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Objective: Community health workers work directly in the communities and are the intermediaries between the population's needs and the primary health care teams. Their work focuses on health education and preventing diseases and disorders, accompanying citizens, families, and households in a particular neighborhood. This study sought to analyze the use of the e-SUS Território application in the work of community health workers in Brazil. Methods: Usability data extracted from Google Analytics from 2019 to 2022 were analyzed, including productivity indicators, number and location of users, and engagement. An overview of the application's main features was also provided. Results: The application is an important work tool used by these professionals, who stopped using printed sheets to record their activities and began recording them in a digital, unified, asynchronous way anywhere in Brazil, regardless of internet connectivity. The application had 425,000 active users in 2022, reaching 141,000 monthly active users in June of the same year, representing 54.8% of all community health workers in Brazil. Conclusion: This study demonstrates the wide and exponential adherence of the e-SUS Território application over the years and the increase in the productivity of professionals who use it, facilitating and encouraging the recording of health information.

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Objective: To compare the adequacy, agreement, and acceptability of Papanicolaou testing (cytology) for cervical cancer screening using self-collected samples compared to physician-collected samples in Grenada in the Caribbean. Furthermore, the study identifies the human papillomavirus (HPV) genotypes present among asymptomatic women testing positive for HPV, the etiologic cause of cervical cancer. Methods: Participants were divided into two groups and two cervical samples were collected from the women in each group: a self-collected sample and a physician-collected sample. Cervical specimens were tested for cytology and HPV. HPV genotyping was performed on positive specimens. Results: Self-collected samples were adequate and in agreement with physician-collected samples, showing no difference between the two sampling methods. Oncogenic high-risk HPV genotypes were identified in cervical samples which were positive for atypical squamous cells and low-grade squamous intraepithelial lesions. The high-risk HPV genotypes found, notably HPV 45 and 53, differed from those most commonly reported. Although the commonly reported high-risk genotypes HPV 16 and 18 were found, so were 31, 33, 35, 52, 66, 68, and 82. Conclusions: Using self-collection facilitated the discovery of unexpected HPV genotypes among asymptomatic women in Grenada. These findings add new information to the literature regarding cervical cancer and neoplasia screening and HPV genotypes in the Caribbean. This genotype information may impact surveillance of women with low-grade lesions, HPV vaccine selection, and possibly further vaccine research. Research regarding HPV in Caribbean pathology samples of cervical neoplasia and cancer is needed.

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Resumen Objetivos: comprender el significado que la rotación de Atención Primaria en Salud tuvo para los médicos internos en formación del último año de la Facultad de Medicina de la Universidad de Antioquia. Metodología: se realizó un estudio hermenéutico que aplicó técnicas de la teoría fundamentada. La fuente de información estuvo conformada por 100 ensayos realizados por los estudiantes tras la rotación en su internado entre 2011 y 2016. Con codificación abierta se obtuvieron 1837 códigos, los cuales se agruparon en 18 categorías descriptivas y se identificaron 158 dimensiones con sus respectivas propiedades. Posteriormente, se construyó una categoría analítica con la matriz paradigmática propia de la teoría fundamentada. Resultados: enfrentarse a la realidad del ejercicio médico en un primer nivel de atención durante la rotación de Atención Primaria en Salud, marcó un antes y un después desde lo personal y profesional en los estudiantes de Medicina de una Universidad Pública de Medellín, llevándolos a aterrizar abruptamente en el complejo contexto del país y a tomar una postura en su quehacer como médicos, ya que su formación previa fue principalmente en hospitales de alta complejidad. Conclusión: la rotación de Atención Primaria en Salud expone a los estudiantes a los problemas sociales, las necesidades de la población colombiana y la crisis del sistema de salud. Esto los obliga a reflexionar acerca de quiénes son y qué tipo de médicos quieren ser. Esta rotación se convierte, además, en una oportunidad para afianzar conocimientos, explorar sentimientos y reconocer que la medicina también debe abordar los problemas del alma.

Abstract Objective: to understand the meanings that the Primary Health Care rotation had for the interns from the Faculty of Medicine of the University of Antioquia during their last year of training. Methodology: a hermeneutical study was conducted using techniques from grounded theory. Information was obtained from 100 essays written by the students after having finished their rotations during an internship period between 2011 and 2016. A total of 1837 codes resulted from the open coding process; these were grouped into 18 descriptive categories, and 158 dimensions were identified along with their respective properties. Subsequently, an analytical category was built using a paradigm matrix, which is typical of grounded theory. Results: facing the reality of the medical profession at a first-level institution during their Primary Health Care rotation was a personal and professional milestone for these students from a public university of Medellín city. Their rotations suddenly connected them with Colombia›s complex context, thus forcing them to take a stance regarding their day-to-day work. This contrasts with their previous training, which took place at high level hospitals for the most part. Conclusion: Primary Health Care rotations expose students to the social problems of the Colombian population, its needs and the crisis of the healthcare system. This in turn forces them to reflect on who they are and what kind of doctors they want to become. The rotations also provide an opportunity to strengthen their knowledge, explore their feelings and understand that medicine should also approach the issues of the soul.

Resumo Objetivo: Compreender o significado que o rodízio da Atenção Primária à Saúde representou para os médicos em formação no último ano da Faculdade de Medicina da Universidade de Antioquia. Métodos: Realizou-se um estudo hermenêutico com aplicação de técnicas da teoria fundamentada. A fonte de informação foram 100 ensaios realizados pelos estudantes após o rodízio no seu internato entre os anos 2011 e 2016. Com codificação aberta obtiveram-se 1837 códigos, que foram agrupados em 18 categorias descritivas e foram identificadas 158 dimensões com as suas respectivas propriedades. Posteriormente, foi construída uma categoria analítica com a matriz paradigmática própria da teoria fundamentada. Resultados: Encarar a realidade da prática médica em um primeiro nível de atenção durante o rodízio de Atenção Primária à Saúde, representou um antes e um depois no plano pessoal e profissional nos estudantes de Medicina de uma universidade pública de Medellín, levando-os a aterrissarem abruptamente no complexo contexto do país e a tomarem uma posição no seu ofício de médicos, pois a sua formação prévia foi principalmente em hospitais de alta complexidade. Conclusão: O rodízio de APS expõe os estudantes aos problemas sociais, às necessidades da população colombiana e à crise do sistema de saúde. Isso exige deles uma reflexão sobre quem eles são e o tipo de médicos que eles desejam ser. Este rodízio torna-se, aliás, em uma oportunidade para fortalecerem conhecimentos, explorarem sentimentos e reconhecerem que a medicina também deve abordar os problemas da alma.

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Women drug-users face significant challenges in accessing and adhering to outpatient treatment. However, this issue has been underexplored. The study aims to understand the experiences of a group of women undergoing drug use treatment. Between March and December 2021, a qualitative phenomenological interpretative study was carried out through semi-structured interviews with 16 women attending a drug-dependence care center in Catalonia, Spain. Data were processed through content analysis. The results indicate that, despite perceiving a positive impact of the treatment, women experience vulnerabilities related to stigmatization, lack of social support, and insufficient coverage of specific needs, impacting therapeutic follow-up. The findings emphasize the need to enhance resources for specialized care and promote a social support network where women drug-users actively participate.

Las mujeres consumidoras de drogas se enfrentan a grandes desafíos en el acceso y la adherencia al tratamiento ambulatorio. Sin embargo, esta cuestión ha sido poco estudiada. El objetivo del estudio es comprender las experiencias de un grupo de mujeres en tratamiento por consumo de drogas. Entre marzo y diciembre de 2021, se realizó un estudio cualitativo fenomenológico interpretativo mediante entrevistas semiestructuradas a 16 mujeres usuarias de un centro de atención a las drogodependencias de Cataluña (España). Los datos se procesaron mediante el análisis de contenido. Los resultados indican que las mujeres, pese a percibir un impacto positivo del tratamiento, viven realidades de vulnerabilidad relacionadas con la estigmatización, la falta de apoyo social y una baja cobertura de necesidades específicas con implicaciones en el seguimiento terapéutico. Los hallazgos enfatizan la necesidad de mejorar los recursos para una atención especializada y promover una red de apoyo social donde participen activamente las mujeres consumidoras de drogas.

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RESUMEN Las mujeres consumidoras de drogas se enfrentan a grandes desafíos en el acceso y la adherencia al tratamiento ambulatorio. Sin embargo, esta cuestión ha sido poco estudiada. El objetivo del estudio es comprender las experiencias de un grupo de mujeres en tratamiento por consumo de drogas. Entre marzo y diciembre de 2021, se realizó un estudio cualitativo fenomenológico interpretativo mediante entrevistas semiestructuradas a 16 mujeres usuarias de un centro de atención a las drogodependencias de Cataluña (España). Los datos se procesaron mediante el análisis de contenido. Los resultados indican que las mujeres, pese a percibir un impacto positivo del tratamiento, viven realidades de vulnerabilidad relacionadas con la estigmatización, la falta de apoyo social y una baja cobertura de necesidades específicas con implicaciones en el seguimiento terapéutico. Los hallazgos enfatizan la necesidad de mejorar los recursos para una atención especializada y promover una red de apoyo social donde participen activamente las mujeres consumidoras de drogas.

ABSTRACT Women drug-users face significant challenges in accessing and adhering to outpatient treatment. However, this issue has been underexplored. The study aims to understand the experiences of a group of women undergoing drug use treatment. Between March and December 2021, a qualitative phenomenological interpretative study was carried out through semi-structured interviews with 16 women attending a drug-dependence care center in Catalonia, Spain. Data were processed through content analysis. The results indicate that, despite perceiving a positive impact of the treatment, women experience vulnerabilities related to stigmatization, lack of social support, and insufficient coverage of specific needs, impacting therapeutic follow-up. The findings emphasize the need to enhance resources for specialized care and promote a social support network where women drug-users actively participate.

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ABSTRACT Objective. To compare the adequacy, agreement, and acceptability of Papanicolaou testing (cytology) for cervical cancer screening using self-collected samples compared to physician-collected samples in Grenada in the Caribbean. Furthermore, the study identifies the human papillomavirus (HPV) genotypes present among asymptomatic women testing positive for HPV, the etiologic cause of cervical cancer. Methods. Participants were divided into two groups and two cervical samples were collected from the women in each group: a self-collected sample and a physician-collected sample. Cervical specimens were tested for cytology and HPV. HPV genotyping was performed on positive specimens. Results. Self-collected samples were adequate and in agreement with physician-collected samples, showing no difference between the two sampling methods. Oncogenic high-risk HPV genotypes were identified in cervical samples which were positive for atypical squamous cells and low-grade squamous intraepithelial lesions. The high-risk HPV genotypes found, notably HPV 45 and 53, differed from those most commonly reported. Although the commonly reported high-risk genotypes HPV 16 and 18 were found, so were 31, 33, 35, 52, 66, 68, and 82. Conclusions. Using self-collection facilitated the discovery of unexpected HPV genotypes among asymptomatic women in Grenada. These findings add new information to the literature regarding cervical cancer and neoplasia screening and HPV genotypes in the Caribbean. This genotype information may impact surveillance of women with low-grade lesions, HPV vaccine selection, and possibly further vaccine research. Research regarding HPV in Caribbean pathology samples of cervical neoplasia and cancer is needed.

RESUMEN Objetivo. Comparar la idoneidad, concordancia y aceptabilidad de la prueba de Papanicolaou (citología) para el tamizaje del cáncer cervicouterino mediante la comparación de muestras obtenidas con automuestreo y muestras tomadas por personal médico en Granada, en el Caribe. Asimismo, en el estudio se identifican los genotipos del virus del papiloma humano (VPH) existentes en las mujeres asintomáticas con un resultado positivo en las pruebas del VPH, la causa etiológica del cáncer cervicouterino. Métodos. Las participantes se dividieron en dos grupos y se tomaron dos muestras cervicouterinas de las mujeres de cada grupo: una muestra tomada por la propia paciente y una muestra tomada por personal médico. Se realizó un examen citológico y una prueba de detección del VPH en las muestras. En las muestras positivas, se determinó el genotipo del VPH. Resultados. Las muestras tomadas por las propias pacientes fueron adecuadas y concordaron con las obtenidas por el personal médico, sin que se observaran diferencias entre ambos métodos de muestreo. Se identificaron genotipos de VPH de alto riesgo oncogénico en muestras cervicouterinas positivas para células escamosas atípicas y lesiones intraepiteliales escamosas de grado bajo. Los genotipos de VPH de alto riesgo encontrados, en especial VPH 45 y 53, diferían de los notificados con mayor frecuencia. Aunque se encontraron los genotipos de alto riesgo habituales 16 y 18 del VPH, también se encontraron los genotipos 31, 33, 35, 52, 66, 68 y 82. Conclusiones. El uso del automuestreo facilitó la detección de genotipos inesperados del VPH en mujeres asintomáticas de Granada. Estos resultados agregan nueva información a la bibliografía sobre el tamizaje de las neoplasias y el cáncer cervicouterino, así como sobre los genotipos del VPH, en el Caribe. Esta información sobre el genotipo puede repercutir en la vigilancia de las mujeres con lesiones de bajo grado, en la elección de la vacuna contra el VPH y, posiblemente, en las ulteriores investigaciones sobre vacunas. Es necesario investigar la presencia del VPH en muestras anatomopatológicas de neoplasias y cánceres cervicouterinos en el Caribe.

RESUMO Objetivo. Comparar a adequação, o nível de concordância e a aceitabilidade do exame de Papanicolau (citologia) para o rastreamento do câncer do colo do útero usando amostras autocoletadas em comparação com amostras coletadas por médicos em Granada, no Caribe. Além disso, o estudo identifica os genótipos de papilomavírus humano (HPV) presentes entre as mulheres assintomáticas com resultado positivo para HPV, a causa etiológica do câncer do colo do útero. Métodos. As participantes foram divididas em dois grupos, e duas amostras cervicais foram coletadas das mulheres de cada grupo: uma amostra autocoletada e uma amostra coletada por um médico. As amostras cervicais foram submetidas a exames citológicos e de HPV. A genotipagem do HPV foi realizada nas amostras positivas. Resultados. As amostras autocoletadas eram adequadas e compatíveis com as amostras coletadas por médicos, não havendo diferença entre os dois métodos de amostragem. Foram identificados genótipos de HPV de alto risco oncogênico em amostras cervicais positivas para células escamosas atípicas e lesões intraepiteliais escamosas de baixo grau. Os genótipos de HPV de alto risco encontrados, principalmente HPV 45 e 53, não correspondiam aos genótipos registrados com mais frequência na literatura. Embora os genótipos de alto risco HPV 16 e 18, que são frequentemente registrados, tenham sido observados, também foram detectados os genótipos 31, 33, 35, 52, 66, 68 e 82. Conclusões. O uso da autocoleta facilitou a detecção de genótipos inesperados de HPV entre mulheres assintomáticas em Granada. Esses achados adicionaram novas informações à literatura sobre o rastreamento de neoplasias e câncer do colo do útero e sobre os genótipos de HPV no Caribe. Essas informações genotípicas podem afetar a vigilância de mulheres com lesões de baixo grau, a seleção da vacina contra o HPV e, possivelmente, futuras pesquisas sobre vacinas. É necessário pesquisar o HPV em amostras patológicas de neoplasias cervicais e câncer do colo do útero no Caribe.

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Fundamento: El panorama económico y epidemiológico ha repercutido en la salud bucal de las comunidades rurales. Objetivo: Describir el estado de salud bucal, así como identificar factores de riesgo en 16 campesinos de la comunidad rural La Picadora. Metodología: En 2022 se realizó un estudio transversal descriptivo en 16 campesinos de la comunidad rural La Picadora, Yaguajay, Sancti Spíritus. Se hicieron entrevistas y examen bucal. Se calcularon indicadores epidemiológicos estomatológicos en el SPSS 16 y se resumieron los factores de riesgo mediante estadística descriptiva. Resultados: El índice de COP-D fue de 10.7 con predominio de dientes perdidos, el índice gingival fue de 1.4 y el de placa bacteriana de 1.0. Fue frecuente el desgaste de incipiente a moderado en menores de 60 años y de moderado a severo en mayores de 60 años. El 75 % de la muestra presentó oclusión normal o maloclusión mínima y el 94 % necesitó rehabilitación protésica. El 81.2 % consumió bebidas alcohólicas en los últimos 30 días, el 62.5 % ha fumado o fuma actualmente, el 87.5 % refirió el cepillado diario menor de 3 veces y el 43.8 % no asistió al estomatólogo en los últimos 10 años. Conclusiones: Se identificó la necesidad de atención estomatológica, así como la urgencia de acciones de prevención y promoción en esta comunidad.

Background: The economic and epidemiological panorama has impacted on oral health in rural communities. Objective: To describe the oral health status, as well as to identify risk factors in 16 farmers from the La Picadora rural community. Methodology: In 2022, a descriptive cross-sectional study was conducted in 16 farmers in the La Picadora rural community, Yaguajay, Sancti Spíritus. Interviews and oral examination were performed. Stomatological epidemiological indicators in SPSS 16 were calculated and risk factors were summarized using descriptive statistics. Results: The COP-D index was 10.7 with a predominance of missing teeth, The COP-D index was 10.7 with a predominance of missing teeth, the gingival index was 1.4 and the bacterial plaque index was 1.0. Incipient to moderate wear was frequent in people under 60 years of age and moderate to severe in over 60 years of age. 75% of the sample presented normal occlusion or minimal malocclusion and 94% required prosthetic rehabilitation. 81.2% consumed alcoholic beverages in the last 30 days, 62.5% have smoked or currently smokes, 87.5% referred the daily brushing less than 3 times a day and 43.8% did not attend a stomatologist in the last 10 years. Conclusions: The need for stomatological attention, was identified, as well as the urgency for prevention and promotion actions in this community.

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SETTING: Lima, Peru. OBJECTIVE: To close the gap in TB diagnosis, TB diagnostic services must match care-seeking preferences. We sought to identify preferred strategies for delivering TB diagnostic services and to determine whether preferences differ among demographic groups. DESIGN: During May 2022-January 2023, we recruited adults who recently initiated treatment for pulmonary TB. We used an object-case best-worst scaling instrument to assess the desirability of nine hypothetical strategies for delivering TB diagnostic services. A t-test was used to assess differences in preference scores between groups. RESULTS: Among 150 participants, the strategies with the highest preference scores were an integrated mobile unit offering screening for multiple conditions, expedited attention at the health center, and home-based screening. These were strongly preferred by 42%, 25%, and 27% of participants, respectively, and 80% of participants strongly preferred at least one of the three. Expedited attention at the health center scored more highly among people who experienced >2 months delay in TB diagnosis compared to those who experienced a more rapid diagnosis (0.37 ± 0.06 vs. 0.17 ± 0.06; P = 0.031). CONCLUSION: Providing person-centered TB diagnostic services at diverse access points could help reach different populations, which could promote early diagnosis and help close the diagnosis gap.

CONTEXTE: Lima, Pérou. OBJECTIF: Pour combler les lacunes dans le diagnostic de la TB, les services de diagnostic de la TB doivent correspondre aux préférences en matière de recherche de soins. Nous avons cherché à identifier les stratégies préférées pour la prestation de services de diagnostic de la TB et à déterminer si les préférences diffèrent entre les groupes démographiques. MÉTHODE: De mai 2022 à janvier 2023, nous avons recruté des adultes ayant récemment commencé un traitement contre la TB pulmonaire. Nous avons utilisé un instrument d'évaluation du meilleur et du pire pour évaluer la désirabilité de neuf stratégies hypothétiques de prestation de services de diagnostic de la TB. Un test-t a été utilisé pour évaluer les différences dans les scores de préférence entre les groupes. RÉSULTATS: Parmi les 150 participants, les stratégies ayant les scores de préférence les plus élevés étaient une unité mobile intégrée offrant un dépistage pour des conditions multiples, une attention accélérée au centre de santé et un dépistage à domicile. Ces stratégies ont été fortement préférées par 42%, 25% et 27% des participants, respectivement, et 80% des participants ont fortement préféré au moins l'une des trois. L'attention accélérée au centre de santé a obtenu un score plus élevé chez les personnes ayant subi un retard de diagnostic de la TB de plus de 2 mois que chez celles ayant subi un diagnostic plus rapide (0,37 ± 0,06 contre 0,17 ± 0,06 ; P = 0,031). CONCLUSION: La fourniture de services de diagnostic de la TB centrés sur la personne à divers points d'accès pourrait permettre d'atteindre différentes populations, ce qui pourrait favoriser un diagnostic précoce et contribuer à combler le fossé en matière de diagnostic.

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INTRODUCCIÓN: El estudio presenta perfiles integrales para usuarios de los Centros de Salud primaria de la comuna de Alto Hospicio. OBJETIVO: Conocer los perfiles de usuarios inscritos en los Centros de Salud de la comuna de Alto Hospicio desde una perspectiva integral e incorporando indicadores de satisfacción y conocimiento acerca del Modelo de Atención Integral de Salud Familiar y Comunitaria (MAIS). MATERIAL Y MÉTODO: Se elaboró un instrumento conformado por ocho dimensiones y 73 ítems, el cual se aplicó en cuatro centros de Atención de Salud Primaria de la comuna. Se realizó un muestreo aleatorio simple por cada Centro. En total se encuestaron a 1.124 personas, se obtuvo una representatividad de entre 95% y 93% de confianza, con niveles de significación que van de 5% a 7%. RESULTADOS: La caracterización usuaria pone en relevancia la diversidad de perfiles atendidos en cada Centro de Salud y revela problemáticas generales como la escasa información recibida respecto del modelo de atención familiar, el desconocimiento de los servicios prestados por los Centros de Salud y la dificultad de enfrentar situaciones de salud mental en el contexto de la pandemia COVID-19. CONCLUSIONES: Aquellos Centros de Salud que transmiten mayor información del MAIS presentan mejores indicadores respecto al conocimiento de los servicios de salud y de satisfacción usuaria. En el marco de la implementación del Modelo de Salud Familiar, es relevante conocer los perfiles de usuarios según las características de cada Centro de Salud, su población y territorio, y compartir buenas prácticas entre los Centros.

BACKGROUND: The study presents comprehensive profiles of Primary Health Care Centers of the Alto Hospicio Commune users. OBJECTIVE: To characterize users registered in the Health Centers of Alto Hospicio Commune from a comprehensive perspective, including satisfaction indicators and knowledge about the Comprehensive Family and Community Health Care Model (MAIS). METHODS: A questionnaire of 8 dimensions and 73 items was designed and applied in 4 Primary Health Care Centers in the commune. Four simple random samplings were applied. In total, 1,124 users were surveyed. The confidence and significance levels were between 95%-93% and 5%-7%, respectively. RESULTS: The user profile highlights the diversity in each Health Care Center and reveals general problems such as the lack of information regarding the family care model and services provided by the Health Care Centers and the difficulty of facing mental health situations in the context of the COVID-19 pandemic. CONCLUSIONS: Those Health Centers that provide more information about MAIS show better indicators regarding knowledge of health services and user satisfaction. The changes in public health policies and the implementation of the Comprehensive Family and Community Health Care Model require clarifying user profiles according to the characteristics of each health center, its population, and the territory, as well as sharing best practices between health centers.

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Introduction: Given the progressive aging of the population, there is an urgent need at the health system level to implement effective models to care for older people (OP). Healthy aging is imperative to reach the Sustainable Development Goals. The World Health Organization (WHO) developed the Integrated Care for Older People (ICOPE) strategy to address this challenge. Implementing ICOPE requires its adaption to a specific context. We propose a pathway for such adaptation through an evaluation of the design of ICOPE; thus, we aim to describe the Theory of Change (ToC) of ICOPE and evaluate it for its implementation in Mexico City. Methods: Based on the WHO and published literature documentation, we drafted an initial ToC for ICOPE. Then, we validated the ToC with experts in ICOPE, after which we evaluated and refined it by discussing the causal pathway, intervention required to activate it, rationale, and assumptions in consecutive workshops with 91 stakeholders and healthcare workers, using the nominal group technique to reach a consensus. Results: The resulting ToC has the potential to contribute to healthy aging by three expected impacts: (1) prevention, reversal, or delaying of the decline of intrinsic capacity (IC) in OP; (2) improvement of the quality of life of OP; and (3) increase of disability-free life expectancy. The ICOPE causal pathway had ten preconditions, including the availability of resources, identifying at-risk individuals, available treatments, and evaluating results. Discussion: We adapted ICOPE to a specific implementation context by evaluating its ToC in a participatory process that allows us to identify challenges and address them, at least in terms of the guidelines to operate the strategy. As ICOPE is an approach for a primary healthcare system, its adoption in a community healthcare program is promising and feasible. Evaluation as a tool could contribute to the design of effective interventions. The evaluation of the design of ICOPE for its implementation contributes to the strength of its potential to improve care for OP. This design for implementing ICOPE has the potential to be applied to similar contexts, for example, in other lower-middle-income countries.

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Objective: To identify and describe innovative initiatives implemented as a response to the interruption of health services during the COVID-19 pandemic in Latin America and the Caribbean (LAC). Methods: This was a descriptive study that reviewed 34 initiatives implemented during the COVID-19 pandemic in LAC to address health services needs among deprioritized groups. The review of initiatives included four phases: a call for submissions of innovative initiatives from LAC countries; a selection of initiatives that had the ability to address health services gaps and that were innovative and effective; systematization and cataloging of the selected initiatives; and a content analysis of the information collected. Data were analyzed from September to October 2021. Results: The 34 initiatives show important variations regarding the target populations, the stakeholders involved, level of implementation, strategies, scope, and relevance of the innovative initiative. There was also evidence of the emergence of a bottom-up set of actions in the absence of top-down actions. Conclusion: The findings of this descriptive review of 34 initiatives implemented during the COVID-19 pandemic in LAC suggest that systematizing the strategies and lessons learned has the potential to expand learning for re-establishing and improving post-pandemic health services.

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AIM: We evaluated the impact of inpatient and outpatient treatment provided by an infant nutrition foundation in Las Heras, Mendoza, Argentina and identified the factors that influenced nutritional recovery. METHODS: This 2010-2018 retrospective study was based on 300 children up to 5 years of age with primary malnutrition, who were treated by an inpatient recovery centre, then an outpatient prevention centre. We analysed the children's height, weight, psychomotor development and living conditions when they were admitted, discharged and had received 1 year of outpatient treatment. There were full data on 241 children and just admission and discharge data for 59. RESULTS: The children's mean age on admission and weight were 14.8 ± 12.4 months and 6.9 ± 2.3 kg and they stayed in hospital for a mean of 59.5 ± 49.7 days. We observed a significant increase in the weight-for-age, height-for-age and weight-for-height z-scores when all three time points were compared (p < 0.001). Psychomotor development improved considerably in all patients after treatment. The factors that negatively influenced nutritional recovery were higher age at admission, suboptimal breastfeeding practices, low birth weight, longer hospital stays, younger maternal age and overcrowded housing. CONCLUSION: Combining inpatient recovery and outpatient preventive treatment was effective for undernourished children in Argentina.

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AIMS AND OBJECTIVES: To illustrate the scope of different types of transitional, community-based health interventions for formerly incarcerated women, trans and nonbinary people, the eligibility criteria for these interventions, and associated health outcomes. BACKGROUND: Meeting the health needs of formerly incarcerated people in community, rather than through the criminal justice system, may prevent further experiences of criminalization. Research is needed to understand what community-based health interventions have been implemented internationally to inform the design of an intervention in Canada. DESIGN: Scoping review using the Joanna Briggs Institute scoping review methodology. METHODS: In consultation with a medical research librarian, key databases and journals were searched for English language articles, from any country, with no specified date range. Three authors independently screened titles and abstracts to identify articles for full-text review. The study adheres to PRISMA-EQUATOR guidelines. RESULTS: Thirty-six studies met the present criteria and were reviewed in full text. Method, setting, participants, sample, relevant outcomes and relevant findings were extracted from each study for synthesis. Included studies had varied methods and were published from 1999 to 2020. Thirty-one studies were based in the United States, one in Puerto Rico and two each in Canada and the United Kingdom. The most common health issue focus was human immunodeficiency virus and/or hepatitis c virus. The most common outcome was uptake of offered services, such as a transitional clinic. CONCLUSIONS: Gaps in the research pertain to a lack of attention to clinical outcomes and patient experience, and a lack of consideration of sexual and reproductive health concerns. Women were the minority population in all studies that included both men and women; transgender participants were mentioned in only four of thirty-six studies. The specific needs of women, trans and nonbinary people must be taken into consideration. RELEVANCE TO CLINICAL PRACTICE: Nurses must be conscious of the elevated health risks associated with exposure to correctional institutions and the risks associated with the period of transition. PATIENT OR PUBLIC CONTRIBUTION: A member of the research team brings lived experience expertise with respect to the criminal justice system.

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Resumo Nesta entrevista à revista Saúde e Sociedade, a Dra. Cupertino faz um relato do seu engajamento para alcançar pessoas em situações desafiadoras como a pandemia de covid-19. O diálogo buscou conhecer experiências exitosas capazes de interromper ou reduzir a perpetuação das disparidades em saúde. Em sua trajetória profissional, perpassou pelo Instituto de Câncer de Wilmot (WIC), onde atua no momento, sempre apoiada em referências brasileiras importantes como Paulo Freire. No seu trabalho, percebe-se a utilização de estratégias que ultrapassam questões acadêmicas e trazem a comunidade para o protagonismo da pesquisa, permitindo que o processo de translação ocorra apropriadamente. Por fim, define as parcerias com países da América Latina como fundamentais para o desenvolvimento de ações de saúde direcionadas a imigrantes que vivem nos Estados Unidos, uma vez que a variável relações sociais é determinante para a saúde de uma comunidade. A fala da Dra. Cupertino revela, assim, um olhar distinto sobre realidades distantes, mas que podem contribuir para reflexões importantes em um mundo globalizado, no qual intercâmbios são cada vez mais frequentes.

Abstract In this interview with the journal Saúde e Sociedade, Dr. Cupertino talks about her actions to reach people under challenging situations, such as the COVID-19 pandemic. The dialogue aimed to learn about successful experiences capable of erasing or reducing the perpetuation of health disparities. In her professional career, she worked at the Wilmot Cancer Institute (WIC), her current employer, always supported by important Brazilian references such as Paulo Freire. Her research work uses strategies that go beyond academic issues and bring the community to the forefront, enabling an accurate translation process. Finally, she considers the partnerships with Latin American countries as fundamental for developing health actions towards immigrants living in the United States, since the social relations variable is crucial for community health. Dr. Cupertino's testimony thus reveals a distinct look at distant realities, which can contribute to important reflections in a globalized world where exchanges are increasingly frequent.

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ABSTRACT Objective. To identify and describe innovative initiatives implemented as a response to the interruption of health services during the COVID-19 pandemic in Latin America and the Caribbean (LAC). Methods. This was a descriptive study that reviewed 34 initiatives implemented during the COVID-19 pandemic in LAC to address health services needs among deprioritized groups. The review of initiatives included four phases: a call for submissions of innovative initiatives from LAC countries; a selection of initiatives that had the ability to address health services gaps and that were innovative and effective; systematization and cataloging of the selected initiatives; and a content analysis of the information collected. Data were analyzed from September to October 2021. Results. The 34 initiatives show important variations regarding the target populations, the stakeholders involved, level of implementation, strategies, scope, and relevance of the innovative initiative. There was also evidence of the emergence of a bottom-up set of actions in the absence of top-down actions. Conclusion. The findings of this descriptive review of 34 initiatives implemented during the COVID-19 pandemic in LAC suggest that systematizing the strategies and lessons learned has the potential to expand learning for re-establishing and improving post-pandemic health services.

RESUMEN Objetivo. Detectar y describir iniciativas innovadoras instrumentadas como respuesta a la interrupción de los servicios de salud durante la pandemia de COVID-19 en América Latina y el Caribe (ALC). Métodos. Se trata de un estudio descriptivo en el que se examinaron 34 iniciativas instrumentadas durante la pandemia de COVID-19 en ALC para hacer frente a las necesidades de servicios de salud en grupos poblacionales desatendidos. La revisión constó de cuatro fases: convocatoria para la presentación de iniciativas innovadoras por parte de los países de la Región; selección de iniciativas capaces de abordar las deficiencias en los servicios de salud y que fueran innovadoras y eficaces; sistematización y clasificación de las iniciativas seleccionadas; y análisis del contenido de la información recopilada. Los datos se analizaron entre septiembre y octubre del 2021. Resultados. Las 34 iniciativas presentan importantes diferencias en cuanto a los grupos poblacionales destinatarios, las partes interesadas implicadas, el grado de aplicación, las estrategias, el alcance y la pertinencia de la iniciativa innovadora. También se constató el surgimiento de un conjunto de acciones generadas desde la base como respuesta a la ausencia de medidas aplicadas de forma descendente. Conclusión. Los resultados de esta revisión descriptiva de 34 iniciativas aplicadas en ALC durante la pandemia de COVID-19 sugieren que la sistematización de las estrategias y las enseñanzas extraídas podría ser útil para ampliar el aprendizaje con vistas al restablecimiento y la mejora de los servicios de salud pospandémicos.

RESUMO Objetivo. Identificar e descrever iniciativas inovadoras implementadas em resposta à interrupção dos serviços de saúde durante a pandemia de COVID-19 na América Latina e no Caribe (ALC). Métodos. Este estudo descritivo analisou 34 iniciativas implementadas durante a pandemia de COVID-19 na ALC para atender às necessidades de serviços de saúde entre grupos que haviam perdido prioridade. A análise das iniciativas incluiu quatro fases: chamada pública para a apresentação de iniciativas inovadoras de países da ALC; seleção de iniciativas inovadoras e efetivas capazes de abordar lacunas nos serviços de saúde; sistematização e catalogação das iniciativas selecionadas; e análise de conteúdo das informações coletadas. Os dados foram analisados de setembro a outubro de 2021. Resultados. As 34 iniciativas apresentam variações importantes com relação às populações-alvo, partes interessadas envolvidas, nível de implementação, estratégias, escopo e relevância da iniciativa inovadora. Também houve evidências do surgimento de um conjunto de ações de baixo para cima (bottom-up) na ausência de ações de cima para baixo (top-down). Conclusão. Os resultados desta análise descritiva de 34 iniciativas implementadas durante a pandemia de COVID-19 nos países da ALC sugerem que a sistematização das estratégias e das lições aprendidas tem o potencial de ampliar as oportunidades de aprendizado para reestabelecer e aprimorar os serviços de saúde pós-pandemia.

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Introduction: In Brazil, the Unified Health System (SUS) controls and oversees public health care, and the Family Health Strategy (FHS) is its primary access, with 60% of the population registered in it. The surveillance of risk factors for cardiovascular diseases (CVD) is the responsibility of the FHS. In 2010, the American Heart Association (AHA) proposed the evaluation of seven metrics (smoking, Body Mass Index (BMI), physical activity, diet, total cholesterol, blood pressure and blood glucose) with an aim to monitoring cardiovascular health (CVH). However, the results of the FHS regarding the CVH of the Brazilian population are unascertained. Objective: Evaluate the control of CVH among adult patients treated by the FHS in the city of Aracaju, Sergipe, Brazil. Material and methods: A cross-sectional study was conducted using the seven metrics recommended by the AHA to evaluate CVH among patients treated by the FHS. The city of Aracaju has a population of 571,149 inhabitants, with 394,267 > 20 years of age; therefore, it was admitted that in a simple random sample, sampling error of 5% with 95% CI, 329 individuals would be needed. Results: Among 400 patients, only 32.5% had controlled CVH. In a univariate analysis, the adjusted multivariate analysis found that being female (aOR: 2.07 IC: 1.20 to 3.60 p: 0.006) under 45 years old (aOR: 1.61 IC: 1.15 to 2.28 p: 0.006) and with the habit of following health advice from family members and neighbors (aOR: 1.28 IC: 1.15 to 2.28 p: 0.040) were associated with control of CVH. On the other hand, those ones who had a greater number of children (aOR: 0.91 IC: 0.84 to 0.95 p: 0.020) were associated with less control of CVH. Conclusions: The study showed that only 32.5% of patients have controlled CVH. Being a woman, young and following health advice from family members and neighbors have a positive influence in controlling CVH. More children reduced controlling these metrics.

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RESUMO O objetivo deste estudo foi analisar a produção científica sobre a continuidade do cuidado e a integralidade da atenção, identificando dispositivos utilizados para essa construção a partir do hospital. A presente investigação é uma revisão integrativa realizada nos meses de junho e julho de 2021. Assim, para a seleção dos artigos, utilizou-se das bases de dados PubMed/Medline, Lilacs, BDENF e Lis. Foram analisados 36 artigos. Da análise, emergiram três categorias: Cuidado em saúde e integralidade dentro do hospital; O enlace e as conexões na continuidade do cuidado; Redes de atenção à saúde no Sistema Único de Saúde e a continuidade do cuidado. A análise permitiu identificar estratégias/ferramentas sobre a organização do trabalho na dimensão micropolítica da produção do cuidado em saúde. Os principais dispositivos encontrados foram: alta segura, corridas de leitos, gestão da clínica, discussão de casos, linhas de cuidado, enfermeira de enlace, complexos reguladores, educação permanente e multidisciplinaridade. Concluiu-se que, embora alguns estudos se refiram a uma prática na rede de atenção à saúde ainda fragmentada, os dispositivos mencionados constituem-se em avanços em direção a um modelo de atenção baseado em linhas de cuidado dentro do hospital e para fora, buscando articulação com a rede de atenção à saúde.

ABSTRACT The aim of this study is to analyze the scientific production on the continuity and comprehensiveness of care, identifying devices used for this construction starting from the hospital. This research is an integrative review carried out in June and July 2021. Thus, PubMed/Medline, Lilacs, BDENF, and Lis databases were used for the selection of articles. Thirty-six articles were analyzed. Three categories emerged from the analysis: Health care and comprehensiveness within the hospital; The linkage and connections in the continuity of care; Health care networks in the Unified Health System and continuity of care. The analysis allowed identifying strategies/tools on the organization of work in the micropolitical dimension of health care production. The main devices found were: safe discharge, bed races, clinic management, case discussion, care lines, liaison nurses, regulatory complexes, continuing education, and multidisciplinarity. It was concluded that, although some studies are related to a practice in the still fragmented health care network, the mentioned devices constitute advances towards a model of care based on lines of care within and outside the hospital seeking articulation with the health care network.

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We describe the experience of integrating COVID-19 screening and testing into a mobile TB screening unit in Lima, Peru. All attendees received chest radiographs, which were analysed using CAD4TB and CAD4COVID; Xpert MTB/RIF Ultra was used to test for TB, and antibody and polymerase chain reaction (PCR) for SARS-CoV-2. One Xpert-positive TB case was diagnosed per 168 people screened, one person with SARS-CoV-2 antibodies per 3 people screened, and one PCR-confirmed SARS-CoV-2 infection per 8 people screened. Integrated screening can help to avoid delays in the diagnosis of both TB and COVID-19.

Nous décrivons l'expérience de l'intégration du dépistage et du test COVID-19 dans une unité mobile de dépistage de la TB à Lima, au Pérou. Toutes les personnes présentes ont reçu des radiographies pulmonaires, qui ont été analysées à l'aide de CAD4TB et CAD4COVID ; Xpert® MTB/RIF Ultra a été utilisé pour le dépistage de la TB, et les anticorps et la réaction en chaîne par polymérase (PCR) pour le SARS-CoV-2. Un cas de TB Xpert-positif a été diagnostiqué pour 168 personnes dépistées, une personne présentant des anticorps du SARS-CoV-2 pour 3 personnes dépistées et une infection du SARS-CoV-2 confirmée par PCR pour 8 personnes dépistées. Le dépistage intégré peut contribuer à éviter les retards dans le diagnostic de la TB et du COVID-19.

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Introducción: Se ha reportado baja satisfacción con la atención recibida en el primer y el segundo nivel de atención de instituciones públicas. Existe incremento del uso de la medicina tradicional. Objetivo: Comparar el nivel de satisfacción percibida por los pacientes que acuden a los servicios de medicina alópata y medicina tradicional. Métodos: Estudio descriptivo, transversal y comparativo. La población estuvo constituida por pacientes que acudieron al Centro de Salud Urbano y curandero de medicina tradicional de la misma comunidad. El tamaño de la muestra fue de 344 personas, seleccionados por muestreo sistemático. Resultados: La media de edad fue de 40,6 años (DE=16,1), predominó el sexo femenino, los casados, con educación primaria y de religión católica. El padecimiento por el cual acudieron a los servicios de medicina alópata fue por consulta familiar y en la medicina tradicional por espanto. Se encontraron diferencias significativas entra la satisfacción medicina tradicional y alópata. Los pacientes reportan mayor satisfacción en los servicios de medicina tradicional. Conclusiones: Los pacientes perciben mayor satisfacción en la explicación, trato y tratamiento médico en la medicina tradicional(AU)

Introduction: Low satisfaction with the care received at the first and second levels in public institutions has been reported. There is an increase in the use of traditional medicine. Objective: To compare the level of satisfaction perceived by patients attending allopathic and traditional medicine services. Methods: Descriptive, cross-sectional and comparative study. The population consisted of patients attending the Urban Health Center and traditional medicine healer in the community of Oaxaca. The sample size was 344 people, selected by systematic sampling. Results: The mean age was 40.6 years (SD=16.1). There was a predominance of the female sex, married persons, with primary education and Catholic religion. The condition for which they sought allopathic medicine services was that they received family advice and, in traditional medicine, for fear. Significant differences were found between satisfaction with traditional and allopathic medicine. Patients report greater satisfaction in traditional medicine services. Conclusions: Patients perceive greater satisfaction in the explanation, treatment and medical treatment in traditional medicine(AU)

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