Introduction: The mortality rate (MT) due to cervical cancer (CC) in Brazil shows a trend towards a significant reduction, but it is unequally distributed throughout the country, with higher rates in regions with lower socioeconomic development. Studies show that regions with effective screening programs have significantly reduced incidence and mortality rates, with the occurrence of this type of cancer being highly preventable in the population of people with a uterus. Primary Care, especially the Family Health Strategy (FHS), develops actions to control cervical cancer and plays a significant role in expanding the tracking and monitoring of the target population. Objective: The objective of the present study was to evaluate the effect of ESF coverage on reducing mortality from cervical cancer in Brazilian municipalities, between 2010 and 2019. Methodology: This is an ecological study, including 4548 Brazilian municipalities, in the period from 2010 to 2019. Crude mortality rates were calculated for the total population and for the age group of the target population for screening (25 to 64 years), the crude mortality rates for the total population and for the age group of the target population of screening (25 to 64 years old) according to FSH coverage levels and coverage of the screening indicator for each municipality per year. FSH coverage was categorized into three levels: without ESF and incipient (<30%), intermediate (>=30% and <70% or >= 70%, for less than the previous four years) and consolidated (>= 70%, for the minimum period of 4 previous years). Multivariate regression analyzes were performed using panel data, using negative binomial regression models with fixed effects, and adjusted for socioeconomic and demographic covariates considered relevant. Analyzes were also carried out stratified by population size, ratio indicator of cervical cytopathological examinations and HDI. Results: The average crude mortality rates for the total population and for the age group of the target population decreased by 7.92% and 16.53%, respectively, in the period studied. The increase in ESF coverage was associated with a reduction in the mortality rate for the total population and for the age group of the screening target population in some of the crude models, but the effect was not maintained after adjustment for confounding variables, further studies are needed to verify these associations. Conclusion: The findings of this study suggest that the expansion of municipal coverage of the ESF can influence reducing mortality from cervical cancer through control actions developed within the scope of Primary Care, such as adequate screening of the target population, education and awareness of the target audience about the importance of adhering to the exam at appropriate intervals, in addition to increasing vaccination coverage against the HPV virus.

Objective: The present study aims to analyze the effects of the regulatory change related to the dispensing of medicines in private pharmacies linked to the “Aqui Tem Farmacia Popular Program” (ATFP), during the COVID-19 pandemic, aimed at low-income individuals registered in the Single Registry for Social Programs in Brazil (CADÚNICO). Methods: This study, of an ecological nature, was based on secondary data covering the period from 2018 to 2020, relating to the dispensing of medications for hypertension (AH) and diabetes mellitus (DM) in municipalities belonging to the Integrated Development Region of the Federal District and Surroundings (RIDE-DF). The data were provided by the Department of Monitoring, Evaluation and Dissemination of Strategic Health Information of the Brazilian Ministry of Health. Linking the registration numbers of individuals between the ATFP and CADÚNICO databases allowed an interrupted temporal analysis to be carried out, evaluating changes in the levels and trends of weekly dispensing before and after the regulatory change that occurred on March 19, 2020. Results: Of the population assisted by ATFP during the study period, 15.89% (n=92,643) was registered with CADÚNICO at the time of dispensation for the treatment of AH and DM. The greatest demand was observed for the treatment of AH (79,169 users; 65.28%), followed by DM (40,095 users; 34.71%). The majority of users were female (average of 73.34%), predominantly for both pathologies, aged over 59 years (median). The analysis of the Time Series Index (STI) applied after the regulatory change showed a significant increase in the dispensing of medicines for AH (+1,907,391 pharmacotechnical units) and DM (+966,265 pharmacotechnical units) between the 115th and 120th epidemiological week, followed by a reduction to levels lower than those prior to the intervention. In the results of the post-intervention period, in the subsequent 41 weeks, the model showed a decrease of 1,149,707 pharmacotechnical units (realized = 12,020,409; counterfactual = 13,170,116) for DM and an increase of 529,252 pharmacotechnical units (realized = 25,058 .344; counterfactual = 24,529,092) for HA. Conclusion: The intervention carried out by ATFP during the pandemic period in Brazil had a positive impact, in the short term, on the number of medicines dispensed for the treatment of AH and DM in the RIDE-DF population registered with CADÚNICO, remaining an effective Pharmaceutical Assistance (AF) program.

Cardiovascular diseases, diabetes, neoplasms, and obesity account for 75% of the causes of death and illness in the world. Chronic non-communicable diseases are a major burden on health systems, society and the economies of families and countries. In 2016, the prevalence of obesity in the Federal District was 15%, while a target of 10% was set for 2022 in the Plan to Combat CNCDs. This study, in two articles, analyzed the influence of multi-professional treatment on anthropometric variations in patients at the Centro Especializado em Diabetes, Obesidade e Hipertensão - CEDOH (Specialized Center for Diabetes, Obesity and Hypertension) in the Federal District; and estimated federal spending on hospital admissions attributable to obesity in the context of the SUS, for the years 2018 and 2021. The first study, a retrospective cohort, analyzed data from the electronic medical records of 371 individuals of both sexes aged between 19 and 75 years. The economic analysis was carried out using a top-down estimate of the costs of hospitalizations in the SUS attributable to obesity and associated conditions, based on the relative risks of associated diseases and the prevalence of obesity in 2018 and 2021. Among the main findings was that dropout was 1.44 times higher among men and individuals ≤29 years old, of whom 72.2% abandoned follow-up. Higher age groups showed a greater accumulation of comorbidities associated with remaining in treatment. The practice of physical activity was positively related to staying in the groups, and among those who did not practice physical activity, 64.8% dropped out. In 2018, the prevalence of obesity in adults was 44% higher than predicted in the Plan to Combat CNCDs; in 2021, the prevalence was 2.11 times higher. In the second study, for the selected diseases, it was observed that in 2018 the costs would have been 25% lower, and in 2021, 44.7% of hospitalization costs could have been avoided if the prevalence of obesity had reached the target proposed in the Plan, which was 10.7%. Multi-professional treatment has achieved positive results, and adherence to the groups needs to be improved. Adequate planning and preventive actions for obesity and CNCD complications are essential if public health spending is not to become unsustainable.

The ombudsmen of the Unified Health System are an important tool in the field of democratic and participatory management, for guaranteeing the right to health, provided for in the 1988 Federal Constitution. difficulties in accessing health services. Thus, given the inability of the State to meet the demands of the population, there has been an exponential growth in lawsuits, the main cause of which is medication. In this sense, the aim of this research is to evaluate the impact of the resolution of the demands registered by the Ombudsman of the SUS in the judicialization of medication requests, from 2015 to 2019. For this purpose, an ecological, longitudinal research was carried out, with analysis of Quali-quantitative data, containing data and information from a secondary public source, based on time series, through data obtained through Excel spreadsheets, extracted from the OuvidorSUS System, by technicians from the SUS Ombudsman and the Bigdata Panel, referring to the years 2015 to 2019, using statistical analysis with Eviews software. In addition, data from “Justice in Numbers”, from the National Council of Justice, through the National Database of the Judiciary Power (DATAJUD), from 2015 to 2019 were used. The number of manifestations about medicines was increasing every year, especially when Law nº 13.460/2017 was created (historical landmark of the ombudsman), according to the graphs previously informed in the management reports. On the other hand, according to a report by “Justice in Numbers” (2021), since 2017 the number of new lawsuits on medicines has fallen, rising again in 2020. after the statistical analysis, it was observed that the effect of the resolution rates of the SUS ombudsman on the total number of new cases in the justice system was positive. Furthermore, there was an impact of Law nº 13,460/2017 on the resolution rate of the SUS Ombudsman, with a shorter deadline for closing demands for medication requests after the regulatory framework.

Edentulism is considered an important problem for oral health, with biological and social precursors, generating a set of difficulties and limitations that impact the quality of life and daily life of the affected population. As a way of expanding and qualifying the services offered and moving towards overcoming the current situation, the National Oral Health Policy (PNSB) enables the inclusion of prosthetic rehabilitation in Primary Care (AB) through the installation of equipment in Regional Dental Prosthesis Laboratories (LRPD), in order to cover different regions of the country. The present study aims to evaluate the effect of the National Oral Health Policy on the provision of dental prostheses in PC in the state of Bahia considering the types of LRPD accreditation, from 2008 to 2019. The study was divided into two stages. In the first stage, a descriptive ecological study was conducted, describing the outpatient production of dental prostheses according to the quantity produced, in the state of Bahia, from 2008 to 2019 and the temporal evolution of municipalities with accredited LRPD in the state of Bahia, from the years 2008 to 2019. In the second stage, an evaluation of the effect of the PNSB on the supply of dental prostheses in the state of Bahia was carried out from 2008 to 2019, using a linear regression model. Greater production of prostheses was observed

maxillary and mandibular, total and partial, and non-significant production values for coronary and temporary prostheses. In the analysis of the temporal evolution of municipalities with accredited LRPD, an increasing percentage was observed between 2010 and 2011, with a subsequent drop between 2012 and 2013. The percentage rose again from 2014, with 2019 being the year with the highest number of accreditations. There was an effect of the PNSB on the production of prostheses for municipalities accredited by the Ministry of Health (MS), with greater significance in the results, and in municipalities accredited by the MS and on the Expansion Plan list. A low magnitude effect was observed for municipalities with accreditation only through the Expansion Plan. The policy provided an increase in the provision of rehabilitation services using dental prostheses, mainly through accreditation through MS ordinances for adherence to the LRPD. However, the creation of the Expansion Plan as an additional tool to increase coverage participated to a lesser extent in this process.

It is considered that approximately 50% of adults suffer from some mental and behavioral disorder at some point in their lives. More than half of these people experience moderate to severe symptoms. It is estimated that four of the ten main causes of disability in people five years of age or older are due to mental health disorders, with depression being the main cause of all diseases that cause disability. The triggering of a mental disorder is multifactorial and constitutes events and characteristics that act as predictors of emotional, physical and social problems throughout the life cycle, such as lack of family support, low socioeconomic status, experiences of victimization, etc., also including factors such as stress, genetics, nutrition, perinatal infections and exposure to environmental hazards. Unfortunately, the resources used in mental health care are still insufficient for all individuals with some type of mental disorder to have access to treatment, especially in low-income countries. In recent decades, in Brazil, Mental Health services have undergone some transformations over time, such as the creation of RAPS – Psychosocial Care Network, with CAPS (Psychosocial Care Center) and its different modalities, the units care strategies within RAPS, aiming at actions that aim to interact with the patient, rehabilitating them for social life, reintegrating them into the environment, providing adequate treatment. Currently Brazil

has 2,755 CAPS units enabled, and between 2019 and 2021. The purpose of this research was to analyze the effect of Psychosocial Care Centers (CAPS) on hospitalizations for mental disorders in the country, motivating new studies and the improvement of policies public resources aimed at mental health. A longitudinal ecological study was carried out, using Brazilian municipalities as the unit of analysis, in the period 2008-2019. Data from 1,634 municipalities were considered, given the availability of data on psychiatric hospitalizations during this period. The period of the COVID-19 pandemic was excluded, due to the possible impact of this period on mental health. There were 3,889,568 hospital admissions due to psychiatric causes in Brazil between 2008 and 2019 in 1634 municipalities, with more than 40% due to disorders related to SCHIZOPHRENIA, followed by causes related to ALCOOL abuse. Male patients of white or mixed race/color make up the preponderant profile of those hospitalized throughout the data series in Brazil. Among Brazilian regions, the Southeast concentrated the majority of hospitalizations (52.53%), followed by the South (23.30%), Northeast (17.03%), Central-West (5.65%) and North (1 .49%). The south and northeast regions stood out for having average CAPS coverage higher than the values estimated in the present study for Brazil. In general, most municipalities in the present study presented, on average, CAPS coverage lower than 2.5 CAPS per 100 thousand inhabitants throughout the data panel considered (Figure 4). The Southeast region led in the number of hospitalizations for SCHIZOPHRENIA, ALCOHOLIC and PSYCHOACTIVES, totaling 1,344,104 hospitalizations, while the South had the highest hospitalization rates for HUMOR, with 207,615 

hospitalizations. Considering the general hospitalization model for Brazil, a positive association was detected between hospitalization rates per 100 thousand inhabita mais internações. Por fim, analisando a parte binomial dos modelos por tipo de diagnóstico é perceptível que a relação da cobertura de CAPS com a probabilidade de taxas de internação igual a zero é semelhante ao observado no modelo geral para o Brasil, i.e., a probabilidade de um município não experimentar internações pelas quatro principais categorias de diagnósticos psiquiátricos reduz 15% em média para cada incremento de cobertura de CAPS. Uma exceção foi a região norte que mostrou que cada incremento da cobertura de CAPS foi associado com um aumento da probabilidade do município não experimentar internações nos quatros modelos por diagnóstico (Figura 5). O mesmo ocorreu para internações por ALCOOL na região sudeste. Em contrapartida, na Região Centro Oeste, para a cobertura de CAPS no modelo para HUMOR, observa-se que cada incremento de uma unidade está associado com um declínio de 14% (i.e. 0,86 – 1  100) nas taxas de internações dos municípios dessa região. Mesmo com a baixa cobertura de CAPS nos municípios brasileiros, regiões com as melhores coberturas entre os municípios, i.e. sul e nordeste (veja Tabela 3), apresentaram redução nas taxas de internação por HUMOR e ESQUIZOFRENIA a cada incremento de cobertura desses centros. Isso pode sinalizar que: a) CAPS são mais efetivos em reduzir internações dessas duas causas e b) há uma efetividade reduzida para a maioria das demais causas psiquiátricas. Assim: há uma necessidade de melhorar os serviços prestados pelos CAPS ou, o que pode estar acontecendo para os CAPS não afetarem significativamente outras causas, como ALCOOL e PSICOATIVAS. Há uma variação na análise quanto à implantação do CAPS e internações dependendo da região e o diagnóstico, o que pode estar relacionado também aos fatores de riscos e de proteção, citados neste trabalho, bem como uma baixa cobertura do CAPS em muitas regiões. Esse estudo evidenciou que o aumento da cobertura do CAPS esteve associado ao aumento das hospitalizações por transtornos psiquiátricos, mas com importante decréscimo das hospitalizações quando os municípios apresentam maiores coberturas sustentadas ao longo do tempo. Assim, novos estudos são indispensáveis para se buscar análises distintas, como gestão da rede, análise sobre a efetividade do CAPS através do matriciamento, acolhimento do usuário e família, adesão ao tratamento, qualificação profissional, entre outros aspectos. nts and CAPS coverage, i.e., each increase in CAPS coverage in the municipalities was related to 1.30 times more hospitalization rates. hospitalizations, that is, in general, considering all AIHs, a reduction in hospital admissions due to psychiatric diagnoses was not observed with the increase in CAPS coverage, a different result from previous studies carried out. It was evident that most municipalities have similar CAPS coverage, despite varying numbers of AIHs. Municipalities with low CAPS coverage (close to zero) have high numbers of hospitalizations, as well as those with the best rates. This may indicate a weak association between the two variables, although the positive effect observed in the models was significant. It is likely that increases in hospitalization rates with each increase in CAPS coverage are reflecting a characteristic of the health system or economic conditions of the municipality, given that, in general, the probability of zero hospitalizations occurring in a municipality is negatively related to the number of beds and GDP per capita. Thus, it is expected that where there are more beds available, larger populations and better economic conditions will occur

Hemotherapy Services (HS) bring together a diversity of health professionals who deal with the
transfusion process, from recruiting donors, and extending to the transfusion of blood
components into the recipient and post-transfusion monitoring. This study aims to develop the
transfusion process by health professionals. The general objective of this study was defined as:
analyzing the perceptions of health professionals regarding technical and managerial
knowledge/knowledge and skills/practices for the development of the transfusion process
suitable for the rational and safe use of blood. Specific objectives were set: to produce a
synthesis of skills and abilities for health professionals involved in the transfusion process;
characterize the profile of health professionals involved in the transfusion process carried out
in a university hospital; identify the perception of health professionals involved in the
transfusion process about their knowledge, skills, potential and limits. Exploratory study with
a qualitative approach, carried out based on document review and application of a form to health
professionals at a public university hospital in the state of Bahia. Using Google Forms, 30
healthcare professionals voluntarily participated in the study. To analyze the findings, the
content analysis technique was used. The project of this study was approved by the Research
Ethics Committee. A synthesis matrix of competencies and skills of professionals involved in
the transfusion process was produced, constituting content for technical material that guides
health services and professionals on specific and common actions in the transfusion process.
The findings from the participation of the interviewees generated five thematic categories: 1)
Conceptions about the transfusion act and reasons for indicating transfusion of blood
components, which were perceived in a restricted way from the moment of transfusion until the
conception of a systematized process for which the indication must be careful and specific; 2)
Knowledge for the development of the transfusion process, defined as: theoretical knowledge,
current legal standards, transfusion practice, conditions for safe transfusion, rational use of
blood and blood components and technical and managerial knowledge; 3) Transfusion reactions
and conduct, the recognition of which is related to the practice and daily life of services that
involve direct patient care, requiring that all professionals involved in the process are trained to
recognition and action; 4) The skills and competencies were defined beyond practical
knowledge, but with the articulation of personal attributes that in synergy build the necessary
competencies; 5) The difficulties reported relate to structural aspects such as deficiencies in
inputs, personnel and technical training, but present potential as mainly human resources,
committed and cohesive with the work; 6) The challenge of maintaining the quality of processes
and the need for improvement, technical and managerial training, personnel adaptation and
process modernization aiming at the good development of the transfusion process. Therefore,
the study sought to demonstrate the transfusion process through the perception of those who
participate, and whether it is fundamental to therapeutic success or which may interfere in some
way with the transfusion act. It was possible to verify the great concern of the respondents
regarding multidisciplinary responsibility in the process considered technical, difficult,
judicious, strictly standardized and, according to the participants, with challenges of structuring
and disseminating knowledge for all professional categories involved. It is concluded that
within the limits of each category involved in the transfusion process, professionals carry out
their activities within normative and legal limits, the perspective and desire for training,
accurate information, training so that the transfusion act can be carried out safely is unanimous.
by the professional who performs it.

Diabetes Mellitus is a chronic non-communicable disease caused by multiple causes and risk factors that subject the person to a long period of latency and a prolonged stage of the problem until the onset of the first symptoms (DUTRA et. al., apud Brasil, 2015 ). Once detected, treatment must be started to prevent possible hospitalizations due to complications of the disease. This prevention can occur through basic and daily care such as healthy eating, physical activity and adherence to medication treatment, whose actions constitute the self-care process. This process is a preponderant factor in intervention on undesirable outcomes, such as hospitalizations, sequelae or deaths. Faced with this problem, the study sought to evaluate the impact of self-care practices on reducing hospital admissions due to diabetes mellitus, in the city of Porto Alegre/RS, in 2022-2023, the results of which showed significant effects on the probability of reducing possible hospitalizations.

Public health system capable of assisting a heterogeneous population, with a multiple burden of diseases, requires the creation of public policies under different aspects, some of them aimed at valuing, training and qualifying human resources in health, in favor of a health care model based on integrality and solvability. Innovative teaching strategies through ICTs such as Telehealth have been configured as an opportunity for assistance and educational support for health professionals within the SUS. Thus, this qualitative study analyzed the Tele-education of Telessaúde Bahia as a support to the Permanent Education in Health of the health professionals of the Basic Attention of Bahia. The logical model of Tele-education was elaborated and later approved, which supported the formulation of questions and structured statements that composed the online form that was sent to the key informants' e-mail. A total of 238 responses were obtained, 193 from health professionals and 45 from municipal managers (primary care coordinators and municipal institutional supporters). Quantitative data were processed using the Microsoft Excel 2013 program, using the 5-point Likert Scale: totally agree, agree, indifferent, disagree, totally disagree and analyzed using the SPSS software (Statistical Package for Social Sciences). For the analysis of qualitative data, the content thematic judgment was used. The Logical Model of Tele-education pointed out the probable theory and practice of operation: the objectives, the interaction between the actors involved, the activities carried out and the expected effects in the short, medium and long term. Professionals and managers showed positive perceptions regarding the enhancement and qualification of learning through Health Information and Communication Technologies, in supporting clinical decision-making and diagnosis, and in providing up-to-date technical-scientific information based on difficulties experienced in the territories. Tele-education was considered a support for EPS, capable of contributing to the development of new care strategies, promoting a humanized view of the professional on the problems and needs of the population, improving the clinical capacity of the teams, resulting in probable benefits on the conditions health of the assisted population. However, it is necessary to improve structural elements and weaknesses pointed out in the organization of the work process, little autonomy and low stimulus from municipal management, and in the absence of discussions and exchange of knowledge between the members of the teams themselves in the municipalities. It is also appropriate to encourage health managers within the three spheres, the Telehealth Management Committee and other health and educational institutions to take on the responsibilities assigned to them by the PNAB, PNEPS and Telessaúde Brasil Redes e Bahia, in order to strengthen Teleeducation. and Permanent Health Education in the State.

The Brazilian administrative restructuring throughout the Reform of the Brazilian State apparatus resulted in new ways of management, mainly in the health field. It contributed and legitimized the Social Organizations to manage basic services, previously executed by State. The management of the health services by Third Sector is justified by important elements such as efficiency, efficacy, low cost and a better administrative and financial dynamic of the resources for the public managers. As a result, the role of the State would be regulator and supervisory of the health services provided. It is necessary to establish a management contract that is a public administrative commitment instrument between the State and the social organization. This paper aimed to analyze sevenmanagement contracts of hospitals managed by social organizations in Bahia in order to contribute with news health indicators by management work perspective. The results revealed that , in the contract, most of the health indicators were quantitative, clinical procedures, numbers of clinical appointments. The health management and health workers were not approached. It is important to strengthen the monitoring and evaluation as management tools, because social organizations have been an international and national trend.

The concern with patient safety (SP) must involve all health services that are part of the Health Care Networks (RAS). The Emergency Care Units (UPA), as a point of attention of the RAS, are structures of intermediate complexity, and must operate 24 hours a day. This study has the general objective: To analyze the actions/practices of Patient Safety developed in Emergency Care Units in the city of Salvador, Bahia, Brazil. The specific objectives are: Identify patient safety practices developed in the UPAs; describe the challenges for patient safety in UPAs. Inclusion criteria were considered for the UPAS and an online questionnaire was applied through google forms to seven health professionals from December 2020 to February 2021, assigned to the Patient Safety Centers in the UPAs for more than six months. Documentary analysis was also performed. The collected data were systematized, organized and processed in a matrix and the contents were analyzed using the thematic analysis technique. All ethical aspects were respected. The results showed that the UPAs of the study constituted the Patient Safety Centers (NSP) by a multidisciplinary team, but most did not have the doctor and pharmacist as members. Most of SP's plans and protocols were implemented and implemented through continuing education and the promotion of SP culture. The UPAs implemented protocols that describe actions for the adoption of hand hygiene, patient identification, phlebitis, sepsis and allergies. The NSP actions performed were patient identification at the bedside, educational actions, informative posters on hand hygiene, decubitus change clock, electronic medical records. Due to the Covid-19 pandemic, educational actions were intensified, focusing on hand hygiene, Personal Protective Equipment (PPE) and control of health care-related infections (IRAS). As challenges, the need to problematize SP, instrumentalization of future professionals and offer support to the centers to act in the promotion of SP culture stand out. This study may contribute to encouraging managers and health professionals to reflect on the subject, bringing safety and quality of care in health services to the agenda of priorities, and the need to implement, implement, monitor and evaluate SP actions.

Introduction: Osteonecrosis of the femoral head (ONCF) is a condition that can lead to progressive destruction of the hip joint, common between the third and fifth decades of life, being the diagnosis responsible for 5 to 18% of total hip arthroplasties (THA). ). Among joint sparing treatments, the role of central decompression (CD) is still debated. Objective: To compare the effectiveness of central decompression (DC) and conservative treatment (CT) to save femoral heads in patients with avascular necrosis of the femoral head. Results: Four clinical trials and two cohorts involving 316 hips, with a mean follow-up of 22 to 48 months were included in this review. Our results suggested that patients undergoing CD were less likely to undergo total hip replacement surgery [OR = 0.42 (95% CI, 0.20–0.85); I 2 = 0.00%; p = 0.74]. In the analysis of the radiographic progression rate stratified by the stage of ONCF, the CD group had a significantly lower failure rate than the CT group at stages 0/I, [OR = 0.32 (95% CI, 0.11– 0.96); I 2 = 25.41%; p = 0.26], but not in stage II [OR = 0.68 (95% CI, 0.14–3.34); I 2 = 71.84%; p < 0.01] nor in stage III [OR = 1.21 (95% CI, 0.11–12.85; I 2 = 67.37%; p = 0.05)]. Conclusions: Performing CD is effective in preventing progression to femoral collapse in the early stages of ONCF in a short-term follow-up and reduces the chance of total hip arthroplasty. However, the short-term follow-up and small sample size of the current meta-analysis provide only limited quality of evidence. Randomized controlled trials with a larger sample size and longer follow-up are needed to provide further insights into the optimal treatment of ONCF.

In January 2020, the World Health Organization (WHO) declared the outbreak of the novel coronavirus disease (COVID-19) a Public Health Emergency of International Concern. The COVID-19 pandemic has become a challenge for science and society, demanding quick responses from health systems. In this perspective, the Municipal Health Department of Salvador implemented the “Salvador Protege” program, aimed at combating the coronavirus and which also aimed to serve to monitor other diseases presented by the population in the post-pandemic, using mainly the resources of telemedicine. The initiative's main objective is to protect and care for people, families and communities impacted by the Covid19 pandemic and to develop the work of the Basic Health Units (UBS), especially with family strategy teams, in addition to the activities already carried out by the agents. community health and endemic diseases. Another focus of the program is to protect and support healthcare workers during the pandemic. The present dissertation is an evaluability study of this Program. The evaluability analysis was based on the logical model of Salvador Protege prepared on September 25 and validated on September 29, 2020 and on documents prepared by the SMS of Salvador. The analysis carried out by this study pointed to the existence of a set of challenges for the implementation of the Salvador Protege Program. The program still presents difficulties in its operationalization and does not present, in its design, evaluation and monitoring strategies. For a Health Program to be evaluated, a proposal that considers the monitoring of professionals' activities, accessibility to services and health technologies is necessary. It is important that the formulation and execution of the Program be improved, highlighting the importance of the present study.

Platelet-rich plasma (PRP) is an innovative, promising technique with significant results in several areas of medicine. The aim of this study is to carry out an evaluation of the results on the applicability of PRP in the treatment of foot ulcers in diabetic patients. Method: This study consists of a systematic review of the specialized literature and meta-analysis of randomized clinical trials in the application of PRP in diabetic foot ulcers. For the elaboration of the research question, the acronym PICOS was used as well as in the orientation in the search strategies. The protocol for this study was registered in the PROSPERO database to register protocols for systematic reviews. The methodology proposed by the Cochrane Collaboration manual was adopted and the PRISMA checklist was used. The AMSTAR 2 tool was used to assess the quality of the review. Inclusion criteria were prospective, randomized clinical studies with no date limit. The forest plot graph was adopted for statistical analysis. Results: Of the 154 articles found in the search engine databases, 87 were excluded due to duplication, 58 because they did not meet the inclusion criteria and ended with 09 articles included. Two analyzes were performed, using the outcomes of treatment efficacy and reduction of ulcer size. Seven of the nine articles (408 patients) specified the outcome of treatment effectiveness, with a significant increase in cured patients. The other three articles (224 patients) specified a reduction in the size of the ulcer, being statistically significant in reducing the size of the ulcer. Conclusion: In conclusion, the sample analyzed from the systematic review of randomized clinical trials indicated that the use of platelet derivatives proved to be a good, safe and effective treatment option to accelerate the healing process of chronic foot ulcers in patients with diabetes mellitus, with no treatment-related complications. In view of the small sample of these studies, more randomized clinical studies are needed with a greater number of diabetic patients and patients with foot ulcers and with a greater follow-up.

In Brazil, diabetes is considered the main metabolic disease during pregnancy. Gestational Diabetes is defined as any degree of glucose intolerance, whose diagnosis occurs at the beginning of pregnancy, and may or may not persist after delivery. The lifestyle habits of pregnant women and / or the hereditary burden are considered important factors for the development of the disease. Pregnant women with diabetes tend to have greater complications in pregnancy and there are greater possibilities of complications, reflecting a higher cost for health services and an impact on families. The general objective of the study is to estimate the average differential of direct hospitalization costs for the delivery of pregnant women with diabetes and without the disease, in a public maternity hospital in Salvador / Bahia, in 2016 from the perspective of the Unified Health System. it is an observational study, with a test of difference of means between two retrospective paired groups, of disease cost assessment, with a quantitative approach. For the collection of data from the epidemiological clinical profile, information from the records of the 135 patients and data from their hospital systems were used. In order to estimate the costs of patients in each group, data were collected regarding the number of tests and medication used, delivery mode, hospitalization of pregnant women in the ward and newborns in the ICU. Descriptive statistical analysis was performed with a mean difference test to obtain the average cost and check the significance of the difference. The results for the case and comparison groups were found respectively: Type of delivery: cesarean section - 81.4% vs 24.6%, normal delivery - 18.6% vs 75.4%; Hospitalization of pregnant women for clinical complications: only those in the case group admitted, which corresponds to 30% of pregnant women in the group; NB admitted to the ICU: 23.2% vs 4.61%. The average total cost was R $ 9,463.4 x R $ 5,986.53,30

case and comparison, respectively. All items had higher values in the case group. The cost item that contributed to a greater difference between the groups was the admission to the pregnant woman and what reduced this difference was the admission of the NB to the ICU. The average incremental cost can be up to 58.8% more for pregnant women with diabetes. This higher proportion corresponded to an average incremental differential of R $ 3,476.9 for pregnant women with diabetes hospitalized for childbirth in 2016. It is evident that the delivery of pregnant women with gestational diabetes, in addition to being more costly for SUS, also implies greater possibility of unfavorable outcomes, therefore reinforcing preventive measures and early diagnosis is necessary and urgent to minimize the health impacts of women and their children.

The study analyzes Work Management in Primary Health Care according to health macro-regions of the state of Bahia through the National Program of Improved Access and Quality of Primary Care (PMAQ-AB) in 2016 to 2017. A descriptive and exploratory study was carried out, based on the results of the external evaluation of the PMAQ in 408 municipalities in the state of Bahia. The chosen variables were the forms of admission and hiring, type of bonds, position plan and career and continuing education actions. The analyzed data is in the public domain, not being submitted to the Ethics Committee for consideration. It is noteworthy that the universe of sample corresponded to 70% of the Family Health teams in the state, with predominance of the nursing profession; 57.7% of the forms of entry into the state and between macroregions are by other unspecified ways; 78.3% of agents contractors is from the direct municipal administration and then from the private sector, and Centro Leste has 41.8% of contracts with outsourced, surpassing all macro-regions of the state; 33.3% of contracts are temporary, although

in the macro-regions West (40.6%), East (36.3%), North (35.1%) the bond predominates statutory; only 13% of participants have a Career, Position and Salary Plan in the state, however, the North (24.9%), East (23.3%) and West (15.7%) surpassed the reality of Bahia and other macros; in relation to permanent education actions, 80% claim to exist and point out that these actions address the needs of professionals. The findings highlight the need to rescue the management policy of the health work, proving to be a new and old challenge that needs to join efforts to strengthen and ensure the sustainability of ABS in the state and among the macro-regions of health

In this work, we sought to investigate the possible effect of the Family Health Strategy (ESF) on the National Neonatal Screening Program in Bahia in one aspect particular, that is, the moment of collection of the first sample of the heel test, recommended between the 3rd and 5th days of life of the newborn according to the Ministry of Health. For the investigation, a data analysis was carried out in a longitudinal panel that evaluated the performance of health units in collecting the exam in relation to existence or not of FHS team active in the establishment. The search found an effect of improvement in the average number of days on which the collection was evolution directly related to the time the health unit had functioning FHS teams.

In addition, the presence of the FHS in the health unit was related to an increased likelihood that the test collection would be performed in the recommended period. The magnitude of this effect, however, proved to be practically null within a context of public health intervention, since, in order to reduce one day in the average collection time, the health facility would need, approximately six years of operation as a Family Health Strategy. It is proposed that the research result does not show an intrinsic limitation of power reach of the FHS; on the contrary, it can point to a performance of the Health Strategy of the Family below its potential, as well as reveal possible failures in actions programmatic, such as visiting the newborn in the first week after delivery.

According to the 2005 International Health Regulations, a public health emergency of international importance is an extraordinary event for the international spread of a disease that constitutes a public health risk for other States. Declared by the World Health Organization as a pandemic, COVID-19 determines the carrying out of epidemiological surveillance actions, attributed to the Network of Strategic Information Centers in Health Surveillance, which acts as a focal point for the International Health Regulations in Brazil. The realization of these actions has caused changes in the way in which the work of the Center for Strategic Information in Health Surveillance in Bahia is organized with a view to the timely generation of information on the magnitude and distribution of cases and deaths from this disease in Bahia. Such modifications lack systematization, an initiative prior to a necessary assessment with a view to improving the epidemiological surveillance actions of COVID-19 under the responsibility of this institution. Thus, the present study aims to evaluate the development of coronavirus epidemiological surveillance actions by the Center for Strategic Information in Health Surveillance in Bahia, according to the International Health Regulations. It is an evaluative study of the normative appreciation type. A logical model and respective judgment matrix adapted from the State Contingency Plan for Coping with the New Coronavirus and the studies by Costa (2013) and Santos (2014) were prepared. For the production and analysis of the data, documental analysis and semi-structured interviews were carried out with technicians and managers of the Center for Strategic Information in Health Surveillance-Bahia who carry out epidemiological surveillance actions by COVID19. In the analysis and judgment matrix, the following dimensions were evaluated: inputs; management and development of the actions of the Center for Strategic Information in Health Surveillance and quality of health information systems. In general, CIEVS-Bahia carries out its actions in accordance with the International Health Regulations, having a specialist coordinator in public health, exclusive teams for the bulletin and for the investigation of confirmed cases and deaths with experience in epidemiological surveillance, administrative support staff, in addition to a reference laboratory, sufficient standards and materials and equipment. The management produces epidemiological bulletins and carries out annual planning activities, educational activities, monitoring meetings and / or actions with other programs on COVID-19. For the monitoring of rumors about the occurrence of suspected cases of COVID-19, the main national and international sites that originate the clippings of CIEVS or the notifications sent to e-mails or institutional telephone, social network applications or official information systems are investigated. Regarding the quality of the systems, the team considers the FORMSUS, GAL and SIVEPGRIPE systems to be functional and reliable, the FORMSUS easy, efficient and of good maintenance and the FORMSUS and SIVEPGRIPE with portability. To improve the work process, it is worth emphasizing the need to hire more professionals, discuss with the team the importance of the International Health Regulations 2005 and with Lacen; propose strategies to disseminate the results in a timely manner and also report the difficulties encountered in the SIS to the Ministry of Health.

He objective of this work is to analyze the perception of managers and professionals involved in the Mais Médicos Project about the challenges of providing and reorganizing the medical work process in light of the Coronavirus pandemic scenario in the city of Ilhéus/BA in 2020. This is a case study of insertion and performance in primary care units of doctors hired by the Mais Médicos program in the city. Data production was carried out through document review and interviews with municipal health managers and four medical professionals hired by the program. The analysis of the results included the perception of managers about the medical provision in the city, as well as the actions of monitoring, supervision and evaluation of the performance of professionals carried out by the coordination of primary care. The analysis of the medical work process, in turn, took as a reference the theory of the health work process, seeking to identify if there were changes in the objects, means of work used by professionals and forms of work organization in the daily life of practice before and during the outbreak of the Covid-19 pandemic. The conclusions point out that despite the number of places being insufficient to meet the needs of the city, with regard to the increase in the coverage of Primary Care, the provision and retention of doctors through the PMMB, presents important advances in terms of access to the population to the network and humanization of care and meeting health needs related to precarious socioeconomic conditions and the epidemiological profile of the population, characterized by the high prevalence of chronic diseases, malnutrition, domestic violence and, more recently, with the outbreak of the pandemic of Covid-19.

Objectives: To analyze the sociodemographic and socioeconomic profile of children and adolescents with osteonecrosis secondary to DF and the social impact of treatment using CMMO in the studied population. Method: qualitative study with individuals with SCD of both sexes and aged between 8 and 19 years with SCD treated with cell therapy at Com - HUPES in 2019. Primary data were used through interviews and secondary data through medical records doctors. Results: Four adolescents were interviewed, two female and two male, with an average age of 14.5 (12-17) years, and with an average monthly income of two minimum wages, all with HbSS. Caregivers, all mothers of adolescents, are exclusively caregivers. Two participants have bilateral osteonecrosis with Ficat III in the right hip and Ficat I in the left hip, one participant has Ficat grade I osteonecrosis in the left hip and the other Ficat III in the right hip. Claudication was the most striking symptom for diagnostic suspicion, and pain the most restrictive symptom. School and recreational activities have been shown to suffer a strong negative influence due to pain or hospitalization. The postoperative results showed improvement in self-esteem, reduced pain and improved functionality of adolescents. Conclusion: The socio-demographic and socioeconomic profile of children and adolescents was between 12 and 17 years old, with an income of up to two minimum wages, the majority declared to have black or brown skin color, mothers are the main caregivers and have the exclusive activity of raising of the teenager. The treatment performed by SUS at HUPES and proved effective in treating pain and improving the self-esteem of the population studied.

BACKGROUND: Galactosemia, an inborn error of galactose metabolism, results on
sepsis and acute liver failure in the neonatal period, with a high risk of death during this
period. Given this, several European countries, Canadian provinces and American states
(USA) perform universal neonatal screening (NS) for this pathology. In 2018, CONITEC
considered that, for clinical diagnostic strategy, the existing evidence was insufficient to
establish the appropriateness of newborn screening for galactosemia. However, in May
2021, an expanded list of diseases that will be compound of the National Newborn
Screening Program (NNSP) was presented to include galactosemia. Health Technology
Assessment procedures require real-life data and economic analyses. AIMS: To describe
data from the pilot project of neonatal screening for galactosemia conducted in Bahia and
to evaluate the cost-effectiveness of neonatal screening compared with a clinical
diagnostic strategy. METHODS: A population screening study was carried out, followed
by a follow-up cohort of patients, coupled with a cost-effectiveness study. Operational
parameters of the newborn screening process were calculated. An analytical model was
developed to estimate the incremental cost-effectiveness ratio (ICER) between neonatal
screening strategies and clinical diagnosis (standard) from the National Health System
perspective. The health outcomes evaluated were death averted and potential life-years
gained. A 5% discount rate was applied. Costs were estimated from the SIGTAP table
and government procurement data. Univariate deterministic and probabilistic sensitivity
analyses were performed. Value of one Gross Domestic Product (GDP) per capita was
used as a threshold of willingness-to-pay. RESULTS: Between November 2015 and
March 2016, 77,148 newborns sequentially had galactose-1-phosphate (Gal-1-P) dosage
in dried blood on filter paper in the state of Bahia. Of these, 184 (0.23%) were positive in
the first screening and, 7.6% (14/184) remained with high Gal-1-P, and 5 cases were
confirmed, with a birth prevalence of 1:15,429 live births. The incremental cost per death
averted was estimated at R$259,052.37 and, R$4,143.31 for the potential gain of one year
of life. The birth prevalence of galactosemia and the probability of making a clinical
diagnosis were the variables with the greatest impact in the univariate deterministic
analysis. For the outcome of potential years of life gained, the acceptability curve showed
that for ICER values starting at R$7,034.40, the diagnostic strategy with neonatal
screening becomes more likely to be cost-effective than the clinical diagnostic strategy.
CONCLUSION: Among the population-based data available in Brazil, the state of Bahia
has the highest birth prevalence of galactosemia. Still, given the low frequency of the
disease, the neonatal screening strategy is not cost-effective at the willingness-to-pay
threshold of 1 GDP per capita to avoid one death. However, considering potential years
of life gained, at a WTP of R$10,561.60, neonatal screening was 100% cost-effective

Objective: This research aimed to describe and analyze the work process of Endemic Disease Combat Agents (ACE) in the city of Cruz das Almas, Bahia, based on the conceptions of Mendes Gonçalves who formulated the concept of the work process in health, characterizing it socially in constitutive elements (agents, objects, instruments and purpose). Methodology: This is a descriptive-analytical research, in which a cross-sectional study was carried out with the ACEs of the health surveillance structure, active in December 2020 in the city of Cruz das Almas. To produce data, a self-applied and semi-structured questionnaire was used, elaborated in the light of the current theoretical and political normative framework regarding the professional practice of the ACE. The database was structured in Excel Version 2016 software of the Microsoft Office professional Plus 2019 package and the variables of interest were analyzed using the statistical program Stata/MP 15.1 for Windows and represented through graphs and tables. Results: Among the participating ACEs, the age group between 35 and 39 years old, black race, male and complete high school predominated. All worked under the statutory regime, a workload of 40 hours per week and 91.89% with a salary range between one and two minimum wages. Arboviruses were the object of work by 100% of the agents surveyed. There was a lack of professional development, equipment, infrastructure, qualification, continuing education in health, integration with other professionals and sectors and incorporation in planning, monitoring and evaluation of actions, as well as gaps in their work practices. Conclusion: In view of the results found, it is essential that there are investments, surpassing the indicated limits, in the perspective that the strengthening of the work process of the ACEs increases the resolution of surveillance and control actions for vector-borne diseases in the city.

This study aimed to analyze the profile of the offer and use of the services of the Alto Sertão Bahia Regional Health Polyclinic (2017-2019) from the description of the process of implementation and definition of the offer of services and characterization of this profile, correlating it with the health needs of the population. This is a retrospective, exploratory, descriptive and qualitative study. Data production was carried out through document analysis and interviews with key informants. The criteria for inclusion of participants considered their involvement in the discussion process that took place regionally, which preceded the implementation. Data analysis was performed using the Thematic Content Analysis technique. The study was submitted and approved by the Research Ethics Committee of the Instituto de Saúde Coletiva at UFBA. In terms of management, the importance of Integrated Regional Planning and the effective participation of regional governance bodies such as the CIR in all stages of the process of implementing regionalized health services was highlighted. In the care field, the influence of the hegemonic care model was demonstrated, as well as the weakness of Primary Health Care in identifying territorial health demands, reflecting the supply and use of specialized care services. The results on the supply profile revealed that this does not have a directly proportional relationship to the use of services, indicating a possible inadequacy of the supply and the emerging need for a reassessment of the regional scenario supported by a careful situational analysis of health in order to identify the real health needs of the population to adapt the services offered at the Alto Sertão Regional Health Polyclinic.

Institutional Support is an innovative management device in the field of Public Health. It is realized through the work of technicians called institutional supporters, who collaborate with projects and policies, while strengthening collectives. This study aims to analyze the work process of the institutional supporter of Escola do SUS Bahia, who works in the development of human resources in health through the decentralized management strategy. The study is exploratory, has an investigative and descriptive character and was developed through a qualitative approach. It is based on the theoretical framework of Mendes-Gonçalves about the work process in health. As a method for data production, documentary research was carried out, with exploration of institutional documents and current legislation and field research, for which interviews were conducted using a semi-structured script. The 12 research participants are professionals who have worked or are working in the function, selected based on 03 categories, according to inclusion and exclusion criteria, such as length of experience. The analysis categories were defined based on the elements of the work process and specific objectives. Resolution CNS/CONEP nº 466/2012 was complied with with regard to ethical aspects. The analysis process considered Bardin's content theme. The results revealed that this agent acts guided by the Policy of Continuing Health Education and by the Institutional Pedagogical Political Project. Through support and co-management strategies, it collaborates to democratize the access of health professionals to knowledge, qualify practices and services from the perspective of strengthening the SUS and comprehensive health care, while encouraging the autonomy and emancipation of subjects. In productive action, it articulates material instruments with specific knowledge, skills and attitudes to develop work that has a managerial and technical-pedagogical character and is oriented based on multiple dimensions (ethical, political, pedagogical, technical, administrative, anthropological and human), weaving a synergistic movement of interaction and collective learning, these being some of the specificities that show its uniqueness. It is concluded that despite the relevance of this work process, challenges are imposed to development, demanding investments in actions to strengthen the team and work qualification, such as: lack of institutionalization of the function and ordering guidelines, investments in permanent education actions, offer of technologies and structuring of support networks.

With the expansion of health professionals working in hospital units of the Unified Health System (SUS) through Social Health Organizations (OSS), the aim of this study was to analyze work management in the relationships between SESAB, OSS and unit management , regarding the nursing professionals contractually linked via OSS in the HGRS. This is a qualitative, exploratory research on a hospital case from the SUS Bahia network. The data sources were primary, being analyzed as a document the Term of Reference (TR) and four interviews with strategic actors with the role of coordinating OSS contracts at the central level of SESAB, nursing coordination of these contracts, supervisor of the HGRS contract and director of nursing at the HGRS. The collected data were submitted to the content analysis plan, whose categories were pre-established from the theoretical framework about work management. The study was approved by CEP with CAAE nº 44808821.7.0000.5030.

As a result, it was recognized that there is a distancing from the contracting party in the recruitment process and a lack of guidelines for selection, monitoring of available resources or monitoring of the conditions to which workers are exposed. It was concluded that the type of employment relationship that prevailed in the analysis was the CLT, however, there was no reference to an information system that would enable the management of people and jobs. Furthermore, these results allowed the understanding of the obstacles in the management of work in an OSS, highlighting the importance of instrumentalizing monitoring by the SESAB to the management of hospital units, so that this monitoring is in line with SUS guidelines in the field of management from work.

Cardiovascular diseases are the main cause of morbidity and mortality in Brazil, causing a great impact on public health indicators. Telediagnóstico in cardiology of the Telehealth Brasil Redes National Program supports the consolidation of Health Care Networks ordered by Primary Care within the Unified Health System, using Information and Communication Technologies to perform diagnostic support services across geographic distances and temporal and qualifying health professionals, strengthening Primary Care, improving the quality of care and increasing resolvability. The objective of this research was to assess the evaluability of the telediagnostic service in cardiology of the Scientific Technical Nucleus of Telehealth, in Primary Care in the state of Bahia. This was a pre-assessment or evaluability study, with a qualitative approach, of the actions of the telediagnostic service in cardiology. The study also described the implementation of the service in the state of Bahia, characterized the program in its theory and practice from the modeling of the service, analyzed the objectives, activities and results observed in the concrete practice of the service, as well as identified and analyzed focuses for its improvement. Fifteen interviews were conducted with managers responsible for implementing the service in the city, with professionals involved in supporting the diagnosis and issuing of reports, in the request and execution of the electrocardiogram exam, in addition to users who used the service. The results revealed convergences between the objectives, activities and results proposed by the program among the key informants, with a broadening of the look at the objectives and reorganization of the results. They were: timely diagnosis and early intervention, better monitoring of patients with cardiovascular diseases, qualification of the clinic of non-specialist physicians, qualification of referrals to Specialized Care, faster regulatory processes, greater resoluteness in Primary Care, improvement of the process of work, improved access to the service and to the specialist, reduced costs for patients and the municipality, improved quality of life for patients and reduced mortality. It presented as a limitation the impossibility of conducting direct observation in the field, due to the moment of pandemic and the imposed measures of social distancing, in addition to being a case study in a small-population municipality and a health region in the state of Bahia, which does not constitute elements to extrapolate these results to other contextual characteristics. The study revealed that the telediagnosis service in cardiology developed by Telessaúde Bahia, in partnership with the Minas Gerais Telehealth Center, is sufficiently implemented to be the object of a systematic evaluation, focusing on future evaluations, a careful cost analysis. benefit through studies of economics, as well as effect from health indicators focused on cardiovascular diseases in the Bahia scenery.

In this study, the proposal to expand the understanding of knowledge and access to health care technologies for people with sickle cell disease was brought forward. Based on the objectives of understanding the knowledge of people with PD about health technologies; characterize the modes of access to health technologies; analyze the extent to which social networks contribute to people with PD about health care technologies. This is a descriptive quantitative study that included the participation of 70 people diagnosed with sickle cell disease, from January to June 2021, in a reference center in Feira de Santana — Bahia. Of these respondents, 61.3% were women and 38.7% were men, with a higher prevalence of HBSC in 48.6%, all participants answered a semi-structured questionnaire developed by the author. Among the results, it was possible to verify that 51.4% obtained the diagnosis through the heel prick test, only 24.3% use Hydroxyurea. Despite the high rates of pain reporting in 78.6% of respondents, only 38.6% use the physiotherapy service as a therapeutic resource to relieve pain, limitations and dysfunctions. Six people were diagnosed with osteonecrosis, 2 people received guidance for referral at the Cell Therapy Center at Hospital das Clínicas, a reference point in the treatment of stem cells in osteonecrosis.

However, none underwent any treatment in the unit. Of the respondents, 95.7% (67) had never heard of this new technology. With the popularization of Smartphones, 90% said they have access to the 'internet' through the device. About 55.7% participate in social networks that discuss the disease. On the other hand, 52.9% said that social networks did not contribute to a greater understanding of the DF and only 14.3% said they had become aware of any new technology for health care through networks. It was possible to conclude that individuals with sickle cell disease, although connected, do not have the proper knowledge about health care technologies and are not properly oriented about the possibilities of technological innovations for the treatment of sickle cell disease. Thus, the creators of technologies should seek to shorten this gap, so that the therapy reaches the demanding population, thus promoting the improvement of the clinical condition and quality of life of people with sickle cell disease

The Mais Médicos Program (PMMB in Portuguese) was created in 2013 through the law 12.871, with the aim of eliminating the shortage of doctors in family health teams and making universal access to health care in primary care in the SUS effective. Among the actions planned to achieve the aims of the PMMB, the promotion of improvement of doctors working in Primary Health Care, in priority regions of the Unified Health System (SUS in Portuguese), through teaching-service-community integration. The physicians of the PMM are involved in professional improvement processes, from a perspective of permanent health education (EPS in Portuguese), through Academic Supervision offered by the Ministry of Education and training cycles offered by the Ministry of Health. This study analyzes the Academic Supervision practice of the Mais Médicos Program strengthens the teaching-service integration in the state of Bahia. These informations was collected through document analysis of reports posted by supervisors included in the survey in the UNASUS Webportfolio system, during the year 2019 and finding out of 12 supervisors linked to the supervisory institutions SESAB, UFOB and UNIVASF/BA and through the records the researcher's observation in the tutoring and supervision meetings. The results demonstrated that, while the possibility of building academic supervision based on territorial realities and the actors involved in its practice brings some power to the PMMB, the definition of guidelines and permanent education spaces for the actors who carry out the academic supervision, implications for weaknesses and commitment to the consolidation of teaching-service integration. The political instability around the federal government, and the coordination and staff at the central level constant changes, resulted in weaknesses in academic supervision. In this perspective, academic supervision is not capable of transforming medical practice, as it is constituted, above all, in a bureaucratic and managerial way, used far below what is expected from qualified supervision.

Continuing Education in Health is a political-pedagogical proposal to transform health practices
based on service problems. The debate gained strength in Brazil from 2004 onwards, with the
publication of the National Policy on Permanent Education in Health, which reflected on
scientific production, especially in the context of Primary Care. This study aimed to analyze
whether the experiences of Continuing Education in Health developed in the Family Health
Strategy of the city of Guanambi-Ba have enabled the constitution of subjects Transformers of
Health Practices. This is a study with a qualitative, exploratory and descriptive approach, about
the constitution of subjects/subjects through the processes of Continuing Education in Health.
For this purpose, 03 teams of the Family Health Strategy were selected from a total of 24 teams
, as they are units linked to the Medical Residency Program in Family Health and
Multiprofessional Residency in Health. Eight health professionals were included as research
subjects, distributed as follows: 06 higher education professionals from the ESF teams, 01
institutional supporter and 01 Primary Care coordinator. Data production took place through
semi-structured interviews and a participant identification form. The analysis process was
carried out using the technique of Content Analysis by Bardin (2016), anchored in the critical
pedagogy of Freire (1987) and the constitution of subjects of Testa (2007). The results pointed
out weaknesses in the EPS management process by the health department, such as: absence of
a Center for Continuing Education in Health, fragmented and vertical planning, and lack of
monitoring and evaluation. Differences in pedagogical choice were identified by the
investigated teams: one of the teams uses a traditional pedagogy, using the methodology of
transmission and knowledge that has not generated changes in health care; two teams prioritize
critical pedagogy, anchored in active methodologies and correct learning, with results that seek
to reframe processes and change practices. It is concluded that EPS, in the investigated context,
has enabled the constitution of subjects and factors in teams that promote educational processes
anchored in the problematization of everyday problems and in the collaborative practice of
workers.

The study is a research of a qualitative nature, a single case study with a built-in focus, with the general objective of analyzing the operation of the State Home-Care Program under a management perspective. The research was approved by the Research Ethics Committee (CEP) of the Institute of Public Health (ISC) at Universidade Federal da Bahia, with co-participation of the CEP of SESAB (Bahia State Department of Health). The study was performed within the scope of the SESAB which, in 2018, promoted substantial changes in its process for offering and organizing this service, through the opening of a public offering process for the accreditation of private home-care companies. The research used documental analysis, secondary data and semistructured interviews with eight key-informants as methodological strategy. The collected data was sorted and consolidated to the analysis criteria defined and treated in accordance with the conceptual elements. The results demonstrated three moments in the handling of the Home-Care (HC) actions in Bahia: direct administration, FESF (State Family Health Foundation) and private enterprises. Included in the grounds for the choice of the provision of services by home-care companies was the influence of a central administration, justified by the need for increasing the high complexity hospital bed turnover rate, with a greater rationalization of financial resources. Among the changes, the de-hospitalization of users outside the HC criteria to smaller units or to the municipalities of origin, one of the pillars of the new Program, contributed towards the release of high complexity hospital beds. Despite the expansion of the healthcare coverage, a decrease was observed in the number admitted patients having a high number of readmissions due to deteriorating clinical condition (41%), during the period from May 2018 to May 2019. The change in the organization of the working processes implied in the loss of federal funding for the healthcare teams and, in turn, the lack of use of assessment parameters of the service evidenced a weakness in the operation and control of the program. It is concluded that the recent option for the provision of services by private enterprises seems to reinforce the fragmentation of the healthcare, not promoting the integration among the services, based on the precariousness of the work, with the continued underfunding of the public sector and the sub-regulation of the private sector. It is suggested that SESAB convene healthcare service user organizations, health professionals and academic specialists to broaden the HC feasibility analysis and expansion, based on the health perspective and in defense of the interests of SUS, and on the healthcare needs of the population.

Operating health systems require qualified, affordable, equitably distributed FTS available to the entire population as these are foundations for ensuring access to health. It is noteworthy that there is a global FTS crisis and, in Brazil, expressed by the unequal distribution of health personnel, particularly in rural regions, urban peripheries or hard to reach places, such situation constitutes a major obstacle to ensuring access to health systems and services. It is noteworthy that the debate between the adequacy of FTS and the organization of practices in health services is a major challenge for management, since PFT is among the most complex types of planning. Based on the above, the sizing and analysis of workloads found for the CO and PA medical staff of a State maternity hospital is relevant to think about improvements in the work processes and future strategies for capturing, selecting and maintaining this type of workers in the unit, which may favor the improvement in the quality of health care for women and children at the state level. This scenario motivated the conception of this dissertation whose general objective was to analyze the workload of obstetric gynecologists, using the WISN method, who work in the IPERBA obstetric center, in 2019. This is an intervention study, descriptive exploratory study with a quantitative approach and qualitative elements, in which the methodological steps recommended by the WISN were used to calculate and analyze the workload of the obstetrician gynecologist medical professionals working in the CO and PA of IPERBA. The work indicated a deficit of 14 obstetricians on duty in the unit with a workload of 0.81. The study also pointed out that the quantitative insufficiency of obstetricians in IPERBA was due to precarious hiring and consequent, idleness of medical posts, associated with poorly structured work processes and a multidisciplinary team deficit. Finally, the dissertation, based on the FTS sizing of obstetricians, has the potential to contribute to the PFT in the health care network of women and children, however, it is advised to repeat the research in the same maternity and , if possible, for a longer period of observation, as in others of the same profile so that stronger recommendations can be made.

The general objective of the research is to build, in a participatory manner, with professional indicators for the evaluation of STP and specific to implement the indicators constructed; identify strengths and weaknesses in the construction of the PTS and contribute to the qualification of professionals regarding the construction of unique therapeutic projects and participatory evaluation. The development of indicators for the evaluation of the Unique Therapeutic Project (PTS) is justified by the lack of instruments in the management of the Unified Health System that enable a systematic assessment of this technology and the need to evaluate the Psychosocial Care Centers (CAPS) services that substitute for psychiatric hospitals, mitigating the possibilities of them producing contradictory or incompatible practices to the assumptions of psychiatric reform. The methodological framework was participatory evaluative research, covering the character of intervention, anchored in the assumptions of the fourth generation assessment. Representatives of 7 CAPS II from the city of Salvador from different professional categories participated in the research, composing the interest groups: assistance workers, managers, technical coordinator, institutional supporters in mental health and students of the Multiprofessional Residence in Family Health - FESF / SUS. Between the months of September and December 2019, a formal extension course was offered at the Institute of Psychology of the Federal University of Bahia, as part of the data collection process. In addition to the course, Shared Appraisal Groups (GAP) and consensus workshops were used to consolidate data collection. For data interpretation, the use of narrative theory and Paul Ricoeur's hermeneutic circle was used. As a product of the research, we obtained three technical productions: the extension course “Qualification of assistance in CAPS type II based on the evaluation of Unique Therapeutic Projects”, the “Methodological guide for the application of PTS evaluation indicators in CAPS II” and the “Form for Registration of Singular Therapeutic Project (PTS)”. The results were organized into three sessions. In the first, we present the reality of the CAPS II narrated by the participants. In the second, we have the process of building the 8 indicators: “Formulation of a unique therapeutic project”; "User cases by reference technician (TR) or reference team (ER)"; “PTS shared with Primary Care (AB)”; “PTS shared with the intersectoral network (except AB)”; "Joint discussion of PTS among the team"; “Systematic review of PTS by TR or ER”; “PTS with treatment only with medication” and “Investment in Permanent Education actions”. Finally, we present the challenges in the implementation of indicators, with the data obtained during the dispersion activity in services. The experience of the qualification course and the process of participatory elaboration of the indicators configured the integration between the experience of practical wisdom and theoretical knowledge. A collective construction in which it is believed that it will provide support so that there are consequences in the daily life of 11 services, generating an intervention effect expected by this research. The biggest challenge is to include the use of indicators and assessment in relation to work processes and not as merely technical expertise used by the manager. This becomes even more difficult when we are in a field where there is no tradition of using this tool

This study is characterized as a production for the Professional Master's Degree in Health Technologies developed in the format of two articles, which present social and service contributions, as well as theoretical and scientific contributions for reflection on the offer and access to health technologies available to SUS specialized care, and its general objective is to analyze the characteristics and strategies that interfere with the supply and influence the access and use of diagnostic imaging services provided in a service contracted by SUS in a city in the region of health in Bahia. The purpose of Article 1 was to characterize the demographic and morbidity profile of the population using CT and MRI services offered by an image service contracted in the city that hosts the health region of the state of Bahia, in the period from 2015 to the first semester of 2019. Prepared from data from the information system, and complementary to reports by key informants, the main findings pointed out that women, population 50 to 59 years old, residents of the headquarters of the health region and the urban zone characterize the predominant profile of users of the services studied. Most of the procedures performed were related to joint and skull exams, with low back pain and headache being the most frequent complaints. There was also a reduction in the total number of consultations in 2019 in the contracted service, especially regarding the TC service, which can be attributed to the implementation of the Regional Polyclinic. As for Article 2, the objective of which was to describe the strategies and regulatory mechanisms for the provision of diagnostic imaging services (CT and MRI) in a regional headquarters, as well as to identify challenges for managers in contracting and allocating services. The findings from the reports of the key informants pointed out that there is an imbalance between the supply and demand of CT and MRI services at SUS and improved access to diagnostic services with the arrival of the Regional Polyclinic, especially regarding CT scans. In addition, underfunding in the SUS, the low resolution of Primary Health Care (PHC), the greater demand than the offer and the reduced number of places were identified as challenges for the allocation of services. Despite the expansion of access to imaging services in SUS, with the implementation of the regional polyclinic, there is still a repressed demand for MR services, which causes an increase in the waiting time for this procedure. Therefore, the study highlights the importance of the regulation sector to monitor the performance of services, as well as the expansion of supply, taking into account the availability of services and the needs for serving the population residing in the health region. Thus, the importance of regulating the provision of image services by managers becomes paramount.

Introduction: With the current criteria for the diagnosis of diabetes mellitus (DM) in pregnancy, it is estimated an increase from 7.6% to 18% of its prevalence in Brazil. The lack of glycemic control increases the risk of unfavorable maternal-fetal and neonatal outcomes. Oral hypoglycemic agents appear as a therapeutic alternative before insulin therapy when behavioral changes (diet and physical activity) are not successful and metformin emerges as a safe and effective drug in pregnancy. Objective: To trace the sociodemographic profile of pregnant women attended at Maternidade Climério de Oliveira (MCO), diagnosed with gestational diabetes mellitus (DMG) and type 2 pre-gestational diabetes (DM2), treated with metformin, observing the convergence of the main gestational complications and of maternal-fetal outcomes with current evidence from the literature. Method: Retrospective cross-sectional observational study involving diabetic pregnant women (DMG or DM2) who used metformin alone or associated with insulin. Discussion: Data from 58 pregnant women and telephone interviews were analyzed in order to compare different maternal-fetal outcomes with current evidence selected in a systematic literature review. Sociodemographic data evaluated: race, education level, income and place of residence. Maternal-fetal and neonatal outcomes analyzed: prematurity; macrosomia or newborns large for gestational age; admission to the Neonatal Intensive Care Unit; neonatal hypoglycemia; Apgar of 5 minutes (> 7); dystocia; frequency of cesarean sections; instrumental deliveries; failure to induce vaginal delivery; maternal-fetal metabolic disorder; body mass index (BMI) at delivery and hypertensive disease specific to pregnancy (DHEG). Relevant clinical variables discussed: age, parity, abortions and comorbidities. Conclusion: This research with extensive literature review showed that in the analyzed population, mostly black, in unfavorable socioeconomic and cultural conditions and without other studies on the use of metformin in pregnancy, the results converged with the current evidence in the literature. Additionally, it aims to collaborate with the decision making of the managers and clinical staff of the maternity hospital on the use of metformin; with the development of indicators related to DM in pregnancy and professional qualification for specific DM care. It also intends to promote effectiveness studies on the impact of the use of metformin in high-risk pregnant women with diabetes mellitus.

Introduction: Family suffers from the admission of a member to an intensive care unit (UTI) and should be considered an object of attention by health professionals. This context justifies exploring what it promotes: how family comfort can be promoted and measured. However, there are no instruments to measure the comfort level of family members of children and adolescents in the ICU, which justifies the adaptation of the Comfort Scale for family members of people in critical health condition (ECONF) for the pediatric context. Main goal: This work aims to validate the content of ECONF for the pediatric context. Methods: The methodological study was developed according to the stages of the content validation process for cultural adaptation of scales: (1) Conceptual and item equivalence - composed of a literature review on comfort and family, analysis of the dimensions, items and theoretical bases of ECONF, adequacy of items to the pediatric context, reaching the first version of ECONF-PED, which was evaluated by the author of the original instrument; (2) Semantic equivalence - corresponded to the evaluation of the first version of ECONF_PED by the judges (specialists and target audience), the consolidation by the researchers of the data provided by the judges, allowing to arrive at the second version of the ECONF-PED, submitted to pre-test with 13 family members. The Content Validity Index (IVC) was applied to analyze the experts' responses regarding the relevance of the items to the construct and their dimensions and their language and clarity, considering an appropriate IVC ≥ 0.78. The agreement rate was applied to analyze the language and clarity of the items in the pre-test. (3) Operational equivalence - assessment of the degree of difficulty of the questions, the adequacy of the location, form of application and response options for the scale. Results: In the conceptual equivalence stage, ten items of ECONF (original scale with 55 items) were eliminated because they did not fit the pediatric context and 10 new items were prepared based on the literature. The items took the form of a question, some had their wording and terms changed for clarity and adequacy to the target audience. In semantic equivalence, the experts were unanimous regarding the pertinence of the four dimensions and respective operational definitions of the first version of ECONF-PED. After analyzing the IVCs, the qualitative considerations of the specialists and the target audience regarding the understanding and importance of the item for their comfort, it was decided to exclude eight items, 19 items remain with change in the wording and 28 without changes, arriving the second version of the ECONF-PED with 47 items was submitted to a pre-test with 13 family members. The pre-test analysis showed 36 items with a 100% agreement rate for language and clarity, six for 92.3% and five between 69.2 and 84.6. Thus, 11 items had their wording modified and underwent another pre-test with four family members, noting that only one reached a 75% agreement rate, being eliminated. Thus, the final version of ECONF-PED has 46 items distributed in the dimensions Safety (16), Support (14), Integration with you and the daily life (10) and Family interaction with the child or adolescent (6). It is a five-point Likert scale, ranging from 0 (never) to 4 (always), and can be self-applied. Conclusion: ECONFPED achieved content validity and is a valid tool to measure the comfort level of family members of children and adolescents in UTI-PED in the bahian context, and can be used to guide health care practices.

Fractures, especially those resulting from traffic accidents, and their complications, represent an important condition that has led to increasing costs for SUS, both in primary treatment and in the care of their injuries. One of them, pseudarthrosis, a well-known entity in orthopedics, is a complication of fractures where the bone does not present consolidation characteristics. Faced with a scenario, in which the increase in hospital costs in the surgical treatment of fractures is observed, as well as pension expenses embedded in the cost of pensions and retirements, resulting in loss of work activity with great repercussion in the country's economy, we decided to carry out a clinical trial comparing the expense of conventional surgical treatment for tibial pseudoarthrosis, using plates and screws, intramedullary nail or external fixators, with the use of a new technology: the injection of platelet-rich plasma in the focus of the referred lesion, in patients treated by the Unified Health System.

Sickle Cell Disease is defined as an autosomal recessive disorder characterized by the presence of abnormal hemoglobin S. Sickle Cell Disease is originating from the African continent. Due to the long historical process of intense enslavement of African peoples and colonization of Brazil, the black population is the most affected. The S gene is more prevalent in Bahia and Salvador. Approximately 50% of patients with Sickle Cell Disease have avascular necrosis, which mainly affects the head of the femur. The treatment of osteonecrosis of the femoral head is considered a challenge. Traditionally, the therapy used is total hip arthroplasty, which corresponds to an invasive procedure with high rates of morbidity and mortality and unsatisfactory results after 5 to 10 years. Cell therapy, with the use of stem cells, proves to be an important alternative to be incorporated into SUS in the treatment of hip osteonecrosis. Patients with Sickle Cell Disease present better prognosis with cell therapy, featuring a 5% failure rate. Considering the efficiency of cell therapy, the objective of the present work was to perform an analysis of the effective spending on this therapy in hip osteonecrosis in people with sickle cell disease, in the context of SUS. For this purpose, a descriptive, comparative and crosssectional study was developed of people assisted at the Professor Edgard Santos University Hospital Complex, with hip osteonecrosis secondary to Sickle Cell Disease and submitted to cell therapy, in the age group of 18 to 40 years old, in the period from 2015 to 2019. From the medical records of the patients, the expenses of cell therapy and total hip arthroplasty were estimated for analysis and comparison purposes. To evaluate health expenditures, the microcosting methodology was applied and the SUS perspective was used as the purchasing organization of public and private health services. All direct expenses were computed based on the coverage of the reimbursement tables of SUS procedures. In addition, data from DATASUS were consulted. Concerning cell therapy in hip osteonecrosis from 2015 to 2019, 74 patients were tended, with 88 surgical procedures being performed. The results showed that the expenses obtained with each procedure were R$ 3,265.22 for cell therapy and R$ 4,764.08 for total hip arthroplasty. Based on scientific evidence, the loosening of prostheses referring to primary total arthroplasty in Sickle Cell Disease, where the value of R$ 4,764.08 has an average useful life of 5 to 10 years, requires a total revision arthroplasty, a procedure with estimated expenses of R$ 6,365.18. Therefore, the expenses are even higher compared to cellular therapy, with an increase of R$ 7,864.04 per procedure. In this context, from the evaluation of the expenses considering the 74 patients analyzed, it was verified that, while cellular therapy generated an expense of R$ 287,339.36, if the traditional method was adopted, the amount spent would be R$ 979,374.88. Then, through the analysis carried out, cell therapy proved to be more economical, being a treatment that makes it possible to treat more people in less time.

The Health Information Systems subsidizes information, important for Analysis of Health Situations and Health Planning and Management for geographic population groups. In Brazil, among several systems, we have the Hospital Information System SUS (SIH-SUS), created for payments and auditing, but it has been used for studies related to epidemiology and hospital quality management analysis. Your system data is provided by DATASUS, through the disseminable files (DEF) and tabulated by the Tabwin application. One of the available variables is the postal address code of the boarding school. The present study proposes the use of the zone and district zoning functionality of residents of the city of Salvador of SIH / DATASUS data in Tabwin and Tabnet Salvador site and describe how the tool is. By adding functionality, it will be made available for both research and health planning purposes, the data more refined allowing a closer intervention of the health problem in and contribute to the construction of the Municipal Health Plan.

The interest by studies in monitoring and evaluation of data quality in information systems has grown in the last years, but the initiatives are still isolated and no systematical. However, Ministry of Health is implementing qualification strategies to these data, as the “The Sixty Cities” Project. In that study, they tried to know the characteristics of variables of Obituary Declarations that had registries of codes of basic causes of death less useful to Health in Salvador County, Bahia, in 2017. These causes of death are called “Garbage” Codes by “Global Burden of Disease” and are less useful to analysis of health situations due to express health complications or damage that has started the chain of events that has led to death, but not the cause that, in fact, has led to death. This is a descriptive, quantitative study, using the secondary data from the Mortality Information Systems with deaths that record the codes that are useful, defined by the Ministry of Health as priorities. Salvador had, in 2017, 16,014 deaths of occurrence and residence in its territory. The most common causes were: Chapter II – Neoplasm (3,137 deaths), Chapter IX - Circulatory System Diseases (2,859 deaths), Chapter XX – External Causes of Morbidy and Mortality (2,281 deaths) and Chapter XVIII – Symptoms, Signals and Abnormal Findings of Clinic Exams and Laboratory ones do not classified (1,700 deaths). About deaths with less useful priority code records, there were 4,775 deaths that matched to 29.8 % of total deaths. Female subjects had a higher frequency (32.1%), indigenous skin color /race of the (71.4%), education level of 1 to 3 years of study (33.9%) and in the age group of 80 and + years (36.7%). As for the less useful codes, the ill-defined causes of Chapter XVIII were used more often (35.5%).

The reality of trans people and their health needs are still little known by the broader society and by health professionals. The objective of this work was to elaborate and carry out an educational intervention to sensitize these professionals about the care of the transsexual population. The field of study was a medical service of a public university, and its subjects were the components of the nursing team. It was qualitative work and brought a double proposal: production of knowledge and transformation of the reality investigated. For that, a workshop was organized in three meetings. An initial survey questionnaire, observation recorded in field diary, participant's written statements during the workshops, as well as a workshop evaluation questionnaire were used. Participants included eight professionals from the nursing team, five nurses and three nursing assistants or technicians, aged between 35 and 65 years and from 10 to 40 years of nursing practice.

Despite this time of substantial professional activity only one participant declared to have undergone training on transsexuality. It was noted that participants did not distinguish between what gender is and what sex is. Some professionals demonstrated that they had contact with concepts related to transsexuality, however, they did not have mastery of them, with difficulty even of differentiation between sexual orientation and gender identity. A concern of the professionals in establishing a relation of cause and effect for the transsexuality was traversed crossing three conceptions so much: biologicist, spiritualistic and behavioral.

There was a manifestation of the feeling of empathy directed at the trans person as well as their relatives by the participating professionals and of reflections on the prejudice / discrimination that involves transsexuality and its consequences. When reflecting on the health problems related to transsexuality the participants made a coherent list with the literature and cited psychological disorders, suicide, violence, indiscriminate use of hormone and industrial silicone. As for the transexualization process, the professionals brought as conclusions: the importance of the multiprofessional team and the priority of health actions for transsexual people that surpass the physical changes. Participants brought an extremely positive evaluation of the educational intervention, stated that they considered themselves to be safer and willing to care for the transgender person, and demonstrated a knowledge of the concept of transsexuality that is closer to what is found in the current literature. I would like to emphasize that no participant has been an expert in the subject, but rather with a greater breadth of knowledge, including the restlessness of the doubt that may foster the desire for further study on the subject

The main issue is the way the haemovigilance service works in the prevention and occurrence of transfusion reactions (RTs). In this sense, it is outlined as a general objective: To discuss the actions, methods and strategies of haemovigilance for the prevention, treatment and minimization of the damages of the occurrences of the transfusion reactions (immediate) in a university hospital of the state of Bahia in the period of 2012 to 2018 (HH) according to the constituent elements of the work process (object, agents, means / instruments and purpose); Identify the frequency of the immediate RTs occurring / reported in the hospital in this period; Relate the type of transfused blood component to the type of reaction; Identify the demand and the capacity of service of this UH; Identify methods and strategies used by UH to prevent RT and minimize harm. This is a retrospective, descriptive study of a qualitative and quantitative approach that adopts as a research strategy the case study. The field of this study is characterized as a hospital and outpatient unit, classified as a university hospital, whose collection was performed considering secondary data (Notivisa records, medical records, etc.), as well as other institutional documents such as clinical guidelines, hemoglobinopathies, hemoglobinopathies, hemoglobinopathies, hemoglobinopathies and hematopoietic stem cell counts. In addition, the primary data collection was done, based on the application of a semistructured interview script. From the data collected, a descriptive analysis of the

frequencies and percentages of the occurrences and typologies of RTs, as well as the demand and the capacity of service of this UH. Also, the thematic (content) analysis technique was used as a strategy to evidence about the characterization of UH, as well as the components of the work process that characterize Hemovigilance in the case studied. All ethical aspects have been respected in accordance with the Resolution. The Hemotherapy Unit studied attends the University Hospital, which is part of the SUS Network, participates in the Sentinel Network and is contracted to the Hemoba Foundation. It is located inside the hospital, having as working agents several professionals, with different specific knowledges, in several areas of activity, having satisfactory number of working means, in conditions suitable for the current reality of this unit and to handle its product in accordance with the proposed purpose of ensuring the transfusion, preventing, treating and minimizing damage to the occurrence of (immediate) transfusion reactions. Frequency of 6.43% of immediate RTs per 1000 transfused blood components was verified. Hemolytic Febrile Reaction and Allergic Reaction were the two immediate RTs that occurred the most, reaching 97.7% of the total reactions, and 57.53% of the RTs occurred in the outpatient and hematology ward. The fever, the

appearance of erythematous plaques and pruritus were the most frequent signs / symptoms. Regarding the gender variable for the occurrence of immediate transfusion reactions, it was observed that 51.9% occurred in women and 48.1% in men, and for the color variable, most of the recipient patients who developed a transfusion reaction declared themselves to be brown , followed by blacks and whites. There was a higher number of RTs with grade I (97.5%), with a higher occurrence of blood group O (+) group transfusions, with red blood cell counts (44.1%) and platelets (41 , 9%) were the most transfused blood components and the two most involved in most of the reported transfusion reactions. The strategies for the prevention, treatment of RTs and risk minimization identified compliance with the technical procedures in accordance with the POPs and current legislation, supervision of work agents, training and professional qualification and procedures 7 management. Therefore, the analysis of the results of this study showed that the development of the work process by the health professionals responsible for haemotherapy and haemovigilance is guided by the norms, procedures and current legislation, as well as by the adoption of strategies and methods that impact on the minimization of damages of the occurrences of the transfusion reactions, although challenges of the daily service of Hemotherapy persist, not only to the studied reality.

B

y reflecting the characteristics of the society in which it is inserted, the Brazilian public university has increasingly identified among its student public, factors that challenge its quality of life. These include challenges related to health, inequalities and social discrimination. In this context, this dissertation analyzes the relationship between vulnerability in health and the intersection of axes of oppression among undergraduate students who are receiving assistance from students who present experience of suffering / mental disorder. From the individual, social and programmatic categories of vulnerability, it presents results based on the narratives of the participants. It is a quantitative and qualitative approach in Collective Health that uses semi-structured interview techniques and documentary analysis. Of the 217 students established as a research population, 43 were excluded from incomplete or inaccessible documentation. With the remaining 174, the sociodemographic profile was analyzed. The definition of the group for conducting the interviews considered students who declare to live in conditions of inequality and oppression from the understanding of intersectionality. Of 12 students invited by e-mail, personal contact and / or telephone call, 7 responded positively and after scheduling, the interviews were conducted at different days and times. The results indicate that the vulnerability in the student's health is largely influenced by intersectionalised oppression, especially in the social perspective. Gender bias, affective-sexual orientation, poverty, color and stigma about their mental health conditions are highlighted. Institutional practices, based on the student vision, favor the overcoming of identified challenges, but, they need better planning in terms of disclosure and unbureaucratization of access to them.

Sickle cell disease (SCD) is a most common genetic pathology in Brazil, with a greater emphasis on black people. This historically neglected population experiences the impact of social vulnerability on the clinical and psychosocial conditions of people living with this condition. The profile was analyzed in the socioeconomic profile of people with sickle cell disease treated at the hematology outpatient clinic of HUPES, identifying contexts of social vulnerability. This is a descriptive, exploratory study with a qualitative approach, which was conducted in a university hospital with users, aged 18 years or over, without outpatient hematology treatment for the treatment of PD. An interview with semi-structured script was used. Data were analyzed and presented in graphs and graphs according to the interviewees' socioeconomic profile and testimony.

The research was approved by the research ethics committee. In the results it was possible to observe that the majority of the people had complete medium level, difficulty to keep jobs and the activities remained manual and with low salaries. These findings confirmed the situation of impoverishment, access difficulties, problems resulting from complications due to late diagnosis, among others. In conclusion, when considering the social vulnerability of people with PD, it is necessary for health services to be able to accommodate these social demands, complying with the guidelines of the Unified Health System, which advocates equity and comprehensiveness as guiding principles of health. caution.

Experiences lived in university trajectory and support found are essential for the mental health of higher education students besides contributing their permanence and academic exercise. The specific expressions of university environment, such as built relationships, pressures, uncertainties and expectations are some of circumstances experienced by students. Research aimed analyze the perceptions of university students from a Federal Institute of Education, Science and Technology of Bahia-IFBA about the relationship between student life and their mental health conditions. Seeking identify the main difficulties experienced in the process of estrangement, learning and overcoming strategies, as well deepening knowledge about factors related their mental health conditions. The study had exploratory character of qualitative nature using focus group technique to enable production of data and as way to analyze them perspective of thematic content analysis was used. Thus units of meaning were constructed, which gave rise to three main categories: difficulties in trajectory and consequences for students' mental health; ease in student trajectory and its consequences for students' mental health and mental health promotion strategies.In summary, the main difficulties experienced in the university career affect the mental health of students refer to arrival at Institute and relations with new environment, as well the conflicting relations between teachers and students, the absence of socialization. As facilitating experiences of adaptation and improvement of mental health, there affiliation strategies. Through organization of time and activities, and factors such as establishment of affective bonds with colleagues. Appropriation of space and also positive relationships between teachers and students. Other actions are still necessary aiming at healthy insertion in university environment, contemplating dimension of mental health promotion. Main strategies cited were qualified listening, welcoming, establishment of living and leisure spaces within the Campus. Teachers with ability to understand individual, collective reality and with better didactic-pedagogical practices. Thus concluded higher education institutions are spaces of multiple facets, capable of causing great suffering and illness in subjects involved in teaching-learning processes. As well have potential to become health promoting environments through attitudes that have as guidelines the promotion of mental health their students and that guarantees student permanence.

Introduction: The Intensive Care Unit (ICU) has, among other functions, the objective of reestablishing the health of individuals with severe pathologies in order to remove them from the risk of death zone. To do so, it has a specialized professional apparatus and advanced technologies that aim to meet your health demands. Objective: To identify the clinical epidemiological profile of patients admitted to the Intensive Care Unit and the factors associated with long stay and its adequacy to SUS guidelines. Method: This is a quantitative descriptive retrospective study conducted with 105 ICU patients admitted to a public university hospital in Salvador, Bahia, Brazil. Data were collected between September 2017 and April 2018 and organized in Stata version 13 and analyzed descriptively from frequency distribution in order to characterize the subjects. For the bivariate analysis, contingency tables with X2 (chi square) were used. The study was also based on the criteria of length of stay in the hospital recommended by the Hospital Quality Control Program and Brazilian Intensive Care Association. Results: The study found that the profile of patients had as reasons for hospitalization postoperative 54.29% (n = 57), sepsis 11.43% (n = 12) and cardiovascular problems 5.71 (n = 06). ); most patients were hypertensive 53.34% (n = 56), 19.05% (n = 20) diabetic and 14.29% (n = 15) heart disease. Regarding lifestyle, 12.38% (n = 13) consumed alcoholic beverages and almost 10% (n = 10) were smokers. Regarding the use of invasive devices, 22.86% (n = 24) required mechanical ventilation, 50.48% (n = 53) central venous access, 41.90% (n = 44), invasive blood mean arterial pressure (MAP) and 58.10% (n = 61) made use of Foley bladder tube (SVF). The main clinical outcome was ICU discharge (83.81%) and most patients had a stay of less than six days (72.38%). Conclusion: Based on these findings, it is possible to direct preventive actions that contribute to a reduction in ICU stay, such as infection control through the use of aseptic techniques in the management of invasive devices. In addition, actions that can be disseminated to the scenarios of Primary Health Care, when it comes to the prevention of lifestyle, since, related to underlying diseases such as hypertension and diabetes, can predispose the patient to other health problems. .

Suicide is a complex phenomenon, considered a serious public health problem, as it is estimated that around 800,000 people commit suicide worldwide each year. In the Americas, according to data from the Pan American Health Organization (PAHO, 2014), 65,000 people commit suicide each year and this is the third leading cause of death in the 20 to 24 year old group, the fourth in the 10 to 19 year old group. 25 to 44 years. The population over 70 years old has the highest suicide rate. Actions proposed in the Strategic Actions Agenda for Suicide Surveillance and Prevention and Health Promotion of the Ministry of Health for the period from 2017 to 2020 point to the co-responsibility of care and articulation in the Psychosocial Care Network (RAPS). OBJECTIVE: To analyze the performance on suicide in the Psychosocial Care Network of the Brotas Sanitary District / Salvador (RAPS-Brotas), according to the coordinators and / or representatives of the health services that compose it. METHODOLOGY:

This study took a qualitative approach (Minayo, 2002). The population consisted of managers and professionals representing the devices that make up the Psychosocial Care Network of a Sanitary District of Salvador. The instruments used for data collection were the semi-structured interviews applied to the managers and the focus group technique applied to the members of the RAPS Working Group. Thematic Content Analysis was performed using the NVIVO 12 software. RESULTS: Two main conceptions about suicide were found: One, markedly biomedical, that unfolded in two directions: 1) delimitation of suicide from a psychopathological perspective, cited by two managers trained in health sciences and only one professional; 2) Multicausal delimitation, which considered multiple and complex determinations, was the most cited subcategory by managers and professionals within the biomedical conception of suicide. A second conception, which addresses suicide as a social phenomenon, also unfolded in two directions: 1) one that considered the importance of social dynamics and relationships, more defended by managers compared to professionals; 2)

another cited only by managers, who considered the role of social inequalities in this analysis. Regarding the most relevant contributions of RAPS, when comparing managers and professionals, the second category mentioned, as a priority, that the most relevant contribution of this health system is to offer continuous and integral attention from the various devices. The second contribution of RAPS: improving the quality of care from a multiprofessional perspective was mentioned only by managers. Among the participants of this study, we found a hierarchical network view organized by levels of attention, cited only by the category of managers, a polyarchic network view with non-hierarchical relationships and sharing common goals, cited by both categories and an organizational view. Network that reiterates the importance of the role played by primary care in accompanying people in psychological distress, also cited by the two categories. As for network articulation strategies, mentioned only by the 10 category of managers, we could observe: 1)estratégia de articulação dos dispositivos de saúde; 2) articulação a partir do apoio institucional e distrital. Segundo gestores e profissionais, não há fluxos estabelecidos para o cuidado específico de pessoas em risco de suicídio, que se apoiam principalmente nos serviços especializados e de urgência e emergência. A organização de um fluxo específico foi defendida por dois profissionais e três gestores. As principais dificuldades da atuação em rede relacionadas ao estado de saúde da população, citadas pelas duas categorias, foram o aumento de casos de sofrimento psíquico, com destaque para as situações de automutilações e tentativas de suicídios. Os elementos dificultadores e facilitadores do trabalho na RAPS, relacionados ao sistema de saúde foram assim categorizados: 1) relacionados à infraestrutura, mais citados por ambas as categorias; 2) à gestão; 3) ao modelo de assistência; 4) a organização dos recursos; além das estratégias de fortalecimento desta rede também assim identificadas. CONSIDERAÇÕES FINAIS: Diante da complexidade conceitual do suicídio, faz-se necessário reafirmar que atuar sobre este fenômeno, seus fatores de risco e de proteção não é uma ação simples, mas muito complexa e que exige a interface de vários atores e o entrelaçamento de distintos saberes no desenvolvimento de um compartilhamento de cuidado interdisciplinar e ações intersetoriais em rede de atenção que possibilite a integralidade da atenção.

Since 1988 several initiatives have been taken to organize and implement at the federal, state and municipal levels of the VISA services, after this period there are advances and weaknesses in the implementation of VISA at the municipal level. The objective of this study is to estimate the degree of implantation of Sanitary Surveillance in a medium municipality of Northeast Brazil. The methodology used was an evaluation research, of type analysis of the degree of implantation. To compose the analysis material,

Since 1988 several initiatives have been taken to organize and implement at the federal, state and municipal levels of the VISA services, after this period there are advances and weaknesses in the implementation of VISA at the municipal level. The objective of this study is to estimate the degree of implantation of Sanitary Surveillance in a medium municipality of Northeast Brazil. The methodology used was an evaluation research, of type analysis of the degree of implantation. To compose the analysis material, official documents and interviews were used. Results: The municipality was considered to have an advanced degree of 

implementation since the Management dimension had a score of 71.90%, Practical dimension, 69.44%, with a general average of 70, 67%. The sub-dimensions evaluated for the Management Dimension "Popular Participation" and "Infrastructure" received the highest score, while the sub-dimensions of "Human Resources" and "Financial Autonomy" received lower scores, especially financial autonomy, which received only 33.33%. Conclusion: The study pointed to the need for adequacy in relation to the quantity of personnel and the accomplishment of training for the team. Regarding financial management, the study pointed to dependence of the municipal VISA in relation to the Municipal Secretary of Health. With the accomplishment of this study it was possible to evaluate the degree of implantation of the VISA in the municipality of Irecê and it was verified that even with difficulties and problems - in line with other studies - the municipal VISA service is organized, but the need to advance on strategic issues such as human resources, financial resources and service organization has been perceived so that the municipal VISA can effectively respond to the challenges the field of action. The logical model used was sufficient to analyze the criteria listed in the management dimension, however with respect to the dimension of practices it was observed that the established criteria did not contemplate the reality of the municipality investigated. Thus, for other investigations in which the researchers need to use this same methodology, it is advised to analyze the criteria of practices can be used and added qualitative indicators of each of the established criteria.

The organization of the Unified Health System (SUS) defines basic care as a gateway to the
health system. Health surveillance actions on health-related products and services associated
with inadequacies are essential for the protection of the population's health and for the
protection of users, health professionals and the environment, as a means of preventing and
controlling risks and adverse events related to the provision of health services in general, as
well as in Primary Care. The inadequacies in the technical and management conditions to
promote the quality of care minimally required to run health services can pose health risks.
The general objective of this study is to describe the health situation of the health services in
basic care in SUS. This is a descriptive exploratory qualitative study with a sample of three
basic units of the Cabula-Beiru Sanitary District. This study used three sources of data:
observation of the services in the Basics Health Units through script, interview with
professionals and analysis of documents issued by health surveillance. The inadequacies
observed in the units were related to noncompliance with the technical, sanitary and legal
requirements of health surveillance for the functioning of health services and were classified
into six dimensions: infrastructure, items related to work processes, inputs, equipment,
documentation and management Of Quality. The results present inadequacies in all
dimensions with variations between them and between the studied units. Despite successive
inspection and reinspection visits at these UBS and the concession of sanitary license at these
sites, a large part of these inadequacies remained, including the relevant items related to the
areas of Sterilization Material Center (CME) and pharmacy.

The access to potable water is a basic human right and an effective component of health protection policy. In the State of Tocantins, although the water supply is priority through a general network, maintain disabilities in the supply of potable water. The performance of the Drinking-Water Quality Surveillance (VQACH) provides the construction of important epidemiological and environmental indicators. The present study aimed to describe the supply and the quality of the water for human consumption in the municipalities of the State of Tocantins, in the year of 2015, as well as identify associations between the consumption of non-potable water and the incidence of Water-and Foodborne Diseases (DVHA). This is an ecological study with a territorial base, using secondary data, whose units of analysis were the municipalities of the State of Tocantins. Indicators of health vulnerability were used related to deficiencies in the supply and quality of water for human consumption (exposure variables) and related indicators of morbidity and mortality associated with DVHA (outcome variables). In order to verify associations between these variables was performed univariate logistic regression analysis, applying also the calculation of Pearson's correlation coefficient to a group of five municipalities with the best monthly data records, from 2014 to 2016. It was observed sampling of water in 122 (88%) of the 139 municipalities, with greater concentration in the Water Supply Systems – SAAs (87%). The percentage of non-standard samples was higher in the alternative solutions. Observed an average of 0% for the population supplied by untreated water, 1% for the population supplied by alternative solutions and 0% for the population served by sewage network. Were identified discrepant values for indicators such as the proportion of the population supplied by untreated water in municipalities Itaguatins (95,8%), Novo Alegre (37,1%) and Pium (34,2%), and the percentage of nonstandard samples in SAAs (E. coli), that was above 17% in the municipalities of Bom Jesus do Tocantins, Tupirama, Angico, Taipas do Tocantins, Pedro Afonso and Ananás. Taking the municipalities as a unit of analysis, there were no statistically significant associations between the exposures and the outcomes, except among the variables coverage by sewage network and deaths in children under five years. Considering the monthly data of the one same municipality over three years, we found positive correlations between the water-and foodborne diseases and the occurrence of nonconformities in water quality. The appreciation of the results of this research should consider the asymmetries in the records of the data used. We recommend prioritizing (VQACH) actions in municipalities with a high degree of inconsistency in SAAs, as well as in situations where water supply alternative are used.

Introduction: Rabies is a viral infectious zoonosis with high importance for public health because the mortality-rate is 100%, preventable disease, high cost for assistance and efficient measures for control are available. Objectives: To evaluate the reported adopted pos-prophylaxis in service, according with the mainly epidemiologic, clinical and related characteristics with rabies prophylaxis, comparing to normative recognized by Brazilian Ministry of Health. Methods:  This study consists on secondary data evaluation of the reported prophylaxis done in SINAN during 2005. It was performed a correction of double report using the software reclink III, the data were clean, removing inconsistent data and no filled fields, which were not available for analyses. Pos-exposure prophylaxis was described analyzing frequency of the mainly variables. It was classified the type of exposure in direct contact, mild accident and severe accident, according to guidelines of epidemiology surveillance of ministry of Health. It was realized evaluation of the pos-exposure prophylaxis comparing to recognize by Ministry of Health. Data were analyzed using reclink III, SPSS 13.0 for windows, epiinfo 6.04d and excel version 2003. Results: During 2005 were reported 523.264 persons who looked for assistance for rabies prophylaxis distributed in all federal units. There were 4,2% of double report, therefore the analyses was performed with 501.123 persons. Among realized attendance, 65,1% were pos-exposure, where 81,2% occurred in  urban area and  Pará, Goiás, Rondônia e Alagoas presented the highest taxes by 1.000 inhabitants of reporting, 5,07%, 5,07%, 4,78% e 4,10% respectively. August was the month with more reported attendance, 9,5% reporting of this year.  About sex, 56% were male and the age rate until 35 years had 65.4% of the reporting. About the wound, 48% was superficial, 52% deep and 6,72% dilacerate. Dog was related with 80,39% of pos-exposure, followed by cats (11,99%), bats (3,45%), monkeys (1,02%), foxes (0,3%) and others species (2,51%). For exposure, it was classified in contact indirect, 92,1% received at least one dosis of vaccine and 23,3% was indicated immunoglobulin. For mild accident 90,14% received vaccine and 5,2% immunoglobulin and for severe accident 90,66% received between two and five dosis of vaccine, 9,3% received at least one dosis and 11,6% immunoglobulin. Conclusion: The tax of double report was 4.2%, considered low. There was a concentration of reported cases in southern region of Brazil, where the most reporting was in urban area and around 90% related dog or cat. Children and adolescent until 15 years had almost 40% of the attendance, showing importance to have education for this group. The main part of the body related with aggression was low member and hands or foot, showing the necessity of protection this areas when to deal with animals. It was demonstrated that contact indirect and mild accident, where it is not recognized immunoglobulin, the indications were done in service, disaccording with the Ministry Health orientations. For severe accidents, it was found indication of low dosis than it was needed, leaving persons in risk to become ill. Health education, as looking for assistance, necessity of prophylaxis and incentive to owner responsible and laws that make the owner to be careful with the animals, avoiding aggressions need to be done.