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BACKGROUND: Colombia, which hosts over 3 million of the Venezuelan diaspora, is lauded for its progressive approach to social integration, including providing migrants access to its universal health coverage system. However, barriers to healthcare persist for both migrant and host populations, with poorly understood disparities in healthcare-seeking behaviors and associated costs. This is the first study to link healthcare-seeking behaviors with costs for Venezuelan migrants in Colombia, encompassing costs of missing work or usual activities due to healthcare events. METHODS: We use self-reported survey data from Venezuelan migrants and Colombians living in Colombia (September-November 2020) to compare healthcare-seeking behaviors and cost variables by nationality using two-sampled t-tests or Chi-square tests (X2). The International Classification of Diseases was used to compare reported household illnesses for both populations. Average health service direct costs were estimated using the Colombian Government's Suficiencia database and self-reported out-of-pocket (OOP) payments for laboratory and pharmacy services. Indirect costs were calculated by multiplying self-reported days of missed work or usual activities with estimated income levels, derived by matching characteristics using the Gran Enquesta Integrada de Hogares database. We calculate economic burdens for both populations, combining self-reported healthcare-seeking behaviors and estimated healthcare service unit costs across six healthcare-seeking behavior categories. RESULTS: Despite similar disease profiles, Venezuelan migrants are 21.3% more likely to forego formal care than Colombians, with 746.3% more Venezuelans reporting lack of health insurance as their primary reason. Venezuelan women and uninsured report the greatest difficulties in accessing health services, with accessing medications becoming more difficult for Venezuelan women during the COVID-19 pandemic. Colombians cost the health system more per treated illness event (US$40) than Venezuelans (US$26) in our sample, over a thirty-day period. Venezuelans incur higher costs for emergency department visits (123.5% more) and laboratory/ pharmacy OOP payments (24.7% more). CONCLUSIONS: While Colombians and Venezuelans share similar disease burdens, significant differences exist in access, cost, and health-seeking behaviors. Increasing Venezuelan health insurance enrollment and tackling accessibility barriers are crucial for ensuring healthcare equity and effectively integrating the migrant population. Findings suggest that improving migrant access to primary healthcare would produce savings in Colombian healthcare expenditures.

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OBJECTIVES: This study aimed to comprehensively evaluate Mexico's health system performance from 1990 to 2019 utilising the Health Access and Quality Index (HAQI) as a primary indicator. STUDY DESIGN: A retrospective ecological analysis was performed using data from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) study and the National Population Council (CONAPO). METHODS: HAQI values for 1990, 2000, 2010, 2015, and 2019 were examined for each state in Mexico and three age groups (young, working, and post-working). Additionally, the marginalisation index was employed to assess inequalities in the HAQI distribution across states. The concentration index of the HAQI for each year was estimated, and the efficiency of states in producing the HAQI was evaluated using a data envelopment approach. RESULTS: Through the analysis of national and subnational data, results indicated an overall improvement in healthcare access and quality during the study period. Although differences in the HAQI value related to state marginalisation decreased from 1990 to 2015, by 2019, the inequality had returned to a level comparable to 2000. Efficiency in producing health (HAQI values) exhibited substantial heterogeneity and fluctuations in the ranking order over time. States such as Nuevo León consistently performed well, while others, such as Guerrero, Chihuahua, Mexico City, and Puebla, consistently underperformed. CONCLUSIONS: The findings from this study emphasise the necessity for nuanced strategies to address healthcare disparities and enhance the overall system performance. The study provides valuable insights for ongoing discussions about the future of Mexico's healthcare system, aiming to inform evidence-based policy decisions and improve the nationwide delivery of healthcare services.

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Introduction: Income inequality is often tolerated and justified, but when it brings about disparities in other domains of life (e.g., health or education), it may be seen with different eyes. In this research, we aimed to explore concerns regarding economic inequality in health, education, and income, and its relationship to supporting collective actions to reduce inequality. Method: We used survey data (N = 20,204, 18 countries) from the Latinobarometer 2020. We conducted descriptive analyses, latent class analyses, and analyses of multilevel linear regression to test our hypothesis. Results: We found that people were more concerned about health access and education opportunities than income inequality. We also identified two classes of people: one class concerned about education and health and the other unconcerned about inequality in any domain. In addition, results showed that all concerns and class membership predicted greater support of collective actions to reduce inequality. Conclusions: These preliminary findings suggest that concerns about education and health disparities may serve to increase awareness of overall inequality and mobilise the public.

Introducción: La desigualdad de ingresos a menudo se tolera y justifica, pero cuando esta conlleva desigualdades en otros ámbitos de la vida (e.g., salud o educación), puede que se vea con ojos diferentes. En este artículo tratamos de explorar la preocupación por la desigualdad económica en salud, educación e ingresos, así como su relación con el apoyo a acciones colectivas para reducir la desigualdad. Método: Usamos datos secundarios (N = 20 204, 18 países) del Latinobarómetro 2020. Llevamos a cabo análisis descriptivos, análisis de clases latentes y análisis de regresión multinivel. Resultados: Encontramos que la gente estaba más preocupada por el acceso a la salud y las oportunidades en educación que por la desigualdad en el ingreso. También identificamos dos perfiles de personas: unas preocupadas por la educación y la salud, y otras poco preocupadas por la desigualdad en ninguno de los ámbitos. Además, los resultados mostraron que todas las preocupaciones y los distintos perfiles predecían un mayor apoyo a las acciones colectivas para reducir la desigualdad. Conclusiones: Estos hallazgos preliminares sugieren que la preocupación por las desigualdades en salud y educación podrían servir para aumentar la conciencia sobre la desigualdad general y movilizar al público.

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A saúde bucal brasileira por muito tempo se restringiu a procedimentos de baixa complexidade, realizados em sua maioria no sistema privado, enaltecendo as diferenças socioeconômicas. A presente pesquisa buscou analisar a evolução da assistência odontológica nas regiões do Brasil, a partir dos dados dos três ciclos do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. Um estudo quantitativo, com amostra composta por 17.202 equipes do primeiro ciclo, 29.778 do segundo e 37.350 do terceiro, e por 46.362 usuários do primeiro e 62.161 do terceiro. Os dados do Ministério da Saúde, foram agrupados por regiões e aplicaram-se os testes de Cochran Mantel Haenszel, Qui-quadrado para K proporções e Marascuilo, com nível de significância de 5%. Observou- se aumento da cobertura em nível nacional, mas redução na relação entre equipes de Saúde Bucal e de Atenção Básica de 72% para 61%; crescimento no agendamento de primeira consulta, 56% para 92%; aumento no tempo de espera pela consulta, exceto no Nordeste; e aumento de agendamento de retornos, 61% para 67%. Os dados mostraram uma cobertura de saúde bucal insuficiente, sendo maior na presença da Estratégia Saúde da Família, a influência do modelo assistencial bem como a interferência dos determinantes sociais de saúde.

Brazilian oral health has for a long time been restricted to procedures of low complexity, mostly performed in the private system, praising socioeconomic differences. The present research sought to analyze the evolution of dental care in the regions of Brazil, based on data from the three cycles of the National Program for Improvement of Access and Quality of Primary Care. A quantitative study, with a sample composed of 17,202 teams from the first cycle, 29,778 from the second and 37,350 from the third, and 46,362 users from the first and 62,161 from the third. The data from the Ministry of Health, were grouped by regions and applied Cochran Mantel Haenszel's tests, Chi-square for K proportions and Marascuilo, with significance level of 5%. We observed an increase in coverage at the national level, but a reduction in the relationship between the Oral Health and Primary Care teams from 72% to 61%; growth in the schedule of the first visit, 56% to 92%; increase in the waiting time for the consultation, except in the Northeast; and an increase in the scheduling of returns, 61% to 67%. The data showed insufficient oral health coverage, being greater in the presence of the Family Health Strategy, the influence of the care model as well as the interference of social determinants of health.

salud oral brasileña se ha limitado durante mucho tiempo a procedimientos de baja complejidad, realizados en su mayoría en el sistema privado, alabando las diferencias socioeconómicas. Esta investigación buscó analizar la evolución de la asistencia dental en las regiones del Brasil, a partir de los datos de los tres ciclos del Programa Nacional para la Mejora del Acceso y la Calidad de la Atención Básica. Un estudio cuantitativo, con una muestra compuesta por 17.202 equipos de primer ciclo, 29.778 segundos y 37.350 tercios, y 46.362 usuarios del primero y 62.161 tercios. Los datos del Ministerio de Salud se agruparon por región y se aplicaron las pruebas de Cochran Mantel Haenszel, Qui-Square para proporciones K y Marascuilo, con un nivel significativo de 5%. Se observó una mayor cobertura a nivel nacional, pero una reducción en la relación entre los equipos de salud bíblica y atención básica del 72% al 61%; un aumento en la programación de la primera visita del 56% al 92%; un aumento en el tiempo de espera de las consultas excepto en el noreste; y un aumento en la programación de los retornos del 61% al 67%. Los datos mostraron una cobertura insuficiente de la salud bucal, siendo mayor en presencia de la Estrategia de Salud Familiar, la influencia del modelo de asistencia, así como la interferencia de los determinantes sociales de la salud. PALABRAS CLAVE: Salud Bucal; Acceso a los Servicios de Salud; Atención Primaria de la Salud.

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Objetivos: conocer el perfil y comprender el contexto descrito en las publicaciones sobre la judicialización del acceso a tecnologías en salud en Brasil. Metodología: revisión sistemática de métodos mixtos. Se consultaron 5 bases de datos y se incluyeron artículos que presentaran datos de procesos judiciales demandando tecnologías en salud del SUS en Brasil, o que analizaran este fenómeno, publicados en portugués, inglés y español, hasta 2019. La calidad metodológica fue evaluada con un enfoque convergente segregado. La caracterización de los datos de los estudios y el análisis e integración de la evidencia cuali-cuantitativa se realizó usando la síntesis realista. Resultados: 27 estudios fueron incluidos en la revisión. Se identificaron 76.666 procesos judiciales en que se solicitaba alguna tecnología en salud, en su mayoría medicamentos (65%); la mayoría de los procesos presentaron una representación jurídica privada (68%) y la mayoría de las acciones fue contra los estados (65%). Los enfoques de análisis de judicialización más frecuentes fueron Social Positivo (32%) y Normativo Negativo (32%), seguidos de 29% para el abordaje de Normativo Positivo. El abordaje Social Negativo (7%) fue el menos frecuente. Conclusiones: se identificó que existen evidencias cuantitativas que soportan las evidencias cualitativas. Estas demuestran que el desconocimiento del Poder Judicial sobre las políticas de salud lleva a un aumento de las desigualdades en salud; al fomento del paternalismo del Estado, así como que el aumento de acciones judiciales explica la necesidad de la búsqueda de alternativas para acceder a tecnologías en salud.

Objectives: to know the profile and understand the context described in publications on the judicialization of access to health technologies in Brazil. Methods: systematic review of mixed methods. Five databases were consulted, and articles were included that presented data from lawsuits demanding health technologies from the SUS in Brazil, or that analyzed this phenomenon, published in Portuguese, English and Spanish, until 2019. The methodological quality was evaluated using the convergent segregated approach. The characterization of data from the studies and the analysis and integration of qualitative-quantitative evidence were conducted through realistic synthesis. Results: 27 studies were included in the review. A total of 76,666 lawsuits were identified in which some health technology was requested, mainly medicines (65%); most lawsuits had private legal representation (68%) and most lawsuits were against the states (65%). The most frequent judicialization analysis approaches were Positive Social (32%) and Negative Normative (32%), followed by 29% for the Positive Normative approach. The Social Negative approach (7%) was the least frequent. Conclusions: it was identified that there is quantitative evidence that supports qualitative evidence. These demonstrate that the Judiciary's lack of knowledge about health policies leads to an increase in health inequalities; to the promotion of state paternalism, as well as the fact that the increase in lawsuits explains the need to seek alternatives for accessing health technologies.

Objetivos: conhecer o perfil e compreender o contexto descrito nas publicações sobre a judicialização do acesso às tecnologias em saúde no Brasil. Metodologia: Revisão sistemática de métodos mistos. Foram consultadas cinco bases de dados e incluídos artigos que apresentassem dados de processos judiciais demandando tecnologias em saúde do SUS no Brasil, ou que analisassem esse fenômeno, publicados em português, inglês e espanhol, até 2019. A qualidade metodológica foi avaliada com a abordagem convergente segregada. A caracterização dos dados dos estudos e a análise e integração das evidências qualitativos-quantitativas foram realizadas por meio da síntese realista. Resultados: 27 estudos foram incluídos na revisão. Foram identificados 76.666 processos judiciais em que foi solicitada alguma tecnologia em saúde, principalmente medicamentos (65%); a maioria dos processos apresentou representação legal privada (68%) e a maioria das ações foi contra os estados (65%). As abordagens de análise de judicialização mais frequentes foram Social Positiva (32%) e Normativa Negativa (32%), seguidas de 29% para a abordagem Normativa Positiva. A abordagem Social Negativa (7%) foi a menos frequente. Conclusões: identificou-se que há evidências quantitativas que sustentam as evidências qualitativas. Estes demonstram que o desconhecimento do Judiciário sobre as políticas de saúde leva ao aumento das desigualdades em saúde; à promoção do paternalismo estatal, bem como o fato de que o aumento das ações judiciais explica a necessidade de buscar alternativas de acesso às tecnologias em saúde.

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Introdução: O número de casos de HIV continua a aumentar globalmente, de forma desproporcional em homens que fazem sexo com homens e outras populações vulneráveis, apesar do desenvolvimento de múltiplas estratégias de prevenção. Dentre essas estratégias, destaca-se a Profilaxia Pós-Exposição ao HIV (PEP), ainda que subutilizada, se encontra no centro da cascata de prevenção. Ao seguir seu protocolo os usuários são levados a testagem, podendo ser encaminhados à profilaxia, ao tratamento (caso seja necessário) e até mesmo ofertados à outras estrategias, sendo assim uma ferramenta multipotente para a interrupção da cadeia de transmissão do HIV. Assim, nosso estudo teve como objetivo explorar o acesso aos serviços de saúde que ofertam a Profilaxia Pós exposição ao HIV e as tecnologias disponíveis para auxiliá-lo. Métodos: Foram realizadas duas etapas sequenciais: 1ª- Estudo exploratório e descritivo com abordagem qualitativa e 2ª- Estudo de Prospecção de Tecnologias. A pesquisa obedeceu às diretrizes éticas sobre pesquisas com seres humanos, reguladas pela resolução 466/12 e aprovado pelo Comitê de Ética e Pesquisa da Escola de Enfermagem de Ribeirão Preto/USP (parecer nº 3.280.490). O estudo qualitativo visou explorar as barreiras de acesso à Profilaxia Pós Exposição ao HIV percebidas por usuários e profissionais de saúde nos serviços de saúde especializados. Para isso foi realizada uma pesquisa exploratória com abordagem qualitativa. Os participantes da pesquisa foram profissionais médicos e enfermeiros envolvidos no protocolo da profilaxia em Centros de Referência e usuários da prevenção, totalizando 10 participantes, amostragem definida por saturação de dados. As entrevistas gravadas foram transcritas e posteriormente processadas pela Classificação Hierárquica Descendente e por análise de Similitude. A prospecção foi guiada pelo objetivo de identificar e analisar os aplicativos móveis que abordam PEP para infecções por HIV. Conduzimos um estudo exploratório descritivo em 3 fases sequenciais: revisão sistemática da literatura, análise de patentes e busca sistemática de lojas de aplicativos. Para a revisão sistemática, seguimos as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyzes adaptadas para uma revisão integrativa nas bases de dados PubMed, Web of Knowledge, Scopus, Cochrane, Embase, Science Direct, Eric, Treasure e CINAHL. Resultados: Foram obtidas cinco classes: Informação; Centralização de acesso; Fluxo de atendimento; Relações interpessoais nos serviços de saúde e Dificuldades e Barreiras. Existem diversos fatores dificultadores no acesso à prevenção que perpassam conhecimento, acolhimento e divulgação de informações. Diante do advento da Pandemia de COVID-19 muitos desses problemas se agravam e aumentam a vulnerabilidade de possíveis utilizadores da profilaxia. Na busca por tecnologias que auxiliassem o acesso a PEP, os aplicativos encontrados apenas informam sobre a prevenção e tratamento do HIV tendo como públicoalvo profissionais de saúde, pessoas com HIV ou a população em geral, mas com recursos disponíveis apenas limitados, isto é, principalmente texto, imagens e vídeos. Os três aplicativos com foco exclusivo no PEP foram criados por pesquisadores de universidades brasileiras. Conclusão: O acesso à profilaxia pós-exposição ao HIV encontra desafios e barreiras, que vão desde o desconhecimento sobre a profilaxia, o que impossibilita sua busca, à centralização dos serviços de saúde e estigmas que permeiam as estruturas dos serviços de saúde. Nossa revisão não encontrou nenhuma conexão entre os estudos científicos, patentes registradas e os aplicativos disponíveis relacionados ao PEP; esse achado indica que esses aplicativos disponíveis não possuem um embasamento teórico ou metodológico em sua criação.

Introduction: The number of HIV cases continues to rise globally, disproportionately in men who have sex with men and other vulnerable populations, despite the development of multiple prevention strategies. Among these strategies, HIV Post-Exposure Prophylaxis (PEP) stands out, although underutilized, is at the center of the prevention cascade. By following its protocol, users are tested and may be referred to prophylaxis, treatment (if necessary) and even offered to other strategies, thus being a multipotent tool for interrupting the HIV transmission chain. Thus, our study aimed to explore access to health services that offer Postexposure HIV Prophylaxis and the technologies available to help it. Methods: Two sequential steps were carried out: 1st - Exploratory and descriptive study with a qualitative approach and 2nd - Technology Prospection Study. The research followed the ethical guidelines on research with human beings, regulated by resolution 466/12 and approved by the Ethics and Research Committee of the Nursing School of Ribeirão Preto/USP (opinion nº3.280,490). The qualitative study aimed to explore the barriers to accessing HIV Post Exposure Prophylaxis perceived by users and professionals in specialized health services. For this, an exploratory research with a qualitative approach was carried out. The research participants were medical professionals and nurses involved in the prophylaxis protocol in Reference Centers and prevention users, totaling 10 participants, a sample defined by data saturation. The recorded interviews were transcribed and later processed by the Descending Hierarchical Classification and by Similitude analysis. The prospect was guided by the objective of identifying and analyzing mobile apps that address PEP for HIV infections. We conducted a descriptive exploratory study in 3 sequential phases: systematic literature review, patent analysis and systematic search of app stores. For the systematic review, we followed the Preferred Reporting Items guidelines for Systematic Reviews and Meta-Analyzes adapted for an integrative review in the PubMed, Web of Knowledge, Scopus, Cochrane, Embase, Science Direct, Eric, Treasure and CINAHL databases. Results: Five classes were obtained: Information; Access centralization; Service flow; Interpersonal relationships in health services and Difficulties and Barriers. There are several factors that hinder access to prevention that permeate knowledge, reception, and dissemination of information. With the advent of the COVID-19 pandemic, many of these problems are aggravated and increase the vulnerability of possible users of prophylaxis. In the search for technologies that would aid access to PEP, the apps found only inform about the prevention and treatment of HIV, targeting health professionals, people with HIV or the general population, but with only available resources limited, that is, mainly text, images, and videos. The three applications with an exclusive focus on PEP were created by researchers from Brazilian universities. Conclusion: Access to HIV post-exposure prophylaxis faces challenges and barriers, ranging from the lack of knowledge about prophylaxis, which makes it impossible to pursue it, to the centralization of health services and stigmas that permeate the structures of health services. Our review found no connection between scientific studies, registered patents, and available applications related to PEP; this finding indicates that these available applications do not have a theoretical or methodological basis in their creation.

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Resumo O crescente fluxo de imigração venezuelana provocou discussões acerca da inserção dessa comunidade no território brasileiro. Atualmente, o sistema de saúde roraimense tem o desafio de efetivar a universalização do acesso à saúde ao imigrante. Logo, este estudo objetiva conhecer as repercussões desse fenômeno sob a ótica de profissionais de saúde. Para isso, trata-se de um estudo qualitativo com abordagem exploratória que analisou a percepção dos técnicos de enfermagem do maior hospital de Roraima sobre os reflexos da imigração nos serviços de saúde e na qualidade da assistência. A análise das entrevistas semiestruturadas foi pautada na técnica de avaliação de conteúdo, sendo elencadas categorias. Por meio de análise da categoria de entraves na assistência de saúde, observaram-se problemas estruturais, como as fragilidades de infraestrutura e a carência de profissionais técnicos, resultando na sobrecarga de trabalho, e étnicos-culturais, como a barreira linguística, que representa um fator limitante para a realização de um atendimento de saúde com qualidade, além da maior fragilidade na condição de saúde dos imigrantes. Os achados deste trabalho podem auxiliar o estado de Roraima a refletir criticamente acerca do emprego correto dos investimentos na saúde, para garantir eficácia, dignidade e humanidade aos imigrantes, bem como aos brasileiros.

Abstract The growing flow of Venezuelan immigration has provoked discussions about the insertion of this community in Brazilian territory. Currently, the health system of Roraima has the challenge of effecting the universalization of access to the immigrant population. Therefore, this study aims to understand the repercussions of this phenomenon from the perspective of health professionals. As such, this is a qualitative study with an exploratory approach that analyzed the perception of nursing technicians of the largest hospital in Roraima about the effects of immigration on health services and quality of care. The analysis of semi-structured interviews was based on the content evaluation technique, and categories were listed. Through the categorical analysis of obstacles in health care, we observed structural problems, such as frailties in infrastructure and lack of technical professionals, resulting in work overload, as well as ethnocultural problems, such as the language barrier, which represents a limiting factor for performing quality health care, in addition to the greater frailty in the health condition of immigrants. The findings of this study may help the state of Roraima to reflect critically on the correct use of investments in health, to ensure efficacy, dignity and humanity to immigrants, as well as Brazilians.

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BACKGROUNDS: The efforts to develop research and training on physical rehabilitation in regards to disasters is considered recent worldwide. In the late evening of the 11th up until the 12th of January of 2011, the most massive natural disaster occurred in Brazil with extremely heavy downpour, abrupt flood, as well as landslides on multiple areas of the Mountain Region of Rio de Janeiro. The objective of this research was to investigate the challenges in terms of physical rehabilitation provided by this event METHODS: The cross-sectional mixed method's study, which was conducted in the city of Nova Friburgo, used two different data sources: hospital records on traumatic injuries pre and post disaster, and interviews with key informants - victims who suffered injuries related to the disaster, professionals from rehabilitation services in the municipality, and also the city's health service management. Pearson's chi-squared test was performed to evaluate statistical significance between the week of a given incident and the type of injury. Interviews were transcribed and analysed through content analysis. RESULTS: A total of 2326 hospital records and 27 interviews were analysed. The proportion of traumatic injury in the municipal emergency service increased from 16% in the prior week, to 40% in the week post-disaster (p <  0.0001). Different injuries were identified: multiple fractures, crushing, amputation, perforation of soft tissues, inhalation of dust and establishment of chronic conditions through stress. Despite this scenario, out of the 16 health professionals interviewed, twelve did not observe an increase in the demand for outpatient rehabilitation services after the disaster. Interviews with the victims revealed that the pathways for care ran into different barriers. From 11 victims interviewed, only one received complete physiotherapy care through the public health services in the city, while all others hired additional assistance, received volunteer services, had assistance in other cities or remained without rehabilitation. CONCLUSIONS: The needs for rehabilitation increased after the disaster; however, the demand was repressed due to different barriers such as competing needs and possible lack of medical referral. Recommendations were made, including the action of performing a search of victims with rehabilitation needs.

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OBJECTIVES: The aim of this study was to investigate the effects of primary healthcare decentralization on type 2 diabetes mellitus mortality and morbidity in different municipalities of a developing country. STUDY DESIGN: This was a retrospective study based on a panel of annual data from 5560 Brazilian municipalities from 2000 to 2011. METHODS: The investigation used the staggered municipal adoption of a federal health information program as a quasi-experiment to identify the treatment effects of health decentralization on diabetes indicators. Using Difference-in-Differences models and instrumental variables, we analyzed the effects of primary healthcare decentralization on diabetes rates (i.e. diabetes deaths and hospitalizations by the number of people with a diabetes diagnosis and by population). RESULTS: Evidence suggests improvements in universal access to primary health care and progress in the average health outcomes related to diabetes mortality (reduction of 30%) and hospitalization (reduction of 2.3%) due to decentralization. Effects are further pronounced in developed regions with higher incomes, while the poorest and less developed regions showed virtually no effect. CONCLUSIONS: These results demonstrate that there are particular preconditions for successful primary health decentralization, especially related to returns of scale (big health facilities are associated with low cost per treatment), lack of human and physical capital, and government coordination problems.

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Objetivo: Identificar, avaliar criticamente e sintetizar as evidências científicas relacionadas ao conhecimento de profissionais de saúde e usuários sobre direito à informação em saúde. Metodologia: Revisão integrativa da literatura. Foram selecionadas as bases de dados Hein Online, ISTA, Lilacs, LISA, PubMed e Web of Science para a identificação de estudos primários. Resultados: Um total de 6888 estudos foi identificado e, considerando os critérios de seleção, 15 estudos primários foram incluídos na revisão. As categorias temáticas desta revisão foram agrupadas de acordo com o conhecimento dos usuários sobre seu direito à informação e conhecimento dos profissionais sobre o direito à informação do usuário. Conclusões: Verifica-se a necessidade de capacitação de profissionais de saúde em relação ao direito dos usuários de serviços de saúde. Assim, a educação dos profissionais mostra-se como uma possibilidade de se fazer cumprir o direito à informação do paciente, melhorando a prática assistencial e, consequentemente, as condições de saúde das pessoas e o exercício de seus direitos.

Objective: To identify, critically evaluate and synthesize the scientific evidence related to the knowledge of health professionals and users about the right to health information. Methodology: Integrative literature review with the goal The databases Hein Online, ISTA, Lilacs, LISA, PubMed and Web of Science were selected for the identification of primary studies. Results: A total of 6888 studies were identified and, considering the selection criteria, 15 primary studies were included in the review. The thematic categories of this review were grouped according to the users' knowledge about their right to information and knowledge of the professionals about the right to information of the user. Conclusions: There is a need to train health professionals in relation to the right of health service users. Thus, the education of professionals is considered a possibility to enforce the right to information of the patient, improving the practice of care and, consequently, the health conditions of people and the exercise of their rights.

Objetivo: Identificar, evaluar críticamente y sintetizar las evidencias científicas relacionadas al conocimiento de profesionales de salud y usuarios sobre derecho a la información en salud. Metodología: Revisión integrativa de la literatura. Se seleccionaron las bases de datos Hein Online, ISTA, Lilacs, LISA, PubMed y Web of Science para la identificación de estudios primarios. Resultados: Un total de 6888 estudios fue identificado y, considerando los criterios de selección, 15 estudios primarios fueron incluidos en la revisión. Las categorías temáticas de esta revisión fueron agrupadas de acuerdo con el conocimiento de los usuarios sobre su derecho a la información y conocimiento de los profesionales sobre el derecho a la información del usuario. Conclusiones: Se verifica la necesidad de capacitación de profesionales de salud en relación al derecho de los usuarios de servicios de salud. Así, la educación de los profesionales se muestra como una posibilidad de hacer cumplir el derecho a la información del paciente, mejorando la práctica asistencial y, consecuentemente, las condiciones de salud de las personas y el ejercicio de sus derechos.

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The consequences of lacking birth certificates remain largely unexplored in the economic literature. We intend to fill this knowledge gap studying the effect of lacking birth certificates on immunization of children in the Dominican Republic. This is an interesting country because a significant number of children of Haitian descent face the consequences of lacking proper documentation. We use the distance to the civil registry office and the mother's document of identification as instrumental variables of the child's birth certificate. After controlling for distance to immunization services and other determinants, this paper finds that children between 0 and 59 months of age that do not have birth certificates are behind by nearly one vaccine (out of a total of nine) compared to those that have birth certificates.

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Background: Understanding problems of access to oral health services requires knowledge of factors that determine access. This study aimed to evaluate factors that determine access to oral health services among children aged <12 years in Peru between 2014 and 2015. Methods: We performed a secondary data analysis of 71,614 Peruvian children aged <12 years and their caregivers. Data were obtained from the Survey on Demography and Family Health 2014-2015 (Encuesta Demográfica y de Salud Familiar - ENDES). Children's access to oral health services within the previous 6 months was used as the dependent variable (i.e. Yes/No), and the Andersen and col model was used to select independent variables. Predisposing (e.g., language spoken by  tutor or guardian, wealth level, caregivers' educational level, area of residence, natural region of residence, age, and sex) and enabling factors (e.g. type of health insurance) were considered. Descriptive statistics were calculated, and multivariate analysis was performed using generalized linear models (Poisson family). Results: Of all the children, 51% were males, 56% were aged <5 years, and 62.6% lived in urban areas. The most common type of health insurance was Integral Health Insurance (57.8%), and most respondents were in the first quintile of wealth (31.6%). Regarding caregivers, the most common educational level was high school (43.02%) and the most frequently spoken language was Spanish (88.4%). Univariate analysis revealed that all variables, except sex and primary educational level, were statistically significant. After adjustment, sex, area of residence, and language were insignificant, whereas the remaining variables were statistically significant. Conclusions: Wealth index, caregivers' education level, natural region of residence, age, and type of health insurance are factors that determine access to oral health services among children aged <12 years in Peru. These factors should be considered when devising strategies to mitigate against inequities in access to oral health services.

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Risk perception is a cognitive process that allows people to organize information and assess their exposure to a hazard. Therefore, this study aimed to describe the risk perception towards HIV in young homosexual women from Cali, Colombia. Six homosexual women participated in this research, which has a qualitative narrative design. Data was collected using semi-structured interviews and analyzed through Thematic Analysis. The findings indicate that women have low knowledge about HIV and the use of preventive methods was not reported. It was found that their beliefs about HIV have been built on their interaction with peers and health service providers. These results provide an initial understanding of how and why to develop comprehensive prevention strategies for this population

A percepção de risco é um processo cognitivo que permite organizar e avaliar a exposição a uma ameaça. Portanto, o objetivo deste estudo é descrever a percepção de risco para o HIV de um grupo de mulheres homossexuais de Cali, na Colômbia. Desta pesquisa, com desenho narrativo, participaram seis mulheres homossexuais. Os dados foram coletados através de entrevistas semiestruturadas e analisados por meio de uma análise temática. Os resultados indicam que as mulheres têm um baixo nível de conhecimento sobre o HIV e o uso de medidas preventivas não foi relatado. Verificou-se que suas crenças sobre o HIV foram construídas em interação com seus pares e seus provedores de serviços de saúde. Esses resultados fornecem uma compreensão inicial de como e por que estratégias adequadas de intervenção devem ser desenvolvidas para essa população

La percepción de riesgo es un proceso cognitivo que permite organizar y evaluar la exposición a una amenaza. Por tanto, el objetivo de este estudio es describir la percepción de riesgo frente al VIH de un grupo de mujeres homosexuales de Cali, Colombia. En esta investigación, con diseño narrativo, participaron seis mujeres homosexuales. Los datos fueron recogidos usando entrevistas semi estructuradas y analizados a través de un análisis temático. Los resultados indican que las mujeres tienen un bajo nivel de conocimientos sobre VIH y no se reportó el uso de medidas preventivas. Se encontró que sus creencias sobre el VIH se habían construido en la interacción con sus pares y sus proveedores de servicios de salud. Estos resultados proveen una comprensión inicial de cómo y porqué se deben desarrollar estrategias de intervención adecuadas para esta población

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BACKGROUND: Hepatitis C affects over 185 million people around the world. This silent disease is responsible for up to 700,000 deaths per year. Despite the scientific revolution in diagnosis and treatment, hepatitis C control remains a huge challenge due to the cost of effective medications. In response to the global outcry of hepatitis epidemic and the need to improve the nation's public health response, the Ministry of Health of Brazil revolutionized hepatitis C treatment by incorporating highly effective drugs that can be accessed through sustainable and universal means. DISCUSSION: This paper describes the unique process of implementing evidence-informed policy to respond to hepatitis C epidemic through the update of hepatitis C treatment in Brazil based on the estimate of disease prevalence, current international guidelines, and the cost-effectiveness impact in the Brazilian Unified Health System. Through a debate of an experience report, the authors underlie the strategic plan implemented according to the situation analysis that emphasized the need to improve its current response over a relatively short-term period. The comprehensive response is detailed comprising three main objectives: improve treatment outcomes by evaluating and incorporating new and effective medications at a sustainable price; elaborate on clinical guidelines to treat hepatitis C patients; and develop awareness and diagnosis campaigns targeted at the population of interest. In this scenario, Brazil was able to obtain an unprecedented discount for a high-medium income country; provided treatment to more than 7000 individuals in the last 2 months of 2015; and expects to treat 38,000 new patients in 2016. The remarkable process applied in Brazil was developed according to epidemiological data and scientific evidence, and it was motivated by the engagement of the country in the Sustainable Development Goals, which may inspire other developing countries to identify ways to achieve these goals by 2030.

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A atual ampliação dos fluxos migratórios internacionais coloca em debate a responsabilização dos Estados pela garantia de direitos sociais básicos às populações imigrantes, dentre eles, o acesso à saúde. Este trabalho busca contribuir para a compreensão do Brasil neste novo quadro, por meio de uma pesquisa qualitativa sobre o acesso à saúde de imigrantes recentes na cidade de São Paulo. Foram realizadas vinte e três entrevistas em profundidade com imigrantes bolivianos, por meio de um roteiro semiestruturado. A intermitente insatisfação dos brasileiros quanto ao atendimento prestado pelo Sistema Único de Saúde no Brasil torna surpreendente a constatação de que, entre os bolivianos entrevistados, os serviços de saúde a que têm acesso são positivamente valorizados, ao contrário do que ocorre em seu próprio país de origem. Tal avaliação positiva só pode ser compreendida se analisada sua condição de imigrantes de primeira geração. Revelou-se fundamental compreender a perspectiva comparativa Brasil-Bolívia, utilizada pelos entrevistados para avaliar o acesso à saúde em São Paulo. Para contextualizar os dados coletados, foram delineados os principais componentes institucionais dos sistemas de saúde nos dois países e apresentado um conjunto sistematizado de dados macrossociais comparativos entre Brasil e Bolívia. Nas considerações finais, discutimos em que medida as experiências relatadas reafirmam ou não as principais teses apresentadas na literatura, à luz dos achados da pesquisa de campo. Destaca-se o papel desempenhado pelos proprietários das oficinas e pelos agentes comunitários de saúde, que aparecem como elementos facilitadores do acesso, além das redes familiares e de conacionais.

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