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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]

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 bacterium Staphylococcus aureus, found in human microbiota, in certain circumstances may cause simple through serious infections, and is counted as the most virulent in its genus. Its enormous capacity of adaptation and resistance to majority of antimicrobials, place it among the most important group in nosocomial infections. The quantity of nosocomial infections is increasing every day, generating a treatment cost three times bigger than in patients without infection and is defined by Healthy Ministry as infections acquired after patient admission in the hospital and that manifest during internment or after discharge from hospital, when could be related to internment or nosocomial procedures. This paper is a bibliographic revision of last five years, based on main electronic libraries and databases of the world, about Staphylococcus aureus, with the purpose of update healthy professionals and identify the importance of its methicillin-resistant form in nosocomial infections. Human and financial costs and prevention steps against this agent were also approached, objectifying put in relief the necessity of developing of new antibiotics and investment in new researches. [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]

Through a literature review this paper sought the types and causes of injuries more frequent in the elderly also addressing how care is delivered in health in the country to that specific group. In recent decade the elderly population has increased considerably, and consequently accidents with trauma has been growing significantly in this age group. Thus, it is necessary for health professionals to adopt preventive measures that can avoid the trauma and thus reduce morbidity and mortality among this population. The decline is greatest among the mechanisms of trauma in the elderly. Furthermore, the clinical picture and the recovery of these patients require special conditions, since they have different characteristics from other age groups, so greater knowledge and expertise of professionals who will act in compliance with this elderly population is necessary. [ABSTRACT FROM AUTHOR]

The dermatophytes are a group of fungi that penetrate the stratum corneum invading the skin, hair and nails, using keratin as a substrate, causing infections in humans and animals known as dermatophytosis. It is a common occurrence these fungal infections in tropical countries, constituting a public health problem. A retrospective analysis of mycological tests on samples received in mycology section of the Biological Research Institute / Central Laboratory of the State / State Foundation for Production and Research in Health / Rio Grande do Sul (IPB - LACEN / FEPPS / RS), originating from health centers in Porto Alegre metropolitan areas and the state during the period 2007 to 2011. Statistical data were obtained using the software PASW Statistics 18, measures were used associations applying the Fisher exact test. Thus, this paper aims to contribute to the distribution of the most frequent etiological agents, is of great importance to investigate the prevalence of these cities in Rio Grande do Sul, in order to portray the epidemiological reality of dermatophytosis in the state, contributing to the realization of public health measures. Of the 6452 samples, 2342 were positive for dermatophytes. Among them T. rubrum was the most prevalent species (72.70%), followed by T. mentagrophytes (22.44%), M. gypseum (1.99%), M. canis (1.39%), E. floccosum (1.30%). Presenting a case for T. shoenleinii and a case for T. tonsurans (0.09%). The anatomical site were more infected toenails with 1,248 (53.23%) cases. Females were more affected. Through this study, we characterize the species of dermatophyte dermatophytosis more involved in our state, noting that the species Trichophyton rubrum is the most cosmopolitan of this fungal group, followed by Trichophyton mentagrophytes, Microsporum gypseum, Microsporum canis, Ephydermophyton floccosun, Trichophyton tonsurans and T. shoenleinii. M. canis was the most frequent species in samples of scalp. [ABSTRACT FROM AUTHOR]

Since the 1970s, the United States has adopted a trade policy agenda that has forced countries to trade away flexible patent provisions for access to US markets. While pharmaceutical companies have argued that the recognition of patent rights is essential for recovering investments in research and development of pharmaceuticals and incentivizing future innovation, the lack of competition has had damaging consequences for public health, as companies tend to set the prices of treatments beyond the reach of consumers and government programs. Thailand and Brazil are bound by law to provide universal access to anti-retroviral treatment ( ART) to People Living with HIV/ AIDS ( PLWHA). This has been made possible in part due to the universal health care systems in each country and the countries' local technical and industrial capacities that provide the government with affordable generic medicines. The introduction of stronger intellectual property protection laws however, has limited possibilities for procuring generic medicines and inflated the cost of treatment. Between 2006-2008, Thailand and Brazil used compulsory licensing to authorize generic competition against the consent of the pharmaceutical companies in order to guarantee the right to health and ensure the viability of government health budgets. This paper will demonstrate how the interaction between individual / collective action and structural and institutional elements in Thailand and Brazil produced propitious conditions for each country to assert the primacy of health over patent rights. [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]

When generic drugs were introduced into the Brazilian market, the main aim was to decrease prices and minimize public health expenditure. However, in addition to this effect, this policy brought about unintended changes to the industrial structure. In this paper, we evaluate the unplanned impacts from the introduction of generic drugs, particularly with respect to the business scale and innovation. Our main results show a large increase in market share in favor of domestic companies, but just a small increase in R&D expenditure and innovation within those companies. Such an increase in the business scale represented a window of opportunity for national firms, but the recent mergers and acquisitions by foreign firms have challenged their position. The weak competitiveness of domestic firms stems from their poor technological capabilities, which are an outcome of a successful ‘demand pull’ industrial policy without the support of a ‘technological’ industrial policy. [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]

Lipid disorders are a major public health problem and drug therapies to control them have high cost, due to the continued use. This paper describes the costs and demographic and epidemiological profiles of the patients treated by the Pharmaceutical Specialized Care of the Brazilian Unified Health Care System, from 2003 to 2006, and identifies the characteristics related to the individual average monthly expenses on drugs. We included in the historical cohort 67,142 individuals, and the results of descriptive and multivariate analyses indicated a high frequency of pure hypercholesterolemia in adult women and elderly residents in the Southeast, of higher use of simvastatin and atorvastatin and individual average monthly expenditure of approximately R$ 88,00. It was observed that increasing age led to lower spending; male patients were more likely to have higher expenditure; and atorvastatin was the drug that most increased expenditures. The epidemiological profile was consistent with the literature and individual spending was high. [ABSTRACT FROM AUTHOR]

This paper tests the hypothesis that one important factor determining household availability of ready-to-consume products is their cost relative to the rest of the diet. National food expenditure surveys in the UK (2008) and Brazil (2008–09) were used. Purchased food quantities were converted into dietary energy (calories) and classified into three groups: (1) foods that are unprocessed or minimally processed; (2) processed culinary ingredients; and (3) ready-to-consume products, either processed or ultra-processed. The contribution of these groups to diets in each country was calculated as a percentage of total energy. Relative cost of ready-to-consume products in each country was calculated by dividing their cost by the cost of the rest of the diet (foods plus culinary ingredients). Linear regression analysis was used to test the association between the UK to Brazil ratios of the caloric share of different ready-to-consume products, and of the relative cost of these products. The caloric share of ready-to-consume products in the UK (63.4%) was well over double that of Brazil (27.7%), whereas their cost relative to the rest of the diet was 43% lower. The lower the relative cost of ready-to-consume products in the UK (compared with Brazil), the higher their relative consumption (R2=0.38, p<0.01). [ABSTRACT FROM AUTHOR]

Unintended pregnancies constitute a serious public health concern in Brazil, representing up to 55% of all pregnancies, and are prevalent among women with low income and low educational backgrounds. Lack of assistance to women in their decision-making has hindered the adoption of more effective contraceptive models. Although clinical consultations constitute an important locus to assist women in decision-making and to facilitate access to subsidized methods, our current knowledge of how contraception is discussed and decisions are reached in actual consultations is limited. Just as scarce is our knowledge of how patients respond and resist contraception recommendations and how physicians counter or accommodate patients. Using a corpus of 103 audio-recorded medical visits and conversation analytic (CA) methods, this paper examines recommendation sequences in the under-investigated gynecological consultations in the Brazilian public healthcare system (SUS). The quantitative analysis reveals a strong orientation to physicians as having primary rights to govern the oversight of women's bodies: 94% of the recommendations are delivered as pronouncements (e.g. , "You'll take X″), the most authoritative action type. Patients largely assume an agreeable and passive role (66%), leading to scarce negotiation and minimal involvement in decision-making. However, in a few cases (12%), all involving contraception, patients become overtly agentive, responding with active resistance. A qualitative analysis of that subset shows that despite women's gaining some agency over their sexual bodies, that agency is still limited. Whereas physicians accommodate patient resistance on grounds of biomedically-related side-effects and incorrect assumptions about the women's lives, they overlook patient resistance based on gendered struggles over contraceptive methods in the domestic sphere. By failing to consider women's lack of agency in choosing whether to have sex or to use condoms, doctors show unawareness of significant consequences of the recommended method, which might include domestic dispute and violence and, paradoxically, ultimately misfire, leading to unwanted pregnancy. • Unintended pregnancies constitute a serious public health concern in Brazil. • Lack of assistance with decision-making hinders best-suited contraception use. • Medical consultations are valuable interactional spaces to discuss contraception. • Women gain by resisting ill-suited recommendations to their own life circumstances. • Contraception decision and access demand partnership between doctors and patients. [ABSTRACT FROM AUTHOR]

Health care in Brazil is set as a unified system, running under a legal basis and protected by the Constitution. Health is positioned as a right of every citizen, and both models are defined with a view to the operation of services organized for this purpose. The first level in Brazil is called Basic Care, and its conceptual basis comes from the Primary Health Care (PHC). This paper aimed to understand and analyze how organized is the theoretical production of Public Health in Brazil about the social construction of health demand care in PHC, in order to create a reference to analyze it. The survey was conducted using the terms related to the initial problem: health care demand, basic health care and technical health care models. [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]

When referring to Public Health, literature points to the need for professionals who are able to work in different contexts. In this perspective, the theme of "competency" emerges from the administrative context for health in order to promote debates in the field of human resource development and training. This paper aims to present an overview of the Brazilian scene on professional skills in health for better understanding the construct at the national level and propose future research. The study used data from the Directory of Research Groups of the National Research Council (CNPq), the database of the Department of Science and Technology of the Ministry of Health (Health Research System), Bank of Theses and Dissertations of the Coordination for Higher Education Personnel (CAPES) and SciELO database. We observed inequality in the distribution of scientific researchers and little encouraged production. Thus greater efforts in the field of health management are necessary to build the theme. [ABSTRACT FROM AUTHOR]

In Brazil, it is estimated that 1,443,350 abortions occur annually, leading thousands of women with incomplete abortion, to seek care in public health. In 2005, the Ministry of Health published the Technical Act for Humane Abortion in response to this challenge. This paper discusses whether the Act sets an evaluable program and proposes an evaluation model. The survey, conducted in 2010, is an evaluability study using techniques of document analysis and interviews with key informants. To validate the indicators, we applied the nominal group technique. The results were elaborated and agreed upon the logical model, the matrix of indicators and evaluative questions that reflect the pillars of care: care, quality clinical care with technical, ethical and legal, reproductive planning, integration with network health and collective women. We conclude that the humanized abortion is an assessable program with development of an evaluation model in a timely manner. The preassessment was suitable and better understood by managers and professionals. There was agreement about the explicitness and relevance of goals, actions, and resource needs, ethical questions to guide changes. The study has increased the knowledge of the actors involved with decisive participation of clinical direction. For subsequent evaluations, the study recommends focusing on the structure and processes of the five components of the program with prioritization of subjective aspects of humanization, infrastructure, and the prevalence of abortion in the public health service. [ABSTRACT FROM AUTHOR]

Chagas disease is a major public health problems because it is a parasitic cardiac edema that causes many deaths and suffering among the people. Even long after its discovery remains a problem in most of Latin America, mainly Brazil. The aim of this paper is to analyze how is the current situation of Chagas disease in Brazil. The treatment of Chagas disease remains partially ineffective, even with the constant effort that has been developed by various laboratories and researchers for its control. Any person infected by the disease should have access to medical care that can make the clinical, epidemiological and laboratory and indicate the necessary treatment. The main way to prevent infection of the disease is to combat the main foci of Chagas disease, because today there is still a specific vaccine to control this disease. The most used control in the country is through chemical control and improvement or replacement of residence in areas of risk. There currently are in Latin America, a prevalence of 11 million people infected and 10 million at risk of contracting the disease. Even today the major problem is controlling the disease, constituting a challenge to health authorities. In particular, overcoming the disease can be an important catalyst for the goal of Latin American unity. [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]

This paper discusses the post-trial access to drugs for patients who participated in clinical trials in Brazil. The ethical guidance for clinical trials in Brazil is arguably one of the clearest in the world in attributing to research sponsors the responsibility for providing post-trial drugs to patients who participated in their experiments. The Federal Constitution recognizes health as a fundamental right to be fulfilled by the State. Based on the Brazilian constitution and on the National Health Council resolutions, courts have been accepting patients' claims and ordering the State and the pharmaceutical companies to provide these patients with the tested treatment in the quantity and duration they need it. This generous interpretation of the duties of the pharmaceutical companies and the State makes the Brazilian model for post-trial access unique when compared to the experience of other countries and thus should be followed with attention by future research in order to assess its consequences for patients, research sponsors, and the public health system. [ABSTRACT FROM AUTHOR]

Investing in the necessary theoretical relationship between Humanization and Mental Health Policies of the Brazilian health system, this paper argues, through the theoretical dialogue between them, the idea that the proposals set forth in such policies are coherent answers to the main contradictions of the intricate national public health system. So are presented: the theoretical basis of the aforementioned ministerial policies; their relations with the society demanded as public policy; and finally, how the combination of both provide essential contributions to the continuity of the Unified Health System (SUS ). The essay methodology was used, according to updated methodological bibliography, listing authors and their contributions in order to defend the views of the authors. We conclude that the public encouragement of protagonizsm of society undermines the logic of biological training courses for health professionals and flattens human relations within the SUS , fortifying it and giving it essential reason for existence to the Brazilian society. [ABSTRACT FROM AUTHOR]

This paper aims to discuss the relation between individual and collective autonomy and health promotion. In order to do so, it reviews the literature on the conceptual course of health promotion since the Ottawa Charter, emphasizing the amplification of autonomy as a guide for health promotion actions. It also highlights the importance of health promotion strategies in Brazil, which prioritize public policies in order to decrease social inequalities. In particular, Brazilian policies are addressed towards increasing individual and collective autonomy. [ABSTRACT FROM AUTHOR]

This paper analyzes the conduct of the federal primary health care politics in Brazil in the 2000's, seeking to identify elements of continuity and change in the previous period. The research was based on the theoretical framework of historical institutionalism and the concept of path dependence. The methodology included a variety of strategies: literature review, document analysis, analysis of secondary databases, budget analysis and interviews with key stakeholders of the policy. It was possible to identify continuities and changes in the conduct of national policy for federal primary care during the study period. The predominance of continuities, emphasizing the persistence of the Family Health Program as a hegemonic strategy for reorientation of primary care in the country, creates a condition of path-dependence. There were also incremental changes, such as initiatives to strengthen inter-sectoral coordination and important innovations, notably the creation of the Centers for Family Health Support. There are, however, structural problems within primary care, and it is important to overcome them to enable the effective change in the health care model in the country. [ABSTRACT FROM AUTHOR]

ABSTRACT The National Institute of Public Policy for Alcohol and Other Drugs (INPAD) is based at the Federal University of São Paulo, Brazil, and was created to collect scientific evidence regarding epidemiology, develop new therapeutic approaches, study health economics and provide education to subsidize the proper measures to change the Brazilian scenario of alcohol and drug consumption. Policies directed towards the control of alcohol and drugs in Brazil are fragmented, poorly enforced and therefore ineffective. The unregulated market of alcohol in Brazil has contributed to the worsening health of the Brazilian population. Since 1994, INPAD has participated actively in academic debates and discussions about alcohol and drug policies and their effects on the political welfare of the country. Many scientific papers and books have been published on this subject, and the internet and other media have provided excellent opportunities for the dissemination of specialized information to the general population. [ABSTRACT FROM AUTHOR]

Abstract: Background: This paper provides a summary and analysis of the regulation of ayahuasca in Brazil, from its prohibition in the mid-eighties to the recent adoption of CONAD''s (Conselho Nacional de Políticas sobre Drogas) 2010 Resolution, which established a set of rules, norms and ethical principles to be applied to religious and ritual uses of ayahuasca. Brazil''s regulatory process is used as a starting point to explore emerging international regulatory themes as various nations respond to the global expansion of the Santo Daime and UDV (União do Vegetal) ayahuasca religions. Methods: The text reviews the primary legislative and court documents, academic literature, as well as solicited expert opinions. Results: Three prominent themes have emerged internationally. The first concerns the scope of international treaties regarding plant-based psychoactive substances, as well as the responsibilities of individual nations to adhere to said treaties. The second concerns the scope of religious liberty and how to determine religious legitimacy. The final theme addresses the potential dangers of ayahuasca to health and public safety. Conclusion: Over the past 20 years the Brazilian ayahuasca religions have established a global presence, with congregations in the USA, Canada, Japan, South Africa, Australia, and throughout Europe and Latin America. As a result, many nations are faced with the predicament of balancing the interests of these religious minorities with the international “war on drugs.” The regulatory process applied in Brazil exemplifies a progressive approach, one which considered issues of anthropology and involved representatives of ayahuasca religions, and which provided a degree of deference to the principle of religious liberty. The Brazilian process has influenced judicial and administrative decisions internationally, and stands as a model worthy of further consideration. [Copyright &y& Elsevier]

Maternal mortality is a complex issue and remains a serious public health problem. This paper aims to look at this phenomenon from the perspective of the right to health, noting that the option for bringing the discussion to the field of human rights provided an extension of its explanation and a clearer presentation to society. It presents brief history of the insertion of this theme in the global policy agenda, exploring national and international initiatives. The current situation of maternal mortality in Brazil is just the most visible face of the precariousness of the health care of women. The situation worsens when cases of severe maternal morbidity are considered, which affects a significant number of women. Despite the initiatives for the realization of the right to safe motherhood, there are few advances, and society must require the State to reverse the injustice against women. [ABSTRACT FROM AUTHOR]

This paper aims to problematize the itinerancy as a way to operationalize care in the territory. With the creation of the Unified Health System, the notion of territory has become an organizing principle of work processes in primary health care and mental health policies. In the delicate field of coordination between these policies, itinerant practices now have a strategic importance in the deinstitutionalization of practices and construction of integral care. We take the deinstitutionalization and the integrality as conceptual operators that make the difference that Psychiatric and Health reforms want to print in the care practices. Warned that by joining in a posture of active search in the life territory of users, the itinerant practices fall in a field of tensions, which can both be called to work as a part of the State apparatus to population control, as in a strategic place for the construction of a contextualized care to users" way of life. We believe that it is possible to resist the social control mandate and build an ethics of care with itinerancy to explore the political power of the movement and transform the users' territory in a laboratory for the invention of life. [ABSTRACT FROM AUTHOR]

Abstract: Funds to promote access to water and sanitation in developing countries are scarce and most of the investments come from the national governments and households sources, not international resources. In many of these countries, mainly in middle income countries, households are paying direct taxes to access these services, and understanding what determines their choice and motivation is fundamental to promote access to them. It has been argued that is not enough to supply a wide range of alternatives unless the individuals can recognise their benefits and sustainability. The objective of this paper is to understand the choice of sanitation technology by residents in the city of Salvador, Brazil. We propose a unique hybrid choice model that incorporates a set of latent attitudinal variables and explains how the demographic factors within a household influence choice. The substantial difference of our hybrid choice model from descriptive frameworks is that it integrates choice and latent variables (such as attitudes and preferences) allowing us to model explicitly the cognitive process that influences sanitation adoption, draw conclusions from cognitive variables associated with individuals’ socio-economic and demographic characteristics, and establishes a causal pathway among these variables. The results show that the attributes of health protection, accessibility, privacy, and house modernisation were what households cared about when opting for flush toilet and sewerage connection, rather than the high cost and consequent household socio-economic status associated with them. The hybrid model is statistically consistent with these findings, and seems to fill the gap between behavioural theory and discrete choice models applied to sanitation. [Copyright &y& Elsevier]

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]

Abstract: Smoking is a worldwide public health problem, and various communication strategies aimed at its cessation have been used. The objective of this paper was to explore differences over time of two communication strategies (gain-framed versus loss-framed) in encouraging calls to a Quitline, according to smoker''s degree of dependence. A study was conducted for four weeks among passengers of two selected subway stations in the city of Rio de Janeiro-Brazil (N average =12,500 passengers a day per station). The interventions – large posters with images and text based on central theme “shortness-of-breath” – also contained the Quitline number. Call rate differences between the strategies, overall and specific per study week, were calculated. Light smokers exposed to the positive-content message called on average 2.2 times more often than those exposed to the negative-content message (p <0.001). The absolute difference in call rates decreased after the first week of the study (p for the additive interaction between intervention and study week, 0.02). For heavy smokers, no differences between the two stations were observed. Additive interaction was found between type of smoker – light or heavy – and intervention (p =0.02). The results suggest that short-term positive-content campaigns based on issues pertaining to individuals'' daily routine could be effective in capturing light smokers. These results may have considerable public health impact, as the prevalence of less dependent smokers is much higher than that of heavier smokers. [Copyright &y& Elsevier]

The efficiency of public health is a growing management need, especially in public hospitals. These organizations are complex because of the multiplicity of services and the high costs involved. So this paper evaluates a hospital in the state of Mato Grosso, Brazil, by the method of "cost-volume-surplus". The results show among other things, that the reduction of excess capacity from the increased number of patients from other cities would produce an increase in revenues due to economies of scale, providing the process of decentralization of SUS (micro-regionalization) with systemic efficiency. [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 paper aims to analyze the links between access to justice and the effectiveness of one aspect of the right to health: access to medicines. It initially presents the challenges and difficulties in the conceptualization of health and right to health, and then analyzes individual lawsuits demanding medicines against public services, from June 2007 to July 2008, entered at Rio de Janeiro State Court of Appeals. It appears that the medical drug prescription, the economic conditions of the applicants and the urgency of access to medicines are the main factual basis of judicial sentences examined, which determine the supply of medicines as required by the authors. Finally, it concludes that the effectiveness of the right to health requires a set of policy and broader government actions, and not merely formal and restrictive court orders. The individual's claims cannot be considered as the main deliberative instrument in the management of pharmaceutical care in the Brazilian Health System, but accepted as an important element in the decision making of managers and, often, in the improvement of the access to medicines under National Health System. In the Brazilian democratic context, the judicialization can express demands and modes of action of citizens and legitimate institutions. Thus, the main challenge is to make policy and social strategies orchestrated with other mechanisms and instruments of democratic security, to improve health and justice systems in order to give effectiveness to the right to health. [ABSTRACT FROM AUTHOR]

This paper proposes a way to analyze the history of eating in São Paulo (Brazil) between 1920 and 1950. It addresses the relative absence of research on this topic for this period characterized by the rapid expansion of the city, which became a key market, an important regulator of consumption habits, and a meeting place for diverse social groups. An abundance of sources makes it possible to undertake a social history of eating. On the one hand, intellectuals of different backgrounds and interests produced a good deal of work on popular food habits. On the other, the article points to the possibility of using lifestyle studies and surveys on eating habits from this period in order to gain insight into the lives of different sectors of the population. [ABSTRACT FROM AUTHOR]

This paper briefly outlines how the political scenario and the mobilization of different actors have contributed to the construction of a public health policy in response to the AIDS epidemics in Brazil. Three factors are presented and discussed: the political context of the 1980s, characterized by redemocratization, growth of social movements, and consolidation of the Brazilian health care reform; the socio-cultural context of the 1970s and 1980s, characterized by achievement of individual freedom, which was key to the organization of the AIDS movement; and finally the actions carried out in the international scenario to support the sustainability of the Brazilian domestic policy and the reinforcement of a global response to face the epidemics in lower-middle income economies. [ABSTRACT FROM AUTHOR]

Objectives: Few studies of comorbidity among cocaine users have been undertaken in Brazil, despite the fact that cocaine is one of the most commonly used illegal drugs in the country. The aim of this paper is to review existing data on psychiatric evaluations of cocaine users, and present data from two studies that have addressed this issue as it pertains to the Brazilian public health system. Study design: Review and results from two studies (cross-sectional and matched control). Methods: The Brazilian literature on PubMed, Lilacs, Psychinfo and DATASUS was searched using the key words: 'psychiatric symptoms', 'diagnosis', 'evaluation', 'assessment', 'cocaine disorders' and others related to this issue. Intake data from two studies of mate and female cocaine users were also analysed with regard to psychiatric symptoms as measured by the Symptom Check List - 90 Revised (SCL-90). Results: The literature review found no specific studies regarding psychiatric evaluation of cocaine users in Brazil. Analyses from the two studies presented showed high levels of psychiatric symptoms in this population. In the first study, psychiatric symptoms were measured at treatment entry and their prevalence was high, ranging from 27.4% to 53.4%. In the second study, SCL-90R scores at programme admission were higher in cocaine users than normal controls, with effect sizes ranging from moderate to high. Conclusions: To the authors' knowledge, this is the first article to discuss psychiatric evaluations of comorbidity among cocaine users in Brazil. The results indicate a need to: pay more attention to the evaluation of psychiatric symptoms in cocaine users; emphasize the importance of standardized data collection in this area; and evaluate the course of these symptoms, their impact on outcome, and how they are best addressed in treatment. [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]