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Objetivo: compreender as facilidades e dificuldades enfrentadas por gestores municipais de saúde com o novo modelo de financiamento da Atenção Primária à Saúde. Método: estudo qualitativo, tipo Pesquisa Convergente Assistencial, fundamentado na Política Nacional de Atenção Básica. Participaram 77 gestores ou seus representantes, de 47 municípios de uma Macrorregião de saúde de Santa Catarina, Brasil. Foram realizadas três oficinas nas Gerências Regionais de Saúde, em agosto e setembro de 2022. Os dados foram analisados pela análise de conteúdo. Resultados: apresentam-se como facilidades do Previne Brasil informatização, comprometimento dos profissionais, e qualificação do cuidado. Foram descritas como dificuldades falta de informações, sistema informatizado e denominador estimado e, equipe de trabalho. Conclusão: o programa apresenta facilidades que qualificam o processo de trabalho e cuidado à saúde da população. Contudo, persistem dificuldades que devem ser consideradas pela gestão municipal para avanços na atenção integral e no financiamento da Atenção Primária à Saúde.

Objective: understand the facilities and difficulties faced by municipal health managers with the new Primary Health Care financing model. Method: this is a qualitative study, of the Convergent Care Research type, based on the National Primary Care Policy. The participants were 77 managers or their representatives from 47 municipalities in a health Macroregion in Santa Catarina, Brazil. Three workshops were held in the Regional Health Departments in August and September 2022. The data was analyzed using content analysis. Results: Previne Brasil's facilities include computerization, commitment of professionals, and qualification of care. Difficulties were described as lack of information, computerized system and estimated denominator, and work team. Conclusion: the program offers facilities that improve the work process and health care for the population. However, there are still difficulties that must be considered by municipal management in order to make progress in comprehensive care and Primary Health Care financing.

Objetivo: comprender las facilidades y dificultades que enfrentan los gestores municipales de salud con el nuevo modelo de financiamiento de la Atención Primaria de Salud. Método: estudio cualitativo, tipo Investigación Convergente Asistencial, basado en la Política Nacional de Atención Primaria. Participaron 77 gestores o sus representantes, de 47 municipios de una Macrorregión de salud de Santa Catarina, Brasil. Se realizaron tres talleres en las Gerencias Regionales de Salud, en agosto y septiembre de 2022. Los datos fueron analizados mediante análisis de contenido. Resultados: las instalaciones de Previne Brasil incluyen informatización, compromiso de los profesionales y calificación de la atención. Las dificultades fueron descritas como falta de información, sistema informatizado y denominador estimado y equipo de trabajo. Conclusión: el programa presenta facilidades que cualifican el proceso de trabajo y la atención de la salud de la población. Sin embargo, aún hay dificultades que la gestión municipal debe considerar para lograr avances en la atención integral y el financiamiento de la Atención Primaria de Salud.

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A Saúde Única é uma crescente abordagem sistêmica para aumentar indissociavelmente os níveis de saúde das pessoas, dos animais e do ambiente no planeta. Por sua característica interdisciplinar e multidisciplinar, a Saúde Única tem arregimentado cada vez mais novos agentes na área de saúde, ampliando novas fronteiras de prática profissional. Objetivo: tendo em vista de que a abordagem sistêmica da Saúde Única (One Health) é holística, objetivou-se descrever e refletir sobre o papel da fonoaudiologia nesse contexto. Métodos: fez-se uma revisão de escopo sobre as ligações da fonoaudiologia com as desordens de saúde que são o foco em Saúde Única. Realizou-se uma procura de artigos nas plataformas PubMed e SciELO, com a combinação booleana dos indexadores "fonoaudiologia" e "Saúde Única", em idioma português; e as palavras "speech-language therapy" e "One Health" em idioma inglês. O operador booleano foi "E" e "AND". Adicionalmente, procurou-se teses e dissertações com esses mesmos operadores e combinações no Catálogo de Teses e Dissertações da CAPES. Analisou-se os dados por uma abordagem qualitativa, por isso os métodos estatísticos não foram aplicados. A partir dessa abordagem, complementou-se a argumentação com uma reflexão crítica sobre a inclusão da fonoaudiologia na estratégia de Saúde Única. Resultados: apenas na plataforma SciELO encontrou-se cinco obras com os descritores e a combinação "Saúde Única AND fonoaudiologia"; esse resultado é fortemente sugestivo de que o profissional em fonoaudiologia não tem sido incluído como um agente na abordagem Saúde Única. Contrariando esse cenário, argumenta--se que a fonoaudiologia pode preencher um nicho de trabalho e atuação acadêmica na abordagem de Saúde Única, cujo foco são desordens de saúde que podem resultar em distúrbios da comunicação nas pessoas. Considerações finais: há um nicho para a fonoaudiologia na abordagem da Saúde Única para a prevenção, o tratamento e a investigação científica das desordens da comunicação humana.

One Health is a growing systemic approach aimed at increasing the health levels of people, animals and the environment on the planet. Due to its inter- and multidisciplinary characteristics, One Health has been recruiting an increasing number of new agents in the health area, expanding new frontiers of professional practice. Objective: considering that the systemic approach of One Health is holistic, the objective is to describe and reflect on the role of speech therapy in this context. Methods: a scoping review was conducted to explore the connections between speech therapy and the health disorders that are the focus of One Health. A search for articles was carried out on the PubMed and SciELO platforms, using the Boolean combination of the terms "fonoaudiologia" (speech therapy) and "Saúde Única" (One Health), in Portuguese; and the words "speech-language therapy" and "One Health" in English using the Boolean operator "E" and "AND". Additionally, we searched for theses and dissertations with these same operators and combinations, in the CAPES Catalog of Theses and Dissertations. The data was analyzed using a qualitative approach, therefore statistical methods were not applied. Based on this approach, the argument was complemented with a critical reflection on the inclusion of speech therapy in the One Health strategy. Results: five works were found on the SciELO platform using the descriptors and combination "Saúde Única AND fonoaudiologia". This result suggests that the speech therapy professional has not been included as an agent in the One Health approach. Contrary to this scenario, it is argued that speech therapy can play a significant professional and academic role in One Health, which focuses on health disorders that may result in communication disorders. Final considerations: there is a niche for speech therapy in the One Health approach to the prevention, treatment and scientific investigation of human communication disorders.

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No Brasil, o direito à saúde passou a ser universal e integral conforme previsão constitucional. No entanto, a via judicial passou a ser utilizada para garantia do acesso a tratamentos de saúde frente à necessidade da população, sem o emprego de muito rigor técnico. Objetivo: revisar a literatura sobre os pontos positivos e negativos encontrados na judicialização da saúde. Metodologia: realizou-se um levantamento na Base de Dados da Biblioteca Virtual em Saúde, com estudos entre 2010 e 2021. Foram encontrados 59 artigos, aplicando os critérios de inclusão para esse estudo, selecionamos 39 para análise. Após aprofundada leitura dos artigos, foram eleitos os temas organizados nas seguintes categorias: medicamentos e tratamentos padronizados pelo Sistema Único de Saúde; medicamentos e tratamentos não padronizados pelo Sistema Único de Saúde; e interferência das indústrias farmacêuticas e diálogos interinstitucionais. Resultados: A maioria dos artigos identificaram pontos positivos e negativos da judicialização da saúde ou mencionaram a existência da contradição que versa esse assunto. Os estudos apontaram que parte da judicialização decorre de falhas da própria gestão. Percebe-se, assim, um conflito presente na dicotomia entre o garantido e a estruturação e capacidade do sistema para a sua realização. Conclusão: Os entes envolvidos na judicialização da saúde devem dialogar entre si, no intuito de compreender o fenômeno e enfrentar os desafios. É necessário reconhecer as demandas judiciais como fonte provocadora para a melhoria da gestão do direito à saúde efetivamente Sistema Único de Saúde, visando sempre ao melhor atendimento aos usuários, promovendo assim a equidade com eficiência no gasto de dinheiro público.

In Brazil, the right to health became universal and comprehensive, as per the constitutional provision. However, the judicial route began to be used to guarantee access to health treatments in response to the population's needs, without the use of much technical rigor. Objective: to review the literature on the positive and negative points found in the Judicialization of health. Methodology: a survey was carried out in the Virtual Health Library Database, with studies between 2010 and 2021. 59 articles were found, applying the inclusion criteria for this study, we selected 39 for analysis. After in-depth reading of the articles, themes organized into the following categories were chosen: medicines and treatments standardized by the SUS; medicines and treatments not standardized by the SUS; and interference from pharmaceutical industries and interinstitutional dialogues. Results: Most articles identified positive and negative points of the Judicialization of health or mentioned the existence of the contradiction regarding this subject. The studies showed that part of the Judicialization results from failures in the management itself. Therefore, a conflict can be seen in the dichotomy between the right to health effectively guaranteed and the structure and capacity of the system to achieve it. Conclusion: The entities involved in the Judicialization of health must dialogue with each other, in order to understand the phenomenon and face the challenges. It is necessary to recognize legal demands as a provocative source for improving SUS management, always aiming to provide better service to users, thus promoting equity and efficiency in spending public money.

En Brasil, el derecho a la salud pasó a ser universal e integral, según disposición constitucional. Sin embargo, se empezó a utilizar la vía judicial para garantizar el acceso a tratamientos de salud que respondieran a las necesidades de la población, sin el uso de mucho rigor técnico. Objetivo: revisar la literatura sobre los puntos positivos y negativos encontrados en la Judicialización de la salud. Metodología: se realizó una encuesta en la Base de Datos de la Biblioteca Virtual en Salud, con estudios entre 2010 y 2021. Se encontraron 59 artículos, aplicando los criterios de inclusión de este estudio, se seleccionaron 39 para el análisis. Después de la lectura en profundidad de los artículos, se eligieron temas organizados en las siguientes categorías: medicamentos y tratamientos estandarizados por el SUS; medicamentos y tratamientos no estandarizados por el SUS; y la interferencia de las industrias farmacéuticas y los diálogos interinstitucionales. Resultados: La mayoría de los artículos identificaron puntos positivos y negativos de la Judicialización de la salud o mencionaron la existencia de la contradicción respecto a este tema. Los estudios demostraron que parte de la Judicialización resulta de fallas en la propia gestión. Por lo tanto, se puede ver un conflicto en la dicotomía entre el derecho a la salud efectivamente garantizado y la estructura y capacidad del sistema para lograrlo. Conclusión: Las entidades involucradas en la Judicialización de la salud deben dialogar entre sí, para comprender el fenómeno y afrontar los desafíos. Es necesario reconocer las demandas legales como una fuente de provocación para mejorar la gestión del SUS, siempre con el objetivo de brindar un mejor servicio a los usuarios, promoviendo así la equidad y la eficiencia en el gasto del dinero público.

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LASER é um acrônimo que sumariza a amplificação da luz por emissão estimulada de radiação (eletromagnética). O Programa Saúde em Ação equipou diversas Unidades Básicas de Saúde com aparelhos de laser diodo. Cirurgiões Dentistas têm aplicado a laserterapia de baixa potência para acelerar a remissão de várias condições clínicas, sem necessidade de encaminhamento imediato para Atenção Secundária. O objetivo deste artigo é apresentar protocolos de laserterapia de baixa potência empregados por Cirurgiões Dentistas da Atenção Primária à Saúde de Campinas-SP, por meio da ilustração com casos clínicos atendidos em consultas de urgência. Aplicações para ulceração traumática e desordem temporomandibular foram realizadas em uma senhora de 60 anos de idade, que aguardava a substituição das próteses totais. Irradiou-se por laser vermelho (660nm) com energia de 1J as margens da ulceração. Após palpação da articulação e dos músculos mastigatórios para mapeamento, os pontos álgicos foram irradiados por laser infravermelho (808nm) com energia de 4J. Um homem de 50 anos de idade queixava-se de paralisia hemifacial havia 10 dias. A tentativa de recuperação do nervo facial ocorreu com irradiação por laser infravermelho com energia de 8J por ponto, em 22 pontos dos ramos do nervo facial. Em ambos os casos, a regressão do quadro clínico desconfortável foi observada. Os Profissionais do Sistema Único de Saúde (SUS) que são aptos ao uso dos equipamentos para laserterapia de baixa potência podem utilizar este recurso de modo seguro e bem sucedido, observando comprimento de onda do laser e doses protocolares para cada alteração a ser tratada.

LASER is an acronym which means light amplification by stimulated emission of radiation (electromagnetic). Many Primary Health Care Units received diode laser devices from the Brazilian Health in Action Program. Dental practitioners have applied low-level laser therapy for accelerating the resolution of several clinical problems, without the need to prompt referral for Secondary Attention. This manuscript aimed at presenting low-level laser therapy protocols, used by Dentists in Primary Health Care Units from Campinas-SP, illustrated with case reports of urgency consultations. Applications for traumatic ulcers and temporomandibular disorder were performed in a 60-year-old woman who was waiting for dental prosthesis replacement. Red laser irradiation (660nm) with 1J energy was delivered at the margins of the ulcer. Upon articular and masticatory muscles palpation for mapping, trigger points were irradiated with infrared laser (808nm), 4J energy. A 50-year-old man complained of hemifacial paresis for 10 days. The recovery attempt of the facial nerve was carried out by infrared laser irradiation with 8J energy per point in 22 points of the facial nerve branches. In both case reports, regression of the uncomfortable clinical problem was noted. Professionals from the Unified Health System (SUS) who are able to use a low-level laser device may safe and successfully operate this equipment, selecting the appropriate laser wavelength and protocol doses for managing each clinical problem.

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In Brazil, the judicialization of public health for access to medications has resulted in significant challenges to the management of public policies, especially at the municipal level. To evaluate the profile of drug litigations against the Campinas municipal health system from 2017 to 2021, this study analyzed the characteristics of litigants, medicine dispensation, and the timing of court decisions. A quantitative, analytical, and comparative cross-sectional study was conducted using data on the dispensation of 506 types of medications and 493 court cases. The analysis included sociodemographic, procedural, medical-sanitary, and pharmaceutical assistance management variables. The time of court decisions was assessed using the Kruskal‒Wallis test complemented by the Dunn test. The plaintiffs were predominantly adults, females, and self-declared students, and some cases involved nonresidents. Most of the lawsuits were represented by private lawyers, gratuitousness of justice and with decisions favorable to the plaintiff. However, only 43% of the patients obtained a preliminary injunction or early tutelage. The median time needed for a court decision from the date of case filing was 12 days until the granting of a preliminary injunction or early tutelage and 6.5 months until a judgment or dismissal without a decision on the merits. Approximately 32.4% of the medications dispensed by the judicial pharmacy already belonged to the list of the Brazil's Unified Health System in 2020; 46.3% were prescribed by their generic name; 75.5% had therapeutic equivalents, and 94.9% had marketing authorization from the Brazilian National Health Surveillance Agency. Judicialization in Campinas is an alternative way of accessing medications, but it is time-consuming and benefits only a small portion of the population (0.068%). The characteristics of the plaintiffs and judicialized medicines highlight the need to review health policies to promote equitable and efficient access to essential treatments for the population.

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Background and Purpose: The purpose of this study was to map the instruments for assessing the comfort of hospitalized older adults in the scientific literature, identifying those instruments validated and transculturally adapted to the realities of Brazil. Methods: This was a scoping review of 14 articles and a website retrieved from the following databases: MEDLINE/PubMed, CINAHL, EMBASE, Web of Science, Scopus, Science Direct/Elsevier, and gray literature (Oasisbr, Catalog of Theses and Dissertations [CAPES], OATD, BDBTD, and The Comfort Line). Results: Seventeen instruments for assessing the comfort of hospitalized older adults were mapped; however, none were specifically designed for this population, as they were originally intended for adults or individuals with neuropsychiatric conditions. Among these, three have been validated and transculturally adapted to the Brazilian context. Conclusions: This study reveals the need for a specific instrument tailored for hospitalized older adults without neuropsychiatric conditions.

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OBJECTIVE: This study aimed to quantify the health and economic impacts of alcohol consumption in Brazil for 2019. STUDY DESIGN: Ecological study using secondary data sources. METHODS: We calculated the disease burden using estimates from the Global Burden of Disease study, which incorporated data from health surveys and hospital records. Costs were estimated based on direct expenses recorded in the Hospital and Outpatient Information System of the Unified Health System, with data by sex, age group, cause, and Federative Units. RESULTS: Alcohol consumption was a necessary cause for 30,355 deaths and approximately 1.69 million disability-adjusted life years in Brazil, representing 2.2% and 2.6% of the national totals, respectively. The impact was more pronounced among men, in the Northeast region and within the 40- to 64-year-old age group. The total costs attributed to these outcomes reached approximately Int$43.1 million, with hospital admissions accounting for 94.16% of these expenses. CONCLUSION: In 2019, alcohol consumption had a significant impact on both the health of Brazilians and the expenses of the health system. As a preventable risk factor, alcohol consumption necessitates effective intersectoral strategies to mitigate its burden.

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Introdução: O uso de medicamentos biológicos tem sido empregado no tratamento de pacientes em várias áreas terapêuticas, incluindo oncologia, reumatologia, endocrinologia e gastroenterolo¬gia, e as terapias imunobiológicas têm contribuído para o aumento dos custos de saúde. Os biossi¬milares são uma estratégia global reconhecida para incentivar a competição no mercado, expandir o acesso dos pacientes aos tratamentos e oferecer eficácia e segurança equivalentes às dos produ¬tos de referência. Material e métodos: A Unimed Maringá adotou um sistema de gerenciamento de trocas entre produtos de referência entre biossimilares baseados em três pilares: estabelecimen¬to de educação continuada para profissionais de saúde sobre biossimilares, uso de protocolos por enfermidade e perfil adequado do paciente para trocas e adoção de princípios gerais de Aquisição de Produtos Biossimilares. Resultados: No centro de infusão da operadora, no período de janeiro a agosto de 2023, havia 547 pacientes em tratamento autoimune: 81,8% utilizavam medicamento de referência, 11,2% estavam usando referência que possui biossimilar e 5,6% já estavam utilizando biossimilares. A redução estimada nos custos de tratamento de 44 pacientes entre 1 de setembro e 31 de dezembro de 2023 foi de 55,9%. A redução de custos total no consumo de medicamentos de 63 pacientes em tratamento autoimune no período compreendido entre setembro e dezembro de 2023 foi de R$ 708.995,78. Conclusões: Os fundamentos adotados pela operadora foram capazes de minimizar os litígios eventuais que ocorrem entre pagadores, pacientes e médicos prescritores durante o processo de trocas. Foi apurada uma redução de custos no total de R$ 708.995,78, no consumo de medicamentos de 63 pacientes em tratamento por doenças autoimunes no período compreendido entre setembro e dezembro de 2023.

Introduction: The use of biological drugs has been employed in the treatment of patients in several therapeutic areas, including oncology, rheumatology, endocrinology, and gastroenterology and Immunobiological therapies has contributed to rising healthcare costs. Adoptance of biosimilars are a global strategy to encourage market competition and expand patient access to treatments at the same time maintaining the efficacy and safety equivalent to reference products. Material and methods: Unimed Maringá has adopted a management system for switching reference products and biosimilars based on three pillars: establishment of continuing education for health professionals on biosimilars, use of protocols by disease and adequate patient profile for exchanges and adoption of general principles for the Acquisition of Biosimilar Products. Results: From January to August 2023, there were 547 patients under autoimmune treatment, of which 81.8% were using reference medication, 11.2% were using reference drugs that had biosimilars, and only 5.6% were already using biosimilars. The estimated reduction in treatment costs for 44 patients between September 1 and December 31, 2023 was 55.9%. The total cost reduction in drug consumption of 63 patients undergoing autoimmune treatment in the period between September and December 2023 was R$ 708,995.78. Conclusions: The adoptance of biosimilars by the payer was able to minimize the eventual litigation that occurs between payers, patients and physicians during the switching process. The total amount of cost reduction in the consumption of medicines by 63 patients being treated for autoimmune diseases in the period between September and December 2023 was R$ 708,995.78.

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Abstract Objective: To estimate the direct costs of treating excess body weight in children and adolescents attending a public children's hospital. Methods: This study analyzed the costs of the disease within the Brazilian Unified Health System (SUS) for 2,221 patients with excess body weight using a microcosting approach. The costs included operational expenses, consultations, and laboratory and imaging tests obtained from medical records for the period from 2009 to 2019. Healthcare expenses were obtained from the Table of Procedures, Medications, Orthoses/Prostheses, and Special Materials of SUS and from the hospital's finance department. Results: Medical consultations accounted for 50.6% (R$703,503.00) of the total cost (R $1,388,449.40) of treatment over the period investigated. The cost of treating excess body weight was 11.8 times higher for children aged 5-18 years compared to children aged 2-5 years over the same period. Additionally, the cost of treating obesity was approximately 4.0 and 6.3 times higher than the cost of treating overweight children aged 2-5 and 5-18 years, respectively. Conclusion: The average annual cost of treating excess body weight was R$138,845.00. Weight status and age influenced the cost of treating this disease, with higher costs being observed for individuals with obesity and children over 5 years of age. Additionally, the important deficit in reimbursement by SUS and the small number of other health professionals highlight the need for restructuring this treatment model to ensure its effectiveness, including a substantial increase in government investment.

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Like other parts of the world, women and girls in the Commonwealth Caribbean (CC) experience high and escalating rates of physical and sexual violence. The interview presented outlines some factors that underscore the gendered disparities of violence against women in the Caribbean as well as how healthcare responses are not developed for marginalised women and girls. The interview explores the invisibility of women and girls within healthcare and broader national healthcare structures responses through case details analysis of a Barbadian strategic litigation case. The interview calls for transdisciplinary approaches to analysing the effectiveness of the global health system that make space for not just traditional research approaches but also lived experiences 'from below' and input of advocates and activists. Despite Barbados being a signatory to a range of global health initiatives to improve healthcare responses to gender-based violence, the country does not have a formalised, comprehensive national plan to inform prevention and intervention measures. The interview shows the connections between plantocratic patriarchal culture (PPC) and the existing gaps that cause harm to women and girls who experience various types of gendered violence.

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The 1978 Alma Ata Declaration established recommendations for health systems, which significantly impacted low-income countries. These guidelines marked improvements in access to health, coverage and financial equity, especially in Latin American countries. Objectives: This paper focuses on the role of the private sector (including for-profit and non-profit organizations) in achieving Universal Health Coverage (UHC). It examines their involvement in the management, service delivery, resource investment and financing of primary health care (PHC) within the sustainable development goals (SDGs). Methods: The study covers a review of health systems, emphasizing the influence of private institutions on public health, and evaluates how private sector experiences contribute to system functions and progress towards UHC. Results: The findings indicate the crucial role of the private sector in global health systems, notably expanded in several countries. Private actors are essential to improve access and coverage, particularly in countries with low health indicators. The article highlights the importance of primary care physicians understanding these dynamics since their management is vital in implementing public policies for UHC.

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Este texto faz uma breve revisão histórica da inserção da violência como questão de saúde pública, destacando a importância da Atenção Primária à Saúde e a inovação estratégica com o Programa Nacional de Gênero, Raça, Raça e Valorização da Mulher Trabalhadora no SUS.

This text provides a brief historical review of the inclusion of violence as a public health issue, highlighting the importance of Primary Health Care and strategic innovation with the National Program for Gender, Race, Race and the Appreciation of Working Women in the SUS.

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Introduction: Vascular ulcers constitute a serious global public health problem, responsible for causing a significant social and economic impact due to their recurrent, disabling nature and the need for prolonged therapies to cure them. Objective: To evaluate the use and efficacy of the rhEGF in the epithelialization of patients with a diagnosis of CEAP stage 6 venous insufficiency, in the two regimes of the health system in Colombia, the contributive (equivalent to a health system where citizens with payment capacity contribute a percentage of their salary) and the subsidized (equivalent to a health system where the state covers the vulnerable population and low socioeconomic level) versus the other treatments used. Methodology: Observational, descriptive, retrospective, multicenter study, in which 105 medical records with 139 ulcers were reviewed, in 2 centers, one belonging to the subsidized system and the other to the contributive system in Colombia. Results: The association with the epithelialization variable of the different treatment groups for ulcers according to the application of the mixed effect model test, for both regimes was for the Biologicals (EC 34.401/p = 0.000), Bioactive Agents (Hydrogels) (EC 24.735/p = 0.005) groups; for the rest of the treatment groups, the results were neither associated nor statistically significant. Conclusion: Intra- and perilesional therapy with rhEGF expands the therapeutic spectrum in patients with venous ulcers, regardless of the type of health system in which it will be applied, shortening the healing time and reaching a possible therapeutic goal, which according to this study there is an association with epithelialization regardless of the regime applied.

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BACKGROUND: We present the first results of the Accreditation System of Medical Schools (Sistema de Acreditação de Escolas Médicas - SAEME) in Brazil. METHODS: We evaluated the results of the accreditation of medical schools from 2015 to 2023. The self-evaluation form of the SAEME is specific for medical education programs and has eighty domains, which results in final decisions that are sufficient or insufficient for each domain. We evaluated the results of the first seventy-six medical schools evaluated by the SAEME. RESULTS: Fifty-five medical schools (72.4%) were accredited, and 21 (27.6%) were not. Seventy-two (94.7%) medical schools were considered sufficient in social accountability, 93.4% in integration with the family health program, 75.0% in faculty development programs and 78.9% in environmental sustainability. There was an emphasis on SAEME in student well-being, with seventeen domains in this area, and 71.7% of these domains were sufficient. The areas with the lowest levels of sufficiency were interprofessional education, mentoring programs, student assessment and weekly distribution of educational activities. CONCLUSION: Medical schools in Brazil are strongly committed to social accountability, integration with the national health system, environmental sustainability and student well-being programs. SAEME is moving from episodic evaluations of medical schools to continuous quality improvement policies.

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OBJECTIVE: To estimate the health and economic burden of non-communicable diseases (NCDs) attributed to alcohol consumption in 2019 for the Brazilian Unified Health System (SUS) stratified by states. STUDY DESIGN: Observational, descriptive, and ecological study. METHODS: We used population attributable fractions (PAFs) of NCDs due to alcohol consumption from the Global Burden of Disease study. We applied the PAFs to the costs of hospitalizations and outpatient procedures of medium to high complexity paid by SUS for each outcome, obtained from official databases. We also calculated the disability-adjusted life years (DALYs) and mortality caused by alcohol-related NCDs. We converted the costs into international dollars (Int$) using the purchasing parity power in 2019. RESULTS: Alcohol-related NCDs accounted for 8.48% of deaths and 7.0% of DALYs among men, and 1.33% of deaths and 1.6% of DALYs among women. The main diseases were substance use, digestive, and neoplastic diseases. The SUS spent Int$202.0 million on alcohol-related NCDs, mostly on hospitalizations. The highest health burden was observed in the states of the Northeast region, and the highest expenses in the states from the South. The burden and cost values varied by sex, age group, and state. CONCLUSION: The study showed that alcohol consumption has a significant impact on Brazilian population morbidity and mortality and SUS expenditures, especially among men. These results can support policies for the prevention and control of alcohol consumption and health promotion at the subnational level, prioritizing strategies that are more appropriate to local realities.

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Osteoarthritis (OA) can incapacitate the individual to perform their activities of daily living due to pain. This is an important public health issue that worsens worldwide and in Brazil, since the population goes through an aging process, and has caused increased public spending on the monitoring and maintenance of treatments that can last for years and still not be resolutive. Thus, the search for innovative and effective therapies that can reduce costs becomes necessary. In this context, the present study reports the first application of cell therapy with adipose-derived stem cells in the treatment of cases of OA that are refractory to the conservative treatment, performed in the Brazilian Unified Health System (Sistema Único de Saúde, SUS). The evaluation was performed with the application of the Visual Analog Scale (VAS), the Short Form Health Survey (SF-36) and the Western Ontario and McMaster Universities (WOMAC), specifics for OA evaluation, and also an analysis of the synovial fluid (inflammatory cytokines). The cell therapy improved the scores on the WOMAC, SF-36 and EVA, and reduced the inflammatory process. We observed a decrease of 0.73x in the TNF, of 0,71x in IL-1b, of 0,68x in IL-8, and of 0,70x in IL-10. For IL-6, an increase of 1,48x was observed. Therefore, this cell therapy can be considered promising in aiding the management of this disease, since it improved the patient's pain, decrease inflammatory markers, and enabled the return to activities of daily living, which resulted in an improvement in their quality of life.

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Apresentar, por meio de resenha analítica, a obra 'Consolidação, Simplificação e Revisão do Arco Normativo Infralegal da Saúde: um projeto, muitas vozes', publicado pelo CONASS e que narra a história biográfica de um projeto pioneiro e inovador da consolidação do arco normativo infralegal do Sistema Único de Saúde.

To present, through an analytical review, the work 'Consolidation, Simplification, and Review of the Infralegal Normative Arch of Health: one project, many voices', published by CONASS, which narrates the biographical history of a pioneering and innovative project in consolidating the infralegal normative arch of the Unified Health System.

Presentar, a través de una reseña analítica, la obra 'Consolidación, Simplificación y Revisión del Arco Normativo Infralegal de la Salud: un proyecto, muchas voces', publicada por CONASS y que narra la historia biográfica de un proyecto pionero e innovador en la consolidación del arco normativo infralegal del Sistema Único de Salud.

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Introduction: The known achievements of the Brazilian Unified Health System (SUS) stand out in an adverse context. This makes it necessary to examine the effect of the SUS on the population's health, using indicators such as deaths by avoidable causes. Objective: To describe the time trends of mortality from avoidable causes in Brazil and to compare them to those of non-avoidable causes. Methods: Ecological time-series study with official mortality data, during years 1996-2019, in the age group 5-74 years. Time trends in mortality were estimated as the annual percent reduction in mortality rates, and the impact of the SUS was calculated as the difference in trend between avoidable (immunopreventable, infectious and noncommunicable diseases, maternal and external causes) and non-avoidable causes. The analyses consisted of multivariable binomial regression models, by quadrennium. Results: Death rates for each avoidability group remained stable or declined throughout the study period. The probability of a positive impact was greater than 90% for immunopreventable diseases throughout the study period; infectious diseases in 1996-2003 and 2016-2019; noncommunicable diseases in 1996-2003 and 2008-2019; maternal causes in 1996-1999; and external causes in 1996-2007. This probability was less than 10% for maternal deaths in 2016-2019; and external causes in 2008-2015. Conclusion: The SUS has had a positive impact in reducing deaths from immunopreventable, infectious and noncommunicable diseases in Brazil, although not so much for maternal and external causes.

Introdução: As conhecidas conquistas do Sistema Único de Saúde (SUS) se destacam num cenário adverso. Isso torna necessário examinar o efeito do SUS na saúde da população, usando indicadores como as mortes por causas evitáveis. Objetivo: Descrever as tendências temporais de mortalidade por causas evitáveis no Brasil e compará-las às tendências por causas não evitáveis. Métodos: Estudo ecológico de série temporal com dados oficiais de mortalidade, durante os anos 1996-2019, na faixa etária dos 5-74 anos. As tendências temporais de mortalidade foram estimadas como a redução percentual anual nas taxas de mortalidade, e o impacto do SUS foi calculado como a diferença de tendência entre causas evitáveis (doenças imunopreveníveis, infecciosas ou não transmissíveis, mortes maternas, causas externas) e não evitáveis. As análises consistiram em modelos de regressão binomial multivariável, por quadriênio. Resultados: A taxa de mortalidade permaneceu igual ou diminuiu para todos os grupos de causas de morte. A probabilidade de um impacto positivo foi maior do que 90% para as doenças imunopreveníveis ao longo de todo o período de estudo; doenças infecciosas em 1996-2003 e 2016-2019; não transmissíveis em 1996-2003 e 2008-2019; mortes maternas em 1996-1999; e externas em 1996-2007. Essa probabilidade foi menor do que 10% para mortes maternas em 2016-2019; e causas externas em 2008-2015. Conclusão: O SUS tem tido um impacto positivo na redução de mortes por doenças sensíveis à imunização, infecciosas e não transmissíveis no Brasil, embora não tanto para mortes maternas e causas externas.

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Abstract Osteoarthritis (OA) can incapacitate the individual to perform their activities of daily living due to pain. This is an important public health issue that worsens worldwide and in Brazil, since the population goes through an aging process, and has caused increased public spending on the monitoring and maintenance of treatments that can last for years and still not be resolutive. Thus, the search for innovative and effective therapies that can reduce costs becomes necessary. In this context, the present study reports the first application of cell therapy with adipose-derived stem cells in the treatment of cases of OA that are refractory to the conservative treatment, performed in the Brazilian Unified Health System (Sistema Único de Saúde, SUS). The evaluation was performed with the application of the Visual Analog Scale (VAS), the Short Form Health Survey (SF-36) and the Western Ontario and McMaster Universities (WOMAC), specifics for OA evaluation, and also an analysis of the synovial fluid (inflammatory cytokines). The cell therapy improved the scores on the WOMAC, SF-36 and EVA, and reduced the inflammatory process. We observed a decrease of 0.73x in the TNF, of 0,71x in IL-1b, of 0,68x in IL-8, and of 0,70x in IL-10. For IL-6, an increase of 1,48x was observed. Therefore, this cell therapy can be considered promising in aiding the management of this disease, since it improved the patient's pain, decrease inflammatory markers, and enabled the return to activities of daily living, which resulted in an improvement in their quality of life.

Resumo A osteoartrite (OA) pode deixar o indivíduo incapacitado para realizar suas atividades da vida diária devido ao quadro álgico. Essa é uma importante questão de saúde pública que se agrava no mundo inteiro e no Brasil, uma vez que a população passa pelo processo de envelhecimento, e isso causa um aumento nos gastos públicos com o acompanhamento e manutenção dos tratamentos que podem perdurar por anos e mesmo assim não serem resolutivos. Assim, torna-se necessária a busca por terapias inovadoras e eficazes que possam reduzir esses custos. Nesse contexto, o presente estudo relata a primeira aplicação de terapia celular com células-tronco mesenquimais do tecido adiposo no tratamento de OA refratária ao tratamento conservador realizada no Sistema Único de Saúde (SUS). Na avaliação, foram usados os instrumentos Escala Visual Analógica (EVA), os questionários de qualidade de vida Short Form Health Survey (SF-36) e Western Ontario and McMaster Universities (WOMAC), específicos para avaliação da OA, e fez-se uma análise do líquido sinovial (citocinas inflamatórias). A terapia celular melhorou as pontuações no WOMAC, SF-36, e EVA, e reduziu o processo inflamatório. Observou-se redução de 0,73 × do TNF, de 0,71 × da IL-1b, de 0,68 × da IL-8, e de 0,70 × da IL-10. Já para a IL-6, observou-se aumento de 1,48 ×. Portanto, considera-se este tipo de terapia celular promissora no auxílio do manejo desta doença, pois melhorou o quadro álgico do paciente, reduziu os marcadores inflamatórios, e possibilitou o retorno às atividades da vida diária, o que resultou em uma melhora de sua qualidade de vida.

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The present work presents as a research problem the importance of efficiency, planning, and principles of good management aiming at capillarity and equity to generate greater access and quality of services. The objective of this article was to identify the expansion of the Family Health Strategy in Brazil between 2007 and 2020, and which variables may explain this evolution. This is a descriptive, ecological research, developed between 2007 and 2020 in Brazil; its variable of interest was the estimated population coverage of this strategy (%). An increase in the coverage of the Family Health Strategy was observed in all regions of Brazil between 2007 and 2020, especially in the Northeast region. At the state level, this coverage showed a significant positive relationship with the following variables: towns with fewer than 40,000 inhabitants and monthly income inferior to half a minimum salary. The Brazilian version of the Family Health Strategy seeks inspiration from the best and most successful health models to achieve high performance and efficiency to provide equity and access to health services.

El presente trabajo aborda como problema de investigación la importancia de la eficiencia, la planificación y los principios de buena gestión que apuntan a la capilaridad y la equidad para generar un mayor acceso y calidad de los servicios. El objetivo de este artículo fue identificar la expansión de la Estrategia Salud de la Familia en Brasil entre 2007 y 2020 y las variables que pueden explicar esta evolución. Se trata de una investigación descriptiva y ecológica, desarrollada entre 2007 y 2020 en Brasil; su variable de interés fue la cobertura demográfica estimada de esta estrategia (%). Se observó un aumento de la cobertura de la Estrategia Salud de la Familia en todas las regiones de Brasil entre 2007 y 2020, especialmente en la región noreste. A nivel estatal, esta cobertura mostró una relación positiva significativa con las siguientes variables: municipios con menos de 40.000 habitantes e ingresos mensuales inferiores a medio salario mínimo. La versión brasileña de la Estrategia de Salud de la Familia busca su inspiración en los mejores y más exitosos modelos de salud para alcanzar un alto rendimiento y eficiencia para proporcionar equidad y acceso a los servicios de salud.

O presente trabalho apresenta como um problema de pesquisa a importância da eficiência, planejamento e princípios de boa gestão objetivando capilaridade e eqüidade para gerar maior acesso e qualidade dos serviços. O objetivo desse artigo foi identificar a expansão da Estratégia de Saúde da Família no Brasil entre 2007e 2020 e quais variáveis podem explicar essa evolução. Esse é uma pesquisa descritiva, ecológica, desenvolvida entre 2007 e 2020 no Brasil: sua variável de interesse foi a cobertura estimada da população dessa estratégia (%). Um aumento na cobertura da Estratégia de Saúde da Família foi observada em todas as regiões do Brasil entre 2007 e 2020, especialmente na região Nordeste. A nível estadual, essa cobertura mostrou uma relação significante positiva com as seguintes variáveis: cidades com menos de 40.000 habitantes e renda mensal inferior a metade do salário mínimo. A versão brasileira da Estratégia de Saúde da Família busca inspiração nos melhores e mais bem sucedidos modelos de saúde para alcançar alto desempenho e eficiência no fornecimento de eqüidade e acesso a serviços de saúde.