ABSTRACT Purpose of review Coronary artery bypass grafting, revascularization by percutaneous coronary intervention, and heart valve surgery are crucial therapeutic interventions for patients with various cardiovascular diseases. The objective of this literature review was to present the main evidence and practical aspects of the perioperative management of patients undergoing coronary artery bypass grafting and heart valve surgery. Recent findings Despite advancements in surgical and anesthetic techniques, coronary artery bypass grafting and heart valve surgery present significant risks for perioperative complications and death. These complications increase morbidity, mortality, and length of hospital stay. Coronary artery bypass grafting is indicated for patients with significant left main or advanced coronary artery disease. Most patients undergoing coronary artery bypass grafting with a reasonable life expectancy are advised to adopt a multiple-arterial graft strategy using two or three arterial grafts. Revascularization by percutaneous coronary intervention is frequently performed to alleviate symptoms in patients with stable angina and coronary artery stenoses causing moderate or severe ischemia. Intraoperative coagulation management should include tranexamic acid after the induction of anesthesia and protamine immediately after the termination of extracorporeal circulation. The prophylactic use of fresh-frozen plasma, desmopressin, recombinant activated factor VII, or fibrinogen to reduce bleeding is not recommended. Inhaled anesthetics have recognized cardioprotective properties; however, it is unclear whether anesthesia with a volatile agent can reduce mortality in patients undergoing elective surgery. Echocardiography plays an important role in the perioperative management of patients by defining myocardial structure, assessing intracardiac blood flow, aiding preoperative evaluation, facilitating intraoperative monitoring, and providing real-time guidance for intervention. The perioperative management of patients undergoing coronary artery bypass grafting, percutaneous coronary intervention, and heart valve surgery is highly complex and involves numerous specific conditions. Effective management requires dedicated multidisciplinary teams skilled in timely recognition, prevention, and treatment to ensure appropriate care.

Abstract The city of São Paulo’s School Meals Program stands out as one of the biggest in the world. This study underscores the potential of sustainable government purchasing for school meals based on the already instituted municipal program and seeks to understand the frailties in the process of implementing the legislation. The study used primary and secondary sources with the secondary data obtained from documental research and primary data from semi-structured interviews with public agents implementing the program. Despite the provisions of the Program implementation legislation, the study analysis reveals various problems and challenges family farmers and the municipal government face to implement this program, ranging from conditions imposed by the Federal legislation for recognizing the São Paulo city producers as family farmers to the insufficiency of their production to meet the demand.

Resumo O Programa de Alimentação Escolar da cidade de São Paulo se destaca por ser um dos maiores do mundo. No estudo, enfatizamos o potencial das compras públicas sustentáveis para a alimentação escolar a partir do programa instituído no município, com o objetivo de compreender as fragilidades no processo de implementação da lei. O estudo se baseou em fontes primárias e secundárias, sendo que os dados secundários foram obtidos através de pesquisa bibliográfica, enquanto os dados primários foram obtidos por meio de pesquisa documental e por entrevista semiestruturada junto aos agentes públicos implementadores do programa. Apesar do que está preconizado na lei de implementação do Programa, a análise demonstrou que são diversos os desafios e problemas enfrentados pelos agricultores e pelo governo municipal para implementar este programa, desde condições impostas pela legislação federal para reconhecer os produtores locais como agricultores familiares até insuficiência de produção para atender a demanda.

Resumen Este estudio analiza el Programa de Alimentación Escolar de São Paulo, uno de los mayores a nivel mundial, como caso de referencia para evaluar cómo la contratación pública sostenible fortalece las iniciativas de alimentación escolar. Con un enfoque metodológico mixto, se utilizaron datos secundarios mediante revisión bibliográfica y datos primarios a través de análisis documental y entrevistas con funcionarios responsables. A pesar de un marco normativo robusto, los hallazgos revelan desafíos significativos, como barreras regulatorias en la legislación federal que dificultan el reconocimiento de productores locales como agricultores familiares y limitan la producción agrícola local para atender la demanda del programa. Estas limitaciones aumentan costos y profundizan la dependencia de productos importados. El propósito es identificar debilidades sistémicas en la implementación legislativa, contribuyendo al debate sobre la sostenibilidad en programas de alimentación escolar.

ABSTRACT: Solanum scuticum M. Nee, known as pickled jurubeba, displays significant commercial and ecological interest. Low seed germination rates; however, have comprised an obstacle to this species conservation and commercial viability. In this sense, this study investigated the presence and type of dormancy present in jurubeba seeds sampled from both unripe and ripe fruits. Chemical scarification (H2SO4 for 5, 10, 15 and 20 min), washing under running water (2 and 5 min), washing under running water for 5 minutes plus immersion in a neutral detergent solution for 15 minutes, immersion in detergent solution for 5 min, and the application of gibberellic acid (GA3) at different concentrations (500 and 1,000 ppm), and soaking times (24 and 48 hours) were all tested. Germination rates (%G), germination speed indices (GSI) and average germination times (AGT) were assessed. The GA3 treatment at 500 ppm and 48 hours of soaking resulted in the highest percentage of germinated seeds, of up to 84.5% for seeds from ripe fruits. These findings indicated the presence of physiological dormancy in jurubeba seeds and highlighted the effectiveness of GA3 in promoting the germination of ripe fruit seeds.

RESUMO: A espécie Solanum scuticum M. Nee, conhecida como jurubeba de conserva, possui grande interesse comercial e ecológico, no entanto, a baixa germinação das sementes tem sido um obstáculo para sua conservação e viabilidade comercial. Objetivou-se com este estudo investigar a presença e o tipo de dormência em sementes de jurubeba, amostradas em frutos verdes e maduros. Foram testados escarificação química (H2SO4 por 5, 10, 15 e 20 min); lavagem em água corrente (2 e 5 min); lavagem em água corrente por 5 min, mais imersão em solução de detergente neutro por 15 min; imersão em solução de detergente por 5 min; e aplicação de GA3 em diferentes concentrações (500 e 1.000 ppm) e tempos (24 e 48 horas) de embebição. Os parâmetros avaliados foram: %G, IVG e TMG. O tratamento com GA3 na concentração de 500 ppm e 48 horas de embebição resultou na maior porcentagem de sementes germinadas, 84,5% para sementes provenientes de frutos maduros. Os resultados indicaram a presença de dormência fisiológica nas sementes de jurubeba e destacaram a eficácia do uso de GA3 para promover a germinação em sementes de frutos maduros.

The present work explores the mechanochemical synthesis and computational study of C-C bond formation at the C-4 position of sodium 1,2-naphthoquinone-4-sulfonate (1, β-NQSNa) with dialkylanilines (2a-2f). This is the first example of using mechanochemistry without transition metal catalysts and solvents to produce 4-(4-(dialkylamino)phenyl)naphthalene-1,2-dione (3a-3f) from symmetric and non-symmetric N,N’-dialkylanilines in good to moderate yields. Preliminary, computational studies were conducted to explain the use of sterically hindered and less hindered anilines, which caused variations in the yields of the analogous products, suggesting the formation of π-π interactions between the anilines and the B ring of the naphthoquinone. Molecular modeling was performed using density functional theory (DFT), employing the hybrid functional M06-2X and the polarized valence triple-zeta basis set augmented for improved correlation (aug-cc-pVTZ).

Abstract Riparian zones are important areas for biodiversity and preservation, where springtails and fungi contribute to nutrient cycling and organic matter decomposition. This study aimed to report a mycophagy interaction involving a colony of Anurida granaria with Peziza arvernensis. In the riparian zone, the use of apothecia as a nutritional source for springtail colonies was investigated. The collected data were analyzed, considering the fungal structures and the number of springtails. A colony of 515 springtails found in the apothecium was observed over a period of 5 weeks. Feeding events, courtship behavior, molting, and oviposition were recorded. The survival and mortality rates of the colony fluctuated during the observation period but remained stable between weeks 4 and 5. This study presents the first report involving P. arvernensis and A. granaria in a mycophagic association, highlighting the significance of this dynamic in benefiting the life cycle and fungal dispersion in riparian zones.

ABSTRACT BACKGROUND: Detraining can partially or completely reduce training-induced metabolic adaptations. However, the duration for which the rehabilitation effects persist after detraining, especially in patients with heart disease, remains unclear. OBJECTIVES: To evaluate the principle of reversibility/detraining in patients with heart disease via the 6-minute walk test (6MWT) after a period of rest. DESIGN AND SETTING: A retrospective cohort study developed at the Rehabilitation Center of the Universidade Federal do Triângulo Mineiro in Uberaba/MG, Brazil. METHODS: This clinical, retrospective longitudinal study involved 20 patients with heart disease who underwent 5 months of supervised cardiac rehabilitation (CR). The mean age of participants was 64.05 ± 9.25 years. The initial rehabilitation was followed by an interruption period and rehabilitation for another 5 months. Functional capacity was assessed using the 6MWT. RESULTS: In the specific analysis of the distance covered, values of P = 0.03 and P = 0.01 were obtained on comparing post-training (669.64 ± 58.80 meters) with post-detraining (640.82 ± 101.23 meters) and post-detraining with post-retraining (650.82 ± 96.28 meters), respectively. No significant difference was observed for the comparison between training and retraining (P = 0.83). CONCLUSION: Cardiovascular rehabilitation positively stimulates functional capacity, whereas detraining significantly reduces it. The 6MWT is effective in measuring changes in physical capacity.

ABSTRACT Soils polluted by potentially toxic elements (PTEs) pose a high risk to human health and must be remediated. Applying biochar to such soils can reduce metal bioavailability and phytotoxicity, improving phytoremediation techniques. This study aimed to assess the effects of rice straw biochar (RSB) on mitigating metal stress and accumulation of Si, Cd, Pb, and Zn in corn plants grown in soil contaminated by metallurgy slag. Soil in pots was amended with RSB rates equivalent to 0, 5, 10, 20, and 30 Mg ha-1 and grown with corn for 45 days. Chlorophyll fluorescence, photosynthetic pigment contents, and gas exchange parameters were evaluated as PTEs toxicity indicators. The RSB rates significantly increased Si uptake while reducing Cd, Pb, and Zn accumulation in corn shoots. The addition of 30 Mg ha-1 RSB promoted 18, 34, and 37 % reductions for Zn, Cd, and Pb in the plants, respectively. Photosynthetic rate, transpiration, and stomatal conductance increased by 68, 67, and 55 %, while chlorophyll a, b, and carotenoid contents increased by 77, 57, and 42 %, correspondingly. Chlorophyll fluorescence measurements showed a linear and positive relationship between photosystem II energy consumption efficiency (Fv/Fm) and RSB rates. The combined use of RSB and corn can effectively phytoattenuate Cd, Pb, and Zn contamination by enhancing biomass and improving maize tolerance to PTE stress. This sustainable and cost-effective strategy offers environmental and health benefits while generating income for stakeholders in resource-limited areas.

Resumo Cor é um importante componente do design de produto, podendo influenciar na interação de uso. O objetivou deste estudo foi estudar a influência da cor de produtos de uso cotidiano, na resposta emocional e na usabilidade percebida de mulheres adultas seniors. Participaram 30 mulheres entre 60 e 80 anos, as quais avaliaram um produto de uso cotidiano e tradicional, em três cores distintas, com base em dois protocolos: Emotional Response Cards (ERC) and Perceived Usability Cards (PUC). O produto na cor “Terracotta” foi significativamente (p ≤ 0,05) melhor avaliado (emotional response and perceived usability) que os produtos nas demais cores (“green” and “grey”). A cor “Terracotta” foi determinante para confirmar que o fator memória de experiências de longo prazo contribuíram para os resultados alcançados. A aplicação de cores no design de produtos destinados à usuários com idades avançadas, deve considerar as experiências de longo prazo e ser tratado como fator de inclusividade.

Abstract Colour is an important component of product design and can influence usage interaction. This study aimed to study the influence of the colour of everyday products on the emotional response and perceived usability of senior adult females. Thirty women between 60 and 80 years old participated, who evaluated clay sausage roaster in three different colours, based on two protocols: Emotional Response Cards (ERC) and Perceived Usability Cards (PUC). The product in the “Terracotta” colour was significantly (p ≤ 0.05) better evaluated (emotional response and perceived usability) than the products in the other colours (“green” and “grey”). The colour “Terracotta” was decisive in confirming that the memory factor of long-term experiences contributed to the results achieved. The application of colours in the design of products aimed at older users must consider long-term experiences and be treated as an inclusivity factor.

Resumen Introducción: En la pandemia por la COVID-19, el temor al contagio y el riesgo de una mala evolución, fueron condiciones que circunscribieron a los pacientes infectados por el VIH, lo que influyó potencialmente en la adherencia al TARGA (A-TARGA). Objetivo: Determinar los factores asociados a la mala adherencia al TARGA (MA-TARGA) en pacientes con VIH durante la pandemia por la COVID-19 en un hospital del norte del Perú durante abril-octubre del año 2021. Material y Métodos: Se desarrolló una investigación analítica transversal en 162 pacientes con diagnóstico confirmado de infección por VIH en TARGA. Para establecer la A-TARGA, se usó el Test de Morisky-Green-Levine. Se evaluó la asociación entre factores sociodemográficos, personales/familiares de COVID-19, de salud y la MA-TARGA mediante la prueba de Chi Cuadrado de Pearson y se consideró significancia estadística para un valor p < 0,05. El estadígrafo de riesgo fue el Odds ratio (OR) > 1. Resultados: La prevalencia de MA-TARGA fue del 32 %, la media de edad 45,8±8,3 y 44,6±7,3 años (con mala y buena adherencia al TARGA); predominó el sexo masculino. Fueron factores asociados a MA-TARGA: Vivir solo (p=0,036, OR:3,1), antecedente personal de COVID-19 (p=0,027, OR: 2,42), antecedente de familiar cercano con COVID-19 (p=0,038, OR 3,42), depresión (p=0,036, OR: 2,18) y comorbilidad (p=0,027, OR: 2,21). Conclusión: En pacientes con VIH, vivir solo, antecedente personal de COVID-19, antecedente de familiar cercano con COVID-19, depresión y presentar comorbilidad, son factores asociados a MA-TARGA.

Abstract Introduction: During the COVID-19 pandemic, the fear of contagion and the risk of poor evolution were conditions that circumscribed HIV-infected patients, potentially influencing adherence to HAART (A-HAART). Objective: To determine the factors associated with poor adherence to HAART (PA-HAART) in patients with HIV during the COVID-19 pandemic in a hospital in northern Peru during April-October 2021. Material and Methods: A cross-sectional analytical study was conducted with 162 patients with a confirmed diagnosis of HIV infection on HAART. To establish A-HAART, the Morisky-Green-Levine Test was used. The association between sociodemographic, personal/family factors of COVID-19, health, and PA-HAART was evaluated using the Pearson Chi-square test, considering statistical significance for a p value < 0.05. The risk statistic used was the Odds ratio (OR) > 1. Results: The prevalence of PA-HAART was 32%, with a mean age of 45.8 ± 8.3 years for poor adherence and 44.6 ± 7.3 years for good adherence, with a predominance of males. Factors associated with PA-HAART were living alone (p=0,036, OR:3,1), personal history of COVID-19 (p=0,027, OR: 2,42), close family member's history of COVID-19 (p =0,038, OR 3,42), depression (p=0,036, OR: 2,18) and comorbidity (p=0,027, OR: 2,21). Conclusion: In HIV patients, living alone, a personal history of COVID-19, a close family member’s history of COVID-19, depression, and comorbidities are factors associated with PA-HAART.

Resumen En este artículo se aproximan algunas elaboraciones al proceso en desarrollo histórico del escenario monetario y bancario de la Provincia de Antioquia a finales del siglo XIX. Se hace tránsito por los lugares de la escasez monetaria, la emisión de moneda y las complicadas redes de capitalistas individuales, que marcarían la senda de la política monetaria y bancaria. En esta exposición, en sumo grado abstracta, la comprensión de la moneda y la banca en el caso que se convoca, más allá del carácter funcional, ayuda a detenerse en las tendencias como constitutivos de los vínculos sociales. Esto remite inmediatamente a la relación entre la emisión de billetes privados y el billete fiscal. Esto no surge súbitamente, sino que corresponde a un proceso de transformación histórica de la producción social.

Abstract This article approaches some elaborations on the historical development process of the monetary and banking scenario of the Province of Antioquia at the end of the 19th century. It goes through the places of monetary scarcity, currency issuance, and the complicated networks of individual capitalists, which would mark the path of monetary and banking policy. In this highly abstract exposition, understanding currency and banking in the case in question, beyond its functional character, helps to focus on tendencies as constitutive of social bonds. This immediately refers to the relationship between the issuance of private banknotes and the fiscal banknote. This does not arise suddenly but corresponds to a process of historical transformation of social production. JEL: N26, N20, E51.

Resumen La investigación se realizó en el ciclo 2020, con el objetivo de determinar las características químicas del suelo y calidad del agua en los municipios de Miahuatlán de Porfirio Díaz y Ejutla de Crespo, Oaxaca, México. Se muestreo el suelo y agua, se determinó contenido de cationes, aniones y variables de calidad del agua. En el suelo se registró alta concentración de Ca2+ y Mg2+ con valores promedio de hasta 19.20 y 19.42 mEq L-1 respectivamente. En el agua se registró alta concentración de Ca2+, Mg2+ y HCO3 - con valores promedio de hasta 4.79, 4.32 y 7.97 mEq L-1 respectivamente. Según las variables SP, RAS, IS y CSR el agua se clasifica como adecuada para riego. Se concluye que el uso de ácidos es necesario para bajar el pH del agua y neutralizar los carbonatos.

Abstract The research was performed in the cycle 2020, with the objective of determining the chemical characteristics of the soil and water quality in the municipalities of Miahuatlán de Porfirio Díaz and Ejutla de Crespo, Oaxaca, Mexico. The soil and water were sampled, the content of cations, anions and water quality variables were determined. High concentrations of Ca and Mg were recorded in the soil with average values of up to 19.20 and 19.42 mEq L-1 respectively. High concentrations of Ca2+, Mg2+ and HCO3 - were recorded in the water with average values of up to 4.79, 4.32 and 7.97 mEq L-1 respectively. According to the variables SP, RAS, IS and CSR, the water is classified as suitable for irrigation. It is concluded that the use of acids is necessary to lower the pH of the water and neutralize the carbonates.

ABSTRACT Although soybean is one of the most important agricultural commodities in the world, it has been losing genetic diversity in recent decades, due to the intense breeding process and reproduction method. Thus, the objective of this study was to evaluate the agronomic performance and estimate the genetic diversity among inbred lines, and identify promising crossings. A total of 66 soybean genotypes were evaluated, 61 of which were pre-commercial lines, and five commercial cultivars (AS3797, DESAFIO, M7110, M7739, M8210) as controls. The experimental design consisted of randomized blocks with three replicates. The distance matrix between the inbred lines was calculated by Mahalanobis distance and grouping by the unweighted pair group method with arithmetic mean (UPGMA). The maximum distance was 1,776.26 between cultivar M7110 and the G23 inbred line, and the minimum 1.50 between inbred lines G13 and G36, with an average distance of 364.40, demonstrating genetic diversity. The traits that contributed most to genetic divergence were number of days to flowering (66.7%) and physiological maturation (28.55%). Inbred lines G60 (higher grain yield), G51 and G33 (lower physiological maturation) and cultivar M7110 (greater divergence) stood out. Four groups were formed, with G1 having the highest grain yield and fewest days to flowering and physiological maturation. The indicated crossings are between G60, G57, CD2728, M7110, G33 and G32 (group G1) and G47 (group G4).

RESUMO A soja é uma das mais importantes comodities agrícolas mundiais, no entanto, devido ao intenso processo de melhoramento e sua forma de reprodução, vem perdendo diversidade genética ao longo das últimas décadas. Assim, o objetivo deste estudo foi avaliar o desempenho agronômico, estimar a diversidade genética entre as linhagens e identificar cruzamentos promissores. Para isto, foram avaliados 66 genótipos de soja, sendo 61 linhagens pré-comerciais e cinco cultivares comerciais (AS3797, DESAFIO, M7110, M7739, M8210) como controles. O delineamento experimental foi o de blocos ao acaso com três repetições. A matriz de distância entre as linhagens foi calculada pela distância de Mahalanobis e o agrupamento pelo método da ligação média entre grupos (UPGMA). A distância máxima foi de 1.776,26 entre as linhagens M7110 e G23, e a mínima de 1,50 entre as linhagens G13 e G36, sendo a distância média de 364,40, demonstrando a existência de diversidade genética. Os caracteres que mais contribuíram para a divergência genética foram número de dias para o florescimento (66,7%) e maturação fisiológica (28,55%). As linhagens G60 (maior produtividade de grãos), G51 e G33 (menor maturação fisiológica) e a cultivar M7110 (maior divergência) se destacaram. Formaram-se quatro grupos, sendo o grupo G1 com maior produtividade de grãos e menor número de dias para o florescimento e maturação fisiológica. Os cruzamentos indicados são entre G60, G57, CD2728, M7110, G33 e G32 (grupo G1) com a G47 (grupo G4).

ABSTRACT Inadequate management of pasture soils in the Amazon has resulted in a predominance of degraded pastures. Considering the natural characteristics of this region can favor more appropriate strategies for sustainability, the objective of this study was to evaluate the differences in the chemical and physical attributes of pasture and forest soils in the Southern Amazon and to identify the most sensitive attributes of their fertility. Additionally, this study suggests appropriate management practices for sustainable pastures. Soil samples from the 0 to 0.20 m layer were analyzed to determine pH, exchangeable bases (calcium, magnesium, and potassium), exchangeable aluminum, potential acidity, phosphorus, organic carbon, bulk density, and texture. Pasture soils had a higher pH, calcium content, and bulk density than forest soils. However, the pasture soils had lower phosphorus and organic matter content. The soil organic carbon stocks were also lower in pasture soils, with levels 0.8 to 12 Mg ha-1 lower than in forest soils. The fertility attributes most sensitive to soil management in these pastures were phosphorus, pH, organic carbon, and bulk density. The lack of nutrients and soil and water conservation practices have contributed to the degradation of these pastures. Therefore, the recommended management for these pastures should aim to improve the organic matter content, reduce compaction, and replenish and cycle nutrients.

RESUMO O manejo inadequado de solos de pastagens na Amazônia resulta em predomínio de pastagens degradadas. Considerando as características naturais dessa região pode favorecer estratégias mais adequadas para sua sustentabilidade, o objetivo desse estudo foi avaliar as diferenças de atributos químicos e físicos de solos de pastagens e florestas no sul da Amazônia e identificar os atributos mais sensíveis de sua fertilidade. Além disso, sugerir práticas de manejo mais adequadas para essas pastagens em direção à sustentabilidade. Amostras de solo da camada de 0 a 0,20 m foram analisadas para determinação de pH, bases trocáveis (cálcio, magnésio e potássio), alumínio trocável, acidez potencial, fósforo, carbono orgânico, densidade aparente e textura. Os solos de pastagem tiveram maior pH, cálcio e densidade aparente do que os solos de floresta. No entanto, os solos de pastagem apresentaram menores teores de fósforo e matéria orgânica. Os estoques de carbono orgânico do solo também foram menores nas pastagens, com teores de 0,8 a 12 Mg ha-1 inferiores aos solos da floresta. Os atributos de fertilidade mais sensíveis ao manejo do solo nessas pastagens foram fósforo, pH, carbono orgânico e densidade aparente. A carência de nutrientes e de práticas de conservação do solo e da água têm contribuído para o estado de degradação dessas pastagens. Portanto, o manejo recomendado para essas pastagens deve visar a melhoria da matéria orgânica, redução da compactação, além da reposição e ciclagem de nutrientes.

Resumo: O objetivo deste estudo foi caracterizar a qualidade da atenção básica com base nas respostas de profissionais e usuários, focando no tipo de médico - inserido ou não no Programa Mais Médicos (PMM). Realizou-se um estudo transversal aplicando o Questionário de Fortalecimento da Atenção Básica a 149 médicos e 795 usuários em unidades básicas de saúde de Pernambuco, Brasil, de fevereiro a novembro de 2018. Neste estudo, foi utilizado o conceito de provimento do PMM no qual foi previsto a destinação do profissional médico para área de vulnerabilidade social. Os médicos foram divididos em três subgrupos: brasileiros não PMM, brasileiros PMM e cubanos PMM. Foram gerados escores médios a partir da perspectiva dos profissionais e dos usuários por meio de análise bivariada e multivariada dos subgrupos dos médicos com variáveis sociodemográficas, educacionais e atributos da atenção primária, considerando-se o nível de significância de 5%. Médicos cubanos do PMM apresentaram os maiores escores médios, especialmente no atributo orientação familiar e comunitária (7,19), seguido pelo subgrupo dos brasileiros do programa (4,74). A análise multivariada mostrou significância para médicos cubanos, sexo feminino e profissionais com residência médica. Entre os usuários, observou-se maior associação com a qualidade da atenção básica no subgrupo dos médicos cubanos, com exceção da longitudinalidade. Os resultados indicam a efetividade dos médicos cubanos do PMM na atenção básica, ressaltando a necessidade de focar na centralidade do usuário. Os achados reforçam a importância de utilizar instrumentos de avaliação precisos e abrangentes na gestão da saúde pública.

Resumen: El objetivo del estudio fue caracterizar la calidad de la atención primaria con base en las respuestas de profesionales y usuarios, centrándose en el tipo de médico, incluido o no en el Programa Más Médicos (PMM). Se realizó un estudio transversal aplicando el Cuestionario de Fortalecimiento de la Atención Primaria a 149 médicos y 795 usuarios de unidades básicas de salud de Pernambuco, Brasil, de febrero a noviembre del 2018. En el presente estudio, se utilizó el concepto de provisión del PMM, que preveía la asignación de profesionales médicos a zonas de vulnerabilidad social. Los médicos fueron divididos en tres subgrupos: brasileños no PMM, brasileños PMM y cubanos PMM. Se generaron puntajes medios con base en la perspectiva de los profesionales y de los usuarios mediante análisis bivariado y multivariado de los subgrupos de médicos con variables sociodemográficas, educativas y atributos de atención primaria, considerando un nivel de significancia del 5%. Los médicos cubanos del PMM presentaron los puntajes medios más altos, especialmente en el atributo orientación familiar y comunitaria (7,19), seguidos por el subgrupo de brasileños del programa (4,74). El análisis multivariado mostró significancia para los médicos cubanos, mujeres y profesionales con residencia médica. Entre los usuarios, se observó una mayor asociación con la calidad de la atención primaria en el subgrupo de médicos cubanos, con excepción de la longitudinalidad. Los resultados indican la efectividad de los médicos cubanos del PMM en la atención primaria, resaltando la necesidad de centrarse en el usuario. Los hallazgos refuerzan la importancia de utilizar herramientas de evaluación precisas e integrales en la gestión de la salud pública.

Abstract: This study characterized the quality of primary care based on the responses of professionals and users, focusing on the type of physician - whether or not they were included in the More Doctors Program (PMM, acronym in Portuguese). A cross-sectional study was conducted applying the Quality and Strengthening of Primary Care Questionnaire to 149 physicians and 795 users in basic health units in Pernambuco State, Brazil, from February to November 2018. The present study used the concept of PMM provision which foresees the allocation of medical professionals to an areas of social vulnerability. Physicians were divided into three subgroups: non-PMM Brazilians, PMM Brazilians, and PMM Cubans. Mean scores were generated from the perspective of professionals and users through bivariate and multivariate analysis of the physicians’ subgroups with sociodemographic, educational and primary care attributes, considering a significance level of 5%. Cuban physicians in the PMM had the highest average scores, especially in the attribute family and community orientation (7.19), followed by the subgroup PMM Brazilians (4.74). Multivariate analysis showed significance for Cuban physicians, females, and professionals with medical residency. Among users, there was a greater association with the quality of primary care in the subgroup of Cuban physicians, except for longitudinality. Results indicate the effectiveness of PMM Cuban physicians in primary care, emphasizing the need to focus on user centrality. The findings reinforce the importance of using accurate and comprehensive assessment instruments in public health management.