Associations between retirement, social security policies and the health of older people: a systematic review.

BACKGROUND: As people age, they are more likely to experience several health conditions which are circumstances that arise throughout life that can interfere with an individual's ability to work, leading them to demand the social security system. This research aims to systematically review and synthesize studies related to health conditions in the aging process with social security policy reforms. METHODS: A systematic review was performed across Embase, Web of Science, Scopus, Pubmed, CINAHL, ASSIA (Proquest) and APA PsycNet from 1979 to 2022. Methods are outlined in a published protocol registered a priori on PROSPERO (CRD42021225820). Eligible studies include original empirical articles published in English, Spanish, French and Portuguese, using the search terms "aging" and "social security". Identified outcomes were organized into categories and a meta-ethnography was completed following the phases proposed by Noblit and Hare and the eMERGe meta-ethnography reporting guidance. RESULTS: There were 17 eligible studies from 4 continents with 10 cross-sectional, 1 both cross-sectional and longitudinal and 5 longitudinal data analysis. These assessed the relationship of health conditions that occur in the aging process related to social security policies, in particular, to retirement. The categories included (i) health as a way to promote an active working life for the elderly; (ii) health as an indicator for reforms in social security policies; (iii) retirement planning as a strategic element for coping with post-retirement life; and (iv) the relationship between social security policies and psychological health. CONCLUSIONS: This review showed that health and retirement defined in social security policies are related and have an impact on people's lives, especially in the decision to leave the labor market. Therefore, measures to assess the possible consequences of this relationship when promoting reforms on social security policies should be encouraged.

From Struggle to Strength: A Multicentric Study on How Public Policies for Celiac Disease Transform Lives.

This multicenter study aims to assess the impact of public policies (PPs) on the health-related quality of life (HRQoL) of individuals with celiac disease (CD) using the Celiac Disease Questionnaire (CDQ) and PPs for Celiac Disease Score (PPCDS). This cross-sectional exploratory study was conducted in four stages: first, standardizing data from countries using the CDQ; second, analyzing PPs aimed at CD patients; third, statistically examining these data; and fourth, associating HRQoL indicators with corresponding PPs. This study analyzed 15 CDQ assessments from 12 countries from 2007 to 2023. It found that comprehensive PPs positively correlated with HRQoL outcomes (Spearman correlation of 0.358). However, policies specifically targeting gluten-free meals and certification did not significantly improve HRQoL individually, suggesting they may be more effective when implemented together. Additionally, specialized health services did not notably reduce gastrointestinal symptoms, underscoring the necessity for improved patient education to enhance the effectiveness of these services. This study concludes that implementing and rigorously monitoring regulations to support CD patients is crucial for enhancing their HRQoL.

Políticas públicas y derecho a la sexualidad de las personas mayores en Chile / Public policies and right to sexuality of the elderly in Chile

Las personas mayores de 65 años constituirán la mayoría de la población mundial en corto plazo, pero en condiciones de vida precarias. Esto quiere decir que vivirán más años en peor condición de vulnerabilidad y fragilidad. Las sociedades y modelos de desarrollo no estarían preparados, generando altos costos personales, familiares y colectivos. En Chile la fragilidad sería altamente prevalente en esta población, impactando el desarrollo pleno de su vida. La sexualidad es uno de los aspectos que son invisibilizados y poco estudiados. Este trabajo realiza una aproximación crítica, a partir de la revisión y análisis de antecedentes de contexto, políticas públicas y legislación vigentes en Chile. En estos aspectos se evidencia atomización y orientación biomédica de las políticas públicas, colaborando en la comprensión de la relación fragilidad y sexualidad en personas mayores. Además, se revelan tareas de formación e investigación pendientes para la generación de políticas públicas para una vida activa y saludable.

People over 65 years of age will constitute the majority of the world's population in the short term, but in precarious living conditions: more years in a worse condition of vulnerability and fragility. Societies and development models would not be prepared, generating high personal, family and collective costs. In Chile, fragility would be highly prevalent in this population, impacting the full development of their lives; with sexuality as one of the aspects that are invisible and little studied. This work makes a critical approach, based on the review and analysis of context, public policies and legislation in force in Chile, evidencing atomization and biomedical orientation of public policies, collaborating in the understanding of the relationship between fragility and sexuality in old people; and revealing pending training and research tasks for the generation of public policies for an active and healthy life.

[Public policies and right to sexuality of the elderly in Chile]. / Public policies and right to sexuality of the elderly in Chile.

People over 65 years of age will constitute the majority of the world's population in the short term, but in precarious living conditions: more years in a worse condition of vulnerability and fragility. Societies and development models would not be prepared, generating high personal, family and collective costs. In Chile, fragility would be highly prevalent in this population, impacting the full development of their lives; with sexuality as one of the aspects that are invisible and little studied. This work makes a critical approach, based on the review and analysis of context, public policies and legislation in force in Chile, evidencing atomization and biomedical orientation of public policies, collaborating in the understanding of the relationship between fragility and sexuality in old people; and revealing pending training and research tasks for the generation of public policies for an active and healthy life.

Las personas mayores de 65 años constituirán la mayoría de la población mundial en corto plazo, pero en condiciones de vida precarias. Esto quiere decir que vivirán más años en peor condición de vulnerabilidad y fragilidad. Las sociedades y modelos de desarrollo no estarían preparados, generando altos costos personales, familiares y colectivos. En Chile la fragilidad sería altamente prevalente en esta población, impactando el desarrollo pleno de su vida. La sexualidad es uno de los aspectos que son invisibilizados y poco estudiados. Este trabajo realiza una aproximación crítica, a partir de la revisión y análisis de antecedentes de contexto, políticas públicas y legislación vigentes en Chile. En estos aspectos se evidencia atomización y orientación biomédica de las políticas públicas, colaborando en la comprensión de la relación fragilidad y sexualidad en personas mayores. Además, se revelan tareas de formación e investigación pendientes para la generación de políticas públicas para una vida activa y saludable.

From Traditionally Extensive to Sustainably Intensive: A Review on the Path to a Sustainable and Inclusive Beef Farming in Brazil.

Brazil is the second largest beef producer and a leading exporter, contributing to some 3000 t CWE in global markets (27.7% of market share). The sector has experienced substantial development, but yields remain far below potential, and there are growing concerns regarding land use change and greenhouse gas emissions. The need for sustainable technologies, such as sound pasture management and integrated farming systems, is evident, but adoption may be low amongst farmers unable to keep up with technological advances. This article describes the historical developments of Brazilian beef farming towards sustainability and discusses possible socioenvironmental outcomes. We combined an extensive literature review, public data, and our own insights as senior researchers to achieve that. The trajectory shown here evidenced the technological intensification of Brazilian beef farming, with strong support of public policies for decarbonizing agriculture. Nonetheless, the pace of this transition may affect small to medium farmers with limited access to information, technologies, and credit. Our recommendations involve a broad program of technical assistance and training on sustainable technologies, including financial and digital literacy. A novel approach to financing farmers is suggested to support a sustainable and inclusive transition in beef farming in Brazil.

Public Telemedicine Policy in Brazilian Unified Health System: An Impact Analysis.

There are several difficulties in evaluating interventions seeking to promote public health policies. In this article, we analyzed the promotion of the use of telemedicine during COVID-19 in Brazil. Using the random promotion method with instrumental variables, we showed that the policy of promoting telemedicine was adequate, with intense use of this type of care. Our results showed that telemedicine works if it is encouraged in the population. We contributed to the discussion of public health policies and their impact on the population's health in times of health crisis, such as during the COVID-19 pandemic.

Sustainable Development versus Extractivist Deforestation in Tropical, Subtropical, and Boreal Forest Ecosystems: Repercussions and Controversies about the Mother Tree and the Mycorrhizal Network Hypothesis.

This research reviews the phenomenon of extractive deforestation as a possible trigger for cascade reactions that could affect part of the forest ecosystem and its biodiversity (surface, aerial, and underground) in tropical, subtropical, and boreal forests. The controversy and disparities in criteria generated in the international scientific community around the hypothesis of a possible link between "mother trees" and mycorrhizal networks in coopetition for nutrients, nitrogen, and carbon are analyzed. The objective is to promote awareness to generate more scientific knowledge about the eventual impacts of forest extraction. Public policies are emphasized as crucial mediators for balanced sustainable development. Currently, the effects of extractive deforestation on forest ecosystems are poorly understood, which requires caution and forest protection. Continued research to increase our knowledge in molecular biology is advocated to understand the adaptation of biological organisms to the new conditions of the ecosystem both in the face of extractive deforestation and reforestation. The environmental impacts of extractive deforestation, such as the loss of biodiversity, soil degradation, altered water cycles, and the contribution of climate change, remain largely unknown. Long-term and high-quality research is essential to ensure forest sustainability and the preservation of biodiversity for future generations.

Perspectivas de Profissionais de Educação sobre ações do Programa Saúde na Escola em Pelotas em 2022 / Perspectives of Education Professionals on actions of the School Health Program in Pelotas in 2022

Esta pesquisa teve como objetivo descrever as ações do Programa Saúde na Escola em 2022 no município de Pelotas, Rio Grande do Sul, segundo a perspectiva de profissionais da educação. Trata-se de um estudo transversal, contemplando 51 das 60 escolas de Ensino Fundamental de nível municipal. Foram utilizados dois questionários estruturados administrados aos responsáveis pelo Programa ou membros da equipe gestora das instituições por meio telefônico, ou presencial. Os temas abordados com diretores, vice-diretores, orientadores educacionais e coordenadores pedagógicos incluíram a existência do Programa, as temáticas desenvolvidas, sua frequência, capacitação, envolvimento de profissionais de saúde e educação, articulação entre setores, apoio, autonomia de estudantes e barreiras para implementação do programa. Entre as 51 escolas analisadas, 41 (80,5%) delas possuíam o programa, com frequência das ações prevalentes a cada 3 meses (39,0%) e sendo a ação de Promoção da saúde bucal (90,2%) a mais apontada. Em 70,7% das escolas foram realizadas ações de promoção de atividade física. Além disso, observou-se o setor saúde como principal responsável pelas ações (87,8%), limitada participação dos alunos na escolha das temáticas (34,0%) e escassez de capacitações aos educadores (36,6%). Embora uma instituição universitária tenha se apresentado como fonte de apoio (53,7%) e todas as escolas com o programa registraram ao menos uma ação realizada, a sobrecarga (36,6%) e a necessidade de articulação (34,1%) foram as barreiras mais relatadas. Apesar dos desafios e dificuldades em diversos indicadores, foram identificadas iniciativas que configuram o Programa como importante ferramenta para promoção da saúde de escolares no município.

This research aimed to describe the actions of the School Health Program in 2022 in the municipality of Pe-lotas, Rio Grande do Sul, Brazil, from the perspective of education professionals. This is a cross-sectional, as-sessing 51 of the 60 municipal elementary schools. Two structured questionnaires were administered to those responsible for the Program or members of the management team of the institutions by telephone or face-to-face. Topics addressed with principals, vice-principals, educational advisors and pedagogical coordinators included the description of the existence of the Program, the themes developed, as well as its frequency, train-ing, involvement of health and education professionals, articulation between sectors, support, autonomy of students and barriers to the implementation of the program. Among the 51 schools analyzed, 41 (80.5%) of them had the program, with the frequency of prevalent actions every 3 months (39.0%) and the Oral Health Promotion action (90.2%) being the most pointed out. In 70.7% of the schools, actions to promote physical activity were carried out. In addition, the health sector was the main responsible for the actions (87.8%), limited participation in the choice of themes (34.0%) and scarcity in the provision of training for educa-tors (36.6%). Although a local university was a strong support (53.7%) and all schools with the program recorded at least one action taken, overload (36.6%) and the need for articulation (34.1%) were the most reported barriers. Despite the challenges and difficulties in several indicators, initiatives were identified that configure the Program as an important tool for promoting the health of schoolchildren in the municipality.

Coping strategies of food insecure households with children and adolescents in Uruguay, a high-income Latin American country: A qualitative study through the lens of Bourdieu's theories of capitals and practice.

Food insecurity has been associated with negative short, medium, and long-term health consequences, which are more detrimental for children and adolescents. These effects may depend on the coping strategies developed to deal with food shortages. The present research aimed at exploring coping strategies in food insecure households with children and adolescents in Uruguay, incorporating sociological theoretical insights from Bourdieu. A qualitative approach based on individual semi-structured interviews was used. A total of 40 interviews were conducted with adults who had parental responsibilities of children and adolescents and who received different types of food assistance, between July and December 2022, in four cities. Results showed that adults tend to develop a wide range of coping strategies aimed at: reducing food expenditure, increasing the availability of money for purchasing food, increasing food availability and/or rationing the food available in the household. Some of the strategies were implemented regardless of the severity of food insecurity, whereas others were characteristic of the moderate and severe levels of the construct. Evidence to support the mediation effect of coping strategies on health outcomes was found. Discourses suggested that lower accumulation of economic and cultural capital may be aligned with the adoption of less socially accepted mechanisms to access to food. Expressions of a specific habitus aimed at securing food were identified among participants with more deprivations. Taken together, the findings suggest that coping strategies may not be a universal or invariant sequence according to the severity of food insecurity and stress the importance of considering households' resources and local context for the development of strategies to improve access to food.

A comprehensive analysis of children's blood lead levels in Latin America and the Caribbean over the last eight years: Progress and recommendations.

In 2017 we published a review on blood lead levels (BLL) in children from Latin America and the Caribbean (LAC) for data available up to 14th of March 2014 and recommended the identification and control of "lead hot spots". In the present study, an evaluation of progress toward reducing BLL in the region was carried out. A systematic review of the latest literature on lead exposure in the LAC region held on the PubMed, Web of Science and LILACS databases (January 2014 to March 2022) was conducted using the PRISMA methodology. Only original papers published in peer-reviewed English, Spanish, or Portuguese journals were eligible. A total of 558 papers were retrieved, 77 of which met the selection criteria and 31 (40.25 %) were carried out in Mexico. The prevalence of children with BLL above 10 µg. dL-1 was 22.08 % in the previous review versus 6.78 % in the current study. In the present review, the prevalence of children with BLL above 5 µg. dL-1 was 29.62 %, and only one study reported a BLL prevalence rate between 3.3 and 5 µg. dL-1. The highest BLLs were associated with well-known sources or occupational exposures. The number of countries (n = 13) that published data on BLL in children was lower compared to the previous review (n = 16). Most studies were conducted in areas with known lead exposure sources, similar to the earlier review. The percentage of children at risk of lead poisoning in the region remains unknown because few studies have published data on environmental exposure levels and most samples were relatively small. The recommendation to identify and control sources of lead exposure was maintained, while further suggestions for establishing a systematic public health surveillance system for lead were proposed to help reduce the knowledge gap and inform public health policy-making in LAC.

An assessment of the owned canine and feline demographics in Chile: registration, sterilization, and unsupervised roaming indicators.

The global rise in companion animal populations, particularly dogs and cats, is driven by emotional and social benefits for owners, and their population management is becoming critically important to avoid a plethora of adverse effects on themselves, humans, and wildlife. We estimated the size and density of the owned canine and feline population in Chile and evaluated the status of microchipping, registration, sterilization rates, and the proportion of owned animals that roam unsupervised. A cross-sectional household survey in 36 districts was conducted and standard inferential statistics was employed to analyze differences between cats and dogs, sexes within each species, and between rural and urban areas. Additionally, two negative binomial models with mixed effects were developed to predict the number of dogs and cats per households. Two methods were used to compare population size estimates at the country level, multiplying: (1) the estimated mean number of companion animals per household by the estimated number of households at the country level, and (2) the estimated human:dog and human:cat ratios by the total human population. The study involved 6333 respondents, of which 76% (74% urban; 83% rural) owned companion animals (dogs and/or cats). Individuals in rural multi-person households increase the probability of owning dogs and/or cats. Additionally, women exhibit a greater inclination towards cat and dog ownership compared to men, while those over 30 years old demonstrate lower rates of companion animal ownership in contrast to the 18-30 age group for both species. The overall human:dog and human:cat ratios estimated were 2.7:1, and 6.2:1, respectively. The estimated total number of owned dogs and cats in Chile ranged from 9.6 to 10.7 million, depending on the methodological approach, while national median density of companion animals was 12 dogs per km2 (ranging from 0.02 to 7232) and 5 cats per km2 (ranging from 0.01 to 3242). This nationwide study showed one of the highest percentages of households with companion animals in Latin America and relatively low registration and sterilization rates, highlighting the need to strength long-term public policies to control populations of companion animals and promote responsibility in pet ownership.

Preparing schools for future pandemics: Insights on water, sanitation and hygiene solutions from the Brazilian school reopening policies.

Post-COVID-19, schools urgently need to enhance infection control and prevention (IPC) measures, including water, sanitation, and hygiene (WASH), to prepare for future outbreaks and pandemics. Particularly in Brazil, that is of particular concern, as students are still recovering from the 20th longest school closure in the world. Hence, the current study had two goals: (i) to describe WASH solutions outlined in policies released at the federal, state, and capital city levels in Brazil during the COVID-19 pandemic for the safe reopening of schools and (ii) to discuss their potential to enhance school's capacity to remain operational during a new pandemic or outbreak. With a qualitative exploratory approach, we performed content analysis to discuss the direction (what, where, how and for whom?) of 66 public policies by integrating four frameworks. Solutions were discussed in the light of the principles of human rights and the human rights to water and sanitation, international guidelines for WASH and IPC in schools and the Sphere minimum standards for humanitarian aid. One hundred and fifty-nine solutions, spanning five thematic areas and five population groups, including software and hardware interventions, were compiled for potential use in Brazil and beyond. While suggested solutions have the potential to provide a cleaner and safer learning environment, it is essential to exercise caution when implementing these measures and adapt them to the specific circumstances of each school.

Intersectorality in a conditional cash transfer programme: Actors, convergences and conflicts.

This study aimed to analyse intersectoral arrangements among the health, education and social assistance sectors in the operationalization of the Bolsa Família Program (BFP). A qualitative approach was carried out, in a peripheral region of a large urban centre of Southeast Brazil. Data content analysis was performed on the basis of reference in the Actor-Network Theory (ANT) using statements by the actors and considering ideas in dispute and work processes in the geopolitical territorial context. Seventeen managers of Municipal Secretariats of Health, Education and Social Assistance were interviewed, as were basic education, primary health care and social assistance professionals. One-off, episodic and discontinuous intersectoral actions were identified, with limited integration among sectors. Convergences and conflicts were found with respect to the institutional processes of BFP. The convergences referred to the conceptions shared among the actors about the role of intersectoral collaboration, as they recognize themselves as providing care to the same vulnerable population. Considering the multiple vulnerabilities of these families, the convergence of actions from different sectors can impact factors that condition inequalities. The conflicts were related to institutional conditions, to sectorized work processes and to a lack of understanding by professionals about the duties of their respective sectors.

The INFORMAS healthy food environment policy index in Brazil: Benchmarking, current policies, and determining priorities for the future.

INTRODUCTION: Obesity and non-communicable diseases are the most important cause of death and inability in Brazil and worldwide. Public policies are an important strategy to prevent obesity. This study analysed the scope of Brazilian public policies for preventing and controlling obesity using the INFORMAS/Food-EPI protocol. METHODS: The public policies evaluation was conducted based on the INFORMAS/Food-EPI protocol. Experts from academia, civil society, and government assessed the level of implementation of food policies compared with international best practices and proposed new actions to be developed nationally. The protocol consisted of five phases: (1) A comprehensive review of the implementation of food environment-related public policies; (2) validation with experts; (3) comparison of the national actions with the international best practice and due to the level of implementation; (4) list a set of actions to improve the current policies; and (5) evaluation of the actions due to their importance and achievability. RESULTS: Brazilian actions were focused on monitoring, leadership, governance, and resources and financing domains. CONCLUSION: The results will provide elements to support and improve the national policies that aim at the promotion of a healthy food environment and obesity prevention.

Determinantes Sociais da Saúde dentro e fora de casa: captura de uma nova abordagem / The Social Determinants of Health inside and outside the household: capturing a new approach

RESUMO Este artigo teve como objetivo compreender os Determinantes Sociais da Saúde (DSS), em área periférica de uma capital brasileira, sob a perspectiva de atores sociais e políticos da região. Baseou-se na abordagem qualitativa, com 45 participantes, entre trabalhadores do setor saúde; de sede administrativa regional; vereadores, líderes religiosos e representantes de entidades organizadas do Grande Bom Jardim, Fortaleza (CE). Utilizou-se de análise documental, de grupo focal e de entrevista semiestruturada. Realizou-se análise de conteúdo, englobando as categorias dos DSS e os temas gerais 'dentro e fora de casa', analisados com base nas representações sociais. As mudanças positivas se evidenciaram no tema 'dentro das casas' dos moradores: alimentação, melhorias advindas de benefícios da política de assistência social, aumento do abastecimento de água e de energia elétrica. No tema 'fora das casas', a influência negativa na saúde destacou-se com baixo índice de cobertura de saneamento básico, insuficiência na oferta de transporte público e insegurança. Propõe-se a inclusão de temas sobre segurança, energia elétrica, mobilidade urbana, assistência social e saneamento básico para subsidiar novos estudos sobre determinação social e elaboração de medidas que contribuam para a promoção da saúde e equidade social nos territórios urbanos.

ABSTRACT The aim was to understand the Social Determinants of Health (SDH) in the outskirts of a Brazilian capital, from the perspective of social and political actors in the region. It was based on the qualitative methodological approach, with 45 participants including health workers of the regional administrative headquarter, councilors, religious leaders, and representatives of organized entities from Grande Bom Jardim - Fortaleza (CE). We used document analysis, focus group, and semi-structured interview. The content analysis was carried out, encompassing the SDH categories and the general themes 'inside the household' and 'outside the household', analyzed based on social representations. In the results, the positive changes were evident on the theme 'inside the household' of residents: nourishment, improvements resulting from benefits of social assistance policies, an increase in water and electricity supply. On the theme 'outside the household', the negative influence on health was evidenced by the low level of basic sanitation coverage, insufficient supply of public transport, and insecurity. It is proposed to include the themes of security, electricity, urban mobility, social assistance, and basic sanitation to support new studies on social determination and the development of measures that contribute to the promotion of health and social equity in urban territories.

Ensaio teórico sobre o contributo de exercícios multicomponentes em idosos de Moçambique / Theoretical essay on the contribution of multicomponent exercises in elderly people in Mozambique / Ensayo teórico sobre la contribución de los ejercicios multicomponentes en personas mayores en Mozambique

Este ensaio tem como objetivo abordar o contributo da implementação de Exercício Multicomponente na vida de pessoas idosas residentes em Moçambique (país em desenvolvimento), bem como, confrontar com as ações ligadas à execução das políticas públicas sociais de proteção adstritas a esse grupo populacional. O exercício multicomponente é constituído por um leque de tarefas físicas combinadas recomendadas ao idoso que consiste em atividades que envolvem várias capacidades físicas simultaneamente: aeróbica, treino de marcha, equilíbrio, força, potência e resistência muscular. Para a escrita do ensaio, além das reflexões dos autores, foi realizada uma revisão de literatura, bem como, a discussão de documentos oficiais de políticas públicas em vigor em Moçambique. Ficou patente a necessidade de se incluir os exercícios multicomponentes na rotina dos idosos de Moçambique devido a sua relevância no impulsionamento do controle ou reversão das fragilidades biopsicossociais do idoso.

This essay aims to address the contribution of the implementation of Multicomponent Exercise in the lives of elderly people living in Mozambique (developing country), as well as confronting the actions related to the implementation of public social protection policies for this populational group. Multicomponent exercise consists of a range of combined physical tasks recommended for the elderly, consisting of activities that involve several physical capabilities simultaneously: aerobics, gait training, balance, strength, power and muscular endurance. For the writing of the essay, in addition to the authors reflections, a literature review was carried out, as well as the discussion of official documents of public policies in ruling in Mozambique. The need to include multicomponent exercises in the routine of elderly people in Mozambique became clear due to their relevance in boosting the control or reversal of biopsychosocial weaknesses in the elderly.

Este ensayo tiene como objetivo abordar la contribución de la implementación del Ejercicio Multicomponente en la vida de las personas mayores que residen en Mozambique (un país en desarrollo), así como confrontar las acciones relacionadas con la implementación de políticas públicas de protección social relacionadas con este grupo poblacional. El ejercicio multicomponente consiste en un conjunto de tareas físicas combinadas recomendadas para personas mayores, consistentes en actividades que involucran varias capacidades físicas simultáneamente: aeróbic, entrenamiento de la marcha, equilibrio, fuerza, potencia y resistencia muscular. Para la redacción del ensayo, además de las reflexiones de los autores, se realizó una revisión de la literatura, así como la discusión de documentos oficiales de políticas públicas vigentes en Mozambique. La necesidad de incluir ejercicios multicomponentes en la rutina de las personas mayores en Mozambique se hizo evidente debido a su relevancia para potenciar el control o la reversión de las debilidades biopsicosociales en las personas mayores.

Políticas sociais e orçamento público em um estado de exceção permanente (2013-2021) / Social policies and public budget in a state of permanent exception (2013-2021)

Resumo: Escrito sob a forma de um ensaio teórico, o artigo levanta reflexões sobre o modo de gestão do orçamento público no Brasil e sua articulação com dois eixos temáticos: tratamento da dívida pública e promoção de políticas sociais. As considerações finais apontam para a possibilidade de associar as práticas na gestão do orçamento federal brasileiro e um estado de exceção econômica perpetuado ao longo do tempo e, como desdobramento, limitante da promoção de direitos de proteção social.

Abstract: Written in the form of a theoretical essay, the article raises reflections on the way the public budget is managed in Brazil and its articulation with two thematic axes: austerity, treatment of public debt and promotion of social policies. Final considerations point to the possibility of associating practices in the management of the Brazilian federal budget and a state of economic exception perpetuated over time and, as a result, limiting the promotion of social protection rights.

Trabalho multiprofissional e integralidade do cuidado na percepção dos profissionais do CAPS / Trabajo multiprofesional y atención integral en la percepción de profesionales de CAPS / Multiprofessional work and comprehensive care in the perception of CAPS professionals

RESUMO Este estudo teve como objetivo verificar a percepção dos profissionais dos Centros de Atenção Psicossocial (CAPS) de São Paulo/SP da importância do trabalho multiprofissional em saúde mental para os usuários dos serviços e as relações possíveis com a integralidade do cuidado. Com as reformas sanitária e psiquiátrica, a integralidade passou a ser um princípio fundamental das ações de saúde, conceito que vem sendo entendido a partir de diversas influências. Foram entrevistados 27 profissionais de nível superior e utilizado o referencial metodológico da análise de conteúdo. Os participantes não apresentaram clareza sobre a noção de integralidade do cuidado, valorizando a integralidade e o trabalho de integração disciplinar de forma concomitante a ações tutelares e não favorecedoras de autonomia. Tal fato se deve ao pouco conhecimento teórico do tema sobre a integralidade e a prática ainda persistente centrada na falta de autonomia e ausência de contratualidade na relação profissional e usuário. A efetivação da integralidade do cuidado é aspecto fundamental na compreensão dos usuários de saúde mental como sujeitos de direitos, importante desafio à reforma psiquiátrica brasileira.

RESUMEN Este estudio tuvo como objetivo verificar la percepción de los profesionales de los Centros de Atención Psicosocial (CAPS) en São Paulo / SP de la importancia del trabajo multiprofesional en Salud Mental para los usuarios del servicio y las posibles relaciones con la atención integral. Con las reformas de salud y psiquiátricas, la integralidad se ha convertido en un principio fundamental de las acciones de salud, un concepto que se ha entendido desde diferentes influencias. Veintisiete profesionales de la educación superior fueron entrevistados y se utilizó el marco metodológico del Análisis de Contenido. Los participantes no tenían claro el concepto de atención integral, valorando el trabajo integral y de integración disciplinaria al mismo tiempo que las acciones tutelares que no favorecen la autonomía. Este hecho se debe a la falta de conocimiento teórico sobre el tema de la exhaustividad y la práctica aún persistente centrada en la falta de autonomía y la ausencia de contractualidad en la relación profesional y de usuario. La efectividad de la atención integral es un aspecto fundamental en la comprensión de los usuarios de salud mental como sujetos de derechos, un desafío importante para la reforma psiquiátrica brasileña.

ABSTRACT This study aimed to verify professionals' perceptions of Psychosocial Care Centers (Centros de Atenção Psicossocial - CAPS) in São Paulo / SP regarding the importance of multiprofessional work in Mental Health for service users and the possible relationships with comprehensive care. The Health and Psychiatric Reforms made comprehensiveness a fundamental principle of health actions, a concept understood through various influences. Twenty-seven higher education professionals were interviewed, and the Content Analysis methodological framework was used. The participants were unclear about integrality care, valuing comprehensiveness and disciplinary integration work concomitantly to tutelage actions that do not favor autonomy. This fact is due to the lack of theoretical knowledge on comprehensiveness issues and the still persistent practice centered on the absence of autonomy and contractuality in the professional-user relationship. The effectiveness of comprehensive care is fundamental to understanding Mental Health users as subjects of rights, an important challenge for Brazilian Psychiatric Reform.

Identidade de gênero e orientação sexual nas estatísticas públicas oficiais: caminhos para inclusão / Gender identity and sexual orientation in official public statistics: pathways to inclusion / Identidad de género y orientación sexual en las estadísticas públicas oficiales: caminos hacia la inclusión

Resumo A realização do Censo Demográfico 2022 trouxe à tona o debate acerca da inclusão de variáveis que permitissem alcançar minorias sexuais com baixa ou nenhuma cobertura em inquéritos populacionais oficiais no Brasil. A pauta se justifica tendo em vista que a população LGBTI+ reivindica visibilidade estatística e demanda políticas públicas para a garantia de seus direitos. O presente artigo analisa o processo de elaboração e inclusão das variáveis orientação sexual e identidade de gênero nas pesquisas domiciliares oficiais de âmbito nacional do IBGE. Para tal, foi realizado um mapeamento das experiências internacionais, que mostrou essa investigação sendo inicialmente aplicada sobretudo em inquéritos de saúde, por meio de autodeclaração e uso do método "2-step" para identificação da população trans. Além disso, sob a luz da bibliografia existente, são apresentadas as etapas de planejamento, os desafios e as perspectivas futuras de investigação do tema. Com isso, espera-se contribuir para um debate informado, tendo em vista a atual invisibilidade da população LGBTI+ nas bases de dados populacionais oficiais.

Abstract The 2022 Demographic Census shed light on the debate concerning the inclusion of variables that would allow one to reach sexual minorities with low or no coverage in official population surveys in Brazil. The agenda is justified, considering that the LGBTI+ population demands statistical visibility and calls for public policies to guarantee their rights. This article analyzes the process of the formulation and inclusion of the sexual orientation and gender identity variables in the IBGE's official national household surveys. To this end, a mapping of international experiences was carried out, which showed that this investigation was initially applied in health surveys through self-reports and the use of the "2-step" method to identify the trans population. Furthermore, in the light of the existing bibliography, the planning stages, challenges, and future perspectives for investigating the topic are presented. With this, we hope to contribute to an informed debate, given the current invisibility of the LGBTI+ population in official population databases.

Resumen El Censo Demográfico de 2022 ha despertado el debate sobre la inclusión de variables que permitan alcanzar a las minorías sexuales con baja o nula cobertura en las encuestas oficiales de población en Brasil. El tema se justifica dado que la población LGBTI+ reclama visibilidad estadística y exige políticas públicas que garanticen sus derechos. Este artículo analiza el proceso de elaboración e inclusión de las variables orientación sexual e identidad de género en las encuestas de hogares oficiales de IBGE en ámbito nacional. Para ello, se realizó un mapeo de las experiencias internacionales, mostrando que esta investigación se aplicó inicialmente sobre todo en las encuestas de salud, a través de la autodeclaración y el uso del método de los "2-step" para identificar a la población trans. Además, a la luz de la bibliografía existente, se presentan las etapas de planificación, los desafíos y las perspectivas futuras de la investigación sobre el tema. Se espera, por tanto, contribuir a un debate informado, dada la actual invisibilidad de la población LGBTI+ en las bases de datos poblacionales oficiales.