The governance of antimicrobial resistance in Brazil: Challenges for developing and implementing a one health agenda.

This article explores stakeholders' perceptions of the challenges for developing a One Health agenda to tackle antimicrobial resistance (AMR) in Brazil, including the development and implementation of the Brazilian National Action Plan (BR-NAP). The data originate from 27 interviews conducted with human, environmental, and animal health stakeholders, including academics, managers, and policymakers involved in developing the BR-NAP. Through thematic analysis, we identified three interconnected themes: governance, the health system, and technical and scientific challenges. The findings draw particular attention to failures in the agenda-setting process, revealed by interviewees strongly emphasising that AMR is not considered a policy priority in Brazil. The lack of political will and awareness of the clinical, social, and economic impacts of AMR are considered the main impediments to the agenda's progress. The joint work across disciplines and ministries must be reinforced through policymaker engagement and better environmental sector integration. The agenda must include sustainable governance structures less affected by political winds. Policies should be designed jointly with state and local governments to create strategies to engage communities and improve their translation into effective implementation.

An analysis of existing national action plans for antimicrobial resistance-gaps and opportunities in strategies optimising antibiotic use in human populations.

At the 2015 World Health Assembly, UN member states adopted a resolution that committed to the development of national action plans (NAPs) for antimicrobial resistance (AMR). The political determination to commit to NAPs and the availability of robust governance structures to assure sustainable translation of the identified NAP objectives from policy to practice remain major barriers to progress. Inter-country variability in economic and political resilience and resource constraints could be fundamental barriers to progressing AMR NAPs. Although there have been regional and global analyses of NAPs from a One Health and policy perspective, a global assessment of the NAP objectives targeting antimicrobial use in human populations is needed. In this Health Policy, we report a systematic evidence synthesis of existing NAPs that are aimed at tackling AMR in human populations. We find marked gaps and variability in maturity of NAP development and operationalisation across the domains of: (1) policy and strategic planning; (2) medicines management and prescribing systems; (3) technology for optimised antimicrobial prescribing; (4) context, culture, and behaviours; (5) operational delivery and monitoring; and (6) patient and public engagement and involvement. The gaps identified in these domains highlight opportunities to facilitate sustainable delivery and operationalisation of NAPs. The findings from this analysis can be used at country, regional, and global levels to identify AMR-related priorities that are relevant to infrastructure needs and contexts.

Coping with in-locus factors and systemic contradictions affecting antibiotic prescription and dispensing practices in primary care-A qualitative One Health study in Brazil.

Antimicrobial resistance (AMR) is an increasing threat to global health. The risks and sanitary consequences of AMR are disproportionately experienced by those living in Low- and Middle-Income Countries (LMICs). While addressing antibiotic use has largely been documented in hospital settings, the understanding of social drivers affecting antibiotic prescribing and dispensing practices in the context of human and animal health in primary care (PC) in LMICs remains extremely limited. We seek to explore how in-locus and multi-level social factors influence antibiotic prescriptions and dispensing practices in the context of human and animal health in primary care in Brazil. This is a baseline qualitative One Health study; semi-structured interviews and field observations were undertaken in primary care sites located in a socioeconomically vulnerable area in the city of São Paulo, the most populated city of Brazil. Twenty-five human and animal healthcare professionals (HP) were purposely sampled. Interview data were subject to thematic analysis. Three overlapping social drivers were identified across HPs' discourses: individual and behavioral challenges; relational and contextual factors influencing the overprescription of antibiotics (AB); and structural barriers and systemic contradictions in the health system. As a result of the interaction between multilevel in-locus and structural and contextual factors, HPs experience contextual and territorial challenges that directly influence their risk perception, diagnosis, use of laboratorial and image exams, time and decision to undergo treatment, choice of AB and strategies in coping with AB prescriptions. Additionally, in-locus factors influencing antibiotic prescriptions and dispensing practices are intertwined with individual accounts of risk management, systemic contradictions and ambivalences in the national health system. Our findings suggest interventions tackling AB use and AMR in Brazil should consider the social context, the complex health system structure and current integrated programs and services in PC.

[Police reports on the prevention of violence among youths: experiences in Brazil and Scotland]. / Narrativas policiais sobre prevenção da violência e juventudes: experiências no Brasil e na Escócia.

This study analyzes the reports of police officers on violence prevention initiatives in the city of Rio de Janeiro, Brazil, and in the city of Glasgow, Scotland. The theoretical-methodological framework of the social sciences, based on interpretative anthropology, was used to analyze the data. The results reveal the demand for intervention at an increasingly early stage, aiming at young people from outlying urban neighborhoods in both countries. Dysfunctional family environment, social vulnerability and involvement with crime are cited as risk factors. Reports such as these, promote the prospect of negativity and of labeling youth as a "social problem", reuniting formulations that are structured on the basis of the symbiosis between the role of agent of the state and the moral ethos that supports the individual decisions of police officers. The study highlights the complexity of the interventions, and the dispute around the forms of control and the maintenance of order in the two contexts analyzed. It is suggested that future studies investigate how the rationale present in the field of public health has been incorporated into public safety policies and programs. The risks of narratives reinforcing the stigmatization of underprivileged youths in violence prevention initiatives are emphasized.

Esse estudo analisa as narrativas de policiais sobre iniciativas de prevenção da violência na cidade do Rio de Janeiro, no Brasil e na cidade de Glasgow, na Escócia. Utilizou-se o referencial teórico-metodológico das ciências sociais, com os aportes da antropologia interpretativa. Os resultados apontam para a produção de intervenções cada vez mais precoces dirigidas às juventudes de periferias urbanas nos dois países. Prevalecem narrativas que reforçam ideias do ambiente familiar desestruturado, da vulnerabilidade social e do envolvimento com o crime como fatores de risco. Tais narrativas privilegiam a ótica do negativismo e da juventude como "problema social", unificando formulações que se estruturam a partir da simbiose entre o papel de agente do estado e o ethos moral que sustenta as decisões individuais de policiais. O estudo sinaliza para a complexidade das intervenções, bem como para a disputa em torno dos modos de controle e da produção da ordem nos dois contextos analisados. Sugere-se investigar, em estudos futuros, como a racionalidade presente no campo da saúde pública vem sendo incorporada em políticas e programas de segurança pública. Ressaltam-se os riscos das narrativas que reforçam estigmas sobre os jovens pobres em iniciativas de prevenção da violência.

Narrativas policiais sobre prevenção da violência e juventudes: experiências no Brasil e na Escócia / Police reports on the prevention of violence among youths: experiences in Brazil and Scotland

Resumo Esse estudo analisa as narrativas de policiais sobre iniciativas de prevenção da violência na cidade do Rio de Janeiro, no Brasil e na cidade de Glasgow, na Escócia. Utilizou-se o referencial teórico-metodológico das ciências sociais, com os aportes da antropologia interpretativa. Os resultados apontam para a produção de intervenções cada vez mais precoces dirigidas às juventudes de periferias urbanas nos dois países. Prevalecem narrativas que reforçam ideias do ambiente familiar desestruturado, da vulnerabilidade social e do envolvimento com o crime como fatores de risco. Tais narrativas privilegiam a ótica do negativismo e da juventude como "problema social", unificando formulações que se estruturam a partir da simbiose entre o papel de agente do estado e o ethos moral que sustenta as decisões individuais de policiais. O estudo sinaliza para a complexidade das intervenções, bem como para a disputa em torno dos modos de controle e da produção da ordem nos dois contextos analisados. Sugere-se investigar, em estudos futuros, como a racionalidade presente no campo da saúde pública vem sendo incorporada em políticas e programas de segurança pública. Ressaltam-se os riscos das narrativas que reforçam estigmas sobre os jovens pobres em iniciativas de prevenção da violência.

Abstract This study analyzes the reports of police officers on violence prevention initiatives in the city of Rio de Janeiro, Brazil, and in the city of Glasgow, Scotland. The theoretical-methodological framework of the social sciences, based on interpretative anthropology, was used to analyze the data. The results reveal the demand for intervention at an increasingly early stage, aiming at young people from outlying urban neighborhoods in both countries. Dysfunctional family environment, social vulnerability and involvement with crime are cited as risk factors. Reports such as these, promote the prospect of negativity and of labeling youth as a "social problem", reuniting formulations that are structured on the basis of the symbiosis between the role of agent of the state and the moral ethos that supports the individual decisions of police officers. The study highlights the complexity of the interventions, and the dispute around the forms of control and the maintenance of order in the two contexts analyzed. It is suggested that future studies investigate how the rationale present in the field of public health has been incorporated into public safety policies and programs. The risks of narratives reinforcing the stigmatization of underprivileged youths in violence prevention initiatives are emphasized.

[Homicides in Rio de Janeiro, Brazil: an analysis of lethal violence]. / Homicídios no Rio de Janeiro, Brasil: uma análise da violência letal.

The evolution of rates were analyzed for the following categories: murder, larceny, bodily harm followed by death, homicide for resistance to police resulting in death, policeman killed, missing persons and dead bodies found in the state and city of Rio de Janeiro and in Integrated Public Security Area 16 (AISP 16). An ecological study was conducted for the period from 2002 to 2013, using data from the Public Security Institute. To analyze the time trend and evolution of murder charges, resistance to police resulting in death and missing persons rates, Joinpoint regression was performed, using these rates as the dependent variables and the calendar year as the independent variable. For the other categories only the time trends of the rates were analyzed for the relative change in rates at the beginning and end of the period. There were falls in rates in all categories, except for missing persons. The murder rate showed a significant downward trend in the three locations. The results contributed to definition of the pattern of violence in the three locations based on the dialogue between the social sciences, public health and safety that made it possible to establish subjective and objective aspects linked to the study findings.

Homicídios no Rio de Janeiro, Brasil: uma análise da violência letal / Homicides in Rio de Janeiro, Brazil: an analysis of lethal violence

Resumo Analisou-se a evolução de taxas das categorias homicídio doloso, latrocínio, lesão corporal seguida de morte, homicídio por auto de resistência, policial morto, pessoa desaparecida e encontro de cadáver, no Estado e na cidade do Rio de Janeiro e na Área Integrada de Segurança Pública 16 (AISP 16). Para tanto, foi realizado estudo ecológico, no período de 2002 a 2013, utilizando os dados do Instituto de Segurança Pública. Para análise da evolução temporal e tendência das taxas de homicídio doloso, de autos de resistência e de pessoas desaparecidas foi realizada regressão Joinpoint, considerando como variável dependente as referidas taxas e como variável independente o ano calendário. Para as demais categorias analisou-se apenas a evolução temporal das taxas a partir do cálculo da variação relativa destas no início e no final do período. Houve queda de taxas em todas as categorias, com exceção de pessoas desaparecidas. A taxa de homicídio doloso apresentou tendência significativa de decréscimo nas três localidades. Os resultados contribuíram para descrever o padrão da violência nas três localidades a partir do diálogo entre as ciências sociais, saúde e segurança pública, o que permitiu contemplar aspectos subjetivos e objetivos ligados aos achados do estudo.

Abstract The evolution of rates were analyzed for the following categories: murder, larceny, bodily harm followed by death, homicide for resistance to police resulting in death, policeman killed, missing persons and dead bodies found in the state and city of Rio de Janeiro and in Integrated Public Security Area 16 (AISP 16). An ecological study was conducted for the period from 2002 to 2013, using data from the Public Security Institute. To analyze the time trend and evolution of murder charges, resistance to police resulting in death and missing persons rates, Joinpoint regression was performed, using these rates as the dependent variables and the calendar year as the independent variable. For the other categories only the time trends of the rates were analyzed for the relative change in rates at the beginning and end of the period. There were falls in rates in all categories, except for missing persons. The murder rate showed a significant downward trend in the three locations. The results contributed to definition of the pattern of violence in the three locations based on the dialogue between the social sciences, public health and safety that made it possible to establish subjective and objective aspects linked to the study findings.

Onde os fracos não têm vez: discursos sobre anabolizantes, corpo e masculinidades em uma revista especializada / Where the weak have no place: discourses on steroids, body and masculinities in a specialized magazine

O objetivo deste estudo é analisar as matérias sobre esteróides anabolizantes androgênicos (EAA) e doping, publicadas em uma revista especializada em artes marciais, a Tatame, entre os anos 1996 e 2010. Utilizou-se metodologia qualitativa, a partir do referencial fornecido pelas Ciências Sociais e suas interfaces com o campo da Saúde Coletiva. A análise e discussão dos discursos acerca do uso de EAA e doping foram organizados em quatro etapas: na primeira, ocorreu uma leitura abrangente do material jornalístico; na segunda etapa, foram examinadas as matérias, focalizando os títulos, subtítulos e conteúdos. Na terceira, verificou-se o meio circundante dos boxes, capas, contracapas e espaços publicitários da revista. A quarta etapa privilegiou a perspectiva dos lutadores sobre a utilização de EAA e/ou doping, veiculadas tanto nas matérias em que estes usos são o foco central, quanto em reportagens em que estes não são a temática principal. Os resultados indicam um descompasso entre os conteúdos veiculados na imprensa, que, de um lado, condenam o uso de EAA e doping, e de outro, divulgam uma série de estímulos para o desenvolvimento da musculosidade. Desta forma, os conteúdos acabam por corroborar a ideia de uma estreita associação entre musculosidade e um tipo de masculinidade tradicional ancorado na positivação da força e na invencibilidade.

This study aims to analyze the materials on anabolic androgenic steroids (AAS) and doping, published in a magazine specializing in martial arts, Tatame, between the years 1996 and 2010. We used qualitative methodology, from the benchmark provided by the Social Sciences and its interfaces with Public Health. The analysis and discussion of the discourses about the use of AAS and doping were organized into four phases: first, there was a comprehensive reading of journalistic material; in the second, the subjects were examined, focusing on titles, subtitles and content. In the third, it was the surroundings of boxes, covers, back covers and magazine advertising space. The fourth stage favored the perspective of fighters on the use of EAA and / or doping, conveyed both in matters where these uses are the central focus, as in stories in which they are not the main theme. The results indicate a mismatch between the content conveyed in the press, which, on one hand, condemns the use of AAS and doping, and the other, discloses a series of stimuli for the development of muscularity. Thus, the contents eventually support the idea of close association between muscularity and a kind of traditional masculinity positivization anchored in the strength and invincibility.