ABSTRACT Objectives: Congenital hypothyroidism (CH) can be permanent (PCH) or transient (TCH). While the importance of thyroxine in myelination of the brain is undisputed, the benefits to neurodevelopmental outcomes of TCH treatment are controversial. Our objectives were to determine predictive factors for PCH and verify its prevalence changes over time. Subjects and methods: A total of 165 children were evaluated at 3 years of age to verify the diagnosis of PCH. 130 were submitted to a two-step cluster analysis, with the aim of grouping them into homogeneous clusters. The mean incidence of PCH and TCH was calculated from 2004 to 2010 and 2011 to 2015. Results: Sixty-six children were diagnosed with PCH, and 99 were diagnosed with TCH. Eighty-one percent of PCH children and all TCH children with thyroid imaging had glands in situ. Eighty children (61.5%) were in Cluster 1, 8 children (6.2%) were in Cluster 2 and 42 children (32.3%) were in Cluster 3. No children had PCH in Cluster 1, while 87.5% of children in Cluster 2 and all children in Cluster 3 had PCH. The most important predictor for PCH was the initial serum TSH, which was marginally higher in importance than the blood spot TSH, followed by the initial serum free T4. The mean incidence of PCH (odds ratio: 1.95, 95% CI 1.36 to 2.95, p < 0.0001) and TCH (odds ratio 1.33, 95%, CI 1.02 to 1.77, p = 0,038) increased over time. Conclusions: The most important PCH predictors are the initial serum TSH and the blood spot TSH. The mean incidence of both PCH and TCH in our series increased.

ABSTRACT Objective To determine the frequency of drug therapy problems among older adults in Primary Health Care, and to analyze the factors associated with their identification in the initial patient assessment, carried out by pharmacists offering medication therapy management services. Methods A cross-sectional study conducted with data from 758 older adults followed up in medication therapy management services in Primary Health Care in the cities of Belo Horizonte, Betim, and Lagoa Santa (MG, Brazil). Univariate and multivariate analyses were performed to evaluate the factors associated with identification of four or more drug therapy problems in the initial clinical assessment. Results A total of 1,683 drug therapy problems were identified, 73.6% of older patients had at least one problem. The most frequent problems were nonadherence (23.0%) and the need for additional drug therapy (18.0%). Polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and aged 75 years or older remained positively and statistically associated with identification of four or more drug therapy problems (p<0.05). Conclusion There is a high frequency of problems related to medication use among older users of Primary Health Care, and the medication therapy management services should be prioritized to the older patients, who present with polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and age ≥ 75 years, since they are more likely to have more drug therapy problems.

ABSTRACT Background: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to evaluate the impact of the use of LPA and Xpert. Methods: Patients with DR-TB were eligible if their drug susceptibility testing results were available to the treating physician at the time of consultation. The standard reference MGITTM 960 was compared with Xpert (arm 1) and LPA (arm 2). Effectiveness was considered as the start of the appropriate TB regimen that matched drug susceptibility testing (DST) and the proportions of culture conversion and favorable treatment outcomes after 6 months. Results: A higher rate of empirical treatment was observed with MGIT alone than with the Xpert assay (97.0% vs. 45.0%) and LPA (98.2% vs. 67.5%). Patients started appropriate TB treatment more quickly than those in the MGIT group (median 15.0 vs. 40.5 days; p<0.01) in arm 1. Compared to the MGIT group, culture conversion after 6 months was higher for Xpert in arm 1 (90.9% vs. 79.3%, p=0.39) and LPA in arm 2 (80.0% vs. 83.0%, p=0.81). Conclusions: In the Xpert arm, there was a significant reduction in days to the start of appropriate anti-TB treatment and a trend towards greater culture conversion in the sixth month.

Abstract INTRODUCTION: The intensification of research and innovation with the creation of networks of rapid and effective molecular tests as strategies for the end of tuberculosis are essential to avoid late diagnosis and for the eradication of the disease. We aimed to evaluate the cost-effectiveness of Xpert®MTB/RIF (Xpert) in the diagnosis of drug-resistant tuberculosis in reference units, in scenarios with and without subsidies, and the respective cost adjustment for today. METHODS: The analyses were performed considering as criterion of effectiveness, negative culture or clinical improvement in the sixth month of follow-up. The comparison was performed using two diagnostic strategies for the drug susceptibility test (DST), BactecTMMGITTM960 System, versus Xpert. The cost effectiveness and incremental cost-effectiveness ratio (ICER) were calculated and dollar-corrected for American inflation (US$ 1.00 = R$ 5,29). RESULTS: Subsidized Xpert had the lowest cost of US$ 33.48 (R$67,52) and the highest incremental average efficiency (13.57), thus being a dominated analysis. After the inflation was calculated, the mean cost was DST-MGIT=US$ 74.85 (R$ 396,73) and Xpert = US$ 37.33 (R$197,86) with subsidies. CONCLUSIONS: The Xpert in the diagnosis of TB-DR in these reference units was cost-effective with subsidies. In the absence of a subsidy, Xpert in TB-DR is not characterized as cost effective. This factor reveals the vulnerability of countries dependent on international organizations’ subsidy policies.

Resumo Introdução Embora sejam percebidos avanços quanto à ampliação na cobertura da Atenção Básica no Brasil, o acesso ou a acessibilidade do usuário na utilização desses serviços ainda é considerado como desafio. Objetivo Descrever as dimensões da acessibilidade na atenção básica na avaliação dos usuários que participaram da avaliação externa do Programa Nacional de Melhoria do Acesso e da Qualidade na Atenção Básica, em 2012, nas macrorregiões do país. Método Trata-se de um estudo descritivo, transversal. Foram utilizados os dados do módulo III, que trata da entrevista com os usuários na Unidade Básica de Saúde (UBS), especificamente do componente referente à utilização dos serviços de saúde. Participaram 65.391 usuários de 3.944 municípios. Resultados Verificou-se que tanto a acessibilidade geográfica como a organizacional estão mais comprometidas nas regiões Norte e Nordeste. Quanto às barreiras de acessibilidade organizacional, constaram-se a forma de agendamento das consultas, a falta de possibilidade de escolha dos profissionais e os horários de atendimento restritos. Ademais, observou-se que boa parte dos usuários não consegue resolver as urgências na Unidade Básica de Saúde. Conclusão Há avanços no alcance da acessibilidade, todavia nas regiões Norte e Nordeste é preciso maiores investimentos para melhorar, sobretudo, a acessibilidade organizacional.

Abstract Background Although advances are perceived in terms of expanding the coverage of Primary Care in Brazil, patient access or accessibility when using these services is still considered a challenge. Objective This work aimed to describe some dimensions of accessibility in primary Health Care in Brazil of the users’ evaluation who participate of the National Program for improving access and quality in primary health care, in 2012 in all the regions of the country. Method It is a descriptive, cross-sectional study. It was used the data of the III module which collect with interview with users, data specifically of the component for the use of health services. 65.391 users of 3.944 municipalities participated of this study. Results It was found problems with the geographical and organizational accessibility in the north and northeast regions. The organizational barriers were more evident in the scheduling consultations, in the lack of choice of professionals and the restricted opening hours. In addition, it was observed that most users cannot solve the emergency in the basic health unity. Conclusion There was progress in the accessibility, on the other hand in the North and Northeast regions needs greater investments to improve the organizational accessibility.

RESUMO Objetivo: descrever as principais evidências disponíveis na literatura sobre as práticas seguras na prevenção e cuidado com as lesões cutâneas em recém-nascidos internados em Unidades de Terapia Intensiva Neonatal (UTIN). Método: revisão integrativa da literatura nas bases de dados PubMed, BDENF, LILACS, MEDLINE, SciELO e Cochrane Library, entre 2013 e 2018. Foram incluídos artigos primários sobre: prevenção de lesão e cuidados com a pele em recém-nascidos, em português, inglês ou espanhol e excluídos editoriais, teses, dissertações e artigos duplicados. Para o nível de evidência, foi utilizado o modelo de Melnyk e Fineout-Overholt, que classifica os estudos entre evidência fraca a forte. Resultados: inclusão de dez artigos com evidência moderada a fraca sobre a termorregulação, o banho, a prevenção de lesões, o uso de adesivos e antissepsia da pele. Considerações finais: foi observada escassez de publicações com evidência alta, sendo necessário investir em pesquisas que busquem subsidiar práticas mais seguras de cuidados com a pele.

ABSTRACT Objective: to describe the main evidence available in the literature on safe practices in the prevention and care of skin lesions in newborns admitted to Neonatal Intensive Care Units. Methods: integrative literature review in the PubMed, BDENF, LILACS, MEDLINE, SciELO and Cochrane Library databases between 2013 and 2018. We included primary articles on: lesion prevention and skin care in newborns in Portuguese, English or Spanish and excluded editorials, thesis, dissertations and duplicate articles. For the evidence level, we used the Melnyk and Fineout-Overholt classification, which classifies studies between weak to strong evidence. Results: a total of 10 articles with moderate to weak evidence on thermoregulation, bathing, lesion prevention, use of patches and skin antisepsis. Final considerations: there was a shortage of publications with high evidence, and it is necessary to invest in research that seeks to support safer skin care practices.

RESUMEN Objetivo: describir la principal evidencia disponible en la literatura sobre prácticas seguras en la prevención y atención de lesiones cutáneas en recién nacidos ingresados en Unidades de Cuidados Intensivos Neonatales. Métodos: revisión integradora de la literatura en las bases de datos PubMed, BDENF, LILACS, MEDLINE, SciELO y Cochrane Library entre 2013 y 2018. Incluimos artículos primarios sobre: prevención de lesiones y cuidado de la piel en recién nacidos, en portugués, inglés o español y excluimos editoriales, tesis, disertaciones y artículos duplicados. Para el nivel de evidencia, utilizamos el modelo de Melnyk y Fineout-Overholt, que clasifica los estudios entre evidencia débil a fuerte. Resultados: inclusión de diez artículos con evidencia moderada a débil sobre termorregulación, baño, prevención de lesiones, uso de parches y antisepsia de la piel. Consideraciones finales: hubo una escasez de publicaciones con evidencia fuerte, y es necesario invertir en investigaciones que busquen apoyar prácticas más seguras para el cuidado de la piel.

ABSTRACT Objective: to describe the main evidence available in the literature on safe practices in the prevention and care of skin lesions in newborns admitted to Neonatal Intensive Care Units. Methods: integrative literature review in the PubMed, BDENF, LILACS, MEDLINE, SciELO and Cochrane Library databases between 2013 and 2018. We included primary articles on: lesion prevention and skin care in newborns in Portuguese, English or Spanish and excluded editorials, thesis, dissertations and duplicate articles. For the evidence level, we used the Melnyk and Fineout-Overholt classification, which classifies studies between weak to strong evidence. Results: a total of 10 articles with moderate to weak evidence on thermoregulation, bathing, lesion prevention, use of patches and skin antisepsis. Final considerations: there was a shortage of publications with high evidence, and it is necessary to invest in research that seeks to support safer skin care practices.

RESUMEN Objetivo: describir la principal evidencia disponible en la literatura sobre prácticas seguras en la prevención y atención de lesiones cutáneas en recién nacidos ingresados en Unidades de Cuidados Intensivos Neonatales. Métodos: revisión integradora de la literatura en las bases de datos PubMed, BDENF, LILACS, MEDLINE, SciELO y Cochrane Library entre 2013 y 2018. Incluimos artículos primarios sobre: prevención de lesiones y cuidado de la piel en recién nacidos, en portugués, inglés o español y excluimos editoriales, tesis, disertaciones y artículos duplicados. Para el nivel de evidencia, utilizamos el modelo de Melnyk y Fineout-Overholt, que clasifica los estudios entre evidencia débil a fuerte. Resultados: inclusión de diez artículos con evidencia moderada a débil sobre termorregulación, baño, prevención de lesiones, uso de parches y antisepsia de la piel. Consideraciones finales: hubo una escasez de publicaciones con evidencia fuerte, y es necesario invertir en investigaciones que busquen apoyar prácticas más seguras para el cuidado de la piel.

RESUMO Objetivo: descrever as principais evidências disponíveis na literatura sobre as práticas seguras na prevenção e cuidado com as lesões cutâneas em recém-nascidos internados em Unidades de Terapia Intensiva Neonatal (UTIN). Método: revisão integrativa da literatura nas bases de dados PubMed, BDENF, LILACS, MEDLINE, SciELO e Cochrane Library, entre 2013 e 2018. Foram incluídos artigos primários sobre: prevenção de lesão e cuidados com a pele em recém-nascidos, em português, inglês ou espanhol e excluídos editoriais, teses, dissertações e artigos duplicados. Para o nível de evidência, foi utilizado o modelo de Melnyk e Fineout-Overholt, que classifica os estudos entre evidência fraca a forte. Resultados: inclusão de dez artigos com evidência moderada a fraca sobre a termorregulação, o banho, a prevenção de lesões, o uso de adesivos e antissepsia da pele. Considerações finais: foi observada escassez de publicações com evidência alta, sendo necessário investir em pesquisas que busquem subsidiar práticas mais seguras de cuidados com a pele.

Abstract Background The reproducibility and reliability of the modified Rodnan's Skin Score (mRSS) are debated due to investigator-related subjectivity. Here, we evaluate if durometry correlates with mRSS in patients with diffuse systemic sclerosis (SSc). Methods This cross-sectional study was conducted from December 2018 to June 2019, including 58 diffuse SSc patients. Two certified researchers, blind to each other's scores, performed the mRSS, followed by durometry at 17 predefined skin sites. For durometry and mRSS, individual scores per skin site were registered. Durometry and mRSS results measured by each researcher, as well as scores from different researchers, were compared. Skin thickness measurements from forearm skin biopsies were available in a subset of the patients, for comparisons. Statistical analyses included Cohen's Kappa Coefficient, Intraclass Correlation Coefficient, Kendall's Coefficient and Spearman's test. Results Mean (standard deviation, SD) patient age was 44.8 (12.9) years, and 88% were female. Inter-rater agreement varied from 0.88 to 0.99 (Intraclass correlation coefficient) for durometry, and 0.54 to 0.79 (Cohen's Kappa coefficient) for mRSS, according to the specific evaluated sites. When data were compared with skin thickness assessed in forearm biopsies, durometry correlated better with skin thickness than mRSS. Conclusion Durometry may be considered as an alternative method to quantify skin involvement in patients with diffuse SSc. The strong inter-rater agreement suggests that the method may be useful for the assessment of patients by multiple researchers, as in clinical trials.

Resumo: As redes sociais se tornaram uma ferramenta importante para a formação de imagens e para o posicionamento de destinos turísticos. O objetivo deste estudo é compreender o uso de redes sociais para o posicionamento de uma cidade por esses meios no importante segmento de visitantes do dia, ou seja, aqueles que não passam a noite no local visitado. Trata-se de um estudo exploratório e qualitativo, para o qual foi escolhido o município de Guararema, em São Paulo, Brasil, com triangulação de dados baseada em a) análise do conteúdo de 11 contas de redes sociais, b) periódicos especializados, c) entrevistas em profundidade com visitantes, e d) conteúdo do site e do plano diretor de turismo da cidade. Como resultado, descobriu-se que neste destino há um posicionamento claro para os visitantes do dia, interessados em paisagens naturais e gastronomia. O posicionamento é consistente com as imagens que são vistas nas redes. As redes sociais e a imprensa tendem a gerar visitas em conjunto, gerando um ciclo. Como sugestão para futuros estudos, propomos a compreensão desse fenômeno no período de baixa ou alta temporada e ampliar estudos sobre os visitantes-dia, ainda pouco estudados na literatura do tema.

Abstract: Social networks have become an important tool for image formation and positioning of tourist destinations. The aim of this study is to understand the use of social networks for the positioning of a city using these means in the important segment of day visitors, i.e., those tourists who do not spend the night in the place visited. This is an exploratory and qualitative study, for which the municipality of Guararema, in São Paulo, Brazil, was chosen. Data triangulation was based on a) content analysis of 11 social network accounts, b) specialized journals, c) in-depth interviews with visitors; and d) content of the city's website and tourism master plan. As a result, it turned out that in this destination there is a clear positioning for day visitors interested in natural landscapes and cuisine. Placement is consistent with images that are viewed on networks. Social networks and the press together tend to generate visits, generating a cycle. As a suggestion for future studies, we propose to understand this phenomenon in the low or high season and expand studies on day-visitors, still little studied in the literature.

Resumen: Las redes sociales se han convertido en una importante herramienta de formación de imagen y para posicionar los destinos turísticos. El objetivo de este estudio es entender el uso de las redes sociales para el posicionamiento de un sitio por estos medios en los visitantes del día, es decir, aquellos que no pernoctan en el lugar visitado. Se trata de un estudio exploratorio y cualitativo, para el que se eligió la ciudad de Guararema, en São Paulo, Brasil, con triangulación de datos basada en a) el análisis del contenido de 11 cuentas de redes sociales, b) periódicos especializados, c) entrevistas en profundidad con visitantes, y d) contenido del websitio y el plan rector de turismo de la ciudad. Como resultado se ha descubierto que en este destino hay un posicionamiento claro para los visitantes del día, interesados en paisajes naturales y gastronomía. El posicionamiento es consistente con las imágenes que se ven en las redes. Las redes sociales y la prensa tienden a generar conjuntamente visitas, generando un ciclo. Como sugerencia para estudios futuros, proponemos la comprensión de este fenómeno en el período de temporada baja o alta.

Resumo Uma vez que mitos e equívocos sobre a procriação natural se espalham rapidamente na era do fácil acesso à informação e às redes sociais, o aconselhamento adequado sobre a fertilidade natural e a concepção espontânea deve ser encorajado em qualquer tipo de assistência à saúde. Apesar do fato de não haver evidências fortes sobre qualquer dos aspectos relacionados à fertilidade natural, existe literatura sobre como aumentar as chances de uma gravidez espontânea. No presente artigo, a Comissão Nacional de Ginecologia Endócrina da Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO) oferece sugestões para otimizar o aconselhamento a pessoas que tentam a concepção espontânea, na ausência do diagnóstico de infertilidade.

Abstract Considering that myths and misconceptions regarding natural procreation spread rapidly in the era of easy access to information and to social networks, adequate counseling about natural fertility and spontaneous conception should be encouraged in any kind of health assistance. Despite the fact that there is no strong-powered evidence about any of the aspects related to natural fertility, literature on how to increase the chances of a spontaneous pregnancy is available. In the present article, the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO, in the Portuguese acronym) Committee on Endocrine Gynecology provides suggestions to optimize counseling for non-infertile people attempting spontaneous conception.

The present study aimed to review literature on studies of dengue cases conducted over 30 years in the state of Ceará. Between November 2015 and January 2016, articles published in Portuguese and English in 7 databases were searched using keywords and a Boolean operator. A total of 191 articles were identified in the databases; 133 were excluded according to the exclusion criteria, and 58 were included in the study. Of the 58 articles analyzed, 6 reported data from Brazil; including the Northeast region and the state of Ceará; 41 reported data for only the city of Fortaleza; 7 reported data for the state of Ceará; 4 reported data for cities in the interior of the state; and 3 included only children. The studies adopted different approaches and focused on different aspects of the disease. Study outcomes included the identification of serological, epidemiological, clinical, and laboratory characteristics; potential larvicides and biological predators of mosquitoes; potential antiviral agents; vector density characteristics; and educational dengue prevention and control strategies. Additionally, one vaccine trial was included. Although studies on dengue in the state of Ceará are scarce, they are encompassing, including several lines of research, and the number of studies and reports on dengue in the state of Ceará continues to increase.

Resumo Este estudo teve como objetivo compreender os elementos essenciais do processo de sistematização da prática clínica de uma farmacêutica da atenção primária à saúde com base no referencial teórico-metodológico da atenção farmacêutica, que subsidia o serviço clínico de gerenciamento da terapia medicamentosa. Tratou-se de pesquisa qualitativa autoetnográfica, construída de forma colaborativa entre os autores, de outubro de 2014 a outubro de 2015, nos Centros de Saúde da Prefeitura Municipal de Belo Horizonte, onde uma das autoras trabalha. Os dados foram produzidos por meio de observação participante, diários de campo, reflexões e entrevistas semiestruturadas com farmacêuticos que desenvolviam prática clínica na atenção primária à saúde. Os resultados evidenciaram que os principais elementos para sistematização da prática clínica passam pela ‘construção de uma nova identidade profissional na equipe multiprofissional’ e pela ‘incorporação de novas atividades na rotina de trabalho’ que, combinadas, resultam em uma ‘proposta de integração de um serviço de gerenciamento da terapia medicamentosa nos fluxos das unidades de saúde’. Dessa forma, para que o farmacêutico possa legitimar o seu papel no cuidado do paciente, é preciso mudar, transformar, reorganizar e reconstruir a sua prática.

Abstract The aim of this study was to understand the essential elements of the systematization process of the clinical practice of a pharmacist in primary health care. This systematization was based on the framework of pharmaceutical care practice, which provides the foundation for comprehensive medication management services. The methodology utilized was autoetnography, built collaboratively between the authors. The data have been produced through participant observation, field journals, reflections and semi structured interviews with pharmacists who are building clinical practices in primary health care. The results have demonstrated that the main elements associated with the systematization of clinical practices are ‘the construction of a new professional identity in a multiprofessional team’ as well as ‘the incorporation of new activities in the work routine’, that, combined, result in ‘Integration of comprehensive medication management services in the flow of the health unit’. In this way, in order for the pharmacist to legitimize his role in patient care, it is necessary to change, to transform, to reorganize and to rebuild his practice.

Resumen Este estudio tuvo como objetivo comprender los elementos esenciales del proceso de sistematización de la práctica clínica del farmacéutico en la atención primaria de salud a partir del marco teórico de la atención farmacéutica, que subvenciona los servicios de gestión integral de la farmacoterapia. Auto etnografía fue la metodología cualitativa utilizada, construida en colaboración entre los autores. Los datos fueron producidos a través de observación participante, diarios de campo, reflexiones y entrevistas semiestructuradas con los farmacéuticos que desarrollan la práctica clínica en atención primaria de salud. Los resultados mostraron que los principales elementos para la sistematización de la práctica clínica son la ‘Construcción de una nueva identidad profesional en equipo multiprofesional’ y la ‘Incorporación de nuevas actividades en el trabajo de rutina’ que, combinados, dan lugar a una ‘propuesta de integración del servicio de gestión integral de la farmacoterapia en los flujos de las unidades de salud’. Por lo tanto, para que el farmacéutico pueda legitimar su papel en la atención al paciente, es necesario cambiar, transformar, reorganizar y reconstruir su práctica.

N-Myristoylation protein is catalyzed by N-myristoyltransferase (NMT), an essential target in Leishmania donovani, the causative agent of kala-azar. Four-dimensional quantitative structure-activity relationship (4D-QSAR) analysis was applied to a series of 77 Leishmania donovani NMT inhibitors. Then, three new compounds were proposed using QSAR models. In addition, molecular docking was performed to predict the binding affinities and interaction modes among the proposed compounds and the NMT active site. In silico absorption, distribution, metabolism and excretion (ADME) evaluation was performed and potential inhibitors demonstrated satisfactory pharmacokinetic properties.

Resumo Incongruência de gênero é umacondição na qual o indivíduo se identifica, deseja viver e ser aceito como uma pessoa do gênero oposto ao designado por ocasião do nascimento. Na disforia de gênero o indivíduo manifesta ansiedade e sofrimento pelo desejo de viver e ser aceito como uma pessoa do gênero oposto ao designado ao nascimento. O processo transsexualizador requer trabalho em equipe multiprofissional. O objetivo do tratamento hormonal é induzir o aparecimento de características sexuais masculinas secundárias por meio da administração da testosterona em indivíduos com idade igual ou superior a 18 anos. O tratamento de estimulação androgênica costuma ser bem tolerado. Entretanto, ainda não existemevidências sobre os efeitos e riscos do uso da testosterona a longo prazo. Diferentes preparações farmacológicas da testosterona têm sido utilizadas. As mais utilizadas têm sido as injeções intramusculares de administração a curto prazo de ésteres, seguidas do cipionato de testosterona e do enantato de testosterona. Na maioria dos protocolos de tratamento observa-se o aparecimento de características corporais masculinas nos primeiros 6 meses, e a obtenção do máximo efeito da estimulação androgênica, após 3 a 5 anos de uso regular da testosterona. Recomenda-se a manutenção dos níveis plasmáticos de testosterona dentro dos limites fisiológicos para o sexo masculino (300 a 1.000 ng/dl), a fim de minimizar os riscos. A monitorização dos homens transgênero é recomendada a cada 3meses durante o primeiro ano de tratamento e a seguir, a cada 6 a 12 meses.

Abstract Gender incongruence is defined as a condition in which an individual self-identifies and desires to have physical characteristics and social roles that connote the opposite biological sex. Gender dysphoria is when an individual displays the anxiety and/or depression disorders that result from the incongruity between the gender identity and the biological sex. The gender affirmation process must be performed by a multidisciplinary team. The main goal of the hormone treatment is to start the development of male physical characteristics by means of testosterone administration that may be offered to transgender men who are 18 years old or over. The use of testosterone is usually well tolerated and improves the quality of life. However, there is still lack of evidence regarding the effects and risks of the long-term use of this hormone. Many different pharmacological formulations have been used in the transsexualization process. The most commonly used formulation is the intramuscular testosterone esters in a short-term release injection, followed by testosterone cypionate or testosterone enanthate. In the majority of testosterone therapy protocols, the male physical characteristics can be seen in almost all users after 6 months of therapy, and themaximum virilization effects are usually achieved after 3 to 5 years of regular use of the hormone. To minimize risks, plasmatic testosterone levels should be kept within male physiological ranges (300 to 1,000 ng/dl) during hormonal treatment. It is recommended that transgender men under androgen therapy be monitored every 3 months during the 1st year of treatment and then, every 6 to 12 months.

ABSTRACT Objective: To describe the evaluation of patients that participated in the National Program for Improving the Access and Quality in Primary Health Care (Programa Nacional de Melhoria do Acesso e da Qualidade na Atenção Básica) for the comprehensive healthcare, the bond and the coordination of care in the country's macro-regions. Method: A descriptive, transversal study, from interviews with 65,391 patients of Primary Health Care, in 3,944 municipalities regarding the use of health services. Results: The professionals seek to solve the patients' problems in their unit (73.1%) but focused mainly on the scope of the appointment (65.6%) and offering care away from the population's reality (69.4%). Difficulties in the rescue of clinical history were referred (50.3%) and in the care performed in other health services (29.2%). Conclusion: The comprehensive health care, the bond and the coordination of care remain challenges to the Primary Health Care in the country, requiring reflections on the implementation of national policies, especially considering the regional diversities in Brazil.

RESUMEN Objetivo: Describir la evaluación de los usuarios que participaron del Programa Nacional de Melhoria do Acesso e da Qualidade na Atenção Básica en cuanto a la atención integral, al vínculo y a la coordinación del cuidado en las macro regiones del país. Método: Estudio descriptivo, transversal, a partir de entrevistas con 65.391 usuarios de la Atención Básica, en 3.944 municipios, referente a la utilización de los servicios de salud. Resultados: Los profesionales buscan resolver los problemas de los usuarios en la propia unidad (73,1%), pero con atención orientada principalmente al alcance de la consulta (65,6%) y a la oferta de cuidado distante de la realidad de la población (69,4%). Se observaron dificultades en el rescate de la historia clínica (50,3%) y en el cuidado realizado en otros servicios de salud (29,2%). Conclusión: La atención integral, el vínculo y la coordinación del cuidado son aún desafíos para la Atención Básica en el país, exigiendo reflexiones sobre la implantación de políticas nacionales, sobre todo considerando las diversidades regionales de Brasil.

RESUMO Objetivo: Descrever a avaliação dos usuários que participaram do Programa Nacional de Melhoria do Acesso e da Qualidade na Atenção Básica quanto à atenção integral, ao vínculo e à coordenação do cuidado nas macrorregiões do país. Método: Estudo descritivo, transversal, a partir de entrevista com 65.391 usuários da Atenção Básica, em 3.944 municípios, referente à utilização dos serviços de saúde. Resultados: Os profissionais buscam resolver os problemas dos usuários na própria unidade (73,1%), mas com atenção voltada principalmente para o escopo da consulta (65,6%) e oferta de cuidado distante da realidade da população (69,4%). Foram referidas dificuldades no resgate da história clínica (50,3%) e no cuidado realizado em outros serviços de saúde (29,2%). Conclusão: A atenção integral, o vínculo e a coordenação do cuidado são ainda desafios para a Atenção Básica no país, exigindo reflexões sobre a implantação de políticas nacionais, sobretudo considerando as diversidades regionais do Brasil.