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

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

Introduction: The objective of this study was to evaluate quality indicators of secondary health care in chronic kidney disease (CKD). Methods: This retrospective longitudinal study was conducted in an outpatient medical nephrology clinic of the Brazilian Unified Health System (UHS) and a multidisciplinary outpatient clinic of a private health plan (PHP). The inclusion criteria were age ≥ 18 years, ≥ 3 medical appointments, and follow‐up time ≥ 6 months. Results: Compared to PHP patients (n = 183), UHS patients (n = 276) were older (63.4 vs. 59.7 years, p = 0.04), had more arterial hypertension (AH) (91.7% vs. 84.7%, p = 0.02) and dyslipidemia (58.3 vs. 38.3%, p < 0.01), and had a lower estimated baseline glomerular filtration rate (eGFR) (29.9 [21.5–42.0] vs. 39.1 [28.6–54.8] mL/min/1.73 m2, p < 0.01). Compared to PHP patients, UHS patients had a lower percentage of diabetics with glycated hemoglobin < 7.5% (46.1% vs. 61.2%, p = 0.03), fewer people with potassium < 5.5 mEq/L (90.4% vs. 95.6%, p = 0.04), and fewer referrals for hemodialysis with functioning arteriovenous fistula (AVF) (9.1% vs. 54.3%, p < 0.01). The percentages of people with hypertension and blood pressure < 140 × 90 mmHg were similar between the UHS and PHP groups (59.7% vs. 66.7%; p = 0.17), as was the percentage of people with parathyroid hormone control (85.6% vs. 84.8%; p = 0.83), dyslipidemia and LDL‐cholesterol < 100 mg/dL (38.3% vs. 49.3%; p = 0.13), phosphorus < 4.5 mg/dL (78.5% vs. 72.0%; p = 0.16), and 25‐OH‐vitamin‐D > 30 ng/mL (28.4% vs. 36.5%; p = 0.11). The crude reduction in eGFR was greater in the UHS group than in PHP (2.3 [−0.1; 5.9] vs. 1.1 [−1.9; 4.6] mL/min/1.73 m2; p < 0.01). In the multivariate linear mixed‐effects model, UHS patients also showed faster CKD progression over time than PHS ones (group effect, p < 0.01; time effect, p < 0.01; interaction, p < 0.01). Conclusions: Quality of care for patients with CKD can be improved through both services, and multidisciplinary care may have a positive impact on the control of comorbidities, the progression of CKD, and the planning of the initiation of hemodialysis. [ABSTRACT FROM AUTHOR]

Background: Mining occupies a prominent place in Brazil, which, if observed, means that one must work with the contingencies that arise from its activity. Mining disasters, such as those in Mariana and Brumadinho, exemplify the impact on the health system and are models for similar situations, so the study sought to investigate the impact of these disasters on hospital admissions in the Brazilian public health system. Methods: Through segmented regression, we sought to assess possible changes in the variables HAA (authorized hospital admissions), total admission value, and mortality rate in Mariana and Brumadinho. This measurement method allows the researcher to identify changes during the study period. Results: The​​​​​​​ study observed significant changes in the variable mortality rate in the city of Brumadinho. Although the other variables, both in Mariana and Brumadinho, do not present a level of significance compatible with possible effects, we can still say that they present a trend that can be inferred as an effect of the disaster. Conclusions: The mining disaster significantly changed the mortality profile in the city of Brumadinho, with implications for the health system. In Mariana, there have been no objective changes, but there is evidence of potential impacts. [ABSTRACT FROM AUTHOR]

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

Abstract Background Although malocclusion is the third most prevalent oral health condition, orthodontics is not part of the minimum list of mandatory specialties to be offered in the Dental Specialty Centers of the Brazilian public health system, but rather as optional. Since the acknowledgment of this field as a part of the Brazilian Unified Health System (SUS), access to orthodontic procedures has become optional by municipal governments. Therefore, this study analyzed the evolution of orthodontic procedure provision within SUS from 2011 to 2022. Methodology We conducted a retrospective observational study of time series analysis trends on the number of orthodontic procedures and municipalities offering them. The presentation of findings followed the recommendations of the Reporting of Studies Conducted using Observational Routinely Collected Data. Secondary data from 2011 to 2022 were collected from the SUS Department of Informatics. Orthodontic procedures were organized by year, region, state, and municipality. The study applied descriptive analyses, and the Prais-Winsten generalized linear regressions for time series analysis. Results The quantity of municipalities offering orthodontic procedures have shown a small increasing during period analyzed (from 128 to 157). Northeast and South macro-regions have increased consistently the municipalities with orthodontic offering. All regions showed stable trends for each procedure, except for the South, which exhibited increasing rates of space maintainer placement (Annual Percentage Change (APC): 72.95; 95% CI: 31.6, 127.3) and maintenance sessions (APC: 15.40; 95% CI: 4.5, 27.5). The study showed decreasing trends for appliance removal in the South (APC: -38.07; 95% CI: -47.1, -27.5) and Northeast (APC: -25.19; 95% CI: -36.5, -11.9) regions. Conclusion From 2011 to 2022, there was a small increase in number of municipalities offering orthodontic procedures in the Brazilian public health system, in addition to a stationary trend for almost all types of procedures.

Abstract Background Mining occupies a prominent place in Brazil, which, if observed, means that one must work with the contingencies that arise from its activity. Mining disasters, such as those in Mariana and Brumadinho, exemplify the impact on the health system and are models for similar situations, so the study sought to investigate the impact of these disasters on hospital admissions in the Brazilian public health system. Methods Through segmented regression, we sought to assess possible changes in the variables HAA (authorized hospital admissions), total admission value, and mortality rate in Mariana and Brumadinho. This measurement method allows the researcher to identify changes during the study period. Results The​​​​​​​ study observed significant changes in the variable mortality rate in the city of Brumadinho. Although the other variables, both in Mariana and Brumadinho, do not present a level of significance compatible with possible effects, we can still say that they present a trend that can be inferred as an effect of the disaster. Conclusions The mining disaster significantly changed the mortality profile in the city of Brumadinho, with implications for the health system. In Mariana, there have been no objective changes, but there is evidence of potential impacts.

Abstract In Brazil, the judicialization of public health for access to medications has resulted in significant challenges to the management of public policies, especially at the municipal level. To evaluate the profile of drug litigations against the Campinas municipal health system from 2017 to 2021, this study analyzed the characteristics of litigants, medicine dispensation, and the timing of court decisions. A quantitative, analytical, and comparative cross-sectional study was conducted using data on the dispensation of 506 types of medications and 493 court cases. The analysis included sociodemographic, procedural, medical–sanitary, and pharmaceutical assistance management variables. The time of court decisions was assessed using the Kruskal‒Wallis test complemented by the Dunn test. The plaintiffs were predominantly adults, females, and self-declared students, and some cases involved nonresidents. Most of the lawsuits were represented by private lawyers, gratuitousness of justice and with decisions favorable to the plaintiff. However, only 43% of the patients obtained a preliminary injunction or early tutelage. The median time needed for a court decision from the date of case filing was 12 days until the granting of a preliminary injunction or early tutelage and 6.5 months until a judgment or dismissal without a decision on the merits. Approximately 32.4% of the medications dispensed by the judicial pharmacy already belonged to the list of the Brazil’s Unified Health System in 2020; 46.3% were prescribed by their generic name; 75.5% had therapeutic equivalents, and 94.9% had marketing authorization from the Brazilian National Health Surveillance Agency. Judicialization in Campinas is an alternative way of accessing medications, but it is time-consuming and benefits only a small portion of the population (0.068%). The characteristics of the plaintiffs and judicialized medicines highlight the need to review health policies to promote equitable and efficient access to essential treatments for the population.

This article analyzes Brazil's Unified Health System (SUS), established by the 1988 Constitution. The papper initially presents the previous trajectory of national health policy and the context of democratization in the 1980s, which favored health reform and created a public, universal, and comprehensive health system. It then explores the advances and contradictions recorded in more than three decades of implementation of the SUS. The main advances observed were the creation of institutional mechanisms compatible with the federative arrangement and social participation, political and administrative decentralization, the national expansion of access to health, changes in the health care model, including strengthening primary care, and improvements in health indicators. On the other hand, the persistence of structural problems and disputes between different health agendas, with differences between governments, led to contradictions in financing and public-private relations in health. Despite the differences between countries, the analysis of the Brazilian case provides lessons on the challenges in building universal health systems in Latin America. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

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

Regarding intracranial aneurysm treatment, the clip versus coil debate remains inconclusive and lacking studies in Brazil. To examine trends in the management of intracranial aneurysms in Brazil over time, both ruptured and unruptured. A descriptive and exploratory study was conducted based on data of neurovascular procedures for aneurysm treatment using the Brazilian Public Health System database (DATASUS). The variables analyzed were the number of procedures, mortality rates, length of hospital stays, and global costs of hospitalization, from 2010 to 2019. Temporal trend analysis and statistical comparisons were conducted to assess changes over time and differences between the treatment options. The mean annual number of aneurysm treatments with endovascular embolization was 2206.30 (± 309.5), with a non-significant increasing trend (B = 55.66; p = 0.104). Conversely, microsurgical clipping exhibited a significant decreasing trend (B = -69.97; p < 0.001) with a mean of 1133.1 (± 223.12) procedures. The mortality rate associated with clipping procedure was higher in the period, with a mean difference of 5.23 (± 0.39); ([CI95%: 4.36; 6.10]; p < 0.001) and showed an increase trend, while embolization showed a stable trend. The length of in-hospital stay remained stable for clipping but increased for embolization. Costs associated with clipping increased over time, whereas costs for embolization decreased. This study highlights a significant shift in the treatment of aneurysm towards Endovascular Embolization. Despite higher costs, endovascular procedures were associated with lower mortality rates and shorter hospital stays. These findings provide valuable insights into aneurysm treatment patterns and indicators in a middle-income country's Public Health System. [ABSTRACT FROM AUTHOR]

In Brazil, the judicialization of public health for access to medications has resulted in significant challenges to the management of public policies, especially at the municipal level. To evaluate the profile of drug litigations against the Campinas municipal health system from 2017 to 2021, this study analyzed the characteristics of litigants, medicine dispensation, and the timing of court decisions. A quantitative, analytical, and comparative cross-sectional study was conducted using data on the dispensation of 506 types of medications and 493 court cases. The analysis included sociodemographic, procedural, medical–sanitary, and pharmaceutical assistance management variables. The time of court decisions was assessed using the Kruskal‒Wallis test complemented by the Dunn test. The plaintiffs were predominantly adults, females, and self-declared students, and some cases involved nonresidents. Most of the lawsuits were represented by private lawyers, gratuitousness of justice and with decisions favorable to the plaintiff. However, only 43% of the patients obtained a preliminary injunction or early tutelage. The median time needed for a court decision from the date of case filing was 12 days until the granting of a preliminary injunction or early tutelage and 6.5 months until a judgment or dismissal without a decision on the merits. Approximately 32.4% of the medications dispensed by the judicial pharmacy already belonged to the list of the Brazil's Unified Health System in 2020; 46.3% were prescribed by their generic name; 75.5% had therapeutic equivalents, and 94.9% had marketing authorization from the Brazilian National Health Surveillance Agency. Judicialization in Campinas is an alternative way of accessing medications, but it is time-consuming and benefits only a small portion of the population (0.068%). The characteristics of the plaintiffs and judicialized medicines highlight the need to review health policies to promote equitable and efficient access to essential treatments for the population. [ABSTRACT FROM AUTHOR]

To estimate the health and economic burden of non-communicable diseases (NCDs) attributed to alcohol consumption in 2019 for the Brazilian Unified Health System (SUS) stratified by states. Observational, descriptive, and ecological study. We used population attributable fractions (PAFs) of NCDs due to alcohol consumption from the Global Burden of Disease study. We applied the PAFs to the costs of hospitalizations and outpatient procedures of medium to high complexity paid by SUS for each outcome, obtained from official databases. We also calculated the disability-adjusted life years (DALYs) and mortality caused by alcohol-related NCDs. We converted the costs into international dollars (Int$) using the purchasing parity power in 2019. Alcohol-related NCDs accounted for 8.48% of deaths and 7.0% of DALYs among men, and 1.33% of deaths and 1.6% of DALYs among women. The main diseases were substance use, digestive, and neoplastic diseases. The SUS spent Int$202.0 million on alcohol-related NCDs, mostly on hospitalizations. The highest health burden was observed in the states of the Northeast region, and the highest expenses in the states from the South. The burden and cost values varied by sex, age group, and state. The study showed that alcohol consumption has a significant impact on Brazilian population morbidity and mortality and SUS expenditures, especially among men. These results can support policies for the prevention and control of alcohol consumption and health promotion at the subnational level, prioritizing strategies that are more appropriate to local realities. [ABSTRACT FROM AUTHOR]

The marketing authorization of Advanced Therapy Medicinal Products (ATMPs) in Brazil is recent. The features of these therapies impose specialized regulatory action and are consequently challenging for developers. The goal of this study was to identify the industry's experience in clinical development, marketing authorization and access to ATMPs through the Unified Health System (SUS, acronym in Portuguese), from a regulatory perspective. A survey containing structured questions was conducted among research participants who work at companies that commercialize ATMPs. A descriptive analysis was performed. We invited 15 foreign pharmaceutical companies, of which 10 agreed to participate. Overall, participants assessed that Brazil has a well-established regulatory system, especially the sanitary registration by the National Health Surveillance Agency (Anvisa), which ensures the quality, safety, and efficacy of the products. The Agency's good interaction with the regulated sector, the harmonization of sanitary and ethical assessment systems with other countries, and the analysis time in the biosafety assessment of Genetically Modified Organisms (GMOs) stand out as positive in industry's evaluation. On the other hand, it is important to advance the pricing regulation for these products since Brazilian regulations do not establish specific criteria for ATMP. One of the biggest challenges is the difficulty for the SUS in reimbursing these very high-cost therapies, especially using current Health Technology Assessment (HTA) methods. Considering the increasing number of approvals of cell and gene therapies in Brazil in the coming years, a close dialogue between the industry and the public sector is recommended to advance regulatory improvements (pricing and HTA). Additionally, the construction of policies to promote the national Health Economic-Industrial Complex, based on a mission-oriented vision that encourages innovative models of financing, especially those that consider risk-sharing and co-financing technologies, will help provide the population with universal, equitable and sustainable access to ATMP in the SUS. [ABSTRACT FROM AUTHOR]

Aim: The Health Gym Program is the main health promotion strategy in the Brazilian public health system. This paper aims to measure the impact of the Health Gym Program on hospital admission expenses for stroke in the state of Pernambuco, Brazil. Subject and methods: This public health impact evaluation used a panel of socioeconomic, demographic, and epidemiological data from 2007 to 2019 for all 185 municipalities in the state of Pernambuco. The empirical strategy used pre-tests, ordinary least-squares econometric modeling, and quantile regression as a robustness test. Results: The municipalities that implemented the Health Gym Program spent an average of 21.04% less on hospitalizations for stroke than the municipalities that did not, and this result was statistically significant at the 1% level. Further, the density of program coverage within the municipality also impacts the reduction of expenses. This saving is directly proportional to the number of hubs of the program in the municipalities. An increase of one program hub for every 10,000 inhabitants results in a 4.57% reduction in expenditure on stroke hospitalizations in the municipalities. Conclusion: The presence of the Health Gym Program led to a reduction in expenses related to hospital admissions for stroke, which may indicate that this program effectively expands the scope of health promotion actions in primary healthcare. The evidence generated from this study can be used to implement evidence-based policies aimed at preventing and controlling chronic diseases in Brazil. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To estimate the direct costs of treating excess body weight in children and adolescents attending a public children's hospital. Methods: This study analyzed the costs of the disease within the Brazilian Unified Health System (SUS) for 2,221 patients with excess body weight using a microcosting approach. The costs included operational expenses, consultations, and laboratory and imaging tests obtained from medical records for the period from 2009 to 2019. Healthcare expenses were obtained from the Table of Procedures, Medications, Orthoses/Prostheses, and Special Materials of SUS and from the hospital's finance department. Results: Medical consultations accounted for 50.6% (R$703,503.00) of the total cost (R $1,388,449.40) of treatment over the period investigated. The cost of treating excess body weight was 11.8 times higher for children aged 5-18 years compared to children aged 2-5 years over the same period. Additionally, the cost of treating obesity was approximately 4.0 and 6.3 times higher than the cost of treating overweight children aged 2-5 and 5-18 years, respectively. Conclusion: The average annual cost of treating excess body weight was R$138,845.00. Weight status and age influenced the cost of treating this disease, with higher costs being observed for individuals with obesity and children over 5 years of age. Additionally, the important deficit in reimbursement by SUS and the small number of other health professionals highlight the need for restructuring this treatment model to ensure its effectiveness, including a substantial increase in government investment. [ABSTRACT FROM AUTHOR]

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

ABSTRACT The interaction between dental students and patients is essential for practical and realistic learning, providing community services, and establishing a dental school clinic. Simultaneously, studies on public healthcare user satisfaction are crucial, contributing to corrective measures planning based on obtained information. The study aimed to understand the demographic and economic profile of patients treated at the Basic Dental Care Clinic of a public university and to assess patient satisfaction with the services and infrastructure. A cross-sectional observational study was conducted, collecting socioeconomic and general health data from patients through dental anamnesis. Validated questionnaires were used: Questionnaire for User Satisfaction with Public Oral Health Services, covering seven quality dimensions, and the Pompeu Questionnaire, addressing dental care aspects. Responses were tabulated for descriptive statistical analysis. Results: Questionnaire for User Satisfaction with Public Oral Health Services results indicate high patient satisfaction in various dimensions, such as human relations, treatment effectiveness, accessibility, and technical-scientific quality. The Pompeu Questionnaire reinforces these findings, emphasizing the students’ and professors’ receptiveness, effective guidance on oral care, and a high clinic recommendation rate by patients. In summary, both questionnaires reveal an overall positive patient satisfaction. In the study’s context, the majority of patients treated in the mentioned clinic expressed satisfaction with the physical structure, service, and dental treatment offered.

ABSTRACT Introduction: Brazilian studies on non-verbal communication and its possible impact on the relationship between health professionals and patients are still incipient in the scientific literature. Most studies are from countries other than Brazil. Objective: to identify the relationship established by people between attire styles used by physicians and different professional profiles or skills as well as to understand the way they feel about certain aspects of these professionals’ appearance. Method: this is a cross-sectional study in which 160 individuals participated in a specialized public healthcare service in the state of Paraná, Brazil. Sociodemographic data and the way in which participants perceive aspects related to physicians’ appearance were collected through a structured questionnaire and analyzed using descriptive and inferential statistics. Results: the sample mainly comprised women (70%). The participants generally demonstrated a preference for attire that included white coat, with “formal with white coat”, “scrubs with white coat” and “casual with white coat” being the most recommended styles when consulted about attire to be worn by physicians. The aspects of the professional image that most generated discomfort in relation to male professionals were dirty and wrinkled clothes and Bermuda shorts. Among female physicians, participants indicated discomfort mainly with dirty and wrinkled clothes, blouses that showed the belly, shorts and short dresses. Conclusion: attire styles that included white coat were the most preferred in general, but there are results depending on specific situations that must be considered. Dirty and wrinkled attire was the aspect that caused the most discomfort for professionals of both sexes.

Introduction: Community-Acquired Pneumonia (CAP) caused by pneumococcus and Invasive Pneumococcal Disease (IPD) pose a substantial economic burden on health systems. The objective of the present study is to explore hospitalization costs of pneumococcal disease in the public health system in Brazil, the Unified Health System. Methods: Retrospective analysis of administrative data on hospitalized cases of pneumococcal disease from January 2019 to July 2023. Hospitalization cases recorded with ICD-10 codes of CAP due to S. pneumoniae and IPD were retrieved from DATASUS, the inpatient information system of the Unified Health System in Brazil. Costs were converted to US dollars by Using Purchasing Power Parity (USD-PPP). Absolute number of hospitalizations, costs of hospitalizations and healthcare resource utilization were presented descriptively. The annual cost estimate was calculated. Differences in costs by type of clinical presentation and age group were assessed. Factors associated with higher costs were explored by multiple linear regression models. Results: A total of 22,498 hospitalization episodes were analyzed. Total cost of hospitalizations was USD-PPP 13,958,959 (BRL 34,659,578) with an annual mean estimate of USD-PPP 3,045,591 (BRL 7,562,090). Cost per hospitalization episode was significantly higher for meningitis, followed by septicemia, CAP and arthritis, with median values ranging from USD-PPP 190.93 to 615.14 (BRL 476.20 to 1529.02). (Kruskal-Wallis χ2 = 6473, df = 3, p-value < 0.0001). Costs were significantly higher among individuals aged 60-years and older. (Kruskal-Wallis test; χ2 = 773.53; df = 2, p-value < 0.0001). There were differences in age at hospitalization, length of stay, and ICU utilization among types of clinical presentations. Conclusions: Our findings reveal the economic burden associated with pneumococcal disease in the Unified Health System in Brazil. Hospitalization costs were higher for cases of meningitis and among individuals aged 60-years and above.

The present work presents as a research problem the importance of efficiency, planning, and principles of good management aiming at capillarity and equity to generate greater access and quality of services. The objective of this article was to identify the expansion of the Family Health Strategy in Brazil between 2007 and 2020, and which variables may explain this evolution. This is a descriptive, ecological research, developed between 2007 and 2020 in Brazil; its variable of interest was the estimated population coverage of this strategy (%). An increase in the coverage of the Family Health Strategy was observed in all regions of Brazil between 2007 and 2020, especially in the Northeast region. At the state level, this coverage showed a significant positive relationship with the following variables: towns with fewer than 40,000 inhabitants and monthly income inferior to half a minimum salary. The Brazilian version of the Family Health Strategy seeks inspiration from the best and most successful health models to achieve high performance and efficiency to provide equity and access to health services. [ABSTRACT FROM AUTHOR]

Social Health Organizations (SHOs) are private entities that receive resources from governments for the management of public healthcare services. With the history of market interest in public health and the high volume of resources transferred to SHOs, one must question if the market logic continues to be inserted in this management model. The understanding of the dynamics of providing healthcare services to the population in the different contracts may help to understand how possible changes in the contracted services may have an influence. This is a descriptive-exploratory study using quantitative and qualitative approaches. Documental research was conducted through the collection of data from management contracts and amendments. The State of São Paulo was chosen because of its economic representativeness and for being the pioneer state in the implementation of SUS services managed by SHO. Medical specialties were included in 184 renegotiations (6.14%) and excluded in 187 (6.24%), whereas non-medical services were included in 26 renegotiations (2.97%) and excluded in 144 (16.44%). Regarding examinations, 101 renegotiations (18.07%) had their goals increased and 60 (10.73%) reduced, while 6 renegotiations (1.07%) included exams and 12 (2.14%) excluded them. [ABSTRACT FROM AUTHOR]

This narrative review aims to analyze the literature on Collective Health to recognize what has been discussed in Popular Health Education (PHE) from 2019 to 2022. Fifty-nine articles were selected, critically analyzed, and separated into six summary categories: popular education practices as promoters of a participatory vision of health; popular education and the valorization of local popular culture knowledge and practices; popular health education as a strategy to support social reconstruction in the face of setbacks in public policies; the importance of national articulation in popular education as a response to its devaluation; popular education as a liberating project thinking about the democratic formation and the fight against institutional and structural violence; popular education in the university health training process. We achieved significant results that elucidate the importance of PHE within the Unified Health System and the academic education of health professionals, fostering respect for ancestral knowledge and care horizontality. We also reaffirm the need for national articulation and dialogue with grassroots movements to advance Brazil's emancipatory and dignifying health agenda. [ABSTRACT FROM AUTHOR]

Carried out through an integrative literature review from 2013 to 2023, on the Capes and BVS platforms, this study aims to identify the relationship between popular education and social control in health, focusing on municipal health Councils as key agents. Inspired by the principles of Paulo Freire, popular education emerges as a practicaltheoretical perspective to empower councilors and the community, driving effective participation in the learning process. The reviewed literature highlights the relevance of the Councils but warns of distancing and excessive emphasis on administrative issues. Popular education emerges as a transformative action, empowering actors and strengthening active participation. Its principles, applied in the councils, contribute to a more critical, effective, and democratic performance. This study suggests the need for participatory and emancipatory approaches to strengthen the Unified Health System. [ABSTRACT FROM AUTHOR]

This essay examines the role of the institutional supporter in the Unified Health System, focusing on the characterization of their "doing" and the differentiation between the "educational" and "pedagogical" dimensions of their work at the School of Public Health of the State Health Department of Paraíba. This is a theoretical-practical-reflexive text, based on the practice in the territory and dialogue with different authors who approach the theme of Institutional Support and Popular Education. The institutional supporter's pedagogical and educational action is characterized by the mediation of processes, the promotion of dialogue and social participation, the construction of collective knowledge, and the search for solutions to the problems of the Unified Health System. Popular Education presents itself as an important theoretical-methodological framework for the development of a transformative and emancipatory "pedagogical action?. Finally, it is concluded that the institutional supporter does not occupy and should not restrict himself to occupying a "non-place" or a "between-place?, but rather that the "pedagogical and educational action" of the supporter should constitute his place in the structure of the Unified Health System and, if it does not yet exist, it must be built/instituted. [ABSTRACT FROM AUTHOR]

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RESUMO A educação pode agir como um fator transformador da prática de saúde ao promover encontros de sujeitos, da assistência à gestão. Ao intermediar a realidade assistencial, o gestor passa a integrar o espaço onde se produz saúde e educação, permitindo o aprendizado e a construção conjunta de respostas aos problemas inerentes à rotina de trabalho. Com objetivo de analisar a perspectiva dos gestores acerca de uma proposta de educação permanente em cuidado paliativo para capacitação de médicos e enfermeiros da Atenção Primária à Saúde, foi realizada uma pesquisa-ação, com abordagem qualitativa, na atenção primária da região Médio Paraíba do estado do Rio de Janeiro. Através da análise das entrevistas semiestruturadas, realizadas com oito gestoras e a representante da Comissão de Integração Ensino-Serviço da região de saúde, emergiram quatro dimensões temáticas: necessidades, aplicabilidade, equipe de saúde e acesso. Identificou-se que a proposta educacional elaborada, ao agregar educação permanente em saúde e cuidado paliativo, possibilitou à gestão vislumbrar uma estratégia dinâmica e capaz de transformar as práticas de serviço da atenção primária. Envolver a gestão ampliou o escopo do modelo proposto, potencializando sua apropriação não só no nível local, mas de forma integrada à rede de atenção à saúde.

Despite significant advancements in antiretroviral therapy (ART) for HIV, adherence remains a challenge. While Brazil has validated scales for treatment adherence, few assess treatment adherence barriers. This underscores the necessity for validated questionnaires on adherence barriers to identify patient-specific challenges and enhance strategies for ART adherence. This study aimed to adapt and validate the Adherence Barriers Questionnaire for HIV Patients on Antiretroviral Therapy (ABQ-HIV), a 17-item questionnaire assessing the adherence barriers to ART, for the Brazilian context and to evaluate its psychometric properties in HIV patients. A methodological study on the psychometric properties and factorial structure of ABQ-HIV was conducted. The study followed seven steps: consent of the original authors, two translations, synthesis of the translations, expert committee, back-translation, pre-test, and reliability test. A high content validity index (0.93) was achieved with the expert committee. The study sample consisted of 230 adults with HIV, with 37.0 (29.3-45.0) years as the median age (IQR), and 52.2% were male. The exploratory factor analysis with a three subscales structure of 17 items showed good interpretability (Bartlett’s sphericity (1167.2 [136]; p < 0.001) and Kaiser-Meyer-Olkin = 0.602) and internal consistency (α = 0.76; Ω = 0.76). The fit indicators were satisfactory (χ2 = 89.931; df = 88; p > 0.005; RMSEA = 0.010; RMSR = 0.07; CFI = 0.996; GFI = 0.940; AGFI = 0.907; NNFI = 0.995). The Brazilian version of ABQ-HIV is a potential instrument for identifying specific barriers to adherence to ART in adults living with HIV in Brazil.

Objective: To evaluate health promotion and prevention in the Brazilian Unified Health System (SUS) between 2008 and 2022. Method: An epidemiological study was conducted, with an ecological approach, as a time series. APPS-related data available in the Outpatient Information System of the SUS (SIA/SUS) over the last 15 years were used, normalized to every 100,000 Brazilian residents, characterizing the incidence. COVID-19 pre- and post-pandemic periods were outlined to verify its impact on productivity. The data were analyzed with a significance level of 5%. Result: Between 2008 and 2022, 6,933,081,931 APPS were carried out in the SUS. The most frequent modality was home visits (56.3%), and the most common health professionals were health and endemic agents (59.8%). For the entire study period, the incidence was 3,407,327 APPS per 100,000 Brazilian residents, with an annual median of 281,999. Furthermore, there was a significant decreasing trend over the last 15 years (p

Introduction: This research was based on the essential components of palliative care provided by the American Society of Clinical Oncology (ASCO). Objective: To find out the knowledge primary care physicians and nurses have on palliative care in oncology and to identify the educational needs and perspectives related to the integration of this practice in primary care. Method: Semi-structured in-depth interviews were carried out with 17 primary care health professionals from the National Health System in eight Brazilian municipalities from Médio Paraíba, State of Rio de Janeiro, Brazil, between March and August 2022. Results: The results were analyzed along five axes: palliative care, welcoming in health, communication, health networking and learning. These axes corresponded to the main aspects detected in the research and revealed that professionals expressed a strong need for an adapted training program. Conclusion: The need for an educational process in palliative care capable of combining patient and family centered care with strengthening and valuing primary care professionals was highlighted.

Objective: To measure the cost of Chronic Obstructive Pulmonary Disease (COPD) in Brazil to present an updated overview of the economic impact. Methods: A descriptive and retrospective analysis was carried out using macro and micro-costing techniques. It was based on information available in the Brazilian Ministry of Health’s databases, national and international guidelines for the clinical management of COPD, and the opinion of specialists. The time horizon adopted included the period from January to December 2019 and considered the direct medical costs linked to the provision of health care. Results: The analysis revealed that the costs of hospital management of COPD totaled BRL107,867,664.40. This represents 8.2% of the total costs of care related to the group of respiratory diseases in Brazil during the specified time range. In addition, it was evidenced that there is a substantial increase in the cost related to the management of the stable phase of the disease according to the severity of the condition, ranging from BRL418.50 for Stage I to BRL4,257.53 for Stage IV. Conclusion: This cost analysis and the estimated prevalence of COPD identified in Brazil demonstrate the importance of implementing effective strategies and public policies aiming to reduce risk factors associated with the disease.

Abstract Background The surge in individuals facing functional impairments has heightened the demand for rehabilitation services. Understanding the distribution of the rehabilitation workforce is pivotal for effective health system planning to address the population’s health needs. Objective To investigate the spatial and temporal dispersion of physical therapists, speech therapists, psychologists and occupational therapists across various tiers of care within Brazil’s Unified Health System and its regions. Method This is an ecological time series study on the supply of rehabilitation professionals. Data were obtained from the National Register of Health Establishments from 2007 to 2020. The density of professionals was calculated per 10,000 inhabitants annually for Brazil and its five regions. The Joinpoint regression model was used to analyze the temporal trends of the density of professionals, considering a 95% confidence interval. Results In 2020, the most notable concentrations of psychologists, speech therapists, and occupational therapists in Brazil were observed in the domain of Specialized Health Care, with densities of 0.60, 0.20, and 0.16 professionals per 10,000 inhabitants, respectively. Conversely, the highest density of physical therapists was found within Hospital Health Care, with a density of 1.19 professionals per 10,000 inhabitants. Notably, variations in professional dispersion across different regions were apparent. Primary Health Care exhibited the highest density of professionals in the Northeast region, while the Southern region accounted for the highest densities in all professional categories within Specialized Health Care. The southeast region exhibited the largest workforce within Hospital Health Care. A marked upsurge in professional availability was noted across all categories, notably in the occupational therapy sector within hospital care (AAPC: 30.8), despite its initial low density. Conclusion The implementation of public health policies played a significant role in the expansion of the rehabilitation workforce at all three levels of care in Brazil and its various regions from 2007 to 2020. Consequently, regional disparities and densities of professionals have emerged, mirroring patterns observed in low-income countries.

Abstract Introduction In Brazil, a country of continental dimensions, the health needs of each region have an impact. In this context and the name of the principle of equity, the SUS organizes actions especially aimed at social groups such as the elderly, children, pregnant women, and indigenous peoples. The concept of justice proposed by John Rawls is one of equity, which is essential to this country. Methods This is an ecological, descriptive study, which analyzed hospital spending on cardiovascular diseases in the Unified Health System (SUS) among the indigenous elderly population and other ethnicities/colors in Brazil, between 2010 and 2019. Results Hospitalization costs and fatality rates for indigenous populations and other colors/ethnicities, between 2010 and 2019, were evaluated. A reduction in hospitalization costs for the indigenous population and an increase in other populations was observed throughout the historical series, while there was an increase in fatality rates for both groups. A comparison was made between hospitalization costs and the fatality rates of indigenous populations and other colors/ethnicities according to sex, between 2010 and 2019. It was observed that regardless of sex, there are significant differences (p

Abstract Background The COVID-19 pandemic brought significant changes to dental care, which may have affected pediatric dental care offered in primary healthcare settings. Therefore, the aim of this study was to analyze the quantity of dental procedures performed in primary healthcare for children aged 6 to 12 years, before and during the COVID-19 pandemic. Methods This is an ecological study using data from the health information system of Piracicaba, São Paulo, Brazil. The variables considered were: coverage of first programmed dental consultation, restoration of permanent and deciduous teeth, topical fluoride application (individual per session), emergency care, and deciduous tooth extraction. Two periods were considered: period I (March 1, 2019 to February 29, 2020) and period II (April 1, 2020 to March 31, 2021), before and during the pandemic, respectively. Comparisons between periods were made using the paired nonparametric Wilcoxon test with a significance level of 5%. Results There was an increase in emergency care from 15.4 to 32.4% (p = 0.0095) and a decrease in the number of restorations of deciduous teeth from 32.8 to 20.2% (p = 0.0217). The first programmed consultation showed a decrease of 9.60% (p = 0.0930) in period II. Conclusions The COVID-19 pandemic has hindered access to primary dental care for children, impacting the quantity of emergency care, reducing restorations of deciduous teeth, and first programmed dental consultations. These findings highlight the need for strategies to ensure that pediatric dental care is not neglected during pandemics.

This study aimed to estimate the economic costs of excessive sodium consumption in terms of hospitalizations and outpatient procedures of medium and high complexity (OPMHC) for the Brazilian Unified Health System (SUS) and its states in 2019. Ecological study. This study used population attributable fractions (PAFs) of excessive sodium consumption estimated by the Global Burden of Disease study based on the theoretical minimum risk exposure level (3 g of sodium per day), the average population consumption, and relative risks of sodium–outcome pairs. PAFs were applied to the total costs of hospitalizations and OPMHC paid by SUS for each outcome obtained from the Outpatient and Hospital Information Systems. The costs per 10,000 inhabitants in all the Brazilian states were calculated and converted into international dollars (Int$), considering the purchasing parity power in the year 2019. Excessive sodium consumption resulted in Int$ 98,882,386.36 (95% uncertainty interval: Int$ 3,398,343.53–312,065,319.80) in hospitalizations and OPMHC costs in Brazil in 2019. Males and the 55- to 69-year-old age group had the highest expenditures attributable to excessive sodium consumption. Cardiovascular diseases were the most significant contributors to the costs associated with the risk factor. Southern and southeastern states had the highest costs of diseases attributable to sodium. Excessive sodium consumption has a significant economic burden on SUS, particularly among men and more developed states. This underscores the inequalities in socio-economic factors and access to health services throughout the country. Economic analyses at the subnational level can provide evidence for public policy planning to define the most appropriate actions for the population's sociodemographic reality. [ABSTRACT FROM AUTHOR]

Palliative care is governed by the principles of reaffirming the importance of life. For children, adolescents and young adults, this comprehensive care provided by a multidisciplinary team has proven to be a challenge, especially with regard to home care. Therefore, the objective is to understand the supply of palliative care services in pediatric oncology and young adults, at home, as well as the coverage of care by health region in Santa Catarina. This is an ecological study, with secondary data from the Ambulatory Information System (SIA/SUS) and Hospital Information System (SIH/SUS), for the state of Santa Catarina, from 2018 to 2021. The records were investigated of care offered to the age groups from 0 to 29 years of age. To characterize palliative care, the name already presented in the literature was followed. The Greater Florianópolis Macroregion was the only one to present records of home hospitalization. Overall, there was a drop in attendance during the first year of the COVID-19 pandemic. It was identified that the distribution was not homogeneous in all macro-regions, but the disparity in the supply of records of procedures at home was notable, which leads us to reflect on whether the low number only reflects the little care provided, or the lack of records in systems linked to productivity in the SUS. The study made it possible to identify disparities between the population's coverage and access to this type of care. [ABSTRACT FROM AUTHOR]

This study aims to develop an action plan to address the main health issues of the population served by Primary Health Care. It is descriptive qualitative research conducted in a municipality in Minas Gerais, based on Situational Strategic Planning. The health situation analysis was carried out using e-SUS data from 2022, employing the Transcendence, Urgency, and Capacity matrix to identify and prioritize health problems. The main issues identified were Hypertension, Mental Disorders, and Type II Diabetes Mellitus, with mental disorders being highlighted in the matrix. A causal determination network was developed, and an intervention plan was proposed focusing on improving care for patients with mental disorders, training health professionals, and promoting mental health. Ensuring effective actions is crucial to guaranteeing the right to mental health through public policies. [ABSTRACT FROM AUTHOR]

The absence of public health policies aimed at sex workers reflects negatively on health equity. Sex workers, since the origins of this profession, constitute a group that has been historically stigmatized and discriminated against for deviating from the standard model of socially and morally established behavior. Given the above, the question is: What are the perceptions of sex workers regarding the care network of the Unified Health System of Pernambuco? The activity was developed with the participation of twelve sex workers, all female, aged between 18 and 60 years old. From the results, discussions, reports, and reflections emerged about the knowledge and care of health professionals who make up the Health Care Network (RAS). Academic and empirical knowledge revealed the identified discursive formations: the teamwork process, structural reality, and the relationship with extension agents and sex workers in the educational process. [ABSTRACT FROM AUTHOR]

Introduction: Financial toxicity can increase healthcare costs, in addition to negatively impacting the therapeutic adherence and healthrelated quality of life of cancer patients within the public healthcare system. Objective: To correlate financial toxicity with the adults living with cancer health-related quality of life during the COVID-19 pandemic. Materials and Methods: This is an observational, cross-sectional, correlational study conducted with 179 patients receiving care from the Unified Health System in a capital city in southern Brazil. Data collection was performed from September 2021 to December 2022, using questionnaires containing sociodemographic and clinical data, and the Comprehensive Score for Financial Toxicity and the Functional Assessment of Cancer Therapy-General. The correlation between financial toxicity and health-related quality of life was assessed using Spearman's correlation coefficient at a 5 % significance level. Results: The correlation between financial toxicity and health-related quality of life was 0.41 (p-value < 0.001). The financial toxicity and health-related quality of life scores were 20.1/44 and 73.3/108, respectively. Conclusion: This study has found that the lower the financial toxicity, the better the patients' health-related quality of life. In this sense, recognizing the presence of financial toxicity in the treatment course could help improve adherence to treatment and health-related quality of life. [ABSTRACT FROM AUTHOR]