This research analyzes education, information and communication actions about the quality of health information on the web carried out by Community Health Agents (CHA) during their daily activities. The proposed recommendations are based on empirical and cognitive experiences, with emphasis on the need to exchange information with different fields, such as information science and journalism. The literature review revealed quality criteria in different contexts, but there is a lack of studies in primary health care and with CHA. The speeches of the CHA in Brazil highlighted the complex role of information flows that include Google, especially during the debate on the "fake news" bill. It is recommended to explore connections between this study and debates about the role of big tech in the quality of health information on the web in primary care. It is recommended to review the management model of information sources, create repositories with a recognized quality seal and strengthen Digital Inclusion Agent programs. The implementation of information and knowledge management policies, communication strategies and digital inclusion policies with the participation of big techs is crucial to improving the quality of health information on the web. These suggestions aim to overcome the challenges of the pandemic and contribute to improving the quality of health information on the web from the perspective of CHA.

The covid-19 crisis highlighted the importance of healthcare professionals, especially nurses, revealing their dedication and leadership. The pandemic emphasized the value of nursing work, widely publicized by the media, and highlighted its fundamental role in healthcare units. In this context, the aim of this research was to analyze the perceptions of nurses working in Primary Health Care in municipalities in the Midwest region and the Federal District, during the covid-19 pandemic. The methodology involved a qualitative approach for data collection and analysis. Individual interviews were conducted with nurses who met the inclusion criteria. The interviews addressed topics related to assistance practices in Primary Health Care, experiences during the covid-19 pandemic, challenges faced, the perception of the importance of nursing work, and other relevant topics. A thematic analysis was performed to identify patterns and trends in the participants' responses, aiming to understand nurses' perceptions and experiences in the context of Primary Health Care during the pandemic. The obtained results were used to enhance the understanding of assistance practices performed by nurses and their role during the covid-19 pandemic. The research conclusions provided valuable insights to improve public health management, support nursing professionals, and enhance the services provided to the community

Malaria is a significant global public health challenge. In Brazil, especially in the Amazon region, its prevalence is especially worrying in remote regions, such as mining areas (reference). These places have peculiar characteristics that favor the transmission of the disease, including high mobility of people, environmental degradation and difficulty in accessing timely diagnosis and treatment. These factors create a favorable environment, making it difficult to control, prevent and eliminate the disease. The objective of this work was to describe the transmission of malaria in municipalities in the Amazon region with mining areas from 2017 to 2021. This is a descriptive study, with analysis of secondary data from Sivep-Malaria, respecting ethical aspects (CAAE 66368322.0.0000.0030). During the period analyzed, 939,200 autochthonous cases of malaria were recorded in the Amazon region. Of these, 76,578 (8.2%) were infected in mining areas covering 52 municipalities and around 836 locations (Figure 1). The annual variation in infection cases in mining areas over the last few years was: +41.8% in 2019, +79.8% in 2020, and +46.3% in 2021.The parasitic species with the highest transmission in these areas was Plasmodium vivax, representing 81.4% of cases. Malaria cases with a probable site of infection in a mining area in the Amazon region were predominantly concentrated in two municipalities in the state of Pará (72.5%) and 83.4% of these cases were reported with their place of residence in this state. On the other hand, in the state of Amazonas, of the autochthonous cases in mining areas, almost 75% had their residence in another state. Regarding the profile of the population affected by malaria in municipalities with mining areas, there is a predominance of males (75%), aged 20 to 39 years (58.4%), do not have completed primary education (45.7%) or are illiterate (4.2%) and 2.8% declared themselves indigenous. Of the occupations reported by patients, 77.2% were involved in mining activities in the 15 days prior to care. Surveillance of malaria cases in mining areas is relevant for the planning and implementation of public policies. Understanding the geographic distribution and monitoring the frequency of cases in mining areas and the mobility of the population involved is essential to promote an effective and comprehensive approach to tackling the socio-environmental and public health challenges related to this activity. 

Considered an infectious disease with a chronic and silent evolution, leprosy has as its etiological agent Mycobacterium leprae, a bacillus with a predilection for skin cells and peripheral nerves that causes changes in the sensitivity of the affected areas. Brazil is characterized as a country with high endemicity, with greater prevalence in the North, Central-West and Northeast regions. Among the states in the Central-West region, the Federal District (DF) maintains a standard of average endemicity, requiring intensification of actions to control the disease. This study aims to analyze the incidence, epidemiological behavior and temporal trend of leprosy in the Federal District in the historical series from 2012 to 2022. Thus, a descriptive study of the sociodemographic and clinical profile of leprosy cases, registered in the Information on Notifiable Diseases (SINAN), in the aforementioned time frame. Additionally, an analysis of endemic monitoring indicators and their trends was carried out. There was a record of 2009 cases of leprosy between 2012 and 2022, with the most prevalent profile being males, aged between 30 and 59 years, with a predominance of brown skin color and a low level of education. The cases presented mainly in the dimorphic clinical form and with multibacillary classification. Of the total cases, 87% were assessed according to the degree of physical disability (GIF), with 47% being GIF 0, 30% GIF I and 10% GIF II. A decreasing trend was observed for the overall detection rates of new leprosy cases (annual percentage variation [APC]= -4,33%; p=0,03), detection of new cases in the population <15 years old (APC= -13,46%; p=0,02), proportion of cases with GIF evaluated at diagnosis (APC= -1,67%; p=0,01) and proportion of cure (APC= - 3,75%; p =0,05). A stationary trend was observed for the indicators of rate of cases with GIF 2 at diagnosis (APC=2,62%; p=0,56) and proportion of contacts examined (APC= -1,07%; p=0,36). Regarding the proportion of cases with GIF 2 at diagnosis, an increasing trend was observed (APC=9,26%; p=0,03). Despite the decreasing trend in the general detection rate of new cases and the rate of new cases < 15 years, the scenario signals the existence of late diagnoses, evidenced by the stationarity of the rate of new cases with grade 2 disability and the increase in the proportion of cases new cases with grade 2 at the time of diagnosis, which leads to the inference that the decline in the rate of new cases may be associated with a difficulty in the operational capacity of health services for the early detection of hidden cases and not with a real decrease in endemic

Objective: The objective was to describe the profile of hospitalizations for Rare Diseases from records in the database of the SUS Hospital Information System (SIH/SUS) in Brazil from 2008 to 2021. Methods: Descriptive epidemiological study carried out based on the information contained in the SUS Hospital Information System (SIH/SUS) in Brazil. The exploratory analysis used as a basis the Reduced Archives (RD) database of Hospital Admission Authorizations (AIH) movements. To process the bank and basic analyzes related to the study, TabWin, version 4.1.5 was used. To calculate the selected indicators and generate the illustrations contained in the work, Microsoft Excel Software was used. Results: Hospitalizations for Rare Diseases in Brazil from 2008 to 2021 show the predominance of females (52%), age group from 1 to 9 years (19.2%), mixed race/color (33.0%). Of the 4,458 death records relating to hospitalizations (2.4%), the main causes are sickle cell disease (21.8%), rheumatoid arthritis (17.4%) and aplastic anemia (10.9%). In the analyzes on the hospitalization profile, the results (50.7%) of full municipal management, medium complexity, equivalent to 95.9% of the records, the highest number of records with a stay of three days, 98,012 hospitalizations (16, 2% of records), analyzing the amount paid for hospitalizations for Rare Diseases in the period from 2008 to 2021, a total of R$331,995,456.78 was recorded. Conclusion: This study shows that the analysis of information on Rare Disease cases present in the Hospital Information System (SIH) is a viable, albeit limited, strategy for constructing epidemiological indicators for rare diseases in Brazil. It is possible to identify and list some characteristics related to the patient's profile (gender, age group, race/color, deaths, cause), information related to hospitalization (establishment management, complexity of the establishment, nature of care, days of stay and total payment per hospitalization), as well as the main causes of hospitalization for Rare Diseases in the regions of Brazil in the period studied.

“Primary Health Care (PHC) is the first level of health care, being considered the main and most adequate form of access for people to health systems. Health systems oriented to primary care have a positive impact on morbidity and mortality indicators, promoting more effective health care and achieving greater effectiveness, efficiency and equity when compared to systems focused on specialized care. In Brazil, PHC plays an important role in the SUS in guaranteeing the citizen's constitutional rights, and should be guided by the principles of universality, integrality and equity, established in the Federal Constitution of 1988. Consistent advances occurred towards universal coverage after the creation of the Family Health Program (FHP), the main strategy for expanding first contact access and changing the care model in Brazil, strengthened from the creation of The Primary Care Floor (PAB), with resources exclusively for Primary Care, transferred to the municipalities on a regular and automatic basis. The registration of the population is one of the fundamentals of work in the Family Health Strategy (ESF), aiming to know the families assigned to the teams, offering information for the realization of the situational diagnosis in health, the development of relationships of bonding and accountability between the teams and the population. According to the National Primary Care Policy, the registration data should be kept updated in the local information system for the analysis of the health situation, considering the social, economic, cultural, demographic and epidemiological characteristics of the territory. The institution of the Previne Brasil Program in November 2019 established a new funding model for aps costing, having as one of its components the weighted capitation, whose remuneration model is calculated based on the number of people registered. The general objective of the study was to analyze the evolution of the population registered in PHC after the creation of the weighted capitation incentive, established by the Prevent Brazil Program. This is a descriptive and quantitative study comparing the 3rd Quarter/2019 and the 3rd Quarter/2021, covering municipalities with Family Health teams (eSF) and Primary Care teams (eAP) approved by the Ministry of Health. The data were obtained through access to the e-Gestor AB and SISAB reports, grouped according to the rural-urban municipal typology and population size, classifications used by IBGE. The study showed that in most municipalities (76.1%) there was an increase in registrations in the period analyzed. In all typologies there was an increase in the proportion of registrations, and in the Remote Intermediate typology and in the Remote Rural, the mean evolution was higher (63.3% and 40%), respectively. There was also an increase in the proportion of registrations in all population sizes, and in small municipalities the proportion of registrations presented a better result than the other ones. The average evolution of the proportion of registrations was higher in the Metropolises with 41.9%. The results indicate that the weighted capitation incentive influenced the increase of the population registered in PHC, regardless of the demographic profile of the municipalities”

“Minor Ailments Service is the service in which the pharmacist accepts a patient's demand and prescribes and guidance on non-pharmacological measures or nonprescription drugs and, when it’s necessary, forwards the patient to another health professional. For the qualification of the pharmacist and the standardization of the work process of this service, it is necessary for the pharmacist to be up to date and in constant training and learning. To this end, the use of clinical guides is an essential strategy for pharmaceutical training. The present study aimed to describe the performance of the minor ailments service in Brazil and to evaluate the effectiveness of a training course for pharmacists in the management of self-limiting health problems. The study was carried out in two stages. The pharmacy pharmacists through the application of a questionnaire released to pharmacists in all Brazilian states, in order to analyze how the demand for the minor ailments service, the most prevalent health conditions in community pharmacies, as well as the care steps performed by pharmacists during the exercise of this service. In the second stage, a distance course was developed, based on evidence-based pharmacy clinical guidelines to train pharmacists and pharmacy students to practice managing self-limited health problems, as well as evaluating the effectiveness of this course through the application of questionnaires in two distinct moments – before and after the course – to measure the participants' acquisition of knowledge. The results indicate that 62% of community pharmacists provide the self-limited health problem management service, in which the main health problems addressed daily or weekly in community pharmacies are muscle pain, headache and cold. As for the training course for pharmaceutical professionals and pharmacy students, there was a 64% increase in performance between the first and second questionnaires, indicating that the course was effective in gaining knowledge among the participants.”

“Introduction: The World Health Organization recommends conducting surveys to validate the elimination of trachoma as a public health problem. To verify that the elimination targets have been met, the Ministry of Health conducted a survey in non-indigenous and indigenous areas of the country between 2018 and 2022. The aim of this study was to know the prevalence of the disease in areas of the state of Maranhão and to evaluate possible differences in prevalence between non-indigenous and indigenous populations based on data from this survey. Methods: Population-based cross-sectional observational study with probabilistic sampling. For the selection of the non-indigenous Evaluation Unit (EU), homogeneous mesoregions with at least one municipality at risk to trachoma and indicators of poverty and sanitation were considered. The Special Indigenous Sanitary District of Maranhão (Dsei-MA) was selected to make up the indigenous EU in the state due to the size of the population, and the proximity to the selected non-indigenous EU made it possible to compare. All residents of one year or older were examined for trachoma. Results: The prevalence of follicular inflammatory trachoma (TF) in Leste Maranhense EU and DseiMA were 0.13% and 2.94% and the prevalence of TT in Dsei-MA EU was 0.12%. The highest prevalence of TF was found in places with poor sanitation".

“The COVID-19 pandemic has produced a protrusion in people’s lives, setting up a scenario of breaks and ruptures, a “new state” of things that are outside the social order. We have experienced the last few years undergoing several changes in our routines. Today, it seems clear that the COVID-19 pandemic is consuming us in many ways and in different ways. This dissertation aims to reflect on the follow-ups of COVID-19 in the daily lives of patients, workers and the management of a Specialized Rehabilitation Center. As a result, we obtained an article derived from a survey carried out with service users, where it was possible to understand the heritage of individuals in relation to the sequelae of COVID-19 in their bodies and in their daily lives, based on narratives of the disease; and two technical products: the first shows the process of implementing and structuring a Standard Operating Protocol and a Monitoring Bank for COVID19 cases in the service; the second, in the form of a report, presents the elaboration and implementation of a Permanent Education in Health, where it was possible to advance in thinking and discussions about the impacts of the COVID-19 pandemic. The results achieved for individuals and society (the collective) – promoting space for their voices to be heard; in the formulation of public policies – bringing to light scientific evidence; and in health practices and services – replicating the technical products. Contributing to avoid or mitigate scenarios marked by death, vulnerability, invisibility, denial and absence of the Government, as it was during and after a pandemic.”

This work embodied in a professional master's dissertation aimed to discuss the Science of Legislation - Legistics - as an instrument to evaluate the quality of the legal act contained in the Interministerial Ordinance n. 1 of January 2nd, 2017, and art. 4th, annex XVIII of the Consolidation Ordinance no. 2 which constituted the National Policy for Comprehensive Health Care for Persons Deprived of Liberty in the Prison System-PNAISP. It was not the objective of the work to substantially analyze the ordinances, nor to propose material changes in the policy. Methodology: This was a qualitative study in which the unit of analysis were the provisions of public prison health policy and its regulation. The normative data were collected from the health information repository of the Virtual Health Library, using the normative numbers for the location. The normative framework used for the analysis was Complementary Law 95 of 1998 in the light of the lessons of Formal Legistics, which analyzes the formalistic aspects of the legal act. Results: It was found that, although the Interministerial ordinance faithfully observed the provisions of LC 95/98, implying the need for minimal adjustments due to the time elapsed since its edition, the same cannot be said of the regulation. The text inserted in Annex XVIII of PRC-2 is confusing, without observing the good technique of normative writing, generating confusion in the applicator of the standard. Conclusion: It was concluded that the regulation of the prison health policy needs a revision of its normative text, without implying substantial changes in the policy itself

"The Stork Network (RC) strategy aggregates actions from previous women's health policies and was created to intervene in the high rates of Maternal and Child mortality. This cross-sectional study from the years 2017 to 2020, referring to the "Analysis of Component I of the Stork Network of the State of Pernambuco" in which it analyzes the responses of the auditees to the non-conformities evidenced in the audit reports, and measures the actions developed in the audited municipalities associating to the indicators considered quality of prenatal care. It aims to identify the limitations and advances of the management on sensitive actions to the quality of prenatal care. Qualitative research supported by the Social Sciences in Collective Health inspired by the discourse analysis, which seeks the meanings of and in the narratives of the auditees. The Audit Reports, source of this research are here considered documents "historical artifacts" and "monuments" produced within the public institutions. And, quantitative through an ecological study of multiple groups, from 184 audits of the State Component of the National Audit System. Ten care actions listed in the reports were related to the indicators considered of qualification of prenatal care. The best evaluated indicators were: "Guarantee of expansion of access to high-risk prenatal care"; "Rapid testing of syphilis/HIV" (SRT); and "Laboratory tests of Habitual Risk and High Risk". The most sensitive audit evaluative indicator associated to the Average Congenital Syphilis Rate (AMCT) is the "SRHR", when analyzed in groups of municipalities. In the final evaluation, two indicators showed statistical significance when analyzed with the Perinatal Mortality Coefficient: "Guarantee of expanded access to high-risk prenatal care" and "Displacement support". It is concluded that the analysis of the variables researched reveals difficulties in the understanding of public health policy and consequently of its execution at the municipal level in Component I, as well as ratifies the incorporation of the audit as an ally of public health management to the extent that it promotes the review of work processes from the signs of non-conformities. In addition to the insufficiency in the degree of compliance in Component I of the Stork Network in Pernambuco and the importance of the significance relationship between dependent and independent variables.

“Syphilis is a persistent disease and a growing public health problem that affects men, women and children. To face this challenge, specific public policies have been developed in the country, in line with the goals proposed by the World Health Organization. The ‘National Rapid Response to Syphilis Project’ is included in this frame, implemented in some priority municipalities of Brazil. This article addresses that project, focusing on priority municipalities for syphilis in the Midwest Region, focusing its analysis on the role played by so-called institutional supporters, responsible for mobilizing institutional capacities to accelerate the implementation of syphilis agendas at the local level. The methodological procedures adopted involved the collection and systematization of indicators and goals defined by the project and the characterization of the main management and governance actions carried out in these territories. Documentary analysis techniques from secondary sources were used, focusing on the production that supported the work of these supporters with the project and synthesized in an analytical matrix. The results point to the facilitating role of supporters and the strengthening of institutional capacity to locally implement defined actions for syphilis control.”

Introduction: Measles is a highly contagious disease that can cause several complications. In recent years, measles outbreaks have occurred in all regions, and the incidence has increased, leading to the reintroduction of the disease in Brazil with 9,325 confirmed cases. The World Health Organization (WHO) advises its member states to conduct annual risk assessments. This study aimed to estimate the risk of measles transmission in the Northern Region of Brazil prior to the reintroduction of measles in the country. Methodology: The measles risk assessment tool was used to estimate the overall risk of measles in 450 municipalities in the Northern Region of Brazil in 2017. Measles risk was calculated based on four categories of indicators, including population immunity, surveillance quality, program performance, and threat assessment, resulting in an overall measles risk score for each municipality. Subsequently, the tool assigned each municipality to a risk category, namely low, medium, high, or very high, based on the overall risk score. Results: Out of the 450 evaluated municipalities, 7 (1.6%) were classified as very high risk, 10 (2.2%) as high risk, 43 (9.6%) as medium risk, and 390 (86.7%) as low risk. The majority of municipalities classified as very high or high risk were located in the state of Pará, accounting for 42.9% and 70%, respectively. Overall risk scores ranged from 15 to 68 out of 100 possible points. There was significant variability in all four categories: population immunity ranged from 0 to 34 points, surveillance quality from 0 to 12 points, program performance from 0 to 16 points, and threat assessment from 2 to 17 points. Across all states, population immunity and program performance were consistently the categories with the lowest scores. The city of Manaus, in the state of Amazonas, was classified as very high risk by the tool, with 7,149 cases confirmed in 2018, exhibiting the second-highest incidence in the country. The municipality with the highest incidence, also in the state of Amazonas, was classified as medium risk by the tool. In the state of Pará, the majority of confirmed cases resided in the municipality of Santarém, accounting for 39 (47.0%) cases. Said municipality was classified as very high risk by the tool. Conclusions: In general, areas classified as high or very high risk in the northern region of Brazil from 2015 to 2017 experienced a high incidence of measles in 2018, suggesting the potential usefulness of the tool in planning programmatic activities that can reduce the risk of outbreaks in subsequent years. This tool also identified areas considered at high or very high risk of measles transmission years later, not only in the immediate year following the assessment. Despite limitations, the risk assessment using the WHO tool can be used as routine practice for it provides a detailed breakdown of points by category and indicator, enabling health teams in municipalities to identify the primary reasons for the identified risk.

“Different conditions and possibilities of urban mobility for populations can result in health inequities, especially in large cities. Risk factors such as air pollution, traffic accidents, physical inactivity, traffic noise, lack of adequate urban infrastructure, and difficulties accessing health services due to barriers related to the urban mobility system contribute to unjust and preventable inequalities. The reduction of these inequities requires intersectoral approaches, involving collaboration between different sectors. In this study, possibilities of intersectorality within the institutional framework of sectoral policies and plans in the areas of urban mobility and health are analyzed. More specifically, intersectorality within the scope of the National Health Promotion Policy (PNPS) and the National Urban Mobility Policy (PNMU), as well as the District Health Plan 2020-2023 (PDS 2020- 2023), the Urban Transport and Mobility Master Plan of the Federal District (PDTU-DF), and the Active Mobility Plan of the Federal District (PMA-DF 2020). The integrated analysis of these juridico-political instruments, with a perspective of intersectorality and the confrontation of health inequities, had the concepts of Totality and Reification as reference points. The assumption was that the closer the policies and plans are to the concept of Totality, the greater the possibility of intersectorality, and the more comprehensive are the intersectoral initiatives in confronting inequities. At the same time, adherence to the concept of Reification results in less comprehensive initiatives with lower potential to address unjust inequalities. The result of the integrated analysis, from the conceptual lens of Totality and Reification, reflected the need for intersectorality between the two areas, in addressing health inequities, to present strategies and initiatives aligned with overcoming the hegemonic model of urban mobility”

Objectives: Elaborate the Brazilian Immunization Logical Model (ML) , and suggestSuggest indicators for monitoring the activities proposed in the ML. Method: Evaluative, propositional study grounded in immunization policy, aiming to guide the restructuring of immunization policy in Brazil. Results: The ML construction started from the low vaccination coverage (CV) in Brazil, seeking to identify its determinants and conditioning factors to describe activities necessary for qualifi execution of the immunization policy. There were nine evaluative components: Federal, State and Municipal Management, Primary Health Care, Secondary and Tertiary Health Care, Special Immunobiologicals Reference Center, Communication, Information System and Private Sector. Conclusion: ML defines activities that assist the immunization policy reorganization , enabling the identification of gaps in the implementation of its policy, providing assertive and timely decision making, aiming at the resumption and maintenance of high CV and consequently, protection of the population regarding vaccine preventable diseases in the country.

Leishmaniasis is a set of diseases caused by parasites of the genus Leishmania, which, comprising more than 20 species known as human pathogens, have the potential to cause a wide spectrum of clinical syndromes. This variability is reflected in the ways of managing these diseases, especially with regard to therapy. In this context, the adoption of Clinical Practice Guidelines (GPC), initially defined as statements systematically developed to help professionals and patients make decisions about appropriate health care for clinical circumstances, is an important strategy for standardizing conduct and definition of best practices. Since the early 2000s, important GPCs on leishmaniasis have been proposed, following the trend of recent decades in relation to the production of these documents, which, despite being intense, has resulted in documents with highly variable structure and quality standards. Objective: To map the extent of world production of GPC on leishmaniasis and assess its quality. Methods: First, a scoping review was developed according to the Joanna Briggs Institute (JBI) guidelines. The literature search was carried out between April 2022 and April 2023, involving 26 databases and scientific repositories, including Medline via PubMed, Embase, VHL and Cochrane. Another 95 informational resources, including websites of international organizations, Health Technology Assessment agencies and medical societies, were included, in addition to official websites of 197 countries. The terms “leishmaniasis” AND “practice guideline” and respective synonyms and, in a complementary way, non-controlled vocabulary terms were used. The most current versions of GPCs on leishmaniasis that contained recommendations for diagnosis and/or treatment and/or clinical management aimed at any form of leishmaniasis, without language or date restriction. Documents that dealt with leishmaniasis only from the perspective of animal and/or environmental health and those of an educational or procedural nature were excluded, in addition to review articles and those resulting from original research. Data collection and analysis was performed by two independent reviewers, following the protocol steps registered at https://osf.io/2khbq/?view_only=e8a44a90535f4dfb932cc1127b4eee75. Then, the GPCs resulting from the scope review were evaluated by three independent evaluators through the application of the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation). Results: Thirty-one GPCs from American (58%), European (32%), Asian (6%) and African (3%) countries were selected. Approximately 55% of them were prepared on the initiative of local governments, although GPCs were identified that were prepared on the initiative of international non-governmental organizations (23%), in partnership or not with local governments, medical societies (10%), and other private ones ( 13%). One hundred percent of the GPCs addressed the treatment of some form of leishmaniasis, while 87% also included recommendations about the diagnosis. Approximately 81% of the GPCs included the visceral form, 77% the cutaneous form and 68% the mucosal or mucocutaneous form. . Other less discussed issues were Leishmania-HIV co-infection (52%) and post-kala-azar dermal leishmaniasis (10%). In all guidelines evaluated in terms of quality, important weaknesses were identified in more than one Domain, with emphasis on “editorial independence”, “applicability” and “rigor of development”. In the overall assessment, two GPCs were recommended for use in practice without modifications, another three were recommended with modifications, and the rest were not recommended. Conclusion: It is necessary to improve the processes for formulating the recommendations contained in the GPCs on leishmaniasis, which involves the adhesion of mechanisms that grant greater editorial independence, in order to mitigate conflicting interests; the adoption of a clear and objective approach regarding the likely facilitating factors and barriers to its implementation, aiming to improve its applicability and, finally, qualify the recommendations with regard to the evidence that underlies them, in order to promote the offer of the best care for people with leishmaniasis in Brazil and worldwide.

“This qualitative study, based in the field of Social Sciences in Health of Collective Health, seeks to reflect on the experience that women living in the countryside had of the Covid-19 pandemic. To this end, it presents the views of three women interviewed who live in the city of Sobral in Ceara, on the following topics: fake news, fear of seeking health services because of possible contamination, the use of home remedies, the lack of multiprofessional accompaniment during the isolation period, and the economic and personal issues faced by the interviewees during the pandemic. Their practices and knowledge about the pandemic were also considered. The field research took place between March and June 2022. For data analysis we used Bardin's methodology. The results of the study showed that rural women faced significant challenges in accessing health services, such as lack of access to the internet, transportation, and information about the pandemic".

“The National Program for Improving Access and Quality of Primary Care (PMAQ-AB), established in 2011, was a Brazilian pay-for-performance (P4P) model, which aimed to improve the quality of Primary Care in SUS. After its implementation, the program was evaluated according to the criteria established by the Ministry of Health, but important aspects for the characterization of these modalities were not investigated. The objectives of this study were: to analyze how the PMAQ-AB resource was applied at the local level, as a pay-for-performance strategy, as well as to verify other purposes for the application of these resources. This is a descriptive-analytical study, with a longitudinal approach, which analyzed the PMAQ-AB implementation modalities in the municipalities, over the three cycles, through an online survey carried out between October and December of 2019, regarding the forms of application of financial incentives. The first stage analyzed the national data in a comparative way between the cycles, and made an association between incentive attributes and socioeconomic, demographic and party indicators through a multinomial logit model. The second stage adopted a regional focus, considering the greater participation of the Northeastern states in the present study, making it possible to compare categories between states. The participation of managers from 798 municipalities in 22 states was obtained. The results showed that 55.4% of municipal managers used the resource to pay for performance for primary care teams. More than 54% of managers used 41 to 60% of total resources to pay teams for performance and opted for monthly periodicity. The certification of health teams was the criterion most used by managers to transfer the resource, above 70%. There was an increase in complete teams over the course of the cycles, and professionals beyond the minimum Family Health team received the incentive. The managers also used the funds for other purposes, such as purchasing equipment for the UBS and carrying out training activities. Municipalities with a larger population and with a low HDI were associated with a higher percentage of the resource destined to payment for performance and greater motivation of the teams. From the second stage of the study, the cutting for the Northeast region had a sample of 79% of the municipalities that paid PHC professionals for their performance. Especially in the third cycle, 95% of the municipalities in the state of Paraíba paid the teams. The results showed that the PMAQ resource was applied with emphasis on payment for the teams, through criteria defined in the MS, with regular payment characteristics, emphasizing non-medical professionals, also observing the infrastructure and professional qualification. An amount of 60% of the managers chose to invest the percentage of resources between 41 and 60%, with emphasis on the categories of nursing 93%, dentistry 90%, and community health agents 85%, the

certification grade was used as a criterion for the payment 79%, monthly 52%, on average in the three cycles, in addition to prioritizing infrastructure and professional qualification with investments in the purchase of equipment and continuing education. The results showed that the PMAQ resource was applied with emphasis on payment for the teams, through criteria defined in the MS, with regular payment characteristics, emphasizing non-medical professionals, also observing the infrastructure and professional qualification. It was observed that this payment-for-performance model aimed at recognizing and qualifying services and professionals. The decisions taken throughout the program cycles resulted in greater adherence, but also demonstrated the need for planning that takes into account institutional and contextual factors for greater efficiency and quality in the implementation of the model. Therefore, further studies are needed in this area to advance knowledge. It is possible to observe that the transfer of PMAQ resources to encourage access to and quality of AB services, through remuneration for performance, training of professionals and improvement of work structures, was an important strategy for strengthening Primary Care_”

Introduction: The National Network of Death Verification Services (RNSVO) is composed of Death Verification and Cause of Death (SVO) services established in municipalities, states and the Federal District. It was created with the objective of promoting the qualification and improvement of data on the cause of death of all deaths due to natural causes, without diagnostic elucidation, with or without medical assistance, and also to strengthen the integration and qualification of data and information on mortality through of the Mortality Information System (SIM). Objective: To analyze the quality of the causes of death attested by the Death Verification Services authorized by the RNSVO Method: An ecological analytical study was developed. Results: In 2019, 1,349,801 deaths were recorded in Brazil, of which 1,207,001 (89%) were due to natural causes. Of this total, 74,972 (6.0%) had an ill-defined underlying cause. Among the groups of Federated Units with and without SVO, 821,055 and 385,946 deaths from natural causes were recorded, with the percentage with an ill-defined cause being 6% and 8%, respectively. Of the total number of deaths from natural causes that occurred in the country, 87,251 were certified by the RNSVO, with 2% of records of ill-defined causes. Analyzing the median number of conditions recorded in Parts I and II of the medical death certificate, it was found that the result was three numbers of conditions on the lines of the certificate for the records from the RNSVO. Conclusion: It is noteworthy that in the federated units where there is an SVO enabled in the RNSVO, the percentage of deaths certified with ill-defined causes is lower than in those federated units that do not have an enabled SVO in the network. It is worth mentioning that in the RNSVO-enabled services themselves, this percentage is even lower. It is suggested that in the federated units that contain the SVO, there may be an active death surveillance in accordance with the regulated conditions for the existence of a service, considering the lower percentage of deaths attested with an ill-defined cause and a greater number of conditions in the lines of the DO certificate, both in part I and in part II.

The National Council of Municipal Health Secretariats (CONASEMS) is the representative of the 5570 Brazilian municipalities in the political and management field of the SUS, recognized as such by Decree 7508/20113. Because of this nature, it is one of the institutions with the greatest potential for capillarity and mobilization capacity with the municipalities, mainly through joint action with the collegiate bodies of the Municipal Health Secretariats in the states, the COSEMS, present in all states of the Federation. The Board took office in 2016 with the axis of its work plan the Strengthening of the Councils of Municipal Health Secretariats (COSEMS) and one of the planned actions was the Implementation of the Strategy to Support Decentralized Management, along the lines of the COSEMS of Minas Gerais, Rio de Janeiro, São Paulo, Amazonas and Paraná. In partnership with the Support Program for the Institutional Development of the Unified Health System (PROADI – SUS) and the Hospital Alemão Oswaldo Cruz (HAOC). In 2017, the project “Collaborative Network for Strengthening Municipal Management of SUS” was launched, with supporters and coordinators for all COSEMS. The project was renewed over the subsequent three years and is currently managed on a collaborative platform between Hospital Alemão Oswaldo Cruz (HAOC) and Beneficência Portuguesa de São Paulo (BP). This project aims to analyze the strategies adopted by the CONASEMS – COSEMS supporters network from 2017 to 2021, to strengthen the Municipal Management of SUS. Seeking to identify specificities and singularities of the members and the support work process with the municipal management of the SUS, I understand what support is being provided to municipal health managers in the territories. To develop the research, a qualitative methodology is being used with a participatory approach and permeated by triangulation techniques for collecting and analyzing information, which will also be linked to qualitative and quantitative analyzes that elucidate the contexts, subjects and specific objectives. For this purpose, techniques for collecting and analyzing information and a set of guiding instruments for dialogue sessions and interviews were designed. semi-structured with strategic informants, with the aim of apprehending the results of actions developed by the Network and its members, based on access to the databases available at CONASEMS

The World Health Organization (WHO) recognizes malaria as an important public health problem in the world. In Brazil, approximately 99% of cases are concentrated in the Amazon region, the country's endemic area for the disease, comprising the states of Acre, Amapá, Amazonas, Pará, Rondônia, Roraima, part of Maranhão, Mato Grosso and Tocantins. The extra-amazonian region (other states and the Federal District) periodically reports some indigenous cases of malaria, that is, cases originating from endemic areas, which makes this region vulnerable to the reintroduction of the disease, given the intense flow of people coming from the amazon region and from other countries where the disease occurs. This scenario of imported malaria can impact local surveillance systems and compromise the achievement of malaria elimination goals in Brazil and the international commitments and goals assumed by the country with the WHO and the United Nations (UN), in relation to the Global Technical Strategy (GTS) and the Sustainable Development Goals (SDGs). This study aimed to analyze the imported cases of malaria notified in Brazil in the last 10 years, identifying the Probable Sites of Infection (PIL) and of notification, analyzing the time between the onset of symptoms and the diagnosis of imported cases, describing the sex, race/color and age group of the patients and the parasitic species involved in the diagnosis of these imported cases. This is a descriptive study, with analysis of secondary data from the information systems of the Ministry of Health - Sinan and Sivep-Malaria. In the analyzed period, 1,670,598 cases of malaria were reported in Brazil, with 50,009 (3.0%) reported cases of malaria imported from another country, with 48,200 cases reported in the amazon region (96.4%) and 1,809 cases reported in the extra-Amazon region (3.6%). 70.6% of the patients declared themselves to be of mixed race/color and the age group with the highest participation was 21 to 30 years old (31.1%). The species Plasmodium vivax was responsible for the highest number of cases (69.1%) and 49.8% of the diagnoses of the disease were premature, occurring within 48 hours of the onset of symptoms. During the study period, 3,798 cases of malaria were reported in the states of the extraAmazon region, 2,874 (75.7%) of which were imported from the Amazon region. Most of these records were notified in São Paulo (17.8%), Goiás (13.8%), Minas Gerais (11.8%) and Paraná (10.3%). The states of Rondônia (27.1%) and Amazonas (26.5%) were the main places of origin for these cases. 42.5% of the patients declared themselves to be of mixed race/color and the age group with the highest participation was 31 to 40 years old (25.5%). The Plasmodium vivax species was the most prevalent (87.0%), and only 16.8% of diagnoses occurred within 48 hours of the onset of symptoms. The mobility of Plasmodium infected individuals can result in reintroduction of the disease into areas where transmission has already been eliminated. Therefore, given the emphasis that imported malaria places on control and elimination efforts, it is important to know the profile of these cases in order to offer strategies that strengthen the national surveillance system in the timely identification of imported cases, especially in regions where elimination of the disease has already been achieved

“Introduction: Tuberculosis (TB) is a disease known for thousands of years, with diagnosis and treatment available and relevant incidence rates, persisting as an international health concern. Like any other health condition, all actions related to its context, from disease prevention to treatment, must be guided by Clinical Practice Documents (CPD). These CPD must be developed with scientific rigor, among other aspects, and its importance should be highlighted in the approach to patients with TB by any professional on the health team, including the Community Health Agent (CHA). Objective: To characterize and evaluate the quality of CPD related to tuberculosis available in the literature and propose the updating of an instrument to guide the approach to the patient by the Community Health Agent (CHA). Method: The study has three stages: the first searching for CPD related to TB, the second referring to the characterization and evaluation of the quality of these documents and the third referring to the update of a technical product related to the topic and based on the previous stages aimed at the ACS. The search for CPDs for the management of tuberculosis was carried out in different databases using search strategies with the descriptors "tuberculosis", "guideline", "clinical protocols" and "consensus". In addition, a non-systematized search and research were also carried out through contacts established with partner countries. The second stage was carried out using the Appraisal of Guidelines for Research & Evaluation II (AGREEII) instrument and the third was carried out in accordance with the findings of the previous stages, based on the Ministry of Health document aimed at the ACS. Results: 949 documents were included from the databases. Of these, 743 were screened to read the title and abstract, of which 16 remained to read the full text. Of the 16, seven were excluded because they were outside the scope of the search or had a specific approach, leaving nine DPCs to continue the study. As for the non-systematized search, of the 43 initial DPC, 20 met the inclusion and exclusion criteria. Of the total of 29 CPDs, the majority presented important problems in more than one domain; the domains with the best evaluations were scope and purpose and clarity of presentation and those with the worst evaluations were methodological rigor and editorial independence. Considering the strengths of the CPD, aspects related to the ACS were considered and adequately made compatible with the currently valid document for subsequent validation. Conclusion: The quality of the guidelines evaluated was below expectations, even though most of them were produced in countries with a high incidence and prevalence rate of TB. There is a need for a greater approach to Evidence-Based Practice in terms of qualifying the preparation of these CPDs aimed at quality and safety of care regarding TB.”

Post-abortion clinical cases often require therapeutic intervention for the total elimination of ovular debris from the uterine canal. The World Health Organization (WHO) as well as the Ministry of Health in Brazil (MS), recommend the preterition of Dilation and Curettage (D&C), by the Manual Intrauterine Aspiration (MVA) after first trimester abortion or medication. However, there is a prevalence of uterine evacuation using the Dilation and Curettage (D&C) technique in the post-abortion period, in public services in Brazil, implying the reproductive right of women to effective, safe health, based on contemporary scientific evidence. The research aimed to understand medical decision-making using the uterine emptying technique, post-abortion in the first trimester of pregnancy in two public hospitals in the Federal District. It was also investigated possible changes in the eligibility of the technique during the COVID-19 pandemic. Methodologically, this is a qualitative study, anchored in the field of Social and Human Sciences in Health. The study had as a field scenario, two public hospitals linked to the Secretary of Health (SES) of the Federal District that serve obstetric emergencies named in the research, as hospital (A) and hospital (B). Two methodological procedures were used for data collection, which took place between May and September 2022. The first was an interview recorded using a semi-structured form with eleven health professionals, including three physicians; four nurses and four nursing technicians, working in the obstetrics/surgical center of the hospitals. The second methodological procedure was the collection of data from 73 clinical records of women in post-abortion in the first trimester treated in field hospitals, in the years 2019 and 2020, and submitted to uterine evacuation, through Dilation and Curettage or Manual Intrauterine Aspiration. The results indicate dichotomous contexts in hospital A and B in medical decision making. In the hospital (A) prevails for uterine emptying, post-abortion of the first trimester of pregnancy, the Intrauterine Manual Aspiration in. Hospital (B) has the input to perform MVA, but, inversely opposite to hospital (A), Dilation and Curettage is the prevalent technique for medical decision making. The prevalence of Dilation and Curettage was evidenced in hospital B, motivated by the lack of technical skill of the doctors to perform Manual Intrauterine Aspiration, recommended as the technique of choice. Thus, the theme appears, a priority to be included in addition to the national political agenda of local public health policy.

“The pandemic of COVID-19 left besides the thousands of deaths, increased hunger and food insecurity, many people became unemployed and mentally ill. The report of the Food and Agriculture Organization of the United Nations (FAO,2022), which recorded the increase of 150 million people in hunger in the world since the beginning of the pandemic, totaling 828 million people. In Brazil, the government's response to these problems has been insufficient with regard to the strategies that aim to minimize these problems, including income transfer programs. Brazil has registered 51 million people living in extreme poverty; in this scenario, in the first year of the pandemic, the concession of eventual benefits increased from 3 to 7.8 million people in the whole Brazilian territory, but poverty continued to grow in our country. Research registers the worsening of the socioeconomic conditions of the Brazilian people, but there are few studies that investigate the problem from the perspective of the perception of the most affected socioeconomic families. In this qualitative research we had the participation of 27 heads of household with low income profile, who were assisted in a CRAS in the Federal District during the pandemic period. Through semistructured interviews, we listened to their perceptions about the effects of the pandemic in their daily lives. As a result it was possible to understand in a deeper way, the difficulties experienced, especially about work and income, food security, school routine, psychological changes, obtaining and using the eventual benefits. The results contribute to the adoption of new strategies, the creation of programs and public policies that have the ability to mitigate the harmful effects of the pandemic, which will be long-lasting. _”

“Population growth and the rapid replacement of durable goods, caused by the Industrial Revolution and technological evolution, have caused a growing environmental concern due to the growth of solid waste generation. With the constant increase in the generation of solid waste, the difficulty of properly managing this waste and the need for new areas for final disposal also grows. As an example, Manaquiri/AM, a municipality belonging to the Legal Amazon, has faced such challenges, with the existence of a dump right at the entrance of the city. In order to identify technology options for the final destination of solid waste that apply to the context of the municipality of Manaquiri/AM, a synthesis of evidence was carried out. 17 Systematic Reviews were identified that pointed to 13 technology options, categorized as follows: organic waste management, recycling, incineration, health services waste management, Integrated Solid Waste Management, Sanitary Landfills, alternative options, participation of groups of interest and software tools.”