Racial disparities and maternal mortality in Brazil: findings from a national database.

OBJECTIVE: To assess maternal mortality (MM) in Brazilian Black, Pardo, and White women. METHODS: We evaluated the maternal mortality rate (MMR) using data from the Brazilian Ministry of Health public databases from 2017 to 2022. We compared MMR among Black, Pardo, and White women according to the region of the country, age, and cause. For statistical analysis, the Q2 test prevalence ratio (PR) and confidence interval (CI) were calculated. RESULTS: From 2017 to 2022, the general MMR was 68.0/100,000 live births (LB). The MMR was almost twice as high among Black women compared to White (125.81 vs 64.15, PR = 1.96, 95%CI:1.84-2.08) and Pardo women (125.8 vs 64.0, PR = 1.96, 95%CI: 1.85-2.09). MMR was higher among Black women in all geographical regions, and the Southeast region reached the highest difference among Black and White women (115.5 versus 60.8, PR = 2.48, 95%CI: 2.03-3.03). During the covid-19 pandemic, MMR increased in all groups of women (Black 144.1, Pardo 74.8 and White 80.5/100.000 LB), and the differences between Black and White (PR = 1.79, 95%CI: 1.64-1.95) and Black and Pardo (PR = 1.92, 95%CI: 1.77-2.09) remained. MMR was significantly higher among Black women than among White or Pardo women in all age ranges and for all causes. CONCLUSION: Black women presented higher MMR in all years, in all geographic regions, age groups, and causes. In Brazil, Black skin color is a key MM determinant. Reducing MM requires reducing racial disparities.

Uma experiência precursora do SUS com a participação de Paulo Freire / A precursor experience of the SUS with the participation of Paulo Freire

Resumo O texto desenvolve-se a partir de uma mesa redonda realizada na Faculdade de Educação (FE) da Universidade Estadual de Campinas (Unicamp), como uma das atividades de comemorações do Centenário de Paulo Freire (2021). Objetiva registrar parte da sua passagem por essa universidade, nos anos de 1980 a 1991, a partir do trabalho realizado com a FE e Faculdade de Ciências Médicas (FCM) por meio de atividades de formação e extensão no Centro de Saúde Escola de Paulínia-SP. Descreve e analisa as pautas do processo de redemocratização do país, os embates em torno das políticas públicas na Assembleia Nacional Constituinte e o processo de constituição de um sistema integrado e universal de educação e saúde pública coletiva a partir de uma perspectiva participativa.

Abstract The text is based on a round table held at the Faculty of Education (FE) of the State University of Campinas (Unicamp) as one of the activities to commemorate Paulo Freire's Centenary (2021). It aims to record part of his time at the university, from 1980 to 1991, based on the work conducted with FE and the Faculty of Medical Sciences (FCM) through training and extension activities at the Paulínia-SP School Health Center. It also describes and analyses the agendas of the country's re-democratization process, the clashes over public policies in the National Constituent Assembly, and the process of setting up an integrated and universal system of education and collective public health from a participatory perspective.

A precursor experience of the SUS with the participation of Paulo Freire. / Uma experiência precursora do SUS com a participação de Paulo Freire.

The text is based on a round table held at the Faculty of Education (FE) of the State University of Campinas (Unicamp) as one of the activities to commemorate Paulo Freire's Centenary (2021). It aims to record part of his time at the university, from 1980 to 1991, based on the work conducted with FE and the Faculty of Medical Sciences (FCM) through training and extension activities at the Paulínia-SP School Health Center. It also describes and analyses the agendas of the country's re-democratization process, the clashes over public policies in the National Constituent Assembly, and the process of setting up an integrated and universal system of education and collective public health from a participatory perspective.

O texto desenvolve-se a partir de uma mesa redonda realizada na Faculdade de Educação (FE) da Universidade Estadual de Campinas (Unicamp), como uma das atividades de comemorações do Centenário de Paulo Freire (2021). Objetiva registrar parte da sua passagem por essa universidade, nos anos de 1980 a 1991, a partir do trabalho realizado com a FE e Faculdade de Ciências Médicas (FCM) por meio de atividades de formação e extensão no Centro de Saúde Escola de Paulínia-SP. Descreve e analisa as pautas do processo de redemocratização do país, os embates em torno das políticas públicas na Assembleia Nacional Constituinte e o processo de constituição de um sistema integrado e universal de educação e saúde pública coletiva a partir de uma perspectiva participativa.

Racial disparities and maternal mortality in Brazil: findings from a national database

ABSTRACT OBJECTIVE To assess maternal mortality (MM) in Brazilian Black, Pardo, and White women. METHODS We evaluated the maternal mortality rate (MMR) using data from the Brazilian Ministry of Health public databases from 2017 to 2022. We compared MMR among Black, Pardo, and White women according to the region of the country, age, and cause. For statistical analysis, the Q2 test prevalence ratio (PR) and confidence interval (CI) were calculated. RESULTS From 2017 to 2022, the general MMR was 68.0/100,000 live births (LB). The MMR was almost twice as high among Black women compared to White (125.81 vs 64.15, PR = 1.96, 95%CI:1.84-2.08) and Pardo women (125.8 vs 64.0, PR = 1.96, 95%CI: 1.85-2.09). MMR was higher among Black women in all geographical regions, and the Southeast region reached the highest difference among Black and White women (115.5 versus 60.8, PR = 2.48, 95%CI: 2.03-3.03). During the covid-19 pandemic, MMR increased in all groups of women (Black 144.1, Pardo 74.8 and White 80.5/100.000 LB), and the differences between Black and White (PR = 1.79, 95%CI: 1.64-1.95) and Black and Pardo (PR = 1.92, 95%CI: 1.77-2.09) remained. MMR was significantly higher among Black women than among White or Pardo women in all age ranges and for all causes. CONCLUSION Black women presented higher MMR in all years, in all geographic regions, age groups, and causes. In Brazil, Black skin color is a key MM determinant. Reducing MM requires reducing racial disparities.

O Itinerário Terapêutico de Pacientes com Câncer de Mama e de Próstata

Objetivou-se compreender os aspectos envolvidos na busca, no acesso e na utilização de serviços de saúde, a partir de trajetórias assistenciais de pacientes com câncer de mama e de próstata, na região de Campinas/SP, Brasil. Trata-se de pesquisa descritiva, com abordagem qualitativa, em que os dados foram obtidos por meio de entrevista semiestruturada e analisados pela metodologia de análise temática. Na atenção primária, verificou-se a realização de ações de promoção da saúde, aparecendo para os usuários no momento em que necessitaram de encaminhamento para acessar os serviços especializados. Observaram-se dificuldades no acesso aos serviços de média e alta complexidade, sobretudo, para iniciar o tratamento, mediante radioterapia. Assim, as redes de atenção regionalizadas precisam ser fortalecidas, para que cumpram com o propósito na garantia de respostas às necessidades de saúde dos usuários, suprimindo as barreiras aos itinerários regionais, ao facilitar o acesso da população com câncer.

The production of the common as a care strategy for complex users: a cartography with homeless women. / A produção do comum como estratégia de cuidado para usuários complexos: uma cartografia com mulheres em situação de rua.

This paper discusses the low power of traditional care offers for so-called complex users in the health sector. It aims to show, from the narratives of two guiding-users, that professionals, services, and policies disregard the multiple singularities involved in the care and attempt to overlap their knowledge in asymmetrical relationships. They are often put at stake in their ability to generate interesting and more life-producing offers. In this sense, this work built on two qualitative, cartographic studies that aimed to reflect, based on two guiding-users, promoting considerations on how contact with the field/territory and the meeting with these two women (guiding-users) deterritorialized concepts and affected researchers and research. The results indicate that cartography allows the production of the common, understood as a way of operating health work. Here, one seeks to consider each subject's unique individual power as a fundamental issue for the production of care. The disease leaves the scenario as a guide, vulnerability as fragility or impotence, to make way for the "defense of a life worth living" as a guide. Possible lives that users generate, whether or not they are in the streets and a vulnerable condition.

O presente artigo problematiza a baixa potência das ofertas tradicionais para o cuidado de usuários ditos complexos no campo da saúde. A partir das narrativas de duas usuárias-guia buscou-se mostrar que profissionais, serviços e políticas que desconsideram singularidades envolvidas no cuidado, apoiados em relações assimétricas são, frequentemente, questionados na sua capacidade de produzir ofertas significativas. Duas pesquisas qualitativas de ethos cartográfico buscaram refletir com base em duas usuárias-guia em seus territórios e que no encontro com pesquisadores e profissionais de saúde, estes experimentaram o impacto da desterritorialização de si e de seus conceitos. O processo cartográfico permitiu a produção de um "comum", ou um modo de operar o trabalho em saúde. Sai de cena a doença como guia, a vulnerabilidade como impotência, para dar lugar à "defesa de uma vida que vale a pena ser vivida" como guia. Vidas possíveis que os usuários engendram, estejam ou não em situação de rua ou qualquer vulnerabilidade.

Fatores associados à violência contra mulher na vida pregressa de mulheres encarceradas / Factors associated with violence against women in the previous life ofimprisoned women / Factores asociados a la violencia contra la mujer en la vida pasada de mujeres detenidas

Sob o olhar da saúde pública, a desproporcional carga de doença física e psiquiátrica no sistema carcerário apresenta um desafio e uma oportunidade para ações interdisciplinares em todo o mundo. OBJETIVO: verificar a prevalência e os fatores associados à violência na vida pregressa das reeducandas da Penitenciária Feminina de Campinas-SP. MÉTODO: trata-se de estudo transversal realizado com 1.013 reeducandas. Realizou-se análise de regressão logística múltipla. RESULTADOS: sofreram violência psicológica 40,3% e violência física/sexual 31,2% das mulheres. Cor da pele não branca (OR=1,40; IC95%:1,09 - 1,81), uso de tranquilizante (OR=1,40; IC95%:1,04-1,93), violência física referida antes dos 15 anos de idade (OR=1,40; IC95%:1,05-1,87) e transtorno mental comum (OR=1,95; IC95%:1,47-2,60), associaram-se positivamente à violência psicológica. A prevalência de violência física foi maior nas mulheres solteiras/divorciadas/separadas, naquelas que presenciaram agressão física na infância e com rastreamento positivo para TMC. CONCLUSÃO: entre as demandas específicas do gênero, merece especial atenção a violência contra a mulher, já que é um agravo recorrente, que causa danos irreparáveis à saúde física e psicológica das vítimas, configurando-se em um problema de saúde pública. Ações de promoção da saúde e cultura de paz devem ser trabalhadas desde a infância.(AU)

From a public health perspective, the disproportionate burden of physical and psychiatric illness in the prison system presents a challenge and an opportunity for interdisciplinary action around the world. Objective: to verify the prevalence and factors associated with violence in the previous life of female prisoners of the Campinas Penitentiary for Women ­ SP. Method: this is a cross-sectional study conducted with 1,013 inmates. Multiple logistic regression analysis was performed. Results: 40.3% of the women suffered psychological violence and 31.2% suffered physical/sexual violence. Non-white skin color (OR=1.40; 95% CI: 1.09 ­ 1.81), tranquilizer use (OR=1.40; 95% CI: 1.04-1.93), physical violence reported before 15-year-olds (OR=1.40; 95% CI: 1.05-1.87) and common mental disorder (OR=1.95; 95% CI: 1.47-2.60) were positively associated to psychological violence. The prevalence of physical violence was higher in single/ divorced/separated women, in those who witnessed physical aggression in childhood and with positive CMD screening. Conclusion: among the gender-specific demands, violence against women deserves special attention, since it is a recurring offense that causes irreparable damage to the physical and psychological health of the victims, thus constituting a public health problem. Actions to promote health and peace culture must be worked on from childhood.(AU)

Desde una perspectiva de salud pública, la carga desproporcionada de enfermedades físicas y psiquiátricas en el sistema penitenciario presenta un reto y una oportunidad para la acción interdisciplinaria en todo el mundo. Objetivo: verificar la prevalencia y los factores asociados con la violencia en el pasado de las presas en CampinasSP. Método: estudio transversal con 1.013 reeducandas. Se realizó un análisis de regresión logística múltiple. Resultados: el 40,3% de las mujeres sufrió violencia psicológica y el 31,2% violencia física / sexual. La tez no blanca (OR = 1,40; IC 95%: 1,09 ­ 1,81), el uso de tranquilizantes (OR = 1,40; IC 95%: 1,04-1,93), la violencia física reportada antes de los 15 años (OR = 1,40; IC 95%: 1,05-1,87) y el trastorno mental común (OR = 1,95; IC 95%: 1,47-2,60) está asociados a la violencia psicológica. La prevalencia de violencia física fue mayor en las mujeres solteras / divorciadas / separadas, en aquéllas que presenciaron agresiones físicas en la infancia y con rastreo positivo de trastornos mentales comunes ( TMC). Conclusión: entre las demandas específicas de género, se debe prestar especial atención a la violencia contra las mujeres, ya que es un delito recurrente que causa daños irreparables a la salud física y psicológica de las víctimas, lo que resulta en un problema de salud pública. Deben trabajarse desde la infancia acciones para promover la salud y la cultura de paz. (AU)

Common mental disorder among incarcerated women: a study on prevalence and associated factors.

Mental disorders are present in four of the ten main causes of incapacity across the world. This article aims to analyze the prevalence of Common Mental Disorders (CMD) in incarcerated women and associated factors. A cross-sectional study was conducted with a population of 1,013 women incarcerated in a female prison. The prevalence of CMD was assessed by the SRQ-20. The hierarchical logistic regression was the method of analysis used to search for independent associations between sociodemographic, lifestyle, morbidity and violence variables with CMD and strength of association. The prevalence of CMD was 66.7%. The following variables were independently and positively associated with CMD: lack of income, hypertension, tranquilizers, physical inactivity, smoking, scabies/pediculosis, psychological violence in the year before being arrested, and having witnessed psychological violence in the family in childhood/adolescence. Interdisciplinary activities among health, justice and education institutions can contribute to a qualified assessment of women before admission into the prison system. This can enable an approach that does not exacerbate or trigger the onset of CMD, contributing to the improvement in living conditions and for better health and recovery strategies.

Common mental disorder among incarcerated women: a study on prevalence and associated factors / Transtorno mental comum entre mulheres encarceradas: estudo de prevalências e fatores associados

Abstract Mental disorders are present in four of the ten main causes of incapacity across the world. This article aims to analyze the prevalence of Common Mental Disorders (CMD) in incarcerated women and associated factors. A cross-sectional study was conducted with a population of 1,013 women incarcerated in a female prison. The prevalence of CMD was assessed by the SRQ-20. The hierarchical logistic regression was the method of analysis used to search for independent associations between sociodemographic, lifestyle, morbidity and violence variables with CMD and strength of association. The prevalence of CMD was 66.7%. The following variables were independently and positively associated with CMD: lack of income, hypertension, tranquilizers, physical inactivity, smoking, scabies/pediculosis, psychological violence in the year before being arrested, and having witnessed psychological violence in the family in childhood/adolescence. Interdisciplinary activities among health, justice and education institutions can contribute to a qualified assessment of women before admission into the prison system. This can enable an approach that does not exacerbate or trigger the onset of CMD, contributing to the improvement in living conditions and for better health and recovery strategies.

Resumo Método Transtornos mentais estão presentes em quatro das dez principais causas de incapacidade em todo o mundo. O objetivo deste artigo é analisar a prevalência e os fatores associados ao transtorno mental comum entre mulheres encarceradas. estudo transversal realizado com uma população de 1.013 mulheres encarceradas em uma prisão feminina. A prevalência de TMC foi avaliada através do SQR-20. O modelo de regressão logística hierárquica foi o método de análise utilizado para verificar associações independentes entre as variáveis sociodemográfica, estilo de vida, morbidade e violência com TMC e sua força de associação. A prevalência de TMC foi de 66,7%. Foram de forma independente e positivamente associadas com TMC as variáveis: falta de renda, hipertensão, uso de tranquilizantes, sedentarismo, tabagismo, sarna/pediculose, violência psicológica no ano antes de ser presa e ter testemunhado violência psicológica na família quando criança/adolescente. Atividades interdisciplinares entre as instituições de saúde, justiça e educação podem contribuir para uma avaliação qualificada das mulheres antes da admissão no sistema prisional, assim como contribuir para a melhoria das condições de vida e de melhores estratégias de saúde e recuperação.

Lay agency and the generation of public-private mix health care maps. / O agir leigo e a produção de mapas de cuidado mistos público-privados.

This paper discusses part of the results obtained from a study carried out in two cities of the so-called ABCD Paulista Region in the period 2010-2012, in an attempt to spot the existence of non-state regulatory rationale towards access and consumption of health care services. The first stage includes interviews carried out with strategic stakeholders (managers and politicians) and key workers players. The second stage collected the stories of 18 very frequent users of health care services. This study revealed the leading role played by users to produce "health care maps", with emphasis on the frequent use of public and private resources in their itineraries, circumventing or merging with government regulation to obtain the care they need. The different formats of public-private mix transcend the still prevailing "official" concepts about the clear distinction between the two systems, which reveals the importance of this theme to public health management.

O agir leigo e a produção de mapas de cuidado mistos público-privados / Lay agency and the generation of public-private mix health care maps

Resumo O artigo problematiza parte dos resultados de estudo realizado em dois municípios do ABCD paulista no período de 2010 a 2012 com o objetivo de evidenciar a existência de lógicas regulatórias não estatais na viabilização do acesso e consumo de serviços de saúde. Na primeira etapa, foram realizadas entrevistas com atores estratégicos (gestores e políticos) e atores-trabalhadores-chave. Na segunda, foram coletadas histórias de vida de 18 pessoas com elevada frequência de utilização de serviços de saúde. O estudo revelou o papel protagonista dos usuários na construção de “mapas do cuidado”, com destaque para a utilização frequente de recursos públicos e privados nos seus percursos, contornando ou se mesclando com a regulação governamental, para a obtenção do cuidado de que necessitam. Os diferentes formatos do mix público-privado observados transcendem as concepções “oficiais” ainda vigentes sobre a distinção nítida entre os dois sistemas, revelando a importância desse tema para a gestão pública da saúde.

Abstract This paper discusses part of the results obtained from a study carried out in two cities of the so-called ABCD Paulista Region in the period 2010-2012, in an attempt to spot the existence of non-state regulatory rationale towards access and consumption of health care services. The first stage includes interviews carried out with strategic stakeholders (managers and politicians) and key workers players. The second stage collected the stories of 18 very frequent users of health care services. This study revealed the leading role played by users to produce “health care maps”, with emphasis on the frequent use of public and private resources in their itineraries, circumventing or merging with government regulation to obtain the care they need. The different formats of public-private mix transcend the still prevailing “official” concepts about the clear distinction between the two systems, which reveals the importance of this theme to public health management.

Pap smear in incarcerated women. / Exame de Papanicolaou em mulheres encarceradas.

In Brazil, in 2012, 6.4% of the prison population was made up of women. The aim of the study was to verify the coverage of the Pap smear according to sociodemographic characteristics and health problems reported among incarcerated women. Cross-sectional study conducted from August 2012 to July 2013, considering the records of 702 inmates aged between 25 and 64 years and the duration of imprisonment (not less than 12 months). The average age of the women surveyed was 34.7 years. The performance of cervical cytology was reported by 26.3% of inmates. There were no difference in prevalence according to selected variables. The containment condition enables the implementation of preventive measures such as offering and realization of Pap smear for most inmates. The observed results are worrying and differ significantly from those presented in the national diagnosis on the health of incarcerated women.

[Risk factors for cardiovascular disease in prison institution staff: a cross-sectional study]. / Fatores de risco para doenças cardiovasculares em servidores de instituição prisional: estudo transversal.

OBJECTIVE: to analyze risk factors for cardiovascular disease in prison institution staff. METHODS: this was a cross-sectional study with a sample of 127 staff of both sexes; prevalence ratios (PR) were estimated adjusted for age and education, as were the respective 95% confidence intervals (95%CI). RESULTS: higher proportions of waist circumference ratios were found above the recommended values (58.1%) and the accumulation of two risk factors for females (33.8%); among males there was higher prevalence of abnormal glucose levels (PR=10.73 - 95%CI 1.31;87.92) and blood pressure (PR=2.63 - 95%CI 1.31;6.50). CONCLUSION: the risk factors for cardiovascular disease found among staff in this study were waist circumference, glucose levels and blood pressure above the recommended values; these health risks can to be addressed through health promotion and disease prevention measures, as well as effective attention to those who are already sick.

Exame de Papanicolaou em mulheres encarceradas / Pap smear in incarcerated women

RESUMO: No Brasil, em 2012, 6,4% da população carcerária era constituida por mulheres. O objetivo do estudo foi verificar a cobertura do exame de Papanicolaou segundo características sociodemográficas e problemas de saúde referidos entre mulheres encarceradas. Estudo transversal realizado entre agosto de 2012 e julho de 2013. Consideraram-se os registros de 702 reeducandas com idade entre 25 e 64 anos de idade e tempo de reclusão igual ou superior a 12 meses. A média de idade das mulheres entrevistadas foi de 34,7 anos. A realização de citologia oncótica cervical foi referida por 26,3% das reeducandas. Não foram encontradas diferenças nas prevalências segundo variáveis selecionadas. A condição de confinamento possibilita a implementação de ações preventivas, como o oferecimento e a realização do exame de Papanicolaou para a maioria das reeducandas. Os resultados observados são preocupantes e divergem de forma importante daqueles apresentados em diagnóstico nacional sobre a saúde das mulheres encarceradas.

ABSTRACT: In Brazil, in 2012, 6.4% of the prison population was made up of women. The aim of the study was to verify the coverage of the Pap smear according to sociodemographic characteristics and health problems reported among incarcerated women. Cross-sectional study conducted from August 2012 to July 2013, considering the records of 702 inmates aged between 25 and 64 years and the duration of imprisonment (not less than 12 months). The average age of the women surveyed was 34.7 years. The performance of cervical cytology was reported by 26.3% of inmates. There were no difference in prevalence according to selected variables. The containment condition enables the implementation of preventive measures such as offering and realization of Pap smear for most inmates. The observed results are worrying and differ significantly from those presented in the national diagnosis on the health of incarcerated women.

Fatores de risco para doenças cardiovasculares em servidores de instituição prisional: estudo transversal / Risk factors for cardiovascular disease in prison institution staff: a cross-sectional study / Factores de riesgo para enfermedad cardiovascular en servidores de una institución penitenciaria: estudio transversal

OBJETIVO: analisar fatores de risco para doença cardiovascular em servidores de instituição prisional. MÉTODOS: estudo transversal com amostra de 127 servidores de ambos os sexos; foram estimadas as razões de prevalência (RP) ajustadas por idade e escolaridade, e respectivos intervalos de confiança de 95% (IC95%). RESULTADOS: observaram-se maiores proporções de circunferência da cintura acima dos valores recomendados (58,1%) e de acúmulo de dois fatores de risco, no sexo feminino (33,8%); entre os homens, observaram-se maiores prevalências de níveis alterados de glicose (RP=10,73 - IC95% 1,31;87,92) e de pressão arterial (RP=2,63 - IC95% 1,31;6,50). CONCLUSÃO: os fatores de risco para doenças cardiovasculares encontrados nos servidores avaliados foram circunferência de cintura e níveis da glicose e pressão arterial acima dos valores recomendados; esses fatores de risco para a saúde podem ser enfrentados com medidas de promoção e prevenção de agravos, somadas à efetiva atenção com aqueles que já se encontram doentes.

OBJECTIVE: to analyze risk factors for cardiovascular disease in prison institution staff. METHODS: this was a cross-sectional study with a sample of 127 staff of both sexes; prevalence ratios (PR) were estimated adjusted for age and education, as were the respective 95% confidence intervals (95%CI). RESULTS: higher proportions of waist circumference ratios were found above the recommended values (58.1%) and the accumulation of two risk factors for females (33.8%); among males there was higher prevalence of abnormal glucose levels (PR=10.73 - 95%CI 1.31;87.92) and blood pressure (PR=2.63 - 95%CI 1.31;6.50). CONCLUSION: the risk factors for cardiovascular disease found among staff in this study were waist circumference, glucose levels and blood pressure above the recommended values; these health risks can to be addressed through health promotion and disease prevention measures, as well as effective attention to those who are already sick.

OBJETIVO: analizar factores de riesgo para enfermedad cardiovascular en servidores de una institución penitenciaria. MÉTODOS: estudio transversal de 127 servidores de ambos sexos; fueron estimadas razones de prevalencia (RP) ajustados para edad y educación e, intervalos de confianza al 95% (IC95%). RESULTADOS: observamos mayores proporciones de circunferencia de cintura encima de los valores recomendados (58,1%) y acumulación de factores de riesgo en mujeres (33,8%); entre los hombres, hubo mayor prevalencia de niveles anormales de glucosa (RP=10,73 - IC95% 1,31;87,92) y presión arterial (RP=2.63 IC95% 1,31;6,50). CONCLUSIÓN: los factores de riesgo para enfermedades cardiovasculares en los servidores evaluados fueron circunferencia de cintura, niveles de glucosa y presión arterial encima de los valores recomendados; los servidores tienen riesgos de salud que deben ser abordados a través de acciones de promoción y prevención, sumados a una atención efectiva en personas ya enfermas.

Inquérito sobre condições de saúde de mulheres encarceradas / Survey on the health conditions of incarcerated women

RESUMO Objetivo: Avaliar o perfil sociodemográfico e as condições de saúde de mulheres encarceradas. Método: Estudo transversal com 1.013 mulheres, realizado em penitenciária feminina. Resultados: Idade média de 30,8 anos; baixa escolaridade; cobertura de exame de Papanicolaou e vacinação; altas prevalências de obesidade; Transtorno Mental Comum; e uso abusivo de tabaco. Considerações: Ações de promoção da saúde; prevenção de doenças e atenção aos agravos devem ser desenvolvidas junto a essa população, assim como ações de recuperação social, como estudo e trabalho. Desenvolvimento de pesquisas em instituições fechadas possibilita ampliar o conhecimento e estabelecer parcerias entre a sociedade e o setor prisional.

ABSTRACT Aim: To evaluate the socio-demographic profile and health conditions of incarcerated women. Method: Cross-sectional study with 1,013 women conducted in female penitentiary. Results: The average age of 30.8 years; low level of education; Papanicolaou test coverage and vaccination; high prevalence of obesity; Common Mental Disorder; and abusive use of tobacco. Considerations: Health promoting actions, disease prevention and attention to grievances must be developed with this population, as well as actions towards social recovery, such as study and work. Research development in closed institutions allows for expanding knowledge and establishing partnerships between the society and the prison sector.

[Lay agency and healthcare: producing healthcare maps]. / O agir leigo e o cuidado em saúde: a produção de mapas de cuidado.

This study aimed to characterize which regulatory logics (other than government regulation) result in healthcare output, using a two-stage qualitative study in two municipalities in the ABCD Paulista region in São Paulo State, Brazil. The first stage included interviews with strategic actors (managers and policymakers) and key health professionals. The second phase collected life histories from 18 individuals with high health-services utilization rates. An analysis of the researchers' involvement in the field allowed a better understanding of the narratives. Four regulatory systems were characterized (governmental, professional, clientelistic, and lay), indicating that regulation is a field in constant dispute, a social production. Users' action produces healthcare maps that reveal the existence of other possible health system arrangements, calling on us to test shared management of healthcare between health teams and users as a promising path to the urgent need to reinvent health.