Impacts of mining disasters on the ambulatory care of the Brazilian national health system: the cases of Mariana and Brumadinho/Brazil.

BACKGROUND: Disasters are events that bring with them effects that contribute to the disruption of the normality of a population and thus highlight the vulnerabilities of the health system. In Mariana and Brumadinho, the collapse of the dam of ore tailings brought with it several impacts that were felt in the short term and will be felt in the medium and long term. And that by being intensely intertwined with issues of economic and productive nature, has as its meaning an uninterrupted result of its activities. METHODS: Through the DATASUS database, two specific variables were chosen to perform the analysis: the approved amount and the approved value. For this research, a methodological device, the segmented regression line, was used to observe the influences that the disasters that occurred in Mariana and Brumadinho had on the ambulatory health systems. RESULTS: The results of the segmented regression line show that, with Mariana, the amount approved continued to grow throughout the period, which shows that there was no change because of the disaster. There was a reduction in spending. In Brumadinho, regarding the amount approved, there was an upward trend in the disaster's month, which did not change immediately afterwards, and regarding expenditure, the growth pattern was maintained in all three periods. Corroborating this data, the relative and absolute base elements show an increase in the amount approved and in the number of services provided at various posts compared with Minas Gerais. CONCLUSIONS: Based on the findings, it was possible to understand that although disasters exert an influence that may have some effect on the health system, the lack of significance sometimes cannot be interpreted as a lack of impact on the disaster. The segmented regression line outlines some effects that are not conclusive but indicative of a numerical interpretation and a trend interpretation.

Notifications of work-related injuries and diseases: an observational study on a mining disaster.

INTRODUCTION: Accidents at work are events that endanger the health and life of workers. They are considered a public health problem, being the object of studies and actions in the Brazilian health system. The collapsed of the ore tailings dam in the municipality of Brumadinho, Brazil, in January 2019, shocked the world due to the proportion of environmental and human damage caused. In this context, concern for the health of workers gained prominence. This paper evaluated the impact of the collapse of the mining tailings dam in Brumadinho, on notifications of occupational health problems before and after the disaster. METHODS: An observational, longitudinal and retrospective study, of the time series type with a statistical approach was carried out on notifications of work-related injuries and diseases, available in the local database of the Notifiable Diseases Information System between January 2017 and December 2021. RESULTS: During the study period, 520 notifications of work-related injuries and conditions were registered. Of this total, 67.3% were serious work accidents, 26.0% mental disorders, 12.3% accidents with biological material and 2.9% repetitive strain injuries/musculoskeletal disorders, occupational dermatoses and induced hearing loss by noise. Occurrences were more frequent in 2019, the year in which the mining disaster occurred, recording 65.2% of total notifications. Regarding the volume of notifications after the disaster, there was a statistically significant reduction (p < 0.001) for accidents with biological material; significant increase for severe work accident and mental disorder. The average time between the occurrence of the injury and the notification showed a statistically significant reduction for accidents involving biological material (p = 0.001) and a significant increase for serious accidents at work (p = 0.016). CONCLUSIONS: It was demonstrated that there were changes in the number of notifications when comparing the period before and after the mining disaster, with a consequent impact on the health of workers, which may persist over the years.

Social participation in the unified health system of Brazil: an exploratory study on the adequacy of health councils to resolution 453/2012.

INTRODUCTION: Social participation is one of the guidelines of the Brazilian health system. Health councils are collegiate instances of participation established by Law 8.142/90. The most recent legal regulation for council organization and functioning was established through Resolution 453/2021. The institution of health councils has a permanent and deliberative nature to act in the formulation, deliberation and control of health policy implementation, including in economic and financial aspects. OBJECTIVE: To evaluate the compliance of health councils with the directives for the establishment, restructuring and operation of the councils from Brazil, based on Resolution 453/2012. METHODS: An exploratory, descriptive study that used the Health Council Monitoring System as a data source. Qualitative variables were selected to identify the characteristics related to the councils' establishment (legal instruments for establishment), the strategies adopted for restructuring (budget allocation, existence of an executive secretariat, provision of a dedicated office) and the characteristics of the health councils' operation (frequency of regular meetings, existence of a board of directors, the election of the board of directors). RESULTS: The study analyzed three groups of characteristics related to the constitution, strategies adopted for restructuring and the functioning of the councils. Regarding the constitution of the councils, the findings revealed that the vast majority was constituted in accordance with the legislation and, therefore, is in compliance with Resolution 453/2021. In the second group of characteristics that describe the restructuring of councils, the study found that less than half of registered councils are in compliance with the standard. And, finally, in the third group of characteristics, it was found that the boards have adopted different frequencies for regular meetings and approximately 50% of the boards studied have a board of directors. CONCLUSIONS: The councils still do not meet the minimum conditions necessary to fulfil their role in the Unified Health System (SUS), as stipulated in Resolution 453/2021. This situation requires monitoring by public oversight agencies. Despite the increase in popular participation with the creation of the health councils, this study demonstrated that most councils still do not meet the minimum conditions for monitoring public health policy. The improvement of the Health Councils Monitoring System (SIACS) to become an instrument for monitoring the councils, with the definition of goals and results, may contribute to the organization of the councils and, therefore, to the realization of social participation in Brazil.

The two transmembrane regions of Candida albicans Dfi1 contribute to its biogenesis.

The opportunistic pathogen Candida albicans forms invasive filaments that grow into host tissues during disease. The glycosylated, integral plasma membrane protein Dfi1 is important for invasive filamentation in a laboratory model, and for lethality in murine disseminated candidiasis. However, Dfi1 topology and essential domains for Dfi1 biogenesis were undefined. Sequence analysis predicted that Dfi1 contains two transmembrane regions, located near the N- and C-termini. In this communication, we show that Dfi1 remains an integral membrane protein despite deletion of either predicted transmembrane region, whereas deletion of both regions results in a soluble protein. Additionally, Dfi1 that was properly oriented in the membrane, as indicated by N-linked glycosylation, was observed when either transmembrane region was deleted, but was absent when both transmembrane regions were deleted. Interestingly, deletion of the N-terminal transmembrane region resulted in production of two forms of Dfi1. Most of the protein molecules acquired normal N-linked glycosylation and a smaller population failed to become normally N-linked glycosylated. This defect was reversed by replacement of the N-terminal hydrophobic sequence with one synthetic transmembrane sequence but not another. Finally, microscopy studies revealed that Dfi1 lacking the N-terminal transmembrane region was observed at the cell periphery, where full-length Dfi1 normally localizes, whereas the double-truncation mutant was diffusely intracellular. Therefore, mature Dfi1 protein contains two transmembrane domains which contribute to its biogenesis.

Compound design guidelines for evading the efflux and permeation barriers of Escherichia coli with the oxazolidinone class of antibacterials: Test case for a general approach to improving whole cell Gram-negative activity.

Previously we reported the results from an effort to improve Gram-negative antibacterial activity in the oxazolidinone class of antibiotics via a systematic medicinal chemistry campaign focused entirely on C-ring modifications. In that series we set about testing if the efflux and permeation barriers intrinsic to the outer membrane of Escherichia coli could be rationally overcome by designing analogs to reside in specific property limits associated with Gram-negative activity: i) low MW (<400), ii) high polarity (clogD7.4 <1), and iii) zwitterionic character at pH 7.4. Indeed, we observed that only analogs residing within these limits were able to overcome these barriers. Herein we report the results from a parallel effort where we explored structural changes throughout all three rings in the scaffold for the same purpose. Compounds were tested against a diagnostic MIC panel of Escherichia coli and Staphylococcus aureus strains to determine the impact of combining structural modifications in overcoming the OM barriers and in bridging the potency gap between the species. The results demonstrated that distributing the charge-carrying moieties across two rings was also beneficial for avoidance of the outer membrane barriers. Importantly, analysis of the structure-permeation relationship (SPR) obtained from this and the prior study indicated that in addition to MW, polarity, and zwitterionic character, having ≤4 rotatable bonds is also associated with evasion of the OM barriers. These combined results provide the medicinal chemist with a framework and strategy for overcoming the OM barriers in GNB in antibacterial drug discovery efforts.

Susceptibility of Multidrug-Resistant Gram-Negative Urine Isolates to Oral Antibiotics.

Increasing resistance among Gram-negative uropathogens limits treatment options, and susceptibility data for multidrug-resistant isolates are limited. We assessed the activity of five oral agents against 91 multidrug-resistant Gram-negative urine isolates that were collected from emergency department/hospitalized patients. Fosfomycin and nitrofurantoin were most active (>75% susceptibility). Susceptibilities to sulfamethoxazole-trimethoprim, ciprofloxacin, and ampicillin were ≤40%; empirical use of these agents likely provides inadequate coverage in areas with a high prevalence of multidrug-resistant uropathogens.

An evaluation of multiple phenotypic screening methods for Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae.

Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae may display MICs to carbapenems within susceptible or intermediate ranges, prompting confirmatory testing. Four phenotypic methods to detect KPC producers were evaluated against a collection of clinical Enterobacteriaceae isolates. Meropenem-phenylboronic acid double disk synergy testing demonstrated the best performance with 100% sensitivity and specificity.

A Candida albicans cell wall-linked protein promotes invasive filamentation into semi-solid medium.

Growth of cells in contact with an abiotic or biological surface profoundly affects cellular physiology. In the opportunistic human pathogen, Candida albicans, growth on a semi-solid matrix such as agar results in invasive filamentation, a process in which cells change their morphology to highly elongated filamentous hyphae that grow into the matrix. We hypothesized that a plasma membrane receptor-type protein would sense the presence of matrix and activate a signal transduction cascade, thus promoting invasive filamentation. In this communication, we demonstrate that during growth in contact with a semi-solid surface, activation of a MAP kinase, Cek1p, is promoted, in part, by a plasma membrane protein termed Dfi1p and results in invasive filamentation. A C. albicans mutant lacking Dfi1p showed reduced virulence in a murine model of disseminated candidiasis. Dfi1p is a relatively small, integral membrane protein that localizes to the plasma membrane. Some Dfi1p molecules become cross-linked to the carbohydrate polymers of the cell wall. Thus, Dfi1p is capable of linking the cell wall to the plasma membrane and cytoplasm.

Analysis of Managers' Perception Regarding the Use of Traceability Tools in the Context of Brazilian Health.

Our society has advanced in terms of technology, and health could not be different. Despite the benefits and advantages that such improvements entail, it is unknown what contributions have been added to the hospital environment and whether such technological engineering has managed to generate value and adapt to different factors within such institutions' professional culture to establish relevance to the base of utilitarian nature. The use of tools can be conditioned to the view that the managerial sectors have such instruments. The work aims to identify and understand the perception that health managers have traceability tools such and their view on their efficiency and effectiveness in the hospital environment. The results direct us that the traceability tools have a significant expression in the hospital context, collaborating for efficiency and efficacy. Traceability tools can help the entire health system to be more uniform in service, in accountability, and in inspection processes.

[Direct costs of the dengue fever control and prevention program in 2005 in the City of São Paulo]. / Custos diretos do programa de prevenção e controle da dengue no Município de São Paulo em 2005.

OBJECTIVE: To estimate the direct costs associated with the control of Aedes aegypti and prevention of dengue fever in the City of São Paulo Dengue Control Program, Brazil, in 2005. METHOD: The following items were considered: human resources, uniforms, field materials, individual protection equipment, spraying equipment, strategic supplies (insecticides and larvicides), and vehicles. The costs associated with laboratory tests for entomological surveillance and dengue fever diagnosis were also calculated, as well as costs relating to information and printed materials for educational campaigns. RESULTS: The total direct costs of the City of São Paulo Dengue Fever Program in 2005 were R$ 21,774,282.82 (US$ 12,486,941.34 considering the dollar/real exchange rate in December 2009). Of this amount, 59.4% were directed to human resources, 38.3% to epidemic control measures, and 2.2% to capital expenditure. The cost per capita was R$ 1.99 in 2005. CONCLUSIONS: The control of dengue fever is essential given the growth of epidemics. Knowledge about the costs of strategies and priority items employed in dengue fever control and prevention programs can guide decision-making regarding the application of budget resources in both the City of São Paulo and Brazil as a whole.

Hospital marketing: characterization of marketing actions in private hospitals in the city of São Paulo - Brazil.

OBJECTIVE: Characterize the marketing actions in private hospitals in the city of São Paulo, the organizational structure of the marketing area, the target public of marketing actions and the media used. METHODS: Exploratory cross-sectional study, carried out by a survey made with hospital administrators. RESULTS: The hospitals studied were clearly divided in two groups whose differentials are statistically significant: 1. good infrastructure and equipment, with a well-defined investment policy in marketing; 2. worse infrastructure and less equipment, with lower proportional investment in marketing. CONCLUSIONS: 1. The actions most used are the evaluation of patients/caregivers satisfaction, web site and dissemination of the hospital services. 2. The hospital administrators attribute a level of significant importance to the application of hospital marketing concepts. 3. There is a marketing structure in most of the hospitals studied. 4. The hospitals consider as extremely or very important publics: patients and relatives, doctors, collaborators, health plans and community. 5. The media most used are the most simple and of lower cost. 6. There is a statistically significant correlation between the higher investment in marketing and the best infrastructure. 7. The studied hospitals apply the concept of marketing in a restricted way.

Permanent education as an inalienable responsibility of health councils: the current scenario in the Unified Health System.

OBJECTIVE: To verify whether health councils in Brazil carry out permanent education activities for municipal, state and federal district councilors. METHOD: This was a cross-sectional study with secondary data collection in the Health Council Monitoring System (Sistema de Acompanhamento dos Conselhos de Saúde - Siacs) from May to August 2017. The Siacs is publicly accessible and available on the internet. It provides data from thousands of health councils throughout Brazil. Analysis and interpretation of the data were based on the literature and the enacted legislation, particularly Resolution 453/2012 and the National Policy of Permanent Education for Social Control in the Unified Health System (Política Nacional de Educação Permanente para o Controle Social no Sistema Único de Saúde). RESULTS: Despite the fact that Resolution 453/2012 establishes the deliberation, elaboration, support and promotion of permanent education for social control as functions of the councils (in accordance with the guidelines of the National Policy of Permanent Education), approximately 40% of councils do not carry out permanent education. CONCLUSIONS: It is necessary to strengthen the role of health councils in the elaboration of educational initiatives across the national territory. This includes the allocation of financial resources to increase access to and participation in these initiatives, which would strengthen social control in the Unified Health System. This study emphasizes that the discussion of permanent education is not given sufficient attention in the agendas and routines of health councils. This compromises the effectiveness of councils' monitoring and deliberation of public health policy.

Health Professionals' Perception Related to Communication Technologies for Access to Information about Crack.

BACKGROUND: The aim of this study is to identify the information and communication technologies used by health professionals to assist in training and updating of technical and scientific knowledge about crack, exchange of experiences, and development of programs to prevent consumption and treatment of addicts. METHODS: The qualitative methodology was used, constructed an intentional sample by criteria and applied research techniques through semi-structured interviews, triangulation of the analysis, and key informants. The study resulted in the presentation of differences between the way key informants and health professionals sought information. RESULTS: Internet was the preferred source; however, key informants sought information on sites of scientific journals and reference centers, while health professionals did free searches on the internet to consume information. CONCLUSIONS: The literature does not reflect a broad scope of the specific area, but relates the problem of access to health information to other characteristics. The sources of information about crack are focused on digital technologies, the internet and its specific tools. It also finds that health professionals are not being capacitate solidly on the subject of study.

Ceftolozane-tazobactam and ceftazidime-avibactam activity against ß-lactam-resistant Pseudomonas aeruginosa and extended-spectrum ß-lactamase-producing Enterobacterales clinical isolates from U.S. medical centres.

BACKGROUND: Despite availability of ceftolozane-tazobactam (C/T) and ceftazidime-avibactam (CZA) for several years, the individual spectrum of activity of each agent may not be widely known. We compared the activity of C/T and CZA against convenience samples of 119 extended-spectrum ß-lactamase (ESBL)-producing Enterobacterales and 60 ß-lactam-resistant Pseudomonas aeruginosa clinical isolates collected from three U.S. institutions. METHODS: Minimal inhibitory concentrations (MICs) for C/T and CZA were determined by broth microdilution. Molecular identification of nine ß-lactamase gene targets was conducted for Enterobacterales and P. aeruginosa isolates with increased MICs to C/T or CZA. RESULTS: More than 90% of Enterobacterales isolates demonstrated susceptibility to both C/T and CZA, in contrast to the other traditional ß-lactam agents tested, which were much less active. The MIC50/90 values were nearly equivalent between agents. The most common ß-lactamase genes identified in Enterobacterales isolates with MIC values ≥2 mg/L were the CTX-M-1 group (85%) and CMY-2-like (23%) ß-lactamases. Both agents were active against >80% of ß-lactam-resistant P. aeruginosa isolates tested, most of which had oprD mutations identified. One P. aeruginosa isolate was positive for a Klebsiella pneumoniae carbapenemase-type gene but remained meropenem-susceptible. The MIC50 values were four-fold lower in favour of C/T (1 mg/L vs. 4 mg/L) against P. aeruginosa. CONCLUSIONS: Our data suggest that either agent may be a reasonable choice for centres with a high proportion of ESBL producers; however, C/T may have improved activity against P. aeruginosa and may be preferred in institutions with a higher frequency of resistant pseudomonal isolates.

[Judicial demands and therapeutic assistance in the Brazilian Public Health System]. / Demandas judiciais e assistência terapêutica no Sistema Unico de Saúde.

OBJECTIVE: To analyze the qualitative coverage of therapeutic policies at federal level in the Brazilian Public Health System (SUS) for diseases that were the subject of lawsuits. METHODS: An exploratory research was performed, based on a sample of diseases referred to in lawsuits against the city of São Paulo Municipal Office for Health, in 2005. A search of the standards that set forth therapeutic policies, as well as recommended therapeutic resources (surgical procedures and drugs), was performed. The database Diseasedex, part of the Micromedex system, was used as the basis for therapeutic procedures used to treat those diseases. A reference summary table was prepared to facilitate comparison between recommendations in public policies and the Diseasedex database. RESULTS: Therapeutic public policy covers the major part (n = 26) of the diseases analyzed, either by public policies for primary care or public policies for rare diseases and/or high cost treatment diseases. This represents 96% of the sample analyzed (n = 27). Only 3 of the 27 diseases in the sample are contemplated by limited therapeutic policies. This means that public policies do not offer full first-line therapy, which corresponds to 11% of the sample. There was only one disease that was not covered by public therapeutic policies: attention deficit hyperactivity disorder. CONCLUSION: There were limitations in the qualitative coverage of treatment of some diseases from the sample analyzed, which may jeopardize the comprehensiveness of therapeutic assistance and health care in some cases.

Prevalence of dermatoses in patients referred for evaluation in an outpatient clinic of specialties.

BACKGROUND: Brazilian Unified Health System presents a long waiting period for a dermatology appointment, varying from 34 to 239 days. OBJECTIVES: Analyze the prevalence of cutaneous diseases evaluated by dermatologists in a specialized center, in patients referred from the primary care, and to present possible interventions for the primary units. METHODS: Retrospective analyses of the International Codes of Diseases (ICD-10) described in every dermatology appointment in a specialty center in Sao Paulo from January 2014 to August 2015. RESULTS: A total of 7.350 consultations were included. Superficial mycosis corresponded to 1,058 (14.4%) of the main complaints and dermatophytosis was the most frequently used ICD, corresponding to 481 individual consultations (6.5%), followed by onychomycosis, responsible for 464 consultations (6.3%), acne in 347 (4,7%). and contact dermatitis in 311 consultations (4,2%). STUDY LIMITATIONS: The study was based on retrospective analysis of ICD described and no previous orientation for a solid use of the codes was performed to the dermatology team; consultations in which the ICD was not informed or a non-especific ICD was used were excluded; different dermatologists were responsible for the consultations. CONCLUSION: Superficial mycosis corresponded to 14.4% of the chief complaints in the studied period and was the most frequent cause of reference from primary care doctors to dermatologists. Prevalence data obtained in the present study could assist the capacitation policies in the primary care system, focusing the dermatology teaching in the most prevalent dermatological disorders.

Analysis of the indicators of the Family Health Program in the Metropolitan Region of São Paulo.

OBJECTIVE: To analyze the Family Health Program replaced by the Family Health Strategy in 2011, based on health indicators and diseases classified as primary care sensitive. METHODS: This was a descriptive, analytical and documental study carried out in the Metropolitan Region of São Paulo between 2002 and 2007. We analyzed data from Health observatory for the Metropolitan Region of São Paulo. Pearson's correlation and the Statistical Package for the Social Sciences software version 17.0 were used to calculate data associations. RESULTS: We used 30 of the 31 health indicators of 24 from the 39 studied municipalities. A total of 720 (100%) health primary care sensitive indicators were analyzed in the Metropolitan Region of São Paulo. CONCLUSION: Percentages of improvements and worsening were low. In addition, some data were not presented. The majority of indicators remained stable.

Thyroid cancer burden and economic impact on the Brazilian public health system.

OBJECTIVE: Recent data indicates an increasing incidence of thyroid cancer not accompanied by a proportional increase in mortality, suggesting overdiagnosis, which may represent a big public health problem, particularly where resources are scarce. This article aims to describe and evaluate the procedures related to investigation of thyroid nodules and treatment and follow-up of thyroid cancer and the costs for the Brazilian public health system between 2008 and 2015. MATERIALS AND METHODS: Data on procedures related to investigation of thyroid nodules and treatment/follow-up of thyroid cancer between 2008 and 2015 in Brazil were collected from the Department of Informatics of the Brazilian Unified Health System (Datasus) website. RESULTS: A statistically significant increase in the use of procedures related to thyroid nodules investigation and thyroid cancer treatment and follow-up was observed in Brazil, though a reduction was noted for procedures related to the treatment of more aggressive thyroid cancer, such as total thyroidectomy with neck dissection and higher radioiodine activities such as 200 and 250 milicuries (mCi). The procedures related to thyroid nodules investigation costs increased by 91% for thyroid ultrasound (p = 0.0003) and 128% in thyroid nodule biopsy (p < 0.001). Costs related to treatment and follow-up related-procedures increased by 120%. CONCLUSION: The increase in the incidence of thyroid cancer in Brazil is directly associated with an increased use of diagnostic tools for thyroid nodules, which leads to an upsurge in thyroid cancer treatment and followup-related procedures. These data suggest that substantial resources are being used for diagnosis, treatment and follow-up of a potentially indolent condition.

Detection of high-risk carbapenem-resistant Klebsiella pneumoniae and Enterobacter cloacae isolates using volatile molecular profiles.

Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are alarming in the clinical setting, as CRE isolates often exhibit resistance to most clinically-available antibiotics. Klebsiella pneumoniae carbapenemase (KPC) is the most common carbapenemase carried by CRE in North America and Europe, frequently detected in isolates of K. pneumoniae, Escherichia coli, and Enterobacter cloacae. Notably, KPC-expressing strains often arise from clonal lineages, with sequence type 258 (ST258) representing the dominant lineage in K. pneumoniae, ST131 in E. coli, and ST78 and ST171 in E. cloacae. Prior studies have demonstrated that carbapenem-resistant K. pneumoniae differs from carbapenem-susceptible K. pneumoniae at both the transcriptomic and soluble metabolomic levels. In the present study, we sought to determine whether carbapenem-resistant and carbapenem-susceptible isolates of K. pneumoniae, E. coli, and E. cloacae produce distinct volatile metabolic profiles. We were able to identify a volatile metabolic fingerprint that could discriminate between CRE and non-CRE with an area under the receiver operating characteristic curve (AUROC) as high as 0.912. Species-specific AUROCs were as high as 0.988 for K. pneumoniae and 1.000 for E. cloacae. Paradoxically, curing of KPC-expressing plasmids from a subset of K. pneumoniae isolates further accentuated the metabolic differences observed between ST258 and non-ST258.

[Distortions to national drug policy caused by lawsuits in Brazil]. / Distorções causadas pelas ações judiciais à política de medicamentos no Brazil.

OBJECTIVE: To describe how lawsuits, which demand the supply of drugs, impact on elements of the national drug policy. METHODS: This is a desk-based study using qualitative and quantitative methods. All legal proceedings brought by citizens against the Municipal Secretary of State of Sao Paulo, relating to the supply of drugs in 2005 were analyzed. A standardized form was used to collect data, with a view to carrying out an exploratory analysis. RESULTS: A total of 170 cases relating to the supply of drugs were brought against the Municipal Secretary of State. The National Health System (SUS) was the source for 59% of the prescriptions: 26% from the municipal level, 33% from other levels. Cancer and diabetes were the diseases most commonly involved (59%). About 62% of drugs requested are on the lists of SUS services. Total expenditure was R$876,000 (Brazilian Reais), covering only non-selected items (i.e. those which are not included in the Municipal Register of Essential Medicines), 73% of which could be substituted. Of the total expenditure, 75% was spent on purchasing anticancer drugs, for which further clinical trials are required to prove their effectiveness. Two of these medicines were not registered in Brazil. CONCLUSIONS: The majority of demands for drugs that have led to legal proceedings could be avoided if two SUS directives were followed, namely the organization of oncology services and the observance of reporting on essential medicines. Failure to do so causes a breakdown in the National Drug Policy, in equality of access and in the rational use of drugs within the National Health System.