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The human-animal relationship in the hospital care setting was investigated based on an ethnographic study of an animal-assisted support program at a tertiary institution within the Brazilian Unified National Health System in Rio de Janeiro, Brazil. This study examines the effects of communicative interactions and the agency that regular visits by a single service dog seem to catalyze among staff members. Using the Actor-Network Theory and Donna Haraway's concept of "companion species" as analytical frameworks, we explore the reconfiguration of social networks in the integration of a non-human other as a collaborator in health promotion activities within hospital settings. By operating according to logics not driven by power or rationality, its political role is highlighted in the various agencies produced within relational dynamics and the economy of affects. The new arrangements introduced by the service dog outline the micropolitical dimension of emotions in the reorganization of interpersonal and interspecies relationships within hospital settings. This study shows that animal-assisted support progra in hospitals can function as an innovative social technology in health, capable of reconfiguring care networks and interaction dynamics.

Internalized stigma has been strongly linked to mental health issues in people living with HIV/AIDS (PLHA), particularly depression. Nonetheless, the overlap between depressive symptoms and other psychopathologies is well-known among specialists. This study aimed to examine the factors predicting depressive and anxiety symptoms in PLHA. This is a community-based study (Stigma Index Brazil 2.0) that involved 1,784 PLHA recruited from seven Brazilian state capitals. Outcomes of interest were derived from the Patient Health Questionnaire (PHQ), and covariates included factors previously linked to poor mental health outcomes, such as social vulnerability, treatment adherence, internalized stigma, among others identified in the Stigma Index study. Internalized stigma was significantly associated with worse mental health outcomes across all models (i.e., depression, anxiety, and total PHQ-4 score). Moreover, other variables were differentially associated with each outcome, possibly indicating distinct pathways with which healthcare professionals might address the burden of mental suffering in PLHA. Clear implications for public policies are equally outlined.

Data on the health of black women and the presence of this topic in national journals remain scarce, especially considering the frequent use of the primary care network and the Brazilian Unified National Health System (SUS, acronym in Portuguese) by these women. In this article, we take an intersectional perspective on the categories of gender, race, class, and nationality interlinked to the concept of "social capital" to analyze the perceptions of healthcare services by Congolese women residing in Rio de Janeiro, Brazil, in 2018. A qualitative study was conducted, consisting of participant observation and eight semi-structured interviews conducted at a refugee shelter (Cáritas RJ). The narratives of these women reveal the impact of daily violence on their experiences upon arriving in Brazil to seek shelter. Mistrust, language limitations, and lack of knowledge contribute to the lack of social capital and inaccessibility of services. As black women compose a large group of individuals that use the SUS, their active participation could exert an impact on their experiences with these services. The existence of spaces for listening to vulnerable groups, such as Congolese refugees, is another strategy for promoting equity and universal access to health for everyone.

The aim of the present study was to analyze technological arrangements for the management of care and beds at a public reference hospital in Portugal. Technological arrangements combine technologies and management practices for greater effectiveness in complex organizational contexts and are used to address challenges, such as excessive demand, rising costs, and complaints with regards to the quality of care. The application of technological arrangements in different contexts has produced varying results and studies are needed to address the impact on interprofessional relationships and the connection between hospitals and service networks. A qualitative, ethnographic case study was conducted, involving 15 interviews with 22 administrators and employees as well as participant observation of three technological arrangements: Inpatient Management Support Service; 11 a.m. Meeting; and High Users Resolution Group. Technological arrangements for managing admissions (input), care (throughput), and hospital discharges (output) were described. The in-depth observation highlighted the dynamics, potential, and challenges of technological arrangements for integrating bed and discharge management. When well implemented, technological arrangements help address hospital overcrowding, but do not solve systemic problems related to discharge and the continuity of care in the network. Strong employee adherence to technological arrangements was found, with a focus on the leadership of nursing staff and the silence of physicians, suggesting new challenges related to autonomy and power. Technological arrangements are effective at bed and care management, alter multidisciplinary practices and interprofessional relationships, and exert an impact on the network of external services. The production of contemporary hospitals requires evidence-based technological arrangements that increase efficiency, sustainability, as well as technical and organizational capabilities.

Pneumonia constitutes a leading cause of death in children from low- and middle-income countries. We aimed to describe the prevalence and the factors associated with pneumonia in children aged from 0 to 6 years in a location with high pneumococcal vaccination coverage. The occurrence of at least one episode of pneumonia diagnosed by a physician as reported by the mother was investigated at the 12-, 24-, and 48-month, and 6-year follow-ups of the 2015 Pelotas (Brazil) birth cohort. The independent variables included family and child characteristics at birth, breastfeeding, and vaccinal status. Prevalence ratios (PR) with 95% confidence interval (95%CI) were estimated by unadjusted and multivariable Poisson regressions with robust variance. At the 12-, 24-, 48-month, and 6-year follow-ups 4,014, 4,006, 3,997, and 3,862 children were assessed, respectively. Prevalence from 0 to 6 years equaled 16.7% (95%CI: 15.5-18.0). Within the first, second, 2-4 and 4-6 years of age the prevalence of at least one episode of pneumonia totaled 7.9%, 5.9%, 6.7%, and 3.4%, respectively. Higher maternal parity (adjusted PR = 1.75, 1.61, and 2.0 at the first, second, and 4-6 years, respectively) and prematurity (adjusted PR = 1.39 and 1.49 at the first and second years of life, respectively) constituted the factors most consistently associated with an increased risk of pneumonia. Almost one in every five children aged 6 years had a positive history of pneumonia, mainly in their first year of life. Greater maternal parity was the strongest and most consistent factor associated with a higher prevalence of pneumonia in childhood.

This article describes methodological aspects and characterizes participation in the first year of the study Impact of Regulation of the School Food Environment. The aim was to monitor food sales in and around private school canteen in three Brazilian cities with different regulatory contexts and investigate the perceptions of students with regards to canteen. A repeated cross-sectional study (2023/2024 and 2025) was conducted with independent samples in the cities of Recife (Pernambuco State), Niterói (Rio de Janeiro State), and Porto Alegre (Rio Grande do Sul State). For the Canteen Module, sampling involved private primary schools and high schools stratified by school size and with inverse replacement. A convenience sample was used for the Street Vendor Module and 3-stage cluster sampling was used for the Student Module. The first two modules replicate the method of the Food Commercialization in Brazilian Schools study. The first data collection process took place between September 2023 and May 2024. Two hundred two schools and 532 students participated. Only three street vendors were located. School participation rates were 47.8% in Porto Alegre, 53.9% in Niterói, and 69.9% in Recife. Schools were reluctant to participate in the survey, which prolonged the data collection process. This article discusses the challenges faced during fieldwork and the methodological adjustments required for the second year of monitoring, offering recommendations for future studies in the school setting. This project is the result of a collaboration between academia and organized civil society, which required information to support advocacy for healthy eating at schools. The evidence generated could assist in the formulation and improvement of protection policies for the school food environment in other cities and on other governmental levels.

The aim of the present study was to understand the participation of global health initiatives (GHIs) in addressing the HIV/AIDS epidemic in Guinea-Bissau based on the insights of different social and political actors, representatives of GHIs, the Guinean government, and civil society organizations. A qualitative, descriptive, exploratory case study was conducted involving interviews with 36 participants. Thematic content analysis was employed. The discourses of the participants were organized into four main topics. The results indicate that, besides the government, at least 15 nongovernmental organizations and a strong partnership with Brazil were identified in the response to HIV/AIDS. The limitations and challenges of the government are related to the acquisition of funding and the management of the resources provided by GHIs. The contributions of GHIs were described as positive, considering the internal lack of funding and external dependence, with the Global Fund as the primary funder of HIV/AIDS response actions. This dependence interferes with the autonomy of management and affects coordination. The situation in Guinea-Bissau resembles that of several countries in Sub-Saharan Africa, in which the work of GHIs is characterized by a paradox: dependence on financial resources and the need to decolonize from external aid, which, to some extent, serves as a disciplinary device. The findings underscore the need for the country to adopt characteristics of a stable government, with measures that ensure its autonomy and independence from colonialism.

This study examined whether a low socioeconomic position over the course of one's life, the accumulation of low socioeconomic position, and intergenerational social mobility are associated with all-cause mortality over a 15-year follow-up period, and whether these associations varied according to race/skin color. A prospective study was conducted with 13,652 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. The outcome was time to death from any cause. The explanatory variables were socioeconomic position in childhood (mother's schooling), adolescence (head of household's socio-occupational class), adulthood (participant's schooling and socio-occupational class), cumulative socioeconomic position, and intergenerational social mobility. Cox proportional hazards models were adjusted for sociodemographic characteristics. The mortality rate was 4.9/1,000 person-years and was higher among men, older adults, Blacks, and those with a low socioeconomic position. After adjustments, low socioeconomic position in childhood, adolescence, and adulthood remained associated with higher mortality. The greatest accumulation of low socioeconomic position across life (HR = 2.02; 95%CI: 1.64-2.48, 4th vs. 1st quartile), as well as downward and stable low educational and socio-occupational trajectories, were also associated with higher mortality. To a lesser degree, an upward socio-occupational trajectory (vs. stable high) increased the risk of death. No multiplicative interaction was found between socioeconomic position and race/skin color regarding risk of death. Lifelong exposure to socioeconomic disadvantages throughout the course of life as well as the accumulation of adverse social experiences and unfavorable intergenerational educational and socio-occupational mobility, increased the risk of mortality, demonstrating the long-term effect of a low socioeconomic position, especially with prolonged exposure.