ABSTRACT: Soil enzymes play a fundamental role in nutrient cycling in forest systems. The stoichiometry of C, N, and P–acquiring enzymes has been used to indicate nutrient limitation in the soil. However, the enzymatic stoichiometry remains poorly understood in pure and mixed eucalypt plantations. Thus, this study aims to assess the activity of enzymes in the soil to address the hypothesis that the introduction of N2-fixing trees could influence the enzymatic stoichiometry on C, N, and P cycling. The activity of β-glucosidase (BG), urease (U), and acid phosphatase (AP) was assessed in soil (0-20 cm depth) of pure Eucalyptus grandis without (E) and with N fertilization (E+N), and a mixed system with E. grandis and Acacia mangium (E+A), and a pure A. mangium (A) plantation at 27 and 39 months after planting. The activities of BG/U, BG/AP, and U/AP were used to calculate the enzyme C/N, C/P, and N/P ratios, respectively. Rates of N–acquiring enzymes were higher in E and E+N, while soil microorganisms invested in P–acquiring enzymes in A and E+A. The vector length and angle demonstrated that C demand by microorganisms does not change in relation to N and P, regardless of the treatment. However, N demand decreased in relation to P in A and E+A (mainly at 27 months). Our results suggest that enzymes activity in pure eucalypt systems is limited for their soil-litter nutrient contents. At the same time while acacia and mixed plantation seem to invest in P–acquiring enzymes to improve biological N2 fixation promoted by diazotrophic bacteria associated to acacia.

Abstract Background This study aimed to analyze the Healthcare-Associated Infections (HAI) rates and antimicrobial consumption in Intensive Care Units (ICU) in São Paulo city during the COVID-19 pandemic and compare them with the pre-pandemic period. Methods This cohort included all hospitals that reported HAI rates (Central-Line-Associated Bloodstream Infection ‒ CLABSI and Ventilator-Associated Pneumonia ‒ VAP), the proportion of microorganisms that caused CLABSI, the proportion of resistant microorganisms, and antimicrobial consumption from January 2017 ‒ December 2020. Hospitals were stratified by the number of beds, Central Venous Catheter (CVC) utilization rate, Mechanical-Ventilation (MV) utilization rate, and type of funding. Statistical analyses were based on time-series plots and regression models. Results 220 ICUs were included. The authors observed an abrupt increase in CLABSI rates after the pandemic onset. High CLABSI rates during the pandemic were associated with hospital size, funding (public and non-profit private), and low CVC use (≤ 50%). An increase in VAP rates was associated with public hospitals, and high MV use (> 35%). The susceptibility profile of microorganisms did not differ from that of the pre-pandemic period. polymyxin, glycopeptides, and antifungal use increased, especially in COVID-19 ICUs. Conclusions HAI increased during COVID-19. The microorganisms’ susceptibility profile did not change with the pandemic, but the authors observed a disproportionate increase in large-spectrum antimicrobial drug use.

Abstract Introduction Tinnitus is experienced by a significant part of the patients suffering from otosclerosis. Objective To assess the prevalence of tinnitus in otosclerosis, its main features, and the impact on the daily life. Methods Patients diagnosed with otosclerosis in 2019 in a tertiary hospital were enrolled in the study. Demographic data were retrieved and, besides a regular audiometric evaluation, the patients underwent acuphenometry to assess the psychoacoustic measurements (pitch and loudness), and the Tinnitus Handicap Inventory (THI). Results In total, 66 patients fulfilled the inclusion criteria, with a female predominance (63.6%; n = 42), and a mean age of 48.7 years. The mean air-bone gap was of 26.3 dB. A total of 72.7% complained of tinnitus; it was mostly unilateral, identified in the low frequencies, namely 500 Hz, with median loudness of 7.5 dB. The median score on the THI score was of 37; most patients had a mild handicap (33.3%, n = 16), followed by those with a severe handicap (22.9%; n = 11). The female gender had a statistically significant association with the presence of tinnitus. The THI scores were higher in middle-aged patients (age groups: 40 to 49 and 50 to 59 years), which was statistically significant. No correlation was found between audiometry results and the prevalence of tinnitus or score on the THI. On the other hand, high-pitched tinnitus, compared to low pitched-tinnitus, was associated with larger air-bone gaps. Conclusion The prevalence of tinnitus in our population was in line with the prevalences reported in the literature. It caused a catastrophic handicap in 22.9% of the patients. High-pitched tinnitus was associated with higher handicap. Nonetheless, the existence of tinnitus and its severity were not associated with the degree of hearing loss.

Resumen Introducción: La falta de adherencia a los medicamentos es uno de los desafíos a los que se enfrentan los sistemas de salud. Los pacientes con mala adherencia al tratamiento no se benefician de la eficacia de la medicación, lo que se asocia con peor calidad de vida, aumento en hospitalizaciones y muertes y, en consecuencia, mayores costes sanitarios. Se ha demostrado que las farmacias comunitarias son elementos clave para mejorar la adherencia a los medicamentos prescritos, optimizar los resultados en pacientes con enfermedades crónicas y aumentar la eficiencia de la atención sanitaria. Objetivos: (1) evaluar la efectividad de la intervención Asistencia a Nuevos Medicamentos (ANM) administrada por farmacéuticos comunitarios para mejorar la adherencia al tratamiento en pacientes a los que se les ha recetado un nuevo medicamento para una enfermedad crónica específica; y (2) realizar una evaluación económica de esta intervención. Métodos: Se realizará un ensayo clínico pragmático aleatorizado a nivel de farmacia comunitaria (clúster). Se invitará a unirse al estudio a los pacientes identificados en la farmacia comunitaria que inicien tratamiento para: enfermedad pulmonar obstructiva crónica, hipertensión arterial, diabetes mellitus o en tratamiento con un anticoagulante/ antiagregante plaquetario. La intervención se basa en la comunicación farmacéutico-paciente, con el objetivo de evaluar la relación del paciente con su nuevo medicamento, e identificar posibles problemas, preocupaciones y falsas creencias-expectativas. Ética y difusión: Se ha obtenido el dictamen favorable del Comité de Ética de la Investigación Biomédica de Andalucía. Los resultados de este estudio se difundirán activamente a través de publicaciones y presentaciones en congresos.

Abstract Introduction: Non-adherence to medications is one of the challenges health systems faces. Patients with poor adherence to treatment fail to benefit from effective medication, and this is associated with reductions in quality of life, poorer outcomes, increased hospitalisations, deaths, and, consequently, higher healthcare costs. Community pharmacies are shown to be key elements in improving adherence to prescribed medications, optimising patient outcomes and increasing the efficiency of care. Objectives: (1) assess the effectiveness of the New Medicine Service (NMS) intervention delivered by community pharmacists to improve adherence to treatment in patients who have been prescribed a new medicine for a specific chronic condition; and (2) to conduct an economic evaluation of this intervention. Methods: A pragmatic randomized clinical trial at community pharmacy-level (clusters) will be performed. Patients identified in the collaborating community pharmacy as starting treatment for the following conditions, will be invited to join the study: chronic obstructive pulmonary disease, hypertension, diabetes mellitus or on an anticoagulant/antiplatelet agent. The intervention is based on the pharmacist-patient communication, aiming to assess the patient's relationship with his/her new prescription, and identify potential issues, concerns and false beliefs or expectations. Ethics and dissemination: The study protocol has been reviewed and ethics approval obtained from the regional ethics committee. The results from this study will be actively disseminated through manuscript publications and conference presentations.

Resumen Objetivo: Determinar las características basales que se asocian a una mayor mortalidad a los 42 días en aquellos pacientes hospitalizados por COVID-19 en España. Método: Cohorte prospectiva de pacientes COVID-19 hospitalizados. La variable dependiente fue la mortalidad a los 42 días. Además, se recogieron características demográficas, clínicas, comorbilidades, tratamiento habitual, intervenciones de soporte y tratamientos en las primeras 48 horas del ingreso. Para determinar la asociación con la mortalidad, se realizó un análisis multivariante mediante regresión logística. Resultados: Se incluyeron 15.628 pacientes, de ellos falleció el 18,2% (n = 2.806). El análisis multivariante mostró que las variables asociadas significativamente (p < 0,05) con la mortalidad al ingreso fueron: proceder de un centro sociosanitario (odds ratio OR 1,9), frecuencia respiratoria (odds ratio 1,5), gravedad de neumonía (CURB-65) moderada (odds ratio 1,7) o alta (odds ratio 2,9), transaminasa aspartato aminotransferasa ≥ 100 UI/l (odds ratio 2,1), lactato-deshidrogenasa ≥ 360 UI/l (odds ratio 1,6), procalcitonina > 0,5 ng/ml (odds ratio 1,8), creatina-quinasa ≥ 294 U/l (odds ratio 1,5), dímero D > 3.000 ng/ml (odds ratio 1,5), hemoglobina < 11,6 g/dl (odds ratio 1,4) y proteína C reactiva > 120 mg/l (odds ratio 1,2), necesidad de soporte respiratorio en las primeras 48 horas (odds ratio 2,0 de oxigenoterapia; odds ratio 2,8 ventilación no invasiva y odds ratio 3,5 ventilación mecánica) y tratamiento con interferón-beta (odds ratio 1,5). Por el contrario, ser menor de 80 años se asoció a una menor mortalidad. Conclusiones: El análisis del Registro Español de Resultados de Farmacoterapia frente a COVID-19 muestra que los factores asociados a peor pronóstico son: mayor edad, valoración mediante la escala CURB‑65, el nivel de requerimiento de soporte respiratorio, neumonía grave (CURB‑65), hipertransaminasemia, elevación de creatina-quinasa, lactato-deshidrogenasa, y dímero-D, anemia y elevación de la frecuencia respiratoria.

Abstract Objective: To determine the baseline characteristics associated with higher mortality at 42 days in patients hospitalized for COVID-19 in Spain. Method: The study analyzed a prospective cohort of hospitalized COVID-19 patients. The dependent variable was 42-day mortality. Data on the subjects’ demographic and clinical characteristics, comorbidities, usual therapy and supportive interventions and treatments was collected within 48 hours from admission. To determine the potential association of the data with mortality, a multivariate analysis was performed using logistic regression. Results: 15,628 patients were included, 18.2% of whom (n = 2,806) died during the study period. According to the multivariate analysis, the variables that were significantly associated (p < 0.05) with mortality upon admission were: being referred from a nursing home (OR 1.9); having a high respiratory rate (OR 1,5); having moderate (OR 1.7) or severe (OR 2.9) pneumonia (CURB-65); aspartate aminotransferase transaminase ≥ 100 IU/l (OR 2.1); lactate dehydrogenase ≥ 360 IU/L (OR 1.6); procalcitonin > 0.5 ng/mL (OR 1.8); creatine kinase ≥ 294 U/L (OR 1.5); D-dimer > 3,000 ng/mL (OR 1.5); hemoglobin < 11.6 g/dL (OR 1.4) and C-reactive protein > 120 mg/L (OR 1.2; requiring respiratory support within the first 48 hours (oxygen therapy [OR 2.0], non-invasive ventilation [OR 2.8], and mechanical ventilation [OR 3.5]); and being treated with interferon-beta (OR 1.5). On the contrary, being under 80 years of age was associated with lower mortality. Conclusions: The analysis, based on the data in the RERFAR registry, showed that the factors associated with poorer prognosis were older age, assessed using the CURB-65 scale, level of respiratory support required, severe pneumonia (CURB-65), hypertransaminasemia, elevated creatine kinase, lactate dehydrogenase, and D-dimer levels, anemia, and elevated respiratory rate.

ABSTRACT: The term rickets refers to insufficient or retarded mineralization of the osteoide matrix. X-linked hypophosphatemic (XLH) rickets is a rare genetic disorder characterized by biochemical changes in bone mineralization due to inactivation of the phosphate regulating gene and primary defect of the osteoblasts. The aim of this article was to report a clinical case of XLH, its oral manifestations, periapical changes and dental management. A 31-year old woman female patient was referred to the school of dentistry with pain and sensitivity in the teeth. She had a childhood history of rickets, hypophosphatemia and alteration in Vitamin D. In the oral exam, enamel hypoplasia, microdontia, fistula, caries and periapical lesions and periodontal disease were diagnosed. The radiographic and tomographic exams exhibited the presence of periapical lesions involving various teeth with radiolucent images, suggestive of granuloma or periapical cysts. The treatme nt prioritized the urgency of eliminating pain and removing the foci of infection. Endodontic treatment began in the teeth that had fistula or periapical lesions and in parallel, oral hygiene guidance was provided and periodontal treatment was performed. There was an improvement in the clinical condition with reduction in inflammation and mobility of the teeth. Dentists and health professionals must evaluate the patient as a whole, considering the relations between systemic and oral health. Knowledge of systemic diseases associated with rickets and their characteristics is essential for making a correct oral diagnosis and planning the dental treatment.

RESUMEN: El término raquitismo se refiere a la mineralización insuficiente o retardada de la matriz osteoide. El raquitismo hipofosfatémico ligado al cromosoma X (XLH) es un trastorno genético caracterizado por cambios bioquímicos en la mineralización ósea debido a la inactivación del gen regulador del fosfato y al defecto primario de los osteoblastos. El objetivo de este artículo fue reportar un caso clínico de XLH, sus manifestaciones orales, cambios periapicales y manejo dental. La paciente, una mujer de 31 años, acudió a la Clínica de Semiología de la UFPR con dolor y sensibilidad en varios dientes. Tenía antecedentes infantiles de raquitismo, hipofosfatemia y alteración de la vitamina D. En el examen oral se diagnosticó hipoplasia del esmalte, microdoontia, fístula, caries y lesiones periapicales y enfermedad periodontal. Los exámenes radiográficos y tomográficos mostraron la presencia de lesiones periapicales en varios dientes con imágenes radiolúcidas, sugestivas de granuloma o quistes periapicales. El tratamiento priorizó la urgencia de eliminar el dolor y remover los focos de infección. Se inició tratamiento de endodoncia en los dientes que presentaban fístula o lesiones periapicales y paralelamente se brindó orientación de higiene oral y se realizó tratamiento periodontal. Hubo una mejoría en la condición clínica con reducción de la inflamación y movilidad de los dientes. Los odontólogos y profesionales de la salud deben evaluar al paciente como un todo, teniendo en cuenta las relaciones entre salud sistémica y oral. El conocimiento de las enfermedades sistémicas asociadas al raquitismo y sus características es fundamental para realizar un correcto diagnóstico oral y planificar el tratamiento odontológico.

RESUMO Objetivo verificar se o desempenho de pré-escolares nascidos prematuros e a termo no subteste de linguagem da Bayley-III difere e identificar se as variáveis idade gestacional, peso ao nascer, nível socioeconômico e escolaridade materna são determinantes no desfecho de desenvolvimento de linguagem. Método estudo transversal descritivo caso controle em que 36 pré-escolares nascidos prematuros e 27 nascidos a termo foram avaliados em relação ao desenvolvimento de linguagem pelo subteste da Bayley III. Foram considerados pré-escolares entre 18 e 36 meses de idade cronológica; com ausência de síndromes ou alterações genéticas, sensoriais, neurológicas, auditivas ou visuais; e que não tinham realizado terapia fonoaudiológica previamente. Os testes de Mann-Whitney, Exato de Fisher e regressão logística binária foram utilizados para análise estatística. Resultados o desempenho dos grupos não diferiu seja pela pontuação composta (p=0,701) ou pela classificação baseada no percentil (p=0,225). A idade gestacional, o peso ao nascimento e o nível socioeconômico não influenciaram no desfecho do desenvolvimento de linguagem. No entanto, a escolaridade materna foi significativa (p=0,014) no modelo de regressão logística binária, sugerindo que a mãe ter estudado até a educação básica aumenta a chance de ter um filho com desempenho abaixo do esperado no subteste de linguagem da Bayley III em 6,31 vezes. Conclusão não houve diferença entre os grupos no subteste de linguagem da Bayley-III e apenas a escolaridade materna influenciou no desfecho do desenvolvimento de linguagem.

ABSTRACT Purpose to verify if the performance of pre-school children born prematurely and at term in the Bayley-III language subtest differs and to identify whether variables gestational age, birth weight, socioeconomic level, and maternal education are determinant in the outcome of language development. Methods Descriptive cross-sectional case-control study in which 36 pre-school children born prematurely and 27 born at term were evaluated concerning language development by the Bayley III subtest. Preschoolers between 18 and 36 months of chronological age were considered; with no syndromes or genetic, sensory, neurological, auditory, or visual impairments; and had not previously undergone speech therapy. Mann-Whitney, Fisher's Exact, and binary logistic regression tests were used for statistical analysis. Results the groups' performance did not differ either by the composite score (p = .701) or by the classification based on the percentile (p = .225). Gestational age, birth weight, and socioeconomic status did not influence the outcome of language development. However, maternal education was significant (p = .014) in the binary logistic regression model, suggesting that the mother having studied until basic education increases the chance of having a child underperforming in the Bayley III language subtest 6.31 times. Conclusion there was no difference between the groups in the Bayley-III language subtest and only maternal education influenced the outcome of language development.

RESUMO O excesso de sais pode afetar diversos processos nas culturas, e o nitrogênio (N) pode atenuar o efeito depressivo da salinidade. Objetivou-se avaliar a influência de doses de nitrogênio no crescimento e nas trocas gasosas da cultura do milho irrigado com água salina. O experimento foi conduzido no período de junho a setembro de 2019, na Universidade da Integração Internacional da Lusofonia Afro-Brasileira, Redenção, CE. O delineamento experimental foi inteiramente casualizado, em arranjo fatorial 2 x 3 água de abastecimento de 0,3 dS m-1 e solução salina de 3,0 dS m-1, e três doses de nitrogênio, 0, 80 e 160 kg ha-1, correspondendo a 0, 50 e 100% da dose recomendada, respectivamente, com seis repetições. Aos 30 e 45 dias após a semeadura (DAS) foram avaliadas altura de planta, área foliar, número de folhas, fotossíntese, transpiração e a condutância estomática. O estresse salino afeta a altura de plantas, área foliar, fotossíntese, transpiração e a condutância aos 30 DAS. As doses de 80 e 160 kg ha-1 proporcionam maior desempenho em altura de plantas, área foliar, fotossíntese, transpiração e a condutância aos 30 DAS. O uso de água de baixa salinidade e as doses de 80 e 160 kg ha-1 foram mais eficientes quanto à altura de plantas, área foliar, fotossíntese, transpiração e a condutância aos 45 DAS. A dose de 160 kg ha-1 de N atenua os efeitos deletérios dos sais nas plantas de milho híbrido AG 1051 proporcionando maiores valores de fotossíntese, transpiração e condutância estomática aos 45 DAS, quando irrigadas com água de 3,0 dS m-1.

ABSTRACT The excess of salts can affect several processes in the crops, and nitrogen (N) can attenuate the depressive effect of salinity. The objective was to evaluate the influence of nitrogen doses on the growth and gas exchange of corn crop irrigated with saline water. The experiment was conducted from June to September 2019 at the University of International Integration of Afro-Brazilian Lusophony, Redenção, CE, Brazil. The experimental design was completely randomized, in a 2 x 3 factorial scheme (supply water of 0.3 dS m-1 and saline solution of 3.0 dS m-1) and three nitrogen doses, 0, 80, and 160 kg ha-1, corresponding to 0, 50, and 100% of the recommended dose respectively, with six repetitions. At 30 and 45 days after sowing (DAS), plant height, leaf area, number of leaves, photosynthesis, transpiration, and stomatal conductance were evaluated. Saline stress affects plant height, leaf area, photosynthesis, transpiration, and conductance at 30 DAS. The doses of 80 and 160 kg ha-1 provide greater performance in plant height, leaf area, photosynthesis, transpiration, and conductance at 30 DAS. The use of low salinity water and doses of 80 and 160 kg ha-1 were more efficient in terms of plant height, leaf area, photosynthesis, transpiration, and conductance at 45 DAS. The dose of 160 kg ha-1 of N attenuates the harmful effects of salts in AG 1051 hybrid maize plants, providing higher values of photosynthesis, transpiration, and stomatal conductance at 45 DAS when irrigated with water of 3.0 dS m-1.

Resumo Objetivou-se neste trabalho avaliar os efeitos da salinidade da água sobre os índices fisiológicos em plantas de amendoim inoculadas e não inoculadas. O trabalho foi desenvolvido em ambiente protegido, na unidade de produção de mudas (UPMA), no Campus das Auroras, na Universidade da Integração Internacional da Lusofonia Afro-Brasileira (UNILAB), Redenção, Ceará. O delineamento experimental utilizado foi o inteiramente casualizado (DIC), com tratamentos arranjados em esquema fatorial, 5 x 2, referentes aos cinco níveis de salinidade da água de irrigação - CEa: 0,5, 1,5, 3, 4,5 e 6 dSm-1, e plantas inoculadas e não inoculadas com mix de rizóbios SEMIA 630, lote 0810 e SEMIA 6144, lote 0312, de Bradyrhizobium sp., isolado, com 4 repetições. Realizou-se também adubação recomendada para o fósforo (62,5 kg ha-1 de P) e o potássio (50 kg ha-1 de K) para suprir as necessidades nutricionais das plantas. O efeito nutricional ocasionado pela simbiose com Bradyrhizobium sp. favorece as plantas inoculadas a apresentarem maior tolerância ao estresse salino. A disponibilidade de nitrogênio ajudou na maior eficiência dos mecanismos fisiológicos da planta. As plantas não inoculadas, mesmo tendo uma maior quantidade de clorofila e CO2, não foram eficientes na taxa fotossintética. O estresse salino afetou a fotossíntese, transpiração, condutância estomática concentração interna de CO2, o uso e eficiência da água e a clorofila, porém com menor intensidade quando inoculadas com Bradyrhizobium sp. O aumento da salinidade da água de irrigação aumentou a temperatura foliar.

Abstract This work evaluated the effects of water salinity on the physiological indices in inoculated and non-inoculated peanut plants. The study was carried out in a protected environment at the seedling production unit (UPMA) at Campus das Auroras, at the University for International Integration of the Afro-Brazilian Lusophony (UNILAB), Redenção, Ceará. The experimental design used was in a completely randomized (CRD), with treatments in a factorial arrangement, 5x2, referring to the five salinity levels of the irrigation water - CEa: 0.5, 1.5, 3, 4.5, and 6.0 dSm-1, and inoculated and non-inoculated plants with a mix of rhizobia SEMIA 630, lot 0810, and SEMIA 6144, lot 0312, from Bradyrhizobium sp., isolated, with four replications. Recommended fertilization was done for phosphorus (62.5 kg ha-1 of P) and potassium (50 kg ha-1 of K) to supply the nutritional needs of the plants. The nutritional effect caused by symbiosis with Bradyrhizobium sp. favored inoculated plants to present greater tolerance to salt stress. The availability of nitrogen collaborated to increase the efficiency of plant physiological mechanisms. Uninoculated plants, even with a higher amount of chlorophyll and CO2, were not efficient in the photosynthetic rate. Saline stress affected photosynthesis, transpiration, stomatal conductance, internal CO2 concentration, water use efficiency, and chlorophyll; however, with less intensity when inoculated with Bradyrhizobium sp. The increase in salinity on irrigation water increased the leaf temperature.

Ações de Saúde Mental na Atenção Primária em Saúde (APS) constituem um desafio no âmbito da Reforma Psiquiátrica Brasileira (RPB). Objetivou-se a compreensão das práticas realizadas com pessoas em condições de sofrimento mental na APS em municípios de pequeno porte. O estudo qualitativo com utilização da etnometodologia envolveu gestores e profissionais da APS em municípios do Vale do Jequitinhonha. Os resultados permitiram sistematizar ações da APS: desvendar o mundo dos transtornos mentais intramuros pela visita domiciliar e a presença na escola; transitar entre universos distintos, de formatos tradicionais até os problemas de Saúde Mental advindos das redes sociais; expansão de abordagem e apoio aos pacientes de Saúde Mental e percepção pela APS da transferência de estigmas operando na rede de Saúde Mental. Conclui-se que a APS faz parte do projeto de RPB, também de forma humanizada, aprofundando-a.

Mental health actions in primary care are a challenge within the scope of the Brazilian Psychiatric Reform. We aimed to understand the primary care practices provided for people with mental illness in small cities. This qualitative study used ethnomethodology and involved primary care managers and professionals from cities located in Vale do Jequitinhonha. The results enabled us to systematize primary care actions: to unveil the world of intramural mental disorders through home visits and presence at schools; to move between different universes, from traditional formats to mental health problems arising from the social media; to expand the approach to and support for mental health patients; and to perceive the transfer of stigmas operating in the mental health network. We conclude that primary care, which has the provision of humanized care as one of its principles, is part of the project of the Brazilian Psychiatric Reform and deepens it.

Acciones de Salud Mental en la Atención Primaria de la Salud (APS) constituyen un desafío en el ámbito de la Reforma Psiquiátrica Brasileña (RPB). El objetivo fue la compresión de las prácticas realizadas a las personas en condiciones de sufrimiento mental en la APS en municipios de pequeño porte. Estudio cualitativo con utilización de la etnometodología que envolvió a gestores y profesionales de la APS en municipios del Vale de Jequitinhonha. Los resultados permitieron sistematizar acciones de la APS: desvendar el mundo de los trastornos mentales intramuros, por la visita domiciliaria y de la presencia en la escuela; transitar entre universos distintos, de formatos tradicionales hasta los problemas de salud mental provenientes de las redes sociales; expansión de abordaje y apoyo a los pacientes de salud mental y percepción por parte de la APS de la transferencia de estigmas operando en la red de salud mental. Se concluyó que la APS forma parte del proyecto de RPB, también de forma humanizada y profundizándola.

Ações de Saúde Mental na Atenção Primária em Saúde (APS) constituem um desafio no âmbito da Reforma Psiquiátrica Brasileira (RPB). Objetivou-se a compreensão das práticas realizadas com pessoas em condições de sofrimento mental na APS em municípios de pequeno porte. O estudo qualitativo com utilização da etnometodologia envolveu gestores e profissionais da APS em municípios do Vale do Jequitinhonha. Os resultados permitiram sistematizar ações da APS: desvendar o mundo dos transtornos mentais intramuros pela visita domiciliar e a presença na escola; transitar entre universos distintos, de formatos tradicionais até os problemas de Saúde Mental advindos das redes sociais; expansão de abordagem e apoio aos pacientes de Saúde Mental e percepção pela APS da transferência de estigmas operando na rede de Saúde Mental. Conclui-se que a APS faz parte do projeto de RPB, também de forma humanizada, aprofundando-a.

Mental health actions in primary care are a challenge within the scope of the Brazilian Psychiatric Reform. We aimed to understand the primary care practices provided for people with mental illness in small cities. This qualitative study used ethnomethodology and involved primary care managers and professionals from cities located in Vale do Jequitinhonha. The results enabled us to systematize primary care actions: to unveil the world of intramural mental disorders through home visits and presence at schools; to move between different universes, from traditional formats to mental health problems arising from the social media; to expand the approach to and support for mental health patients; and to perceive the transfer of stigmas operating in the mental health network. We conclude that primary care, which has the provision of humanized care as one of its principles, is part of the project of the Brazilian Psychiatric Reform and deepens it.

Acciones de Salud Mental en la Atención Primaria de la Salud (APS) constituyen un desafío en el ámbito de la Reforma Psiquiátrica Brasileña (RPB). El objetivo fue la compresión de las prácticas realizadas a las personas en condiciones de sufrimiento mental en la APS en municipios de pequeño porte. Estudio cualitativo con utilización de la etnometodología que envolvió a gestores y profesionales de la APS en municipios del Vale de Jequitinhonha. Los resultados permitieron sistematizar acciones de la APS: desvendar el mundo de los trastornos mentales intramuros, por la visita domiciliaria y de la presencia en la escuela; transitar entre universos distintos, de formatos tradicionales hasta los problemas de salud mental provenientes de las redes sociales; expansión de abordaje y apoyo a los pacientes de salud mental y percepción por parte de la APS de la transferencia de estigmas operando en la red de salud mental. Se concluyó que la APS forma parte del proyecto de RPB, también de forma humanizada y profundizándola.

RESUMO OBJETIVO: Verificar se equipes de atenção básica que possuem atributos mais bem estruturados da atenção primária à saúde (APS) conseguem oferecer melhor assistência em saúde mental (SM). MÉTODOS: Estudo transversal realizado a partir dos dados da avaliação externa do segundo ciclo do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), envolvendo 31.587 equipes de atenção básica, entre 2013 e 2014. Foram construídas duas tipologias: qualidade da assistência em saúde mental (variável dependente) e estruturação da APS segundo atributos essenciais (variável independente). Para a construção da tipologia de saúde mental, foram identificados conteúdos sobre o tema no módulo II do PMAQ e realizados somatórios das perguntas para a categorização dos índices. Para a estruturação da APS segundo atributos, utilizou-se técnica Delphi para consensualidade em quatro rodadas referendadas por especialistas. Com análises de regressão logística multinomial, verificou-se associação entre as tipologias e identificou-se qual atributo mais contribuía para qualidade da atenção em saúde mental. RESULTADOS: Verificou-se que 29,2% das equipes encontram-se em um nível baixo de qualidade em assistência à SM, enquanto 7,5% das equipes apresentam um nível baixo de estruturação da APS segundo atributos essenciais. Diferenças regionais são mantidas, tanto para estruturação da APS quanto para a qualidade da assistência à saúde mental. Evidenciou-se uma chance maior de realizar uma assistência em SM com melhor qualidade quando a APS está mais bem estruturada em nível alto (OR = 14,74) e em nível médio (OR = 2,193). Alto nível de Integralidade está associado a alto nível de Qualidade da Assistência em SM (OR = 3,21). CONCLUSÕES: Os resultados indicam que há predomínio de baixos níveis de qualidade da assistência à saúde mental, em descompasso com o processo de estruturação da APS, considerando seus atributos essenciais.

ABSTRACT OBJECTIVE: To verify if primary care teams with better structured primary health care (PHC) attributes could offer better mental health (MH) care. METHODS: Cross-sectional study based on data from the external evaluation of the second cycle of the Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB - Access and Quality Improvement of Primary Care Program), involving 31,587 primary care teams, between 2013 and 2014. Two typologies were built: quality of mental health care (dependent variable) and PHC structuring according to essential attributes (independent variable). We identified some contents for the construction of the mental health typology (module II of the PMAQ) and performed sums of questions for the categorization of indices. The Delphi technique rendered consensus in four rounds endorsed by experts, following the attributes of PHC structure. Multinomial logistic regression analyses verified the association between the typologies and identified which attribute most contributed to the quality of mental health care. RESULTS: We found out that 29.2% of the teams are at low levels of quality in assistance to MH, while 7.5% of the teams have a low level of structuring the PHC according to essential attributes. Regional differences are maintained, both for the structuring of the PHC and for the quality of mental health care. There was a greater chance of providing care in MH with better quality when the PHC is better structured at a high level (OR = 14.74) and at a medium level (OR = 2.193). A high level of completeness is associated with a high level of Quality of Care in MH (OR = 3.21). CONCLUSION: results indicate a predominance of low levels of quality in mental health care, out of step with the process of PHC structuring and its essential attributes.