Health Services In Brazil Research Articles

Associations between IL-33 gene and IL1RL1 gene variants in periodontitis

Background: Periodontitis is initiated by a dysbiosis in the subgingival microbial biofilm and can be related to host genetic factors. This study investigated association between periodontitis and single nucleotide variants (SNVs) in the IL-33 and IL1RL1 genes. Methods: This cross-sectional study involved 359 individuals from a public health service in Brazil. Structured questionnaire was used to collect health status and socioeconomic, demographic and behavioral characteristics. Periodontitis was diagnosed by clinical periodontal examination. Subgingival biofilm was collected at the deepest site of each sextant, and biofilm bacterial DNA was amplified by real time polymerase chain reaction (qPCR) to determine relative quantification of pathogens. Peripheral blood was collected for genomic DNA extraction and SNV genotyping was performed by qPCR. Logistic regression model was used to obtain association measures (95% confidence interval), by ussing the additive model. Results: The C allele variant of IL33 (rs2381416) was inversely associated with periodontitis, even after adjusting for the confounding covariates (p < 0.01 ORadjusted: 0.45; CI: 0.24-0.84), and with the presence of the Aggregatibacter actinomycetemcomitans (Aa) pathogen, adjusting for the same covariates (p < 0.01; ORadjusted: 0.46; CI: 0.27-0.76). Inverse association between this SNV and periodontitis was observed (p = 0.02; ORadjusted: 0.46; CI: 0.28-0.76) using additive genotypic model. Conclusions: Frequency of C allele variant of IL-33 (rs2381416) was lower in individuals with periodontitis and in individuals with relatively higher levels of Aa. Investigations of this variant as a potential predictor of the protective phenotype in the context of periodontitis are needed. This study will contribute to the training of health professionals involved in the treatment of periodontitis.

EXPERIENCES OF WOMEN SEEKING LEGAL ABORTION IN BRAZIL

After being raped and discovering they are pregnant, women face numerous difficulties in seeking a legal termination of pregnancy (legal abortion). The aim of this study was to understand the experiences of women seeking a legal termination of pregnancy in a Brazilian health service and their experiences with health care. Interviews were conducted with six women who had undergone a termination of pregnancy at a public health service in a city in the interior of Minas Gerais (Brazil). Using Reflective Thematic Analysis, we chose three categories to analyse: (Dis)Information and (Dis)Guidance; Loneliness and the fragility of the Network; Performance of the healthcare team. We used feminist epistemologies to analyse the content of the interviews and noted: misinformation about their rights; difficulties in finding specialised care in the public health sector for legal abortion; gaps between what is prescribed in the Ministry of Health's rules and the implementation of these actions by health professionals.

The Shift to Online Psychotherapy: Adaptation and Implications for Brazilian Clinical Psychologists Amid Covid-19

The Covid-19 pandemic disrupted traditional psychotherapy practices, prompting a rapid transition to online modalities. This qualitative study investigates how Brazilian clinical psychologists adapted to online psychotherapy during and after the pandemic. Semi-structured interviews were conducted with five psychologists, each with an average professional experience of 8.9 years. Using the Iramuteq software for lexical analysis, six thematic classes were identified: uncertainties during the transition, emerging possibilities, adaptability movements, pandemic context, new professional perspectives, and academic and professional trajectories. The findings highlight significant challenges, including managing technological tools, maintaining therapeutic relationships, and addressing client concerns in virtual settings. However, the transition also revealed notable advantages, such as reduced operational costs, enhanced flexibility, and expanded access to psychological care. The analysis underscores the critical role of digital competencies, including technical, communicational, and cultural skills, in ensuring effective online therapy. Additionally, the results point to gaps in academic training and professional preparation for telepsychology, emphasizing the need for curriculum reform to include digital literacy and teletherapy-specific strategies. The study concludes that online psychotherapy represents not only a response to crisis but also a sustainable model for expanding access to mental health care. It calls for targeted professional development and ethical guidelines to support psychologists in navigating digital environments effectively. These insights contribute to understanding the evolving dynamics of psychotherapy and provide actionable recommendations for improving digital mental health services in Brazil and beyond.

A Proteção do Direito à Saúde de Refugiados e Indocumentados: desafios no contexto brasileiro

Objective: The article presents reflections on the linguistic, cultural, and bureaucratic barriers faced by refugees and undocumented individuals in accessing public health services in Brazil, which has a characteristic of universality, as provided by the Federal Constitution of 1988 and Law No. 8080 of 1990. Methodology: A documentary review of national and international norms addressing health and migration was conducted, complemented by an unsystematic literature review. Results: The results indicate that Brazil formally ensures that nationals of other countries or stateless persons, on equal terms with Brazilians, have access to public health services without discrimination based on nationality or migratory status. However, discrimination from health professionals, lack of knowledge among migrants about how the Unified Health System works, and excessive bureaucracy are barriers that limit the enjoyment of the right to health. Conclusion: It was concluded that despite Brazil having, through its health system, an important guarantee of social inclusion for refugees and undocumented migrants, it still needs to take action to combat barriers to their access. Submission: 10/08/24| Review: 10/16/24| Approval: 16/10/24

E-Health Technologies: Implications for Quality in Public Health Services

Objective: The research sought to investigate the implications of e-Health technologies on the quality of public health services in Brazil, in order to identify opportunities and challenges. Methodology: Using a bibliographic research methodology, materials already published were analyzed, with emphasis on telemedicine studies and electronic health records. The bibliographic survey was carried out on platforms such as SciELO, Scopus and Google Academic, besides national repositories, such as the Capes Thesis Bank and other Brazilian open access repositories. Data Results and Analysis: The results show that these technologies can increase the efficiency, accessibility, and continuity of care, especially in remote areas, by enabling better management of information and services. However, significant challenges arise, such as digital inclusion, the empowerment of health professionals and the protection of patient data. Conclusion: As a conclusion, it is highlighted that although e-Health technologies have the potential to transform the health system, their implementation must be accompanied by policies that guarantee inclusion and safety, ensuring that all citizens benefit from these innovations.

A-258 Hepatitis A infections among patients suspected of acute hepatitis attended in Brazilian health services

Abstract Background Millions of people worldwide are infected with Hepatitis A Virus (HAV) annually - the leading widely spread causes of acute viral hepatitis in developing countries across all continents. Objective To evaluate the prevalence of anti-HAV antibodies; to determine HAV genotypes by nucleotide sequencing in patients suspected of acute hepatitis at public healthcare institutions; and to assess the association between this infection with age, gender, region, and other risk factors Methods Between October 2019 and May 2023, we analyzed 1,562 patients with more than 18 years old with clinical suspected acute hepatitis. Results Out of the 1,562 individuals, 1,244 were seropositive for Anti-HAV IgG, a median age of 45 years (IQR: 35 to 56) vs. 31 years (IQR: 25 to 39) in non-reactive individuals (p<0.001). A higher seropositivity was found in men compared to women (p=0.002). North region showed the highest seropositivity (p<0.001). There was also an association between poor sanitation conditions and seropositivity, such as lack of sewage collection and consumption of untreated water (p<0.001), as well as an association between heterosexual orientation and higher likelihood of seropositivity (p=0.015). In the logistic regression analysis for anti-HAV IgG seropositivity, age and male sex were significantly associated with seropositivity (OR = 1.09, 95% CI: 1.08 to 1.11, p<0.001; OR = 1.56, 95% CI: 1.16 to 2.11, p=0.004). North region showed a significant increase in the odds for seropositivity compared to all other regions. For anti-HAV IgM, out of the 1,562 individuals, 97 were seropositive, significantly higher in younger individuals [median age of 34 years (IQR: 28 to 40) vs. 42 years (IQR: 32 to 54) in non-reactive individuals (p<0.001)] and in males (p<0.001). South and Southeast regions had higher seropositivity (p<0.001). Non-heterosexual orientation and more than 2 sexual partners significantly correlated with seropositivity (p<0.001). In the logistic regression analysis for anti-HAV IgM, age showed an inverse association with seropositivity (OR = 0.96, 95% CI: 0.94 to 0.98, p<0.001), being more frequent in men (OR = 1.86, 95% CI: 1.11 to 3.21, p=0.021). Consumption of seafood was significantly associated with increased odds of seropositivity for anti-HAV IgM (OR = 2.26, 95% CI: 1.43 to 3.56, p<0.001). South and Southeast regions showed more IgM positive cases than North, Northeast and Midwest regions. Among the 1,562 cases, 35 complete (or almost complete) HAV genomes were successfully recovered from metagenomics sequencing data. These genomes range from 6,625 to 7,462 bp in length (89-100% completeness), sequences were fairly similar in pairwise nucleotide alignment, classified as genotype I.A, and displaying identities ranging from 94.7 to 99.7%. Conclusions Hepatitis A infection was found among 6.2% acute hepatitis cases attended in public services in Brazil while previous infections or vaccinated patients were found in 78.9% patients. While anti-HAV IgG positive patients where most frequent in the North region of Brazil, acute hepatitis A (IgM-positive) were more frequent in South and Southeast regions. Our results reinforce the need to implement vaccination against hepatitis A among individuals with more than 18 years in our country.

Academic Essay On Equitable Access To Mental Health Services In Brazil

Equitable access to mental health services in Brazil faces complex and interconnected challenges. Among the main issues are regional inequalities, socioeconomic barriers, and the stigma associated with mental disorders. Regional inequality results in significant differences in the quality and availability of mental health services between urban and rural areas. While large cities such as São Paulo and Rio de Janeiro have advanced infrastructure and qualified professionals, rural areas and urban outskirts suffer from a lack of resources and professionals, limiting access to necessary care. Socioeconomic barriers also play a crucial role. Low-income populations face additional difficulties, such as lack of transportation and inadequate health insurance, which restrict access to mental health services. The lack of information and the stigmatization of mental disorders worsen the situation, discouraging individuals from seeking treatment due to fear of discrimination and prejudice. To address these challenges, it is essential to adopt integrated strategies. Expanding mental health infrastructure in underserved areas and creating integrated care networks are fundamental. Public policies should reduce socioeconomic inequalities by providing financial support and improving transportation. Awareness campaigns about mental health can overcome informational barriers and stigma. Continuous training of health professionals and community participation are also crucial to ensure inclusive and locally adapted care. With a coordinated effort, it is possible to promote more just and comprehensive access to mental health services in Brazil.

Non-cutaneous soft tissue tumors and pseudotumors in the foot and ankle reported in Brazilian services

Objectives: Review the histological types of non-cutaneous soft tissue tumors and pseudotumors that affect the foot and ankle,reported in Brazilian health services.Methods: An integrative review of the literature from the Scielo and PubMed platforms, based on the descriptors “Soft Tissue Tumors,”“Pseudotumors,” “Foot, “Ankle,” and “Brazil.” Those who answered the following research question: “What are the non-cutaneous softtissue tumors and pseudotumors in the foot and ankle reported in Brazilian health services?” were included. The combination of eachauthor’s analysis contributed to reducing possible biases.Results: Six articles were selected, yielding 23 reports of tumors and pseudotumors, which were subsequently categorized intomalignant and benign tumors. There were five benign findings: three benign tumors, two giant cell tumors, one fibromatosis, andtwo pseudotumors classified as synovial chondromatosis. Eighteen malignant findings were reported: seven unspecified soft tissuesarcomas, four synovial sarcomas, three myxofibrosarcomas, one fibrosarcoma, one liposarcoma, one undifferentiated pleomorphicsarcoma and one papillary intralymphatic angioendothelioma.Conclusion: In the last ten years, more reports of malignant than benign tumors have been reported. However, this finding does notnecessarily reflect the Brazilian epidemiological reality, as it may represent a view in which resected benign tumors and pseudotumorsare often not sent for anatomopathological study or reported in the literature. Level of evidence I; Prognostic studies - investigating the effect of a patient characteristic on the outcome of disease

Reframing goals and strategies for delivering humanized obstetric care in Brazil

Introduction: Despite the long-lasting efforts to promote the quality of obstetric care, Brazil requires robust changes in the care practices throughout the prenatal-labour-postpartum continuum. The ongoing National Program for the Humanization of Prenatal and Childbirth (PHPN) efforts address the fight against obstetric violence (OV), the improvement in the quality of obstetric care, but its implementation has faced obstacles and difficulties, such as responding to cultural values and operating with a weak infrastructure. This research explored Brazilian health and social service professionals’ perceptions of the PHPN’s recommendations regarding innovation, policy and practice changes necessary to respect women’s human rights to receive a high quality, dignifying obstetric care. Methods: An online multi-site survey in which data were collected (Jun 2019-Mar 2020) from health professionals working in the public health system in Brazil. Data analysis used descriptive statistics and thematic analysis. Analytical themes were Perceptions of Program effectiveness to minimize obstetric violence and Program’s gaps, inadequacies and needed changes. Results: Respondents (n=369) disclosed their perceptions about the Program’s nature, utility, and gaps towards an improved implementation. Key issues were rooted in the outdated university education, reduced accountability, and governance in services’ management; unfavourable work conditions and climate; professional power-imbalance; population’s lack of information about the Program; underutilization of obstetric nurses’ and midwives’ skills; neglect of professional development; no denunciation & re-education, and culture of quality improvement. Conclusions: Firmness, hope and determination will be needed to transform society’s culture of silence about OV, awakening the public awareness and mobilizing to enhance collective health and political literacy to ensure professional accountability while protecting women and newborns. There is a need for a realignment of work processes, an investment in professional education, and education within women’s social networks for women to become partners in the active process of improvement of quality of obstetric care.

Association between high assessment of Primary Health Care and health state and use of health services in Brazil

Association between high assessment of Primary Health Care and health state and use of health services in Brazil

Assessing the risks for stillbirth in São Paulo, Brazil: protocol for a multidisciplinary case–control study – FetRisks

Stillbirth is a fundamental component of childhood mortality, but its causes are still insufficiently understood. This study aims to explore stillbirth risk factors by using a multidisciplinary approach to stimulate...

Paths and inter-mediations between Brazilian Health Services and Youth Detention Centers.

Socio-education is an educational and (re)socialization proposal for young people having troubles with the law, a law which also includes the right to health care guaranteed by the Unified Health System (SUS). This study aims to investigate the relationship between health services and socio-educational units in Paraná state, from the perspective of service workers and managers. The qualitative and exploratory research consisted of sixteen semi-structured interviews in five municipalities in the state, with subsequent categorization of the narratives based on hermeneutic analysis. As a result, there was considerable weakness in the coordination between the network's facilities to promote overall health care, specifically the mental health of young people. Security issues have a strong influence on the regulation of actions, even health actions, in socio-education. The current policy of comprehensive health care in socio-education, implemented in Brazil in 2014, is, however, an important counterpoint for the reordering and nudging policies in this area.

Comparing health systems readiness for integrating domestic violence services in Brazil, occupied Palestinian Territories, Nepal and Sri Lanka.

Domestic violence (DV) is a global prevalent health problem leading to adverse health consequences, yet health systems are often unprepared to address it. This article presents a comparative synthesis of the health system's pre-conditions necessary to enable integration of DV in health services in Brazil, Nepal, Sri Lanka and occupied Palestinian Territories (oPT). A cross-country, comparative analysis was conducted using a health systems readiness framework. Data collection involved multiple data sources, including qualitative interviews with various stakeholders; focus-group discussions with women; structured facility observations; and a survey with providers. Our findings highlight deficiencies in policy and practice that need to be addressed for an effective DV response. Common readiness gaps include unclear and limited guidance on DV, unsupportive leadership coupled with limited training and resources. Most providers felt unprepared, lacked guidance and felt unsupported and unprotected by managers and their health system. While in Brazil most providers felt they should respond to DV cases, many in Sri Lanka preferred not to. Such organizational and service delivery challenges, in turn, also affected how health providers responded to DV cases leaving them not confident, uncertain about their knowledge and unsure about their role. Furthermore, providers' personal beliefs and values on DV and gender norms also impacted their motivation and ability to respond, prompting some to become 'activists' while others were reluctant to intervene and prone to blame women. Our synthesis also pointed to a gap in women's use of health services for DV as they had low trust in providers. Our conceptual framework demonstrates the importance of having clear policies and highlights the need to engage leadership across every level of the system to reframe challenges and strengthen routine practices. Future research should also determine the ways in which women's understanding and needs related to DV help-seeking are addressed.

The application of measures against avoidable harm in Brazilian Health Services: A strategy focusing on patient safety

The study is the development of a qualitative integrative review, which addresses questions about patient safety with an emphasis on the nuances that permeate the proposals of the praxis of the professional who works in health care and the correlation with common practices and the possibility of reducing possibly avoidable damage. The study's main objective is to find out about the tools used to eliminate avoidable harm to patients in Brazilian health services. The methodology used consisted of an integrative review with a qualitative approach that analyzed studies on the subject published over a 5-year period (2018-2023). The results found were that nursing plays a leading role in the development of actions to prevent the onset of damage compared to other team members, and that there is a need for ongoing education strategies to share knowledge and provide continuity in comprehensive user care. It is therefore necessary to strengthen reporting tools in order to understand the overall picture and create strategies to reduce the potential for harm to occur, as well as proposing health education strategies at all hierarchical levels for professionals who work directly or indirectly in patient care.

Managing long COVID symptoms and accessing health services in Brazil: A grounded theory analysis

BackgroundThe worldwide community has shown significant interest in researching the management of Long COVID. However, there is scarce evidence about the daily experiences of people living with Long COVID and their insights into the healthcare services provided to them. AimsThis study aims to understand the experience of Long COVID sufferers with their symptoms and in accessing health services. MethodWe employed Charmaz's grounded theory methodology, informed by constructivism, and applied the COREQ guidelines for qualitative research. Sixty-six Brazilians living with Long COVID participated in the study. The data was collected using semi-structured telephone interviews and analyzed using a constant comparative process. FindingsThe findings refer firstly to the consequences of persistent Long COVID symptoms. Secondly, they describe how the disease trajectory required Long COVID sufferers to reorganize their routines and develop adaptive strategies. Lastly, they reflect a diverse array of both positive and negative interactions inside the healthcare system conveyed by individuals suffering from Long COVID. These elements converge towards the core category of the study: “The limbo of Long COVID sufferers: between the persistence of symptoms and access to health services”. ConclusionsLong COVID is characterized by its varied nature, including a range of physical and emotional repercussions experienced by individuals. There is a need for enhanced comprehension and discourse about Long COVID across several domains, including the general public, policy-making entities, and healthcare professionals. In this sense, the development of specialized services or the reinforcement of existing services to support long COVID sufferers is imperative.

Influence of simultaneous comorbidities on COVID-associated acute respiratory distress syndrome mortality in people with diabetes

ObjectivesThis study analyzed the influence of 23 comorbidities on COVID-associated acute distress respiratory syndrome (CARDS) mortality in people with a history of diabetes mellitus. MethodsAn observational, analytical, cross sectional study was utilized to investigate data from 6723 health services in Brazil, comprising 5433 people with diabetes. Adjusted logistic regression models for demographic factors such as age, sex, and race were used to analyze the association between CARDS mortality and comorbidities. ResultsPersons with two (p < 0.001), three (p < 0.001), four (p < 0.001), and five (p < 0.001) simultaneous comorbidities had a higher chance of dying. We identified that diabetes patients who had concomitant metabolic diseases (p = 0.019), neurological disorders (p < 0.001), or were smokers (p < 0.001) had a higher predicted mortality risk based on CADRS. ConclusionThe number of comorbidities plays a determining role in CARDS mortality in people with diabetes, especially those who suffer from smoking and neurological diseases simultaneously.

Availability of Electroconvulsive Therapy in Public Health Services in the Last Decade in Brazil.

To identify the current treatment options for electroconvulsive therapy (ECT) therapy in public services linked to the Unified Health System in Brazil and compare them with data published in 2012 based on their availability. In this retrospective observational study, we mapped institutions that perform ECT under public health services in Brazil. A questionnaire was administered to active and inactive service centers between August 2022 and June 2023. We identified 16 institutions that performed ECT, including 12 linked to public universities and 4 with various links. In the last decade, 2 new public services that perform ECT in the country have emerged, whereas 4 services have ceased function. In 2022, the number of individuals treated with ECT per 100,000 population was 1.86, whereas the number of procedures performed per 100,000 people was 6.55. Although 2 new public ECT services have been identified, 4 have turned inactive. Most services are linked to public universities, and inactive service points to financial issues as the main factor in service interruption. Brazil has one of the lowest rates of individuals treated with ECT per 100,000 population compared with countries in North America and Europe. Thus, it is essential to raise awareness to improve ECT adoption rates and bring it out of the shadows in Brazil.

The effects of a large-scale home visiting programme for child development on use of health services in Brazil.

Partnership between early childhood development interventions and primary health care services can help catalyse health care uptake by socially vulnerable families. This study aimed to assess the real-life effects of a large-scale home visiting programme [Primeira Infância Melhor (PIM)] in Brazil on the use of preventive (prenatal visits, well child visits, dentist visits and vaccination) and recovery (emergency room visits and hospitalization) health services. A quasi-experiment nested in a population-based birth cohort study was conducted. The intervention group was firstly defined as all children enrolled in PIM up to age 6 months, and afterwards stratified between those enrolled during pregnancy or after birth up to 6 months. Children receiving PIM were matched with controls on propensity scores based on 27 confounders to estimate effects on health service use from prenatal to age 2 years. Double adjustment was applied in outcome Quasi-Poisson regressions. No evidence was found for effects of PIM starting anytime up to 6 months (262 pairs), or for the children enrolled only after birth (133 pairs), on outcomes occurring after age 6 months. When the programme started during pregnancy (129 pairs), there was a 13% higher prevalence of adequate prenatal visits (prevalence ratio = 1.13; 95% confidence interval 1.01-1.27), but no effect on use of any other health service. Sensitivity analyses suggested longer participation in the programme with reduced visitor turnover might improve its impact on prenatal visits. Integration between PIM and primary health care was not adequate to affect overall patterns of contacts with health services. Nevertheless, prenatal home visits showed potential to increase health service contact during a sensitive period of development, indicating the need to start such programmes before birth, when there is more time for maternal care, and family engagement in a network of services is facilitated.

Preliminary psychometric properties of the Brazilian Portuguese version of the emotional outburst questionnaire

This study focuses on the cross-cultural adaptation of the Emotional Outburst Questionnaire (EOQ) to Brazilian Portuguese and preliminarily assesses its predictive validity. The EOQ evaluates aspects of emotional outbursts (EO), including frequency, duration, intensity, types, associated behaviours, recovery time, triggers, and effectiveness of calming strategies. Two independent translators performed the translation, with subsequent synthesis and analysis revealing that only 33 items (24.81%) required revision. Among these, one item needed partial modification, and two needed total modification. The study demonstrated strong content validity and adaptation in terms of conceptual, idiomatic, and semantic aspects. The EOQ's predictive validity was assessed by analysing the interruption of mental health services in Brazil due to Covid-19 (T1) compared to when services resumed after social distancing measures were lifted (T2). Parents of 25 individuals with developmental disabilities (ASD, DS and ID), with a mean of 11 y/o, mostly male (76%), completed the EOQ. Service interruption during T1 led to increased frequency and duration of severe emotional outbursts reported by caregivers compared to T2 (frequency: p < .001; duration: p = 0.05). This suggests that the EOQ exhibits predictive validity and sensitivity to changes influenced by individual contexts. These findings highlight the EOQ's potential as an outcome measure for intervention development.

Occupations of users of a Brazilian mental health service during the COVID-19 pandemic

ABSTRACT The coronavirus disease 2019 (COVID-19) pandemic and its resulting health measures led to occupational disruption in several contexts of everyday life. This study aimed to investigate the occupations of users of a unique Brazilian mental health service during the pandemic. This qualitative case study utilized semi-structured interviews to examine the lived experiences of 14 individuals (11 male and 3 female) who were users of a Center of Convivência for mental health. The participants were primarily from low-income backgrounds and mostly identified as Black. Two categories emerged from the content analysis: occupations experienced in and through the Center of Convivência and at home. The center was one of the few places attended by users outside home. During the pandemic, users reduced their weekly attendance, choices, and modality for participating in workshops at the center. Also, they presented a home-restricted life before the pandemic, with limited social circulation, access to leisure and work opportunities. Thus, users had few changes in routine during the pandemic, and housework was their main occupation. Although users had no changes in the existing social limitations and occupational deprivation in the home environment, they experienced occupational disruptions in the Center of Convivência during the pandemic.