Previne brasil e financiamento da atenção primária: facilidades e dificuldades de gestores municipais de saúde / Previne Brasil and primary care financing: facilities and difficulties for municipal health managers / Previne Brasil y financiamiento de la atención primaria: facilidades y dificultades para los gestores municipales de salud

Objetivo: compreender as facilidades e dificuldades enfrentadas por gestores municipais de saúde com o novo modelo de financiamento da Atenção Primária à Saúde. Método: estudo qualitativo, tipo Pesquisa Convergente Assistencial, fundamentado na Política Nacional de Atenção Básica. Participaram 77 gestores ou seus representantes, de 47 municípios de uma Macrorregião de saúde de Santa Catarina, Brasil. Foram realizadas três oficinas nas Gerências Regionais de Saúde, em agosto e setembro de 2022. Os dados foram analisados pela análise de conteúdo. Resultados: apresentam-se como facilidades do Previne Brasil informatização, comprometimento dos profissionais, e qualificação do cuidado. Foram descritas como dificuldades falta de informações, sistema informatizado e denominador estimado e, equipe de trabalho. Conclusão: o programa apresenta facilidades que qualificam o processo de trabalho e cuidado à saúde da população. Contudo, persistem dificuldades que devem ser consideradas pela gestão municipal para avanços na atenção integral e no financiamento da Atenção Primária à Saúde.

Objective: understand the facilities and difficulties faced by municipal health managers with the new Primary Health Care financing model. Method: this is a qualitative study, of the Convergent Care Research type, based on the National Primary Care Policy. The participants were 77 managers or their representatives from 47 municipalities in a health Macroregion in Santa Catarina, Brazil. Three workshops were held in the Regional Health Departments in August and September 2022. The data was analyzed using content analysis. Results: Previne Brasil's facilities include computerization, commitment of professionals, and qualification of care. Difficulties were described as lack of information, computerized system and estimated denominator, and work team. Conclusion: the program offers facilities that improve the work process and health care for the population. However, there are still difficulties that must be considered by municipal management in order to make progress in comprehensive care and Primary Health Care financing.

Objetivo: comprender las facilidades y dificultades que enfrentan los gestores municipales de salud con el nuevo modelo de financiamiento de la Atención Primaria de Salud. Método: estudio cualitativo, tipo Investigación Convergente Asistencial, basado en la Política Nacional de Atención Primaria. Participaron 77 gestores o sus representantes, de 47 municipios de una Macrorregión de salud de Santa Catarina, Brasil. Se realizaron tres talleres en las Gerencias Regionales de Salud, en agosto y septiembre de 2022. Los datos fueron analizados mediante análisis de contenido. Resultados: las instalaciones de Previne Brasil incluyen informatización, compromiso de los profesionales y calificación de la atención. Las dificultades fueron descritas como falta de información, sistema informatizado y denominador estimado y equipo de trabajo. Conclusión: el programa presenta facilidades que cualifican el proceso de trabajo y la atención de la salud de la población. Sin embargo, aún hay dificultades que la gestión municipal debe considerar para lograr avances en la atención integral y el financiamiento de la Atención Primaria de Salud.

Hospitalizations in the public health system and mining disasters in Mariana and Brumadinho, Brazil.

BACKGROUND: Mining occupies a prominent place in Brazil, which, if observed, means that one must work with the contingencies that arise from its activity. Mining disasters, such as those in Mariana and Brumadinho, exemplify the impact on the health system and are models for similar situations, so the study sought to investigate the impact of these disasters on hospital admissions in the Brazilian public health system. METHODS: Through segmented regression, we sought to assess possible changes in the variables HAA (authorized hospital admissions), total admission value, and mortality rate in Mariana and Brumadinho. This measurement method allows the researcher to identify changes during the study period. RESULTS: The​​​​​​​ study observed significant changes in the variable mortality rate in the city of Brumadinho. Although the other variables, both in Mariana and Brumadinho, do not present a level of significance compatible with possible effects, we can still say that they present a trend that can be inferred as an effect of the disaster. CONCLUSIONS: The mining disaster significantly changed the mortality profile in the city of Brumadinho, with implications for the health system. In Mariana, there have been no objective changes, but there is evidence of potential impacts.

Assessment of the COVID-19 impact on the Brazilian Unified Health System (SUS) financing: an analysis of the financing dynamics of 2020 and 2021.

BACKGROUND: After the establishment of the public health emergency of international concern in 2020, health systems worldwide and in Brazil observed the need to apply more extraordinary logistical efforts and possibly resources to combat the imminent pandemic. METHODS: Using the historical series of public expenditures of the National Health Fund (FNS), 2015 to 2021, the number of confirmed cases of COVID-19, and a seasonal ARIMAX model, we sought to assess how the increase in the new virus infections affected the systematic financing of the SUS in Brazil. RESULTS: There were signs of seasonality and an increasing trend in the expenditure variable, which in practical terms, only indicated that the resource contributions followed an increasing trajectory already underway before the advent of the pandemic. The 1% increase in COVID-19 cases, with a one-month lag, contributes to the 0.062% increase in the variation in FNS expenditures but a decrease of 0.058% with a two-month lag. CONCLUSION: The tests showed no evidence to confirm a positive shift on FNS spending growth trajectory due to the increase of COVID-19 cases, only observing a significant increase one month after the occurrence of COVID cases, probably due to their worsening after this period, which was followed by a similar and comparable decrease in percentage of growth in the following month.

The High Cost of the Legal Route in Public Health: The Impact of the Judicialization of Medicines in the Municipal Unified Health System in Campinas.

OBJECTIVE: This study aimed to assess the costs and factors associated with the judicialization of medicines for the municipal Unified Health System in Campinas, São Paulo, Brazil, from 2017 to 2021. METHODS: This cross-sectional study used data provided by the Municipal Health Department of Campinas and the Court of Justice of the State of São Paulo. RESULTS: The sample comprised 506 medicines (322 active substances) and 493 legal cases. Of the US$9.270 million disbursed, 67.3% were allocated to purchase medicines. On average, 28.8% of the pharmaceuticals were listed on the National List of Essential Medicines (Rename), of which 52.3% were listed in the specialized component. Expenditures on nonincorporated and oncological medicines accounted for 76% of the total value. Acquisition of brand-specific medicines was predominant (53.7%), of which 75.5% had therapeutic equivalents. ABC curve shows that only 28 active substances corresponded to 79.8% of the expenses incurred to serve 573 plaintiffs. Four factors, when present in legal actions, prevented the rational use of public resources: assumption of responsibilities of other federative entities, acquisition of medicines not incorporated in Rename and oncological drugs, trademark determination, and the requirement to supply the medicine for an indefinite period. Costs associated with these factors caused an increase in expenditure, even with a decrease in legal demands filed against the municipality. CONCLUSIONS: Judicialization of medicines in Campinas from 2017 to 2021 required an allocation of US$6.2 million, aimed at treating only 0.068% of the population. Associated factors include legal requirements and internal management challenges that have increased costs.

Proporção de gestantes com atendimento odontológico realizado de 2018 a 2022: mudanças reais ou focalização da assistência? / The proportion of pregnant women with dental care performed from 2018 to 2022: real changes or focus of care? / Proporción de mujeres embarazadas con atención dental realizada de 2018 a 2022: ¿cambios reales o enfoque de atención?

O objetivo desse estudo foi descrever o comportamento do indicador de proporção de gestantes com atendimento odontológico realizado em todos os estados brasileiros antes e após a implantação do Programa Previne Brasil e correlacionando os achados com variáveis. Trata-se de um estudo ecológico, analítico, com dados secundários, cujas unidades de análise são 26 as unidades federativas do Brasil e o Distrito Federal. As variáveis proporção de gestantes com atendimento odontológico realizado entre os anos de 2018 e 2022 (por quadrimestre), número de equipes de Estratégia de Saúde da Família, cobertura de eSF e cobertura da Atenção Básica (AB) no ano de 2020, número de equipes da saúde da família de saúde bucal (eSB) no ano de 2021, tamanho populacional estimado para 2021 e Índice de Desenvolvimento Humano para o ano de 2010, foram coletadas do Sistema de Informação da Saúde da Atenção Básica (SISAB), do Instituto Brasileiro de Geografia e Estatística (IBGE) e do Sistema e-Gestor do Ministério da Saúde. Os resultados obtidos mostram que durante os anos analisados o indicador teve crescimento em todas as unidades federativas e no Distrito Federal, no entanto alguns estados tiveram crescimento do indicador acima da média nacional: Amazonas, Tocantins, Alagoas, Ceará, Paraíba, Pernambuco, Rio Grande do Norte, Sergipe, Mato Grosso do Sul Paraná e Santa Catarina. O indicador teve correlação negativa com IDH e positiva com as coberturas de equipes de saúde da família e de saúde bucal. Houve um aumento na proporção de atendimentos odontológicos a gestantes na APS entre os anos estudados, no entanto, esse indicador não permite a avaliação da qualidade desse atendimento e nem o impacto na morbimortalidade materna e infantil.

The aim of this study was to describe the behavior of the indicator of the proportion of pregnant women with dental care performed in all Brazilian states before and after the implementation of the Prevent Brazil Program and correlate the findings with variables. This is an ecological, analytical study with secondary data, whose units of analysis are 26 of the federative units of Brazil and the Federal District. The variables proportion of pregnant women with dental care performed between the years 2018 and 2022 (per four months), number of Family Health Strategy teams, FHS coverage and Primary Care (PHC) coverage in 2020, number of oral health family health teams (eSB) in 2021, estimated population size for 2021 and Human Development Index for 2010, were collected from the Primary Care Health Information System (SISAB), the Brazilian Institute of Geography and Statistics (IBGE) and the e-Manager System of the Ministry of Health. The results obtained show that during the years analyzed the indicator had growth in all federative units and in the Federal District, however, some states had growth of the indicator above the national average: Amazonas, Tocantins, Alagoas, Ceará, Paraíba, Pernambuco, Rio Grande do Norte, Sergipe, Mato Grosso do Sul Paraná and Santa Catarina. The indicator had a negative correlation with HDI and a positive correlation with the coverage of family health and oral health teams. There was an increase in the proportion of dental care to pregnant women in PHC between the years studied, however, this indicator does not allow the evaluation of the quality of this care nor the impact on maternal and infant morbidity and mortality.

El objetivo de este estudio fue describir el comportamiento del indicador de proporción de gestantes con atención odontológica realizada en todos los estados brasileños antes y después de la implementación del Programa Prevent Brazil y correlacionar los hallazgos con variables. Se trata de un estudio ecológico, analítico, con datos secundarios, cuyas unidades de análisis son 26 unidades federativas de Brasil y del Distrito Federal. Las variables proporción de gestantes con atención odontológica realizadas entre los años 2018 y 2022 (por cuatro meses), número de equipos de la Estrategia Salud de la Familia, cobertura de la ESF y cobertura de Atención Primaria (APS) en 2020, número de equipos de salud familiar de salud bucal (eSB) en 2021, tamaño estimado de la población para 2021 e Índice de Desarrollo Humano para 2010, fueron recolectados del Sistema de Información en Salud de Atención Primaria (SISAB), del Instituto Brasileño de Geografía y Estadística (IBGE) y del Sistema e-Manager del Ministerio de Salud. Los resultados obtenidos muestran que durante los años analizados el indicador tuvo crecimiento en todas las unidades federativas y en el Distrito Federal, sin embargo algunos estados tuvieron crecimiento del indicador por encima del promedio nacional: Amazonas, Tocantins, Alagoas, Ceará, Paraíba, Pernambuco, Rio Grande do Norte, Sergipe, Mato Grosso do Sul Paraná y Santa Catarina. El indicador tuvo una correlación negativa con el IDH y una correlación positiva con la cobertura de los equipos de salud de la familia y salud bucal. Hubo un aumento en la proporción de atención odontológica a gestantes en APS entre los años estudiados, sin embargo, este indicador no permite evaluar la calidad de esta atención ni el impacto en la morbilidad y mortalidad materna e infantil.

Reflexões sobre o caráter ambivalente da judicialização na saúde: Desafio para garantia da integralidade e equidade no SUS / Reflections on the ambivalent nature of judicialization in health: Challenge to guarantee comprehensiveness and equity in the SUS / Reflexiones sobre el carácter ambivalente de la judicialización en salud: Desafío para garantizar integralidad y equidad em el SUS

No Brasil, o direito à saúde passou a ser universal e integral conforme previsão constitucional. No entanto, a via judicial passou a ser utilizada para garantia do acesso a tratamentos de saúde frente à necessidade da população, sem o emprego de muito rigor técnico. Objetivo: revisar a literatura sobre os pontos positivos e negativos encontrados na judicialização da saúde. Metodologia: realizou-se um levantamento na Base de Dados da Biblioteca Virtual em Saúde, com estudos entre 2010 e 2021. Foram encontrados 59 artigos, aplicando os critérios de inclusão para esse estudo, selecionamos 39 para análise. Após aprofundada leitura dos artigos, foram eleitos os temas organizados nas seguintes categorias: medicamentos e tratamentos padronizados pelo Sistema Único de Saúde; medicamentos e tratamentos não padronizados pelo Sistema Único de Saúde; e interferência das indústrias farmacêuticas e diálogos interinstitucionais. Resultados: A maioria dos artigos identificaram pontos positivos e negativos da judicialização da saúde ou mencionaram a existência da contradição que versa esse assunto. Os estudos apontaram que parte da judicialização decorre de falhas da própria gestão. Percebe-se, assim, um conflito presente na dicotomia entre o garantido e a estruturação e capacidade do sistema para a sua realização. Conclusão: Os entes envolvidos na judicialização da saúde devem dialogar entre si, no intuito de compreender o fenômeno e enfrentar os desafios. É necessário reconhecer as demandas judiciais como fonte provocadora para a melhoria da gestão do direito à saúde efetivamente Sistema Único de Saúde, visando sempre ao melhor atendimento aos usuários, promovendo assim a equidade com eficiência no gasto de dinheiro público.

In Brazil, the right to health became universal and comprehensive, as per the constitutional provision. However, the judicial route began to be used to guarantee access to health treatments in response to the population's needs, without the use of much technical rigor. Objective: to review the literature on the positive and negative points found in the Judicialization of health. Methodology: a survey was carried out in the Virtual Health Library Database, with studies between 2010 and 2021. 59 articles were found, applying the inclusion criteria for this study, we selected 39 for analysis. After in-depth reading of the articles, themes organized into the following categories were chosen: medicines and treatments standardized by the SUS; medicines and treatments not standardized by the SUS; and interference from pharmaceutical industries and interinstitutional dialogues. Results: Most articles identified positive and negative points of the Judicialization of health or mentioned the existence of the contradiction regarding this subject. The studies showed that part of the Judicialization results from failures in the management itself. Therefore, a conflict can be seen in the dichotomy between the right to health effectively guaranteed and the structure and capacity of the system to achieve it. Conclusion: The entities involved in the Judicialization of health must dialogue with each other, in order to understand the phenomenon and face the challenges. It is necessary to recognize legal demands as a provocative source for improving SUS management, always aiming to provide better service to users, thus promoting equity and efficiency in spending public money.

En Brasil, el derecho a la salud pasó a ser universal e integral, según disposición constitucional. Sin embargo, se empezó a utilizar la vía judicial para garantizar el acceso a tratamientos de salud que respondieran a las necesidades de la población, sin el uso de mucho rigor técnico. Objetivo: revisar la literatura sobre los puntos positivos y negativos encontrados en la Judicialización de la salud. Metodología: se realizó una encuesta en la Base de Datos de la Biblioteca Virtual en Salud, con estudios entre 2010 y 2021. Se encontraron 59 artículos, aplicando los criterios de inclusión de este estudio, se seleccionaron 39 para el análisis. Después de la lectura en profundidad de los artículos, se eligieron temas organizados en las siguientes categorías: medicamentos y tratamientos estandarizados por el SUS; medicamentos y tratamientos no estandarizados por el SUS; y la interferencia de las industrias farmacéuticas y los diálogos interinstitucionales. Resultados: La mayoría de los artículos identificaron puntos positivos y negativos de la Judicialización de la salud o mencionaron la existencia de la contradicción respecto a este tema. Los estudios demostraron que parte de la Judicialización resulta de fallas en la propia gestión. Por lo tanto, se puede ver un conflicto en la dicotomía entre el derecho a la salud efectivamente garantizado y la estructura y capacidad del sistema para lograrlo. Conclusión: Las entidades involucradas en la Judicialización de la salud deben dialogar entre sí, para comprender el fenómeno y afrontar los desafíos. Es necesario reconocer las demandas legales como una fuente de provocación para mejorar la gestión del SUS, siempre con el objetivo de brindar un mejor servicio a los usuarios, promoviendo así la equidad y la eficiencia en el gasto del dinero público.

Burden of disease and costs for the Unified Health System in Brazil due to diseases whose alcohol consumption is a necessary cause: an ecological study.

OBJECTIVE: This study aimed to quantify the health and economic impacts of alcohol consumption in Brazil for 2019. STUDY DESIGN: Ecological study using secondary data sources. METHODS: We calculated the disease burden using estimates from the Global Burden of Disease study, which incorporated data from health surveys and hospital records. Costs were estimated based on direct expenses recorded in the Hospital and Outpatient Information System of the Unified Health System, with data by sex, age group, cause, and Federative Units. RESULTS: Alcohol consumption was a necessary cause for 30,355 deaths and approximately 1.69 million disability-adjusted life years in Brazil, representing 2.2% and 2.6% of the national totals, respectively. The impact was more pronounced among men, in the Northeast region and within the 40- to 64-year-old age group. The total costs attributed to these outcomes reached approximately Int$43.1 million, with hospital admissions accounting for 94.16% of these expenses. CONCLUSION: In 2019, alcohol consumption had a significant impact on both the health of Brazilians and the expenses of the health system. As a preventable risk factor, alcohol consumption necessitates effective intersectoral strategies to mitigate its burden.

Clip versus coil shift for aneurysm treatment in Brazil: an exploratory analysis of trends in a 10-year time-series.

Regarding intracranial aneurysm treatment, the clip versus coil debate remains inconclusive and lacking studies in Brazil. To examine trends in the management of intracranial aneurysms in Brazil over time, both ruptured and unruptured. A descriptive and exploratory study was conducted based on data of neurovascular procedures for aneurysm treatment using the Brazilian Public Health System database (DATASUS). The variables analyzed were the number of procedures, mortality rates, length of hospital stays, and global costs of hospitalization, from 2010 to 2019. Temporal trend analysis and statistical comparisons were conducted to assess changes over time and differences between the treatment options. The mean annual number of aneurysm treatments with endovascular embolization was 2206.30 (± 309.5), with a non-significant increasing trend (B = 55.66; p = 0.104). Conversely, microsurgical clipping exhibited a significant decreasing trend (B = -69.97; p < 0.001) with a mean of 1133.1 (± 223.12) procedures. The mortality rate associated with clipping procedure was higher in the period, with a mean difference of 5.23 (± 0.39); ([CI95%: 4.36; 6.10]; p < 0.001) and showed an increase trend, while embolization showed a stable trend. The length of in-hospital stay remained stable for clipping but increased for embolization. Costs associated with clipping increased over time, whereas costs for embolization decreased. This study highlights a significant shift in the treatment of aneurysm towards Endovascular Embolization. Despite higher costs, endovascular procedures were associated with lower mortality rates and shorter hospital stays. These findings provide valuable insights into aneurysm treatment patterns and indicators in a middle-income country's Public Health System.

Direct costs for outpatient excess body weight treatment in Brazilian children and adolescents attending a public children's hospital

Abstract Objective: To estimate the direct costs of treating excess body weight in children and adolescents attending a public children's hospital. Methods: This study analyzed the costs of the disease within the Brazilian Unified Health System (SUS) for 2,221 patients with excess body weight using a microcosting approach. The costs included operational expenses, consultations, and laboratory and imaging tests obtained from medical records for the period from 2009 to 2019. Healthcare expenses were obtained from the Table of Procedures, Medications, Orthoses/Prostheses, and Special Materials of SUS and from the hospital's finance department. Results: Medical consultations accounted for 50.6% (R$703,503.00) of the total cost (R $1,388,449.40) of treatment over the period investigated. The cost of treating excess body weight was 11.8 times higher for children aged 5-18 years compared to children aged 2-5 years over the same period. Additionally, the cost of treating obesity was approximately 4.0 and 6.3 times higher than the cost of treating overweight children aged 2-5 and 5-18 years, respectively. Conclusion: The average annual cost of treating excess body weight was R$138,845.00. Weight status and age influenced the cost of treating this disease, with higher costs being observed for individuals with obesity and children over 5 years of age. Additionally, the important deficit in reimbursement by SUS and the small number of other health professionals highlight the need for restructuring this treatment model to ensure its effectiveness, including a substantial increase in government investment.

Evaluation of drug litigation against the Campinas municipal health system from 2017 to 2021.

In Brazil, the judicialization of public health for access to medications has resulted in significant challenges to the management of public policies, especially at the municipal level. To evaluate the profile of drug litigations against the Campinas municipal health system from 2017 to 2021, this study analyzed the characteristics of litigants, medicine dispensation, and the timing of court decisions. A quantitative, analytical, and comparative cross-sectional study was conducted using data on the dispensation of 506 types of medications and 493 court cases. The analysis included sociodemographic, procedural, medical-sanitary, and pharmaceutical assistance management variables. The time of court decisions was assessed using the Kruskal‒Wallis test complemented by the Dunn test. The plaintiffs were predominantly adults, females, and self-declared students, and some cases involved nonresidents. Most of the lawsuits were represented by private lawyers, gratuitousness of justice and with decisions favorable to the plaintiff. However, only 43% of the patients obtained a preliminary injunction or early tutelage. The median time needed for a court decision from the date of case filing was 12 days until the granting of a preliminary injunction or early tutelage and 6.5 months until a judgment or dismissal without a decision on the merits. Approximately 32.4% of the medications dispensed by the judicial pharmacy already belonged to the list of the Brazil's Unified Health System in 2020; 46.3% were prescribed by their generic name; 75.5% had therapeutic equivalents, and 94.9% had marketing authorization from the Brazilian National Health Surveillance Agency. Judicialization in Campinas is an alternative way of accessing medications, but it is time-consuming and benefits only a small portion of the population (0.068%). The characteristics of the plaintiffs and judicialized medicines highlight the need to review health policies to promote equitable and efficient access to essential treatments for the population.

A importância da Atenção Primária à Saúde na prevenção e redução da violência / The importance of Primary Health Care in preventing and reducing violence

Este texto faz uma breve revisão histórica da inserção da violência como questão de saúde pública, destacando a importância da Atenção Primária à Saúde e a inovação estratégica com o Programa Nacional de Gênero, Raça, Raça e Valorização da Mulher Trabalhadora no SUS.

This text provides a brief historical review of the inclusion of violence as a public health issue, highlighting the importance of Primary Health Care and strategic innovation with the National Program for Gender, Race, Race and the Appreciation of Working Women in the SUS.

Burden of non-communicable diseases attributed to alcohol consumption in 2019 for the Brazilian Unified Health System.

OBJECTIVE: To estimate the health and economic burden of non-communicable diseases (NCDs) attributed to alcohol consumption in 2019 for the Brazilian Unified Health System (SUS) stratified by states. STUDY DESIGN: Observational, descriptive, and ecological study. METHODS: We used population attributable fractions (PAFs) of NCDs due to alcohol consumption from the Global Burden of Disease study. We applied the PAFs to the costs of hospitalizations and outpatient procedures of medium to high complexity paid by SUS for each outcome, obtained from official databases. We also calculated the disability-adjusted life years (DALYs) and mortality caused by alcohol-related NCDs. We converted the costs into international dollars (Int$) using the purchasing parity power in 2019. RESULTS: Alcohol-related NCDs accounted for 8.48% of deaths and 7.0% of DALYs among men, and 1.33% of deaths and 1.6% of DALYs among women. The main diseases were substance use, digestive, and neoplastic diseases. The SUS spent Int$202.0 million on alcohol-related NCDs, mostly on hospitalizations. The highest health burden was observed in the states of the Northeast region, and the highest expenses in the states from the South. The burden and cost values varied by sex, age group, and state. CONCLUSION: The study showed that alcohol consumption has a significant impact on Brazilian population morbidity and mortality and SUS expenditures, especially among men. These results can support policies for the prevention and control of alcohol consumption and health promotion at the subnational level, prioritizing strategies that are more appropriate to local realities.

Efficiency, planning and good management, determining factors for a greater equity on health care expenses: the experience from the program family health strategy in Brazil

The present work presents as a research problem the importance of efficiency, planning, and principles of good management aiming at capillarity and equity to generate greater access and quality of services. The objective of this article was to identify the expansion of the Family Health Strategy in Brazil between 2007 and 2020, and which variables may explain this evolution. This is a descriptive, ecological research, developed between 2007 and 2020 in Brazil; its variable of interest was the estimated population coverage of this strategy (%). An increase in the coverage of the Family Health Strategy was observed in all regions of Brazil between 2007 and 2020, especially in the Northeast region. At the state level, this coverage showed a significant positive relationship with the following variables: towns with fewer than 40,000 inhabitants and monthly income inferior to half a minimum salary. The Brazilian version of the Family Health Strategy seeks inspiration from the best and most successful health models to achieve high performance and efficiency to provide equity and access to health services.

El presente trabajo aborda como problema de investigación la importancia de la eficiencia, la planificación y los principios de buena gestión que apuntan a la capilaridad y la equidad para generar un mayor acceso y calidad de los servicios. El objetivo de este artículo fue identificar la expansión de la Estrategia Salud de la Familia en Brasil entre 2007 y 2020 y las variables que pueden explicar esta evolución. Se trata de una investigación descriptiva y ecológica, desarrollada entre 2007 y 2020 en Brasil; su variable de interés fue la cobertura demográfica estimada de esta estrategia (%). Se observó un aumento de la cobertura de la Estrategia Salud de la Familia en todas las regiones de Brasil entre 2007 y 2020, especialmente en la región noreste. A nivel estatal, esta cobertura mostró una relación positiva significativa con las siguientes variables: municipios con menos de 40.000 habitantes e ingresos mensuales inferiores a medio salario mínimo. La versión brasileña de la Estrategia de Salud de la Familia busca su inspiración en los mejores y más exitosos modelos de salud para alcanzar un alto rendimiento y eficiencia para proporcionar equidad y acceso a los servicios de salud.

O presente trabalho apresenta como um problema de pesquisa a importância da eficiência, planejamento e princípios de boa gestão objetivando capilaridade e eqüidade para gerar maior acesso e qualidade dos serviços. O objetivo desse artigo foi identificar a expansão da Estratégia de Saúde da Família no Brasil entre 2007e 2020 e quais variáveis podem explicar essa evolução. Esse é uma pesquisa descritiva, ecológica, desenvolvida entre 2007 e 2020 no Brasil: sua variável de interesse foi a cobertura estimada da população dessa estratégia (%). Um aumento na cobertura da Estratégia de Saúde da Família foi observada em todas as regiões do Brasil entre 2007 e 2020, especialmente na região Nordeste. A nível estadual, essa cobertura mostrou uma relação significante positiva com as seguintes variáveis: cidades com menos de 40.000 habitantes e renda mensal inferior a metade do salário mínimo. A versão brasileira da Estratégia de Saúde da Família busca inspiração nos melhores e mais bem sucedidos modelos de saúde para alcançar alto desempenho e eficiência no fornecimento de eqüidade e acesso a serviços de saúde.

O que se tem discutido sobre Educação Popular em Saúde nos últimos anos: uma revisão narrativa da literatura / What has been discussed about Popular Health Education in recent years: a narrative review of the literature

Resumo Esta revisão narrativa tem por objetivo analisar a literatura no âmbito da Saúde Coletiva no intento de reconhecer o que se tem discutido em Educação Popular em Saúde (EPS) entre 2019 e 2022. Após busca, 59 artigos foram selecionados, analisados criticamente e separados em seis categorias-síntese: as práticas de educação popular como promotoras de uma visão participativa da saúde; educação popular e a valorização dos saberes e práticas da cultura popular local; a educação popular em saúde como estratégia de apoio à reconstrução social ante aos retrocessos nas políticas públicas; a importância da articulação nacional em educação popular como resposta à sua desvalorização; a educação popular como projeto libertador pensando a formação democrática e luta contra violências institucionais e estruturais; educação popular no processo de formação universitária em saúde. Pôde-se obter importantes resultados que elucidam a importância da EPS no contexto do Sistema Único de Saúde e na formação acadêmica de profissionais da saúde, favorecendo o respeito aos saberes ancestrais e a horizontalidade do cuidado. Ainda, reafirma-se a necessidade de articulação nacional e dialogada com os movimentos populares para o avanço de uma agenda emancipadora e dignificante da saúde no Brasil.

Abstract This narrative review aims to analyze the literature on Collective Health to recognize what has been discussed in Popular Health Education (PHE) from 2019 to 2022. Fifty-nine articles were selected, critically analyzed, and separated into six summary categories: popular education practices as promoters of a participatory vision of health; popular education and the valorization of local popular culture knowledge and practices; popular health education as a strategy to support social reconstruction in the face of setbacks in public policies; the importance of national articulation in popular education as a response to its devaluation; popular education as a liberating project thinking about the democratic formation and the fight against institutional and structural violence; popular education in the university health training process. We achieved significant results that elucidate the importance of PHE within the Unified Health System and the academic education of health professionals, fostering respect for ancestral knowledge and care horizontality. We also reaffirm the need for national articulation and dialogue with grassroots movements to advance Brazil's emancipatory and dignifying health agenda.

Organizações sociais de saúde: análise sobre as especialidades e exames contratados pelo Estado de São Paulo, Brasil / Social health organizations: an analysis of the specialties and exams contracted by the State of São Paulo, Brazil

Resumo As organizações sociais de saúde (OSS) são entidades privadas que recebem repasses de governos para gestão de serviços públicos de saúde. Com o histórico de interesses mercadológicos na saúde pública e o aporte de vultosos recursos às OSS, questiona-se se a lógica de mercado permanece inserida nesse modelo de gestão. Conhecer a dinâmica da oferta de serviços à população ao longo das contratações pode ajudar a compreender como se comportam as possíveis alterações nos serviços contratados. Trata-se de estudo descritivo-exploratório com abordagens quanti e qualitativa. Realizou-se pesquisa documental com coleta de dados dos contratos de gestão e termos aditivos. A escolha pelo estado de São Paulo se deu por este ter sido pioneiro na implantação da gestão de serviços do SUS por OSS e pela sua representatividade econômica. Especialidades médicas foram incluídas em 184 repactuações (6,14%) e excluídas em 187 (6,24%), enquanto as não médicas foram incluídas em 26 repactuações (2,97%) e excluídas em 144 (16,44%). Quanto aos exames, 101 repactuações (18,07%) aumentaram metas e 60 (10,73%) reduziram, enquanto 6 repactuações (1,07%) incluíram exames e 12 (2,14%) excluíram.

Abstract Social Health Organizations (SHOs) are private entities that receive resources from governments for the management of public healthcare services. With the history of market interest in public health and the high volume of resources transferred to SHOs, one must question if the market logic continues to be inserted in this management model. The understanding of the dynamics of providing healthcare services to the population in the different contracts may help to understand how possible changes in the contracted services may have an influence. This is a descriptive-exploratory study using quantitative and qualitative approaches. Documental research was conducted through the collection of data from management contracts and amendments. The State of São Paulo was chosen because of its economic representativeness and for being the pioneer state in the implementation of SUS services managed by SHO. Medical specialties were included in 184 renegotiations (6.14%) and excluded in 187 (6.24%), whereas non-medical services were included in 26 renegotiations (2.97%) and excluded in 144 (16.44%). Regarding examinations, 101 renegotiations (18.07%) had their goals increased and 60 (10.73%) reduced, while 6 renegotiations (1.07%) included exams and 12 (2.14%) excluded them.

Prevalência de fissuras labiopalatais no Brasil e sua notificação no sistema de informação / Prevalence of cleft lip and palate in Brazil and its notification in the information system

Introdução: A fissura labiopalatina é a deformidade congênita mais comum, com uma incidência de 1,53/1000 nascidos vivos e o tratamento predominantemente realizado no Sistema Único de Saúde (SUS). Em 1999, o Sistema de Informações sobre Nascidos Vivos (SINASC) implantou a lacuna para preenchimento referente a deformidade congênita. Trabalhos vêm demostrando a subnotificação importante da fissura no SINASC. Método: Foi levantado o número de crianças nascidas por ano no Brasil entre 2012 e 2018 nas respectivas regiões, projetando o número de fissurados nascidos por ano usando a proporção 1,53/1000 nascidos vivos. A partir destes dados, observado o número de fissurados notificados no sistema SUS e comparado com a projeção feita observando uma estimativa de notificação por região. Verificada também a evolução dos gastos governamentais por região com cirurgia de fissura labiopalatina no período de 2012 a 2018. Resultados: Houve uma notificação de 54,1% a 36,7% das crianças nascidas com fissura, sendo a Região Sudeste com melhor índice e o Nordeste com o índice mais baixo de notificação. Os gastos federais em cirurgia de fissura labiopalatina diminuíram entre 2012 e 2018, frente ao número de nascimentos com fissuras, que se manteve estável neste período. Conclusão: Apesar do SINASC ser uma ferramenta importante, as subnotificações expressivas desta afecção impactam nas políticas públicas, pois utilizam dados inconsistentes com a realidade. Outra preocupação é a diminuição dos gastos federais com cirurgias de fissurados, o que demostra que mais crianças estão deixando de receber tratamento adequado.

Introduction: Cleft lip and palate is the most common congenital deformity, with an incidence of 1.53/1000 live births, and treatment is predominantly carried out in the Unified Health System (Sistema Único de Saúde SUS). In 1999, the Live Birth Information System (Sistema de Informações sobre Nascidos Vivos SINASC) implemented the gap to be filled in regarding congenital deformities. Studies have demonstrated the significant underreporting of the fissure in SINASC. Method: The number of children born per year in Brazil between 2012 and 2018 was surveyed in the respective regions, projecting the number of cleft children born per year using the proportion 1.53/1000 live births. From these data, the number of cleft patients notified in the SUS system was observed and compared with the projection made by observing an estimate of notification by region. The evolution of government spending by region on cleft lip and palate surgery in the period from 2012 to 2018 was also verified. Results: There was a notification of 54.1% to 36.7% of children born with cleft, with the Southeast Region having the best rate and the Northeast with the lowest notification rate. Federal spending on cleft lip and palate surgery decreased between 2012 and 2018, compared to the number of births with clefts, which remained stable during this period. Conclusion: Although SINASC is an important tool, the significant underreporting of this condition impacts public policies, as it uses data inconsistent with reality. Another concern is the decrease in federal spending on cleft surgery, which shows that more children are failing to receive adequate treatment.

A história de construção das Portarias de Consolidação do Sistema Único de Saúde: um marco normativo / The history of the construction of the Consolidation Ordinances of the Unified Health System: a normative milestone / La historia de la construcción de las Ordenanzas de Consolidación del Sistema Único de Salud: un hito normativo

Apresentar, por meio de resenha analítica, a obra 'Consolidação, Simplificação e Revisão do Arco Normativo Infralegal da Saúde: um projeto, muitas vozes', publicado pelo CONASS e que narra a história biográfica de um projeto pioneiro e inovador da consolidação do arco normativo infralegal do Sistema Único de Saúde.

To present, through an analytical review, the work 'Consolidation, Simplification, and Review of the Infralegal Normative Arch of Health: one project, many voices', published by CONASS, which narrates the biographical history of a pioneering and innovative project in consolidating the infralegal normative arch of the Unified Health System.

Presentar, a través de una reseña analítica, la obra 'Consolidación, Simplificación y Revisión del Arco Normativo Infralegal de la Salud: un proyecto, muchas voces', publicada por CONASS y que narra la historia biográfica de un proyecto pionero e innovador en la consolidación del arco normativo infralegal del Sistema Único de Salud.

Time trends of avoidable deaths in Brazil, 1996 to 2019 / Tendência temporal das mortes evitáveis no Brasil, 1996 a 2019

Introduction: The known achievements of the Brazilian Unified Health System (SUS) stand out in an adverse context. This makes it necessary to examine the effect of the SUS on the population's health, using indicators such as deaths by avoidable causes. Objective: To describe the time trends of mortality from avoidable causes in Brazil and to compare them to those of non-avoidable causes. Methods: Ecological time-series study with official mortality data, during years 1996-2019, in the age group 5-74 years. Time trends in mortality were estimated as the annual percent reduction in mortality rates, and the impact of the SUS was calculated as the difference in trend between avoidable (immunopreventable, infectious and noncommunicable diseases, maternal and external causes) and non-avoidable causes. The analyses consisted of multivariable binomial regression models, by quadrennium. Results: Death rates for each avoidability group remained stable or declined throughout the study period. The probability of a positive impact was greater than 90% for immunopreventable diseases throughout the study period; infectious diseases in 1996-2003 and 2016-2019; noncommunicable diseases in 1996-2003 and 2008-2019; maternal causes in 1996-1999; and external causes in 1996-2007. This probability was less than 10% for maternal deaths in 2016-2019; and external causes in 2008-2015. Conclusion: The SUS has had a positive impact in reducing deaths from immunopreventable, infectious and noncommunicable diseases in Brazil, although not so much for maternal and external causes.

Introdução: As conhecidas conquistas do Sistema Único de Saúde (SUS) se destacam num cenário adverso. Isso torna necessário examinar o efeito do SUS na saúde da população, usando indicadores como as mortes por causas evitáveis. Objetivo: Descrever as tendências temporais de mortalidade por causas evitáveis no Brasil e compará-las às tendências por causas não evitáveis. Métodos: Estudo ecológico de série temporal com dados oficiais de mortalidade, durante os anos 1996-2019, na faixa etária dos 5-74 anos. As tendências temporais de mortalidade foram estimadas como a redução percentual anual nas taxas de mortalidade, e o impacto do SUS foi calculado como a diferença de tendência entre causas evitáveis (doenças imunopreveníveis, infecciosas ou não transmissíveis, mortes maternas, causas externas) e não evitáveis. As análises consistiram em modelos de regressão binomial multivariável, por quadriênio. Resultados: A taxa de mortalidade permaneceu igual ou diminuiu para todos os grupos de causas de morte. A probabilidade de um impacto positivo foi maior do que 90% para as doenças imunopreveníveis ao longo de todo o período de estudo; doenças infecciosas em 1996-2003 e 2016-2019; não transmissíveis em 1996-2003 e 2008-2019; mortes maternas em 1996-1999; e externas em 1996-2007. Essa probabilidade foi menor do que 10% para mortes maternas em 2016-2019; e causas externas em 2008-2015. Conclusão: O SUS tem tido um impacto positivo na redução de mortes por doenças sensíveis à imunização, infecciosas e não transmissíveis no Brasil, embora não tanto para mortes maternas e causas externas.

Effects of Adipose-derived Stem Cells in the Treatment of Knee Osteoarthritis: A Case Report in Brazil's Unified Health System / Efeitos das células-tronco mesenquimais no tratamento da osteoartrite de joelho: Um relato de caso no Sistema Único de Saúde do Brasil

Abstract Osteoarthritis (OA) can incapacitate the individual to perform their activities of daily living due to pain. This is an important public health issue that worsens worldwide and in Brazil, since the population goes through an aging process, and has caused increased public spending on the monitoring and maintenance of treatments that can last for years and still not be resolutive. Thus, the search for innovative and effective therapies that can reduce costs becomes necessary. In this context, the present study reports the first application of cell therapy with adipose-derived stem cells in the treatment of cases of OA that are refractory to the conservative treatment, performed in the Brazilian Unified Health System (Sistema Único de Saúde, SUS). The evaluation was performed with the application of the Visual Analog Scale (VAS), the Short Form Health Survey (SF-36) and the Western Ontario and McMaster Universities (WOMAC), specifics for OA evaluation, and also an analysis of the synovial fluid (inflammatory cytokines). The cell therapy improved the scores on the WOMAC, SF-36 and EVA, and reduced the inflammatory process. We observed a decrease of 0.73x in the TNF, of 0,71x in IL-1b, of 0,68x in IL-8, and of 0,70x in IL-10. For IL-6, an increase of 1,48x was observed. Therefore, this cell therapy can be considered promising in aiding the management of this disease, since it improved the patient's pain, decrease inflammatory markers, and enabled the return to activities of daily living, which resulted in an improvement in their quality of life.

Resumo A osteoartrite (OA) pode deixar o indivíduo incapacitado para realizar suas atividades da vida diária devido ao quadro álgico. Essa é uma importante questão de saúde pública que se agrava no mundo inteiro e no Brasil, uma vez que a população passa pelo processo de envelhecimento, e isso causa um aumento nos gastos públicos com o acompanhamento e manutenção dos tratamentos que podem perdurar por anos e mesmo assim não serem resolutivos. Assim, torna-se necessária a busca por terapias inovadoras e eficazes que possam reduzir esses custos. Nesse contexto, o presente estudo relata a primeira aplicação de terapia celular com células-tronco mesenquimais do tecido adiposo no tratamento de OA refratária ao tratamento conservador realizada no Sistema Único de Saúde (SUS). Na avaliação, foram usados os instrumentos Escala Visual Analógica (EVA), os questionários de qualidade de vida Short Form Health Survey (SF-36) e Western Ontario and McMaster Universities (WOMAC), específicos para avaliação da OA, e fez-se uma análise do líquido sinovial (citocinas inflamatórias). A terapia celular melhorou as pontuações no WOMAC, SF-36, e EVA, e reduziu o processo inflamatório. Observou-se redução de 0,73 × do TNF, de 0,71 × da IL-1b, de 0,68 × da IL-8, e de 0,70 × da IL-10. Já para a IL-6, observou-se aumento de 1,48 ×. Portanto, considera-se este tipo de terapia celular promissora no auxílio do manejo desta doença, pois melhorou o quadro álgico do paciente, reduziu os marcadores inflamatórios, e possibilitou o retorno às atividades da vida diária, o que resultou em uma melhora de sua qualidade de vida.

O perfil dos egressos de um mestrado profissional: uma contribuição para o entendimento da relação formação-trabalho no SUS / Profile of graduates of a Professional Master's Degree: a contribution to understanding the training-work relationship in the SUS

RESUMO Este artigo apresenta perfil dos egressos, efeitos da formação e trajetória profissional dos concluintes do Curso de Mestrado Profissional em Saúde Pública, do Instituto Aggeu Magalhães, parte de pesquisa avaliativa em desenvolvimento. Dos 99 egressos convidados que concluíram seus cursos entre 2013-2020, 54 responderam a um questionário aplicado por meio do software Lime Survey. O estudo descritivo e transversal utilizou frequência absoluta e relativa e cruzamento de variáveis na análise, cujo instrumento constou dos temas: identificação do egresso e do programa/curso; atividade profissional antes e ao término do curso e expectativas; condição empregatícia atual e efeitos da formação; avaliação da trajetória formativa. Entre os respondentes, a maioria é do sexo feminino, com idade entre 31-40 anos, enfermeiros de formação, autodeclarados pretos ou pardos, não ser pessoa com deficiência, predominantemente residentes em Pernambuco e não ingressaram mediante cota. Como efeito na vida profissional, encontrou-se que o curso aumentou o prestígio/reconhecimento dos colegas, qualificou para atividades que já exerciam e para atividades diferentes, e trouxe ganhos de remuneração, proporcionando mudanças na vida pessoal e profissional. Os resultados estão em conformidade com achados científicos desse mesmo contexto, e a ferramenta desenvolvida pela Fiocruz permitiu conhecer a relação entre formação e trabalho.

ABSTRACT This article presents the profile of graduates, the effects of training, and the professional trajectory of the Professional Master's Course in Public Health graduates at the Aggeu Magalhaes Institute. Of the 99 invited graduates who completed the program between 2013-2020, 54 responded to a questionnaire applied through the Lime Survey software. The descriptive and cross-sectional study used absolute and relative frequency cross-tabulation variables in the analysis, with the instrument covering the following themes: identification of the graduate and program/course; professional activity before and at the end of the program and expectations; current employment status and formation effects; evaluation of the formative trajectory. Among the respondents, most are female, aged between 31-40 years, trained as nurses, self-declared as black or brown-skinned, not having a disability, predominantly residing in Pernambuco, and did not enter through a quota system. As an effect on their professional life, it was found that the program increased prestige/recognition among colleagues, qualified them for activities they were already performing and also different activities, and brought salary increases leading to changes in personal and professional lives. The results are consistent with scientific findings in the same context, and the tool developed by FIOCRUZ made it possible to understand the relationship between education and work.