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

Introduction: The use of phytotherapy in health care is accessible, reliable, and culturally accepted, and it is recognized that about 80% of the world population makes use of medicinal plants. In the Unified Health System (Sistema Único de Saúde – SUS), based on the Sanitary Reform movement and popular and institutional interests, the National Policy on Medicinal Plants and Phytotherapeutics was created, which encouraged the implementation of several phytotherapy programs in Brazil. Despite this rise of phytotherapy in the SUS, medicalization continues to influence clinical practice and make individuals increasingly susceptible to unnecessary interventions that often end up causing damage. Objective: To discuss possibilities of using phytotherapy to face overmedicalization to promote quaternary prevention in Primary Health Care. Methods: This is a theoretical essay based on the contextualization of the possibility of facing medicalization within the SUS from the perspective of Phytotherapy. Results: The theoretical framework started with a brief review of the advance of medicalization in the SUS, then considering phytotherapy as an accessible and widespread practice among the Brazilian population as a possibility to reduce medicalization when correlated with the Person-Centered Clinical Method. Conclusions: Phytotherapy can be an ally of the practice of quaternary prevention by making it possible to meet traditional and technical-scientific knowledge, enabling an alternative care method to the medicalizing logic.

Introduction: Brazilian Family Doctors, until recently, were restricted to the public health system as the only job market. In the last decade, they are being increasingly required in the supplementary private system. Their experiences as professionals directly linked to the assistance and as managers have led some to open their own businesses in the form of clinics and offices. There is a set of competencies that characterize entrepreneurial behavior, called Personal Entrepreneurial Competencies in the literature. Objective: To understand how these Personal Entrepreneurial Competencies are present in these pioneering Family Doctors, their demographic and socioeconomic profile, and what past influences encouraged them to accept the risk and invest. Methods: Mixed study with exploratory-descriptive qualitative and quantitative design with Family Doctors that already have their own businesses. The instrument for quantifying Personal Entrepreneurial Competencies created by Lenzi and another one with questions of sociodemographic and contextual characterization were applied. Results: The researchers invited 16 entrepreneur physicians working in the Brazilian territory found through digital social networks. Only 11 answered both questionnaires: 6 men and 5 women from 8 different cities, most of them state capitals with more than 1 million inhabitants, 90.9% graduated from public universities, 63.6% between 30 and 40 years old, all with previous experience in the public sector. Most businesses have less than 1 year (45.5%), yield less than U$ 1,100.00 American dollars per month (45.5%) and most of the interviewees still work in other services such as the public sector (90.9%). The most present Personal Entrepreneurial Competencies were "Commitment" (90.9%), "Information Seeking" (81.8%), "Persistence" (72.7%) and "Taking Calculated Risks" (72.7%). The least present were “Independence and Self-confidence” (27.3%) and “Goal Setting” (45.4%). Conclusions: Although by convenience, it is possible that the sample in this study represent a significant portion of the Family Doctors who have risked themselves in the competitive private health market. Its characteristics: young, with a balanced gender, with long experience in the public sector and a recent start in the private market, still very afraid of investing and little formal training in the field of entrepreneurship, are probably a reliable portrait of the current moment. The profile of the developed Personal Entrepreneurial Competencies corroborated with the literature and served to warn about the lack of focus on planning, pointing out that bringing Family Medicine to the Brazilian private market is an innovative idea, but only good ideas are not enough to produce stability and sustainability for business.

Introduction: During clinical consultations performed in Primary Care, it is not uncommon for patients to cry. However, the professionals that operate in this scope may feel unprepared to deal with this scenario, due to the lack of skills knowledge for the approach to patients with this kind of demand. Objective: This study aims to list and categorize techniques to approach a crying patient, through interviews with preceptors of the Family and Community Medicine (FCM) Residency Program from the Municipal Government of Rio de Janeiro. Methods: 16 preceptors were interviewed, and those interviews were recorded, transcribed and later analyzed according to Bardin’s precepts. Results: As a result, we obtained a compilation of 94 quotations of non-verbal techniques and 27 of verbal techniques, as well as their learning methods, which occurred mainly through knowledge obtained during the Residency in FCM, practical experience and reading of related topics, highlighting the references about clinical communication. Moreover, reasons for patients crying, doctors' feelings, objectives of the techniques and whether they were considered to be helpful to both physicians and patients in this situation, were also categorized. Conclusions: It was concluded that the applied techniques belong to the set of clinical communication tools, based on empathy and bond, and that the first contact with these usually occurs at the FCM Residency and is later improved with clinical experience. In this context, stands out the importance of the emphasis given to the topic during specialization and continuing education for the benefit of the physician and the patient.

Introduction: The insertion of Auriculotherapy in the scope of Primary Health Care in João Pessoa is recent and occurs in an autonomous and diffuse way, depending on the professional’s motivation. Objective: The purpose of this article is to present a brief analysis of the Auriculotherapy offered in a closed group. Methods: Qualitative exploratory research, using data collected through semi-structured interviews with users who used Auriculotherapy in the therapeutic process.  Results: After the qualitative analysis of the data using the Bardin Content Analysis technique, three categories emerged: Understanding and building concepts about Auriculotherapy; Conception about the Auriculotherapy effectiveness; Auriculotherapy group experience. We can infer that the offer of Auriculotherapy in Primary Care is viewed by the user as a practice that leads to well-being and relieves their pain, whether physical or emotional. They also reveal the importance of health education for understanding the therapy they enjoy, building their conceptions from experiences, exchanges and knowledge sharing. Conclusions: Auriculotherapy is, therefore, a practice by which can build and strengthen bonds and increase the scope of actions offered to reach the integrality.

Introduction: Information on the presence of chronic diseases in older adults is not registered during influenza vaccination campaigns, which hinders its identification (proportion) in vaccinated older people. Objective: To describe the prevalence of self-reported chronic diseases in older people vaccinated against influenza; to verify the influence of the media in the decision to receive the vaccine; and if older adults received guidance on the importance of the vaccine, according to the type of health professional. Methods: This is a descriptive, cross-sectional study with data collected via interviews with older people vaccinated against influenza (n=798) in a Health Center of Campinas (state of São Paulo, Brazil) in 2019. Results: Most individuals were women (58.0%), with high school degree or higher education (53.0%), and with health insurance (72.3%). The most prevalent diseases were hypertension (56.9%; 95%CI 53.4-60.3), diabetes (24.7%; 95%CI 21.8-27.8), heart diseases (13.6%; 95%CI 11.4-16.2), and respiratory diseases (5.6%; 95%CI 4.2-7.5). A maioria (58,0%) considerou que a mídia influenciou sua decisão de tomar a vacina. The majority (58.0%) considered that the media influenced the decision to have the vaccine; 21.1% of the older adults received guidance on the importance of vaccination, mainly provided by physicians (67.4%), nurses (18.2%), and health workers (7.0%). Conclusions: The main diseases reported by the vaccinated older adults were hypertension, diabetes, heart diseases, and respiratory diseases. The guidance of health professionals was little reported, and most older people mentioned that the media influenced the decision to be vaccinated. The authors emphasize the need and relevance of investing in health communication strategies to inform the population about the importance of influenza vaccination for older adults and those with chronic diseases.

Introduction: The More Physicians Program was created with the purpose of providing professionals to the most vulnerable regions, considering that physicians in Primary Care acts on demands such as health promotion and surveillance, prevention, diagnosis and treatment of diseases. Objective: This study evaluated the effectiveness of the More Physicians Program in Pernambuco using hospitalization and death by arterial hypertension (AH) and Diabetes Mellitus (DM) as tracer conditions. Methods: Cross-sectional study carried out before and after the Program from 2011 to 2013 and from 2014 to 2016. Data were obtained from the Hospital Information System of the Unified Health System (SIH/SUS), at the Department of Informatics of SUS (DATASUS), considering the state as a whole and its regions. Results: The number of hospitalizations was reduced in the state, 27% for AH and 26% for DM. There was a 58% decrease in admissions due to AH in the Sertão, being greater if due to urgency. Deaths from AH declined in almost all regions, with a drop of 41% in Pernambuco; except for Recife’s Metropolitan Region, where the percentage actually increased. As for DM, hospital admissions decreased compared to AH, with an increase in admissions due to urgencies in Zona da Mata and Sertão do San Francisco. Deaths from DM showed a downward trend in all regions, totaling 42% in the State.  Conclusion: The Program was proven effective in reducing hospital admissions and deaths from AH and DM in Pernambuco, featuring as an important strategy to strengthen Primary Health Care, especially to reduce complications in sensitive conditions. The need for medical professional to expand care is highlighted, mainly in more vulnerable regions where there is a lack of physicians.  

Abstract The Addison Disease, or primary adrenal insufficiency, is an insidious disease and rare, which may present high morbimortality levels when the diagnosis is unknown and the treatment doesn’t start at the right time. There is multiple symptoms, highlighting arterial hypotension, skin hyperpigmentation, hyponatremia and hyperkalemia. When left untreated, it can evolve with adrenal crisis and cardiovascular collapse. The Addison Disease diagnosis is clinical and through the laboratorial discoveries, as high adrenocorticotropic hormone (ACTH) levels and low cortisol plasmatic concentrations. The treatment depends on the cause and requires multidisciplinary approach, but overall can be done with glucocorticoids replacement and, occasionally, other hormones. This article describes an Addison Disease case diagnosed in Primary Health Assistance, an uncommon situation, due to the  beginning nonspecific disease symptoms, which is not considered. Key-words: Addison Disease; Primary Adrenal Insufficiency; Case Report; Primary  Health Assistance.

Introduction: The reflection on family violence against children has gained international prominence in last decades, accompanied by policies for abolition of acts of violent discipline, which still remains socially accepted and used by many responsible. Objectives: To know the perceptions and practices within the scope of Family Health Strategy (FHS) in relation to guidance on methods of discipline in two units in the municipality of Rio de Janeiro. Methods: 38 professionals working in daily care of children were approached. The content analysis of reports obtained through semi-structured interviews was carried out and data were organized in two main categories: professional's perception of child discipline and practices about childhood discipline: are there opportunities for promotion in the FHS? Results: There is still no routine approach to child discipline in any of the studied clinics, nor are activities carried out to prevent abuse. Professionals related their personal experiences (lived in their own childhood and with their children) with actions carried out in their daily practice. Conclusions: Reports suggest that the approach to corporal punishment remains hidden in childcare care, with loss of opportunities to support parents and to promote positive family bonds. Based on significant changes in violence perception, professionals can reframe their beliefs, expanding their actions on the topic.

Introduction: Telemedicine facilitates the care in health by distance. This health technology has shown good clinical results and user satisfaction. The satisfaction is a main indication of service quality, your evaluation allows changes in the quality of care, identifies problems and enables better management and behaviors of health professionals. The increase in the use of telemedicine in the world has emerged in a need to understand the quality of this service. Objective: To translate, culturally adapt and validate a questionnaire to assess the satisfaction of patients treated by telemedicine. Methods: The version adapted after evaluation by a committee of judges was used in a pre-test with 30 patients seen in the project. The results of the pre-test were evaluated in order to obtain an adequate version of the instrument. In addition, this questionnaire was applied to a sample of 141 patients treated via telemedicine. Analysis of internal consistency and construct validation were performed. Results: The Global Content Validity Coefficient (CVC) score was 0.942, demonstrating the questions' clarity, relevance and relevance. The instrument showed internal consistency with a standardized Cronbach’s alpha of 0.6; considered acceptable. The exploratory factor analysis showed a KMO of 0.56 and Bartlett's sphericity test showed a value of 0.001. Conclusions: The Brazilian version of the Questionnaire for the Evaluation of Patient Satisfaction Via Telemedicine (QAS-Tele) is an easy and viable instrument for the evaluation of the satisfaction of patients treated by telemedicine.

Introduction: The Amplified Clinic (CA) seeks to integrate and build bonds between professionals and users of the health system, expanding the intervention resources on the health-disease process. Objective: This study aimed to analyze the knowledge about AC among students of a medical school boarding school in northeastern Brazil. Methods: This is a qualitative study conducted in 2017, involving 25 medical students from the Federal University of Alagoas. The data were collected through a questionnaire on Amplified Clinic and analyzed by the IRAMUTEQ program. Results: Five classes were observed: “Application of AC”, “Knowledge about AC”, “Space for using AC at boarding school”, “Experience in AC” and “Training challenges for AC”. The students know the AC and that the medical training they experience is based on the perspective of expanded care, especially in primary care. At the other levels of care, CA is little worked on. Conclusions: It is concluded that, although advances are noticed in the formative course of the course in question, there is still a need for a better articulation regarding the CA application in all levels of care.