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The provision of care and support to persons living with human immunodeficiency virus (HIV) in Brazil who also use drugs and/or alcohol represents special challenges because of the combined effects of addiction, poverty, stigma, and discrimination. This paper presents details on a program providing both clinic- and field- based care to HIV-infected injection drug users, highlighting the use of a specialized case management approach to address the clinical and psychosocial needs of this population. This program includes both a mobile case management team that fosters group discussions and provides individual counseling, and provision of medical consultations at 2 major drug treatment centers in Rio de Janeiro. The article also describes the experience of working with injection drug users who regularly attend an outpatient clinic serving marginalized communities through the use of mutual self-help groups and specialized support groups to address to issue of adherence to antiretroviral therapies for the treatment of HIV/acquired immunodeficiency syndrome. [ABSTRACT FROM AUTHOR]

The article focuses on a research that describes the parasitization of a 49-year-old single man with tracheostomy by larvae of the screwworm called Cochliomyia hominivorax while undergoing chemotherapy treatment for cancer in a hospital located in Rio de Janeiro, Brazil. It states that the occurrence of obligate myiasis caused by screwworm in urban and rural environments represent serious economic and public health concerns.

The article discusses community health agents (CHA) in Brazil and an evaluation of how effective such persons can be in situations where they are helping people in dangerous areas. The Family Health Strategy in Brazil promotes health education and oversees the work of CHAs. The disparate living conditions that divide the rich from the poor and the social implications are discussed. The CHAs work in the communities in which they live and a description is included of the work they do to identify health problems and educate the community about health concerns. It is noted that some CHAs who encountered children not enrolled in school addressed the situation and also help their clients in terms of improving their quality of life.

This article explores the criminal regulation of misoprostol as a controlled drug in Brazil as a new form of abortion criminalization. A qualitative analysis of Brazilian case law shows how the courts use a public health rhetoric of unsafe abortion to criminalize the distribution of misoprostol in the informal sector. Rather than an invention of the local bench, this judicial rhetoric reflects global public health discourse and policy on unsafe abortion and the double life of misoprostol as both an essential medicine and a controlled drug. In contrast to previous studies, the article shows that abortion criminalization is not the cause, but rather the consequence of misoprostol's double life. In the last section, it draws on an outlier judgment of the case law to chart a regulatory future for misoprostol and its supply in the informal sector as a site of harm reduction and safe abortion in public health policy. [ABSTRACT FROM AUTHOR]

Background To evaluate the early age of onset (AOO) of alcohol consumption and its association with sociodemographic, nutritional and lifestyle characteristics. Methods A national cross-sectional multi-centered study assessed 12–17-year old adolescents from 1247 public and private schools in 124 Brazilian municipalities with more than 100 000 habitants. Our variable of interest was the AOO of alcohol consumption. Covariates comprised sociodemographic status, lifestyle habits and nutritional parameters. We used adapted survival models to investigate the association between covariates and the AOO of alcohol consumption. Results From a sample of 67 672 adolescents, 50% were females. The mean AOO of alcohol consumption was 12.9 years. Male adolescents had a lower mean age of alcohol experimentation when compared to females in Northeast and South regions. The difference between private and public school for AOO was observed only for the Northeast Region (12.6 versus 13.1, respectively). Adolescents who reported smoking or mental health problems or from the Southern Region presented earlier alcohol use. Physical activity and overweight were positively associated with earlier use of alcohol. Conclusions There is no homogeneity in the AOO of alcohol consumption among adolescents, which should be considered when formulating public policies and government campaigns directed toward reducing alcohol consumption. [ABSTRACT FROM AUTHOR]

The health sector is considered extremely important by governments and multilateral international organisms, due to its implication to life, as well as material and human struggling involved. This study adopts a systematical approach in order to question if the mortality outcomes in medium Brazilian cities explain or may be explained by factors considered external to the public health service, expressed by health social determinants. Therefore, this study aims to investigate health conditions in public health management in medium Brazilian cities. The scenario adopted contains 192 cities with a population contingent between 100 000 and 500 000 inhabitants, between the years 2007 and 2011. The database produced, containing 30 indicators representing conceptual models referenced, allowed the elaboration of an operational model of health social determinants from a Bayesian network. As result, we elaborated a model of health system formed by six factors, showing associations that allow a better comprehension about relations among health social determinants and health conditions, producing contextualized information, able to subsidize the formulation of strategies by managers of Sistema Único de Saúde. [ABSTRACT FROM AUTHOR]

Introduction Ovarian cancer (OC) is the most lethal gynecological tumor. In Brazil, there are important regional differences regarding mortality rates for the same cancer type. Objectives To analyze the progression of OC mortality rates in Brazil and its regions, in age groups over 50 years, between 2000 and 2015. Methods Ecological longitudinal study carried out using secondary data from DATASUS (Brazil's public health system database) regarding deaths due to OC in women living in Brazil between 2000 and 2015. We calculated gross and adjusted mortality, estimated the impact of death of OC and proportional mortality rate of all cancer types in women between the age of 50 and 79 years. Results There were 34.335 deaths due to OC in women in the referred age interval, with a 9% increase in mortality adjusted for age, a 0.05% (P = 0.012) trend and a 24.67% increase in the proportional mortality due to all causes with a 0.02% (P < 0.001) trend. There were statistically significant increases in mortality rates due to OC in the age groups of 50–54 (28,4%, P < 0,05) and 75–79 years (25,1%, P < 0,05). Conclusion Although there are oscillations in mortality rates of OC in Brazil and its regions over the period studied, this parameter has remained relatively stable. [ABSTRACT FROM AUTHOR]

Universal Health Coverage (UHC) is one of the United Nations Sustainable Development Goals (SDGs). Achieving UHC will require strong health systems to promote and deliver equitable and integrated healthcare services through primary healthcare (PHC). In Brazil, the Family Health Strategy (FHS) delivers PHC through the public health system. Created in 1994, the FHS covered almost 123 million individuals (63% of the Brazilian population) by 2015. The FHS has been associated with many health improvements, but gaps in coverage still remain. This article examines factors associated with the implementation and expansion of the FHS across 5419 Brazilian municipalities from 1998 to 2012. The proportion of the municipal population covered by the FHS over time was assessed using a longitudinal multilevel model for change that accounted for variables covering eight domains: economic development, healthcare supply, healthcare needs/access, availability of other sources of healthcare, political context, geographical isolation, regional characteristics and population size. Data were obtained from multiple publicly available sources. During the 15-year study period, national coverage of the FHS increased from 4.4% to 54%, with 58% of the municipalities having population coverage of 95% or more, and municipalities that had not adopted the programme decreased from 86.4% to 4.9%. The increase in FHS uptake and coverage was not homogenous across municipalities, and was positively associated with small population size, low population density, low coverage of private health insurance, low level of economic development, alignment of the political party of the Mayor and the state Governor, and availability of healthcare supply. Efforts to expand the FHS coverage will need to focus on increasing the availability of health personnel, devising financial incentives for municipalities to uptake/expand the FHS and devising new policies that encompass both private and public sectors. [ABSTRACT FROM AUTHOR]

Copyright of Health Policy & Planning is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Family Practice is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Health Policy & Planning is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives How to provide effective and efficient care to the burgeoning and aging populations of the major cities of low- and middle-income countries constitutes one of the principle public health issues of our times. We evaluated the Family Health Strategy, the Brazilian national health system’s public approach to primary health care, in the major city of Belo Horizonte, describing trends and factors associated with hospitalizations for primary care sensitive conditions following the implementation of 506 family health teams, most of which were established in 2002.Methods We conducted an ecological study covering 2003 to 2006, using mixed models to investigate time trends in public system hospitalizations as well as their association with social vulnerability and primary care team characteristics.Results Sensitive conditions accounted for 115 340 (26.4%) hospitalizations. Over the 4-year period, hospitalizations for sensitive conditions declined by 17.9%, vs only 8.3% for non-sensitive ones (P < 0.001). Hospitalization for sensitive conditions declined 22% for women in areas of high social vulnerability vs 9% for women in areas of low vulnerability (P < 0.001); for men, 17% vs 10% (P = 0.11).Conclusions Though the ecologic nature of our study limits the confidence with which conclusions can be affirmed, the Family Health Strategy appears to have contributed to a major reduction in hospitalizations due to primary care sensitive conditions in this large Brazilian metropolis, while at the same time promoting greater health equity. [ABSTRACT FROM AUTHOR]

The article focuses on a research conducted in order to investigate the occurrence and epidemiological aspects of human myiasis caused by the screw-worm, Cochliomyia hominivorax, in Rio de Janeiro, Brazil. It discusses the use of vaseline to suffocate the larvae, followed by their preservation in 70 percent ethanol. The study revealed the occurrence of factors like open wounds, poor personal hygiene, alcoholism and physical or mental disability that are responsible human myiasis.

BACKGROUND In Brazil, access to infertility care, including assisted reproductive technology (ART) is restricted. This is a second report of a study which evaluated the availability and access of low-income couples to ART services. The objective was to assess the perspective of health professionals and patients with respect to access to ART procedures within the public health network METHODS Qualitative case studies were conducted in five centres offering ART in the public sector. Semi-structured interviews were conducted with 19 health professionals based at these centres and 48 patients (men and women). Data were analysed using thematic content analysis. RESULTS All services implemented ART procedures using resources already available. In all except one centre, patients had to pay for the drugs used for the procedures and, in some cases, a fee to cover operative costs and supplies. These charges were incompatible with the financial possibilities of the majority of the low-income Brazilian population. The waiting time for access to ART varied between 3 months and 6 years. In the perspective of both patients and health professionals, the government should help centres to offer ART procedures at no cost to low-income populations. CONCLUSIONS The low-income Brazilian population has limited access to ART procedures at the public services. The implementation of ART services cannot be based only on initiatives of the professionals involved but must be part of public health policies. One possible solution is to provide ART at lower cost, making it accessible for a large part of the population. [ABSTRACT FROM PUBLISHER]

Traces the history of measles control and elimination in Brazil and presents evidence for the interruption of measles transmission in the country in 2000-2001. Designation of one measles surveillance technician to each state; Number of suspected measles reported in 2000; Occurrence of the least outbreak in February 2000.