Basic Health Care Units Research Articles

Matrix support in mental health in primary care: the vision of supporters and nurses.

To understand the view of supporters and nurses on matrix support mental health actions in Primary Health Care. A qualitative and phenomenological study, with Alfred Schutz's framework of phenomenological sociology. The study was conducted with five supporters and 22 nurses from Basic Health Care Units in the city of Porto Alegre. The participants' intentions and expectations, captured through a phenomenological interview, made up the corpus of analysis. The supporters have the intention, given the actions of the matrix support, to improve mental health care for the user. On the other hand, the nurses expect support to the health units, which reveals nonconformities in the mental health practices instituted in the basic network. Knowing the motivations of supporters and nurses can be a powerful strategy for consolidating public policies with a view to the psychosocial way in the territory.

Do women have an accurate perception of their pelvic floor muscle contraction? A cross-sectional study.

To assess women's self-perception of their pelvic floor muscle (PFM) contraction and its agreement with an assessed PFM contraction. Further, to assess a possible correlation between women's self-perception and reports of urinary incontinence (UI) and between PFM contraction and severity of UI. A cross-sectional observational study including 82 women. The study was conducted in a basic healthcare unit in Brazil. PFM contraction was assessed by a physiotherapist and estimated by women using the Modified Oxford Scale (MOS). UI symptoms were assessed using a validated questionnaire (ICIQ-UI-SF). A descriptive analysis of the data was performed. The weighted κ coefficient, Spearman's correlation coefficient, and Fisher's exact test were used to analyze data. Eighty-two women with a mean age of 46.83 (±17.94) were analyzed. The majority (98.8%) believed they were able to voluntarily contract their PFM, but only 33% correctly estimated their PFM considering the examiner assessment as reference. No agreement (κ = 0.139, P = .087) was found between the examiner's classification and the women's estimation of their PFM contraction. Women's self-perception did not correlate with the ICIQ-IU-SF (r's = .011, P = .922). A moderate negative correlation was found between the assessed PFM contraction and the ICIQ-UI-SF score (r's = -.406, P = .00). Most of the women did not show an accurate self-perception of PFM contraction. No correlation between women's self-perception and the ICIQ-UI-SF score was found, but a negative correlation was found between the assessed PFM contraction and the ICIQ-UI-SF score.

Sleep pattern, obesity and healthcare expenditures in Brazilian adults.

The aim of this study was to analyze the relationship between sleep pattern and healthcare expenditures in adults, as well as to identify whether physical activity, biochemical markers and obesity affect this relationship. The sample was composed of 168 adults aged ≥ 50 years attended by two Basic Healthcare Units in Presidente Prudente, SP, Brazil. Health expenditure, sleep pattern, anthropometry, adiposity index, physical activity, metabolic and cardiovascular variables were assessed. Statistical analyses were performed using Kruskal-Wallis, Mann-Whitney and Spearman tests. Sleep disorders were positively correlated to higher costs with medicines and negatively correlated to costs with laboratory tests, even after adjusts by confounders. In addition, healthcare costs were also correlated to physical activity score, blood pressure, obesity and metabolic variables. Severe sleep disorders and high percentage of body fat were associated with increased use of medications. Sleep pattern is correlated to primary care healthcare costs, obesity and physical activity level.

Impact of type 2 diabetes mellitus and physical activity on medication costs in older adults.

The high prevalence of diabetes mellitus leads to high costs of medication for treatment and the practice of physical activity, as well as reducing the risks of diabetes mellitus is able to substantially mitigate costs. To investigate the impact of diabetes mellitus on costs of medication and identify whether physical activity can influence the relationship between diabetes mellitus and costs of medication. The sample consisted of adults enrolled in five basic healthcare units. The presence of diabetes mellitus and habitual physical activity were assessed by a questionnaire, the quantity of medication used was evaluated according to the medical records, and medication costs, through receipts. Individuals with diabetes mellitus from baseline presented higher body weight (P value = .001) and lower levels of physical activity (P value = .014). The presence of diabetes mellitus was positively related to costs of medication for diseases of the circulatory system (β = 4.89), endocrine, nutritional, and metabolic diseases (β = 109.72), and total costs of medication (β = 113.41). The impact of diabetes mellitus was attenuated by physical activity. It was identified that diabetes mellitus has a significant impact on public costs with medication, and physical activity was effective in reducing health costs independently of diabetes mellitus by less than 1%.

Assessing the Coverage of Health Care Facilities in Surakarta using the Hierarchical Maximal Covering Model: Case Study

The assessment of optimal health location becomes one of the main concerns of developing countries to avoid the occurrence of epidemic diseases that can reduce the quality of life of the community. The purpose of this study is to assess the ability of the existing health facility in Surakarta City, Indonesia to serve the available demand based on the hierarchy of National Health Insurance Program (NHIP). The assessment is modelled by using integer linear programming called model of capacitated hierarchical maximal covering. The results of this study found that not all of the existing demand has been able to be served by the existing health facilities. At the first level, it is found that not all communities in Banjarsari district could be served by Basic Healthcare Unit or Family Doctors because of their capacity are not sufficient to serve all demand. While at the fourth level, demand from Kasih Ibu Hospital could not served by dr. Moewardi Hospital because the distance between the two hospitals exceeds the allowed critical distances.

Aerobic exercise program with or without motor complexity as an add-on to the pharmacological treatment of depression \u2013 study protocol for a randomized controlled trial

BackgroundPatients with major depression disorder presents increased rates of cognitive decline, reduced hippocampal volume, poor sleep quality, hypertension, obesity, suicidal ideation and behavior, and decreased functionality. Although continuous aerobic exercise (CAE) improves some of the aforementioned symptoms, comorbidities, and conditions, recent studies have suggested that performing aerobic exercise with motor complexity (AEMC) may be more beneficial for cognitive decline, hippocampal volume, and functionality. Therefore, this randomized controlled trial will compare the effects of CAE and AEMC on depression score, cognitive function, hippocampal volume, brain-derived neurotrophic factor expression, sleep parameters, cardiovascular risk parameters, suicidal behavior, functionality, and treatment costs in patients with depression.Methods/designSeventy-five medicated patients with depression will be recruited from a Basic Healthcare Unit to participate in this prospective, parallel group, single blinded, superiority, randomized controlled trial. Patients with depression according to DSM-V criteria will be balanced and randomly assigned (based on depression scores and number of depressive episodes) to a non-exercising control (C), CAE, and AEMC groups. The CAE and AEMC groups will exercise for 60 min, twice a week for 24 weeks (on non-consecutive days). Exercise intensity will be maintained between 12 and 14 points of the rating of perceived exertion scale (~ 70–80% of the maximum heart rate). The CAE group will perform a continuous aerobic exercise while the AEMC group will perform exercises with progressively increased motor complexity. Blinded raters will assess patients before and after the intervention period. The primary outcome measure will be the change in depression score measured by the Montgomery-Asberg Depression Rating Scale. Secondary outcomes will include measures of cognitive function, hippocampal volume, brain-derived neurotrophic factor expression, sleep parameters, cardiovascular risk parameters, suicidal behavior, functionality, and treatment costs.DiscussionThis study was selected in the call of public policy programs for the Brazilian Unified National Health System – “PPSUS 2015”. To our knowledge, this is the first pragmatic trial to test the effect of adding AEMC to the pharmacological treatment of patients with depression and to evaluate the possible reductions in depression symptoms and healthcare costs.Trial registrationBrazilian Clinical Trials Registry (ReBec) - RBR-9zgxzd - Registered on 4 Jan. 2017.

Anxiety presented by children facing dental treatment

ABSTRACT Objective: To determine the profile of children from 6 to 12 years of age, in relation to anxiety towards dental treatment and evaluate the main factors that trigger anxiety in this population. Methods: The sample was composed of 200 children with an average age of 8.5 years who attended the Clinic of the School of Dentistry of the Federal University of Campina Grande and the Basic Healthcare Units of the municipality of Patos, Paraíba, Brazil between June 2015 and May 2016. Anxiety was assessed using the Dental Anxiety Scale and the Venham Picture Test. The Chi-Square test and Fisher’s exact test were used to explore the level of significance of the associations between the variables Results: Anxiety was observed in the majority of children (Dental Anxiety Scale - 89% and Venham Picture Test - 70.5%) and the predominant levels were low to moderate. The child´s age group was significantly associated with anxiety (p=0.014) by the Venham Picture Test, while gender did not present this correlation. Anxiety was influenced by all the factors studied: making the appointment, waiting room, rotary instrument and periodontal scaling. Conclusion: The majority of children presented anxiety and the trigger factors: making the appointment, waiting room, rotary instrument and periodontal scaling contributed considerably to its development.

Seroprevalence of Toxoplasma gondii and Toxocara canis in a human rural population of Southern Rio Grande do Sul.

ABSTRACTDue to the growing population of pets, especially homeless dogs and cats, zoonoses still represent a significant public health problem. Toxoplasma gondii and Toxocara spp. are epidemiologically important zoonotic agents as they are etiological factors of human toxoplasmosis and toxocariasis, respectively. These parasites remain neglected even though they are substantially prevalent in rural areas. The aim of this study was to investigate T. gondii and T. canis seroprevalence and risk factors of seropositivity in a rural population in Pelotas municipality, Brazil. The study participants (n=344) were patients of a Basic Healthcare Unit (BHU) located in Cerrito Alegre. Blood samples were collected and tested for T. gondii antibodies by indirect immunofluorescence and T. canis antibodies by an indirect ELISA that targets an excreted-secreted antigen (TES). T. gondii seropositivity was 53.2%, with higher titers (1:256 - 1:1,024) in individuals who habitually eat pork, beef, or chicken, while T. canis seropositivity was 71.8% and concomitant T. gondii and T. canis seropositivity was 38.3%. Among the seropositivity risk factors assessed, only habitual undercooked meat consumption was significant (p = 0.046; OR = 3.7) for T. gondii and none of them were associated with T. canis seropositivity. Both parasites have a high prevalence in rural areas, which reinforces the need to invest in rural community education and health.

Patterns of Physical Activity and Screen Time Among Brazilian Children.

To investigate the patterns of physical activity (PA) and screen time among children and adolescents attended by the Brazilian National Health System. This cross-sectional study was conducted in the city of Bauru, São Paulo, Brazil. The sample was composed of 270 children and adolescents attending 5 basic health care units. PA and screen time were assessed through a questionnaire. Economic status, sex, and body composition variables were used as covariates. Boys were more likely to be active when compared with girls (odds ratio = 2.56; 95% confidence interval, 1.43-4.58). Children and adolescents who accumulated less screen time were more likely to be in the most active group (odds ratio = 0.41; 95% confidence interval, 0.24-0.72). When comparing data year on year, we found that the level of PA has not changed significantly among children aged 7-10 years; however, at the age of 10, we noticed a significant reduction in PA scores, which kept decreasing until the age of 12. Regarding screen time, the situation was the opposite, with the amount of time spent in this behavior increasing over the years. Our results showed an association between low PA levels and high amount of screen time among children and adolescents, showing that is necessary to encourage an active lifestyle, decreasing time spent on television, computers, cell phones, and video games.

Conhecimento, atitude e prática da equipe de saúde sobre melasma na gravidez

Objective: to study health professionals’ knowledge, attitudes and practices on melasma (skin discoloration) in pregnancy.Methods: a descriptive, cross-sectional study was conducted from October 2012 to March 2013 in two distinct stages, with a quantitative and qualitative approach. 61 health professionals from five basic health-care units on the east side of São Paulo who attend to pregnant women participated in the first phase, answering a questionnaire with open-ended and closed-ended questions. Nine of these professionals were also interviewed. The data from the questionnaires were analyzed using a descriptive statistical method and the interviews were subjected to a the thematic content analysis.Results: the average number of wrong answers to questions about the causes, prevention and treatment of melasma was greater than 50%. 52.4% of the respondents thought that skin blemishes do not affect the quality of life of the patients and regarded the condition as a simple problem. Skin care during pregnancy was thought to be of minor importance. Most of them do not deal with this subject in consultations with the patients.Conclusion: the staffs’ knowledge of melasma and its psychosocial consequences proved to be poor, with little concern about this problem, primarily because of the low morbidity rate. The teams should be trained about the importance of this condition.

Solanum paniculatum Linn: A potential antimicrobial agent against oral microorganisms

In Brazil, several species of potentially medicinal native plants exist, including Solanum paniculatum. This species is commonly known as “jurubeba” and belongs to the Solanaceae family, which is found in several regions in Brazil. It is widely used as a remedy for bronchitis, coughs, arthritis, jaundice, hepatitis, fever and stomach problems. The plant is believed to possess anti-viral, anti-cancer, anti-inflammatory, antioxidant, diuretic, hepatoprotective and antimicrobial properties. The chemical constitution of the species contains flavonoids, amides, steroids, lignans, steroidal saponins and steroidal alkaloids. This species is listed in the Brazilian Pharmacopoeia and the National Report on Medicinal Plants of Interest to the Single Health System (Renisus), due to its potential for use in products of interest to the Brazilian Ministry of Health. Therefore, the value of the present review manuscript lies in its aim to discuss the antimicrobial, antiadherent, bactericidal, fungicidal and anti-inflammatory action of S. paniculatum Linn (jurubeba). Furthermore, it is extremely important to characterize their chemical profile and cytotoxicity, thereby favoring the safe application of natural bioactive substances. A phytotherapeutic agent causes less damage to the body, is inexpensive and is more accessible to the general public. The present review is important to provide the concrete possibility of using phytotherapeutic and medicinal plants as a therapeutic resource in Basic Healthcare Units operated by the Sistema Unico de Saude (SUS), particularly those represented by the Family Health Strategy. Key words: Solanum paniculatum, microbiology, phytotherapy, toxicity, chromatography.

Physical exercise programs at Basic Healthcare Units decrease body fat and improve the functional capacity of women over 50 years old.

This study verified the effects of a physical exercise program performed at Basic Healthcare Units on the body composition and functional capacity of women over 50 years old and to compare these variables according to age. Forty-eight women (age, 65.4±7.3 years) were assessed. The program lasted 20 weeks, and was conducted 2 times per week, 60 min/day. Body mass and height were collected and body mass index (BMI) was calculated. Bioelectrical impedance was used to estimate fat mass and fat free mass. Functional capacities: handgrip test, Timed Up and Go (TUG) test, and Guralnick test were assessment. Weight (68.7±12.5 [pre]×66.8±12.5 [post], P<0.001), BMI (28.5±4.1 kg/m2 [pre]×27.6±4.0 kg/m2 [post], P<0.001), and fat mass (28.4±7.8 kg [pre]×26.4±7.3 kg [post], P<0.001) were decreased. For functional capacity, handgrip (21.2±5.8 kg [pre]×22.9±6.9 kg [post], P=0.014), lower limb strength (12.0±3.0 sec [pre]×8.5±2.2 sec [post], P<0.001), TUG (8.4±1.5 sec [pre]×7.6±1.1 se [post], P<0.001) and Guralnik tests (10.6±1.6 [pre]×11.8±0.5 [post], P<0.001) were improved. 20 weeks of exercise program performed at Basic Healthcare Units decreased body fat and improvement of functional capacity of women over 50 years old and there was difference according to age only on the body composition variables.

Avaliação da Atenção Primária à Saúde utilizando o Instrumento PCATool-Brasil

Introdução: A avaliação dos serviços é relevante, uma vez que permite o planejamento das ações em saúde. Objetivo: O presente estudo tem como objetivo avaliar a Atenção Primária à Saúde com o uso do instrumento PCATool-Brasil (versão profissionais da saúde), aplicado às equipes de atenção básica do município de Lajeado, sede da 16ª Coordenadoria Regional da Saúde do Rio Grande do Sul. Métodos: Realizou-se um estudo transversal com 54 profissionais lotados nas unidades básicas de saúde, que responderam ao instrumento PCATool-Brasil. Resultados: O Escore Geral, mensurado pela média do Escore Essencial e do Escore Derivado, superou o ponte de corte de 6,6. A média do Escore Essencial foi de 6,66, enquanto a média do Escore Derivado foi de 7,60. Conclusão: As equipes possuem, de maneira geral, alto grau de orientação à Atenção Primária à Saúde, embora dois atributos essenciais possuam indicadores que necessitam ser melhorados.

Social and demographic profile and reproductive behavior of pregnant teenagers accompanied on the basic health care unit

The present work was developed in two Family Health Units (USF) of Sinop, Mato Grosso. The objective was to identify the epidemiological profile and reproductive behavior of adolescent pregnant women attending primary care. The sample consisted of 20 pregnant women between 12 and 18 years of age. Semi-structured interviews were conducted and the data showed that the average age of pregnant women was 15.6 years. All had their first sexual intercourse before the age of 16. School dropout rates were 36.7% among adolescents attended at the Boa Esperanca health unit and 33.3% at those attended at USF Dr. Carlos Scholtao. The unemployment rate was significant, being 78.6% and 50% in the respective USF Boa Esperanca and Dr. Carlos Scholtao. The financial support of the parents was expressive. Most teens in both USFs have not been able to characterize what is a sexually transmitted disease. The results pointed to the need for differential support to these adolescents, since they are not aware of STDs and are characterized by being at risk of not using contraceptive methods.

Association between cardiovascular diseases and hospitalization among patients users of the Brazilian National Health System

Study Design: Cross-sectional. Objective of the study: To investigate the relationship between cardiovascular disease and hospitalizations among users of the Brazilian Public Healthcare System of Presidente Prudente, SP, Brazil. Methods: The sample was composed by patients from two Basic Healthcare Units of Presidente Prudente / SP. Hospitalizations, presence of disease, habitual physical activity, body mass index and blood pressure measures were the variables analyzed. Spearman correlation indicated relationship between variables and statistical significance was set at p-value &lt; 5%. Results: 514 adults of both sexes were interviewed. The occurrence of hospitalization in the previous year was 14.9%. There was relationship between habitual physical activity, diagnosis of hypertension, arrhythmia and stroke with number of days hospitalized. After adjustment for confounders, patients with two and three/four diagnostic for cardiovascular diseases were more frequent hospitalized compared to patients without diagnoses. Conclusion: It was found relationship between hospitalizations and diagnosis of hypertension, arrhythmia, stroke and lower levels of habitual physical activity among patients users of the public healthcare system in Presidente Prudente, SP, Brazil

Low-dose progestin-releasing contraceptives are associated with a higher pain threshold in healthy women

To determine the pain thresholds of women taking different formulations of hormonal contraceptives. Cross-sectional study. Basic health care unit. Eighty-nine healthy nonusers and 188 users of hormonal contraceptives. Subject interviews were followed by the application of a semistructured questionnaire, including a psychometric assessment with the Beck Depression Inventory and the State-Trait Anxiety Inventory. After the interview, a 10-mL peripheral blood sample was collected. Pain thresholds were obtained by performing pressure algometry. Serum concentrations of E2, P, and T (free fraction) were determined via chemoluminescence. The menstrual cycle phase was determined according to hormonal level and identification of an LH surge in urine. Pain threshold was evaluated with a dynamometer applied to the forearm skin of the nondominant limb and abdominal wall. Progestin-only contraceptive users showed a higher pain pressure threshold in the forearm (2.94 ± 0.96 vs. 2.74 ± 0.89 vs. 2.62 ± 0.92) and right (2.11 ± 0.87 vs. 1.83 ± 0.81 vs. 1.78 ± 0.77) and left abdomen (2.12 ± 0.88 vs. 1.79 ± 0.76 vs. 1.73 ± 0.70) than did combined hormonal contraceptive users and nonusers of hormonal contraceptives, respectively. Users of contraceptives that continuously release etonogestrel (subcutaneous implant, vaginal ring) or levonorgestrel (intrauterine devices) had higher pain thresholds. Women who used hormonal contraceptives enabling continuous release of etonogestrel or levonorgestrel tended to have higher pain thresholds than did nonusers of hormonal contraceptives.

Ambiência na Estratégia Saúde da Família

Ambience is considered an important factor that affects the work process of family healthcare teams, their structural aspect, as well as the aspects related to the interaction among workers and clients. The article aims to analyze the aspects related to ambience in the perception of the professionals involved in the Family Healthcare Strategy. This descriptive exploratory study with a quantitative approach was performed in Espirito Santo’s state municipalities having a population of more than 50,000 inhabitants. The results showed that more than half of the professionals considered that the physical space did not allow for comfortable care of the client. A divergence was observed in the answers related to access to technology for the development of basic actions. Technology was misunderstood as being a product or piece of equipment only (hard technology), as opposed to soft technology, i.e., different types of knowledge. The workers pointed out the limitations and difficulties in maintaining the privacy of the clients. They also highlighted the absence of satisfactory maintenance of the physical space and presented contradictory opinions in relation to the facilities of the basic healthcare units. It was concluded that the professionals have different viewpoints regarding their place of work and that there are limitations in the ambience for the production of teamwork in the Family Healthcare Strategy.

Associação entre desordens musculoesqueléticas e gastos com cuidado à saúde entre pacientes do Sistema Único de Saúde

Delineamento: transversal. Objetivos: (i) Identificar a ocorrência de desordens musculoesqueléticas, (ii) identificar seus determinantes e (iii) suas relações com gastos com saúde em adultos atendidos pelo Sistema Único de Saúde. Métodos: Estudo transversal com 963 adultos, com 50 anos e de ambos os sexos tratados em unidades básicas de saúde. Participantes responderam questionários sobre doenças, condição econômica, desordens musculoesqueléticas, atividade ocupacional, consultas de fisioterapia e compra de medicamentos; peso e estatura foram mensurados para calcular o índice de massa corporal. Custos com saúde foram computados retroagindo 12 meses. Resultados: A prevalência de desordens musculoesqueléticas foi 65%, sendo maior em pacientes com doenças do tecido conjuntivo (OR=4,11 [2,98-5,67]) e pessoas que levantam cargas no trabalho (OR=1,45 [1,27-1,66]). Além disso, a ocorrência de desordens musculoesqueléticas nos ombros, região lombar, joelhos e tornozelos/pés foram relacionados a maiores gastos com medicamentos e consultas médicas. Conclusão: A ocorrência de desordens musculoesqueléticas foi elevada entre estes pacientes, é afetada por sexo e atividade ocupacional e positivamente relacionada com gastos com saúde.

Educational group practices in primary care: interaction between professionals, users and knowledge

To investigate the concept understood by Family Healthcare Strategy (ESF) professionals of knowledge, education and subjects participating in learning activities. Qualitative study carried out with the ESF professionals with university degree, members of the healthcare staff who undertook educational health group activities at Basic Healthcare Units (UBS) in Belo Horizonte. The following triangulation techniques were used: participant observation, photos and field notes; interviews with professionals; and document analysis. We identified three interaction patterns that are different from each other. Firstly, the professional questions, listens and provides information to users, trusting in the transmission of knowledge; secondly, the professional questions and listens, trusting that users can learn from each other; thirdly, the professional questions, listens, discusses and produces knowledge with users, both teaching and learning from each other. There are educational practices that include unique methods capable of creating a militant space for citizenship engagement.

Tuberculose pulmonar entre usuários de uma unidade de atenção básica

Objective: To evaluate the prevalence of positive bacterial sputum cases of pulmonary tuberculosis among users of a primary healthcare unit. Methods: Cross-sectional, observational study, conducted between February and August 2011 with 1,873 individuals aged above 18 years seen at a Basic Healthcare Unit (BHU) in the city of Rio de Janeiro, Brazil, selected through convenience non-probabilistic sampling. A tool for the presumptive diagnosis of pulmonary tuberculosis was initially applied. The individuals with positive score were submitted to bacilloscopy. Descriptive statistics was performed, with absolute and percentage frequencies, as well as Fisher’s exact test to assess the association between gender, age, and the results of bacterial sputum microscopy. Results: Of the users seen at the studied BHU, 157 individuals were tested positive for the presumptive diagnosis of tuberculosis. Their most frequent symptoms were cough (76.5%, n=13) and chest pain (70.6%, n=12). There was no significant association between positive bacilloscopy, sex (p=0.477), and age (p=0.186). Conclusion: The frequency of positive bacilloscopy cases of pulmonary tuberculosis among individuals with positive score for presumption of that disease was high in the studied health unit.