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

Introduction: In Brazil, one of the main challenges that Family Health Strategy (ESF) has been facing is the high turnover of professionals, especially family and community doctors. Thus, the More Doctors Program (MDP) emerged to meet the shortage of medical professionals in Brazilian regions, to ensure quality care in primary health care. Objective: To analyze the effectiveness of the More Doctors Program (MDP) based on hospitalizations for conditions seen in primary care before and after implementation. Methods: Ecological time series study, with data from 2010 to 2016, a period of three years before and after the implementation of MDP in Southwest Goiás, extracted from the hospital information system. Data tabulation was performed using TabWin3.2 and later analyzed using the Stata 15.0 program, with trend analysis using linear regression. Results: The mean hospitalization rate was statistically higher than that for primary care conditions (p<0.001). The latter was statistically higher in men (p<0.05). There was a reduction in the overall hospitalization rate for primary care-treated conditions (p<0.001) after the implementation of MDP (p<0.001). Conclusions: The results of this study suggest that the inclusion of physicians in primary health care services after the implementation of the program contributed to access to health services, by showing a tendency of the Program's actions to reduce the most significant ICSAP.

Introduction: The COVID-19 pandemic has caused countless fatalities around the world. It not only threatens the individual’s physical sphere, but it can also generate significant psychological illness in the population, mainly due to the fear of contracting the disease. Objective: To evaluate the correlation of fear of COVID-19 with the anxious and depressive symptoms of Family Medicine residents in the metropolitan region of Fortaleza, Brazil. Methods: An analytical, correlational, cross-sectional and quantitative study was carried out, in which the participants answered an electronic form containing a questionnaire developed by the authors and the instruments Hospital Anxiety and Depression Scale (HADS) and the Brazilian version of the Fear of COVID-19 Scale (EMC-19). Results: The research had 50 participants. We verified that 52% of residents had anxiety symptoms, 36% had depressive symptoms; and 22% were moderately to very afraid of the disease. The highest fear averages were for residents who were already treating psychological disorders and for residents who started treatment during the pandemic. Conclusions: The study showed a relevant percentage of anxiety and depression symptoms, in addition to showing a direct association between these symptoms and fear of COVID-19. In conclusion, we emphasize that the pandemic context requires greater attention to the circumstances of the mental health of Family Medicine residents, seeking to propose coping measures that are more resolute to the problem.

The Person-Centered Approach (PCA) is a structuring clinical tool of Family and Community Medicine (FCM), and its teaching is an essential part of Medical Residency Programs in this specialty. The theoretical foundation of PCA is based on the work of the North American psychologist Carl Ransom Rogers, considered the precursor of Humanist Psychology. The purpose of this article is to present the fundamentals of PCA in Rogers’ work and their relevance to the clinical practice of FCM. The main concepts are presented in three points: 1) Actualizing (or formative) tendency; 2) PCA and the production of insight; and 3) The three key concepts (or key attitudes) of PCA: congruence, unconditional positive regard, and empathetic understanding. The perspective of construction and improvement of the humanist clinic, through Roger’s work, is alive and, precisely for this reason, this reference offers enormous potential for qualifying the FCM clinic.

The conspiracy of silence is a recurrent theme in the care of families dealing with terminal illness. It is a form of communication often seen as harmful by health care teams. The 2019 film "The Farewell" puts this issue in check by exploring the story, based on true events, of a Chinese family whose matriarch is diagnosed with lung cancer that threatens the continuity of her life. The ethical conflict is evident, opposing the wishes of family members who are divided between Eastern traditions and Western philosophies. The unusual ending of the plot raises the discussion about cultural differences in the perception of well-being at the end of life and makes room for the application of this reflection in the care of people and families from different cultures in the finitude process.

In 1971, Hart published an article proposing the Inverse Care Law, suggesting that “The availability of good medical care tends to vary inversely with the needs of the population served”. Over the past 50 years, the article has been cited with increasing frequency in the literature. The present article provides a perspective about how Hart’s reflections connect with the changes in health prevention during this period, especially in relation to primary health care.  

Introduction: Diabetic complications are mostly preventable conditions, the diabetic foot being one of the most common. Proper management of the diabetic foot mitigates disabling events and higher costs to the health system. Effective interventions in Primary Health Care (PHC) make it possible to prevent diabetic complications. The care scenario for preventing diabetic complications is Primary Health Care (PHC). Objective: To analyze the temporal trend of diabetic foot complications and their relationship with PHC coverage in Brazilian capitals, between 2008 and 2018, and the relationship between them. Methods: An ecological time-series study of the cumulative incidences of diabetic foot complications in the 27 capitals using data from the Information System on Hypertensive and Diabetic Patients. The independent variables were year, PHC coverage and the family health strategy (ESF). A Prais-Winsten regression model was used. Results: In Brazil, there were 45,095 cases of diabetic foot complications in the period, with an average of 0.57 cases/100,000 inhabitants (p<0.001), being stable in 14 capitals (p>0.05) and 13 increasing capitals (p<0.05). There is an interaction between the increase in the level of PHC coverage and stability in the evolution of diabetic complications (p<0.05). Conclusions: Despite the increase in the occurrence of diabetic foot complications, however, in the capitals with growth in PHC coverage, there was control of the progression of diabetic foot complications.

Introduction: The "Deixando de Fumar sem Mistérios" (Stop Smoking with no Mysteries) program was developed to help participants quit smoking. Objective: To assess the number of participants who quit smoking after 12 months of the "Deixando de Fumar sem Mistérios" program, measure the current level of nicotine dependence in those who did not stop smoking, and detect the factors involved in the lack of adherence to the program. Methods: Interviews were conducted with 39 participants of the program in a municipality in Minas Gerais to administer the Fagerström test and a questionnaire on the operation of the program. We analyzed the data by calculating absolute (n) and relative (%) frequencies. Results: Among the interviewees, 23% reported stopping smoking, 51% did not miss the meetings, and 74% declared satisfaction with the program results. The level of tobacco dependence among participants who did not quit smoking was moderate (5.2±2.8 points), with a mean consumption of 22.9±17.3 cigarettes/day and 35.0±15.5 years of use. The factors that contributed most to the lack of adherence were logistical issues (56%) and personal beliefs (36%). Conclusion: The level of satisfaction with the program was high. Outdated records made it difficult to contact most participants, evidencing the need for logistical adjustments so that the program can contribute more effectively to smoking cessation among the participants.

Introduction: The pandemic caused by COVID-19 has unevenly affected the world. Countries with lack of national coordination and/or which resisted implementing non-pharmacological public health actions had their populations impacted by the high number of cases, deaths from COVID-19, and suffered significant socioeconomic impacts. In the case of Brazil, special attention should be given to the role played by Primary Health Care in the prevention and control of COVID-19, considering its function as coordinator and organizer of the Brazilian Unified Health System. Objective: We aim to discuss the actions of Primary Health Care during the first year of the health emergency in Brazil. Methods: To do so, plans proposed by several organizations were considered: World Health Organization, National Council of State Health Secretaries and National Council of Local Health Secretaries, Brazilian Association of Collective Health, and the Brazilian Society of Family and Community Medicine. The plans were compared with the set of documents related to Primary Health Care published by the Brazilian Ministry of Health. Results: The strategy to combat the pandemic in Brazil, from the perspective of the Brazilian Ministry of Health coordination, failed in underestimating the role of Primary Health Care. Despite the appeal and parameters established by national and international entities, the action was uncoordinated, and little of what was recommended in technical notes was implemented. Conclusions: Considering that the pandemic is still ongoing in Brazil, the centrality of Primary Health Care must be resumed.

Annual influenza vaccination in older adults has been successful since its implementation in Brazil, reaching vaccination coverage targets. With the emergence of COVID-19, two scenarios were observed. In 2020, influenza vaccination coverage in older adults reached 120.7%; and in 2021, with the advent of the vaccine against COVID-19 and vaccination in the same period of the influenza campaign, coverage was 70.9% in the older group. In 2022, the influenza campaign was also concomitant with the application of booster doses against COVID-19. Until August 2022, influenza vaccination coverage was 70.2% in older adults, despite its relevance for protection against subtype A (H3N2). The text discusses some strategies to increase influenza vaccination coverage in older adults in the next years, aiming to strengthen Primary Health Care to raise awareness among the older adults and adopt extramural vaccination strategies.

Introduction: The implementation of the Mais Médicos (More Doctors) Program provided a favorable response to the inequality of access to health care in Brazil. Objective: This is a study that shows the implementation of the Mais Médicos (More Doctors) Program in two different scenarios in Espírito Santo, both of which were in areas of extreme poverty. Methods: 23 interviews were conducted with managers who worked from 2013 to the end of 2016. A content analysis technique was used after full transcription. Results: Four categories of empirical material emerged, and the results reiterate the possibility of access to medical services from the permanence of the professional in the communities. Conclusions: Showed the needs of personnel policies, the professional bond with the community which allows better communication, in addition to sociocultural interaction reinforce the debate about Brazilian medical training.