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BACKGROUND: Long-term deterioration in the mental health of healthcare workers (HCWs) has been reported during and after the COVID-19 pandemic. Determining the impact of COVID-19 incidence and mortality rates on the mental health of HCWs is essential to prepare for potential new pandemics. This study aimed to investigate the association of COVID-19 incidence and mortality rates with depressive symptoms over 2 years among HCWs in 20 countries during and after the COVID-19 pandemic. METHODS: This was a multi-country serial cross-sectional study using data from the first and second survey waves of the COVID-19 HEalth caRe wOrkErS (HEROES) global study. The HEROES study prospectively collected data from HCWs at various health facilities. The target population included HCWs with both clinical and non-clinical roles. In most countries, healthcare centers were recruited based on convenience sampling. As an independent variable, daily COVID-19 incidence and mortality rates were calculated using confirmed cases and deaths reported by Johns Hopkins University. These rates represent the average for the 7 days preceding the participants' response date. The primary outcome was depressive symptoms, assessed by the Patient Health Questionnaire-9. A multilevel linear mixed model (LMM) was conducted to investigate the association of depressive symptoms with the average incidence and mortality rates. RESULTS: A total of 32,223 responses from the participants who responded to all measures used in this study on either the first or second survey, and on both the first and second surveys in 20 countries were included in the analysis. The mean age was 40.1 (SD = 11.1), and 23,619 responses (73.3%) were from females. The 9323 responses (28.9%) were nurses and 9119 (28.3%) were physicians. LMM showed that the incidence rate was significantly and positively associated with depressive symptoms (coefficient = 0.008, standard error 0.003, p = 0.003). The mortality rate was significantly and positively associated with depressive symptoms (coefficient = 0.049, se = 0.020, p = 0.017). CONCLUSIONS: This is the first study to show an association between COVID-19 incidence and mortality rates with depressive symptoms among HCWs during the first 2 years of the outbreak in multiple countries. This study's findings indicate that additional mental health support for HCWs was needed when the COVID-19 incidence and mortality rates increase during and after the early phase of the pandemic, and these findings may apply to future pandemics. TRIAL REGISTRATION: Clinicaltrials.gov, NCT04352634.

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The objective was to analyze the perceptions of primary health care (PHC) workers about interprofessional collaboration from the perspective of implementation science. This is a qualitative study that used in-depth interview as a data production technique. Interviews were conducted with 15 workers (three community health agents, one nursing assistant, three nurses, three managers, three physicians, and two nursing technicians) from basic health units in the Municipality of São Bernardo do Campo, São Paulo State, Brazil. The interview plan was based on three domains of the Consolidated Framework for Implementation Research (CFIR). Thematic content analysis was used. In the interprofessional collaboration characteristics domain, respondents highlighted the complexity, and its possible influence, as to the implementation and sustainability of this practice. In the inner setting domain, factors that influence interprofessional collaboration were identified, namely: how the time allocated to formal communication/team meetings is used; social interactions between professionals; and leadership characteristics, such as feedback, autonomy and participation in decisions. In the individuals characteristics domain, participants noted interprofessional collaboration geared to quality of care and the need for integration between knowledge centers. Thus, measures to enhance the quality of communication, collective team building and leadership can contribute to improve interprofessional collaboration in PHC and leverage its impacts on health care.

O objetivo foi analisar as percepções de trabalhadores da atenção primária à saúde (APS) sobre a colaboração interprofissional na perspectiva da ciência de implementação. Trata-se de estudo qualitativo que utilizou a entrevista em profundidade como técnica de produção de dados. Foram entrevistados 15 trabalhadores (três agentes comunitários de saúde, um auxiliar de enfermagem, três enfermeiros, três gerentes, três médicos e dois técnicos de enfermagem) de unidades básicas de saúde no Município de São Bernardo do Campo, São Paulo, Brasil. O roteiro da entrevista baseou-se em três dimensões do Quadro Conceitual Consolidado para Pesquisa de Implementação (CFIR; Consolidated Framework for Implementation Research). Foi realizada análise de conteúdo temática. Na dimensão características da colaboração interprofissional, os entrevistados destacaram a complexidade, e sua possível influência, na implementação e sustentabilidade dessa prática. Na dimensão cenário interno, foram identificados fatores que influenciam a colaboração interprofissional: como se utiliza o tempo destinado a comunicação formal/reuniões de equipe; interações sociais entre os profissionais; e características da liderança, como feedback, autonomia e participação nas decisões. Na dimensão características dos indivíduos, os participantes destacaram a colaboração interprofissional direcionada para a qualidade do cuidado e a necessidade de integração entre os núcleos de saberes. Assim, ações para aperfeiçoar a qualidade da comunicação, a construção coletiva em equipe e o aprimoramento da liderança podem contribuir para melhorar a colaboração interprofissional na APS e potencializar seus impactos na atenção à saúde.

El objetivo fue analizar las percepciones de los trabajadores de atención primaria de salud (APS) sobre la colaboración interprofesional desde la perspectiva de la ciencia de implementación. Se trata de un estudio cualitativo que utilizó la entrevista en profundidad como técnica de producción de datos. Fueron entrevistados 15 trabajadores (tres agentes comunitarios de salud, un auxiliar de enfermería, tres enfermeros, tres gerentes, tres médicos y dos técnicos de enfermería) de unidades básicas de salud en el Municipio de São Bernardo do Campo, São Paulo, Brasil. La guía de la entrevista se basó en tres dimensiones del Marco Consolidado para la Investigación sobre la Implementación (CFIR; Consolidated Framework for Implementation Research). Se realizó un análisis de contenido temático. En la dimensión característica de la colaboración interprofesional, los entrevistados destacaron la complejidad y la posible influencia en su implantación y sostenibilidad. En la dimensión escenario interno, fueron identificados factores que influencian en la colaboración interprofesional: cómo se utiliza el tiempo destinado a la comunicación formal/reuniones de equipo; las interacciones sociales entre los profesionales, y las características del liderazgo, como feedback, la autonomía y la participación en las decisiones. En la dimensión de las características de los individuos, los participantes destacaron la colaboración interprofesional orientada a la calidad de la atención y la necesidad de integración entre los núcleos de saberes. Así, las acciones para mejorar la calidad de la comunicación, la construcción colectiva en equipo y la mejora del liderazgo pueden contribuir para mejorar la colaboración interprofesional en la APS y mejorar sus impactos en la atención a la salud.

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Background and Objectives: Syphilis is a sexually transmitted infection with low-cost and accessible treatment; however, it is considered a public health problem. Further studies are needed to improve knowledge about the factors that may contribute to the mother-to-child transmission of syphilis. Given its high detection rate in pregnant women and the possible adverse events of syphilis in Brazil, the objective was to evaluate the association of individual and clinical characteristics of syphilis with the incidence of congenital syphilis in pregnant women. Methods: This retrospective study was performed in a medium-size municipality in the State of São Paulo. Notification forms from the Notifiable Diseases Information System were used and the occurrence of congenital syphilis was the outcome of the study. Bivariate analyses and logistic regression were performed with variables that obtained p values <0.25. Results: Most pregnant women were 20-34 years old (62.2%) and had white skin (63.2%) and incomplete elementary schooling (35.4%). The occurrence of congenital syphilis was associated with the maternal syphilis diagnosis (p<0,001) and with not performing the treponemal test during the prenatal examination (p =0.014). There was a greater risk for the occurrence of congenital syphilis in cases with late diagnosis during pregnancy (OR=16.48; 95%CI 3.22-84.26) and tertiary/latent clinical classification (OR=7.62; 95%CI 1.40-41.54). Conclusion: Maternal diagnosis in the third trimester of pregnancy and tertiary/latent clinical classification were the main risk factors for the occurrence of congenital syphilis, reinforcing the importance of a quality prenatal examination performed timely.(AU)

Justificativa e Objetivos: A sífilis é uma Infecção Sexualmente Transmissível, com tratamento de baixo custo e acessível; porém, ela é considerada um problema de saúde pública. Para aprimorar o conhecimento sobre os fatores que podem contribuir para transmissão vertical da sífilis, mais estudos são necessários. Diante da elevada taxa de detecção em gestantes e dos possíveis eventos adversos da sífilis no Brasil, o objetivo foi avaliar a associação das características individuais e clínicas de sífilis com a incidência de sífilis congênita em gestantes. Métodos: Este estudo retrospectivo foi realizado em um município de médio porte no Estado de São Paulo. Foram usadas as fichas de notificação do Sistema de Informação de Agravos de Notificação e o desfecho do estudo foi a ocorrência de sífilis congênita. Foram realizadas análises bivariadas e regressão logística com as variáveis que obtiveram valores de p<0,25. Resultados: As maioria das gestantes tinha 20-34 anos (62,2%), era branca (63,2%), com escolaridade fundamental incompleta (35,4%). A ocorrência de sífilis congênita esteve associada ao diagnóstico de sífilis materno no terceiro trimestre de gestação (p<0,001) e com a não realização de teste treponêmico durante o pré-natal (p=0,014). Houve maior risco para a ocorrência de sífilis congênita os casos com diagnóstico tardio na gestação (OR=16,48; IC95% 3,22-84,26) e classificação clínica terciária/latente (OR=7,62; IC95% 1,40-41,54). Conclusão: Os principais fatores de risco para ocorrência de sífilis congênita foram o diagnóstico materno no terceiro trimestre de gestação e classificação clínica terciária/latente, reforçando a importância de um exame pré-natal de qualidade e em tempo oportuno.(AU)

Justificación y objetivos: La sífilis es una Infección de Transmisión Sexual con tratamiento accesible y de bajo coste, sin embargo, es considerada un problema de salud pública. Se necesitan más estudios para mejorar el conocimiento sobre los factores que pueden contribuir a la transmisión maternoinfantil de la sífilis. Dada su alta tasa de detección en gestantes y los posibles eventos adversos de la sífilis en Brasil, el objetivo fue evaluar la asociación de las características individuales y clínicas de la sífilis con la incidencia de sífilis congénita en gestantes. Métodos: Estudio retrospectivo realizado en una ciudad de mediano porte del Estado de São Paulo. Fueran utilizados formularios de notificación obligatoria del Sistema de Información de Enfermedades de Declaración Obligatoria y el desenlance fue la ocurrencia de sífilis congénita. Se realizaron análisis bivariados y regresión logística con las variables que obtuvieron p-value<0,25. Resultados: La mayoría de las mujeres embarazadas tenían entre 20 y 34 años (62,2%), eran blancas (63,2%), con instrucción primaria incompleta (35,4%). La aparición de sífilis congénita se asoció con el diagnóstico de sífilis materna en el tercer trimestre del embarazo (p<0,001) y con la no realización de prueba treponémica durante el prenatal (p=0,014). Hubo un mayor riesgo de sífilis congénita en los casos diagnosticados tardíamente en el embarazo (OR=16,48; IC95% 3,22-84,26) y clasificación clínica terciaria/latente (OR=7,62; IC95% 1,40-41,54). Conclusiones: Los principales factores de riesgo de aparición de sífilis congénita fueron el diagnóstico materno en el tercer trimestre de gestación y la clasificación clínica terciaria/tardía, lo que refuerza la importancia de una atención prenatal de calidad y oportuna.(AU)

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Resumo A pandemia da COVID-19 exigiu a reestruturação dos modelos educacionais nas universidades, incluindo a rápida transição para o ensino remoto. Realizamos uma pesquisa qualitativa com o objetivo de compreender a percepção de professores universitários sobre os efeitos da pandemia da COVID-19 para a rotina de trabalho e para a saúde dos docentes de uma universidade pública no estado de São Paulo. Foram realizadas entrevistas semiestruturadas com 17 docentes de cursos de graduação das ciências humanas, biológicas e exatas, entre agosto e setembro de 2020. As entrevistas foram gravadas e transcritas na íntegra. Da análise de conteúdo, quatro categorias temáticas emergiram: (1) mudanças na rotina de trabalho e seus impactos, incluindo a adaptação ao trabalho remoto e dificuldade em estabelecer limites entre trabalho e rotina pessoal; (2) alterações na dinâmica entre professor/alunos e possibilidade de repensar a prática docente; (3) relação dos docentes com a universidade, o processo de tomada de decisões, suporte para a transição ao ensino remoto e preocupações com a qualidade do ensino; e (4) angústias e medos relacionamos à pandemia que se somaram aos estressores do trabalho. Os resultados ressaltam a necessidade de ações direcionadas à gestão educacional, às dinâmicas comunicacionais e à saúde mental.

Abstract The COVID-19 pandemic required the restructuring of educational models, including the rapid transition from face-to-face to remote education. The aim of this qualitative research was to understand the effect of the COVID-19 pandemic on undergraduate professors' work and health at a public university in the state of São Paulo. Semi-structured interviews were conducted with 17 undergraduate faculty of humanities, biological and exact sciences form August to September 2020. The interviews were recorded and transcribed. From the content analysis, four thematic categories emerged: (1) changes in the work routine and their impacts, including adjustment to remote work and the difficulties in establishing boundaries between work and their personal life; (2) changes in the dynamics between faculty and students and the possibility of rethinking teaching practice; (3) the relationship between faculty and the university with emphasis on the decision-making process, support for the transition to remote teaching, and concerns about the quality of teaching; and (4) anguish and fears related to the pandemic that added to the set of work-related stressors. Our findings showed that actions towards the communicational dynamics, as well as actions towards faculties' mental health should be implemented.

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The COVID-19 pandemic required the restructuring of educational models, including the rapid transition from face-to-face to remote education. The aim of this qualitative research was to understand the effect of the COVID-19 pandemic on undergraduate professors' work and health at a public university in the state of São Paulo. Semi-structured interviews were conducted with 17 undergraduate faculty of humanities, biological and exact sciences form August to September 2020. The interviews were recorded and transcribed. From the content analysis, four thematic categories emerged: (1) changes in the work routine and their impacts, including adjustment to remote work and the difficulties in establishing boundaries between work and their personal life; (2) changes in the dynamics between faculty and students and the possibility of rethinking teaching practice; (3) the relationship between faculty and the university with emphasis on the decision-making process, support for the transition to remote teaching, and concerns about the quality of teaching; and (4) anguish and fears related to the pandemic that added to the set of work-related stressors. Our findings showed that actions towards the communicational dynamics, as well as actions towards faculties' mental health should be implemented.

A pandemia da COVID-19 exigiu a reestruturação dos modelos educacionais nas universidades, incluindo a rápida transição para o ensino remoto. Realizamos uma pesquisa qualitativa com o objetivo de compreender a percepção de professores universitários sobre os efeitos da pandemia da COVID-19 para a rotina de trabalho e para a saúde dos docentes de uma universidade pública no estado de São Paulo. Foram realizadas entrevistas semiestruturadas com 17 docentes de cursos de graduação das ciências humanas, biológicas e exatas, entre agosto e setembro de 2020. As entrevistas foram gravadas e transcritas na íntegra. Da análise de conteúdo, quatro categorias temáticas emergiram: (1) mudanças na rotina de trabalho e seus impactos, incluindo a adaptação ao trabalho remoto e dificuldade em estabelecer limites entre trabalho e rotina pessoal; (2) alterações na dinâmica entre professor/alunos e possibilidade de repensar a prática docente; (3) relação dos docentes com a universidade, o processo de tomada de decisões, suporte para a transição ao ensino remoto e preocupações com a qualidade do ensino; e (4) angústias e medos relacionamos à pandemia que se somaram aos estressores do trabalho. Os resultados ressaltam a necessidade de ações direcionadas à gestão educacional, às dinâmicas comunicacionais e à saúde mental.

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O objetivo foi analisar as percepções de trabalhadores da atenção primária à saúde (APS) sobre a colaboração interprofissional na perspectiva da ciência de implementação. Trata-se de estudo qualitativo que utilizou a entrevista em profundidade como técnica de produção de dados. Foram entrevistados 15 trabalhadores (três agentes comunitários de saúde, um auxiliar de enfermagem, três enfermeiros, três gerentes, três médicos e dois técnicos de enfermagem) de unidades básicas de saúde no Município de São Bernardo do Campo, São Paulo, Brasil. O roteiro da entrevista baseou-se em três dimensões do Quadro Conceitual Consolidado para Pesquisa de Implementação (CFIR; Consolidated Framework for Implementation Research). Foi realizada análise de conteúdo temática. Na dimensão características da colaboração interprofissional, os entrevistados destacaram a complexidade, e sua possível influência, na implementação e sustentabilidade dessa prática. Na dimensão cenário interno, foram identificados fatores que influenciam a colaboração interprofissional: como se utiliza o tempo destinado a comunicação formal/reuniões de equipe; interações sociais entre os profissionais; e características da liderança, como feedback, autonomia e participação nas decisões. Na dimensão características dos indivíduos, os participantes destacaram a colaboração interprofissional direcionada para a qualidade do cuidado e a necessidade de integração entre os núcleos de saberes. Assim, ações para aperfeiçoar a qualidade da comunicação, a construção coletiva em equipe e o aprimoramento da liderança podem contribuir para melhorar a colaboração interprofissional na APS e potencializar seus impactos na atenção à saúde.

The objective was to analyze the perceptions of primary health care (PHC) workers about interprofessional collaboration from the perspective of implementation science. This is a qualitative study that used in-depth interview as a data production technique. Interviews were conducted with 15 workers (three community health agents, one nursing assistant, three nurses, three managers, three physicians, and two nursing technicians) from basic health units in the Municipality of São Bernardo do Campo, São Paulo State, Brazil. The interview plan was based on three domains of the Consolidated Framework for Implementation Research (CFIR). Thematic content analysis was used. In the interprofessional collaboration characteristics domain, respondents highlighted the complexity, and its possible influence, as to the implementation and sustainability of this practice. In the inner setting domain, factors that influence interprofessional collaboration were identified, namely: how the time allocated to formal communication/team meetings is used; social interactions between professionals; and leadership characteristics, such as feedback, autonomy and participation in decisions. In the individuals characteristics domain, participants noted interprofessional collaboration geared to quality of care and the need for integration between knowledge centers. Thus, measures to enhance the quality of communication, collective team building and leadership can contribute to improve interprofessional collaboration in PHC and leverage its impacts on health care.

El objetivo fue analizar las percepciones de los trabajadores de atención primaria de salud (APS) sobre la colaboración interprofesional desde la perspectiva de la ciencia de implementación. Se trata de un estudio cualitativo que utilizó la entrevista en profundidad como técnica de producción de datos. Fueron entrevistados 15 trabajadores (tres agentes comunitarios de salud, un auxiliar de enfermería, tres enfermeros, tres gerentes, tres médicos y dos técnicos de enfermería) de unidades básicas de salud en el Municipio de São Bernardo do Campo, São Paulo, Brasil. La guía de la entrevista se basó en tres dimensiones del Marco Consolidado para la Investigación sobre la Implementación (CFIR; Consolidated Framework for Implementation Research). Se realizó un análisis de contenido temático. En la dimensión característica de la colaboración interprofesional, los entrevistados destacaron la complejidad y la posible influencia en su implantación y sostenibilidad. En la dimensión escenario interno, fueron identificados factores que influencian en la colaboración interprofesional: cómo se utiliza el tiempo destinado a la comunicación formal/reuniones de equipo; las interacciones sociales entre los profesionales, y las características del liderazgo, como feedback, la autonomía y la participación en las decisiones. En la dimensión de las características de los individuos, los participantes destacaron la colaboración interprofesional orientada a la calidad de la atención y la necesidad de integración entre los núcleos de saberes. Así, las acciones para mejorar la calidad de la comunicación, la construcción colectiva en equipo y la mejora del liderazgo pueden contribuir para mejorar la colaboración interprofesional en la APS y mejorar sus impactos en la atención a la salud.

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Objetivo: identificar os diferentes perfis de trabalhadores de Centros de Atenção Psicossocial (CAPS) e investigar suas características sociodemográficas e de saúde mental no contexto da pandemia da COVID-19. Métodos: foram convidados os 127 trabalhadores de seis CAPS da cidade de Pelotas ­ RS, dos quais 82 participaram (taxa de resposta de 67%); os questionários PHQ-9 e GHQ-12 foram aplicados para rastreamento de sintomas depressivos e transtornos mentais comuns, sendo realizada uma análise de clusters. Resultados: os agrupamentos exibiram elevada homogeneidade interna e heterogeneidade externa, permitindo observar associações com as variáveis explicativas e diferenças entre os clusters, que revelam potenciais riscos para depressão e transtornos mentais comuns. Conclusão: os trabalhadores da saúde mental estão expostos a riscos para a saúde mental, sendo necessário compreender o impacto da pandemia da COVID-19 nestes trabalhadores e dar subsídios para atender às suas necessidades. (AU).

ABSTRACT Objective: to identify different profiles of workers of Community Mental Health Centres and their socio demographic and mental health characteristics in relation to the COVID-19 pandemic. Methods: 127 workers from six Centres in the city of Pelotas, South Brazil, were invited to a survey and 82 applied (67% response rate); PHQ-9 and GHQ-12 questionnaires were used to the screening of depressive symptoms and common mental health problems and a cluster analysis was performed. Results: clusters showed high internal homogeneity and external heterogeneity, with associations between explanatory variables and differences among clusters, which reveal potential risks for depression and common mental disorders. Conclusion: mental health workers are exposed to risks, and it is necessary to understand the impact of the COVID-19 pandemic on the mental health of these workers to support your needs. (AU).

Objetivo: identificar los diferentes perfiles de trabajadores de los Centros de Atención Psicosocial y sus características sociodemográficas y de salud mental en relación con la pandemia de COVID-19. Métodos: de los 127 trabajadores invitados de los 6 Centros en de Pelotas, Sur de Brasil, 82 contestaron (tasa de respuesta de 67%); los cuestionarios PHQ-9 e GHQ-12 fueron utilizados para rastreo de síntomas depresivos y trastornos mentales comunes y se hizo una análisis de conglomerados. Resultados: los conglomerados exhibieron alta homogeneidad interna y heterogeneidad externa, permitiendo observar asociaciones con variables explicativas y diferencias entre conglomerados, que revelan riesgos de depresión y trastornos mentales comunes. Conclusión: los trabajadores de la salud mental tienen riesgos para la salud mental siendo necesario comprender el impacto de la pandemia de COVID-19 en estos trabajadores y proporcionar subsidios para el apoyo a sus necesidades. (AU).

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Resumo Os efeitos da justiça organizacional sobre a saúde dos trabalhadores têm sido investigados em diversas áreas de trabalho. Entretanto, a sistematização da informação disponível sobre os efeitos relacionados às doenças cardiovasculares (DCV) e à diabetes é escassa. O objetivo deste artigo é revisar sistematicamente a associação entre justiça organizacional e DCV e metabólica em trabalhadores adultos. A estratégia de busca incluiu os termos justiça organizacional, doença coronariana, doença cerebrovascular, hipertensão arterial sistêmica, diabetes mellitus e DCV. As bases de dados investigadas foram MEDLINE, EMBASE e LILACS. A qualidade dos estudos foi avaliada pelo instrumento desenvolvido pelo National Institute of Health. Foram identificados 1.959 títulos. Após avaliação, foram selecionados oito estudos. Os indivíduos com percepção de justiça organizacional alta apresentaram menor risco de DCV e metabólica. Baixa justiça organizacional tem repercussões para a saúde cardiovascular e metabólica dos trabalhadores. A elaboração de estratégias para promover justiça organizacional deve ser priorizada para assim mitigar seus impactos para os trabalhadores e as instituições.

Abstract The effects of organizational justice on workers' health have been investigated in several areas of work. However, the systematization of available information on the effects related to cardiovascular diseases (CVD) and diabetes is scarce. This article aims to systematically review the association between organizational justice and CVD and metabolic disease in adult workers. The search strategy included the terms organizational justice, coronary heart disease, cerebrovascular disease, systemic arterial hypertension, diabetes mellitus and CVD. This study investigated the following databases: MEDLINE, EMBASE, and LILACS. The quality of the studies was assessed using the instrument developed by the National Institute of Health. Results: This study identified 1,959 titles. After evaluation, eight studies were selected. Individuals with a high perception of organizational justice showed a lower risk of CVD and metabolic disease, whereas low organizational justice presented repercussions for the cardiovascular and metabolic health of workers. The development of strategies to promote organizational justice must be prioritized and thus mitigate its impacts on workers and institutions.

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The effects of organizational justice on workers' health have been investigated in several areas of work. However, the systematization of available information on the effects related to cardiovascular diseases (CVD) and diabetes is scarce. This article aims to systematically review the association between organizational justice and CVD and metabolic disease in adult workers. The search strategy included the terms organizational justice, coronary heart disease, cerebrovascular disease, systemic arterial hypertension, diabetes mellitus and CVD. This study investigated the following databases: MEDLINE, EMBASE, and LILACS. The quality of the studies was assessed using the instrument developed by the National Institute of Health. Results: This study identified 1,959 titles. After evaluation, eight studies were selected. Individuals with a high perception of organizational justice showed a lower risk of CVD and metabolic disease, whereas low organizational justice presented repercussions for the cardiovascular and metabolic health of workers. The development of strategies to promote organizational justice must be prioritized and thus mitigate its impacts on workers and institutions.

Os efeitos da justiça organizacional sobre a saúde dos trabalhadores têm sido investigados em diversas áreas de trabalho. Entretanto, a sistematização da informação disponível sobre os efeitos relacionados às doenças cardiovasculares (DCV) e à diabetes é escassa. O objetivo deste artigo é revisar sistematicamente a associação entre justiça organizacional e DCV e metabólica em trabalhadores adultos. A estratégia de busca incluiu os termos justiça organizacional, doença coronariana, doença cerebrovascular, hipertensão arterial sistêmica, diabetes mellitus e DCV. As bases de dados investigadas foram MEDLINE, EMBASE e LILACS. A qualidade dos estudos foi avaliada pelo instrumento desenvolvido pelo National Institute of Health. Foram identificados 1.959 títulos. Após avaliação, foram selecionados oito estudos. Os indivíduos com percepção de justiça organizacional alta apresentaram menor risco de DCV e metabólica. Baixa justiça organizacional tem repercussões para a saúde cardiovascular e metabólica dos trabalhadores. A elaboração de estratégias para promover justiça organizacional deve ser priorizada para assim mitigar seus impactos para os trabalhadores e as instituições.

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PURPOSE: Burnout among health care workers may hamper the quality of care and effectiveness of health systems. Hence, we examined the prevalence of burnout in primary care teams, including community health workers; and investigated associations between individuals' characteristics, team and primary care center factors, and burnout. METHODS: We carried out a cross-sectional study among primary care teams in the city of São Paulo, Brazil (n = 2940). We randomly selected 66 primary care centers. The Maslach burnout inventory was used to investigate burnout. We used multilevel modelling to examine the associations between individuals' characteristics, team and primary care center variables with burnout. RESULTS: We addressed 351 primary care teams, with 11.4% of participants presenting severe burnout. The variance in burnout among primary care workers was partially explained by individuals' characteristics, and by team and primary care center factors. Severe burnout was associated with the following: (1) individuals' characteristics: being black, being younger, a higher length of employment in primary care, and presenting a lack of feedback from supervisors; (2) team factors: working in deprived areas and not receiving the support of a multidisciplinary team; and (3) primary care center factors: inadequate infrastructure (less than one office available per team), and having a bad/very bad relationship with the community council. CONCLUSIONS: To reduce burnout among primary care teams, stakeholders should: (1) train managers/supervisors on leadership styles that prioritize performance feedback, support, and communication skills; (2) allocate catchment areas to teams according to each community's vulnerability; (3) provide a multidisciplinary team to support primary care workers; and (4) offer suitable facilities and infra-structure.

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Abstract: Introduction: Although Primary Health Care (PHC) is essential for medical students' training, the perceptions of primary care workers about the teaching-learning process have been overlooked, particularly in municipalities where PHC management is performed by a private organization instead of the government, such as in the city of São Paulo. Objective: to analyze the perceptions of primary care workers about barriers and facilitators of medical students' teaching-learning process in PHC in the city of São Paulo. Method: we conducted a qualitative research. We performed in-depth interviews with 12 primary care workers from the family health teams (four physicians, four nurses and four community health workers), who worked in primary care clinics in the east region of the city and received medical students, from 1st-year to internship students. The interviews were recorded, transcribed and afterwards, they were repeatedly read. We identified thematic units following the content analysis principles. Results: the barriers to medical students' teaching-learning process in PHC were the following: (1) excessive number of scheduled patients and scarcity of time for discussion; (2) inadequate infrastructure of primary care clinics; (3) lack of training; and (4) ineffective integration among faculty, healthcare workers, managers and the assisted population. The facilitating factors of the teaching-learning process were: (1) high quality of healthcare services; (2) integration among primary care teams, interdisciplinary teams, and students; and (3) well-trained medical preceptors. Conclusions: our results have implications for PHC professionals, educational institutions, and managers. The improvement of the integration among educational institutions, health services managers, primary care workers, and the population is a condition to reach the effectiveness in the teaching-learning process, and to ensure the development of essential competencies for PHC assistance quality. Thus, the training of health professionals, improving the primary care clinic infrastructure, and creating strategies to ensure enough time for discussion and feedback could contribute to mitigate barriers to medical students' teaching-learning process in PHC.

Resumo: Introdução: Apesar de a atenção primária à saúde (APS) ser essencial para a formação médica, as percepções dos profissionais das equipes de saúde da família (eSF) sobre o processo ensino-aprendizagem foram pouco estudadas, em particular em municípios nos quais o modelo de gestão da APS é indireto, como na cidade de São Paulo. O objetivo deste estudo foi analisar as percepções de profissionais das eSF sobre as barreiras e os facilitadores do processo ensino-aprendizagem dos estudantes de medicina na APS, no município de São Paulo. Método: Trata-se de uma pesquisa qualitativa. Foram realizadas entrevistas semiestruturada com 12 profissionais das eSF (quatro médicos, quatro enfermeiros e quatro agentes comunitários de saúde), que atuavam em unidades básicas de saúde (UBSs) localizadas na zona leste do município de São Paulo e que recebiam estudantes de Medicina do primeiro ano ao internato. As entrevistas foram gravadas e transcritas, lidas e relidas, sendo identificadas unidades de significado de acordo com os pressupostos da análise de conteúdo. Resultados: Os entrevistados destacaram as seguintes barreiras relacionados ao processo ensino-aprendizagem na APS: 1. excesso de pacientes agendados e escassez de tempo para discussão do caso com os estudantes; 2. inadequada estrutura física do serviço de saúde; 3. falta de preparação dos profissionais; e 4. falta de articulação ensino-serviço-comunidade. Os aspectos reconhecidos como fatores facilitadores do processo ensino-aprendizagem foram: 1. qualificação do serviço de saúde e da equipe; 2. integração com a eSF e com equipe multiprofissional; e 3. preparação dos preceptores médicos. Conclusões: Os resultados têm implicações para os profissionais da APS, as instituições de ensino superior e os gestores da saúde da APS estudados. O aprimoramento das relações e articulações entre as instituições de ensino, os gestores dos serviços de saúde, os profissionais de saúde e a comunidade é condição necessária para efetivar o processo ensino-aprendizagem e garantir o desenvolvimento de competências para a qualidade do cuidado na APS. Assim, o preparo dos profissionais de saúde, a adequação do espaço físico da UBS, a reflexão sobre o agendamento e estratégias para garantir tempo para discussão do caso e espaço para feedback podem contribuir para mitigar as barreiras ao processo ensino-aprendizagem na APS.

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BACKGROUND: Emerging researchers in low- and middle-income countries (LMIC) face many barriers, including inadequacies in funding, international exposure and mentorship. In 2012, the National Institute of Mental Health (NIMH) funded five research hubs aimed at improving the research core for evidence-based mental health interventions, enhancing research skills in global mental health, and providing capacity building (CB) opportunities for early career investigators in LMIC. In this paper emerging researchers contextualize their experiences. CASE PRESENTATION: Each of the five hubs purposively selected an emerging researcher who had experienced more than one hub-related CB opportunity and actively participated in hub-related clinical trial activities. The five 'voices' were invited to contribute narratives on their professional backgrounds, CB experience, challenges and successes as an emerging mental health researcher, and suggestions for future CB activities. These narratives are presented as case studies. CB activities provided broader learning opportunities for emerging researchers. Benefits included the receipt of research funding, hands-on training and mentorship, as well as exposure to networks and collaborative opportunities on a global scale. To overcome ongoing challenges of access to funding, mentoring, networking and global exposure, the emerging voices recommend making mentorship and training opportunities available to a wider range of emerging mental health researchers. CONCLUSIONS: Investing in CB is not enough to ensure sustainability and leave a legacy unless it is accompanied by ongoing mentorship and international exposure. Financial investment in building research capacity, promotion of mentorship and supervision, and international networking are essential to yield well-prepared young investigators in LMIC as experienced by these rising stars. Governments and policymakers should prioritize educational policies to support the continuous development and international engagement of emerging researchers. This can advance strategies to deal with one of most important and costly problems faced by healthcare systems in LMIC: the mental health treatment gap.

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INTRODUCTION: Characteristics of primary health care and emergency services may hamper their integration and, therefore, reduce the quality of care and the effectiveness of health systems. This study aims to identify and analyse policy, structural and organizational aspects of healthcare services that may affect the integration between primary health and emergency care networks. THEORY AND METHODS: We conducted a qualitative research study based on grounded theory that included: (1) interviews with 30 health care leaders; and (2) documental analysis of the summaries of Regional Interagency Committee meetings from two regions in the state of Sao Paulo, Brazil. RESULTS: The integration between primary health and emergency care network is inefficient. The barriers that contributed to this situation are as follows: (1) policy: the municipal health department is responsible for providing primary health care and the regional health department provides emergency care, but there is a lack of space for the integration of services; (2) structural: distinct criteria for planning mechanisms; and (3) organizational: ineffective point of interaction between different levels of the health system. CONCLUSIONS AND DISCUSSION: Our findings have implications for health management and planning in low-and middle-income countries (LMICs) with suggestions for interventions for overcoming the aforementioned barriers.

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ABSTRACT Medical training is current topic of discussion both on the national and international stage due to changes in contemporary society and the consequent health demands. In Brazil, insertion into the workplace of the Primary Health Care (PHC) student is recommended throughout the medical course. However, such insertion is hampered by inadequate practical scenarios, the lack of preceptors, insufficient training of general practitioners to receive students, teachers without adequate training in teaching in the area and resistance by teachers of traditional disciplines. This article describes and analyzes a model for insertion into PHC and Family and Community Medicine (FCM) of students from a medical course in São Paulo, the challenges of teaching-management integration and the actions that help to address these issues. The proposal is based on educational objectives aimed at developing competences (knowledge, skills and attitudes) so that the student can offer comprehensive care, understanding the individual in the context of family, social and environmental life. The program contents were developed to provide learning in an increasing degree of complexity, connecting previous knowledge to new knowledge. From this starting point, the development of the educational project has as innovative brand involving a combination of planning and educational management that adopts the following measures to improve the quality of the teaching-learning process: (1) insertion of students into Basic Health Units (BHU) from the first year to internship; (2) hiring family doctors as faculty staff; (3) integration of the contents of the Family Medicine and PHC modules with the contents of other disciplines, such as Epidemiology, Health Policies and Evidence-Based Medicine; (4) critically questioning teaching methodologies regarding their suitability for the topic addressed and the student and teacher profiles; (5) formative assessments; (6) pedagogical improvement for teachers and preceptors for the exercise of teaching in health; (7) practices that encourage students to work in interprofessional teams; (8) encouragement of national and international exchange programs for undergraduate and residency students in FCM; (9) promotion of the publication of books, articles and research in PHC. Among the facilitating factors for the good progress of this teaching proposal, it is highlighted that FCM and PHC are the axial foundations of the political-pedagogical project of the medical course and are developed in an institution that has a long history of assistance and teaching in the health area, contributing significantly to service-school integration. Dialogue is required for the execution of didactic activities in the practical settings, due to the proximity between local management, preceptors and teacher-managers. Another factor which strengthens the proposal is the investment in the preceptor team through training, participation in the construction and integration of content proposed in the FCM modules and a human resources policy that values them. Thus, it is considered that the presentation of this initiative could contribute to the debate on educational models for curricular insertion into FCM and PHC, and the related challenges and possibilities in contemporary medical education.

RESUMO Em contexto nacional e internacional, discute-se a formação médica devido às mudanças na sociedade contemporânea e suas demandas de saúde. No Brasil, preconiza-se a inserção do aluno na Atenção Primária à Saúde (APS) durante todo o curso médico. Tal inserção é dificultada pelos cenários práticos inadequados, pela falta de preceptores, pela formação insuficiente dos médicos generalistas para receber estudantes, pelos docentes sem capacitação adequada para o ensino na área e pela resistência de docentes de disciplinas tradicionais. Este artigo descreve e analisa um modelo de inserção da APS e Medicina de Família e Comunidade (MFC) em um curso médico no município de São Paulo, os desafios da articulação ensino-gestão e as ações que ajudam a enfrentá-los. A proposta parte de objetivos educacionais que visam desenvolver competências (conhecimentos, habilidades e atitudes) para que o aluno possa oferecer cuidado integral, compreendendo o indivíduo no contexto de vida familiar, social e ambiental. Os conteúdos programáticos foram desenvolvidos para propiciar aprendizagem em grau crescente de complexidade, articulando saberes prévios com novos saberes. Deste ponto de partida, o desenvolvimento do projeto educacional tem como marca inovadora a combinação de planejamento e gestão educacional que adota as seguintes medidas para aprimorar a qualidade do processo ensino-aprendizagem: (1) inserção dos alunos em Unidades Básicas de Saúde (UBS) do primeiro ano ao internato; (2) contratação de médicos de família como docentes da faculdade; (3) integração dos conteúdos dos módulos de Medicina de Família e APS com os conteúdos de outras disciplinas, como Epidemiologia, Políticas de Saúde e Medicina Baseada em Evidências; (4) metodologias de ensino problematizadoras adequadas à temática abordada e ao perfil do estudante e do docente; (5) avaliações formativas; (6) aprimoramento pedagógico para docentes e preceptores para o exercício do ensino em saúde; (7) práticas que estimulem o aluno a trabalhar em equipes interprofissionais; (8) incentivo a programas de intercâmbio nacionais e internacionais para alunos de graduação e de residência em MFC; (9) fomento à publicação de livros, artigos e pesquisa em APS. Entre os fatores facilitadores para o bom andamento dessa proposta de ensino, ressalta-se o fato de que MFC e APS são fundamentos axiais do projeto político-pedagógico do curso médico e se desenvolvem em uma instituição que tem longa história de assistência e ensino na área da saúde, contribuindo fortemente para a integração serviço-escola. A interlocução necessária às atividades didáticas nos cenários de prática se dá pela proximidade entre gestão local, preceptores e gestores-docentes. Outro fator de fortalecimento da proposta é o investimento na equipe de preceptores por meio de capacitação, participação na construção e na integração de conteúdos propostos nos módulos de MFC e a política de recursos humanos que os valoriza. Assim, considera-se que a apresentação desta iniciativa poda contribuir para o debate de modelos educacionais para inserção curricular da MFC e APS, seus desafios e possibilidades na educação médica contemporânea.

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BACKGROUND: The purpose of this study was to assess the prevalence and associated factors of generalized anxiety disorder (GAD) in adults using the seven-item GAD scale (GAD-7) and to evaluate the properties of the two-item (GAD-2) as a population screening tool. METHODS: We carried out a cross-sectional population-based study in the Manaus Metropolitan Region in 2015, Brazil. Adults aged 18 years or more were eligible to participate. We performed probabilistic three-phase sampling and collected sociodemographic and clinical variables. Descriptive statistics and a Poisson regression with robust variance with corrections for complex sampling were used. The accuracy of GAD-2 was assessed using GAD-7 as the gold standard. RESULTS: We included 4001 participants. The prevalence of GAD was 8.4% (95% confidence interval 7.6-9.4%) and was significantly associated with self-reported poor health status and presenting depressive symptoms (p < 0.01). GAD-2 sensitivity was 63.9%, and its specificity was 97.4%. LIMITATIONS: Because of the cross-sectional design of the study, the results are prone to reverse causality and recall bias. The surveyed people were not questioned about their medical diagnosis of anxiety, access to mental health services, or alcohol, tobacco or other drug use. The screening tools were not validated in the Brazilian or Amazon population. CONCLUSION: About eight in 100 adults living in Manaus presented GAD, and it is more prevalent among people with a poorer health status and depression. Because of its low sensitivity, GAD-2 is not useful as a screening tool.

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Objetivos. Determinar factores relacionados con el trabajo asociados a síntomas depresivos y posible depresión mayor en personal de los equipos de atención primaria. Métodos. Estudio transversal en equipos de atención primaria (agentes comunitarios de salud, auxiliares de enfermería, enfermeras y médicos) en la ciudad de São Paulo (Brasil) (2011‑2012; n = 2940) para evaluar los síntomas depresivos y la posible depresión mayor y su asociación con la presión laboral y otras condiciones laborales. Resultados. Los agentes comunitarios de salud presentaron una prevalencia más elevada de posible depresión mayor (18%) que otros trabajadores de atención primaria. Las razones de posibilidades [odds ratios] mayores de los síntomas depresivos o la posible depresión mayor se asociaron a una antigüedad mayor en el empleo en la atención primaria; a tener un trabajo pasivo, activo o con gran presión laboral; a la falta de retroalimentación de los supervisores con respecto al desempeño; y al escaso apoyo social de los colegas y los supervisores. Conclusiones. Los niveles observados de depresión relacionada con el trabajo pueden poner en peligro la sostenibilidad de los programas de atención primaria. Implicaciones para la salud pública. Se necesitan estrategias para brindar asistencia a los trabajadores de atención primaria con depresión, facilitando el diagnóstico y el acceso al tratamiento, sobre todo en los países de ingresos bajos y medianos. Entre las intervenciones preventivas pueden incluirse la capacitación de los supervisores para que brinden retroalimentación a los trabajadores y la creación de estrategias para aumentar la autonomía laboral y el apoyo social en el trabajo.

Objectives. To identify work-related factors associated with depressive symptoms and probable major depression in primary care teams. Methods. Cross-sectional study among primary care teams (community health workers, nursing assistants, nurses, and physicians) in the city of São Paulo, Brazil (2011– 2012; n = 2940), to assess depressive symptoms and probable major depression and their associations with job strain and other work-related conditions. Results. Community health workers presented higher prevalence of probable major depression (18%) than other primary care workers. Higher odds ratios for depressive symptoms or probable major depression were associated with longer duration of employment in primary care; having a passive, active, or high-strain job; lack of supervisor feedback regarding performance; and low social support from colleagues and supervisors. Conclusions. Observed levels of job-related depression can endanger the sustainability of primary care programs. Public Health implications. Strategies are needed to deliver care to primary care workers with depression, facilitating diagnosis and access to treatment, particularly in low- and middle-income countries. Preventive interventions can include training managers to provide feedback and creating strategies to increase job autonomy and social support at work.

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BACKGROUND: Depression is an affective disorder and one of the main contributors to the burden of disease worldwide. Our purpose is to estimate the prevalence of depressive symptoms and associated factors in the population of the Manaus Metropolitan Region. METHODS: We conducted a population-based, cross-sectional study with a probabilistic three-phase sampling in 2015, based on a previously calculated sample size. Adults living in Manaus and seven inner cities of the metropolitan region were surveyed for depressive symptoms using the Patient Health Questionnaire (PHQ-9) and a cutoff score of ≥ 9. We performed a Poisson regression with robust variance using a hierarchical approach to calculate the prevalence ratio (PR) of depression and 95% confidence intervals (CIs). RESULTS: Among 4001 participants (response rate 76%), the prevalence of current depressive symptoms was 7% (95% CI: 6-8%). Depressive symptoms were more frequent in inhabitants of Manaus than in those from the countryside (PR = 6.13, 95% CI: 2.91-12.91); in women than in men (PR = 2.55, 95% CI: 1.96-3.33); in indigenous than in white people (PR = 2.56, 95% CI: 1.24-5.30); and in those with hypertension (PR = 1.47, 95% CI: 1.13-1.92), cardiac disease (PR = 1.62, 95% CI: 1.12-2.33), and poor health status (fair: PR = 5.10, 95% CI: 2.50-10.37; bad: PR = 10.27, 95% CI: 4.92-21.44 very bad: PR = 21.14, CI 95%: 10.16-43.99). High school education (PR = 0.55, 95% CI: 0.32-0.95) and middle class economic status (PR = 0.33, 95% CI: 0.12-0.89) were protective factors. LIMITATIONS: Limitations include the lack of measurement of physical activity, religious beliefs, leisure time, and use of alcohol and other drugs since these factors can affect depression and health status. CONCLUSION: Seven out of every 100 adults from the Manaus Metropolitan Region have depressive symptoms. This rate is higher in women, individuals living in Manaus, indigenous people, people with hypertension or chronic cardiac disease, and those with a poor health status.

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RESUMO Em contexto nacional e internacional, discute-se a formação médica devido às mudanças na sociedade contemporânea e suas demandas de saúde. No Brasil, preconiza-se a inserção do aluno na Atenção Primária à Saúde (APS) durante todo o curso médico. Tal inserção é dificultada pelos cenários práticos inadequados, pela falta de preceptores, pela formação insuficiente dos médicos generalistas para receber estudantes, pelos docentes sem capacitação adequada para o ensino na área e pela resistência de docentes de disciplinas tradicionais. Este artigo descreve e analisa um modelo de inserção da APS e Medicina de Família e Comunidade (MFC) em um curso médico no município de São Paulo, os desafios da articulação ensino-gestão e as ações que ajudam a enfrentá-los. A proposta parte de objetivos educacionais que visam desenvolver competências (conhecimentos, habilidades e atitudes) para que o aluno possa oferecer cuidado integral, compreendendo o indivíduo no contexto de vida familiar, social e ambiental. Os conteúdos programáticos foram desenvolvidos para propiciar aprendizagem em grau crescente de complexidade, articulando saberes prévios com novos saberes. Deste ponto de partida, o desenvolvimento do projeto educacional tem como marca inovadora a combinação de planejamento e gestão educacional que adota as seguintes medidas para aprimorar a qualidade do processo ensino-aprendizagem: (1) inserção dos alunos em Unidades Básicas de Saúde (UBS) do primeiro ano ao internato; (2) contratação de médicos de família como docentes da faculdade; (3) integração dos conteúdos dos módulos de Medicina de Família e APS com os conteúdos de outras disciplinas, como Epidemiologia, Políticas de Saúde e Medicina Baseada em Evidências; (4) metodologias de ensino problematizadoras adequadas à temática abordada e ao perfil do estudante e do docente; (5) avaliações formativas; (6) aprimoramento pedagógico para docentes e preceptores para o exercício do ensino em saúde; (7) práticas que estimulem o aluno a trabalhar em equipes interprofissionais; (8) incentivo a programas de intercâmbio nacionais e internacionais para alunos de graduação e de residência em MFC; (9) fomento à publicação de livros, artigos e pesquisa em APS. Entre os fatores facilitadores para o bom andamento dessa proposta de ensino, ressalta-se o fato de que MFC e APS são fundamentos axiais do projeto político-pedagógico do curso médico e se desenvolvem em uma instituição que tem longa história de assistência e ensino na área da saúde, contribuindo fortemente para a integração serviço-escola. A interlocução necessária às atividades didáticas nos cenários de prática se dá pela proximidade entre gestão local, preceptores e gestores-docentes. Outro fator de fortalecimento da proposta é o investimento na equipe de preceptores por meio de capacitação, participação na construção e na integração de conteúdos propostos nos módulos de MFC e a política de recursos humanos que os valoriza. Assim, considera-se que a apresentação desta iniciativa poda contribuir para o debate de modelos educacionais para inserção curricular da MFC e APS, seus desafios e possibilidades na educação médica contemporânea.

ABSTRACT Medical education has been heavily debated in both national and international contexts due to changes in society and public health demands. In Brazil, it is postulated that learning in Primary Health Care (PHC) should occur throughout the entire medical course. Learning in PHC has faced some barriers such as inadequate environment for medical practice, including a lack of supervisors and general practitioners with insufficient training to assist students, lack of lecturers with expertise in the area, and resistance from traditional faculties to include PHC in the curriculum. This paper addresses an educational model to include PHC and family medicine in a medical school curriculum in the city of São Paulo, Brazil. Furthermore, we describe the challenges of tying in educational and managerial objectives in the context of primary care services, and how to overcome such challenges. Our proposal is based on using educational objectives to develop student competencies (knowledge, skills and attitudes) so they can provide comprehensive care as regards the individual's background (social, family and environmental). Students are exposed to increasingly complex educational content that requires connecting new knowledge to previous knowledge. The innovative aspect of this educational project is its integration of planning and educational management, involving the following strategies to achieve a better quality learning process: (1) Students in primary care services from the first to the last semester of the course; (2) Hiring family doctors as faculty members; (3) Integrating PHC and family medicine with the contents of other subjects such as epidemiology, public health policies and evidenced-based medicine; (4) Using problem-solving methodologies suitable both to the studied theme and to student and lecturer profiles; (5) Formative evaluations; (6) Improving teaching skills for lecturers and field supervisors; (7) Implementing practices to encourage students to work in multi-professional teams; (8) Motivating students to take part in interchange programs with national and international institutions; and (9) Encouraging the publications of books, scientific papers and research into PHC and family medicine. Several factors facilitate the success of this educational proposal, including: PHC and family medicine being underlying matters in the political-pedagogical faculty project; the educational setting being that of an institution with a long history of health education, public care provision and contributions to service-learning integration; the close relationship between health service managers, lecturers and supervisors, which facilitates coordination between the theoretical content and practice in PHC; the investments made to develop supervisor teaching skills, to support their participation in the debate about relevant family medicine content, and in the discussion about integrating theory with practice; and finally the human resource policies that raise the value of family doctors who are also supervisors. We hope this experience contributes to enhancing the debate about PHC and family medicine educational models in medical courses, and the related challenges and possibilities within medical training.

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The objective of this study was to examine the experience of primary care center (PCC) users in Brazil, classified according to the quality of its structure, in relation to the aspects of accessibility, continuity, and acceptability. The source of information was the National Program to Improve Access and Quality of Primary Care in 2013-2014. A total of 109 919 interviewees in 24 055 PCCs comprised the sample. Results show that the structure of a PCC was associated with better indicators of accessibility (oral health and medicines) and continuity of care (patient navigation in the health system). No association was found between indicators of accessibility and the PCC structure.

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OBJECTIVES: To identify work-related factors associated with depressive symptoms and probable major depression in primary care teams. METHODS: Cross-sectional study among primary care teams (community health workers, nursing assistants, nurses, and physicians) in the city of São Paulo, Brazil (2011-2012; n = 2940), to assess depressive symptoms and probable major depression and their associations with job strain and other work-related conditions. RESULTS: Community health workers presented higher prevalence of probable major depression (18%) than other primary care workers. Higher odds ratios for depressive symptoms or probable major depression were associated with longer duration of employment in primary care; having a passive, active, or high-strain job; lack of supervisor feedback regarding performance; and low social support from colleagues and supervisors. CONCLUSIONS: Observed levels of job-related depression can endanger the sustainability of primary care programs. Public Health implications. Strategies are needed to deliver care to primary care workers with depression, facilitating diagnosis and access to treatment, particularly in low- and middle-income countries. Preventive interventions can include training managers to provide feedback and creating strategies to increase job autonomy and social support at work.

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