Federal transfers to municipalities through parliamentary amendments: implications for SUS funding. / Transferências federais por emendas parlamentares aos municípios: implicações para o financiamento do SUS.

The present article analyzes the transfers from parliamentary amendments by the Ministry of Health to municipalities to finance public health actions and services from 2015 to 2021. A descriptive and exploratory study was carried out with secondary data, including all Brazilian cities. Resources from amendments showed an increase, particularly from 2018 onwards, indicating the expansion of their relevance for financing SUS. From 2016 to 2021, over 80% was allocated to municipalities, representing 9.5% of all federal transfers, with 91.2% for operational expenses. Transfers from amendments differ from regular transfers due to greater instability and per capita variation among the amounts collected by municipalities and due to the fact that they allocate most resources to the Northeast and primary care to the detriment of the Southeast and medium and high complexity care. These transfers represent a differentiated modality of resource allocation in SUS that produces new distortions and asymmetries, with implications for intergovernmental relations, as well as between the executive and legislative powers, increasing the risk of the discontinuity of actions and services and imposing challenges for the municipal management.

O artigo tem como objetivo analisar as transferências por emendas parlamentares do Ministério da Saúde aos municípios para o financiamento de ações e serviços públicos de saúde, de 2015 a 2021. Foi realizado estudo descritivo e exploratório com dados secundários, abrangendo a totalidade de municípios brasileiros. Os recursos provenientes de emendas apresentaram aumento, em especial a partir de 2018, indicando a expansão de sua relevância para o financiamento do SUS. No período de 2016 a 2021, mais de 80% foram alocados aos municípios, representando 9,5% dos repasses federais, com 91,2% de natureza de custeio. As transferências por emendas diferem dos repasses regulares por possuir maior instabilidade e variação per capita entre os montantes captados pelos municípios, e por destinar a maior parte dos recursos ao Nordeste e à atenção primária, em detrimento do Sudeste e da média e alta complexidade. Configura-se uma modalidade diferenciada de alocação de recursos no SUS que produz novas distorções e assimetrias, com implicações para as relações intergovernamentais e entre os poderes executivo e legislativo, ampliando o risco de descontinuidade de ações e serviços e impondo desafios para as gestões municipais.

Promoting Equity, Diversity, and Inclusion in Surveys: Insights from a Patient-engaged Study to Assess Long COVID Healthcare Needs in Brazil.

BACKGROUND AND OBJECTIVE: Long COVID (LC) refers to persistent symptoms after acute COVID-19 infection, which may endure for months or years. LC affects millions of people globally, with substantial impacts on quality of life, employment, and social participation. Ensuring access to effective, patient-centered care for LC demands evidence, grounded in inclusive representation of those affected by the condition. Yet survey studies frequently under-represent people with the most disabling disease presentations and racially and socio-economically marginalized groups. We aimed to describe a patient-engaged approach to developing a survey to inform public LC healthcare, and to assess its implementation in terms of enabling participation by diverse LC patients in Brazil. METHODS: Survey development was iterative, achieved through an interdisciplinary collaboration among researchers including people living with LC, and grounded in three guiding principles: (1) evidence-based; (2) inclusive, intersectional, and patient-centered understanding of chronic illness and research participation; and (3) sensitivity to the context of healthcare access. RESULTS: The product of our collaboration was a longitudinal survey using a questionnaire assessing: LC symptoms; their clinical and functional evolution; and impacts on quality of life, household income, health service access, utilization, and out-of-pocket expenses. We illustrate how we operationalized our three principles through survey content, instrument design, and administration. 651 participants with diverse LC symptoms, demography, and socio-economic status completed the survey. We successfully included participants experiencing disabling symptoms, Black and mixed race participants, and those with lower education and income. CONCLUSION: By centering patient experience, our novel, principles-based approach succeeded in promoting equity, diversity, and inclusion in LC survey research. These principles guiding patient-engaged collaboration have broad transferability. We encourage survey researchers working on chronic illness and in other contexts of marginalization and inequality to adopt them.

Cross-sectional study of psychiatric disorders in patients with chronic musculoskeletal pain and individuals without pain.

BACKGROUND: Musculoskeletal chronic pain is a leading cause of global disability and laboral incapacity. However, there is a lack of population-based studies that investigate the relationship between chronic pain and mental disorders with a control group, particularly among low- and middle-income countries. Chronic pain is a serious public health problem in terms of human suffering, and in terms of socioeconomic implications. Frequent association with different mental disorders increases disability, decreases quality of life, and makes diagnosis and treatment challenging. The present study aimed to evaluate the presence of mental disorders in patients with chronic musculoskeletal pain and compare with a control group without pain. METHODS: We selected 100 patients in a regular follow-up at the Musculoskeletal Pain Outpatient Clinic of the University Hospital and compared them with 100 painless individuals from the control group from June 2016 to June 2018. The instruments used were the Mini International Neuropsychiatric Interview (MINI-PLUS) and a structured questionnaire to collect sociodemographic data. Statistical analysis used t-test, chi-square, Fisher's exact test, Mann-Whitney, Kolmogorov-Smirnov tests, and multiple logistic regression. RESULTS: In the sample evaluated, the majority of patients were women (83%), of brown color (54%), with lower-level education (51%), lower salary range (73%) and high absenteeism rate at work (60,7%). Patients with chronic pain had more psychiatric disorders (88% vs. 48% in the control group; p < 0.001). The most frequent diagnoses were anxiety disorders with panic attacks (44%), generalized anxiety (36%), mixed anxiety and depression disorder (33%), social phobia (30%), agoraphobia (29%), suicide risk (28%), and major depression (27%). CONCLUSION: Positive correlations of mental disorders and chronic musculoskeletal pain have been documented. This suggests that psychiatric components must be taken into account in the management of chronic pain syndromes. The use of Mini Plus as a diagnostic tool for psychiatric disorders can contribute to optimizing the diagnosis and treatment of patients with chronic pain and encourage the creation of policies with strategies and criteria for quick access to Multi-professional Services.

Psychoactive substance consumption after the Fundão dam mine tailing disaster in Minas Gerais State, Brazil.

Disasters cause changes in morbidity, mortality, and medicine use. Brazil is one of the main producers of mineral ores at great environmental cost. Mine tailings are stored in dams and ruptures have led to major disasters. We investigated the consumption of psychoactive medicines in the municipalities affected by the Fundão dam disaster in Minas Gerais State. An ecological study was carried out on drug consumption, estimated using public purchases in Minas Gerais and dispensing data from private retail pharmacies. Consumption (in number of defined daily doses/100,000 inhabitants per day) was analyzed descriptively in eight municipalities, stratified according to consumption level during a 25-month period. Six comparisons of mean consumption values for both data sets were done for pre- and post-disaster periods. The means of medicine consumption before and after the event were plotted and linear trends were added. Public purchase data evinced high consumption levels. Only pharmaceutical retail showed significant differences between the strata in the pre-disaster versus two post-disaster periods. Smaller municipalities showed an increase in consumption 15 months after the disaster. Clonazepam led the way in pharmaceutical retail consumption, followed by fluoxetine. Medicines showed an upward trend after the disaster. The high public provision may have stifled significant consumption patterns of psychoactive drugs; however, peak consumption were observed in private retail, suggesting a modification in use patterns after the disaster. The decrease in consumption immediately after the event was probably related to lower care-seeking behavior on the part of the population, and significant peaks after the disaster may reflect economic consequences of it.

Psychoactive substance consumption after the Fundão dam mine tailing disaster in Minas Gerais State, Brazil / Consumo de psicoativos após o desastre da Barragem de Fundão, em Minas Gerais, Brasil / Consumo de psicoactivos tras el desastre de la presa Fundão, en Minas Gerais, Brasil

Abstract: Disasters cause changes in morbidity, mortality, and medicine use. Brazil is one of the main producers of mineral ores at great environmental cost. Mine tailings are stored in dams and ruptures have led to major disasters. We investigated the consumption of psychoactive medicines in the municipalities affected by the Fundão dam disaster in Minas Gerais State. An ecological study was carried out on drug consumption, estimated using public purchases in Minas Gerais and dispensing data from private retail pharmacies. Consumption (in number of defined daily doses/100,000 inhabitants per day) was analyzed descriptively in eight municipalities, stratified according to consumption level during a 25-month period. Six comparisons of mean consumption values for both data sets were done for pre- and post-disaster periods. The means of medicine consumption before and after the event were plotted and linear trends were added. Public purchase data evinced high consumption levels. Only pharmaceutical retail showed significant differences between the strata in the pre-disaster versus two post-disaster periods. Smaller municipalities showed an increase in consumption 15 months after the disaster. Clonazepam led the way in pharmaceutical retail consumption, followed by fluoxetine. Medicines showed an upward trend after the disaster. The high public provision may have stifled significant consumption patterns of psychoactive drugs; however, peak consumption were observed in private retail, suggesting a modification in use patterns after the disaster. The decrease in consumption immediately after the event was probably related to lower care-seeking behavior on the part of the population, and significant peaks after the disaster may reflect economic consequences of it.

Resumo: Os desastres provocam alterações na morbidade, mortalidade e no uso de medicamentos. O Brasil é líder na produção de minérios com grande custo ambiental. Os rejeitos de mineração são armazenados em barragens e as rupturas dessas barragens têm causados grandes desastres. Investigamos o consumo de medicamentos psicoativos em municípios atingidos pelo desastre da Barragem de Fundão, em Minas Gerais. Foi realizado um estudo ecológico sobre o consumo de medicamentos, com base em dados de compras públicas e distribuição de farmácias privadas do varejo de Minas Gerais. O consumo (em número de doses diárias definidas/100 mil habitantes por dia) foi analisado descritivamente em oito municípios, estratificados segundo o nível de consumo durante um período de 25 meses. Foram feitas seis comparações de valores médios de consumo para os dois conjuntos de dados dos períodos pré- e pós-desastre. Foram calculadas as médias de consumo de medicamentos antes e depois do evento e adicionadas tendências lineares. Os dados de compras públicas mostraram elevados níveis de consumo. Apenas o varejo farmacêutico apresentou diferenças significativas entre os estratos no período pré-desastre versus dois períodos pós-desastre. Municípios menores apresentaram aumento no consumo a partir do 15º mês após o desastre. Clonazepam liderou o consumo no varejo farmacêutico, seguido pela fluoxetina. Os medicamentos apresentaram tendência de alta após o desastre. A elevada oferta pública pode ter afetado os padrões de consumo significativo de medicamentos psicoativos; no entanto, foram observados aumentos no comércio privado, sugerindo alterações nos padrões de uso após o desastre. A diminuição do consumo imediatamente após o evento estava provavelmente relacionada a um menor comportamento de procura de cuidados por parte da população e os aumentos significativos posteriores podem refletir as consequências econômicas do desastre.

Resumen: Los desastres provocan cambios en la morbilidad, mortalidad y en el uso de medicamentos. Brasil es líder en la producción de minerales con grandes costos ambientales. Los desechos mineros se almacenan en represas y las roturas de dichas represas han causado grandes desastres. Investigamos el consumo de medicamentos psicoactivos en municipios afectados por el desastre de la presa de Fundão, en Minas Gerais. Se realizó un estudio ecológico sobre el consumo de medicamentos, con base en datos de compras públicas y distribución en farmacias privadas minoristas de Minas Gerais. El consumo (en número de dosis diarias definidas/100.000 habitantes por día) se analizó descriptivamente en ocho municipios, estratificados según el nivel de consumo durante un período de 25 meses. Se realizaron seis comparaciones de los valores medios de consumo para los dos conjuntos de datos de los períodos anterior y posterior al desastre. Se calculó el consumo medio de medicamentos antes y después del evento y se añadieron las tendencias lineales. Los datos de compras públicas mostraron altos niveles de consumo. Solo el comercio minorista farmacéutico presentó diferencias significativas entre los estratos en el período anterior al desastre frente a dos períodos posteriores al desastre. Los municipios más pequeños presentaron un aumento en el consumo a partir del 15º mes después del desastre. El clonazepam lideró el consumo en el comercio minorista farmacéutico, seguido de la fluoxetina. Los medicamentos presentaron una tendencia al alza después del desastre. La elevada oferta pública puede haber afectado los patrones de consumo significativo de medicamentos psicoactivos; sin embargo, se observaron aumentos en el comercio privado, lo que sugiere cambios en los patrones de uso después del desastre. La disminución del consumo inmediatamente después del evento probablemente relacionada con un menor comportamiento de búsqueda de cuidados por parte de la población, y los aumentos significativos posteriores pueden reflejar las consecuencias económicas del desastre.

COVID-19 inpatient mortality in Brazil from 2020 to 2022: a cross-sectional overview study based on secondary data.

BACKGROUND: In Brazil, the COVID-19 pandemic found the universal and public Unified Health System (SUS) with problems accumulated over time, due, among other reasons, to low investments, and disparities in resource distribution. The preparedness and response of the healthcare system, involving the SUS and a private sector, was affected by large socioeconomic and healthcare access inequities. This work was aimed at offering an overview of COVID-19 inpatient mortality during the pandemic in Brazil, exploring factors associated with its variations and, specifically, differences across public, private (for-profit) and philanthropic (private non-profit) inpatient healthcare units, providers, and non-providers of services to the SUS. METHODS: This cross-sectional study used public secondary data. The main data source was the SIVEP-Gripe, which comprises data on severe acute respiratory illness records prospectively collected. We also employed the National Record of Health Establishments, the SUS' Hospitalization Information System and municipalities' data from IBGE. We considered adult COVID-19 hospitalizations registered in SIVEP-Gripe from February 2020 to December 2022 in inpatient healthcare units with a minimum of 100 cases in the period. Data analyses explored the occurrence of inpatient mortality, employing general linear mixed models to identify the effects of patients', health care processes', healthcare units' and municipalities' characteristics on it. RESULTS: About 70% of the COVID-19 hospitalizations in Brazil were covered by the SUS, which attended the more vulnerable population groups and had worse inpatient mortality. In general, non-SUS private and philanthropic hospitals, mostly reimbursed by healthcare insurance plans accessible for more privileged socioeconomic classes, presented the best outcomes. Southern Brazil had the best performance among the macro-regions. Black and indigenous individuals, residents of lower HDI municipalities, and those hospitalized out of their residence city presented higher odds of inpatient mortality. Moreover, adjusted inpatient mortality rates were higher in the pandemic peak moments and were significantly reduced after COVID-19 vaccination reaching a reasonable coverage, from July 2021. CONCLUSIONS: COVID-19 exposed socioeconomic and healthcare inequalities and the importance and weaknesses of SUS in Brazil. This work indicates the need to revert the disinvestment in the universal public system, a fundamental policy for reduction of inequities in the country.

Biomechanical effects of different materials for an occlusal device on implant-supported rehabilitation in a tooth clenching situation. A 3D finite element analysis.

PURPOSE: The purpose of this 3D finite element analysis was to evaluate the biomechanical effects of different materials used to fabricate occlusal devices to achieve stress distribution in simulated abutment screws, dental implants, and peri-implant bone tissue in individuals who clench their teeth. MATERIALS AND METHODS: Eight 3D models simulated a posterior maxillary bone block with three external hexagon implants (Ø4.0 × 7.0 mm) supporting a 3-unit screw-retained metal-ceramic prosthesis with different crown connection (splinting), and the use of an occlusal device (OD). The OD was modeled to be 2-mm thick. ANSYS 19.2 software was used to generate the finite-element models in the pre-and post-processing phases. Simulated abutment screws and dental implants were evaluated by von Mises stress maps, and simulated bone was evaluated by maximum principal stress and microstrain maps by using a finite element software program. RESULTS: The highest stress values in the dental implants and screws were observed in single crowns without OD (M1). Furthermore, the highest stress values and bone tissue strain were found in single crowns without OD (M1). The simulated material for the OD did not cause many discrepancies in terms of the stress magnitude in the simulated dental implant and abutment screw for both single and splinted crowns; however, more rigid materials exhibited lower stress values. CONCLUSION: The use of OD was effective in reducing stress in the simulated implants and abutment screws and stress and strain in the simulated bone tissue. The material used to simulate the OD influenced the biomechanical behavior of implant-supported fixed prostheses, whereas splints with rigid materials such as PEEK and PMMA exhibited better biomechanical behavior.

[COVID-19 in Latin America: inequalities and response capacity of health systems to health emergenciesCOVID-19 en América Latina: desigualdades y capacidad de respuesta de los sistemas de salud ante emergencias de salud]. / Covid-19 na América Latina: desigualdades e capacidades de resposta dos sistemas de saúde a emergências sanitárias.

Objective: To identify correlations between COVID-19, demographic and socioeconomic characteristics, and the capacity of Latin American health systems to respond to health emergencies. Method: An ecological study was performed using secondary data from 20 Latin American countries regarding incidence, mortality, testing and vaccination coverage for covid-19 from 2020 to 2021 as well as demographic and socioeconomic indicators. The preparedness of countries to respond to health emergencies was explored based on the 2019 State Party Self-Assessment Annual Report on the implementation of the International Health Regulations (IHR). Statistical analyses were performed using the Spearman correlation test (rho). Results: A high positive correlation was noted between gross domestic product per capita and the human development index with the incidence of COVID-19, testing, and vaccination coverage; and between the proportion of elderly population and vaccination coverage. No correlations were identified between the covid-19 indicators and previous IHR implementation capacities. Conclusions: The lack of correlation between indicators related to COVID-19 and the ability to implement the IHR may reflect limitations of the indicators used or of the IHR monitoring tool as an instrument that induces the preparedness of countries to face health emergencies. The results suggest the importance of structural conditioning factors and the need for longitudinal, comparative, and qualitative studies to understand the factors that influenced the response of countries to COVID-19.

Objetivo: Determinar las posibles correlaciones entre la COVID-19, las características demográficas y socioeconómicas, y la capacidad de los sistemas de salud latinoamericanos para responder a emergencias de salud. Método: Se realizó un estudio ecológico con datos secundarios de 20 países latinoamericanos sobre la incidencia, la mortalidad, las pruebas y la cobertura de vacunación relativas a la COVID-19 en el período 2020-2021, y con información demográfica y socioeconómica. Se exploró la preparación de los países para responder a emergencias de salud a partir del Informe Anual de Autoevaluación de los Estados Miembros de la Organización Mundial de la Salud del 2019 sobre la implementación del Reglamento Sanitario Internacional (RSI). Los análisis estadísticos se realizaron con la prueba de correlación (ro) de Spearman. Resultados: Se observó una alta correlación positiva del producto interno bruto per cápita y del índice de desarrollo humano con la incidencia, las pruebas y la cobertura de vacunación respecto a la COVID-19, así como de la proporción de personas mayores en la población con la cobertura de vacunación. No se observó ninguna correlación entre los indicadores de COVID-19 y la capacidad previa de implementación del RSI. Conclusiones: La falta de correlación entre los indicadores relativos a la COVID-19 y la capacidad de implementación del RSI puede deberse a limitaciones de los indicadores utilizados o del mecanismo de seguimiento del RSI como instrumento inductor de la preparación de los países para enfrentar emergencias de salud. Los resultados sugieren la importancia de los factores condicionantes estructurales y la necesidad de realizar estudios longitudinales, comparativos y cualitativos para determinar los factores que influyeron en la respuesta de los países a la COVID-19.

Marketing authorisation and pricing of FDA-approved cancer drugs in Brazil: a retrospective analysis.

Background: Most cancer drugs enter the US market first. US Food and Drug Administration (FDA) approvals of new cancer drugs may influence regulatory decisions in other settings. The study examined whether characteristics of available evidence at FDA approval influenced time-to-marketing authorisation (MA) in Brazil, and price differences between the two countries. Methods: All new FDA-approved cancer drugs from 2010 to 2019 were matched to drugs with MA and prices approved in Brazil by December 2020. Characteristics of main studies, availability of randomised controlled trials (RCTs), overall survival (OS) benefit, added therapeutic benefit, and prices were compared. Findings: Fifty-six FDA-approved cancer drugs with matching indications received a MA at the Brazilian Health Regulatory Agency (Anvisa) after a median of 522 days following US approval (IQR: 351-932). Earlier authorisation in Brazil was associated with availability of RCT (median: 506 vs 760 days, p = 0.031) and evidence of OS benefit (390 vs 543 days, p = 0.019) at FDA approval. At Brazilian marketing authorisation, a greater proportion of cancer drugs had main RCTs (75% vs 60.7%) and OS benefit (42.9% vs 21.4%) than that in the US. Twenty-eight (50%) drugs did not demonstrate added therapeutic benefit over drugs for the same indication in Brazil. Median approved prices of new cancer drugs were 12.9% lower in Brazil compared to the US (adjusted by Purchasing Power Parity). However, for drugs with added therapeutic benefit median prices were 5.9% higher in Brazil compared to the US, while 17.9% lower for those without added benefit. Interpretation: High-quality clinical evidence accelerated the availability of cancer medicines in Brazil. The combination of marketing and pricing authorisation in Brazil may favour the approval of cancer drugs with better supporting evidence, and more meaningful clinical benefit albeit with variable degree of success in achieving lower prices compared to the US. Funding: None.

Professional trajectory and the impact of education on Fiocruz specialization graduates. / Trajetória profissional e impacto da formação em egressos da Especialização da Fiocruz.

This work aimed to analyze graduates' profiles, education's effects, and the professional trajectory of those who completed lato sensu courses at Fiocruz. A total of 1,620 graduates participated in 79 courses completed in the 2013-2020 period. A questionnaire was applied before the course and after its completion. A description of the absolute and relative frequency of the variables was realized. A binary logistic regression model was developed to identify variables associated with the positive impact of the course. The odds ratio and its 95% confidence interval were the measures used. Among graduates with a positive impact from the course, those with black/brown skin color are 40% more likely to have a positive impact from the course than those with white skin color; those who have other academic education before the course are 1.5 times more likely than those who have no previous education; those who changed their professional activity as a result of the course are 3.3 more likely than those who were not working; those who reported that the course was closely related to their professional activity were 5.7 more likely than those who reported that the course had poor or no relationship. Every one-year increase since graduation increased the likelihood of the course's positive impact by 14%.

O objetivo da pesquisa foi analisar o perfil dos egressos, os efeitos da formação e a trajetória profissional dos que concluíram cursos presenciais de Especialização da Fiocruz. Participaram 1.620 egressos de 79 cursos concluídos entre 2013 e 2020. Foi aplicado questionário antes do ingresso e após o término do curso. Foi realizada descrição da frequência absoluta e relativa das variáveis e desenvolvido modelo de regressão logística binária para identificar variáveis associadas ao impacto positivo do curso. A razão de chance e seu intervalo de confiança de 95% foram as medidas utilizadas. Entre os egressos com impacto positivo do curso concluído: aqueles com cor de pele preta ou parda têm cerca de 40% mais chance de ter impacto positivo do curso do que os de cor de pele branca; os que têm outra formação acadêmica antes do curso têm 1,5 vez mais chance do que os que não têm outra formação anterior, aqueles que mudaram a atividade profissional em função do curso têm 3,3 mais chance do que os que não estavam trabalhando, os que informaram que o curso estava muito relacionado à atividade profissional têm 5,7 mais chance do que os que relataram que o curso teve pouca ou nenhuma relação; e cada acréscimo de 1 ano no tempo de formado aumenta em 14% a chance do impacto positivo do curso.

Standardized extract of Ginkgo biloba treatment and novelty on the weak encoding of spatial recognition memory in rats.

Long-term memory (LTM) formation is dependent on neurochemical changes that guarantee that a recently formed memory (short-term memory [STM]) remains in the specific neural circuitry via the consolidation process. The persistence of recognition memory has been evidenced by using behavioral tagging in young adult rats, but it has not been effective on aging. Here, we investigated the effects of treatment with a standardized extract of Ginkgo biloba (EGb) associated with novelty on the consolidation of object location memory (OLM) and its persistence after weak training of spatial object preference in young adult and aged rats. The object location task used in this study included two habituation sessions, training sessions associated or not associated with EGb treatment and contextual novelty, and short-term or long-term retention testing sessions. Altogether, our data showed that treatment with EGb associated with novelty close to the time of encoding resulted in STM that lasted for 1 h and persisted for 24 h for both young adult and aged rats. In aged rats, the cooperative mechanisms induced robust long-term OLM. Our findings support and extend our knowledge about recognition memory in aged rats and the modulating effects of EGb treatment and contextual novelty on the persistence of memory.

Trajetória profissional e impacto da formação em egressos da Especialização da Fiocruz / Professional trajectory and the impact of education on Fiocruz specialization graduates

Resumo O objetivo da pesquisa foi analisar o perfil dos egressos, os efeitos da formação e a trajetória profissional dos que concluíram cursos presenciais de Especialização da Fiocruz. Participaram 1.620 egressos de 79 cursos concluídos entre 2013 e 2020. Foi aplicado questionário antes do ingresso e após o término do curso. Foi realizada descrição da frequência absoluta e relativa das variáveis e desenvolvido modelo de regressão logística binária para identificar variáveis associadas ao impacto positivo do curso. A razão de chance e seu intervalo de confiança de 95% foram as medidas utilizadas. Entre os egressos com impacto positivo do curso concluído: aqueles com cor de pele preta ou parda têm cerca de 40% mais chance de ter impacto positivo do curso do que os de cor de pele branca; os que têm outra formação acadêmica antes do curso têm 1,5 vez mais chance do que os que não têm outra formação anterior, aqueles que mudaram a atividade profissional em função do curso têm 3,3 mais chance do que os que não estavam trabalhando, os que informaram que o curso estava muito relacionado à atividade profissional têm 5,7 mais chance do que os que relataram que o curso teve pouca ou nenhuma relação; e cada acréscimo de 1 ano no tempo de formado aumenta em 14% a chance do impacto positivo do curso.

Abstract This work aimed to analyze graduates' profiles, education's effects, and the professional trajectory of those who completed lato sensu courses at Fiocruz. A total of 1,620 graduates participated in 79 courses completed in the 2013-2020 period. A questionnaire was applied before the course and after its completion. A description of the absolute and relative frequency of the variables was realized. A binary logistic regression model was developed to identify variables associated with the positive impact of the course. The odds ratio and its 95% confidence interval were the measures used. Among graduates with a positive impact from the course, those with black/brown skin color are 40% more likely to have a positive impact from the course than those with white skin color; those who have other academic education before the course are 1.5 times more likely than those who have no previous education; those who changed their professional activity as a result of the course are 3.3 more likely than those who were not working; those who reported that the course was closely related to their professional activity were 5.7 more likely than those who reported that the course had poor or no relationship. Every one-year increase since graduation increased the likelihood of the course's positive impact by 14%.

Inclusion of Soybean Hulls (Glycine max) and Pupunha Peach Palm (Bactris gasipaes) Nanofibers in the Diet of Growing Rabbits: Effects on Zootechnical Performance and Intestinal Health.

This study evaluated the inclusion of nanofibers from soybean hulls and pupunha peach palm heart sheaths in the diet of growing rabbits. Twenty-four New Zealand White rabbits (male and female) were allocated in three experimental groups: control, fed a basal diet; Nanosoy, fed a diet containing 7% soybean-hull nanofibers; and Nanopupunha, fed a diet containing 7% pupunha palm heart-sheath nanofibers. The Nanosoy-group rabbits showed poorer final weight, daily feed intake, and daily weight gain than those in other groups. In the duodenum, villus height, total mucosal thickness, and villus width were higher in rabbits that received nanofiber-supplemented diets than in the controls. Higher villus density and wall thickness were observed in Nanopupunha-fed rabbits than in the controls. In the jejunum, although the crypt depth was higher in Nanosoy-fed rabbits, the villus height:crypt depth ratio was higher in the Nanopupunha-fed group. Nanosoy-fed animals exhibited increased count Enterobacteriaceae populations. Rabbits in both nanofiber-fed groups exhibited higher lactic-acid bacterial counts than those in the control-diet group. Therefore, although the inclusion of 7% Nanopupunha in the diet of rabbits did not alter the performance, it improved intestinal health and increased the lactic-acid bacterial count in the cecum of growing rabbits.

Covid-19 na América Latina: desigualdades e capacidades de resposta dos sistemas de saúde a emergências sanitárias / COVID-19 in Latin America: inequalities and response capacity of health systems to health emergencies / COVID-19 en América Latina: desigualdades y capacidad de respuesta de los sistemas de salud ante emergencias de salud

RESUMO Objetivo. Identificar correlações entre a covid-19, características demográficas e socioeconômicas e capacidade dos sistemas de saúde latino-americanos para resposta a emergências sanitárias. Método. Realizou-se um estudo ecológico, utilizando dados secundários de 20 países latino-americanos relativos a incidência, mortalidade, testagem e cobertura vacinal para covid-19 no período de 2020 a 2021, assim como informações demográficas e socioeconômicas. A preparação dos países para responder a emergências sanitárias foi explorada a partir do Relatório Anual de Autoavaliação dos Estados Partes da Organização Mundial da Saúde de 2019 sobre a implementação do Regulamento Sanitário Internacional (RSI). Realizaramse análises estatísticas por meio do teste de correlação de Spearman (rho). Resultados. Observou-se correlação positiva alta do produto interno bruto per capita e do índice de desenvolvimento humano com incidência de covid-19, testagem e cobertura vacinal; e entre proporção da população idosa e cobertura vacinal. Não foram identificadas correlações entre os indicadores da covid-19 e as capacidades prévias de implementação do RSI. Conclusões. A ausência de correlação entre indicadores relativos à covid-19 e a capacidade de implementação do RSI pode estar relacionada a limites dos indicadores utilizados ou da ferramenta de acompanhamento do RSI como instrumento indutor da preparação dos países para enfrentamento de emergências sanitárias. Os resultados sugerem a importância de condicionantes estruturais e a necessidade de estudos longitudinais, comparativos e qualitativos para compreender os fatores que influenciaram a resposta dos países à covid-19.

ABSTRACT Objective. To identify correlations between COVID-19, demographic and socioeconomic characteristics, and the capacity of Latin American health systems to respond to health emergencies. Method. An ecological study was performed using secondary data from 20 Latin American countries regarding incidence, mortality, testing and vaccination coverage for covid-19 from 2020 to 2021 as well as demographic and socioeconomic indicators. The preparedness of countries to respond to health emergencies was explored based on the 2019 State Party Self-Assessment Annual Report on the implementation of the International Health Regulations (IHR). Statistical analyses were performed using the Spearman correlation test (rho). Results. A high positive correlation was noted between gross domestic product per capita and the human development index with the incidence of COVID-19, testing, and vaccination coverage; and between the proportion of elderly population and vaccination coverage. No correlations were identified between the covid-19 indicators and previous IHR implementation capacities. Conclusions. The lack of correlation between indicators related to COVID-19 and the ability to implement the IHR may reflect limitations of the indicators used or of the IHR monitoring tool as an instrument that induces the preparedness of countries to face health emergencies. The results suggest the importance of structural conditioning factors and the need for longitudinal, comparative, and qualitative studies to understand the factors that influenced the response of countries to COVID-19.

RESUMEN Objetivo. Determinar las posibles correlaciones entre la COVID-19, las características demográficas y socioeconómicas, y la capacidad de los sistemas de salud latinoamericanos para responder a emergencias de salud. Método. Se realizó un estudio ecológico con datos secundarios de 20 países latinoamericanos sobre la incidencia, la mortalidad, las pruebas y la cobertura de vacunación relativas a la COVID-19 en el período 2020-2021, y con información demográfica y socioeconómica. Se exploró la preparación de los países para responder a emergencias de salud a partir del Informe Anual de Autoevaluación de los Estados Miembros de la Organización Mundial de la Salud del 2019 sobre la implementación del Reglamento Sanitario Internacional (RSI). Los análisis estadísticos se realizaron con la prueba de correlación (ro) de Spearman. Resultados. Se observó una alta correlación positiva del producto interno bruto per cápita y del índice de desarrollo humano con la incidencia, las pruebas y la cobertura de vacunación respecto a la COVID-19, así como de la proporción de personas mayores en la población con la cobertura de vacunación. No se observó ninguna correlación entre los indicadores de COVID-19 y la capacidad previa de implementación del RSI. Conclusiones. La falta de correlación entre los indicadores relativos a la COVID-19 y la capacidad de implementación del RSI puede deberse a limitaciones de los indicadores utilizados o del mecanismo de seguimiento del RSI como instrumento inductor de la preparación de los países para enfrentar emergencias de salud. Los resultados sugieren la importancia de los factores condicionantes estructurales y la necesidad de realizar estudios longitudinales, comparativos y cualitativos para determinar los factores que influyeron en la respuesta de los países a la COVID-19.

[Hip arthroplasty in the Brazilian Unified National Health System: analysis of hospital deaths in the State of Rio de Janeiro, Brazil]. / Artroplastia de quadril no Sistema Único de Saúde: análise dos óbitos hospitalares no Estado do Rio de Janeiro, Brasil.

Population aging brings challenges to the health system. Increased degenerative joint diseases and occurrence of falls may require hip arthroplasties. The objective of this study was to evaluate factors associated with hospital deaths due to hip arthroplasties in the Brazilian Unified National Health System (SUS), in the State of Rio de Janeiro, Brazil. A cross-sectional study was carried out using the Brazilian Hospital Information System of the SUS, considering hospitalizations and deaths from hip arthroplasties that occurred between 2016 to 2018. The analyses considered hospitalizations by type of care (elective, urgency and accidents or injury and poisoning). Binary logistic regression was performed to obtain a ratio for the chance of death. Mortality increased according to the severity of hospitalization. Most of the hospitalizations with death were due to femoral fracture, demanded intensive care, had mean length of stay of 21.5 days, and involved women aged 80 years and over, of the white race/color, who had their procedure performed in municipal units qualified in orthopedics and traumatology of high complexity and classified as general II, located in the patients' region of residence. The chance of death was significant for the age of the patient, use of intensive care unit (ICU), and length of hospital stay. We expect an increase in the demand for hip arthroplasties and physical rehabilitation due to population aging. Health teams must be prepared to deal with an ageing population. Knowing the factors that increase the risk of death favors care planning and management by hospital staff, including in the reduction of hospital stay, which is so impactful on the functional condition of the elderly.

O envelhecimento populacional traz desafios ao sistema de saúde. O aumento das doenças degenerativas articulares e a ocorrência de quedas podem demandar a realização de artroplastia de quadril. Objetivou-se avaliar os fatores associados a óbitos hospitalares por artroplastia de quadril no Sistema Único de Saúde (SUS), no Estado do Rio de Janeiro, Brasil. Realizou-se um estudo transversal utilizando o Sistema de Informações Hospitalares do SUS, considerando internações e óbitos por artroplastias de quadril ocorridos entre 2016-2018. As análises consideraram as internações por caráter de atendimento (eletivo, urgência e acidentes ou lesão e envenenamento). Realizou-se regressão logística binária para obter a razão de chance de óbito. A mortalidade aumentou conforme a gravidade da internação. A maioria das internações com óbito foi por fratura de fêmur, demandando cuidados intensivos, tempo médio de permanência de 21,5 dias, envolveu mulheres com 80 anos e mais, da raça/cor branca, que realizaram procedimento em unidades habilitadas em alta complexidade em ortopedia e traumatologia, municipais e classificadas como geral II, localizadas na região de moradia do usuário. A chance de óbito se mostrou significativa para a idade do usuário, uso de unidade de terapia intensiva (UTI) e permanência hospitalar. Espera-se aumento da demanda por artroplastias de quadril e reabilitação física com o envelhecimento populacional. As equipes de saúde devem estar preparadas para lidar com uma população envelhecida. Conhecer os fatores que incrementem o risco de óbito favorece o planejamento e o manejo do cuidado pela equipe hospitalar, inclusive no sentido de diminuir a permanência hospitalar, tão impactante na condição funcional de pessoas idosas.

El envejecimiento poblacional trae desafíos al sistema de salud. El aumento de las enfermedades degenerativas articulares y la incidencia de caídas pueden demandar la realización de artroplastias de cadera. Tuvo como objetivo evaluar los factores asociados a las muertes hospitalarias por artroplastias de cadera en el Sistema Único de Salud (SUS), en el Estado de Rio de Janeiro, Brasil. Se realizó un estudio transversal utilizando el Sistema de Información Hospitalaria del SUS, considerando hospitalizaciones y muertes por artroplastias de cadera ocurridas entre 2016-2018. Los análisis consideraron las hospitalizaciones según la naturaleza de la atención (electiva, urgencia y accidentes o lesiones e intoxicaciones). Se realizó una regresión logística binaria para obtener la razón de probabilidad de muerte. La mortalidad aumentó según la gravedad de la hospitalización. La mayoría de las hospitalizaciones con muerte se debió a la fractura de fémur, y requirió cuidados intensivos, tiempo promedio de estancia de 21,5 días, correspondió a mujeres de 80 años o más, de raza/color blanca, a quienes se sometió al procedimiento en unidades habilitadas de alta complejidad en ortopedia y traumatología, municipal y clasificadas como general II, ubicadas en la región de residencia del usuario. La probabilidad de muerte se mostró significativa para la edad del usuario, el uso de la unidad de cuidados intensivos (UCI) y la estancia hospitalaria. Se espera que la demanda de artroplastias de cadera y rehabilitación física aumente a medida que la población envejece. Los equipos de salud deben estar preparados para atender a una población que envejece. El conocimiento de los factores que incrementan el riesgo de muerte favorece la planificación y el manejo del cuidado por parte del equipo hospitalario, incluso en el sentido de reducir la estancia hospitalaria, que tanto afecta la condición funcional de la persona mayor.

Consumption of antidepressants and economic austerity in Brazil.

OBJECTIVE: To describe consumption of antidepressants in Brazil through dispensing data from pharmacy retail outlets, in between 2011 and 2017, and explore the relationship between consumption patterns and changing economic context during this period. METHODS: A time-series analysis of dispensing data from pharmacy retail outlets was carried out considering 10 commonly used antidepressants. DDDs/1000 inhabitants/year for each drug were calculated for each quarter. Ttime-series graphs were constructed to analyze the volumes of drugs purchasedRelationship between economic context and consumption was assessed using the following indicators: annual percent change in Gross Domestic Product (GDP), public debt (% of GDP), and annual net savings (in billions of Brazilian reais - BRL). RESULTS: Overall consumption of antidepressants increased over the study period despite a sharp fall of -3.55% in annual percent change in GDP, negative net annual savings of -53.568 BRL, and an increase in public debt exceeding 32% of the GDP during the economic crisis of 2015. CONCLUSION: Consumption of antidepressants from pharmacy retail outlets increased even within a context of economic crisis, which may be a reflection of the disease burden in Brazil. Health budget cuts due to the economic crisis may be directing users to out-of-pocket expenses, deepening social inequalities.

Effects of Inspiratory Muscle Training in Patients With Class III and IV Heart Failure.

The effects of inspiratory muscle training on functional capacity and quality of life in functional class III and IV heart failure patients were evaluated. The inspiratory muscle training protocol was applied to 20 patients with heart disease, over a period of 6 weeks, 3 times a week, for 30 minutes, with a load of 40% of the maximum inspiratory pressure and 5 sets of 10 repetitions, with an interval of 1-2 minutes. The Minnesota Quality of Life Questionnaire, the 6-minute walk test, vital data and manovacuometry (pre- and post-intervention) were used. Pre- and post-test comparisons revealed significant differences in the 6-minute walk test, heart rate, respiratory rate, Borg scale, respiratory muscle strength, and systolic and diastolic blood pressure, and an increase in quality of life was also observed (P < 0.01). Inspiratory muscle training improved functional capacity and quality of life, suggesting that inspiratory muscle training should be included in Class III and IV cardiac rehabilitation.

Outpatient regulation in Primary Care in the municipality of Rio de Janeiro, Brazil, based on the local regulatory doctors. / A regulação ambulatorial na Atenção Primária do Município do Rio de Janeiro, Brasil, a partir dos médicos reguladores locais.

The scope of the article was to characterize the process of regulation of care in Primary Health Care units in the city of Rio de Janeiro, with an emphasis on the outpatient dimension. A cross-sectional study was carried out in 2019, by means of a survey, with the participation of 114 local regulatory physicians. With respect to the profile of local regulators, there is a high percentage with training in Family and Community Medicine and the length of service of these professionals in the units is relatively satisfactory. For 52.6%, the infrastructure for regulation is adequate, but connectivity frequently presents problems. In the regulation system, the mechanisms and schedules for making vacancies available and accessing them elicit competition between the regulators of the units, with work overload and associated access inequities. There was major involvement of local regulators in activities of evaluation and management of waiting times. The majority reported that there was little or no interaction with specialized care. Although the decentralized regulation process still has some shortcomings, the study points to the feasibility and contribution of more intense participation of Primary Care in the regulation of access.

O artigo teve por objetivo caracterizar o processo de regulação assistencial realizado nas unidades de Atenção Primária à Saúde do município do Rio de Janeiro, com ênfase na dimensão ambulatorial. Foi realizado estudo transversal, por meio de um survey, com participação de 114 médicos reguladores locais, no ano de 2019. Quanto ao perfil dos reguladores locais, destacou-se o alto percentual com formação em Medicina de Família e Comunidade e o tempo de atuação relativamente adequado destes profissionais nas unidades. Para 52,6%, a infraestrutura para regulação é adequada, mas a conectividade apresenta problemas com frequência. No sistema de regulação, os mecanismos e horários de disponibilização de vagas produzem competição entre os reguladores das unidades, com sobrecarga de trabalho e iniquidades de acesso associadas. Observou-se importante envolvimento dos reguladores locais em atividades de avaliação e gestão de filas de espera. A maioria informou haver pouca ou nenhuma interação com a atenção especializada. Apesar do processo de regulação descentralizada ainda apresentar importantes limites, o estudo aponta a factibilidade e contribuição da entrada mais intensa da Atenção Primária na regulação do acesso.