Food web structure of fish communities of Doce River, 5 years after the Fundão dam failure.

The rupture of the Fundão dam is considered the largest mining failure in history, which had a particularly detrimental impact on fish populations, as the mud from the ore tailings significantly altered the water quality and habitat of Doce River basin. This study aimed to assess the trophic structure of fish communities in areas impacted and not impacted by the dam rupture in the Doce River basin. To evaluate the food web structure, community-wide trophic niche, and trophic positions of fish, stable isotopes of carbon (δ13C) and nitrogen (δ15N) were utilized across ten sites (seven impacted and three control). In general, fish appeared to assimilate resources such as invertebrates, algae, and periphyton, although the importance of each resource varied among sites. The site closest to the dam rupture exhibited a more simplified trophic structure compared to the control sites and those nearer the river mouth. In this site, most fish species occupied a similar trophic position. Trophic niches also exhibited the greatest dissimilarity between the site closest to the dam failure and those farther away from it, with an expansion of trophic niche breadth observed with an increase in the distance from the dam rupture. Our study provided valuable insights into the trophic structure of fish communities within the Doce River basin, shedding light on the trophic ecology of the 59 fish species investigated. We also emphasize the importance of our study for future assessments of ore tailings dam failure disasters and evaluating the effectiveness of mitigation measures for Doce River basin recovery.

Mindfulness intervention effect on endometriosis-related pain dimensions and its mediator role on stress and vitality: a path analysis approach.

Endometriosis-related pain is supposedly mainly responsible for generating psychological stress and deteriorating the quality of life. However, the interaction between these factors has not been investigated, considering its multidimensional nature and through the path of effects of psychosocial approaches. The present study aims to investigate the effect of a brief mindfulness-based intervention (bMBI) on pain dimensions and its mediator role on psychological stress and QoL-Vitality improvement. A secondary analysis of a pilot randomized controlled trial using a series of parallel and serial mediators was carried out. The results showed that bMBI improves the sensory (B = -6.09 [-9.81, -2.52], ß = -0.42) and affective (B = -3.40 [-5.02, -1.80], ß = -0.47) pain. The bMBI effect on psychological stress reduction was mediated by these changes in sensory (B = -2.81 [-6.06, -0.41], ß = -0.21) and affective (B = -1.97 [-5.07, -0.17], ß = -0.15) pain. Serial sensory pain and psychological stress reduction (B = 2.27 [0.11, 5.81], ß = -0.09) mediated the bMBI effect on quality of life vitality. Meditation training promotes additional improvement in affective and sensory pain characteristics through which psychological stress is reduced. The sensory pain dimension must be positively impacted in combination with psychological stress for the bMBI improves women's vitality. Adding a psychosocial intervention like meditation training to the standard treatment plan may be required for some women to achieve the needed changes to restore well-being.

Maternal deaths as a challenge for obstetric care in times of COVID-19 in Brazil / Mortes maternas como desafio para a assistência obstétrica em tempos da Covid-19 no Brasil

Abstract Objectives: to describe the effects of the Covid-19 pandemic on maternal mortality in Brazil in 2021. Methods: it is an exploratory study with description of the excess maternal mortality in Brazil for 2021, considering different scenarios: (i) 2015-2019 linear trend; (ii) 2020 observed number of deaths; (iii) 2015-2019 linear trend corrected for general mortality excess; (iv) 2020 observed number of deaths corrected for general mortality excess. Results: compared to the trend of the previous five years, the year 2021 showed an excess mortality of 39% (n=3030). The maternal mortality ratio for 2021 drastically exceeded the SDG target for this indicator, reaching approximately 110 maternal deaths per 100,000 live births. In any scenario described, there will be excess maternal mortality in 2021 higher than general mortality and higher than level presented in 2020. Analysis stratified by region demonstrates subnational heterogeneity. Conclusion: Covid-19 pandemic had a considerable impact on maternal health, not only by leading to increased deaths but also by increasing social health inequality. The year 2021 was the most critical period of the pandemic regarding the magnitude of mortality. Barriers to accessing and using essential health services are challenging to achieving health-related Sustainable Development Goals.

Resumo Objetivos: analisar os efeitos da pandemia da Covid-19 na mortalidade materna no Brasil em 2021. Métodos: realizou-se estudo exploratório com descrição do excesso de mortalidade materna no Brasil para 2021, considerando diferentes cenários: (i) tendência linear 2015-2019; (ii) número de óbitos observados em 2020; (iii) tendência linear 2015-2019 corrigida para excesso de mortalidade geral; (iv) número de óbitos observados em 2020 corrigido pelo excesso de mortalidade geral. Resultados: em comparação com a tendência dos cinco anos anteriores, o ano de 2021 apresentou excesso de mortalidade de 39% (n=3030). A razãode mortalidade materna para 2021 ultrapassou a meta dos ODS para este indicador, atingindo um nível superior a 110 mortes maternas por cem mil nascidos vivos. Em qualquer cenário, houve excesso de mortalidade materna em 2021 superior à mortalidade geral em 2020. A análise estratificada por região demonstra heterogeneidade subnacional. Conclusão: a pandemia da Covid-19 teve impacto considerável na saúde materna, não só por levar ao aumento de mortes, mas também por aumentar a iniquidade em saúde. O ano de 2021 foi o período mais crítico da pandemia em termos de mortalidade. Barreiras ao acesso e uso de serviços de saúde são um desafio para alcançar os Objetivos de Desenvolvimento Sustentável relacionados à saúde.

Mindfulness-Based Intervention Effect on the Psychophysiological Marker of Self-Regulation in Women With Endometriosis-Related Chronic Pain.

Endometriosis is a gynecological disease that involves a broad biopsychosocial compromise with the potential to create a negative vicious cycle. Despite the complexity of factors influencing women's improvement, most interventions investigated target just the peripheral nociceptive sources of endometriosis-related pain. An alternative is intervening in self-regulation, which can potentially influence multiple domains of the illness experience. The present study examines the effect of a brief Mindfulness-Based Intervention (bMBI) on attention and autonomic nervous system regulation in women with endometriosis-related pain. Also, explore the interaction between these self-regulation domains and the affective pain dimension. An exploratory analysis of the secondary outcomes of a pilot randomized controlled trial was performed. The vagally-mediated Heart Rate Variability (vmHRV) at rest, cognitive stress, and recovery was employed to measure autonomic regulation. The Flanker and Stroop tasks were used to estimate the attention domains. Results showed that bMBI (n = 26) significantly improved Flanker accuracy and Flanker and Stroop reaction time compared to the control group (n = 28). bMBI significantly increased vmHRV at rest and recovery after cognitive stress. Attention mediated the bMBI effect on affective pain improvement. Results suggest that bMBI improves self-regulation domains with the potential to develop a broad biopsychosocial benefit in the endometriosis context. PERSPECTIVE: This article demonstrates the positive impact of a brief Mindfulness-Based Intervention on attention and parasympathetic regulation in women suffering from endometriosis-related pain. This mindfulness-induced self-regulation improvement can benefit affective pain and potentially multiple psychophysiological processes relevant to endometriosis.

Cognitive-affective changes mediate the mindfulness-based intervention effect on endometriosis-related pain and mental health: A path analysis approach.

BACKGROUND: There is poor knowledge about the therapeutic mechanisms of the conservative interventions for endometriosis. We hypothesized that the effects of a brief mindfulness-based intervention (bMBI) on pelvic pain intensity (PPI), pain unpleasantness (PU) and quality of life mental health (QoL-MH) are mediated by direct and indirect paths of changes in pain catastrophizing (PC), positive affect (PA) and negative affect (NA). METHODS: A secondary analysis of a pilot randomized controlled trial of women with endometriosis, assigned to standard medical treatment (n = 32) and standard medical treatment plus bMBI (n = 31). We tested a series of parallel and serial mediators (PC, PA and NA) of the relationship between bMBI and outcomes (PPI, PU and QoL-MH). RESULTS: The bMBI group demonstrated improvement in PA (Cohen's f2 = 0.12 [0.01, 0.36]), decreases in NA (Cohen's f2 = 0.06 [0.00, 0.24]) and PC (Cohen's f2 = 0.16 [0.02, 0.42]). The PC reduction mediated the effect of the bMBI on PPI and PU directly; however, the PC effect through PA increase mediated the PU marginally but not PPI changes. bMBI effect on Qol-MH was mediated directly by PA and NA. The PC improved Qol-MH through PA increase and Pain decrease but not via NA. CONCLUSIONS: Our findings showed that bMBI impacts pain through changes in pain-related cognitive-affective factors. bMBI can improve QoL-MH by multiple pathways, including but not limited to pain reduction, highlighting the independent potential of improvement in affect to restore mental health in endometriosis. SIGNIFICANCE: Brief mindfulness-based intervention improves endometriosis pain through pain-related cognitive-affective factors and quality of life mental health via pain and affect changes unrelated to pain.

What a few hairs can tell us about the resource use of giant armadillos.

Understanding of resource requirements of vulnerable species is key for conservation planning. Here, we used stable carbon (δ13 C) and nitrogen isotopes (δ15 N) of hair from giant armadillos (Priodontes maximus) to understand individual resource use. We collected hair from 19 giant armadillos analyzing 34 samples from the Brazilian Pantanal and compared the resource use between sexes and age classes. We also assessed the relationship of isotopic values with individuals' body mass and the habitat type used. We observed a wide variation in resource use by giant armadillos, showing that individuals consume prey that feeds on distinct resources and occupies different habitat types, indicating that there is individual variation in foraging behavior. Most giant armadillos presented a mixed diet (C3 /C4 resources, forests/open areas), but a quarter of individuals had strictly C4 diets (open areas). Males are more prone to forage on C4 resources, presenting an isotopic niche 2.6-times larger than that of females. Subadults presented diets more associated with habitats with high arboreal cover (C3 resources, forests), while adults foraged more in open areas (C4 resources). This result is mirrored by the positive relationship between δ13 C values and body mass, suggesting that larger giant armadillos tend to feed more in open areas. We observed that δ13 C values decreased as individuals increased the use of habitats with high arboreal cover. We stress the importance of conserving the natural mosaic in the Pantanal landscape for the species persistence, given that giant armadillos require all habitat types to fulfill their dietary, spatial, and developmental needs.

Participação, representação e deliberação no processo decisório do Conselho Municipal de Saúde de Marabá-PA (2018-2020) / Participation, representation, and deliberation in the decision-making process of the Municipal Health Council of Marabá-PA (2018-2020)

RESUMO O objetivo deste artigo foi analisar o processo decisório do Conselho Municipal de Saúde de Marabá (CMS-M), no estado do Pará, no período de 2018 a 2020, tendo como foco os temas que foram discutidos nas reuniões ordinárias ocorridas nesse intervalo. Foi utilizado o estudo de caso como método de uma pesquisa de abordagem qualitativa que conjuga fontes primárias e secundárias. As fontes primárias foram obtidas por meio da observação participante nas reuniões realizadas no CMS-M, e as fontes secundárias, mediante análise de documentos públicos, especialmente 'pautas' e 'atas' produzidas. Tal método está vinculado a um modelo de análise próprio, concebido no escopo deste artigo. Como resultados, foram constatadas: efetiva participação dos conselheiros no processo deliberativo; regras institucionais restritivas à participação da sociedade na apresentação de demandas e denúncias; forte influência da gestão municipal no processo decisório do conselho; e baixa resposta do poder público municipal no cumprimento das deliberações produzidas no CMS-M.

ABSTRACT The objective of this article is to analyze the decision-making process of the Municipal Health Council of Marabá (CMS-M), in the state of Pará, in the period of 2018 to 2020, focusing on the themes that were discussed in the regular meetings that took place during such period. The case study was used as a research method with a qualitative approach that combines primary and secondary sources. The primary sources were obtained through participant observation in the meetings held at the CMS-M and the secondary sources through the analysis of public documents, especially 'guidelines' and 'minutes' produced. This method is linked to its analysis model, conceived within the scope of this article. As results, the following was found: effective participation of councilors in the deliberative process; institutional rules restricting society's participation in filing claims and complaints; strong influence of municipal management in the decision-making process of the council; and low response from the municipal government in complying with the deliberations produced in the CMS-M.

Entrevista com Fernando Pigatto - Presidente do Conselho Nacional de Saúde (25/06/2021) / Interview with Fernando Pigatto - President of National Health Council (06/25/2021)

RESUMO Entrevista realizada com Fernando Pigatto, atual presidente do Conselho Nacional de Saúde (CNS), por via remota, em 25 de junho de 2021, quando o País chegava a 500 mil mortos pela pandemia de Covid-19. Nela, os entrevistadores objetivaram, por meio de perguntas abertas, levantar informações que: i) apresentassem a atuação do CNS no contexto pandêmico, em especial, seus desafios e avanços; e ii) promovessem a reflexão do entrevistado sobre aspectos fundamentais da democracia e da participação social, sobretudo a relação do Conselho com a sociedade civil e a sociedade política, o papel do CNS no processo decisório das políticas de saúde (ator e/ou arena?) e a interação Conselho-Conferência.

ABSTRACT Interview with Fernando Pigatto, President of National Health Council (CNS), carried out remotely, on 25/06/2021, when the country reached the mark of 500,000 deaths from the COVID-19 pandemic. The interviewers aimed, through open questions, to collected information that would: i) present the performance of the CNS in the pandemic context, in special its challenges and advances; and ii) promote the interviewee's reflection on fundamental aspects of democracy and social participation, especially the relationship between the Council and civil society and political society, the role of CNS in the decision-making process of health policies (actor and/or arena?), and the Council-Conference interaction.

From the struggles against dictatorship to the democracy struggles: the thinking of Antônio Ivo de Carvalho / Das lutas contra a ditadura às lutas pela democracia: o pensamento de Antônio Ivo de Carvalho

This article is a tribute to Antônio Ivo de Carvalho, social activist, partisan, active member of the Movement for Health Reform (MRS), manager who led the National School of Public Health (ENSP/FIOCRUZ) to the level of international excellence and one of the creators of the FIOCRUZ Center for Strategic Studies.

O presente artigo é um tributo a Antônio Ivo de Carvalho, militante social, partisan, membro ativo do Movimento pela Reforma Sanitária (MRS), gestor que conduziu a Escola Nacional de Saúde Pública (ENSP/FIOCRUZ) ao patamar de excelência internacional e um dos criadores do Centro de Estudos Estratégicos da FIOCRUZ.

A single-blind, randomized, pilot study of a brief mindfulness-based intervention for the endometriosis-related pain management.

BACKGROUND: Women with endometriosis suffer from frequent symptoms despite multiple treatments in tertiary care. Although there is a need for a biopsychosocial perspective on endometriosis treatment, few conservative treatments have been investigated. We aimed to investigate the effects of a brief Mindfulness-Based Intervention (bMBI) in women with deep endometriosis who remain symptomatic despite undergoing conventional medical treatment. METHODS: A randomized controlled trial was performed with two groups: a standard medical treatment plus bMBI program and only standard medical treatment as a control. A total of 63 eligible participants were randomized to bMBI and control groups. The primary outcome was endometriosis-related pain, and secondary outcomes were quality of life and stress perception post-treatment. Analyses were carried out using multiple regression models. RESULTS: The results show that bMBI significantly improved pain unpleasantness (Cohen's f2  = 0.67, NNT = 3.2), pelvic pain (Cohen's f2  = 0.16, NNT = 5.3) and dyschezia (Cohen's f2  = 0.23, NNT = 2.9) immediately post-treatment and decreased all endometriosis-related pain (Cohen's f2 ranging from 0.20 to 0.60 and NNT ranging from 5 to -9) after the follow-up. We found an extensive positive effect of bMBI on the mental health dimension in the two time point measures (Cohen's f2  = 0.34 and 0.25, NNT = 3.5 and 2.3) and vitality (Cohen's f2  = 0.22, NNT = 2.1) after the follow-up. CONCLUSIONS: Our study suggests that bMBI is useful for managing endometriosis-related pain and restoring women's psychological well-being. SIGNIFICANCE: Brief Mindfulness-Based Intervention (bMBI) improved endometriosis-related pain and mental health compared to standard medical care. The present findings contribute to the applicability of MBI in visceral pain patients.

Interview with Fernando Pigatto ­ President of National Health Council (25/06/2021) / Entrevista com Fernando Pigatto ­ Presidente do Conselho Nacional de Saúde (25/06/2021)

Interview with Fernando Pigatto, President of National Health Council (CNS), remotely, on 06/25/2021, when the country reached 500.000 deaths from the COVID-19 pandemic. The interviewers aimed, through open questions, to collected informations that (i) present the performance of CNS in the pandemic context, in special its challenges and advances; and (ii) promote the reflexions of interviewee's reflection on fundamental aspects of democracy and social participation, especially the relationship between the Council and civil society and political society, the role of CNS in the decision-making process of health policies (actor and/or arena?) and the Council-Conference interation. 

Entrevista realizada com Fernando Pigatto, atual presidente do Conselho Nacional de Saúde (CNS), por via remota, em 25/06/2021, quando o País chegava a 500.000 mortos pela pandemia de Covid-19. Nela, os entrevistadores objetivaram, por meio de perguntas abertas, levantar informações que (i) apresentassem a atuação do CNS no contexto pandêmico, em especial seus desafios e avanços; e (ii) promovessem a reflexão do entrevistado sobre aspectos fundamentais da democracia e da participação social, sobretudo a relação do Conselho com a sociedade civil e a sociedade política, o papel do CNS no processo decisório das políticas de saúde (ator e/ou arena?) e a interação Conselho-Conferência.      

[Analysis of manifestations to the General Ombudsman of the Unified Health System (SUS), from 2014 to 2018: evidence for decision-making]. / Análise das manifestações à Ouvidoria-Geral do SUS, no período de 2014 a 2018: evidências para a tomada de decisões.

This paper aims to analyze the manifestations of citizens to the Unified Health System (SUS) General Ombudsman, in the 2014-2018 period, discussing and understanding them as evidence to guide the decision-making of SUS managers. To this end, the database of the OuvidorSUS computerized system was extracted from 16 variables related to the content of the manifestations, their categorization, and the citizen's profile. We identified 216,832 registered manifestations and 114,618 profiles of citizens who contacted the SUS General Ombudsman during this period, mainly through the hotline Disque Saúde 136. The groups that most accessed the Ombudsman and responded to the citizen profile were women, white, heterosexual, aged between 31 and 40, having complete or incomplete higher education, and private sector workers with an income of 1-2 minimum wages. The most frequent issues of demands, mainly related to requests, complaints and denunciations, were system management, health care, and pharmaceutical care. The records show the importance of consolidating the Ombudsman's strategic variables for qualifying the system management.

O objetivo deste artigo é analisar as manifestações dos cidadãos à Ouvidoria-Geral do Sistema Único de Saúde (SUS), no período de 2014-2018, discutindo-as e compreendendo-as como evidências capazes de orientar a tomada de decisões dos gestores do SUS. Para isso, foi extraído o banco de dados do sistema informatizado OuvidorSUS, a partir de 16 variáveis referentes ao conteúdo das manifestações, à sua categorização e ao perfil do cidadão. Foram registradas 216.832 manifestações e 114.618 perfis dos cidadãos que entraram em contato com a Ouvidoria-Geral do SUS nesse período, sendo o principal canal o Disque Saúde 136. Os grupos que mais acessaram a Ouvidoria e responderam ao perfil do cidadão foram mulheres, brancos, heterossexuais, com idade entre 31 e 40 anos, nível superior completo ou incompleto, trabalhadores do setor privado e com renda entre 1 e 2 salários mínimos. As demandas, principalmente relacionadas a solicitações, reclamações e denúncias, tiveram como assuntos mais frequentes a gestão do sistema, a assistência à saúde e a assistência farmacêutica. Os registros apontam a importância da consolidação de variáveis estratégicas da Ouvidoria para a qualificação da gestão do sistema.

Análise das manifestações à Ouvidoria-Geral do SUS, no período de 2014 a 2018: evidências para a tomada de decisões / Analysis of manifestations to the General Ombudsman of the Unified Health System (SUS), from 2014 to 2018: evidence for decision-making

Resumo O objetivo deste artigo é analisar as manifestações dos cidadãos à Ouvidoria-Geral do Sistema Único de Saúde (SUS), no período de 2014-2018, discutindo-as e compreendendo-as como evidências capazes de orientar a tomada de decisões dos gestores do SUS. Para isso, foi extraído o banco de dados do sistema informatizado OuvidorSUS, a partir de 16 variáveis referentes ao conteúdo das manifestações, à sua categorização e ao perfil do cidadão. Foram registradas 216.832 manifestações e 114.618 perfis dos cidadãos que entraram em contato com a Ouvidoria-Geral do SUS nesse período, sendo o principal canal o Disque Saúde 136. Os grupos que mais acessaram a Ouvidoria e responderam ao perfil do cidadão foram mulheres, brancos, heterossexuais, com idade entre 31 e 40 anos, nível superior completo ou incompleto, trabalhadores do setor privado e com renda entre 1 e 2 salários mínimos. As demandas, principalmente relacionadas a solicitações, reclamações e denúncias, tiveram como assuntos mais frequentes a gestão do sistema, a assistência à saúde e a assistência farmacêutica. Os registros apontam a importância da consolidação de variáveis estratégicas da Ouvidoria para a qualificação da gestão do sistema.

Abstract This paper aims to analyze the manifestations of citizens to the Unified Health System (SUS) General Ombudsman, in the 2014-2018 period, discussing and understanding them as evidence to guide the decision-making of SUS managers. To this end, the database of the OuvidorSUS computerized system was extracted from 16 variables related to the content of the manifestations, their categorization, and the citizen's profile. We identified 216,832 registered manifestations and 114,618 profiles of citizens who contacted the SUS General Ombudsman during this period, mainly through the hotline Disque Saúde 136. The groups that most accessed the Ombudsman and responded to the citizen profile were women, white, heterosexual, aged between 31 and 40, having complete or incomplete higher education, and private sector workers with an income of 1-2 minimum wages. The most frequent issues of demands, mainly related to requests, complaints and denunciations, were system management, health care, and pharmaceutical care. The records show the importance of consolidating the Ombudsman's strategic variables for qualifying the system management.

Association between severity of pain, perceived stress and vagally-mediated heart rate variability in women with endometriosis.

Chronic pelvic pain is the main symptom in women with endometriosis. Evidence suggests that psychological stress and autonomic regulation contribute to symptoms and pathophysiological modulation. We investigated the relationship between endometriosis-related pain severity, perceived stress, and autonomic balance in a sample of 81 women suffering chronic pelvic pain with deep endometriosis. Perceived stress and pelvic pain symptoms were assessed using the 10-item version of the Perceived Stress Scale (PSS-10) and the Numeric Pain Rating Scale (NPRS), respectively. Autonomic nervous system regulation was evaluated using vagally mediated components of the heart rate variability (vmHRV). Our results showed that pain unpleasantness and perceived stress were positively correlated, and women with mood disorders had higher perceived stress. The women with low resting vmHRV experience more intense pelvic pain, pain unpleasantness, and a higher number of severe endometriosis-related pain descriptors. The positive association between perceived stress, mood disorder, and pain unpleasantness demonstrates the additive effect between these aversive experiences. The inverse association between parasympathetic tone and pain suggests contributions of the Descending Inhibitory Pain pathway efficiency to symptom severity in women with endometriosis.

Will Brazil comply with the SDG 3.1 of the 2030 Agenda? An analysis of maternal mortality, from 1996 to 2018. / O Brasil cumprirá o ODS 3.1 da Agenda 2030? Uma análise sobre a mortalidade materna, de 1996 a 2018.

This article aims to analyze if it is possible for Brazil to meet the Sustainable Development Goals (SDG) 3.1, based on a diagnosis of the situation of maternal mortality in the Health Regions (HRs) of Brazil, in 2018, and the main characteristics of this mortality between 1996 and 2018 in the country. The study consists of two articulated phases: (i) bibliographical analysis of maternal mortality in Brazil; (ii) study in the Mortality Information System (SIM, in Portuguese). In 2018, from the 450 HRs, 159 showed a maternal mortality rate (MMR) of above 70 per 100,000 live births (LBs). Between 1996 and 2018, in Brazil, there was a reduction among women 30 to 49 years of age. However, in the age group of 10 to 29 years, there was no change during the time studied. The dissemination of the Maternal Mortality Committees, the PHPN, the PNAISM, and the "Stork Network" have all contributed to improvements in late pregnancies; however, they were inefficient at preventing deaths among young mothers. Compliance with SDG 3.1 requires: prioritization of CIR with MMR greater than 70.0/100,000 LB; qualification of prenatal services, focusing on care among women aged 10 to 29 years and hypertensive complications; and legalization of abortion.

O objetivo deste artigo é analisar as possibilidades de cumprimento da Meta 3.1 dos Objetivos de Desenvolvimento Sustentável pelo Brasil, a partir do diagnóstico sobre a situação da mortalidade materna nas Regiões de Saúde (CIR), em 2018, e as principais características desta mortalidade, entre 1996 e 2018, no país. Estudo com duas etapas articuladas: análise bibliográfica sobre a mortalidade materna no Brasil; e pesquisa no Sistema de Informação sobre Mortalidade (SIM). Em 2018, das 450 CIR, 159 apresentaram razão de mortalidade materna (RMM) superior a 70 por 100 mil nascidos vivos (NV). Entre 1996 e 2018, no Brasil, houve redução entre mulheres de 30 a 49 anos. Entretanto, a faixa de 10 a 29 anos permaneceu inalterada ao longo da série. A disseminação dos Comitês de Mortalidade Materna, o Programa de Humanização do Pré-Natal e Nascimento (PHPN), a Política Nacional de Atenção Integral à Saúde da Mulher (PNAISM) e a Rede Cegonha influenciaram melhorias na gravidez tardia, mas, não impactaram a prevenção dos óbitos entre mães jovens. O cumprimento do ODS 3.1 requer: a priorização das CIR com RMM superior a 70,0/100 mil NV; a qualificação dos serviços de pré-natal, com foco na atenção entre mulheres de 10 e 29 anos e nas complicações hipertensivas; a e legalização do aborto.

[Agenda 2030 in Argentina: perceptions of health experts, comparison with the perceptions of Brazilian experts and the first impacts of the COVID-19 Pandemic]. / Agenda 2030 en Argentina: percepciones de expertos en salud, comparación con expertos de Brasil y primeros impactos de la pandemia COVID-19.

The 2030 Agenda - a strategy of the United Nations Organization (UN) to promote global and sustainable human development capable of satisfying basic social needs - is still in the initial stages in most of the countries of South America. The scope of this investigation was to consult a group of health experts on the possibilities of Argentina fulfilling the 2030 Agenda, especially the goals of ODS3 - Health and Wellbeing - when they were consulted on obstacles, challenges, and policy recommendations to meet the goals. The change of management of the government in December 2019, and the outbreak of the Covid-19 pandemic in 2020, broadened the investigation incorporating the analysis of the incumbent Minister of Health of the Nation on the 2030 Agenda, the study carried out and the current perspectives in the pandemic period. The results were analyzed from a comparative standpoint with a Brazilian study, which revealed that most experts agree on the country's potential to meet the goals of the 2030 Agenda. However, in the analysis of the new Minister of Health, there are "the paradoxes of the pandemic" that relate to the opportunity to empower the health system pursuant to the Covid-19 pandemic.

La Agenda 2030, una estrategia de la Organización de las Naciones Unidas (ONU) para promover un desarrollo humano global y sostenible capaz de satisfacer necesidades sociales básicas, aún se encuentra en sus etapas iniciales en la mayoría de los países de América del Sur. La presente investigación tuvo como objetivo consultar a un grupo de expertos en salud sobre las posibilidades de Argentina de cumplir con la Agenda 2030, en especial las metas del ODS3-Salud y Bienestar-, a su vez que se les consultó sobre los obstáculos, desafíos y recomendaciones de políticas para cumplir con las metas. El cambio de gestión del gobierno en diciembre de 2019, y el surgimiento de la pandemia COVID19 en el presente año, amplió la investigación incorporando el análisis del actual Ministro de Salud de la Nación sobre la Agenda 2030, el estudio realizado y las perspectivas actuales en el periodo de la pandemia. Los resultados fueron analizados en perspectiva comparada con un estudio brasilero, y mostraron que la mayoría de los expertos coincide en el bajo potencial del país para cumplir con las metas de la Agenda 2030. Sin embargo en el análisis del nuevo Ministro de salud surgen "las paradojas de la pandemia" que refieren a la oportunidad de fortalecer el sistema sanitario producto de la pandemia COVID-19.