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

El artículo analiza el papel de las Escuelas Nacionales de Arte de La Habana como una experiencia piloto revolucionaria a nivel internacional en el panorama arquitectónico. La investigación profundiza en dos campos complementarios que se consideran fundamentales y que hacen de este conjunto de edificios un “proyecto innovador”: por un lado, la gestación del proyecto, la reinterpretación de la tradición, la relación con las preexistencias, la recuperación de un sistema constructivo y la relectura de los materiales; y por otro lado, el equipo interdisciplinar, la innovación educativa (programa y proyecto) y las aulas como espacios formativos. Esto permitirá apoyar la hipótesis de que el proyecto no solo fue trascendental desde el punto de vista arquitectónico sino desde el punto de vista pedagógico y educativo, contribuyendo la arquitectura a la formación de los artistas.

Introduction: The Family Health Program was created in 1994 and was reoriented as a strategy to change the care model from 1998 onwards, becoming a model for the organization and qualification of Primary Health Care in Brazil. In Rio de Janeiro city, in recent years, there has been a rapid increase in the coverage of the population by the family health teams, with the perspective of developing comprehensive Primary Health Care. In this perspective emerges the outpatient surgery, which has been incorporated very timidly to the practices of the Basic Health Units. Objectives: This article analyzes the incorporation of outpatient surgery by the Family Health Teams as one of the aspects involved in the expansion of the coordination of care and the resolution of Primary Health Care in this municipality. Methods: A descriptive exploratory study was carried out using the data analysis of the production of surgical procedures in the basic care network of the city. The study analyzed the information available on the Carteirômetro database for the period of October 2015 to March 2017, in addition to online interviews with family doctors working in the Family Health Strategy. It was observed that the expansion of the Family Health Strategy teams during the study period was accompanied by the percentage increase in outpatient surgery procedures (63.8%). Results: However, this evolution also represents a timid amount of surgeries performed by the number of teams implanted, that is, about 1.5 procedure/team in the last quarter surveyed. Conclusion: Among the limiting factors for the development of these interventions in Primary Health Care was the lack of professional training for the execution of these procedures, as well as inadequate physical and procedural structure of the health units.

Objective: To identify the prevalence of common mental disorders (CMD) in medical students at Vila Velha University (UVV), ES, and its associated factors. Methods: A cross-sectional study was conducted with 360 medical students from February to April 2018. A self-administered, confidential and online questionnaire was used, including sociodemographic, economic data, family support, friends’ network, physical activity and academic performance, as well as Self-Reporting Questionnaire (SRQ-20). Statistical analysis was performed using the STATA program, version 13.0. The Ethics Committee on Research with Humans approved the study, under number 2.108.290. Results: The prevalence of CMD among students was 45.6%. Risk factors were mental disorder in the family (RR 1.24, 95% CI 1.01-1.54), poor sleep quality (RR 1.49, 95% CI 1.17-1.90), fear that impaired the academic result (RR 1.33, 95% CI 1.01-1.77), feeling rejected by friends (RR 1.45, 95% CI 1.07-1.96), thinking about giving up the course (RR 1.67, 95% CI 1.29-2.17) and physical discomfort during the test (RR 1.63, 95% CI, 1.21-2.20). Conclusions: The overall prevalence of CMD among students was high, and the risk factors were significant. It is recommended that educational institutions and responsible government agencies be able to formulate and subsidize preventive actions and care for the mental health of medical students.  

Asymptomatic bacteriuria (ASB) has been associated with an increased risk of maternal pyelonephritis (PN) and preterm birth (PTB). International clinical guidelines recommend its research and treatment during pregnancy. However, the benefit and risk of screening and treating ASB is not consensual, and this review intends to analyze the available evidence regarding the influence of ASB treatment on maternal and fetal morbidity and mortality. We search on MEDLINE database and Evidence-Based Medicine sites of evidence-based reviews, clinical guidelines, meta-analysis, systematic reviews and randomized controlled trials, using the MeSH terms “Bacteriuria AND Pregnancy”, of articles published between January 2008 and May 2018, in English, French, Spanish and Portuguese. The Strength of Recommendation Taxonomy (SORT) scale of the American Family Physician was used to assess the levels of evidence and assignment of recommendation forces. We identified 136 articles, of which ten met the inclusion criteria. The existing evidence, mostly based on outdated or small and with methodological shortcomings clinical trials, does not allow a clear conclusion as to whether the treatment of ASB positively influences maternal and fetal morbidity and mortality; the most recent data effectively points to a lack of benefit with ASB treatment (SOR B). To address the limitations of the studies found, controlled, randomized, higher quality and larger studies are needed to assess the influence of ASB treatment on maternal and fetal morbidity and mortality.

Chronic diarrhea, characterized by the presence of more than three loose stools for at least four weeks, is often found in clinical practice. In chronic diarrhea, the probability of an infectious etiology is low, having usually a functional, inflammatory, osmotic or secretory origin. Intestinal amebiasis is a cause of chronic diarrhea, caused by the protozoan Entamoeba histolytica, common and prevalent in developing countries. It can have different presentations but most patients are asymptomatic. We present a 27-year-old Caucasian male, man who have sex with men (MSM), with chronic diarrhea starting six years ago. The physical exam was normal. A parasitological stool examination was performed with isolation of cysts of Entamoeba histolytica. He was treated with metronidazole and paromomycin with clinical resolution. It is important for General Practice to address this etiology in the investigation of patients with diarrhea for a correct and timely diagnosis and treatment, to avoid unnecessary testing, possible complications, transmission of the agent and a serious public health problem.

Academic production on sexuality and diversity has important gaps, and many series of clinical care series in which children are more science-driven, such as the lesbian, gay, bisexual, transvestite, transsexual, and intersex population (LGBTI). Thus, the foundation of the Working Group (WG) on Gender, Sexuality, Diversity and Rights, with the Brazilian Society of Family and Community Medicine (BSFCM), arises with the important objective of promoting studies and debates on gender and sexuality in order to promote rights, diversity and equity in Primary Health Care (PHC). As one of the activities of this WG, the I Seminar Sexuality and Diversity was conceived and prepared, with the theme “Primary Health Care Breaking Taboos”, which took place in São Paulo, between April 20 and 22, 2018. This text aims to present how the event was built, describing the spaces held and the participants’ impressions about the seminar. The program was elaborated from the search of the WG forums (e-mail groups, Facebook and WhatsApp), with the proposal of four axes for the activities: 1-Research/academic production, 2- Assistance/clinical subjects, 3- Medical education and 4-Representativeness and public votes. In all, there were 6 round tables, 6 workshops, 3 artistic performances and 1 cultural exhibition, with a participation of 202 people from 11 states. The WG achieved its goal with this seminar to produce knowledge and discuss sexuality and gender, focusing on Primary Care, with family and community doctors, health professionals and students. Considering that the demand for the Seminar was higher than expected and that the discussion of the topics does not end at an event, the intention is for the Seminar to become part of BSFCM’s regular agenda.

Introduction: The absenteeism at scheduled medical appointments is a problem that interferes with the effectiveness of health services. In this context, the reorganization of the professionals schedule is central in ensuring the reception and continuity of care. Objective: To describe the prevalence of absenteeism from the health care agenda of a primary health care service (APS) for undergraduate and postgraduate education in the municipality of Pelotas, state of Rio Grande do Sul. Methods: A cross-sectional study was carried out with all the schedules of one month of medical appointments in each season between July 2016 and April 2017. The data were collected from the local appointment system, typed and analyzed in an Excel® worksheet. Results: Of the 3,131 scheduled medical appointments, 598 absences were recorded, resulting in a prevalence of absenteeism of 19.2% (95% CI, 17.7-20.8). Of the 153 care shifts in only 2%, there were no absences and, among others, the prevalence ranged from 4.2% to 45%. In the distribution of absenteeism among the seven groups of consultations surveyed, 62.3% of absenteeism was observed for general practitioner and 12.2% for the accomplishment of cytopathological exam of the uterine cervix. Conclusion: The results show a high prevalence of absenteeism, especially in medical clinic visits, which can lead to problems both for continuity of care, especially for general practitioners, and for medical teaching in APS. This finding is superior to that found by Tristão et al. in a Brazilian study on outpatient health services, and lower than the result described by Izecksohn and Ferreira in a School Health Center. The authors suggest the need for organizational changes aiming at increasing access and facilitating adherence to scheduled appointments, in order to guarantee the longitudinality of care.

New epidemiological and demographic challenges require new ways of organizing healthcare systems. This essay proposes telehealth as an organizational tool, capable of smoothing the iron triangle of health care and facilitating achievement of the triple aim, namely greater access and quality with cost reduction. The integration of telehealth into the referral process and the transition between care services increases the resolvability of primary health care (PHC), facilitates the coordination of care, promotes treatment adherence, decreases readmissions, and stimulates quaternary prevention. This essay introduces the notion of telehealth as a meta-service that confers technological density to PHC and allows it to become an effective coordinator of care, organizing the flow of information, people and supplies. In view of the innovations proposed, it is essential to evaluate the impact of existing telehealth initiatives so as to extend their applicability as meta-service.

Objectives: The present study sought from the reflections on the process of execution and maintenance of a group for health promotion in a primary health care unit in the city of Fortaleza, CE, to systematize the experience of organization, execution and maintenance of a group for the promotion of health in a primary health care unit in the city of Fortaleza, CE, correlating the experience of the group process with the theoretical frameworks of Primary Health Care (PHC) and the Community Systemic Approach (CSA), pointing out challenges and potentialities of this approach in the context of PHC and its potential impact on the health of communities and on the training of specialists in Family and Community Medicine. Methods: A methodology of experience systematization was used in dialogue with the autobiographical narratives and the circle of culture. Results: The recovery of the experienced process evidenced the potential of the integration between ASC, Popular Education and Group Process tools, anchored in the knowledge and application of the guiding principles of Family and Community Medicine for producing changes in the work process of the medical professional and in its context of action. Conclusion: By systematizing the experienced process and confronting it with the theory of subject implication, aspects of medical practice in APS that would otherwise remain restricted and implicit in the mode of Family and Community Medical Being emerged. The narrative proposes questions about the impact of this medical practice on the health of populations, individually and collectively, and about the professional himself as a human being that can be endured and endowed with infinite potentialities. Possible paths and the possibilities of change and overcoming of the hegemonic and current medical model were proposed from this narrative full of signs and meanings.

Introduction: The increase in life expectancy has led to a larger number of people who need care, which is mostly provided by informal and female caregivers. However, studies have shown a growth in the number of male caregivers. In this context, this study intends to observe motivations that make men become informal caregivers. Methods: Qualitative study with semi-structured interviews, sociodemographic questionnaires and Zarit questionnaires answered by ten male caregivers registered in the home care program of two primary health care clinics in Porto Alegre. Results and Discussion: The motivations identified in the caregiving process were obligation and reciprocity. Obligation was mentioned by all of the caregivers and the lack of a support network seemed to reinforce it. Reciprocity was mentioned in four interviews and was mostly correlated to sons who took care of their parents. Studies show that the motivation “obligation” seems to be related to higher levels of caregiver burden, depression and anxiety when compared to the motivation “reciprocity”. In the Zarit scale, there weren’t caregivers with severe burden, which can be related to a greater demand for social/professional support. Conclusion: The theme of the relation between caregiving and masculinity is vast and unknown. However, we could observe a correlation between gender and caregiving motivations as obligation and reciprocity, and it is suggested that the motivation “obligation” can be related to a more severe burden.