Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Introduction: Burnout syndrome is an adjustment disorder related to chronic stress in the work environment, with consequences both to the professional's health and quality of life and to their work organization and performance. Physicians from all specialties are vulnerable to the development of burnout syndrome. Those who work in primary health care — general practitioners and family physicians — seem to be at higher risk since they are exposed to several stressors in their practice. Research on burnout syndrome in primary care physicians has been gaining prominence in the past 20 years, but the scarcity of studies in Brazil makes it difficult to characterize the real impact of this syndrome on these professionals. Objective: To review the literature searching for publications related to burnout syndrome in primary care physicians and analyze them, systematizing the areas of interest. Methods: This is a narrative literature review on the burnout syndrome in primary care physicians based on a systematic search in the electronic databases PubMed and Scientific Electronic Library Online (SciELO), using the following descriptors: "burnout, professional", "physicians, primary care", and "physicians, family". The search was conducted in October 2018 and allowed the identification of 192 publications, of which 55 were included in the analysis and categorized according to the year of publication, country of origin, study design, and areas of interest. Results: Most studies (40) adopted an observational descriptive cross-sectional design. We also found two systematic reviews of observational studies, two qualitative descriptive studies, two longitudinal cohort studies, two randomized clinical trials, two opinion papers, two editorials, one time trial, one time series, and one case study. We found many topics investigating burnout syndrome in primary care physicians, but the studies are often observational and describe the prevalence of the syndrome in these professionals and the various associated variables. The most frequently studied variables are sociodemographic aspects and those related to the work environment or to the professional. Studies collecting epidemiological data about primary care physicians in Brazil are scarce, but this is an important step toward understanding how this syndrome behaves in our context. Conclusions: We need studies on the prevalence and impact of burnout syndrome on primary care physicians that can particularly investigate factors related to the environment and the work process. Clinical trials can provide evidence to combat burnout effectively. Qualitative studies can collect data on the motivations of professionals, as well as their behaviors, opinions, and expectations, guiding strategies for coping with this syndrome.

Introduction: Chronic noncommunicable diseases (NCDs) — including diabetes mellitus (DM) and systemic arterial hypertension (SAH) — are responsible for most of the worldwide deaths today, and the identification of associated factors is an essential tool for their prevention and health promotion strategies. Objective: To determine the prevalence of SAH and DM in the adult population served by Projeto Vozes das Ruas (PVR) in Jundiaí, SP, Brazil and associated factors. Methods: A cross-sectional study was carried out from March to November 2019, with a sample of adults over 18 years of age, participating in PVR's health promotion actions in 2019, which consisted in the application of a sociodemographic and health behavior questionnaire, evaluation of capillary glucose, blood pressure, weight, height and waist circumference and subsequent health counseling. Descriptive analysis of the data was performed to determine the association of the outcomes DM and SAH with independent variables. A chi-square test was carried out and variables with p<0.20 were included in multivariate logistic regression (p<0.05). Results: The sample consisted of 50% females with an average age of 48.56 years. The self-reported prevalence of DM was 16.2% and SAH 30.2%, with a relationship between them. The common associated factors were: age group over 39 years and continuous-use medications. Associated with DM were family history of DM, use of basic health unit and smoking history. In relation to SAH the associations were less than eight years of schooling, overweight and obesity and smoking. Conclusions: In the population studied, there was a high prevalence of two of the main NCDs, SAH and DM, which presented risk factors of extreme relevance for the planning of health promotion and disease prevention strategies.

Introduction: Lately, social networks have been enabling new forms of interaction between people and institutions and the scalable sharing of contents from different areas, although not always reliable. Objective: To characterize the presence of Facebook pages of Family Health Units (FHU) of the Porto Metropolitan Area (Portugal) as of December 2020, its metrics of age, followers, publications, and interactions in a given time interval, and its distribution by organizational model (Family Health Units A and B) and Health Center Group; to verify the trend of creating pages in 2020 (first year of the COVID-19 pandemic); and to assess the topics addressed by the 50 publications of the last 60 days with which people interacted the most. Methods: This is an exploratory, cross-sectional, descriptive, and analytical study in which Facebook pages of Family Health Units of the Porto Metropolitan Area were individually assessed on December 30, 2020 and respective metrics for an interval of 60 days of activity were obtained from the Fanpage Karma platform. Frequencies, intervals, means, and medians were estimated and parametric and nonparametric tests were applied. Results: Of the 135 operating Family Health Units (FHU–B: 64%), 53% had an active page (FHU–B: 61%, p<0.05), ranging between 0 and 81.3% of the Family Health Units in each Health Center Group, created in the last ten years (median 4.6 years, FHU–A 1.5 versus FHU–B 5.3, p<0.05), increasing 44% in 2020. The number of followers is heterogeneously distributed among different Family Health Units and Health Center Groups, although without differences between Family Health Units models, not exceeding 1,000 in 69% of pages and only five pages reaching more than 2,000 followers. Of the active pages, 75% (54/72) posted an average of 0.3 times a day for the last 60 days. There are no significant associations between number of followers or between FHU A and B models and time of the last publication or number of publications at 60 days. During that time, 15,913 interactions were generated (average of 18.8 per publication). When analyzing the 50 publications with most interactions in the last 60 days, there is a predominance of topics related to COVID-19, organizational and bureaucratic issues, remarkable events related to the Family Health Units, and COVID-19 vaccine promotion/information. Conclusions: It was verified that Family Health Units have not been sufficiently exploring the communicative and collaborative potential of social networks (although it has increased in a pandemic year). With room for advancement, social networks can constitute a complementary and interactive tool for promoting access to and improving the quality of services, combating misinformation, empowering citizens for health, and improving health outcomes.

Introduction: The institutional marginalization scenario to which transgender people and travestis are exposed is undeniable. Even healthcare services in the Brazilian Unified Health System (SUS) are part of this scenario. This situation, as suggested by the literature and social movements themselves, is mainly evidenced through disrespect regarding the social name, discrimination, the need for diagnosis to access services, and the unpreparedness of health teams. To reduce historical iniquities in the constitution of health care and in the implementation of public health policies it is necessary to characterize the health care provided to this population in the context of SUS. Objective: To analyze how comprehensive healthcare services have been constituted to transgender people and travestis in Brazil based on an integrative literature review. Methods: This is a qualitative and exploratory study. An integrative literature review was carried out, seeking to explore the current scenario of health care for transgender people in Brazil. The research was performed in LILACS, SciELO, and Portal de Periódicos CAPES databases, during July and September 2020. The inclusion criteria were topics concerning public Brazilian healthcare services for transgender people and travestis, regardless of the level of complexity. Results: A total of 22 studies were fully read. The scenario of health care for transgender people and travestis within the scope of SUS consists mainly of specialized care services and is concentrated in the south region of the country, in large urban centers. The health devices that already exist in the network are not sufficient and qualified to provide comprehensive health care, from a perspective other than heterocysnormativity and the biomedical pathologizing model of transidentities. Nevertheless, models of successful services in Primary Health Care (PHC) have been changing this scenario. Conclusions: Specific services for the population of transgender people and travestis are necessary, as they operate in the logic of remedying historical inequities faced by this population. PHC is a strategic scenario in this care, and public policies must operate from this perspective.

Introduction: Home Care Service (HCS) is a complementary service to the care provided in primary and urgent care and aims to strengthen the completeness of health care, because it assumes an important role in the formation of new care strategies in the modality of complementary and substitutive care. Objective: To identify how the HCS work process occurs from the perspective of primary health care professionals in a municipality in the extreme south of Santa Catarina, Brazil. Methods: This was a qualitative study of the descriptive-exploratory type, carried out with 14 professionals who worked before the implementation of HCS and continued to work in family health teams in the municipality. The analysis process emerged through the content analysis technique, with the help of Atlas.ti qualitative data analysis software. Results: The role of HCS is restricted to providing care at home, carrying out multidisciplinary work, focusing on the care of bedridden patients, and being a referral team to provide care. In relation to the role of the HCS, family health teams are associated with support in helping to carry out comprehensive care, encouraging no hospitalization, improving quality of life and providing access to health services. Conclusions: HCS's performance represents a service closer to the bedridden population, performed by a multidisciplinary referral team, and its function is linked to the improvement of care and guarantee of the right to health.

Introduction: A constant growth in the number of elderlies in Brazil highlights the importance of dialogues about end of life. Brazil was 42th positioned in the Death Quality Index publicized in 2015, which reflects a need of improvements in quality of death associated to institution of strong and effective national politics of Palliative Care. Objective: To produce an integrative review about how the application of PC in elderly people help their partner/spouse in the terminality process when compared to patient that do not receive PC. Methods: It was produced an Integrative Review with articles of the databases PUBMED and BVS during the period of 2000 to August 2020. Results: The main results demonstrated that caregivers that utilized PC reported more discrete symptoms of post-death depression and anxiety, in comparison with did not used PC. The most important determinants of satisfaction with PC were the professional help available and holistic attendance, when including family and observing their physic, psychologic, spiritual and psychosocial determinants. Conclusions: As presented, frequently it is responsibility of the partner/spouse to assume a caregiver role. The isolation and exclusive dedication of the caregiver could initiate depressive feelings and overload, especially when there is a lack of support. In this scientific work it could be observed that the use of PC can provide a better understanding of the illness evolutive process, since the beginning of evolution until family grief.

Introduction: Direct ophthalmoscopy is an examination performed for the diagnosis and screening of diseases of the retina, optic disc, and vitreous humor in the context of primary health care. Studies show that this practice is rarely used by primary care physicians. Objective: The aim of this study is to identify barriers for primary care physicians to perform ophthalmoscopy. Methods: This study used a qualitative methodology based on a semi-structured interview with primary care physicians with subsequent thematic analysis. Results: It was verified that barriers to performing direct ophthalmoscopy include difficulty in handling the ophthalmoscope and pupil dilation, little knowledge of eye anatomy, feeling of insecurity in performing and interpreting findings, perception that the examination would be better performed by a specialist, lack of training and practical experience in undergraduate program and medical residency, perception of little use or resolution, difficulty in adjusting the room environment for the examination, absence of equipment and mydriatics in health units, increase in consultation time, absence of referral flows when facing altered findings, presence of teleophthalmology services and lack of training of the multidisciplinary team. Conclusions: Barriers to performing ophthalmoscopy by primary care physicians include emotional, behavioral, cognitive, educational, and work-environment aspects.

The COVID 19 pandemic has caused an unforeseen change in the world, it has exposed, as never before, inequity, distributive injustice, and the fallacies of economic models that have dominated the last decades. At the same time, a window of opportunity has opened to move toward profound changes in health systems. It is within this framework that, from the vision of Quaternary Prevention, we propose the guiding principles of what we consider should be the change in the health system so that this change is not more of the same. There is a unique opportunity for this task in South America, provided one must “get rid” of coloniality, we must dare to found a new social agreement that privileges life, people, a more equitable distribution of wealth and leave behind neoliberalism, racism, and sexism that are a constitutive and inseparable part of the current model.

Introduction: Mild hypertension is a common asymptomatic condition present in people at low risk of future cardiovascular events. These people represent approximately two-thirds of those diagnosed with hypertension. The best available evidence does not support pharmacological treatment for mild hypertension to reduce cardiovascular mortality. Additionally, overdetection of hypertension also occurs, and this practice is supported by public awareness campaigns, screening, easy access to testing, and poor clinical practice, enhancing the overdiagnosis potential. Moreover, sparse qualitative patient-oriented evidence that diagnosing hypertension has harmful consequences is observed. Therefore, evidence regarding the potential for unintended psychosocial effects of diagnosing mild hypertension is required. Objective: The aim of this study was to investigate if diagnosing low-risk people with mild hypertension has unintended psychosocial consequences. Methods: Eleven semi-structured single interviews and four focus groups were conducted in São Paulo, Brazil, among people diagnosed with mild hypertension without comorbidities. Informants were selected among the general population from a list of patients, a primary healthcare clinic, or a social network. The informants had a broad range of characteristics, including sex, age, education level, race/skin colour, and time from diagnosis. Data were subjected to qualitative thematic content analysis by three of the authors independently, followed by discussions, to generate categories and themes. Results: The informants confirmed that the hypertension diagnosis was a label for psychosomatic reactions to stress, medicalised illness experiences, and set a biographical milestone. We observed unintended consequences of the diagnosis in a broad range of psychosocial dimensions, for example, fear of death, disabilities, or ageing; pressure and control from significant others; and guilt, shame, and anxiety regarding work and leisure. Although informants had a broad range of characteristics, they shared similar stories, understandings, and labelling effects of the diagnosis. Conclusion: The diagnosis of hypertension is a significant event and affects daily life. Most of the impact is regarded as negative psychosocial consequences or harm; however, sometimes the impact might be ambiguous. Patients’ explanatory models are key elements in understanding and changing the psychosocial consequences of the diagnosis, and healthcare providers must be aware of explanatory models and psychosocial consequences when evaluating blood pressure elevations.

Introduction: Deaths attributable to long-term air pollution are estimated to be as high as 9 million a year, mainly concentrated in low- and middle-income countries such as Brazil. Air pollution is classified as household (indoor) or ambient(outdoor). Inhalation of pollutants is related to the increased incidence and development of clinical conditions, such as cardiovascular, respiratory and other diseases, which are part of the practice of family doctors. Objective: To reviewthe clinical evidence for an approach to air pollution related to human health in the context of the practice in primary health care. Methods: A scoping review was carried out with a cross-sectional focus on the role of primary health care in relation to air pollution and health, focusing on clinical issues related to air pollution. Results: A total of 35 articles were included in this review. Clinical recommendations at the individual level were: reduction in the use of solid fuels in wood stoves, use of strategies to protect polluting sources (such as forest fires, roads and industry), air filtration, promotion of active transport and smoking cessation. These actions must be complementary to government policies related to air pollution reduction. Clinical interview questions were proposed. Specific recommendations on the use of masks, physical activity and COVID-19 were explored. Research topics were proposed that could be carried out in primary health care and the role of family doctors in this context. Considerations: The inclusion of “exposure to air pollution” in the International Classification of Primary Care and in the International Classification of Diseases could improve notification and epidemiological studies on the subject.