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.

Simple economics of vaccination: public policies and incentives.

This paper focuses on the economics of vaccination and, more specifically, analyzes the vaccination decision of individuals using a game-theoretic model combined with an epidemiological SIR model that reproduces the infection dynamics of a generic disease. We characterize the equilibrium individual vaccination rate, and we show that it is below the rate compatible with herd immunity due to the existence of externalities that individuals do not internalize when they decide on vaccination. In addition, we analyze three public policies consisting of informational campaigns to reduce the disutility of vaccination, monetary payments to vaccinated individuals and measures to increase the disutility of non-vaccination. If the public authority uses only one type of policy, herd immunity is not necessarily achieved unless monetary incentives are used. When the public authority is not limited to use only one policy, we find that the optimal public policy should consist only of informational campaigns if they are sufficiently effective, or a combination of informational campaigns and monetary incentives otherwise. Surprisingly, the requirement of vaccine passports or other restrictions on the non-vaccinated are not desirable.

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.

Air, land, and water pollutants and public health expenditures: Empirical data from selected EU countries in the transport sector.

The increase in economic activity, particularly in transport, leads to a significant increase in emissions of pollutants, such as ammonia, arsenic and cadmium, at the European Union (EU) level. This can seriously impact human health and, consequently, public health spending. Based on data from 15 European Union countries from 1992 to 2020, a panel co-integration approach is used to study these pollutants' short- and long-term co-movements and per capita health expenditure. The results show a long-term relationship between ammonia, arsenic and cadmium emissions and per capita health spending, as they are panel-cointegrated. Ammonia and cadmium emissions exert a statistically significant positive effect on health expenditure in the short run, and arsenic emissions have a statistically significant positive impact in the long run. The forecast assessment of reductions in health spending resulting from policies to reduce emissions of air, land and water pollutants, such as ammonia, arsenic and cadmium, from the transport sector supports investments in its policies that reduce pressure on health spending. The reduction in annual healthcare expenditure is greater when these reductions are made sooner and more severely. Indeed, varying the reduction in emissions for each pollutant by 10% and 100%, respectively, from the first year for all countries over a 3-year period results in an average annual reduction in health spending of 2.05% and 51.02%, respectively. However, if we wait until the third year, the annual reduction is only 0.77% and 17.63% respectively.

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.

Food and nutritional insecurity in the rural community Laguinha near the wind energy complex in Caetés in Pernambuco / Insegurança alimentar e nutricional na comunidade rural Laguinha nas proximidades do complexo eólico do município de Caetés em Pernambuco

Food and Nutrition Security (SAN) is the realization of everyone's right to access food in sufficient quantities, quality and regularly, without compromising access to other needs. In view of the increase in food and nutrition insecurity, observed in recent years in Brazil and in the world, concomitant with the disruption of programs and public policies combined with the incentive to promote the right to Food and Nutritional Security (SAN) in Brazil (2019-2022) , and the pandemic context that aggravated this problem, we are currently experiencing alarming levels of Food and Nutrition Insecurity (INSAN), including the serious one that is characterized by hunger, which preferentially affects a certain social class and region in Brazil, North and Northeast. The present study analyzed the food and nutritional security profile of families residing in the rural community of Sítio Laguinha, around a wind farm in the municipality of Caetés, in Pernambuco. This study can be characterized as a mixed descriptive study with a quantitative and qualitative approach, in order to identify the prevalence of food (in)security and the associated factors. A semi-structured questionnaire was used to obtain information on socioeconomic conditions and food consumption in the rural community of Laguinha, as well as the Brazilian Food Insecurity Scale (EBIA) to assess the situation of Food and Nutritional Security. Among the factors associated with the community, the vulnerabilities to which this community is exposed stand out, such as the location in a rural area that is difficult to move around, around a wind farm that brings with it impacts and the pandemic context. The results obtained showed a high prevalence of food and nutritional insecurity (88.4%) at all levels, mild, moderate and severe. Among the factors that may be associated with and aggravate the INSAN situation, we can mention the impact of the wind farm and the pandemic, with all associated socioeconomic impacts. The results obtained in this work bring relevant data about the situation of an invisible community that needs assistance to achieve food and nutritional security, a right established in our constitution. In addition, these data can serve as a basis for the implementation of public policies aimed at the community

A Segurança Alimentar e Nutricional (SAN) é a realização do direito de todos ao acesso a alimentos em quantidade suficiente, qualidade e regularmente, sem comprometer o acesso a outras necessidades. Diante do aumento da insegurança alimentar e nutricional, observada nos últimos anos no Brasil e no mundo, concomitante com a desestruturação de programas e políticas públicas aliadas ao incentivo à promoção do direito à Segurança Alimentar e Nutricional (SAN) no Brasil (2019-2022), e o contexto pandêmico que agravou esse problema, atualmente vivenciamos índices alarmantes de Insegurança Alimentar e Nutricional (INSAN), incluindo a insegurança grave que se caracteriza pela fome, que afeta preferencialmente uma determinada classe social e região no Brasil, Norte e Nordeste. O presente estudo analisou o perfil da segurança alimentar e nutricional de famílias residentes na comunidade rural do Sítio Laguinha, em torno de um parque eólico no município de Caetés, em Pernambuco. Esse estudo pode ser caracterizado como descritivo misto com abordagem quantitativa e qualitativa, a fim de identificar a prevalência da (in)segurança alimentar e os fatores que a ela se associam. Foram utilizados um questionário semiestruturado para obtenção de informações sobre condições socioeconômicas e de consumo alimentar da comunidade rural de Laguinha bem como a Escala Brasileira de Insegurança Alimentar (EBIA) para avaliar a situação de Segurança Alimentar e Nutricional. Dentre os fatores associados à comunidade destaca-se as vulnerabilidades às quais essa comunidade está exposta, como a localização em uma área rural de difícil deslocamento, em torno de um parque eólico que traz consigo impactos e o contexto pandêmico. Os resultados obtidos mostraram alta prevalência de insegurança alimentar e nutricional (88,4%) em todos os níveis, leve, moderada e grave. Dentre os fatores que podem estar associados e agravar a situação de INSAN podemos citar o impacto do parque eólico e a pandemia, com todos impactos socioeconômicos associados. Os resultados obtidos neste trabalho trazem dados relevantes sobre a situação de uma comunidade invisibilizada e que necessita de assistência para alcançar a segurança alimentar e nutricional, um direito estabelecido na nossa constituição. Além disso, esses dados podem servir de base para implementação de políticas públicas voltadas à comunidade.

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.

Long-term care needs and the risk of household poverty across Europe: a comparative secondary data study.

PURPOSE: Population ageing and rising poverty are two of the most pressing issues today, even in Western European nations, growing as a result of the recent global economic crisis and the COVID-19 containment measures. This study explores the relationship between long-term care (LTC) needs and risk of poverty at household level in eight European countries, representing the different European care regimes. METHODS: The main international databases were scoured for study variables, categorized according to the following conceptual areas: home care, residential care, health expenditure, service coverage, cash benefits, private services, population, family, education, employment, poverty, disability and care recipients, and life expectancy. We initially identified 104 variables regarding 8 different countries (Austria, Finland, Germany, the Netherlands, Italy, Spain, Poland, Romania). Statistical analyses were conducted as described hereafter: analysis of the Pearson's Bivariate Correlation between the dependent variable and all other variables; a Multivariable Linear Regression Model between the Poverty Index (dependent variable) and the covariates identified in the preceding step; a check for geographical clustering effects and a reduced Multivariable Linear Regression Model for each identified European cluster. RESULTS: The variables that addressed the risk of poverty pertained to the area of policy intervention and service provision. Rising private out-of-pocket health expenditures and proportion of "poor" couples with at least one child are two factors that contributed significantly to poverty increasing. Moreover, rising private out-of-pocket health expenditures for covering LTC needs (even in presence of public financial contribution to the family) is the main contributor to household poverty increasing in presence of ADL disability. CONCLUSION: The results reveal the existence of a clear correlation between the need for LTC and the risk of poverty in households across Europe. These results highlight the central relevance of LTC policies, which are often still treated as marginal and sectoral, for the future sustainability of integrated care strategies.

Obesogenic environments as major determinants of a disease: It is time to re-shape our cities.

Obesity rates are increasing in almost all high- and low-income countries, and population-based approaches are necessary to reverse this trend. The current global efforts are focused on identifying the root causes of obesity and developing effective methods for early diagnosis, screening, treatment, and long-term management, both at an individual and health system level. However, there is a relative lack of effective options for early diagnosis, treatment, and long-term management, which means that population-based strategies are also needed. These strategies involve conceptual shifts towards community- and environment-focused approaches. This review aimed to provide evidence on how environmental factors contribute to the risk of obesity and how reshaping cities can help slow down obesity prevalence rates and improve long-term management.

Pollution and endometriosis: A deep dive into the environmental impacts on women's health.

BACKGROUND: The interaction between pollution and endometriosis is a pressing issue that demands immediate attention. The impact of pollution, particularly air and water pollution, or occupational hazards, on hormonal disruption and the initiation of endometriosis remains a major issue. OBJECTIVES: This narrative review aims to delve into the intricate connection between pollution and endometriosis, shedding light on how environmental factors contribute to the onset and severity of this disease and, thus, the possible public health policy implications. DISCUSSION: Endocrine-disrupting chemicals (EDCs) in pollutants dysregulate the hormonal balance, contributing to the progression of this major gynaecological disorder. Air pollution, specifically PM2.5 and PAHs, has been associated with an increased risk of endometriosis by enhancing chronic inflammation, oxidative stress, and hormonal imbalances. Chemical contaminants in water and work exposures, including heavy metals, dioxins, and PCBs, disrupt the hormonal regulation and potentially contribute to endometriosis. Mitigating the environmental impact of pollution is required to safeguard women's reproductive health. This requires a comprehensive approach involving stringent environmental regulations, sustainable practices, responsible waste management, research and innovation, public awareness, and collaboration among stakeholders. CONCLUSION: Public health policies have a major role in addressing the interaction between pollution and endometriosis in a long-term commitment.

Insegurança alimentar, saúde e produção da vida: uma aproximação às práticas alimentares de mulheres de camadas populares à luz da antropologia da alimentação / Food insecurity, health, and life production: an approach to the food practices among low-income women in light of the anthropology of food

Resumo A alimentação, além de imperativo biológico para sobrevivência e saúde humana, é revestida de significados culturais que determinam suas múltiplas expressões na sociedade. Os campos da alimentação, da nutrição, da saúde e da antropologia se interseccionam na discussão sobre práticas alimentares. Este ensaio teórico do tipo reflexivo tem como objetivo refletir sobre a relevância das práticas alimentares das mulheres de camadas populares para possível superação da insegurança alimentar e nutricional, examinando as relações estabelecidas com a comida no contexto da cozinha, de seus corpos e do acesso aos alimentos. O percurso metodológico consiste no estudo reflexivo de caráter exploratório, que recorre a fontes bibliográficas e documentais para alicerçar as análises com base em uma leitura crítica da realidade. A herança patriarcal continua delegando à mulher o papel de cuidadora familiar, o que abarca a alimentação: desde a aquisição do alimento até o preparo e fornecimento das refeições. Propomos que as práticas alimentares dessas mulheres podem impulsionar potenciais mudanças, que serviriam como ferramentas para aplicação de políticas públicas. As reflexões oferecem subsídios para o planejamento de políticas que possam empoderá-las como sujeitos de ação e reflexão crítica, abrindo uma projeção de cenários possíveis para agenciar formas de superação das inseguranças alimentares.

Abstract Food, besides being a biological imperative for survival and human health, is coated with cultural meanings that determine its multiple expressions in society. The fields of food, nutrition, health, and anthropology intersect in the discussion about food practices. This theoretical and reflexive essay aims to reflect on the relevance of the food practices of low-income women for the possible overcoming of food and nutritional insecurity, examining the relationships established with food in the context of the kitchen, of their bodies, and of the access to food. The methodological path followed was the reflexive and exploratory study, which uses bibliographical and documental sources to support the analyses based on a critical reading of reality. The patriarchal heritage continues to assign women the role of family caretaker, which encompasses everything from acquiring food to its preparation and serving meals. We propose that the food practices of these women can drive potential changes, which would serve as tools for the application of public health policies. The reflections offer subsidies for planning of policies that can empower them as subjects of critical action and reflection, opening a projection of possible scenarios for the agency of ways to overcome food insecurity.

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.

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.

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.

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.

Percepción de dirigentes deportivos locales y funcionarios municipales sobre políticas públicas deportivas locales de la comuna de Linares

La aplicación de las políticas públicas deportivas locales (PPDL) de la comuna de Linares se han visualizado gracias a la aplicación del Plan de Desarrollo Comunal de Actividad Física y Deportes (PDC AFyD) en el período 2018 - 2022 en la comunidad y las organizaciones deportivas locales (OODD), así como de funcionarios del propio municipio. Para conocer la percepción sobre la aplicación de PPDL se aplica una entrevista semiestructurada y confeccionada para tales efectos, a 28 dirigentes deportivos y 18 funcionarios municipales, de un universo muestral total de 127 posibles. Los individuos indican que, pese a ver cambios favorables en el período desconocen el proceso y, por ende, el mecanismo aplicado para el cambio, lo que despotencia la comprensión de la PPDL y el desarrollo de ésta por medio de las propias OODD y el municipio. La aplicación de las PPDL por medio de sus distintas herramientas e instrumentos requiere que se desarrolle bajo un proceso de consulta, pertinencia y complementación entre municipio, OODD, mundo educativo y vecinos beneficiarios; todo dentro de un marco de comunicación e información concreta y permanente que logre involucrar a todos los actores, brindando con ello una cuota de responsabilidad en su ejecución, control y evaluación.

The application of local public policies on sports (LPSP) of the commune of Linares has been visualized thanks to the application of the Communal Development Plan for Physical Activity and Sports (CDP PA&S) in the period 2018 - 2022 in the community and local sports organizations (LSO), as well as officials of the municipality itself. To know the perception of the implementation of LPSP, a semi-structured interview was applied to 28 sports leaders and 18 municipal officials out of a total sample universe of 127 possible. The individuals indicate that, despite seeing favorable changes in the period, they are unaware of the process and, therefore, the mechanism applied for change, which undermines the understanding of the LPSP and its development through the LSOO and the municipality. The application of the LPSP through its different tools and instruments requires that it be developed under a process of consultation, relevance, and complementarity between the municipality, LSOO, the educational world and beneficiary neighbors; all under a framework of communication and concrete and permanent information that manages to involve all the actors, thus providing a share of responsibility in its execution, control, and evaluation.

A implementação das políticas esportivas públicas locais (PEPL) na comuna de Linares foi visualizada graças à implementação do Plano de Desenvolvimento Comunitário para Atividade Física e Esporte (PDC AFyE) no período 2018 - 2022 na comunidade e organizações esportivas locais (OOEE), bem como funcionários do próprio município. Foi realizada uma entrevista semi-estruturada com 28 líderes esportivos e 18 funcionários municipais de um universo de amostra total de 127. Os indivíduos indicam que, apesar de verem mudanças favoráveis no período, não conhecem o processo e, portanto, o mecanismo aplicado para a mudança, o que prejudica a compreensão do PEPL e seu desenvolvimento através do OOEE e do próprio município. A implementação do PEPL através de suas diferentes ferramentas e instrumentos requer um processo de consulta, relevância e complementaridade entre o município, o OOEE, o mundo educacional e os vizinhos beneficiários; tudo isso dentro de uma estrutura de comunicação e informação concreta e permanente que envolva todos os atores, proporcionando assim uma parcela de responsabilidade em sua implementação, controle e avaliação.

Mortalidade materno-infantil em um estado nortista brasileiro: coerência e discrepância entre instrumentos de gestão e agenda 2030 / Addressing maternal and child mortality in a northern brazilian state: coherence and discrepancy between management instruments and the 2030 agenda / Abordando la mortalidad materno-infantil en un estado del norte de brasil: coherencia y discrepancia entre los instrumentos de gestión y la agenda 2030

Introdução:As mortes maternas e infantis refletem as condições de vida de uma determinada população e são marcadores importantes de desenvolvimento de uma nação, reduzi-las tornou-se prioridade na Agenda 2030 de desenvolvimento sustentável. Políticas públicas devem ser formuladas, executadas e monitoradas em escalas nacionais, estaduais e locais para melhorar a qualidade de vida e cumprir os compromissos pactuados nacional e internacionalmente.Objetivo:identificar o alinhamento dos indicadores e os resultados alcançados nas metas para redução de mortalidades materna e infantil do Plano de Desenvolvimento Sustentável e Plano Estadual de Saúde do Estado de Rondônia com Agenda 2030.Metodologia:Trata-se de uma pesquisa documental e bibliográficacomanálise crítica de indicadores referentes à redução da mortalidade materno-infantil na Agenda 2030 e respectivos ações e metas alcançadas ou não contempladas no Plano de Desenvolvimento Sustentável de Rondônia (2015-2030) e Planos Estaduais de Saúde (2016-2019 e 2020-2021). Verificou-se os resultados alcançados em relatórios da sociedade civil e anual de gestão.Resultados:Constatou-se que a redução das mortes materna e infantil são destacadas nos planejamentos analisados, contudo a mortalidade infantil contida nos planosconsidera somente as mortes em menores de um ano de vida e há incompletudes nos escopos selecionados para o monitoramento, assim como diferentes indicadores de verificação, dificultando análise das metas pactuadas na Agenda 2030.Conclusões:Os relatóriosdos resultados alcançados apontaram retrocessos para o alcance das metas. Instrumentos de gestão e planejamento são imprescindíveis para nortear ações e estabelecer prioridades, porém para que haja avanços é necessário coerência não somente em metas pactuadas, mas nos indicadores e meios de verificação a fim de corroborar para análise e retroalimentação do planejamento (AU).

Introduction:Maternal and infant deaths reflect the living conditions of a given population and are important markers of a nation's development, reducing them has become a priority in the 2030 Agenda for sustainable development. Public policies must be formulated, implemented and monitored at national, state and local scales to improve the quality of life and meet the commitments agreed nationally and internationally. Objective:To identify the alignment of indicators and the results achieved in the goals for reducing maternal and child mortality of the Sustainable Development Plan and State Health Plan of the State of Rondônia with Agenda 2030. Methodology:This is a documentary and bibliographical research with critical analysis of indicators related to the reduction of maternal and child mortality in the 2030 Agenda and respective actions and goals achieved or not contemplated in the Sustainable Development Plan of Rondônia (2015-2030) and State Health Plans (2016-2019 and 2020-2021). It was verified the results achieved in reports of civil society and annual management. Results:It was found that the reduction of maternal and infant deaths are highlighted in the however the infant mortality contained in the plans considers only deaths in children under one year of age and there are incompleteness in the scopes selected for monitoring, as well as different verification indicators, making it difficult to analyze the goals agreed in the 2030 Agenda. Conclusions:The reports of the achieved results pointed setbacks to the achievement of the goals. Management and planning tools are essential to guide actions and establish priorities, but for there to be progress it is necessary coherence not only in agreed indicators and means of verification in order to corroborate for analysis and feedback of planning (AU).

Introducción: Las muertes maternas e infantiles reflejan las condiciones de vida de una determinada poblacióny son marcadores importantes del desarrollo de una nación, su reducción se ha convertido en prioridad en la Agenda 2030 de desarrollo sostenible. Las políticas públicas deben ser formuladas, ejecutadas y monitoreadas a escala nacional, estatal y local para mejorar la calidad de vida y cumplir con los compromisos pactados a nivel nacional e internacional. Objetivo: Identificar la alineación de los indicadores y los resultados alcanzados en las metas para reducción de mortalidades materna e infantil del Plande Desarrollo Sostenible y Plan Estadual de Salud del Estado de Rondônia com Agenda 2030.Metodología: Se trata de una investigación documental y bibliográfica con análisis crítico de indicadores referentes a la reducción de la mortalidad materno-infantilen la Agenda 2030 y respectivos acciones y metas alcanzadas o no contempladas en el Plan de Desarrollo Sostenible de Rondônia (2015-2030) y Planes Estatales de Salud (2016-2019 y 2020-2021). Se han verificado los resultados obtenidos en informes de la sociedad civil y anual de gestión.Resultados: Se constató que la reducción de las muertes materna e infantil son destacadas en los planeamientos analizados, sin embargo, la mortalidad infantil contenida en los planes considera solamente las muertes en menores de un año de vida y hay incompletudes en los ámbitos seleccionados para el monitoreo, así como diferentes indicadores de verificación, dificultando el análisis de las metas pactadas en laAgenda 2030.Conclusiones: Los informes de los resultados alcanzados apuntaron retrocesos para el alcance de las metas. Instrumentos de gestión y planificación son imprescindibles para orientar acciones y establecer prioridades, pero para que haya avances es necesaria coherencia no solo en metas pactadas, pero en los indicadores y medios de verificación con el fin de corroborar el análisis y retroalimentación de la planificación (AU).

Política pública y salud mental en agentes de educación básica de Lima, 2023 / Public policy and mental health in basic education agents in Lima, 2023 / Políticas públicas e saúde mental em agentes de educação básica em Lima, 2023

El panorama de la salud mental presenta desafíos palpables. A pesar de un incremento en el número de médicos, la dotación de personal sanitario es insuficiente, situando a Perú por debajo de estándares internacionales recomendados por la OMS. Objetivo. Analizar la influencia de las políticas públicas en la salud mental en agentes involucrados en la educación básica regular de la región Lima. Materiales y Métodos. Se realizó una investigación de tipo aplicada, de diseño no experimental, transversal y correlacional causal. La muestra estuvo conformada por 50 agentes educativos; se utilizó un muestreo no probabilístico por conveniencia. Resultados. Indican que la variable Políticas Públicas se correlaciona con la variable Salud Mental, ya que por medio del coeficiente de determinación R² se obtuvo un valor de ,063, esto quiere decir que el 6,3% de problemas en la Salud Mental se presenta por una inadecuada gestión de Políticas Públicas. Por lo tanto, las Políticas Públicas (PP) influyen en un 6,3% de problemas en la Salud Mental (SM). Conclusiones. Se determinó que el 3,7% de los problemas en la SM están vinculados con una gestión deficiente de las PPT. La importancia de una gestión adecuada aquí radica en asegurar que los servicios de tratamiento sean accesibles, de calidad y basados en evidencia, garantizando así una atención integral y continua para quienes lo necesiten.

The mental health landscape presents palpable challenges. Despite an increase in the number of physicians, the number of health personnel is insufficient, placing Peru below international standards recommended by the WHO. Objective. To analyze the influence of public policies on mental health in agents involved in regular basic education in the Lima region. Materials and Methods. An applied, non-experimental, cross-sectional and causal correlational research was carried out. The sample consisted of 50 educational agents; non-probabilistic convenience sampling was used. Results. They indicate that the variable Public Policies correlates with the variable Mental Health, since by means of the coefficient of determination R² a value of .063 was obtained, this means that 6.3% of problems in Mental Health are presented by an inadequate management of Public Policies. Therefore, Public Policies (PP) influence 6.3% of Mental Health (MH) problems. Conclusions. It was determined that 3.7% of the problems in MH are linked to inadequate management of the PPPs. The importance of proper management here lies in ensuring that treatment services are accessible, quality and evidence-based, thus guaranteeing comprehensive and continuous care for those in need.

O cenário da saúde mental apresenta desafios palpáveis. Apesar de um aumento no número de médicos, o número de profissionais de saúde é insuficiente, colocando o Peru abaixo dos padrões internacionais recomendados pela OMS. Objetivo. Analisar a influência das políticas públicas na saúde mental dos agentes envolvidos na educação básica regular na região de Lima. Materiais e métodos. Foi realizado um estudo de pesquisa correlacional aplicado, não experimental, transversal e causal. A amostra consistiu em 50 agentes educacionais; foi utilizada uma amostragem de conveniência não probabilística. Resultados. Indicam que a variável Políticas Públicas se correlaciona com a variável Saúde Mental, já que por meio do coeficiente de determinação R² foi obtido um valor de ,063, o que significa que 6,3% dos problemas em Saúde Mental são apresentados por uma gestão inadequada das Políticas Públicas. Portanto, as Políticas Públicas (PP) influenciam 6,3% dos problemas de Saúde Mental (SM). Conclusões. Foi determinado que 3,7% dos problemas em SM estão ligados à má gestão de PPPs. A importância de uma gestão adequada nesse caso está em garantir que os serviços de tratamento sejam acessíveis, de qualidade e baseados em evidências, assegurando assim um atendimento contínuo e abrangente para aqueles que precisam.

Seguridad alimentaria, subalimentación y canasta alimentaría en el contexto de las políticas públicas en Venezuela. Período2017-2022 / Food security, undernourishment and food basket in thecontext of public policies in Venezuela. Period 2017-2022

El presente estudio tiene como objetivo analizarla relación entre los indicadores de seguridad alimentaria,subalimentación y costo de la canasta alimentaria en el contextode las políticas públicas en materia alimentaria en Venezuela,durante el periodo comprendido entre 2017 y 2022. Para ello, sellevó a cabo un análisis exhaustivo de los datos disponibles sobrela seguridad alimentaria en Venezuela, incluyendo informaciónsobre la subalimentación, y el costo de la canasta alimentaria.Asimismo, se analizaron las políticas públicas implementadas enel país en materia alimentaria durante el periodo de estudio, conel fin de entender su impacto en los indicadores de seguridadalimentaria. Ninguna de las asociaciones estudiadas resultó sersignificativa a nivel estadístico (p>0,05), por lo que, aunqueteóricamente existe una relación entre estos indicadores en elperíodo estudiado, el carácter multidimensional prevalece y hacecompleja la posibilidad de comparaciones. Se identificaron laspolíticas públicas que requieren mejoras o ajustes para proteger laseguridad alimentaria del venezolano. Estos resultados obtenidospodrán ser de utilidad para los responsables de la toma dedecisiones en el país, así como para los investigadores yprofesionales interesados en el tema de la seguridad alimentariay la nutrición

EL objective of this study is to analyzethe relationship between the indicators of food security,undernourishment and the cost of the food basket in thecontext of public policies on food in Venezuela, during theperiod between 2017 and 2022. For this, an exhaustive analysisof the available data on food security in Venezuela wascarried out, including information on undernourishment, andthe cost of the food basket. Likewise, the public policiesimplemented in the country regarding food during the studyperiod were analyzed, in order to understand their impacton food security indicators. None of the associations studiedturned out to be statistically significant (p>0.05), therefore,although theoretically there is a relationship between theseindicators in the period studied, the multidimensional natureprevails and makes comparability complex. Public policies that require improvements or adjustments to protect Venezuelanfood security were identified. These results obtained may beuseful for those responsible for decision-making in the country,as well as for researchers and professionals interested in thesubject of food security and nutrition.