La influencia de las instituciones en los consejos locales de salud / The influence of the institutions on local health councils

Objetivo: Analizar la influencia de las instituciones en el funcionamiento de los consejos locales de salud. Diseño: Estudio cualitativo, descriptivo y exploratorio. Emplazamiento: Dos servicios de atención primaria de salud de un municipio del interior del estado de São Paulo, Brasil.Participantes: Veinticuatro miembros de los consejos locales de salud y 4 informantes clave. Método: Basado en el marco teórico y metodológico del análisis institucional. Los datos fueron producidos a través de 28 entrevistas individuales con preguntas semiestructuradas, observación, participación en las actividades de los consejos y registro en el diario de investigación. Los datos fueron organizados por el proceso de transcripción, transposición y reconstitución. Resultados: Las instituciones actúan en los territorios representados por actores sociales que ocupan cargos y funciones dentro de los servicios de atención primaria de salud, evidenciando la perpetuación de la jerarquización con valorización de los discursos de los profesionales y gestores en detrimento de los pacientes y predominio de reuniones burocratizadas. Los actores sociales reproducen los ideales del colectivo al que pertenecen en estos espacios. Conclusión: No siempre los equipos de gestión de salud reconocen las diferentes fuerzas que actúan en el territorio de salud, sin embargo, estas fuerzas interfieren en las actividades desarrolladas y en la atención de la salud. Los grupos actúan tanto en espacios formales a través de representantes oficiales que se reúnen y discuten temas en colegiados como en espacios informales y constituyen fuerzas en disputa en el territorio de salud.(AU)

Objective: To analyze the influences of the institutions in the operation of the Local Health councils. Design: qualitative, descriptive and exploratory study. Study setting: 02 Primary Health Care services of a municipality in the inland of the state of São Paulo, Brazil. Participants: twenty-four members of the Local Health Councils and 4 key informants. Methods: Supported by the theoretical methodological framework of Institutional Analysis. Data were produced through 28 semi-structured interviews, observation and participation in the activities of the councils and recording in the research diary. Data were organized and analyzed by the process of transcription, transposition and reconstitution. Results: The institutions act in the territories represented by social actors who occupy positions and functions within the Primary Health Care services, evidencing the perpetuation of hierarchization with valorization of the speeches of professionals and managers to the detriment of patients and predominance of bureaucratized meetings. The social actors reproduce the ideals of the collective to which they belong in these spaces. Conclusions: The health management teams do not recognize the different forces that act in the health territory, however, these forces interfere in the activities performed and in health care. The groups act both in formal spaces through official representatives who meet and discuss issues in collegiate meetings and in informal spaces, and constitute forces in dispute in the health territory.(AU)

[The influence of the institutions on local health councils]. / La influencia de las instituciones en los consejos locales de salud.

OBJECTIVE: To analyze the influences of the institutions in the operation of the Local Health councils. DESIGN: qualitative, descriptive and exploratory study. STUDY SETTING: 02 Primary Health Care services of a municipality in the inland of the state of São Paulo, Brazil. PARTICIPANTS: twenty-four members of the Local Health Councils and 4 key informants. METHODS: Supported by the theoretical methodological framework of Institutional Analysis. Data were produced through 28 semi-structured interviews, observation and participation in the activities of the councils and recording in the research diary. Data were organized and analyzed by the process of transcription, transposition and reconstitution. RESULTS: The institutions act in the territories represented by social actors who occupy positions and functions within the Primary Health Care services, evidencing the perpetuation of hierarchization with valorization of the speeches of professionals and managers to the detriment of patients and predominance of bureaucratized meetings. The social actors reproduce the ideals of the collective to which they belong in these spaces. CONCLUSIONS: The health management teams do not recognize the different forces that act in the health territory, however, these forces interfere in the activities performed and in health care. The groups act both in formal spaces through official representatives who meet and discuss issues in collegiate meetings and in informal spaces, and constitute forces in dispute in the health territory.

Violence in the Nursing Workplace in the Context of Primary Health Care: A Qualitative Study.

Violence demands considerable attention due to its complexity and social consequences. The objective of this study was to analyze violence in the nursing professional workplace in the context of primary health care in Brazil. It is a qualitative study with theoretical and methodological reference to institutional analysis. It was carried out in basic health units in Brazil. Nursing professionals (N = 11) participated in semi-structured interviews and discussion groups, in addition to a research diary and participant observation. Data collection took place from October to December 2021. The results are presented in five categories: types of violence and aggressors from the perspective of nursing professionals; the causes of violence reported by professionals; strategies for the management of violence; professionals' proposals for preventing violence in health contexts; the consequences of violence in the workplace. Nursing professionals make up a large part of the workforce and have reported verbal, physical, moral, and psychological violence. The main causes are associated with user access to services. For the prevention of violence, professionals do not see themselves as protagonists of change. The consequences are the loss of quality of work and the health of professionals who requested sick leave and transfers. The study's findings can help in the development of public policies and educational and management actions.

The Work of Nurses in Primary Health Care: Crossings of the New Public Management.

The literature in the field of health management mentions a concept called new public management (NPM), introduced in Brazil and France at the end of the 20th century. The objective of the study was to analyze the repercussions of the work of nurses in primary health care in Brazil and France under the influence of NPM. This is an excerpt of a double-titled thesis, which is a research intervention with nurses from two Brazilian states and five French departments. Data were produced between February 2019 and July 2021. The public policy Health on the Hour acted as an institutional transducer, provoking a reduction in access and producing effects on professional practices. In both countries, NPM amplified the predominance of technical and quantifiable acts, the focus on individual care, and the loss of autonomy. Nurses reported insurmountable situations, using the metaphor "Sophie's choice". The results showed that making dilemmatic decisions has been the daily routine of nurses, which has not resulted in debureaucratization and higher quality of care.

The burden of alcohol, tobacco and others drugs among incarcerated population diagnosed with tuberculosis: time trends and spatial determinants in Southern Brazil.

BACKGROUND: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis and is a public health problem worldwide. It is estimated that 90% of the patients diagnosed with TB live in vulnerable environments with limited health resources, such as individuals living in correctional facilities. This study aimed to identify the consumption of alcohol, tobacco, and other drugs among prisoners diagnosed with TB and the spatial determinants and time trends of the phenomenon in southern Brazil. METHODS: A cross-sectional study using data from the Brazilian Notifiable Diseases Information System was carried out. TB cases confirmed from 2014 to 2018 in prisons located in Paraná, Brazil, were selected. The Prais-Winsten procedure was performed to identify time trends by calculating monthly rates and the percentage of monthly variation. The Seasonal-Trend by Loess decomposition method was used to verify the time series and trends. The spatial association was verified with the Getis-Ord Gi* technique, and the risk areas were identified using spatial scan statistics. RESULTS: A total of 1,099 TB cases were found in the studied population. The consumption of tobacco (n = 460; 41.9%), illegal drugs (n = 451; 41.0%), and alcohol (n = 179; 16.3%) stood out. An ascending trend was found for the consumption of alcohol (+ 19.4%/mo. (95%CI: 12.20-23.03)), tobacco (+ 20.2%/mo. (95%CI: 12.20-28.82)), and illegal drugs (+ 62.2%/mo. (95%CI: 44.54-81.97)). Spatial analysis revealed clusters for the use of alcohol, tobacco, and illegal drugs. CONCLUSIONS: This study advances knowledge presenting the burden of drug use and its typology among individuals diagnosed with TB in the prison system. There is a growing trend among patients to use drugs, especially illegal drugs. The clusters show differences between the places where the prisons are located.

Distribuição e dependência espacial da mortalidade por tuberculose em um município da região amazônica / Spatial distribution and dependence of mortality due to tuberculosis in a city in the Amazon region

Resumo Introdução A mortalidade por tuberculose é um indicador sensível às desigualdades em saúde, considerando-se que o risco para sua ocorrência está relacionado à vulnerabilidade dos territórios. Objetivo Investigar se as variações espaciais dos determinantes sociais afetam as mortes por tuberculose em um município da região amazônica. Método Estudo ecológico com medidas múltiplas de análise, composto por óbitos por tuberculose como causa básica em Manaus, Amazonas, Brasil, notificados no Sistema de Informação sobre Mortalidade (2006-2015). Nas análises, foram calculadas as taxas bruta e padronizada, e usado o Índice de Moran para verificar a autocorrelação espacial da mortalidade e, posteriormente, foi aplicada a regressão geograficamente ponderada para aferir a relação da desigualdade com as mortes por tuberculose. Resultados Foram identificados 731 óbitos pela doença. A distribuição da mortalidade ocorreu de forma heterogênea, sendo que as altas taxas de óbito por tuberculose estavam em áreas mais socialmente vulneráveis. Foram confirmadas a autocorrelação e a dependência espacial. O modelo final apresentou as variáveis indicadoras de iniquidades (baixa renda, pobreza e escolaridade), mostrando relação destas com a mortalidade. Conclusão Ficou evidente que os determinantes sociais no espaço urbano influenciam a mortalidade por tuberculose na região. Portanto, avançar em políticas públicas para corrigir as iniquidades em saúde pode influenciar positivamente esse cenário.

Abstract Background Mortality from tuberculosis is a sensitive indicator of health inequalities, given that the risk for its occurrence is related to the vulnerability of the territories. Objective To investigate whether the spatial variations of social determinants affect deaths from tuberculosis in a municipality in the Amazon region. Method Ecological study with multiple measures of analysis. The study was composed of deaths from tuberculosis as a basic cause in Manaus, Amazonas, Brazil, reported in the Brazilian Mortality Information System (2006-2015). In the analyzes, the crude and standardized rate was calculated, Moran Index was used to verify the spatial autocorrelation of mortality, and subsequently, the geographically weighted regression was applied to assess the inequality relationship of deaths from tuberculosis. Results 731 deaths from the disease were identified. The distribution of mortality was heterogeneous, with high rates of death from tuberculosis in more socially vulnerable areas. The autocorrelation and spatial dependence was confirmed. The final model presented variables that indicate inequities: low income, poverty and education, showing their relationship with mortality. Conclusion It was evident that social determinants in the urban space influence mortality from tuberculosis in the region. Therefore, advancing public policies to correct health inequities can positively impact this scenario.

Morbimortalidade por COVID-19 associada a condições crônicas, serviços de saúde e iniquidades: evidências de sindemia / COVID-19 morbidity and mortality associated with chronic disorders, healthcare services, and inequity: evidence for a syndemic / Morbimortalidad por COVID-19 asociada a los problemas crónicos de salud, los servicios de salud y las inequidades: evidencia de sindemia

RESUMO Objetivo. Identificar os fatores correlacionados à incidência e mortalidade por COVID-19 e verificar situações de sindemia em escala global. Métodos. Realizou-se um estudo ecológico de casos e óbitos confirmados de COVID-19 a partir de informações coletadas do European Center for Disease Prevention and Control em 2019 e 2020. Para a caracterização dos países, utilizaram-se indicadores do Banco Mundial e Worldometer Coronavirus. Foram realizadas análises descritivas e de correlação entre as variáveis independentes para posteriormente realizar o modelo de regressão linear múltipla, com o objetivo de identificar os fatores correlacionados à incidência e mortalidade por COVID-19. Resultados. Obtiveram-se dados de 185 países. A média da incidência dos casos foi de 16 482/mil habitantes, enquanto a média para mortalidade por COVID-19 foi de 291/mil habitantes, sendo América do Norte e Leste Asiático e Pacífico as regiões que apresentaram maiores e menores índices, respectivamente. Identificouse correlação positiva da taxa de incidência com proporção da população com idade de 15 a 64 anos, população urbana, desigualdade conforme Índice de Gini e com seis das sete regiões analisadas (exceto Leste Asiático e Pacífico). A taxa de mortalidade apresentou correlação negativa com a população de 0 a 14 anos e positiva com população urbana, desigualdade conforme índice de Gini e todas as regiões analisadas, exceto Leste Asiático e Pacífico. Conclusões. A morbimortalidade da COVID-19 esteve correlacionada à carga de condições crônicas, ao envelhecimento da população e à baixa capacidade dos serviços de saúde para testagem e oferta de leitos hospitalares, quadro agravado em países ou regiões com elevada desigualdade social, caracterizando uma situação de sindemia.

ABSTRACT Objective. To identify factors correlated with the incidence and mortality from COVID-19 and investigate syndemic situations at the global level. Method. An ecologic study of confirmed COVID-19 cases and deaths was performed using information collected from the European Center for Disease Prevention and Control in 2019 and 2020. World Bank indicators and information obtained from Worldometer Coronavirus were used to characterize the countries. Descriptive analyses and correlations between independent variables were performed, followed by multiple linear regression analysis to identify factors correlated with COVID-19 incidence and mortality. Results. Data were obtained for 185 countries. Mean case incidence was 16 482/1,000 population, whereas mean COVID-19 mortality was 291/1,000 population, with the highest and lowest rates recorded in North America and East Asia and Pacific respectively. A positive correlation was identified between incidence rate and percent population aged 15 to 64 years, urban population, inequality measured by the Gini coefficient, and six out of the seven regions analyzed (except East Asia and Pacific). Mortality rate was negatively correlated with population aged 0 to 14 years and positively correlated with urban population, inequality measured by the Gini coefficient, and all regions analyzed except East Asia and Pacific. Conclusions. COVID-19 morbidity and mortality were correlated with the burden of chronic diseases, aging population, and low capacity of healthcare services for testing and providing hospital beds, a scenario complicated by social inequality in countries and regions, indicating a syndemic effect.

RESUMEN Objetivo. Identificar los factores correlacionados con la incidencia de COVID-19 y la mortalidad por esa causa y verificar las situaciones de sindemia a escala mundial. Métodos. Se realizó un estudio ecológico de casos de COVID-19 y de defunciones confirmadas por esa causa a partir de la información obtenida del Centro Europeo para la Prevención y el Control de las Enfermedades en el 2019 y el 2020. Para caracterizar a los países, se utilizaron indicadores del Banco Mundial y del sitio web de referencia Worldometer Coronavirus. Se hicieron análisis descriptivos y de correlación entre las variables independientes para crear posteriormente un modelo de regresión lineal múltiple con el fin de identificar los factores correlacionados con la incidencia de COVID-19 y la mortalidad por esa causa. Resultados. Se obtuvieron datos de 185 países. La tasa media de incidencia de casos de COVID-19 fue de 16 482 por mil habitantes y la tasa media de mortalidad por esa causa fue de 291 por mil habitantes. Las regiones de América del Norte y de Asia oriental y el Pacífico presentaron los mayores y menores índices, respectivamente. Se observó una correlación positiva de la tasa de incidencia con la proporción del grupo de 15 a 64 años de edad, la población urbana, la desigualdad medida por el coeficiente de Gini y seis de las siete regiones analizadas (excepto Asia oriental y el Pacífico). La tasa de mortalidad presentó una correlación negativa con el grupo de 0 a 14 años de edad y positiva con la población urbana, la desigualdad medida por el coeficiente de Gini y todas las regiones analizadas, excepto Asia oriental y el Pacífico. Conclusiones. La morbimortalidad por COVID-19 guardó una correlación con la carga de problemas crónicos de salud, el envejecimiento de la población y la poca capacidad de realizar pruebas en los servicios de salud y de ofrecer camas de hospital, cuadro agravado en los países o regiones con una elevada tasa de desigualdad social y característico de una situación de sindemia.

Inequality of gender, age and disabilities due to leprosy and trends in a hyperendemic metropolis: Evidence from an eleven-year time series study in Central-West Brazil.

The present study aimed to investigate the epidemiological situation of leprosy (Hansen's Disease), in a hyperendemic metropolis in the Central-West region of Brazil. We studied trends over eleven years, both in the detection of the disease and in disabilities, analyzing disparities and/or differences regarding gender and age. This is an ecological time series study conducted in Cuiabá, capital of the state of Mato Grosso. The population consisted of patients diagnosed with leprosy between the years 2008 and 2018. The time series of leprosy cases was used, stratifying it according to gender (male and female), disability grade (G0D, G1D, G2D, and not evaluated) and age. The calendar adjustment technique was applied. For modeling the trends, the Seasonal-Trend decomposition procedure based on Loess (STL) was used. We identified 9.739 diagnosed cases, in which 58.37% were male and 87.55% aged between 15 and 59 years. Regarding detection according to gender, there was a decrease among women and an increase in men. The study shows an increasing trend in disabilities in both genders, which may be related to the delay in diagnosis. There was also an increasing number of cases that were not assessed for disability at the time of diagnosis, which denotes the quality of the services.

Causes of multidrug-resistant tuberculosis from the perspectives of health providers: challenges and strategies for adherence to treatment during the COVID-19 pandemic in Brazil.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is a serious phenomenon on a global scale that can worsen with the COVID-19 pandemic. The study aimed to understand the perceptions of health professionals about MDR-TB, their strategies to ensure adherence to treatment and their challenges in the context of the COVID-19 pandemic in a priority municipality for disease control. METHODS: We conducted a qualitative study and recruited 14 health providers (four doctors, three nurses, three nursing technicians, three nursing assistants and a social worker) working in a city in the state of São Paulo, Brazil. Remote semi-structured interviews were conducted with the participants. For data analysis, the thematic content analysis technique was applied according to the study's theoretical framework. RESULTS: The study revealed the causes of MDR-TB are associated with poverty, vulnerability, and social risk. A pre-judgement from the providers was observed, namely, all patients do not adhere due their resistance and association with drug abuse or alcoholism. The study also observed difficulty among health providers in helping patients reconstruct and reframe their life projects under a care perspective, which would strengthen adherence. Other issues that weakened adherence were the cuts in social protection and the benefits really necessary to the patients and a challenge for the providers manage that. The participants revealed that their actions were impacted by the pandemic and insecurity and fear manifested by patients after acquiring COVID-19. For alleviating this, medical appointments by telephone, delivery of medicine in the homes of patients and visits by health professionals once per week were provided. CONCLUSION: The study advances knowledge by highlighting the challenges faced by the health system with the adherence of patients with MDR-TB in a context aggravated by the pandemic. An improvement in DOT is really necessary to help the patients reframe their lives without prejudices, face their fears and insecurity, recover their self-esteem and motivate in concluding their treatment.

Effectiveness and trend forecasting of tuberculosis diagnosis after the introduction of GeneXpert in a city in south-eastern Brazil.

BACKGROUND: To evaluate the effectiveness of a rapid molecular test for the detection of tuberculosis (TB) and to predict the rates of disease in a municipality of Brazil where TB is endemic. METHODS: An ecological study was carried out in Ribeirão Preto-SP on a population of TB cases notified between 2006 and 2017. Monthly TB incidence rates and the average monthly percentage change (AMPC) were calculated. In order to identify changes in the series, the breakpoint technique was performed; the rates were modelled and predictions of the incidence of TB until 2025 were made. RESULTS: AMPC showed a fall of 0.69% per month in TB and human immunodeficiency virus (TB-HIV) co-infection, a fall of 0.01% per month in general and lung TB and a fall of 0.33% per month in extrapulmonary TB. With the breakpoint technique, general and pulmonary TB changed in structure in late 2007, and extrapulmonary TB and TB-HIV co-infection changed in structure after 2014, which is considered the cut-off point. The IMA(3) models were adjusted for general and pulmonary TB and TB-HIV co-infection, and the AR(5) models for extrapulmonary TB, and predictions were performed. CONCLUSIONS: The rapid molecular test for TB is the method currently recommended by the WHO for the diagnosis of the disease and its main advantage is to provide faster, more accurate results and to already check for drug resistance. It is necessary that professionals encourage the use of this technology in order to optimize the diagnosis so that the treatment begins as quickly as possible and in an effective way. Only by uniting professionals from all areas with health policies aimed at early case identification and rapid treatment initiation it is possible to break the chain of TB transmission so that its rates decrease and the goals proposed by the WHO are achieved.

Patients' perceptions regarding multidrug-resistant tuberculosis and barriers to seeking care in a priority city in Brazil during COVID-19 pandemic: A qualitative study.

This study aimed to analyze the discourses of patients who were diagnosed with multidrug-resistant tuberculosis, the perception of why they acquired this health condition and barriers to seeking care in a priority city in Brazil during the COVID-19 pandemic. This was an exploratory qualitative study, which used the theoretical-methodological framework of the Discourse Analysis of French matrix, guided by the Consolidated Criteria for Reporting Qualitative Research. The study was conducted in Ribeirão Preto, São Paulo, Brazil. Seven participants were interviewed who were undergoing treatment at the time of the interview. The analysis of the participants' discourses allowed the emergence of four discursive blocks: (1) impact of the social determinants in the development of multidrug-resistant tuberculosis, (2) barriers to seeking care and difficulties accessing health services, (3) perceptions of the side effects and their impact on multidrug-resistant tuberculosis treatment, and (4) tuberculosis and COVID-19: a necessary dialogue. Through discursive formations, these revealed the determinants of multidrug-resistant tuberculosis. Considering the complexity involved in the dynamics of multidrug-resistant tuberculosis, advancing in terms of equity in health, that is, in reducing unjust differences, is a challenge for public policies, especially at the current moment in Brazil, which is of accentuated economic, political and social crisis. The importance of psychosocial stressors and the lack of social support should also be highlighted as intermediary determinants of health. The study has also shown the situation of COVID-19, which consists of an important barrier for patients seeking care. Many patients reported fear, insecurity and worry with regard to returning to medical appointments, which might contribute to the worsening of tuberculosis in the scenario under study.

Social inequalities and their association with the leprosy burden in a Brazilian city of low endemicity: An ecological study.

OBJECTIVE: To analyse the association between social inequalities and the leprosy burden in a low endemicity scenario in the state of São Paulo, Brazil. METHODS: This ecological study was carried out in the city of Ribeirão Preto, state of São Paulo, Brazil, considering leprosy cases notified from 2006 to 2016. Regarding social inequalities, dimensions related to high household density, literacy, home occupation conditions, health conditions, household income, ethnicity and age were considered. The generalised additive model for location, scale and shape (GAMLSS) was used to verify the association between the social inequalities and leprosy burden. RESULTS: The increase in men and women with no education and people with an income of 1 to 2 minimum wages was associated with a relative increase in the number of leprosy cases (7.37%, 7.10% and 2.44%, respectively). Regarding the ethnicity variables, the increase in the proportion of men (black) and women (mixed race) with no schooling was associated with a relative increase in the number of cases of the disease (10.77% and 4.02%, respectively). Finally, for people of mixed race or ethnicity, the increase in the proportion of households with 1/2 to 1 minimum wage was related to a relative decrease in the total number of cases (-4.90%). CONCLUSION: The results show that the determinants associated with the increase in leprosy cases are similar to those in Brazilian hyperendemic regions, and that even in cities with low endemicity, social inequality is one of the main determinants of the disease.

Impact and trend of COVID-19 in the Brazilian prison system: an ecological study. / Impacto e tendência da COVID-19 no sistema penitenciário do Brasil: um estudo ecológico.

Given the rapid spread of new coronavirus within the prison system, this study's objective was to identify spatial clusters for the occurrence of COVID-19 in the incarcerated population and analyze temporal trends of confirmed cases in the Brazilian prison system. This ecological study considered the five Brazilian macro-regions to be units of analysis, with its 26 states and the Federal District. The population was composed of all COVID-19 cases confirmed from April 14th to August 31st, 2020. The source used to collect data was the COVID-19 Monitoring Panel from the National Prison Department. Descriptive analysis, scan statistics, and time series were performed. A total of 18,767 COVID-19 cases were reported among the incarcerated population, 4,724 in São Paulo. The scan statistic analysis resulted in 14 spatial risk clusters for COVID-19 among persons deprived of liberty; the highest-risk cluster was in the Federal District. Although the country ends the series with a decreasing behavior, a growing trend was verified in most of the study period. The conclusion is that there is a need to implement mass testing among the incarcerated population while continually monitoring and recording COVID-19 cases.

Tendo em vista a rápida disseminação do novo coronavírus no sistema prisional, o presente trabalho teve como objetivos identificar aglomerados espaciais para ocorrência da COVID-19 na população privada de liberdade (PPL) e analisar a tendência temporal dos casos confirmados no sistema penitenciário do Brasil. Estudo ecológico que considerou como unidades de análise as cinco macrorregiões do Brasil, seus 26 estados e o Distrito Federal. A população foi composta por todos os casos de COVID-19 confirmados, no período de 14 de abril a 31 de agosto de 2020. A fonte de dados utilizada foi o Painel de Monitoramento dos casos de COVID-19 nos sistemas prisionais do Departamento Penitenciário Nacional. Realizou-se análise descritiva, estatística de varredura e análise da tendência temporal. Foram notificados 18.767 casos de COVID-19 na PPL, dos quais 4.724 ocorreram no estado de São Paulo. A estatística de varredura possibilitou a identificação de 14 clusters espaciais de risco para COVID-19 na PPL, sendo o aglomerado de maior risco formado pelo Distrito Federal. Embora o país finalize a série com um comportamento decrescente, observa-se que no período de investigação a tendência apresentou um comportamento maioritariamente crescente. Evidencia-se a necessidade de testagem em massa, monitoramento e registro contínuo dos casos de COVID-19 na PPL do país.

Impacto e tendência da COVID-19 no sistema penitenciário do Brasil: um estudo ecológico / Impact and trend of COVID-19 in the Brazilian prison system: an ecological study

Resumo Tendo em vista a rápida disseminação do novo coronavírus no sistema prisional, o presente trabalho teve como objetivos identificar aglomerados espaciais para ocorrência da COVID-19 na população privada de liberdade (PPL) e analisar a tendência temporal dos casos confirmados no sistema penitenciário do Brasil. Estudo ecológico que considerou como unidades de análise as cinco macrorregiões do Brasil, seus 26 estados e o Distrito Federal. A população foi composta por todos os casos de COVID-19 confirmados, no período de 14 de abril a 31 de agosto de 2020. A fonte de dados utilizada foi o Painel de Monitoramento dos casos de COVID-19 nos sistemas prisionais do Departamento Penitenciário Nacional. Realizou-se análise descritiva, estatística de varredura e análise da tendência temporal. Foram notificados 18.767 casos de COVID-19 na PPL, dos quais 4.724 ocorreram no estado de São Paulo. A estatística de varredura possibilitou a identificação de 14 clusters espaciais de risco para COVID-19 na PPL, sendo o aglomerado de maior risco formado pelo Distrito Federal. Embora o país finalize a série com um comportamento decrescente, observa-se que no período de investigação a tendência apresentou um comportamento maioritariamente crescente. Evidencia-se a necessidade de testagem em massa, monitoramento e registro contínuo dos casos de COVID-19 na PPL do país.

Abstract Given the rapid spread of new coronavirus within the prison system, this study's objective was to identify spatial clusters for the occurrence of COVID-19 in the incarcerated population and analyze temporal trends of confirmed cases in the Brazilian prison system. This ecological study considered the five Brazilian macro-regions to be units of analysis, with its 26 states and the Federal District. The population was composed of all COVID-19 cases confirmed from April 14th to August 31st, 2020. The source used to collect data was the COVID-19 Monitoring Panel from the National Prison Department. Descriptive analysis, scan statistics, and time series were performed. A total of 18,767 COVID-19 cases were reported among the incarcerated population, 4,724 in São Paulo. The scan statistic analysis resulted in 14 spatial risk clusters for COVID-19 among persons deprived of liberty; the highest-risk cluster was in the Federal District. Although the country ends the series with a decreasing behavior, a growing trend was verified in most of the study period. The conclusion is that there is a need to implement mass testing among the incarcerated population while continually monitoring and recording COVID-19 cases.

Entremeios dos sentidos: discursividade sobre os determinantes da tuberculose multidroga-resistente e as barreiras para o cuidado em saúde / Intermediations of the senses: discourse on the determinants of multidrug-resistant tuberculosis and the barriers to health care

multidroga resistência é um fenômeno evolutivo considerado iatrogênico, devido a sua origem ser proveniente de tratamentos inadequados, abandono e/ou por esquemas terapêuticos de baixa potência contra o Mycobacterium tuberculosis. Dessa forma, tem-se como objetivo analisar a discursividade das pessoas com tuberculose multidroga-resistente acerca dos determinantes da sua condição de saúde, e as barreiras enfrentadas para o cuidado em saúde em Ribeirão Preto, São Paulo, Brasil. Trata-se de um estudo qualitativo exploratório, que utilizou o referencial teórico-metodológico da Análise de Discurso de Matriz Francesa, elaborado a partir do Consolidated Criteria for Reporting Qualitative Research, realizado em Ribeirão Preto, São Paulo, Brasil. Quatorze participantes foram elegíveis aos critérios de inclusão, entretanto, sete participantes, que estavam em tratamento no momento da entrevista, participaram do estudo. Da análise dos discursos dos participantes emergiram quatro blocos discursivos: (1) Impacto dos determinantes sociais no desenvolvimento da tuberculose multidroga-resistente; (2) Barreiras enfrentadas para o cuidado em saúde da tuberculose multidroga-resistente; (3) Percepções sobre os efeitos colaterais e seu impacto no tratamento da tuberculose multidroga-resistente; e (4) Tuberculose multidroga-resistente e COVID-19: um diálogo necessário. Por meio das formações discursivas, essas demonstraram os determinantes da tuberculose multidroga-resistente. Considerando a complexidade envolvida na dinâmica da tuberculose multidroga-resistente, avançar em termos de equidade em saúde, ou seja, na redução de desigualdades sociais, é um desafio para as políticas públicas, principalmente no atual contexto vivenciado no Brasil, de acentuada crise econômica, política e social. Os estressores psicossociais e a falta de suporte social também devem ser destacados como determinantes intermediários da saúde. O estudo também evidenciou a situação da COVID-19, que consiste como uma importante barreira para as pessoas acometidas pela doença que buscam atendimento. Os participantes relataram medo, insegurança e preocupação em relação ao retorno às consultas médicas, o que pode contribuir para o agravamento da tuberculose no cenário em estudo

Avaliação dos serviços de Atenção Primária à Saúde na tuberculose / Evaluation of primary health care services in tuberculosis

Objetivo: analisar produções científicas sobre a avaliação dos serviços da Atenção Primária à Saúde no controle da tuberculose. Método: trata-se de estudo bibliográfico, tipo revisão integrativa, que incluiu artigos completos disponibilizados nas Bases de Dados LILACS, CINAHL, SCOPUS, Web of Science e MEDLINE, publicados no Brasil entre janeiro de 2013 a setembro de 2017. Apresentaram-se os resultados em forma de figuras. Resultados: selecionaram-se e classificaram-se 12 artigos em duas categorias temáticas: "Avaliação dos serviços na perspectiva dos profissionais de saúde" e "Avaliação dos serviços na perspectiva dos usuários". Conclusão: ratificam-se, pela síntese dos estudos, as fragilidades, sugerindo a formação complementar aos profissionais, além do resgate do conceito expandido de saúde, principalmente, com relação à família e à comunidade, contribuindo para o embasamento de condutas de gestão para a melhoria das intervenções em saúde.(AU)

Objective: to analyze scientific production on the evaluation of Primary Health Care services in the control of tuberculosis. Method: this is a bibliographical study, including an integrative review, which included complete articles available in the LILACS, CINAHL, SCOPUS, Web of Science and MEDLINE databases, "published in Brazil between January 2013 and September 2017. The results were presented in the form of figures. Results: 12 articles were selected and classified in two thematic categories: "Evaluation of services from the perspective of health professionals" and "Evaluation of services from the perspective of users". Conclusion: the synthesis of the studies confirms the weaknesses, suggesting the complementary training to the professionals, besides the rescue of the expanded concept of health, mainly, in relation to the family and the community, contributing to the base of management conduits for the improvement of health interventions.(AU)

Objetivo: analizar producciones científicas sobre la evaluación de los servicios de la Atención Primaria a la Salud en el control de la tuberculosis. Método: se trata de un estudio bibliográfico, tipo revisión integrativa, que incluyó artículos completos disponibles en las Bases de Datos LILACS, CINAHL, SCOPUS, Web of Science y MEDLINE, publicados en Brasil entre enero de 2013 a septiembre de 2017. Se presentaron los resultados en forma de figuras. Resultados: se seleccionaron y se clasificaron 12 artículos en dos categorías temáticas: "Evaluación de los servicios en la perspectiva de los profesionales de salud" y "Evaluación de los servicios en la perspectiva de los usuarios". Conclusión: se ratifican, por la síntesis de los estudios, las fragilidades, sugiriendo la formación complementaria a los profesionales, además del rescate del concepto ampliado de salud, principalmente, con relación a la familia y a la comunidad, contribuyendo para el basamento de conductas de gestión para la mejora de las intervenciones en salud.(AU)