What Are the Best Practices for Nursing Care during an Earthquake? A Scoping Review.

Among natural disasters, earthquakes have a considerable impact and are among the ten deadliest, with an extreme impact on the healthcare sector. This study aimed to analyze the best practices in nursing care for earthquake victims. An in-depth analysis was carried out by using a scoping review, a method used in accordance with the PRISMA-ScR recommendations, to identify best nursing practice in these circumstances based on searches of eight databases: MEDLINE via PubMed; Cochrane Library; Embase; VHL; PDQ-Evidence; Scopus; ProQuest; and Google Scholar. Twenty-one studies were selected. The nursing practices identified were grouped into two distinct dimensions, each subdivided into four subcategories: (i) care practices: (a) immediate care, (b) intermediate care, (c) psychosocial care, and (d) ethical care; (ii) care management and coordination practices, which cover (a) care coordination, (b) victim care network organization, (c) teamwork, and (d) training. By analyzing these nursing practices during care and relief operations for earthquake victims, this study identified the various actions carried out, the nursing skills to be developed, and the reinforcement of these advanced practices through the systematization of nurses' skills, in order to promote victims' rehabilitation, minimize their suffering, and improve their quality of life during and after an earthquake.

Understanding the municipal-level design and adaptation of pay-for-performance schemes across two states of Brazil.

The design of complex health systems interventions, such as pay for performance (P4P), can be critical to determining such programmes' success. In P4P programmes, the design of financial incentives is crucial in shaping how these programmes work. However, the design of such schemes is usually homogenous across providers within a given scheme. Consequently, there is a limited understanding of the strengths and weaknesses of P4P design elements from the implementers' perspective. This study takes advantage of the unique context of Brazil, where municipalities adapted the federal incentive design, resulting in variations in incentive design across municipalities. The study aims to understand why municipalities in Brazil chose certain P4P design features, the associated challenges, and the local adaptations made to address problems in scheme design. This study was a multiple-case study design relying on qualitative data from twenty municipalities from two states in northeastern Brazil. We conducted two key informant interviews with municipal-level stakeholders and focus group discussions with primary care providers. We also reviewed municipal PMAQ laws in each municipality. We found substantial variation in the design choices made by municipalities regarding 'who was incentivised', the 'payment size' and 'frequency'. Design choices affected relationships within municipalities and within teams. Challenges were chiefly associated with fairness relating to 'who received the incentive', 'what is incentivised', and the 'incentive size'. Adaptations were made to improve fairness, mostly in response to pressure from the healthcare workers. The significant variation in design choices across municipalities and providers' response to them highlights the importance of considering local context in the design and implementation of P4P schemes and ensuring flexibility to accommodate local preferences and emerging needs. Attention is needed to ensure the choice of 'who is incentivised' and the 'size of incentives' are inclusive and fair, and the allocation and 'use of funds' are transparent.

Does pay-for-performance design matter? Evidence from Brazil.

Pay-for-performance (P4P) schemes have been shown to have mixed effects on health care outcomes. A challenge in interpreting this evidence is that P4P is often considered a homogenous intervention, when in practice schemes vary widely in their design. Our study contributes to this literature by providing a detailed depiction of incentive design across municipalities within a national P4P scheme in Brazil [Primary Care Access and Quality (PMAQ)] and exploring the association of alternative design typologies with the performance of primary health care providers. We carried out a nation-wide survey of municipal health managers to characterize the scheme design, based on the size of the bonus, the providers incentivized and the frequency of payment. Using OLS regressions and controlling for municipality characteristics, we examined whether each design feature was associated with better family health team (FHT) performance. To capture potential interactions between design features, we used cluster analysis to group municipalities into five design typologies and then examined associations with quality of care. A majority of the municipalities included in our study used some of the PMAQ funds to provide bonuses to FHT workers, while the remaining municipalities spent the funds in the traditional way using input-based budgets. Frequent bonus payments (monthly) and higher size bonus allocations (share of 20-80%) were strongly associated with better team performance, while who within a team was eligible to receive bonuses did not in isolation appear to influence performance. The cluster analysis showed what combinations of design features were associated with better performance. The PMAQ score in the 'large bonus/many workers/high-frequency' cluster was 8.44 points higher than the 'no bonus' cluster, equivalent to a difference of 21.7% in the mean PMAQ score. Evidence from our study shows how design features can potentially influence health provider performance, informing the design of more effective P4P schemes.

Sleep and memory complaints in long COVID: an insight into clustered psychological phenotypes.

This study evaluated clinical features of individuals with long COVID (5-8 months after diagnosis) who reported sleep and memory problems (62 cases) compared to those without (52 controls). Both groups had a similar mean age (41 vs. 39 years). Around 86% of the participants were non-hospitalized at the time of infection, and none of them were vaccinated at that point. Subsequently, both cases and controls received the vaccine; however, the vaccination rates differed significantly between the groups (30.7% vs. 51.0%). Cases and controls had similar rates of symptoms at acute COVID phase. However, cases were more likely to experience coryza, dyspnea, headache, and nausea/vomiting during long COVID. Regarding new-onset symptoms in long COVID, 12.9% of cases had dyspnea, and 14.5% experienced nausea/vomiting, whereas in the control group there were only 1.9% and 0.0%, respectively. Cases also had a significantly higher prevalence of persistent headache (22.6% vs. 7.7%), and dyspnea (12.9% vs. 0.0). In addition, cases also showed an increased rate of mental health complaints: disability in daily activities (45.2% vs. 9.6%; P < 0.001); concentration/sustained attention difficulties (74.2% vs. 9.6%; P < 0.001); anxiety-Generalized Anxiety Disorder 2-item scale (GAD-2) ≥ 3 (66.1% vs. 34.6%; P = 0.0013); and "post-COVID sadness" (82.3% vs. 40.4%; P < 0.001). We observed a significant correlation between sadness and anxiety in cases, which was not observed in controls (P=0.0212; Spearman correlation test). Furthermore, the frequency of concomitant sadness and anxiety was markedly higher in cases compared to controls (59.7% vs. 19.2%) (P < 0.0001; Mann-Whitney test). These findings highlight a noteworthy association between sadness and anxiety specifically in cases. In conclusion, our data identified concurrent psychological phenotypes in individuals experiencing sleep and memory disturbances during long COVID. This strengthens the existing evidence that SARS-CoV-2 causes widespread brain pathology with interconnected phenotypic clusters. This finding highlights the need for comprehensive medical attention to address these complex issues, as well as major investments in testing strategies capable of preventing the development of long COVID sequelae, such as vaccination.

Reflexos do pagamento por desempenho na atuação do(a)s profissionais da Atenção Primária à Saúde, Paraíba, Brasil / Effects of pay-for-performance on the work of primary health care professionals in the state of Paraíba, Brazil / Reflejos del pago por desempeño en la actuación de los y las profesionales de la atención primaria de la salud, Paraíba, Brasil

O estudo buscou compreender a influência da estratégia do Pay for Performance (P4P), por meio do Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB), na atuação do(a)s trabalhadore(a)s. Trata-se de um estudo de caso qualitativo realizado com o(a)s trabalhadore(a)s das Estratégias de Saúde da Família. A análise foi realizada mediante a técnica de construção de narrativas. Constatou-se que o P4P contribuiu para qualificação do processo de trabalho, ao mesmo tempo que estimulou competição e conflito entre as equipes, aflorando sentimentos de culpa e injustiça e, devido à precarização do trabalho, o estímulo financeiro se descaracteriza, tornando-se complemento salarial. Problemas macroestruturais afetam as condições de trabalho e a motivação do(a)s trabalhadore(a)s, de modo que modelos de incentivo financeiro, isoladamente, não são suficientes para reverter tal cenário.

This study sought to understand the influence of pay-for-performance (P4P) on worker performance using data from the National Program for Improving Primary Care Access and Quality (PMAQ-AB). We conducted a qualitative case study with professionals working in family health strategy teams. The data were analyzed using the narrative construction technique. The findings show that P4P contributed to the improvement of work processes, while at the same time stimulating competition and conflict between the teams, causing feelings of guilt and injustice. However, the original purpose of the financial incentive is defeated due to poor working terms and conditions, becoming akin to a salary supplement. Macrostructural problems affect working conditions and worker motivation, showing that financial incentive models alone are not sufficient to reverse this situation.

El estudio buscó comprender la influencia de la estrategia Pay for Performance (P4P), por medio del Programa de Mejora del Acceso y Calidad de la Atención Básica (Pmaq-AB), en la actuación de los trabajadores y las trabajadoras. Se trata de un estudio de caso, cualitativo, realizado con los trabajadores y las trabajadoras de las Estrategias de Salud de la Familia. El análisis se realizó mediante la construcción de narrativas. Se constató que el P4P contribuyó para la calificación del proceso de trabajo, al mismo tiempo que incentivó competencia y conflicto entre los equipos, haciendo aflorar los sentimientos de culpa e injusticia y, debido a la precarización del trabajo, el incentivo financiero se descaracteriza pasando a ser complemento salarial. Problemas macroestructurales afectan las condiciones de trabajo y la motivación de los trabajadores y de las trabajadoras, de modo que los modelos de incentivo económico, aisladamente, no son suficientes para revertir ese escenario.

The vulnerabilities of Venezuelan immigrants in Brazil and Colombia from the perspective of Intervention Bioethics.

OBJECTIVE: To understand the vulnerabilities to which Venezuelan immigrants living in Brazil and Colombia are exposed, from the perspective of Intervention Bioethics. METHOD: Qualitative study, carried out through a semi-structured interview, with 15 immigrants living in Brasília-Brazil and 20 in Medellín-Colombia, analyzed by the IRAMUTEQ software, in the Descending Hierarchical Classification and Similitude Analysis modalities. RESULTS: The first thematic axis dealt with the reasons for immigrating, above all, difficulties in accessing food and health services. The second axis revealed the trajectory of the migration process, especially the adversities faced before arriving in the countries. The third axis highlighted the challenges of integration in the destination countries, with emphasis on the processes of exclusion and discrimination faced. CONCLUSION: It was observed that both Brazil and Colombia need, as proposed by Bioethics of Intervention, to develop policies to reduce the vulnerabilities of immigrants to guarantee a dignified life without discrimination against them.

Análise da implantação do Componente Hospitalar na Rede de Atenção às Urgências e Emergências / Analysis of the implementation of the Hospital Component in the Emergency Care Network

RESUMO Objetivou-se descrever a implantação dos serviços do Componente Hospitalar da Rede de Atenção às Urgências e Emergências (RUE) e avaliar a efetividade das Linhas de Cuidado prioritárias nos estabelecimentos habilitados como Portas de Entrada, nas regiões/Unidade da Federação do Brasil, entre 2011 e 2019. Estudo descritivo e analítico, cujos dados foram obtidos do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e do Ministério da Saúde, para avaliar diferenças significativas, antes e depois, da implantação das Linhas de Cuidado prioritárias por meio do teste de Wilcoxon. Constatou-se que a região Sudeste foi a que mais evoluiu, inclusive na implantação de pontos de atenção mais densos tecnologicamente, seguida das regiões: Nordeste, Sul, Norte e Centro-Oeste. A região Sul se destacou na implantação das Linhas de Cuidado prioritárias; além de ter abarcado maior número de implantações dessa Linha, também foi a que melhor evidenciou o crescimento no número de atendimentos e a diminuição no Tempo Médio de Permanência. Verificou-se que a Linha de Cuidado do Trauma foi a que apresentou maior efetividade ao se verificar o número de atendimentos com o crescimento populacional. Concluiuse que o Componente Hospitalar da RUE teve considerável avanço, contudo, as desigualdades regionais são ainda expressivas.

ABSTRACT This study aims to describe the implementation of the Hospital Component of the Urgent and Emergency Care Network (RUE), and to evaluate the delivery of priority Lines of Care in places that serve as gateways in Brazilian regions, between 2011 and 2019. This is a descriptive and analytical study, using data from the National Registration System of Health Institutions (CNES) of the Ministry of Health. To assess significant differences before and after the implementation of Priority Lines of Care, the Wilcoxon test was used. It was found that the Southeast region had the largest increase, including the implementation of technologically denser care points, followed by the Northeast, South, North, and Midwest regions. The South region stood out for the implementation of Priority Lines of Care. Not only did it implement the most of these lines, but it also increased the number of visits and decreased the average length of stay. The Trauma Line of Care was found to be the most effective, when verifying the number of visits with population growth. It was concluded that the Hospital Component of the RUE has made considerable advance, but regional inequalities are still significant.

Pay-for-performance for primary health care in Brazil: A comparison with England's Quality Outcomes Framework and lessons for the future.

Pay-for-performance (P4P) has been widely applied in OECD countries to improve the quality of both primary and secondary care, and is increasingly being implemented in low- and middle-income countries. In 2011, Brazil introduced one of the largest P4P schemes in the world, the National Programme for Improving Primary Care Access and Quality (PMAQ). We critically assess the design of PMAQ, drawing on a comparison with England's quality and outcome framework which, like PMAQ, was implemented at scale relatively rapidly within a nationalised health system. A key feature of PMAQ was that payment was based on the performance of primary care teams but rewards were given to municipalities, who had autonomy in how the funds could be used. This meant the incentives felt by family health teams were contingent on municipality decisions on whether to pass the funds on as bonuses and the basis upon which they allocated the funds between and within teams. Compared with England's P4P scheme, performance measurement under PMAQ focused more on structural rather than process quality of care, relied on many more indicators, and was less regular. While PMAQ represented an important new funding stream for primary health care, our review suggests that theoretical incentives generated were unclear and could have been better structured to direct health providers towards improvements in quality of care.

The vulnerabilities of Venezuelan immigrants in Brazil and Colombia from the perspective of Intervention Bioethics / Las vulnerabilidades de los inmigrantes venezolanos en Brasil y en Colombia bajo la perspectiva de la Bioética de Intervención / As vulnerabilidades dos imigrantes venezuelanos no Brasil e na Colômbia na perspectiva da Bioética de Intervenção

ABSTRACT Objective: To understand the vulnerabilities to which Venezuelan immigrants living in Brazil and Colombia are exposed, from the perspective of Intervention Bioethics. Method: Qualitative study, carried out through a semi-structured interview, with 15 immigrants living in Brasília-Brazil and 20 in Medellín-Colombia, analyzed by the IRAMUTEQ software, in the Descending Hierarchical Classification and Similitude Analysis modalities. Results: The first thematic axis dealt with the reasons for immigrating, above all, difficulties in accessing food and health services. The second axis revealed the trajectory of the migration process, especially the adversities faced before arriving in the countries. The third axis highlighted the challenges of integration in the destination countries, with emphasis on the processes of exclusion and discrimination faced. Conclusion: It was observed that both Brazil and Colombia need, as proposed by Bioethics of Intervention, to develop policies to reduce the vulnerabilities of immigrants to guarantee a dignified life without discrimination against them.

RESUMEN Objetivo: Comprender las vulnerabilidades a las que están expuestos los inmigrantes venezolanos que viven en Brasil y Colombia, bajo la perspectiva de la Bioética de la Intervención. Método: Se trata de un estudio cualitativo, llevado a cabo mediante entrevista semiestructurada, entre 15 inmigrantes que viven en Brasilia, Brasil y entre otros 20 en Medellín, Colombia. Los datos se analizaron con el programa IRAMUTEQ, según las modalidades Clasificación Jerárquica Descendente y Análisis de Similitud. Resultados: El primer eje temático abordó las razones para emigrar, especialmente las dificultades para acceder a la alimentación y a los servicios sanitarios. El segundo eje reveló la trayectoria del proceso migratorio, principalmente lo relacionado a las adversidades afrontadas hasta la llegada a los países de destino. El tercer eje destacó los retos de la integración en dichos países, haciendo hincapié en los procesos de exclusión y discriminación a los que se enfrentan los inmigrantes. Conclusión: Se observó que tanto Brasil como Colombia necesitan, conforme la Intervención Bioética, desarrollar políticas para reducir las vulnerabilidades de los inmigrantes con el fin de garantizarles una vida digna y sin discriminación.

RESUMO Objetivo: Compreender as vulnerabilidades a que estão expostos os imigrantes venezuelanos radicados no Brasil e na Colômbia, na perspectiva da Bioética de Intervenção. Método: Estudo qualitativo, realizado por meio de entrevistada semiestruturada, com 15 imigrantes que vivem em Brasília-Brasil e com 20, em Medellín-Colômbia, analisados pelo software IRAMUTEQ, nas modalidades Classificação Hierárquica Descendente e Análise de Similitude. Resultados: O primeiro eixo temático tratou dos motivos para imigrar, sobretudo, as dificuldades de acesso aos alimentos e aos serviços de saúde. O segundo eixo revelou a trajetória do processo migratório, especialmente as adversidades enfrentadas até a chegada aos países. O terceiro eixo evidenciou os desafios da integração nos países de destino, com destaque para os processos de exclusão e discriminação enfrentados. Conclusão: Observou-se que tanto o Brasil como a Colômbia precisam, conforme propõe a Bioética de Intervenção, desenvolver políticas de redução das vulnerabilidades dos imigrantes para garantir uma vida digna e sem discriminação a eles.

Motivaciones y migración venezolana: análisis desde la bioética de intervención / Motivations and Venezuelan migration: bioethics of intervention-based analysis / Motivações e migração venezuelana: análise a partir da bioética da intervenção

Resumen Este estudio cualitativo tuvo como objetivo analizar, desde la perspectiva de la bioética de intervención, las motivaciones de la migración de venezolanos que residen en la ciudad de Medellín, Colombia. Se entrevistaron a 20 personas, de las cuales 9 son hombres y 11 mujeres, y los datos recolectados se procesaron en el software IRAMUTEQ. Los ejes que resultaron del análisis de las entrevistas fueron: 1) acceso a los servicios de salud en Venezuela y Colombia; 2) acceso a los medicamentos y alimentos; y 3) proceso migratorio para Colombia, que sirvieron como referentes que dialogan con la perspectiva bioética de intervención. En conclusión, la alimentación y la salud tienen un papel preponderante en la vida de los sujetos como derechos humanos de primera necesidad, y se refuerza el papel del Estado en la promoción de políticas que garanticen los derechos civiles, económicos, sociales y culturales a los migrantes.

Abstract This qualitative study aimed to analyze from the perspective of intervention bioethics, the motivations for migration in Venezuelans residing in the city of Medellín-Colombia. Twenty people were interviewed, being 9 men and 11 women. The collected data was processed through the IRAMUTEQ software. The thematic axes that resulted from the analysis of the interviews; the first thematic axis, access to health services in Venezuela and Colombia; the second thematic axis, access to medicines and food; the third and last axis, the migratory process for Colombia, it served as references that dialogue with the selected bioethical perspective. In conclusion, food and health have a preponderant role in the lives of people, as essential human rights, the role of States is reinforced in promoting policies that guarantee civil, economic, social and cultures rigths of migrants.

Resumo Este estudo qualitativo teve como objetivo analisar, na perspectiva da bioética de intervenção, as motivações para a migração de venezuelanos residentes na cidade de Medellín, Colômbia. Foram entrevistadas 20 pessoas, sendo nove homens e 11 mulheres, e os dados coletados foram processados por meio do software Iramuteq. Os eixos que resultaram da análise das entrevistas foram: 1) acesso aos serviços de saúde na Venezuela e na Colômbia; 2) acesso a medicamentos e alimentação; e 3) processo migratório para a Colômbia, que serviram de referencial que dialoga com a perspectiva bioética de intervenção. Em conclusão, a alimentação e a saúde têm um papel preponderante na vida dos sujeitos como direitos humanos básicos, sendo papel do Estado promover políticas que garantam os direitos civis, econômicos, sociais e culturais aos migrantes.

Elderly Mortality due to Ambulatory Care Sensitive Conditions and Primary Health Care Coverage in the Federal District / Mortalidad de ancianos por causas sensibles y cobertura de Atención Primaria en Distrito Federal / Mortalidade de idosos por causas sensíveis e cobertura de Atenção Primária no Distrito Federal

ABSTRACT Objectives: To describe the mortality coefficients of elderly due to primary care sensitive conditions, from 2008 to 2018, and determine its association with the coverage of the Primary Health Care (Family Health Strategy and Basic Care models) in the Federal District. Methods: Ecological time series of mortality in Federal District elderly, from 2008 to 2018. The Poisson regression model was applied, considering as significant those with p<0.05, with a CI of 95%. Results: There were 70,503 deaths. There was a decrease in the risk of death of elders due to cardiovascular diseases and diabetes. Higher primary care coverage decreased the chance of death by sensitive conditions, both in Basic Care (OR: 0.994, CI: 0.990-0.998) and in the Family Health Strategy (OR: 0.997, CI: 0.995-0.999). Conclusions: Primary Care coverage was associated with a lower chance of death of the elderly due to Ambulatory Care Sensitive Conditions, especially in Basic Care.

RESUMEN Objetivo: Describir coeficientes de mortalidad entre ancianos por condiciones sensibles, de 2008 a 2018, y verificar relación con la cobertura de Atención Primaria de Salud (Modelo Estrategia Salud de la Familia y Atención Básica) en Distrito Federal. Métodos: Estudio ecológico tipo serie temporal de mortalidad de ancianos en Distrito Federal, entre 2008 y 2018. Para análisis de las relaciones, aplicado modelo de regresión Poisson, siendo consideradas significantes las que presentaron p<0,05, con IC de 95%. Resultados: Hubo70.503 óbitos. Observado disminución del riesgo de morir de ancianos por enfermedad cardiovasculares y diabetes. La cobertura de Atención Primaria disminuyó la probabilidad de morir por condiciones sensibles tanto en Atención Básica (OR: 0,994, IC: 0,990-0,998) mientras en Estrategia Salud de la Familia (OR: 0,997, IC: 0,995-0,999). Conclusiones: La cobertura de Atención Primaria fue relacionada la menor probabilidad de morir de ancianos por condiciones sensibles a la Atención Primaria, sobretodo en Atención Básica.

RESUMO Objetivos: Descrever os coeficientes de mortalidade entre idosos por condições sensíveis, de 2008 a 2018, e verificar a associação com a cobertura da Atenção Primária à Saúde (Modelo Estratégia Saúde da Família e Atenção Básica) no Distrito Federal. Métodos: Estudo ecológico tipo série temporal da mortalidade dos idosos no Distrito Federal, entre 2008 e 2018. Para análise das associações, aplicou se o modelo de regressão Poisson, sendo consideradas significantes as que apresentaram p<0,05, com IC de 95%. Resultados: Houve70.503 óbitos. Observou-se diminuição do risco de morrer dos idosos por doenças cardiovasculares e diabetes. A cobertura da Atenção Primária diminuiu a chance de morrer por condições sensíveis tanto na Atenção Básica (OR: 0,994, IC: 0,990-0,998) quanto na Estratégia Saúde da Família (OR: 0,997, IC: 0,995-0,999). Conclusões: A cobertura de Atenção Primária foi associada a menor chance de morrer dos idosos por condições sensíveis à Atenção Primária, sobretudo na Atenção Básica.

Conflito distributivo: análise do Programa de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB) em duas capitais nordestinas / Conflicto distributivo: análisis del Programa de Mejora del Acceso y Calidad de la Atención Básica (PMAQ-AB) en dos capitales del nordeste de Brasil / Distributive conflict: analysis of the Program for Improving Access and Quality of Primary Care (PMAQ-AB) in two Brazilian northeastern capitals

Este artigo analisa a execução do PMAQ-AB a partir de sua contextualização em um cenário político nacional de profundas transformações, desde o reformismo fraco que promoveu lenta extensão de direitos até o contrarreformismo forte da restauração neoliberal. Para debater os elementos relacionados ao trabalho e às disputas pela distribuição dos recursos públicos, foi realizado estudo de caso com trabalhadores, gestores e conselheiros de saúde em duas capitais do nordeste brasileiro. Os resultados evidenciam o acirramento do conflito distributivo e o resultado desfavorável aos trabalhadores no contexto pós-golpe parlamentar de 2016. As dinâmicas locais expõem processos de contração salarial e individualização das relações de trabalho e a reafirmação da meritocracia como justificativa ideológica da precarização. A isso, trabalhadores se contrapõem pela reafirmação de sua condição coletiva de classe, em favor de benefícios derivados do PMAQ, como recomposição salarial para todos.(AU)

Este artículo analiza la realización del PMAQ-AB a partir de su contextualización en un escenario político nacional de profundas transformaciones, desde el reformismo débil que promovió una lenta extensión de derechos contra el reformismo fuerte de la restauración neoliberal. Para discutir los elementos relacionados al trabajo y a las disputas por la distribución en los recursos públicos se realizó un estudio de caso con trabajadores, gestores y consejeros de salud en dos capitales del nordeste brasileño. Los resultados ponen en evidencia el recrudecimiento del conflicto distributivo y el resultado desfavorable para los trabajadores en el contexto post-golpe parlamentario de 2016. Las dinámicas locales exponen procesos de contracción salarial e individualización de las relaciones de trabajo y la reafirmación de la meritocracia como justificativa ideológica de la precarización. A eso se contraponen los trabajadores por medio de la reafirmación de su condición colectiva de clase, en favor del beneficio derivado del PMAQ con la recomposición salarial para todos.(AU)

This article analyzes the implementation of the Program for Improving Access and Quality of Primary Care (PMAQ-AB) in the context of a national political scenario of deep transformations, from the weak reformism that promoted slow extension of rights to the strong counter-reformism of neoliberal restoration. It is a case study with health workers, managers, and counselors in two capital cities in northeastern Brazil, discussing matters of work and distributive disputes of public resources. Results show the intensification of these conflicts in health and the unfavorable outcome for workers after the parliamentary coup in 2016 political context. Local dynamics expose the wage contraction and individualization of labor relations and the reassertion of meritocracy as an ideological ground for precariousness. Workers oppose this, reaffirming their collective class condition, favoring the benefit derived from PMAQ for fully regaining their group wages.(AU)

Elderly Mortality due to Ambulatory Care Sensitive Conditions and Primary Health Care Coverage in the Federal District.

OBJECTIVES: To describe the mortality coefficients of elderly due to primary care sensitive conditions, from 2008 to 2018, and determine its association with the coverage of the Primary Health Care (Family Health Strategy and Basic Care models) in the Federal District. METHODS: Ecological time series of mortality in Federal District elderly, from 2008 to 2018. The Poisson regression model was applied, considering as significant those with p<0.05, with a CI of 95%. RESULTS: There were 70,503 deaths. There was a decrease in the risk of death of elders due to cardiovascular diseases and diabetes. Higher primary care coverage decreased the chance of death by sensitive conditions, both in Basic Care (OR: 0.994, CI: 0.990-0.998) and in the Family Health Strategy (OR: 0.997, CI: 0.995-0.999). CONCLUSIONS: Primary Care coverage was associated with a lower chance of death of the elderly due to Ambulatory Care Sensitive Conditions, especially in Basic Care.

Big Data e Inteligência Artificial para pesquisa translacional na Covid-19: revisão rápida / Big Data and artificial intelligence for translational research in COVID-19: a rapid review

RESUMO O objetivo deste estudo foi identificar como a Inteligência Artificial (IA) vem sendo utilizada para a pesquisa translacional no contexto da Covid-19. Foi realizada uma revisão rápida para identificar o uso de técnicas de IA na translação de tecnologias para o enfrentamento da Covid-19. Empregou-se estratégia de busca com base em termos MeSH e seus respectivos sinônimos em sete bases de dados. Dos 59 artigos identificados, oito foram incluídos. Foram identificadas 11 experiências que usaram IA para a pesquisa translacional em Covid-19: predição de eficácia medicamentosa; predição de patogenicidade do Sars-CoV-2; diagnóstico de imagem para Covid-19; predição de incidência de Covid-19; estimativas de impacto da Covid-19 na sociedade; automatização de sanitização de ambientes hospitalares e clínicos; rastreio de pessoas infectadas e possivelmente infectadas; monitoramento do uso de máscaras; predição de gravidade de pacientes; estratificação de risco do paciente; e predição de recursos hospitalares. A pesquisa translacional pode ajudar no desenvolvimento produtivo e industrial em saúde, especialmente quando apoiada em métodos de IA, uma ferramenta cada vez mais importante, sobretudo quando se discute a Quarta Revolução Industrial e suas aplicações na saúde.

ABSTRACT The objective of this study was to identify how Artificial Intelligence (AI) has been used for translational research in the context of COVID-19. A rapid review was carried out to identify the use of AI techniques in the translation of technologies to face COVID-19. A search strategy was used based on MeSH terms and their respective synonyms in seven databases. Of the 59 articles identified, eight were included. We identified 11 experiments that used AI for translational research in Covid-19: prediction of drug efficacy; predicting the pathogenicity of SARS-CoV-2; imaging diagnosis for COVID-19; predicting the incidence of COVID-19; estimates of the impact of COVID-19 on society; automation of sanitizing hospital and clinical environments; screening of infected and possibly infected people; monitoring the use of masks; prediction of patient severity; patient risk stratification; and prediction of hospital resources. Translational research can help in productive and industrial development in health, especially when supported by AI methods, an increasingly important tool, especially when discussing the Fourth Industrial Revolution and its applications in health.

Trajetória dos 15 anos de implementação do Programa Saúde na Escola no Brasil / Trajectory of the 15 years of implementation of the School Health Program in Brazil

RESUMO O objetivo deste estudo foi analisar a evolução da implementação do Programa Saúde na Escola (PSE) ao longo dos 15 anos no Brasil. Utilizou-se a abordagem metodológica mista, envolvendo a combinação de análise documental e estudo ecológico com dados secundários de 2007 a 2021 registrados no processo histórico de implementação do PSE no Brasil. Observou-se que, nesses 15 anos, o PSE avançou não somente impactando expressivamente no percentual de municípios que aderiram ao Programa, mas também na sua estrutura e formatação, tendo o território como principal lócus do seu desenvolvimento e a articulação entre saúde e educação como a estratégia propulsora de arranjos locais. Ademais, o modelo de gestão intersetorial do PSE auxilia a articulação das redes de saúde e de educação de forma interfederativa. Portanto, esta análise histórica dá um panorama da saúde escolar no Brasil sob o prisma do PSE e provê a perspectiva de aprimoramento necessária para a continuidade sustentável e qualificada do Programa.

ABSTRACT The aim of this study is to analyze the evolution of the implementation of the School Health Program (PSE) over its 15 years in Brazil. A mixed methodological approach was used, involving a combination of document analysis and ecological study with secondary data from 2007 to 2021 recorded in the historical process of implementing the PSE in Brazil. It was observed that in these fifteen years the PSE has advanced not only significantly impacting the percentage of municipalities that joined the Program, but also in its structure and format, having the territory as the main locus of its development, and the articulation between health and education as the driving strategy of local arrangements. Furthermore, the PSE's intersectoral management model helps the articulation of health and education networks in an interfederative manner. Therefore, this historical analysis gives an overview of school health in Brazil from the perspective of the PSE and provides the perspective of improvement necessary for the sustainable and qualified continuity of the Program.

Factors associated with mortality of the elderly due to ambulatory care sensitive conditions, between 2008 and 2018, in the Federal District, Brazil.

INTRODUCTION: In Brazil, the Unified Health System (Sistema Único de Saúde, or SUS) provides health care, and an aging population overwhelms the system due to the greater vulnerability of the elderly. In the Federal District, two models of primary care coexist-the traditional primary care and the family health strategy. The present study aimed to analyze the factors associated with mortality of the elderly due to conditions sensitive to ambulatory care in the Federal District, Brazil. MATERIALS AND METHODS: This cross-sectional study investigated all deaths that occurred in people over 60 years old between 2008 and 2018. The variables studied were age at death, sex, marital status, education, race/color, death by condition sensitive to ambulatory care, and population coverage of primary care services. The Urban Well-Being Index (UWBI) was used, which includes the dimensions: mobility, environmental and housing conditions, infrastructure, and collective services, to analyze issues related to the place where the senior citizen resides. RESULTS: The deaths 70,503 senior citizens were recorded during the study period. The factors associated with mortality in the elderly due to ambulatory care sensitive conditions were male, lower income, and less education. Residing in a place with poor UWBI presented a response gradient with higher mortality. Increased ambulatory care coverage was also associated with lower mortality. CONCLUSIONS: The study evidenced an association between male gender, age, income, and education, and UWBI with lower mortality due to ambulatory care sensitive conditions, and these associations presented a response gradient. The study also found that increased coverage of the elderly population was associated with lower mortality from sensitive conditions.

Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: A difference-in-differences analysis.

BACKGROUND: Pay-for-performance (P4P) programmes to incentivise health providers to improve quality of care have been widely implemented globally. Despite intuitive appeal, evidence on the effectiveness of P4P is mixed, potentially due to differences in how schemes are designed. We exploited municipality variation in the design features of Brazil's National Programme for Improving Primary Care Access and Quality (PMAQ) to examine whether performance bonuses given to family health team workers were associated with changes in the quality of care and whether the size of bonus mattered. METHODS AND FINDINGS: For this quasi-experimental study, we used a difference-in-differences approach combined with matching. We compared changes over time in the quality of care delivered by family health teams between (bonus) municipalities that chose to use some or all of the PMAQ money to provide performance-related bonuses to team workers with (nonbonus) municipalities that invested the funds using traditional input-based budgets. The primary outcome was the PMAQ score, a quality of care index on a scale of 0 to 100, based on several hundred indicators (ranging from 598 to 660) of health care delivery. We did one-to-one matching of bonus municipalities to nonbonus municipalities based on baseline demographic and economic characteristics. On the matched sample, we used ordinary least squares regression to estimate the association of any bonus and size of bonus with the prepost change over time (between November 2011 and October 2015) in the PMAQ score. We performed subgroup analyses with respect to the local area income of the family health team. The matched analytical sample comprised 2,346 municipalities (1,173 nonbonus municipalities; 1,173 bonus municipalities), containing 10,275 family health teams that participated in PMAQ from the outset. Bonus municipalities were associated with a 4.6 (95% CI: 2.7 to 6.4; p < 0.001) percentage point increase in the PMAQ score compared with nonbonus municipalities. The association with quality of care increased with the size of bonus: the largest bonus group saw an improvement of 8.2 percentage points (95% CI: 6.2 to 10.2; p < 0.001) compared with the control. The subgroup analysis showed that the observed improvement in performance was most pronounced in the poorest two-fifths of localities. The limitations of the study include the potential for bias from unmeasured time-varying confounding and the fact that the PMAQ score has not been validated as a measure of quality of care. CONCLUSIONS: Performance bonuses to family health team workers compared with traditional input-based budgets were associated with an improvement in the quality of care.

Estigma, cuidador e criança com síndrome de Down: análise bioética / Stigma, caregivers and the child with Down syndrome: a bioethical analysis / Estigma, cuidador y niño con síndrome de Down: análisis bioético

Resumo Objetivou-se analisar a percepção de pais de crianças com síndrome de Down acerca de estigma social e refletir sobre o tema à luz da bioética. Trata-se de estudo de elaboração e validação de instrumento de medida cujo teste-piloto contou com 106 participantes. Os resultados apontaram que o estigma inferioriza os afetados, acarretando desvantagem social, desemprego, diminuição de recursos financeiros, não aceitação, intolerância, invisibilidade social, menor acesso a serviços de saúde e piora da qualidade de vida. Isso gera efeitos negativos na saúde dos genitores. Concluiu-se que o estigma está presente na sociedade, e por isso faz-se necessário formular políticas públicas que conscientizem os pais e garantam seu direito à saúde. Reconhece-se que apesar de ser mais um elemento de adoecimento, o estigma não deve ser subestimado.

Abstract The aim of this study was to analyze the perception of parents of children with Down syndrome about social stigma and reflect on the theme in the light of bioethics. This study consists of the elaboration and validation of a measurement instrument whose pilot test had 106 participants. Results showed the stigma creates feelings of inferiority on those affected, causing social disadvantage, unemployment, decreased financial resources, non-acceptance, intolerance, social invisibility, less access to health services and worse quality of life. This generates negative effects on the parents' health. It was concluded that stigma is present in society, so public policies that raise awareness among parents and guarantee their right to health are required. Despite being another element of illness, stigma should not be underestimated.

Resumen El objetivo era analizar la percepción de los padres de niños con síndrome de Down sobre el estigma social y reflexionar sobre el tema a la luz de la bioética. Se trata de un estudio de elaboración y validación de un instrumento de medición en cuya prueba piloto contó con 106 participantes. Los resultados señalaron que el estigma inferioriza a los afectados, lo que conlleva desventajas sociales, desempleo, disminución de recursos financieros, no aceptación, intolerancia, invisibilidad social, menor acceso a servicios de la salud y el empeoramiento de la calidad de vida. Esto genera efectos negativos en la salud de los padres. En conclusión el estigma está presente en la sociedad, por lo que es necesario formular políticas públicas que concienticen a los padres y garanticen su derecho a la salud. Hay que reconocer que a pesar de ser un elemento más de enfermedad, el estigma no debe subestimarse.

Persistent, new-onset symptoms and mental health complaints in Long COVID in a Brazilian cohort of non-hospitalized patients.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections lead to acute- and chronic Long COVID (LC) symptoms. However, few studies have addressed LC sequelae on brain functions. This study was aimed to examine if acute symptoms of coronavirus disease 2019 (COVID-19) would persist during LC, and if memory problems would be correlated with sleep, depressive mood, or anxious complaints. METHODS: Our work followed a cohort of 236 patients from two public hospitals of the Federal District in mid-western Brazil. Patients' interviews checked for clinical symptoms during acute and LC (5-8 months after real-time reverse transcription polymerase chain reaction, RT-qPCR). RESULTS: Most cases were non-hospitalized individuals (86.3%) with a median age of 41.2 years. While myalgia (50%), hyposmia (48.3%), and dysgeusia (45.8%) were prevalent symptoms in acute phase, fatigue (21.6%) followed by headache (19.1%) and myalgia (16.1%) commonly occurred during LC. In LC, 39.8% of individuals reported memory complaints, 36.9% felt anxious, 44.9% felt depressed, and 45.8% had sleep problems. Furthermore, memory complaints were associated with sleep problems (adjusted OR 3.206; 95% CI 1.723-6.030) and depressive feelings (adjusted OR 3.981; 95% CI 2.068-7.815). CONCLUSIONS: The SARS-CoV-2 infection leads to persistent symptoms during LC, in which memory problems may be associated with sleep and depressive complaints.

Regionalização em saúde no Brasil: uma análise da percepção dos gestores de Comissões Intergestores Regionais / Health regionalization in Brazil: an analysis of the managers' perceptions of the Regional Intermanager Commissions

Resumo O estudo tem como objetivo conhecer as percepções dos gestores acerca dos avanços, barreiras e desafios do processo regionalização. Estudo qualitativo realizado por meio de 40 entrevistas em profundidade com os gestores das regiões de saúde dos estados do Ceará, Mato Grosso do Sul, Paraná, Minas Gerais e Tocantins, analisadas com auxílio do software Iramuteq. O primeiro eixo demonstrou a falta de financiamento, a dificuldade e os esforços para prover as ações e serviços, bem como as iniquidades no acesso. O segundo eixo revelou dinâmica da organização e funcionamento regional, que apresenta avanços, sobretudo no modus operandi da organização regional, que conta com melhorias na organização e no desempenho dos Colegiados Intergestores Regionais. Todavia, demonstrou-se que há que se continuar investindo na construção de coordenação federativa cooperativa para melhor organização e redução das desigualdades regionais.

Abstract The study aims to understand the perceptions of managers about the advances, barriers and challenges of the regionalization process. Qualitative study carried out through 40 in-depth interviews with managers of health regions in the states of Ceará, Mato Grosso do Sul, Paraná, Minas Gerais and Tocantins, analyzed using the Iramuteq software. The first axis demonstrated the lack of funding, the difficulty and efforts to provide actions and services, as well as inequities in access. The second axis revealed the dynamics of the regional organization and functioning, which presents advances, especially in the modus operandi of the regional organization, which includes improvements in the organization and performance of the Regional Inter-Management Collegiate. However, it showed that it is necessary to continue investing in the construction of cooperative federative coordination for better organization and reduction of regional inequalities.