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Farmers' markets are important spaces for the commercialization of fruits and vegetables, which access by the urban population is considered one of the key aspects of healthy cities. This study adopts an ecological approach with geographic-spatial emphasis to describe accessibility to farmers' markets in Porto Alegre-RS, by four different modes of transport (walking, bicycle, bus, and car) and their associations with income and race/skin color. The distribution of markets across the city is more balanced than other food establishments, although physical accessibility is highly uneven across modes of transport: the ability to reach a market on foot in 10 minutes or less is restricted to no more than 25% of the population, while almost 90% can do it by driving a car. The study found a direct and positive association between levels of accessibility to farmers' markets and income: wealthier areas can reach fairs in less time using any mode of transport than poorer ones (p<0.001). Regions with a majority of white inhabitants have better accessibility to the fairs on foot, by bicycle, and by bus (p<0.01) than regions with a majority of Black, Indigenous, or yellow populations.

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Despite the growing accessibility of international grain and oilseed markets, high production costs and trade frictions are still prevalent, contributing to regional heterogeneities in the landed cost of grain imports. Here we quantify the landed cost for six grain commodities across 3,500 administrative regions, capturing regional cost differences to produce grain and transport it across international borders. We find large heterogeneities in the costs of imported grain, which are highest in Oceania, Central America and landlocked Africa. While some regions have uniform landed costs across sourcing locations, others face cost variations across trading partners, showing large inequalities in access. We find that most regions could benefit from a targeted approach to reduce landed cost while others benefit from a mixed strategies approach. Our results highlight that spatial information on production, trade and transport is essential to inform policies aiming to build an efficient and resilient global agricultural commodity trade system.

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Introduction: Shortage of medicines in Peruvian healthcare facilities is a significant public health issue that may affect patient satisfaction. Objective: To estimate the association between access to medicines and the level of satisfaction with the received care from users of healthcare facilities in Peru during 2016. Methods: An analytical cross-sectional study was conducted using data from the 2016 National Survey of User Satisfaction in Health (ENSUSALUD). Access to medicines at the healthcare facilities' pharmacy and patient satisfaction were measured using self-report questions. Crude and adjusted ordinal logistic regression models were used to estimate Odds ratios with 95% confidence intervals. The complex sample design of the 2016 National Health User Satisfaction Survey was considered in all calculations. Results: Data from 10 386 healthcare facility users were included. After receiving medical care, 19.6% had partial access to medications, 6.8% had no access, and 6% were dissatisfied with the care received. Users with partial access to drugs had 87% higher odds of dissatisfaction (Odds ratio: 1.87; 95% confidence interval: 1.56 to 2.23), while users without access to medications had 51% higher odds of dissatisfaction (OR: 1.51; 95% CI: 1.06 to 2.16), compared to users with full access to drugs, adjusted for confounding variables. Conclusions: Patients with limited access to medicine at pharmacies in Peruvian healthcare facilities reported higher dissatisfaction with the care received.

Introducción: La falta de medicamentos en los establecimientos de salud de Perú es un importante problema de salud pública que puede afectar la satisfacción de los pacientes. Objetivo: Estimar la asociación entre el acceso a los medicamentos y el nivel de satisfacción con la atención recibida, en usuarios de establecimientos de salud de Perú, durante 2016. Métodos: Se realizó un estudio transversal analítico con los datos de la Encuesta Nacional de Satisfacción de Usuarios en Salud (ENSUSALUD) 2016. El acceso a los medicamentos en la farmacia del establecimiento de salud y la satisfacción con la atención recibida se midieron con preguntas de autorreporte. Se usaron modelos crudos y ajustados de regresión logística ordinal para estimar con intervalos de confianza al 95%. En todos los cálculos se consideró el diseño muestral complejo de la Encuesta Nacional de Satisfacción de Usuarios en Salud 2016. Resultados: Se incluyeron datos de 10 386 usuarios de establecimientos de salud. Luego de recibir la atención médica, el 19,6% tuvo un acceso parcial a los medicamentos y el 6,8% no tuvo acceso, mientras que el 6% se sintió insatisfecho por la atención recibida. Los usuarios con acceso parcial a los medicamentos presentaron 87% más de insatisfacción (: 1,87; intervalo de confianza 95%: de 1,56 a 2,23), mientras que los usuarios sin acceso a los medicamentos presentaron 51% más de insatisfacción (: 1,51; intervalo de confianza 95%: de 1,06 a 2,16), en comparación con los usuarios con acceso total a los medicamentos, ajustado por variables de confusión. Conclusiones: Los usuarios que tuvieron menor acceso a los medicamentos en las farmacias de los establecimientos de salud de Perú presentaron mayor insatisfacción con la atención recibida.

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Rapid sequence intubation is the preferred method of securing the airway in patients who are critically ill, or at risk for aspiration. This involves the administration of an anesthetic induction agent followed rapidly by a neuromuscular blocking agent to create optimal intubation conditions and minimize the duration of the patient's apnea and the time the airway is unprotected. Furthermore, the risk that the patient may be expected to aspirate gastric contents can be mitigated by incorporating medications and techniques to reduce the possible adverse effects of airway manipulation.

La intubación de secuencia rápida, es el método preferido para asegurar la vía aérea en pacientes con enfermedades graves que conllevan riesgo de broncoaspiración. Esta implica la administración de un agente de inducción anestésica o hipnótico, seguido rápidamente de un agente bloqueador neuromuscular, para crear condiciones óptimas de intubación y minimizar la duración de la apnea del paciente y el tiempo en que la vía aérea está desprotegida. Además, el riesgo que se presupone a que el paciente pueda aspirar el contenido gástrico, puede ser mitigado, incorporando medicamentos y técnicas para disminuir los posibles efectos adversos de la manipulación de la vía aérea.

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BACKGROUND: The vaccine supply chain (VSC) integrates all activities from production to dispensing, characterized by complexity and low responsiveness. This study aims to define key performance indicators (KPIs) to evaluate the logistic and operational performance during the COVID-19 National Vaccination Plan in Colombia. METHODS: This study employed the design science research (DSR) methodology to develop a dashboard for monitoring COVID-19 vaccination progress. DSR is a problem-solving paradigm focused on conceiving, testing, and evaluating artifacts to tackle specific challenges. The dashboard integrated a set of Key Performance Indicators (KPIs) that incorporated three dimensions: epidemiological, humanitarian, and logistical. Both, the dashboard and the KPIs underwent validation through three iterative DSR cycles, in collaboration with both private and public health stakeholders. RESULTS: A set of 38 validated KPIs, grouped into eight categories, was consolidated into an online dashboard. This tool enabled real-time tracking of the National Vaccination Plan at both national and departmental levels, providing stakeholders with a comprehensive view of the vaccine supply chain. It also allowed for the assessment and comparison of the execution and effectiveness of public policies. CONCLUSIONS: These KPIs supported decision-making from a logistical standpoint, enhancing the planning, preparation, and continuous improvement of mass vaccination processes, thereby increasing their potential impact even further.

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OBJECTIVE: To analyze the investments made in medicines by the federated entities and the asymmetries in these investments from 2016 to 2020, which may have an impact on the supply of and access to these medicines in the SUS. METHODS: This is an exploratory, retrospective study to identify who are the main entities responsible for investment in Primary Care medicines in municipalities, the evolution, counterparts, and regional differences of this investment between 2016 and 2020. RESULTS: The amounts spent on medicines by Brazilian municipalities were higher than the contribution to the CBAF from the MS or the MS + State in all the years analyzed. The average percentages of federal funds transferred and municipal spending varied according to the region of Brazil. The average per capita amount invested in medicines by municipalities increased between 2016 and 2020 (deflation applied), with a greater impact for municipalities with lower MHDI. The Farmácia Popular program mainly reaches municipalities with the largest populations and the highest MHDI and is therefore not enough to address the inequalities in access pointed out. CONCLUSIONS: There has been a widening of inequalities in the capacity of municipalities to ensure access to medicines, especially among the most vulnerable municipalities, accumulating even more risks of illnesses and deaths from primary care-sensitive diseases.

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INTRODUCTION: Rheumatoid arthritis (RA) poses significant healthcare challenges in Latin America (LA) due to its high prevalence and unique healthcare dynamics. Despite global advancements, LA faces specific hurdles in effectively managing RA. AREAS COVERED: This review examines RA epidemiology, treatment strategies, and clinical challenges in LA. RA prevalence varies, with higher rates among indigenous populations. While conventional disease-modifying antirheumatic drugs (csDMARDs) are recommended as first-line therapy, access remains inconsistent. Biologics and targeted synthetic DMARDs are available, but biosimilars have limited accessibility, with drug prices varying significantly. Key barriers include supply interruptions, diagnosis delays, and high non-adherence rates driven by socioeconomic factors. A severe shortage of rheumatologists, particularly in rural areas, affects patient care. Cardiovascular events, comorbidities, and endemic infections further complicate RA management. EXPERT OPINION: Although RA care in LA has improved through better use of csDMARDs and advanced treatments, major challenges persist, such as a shortage of specialists, limited medical education, and fragmented healthcare systems. Expanding training programs, enhancing telemedicine, and ensuring drug supply continuity are essential. Strengthening clinical research, improving access to affordable treatments, and developing comprehensive, region-specific strategies are crucial to closing the gap between LA and more developed regions in RA care..

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Although there has been an increase in bench test evaluation of mechanical ventilators in recent years, a publication gap remains in assessing Pressure Control Continuous Mandatory Ventilation Modes with a set point targeting scheme PC-CMVs. This study evaluates the operational variability in PC-CMVs of eleven transport and emergency ventilators used in ICU units in Brazil during the COVID-19 pandemic. The assessment involved a comprehensive set of test scenarios derived from existing literature and the NBR ISO 80601-2-12:2014 standard. Nine parameters were computed for five consecutive breaths, offering a comprehensive characterization of pressure and flow waveforms. Most ventilators had Inspiratory pressure and PEEP values that fell outside of the tolerance ranges. Notably, three mechanical ventilators failed to reach the target pressures within the specified inspiratory times during test scenarios with a higher time constant (τ). We observed significant differences among emergency and transport ventilators in all assessed parameters, indicating a performance difference in PC-CMVs modes. The current results might help clinicians determine which ventilator models are suitable for specific clinical situations, particularly when unfavorable circumstances compel doctors to use ventilators that may not provide adequate support for patients in intensive care units.

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The present article analyzes the formation of the first pharmaceutical care policies implemented by the Brazilian Federal Government between 1968 and 1974, during the civil-military dictatorship. It examines a set of measures adopted by the Costa e Silva and Médici governments to contain a continuous rise in the prices of raw materials and pharmaceutical specialties, with this context being essential to the creation of the Medicines Center (CEME) in 1971. The core argument of the article is that CEME represented, at the federal level, the consolidation of a policy carried out at the National Institute of Social Security (Instituto Nacional da Previdência Social - INPS) between 1968 and 1970, based on the production of inputs and medicines in public laboratories. Ended in 1970, this policy was resumed the following year with broad participation of military personnel and laboratories of the Armed Forces. The originality of this article lies in its explanation of how such support influenced the establishment of CEME in its early years. Until 1974, military members were the majority in the Board of Directors of CEME, with some of the agency's early missions being the supplier for Civil-Social Actions of the Armed Forces.

O artigo analisa a formação das primeiras políticas de assistência farmacêutica executadas pelo Governo Federal brasileiro entre 1968 e 1974, durante a ditadura civil-militar. Examina um conjunto de medidas adotadas pelos governos Costa e Silva e Médici para conter uma contínua elevação nos preços de matérias-primas e especialidades farmacêuticas, sendo este contexto fundamental para a criação da Central de Medicamentos (CEME), em 1971. O argumento central do artigo é o de que a CEME representou a consolidação, em âmbito federal, de uma política realizada no Instituto Nacional da Previdência Social (INPS) entre 1968 e 1970, baseada na produção de insumos e medicamentos em laboratórios públicos. Encerrada em 1970, esta política foi retomada no ano seguinte com ampla participação de militares e laboratórios das Forças Armadas, sendo a originalidade deste artigo explicar como tal apoio influiu na montagem da CEME em seus primeiros anos. Até 1974, os membros militares eram majoritários na Comissão Diretora da CEME, sendo algumas das primeiras missões da autarquia o abastecimento de Ações Cívico-Sociais das Forças Armadas.

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This study aimed to measure access to medicines for the treatment of systemic arterial hypertension and type 2 diabetes mellitus in Brazil according to the mode of acquisition, as well as to analyze the factors associated with this access, based on data from the 2019 Brazilian National Survey of Health (PNS, acronym in Portuguese). Socioeconomic data and data related to the use of medicines by people aged 15 and over were analyzed in relation to access via the Brazilian Popular Pharmacy Program (PFPB, acronym in Portuguese) and via public services. The majority of Brazilians who took part in the PNS reported using medication to control hypertension in the previous 15 days (91.5%) and using oral medication for diabetes (95.2%) and/or insulin (70%). Most participants obtained oral medication for hypertension and type 2 diabetes mellitus via PFPB (45.2% and 53.6%, respectively), and the factors that most negatively influenced this access were older age, lower income, lower schooling, very poor self-rated health and not having private health insurance. Access to insulin, on the other hand, was most often via the public health service (69.7%), and the factors that most negatively influenced this access were black/mixed-race skin color, lower income, very poor self-rated health and not having private health insurance. Generally, the importance of the PFPB as a policy to increase access to essential medicines in Brazil was highlighted, considering the free supply of antihypertensive and antidiabetic drugs.

Este estudo objetivou mensurar o acesso aos medicamentos para o tratamento da hipertensão arterial sistêmica e diabetes mellitus tipo 2 no Brasil segundo a via de obtenção, bem como analisar os fatores associados a esse acesso, de acordo com os dados da Pesquisa Nacional de Saúde (PNS) de 2019. Foram analisados dados socioeconômicos e relacionados ao uso de medicamentos de pessoas de 15 anos ou mais, em relação ao acesso via Programa Farmácia Popular do Brasil (PFPB) e via serviço público. A maior parte dos brasileiros que participaram da PNS referiu fazer uso do medicamento para controle da hipertensão, nos últimos 15 dias (91,5%), assim como a maior parte referiu fazer uso de medicamento oral para diabetes (95,2%) e/ou uso da insulina (70%).Os medicamentos orais para hipertensão arterial sistêmica e diabetes mellitus tipo 2 foram obtidos majoritariamente via PFPB, sendo respectivamente (45,2% e 53,6%), e os fatores que mais influenciaram negativamente esse acesso foram maior faixa etária, menor renda, menor escolaridade, não ter plano de saúde e referir uma autoavaliação de saúde muito ruim. O acesso à insulina, por sua vez, se deu com maior frequência via serviço público de saúde (69,7%), e os fatores que mais influenciaram negativamente esse acesso foram raça preta/parda, menor renda, não ter plano de saúde e referir uma autoavaliação de saúde muito ruim. De forma geral, foi evidenciada a importância do PFPB como política de ampliação de acesso a medicamentos essenciais no Brasil, considerando a gratuidade dos anti-hipertensivos e antidiabéticos.

Este estudio tuvo como objetivo medir el acceso a los medicamentos para el tratamiento de la hipertensión arterial sistémica y de la diabetes mellitus tipo 2 en Brasil según la vía de obtención, además de analizar los factores asociados a este acceso, según datos de la Encuesta Nacional de Salud (PNS) de 2019. Se analizaron datos socioeconómicos y relacionados con el uso de medicamentos de personas de 15 años o más, con relación al acceso por medio del Programa Farmacia Popular de Brasil (PFPB) y por medio del servicio público. La mayor parte de los brasileños que participaron en la PNS refirió utilizar medicamentos para controlar la hipertensión, en los últimos 15 días (91,5%), así como la mayoría refirió el uso de medicamentos orales para la diabetes (95,2%) o uso de insulina (70%). Los medicamentos orales para hipertensión arterial sistémica y diabetes mellitus tipo 2 se obtuvieron en su mayoría por medio del PFPB, respectivamente (45,2% y 53,6%), y los factores que influyeron de forma más negativa en este acceso fueron mayor rango de edad, menores ingresos, menor escolaridad, no tener seguro de salud y reportar una autoevaluación de salud muy mala. El acceso a la insulina, a su vez, se produjo con mayor frecuencia por medio del servicio público de salud (69,7%), y los factores que influyeron de forma más negativa en este acceso fueron la raza negra/morena, menores ingresos, no tener plan de salud y reportar una autoevaluación de salud muy mala. En general, se destacó la importancia de la PFPB como política de ampliación del acceso a medicamentos esenciales en Brasil, considerando la gratuidad de los antihipertensivos y antidiabéticos.

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OBJECTIVE: to analyze the availability (in terms of stock and composition) and accessibility (in terms of geographical distribution) of the nursing workforce in Brazil. METHOD: this is a descriptive, cross-sectional study with retrospective data collection, identified by combining databases available on institutional websites and structured according to indicators from the World Health Organization's "National Health Workforce Accounts". The study considered nursing professionals at senior level (nurses) and middle level (nursing auxiliaries and technicians). Indicators of stock, composition, distribution (by age group and gender) and the ratio of nurses to doctors were included. RESULTS: there was an increase in the number of personnel between 2005 and 2010, mainly in middle and technical level professionals. There are more personnel aged between 36 and 55, with a predominance of women in all categories, despite the increase in men. There was an uneven distribution of personnel across the country's regions, with the Southeast having the largest number of professionals. The ratio of nurses to doctors is less than one in the South and Southeast. CONCLUSION: despite the large number of nurses, their distribution is uneven. The growth of nursing technicians has significantly outstripped that of nurses, indicating more intensive technical training policies than those found in higher education.

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BACKGROUND: Brazil has a large public transplant program, but it remains unclear if the kidney waitlist criteria effectively allocate organs. This study aimed to investigate whether gender, ethnicity, clinical characteristics, and Brazilian regions affect the chance of deceased donor kidney transplant (DDKT). METHODS: We conducted a retrospective cohort study using the National Transplant System/Brazil database, which included all patients on the kidney transplant waitlist from January 2012 to December 2022, followed until May 2023. The primary outcome assessed was the chance of DDKT, measured using subdistribution hazard and cause-specific hazard models (subdistribution hazard ratio [sHR]). RESULTS: We analyzed 118 617 waitlisted patients over a 10-year study period. Male patients had an sHR of 1.07 ([95% CI: 1.05-1.10], p < 0.001), indicating a higher chance of DDTK. Patients of mixed race and Yellow/Indigenous ethnicity had lower rates of receiving a transplant compared to Caucasian patients, with sHR of 0.97 (95% CI: 0.95-1) and 0.89 (95% CI: 0.95-1), respectively. Patients from the South region had the highest chance of DDKT, followed by those from the Midwest and Northeast, compared to patients from the Southeast, with sHR of 2.53 (95% CI: 2.47-2.61), 1.21 (95% CI: 1.16-1.27), and 1.10 (95% CI: 1.07-1.13), respectively. The North region had the lowest chance of DDTK, sHR of 0.29 (95% CI: 0.27-0.31). CONCLUSION: We found that women and racial minorities faced disadvantages in kidney transplantation. Additionally, we observed regional disparities, with the North region having the lowest chance of DDKT and longer times on dialysis before being waitlisted. In contrast, patients in the South regions had a chance of DDKT and shorter times on dialysis before being waitlisted. It is urgent to implement approaches to enhance transplant capacity in the North region and address race and gender disparities in transplantation.

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OBJECTIVE: To estimate the prevalence of general and public access to prescription drugs in the Brazilian population aged 15 or older in 2019, and to identify inequities in access, according to intersections of gender, color/race, socioeconomic level, and territory. METHODS: We analyzed data from the 2019 National Health Survey with respondents aged 15 years or older who had been prescribed a medication in a healthcare service in the two weeks prior to the interview (n = 19,819). The outcome variable was access to medicines, subdivided into general access (public, private and mixed), public access (via the Unified Health System - SUS) for those treated by the SUS, and public access (via the SUS) for those not treated by the SUS. The study's independent variables were used to represent axes of marginalization: gender, color/race, socioeconomic level, and territory. The prevalence of general and public access in the different groups analyzed was calculated and the association of the outcomes with the aforementioned axes was estimated with odds ratios (OR) using logistic regression models. RESULTS: There was a high prevalence of general access (84.9%), when all sources of access were considered, favoring more privileged segments of the population, such as men, white, and those of high socioeconomic status. When only the medicines prescribed in the SUS were considered, there was a low prevalence (30.4% access) that otherwise benefited marginalized population segments, such as women, black, and people from low socioeconomic backgrounds. CONCLUSIONS: Access to medicines through the SUS proves to be an instrument for combating intersectional inequities, lending credence to the idea that the SUS is an efficient public policy for promoting social justice.

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OBJECTIVE: to analyze the frequency and associated risk factors for COVID-19 infection and the availability of Personal Protective Equipment used by primary healthcare workers. METHOD: a cross-sectional study was conducted over six months in Rio Grande do Sul. Descriptive analysis was performed, with the comparison of independent samples using Pearson's Chi-square test and Fisher's Exact test (p<.05). RESULTS: the study included 206 (27%) healthcare workers who presented COVID-19 symptoms. There was a statistical association for the following variables: availability of surgical masks (p=.003), seeking information on the correct use of personal protective equipment (p=.045), having attended people with flu-like syndrome (p=.024), and believing that the highest risk of contamination is when attending a patient positive for coronavirus disease (p=.001). CONCLUSION: the availability of personal protective equipment is indispensable for COVID-19 prevention, with special emphasis on the use of surgical masks. Furthermore, the study highlighted the importance of providing Personal Protective Equipment in conjunction with guidance on its use. HIGHLIGHTS: (1) Highlighted impacts on the distribution of PPE necessary for worker safety.(2) Emphasized the need for training and education regarding the use of PPE.(3) Found significance regarding the availability of surgical masks.(4) Identified the need for further research on health safety topics.(5) Revealed a high incidence of symptomatic workers and positive cases of COVID-19.

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OBJECTIVES: Identifying key barriers to accessing quality-assured and affordable antimicrobials among forcibly displaced persons in Uganda, Yemen and Colombia and investigating their (1) utilisation patterns of antibiotics, (2) knowledge about antimicrobial resistance (AMR) and (3) perception of the quality of antimicrobials received. DESIGN: Pilot cross-sectional survey. SETTING: Data were collected from five health facilities in the Kiryandongo refugee settlement (Bweyale, Uganda), three camps for internally displaced persons (IDPs) in the Dar Sad district (Aden, Yemen) and a district with a high population of Venezuelan migrants (Kennedy district, Bogotá, Colombia). Data collection took place between February and May 2021. The three countries were selected due to their high number of displaced people in their respective continents. PARTICIPANTS: South Sudanese refugees in Uganda, IDPs in Yemen and Venezuelan migrants in Colombia. OUTCOME MEASURE: The most common barriers to access to quality-assured and affordable antimicrobials. RESULTS: A total of 136 participants were enrolled in this study. Obtaining antimicrobials through informal pathways, either without a doctor's prescription or through family and friends, was common in Yemen (27/50, 54.0%) and Colombia (34/50, 68.0%). In Yemen and Uganda, respondents used antibiotics to treat (58/86, 67.4%) and prevent (39/86, 45.3%) a cold. Knowledge of AMR was generally low (24/136, 17.6%). Barriers to access included financial constraints in Colombia and Uganda, prescription requirements in Yemen and Colombia, and non-availability of drugs in Uganda and Yemen. CONCLUSION: Our multicentred research identified common barriers to accessing quality antimicrobials among refugees/IDPs/migrants and common use of informal pathways. The results suggest that knowledge gaps about AMR may lead to potential misuse of antimicrobials. Due to the study's small sample size and use of non-probability sampling, the results should be interpreted with caution, and larger-scale assessments on this topic are needed. Future interventions designed for similar humanitarian settings should consider the interlinked barriers identified.

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BACKGROUND: Liver transplantation is used for treating end-stage liver disease, fulminant hepatitis, and oncological malignancies and organ shortage is a major limiting factor worldwide. The use of grafts based on extended donor criteria have become internationally accepted. Oxygenated machine perfusion technologies are the most recent advances in organ transplantation; however, it is only applied after a period of cold ischemia. Due to its high cost, we aimed to use a novel device, OxyFlush®, based on oxygenation of the preservation solution, applied during liver procurement targeting the maintenance of ATP during static cold storage (SCS). METHODS: Twenty patients were randomly assigned to the OxyFlush or control group based on a 1:1 ratio. In the OxyFlush group, the perfusion solution was oxygenated with OxyFlush® device while the control group received a non-oxygenated solution. Liver and the common bile duct (CBD) biopsies were obtained at three different time points. The first was at the beginning of the procedure, the second during organ preparation, and the third after total liver reperfusion. Biopsies were analyzed, and adenosine triphosphate (ATP) levels and histological scores of the liver parenchyma and CBD were assessed. Postoperative laboratory tests were performed. RESULTS: OxyFlush® was able to maintain ATP levels during SCS and improved the damage caused by the lack of oxygen in the CBD. However, OxyFlush® did not affect laboratory test results and histological findings of the parenchyma. CONCLUSION: We present a novel low-cost device that is feasible and could represent a valuable tool in organ preservation during SCS.

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This cross-sectional study investigates whether there are associations between inflation, economic policy changes, and retirees' access to medicines in Argentina.

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Difficult access to birth care services is associated with infant and neonatal mortality and maternal morbidity and mortality. In this study, data from the Brazilian Unified National Health System (SUS) were used to map the evolution of geographic accessibility to hospital birth of usual risk in the state of Rio de Janeiro, Brazil, corresponding to 418,243 admissions in 2010-2011 and 2018-2019. Travel flows, distances traveled, and intermunicipal travel time between the pregnant women's municipality and hospital location were estimated. An increase from 15.9% to 21.5% was observed in the number of pregnant women who needed to travel. The distance traveled increased from 24.6 to 26km, and the travel time from 76.4 to 96.1 minutes, with high variation between Health Regions (HR). Pregnant women living in HR Central-South traveled more frequently (37.4-48.9%), and those living in the HRs Baía da Ilha Grande and Northwest traveled the largest distances (90.9-132.1km) and took more time to get to the hospital in 2018-2019 (96-137 minutes). The identification of municipalities that received pregnant women from many other municipalities and municipalities that treated a higher number of pregnant women (hubs and attraction poles, respectively) reflected the unavailability and disparities in access to services. Regional inequalities and reduced accessibility highlight the need to adapt supply to demand and review the distribution of birth care services in the state of Rio de Janeiro. This study contributes to research and planning on access to maternal and child health services and can be used as a reference study for other states in the country.

A dificuldade de acesso aos serviços de atenção ao parto está associada à mortalidade infantil e neonatal e à morbimortalidade materna. Neste estudo, dados do Sistema Único de Saúde (SUS) foram utilizados para mapear a evolução da acessibilidade geográfica ao parto hospitalar de risco habitual no Estado do Rio de Janeiro, Brasil, correspondentes a 418.243 internações nos biênios 2010-2011 e 2018-2019. Foram estimados os fluxos de deslocamento, as distâncias percorridas e o tempo de deslocamento intermunicipal entre o município de residência e de internação das gestantes. Houve um crescimento de 15,9% para 21,5% na proporção de gestantes que precisaram se deslocar. A distância percorrida aumentou de 24,6 para 26km, e o tempo de deslocamento de 76,4 para 96,1 minutos, com grande variação entre as Regiões de Saúde (RS). As gestantes residentes na RS Centro Sul se deslocaram mais frequentemente (37,4-48,9%), e as residentes nas RS Baía da Ilha Grande e Noroeste percorreram as maiores distâncias (90,9-132,1km) e levaram mais tempo para chegar ao hospital no último biênio (96-137 minutos). A identificação dos municípios que receberam gestantes de muitos outros municípios e daqueles que atenderam maior volume de gestantes (núcleos e polos de atração, respectivamente) refletiu a indisponibilidade e as disparidades no acesso aos serviços. As desigualdades regionais e a redução da acessibilidade alertam para a necessidade de adequar a oferta à demanda e de revisar a distribuição dos serviços de atenção ao parto no Rio de Janeiro. O estudo contribui para as pesquisas e o planejamento sobre o acesso a serviços de saúde materno-infantil, além de servir como referência para outros estados do país.

La dificultad para acceder a los servicios de atención al parto está asociada con la mortalidad infantil y neonatal, y con la morbimortalidad materna. En este estudio, se utilizaron datos del Sistema Único de Salud (SUS) para mapear la evolución de la accesibilidad geográfica al parto hospitalario de riesgo habitual en el estado de Río de Janeiro, Brasil, correspondiente a 418.243 hospitalizaciones en los bienios 2010-2011 y 2018-2019. Se estimaron los flujos de desplazamiento, las distancias recorridas y el tiempo de desplazamiento intermunicipal entre el municipio de residencia y la hospitalización de las mujeres embarazadas. Hubo un aumento del 15,9% al 21,5% en la proporción de mujeres embarazadas que necesitaron desplazarse. La distancia recorrida aumentó de 24,6 a 26km y el tiempo de desplazamiento de 76,4 a 96,1 minutos, con gran variación entre las Regiones de Salud (RS). Las mujeres embarazadas residentes en la RS Centro Sul se desplazaron con mayor frecuencia (37,4-48,9%), y las residentes en las RS Baía da Ilha Grande y Noroeste recorrieron las mayores distancias (90,9-132,1km) y tardaron más en llegar al hospital en el últimos bienio (96-137 minutos). La identificación de los municipios que recibieron mujeres embarazadas de muchos otros municipios y de aquellos que atendieron a un mayor volumen de mujeres embarazadas (núcleos y polos de atracción, respectivamente) reflejó la indisponibilidad y las disparidades en el acceso a los servicios. Las desigualdades regionales y la reducida accesibilidad alertan sobre la necesidad de adaptar la oferta a la demanda, y de revisar la distribución de los servicios de atención al parto en el estado de Rio de Janeiro. El estudio contribuye a las investigaciones y a la planificación sobre el acceso a los servicios de salud materno-infantil, y puede servir como referencia para otros estados del país.