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This qualitative study researched the determinants influencing family physician’s decision on benzodiazepine prescription in a primary care setting, in the city of Rio de Janeiro. An analysis was sought to be elaborated, on how the prescription is negotiated between physician and user. Twelve general practitioners settled in primary care were recruited, gave acceptance signing free and informed consent form, responding to a semi-structured questionnaire that was recorded and transcribed verbatim for analysis, from August to December 2017. The questionnaire addressed physicians' perception of complaints in benzodiazepines users, and alternatives offered instead of medicines. Anxiety and insomnia were cited as the most frequent reasons for use. There was also mention of nonspecific somatic complaints, chronic pain, arterial hypertension, and dependence. Most physicians proposed the therapeutic alliance as a mechanism for offering alternatives to reduce the chronic use of benzodiazepines, despite this intervention achieving a low success rate. Longitudinal care was evidenced as a guiding principle. The analysis of the meanings attributed to BZD, as unveiled in this work, promotes a discussion about the place of medication in culture and its consequences in the approach to psychological and mental suffering., Competing Interests: The authors have no conflicts of interest to declare, (CC BY NC ND)

For the purpose of analyzing topics linking the health-disease-work process to medical evaluation practices under the scope of the federal public service and their interaction with Worker's Health, this article investigates the issue of determining the duration of the sick leave period that a worker is granted for caring for their own health, within the Subsistema Integrado de Atenção à Saúde do Servidor (SIASS). To that end, the parameters for granting time off work, as provided by the Manual de Perícia Oficial, and the speeches on this topic by the interviewees were analyzed. The importance given to the topic 'days off work' arises from the fact that it is related to the time it takes the worker to recover, which implies fewer days dedicated to being productive. Interviews were conducted with 32 professionals from 5 educational institutions, and this article highlights some analytical categories: days off work; Manual da Perícia and disagreement between medical evaluators and attending physicians. The results point to the usefulness of revising the Manual taking into account Worker's Health, identifying contradictions; the need for shaping an effectively interdisciplinary evaluation, so that the worker's health-related complaints can be handled from the perspective of the worker's care, and not simply concerning control and surveillance.

Objective: Adolescent depression is a heterogeneous disorder, with a wide variety of symptoms and inconsistent treatment response, and is not completely understood. A dysregulated stress system is a consistent finding, however, and exhaustion is a consistent trait in adolescent patients. The aim of this paper is to critically assess current hypotheses in adolescent depression research and reframe causes and treatment approaches., Methods: A mixed-method approach involved a review based on publications from PubMed, Embase and PsycInfo, and two exemplary adolescent cases., Results: Both cases show a spiral of stress and exhaustion, but with a different profile of symptoms and coping mechanisms. Reframing both cases from the perspective of coping behavior, searching for the sources of experienced stress and exhaustion, showed coping similarities. This proved essential in the successful personalized treatment and recovery process. In combination with recent evidence, both cases support the functional reframing of depression as the outcome of a stress- and exhaustion-related spiralling mechanism., Conclusions: We propose to open up a symptom-based, mood-centered view to a model in which adolescent depression is framed as a consecutive failure of stress coping mechanisms and chronic exhaustion. Addressing exhaustion and coping primarily as a treatment strategy in adolescents and young adults might work in synergy with existing treatments and improve overall outcomes. This perspective warrants further investigation., (Copyright © 2020 van der Gronde, Los, Herremans, Oosting, Zorzanelli and Pieters.)

This descriptive, ecological study of clonazepam consumption in Rio de Janeiro State (RJ) estimated use prevalence from 2009 to 2013 using data from the National Controlled Product Management System operated by Brazil's health surveillance agency, Anvisa. Consumption was measured by total population and by population over 18 years old, using the standardised Daily Defined Doses of 8 mg (anticonvulsant) and 1 mg (sedative-hypnotic). The municipalities of the Rio de Janeiro Metropolitan Region were grouped by Human Development Index (HDI) and GINI index, subjected to cluster analysis and ranked by clonazepam consumption. From 2009 to 2013, consumption in the state rose from 0.35 to 1.97 DDD/1000 population, but the figures are higher for individuals over 18 years of age. A DDD of 1 mg instead of 8mg returns consumption in 2013 of 21 DDD/1000 population over 18 years of age. Consumption in 2013 was highest - 3.38 and 4.52 DDD, respectively - in Rio de Janeiro and Niterói, which have the highest HDIs. This suggests that up to 2% of the adult population uses clonazepam, possibly as a sedative-hypnotic. This broad use and use outside therapeutic indications deserves attention, given clonazepam's potential for abuse and adverse reactions.

Objectives: To present and discuss recent patterns of prescription opioid sales throughout Brazil., Methods: We graphed linear trends of opioid prescriptions sold from registered pharmacies across Brazil from 2009 to 2015. We then calculated the change in rate of prescriptions sold per 1000 persons in 2015 compared with 2009., Results: Opioid sales increased across Brazil from 1 601 043 prescriptions in 2009 to 9 045 945 prescriptions in 2015, corresponding to a 465% increase in 6 years. The largest absolute increase was for codeine products (rate ratio (RR) = 5.30; 95% confidence interval [CI] = 5.29, 5.31), accounting for more than 98% of prescriptions in both years. Oxycodone had the largest relative increase (RR = 11.39; 95% CI = 11.19, 11.59), and fentanyl products had the smallest absolute and relative increase (RR = 2.91; 95% CI = 2.78, 3.03)., Conclusions: Given rapid increases in opioid sales across Brazil, it is critical to introduce effective prescribing and monitoring methods that allow patients to access necessary medications without escalating risk of opioid misuse and related consequences. Careful surveillance of supply and subsequent outcomes are needed to prevent the development of another devastating opioid epidemic in the Americas.

Based on a review of the literature published in the early twenty-first century by Brazilian researchers, the article offers an overview of stem cell research in Brazil. Three central topics were detected in these papers: (1) the funding of stem cell research in Brazil; (2) preclinical and clinical trials in Brazil; and (3) social anthropological analysis focused on ethical and legal matters. Our review identifies controversial questions in the construction of this scientific field, especially issues involving the media as a disseminator of values and of certain social representations, where new kinds of hope figure large. Within this climate of uncertainty, we find patients and their families energized by the promises of the "medicine of the future."

This article examines the pertinence of the concept of medicalization for socio-cultural analysis. The study is based on the criticism which emerged in the international literature between 2000 and 2010. The criticism stressed the excessive generality of the expression that encompasses different situations and thereby loses its analytical precision. The main meanings of the term medicalization are examined, namely 1) the major strategies of hygienization of the population; 2) the transformation of behavior considered deviant into disorders; 3) control strategies and the medical imperative; 4) the participation of non-medical actors. Based on the different meanings of the notion of medicalization, the transient nature of the concept needs to be stressed, i.e. the need to specify the different meanings attributed to the notion depending on the different contexts in which it is used. If this is not done, the concept will lose its theoretical accuracy and will possibly no longer be useful for social analysis.

This article analyzes the use of neuroimaging in research into chronic fatigue syndrome. It reviews some works published in the 1990 s and investigates a specific aspect of these studies, namely the search for a cerebral abnormality, in the form of an altered activation pattern, which could provide a pattern for diagnosis and treatment of the disease. The understanding of chronic fatigue syndrome as a disease reduced to some cerebral findings is analyzed, arguing in favor of a broader vision of this disease that includes psychosocial elements of the patient's life as opposed to entirely somatic explanations.

The article analyzes a number of conditions that allowed the brain to become established as an etiological hypothesis in the case of chronic fatigue syndrome (CFS), together with other hypotheses related to organic causes, such as viruses and immunity. It also addresses the process of cerebralization of personhood, which grew out of the use of neuroimaging for research and diagnostic purposes and according to which the brain constitutes the prime place for looking for the cause of the diseases - including CFS - within the context of a somatic culture, intensified at the end of the twentieth century.

The article first analyzes some of the social and historical components underlying the conditions ofpossibility that allowed neurasthenia to emerge as a nosological category in the latter half of the nineteenth century and then explores the elements that influenced its demise in medical and lay circles. It offers a brief introduction to this medical category and a more detailed discussion of some supporting debates, including the idea of nervous exhaustion, twentieth-century studies and concerns on fatigue, and the malady's presumed somatogenesis. The concluding analysis of how the category met its demise highlights elements that altered its status and its diagnostic usefulness.