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

Objective: To estimate how reliably and validly can medical students encode reasons for encounter and diagnoses using the International Classification of Primary Care, revised 2nd edition (ICPC-2-R). Methods: For every encounter they supervised during an entire semester, three family and community physician teachers entered the reasons for encounter and diagnoses in free text into a form. Two of four medical students and one teacher encoded each reason for encounter or diagnosis using the ICPC-2-R. In the beginning of the study, two three-hour workshops were held, until the teachers were confident the students were ready for the encoding. After all the reasons for encounter and the diagnoses had been independently encoded, the seven encoders resolved the definitive codes by consensus. We defined reliability as agreement between students and validity as their agreement with the definitive codes, and used Gwet’s AC1 to estimate this agreement. Results: After exclusion of encounters encoded before the last workshop, the sample consisted of 149 consecutive encounters, comprising 262 reasons for encounter and 226 diagnoses. The encoding had moderate to substantial reliability (AC1, 0.805; 95% CI, 0.767–0.843) and substantial validity (AC1, 0.864; 95% CI, 0.833–0.891). Conclusion: Medical students can encode reasons for encounter and diagnoses with the ICPC-2-R if they are adequately trained.

Introduction: Organized cervix cancer tracking remains a challenge to be overcome across Brazil. Objective: To describe the intervention of a Family Health team to improve the quality of the actions to track this condition. Methods: The intervention was structured based on the national recommendations for the tracking of cervix cancer and the available evidence on how to improve popular participation in tracking programs. Functionalities of the electronic medical records were fundamental to the viability of this proposal. From the reorientation of care and administrative practices, an organized cervix cancer tracking program was established and maintained for 15 months in this Family Health team. Results: In the month prior to the beginning of the intervention, the health unit and programmatic area teams had a 10% average coverage of the target population screened. At the end of 15 months, the intervention team reached a 44% coverage, in contrast to the 22% average of the other teams in the unit, and 25% of the programmatic area. Conclusions: When a Family Health team undertakes efforts to organize the tracking of cervix cancer, good results can be achieved in increasing population coverage. We hope that every Family Health team may benefit for this publication and engage in organized cervix cancer tracking, contributing in this way to community’s health improvement.

Objectives: To report the experience of teachers and students of courses in the health area during the activities of the optional subject “Health in Quilombos”. Methods: This is an experience report, based on the experience of the teachers of the subject, during the teaching and extension activities carried out in a remaining quilombo community (RQC) in the state of Tocantins. Results: Four dimensions were raised: the lack of knowledge about the living and health conditions of the remaining quilombos’ populations; The scarcity of study material on the subject; Ethnic-racial issues as determinants of health and the interest of academics in building practices in the community. Conclusion: This study demonstrates the importance of the insertion of content and extension activities directed to the health of CRQs, for teachers and students of Universidade Federal do Tocantins (UFT).

Objective: Discover the prevalence of depression in physicians of the Family Health Strategy (FHS) of the city of Itajaí/SC. Methods: The Beck Depression Inventory was used to track depressive symptoms and a questionnaire developed by the researchers was used to collect information about personal and professional life. Data collected were stored in a Microsoft Excel table, stratified according to symptom intensity and relatable variables. Absolute and percentage frequencies were calculated for presentation. Results: In a sample of 45 physicians, only mild depressive symptoms were identified, which represented only 13% of the participants, but none of the variables analyzed in this study was associated with depression. The great majority of the results were satisfactorily positive for prevention and stressors: sufficient sleep hours, adequate number of consultations, satisfaction with work, practice of physical activity and no report of psychiatric records. Conclusions: In the present study, few physicians in the FHS01 of Itajaí/SC were found with depressive symptoms, however, the adoption of strategies to improve the mental health of these professionals is still considered essential.

Objective: Discuss the implementation process of three Medical Residency Programs in Family and Community Medicine (PRM-MFC) in a capital city of the Southeast Region of Brazil, in the perspective of the interface of the programs with the organization of the local health system. Method: This is an experience report from the experiences of the program supervisors and the technical team of the municipality responsible for integration of teaching-service. A significant narrative to the actors of the process was produced in a collective presencial moment. A SWOT matrix was developed to list the factors that influence the implementation of PRM-MFC in the health service network. Results: There are three PRM-MFC in activity in the municipality, all in the initial stage of implementation, totaling nine vacancies of R1. Residents are benefited by a well-structured, diversified and computerized service network, including sensitized preceptors and strong multi-professional support. However, there are issues that complicate this process, such as the incipient preceptory valorization policy, the insufficiencies of the existing primary care model for medical training, the difficulties in the shared management of the process, and the lack of legitimacy of RM before the community and service workers. Conclusion: There is an intimate relationship between the development of the local health care network, in particular APS, with the quality of the PRM. Thus, it is essential to look not only at pedagogical issues, but also at the whole set of shared management devices and qualification of the service network.

Introduction: According to the Resolution No. 3, 2014, from the Brazilian Ministry of Health, that establishes the National Curricular Guidelines of the Medicine Undergraduate Course. According to the guidelines, the medicine student must have general, humanistic, critical, reflexive and ethical training, with capacity to act at the different levels of health care, among them, prevention. The diagnostic investigation should be based on the best scientific evidence and according to the needs of the person. In this sense, quaternary prevention and its principles meet the objectives of the DNC. Objectives: To perform the intersection in Brazilian journals between the quaternary prevention and medical teaching after the implementation of the DNC of 2014. Methods: Integrative review of the articles available on CAPES, Scielo, PubMed and Google Academic platforms, from 2014 until October 2017, by the keywords “quaternary prevention” and “education”. Exclusion criteria includes articles sponsored by pharmaceutical industries, unavailable in their entirety, without abstract and foreign articles. Results: 33 documents were found and 9 articles were selected for analysis, focused mainly on the practice of quaternary prevention. Only 3 studies allude to medical education. Conclusion: Quaternary prevention is a subject of great relevance in medical practice, however, it is still deficient in graduation, based on the restricted productions available. Despite the new guidelines of the medical course, medical education in the current scenario is predominantly focused on specialties, hindering the integral and person-centered performance.

Objective: To evaluate whether a short compilation of screening tools for specific disorders could identify Mental or Emotional Disorders (MEDs) in the general population. Methods: We selected validated screening tools for the most prevalent MEDs. In order to be selected, these tools should maintain the psychometric properties of the complete instrument with a reduced number of items. These instruments were: Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder Scale-2 (GAD-2), item 3 of the Alcohol Use Disorders Identification Test (AUDIT), and three items on the Adolescent Psychotic-Like Symptom Screener (APSS-3). We called this compilation of screening tools Mini Screening for Mental Disorders (Mini-SMD). The study was divided in two phases. Firstly, 545 subjects were interviewed with the Mini-SMD and COOP/WONCA-Feelings at their residences. Subsequently, subjects who had agreed to participate (230) were reinterviewed with Mini-SMD, COOP/WONCA-Feelings and MINI interview. Test-retest reliability was calculated by Intraclass Correlation Coefficient (ICC). Receiver operating characteristic (ROC) curves were generated for the analysis of discriminative validity. Concurrent validity was calculated by analyzing the correlation between Mini-SMD and COOP/WONCA-Feelings. Results: The joint administration of screening tools for specific disorders showed sensitivities that ranged from 0.76 to 0.88 and specificities from 0.67 to 0.85. The ICC value for the total score of Mini-SMD was 0.78. The area under the curve was 0.84, with a sensitivity of 0.74 and specificity of 0.76 (for a cutoff ≥ 4). Conclusion: This study showed that a short compilation of screening tools for specific disorders can detect MEDs in general population.

Introduction: Health in Brazil was established as a universal right from the promulgation of the Constitution of the Federative Republic of Brazil in 1988. Subsequently, ratified and standardized by the edition of the Law 8080 of 1990, which provides the conditions for the promotion, protection and recovery of health, organization and functioning of the corresponding services, known as the organic law of the unique system of Health (SUS). Based on the guiding principles of SUS, the Family Health Program was launched by the Ministry of Health in 1994, which became the Family Health Strategy twelve years later. As the country began to prioritize Primary Health Care (PHC) as the central axis of the health system, as in the main national health systems in the world, the shortage of medical professionals trained to this level of care. The need to expand access to family and community medicine (MFC) in Brazil emerged. Objective: To present aspects of the historical constitution of the Residency Programs in Brazilian CFM (PRMFC). Results: In the first years of the 20th century, in several federal units, there was a considerable increase in RMFC vacancies – with emphasis on the PRMFC of the Municipal Health Department of Rio de Janeiro –, covering cities that did not previously have this training. This context can be understood in the light of the significant articulation built within the SUS, for the formation of human resources in health. Conclusion: The MFC Residency continues to expand in the country and can already be found in some of the main Brazilian cities.

Objective: To investigate the perception and oral health practices among older quilombola women (black population group, descendants of slaves in Brazil). Methods: Qualitative research with elderly women living in a rural community formed by descendants of slaves in Brazil. The study was performed through a semi-structured interview with nine of the rural community residents and following content analysis of the narratives. Results: All elderly women are edentulous (partially or totally) and dental problems that led them to use natural means of pain relief were identified. With the analysis of the transcripts, three main categories emerged: the elderly of Quilombola Rural Community Julia Mulata and edentulism; self-perceived oral health of older women of the Quilombola Rural Community Julia Mulata; Popular practices used in the presence of health problems. Conclusion: Quilombola elderly consider the loss of teeth as natural aging; they present life stories linked to dental problems; seek to solve their dental problems with the use of traditional folk therapies.

Introduction: The prevention of falls among elder people is an urgent public health challenge. Physical exercise has proven an effective preventive intervention. Objective: Review the latest scientific evidence, concerning the recommendation of physical exercise in the prevention of falls of the elderly of the community. Identify the optimal type and frequency of exercise with better benefits. Methods: A bibliographic search was carried out using the terms MeSH “aged”, “accidental falls/prevention and control” and “exercise”, in PubMed, Cochrane Library, National Guideline Clearinghouse, Canadian Medical Association, Evidence based Medicine e NICE Evidence Search databases, in the last five years. We included articles evaluating the exercise as an isolated intervention in the prevention of falls of the individual of the community, with ≥60 years. Rated result: incidence of falls. Results: Of 637 potential articles, 4 fulfilled inclusion criteria: 2 randomized controlled trials (RCT), 1 cohort study and 1 meta- analysis (MA). Overall, the results demonstrate a protective effect of exercise. The MA obtained a ratio of incidence rates (IR) was 0.79 (p<0.001), with the training of balance (IR=0.85, p=0.04) and greater weekly dose (IR=0.77, p=0.03) has demonstrated more effective. Contrarily, one RCT suggested that hike can be more effective. The cohort study revealed greater benefit in ≥3 years participations (IR=0.90; p=0.03). Conclusion: Physical exercise is effective in preventing falls in the community elder. Balancing training and weekly ≥3 hours practices showed better results (SORT A). Its maintenance must be encouraged in the long term (SORT B).