OBJECTIVE To characterize the polypharmacy in primary health care patients and to identify its associated factors.METHODS This is a cross-sectional, exploratory, and evaluative study, part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). The variable of interest was polypharmacy, defined as the use of five or more medicines. We sought to identify the association of sociodemographic variables and indicators of health conditions to polypharmacy. For group comparison, the Pearson’s Chi-square test was used. The association between polypharmacy and explanatory variables was evaluated by logistic regression model (p < 0.05). The quality of the adjustment was verified by Hosmer-Lemeshow test.RESULTS The prevalence of polypharmacy among medicine users was 9.4% (95%CI 7.8–12.0) in the general population and 18.1% (95%CI 13.6–22.8) in older adults above 65 years old. We found statistically significant association between polypharmacy and age above 45 years, lower self-perception of health, presence of chronic diseases, having health insurance, care in emergency services, and region of the Country. South users presented the highest chances to polypharmacy. The most used medicines were those of the cardiovascular system, being compatible with the national epidemiological profile.CONCLUSIONS Polypharmacy is a reality in the population met within the primary care of Brazilian Unified Health System and may be related to excessive or inappropriate use of medicines. The main challenge to qualify health care is to ensure that prescription of multiple medicines be appropriate and safe.

OBJECTIVE:To describe the clinical and epidemiological profi le of patients under renal replacement therapies, identifying risk factors for death. METHODS:This is a non-concurrent cohort study of data for 90,356 patients in the National Renal Replacement Therapies Database. A deterministicprobabilistic linkage was performed using the Authorization System for High Complexity/Cost Procedures and the Mortality Information System databases. All patients who started dialysis between 1/1/2000 and 12/31/2004 were included and followed until death or the end of 2004. Age, sex, region of residence, primary renal disease and causes of death were analyzed. A proportional hazards model was used to identify factors associated with risk of death. RESULTS:The prevalence of patients under renal replacement therapies increased an average of 5.5%, while incidence remained stable during the period. Hemodialysis was the predominant initial modality (89%). The patients were majority male with mean age 53 years, residents of the Southeast region and presented unknown causes as the main cause of chronic renal disease, followed by hypertension, diabetes and glomerulonephritis. Of these patients, 42% progressed to death and 7% underwent kidney transplantation. The patients on peritoneal dialysis were older and had higher prevalence of diabetes. The death rate varied from 7% among transplanted patients to 45% among non-transplanted patients. In the fi nal Cox proportional hazards model, the risk of mortality was associated with increasing age, female sex, having diabetes, living in the North and Northeast region, peritoneal dialysis as a fi rst modality and not having renal transplantation. CONCLUSIONS:There was an increased prevalence of patients on renal therapy in Brazil. Increased risk of death was associated with advanced age, diabetes, the female sex, residents of the North and Northeast region and lack of renal transplant.

OBJECTIVETo characterize the availability of tracer medicines in pharmaceutical services in primary health care of the Brazilian Unified Health System (SUS).METHODSThis is a cross-sectional and evaluative study, part of the Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). To analyze the availability of medicines, we verified 50 items selected from the Relação Nacional de Medicamentos Essenciais (Rename – National List of Essential Medicines) of 2012. Observation scripts were applied to medicine dispensing services in the primary health care. Interviews were carried out with patients, health care professionals, and public managers, using semi-structured questionnaires. The availability index was presented as the percentage of health units where the medicines were available. For statistical analysis, absolute, relative, and mean frequencies were presented (with 95% confidence intervals). The comparison of groups was carried out by Pearson Chi-square tests or variance analysis, when needed.RESULTSOne thousand, one hundred, and seventy-five observation scripts were filled in a national representative sample composed by 273 cities. Statistically significant differences were observed regarding the type of unit, infrastructure, and presence of a pharmacist between regions of Brazil. The average availability of tracer medicines in primary health care was 52.9%, with differences between regions and sampling strata. This index increased to 62.5% when phytotherapic medicines were excluded. We found limited availability of medicines for treatment of chronic and epidemiological diseases, such as tuberculosis and congenital syphilis.CONCLUSIONSThe low availability of essential medicines purchased centrally by the Brazilian Ministry of Health indicates deficiencies in supply chain management. The different views on the availability of tracer medicines in SUS confirm the general availability verified in this study. Among patients, about 60% said they obtain medicines in SUS units, data consistent with the lack of medicines reported by medicine dispensers and in line with physicians’ evaluations.

Em meio às diversas transformações sofridas pelo casamento e pela família ao longo da história, várias configurações familiares convivem na contemporaneidade: nuclear, monoparental, homoparental, recomposta, entre outras possibilidades. Nesse contexto, aumenta, em vários países, e mais recentemente no Brasil, o número de casais que escolhem não ter filhos. O objetivo deste trabalho foi realizar uma revisão bibliográfica sobre o tema, incluindo publicações nacionais e internacionais. A busca foi feita em bases de dados (Web of Science, PsycINFO, Medline, SciELO, Lilacs, Psicodoc, BVS-Psi, Dedalus), e foram levantados artigos completos em periódicos indexados e resumos de teses e dissertações produzidas nos últimos dez anos. Os resultados coletados abordam diversas facetas do fenômeno da escolha contemporânea por não ter filhos: motivações declaradas, associação entre esse tipo de escolha e a situação profissional, relação com fatores de história de vida e família de origem, satisfação de vida e conjugal, preconceito e estereótipos negativos.

OBJECTIVE:To identify factors associated with health-related quality of life in elderly patients on hemodialysis.

Background and objectives: The use of dialysis modalities for ESRD varies around the world. There is no consensus in literature regarding the most appropriate choice of dialysis method. The aim of this study was to analyze the initial modality for ESRD in Brazil and evaluate the factors determining patients' allocation to either hemodialysis (HD) or peritoneal dialysis (PD).Design, setting, participants, & measurements: A retrospective cohort study was performed using national administrative registries of all patients financed by the public system who began renal replacement therapy in 2000 in Brazil. Logistic regression analysis was used to investigate factors associated with the probability of receiving HD or PD at the start of treatment. Independent variables tested were age, sex, presence of diabetes, geographic region of residence, and health care supply indicators.Results: Of 11,563 patients analyzed, 88% started on HD and 12% started on PD. Patients were more likely to be assigned to HD if they were male (odds ratio: 1.44; 95% confidence interval: 1.23 to 1.68) and nondiabetic (odds ratio: 0.71; 95% confidence interval: 0.60 to 0.84). With regard to age, the youngest and the elderly showed lower probability of being in HD. In addition, the state of residence at the start of treatment was very important to explain initial modality allocation.Conclusions: Our findings suggest that patient allocation in Brazil is not random. The probability of allocation to HD or PD is highly associated with individual attributes and supply variables.

ResumoDa família tradicional-patriarcal à família contemporânea, mudanças relevantes ocorreram, gerando uma pluralidade de modelos. O papel fundamental da família na constituição psíquica do indivíduo, frente ao crescente aparecimento de novos arranjos familiares, torna essencial construir conhecimento acerca das novas formas de se relacionar e vivenciar a parentalidade. Este trabalho objetiva apresentar os resultados de uma pesquisa que investigou as representações parentais de casais homossexuais masculinos, por meio das imagos parentais e legados geracionais. Com objetivo de compreender como se dão tais representações, bem como, suas possíveis ligações e/ou infl uências na relação do casal homoafetivo e, possivelmente, na família homoparental, foram entrevistados cinco casais homossexuais masculinos sem fi lhos e aplicado o Desenhos de Família com Estórias (DF-E) adaptado. O método utilizado foi o clínico-qualitativo e a análise feita com base no referencial psicanalítico vincular. Os resultados apontaram casais ainda muito ligados à suas famílias de origem; com questões confl itivas associadas ao processo de construção de suas identidades homossexuais; presos ao modelo de conjugalidade heteronormativa; cujos relacionamentos caracterizaram-se pela brevidade com que se tornaram compromissados, com a fi nalidade principal de apoio mútuo à assunção da identidade homossexual. Concluiu-se que o despreparo para deixar o lugar de fi lho é fator infl uente para não se pensar acerca da parentalidade; e está relacionado aos confl itos de cerne familiar, especialmente à falta de aceitação. Enfatizamos a necessidade de maior número de pesquisas na área, visando uma abordagem científi ca que propicie o estabelecimento de uma ética pautada no vínculo fi liativo. Palavras-chave:Parentalidade, representação parental, homoparentalidade, família. A Study on the Parental Representation of Homoaffective Male Couples AbstractFrom the traditional patriarchal family, relevant changes have occurred, generating a plurality of models. The fundamental role of family in psychic constitution, ahead of the growing emergence of new family arrangements, it is considered essential the study of the new functions and forms of relating in these groups. Aiming to comprehend how these representations and its possible relations and/or infl uences in the homoaffective couple relation and, possibly, in the homoparental family, fi ve homosexual couples 1 Endereço para correspondência: Rua Daniel Peçanha de Moraes, 255,

This is the first population based study in Brazil to assess statin use in SUS primary healthcare patients. Addressing inequalities in access and use of medicines including statins is an important step in achieving the full benefit of statins in Brazil, with the findings guiding future research and policies.