Politics and confidence toward the COVID-19 vaccination: A Brazilian cross-sectional study.

This study has the aim of assessing the Brazilian perceptions, influencing factors and political positioning on the confidence concerning COVID-19 vaccination. To achieve the objective, the methods rely on a cross-sectional survey of Brazilian citizens, distributed through different social networks. The sample is composed of 1,670 valid responses, collected from almost all Brazilian states and state capitals. To analyze the data and give a clear view of the variables' relationship, the study used bivariate and comparative graphs. Results show a higher level of confidence in vaccines from Pfizer and AstraZeneca, while the lower level of confidence is associated with vaccines from Sinopharm and Sputinik5. Vaccine efficacy is the most significant influencing factor that helps in the decision to get vaccinated. Also, individuals are less willing to get vaccinated if their political preferences are related to the right-wing. The results led to three main health and social implications: i) the vaccination strategy campaigns should take in count vaccine efficacy and political aspects; ii) the vaccination process should be adapted to regions with different political positions; and iii) a reinforcement in the educational policies of the vaccine's importance to the public health, to avoid the politization of a health issue.

Perceptions of institutional performance and compliance to non-pharmaceutical interventions: How performance perceptions and policy compliance affect public health in a decentralized health system.

Trust in institutions is a key driver to shape population attitudes and behavior, such as compliance of non-pharmaceutical interventions (NPI). During the COVID-19 pandemic, this was fundamental and its compliance was supported by governmental and non-governmental institutions. Nevertheless, the situation of political polarization in some countries with decentralized health systems increased the difficulty of such interventions. This study analyzes the association between non-pharmaceutical interventions' compliance and individual perception regarding institutions' performance during the COVID-19 pandemic in Brazil. A web survey was conducted in Brazil between November 2020 and February 2021. Bivariate analysis and ordered logit regressions were performed to assess the association between NPIs compliance and perceived institutions' performance. Results suggest a negative association between NPIs' compliance and Federal Government and Ministry of health perceived performance, which may reflect the political positioning of the respondents. Moreover, we find a positive association between NPI compliance and the perceived performance of the remaining institutions (state government, federal supreme court, national congress, WHO, media and SUS). Our contribution goes beyond the study of a relationship between non-pharmaceutical interventions' compliance and institutions' performance, by pointing out the importance of subnational and local governmental spheres in a decentralized health system, as well as highlighting the importance of social communication based on health organizations' information and scientific institutions.

Health Education in Brazil: an analysis of scientific production between 2010 and 2020 / Educación para la salud en Brasil: un análisis de la producción científica entre 2010 y 2020 / Educação na Saúde no Brasil: uma análise da produção científica entre 2010 e 2020

Health education is defined as any production of knowledge aimed at professional training to work in health, but it is marked by confusion in the use of terms that involve its theoretical foundation. We mapped the scientific production on Health Education in Brazil between 2010 and 2020, through bibliometric review with collection in three databases (Web of Science, MEDLINE and Scopus) and use of the Bibliometrix software. The analysis shows an increase in publications on the theme of health education in the national territory in the period described. The theme shows international influence in citations, absence of specific descriptors, inappropriate use of the most convenient descriptors and presence of research networks. The results obtained create a safe comparison framework for future studies that analyze the evolution of health education in Brazil and the need to create a theme-specific descriptor in the DeCS/MeSH system.

La educación para la salud se define como toda producción de conocimiento orientada a la formación profesional para trabajar en salud, pero está marcada por la confusión en el uso de términos que involucran su fundamento teórico. Mapeamos la producción científica en Educación para la Salud en Brasil entre 2010 y 2020, mediante revisión bibliométrica con recolección en tres bases de datos (Web of Science, MEDLINE y Scopus) y uso del software Bibliometrix. El análisis muestra un incremento de publicaciones sobre el tema de educación para la salud en el territorio nacional en el período descrito. El tema muestra influencia internacional en las citas, ausencia de descriptores específicos, uso inadecuado de los descriptores más convenientes y presencia de redes de investigación. Los resultados obtenidos crean un marco de comparación seguro para futuros estudios que analicen la evolución de la educación para la salud en Brasil y la necesidad de crear un descriptor temático específico en el sistema DeCS / MeSH.

A educação na saúde é definida como qualquer produção de conhecimento voltado à formação profissional para atuação na saúde, mas é marcada pela confusão no uso de termos que envolvem sua base teórica. Para preencher essa lacuna, esta pesquisa mapeou a produção científica sobre Educação na Saúde no Brasil entre 2010 a 2020, por meio de uma revisão bibliométrica com coleta em três bases de dados (Web of Science, MEDLINE e Scopus) e uso do software Bibliometrix. A análise demonstra um aumento de publicações sobre a temática da educação na saúde em território nacional no período descrito. Além disso, observa-se uma influência internacional nas citações da educação na saúde, com ausência de descritores específicos, uso inoportuno dos descritores mais convenientes e presença de redes de investigação. Os resultados obtidos criam uma estrutura de comparação segura para futuros estudos que analisem a evolução da educação na saúde no Brasil e a necessidade de criação de um descritor específico à temática no sistema DeCS/MeSH.

Health systems resilience: is it time to revisit resilience after COVID-19?

The concept of health system resilience has been challenged by the COVID-19 pandemic. Even well-established health systems, considered resilient, collapsed during the pandemic. To revisit the concept of resilience two years and a half after the initial impact of COVID-19, we conducted a qualitative study with 26 international experts in health systems to explore their views on concepts, stages, analytical frameworks, and implementation from a comparative perspective of high- and low-and-middle-income countries (HICs and LMICs). The interview guide was informed by a comprehensive literature review, and all interviewees had practice and academic expertise in some of the largest health systems in the world. Results show that the pandemic did modify experts' views on various aspects of health system resilience, which we summarize and propose as refinements to the current understanding of health systems resilience.

Aderência dos PPC de Medicina aos parâmetros da política de formação médica brasileira / Adherence of the Medical Course PPCs to the parameters of the Brazilian medical education policy

Resumo: Introdução: Pesquisas recentes têm se dedicado a analisar os projetos pedagógicos dos cursos (PPC) de Medicina e o grau de alinhamento deles ao que determina a legislação brasileira para abertura e funcionamento dos cursos no país. No entanto, não há estudos de abrangência nacional que tenham investigado se os PPC de Medicina estão em conformidade com a legislação brasileira vigente. Objetivo: Neste estudo, buscou-se analisar a aderência dos PPC de Medicina no Brasil às Diretrizes Curriculares Nacionais (DCN) do ensino médico e ao Programa Mais Médicos para o Brasil (PMM). Método: Para alcançar esse objetivo, coletaram-se 157 PPC de Medicina no Brasil que foram categorizados em uma escala Likert de aderência, que varia de não aderente (1) a fortemente aderente (5), a partir de três dimensões de análise: aspectos norteadores de formação, aspectos curriculares, aspectos ensino-serviço. Posteriormente, por meio da análise de componentes principais, criou-se o Índice Sintético de Aderência dos PPC. Com o banco de dados criado, aplicaram-se estatísticas descritivas e gráficos relacionais para descrever a situação no Brasil. Resultado: Os resultados demonstram o seguinte: 1. a Região Centro-Oeste obteve a melhor performance nas três dimensões analisadas; 2. as instituições públicas (39% do total) têm maior aderência dos PPC aos parâmetros normativos analisados; e 3. a dimensão ensino-serviço aponta maior variação entre os tipos de administração das instituições, com menor aderência das instituições privadas. Conclusão: Este trabalho acende um alerta em relação à adequação dos cursos de Medicina das instituições privadas aos parâmetros normativos e legais exigidos para a formação médica no Brasil. Além disso, contribui para a literatura ao apresentar um modelo de avaliação de PPC por meio do Índice Sintético de Aderência dos PPC como sugestão para trabalhos futuros.

Abstract: Introduction: Recent studies have been dedicated to analyzing the PPCs of the medical course and their degree of alignment with what is determined by the Brazilian legislation for the opening and operation of the course in the country. However, there are no nationwide studies that have investigated whether the pedagogical projects for the medical courses are in compliance with current Brazilian legislation. Objective: In this study, we analyzed the adherence of the Pedagogical Course Projects (PPCs) of medical schools in Brazil based on the National Curriculum Guidelines (DCNs, Diretrizes Curriculares Nacionais) of medical education and the "Mais Médicos" Program (PMM, Programa Mais Médicos) for Brazil. Method: To achieve this objective, we collected 157 PPCs from medical courses in Brazil and categorized them in a Likert Scale of adherence, ranging from non-adherent (1) to strongly adherent (5), based on three dimensions of analysis: guiding aspects of training, curricular aspects, teaching-service aspects. Subsequently, using the Principal Component Analysis, we created the PPC Adherence Synthetic Index. After the database was created, descriptive statistics and relational graphs were applied to describe the situation in Brazil. Results: The results show that: I) the Midwest region is the one with the best performance in the three analyzed dimensions; II) public institutions (39% of the total) have greater adherence of PPCs to the analyzed normative parameters; and III) the teaching-service dimension shows greater variation between the types of institution administration, with less adherence by private institutions. Conclusions: Therefore, ultimately, this study raises an alert regarding the adequacy of medical courses in private institutions to the normative and legal parameters required for medical training in Brazil. In addition, it contributes to the literature by presenting an evaluation model for pedagogical course projects through the Synthetic Index of Adherence of PPCs as a suggestion for future studies.

A resiliência de sistemas de saúde: apontamentos para uma agenda de pesquisa para o SUS / The health systems resilience: notes for a research agenda for the SUS

RESUMO A pandemia provocada pela Covid-19 deu relevância à resiliência dos sistemas de saúde. Neste artigo, buscou-se explorar elementos que subsidiem uma agenda de pesquisa sobre resiliência para o Sistema Único de Saúde (SUS). A partir de revisão de escopo, analisou-se o desenvolvimento conceitual e metodológico da resiliência aplicada à pesquisa sobre sistemas de saúde em nível internacional e nacional, identificando quem são os grupos formuladores e o que propõem como modelos de análise. Em seguida, apresentou-se uma proposta de modelo de análise de resiliência adaptada às características do sistema de saúde brasileiro. O modelo embasou o apontamento de questões-chave a serem investigadas em pesquisas sobre a resiliência do SUS, a partir de quatro dimensões: governança e liderança, financiamento, recursos (força de trabalho, infraestrutura, medicamentos e tecnologias) e prestação de serviços. Ao final, discutem-se oportunidades e desafios para implementação de uma agenda de pesquisas de resiliência para o SUS.

ABSTRACT The COVID-19 pandemic highlighted the resilience of health systems. In this paper, we seek to explore elements to support a research agenda on resilience for the Unified Health System (SUS). First, based on a scoping review, we analyzed the conceptual and methodological development of resilience applied to health systems research both at international and national levels, identifying who the formulating groups are and what they propose as analytical frameworks. Then, we propose an analytical framework adapted for the Brazilian health system features. The framework underpinned the pointing out of critical issues to be investigated in research on SUS resilience, based on four dimensions: governance and leadership, financing, resources (workforce, infrastructure, medicines, and technologies), and service provision. Finally, we discuss opportunities and challenges for implementing a research agenda on resilience for the SUS.

Running away from the jab: factors associated with COVID-19 vaccine hesitancy in Brazil.

OBJECTIVE: To investigate how sociodemographic conditions, political factors, organizational confidence, and non-pharmaceutical interventions compliance affect the COVID-19 vaccine hesitancy in Brazil. METHODS: Data collection took place between November 25th, 2020 and January 11th, 2021 using a nationwide online survey. Subsequently, the researches performed a descriptive analysis on the main variables and used logistic regression models to investigate the factors associated with COVID-19 vaccine hesitancy. RESULTS: Less concern over vaccine side effects could improve the willingness to be vaccinated (probability changed by 7.7 pp; p < 0.10). The current vaccine distrust espoused by the Brazilian president is associated with vaccine hesitancy, among his voter base. Lower performance perception ("Very Bad" with 10.7 pp; p < 0.01) or higher political opposition (left-oriented) regarding the current presidency is associated with the willingness to be vaccinated. Higher compliance with non-pharmaceutical interventions (NPIs) is usually positively associated with the willingness to take the COVID-19 vaccine (+1 score to NPI compliance index is associated with higher willingness to be vaccinated by 1.4 pp, p < 0.05). CONCLUSION: Willingness to be vaccinated is strongly associated with political leaning, perceived federal government performance, vaccine side effects, and compliance with non-pharmaceutical interventions (NPIs).

How did the UK government face the global COVID-19 pandemic? / Como o governo do Reino Unido enfrentou a pandemia global da COVID-19? / ¿Cómo hizo frente el gobierno del Reino Unido a la pandemia mundial de COVID-19?

Abstract This paper aims to analyse the coordination and cooperation in Primary Health Care (PHC) measures adopted by the British government against the spread of the COVID-19. PHC is clearly part of the solution founded by governments across the world to fight against the spread of the virus. Data analysis was performed based on coordination, cooperation, and PHC literature crossed with documentary analysis of the situation reports released by the World Health Organisation and documents, guides, speeches and action plans on the official UK government website. The measures adopted by the United Kingdom were analysed in four periods, which helps to explain the courses of action during the pandemic: pre-first case (January 22- January 31, 2020), developing prevention measures (February 1 -February 29, 2020), first Action Plan (March 1- March 23, 2020) and lockdown (March 24-May 6, 2020). Despite the lack of consensus in essential matters such as Brexit, the nations in the United Kingdom are working together with a high level of cooperation and coordination in decision-making during the COVID-19 pandemic.

Resumo Este artigo tem o objetivo de analisar a coordenação e cooperação nas medidas de atenção básica à saúde adotadas pelo governo britânico no combate a evolução da COVID-19. A atenção básica à saúde é parte da solução adotada pelos governos no mundo para combater o vírus. Foi utilizada da análise de dados baseada na literatura de coordenação, cooperação e atenção básica à saúde, de forma cruzada com a análise documental dos relatórios elaborados pela Organização Mundial da Saúde e documentos, guias, discursos e planos de ação nos sites oficiais do governo britânico. As medidas adotadas pelo governo britânico foram analisadas em 4 períodos, de forma a ajudar na explicação das ações durante a pandemia: pré-primeiro caso (22 a 31 de janeiro), desenvolvendo medidas de prevenção (01 a 29 de fevereiro), primeiro plano de ação (1 a 23 de março) e lockdown (24 de março a 6 de maio). Apesar da falta de consenso em temas essenciais como o Brexit, as nações no Reino Unido estão trabalhando juntas com um alto nível de cooperação e coordenação na tomada de decisão durante o surto do coronavírus.

Resumen Este artículo tiene como objetivo analizar la coordinación y cooperación en las medidas de atención primaria de salud adoptadas por el gobierno británico para combatir la evolución de la COVID-19. Una crisis sin precedentes exige soluciones de políticas públicas y una gobernanza única en el desafío más importante del siglo XXI. La atención primaria de salud es claramente parte de la solución adoptada por los gobiernos de todo el mundo para combatir el virus. Se utilizó el análisis de datos ‒basado en la literatura sobre coordinación, cooperación y atención primaria de salud‒ cruzado con el análisis documental de informes elaborados por la Organización Mundial de la Salud y documentos, guías, discursos y planes de acción de los sitios web oficiales del gobierno británico. Las medidas adoptadas por el gobierno británico se analizaron en 4 periodos con el fin de ayudar a explicar las acciones durante la pandemia: pre-primer caso (22 a 31 de enero), desarrollo de medidas preventivas (01 a 29 de febrero), primer plan de acción (01 a 23 de marzo) y confinamiento (24 de marzo a 6 de mayo). A pesar de la disparidad en el consenso sobre temas clave como el Brexit, las naciones del Reino Unido están trabajando juntas con un alto nivel de cooperación y coordinación en la toma de decisiones durante el brote de coronavirus.

Erratum to: Running away from the jab: factors associated with COVID-19 vaccine hesitancy in Brazil

ABSTRACT OBJECTIVE: To investigate how sociodemographic conditions, political factors, organizational confidence, and non-pharmaceutical interventions compliance affect the COVID-19 vaccine hesitancy in Brazil. METHODS: Data collection took place between November 25th, 2020 and January 11th, 2021 using a nationwide online survey. Subsequently, the researches performed a descriptive analysis on the main variables and used logistic regression models to investigate the factors associated with COVID-19 vaccine hesitancy. RESULTS: Less concern over vaccine side effects could improve the willingness to be vaccinated (probability changed by 7.7 pp; p < 0.10). The current vaccine distrust espoused by the Brazilian president is associated with vaccine hesitancy, among his voter base. Lower performance perception ("Very Bad" with 10.7 pp; p < 0.01) or higher political opposition (left-oriented) regarding the current presidency is associated with the willingness to be vaccinated. Higher compliance with non-pharmaceutical interventions (NPIs) is usually positively associated with the willingness to take the COVID-19 vaccine (+1 score to NPI compliance index is associated with higher willingness to be vaccinated by 1.4 pp, p < 0.05). CONCLUSION: Willingness to be vaccinated is strongly associated with political leaning, perceived federal government performance, vaccine side effects, and compliance with non-pharmaceutical interventions (NPIs). DESCRIPTORS: COVID-19 Vaccines. Vaccination Refusal. Socioeconomic Factors. Political Activism. Health Knowledge, Attitudes, Practice.

Running away from the jab: factors associated with COVID-19 vaccine hesitancy in Brazil

ABSTRACT OBJECTIVE: To investigate how sociodemographic conditions, political factors, organizational confidence, and non-pharmaceutical interventions compliance affect the COVID-19 vaccine hesitancy in Brazil. METHODS: Data collection took place between November 25th, 2020 and January 11th, 2021 using a nationwide online survey. Subsequently, the researches performed a descriptive analysis on the main variables and used logistic regression models to investigate the factors associated with COVID-19 vaccine hesitancy. RESULTS: Less concern over vaccine side effects could improve the willingness to be vaccinated (probability changed by 7.7 pp; p < 0.10). The current vaccine distrust espoused by the Brazilian president is associated with vaccine hesitancy, among his voter base. Lower performance perception ("Very Bad" with 10.7 pp; p < 0.01) or higher political opposition (left-oriented) regarding the current presidency is associated with the willingness to be vaccinated. Higher compliance with non-pharmaceutical interventions (NPIs) is usually positively associated with the willingness to take the COVID-19 vaccine (+1 score to NPI compliance index is associated with higher willingness to be vaccinated by 1.4 pp, p < 0.05). CONCLUSION: Willingness to be vaccinated is strongly associated with political leaning, perceived federal government performance, vaccine side effects, and compliance with non-pharmaceutical interventions (NPIs).

A regionalização do SUS: proposta de avaliação de desempenho dos Departamentos Regionais de Saúde do estado de São Paulo / The regionalization of the Brazilian National Health System: proposition for performance evaluation of the Regional Health Departments of São Paulo state, Brazil

Resumo Nas últimas décadas, a saúde brasileira sofreu grandes transformações, tanto em seu modelo como no desempenho do Estado. No entanto, devido a deficiências processuais e práticas, seu desempenho mostra ineficiência na prestação de serviços para a população. A regionalização, como estratégia de descentralização, surgiu como uma alternativa para resolver esses problemas interfederativos. Assim, este estudo visa analisar o desempenho da estratégia de regionalização do Sistema Único de Saúde no estado de São Paulo, pelos Departamentos Regionais de Saúde (DRS). Para atingir o objetivo, foi realizado um estudo descritivo e quantitativo, que resultou no Indicador Sintético Regional de Saúde do Estado de São Paulo (ISRS/SP). Observou-se uma concentração dos DRS com melhor desempenho no interior do estado de São Paulo, bem como uma relação não direta entre as regiões que receberam mais recursos e aqueles que obtiveram melhor desempenho, isto é, os conceitos de eficiência e eficácia estão intimamente relacionados em seu desempenho. No final do estudo, é possível compreender a regionalização da saúde no estado de São Paulo de forma abrangente, com possibilidades de adaptar o indicador sintético criado para outras regiões e realizar estudos mais aprofundados sobre o desempenho de cada nível.

Abstract In the last decades, the Brazilian public health has undergone major transformations, both in its model and in the performance of the State. However, due to procedural and practical deficiencies, their performance shows inefficiency in the provision of services for the population. The regionalization, as a strategy of decentralization, emerged as an alternative to solve these interfederative problems. Thus, this study aims to analyze the performance of the Brazilian National Health System regionalization strategy in São Paulo State, through the Regional Health Departments (RHD). To reach the objective, a descriptive and quantitative study was carried out, which resulted in the Regional Synthetic Indicator of Health of the State of São Paulo (RSIH/SP). A concentration of RHD with better performance was observed in the interior of São Paulo State, as well as a non-direct relation between the regions that received more resources and those that obtained better results, that is, the concepts of efficiency and effectiveness are closely related in their performance. At the end of the study, it is possible to comprehend the regionalization of health in São Paulo State in a comprehensive way, with possibilities to adapt the synthetic indicator created for other regions and to carry out more detailed studies on the performance of each level.

Cross-sectoral assessment of public policies in health and the environment: Scenario of the municipalities in the state of Sao Paulo.

From the identification of the current and rising demand for integrated solutions by government players, especially at the stage of evaluation of public policies, this paper carried out an cross-sectoral outcome assessment of local government cost-effectiveness in the fields of health and environment. The analysis is based on the amount of resources allocated by each of the 645 municipalities in the state of São Paulo, to each field, involving consolidated evaluation indicators (IDSUS and IAA, respectively). This study required the prior distribution of municipalities in clusters within homogeneous groups previously proposed in IDSUS calculation methodology. The results suggest that the addressed areas are intimately connected, indicating that larger (and better) environmental investments can produce promising outcomes toward health performance. Therefore, there is a demand for integrated public policies in the context of environmental health. Also, there is the indication that the resource management and the proper allocation thereof may be more relevant than the total amount spent; and that lower cost-effectiveness values do not necessarily demonstrate high scores in the assessed performance indicators.