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

Introduction: Tobacco production is mainly concentrated in rural areas of the southern region of the country. Rural areas present socioeconomic disparities, inequalities in geographic access, and difficulties in retaining professionals in primary care. Mental health problems, such as insomnia, are common in clinical practice. Case presentation: This article describes the intersections of the social determinants of health when approaching a patient with chronic use of benzodiazepines for treatment of insomnia. By delving deep into anamnesis, the socioeconomic determinants that led to the development of insomnia were identified as: financial trouble with tobacco production, excessive concern about work and presence of depression as comorbidity. Conclusions: In this context, the turnover of health professionals and lack of doctor-patient relationship meant that the patient continued using benzodiazepines, which are not recommended for long-term treatment. Therefore, fragmented care and high professional turnover stand out as socioeconomic determinants of health.

Introduction: The increase in obesity is related to changes in the pattern of acquisition and consumption of ultra-processed food products to the detriment of fresh and minimally processed foods. The objective of the present study was to investigate the prevalence of obesity in a small city and to evaluate the food products acquired by individuals with obesity according to the degree of processing. Methods: Analytical cross-sectional study divided into two stages. In the first stage, a Body Mass Index (BMI) of 533 individuals was investigated. 60 individuals were selected for the second stage, in which determinants of the nutritional profile were investigated, such as the acquisition of food and expenditure on food. Results: In the first stage, a prevalence of 30.39% of obesity was found. In the second stage, there was no significant difference between the acquisition of food by the degree of processing. More than 18% of respondents reported skipping breakfast and almost 22% reported having lunch at work. There were no differences in total spending, by place of purchase and in the proportion of spending on food in relation to family income and obesity categories. Conclusions: The prevalence of obesity in the studied district is high, considering its population. We suggest that this prevalence may be influenced by the acquisition of ultra-processed foods, food outside the home and omission of breakfast.

Problem: Currently, the paradigm of health production is lavished by a myriad of commercial interests, gallant in the biomedical model that overestimates modern scientific knowledge. Even though they are discredited by scientific sovereignty, about 70% of the popular use of medicinal plants is scientifically confirmed and this non-institutional knowledge is common in everyday practices. According to data from the World Health Organization (WHO), 80% of the population in developing countries use traditional practices in primary health care and, of that total, 85% make use of medicinal plants. In Brazil, approximately 82% of Brazilians use herbal products to take care of their health. Before this mismatch, primary health care highlights as a strategic space to fertilize the terrain of herbal practices. Methodology: This is a descriptive, qualitative, experience report type study, on the development of a medicinal garden located in a Family Health Unit in the city of Recife, Pernambuco. A systematic record of activities was used by making a field diary with a photographic record, complemented by a bibliographical survey and documentary research. Results: The project passed through the Informational, Structural and Planting stages, gathering several types of knowledge based on the spirit of multiprofessionality and community participation. In the end, efforts culminated in the growth of a medicinal garden, providing a space for the exchange of learning and experiences. Conclusion: Can be concluded that the structuring of a medicinal garden in the scope of primary health care calls for a prodigious potential in strengthening the principles that guide this level of care, repositioning the user to the center of the care model and expanding the effective therapeutic options and low cost.

Introduction: A new profile of demand for Brazil's public healthcare – Sistema Único de Saúde (SUS), is expected in the coming years, due to population-aging and increased prevalence of chronic diseases. Thus, it is necessary to use tools for planning the responsiveness of health services. Models for time series analysis such as the AutoRegressive Integrated Moving Average (ARIMA), can be useful. Objective: The aim of the study is to estimate the demand for home visits in Primary Health Care (PHC) of SUS, in Florianópolis (SC). Methods: Ecological study of time series using ARIMA for projections. Home visits carried out by the PHC, recorded in the electronic medical record of the Municipal Health Department, from January 2015 to February 2019 were used. Results: The forecast points to a maximum of 702 visits in August 2019, followed by a drop to 573 visits in December 2019, and subsequent recovery, with an estimate of 632 for October 2020. The forecast for each Health Center indicated variations in demand between units with the same number of Family Health Teams, between 11.3 to 1.3 visits/FHT, in the 20th month. Conclusions: ARIMA made it possible to carry out projections of home visits in the municipality, indicating a drop in the demand for home visits. The method can be of great value for the projection of other demands in the same municipality or in other municipalities that have historical series data. Future studies can expand the analysis in this regard, as well as compare ARIMA with models such as exponential smoothing.

COVID-19 has brought a challenging and uncertain outlook to the world. Especially in Brazil, the pandemic scenario has been devastating due to the discredit of proven effective measures and negative policies. However, the country has a great potential to face the health crisis through Primary Health Care. The Family Health Support Centers can be highlighted, which could meet the multidimensional demands of the population that were caused or aggravated by the pandemic. However, the Family Health Support Centers were almost extinct due to Ordinance No. 2.979, of November 2019 and Technical Note No. 3/2020 of the Secretariat of Primary Health Care, which represented, in summary, the disruption of Primary Health Care. Thus, we aimed to expose the importance of Family Health Support Centers and the impacts of their absence in the post-pandemic scenario.

Introduction: Spirituality/religiosity is considered an essential dimension in good practices in palliative care, especially during the terminal phase. Patients, as well as their families, make use of spiritual/religious coping strategies. Objective: The purpose of this review was to highlight the relationship between spiritual/religious coping and terminality. Method: The method applied was a systematic review that used PUBMED, LILACS, BVS, PSYCINFO and SCIELO as databases. Results: In total, 96 articles were captured and seven were selected for analysis. These articles addressed issues about attachment, types of coping, meaning of the illness and difficulties in measuring spirituality/religiosity. Conclusion: Studies indicate that spiritual/religious coping influences the quality of death during the dying process.

Family physicians (FP) have been playing a pivotal role in fighting the COVID-19 pandemic worldwide. Sharing the learning and work methodologies developed in this context has been essential to ensure adequate health care to the communities. This work reports the organizational strategies and tools developed in Portugal to face the pandemic. Particular focus is given to the methodologies developed in a family health unit in the metropolitan area of Lisbon, which have allowed to ensure the surveillance of COVID-19 patients, while maintaining assistance activities to other vulnerable groups. The core competencies of FP, such as proximity and knowledge of the communities, together with an enormous capacity for adaptation and reorganization of the teams, are key determinants to overcome this health crisis. 

Introduction: The World Health Organization has been working with the premise of equity with universal respect for human dignity, making a commitment to “leave no one behind,” and for this reason, it directs special attention to the lesbian, gay, bisexual, transgender, queer, and intersex population. The transgender population is especially affected by several social stigmas that impact their health and illness processes.  Understanding Primary Health Care as an essential space for guaranteeing the rights of this population, Health Centers must intensify efforts to welcome these people, and an important step may be to understand their family relationship and community insertion. Objective: To assist in raising visibility of the representations that travestis and transgender women seen at a Health Center have about their social relationships. Methods: Travestis and transgender women living in a community assisted by the Health Center were interviewed. In-depth interviews were conducted with the elaboration of the ecomap, which were systematized with the participants and later sent for their approval. The individual ecomaps were synthesized in a single ecomap. Results: All five travestis and transgender women residing in the area were interviewed. The average age was 27.5 years.  As for self-reported ethinicity/skin color, one is white, two are mixed-race, and two are black. Two of them were formally employed and three were unemployed. Regarding level of education, four of the interviewees held a high school degree and one had some elementary school. For most travestis and transgender women in this community, family support is noteworthy. Concerning social protection equipment, the most cited were the Public Defender’s Office, a Nongovernmental Organization, and the Social Assistance Reference Center. All participants are followed up at the Health Center, and one reported being absent for having no demands. The Candomblé religion also consisted in a support factor for two of the interviewees. The greatest difficulty was in relation to employability, with the report of transphobia situations. One of the interviewees identified that she has a problem related to drug addiction. Conclusions: There is still much to improve in public policies that promote equity and health for travestis and transgender women, especially in guaranteeing health care, incentives for employability, and combating transphobia. Nevertheless, women in the studied community and their families indicate how welcoming and support can be differentiating factors in these life trajectories.

Introduction: The Attachment Theory can be useful to complement the Patient-Centered Clinical Method, especially in its fourth component, "enhancing the patient-doctor relationship. Objective: To perform an integrative review of studies that associate the Attachment Theory with the doctor-patient relationship and extract its applicability in the routine of family physicians. Methods: Integrative review in the United States National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO) databases using the terms "doctor-patient relationship" and "attachment theory". Results: In February 2021, we retrieved 184 articles in PubMed and one in SciELO, reducing them to 11 articles. Their settings involved oncology/palliative care or general primary care, considering the vulnerabilities of each context and how they can activate the attachment system. The impact of Attachment Theory principles on several aspects of the doctor-patient relationship and even on clinical outcomes was evident. Correlating attachment styles with Emanuel and Emanuel's (1992) doctor-patient relationship models can help us understand which model is best for each style. People with "secure" attachment benefit from deliberative relationships; those with "anxious-preoccupied" attachment need the physician to be more active to compensate for their low self-confidence, as in the paternalistic model; in the "dismissing" attachment, the patient needs to feel independent, and the informative model contributes to strengthening the relationship; and individuals who have "anxious-fearful" attachment tend to share negative feelings with the physician, who needs to understand this and reaffirm the bond despite the person's counterproductive attitudes, and the interpretive model has a way of dealing with the situation. Conclusion: The Attachment Theory can potentially address many anxieties that plague the daily practice of the family physician and that the Patient-Centered Clinical Method cannot solve alone. We can infer that the Attachment Theory complements the method, providing tools to continue applying it with its four components.

Introduction: Aging is accompanied by changes that contribute to aged people needing increased pharmacotherapy. Objective: It was aimed to identify the difficulty of understanding by aged patients regarding the prescription of medicines in Primary Care in the city of Fortaleza (CE). Methods: This is a descriptive and cross-sectional study with a quantitative approach, carried out in a Primary Health Care Unit (UAPS) in the city of Fortaleza-CE. A structured questionnaire was applied to 105 aged people. The interviews took place between the months of September to October 2019. Results: The results showed that the female gender was prevalent in 88 (83%) participants, the self-perception of the predominant health was regular with 39 (40.95%) members and 100 (95.2%) aged individuals use continuous medication. A portion of 78 (74.28%) participants knew the name of the drug and 83 (79.04%) knew its indication. As for the dosage, 83 (80.95%) knew how to take the medication and 41 (39.05%) did not know how to proceed in case of forgetting to take it, 51 (53.54%) were unaware of the side effects, and 30 (28.58%) needed more information about the treatment. Conclusion: It is concluded that there is a gap between the knowledge of aged patients and the knowledge regarding their medicines/treatment, requiring greater attention to the pharmacological aspects of the treatment and information in a clear, didactic, and objective way.