Physicians' and nurses' perspective on chronic disease care practices in Primary Health Care in Brazil: a qualitative study.

BACKGROUND: Primary health care-oriented systems provide better healthcare, especially for chronic diseases. This study analyzed the perspectives of physicians and nurses performing care for patients with chronic diseases in Primary Health Care in a Brazilian city. METHODS: A qualitative study was conducted in Vitória da Conquista, Bahia, Brazil, using semi-structured interviews with five physicians and 18 nurses. The interview included questions from an analytical matrix based on three dimensions of healthcare practices: organizational, technical care, and biopsychosocial, following a deductive approach. The interviews were fully transcribed and analyzed using a thematic categorical approach. RESULTS: The results indicated that the provision of chronic care occurs in a comprehensive way. Potentialities were identified in the diversification of access, offer of care actions and technologies, integration of teamwork, and bringing together social networks to foster autonomy and self-care. Weaknesses were mostly related to the high number of people in the teams, follow-up of several cases, high turnover of support teams, low integration of Primary Health Care with other levels, difficulties in intersectoral articulation and family participation in care. CONCLUSION: The multidimensional assessment of health care practices aimed at individuals with chronic noncommunicable diseases was useful to portray the strengths and weaknesses of the services. It also ratifies the need to consider the importance of and investment in primary health care by offering the necessary technical, political, logistical and financial support to the units, to ensure the sustainability of the actions by nurses, doctors and entire team.

Industry workers with hypertension and diabetes mellitus, the prevalence of self-reported adherence, and disease control

Abstract To evaluate the prevalence of self-reported drug adherence and factors associated, as well as clinical health outcomes, for industry workers with hypertension (HTN) and diabetes mellitus (DM). This was a cross-sectional study of 137 Brazilian industry workers with HTN and/ or DM. Self-reported adherence was assessed, and the disease control was defined through blood pressure and capillary glycemia values. Data were descriptively analyzed and the factors associated with adherence were evaluated using the Poisson model with robust variance to calculate prevalence ratios. The prevalence of self-reported drug adherence was 79.6% and the prevalence of disease control was 53.8%. There was no statistically significant association between the two variables. In the controlled disease group, non-adherence was associated with being under 40 years of age, not having a partner, and having a risky alcohol consumption habit. In the uncontrolled disease group, adherence was highest for participants aged 40 years and older. The prevalence of self-reported drug adherence was high, but the prevalence of disease control was low and not associated with adherence, indicating that the self-reported adherence measure may be inaccurate. Our findings identify some factors that explain non-adherent behavior in the workforce.

[Periodic occupational examination: an opportunity for diagnosis and monitoring of chronic noncommunicable diseases in men]. / Exame ocupacional periódico: oportunidade de diagnóstico e monitoramento de doença crônica não transmissível em homens.

The study aimed to estimate the prevalence of arterial hypertension as the principal marker of chronic noncommunicable diseases (NCDs) and to identify associated modifiable factors in male workers. Baseline data were used from a longitudinal study with a sample of 1,024 male workers 18 years or older in a municipality in Northeast Brazil. The marker for NCDs was arterial hypertension, defined as systolic pressure ≥ 140mmHg and/or diastolic pressure ≥ 90mmHg and/or prior diagnosis of arterial hypertension and/or use of antihypertensive medication. Poisson regression with robust variance was used, adopting hierarchical entry of variables. Population attributable fractions (PAFs) were calculated for the lifestyle variables to measure the impact of modifiable factors on workers' health. Prevalence of hypertension was 28.6% (95%CI: 25.9-31.5). Distal factors associated with hypertension were age > 40 years, black skin color, and family income ≥ 3 times the monthly minimum wage. Intermediate factors were alcohol abuse, smoking, high self-rated salt intake, and physical inactivity. Proximal factors were overweight and obesity. Calculation of PAFs showed that a reduction or elimination of unhealthy lifestyle habits and behaviors in this population group would reduce the prevalence of the target NCD, hypertension, by 56.1%. The identification of modifiable factors and the ways they can negatively impact male workers' health allows planning interventions in the workplace itself to reach the largest number of individuals, aimed at reducing the harmful effects of NCDs.

Objetivou-se estimar a prevalência de hipertensão arterial, como principal marcador de doença crônica não transmissível (DCNT), e identificar os fatores modificáveis associados, em trabalhadores homens. Foram utilizados dados da linha de base de um estudo longitudinal com uma amostra de 1.024 trabalhadores homens com 18 anos ou mais de um município do Nordeste do Brasil. O marcador de DCNT foi a hipertensão arterial, definida por pressão arterial sistólica ≥ 140mmHg e/ou pressão arterial diastólica ≥ 90mmHg e/ou diagnóstico prévio de hipertensão arterial e/ou uso de medicamentos anti-hipertensivos. Empregou-se a regressão de Poisson com variância robusta, adotando a entrada hierárquica de variáveis. Foram calculadas frações atribuíveis populacionais (FAP) para as variáveis de estilo de vida, a fim de dimensionar o impacto dos fatores modificáveis na saúde dos trabalhadores. A prevalência da hipertensão arterial nesta população foi de 28,6% (IC95%: 25,9-31,5), os fatores distais: idade > 40 anos, cor da pele preta e renda familiar ≥ 3 salários mínimos; fatores intermediários: consumo abusivo de álcool, consumo de tabaco, percepção de um consumo elevado de sal e inatividade física e o fator proximal: sobrepeso e obesidade associaram-se positivamente com a hipertensão arterial. O cálculo da FAP permitiu observar que se ocorresse a redução ou eliminação de hábitos e comportamentos relacionados ao estilo de vida deste público, reduziria em 56,1% a prevalência da DCNT estudada. A identificação de fatores modificáveis e como estes podem interferir negativamente na saúde de trabalhadores homens possibilita o planejamento de intervenções no próprio local de trabalho, a fim de alcançar o maior número de indivíduos, visando reduzir os efeitos deletérios das DCNT.

El objetivo fue estimar la prevalencia de hipertensão arterial, como principal marcador de enfermedad crónica no transmisible (ECNT), así como identificar factores modificables asociados, en hombres trabajadores. Se utilizaron datos de la línea de base, procedentes de un estudio longitudinal, con una muestra de 1.024 hombres trabajadores con 18 años o más de un municipio del Nordeste de Brasil. El marcador de ECNT fue la hipertensão arterial, definida por presión arterial sistólica ≥ 140mmHg y/o presión arterial diastólica ≥ 90mmHg y/o diagnóstico previo de hipertensão arterial y/o uso de medicamentos antihipertensivos. Se empleó la regresión de Poisson con varianza robusta, adoptando la entrada jerárquica de variables. Se calcularon fracciones atribuibles poblacionales (FAP) en las variables de estilo de vida, a fin de dimensionar el impacto de los factores modificables en la salud de los trabajadores. La prevalencia de la hipertensão arterial en esta población fue de 28,6% (IC95%: 25,9-31,5), los factores distales: edad > 40 años, color de piel negra y renta familiar ≥ 3 salarios mínimos; factores intermedios: consumo abusivo de alcohol, consumo de tabaco, percepción de un consumo elevado de sal e inactividad física y el factor proximal: sobrepeso y obesidad se asociaron positivamente con la hipertensão arterial. El cálculo de la FAP permitió observar que, si se produjese una reducción o eliminación de hábitos y comportamientos relacionados con el estilo de vida de este público, se reduciría en un 56,1% la prevalencia de la ECNT estudiada. La identificación de factores modificables y cómo pueden interferir negativamente en la salud de hombres trabajadores posibilita la planificación de intervenciones en el propio lugar de trabajo, con el fin de alcanzar al mayor número de individuos para reducir los efectos mortíferos de las ECNT.

Comparison of cardiovascular risk calculators in patients with diabetes.

OBJECTIVE: Cardiovascular risk stratification is an important clinical practice to estimate the severity of cardiovascular disease in patients with type 2 diabetes. This study aimed to compare the stratification of global cardiovascular risk with the specific risk stratification for patients with type 2 diabetes, seen at specialized outpatient clinics, and to evaluate possible differences in diagnoses and treatments. METHODS: A total of 122 patients with type 2 diabetes treated at two specialized outpatient clinics, from 2017 to 2019, were studied. The cardiovascular risk stratification calculators, global risk score, Cardiovascular Risk Stratification Calculator, and United Kingdom Prospective Diabetes Study-Risk Engine, were used to calculate the risk of death from cardiovascular disease. The agreement between these calculators was analyzed using the kappa index. The indications for the use of statins and acetylsalicylic acid for the group studied were evaluated according to the Brazilian Diabetes Society Guideline. RESULTS: There was a low degree of agreement among the three risk calculators. The global risk score calculator showed insignificant agreement with the Cardiovascular Risk Stratification Calculator (kappa=0.0816; p=0.0671). There was no agreement between the global risk score calculator and United Kingdom Prospective Diabetes Study-Risk Engine (kappa=-0.099), or between the Cardiovascular Risk Stratification Calculator and United Kingdom Prospective Diabetes Study-Risk Engine (kappa=-0.0095). CONCLUSION: The substantial disagreements among the cardiovascular risk calculators may lead to different diagnoses and may consequently influence therapeutic strategies. The findings herein highlight the need for specific validated cardiovascular risk calculators for patients with DM2 that can reliably estimate risk in these individuals.

Evaluation of blood pressure through home monitoring in brazilian primary care: a feasibility study.

Blood pressure measurements taken in a clinical setting are subject to errors, therefore there are advantages to monitoring blood pressure at home, especially in in patients diagnosed with hypertension. The study describes the feasibility of home monitoring to assess blood pressure in primary care and compares blood pressure measured at home and during a medical consultation. This cross-sectional study was carried out with patients whose used home blood pressure in the morning and evening, thrice for seven consecutive day sat home. Participants included patients older than 18 years with suspected whitecoat hypertension, taking antihypertensives, or those intolerant of ambulatory blood pressure monitoring, and excluded patients who did not follow the protocol, suffered from an irregular heart rate, and pregnant women. Of the 134 patients who participated in the study, 63.3% had altered blood pressure when measured at health facilities and 48% had higher blood pressure at home. The mean difference between the methods was 10.1 mmHg for systolic and 4.3 mmHg for diastolic. The prevalence of whitecoat hypertension was 19.4%. Blood pressure monitoring at home is a practicable strategy in the Brazilian healthcare system.

Evaluation of blood pressure through home monitoring in brazilian primary care: a feasibility study / Avaliação da pressão arterial através da monitorização residencial na atenção básica brasileira: um estudo de viabilidade

Abstract Blood pressure measurements taken in a clinical setting are subject to errors, therefore there are advantages to monitoring blood pressure at home, especially in in patients diagnosed with hypertension. The study describes the feasibility of home monitoring to assess blood pressure in primary care and compares blood pressure measured at home and during a medical consultation. This cross-sectional study was carried out with patients whose used home blood pressure in the morning and evening, thrice for seven consecutive day sat home. Participants included patients older than 18 years with suspected whitecoat hypertension, taking antihypertensives, or those intolerant of ambulatory blood pressure monitoring, and excluded patients who did not follow the protocol, suffered from an irregular heart rate, and pregnant women. Of the 134 patients who participated in the study, 63.3% had altered blood pressure when measured at health facilities and 48% had higher blood pressure at home. The mean difference between the methods was 10.1 mmHg for systolic and 4.3 mmHg for diastolic. The prevalence of whitecoat hypertension was 19.4%. Blood pressure monitoring at home is a practicable strategy in the Brazilian healthcare system.

Resumo A medição da pressão arterial no consultório está sujeita a erros; assim, a monitorização residencial da pressão arterial é utilizada para o monitoramento e diagnóstico da hipertensão. Descrever a viabilidade da monitorização residencial para avaliar a pressão arterial na atenção primária e comparar os valores da pressão arterial através da monitorização residencial e medida de consultório. Estudo transversal realizado com pacientes que utilizaram a monitorização residencial pela manhã e pela noite, em triplicata por sete dias consecutivos em domicílio. Foram incluídos pacientes maiores de 18 anos, com suspeita de hipertensão do avental branco, utilizando anti-hipertensivos ou intolerantes a monitorização ambulatorial. Foram excluídos pacientes que não seguiram o protocolo, aqueles que apresentavam ritmo cardíaco irregular ou mulheres grávidas. 134 pacientes participaram do estudo, 63,3% apresentaram pressão arterial alteradas em consultório e 48% pela monitorização residencial. A diferença média dos métodos foi de 10,1 mmHg para sistólica e 4,3 mmHg para diastólica. A prevalência de hipertensão do avental branco foi 19,4%. A monitorização residencial da pressão arterial no sistema de saúde brasileiro provou ser uma estratégia viável.

Gender Differences in the Quality of Life of Formal Workers.

BACKGROUND: This study aimed to assess the quality of life associated with gender inequalities in formal workers and to determine the effect of sociodemographic, clinical, and behavioral factors on the quality of life (QOL). METHODS: This cross-sectional study involved 1270 workers. Quality of life was measured using the EUROHIS-QOL 8-Item and assessed in terms of psychological, environmental, social, and physical domains, while demographic, socioeconomic, behavioral, and clinical variables served as explanatory variables. Analyses were performed using an ordinal logistic regression model whose significance level was 5%. RESULTS: Of the participants, 80.2% were men, and 19.8% were women; the mean age was 34 (standard deviation: ±10) and 32 (±9) years, respectively. In all prediction scenarios, men were more likely to have a higher quality of life, especially in the physical (odds ratio: 2.16; 95% confidence interval: 1.60-2.93) and psychological (odds ratio: 2.09; 95% confidence interval: 1.51-2.91) domains. CONCLUSIONS: Men and women had significantly different levels of quality of life, and sociodemographic, clinical, and behavioral variables partially clarified these differences, which were possibly established by a socio-historical process of construction of the work role determined by gender issues.

Comparison of cardiovascular risk calculators in patients with diabetes

SUMMARY OBJECTIVE: Cardiovascular risk stratification is an important clinical practice to estimate the severity of cardiovascular disease in patients with type 2 diabetes. This study aimed to compare the stratification of global cardiovascular risk with the specific risk stratification for patients with type 2 diabetes, seen at specialized outpatient clinics, and to evaluate possible differences in diagnoses and treatments. METHODS: A total of 122 patients with type 2 diabetes treated at two specialized outpatient clinics, from 2017 to 2019, were studied. The cardiovascular risk stratification calculators, global risk score, Cardiovascular Risk Stratification Calculator, and United Kingdom Prospective Diabetes Study-Risk Engine, were used to calculate the risk of death from cardiovascular disease. The agreement between these calculators was analyzed using the kappa index. The indications for the use of statins and acetylsalicylic acid for the group studied were evaluated according to the Brazilian Diabetes Society Guideline. RESULTS: There was a low degree of agreement among the three risk calculators. The global risk score calculator showed insignificant agreement with the Cardiovascular Risk Stratification Calculator (kappa=0.0816; p=0.0671). There was no agreement between the global risk score calculator and United Kingdom Prospective Diabetes Study-Risk Engine (kappa=-0.099), or between the Cardiovascular Risk Stratification Calculator and United Kingdom Prospective Diabetes Study-Risk Engine (kappa=-0.0095). CONCLUSION: The substantial disagreements among the cardiovascular risk calculators may lead to different diagnoses and may consequently influence therapeutic strategies. The findings herein highlight the need for specific validated cardiovascular risk calculators for patients with DM2 that can reliably estimate risk in these individuals.

Exame ocupacional periódico: oportunidade de diagnóstico e monitoramento de doença crônica não transmissível em homens / Periodic occupational examination: an opportunity for diagnosis and monitoring of chronic noncommunicable diseases in men / Examen ocupacional periódico: oportunidad de diagnóstico y supervisión de enfermedad crónica no transmisible en hombres

Objetivou-se estimar a prevalência de hipertensão arterial, como principal marcador de doença crônica não transmissível (DCNT), e identificar os fatores modificáveis associados, em trabalhadores homens. Foram utilizados dados da linha de base de um estudo longitudinal com uma amostra de 1.024 trabalhadores homens com 18 anos ou mais de um município do Nordeste do Brasil. O marcador de DCNT foi a hipertensão arterial, definida por pressão arterial sistólica ≥ 140mmHg e/ou pressão arterial diastólica ≥ 90mmHg e/ou diagnóstico prévio de hipertensão arterial e/ou uso de medicamentos anti-hipertensivos. Empregou-se a regressão de Poisson com variância robusta, adotando a entrada hierárquica de variáveis. Foram calculadas frações atribuíveis populacionais (FAP) para as variáveis de estilo de vida, a fim de dimensionar o impacto dos fatores modificáveis na saúde dos trabalhadores. A prevalência da hipertensão arterial nesta população foi de 28,6% (IC95%: 25,9-31,5), os fatores distais: idade > 40 anos, cor da pele preta e renda familiar ≥ 3 salários mínimos; fatores intermediários: consumo abusivo de álcool, consumo de tabaco, percepção de um consumo elevado de sal e inatividade física e o fator proximal: sobrepeso e obesidade associaram-se positivamente com a hipertensão arterial. O cálculo da FAP permitiu observar que se ocorresse a redução ou eliminação de hábitos e comportamentos relacionados ao estilo de vida deste público, reduziria em 56,1% a prevalência da DCNT estudada. A identificação de fatores modificáveis e como estes podem interferir negativamente na saúde de trabalhadores homens possibilita o planejamento de intervenções no próprio local de trabalho, a fim de alcançar o maior número de indivíduos, visando reduzir os efeitos deletérios das DCNT.

The study aimed to estimate the prevalence of arterial hypertension as the principal marker of chronic noncommunicable diseases (NCDs) and to identify associated modifiable factors in male workers. Baseline data were used from a longitudinal study with a sample of 1,024 male workers 18 years or older in a municipality in Northeast Brazil. The marker for NCDs was arterial hypertension, defined as systolic pressure ≥ 140mmHg and/or diastolic pressure ≥ 90mmHg and/or prior diagnosis of arterial hypertension and/or use of antihypertensive medication. Poisson regression with robust variance was used, adopting hierarchical entry of variables. Population attributable fractions (PAFs) were calculated for the lifestyle variables to measure the impact of modifiable factors on workers' health. Prevalence of hypertension was 28.6% (95%CI: 25.9-31.5). Distal factors associated with hypertension were age > 40 years, black skin color, and family income ≥ 3 times the monthly minimum wage. Intermediate factors were alcohol abuse, smoking, high self-rated salt intake, and physical inactivity. Proximal factors were overweight and obesity. Calculation of PAFs showed that a reduction or elimination of unhealthy lifestyle habits and behaviors in this population group would reduce the prevalence of the target NCD, hypertension, by 56.1%. The identification of modifiable factors and the ways they can negatively impact male workers' health allows planning interventions in the workplace itself to reach the largest number of individuals, aimed at reducing the harmful effects of NCDs.

El objetivo fue estimar la prevalencia de hipertensão arterial, como principal marcador de enfermedad crónica no transmisible (ECNT), así como identificar factores modificables asociados, en hombres trabajadores. Se utilizaron datos de la línea de base, procedentes de un estudio longitudinal, con una muestra de 1.024 hombres trabajadores con 18 años o más de un municipio del Nordeste de Brasil. El marcador de ECNT fue la hipertensão arterial, definida por presión arterial sistólica ≥ 140mmHg y/o presión arterial diastólica ≥ 90mmHg y/o diagnóstico previo de hipertensão arterial y/o uso de medicamentos antihipertensivos. Se empleó la regresión de Poisson con varianza robusta, adoptando la entrada jerárquica de variables. Se calcularon fracciones atribuibles poblacionales (FAP) en las variables de estilo de vida, a fin de dimensionar el impacto de los factores modificables en la salud de los trabajadores. La prevalencia de la hipertensão arterial en esta población fue de 28,6% (IC95%: 25,9-31,5), los factores distales: edad > 40 años, color de piel negra y renta familiar ≥ 3 salarios mínimos; factores intermedios: consumo abusivo de alcohol, consumo de tabaco, percepción de un consumo elevado de sal e inactividad física y el factor proximal: sobrepeso y obesidad se asociaron positivamente con la hipertensão arterial. El cálculo de la FAP permitió observar que, si se produjese una reducción o eliminación de hábitos y comportamientos relacionados con el estilo de vida de este público, se reduciría en un 56,1% la prevalencia de la ECNT estudiada. La identificación de factores modificables y cómo pueden interferir negativamente en la salud de hombres trabajadores posibilita la planificación de intervenciones en el propio lugar de trabajo, con el fin de alcanzar al mayor número de individuos para reducir los efectos mortíferos de las ECNT.

Covid-19 telescreening in SUS users with risk conditions: case report.

This case report aims to describe the conception and preliminary data of the implementation of a telescreening and telemonitoring program of covid-19 for users of the Unified Health System with risk conditions. A system of telerscreening was implemented through which undergraduate students in the health area contact patients by telephone, according to periodicity and predefined criteria, to monitor the evolution of the condition. In eight weeks, 2,190 attempts at remote contact were made with individuals from five health units. The effective number of individuals monitored at the time this writing is 802.

Cost-Effectiveness of Point-of-Care A1C Tests in a Primary Care Setting.

Objective: We evaluated the cost-effectiveness of the point-of-care A1c (POC-A1c) test device vs. the traditional laboratory dosage in a primary care setting for people living with type 2 diabetes. Materials and Methods: The Markov model with a 10-year time horizon was based on data from the HealthRise project, in which a group of interventions was implemented to improve diabetes and hypertension control in the primary care network of the urban area of a Brazilian municipality. A POC-A1c device was provided to be used directly in a primary care unit, and for a period of 18 months, 288 patients were included in the point-of-care group, and 1,102 were included in the comparison group. Sensitivity analysis was performed via Monte Carlo simulation and tornado diagram. Results: The results indicated that the POC-A1c device used in the primary care unit was a cost-effective alternative, which improved access to A1c tests and resulted in an increased rate of early control of blood glucose. In the 10-year period, POC-A1c group presented a mean cost of US$10,503.48 per patient and an effectiveness of 0.35 vs. US$9,992.35 and 0.09 for the traditional laboratory test, respectively. The incremental cost was US$511.13 and the incremental effectiveness was 0.26, resulting in an incremental cost-effectiveness ratio of 1,947.10. In Monte Carlo simulation, costs and effectiveness ranged between $9,663.20-$10,683.53 and 0.33-0.37 for POC-A1c test group, and $9,288.28-$10,413.99 and 0.08-0.10 for traditional laboratory test group, at 2.5 and 97.5 percentiles. The costs for nephropathy, retinopathy, and cardiovascular disease and the probability of being hospitalized due to diabetes presented the greatest impact on the model's result. Conclusion: This study showed that using POC-A1c devices in primary care settings is a cost-effective alternative for monitoring glycated hemoglobin A1c as a marker of blood glucose control in people living with type 2 diabetes. According to our model, the use of POC-A1c device in a healthcare unit increased the early control of type 2 diabetes and, consequently, reduced the costs of diabetes-related outcomes, in comparison with a centralized laboratory test.

Covid-19 telescreening in SUS users with risk conditions: case report / Telerrastreio da covid-19 em usuários do SUS com condições de risco: relato de experiência

ABSTRACT This case report aims to describe the conception and preliminary data of the implementation of a telescreening and telemonitoring program of covid-19 for users of the Unified Health System with risk conditions. A system of telerscreening was implemented through which undergraduate students in the health area contact patients by telephone, according to periodicity and predefined criteria, to monitor the evolution of the condition. In eight weeks, 2,190 attempts at remote contact were made with individuals from five health units. The effective number of individuals monitored at the time this writing is 802.

RESUMO O presente relato de experiência tem como objetivo descrever a concepção e os dados preliminares da implementação de um programa de telerrastreio e telemonitoramento da covid-19 para usuários do Sistema Único de Saúde com condições de risco para agravamento. Foi implantado um sistema de telerrastreio por meio do qual estudantes de graduação na área da saúde contactam os pacientes via telefone, conforme periodicidade e critérios predefinidos, para monitorar a evolução do quadro. Em oito semanas, foram realizadas 2.190 tentativas de contato remoto com indivíduos de cinco unidades de saúde. O número efetivo de indivíduos monitorados no momento da escrita deste artigo é de 802.

Representações Sociais do Cuidado de Enfermagem em Saúde Mental na Atenção Básica / Social Representations of Nursing Care in Mental Health in Primary Care

Esta pesquisa teve como objetivos analisar as ferramentas utilizadas por enfermeiras para o desenvolvimento do cuidado em saúde mental na Estratégia Saúde da Família e as limitações para a sua produção. Trata-se de uma pesquisa qualitativa do tipo estudo de caso. Os dados foram coletados por meio de entrevistas semiestruturadas e analisados a partir da Análise de Conteúdo Temática, a partir da Teoria das Representações Sociais. Foram depreendidas duas categorias: ferramentas utilizadas para a produção do cuidado em saúde mental e as limitações para a sua efetivação. As participantes da pesquisa ancoraram suas representações sociais em elementos que retrataram as possibilidades/limitações para o cuidado em saúde mental, principalmente, relacionadas ao usuário com transtorno mental. Destarte, as participantes da pesquisa reconheceram o encaminhamento/medicalização, o acolhimento/vínculo/escuta como possibilidades para produção do cuidado em saúde mental e apontaram as deficiências nos processos formativos e o medo como limitadores para a produção deste cuidado

This research aimed to analyze the tools used by nurses for the development of mental health care in the Family Health Strategy and the limitations to their production. This is a qualitative case-study research. The data were collected through semi-structured interviews and analyzed from the Thematic Content Analysis, based on the Social Representations Theory. Two categories emerged: tools used for the production of mental health care and the limitations to its effectiveness. The research participants anchored their social representations in elements that portrayed the possibilities / limitations for mental health care, mainly related to the user with mental disorder. Thus, the research participants acknowledged referral / medicalization, welcoming / bonding / listening as possibilities for the production of mental health care, and pointed out deficiencies in the formative processes and fear as limiters for the production of this care

Saúde dos homens nas percepções de enfermeiros da estratégia saúde da família / "Men are very tough" ­ men's health in the perceptions of family health strategy nurses

A saúde do homem adquiriu maior visibilidade a partir da publicação da Política Nacional de Atenção Integral à Saúde do Homem. Trata-se de um estudo de abordagem qualitativa, do tipo exploratório e descritivo, cujo objetivo foi analisar as percepções de enfermeiras da Estratégia Saúde da Família sobre a produção de cuidados à saúde do homem. Participaram da pesquisa dez enfermeiras que atuavam nos serviços da Estratégia Saúde da Família de um município localizado no sudoeste baiano. Os dados foram coletados por meio de entrevistas semiestruturadas. A análise dos dados se deu por meio da Análise de Conteúdo Temática. A partir da leitura e interpretação dos dados foram construídas três categorias temáticas: 1) Saúde do homem: significados de enfermeiros da Estratégia Saúde da Família; 2) Dificuldades para o desenvolvimento de ações voltadas à saúde do homem e 3) Estratégias de assistência à saúde do homem na Estratégia Saúde da Família. Os resultados apontaram para as fragilidades que o público masculino se depara em relação aos serviços de saúde da família, evidenciadas pela falta de estrutura dos serviços; a falta de qualificação profissional para produção de cuidados dirigidos ao público masculino e os estereótipos de masculinidade que afastam os homens dos serviços de saúde.

Men's health acquired greater visibility from the publication of the National Policy on Comprehensive Attention to Men's Health. This is an exploratory, descriptive study, with a qualitative approach, whose purpose was to analyze the perceptions of Family Health Strategy nurses about the production of men's health care. The participants were ten nurses working in the Family Health Strategy services of a municipality in southwest Bahia. Data were collected through semi-structured interviews. Data analysis was done through Thematic Content Analysis. From the reading and interpretation of the data, three thematic categories were constructed: 1) Men's health: meanings for nurses in the Family Health Strategy; 2) Difficulties in developing actions for men's health; and 3) Assistance strategies for men's health in the Family Health Strategy. The results pointed to the weaknesses that the male public is faced with, compared to family health services, as evidenced by the lack of services structure; the lack of professional qualification for providing care for the male public; and the masculine stereotypes that keep men away from health services.