ABSTRACT OBJECTIVE The transgender population in Brazil faces marginalization and difficulties in accessing education and health, leading many individuals to self-medicate. This study aimed to evaluate the impact of the implementation of Specialized Centers in the Transsexualizing Process (SCTP) on the use of cross-sex hormone therapy (CSHT) without medical prescription, as well as the level of education and mental health profile of these individuals. METHODS This is a cross-sectional study with data from physical and electronic medical records between September 2017 and February 2023 regarding the use of CSHT before and after the implementation of two SCTP in the state of Bahia, Brazil, in addition to data on education level, previous diagnosis of anxiety and depression of patients. RESULTS A total of 219 participants, 127 transgender men (TM) and 92 transgender women and travestis (TrTW), were assessed. A significant reduction in the prevalence of self-medication was observed in both TrTW (92.98% before and 51.43% after, p<0.001), and TM (47.17% before and 25.67% after, p = 0.010) with the implementation of SCTP. Transgender individuals who used CSHT before accessing the service were found to have a lower prevalence of depression. Self-medication was not significantly associated with education or anxiety in our sample. CONCLUSION The results indicate the need for the expansion of SCTP, as they were associated with lower rates of self-medication in the transgender population.

ABSTRACT OBJECTIVE The transgender population in Brazil faces marginalization and difficulties in accessing education and health, leading many individuals to self-medicate. This study aimed to evaluate the impact of the implementation of Specialized Centers in the Transsexualizing Process (SCTP) on the use of cross-sex hormone therapy (CSHT) without medical prescription, as well as the level of education and mental health profile of these individuals. METHODS This is a cross-sectional study with data from physical and electronic medical records between September 2017 and February 2023 regarding the use of CSHT before and after the implementation of two SCTP in the state of Bahia, Brazil, in addition to data on education level, previous diagnosis of anxiety and depression of patients. RESULTS A total of 219 participants, 127 transgender men (TM) and 92 transgender women and travestis (TrTW), were assessed. A significant reduction in the prevalence of self-medication was observed in both TrTW (92.98% before and 51.43% after, p<0.001), and TM (47.17% before and 25.67% after, p = 0.010) with the implementation of SCTP. Transgender individuals who used CSHT before accessing the service were found to have a lower prevalence of depression. Self-medication was not significantly associated with education or anxiety in our sample. CONCLUSION The results indicate the need for the expansion of SCTP, as they were associated with lower rates of self-medication in the transgender population.

Resumo O objetivo deste artigo é investigar a associação entre a Pressão Inspiratória Máxima (PImáx) e Pressão Expiratória Máxima (PEmáx) com a incidência da síndrome de fragilidade (SF), além de testar a capacidade preditiva da PImáx e PEmáx em discriminar a SF em idosos, de acordo com o sexo. Estudo longitudinal com cinco anos de seguimento (2014-2019), realizado com 104 idosos cadastrados na Estratégia Saúde da Família de um município da Bahia. A incidência da síndrome de fragilidade foi diagnosticada de acordo os critérios propostos por Fried et al., utilizando dados de 2019, após cinco anos de seguimento. A PImáx e PEmáx foram avaliadas conforme recomendações da Sociedade Brasileira de Pneumologia e Tisiologia em 2014 (linha de base). A incidência total da SF foi de 16,3% (IC95%: 9,2-23,6), sendo 13,6% (IC95%: 4,56-22,55) no sexo feminino e 20,0% (IC95%: 7,85-32,15) no sexo masculino. Os valores médios da PImáx e PEmáx foram, respectivamente, 60,8±21,2 cmH2O e 76,7±23,1 cmH2O no sexo feminino, e 79,5±27,0 cmH2Oe 114,7±29,8 cmH2O no sexo masculino. A SF esteve associada à PEmáx em idosos do sexo masculino (RR ajustado: 0,96; IC95%: 0,95-0,98; p-valor: 0,002), indicando que o aumento de 1 cmH2O da PEmáx reduz em 4% o risco de desenvolver a síndrome de fragilidade.

Abstract This article aims to investigate the association between maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) with the incidence of frailty syndrome (FS), in addition to testing the predictive ability of MIP and MEP to discriminate FS in elderly adults, according to sex. It is a longitudinal study with a five-year follow-up period (2014-2019), carried out with 104 elderly adults registered in the Family Health Strategy of a municipality in Bahia. The incidence of frailty syndrome was diagnosed according to criteria proposed by Fried et al., using data from 2019, after a five-year follow-up. The MIP and MEP were evaluated according to the recommendations of the Brazilian Society of Pulmonology and Phthisiology data in 2014 (baseline data). The total incidence of frailty syndrome was 16.3% (95%CI: 9.2-23.6), with 13.6% (95%CI: 4.56-22.55) in women and 20% (95%CI: 7.85-32.15) in men. The mean values of MIP and MEP were, respectively, 60,8±21,2 cmH2O and 76,7±23,1 cmH2O in women, and 79,5±27,0 cmH2O and 114,7±29,8 cmH2O in men. The frailty syndrome was associated with MEP in elderly adult men (adjusted RR: 0.96; 95%CI: 0.95-0.98; P-value: 0.002), indicating that the increase of 1cmH2O in MEP reduces by 4% the risk of developing the syndrome.

This study aimed to identify the motor performance tests more strongly associated with frailty and respective cut-off points, and verify the best motor performance indicator as screening tool to discriminate frailty in elderly registered in Family Health Unit. Participated in the study 139 elderly aged ≥60 years, 105 women and 34 men. The frailty was identified by the criteria of Fried et al. (2001). The motor performance tests realized were: Handgrip strength (HS), sit-to-stand test, walk test (WT) and pick up a pen test. Logistic regression analysis was used to associate the motor performance tests and frailty. The cutoff points were evaluated by parameters provided by Receiver Operating Characteristic curve (ROC), with significance level of 5%. Data were analyzed using SPSS 21.0 and MedCalc. The mean age was 72.32 ± 8.4. The walk test was positively associated with frailty (OR 1.30; p <0.01), and handgrip strength in elderly women was inversely associated with frailty on feminine sex (OR 0.74; p <0.001). The WT presented a cutoff 5s (sensitivity 88.9 and specificity 74.5%) and the handgrip in the women obtained a cutoff point 14.6 kgf (sensitivity 83.3 and specificity 79.0%). It was concluded that the walk test was the best screening indicator to discriminate the frailty in elderly, both sexes, registered in a Family Health Unit.

Este estudo objetivou identificar os testes de desempenho motor mais fortemente associados à fragilidade e seus respectivos pontos de corte, e verificar o melhor indicador de desempenho motor como instrumento de triagem para discriminar fragilidade em idosos cadastrados em Unidade de Saúde da Família. Participaram da pesquisa 139 idosos com idade ≥60 anos, sendo 105 mulheres e 34 homens. A fragilidade foi identificada por meio dos critérios de Fried et al. (2001). Os testes de desempenho motor realizados foram: Força de preensão manual (FPM), sentar e levantar, caminhada (TC) e pegar um lápis. A análise de regressão logística foi usada para associar os testes de desempenho motor e fragilidade. Os pontos de corte foram avaliados por parâmetros fornecidos pela curva Receiver Operating Characteristic (ROC), com nível de significância de 5%. Os dados foram analisados usando SPSS 21.0 e MedCalc. A média de idade dos idosos foi de 72.32 ±8.4 anos. O teste de caminhada foi positivamente associado à fragilidade (OR 1,30; p<0.01), e a força de preensão manual foi inversamente associada à fragilidade no sexo feminino (OR 0.74; p<0.001). O TC apresentou um ponto de corte 5s (sensibilidade 88,9 e especificidade 74,5%) e a FPM-F obteve um ponto de corte de 14.6 kgf (sensibilidade 83.3 e especificidade 79.0%). Conclui-se que o teste de caminhada foi o melhor indicador de triagem para discriminar a fragilidade em idosos, de ambos os sexos, cadastrados em uma Unidade de Saúde da Família.

O objetivo deste estudo foi identificar o perfil de fragilidade e os fatores associados a idosos cadastrados em uma Unidade de Saúde da Família. Trata-se de um estudo observacional de corte transversal, exploratório de base domiciliar, realizado com 139 idosos. Os dados foram coletados por meio de um questionário estruturado, contendo as seguintes informações: antecedentes pessoais, familiares e doenças autorreferidas, sociodemográficas, nível de atividade física, variáveis comportamentais, eventos de quedas no último ano, sintomatologia depressiva, perda de peso não intencional e fadiga. Foram ainda realizadas medidas antropométricas (peso e altura) e calculado o Índice de Massa Corpórea (IMC). Foram realizadas análises descritivas e o teste de qui-quadrado de Pearson, ou exato de Fisher, com nível de significância (p < 0,05). Para as análises, foi utilizado o programa estatístico SPSS®, versão 21.0. Encontrou-se uma prevalência de idosos frágeis de 16,9%, pré-frágeis de 61,8% e não frágil de 21,3%. Foram observadas associações de fragilidade com grupo etário (p < 0,001), IMC (p = 0,018), arranjo familiar (p = 0,014), atividade física (p < 0,001) e quedas (p = 0,043). Neste estudo, observou-se uma alta prevalência de idosos pré-frágeis e frágeis e identificou fatores associados com esta síndrome.

The scope of this study was to identify the profile of fragility and associated factors among the elderly registered in a Family Health Unit. It involved an observational, exploratory, household -based and cross-sectional study conducted with 139 elderly individuals. The data were collected using a structured questionnaire requesting the following information: personal history, family and self-reported diseases, socio-demographic information, level of physical activity, behavior variables, number of falls in the last year, depressive symptoms, unintentional weight loss and fatigue. Anthropometric measurements (weight and height) were also taken and the body mass index (BMI) was calculated. Descriptive analyses and Pearson’s chi-square test or Fisher’s exact test were performed, with a significance level of p < 0.05. SPSS software version 21.0 was used for statistical analysis. The prevalence of fragility among the elderly was: frail (16.9%), pre-frail (61.8%) and non-frail (21.3%), respectively. The fragility profile was associated with: age (p < 0.001), BMI (p = 0.018), family situation (p = 0.014), level of physical activity (p < 0.001) and falls (p = 0.043). In this study, a high prevalence was observed of pre-frail and frail elderly individuals and identified factors associated with this syndrome.

Este artigo tem o objetivo de relatar uma experiência de educação popular em Saúde Mental, no contexto do movimento de Reforma Psiquiátrica, realizada no bairro de Pernambués, território do Centro de Atenção Psicossocial Álcool e Outras Drogas, localizado no município de Salvador-BA e campo de prática dos residentes do Núcleo de Saúde Mental da Residência Multiprofissional em Saúde da Universidade do Estado da Bahia - UNEB. Tal estratégia foi viabilizada através da realização de fóruns comunitários envolvendo vários atores sociais. Adotou-se neste trabalho a metodologia da sistematização da experiência proposta por Holliday, utilizando-se, para tanto, de registros de observações em diários de campo. Ao dar voz e vez a cada participante/falante, numa relação de valorização de saber e poder, a estratégia da educação popular permitiu que os sujeitos envolvidos no processo se organizassem politicamente e participassem da construção coletiva de novos saberes e práticas no campo da Saúde Mental, condizentes com a valorização da vida em sua multiplicidade.

This article presents an experience of popular education in mental health in the context of the Psychiatric Reform. Such experience occurred in the district of Pernambués, territory of the Centro de Atenção Psicossocial Álcool e Outras Drogas (Center for Psychosocial Assistance Alcohol and Other Drugs), located in the city of Salvador, state of Bahia. This center is the field for the practice of interns of the Mental Health Nucleus of the Multiprofessional Health Internship of Universidade do Estado da Bahia (UNEB - University of the State of Bahia). Such strategy was enabled by the organization of community forums involving many social actors. In this work, we used the methodology of experience systematization proposed by Holliday. By giving voice and time to each speaker/participant, in equal levels of knowledge and power, the popular education strategy allowed the people involved in this process to politically organize themselves. In addition, these people participated in the collective construction of new knowledge and practices in the mental health area, in keeping with the valuation of life in its multiplicity.