The aim of the present study was to analyze technological arrangements for the management of care and beds at a public reference hospital in Portugal. Technological arrangements combine technologies and management practices for greater effectiveness in complex organizational contexts and are used to address challenges, such as excessive demand, rising costs, and complaints with regards to the quality of care. The application of technological arrangements in different contexts has produced varying results and studies are needed to address the impact on interprofessional relationships and the connection between hospitals and service networks. A qualitative, ethnographic case study was conducted, involving 15 interviews with 22 administrators and employees as well as participant observation of three technological arrangements: Inpatient Management Support Service; 11 a.m. Meeting; and High Users Resolution Group. Technological arrangements for managing admissions (input), care (throughput), and hospital discharges (output) were described. The in-depth observation highlighted the dynamics, potential, and challenges of technological arrangements for integrating bed and discharge management. When well implemented, technological arrangements help address hospital overcrowding, but do not solve systemic problems related to discharge and the continuity of care in the network. Strong employee adherence to technological arrangements was found, with a focus on the leadership of nursing staff and the silence of physicians, suggesting new challenges related to autonomy and power. Technological arrangements are effective at bed and care management, alter multidisciplinary practices and interprofessional relationships, and exert an impact on the network of external services. The production of contemporary hospitals requires evidence-based technological arrangements that increase efficiency, sustainability, as well as technical and organizational capabilities.

[This corrects the article doi: 10.1590/0102-311XEN200624].

Internalized stigma has been strongly linked to mental health issues in people living with HIV/AIDS (PLHA), particularly depression. Nonetheless, the overlap between depressive symptoms and other psychopathologies is well-known among specialists. This study aimed to examine the factors predicting depressive and anxiety symptoms in PLHA. This is a community-based study (Stigma Index Brazil 2.0) that involved 1,784 PLHA recruited from seven Brazilian state capitals. Outcomes of interest were derived from the Patient Health Questionnaire (PHQ), and covariates included factors previously linked to poor mental health outcomes, such as social vulnerability, treatment adherence, internalized stigma, among others identified in the Stigma Index study. Internalized stigma was significantly associated with worse mental health outcomes across all models (i.e., depression, anxiety, and total PHQ-4 score). Moreover, other variables were differentially associated with each outcome, possibly indicating distinct pathways with which healthcare professionals might address the burden of mental suffering in PLHA. Clear implications for public policies are equally outlined.

Practices developed by nurses of family health teams (FHTs) in remote rural municipalities were analyzed. A multiple case study with a qualitative approach was conducted through 52 interviews with nurses from 27 remote rural municipalities distributed across 10 states. With few specificities among the remote rural municipalities, nurses stood out for developing a broad range of skills related to management activities, individual care practices, and actions in the local community. Irrespective of the obstacles to care faced by FHTs, the work of nurses stood out in all remote rural municipalities to overcome adversities, reestablish patient flow, and minimize the lack of care as much as possible. In all remote rural municipalities, nurses sought to reestablish the communication link and enable the continuity of care for individuals who required assistance outside primary care. None of the nurses established dialogue between folk knowledge and the biomedical actions of the practices established in primary care but recognized the cultural and ethnic diversity in the local communities. In summary, nurses in the remote rural municipalities sought to overcome communication difficulties and forged - although in a limited way - practices sensitive to the needs of individuals and the community.

This study aimed to evaluate whether individuals who self-identify as black and/or mixed-race have a higher prevalence of tooth loss compared to white individuals in Brazil, using a systematic review and meta-analysis. Searches were conducted in the PubMed, Scopus, Web of Science, Virtual Health Library, Embase, and gray literature databases. Two independent reviewers performed the searches and article selection processes. The Newcastle-Ottawa Scale was used for observational cohort studies, and its modified version was used for cross-sectional studies. The I2 statistic assessed the heterogeneity of studies included in the meta-analyses. Of the 25 articles eligible for qualitative evaluation, 17 were included in the quantitative assessment. Sample sizes ranged from 101 to 18,718 individuals aged 11 to 74 years. Most studies compared white individuals to non-white individuals (black, mixed-race, Asian, and Indigenous people). In the comparison between white and non-white individuals, no differences were found concerning edentulism (OR = 0.86; 95%CI: 0.71; 1.06), absence of functional dentition (OR = 0.82; 95%CI: 0.33; 2.03), or mean number of missing teeth (MD = -0.21; 95%CI: -2.92; 2.49), but it was associated with tooth loss (OR = 1.40; 95%CI: 1.26; 1.55). When comparing black/mixed-race people to white individuals, tooth loss was higher among those who self-identified as black/mixed-race (OR = 1.41; 95%CI: 1.27; 1.57). This difference was also observed when comparing black/mixed-race individuals to other races/skin color (OR = 1.24; 95%CI: 1.15; 1.33). Overall, studies conducted in Brazil found that tooth loss was more prevalent among self-declared black and/or mixed-race individuals.

This article describes methodological aspects and characterizes participation in the first year of the study Impact of Regulation of the School Food Environment. The aim was to monitor food sales in and around private school canteen in three Brazilian cities with different regulatory contexts and investigate the perceptions of students with regards to canteen. A repeated cross-sectional study (2023/2024 and 2025) was conducted with independent samples in the cities of Recife (Pernambuco State), Niterói (Rio de Janeiro State), and Porto Alegre (Rio Grande do Sul State). For the Canteen Module, sampling involved private primary schools and high schools stratified by school size and with inverse replacement. A convenience sample was used for the Street Vendor Module and 3-stage cluster sampling was used for the Student Module. The first two modules replicate the method of the Food Commercialization in Brazilian Schools study. The first data collection process took place between September 2023 and May 2024. Two hundred two schools and 532 students participated. Only three street vendors were located. School participation rates were 47.8% in Porto Alegre, 53.9% in Niterói, and 69.9% in Recife. Schools were reluctant to participate in the survey, which prolonged the data collection process. This article discusses the challenges faced during fieldwork and the methodological adjustments required for the second year of monitoring, offering recommendations for future studies in the school setting. This project is the result of a collaboration between academia and organized civil society, which required information to support advocacy for healthy eating at schools. The evidence generated could assist in the formulation and improvement of protection policies for the school food environment in other cities and on other governmental levels.

Losses in the tuberculosis (TB) preventive treatment cascade among people living with HIV/AIDS (PLHIV) are frequent, ranging from the identification of individuals at risk to treatment completion. This study aimed to analyze the factors associated with the completion of TB preventive treatment and the effect of the 3HP regimen on this outcome among PLHIV in Brazil between 2021 and 2023. A retrospective cohort study was conducted using secondary data from the Information System for the Notification of People Undergoing Treatment for Latent Mycobacterium tuberculosis Infection (IL-TB). PLHIV aged 18 years or older, regardless of CD4+ T-cell count, who were reported to IL-TB as new cases or re-exposure, were included. The outcome was the completion of TB preventive treatment. Poisson regression with robust variance was used to estimate the relative risk of treatment completion, with a 95% confidence interval. The average effect of the 3HP regimen on treatment completion was estimated using propensity score weighting. A total of 15,171 PLHIV were included, of whom 11,546 (76%) completed TB preventive treatment. Completion rates were higher among individuals aged ≥60 years, those with tuberculin skin test results ≥5 mm, and those who received the 3HP regimen. The 3HP regimen showed an average effect of increasing TB preventive treatment completion by 11%. These findings highlight the positive impact of the 3HP regimen compared to monotherapy with rifampin or isoniazid, suggesting its potential to enhance TB prevention strategies among PLHIV.

Data on the health of black women and the presence of this topic in national journals remain scarce, especially considering the frequent use of the primary care network and the Brazilian Unified National Health System (SUS, acronym in Portuguese) by these women. In this article, we take an intersectional perspective on the categories of gender, race, class, and nationality interlinked to the concept of "social capital" to analyze the perceptions of healthcare services by Congolese women residing in Rio de Janeiro, Brazil, in 2018. A qualitative study was conducted, consisting of participant observation and eight semi-structured interviews conducted at a refugee shelter (Cáritas RJ). The narratives of these women reveal the impact of daily violence on their experiences upon arriving in Brazil to seek shelter. Mistrust, language limitations, and lack of knowledge contribute to the lack of social capital and inaccessibility of services. As black women compose a large group of individuals that use the SUS, their active participation could exert an impact on their experiences with these services. The existence of spaces for listening to vulnerable groups, such as Congolese refugees, is another strategy for promoting equity and universal access to health for everyone.

The aim of the present study was to understand the participation of global health initiatives (GHIs) in addressing the HIV/AIDS epidemic in Guinea-Bissau based on the insights of different social and political actors, representatives of GHIs, the Guinean government, and civil society organizations. A qualitative, descriptive, exploratory case study was conducted involving interviews with 36 participants. Thematic content analysis was employed. The discourses of the participants were organized into four main topics. The results indicate that, besides the government, at least 15 nongovernmental organizations and a strong partnership with Brazil were identified in the response to HIV/AIDS. The limitations and challenges of the government are related to the acquisition of funding and the management of the resources provided by GHIs. The contributions of GHIs were described as positive, considering the internal lack of funding and external dependence, with the Global Fund as the primary funder of HIV/AIDS response actions. This dependence interferes with the autonomy of management and affects coordination. The situation in Guinea-Bissau resembles that of several countries in Sub-Saharan Africa, in which the work of GHIs is characterized by a paradox: dependence on financial resources and the need to decolonize from external aid, which, to some extent, serves as a disciplinary device. The findings underscore the need for the country to adopt characteristics of a stable government, with measures that ensure its autonomy and independence from colonialism.

This cross-sectional study assessed the association of demographic and socioeconomic variables with comorbidities at 40 years of age in participants of the 1982 Pelotas (Brazil) birth cohort. At age 40, study participants were invited to visit the research clinic to be examined and answered an online questionnaire. Subjects reported medical diagnosis of several morbidities that were grouped according to the 11th revision of the International Classification of Diseases into four groups (endocrine, cardiovascular, musculoskeletal, and allergic/respiratory). Ordinal logistic regression was used to estimate the proportional odds ratio, and Brant test to check the proportional odds assumption. Latent class analysis was used to identify multimorbidity patterns, and their association with demographic and socioeconomic factors was evaluated via multinomial logistic regression. A total of 2,986 participants were included in this study. At least one endocrine disorder was reported by 48.1% participant, cardiovascular morbidities by 26.6%, allergic/respiratory morbidities by 59%, and musculoskeletal morbidities by 32.5% of participants. In the latent class analysis, three morbidity patterns were identified: relatively healthy, metabolic and allergic/respiratory. The odds of being in a higher category of number of cardiovascular morbidities was higher among blacks (OR = 1.79; 95%CI: 1.43; 2.24). Notably, lower socioeconomic status was associated with a lower odds of being in a higher category of number of allergic/respiratory morbidities (OR = 0.59; 95%CI: 0.47; 0.74) and a higher odds of being in a higher category of number of cardiovascular and musculoskeletal morbidities. Our findings suggest that multiple morbidities occur in different directions depending on the socioeconomic and educational levels.

This study aimed to characterize the quality of child health care and explore its relationship with municipal characteristics. Using data from the external assessment of the first cycle of the Brazilian National Program for Access and Quality Improvement in Primary Care (PMAQ-AB, acronym in Portuguese), this cross-sectional study evaluated 16,566 Family Health Strategy teams. In total, nine binary indicators were created based on recommendations from the Brazilian Ministry of Health. We employed latent class analysis and multinomial logistic regression to assess the quality of care and its association with region and the Brazilian Deprivation Index. Three patterns of quality of care were identified: high, intermediate, and low adequacy. The "high adequacy" pattern included 22.5% of teams, "intermediate adequacy" 60.2%, and "low adequacy" only 17.3%. Teams in the Northeast Region were over twice as likely to belong to the "high adequacy" pattern (OR = 2.34; 95%CI: 1.15-4.76) compared with those in the Central-West Region. For teams located in municipalities with moderate and low deprivation, the chance of belonging to the "high adequacy" pattern was 2.04 (95%CI: 1.44-2.89) and 9.08 (95%CI: 4.54-18.14) times higher, respectively, compared with the high deprivation municipalities. This study identified three patterns of quality of child care, with most teams characterized by an "intermediate adequacy" pattern. The quality of care was associated with the municipality's characteristics. The methodology used in this study proved effective in characterizing the quality of care in a more consistent way.

This study aims to analyze the distribution of gestational weight gain in a group of Latin American adolescents according to their pre-pregnancy body mass index (BMI, based on the World Health Organization criteria for adolescents and adults) and its association with their newborns' birth weight. This longitudinal retrospective study used secondary data from national or institutional perinatal information systems about pregnant adolescents from Argentina, Colombia, Mexico, Panama, Paraguay, and Uruguay. The degree of agreement between the two classification criteria for the pre-pregnancy BMI was determined with the B statistic and the Bangdiwala graph. The association of newborns' weight with the pre-pregnancy BMI and the gestational weight gain was assessed using regression models. This study included 6,141 pregnant adolescents. When compared to the adolescents' criterion, the pre-pregnancy BMI classification for adults tends to underestimate the assigned category, leading to a higher recommended weight gain. Regardless of the criterion, overweight and high gestational weight gain were significantly associated with a higher probability of newborns with macrosomia and birth weight > P90, obesity was associated with birth weight > P90, and low weight gain was associated with low, insufficient, and < P10 birth weight. In conclusion, pre-pregnancy BMI and gestational weight gain are associated with the birth weight of newborns from Latin American adolescents.

Noncommunicable diseases (NCDs) are the leading causes of morbidity and mortality in Brazil. The aim of the present study was to determine whether the reduction in the occurrence of NCDs by 2030, which is one of the Sustainable Development Goals (SDGs), will be achieved through an analysis of trends in the unconditional probability of premature deaths between 1990 and 2021 in Brazil and its 27 states. A time-series study was conducted on the probability of premature death (30-69 years of age) due to NCDs (cardiovascular diseases, neoplasms, chronic respiratory diseases, and diabetes mellitus) based on data from the 2021 Global Burden of Disease Study. Joinpoint regression models were used to estimate trends and projections up to 2030 using Holt's model. Regional inequalities were assessed based on quintiles of the sociodemographic index (SDI). The probability of premature death due to NCDs reduced from 0.233 (1990) to 0.152 (2021) (average annual percent change = -1.3; p < 0.001), with a decline in all SDI quintiles. Mortality was consistently higher among men. Projections indicate that the target of a one-third reduction by 2030 will likely not be achieved, especially in the lowest SDI quintiles, with variations according to sex. Despite the downward trend, regional and social inequalities persist. Improvements in access to health care and public policies contributed to the decline, but challenges remain, such as the weakening of risk factor control policies, the influence of commercial determinants of health, and the effects of the COVID-19 pandemic.

The human-animal relationship in the hospital care setting was investigated based on an ethnographic study of an animal-assisted support program at a tertiary institution within the Brazilian Unified National Health System in Rio de Janeiro, Brazil. This study examines the effects of communicative interactions and the agency that regular visits by a single service dog seem to catalyze among staff members. Using the Actor-Network Theory and Donna Haraway's concept of "companion species" as analytical frameworks, we explore the reconfiguration of social networks in the integration of a non-human other as a collaborator in health promotion activities within hospital settings. By operating according to logics not driven by power or rationality, its political role is highlighted in the various agencies produced within relational dynamics and the economy of affects. The new arrangements introduced by the service dog outline the micropolitical dimension of emotions in the reorganization of interpersonal and interspecies relationships within hospital settings. This study shows that animal-assisted support progra in hospitals can function as an innovative social technology in health, capable of reconfiguring care networks and interaction dynamics.

This study examined whether a low socioeconomic position over the course of one's life, the accumulation of low socioeconomic position, and intergenerational social mobility are associated with all-cause mortality over a 15-year follow-up period, and whether these associations varied according to race/skin color. A prospective study was conducted with 13,652 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. The outcome was time to death from any cause. The explanatory variables were socioeconomic position in childhood (mother's schooling), adolescence (head of household's socio-occupational class), adulthood (participant's schooling and socio-occupational class), cumulative socioeconomic position, and intergenerational social mobility. Cox proportional hazards models were adjusted for sociodemographic characteristics. The mortality rate was 4.9/1,000 person-years and was higher among men, older adults, Blacks, and those with a low socioeconomic position. After adjustments, low socioeconomic position in childhood, adolescence, and adulthood remained associated with higher mortality. The greatest accumulation of low socioeconomic position across life (HR = 2.02; 95%CI: 1.64-2.48, 4th vs. 1st quartile), as well as downward and stable low educational and socio-occupational trajectories, were also associated with higher mortality. To a lesser degree, an upward socio-occupational trajectory (vs. stable high) increased the risk of death. No multiplicative interaction was found between socioeconomic position and race/skin color regarding risk of death. Lifelong exposure to socioeconomic disadvantages throughout the course of life as well as the accumulation of adverse social experiences and unfavorable intergenerational educational and socio-occupational mobility, increased the risk of mortality, demonstrating the long-term effect of a low socioeconomic position, especially with prolonged exposure.

The aim of the present study was to analyze access to healthcare among deaf individuals who communicate through Brazilian Sign Language (Libras, acronym in Portuguese) 18 years of age or older residing in the Metropolitan Region of Campinas, São Paulo State, Brazil, comparing public and private healthcare systems. A descriptive cross-sectional epidemiological study was conducted. The data collection instrument was an online form accessible in sign language. Statistical analysis involved contingency and frequency tables, georeferencing, and logistic regression. Among the 316 participants, most considered communication with health professionals to be poor in both the public (64.3%) and private (67.6%) systems. The likelihood of effective communication was only 40.47% in the best-case scenario (patients in public healthcare with a positive self-assessment of their health status). Hearing impaired individuals who use Libras and only use the public healthcare system were 22% more likely to have effective communication with health professionals compared to those who use the private healthcare system. Both public and private health services lack linguistic and communication accessibility, mainly due to a lack of knowledge of Libras on the part of health professionals.

Pneumonia constitutes a leading cause of death in children from low- and middle-income countries. We aimed to describe the prevalence and the factors associated with pneumonia in children aged from 0 to 6 years in a location with high pneumococcal vaccination coverage. The occurrence of at least one episode of pneumonia diagnosed by a physician as reported by the mother was investigated at the 12-, 24-, and 48-month, and 6-year follow-ups of the 2015 Pelotas (Brazil) birth cohort. The independent variables included family and child characteristics at birth, breastfeeding, and vaccinal status. Prevalence ratios (PR) with 95% confidence interval (95%CI) were estimated by unadjusted and multivariable Poisson regressions with robust variance. At the 12-, 24-, 48-month, and 6-year follow-ups 4,014, 4,006, 3,997, and 3,862 children were assessed, respectively. Prevalence from 0 to 6 years equaled 16.7% (95%CI: 15.5-18.0). Within the first, second, 2-4 and 4-6 years of age the prevalence of at least one episode of pneumonia totaled 7.9%, 5.9%, 6.7%, and 3.4%, respectively. Higher maternal parity (adjusted PR = 1.75, 1.61, and 2.0 at the first, second, and 4-6 years, respectively) and prematurity (adjusted PR = 1.39 and 1.49 at the first and second years of life, respectively) constituted the factors most consistently associated with an increased risk of pneumonia. Almost one in every five children aged 6 years had a positive history of pneumonia, mainly in their first year of life. Greater maternal parity was the strongest and most consistent factor associated with a higher prevalence of pneumonia in childhood.

This study analyzes the conceptions and communication practices of government agents on HIV prevention and their symbolic and programmatic implications based on the criticism regarding the end of the paradigm of exceptionality in AIDS responses in Brazil. This reflection is part of broader research with users, professionals and managers of five municipal HIV/AIDS programs carried out in the Metropolitan Area of Rio de Janeiro, Brazil, and run by the Federal Government. Based on contributions of the social sciences to the understanding of social representations and practices in health, the investigation involved an analysis of interviews with managers (federal and local) and health professionals about the communication strategies of combined prevention (CP), HIV pre-exposure (PrEP) and post-exposure (PEP) prophylaxis and an analysis of 24 pieces of communication on CP, PrEP and PEP. Government agents reported strategies for disseminating PrEP and PEP to health professionals via consultation material and workshops, considering the turnover of this group and moral and ethical-political resistance. However, the public disclosure of prophylaxis is discreet or carried out digitally. The exploration of the meanings of the communication pieces indicates an emphasis on the clinical dimension of prophylaxis in government materials; in pieces created by nongovernmental organizations a greater contextualization of CP strategies for sexual scenes, practices, and identities was found. A shift from communication strategies to a grammar informed by the availability of biotechnologies and their dispersed enunciation was observed. The weakening of government communication in the era of CP compromises the effectiveness of the right to prevention.

The COVID-19 pandemic in Brazil was marked by a set of measures to contain the virus, which had specific repercussions in different social groups, especially the most vulnerable, such as transvestites and transgender individuals. The aim of the present article was to investigate the particularities of transphobia in Brazil in the context of the COVID-19 pandemic as well as the actions of organizations and political groups in this scenario. The novelty and relevance of this study is evident by the scarcity of investigations focused on understanding the transphobic phenomenon in the context of a serious social crisis. Adopting a qualitative approach, five interviews were conducted with representatives of trans support groups on the local, regional, and national levels. The treatment of the material collected involved the content analysis technique proposed by Bardin and prioritized queer theoretical contributions. The results were organized into two major topics: (1) transphobia in everyday relationships; and (2) challenges in accessing public policies, the latter of which was subdivided: (a) education policy and the job market; (b) social assistance policy and food security; and (c) health policy and mental health. In the assessment of the groups interviewed, the pandemic intensified a series of inequalities and violence already experienced by transvestites and transgender individuals, highlighting the (in)action of the government, which itself is an agent of transphobia.