Ciencia & saude coletiva最新文献

Rare diseases are an important cause of infant mortality, yet their care presents many challenges. Legal claims have enabled access to medicines, but there are concerns about interference in health policy and patient safety. The present study analyzed 912 lawsuits, involving 23 medicines for 18 rare diseases between 2008 and 2022. Most plaintiffs were women and children, aged 0 to 5 years, residing in São Paulo and Minas Gerais. Legal aid was commonly granted, and 36 deaths were reported. The lawsuits originated from the Federal District, with limited use of alternative resolution methods. Private attorneys and prescriptions from private health services predominated. Court decisions were predominantly favorable to the plaintiffs, but only 4.2% of the actions indicated the inclusion of claimants in the Unified Health System (SUS). Despite Brazil's high rate of health litigation, some medicines involved in these lawsuits lacked strong evidence of efficacy and safety. Monitoring medicine use in this context is crucial to support future decisions. It is essential to develop innovative policies and coordination among different sectors to ensure effective and comprehensive care for individuals with rare diseases.

Syphilis remains a significant sexually transmitted infection in Brazil, with benzathine penicillin (BPG) as the first-line treatment. In 2014, the country faced a global penicillin shortage, prompting a coordinated federal response, especially in light of rising congenital syphilis cases. This study conducted a documentary analysis of 37 official documents (price registration minutes, technical notes, ordinances, and decrees) to characterize strategies for procurement, price negotiation, and national and international cooperation. The analysis revealed a progressive increase in public procurement of penicillin after 2014 and growing integration between pharmaceutical services, surveillance, and care within the Brazilian Unified Health System (SUS). Federal pharmaceutical services and medicines management was central in overcoming shortages, ensuring BPG supply, and articulating surveillance and comprehensive care. The findings highlight pharmaceutical services as a structural component of the Brazilian response to syphilis, impacting case detection, care, and epidemiological surveillance.

The pharmaceutical workforce in the Unified Health System is responsible for the actions that materialize the National Pharmaceutical Policy from management to care. This study sets out to analyze the dynamics of the pharmaceutical workforce in the SUS over the last 10 years, starting from 2013, a period of rapid growth. We analyzed data recorded in the CNES and IBGE, shown in terms of growth and population rates. Between 2014 and 2023, the total pharmacist workforce in the facilities that serve the SUS in Brazil grew by 36%, and in PHC settings by 47%; 91.96% of pharmacists are not linked to any team. The types of professional relationships that have shown the most growth in the last ten years have been those characterized as "unprotected", such as scholarships and internships, or other types of employment that do not guarantee labor rights. The highest population rates were in the southern states (49.2/100,000), and the lowest in the Northeast and Midwest (32/100,000). The slower growth over the last decade, the disparities between states and regions, and the types of employment contracts all point to the need for continuous work by professional bodies and social participation to defend the pharmaceutical workforce in order to advance the PNAF.

In 2024, we celebrate the twentieth anniversary of the National Pharmaceutical Policy (PNAF), which involves actions to promote, protect, and restore health, with the population's access to medicines and their rational use as an essential part of its principles. This intersectoral policy is strategic for including SUS demands in the agenda of other sectors with impacts on the field of Health, including those that are part of the Health Economic-Industrial Complex (CEIS). Given its characteristics, this study aimed to identify the PNAF's influence in CEIS-related public policies from 2004 to 2024 to improve such policies. We adopted the model developed by Walt and Gilson (1994) to analyze public policies, identifying contexts proposed by Araújo Júnior and Maciel Filho (2001) and the typology of policies proposed by Walt (1994). The results showed the PNAF's principles and strategic lines in 17 CEIS-and-Health-related sectoral policies over 20 years, with notable invisibilities from 2017 to April 2023.

The scope of this study was to analyze the association between effort-reward imbalance (ERI) at work and satisfaction with life among Brazilian public servants. It involved a cross-sectional study with 9,199 active participants in the second stage (2012-2014) of ELSA-Brasil. Sex-stratified analyses were performed using logistic regression at a 5% significance level. Women and men who reported ERI at work were more likely to report dissatisfaction with life (OR = 2.38; 95%CI: 1.93-2.93 and OR = 2.01; 95%CI: 1.68-2.39, respectively) compared to those without ERI. Among women, those in higher/teaching positions revealed a stronger association between ERI and dissatisfaction with life (OR = 2.77; 95%CI: 1.90-4.04) compared to those in support/medium-level positions (OR = 1.71; 95%CI: 1.38-2.12). Occupational stressors, as measured by ERI, were associated with dissatisfaction with life among public servants of both sexes. Functional level acted as an effect modifier in the association between ERI and satisfaction with life among women, potentially reflecting the increased educational and professional requirements women face to access and remain in the labor market as part of efforts to mitigate gender inequality.

In Brazil, studies and practices around the concept of health literacy are recent and linked to the application of internationally validated instruments. From this perspective, a more conservative emphasis on the adoption of health literacy practices can be observed. This article explores possibilities for a Brazilian model of health literacy, considering the marked presence of the Brazilian community in public health in the promotion of health, popular education and educommunication, by linking timelines of these four areas of knowledge and practices. Having established these timelines, it seeks to highlight the main national and international historical, academic and political milestones, of each of these areas, over a specific period (1970-2023), against the backdrop of four political scenarios: "military governments," "redemocratization and neoliberalism," "progressive governments" and "conservatism." Based on the identification of significant national and international milestones and the confluence between the fields of health promotion, popular health education, and educommunication, the possibility of a Brazilian model is postulated for promoting health literacy.

The structural typology of PHC units was drawn up based on the results of the 2024 National Census of PHC units, and the results were compared with those of 2012. Types of teams, diversity of professionals, shifts, available services, and facilities and supplies were used as the sub-dimension categories. A reference standard was set for each sub-dimension and a standardized score was calculated, with 1 being the best. Of the 44,938 PHC units that took part in the Census, 43,209 presented complete information on the variables and were analyzed. The final average score was 0.878, which proved to be 20% higher than in 2012. The sub-dimension with the worst score was "types of teams", and the best was "shifts". The units were grouped according to their final score from best to worst: A, B, C, D, E. All regions increased the percentage of PHC units in groups A and B, especially the North and Northeast. Type A was observed in 21.3% of the PHC units, a 4.4-fold increase, when compared to 2012. Advances in infrastructure conditions, shifts, and the increased presence of doctors indicate the effects of policies aimed at expanding access to PHC. However, essential components for comprehensive PHC still deserve attention, such as the presence of a sufficient number of Community Health Workers (CHWs), universal dispensing of medicines, and equalization between oral health teams and family health strategy (FHS) teams.

This study aimed to assess the prevalence of multimorbidity and associated factors in Manaus, Brazil. A cross-sectional population-based survey was conducted in 2019 using probabilistic sampling. Multimorbidity was defined as two or more self-reported chronic diseases. Multimorbidity treatment was considered if participants received treatment for all their conditions. Limitations in daily activities were assessed using a 5-point Likert scale. Poisson regression was applied to estimate prevalence ratios (PR) of multimorbidity with 95% confidence intervals (95%CI). Out of 2,321 participants, 30.6% (95%CI 28.7-32.4%) had multimorbidity (mean: 2.99 ± 1.27 conditions), and 28.8% (95%CI 25.3-32.0%) of them were treated for all diseases. Back pain, hypertension, and hypercholesterolemia were the most common conditions, while mental disorders, renal disease, and other less frequent illnesses were most markedly associated with severe limitations in daily activities. Multimorbidity was higher in women (PR =1.46; 95%CI 1.28-1.66), older people (p < 0.001), and retired individuals (PR = 1.41; 95%CI 1.13-1.75). Nearly 30% of the population of Manaus live with multimorbidity, which is associated with socioeconomic determinants; among them, approximately one-quarter received multimorbidity treatment.

Integrative and complementary practices (ICPs) comprise complex medical systems and therapeutic resources that seek to stimulate natural disease prevention and health recovery mechanisms by promoting changes in lifestyle habits. The aim is to investigate the association between the use of ICPs and the prevalence of healthy eating habits in Brazil's population. This cross-sectional study used data on adult and older adult participants in Brazil's 2019 National Health Survey. Prevalence of habits was estimated by categories of ICP use, together with prevalence ratios adjusted by sociodemographic characteristics and chronic disease, using Poisson regression models with robust variance and 95% confidence intervals. ICP use was 5.5% prevalent. Interviewees who used some ICP during the period, returned a higher prevalence of regular consumption of fruits and vegetables and a lower prevalence of consumption of soft drinks, ultra-processed foods and beans. ICP users reported a higher prevalence of healthy eating habits, which is consistent with the approach the practices foster. Expanding access to ICPs can contribute to a healthier lifestyle.

Identify municipalities with underreporting of interpersonal violence based on homicide in Brazil, 2016 to 2018. Ecological study with rate on violence from the Notifiable Diseases Information System and homicide estimates from the Global Burden of Disease concerning < 20 years, women of 20 to 59 years, ≥ 60 years and the total of these subgroups. Bivariate Local Moran identified clusters of critical areas of low reporting rates and high homicide rates (p < 0.05). Municipalities in the North, Northeast, and Midwest of Brazil represented 29% of all reports of violence and 58% of homicides. The majority of these municipalities were concentrated in low reporting rates (≤ 0.8/10,000) and high homicide rates (≥ 13.7/100,000); and 31.4% of municipalities with high homicide rate reported zero cases. Reports of violence and homicide rates showed a negative spatial correlation (I<20 = -0.083; Iwomen20-59 = -0.023; I≥60 = -0.086; Itotal = -0.085), showing that nearby places have inverse values. Critical municipalities for underreporting of violence reach 16% of < 20 years, 12% of women, 23% of the elderly, and 18% in total. The low reporting in seriously violent areas provides evidence of underreporting. The findings can provide management with tools for initiatives to improve violence surveillance and access to the protection network.