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

A Revista Brasileira de Medicina de Família e Comunidade (RBMFC) agradece aos Avaliadores listados abaixo que atuaram como revisores ad hoc durante o ano de 2021, dedicando horas voluntariamente para a emissão de pareceres técnicos sobre manuscritos submetidos a esta revista.

Introduction: From the point of view of public health, the adult male population is vulnerable to alcohol use and its consequences. Early detection and the search for associated factors are necessary, and the Family Health Units are important places for this approach. Objective: This study aimed to identify the use of alcohol in adult men and to verify its association with socioeconomic and demographic factors and mental disorders (major depressive episode and generalized anxiety disorder). Methods: A cross-sectional analytical study was carried out on adults aged 20 to 59 years in the city of Piracicaba, Brazil, registered in Family Health Units in the year 2018. After descriptive analyses, variables with p<0.20 in simple analyses were studied in multiple negative binomial regression models. According to the final model, the adjusted ratios of means were estimated with 95% confidence intervals. Results: There was a high prevalence of alcohol consumption (26.9%) in the study population. Alcohol Use Disorders Identification Test (AUDIT) score increased with age (ratios of means – RoM=1.02; confidence interval – 95%CI 0.99–1.03). Concerning religion, Protestants and Evangelicals had an average AUDIT score lower than other religions (RoM=1.78; 95%CI 1.14–2.79). People with mental disorders have an average AUDIT score higher than those without disorders (RoM=2.30; 95%CI 1.28–4.11). Conclusions: The authors conclude that alcohol in the adult male population is prevalent, with consumption increasing with age; religion has a protective effect, and people with depression and anxiety are more likely to use it. Taking this into consideration, it is worth highlighting the importance of Family Health Units in the development of strategies to monitor the risk conditions of its population as well as the discussion and approach of interventions.

Introduction: Homeless people (HP) are daily subjected to significant risks, among which those related to health stand out. Objective: To discuss the main issues related to the health care of HP. Methods: Theoretical research was carried out based on the reading and assessment of current texts and documents concerning the topic, in order to highlight (1) the key concepts presented and (2) the developed argumentation. Results: This endeavor considered (1) the concept of health-disease and the health needs and demands of these populations; (2) public policies and the role of services in the health care of HP; and (3) the role of Primary Health Care (PHC), with emphasis on the work of the Outdoor Clinics Program. Conclusions: This reflective-critical systematization sought the delimitation of elements of the legal-social and ethical-political apparatus that involve the processes of expansion of health care to such users.

Problem: COVID-19 is a challenge for the entire health network and primary health care stands out as a care provider in this scenario. The team of residents who work in a Family Health Unit in Itabuna-BA, Brazil, has been looking for new ways to plan and develop actions in the face of this pandemic. Methods: This is an experience report on the operationalization of an Action Plan prepared by the residents of a Family Health Strategy territory in response to the context of the COVID-19 pandemic. Results: Information was produced, the flows in the unit were reorganized, avoiding agglomeration in services, personal protective equipment was guaranteed for health professionals, educational material was produced to guide these actions and, especially, not losing sight of the integrality of care in ensuring the maintenance of actions and previous programs. Conclusions: The adoption of these new measures has had a positive impact on the work process, emphasizing prevention as the main axis.

Introduction: Functional Health Literacy (FHL) is associated with patients’ ability to understand and use their health knowledge in the context of self-care and health promotion. Therefore, it is essential to recognize the level of FHL and identify the factors that influence it. Objective: To analyze the FHL level in users of Family Health Units (FHU) in the urban area of Altamira (state of Pará, Brazil). Methods: Cross-sectional study. Data collections took place between August 2018 and December 2019 in 12 FHU of the urban area. The sample calculation was based on the urban population of Altamira as recorded by the 2010 Population Census of IBGE. A 95% confidence interval with a margin of error of 5% and a prevalence of findings of 50% in a similar population were used, thus reaching a value of 382. The participants were interviewed to collect information on sociodemographic data. Subsequently, a questionnaire based on the Brazilian version of the Short Test of Functional Health Literacy (S-TOFHLA) was applied, which is used as an instrument to measure FHL. Pearson’s correlation coefficient, Chi-Square test, G-test, and odds ratio were used to verify the correlation between S-TOFHLA score and sociodemographic data. Furthermore, a multiple regression analysis was carried out to predict the factors that affect FHL. Finally, the ANOVA test has sought differences between the users’ FHL level in the analyzed family health units. Results:  The variables “education level,” “age,” and “income” were associated with FHL in the studied population, and predicted, respectively, 46, 26, and 17% of the performance in the S-TOFHLA test. Low education level and low income increase the risk of individuals having unsatisfactory FHL by five and four times, respectively. Finally, differences in FHL between users of the analyzed FHU were found. Conclusions: The population of the urban area of Altamira presented a high prevalence of unsatisfactory FHL. Therefore, seeking to increase the positive health results, healthcare professionals of the region must adapt their ways of communication and language to the needs of FHU users, observing that the team adequacy can improve the understanding of information and provide better conditions of recovery and self-care.

Introduction: Stigma against people with mental disorders is present in society as a whole, including among health professionals, harming both social relationships of these individuals and the health care provided to them. Objective: To analyze how Health Education alters the stigma of professionals in Primary Health Care (PHC) on people with mental disorders. Methods: Experimental study with pre- and post-intervention evaluation approach, conducted in four PHC Units in Regional Health VI in Fortaleza (Ceará), from June to December 2019, with professionals from the Family Health Strategy. Educational training based on the World Health Organization’s Mental Health Gap Action Program manual was carried out by two researchers. The degree of stigma was assessed using the Attribution Questionnaire in Portuguese (AQ-9). Results: 64 health professionals participated, mostly women (92%, n=58) with completed higher education (56%, n=34), predominantly Community Health Agents (63%, n=39), with mean age of 43 years. The sums of responses of questionnaire items for each participant were compared before and after the intervention using the Wilcoxon test, and the value of p<0.001 was found. Conclusions: The intervention was able to reduce the stigma of health professionals in relation to people with mental disorders and may serve as basis for the creation of a municipal model for permanent professional education.

Introduction: In the 1990s, sexually transmitted infections prevention activities for primary health care began. In the last two decades, there has been an increase in the assistance provided by nurses in the treatment of these infections. The Nusing Professional Practice Law No. 7.498/86 guarantees nurses in consultations the right to prescribe medication approved by institutional protocols. Objective: Identify whether nurses from the Primary Health Care Network in Florianopolis feel able to diagnose and prescribe medications for the treatment of sexually transmitted infections, based on the municipality's nursing protocols. Methods: exploratory-descriptive research with a qualitative approach, conducted through semi-structured interviews with trigger questions. 10 nurses with experience in primary care in the municipality were interviewed. The data were analyzed using the Bardin technique. Results: two analytical categories were identified: The nurse and the (re)construction of their professional practice and the nurse and their contribution to the quality of service in Primary Health Care. Conclusions: The Primary Health Care Network in Florianopolis is highly qualified, and nurses feel capable of adequately responding to the needs of their professional practices.

Problem: The COVID-19-CoV pandemic caused by the novel coronavirus (SARS-CoV-2) has become one of the greatest public health challenges of this century. Method: This was an experience report study carried out by final-year students in medicine, nursing and dentistry at Amazonas State University (Universidade do Estado do Amazonas, UEA), in the discipline of “Rural Internship in Collective Health,” in the municipality of Itapiranga, state of Amazonas. The experience that prompted the students’ report took place in August and September of 2020. Results: The students were included in the municipality’s family health teams, with which they developed activities such as  visits to riverside communities, consultations, and nursing, medical and dental care. COVID-19 prevention measures in the municipality were implemented with the guidance of health professionals in the management of the disease. The use of masks, social distancing and closing of shops were some measures adopted after the first confirmed case of the virus, which occurred on April 21, 2020. Mass testing was carried out in the population to detect symptomatic and  asymptomatic cases. In addition, more health professionals including physicians, nurses, psychologists and nursing technicians were hired to reinforce the health team. Conclusion: The Rural Internship in Collective Health in Itapiranga represented a unique opportunity for interaction between students and the health teams in the municipality, and made it possible for students to have a broader view of the functioning of primary health care, especially in a pandemic period, when the level of care proved to be as important for early diagnosis of the disease as for the effectiveness of containment measures.

Introduction: Currently, medical students are required to complete 30% of their mandatory internship in the Public Health System, primary care, and emergency services. In Rio de Janeiro, the main higher education institutes adjusted their curricula to this requirement, and the internship in family and community medicine began to take up a large portion of this class load. Objective: This work aimed to understand how this internship, conducted in health service units with medical residency programs in the city of Rio de Janeiro, impacts the training of future physicians, understanding the main factors involved and the potentials of this internship, and its personal and social influence on medical students. Methods: A qualitative study was conducted, and data were gathered in collective interviews with students of a federal university that had a family and community medicine internship in health service units in which residency programs are implemented. A thematic analysis was later conducted following Bardin's guidelines. Results: Data analysis identified 6 categories: expectations regarding the internship and family and community medicine; current impressions about the internship and family and community medicine; experiences that turn students away from family and community medicine; and extra-academic learning. Conclusions: This study, through students’ perceptions, was able to identify strengths and weaknesses of doing an internship in health service units with a residency in family and community medicine in Rio de Janeiro; and how this experience impacts medical students' training. Because of the demonstrated potential, the promotion and investments in this type of internship are suggested.

Problem: The demand for mental health in Primary Health Care (PHC) is high, and the training of healthcare teams to detect and treat these patients is essential. Matrix support, a collaborative healthcare model developed in the Brazilian context, is an important tool for the effectiveness of mental health care in PHC. In March 2020, with social distancing measures adopted due to the new coronavirus (COVID-19) pandemic, healthcare services needed to be reorganized. The objective of this article is to describe an experience of remote matrix support and its reorganization in mental health at a PHC unit in the city of Rio de Janeiro during the COVID-19 pandemic. Methods: The Heitor Beltrão Municipal Health Center is located in the North region of Rio de Janeiro. Before the pandemic, in the 2017-2019 period, matrix support took place through joint consultations, case discussions, and a group of psychotropic drugs. During the pandemic, the work was reorganized into two fronts: synchronous joint teleconsultations and the organization of a mental health users’ list for telemonitoring. Results: A total of 50 joint teleconsultations were carried out over 12 weeks, with an average of 4.16 consultations/week. The most frequent diagnoses were depressive and anxiety disorders, followed by personality and substance use disorders. These new actions allowed the maintenance of mental health users’ access to the service, inclusion of new cases, improvement of access for mental health users that are at risk for COVID-19 infection, and continuity of the training process in health with the acquisition of new skills and modernization of work. The main limitations were lack of available equipment and difficulty in access to the internet. Conclusions: This experience developed due to the COVID-19 pandemic describes the challenges and benefits of using remote matrix support and creating a list of mental health users. It may be able to help professionals and managers of other services to develop adaptations more suitable to local realities.