Construção de uma ontologia de referência para o domínio da HIV/aids / Construction of a reference ontology for the domain of HIV/Aids / Construcción de una ontología de referencia para el dominio del VIH/sida

O uso da Tecnologia da Informação está presente nos mais diversos domínios, inclusive no da saúde, ao utilizar várias metodologias e ferramentas computacionais. O objetivo deste artigo é apresentar o modelo conceitual baseado em ontologia sobre o domínio HIV/aids denominado OntoHI. No processo para desenvol-ver a OntoHI adotam-se a metodologia SABiO e a ontologia de fundamentação UFO, além do conhecimento de especialistas da área da saúde, o que garante a representação da realidade. Artefatos da ontologia aqui apresentados: representação gráfica, glossário de termos, questões de competência. O controle de qualidade se dá através dos processos de validação e verificação das questões de competências. A OntoHI possibilita a integração com representações de outros domínios. Pode ser utilizado como artefato para a construção de ferramentas computacionais, principalmente sistemas de informações e aplicativos móveis para acompanhar o tratamento de pacientes, além de poder ser expandida para se adaptar a novas situações

The use of Information Technology is present in the most diverse domains, including health care, using various methodologies and computational tools. The goal of this work is to present an ontology-driven con-ceptual model on the HIV/AIDS domain called OntoHI. In the process of developing OntoHI, the SABiO methodology and the UFO foundational ontology are adopted, in addition to the specialist's knowledge in the field of health care, which guarantees a consistent representation of reality. Ontology artifacts that are presented here: graphical representation, glossary of terms, validation of competence questions. Quality control happens in the process of validation and verification of competency questions. OntoHI enables in-tegration with representations from other domains. It can be used as an artifact for building computational tools, mainly information systems and mobile applications to monitor patient treatment, in addition to being able to be expanded to adapt to new situations

El uso de las Tecnologías de la Información ocurre en los más diversos dominios, incluido el de la salud, uti-lizando diversas metodologías y herramientas computacionales. El objetivo de este trabajo es presentar el modelo conceptual basado en ontologías sobre el dominio del VIH/sida denominado OntoHI. En el proceso de desarrollo de OntoHI se adoptan la metodología SABiO y la ontología de fundamentos OVNI, además del conocimiento de especialistas en el campo de la salud, lo que garantiza la representación de la realidad. Artefactos ontológicos presentados: representación gráfica, glosario, temas competenciales. El control de calidad se lleva a cabo a través del proceso de validación y verificación de problemas de competencia. Onto-HI permite la integración con representaciones de otros dominios. Puede usarse como artefacto para cons-truir herramientas computacionales, principalmente sistemas de información y aplicaciones móviles para monitorear el tratamiento del paciente, además de poder expandirse para adaptarse a nuevas situaciones

O direito à internação psiquiátrica no sistema de saúde brasileiro: as representações sociais do Tribunal de Justiça de São Paulo / The right to psychiatric admission in the Brazilian health system: the São Paulo Court of Justice' social representations

Este artigo teve como objetivo analisar as representações sociais do Tribunal de Justiça de São Paulo sobre o direito à internação psiquiátrica no sistema de saúde brasileiro. Os dados foram coletados do sítio eletrônico do tribunal paulista, a partir de 184 acórdãos de ações julgadas em segunda instância, proferidos em razão de recursos de apelação e publicados no período de janeiro de 1998 a dezembro de 2012, referentes às internações psiquiátricas pleiteadas no Sistema Único de Saúde e no sistema de saúde suplementar. Os métodos empregados para análise dos resultados foram a estatística descritiva e o discurso do sujeito coletivo. Aplicou-se, ainda, a Teoria das Representações Sociais como referencial teórico de interpretação dos discursos elaborados. No Sistema Único de Saúde, a internação reclamada em juízo foi a compulsória, representada, majoritariamente, como medida de proteção da dignidade da pessoa com transtorno mental e, minoritariamente, como violência contra essa mesma dignidade. No sistema suplementar, a representação judicial assumiu o enfoque consumerista, consubstanciado na abusividade da cláusula limitativa da internação psiquiátrica e no direito superior à vida. O direito à saúde, vislumbrado nas decisões judiciais, resumiu-se ao direito de acesso aos serviços de saúde e ao direito à doença. A compreensão do Poder Judiciário, nos dois sistemas investigados, foi a do direito à saúde como o direito ao bem de saúde pleiteado em juízo, o que coloca muitos desafios para os sistemas de saúde e para o Poder Judiciário frente à consolidação dos ideais da reforma psiquiátrica estatuída pela Lei n. 10.216/2001.

The current research sought to present the social representations of judges from the São Paulo Court of Justice about the law regarding psychiatric admissions. Data were collected through the court website, from 184 judgments including all the decisions published between January 1998, and December 2012, regarding psychiatric admissions claimed to both the Brazilian Public Health System, and the private insurance health system. As methods, the author used descriptive statistics and the collective subject speech. The Social Representations Theory was applied as a theoretical framework to interpret the collected speeches. Considering Brazilian Public Health System, the admissions claimed on the court were compulsory and judges presented the psychiatric admissions, mostly, as a protection measure of people with mental disorders dignity and, at a lower degree, as a violence against this same dignity. With respect to the private insurance health system, the judicial representation was related to the consumerist approach, supported by the abuse of a clause restricting the time for psychiatric admissions and its contradiction with the right to life. The right to health was characterized in the decisions as the right of access to health services and the right to be ill. The comprehension of the judges in both investigated systems related the right to health to the right to a health as a good claimed in court, imposing many challenges to health systems and the Judiciary Power in order to consolidate the principles of the psychiatric reform brought by Law n. 10.216/2001.

Os não nacionais imigrantes e o sistema público de saúde do Brasil: a universalidade do direito à saúde e a pandemia de Covid-19 / Non-national immigrants and the public health system in Brazil: the universality of the right to health and the covid-19 pandemic

O objetivo deste artigo foi investigar o direito humano e fundamental à saúde pública dos não nacionais imigrantes, especificamente durante a pandemia de covid-19. Para cumprir essa proposta, buscou-se compreender o contexto em que os não nacionais imigrantes estão inseridos em nosso país, bem como analisar o atendimento dessa população no âmbito do Sistema Único de Saúde, em especial o preenchimento dos formulários do sistema público em relação aos não nacionais imigrantes no curso da covid-19 no Brasil. A metodologia incluiu análises doutrinária, legislativa e documental a partir de uma abordagem analítico-interpretativa. Concluiu-se que existe, por parte dos poderes públicos, relativo esquecimento dos não nacionais imigrantes. A fim de mitigar essa situação, defendem-se a mudança nos formulários do Sistema Único de Saúde para a inclusão do campo "não nacional", a ampliação dos programas de medicina preventiva, a capacitação dos profissionais de saúde e a criação de canais de diálogo no idioma dos não nacionais imigrantes.

This article aimed to investigate the human and fundamental right to public health of non-national immigrants, specifically during the covid-19 pandemic. To fulfill this proposal, we sought to understand the context in which non-national immigrants are inserted in our country, as well as to analyze the care provided to this population within the scope of the Brazilian Public Health System, in particular the completion of the public system forms in relation to non-nationals. national immigrants during covid-19 in Brazil. The methodology included doctrinal, legislative and document analysis from an analytical-interpretative approach. It was concluded that there is, on the part of public authorities, relative forgetfulness of non-national immigrants. To mitigate this situation, a change in the forms of the Brazilian Public Health System for the inclusion of the "non-national" field, the expansion of preventive medicine programs, and the training of health professionals and the creation of dialogue channels, are advocated. All this, using the language of non-national immigrants.

O processo regulatório do exercício da acupuntura no Brasil: dilemas e conflitos / The regulatory process of acupuncture practice in Brazil: dilemmas and conflicts

Embora muitas das técnicas da medicina tradicional chinesa sejam praticadas atualmente nos serviços do Sistema Único de Saúde, a regulamentação da acupuntura no Brasil é conflituosa e marcada por disputas judiciais. Envolvidas nas disputas em torno do exercício profissional dessas práticas estão autarquias federais e entidades profissionais da saúde. O presente artigo analisou a constituição dos discursos de atores envolvidos no processo de regulamentação da acupuntura no Brasil em um recorte temporal histórico, referente ao período de 2000 a 2012. Foram pesquisados 228 textos nos sites institucionais de 39 entidades ligadas à medicina tradicional chinesa e, particularmente, à acupuntura. Os textos foram submetidos à análise de discurso conforme a abordagem de Dominique Maingueneau. As formações discursivas da acupuntura médica e da acupuntura multiprofissional configuram entendimentos distintos sobre a institucionalização dessa prática. A ausência de um consenso sobre a delimitação do campo de atuação do acupunturista é um obstáculo considerável para a regulamentação da prática. As questões ético-legais das delimitações do campo de atuação, a criação de diretrizes para ensino e pesquisa e o estabelecimento de parâmetros de segurança, qualidade e eficácia são desafios para a implementação da acupuntura nos serviços de saúde.

Although many of the techniques of traditional Chinese medicine are currently practiced in the Brazilian Public Health System health services, the regulation of acupuncture in Brazil is conflicting and marked by legal disputes between federal authorities and health professionals about the professional practice of this health practice. The presente article aimed to analyse the constitution of the different discourses of actors involved in the process of acupuncture regulation in Brazil in a historical timeframe of this trajectory, from 2000 to 2012. 228 texts were collected from the institutional websites of 39 entities related to traditional Chinese medicine and acupuncture. Texts were submit ted to the discourse analysis of Dominique Maingueneau. The discursive formations of medical acupuncture and multidisciplinary acupuncture constitute different understandings about the institutionalization of acupuncture. The absence of a consensus on the delimitation of the acupuncturist's field of action is a considerable obstacle to the regulation of the practice. The ethical-legal dilemmas of the field boundaries, the creation of guidelines for teaching and research and the establishment of safety, quality and efficacy parameters are challenges for the implementation of acupuncture in health services.

Brazilian Public Health System: history and profile of heart failure care and the impacts of COVID-19 / Sistema Público de Saúde Brasileiro: história e perfil dos cuidados com a insuficiência cardíaca e os impactos da COVID-19

Objective: The objective of this study is to describe the general and specific context of hospitalizations for Heart Failure (HF) in the Unified Health System and its main care indicators and economic aspects in the period before and during COVID-19. Methods: The economic indicators were evaluated between January 2011 and June 2022, comparing these indicators before and during the COVID-19 pandemic, using data from the DataSUS Health Information of the Ministry of Health of Brazil. The number of hospitalizations, length of stay, lethality and hospitalization costs were evaluated. The ARIMA method and the general regression model were used to analyze monthly results before and during COVID-19. Results: Hospitalization for HF has decreased in the last 11 years, with the most significant drop in the COVID-19 pandemic. After the pandemic, there was an increase in lethality in patients hospitalized for HF and also an increase in length of stay, despite the decrease in hospitalizations. When analyzing the economic aspects, more than US$ 725 million were spent. The average ticket showed a clear drop in per capita investment, with a real devaluation of 30.46% in the period from 2011 to 2022, which can be related to two main hypotheses: increased effectiveness and effectiveness of the analysis of service costs and/ or chronic underfunding of the Brazilian Public Health System. Conclusion: HF has its lethality worsened over time, especially in the COVID-19 period, also associated with a significant expense with the SUS and a tendency to decrease the allocation of resources.

Objetivo: O objetivo deste estudo é descrever o contexto geral e específico das internações por insuficiência cardíaca (IC) junto ao Sistema Único de Saúde e seus principais indicadores assistenciais e aspectos econômicos no período pré e durante a COVID-19. Métodos: Os indicadores econômicos foram avaliados no período entre janeiro de 2011 e junho de 2022, comparando esses indicadores antes e durante a pandemia por COVID-19, utilizando dados do DataSUS Informações de Saúde do Ministério da Saúde do Brasil. Foram avaliados o número de internações, tempo de internação, etalidade e custos de internação. O método ARIMA e o modelo de regressão geral foram usados para analisar os resultados mensais antes e durante a COVID-19. Resultados: A hospitalização por IC diminuiu nos últimos 11 anos, com queda mais significativa na pandemia da COVID-19. Após a pandemia, houve aumento da letalidade em pacientes internados por IC e também um aumento do tempo de permanência, mesmo diante da diminuição das internações. Ao analisar os aspectos econômicos, foram gastos mais de US$ 725 milhões. O ticket médio apresentou uma clara queda no investimento per capita, com desvalorização real de 30,46% no período de 2011 a 2022, o que pode estar relacionado a duas hipóteses principais: aumento da efetividade e efetividade da análise de custos do atendimento e/ou subfinanciamento crônico do Sistema Público de Saúde Brasileiro. Conclusão: A IC tem sua letalidade agravada ao longo do tempo, principalmente no período da COVID-19, associada também a um gasto relevante com o sistema público brasileiro e a uma tendência de diminuição da alocação de recursos.

Age at Diagnosis for Autism Spectrum Disorders: Does it Differ by Place of Residence?

Background: Despite steady decline in the age of diagnosis (AOD) at the global level, it has not declined uniformly, and marked disparities are documented by income, education, race, and access to health care. Objectives: The objectives of the study are to examine the urban/rural disparities in the initial age of autism diagnosis and to understand the interplay of the underlying demographic and social factors. Methods: A retrospective case record review of all children who received their initial diagnosis of autism at the Pediatric Psychology Clinic (1997–2018) of a tertiary advanced pediatric center at Chandigarh was conducted. Astructured abstraction data form was used to extract demographic, socioeconomic, and clinical information from the files maintained at the clinic. Results: A total of 1321 case records were examined. The mean AOD was 4.62 years (standard deviation = 2.38) and children from rural communities were diagnosed at 4.87 years, nearly 0.35 years later than urban children (t = 2.47, P = 0.013). Results indicated that 31.1% of the variance in the AOD for children from rural areas was predicted by two variables, namely the number of children in the family and total Childhood Autism Rating Scale (CARS) score (F = 13.62, P = 0.001). For the urban sample, three variables emerged as significant predictors including the number of children in the family, total CARS score, and maternal education and these together explained 20.2% of the variance in the AOD (F = 19.60, P = 0.001). Conclusion: The public health system must be sensitized to the unmet needs of the marginalized socioeconomic groups to access diagnostic and management services in a timely manner.

Quality of life in patients with malignant pleural effusion treated with an indwelling pleural catheter in an emerging country

Abstract Background: The use of Indwelling Pleural Catheter (IPC) in the care of patients with Malignant Pleural Effusion (MPE) is well established, however studies involving public health systems of low and middle-income countries are still lacking. This study aimed to determine the effect of IPC on the respiratory symptoms and Quality of Life (QoL) of patients with MPE in the setting of a Brazilian public health system. Methods: From August 2015 to November 2019, patients with MPE underwent IPC placement and were prospectively followed. QoL and respiratory symptoms were assessed by the EORTC questionnaires (QLQ-30; LC13) and Visual Analogue Scale (VAS), respectively, at pre-treatment, 30 , and 60 days after IPC placement. Results: 56 patients were enrolled with 57 catheters inserted. The mean age was 63 (23‒88) years, of which 17 (30%) were men and 39 (70%) were women. Breast 24 (42%) and lung 21 (37%) were the main primary neoplasms. Cellulitis was the most common complication and all patients recovered with appropriate antimicrobial therapy. QoL did not change significantly over time, however, the VAS showed a significant improvement in dyspnea (+1.2: -0.5; p = 0.001). Conclusion: IPC relieves respiratory symptoms without compromising the QoL, with a low complication rate. It represents a suitable option for patients with MPE and short LE in an emerging country. HIGHLIGHTS Indwelling pleural catheter represents a suitable option for patients with malignant pleural effusion and short life expectancy. It relieves respiratory symptoms without compromising the quality of life, and the complication rate is low, even in an emerging country, with a low socioeconomic and under-educated patient population. The rate of spontaneous pleurodesis was 45%. The analysis of the visual analog scale showed significant control of dyspnea (p = 0.001), but pain and quality of life did not change significantly.

Temporal trends in vena cava filter implantation in public health system inpatients: an 11-year analysis of the largest city in Brazil / Tendência temporal do implante de filtro de veia cava em pacientes internados no SUS em São Paulo: análise de 11 anos da maior cidade do Brasil

Abstract Background Vena cava filter implantation is considered a simple procedure, which can lead to overuse and over-indication. It is nevertheless associated with short and long-term complications. Objectives The goals of this study were to evaluate rates of vena cava filter implantation conducted by Brazil's Unified Public Health System, analyzing in-hospital mortality and migration of patients from other cities seeking medical attention in São Paulo. Methods This study analyzed all vena cava filter procedures conducted from 2008 to 2018 in the city of São Paulo and registered on the public database using a big data system to conduct web scraping of publicly available databases. Results A total of 1324 vena cava filter implantations were analyzed. 60.5% of the patients were female; 61.7% were under 65 years old; 34.07% had registered addresses in other cities or states; and there was a 7.4% in-hospital mortality rate. Conclusions We observed an increase in the rates of use of vena cava filters up to 2010 and a decrease in rates from that year onwards, which coincides with the year that the Food and Drug Administration published a recommendation to better evaluate vena cava filter indications.

Resumo Contexto O implante de filtro de veia cava é considerado um procedimento de baixa complexidade, o que pode resultar em indicação excessiva. No entanto, não é isento de complicações a curto e longo prazo. Objetivos Avaliar as taxas de implantes de filtro de veia cava realizados pelo Sistema Único de Saúde e a origem geográfica e mortalidade intra-hospitalar dos pacientes. Métodos Foi conduzida uma análise em um banco de dados públicos referente às taxas de implantes de filtro de veia cava realizados de 2008 a 2018 na cidade de São Paulo, utilizando o sistema de big data. Resultados Foram analisados 1.324 implantes de filtro de veia cava financiados pelo Sistema Único de Saúde. Identificou-se tendência de aumento da taxa de implantação até 2010 e de redução dos números após esse período. Do total de pacientes, 60,5% eram do sexo feminino; 61,75% tinham menos de 65 anos; e 34,07% possuíam endereço oficial em outra cidade ou estado. A taxa de mortalidade intra-hospitalar foi de 7,4%. Conclusões Observamos aumento das taxas de implante de filtro de veia cava até 2010 e redução das taxas após esse período, o que coincide com o ano em que a organização norte-americana Food and Drug Administration publicou uma recomendação para melhor avaliar as indicações de filtros.

Expresiones del engagement en el programa peruano de vacunación contra SARS-CoV-2 / Expressions of engagement in the Peruvian vaccination program against SARS-CoV-2

La investigación estuvo enfocada en el estudio de las expresiones emergentes del engagement en el programa peruano de vacunación COVID-19. Es de tipo descriptiva, transversal y con combinación de aspectos cuantitativos y cualitativos, en sus dimensiones vigor, dedicación y absorción, medidos a través de una adaptación del cuestionario Utrecht Work Engagement Scale, validado por expertos y con una muy alta confiabilidad (0,903), realizada entre los meses de febrero a mayo de 2021, en las localidades de Huancayo y Lima. Las expresiones emergentes nacen del conocimiento adquirido de las acciones realizadas y los factores motivacionales que condujeron al desarrollo de un accionar que va más allá de lo que el ministerio pudo haber solicitado de sus trabajadores, quienes a pesar de poner en riesgo constante su salud y su vida, por ser la primera línea de contención en defensa de la enfermedad, contribuyen enormemente con la población del Perú, logrando en la actualidad un 87,3% de total aplicación de los esquemas de vacunación indicados por las autoridades sanitarias en sus pobladores, aunque ello conlleva a largas jornadas de trabajo, sin límites de horas, pero imprimiéndole altos niveles de energía, así como deseo de invertir esfuerzos en el desarrollo de la labor con una amplia resistencia mental, gran implicación al compromiso laboral y sentido de significación ante la acción realizada, lo que finalmente genera en el individuo un estado positivo en los aspectos emocional, cognitivo, afectivo, social e integral del trabajador del sistema peruano de salud(AU)

The research was focused on the study of the emerging expressions of engagement in the Peruvian COVID-19 vaccination program. It is descriptive, cross-sectional and with a combination of quantitative and qualitative aspects, in its vigor, dedication and absorption dimensions, measured through an adaptation of the Utrecht Work Engagement Scale questionnaire, validated by experts and with a very high reliability (0.903), carried out between the months of February to May 2021, in Huancayo and Lima towns. The emerging expressions are born from the knowledge acquired from the actions carried out and the motivational factors that led to the development of actions that go beyond what the ministry could have requested of its workers, who despite constantly putting their health and safety at risk life, for being the first line of containment in defense of the disease, contribute enormously to the population of Peru, currently achieving 87.3% of total application of the vaccination schemes indicated by the health authorities in its inhabitants, although this leads to long working hours, with no limits on hours, but imprinting high levels of energy, as well as the desire to invest efforts in the development of the work with a broad mental resistance, great involvement in work commitment and a sense of significance in the face of action carried out, which finally generates in the individual a positive state in the emotional, cognitive, affective, social and integral of the worker of the peruvian health system(AU)

A new stage for healthy China： new characteristics and urgency of public health / 上海预防医学

Building a strong public health system has become an urgent task in the new era. Based on more than eight years of systematic research， we believe that five aspects need to be prioritized for a strong system. First， we should change the perspective on public health， using the word “gonggong jiankang” to replace “gonggong weisheng” and the word “gonggong jiankang tixi” to replace “gonggong weisheng tixi”， to lead the public health system development. Second， we should develop a suitable public health system and continuously improve the health capacity for governance. Third， we should make it clear that the goal of building a strong system is not far-fetched， and we need to consolidate the existing institutional advantages of China’s public health system： when encountering major problems， we can maintain a unified goal and mobilize the whole society to cooperate effectively to accomplish the goal. However， we need to make up for shortcomings one by one， especially to solve the key problem of lacking a strong coordination mechanism in daily work. Fourth， we should pursue excellence and consolidate the“suitable” mechanism proven in the process of coping with the COVID-19， so that efficient mechanisms to deal with major issues can be used in routine work， and efforts should be made to consolidate the advantages of prevention and control of infectious diseases and emergency response，so as to achieve the balanced development of regions categories and units.Finally， it is necessary to strengthen the coordination of government and research institutions， in the aspects of technological innovation， talent team building and accurate consulting services， and work together to pursue a suitable and strong system to realize the modernization of the health system and capacity for governance.

Analysis on the surveillance of infectious disease related public health bud-events in Shanghai from 2017 to 2020 / 上海预防医学

ObjectiveTo determine the epidemiological characteristics of infectious disease related public health bud-events in Shanghai and assess the effects of bud-event surveillance， so as to provide scientific evidence for improving the surveillance system. MethodsSurveillance data of infectious disease related public health bud-events were collected from 16 districts of Shanghai from 2017 through 2020. Then the data were analyzed and compared with infectious disease related public health emergencies during the same period. ResultsA total of 6 376 infectious disease related public health bud-events were documented in Shanghai in 2017‒2020， which involved 29 792 cases. There were two seasonal peaks， April through June and November through December. Clustered events accounted for 38.85%， mainly caused by chickenpox （14.10%）， hand，foot and mouth disease （11.17%） and norovirus-associated infectious diarrhea （6.54%）. The 36.73% of the bud-events occurred in school settings， which involved 24 718 cases （accounting for 83.00% of all cases）. Median time duration between onset date of the first cases and report date of the events was 4 days， and median duration of the events was 14 days， demonstrating positive correlation. In addition， all the infectious disease related public health emergencies（n=77） from 2017 through 2020 were classified as common events or unclassified. The proportion of infectious disease related public health emergencies in the bud-events during the same period was 1.21%， and that of infectious disease related public health emergencies in the bud-events in school settings was 2.48%. ConclusionTwo peaks of infectious disease related public health bud-events are observed in spring as well as autumn and winter in Shanghai from 2017 through 2020. Schools should be prioritized for control and prevention of infectious diseases. Bud-event surveillance system has been contributable to the prevention and control of public health emergencies， especially in the early detection， reporting and control of clustered events in schools. Bud-event surveillance system should be further improved and assessed comprehensively.

Establishing a modernized and integrated surveillance system for infectious diseases in a megacity with model transformation and innovation / 上海预防医学

The COVID-19 epidemic fully reflects the importance of surveillance and early warning of infectious diseases， and also puts forward higher requirements for us to further improve epidemic surveillance to achieve early detection， early identification， early reporting and early disposal of various pathogens. In this paper， we reviewed the development of the integrated surveillance system for infectious diseases in Shanghai in recent years， illustrated the approach of integrated surveillance based on syndromes and events， and initially summarized the key results of the integrated surveillance， expanding the scope of surveillance， improving sensitivity and enhancing the capacity of the system. Moreover， considering the requirements regarding the public health system， we provide some thoughts and suggestions on further expanding of the integrated surveillance， continuously strengthening the integration of public health surveillance with clinical diagnosis and treatment， laboratory capacity development， and public health information technology.

"Desaprender 8 horas por dia": psicologia e saúde indígena / "Desaprender 8 horas al día": psicología y salud indígena / "Unlearning 8 hours a day": psychology and indigenous health

Este texto é uma cartografia a partir de minhas experiências como docente de Psicologia e como trabalhadora da atenção e da gestão do Sistema Único de Saúde com os povos Kaiowá e Guarani da região de Dourados - Mato Grosso do Sul. As Ciências Humanas e Sociais e a Saúde Coletiva possuem acúmulos significativos sobre as inúmeras violências e as violações de direitos dos povos indígenas do Brasil. Mas uma pergunta continua sem resposta: até quando? A qualificação do Sistema Único de Saúde e o fortalecimento da saúde como direito de cidadania, em especial na construção de uma Saúde Indígena que respeite, de forma radical, os saberes e as práticas tradicionais, acarretam muitas desaprendizagens à Psicologia e aos demais trabalhadores do e pelo Sistema Único de Saúde. Dentre os inúmeros desafios e incertezas, é urgente reaprender a viver com os povos tradicionais e construir enfrentamentos coletivos às práticas biopolíticas de medicalização e aprisionamento da vida.(AU)

This text is a cartography based on my experiences as a Psychology teacher and as a worker in the care and management of the Public Health System with the Kaiowá and Guarani peoples in the region of Dourados - Mato Grosso do Sul. The Human and Social Sciences and Public Health have significant accumulations of the countless types of violence and violations of the rights of indigenous peoples in Brazil. But one question remains unanswered: Until when? The qualification of the Public Health System and the strengthening of health as a right of citizenship, especially in the construction of an Indigenous Health that respects, in a radical way, traditional knowledge and practices, imply many unlearning of Psychology and other workers of the and by Public Health System. Among the countless challenges and uncertainties, it is urgent to relearn how to live with traditional peoples and build collective confrontations to biopolitical practices of medicalization and life imprisonment.(AU)

Este texto es una cartografía basada en mis experiencias como profesor de Psicología y como trabajador en la atención y gestión del Sistema Único de Salud con los pueblos Kaiowá y Guarani en la región de Dourados - Mato Grosso do Sul. Las Ciencias Humanas y Sociales y la Salud Pública tienen acumulaciones significativas de innumerables tipos de violencia y violaciones de los derechos de los pueblos indígenas en Brasil. Pero una pregunta sigue sin respuesta: ¿hasta cuándo? La calificación del Sistema Único de Salud y el fortalecimiento de la salud como derecho de ciudadanía, especialmente en la construcción de una Salud Indígena que respete, de manera radical, los saberes y prácticas tradicionales, implican muchos desaprendizajes de la Psicología y de otros trabajadores de la y por SUS. Entre los innumerables desafíos e incertidumbres, urge reaprender a convivir con los pueblos tradicionales y construir enfrentamientos colectivos a las prácticas biopolíticas de medicalización y encarcelamiento de la vida.(AU)

Repeated cesarean section and vaginal delivery after cesarean section in São Paulo State in 2012 / Repetição de cesárea e parto vaginal após cesárea, no Estado de São Paulo, em 2012

Abstract Objectives: describe mothers, pregnancies and newborns' characteristics according to the type of childbirth history and to analyze repeated cesarean section (RCS) and vaginal delivery after cesarean section (VBACS), in São Paulo State in 2012. Methods: data are from the Sistema de Informações sobre Nascidos Vivos (Live Birth Information Systems). To find the RCS's group, the current type of childbirth equal to cesarean section was selected and from these all the previous cesareans. To identify the VBACS's group all live birth with current vaginal delivery were selected and from these all previous cesareans. Mothers with a history of RCS and VBACS were analyzed according to the characteristics of the pregnancy, newborn and the childbirth hospital. Results: 273,329 mothers of live birth with at least one previous child were studied. 43% of these were born of RCS and 7.4% of VBACS. Mothers who underwent RCS are older and higher educated and their newborns presented a lower incidence of low birth weight. Early term was the most frequent rating for gestational age born of RCS. Live births were of VBACS and had greater proportions of late term. The RCS was more common in hospitals not affiliated with the Sistema Único de Saúde (SUS) (Public Health System) (44.1%). Conclusion: the high RCS's rates, especially in the private sector, highlight the necessity of improvements in childbirth care model in São Paulo.

Resumo Objetivos: descrever características das mães, da gestação e do recém-nascido, segundo histórico de tipo de parto, analisando repetição de cesárea (RC) e parto vaginal após cesárea (PVAC), no Estado de São Paulo, em 2012. Métodos: os dados são provenientes do Sistema de Informações sobre Nascidos Vivos. Para encontrar o conjunto RC, selecionou-se o tipo de parto atual igual a cesárea e destes buscou-se todos com cesárea anterior. Para identificar o grupo PVAC, selecionou-se os recém-nascido com parto atual vaginal e destes buscou-se todos com cesárea anterior. Foram analisadas mães com história de RC e PVAC, segundo características da gestação, do recémnascido e hospital do parto. Resultados: estudou-se 273.329 nascidos vivos de mães com pelo menos um filho anterior. Destes, 43% nasceram por RC e 7,4% por PVAC. As mães que realizaram RC são mais velhas e mais escolarizadas, seus recém-nascidos apresentaram menor proporção de baixo peso ao nascer. Termo precoce foi a mais frequente idade gestacional dos que nasceram por RC. Os recém-nascidos por PVAC apresentaram maiores proporções de termo tardio. RC foi mais frequente nos hospitais sem vínculo com o Sistema Único de Saúde (44,1%). Conclusão: as altas taxas de RC, principalmente no setor privado, evidenciam necessidade de melhoras no modelo de atenção ao parto em São Paulo.

O projeto dos planos de saúde acessíveis: prejuízo para beneficiários e para o sistema público / The Accessible Health Insurance Bill: Harm to beneficiaries and the public system

O presente trabalho analisou, sob a perspectiva econômica da concretização do direito à saúde, o Projeto de Lei dos Planos de Saúde Acessíveis (PL n. 7.419/2006), apensado ao projeto geral de reforma da Lei n. 9.656/1998, desenvolvido pelo Ministério da Saúde em 2016 e atualmente em tramitação na Câmara dos Deputados. Para isso, os documentos oficiais da proposta foram analisados à luz de suas justificativas econômicas e da amplitude do acesso a serviços. As principais diretrizes do projeto, destacando-se os novos modelos de planos, evidenciam a criação de entraves burocráticos à realização de procedimentos, além da flexibilização do rol de cobertura dos planos de acordo com a infraestrutura local, em desacordo com a cobertura mínima prevista na regulação atual. A proposta favorece economicamente as operadoras de planos de saúde ao estabelecer a coparticipação de 50% e o reajuste conforme tabela de custos. Além disso, na prática, o projeto apresenta um duplo prejuízo: ao beneficiário, que arca com os custos do plano e, no momento de maior necessidade, de procedimentos de urgência ou de maior complexidade por não estar amparado pela cobertura; e ao sistema público, que deve suprir as deficiências da cobertura privada, o que, em um momento de maior demanda e recursos limitados, pode levá-lo à sobrecarga.

The present work analyzed, from the economic perspective of the realization of the right to health, the Accessible Health Insurance Bill (PL No. 7,419/2006), attached to the general project of reform of Law No. 9,656/1998, developed by the Ministry of Health in 2016 and currently being processed in the Chamber of Deputies. For this, the official documents of the proposal were analyzed in light of its economic justifications and the scope of access to services. The main guidelines of the project, highlighting the new models of plans, show the creation of bureaucratic obstacles to the performance of procedures, in addition to the flexibility of the coverage list of the plans according to the local infrastructure, in disagreement with the minimum coverage in the current regulation. The proposal economically favors the health insurance companies by establishing the 50% coparticipation and adjustment according to the cost table. Moreover, in practice, the project presents a double loss: to the beneficiary, who bears plan costs and, at the moment of greatest need, emergency procedures or of greater complexity, because he is not protected by the coverage; and to the public system, which must supply the deficiencies of private coverage, which, at a time of greater demand and limited resources, can lead to overload.

Profile of pharmaceutical care in primary health centers in São Bernardo do Campo, Southeastern Brazil

The effective insertion of the pharmacist into primary care is an important goal for health policies. The objective of this study was to describe and analyze pharmacists and Pharmaceutical Care in the primary health centers (UBS) of São Bernardo do Campo. Data were obtained through an interview applied to pharmacists. The instrument has three sections: (1) Pharmacist identification; (2) Pharmacist work; and (3) Pharmaceutical activities. Items in section 3 correspond to the guidelines of agencies that promote Pharmaceutical Care in the primary health system. All 24 pharmacists working in UBS in São Bernardo do Campo were interviewed. Every center dispensing medicines has a responsible pharmacist. These pharmacists are predominantly women and postgraduates. Activities of Pharmaceutical Care reported were: daily prescription analysis (75% of interviewees); monthly participation in patient groups (70.8%); monthly follow-up of pharmacotherapy adherence (58.3%); monthly participation in multiprofessional team meetings (54.2%); monthly home visits (12.5%); health education to the community (83.3%); and pharmacist consultation (37.5%). Frequency of prescription analysis and home visits was weakly associated with aspects of the pharmacist and the facility. This study showed that Pharmaceutical Services are structured in primary care in São Bernardo do Campo and many Pharmaceutical Care activities are offered in its UBS

Cuidados Paliativos na Atenção Primária à Saúde: Percepções de médicos da Estratégia de Saúde da Família sobre o tema na prática / Palliative Care in primaryhealth care: Perceptions of physicians of the family’s health strategy on the subject in practice

O presente Trabalho de Conclusão de Residência multidisciplinar em Saúdepossui o objetivode conhecer a percepção e a prática de profissionais médicos, atuantes na Estratégia de Saúde da Família (ESF), no que concerne aos Cuidados Paliativos (CP) na Atenção Primária à Saúde (APS). Os seis profissionaisdesta amostra estão vinculados aESF de uma Unidade Básica de Saúde (UBS) localizada em Canoas/RS.Oestudo possuimetodologia de natureza qualitativa e abordagem descritiva. Oreferencial teórico utiliza-se deáreas dapsicologia da saúde, medicina paliativa, e do Sistema Único de Saúde (SUS). Os resultados apontamparanecessidade de incluir nas práticas de CPdimensões subjetivasno cuidado e a interdisciplinaridade como método de trabalho.Ademais, identificaram-se lacunas referentes acapacitações e formações especificas em CP,sobrecarga de trabalho e insatisfação profissional. Essa pesquisa pretende ampliar a discussão dos muitos desafios éticos a serem vencidos na APS,referente aos CP.

This article presents the perception and practice in Palliative Care (PC) of physicians working in the Family Health Strategy (FHS), in Primary Health Care (PHC), in connection with the Basic Health Care Unit (UBS) of the city of Canoas/RS. Data were collected between June and August 2019. The analysis followed theoretical-methodological reference in health psychology, palliative medicine, and public policies of the Unified PublicHealth System (SUS). The study points out to the need for comprehensive care of patients in PC, evidencing difficulty in the identification, which makes it impossible to have a proper connection with patient-family-team.The challenge is to find interdisciplinary means of work, including emotional and spiritual dimensions, in addition to clinical practice. Itissuggested trainings, aiming at competenciesthatmeetethicalchallenges in PC. This research aims to subsidies the discussion of PC in public health, and provides information for future studies about this theme.

Expansão das práticas integrativas e complementares no brasil e o processo de implantação no sistema único de saúde / Expansión de las prácticas integrativas y complementarias en Brasil y el proceso de implantación en el Sistema Único de Salud / Expansion of integrative and complementary practices in brazil and the process of implementation in the single health system

Resumo Este estudo teve como objetivo apresentar uma reflexão acerca da expansão da Política Nacional de Práticas Integrativas e Complementares no Sistema Único de Saúde nos últimos 13 anos, no Brasil, tendo como pano de fundo analisar, no âmbito da pesquisa científica, a implantação das Práticas Integrativas e Complementares nos serviços de saúde e a implicação dos próprios autores nessa experiência. Trata-se de uma revisão integrativa, com análise da produção acadêmica nos últimos 13 anos (2006 a 2019), com busca na base de dados da Biblioteca Virtual em Saúde. Foram selecionados sete trabalhos que compuseram o corpo deste estudo. Diante das reflexões apresentadas neste estudo, é possível observar, ao longo dos últimos 13 anos, a presença da expansão das Práticas Integrativas e Complementares, sobretudo nas regiões Nordeste e Sudeste, sendo inegável o impacto positivo dessas práticas no Brasil. Contudo, a inserção das Práticas Integrativas e Complementares no Sistema Único de Saúde configura uma ação de ampliação de acesso e qualificação dos serviços na perspectiva da integralidade da atenção à saúde da população. Diante do exposto, reafirma-se a necessidade de se empreenderem novos estudos acadêmicos, no que se refere aos movimentos de implantação da Política Nacional de Práticas Integrativas e Complementares em Saúde no Brasil, com vistas a análises direcionadas à redução significante de recursos financeiros principalmente pelo período político e econômico que o Brasil enfrenta atualmente.

Abstract The present study aimed to present a reflection on the expansion of the National Policy of Integrative and Complementary Practices in the Unified Health System in the last 13 years in Brazil. health services and the implication of the authors themselves in this experience. This is an integrative review with analysis of academic production in the last 13 years (2006 to 2019) searching the database of the Virtual Health Library. We selected 7 papers that comprised the body of this study. Given the reflections presented in this study, it is possible to observe, over the last 13 years, the presence of the expansion of the Integrative and Complementary Practices, especially in the Northeast and Southeast, being undeniable the positive impact of these practices in Brazil. However, the inclusion of Integrative and Complementary Practices in the Unified Health System constitutes an action to expand access and qualification of services, from the perspective of comprehensive health care for the population. Given the above, it is reaffirmed the need to undertake new academic studies regarding the implementation of the National Policy of Integrative and Complementary Practices in Health in Brazil, with a view to analyzes directed to significant reduction of financial resources, especially by political and economic period that Brazil faces today.

Resumen El presente estudio tuvo como objetivo presentar una reflexión sobre la expansión de la Política Nacional de Prácticas Integrativas y Complementarias en el Sistema Único de Salud en los últimos 13 años en Brasil, con el trasfondo de analizar en el ámbito de la investigación científica la implementación de Prácticas Integrativas y Complementarias en servicios de salud y la implicación de los propios autores en esta experiencia. Esta es una revisión integradora con análisis de la producción académica en los últimos 13 años (2006 a 2019) buscando en la base de datos de la Biblioteca Virtual en Salud. Seleccionamos 7 documentos, que componen el cuerpo de este estudio. Dadas las reflexiones presentadas, es posible observar, en los últimos 13 años, la presencia de la expansión de las Prácticas Integrativas y Complementarias, especialmente en el Nordeste y Sudeste, siendo innegable el impacto positivo de estas prácticas en Brasil. Sin embargo, la inclusión de Prácticas Integrativas y Complementarias en el Sistema Único de Salud constituye una acción para ampliar el acceso y la calificación de los servicios, desde la perspectiva de la atención integral de salud para la población. Dado lo anterior, se reafirma la necesidad de emprender nuevos estudios académicos sobre la implementación de la Política Nacional de Prácticas Integrales y Complementarias en Salud en Brasil, con miras a análisis dirigidos a una reducción significativa de los recursos financieros, especialmente por período político y económico que enfrenta Brasil hoy.

Problemas e estratégias de gestão do SUS: a vulnerabilidade dos municípios de pequeno porte / Management problems and strategies: The vulnerability of small-sized municipalities

Resumo O processo de descentralização exerce forte impacto nas finanças dos Municípios de Pequeno Porte (MPP) e estes são o ente mais vulnerável da federação. Objetivou-se analisar os principais problemas e as estratégias de gestão utilizadas pelos MPP para enfrentar as desigualdades decorrentes do processo de descentralização. Pesquisa qualitativa desenvolvida por meio de grupos operativos com 55 trabalhadores das equipes gestoras de MPP da macrorregião norte do Paraná. Foi realizada análise compreensiva e interpretativa utilizando a Teoria do Jogo Social como referencial teórico. Dentre os problemas, estão a insuficiente capacidade para fazer a gestão dos municípios e para ofertar atenção integral à saúde aos munícipes. A constituição de Consórcios Intermunicipais de Saúde, a compra de serviços por contratos paralelos com prestadores privados e a adesão a programas do estado e da União são estratégias para o enfrentamento dos problemas, porém estas desencadeiam um intercâmbio de problemas. Para minimizar a vulnerabilidade dos MPP, é preciso fomentar o empoderamento do gestor municipal, implantar processos de escuta dos MPP e de uma cultura de enfrentamento dos problemas de forma coletiva e compartilhada entre os entes federados, para que haja uma gestão interfederativa.

Abstract The decentralization process has a strong impact on the finances of small-sized municipalities (SSMs), which are the most vulnerable entity of the Federative Republic of Brazil. This paper aims to analyze the main problems and management strategies used by SSMs to address the inequalities resulting from the decentralization process. This qualitative research is developed through operative groups with 55 workers from the management teams of SSMs in the northern macroregion of Paraná. A comprehensive and interpretative analysis was conducted using the Social Game Theory as a theoretical reference. Among the problems examined are the insufficient capacity to manage municipalities and provide comprehensive health care to citizens. The formation of Intermunicipal Health Consortia, the purchase of services through parallel contracts with private providers, and the adhesion to state and federal programs are strategies to address the problems, but they trigger problems of their own. To minimize the vulnerability of SSMs, it is necessary to empower the municipal manager, implement processes of listening to the SSMs, and foster a culture of facing problems in a collective and shared way among the federated entities to create interfederative management.

Cesarean section rates in São Paulo State: regional inequalities in SUS obstetric care / Taxas de cesárea no Estado de São Paulo: desigualdades regionais na assistência obstétrica prestada pelo SUS

Abstract Objectives: to analyze the relation between cesarean section rates in SUS childbirth care establishments in São Paulo State and urbanization conditions, according to Robson group classification system. Methods: Sistema de Informação sobre Nascidos Vivos (Live Births Information System) and Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Establishments) 2016 databases were analyzed. The studied outcome was cesarean section rates in the establishments, grouped by administration type (public or nonprofit entities) and urbanization condition. Results: the cesarean section rate in SUS childbirth care establishments was 50.5%, ranging from 41.1% in metropolitan regions up to 75.2% in the low urbanized regions. Cesarean section rates in public administration establishments (38.2%) were significantly lower than the nonprofit administration maternity hospitals (62.3%). Robson groups 5 and 2 contributed mostly to the cesarean section global rate (36.6% and 21.5%, respectively). Conclusions: The less urbanized regions showed significantly higher cesarean section rates than the metropolitan and highly urbanized regions. Cesarean section rates of public administration establishments were significantly lower than the nonprofit administration establishments. However, when separated by urbanization condition its difference was only observed in the metropolitan regions.

Resumo Objetivos: analisar a relação entre as taxas de cesárea, segundo grupos da classificação de Robson, dos estabelecimentos que prestam assistência ao parto no SUS no estado de São Paulo e as condições de urbanização. Métodos: foram analisados dados de 2016 do Sistema de Informação sobre Nascidos Vivos e do Cadastro Nacional de Estabelecimentos de Saúde. O desfecho estudado foi a taxa de cesárea dos estabelecimentos, agrupados por tipo de administração (pública ou por entidades filantrópicas) e por condição de urbanização. Resultados: a taxa de cesárea dos serviços que prestam assistência ao parto no SUS no estado de São Paulo foi de 50,5%, variando de 41,1% nas regiões metropolitanas até 75,2% nas regiões de baixa urbanização. As taxas de cesárea dos estabelecimentos de administração pública (38,2%) foram significativamente menores que dos estabelecimentos administrados por entidades filantrópicas (62,3%). Os grupos de Robson que mais contribuíram na taxa global de cesárea foram o 5 (36,6%) e o 2 (21,5%). Conclusões: as regiões menos urbanizadas apresentaram taxas de cesárea significativamente maiores que as regiões metropolitanas e de alta urbanização. As taxas de cesárea dos estabelecimentos públicos foram significativamente menores que dos filantrópicos, entretanto, quando separados por condição de urbanização, essa diferença só foi observada nas regiões metropolitanas.