Showing papers in "Ciencia & Saude Coletiva in 2023"

Vacinação do sarampo no Brasil: onde estivemos e para onde vamos?

Abstract: Resumo A reemergência de doenças imunopreveníveis devido à queda das coberturas vacinais (CV) tem sido documentada em vários países. O objetivo foi analisar a CV, a homogeneidade das CV e os casos de sarampo no Brasil de 2011 a 2021, com enfoque no período da pandemia de COVID-19, sua tendência temporal, distribuição espaço-temporal e fatores associados aos aglomerados de menor CV. Trata-se de um estudo ecológico sobre a CV de sarampo (dose 1), com métodos de série temporal interrompida e de avaliação da disposição espaço-temporal, por meio do teste de varredura na identificação de aglomerados de CV. A partir de 2015, observa-se queda progressiva das CV e da homogeneidade, acentuando-se após 2020 em todas as regiões, particularmente Norte e Nordeste. Aglomerados de baixa CV foram associados a piores indicadores de desenvolvimento humano, desigualdade social e menor acesso à Estratégia de Saúde da Família. No Brasil, a pandemia intensificou as iniquidades em saúde, com baixas CV de sarampo em municípios socialmente mais vulneráveis e desiguais. Há risco de circulação do vírus, reafirmando o desafio de fortalecer a atenção básica, aprimorar a comunicação em saúde e garantir acesso à vacina, diminuindo oportunidades perdidas de vacinação e a hesitação vacinal.

Measles vaccination in Brazil: where have we been and where are we headed?

Abstract: The re-emergence of vaccine-preventable diseases due to the decline in vaccine coverage (VC) has been documented in several countries. The objective was to analyze the VC, the homogeneity of VC, and measles cases in Brazil from 2011 to 2021, focusing on the period of the COVID-19 pandemic, its temporal trend, space-time distribution, and factors associated with clusters of lower VC. This is an ecological study on measles VC (dose 1), with methods of interrupted time series and evaluation of spatio-temporal disposition, through the sweep test to identify clusters of VC. Starting in 2015, we observe a progressive decline in VC and homogeneity, with an accentuation after 2020, in all regions, particularly in the North and Northeast. Low VC clusters were associated with worse human development indicators, social inequality, and less access to the Family Health Strategy. In Brazil, the pandemic intensified health inequalities with low VC of measles in socially more vulnerable and unequal municipalities. There is a risk of virus circulation, however, the challenge of strengthening primary care, improving health communication and guaranteeing access to the vaccine, reducing missed opportunities for vaccination and vaccine hesitancy, is highlighted.

Vaccination against poliomyelitis in Brazil from 2011 to 2021: successes, setbacks, and challenges ahead.

Abstract: The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).

Direct healthcare cost of hospital admissions for chronic non-communicable diseases sensitive to primary care in the elderly.

Abstract: Aging has imposed changes in the epidemiological profile and an increase in the prevalence of chronic non-communicable diseases (CNCDs). The aim was to estimate the direct cost related to hospital admissions of elderly people affected by CNCDs (hypertension, heart failure and diabetes mellitus) sensitive to primary care, in a medium-sized hospital, in the period 2015-2019. Secondly, we investigated whether clinical and demographic factors explain the costs and length of stay. The medical records of 165 elderly people were analyzed. We found a predominance of women with a mean age of 76.9 years. The most frequent cause of hospitalization was heart failure (62%), and the average length of stay was 9.5 days, and 16% of hospitalizations corresponded to rehospitalizations. Of these, 81% were caused by complications from the previous hospitalization. The estimated total cost was R$ 3 million. Male patients had a longer hospital stay compared to female patients. Hypertension and the total number of procedures were significant predictors of cost and length of stay. We found that in 5 years, the costs of hospital admissions for conditions sensitive to primary care in the elderly are considerable, indicating the relevance of investments in primary care.

Vacinação contra poliomielite no Brasil de 2011 a 2021: sucessos, reveses e desafios futuros

Abstract: Resumo A queda de coberturas vacinais (CV) na infância, entre elas a da poliomielite, vem se tornando uma preocupação sanitária. O objetivo foi analisar a tendência temporal das coberturas das três doses da vacina contra a poliomielite nos primeiros 12 meses de vida entre 2011 e 2021, com destaque na pandemia de COVID-19, além de mapear as CV no Brasil. Foi realizado um estudo ecológico com técnicas de série temporal interrompida (STI) e análise espacial, a partir dos dados do Sistema de Informação do Programa Nacional de Imunização. A tendência da CV foi ajustada pelo estimador de variância de Newey-West, segundo as unidades federadas e o Índice de Privação Brasileiro. A distribuição da CV foi estimada por modelos bayesianos e os aglomerados espaciais pelos índices de Moran global e local, identificando áreas de menor cobertura nas Regiões de Saúde. Observa-se perda da CV ao longo do período em todas as regiões do país, sendo maiores no Norte e no Nordeste e se acentuando durante a pandemia. As maiores quedas foram identificadas em estados e regiões de saúde com maior vulnerabilidade social. A queda na CV mostra que o risco de reintrodução do vírus selvagem é iminente e os desafios precisam ser enfrentados com o fortalecimento do Sistema Único de Saúde.

Food consumption is associated with frailty in edentulous older adults: evidence from the ELSI-Brazil study.

Abstract: This cross-sectional study aimed to evaluate the association between food consumption (meat, fish, and fruits and vegetables), anthropometric indicators (body mass index, waist circumference, and waist-to-height ratio), and frailty; and to verify whether these associations vary with edentulism. We used data from 8,629 participants of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) (2015-16). Frailty was defined by unintentional weight loss, weakness, slow walking speed, exhaustion, and low physical activity. Statistical analyses included multinomial logistic regression. Of the participants, 9% were frail and 54% pre-frail. Non-regular meat consumption was positively associated with pre-frailty and frailty. Non-regular fish consumption, and underweight were associated only with frailty. Models with interactions reveled a marginal interaction between meat consumption and edentulism (p-value = 0.051). After stratification, non-regular meat consumption remained associated with frailty only in edentulous individuals (OR = 1.97; 95%CI 1.27-3.04). Our results highlight the importance of nutritional assessment, oral health, and public health-promoting policies to avoid, delay and/or reverse frailty in older adults.

Vaccination against poliomyelitis in Brazil from 2011 to 2021: successes, setbacks, and challenges ahead

Abstract: Abstract The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).

Custo direto de internações hospitalares por doenças crônicas não transmissíveis sensíveis à atenção primária em idosos

Abstract: Resumo O envelhecimento tem imposto mudanças epidemiológicas e aumento na prevalência de doenças crônicas não-transmissíveis (DCNT). O objetivo foi estimar o custo direto relacionado às internações hospitalares de idosos acometidos por DCNT (hipertensão arterial, insuficiência cardíaca e diabetes mellitus) sensíveis à atenção primária, em hospital de médio porte, no período de 2015-2019. Secundariamente, investigamos se fatores clínicos e demográficos explicam o custo e tempo de permanência. Foram analisados prontuários de 165 idosos. Verificamos predominância de mulheres com média de idade de 76,9 anos. A causa de internação mais frequente foi insuficiência cardíaca (62%) e o tempo médio de permanência foi de 9,5 dias, e 16% das internações corresponderam a idosos reinternados. Dessas, 81% foram causadas por complicações da internação anterior. O custo total estimado foi de R$ 3 milhões. Pacientes do sexo masculino ficaram mais tempo internados, comparado ao sexo feminino. Hipertensão e o total de exames realizados foram preditores significantes do custo e tempo de permanência. Verificamos que em 5 anos, os custos com internações hospitalares por condições sensíveis à atenção primária em idosos são consideráveis, indicando a relevância de investimentos na atenção primária.

The COVID-19 pandemic and teachers’ work: perceptions of teachers from a public university in the state of São Paulo, Brazil

Abstract: Abstract The COVID-19 pandemic required the restructuring of educational models, including the rapid transition from face-to-face to remote education. The aim of this qualitative research was to understand the effect of the COVID-19 pandemic on undergraduate professors’ work and health at a public university in the state of São Paulo. Semi-structured interviews were conducted with 17 undergraduate faculty of humanities, biological and exact sciences form August to September 2020. The interviews were recorded and transcribed. From the content analysis, four thematic categories emerged: (1) changes in the work routine and their impacts, including adjustment to remote work and the difficulties in establishing boundaries between work and their personal life; (2) changes in the dynamics between faculty and students and the possibility of rethinking teaching practice; (3) the relationship between faculty and the university with emphasis on the decision-making process, support for the transition to remote teaching, and concerns about the quality of teaching; and (4) anguish and fears related to the pandemic that added to the set of work-related stressors. Our findings showed that actions towards the communicational dynamics, as well as actions towards faculties’ mental health should be implemented.

[Leprosy and vulnerability: a scoping review].

Abstract: The objective of this work was to review published scientific works on leprosy as a public health problem in Brazil, and the marker of vulnerability for people with the disease. A scoping review was carried out with the descriptor 'leprosy AND vulnerability', on the Virtual Health Library (BVS) database. A total of 29 articles published between January 2016 and December 2020 that met the inclusion criteria were selected. The results pointed to scientific papers published in indexed journals and with different impact factors, with emphasis on the fact that most of the selected publications appear in journals with impact metrics that are not very significant in the eyes of the international community, even though they have national impact. The majority of the studies had municipal coverage, with emphasis on cities in the North and Northeast of Brazil. The works addressed vulnerability in leprosy using different typologies.

A introdução precoce de sucos pode influenciar desfechos antropométricos e consumo alimentar em idade pré-escolar?

Abstract: Resumo Objetivou-se avaliar o impacto do consumo de sucos antes dos 6 meses de idade no Índice de Massa Corporal para Idade (IMC/I) e no consumo alimentar em pré-escolares. Estudo longitudinal com amostra composta por mães e seus filhos (n=103) entre 6 meses e 3 a 6 anos. Peso e estatura foram aferidos e convertidos para o escore z de IMC/I. Para avaliar o consumo alimentar, foi utilizado o Questionário de Frequência Alimentar Infantil. Testes de Qui-Quadrado e t de Student foram utilizados para comparação entre os grupos. Não houve diferença nos parâmetros antropométricos entre pré-escolares que receberam ou não suco antes dos seis meses. Aquelas que tiveram introdução de suco mais precoce (≤150 dias de vida) apresentaram consumo mais frequente (≥1x/dia) de suco artificial (63,8% versus 35,7%; p=0,028) e biscoito recheado (21,3% versus 14,3%; p=0,001) na idade pré-escolar. Crianças que receberam suco do tipo artificial antes dos 6 meses tiveram maior prevalência de consumo de refrigerante entre 1 e 4x/semana (69,2% versus 27,4%; p=0,014) e menor prevalência de consumo de achocolatado pelo menos 1x/dia (38,5% versus 69,4%; p=0,027). Sendo assim, crianças com introdução precoce de suco apresentaram maior consumo de alimentos doces e bebidas açucaradas em fase pré-escolar.

Avaliação do programa comportamental em diabetes mellitus tipo 2: ensaio clínico randomizado

Abstract: Resumo O objetivo deste artigo é avaliar o efeito do programa comportamental educação em grupo e intervenção telefônica na modificação das atitudes psicológicas, melhora do empoderamento e das práticas de autocuidado visando à melhora do controle clínico em diabetes mellitus tipo 2. Trata-se de um ensaio clínico com cluster randomizado, realizado em 199 pessoas com diabetes. Para realizar as comparações intragrupos (tempos final e inicial) e entre grupos quanto aos valores das variáveis atitudes psicológicas, empoderamento, autocuidado e medidas da hemoglobina glicada, foi utilizada a abordagem das Generalizing Estimating Equations (GEE). Em todas as análises, utilizou-se um nível de significância de 5% e intervalos de 95% de confiança. Quando comparado ao GC, o GI apresentou uma redução significativa nos valores médios de hemoglobina glicada (IC95%: -1,49 a - 0,45), aumento estatisticamente significativo na modificação dos escores de atitudes psicológicas (IC95%: 9,70 a 15,40), na escala do empoderamento (IC95%: 0,81 a 2,72) e na adesão às práticas de autocuidado (IC95%: 1,44 a 2,10) ao final do estudo. O programa comportamental se mostrou capaz de modificar as atitudes psicológicas, melhorar o empoderamento, as práticas de autocuidado e o controle clínico.

[Temporal analysis of the inclusion of Physical Education Professionals and Residents in the Brazilian Unified Health System (SUS) from 2009 to 2021].

Abstract: Physical Education is one of the categories featured in the SUS workforce. An ecological time series study, based on the National Registry of Health Establishments, was conducted to analyze the inclusion of Physical Education Professionals (PEFs) and residents in the SUS between 2009 and 2021. The scope of the article was to establish a panorama of the inclusion of Physical Education and analyze the distribution of PEFs and residents in the different regions. An increase of 476.01% in the number of PEFs and 10,366.67% among residents was revealed. The PEF rate per 100,000 inhabitants increased by 13.7% per year from 2009 to 2021, with an increase of 28.1% between 2009 and 2014 and 7.8% between 2014 and 2019, and a decrease of 3.4% between 2019 and 2021. The resident rate increased by 36.2% per year between 2009 and 2021, with a 45.9% increase between 2009 and 2017 and 18.7% between 2017 and 2021. Regional inequalities in the distribution of PEFs and residents were revealed, with the highest concentration, in 2021, in the Northeast and South regions, respectively. The increase in PEFs and residents in the SUS can be linked to policies and programs of physical exercise and activities, while the decrease is possibly related to the Previne Brasil Program and the COVID-19 pandemic.

General Health Questionnaire (GHQ12): new evidence of construct validity.

Abstract: This study aimed to gather evidence on the adequacy of the General Health Questionnaire (GHQ-12) in Brazil, considering a random sample of Brazilian physicians. Specifically aimed: (1) to test the GHQ-12 bifactor structure compared to alternative models, (2) to check its factorial invariance regarding to gender and the diagnosis of mental and behavioral disorders, and (3) to know the association of this measure with indicators of poor health (e.g., suicidal thoughts, decreased libido, medication use). The study included 1,085 physicians with a mean age of 45.7 (SD = 10.6), mostly male (61.5%), married (72.6%) and Catholic (59.2%). They answered the GHQ-12, the Positive and Negative Suicidal Ideation Inventory, and demographic questions. The best fit model was the bifactor structure composed of anxiety and depression, in addition to a general dimension, which presented Cronbach's alpha, McDonald's ω and composite reliability higher than 0.70 just for a general fact. Psychological distress scores correlated with suicidal ideation and indicators of health and sexual satisfaction. This is a psychometrically suitable instrument that can be used in terms of its total, but its specific factors need to be used with caution.

Socioeconomic status, screen time, and time spent at school, and children's food consumption.

Abstract: The present study aimed to evaluate the association of sociodemographic factors and lifestyle with the consumption of in natura or minimally processed (INMP) foods, ultra-processed foods (UPFs), and fruits and vegetables. This was a cross-sectional study conducted with 403 children, aged 4 to 7 years, from a retrospective cohort. Sociodemographic and lifestyle variables were investigated using a sociodemographic questionnaire. Food consumption was assessed by three food records. Bivariate and multivariate linear regression analyses were used to analyze associations. Children with lower income had a higher consumption of INMP foods and a lower consumption of UPFs. A shorter time spent at school was associated with a lower consumption of INMP foods and a higher consumption of UPFs. Children with more screen time and less educated parents consumed less fruits and vegetables. Unfavorable sociodemographic factors were associated with a better profile of food consumption according to the level of processing, except for fruits and vegetables. The longer time spent at school and a shorter screen time contributed to a healthier diet.

Análise temporal da inserção de Profissionais e Residentes de Educação Física no Sistema Único de Saúde de 2009 a 2021

Abstract: Resumo Dentre as categorias que fazem parte da força de trabalho do SUS está a Educação Física. Por meio de estudo ecológico de séries temporais, com base no Cadastro Nacional de Estabelecimentos de Saúde, os objetivos do artigo foram analisar a inserção de Profissionais de Educação Física (PEF) e residentes no SUS entre 2009 e 2021 com vistas a traçar um panorama da inserção da Educação Física e analisar a distribuição de PEF e residentes entre as diferentes regiões. Foi revelado um aumento de 476,01% no número de PEF e de 10.366,67% entre os residentes. A taxa de PEF por 100.000 habitantes aumentou 13,7% ao ano entre 2009 e 2021, com aumento de 28,1% entre 2009 e 2014 e de 7,8% entre 2014 e 2019, e redução de 3,4% entre 2019 e 2021. A taxa de residentes aumentou 36,2% ao ano entre 2009 a 2021, com aumento de 45,9% entre 2009 e 2017 e de 18,7% entre 2017 e 2021. Foram reveladas desigualdades regionais na distribuição de PEF e residentes, com maior concentração, em 2021, respectivamente nas regiões Nordeste e Sul. O aumento de PEF e residentes no SUS pode ser relacionado com políticas e programas de práticas corporais e atividades físicas, enquanto o decréscimo, possivelmente, se relaciona com o Programa Previne Brasil e à pandemia de COVID-19.

The burden of Noncommunicable Diseases in Portuguese Language Countries

Abstract: Abstract The present study analyzed trends in premature mortality from Noncommunicable diseases (NCDs) between 1990 and 2019, the projections up to 2030, and the risk factors (RFs) attributable to these diseases in the Community of Portuguese Language Countries (CPLP). Estimates from the Global Burden of Disease (GBD) study and the analysis of the burden of premature mortality due to NCDs were used for nine CPLP countries, applying age-standardized rates, using RStudio. Portugal, Brazil, Equatorial Guinea, Angola, and Guinea Bissau showed declining premature mortality rates caused by NCDs, while East Timor, Cape Verde, São Tomé and Príncipe, and Mozambique showed an increase in rates. Projections indicate that none of the countries is expected to achieve the goals of reducing premature mortality due to NCDs by one third by 2030. The attributable burden of disease showed that the most important RFs in 2019 were: high systolic blood pressure (SBP), tobacco, dietary risks, high body mass index (BMI), and air pollution. It can therefore be concluded that there are profound differences in the burden of NCDs among the countries, with better results in Portugal and Brazil, and that no CPLP country is likely to reach the NCD reduction target by 2030.

Knowledge of women who have sex with women about Sexually Transmitted Infections and AIDS.

Abstract: This article aims to study the knowledge of women who have sex with women about Sexually Transmitted Infections and AIDS. Cross-sectional study of 260 women, 81 women who either have sex with women or with men and women (WSW) and 179 women who have sex exclusively with men (WSM). Data were collected in 2019/2020 by means of a form and validated instruments. To study the association between sexual partnership and level of knowledge about Sexually Transmitted Infections and AIDS, multiple Cox regression models were adjusted, producing significant associations of p<0,05. The median percentage of correct answers was lower among WSW when compared to WSM [68% (18-96) vs 75% (14-96); p=0.023]. Having sex with woman [PR=2.36 (1.07-5.21); p=0.033] and less than 11 years of schooling [PR=2.64 (1.12-6.21); p=0.026] were independently associated with low knowledge. WSW had a lower level of knowledge about Sexually Transmitted Infections and AIDS than WSM, and lower education was independently associated with this finding.

Community Health Workers: what do international studies tell us?

Abstract: This is a narrative review whose objective is to understand the state of the art of the literature on Community Health Worker (CHW) programs worldwide, identifying their nomenclatures, practices, training, and working conditions. The major concentration of CHW programs can still be found in low- and middle-income countries in Africa (18), Asia (12), and Latin America (05), with a few experiences in high-income countries in North America (02) and Oceania (01). In total, 38 experiences were cataloged, and the practices of care, surveillance, education, health communication, administrative practices, intersectoral articulation, and social mobilization were described. The levels and duration of CHW training were characterized, as were the different working conditions in each country. Much of the work is precarious, often voluntary and carried out by women. This review provided a comparative overview that can contribute to enrich the view of managers and decision-makers in contexts of the implementation, expansion, and reconfiguration of such programs.

Does early fruit juice introduction influence anthropometric outcomes and food consumption at preschool age?

Abstract: The aim of this study was to evaluate the impact of fruit juice consumption before 6 months of age on Body Mass Index-for-age (BMI-for-age) and food consumption in preschoolers. We conducted a longitudinal study with mothers and their children (n=103) at 6 months and 3-6 years. Weight and height were measured and converted into BMI-for-age z-scores. Food consumption was analyzed using the Food Frequency Questionnaire for Children. Groups were compared using the chi-squared and Student's t-tests. No differences in anthropometric measurements were found at preschool age between children who had been given fruit juice before 6 months and those who had not. Consumption of artificial juice (≥once/day) and sandwich cookies at preschool age was higher in children with early introduction of fruit juice (≤150 days of life) (63.8% versus 35.7%; p=0.028 and 21.3% versus 14.3%; p=0.001, respectively). The prevalence of the consumption of soda (1 to 4 times/week) and chocolate milk (at least once/day) was higher in children who had been given artificial juice before 6 months (69.2% versus 27.4%; p=0.014 and 38.5% versus 69.4%; p=0.027, respectively). It can be concluded that the consumption of sweet foods and sugary beverages was higher in children with early introduction of fruit juice.

Analysis of femicide cases in Campinas, SP, Brazil, from 2018 to 2019 through the ecological model of violence.

Abstract: Lethal violence against women is a complex and multidimensional phenomenon in which a wide number of factors intersect and converge to make a femicide happen at a specific time and place. The main factors that contributed to the occurrence of femicides in the city of Campinas were identified from January 2018 to December 2019. Interviews were conducted with family members, friends, neighbors, witnesses, and health agents about 24 femicides using the verbal autopsy technique. The autopsies were supplemented, when possible, with information from the media and clinical autopsy reports. For the data analysis process, narratives of the cases were carried out, recovering the most important aspects of the verbal autopsies and organizing the factors found in the four levels of the ecological model of violence used by the World Health Organization: individual, relational, community, and social. The analysis was structured in categories following a deductive approach. Starting from particular cases delimited in time (2018 and 2019) and in space (municipality of Campinas) it is expected to understand the phenomenon of femicide in its broadest dimension.

Water, sanitation and schistosomiasis mansoni: a study based on the Brazilian National Prevalence Survey (2011-2015).

Abstract: This study aimed to explore the association between water, sanitation, and the prevalence of schistosomiasis mansoni in students aged 7 to 17 years from all 27 federative units in Brazil. It was a cross-sectional study conducted based on data on the prevalence of schistosomiasis mansoni referring to 197,567 students from 521 Brazilian municipalities, who participated in the National Survey on the Prevalence of Schistosomiasis Mansoni and Soil-transmitted Helminth Infections (2011-2015). Univariable and multivariable generalized linear models of the negative binomial type were adjusted using 25 and 5% significance levels, respectively, considering municipalities as the unit of analysis. While a protective association was found between access to filtered water in schools and schistosomiasis mansoni prevalence, sanitation in schools was indicated as a risk factor. The collection of wastewater through a network is not universal in Brazil, and even when present, it is not necessarily carried out by the treatment of collected effluents, thus often resulting in the direct discharge of raw sewage into water resources. Regarding septic tanks, only the presence of infrastructure alone does not guarantee its correct use by the population.

Análise da estruturação da Rede de Atenção à Saúde no estado de Mato Grosso, Brasil, no contexto da Regionalização

Abstract: Resumo O artigo objetiva analisar aspectos da estruturação da rede de atenção à saúde nas regiões do estado de Mato Grosso e a narrativa sobre eles, de atores institucionais representantes da gestão, da prestação de serviços e da sociedade. Tem por base a pesquisa sobre governança e regionalização do SUS neste estado, de abordagem quantitativa e qualitativa, cuja base empírica contemplou dados secundários, documentos institucionais e entrevistas com atores-chave, estes representando a gestão, a prestação de serviços e a sociedade. Os aspectos da estrutura deste recorte focam: cobertura da ESF; disponibilidade de estabelecimentos/serviços de saúde; força de trabalho; despesas com saúde. Entre 2010 e 2018, em que pese a melhoria de vários indicadores explorados: a oferta e a distribuição de serviços e de profissionais evidenciam desigualdades regionais; há limitações financeiras, insuficiência de serviços e de profissionais. A Rede de Atenção à Saúde não está estruturada como regulamentada e sim como cada região - e seus municípios - a entendem e a adaptam, conforme sua capacidade instalada. A APS promoveu avanços, porém não tem conseguido ser efetiva e resolutiva frente às necessidades de saúde, não coordenando adequadamente o cuidado e tampouco orientando a RAS.

Participation in health in the Americas: Bibliometric mapping of production, impact, visibility and collaboration.

Abstract: Participation in health has generated a large number of publications around the world. In order to know the specificities of this production in the Americas, a bibliometric analysis of articles in English, Spanish and Portuguese was carried out. Searches were carried out in the VHL, PubMed, SCOPUS, WOS and SciELO, consolidating a database with 641 references. With the help of the VOSviewer software, we analyzed citation patterns, co-authorship and the chronological distribution by countries and languages. It was possible to verify the growth of production, the quantitative relevance and the impact of the different countries. The analysis indicated that the USA concentrates the largest number of citations and Brazil, despite being the first in number of publications, is the third in number of citations. The same occurs with Brazilian journals that, with the largest number of articles, fall in the ranking of the most cited. The co-authorship analysis indicated that the University of Toronto, Fiocruz and Harvard University have the most formal collaborations with other organizations. We conclude that there are inequalities of impact, visibility and internationalization in this field, indicating obstacles to scientific development and health policies.

National Abortion Survey - Brazil, 2021.

Abstract: The National Abortion Survey 2021 (PNA 2021) utilized face-to-face structured interviews and a self-administered questionnaire placed in a sealed box to collect data on abortions in Brazil. Interviews were held with a nationally representative sample of 2,000 women, randomly selected from among literate women ages 18 to 39 residing in urban areas. We compared some of the results with previous waves of the survey, PNA 2010 and PNA 2016. Findings show that abortion is in decline but remains a major public health issue. Around 10% of the women interviewed in 2021 said they had had at least one abortion in their lives (compared to 15% in 2010). We estimate that nearly one in every seven women (15%) have had an abortion by the age of 40. We identified a decline in the proportion of women who needed to be hospitalized to finalize their abortions (55% in 2010; 43% in 2021; p = 0.003) and in the proportion of women who used medication for the abortion (48% in 2010; 39% in 2021; p = 0.028). Abortion is an event that generally happens early on in women's reproductive lives: the PNA 2021 found that 52% of women were 19 years old or younger when they had their first abortion. Higher rates were detected among respondents with lower educational levels, Black and Indigenous women, and women residing in poorer regions.

[COVID-19 in the midst of a "perfect storm" in neoliberal capitalism: critical reflections on its impacts in Brazil].

Abstract: The impacts of the recent coronavirus pandemic on Brazilian society revealed a scenario that goes beyond a health crisis. This article sets out to present the causes and consequences of a systemic crisis in the neoliberal economic order based on the prominence of markets and social exclusion, while the role of the State - as the guardian of social rights - is neglected. The methodology adopted follows a critical interdisciplinary perspective from the fields of political economy and social sciences, located in socioeconomic reports referred to in this analysis. It is argued that the neoliberal rationale guiding government policies, which is deep rooted in the social environment, has contributed to the increase in structural inequalities in Brazil, thus creating favorable conditions for exacerbating the impacts caused by the pandemic in society, particularly among the most vulnerable social groups.

Analysis of femicide cases in Campinas, SP, Brazil, from 2018 to 2019 through the ecological model of violence

Abstract: Abstract Lethal violence against women is a complex and multidimensional phenomenon in which a wide number of factors intersect and converge to make a femicide happen at a specific time and place. The main factors that contributed to the occurrence of femicides in the city of Campinas were identified from January 2018 to December 2019. Interviews were conducted with family members, friends, neighbors, witnesses, and health agents about 24 femicides using the verbal autopsy technique. The autopsies were supplemented, when possible, with information from the media and clinical autopsy reports. For the data analysis process, narratives of the cases were carried out, recovering the most important aspects of the verbal autopsies and organizing the factors found in the four levels of the ecological model of violence used by the World Health Organization: individual, relational, community, and social. The analysis was structured in categories following a deductive approach. Starting from particular cases delimited in time (2018 and 2019) and in space (municipality of Campinas) it is expected to understand the phenomenon of femicide in its broadest dimension.

A COVID-19 em meio a uma “tempestade perfeita” no capitalismo neoliberal: reflexões críticas sobre seus impactos no Brasil

Abstract: Resumo Os impactos da pandemia do novo coronavírus na sociedade brasileira revelaram um cenário que extrapola uma crise sanitária. Este artigo tem por objetivo apresentar as causas e consequências de uma crise sistêmica sob a ordem econômica neoliberal lastreada na proeminência dos mercados e da exclusão social, enquanto o papel do Estado como garantidor de direitos sociais é negligenciado. A metodologia adotada segue uma perspectiva interdisciplinar crítica dos campos da economia política e das ciências sociais presente em relatórios socioeconômicos referidos nesta análise. Argumenta-se que a racionalidade neoliberal, orientando as políticas governamentais e presente no ambiente social, contribuiu para um aprofundamento das desigualdades estruturais no Brasil, gerando condições propícias para o agravamento dos impactos causados pela pandemia na sociedade, em particular nos segmentos sociais mais vulneráveis.

Participação em saúde nas Américas: mapeamento bibliométrico da produção, impacto, visibilidade e colaboração

Abstract: Resumo A participação em saúde tem gerado um grande número de publicações em todo o mundo. Para conhecer as especificidades dessa produção nas Américas, foi realizada uma análise bibliométrica de artigos em inglês, espanhol e português. Foram realizadas buscas na BVS, PubMed, SCOPUS, WOS e SciELO, consolidando uma base de dados com 641 referências. Com auxílio do software VOSviewer, analisamos padrões de citação, coautoria e a distribuição cronológica por países e idiomas. Foi possível verificar o crescimento da produção, a relevância quantitativa e o impacto dos diferentes países. A análise indicou que os EUA concentram o maior número de citações, e o Brasil, apesar de ser o primeiro em número de publicações, é o terceiro em número de citações. O mesmo ocorre com os periódicos brasileiros que, com o maior número de artigos, caem no ranking dos mais citados. Nos dez artigos mais citados, descatam-se trabalhos desenvolvidos nos EUA e Canadá. A análise de coautoria indicou que a Universidade de Toronto, a Fiocruz e a Universidade de Harvard são as que mais têm colaborações formais com outras organizações. Concluímos que existem desigualdades de impacto, visibilidade e internacionalização neste campo, indicando obstáculos para o desenvolvimento científico e das políticas de saúde.

Agentes Comunitárias de Saúde: o que dizem os estudos internacionais?

Abstract: Resumo Trata-se de uma revisão narrativa cujo objetivo é compreender o estado da arte da literatura sobre programas de Agentes Comunitárias de Saúde (ACS) no mundo, identificando suas nomenclaturas, práticas, formação e condições trabalhistas. A grande concentração de programas de ACS ainda ocorre em países de baixa e média renda da África (18), Ásia (12) e América Latina (05), com algumas poucas experiências em países de alta renda na América do Norte (02) e Oceania (01). No total foram catalogadas 38 experiências, tendo sido descritas as práticas de cuidado, vigilância, educação, comunicação em saúde, práticas administrativas, de articulação intersetorial e mobilização social. Caracterizou-se os níveis e duração das formações das ACS, assim como as diversas condições de trabalho em cada país. Em grande parte, o trabalho é precarizado, muitas vezes voluntário e realizado por mulheres. A revisão proporcionou um panorama comparativo que pode contribuir para enriquecer o olhar de gestores e tomadores de decisão em contextos de implantação, ampliação e reconfiguração de tais programas.