This article shows a qualitative study on the access of young people to public health services in the cities of Santos, São Paulo, and Sorocaba, São Paulo State, Brazil. The objective was to identify the meaning attributed to access experiences in order to characterize a set of criteria for the acceptability of health care practices. The methodological instruments used were the observation of daily life in the basic health units and in the assigned territories and 34 semi-structured interviews with young people between 15 and 24 years old. In addition to structural barriers that restrict presence in these services (long waiting times, difficulty in scheduling appointments and unsatisfactory care outcomes), the young people's narratives emphasize the interactive nature of care, the observance of the specificities of adolescence and the role of health services in the construction of themselves, through the intersubjective engendering of resources for a happier life. They affirm the centrality of their recognition as subjects of rights, co-producers of comprehensive health care, which contributes with learning for living. To this end, satisfactory care must promote their participation in the therapeutic process, provide information and guidance that enable dialogued decisions and, in a broader dimension, the development of autonomy.
The Productive Development Partnerships (PDPs) are one of the main instruments of industrial health policy in Brazil, by articulating the purchasing power of the State with the transfer of technology to official pharmaceutical laboratories (LFOs). This article evaluated the extent to which PDPs contributed to strengthening the national production capacity of strategic medicines in the period from 2011 to 2024. A formative evaluation of public policy was carried out, based on documentary analysis, data from government acquisitions and the construction of indicators of productive and technological sustainability. The results show relevant, but uneven, advances between technological platforms, public institutions and therapeutic classes. PDPs associated with synthetic drugs showed greater production stability, while partnerships in biotechnology platforms faced greater challenges of technological internalization. High institutional heterogeneity and concentration of capacities were observed in a few public laboratories. It is concluded that the PDPs represent a strategic instrument for strengthening the Economic-Industrial Health Complex, although their effectiveness remains conditioned to the overcoming of structural weaknesses and the consolidation of long-term productive and technological capacities.
O ensaio analisa as desigualdades sociais e de saúde que afetam mulheres latino-americanas, com foco nas mulheres negras, situando-as nas bases históricas e estruturais da colonialidade do poder, do saber e do ser. Objetiva problematizar como o racismo, o sexismo e o patriarcado - legados da modernidade colonial - conformam a determinação interseccional de iniquidades em saúde, sustentadas por sistemas políticos, econômicos e simbólicos que naturalizam a subalternização dos corpos racializados. Metodologicamente, trata-se de um ensaio teórico-analítico que articula literatura crítica, com base em referenciais decoloniais e interseccionais, e análise de documentos como relatórios e estudos regionais latino-americanos. O percurso argumentativo parte da conceituação de colonialidade em diálogo com autoras do feminismo negro, no sentido de evidenciar como a racialização, a classe e o gênero estruturam a distribuição desigual de oportunidades, riscos e mortes. O texto também examina alguns dados recentes, pré e pós-pandemia de COVID-19, sobre trabalho, violência, pobreza e saúde, destacando as persistentes assimetrias raciais e de gênero, indicando que as desigualdades interseccionadas se expressam de forma contínua e multifacetada nos campos econômico, social e sanitário, perpetuando hierarquias coloniais. Conclui-se que enfrentá-las requer políticas reparadoras e de justiça social com enfoque interseccional e decolonial, fortalecendo a autonomia das mulheres racializadas e a equidade nas políticas públicas de saúde.
As Parcerias para o Desenvolvimento Produtivo (PDPs) configuram um dos principais instrumentos da política industrial em saúde no Brasil, ao articular o poder de compra do Estado à transferência de tecnologia para laboratórios farmacêuticos oficiais (LFOs). Este artigo avaliou em que medida as PDPs contribuíram para o fortalecimento da capacidade produtiva nacional de medicamentos estratégicos no período de 2011 a 2024. Realizou-se uma avaliação formativa de política pública, baseada em análise documental, dados de aquisições governamentais e construção de indicadores de sustentabilidade produtiva e tecnológica. Os resultados evidenciam avanços relevantes, porém desiguais, entre plataformas tecnológicas, instituições públicas e classes terapêuticas. As PDPs associadas a medicamentos sintéticos apresentaram maior estabilidade produtiva, já as parcerias em plataformas biotecnológicas enfrentaram maiores desafios de internalização tecnológica. Observou-se elevada heterogeneidade institucional e concentração de capacidades em poucos laboratórios públicos. Conclui-se que as PDPs representam um instrumento estratégico para o fortalecimento do Complexo Econômico-Industrial da Saúde, embora sua efetividade permaneça condicionada à superação de fragilidades estruturais e à consolidação de capacidades produtivas e tecnológicas de longo prazo.
O artigo analisa a resposta do sistema de saúde chileno à COVID-19 no período de 2020 a 2023, destacando momentos da trajetória (segundo o contexto epidemiológico e sociopolítico) e as principais medidas. Por fim, traz reflexões acerca das oportunidades e dos limites da resposta à epidemia para a indução de reformas nesse sistema. Realizou-se estudo de caso abrangendo revisão bibliográfica, análise documental e 19 entrevistas semiestruturadas com atores institucionais relevantes. Os resultados indicam que, em meio à instabilidade política, houve investimentos em capacidades sanitárias nacionais. As medidas adotadas evidenciaram a relevância do sistema público de saúde, com gestão centralizada de leitos hospitalares pelo Ministério da Saúde, além de políticas de vigilância em saúde de forma integrada à atenção primária à saúde (APS). A manutenção das capacidades adquiridas e a recuperação da atenção à saúde que fora reprimida foram desafios do momento seguinte, tendo fortalecido na agenda processos de universalização do sistema de saúde via extinção de copagamentos e APS universal.
This study sought to understand the manifestations of violence affecting Indigenous and Afro-descendant communities in the Nariño Pacific region, Colombia, through the framework of the social determinants of health. A qualitative research design was implemented with 60 purposively selected participants, ensuring variation by ethnicity (49 Afro-descendant and 11 Indigenous), gender (34 women and 26 men), and role (institutional and community). All participants were adults affected by the armed conflict and registered in the National Victims Registry (RUV). Data were collected through in-depth interviews and the analysis of paradigmatic cases, complemented by field notes documenting contextual aspects of the data collection process. An inductive thematic analysis was conducted using the social determinants of health as the analytical framework. The findings reveal that violence affecting communities in the Nariño Pacific region operates as a structural determinant of health, characterized by systemic, symbolic, and historical configurations embedded within multiple social determinants (sociocultural, economic, political, environmental, and health service-related). These dynamics are reinforced by persistent symbols of domination, structural institutional crises, restricted access to fundamental rights, mistrust in the State, corruption, and the territorial control exercised by armed groups in these collective ethnic territories.
Traditional diets are generally associated with health benefits and are commonly recommended in food-based dietary guidelines. As climate change intensifies in the 21st century, food-based dietary guidelines have begun integrating environmental sustainability considerations. Despite growing global efforts to incorporate sustainability into food-based dietary guidelines, few studies have explored how to operationalize such guidance. A multiregional participatory study was conducted with adults from the central urban metropolitan area and the La Araucanía Region, in southern Chile, using semistructured interviews combined with card-sorting activities. The most commonly consumed and preferred traditional culinary preparations from each region were presented on cards and sorted according to participants’ perceptions across five dimensions of sustainable diets. In both regions, over 70% of participants reported physical access to most traditional culinary preparations, although economic access varied. In the Metropolitan Area, perceptions of environmental impact were more diverse, while participants in the La Araucanía Region generally viewed traditional foods as sustainable due to their natural origins. Taste preference was high across preparations; however, only fruits and salads were consumed almost daily. Only six traditional preparations scored below 60% for overall sustainability. These findings highlight important regional differences and gaps between taste preferences, perceptions of environmental sustainability, and actual consumption of sustainable traditional culinary preparations. They also demonstrate the value of participatory research in identifying sustainable and healthy food options that can support food-based dietary guidelines in territorially diverse populations.
This study aimed to conduct a systematic review of the association between Chagas disease and stroke, and to estimate the magnitude of this association through meta-analyses. A systematic review was conducted following the steps recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The MEDLINE via PubMed, Virtual Health Library, Web of Science, and Embase databases were searched, and all studies on the topic were considered, with no restrictions on language or publication period. Studies lacking the groups of interest (individuals with and without Chagas disease) or stroke as an outcome were excluded. Design-specific meta-analyses were performed using a random-effects model. Of the 1,695 studies identified, 7 were included in the systematic review and 6 in the meta-analysis. Among cohort studies (n = 2), the pooled meta-analysis estimate showed an increased risk of stroke among individuals with Chagas disease (RR = 1.92; 95%CI: 1.20-3.06). Among cross-sectional studies (n = 4), the pooled estimate revealed a higher prevalence of stroke among individuals with Chagas disease (PR = 1.63; 95%CI: 1.22-2.18). The certainty of evidence was rated as very low according to the GRADE approach. The results indicated an association between Chagas disease and stroke; however, they should be interpreted with caution, considering the heterogeneity across study designs and the small number of studies. Further studies with more homogeneous designs are needed to better understand this relationship.
O artigo apresenta um estudo qualitativo sobre o acesso de jovens a serviços públicos de saúde nas cidades de Santos, São Paulo e Sorocaba, Estado de São Paulo, Brasil. O objetivo foi identificar a significação atribuída às experiências de acesso para caracterizar um conjunto de critérios de aceitabilidade de práticas de atenção à saúde. Os instrumentos metodológicos utilizados foram a observação do cotidiano em unidades básicas de saúde e nos territórios adscritos, e 34 entrevistas semiestruturadas com jovens, entre 15 e 24 anos. Além de barreiras estruturais que restringem a presença nesses serviços (elevado tempo de espera, dificuldade em agendamento de consulta e desfechos insatisfatórios na atenção), as narrativas dos jovens enfatizam o caráter interativo do cuidado, a observância às especificidades da adolescência e o papel dos serviços de saúde na construção de si, mediante o engendramento intersubjetivo de recursos para uma vida mais feliz. Eles afirmam a centralidade de seu reconhecimento como sujeitos de direito, coprodutores de um cuidado integral em saúde, que contribua com aprendizados para o viver. Para tanto, o atendimento satisfatório deve promover a sua participação no processo terapêutico, dispor de informações e orientações que propiciem decisões dialogadas e, numa dimensão ampliada, o desenvolvimento da autonomia.
This study compared the possible impacts caused by the Samarco dam collapse (Minas Gerais State, Brazil) and municipalities with a similar profile to analyze the morbidity and mortality patterns due to chronic noncommunicable diseases in the affected municipalities. This ecological study was based on publicly available secondary data (SIA/SUS, SIH/SUS, and SIM) from 2008 to 2023. The analyses were carried out by disease chapters and groups (circulatory, diabetes, respiratory, neoplasms, and mental disorders) and population strata. Rates per 100,000 inhabitants, percentage differences, and relative risk were calculated with 95% confidence intervals. The "post-collapse" period (2016-2019) was compared to the "before the collapse" (2008-2015) and "post-COVID-19" (2020-2023) ones. An increase in the rates of outpatient care occurred in the affected municipalities in relation to the comparison municipalities, especially regarding diabetes (strata 1, 2, 3, and 5), respiratory diseases (strata 1, 3, 4, and 5), mental disorders (strata 4 and 5), and neoplasms (strata 1, 2, 3, and 4). In hospitalizations, slight increases due to respiratory problems occurred in stratum 4 and due to neoplasms in strata 3, 4, and 5. Regarding mortality, this study found an increase in the rates of mental disorders in strata 2 and 4. These findings suggest changes in care patterns in the affected municipalities with possible post-disaster overload and reinforce the importance of surveillance and integration between health, environmental, and risk management policies.
This study aimed to analyze, through Critical Discourse Analysis, how five legal devices are activated, blocked, or reconfigured in the care trajectories of adoptive families of children with disabilities and with what effects on participation, predictability, comfort and continuity. This is a qualitative, analytical-descriptive study; with 11 caregivers. Semi-structured face-to-face interviews were conducted between 2023 and 2024, transcribed and analyzed by the three-dimensional model. It was found that normative texts enter the scene through practices and statements that sometimes unlock, sometimes erode rights. Strategies of blocking, gatekeeping, bureaucratization of the difference and neutralization by the report were identified - associated with the drop in markers; and low-cost mediations - bridge professional, light protocols, transparency of queues and reasonable adjustments agreed upon - associated with the increase in markers. Variations appeared by family arrangement and institutional scope. The re-textualization of the provisions depends on the definition of the situation and the negotiation of roles; when affiliation is publicized and coordination exists, paths are shortened and anxieties decrease; when the revolving door based on a report prevails, rescheduling and "new beginnings" multiply. It was concluded that the caregiver matters, but how the network responds matters just as much. It is recommended to institute a bridge professional, co-construct light protocols and reasonable adjustments, and ensure transparency of queues as a minimum infrastructure to transform a right provided for into a right lived; It is suggested to expand scenarios and include professional voices in future studies.
Resumo: O presente estudo comparou os possíveis impactos causados pelo rompimento da barragem da Samarco (Minas Gerais, Brasil) e municípios com perfil semelhante, com o objetivo analisar os padrões de morbimortalidade por doenças crônicas não transmissíveis em municípios atingidos. Trata-se de um estudo ecológico baseado em dados secundários de acesso público (SIA/SUS, SIH/SUS e SIM) entre os anos de 2008 a 2023. As análises foram realizadas por capítulos e grupos de doenças (circulatório, diabetes, respiratório, neoplasias e transtornos mentais) e estrato populacional. Foram calculadas taxas por 100 mil habitantes, diferenças percentuais e risco relativo, todos com intervalos de 95% de confiança. O período “pós-rompimento” (2016-2019) foi comparado aos períodos “antes do rompimento” (2008-2015) e “pós-COVID-19” (2020-2023). Observou-se aumento nas taxas de atendimentos ambulatoriais nos municipios atingidos em relação aos municípios de comparação, com destaque para diabetes (estratos 1, 2, 3 e 5), doenças respiratórias (estratos 1, 3, 4 e 5), transtornos mentais (estratos 4 e 5) e neoplasias (estratos 1, 2, 3 e 4). Nas internações, observaram-se aumentos discretos por problemas respiratórios no estrato 4 e neoplasias nos estratos 3, 4 e 5. Já em mortalidade, houve elevação nas taxas por transtornos mentais nos estratos 2 e 4. Os achados sugerem mudanças nos padrões assitenciais nos municípios atingidos, com possível sobrecarga pós-desastre, e reforçam a importância da vigilância e integração entre políticas de saúde, ambientais e gestão de riscos.
Abstract: Short sleep duration and sleep deprivation are increasingly frequent in the population and associated with negative health outcomes. Few longitudinal studies have assessed the influence of sleep parameters on thyroid hormones and related indices. This study aimed to analyze the longitudinal association between short sleep duration and sleep deprivation and thyroid hormones and indices, stratified by sex. This prospective cohort analysis included 9,564 participants (4,649 men and 4,915 women) from the first (2012-2014) and second (2016-2018) follow-up waves of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Individuals using medications for thyroid dysfunction or drugs known to alter thyroid hormone levels were excluded. Data on short sleep duration, sleep deprivation, sociodemographic characteristics, and health-related behaviors were obtained from multidimensional questionnaires. Thyroid hormones were titrated in centrifuged serum samples collected after a 12-hour overnight fast using a third-generation immunoenzymatic assay. Crude and adjusted Bayesian multilevel models stratified by sex were used to estimate coefficients and 95% credibility intervals (95%CrI). In models adjusted for age, race/skin color, educational attainment, excessive alcohol consumption, smoking, level of physical activity, coffee consumption, and menopause (for women), both men and women with short sleep duration showed lower TSH values compared to those with normal sleep duration. Only women with short sleep duration showed lower TSHI and the values (coefficient.: -0.6019; 95%CrI: -0.9072; -0.2894) compared to women with normal sleep duration. Our findings emphasize the importance of adequate sleep duration and of avoiding sleep deprivation whenever possible to ensure homeostatic maintenance of thyroid hormones.
The Mexican health system is historically segmented, being based on social insurance for formal workers and public health actions for the general population. This study characterizes health reforms in Mexico from 2000 to 2024 considering the trajectory of health policies, coverage, and use of the health system. This research involved a literature review, documentary analysis, secondary data and interviews with key informants. We observed moments of reform under the influence of various groups and government political orientations. From 2003 to 2018, the implementation of a Popular Health Insurance with limited supply of services for informal workers and the poor increased coverage but reiterated segmentation and inequalities. From 2018 to 2024, center-left governments extinguished popular insurance and adopted reform strategies that centralized actions in the Federal Government and integrated efforts between institutions and public services. The results also showed the growing use of private clinics adjacent to pharmacies. In the period, the adopted reforms failed to overcome the legacy of segmentation by clientele, organizational fragmentation, and inequalities in health. Despite the announcement in April 2026 of reforms toward universal health some challenges can still be noticed, namely: insufficient public funding, limitations in infrastructure and the health workforce in the states, resistance from states and social security institutions, federative and political-party conflicts, expansion of private services under scarce regulation, and territorial inequalities and inequalities between social groups.
Resumo: Este estudo teve o objetivo de analisar, pela Análise de Discurso Crítica, como cinco dispositivos legais são ativados, bloqueados ou reconfigurados nas trajetórias de cuidado de famílias adotivas de crianças com deficiência e com quais efeitos em participação, previsibilidade, conforto e continuidade. Trata-se de um estudo qualitativo analítico-descritivo, com 11 cuidadores. Foram realizadas entrevistas presenciais, semiestruturadas, entre 2023 e 2024, transcritas e analisadas pelo modelo tridimensional. Constatou-se que textos normativos entram na cena por práticas e enunciados que ora destravam, ora erodem direitos. Identificaram-se estratégias de bloqueio, gatekeeping, burocratização da diferença e neutralização pelo laudo - associadas à queda dos marcadores; e mediações de baixo custo - profissional-ponte, protocolos leves, transparência de filas e ajustes razoáveis pactuados - associadas ao aumento dos marcadores. Variações apareceram por arranjo familiar e âmbito institucional. A retextualização dos dispositivos depende da definição de situação e da negociação de papéis; quando a filiação é publicizada e a coordenação existe, trajetos se encurtam e ansiedades diminuem; quando prevalece a porta giratória baseada em laudo, multiplicam-se remarcações e “recomeços”. Concluiu-se que quem cuida importa, mas como a rede responde importa tanto quanto. Recomenda-se instituir profissional-ponte, coconstruir protocolos leves e ajustes razoáveis, e garantir transparência de filas como infraestrutura mínima para transformar direito previsto em direito vivido; sugere-se ampliar cenários e incluir vozes profissionais em estudos futuros.
Abstract: HIV testing uptake among key populations remains suboptimal despite its central role in HIV prevention. Digital health promotion strategies have been increasingly implemented to address multilevel barriers to testing. However, current evidence is fragmented across platforms, populations, and settings. This scoping review aimed to map and synthesize current evidence on digital health promotion strategies designed to increase HIV testing uptake among key populations. This scoping review adopted Arksey & O’Malley’s five-stage framework and reported the process following PRISMA-ScR. PubMed, Scopus, the Cochrane Library, and CINAHL were searched for studies published from January 2015 to April 2025. Eligible studies examined digital health promotion strategies focused on HIV testing uptake among key populations. Sixteen studies were included. We identified four thematic clusters of digital health promotion strategies. Overall, the identified approaches showed potential to increase testing uptake and reduce barriers; however, evidence remains heterogeneous and uneven across populations and settings. Digital strategies for HIV testing are complementary. Integrating mobile apps, social media outreach, digital messaging, and peer-driven networks may offer scalable, context-sensitive solutions for key populations. However, the limited representation of certain groups, particularly transgender women and people who inject drugs, highlights important gaps in the evidence base. Further studies with more robust design, wider geographic coverage, and longer follow-up are warranted.
O sistema de saúde mexicano é historicamente segmentado, baseado em um seguro social para trabalhadores formais e em ações de saúde pública para a população em geral. O artigo caracteriza as reformas de saúde no México entre 2000 e 2024, considerando-se a trajetória das políticas de saúde, a cobertura e a utilização do sistema de saúde. A pesquisa envolveu revisão bibliográfica, análise documental e de dados secundários, complementadas por entrevistas com informantes-chave. Observaram-se diferentes momentos de reforma, influenciados por distintos grupos e orientações políticas dos governos. Entre 2003 e 2018, a implantação de um Seguro Popular de Saúde voltado a trabalhadores informais e pobres, com oferta limitada de serviços, levou ao aumento da cobertura, mas reiterou segmentação e desigualdades. Entre 2018 e 2024, sob governos de centro-esquerda, extinguiu-se o seguro popular e foram adotadas estratégias de reforma que envolvem a centralização de funções no Governo Federal e esforços de integração entre instituições e serviços públicos. Os resultados mostraram, ainda, a expansão da utilização de consultórios privados adjacentes a farmácias. Conclui-se que, no período, as reformas adotadas não superaram o legado de segmentação por clientelas, fragmentação organizacional e desigualdades em saúde. Apesar do anúncio em abril de 2026 de reformas no caminho da universalização da saúde, persistem como desafios o insuficiente financiamento público, limitações de infraestrutura e de força de trabalho de saúde nos estados, resistências dos estados e das instituições previdenciárias, conflitos federativos e político-partidários, expansão de serviços privados sob escassa regulação e desigualdades territoriais e entre grupos sociais.
