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

Problem: In Brazil, there is evidence that certain disadvantaged groups have lower survival rates and a higher probability of premature death. Health inequities are favored by the poor distribution of healthcare professionals, especially doctors, across the country. Telehealth has the potential to support the resolution of issues related to the population’s health. This article described the implementation of a teleconsultation service for Primary Health Care (PHC) with secondary services through telemedicine. It includes challenges and barriers to implementation not commonly described in the literature. Methods: This is an experiential report on the implementation of TeleNordeste in Rio Grande do Norte. The project was developed in collaboration with the Brazilian Ministry of Health through the Support Program for Sustainable Development of the Unified Health System (PROADI-SUS) and built with the assistance of local professionals and managers based on the PASA model, linking teleconsultant doctors to Family Health Teams in the territory. Results: Several stages were necessary for implementation, such as situational diagnosis, approach visits, and collaboration contracts between municipalities and Moinhos de Vento Hospital Association (Associação Hospitalar Moinhos de Vento – AHMV). During implementation, barriers and challenges related to technological, human, and social aspects of the healthcare network, psychosocial and anthropological factors, as well as governmental and economic factors, were identified. Conclusions: Despite all the barriers and challenges encountered in the implementation process, it was possible to verify that teleconsultations have many advantages and also function as a strategy for continued education. The teleconsultation model implemented in Rio Grande do Norte has demonstrated a reduction in waiting time and resolved the majority of cases attended, reducing in-person referrals.

Introduction: Violence is a severe and frequent public health issue. It has an impact on the health and lives of individuals, families, and communities, whether physically, psychologically, or socially. Among types of violence, domestic violence has a high prevalence; it has a systemic character, meaning all family members are somehow involved. In Primary Health Care (PHC), families experiencing violence are often attended to by professionals from the Family Health Strategy. However, there is an observed absence or little space in medical education addressing the issue. Objective: To understand the perspective of Family Practice Physicians (FPP), preceptors of Residency Programs in FPP, on the Family Approach in contexts of domestic violence in PHC. Methods: This is a qualitative study with a descriptive and exploratory character. A survey on the topic was applied to active preceptors in Rio de Janeiro at the time of the research, followed by interviews with 15 of these preceptors. Results: There were identified potentials and challenges for the daily practice of the Family Approach with families in violent situations in PHC. As advantages/ potentials, the following stood out: strengthening of the bond between the professional and the family; expanding therapeutic resources and intervention effectiveness; promoting comprehensive care; networking across sectors; promoting reflection and self-care within families. Among the challenges reported were gaps in medical education and lack of practical experience in addressing the problem; silenced violence and fear of addressing domestic violence situations; lack of specific guidelines for PHC health professionals; poor working conditions, excessive designated population, care overload, difficulties in intersectoral networking, and management undervaluing the importance of the approach. Conclusions: The importance of the Family Approach by FPP was highlighted by the respondents as strategic in addressing domestic violence. However, there are many challenges to its practical application. Efforts and guidelines are needed for FPP and other professionals working in PHC to be valued, enabled, and trained to systematically and regularly address both family issues and domestic violence, considering its high prevalence and severity.

Introduction: Cough is one of the main causes of demand for care in primary care, as it affects the patient’s quality of life. An acute cough is considered a self-limiting problem because it is of low severity and has a short latency period. Objective: The aim of this study was to evaluate the quality of clinical guidelines (CGs) for the treatment of acute cough. Methods: Searches were carried out on the websites of national and international institutions and organizations using the descriptors “cough,” “tos,” “practice guideline,” “guideline,” and “guide of clinical practice.” The selected guidelines were evaluated by four reviewers using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument, and then, they were classified as strongly recommended, recommended with modifications, and non-recommended. Results: A total of 11 international guidelines were selected, published between 2006 and 2019, most from the United States of America. A total of seven guidelines were specific to the treatment of acute cough, only one guideline was focused on pharmaceutical care, and six were focused on the treatment of adults and children. Scope and purpose were the domains that presented the best score; editorial independence (D6) had the highest score variation (0–98%); and applicability (D5) of guidelines had the lowest mean score, 46% (range 2–88%). Regarding interventions, most of the guidelines referred to pharmacological interventions as unnecessary and the most cited non-pharmacological intervention was menthol (ointment). Conclusions: Therefore, it is necessary to carry out more clinical studies of good quality so that the CGs can be revised, to make the recommendations more reliable.

Introduction: Pregnant women experiencing homelessness face a global challenge with negative consequences for both mothers and children, including unplanned pregnancies, sexual exploitation, reproductive health complications and premature births. Lack of access to basic health services and stress resulting from homelessness adversely affect fetal development and can lead to chronic diseases. Given the complexity and heterogeneity of the literature on this topic, a scoping review is necessary to map existing evidence, identify gaps and synthesize the risks faced by this vulnerable population. Objective: To identify and map the risk factors associated with pregnant women experiencing homelessness and the main consequences for maternal and fetal health described in recent scientific literature. Methods: A scoping review was conducted using the PubMed and SciELO databases with the descriptors «Pregnancy,» «Homelessness» and «Risk.» The search took place between February and March 2023, including articles published in the last 10 years (2013–2023) that addressed pre-pregnancy risks and post-pregnancy consequences. A thematic content analysis of the 30 selected articles was performed to identify and categorize the main risks and outcomes. Results: Thematic analysis of the 30 articles revealed three main axes: prenatal care, pregnant woman’s health and childbirth/post-pregnancy. Findings indicated a high prevalence of unplanned pregnancy, exposure to sexual violence and substance use as pre-pregnancy risks. During pregnancy, mental health challenges, limited (though variable) access to prenatal care and comorbidities are prominent. Outcomes include higher risks of preterm birth, low birth weight and neonatal complications. Quantitative analysis of theme frequency showed a higher concentration of studies focusing on the pregnant woman’s health. Conclusions: Pregnant women experiencing homelessness face multiple interconnected risks that negatively impact  maternal-fetal health. This review highlights the need for public policies and interventions that address socio-structural determinants,  improve  access  to  sexual  and  reproductive  health  care  and offer  psychosocial support. The lack of official data in Brazil is a significant limitation. Future research should focus on the effectiveness of interventions and longitudinal data.

Introduction: In Brazil, Integrative and Complementary Practices Health (PICS) are therapeutic approaches offered in conjunction with conventional medicine through the Unified Health System (SUS). Objective: To identify the knowledge, perception, and interest of different professionals in the Family Heath Strategy regarding PICS. Methods: This quantitative observational cross-sectional study was conducted from July to October 2022. A total of 310 medical doctors, nurses and dentists from 53 Family Health Strategy units were evaluated. Participants answered a self-administered, semi-structured questionnaire containing seven questions related to the sample profile (sex, age, marital status, training, time since graduation, postgraduate education, public service time); four questions  related to knowledge (about PICS in the undergraduate course, training and/or specialization, Acupuncture, Homeopathy, Anthroposophical Medicine, and the National Policy for Integrative and Complementary Practices (PNPIC)); six questions on general perception (PICS effectiveness, inclusion in health courses, availability at different levels of care in SUS and  current workplace, inclusion of PICS in SUS and contribution to professional life) and two questions about interest in the topic (community interest and professional interest in obtaining more information). Descriptive data analyzed were performed using the R Core Team software (2022). The chi-square and Fisher’s exact tests were used to analyze associations with professionals’ education. Results: Of the sample, 79.4% were female, with mean age of 40.6 years, and 54.2% were married; 43.2% were nurses, 29.7% were medical doctors, and 27.1% were dentists; and 72.6% had postgraduate education. The majority (66.5%) were not familiar with the PNPIC; 1.6% considered  PICS to be effective, 92.4% agreed with the inclusion of PICS in SUS, and 91.3% expressed a desire to obtain further knowledge in this field. There was no significant association between professionals’ responses about PICS and professional training (p>0.05). Conclusions: Academic training did not influence professionals’ knowledge and interest in PICS. Professionals recognize the efficacy of these practices, believe they should be offered in SUS, and demonstrate interest in increasing their knowledge. Acupuncture is a well-known practice, although it is seldom applied in primary health care.

Introduction: The Primary Health Care teams represent an opportunity to welcome and care for people with disabilities or with some kind of loss of functional capacity who reside in the territories covered by them. Objective: To describe the profile of the Family Health Support Centers according to care practices for people with disabilities and rehabilitation needs. Methods: This is a cross-sectional, descriptive study with secondary data from the third cycle of the National Program for Improving Primary Care Access and Quality, 2017, including 4,031 professionals from the country’s Family Health Support Centers, 98.0% of these. Results: Only 5.0% of the teams reported not performing care actions for people with disabilities and rehabilitation needs, with worse results in relation to planning, execution, and evaluation of the tasks provided for the Family Health Support Centers. Adaptations of home conditions and functional approach were the most mentioned actions; and support to Primary Health Care teams in the early identification of disability, the least mentioned. Conclusions: The teams that reported providing some care for people with disabilities and rehabilitation needs have a better organized work, but challenges remain related to the management of teamwork, intersectoral organization, and the development of singular therapeutic projects.

Introduction: Long-acting reversible contraceptives (LARCs) have become cornerstones of modern reproductive planning. In Primary Health Care (PHC), LARCs are essential tools for comprehensive women’s health care. The Mais Médicos Campineiros Program (PMMC), which introduced Family Practice (FP) residents into the health network, initiated a new paradigm in women’s health care within PHC in Campinas, São Paulo, starting in 2020. Objective: To evaluate and compare indicators related to reproductive planning in PHC in the district of Sousas, in Campinas, and the city as a whole, before and after the introduction of FP residents. Methods: Data were extracted from the Tabnet-Campinas system and the Strategic Management of Materials and Medicines (GEMM) platform. Analyses focused on reproductive planning indicators and the acquisition and use of LARCs in PHC. Results: A 300% increase in the use of LARCs was observed in Sousas, along with a reduction in adolescent pregnancy rates, an increase in the frequency of prenatal consultations, and an improvement in maternal educational levels in both Sousas and Campinas in 2022. Conclusions: The introduction of the PMMC in 2020 led to a significant increase in the use of LARCs in PHC and a substantial improvement in reproductive planning indicators, highlighting the positive impact of integrating FP residents into the health system.

Introduction: Type 1 diabetes (DM1) is one of the main chronic diseases in childhood significantly impacting the lives and routines of caregivers and patients in a traumatic manner, serving as a major stressor. Objective: This systematic review aims to assess whether children with DM1 may exhibit a higher prevalence of symptoms or psychiatric disorders compared to their peers and whether the presence of these disorders leads to poorer diabetes control. Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the PROSPERO database for systematic reviews. The last search in databases was on May 11, 2023, resulting in 1910 articles selected on the basis of topic, keywords or abstract. Articles involving a population aged 0 to 12 years with type 1 diabetes from 2013 to 2023 were included, focusing on mental health. Results: Of the 1910 articles systematically selected, only 7 were chosen for analysis. Among these, 3 showed a significant association in mental health scores when comparing children with and without diabetes, while the others indicated a weak association. Conclusions: It appears that there is a relationship between the control of diabetes mellitus and mental health indicators, underscoring the importance of clinical monitoring and proper disease management for the quality of life of those with this condition. In the selected studies, the main limitation was the restricted number of participants and the assessment tools used.

Introduction: Guillain-Barré syndrome (GBS) is an autoimmune condition affecting peripheral nerves, often triggered by infectious processes, with COVID-19, among other infectious agents, linked to its development. Additionally, the association between GBS and vaccines that stimulate the immune system has been observed, although the pathophysiology of this condition is not fully understood. The importance of early identification of possible adverse effects is emphasized, especially in primary care. Case presentation: We present the case of a 37-year-old male patient who arrived at the emergency department with complaints of dyspnea, desaturation, dry cough, headache, and a sensation of paresthesia in the fingers, progressing to limb paralysis and dysphagia. In the personal history assessment, the patient reported receiving one dose of the COVID-19 vaccine (CoronaVac) two weeks prior. Conclusions: Based on the presented case, the occurrence of GBS related to the COVID-19 vaccine is discussed in the literature, emphasizing the importance of knowledge about possible adverse effects. Although the manifestation of neurological effects is rare, it is crucial for health care professionals to be aware and well-informed for an effective approach, emphasizing that the benefits of immunization outweigh the associated risks.

Introduction: Medically unexplained symptoms are common in the routine of family and community physicians. Nevertheless, many doctors face challenges in appointments for this type of complaint. Objective: To identify the difficulties faced and the strategies used by Primary Health Care physicians in appointments with people with unexplained symptoms. Methods: A scoping review was performed. The searches were carried out in the following sources: MEDLINE via Pubmed, Cochrane Library, LILACS via VHL, and Epistemonikos. Studies that evaluated physicians who care for people with unexplained symptoms (either resident physicians or experienced physicians), the difficulties faced and the strategies used in appointments with people with unexplained symptoms in the context of primary health care were included. Results: Eight studies were selected. Based on such studies, the difficulties reported were: concerns about iatrogenesis, negative feelings arising from these appointments (frustration and anxiety), discomfort with uncertainty, biomedical model, and limited explanations. Some strategies were identified, among which the most cited were: ensuring the person’s care and the absence of severity; adopting the biopsychosocial model; having a quality dialogue; and validating symptoms as well as suffering. Conclusions: There is no set of strategies that work for all cases of medically unexplained symptoms. We present some difficulties experienced by primary health care physicians in appointments for unexplained symptoms and reported the strategies used by them, which serve as a subsidy to improve our provision of care.