Impact Analysis of the Brazilian Suicide Prevention Campaign "Yellow September": an Ecological Study.

INTRODUCTION: Yellow September (YS) is a Brazilian suicide prevention campaign implemented in 2015, however, its effectiveness in reducing mortality is still unknown. MATERIAL AND METHODS: This is an ecologically interrupted time series study that analyses the evolution of suicide rates in Brazil between 2011 and 2019 and its association with the implementation of YS at a national level. Data was provided by the Mortality Information System. A segmented interrupted series regression analysis was performed, using a generalized linear Poisson model, with correction for seasonal trends. RESULTS: There was an increase in the annual rates of suicide deaths between 2011 and 2019, with 4.99 and 6.41 suicides per 100,000 inhabitants, respectively. The null hypothesis, that the YS did not change the historical trend of growth in suicides in Brazil after its implementation, was affirmed. However, there was an eventual significant increase of 6.2% in the risk of mortality in 2017 and of 8.6% in 2019. DISCUSSION: The results are consistent with the literature, which proposes that campaigns focused solely on publications through the media generate unsound findings regarding the effective reduction in the number of deaths by suicide. Conclusions: The lack of initiative in multisectoral actions may explain the failure of YS on changing deaths by suicide, therefore the development of new lines of action focused on training professionals and expanding the care network could make it an effective instrument in reducing mortality from suicide. CONCLUSIONS: The lack of initiative in multisectoral actions may explain the failure of YS on changing deaths by suicide, therefore the development of new lines of action focused on training professionals and expanding the care network could make it an effective instrument in reducing mortality from suicide.

Financing of health and the fiscal dependency of Brazilian municipalities between 2004 and 2019. / Financiamento da saúde e dependência fiscal dos municípios brasileiros entre 2004 e 2019.

This article describes the evolution of municipal financing of the Unified Health System, from 2004 to 2019, considering revenues and expenses from own and non-own sources, analyzes fiscal redistribution, according to population size and average household income, and compares this evolution in two periods, characterized as economic growth (2004-2014) and recession (2015-2019). The study was based on data from the Information System on Public Health Budgets. There was real growth in municipal spending on health from 2004 to 2014 (156.3%), with a drop between 2014 and 2015, followed by a recovery between 2015 and 2019. During the recession period, there was an overall increase in the fiscal dependence of municipalities, indicated by the increase in non-own revenues, even with the decrease in the Federal Government participation in transfers. The growth of own health expenses was lower among municipalities with lower household income, while for non-own expenses it was higher in municipalities with a smaller population size. In short, the results indicate a process of increasing municipal spending on health, as well as the increased fiscal dependence of municipalities to fund health, intensified after the 2015 crisis, which especially affected small and lower income municipalities.

Este artigo descreve a evolução do financiamento municipal do Sistema Único de Saúde, de 2004 a 2019, considerando receitas e despesas de fontes próprias e não-próprias, analisa a redistribuição fiscal, de acordo com o porte populacional e a renda média domiciliar, e compara essa evolução em dois períodos, caracterizados como de crescimento econômico (2004-2014) e de recessão (2015-2019). O estudo se baseou em dados do Sistema de Informações sobre Orçamentos Públicos em Saúde. Constatou-se crescimento real dos gastos municipais em saúde de 2004 a 2014 (156,3%), com queda entre 2014 e 2015, seguida de recuperação até 2019. Na recessão, detectou-se aumento global da dependência fiscal dos municípios, indicada pelo aumento de receitas não-próprias, mesmo com a diminuição da participação da União nas transferências. O crescimento das despesas próprias em saúde foi menor entre os municípios de menor renda domiciliar, enquanto para as despesas não-próprias foi maior nos municípios de menor porte populacional. Em suma, indica-se um processo de incremento dos gastos municipais em saúde, assim como o aumento da dependência fiscal para custeio da saúde, intensificado após a crise de 2015, que atingiu especialmente os municípios de pequeno porte e de menor renda domiciliar.

Financiamento da saúde e dependência fiscal dos municípios brasileiros entre 2004 e 2019 / Financing of health and the fiscal dependency of Brazilian municipalities between 2004 and 2019

Resumo Este artigo descreve a evolução do financiamento municipal do Sistema Único de Saúde, de 2004 a 2019, considerando receitas e despesas de fontes próprias e não-próprias, analisa a redistribuição fiscal, de acordo com o porte populacional e a renda média domiciliar, e compara essa evolução em dois períodos, caracterizados como de crescimento econômico (2004-2014) e de recessão (2015-2019). O estudo se baseou em dados do Sistema de Informações sobre Orçamentos Públicos em Saúde. Constatou-se crescimento real dos gastos municipais em saúde de 2004 a 2014 (156,3%), com queda entre 2014 e 2015, seguida de recuperação até 2019. Na recessão, detectou-se aumento global da dependência fiscal dos municípios, indicada pelo aumento de receitas não-próprias, mesmo com a diminuição da participação da União nas transferências. O crescimento das despesas próprias em saúde foi menor entre os municípios de menor renda domiciliar, enquanto para as despesas não-próprias foi maior nos municípios de menor porte populacional. Em suma, indica-se um processo de incremento dos gastos municipais em saúde, assim como o aumento da dependência fiscal para custeio da saúde, intensificado após a crise de 2015, que atingiu especialmente os municípios de pequeno porte e de menor renda domiciliar.

Abstract This article describes the evolution of municipal financing of the Unified Health System, from 2004 to 2019, considering revenues and expenses from own and non-own sources, analyzes fiscal redistribution, according to population size and average household income, and compares this evolution in two periods, characterized as economic growth (2004-2014) and recession (2015-2019). The study was based on data from the Information System on Public Health Budgets. There was real growth in municipal spending on health from 2004 to 2014 (156.3%), with a drop between 2014 and 2015, followed by a recovery between 2015 and 2019. During the recession period, there was an overall increase in the fiscal dependence of municipalities, indicated by the increase in non-own revenues, even with the decrease in the Federal Government participation in transfers. The growth of own health expenses was lower among municipalities with lower household income, while for non-own expenses it was higher in municipalities with a smaller population size. In short, the results indicate a process of increasing municipal spending on health, as well as the increased fiscal dependence of municipalities to fund health, intensified after the 2015 crisis, which especially affected small and lower income municipalities.

Currículo informal singular: eletividade na formação médica durante a pandemia / Singular informal curriculum: electiveness in medical training during the pandemic

Resumo: Introdução: A interrupção das atividades de ensino imposta pela pandemia de Sars-CoV-2 ofereceu uma oportunidade ímpar de analisar os hábitos de estudo extracurriculares dos estudantes de Medicina, buscando compreender como a inexistência de um direcionamento institucional temático impactou a formação médica durante esse período de isolamento social. Objetivo: Este estudo teve como objetivo avaliar a ocorrência, as temáticas e as principais fontes dos estudos durante o período de suspensão de aulas na pandemia. Método: Trata-se de um estudo analítico e descritivo com dados colhidos a partir de um questionário virtual aplicado a estudantes de Medicina de uma instituição de ensino superior. Resultado: A partir da suspensão total das aulas, dos 310 participantes, 152 (49,0%) discentes alegaram ter estudado temas relacionados à área de ciências da saúde e 93 (30,0%) estudaram temas não relacionados à área de ciências da saúde. Estatisticamente, houve preferência exclusiva por uma área outra (p < 0,001), indicando dois perfis de estudo no período. Os interesses temáticos mais abundantes foram aqueles abordados em eventos médicos virtuais, como congressos ou simpósios, bem como os relacionados à Covid-19. Entre os temas mais citados, destacaram-se: fisiologia, clínica médica e geral ou especializada, anatomia, idiomas, finanças e filosofia. Conclusão: A despeito da suspensão das atividades acadêmicas curriculares, os estudantes buscaram novos aprendizados de acordo com suas demandas intelectivas, denotando o desenvolvimento de um currículo informal singularizado.

Abstract: Introduction: The interruption of teaching activities imposed by the Sars-CoV-2 pandemic offered a unique opportunity to analyze the extracurricular study habits of medical students, seeking to understand how the lack of a thematic institutional targeting impacted on medical training during the period of social isolation. Objective: This study aimed to evaluation of the occurrence, themes, and main sources of studies during the period of suspension of classes in the pandemic. Method: Analytical and descriptive study with data collected from a virtual questionnaire applied to medical students of a higher education institution. Result: From the complete suspension of local activities, of the 310 participants, 152 (49.0%) students claimed to have studied topics related to the health sciences and 93 (30.0%) studied topics not related to the health sciences area. Statistically, there was an exclusive preference for one area to another (p < 0.001), indicating two study profiles in the period. The most abundant thematic interests were those addressed in virtual medical events, such as conferences or symposia, as well as those related to Covid-19. It stands out as the most cited themes: physiology, medical and general or specialized clinic, anatomy, languages, finance and philosophy. Conclusion: Despite the suspension of academic activities, students sought new learning habits according to their intellectual demands, denoting the development of a singularized informal curriculum.