Desafios na comunicação entre homens e seus médicos de família / Communication challenges between men and family doctors / Desafíos en la comunicación entre hombres y sus médicos de familia

O artigo discute aspectos da comunicação na relação médico(a) + homem usuário no contexto de serviços com Estratégia de Saúde da Família (ESF). A presente pesquisa qualitativa foi realizada em três fases distintas e articuladas, com triangulação de técnicas (entrevistas semiestruturadas e grupos focais) e com homens usuários e médico(a)s de Família e Comunidade (MFC) em serviços de saúde em Florianópolis, SC, Brasil. As análises apontam que a busca por consulta é guiada por sintomas e/ou pressão de familiares e pela expectativa por exames que comprovem estarem saudáveis. O(a)s MFC incentivam o autocuidado sem efetivamente convencer os usuários. A troca frequente de médico(a) é um forte entrave para o vínculo e a comunicação. O estudo contribui para o debate sobre a relação médico(a) + pessoa em segmento da população reticente e pouco envolvido com o autocuidado e a prevenção. (AU)

This article discusses aspects of communication in the doctor-male patient relationship in the context of family health strategy services. A qualitative study was undertaken with family and community doctors (FCDs) in health services in Florianópolis, Brazil in three distinct stages using triangulation techniques (semi-structured interviews and focus groups). The findings show that seeking an appointment was guided by symptoms and/or family pressure and the expectation of receiving examination results that show that the patient is healthy. The FCDs encouraged self-care without effectively convincing the patients. The frequent change of doctors strongly hampered the creation of doctor-patient bonds and communication. This study contributes to the discussion about doctor-patient relationships in a segment of the population that is reticent and not very engaged in self-care and prevention. (AU)

El artículo discute aspectos de comunicación en la relación médico(a) + hombre usuario en el contexto de servicios con Estrategia de Salud de la Familia (ESF). Investigación cualitativa realizada en tres fases distintas y articuladas, con triangulación de técnicas (entrevistas semiestructuradas y grupos focales), con hombre usuarios y Médicos(as) de Familia y Comunidad (MFC) en servicios de salud en Florianópolis, Estado de Santa Catarina, Brasil. Los análisis señalan que la búsqueda de la consulta es dirigida por síntomas y/o presión de familiares y por la expectativa de realización de análisis que demuestren que están saludables. Los(las) MFCs incentivan el autocuidado, sin efectivamente convencer a los usuarios. El cambio frecuente de médico(a) es un fuerte obstáculo para el vínculo y la comunicación. El estudio contribuyó para el debate sobre la relación médico(a)+persona en un segmento de la población reticente y poco involucrado en el autocuidado y la prevención. (AU)

As práticas de educação em diabetes vivenciadas no sus: uma discussão da literatura com ênfase na atenção primária à saúde / The education practices in diabetes experienced in SUS: a literature discussion with emphasis on primary health care

O objetivo deste estudo foi apresentar e discutir as práticas de educação em saúde direcionadas aos portadores de diabetes produzidas no Brasil a partir da criação do SUS, com ênfase na Atenção Primária à Saúde. Tratou- se de uma pesquisa bibliográfica e foram consultadas as principais bases de dados em saúde com interseções dos conjuntos dos termos: "educação em saúde", "diabetes" e "Brasil". Foram selecionados 22 trabalhos realizados em âmbito nacional, sendo 18 na Atenção Básica e 4 em outros níveis de atenção. Foram encontradas tanto práticas coletivas, como a educação em grupos, quanto individuais, como consultas, visitas domiciliares e monitoramento telefônico. Uma maior diversidade de formatos de práticas educativas foi identificada na Atenção Básica. Predominaram atividades multiprofissionais realizadas com idosos e que enfatizaram os temas: alimentação saudável, exercício físico e medicamentos. A maior parte das vivências baseou-se na relação dialógica e na abordagem educacional construtivista/problematizadora, com tendência voltada à concepção pedagógica de Paulo Freire. O grande desafio da educação em saúde está vinculado à formação profissional e ao processo de trabalho, portanto é essencial o papel de gestores de saúde no estímulo à capacitação dos profissionais para que possam desenvolver e ampliar habilidades de escuta e linguagem em futuras práticas educativas.

The objective of this research was to present the practices of health education directed to patients with diabetes produced in Brazil since the SUS creation, with emphasis on the primary health care. The methodology used was the bibliographic survey, and health databases using intersections of terms have been searched: "health education", "diabetes" and "Brazil", selecting just national research. A total of 22 studies describing educational processes was selected, 18 in Primary Care and 4 in other levels of care, resulting in collective educational practices, as group education, and individualized practices, as consultations, home visits, and telephone monitoring. A greater diversity of educational practices formats was seen in primary care. Multidisciplinary activities in which the audience were elderly predominated, discussing the subjects: healthy eating, exercise, and medications. Most of the experiences, both in primary care as in other levels were based on dialogic relationship and constructivist/ problem-based educational approach, with tendencies toward the pedagogical conception of Paulo Freire. The major challenge in health education is related to vocational training and work process, so it is essential that health managers encourage professional training so they can develop and extend listening and language skills.

Accounting for intimate partner violence perpetration. A cross-cultural comparison of English and Brazilian male substance users' explanations.

INTRODUCTION AND AIMS: This paper describes how substance use features in the accounts of intimate partner violence (IPV) perpetrators in treatment in England and Brazil. The aim of the research was to better understand cross cultural constructions of IPV perpetration amongst men in treatment for substance use. DESIGN AND METHODS: Semi-structured interviews were conducted with 40 men in community substance use treatment in Sao Paolo, Brazil and London and the South East of England who had reported IPV perpetration in a questionnaire survey. A thematic, narrative analysis was carried out of men's explanations for IPV perpetration. FINDINGS: Three types of narratives were distinguished: (i) disputes, centred on substance use, that escalate to IPV perpetration; (ii) IPV perpetration that is explained by uncharacteristic loss of control, as a result of intoxication; and (iii) IPV perpetration provoked by a perceived betrayal, in which substance use is incidental. In all types of accounts hegemonic principles of male and female roles and behaviour provided a context for and make IPV perpetration explicable. DISCUSSION AND CONCLUSIONS: Substance use and IPV are culturally constructed and contextually defined. Understanding the meaning-making of substance using IPV perpetrators has implications for the treatment of both substance abuse and IPV. [Radcliffe P, d'Oliveira AFPL, Lea S, dos Santos Figueiredo W, Gilchrist G. Accounting for intimate partner violence perpetration. A cross-cultural comparison of English and Brazilian male substance users' explanations. Drug Alcohol Rev 2017;36:64-71].

Species survival and scaling laws in hostile and disordered environments.

In this work we study the likelihood of survival of single-species in the context of hostile and disordered environments. Population dynamics in this environment, as modeled by the Fisher equation, is characterized by negative average growth rate, except in some random spatially distributed patches that may support life. In particular, we are interested in the phase diagram of the survival probability and in the critical size problem, i.e., the minimum patch size required for surviving in the long-time dynamics. We propose a measure for the critical patch size as being proportional to the participation ratio of the eigenvector corresponding to the largest eigenvalue of the linearized Fisher dynamics. We obtain the (extinction-survival) phase diagram and the probability distribution function (PDF) of the critical patch sizes for two topologies, namely, the one-dimensional system and the fractal Peano basin. We show that both topologies share the same qualitative features, but the fractal topology requires higher spatial fluctuations to guarantee species survival. We perform a finite-size scaling and we obtain the associated scaling exponents. In addition, we show that the PDF of the critical patch sizes has an universal shape for the 1D case in terms of the model parameters (diffusion, growth rate, etc.). In contrast, the diffusion coefficient has a drastic effect on the PDF of the critical patch sizes of the fractal Peano basin, and it does not obey the same scaling law of the 1D case.

Between flows and therapeutic projects: revisiting the notions of lines of care in health and therapeutic itineraries.

This essay discusses the possibilities of conceptual and practical connections between the ideas of line of care and therapeutic itineraries, beginning with the theoretical contributions that lay the foundations for the Line of Integrated Healthcare and the hermeneutic approaches to Care. The implementation of lines of care tuned to individual and collective health needs can be glimpsed in the construction of therapeutic projects, inasmuch as they privilege the particularities of each situation in the agreement of flows of appointments, exams, and other procedures. The therapeutic project - taken as an arrangement, strategy, device, or basic dimension of Care in the work process in health - can be seen as an image that lays out a possibility of the future, which in turn is a projection conditioned by past experiences of health, illness, and life. From the criticism of explanatory models, preponderant in the studies of therapeutic itineraries, we defend the investment in approaches that privilege interpretation and understanding, capable of recuperating, contextualizing, and reconstructing trajectories, beginning with the subjects involved in the care process.

Entre fluxos e projetos terapêuticos: revisitando as noções de linha do cuidado em saúde e itinerários terapêuticos / Between flows and therapeutic projects: revisiting the notions of lines of care in health and therapeutic itineraries

Resumo Trata-se de ensaio que discute possibilidades de conexões conceituais e práticas entre as noções de linha do cuidado e de itinerários terapêuticos, a partir dos aportes teóricos que embasam a Linha do Cuidado Integral em Saúde e das abordagens hermenêuticas sobre o Cuidado. Vislumbra-se a implementação de linhas do cuidado afinadas com as necessidades de saúde – individuais e coletivas – a partir da construção de projetos terapêuticos, na medida em que privilegiam as particularidades de cada situação na pactuação de fluxos de consultas, exames e demais procedimentos. O projeto terapêutico, tomado como arranjo, estratégia, dispositivo ou dimensão basilar do Cuidado no processo de trabalho em saúde, pode ser concebido como imagem que desenha uma possibilidade de futuro, este, por sua vez, uma projeção condicionada por experiências prévias – de saúde, de doença, de vida. Da crítica aos modelos explicativos, pregnantes nos estudos sobre itinerários terapêuticos, defende-se o investimento em abordagens que privilegiam a interpretação e a compreensão, capazes de recuperar, contextualizar e reconstruir as trajetórias, a partir dos sujeitos implicados no processo do cuidado.

Abstract This essay discusses the possibilities of conceptual and practical connections between the ideas of line of care and therapeutic itineraries, beginning with the theoretical contributions that lay the foundations for the Line of Integrated Healthcare and the hermeneutic approaches to Care. The implementation of lines of care tuned to individual and collective health needs can be glimpsed in the construction of therapeutic projects, inasmuch as they privilege the particularities of each situation in the agreement of flows of appointments, exams, and other procedures. The therapeutic project – taken as an arrangement, strategy, device, or basic dimension of Care in the work process in health - can be seen as an image that lays out a possibility of the future, which in turn is a projection conditioned by past experiences of health, illness, and life. From the criticism of explanatory models, preponderant in the studies of therapeutic itineraries, we defend the investment in approaches that privilege interpretation and understanding, capable of recuperating, contextualizing, and reconstructing trajectories, beginning with the subjects involved in the care process.

Ion specificity and micellization of ionic surfactants: a Monte Carlo study.

We developed a simulation method that allows us to calculate the critical micelle concentrations for ionic surfactants in the presence of different salts. The results are in good agreement with the experimental data. The simulations are performed on a simple cubic lattice. The anionic interactions with the alkyl chains are taken into account based on the previously developed theory of the interfacial tensions of hydrophobic interfaces: the kosmotropic anions do not interact with the hydrocarbon tails of ionic surfactants, while chaotropic anions interact with the alkyl chains through a dispersion potential proportional to the anionic polarizability.

Homens, masculinidade e violência: estudo em serviços de atenção primária à saúde / Men, masculinity and violence: a study in primary health care services

Há poucos estudos sobre homens abordando violência como evento não fatal. Contribuindo nessa direção, descrevem-se as prevalências da violência psicológica, física e/ou sexual sofridas por homens, detalhando-se nestes tipos a perpetrada contra parceiras. Trata-se de estudo transversal realizado com 789 homens de 18 a 60 anos, dos quais 775 com alguma parceria íntima na vida, selecionados por ordem de chegada em dois serviços de atenção primária na cidade de São Paulo. Foram investigadas as características sociodemográficas e as violências mencionadas, examinadas ainda quanto a sobreposições e à percepção de havê-las sofrido ou perpetrado. As prevalências de violências sofridas na vida foram de 79% para qualquer tipo e por qualquer agressor; 63,9%, 52,8% e 6,1% respectivamente para psicológica, física e sexual. Para violências perpetradas contra a parceira na vida, temos 52,1% qualquer tipo e 40%, 31,9% e 3,9%, respectivamente, para violência psicológica, física e sexual. Nas sofridas e nas perpetradas, a psicológica é a de maior taxa exclusiva, seguida da física. Quanto aos agressores, conhecidos é o principal agressor, seguido de familiar, estranhos e parceira íntima. Na relação entre sofrer por suas parceiras e perpetrar, 14,2% dos casos são sobrepostos e 81,2% somente perpetraram. Conclui-se que, embora nas violências relativas às parceiras íntimas os homens sofram muito menos do que perpetrem, os dados mostram que eles se envolvem em muitas situações de violência, de grandes magnitudes e sobreposições, quer como vitimas ou agressores, reiterando estudos sobre masculinidade. Este conjunto complexo de situações também deve ser considerado nos serviços básicos de saúde.

There are few studies on men dealing with violence as a non-fatal event. As a contribution, the prevalences of psychological, physical and/or sexual violence suffered by men and the perpetrated intimate partner violence (IPV) are described. This was a cross-sectional study on 789 men aged 18 to 60 years, of whom 775 ever partnered. Men were selected in order of arrival at two primary healthcare clinics in the city of São Paulo. Sociodemographic characteristics and reported violence were investigated, along with the violence overlapping and perceptions of having suffered or perpetrated violence. The lifetime prevalence of suffered violence was 79% for any type and any aggressor; 63.9%, 52.8% and 6.1% respectively for psychological, physical and sexual violence. For lifetime IPV, the rates were 52.1% for any type and 40%, 31.9% and 3.9% respectively for psychological, physical and sexual violence. For both suffered and perpetrated violence, the psychological type had the highest exclusive rate, followed by physical. Acquaintances were the main aggressors, followed by family members, strangers and female intimate partners. Between suffering and perpetrating IPV, 14.2% of the cases overlapped and 81.2% consisted only of perpetrated violence. It was concluded that although in relation to intimate partner violence, men suffered much less than they perpetrated, the data showed that they were involved in many situations of violence of large magnitude and overlapping situations, both as victims and as aggressors, thus echoing studies on masculinity. This complex set of situations should also be taken into consideration in primary healthcare services.

[Charting the Brazilian Comprehensive Healthcare Policy for Men (PNAISH), from its formulation through to its implementation in local public health services]. / O percurso da Política Nacional de Atenção Integral à Saúde dos Homens (PNAISH), desde a sua formulação até sua implementação nos serviços públicos locais de atenção à saúde.

The scope of this article is to see how the Brazilian Comprehensive Healthcare Policy for Men (PNAISH) has been implemented in the Unified Health System, from the standpoint of health professionals. A case study, involving five cases (each from a different macro region of Brazil) conducted using ethnographic techniques of data collection charted the progress of PNAISH implementation based on an anthropological approach using Lipsky's idea of street-level bureaucracy. PNAISH is contextualized in historical terms with national and international documents. Acknowledging the inevitable gap between the formulation and the implementation of any policy, an attempt is made to see how this gap has evolved by analyzing the transition of PNAISH into city Action Plans (PAs). It was revealed that the implementing agents had little knowledge of PNAISH, of the local health care network for men, of the techniques required to meet men's specific needs and of the concept of gender. It faced institutional obstacles, such as lack of an organizational structure, of a consolidated healthcare network - where the user receives services with different degrees of complexity within the system - and resources in general, especially human resources.

[The standpoint of professionals on the presence and demands of men on the healthcare services: perspectives for the analysis of the implementation of the Comprehensive Healthcare Policy for Men]. / A visão dos profissionais sobre a presença e as demandas dos homens nos serviços de saúde: perspectivas para a análise da implantação da Política Nacional de Atenção Integral à Saúde do Homem.

In 2009, the Brazilian Comprehensive Healthcare Policy for Men (PNAISH) was launched in Brazil, seeking to reduce morbidity and mortality in this population group. This article strives to analyze the conceptions that health professionals have about the specific demands and behaviors of the male population served by the healthcare services. The data analyzed are part of a larger research project, the objective of which was to evaluate the initial actions of the implementation of PNAISH. Ethnographic observations in 11 health services and semi-structured interviews were conducted with 21 health professionals. From the perspective of health professionals, the presence of men in the healthcare services is still limited. According to them, it is comprised of two types of clients: workers and the elderly. The male behavior characteristics - haste, objectivity, fear and resistance - and the difficulty faced by health services in receiving this population are the main factors that drive men away from health services. Although the concept of gender is central to PNAISH, it is only triggered by healthcare professionals in order to justify the social standards expected in terms of men's behavior. The attribution of men's behavior to cultural factors ultimately obscures the relations of power that underlie gender relations.

O percurso da Política Nacional de Atenção Integral à Saúde dos Homens (PNAISH), desde a sua formulação até sua implementação nos serviços públicos locais de atenção à saúde / Charting the Brazilian Comprehensive Healthcare Policy for Men (PNAISH), from its formulation through to its implementation in local public health services

O artigo tem como objetivo compreender como a Política Nacional de Atenção Integral à Saúde dos Homens (PNAISH) chega aos serviços da Atenção Básica do Sistema Único de Saúde, a partir do ponto de vista dos seus profissionais. Acompanhamos o caminho trilhado pela PNAISH com um estudo, etnográfico, de cinco casos (de cada Macro Região do país). A análise está ancorada no referencial da Antropologia e emprega a ideia de street-level bureaucreacy, de Lipsky. A formulação da PNAISH é contextualizada em termos históricos e da produção de documentos internacionais e nacionais. Reconhecendo a distância entre formulação e implementação de qualquer política, buscamos compreender como tal distância foi se construindo, na tradução da PNAISH para Planos de Ação (PA) municipais. Observou-se desconhecimento dos agentes implementadores sobre a PNAISH, a rede local de atenção à saúde do homem, as técnicas para atender às especificidades dos homens e o conceito de gênero. A implementação esbarrou na ausência de condições institucionais, como uma estrutura organizacional, uma rede consolidada de atenção - em que o usuário seja atendido por serviços com diferentes graus de complexidade dentro do sistema - e recursos em geral, especialmente humanos.

The scope of this article is to see how the Brazilian Comprehensive Healthcare Policy for Men (PNAISH) has been implemented in the Unified Health System, from the standpoint of health professionals. A case study, involving five cases (each from a different macro region of Brazil) conducted using ethnographic techniques of data collection charted the progress of PNAISH implementation based on an anthropological approach using Lipsky's idea of street-level bureaucracy. PNAISH is contextualized in historical terms with national and international documents. Acknowledging the inevitable gap between the formulation and the implementation of any policy, an attempt is made to see how this gap has evolved by analyzing the transition of PNAISH into city Action Plans (PAs). It was revealed that the implementing agents had little knowledge of PNAISH, of the local health care network for men, of the techniques required to meet men's specific needs and of the concept of gender. It faced institutional obstacles, such as lack of an organizational structure, of a consolidated healthcare network - where the user receives services with different degrees of complexity within the system - and resources in general, especially human resources.

A visão dos profissionais sobre a presença e as demandas dos homens nos serviços de saúde: perspectivas para a análise da implantação da Política Nacional de Atenção Integral à Saúde do Homem / The standpoint of professionals on the presence and demands of men on the healthcare services: perspectives for the analysis of the implementation of the Comprehensive Healthcare Policy for Men

Em 2009 é lançada, no Brasil, a Política Nacional de Atenção Integral à Saúde do Homem (PNAISH), que tem por objetivo reduzir a morbimortalidade deste grupo populacional. O presente artigo tem por objetivo analisar as concepções que os profissionais da saúde possuem sobre as demandas e os comportamentos específicos da população masculina atendida nos serviços de saúde. Os dados analisados são parte de uma pesquisa maior, cujo objetivo foi avaliar as ações iniciais da implantação da PNAISH. Foram realizadas observações etnográficas em 11 serviços de saúde e entrevistas semiestruturadas com 21 profissionais de saúde. Na perspectiva destes, a presença dos homens nos serviços de saúde é ainda bastante limitada, sendo constituída, por dois tipos de clientela: trabalhadores e idosos. As características do comportamento masculino - a pressa, objetividade, medo e resistência -, e a dificuldade dos serviços em acolher esta população, são os principais fatores que afastam os homens dos serviços de saúde. Apesar do conceito de gênero se encontrar no centro da PNAISH, este é acionado pelos profissionais de saúde apenas no sentido de justificar os padrões socialmente esperados em termos do comportamento dos homens. A atribuição do comportamento dos homens a fatores culturais acaba por ocultar as relações de poder que permeiam as relações de gênero.

In 2009, the Brazilian Comprehensive Healthcare Policy for Men (PNAISH) was launched in Brazil, seeking to reduce morbidity and mortality in this population group. This article strives to analyze the conceptions that health professionals have about the specific demands and behaviors of the male population served by the healthcare services. The data analyzed are part of a larger research project, the objective of which was to evaluate the initial actions of the implementation of PNAISH. Ethnographic observations in 11 health services and semi-structured interviews were conducted with 21 health professionals. From the perspective of health professionals, the presence of men in the healthcare services is still limited. According to them, it is comprised of two types of clients: workers and the elderly. The male behavior characteristics - haste, objectivity, fear and resistance - and the difficulty faced by health services in receiving this population are the main factors that drive men away from health services. Although the concept of gender is central to PNAISH, it is only triggered by healthcare professionals in order to justify the social standards expected in terms of men's behavior. The attribution of men's behavior to cultural factors ultimately obscures the relations of power that underlie gender relations.

Men, masculinity and violence: a study in primary health care services.

There are few studies on men dealing with violence as a non-fatal event. As a contribution, the prevalences of psychological, physical and/or sexual violence suffered by men and the perpetrated intimate partner violence (IPV) are described. This was a cross-sectional study on 789 men aged 18 to 60 years, of whom 775 ever partnered. Men were selected in order of arrival at two primary healthcare clinics in the city of São Paulo. Sociodemographic characteristics and reported violence were investigated, along with the violence overlapping and perceptions of having suffered or perpetrated violence. The lifetime prevalence of suffered violence was 79% for any type and any aggressor; 63.9%, 52.8% and 6.1% respectively for psychological, physical and sexual violence. For lifetime IPV, the rates were 52.1% for any type and 40%, 31.9% and 3.9% respectively for psychological, physical and sexual violence. For both suffered and perpetrated violence, the psychological type had the highest exclusive rate, followed by physical. Acquaintances were the main aggressors, followed by family members, strangers and female intimate partners. Between suffering and perpetrating IPV, 14.2% of the cases overlapped and 81.2% consisted only of perpetrated violence. It was concluded that although in relation to intimate partner violence, men suffered much less than they perpetrated, the data showed that they were involved in many situations of violence of large magnitude and overlapping situations, both as victims and as aggressors, thus echoing studies on masculinity. This complex set of situations should also be taken into consideration in primary healthcare services.

[Concepts of gender, masculinity and healthcare: a study of primary healthcare professionals]. / Concepções de gênero, masculinidade e cuidados em saúde: estudo com profissionais de saúde da atenção primária.

This paper analyzes concepts of gender and masculinity among Primary Healthcare professionals in four Brazilian States (Pernambuco, Rio de Janeiro, Rio Grande do Norte, São Paulo). It is based on two perspectives: the meanings associated with being a man and the relations between masculinity and healthcare. This qualitative study is part of a multicentric investigation, which used triangulation methods as a benchmark. Sixty-nine in-depth interviews carried out among health professionals with higher education were analyzed. The discourses (re)produce the notion that health facilities are "feminized spaces". Within the daily routine, this notion is translated as reinforcing the idea that the male body is not a locus of this care, as opposed to the female body which is considered a locus of care. The presence of a hegemonic pattern of masculinity is prominent among professionals' representations of men and seems to influence the latter, in their lack of commitment with healthcare. The existence of a stereotyped gender model (re)produces disparities between men and women in healthcare and compromises the visibility of other meanings and expressions of gender identities.

Concepções de gênero, masculinidade e cuidados em saúde: estudo com profissionais de saúde da atenção primária / Concepts of gender, masculinity and healthcare: a study of primary healthcare professionals

O trabalho analisa as concepções de gênero e masculinidades de profissionais de saúde da Atenção Primária à Saúde em quatro estados do país (PE, RJ, RN, SP) a partir de duas perspectivas: os significados associados a ser homem e a relação masculinidade e cuidados em saúde. O estudo de natureza qualitativa é parte de pesquisa multicêntrica tendo por referência a triangulação de métodos. Foram analisadas 69 entrevistas em profundidade de profissionais de saúde com formação de nível superior. Os relatos dos profissionais (re)produzem a noção de que os serviços são "espaços feminilizados", o que se traduz no seu cotidiano por um reforço à ideia do corpo masculino como lócus do não cuidado em oposição ao corpo feminino visto como lócus desse cuidado. Sobressai a representação dos profissionais sobre os homens centrados na forte presença de um padrão hegemônico de masculinidade, que influencia o pouco envolvimento destes com os cuidados em saúde. A existência de um modelo estereotipado de gênero acarreta a (re)produção de desigualdades entre homens e mulheres na assistência a saúde e compromete a visibilidade de outros significados e expressões de identidades de gênero.

This paper analyzes concepts of gender and masculinity among Primary Healthcare professionals in four Brazilian States (Pernambuco, Rio de Janeiro, Rio Grande do Norte, São Paulo). It is based on two perspectives: the meanings associated with being a man and the relations between masculinity and healthcare. This qualitative study is part of a multicentric investigation, which used triangulation methods as a benchmark. Sixty-nine in-depth interviews carried out among health professionals with higher education were analyzed. The discourses (re)produce the notion that health facilities are "feminized spaces". Within the daily routine, this notion is translated as reinforcing the idea that the male body is not a locus of this care, as opposed to the female body which is considered a locus of care. The presence of a hegemonic pattern of masculinity is prominent among professionals' representations of men and seems to influence the latter, in their lack of commitment with healthcare. The existence of a stereotyped gender model (re)produces disparities between men and women in healthcare and compromises the visibility of other meanings and expressions of gender identities.

[Male users' and primary care services health professionals' conceptions of gender and possible impacts on men's health, São Paulo, Brazil]. / Concepções de gênero de homens usuários e profissionais de saúde de serviços de atenção primária e os possíveis impactos na saúde da população masculina, São Paulo, Brasil.

This paper studied the relation between the exercise of masculinities and health care of men in primary health care services. It focuses on representations and meanings of primary health care service users and professional of what it is to be a man. Male service users and professionals were interviewed in two primary health care facilities. Diverse models of masculinity were found, defining various forms of reasoning upon men's health care. This study indicates that issues such as work, sexuality, body structure, relationship with women, and transformations in gender relations are important for men, and should be considered in health care services.

Concepções de gênero de homens usuários e profissionais de saúde de serviços de atenção primária e os possíveis impactos na saúde da população masculina, São Paulo, Brasil / Male users' and primary care services health professionals' conceptions of gender and possible impacts on men's health,São Paulo, Brazil

Estudou-se a relação do exercício das masculinidades com o cuidado em saúde para homens na atenção primária, por meio de representações e significados de usuários e trabalhadores acerca do que vem ser homem. Foram entrevistados homens usuários e profissionais de saúde de dois serviços de atenção primária. Encontrou-se uma diversidade de modelos de masculinidade que podem definir diferentes formas para pensar o cuidado de saúde dos homens. Observou-se que questões como trabalho, sexualidade, estrutura corporal, relações com as mulheres e transformações nas relações de gênero são temas importantes para os homens e devem ser consideradas nos serviços de saúde.

This paper studied the relation between the exercise of masculinities and health care of men in primary health care services. It focuses on representations and meanings of primary health care service users and professional of what it is to be a man. Male service users and professionals were interviewed in two primary health care facilities. Diverse models of masculinity were found, defining various forms of reasoning upon men's health care. This study indicates that issues such as work, sexuality, body structure, relationship with women, and transformations in gender relations are important for men, and should be considered in health care services.

O atendimento à saúde de homens: estudo qualitativo em quatro estados brasileiros / Men's public health care: a qualitative study in four Brazilian federal states

O objetivo deste estudo é analisar os sentidos atribuídos por usuários homens ao atendimento que lhes é prestado no âmbito da atenção básica à saúde, buscando subsidiar a construção de indicadores qualitativos de satisfação em relação ao uso desses serviços por usuários masculinos. Trata-se de uma pesquisa qualitativa, envolvendo entrevistas semiestruturadas com 201 usuários de quatro estados brasileiros. A análise se baseia no método de interpretação de sentidos, ancorando-se em princípios hermenêutico-dialéticos. Em termos de resultados, os usuários apontam critérios para avaliar positivamente os serviços, tomando como referências um atendimento comunicativo e atencioso, que lhes faça algo e que revele prontidão. Conclui-se que os homens usuários idealizam e reivindicam uma dada forma de atendimento considerada boa e que, a princípio, poderia servir para se discutir o atendimento de mulheres também. Entretanto, em razão da socialização que homens e mulheres experimentam, são reforçadas as diferenças entre o ser usuário homem e ser usuário mulher. Por outro lado, tanto no que tange aos profissionais quanto aos usuários, essa mesma segmentação por gênero pode contribuir para que se acirrem as impossibilidades de se lidar com as especificidades de homens e mulheres, em termos de demandas da saúde.

This study aims to analyze the meanings attributed by male users to the health care provided to them by the primary health care. It also tries to hook up the construction of qualitative indicators of satisfaction with the use of such services by males. For this purpose, a qualitative study was conducted, involving semi-structured interviews with 201 users from four Brazilian federal states. The data has been analyzed under the method of interpretation of meanings inbuilt in hermeneutic-dialectical principles. As for the results, users were asked to point toward criteria to evaluate positively the services, taking as reference a communicative and attentive service, as long as it makes a difference to them as well as bring up readiness. As a conclusion, it was found that male users outlook the services through rose-tinted glasses and therefore claim a particular form of care grounded on that assumption. Moreover, this conclusion could also be used to discuss the health care of women as well. On the other hand, due to the socialization that men and women experience, differences between male and female users could be reinforced. Conversely, regarding to both professionals and users, this gender segmentation may add to bring about the impossibilities of dealing with the specifics of men and women in terms of public health care demands.

Hipertensão pulmonar e insuficiência cardíaca direita secundária ao hipertireoidismo. Relato de caso / Pulmonary hypertension and right heart failure associated with hyperthyroidism. Case report

JUSTIFICATIVA E OBJETIVOS: O hipertireoidismo é considerado uma causa rara de hipertensão arterial pulmonar isolada. Evidências recentes, entretanto, sugerem ser esta associação frequente, porém subdiagnosticada. O objetivo deste estudo foi apresentar um caso de hipertensão arterial pulmonar (HP) isolada, com falência ventricular direita, secundária ao hipertireoidismo, reversível após o restabelecimento do estado eutireoideo. RELATO DO CASO: Paciente do sexo feminino, 60 anos, previamente hígida, apresentando dispneia aos esforços, emagrecimento, palpitações, ascite e congestão periférica de início há um ano. As avaliações clínicas e os exames complementares evidenciaram HP (pressão arterial sistólica pulmonar = 60-65 mmHg), falência ventricular direita com hipertensão porta supra-hepática e fibrilação atrial. Foram afastadas inicialmente as principais causas secundárias de HP, incluindo cardiopatias esquerdas, pneumopatias, eventos tromboembólicos, colagenoses, drogas, toxinas e doenças infecciosas. Hipertireoidismo foi diagnosticado e iniciado tratamento com propiltiouracil. Após restabelecimento do eutireoidismo, houve importante melhora clínica, com redução gradual e significativa da pressão arterial pulmonar e resolução da congestão periférica. Após um ano de acompanhamento, foi realizado um novo ecocardiograma com a paciente em eutireoidismo que demonstrou recuperação da função cardíaca direita e pressão arterial pulmonar = 37 mmHg, tendo ocorrido reversão do quadro de HP. CONCLUSÃO: A descrição deste caso e a revisão da literatura visam salientar que a associação entre HP e hipertireoidismo é frequente e potencialmente reversível. Dessa forma, a avaliação da função tireoidiana deveria ser incluída rotineiramente na investigação inicial dos casos de hipertensão pulmonar.

BACKGROUND AND OBJECTIVES: Hyperthyroidism is considered a rare cause of isolated pulmonary arterial hypertension. However, recent data suggests that it may be a frequent finding in thyrotoxicosis, normally under diagnosed. The aim of this study was to describe a case of pulmonary hypertension and right heart failure secondary to hyperthyroidism, reversible after euthyroidism achievement. CASE REPORT: A 60 years-old female patient presented with exertion dyspnea, weight lost, palpitations, ascites and peripheral edema for one year. Clinical evaluation demonstrated atrial fibrillation and pulmonary hypertension (pulmonary arterial pressure of 60-65 mmHg), with right heart failure and supra-hepatic portal hypertension. Initial work up for the common secondary causes of pulmonary hypertension was negative, including causes of left heart disease, pulmonary disorders, tromboembolic events, collagen vascular disease, drugs, toxins and infectious diseases. Hyperthyroidism was diagnosed and propylthiouracil was initiated. After euthyroid state was achieved, there was a significant progressive reduction of pulmonary arterial pressure and clinical resolution peripheral edema. After one year of follow-up, an echocardiography was performed with the patient in euthyroidism and demonstrated resolution of right heart failure and pulmonary arterial pressure of 37 mmHg, with resolution of pulmonary hypertension. CONCLUSION: This case report and literature review gave further evidence that the association of pulmonary hypertension and hyperthyroidism is frequent and potentially reversible. Thus, thyroid function should be routinely evaluated in the initial investigation of all pulmonary hypertension cases.