Ciencia & saude coletiva最新文献

The Stork Network (SN) strategy was created to guarantee comprehensive care and address high maternal and infant mortality rates. The aim of this study was to assess the actions developed by the SN across municipalities in the state Pernambuco and the association between these actions and prenatal care quality indicators. We conducted a multi-group ecological study of Component I of the SN in Pernambuco using data from audits conducted under the state component of the National Audit System for the period 2017 to 2020. We explored the association between ten actions and the prenatal care quality indicators. The indicators with the highest ratings were "improved access to high-risk prenatal care", "rapid syphilis/HIV testing" and "laboratory testing for low and high risk pregnant women". The indicator with the strongest association to mean congenital syphilis rate was rapid testing for syphilis/HIV. Two indicators showed a statistically significant association with mean perinatal mortality rate: "improved access to high-risk prenatal care" and "support for travel". We conclude that the organizational management of the SN in Pernambuco and provision of services under component I did not meet the objectives of strategy. Our findings demonstrate the potential of auditing for supporting policy implementation.

This study analyzes the regulatory mechanisms governing the integration of pharmaceutical services between high-complexity oncology care and primary health care within the Brazilian Unified Health System. The fragmented care levels undermine treatment continuity, particularly for oncology patients who require ongoing follow-up across both settings. A document analysis of federal regulations in effect from 1990 to 2024 was conducted to identify barriers and facilitators to this integration. The findings indicate that, although normative guidelines are in place, significant challenges persist, including unequal access to expensive medicines, the lack of integrated health information systems, and discontinuous pharmacotherapeutic follow-up. The study advocates for shared care, emphasizing greater collaboration among healthcare teams as a strategy to streamline pharmacotherapy management and ensure care continuity. It concludes that updated regulatory frameworks and coordinated practices are essential to overcoming a fragmented system and ensuring comprehensive and equitable care within the Brazilian Unified Health System.

This article analyzes the evolution of pharmaceutical policies and services in Brazil, emphasizing the development of the latter and the political disputes and influence networks shaping governance in the sector. Based on an ethnography of documents, the study examines the institutional pathways and decision-making processes involved in the formulation of the National Pharmaceutical Services Policy, tracing its development from the National Medicines Policy. The findings reveal that the proposed model for pharmaceutical services was strongly influenced by social control mechanisms, establishing itself as a key coordinating axis of intersectoral policies. The incorporation of principles such as pharmaceutical care, initially promoted by the Pan American Health Organization, shows the strategic role played by this institution in shaping the policy. This new approach to pharmacotherapeutic care redefined the role of pharmacists, expanding their responsibilities beyond the mere distribution of medicines. The article thus presents innovative conceptual and methodological tools to theorize and analyze the functioning of public policies, offering insights for a critical understanding of the development of pharmaceutical services.

The integrality of care is one of the core principles of the National Policy of Pharmaceutical Assistance (Política Nacional de Assistência Farmacêutica - PNAF) and underpins two tools that guide the use of medicines: clinical protocols and therapeutic guidelines (protocolos clínicos e diretrizes terapêuticas - PCDT) and the lists of essential medicines. municipalities are encouraged to use these for healthcare management, but the development of municipal lists (relações municipais de medicamentos essenciais - Remume) presents weak points. The aim is to describe potential impacts on the implementation of PCDT from the perspective of the unavailability of medicines from the Basic Component of Pharmaceutical Assistance (Componente Básico da Assistência Farmacêutica - CBAF) in Remume. The CBAF medicines included in the PCDT until June 2023 were extracted. Forty-eight municipalities were selected for the Remume search and verification of the medicines of interest. Each PCDT was analyzed according to the lack of the least found medicines. The Remume contained, on average, 60% (44-75%) of the listed medicines, and the average coverage of each PCDT ranged from 2% to 100%. Of 62, 11 PCDT were impacted by the low availability of medicines. A lack of coverage of CBAF medicines in Remume was identified, which may challenge the implementation of PCDT.

The oil spill disaster that affected 11 states along the Brazilian coast in 2019/2020 is considered the largest in Brazil's history, with approximately five tons of oil residues collected. Small-scale fishers (SSF) were the group at greatest risk of exposure. This article describes the study design and questionnaire validation of the first epidemiological study in Brazil aimed at investigating the potential health effects of this disaster on SSF. The questionnaire was validated using the Delphi method and consists of 325 questions organized into 13 sections: identification and control, general information, socioeconomic conditions and living situation, work history and organization, fishing activities during the spill, exposure related to spill cleanup, seafood consumption, perceived impacts of the spill, clinical measurements, additional health information, lifestyle, quality of life, and COVID-19. The study design incorporated community engagement approaches. The results will enable the assessment of associations between oil exposure and health outcomes, the monitoring of long-term health effects in this population, and the analysis of the occupational and socioeconomic impacts of the disaster.

This study aimed to analyze the evolution in the incorporation of psychotropics into National List of Essential Medicines (Relação Nacional de Medicamentos Essenciais - RENAME) and whether the current list meets the burden of mental disorders in Brazil. Requests for psychotropics sent to National Commission for the Incorporation of Technologies in the SUS (Comissão Nacional de Incorporação de Tecnologias no SUS - CONITEC) between 2012 and December 2024 were collected and the number of psychotropics for mental disorders in the last eight versions of RENAME was analyzed, as compared to the World Health Organization (WHO) list. Next, the relationship between the number of psychotropics in RENAME 2024 and the burden of disease in Brazil according to the DALY indicator was analyzed. Eleven requests for psychotropics were sent to CONITEC, equivalent to 1.0% of the total, while 90.9% of the demands referred to the incorporation and 9.1% to the expansion of use. Between 2010 and 2014, an increase was observed in the incorporation of psychotropics in RENAME, but the following RENAMEs were not changed. RENAME 2024 includes 18 psychotropics, and 66.7% are funded by the Basic Component. There is a disproportionate relationship between the number of medications for anxiety and depression in RENAME and the high burden of these diseases in Brazil. The findings indicate that the lack of review of RENAME may be impacting the mental health needs of the Brazilian population.

The National Pharmaceutical Policy (Política Nacional de Assistência Farmacêutica - PNAF) takes regional priorities into account. In the Amazon region, social and geographic accessibility indicators are crucial for improving access and ensuring health equity. This study analyzed the organization of pharmaceutical management in 18 municipalities in the countryside of the state of Amazonas. Social, demographic, and structural indicators were described. Medicines accessibility settings (Unidades de Acessibilidade a Medicamentos - UAM), medicine accessibility support settings (Pontos de Apoio à Acessibilidade de Medicamentos - PAAM), and pharmacists were identified. Coverage factors related to Health Centers, territory and population, as well as pharmacists per UAM and per inhabitant, were calculated and suported by selected statements. Access to both the capital city and the most distant village was analyzed. There was at least one UAM in each municipality, and 74% of the establishments stocked medicines. This figure varied between more centralized and decentralized municipalities, with integration with other structures increasing medicine accessibility. The 91 PAAMs serve as a strategy to further increase accessibility, particularly in remote areas with limited infrastructure. The workforce is diversified, with at least one pharmacist in each setting. The synergy between primary health care and pharmaceutical services proved crucial.

In the intersectoral political context covered by the National Pharmaceutical Policy (Política Nacional de Assistência Farmacêutica - PNAF), the Drug Market Regulation Chamber (Câmara de Regulação do Mercado de Medicamentos - CMED) is responsible for regulating and monitoring the medicines market. To identify medicines with a provisional price in Brazil and those incorporated into the Unified Health System (SUS), and to understand the transition to a definitive price, a case study was conducted based on a documentary analysis of technical-scientific reports on medicines pricing between 2017 and 2023, prepared by CMED, as well as public documents on medicines incorporated into SUS. Twenty-nine medicines by trade name and 95 presentations with provisional prices were identified, five of which were incorporated by SUS. The main reason for establishing a provisional price was that they only had a price in the United States. Four medicines had their provisional price confirmed after being sold in at least three other countries, resulting in a definitive price. Practical and regulatory improvements are being implemented to enhance the completeness of the PNAF's strategic axis related to the regulation and monitoring of the pharmaceutical market.

The present study aims to create a unified relational database (BEM-SUS) to analyze the use of medicines from the assistance program called Specialized Component of Pharmaceutical Assistance (Componente Especializado da Assistência Farmacêutica - CEAF) within the Brazilian National Health System (SUS). It integrates information from different SUS data sources and considers data on CEAF medicines dispensing from 2013 to 2022. The study is based on 5,991 public datafiles from the SUS Outpatient Information System, including data on outpatient production (produção ambulatorial - PA) and APAC Medicines (APAC-M). The PA data contains 239,125,819 records, while the APAC-M data contains 180,692,466 records. APAC-M accounts for 75.6% of the PA records, and PA lacks variables in the APAC-M files. The BEM-SUS was constructed from PA data in addition to APAC-M data. Deterministic linking enabled the matching of 99.96% of the records, resulting in 239,027,991 records from 6,431,208 different users. This study emphasizes the importance of prior data treatment and linkage between available databases for a correct interpretation of the data in drug utilization studies (DUS).