Acceptability of decentralizing childhood tuberculosis diagnosis in low-income countries with high tuberculosis incidence: Experiences and perceptions from health care workers in Sub-Saharan Africa and South-East Asia.

Decentralizing childhood tuberculosis services, including diagnosis, is now recommended by the WHO and could contribute to increasing tuberculosis detection in high burden countries. However, implementing microbiological tests and clinical evaluation could be challenging for health care workers (HCWs) in Primary Health Centers (PHCs) and even District Hospitals (DHs). We sought to assess the acceptability of decentralizing a comprehensive childhood tuberculosis diagnosis package from HCWs' perspective. We conducted implementation research nested within the TB-Speed Decentralization study. HCWs from two health districts of Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Sierra Leone, and Uganda implemented systematic screening, nasopharyngeal aspirates (NPA) and stool sample collection with molecular testing, clinical evaluation and chest X-ray (CXR) interpretation. We investigated their experiences and perceptions in delivering the diagnostic package components in 2020-21 using individual semi-structured interviews. We conducted thematic analysis, supported by the Theoretical Framework of Acceptability. HCWs (n = 130, 55% female, median age 36 years, 53% nurses, 72% PHC-based) perceived that systematic screening, although increasing workload, was beneficial as it improved childhood tuberculosis awareness. Most HCWs shared satisfaction and confidence in performing NPA, despite procedure duration, need to involve parents/colleagues and discomfort for children. HCWs shared positive attitudes towards stool sample-collection but were frustrated by delayed stool collection associated with cultural practices, transport and distance challenges. Molecular testing, conducted by nurses or laboratory technicians, was perceived as providing quality results, contributing to diagnosis. Clinical evaluation and diagnosis raised self-efficacy issues and need for continuous training and clinical mentoring. HCWs valued CXR, however complained that technical and logistical problems limited access to digital reports. Referral from PHC to DH was experienced as burdensome. HCWs at DH and PHC-levels perceived and experienced decentralized childhood tuberculosis diagnosis as acceptable. Implementation however could be hampered by feasibility issues, and calls for innovative referral mechanisms for patients, samples and CXR.

Estimating the effect of a rifampicin resistant tuberculosis diagnosis by the Xpert MTB/RIF assay on two-year mortality.

Studies assessing patient-centred outcomes of novel rifampicin resistant tuberculosis (RR-TB) diagnostics are rare and mostly apply conventional methods which may not adequately address biases. Even though the Xpert MTB/RIF molecular assay was endorsed a decade ago for simultaneous diagnosis of tuberculosis and RR-TB, the impact of the assay on mortality among people with RR-TB has not yet been assessed. We analysed data of an observational prospective cohort study (EXIT-RIF) performed in South Africa. We applied a causal inference approach using inverse odds of sampling weights to rectify survivor bias and selection bias caused by differing screening guidelines. We also adjusted for confounding using a marginal structural model with inverse probability of treatment weights. We estimated the total effect of an RR-TB diagnosis made by the Xpert assay versus the pre-Xpert diagnostic algorithm (entailing a targeted Line Probe Assay (LPA) among TB-confirmed patients) on two-year mortality and we assessed mediation by RR-treatment initiation. Of the 749 patients diagnosed with RR-TB [247 (33%) by the pre-Xpert diagnostic algorithm and 502 (67%) by the Xpert assay], 42.7% died. Of these, 364 (48.6%) patients died in the pre-Xpert group and 200 (39.8%) in the Xpert group. People diagnosed with RR-TB by the Xpert assay had a higher odds of RR-TB treatment initiation compared to those diagnosed by the targeted LPA-based diagnostic process (OR 2.79; 95%CI 2.19-3.56). Receiving an RR-TB diagnosis by Xpert resulted in a 28% reduction in the odds of mortality within 2 years after presentation to the clinic (ORCI 0.72; 95%CI 0.53-0.99). Causal mediation analysis suggests that the higher rate of RR-TB treatment initiation in people diagnosed by the Xpert assay explains the effect of Xpert on 2-year mortality [natural indirect effect odds ratio 0.90 (95%CI 0.85-0.96). By using causal inference methods in combination with high quality observational data, we could demonstrate that the introduction of the Xpert assay caused a 28% reduction in 2-year odds of mortality of RR-TB. This finding highlights the need for advocacy for a worldwide roll-out of rapid molecular tests. Because the effect is mainly caused by increased RR-TB treatment initiation, health care systems should also ensure timely initiation of effective treatment upon an RR-TB diagnosis.

Effects of the COVID-19 pandemic on health surveillance work. / Efeitos da pandemia de COVID-19 no trabalho em vigilância sanitária.

The COVID-19 pandemic has challenged managers and exposed weaknesses in health systems. In Brazil, the pandemic emerged amid difficulties to work in the Brazilian Unified Health System (SUS) and in health surveillance (HS). The purpose of this article is to analyze the effects of COVID-19 on the organization, working conditions, management, and performance of HS, according to the perception of capital city managers from three regions of Brazil. This is an exploratory, descriptive research with qualitative analysis. The Iramuteq software was used in the treatment of the textual corpus and analysis of descending hierarchical classification, which generated four classes: characteristics of HS work during the pandemic (39.9%), HS organization and working conditions during the pandemic (12.3%), effects of the pandemic on work (34.4%), and the class of the health protection of workers and the population (13.4%). HS implemented remote work, expanded work shifts, and diversified its actions. However, it faced difficulties with personnel, infrastructure, and insufficient training. The present study also pointed out the potential for joint actions concerning HS.

A pandemia de COVID-19 desafiou gestores e explicitou fragilidades dos sistemas de saúde. No Brasil, a pandemia surgiu em meio a dificuldades para o trabalho no SUS e na vigilância sanitária (VISA). O objetivo deste artigo é analisar os efeitos da COVID-19 sobre a organização, as condições de trabalho, a gestão e a atuação de VISA, conforme a percepção de gestores de capitais de três regiões do Brasil. É uma pesquisa exploratória, descritiva, com análise qualitativa. Utilizou-se o software Iramuteq no tratamento do corpus textual e a análise de classificação hierárquica descendente gerou quatro classes: características do trabalho de VISA na pandemia (39,9%), organização e condições de trabalho de VISA na pandemia (12,3%), efeitos da pandemia sobre o trabalho (34,4%) e proteção da saúde de trabalhadores e da população (13,4%). A VISA implantou trabalho remoto, ampliou turnos de trabalho e diversificou suas ações. Entretanto, enfrentou dificuldades de pessoal, infraestrutura e capacitação insuficiente. O estudo apontou as potencialidades das ações conjuntas para a VISA.

Efeitos da pandemia de COVID-19 no trabalho em vigilância sanitária / Effects of the COVID-19 pandemic on health surveillance work

Resumo A pandemia de COVID-19 desafiou gestores e explicitou fragilidades dos sistemas de saúde. No Brasil, a pandemia surgiu em meio a dificuldades para o trabalho no SUS e na vigilância sanitária (VISA). O objetivo deste artigo é analisar os efeitos da COVID-19 sobre a organização, as condições de trabalho, a gestão e a atuação de VISA, conforme a percepção de gestores de capitais de três regiões do Brasil. É uma pesquisa exploratória, descritiva, com análise qualitativa. Utilizou-se o software Iramuteq no tratamento do corpus textual e a análise de classificação hierárquica descendente gerou quatro classes: características do trabalho de VISA na pandemia (39,9%), organização e condições de trabalho de VISA na pandemia (12,3%), efeitos da pandemia sobre o trabalho (34,4%) e proteção da saúde de trabalhadores e da população (13,4%). A VISA implantou trabalho remoto, ampliou turnos de trabalho e diversificou suas ações. Entretanto, enfrentou dificuldades de pessoal, infraestrutura e capacitação insuficiente. O estudo apontou as potencialidades das ações conjuntas para a VISA.

Abstract The COVID-19 pandemic has challenged managers and exposed weaknesses in health systems. In Brazil, the pandemic emerged amid difficulties to work in the Brazilian Unified Health System (SUS) and in health surveillance (HS). The purpose of this article is to analyze the effects of COVID-19 on the organization, working conditions, management, and performance of HS, according to the perception of capital city managers from three regions of Brazil. This is an exploratory, descriptive research with qualitative analysis. The Iramuteq software was used in the treatment of the textual corpus and analysis of descending hierarchical classification, which generated four classes: characteristics of HS work during the pandemic (39.9%), HS organization and working conditions during the pandemic (12.3%), effects of the pandemic on work (34.4%), and the class of the health protection of workers and the population (13.4%). HS implemented remote work, expanded work shifts, and diversified its actions. However, it faced difficulties with personnel, infrastructure, and insufficient training. The present study also pointed out the potential for joint actions concerning HS.

Chronic headache and cannabinoids use: myths and truths / Cefaleia crônica e uso de canabinoides: mitos e verdades

ABSTRACT BACKGROUND AND OBJECTIVES: The use of cannabis for medical purposes is known since ancient times. The endocannabinoid system is present throughout central and peripheral nervous system and plays a role in many important regulatory physiological processes like immune function, synaptic plasticity, pain and regulation of stress and emotion, among others. Due to its wide distribution and according to researches, cannabis can be indicated for symptoms management in different disorders such as chronic pain, headache, epilepsy, anxiety and other psychiatric disorders. The primary cannabinoids studied to date include delta-9-tetrahydrocannabinol (THC), cannabinol (CBN), cannabigerol (CBG), and tetrahydrocannabivarin (THCV). The active ingredients in cannabis include flavonoids, terpenes, delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD) and they are able to act within the endocannabinoid system and decrease nociception and also the frequency of the symptoms. The purpose of the article is to document the validity of how medical cannabis can be utilized as an alternative therapy for chronic headache management and enlighten about false beliefs regarding its use. CONTENTS: Sixty-four relevant articles were selected after a thorough screening process using PubMed and Google Scholar databases. The following keywords were used: "Cannabis", "Medical Marijuana", "Headache", "Migraine", "Cannabis and Migraine", "Cannabis and Headache". This literature study demonstrates that medical cannabis use decreases migraine duration and frequency and headaches of unknown origin. CONCLUSION: Patients suffering from migraines and related conditions may benefit from medical cannabis therapy due to its convenience and efficacy.

RESUMO JUSTIFICATIVA E OBJETIVOS: O uso da cannabis medicinal é conhecido desde a antiguidade. O sistema endocanabinoide está distribuído no sistema nervoso central e periférico e atua como importante regulador em processos fisiológicos como função imune, plasticidade sináptica, regulação da dor e das emoções/estresse, entre outros. Devido à sua ampla distribuição e, de acordo com pesquisas, a cannabis pode ser indicada no manejo de sintomas em diferentes condições, como dor crônica, cefaleias, epilepsia, ansiedade e outras doenças psiquiátricas. Os canabinoides primários estudados são o 9-tetrahydrocannabinol (THC), cannabinol (CBN), canabigeral (CBG), e a tetrahidrocannabivarina (THCV). Os ingredientes ativos da cannabis incluem flavonoides, terpenos, delta-9- tetrahydrocannabinol (THC), canabidiol (CBD), e eles são capazes de agir dentro do sistema endocanabinoide e diminuir a nocicepção e a frequência dos sintomas. O objetivo deste estudo foi documentar a validade de como a cannabis medicinal pode ser utilizada como terapia alternativa para o manejo da cefaleia crônica, além de esclarecer sobre falsas crenças ligadas a seu uso. CONTEÚDO: Sessenta e quatro artigos foram selecionados por meio de pesquisa nas bases de dados Pubmed e Google Scholar. As seguintes palavras-chave foram usadas: "Cannabis", "Maconha Medicinal", "Cefaleia", "Enxaqueca", "Cannabis e Enxaqueca", "Cannabis e Cefaleia". A literatura mostra que o uso da cannabis medicinal reduz a duração e a frequência da enxaqueca e das cefaleias de origens não conhecidas. CONCLUSÃO: Pacientes sofrendo com enxaqueca e condições relacionadas podem se beneficiar da terapia com cannabis devido à sua conveniência e eficácia.

Curso de especialização em saúde coletiva com foco na atenção básica para o programa mais médicos: análise comparativa da experiência desenvolvida pelo ISC/UFBA / Specialization course in public health with a focus on primary care for the mais médicos program: comparative analysis of the experience developed by ISC/UFBA / Curso de especialización en salud colectiva con énfasis en atención primaria para el programa más médicos: análisis comparativo de la experiencia desarrollada por el ISC/UFBA

Este artigo relata a experiência da implementação do curso de especialização em saúde coletiva, realizada pela UNA-SUS/UFBA, por meio do Instituto de Saúde Coletiva (ISC) e da Faculdade de Medicina da Universidade Federal da Bahia, para a formação dos médicos vinculados ao Programa Mais Médicos (PMM) no estado da Bahia. A análise da experiência foi apresentada com base na formulação de Donabedian sobre estrutura, processo e resultado, aplicada ao curso. Para isso, foram estabelecidos critérios das três dimensões e indicadores de análise, que mostraram, ao final, uma análise positiva da proposta analisada. Os resultados apontaram que o curso apresentou uma estrutura inovadora, do ponto de vista teórico e metodológico, pelos dispositivos utilizados e pela articulação de suas atividades. No processo, foram fundamentais as experiências e vivências do tutor da aprendizagem e, por último, a importância dos projetos de intervenção focados na realidade do médico.

This paper reports the experience carried out by UNA-SUS ­ UFBA, with support from the Institute of Public Health and the Faculty of Medicine of the University of Bahia, to implement a specialization course in public health for the training of Mais Médicos Program physicians in Bahia, Brazil. The experience was analyzed based on Donabedian's formulation about structure, process and result, applied to the course. For this purpose, the study established criteria for each dimension and analysis indicators, which showed a positive analysis of the proposal. Results showed that the course presented an innovative structure, from a theoretical and methodological perspective, due to the resources used and the articulation of its activities. The professor's experiences and the intervention projects focused on the physician's reality were fundamental in the process.

Este artículo describe la experiencia en la implementación del Curso de Especialización en Salud Colectiva realizado por la UNA-SUS-UFBA a través del Instituto de Saúde Coletiva y la Facultad de Medicina de la Universidad da Bahia para la formación de Médicos incluidos en el Programa Más Médicos (PMM) en el estado de Bahía. El análisis de la experiencia se presentó a partir de la formulación de estructura, proceso y resultado de Donabedian, aplicada al curso. Para ello, se establecieron criterios de las tres dimensiones e indicadores de análisis, que permitieron realizar un análisis positivo de la propuesta analizada. Los resultados mostraron que el curso presentó una estructura innovadora desde el punto de vista teórico y metodológico, debido a los dispositivos utilizados y la articulación de sus actividades. Las experiencias y vivencias del tutor de aprendizaje fueron fundamentales en el proceso y también la importancia de los proyectos de intervención con énfasis en la realidad del médico.

Prevalence of ultra-processed food, alcohol and tobacco consumption and chronic non-communicable diseases in Rio Branco, capital city of the state of Acre, Brazil, 2019: comparative analysis of two epidemiological surveys. / Prevalência de consumo de alimentos ultraprocessados, álcool, tabaco e doenças crônicas não transmissíveis em Rio Branco, Acre, 2019: análise comparativa de dois inquéritos epidemiológicos.

OBJECTIVE: To describe, in a comparative manner, the prevalence of chronic non-communicable diseases and ultra-processed food, alcohol and tobacco consumption, estimated by the Chronic Disease Risk and Protective Factors Surveillance Telephone Survey (Vigitel) and National Health Survey (PNS), in Rio Branco, capital city of the state of Acre, Brazil. METHODS: This was a cross-sectional study on sociodemographic, health and lifestyle data from surveys conducted in 2019. Prevalence and 95% confidence intervals (95%CI) were described, and percentage difference was calculated. RESULTS: Of the 3,037 individuals assessed, similar prevalence, with difference between Vigitel (60.3%; 95%CI 56.2;64.3) and PNS (70.8%; 95%CI 67.4;73.9) regarding people of Brown race/skin color was found. In the stratification by sex, it could be seen percentage difference between the surveys, regarding obesity (male= 6.5%; female= 0.4%), smoking (male= 4.0%; female= -1.5%) and alcohol abuse (male= 6.9%; female= -2.5%), although with overlapping 95%CI. CONCLUSION: The estimates assessed in both surveys were similar.

Factors Associated with Overweight and Obesity in Adults from Rio Branco, Acre in the Western Brazilian Amazon.

This study aimed to assess factors associated with overweight and obesity in adults from Rio Branco, Acre, in the western Brazilian Amazon. This is a cross-sectional, population-based study conducted in Rio Branco, which used data on individuals aged 18 years or older collected by the 2019 National Health Survey. Software R version 4.0.5 was used to estimate the prevalence of overweight and obesity, prevalence ratios, and 95% confidence intervals. Multiple analysis was performed by Poisson's regression with robust variance and hierarchical selection of variables. This study included 1217 adults. The prevalence of overweight was 58.2% (95%CI: 54.7-61.6) and of obesity, 20.1% (95%CI: 17.2-23.4). The factors associated with overweight were arterial hypertension (AdjPR: 1.45; 95%CI: 1.31-1.61), physical inactivity (AdjPR: 1.19; 95%CI: 1.04-1.36), age group (25-39 years, AdjPR: 1.49; 95%CI: 1.10-2.00; 40-59 years, AdjPR: 1.69; 95%CI: 1.28-2.23; 60 years or older, AdjPR: 1.37; 95%CI: 1.01-1.87); and smoking (AdjPR: 0.62; 95%CI: 0.41-0.93). The factors associated with obesity were arterial hypertension (AdjPR: 1.80; 95%CI: 1.41-2.30) and diabetes mellitus (AdjPR: 1.52; 95%CI: 1.08-2.13). Smoking and female sex remained in the hierarchical model for obesity, even without statistical significance. Despite intervention guidelines for these chronic diseases, there is a need for the public recognition of overweight and obesity and their possible associated factors in the Amazon and other regions with similar socioeconomic and demographic characteristics.

Time Trend of Overweight and Obesity in Adults from Rio Branco, Acre, Western Brazilian Amazon (2006-2020).

This study aimed to analyze overweight trend and obesity in adults from Rio Branco, Acre, Western Brazilian Amazon, from 2006 to 2020. This is a time series study, with data from Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL). To estimate annual percentage change (APC) and 95% confidence intervals, the software Jointpoint Regression Analysis v.4.6.0.0., was used. In Rio Branco, overweight prevalence ranged from 44.0% in 2006 to 58.9% in 2020, with a bigger frequency among men than that among women. Obesity prevalence has increased from 12.5% in 2006 to 21.4% in 2020, similar between both sexes. From 2006 to 2020, overweight APC was 5.2% (95% CI: 1.4; 9.1) by 2010, and decreased to 1.3% by 2020. Public policies to control obesity and its risks must be both, implemented as strengthened.

Prevalence of the consumption of ultra-processed foods, alcohol, tobacco and chronic non-communicable diseases in Rio Branco, Acre, Brazil, 2019: comparative analysis of two epidemiological surveys / Prevalencia del consumo de alimentos ultraprocesados, alcohol, tabaco y enfermedades crónicas no transmisibles en Rio Branco, Acre, Brasil, 2019: análisis comparativo de dos encuestas epidemiológicas / Prevalência de consumo de alimentos ultraprocessados, álcool, tabaco e doenças crônicas não transmissíveis em Rio Branco, Acre, 2019: análise comparativa de dois inquéritos epidemiológicos

Objective: To describe, comparatively, the prevalence of non-communicable chronic diseases, consumption of ultra-processed foods, alcohol and tobacco, estimated by the Surveillance System for Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel) and by the National Health Survey (PNS), in Rio Branco, Acre. Methods: Cross-sectional study, using sociodemographic, health and lifestyle variables from surveys conducted in 2019. Prevalences and 95% confidence intervals (95%CI) were described and percentage differences were calculated. Results: Of the 3,037 individuals evaluated, there was similarity in the prevalence, with difference in people with mixed race/skin color in Vigitel (60.3 ­ 95%CI 56.2;64.3) and PNS (70.8 ­ 95%CI 67.4;73.9). In the stratification by sex, percentage differences between the surveys were observed for obesity (male = 6.5%; female = 0.4%), smoking (male = 4.0%; female = -1.5%) and alcohol abuse (male = 6.9%; female = -2.5%), but with 95%CI overlapping. Conclusion: Estimates evaluated in both surveys were similar.

Objetivo: Comparar la prevalencia de enfermedades crónicas no transmisibles, consumo de alimentos ultraprocesados, alcohol y tabaco, según el Sistema de Vigilancia de Factores de Riesgo y Protección de Enfermedades Crónicas por Encuesta Telefónica (Vigitel) y por la Encuesta Nacional de Salud (PNS), en Rio Branco, Acre. Métodos: Estudio transversal, utilizando variables sociodemográficas, salud y estilo de vida de encuestas de 2019. Se describieron prevalencias e intervalos de confianza al 95% (IC95%) y se calcularon diferencias porcentuales. Resultados: Los 3.037 individuos evaluados, hubo similitud en la prevalencia, con diferencia en raza mixta/color de piel en Vigitel (60,3I ­ C95% 56,2;64.3) y SNP (70,8 ­ C95% 67,4;73,9). La estratificación por sexo, se observaron diferencias porcentuales entre las encuestas para obesidad (hombres 6,5%; mujeres 0,4%), tabaquismo (hombres = 4,0%; mujeres = -1,5%) y abuso de alcohol (hombres = 6,9%; mujeres = -2,5%), pero con IC95% superpuesto. Conclusión: Las encuestas arrojaron estimaciones similares.

Objetivo: Descrever, comparativamente, as prevalências de doenças crônicas não transmissíveis, consumo de alimentos ultraprocessados, álcool e tabaco, estimadas pelo Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) e pela Pesquisa Nacional de Saúde (PNS), Rio Branco, Acre, Brasil. Métodos: Estudo transversal, sobre dados sociodemográficos, de saúde e estilo de vida de inquéritos realizados em 2019. Foram descritas as prevalências e intervalos de confiança de 95% (IC95%), e calculadas as diferenças percentuais. Resultados: Dos 3.037 indivíduos avaliados, observou-se prevalências similares com diferença para pessoas de raça/cor da pele parda, entre Vigitel (60,3 ­ IC95% 56,2;64,3) e PNS (70,8 ­ IC95% 67,4;73,9). Na estratificação por sexo, diferenças percentuais entre os inquéritos foram observadas para obesidade (masculino = 6,5%; feminino = 0,4%), tabagismo (masculino = 4,0%; feminino = -1,5%) e consumo abusivo de álcool (masculino = 6,9%; feminino = -2,5%), embora com IC95% sobrepostos. Conclusão: As estimativas avaliadas em ambos inquéritos foram similares.

Desafos à atuação dos trabalhadores de Vigilância Sanitária nos serviços de saúde / Challenges to the performance of health surveillance workers in health services

Introdução: A vigilância sanitária é uma função precípua do Estado para proteção da saúde individual e coletiva mediante ações de controle de riscos, atuais ou potenciais, presentes na produção de bens e serviços, e integra o Sistema Único de Saúde. A vigilância sanitária de serviços de saúde é parte do escopo de atuação da Vigilância Sanitária (Visa) para o controle dos riscos e iatrogenias nos serviços de saúde. Objetivo: Analisar desafios à atuação dos trabalhadores de Visa nos serviços de saúde. Método: O estudo, de abordagem qualitativa, integra uma pesquisa financiada pelo CNPQ para análise do controle sanitário realizado pelas Visa em serviços de saúde da atenção básica e especializada. Utilizou-se a técnica de Grupo Focal com trabalhadores da Visa de oito estados brasileiros. As falas foram transcritas e analisadas segundo a técnica de análise de conteúdo temática, sistematizadas em duas categorias: Gestão e Organização dos Serviços e Condições de Trabalho. Resultados: Identificou-se problemas e desafios, tais como: incipiente planejamento das ações; dificuldades na organização do trabalho decorrentes da rotatividade de gestores, da falta de recursos humanos e tecnológicos, da ausência de coordenação e da integração dos níveis do Sistema Nacional de Vigilância Sanitária. Emergiram insatisfações e desafios sobre condições de trabalho, precarizações dos vínculos, baixos salários, equipes incompletas e necessidade de concursos públicos e de valorização do trabalho. Conclusões: A atuação da Visa em serviços de saúde requer a superação de múltiplos desafios, que perpassam a integração das ações nos distintos níveis de gestão e questões de capacitação, incorporação de tecnologias e de readequação de processos de trabalho.

Introduction: Health surveillance (Visa) is a primary function of the State for the protection of individual and collective health through risk control actions, current or potential, present in the production of goods and services, and is part of SUS (Brazilian Universal Health System). Health surveillance of health services is part of Visa's scope of action for the control of risks and iatrogenic diseases in health services. Objective: To analyze challenges to the performance of Visa in health services. Method: The study, with a qualitative approach, integrates research funded by CNPq to analyze the sanitary control carried out by Visa in health services of primary and specialized care; the Focus Group technique was used with Visa workers from 8 Brazilian states. The speeches were transcribed and analyzed according to the thematic content analysis technique, systematized in two categories: Management and Organization of Services, and Working Conditions. Results: Problems and challenges were identifed, such as: incipient planning of actions; difculties in the organization of work, resulting from the turnover of managers, the lack of human and technological resources, and the lack of coordination and integration of the levels of the National Health Surveillance System. Dissatisfactions and challenges about working conditions, precarious employment conditions, low wages, incomplete teams and the need for public tenders and work valorization emerged. Conclusions: Visa's performance in health services requires overcoming multiple challenges, which permeate the integration of actions at different levels of management and training issues, incorporation of technologies and readjustment of work processes.

Adolescentes institucionalizados em semiliberdade: cenário de vulnerabilidades sociais e de saúde em uma Região Amazônica / Adolescent institutionalization in semi-liberty: the scenario of social and health vulnerabilities in an Amazon region

A violência e a prática de atos infracionais estão atreladas aos processos de identificação do ser, fatos estes que acabam por constituir a identidade do adolescente autor de atos infracionais. Nesse sentido, o presente artigo visa descrever o perfil socioepidemiológico da população de adolescentes institucionalizados em semiliberdade no município de Santarém, estado do Pará. Tratou-se de um estudo epidemiológico, descritivo, transversal retrospectivo, com abordagem quantitativa, a partir da análise de prontuários dos adolescentes atendidos no Centro de Semiliberdade da Fundação de Atendimento Socioeducativa do Pará, no período entre janeiro de 2013 e junho de 2017. Dentre os resultados encontrados destacam-se: a faixa etária de maior incidência entre 16 a 17 anos (n= 42; 60%), majoritariamente pardos (n= 54; 77%), baixos níveis de escolaridade com prevalência do ensino fundamental incompleto (n= 54; 77%), componentes de famílias de baixa renda, usuários de drogas (n= 65; 93%) roubo e homicídio foram os principais delitos cometidos. Além disso foi detectado doença mental (n= 10; 14%) e histórico de Infecções Sexualmente Transmissíveis - IST (n= 9; 13%) entre os jovens pesquisados. Assim, observa-se que, de acordo com o perfil encontrado e frente à vulnerabilidade desta população, sendo necessário um processo de intervenção, de acordo com o perfil socioepidemiológico encontrado, pautado nas ações da Atenção Primária em Saúde, tendo a educação em saúde como instrumento na promoção de uma assistência de qualidade para esta população e junto à família, atuando nos fatores que interferem no processo do adoecer, e nesse caso, do adolescente em conflito com a lei.

Violence and the practice of breaking the law are linked to the process of one's identity, facts that end up constituting the identity of the adolescent who commits infractions. In this sense, this article aims to describe the socio-epidemiological profile of the population of detained adolescents in semi-liberty in the municipality of Santarém, state of Pará. This was an epidemiological, descriptive, and retrospective cross-sectional study with a quantitative approach, based on the analysis of medical records of adolescents treated at the Semi-Liberty Center of the Foundation for Socio-Educational Assistance of Pará, between January 2013 and June 2017. Among the results found were: the age group with the highest incidence was between 16 and 17 years (n= 42; 60%), mostly mixed race (n= 54; 77%), low levels of education with prevalence of incomplete elementary education (n= 54; 77%), members of low-income families, drug users (n= 65; 93%), and robbery and homicide were the main crimes committed. In addition, mental illness (n= 10; 14%) and a history of Sexually Transmitted Infections - STIs (n= 9; 13%) were detected among the young people surveyed. Thus, it is observed that, according to the socio-epidemiological profile identified and given the vulnerability of this population, an intervention process is necessary based upon the actions of Primary Health Care, where health education acts as an instrument in the promotion of quality care for this population, and with their family they act on the factors that interfere in the process of this juvenile, in trouble with the law, becoming ill.

Prevalência de consumo de alimentos ultraprocessados, álcool, tabaco e doenças crônicas não transmissíveis em Rio Branco, Acre, 2019: análise comparativa de dois inquéritos epidemiológicos / Prevalencia de consumo de alimentos ultraprocesados, alcohol, tabaco y enfermedades crónicas no transmisibles en Rio Branco, Acre, Brasil, 2019: análisis comparativo de dos encuestas epidemiológicas / Prevalence of ultra-processed food, alcohol and tobacco consumption and chronic non-communicable diseases in Rio Branco, capital city of the state of Acre, Brazil, 2019: comparative analysis of two epidemiological surveys

Objetivo: Descrever, comparativamente, as prevalências de doenças crônicas não transmissíveis, consumo de alimentos ultraprocessados, álcool e tabaco, estimadas pelo Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) e pela Pesquisa Nacional de Saúde (PNS), em Rio Branco, Acre, Brasil. Métodos: Estudo transversal, sobre dados sociodemográficos, de saúde e estilo de vida de inquéritos realizados em 2019. Foram descritas as prevalências e intervalos de confiança de 95% (IC95%), e calculadas as diferenças percentuais. Resultados: Dos 3.037 indivíduos avaliados, observaram-se prevalências similares com diferença para pessoas de raça/cor da pele parda, entre Vigitel (60,3%; IC95% 56,2;64,3) e PNS (70,8%; IC95% 67,4;73,9). Na estratificação por sexo, diferenças percentuais entre os inquéritos foram observadas para obesidade (masculino= 6,5%; feminino= 0,4%), tabagismo (masculino= 4,0%; feminino= -1,5%) e consumo abusivo de álcool (masculino= 6,9%; feminino= -2,5%), embora com IC95% sobrepostos. Conclusão: As estimativas avaliadas em ambos os inquéritos foram similares.

Objetivo: Comparar la prevalencia de enfermedades crónicas no transmisibles, consumo de alimentos ultraprocesados, alcohol y tabaco, según el Sistema de Vigilancia de Factores de Riesgo y Protección de Enfermedades Crónicas por Encuesta Telefónica (Vigitel) y por la Encuesta Nacional de Salud (PNS), en Rio Branco, Acre. Métodos: Estudio transversal, utilizando variables sociodemográficas, salud y estilo de vida de encuestas de 2019. Se describieron prevalencias e intervalos de confianza al 95% (IC95%) y se calcularon diferencias porcentuales. Resultados: En los 3.037 individuos evaluados, hubo similitud en la prevalencia, con diferencia en raza/color de piel parda en Vigitel (60,3%; IC95% 56,2;64.3) y en PNS (70,8%; IC95% 67,4;73,9). En la estratificación por sexo, se observaron diferencias porcentuales entre las encuestas para obesidad (hombres= 6,5%; mujeres= 0,4%), tabaquismo (hombres= 4,0%; mujeres= -1,5%) y abuso de alcohol (hombres= 6,9%; mujeres= -2,5%), pero con IC95% superpuesto. Conclusión: Las encuestas arrojaron estimaciones similares.

Objective: To describe, in a comparative manner, the prevalence of chronic non-communicable diseases and ultra-processed food, alcohol and tobacco consumption, estimated by the Chronic Disease Risk and Protective Factors Surveillance Telephone Survey (Vigitel) and National Health Survey (PNS), in Rio Branco, capital city of the state of Acre, Brazil. Methods: This was a cross-sectional study on sociodemographic, health and lifestyle data from surveys conducted in 2019. Prevalence and 95% confidence intervals (95%CI) were described, and percentage difference was calculated. Results: Of the 3,037 individuals assessed, similar prevalence, with difference between Vigitel (60.3%; 95%CI 56.2;64.3) and PNS (70.8%; 95%CI 67.4;73.9) regarding people of Brown race/skin color was found. In the stratification by sex, it could be seen percentage difference between the surveys, regarding obesity (male= 6.5%; female= 0.4%), smoking (male= 4.0%; female= -1.5%) and alcohol abuse (male= 6.9%; female= -2.5%), although with overlapping 95%CI. Conclusion: The estimates assessed in both surveys were similar.

Programa Farmácia Popular do Brasil: uma análise política de sua origem, seus desdobramentos e inflexões / Popular Pharmacy Program of Brazil: a political analysis of its origin, unfoldings and inflections

RESUMO O artigo se refere a uma investigação qualitativa que analisa as origens, os desdobramentos, resultados e desafios do Programa Farmácia Popular do Brasil, face à necessária integralidade da assistência farmacêutica. Para a produção dos dados, foram utilizados documentos e entrevistas semiestruturadas com informantes envolvidos com o movimento da Reforma Sanitária Brasileira e/ou a questão medicamentos/assistência farmacêutica, considerando o período de 2003 a 2016; notícias produzidas entre 2013 e 2018, disponíveis em sítios eletrônicos de instituições entendidas como atores no processo de implementação de políticas farmacêuticas. A análise dos dados revelou que, apesar dos conflitos em torno da construção da proposta, o programa resultou em ampliação do acesso aos medicamentos essenciais, redução da mortalidade e de internações por doenças crônicas. Por esse motivo, inflexões no programa, como o fechamento da modalidade rede própria, resultaram em posicionamentos de organizações da sociedade civil, também motivados diante da conjuntura de perdas de direitos sociais. Permanecem lacunas concernentes à qualidade do acesso em suas diversas dimensões de análise e à promoção do uso racional de medicamentos, na perspectiva da integralidade da Assistência Farmacêutica.

ABSTRACT The article refers to a qualitative research that analyzes the origins, unfoldings, results and challenges of the Brazilian Popular Pharmacy Program, in view of the necessary integrality of pharmaceutical assistance. For the production of the data, documents and semi-structured interviews were used with informants involved with the Brazilian Health Reform movement and the issue of medicines/pharmaceutical assistance, considering the period from 2003 to 2016; news produced between 2013 to 2018, available on electronic sites of institutions understood as actors in the process of implementing pharmaceutical policies. Analysis of the data revealed that, despite the conflicts surrounding the proposal's construction, the program resulted in increased access to essential drugs, reduced mortality and hospitalizations for chronic diseases. For this reason, inflections in the program, such as the closing of the first modality, have resulted in positions of civil society organizations, also motivated by the conjuncture of losses of social rights. Gaps remain regarding the quality of access in its various dimensions of analysis and the promotion of rational use of medicines, from the perspective of the integrality of Pharmaceutical Assistance.

Os conflitos do consentimento acerca da doação de órgãos post mortem no Brasil / Conflict of consent for post mortem organs donation in Brazil

Com o refinamento das técnicas de cirurgias e imunogenética pela medicina nas últimas décadas e com os avanços na farmacoterapia, o transplante de órgãos e tecidos tornou-se uma possibilidade real e uma alternativa essencial ao prolongamento e à qualidade da vida humana. Este estudo objetivou analisar o consentimento para remoção de órgãos e tecidos post mortem na legislação brasileira, na perspectiva da autorização da família. Adotou-se, para tanto, estratégia metodológica qualitativa através de revisão de literatura e revisão legislativa, que permitem um aprofundamento no universo dos significados, dos motivos, das aspirações, das crenças, dos valores e das atitudes em relação ao tema. Os resultados apontam que, na atual Lei de Transplantes, os direitos da personalidade e o princípio da autonomia da vontade são institutos pouco homenageados em função da predominância do monopólio da decisão familiar na hipótese de um confronto entre a vontade do doador e a vontade da família. Frente ao problema da escassez de órgãos no país, a solução mais consentânea com a justiça seria uma adequação entre os dispositivos de lei do Código Civil e da Lei de Transplantes. Oportuno partir do texto já existente do artigo 4º da Lei n. 9.434/1997, para incluir a manifestação da vontade do doador em vida, devidamente documentada. É igualmente importante a informação e a conscientização popular sobre a natureza humanitária da doação de órgãos como medidas direcionadas à discussão do princípio da solidariedade para uma política de doação de órgãos...

Given the refinement in surgical, immunogenetic and pharmacotherapeutic techniques fostered by medicine in the last few decades, organ and tissue transplantation has become a real possibility and an essential alternative towards the extension and quality of human life. This study aimed to analyze the consent for post mortem organ and tissue removal in Brazilian law, from the perspective of the authorization of the family. A qualitative methodological approach was adopted, using literature and legislative reviews, and allowing a deeper insight into the meanings, motives, aspirations, beliefs, values and attitudes surrounding the subject. Results showed that, in the current Transplant Act, and in the event of a confrontation between the will of the donor and the family’s wishes, personality rights and the principle of freedom of choice are underestimated at the expense of the prevailing monopoly of the family decision making process. In view of the organ shortages faced by the country, the solution that is most consentaneous to justice would be to tailor the dispositions of the Transplant Act to those of the Civil Code. It would be suitable to take the existing wording in Article 4 of Law 9,434/97 and to include the duly documented expression of the donor’s will before death. Public awareness and information about the humanitarian nature of organ donation are likewise important as measures aimed at discussing the principle of solidarity for an organ donation policy...

Implementing International Health Regulation (2005) in the Brazilian legal-administrative system.

The scope of this study was to analyze how the International Sanitary Regulation (ISR 2005)has been incorporated into the Brazilian legal-administrative system, in relation to sanitary control measures involving freight, means of transportation and travelers and possible alterations to health surveillance activities, competencies and procedures. This case study has been undertaken using a qualitative approach, of a descriptive and exploratory nature, using institutional data sources and interviews with key-informants involved in implementing ISR (2005). Alterations to the Brazilian legal-administrative system resulting from ISR (2005) were identified, in relation to standards, special competencies and procedures relating to sanitary controls for freight, modes of transportation and travelers. In its present form, the International Sanitary Regulation is an instrument that, in addition to introducing new international and national sanitary control concepts and elements, also helps to clarify questions that are helpful on a national level, relating to the specific competencies and procedures which will, to a certain extent, put pressure on administrative structures in the areas of sanitary control and surveillance.

Implementação do Regulamento Sanitário Internacional (2005) no ordenamento jurídico-administrativo brasileiro / Implementing International Health Regulation (2005) in the Brazilian legal-administrative system

O objetivo deste estudo foi analisar a incorporação do Regulamento Sanitário Internacional (RSI 2005) no ordenamento jurídico-administrativo brasileiro, no tocante às medidas de controle sanitário relativas a cargas, meios de transporte e viajantes e as possíveis alterações de normas, competências e procedimentos nas atividades de vigilância. Trata-se de um estudo de caso, com abordagem qualitativa, do tipo descritivo e exploratório, tendo-se utilizado como fonte de dados documentos institucionais e entrevistas com informantes-chave envolvidos com a implementação do RSI (2005). Foram identificadas alterações no ordenamento jurídico-administrativo brasileiro decorrentes do RSI (2005), em normas, competências e procedimentos de controle sanitário sobre cargas, meios de transporte e viajantes. O Regulamento Sanitário Internacional em sua versão atual conforma um instrumento que, além de inserir novos conceitos e elementos para o controle sanitário em âmbito internacional e nacional, vem propiciando ao país o desvelamento de questões relacionadas a competências e procedimentos que, de certa forma, tensionam as estruturas administrativas nas áreas de vigilância e controle sanitário.

The scope of this study was to analyze how the International Sanitary Regulation (ISR 2005)has been incorporated into the Brazilian legal-administrative system, in relation to sanitary control measures involving freight, means of transportation and travelers and possible alterations to health surveillance activities, competencies and procedures. This case study has been undertaken using a qualitative approach, of a descriptive and exploratory nature, using institutional data sources and interviews with key-informants involved in implementing ISR (2005). Alterations to the Brazilian legal-administrative system resulting from ISR (2005) were identified, in relation to standards, special competencies and procedures relating to sanitary controls for freight, modes of transportation and travelers. In its present form, the International Sanitary Regulation is an instrument that, in addition to introducing new international and national sanitary control concepts and elements, also helps to clarify questions that are helpful on a national level, relating to the specific competencies and procedures which will, to a certain extent, put pressure on administrative structures in the areas of sanitary control and surveillance.

True Cervicothoracic Meningocele: A Rare and Benign Condition.

Cervical meningoceles are rare spinal dysraphism, accounting for approximately 7% of all cystic spinal dysraphism. In spite of the rarity, the clinical course is most of the times benign. The surgical treatment includes resection of the lesion and untethering, when presented. We present a 14-day-old female child with true meningoceles who underwent to surgical excision and dura-mater repair. Retrospect analysis of the literature concerning true cervical meningocele is performed. By reporting this illustrative case, we focus on its classification and its differentiation from other types of cervical spinal dysraphism, such as myelocystocele and myelomeningocele. Although its course is benign, it is mandatory a continuum follow up with periodic magnetic resonance imaging of spinal cord, since late neurological deterioration has been described.

Regulamento sanitário internacional: emergências em saúde pública, medidas restritivas de liberdade e liberdades individuais / International health regulations: public health emergencies, restrictive measures of liberty and individual freedoms

O estudo objetiva identificar as principais características das medidas de controle restritivas de liberdade, adotadas nos países signatários do Regulamento Sanitário Internacional (RSI), em situações de epidemias/pandemias, com ênfase nas relações entre leis e princípios, benefícios e desvantagens da utilização dessas medidas. Realizou-se revisão até julho de 2012 nas bases de dados Medline, Web of Science e Scielo com os descritores: "Restrictives Measures", "Quarantine", "Nonpharmaceutical", "Quarantine and Isolation", "medidas restritivas", "Quarentena", "não-farmacêuticas", "isolamento". Encontrou-se diferentes posições entre os países e que o problema central no debate sobre medidas restritivas de liberdade não é exatamente a quarentena e o isolamento e sim questões de cunho econômico, social e administrativo. Percebe-se concordância tácita quanto à importância das medidas restritivas nas Emergências em Saúde Pública e que a efetivação de sua aplicação enseja problemas ainda não harmonizados entre os países signatários do RSI (2005).

Linkage to care and treatment for TB and HIV among people newly diagnosed with TB or HIV-associated TB at a large, inner city South African hospital.

OBJECTIVE: To assess the outcomes of linkage to TB and HIV care and identify risk factors for poor referral outcomes. DESIGN: Cohort study of TB patients diagnosed at an urban hospital. METHODS: Linkage to care was determined by review of clinic files, national death register, and telephone contact, and classified as linked to care, delayed linkage to care (>7 days for TB treatment, >30 days for HIV care), or failed linkage to care. We performed log-binomial regression to identify patient and referral characteristics associated with poor referral outcomes. RESULTS: Among 593 TB patients, 23% failed linkage to TB treatment and 30.3% of the 77.0% who linked to care arrived late. Among 486 (86.9%) HIV-infected TB patients, 38.3% failed linkage to HIV care, and 32% of the 61.7% who linked to care presented late. One in six HIV-infected patients failed linkage to both TB and HIV care. Only 20.2% of HIV-infected patients were referred to a single clinic for integrated care. A referral letter was present in 90.3%, but only 23.7% included HIV status and 18.8% CD4 cell count. Lack of education (RR 1.85) and low CD4 count (CD4≤50 vs. >250cells/mm(3); RR 1.66) were associated with failed linkage to TB care. Risk factors for failed linkage to HIV care were antiretroviral-naïve status (RR 1.29), and absence of referral letter with HIV or CD4 cell count (RR1.23). CONCLUSIONS: Linkage to TB/HIV care should be strengthened by communication of HIV and CD4 results, ART initiation during hospitalization and TB/HIV integration at primary care.