ABSTRACT OBJECTIVE To analyze how gender coloniality and necropolitics materialize in the everyday functioning of the Brazilian prison system, highlighting institutional mechanisms for the production of suffering, disciplining, and slow death, as well as to describe everyday practices of care and solidarity as zones of friction between institutional capture, collective agency, and micropolitical resistances. METHODS A qualitative study with a critical-interpretive approach, grounded in critical Public Health, decolonial theory, and feminist critique. It is based on direct professional experience in health care within the prison system of the state of Rio de Janeiro between 2022 and 2024, in facilities housing women, men, and the elderly, within the framework of the Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade (National Policy for Comprehensive Health Care for People Deprived of Liberty). The empirical material included field notes, systematized reflective records, and non-traceable analytical narrative reconstructions, organized as institutional vignettes selected for empirical recurrence, ethical relevance, and the ability to express structural mechanisms. The analysis was conducted through successive approaches, combining dense description, identification of institutional patterns, and situated theoretical interpretation. RESULTS The analysis was organized around four interconnected themes. The centrality of medicalization in the institutional management of suffering was evident, especially among incarcerated women. Aging in custody was identified as an expression of necropolitics, marked by diagnostic delays, therapeutic discontinuity, and architectural barriers. Systematic barriers to the recognition of trans and transvestite identities were observed, including the refusal to use a social name and the interruption of hormone therapy. Everyday care practices were described as ambiguous zones of friction, at times controlled by authorities and at other times collectively redefined. CONCLUSIONS The prison system perpetuates gender coloniality and necropolitics, while care practices create ethical-political fissures that affirm dignity under state custody.
ABSTRACT OBJECTIVE To estimate the accuracy of rapid tests for Zika and dengue in areas with cocirculation of flaviviruses and their prevalence rates in the municipality of Rio de Janeiro, Brazil, using methodologies for correction of partial verification bias. METHODS A study was conducted based on a seroepidemiological survey. Participants underwent rapid tests for Zika and dengue. Venous blood samples were collected from participants with positive rapid test results for Zika and/or dengue, for diagnostic confirmation by the plaque reduction neutralization test (PRNT). To estimate prevalence, sensitivity and specificity parameters of the rapid tests were verified using the correction methodology proposed by Begg and Greenes (1983). RESULTS A total of 2,120 participants underwent rapid test, and 1,087 (51.2%) were indicated for performing PRNT. The samples from 769 participants underwent PRNT, resulting in 686 (89.2%) positive samples for dengue and 522 (67.8%) for Zika. The sensitivity rates corrected for partial verification bias were 81.0% and 91.5% for the dengue and Zika rapid tests, respectively. The corrected specificity rates were 66.7% for the dengue rapid test and 77.1% for the Zika rapid test. The estimated population prevalence rates, corrected for rapid test accuracy, were 88.0% for dengue (95%CI: 86.7–89.4) and 41.6% for Zika (95%CI: 38.6–44.5). CONCLUSIONS After correction for partial verification bias, the Zika rapid test performed better than the dengue rapid test in the scenario of arbovirus cocirculation. Our findings indicate that the population of the municipality of Rio de Janeiro is predominantly exposed to the dengue virus.
ABSTRACT OBJECTIVE To analyze care outcomes related to monitoring and evaluation indicators at Freestanding Birth Centers operating in Brazil. METHODS A nationwide cross-sectional study integrated with the Nascer no Brasil II initiative. The study included the eight Freestanding Birth Centers that attended to more than 100 births in 2019; the sample comprised all women admitted to these centers, provided they met the inclusion criteria. The outcomes corresponded to the 12 monitoring indicators for Freestanding Birth Centers defined by the Ministry of Health, including data on care, interventions, transfers, and maternal and neonatal outcomes. RESULTS The vaginal birth rate was 91.8%, while the cesarean section rate was6.2%. The rates of episiotomy (2.0%), amniotomy (14.5%), and oxytocin use (12.7%) were low. Most women had six or more prenatal visits (94.5%) and were accompanied by a support person during hospitalization (97.7%). Newborns with an Apgar score of less than seven at five minutes of life accounted for 0.4%, and 93.3% had immediate and uninterrupted skin-to-skin contact. The intrapartum transfer rate was 19.3%, the postpartum transfer rate was 1.5%, and the neonatal transfer rate was 2.9%. CONCLUSIONS The Freestanding Birth Centers showed low rates of interventions and care based on best practices, resulting in favorable maternal and neonatal outcomes, indicating a safe, evidence-based care model for low-risk women.
ABSTRACT OBJECTIVE To analyze the direct and indirect associations between adverse life course conditions and impairment of intrinsic capacity in Brazilians aged 50 years or older. METHODS An analytical cross-sectional study using data from the second wave of the Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil) (n = 4,817). Intrinsic capacity was assessed across five domains (cognition, vitality, mobility, psychological aspects, and sensory aspects) and was considered impaired when three or more domains were affected. Childhood adversities included parental illiteracy, lack of running water at home, and food insecurity. Educational attainment and income in adulthood were considered mediating variables. Path analysis was used. RESULTS Childhood adversities had significant direct and indirect effects on the impairment of intrinsic capacity. These effects were mediated by lower educational attainment and income in adulthood. Educational attainment stood out as a central mediator, exerting a direct protective effect on intrinsic capacity and an indirect effect through its influence on income. CONCLUSIONS The findings reinforce the relevance of the life-course perspective for understanding inequalities in aging and indicate educational attainment as a priority target for interventions aimed at promoting healthy aging in the Brazilian context.
OBJETIVO: Avaliar a implantação da atenção nutricional no âmbito da Atenção Primária à Saúde em municípios brasileiros e identificar a associação do grau de implantação com aspectos do contexto sociodemográfico e político-organizacional. MÉTODOS: Trata-se de uma pesquisa avaliativa, com abordagem quantitativa, que considerou a responsabilidade do gestor municipal na garantia das condições e do provimento de ações, a partir da análise de 17 indicadores agrupados nas dimensões gestão e assistência. Os municípios foram classificados segundo o grau de implantação da atenção nutricional na Atenção Primária à Saúde pelo ajuizamento da pontuação observada em relação à pontuação máxima, utilizando critérios incipiente, intermediário e avançado. Analisou-se a influência do contexto sobre o grau de implantação, com as variáveis independentes agrupadas em dois blocos, utilizando-se regressão logística multivariada. RESULTADOS: Foram avaliados 4.064 municípios brasileiros, sendo observado grau de implantação avançado em 11,6% (n = 471). Os aspectos de gestão receberam piores resultados quando comparados aos de assistência. Os fatores de contexto associados ao melhor grau de implantação da atenção nutricional foram municípios com porte populacional menor de 25.000 habitantes, localizados na Região Sul, melhores indicadores sociais, menor proporção de crianças menores de cinco anos, 100% de cobertura da Estratégia Saúde da Família e apoio do nutricionista na Atenção Primária à Saúde. CONCLUSÃO: A implantação da atenção nutricional na Atenção Primária à Saúde brasileira foi considerada incipiente no período investigado. Apesar dos avanços significativos em relação à vigilância alimentar e nutricional, a atenção nutricional apresentou fragilidades importantes na gestão e na coordenação do cuidado. Reitera-se a necessidade de processos contínuos de avaliação e monitoramento das intervenções na Atenção Primária à Saúde, qualificação da assistência e inserção da atenção nutricional como parte do modelo assistencial.
