[A conceptual framework for good preventive practices (or for quaternary prevention)].

Prevention is universally advocated, especially in the case of noncommunicable diseases. However, given the proliferation of preventive technologies, it does not seem defensible to generically encourage preventive behaviors and tests for healthcare professionals and users. In this essay, we articulate concepts, ideas and criteria for considering preventive measures, providing a minimum guide to be used by professionals (especially in primary healthcare) and managers.

Obstacles to SUS universalization: tax expenditures, labor union demands and health insurance state subsidy.

In the light of the comparative analysis of health systems, we discuss three strategic phenomena for the SUS universalization, as follows: a) health tax expenditures; b) State funding of private plans for public servants; and c) trade union's demand for private health plans. Among the ideal types of health systems, SUS is universal in law, but hybrid in practice: Beveridgian in primary health care (PHC) and mixed in specialized/hospital care; without really being universal (public spending is only 43% of total health expenditure). There is a massive state subsidy to the private sector, through health tax expenditures (30% of the federal health budget) and financing of private plans for public servants, which generates incoherence, segmentation of the health system and inequities.

[From yoga to psychosocial care in Primary Health Care: a hermeneutic study on the ethical values and principles of the Yoga Sutras of Patañjali].

The scope of this article is to interpret ethical values and principles of the yoga tradition and discuss them with a view to possible contributions to psychosocial care in Primary Health Care (PHC). A theoretical-hermeneutic study was conducted, in which concepts contained in the Yoga Sutras of Patañjali were interpreted from the standpoint of mental health. It was revealed that the values found in the texts can enrich the existing practices of yoga for PHC users (who suffer from afflictions inherent to life) by providing ideas and guidelines that promote a sense of liberation from suffering.

[Complementary and alternative medicine and social medicalization: lack of definitions, risks, and potentials in primary healthcare].

Complementary and Alternative Medicine (CAM) need to be increasingly understood in the academic and research setting, given their growing inclusion in health institutions and scientific studies. However, vague definitions or broad generalizations are common in the Brazilian scientific literature, an example of which is the relationship between CAM and social medicalization. This study aims to discuss the medicalizing and de-medicalizing potential of the use of CAM, especially in primary healthcare (PHC).

Profile of acupuncture use among primary care physicians working in the Brazilian public healthcare system.

Background: An introductory acupuncture course has been offered to primary health care physicians and family medicine residents in southern Brazil since 2011.

Objective: To analyze the profile of acupuncture utilization of primary care physicians who completed an introductory course of acupuncture between 2011 and 2018.

Method: A survey using an electronic questionnaire was sent to all 119 physicians who completed the course.

Characteristics and performance of professionals of the Expanded Family Health and Basic Healthcare Centers.

Objective: To analyze the characteristics and performance of the teams of the Expanded Family Health and Basic Healthcare Centers (Nasf-AB) of Santa Catarina state.

Method: A multicenter study implementing mixed methods, a sample of 149 municipalities (50.5% of the state) and 359 professionals through applying a survey and collective interviews with five teams of 43 professionals.

[Supply of Integrative and Complementary Health Practices in the Family Health Strategy in Brazil].

The article analyzes the supply of Integrative and Complementary Health Practices in the Family Health Strategy (FHS), based on the agreement between answers by administrators and health professionals. This was a quantitative descriptive-exploratory study using two databases, the National Survey on Integrative and Complementary Practices in Health in the Unified National Health System (SUS) and the National Program for Improvement of Access and Quality of Basic Care (PMAQ). According to the administrators, the supply of Integrative and Complementary Health Practices was present in the FHS in 26.

Prevalence and associated factors with integrative and complementary practices use in Brazil.

The aim of the current study was to investigate the prevalence of the use the integrative and complementary practices (ICP) and its associated factors in Brazil. Data was obtained from the cross-sectional National Health Survey 2013 (NHS), which had 145,580 adults aged 18 or over were interviewed. The outcome was the use of any ICP over the last 12 months and independent variables were macro-region, sex, age, educational attainment, skin color/race, and chronic disease.

Auriculotherapy in primary health care: A large-scale educational experience in Brazil.

Auriculotherapy consists of physical stimuli applied to the outer ear and is commonly associated with traditional Chinese medicine (TCM). The authors present and discuss the development of a course that offers a semi-on-site auriculotherapy course for Brazilian primary health care (PHC) professionals. The course was funded by the Brazilian Ministry of Health and developed at the Federal University of Santa Catarina in 2015 by a team of experts in auriculotherapy.

Scheduling models and primary health care quality: a multilevel and cross-sectional study.

Objective: To evaluate whether the scheduling model influences the perception of the user about the quality of primary health care centers.

Methods: This is a cross-sectional and population-based study that measured the quality of centers by the Primary Care Assessment Tool (PCATool-Brazil), applied to adult users (n = 409) from 11 health centers in Florianópolis, state of Santa Catarina. Multilevel analysis was used to verify the relationship between the score of general quality of the primary health care and the scheduling model.

Evaluation of Primary Health Care performance in Florianopolis, Santa Catarina, Brazil, 2012: a cross-sectional population-based study.

Objective: to evaluate the performance of Primary Health Care (PHC) in Florianopolis, SC, Brazil.

Methods: this was a cross-sectional population-based study with adults living in the catchment areas of the Health Centers (HC) located in the Northern Health District of Florianópolis in 2012; the Primary Care Assessment Tool (PCATool-Brazil) was applied do assess the presence and extent of PHC characteristics.

Results: of the 598 interviewees, 68,4% reported that they considered PHC centers to be their usual source of care; while the usage subdimension of the First Contact Access characteristic was the best evaluated (8.

[Chinese medicine/acupuncture: historical notes on the colonization of a body of knowledge].

Western colonialism influenced the encounter between traditional and modern knowledge from the nineteenth century onwards, resulting in the overlapping of Western medicine as a privileged form of knowledge. In 1958 the hybridization between Chinese and Western medicines became official under the name of traditional Chinese medicine and, through the development of biomedical research on acupuncture, it distanced itself from traditional knowledge. This essay presents historical changes experienced by Chinese medicine/acupuncture and discusses the effects of its absorption by modern medical reasoning from a postcolonial standpoint.

Use of Complementary and Alternative Medicine in primary healthcare in Florianópolis, Santa Catarina, Brazil: user perception.

This is a partial analysis of the outcome of a survey looking at user perception of the institutional use of Complementary and Alternative Medicine (CAM) in Florianópolis healthcare centers. Structured interviews were applied to users treated with CAM in the locations offering this option most often, using data-based theory as a theoretical-methodological reference. For the most part, the use of CAM was proposed by basic health professionals (the operators of biomedical care), initially as a preferred alternative to biomedicine.

Why is quaternary prevention important in prevention?

Quaternary prevention consists in the identification of persons at risk of excessive medicalization and their protection against new unnecessary interventions, avoiding iatrogenic damages. Here, we argue about the importance of quaternary prevention in specific primary and secondary prevention. The recent great development of preventive medicine, biomedicalization of risks and their treatment as if they were diseases, and the powerful influence of the commercial interests of pharmaceutical industries on the production of medical-sanitary knowledge alter classifications, create diseases and pre-diseases, lower cutoff points, and erase the distinction between prevention and healing.

[Specialized outpatient care in the Unified Health System: how to fill a void].

The structuring of specialized outpatient care is a bottleneck in the operation of the Unified Health System. Based on a brief discussion about this void in an organizational model, we propose the federal induction of a format of specialized services from the experiences of Centers of Support for Family Health (NASF). They adapted matrix operations and constitute an excellent prototype for the organization of specialized outpatient care.

[Traditional and Complementary Medicine in Brazil: inclusion in the Brazilian Unified National Health System and integration with primary care].

This study aimed to analyze the inclusion of Traditional and Complementary Medicine in Brazilian Unified National Health System (SUS) and its integration with primary healthcare (PHC). A qualitative study drew on institutional data, indexed articles, and case studies in selected Brazilian cities: Campinas (São Paulo State), Florianópolis (Santa Catarina State), Recife (Pernambuco State), Rio de Janeiro, and São Paulo. The analysis adopted the perspective of inclusion of Traditional and Complementary Medicine in the healthcare network and its integration with primary healthcare, based on the following dimensions: presence of Traditional and Complementary Medicine on the municipal agenda; position in the services; mode of access to Traditional and Complementary Medicine; Traditional and Complementary Medicine practitioners; types of practices; demand profile; and potential for expansion in the SUS.

Differentiating clinical care from disease prevention: a prerequisite for practicing quaternary prevention.

This article contends that the distinction between clinical care (illness) and prevention of future disease is essential to the practice of quaternary prevention. The authors argue that the ongoing entanglement of clinical care and prevention transforms healthy into "sick" people through changes in disease classification criteria and/or cut-off points for defining high-risk states. This diverts health care resources away from those in need of care and increases the risk of iatrogenic harm in healthy people.

Integrating acupuncture into primary health care: the experience of an educational model implemented within the Brazilian Unified Health System in Florianópolis.

Objective: Primary health care (PHC) is the main entry point and the first level of contact for individuals, families and communities within the Brazilian public health system. Considering that few studies have investigated the use of acupuncture in PHC, this article presents our experience in the city of Florianópolis when integrating acupuncture into PHC using an educational programme developed to teach acupuncture to primary care physicians (PCPs).

Methods: The course programme was designed using the WHO standards for acupuncture training and discussed at three consensus meetings.

[Why reconsider the recommendation of breast cancer screening?].

The aim of this article was to discuss the recommendation of mammogram screening for breast cancer and its technical basis. The first part discusses criteria for the decision, which should be consistent with high-quality scientific evidence. The second part discusses over-diagnosis (the greatest harm of screening) and its meaning in questioning the natural history of disease model.

Status and Impact of Acupuncture Research: A Bibliometric Analysis of Global and Brazilian Scientific Output from 2000 to 2014.

Objective: This bibliometric study was designed to evaluate the scientific output of Brazilian acupuncture publications and compare that output to the global trends in the same area.

Methods: The analyzed data were retrieved from the online version of Science Citation Index Expanded (SCI-E) database and covered the period from 2000 to 2014. The documents were searched by using the topic filter to find acupuncture-related documents (ARDs) and the title filter for acupuncture-specific documents (ASDs).

Mental health care practices in primary health care: an analysis based on experiences developed in Florianópolis, Brazil.

This article analyzes mental health care practices in primary health care (PHC) in the city of Florianópolis, which were based on proposals by Abilio Costa-Rosa regarding the asylum-psychiatric and psychosocial modes of care. The methods involved the following: a) the contextualization of the empirical field with documental analysis and interviews with managers; b) mapping interventions through interviews with professionals from nine selected Family Health Teams (ESF); c) deepening the understanding about these actions through observations and interviews with professionals and 20 case studies, which were systematized in accordance with the flowchart proposed by Merhy through interviews with service users and analysis of records. It was identified that the actions aimed at access and monitoring of the cases involved the whole team, and that medical and pharmacological treatment was centrally administered.