Resumo A Atenção Primária em Saúde é um modelo de cuidado cujos atributos contribuem para resolver a maioria dos problemas de saúde dos idosos, em um contexto de aumento da longevidade no Brasil. Esta investigação tem como objetivo analisar o cuidado dispensado ao idoso dependente e seus cuidadores no âmbito da Atenção Primária à Saúde. Trata-se de um estudo qualitativo realizado em oito municípios brasileiros no ano de 2019. Participaram da pesquisa 190 sujeitos, cujas informações foram coletadas por meio de entrevistas semiestruturadas e analisadas através do marco teórico da Hermenêutica Dialética. Foram identificados problemas no acesso, na atenção domiciliar, na rede de atenção à saúde e no trabalho interprofissional. As equipes ofertam práticas sob a lógica do modelo biomédico e centradas no profissional médico, embora tenham sido identificadas ações de promoção de saúde e prevenção de doenças. Há necessidade de qualificar a APS e ampliar o escopo de práticas, incorporando núcleos de saberes que não estão tradicionalmente inseridos nas equipes. Além do mais, é fundamental o fortalecimento do papel do Estado e a criação de políticas públicas específicas para os idosos dependentes e seus cuidadores.

Abstract Primary Health Care is a care model whose attributes contribute to solving most of the health problems of older adults in Brazil’s increased longevity. This investigation aims to analyze the care provided to the dependent older adults and their caregivers within Primary Health Care. This is a qualitative study conducted in eight Brazilian municipalities in 2019. A total of 190 subjects participated in the research, whose information was collected through semi-structured interviews and analyzed through the theoretical framework of Dialectic Hermeneutics. Problems with access, home care, the health care network, and interprofessional work were identified. The teams provide practices under the biomedical model’s logic focused on the medical professional, although health promotion and disease prevention actions have been identified. There is a need to qualify PHC and expand the scope of practices, incorporating the core of knowledge not traditionally introduced into the teams. Moreover, it is essential to strengthen the State’s role and create specific public policies for dependent older adults and their caregivers.

Abstract Primary Health Care is a care model whose attributes contribute to solving most of the health problems of older adults in Brazil’s increased longevity. This investigation aims to analyze the care provided to the dependent older adults and their caregivers within Primary Health Care. This is a qualitative study conducted in eight Brazilian municipalities in 2019. A total of 190 subjects participated in the research, whose information was collected through semi-structured interviews and analyzed through the theoretical framework of Dialectic Hermeneutics. Problems with access, home care, the health care network, and interprofessional work were identified. The teams provide practices under the biomedical model’s logic focused on the medical professional, although health promotion and disease prevention actions have been identified. There is a need to qualify PHC and expand the scope of practices, incorporating the core of knowledge not traditionally introduced into the teams. Moreover, it is essential to strengthen the State’s role and create specific public policies for dependent older adults and their caregivers.

Resumo A Atenção Primária em Saúde é um modelo de cuidado cujos atributos contribuem para resolver a maioria dos problemas de saúde dos idosos, em um contexto de aumento da longevidade no Brasil. Esta investigação tem como objetivo analisar o cuidado dispensado ao idoso dependente e seus cuidadores no âmbito da Atenção Primária à Saúde. Trata-se de um estudo qualitativo realizado em oito municípios brasileiros no ano de 2019. Participaram da pesquisa 190 sujeitos, cujas informações foram coletadas por meio de entrevistas semiestruturadas e analisadas através do marco teórico da Hermenêutica Dialética. Foram identificados problemas no acesso, na atenção domiciliar, na rede de atenção à saúde e no trabalho interprofissional. As equipes ofertam práticas sob a lógica do modelo biomédico e centradas no profissional médico, embora tenham sido identificadas ações de promoção de saúde e prevenção de doenças. Há necessidade de qualificar a APS e ampliar o escopo de práticas, incorporando núcleos de saberes que não estão tradicionalmente inseridos nas equipes. Além do mais, é fundamental o fortalecimento do papel do Estado e a criação de políticas públicas específicas para os idosos dependentes e seus cuidadores.

ABSTRACT Due to social distancing guidelines and the displacement of both human and material resources to fight the covid-19 pandemic, individuals seeking healthcare services face certain challenges. Immunization programs have already been a worrisome topic for health authorities due to declines in vaccine uptake rates and are now especially affected by the covid-19 pandemic. Disbelief in science, dissemination of fake news about vaccines, socioeconomic vulnerability and social inequality are some of the challenges faced. This commentary article discusses the impacts of the covid-19 pandemic on immunization programs in Brazil. In light of advances (and notability) of Brazil's national immunization program, established in the 1970s, the programs face challenges, such as the recent drop in vaccine uptake rates. In addition to this health crisis, there is also Brazil's current political crisis, which will undoubtedly require assistance from researchers, policymakers and society to be fixed.

ABSTRACT Due to social distancing guidelines and the displacement of both human and material resources to fight the covid-19 pandemic, individuals seeking healthcare services face certain challenges. Immunization programs have already been a worrisome topic for health authorities due to declines in vaccine uptake rates and are now especially affected by the covid-19 pandemic. Disbelief in science, dissemination of fake news about vaccines, socioeconomic vulnerability and social inequality are some of the challenges faced. This commentary article discusses the impacts of the covid-19 pandemic on immunization programs in Brazil. In light of advances (and notability) of Brazil's national immunization program, established in the 1970s, the programs face challenges, such as the recent drop in vaccine uptake rates. In addition to this health crisis, there is also Brazil's current political crisis, which will undoubtedly require assistance from researchers, policymakers and society to be fixed.

Abstract This study compares waiting time from diagnosis of breast cancer to start of treatment with patients’ social-demographic and clinical profiles in women aged 60 or more at the PérolaByington Hospital, São Paulo, over the years 2001–2006.It is a descriptive study based on secondary data in a sample of 1,299 cases. Social-demographic, clinical and temporal variables were collected. Patients were divided into two groups: those with period between diagnosis and start of treatment less than 60 days, and greater than 60 days. The average time between diagnosis and start of treatment was 74.7 days (SD = 212.6), and the median time was 45 days. This waiting time was lower for subjects without diagnosis and without prior treatment (p = 0.001), and also for those with tumors at Stage 0, in situ or Stage I(p = 0.001). Time was significant for the outcomes of relapse (p = 0.004) and metastasis (p = 0.038). Having established diagnosis and treatment also resulted in lower time to start of the required care. Improvement to the structuring and functioning of the health service is an essential need, for dealing with the cases of the disease in an efficient manner, an important challenge for Brazil’s Unified Health System.

Resumo Objetivou-se analisar o tempo entre o diagnóstico e o início do tratamento e conhecer o perfil sociodemográfico e clínico de mulheres com 60 ou mais anos de idade, diagnosticadas com câncer de mama entre os anos de 2001 a 2006, no Hospital Pérola Byington, São Paulo. Trata-se de um estudo descritivo, com dados secundários e amostra de 1299 casos. Coletou-se variáveis sociodemográficas, clínicas e temporais. Formou-se dois grupos de mulheres utilizando a variável tempo, sendo o tempo entre o diagnóstico e o início do tratamento: “até e maior que 60 dias”. A média do tempo entre o diagnóstico e o início do tratamento foi de 74,7 dias (DP = 212,6), e o tempo mediano de 45 dias. As idosas sem o diagnóstico e sem o tratamento anterior levaram menos tempo para dar início ao tratamento (p = 0,001), bem como as mulheres com estadiamento do tumor na fase inicial, in situ e I (p = 0,001). O tempo foi significante para os desfechos de recidiva (p = 0,004) e metástase (p = 0,038). O diagnóstico e o tratamento estabelecidos garantiu às idosas menor tempo para o início da assistência devida. Melhorar a estruturação e o funcionamento dos serviços de saúde constitui fator imprescindível para o atendimento dos casos da doença de forma eficiente, um importante desafio para o Sistema Único de Saúde.

Resumo Objetivou-se analisar o tempo entre o diagnóstico e o início do tratamento e conhecer o perfil sociodemográfico e clínico de mulheres com 60 ou mais anos de idade, diagnosticadas com câncer de mama entre os anos de 2001 a 2006, no Hospital Pérola Byington, São Paulo. Trata-se de um estudo descritivo, com dados secundários e amostra de 1299 casos. Coletou-se variáveis sociodemográficas, clínicas e temporais. Formou-se dois grupos de mulheres utilizando a variável tempo, sendo o tempo entre o diagnóstico e o início do tratamento: “até e maior que 60 dias”. A média do tempo entre o diagnóstico e o início do tratamento foi de 74,7 dias (DP = 212,6), e o tempo mediano de 45 dias. As idosas sem o diagnóstico e sem o tratamento anterior levaram menos tempo para dar início ao tratamento (p = 0,001), bem como as mulheres com estadiamento do tumor na fase inicial, in situ e I (p = 0,001). O tempo foi significante para os desfechos de recidiva (p = 0,004) e metástase (p = 0,038). O diagnóstico e o tratamento estabelecidos garantiu às idosas menor tempo para o início da assistência devida. Melhorar a estruturação e o funcionamento dos serviços de saúde constitui fator imprescindível para o atendimento dos casos da doença de forma eficiente, um importante desafio para o Sistema Único de Saúde.

Abstract This study compares waiting time from diagnosis of breast cancer to start of treatment with patients’ social-demographic and clinical profiles in women aged 60 or more at the PérolaByington Hospital, São Paulo, over the years 2001–2006.It is a descriptive study based on secondary data in a sample of 1,299 cases. Social-demographic, clinical and temporal variables were collected. Patients were divided into two groups: those with period between diagnosis and start of treatment less than 60 days, and greater than 60 days. The average time between diagnosis and start of treatment was 74.7 days (SD = 212.6), and the median time was 45 days. This waiting time was lower for subjects without diagnosis and without prior treatment (p = 0.001), and also for those with tumors at Stage 0, in situ or Stage I(p = 0.001). Time was significant for the outcomes of relapse (p = 0.004) and metastasis (p = 0.038). Having established diagnosis and treatment also resulted in lower time to start of the required care. Improvement to the structuring and functioning of the health service is an essential need, for dealing with the cases of the disease in an efficient manner, an important challenge for Brazil’s Unified Health System.