Ciencia & saude coletiva最新文献

The aim is to characterize the provision of practices in Primary Health Care (PHC) in Brazil by region and the population of each municipality. The 2024 National Census of Basic Health Units (BHUs) was applied through an electronic instrument on the e-Gestor platform. Variables regarding life course and chronic diseases, among other health conditions, were selected. Outcomes were constructed with the sum of positive responses to each set of variables, and the 75% percentile of the distribution was set as the cutoff point for analysis according to the geopolitical region and population of the specific municipality. A total of 44,938 BHUs were included. For life course, 46.2% of the BHUs achieved a score above the cutoff point, while for chronic diseases and other conditions, this score was 33.6%. For both outcomes, the Northeast and Southeast regions reached the highest proportions, and the North and Midwest regions, the lowest. In relation to population size, both outcomes showed a higher prevalence in municipalities with more than 900,000 inhabitants and a lower prevalence in municipalities with less than 20,000 inhabitants. Considering the marked regional inequalities, it is necessary to seek a universalization of the provision of actions aimed at priority groups in PHC.

The Family Health Strategy (FHS), after thirty years, has shown numerous advances in reorienting the care model, expanding equitable access, and improving population health. However, networked care remains an unresolved issue. This article addresses the challenges and possibilities for care coordination within the FHS, which is the predominant model for structuring Primary Health Care (PHC) in Brazil, considering its role within care networks and regions of the Unified Health System (SUS). Initially, a brief overview of the situation regarding coordination, continuity, and integration of care is presented. In addition to recognizing the internal aspects of coordination within the scope of PHC (also related to access, quality, and availability of care), this article discusses decisive factors for coordination that go beyond PHC, particularly those related to the organization and functioning of specialized care, while still focusing on their connection with structural challenges of SUS. This article also explores certain mechanisms for coordination, integration, and continuity of care between PHC and SC. Finally, it presents technical-political strategy proposals to improve care coordination by the FHS.

This article analyzes the trajectory of Community Health Agents (CHAs) in the Family Health Strategy over its 30 years, highlighting their role in consolidating Primary Health Care (PHC) within Brazil's Unified Health System (SUS). It aims to understand how public policies shaped their work, training, and professionalization, and the challenges faced. Using a historical-critical approach, it combines document analysis (laws, ordinances) and literature review, aligned with Comprehensive PHC and social determination of health frameworks. Key findings: (1) CHAs evolved from an occupation to a regulated profession with legislative achievements; (2) their work faces tensions between bureaucratic and community roles, aggravated by the decrease in their presence within the teams, harming comprehensive PHC; and (3) they confront violence, socio-environmental crises, and misinformation. Despite the adversities, CHAs have established themselves as essential workers for the Unified Health System (SUS), which is crucial for territorialization, community orientation, and multidisciplinary work, whose future depends on the direction that will prevail in the conduction of PHC in Brazil.

With the technological advances in pediatric intensive care units (PICUs) and increased survival rates, there is growing interest in the challenges of post-discharge care. This study aimed to estimate the prevalence of caregiver burden among relatives of children who had been admitted to PICUs, considering their sociodemographic characteristics and the children's clinical conditions. A cross-sectional study was conducted with relatives of children admitted to public and private PICUs in Rio de Janeiro (n = 339). Interviews were conducted in person and/or by telephone 60 days after discharge. Caregiver burden was assessed using the Zarit Burden Interview technique. Chi-square tests were used to examine differences in subgroup proportions. Results showed that 41.3% of relatives experienced burden. The prevalence was higher among unmarried caregivers, those without religion, caregivers of children not attending daycare/school, relatives of children who developed new morbidities during hospitalization, and those with low social support. The high prevalence of caregiver burden in certain subgroups necessitates that primary care teams be attentive to identify the most vulnerable, prioritizing them in actions aimed at promoting the health of the entire family.

This article examines family violence against LGBTQIA+ individuals as a dimension of social inequality in mental health and, more specifically, as a predisposing factor for suicidal behavior. The data presented are drawn from intervention research conducted between 2020 and 2023, which explored the affections and sufferings of LGBTQIA+ individuals through therapeutic groups. We highlight three clinical cases that illustrate the relationship between suicide, rape and family institutions. Considering the complexities of these cases, we propose the concept of certification rape to describe situations in which individuals engage in unwanted sexual relations in order to "certify" their sexual orientation, often prompted by recurring suggestions from family members. Lastly, we stress the role of the family institution as a mechanism contributing to the death of LGBTQIA+ individuals, which operates as a microphysics of necropower.

This article aims to review approaches to community participation in the historical and social context of Primary Health Care (PHC) to reflect on the critical reconstruction of the care model of the Family Health Strategy (ESF) and the Unified Health System (SUS). We present the results of several evaluative studies with users and health professionals, highlighting challenges to community participation in PHC: the population's knowledge of the SUS and health as a human right; the imposition of social determinants of the health-disease process that weakens population participation; a shortage of financial and material resources to run activities; workers' limited time and focus in developing these activities; a lack of management support for these initiatives; and a lack of interest on the part of some professionals in the dimension of community participation, preferring to focus exclusively on individual clinical care. The conclusion is drawn regarding the importance of community participation in the ESF for building a shared agenda between service providers, management, and the population to mobilize strategies that affirm life, well-being, and healthy and sustainable territories.

The aim of this study was to compare the reorganization of primary health care (PHC) across the different regions of Brazil during the critical phase of the COVID-19 pandemic. We conducted an analytical cross-sectional study with municipal primary care managers. The data were collected between September 2021 and September 2022 using a self-administered questionnaire created in Google Forms. The data were analyzed by means of prevalence ratios calculated using Poisson regression with random effects, adopting a 5% significance level. Prevalence of modifications to the physical structure of health facilities to care for suspected and confirmed COVID-19 cases was 15% and 19% lower in the Southeast and Northeast, respectively, than in the South. Prevalence of teleconsultation was 23% lower in the North than in the Southeast and 25% lower in the North than in the South. Referral of COVID-19 patients at risk of clinical deterioration was 6% higher in the Northeast than in the North and South. The findings show that while all regions adopted measures to reorganize PHC to respond to the pandemic, these measures were implemented differently across regions, underlining the need for a more comprehensive and equitable approach to health management, especially during health emergencies.