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Bisphenol A (BPA) is an endocrine and metabolic disruptor commonly employed as a color developer in thermal papers. Consequently, BPA derived from thermal papers has been considered an important source of exposure for humans, since this chemical may migrate from paper to skin upon contact. Further, due to recent restrictions on BPA use in some countries, it has been replaced by a new analogue, bisphenol S (BPS). The aim of the present study was to determine levels of BPA and BPS in 190 different thermal receipts, randomly collected from different locations in São Paulo State, Brazil, including receipts from supermarkets, general and fast-food restaurants, gas stations, bus and airplane tickets, and credit card and bank accounts. BPA and/or BPS were detected in 98% of samples at concentrations ranging from below the quantification limit to 4.3% (mg/100 mg paper). The obtained values were higher than amounts previously reported in other countries. The estimated daily intake through dermal absorption from handling of thermal receipt papers was estimated on the basis of concentrations and frequencies of handling of papers by humans in both the general population and occupationally exposed individuals. Fifth percentile, median, and 95th percentile daily intakes by the general population were 0.44, 1.42, and 2 μg/d, respectively, whereas the corresponding values for occupationally exposed population are 21.8, 71 and 101 μg/d. The potential adverse consequences of elevated occupational exposure are currently being examined. [ABSTRACT FROM AUTHOR]

There has been an alarming rise in suicide attempts among Indigenous people in Brazil, leading to national concerns about the provision of psychosocial care and professional support. In this study, we make an attempt to understand the perspectives of professionals in assisting Indigenous people from a specific group, the Inỹ, and identify the specific challenges of addressing issues through the mental health care system related specifically to suicide prevention. Using a qualitative approach with participant observation and semi-structured interviews, the research included Indigenous and their families assisted by three public institutions and the professionals that work in public psychosocial assistance. For this paper, we examined the tensions, conflicts, and challenges of the healthcare professionals at one of these institutions, a Psychosocial Care Center in the state of Goiás/Brazil. For data analysis, a sociocultural protocol was built to identify dialogical tensions between the different thematic fields of mental health care. The findings reveal that the theme of suicide was an important concern in the daily work with the community. Still, there were significant issues related to the assumptions, methodology, and meaning of care between the professionals and the community, on account of which the objective of the programme to address suicide attempts had not been effective or successful. The discussion of the results raises several critical questions about the possible contributions of dialogical cultural psychology in the context of Indigenous health. Also, it has important implications for the global issue of the wellbeing of Indigenous people. [ABSTRACT FROM AUTHOR]

This paper uses the internet-based biosurveillance to describe the Brazilian e-commerce of non-inspected dairy products and maps its traditional sale in a medium-sized city (Londrina). We searched the sales of illegal dairy products on Facebook Marketplace and conducted a census of street markets and a random sample of formal markets. Although prohibited in Brazil, consumers can easily find informal dairy products on internet and retail sale. In addition, 7% of the food products hold a false label to mimic food inspection. The e-commerce was linked with regions with higher access to technology and Human Development Index (HDI). We believe that our approach shows a step forward in the public health interventions and could be replicated stimulating debates about policies required to improve the public health surveillance. [ABSTRACT FROM AUTHOR]

From 2015 to 2016, an epidemic of births of children with Congenital Zika Virus Syndrome emerged in Brazil, and the state of Bahia concentrated the highest incidence of cases. The official health guidelines recommended that the affected children and their families should be supported by interdisciplinary teams of early intervention. This paper aims to deepen the comprehension of regulation and affective-semiotic mediation processes involved in the early intervention with children with Congenital Zika Virus Syndrome and their families. It focus on the experiences of a professional interviewed in a public health service in Salvador, Bahia – Brazil, through narrative analysis and the theoretical-methodological foundations of Cultural Psychology of the Semiotic Dynamics. These approaches allowed the understanding of the processes of construction of meanings, symbolic action and affective-semiotic regulation. The care of Congenital Zika Virus Syndrome children by professionals relates to disquieting experiences, inter subjectivity, meaning construction, affections and symbolic actions. These dynamic processes allowed the professional to better adapt to regulation and affective-semiotic mediation, as well as her own performance in face of children and their families. This analysis emphasizes the reflections of health care practices and their repercussions in the quality of the assistance. [ABSTRACT FROM AUTHOR]

The pandemic caused by the COVID-19 has influenced peoples' lifestyles. Home-confinement scenario might impair physical activity practice, resulting in new challenges for maintaining health during the pandemic of the COVID-19. The aim of this study was to present the current context of COVID-19 pandemic, its impact on the practice of physical activity, and the strategies available to remain active during home-confinement according to international recommendations. The narrative review was conducted based on studies that analyzed themes related to physical activity and COVID-19. Virtual Health Library (VHL), CINAHL, Cochrane, PsycINFO, PubMed, ScienceDirect, Scientific Electronic Library Online (SciELO), Scopus, SPORTDiscus, and Web of Science databases were searched for relevant papers. Although an increased number of experimental studies are still necessary, people should devote more time to physical activity during social isolation. Guidelines were adjusted by international entities in order to encourage people to remain active, through practice regular physical activity, using alternative strategies such as fitness program applications, exergames, online exercise classes, and even chores. Reduction of prolonged sedentary behavior could contribute to maintain health and improve quality of life during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To discuss studies conducted in Brazil relating to PrEP, from 2012 to 2022, based on a narrative review. METHODOLOGY: The databases of the Virtual Health Library/PAHO, portals from Scielo, Scopus, and PubMed, and the descriptors in English and Portuguese 'Pre-exposure to HIV' and 'Brazil' were used, as well as a list of planned/in-progress demonstrative studies. Inclusion criteria consists of articles with fieldwork in Brazil coupled with PrEP in the Brazilian scenario; and articles in English or Portuguese. Articles in which PrEP was not the central theme and the participating Brazilian population did not reside in Brazil were excluded. RESULTS: 107 papers have been reviewed, 80 articles met the inclusion criteria. The majority participating population was men who have sex with men. 61 studies preceded the implementation of PrEP in Brazil. Studies carried out after implementation (n = 19) deal primarily with the impact of the COVID-19 pandemic. CONCLUSIONS: There was an incipient number of studies on the injectable form of PrEP. Fewer studies included segments with greater difficulties in access, use, and adherence. Despite the issues that circumscribe this prevention technology, literature is consensual on the importance of Brazilian leadership for implementing PrEP. [ABSTRACT FROM AUTHOR]

This paper includes a systematic review of the SARS-CoV-2 occurrence in environmental aquatic matrices and a critical sanitation analysis. We discussed the interconnection of sanitation services (wastewater, water supply, solid waste, and stormwater drainage) functioning as an important network for controlling the spread of SARS-CoV-2 in waters. We collected 98 studies containing data of the SARS-CoV-2 occurrence in aquatic matrices around the world, of which 40% were from developing countries. Alongside a significant number of people infected by the virus, developing countries face socioeconomic deficiencies and insufficient public investment in infrastructure. Therefore, our study focused on highlighting solutions to provide sanitation in developing countries, considering the virus control in waters by disinfection techniques and sanitary measures, including alternatives for the vulnerable communities. The need for multilateral efforts to improve the universal coverage of sanitation services demands urgent attention in a pandemic scenario. [ABSTRACT FROM AUTHOR]

New juridical needs linked to the National Health System (SUS) in Brazil during the pandemic forward significant cases for the analysis of the national public health during the period. Through urgency tutelages which demanded the transference of SARS-CoV-2 infected people to Intensive Care Therapy, current paper analyzes aspects of juridical decisions in the health area during the pandemic. Juridical demand and the deferment or not of demands are analytic sources to understand the state of the Brazilian health system couple to the usefulness of these decisions within the same context and to identify important aspects on the situation. [ABSTRACT FROM AUTHOR]

Community health workers (CHWs) are framed as the link between communities and the formal health system. CHWs must establish trusting relationships with the community and with the broader health service. How to find the optimal balance between the various strands of work for CHWs, and how to formalise this, has been the focus of different studies. We performed an extensive documentary analysis of federal legislation in Brazil to understand the institutionalisation of the CHW workforce in Brazil over the last 3 decades. The paper offers three contributions to the literature: the development and application of an analytical framework to consider the institutionalisation process of CHWs; a historical analysis of the professional institutionalisation of CHW in Brazil; and the identification of the paradoxes that such institutionalisation faces: firstly, institutionalisation focused on improving CHW remuneration created difficulties in hiring and paying these professionals; when CHW are incorporated within state bureaucracy they start to lose their autonomy as community agents; and that the effectiveness of CHW programmes depends on the improvement of clinical services in the most deprived areas. [ABSTRACT FROM AUTHOR]

This paper aims to present an ex-post analysis of industrial and science, technology and innovation (sti) policies to the Health Industrial Complex, between 2003-2017 in Brazil, from the perspective of the public health value. We concluded that the intention to meet social health needs was present in the policies' design, however, the lack of objectivity and clarity in their definitions made it difficult to articulate the three fields of policies. [ABSTRACT FROM AUTHOR]

The Brazilian Policy of Comprehensive Care for People with Rare Diseases (BPCCPRD) was established by the Ministry of Health to reduce morbidity and mortality and improve the quality of life of people with rare diseases (RD). Several laboratory tests, most using molecular genetic technologies, have been incorporated by the Brazilian Public Health System, and 18 specialised centres have so far been established at university hospitals (UH) in the capitals of the Southern, Southeastern and Northeastern regions. However, whether the available human and technological resources in these services are appropriate and sufficient to achieve the goals of care established by the BPCCPRD is unknown. Despite great advances in diagnosis, especially due to new technologies and the recent structuring of clinical assessment of RD in Brazil, epidemiological data are lacking and when available, restricted to specific disorders. This position paper summarises the performance of a nationally representative survey on epidemiology, clinical status, and diagnostic and therapeutic resources employed for individuals with genetic and non-genetic RD in Brazil. The Brazilian Rare Disease Network (BRDN) is under development, comprising 40 institutions, including 18 UH, 17 Rare Diseases Reference Services and five Newborn Screening Reference Services. A retrospective study will be initially conducted, followed by a prospective study. The data collection instrument will use a standard protocol with sociodemographic data and clinical and diagnostic aspects according to international ontology. This great collaborative network is the first initiative of a large epidemiological data collection of RD in Latin America, and the results will increase the knowledge of RD in Brazil and help health managers to improve national public policy on RD in Brazil. [ABSTRACT FROM AUTHOR]

Agrochemicals are chemical products used in agricultural and stock breeding programs. Since they are products which endanger the environment, they are regulated by specific norms. Brazil is one of the biggest agricultural and stock breeding producers with the highest rates of pesticides. The number of agrochemicals registered in Brazil has greatly increased during the last years, but regulating norms remained unaltered. Normative and policy changes occurred which made flexible registers and increased uses. Current paper analyzes present norms and verifies the occurrence of flexibilization by quality research with a review of the literature and documents. Results show that there was an increase in the number of registers and the employment of agrochemicals, many of which have been prohibited in Europe. Flexibilization occurred by political and economical decisions without taking into account issues of public health and environment. [ABSTRACT FROM AUTHOR]

Leptospirosis is one of the waterborne diseases that strongly concern the health in Brazil. Therefore, the objective of the present study was to identify, analyze, and describe the socioeconomic, environmental, and climatic factors that can be directly related to the increase of the leptospirosis cases. In addition, the present study carried out a temporal and spatial analysis to demonstrate the relationship between publications and cases-deaths in Brazil. By searching the databases of the CAPES and LILACS, we selected 43 papers that dealt with leptospirosis and flood in Brazil. Most of the evaluated papers related the occurrence of extreme hydrological events to the increase in the number of cases of leptospirosis. The others focused other factors such as waste accumulation, lack of urban drainage, working services, and so on. [ABSTRACT FROM AUTHOR]

Yellow Fever (YF) is a viral arbovirosis of Public Health importance. In Brazil, surveillance is focused mainly on detecting epizootic events of Platyrrhini. Herein, we compared the detection and phylogenetic analysis of YF virus in two neotropical primates (NTP), a Callithrix detected in the previous epidemic period (2016–2020), and a Callicebus nigrifons , showing a new introduction of YF in 2023. This paper illustrates the importance of joint actions of laboratory and field teams to ensure quick response to Public Health emergencies, such as the intensification of vaccination of susceptible human populations. [ABSTRACT FROM AUTHOR]

This paper analyzes ten recovery narratives of people with a serious mental illness who received mental health services in the public health care system of the city of Campinas, Brazil. We describe the person's recovery process and their relationship with the clinical services they received. This is a very needed conversation because the incorporation of recovery and recovering citizenship concepts in clinical practice are still incipient in South America. Most importantly, this research adds to the dialogue around recovering citizenship in different cultures. Methods: We used phenomenological methodology to interpret data drawn from the participant's life course interview (using the McGill Illness Narrative Interview). Results: We found that a) Before receiving services, people were overwhelmed by symptoms, but did not know what was going on; b) Loved ones and clinicians explained symptoms as part of a mental illness, and the proposed treatment was largely accepted; c) Mental health treatment was seen as helpful but not enough to address what was meaningful for their lives; d) People regained a life in their community, they felt proud of their recovery process, and solidarity and collectivism seemed to play important roles in their recovery process. Discussion: We identified similarities and differences in the recovery process of people with serious mental illness receiving public mental health services in Campinas, Brazil, when compared to the international literature. Receiving mental health services was very helpful for participants, principally when feeling overwhelmed by symptoms. Mental health services seemed to be less effective in helping people regain a meaningful life in their communities. Solidarity from friends and family members was recognized as an important recovery asset. [ABSTRACT FROM AUTHOR]

In the context of the COVID-19 pandemic, masks and the act of masking have become emotive subjects for social and political debate. In Brazil, one of the countries most severely affected by the pandemic, the seemingly mundane act of mask-wearing has become part of a deep social, political and economic crisis at the centre of which is the far-right president Jair Bolsonaro. In this paper we explore the politics of (un)masking in Brazil from three vantage points in which the mask serves to dramatise the country's current moment. Firstly, we trace the connections and disjunctions between the politics of mask-wearing and the genealogies of hygienist policies associated with the modern aspirations of the Brazilian republic. Secondly, we consider how masks are incorporated into the everyday life of the city through popular economies, which reveal the potentialities and limitations of work beyond the modern ideals of waged labour. Finally, we explore the incorporation of masks in urban street-art. We approach graffiti and murals as situated performances of symbolic resistance that contest and reveal the incoherences of Bolsonaro's anti-science discourse. In tandem, these three perspectives foreground practices of (un)masking that expose long-standing tensions and new contemporary challenges that characterise the politics of a 'crisis society'. [ABSTRACT FROM AUTHOR]

Background: In 2015–2017, the Americas experienced a highly consequential epidemics for pregnancy and childbearing. Mainly transmitted by the mosquito Aedes aegypti, but also through sexual intercourse, the Zika virus poses the risk of congenital Zika syndrome to fetus, which includes microcephaly and other child development complications. When a public health crisis taps directly into reproductive health, typically a feminine realm, responses to the emergency may exacerbate deeply-rooted gender norms. This paper investigates the role of gender in two relational contexts: (a) the government-led response to the pandemic in terms of communication campaigns aimed at preventing Zika infections; and (b) an individual level of response to the emergency, concerning women's negotiation with their sexual partners with regard to the prevention of Zika as well as pregnancies. Methods: We conducted content analysis of 94 unique pieces from public health communication campaigns produced by governmental agencies with the goal of promoting Zika awareness. Print and online materials were collected from May 2016 to August 2017, and included TV ads, Internet Pop-ups, and pamphlets. We also analyzed transcripts from 16 focus groups conducted with reproductive-aged women (18–40) in Belo Horizonte and Recife, two large cities differently affected by the Zika outbreak. Women answered open-ended questions connected to the epidemic, in areas such as personal knowledge and experiences with the Zika virus, experiences of their friends and acquaintances, their primary information sources, their perceptions of public health efforts toward containing the outbreak, as well as women's contraceptive use. Results: Campaign pieces handling pregnancy and microcephaly were largely gendered. Pieces targeted women, placing on their shoulders the responsibility for protecting a potential fetus from the disease. Importantly, campaigns neglected addressing male's participation on Zika prevention and contraceptive management, while failing to take into account Brazil's large proportion of unplanned pregnancies. Women were placed in a double bind by being expected to prevent both pregnancy and Zika, in a context where gendered power imbalances often translate in women having little power/means for condom negotiation/avoiding unprotected sexual intercourse. Conclusion: Government and individual responses to the epidemics reinforced gender roles, situating pregnant women as responsible for averting mosquito bites and microcephaly. Further, prevention campaigns largely excluded men. Since low-socioeconomic status women possessed fewer resources to preclude infection, we also found that beyond the gender divide, this subgroup faced more pronounced Zika prevention challenges as they found it harder to negotiate condom use with their sexual partners and often could not access other types of contraceptives resulting in unplanned pregnancies. [ABSTRACT FROM AUTHOR]

Introduction: The arbovirus proposes an important problem of public health in Brazil, especially in the Amazon, due to its capacity to cause outbreaks with high levels of morbidity-mortality in humans as well as in animals. Objective: This paper had the objective to estimate the prevalence of antibodies to arbovirus in communities that live under the influence of the artificial lake of UHE Tucuruí in the State of Pará, Brazil. Method: The analytical transversal study has selected 657 blood serum samples of individuals over 18, both genders, residents at the Sustainable Development Reserves (SDR) in the region of the lake of UHE Tucuruí. The epidemiological information has been registered in an instrument especially designed for such a study and the blood samples were collected in two periods of high and low tide of the lake. The blood serum tests were performed by the method of hemagglutination inhibition (HI). Results: The results revealed a prevalence of positive antibodies to arbovirus of 85.0%, being 84.1% related to Flavivirus (vaccine strain of YFV), 25.5% related to Alphavirus and 34.6% to Bunyavirus. The results of serum prevalence to arbovirus between the periods of high tide and low tide have revealed significance amongst the Alphavirus, not observed in the other families. Conclusion: In general, the data from this paper have suggested that the anthropoid actions on the environment of the lake have become determinant factors for the prevalence of arboviral antibodies. [ABSTRACT FROM AUTHOR]

Civil society engagement around health care and population health improvement is an important driver towards Health for All. Research can improve the effectiveness of health activism by examining the resources, structures and strategies of civil society engagement. However, research to support such engagement faces epistemological and methodological challenges which call for specific research strategies. A four year multi-country study was undertaken by the People's Health Movement, a global network working for health for all. The research took place in six countries (Brazil, Colombia, DR Congo, India, Italy, South Africa) and globally, and was directed to understanding five domains of civil society engagement: movement building; campaigning and advocacy; capacity building; knowledge generation, access and use; and engaging with governance. The research plan and methods of data collection and analysis were tailored to address the objective of improving activist practice, while negotiating research challenges identified during the design phase. Results include insights into the practice of civil society engagement in relation to the five domains of activist practice, as well as experience gained in managing six methodological challenges which we describe as: making meaning, aligning research and action, managing power relations, valuing experiential knowledges, chaos and contingency, challenging preconceptions. Researching activism can produce useful insights into practice as well as support continuous improvement in the effectiveness of such activism. However, there are significant methodological challenges that can be addressed through appropriate strategies. More research, building on the approach described in this paper, can contribute to more effective civil society activism for health. [ABSTRACT FROM AUTHOR]

This paper presents a detailed analysis of how health information was shared and discussed on Twitter in terms of awareness and opinions during the 2017 Yellow Fever outbreak in Brazil. For this, the data mining approach with exploratory graph analysis was performed. As main results, Twitter activity peaks were identified compared to peaks of cases reported in some regions of the country, an analysis of hashtags linked to the main subject and different topics from the exploratory analysis of graphs such as vaccination campaign, feelings, prevention, rumors, other diseases linked to the same transmitter, among others. This study illustrates that social networks, such as Twitter, offer unique opportunities for participatory surveillance, which can assist in monitoring some aspects of public health and offer additional data to health managers on how people interact during an outbreak. [ABSTRACT FROM AUTHOR]

In this paper, we discuss the impact of COVID-19 on Brazilian families, considering socioeconomic data from before and during the outbreak. The coronavirus threatens Brazil's entire population. Since May 2020, Brazil is considered the pandemic epicenter, presenting high rates of infections and deaths at least up to the end of August 2020. Families in which members may have lost their jobs or are living from informal work face the challenge of protecting themselves from COVID-19, but also of maintaining financial conditions despite the risk. Access to healthcare has proven to be more precarious for the poor, Indigenous, Black, street population, women, and LGBTQI+. Impacts on the mental health of family members who comply with social isolation and are overburdened with domestic duties, home office and their children's education by digital media are increased by stress, anxiety, and uncertainties about the future. Due to the great impact COVID-19 has provoked on Brazilian families, already existing socioeconomic iniquities increased during the pandemic. Unemployment, bad basic sanitation conditions and a high rate of informal work contrast with the situation of high-income families. The postpandemic period will be decisive for Brazil to prioritize the recovery of its already existing public policies. We suggest the proposed initiatives be organized around the goal of mitigating adverse effects on mental health aggravated by COVID-19. [ABSTRACT FROM AUTHOR]

This paper aims to discuss how the public budget and the model of basic attention in public health could affect the infant mortality rates in a certain territory. The research was carried out in the Southern Coastal Territory of Bahia, in the State of Bahia, Northeast Region of Brazil. It is a quantitative and descriptive investigation, based on secondary data referring to the period from 2006 to 2015, collected between 2017 and 2018 in official Brazilian public data banks. It was verified that, although the average rate of infant mortality fell gradually from 2006 in the territory, it is still higher than the national average within the investigated period. In 2006, the average rate of the territory was 35.53% and decreased to 18.56% in 2015. However, throughout the period the average rate remained higher than the Brazilian average, which is 18%. Infant mortality rates have a strong relationship with social, economic, and environmental factors. In the case investigated, they are associated with the fragmentation and fragility of public health service networks in the municipalities of the region. [ABSTRACT FROM AUTHOR]

Cannabis is the most commonly used illegal drug, and is associated with well-documented adverse health outcomes, both acute and chronic. Cannabis use prevalence in Brazil is lower than in high-use regions in the Americas (e.g., North America), but concentrated among young people. Frameworks for cannabis control are increasingly shifting towards public health-oriented principles, with some countries undertaking respective policy reforms. These frameworks require a continuum of population-level interventions (e.g., prevention and treatment) including targeted prevention of adverse health outcomes among users. In this context, and based on examples from other health fields, an international expert group developed the evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG), originally for Canada, including a set of 10 recommendations based on systematic data reviews and expert consensus methods. The LRCUG form a scientific population-health prevention tool to reduce adverse public health impacts for broad application among cannabis users. In Canada, the LRCUG have been formally endorsed and are supported by leading national health organizations and government authorities within the continuum of cannabis interventions. As the LRCUG are being internationalized, this paper introduces the LRCUG's concept and content - including their original recommendations translated into Portuguese - to the Brazilian context as an evidence-based population-level intervention tool for uptake, dissemination, and discussion. Sociocultural adaptation may be required for meaningful implementation. [ABSTRACT FROM AUTHOR]

The public water supply is a constant subject of concern since its quality depends on many different factors. The intention of this paper was to evaluate the quality of the public water supply in 38 cities from the midwest region of the State of São Paulo, Brazil, during the year of 2016. The parameters investigated included free residual chlorine, pH, apparent color, turbidity, fluoride, nitrate, and the presence of total coliforms and Escherichia coli. In total, from the 2,897 samples of water under analysis, 545 (18.81%) samples conflicted with the country's current legislation. The highest rates of noncompliance were related to fluoride contents and the presence of total coliforms. In addition, high nitrate concentrations (>10 mg/L NO3‐N) were observed in one of the cities' water sample. Our data display the major critical points of the water offered to the population and expose the potential risks for human health, indicating the need of a regular surveillance of the water and the adoption of corrective and preventive measures, in order to avoid the waterborne diseases occurrence, thus contributing to the population's health improvement. Practitioner points: Approximately 20% of the unsatisfactory water samples.High nitrate concentrations in public supply water.Potential risks for human health. [ABSTRACT FROM AUTHOR]

The objective of this study is to verify the impact of federal funding on actions to combat dengue in Brazil. The paper tests the hypothesis that an improvement in dengue epidemiological surveillance actions, a result of increased government funding, reduces reported cases of the disease in the municipalities. Methodologically, the work uses a diff-in-diff model and the evidence suggests that the dengue vector control program, through community-level epidemiological monitoring, is effective as a tool for to reduce the cases of the disease, also presents strong heterogeneity in the response between the regions of the country. [ABSTRACT FROM AUTHOR]

Drawing on ethnographic research conducted from 2011 to 2015 and the authors' long-term engagement in diverse aspects of HIV and human rights advocacy in Brazil, this paper explores key elements of the Brazilian sex workers' movement response to HIV and the broader political factors that profoundly influenced its trajectory. We argue that the movement has constantly challenged representations of prostitution by affirming sex workers' roles as political actors, not just peer educators, in fighting the HIV epidemic and highlight their development of a sex positive and pleasure centred response that fought stigma on multiple fronts. Moments of tension such as the censorship of an HIV prevention campaign and implementation of 'test and treat' projects are analysed, as are the complex questions that Brazil's 2016 political and economic crisis evokes in terms of how to develop and sustain responses to HIV driven by communities but with material commitment from the State. We conclude with what we see to be the unique, central components of Brazilian sex workers' approach to HIV prevention and what lessons can be learned from it for broader collective health movements in Latin America and beyond. [ABSTRACT FROM AUTHOR]

Abstract The Brazilian Unified Health System was created in the late 1980s to ensure free universal access to health care and was funded by taxes and social contributions. The persistent inequity in access to health services in favour of richer individuals in Brazil has been observed in the literature. However, to the best of our knowledge, no measurement of inequality in medicine use or private health insurance (PHI) among children has been performed with longitudinal data. This paper uses inequality indices and their decompositions to analyse the income-related inequalities/inequities in children's health care in the city of Pelotas, Brazil, using longitudinal data following children from 12 to 72 months of age. Our sample with data in all waves has between 1877 and 2638 children (varying according to outcome). We seek to answer three questions: i) How does the inequality/inequity in health care evolve as children grow up? ii) What are the main factors associated with inequality in children's health care? iii) How much of the change in inequality/inequity is explained by mobility in children's health care and income mobility? We found that inequities in health care have their beginnings in early childhood but that there was a reduction in inequity at 72 months of age. Ownership of children's PHI was associated with greater pro-rich inequity in health care. The reduction in inequality/inequity was linked to mobility in the sense that initially poorer children had greater gains in health care (a greater increase in PHI ownership and a lower reduction in medicine use). Despite this improvement among the poorest, apparently, the Brazilian public health service seems to fail to ensure equity in health care use among children, with possible long-term consequences on inequalities in health. Highlights • The inequities in health care have their beginnings even in early childhood. • Income and mother's education have a strong contribution in the inequalities. • Private health insurance has strong contribution in inequalities of medicine use. • There was reduction in inequity for children's health care in Pelotas/Brazil. • This improvement for poorest children occurred when they reached 72 months. [ABSTRACT FROM AUTHOR]

Highlights • The 21-st century has seen many pivotal advances in science and technology. • The BioMed21 Collaboration grew out of a 2015 review paper authored by a diverse group of stakeholders. • "Emerging Technology Toward Pathway-Based Human Brain Research", was the theme of a meeting of the Biomed Collaboration held in Brazil in 2017. • It aimed to foster strategic scientific dialogue and identify actionable consensus towards a roadmap for human-specific health research. The 21st century paradigm in toxicology, which emphasizes mechanistic understanding and species-relevant modeling of human biology and pathophysiology, is gaining traction in the wider biosciences through a global workshop series organized by the BioMed21 Collaboration. The second of this series, entitled Emerging Technology Toward Pathway-Based Human Brain Research, was held in Brazil in 2017, bringing together leading South American and international scientists, research funders and other stakeholders. The aims were to foster strategic scientific dialogue and identify actionable consensus recommendations as a first step toward a roadmap for 21st century, human-specific health research and funding in the region. [ABSTRACT FROM AUTHOR]

This paper questions the relation between human health and society from the case study of leprosy. To discuss the cultural and social mediator factors of both the experience of leprosy and outcomes of medical practices, it examines the biomedical twist in the dialectic between citizenship and public good that aimed to turn leprosy into a disease like any other, with the advent of multidrug therapy during the 1980s. Such analysis is based on a multisited ethnography, developed between 2008 and 2013 in two divergent contexts from the global South and North: Brazil, which remains the country in the world with the highest relative cases of leprosy, and Portugal, in which leprosy has become an imported disease. The main results of this research point to the limits of a pharmaceuticalized governmentality of leprosy and to heterogeneous medicalization’s processes, which evince the determinacy of historical intersections between the State and civil society, as well as the corollaries of the former in medical care. This paper concludes with an analysis of the partition between biomedical cure and the healing of leprosy, which unveils the intermediation of institutional and extrainstitutional factors in access to health and in the cure of leprosy. It is finally argued that such intermediation requires a public health approach that might resocialize leprosy through a paradigmatic shift toward intersectoral and participatory operational strategies. [ABSTRACT FROM AUTHOR]

Within the context of a globalising agenda for genetic research where ‘global health’ is increasingly seen as necessarily informed by and having to account for genomics, the focus on rare genetic diseases is becoming prominent. Drawing from ethnographic research carried out separately by both authors in Brazil, this paper examines how an emerging focus on two different arenas of rare genetic disease, cancer genetics and a class of degenerative neurological diseases known as Ataxias, is subject to and a product of the dynamics of inclusion and exclusion as this concerns participation in research and access to health care. It examines how in these different cases ‘rarenesss’ has been diversely situated and differently politicised and how clinicians, patients and their families grapple with the slippery boundaries between research, rights to health and the limits of care, therapy or prevention. It illustrates how attention to rare genetic disease in Brazil emerges at the intersection of a particular history of genetic research and public health infrastructure, densely complicated feedback loops between clinical care and research, patient mobilisation around the ‘judicialisation’ of health and recent state legislation regarding rare disease in Brazil. It highlights the relevance of local configurations in the way rare genetic disease is being made relevant for and by different communities. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to test whether training correctional facility (CF) officers in the admission process would identify risk factors for inmates' unscheduled transfers to healthcare units in the first 24 hours. Design/methodology/approach Correctional officers (COs) were trained to use a questionnaire with ten closed questions, which seeks to identify occupational or nosocomial risk, applied upon the admission of inmates to a CF. Findings There were 1,288 admissions in six CFs in Ribeirão Preto and Serra Azul/Brazil from March 2010 to May 2011. Of those admissions, 21.2 percent were in penitentiaries and 78.9 percent in provisional detention centers. Of the questionnaires applied, 580 answered affirmatively (45 percent) for one or more of the questions, with nearly 60 percent related to drug use in the last 12 hours, 37.7 percent use of medications while the most frequently mentioned diseases were respiratory diseases (37 percent) and mental disorders (19 percent).The number of positive responses per evaluation presented an odds ratio of 3.6 (CI 95% - 1.6, 10.5) for unscheduled transfers for external clinical evaluation. Research limitations/implications The lack of a control group and the fact that morbidities described by prisoners could not be confirmed are study limitations. The research does, however, still contribute to the goal of achieving appropriate medical care within CFs. Originality/value The training of COs to identify risk factors that predict the need for unplanned transfers to healthcare units was feasible. These findings have important implications for CFs that do not provide ongoing medical service, a universal reality in Brazil. [ABSTRACT FROM AUTHOR]

The global health community is increasingly advocating for the local production of pharmaceuticals in developing countries as a way to promote technology transfer, capacity building and improve access to medicines. However, efforts to advance drug manufacturing in these countries revive an old dilemma of fostering technological development versus granting access to social services, such as healthcare. This paper explores the case of Brazil, a country that has developed large-scale health-inspired industrial policies, but is, yet, little understood. Brazil’s experience suggests that progressive healthcare bureaucrats can create innovative practices for technology and knowledge transfers. It also demonstrates that highly competitive pharmaceutical firms can collaborate with each other, if a government provides them the right incentives. Reforming regulatory policies is crucial for guaranteeing high-quality products in developing countries, but governments must play a crucial role in supporting local firms to adapt to these regulations. These findings send a strong message to global health policymakers and practitioners on the conditions to create a suitable environment for local production of medical products. [ABSTRACT FROM PUBLISHER]

Background: Aedes aegypti, vector of dengue, chikungunya and Zika viruses, is found at high densities in tropical urban areas. The dissemination of this vector is partially the consequence of failures in current vector control methods, still mainly relying upon insecticides. In the State of São Paulo (SP), Brazil, public health managers employed pyrethroids against Ae. aegypti adults from 1989 to 2000, when a robust insecticide resistance monitoring system detected resistance to pyrethroids in several Ae. aegypti populations. However, pyrethroids are also the preferred compounds engaged in household applications due to their rapid knockdown effect, lower toxicity to mammals and less irritating smell. Methodology/Principal findings: We evaluated pyrethroid resistance in Ae. aegypti populations over the course of a decade, from 2004 to 2015, after interruption of pyrethroid public applications in SP. Qualitative bioassays with papers impregnated with a deltamethrin diagnostic dose (DD) performed with insects from seven SP municipalities and evaluated yearly from 2006 to 2014, detected resistance in most of the cases. Quantitative bioassays were also carried out with four populations in 2011, suggesting a positive correlation between resistance level and survivorship in the DD bioassays. Biochemical tests conducted with seven insect populations in 2006 and 2015, detected increasing metabolic alterations of all major classes of detoxifying enzymes, mostly of mixed function oxidases. Genotyping of the voltage-gated sodium channel (AaNaV, the pyrethroid target-site) with a TaqMan real time PCR based technique was performed from 2004 to 2014 in all seven localities. The two kdr mutations, Val1016Ile and Phe1534Cys, known to be spread throughout Brazil, were always present with a severe decrease of the susceptible allele over time. Conclusions/Significance: These results are discussed in the context of public and domestic insecticide use, the necessity of implementation of a strong integrated vector control strategy and the conceptual misunderstanding between 'vector control' and 'chemical control of vectors'. [ABSTRACT FROM AUTHOR]

In the present paper, an investigation regarding the transformations of studies published in the Brazilian Journal of Public Administration (RAP) from 2003 to 2016 was conducted, through bibliometric research. The main results indicate consolidation of the field, with an increase in the number of authors per article. Most authors were male, although with a high participation of female researchers, in a context where most authors are Brazilian, from public institutions. Case-studies, applied-approaches and quantitative methodology studies increased in comparison to studies published from 1994 to 2002. [ABSTRACT FROM AUTHOR]

Most policies, explicitly or implicitly, involve sharing responsibilities between different organizations, such as departments, government spheres, ministries, or private organizations. Thus, in recent decades, networks have become increasingly common in public policies. The Brazilian health system - given its size and geographic scope - is an example of complexity and sometimes fragmentation in policy implementation. In this context, the government adopts the concept of Healthcare Networks (RASs) in the operation of its health system. A characteristic that defines RASs is their regional character, since it is necessary to go beyond the municipal borders for the optimization of resources. This scenario of interregional relations becomes denser when the territory in question is configured in an urban superstructure, as is the case in metropolitan regions. Thus, this paper proposes the discussion of the case of Healthcare Networks in the Brazilian metropolitan regions and describes, in greater detail, the case of Campinas Metropolitan Region. [ABSTRACT FROM AUTHOR]

In recent decades, the Aedes aegypti mosquito, the vector of dengue, Zika, chikungunya and other diseases, has become an increasing concern in Brazil and other tropical countries. However, the spatial distribution of these diseases in Brazil is not homogeneous, implying that there are distinct risk levels and various guiding strategies for fighting these diseases. This paper presents a didactic exploratory multivariate spatial data analysis of dengue, Zika and chikungunya cases in Brazil in 2016 in the context of an undergraduate course. The students elaborated, interpreted and discussed multivariate maps using techniques such as proportional symbols, hachure density, bivariate and trivariate choropleth composition, contiguous cartograms, conditional maps and matrices of maps and graphs. The students investigated the various interpretative possibilities based on the intrinsic and extrinsic combinations of multivariate geovisualizations. Through their interpretations of the spatial representations, the students were able to identify that the states of Rio Grande do Norte, Paraíba and Alagoas are experiencing the most critical situations for these three diseases, while the state of Minas Gerais has a serious situation only for dengue. In contrast, the maps clearly revealed that the states of Rio Grande do Sul, Santa Catarina and the Northern Region of the country experienced fewer cases of the diseases. It can be concluded that the undergraduate course improved the students' abilities to build and interpret spatial representations using geotechnologies. [ABSTRACT FROM AUTHOR]

To detect outbreaks of diseases in public health, several control charts have been proposed in the literature. In this context, the usual generalized linear model may be fitted for counts under a Negative Binomial distribution with a logarithm link function and the population size included as offset to model hospitalization rates. Different statistics are used to build CUSUM control charts to monitor daily hospitalizations and their performances are compared in simulation studies. The main contribution of the current paper is to consider different statistics based on transformations and the deviance residual to build control charts to monitor counts with seasonality effects and evaluate all the assumptions of the monitored statistics. The monitoring of daily number of hospital admissions due to respiratory diseases for people aged over 65 years in the city São Paulo-Brazil is considered as an illustration of the current proposal. [ABSTRACT FROM AUTHOR]

Since 1993, Brazil's public Unified Health System (SUS) has been enhancing the provision of hearing healthcare services, ranging from prevention to intervention. The provision of quality services is challenged by the country's large size, socio-economic contrasts, poorly distributed infrastructure, and the concentration of qualified audiology professionals in metropolitan areas. It is estimated that 14 million Brazilians have a disabling hearing impairment -- a number already beyond service capacity. Increased life expectancy enlarges the prevalence of hearing impairment, further saturating the system. Ongoing societal changes call for alternative approaches to healthcare -- one of them being telehealth. This paper describes the milestones in the development of hearing healthcare public policies in Brazil and discusses the main concepts behind the provision of services via telehealth and the implementation of the Brazilian Telehealth Networks Program. Furthermore, the results and implications of research on remote hearing aid fitting, conducted at Bauru Dental School, are presented. This review indicates that issues such as shortage of audiologists, lack of the use of real ear measures, and patient absenteeism could be mitigated by incorporating remote hearing aid fitting routinely in public hearing healthcare clinics. But in order to implement this approach, more constructive interactions among different stakeholders is required. Overall, telehealth has the potential to help healthcare providers meet the demands of a technologically increasing society. [ABSTRACT FROM AUTHOR]

Air pollution is an important public health issue. High levels of carbon monoxide in the atmosphere are hazardous to human health. Studies regarding the concentration of this and other gases in the atmosphere allow political actions to manage and reduce the emission of pollutants. In this context, this paper studied the annual, seasonal, weekly and daily variations of carbon monoxide (CO) concentration for the Metropolitan Region of São Paulo (MRSP).We studied three sites in the MRSP, two of them are located in areas under the influence of heavy vehicle traffic (Osasco and Congonhas) and the third one in a city park (Ibirapuera Park). The results showed high influence of gasoline vehicles on CO emission. In the annual scale, CO concentration decreased due to improvements in emission technology, despite the increasing number of vehicles. CO emission showed a seasonal, weekly and diurnal cycle associated to meteorological conditions and emission patterns. The highest values of mean concentration were observed in June/July for Osasco (2.20 ppm), Congonhas (2.04 ppm) and Ibirapuera (1.04 ppm), during the morning, due to weak dispersion of the polluting gases and higher emission from the rush hours. [ABSTRACT FROM AUTHOR]

Engaging in collaborative networks can be an important facilitator of innovation for public sector science and technology (S&T) organizations. It is also an important component of S&T policies that require indicators that can assess the networks through which these organizations innovate. In this study, we apply network indicators to two S&T organizations that are part of the Brazilian public health sector. The indicators cover two complementary perspectives: one that considers the organizations' scientific networks and the other that considers their technological networks. The indicators allowed the analysis of the networks in which the organizations were engaged and the understanding of important aspects of their collaboration patterns that can support strategic decisions. The method employed in this paper proved to be a valuable diagnostic tool and a useful mechanism for evaluating the performance and supporting the development of S&T institutions. [ABSTRACT FROM AUTHOR]

Objective: International guidelines recommend routine screening for distress as part of care practices. Accordingly, a Brazilian cancer center developed and implemented a distress screening program (DS) in 2007, which was enhanced in 2009 through the inclusion of a psychosocial care meeting group (DS + PCM) regarding patients' psychosocial needs. The current paper will provide an overview of the development and pilot implementation of this program and initial analyses to assess patient outcomes and report initial results to extend international research on this key aspect of cancer care.Method: Patients were assessed for distress, anxiety and depression, and in the DS+PCM phase for quality of life at the first day of chemotherapy infusion, at midpoint, and at treatment end. We compared data from program phases (DS vs DS + PCM), with a sequential cohort design and mixed effects modeling.Results: Clinical and demographic characteristics were similar between groups. Patients receiving DS + PCM showed significantly lower distress and depression/anxiety upon chemotherapy initiation (Ps < .001). While both groups reported significantly lowered distress and total depression/anxiety scores across time (Ps < .003), patients receiving DS + PCM maintained the lowest distress and total anxiety/depression at all assessments. Patients from DS + PCM group also reported improvements in quality of life over time.Conclusions: The current study provides preliminary evidence that a multidisciplinary structured screening program utilizing validated measures and team meetings is associated with reduced impairment in patients' psychological well being. This program provided more opportunities for collaboration among providers with increased multidisciplinary meetings, enabled patients to more easily report problems, and ensured rapid access to relevant resources. [ABSTRACT FROM AUTHOR]

The struggle for healthy eating is a nascent social movement that represents active resistance to the hostile food environments created by multinational food and beverage corporations. Using a political economy approach and leveraging Winson's [2013.The industrial diet: the degradation of food and the struggle for healthy eating. Vancouver: UBC Press] concepts of dietary regimes and the industrial diet, this paper will examine the strengths and limitations of Brazil's new dietary guidelines and discuss its role as a precursor to a new dietary regime that incorporates social justice and sustainability. [ABSTRACT FROM AUTHOR]

Background: Community-based primary mental health care is recommended in low and middle-income countries. The Brazilian Health System has been restructuring primary care by expanding its Family Health Strategy. Due to mental health problems, psychosocial vulnerability and accessibility, Matrix Support teams are being set up to broaden the professional scope of primary care. This paper aims to analyse the perceptions of health professionals and managers about the integration of primary care and mental health. Method: In this mixed-method study 18 health managers and 24 professionals were interviewed from different primary and mental health care services in Rio de Janeiro. A semi-structured survey was conducted with 185 closed questions ranging from 1 to 5 and one open-ended question, to evaluate: access, gateway, trust, family focus, primary mental health interventions, mental health records, mental health problems, team collaboration, integration with community resources and primary mental health education. Two comparisons were made: health managers and professionals' (Mann-Whitney non-parametric test) and health managers' perceptions (Kruskall-Wallis non parametric-test) in 4 service designs (General Traditional Outpatients, Mental Health Specialised Outpatients, Psychosocial Community Centre and Family Health Strategy)(SPSS version 17.0). Qualitative data were subjected to Framework Analysis. Results: Firstly, health managers and professionals' perceptions converged in all components, except the health record system. Secondly, managers' perceptions in traditional services contrasted with managers' perceptions in community-based services in components such as mental health interventions and team collaboration, and converged in gateway, trust, record system and primary mental health education. Qualitative data revealed an acceptance of mental health and primary care integration, but a lack of communication between institutions. The Mixed Method demonstrated that interviewees consider mental health and primary care integration as a requirement of the system, while their perceptions and the model of work produced by the institutional culture are inextricably linked. Conclusion: There is a gap between health managers' and professionals' understanding of community-based primary mental health care. The integration of different processes of work entails both rethinking workforce actions and institutional support to help make changes. [ABSTRACT FROM AUTHOR]

The emergence of scientific disciplines, as well as the policies aimed to steer them, have geographical implications. This becomes visible in areas such as genomics and related fields. In this paper, the relation between scientific evolution, political decisions and geographical configuration is studied. The recent formation of bioinformatics in Brazil is focused on. The study involves an analysis of data collected on the website of CNPq, a funding agency attached to the Ministry of Science and Technology. Furthermore, I conducted fieldwork in four cities, interviewing 15 bioinformaticians. In the history of Brazilian bioinformatics, three periods can be identified. In the first period (1900-1996), bioinformatics was actually absent, but biology research groups were formed which would subsequently explore bioinformatics. The second period (1997-2006) was marked by the emergence of the discipline and geographical concentration of major research groups in the southern part of Brazil. A third period can be pointed to (2007-2014), in which political choices have turned geographical diffusion and institutional equality into a national target. As a consequence of the recent shifts, genomics and bioinformatics researchers have been involved in a debate, some defending the existence of few specialized research and sequencing platforms, whereas others welcoming the constitution of a scientific scenario based on decentralized platforms. I defend an intermediate solution, whereby some places would be selected to be genomics hubs. This would fit the regional diversity of this vast country, in addition to tackling the scientific weaknesses of the northern area. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity is a public health problem with high prevalence and important consequences. The aim of this paper was to verify the prevalence and distribution of multimorbidity in Brazilian older adults.Methods: A population-based survey was carried out in 2008 through face-to-face interviews with 1593 older adults (aged 60 or over) living in Bagé, a medium-sized city in Southern Brazil. Multimorbidity was evaluated by 17 morbidities and operationalized according to two cutoff points: 2 or more and 3 or more morbidities. Descriptive analysis examined the occurrence of multimorbidity by demographic, socioeconomic and health services variables. Observed and expected dyads and triads of diseases were calculated.Results: From total sample, 6 % did not have morbidities. Mean morbidity was 3.6. Morbidities showing higher prevalence were high blood pressure - HBP - (55.3 %) and spinal column disease (37.4 %). The percent of participants with multimorbidity was 81.3 % (95 % CI: 79.3; 83.3) for 2 or more morbidities and 64.0 % (95 % CI: 61.5; 66.4) for 3 or more morbidities. In both measures occurrence was higher among women, the more elderly, less socioeconomic status, the bedridden, those who did not have a health private plan, those who used health services and those living in Family Health Strategy catchment areas. We found 22 dyads of morbidities with prevalence 10 % or more and 35 triads with prevalence 5 % or more. The most prevalent observed pair and triplet of morbidities were HBP and spinal column disease (23.6 %) and HBP, rheumatism/arthritis/arthrosis and spinal column disease (10.6 %), respectively.Conclusions: Multimorbidity frequency was high in the sample studied, in keeping with percentage found in other countries. The social inequities identified increase the health system challenges for the management of multimorbidity, requiring a comprehensive and multidimensional care. The combinations of diseases can provide initial input to include multimorbidity in Brazilian clinical protocols. [ABSTRACT FROM AUTHOR]

There have been many empirical studies associating commuting time and health outcomes in the last few decades. Their general conclusion is that commuting and health are negatively related. The validity of their findings, however, is questionable, given their lack of good identification strategies to correctly account for omitted variables. In this paper, we analyze this relationship using a large and unique nationally representative sample of Brazilian individuals, coupled with the use of propensity score matching techniques, and the application of an exhaustive set of standard falsification tests and sensitivity analysis that may prevent one from claiming a causal link between the two variables. Our results indicate that individuals with more than one hour of commuting appear to have statistically higher probability, ranging from 1.9 to 4.6 percentage points, of reporting bad health status when compared to a person whose commuting time is less than one hour. [ABSTRACT FROM AUTHOR]

The historical museums, such as the monuments, have been understood as images the societies produce for the future. However, this concept of museums as maintainers and guardians of the memory of a community or a locality is been revised. The city of Londrina, even though fairly new, preserves by various means a praise of the memory of certain groups, called 'pioneers'. The challenging of such memorial practices and inclusion of new actors is quite controversial and costly. Thus, this paper aims to reflect on the representations of women in the language of the Historical Museum of Londrina. To this end, it is proposed to analyze a temporary exhibition placed in that Museum: "Caring, Healing, Remember - memory of the health in Londrina." Therefore, we will investigate what (s) language (s) the MHL aligns to and presents itself for the public. [ABSTRACT FROM AUTHOR]

Lyme disease is a systemic infection caused by a tick bite and transmission of the Borrelia burgdorferi spirochete. Species of tick vectors of the disease infest mainly wild or rural animals and rodents that may be asymptomatic reservoirs of the bacteria. Characteristic of the northern hemisphere, Lyme disease in Brazil takes on different characteristics, complicating diagnosis. This paper aims to describe three cases of Lyme-like disease in a city in the state of Bahia, Brazil, with ophthalmologic findings. [ABSTRACT FROM AUTHOR]