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The Care Block of Bogotá, Colombia, is an urban program that offers services for low-income unpaid caregivers. This study aimed to (i) characterize unpaid caregivers' subjective well-being, mental health symptoms, physical activity levels, and use of public spaces linked to the Care Block; (ii) identify caregivers' perceived built and social environment facilitators and barriers to accessing the Care Block facility; and (iii) document the community-led advocacy process to improve the Care Block program. The quantitative component included a subjective well-being and mental health symptoms survey, and the System for Observing Play and Recreation in Communities (SOPARC) instrument. The qualitative component included the Our Voice citizen science method augmented with portable virtual reality equipment to engage participants in advocacy for changes. Participants (median age of 53 years) dedicated a median of 13.8 h a day to unpaid caregiving, had an average subjective well-being score of 7.0, and 19.1% and 23.8% reported having depression and generalized anxiety symptoms respectively. Caregivers reported that the program fosters their perception of purpose, enjoyment, resilience, and cognitive and emotional awareness. SOPARC evaluation showed that most women engaged in moderate to vigorous physical activity. The caregivers highlighted education, physical activity services, and integration of facilities as facilitators to accessing the Care Block program. Poor quality and lack of sidewalks and roads, limited personal safety, and the risk of pedestrian-vehicle collisions were identified as barriers. Virtual Reality sparked compelling dialogue between participants and stakeholders, allowing stakeholders to reflect on an urban program facilitating unpaid care work.

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RESUMO. No Brasil, o funcionamento das residências terapêuticas tende a apresentar desafios, tais como a falta de apoio social, que podem dificultar a produção do cuidado em saúde e afetar os trabalhadores do serviço. Por isso, a presente pesquisa tem como objetivo relatar a experiência de realização de oficinas com profissionais de uma residência terapêutica, além de descrever os desafios e potencialidades enfrentados pelos profissionais ao produzirem o cuidado em saúde. Para tanto, realizou-se um estudo qualitativo-descritivo, do tipo relato de experiência, embasado na abordagem metodológica do construcionismo social. Os dados foram coletados a partir de entrevistas semiestruturadas, gravadas, com cinco profissionais de uma residência terapêutica, seguidas por quatro oficinas, adaptadas a partir da Metodologia 'Ritmos da Vida', e diários de campo da pesquisadora. A partir dos relatos apresentados percebe-se que as participantes do estudo relataram muito mais desafios do que potencialidades para a produção do cuidado em saúde mental. Contudo, os espaços de fala e de escuta ofertados às profissionais parecem ter disponibilizado reflexões que possibilitaram a construção de sentidos positivos relacionados ao trabalho em saúde mental.

RESUMEN. En el Brasil, el funcionamiento de las residencias terapéuticas tiende a presentar desafíos, como la falta de apoyo social, que pueden dificultar la producción del cuidado en salud y afectar a los trabajadores del servicio. Por eso, la presente investigación tiene como objetivo relatar la experiencia de realización de talleres con profesionales de una residencia terapéutica, además describir los desafíos y potencialidades enfrentados por los profesionales al producir el cuidado en salud. Para ello, se realizó un estudio cualitativo-descriptivo, del tipo relato de experiencia, basado en el enfoque metodológico del construccionismo social. Los datos fueron recolectados a partir de entrevistas semiestructuradas, grabadas, con cinco profesionales de una residencia terapéutica, seguidas por cuatro talleres, adaptados a partir de la Metodología 'Ritmos da Vida', y diarios de campo de la investigadora. A partir de los relatos presentados se percibe que las participantes del estudio relataron mucho más desafíos que potencialidades para la producción del cuidado en salud mental. Sin embargo, los espacios de habla y de escucha ofrecidos a las profesionales parecen haber ofrecido reflexiones que posibilitaron la construcción de sentidos positivos relacionados con el trabajo en salud mental.

ABSTRACT. n Brazil, the functioning of therapeutic residences tends to present challenges, such as the lack of social support, which can hinder the production of health care and affect the workers of the service. Therefore, this study aimed to report the experience of conducting workshops with professionals of a therapeutic residence, besides describing the challenges and potentialities faced by professionals when producing health care. To this end, a qualitative-descriptive study, experience report was carried out, based on the social constructionism approach. Data were collected from semi-structured interviews, recorded, with five professionals of a therapeutic residence, followed by four workshops, adapted from the methodology 'Rhythms of Life', and field diaries of the first author. From the reports presented, the study participants clearly reported many more challenges than potentialities to produce mental health care. However, the spaces for talking and listening offered to professionals seem to have provided reflections that enabled the construction of positive meanings related to mental health work.

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O NASF foi pensado como um dispositivo potente com o intuito de promover mudanças nas práticas de cuidado e no modo de atuação das equipes da Estratégia Saúde da Família. Desde sua implantação, há 14 anos, representa objeto de indagações acerca do seu papel. Transformações significativas no âmbito da Atenção Primária brasileira vêm acontecendo nos últimos anos colocando em risco a manutenção dessas equipes. O objetivo geral do estudo foi descrever o modelo de gestão e de financiamento dos NASF no estado do Rio de Janeiro, suas potencialidades e os desafios no âmbito da PNAB. Os objetivos específicos buscaram compreender as principais mudanças conceituais e de gestão do NASF impostas pela PNAB 2012 e PNAB 2017, analisando comparativamente os seus avanços e limites; descrever e analisar o histórico de implantação das equipes NASF no âmbito do estado do Rio de Janeiro, desde a publicação da Portaria nº154 de 2008 até 2021; descrever o Programa de Financiamento Estadual da Atenção Primária à Saúde (PREFAPS) no estado do Rio de Janeiro no período de 2019 até 2021 e discutir o papel do PREFAPS e sua influência para a manutenção e fortalecimento dos NASF no estado do Rio de Janeiro. O percurso metodológico seguiu as seguintes etapas: revisão bibliográfica; levantamento de documentos normativos relacionados ao NASF, a PNAB e ao financiamento da APS; coleta de dados secundários, relacionados ao quantitativo de equipes NASF implantadas e cadastradas; cobertura de APS e ESF e dados populacionais do ERJ; análise documental e descrição dos resultados. Como resultados apontados relata-se que apesar de ser considerada satisfatória a adesão dos municípios à proposta do NASF no ERJ de forma ascendente na ampliação das equipes no período de 2008 a 2016, observa-se que sua implementação se deu de maneira heterogênea nas Regiões. No período de 2017 a 2021 percebeu-se uma redução dessas equipes no estado, efeito da diminuição do número de equipes no município do Rio de Janeiro com a reestruturação da APS e também o reflexo das mudanças ocorridas na PNAB de 2017 e em 2019 com o Programa Previne Brasil. Observou-se que apesar do esforço da gestão estadual para manter as equipes NASF, o PREFAPS influenciou pouco para a sua manutenção, sendo necessárias ações de apoio técnico e maior aporte financeiro para garantir que o NASF possa cumprir seu papel mais abrangente na APS. Ao final do estudo sugerimos a continuidade de novas análises acerca da temática e apontamos algumas recomendações no âmbito da gestão estadual, para o fortalecimento e manutenção das equipes APS, sobretudo para as equipes NASF.

The NASF was thought of as a powerful device with the aim of promoting changes in care practices and in the ways in which a Familia Health Strategy team works. Since its implementation, 14 years ago, it has been the object of inquiries about its role. Significant changes in the scope of Brazilian Primary Care have been taking place in recent years, putting the maintenance of these teams at risk. The general objective of the study was to describe the management and financing model of the NASF in the state of Rio de Janeiro, its potential and the challenges within the scope of the PNAB. The specific objectives sought to understand the main conceptual and management changes of the NASF imposed by the PNAB 2012 and PNAB 2017, comparatively analyzing their advances and limits; describe and analyze the history of implementation of NASF teams within the state of Rio de Janeiro, from the publication of Ordinance nº154 from 2008 to 2021; describe the State Financing Program for Primary Health Care (PREFAPS) in the state of Rio de Janeiro from 2019 to 2021 and discuss the role of PREFAPS and its influence on the maintenance and strengthening of NASF in the state of Rio de Janeiro. The methodological course followed the following steps: bibliographic review; survey of normative documents related to the NASF, the PNAB and the financing of PHC; secondary data collection, related to the number of NASF teams implemented and registered; coverage of PHC and ESF and population data from the ERJ; document analysis and description of the results. As results pointed out, it is reported that although the adherence of municipalities to the NASF proposal in the ERJ is considered satisfactory in the expansion of teams, in the period from 2008 to 2016, it is observed that its implementation took place in a heterogeneous way in the Regions. In the period from 2017 to 2021, there was a reduction in these teams in the state, an effect of the decrease in the number of teams in the municipality of Rio de Janeiro with the restructuring of the APS and also a reflection of the changes that occurred in the PNAB in 2017 and in 2019 with the Previne Program Brazil. It was observed that despite the effort of state management to maintain the NASF teams, PREFAPS had little influence on their maintenance, requiring technical support actions and greater financial support to ensure that the NASF can fulfill its broader role in PHC. At the end of the study, we suggest the continuation of new analyzes on the subject and point out some recommendations within the scope of state management, for the strengthening and maintenance of the APS teams, especially for the NASF teams.

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INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has been a worldwide challenge, and efforts to "flatten the curve," including restrictions imposed by policymakers and medical societies, have forced a reduction in the number of procedures performed in the Brazilian Health Care System. The aim of this study is to evaluate the outcomes of coronary artery bypass graft (CABG) from 2008 to 2020 in the SUS and to assess the impacts of the COVID-19 pandemic in the number of procedures and death rate of CABG performed in 2020 through the database DATASUS. METHODS: This study is based on publicly available material obtained from DATASUS, the Brazilian Ministry of Health's data processing system, on numbers of surgical procedures and death rates. Only isolated CABG procedures were included in our study. We used the TabNet software from the DATASUS website to generate reports. RESULTS: We identified 281,760 CABG procedures performed from January 2008 to December 2020. The average number of procedures until the end of 2019 was of 22,104. During 2020 there was a 25% reduction CABG procedures, to 16,501. There was an increase in the national death rate caused by a statistical significant increase in death rates in Brazil's Southeast and Central-west regions. CONCLUSION: The COVID-19 pandemic remains a global challenge for Brazil's health care system. During the year of 2020 there was a reduction in access to CABG related to an increase in the number of COVID-19 cases. There was also an increase in the national CABG death rate.

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BACKGROUND: The prevalence of total joint arthroplasty (TJA) in the United States has drawn the attention of health care stakeholders. The payers have also used a variety of strategies to regulate the medical necessity of these procedures. The purpose of this study was to examine the level of evidence of the coverage policies being used by commercial payers in the United States. METHODS: The references of the coverage policies of four commercial insurance companies were reviewed for type of document, level of evidence, applicability to a TJA population, and success of nonoperative treatment in patients with severe degenerative joint disease. RESULTS: 282 documents were reviewed. 45.8% were primary journal articles, 14.2% were level I or II, 41.2% were applicable to patients who were candidates for TJA, and 9.9% discussed the success of nonoperative treatment in patients who would be candidates for TJA. CONCLUSION: Most of the references cited by commercial payers are of a lower level of scientific evidence and not applicable to patients considered to be candidates for TJA. This is relatively uniform across the reviewed payers. The dearth of high-quality literature cited by commercial payers reflects the lack of evidence and difficulty in conducting high level studies on the outcomes of nonoperative versus operative treatment for patients with severe, symptomatic osteoarthritis. Patients, surgeons, and payers would all benefit from such studies and we encourage professional societies to strive toward that end through multicenter collaboration.

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Evaluation of patients for kidney transplant candidacy is a comprehensive process that involves a detailed assessment of medical and surgical issues, psychosocial factors, and patients' physical and cognitive abilities with an aim of balancing the benefits of transplantation and potential risks of surgery and long-term immunosuppression. There is considerable variability among transplant centers in their approach to evaluation and decision-making regarding transplant candidacy. The 2020 KDIGO (Kidney Disease: Improving Guidelines Outcome) clinical practice guideline on the evaluation and management of candidates for kidney transplantation provides practice recommendations that can serve as a useful reference guide to transplant professionals. The guideline, covering a broad range of topics, was developed by an international group of experts from transplant and nephrology through a review of literature published until May 2019. A work group of US transplant nephrologists convened by NKF-KDOQI (National Kidney Foundation-Kidney Disease Quality Initiative) chose key topics for this commentary with a goal of presenting a broad discussion to the US transplant community. Each section of this article has a summary of the key KDIGO guideline recommendations, followed by a brief commentary on the recommendations, their clinical utility, and potential implementation challenges. The KDOQI work group agrees broadly with the KDIGO recommendations but also recognizes and highlights the decision-making challenges that arise from lack of high-quality evidence and the need to balance equity with utility of organ transplantation.

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BACKGROUND: Brazil is an upper middle-income country in South America with the world's sixth largest population. Despite great advances in health-care services and cardiac surgical care in both its public and private health systems, little is known on the volume, outcomes, and trends of coronary artery bypass grafting (CABG) in Brazil's public health system. OBJECTIVE: The aim of this study was to evaluate the outcome of CABG on the public health system from January 2008 to December 2017 through the database DATASUS. METHODS: This study is based on publicly available material obtained from DATASUS, the Brazilian Ministry of Health's data processing system, on numbers of surgical procedures, death rates, length of stay, and costs. Only isolated CABG procedures were included in our study. We used the TabNet software from the DATASUS website to generate reports. The χ2 test was used to compare death rates. A p < .05 was considered statistically significant. RESULTS: We identified 226,697 CABG procedures performed from January 2008 to December 2017. The overall in-hospital mortality over the 10-year period was 5.7%. We observed statistically significant differences in death rates between the five Brazilian macro-regions. Death rates by state ranged from 2.6% to 13.1%. The national average mortality rate remained stable over the course of time. CONCLUSION: Over 10 years, a high volume of CABG was performed in the Brazilian Public Health System, with significant differences in mortality, number of procedures, and distribution of surgeries by region. Future databases involving all centers that perform CABG and carry out risk-adjusted analysis will help improve Brazilian results and enable policymakers to adopt appropriate health-care policies for greater transparency and accountability.

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Free Trade Agreements (FTA) are controversial for threatening essential aspects of health, especially access to affordable medicines. The US-Peru FTA required changes in the Peruvian pharmaceutical legislation that resulted in the implementation of the National Drug Policy (NDP) of 2009. The NDP included more robust technical requirements for registration, a Peruvian Good Manufacturing Practices certificate, a longer timeline for drug registration, and an increase in registration fees. This study evaluated the impact of the FTA on the number of registrations and competition in the Peruvian pharmaceutical market. Data for the period January 2005 to April 2014 were provided by the Peruvian drug regulatory authority (Dirección General de Medicamentos, Insumos y Drogas, DIGEMID). A total of 31,114 pharmaceutical products with unique registration numbers were evaluated. Brand drug new registrations decreased from 1789 in 2005 to 455 in 2013, and the number of generic registrations decreased from 621 in 2005 to 114 in 2013. Brand re-registrations also decreased from 714 in 2005 to 58 in 2013. There were 228 brand products awaiting registration in 2009 and 1,908 in 2013. The proportion of products awaiting registration was three times greater for brand than for generic products in 2009-2013. Registration of brand and generic medicines significantly declined after the implementation of the US-Peru FTA in 2009. The decline in the number of registrations was associated with more robust technical requirements, a longer DIGEMID registration timeline, and an increase in registration fees. The stronger registration requirements are expected to increase the quality of the drugs marketed in the country, but also less competition and a reduction in domestic registrations.

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OBJECTIVE: Provide a synthesis of the COVID-19 policies targeting older people in Chile, stressing their short- and long-term challenges. METHOD: Critical analysis of the current legal and policy measures, based on national-level data and international experiences. RESULTS: Although several policies have been enacted to protect older people from COVID-19, these measures could have important unintended negative consequences in this group's mental and physical health, as well as financial aspects. DISCUSSION: A wider perspective is needed to include a broader definition of health-considering financial scarcity, access to health services, mental health issues, and long-term care-in the policy responses to COVID-19 targeted to older people in Chile.

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Resumo O artigo objetiva analisar as relações que a política de acolhimento estabelece com a juventude em idade de inserção na formação profissional. Pressupõe-se que não há um planejamento sistematizado da política de acolhimento voltado à inserção dos jovens que atendam ao critério de idade na formação profissional, havendo ações pontuais e descontínuas. Trata-se de uma pesquisa qualitativa e exploratória de campo, realizada em sete instituições de acolhimento de um município da Paraíba. A pesquisa documental foi guiada por um protocolo elaborado pelas autoras, a partir do qual se buscaram informações para caracterização dos(as) jovens e das experiências registradas como a formação acessada. No diário de campo, fizeram-se anotações de caráter reflexivo, especulativo e descritivo. Procedeu-se a uma análise descritiva e de conteúdo, baseada na literatura que trata da temática. Os resultados apontam que dos(as) 51 jovens caracterizados(as), apenas 29 foram inseridos(as) na formação profissional, com prevalência no programa Jovem Aprendiz. Dentre os obstáculos mais enfatizados para inserção na formação profissional, está a defasagem escolar dos(as) jovens, que, somada à falta de clareza dos(as) profissionais sobre o que configura a formação profissional, conduziu a inserções em qualificações diversas e desvinculadas de uma proposta de inserção no mercado de trabalho. Aponta-se a necessidade de investimento na política de acolhimento em sua articulação com a política de formação profissional, a fim de contribuírem para o desenvolvimento juvenil, com potencial de colaborar para a construção de projetos de vida e para a inserção no mercado de trabalho.(AU)

Abstract This paper analyzes the relations established between foster care policy and youth of vocational training age. We assumed a lack of systematic planning by the foster care policy aimed at young people of vocational training age, with only specific and discontinuous actions. This qualitative and exploratory field research was carried out in seven host institutions in a municipality of Paraíba. Guided by a protocol developed by the authors, the documentary research sought to characterize these young people and their experiences, such as the training accessed. The field diary consisted of reflective, speculative, and descriptive observations. After, the data collected underwent descriptive and content analysis, based on the literature regarding this topic. Results show that, of the 51 young individuals characterized, only 29 accessed vocational training, with prevalence of the Jovem Aprendiz program. Among the major obstacles for insertion in vocational training is the learning discrepancy of these young people, which, added to the professionals' lack of clarity on what constitutes vocational training, led to insertions in diverse programs, disconnected from a proposal for entry in the labor market. These findings point out the need for investment in foster care policy articulated with a vocational training policy, as to contribute to youth development, and that may collaborate to the construction of life projects and to the insertion in the labor market.(AU)

Resumen Este artículo pretende analizar las relaciones que la política de acogida establece con los jóvenes en edad de insertarse en la formación profesional. Se supone que no existe una planificación sistemática de la política de acogida orientada a la inserción profesional de jóvenes que cumplan con el criterio de edad, sino acciones puntuales y discontinuas. Esta es una investigación cualitativa y exploratoria de campo, realizada en siete instituciones del acogida de un municipio de Paraíba (Brasil). La investigación documental estuvo guiada por un protocolo elaborado por las autoras, a partir del cual se buscó información para caracterizar a los/las jóvenes y las vivencias registradas como la formación que accedieron. En el diario de campo, se tomaron notas de carácter reflexivo, especulativo y descriptivo. Se realizó un análisis descriptivo y de contenido, con base en la literatura que trata el tema. Los resultados muestran que, de los/las 51 jóvenes caracterizados/as, solo 29 fueron incluidos/as en la formación profesional, con predominio en el programa Jovem Aprendiz. Entre los obstáculos más destacados para insertarse en la formación profesional, se encuentra el retraso escolar de los/las jóvenes, al que se suma la falta de claridad de los/las profesionales sobre lo que constituye la formación profesional, lo que propició inserciones en cursos diferentes y desconectados de una propuesta de inserción en el mercado laboral. Se señala la necesidad de invertir en la política de acogida vinculada con la política de formación profesional, con el fin de contribuir con el desarrollo juvenil y colaborar para la construcción de proyectos de vida y para la inserción en el mercado laboral.(AU)

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Abstract The COVID-19 pandemic highlighted the strategic role of social care policy to minimize the effects of this health crisis and its consequences on the poorest and most vulnerable population. This article analyzes the perception of street-level bureaucrats in the Brazilian social care network on how the pandemic has affected their performance and professional routine. The research was based on a survey, consultations with representatives of municipal social care services, and analysis of government regulations. The results show that social workers feel unprotected and unable to provide adequate responses to the pandemic's increasing and urgent demands, revealing a lack of institutional support to act appropriately. The professionals also reported substantial changes in their working dynamics, particularly in their relationship with the attended population, one of the main pillars of the Brazilian social care network. These elements directly affect the provision of social care services and their potential to combat the adverse effects of the crisis.

Resumen La pandemia de COVID-19 destacó el papel estratégico de la política de atención social para minimizar los efectos de esta crisis de salud y de sus consecuencias en la población más pobre y vulnerable. A partir de este entendimiento, este artículo analiza la percepción de los burócratas a nivel de calle en la red de atención social brasileña en relación a cómo la pandemia ha afectado su desempeño y su rutina profesional. Con base en una encuesta, en consultas con representantes de los servicios municipales de atención social y regulaciones gubernamentales, la investigación ha identificado que, en la pandemia, estos trabajadores se sienten desprotegidos e incapaces de dar respuestas adecuadas a las crecientes y urgentes demandas, además de reportar cambios sustanciales en su dinámica de trabajo, incluyendo uno de sus principales pilares de actuación, el vínculo establecido con los usuarios del servicio. Al mismo tiempo, carecen de apoyo institucional para actuar con seguridad. Estos elementos afectan directamente la prestación de servicios de atención social y su potencial para combatir los efectos adversos de la crisis.

Resumo A pandemia da COVID-19 ressaltou o papel estratégico da política de assistência social para minimizar os efeitos desta crise de saúde e de suas consequências sobre a população mais pobre e vulnerável. A partir desse entendimento, este artigo analisa a percepção de burocratas de nível de rua da rede socioassistencial brasileira sobre como a pandemia tem afetado sua atuação e seu cotidiano profissional. Com base em um survey, em consultas com representantes de serviços socioassistenciais municipais e em regulações governamentais, a pesquisa identificou que, na pandemia, esses trabalhadores se sentem desprotegidos e pouco capazes de dar respostas adequadas às demandas cada vez maiores e urgentes, além de relatarem mudanças substanciais nas suas dinâmicas de trabalho, incluindo um dos seus principais pilares de atuação, o vínculo estabelecido com os usuários dos serviços. Simultaneamente, sentem falta de apoio institucional para atuar com segurança. Esses elementos afetam diretamente a prestação dos serviços socioassistenciais e seu potencial de combater os efeitos adversos da crise.

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Resumo A Estratégia Saúde da Família é a principal forma de organização do sistema de saúde brasileiro. Contudo, a terceira edição da Política Nacional de Atenção Básica (PNAB) passou a reconhecer financeiramente outros tipos de equipes. Para analisar os efeitos da PNAB de 2017 na composição das equipes, foi realizado um estudo de série temporal de 2007 a 2019 utilizando dados do Cadastro Nacional de Estabelecimentos de Saúde (CNES) de postos de trabalho e de equipes e a cobertura nacional da Saúde da Família. Observou-se a concentração de médicos nas regiões Sudeste e Nordeste e oscilação dessa categoria profissional ante os acontecimentos do Programa Mais Médicos. Houve acréscimo de 5% de enfermeiros e redução de 0,3% dos ACS no país. A despeito da autorização e financiamento para implantação de equipes de "Atenção Básica" (eAB), elas correspondem a menos de 1% do total de equipes. Vale ressaltar que a modalidade preferencial dos gestores municipais se mantem pela Equipes de Saúde da Família, correspondendo a 75% do total de equipes e em crescimento. Apesar dos questionamentos e expectativas gerados pela PNAB de 2017 no contexto da Atenção Primária à Saúde, conclui-se que, em relação às equipes e suas composições, não houve mudança significativa após dois anos de sua vigência.

Abstract The Family Health Strategy is the main form of organization of the Brazilian health system. However, the third edition of the National Primary Health Care Policy (PNAB) recognized other types of teams financially. A time series study was conducted from 2007 to 2019 using data from the National Register of Health Facilities (CNES) of jobs, teams and national coverage of Family Health to analyze the effects of the 2017 National Primary Health Care Policy (PNAB) on team composition. We observed the concentration of doctors in the Southeast and Northeast and variation of this professional category before the events of the "Mais Médicos" (More Doctors) Program. The number of nurses increased 5% and Community Health Workers (ACS) dropped 0.3% in the country. Despite the authorization and funding for the implementation of "Primary Care" teams (eAB), they correspond to less than 1% of the total teams. It is noteworthy that the municipal managers' preferred mode is the traditional Family Health Teams, equivalent to 75% of the total and growing. While the questionings and expectations generated by the 2017 PNAB in the context of Primary Health Care, we can conclude that, regarding the teams and their compositions, no significant change was identified two years into its coming into force.

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Resumo A expansão da Atenção Primária à Saúde (APS) exigiu mudanças na Assistência Farmacêutica, de maneira a aumentar a cobertura da distribuição gratuita de medicamentos e reforçando a necessidade do uso racional de medicamentos. O objetivo deste trabalho foi estudar a Assistência Farmacêutica na produção do cuidado na APS, contribuindo para o entendimento do uso racional de medicamentos. Método: Optou-se por analisar o material de uma investigação de natureza etnográfica, realizada no ano de 2014 em sete Unidades Básicas de Saúde. Além disso, realizou-se um seminário com atores institucionais das Unidades estudadas, de forma a aumentar a lateralidade dos resultados. Resultados: Foi possível identificar cenas e falas, que se conectavam e davam visibilidades a elementos micropolíticos relacionados ao uso de medicamentos, a autonomia profissional − o papel do médico na prescrição dos medicamentos e o usuário prescritor do seu cuidado. Conclusão: O que acontece depois que o usuário deixa a Unidade com seus medicamentos retirados na farmácia parece ainda ficar oculto aos olhos dos profissionais de saúde. O estudo produz indicações de algumas falhas na atuação da Assistência Farmacêutica e mostra o quanto estamos distantes de uma gestão do cuidado que inclua o uso racional de medicamentos em suas múltiplas racionalidades.

Abstract The expansion of Primary Health Care required changes in Pharmaceutical Care, in order to increase the coverage of the free distribution of medicines and reinforcing the need for the rational use of medicines. This work aimed to study Pharmaceutical Care in the production of care in Primary Health Care, contributing to the understanding of rational use of medicines. Method: We chose to analyze the material of an ethnographic investigation, carried out in 2014 in seven Basic Health Units. In addition, a seminar was held with institutional actors from the Units studied, in order to increase the laterality of the results. Results: It was possible to identify scenes and speeches, which connected and gave visibility to micropolitical elements related to the use of medicines, professional autonomy - the role of the physician in the prescription of medicines and the user who prescribes their care. Conclusion: What happens after the user leaves the UBS with his medicines taken at the pharmacy still seems to be hidden from the eyes of health professionals. The study produces indications of some flaws in the performance of Pharmaceutical Care and shows how far we are from a care management that includes the rational use of medicines in its multiple rationalities.

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Resumo Este estudo avaliou o impacto do tempo de adesão ao termo de compromisso de gestão (TCG), no âmbito do programa Pacto pela Saúde, sobre o nível de eficácia da política municipal de atenção básica, no período de 2008 a 2012. O TCG objetivou aprimorar a governança de política de saúde pelos entes federados, com especial atenção à gestão por resultados. O programa vigorou no Brasil entre 2006 e 2012, tendo recebido a adesão de 4.587 municípios (80% do total). Esta pesquisa buscou responder à seguinte questão: "qual foi o efeito causal do tempo de participação (em anos) no programa Pacto pela Saúde sobre o nível da eficácia da política local de atenção básica, para os municípios participantes?". Para tanto, adotou-se um desenho de pesquisa quase experimental, mediante estimação de um modelo de dose-resposta com escore de propensão generalizado. Estimou-se, via análise de componentes principais, um indicador de eficácia da política de atenção básica (IDEAB), tendo como referência as metas preconizadas pelo programa. Os resultados da estimação da função de dose-resposta evidenciaram que o tempo de adesão ao Pacto pela Saúde teve impacto positivo e estatisticamente significativo sobre o nível de eficácia das políticas de atenção básica nos municípios participantes. Para cada ano adicional de permanência da política, o IDEAB aumentou, em média, entre 0,011 e 0,019 unidades. Portanto, os resultados sugerem que as metas importam para a governança de política de saúde municipal brasileira.

Resumen El presente estudio evaluó el impacto del tiempo de membresía al Término de Compromiso de Gestión (TCG) sobre el nivel de efectividad de la política municipal de salud en Brasil, de 2008 a 2012. El TCG fue parte del programa Pacto por la Salud, y tenía como objetivo mejorar la gobernanza de la política de salud por parte de los estados federados, con especial atención a la gestión basada en resultados. El programa se ejecutó en Brasil entre 2006 y 2012, y fue adoptado por 4.587 municipios (80 por ciento del total). Esta investigación buscó responder a la siguiente pregunta: ¿Cuál fue el efecto causal del tiempo de participación en el programa (en número de años) sobre la efectividad de la política de atención primaria para los municipios participantes? Para ello, se adoptó un diseño de investigación cuasiexperimental, estimando un modelo de dosis-respuesta con puntaje de propensión generalizada. Se estimó un indicador de efectividad de la política de atención primaria (IDEAB) a través del análisis de componentes principales, con base en los objetivos recomendados por el programa. Los resultados de la estimación de la función dosis-respuesta mostraron que el número de años en el programa Pacto por la Salud tuvo un impacto positivo y estadísticamente significativo en el indicador de efectividad de la política de atención primaria para los municipios participantes. Por cada año adicional en la política, el IDEAB aumentó en un promedio de 0.011 a 0.019 unidades. Por lo tanto, los resultados sugieren que los objetivos son importantes para la gobernanza de la política de salud municipal brasileña.

Abstract This study evaluated the impact of the time a Brazilian local government stays as member of the program "Pacto pela Saúde" (Pact for Health) - by signing a Management Agreement -, and its efficiency to provide primary health care for the population. The research observed the period from 2008 to 2012. The program was an initiative of the Federal Government operated by municipalities through the Management Agreement and aimed to improve healthcare policy management adopting a results-based managerial approach. The program was in place between 2006 and 2012 and was operated by 4,587 local governments (80 percent of the Brazilian municipalities). The research question guiding the study was 'What was the effect of the time of a local government in the program (in years) on the efficiency of health care delivery to local populations? A quasi-experimental research design was adopted, estimating a dose-response model with generalized propensity score. An efficiency indicator of the primary care policy (IDEAB) was estimated via principal component analysis, based on the targets recommended by the program. The results of the dose-response model showed that the number of years in the Management Agreement had a positive and statistically significant impact on the efficiency of health care delivery in participating municipalities. For each additional year in the agreement, IDEAB increased by an average of 0.011 to 0.019 units. Therefore, the results suggest that establishing targets are important for the governance of the Brazilian health care policy.

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Resumo O Sistema Único de Saúde tem passado por constante evolução e ampliação desde a publicação da Constituição Federal de 1988. O Distrito Federal apresentou contribuições no campo da Política de Atenção Primária à Saúde, sobretudo entre os anos 2016 e 2018, ao definir a Estratégia Saúde da Família como forma definitiva de organização dos serviços na APS e estabelecer um conjunto de ações orientadas para a conversão ao modelo. Esse artigo descreve e analisa os principais processos dessa mudança. Utilizou-se o método de análise documental de portarias, resoluções, relatórios e outros documentos, bem como dados disponíveis nas bases oficiais. Destacam-se a elaboração de um arcabouço normativo que inclui a implantação das equipes, os processos de trabalho dos profissionais, mudanças nas especialidades médicas e reordenamento dos profissionais de saúde que já atuavam na APS. A experiência demonstra a viabilidade de mudanças incrementais nas políticas de saúde em prol da ampliação de acesso da população aos serviços de saúde, por meio da definição de prioridades, melhor gestão da força de trabalho, capacitação e planejamento descentralizado, repercutindo na elevação da cobertura populacional de Saúde da Família dos iniciais 28% para 69%, alcançados em um período de dois anos.

Abstract Conclusion The Unified Health System has undergone constant evolution and expansion since the publication of Brazil's 1988 Federal Constitution. The Federal District has provided contributions to the field of Primary Health Care Policy, especially between 2016 and 2018, by defining the Family Health Strategy as the definitive way of organizing Primary Health Care (PHC) services and by establishing a set of actions aimed at conversion of existing PHC services to this model. This article describes and analyzes the key processes of this change. The method used was analysis of ordinances, resolutions, reports and other documents, as well as assessment of data from official databases. We emphasize the development of a normative structure that includes the teams' implementation, the professionals' work processes, changes in medical specialties and reorganization of the health professionals who already worked in PHC. with an effect of increasing the population's Family Health Strategy coverage (in a population of approximately 3 million inhabitants) from 28% to 69% during a two-year period, the experience demonstrates the feasibility of incremental changes in health policies such as defining priorities, better management of the workforce, training and decentralized planning to increase access to health services.

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Pessoas em situação de rua (PSR) foram historicamente negligenciadas nas políticas públicas de saúde, realidade que vem mudando nos últimos anos. Investigou-se como são relatadas as ações de cuidado à saúde para a PSR através de uma revisão da literatura, destacando-se possibilidades e desafios. Os relatos de experiência revisados concentram-se em atividades desenvolvidas por equipes de Consultório na Rua (CR), buscando o cuidado integral à saúde, pautando-se na produção de vínculos e imersão no território. Dentre os desafios para o cuidado desse público estão: contornar as ações de repressão, enfrentar o déficit na formação, consolidar as ações intersetoriais e aprimorar as condições de oferta. As equipes de CR são importantes no cuidado à saúde e garantia dos direitos da PSR. Porém, não se problematiza o cuidado à saúde desse público na ausência do CR, como ocorre em cidades de pequeno e médio porte.

People living in the streets (PLS) have been historically neglected by the public policy in Brazil, a changing reality in the past few years. Reports about the health care provided to the PLS were investigated through a literature review of Brazilian scientific papers, highlighting opportunities and challenges. The analysis of selected studies indicates that street outreach teams (SOT) seek a comprehensive health care to the PLS, relying on the constitution of bonds and territorial immersion. Avoiding repression, training of professionals, consolidating of intersectoriality and improving the health care quality are the main challenges towards a comprehensive health care approach. SOT teams are important both to the health care and the human rights of PLS. However, it is not discussed the health care provided in the absence of SOT that occurs in small and mid-sized cities.

Las personas en situación de calle (PSC) fueron históricamente desconsideradas en las políticas públicas, realidad que viene cambiando. Fueron investigadas las acciones de cuidado de la salud hacia la PSC a través de una revisión de la literatura, destacándose las posibilidades y desafíos. El análisis de los estudios indica que el Consultorio de Calle (CC) tiene como objetivo el cuidado integral a salud de la PSC, pautado en la producción de vínculos e inmersión en el territorio. Entre los retos para el cuidado integral están: evitar las acciones de represión, enfrentar el déficit en la formación, consolidar acciones intersectoriales y valorizar las condiciones de oferta. Las equipes del CC son importantes en el cuidado a la salud y garantía de los derechos humanos. Sin embargo, no se problematiza cómo funciona la atención a la salud de ese público en la ausencia del CC, como ocurre en ciudades de tamaño pequeño y mediano.

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O aumento nas taxas de diabetes no México levaram as autoridades mexiacanas a delcarem estado de emergência. Estima-se que in 2017 aproximadamente 13 milhôes ou 10% das pessoas no México tenham diabetes mellitus, sendo a diabetes tipo II a causa líder de morte e incapacidade associadas no referido país. Na verdade, se as taxas continuarem a aumentar dessa forma, um efeito adverso na redução da expetativa de vida do pais é esperado. O objetivo desse artigo é discutir a necessidade de expandir as politicas de saúde em relação à alimentação e consumo de calorias inúteis para combater a epidemia de diabetes no méxico, bem como discutir a importância do exercício, promocao de saúde e educação em saúde em relação a doencas não comunicáveis, detecção de diabetes and cobertura de serviços de saúde

Increasing rates of diabetes in Mexico have lead health authorities to declare a state of emergency. It is estimated that in 2017 some 13 million, or 10% of people in Mexico have diabetes mellitus, with Type 2 diabetes being the leading cause of death and disability combined in that country. In fact, if rates continue to increase unabated, it is expected to have an adverse impact on the life expectancy of the country. The aim of this paper is to discuss the necessity of expanding health care policy regarding nutrition and the consumption of empty calories to combat the diabetes epidemic in Mexico as well as discussing the importance of exercise, health promotion and health education regarding non-communicable diseases, diabetes detection, and health coverage.

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Resumo Os hospitais de custódia brasileiros são marcados por uma lógica de exclusão e segregação social. Indivíduos considerados inimputáveis ou semi-imputáveis são destinados a esses espaços com o intuito de cumprir medidas de segurança, mas não recebem os devidos cuidados em saúde mental, o que impossibilita a completa reintegração social e sentencia o indivíduo à marginalização. Nesse contexto, o objetivo deste ensaio foi propor princípios para definir uma Política Territorial de Reabilitação Psicossocial como alternativa aos manicômios judiciários brasileiros. Para tanto, analisou-se a formação da política territorial em saúde mental como proposta eficaz para assistência em saúde no contexto brasileiro, tecendo críticas ao modelo vigente para acompanhamento de medidas de segurança. Também se evidenciaram as contradições relativas ao processo de diagnóstico e acompanhamento em saúde mental na proposta não territorial. Assim, estabelecidos os pontos críticos do modelo excludente vigente, propôs-se uma política alternativa, cuja fundamentação territorial insere o cumprimento das medidas de segurança no contexto das políticas públicas de assistência social e saúde mental, tendo como finalidade a reabilitação integral do sujeito, tal como preconizado pela Lei nº 10.216/2001.

Abstract Brazilian judiciary asylum hospitals are marked by exclusion and social segregation. Individuals who are not considered to be criminally responsible due to mental illnesses are destined to these spaces to comply with detention orders but do not receive the necessary mental health care, making it impossible to bring them back to social coexistence, thus sentencing these individuals to marginalization. In this context, we aimed at proposing principles for the definition of a Territorial Psychosocial Rehabilitation Policy as an alternative to the Brazilian judiciary asylums. To do so, the formation of the territorial policy in mental health was analyzed as an effective proposal for health care in the Brazilian context, and criticism was proposed on the current model of monitoring detention orders. Also, the contradictions related to the process of diagnosis and follow-up in mental health in the non-territorial proposal were highlighted. Thus, after we established the critical points of the existing exclusionary model, we proposed an alternative policy, whose territorial foundation inserts the fulfillment of the detention orders into a context of social assistance and mental health care public policies, aiming at the full rehabilitation of the subject, as recommended by Law No. 10,216/2001.

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One year ago, Hurricane Maria passed over the archipelago of Puerto Rico, leaving widespread disruption of nearly all human services, including the health care sector. In the aftermath of the hurricane, limited access to medical care and prescription medications presented a serious challenge to maintaining control of preexisting chronic diseases. Many patients did not have access to refrigeration for heat-sensitive medications. Significant dietary changes due to the limited availability of shelf-stable foods further exacerbated chronic conditions such as heart failure and diabetes. The role of community pharmacists following a natural disaster has previously been documented, and may include the triage of evacuees, assessment of immunization needs, and provision of prescription medications under a collaborative practice agreement. However, our experience in Puerto Rico demonstrated a variety of barriers limited pharmacists' ability to adequately respond to the magnitude of this disaster. These included medication shortages, extended loss of power, and limited telecommunications for contacting prescribers, disaster relief agencies, and third-party payers. Ultimately, the lack of preexisting emergency protocols made overcoming such barriers difficult. As the first and sometimes only accessible health care provider to many patients following a natural disaster, we must build a solid evidence base and better understanding of the individual, interpersonal, and environmental factors that contribute to the community pharmacist response. To date, however, a paucity of data exists on both the pharmacist and patient factors, which may contribute to an effective immediate response to patient needs at the community pharmacy following a natural disaster. Future research must focus on these multi-level factors to better inform public policy and effective disaster planning. Ultimately, such research and planning will lead to increased resiliency in our primary health care systems in the face of future disasters.

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In the 2017, "Cairo Accord on Rheumatic Heart Disease-From Molecules to The Global Community" experts from endemic areas enumerated an approach to reduce the population burden of rheumatic heart disease. The 10 key recommendations include immediate logistical objectives as well as domains for further study. Echocardiographic population screening programs were relegated to research alone. Given the large body of supporting data, relegating echo screening to an investigational modality is an opportunity lost.

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