SARS CoV-2 infection among Healthcare Workers from different public health units in Brazil.

Understanding COVID-19 exposure differences among Healthcare Workers (HCWs) across various healthcare units is crucial for their protection and effective management of future outbreaks. However, comparative data on COVID-19 among HCWs in different healthcare units are scarce in Brazil. This study evaluated the relationship between SARS-CoV-2 infection and workplaces in HCWs from three distinct healthcare settings in Brazil. It also examined COVID-19 symptom dynamics reported by them. The cohort comprised 464 HCWs vaccinated with two doses of CoronaVac and a BNT162b2 booster from different institutions: Primary Health Care Units (PHCUs), Emergency Care Units (ECUs), and Hospitals. Participants answered a questionnaire and underwent blood collection at various time points after vaccinations. RT-PCR data and post-vaccination antibody responses were utilized as indicators of SARS-CoV-2 infection. We found that most infected HCWs worked in ECUs, where positive RT-PCR percentages were higher compared to PHCUs and Hospitals. ECUs also showed the highest seropositivity and antibody levels, especially after the first CoronaVac dose. The second dose of CoronaVac diminished the differences in the antibody levels among HCWs from ECUS, PHCUs, and Hospitals, indicating the benefit of the second dose to equalize the antibody levels between previously exposed and unexposed persons. Moreover, COVID-19 symptoms appeared to evolve over time.

Dynamics of SARS-CoV-2 Antibody Response to CoronaVac followed by Booster Dose of BNT162b2 Vaccine.

We evaluated the longitudinal dynamics of antibody response to the SARS-CoV-2 vaccine CoronaVac and the effect of a booster dose of BNT162b2 vaccine. We found a robust antibody response after the second dose of CoronaVac that wanes over time. The response was recovered by BNT162b2, which boosted anti-spike antibody titers.

Dynamics of antibody response to CoronaVac vaccine.

CoronaVac was the first vaccine approved in Brazil for use in healthcare workers (HCWs). However, there is limited information about it, with little long-term evidence on post-vaccination antibody persistence. This study evaluated the antibody response to SARS-CoV-2 in 1237 HCWs after the first (1D), second dose (2D), and 6 months postvaccination (6mA2D) with CoronaVac. The seropositivity was 88% at 1D, increasing to 99.8% at 2D, but decreasing to 97.9% at 6mA2D, which was also observed at the analyzed antibody levels. Interestingly, the levels in females were higher than males, and we found a positive correlation with previous SARS-CoV-2 infection. Participants with comorbidities had lower levels suggesting the need to monitor for a potential booster dose. Our findings suggest that CoronaVac induced a robust antibody response that wanes significantly over time. Further longitudinal studies are needed to identify whether the antibodies will decline or plateau at a lower level.

Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries.

Many intrinsically related determinants of health and disease exist, including social and economic status, education, employment, housing, and physical and environmental exposures. These factors interact to cumulatively affect health and disease burden of individuals and populations, and to establish health inequities and disparities across and within countries. Biomedical models of health care decrease adverse consequences of disease, but are not enough to effectively improve individual and population health and advance health equity. Social determinants of health are especially important in Latin American countries, which are characterised by adverse colonial legacies, tremendous social injustice, huge socioeconomic disparities, and wide health inequities. Poverty and inequality worsened substantially in the 1980s, 1990s, and early 2000s in these countries. Many Latin American countries have introduced public policies that integrate health, social, and economic actions, and have sought to develop health systems that incorporate multisectoral interventions when introducing universal health coverage to improve health and its upstream determinants. We present case studies from four Latin American countries to show the design and implementation of health programmes underpinned by intersectoral action and social participation that have reached national scale to effectively address social determinants of health, improve health outcomes, and reduce health inequities. Investment in managerial and political capacity, strong political and managerial commitment, and state programmes, not just time-limited government actions, have been crucial in underpinning the success of these policies.

Health-system reform and universal health coverage in Latin America.

Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens--with defined and enlarged benefits packages--and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and improving access of the most disadvantaged populations. Hence, the distinguishing features of health-system strengthening for universal health coverage and lessons from the Latin American experience are relevant for countries advancing universal health coverage.

Equitable access to health services for children aged 5 to 9 in a medium city of northeasth of Brazil: a result of Family Health Strategy.

INTRODUCTION: The Brazilian National Health System may reduce inequalities in access to health services through strategies that can reach those most in need with no access to care services. OBJECTIVE: To identify factors associated with the use of health service by children aged 5 to 9 years in the city of Sobral, Ceará, northeastern Brazil. RESULTS: Only 558 (17.0%) children used health care services in the 30 days preceding this survey. Children with any health condition (OR = 3.90) who were frequent attenders of primary care strategy of organization (the Family Health Strategy, FHS) (OR = 1.81) and living in the city's urban area (OR = 1.51) were more likely to use health services. Almost 80% of children used FHS as their referral care service. Children from poorer families and with easier access to services were more likely to be FHS users. CONCLUSION: The study showed that access to health services has been relatively equitable through the FHS, a point of entry to the local health system.

Social Determinants of Health among children aged between 5 and 9 years within the urban area, Sobral, Ceará, Brazil.

INTRODUCTION: In the district of Sobral, for the decade of 2000 at the same time that political measures were implanted towards the decrease of children mortality, discussions have begun about health and educations conditions, as well as life quality of children aged between 5 and 9, which is an age group of lesser vulnerability as far as health goes, although of major importance in the development of healthy habits and for the child's development itself. OBJECTIVE: Based on such scenario, it was set up a cohort of children aged between 5 and 9 and residents of the urban area of the district in order to study health and education conditions and quality of life which are essential for the future of these children in light of the Social Determinants of Health. METHODS: This is a cross-sectional study with a cohort of children born from 1990 to 1994, home interviews, clinical evaluation and lab exams. The structure for the development of the research was elaborated based on the model of attention towards the health of Family Health Strategy. In this report, the results of such home interviews shall be presented in regards to socio-demographic and environmental conditions in general, with a more detailed analysis of life styles, educational levels, child labor, nutrition and the use of health services by children.

[Access and comprehensiveness: the viewpoint of users of a mental health network]. / Acesso e integralidade: a compreensão dos usuários de uma rede de saúde mental.

This article analyzes user viewpoints regarding mental health care, with a focus on comprehensiveness and access at Psychosocial Care Centers (PCCs). It is a qualitative study with theoretical and methodological references of the Fourth Generation Evaluation and application of the Hermeneutic Dialectic Circle technique. Twelve users of ten mental health services in Fortaleza were interviewed from March to May 2011. Themes of the study were grouped from the narratives, with the hermeneutics of Paul Ricoeur as the benchmark for analysis. The thematic categories were: viewpoints on mental healthcare; conflicts between supply and the subjective need to receive; similarities and differences: from tutelage to autonomy; absence and belonging: open PCCs and non-community centers; between stigma and humanization. The main findings are: the PCCs are seen as spaces for conviviality able to establish affective and social networks; stigma, prejudice and tutelage are present in the services, in their families and in the community; asylum practices persist in alternative services; the humanization of care extends access and bonding in the services; the trajectory of users of the Unified Health System occurs due to their social and health needs.