Hospital Ana Nery

The COVID-19 pandemic has challenged researchers and policy makers to identify public safety measures forpreventing the collapse of healthcare systems and reducingdeaths. This narrative review summarizes the available evidence on the impact of social distancing measures on the epidemic and discusses the implementation of these measures in Brazil. Articles on the effect of social distancing on COVID-19 were selected from the PubMed, medRXiv and bioRvix databases. Federal and state legislation was analyzed to summarize the strategies implemented in Brazil. Social distancing measures adopted by the population appear effective, particularly when implemented in conjunction with the isolation of cases and quarantining of contacts. Therefore, social distancing measures, and social protection policies to guarantee the sustainability of these measures, should be implemented. To control COVID-19 in Brazil, it is also crucial that epidemiological monitoring is strengthened at all three levels of the Brazilian National Health System (SUS). This includes evaluating and usingsupplementary indicators to monitor the progression of the pandemic and the effect of the control measures, increasing testing capacity, and making disaggregated notificationsand testing resultstransparentand broadly available.

Although low- and middle-income countries still bear the burden of major infectious diseases, chronic noncommunicable diseases are becoming increasingly common due to rapid demographic, epidemiologic, and nutritional transitions. However, information is generally scant in these countries regarding chronic disease incidence, social determinants, and risk factors. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) aims to contribute relevant information with respect to the development and progression of clinical and subclinical chronic diseases, particularly cardiovascular diseases and diabetes. In this report, the authors delineate the study's objectives, principal methodological features, and timeline. At baseline, ELSA-Brasil enrolled 15,105 civil servants from 5 universities and 1 research institute. The baseline examination (2008-2010) included detailed interviews, clinical and anthropometric examinations, an oral glucose tolerance test, overnight urine collection, a 12-lead resting electrocardiogram, measurement of carotid intima-media thickness, echocardiography, measurement of pulse wave velocity, hepatic ultrasonography, retinal fundus photography, and an analysis of heart rate variability. Long-term biologic sample storage will allow investigation of biomarkers that may predict cardiovascular diseases and diabetes. Annual telephone surveillance, initiated in 2009, will continue for the duration of the study. A follow-up examination is scheduled for 2012-2013.

O artigo apresenta uma revisão dos principais conceitos e modelos de formulação e análise de políticas públicas, buscando sintetizar o estado-da-arte da área, ou seja, mapear como a literatura clássica e a mais recente tratam o tema. O artigo busca, também, discutir as possibilidades aplicativas das diferentes vertentes das teorias neo-institucionalistas à análise de políticas públicas.

This work aims to systematize a set of scientific evidence presented in international papers that identify the main problems affecting health professionals directly involved in coping with the COVID-19 pandemic and point out actions and strategies for the protection and healthcare of these professionals. The risk of infection is the main issue and has led to absence from work, illness, death, and intense psychological distress, expressed in generalized anxiety and sleep disorders, fear of becoming ill and infecting colleagues and relatives. In the Brazilian reality, this work revives the analysis of the chronic problems affecting health workers, resulting from the underfinancing of the Brazilian Unified Health System (SUS), the sector's spending freeze, the deterioration of services and workforce's insecurity, and points out the acute challenges of work management and staff training, given the expanded hospital bed infrastructure and reorganization of the work process in primary care to face the pandemic, emphasizing the necessary measures for the protection and promotion of the physical and mental health of health professionals and workers.

The comparison of genetic divergence or genetic distances, estimated by pairwise FST and related statistics, with geographical distances by Mantel test is one of the most popular approaches to evaluate spatial processes driving population structure. There have been, however, recent criticisms and discussions on the statistical performance of the Mantel test. Simultaneously, alternative frameworks for data analyses are being proposed. Here, we review the Mantel test and its variations, including Mantel correlograms and partial correlations and regressions. For illustrative purposes, we studied spatial genetic divergence among 25 populations of Dipteryx alata ("Baru"), a tree species endemic to the Cerrado, the Brazilian savannas, based on 8 microsatellite loci. We also applied alternative methods to analyze spatial patterns in this dataset, especially a multivariate generalization of Spatial Eigenfunction Analysis based on redundancy analysis. The different approaches resulted in similar estimates of the magnitude of spatial structure in the genetic data. Furthermore, the results were expected based on previous knowledge of the ecological and evolutionary processes underlying genetic variation in this species. Our review shows that a careful application and interpretation of Mantel tests, especially Mantel correlograms, can overcome some potential statistical problems and provide a simple and useful tool for multivariate analysis of spatial patterns of genetic divergence.

<abstract language="eng">This work describes the mechanism of action of some reactive oxygen species (ROS) and reactive nitrogen species (RNS) in the oxidative stress of the human body, and their consequences on damage to DNA, RNA, proteins and lipids. It also illustrates the defense system of our organism against these ROS and RNS species. The action of nonenzymatic protection systems is reported, with emphasis on micromolecules like Q10 coenzyme, vitamin C, alpha-tocopherol, carotenoids and flavonoids. The importance of flavonoids is also emphasized, and their body protection mechanism is detailed.

Spirulina maxima, which is used as a food additive, is a microalga rich in protein and other essential nutrients. Spirulina contains phenolic acids, tocopherols and beta-carotene which are known to exhibit antioxidant properties. The aim of the present study was to evaluate the antioxidant capacity of a Spirulina extract. The antioxidant activity of a methanolic extract of Spirulina was determined in vitro and in vivo. The in vitro antioxidant capacity was tested on a brain homogenate incubated with and without the extract at 37 degrees C. The IC50 (concentration which causes a 50% reduction of oxidation) of the extract in this system was 0.18 mg/ml. The in vivo antioxidant capacity was evaluated in plasma and liver of animals receiving a daily dose of 5 mg for 2 and 7 weeks. Plasma antioxidant capacity was measured in brain homogenate incubated for 1 h at 37 degrees C. The production of oxidized compounds in liver after 2 h of incubation at 37 degrees C was measured in terms of thiobarbituric acid reactant substances (TBARS) in control and experimental groups. Upon treatment, the antioxidant capacity of plasma was 71% for the experimental group and 54% for the control group. Data from liver spontaneous peroxidation studies were not significantly different between groups. The amounts of phenolic acids, alpha-tocopherol and beta-carotene were determined in Spirulina extracts. The results obtained indicate that Spirulina provides some antioxidant protection for both in vitro and in vivo systems.

treated with doxycycline (100 mg 2/d) for 10 days; they clinically recovered, and laboratory abnormalities returned to reference ranges at discharge 12 days after admission.

Ambulatory care sensitive hospitalizations are a set of conditions for which access to effective primary care can reduce the likelihood of hospitalization. These hospitalizations have been used as an indicator of primary care performance in several countries and in three Brazilian states, but there is little consensus on which conditions should be included in this indicator. This paper presents a description of the steps undertaken to construct and validate a list for Brazil. The final list includes 20 groups of diagnostic conditions that represented 28.3% of a total of 2.8 million hospitalizations in the National Unified Health System in 2006. Gastroenteritis and complications, congestive heart failure, and asthma represented 44.1% of all ambulatory care sensitive hospitalizations. From 2000 to 2006, ambulatory care sensitive hospitalizations decreased by 15.8%, and this reduction was more significant than that observed in all other hospitalizations. The article concludes with potential applications and limitations of the proposed Brazilian list.

The present essay is an exploratory study of the historical and institutional background of the so-called "crisis in public health", aimed at identifying the new trends and perspectives for the paradigmatic transformation of the health field in the context of the current international panorama of economic and cultural globalization. First, the rhetoric of health is analysed in historical perspective, briefly considering the main elements of the discourse of the ideological movements that historically built the social field of health. Medical Police, Social Medicine and Public Health are included as representative of such movements in 19th century Western Europe. After the Flexnerian turn, these movements were followed by Preventive Medicine, Community Health, Primary Health Care and Health Promotion, which dominated the scene particularly in the second half of the 20th century. The authors also summarise recent concerted PAHO efforts to debate the theory and practice of Public Health in the Americas, vis à vis the emerging demands of the economic, political and social context of Latin American countries. In this regard, the need for a common political agenda is emphasized, with the convergence of three topics-sectorial reform, "Renovation of Health for All" and the "new public health", covering the conceptual, methodological and operative domains. Secondly, a brief systematic account of the conceptual landmarks of the Collective Health movement, as carried through in the two last decades in Latin America, is presented, focusing more particularly on its potential for building up both a domain of transdisciplinary knowledge and a universe of practices. As a field of knowledge, it contributes to the study of health-disease phenomena in populations as a social process, investigating the production and distribution of disease in society as an aspect of social reproduction, and analysing health practices as a labor process integrated into the other social practices. As a universe of practices, Collective Health focuses on its models or action guidelines four objects of intervention: policies (forms of power distribution); practices (behavior modification; culture; institutions; knowledge production; institutional, professional and relational practices); technologies (organization and regulation of productive resources and processes; bodies/environments), and instruments (means of production of interventions). Finally, it is concluded that, although not being in itself a paradigm, Collective Health, as a movement committed to the social transformation of health, presents some possibilities of articulation with new scientific paradigms capable of approaching the health-disease-care object with due regard to its historicity and complexity.

The advent of immune-checkpoint inhibitors (ICI) in modern oncology has significantly improved survival in several cancer settings. A subgroup of women with breast cancer (BC) has immunogenic infiltration of lymphocytes with expression of programmed death-ligand 1 (PD-L1). These patients may potentially benefit from ICI targeting the programmed death 1 (PD-1)/PD-L1 signaling axis. The use of tumor-infiltrating lymphocytes (TILs) as predictive and prognostic biomarkers has been under intense examination. Emerging data suggest that TILs are associated with response to both cytotoxic treatments and immunotherapy, particularly for patients with triple-negative BC. In this review from The International Immuno-Oncology Biomarker Working Group, we discuss (a) the biological understanding of TILs, (b) their analytical and clinical validity and efforts toward the clinical utility in BC, and (c) the current status of PD-L1 and TIL testing across different continents, including experiences from low-to-middle-income countries, incorporating also the view of a patient advocate. This information will help set the stage for future approaches to optimize the understanding and clinical utilization of TIL analysis in patients with BC.

Partindo da concepção de que as políticas de saúde se materializam nos serviços, mediante as ações de atores sociais e suas práticas cotidianas, este ensaio tem o objetivo de refletir sobre as práticas de educação em saúde no contexto do Programa Saúde da Família (PSF). Pretende-se apreciar a assimilação do princípio da integralidade nessas práticas e, desta maneira, contribuir para o debate sobre os alcances e limites da estratégia do PSF para a reorientação do modelo assistencial a partir da atenção básica. Na conjuntura atual da política de saúde brasileira, o PSF tem desempenhado papel estratégico para a construção e consolidação do Sistema Único de Saúde (SUS). A partir de uma revisão histórica das práticas de educação em saúde e dos discursos sanitários a elas subjacentes, são reconstituídas as racionalidades determinantes de tais práticas. O modelo hegemônico de educação em saúde, em sua essência divergente do princípio da integralidade, é caracterizado e discutido em comparação a um modelo de práticas de educação em saúde emergente, denominado neste ensaio de modelo dialógico, cuja lógica manteria coerência com a integralidade da atenção.

Nas duas últimas décadas, constata-se um incremento significativo da utilização de grupos focais como instrumento de coleta de dados em pesquisas no campo da Saúde Coletiva no Brasil. Seja ocupando a função de técnica principal, ou como estratégia complementar de tipo qualitativa, sua adoção atende invariavelmente ao objetivo de apreender percepções, opiniões e sentimentos frente a um tema determinado num ambiente de interação. A regularidade quanto à finalidade no emprego do grupo focal contrasta com a variação observada no tocante aos requisitos e procedimentos práticos referidos. Este artigo apresenta conceitos, finalidades e procedimentos relativos à técnica de grupos focais e problematiza sua operacionalização prática na pesquisa, particularmente no campo da saúde. Com base neste objetivo, o trabalho integra uma revisão da literatura sobre grupo focal com uma reflexão derivada de experiências de utilização da técnica em estudos de avaliação em saúde, conduzidos ou orientados pela autora.

A pandemia de COVID-19 um desafio sem precedentes para a cincia e para a sociedade, cobrando respostas rpidas e diversas dos sistemas de sade que precisam ser reorganizados, em todos os seus componentes, para o seu enfrentamento.

This article revisits the epidemiology of dengue in Brazil, 25 years after its reemergence in the country, discussing the main determinants and implications for its control. The authors emphasize the clinical and epidemiological peculiarities of this viral disease in Brazil, which leads the world in both the number of cases reported and risk of occurrence of the disease. The article presents the changes occurring in the dengue epidemiological pattern in recent years, like the sudden age shift in the incidence of dengue hemorrhagic fever, and discusses possible associated factors. The article focuses specifically on the epidemic in Rio de Janeiro in 2008, this episode's impact on the international community, and the fear that the disease could spread to Europe. The authors conclude that the current situation emphasizes the need for the international scientific community to renew its efforts to generate knowledge allowing improvement and progress in the development of new tools and strategies for dengue prevention.

OBJECTIVE: To assess the association between quality of stimulation in the family environment and child's cognitive development considering the impact of mother's schooling on the quality of stimulation. METHODS: A cross-sectional study comprising 350 children aged 17-42 months was carried out in central and peripheral areas of Salvador, Northeastern Brazil, in 1999. A socio-economic questionnaire was used, along with the Home Observation for Measurement of the Environment Scale (HOME Inventory), and the Bayley Scale for Infant Development. Bivariate and multivariate analyses were carried out through linear regression at 5% level of significance. RESULTS: There was a positive (beta=0.66) and statistically significant association between quality of stimulation in the family environment and child's cognitive development. Part of the effect was mediated by the mother's working circumstances and educational level. It was verified that a better quality of stimulation is provided for those who come early in the birth order in family, and live with only a few others under five years of age. This pattern of stimulation is better among children who live with their parents and whose mothers have better education, have a job and a partner involved in the family environment. CONCLUSIONS: Quality of stimulation in the family environment is crucial for child's cognitive development, besides the significant role of the available resources and family dynamics. The study findings show the pertinence to cognitive development of interventions which improve the quality of the environment and the child-caregiver relationship.

This article, which aims to explore questions relating to SUS at 30 and to dialogue with other studies, presents an overview of the positive drivers, the obstacles and the threats to Brazil's Unified Health System. It points to a lack of prioritizing the SUS on the part of the government, underfunding and attacks on the system made by capital's policies. The article also suggests that one of the most significant threats to SUS is the financialization of health, linked to the financial dominance. It concludes by arguing that the SUS is not consolidated, justifying alliances between democratic, popular and socialist forces, with new strategies, tactics and forms of organization to face up to the power of capital and its representatives in society and in the State.

This study presents an overview of public sector interventions and progress made on the women's and child health front in Brazil between 1990 and 2015. We analyzed indicators of antenatal and labor and delivery care and maternal and infant health status using data from the Live Birth Information System and Mortality Information System, national surveys, published articles, and other sources. We also outline the main women's and child health policies and intersectoral poverty reduction programs. There was a sharp fall in fertility rates; the country achieved universal access to antenatal and labor and delivery care services; access to contraception and breastfeeding improved significantly; there was a reduction in hospital admissions due to abortion and in malnutrition. The rates of congenital syphilis, caesarean sections and preterm births remain excessive. Under-five mortality decreased by more than two-thirds, but less pronounced for the neonatal component. The maternal mortality ratio decreased from 143.2 to 59.7 per 100 000 live births. Despite worsening scores or levelling off across certain health indicators, the large majority improved markedly.

T This article presents a historical and epistemological study of the construction of public policies about mental health and psychosocial care in Brazil´s Unified Health System, the SUS. To that end, it proposes an approach that identifies actions and strategies related to social participation in the construction of policies, one of the founding principles of SUS, seeking to delineate its importance in the specific trajectory of the psychiatric reform process. Subsequently, it highlights the originality and importance of actions that used culture as a means and as an end, in the sense of not restricting psychiatric reform to a transformation limited to public services or health in the strict sense of the term, emphasizing the principle of construction of a new locus in society for madness. Finally, it provides a historical follow-up of the promulgation of mental health policies in Brazil, identifying the most important initiatives and their impacts on the transformation of the care model, and concludes by questioning the conservative restructuring that is currently taking place.

This article analyzes the identity-building process for community-based health workers in the context of their role in the Health Family Program team and their interaction with the residents of communities where they work. Based on this analysis we specifically emphasize conflicts of interpretation, power relationships between both sides of identity-building for community-based health workers from three perspectives: that included in the official training of these workers, that produced by workers concerning themselves, and that transmitted by the community. The fact that community-based health workers live the reality of health practices in the neighborhoods where they live and work and are trained with biomedical references makes them actors that convey both the contradictions and the possibility for a deep dialogue between these two forms of knowledge and practice.