Instrumentos para la evaluación de la atención primaria de salud: una revisión narrativa

Objective: To conduct a narrative review about articles that present instruments used for primary health care evaluation worldwide.Materials and methods: The search was performed in PubMed, Embase, Cochrane, and Lilacs of articles published between 2008 and 2013. The descriptors used were: primary health care, health care evaluation mechanisms, questionnaires and validation study. The eligibility criteria for articles were three languages and validation studies. An analysis matrix was constructed by database with the characteristics of each item, then a final matrix was consolidated with the articles that met the inclusion criteria and the found instruments were analyzed. The data analysis was carried out by the two authors independently for greater objectivity.Results: 128 articles that met the inclusion criteria for the study were obtained. The percentage of instruments identified by analysis categories were: Lifestyle and chronic diseases 20.3%, PHC - Management 5.4% PHC - Relationship between Health equipment and User 23.4 %, Mental health 28, 9% and other subject areas 21.9%.Conclusions: There is a wide and varied availability of generic and specific instruments that have been validated in the global context for evaluating the primary health care strategy, from which it is possible to reconstruct the best evidence as a working tool.Objetivo: Realizar una revisión narrativa sobre artículos que presentan instrumentos utilizados para la evaluación de la atención primaria de salud a nivel mundial.Materiales y métodos: La búsqueda se realizó en Pubmed, Embase, Cochrane y Lilacs de artículos publicados entre 2008 y 2013. Los descriptores utilizados fueron: primary health care, health care evaluation mechanisms, questionnaires and validation study. Como criterios de elegibilidad de los artículos se incluyeron tres idiomas y estudios de validación. Se construyó una matriz de análisis por base de datos con las características de cada artículo, luego se consolidó una matriz final con los artículos que cumplieron con los criterios de inclusión y se analizaron los instrumentos encontrados. El análisis de la información se llevó a cabo por las dos autoras de forma independiente, para una mayor objetividad.Resultados: Se obtuvieron 128 artículos que cumplieron con los criterios de inclusión establecidos en el estudio. El porcentaje de instrumentos identificados por categorías de análisis fueron: Estilos de vida y enfermedades crónicas 20,3%, Estrategia de APS – Administración 5,4%, Estrategia de APS - Relación Equipo de salud Usuario 23,4%, Salud Mental 28,9% y otras áreas temáticas 21,9%.Conclusiones: Existe una amplia y variada disponibilidad de instrumentos genéricos y específicos que han sido validados en el contexto mundial para evaluar la estrategia de atención primaria de salud, sobre los cuales es posible reconstruir la mejor evidencia como herramienta de trabajo

La atención primaria de salud desde la perspectiva de los usuarios

Objective: To identify the characteristics of the development of the Primary Health Care strategy according to the users and factors that relate to the use of services. Materials and methods: Descriptive and mixed study. This study included 393 primary health care users. The sample selection was made according to established criteria. It used the focus group and the survey. The information was categorized and processed in SPSS 15.0. Results: The average age was 37.62 years. The main reasons for seeking care are recovering and disease prevent. The age was associated significantly with recover as one of the reasons for seeking attention p<0.05. The highest level of studies showed statistically significant association with recovery as a reason for requesting attention p <0.05 and the health status perception was associated with satisfaction with care last was offered or requested p<0.05. Conclusions: The activities were directed to priority groups. The users benefited from the services through family visit, health day, mobile unit and community meetings. The factors related to services use were age, gender, geographic accessibility, satisfaction with the last care received, health status perception and recovery as one of the reasons for seeking health care.Objetivos: Identificar lascaracterísticas del desarrollo de la estrategia de Atención Primaria de Saluddesde la perspectiva de los usuarios y los factores que serelacionan con la utilización de los servicios. Materiales y métodos: Estudio descriptivo, mixto. Muestra 393 usuarios beneficiarios de la estrategia. La selección de la muestra se realizó según criterios establecidos.Se utilizaron el grupo focal yla encuesta. La información fue categorizada y procesada en el SPSS 15.0.  Resultados: La edad promedio fue 37.62 años. Las principales razones para solicitaruna atención fueron recuperarse y prevenir la enfermedad. La edad se  asocio significativamente con recuperarse como una razón para solicitar una atenciónp<0.05, el máximo nivel de estudios presentó asociación estadísticamente significativa con recuperarse como una razón para solicitaruna atención p<0.05 y la percepción del estado de salud se asoció con la satisfacción con la ultima atención que se le ofreció o solicitó p<0.05. Conclusiones: Las actividades estaban dirigidas a grupos prioritarios. Los medios porlos cuales los usuarios se beneficiaron del servicio fueron visita familiar, jornada de salud, unidad móvil y reuniones comunitarias. Los factores que se relacionaron conla utilización de los servicios fueron edad, género, accesibilidad geográfica, satisfacción con la última atención recibida, percepción del estado de salud yrecuperarse como una razón para solicitar una atención

La atención primaria de salud desde la perspectiva del equipo de salud en una institución de primer nivel de atención

Objetivo: establecer las características de la estrategia de Atención Primaria de Salud (APS) en una institución de primer nivel de atención a partir del equipo que la ejecuta. Materiales y Métodos: Investigación cualicuantitativa. Población: 32 integrantes del Equipo de Atención Primaria (EAP) al momento del estudio. Técnicas: grupo focal y encuesta. La información se analizó retomando las características de la APS, y se procesó en el Statistical Package for the Social Sciences (SPSS) 15.0. Resultados: el EAP está conformado por personal médico  y asistencial. El 96.9% informó que la APS es el primer contacto de los usuarios con el servicio de salud. Las estrategias básicas son promoción de la salud, prevención de la enfermedad, detección temprana y protección específica. El 75.8% realiza educación en todos los grupos poblacionales. La estrategia posee enfoque comunitario. La atención ha sido a través de visita familiar (81.3%), unidad móvil y jornadas de salud (68.8%). La frecuencia de visitas familiares es según el riesgo. El 81.3% afirmó que existe una coordinación de los servicios con otros niveles y que se articulan con otros actores. Existe asociación y dependencia entre la motivación para hacer parte del EAP como formación profesional y el convencimiento de la relevancia de la estrategia con la satisfacción en la atención brindada p<0,05. Conclusiones: el EAP tiene un enfoque comunitario, incluye todos los grupos poblacionales, desarrolla acciones de promoción de la salud, prevención de la enfermedad, protección específica y detección temprana. Se integra con otros niveles e instituciones.Palabras clave: Motivación, gestión en salud, centros de salud, Colombia. The primary health care from the perspective of the health team in a first level care institution Abstract Goal: To establish the characteristics of the strategy of Primary Health Care (PHC) in an institution of primary care from the team which implements it. Materials and Methods: Qualitative and quantitative research. Population: 32 members of the Primary Care Team (EAP) at the time of the study. Techniques: focus group and survey. Data was analyzed taking account the characteristics of the APS, and it was processed in the Statistical Package for the Social Sciences (SPSS) 15.0. Results: The EAP is made by medical and nursing staff. 96.9% reported that PHC is the first contact with service users health. The basic strategies are health promotion, disease prevention, early detection and specific protection. The education takes 75.8% in all population groups. The strategy has a community focus. Attention has been through family visits (81.3%), movil units and health journeys (68.8%). The frequency of family visits are according to risk. 81.3% said that there is a coordination of services with other levels and it articulates with other factors. A relationship between motivation and dependence to EAP as part of vocational training and the conviction of the relevance of the strategy with the care given satisfaction p <0.05. Conclusions: The EAP has a community focus , it includes all population groups and develops actions to promote health, disease prevention, early detection and specific protection. It is Integrated with other levels and institutions.Keywords: Motivation, health management, health centers, Colombia. Primária da equipe de saúde na perspectiva da saúde instituição de um serviço de primeira classe Resumo Objetivo: estabelecer as características da estratégia de Atenção Primária à Saúde (APS) em uma instituição de cuidados de saúde primários da equipe que executa. Materiais e Métodos: pesquisa qualitativa e quantitativa. População: 32 membros da Equipa de Cuidados Primários (EAP) no momento do estudo. Técnicas: grupo focal e questionário. Os dados foram analisados retomando as características da APS, e processados no programa Statistical Package for the Social Sciences (SPSS) 15.0. Resultados: A EAP é feito por uma equipe médica e de enfermagem. 96,9% relataram que a APS é o primeiro contato com os usuários do serviço de saúde. As estratégias básicas são a promoção da saúde, prevenção de doenças, detecção precoce e proteção específica. A educação leva 75,8% em todos os grupos populacionais. A estratégia tem um foco da comunidade. Atenção tem sido através de visitas de familiares (81,3%), a unidade móvel e dias de saúde (68,8%). A freqüência de visitas de familiares de acordo com o risco. 81,3% disseram que há uma coordenação de serviços com outros níveis e articulada com outros atores. A relação entre a motivação ea dependência a EAP como parte da formação profissional e da convicção da relevância da estratégia com o cuidado dado satisfação p <0,05. Conclusão: A EAP tem um foco comunidade inclui todos os grupos da população, o desenvolvimento de ações de promoção da saúde, prevenção de doenças, detecção precoce e proteção específica. Integra-se com os outros níveis e instituições.Palavras-chave: Motivação, gestão de saúde, centros de saúde, na Colômbia.

Conhecimento popular em saúde de famílias de camponeses (Colômbia)

Objetivo. Comprender los saberes populares de las familias campesinas de Villamaría (Caldas, Colombia), a partir del rol de enfermería en la Atención Primaria de Salud. Método. Etnografía interpretativa con observación participante y entrevistas a profundidad. Participaron 7 familias de la zona rural dispersa. Se realizaron 29 visitas familiares (septiembre de 2017 a noviembre de 2018). El análisis se realizó con Atlas.ti mediante cuatro fases: recolección y registro de datos; agrupación, clasificación y codificación; identificación de patrones recurrentes, y hallazgos de investigación. Resultados. Se identificó el tema cultural “Con nuestros saberes populares salimos adelante y nos cuidamos”, justificado en tres patrones: “sobreviviendo con la familia, la espiritualidad y quienes nos apoyan”, “riesgos y experiencias ante la salud y enfermedad” y “con las comidas y métodos para cuidar sobrevivimos a los riesgos”. Conclusiones. Los saberes populares de las familias campesinas están formados por varios elementos en búsqueda de bienestar. Para la enfermedad, se encuentra sincretismo entre la medicina occidental y los métodos naturales, en especial con el manejo de las plantas. Los resultados aportan al currículo y atención de los profesionales de la salud, especialmente a enfermería al contribuir como respuesta a la normativa actual en salud.Objective. To understand the popular knowledge of the rural families of Villamaría (Caldas, Colombia), based on the role of nursing in Primary Health Care. Methods. Interpretive ethnography with participant observation and in-depth interviews. Seven families from the dispersed rural area participated. 29 family visits were made (September 2017 to November 2018). The analysis was performed with Atlas.ti, through four phases: data collection and recording; grouping, classification and coding; identification of recurring patterns, and research findings. Results. The cultural theme was identified “With our popular knowledge we go ahead and take care of ourselves”, justified in three patterns: “Surviving with the family, spirituality and those who support us”, “Risks and experiences in the face of health and illness” and “With the meals and caring methods we survive the risks”. Conclusions. The popular knowledge of peasant families consists of several elements in search of well-being. For the disease, syncretism is found between Western medicine and natural methods, especially the use of plants. The results contribute to the curriculum and attention of health sciences professionals, particularly those of nursing by contributing in response to current health regulations.Objetivo. Compreender o conhecimento popular das famílias camponesas de Villamaría (Caldas-Colômbia), desde o papel da enfermagem na Atenção Primaria em Saúde. Métodos. Etnografia interpretativa com observação participante e entrevistas a profundidade. Participaram 7 famílias da área rural dispersa. Foram realizadas 29 visitas familiares (setembro de 2017 até novembro de 2018). A análise foi feita com Atlas.ti, diante quatro momentos: recolecção e registro de dados; agrupação, classificação e codificação; identificação de padrões recorrentes, e achados de pesquisa. Resultados: foi identificado o tema cultural “Com o nosso conhecimento popular vamos em frente e a gente se cuidou”, justificado em três padrões: “sobrevivendo com a família, a espiritualidade e das pessoas que apoiam a gente”, “Riscos e experiências diante a saúde e a doença” e “Com as comidas e métodos pra cuidar sobrevivemos a os riscos”. Conclusões. O conhecimento popular das famílias camponesas está formado por vários elementos na procura de bem-estar. Pra doença, se encontra sincretismo entre a medicina ocidental e os métodos naturais, em especial no atendimento das plantas. Os resultados contribuem no currículo e atenção dos professionais das ciências da saúde, do jeito particular, os de enfermagem contribuindo como resposta a legislação atual de saúde

Residential Radon in Central and South America: A Systematic Review.

Radon gas is a pulmonary carcinogen and the second leading cause of lung cancer after smoking. There are many countries that have not implemented measures to reduce the risk it poses to the general population. The aim of this study was to locate available evidence on exposure to residential radon and the regulations to monitor and control this across Central and South America, by conducting a review of the scientific literature and government documents in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review included 31 studies which had taken measurements of radon in these countries. While Brazil, Argentina, and Peru have undertaken most research, no country in Central and South America has a national map of exposure to residential radon. The prevalence of exposure to radon was uneven, both among the different countries and within individual countries. No country has regulations to prevent the entry of radon into homes, and nine countries have not set maximum permissible concentrations for residential radon. There is a limited number of studies in South and Central America, with a limited spatial coverage, and there is a need to improve knowledge on exposure to residential radon and its effects, and for governments to take the necessary actions to introduce preventive measures in their statutory regulations

Quality of the instruments that value the functions of primary health : a systematic review.

Objetivo: evaluar las propiedades métricas de los instrumentos que valoran las funciones de la atención primaria en salud desde la perspectiva de usuarios. Métodos: revisión sistemática. Se utilizaron los descriptores “primary health care”, “questionnaires”, “psychometrics”, “outcome measurement” y “process measurement”. Los criterios de inclusión fueron publicaciones de revistas científicas en español, inglés y portugués, estudios de validación de cuestionarios que evaluaran funciones de la atención primaria en salud. Las propiedades métricas de los instrumentos se valoraron mediante el cuestionario EMPRO (por su sigla en inglés: Evaluating Measures of Patient Reported Outcomes). Resultados: se identificaron 28 artículos que cumplieron con los criterios de inclusión. Los cuestionarios que resultaron adecuados para su aplicación fueron 11, y de estos, ocho partían del PCAT (por su sigla en inglés: Primary Care Assessment Tool), ya que reunieron más evidencias sobre la calidad de sus propiedades métricas. Conclusiones: existen cuestionarios para evaluar las funciones esenciales de la atención primaria en salud. Las propiedades métricas del PCAT fueron adecuadas en la mayoría de las versiones adaptadas y validadas, por lo que permite obtener resultados confiables.Objective: To evaluate the metric properties of the instruments that value the functions of primary health care from the perspective of the users. Materials and methods: Systematic review. The “primary health care” descriptors, “questionnaires”, “psychometrics”, “outcome measurement”, and “process measurement” were used. The inclusion criteria were publications of scientific journals in Spanish, English and Portuguese, validation studies of questionnaires that evaluated functions of primary health care. The metric properties of the instruments were assessed using the EMPRO (by its acronym in English: Evaluating Measures of Patient Reported Outcomes) questionnaire. Results: A total of 28 descriptors that met the inclusion criteria were identified. Eleven questionnaires were suitable for application, and of these, eight came from the PCAT (by its acronym in English: Primary Care Assessment Tool), since they gathered more evidence on the quality of their metric properties. Conclusions: There are questionnaires to evaluate the essential functions of primary health care. The metric properties of the PCAT were adequate in most of the adapted and validated versions thus allowing reliable results

Residential Radon in Manizales, Colombia: Results of a Pilot Study

Radon is a colorless, odorless, and tasteless noble gas, causally related with the onset of lung cancer. We aimed to describe the distribution of radon exposure in the municipality of Manizales, Colombia, in order to estimate the population’s exposure and establish the percentage of dwellings that surpass reference levels. A cross-sectional study representing all geographical areas was carried out by measuring indoor radon concentrations. Participants answered a short questionnaire. Alpha-track type radon detectors were installed in all residences for six months. The detectors were subsequently processed at the Galician Radon Laboratory, an accredited laboratory at the University of Santiago de Compostela. A total of 202 homes were measured. Seventy-seven percent of the sampled houses were three stories high, their median age was 30 years, and half were inhabited by three people or fewer. For most dwellings, the building materials of walls and flooring were brick and covered cement, respectively. Results showed a geometric mean of radon concentration of 8.5 Bq/m3 and a maximum value of 50 Bq/m3. No statistically significant differences were found either between the geometric mean of the dwelling’s site, the height at which detectors were placed inside the home, or the wall and flooring materials, or between mean 222Rn concentrations in rural and urban areas. No dwelling surpassed the 222Rn reference level established by the WHO. This study shows that residential radon levels in Manizales, Colombia, seem to be low, though a more in-depth approach should be carried out. Despite these results, it is essential to create a national radon program and establish a radon concentration reference level for Colombia in line with international recommendationsThis study was funded by the Galician Radon Laboratory from the University of Santiago de Compostela (School of Medicine) and by the Institute of Health Research and Vicerrectorate of Research and post-graduate studies REF 0340220) of the University of Caldas (Manizales, Colombia)S

Serum cotinine cut-points for secondhand smoke exposure assessment in children under 5 years: A systemic review

Background Serum cotinine has become the most widely used biomarker of secondhand smoke exposure (SHS) over time in all ages. The aim of this study was to review the serum cotinine cutpoints used to classify children under 5 years as exposed to SHS. Methods A systematic review performed in the Pubmed (MEDLINE) and EMBASE databases up to April 2021 was conducted using as key words serum cotinine, tobacco smoke pollution (MeSH), secondhand smoke, environmental tobacco smoke and tobacco smoke exposure. Papers which assessed SHS exposure among children younger than 5 years old were included. The PRISMA 2020 guidelines were followed. Analysis was pre-registered in PROSPERO (registration number: CRD42021251263). Results 247 articles were identified and 51 fulfilled inclusion criteria. The selected studies were published between 1985-2020. Most of them included adolescents and adults. Only three assessed postnatal exposure exclusively among children under 5 years. None of the selected studies proposed age-specific cut-points for children < 5 years old. Cut-point values to assess SHS exposure ranged from 0.015 to 100 ng/ml. The most commonly used cut-point was 0.05 ng/ml, derived from the assay limit of detection used by the National Health and Nutrition Examination Survey (NHANES). Conclusions No studies have calculated serum cotinine age-specific cut-points to ascertained SHS exposure among children under 5 years old. Children's age-specific cut-points are warranted for health research and public health purposes aimed at accurately estimating the prevalence of SHS exposure and attributable burden of disease to such exposure, and at reinforcing 100% smoke-free policies worldwide, both in homes, private vehicles and public places

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Objetivo: profundizar en el tema de la promoción de salud como estrategia para el fomento de estilos de&amp;nbsp; vida saludables. Metodología: revisión sistemática de publicaciones científicas derivadas de investigaciones&amp;nbsp; y revisiones detalladas acerca de la promoción de la salud y los estilos de vida saludables, para lo cual se&amp;nbsp; tomaron como fuentes bibliográficas: las publicaciones de la Biblioteca Virtual de Salud, bases de datos como Proquest, LILACS, Dialnet, Ovid, Hinary, Medline e índices bibliográficos como Scielo, que fueron publicados&amp;nbsp; entre los años 1992-2009. Para determinar su pertinencia, los artículos y documentos fueron revisados a&amp;nbsp; partir de su resumen y los libros a partir de su tabla de contenido. Resultados: se obtuvo una descripción&amp;nbsp; detallada de la promoción de la salud como estrategia, sus componentes y la forma de aplicación. Respecto a los estilos de vida saludables, además de las definiciones se tuvieron en cuenta los factores tanto internos&amp;nbsp; como externos a las personas que intervienen para su fomento. Adicional a lo anterior, se encontró una&amp;nbsp; autora que halló en la promoción de la salud la base para proponer el “Modelo de Promoción de la Salud”,&amp;nbsp; que dado su aporte a la profesión de Enfermería, ha sido aplicado en la práctica profesional y utilizado para&amp;nbsp; la realización de trabajos de investigación en salud. Conclusión: la promoción de la salud se constituye como una estrategia encaminada a desarrollar procesos y actividades individuales o grupales con el fin de&amp;nbsp; modificar conductas de riesgo y adoptar estilos de vida saludables. De igual forma la promoción de la salud&amp;nbsp; apunta a que las personas y colectivos tengan una mejor calidad de vida, teniendo en cuenta que los seres&amp;nbsp; humanos son entidades biológicas y también entidades sociales que requieren ser intervenidas por los&amp;nbsp; profesionales de la salud como un todo para así conseguir personas y comunidades saludables.&amp;nbsp;Objective: extend the knowledge on health promotion as a strategy to encourage a healthy life style.&amp;nbsp; Methodology: systematic revision of scientific publications derived from detailed research and revisions on&amp;nbsp; health promotion and healthy life styles, using bibliographical sources such as: Virtual Health Library,&amp;nbsp; databases such as Proquest, LILACS, Dialnet, Ovid, Hinary, Medline and bibliographical indexes such as Scielo, published between 1992 and 2009. In order to determine their pertinence, the abstract of articles and&amp;nbsp; documents was used, and the table of contents was used in the case of books. Results: a detailed description of health promotion as a strategy, its components and application form. Regarding healthy life styles, in&amp;nbsp; addition to the definitions, internal and external factors of people were taken into consideration for&amp;nbsp; encouraging these life styles. An author used health promotion as the basis to propose “Health Promotion&amp;nbsp; Model” that given its contribution to the nursing profession, has been applied to the professional practice&amp;nbsp; and implemented in research projects regarding health. Conclusions: health promotion has become a&amp;nbsp; strategy oriented towards developing individual or group processes and activities in order to modify risky&amp;nbsp; behavior and to adopt healthy life styles. In the same manner, health promotion seeks that people and&amp;nbsp; groups have a better quality of life, considering that human beings are biological entities, but social beings as well, that require intervention by health professionals as a whole, in order to have healthy people and&amp;nbsp; communities

Trends in smoking-attributable mortality in Spain: 1990-2018

Background: This study sought to analyse the trend in smoking-attributable mortality (SAM) in Spain among the population aged ≥35 years across the period 1990-2018. Methods: SAM was estimated by applying a prevalence-independent method, which uses lung cancer (LC) mortality as a proxy of tobacco consumption. We sourced observed mortality from the National Institute of Statistics (Spain), LC mortality rates in smokers and never smokers from the Cancer Prevention Study I-II, and relative risks from 5 US cohorts. Estimates of annual SAM by cause of death, sex and age are shown, along with crude and annual standardised SAM rates. The trend in standardised all-cause and LC rates was analysed using a joinpoint regression model. Results: Tobacco caused 1 717 150 deaths in Spain in the period 1990-2018. Among men, cancers replaced cardiovascular diseases-diabetes mellitus (CVD-DM) as the leading group of tobacco-related cause of death in 1994. Among women, CVD-DM remained the leading cause of death throughout the period. Trend analysis of standardised SAM rates due to all causes and LC showed a decrease in men and an increase in women. Conclusions: The tobacco epidemic in Spain across the period 1990-2018 has had an important impact on mortality and has evolved differently in both genders. SAM is expected to increase dramatically in women in the coming years. SAM data highlight the importance of including a gender perspective in SAM analyses, in designing more effective and comprehensive public health interventions and in developing gender-specific tobacco control policies to curb tobacco consumption.This article forms part of the research conducting to the PhD degree of Julia Rey-Brandariz, who has received a FPU fellowship (reference number FPU20/00926), from the Ministry of Universities of Spain.S