COVID-19 and health systems in Brazil and around the world: effects on the working conditions and health of health workers. / COVID-19 e os sistemas de saúde do Brasil e do mundo: repercussões das condições de trabalho e de saúde dos profissionais de saúde.

This article discusses the impacts of the COVID-19 pandemic on health systems and its effects on the working conditions and mental health of health professionals and invisible health workers. It presents data on deaths among health professionals, highlighting the need for better and safer working conditions and improvements in public management. We emphasize WHO/PAHO recommendations and the need for equitable vaccine distribution, including poor countries and vulnerable populations. We also highlight the impacts of interrupting essential health services, such as the treatment of chronic conditions and infectious disease prevention, and the damage caused by the dissemination of fake news, stressing the need to improve access to correct and safe health information.

Este artigo apresenta os impactos da pandemia nos sistemas de saúde e as repercussões nas condições de trabalho e saúde mental dos profissionais de saúde e trabalhadores invisíveis da saúde no contexto da COVID-19. Apresenta a mortalidade entre os profissionais da saúde destacando a necessidade de melhores condições de trabalho e de segurança para os trabalhadores da saúde e melhora da gestão pública. Enfatiza as recomendações da OMS/OPAS, a necessidade de vacinação equânime, incluindo os países mais pobres e as populações mais vulneráveis. Relata os impactos da interrupção dos serviços essenciais em saúde, como para as doenças crônicas e infecciosas, e os prejuízos causados pela disseminação de informações falsas pela rede social, e lembra da necessidade de veiculação de informações corretas e seguras na saúde.

COVID-19 e os sistemas de saúde do Brasil e do mundo: repercussões das condições de trabalho e de saúde dos profissionais de saúde / COVID-19 and health systems in Brazil and around the world: effects on the working conditions and health of health workers

Resumo Este artigo apresenta os impactos da pandemia nos sistemas de saúde e as repercussões nas condições de trabalho e saúde mental dos profissionais de saúde e trabalhadores invisíveis da saúde no contexto da COVID-19. Apresenta a mortalidade entre os profissionais da saúde destacando a necessidade de melhores condições de trabalho e de segurança para os trabalhadores da saúde e melhora da gestão pública. Enfatiza as recomendações da OMS/OPAS, a necessidade de vacinação equânime, incluindo os países mais pobres e as populações mais vulneráveis. Relata os impactos da interrupção dos serviços essenciais em saúde, como para as doenças crônicas e infecciosas, e os prejuízos causados pela disseminação de informações falsas pela rede social, e lembra da necessidade de veiculação de informações corretas e seguras na saúde.

Abstract This article discusses the impacts of the COVID-19 pandemic on health systems and its effects on the working conditions and mental health of health professionals and invisible health workers. It presents data on deaths among health professionals, highlighting the need for better and safer working conditions and improvements in public management. We emphasize WHO/PAHO recommendations and the need for equitable vaccine distribution, including poor countries and vulnerable populations. We also highlight the impacts of interrupting essential health services, such as the treatment of chronic conditions and infectious disease prevention, and the damage caused by the dissemination of fake news, stressing the need to improve access to correct and safe health information.

The Brazilian experience of implementing the active pharmacovigilance of dolutegravir.

In 2017, the Ministry of Health Brazilian started using dolutegravir (DTG) 50 mg to all people living with HIV who began antiretroviral therapy (ART) or rescue regimens. Although DTG is thought to have better tolerability levels and a lower possibility of causing adverse reactions, it is necessary to continuously evaluate the safety profile of the drug in the population. Therefore, an active pharmacovigilance project for DTG was implemented. The objective of this study was to describe the Brazilian experience of implementing pharmacovigilance and the results obtained during the period between April and December 2017.Active pharmacovigilance was implemented through patient interviews and an online questionnaire developed in the Medication Logistics Control System (SICLOM).Of the total number of people on DTG in Brazil (79,742) 90.33% participated in the project, and 2.24% of those who participated reported adverse reactions to the drug; of those who reported adverse reactions, 73.86% were on first-line ART regimens, and 26.13% were on third-line regimens. The mean age of the patients who had adverse reactions to DTG was 39 years; 68.79% were male, and 31.21% were female. Of the adverse reactions reported, 50.39% were considered persistent. The 3 most frequent reactions were nausea (13.34%), diarrhea (9.83%), and headaches (9.23%).The Brazilian experience with this project has been deemed successful by federal and local managers, and the online tool to collect data has proved to be an important strategy for the pharmacovigilance of DTG as well as that of other drugs.

Changing mortality profile among HIV-infected patients in Rio de Janeiro, Brazil: shifting from AIDS to non-AIDS related conditions in the HAART era.

INTRODUCTION: We describe temporal trends in the mortality rates and factors associated with AIDS and non-AIDS related mortality at the Evandro Chagas Clinical Research Institute (IPEC), Oswaldo Cruz Foundation (FIOCRUZ). METHODS: Adult patients enrolling from 1986 through 2009 with a minimum follow up of 60 days were included. Vital status was exhaustively checked using patients' medical charts, through active contact with individuals and family members and by linkage with the Rio de Janeiro Mortality database using a previously validated algorithm. The CoDe protocol was used to establish the cause of death. Extended Cox proportional hazards models were used for multivariate modeling. RESULTS: A total of 3530 individuals met the inclusion criteria, out of which 868 (24.6%) deceased; median follow up per patient was 3.9 years (interquartile range 1.7-9.2 years). The dramatic decrease in the overall mortality rates was driven by AIDS-related causes that decreased from 9.19 deaths/100PYs n 1986-1991 to 1.35/100PYs in 2007-2009. Non-AIDS related mortality rates remained stable overtime, at around 1 death/100PYs. Immunodeficiency significantly increased the hazard of both AIDS-related and non-AIDS-related causes of death, while HAART use was strongly associated with a lower hazard of death from either cause. CONCLUSIONS: Our results confirm the remarkable decrease in AIDS-related mortality as the HIV epidemic evolved and alerts to the conditions not traditionally related to HIV/AIDS which are now becoming more frequent, needing careful monitoring.

Prevenção e tratamento dos agravos resultantes da violência sexual contra mulheres e adolescentes: norma técnica / Prevention and treatment of demages resulting from sexual violence against women and adolescents: technical standard

O Estado brasileiro, por intermédio do Ministério da Saúde, assumiu o compromisso com os direitos humanos das mulheres e com a garantia do exercício pleno de sua saúde física e mental, por meio da formulação de políticas públicas de saúde que respondam a suas reais necessidades. A atenção à violência sexual e doméstica é objetivo específico da Política Nacional de Atenção Integral à Saúde da Mulher, na qual estão previstas ações

Antiretroviral treatment in resource-poor settings: the Brazilian experience.

The Brazilian HIV/AIDS drug policy has been highly debated and even criticized, particularly at the time of its implementation by the Government in early 90s. However, after more than a decade of action, the success of the Brazilian response to HIV is evident and recognized worldwide, lying upon a concerted early governmental response, a strong and effective participation of the civil society, a multisectoral mobilization, a balanced prevention and treatment approach and the advocacy of human rights in all strategies, particularly with the policy of wide access to antiretroviral drugs. This policy made highly active anti-retroviral therapy (HAART) universally available since 1996, with logistic and criteria distribution based on regularly updated national guidelines. Approximately 140,000 patients now receive antiretroviral (ARV) treatment through the public health system. As a result there has been a significant fall in morbidity/mortality rates, hospital admissions and costs of treatment, with significant growth in demand for outpatient services and decrease for hospital, home and day-care services. It has also led to improvements in the quality of life for HIV+ individuals and savings in the medical costs, while economic and social related costs also have fallen. The policy of universal access to combined antiretroviral treatment (ART)' in Brazil has been shown to be cost-effective and the financial resources devoted to this initiative represents an economically viable investment. This experience also shows that a well-designed and supported international effort to reduce drug prices and improve health infrastructure could overcome many obstacles in middle-income and limited-resource countries.

Antiretroviral treatment in resource-poor settings: the Brazilian experience

The Brazilian HIV/AIDS drug policy has been highly debated and even criticized, particularly at the time of its implementation by the Government in early 90s. However, after more than a decade of action, the success of the Brazilian response to HIV is evident and recognized worldwide, lying upon a concerted early governmental response, a strong and effective participation of the civil society, a multisectoral mobilization, a balanced prevention and treatment approach and the advocacy of human rights in all strategies, particularly with the policy of wide access to antiretroviral drugs. This policy made highly active anti-retroviral therapy (HAART) universally available since 1996, with logistic and criteria distribution based on regularly updated national guidelines. Approximately 140,000 patients now receive antiretroviral (ARV) treatment through the public health system. As a result there has been a significant fall in morbidity/mortality rates, hospital admissions and costs of treatment, with significant growth in demand for outpatient services and decrease for hospital, home and day-care services. It has also led to improvements in the quality of life for HIV+ individuals and savings in the medical costs, while economic and social related costs also have fallen. The policy of universal access to combined antiretroviral treatment (ART)' in Brazil has been shown to be cost-effective and the financial resources devoted to this initiative represents an economically viable investment. This experience also shows that a well-designed and supported international effort to reduce drug prices and improve health infrastructure could overcome many obstacles in middle-income and limited-resource countries

Diagnóstico da tuberculose em pacientes infectados pelo HIV/AIDS / Tuberculosis diagnosis in HIV/AIDS patients

A co-infecção tuberculose-HIV altera a história natural das duas doenças. O aumento da replicação do HIV secundário à infecção pelo Mycobacterium tuberculosis agrava a imunodeficência, o que, por sua vez, toma a tuberculose mais agressiva e de difícil diagnóstico. Com o aumento da epidemia do HIV, a sobreposição das duas doenças deve se tomar cada vez mais freqüente. Os quadros clínicos atípicos dificultam o diagnóstico, e o tratamento de prova pode ser usado como auxilio ao diagnóstico em situações que ponham em risco a vida do paciente. As peculiaridades no diagnóstico da tuberculose associada à infecção pelo HIV e os exames laboratoriais disponíveis são discutidos em detalhes neste artigo, tendo em vista que a precocidade do diagnóstico é decisiva na sobrevida do paciente.

The co-infection tuberculosis-HIV modifies the natural history of both diseases. The HIV replication increase due to Mycobacterium tuberculosis infection worsens immunodeficiency, which turns tuberculosis more aggressive and hard to diagnosis. The spread of HIV epidemics is increasing these diseases overlap, whit an increase of co-infection cases. Atypical clinical presentation impairs the diagnosis and the treatment could be used as a diagnostic tool in life-threatened cases. The peculiarities of tuberculosis diagnosis and laboratory tests available are discussed in details, once the early diagnosis is very important to patient survival.

Estudo comparativo entre crianças de escolas públicas e privadas de Belo Horizonte-MG: avaliaçäo sócio-econômica e nutricional / Comparative study between children from public and private schools of Belo Horizonte: nutritional and socioeconomical evaluation

Com o objetivo de quantificar as diferenças existentes entre escolares de classes sociais ricas e pobres de Belo Horizonte, Minas Gerais, foram estudadas, em 1987, 800 crianças, a metade alunos da rede de ensino privada e a outra metade da rede pública da periferia da cidade. Os resultados evidenciam as precárias condiçöes habitacionais das classes mais pobres, o represamento dos escolares da rede pública nos primeiros anos do primeiro grau, a baixa ingestäo domiciliar de proteina animal e o consequente deficit das crianças das classes menos favorecidas. É comentada a necessidade de um diagnóstico preciso da questäo para que as açöes para combatê-las, ao serem implementadas de fato, possam ter sua eficácia avaliada.

SIDA: uma visäo acadêmica de um problema multidisciplinar / AIDS: an academic view of a multidisciplinary problem

Analisa-se inicialmente a síndrome de imunodeficiência adquirida (AIDS) como uma nova epidemia, fazendo-se consideraçöes sobre os vários aspectos desta nova entidade nosológica, bem como as repercussöes nos meios social e médico. Apresenta-se, ainda, alguns conceitos e informaçöes sobre novas descobertas, envolvendo a doença, principalmente sob o aspecto da sua transmissäo; por outro lado, apontam-se problemas no seu atendimento médico-hospitalar e fazem-se consideraçöes éticas sobre este problema. Procura-se mostrar a importância do estudo da AIDS no desenvolvimento dos vários ramos da medicina, sobretudo na imunologia, e como a elucidaçäo de sua patogênese pode auxiliar na soluçäo de alguns problemas cruciais da medicina moderna. Coloca-se o atendimento médico do paciente portador de AIDS como uma açäo multidisciplinar e destacando-se a importância do hospital de ensino nesta funçäo. Por fim,fazem-se sugestöes para o melhor atendimento destes pacientes, discutindo-se os riscos potencias desta infecçäo diante do quadro das grandes endemias nacionais