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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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

This paper describes the Brazilian health system, which includes a public sector covering almost 75% of the population and an expanding private sector offering health services to the rest of the population. The public sector is organized around the Sistema Único de Saúde (SUS) and it is financed with general taxes and social contributions collected by the three levels of government (federal, state and municipal). SUS provides health care through a decentralized network of clinics, hospitals and other establishments, as well as through contracts with private providers. SUS is also responsible for the coordination of the public sector. The private sector includes a system of insurance schemes known as Supplementary Health which is financed by employers and/or households: group medicine (companies and households), medical cooperatives, the so called Self-Administered Plans (companies) and individual insurance plans. The private sector also includes clinics, hospitals and laboratories offering services on out-of-pocket basis mostly used by the high-income population. This paper also describes the resources of the system, the stewardship activities developed by the Ministry of Health and other actors, and the most recent policy innovations implemented in Brazil, including the programs saúde da Familia and Mais Saúde. [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]

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]

Background: Unhealthy lifestyle choices, such as smoking and sedentary behavior, are among the main modifiable risk factors for chronic non-communicable diseases. The workplace is regarded as an important site of potential health risks where preventive strategies can be effective. We investigated independent associations among psychosocial job strain, leisure-time physical inactivity, and smoking in public servants in the largest Brazilian adult cohort. Methods: We conducted a cross-sectional analysis of baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)-a multicenter prospective cohort study of civil servants. Our analytical samples comprised 11,779 and 11,963 current workers for, respectively, analyses of job strain and leisure-time physical activity and analyses of job strain and smoking. Job strain was assessed using the Brazilian version of the Swedish Demand-Control-Support Questionnaire; physical activity was evaluated using a short form of the International Physical Activity Questionnaire. We also examined smoking status and number of cigarettes smoked per day. The association reported in this paper was assessed by means of multinomial and logistic regression, stratified by sex. Results: Among men, compared with low-strain activities (low demand and high control), job strain showed an association with physical inactivity (odds ratio [OR] = 1.34; 95% confidence interval [CI] = 1.09-1.64) or with the practice of physical activities of less than recommended duration (OR = 1.44; 95% CI = 1.15-1.82). Among women, greater likelihood of physical inactivity was identified among job-strain and passive-job groups (OR = 1.47; 95% CI = 1.22-1.77 and OR = 1.42; 95% CI = 1.20-1.67, respectively). Greater control at work was a protective factor for physical inactivity among both men and women. Social support at work was a protective factor for physical inactivity among women, as was smoking for both genders. We observed no association between demand or control dimensions and smoking. Conclusions: Job strain, job control, and social support were associated with physical activity. Social support at work was protective of smoking. Our results are comparable to those found in more developed countries; they provide additional evidence of an association between an adverse psychosocial work environment and health-related behaviors. [ABSTRACT FROM AUTHOR]

Despite the serious threat to public health that it represents, hazardous household waste (HHW) is not perceived as dangerous by a majority of the population. Existing waste management systems contribute to this misperception, by underestimating the importance of these residues. This, in practice, reflects the lack of knowledge of citizens about the risks and about their responsibility. This study aimed to identify the major HHW generated and disposal practices of the population of São Luís District and know the HHW management situation of the municipality of Canoas, Brazil. We conducted a neighborhood survey, identifying the generation and destination of 15 types of HHW. The situation of the management of this waste was obtained through consultations with the City of Canoas, where we observed little effective action to correct mismanagement. With the aim of improving the current administration, this paper proposes the use of the Family Health Strategy as a liaison for implementation of an appropriate hazardous household waste management program. The role of Community Health Workers restates the important potential for the integration of environmental education and preventive action. [ABSTRACT FROM AUTHOR]

The Secretary of Health State of Minas Gerais, with the support of the Ministry of Health, have been making extensive effort to universalize the primary health care, given its strategic role in the formation the networks of the health care in the Unique Health System (SUS). Therefore, began to encourage the adoption of the Family Health Teams through of the "Program Structuring Health at Home". Associated with this program, was created the Master Plan of the Primary Health Care (PDAPS), whose goal it's provide an instrument to territorial planning and management of these service, qualifying them to fulfill the role as gateway of the network of the health in the SUS. The aim of this paper is discuss the territorial planning of the primary health care and the networks of the health care the SUS in Minas Gerais, Brazil. The hypothetical premise of the discussion is the existential interdependence between primary health care, networks and the territory. The methodology is based on a theoretical study and descriptive, on one side, and a theorical analysis and critical, of another. Therefore, have a dimension of discovery of the relationship between networks, territory and primary health care, on one side, and a dimension of note about the ways how this is being planned, of another. The results indicate improvements in the construction of networks in Minas Gerais, but there are also theoretical issues and methodological that needs to be addressed, especially on the forms of territorial definition of the services. [ABSTRACT FROM AUTHOR]

The obesity epidemic is rapidly advancing in South America, leading to inevitable health consequences. Argentinian and Brazilian health policies try to become adapted to the new economic and social framework that follows from this epidemic. It is in incipient and ineffective control so far since the prevalence of obesity was not restrained. The Argentine national legislation is more advanced, through the so-called "Ley de Obesidad." In Brazil, there are numerous local initiatives but still not a comprehensive law. National policies relating to decisions regarding obesity are discussed in this paper. Trends in decisions issued in higher courts of Argentina (Supreme Court of Justice of the Nation-CSJN) and Brazil (Supreme Court of Justice-STF), in the last 15 years, seek to clarify the approach of each country and court´s resolutions. Marked differences were found in their positions. Finally, legal and health solutions to this obesity epidemic are proposed. [ABSTRACT FROM AUTHOR]

The management processes of the Unified Health System (SUS) are supported by a set of information systems with national scope, having features for the epidemiological, ambulatory, hospital, and administrative areas. This article proposes a model for evaluating health information systems that may be applied to the systems of SUS. It describes the research, analysis, and classification process of evaluation indicators for the model. The indicators were obtained by search in bibliographic databases and they were classified according to the quality attributes of the standard ISO/IEC 25010, adopted as quality model in the study. As a result, 66 indicators were identified and mapped, covering all quality features of the model. This paper will be able to contribute as a further reference for studies involving quality assessment processes for softwares in health and to assist in the standardization of plans for assessing and monitoring the quality of systems and data on public health in Brazil and in projects for improving softwares. [ABSTRACT FROM AUTHOR]

This paper aims to draw the historical framework of the Nutritional Care Program for People with Special Dietary Needs (PAN), the advancements and challenges in public policy for people with special dietary needs in the city of Curitiba, Parana state, Brazil. Historically, PAN was created to replace the former Enteral Diets and Special Milks Program and to organize nutritional care in the city, so as to offer better nutritional care to these people, based on the principles of the Unified Health System (SUS). In this perspective, we attempted to draw the historical framework of PAN in the management of public policies within the SUS, and at such a landmark, the impact in management, professionals and users involved in this process. [ABSTRACT FROM AUTHOR]

The article discusses the paper "Profile of judicial demands filed against the Ministry of Health for the provision of nutrition formulas," which focuses on the importance of nutrition to health, the judicial lawsuits against the Ministry of Health in Brazil, and the judicial system in the country.

The aim of this paper is to present the historical background in which the current Brazilian Health Policy was drawn, telling both a literature survey conducted with authors who address the topic of Social Services and Mental Health and the relation of social work with respective area, among the authors discussed include Iamamoto (2002), Faleiros (2000), Vasconcelos (2010) and Bravo (2006). The work will take into account the major changes in the Brazilian reality from the 1930s to the period of great social mobilization that occurred in the 1980s, which resulted in the promulgation of the 1988 Constitution, considered one of the greatest achievements of Brazilian society, the article will highlight the importance of this document for effective health policy of the country. Then far will a brief explanation of the insertion of the social worker in the area of Brazilian psychiatry and its participation in the first institutions dedicated to serving the mentally ill. Later we will describe on the Mental Health area, identifying key areas of work that rely on the work of this professional, which is driven by both the principles and guidelines of the National Health System as well as the principles of psychiatric reform, enhancing professional action and recognition in the field of health in Brazil. [ABSTRACT FROM AUTHOR]

Background A number of scientific papers on yellow fever have been published but no broad scientometric analysis on the published research of yellow fever has been reported. The aim of the article based study was to provide an in-depth evaluation of the yellow fever field using large-scale data analysis and employment of bibliometric indicators of production and quantity. Methods Data were retrieved from the Web of Science database (WoS) and analyzed as part of the NewQis platform. Then data were extracted from each file, transferred to databases and visualized as diagrams. Partially by means of density-equalizing mapping makes the findings clear and emphasizes the output of the analysis. Results In the study period from 1900 to 2012 a total of 5,053 yellow fever-associated items were published by 79 countries. The United States (USA) having the highest publication rate at 42% (n = 751) followed by far from Brazil (n = 203), France (n = 149) and the United Kingdom (n = 113). The most productive journals are the "Public Health Reports", the "American Journal of Tropical Medicine and Hygiene" and the"ournal of Virology". The gender analysis showed an overall steady increase of female authorship from 1950 to 2011. Brazil is the only country of the five most productive countries with a higher proportion of female scientists. Conclusions The present data shows an increase in research productivity over the entire study period, in particular an increase of female scientists. Brazil shows a majority of female authors, a fact that is confirmed by other studies. [ABSTRACT FROM AUTHOR]

Recent debate on institutional change in the Brazilian public health system pays little attention to organizational innovation in Hospital Units (HUs). Calling upon the analytical framework proposed by Economic Analysis to investigate asymmetric information and innovation, this paper analyzes the connections among effectiveness of rules, routines and protocols, staff training, and service quality in HUs with the help of statistical analysis of Hospital Accreditation reports. The convenience sample consisted of ten reports containing perceived assessment data. As a theoretical contribution, the proposed model analyzes the dynamic relationship between organizational innovation, service quality and growth in HU and development of the market for healthcare services. Empirical findings show that the effect of organizational innovation in Referral Hospital Units is stronger than the effect of staff training. [ABSTRACT FROM AUTHOR]

Background: Brazil has reduced its smoking rate by about 50% in the last 20 y. During that time period, strong tobacco control policies were implemented. This paper estimates the effect of these stricter policies on smoking prevalence and associated premature mortality, and the effect that additional policies may have. Methods and Findings: The model was developed using the SimSmoke tobacco control policy model. Using policy, population, and smoking data for Brazil, the model assesses the effect on premature deaths of cigarette taxes, smoke-free air laws, mass media campaigns, marketing restrictions, packaging requirements, cessation treatment programs, and youth access restrictions. We estimate the effect of past policies relative to a counterfactual of policies kept to 1989 levels, and the effect of stricter future policies. Male and female smoking prevalence in Brazil have fallen by about half since 1989, which represents a 46% (lower and upper bounds: 28%-66%) relative reduction compared to the 2010 prevalence under the counterfactual scenario of policies held to 1989 levels. Almost half of that 46% reduction is explained by price increases, 14% by smoke-free air laws, 14% by marketing restrictions, 8% by health warnings, 6% by mass media campaigns, and 10% by cessation treatment programs. As a result of the past policies, a total of almost 420,000 (260,000-715,000) deaths had been averted by 2010, increasing to almost 7 million (4.5 million-10.3 million) deaths projected by 2050. Comparing future implementation of a set of stricter policies to a scenario with 2010 policies held constant, smoking prevalence by 2050 could be reduced by another 39% (29%-54%), and 1.3 million (0.9 million-2.0 million) out of 9 million future premature deaths could be averted. Conclusions: Brazil provides one of the outstanding public health success stories in reducing deaths due to smoking, and serves as a model for other low and middle income nations. However, a set of stricter policies could further reduce smoking and save many additional lives. [ABSTRACT FROM AUTHOR]

Abstract: A number of proposals for integrating geographical (Geographical Information Systems—GIS) and multidimensional (data warehouse—DW and online analytical processing—OLAP) processing are found in the database literature. However, most of the current approaches do not take into account the use of a GDW (geographical data warehouse) metamodel or query language to make available the simultaneous specification of multidimensional and spatial operators. To address this, this paper discusses the UML class diagram of a GDW metamodel and proposes its formal specifications. We then present a formal metamodel for a geographical data cube and propose the Geographical Multidimensional Query Language (GeoMDQL) as well. GeoMDQL is based on well-known standards such as the MultiDimensional eXpressions (MDX) language and OGC simple features specification for SQL and has been specifically defined for spatial OLAP environments based on a GDW. We also present the GeoMDQL syntax and a discussion regarding the taxonomy of GeoMDQL query types. Additionally, aspects related to the GeoMDQL architecture implementation are described, along with a case study involving the Brazilian public healthcare system in order to illustrate the proposed query language. [Copyright &y& Elsevier]

Background: Acquired Immunodeficiency Syndrome (or Acquired immune deficiency syndrome or AIDS) is caused by the Human Immunodeficiency Virus (HIV) and results in reduced immunity, leaving affected individuals more susceptible to illness and opportunistic infections. As the disease progresses, structures within the central auditory system can be affected either by the direct action of the virus or as a consequence of secondary infections. Other areas of the auditory system may also be more vulnerable to pathology in people living with HIV or AIDS. Purpose: the goal of this review was exploratory, to identify possible points of intersection between auditory disorders and Acquired Immune Deficiency Syndrome. This paper reports the results of a literature review on auditory disorders associated with HIV and AIDS and discusses the potential impact of ear pathologies among HIV/AIDS-infected populations. Conclusion: literature suggests several possible types of association between auditory disorders and the Acquired Immune Deficiency Syndrome and the Human Immunodeficiency Virus, and that people with HIV/AIDS may require hearing care interventions. Health professionals, including those from the Brazilian public health system, should examine the need for hearing-related services among HIV/AIDS patients in order to reduce the impact of the disease on daily life activities and prevent insofar, further auditory deterioration. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) infection is a global public health problem. Long-distance truck drivers live apart from their family for long periods of time, a lifestyle that favors at-risk behaviors such as unprotected sex with multiple partners and illicit drug use. As data concerning HCV infection in this population are still rare, this paper aims to investigate the prevalence, genotypes/subtypes, and the factors associated with HCV infection in long-distance truck drivers in Brazil. A cross-sectional survey was carried out with 641 Brazilian long-truck drivers who were recruited at a major truck stop located at kilometer 1,296 of the BR-153 highway, which is considered to be one of the longest roads in Brazil. All individuals were interviewed, and their serum samples were tested for the presence of antibodies to HCV (anti-HCV) by ELISA and immunoblot. Anti-HCV positive samples were tested for HCV RNA by PCR amplification of the 5' NC and NS5B regions and were genotyped using the LiPA assay and nucleotide sequencing, respectively. Factors associated with HCV infection were identified with logistic regression. The prevalence of HCV infection was 1.4% (95% CI: 0.7-2.8). History of blood transfusion, sharing of personal hygiene tools, illicit drug use and HBV status were factors independently associated with HCV infection in the study population. HCV RNA was detected in 8/9 anti-HCV positive samples, in which genotypes 1 (n = 3), 2 (n = 2), and 3 (n = 3) were determined by LiPA. Using phylogenetic tree analysis of the NS5B region, subtypes 1a (n = 1), 1b (n = 2), 2b (n = 2) and 3a (n = 3) were identified. These data show that the prevalence of HCV infection among Brazilian truck drivers was similar to that observed for the general population. History of blood transfusion, sharing of personal hygiene tools, illicit drug use and HBV status were predictors of HCV infection. The HCV genotypes/subtypes identified in the study population are consistent with those circulating in Brazil. [ABSTRACT FROM AUTHOR]

Drug safety profile is an important theme throughout the world. Recently, it has gained importance in the field of veterinary medicines. In Brazil, Ministry of Agriculture Law SDA 152/2008 submitted to the public consultation the draft of a National Program of Veterinary Pharmacovigilance. Taking into consideration the health risk to exposed human beings, the objectives of this paper are: characterization of veterinary pharmacovigilance and its usefulness for the Public Health, the description of established veterinary pharmacovigilance programs from the United States of America, the European Union and the United Kingdom, and the analysis of the Brazilian Program of veterinary pharmacovigilance draft. [ABSTRACT FROM AUTHOR]

Background: The Brazilian health system is founded on the principle of equity, meaning provision of equal care for equal needs. However, little is known about the impact of health policies in narrowing socioeconomic health inequalities. Using data from the Brazilian World Health Survey, this paper addresses socioeconomic inequalities in the use of outpatient services according to intensity of need. Methods: A three-stage cluster sampling was used to select 5000 adults (18 years and over). The non-response rate was 24.7% and calibration of the natural expansion factors was necessary to obtain the demographic structure of the Brazilian population. Utilization was established by use of outpatient services in the 12 months prior to the interview. Socioeconomic inequalities were analyzed by logistic regression models using years of schooling and private health insurance as independent variables, and controlling by age and sex. Effects of the socioeconomic variables on health services utilization were further analyzed according to self-rated health (good, fair and poor), considered as an indicator of intensity of health care need. Results: Among the 5000 respondents, 63.4% used an outpatient service in the year preceding the survey. The association of health services utilization and self-rated health was significant (p < 0.001). Regarding socioeconomic inequalities, the less educated used health services less frequently, despite presenting worse health conditions. Highly significant effects were found for both socioeconomic variables, years of schooling (p < 0.001) and private health insurance (p < 0.00), after controlling for age and sex. Stratifying by self-rated health, the effects of both socioeconomic variables were significant among those with good health status, but not statistically significant among those with poor self-rated health. Conclusions: The analysis showed that the social gradient in outpatient services utilization decreases as the need is more intense. Among individuals with good self-rated health, possible explanations for the inequality are the lower use of preventive services and unequal supply of health services among the socially disadvantaged groups, or excessive use of health services by the wealthy. On the other hand, our results indicate an adequate performance of the Brazilian health system in narrowing socioeconomic inequalities in health in the most serious situations of need. [ABSTRACT FROM AUTHOR]

This article analyses Brazilian state policy for indigenous health based on the inquiry of the recent historical, political and managerial process that resulted in the creation, in 1991, of the National Health Foundation (Funasa). I t attempts to bring together two lines of thought triggered by the examination of the Funasa Museum collection and by interviews with Funasa employees. T he threads thus woven should make possible, on the one hand, (i) to trace a genealogy of the National Health Foundation, and, on the other, (ii) to highlight its role in setting the hurdles that prevent the consolidation of a political field of respect for diversity in indigenous health policy. T he paper, therefore, consists of an approach which aims at pulling together biographic narratives with institutional memory. [ABSTRACT FROM AUTHOR]

On Public Health, nurses can influence the care of the health needs of the population. The objective of this paper is to feature and understand the practices of nurses working at Health Basic Units. It is a qualitative research whereby semi-structured interviews were made with 15 nurses who work at Porto Alegre-Brasil. The treatment of the data was based on analysis of content of the thematic type. Outcomes indicate that the activities performed by nurses are influenced by the Health System and its limitations, especially the lack of nursing workers. Nurses are sought to solve problems that are not always related with their work, demonstrating the diversity of their practices. The conclusion is that the presence of nurses in the daily care and their articulating role contributes to change the realities of health. [ABSTRACT FROM AUTHOR]

Background: Data on food intake at the individual level and its statistical distribution in population groups defined by age, gender, or geographic areas are important in planning public health and nutrition programs. However, individual-based surveys in representative population samples are expensive to perform. Methods/Design: In Brazil, an individual based survey is under consideration to be conducted alongside the household budget survey (HBS), which will be carried out in 2008-2009. This paper presents the methodological framework of dietary data collection and indicates the directions to combining both sources of data. The 2008-2009 Brazilian HBS sample will include 60,000 households. Of the selected HBS households, 30% will be randomly sampled to gather data on individual food intake. Therefore, individual dietary intake data is expected to be gathered for 70,000 individuals. Data collection procedures will comprise: completion of a diary with information regarding food purchases during a seven-day period; registration of all items consumed during two non-consecutive days for all 10 year-old or older members of the household. The sample will be large enough to capture the variation between individuals, and the two records will assure the estimation of the variation within individuals for food groups, energy and nutrients. Data on individual dietary intake and food family budget will be stratified by the five regions of the country and by rural or urban. A pilot study has been conducted in two states, and it indicated that combining individual and budgetary data in a survey is feasible. Discussion: This kind of study will allow us to estimate correlations between individual intake and household purchases, overcoming the limitations of individual dietary surveys, and enhancing the HBS with information on eating out and intra-familiar distribution of food. [ABSTRACT FROM AUTHOR]

The story of Brazil's evolution in sexual and reproductive health and rights during the 1990s documents not only a decade of change in the population field, but the powerful role of social movements in a democracy. Between October and December 2002, 23 people were interviewed about where they believe progress has been made in Brazil and where there are still needs in relation to population trends, sexual and reproductive rights, and health policies. This paper contains excerpts from the full report and covers the economic and political background of Brazil; the role of non-governmental and women's organisations in influencing the national agenda; the intersection of national and international agendas on population and development, HIV/AIDS, human rights, racism and other issues; changes in sexual and reproductive health policies; HIV/AIDS policy progress, perhaps most importantly mandatory free treatment for people with HIV/AIDS; recent progress in women's health, especially in relation to antenatal and obstetric services, and services addressing violence against women. Finally it describes the role of policy accountability mechanisms that aim to ensure that the many excellent policies that have been passed since 1990 are implemented in a decentralised health system of national, state and local management and services. L'histoire de l'évolution du Brésil en matière de santé et de droits génésiques pendant les années 90 met en lumière des changements dans le domaine démographique et l'influence des mouvements sociaux dans une démocratie. Entre octobre et décembre 2002, on a demandé à 23 personnes d'indiquer les secteurs où le Brésil avait progressé et ceux où des lacunes demeuraient en rapport avec les tendances démographiques, les droits génésiques et les politiques de santé. Cet article, contenant des extraits du rapport, décrit l'environnement économique et politique du Brésil ; l'influence des organisations féminines et des ONG sur les politiques nationales ; l'intersection des priorités nationales et internationales en matière de population et développement, VIH/SIDA, droits de l'homme, racisme et autres questions ; les changements dans les politiques de santé génésique ; les progrès de la lutte contre le VIH/SIDA, avec le traitement gratuit obligatoire des séropositifs ; les récents progrès dans la santé des femmes, particulièrement les services prénatals et obstétriques, et les services spécialisés dans la violence à l'égard des femmes ; et enfin le rôle des mécanismes de responsabilité politique pour que les excellentes politiques adoptées depuis 1990 soient aussi appliquées dans un système de santé décentralisé avec une gestion et des services aux niveaux national, des États et local. La historia de la evolución de Brasil en salud y derechos sexuales y reproductivos durante los años noventa documenta una década de cambios en el campo de la población, y el poder de los movimientos sociales en una democracia. Entre octubre y diciembre de 2002, se entrevistaron a 23 personas respecto a los avances logrados en Brasil y las carencias aãn existentes con relación a las tendencias demográficas, los derechos sexuales y reproductivos y las políticas de salud. Este artículo contiene pasajes del informe y abarca los antecedentes económicos y políticos de Brasil; la influencia de las ONG y organizaciones de mujeres en la agenda nacional; la intersección de las agendas nacionales e internacionales respecto a la población y el desarrollo, el VIH-sida, los derechos humanos, el racismo y otros temas; los cambios en las políticas de salud sexual y reproductiva; los avances en políticas de VIH-sida, destacada la prestación obligatoria de tratamiento gratuito para las personas con VIH-sida; los recientes avances en la salud de la mujer, especialmente con relación a los servicios antenatales y obstétricos y los servicios que tratan la violencia contra las mujeres; y, por ãltimo, los mecanismos destinados a garantizar que las numerosas excelentes políticas aprobadas a partir de 1990 sean aplicadas en un sistema de salud descentralizado de administración y servicios nacionales, estatales y locales. [ABSTRACT FROM AUTHOR]

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]

This paper compares anti-hookworm campaigns conducted in the early twentieth century in France, Germany, Brazil and West India. The populations that suffer from hookworm are not identical in the North and in the South. In tropical and semi-tropical regions hookworm is mainly found among poor peasants and is related to lack of hygiene, while in temperate climates hookworm was a professional disease of miners, a highly organized professional segment. Nevertheless, major disparities in the pattern of hookworm control did not reflect the North-South divide, but a difference between campaigns. These aimed at the eradication of hookworm infection (Germany and West-India) and at alleviating the effects of this infection on populations (France and Brazil). Maps that represented the prevalence of hookworm mirrored the aims of the sanitary campaign in which they were used: eradication of parasitic worms versus the reduction of the handicap induced by these worms. In public health as well, representing is intervening. And vice versa: patterns of intervention shape representations. [ABSTRACT FROM AUTHOR]

Background: Pathways to care are actions and strategies employed by individuals in order to get help for health-related distress and the related processes of care providers. On several systematic reviews regarding pathways to mental health care (PMHC), studies regarding South American countries were not present. This review synthesizes qualitative and quantitative research about PMHC in Brazil. Methods: LILACS, MEDLINE and SCIELO databases were searched for papers regarding PMHC in Brazil. The results were organized in pathway stages, based on Goldberg and Huxley's 'model of Levels and Filters' and on Kleinman's framework of 'Popular, Folk and Professional health sectors'. Analysis also considered the changes in national mental health policy over time. Results: 25 papers were found, with data ranging from 1989 to 2013. Complex social networks were involved in the initial recognition of MH issues. The preferred points of first contact also varied with the nature and severity of problems. A high proportion of patients is treated in specialized services, including mild cases. There is limited capacity of primary care professionals to identify and treat MH problems, with some improvement from collaborative care in the more recent years. The model for crisis management and acute care remains unclear: scarce evidence was found over the different arrangements used, mostly stressing lack of integration between emergency, hospital and community services and fragile continuity of care. Conclusions: The performance of primary care and the regulation of acute demands, especially crisis management, are the most critical aspects on PMHC. Although primary care performance seems to be improving, the balanced provision and integration between services for adequate acute and long-term care is yet to be achieved. [ABSTRACT FROM AUTHOR]

: This paper is a country case study for the Universal Health Coverage Collection, organized by WHO. Mauricio Barreto and colleagues illustrates progress towards UHC and its monitoring and evaluation in Brazil. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]

In 1988, a new Constitution was adopted in Brazil in which guidelines for community participation in the development and implementation of the national health system were delineated. The health and welfare of women and children were given priority. Implementation of these guidelines presents a major challenge in a city such as São Paulo with a population of 15 million, of which an estimated 5.8 million are women of childbearing age. In order to determine the extent to which community organizations are actively participating in planning health services for women and children in São Paulo, a study was undertaken to examine the experience of community and professional organizations in public health advocacy. This paper describes a sample of these organizations, their constituents, membership, history, funding, advocacy objectives, and strategies used and results obtained. The information gathered indicates that the community organizations are involved in activities that include major efforts to improve access to health care by providing specialized courses in women's health, including the status of women's work, sexuality, discrimination, family planning, and the politics of health; publishing newsletters; producing radio programs; engaging in legal action; and using petitions, demonstrations, and public meetings to garner public support on specific issues. [ABSTRACT FROM AUTHOR]

Objectives. This paper measured the extent to which human immunodeficiency virus (HIV) infection has spread among the male working-class population of Santos, Brazil. Methods. Questionnaires on risk behaviors and blood tests were administered to a random sample (n = 395) of male port workers employed by the Santos Port Authority. Results. Although the rate of HIV infection among these men--the working-class male population of Santos--remains low (1.1%), self-reported behavioral risks for HIV infection are common. Conclusions. There is still time to prevent a widespread outbreak of HIV infection among the heterosexual population of Santos and of the transportation corridors emanating from that city. [ABSTRACT FROM AUTHOR]

Chikungunya Virus (CHIKV) is a well-described alpha virus that causes infection in humans. The main symptoms are fever, rash and arthralgia and recently neurological disorders have been reported, in particular encephalitis. It is uncertain whether neurological symptoms are due to persistence of the virus or an ineffective immune response. One rarely described neurologic syndrome is myositis. In this paper, we report the case of a 19-year-old woman with mental confusion and aggressiveness two days after complaints of fever and arthralgia. On clinical evaluation, the patient had power 5/5 in the upper limbs and 3/5 in the lower limbs. Electromyography revealed the presence of myogenic potentials with reduced amplitudes and early recruitment predominantly in the proximal muscle. Two weeks later, she complained of muscle weakness of the lower limbs that started 15 days after acute Chikungunya infection. The patient improved within two months with only supportive care. [ABSTRACT FROM AUTHOR]

The author talks about challenge of health inequality in Brazil and progress made in the same field. Topics discussed include a paper showing non-communicable diseases as more common in people of lower social position, implementation of the Brazilian Unified Health System that has eliminated inequalities and need of development of systems to monitor health inequalities and social determinants.