Diagnóstico situacional do programa academia da saúde no estado de Mato Grosso do Sul: relatório técnico 2022 / Situational diagnosis of the health academy program in the state of Mato Grosso do Sul: technical report 2022

O Programa Academia na Saúde (PAS) é considerado como um programa estratégico para a execução das Política Nacional de Promoção da Saúde (PNPS) e da Política Nacional de Atenção Básica (PNAB), e o programa é apontado como uma das ações de prevenção e controle que integram o Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis (DCNT).

The Impact of the Declaration of the State of Emergency on the Spread of COVID-19: A Modeling Analysis.

When encountering the outbreak and early spreading of COVID-19, the Government of Japan imposed gradually upgraded restriction policies and declared the state of emergency in April 2020 for the first time. To evaluate the efficacy of the countering strategies in different periods, we constructed a SEIADR (susceptible-exposed-infected-asymptomatic-documented-recovered) model to simulate the cases and determined corresponding spreading coefficients. The effective reproduction number R t was obtained to evaluate the measures controlling the COVID-19 conducted by the Government of Japan during different stages. It was found that the strict containing strategies during the state of emergency period drastically inhibit the COVID-19 trend. R t was decreased to 1.1123 and 0.8911 in stages 4 and 5 (a state of emergency in April and May 2020) from 3.5736, 2.0126, 3.0672 in the previous three stages when the containing strategies were weak. The state of emergency was declared again in view of the second wave of massive infections in January 2021. We estimated the cumulative infected cases and additional days to contain the COVID-19 transmission for the second state of emergency using this model. R t was 1.028 which illustrated that the strategies were less effective than the previous state of emergency. Finally, the overall infected population was predicted using combined isolation and testing intensity; the effectiveness and the expected peak time were evaluated. If using the optimized control strategies in the current stage, the spread of COVID-19 in Japan could be controlled within 30 days. The total confirmed cases should reduce to less than 4.2 × 105 by April 2021. This model study suggested stricter isolating measures may be required to shorten the period of the state of emergency.

Non-invasive prenatal diagnostics (NIPD) in the system of medical care. Ethical and legal issues.

The procedures of prenatal and preimplantation diagnostics are discussed critically again and again in our community. In addition to the permanently controversial issues of embryo protection and abortion, considerations that discrimination on the basis of disability could occur with problematic consequences also for already born people with disabilities and their relatives now play a central role.

Government strategies to ensure the human right to adequate and healthy food facing the Covid-19 pandemic in Brazil. / Estratégias governamentais para a garantia do direito humano à alimentação adequada e saudável no enfrentamento à pandemia de Covid-19 no Brasil.

The Covid-19 pandemic revealed a concrete and immediate threat to food and nutrition security (FNS), especially for vulnerable groups. This study aimed to identify government strategies implemented in Brazil to provide the Human Right to Adequate and Healthy Food in high social vulnerability contexts during the Covid-19 pandemic. A cross-sectional study was carried out, with analysis of official documents published between March 20 and July 30, 2020, by the Federal Government, Federal District, Brazilian states, and capitals, focusing on measures to ensure availability and physical or financial access to food. Strategies implemented mainly involve food distribution and minimum income assurance. The following were implemented: Basic Emergency Income (Federal Government); Food Acquisition Program (PAA), and emergency financial aid (states); emergency food donation programs (states and municipalities). Existing measures were adapted to the pandemic, such as the National School Food Program (PNAE), the National Food Acquisition Program (PAA), and the distribution of food and staple food baskets. While essential, these strategies have limited scope and are insufficient to ensure FNS.

A pandemia de Covid-19 revelou a existência de ameaça concreta e imediata à segurança alimentar e nutricional (SAN), em especial de grupos vulnerabilizados. O estudo buscou identificar as estratégias governamentais implementadas no Brasil para prover o Direito Humano à Alimentação Adequada e Saudável em contextos de elevada vulnerabilidade social frente à Covid-19. Foi realizado um estudo transversal, com análise de documentos oficiais publicados entre 20 de março e 30 de julho de 2020 pela União, Distrito Federal, estados e capitais brasileiras, com foco em medidas que assegurem disponibilidade e acesso físico ou financeiro a alimentos. As estratégias implementadas envolvem fundamentalmente distribuição de alimentos e garantia de renda mínima. Foram instituídas: Renda Básica Emergencial (União); Programa de Aquisição de Alimentos (PAA) e auxílio financeiro emergencial (estados); programas de doação emergencial de alimentos (estados e municípios). Medidas existentes foram adaptadas frente à pandemia, como o Programa Nacional de Alimentação Escolar (PNAE), o Programa de Aquisição de Alimentos (PAA) nacional, a distribuição de alimentos e de cestas básicas. Embora importantes, essas estratégias têm alcance limitado e são insuficientes para assegurar a SAN.

Estratégias governamentais para a garantia do direito humano à alimentação adequada e saudável no enfrentamento à pandemia de Covid-19 no Brasil / Government strategies to ensure the human right to adequate and healthy food facing the Covid-19 pandemic in Brazil

Resumo A pandemia de Covid-19 revelou a existência de ameaça concreta e imediata à segurança alimentar e nutricional (SAN), em especial de grupos vulnerabilizados. O estudo buscou identificar as estratégias governamentais implementadas no Brasil para prover o Direito Humano à Alimentação Adequada e Saudável em contextos de elevada vulnerabilidade social frente à Covid-19. Foi realizado um estudo transversal, com análise de documentos oficiais publicados entre 20 de março e 30 de julho de 2020 pela União, Distrito Federal, estados e capitais brasileiras, com foco em medidas que assegurem disponibilidade e acesso físico ou financeiro a alimentos. As estratégias implementadas envolvem fundamentalmente distribuição de alimentos e garantia de renda mínima. Foram instituídas: Renda Básica Emergencial (União); Programa de Aquisição de Alimentos (PAA) e auxílio financeiro emergencial (estados); programas de doação emergencial de alimentos (estados e municípios). Medidas existentes foram adaptadas frente à pandemia, como o Programa Nacional de Alimentação Escolar (PNAE), o Programa de Aquisição de Alimentos (PAA) nacional, a distribuição de alimentos e de cestas básicas. Embora importantes, essas estratégias têm alcance limitado e são insuficientes para assegurar a SAN.

Abstract The Covid-19 pandemic revealed a concrete and immediate threat to food and nutrition security (FNS), especially for vulnerable groups. This study aimed to identify government strategies implemented in Brazil to provide the Human Right to Adequate and Healthy Food in high social vulnerability contexts during the Covid-19 pandemic. A cross-sectional study was carried out, with analysis of official documents published between March 20 and July 30, 2020, by the Federal Government, Federal District, Brazilian states, and capitals, focusing on measures to ensure availability and physical or financial access to food. Strategies implemented mainly involve food distribution and minimum income assurance. The following were implemented: Basic Emergency Income (Federal Government); Food Acquisition Program (PAA), and emergency financial aid (states); emergency food donation programs (states and municipalities). Existing measures were adapted to the pandemic, such as the National School Food Program (PNAE), the National Food Acquisition Program (PAA), and the distribution of food and staple food baskets. While essential, these strategies have limited scope and are insufficient to ensure FNS.

New problems of a new health system: the creation of a national public policy of rare diseases care in Brazil (1990s-2010s). / Nuevos problemas de un nuevo sistema de salud: la creación de una política pública nacional de atención de enfermedades raras en Brasil (1990-2014).

This study discusses actors and institution movements leading to the disclosure in 2014 of Resolution 199 by the Brazilian Ministry of Health, which establishes the National Policy for the Comprehensive Care of Persons with Rare Diseases. Taking as sources the mainstream newspapers, drafts law, and secondary literature on the subject, we begin our analysis in the early 1990s when the first patient associations were created in Brazil - mainly for claiming more funds for research on genetic diseases - and arrive at the late 2010s when negotiations for a national policy are taking place in the National Congress. Resolution 199 is part of an ongoing process and the path towards its disclosure and the complications that followed have given us elements to discuss contemporary aspects of the Brazilian public health. Based on the references of the history of the present time and the social studies of science, we argue that two aspects have been fundamental to creating a national policy: framing different illnesses within the terminology "rare diseases" and the construction of a public perception about the right of health which is guaranteed by the 1988 Brazilian Constitution.

En este trabajo se analizan los movimientos de actores e instituciones que llevaron a la promulgación, en 2014, de la Resolución 199 del Ministerio de Salud de Brasil, que establece la Política Nacional de Atención Integral a las Personas con Enfermedades Raras. Tomando como fuentes los principales periódicos, proyectos de ley y bibliografía secundaria sobre el tema, comenzamos nuestro análisis a principios de la década de 1990 con la creación de las primeras asociaciones de pacientes en Brasil, para reclamar fundamentalmente más fondos para la investigación de enfermedades genéticas, y llegamos a fines de la década de 2010 con las negociaciones para una política nacional. La Resolución 199 es parte de un proceso en curso, en el que el camino hacia la promulgación y las complicaciones posteriores nos dan elementos para discutir aspectos actuales de la salud pública brasileña. Sobre la base de la historia del tiempo presente y los estudios sociales de la ciencia, argumentamos que hay dos aspectos que han sido fundamentales para crear una política nacional: enmarcar diferentes enfermedades en la terminología "enfermedades raras" y la construcción de una percepción pública sobre el derecho a la salud, que se garantiza en la Constitución brasileña de 1988.

Differences in realized access to healthcare among newly arrived refugees in Germany: results from a natural quasi-experiment.

BACKGROUND: Germany has a statutory health insurance (SHI) that covers nearly the entire population and most of the health services provided. Newly arrived refugees whose asylum claim is still being processed are initially excluded from the SHI. Instead, their entitlements are restricted and parallel access models have been implemented. We assessed differences in realized access of healthcare services between these access models. METHODS: In Germany's largest federal state, North Rhine-Westphalia, two different access models have been implemented in the 396 municipalities: the healthcare voucher (HcV) model and the electronic health card (eHC) model. As refugees are quasi-randomly assigned to municipalities, we were able to realize a natural quasi-experiment including all newly assigned refugees from six municipalities (three for each model) in 2016 and 2017. Using claims data, we compared the standardized incidence rates (SIR) of specialist services use, emergency services use, and hospitalization due to ambulatory care sensitive conditions (ACSC) between both models. We indirectly standardized utilization patterns first for age and then for the sex. RESULTS: SIRs of emergency use were higher in municipalities with HcV (ranging from 1.41 to 2.63) compared to emergency rates in municipalities with eHC (ranging from 1.40 to 1.71) and differed significantly from the expected rates derived from official health reporting. SIRs of emergency and specialist use in municipalities with eHC converged with the expected rates over time. There were no significant differences in standardized hospitalization rates for ACSC. CONCLUSION: The results suggest that the eHC model is slightly better able to provide refugees with SHI-like access to specialist services and goes along with lower utilization of emergency services compared to the HcV model. No difference between the models was found for hospitalizations due to ACSC. Results might be slightly biased due to incompletely documented service use and due to (self-) selection on the level of municipalities with municipalities interested in facilitating access showing more interest in joining the project.

Challenges and opportunities for telehealth during the COVID-19 pandemic: ideas on spaces and initiatives in the Brazilian context. / Desafios e oportunidades para telessaúde em tempos da pandemia pela COVID-19: uma reflexão sobre os espaços e iniciativas no contexto brasileiro.

COVID-19 has created enormous challenges for health systems worldwide, with the rapidly growing number of deaths and critical patients with pneumonia requiring ventilatory support. Alternative methods to control the spread of the disease such as social isolation, extreme quarantine measures, and contact tracing have been used around the world. However, these measures may not be totally effective to fight COVID-19, in step with the necessary national preparations to meet the new patient care demands. A wide range of digital technologies can be used to enhance these public health strategies, and the pandemic has sparked increasing use of telehealth. This field has grown considerably in Brazil in recent years. Still, despite the intense proliferation of recommendations and rules, until the current pandemic the country still lacked a fully consolidated regulatory framework. The emergence of COVID-19 marks a key moment in the expansion of applications and use of telehealth for improving the health system's response to the current crisis. The article discusses telehealth's contribution to the fight against COVID-19 and the recent initiatives triggered in Brazil as opportunities for the consolidation of telemedicine and improvement of the Brazilian Unified National Health System. The authors conclude that telehealth offers capabilities for remote screening, care and treatment, and assists monitoring, surveillance, detection, prevention, and mitigation of the impacts on healthcare indirectly related to COVID-19. The initiatives triggered in this process can reshape the future space of telemedicine in health services in the territory.

Global landscape analysis of no-fault compensation programmes for vaccine injuries: A review and survey of implementing countries.

To update the landscape analysis of vaccine injuries no-fault compensation programmes, we conducted a scoping review and a survey of World Health Organization Member States. We describe the characteristics of existing no-fault compensation systems during 2018 based on six common programme elements. No-fault compensation systems for vaccine injuries have been developed in a few high-income countries for more than 50 years. Twenty-five jurisdictions were identified with no-fault compensation programmes, of which two were recently implemented in a low- and a lower-middle-income country. The no-fault compensation programmes in most jurisdictions are implemented at the central or federal government level and are government funded. Eligibility criteria for vaccine injury compensation vary considerably across the evaluated programmes. Notably, most programmes cover injuries arising from vaccines that are registered in the country and are recommended by authorities for routine use in children, pregnant women, adults (e.g. influenza vaccines) and for special indications. A claim process is initiated once the injured party or their legal representative files for compensation with a special administrative body in most programmes. All no-fault compensation programmes reviewed require standard of proof showing a causal association between vaccination and injury. Once a final decision has been reached, claimants are compensated with either: lump-sums; amounts calculated based on medical care costs and expenses, loss of earnings or earning capacity; or monetary compensation calculated based on pain and suffering, emotional distress, permanent impairment or loss of function; or combination of those. In most jurisdictions, vaccine injury claimants have the right to seek damages either through civil litigation or from a compensation scheme but not both simultaneously. Data from this report provide an empirical basis on which global guidance for implementing such schemes could be developed.

From Alma-Ata to Astana: the path of Primary Health Care in Portugal, 1978-2018 and the genesis of Family Medicine. / De Alma-Ata a Astana: o percurso dos Cuidados de Saúde Primários em Portugal,1978-2018 e a génese da Medicina Familiar.

Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.

Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.

The Contribution of Family Medicine and Family Medicine Leaders to Primary Health Care Development in Americas - from Alma-Ata to Astana and beyond.

Since 2012, the Besrour Centre for Global Family Medicine at the College of Family Physician of Canada has brought together its partners from the Americas annually, to reflect on the evolution of Family Medicine on the continent since Alma-Ata, and to look forward to future challenges. Family doctors are but one element of a strong health system. Family Medicine provides key ingredients to respond to population health needs especially as countries move through the epidemiological transition to face larger burdens of chronic disease and multimorbidity. In this paper, we provide a high-level overview of the state of Family Medicine on the continent. We then analyze trends in the education of family physicians to face this changing landscape, including the emphasis on the leader role of future family physicians. Postgraduate programs in Family Medicine in the Americas are placing increasing emphasis on teaching collaborative care in view of creating truly interdisciplinary health teams for the benefit of patients.

The Contribution of Family Medicine and Family Medicine Leaders to Primary Health Care Development in Americas - from Alma-Ata to Astana and beyond / A contribuição da Medicina de Família e dos líderes em Medicina de Família para o desenvolvimento da Atenção Primária à Saúde nas Américas - de Alma-Ata à Astana e além

Abstract Since 2012, the Besrour Centre for Global Family Medicine at the College of Family Physician of Canada has brought together its partners from the Americas annually, to reflect on the evolution of Family Medicine on the continent since Alma-Ata, and to look forward to future challenges. Family doctors are but one element of a strong health system. Family Medicine provides key ingredients to respond to population health needs especially as countries move through the epidemiological transition to face larger burdens of chronic disease and multimorbidity. In this paper, we provide a high-level overview of the state of Family Medicine on the continent. We then analyze trends in the education of family physicians to face this changing landscape, including the emphasis on the leader role of future family physicians. Postgraduate programs in Family Medicine in the Americas are placing increasing emphasis on teaching collaborative care in view of creating truly interdisciplinary health teams for the benefit of patients.

Resumo Desde 2012, o Centro Besrour de Medicina Global de Família, na Faculdade de Medicina de Família do Canadá, reúne seus parceiros das Américas anualmente para refletir sobre a evolução da Medicina de Família no continente desde Alma-Ata e para os desafios futuros. Os médicos de família são apenas um elemento de um forte sistema de saúde. A Medicina de Família fornece ingredientes-chave para responder às necessidades de saúde da população, especialmente à medida em que os países passam pela transição epidemiológica para enfrentar um fardo maior de doenças crônicas e de multimorbidade. Neste artigo, fornecemos uma visão geral de alto nível do estado da Medicina de Família no continente. Em seguida, analisamos as tendências na educação dos médicos de família para enfrentar esse cenário em mudança, incluindo a ênfase no papel de líder dos futuros médicos de família. Os programas de pós-graduação em Medicina de Família nas Américas estão enfatizando cada vez mais o ensino do cuidado colaborativo, a fim de criar equipes de saúde verdadeiramente interdisciplinares para o benefício dos pacientes.

De Alma-Ata a Astana: o percurso dos Cuidados de Saúde Primários em Portugal, 1978-2018 e a génese da Medicina Familiar / From Alma-Ata to Astana: the path of Primary Health Care in Portugal, 1978-2018 and the genesis of Family Medicine

Resumo Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.

Abstract Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.

HIV policy in Italy and recommendations across the HIV care continuum.

The HIV epidemic has not yet ended, and there are ever more challenges: the recent Italian National Plan of Interventions against HIV and AIDS (Piano Nazionale di Interventi Contro HIV e AIDS (PNAIDS) 2017-2019) was hailed for its comprehensiveness. Its likelihood of success across the HIV care continuum was therefore assessed. Awareness interventions are sporadic and continue to miss high risk populations; if effectively implemented, the prescriptive detail in PNAIDS may help address this. Combined prevention needs greater focus and investment. However, there has been recent progress: free anonymous testing is available at multiple settings although improvements to provide access to key vulnerable populations are needed. Clinical management is available to a high standard across the country, with some areas for improvement in ensuring equality of access. Long-term management of people living with HIV is often effective, but discrepancies exist across regions and settings of care. It is recommended to enable implementation of PNAIDS as a matter of urgency, develop integrated awareness and testing interventions for STIs and HIV, make condoms free for high-risk populations, and develop a network of multidisciplinary services for long-term holistic care of people living with HIV.

Implementation of Brazil's National Policy on Complementary and Integrative Practices: strengths and weaknesses. / Potencialidades e fragilidades de implantação da Política Nacional de Práticas Integrativas e Complementares.

This narrative review examines the literature on complementary and integrative practices (CIPs) and their incorporation into Brazil's national health system (Sistema Único de Saúde - SUS) in an attempt to understand the strengths and weaknesses of the implementation of the National Policy on Complementary and Integrative Practices in the SUS (PNPIC, acronym in Portuguese). A search was conducted of the MEDLINE, LILACS, and SciELO databases, resulting in final sample of 25 articles. Our analysis identified five key themes in the literature related to the strengths and weaknesses of policy implementation: 1) Professional training in CIPs in the SUS; 2) structuring the provision of CIPs, access, and health promotion; 3) knowledge, access, and acceptance of service users in relation to CIPs; 4) knowledge of SUS professional staff and managers in relation to the PNPIC; and 5) scope and monitoring and evaluation of the PNPIC. In consonance with the conclusions of the PNPIC management reports, the findings provide a deeper insight into policy implementation problems and reinforce the need to empower the actors involved in this process to tackle these challenges.

Esta revisão narrativa tem por objetivo analisar a produção científica sobre as Práticas Integrativas e Complementares (PIC) no Sistema Único de Saúde (SUS) visando compreender as potencialidades e fragilidades do processo de implantação da Política Nacional de Práticas Integrativas e Complementares (PNPIC). Após busca nas bases de dados, 25 artigos foram selecionados e os seus resultados analisados criticamente. Da análise do material emergiram cinco temas principais que explicitaram potencialidades e fragilidades de implantação da política: 1) Formação profissional em PIC para o SUS; 2) Estruturação da oferta em PIC, acesso e promoção da saúde; 3) Conhecimento, acesso e aceitação de usuários em relação às PIC; 4) Conhecimento de profissionais e gestores em relação à PNPIC; e 5) Escopo, monitoramento e avaliação da PNPIC. Os resultados se alinham aos relatórios de gestão da PNPIC aprofundando o conhecimento acerca da implantação da política e reforçando a necessidade de empoderamento dos atores do SUS para o enfrentamento de seus desafios.