Brazilian Unified Health System Research Articles

Evolution of orthodontic services in the Brazilian Unified Health System: a time series analysis (2011-2022).

Although malocclusion is the third most prevalent oral health condition, orthodontics is not part of the minimum list of mandatory specialties to be offered in the Dental Specialty Centers of the Brazilian public health system, but rather as optional. Since the acknowledgment of this field as a part of the Brazilian Unified Health System (SUS), access to orthodontic procedures has become optional by municipal governments. Therefore, this study analyzed the evolution of orthodontic procedure provision within SUS from 2011 to 2022. We conducted a retrospective observational study of time series analysis trends on the number of orthodontic procedures and municipalities offering them. The presentation of findings followed the recommendations of the Reporting of Studies Conducted using Observational Routinely Collected Data. Secondary data from 2011 to 2022 were collected from the SUS Department of Informatics. Orthodontic procedures were organized by year, region, state, and municipality. The study applied descriptive analyses, and the Prais-Winsten generalized linear regressions for time series analysis. The quantity of municipalities offering orthodontic procedures have shown a small increasing during period analyzed (from 128 to 157). Northeast and South macro-regions have increased consistently the municipalities with orthodontic offering. All regions showed stable trends for each procedure, except for the South, which exhibited increasing rates of space maintainer placement (Annual Percentage Change (APC): 72.95; 95% CI: 31.6, 127.3) and maintenance sessions (APC: 15.40; 95% CI: 4.5, 27.5). The study showed decreasing trends for appliance removal in the South (APC: -38.07; 95% CI: -47.1, -27.5) and Northeast (APC: -25.19; 95% CI: -36.5, -11.9) regions. From 2011 to 2022, there was a small increase in number of municipalities offering orthodontic procedures in the Brazilian public health system, in addition to a stationary trend for almost all types of procedures.

Patients' Nonattendance in Outpatient Specialist Consultations: A National Cohort Analysis of a Health System.

Analyzing patients' nonattendance at medical appointments helps address an issue impacting the management and sustainability of health systems globally, providing valuable insights for healthcare managers. This study aims to identify factors at both patient and health system levels that contribute to understanding missed appointments. The analysis was conducted using data from secondary care consultations within the Brazilian Unified Health System between April 2018 and March 2020. Primary care includes general medical consultations, while secondary care involves specialized services provided by doctors with advanced expertise. We examined demographic factors (age, sex, race/color, socioeconomic level) and health system practices (waiting time, hospitalization, distance to service, medical specialty, and severity of clinical condition) to assess their impact on patient attendance. A weighted analysis and receiver operating characteristic (ROC) analysis were applied to determine the relative risk of nonattendance. Of 5,003,159 consultations, 435,523 (8.7%) were missed. Nonattendance was highest among patients facing long distances to the service (13.3%, [RRR] 1.227), younger age (16-30 years: 11.8%, [RRR] 1.041), and waiting times (>30: 10.9%, [RRR] 1.738). Socially vulnerable patients were more likely to miss appointments (9.6%, [RRR] 1.055) compared to less vulnerable groups (8.6%). Practice-level factors had a slightly greater impact on nonattendance (ROC: 0.621) than patient-level factors (ROC: 0.5674). The overall predictive model achieved a C statistic of 0.6228, resulting in a fair predictive ability. However, the model showed only modest prediction of no-shows, indicating the need for more detailed data to improve accuracy. Gauging which group suffers the highest risk of nonattendance was a secondary goal of this analysis. Young, socially vulnerable patients with long commutes and extended waiting times are at higher risk of nonattendance. Effective management of these risk factors and targeted preventive actions are essential to reduce absenteeism and improve health system efficiency.

Development of optimized standardized extracts of Echinodorus macrophyllus for arthritis management

Ethnopharmacological relevanceEchinodorus macrophyllus is a medicinal plant traditionally used in Brazil to treat rheumatic diseases. It is listed as a priority species for the development of herbal preparations for the Brazilian Unified Health System (SUS). Previous studies have demonstrated the anti-inflammatory and antiedematogenic properties of extracts and fractions from this species, but these preparations were neither standardized nor optimized for anti-arthritis effects. Aim of studyThis study aimed to investigate the anti-inflammatory and antiarthritic effects of various standardized extracts from the aerial parts of E. macrophyllus and to outline their mechanisms of action. The goal was to define an extract suitable for future scientific validation and clinical use. Material and methodsExtracts from the aerial parts of E. macrophyllus were prepared through percolation with 96°GL ethanol (EtOH) and hydroethanolic solutions at 90%, 70%, and 50% (v/v). They were standardized based on the contents of six chemical markers quantified by UPLC-DAD. Mice with acute or chronic antigen-induced arthritis (AIA) were treated with the extracts orally. The effects were evaluated by counting total and differential inflammatory cells, measuring cytokines by ELISA, and by histological analysis with toluidine blue staining. The mechanism of selected extracts was investigated in LPS-stimulated murine chondrocytes. ResultsAll extracts, except for the 90% EtOH extract, exhibited significant anti-inflammatory activity in acute AIA, reducing the migration of total inflammatory cells, neutrophils, and monocytes to the intra-articular cavity. In chronic AIA, both the 96°GL EtOH and 70% EtOH extracts markedly reduced the migration of total inflammatory cells, neutrophils, and monocytes to the intra-articular cavity, decreased IL-1β and CXCL1 levels in the periarticular tissue, and diminished proteoglycan loss in the articular cartilage. Both extracts reduced IL-6 release and MMP-3 expression in LPS-stimulated chondrocytes. The 70% EtOH and 50% EtOH extracts showed heightened activity and higher levels of chemical markers, notably cinnamoyl-tartaric acid derivatives. ConclusionsThe standardized 70% EtOH and 50% EtOH extracts from the aerial parts of E. macrophyllus, which contain higher levels of chemical markers, exhibit potent anti-inflammatory activity and reduce proteoglycan degradation. These extracts are potentially useful for developing herbal preparations to manage arthritic conditions and should be prioritized for further studies.

A ATUAÇÃO DO PSICÓLOGO NAS PRÁTICAS MULTIPROFISSIONAIS DA GESTÃO DA SAÚDE PÚBLICA

The psychologist’s role in public health management has become essential in providing comprehensive care to users of the Brazilian Unified Health System (SUS). Through a multidisciplinary approach, psychology contributes to understanding the psychological and social demands of individuals, while promoting mental health care strategies that complement medical and social practices. This chapter explores the role of the psychologist in public health, emphasizing their integration into multidisciplinary teams, especially in Psychosocial Care Centers (CAPS) and Primary Health Care. The challenges and potentialities of psychological practice in a context of shared management focused on promoting biopsychosocial well-being will be discussed.

Environmental Education and Health Promotion: Diagnosis of the Epidemiological Profile of Dengue Cases in the City of Anápolis, Goiás, From 2014 to 2017

Objective: The aim of this study is to investigate the epidemiological profile of dengue cases reported in the city of Anápolis - Goiás, during the years 2014 to 2017, with the aim of providing an overview to support control and prevention actions. Theoretical Framework: Considered a Public Health problem in Brazil, dengue is a disease transmitted by the main arbovirus vector, the Aedes aegypti mosquito, through the bite of an infected female, which causes morbidity in the country and it is re-emerging. In the case of dengue fever in the urban environment, it is necessary to monitor the epidemiology, due to the probability of epidemics due to the conditions that facilitate the formation of the transmission chain. Method: The methodology adopted for this research was an exploratory study, in order to understand the subject to be addressed, and a documentary research to present the data, which were obtained from the Notifiable Diseases Information System – Goiás (SINAN), and in the IT Department of the Brazilian Unified Health System / Health Information System (DATASUS). Results and Discussion: During the period evaluated, 22,592 cases were reported. Data for the years 2014 to 2017 showed that the number of cases of dengue fluctuated over the period studied and the need for more investment in information as a disease prevention strategy. Research Implications: The practical and theoretical implications of this research are discussed below, providing insights into how the results can be applied or influence practices in the field of Epidemiology and Environmental Sciences. These implications can cover the Surveillance and Health Care sectors, as well as directly impact the management sector. Originality/Value: This study contributes to the democratization of information and is relevant for identifying the epidemiological reality of certain geographic areas, identifying certain weaknesses and providing data for managers in light of scientific evidence.

Integralidade na formação de Terapeutas Ocupacionais: análise das percepções e estrutura curricular da Graduação

Introduction: Integrative and Complementary Health Practices (PICS) in the area of ​​Occupational Therapy (OT) require training and discussion in the graduation process to guarantee access and care within the integral reasoning of the body, mind, emotions and connections. Objectives: To verify the training, perceptions and experiences with PICS of OT undergraduates at the Faculty of Medicine of Ribeirão Preto at the University of São Paulo. Methods: Cross-sectional, exploratory, descriptive and quantitative study using an online questionnaire developed in research with undergraduates in the last semester and analysis of the curricular structure and teaching plans. Results and discussion: Of the total of 17 undergraduates, 12 reported knowledge about PICS (100%), 92% used them for personal purposes, and 17% stated doubts about their effectiveness and uncertainty about their credibility in the Brazilian Unified Health System (SUS) as a therapeutic resource in the profession. There was minimal training offered on PICS, of the 69 subjects in the undergraduate course, 3 dealt with the topic in a theoretical and experimental way, with a low workload and insufficient content for logic and professional use. Final considerations: There is a need for curricular changes to incorporate these practices as a therapeutic resource within the profession in order to guarantee access and quality care to the population.

Narrativa, tempo e memória: subjetividades sobre vacina e seus efeitos políticos na saúde

Narratives are produced, put into circulation and serve as references for social actors to give meaning to their actions. Based on this communication circuit and the way the so-called commercial media constructs its statements, we have been interested in observing how the meanings about the vaccine and vaccination, compulsory or not, that have circulated during the covid-19 pandemic in the newspapers Correio Braziliense, O Globo and O Estado de São Paulo have been constructed and how much these meanings are immersed - and to what extent they can be understood - in a field of disputes. Understanding this process from the perspective of the field of Communication and Health, it becomes possible to identify traces, clues, signs of a complex game that is established around the way in which the right to health can be exercised. These narrative strategies, intertwined with time and memory, configure forms of action in the world whose marks are very long-lasting. By using the aesthetic-expressive paradigm to identify these characteristics, it becomes possible to understand that resorting to a certain immunizer over others is less than a simple individual choice. Rather, it is an effect of the way in which health, and especially the Brazilian Unified Health System, has been presented for almost four decades.

Welcoming pregnant women as a strategy for adherence to dental prenatal care and health promotion in early childhood

This research deals with implementing Dental Prenatal Care as a public policy in the Brazilian Unified Health System (SUS) to care for pregnant women and their future babies. The legal framework that assures pregnant women's rights of priority in accessing services is usually not enough to guarantee the health promotion coverage goals for this population group, who frequently have low adherence to dental care. Brazilian Unified Healthcare System (SUS) recommends monitoring pregnant women through eight mensal consultations during healthy pregnancy. Oral health is usually not monitored to the same extent, and many pregnant women still go through pregnancy without any dental consultation. This study was proposed to improve dental prenatal care and program adherence by mothers and children in the Basic Healthcare Unit Amaro José de Souza, in the municipality of Barueri, through the increased participation of the dental surgeon in the pregnant women welcoming team. A cross-sectional cohort study was designed to identify and meet the demands of low-risk pregnant women. For six months, all the women attending prenatal care at BHU Amaro José de Souza in Barueri were invited to participate and receive personal guidance from the multi-professional team. Information on dental health was investigated through questions targeting previous knowledge about the recommended moments for the first dental appointment of a child, the importance of exclusive nasal respiration, the identification of craniofacial asymmetries at birth, and general baby care. Attitudes and self-care were also investigated, including prenatal program adherence. Answers were collected in a Google Form platform and analyzed to characterize the group's literacy about prenatal care and breastfeeding and identify information needs about dental health care during pregnancy. At the same time, a welcoming expanded listening, educational, and preventive health action was developed: conversation and sharing experience groups were promoted monthly for pregnant women, breastfeeding mothers, and their families. 90 pregnant women out of the 104 attending the BHU in the six months of the research were invited, and 83 agreed to participate. All the participants declared at least one previous appointment with the healthcare team, 92.8 % of them, with a gynecologist. The nursing team was involved in 53.0 % of the appointments, but only 6.0 % were reported to have been conducted exclusively by a nurse. A dental surgeon appointment was mentioned by 30.1 % of the research participants. The dental health literacy investigation revealed that 57.8 % believed they should only take their babies to a dental appointment after teething, and 27.7 % were aware of the child's craniofacial asymmetries at birth. Only 28.9 % had previous knowledge about the importance of exclusive nasal respiration. Despite only 34.9 % having their first pregnancy, 78.3 % declared they would appreciate receiving information about pregnancy. After the guidance, 72.0 % of the pregnant women had undergone dental prenatal care. Workshops for pregnant women and breastfeeding mothers provided a convenient welcoming space, to listen and provide guidance to pregnant women and their families, in addition to demystifying the fear of dental care during pregnancy and breastfeeding. The intervention to guide pregnant women to perceive the BHU as an educational and health promotion space, not just a curative intervention, effectively increased adherence to dental prenatal care. The contact with the Specialist in Functional Jaw Orthopedics in this first phase of life facilitated dental health education and access to more complex cases. The prenatal program adherence, the pregnant woman’s self-care, and the care of the baby were favored by the welcoming, expanded listening, and personalized service.

Assessment of the COVID-19 impact on the Brazilian Unified Health System (SUS) financing: an analysis of the financing dynamics of 2020 and 2021

BackgroundAfter the establishment of the public health emergency of international concern in 2020, health systems worldwide and in Brazil observed the need to apply more extraordinary logistical efforts and possibly resources to combat the imminent pandemic.MethodsUsing the historical series of public expenditures of the National Health Fund (FNS), 2015 to 2021, the number of confirmed cases of COVID-19, and a seasonal ARIMAX model, we sought to assess how the increase in the new virus infections affected the systematic financing of the SUS in Brazil.ResultsThere were signs of seasonality and an increasing trend in the expenditure variable, which in practical terms, only indicated that the resource contributions followed an increasing trajectory already underway before the advent of the pandemic. The 1% increase in COVID-19 cases, with a one-month lag, contributes to the 0.062% increase in the variation in FNS expenditures but a decrease of 0.058% with a two-month lag.ConclusionThe tests showed no evidence to confirm a positive shift on FNS spending growth trajectory due to the increase of COVID-19 cases, only observing a significant increase one month after the occurrence of COVID cases, probably due to their worsening after this period, which was followed by a similar and comparable decrease in percentage of growth in the following month.

Racial Disparities in Foot Examination among People with Diabetes in Brazil: A Nationwide Survey, 2019.

To assess the absence of diabetic foot examination in Brazil and how ethnicity affected this outcome. This is an analysis of a nationwide survey held in Brazil in 2019. Participants with diabetes and that were 15 years of age or older were eligible for inclusion in the analysis. Adjusted Poisson regression with robust variance was used to calculate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) of never having had the foot examined, with separate models according to ethnicity. Stata 14.2 was used for all calculations. We included 6216 individuals with diabetes; 52.1% (95%CI: 50.0%-54.2%) reported never having had their feet examined by a health care professional and 61% self-declared as Black (Black and Brown [Brazilian mixed race]). A higher frequency of negligence was observed among Black individuals (55.3%; 52.5%-58.1%) than among White individuals (48.2%; 45.0%-51.5%). Negligence was higher between 15- to 39-year-old participants (PR = 1.34, 1.14-1.57), lower educational level (PR = 1.37, 1.13-1.65), higher alcohol consumption (PR = 1.18, 1.06-1.31), fair health status (PR = 1.11, 1.01-1.21), and diabetes diagnosis of up to 10 years (PR = 1.42, 1.28-1.57). Among Blacks, tobacco use and other factors increased the frequency of the outcome, whereas participation in the Brazilian Unified Health System primary care program was a protection factor (P<.05). Black Brazilians with diabetes had higher negligence of foot examination by health care professionals. Strengthening primary care would help mitigate systemic racism in Brazil.

MORTALIDADE DE PESSOAS IDOSAS POR NEOPLASIAS MALIGNAS DOS ÓRGÃOS GENITAIS

Introduction: This article discusses malignant neoplasms of the genital organs in the elderly, in both sexes, in the last ten years, as the elderly population and the number of cancers in the reproductive systems are growing. Objective: To investigate the mortality of elderly people due to malignant neoplasms of the genital organs, according to sex, in the state of Minas Gerais, in the last 10 years. Methodology: This is a descriptive study, with a quantitative, longitudinal approach, carried out using secondary data collected through DATASUS (Informatics Department of the Brazilian Unified Health System). Results and Discussion: From 2013 to 2022, 15,036 deaths of elderly men due to malignant neoplasms of the genital organs were recorded, and 7,965 deaths of elderly women, which corresponded to 65.37% and 34.62% respectively. Men were the most affected by neoplasms of the genital organs in the period studied, and deaths increased with age; It is believed that this is due to the greater omission in seeking public health assistance. In men, the most evident cancer was prostate cancer; in women, the cervix. Conclusion: Health monitoring of elderly people is essential, as this is the population that has grown the most in recent years, in addition to being the most affected by neoplasms. The research highlighted an overview of the number of cases that can favor the planning of strategies to approach this population.

HEMATOPOIETIC CELL TRANSPLANTATION (HCT) FOR ALL: A report from the 2024 Congress of the Brazilian Bone Marrow Transplantation and Cellular Therapy Society (SBTMO)

This article analyzes current data, and the main challenges faced in Hematopoietic cell Transplantation (HCT) in Brazil, as presented at the SBTMO 2024 meeting, with the aim of guiding future actions. Topics discussed included the waiting list for HCT transplants, access to beds for adults and pediatric patients, and the need for a more efficient distribution of resources across the country. Among the identified needs were the creation of a program to expand access to transplants through the Brazilian Unified Health System (SUS), the importance of health registries for data-driven decisions, and the development of the "Mais Saúde Amazônia" project to expand transplant centers in the Amazon region. Additionally, the provision of financial incentives for transplant centers, the implementation of mentorship programs to increase access to HCT, and the formation of a cooperative network between SBTMO (Brazilian Society of Bone Marrow Transplantation and Cellular Therapy), ABHH (Brazilian Association of Hematology, Hemotherapy, and Cellular Therapy), ANVISA (Brazilian Health Regulatory Agency), ABRALE (Brazilian Association of Lymphoma and Leukemia), and INCA (Brazilian National Cancer Institute) to improve the integration of HCT services were discussed

Amplitude do rastreio e diagnóstico do câncer de mama no estado do Piauí e o impacto da pandemia da COVID-19

Introduction: The COVID-19 pandemic has brought about a new epidemiological reality worldwide that is responsible for altering the entire dynamics of addressing health issues globally. Cancer management policies were directly impacted, potentially leading to a decline in early case detection and a consequent increase in morbidity and mortality among patients with cancer. Objective: To analyze the impacts of the pandemic on breast cancer screening measures in the state of Piauí. Method: This epidemiological study used secondary data provided by the Department of Health Information of the Brazilian Unified Health System regarding the performance of mammograms and breast cancer diagnoses in the state of Piauí between 2017 and 2021. Results: Between 2017 and 2019, an average of 39,165 mammograms were performed annually, compared with an average of 22,367 exams in each year between 2020 and 2021. The data presented in this study indicate a significant decrease in the number of exams performed, associated with a decline in the absolute number of diagnoses, as well as delayed diagnoses. Conclusions: The scenario described in this study suggests the possibility of developing an epidemiological emergency related to breast cancer, both due to the structural incapacity of the state of Piauí to provide adequate assistance to patients and the increasing observation of more advanced cases. Therefore, we highlight the need for intensified efforts to strengthen breast cancer management and early diagnosis strategies in the state of Piauí.

Brazil’s Unified Health System: the fight for a universal right in an unequal country

This article analyzes Brazil's Unified Health System (SUS), established by the 1988 Constitution. The article initially presents the previous trajectory of national health policy and the context of democratization in the 1980s, which favored health reform and created a public, universal, and comprehensive health system. It then explores the advances and contradictions recorded in more than three decades of implementation of the SUS. The main advances observed were the creation of institutional mechanisms compatible with the federative arrangement and social participation, political and administrative decentralization, the national expansion of access to health, changes in the health care model, including strengthening primary care, and improvements in health indicators. On the other hand, the persistence of structural problems and disputes between different health agendas, with differences between governments, led to contradictions in financing and public-private relations in health. Despite the differences between countries, the analysis of the Brazilian case provides lessons on the challenges in building universal health systems in Latin America.

Earth observation data uncover green spaces’ role in mental health

The prevalence of mental health disorders, a key disability cause, is linked to demographic and socioeconomic factors. However, limited data exists on mental health and the urban environment. Urbanization exposes populations to environmental stressors, particularly affecting low-middle-income countries with complex urban arrangements. We used remote sensing and census data to investigate potential connections between environmental factors and mental health disorders. Land cover variables were assessed using the European Space Agency (ESA) global WorldCover product at 10 m resolution together with the database of mental health diagnosed cases (n = 5769) from the Brazilian Unified Health System’s Department of Informatics (DATASUS) from every health facility of the city of Porto Alegre. The association of mental health data with land cover was established with machine learning algorithms and polynomial regression models. The results suggest that higher trees cover at neighborhood level was associated with better mental health index. A lower mental health index was also found to be associated with an higher Human Development Index. Our results highlight the potential of greenness in the city environment to achieve substantially better mental health outcomes.

Popular Participation And Social Control As A Principle Of The Brazilian Unified Health System (SUS)

The following article addresses the importance of popular participation and social control in the Brazilian Unified Health System (SUS), as established by the Federal Constitution of 1988. These principles aim to ensure that health is a universal right and a state duty, and that the community plays an active role in the formulation, implementation, and oversight of health policies. Popular participation allows citizens to influence health decisions and ensures that their needs are reflected in public policies. This is achieved through meetings, consultations, and public hearings. Social control enables citizens to oversee the implementation of health policies, ensuring transparency and accountability among health managers. Health Councils, Health Conferences, and Health Ombudsman Offices are the main mechanisms for implementing these principles. Health Councils, operating at municipal, state, and federal levels, include representatives from the government, health professionals, and users, and are involved in the formulation, evaluation, and oversight of health policies. Health Conferences bring together a broad range of participants to discuss and propose improvements to the SUS, while Ombudsman Offices serve as channels for citizens to file complaints, suggestions, and reports of irregularities. However, the text also highlights challenges such as low community engagement, lack of resources and training, and issues of representativeness. These challenges impact the effectiveness of Health Councils and Conferences. To overcome these issues, it is necessary to promote greater awareness, improve infrastructure, and ensure diverse representation, ensuring that health policies adequately address the needs of the population.

P085 BLOOD PRESSURE AND THE CARDIOMETABOLIC PROFILE IN YOUNG ADULTS ASSISTED IN PRIMARY HEALTH CARE – LapARC MULTICENTRIC STUDY

Introduction: Hypertension, diabetes mellitus, dyslipidemia, obesity and smoking are risk factors that impact the emergence of subclinical lesions and contribute to increased cardiovascular (CV) morbidity and mortality. Objective: to evaluate the cardiometabolic profile and blood pressure levels in young adults treated in primary care in the Brazilian Unified Health System. Methods: Multicenter cross-sectional population study (arm of the LapARC study – Rio de Janeiro) approved by the Ethics Committee under registration: 5,046,133. Our center is located in the municipality of Santarém, Pará, Brazilian Amazon. Young adults (20 to 50 years old) were evaluated in relation to their cardiovascular risk profile, sociodemographic, anthropometry and laboratory tests. Office blood pressure (BP) was measured and patients underwent Home Blood Pressure Monitoring (HBPM), with a seven-day protocol. Results: 161 individuals were included (81.4% female; mean age 39.6 ± 7.9 years), 90% declared themselves black and mixed race and 27.3% had low education. More than half of the population has 3 or more CV risk factors (55.9%), with dyslipidemia being the most prevalent (60.2%), followed by hypertension (55.9%) and women with significantly more abdominal obesity (67.2% vs 30.0%, p&lt;0.001). Among hypertensives, 84.4% knew the diagnosis, of which 71 were treated, with only 31.1% reaching blood pressure control. The most frequently mentioned antihypertensives were renin-angiotensin-aldosterone system inhibitors (36.6%) and diuretics (18.6%). Men had higher office and home systolic BP levels than women (136 ± 22 vs 128 ± 23 and 127 ± 21 vs 116 ± 15, p&lt;0.05), respectively. Furthermore, the mean ankle-brachial index was 1.12 [1.07-1.20]. After HBPM, 20.9% of individuals were identified with masked hypertension, only 1.2% with white coat hypertension and 26.7% with sustained hypertension. Conclusion: although apparently healthy, this population have an adverse cardiometabolic profile, marked by low blood pressure control and the prevalence of masked hypertension, which justifies the continuation of the study.

P136 EMOTIONAL DISORDERS AND CARDIOVASCULAR RISK PROFILE IN YOUNG ADULTS IN PRIMARY HEALTH CARE – MULTICENTRIC LAPARC STUDY

Introduction: Several factors are associated with the diseases genesis that affect heart and blood vessels, and emotional disorders, such as depression and anxiety, are progressively related to an increase in cardiovascular risk. Objective: to evaluate the cardiovascular risk profile and the prevalence of anxiety and depression in young adults receiving primary care in the Brazilian Unified Health System. Methods: This is a multicenter cross-sectional population study (arm of the LapARC study–Rio de Janeiro) developed in a center in Santarém, Pará, located in the Brazilian Amazon. Young adults (20 to 50 years old) were evaluated in relation to their cardiovascular risk profile, sociodemographic characteristics, anthropometry, electrical bioimpedance and laboratory tests. Blood pressure (BP) was measured in the office and Home Blood Pressure Monitoring (HBPM) was performed with a 7-day protocol. In screening for depression and anxiety, the PHQ-9 and GAD-7 questionnaires were applied, respectively. Results: 161 individuals were included (81.4% female; mean age 39.6 ± 7.9 years). More than half of the population has 3 or more risk factors (55.9%), with dyslipidemia being the most prevalent (60.2%), followed by hypertension (55.9%) and obesity (41.0%). Women had significantly more abdominal obesity (67.2% vs 30.0%, p&lt;0.001), with a higher percentage of body fat (42.2 ± 7.5 vs 28.7 ± 7.8%, p&lt;0.001). Men have a higher prevalence of dyslipidemia (80.0% vs 55.7%, p&lt;0.05). Regarding emotional disorders, we observed high prevalence in the moderate/severe category of depression (51.6%) and anxiety (57.8%), both conditions being significantly higher among women (55.7% vs 33.3%, p&lt;0.05|63.4% vs 33.3%, p&lt;0.05), respectively. Conclusion: the population, although apparently young and healthy, presented moderate and high risk, which associated with the high prevalence of symptoms of depression and anxiety, can increase the risk for the emergence of cardiovascular diseases, which supports the importance of continuing the study, in order to understand the behavior of these variables in this age group and draw attention to psychological screening and monitoring in primary health care.

Equity And Inclusion For Access To The Brazilian Unified Health System (SUS)

The concept of equity in the Unified Health System (SUS) is crucial for ensuring a fair distribution of resources and health opportunities, taking into account the specific needs of different population groups. This principle aims not only to ensure universal access to health services but also to adjust these services to address socioeconomic, geographic, and cultural inequalities. Equity in SUS involves providing additional support to the most vulnerable populations, such as individuals with low income, those living in remote areas, and groups facing cultural and language barriers. Significant challenges include regional disparities, with inadequate health infrastructure in rural and peripheral areas, and socioeconomic inequalities that hinder access to care due to indirect costs and lack of information. To address these challenges, SUS must adopt multifaceted strategies, including increased funding and resources for underserved areas, public policies to reduce socioeconomic inequalities, and investments in transportation and health education. Inclusion in SUS is equally fundamental, requiring the removal of physical and social barriers, the promotion of a culture of respect and cultural competence among health professionals, and the active participation of diverse groups in health policy formulation. Additional strategies involve interinstitutional collaboration, community engagement, and the collection and analysis of disaggregated data to inform targeted policies. These approaches aim to create a fairer and more inclusive health system capable of meeting the needs of the entire Brazilian population

Effect of reiki on people with advanced cancer: a randomized controlled trial

Introduction: Reiki is an Integrative and Complementary Health Practice (PICS), recognized and incorporated into the table of procedures of Brazil's Unified Health System (SUS). Objective: To evaluate the effects of applying Reiki in relieving the symptoms of people with advanced cancer who are hospitalized. Methodology: Randomized controlled study, approved by the Research Ethics Committee, to verify the effect of applying Reiki to people with advanced cancer, admitted to a large, highly complex university hospital located in the interior of the state of São Paulo, Brazil. Fourteen participants were selected from the clinical oncology ward and randomly divided into two groups - Reiki and control - with seven participants each. For data collection, an anamnesis was taken, blood pressure and heart rate were measured, saliva was collected to check cortisol levels; the Edmonton Symptom Assessment System (ESAS), Hospital Anxiety and Depression Scale (HAD-S) and Karnofsky Performance Status (KPS) were applied; Reiki was applied for 21 minutes to participants in the Reiki group and, 30 minutes after Reiki, the scales were reapplied and salivary cortisol was collected again. Results: The Mann-Whitney U-test showed a statistically significant difference for the sleep variable (p&lt;0.007) in the intervention group when compared to the control group. Conclusion: The results showed that Reiki improved the sleep of the participants in this randomized controlled trial and demonstrated that, despite the small caseload, the methodology used is valid for studying the impact of Reiki on the symptoms of people with advanced cancer.