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BACKGROUND: Tuberculosis (TB) infectiousness decreases significantly with only a few days of treatment, but delayed diagnosis often leads to late treatment initiation. We conducted a sequential explanatory mixed methods study to understand the barriers and facilitators to prompt diagnosis among people with TB. METHODS: We enrolled 100 adults who started TB treatment in the Carabayllo district of Lima, Peru, between November 2020 and February 2022 and administered a survey about their symptoms and healthcare encounters. We calculated total diagnostic delay as time from symptom onset to diagnosis. We conducted semi-structured interviews of 26 participants who had a range of delays investigating their experience navigating the health system. Interview transcripts were inductively coded for concepts related to diagnostic barriers and facilitators. RESULTS: Overall, 38% of participants sought care first from public facilities and 42% from the private sector. Only 14% reported being diagnosed with TB on their first visit, and participants visited a median of 3 (interquartile range [IQR] health facilities before diagnosis. The median total diagnostic delay was 9 weeks (interquartile range [IQR] 4-22), with a median of 4 weeks (IQR 0-9) before contact with the health system and of 3 weeks (IQR 0-9) after. Barriers to prompt diagnosis included participants attributing their symptoms to an alternative cause or having misconceptions about TB, and leading them to postpone seeking care. Once connected to care, variations in clinical management, health facility resource limitations, and lack of formal referral processes contributed to the need for multiple healthcare visits before obtaining a diagnosis. Facilitators to prompt diagnosis included knowing someone with TB, supportive friends and family, referral documents, and seeing a pulmonologist. CONCLUSIONS: Misinformation about TB among people with TB and providers, poor accessibility of health services, and the need for multiple encounters to obtain diagnostic tests were major factors leading to delays. Extending the hours of operation of public health facilities, improving community awareness and provider training, and creating a formal referral process between the public and private sectors should be priorities in the efforts to combat TB.

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Objective: To compare information on highly complex radiological procedures-computed tomography (CT) and magnetic resonance imaging (MRI)-between the public and private health care systems, across the five regions of Brazil, in terms of the numbers of radiological devices and examinations performed, between 2015 and 2021. Materials and Methods: This was a descriptive time series analysis of secondary data in the public domain, available from the Information Technology Department of the Brazilian Unified Health Care System, an entity of the Brazilian National Ministry of Health (NMH) that is responsible for collecting and storing health-related information in Brazil. The analysis included the numbers of CT and MRI scanners; the volumes and types of examinations; the type of institution (public or private); the regions of the country; and the years (2015 to 2021). Results: Progressive increases in the numbers of CT and MRI devices, as well as in the volumes of examinations, were observed over the years in all regions of the country. The private sector showed higher rates of equipment acquisition and of growth in the number of examinations. However, the public health care system did not reach the equipment targets set by the NMH, whereas the private health care system surpassed those targets. A greater number of examinations were performed in the private sector than in the public sector. Conclusion: During the period evaluated, the public health care system did not meet the equipment or examination targets recommended by the NMH, in any of the regions of the country, unlike the private health care system, which exceeded both in all of the regions.

Objetivo: Comparar informações sobre procedimentos radiológicos de alta complexidade ­ tomografia computadorizada (TC) e ressonância magnética (RM) ­, considerando o número de aparelhos e o quantitativo de exames nas esferas pública e privada nas cinco regiões brasileiras entre 2015 e 2021. Materiais e Métodos: Trata-se de um estudo descritivo de série temporal que utilizou dados secundários do Departamento de Informática do Sistema Único de Saúde, órgão do Ministério da Saúde (MS) responsável pela coleta e armazenamento das informações relacionadas à saúde no Brasil. Analisamos os números de aparelhos e de exames de TC e RM, considerando os tipos de aparelhos e exames, instituição (pública ou privada), região brasileira e ano (2015 a 2021). Resultados: Houve aumento de aparelhos e exames de TC e RM em todas as regiões ao longo dos anos. A esfera privada apresentou maior aquisição desses aparelhos e crescimento no número de exames. O sistema público não atingiu o número de aparelhos preconizado pelo MS, enquanto o sistema privado superou a recomendação. Observou-se maior número de exames na esfera privada quando comparada à pública. Conclusão: O sistema público não atendeu aos números de aparelhos e exames realizados preconizados pelo MS, diferentemente da esfera privada, em todas as regiões no período estudado.

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Abstract Objective: To compare information on highly complex radiological procedures—computed tomography (CT) and magnetic resonance imaging (MRI)—between the public and private health care systems, across the five regions of Brazil, in terms of the numbers of radiological devices and examinations performed, between 2015 and 2021. Materials and Methods: This was a descriptive time series analysis of secondary data in the public domain, available from the Information Technology Department of the Brazilian Unified Health Care System, an entity of the Brazilian National Ministry of Health (NMH) that is responsible for collecting and storing health-related information in Brazil. The analysis included the numbers of CT and MRI scanners; the volumes and types of examinations; the type of institution (public or private); the regions of the country; and the years (2015 to 2021). Results: Progressive increases in the numbers of CT and MRI devices, as well as in the volumes of examinations, were observed over the years in all regions of the country. The private sector showed higher rates of equipment acquisition and of growth in the number of examinations. However, the public health care system did not reach the equipment targets set by the NMH, whereas the private health care system surpassed those targets. A greater number of examinations were performed in the private sector than in the public sector. Conclusion: During the period evaluated, the public health care system did not meet the equipment or examination targets recommended by the NMH, in any of the regions of the country, unlike the private health care system, which exceeded both in all of the regions.

Resumo Objetivo: Comparar informações sobre procedimentos radiológicos de alta complexidade - tomografia computadorizada (TC) e ressonância magnética (RM) -, considerando o número de aparelhos e o quantitativo de exames nas esferas pública e privada nas cinco regiões brasileiras entre 2015 e 2021. Materiais e Métodos: Trata-se de um estudo descritivo de série temporal que utilizou dados secundários do Departamento de Informática do Sistema Único de Saúde, órgão do Ministério da Saúde (MS) responsável pela coleta e armazenamento das informações relacionadas à saúde no Brasil. Analisamos os números de aparelhos e de exames de TC e RM, considerando os tipos de aparelhos e exames, instituição (pública ou privada), região brasileira e ano (2015 a 2021). Resultados: Houve aumento de aparelhos e exames de TC e RM em todas as regiões ao longo dos anos. A esfera privada apresentou maior aquisição desses aparelhos e crescimento no número de exames. O sistema público não atingiu o número de aparelhos preconizado pelo MS, enquanto o sistema privado superou a recomendação. Observou-se maior número de exames na esfera privada quando comparada à pública. Conclusão: O sistema público não atendeu aos números de aparelhos e exames realizados preconizados pelo MS, diferentemente da esfera privada, em todas as regiões no período estudado.

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Background: Despite the efforts to promote universal coverage for family planning, inequalities are still high in several countries. Our aim was to identify which sources of contraceptives women mostly rely on in low- and middle-income countries (LMICs). We also explored the different sources according to age and marital status. Methods: We used data from national health surveys carried out in 59 LMICs since 2010. Among all sexually active women at reproductive age, we explored inequalities in demand for family planning satisfied by modern methods (mDFPS) and in the source of modern contraceptives according to women's age, classified as: 15-19, 20-34, or 35-49 years of age. Among adolescents, mDFPS and source of method were explored by marital status, classified as married or in union and not married nor in a union. Results: mDFPS was lower among adolescents than among adult women in 28 of the 59 countries. The lowest levels of mDFPS among adolescents were identified in Albania (6.1%) and Chad (8.2%). According to adolescents' marital status, the pattern of inequalities in mDFPS varied widely between regions, with married and unmarried adolescents showing similar levels of coverage in Latin America and the Caribbean, higher coverage among unmarried adolescents in Africa, and lower coverage among unmarried adolescents in Asia. Public and private health services were the main sources, with a lower share of the public sector among adolescents in almost all countries. The proportion of adolescents who obtained their contraceptives in the public sector was lower among unmarried girls than married ones in 31 of the 38 countries with data. Friends or relatives were a more significant source of contraceptives among unmarried compared to married adolescents in all regions. Conclusions: Our findings indicate lower levels of mDFPS and lower use of the public sector by adolescents, especially unmarried girls. More attention is needed to provide high-quality and affordable family planning services for adolescents, especially for those who are not married.

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Introduction: Disability retirement is granted to civil servants considered permanently incapable of working. Noncommunicable diseases are the main cause of permanent disability and retirement in Brazil. The Federal University of Rio de Janeiro is one of the largest universities in Brazil, and determining the profile of employees who receive disability pensions at this institution is of great relevance. Objectives: To describe the profile of university employees who retired due to a disability between 2003 and 2017. Methods: This cross-sectional study was based on disability retirement records for civil servants. Demographic variables such as sex, age at retirement, and employment position were evaluated. Results: A total of 630 cases were analyzed, including 334 (53%) full and 296 (47%) proportional retirements; 499 (79.2%) were aged 30 to 59 years at retirement, and 368 (51.4%) were women. The full retirement rate was higher among those with senior level positions (p < 0.001), in older age groups (p < 0.001), and in men (p = 0.012). Conclusions: Noncommunicable disease was the main cause of retirement. The mean age at permanent disability was early, regardless of sex or retirement type. Permanent disability was more common among employees in positions requiring less education. The disability rate was highest among women.

Introdução: A aposentadoria por invalidez é o benefício concedido aos servidores públicos quando considerados incapazes de forma permanente para o trabalho. As doenças não comunicáveis são a principal causa de incapacidade permanente e aposentadoria por invalidez no Brasil. A Universidade Federal do Rio de Janeiro é uma das maiores do Brasil, e conhecer o perfil das aposentadorias por invalidez dentro dessa instituição possui grande relevância. Objetivos: Descrever o perfil das aposentadorias por invalidez na Universidade Federal do Rio de Janeiro no período entre 2003 e 2017. Métodos: Estudo seccional baseado no registro das aposentadorias por invalidez dos servidores. Foram avaliadas variáveis demográficas como sexo, idade na ocasião da aposentadoria e cargo de ingresso na universidade. Resultados: Foram analisados 630 casos, com 334 (53%) aposentadorias integrais e 296 (47%) proporcionais. Na ocasião da aposentadoria, 499 (79,2%) servidores apresentavam idade entre 30 e 59 anos e 368 (51,4%) eram do sexo feminino. Foi observado que, nos cargos de nível superior, há maior ocorrência de aposentadorias integrais (p < 0,001 ), assim como nas faixas etárias mais elevadas (p < 0,001 ) e também no sexo masculino (p = 0,012). Conclusões: As doenças não comunicáveis foram as principais causas das aposentadorias. A média de idade da invalidez permanente foi precoce, independentemente do sexo e do tipo de aposentadoria. Servidores de cargos de menor escolaridade estiveram entre os que mais apresentaram incapacidade permanente. O sexo feminino foi o que mais apresentou invalidez.

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Resumo Objetivo: analisar a introdução do Programa de Gestão e Desempenho (PGD) na Universidade Federal Fluminense (UFF). Métodos: o PGD começou a ser implementado na UFF a partir de maio de 2022, este ensaio apresenta as mudanças estabelecidas e discute suas relações com o processo de uberização. Resultados: as diretrizes estabelecidas pelo PGD, bem como a experiência inicial de sua implementação na UFF, apontam uma forte influência do ideário que orienta o fenômeno da uberização do trabalho. Ao produzir mudanças profundas na forma de organização e controle das atividades laborais, o PGD traz também potenciais impactos na saúde do trabalhador, destacadamente a maior dificuldade no mapeamento e controle dos riscos nos ambientes de trabalho, que se tornam mais pulverizados; e os efeitos nocivos à saúde mental, provocados por um modelo de gestão baseado no controle rigoroso de processos e cumprimento de metas. Conclusões: o programa instituído na UFF guarda muitas relações com o modelo de gestão do trabalho uberizado, que vem se impondo como tendência do capitalismo contemporâneo, impactando, de forma desigual, os trabalhadores. A mudança no modelo de gestão das atividades laborais, imposta pelo programa, aponta para potenciais efeitos sobre a saúde física e mental do trabalhador.

Abstract Objective: to analyze the introduction of the Performance and Management Program (PMP) at the Federal Fluminense University (UFF). Methods: the PMP began to be implemented at the UFF in May 2022. This essay presents the established changes and discusses their relationship with the process of "uberization". Results: the guidelines established by the PMP, as well as the initial experience of its implementation at UFF, indicate a strong influence of the ideas guiding the phenomenon of "uberization" of work. By bringing about profound changes in the organization and control of work activities, the PMP also has the potential to impact the workers' health, notably increasing the difficulty in mapping and controlling risks in work environments, which become more decentralized. It can also have detrimental effects on mental health, caused by a management model based on strict process control and goal fulfillment. Conclusions: the program instituted at UFF shares many similarities with the model of "uberized" work management, which has been emerging as a trend in contemporary capitalism, affecting workers unevenly. The change in the management model of work activities imposed by the program suggests potential effects on the workers' physical and mental health..

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Abstract The growing investments in information technology (IT) each year pushes public sector organizations to develop the ability to gather, integrate, and implement these resources to improve organizational processes. Public sector organizations have to be agile and flexible to meet society's dynamic demands. In this sense, IT management and creating an organizational environment facilitating innovation are crucial measures. These organizations must learn to cultivate IT capabilities and innovativeness to improve their performance and create public value. Thus, this study aims to identify the existing relationships between innovativeness, IT capabilities, IT reconfiguration capability, and organizational performance in the public sector. The research analyzed data from 254 Brazilian public organizations of the most diverse sizes and sectors using structural equation modeling (SEM). The results indicated that the ability to reconfigure IT must be listed among the organizations' IT capabilities. Also, the findings suggest that IT capabilities foster organizations' innovativeness, and IT capabilities and innovativeness positively impact the organizations' performance. The study contributes to knowledge of innovation and IT capabilities by testing theoretical propositions identified in the context of the private sector but insufficiently assessed in the public sector. Finally, the study points out ways for public managers to better prepare their institutions to face constantly changing environments.

Resumen En vista del creciente volumen de recursos invertidos anualmente en tecnología de la información, las organizaciones del sector público deben tener cada vez más la capacidad de reunir, integrar e implementar recursos de TI para satisfacer las necesidades de los procesos organizacionales. Además, a las organizaciones públicas se les exige cada vez más ser más ágiles y flexibles para poder atender las demandas dinámicas de las sociedades. En este sentido, las organizaciones públicas deben ser capaces de gestionar y aplicar adecuadamente los recursos informáticos de los que disponen, así como crear entornos organizativos que permitan y favorezcan el florecimiento de la innovación. Es decir, deben aprender a cultivar las capacidades de TI y la innovación, con el objetivo de cumplir mejor su misión y crear valor público. Así, el objetivo de este estudio es identificar las relaciones existentes entre la innovación, las capacidades de TI, la capacidad de reconfiguración de TI y el desempeño organizacional, en el contexto del sector público. Para ello, se analizaron datos de 254 organizaciones públicas brasileñas de los más diversos tamaños y sectores, utilizando un enfoque de ecuaciones estructurales (SEM). Los resultados indicaron que la capacidad de reconfigurar la TI debe figurar entre las capacidades de TI de las organizaciones públicas, así como que las capacidades de TI desempeñan un papel en el fomento de la innovación de las organizaciones y que ambas (capacidades de TI e innovación) tienen un impacto positivo en el desempeño de las organizaciones. Al contrastar proposiciones teóricas identificadas en el contexto del sector privado, pero insuficientemente evaluadas en el sector público, el estudio agrega un bloque en la construcción de conocimiento sobre la capacidad de innovación y las capacidades de TI, además de señalar caminos para los gestores públicos sobre cómo pueden hacer que sus instituciones estén mejor preparadas para enfrentar entornos en constante cambio.

Resumo Tendo em vista o crescente volume de recursos investidos em tecnologia da informação a cada ano, as organizações do setor público devem cada vez mais ter a capacidade de reunir, integrar e implementar recursos de TI, a fim de atender às necessidades dos processos organizacionais. Além disso, as organizações públicas são cada vez mais exigidas a serem mais ágeis e flexíveis para atender às demandas dinâmicas das sociedades. Nesse sentido, as organizações públicas devem ser capazes de administrar e aplicar adequadamente os recursos de TI de que dispõem, bem como criar ambientes organizacionais que permitam e estimulem o florescimento da inovação. Ou seja, devem aprender a cultivar as capacidades de TI e a inovação, com o objetivo de melhor cumprir sua missão e criar valor público. Assim, o objetivo deste estudo é identificar as relações existentes entre inovatividade, capacidades de TI, capacidade de reconfiguração de TI e desempenho organizacional, no contexto do setor público. Para tanto, dados de 254 organizações públicas brasileiras, dos mais diversos portes e setores, foram analisados por meio de uma abordagem de equações estruturais (SEM). Os resultados indicaram que a capacidade de reconfigurar TI deve ser listada entre as capacidades de TI das organizações públicas, bem como que as capacidades de TI desempenham um papel no fomento da inovação das organizações e que ambas (as capacidades de TI e a inovatividade) têm um impacto positivo no desempenho das organizações. Ao testar proposições teóricas identificadas no contexto do setor privado, mas insuficientemente avaliadas no setor público, o estudo acrescenta um bloqueio na construção do conhecimento sobre capacidade de inovação e capacidades de TI, além de apontar caminhos para gestores públicos sobre como eles podem tornar suas instituições mais bem preparadas para enfrentar ambientes em constante mudança.

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Este estudo analisou matérias jornalísticas sobre Organizações Sociais de Saúde (OSS) contratadas para gerir hospitais estaduais no Brasil. Foram levantadas publicações nos meios de comunicação G1, Estadão e Valor Econômico sobre as dez maiores OSS do país. Analisou-se o conteúdo de 124 matérias, sendo a maioria da organização Associação Paulista para o Desenvolvimento da Medicina (SPDM), entre os temas: denúncia de irregularidades, desvio de verbas, metas subestimadas, falta de licitações e precarização do trabalho. Houve também conteúdos sobre flexibilidade, dinamismo gerencial, agilidade nas contratações e economia aos cofres públicos. Os achados apontaram para elementos que visam tanto ao fortalecimento do modelo de gestão reforçado pela Nova Gestão Pública (NGP) quanto à mobilização da sociedade frente a essas instituições privadas.

This study analyzed news stories about Social Health Organizations contracted to manage state hospitals in Brazil. We selected publications from G1, Estadão and Valor Econômico media about the ten largest Brazil-ian Social Health Organizations. We analyzed the content of a total of 124 articles, most of them from the Associação Paulista para o Desenvolvimento da Medicina (SPDM) organization, denouncing irregularities, misuse of funds, underestimated goals, lack of tenders and precarious work. There were articles also about flexibility, managerial dynamism, agility in hiring and savings to public coffers. The findings pointed to an outline aimed both at strengthening the management model reinforced by the New Public Management, and at mobilizing society towards these private institutions.

Este estudio analizó artículos sobre Organizaciones Sociales de Salud (OSS) contratadas para administrar hospitales estatales en Brasil. Se levantaron publicaciones en los medios G1, Estadão y Valor Econômico sobre las diez mayores OSS del país. Se analizó el contenido de 124 artículos, la mayoría de la organización Associação Paulista para o Desenvolvimento da Medicina (SPDM), de denuncia de irregularidades, malversación de fondos, subestimación de metas, falta de licitaciones y precariedad laboral. También tuvo contenidos sobre flexibilidad, dinamismo gerencial, agilidad en la contratación y ahorro para las arcas públicas. Los hallazgos apuntaron elementos dirigidos tanto al fortalecimiento del modelo de gestión reforzado por la Nueva Gestión Pública, como a la movilización de la sociedad hacia estas instituciones privadas.

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Resumen Introducción: La infección por SARS-CoV-2 en la mayoría de los casos tiene un curso leve, aunque la insuficiencia respiratoria aguda se asocia a mayor mortalidad. Objetivo: Determinar la mortalidad global en pacientes con COVID-19 hospitalizados o en una unidad de cuidados intensivos (UCI). Métodos: Análisis inferencial a partir de una base de datos del periodo enero de 2020-diciembre de 2021, de la Dirección General de Epidemiología de México. Se incluyeron pacientes hospitalizados positivos a SARS-CoV-2. Se describieron las características generales y se realizó un modelo de regresión binaria para determinar las asociaciones con la mortalidad. Resultados: Se identificaron 116 446 pacientes que requirieron ingreso hospitalario. La mortalidad global fue de 44 %, la intrahospitalaria de 33 % y en la UCI de 33 %. La mortalidad de pacientes con ventilación mecánica e ingreso hospitalario fue de 87 % y en la UCI de 75 %. En el sector público predominaron los ingresos al Instituto Mexicano del Seguro Social y a la Secretaría de Salud, cada uno con RM = 2.24 (p = 0.004) y RM = 2.55 (p = 0.001) para mortalidad. Conclusión: La mortalidad fue mayor en el sector público y pudo deberse a la saturación de los servicios, lo que condicionó escasez de recursos.

Abstract Introduction: SARS-CoV-2 infection has in, most cases, a mild course, although acute respiratory distress syndrome is associated with higher mortality. Objective: To determine overall mortality in hospitalized or intensive care unit (ICU)-admitted COVID-19 patients. Methods: Inferential analysis from a database of the General Directorate of Epidemiology of Mexico. SARS-CoV-2-positive patients, hospitalized within the January 2020-December 2021 period, were included. General characteristics were described and a binary regression model was created to determine associations with mortality. Results: 116,446 patients who required hospital admission were identified. Overall mortality was 44%; in-hospital mortality, 33%; and ICU mortality, 33%. Mortality of patients with mechanical ventilation and hospital admission was 87%, and with ICU admission, 75%. In the public sector, hospital admissions at the Mexican Institute of Social Security and the Ministry of Health predominated, with OR = 2.24 (p = 0.004) and OR = 2.55 (p = 0.001), respectively, for mortality. Conclusion: Mortality was higher in the public sector, and this could be due to the overcrowding of services, which determined a scarcity of resources.

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Introduction: The COVID-19 pandemic made it necessary to rapidly adapt ways of working, forcing adoption of home working, and public higher education institutions were no exception to this trend. Objectives: To analyze the initial phase of implementation of emergency teleworking at a public university, including its ramifications and repercussions for workers. Methods: This article constitutes a narrative account of the university's experience with teleworking, evaluated by analysis of a report produced by the institution after a survey of the needs of workers assigned to emergency teleworking because of the health crisis. Report of the experience: The analysis identified both opportunities and challenges created by the experience, which involved 50% of the institution's workers who were assigned to this modality of working. The most important opportunities were a perception of increased productivity compared to on-site working and improvements in quality of life and mental health. In counterpoint, barriers observed included worsening of mental health symptoms in the majority of workers who already had some type of mental disorder before the pandemic, work overload, difficulties with reconciling work routines with domestic activities, and a lack of the conditions and training needed to work from home. Conclusions: It should be emphasized that the various characteristics observed are related to the initial stages of adaptation to pandemic conditions and the new working routine. In counterpoint, some of the characteristics identified could offer important clues for continuation of teleworking and support for the university administration's planning for the future.

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Objetivo: Esta pesquisa objetiva estimar os custos econômicos indiretos decorrentes dos transtornos mentais (TMs) entre servidores públicos federais, no período entre janeiro de 2012 e dezembro de 2017. Métodos: Trata-se de um estudo ecológico, de delineamento longitudinal retrospectivo e caráter exploratório. Utilizou-se a Abordagem do Capital Humano para o cálculo do custo indireto. Resultados: Os TMs foram responsáveis por 5.664.800 dias concedidos de licença ao longo de todo o período, resultando em custo indireto estimado em R$ 1.889.554.416,60, dos quais os transtornos do humor e ansiosos representaram os maiores custos. Conclusões: Este estudo demonstrou a relevância dos TMs para essa comunidade de servidores, bem como revelou a dimensão dos impactos econômicos decorrentes do absenteísmo, o que pode possibilitar, às instâncias gestoras e aos profissionais envolvidos com a saúde do servidor público federal, melhor compreensão dos custos dos TMs, direcionando-os ao planejamento de intervenções mais acertadas.

Objective: This research aims to estimate the indirect economic costs resulting from DM among federal civil servants, between January 2012 and December 2017. Methods: This is an ecological study, with a retrospective longitudinal design and exploratory character. The Human Capital Approach was used to calculate the indirect cost. Results: DM were responsible for 5.664.800 days of leave granted throughout the period, resulting in an estimated indirect cost of R$ .889.554.416,60, of which mood and anxiety disorders represented the highest costs. Conclusions: This study demonstrated the relevance of DM for this community of servers, as well as revealed the dimension of the economic impacts resulting from absenteeism, which can enable management bodies and professionals involved in the health of the federal public servant to better understand the costs of DM, directing them to the planning of the most appropriate interventions.

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Resumo Decisões sobre questões concernentes à saúde do servidor público, como o afastamento para tratamento, baseiam-se em resultados de perícia médica realizada por profissional médico. Os servidores são periciados por meio do chamado Subsistema Integrado de Atenção à Saúde do Servidor. No entanto, os peritos que nele atuam e os periciados exercem seu trabalho nos mesmos órgãos, o que pode criar situações conflitantes e dilemas éticos. Este artigo trata do tema sob a ótica de um perito da Administração Pública Federal, buscando enfatizar a ética, o respeito aos princípios deontológicos, o primor técnico e o bom senso como norteadores para o equilíbrio entre a função de perito e a proximidade pessoal com o colega de trabalho.

Abstract Decisions on issues concerning the health of public servants, such as leaves for treatment, are based on the results of medical examinations conducted by a medical professional. These workers are examined by the so-called Integrated Subsystem for Civil Servant Health Care. However, the experts who work in it and the patients work in the same governmental bodies, which can create conflicting situations and ethical dilemmas. This article addresses the issue from the perspective of an expert of the Federal Public Administration, seeking to emphasize ethics, respect for ethical principles, technical excellence, and common sense as guidelines for the balance between the role of expert and personal closeness to co-workers.

Resumen Las decisiones sobre cuestiones relacionados con la salud del servidor público, como la licencia para tratamiento, se basan en los resultados de una pericia médica realizada por un profesional médico. Los servidores son periciados por medio del denominado Subsistema Integrado de Atención a la Salud del Servidor. Sin embargo, tanto los peritos que actúan en él como los periciados comparten el mismo entorno laboral, lo que puede dar lugar a situaciones conflictivas y dilemas éticos. Este artículo aborda el tema desde la perspectiva de un perito de la Administración Pública Federal, buscando dar énfasis ar la ética, al respeto a los principios deontológicos, al primor técnico y al sentido común como los elementos orientadores para el equilibrio entre la función de perito y la proximidad personal con el compañero de trabajo.

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The issue of quality of working life (QWL) has assumed social and corporate relevance due to the worsening of harmful indicators for the health and safety of workers and the scope of the organizational mission. The research aimed to highlight the structuring representations of well-being and malaise at work by servants of a public organization seeking to contribute to the sustainable management of QWL. A total of 1,110 civil ser-vants of an executive branch of the Federal District, in Brazil, participated in the survey. Data were collected based on two open questions from the qualitative part of the Quality of Working Life Assessment Inventory (QWL-AI) and were analyzed using the Interface de R pour les Analyses Multidimensionnelles de Textes et de Ques-tionnaires (IRaMuTeQ) application. The results pointed to three discourse structuring thematic nuclei for work well-being (having a good relationship with colleagues, doing a job you like, and feeling useful to society) and malaise at work (work overload, lack of recognition, time pressure, and rework). Therefore, sustainable man-agement of QWL must be anchored in people management practices that foster professional development, the alignment between tasks, roles, and organizational mission, highlighting the social contributions, the recognition of the worker by their superiors, peers, and society, and the review of work organization, focusing on the reassessment of work processes, distribution of demands, and ways of setting and demanding goals

A questão da Qualidade de Vida no Trabalho (QVT) tem relevância social e corporativa em face do agravamento de indicadores nocivos para a saúde e segurança dos trabalhadores e o alcance da missão organizacional. A pesquisa objetivou evidenciar as representações estruturantes das vivências de bem-estar e mal-estar no trabalho por servidores de uma organização pública visando contribuir para o gerenciamento sustentável de QVT. Participaram da pesquisa 1.110 servidores de um órgão do poder executivo do Distrito Federal, no Brasil. Os dados foram coletados com base em duas questões abertas da parte qualitativa do Inventário de Avaliação de Qualidade de Vida no Trabalho (IA_QVT) e foram analisados com o aplicativo IRaMuTeQ. Os resultados apontaram três núcleos temáticos estruturadores do discurso para bem-estar no trabalho (relacionamento com colegas, fazer trabalho que gosta e sentir-se útil à sociedade) e mal-estar no trabalho (sobrecarga de trabalho, falta de reconhecimento e pressão temporal e retrabalho). A gestão sustentável de QVT, portanto, deve estar ancorada em práticas de gestão de pessoas que fomentem o investimento no desenvolvimento dos profissionais, o alinhamento das tarefas e papéis com a missão organizacional, evidenciando a conexão com as contribuições sociais, o reconhecimento do trabalhador por superiores, pares e sociedade, a revisão da organização do trabalho, com foco na reavaliação de processos de trabalho, distribuição de demandas e formas de pactuação e cobrança de resultados.

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ABSTRACT BACKGROUND: Cardiac rehabilitation (CR) barriers are well-understood in high-resource settings. However, they are under-studied in low-resource settings, where access is even poorer and the context is significantly different, including two-tiered healthcare systems and greater socioeconomic challenges. OBJECTIVE: To investigate differences in characteristics of patients attending publicly versus privately funded CR and their barriers to adherence. DESIGN AND SETTING: Observational, cross-sectional study in public and private CR programs offered in Brazil. METHODS: Patients who had been attending CR for ≥ 3 months were recruited from one publicly and one privately funded CR program. They completed assessments regarding sociodemographic and clinical characteristics and the CR Barriers Scale. RESULTS: From the public program, 74 patients were recruited, and from the private, 100. Participants in the public program had significantly lower educational attainment (P < 0.001) and lower socioeconomic status (P < 0.001). Participants in the private program had more cognitive impairment (P = 0.015), and in the public program more anxiety (P = 0.001) and depressive symptoms (P = 0.008) than their counterparts. Total barriers among public CR participants were significantly higher than those among private CR participants (1.34 ± 0.26 versus 1.23 ± 0.15/5]; P = 0.003), as were scores on 3 out of 5 subscales, namely: comorbidities/functional status (P = 0.027), perceived need (P < 0.001) and access (P = 0.012). CONCLUSION: Publicly funded programs need to be tailored to meet their patients' requirements, through consideration of educational and psychosocial matters, and be amenable to mitigation of patient barriers relating to presence of comorbidities and poorer health status.

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INTRODUCTION: SARS-CoV-2 infection has, in most cases, a mild course, although acute respiratory distress syndrome is associated with higher mortality. OBJECTIVE: To determine overall mortality in hospitalized or intensive care unit (ICU)-admitted COVID-19 patients. METHODS: Inferential analysis from a database of the General Directorate of Epidemiology of Mexico. SARS-CoV-2-positive patients, hospitalized within the January 2020-December 2021 period, were included. General characteristics were described and a binary regression model was created to determine associations with mortality. RESULTS: 116,446 patients who required hospital admission were identified. Overall mortality was 44%; in-hospital mortality, 33%; and ICU mortality, 33%. Mortality of patients with mechanical ventilation and hospital admission was 87%, and with ICU admission, 75%. In the public sector, hospital admissions at the Mexican Institute of Social Security and the Ministry of Health predominated, with OR = 2.24 (p = 0.004) and OR = 2.55 (p = 0.001), respectively, for mortality. CONCLUSION: Mortality was higher in the public sector, and this could be due to the overcrowding of services, which determined a scarcity of resources.

INTRODUCCIÓN: La infección por SARS-CoV-2 en la mayoría de los casos tiene un curso leve, aunque la insuficiencia respiratoria aguda se asocia a mayor mortalidad. OBJETIVO: Determinar la mortalidad global en pacientes con COVID-19 hospitalizados o en una unidad de cuidados intensivos (UCI). MÉTODOS: Análisis inferencial a partir de una base de datos del periodo enero de 2020-diciembre de 2021, de la Dirección General de Epidemiología de México. Se incluyeron pacientes hospitalizados positivos a SARS-CoV-2. Se describieron las características generales y se realizó un modelo de regresión binaria para determinar las asociaciones con la mortalidad. RESULTADOS: Se identificaron 116 446 pacientes que requirieron ingreso hospitalario. La mortalidad global fue de 44 %, la intrahospitalaria de 33 % y en la UCI de 33 %. La mortalidad de pacientes con ventilación mecánica e ingreso hospitalario fue de 87 % y en la UCI de 75 %. En el sector público predominaron los ingresos al Instituto Mexicano del Seguro Social y a la Secretaría de Salud, cada uno con RM = 2.24 (p = 0.004) y RM = 2.55 (p = 0.001) para mortalidad. CONCLUSIÓN: La mortalidad fue mayor en el sector público y pudo deberse a la saturación de los servicios, lo que condicionó escasez de recursos.

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RESUMO O artigo visou discutir a desigualdade internacional no combate à Covid-19, mostrando a distribuição relativamente tardia de vacinas para os países de renda baixa e a forma com que a persistência da pandemia, exigindo medidas assistenciais, impactou os gastos públicos. A partir de um modelo estatístico de painel, evidenciou-se que o aumento da cobertura vacinal diminuiu a necessidade de imposição de medidas restritivas, que, por sua vez, possibilitou a redução dos gastos públicos. Concluiu-se, então, que a oferta internacional desigual de vacinas está relacionada também com a piora das contas públicas e do cenário econômico, principalmente para os países já financeiramente mais debilitados, provavelmente contribuindo para o aumento das desigualdades socioeconômicas internacionais.

ABSTRACT The article aims to discuss the international inequality in the fight against COVID-19, showing the relatively late vaccine distribution to low-income countries, and the way the persistence of the pandemic, requiring assistance measures, impacted public expenditure. By means of a panel statistic model, it is evident that the increase in vaccination coverage reduced the necessity of imposing restrictive measures, which, in turn, made reducing public expenditure possible. It is concluded that the unequal international supply of vaccines is also related to the worsening of public accounts and the economic scenario, mainly for countries that are already financially constrained, probably contributing to the increase in international socioeconomic inequalities.

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Resumen Introducción: El interés por la ciencia de datos a tenido un aumento en los últimos años, motivado principalmente por el uso recurrente de conceptos como cuarta revolución industrial o Big Data, los escenarios de aplicación de la ciencia de datos son amplios, sin embargo, la literatura especializada reporta pocas aplicaciones en el sector público, especialmente como herramienta para la toma de decisiones. Objetivo: Proponer un esquema de flujo de datos orientado al sector público para el apoyo en la toma de decisiones. Materiales y Métodos: El trabajo se suscribió a una metodología de tipo cualitativo y de enfoque descriptivo; considerando una ruta de tres momentos: (1) rastreo documental, (2) focalización y análisis, y (3) definición de dimensiones y diseño de esquema. Resultados: Se propone un esquema de flujo de datos, compuesto por cuatro dimensiones: datos masivos, gestión de datos, gestión de la información y toma de decisiones. Conclusiones.: El esquema propuesto se configura como una herramienta con la cual el sector público puede pasar de un flujo de datos no estructurados a un esquema secuencial que permite la generación de información útil, favoreciendo los procesos de toma de decisiones.

Abstract Introduction: The application scenarios of data science are wide, but the specialized literature reports few applications in the public sector, particularly as a decision-making tool. Interest in data science has increased in recent years, primarily motivated by the recurrent use of concepts such as the fourth industrial revolution or Big Data. Objective: Propose a data flow scheme for the public sector to aid decision-making. Materials and methods: The work followed a qualitative and descriptive approach methodology, with three stages: (1) documentary tracking, (2) targeting and analysis, and (3) dimension definition and schema design. Results: A data flow scheme with four dimensions is proposed: Big Data, data management, information management, and decision making. Conclusions: The proposed scheme is designed as a tool to help the public sector transition from an unstructured data flow to a sequential scheme that allows the generation of useful information, thereby facilitating decision-making processes.

Resumo Introdução: O interesse pela ciência de dados tem aumentado nos últimos anos, principalmente motivado pelo uso recorrente de conceitos como a quarta revolução industrial ou Big Data, os cenários de aplicação da ciência de dados são amplos, porém, a literatura especializada relata poucas aplicações no setor público, especialmente como uma ferramenta de tomada de decisão. Objetivo: Propor um esquema de fluxo de dados voltado para o setor público para apoiar a tomada de decisão. Materiais e métodos: O trabalho subscreveu uma metodologia de abordagem qualitativa e descritiva; considerando uma rota de três momentos: (1) rastreamento documental, (2) direcionamento e análise, e (3) definição das dimensões e desenho do esquema. Resultados: É proposto um esquema de fluxo de dados, composto por quatro dimensões: captura massiva de dados, gerenciamento de dados, gerenciamento de informações e tomada de decisão. Conclusões: O esquema proposto configura-se cómo uma ferramenta com a qual o setor público pode passar de um fluxo de dados não estruturados a um esquema sequencial que permite a geração de informações úteis, favorecendo os processos de tomada de decisão.

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Resumen Objetivo: Identificar cambios en la tendencia anual (CTA) de la Depresión según las Licencias Médicas Psiquiátricas del Fondo Nacional de Salud en la Región de Ñuble, Chile 2008-2017 Materiales y métodos: Estudio descriptivo y de tendencia que incluyó 34.467 de estas licencias médicas registradas en la Comisión de Medicina Preventiva e Invalidez de la Secretaría Ministerial de Salud de la Región de Ñuble, según características en número de licencias, tipo de licencia, tipo de diagnóstico CIE-10, y entidad pagadora de subsidio. Los resultados se presentaron en números absolutos y porcentajes, para el CTA se construyó un modelo de regresión de Joinpoint, y se utilizó el software Joinpoint Regression Program, Version 4.7.0.0. Resultados: El número de licencias médicas por depresión aumentaron 152.3% del 2008 al 2017, según Tipo de Licencia 99.7% fue por enfermedad o accidente común, por Tipo de Diagnóstico CIE-10 50.7% fue por episodio depresivo inespecífico (F32.9), 71.6% por pagadora de subsidio cajas de compensación. El modelo Joinpoint no identificó CTA de la depresión según el número de las licencias médicas, más bien hubo un aumento constante estimado en 166 licencias (p=0.122) por cada año, diferentes CTA se observó en los diagnósticos de depresión según CIE-10. Conclusiones: La depresión va en aumento constante en la Región de Ñuble, y con la aparición de la COVID-19 más se agrava la salud mental de la población. Aumentar la inversión en salud mental, capacitar al personal sanitario en estas materias y que los tomadores de decisiones reconsideren la implementación del nuevo Plan Nacional de Salud Mental 2017-2025 es apremiante, para que estos esfuerzos reflejen un adecuado control de esta patología y una disminución de este tipo de licencias médicas psiquiátricas.

Abstract Objective: Identify changes in the annual trend (CTA) of Depression according to the Psychiatrics sick leave of the National Health Fund in the Ñuble Region, Chile 2008-2017 Materials and methods: Descriptive and trend study that included 34,467 of these medical licenses registered in the Commission for Preventive Medicine and Disability of the Ministerial Secretary of Health of the Ñuble Region and issued in 10 years, according to characteristics in number of licenses, type of license, type of ICD-10 diagnosis, and subsidy paying entity. The results were presented in absolute numbers and percentages. For the CTA, a Joinpoint regression model was constructed, and the Joinpoint Regression Program, Version 4.7.0.0 software was used. Results: The number of medical leave for depression increased 152.3% from 2008 to 2017, according to Type of Leave 99.7% was due to common illness or accident, by Type of ICD-10 Diagnosis 50.7% was due to nonspecific depressive episode (F32 .9), 71.6% per compensation fund subsidy payer.The Joinpoint model did not identify a CTA in depression according to the number of medical licenses, rather there was a constant increase estimated at 166 licenses (p = 0.122) for each year, and the depression diagnoses according to ICD-10 had different CTAs. Conclusions: Depression is constantly increasing in the Ñuble Region, and with the appearance of covid -19 the mental health of the population worsens, increase investment in mental health, train health personnel in these matters and that decisionmakers reconsider the implementation of the new National Mental Health Plan 2017-2025 is urgent so that these efforts are reflected in the control of this pathology and in the reduction of this type of psychiatrics sick leave.

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Problem Management Plus (PM+) is a low-intensity psychological intervention developed by the World Health Organization that can be delivered by nonspecialists to address common mental health conditions in people affected by adversity. Emerging evidence demonstrates the efficacy of PM+ across a range of settings. However, the published literature rarely documents the adaptation processes for psychological interventions to context or culture, including curriculum or implementation adaptations. Practical guidance for adapting PM+ to context while maintaining fidelity to core psychological elements is essential for mental health implementers to enable replication and scale. This paper describes the process of contextually adapting PM+ for implementation in Rwanda, Peru, Mexico and Malawi undertaken by the international nongovernmental organization Partners In Health. To our knowledge, this initiative is among the first to adapt PM+ for routine delivery across multiple public sector primary care and community settings in partnership with Ministries of Health. Lessons learned contribute to a broader understanding of effective processes for adapting low-intensity psychological interventions to real-world contexts.

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Há espaço para melhorias na forma como a gestão pública presta contas e prioriza intervenções. A transferência de informações de unidades hospitalares para o Executivo e instituições de controle é defasada temporalmente e realizada em formatos que não permitem o melhor uso da tecnologia. O projeto Bússola, desenhado pelo Laboratório de Inovação do MPRJ, propôs definir estratégias de abertura e monitoramento contínuo de dados. Com base em método desenvolvido pelo Laboratório, foram desenhados protótipos em dois hospitais municipais de Volta Redonda. Entre os resultados, destacam-se: (1) diagnóstico de bases, sistemas e fluxos de informação; (2) priorização de problemas; (3) obtenção de acesso direto a dados; (4) concepção de inteligência para orientar tomadores de decisão; e (5) três revisões sistemáticas de políticas públicas baseadas em evidência.

There is room for improvement in the way the public sector delivers accountability and prioritizes interventions. The information transmission between public health facilities, the executive authorities and the control institutions is lagged and relies in formats that do not allow for the best use of available technology. The Bússola ('Compass') project, designed by MPRJ's Innovation Lab, suggested setting strategies to open and continously monitor data from these facilities. Based on the method developed by the Lab, prototipes were established in two municipal hospitals in Volta Redonda. Among the results, we highlight: (1) diagnosis of databases, data flows and information systems; (2) management challenges priorization; (3) acquisition of direct access to data; (4) design of tools to guide decision making; and (5) three systematic reviews of evidence-based public policies.

Hay margen de mejora en la forma en que la gestión pública riende cuentas y prioriza intervenciones. La transferencia de información de las unidades hospitalarias a las instituciones ejecutivas y de control es temporalmente desfasada y se realiza en formatos que no permiten el mejor aprovechamiento de la tecnología. El proyecto Bússola, diseñado por el Laboratorio de Innovación de MPRJ, propuso definir estrategias de apertura y monitoreo continuo de datos. A partir de método desarrollado por el Laboratorio, se diseñaron prototipos en dos hospitales municipales de Volta Redonda. Entre los resultados, destacamos: (1) diagnóstico de bases, sistemas y flujos de información; (2) priorizaciónd de problemas; (3) obtención de acceso directo a datos; (4) concepción de la inteligencia para guiar a toma de decisiones; y (5) tres revisiones sistemáticas de políticas públicas basadas en evidencia.

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