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PURPOSE: The relationship between engaging in two domains of cancer-preventive behaviors, lifestyle behaviors and colonoscopy screening, is unknown in Hispanic adults. Accordingly, the study examined the association between lifestyle and colonoscopy screening in Hispanic adults along the Texas-Mexico border, where there is suboptimal colorectal cancer prevention. METHODS: Lifestyle behavior adherence and compliance with colonoscopy screening schedules were assessed using 2013-2023 data from the Cameron County Hispanic Cohorta population-based sample of Hispanic adults living along the Texas-Mexico border. The 2018 World Cancer Research Fund scoring system characterized healthy lifestyle engagement. Multivariable logistic regression quantified the association between lifestyle behaviors and colonoscopy screening. RESULTS: Among 914 Hispanic adults, there was a mean adherence score of 2.5 out of 7 for recommended behaviors. Only 33.0% (95% CI 25.64-41.39%) were up-to-date with colonoscopy. Complete adherence to fruit and vegetable (AOR [adjusted odds ratio] 5.2, 95% CI 1.68-16.30; p = 0.004), fiber (AOR 2.2, 95% CI 1.06-4.37; p = 0.04), and ultra-processed foods (AOR 2.8, 95% CI 1.30-6.21; p = 0.01) consumption recommendations were associated with up-to-date colonoscopy screening. Having insurance versus being uninsured (AOR 10.8, 95% CI 3.83-30.62; p < 0.001) and having local medical care versus in Mexico (AOR 7.0, 95% CI 2.26-21.43; p < 0.001) were associated with up-to-date colonoscopy. CONCLUSIONS: Adherence to dietary lifestyle recommendations was associated with being up-to-date with colonoscopy screenings. Those with poor dietary behavior are at risk for low-colonoscopy use. Improving lifestyle behaviors may complement colonoscopy promotion interventions. Healthcare accessibility influences up-to-date colonoscopy prevalence. Our findings can inform cancer prevention strategies for the Hispanic population.

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This study aims to analyze the feasibility of building an evaluative model for the management of the Tuberculosis Prevention and Control Program in the State of Roraima, located on the border between Brazil and Venezuela. This is an evaluability assessment, a type of study used as a pre-evaluation of the development and implementation stages of a program, as well as throughout its execution. The study was developed in stages comprising the: (i) definition of the intervention to be analyzed and its objectives and goals; (ii) construction of the intervention logical model; (iii) screening of parties interested in the evaluation; (iv) definition of the evaluative questions; and (v) design of the evaluation matrix. Four priority components were defined for the evaluation: management of the organization and implementation of tuberculosis (TB) prevention and control policy; epidemiological surveillance management; care network management; and management of expected/achieved results. In this model, and based on theoretical references, we defined the necessary resources, activities, outputs, outcomes, and the expected impact for each of the policy management components. The management of the TB control program is feasible for evaluation based on the design of its components, the definition of structure and process indicators, and relevant results for the analysis of the management of TB prevention and control actions, as well as its influence on compliance with the agreed indicators and targets aiming at eradicating the disease by 2035.

Objetivou-se examinar a viabilidade da construção de um modelo avaliativo para a gestão do Programa de Prevenção e Controle da Tuberculose no Estado de Roraima, localizado na fronteira entre Brasil e Venezuela. Trata-se de um estudo de avaliabilidade, um tipo de estudo utilizado como pré-avaliação na fase de desenvolvimento e implementação de um programa, bem como ao longo de sua execução. O estudo foi desenvolvido em etapas: (i) definição da intervenção a ser analisada e seus objetivos e metas; (ii) construção do modelo lógico da intervenção; (iii) mapeamento dos interessados na avaliação; (iv) definição das questões avaliativas e (v) delineamento da matriz de avaliação. Foram definidos quatro componentes prioritários para avaliação: gestão da organização e implementação da política de prevenção e controle da tuberculose (TB), gestão da vigilância epidemiológica, gestão da rede de atenção à saúde e gestão dos resultados esperados/obtidos. Nesse modelo, e com base em referenciais teóricos, definimos os recursos, atividades, produtos, resultados e o impacto esperado para cada um dos componentes de gestão de políticas. A gestão do programa de controle da TB é passível de avaliação a partir do delineamento de seus componentes e da definição de indicadores de estrutura e processo, assim como de resultados relevantes e sua influência para o cumprimento das metas pactuadas, visando erradicar a doença até 2035.

El objetivo fue analizar la viabilidad de elaborar un modelo de evaluación para la gestión del Programa de Prevención y Control de la Tuberculosis en el Estado de Roraima, que está en la frontera entre Brasil y Venezuela. Se trata de un estudio de evaluabilidad, un modelo de estudio que se utiliza como evaluación previa en la fase de desarrollo e implementación de un programa, así como a lo largo de su ejecución. El desarrollo del estudio se realizó en etapas: (i) definir la intervención a analizar y sus objetivos y metas; (ii) construir el modelo lógico de la intervención; (iii) mapear los interesados en la evaluación; (iv) definir las preguntas de la evaluación; y (v) trazar la matriz de evaluación. Se definieron cuatro componentes prioritarios para la evaluación: la gestión de la organización e implementación de la política de prevención y control de la tuberculosis (TB), la gestión de la vigilancia epidemiológica, la gestión de la red de atención a la salud y la gestión de los resultados esperados/obtenidos. En este modelo, y basándonos en referentes teóricos, definimos los recursos, actividades, productos, resultados y el impacto esperado para cada uno de los componentes de la gestión de políticas. La gestión del programa de control de la TB puede evaluarse a partir del diseño de sus componentes y de la definición de indicadores de estructura y proceso, así como de resultados relevantes y su influencia para el cumplimiento de las metas pactadas, con el fin de erradicar la enfermedad para 2035.

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ABSTRACT Objective: To map the competencies of Primary Health Care nurses in border regions of Brazil and Paraguay. Method: Exploratory qualitative studyconducted between February and July 2020, with 64 nurses from six Brazilian municipalities bordering Paraguay. It was conducted in three stages: 1. Documentary study: analysis of legal documents to identify the nurse's competencies. 2. Application of instrument to the study population .3. Mapping of competencies, through the competencies expressed by nurses analyzed using the collective subject discourse technique. Results: Twenty-eight general competencies were identified, categorized as assistance and management, and five specific competencies required to work in border regions: conducting a situational diagnosis of the border community; attending to foreign users with active and humanized listening; communicating appropriately with foreign users; identifying the epidemiological profile of the border; and, understanding the health policies of the neighboring country. The competencies required for the work from the participants' perspective were included in the mapping. The competence gap identified in the mapping refers to educational practices in communities. Final considerations: The study identified the necessary competencies for nurses to work in border regions, but pointed out gaps in the training and continuing education of these professionals.

RESUMEN Objetivo: Mapear las competencias de enfermeros de Atención Primaria de Salud en regiones fronterizas de Brasil y Paraguay. Método: investigación exploratoria descriptiva con enfoque cualitativo realizada entre febrero y julio de 2020, con 64 enfermeros de seis municipios brasileños fronterizos con Paraguay. Se realizó en tres etapas: 1. Estudio documental: análisis de documentos legales para identificar las competencias del enfermero. 2. Aplicación del instrumento a la población de estudio .3. Mapeo de competencias, a través de las competencias expresadas por enfermeros analizadas mediante la técnica del discurso del sujeto colectivo. Resultados: Se identificaron 28 competencias generales categorizadas en asistencia y gestión, y cinco competencias específicas requeridas para trabajar en regiones fronterizas: realizar un diagnóstico situacional de la comunidad fronteriza; atender a los usuarios extranjeros con una escucha activa y humanizada; comunicarse adecuadamente con el usuario extranjero; entender el perfil epidemiológico de la frontera; y, conocer las políticas sanitarias del país vecino. En el mapeo se incluyeron las habilidades requeridas para el trabajo desde la perspectiva de los participantes. La brecha de competencias identificada en el mapeo se refiere a las prácticas educativas en las comunidades. Consideraciones finales: El estudio identificó las habilidades necesarias para que las enfermeras trabajen en regiones fronterizas, pero señaló brechas en la formación y educación continua de estos profesionales.

RESUMO Objetivo: Mapear as competências dos enfermeiros da Atenção Primária à Saúde em regiões fronteiriças do Brasil e Paraguai. Método: Estudo exploratório de natureza qualitativa realizado entre fevereiro e julho de 2020, com 64 enfermeiros de seis municípios brasileiros fronteiriços com o Paraguai. Foi realizada em três etapas: 1. Estudo documental: análise de documentos legais para identificar as competências do enfermeiro. 2. Aplicação de instrumento para a população do estudo. 3. Mapeamento das competências, através das competências expressas pelos enfermeiros analisados pela técnica do discurso do sujeito coletivo. Resultados: Identificaram-se 28 competências gerais, categorizadas como assistenciais e gerenciais e cinco competências específicas requeridas atuar para regiões de fronteira: realizar o diagnóstico situacional da comunidade fronteiriça; atender o usuário estrangeiro com escuta ativa e humanizada; comunicar-se de forma adequada com o usuário estrangeiro; identificar o perfil epidemiológico da fronteira; e, conhecer as políticas de saúde do país vizinho. As competências requeridas para o trabalho na perspectiva dos participantes, foram contempladas no mapeamento. A lacuna de competência identificada no mapeamento se refere às práticas educativas nas comunidades. Considerações finais: O estudo identificou as competências necessárias para enfermeiros atuarem em região de fronteira, mas apontoulacunas na formação e educação permanente desses profissionais.

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RESUMO O estudo objetivou compreender a atenção pré-natal em uma região de fronteira na vigência da pandemia da Covid-19. Trata-se de um estudo qualitativo, realizado em serviços da atenção primária à saúde, com 27 participantes, entre mulheres e profissionais de saúde, por meio de entrevistas semiestruturadas, remotas e presenciais, entre agosto de 2021 e janeiro de 2022, cujos dados foram averiguados por análise temática. Foram identificadas quatro categorias temáticas, quais sejam: Início do pré-natal adiado; Parcialidade nas ações em saúde no pré-natal; (Des)informação em saúde em período de pandemia; e Medidas de prevenção à Covid-19 na gestação. A pandemia da Covid-19 gerou retrocessos no pré-natal, como a restrição do acompanhante nas consultas e exames e suspensão de grupos de gestantes, com prejuízos na educação em saúde, adiamento do início do pré-natal e/ou comprometimento da sua realização, particularmente de brasileiras residentes no Paraguai. Teleatendimento, como estratégia para acompanhamento do pré-natal, apareceu timidamente. Os serviços de saúde se reorganizaram para manter as medidas para evitar a infecção e, assim, tentar garantir o seguimento pré-natal de forma presencial.

ABSTRACT The purpose of this study was to understand prenatal care in a border region during the COVID-19 pandemic. It was a qualitative study conducted between August 2021 and January 2022 in primary health care facilities with 27 participants from among women and health workers in semistructured, remote, and in-person interviews, whose data were analyzed using thematic analysis. Four thematic categories were identified: delayed initiation of prenatal care, partiality in prenatal health measures, (in)health information in a pandemic period, and COVID-19 preventive measures in pregnancy. The COVID-19 pandemic has led to setbacks in prenatal care, such as limiting the presence of others than not the pregnant individual during consultations and examinations, exposing groups of pregnant women to health information losses, postponing the start of prenatal care, and or compromising their deliveries, especially among Brazilian women living in Paraguay. Telecare as a strategy for prenatal follow-up has been slow to be implemented. Health services have been reorganized to maintain infection prevention measures and provide prenatal follow-up in person.

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The economic, social, cultural and political milieus that influence injection drug-related HIV risk behaviors along the US-Mexico border in the previous decade have been studied comparing cities on an East-West axis. In an effort to inform interventions targeting factors beyond the individual level, we used a cross-sectional study design comparing people who inject drugs during 2016-2018, living on a North-South axis, in two cities-Ciudad Juárez, Chihuahua, Mexico and El Paso, Texas, USA-situated at the midpoint of the 2000 US-Mexico borderland stretch. We conceptualize injection drug use and its antecedents and consequences as influenced by factors operating at various levels of influence. Results of analysis comparing samples recruited from each border city indicated significant differences in demographic, socioeconomic, micro- and macro-level factors that affect risk. Similarities emerged in individual-level risk behaviors and some dynamics of risk at the drug use site most frequented to use drugs. In addition, analyses testing associations across samples indicated that different contextual factors such as characteristics of the drug use sites influenced syringe sharing. In this article, we reflect on the potential tailored interventions needed to target the context of HIV transmission risk among people who use drugs and reside in binational environment.

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OBJECTIVE: To investigate the perinatal outcomes in Brazilian, Peruvian, and Colombian women in a Brazilian reference maternity hospital based at Amazon triple border region. METHOD: A cross-sectional case study of data from 3242 live birth certificates issued at the Tabatinga public maternity hospital, in the countryside of Amazonas, in the period between January 2015 and December 2017. Maternal and perinatal independent variables were analysed based on central tendency and variability, and frequency distribution for categorical variables. The Pearson's Chi-Square test and univariate analyses were performed to estimate probability ratios (Odds Ratio-OR). RESULTS: Significant differences were found in the education level in the three population groups, as well as in the number of previous pregnancies, antenatal consultations, month of initial prenatal care, and type of delivery. Brazilian pregnant women had more prenatal consultations, caesarean sections, and premature births. Peruvian and Colombian women started antenatal care later, and those with high-risk pregnancies tended to deliver in their home country. CONCLUSION FOR PRACTICE: Our findings show some singularities in the care of women and infants in the Amazonian triple border region. The Brazilian Unified Health Care System performs an important role in the guarantee of free access to health services, and ensures comprehensive care for women and infants, promoting human rights in border regions regardless of nationality.

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Background: Mexican migrants in the United States (U.S.) are twice more likely to underutilize health care and to experience low quality of care compared to the U.S.-born population. Current and former Mexican migrants in the U.S have used health services in Mexico due to lower cost, perceived quality, cultural familiarity, and the geographic proximity of the two countries. Objective: This study aims to characterize the different health care interactions of current and former U.S. Mexican migrants with public and private health care organizations of the Mexican health system and to identify strategies to improve health care interactions post-COVID19. Methods: We use a typology of cross-border patient mobility to analyze the facilitators and barriers to improve the health care interactions of current and former U.S. Mexican migrants with the Mexican health system. Our policy analysis framework examines how an outcome can be achieved by various configurations or combinations of independent variables. The main outcome variable is the improvement of health care interactions of U.S. Mexican migrants and return migrants with different government agencies and public and private health care providers in the Mexican health system. The main explanatory variables are availability, affordability, familiarity, perceived quality of health care and type of health coverage. Findings: As the Mexican health system emerges from the COVID19 pandemic, new strategies to integrate current and former U.S. Mexican migrants to the Mexican health system could be considered such as the expansion of telehealth services, a regulatory framework for health services used by transnational patients, making enrollment procedures more flexible for return migrants and guiding return migrants as they reintegrate to the Mexican health system. Conclusions: The health care interactions of U.S. Mexican migrants with the Mexican health system are likely to increase in the upcoming decades due to population ageing. Regulatory improvements and programs that address the unique needs of U.S. Mexican migrants and return migrants could substantially improve their health care interactions with the Mexican health system.

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INTRODUCTION: Breast cancer in Brazil is considered a public health problem, as it represents one of the main causes of death in female population. OBJECTIVE: To analyze the presence of essential attributes of Primary Health Care in border region in the context of care for women with breast cancer. METHODS: This is a qualitative research based on the Complexity Paradigm, held in Foz do Iguaçu, Paraná. In-depth interviews were conducted with 13 women diagnosed with breast cancer. Thematic analysis was chosen as a technique to analyze the material produced. RESULTS: The following categories emerged: Barriers to access services for women with breast cancer; (De)constructing the bond: women, professionals and health services; Fragmented care, focused on the biological: interference for comprehensiveness; and (Dis)coordination of care for women with breast cancer within the public health system. CONCLUSION: The essential attributes of Primary Health Care were not present in their entirety for care for women with breast cancer, as difficulties in accessing primary care services, weaknesses in the construction and strengthening of bonds due to discontinuity of care were reported, attributed to the incipient coordination within the public health system. It points to the need to implement care strategies, with behavioral, functional and structural changes in health services at the border.

INTRODUÇÃO: O câncer de mama no Brasil é considerado um problema de saúde pública, por representar uma das principais causas de mortes na população feminina. OBJETIVO: Analisar a presença dos atributos essenciais da atenção primária à saúde na região de fronteira no contexto do cuidado à mulher com câncer de mama. MÉTODO: Pesquisa qualitativa baseada no Paradigma da Complexidade, realizada em Foz do Iguaçu-PR. Conduziram-se entrevistas em profundidade com 13 mulheres com diagnóstico de câncer de mama. Elegeu-se a Análise Temática como técnica para analisar o material produzido. RESULTADOS: Emergiram as categorias: Barreiras para o acesso aos serviços para atenção à mulher com câncer de mama; (Des)construindo o vínculo: mulheres, profissionais e serviços de saúde; Cuidado fragmentado, focado no biológico: interferência para a integralidade; e (Des)coordenação da atenção à mulher com câncer de mama no âmbito do sistema público de saúde. CONCLUSÃO: Os atributos essenciais da atenção primária não estiveram presentes em sua totalidade para o cuidado à mulher com câncer de mama, visto que foram reportadas dificuldades para o acesso nos serviços de atenção primária, fragilidades na construção e fortalecimento do vínculo pela descontinuidade do cuidado, atribuído à incipiência da coordenação no âmbito do sistema público de saúde. Aponta-se para a necessidade de implementar estratégias de cuidados, com transformações comportamentais, funcionais e estruturais nos serviços de saúde na fronteira.

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Although human papillomavirus (HPV)-associated cancers are preventable and treatable at early stages, health disparities in HPV-associated cancer outcomes continue to exist among Hispanic populations. Hispanics residing along the U.S.-Mexico border face barriers distinct from other geographically dispersed populations within the United States. The current research aimed to explore perspectives and lived experiences of survivors and caregivers of HPV-associated cancers in El Paso, Texas, to inform intervention development and health practices to increase preventive services among populations residing on the U.S.-Mexico border region. A mixed-method approach was employed using a semi-structured interview guide with Quality of Life (QOL) scales with (N = 29) survivors and caregivers of HPV-associated cancers. Content analysis was used to extract themes and descriptive statistics were reported for quality of life. Five major themes were identified: (1) barriers to preventive services and treatment; (2) role of health care providers in diagnosis and care; (3) treatment challenges, support systems, and challenges associated with caregiving; and (4) HPV prevention and health recommendations from survivors and caregivers. Finally, given the context of the COVID-19 pandemic, an additional theme was explored on accessibility to health and human services. QOL scales suggested better overall physical health and spiritual well-being in survivors and fear of reoccurrence among caregivers and survivors. The current research highlights the role of health care providers and human service professionals in the promotion of health practices of at-risk populations by increasing health literacy among cancer patients and caregivers, and exploring experiences, challenges, and messages caregivers and survivors had regarding HPV prevention.

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