95%CI 0.61-2.82; p=0.49). For the secondary results, the results were: controlled asthma OR 1.29 (95%CI 0.89-1.87; p=0.18); unscheduled asthma doctor visits OR 0.81 (95%CI 0.60-1.10; p=0.17); and preventive inhaled corticosteroid use OR 1.02 (95%CI 0.71-1.47; p=0.91). Conclusions: Multifaceted distance education in asthma care for primary care providers was not effective to improve patients’ results. Telemedicine needs to deal with significant obstacles in professional education. ClinicalTrials.gov registry: NCT01595971.