O presente trabalho de dissertação investigou as desigualdades sociais no acesso ao pré-natal antes e durante a pandemia de Covid-19, com o objetivo de analisar a magnitude das desigualdades sociais a partir dos marcadores raça/cor, grau de escolaridade e geração/idade na adequação da assistência pré-natal, antes e durante a pandemia de Covid-19, no Brasil, entre os anos de 2014 a 2021. Para alcançar este propósito, foram utilizados os softwares estatísticos Rstudio e Stata (versões 12 e 16) para extrair e analisar dados de agregados do SINASC, e aplicado o cálculo da Fração Atribuível às Desigualdades. Os resultados revelaram que as gestantes adolescentes, com 0 a 3 anos de estudo, indígenas e negras registram a maior taxa de inadequação pré-natal atribuível às desigualdades, destacando que não foi identificado a redução da taxa de inadequação no período de pandemia. Além disso, a análise apontou para o aumento das desigualdades nos períodos de transição de governo em 2016/2017 e 2018/2019. Este estudo contribui para a literatura existente sobre as desigualdades sociais na assistência pré-natal ao [destaque da contribuição]. No entanto, algumas limitações devem ser consideradas, como: a não realização da estratificação da análise por regiões, devido ao tempo para o desenvolvimento do estudo; e o não cumprimento da proposta de utilizar o recorte temporal de 10 anos, 2012 a 2022, devido a variável de adequação pré-natal ter sido inserida no SINASC a partir do ano de 2014 e a base de dados do ano de 2022 ainda não havia sido disponibilizada, havendo a necessidade de reduzir o recorte para os anos de 2014 a 2021. Por tratar-se de um estudo ecológico e observacional, faz-se necessário investir em novos estudos sobre a temática para compreender a relação entre as desigualdades sociais e as suas implicações na assistência pré-natal.

Introduction: For around 454 years, quilombos have represented a form of social organization and Afro-Latin American resistance to slavery, coloniality and racism, with Quilombo dos Palmares as its exponent. Considered a Bantu technology, “Kilombo” as an institution, code and hemispheric phenomenon, has records in several Latin American countries. In the case of Brazil, the achievement of unprecedented quilombola social policies in the Federal Constitution (1988) represented a substantial advance in the search for citizenship, equality and guarantee of rights for quilombolas. Even so, there is currently no record of a national policy focused on the health specificities of the quilombola population, which has been the subject of demands from the National Coordination of Articulation of Black Rural Quilombola Communities (CONAQ) visà-vis the State, constituting a process of struggles based on a specific political project, which has rarely been the subject of studies in the field of Public Health, thus justifying the development of a scientific investigation on the topic. Objective: To analyze the process of building the political project of the Brazilian quilombola social movement for health in the period 1988-2023. Methodology: This is a political analysis based on qualitative documentary research, supported by ten public documents prepared by CONAQ, together with public bodies and Brazilian political parties, and published between 1996-2023. In turn, the documentary analysis and categorization gave rise to the following points: 1) characterization of CONAQ regarding its origin, objectives and structure; 2) CONAQ's health concepts and proposals; 3) CONAQ's action in the face of the 1988-2023 facts surrounding quilombola health. Results and Discussion: The results are presented in the form of a scientific scoping review article about the scientific production on quilombola health policies 1988-2023, followed by the dissertation, which in this case, illustrates
the steps that constituted CONAQ as a political subject of the quilombola movement, leading the struggles around quilombola health through the Health Collective (2013). Thus, CONAQ has anchored its collective action in two main conceptions of health, “quilombola ancestral health”, a traditional and community dimension, and “quilombola health care”, an institutional dimension of public policies. With proposals to defend the public and universal Unified Health System (SUS), creation of a specific national health policy and a “health model” that takes into account the specificities of quilombos. In turn, CONAQ was present in the main facts and achievements of 1996-2023, such as the formulation of the National Policies for Comprehensive Health of Black Populations (2007) and Countryside, Forests and Waters (2014), mobilizations to guarantee protection against covid-19 (2020) and at the 1st Free National Quilombola Health Conference (2023). Final Considerations: Therefore, the political project of the contemporary quilombola movement finds in the collective action of the political subject 'CONAQ', a praxis supported by the counter-colonial and quilombola exit for health struggles, connected to a broader project of defending the right to land, emancipation, equality, freedom and differentiation in the exercise of citizenship, approaching at this point the ideas and characteristics of ethnoterritorial mobilizations and left-wing black nationalism. So, in the case of health, the CONAQ project seeks to respect quilombola ethnocultural and territorial specificities, combining the defense of a 100% public, democratic and universal SUS, thus resembling the ideas present in the Reform Movement project Brazilian Health.

Introduction: Homeless individuals (HIs) form a vulnerable group that historically is faced with poor socioeconomic conditions, such as poverty, lack of adequate housing, and deprivation of social rights. In Brazil, HIs are often male, black, with low educational levels, and of working age. HIs have no source of formal income and enjoy little or no social assistance, forcing them to resort into some form of informal economic activities commonly referred to as "corre" to survive. "Corre" can be considered as any type of labor activity that generates income to meet fundamental subsistence needs, usually food and hygiene. However, these activities are often carried out in unhealthy conditions, predisposing them to multiple physical, chemical, ergonomic agents in addition to exhausting working hours etc., thereby posing health risks and the occurrence of occupational accidents (OAs). In the country, there is limited information on the occupational profile, work process, frequency of OAs, and the health consequences of HIs. These knowledge gaps hinder the formulation of adequate public policies, especially professional training, that could mitigate the daily challenges faced by nearly 236 thousand current homeless people in Brazil. Objective: To describe the socio-occupational profile, prevalence of OAs, and the associated factors among HIs in Salvador/BA, from 2021 to 2022. Methodology: Observational cross-sectional epidemiological study, with a convenience sample of HIs aged ≥18 years, in public places or housed in municipal shelter units in the municipality of Salvador/BA, with data collection from September 2021 to February 2022. A total of 529 individuals participated, from four municipal geographic areas (Health Districts) chosen based on a history of high concentration of HIs, while also aligning with the structure of municipal street clinic teams. Structured questionnaires were individually administered by an interviewing team, using cell phones and tablets containing REDCap software. In addition to sociodemographic and occupational variables, among others, participants were asked about their history of OAs, using the question: "Have you ever had any work-related accident?" as the outcome indicator. The study was approved by the Research Ethics Committee of the Gonçalo Moniz Institute of the Oswaldo Cruz Foundation (IGM/Fiocruz) with protocol No. 42517021.0.0000.0040 in compliance with the resolutions 466/12 and 510/16. All participants provided consent and signed the free and Informed Consent Form (ICF). Initially, descriptive analyses of the demographic and occupational profile, as well as OAs prevalence were performed. In the crude analysis, Prevalence Ratios (PR) and 95% confidence intervals (95% CI) were calculated, also possible associations were identified using Pearson's Chi-square test. In the multivariate analysis, Quasi-Poisson regression was applied, considering robust variance and stepwise procedure for model adjustments, while controlling for multicollinearity and confounding biases. A value of p <0.05 was adopted for result interpretation. Data set construction, organization, and cleaning, as well as statistical analyses, were performed using RStudio software, version 4.2.3 (x64). Results: The predominant sociodemographic and occupational profile corresponded to cisgender men (70.9%), black individuals (91.6%), no education or only primary education (73%), engaged in scavenging activities (30.9%), sales (28.3%), and general services (20%). Among the respondents, the frequency of engaging in "corre" activities ranged from 66.7% to 95.8%, depending on the category analyzed. Surprisingly, when asked if they were working, this variation was much lower, between 12.0% and 45.2%. Regarding the outcome OAs, the overall prevalence was 31.4%, with statistically significant association for age group ≥50 years (PR: 1.13; 95% CI: 1.03-1.25), working ≥13 hours/day (PR:1.11; 95% CI: 1.01-1.23), and experiencing violence during "corre" activities (PR:1.17; 95% CI: 1.09-1.25). Conclusions: Low frequencies of HIs were identified who recognize their activities as "work", referring to them as “corre”. Groups with higher probabilities of experiencing OAs are represented by individuals aged ≥50 years, working ≥13 hours/day, and reporting violence during work or "corre" activities. There is a lack of recognition of interpersonal violence as OAs, leading to occupational vulnerability. In addition to recognizing HIs activities as work, training, formal opportunities, and policies for social/professional reintegration are needed to reduce the time spent in homelessness.

“Aquilombada. I resist. Let's forge a new world!” This is a passage that echoes throughout the writing of this thesis. It comes from a song that is part of my becoming an activist and our form of organization: aquilombadas. Writing about black women activists comes from the desire to reference our ancestry, to make visible the experiences that break with the destiny organized by anti-black racism, and to empower the existence of women builders of a new world. Activism, in this sense, is a crucial strategy for confronting anti-black and racist society. The work of black women activists revolves around network collaborations in the process of consolidating Well Living. Forging new (and reclaiming already organized) ways of life is a challenge for all groups that believe in social justice. In view of the rescue of knowledge from the black community, the political and epistemological stance we adopted in this work is from an intersectional lens. We examine social reality through the intersectional phenomenon because it allows us to responsibly and coherently address health inequities, such as how racism produces neglect and which bodies are rendered invisible and susceptible to death. Moreover, the intersectional lens enables collective empowerment, removing the veil of invisibility and proclaiming loudly and clearly: we are powerful women, we are thunderous women! With that said, the objective of this thesis is to analyze the trajectories of black women whose actions (in the state of Bahia) have contributed to the production of knowledge, public policies, and/or ancestral care practices focused on black population health. To achieve this, we employed a feminist and anti-racist methodology, using the tool of Escrevivência coined by writer Conceição Evaristo. The Escrevivências encompassed trajectories - with their singularities and shared experiences - that involve becoming activists, protagonists, and references in the field of Black Population Health, existing and resisting for Well Living, sowing ancestral care practices, as well as the paths taken towards the construction of an anti-racist Collective Health. Consequently, I sought to broaden the perspective of Collective Health on its own battle and history, aiming to give visibility to the many women who also fought for the Unified Health System (SUS) and Sanitary Reform, as well as social justice. Collective Health needs to recognize other voices and subjects who were at the forefront but were silenced and made invisible due to the fact that the white racial group is primarily recognized as the protagonists in the field. Therefore, this work is both a historical reparation and a change in perspective. The Escrevivências told here mark territories of struggles, stories, powers, existences, and bodies that still resist despite all adversity, and they resist because there is circularity, there is collective, there are refuges and survival strategies necessary to exist in this world. The wheel keeps turning. “[...] smiling while fighting is a way to confuse the enemies”, informs us Sérgio Vaz in his poetry. Smiling is one of the weapons against racism, living is a powerful weapon! Is Well Living possible? We do not have answers. But as long as we do not normalize genocide, daily death, as long as we denounce the necropolitics that structure the death project of this country, as long as we are fighting for a world without racism, we will continue this utopia. We resist together. Let's forge a new world!

Introduction. In Brazil, the incidence of the human immunodeficiency virus (HIV) is increasing among adolescents from sexual minorities, and anal sex without a condom constitutes a risky sexual practice for the infection of this virus in this population. Objectives: To estimate the prevalence of condomless anal sex (CAS) among adolescent men who have sex with men (AMSM), transvestites and transgender women (ATGW) and their associated factors in three Brazilian capitals. Methodology: PrEP1519 is a prospective, multicentre of pre-exposure prophylaxis (PrEP) demonstration cohort study of AMSM and ATGW aged 15 to 19 years in three Brazilian capitals, enrolled in the cohort from 2019 to 2021. The outcome studied was CAS in the last six months and the predictors were sociodemographic, behavioral variables, those related to health care, violence and discrimination based on gender and sexual orientation. Descriptive and bivariate analyzes were performed. Multivariate analysis was performed to estimate adjusted odds ratio (aOR) and 95% confidence interval (95% CI). Results: A total of 1418 participants were included, most participants were AMSM (91.5%), aged 18 to 19 years (75.9%), high school and higher education in progress (92.7%) and CAS report in the first sexual intercourse (54.2%). In addition, a high proportion of the population declared themselves to be black (40.5%), having a steady partner aged five years or more (17.9%), starting their sexual life before the age of 14 (43.4%), with a history of group sex (24.6%) and transactional sex (14.6%). The prevalence of CAS in the last six months was 80.6% (95%CI: 78.5%–82.6%). Multivariate analysis showed that adolescents with SASP at first sexual intercourse (aOR:2.28; 95%CI:1.68-3.11), consumption of psychoactive substances (aOR:1.60; 95%CI: 1.17-2.20) and transactional gender (aOR:1.99; 95%CI:1.14-3.46) were more likely to have CAS. Conclusion: The prevalence of CAS and other risk behaviors was high among AMSM and ATGW. We recommend strengthening sex education programs in schools and youth social settings, addressing sexuality and sexually transmitted infections and providing access to PrEP, condoms and other preventive methods.

Background: Implementing the Citizen's Electronic Medical Record (EMR) in the Oral Health Teams in Primary Health Care can change the workflow and the practices of these teams in the family health strategy. Objective: The present study evaluated the results of implementing the Citizen’s EMR in the dentists work process of the family health strategy in the city of Dias D'Ávila-BA. Methodology: This is a “quasi-experimental” study that uses quantitative and qualitative methods. The theoretical-logical model of the implementation of the Citizen’s EMR in Primary Care in the work process of the dentist in Primary Care was elaborated. In the exante stage, questionnaires were applied and semi-structured interviews were conducted with the dentists of five family health teams that would have the Citizen’s EMR implanted and with the dentists of the other five family health teams that did not undergo this implantation and constituted the “control” group, totaling 11 dentists participating in the study. The questionnaire of the ex-ante stage had 48 questions to mark and the interview script had six guiding questions. At the end of this stage, the electronic medical record was implemented in three family health units with oral health, as well as the training of the teams involved in the use of the electronic medical record. In the second stage, after a period of eleven months of implementation of the EMR in the health units, the ex-post evaluation was carried out with the participation of six dental surgeons. Results and Discussion: The change in the medical record system was seen as positive among dentists and the Citizen’s EMR effects on the dentists work process were perceived in the professional-patient interaction, agility in carrying out activities, work performance, productivity, system readability, sharing of interprofessional and professionalmanager information, service flow, and referral of users. However, the difficulties in registering with the Citizen’s EMR were poor typing skills, failure to cancel a registration made wrong after saving, completion is more complex than in the streamlined data collection system form, rework when sudden interruption occurs and analysis of epidemiological data and outcomes of care. Permanent education actions play a fundamental role in better using of the EMR's functionalities and their potential contributions to the healthcare qualification by improving the quality of information. Conclusions: The Citizen’s EMR produced important positive effects on communication, relationships and care production processes in oral health care. However, improvements and evaluations of this technology are needed to strengthen it as a support for decision-making and the development of work based on attention to first contact, longitudinality, comprehensiveness and coordination of care.

In view of the regionalization process, there is a need to organize hospital care and redefine the role of this service according to its classification (local, regional, state reference hospital) from the perspective of the hospital in a care network that meets the health needs of the population. In this aspect, planning allows for the articulation process in the territories and favors the aggregation of actions and services of different technological densities in the network, through the actions of actors and existing intuitions in the region. The general objective of the research is to analyze the planning of hospital care in a health region of Bahia, in the period between 2016 and 2019. This study is a qualitative research, based on document analysis, with the adoption of historical neoinstitutionalism as a theoretical reference, which based on the analysis of documents and organization of the study in three dimensions: institutional-formal dimension, political-institutional dimension and historicalinstitutional dimension based on the theoretical framework. In this context, it was possible to identify the actors and institutions involved in the process and the function they perform. As an important institution, the Regional Intermanagers Commission (CIR) is a negotiation arena and a decision-making space, with a political-institutional context that reflects the behavior of the actors and they affect the conduct within the institutions. Institutions are an integral part of the historical context, and their trajectory is relevant in shaping current health policies. The planning of hospital care, in spaces such as the CIR, addresses issues that involve the potentialities and difficulties in the implementation of the various thematic networks in the territory, which are punctuated in the structural design of the network, in the flow of access, in the regulation system and in the resources such as in the integrated agreed programming, guidelines are that generate conflicts and point out the difficulties in the implementation process. There are challenges in the construction of hospital care planning in the sense of accompanying and being cohesive with the Integrated Regional Planning. Therefore, this study helps to identify the psychological and powerful points of the institutions and actors that are part of regional and hospital planning, leading to a reflection on the importance of decentralizing state attributions in this area and strengthening regional instances such as the Regional Health Center and the CIR.

The discussion regarding environmental issues has been growing over decades from environmental movements and fortifies, particularly with the understanding that it is essential to conciliate economic development with nature's carefulness. In Brazil, social-racial injustices resulting from enslavement endorsed the need to deepen the discussion about environmental racism in the country, correlating racism with poverty. This correlation has been comprehended through the debate of the “centerperiphery” of the capitalist system, which exposes an exploration organization of countries and regions underdeveloped for the spatial expansion of the economic center industry to the periphery. The quilombola people's territory is an example because, in addition to the continual struggle for land demarcation, having their domains severely exploited generates serious physical and subjective consequences. This study, therefore, intends to concur with the knowledge production about the environmental challenges faced by the quilombola population, ascertaining the meaning that an ancestral territory has for the quilombolas of Ilha de Maré. Aiming to analyze, from a racialized perspective, the relationships between environmental problems, racism and living and health conditions in three quilombola communities located in the territory of Ilha de Maré based on the resident's understanding. It is qualitative research based on semi-structured observation interviews (in a complementary way) with records in a field diary and carried out in quilombola communities in Ilha de Maré. The survey included people over 18 years old; with activist ties or not; both female and male considering possible differences in the narratives of fishermen and shellfish gatherers. Seven persons were interviewed, five women and two men aged between 18 and 63 years, and ethical precepts involving research with human beings were utterly respected. The interviews were recorded, transcribed and the analysis was carried out in the light of the Interpretive Anthropology of Cultures, understanding the context in which the narratives were extracted and situated. Two topics of analysis were built: 1) Environmental problems in the Quilombola territorial space: community perceptions; 2) Imbrications between racism, environmental problems and illness processes. The interviewees reported having a very positive dynamic with the territorial space of Ilha de Maré since the island transcends the aspect of beauty and acts as a place of survival, being the place that, in addition to being a source of food, is also where they come from sustenance. However, contamination has been deteriorating the ecological environment since the implication of environmental problems in the air, marine and terrestrial fauna and flora is perceptible, generating a socioeconomic impact for the quilombolas. It's evidenced in the interviews the massive exploitation of the territory by the private fixed without positive return for the communities. Residents highlighted the illness processes caused by contamination, such as respiratory and skin problems and alterations in exams regarding the presence of chemical components. 9 Some interviewees tell in their speeches, the symbolism of the territory and the ancestral subjectivity that involves, even if unconsciously and already shaken for some, the tradition between the relationship of nature, health and spirituality as part of their identities. The subject's perception of the invisibility of his neighborhood in the face of exploitative companies and especially the State, which despite complaints made, remains indifferent to the community's health problems, reveals institutional racism as the primary problem residents confront.

The present study aims to analyze the response to the covid-19 pandemic in Uruguay and Cuba in the years 2020 and 2021, systematizing possible lessons. This is a comparative case study, supported by an integrative review, document analysis and secondary data. Both countries can be described as successful cases in fighting Covid-19 in 2020, having suffered, however, a turnaround in the situation in 2021. As highlighted elements in the first phase, the coordination of the response, exercised by the chief government, public health institutions and the academic field, in addition to pre-existing characteristics of their health and social protection systems. The failure in 2021 may be related, in turn, to the misalignment between Uruguayan government authorities and scientific advice, in the relaxation of measures, and the entry of new variants; the reopening of tourism in Cuba; the loosening of social distancing measures and the emergence and spread of new variants in both cases. This year, the disease was contained mainly through rapid immunization in both countries, despite a relative delay in its initiation. Based on the experiences reported, aspects that can help future responses in dealing with health emergencies were discussed.

The discovery of the causal relationship between Zika infection and microcephaly/Congenital Zika Syndrome (CZS) further strengthened the discussion on the impact of vector-borne diseases on the quality of life of Brazilian families. In addition to the health and functional challenges that encompass the child development of children with CZS, the quality of life and mental health of affected families is related to sociodemographic structures and access to health services, closely related to income, formal employment relationships, social benefits, number of children and access to preventive health care, especially in the context of Primary Health Care. The general objective of this study was to analyze the factors associated with the quality of life and mental health of mothers/caregivers of children born during the Zika virus epidemic. We respond to this objective through three articles. Article 1 “Factors associated with the quality of life of caregivers of children diagnosed with Congenital Zika Syndrome”, where we describe the quality of life among caregivers of children with microcephaly associated with CZS and analyze the factors associated with it, using the WHOQOL instrument -bref. This was a cross-sectional study, carried out using descriptive data analysis, bivariate analysis and linear regression as multivariate analysis. Socioeconomic and clinical factors of the caregiver, such as returning to the job market after the child's birth (p<0.001), number of children (p<0.005) and number of prenatal consultations (p<0.001) were associated with overall QoL, in the multivariate analysis. Aspects related to child neurodevelopment increased the variation in the prediction of caregivers' quality of life, after their inclusion in the multivariate model for all QoL domains, except psychological. In Article 2, “Longitudinal dynamics of quality of life in caregivers of children with microcephaly associated with Congenital Zika Syndrome during the COVID-19 pandemic”, we analyze the influence of social support on quality of life during the first and second wave of the pandemic of COVID-19, for caregivers of children with microcephaly associated with CZS. Emotional, material support and social interaction tended to improve between the first and second wave of Covid-19, as well as QoL. This was a longitudinal article conducted with 50 caregivers recruited from a hospital-based cohort. There was an association between the social support subscales and the outcome, quality of life of caregivers during the first and second wave of COVID-19, through bivariate and multivariate analysis with a multiple linear regression model with the Jackknife resampling method to standard error correction for small samples. The results of this manuscript showed a statistically significant difference between the evaluations of the environmental domain of QoL over time. In the multivariate analysis, emotional and material support predicted quality of life in 34% in the psychological domain and in 19% in the environmental domain. Article 3: “Factors associated with the mental health of caregivers of children born during the Zika virus epidemic: analysis in times of covid19”, we analyze the factors associated with the mental health of caregivers during the first wave of the COVID-19 pandemic. 19. This manuscript was cross-sectional and carried out with 53 caregivers. There was an association between the independent sociodemographic and access variables of children and their caregivers and the outcome, mental health, through bivariate and multivariate analysis with multiple linear regression models with the Jackknife resampling method to correct the standard error of small samples. The results showed that access to monitoring in Primary Health Care for children and their caregivers and the caregiver's routine consultations were predictors of stress and anxiety in caregivers. For the depression subscale, the final model was predicted in 30% by experience of unemployment in the family, care provided by the caregiver at the basic health unit and the caregiver's routine appointments. Factors related to the socioeconomic profile, social support and access to health services of caregivers and their children were associated with the outcomes quality of life and mental health of caregivers of children with CZS. Caregivers with socioeconomic disadvantages, low social support and limited access to preventive services for families are more likely to experience low quality of life and greater stress, anxiety and depression. The integrated surveillance and health care monitoring of cases of changes in the growth and development of children affected by the Zika virus, as well as their impact on the mental health and quality of life of the caregiver, is crucial for a targeted approach to these caregivers and children, promoting public health interventions as early as possible in order to enhance favorable outcomes and assist in the evaluation of rehabilitation results, fostering the qualification of decision-making by managers.

The Unified Health System (SUS) is the result of political action of a movement recognized as the Brazilian Health Reform Movement (MRSB), conducted within the framework of civil society. In 2017, under extensive controversy, the National Primary Care Policy was published, establishing the revision of guidelines for the organization of Primary Care. The core of the controversy was the process of implantation/implementation of the Family Health Strategy - FHS, mobilizing and sustaining divergent meanings (advance or retreat) about the same phenomenon. The FHS received incentives and investments of various kinds and expanded in different dimensions, and can be considered one of the main health policies implemented by the SUS. However, in the actual historical process, since its launching, discourses have circulated that criticize the possibility of that strategy to promote changes in the care model. The struggle over the meanings mobilized around the ESF is something complex since its institutional origin. We consider that we are, therefore, facing the historical contradiction of the Capital-Labor relation, which, as such, mobilizes senses and meanings that can constitute material force, in the scope of the class struggle, for its conservation (production and reproduction) or transformation (revolution). We conducted a study guided by the historical materialist method from the French tradition Discourse Analysis (DA), aiming to analyze the origin of the official discursive process about ESF in Brazil. We constituted a heterogeneous corpus composed of discursive sequences of the official discourse, mobilized by theoretical-analytical devices of AD, having as fundamental concepts/categories conditions of discourse production, Interdiscourse, Discursive Formation - FD and Ideological Formation - IF. The discourse studied was enunciated in a conjuncture in which the country was deepening its adherence to the neoliberal prescriptions, economically and ideologically, after the period of great effervescence in the aftermath of the military regime, especially at the end of the 1970s and until the mid-1980s. The analyses demonstrated marks of fits and joints of interdiscourse processes that allow us to consider a discourse affiliated to the neoliberal discourse that has as Universal Subject "the Capital", personified in the fraction of the Brazilian cosmopolitan bourgeoisie, in the expression of its contemporary development to the enunciation, neoliberal. Such affiliation is expressed in the "reading" of the problem that one intends to face, "the structural crisis of the public sector", therefore at the base of the syllogistic support of the discourse, almost as a "genetic determination" associated to the affiliation of the discourse to the FD of the Ministry of State Reform. It is a discourse directed to the needs of the hegemonic system in reconfiguration, facing the contradictions "posed" by the MRSB discourse, in the debate about the development of health policies, in a conjuncture in which the State, in reform, implements a neoliberal economic model, oriented to the shrinking of state public structures. "ESF" is configured as a paradoxical ideological object, acting in the Ideological Apparatus of Health for the saturation of senses referring to the organization of health services, showing itself at the same time as a strategy for transformation and for conservation of the care model. Perhaps the most immediate contribution of this study is to allow, for those organizations that recognize themselves as supporters of the defense of the Universal Right to Health under the aegis of the SRB project, a repositioning in the ideological class struggle.

Leptospirosis is a public health problem, and it is among the world’s neglected diseases. It is a zoonotic infectious disease caused by bacteria of the genus Leptospira, which has a high diversity of serovars and reservoirs. Therefore, it is essential to know the geographic distribution of serovars and their ecological niches. This general objective of this study was characterizing the diversity of pathogenic leptospires in the Americas and its relation to their ecological niches and impact on the transmission of leptospirosis. We responded to this objective through three articles. Article 1: The objective was to characterize the geographic distribution of pathogenic leptospire serovars in the Americas, based on a systematic review between 1930 and 2017, where a total of 1310 articles were identified. After evaluation by inclusion and exclusion criteria based on title and abstract review, 750 articles remained. Finally, the evaluation of the full text and analyzed of 283 articles, of which 69 were performed in humans, 86 in wild animals and 182 in domestic animals, most of them performed in Brazil (104), in rural environments, being the most frequent serovars: the Icterohaemorrhgiae , Pomona, Canicola and Grippotyphosa . The results found point to a concentration of georeferenced points in Latin America, especially in Brazil. In addition, studies that deepen the environmental characteristics should be explored. Article 2: This study aims to analyze the prevalence of leptospirosis in the Americas, from a systematic review with meta -analysis, in the period from 1930 to 2017, carried out on six research platforms: PubMed , Web of Science, Scopus, Lilacs , Embase and Cochrane. Articles (77) were found in all countries of the Americas; North (11, 14%), Central (9;11%) and South (42; 53%); most from rural areas (12;15%) and 53 (67.9%) articles are from 2000 to 2017. The overall average prevalence of leptospirosis across all articles corresponds to 28% (0.23-0.32) 95% CI. The countries with the highest prevalence were the USA (41%), Brazil (21%) and Colombia (29%). The most frequent serovars found were: Icterohaemorrageae (43;55%), Canicola (35;45%), Pomona (28;36%) and Grippotyphosa (26;33%). There is a variability of Leptospira species and serovars heterogeneously distributed throughout the Americas, with high prevalence in some countries, which shows that it is necessary to undertake actions to control this disease that is still neglected in the world. Article 3: The objective is to investigate the current geographic distribution and the impact of different climate change scenarios on the potential geographic distribution of pathogenic leptospiral serovars circulating in the Americas. Information related to serovars including location and reservoir was extracted from articles identified through a systematic review from 1930-2017. Environmental variables were used as predictors in ecological niche modeling. Analyzes were based on the scale of leptospirosis transmission in time and space, considering pathogenic serovars, considering RCP 4.5 and RCP8.5, for the years 2050 and 2070. The results point to a potential conservation of leptospirosis transmission in scenarios of global climate change, mainly in Central and South America. And finally, it is believed that based on the findings found, it will be possible to mitigate environmental conservation actions to control and reduce the consequences of future temperature changes, which are important variables for the transmission of leptospirosis.

Under adverse conditions, work can lead to illness and serious consequences, including work disability. Work disability can be defined as the situation in which a worker is unable to maintain or return to work due to injury or illness. There are several determinants that can influence the process of leave and return to work. This study sought to understand, from a gender perspective, the experiences and trajectories of work disability of male and female workers in the automotive industry. This is a qualitative research, designed from the perspective of an Extended Case Study. Data production relied on a meta-synthesis of qualitative studies, document analysis, and public databases; and an ethnographic fieldwork, which involved participant observation, interviews with men and women that worked in the automotive industry in the metropolitan region of Salvador and experienced work disability, as well as interviews with agents interested in the problem of work-related illness and work disability in the automotive industry. Data analysis was based on the theoretical perspective of Burawoy's reflective science and Bourdieu's reflective sociology. The research results are presented in this thesis in 4 chapters: Chapter 1 is a meta-synthesis of qualitative studies that investigated the relationship between gender and disability in the period between 2008 and 2018; Chapter 2 addresses the trajectories of entering the factory, the incorporation of dispositions to work in the metallurgical industry, and the process of constituting oneself as part of a class under construction, and the strategies for staying at work. The results of this chapter seek to explain how Gender mediates this process and how gender differences and inequalities are expressed; Chapter 3 presents the emergence of the phenomenon of work-related illness, the available data on illness in the automotive sector, the different points of view on this problem, the intersection of gender in the construction of this point of view, and the actions developed on this theme; The chapter presents the findings that are related to trajectories disruption of agents from the point of work disability, showing how the illness represents a moment of rupture with the laborer’s mobility and with belonging to a social class in formation. It also discusses how the “Work x Family tensions” are shown to be decisive in the decision to leave work and highlights the decision-making of workforce management in relation to workers with disabilities. This chapter discuss how male and female workers make return-to-work decisions, seeking to analyze how the interactions between the Labor, Health and Social Security systems occur in the process of recognizing the illness, specifically among women. The results systematized in this study show that Gender is an important category to be considered for understanding the processes of work disability, as gender relations mediate the trajectories of workers since the process of entering the factory, to incorporation of provisions for work, maintenance of jobs, and professional rise in the career, as well as in the trajectories of breaking with work due to illness. Disability experiences are marked by mediations of the processes of sexual division of labor in the industry and the social gender roles expected of men and women. Gender is also used in the dispute over explanatory models of illness in the automotive industry by different fields involved. Women experience greater difficulty in legitimizing their illness and incapacity for work, as well as greater difficulties in returning to work, due to an interaction of the Work, Health and Social Security systems that reproduce gender inequalities.

Emerging infectious diseases continue to be one of the main causes of morbidity and mortality in the world. In recent decades, humanity has faced several problems arising from emerging zoonoses, such as the recent Zika virus epidemic and the current SARS-CoV-2 pandemic. Although these diseases affect populations in different regions of the planet, residents of impoverished urban regions, such as slums, are more vulnerable and exposed to a greater burden of them. In this thesis, the objectives seek to describe the sociodemographic determinants associated with exposure to the zika virus and SARS-CoV-2 infection, as well as the frequency and factors associated with the interest of individuals in vaccinating against COVID-19. These objectives led to the creation of four articles whose results will be presented in a specific section within the thesis. In Article 1, a cross-sectional study was carried out, recruiting 469 pregnant women who gave birth at the obstetric center of an important public hospital in the city of Salvador, between October 2015 and January 2016. For this group of women, a seropositivity of 61% for ZIKV, and a social gradient linked to the result of this exposure. In Article 2, a cross-sectional survey of a cohort of 2,041 residents of an urban slum in the city of Salvador was carried out between November 2020 and February 2021, after the first wave of the COVID-19 pandemic. In this study, seropositivity for the virus was found in approximately 50% of residents, with women and children being more prone to infection. In Article 3, a cross-sectional population-based survey was carried out in 12 districts of the city of Salvador, between November 2020 and January 2021, to identify factors associated with vaccine acceptance for a possible safe vaccine against COVID-19. Among the 2,521 participants, 81.4% reported intending to take a vaccine, and of these, 68.2% also mentioned that if necessary, they would pay to have access to it. In Article 4, we used data from participants aged 18 years or older who participated in the survey referred to in Article 2 to assess the frequency and factors associated with willingness or hesitation to vaccinate against COVID-19. We found that vaccine acceptance in residents of an urban slum is lower than that obtained in the general population, with a percentage of 66%, with the lack of knowledge about the efficacy of the vaccine and the potential side effects of its administration being the main reasons for hesitation. Based on these discoveries, we hope to contribute knowledge to collective health, resulting in more effective health responses and public policies, aimed at reducing inequalities, providing better social conditions for the impoverished population. In addition to making us better prepared, with a strong and vigilant public health system to face these and future health challenges that may arise.

Background: Since 2017, daily oral PrEP has been offered for free by the Brazilian National Health System, and in 2022, it was extended to adolescents from 15 years of age who are sexually active and at increased risk of acquiring HIV infection. To ensure effectiveness in the implementation of PrEP, it is essential to have cost-effective tools that provide information to identify adolescents who need additional adherence support, as well as to identify individual, social, and programmatic factors that may lead to early PrEP discontinuation. Objectives: 1) To summarize the evidence on measures for monitoring PrEP adherence; 2) To evaluate the performance of indirect adherence measures among men who have sex with men (MSM) and transgender women (TGW) in Brazil; 3) To study factors associated with PrEP discontinuation among MSM and TGW in the PrEP1519 cohort in Brazil. Methods: This doctoral thesis analyzed adherence data from the PrEP1519 study, the first demonstrative PrEP cohort that included MSM and TGW aged 15-19 in three Brazilian capitals: Salvador, Belo Horizonte, and São Paulo. The outcomes evaluated were PrEP adherence measures [self-report, pill count, medication possession ratio (MPR)] and discontinuation. In addition, individual, social, and behavioral factors associated with PrEP discontinuation were evaluated. Results: Three articles were developed to address our objectives. The first article is a systematic review on the accuracy of adherence measures for PrEP use. The second article is a diagnostic test study that evaluates the performance of three indirect measures, using tenofovir diphosphate (TFV-DP) quantification in Dried Blood Spots (DBS) as the gold standard. The third article is a cohort study that evaluates PrEP discontinuation and associated factors. Conclusions: The thesis presents important contributions to monitoring PrEP adherence among key population adolescents. The results suggest that indirect adherence measures are cost-effective tools for monitoring PrEP adherence in clinical practice. The combination of measures provides more accurate information. In addition, the PrEP discontinuation rate among adolescents is high, associated with risk perception and the vulnerability of transgender women. PrEP implementation in adolescents should be accompanied by effective strategies for adherence monitoring and to identify and address factors that may contribute to discontinuation.

Mental disorders have become one of the greatest psychosocial phenomena today, increasing their prevalence in low-, middle-, and high-income countries around the world and accounting globally for about a third of mental illnesses. Estimates show that mental disorders such as depression and anxiety represent the main causes of disability worldwide, having caused approximately 40 million years of disability in the age group between 20 and 29 years and impacting not only on health systems, but also on the working lives of these individuals, affecting mainly women. Aiming to collaborate with the field of workers' health in the public service of federal institutions and to identify possible predictors of the scope of work associated with the generation by birth year and the effects on their mental health from a gender perspective, this thesis proposes to present discussions regarding the occurrence of common mental disorders related to occupational stress, so that it is possible to favor a clearer understanding of this theme in a generational perspective, providing new debates, since studies on gender, health, work and generation of birth still remain little present in Brazilian and international literature. This research is part of the Longitudinal Study of Adult Health (ELSABrasil), a multicenter study carried out at universities and research institutions in six Brazilian states (Bahia, Espírito Santo, Minas Gerais, Rio de Janeiro, Rio Grande do Sul and São Paulo). This is a cross-sectional study including 15,105 participants interviewed at the baseline of the ELSA-Brasil, aged between 35 and 74 years. Sociodemographic characteristics, health behaviors, medication use, work domains, which included weekly working hours, time in current activity and social support with repercussions on mental health, were included in the analyzes. Common mental disorders (CMD) were measured by the Clinical Interview Schedule (CIS-R) and occupational stressors by the Swedish scale of the Demand-Control-Social Support Questionnaire (DCSQ). All analyzes were carried out using the Statistics Data Analysis (Stata) software, version 14. As a result of the thesis, three articles were prepared: (1) Generations by birth year, gender and common mental disorders in civil servants participating in the ELSABrasil; (2) Occupational stress and common mental disorders: generational and gender differences in the ELSA-Brasil cohort; (3) Generational and gender differences in the severity of common mental disorders in the ELSA-Brasil cohort: the influence of occupational stress. In Article 01, a cross-sectional study was carried out with 15,105 participants from the baseline of the ELSA-Brasil, where the prevalence of CMD was estimated and description according to race/skin color, education, marital status, alcohol consumption, smoking, use of antidepressants and benzodiazepines. The date of birth characterized generation by birth year. More than 60% of the cohort belong to the Baby Boomer generation. The prevalence of CMD was 26.7% (women=33.8% and men=18.4%). The highest prevalence occurred among Generation X participants (30.4%), with a 95%CI [1.62-2.03]. CMD were more prevalent among females compared to males across all generations. In Article 02, 12,015 active participants were eligible, excluding retired workers. Among active study participants, 26.8% had CMD. However, the prevalence among women reached 35.9% compared to 19.3% among men, with an 86% higher risk (PR=1.86; 95%CI 1.75-1.98). Analyzing the association between occupational stress and CMD after adjusting the model, the positive and statistically significant association between occupational stress and CMD was maintained only among women from the Baby Boomer Generation who had an active job (PR=1.32; 95%CI [1.13-1.54]) and high strain/exhaustion work (PR=1.41; 95%CI [1.14-1.73]) and among women from Generation X who performed 11 active work (PR=1.39; 95%CI [1.09-1.78]). Among men, there was no statistically significant positive association between occupational stress and CMD. In Article 03, the extent to which occupational stress modified the severity of CMD according to gender and generation by birth year among active participants was evaluated. Women had 2.4 times more severe CMD and 1.5 times milder to moderate CMD than men. The presence of interaction between education, occupational stress and CMD severity was observed in women from the Baby Boomer Generation (p value 0.0025). Women with complete secondary education submitted to active work (combined by high demands and high control) when compared to low demand/exhaustion work (low demand and high control) have 53% more occurrence of mild to moderate CMD (PR=1.53; 95%CI [1.09-2.15]) and 42% more severe CMD. When this adjustment is made for weekly working hours, active time at work and social support, the association of interest was little affected. Based on these discoveries, we hope to contribute knowledge to collective health, from the perspective of generations by birth year and gender, suggesting new studies to evaluate the role of public policies in the prevention of common mental disorders. It should be noted that new investigations based on generational cohorts are salutary to analyze the impact of these work demands and domestic tasks on the illness of these workers, seeking alternatives to reduce the current demands in universities, in addition to promoting improvements to minimize gender inequalities.

The study aimed to understand the meanings of the involvement and experience of homeless people in the Brazilian National Movement of the Homeless (“Movimento Nacional da População de Rua - MNPR”). In relation to specific objectives, the purpose of the study was to: (1) identify mobilizing elements of the engagement of homeless people to the “MNPR”, with emphasis to aspects related to their life stories and experiences in social policies; (2) understand transformations and homelessness, before and after involvement in collective actions; (3) identify how individuals narratively perform their identities and become militants; and (4) analyze experiences of homelessness and involvement in the movement, based on networks of solidarity, conflicts and resistance strategies adopted by the militants. We have taken as relevant theoretical frameworks the studies on race relations and subjectivation processes, decoloniality and the Theory of New Social Movements. A qualitative study with a biographical approach, including ten participants who presented narratives on their homelessness experiences and on how they became involved in the collective actions. In-depth interviews were conducted as a data production technique. Data analysis was based on Catherine Riessman’s narrative analysis. It was observed that for the interviewees, the street is an ambiguous space where situations of abandonment, violence and negligence are experienced, but also where they build emotional ties and solidarity networks, turning them into militants in the measure in which they reframe their biographical trajectories. From their increased involvement in the social activities, militants begin to take their place as active subjects, facing adversities and reaching important achievements in their lives and in that of their peers, changing the concept that they had about their own self. Despite overcoming the situation of homelessness, through their involvement in the social struggle, militants usually maintain a deep attachment with their street kinsmen. Through their own personal narratives that they tell themselves and to others, they reconstruct their identities, established in the relationships with other more experienced people who are part of the group of reference, where they acquire the necessary rules towards a narrative formula. These personal narratives take on the role of transforming the lives of those who survive the necropolitical regime of extermination and obliteration of black existences, to enable these trajectories, reconstructed through stories of resilience, generating the existence of activists, lives that acquire meaning through their engagement in collective actions. Becoming a militant means having a voice and being heard in spaces where militance is being exercised. Accordingly, having a voice is only possible over time and in the measure in which militant identities acquire form, forged from accumulated experiences of violence, abuse, negligence and abandonment and through protesting behaviors, demanding dignity and the right to exist, without being relegated at all times to the other side of abyssal lines.

IntroducQon - Afer World War II, the efficient fight against pests that threatened agriculture became a priority in measures to combat hunger in Europe, Asia and other regions. This is how large investments in chemical research emerged and the produc8on and consump8on of pes8cides (agrotóxicos) intensified. Widespread throughout the world, its acute and chronic toxic effects on living beings can be lethal, cause malforma8ons, cancers and mental, neurological and endocrine disorders. Consequently, pes8cides are responsible for several health problems, including deaths due to acute poisoning (IFA), the object of this study. These IFA may be inten8onal and the result of violence, and will not be included in this study. There are numerous barriers to the diagnosis and registra8on of IFA, and, among them, the different dimensions, or specific layers. They are: 1) diagnoses classified with codes from the Interna8onal Classifica8on of Diseases, 10th Rev. (ICD-10) as basic and contribu8ng causes; 2) the type/group of substance involved; 3) place of occurrence; 4) the rela8onship with work. Around the world, studies demonstrate the great under-iden8fica8on, under-registra8on, underrepor 8ng and possible under-enumera8on of deaths due to IFA, resul8ng in the underes8ma8on of mortality es8mates. However, there are few studies and there are no es8mates of the extent of missing records. Objectives - This research aimed to: 1) iden8fy all IFA death records in the na8onal SIS, public access and individualized data, as well as possible deaths due to IFA(X48.x) with diagnos8c classification error (IFAec) and describe the different characteris8cs required for diagnosis; 2) Estimate mortality coefficients due to IFA(X48.x) and IFAec in agricultural workers; 3) Spatically compare the mortality coefficients due to IFA(X48.x) and IFAec in agricultural workers. Results - 1) Five SIS were iden8fied with records of deaths due to IFA na8onwide with individual and public data and the number of fields with informa8on on diagnoses varied between the SIS. 670 (23.2%) deaths were iden8fied due to IFA(X48.x) and 2,223 (76.8%) due to IFAec. Diagnoses with undetermined intent represented 52.8% and 64.7% iden8fied the pes8cide substance. Only 54 deaths were found in more than one SIS and, of these, 29 had the same diagnosis. IFA under-registration in SIM was es8mated at 33.8% and 90.4% in Sinan-Intox. 2) 806 deaths due to IFA(X48.x) and IFAec in agricultural workers were analyzed and were more frequent in men, aged 25-44 years, living in the Northeast. The diagnosis with the highest number of records was Y19.x (29.6%), followed by X48.x (25.3%) and Y18.x (18.4%). The mortality profile for IFA(X48.x) and IFAec showed differences in the variables analyzed. MP-AT were higher in the IFA(X48.x) group, especially in the South and Southeast regions and workers aged between 55-69 years. 3) 806 records of deaths due to acute poisoning in agriculture were analyzed. Of these, 25.3% were diagnosed with IFA(X48.x) and 74.7% were diagnosed with IFAec. Deaths predominated among men, aged between 25 and 44 years in the Northeast region. CM had a downward trend in both diagnos8c classifica8ons and was higher in the IFAec group throughout the period. The CM by IFA(X48.x) was higher in Tocan8ns, Rio Grande do Norte, Rio Grande do Sul and Mato Grosso do Sul.

This study presents the history of the expanded clinic, in relation to care practices in the field of Collective Mental Health in Brazil. The emergence of the expanded clinic, as an area of knowledge, is located at the interface between Mental Health and Primary Care. His history is reconstructed, in this dissertation, through an archeogenealogy. The research demarcation of the historical and epistemological conditions so that the expanded clinic has become a device in Mental Health, from which it articulates care practices in this field. As specific objectives, it identifies the conditions of historical appearance and transformations of the expanded clinic as a device in the field of mental health; explains the breaking points with other discourses that guide the clinic, describes the discursive plot that characterizes the expanded clinic as a care device and analyzes the extent to which the expanded clinic establishes correlations with other clinical discourses in the context of psychosocial care. The strategies used were literature review, documentary analysis and thematic and unstructured interview, through Oral History. The analysis of the material produced was carried out based on operations for an archaeological analysis, identifying the relationships contained among discursive and non-discursive elements, based on the reference of The Archaeology of Knowledge. The results point to the analysis that the support of the expanded clinic presents itself as a challenge, to the extent that it is born as a device of counterpower, institutionalized and today, in undemocratic times, has its place threatened by an evidence-based clinic and in protocol procedures. In that sense, it may become a strategy for confronting and resisting the current scenario of degradation of the Unified Health System and for the return of asylum proposals associated with setbacks and hard blows to work in the Brazilian Public Health, as in being able to reinvent itself collectively and reposition in the face the power relations that are established nowadays.

Accessibility is indicated as one of the relevant structural elements of Primary Healthcare; it is at this level of attention where requirements prove to be different, once it is set up as a preferential entry to the health service system. Every municipality in Brazil has the power to organize, execute and manage services and actions related to aspects pertaining to the structure of the primary healthcare units and the organization of the work process of the health teams related to socio-organizational accessibility to Primary Healthcare services in rural municipalities of Brazil. A cross-sectional descriptive study that used secondary data related to Family Healthcare teams in Brazil which adhered to the third cycle of the National Program for Access and Quality Improvement in Primary Healthcare (PMAQ-AB). The sample comprised of 2,940 municipalities, with populations equal or inferior to 20 thousand inhabitants, classified as rural municipalities (remote and adjacent rural areas), participants of the external assessment of the 3rd PMAQ-AB cycle. The results obtained in this study indicate deficiencies, both in aspects of the structure of the health units as well as in the work process which hinder accessibility to the health services, such as the healthcare environments and pharmacies; supplies and medication for emergency medical care; immunobiology and diagnostic tests in the unit, working hours/days of the unit; dealing with spontaneous demand; sample collection for medical exams and procedures, insufficient professionals to form the core team, availability and use of information technology. Considering that few of these municipalities have other levels of health systems, a structured Primary Healthcare would offer a more effective care to the population. The development of other studies could contribute towards understanding the issues faced by primary healthcare in rural and remote municipalities.

Systemic Arterial Hypertension (SAH) is considered, worldwide, as a high-prevalence chronic disease, affecting around one third of the adult population, besides being one of the most significant risk factors for the development of cardiovascular diseases. In Brazil, SAH is considered a major public health problem, presenting high prevalence and low levels of control. The study has the purpose of assessing the quality of care to patients with SAH provided by the primary healthcare teams that have adhered to the third cycle of external assessment of Brazil’s National Program for Access and Quality Improvement in Primary Care. It is a normative assessment study, that aims to verify whether an intervention is in compliance with the established standards, using the quality assessment definition proposed by Donabedian. Accordingly, a logical operational framework was prepared in relation to the care for SAH in primary healthcare, comprising the management and care dimensions, giving origin to a criteria matrix, indicators and standards, enabling the assessment of the degree of appropriateness of the actions and classify the criteria as adequate, intermediary or inadequate. Simple and relative frequencies were calculated, as well as percentages for each criteria, using the R Studio software. The data was stratified by regions. The results point out to a deficiency in the scope of the standard of quality considering the structure criteria, especially those related to the physical structure of the healthcare units, as well as the administrative and support environments and the compatibility of the number of teams working in such spaces; ambience and accessibility characteristics for people with special needs, as well as availability of equipment for health education activities, not to mention the extremely low percentage of availability of basic medicines for the treatment of the condition, significantly compromising its control at the primary level and indicating deficiencies in the quality of the care provided. The process criteria had a better performance, however those related to working hours of the Primary Healthcare Unit (48.0%), adscription of the population (47.1%), receptivity of spontaneous demand (6.3%) and coordination of primary care (52.4%) demand interventions aimed at improvement, once important aspects in the care process of primary healthcare are reflected. Despite the existence of a set of norms related to the SAH care process of the patient in primary healthcare, issues related to the physical structure of the Primary Healthcare Units, materials, inputs and equipment are not adequate to guarantee quality in the care of hypertensive patients. Furthermore, qualification in the work process of the teams is necessary for Primary Healthcare to fulfill its healthcare coordination role.

The Family Health Strategy (FHS) was adopted by the Ministry of Health to reorganize Primary Health Care in Brazil and redefine the current healthcare model. It presents a work process characterized by interdisciplinary teamwork within a generalist scope, permeated by numerous challenges. Several studies reveal that, due to the characteristics of the work process and working conditions in the FHS, professionals are exposed to experiences of pleasure and suffering that affect their health situation. It can generate satisfaction and a sense of well-being or dissatisfaction that can manifest itself in physical and/or psychological illness. This research sought to analyze the relationships between work processes and the health of professionals in the Family Health (FH) teams. This is an integrative literature review study. The integrative literature review is characterized by being a review method that provides broader information about a given phenomenon, allowing the synthesis of knowledge from the analysis of significant studies. This review was carried out from searches in electronic libraries: Virtual Health Library (VHL), Scientific Electronic Library Online (Scielo), Latin American and Caribbean Literature on Health Sciences (LILACS) and Medical Literature Analysis and Retrieval System Online (PubMed/MEDLINE/NIH), with the combination of the keywords: Saúde do trabalhador, Estratégia de Saúde da Família, Estratégia Saúde da Família, Programa de Saúde da Família, Programa Saúde da Família, Saúde do profissional, Trabalho, Occupatinal Health e Family Health Strategy. It was observed in the selected studies that the elements of the work process are still not well understood by the users and workers of the FHS, who also face scarcity of material and immaterial resources. This situation reflects negatively on the work process and on the health situation of professionals. However, despite most publications having negative repercussions, beneficial repercussions were also identified, where the work process was not pathogenic. It is concluded, therefore, that the factors that lead to the development and/or suffering in professionals of some Family Health teams (EqSF), can promote pleasure and well-being in workers of other EqSF, which leads us to infer that the intrinsic specificities of each team and its territory of operation are related to the type of repercussion (negative or positive) that the work process has on the health of professionals.

In 2019, the emergence of the first cases of COVID-19 in China and the rapid spread between countries and continents led the World Health Organization to declare a Public Health Emergency of International Concern. From this, a new epidemiological scenario was installed, requiring a restructuring of the various health systems and services around the world, in order to provide quick responses to contain and/or mitigate the advance of the pandemic, mainly organizing emergency services, a priority location of search for health care in times of outbreaks and epidemics. In Brazil, the measures of the Unified Health System for the organization of health actions and services to face the pandemic began with the publication of Ordinance No. 188, of February 3, 2020, of the Ministry of Health, which declares a Public Health Emergency of National Importance. In the state of Bahia, actions to face the COVID-19 pandemic began in February 2020 with the publication of the 1st edition of the State Contingency Plan to Combat the New Coronavirus. In this sense, this research sought to characterize the process of organizing the Health Care Network in the state of Bahia to face COVID-19, from February to December 2020. This is a case study, qualitative research, exploratory and descriptive. Data were produced from secondary sources, and in total, the study included 102 documents. The results found in this study indicate that, during the formulation and implementation of the Health Policy in the state, the Directorate of Epidemiological Surveillance, the Directorate of Specialized Care, and the State Council of Municipal Health Secretaries played a leading role in the face of other sectors of the governmental structure of the Secretariat of Health in the State of Bahia, a situation that did not compromise the government's response to the pandemic.

Introduction: The perception of body image is a subjective construct that can influence people's lives in different spheres, especially health. It can be established according to an accurate or distorted view and, when it distorts, it can do so for both overweight and underweight, with consequences for physical and mental health. There are aspects of various orders that influence the perception of body image, and socioeconomic, lifestyle and health care factors are some of them. Objective: To estimate the prevalence of body image accuracy and distortion, as well as to investigate associations between body image distortion, socioeconomic characteristics, lifestyle and gynecological health care demand among Bahian women participating in the ELSA-Brasil cohort. Methods: A total of 609 women aged 50 to 69 years from the ELSA-Brasil cohort residing in Bahia participated in the study. The data were produced through questionnaires used in Wave 2 of the cohort, which allowed access to information related to the variables body image perception, socioeconomic characteristics and lifestyle, and another questionnaire that included questions about gynecological care, place of birth and of residence of the participants. The association measures were calculated using simple and multinomial logistic regression, which were computed using the Stata statistical software version 13. Results: Most participants have an accurate perspective of their own bodies. Among those who presented distorted perception, there is a tendency to distort for less weight. Younger women presented greater distortion for more weight than older women, and these presented more prevalent distortion for less weight. There were no significant associations for distortion to more weight. The distortion model for less weight revealed an association between the variables race/color and education, according to which brown and black women and less educated are more likely to develop distortion for less weight than white and more educated women. Conclusion: The results contribute to the discussion about the perception of body image associated with socioeconomic factors, especially race/color and education, and their relationship with the sphere of women's health.

Context - Benzene has been recognized worldwide as a carcinogen to humans since 1982. This spurred the formulation and implementation of prevention policies based on Conventions of the International Labor Organization. Brazil produces and widely employs benzene in various production processes, resulting in a large number of potentially exposed workers. In 1995, Regulatory Standard 15, 13a, of the Ministry of Labor, MT, established the compulsory implementation of Programs for the Prevention of Occupational Exposure to Benzene (PPEOB). Later MT defined the use of trans-mucic acid (ttMA) as a biomarker of benzene exposure. After 25 years, the effects of this Policy on occupational exposure to this agent are still unknown.
Objective – to describe the advances in the world and, in Brazil, of the prevention policies effects on benzene occupational exposure.
Specific objectives – 1) Study 1: systematize knowledge about the impact of prevention policies on benzene exposure in the world; 2) Study 2- investigate the adoption of NR15, 13a through the degree of implementation of the PPEOB according to components, dimensions and subdimensions, in some companies in Brazil; 3) Study 3- verify the effects on exposure levels, analyzed by a biological marker - trans-mucic acid.
Methods – Study 1: Systematic review of observational studies or literature reviews through publications from 2000 to 2020 sought in Web of Science, PUBMED, VHL, SCIELO, LILACS, EMBASE. Study 2. Pre-post study conducted with documents and databases for the years 2000 and 2017, in industries that employ benzene. Data come from a checklist, drawn up by a Tripartite Commission, employed by the auditors of the MT, inspections accompanied by members of the GTB and technicians of the companies, to evaluate the implementation of the prevention and control actions provided for in the regulation of benzene in which dimensions, subdimensions and component variables were identified. Each variable was answered with 0=not implanted, 1=partially implanted and 2 = fully implanted, used to estimate scores with the unweighted sum of the points corresponding to the variables The degree of implantation corresponds to the proportion achieved of the maximum possible score. The pre-post difference was analyzed with the proportional percentage variation (PPV%) of the degree of implantation over the study time. Study 3. The design is cross-sectional ly conducted with PPEOB documents and databases delivered to the MT by companies inspected every six monthsfrom 2012 to 2017. All companies under inspection of the MT of a state (N=9) with available data were studied. It was defined as exposed to benzene trabalhadores with measurements of EI greater than or equal to 0.5 mg/g of creatinine.
Findings
Study 1. Twenty-five articles were selected that focused on European and North American countries. Average concentrations of benzene in the air declined from the mid-1980s to the end of the study period. In China and Korea, the decline had fluctuations. There were differences in trends according to occupation and companies, even if they were in the same branch of activity. Factors associated with the decline were: reduction in the permitted limits of occupational exposure, regulatory changes and the adoption of technological measures. Study 2. Of the nine companies almost half (n = 4) evolved positively in the implementation of the PPEOB, most commonly with the adoption of Technological Solutions for Collective Protection; three presented variable evolution (positive, negative and stationary), according to the subdimensions and two presented some subdimensions with negative evolution and scope as well as quality of monitoring of benzene exposure. Study 3- Of the 1,058 workers with IBE measures between 2012 and 2017, in the base year of 2012, there were exposed in each of the companies, which was reduced in the last year of the study (2017) to only one of them. Consistently, the highest proportion of exposed occurred in those of negative evolution of the implementation of the PPEOB. The characteristics of the available data compromised the conclusions.
Conclusion: Study 1- scientific evidence shows a decline in the levels of benzene concentrations in the work environments, with variations between countries, companies, and occupations. Study 2 - Despite the small number and limited representativeness of the companies, the findings show advances in the degree of implementation of measures to control benzene exposure in almost half of the companies, although, despite the inspections, 1/3 did not advance significantly. Although the inspections were carried out on a biennial basis, the process of implementing control measures, particularly technological solutions, occurs in the medium or long term, for this reason, in Study 2, we chose to use the data of the first audit performed after the new regulation of benzene, and the last, with an interval of 17 years between the pre and post measures. This large interval limits the conclusions/inferences of this study, specifically. Study 3 - Although with methodological limitations, this study advances knowledge about occupational exposure to benzene in Brazilian companies at a later stage the implementation of a new regulation. Brazilian studies are scarce and focus on a time prior to the publication of new regulation. So, this analysis innovates by revealing the levels of exposure to benzene that workers in occupations and various companies are subject. This information can be valuable to support discussions on improvements in the policy of preventing benzene exposure in the country. However, in general, the conclusions of study 2 and 3 present several limits due to: 1 ) the data were not planned for one of the research, they come from the databases of the MT and the companies, for which the author was allowed access; 2)the data of IBE measurements, used in Article 3, are the responsibility of the companies, relating to compliance with a legal standard, (potential conflict of interest); 3)the sample was not probabilistic or representative, nor guided by the required statistical power of the study, to allow population inferences even if it were for each company separately; 4)the data available for study 3 are sparse with long intervals without records and focusing on some repeated measures making it difficult to analyze the measures of continuous nature; 5) due to the large difference between companies and missing data that have focused on some difficult joint analysis of the data. Despite the limitations, the results obtained showed that, although with positive evolution in the implementation of prevention policy in almost half of the evaluated companies, situations of exposure to benzene still persist in all companies included in this study. These results are significant, especially since it is the first quantitative evaluation after the regulatory framework for the prevention of occupational exposure to benzene. It is suggested the dissemination and return among auditors, workers and in the academic environment, emphasizing the necessary walk in ensuring the rights of the most vulnerable.

The present work aims to analyze the implementation of the National Mental Health Policy (PNSM), at the national level, from 2001 to 2018. It is a single case study, of an exploratory and analytical nature, which took as its object the process implementation of the PNSM, in the FHC (2001-2002), Lula (2003-2010), Dilma (2011-2016) and Temer (2016-2018) governments, emphasizing the analysis of the actions carried out by the National Coordination of Mental Health of the Ministry of Health. Health and the actions and positioning of the different entities that make up the Social Movement organized around the Brazilian Psychiatric Reform, represented in the Intersectoral Commission on Mental Health of the National Health Council. The theoretical framework articulates concepts extracted from Neo-institutionalism, especially the Coalition Model of Defense and concepts derived from Strategic Thinking in Health. The empirical research used primary and secondary data, obtained through document analysis – laws, norms, portarias, resolutions, management reports, reports of the National Mental Health Conferences and minutes of meetings, recommendations, motions of the National Health Council - related to the PNSM and interviews with key informants, linked to the main national movements linked, both to the perspective of reform psychiatric and the perspective of the psychiatric counter-reform, in addition to a representative of the National Coordination of Mental Health, from one of the study periods. The results are presented according to the following dimensions: Fundamentals, objectives and strategies of the PNSM; Constitution and dynamics of the MS Coordination; SM Policy implementation process 2001-2018; Participation of the National Health Council in the PNSM implementation process (2001-2018); Debates and controversies around the PNSM implementation process. The analysis of the results shows that the implementation of the PNSM suffered inflections during the different governments in the analyzed period, which gave specific contours and rhythms to the actions of management, financing, social protagonism, implementation and expansion of services through normative acts adopted in in line with the macroeconomic situation, but mainly with the ethical-politicalideological position on the phenomenon of madness and mental health prevalent in the management of the Policy. Even so, the PNSM, as it was implemented, represented, for most of the analyzed period, an important advance in the conception of madness historically constructed in the country, as well as in the forms of care and attention to the population with mental disorders, psychological suffering and use, abuse of alcohol and other drugs. Considering that the constitutive actors of the different coalitions acted as “guardians” of the structuring principles and projects of each of them, it is concluded that the State and the public health system (SUS), in particular, has been configured as a space in permanent tension. by the coexistence of a mental health care reform project based on the universality and integrality of care, through the RAPS and the privatist, medicalizing, hospital-centric and excluding project, traditionally hegemonic and resistant to the Brazilian Psychiatric Reform process.

This is an ethnography about Atenas Program - a counter-hegemonic service (to the national current model) and "humanized" care to women undergoing abortion (provoked or spontaneous), in a public maternity hospital in the Northeast of Brazil - and the subjects involved (participants and professionals) in the initiative. The scientific literature points out that the abortion care model proposed by the ministerial Technical Standard 2005/2011 is not being followed by health services. There is emphasis on the technical component, devaluation of the professional-user relationship, little participation of women in decisions about their sexual and reproductive health, and neglect of reproductive planning. Facing this problem, the Atenas Program emerges as an alternative proposal to such a model. Guided by principles of humanization and by the aforementioned technical standard, the Atenas Program proposed a multiprofessional approach (in- and out-of-hospital) to women undergoing abortion in the studied maternity hospital. Between July and September 2018, in addition to participant observation, semi-structured interviews were applied with 16 members of the program and 35 professionals of the institution, of which 10 were in the core team of the "project". For the participants, in addition to the opportunity to elaborate feelings related to the abortion, the initiative provided an opportunity to finalize it in a longer, but safe, discreet way, at home, without removing them from family life and with less impact on the management of their social and work routine. At the same time, the non-immediate resolution of the abortion, characteristic of the methods proposed by the initiative, made evident in them the fear of infection and death due to the permanence of the "dead fetus in the belly". In this context, many suffered pressure from their close support network for uterine curettage. From the professionals' point of view, the Atenas Program represented a strategy of humanized care to these women that, facing the demands of pregnant women and neonates, had little opportunity to be assisted during hospitalization. The core team members praised the nurses' telemonitoring and the multiprofessional approach, which included psychosocial care - peculiarities that favored individualized care, the bond with the participants, and the women's autonomy. For the professionals of the institution, the Atenas Program helped in the turnover of obstetric beds, in reducing hospital costs, and in demystifying compulsory uterine curettage. However, it was observed that the Atenas Program was a recent and fragile initiative that was struggling for consolidation. Silencing about induced abortion was also perceived. By symbolically transforming all participants into "mothers" who lost a "child," the Atenas Program offered women who had spontaneous abortions a space to elaborate their feelings and, for those who induced them, provided moral protection and the opportunity to access integrated care. This silencing also prevented professionals from confronting their personal dilemmas about the issue and not running into the professional purpose of "saving lives" - given that, in the Brazilian social context and in the health field, fetal vitality is still paramount to the woman's well-being. Given the incipience of initiatives to improve abortion care for women, analyzing this experience was relevant.

This thesis analyses the practices of biomedical technologies in abortion-related care in a public maternity hospital in Salvador, Bahia, from an ethnographic approach. This ethnography is about the technologies that are part of women's reproductive and abortion itinerary and post-abortion hospital care in Salvador, Bahia, focusing on obstetric ultrasonography (USG). Participant observations were conducted in a public maternity hospital and in lectures and events in the area of ultrasonography, in addition to in-depth and informal interviews with women and health professionals. The main argument I defend in this thesis is that biomedical technologies, or reproductive technologies specifically, including obstetric USG, assume different agencies and participate in relation with human actors, women and professionals, in the production of multiple realities and knowledges about reproductive issues or reproductive control - among them pregnancy, abortion - given the space, time and layers of the body where they intervene and are practiced, in specific places where they are situated. It is also central to the argument that the hospital is an encompassing technology in abortion care in Salvador. In this, technologies establish social relations, which are marked by the hospital itself, an overarching technology in abortion care in Salvador. It proposes the notion of 'epistemological itineraries' to synthesise the production of women's knowledge throughout the procreative and abortion process, in relation to technologies, about their own bodies and the content that is formed in the uterus during pregnancy, visualisation and its expulsion. It shows how stratification collaborates in the production of these multiple realities, whether from the point of view of health professionals or women. It discusses the relationship between the device industry, and the dichotomies between public and private services. The biomedical technologies practiced in the hospital are examined, among these, protocols, charts, USG and curettage. It concludes that the hospital as a technology - and the multiple realities emerging therein - participate in the production of reproductive (in)justice (freedom and justice).

The National Oral Health Policy (PNSB) published in 2004 configures an update of the State's social response before the oral health problems of the population and their determinants. We analyzed the social space of the PNSB in Brazil, at the federal level, in the period from 2003 to 2018, through a case study of socio-historical approach, based on the reflexive sociology of Pierre Bourdieu and the contributions of Patrice Pinell. Documentary, bibliographic, and secondary data analysis, and in-depth interviews with 27 agents from the national formulation and implementation space were conducted. Their capitals, trajectories, networks of relations, positions taken, main issues at stake and disputes over the PNSB were analyzed. Transformations, continuities, and ruptures of the PNSB were evidenced. The formulating agents were all dentists, mostly men, white and of average social origin. Participation in the student movement and work in public management were decisive aspects for the development of more critical political dispositions, and for entering the field of Collective Health, and Collective Oral Health. The PNSB had a greater impulse in the Lula Government, with continuities and a slower pace in the Dilma Government. Innovations in the Lula Government include the creation of the CEO and LRPD, the regulation of the ASB and TSB, and the participation of oral health in international cooperation, and in the Dilma Government, the launching of the PMAQ-AB, the PMAQ-CEO, and the GraduaCEO, although the latter has not been implemented. There was a reduction in the symbolic capital of the Coordination starting in the Dilma Government, which was aggravated in the Temer Government, whose neoliberal agenda of fiscal austerity strongly modified the historical conditions of possibility for the PNSB. From 2015 on, successive changes in the Coordination affected the national implementation, with progressive reduction of results in the indicators of public dental services. Of the initiatives that were not consolidated and may become "possible dead", prosthetics in PHC and the expansion of teams with oral health technician stood out. Specialized care of public supply was an open "possibility", but a "poor" service for "poor people" is still an issue to be faced. The training of dentists, with more robust theoretical elements on Collective Health, politics, power, among other topics, and the confrontation of the hegemonic care model, still predominantly curative, restorative, and school dentistry, were also insufficient. The approval of legislative bill 8.131/2017, which seeks to make the PNSB a component of SUS, can contribute to its legal, political, and financial support. And, even if it is not possible to affirm the existence of a dental field in Brazil, in the sense proposed by Bourdieu (2019), it can be considered that there is a dental space in consolidation, with specific rules and laws, dominant from the market pole and dominated from the universal pole. The proposal of dental capital elaborated represents a contribution to this analysis. To know and recognize its rules and objects in dispute is part of the sociological work of the historical process underway in Brazil, with defense of the expansion of oral health in SUS, universal, integral, and health promoting.

Introduction: Having a usual source of care (FUC) from Primary Health Care (PHC) can improve health care for Brazilian adolescents, and access to health promotion and disease prevention actions. Among the recommended actions to be developed by PHC professionals, the School Health Program (PSE) stands out, developed through intersectoral actions between Primary Health Care services (PHC) and school units in the public sphere. These actions can favor a relationship of bond and reliability between adolescents and PHC services, based on the integration between the health and education sectors, contributing to the recognition of PHC as their FUC. A longitudinal relationship of accountability and trust can favor access to PHC health services. In this sense, adolescence is a period of life considered vulnerable due to the experience that can compromise the integrity of health. It is necessary to develop studies that make it possible to understand the determining factors in access to health and health care practices that consider the specificities and singularities of these individuals, in order to favor inclusion, autonomy and social participation in their care processes for adolescents. the health. General objective: To analyze the conceptual and methodological approaches and the determining factors for the recognition of a usual source of care and its association with access to PHC services among Brazilian adolescents. Specific Objectives: Systematize in national and international scientific literature, the concepts of usual source of care, the methodological approaches used and the determining factors evidenced by the studies; To analyze the demographic, socioeconomic, health factors and risk behaviors associated with the recognition of a usual source of care, according to sex, among Brazilian adolescents; To analyze the association between the development of intersectoral actions between school/health services and the recognition of a usual source of PHC care; To analyze the association between the recognition of a usual source of PHC care and access to PHC services, according to sex, among Brazilian adolescents. Methodology: The thesis was presented in four articles according to each specific objective. To carry out the first objective, a scope review study was carried out, with an article from the international literature, being developed with 41 original articles as a final sample. In the second objective, a cross-sectional study was conducted with 100,464 Brazilian adolescents, using complex sampling by cluster, based on data from the National School Health Survey (2015), with the dependent variable - Usual Source of Care. For data analysis, multilevel logistic regression models were used, based on the analysis of the Prevalence Ratio (PR), adjusted for demographic, socioeconomic, risk behavior and health variables, and stratified by sex. In the third objective, a cross-sectional study was conducted with 97,903 Brazilian adolescents, based on the PeSNE survey (2015) which considered adolescents from schools who reported developing intersectoral actions between the school and PHC services. For the statistical analysis, defined as the main independent variable – intersectoral actions and the dependent variable – Usual Source of Care of PHC, multilevel logistic regression models were used, estimating the PR. In the fourth objective, a cross-sectional study was conducted, based on the PeNSE survey (2015) with 68,968 Brazilian adolescents who sought PHC services in the last 12 months after the interview. It considered as the main independent variable – FUC APS and the dependent variable – Access to PHC health services. PRs were estimated from multilevel logistic regression models and adjusted for demographic, socioeconomic, risk behavior and health variables, and stratified by sex. For the analyses, corrections were made for complex, multilevel sampling using the stata 14 software and the use of the adjrr command for PR estimates. Results regarding the first objective: 632 articles were identified, of which 291 were excluded because they were repeated in the databases, with a final sample of 41 articles that were selected for review after the process of reading and evaluating the inclusion criteria. Being female, white race/color, higher income and education, and having health insurance were associated with the recognition of a FUC. The same association was observed for FUC APS, in addition to studies highlighting the relationship with mixed race/color, lower level of education and living in rural areas. Results regarding the second objective: The recognition of a FUC was mentioned by 55.5% of Brazilian adolescents, being 58.6% for females and 51.4% for males. In the multivariate analysis, the variables that present social, economic and risk behavior inequalities showed positive associations for FUC APS, for both sexes (race/black/childbirth/yellow and indigenous, low level of maternal education, being a high school student, public schools, unprotected sexual intercourse and having suffered violence). The other types of FUC (private practice, hospital and emergency), the demographic and socioeconomic characteristics when associated, showed negative associations, with positive associations for the variables of risk behavior and health conditions. Results regarding the third objective: Of the adolescents analyzed, 72.8% studied in schools that developed intersectoral actions with PHC services. Among the adolescent students from schools that developed intersectoral actions, an association was observed between the recognition of FUC APS and intersectoral actions (PR: 1.11; 95%CI: 1.08 – 1.15). When analyzing the multivariate model for the variations of the main independent variable, positive associations were observed for actions of the Health at School Program (PSE) (PR: 1.34; 95%CI: 1.30 – 1.38), and the development of actions between the school and PHC services (PR: 1.10; 95%CI: 1.06 – 1.14). Results regarding the fourth objective: Of the adolescents who sought PHC services, 74.6% reported access, with the highest proportion being female (79.3%). In the multivariate analysis, between the recognition of a FUC APS and access to PHC services, a positive association was observed (PR: 1.25; 95%CI: 1.24 – 1.26), and in the stratified by sex, it was observed that positive associations were found for both sexes, (PR: 1.30; 95%CI: 1.28 – 1.31) for males and (PR: 1.21; 95%CI: 1.20 – 1.23) for the female sex. Final considerations: The results of this study showed that social, economic and risk behavior determinants, such as being female, white race/color, higher level of education and income, and the availability of health insurance, are associated with the recognition of a FUC. The findings between the social determinants and the recognition of PHC as a FUC showed that adolescents in conditions of greater social and economic vulnerability are more likely to recognize PHC as a FUC. FUC APS also showed an association with intersectoral actions, between health and education. Regarding access to PHC services, the present study showed a positive association between the recognition of FUC APS and access to PHC services, with individuals experiencing less social inequalities, despite recognizing PHC as their FUC, they are less likely to access when compared to adolescents who do not recognize PHC as their FUC. In addition, social policies must be improved to expand the quality and access to PHC services and strengthen bonds and trust.

The field of Mental Health is endowed with multiple and distinct nuances that are necessary for a more accurate and careful analysis of the phenomena to be understood in this context – nuances among which we highlight, with overpowering, Brazilian ethnic and racial issues. The present study, therefore, derives from a research, at a doctoral level, whose general objective is to identify the narratives produced on the relationship between Mental Health and racism in the early 20th century, in Brazil, from the autobiographical work Diário do Hospício & O Cemitério dos Vivos (1956), by Lima Barreto. Such research comprises the theoretical, methodological and critical field of Collective Health, from its area of concentration in Social Sciences in Health, also being at the interface between Mental Health and Ethnic and Racial Studies. It starts from a qualitative and bibliographic approach (MINAYO; DESLANDES; ROMEU, 2012), and its method of production and data analysis is the Analysis of Autobiographical Narratives – as will be seen, respectively, in Schütze (1976; 2014) and Jovchelovitch and Bauer (2002). This method was applied to the analysis of the aforementioned work, and collaborated in the very conception of organization of the present study, which will be arranged in seven segments, namely: (1st) Presentation (or Self Narrative); (2nd) Introductory Considerations: Firstfruits; (3rd) Theoretical-Methodological Considerations: The Analysis of Autobiographical Narratives in Public Health; (4th) Theoretical-Critical Considerations: Historical and Contemporary Readings of Brazilian Scientific Thought on Mental Health and Racism in the 20th and 21st Centuries; (5th) Systematic Review of Scientific Literature: Lima Barreto, Madness and Madness in Lima Barreto; (6th) Analysis and Discussion of Results: Narratives by Lima Barreto and Further Elucubrations; and (7th) Final Considerations: Finishings. As a result, it is worth noting that Lima Barreto was one of the first black Brazilian men to have written about the reality of a psychiatric hospital in the country, as a patient, during his own hospitalization. It cannot be categorically stated that his racial and asylum experiences led him to the mishaps he encountered in life; however, such mishaps are added to a set of analyzes that the author himself produced, in his works, about life in Brazil at the beginning of the 20th century. In these, he evidences the existence of an oppressive system before the population that is metaphorized in the expression of what should be “care” for “alienated” or “crazy” people, but which ends up revealing itself as something extremely humiliating – especially when directed to black people. Therefore, far from proposing definitive conclusions, we seek to provoke which places were reserved for the national psychological/psychiatric thought of the time in the selected work of Lima Barreto, so that this research can, then, guide the analysis of our professional practices in Mental Health today, avoiding the repetition of mistakes of the past and provoking the production of practices in Mental Health that propose, effectively, anti-asylum and anti-racist positions.

In the scope of health policies, judicialization has been revealed as a search for the guarantee of access to goods and services through lawsuits, assuming a fundamental role in moderation and decision-making on health issues. This phenomenon has been taking great proportions in Brazil since the mid-1990s and has motivated numerous studies in the country, especially in access to medicines. This study aims to analyze the evolution of lawsuits filed against the Department of Health of the State of Bahia regarding access to medicines, from 2007 to 2016. And, as specific objectives, describe the sociodemographic characteristics of the authors of the lawsuits filed against the Secretariat of Health of the State of Bahia, regarding access to medicines and corresponding to the period 2007 to 2016; characterize the lawsuits filed against the Health Secretariat of the State of Bahia regarding access to medicines, regarding procedural, medical-health and political-administrative elements corresponding to the period 2007 to 2016; and discuss possible relations between the lawsuits filed against the Health Secretariat of the State of Bahia and the incorporation of medicines by the Unified Health System-Bahia in the view of managers of pharmaceutical services of the Health Secretariat of the State of Bahia. The research consisted of conducting a case study, focusing on the analysis of lawsuits filed against the Bahia Department of Health for the supply of medicines between 2007 and 2016, Using as data production strategies the transcription of the information present in the judicial processes and interviews with informants that could reveal the existence or not of any influence of lawsuits on the decisions to incorporate medicines. It was found in this study that almost 95% of the actions were individual, that the granting of injunction or anticipation of guardianship occurred in 71.08% of the actions and that the Public Defender was the legal representative responsible for most of the actions (45.4%). The delivery of the drug was one to five days in more than half of the processes (53.3%), with demand for only one drug by the vast majority of the plaintiffs. We identified only 15 (2.7%) actions with off-label use of medicines and mostly medicines that are not part of the official lists. About 227 (45.6%) prescriptions were issued by physicians not linked to the Unified Health System with 57.6% containing additional documents. In the interviews, most managers say that the large number of lawsuits has influenced decision-making regarding the incorporation of the Unified Health System, and some cite that the judicialization of health can contribute to the resolution of individual problems, but not of the collective. Given the results presented, it is concluded that the judicial way has been consolidated as an alternative way of access to medicines in the Unified Health System-Bahia, despite the executive and judicial powers seek strategies to mitigate this phenomenon.

Studies have proven that race, gender and social class are articulated, producing different experiences for men and women. Sickle cell disease (DF) is a chronic condition that marks the lives of black women with the disease and points out the intersectionality of race, gender and social class. It is assumed that being black and, especially with a chronic disease, contributes to the difficulty of these women in the Brazilian context by establishing themselves as active subjects and accessing health services in search of care. We sought to understand the life trajectories of black women with sickle cell disease and the meanings they attribute to the impacts of the disease in different areas of their lives, in addition to the processes in search of care. To understand these experiences, it is necessary to apply an intersectional analysis when looking at their life trajectories. This research analyzed the life trajectory of black women with sickle cell disease and got to know the experiences that these women have in their daily lives and their perceptions about living with DF. A descriptive / exploratory study with a qualitative approach was developed, based on the life stories of black women with DF living in Salvador and the metropolitan region. Ten black women with the disease collaborated with the research, of which eight have sickle cell disease type HbSS, known as sickle cell anemia and two with sickle cell disease type HbSC, with ages varying between 25 and 54 years old. All of them come from low-income families. The interviews were conducted between the months of December 2019 and July 2020. The feminist and anti-racist perspective was the basis for the development of this research. Racism is expressed in different forms in the life of the black population. Sickle cell disease profoundly marks the lives of people affected by the disease, as they prevent socializing and socialization processes from being fully experienced, these elements were considered when black women with SCD referred to the marks of the disease that made it impossible in social interactions. These women seek to transform the social role they were given, that of a black woman with a DF full of stigmas, stereotypes and restraint. We also identified in this study that black women with SCD report a dynamic in the health service that disregards their social and cultural conditions and disqualifies their experiences. It is concluded that it is necessary to recognize black women with sickle cell disease as active subjects, as this recognition opens space for shared care and a better quality of life for them. The interlocutors proved to be able to manage their own bodies, establishing the limits and possibilities promoting self-care. Even with all the difficulties that the symptoms of the disease had, these women developed strategies that allowed them to proceed with their plans, giving an account of what had been elaborated in their subjective constructions.

The relations between health policies, Parliament and media have been little explored in research carried out in Brazil in the area of Public Health. This investigation has as objectiveto analyze the media coverage of the role of the Legislative in issues related to health policies. To this end, a case study of the Folha de S. Paulo portal was carried out, from 2015 to 2017, adopting elements of the expanded theory of the State, by Antonio Gramsci, and reflections on the concepts of public sphere and public opinion,by Jürgen Habermas, as a theoretical reference, as well as the places occupied by the media in this discussion board. The analysis of legislative documents in the Brazilian Parliament and news about parliamentary activity points out which topics are more visible–with emphasis on financing, health policies, health plans and health surveillance–and less visiblein the newspaper and in the National Congress, among them AIDS, indigenous health, LGBT, generic drugs and the black population. The study also discusses possible factors associated with the phenomenon, such as the alignment between the newspaper and the government's neoliberal economic agenda, allowing the understanding of which proposals related to health policies become news.

Communities distanced from health care, education, culture and leisure services are more vulnerable to the occurrence of socio-environmental problems, with damage to the environment and these population groups. Human leptospirosis is a potentially lethal disease whose social and economic impact on the Brazilian population is underestimated. A health problem neglected by the processes that produce programmatic invisibilities of this disease. Given this reality, this study has the general objective of analyzing the process of producing negligence in relation to urban leptospirosis, considering the perceptions and performance of primary health care professionals in a popular neighborhood of Salvador / BA. This is a qualitative study, with semi-structured interviews with health professionals, of different categories, a focus group with community health agents and participant observation in the daily work of health, with records in the field diary. Data analysis, guided by interpretive anthropology, sought to identify the structures of meanings inscribed in the social discourse expressed in the narratives produced by health professionals and / or in their concrete practices in relation to the issues of urban leptospirosis and the territory in question. The results point to leptospirosis as a disease of poverty, marked by invisibility in multiple aspects: the problem itself, its social determinants and its effects on affected communities and people. Such invisibility contributes to the inaction of the health professionals who work there, which is a result of gaps in the training processes (past and continuous in the professional field) about the disease in its broad socio-environmental context. The absence of intersectoral actions coupled with clinical underdiagnosis, underreporting and neglect with the affected population, is the basis for segregation, marginalization and disparagement. Finally, we highlight that the neglect process causes urban leptospirosis to persist in territories and among marginalized social groups, reflecting the systematic absence of public housing, environmental, health and education policies for the most vulnerable classes in the country's history, being one of the expressions of socio-spatial inequalities in our society. Broader approaches for detecting early diagnosis are also considered necessary and urgent, and should be part of PHC, so that actions can be taken to promote the early detection of the disease and reduce the lethality observed in the country. 

There is a growing demand for urgent and emergency services, which often does not correspond to the urgency character. On the other hand, the APS is singled out for remaining focused on preferentially “preventive and programmatic” actions, to the detriment of welcoming and attending to citizens affected by low-complexity acute conditions. In Brazil, 24-hour Emergency Care Units (UPA) had a great expansion from the year 2008, and despite the emphasis on the assistance and emergency services, it was formulated with the legal mission of composing a care complex linked to primary care. However, some evidence points to an informal and fragmented relationship between the "APS" and the UPA, especially in the conduct of less severe emergency care, which deserves further investigation. The objectives of the study were: To analyze the organizational dynamics established in the relationship between the Primary Health Care (APS) and 24-hour Emergency Care (UPA) units in the city of Petrolina-PE; Identify assistance flows and existing integration mechanisms between APS and UPA services; Analyze the attributions and competences of the APS and UPA in situations of low urgency; Characterize the determining factors in the choices of users between the search for emergency services and APS. This is a unique case study in a municipality of the Interstate Health Network of the Middle São Francisco Valley (PEBA Network), Northeastern Brazil. The primary sources of evidence were the information recorded in the researcher's field diary, data obtained through semi-structured interviews with professionals, managers and users of the 24h UPA and APS and, as secondary sources, documents from the State and Municipal Health and UPA. The information was processed with the help of the NVIVO software. Four dimensions of integration were adopted as categories of analysis based on the concept of 'integrated health system' proposed by Contandriopoulos: Clinical integration; Functional Integration; Systemic Integration and Normative Integration. The evidence produced indicates low integration between APS and UPA in the different dimensions studied. From the more operational elements, predominantly described in functional integration, to the more subjective elements, referred to in normative integration, they point out gaps for the effective integration between services. Furthermore, there is a mismatch between the profile of care related to low severity emergencies provided by the two levels of care and the “ideal view” of professionals and managers regarding what this care should be. In the UPA, mostly low severity situations are attended to, a service profile understood by the actors as adequate for APS. On the other hand, the ESF have limitations for exercising this function. As a result, this user profile is not prioritized in both services. Still, the UPA has just accounting for a large portion of this demand, causing the search subject in the perception that are even more unsuccessful by APS, resulting in low confidence and credibility in relation to services in primary care.

This research aims to analyze the actuality of social struggles for the right to health, focusing on the experience and point of view of traditional communities located in Ilha de Mare, Salvador, Bahia. It is observed that the limits of the realization of the right to health are presented unequally in the Brazilian population, the result of a long process of exclusion of social groups, historically neglected by the Brazilian State, in health policies. The study locates the traditional communities, inhabitants of Ilha de Maré and their socioenvironmental conditions, giving priority to the explanations of the social agents involved in the struggle for changes in the social reality. The perspective of this research is to bring to the debate of social struggles for the right to health the voices that are systematically absent from the decision-making processes that define economic and social development projects and health policies in the territories. For that, a methodology is proposed that uses ethnographic instruments to gain an in-depth understanding of the point of view of the communities of Ilha de Maré, establishing their political leaders as interlocutors of the communities, who represent collective subjects involved in social struggles. In this sense, the research focuses on the explanations of community leaders about the health situation and ways to claim the right to health. The territory and the interaction processes between shellfish gatherers and artisanal fishermen are taken as the theoretical basis for the analysis of social struggles, in the macro-structural context in which these struggles erupt. The result is the intertwining of health with territory and territoriality, with environmental justice and with recognition of the citizenship rights of traditional communities. The construction of arguments based on rationalist science is observed to give legitimacy to the health demands of these communities, demonstrating the need for Public Health to rethink its theoretical bases that contribute to the strengthening of social struggles that bring health as an object of demand and new horizons for health policies in Brazil.

By means of an exploratory descriptive time series approach, this study aims to analyze the transfer of resources from the federal government to the Primary Health Care (PHC) accounts of the municipalities of the state of Bahia. Specifically, it will characterize the fixed and variable components of the Basic Attention Floor (PAB), according to population size, during the period of implementation of the SUS financing blocks (2008 to 2017). The study used data available on the National Health Fund website, stratified into four groups of municipalities according to population size, based on the population of the 2010 Census. Absolute (n) and relative (%) frequencies of financial volume and per capita value were calculated, as well as a central tendency measure. For the purpose of comparing the financial data across the years of interest, monetary restatement for the last year of the study was carried out using the Broad Consumer Price Index (IPCA). The results revealed a 14.3% increase in federal funding for primary care, in real values, for municipalities in the state of Bahia, especially for small ones, which recorded a per capita variation in the PAB of R$ 124.32 inhab/year in 2008 to R$143.36 inhab/year in 2017. It is worth to mention that more than 60% of large municipalities received fixed PAB transfers per capita below the minimum values established by the legislation. It is also noteworthy that, for the fixed PAB of small municipalities, parliamentary amendments (temporary increases in the PAB) were found to be fundamental for the financing of primary care in Bahian municipalities between 2015 and 2017. The findings reinforced the significance of the variable PAB within municipal PHC accounts, especially for small and medium-sized municipalities. The predominant vertical ministerial programs within the variable PAB were the Family Health Program (PSF), the Community Health Agents (ACS) Programme, the National Program for Improving Access and Quality of Primary Care (PMAQ-AB), and the Family Health Support Units (NASF), across all the analyzed population groups. Thus, the research revealed an overall scenario of federal funding of primary care for the municipalities of Bahia with a relatively equitable perspective, given the distribution of federal resources according to population size. Further investigations are recommended to be carried out at the municipal level, as well as across the geographic regions of Brazil, to better understand the patterns of allocation of federal resources, as well as to identify whether the distribution of federal resources has contributed to the reduction of health inequalities across the Brazilian territory. Furthermore, given the change in policies related to the federal funding of primary health care, it is recommended that studies be carried out on the possible effects of the Previne Brazil Programme on the distribution of federal resources for this level of care in Brazil.

Introduction: Cardiovascular diseases (CVD) are the main causes of general and premature death in Brazil and worldwide. Harmful food environments have been identified as one of the factors associated with morbidity and mortality from CVD, as they affect people's health and nutrition conditions. Objective: To explore the association between harmful food environments and premature mortality from CVD in the Brazilian population in 2016. Methodology: Cross-sectional ecological study, with data from 5,558 Brazilian municipalities. Data on CVD mortality were obtained from the Mortality Information System (SIM) of the Ministry of Health. The study on mapping food deserts in Brazil developed by the Interministerial Chamber for Food and Nutritional Security – CAISAN was used to assess the physical dimension of the food access. Standardized rates of general premature mortality from CVD and from specific causes (CVA and AMI) were calculated for the period analyzed. To characterize the food environments, the density of establishments that sell food (in natura and ultra-processed) per 10,000 inhabitants in tertiles was used. Crude and adjusted negative binomial regression models were used to study the associations of interest. Results: After the appropriate adjustments), it was found that the municipalities in which there was little supply of fresh food had a higher risk for increased mortality in women due to stroke ([RT1st tertile 1.08 (1.01-1.15)]. On the other hand, municipalities in which there was a greater supply of ultra-processed foods presented a higher risk of death [RT2nd tertile 1.17 (1.12-1.22), RT3rd tertile 1.20 (1.14-1, 26)] by CVD; [RT2nd tertile 1.19 (1.13-1.25), RT3rd tertile 1.22 (1.15-1.30)] by stroke and [RT2nd tertile 1.19 (1.12 -1.25), RT3rd tertile 1.22 (1.13-1.29)] due to Infarction Conclusion: Our findings show an increased risk of mortality from CVD, CVA and AMI, especially in municipalities where there was greater offer of ultra-processed foods, these are of low nutritional quality and come from unsustainable food systems. Initiatives to minimize the effects of these environments are necessary and urgent in the Brazilian context.

Introduction: Externalizing behavior problems are disruptive behaviors. Among the factors that contribute to the occurrence of behavioral problems in childhood, exposure to violence stands out as an important predictor, having already been observed ways in which exposure to community violence generates instabilities and conflicts familial context. This conflicts are responsible for the increase in occurrence of violent events against the child, which are responsible for damage to child development and associated with the occurrence of externalizing behavioral changes. Objective: To understand the relationship between exposure to community violence and the occurrence of externalizing behavior problems in preschool children living in the province of Esmeraldas, district of Quinindé, Ecuador, considering the mediating effect of exposure to intrafamilial violence. Methodology: this is a cross-sectional study associated with a cohort of the ECUAVIDA project, which includes 1673 residents in Ecuador. Exposure to community violence was assessed through a questionnaire produced for the collection of cohort data; the occurrence of intrafamily violence events using the Conflict Tactics Scale - Parent-Child (CTS-PC); the occurrence of externalizing behavior problems through the Child Behavior Checklist (CBCL), version 1.5-5 years; in addition to variables related to socio-demographic information from a standardized and pre-coded questionnaire. Descriptive analysis was performed on each of the variables, later logistic regression was performed regarding the relationships between the exposure, mediation, outcome and covariate variables. Finally, structural equation modeling was performed in order to analyze the possible mediation mechanisms of physical abuse in the relationship between exposure to community violence and the occurrence of externalizing behavior problems. For all analyses, STATA 14.0 software was used. Results: It was observed that 49.55% of respondents were direct victims of community violence, 88.40% witnessed 2 or more acts and 68.74% presented intermediate or high perceptions of violence. Among the intrafamilial variables, 24.03% of the children were exposed to psychological violence, 64.32% to corporal punishment and 26.02% to physical abuse. The prevalence of externalizing behavior problems was 6.52%. Through simple logistic regression, a statistically significant association was observed with the occurrence of externalizing behavior problems, direct victimization and high levels of perception of community violence; the occurrence of psychological violence, corporal punishment and physical abuse in the intrafamilial environment; in addition to the child being male. Through mediation analysis, it was identified that the perception of violence is associated with the occurrence of externalizing behavior through the mediating role of the occurrence of physical abuse aimed at the child, with no statistically significant effect being observed in the direct action of the perception on the occurrence of behavior problems. It was also identified the way in which direct victimization is associated with the outcome through the mediating effect of the occurrence of physical abuse. In contrast, direct victimization is also associated with the occurrence of externalizing behavior problems directly. Conclusion: in both analyzed models, it was observed that community violence is associated with the occurrence of externalizing behavior problems through the mediation of intraafamilial physical abuse. Such results can contribute to the advancement of knowledge about the ways in which exposure to community violence and the experience of violent events in childhood perpetrated by the family affect children's mental health.

Introduction: The aspects related to body modification in Travestis and Transgender Women (TGW) are still little explored regarding the health impacts of this vulnerable population. Little access to health services and discrimination are data that point to social exclusion and, consequently, to the increase in morbidities that may be related to the non-prescribed use of hormones, illicit use of industrial liquid silicone (ILS) and sexually transmitted infections like syphilis and HIV. Objective: To investigate the association between body change, sexual practices and sociodemographic aspects in TGW and health risks. Methodology: This is a cross-sectional study, with 127 TGW recruited through the RDS method - Respondent Driven Sampling - or participant-directed sampling. The quantitative data came from na epidemiological survey, carried out between 2014 and 2016 in Salvador-Bahia-Brazil. Results: The data analyzed showed that 60% of the sample was less than 25 years old; that TGW make indiscriminate use of hormones in a non-prescribed manner and in high amounts, from 12 years of age. The proportion of ILS use was 31.6%, and the use of these substances is associated with sex work. In addition, a positive association was estimated between syphilis infection and unprotected receptive anal sex with clients (PR: 1.96; 95% CI = 0.85-4.53;), but without reaching statistical significance at the descriptive level p value = 0.05. Sexual practice with cis men in the six months prior to the survey also appears to be associated with syphilis infection (PR: 3.34; 95% CI = 0.77-14.40). Conclusion: The data suggest the need for investment in public health policies, which includes the reorganization of services aimed at the population of TGW, and better training of health professionals to meet these demands mentioned here.

Introduction: Cardiovascular diseases (CVD) are the main causes of death in Brazil and are closely related to living conditions, particularly affecting individuals in situations of social vulnerability. In this sense, social protection programs, such as income, food and input transfer programs, and social housing have been identified as interventions capable of reducing social and health inequities, including those associated with cardiovascular health. Evidence regarding the effects of social programs on cardiovascular health is scarce, and even more so are studies on the effects of social housing programs on CVD mortality, especially in low- and middle-income countries (LMICs). Thus, the present work had the general objective of studying the effect of social protection programs on cardiovascular health in low and middle-income countries. The central theme of this Thesis was approached through two articles and a research protocol. The article entitled “Impact of social protection policies on cardiovascular health in low-and-middle-income countries: a systematic review” corresponds to a systematic review of the effects of social protection programs on cardiovascular health in lowand- middle-income countries; the protocol corresponds to the research description, entitled “Evaluating the health effect of a Social Housing programme, Minha Casa Minha Vida, using the 100 million Brazilian Cohort: a natural experiment study protocol” to study, through a quasi-experimental study, the impact of Minha Casa Minha Vida (MCMV) program on health outcomes, using data from the 100 Million Brazilian Cohort. This protocol supported the elaboration of the third article, entitled “Effect of social housing programme, Minha Casa Minha Vida, on the risk of premature cardiovascular mortality among vulnerable and underprivileged: a population based nested case-control study”. In this, we investigate the influence of the MCMV program on CVD mortality. Methods: For the systematic review study, articles published until July 31st, 2020, in MEDLINE, Scopus, Lilacs, Web of Science and Google Scholar were considered, observing the effect of social protection programs on health behaviours (diet, physical activity and use of alcohol and tobacco), cardiometabolic risk factors (hypertension, type 2 diabetes, dyslipidemia, and excess weight) and CVD mortality. All peer-reviewed studies published between 1990 and 2020, conducted in any LMICs, that quantitatively assess the effect of any social protection policy or program on the cardiovascular health of adults were included and synthesized in tables. The review article was conducted according to the reference document Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). For the protocol, a quasi-experimental study was designed, from 2007 to 2015, after linking the cohort data with the base data of the MCMV program (2009-2015), and of CVD mortality (2007-2015), leprosy (2007-2015) and tuberculosis records (2007–2015). The exposed population was defined as individuals who signed the contract to receive the MCMV social benefit, and the unexposed group included comparable individuals within the cohort who did not sign a contract to receive social housing. The impact of MCMV on health outcomes will be estimated using different propensity score approaches to control observed confounders. Individuals will be followed up until the occurrence of the specific outcome, date of death or end of follow-up (December 31st , 2015). The analyzes will be stratified by follow-up time, age group, race/ethnicity, gender and socioeconomic status. The protocol was developed according to the guidelines suggested bythe Template for Intervention Description and Replication for Population Health and Policy (TIDieR-PHP). For the empirical article of the Thesis, premature death from CVD was the only outcome studied. Also, we opted for a case-control study design paired and nested with the Cohort, with 102,882 individuals aged 30-69 years. The cases, premature deaths due to CVD, were defined considering the date of occurrence of death and paired with two controls, selected at random and without replacement in the period of death`s occurrence. Variables such as age, sex, race, education, region and receipt of Bolsa Família programme were used to match cases and controls. Receiving social housing from the MCMV program was the main exposure of the study. This was defined, considering the date of signature of the new housing contract, being necessary to be before the date of death. Conditional logistic regression models, adjusted for household characteristics and the size of the municipality, were used to model the odds ratio for premature CVD mortality. Sensitivity analyzes considering Only individuals residing in municipalities with a high Human Development Index (HDI) were performed. Results: For the systematic review article, 34 studies were included, distributed in 15 low and middle-income countries. In twenty-two studies, results on health behaviours (61.8%), 12 on cardiometabolic risk factors (35.3%) and one on CVD mortality (2.9%) were identified. Results point out that social protection programs are associated with a healthy diet (N = 17/26, 65.3%), increased physical activity (N = 2/2, 100%), lower prevalence of hypertension (N = 2/3, 66, 6%) and type 2 diabetes (N = 1, 100%). These programs were associated with excess body weight (N = 8/11, 72.7%), especially among beneficiaries of unconditional food transfer programs. We found no association between social protection programs and the use of tobacco and alcohol (N = 4/7, 57.1%) or mortality from CVD (N = 1, 100%). Regarding the empirical article, the results showed that during the follow-up period (2010-2015), 34,294 cases of premature deaths from CVD were registered in the Cohort of 100 Million Brazilians, with a median age of 58 years (50- 63), who were paired with 68,588 controls, with a median age of 55 years (50-61). Most cases (59.72%) and controls (57.14%) are from large municipalities, with more than one hundred thousand inhabitants. However, those who died from CVD (cases) had higher proportions of inadequate access to water supply (9.02 vs 8.77%) and households without electricity or meter (7.21% vs 6.11%), When compared to the control group. Beneficiaries of social housing had a higher risk of premature death from CVD compared to non-beneficiaries of the social program, after adjusting the models for family housing conditions and the size of the municipality (OR = 1.18; 95% CI = 1.07- 1.30). The same pattern of association remained after analyzing the cases and controls residing in municipalities with a high HDI (ORaj = 1.16; 95% CI = 1.03-1.30). Conclusion: Social protection programs have a positive influence on improving the quality and diversity of the diet. However, they were associated with an increase in the prevalence of overweight, especially among beneficiaries of non-conditional food transfer programs. Limited evidence on its effects on other indicators of cardiovascular health (type 2 diabetes, hypertension, physical activities and dyslipidemia) and mortality from CVD, highlight the importance of further studies on the subject. Besides, we have not found studies on the effects of housing interventions on cardiovascular outcomes, especially mortality, in low and middle-income countries, despite housing being an important social determinant of health. The results of the empirical study, unexpectedly, a greater risk of premature death was observed among beneficiaries of the MCMV program compared to non-beneficiaries. However, the findings should be interpreted with caution. The construction of an enterprise in areas devoid, in particular, of health promotion service, leisure area, healthy food and adequate public transport, combined with the loss or weakening of the support and social support networks, associated with the relocation of families in new territories may have contributed to such unfavourable results. On the other hand, some study limits need to be considered, such as the short time of exposure to the program and the beneficiaries' previous health condition (we do not have such information), which may have influenced the results. It is also argued that the PMCMV was initially designed to meet only housing demands, not addressing issues associated with the characteristics of the neighbourhood and access to housing developments. It is important to note that other analyzes are planned (see protocol), which makes the results presented here still preliminary.

Introduction: Children with Congenital Zika Syndrome (SCZ) have multiple disabilities and require continuous care, which, in a context of gender inequality, are assumed by women. According to the literature, they are fundamental in the management of therapeutic demands and experience losses in mental health and in different spheres of life. There are gaps in the characterization of this experience in the light of the International Classification of Functioning, Disability and Health (ICF) model - composed of body functions and structures, activities and participation, environmental and personal factors -, and in the analysis of the systemic influences of this phenomenon, that can be realized from the Bioecological Model and its pillars: person-context-process-time. Objective: To characterize the impact of SCZ on caregivers in the light of the ICF. Methodology: This research was carried out in three stages: (1) study of domains of the ICF, Family Impact Module, of the Pediatric Quality of Life Questionnaire (PedsQL-FIM 2.0), based on connection rules established in the literature; (2) a descriptive cross-sectional study of the disability profile of 46 caregivers of children with SCZ, participants in the Family Together Intervention Program, which was carried out in the years 2017 and 2018 in the states of Bahia and Rio de Janeiro, based on the domains the PedsQL-FIM 2.0 CIF; (3) qualitative study carried out, based on the content analysis of thirteen caregiver interviews, to characterize their functionality ecosystem in the context of SCZ. Results: (1) In the PedsQL-FIM 2.0, 39 main contents and 13 additional ones related to the ICF were identified, most of which were related to mental functions; (2) In the profile analysis, the biggest losses were seen in the ‘emotional functions’ and ‘energy and impulses’, in the performance of ‘housework’ and ‘decision making’. ‘Attitudes’ have been identified as a major barrier. The partial score of ‘activities and participation’ portrayed worse performance and, in the bivariate analysis, lower scores on the total score were related to worse assessment of the standard of living (of caregivers and children) and lower education. (3) The analysis of the interviews in the light of the ICF and the Bioecological Model revealed impacts on the mental functions, self-care and knowledge and concepts of the caregivers. In addition to a set of proximal (home environment and health services) and distal systems (gender and capacitist social norms and ideologies and insufficient systems and public policies) that were connected to different components of functionality, revealing that the losses experienced by women in that role they extrapolate the individual dimension. Conclusion: The evidence suggests the urgency of structuring policies related to care, to protect those who care and redistribute this work, as well as to cope with attitudinal barriers and access to services. Furthermore, it reinforces the need to overcome the focus on morbidity psychiatric of this public, with incorporation of socio-structural aspects related to care within the scope of the clinic and research.

The study aimed to evaluate the evolution, results and efficiency of Primary Health Care in Brazil. The analysis of evolution considered elements of organization and structure, service provision and results of primary care in Brazilian municipalities between 2002 and 2019. Negative binomial regressions of panel data with fixed effect were used to investigate the effect of the population size of municipalities on the said elements. It was found that municipalities with smaller population size had higher per capita expenditure, coverage and provision of services. Municipalities with a larger population had a lower morbidity and mortality due to conditions sensitive to primary care. Based on these results, the association of socioeconomic, demographic and municipal health system structure factors with morbidity and mortality due to PHC-sensitive conditions in Brazil was investigated. For this purpose, negative binomial regressions of panel data with fixed effect were performed. The results indicated that users who lived in cities with worse socioeconomic conditions had a higher risk of dying and especially of being hospitalized for conditions sensitive to primary care. Greater access to computed tomography and ultrasound examinations also contributed to reducing the risk of death or hospitalization for the same conditions. Still on the health outcomes of users and the population, the impact of elements of the organization, structure and provision of primary care services with morbidity and mortality due to conditions sensitive to primary care was investigated. To this end, negative binomial regressions of panel data with a fixed effect were also performed, controlled by socioeconomic factors, population size and the structure of municipal health systems. Users who lived in municipalities with greater coverage or provision of services had a lower risk of death and hospitalization for conditions sensitive to primary care. Per capita expenditure was not associated with mortality, but acted to reduce the risk of hospitalizations. The effect of organization, structure, and service provision was stronger on admissions than on mortality. Finally, the efficiency of processes and results of primary care in Brazilian municipalities between 2008 and 2019 was evaluated using the Data Envelopment Analysis technique based on slacks, with product orientation and variable returns to scale. To analyze the environmental and non-discretionary factors that were related to efficiency, a second-stage data envelopment analysis was performed using a truncated bootstrap regression. The average efficiency of the municipalities was 66% and 50% for processes and results, respectively. That is, with the same levels of per capita expenditure and number of teams per 3,450 inhabitants, it would be possible to expand the provision of services and reduce deaths and hospitalizations, by reducing the inefficiency of the primary attention. Municipalities with smaller population size were more efficient in processes, showing, on average, a higher productivity per team in the researched period. Municipalities with worse socioeconomic conditions were more efficient in processes and less efficient in results. The presence of tomographs, ultrasound devices and a greater number of medical appointments in specialized care per inhabitant contributed to increase the efficiency of the results. Greater financial investment in health with the municipalities' own resources was also associated with an increase in the efficiency of results. The findings of this thesis reinforce the hypothesis that the context in which each municipality is inserted impacts its efficiency, therefore the actors involved with the organization and planning of primary care must take these aspects into account, strengthening equity in decision-making, seeking , finally, to reduce the inefficiency of primary health care in Brazilian municipalities.

Metabolic Syndrome (MS) is a complex disorder characterized by the co-occurrence of metabolic abnormalities, which has outstanding importance from an epidemiological point of view due to its high prevalence and the evidence of its association with cardiovascular diseases (CVD) and type 2 diabetes mellitus (DM2) . The most recent criterion proposed for MS diagnosis establishes the presence of at least three of the following components: abdominal obesity, hyperglycemia, hypertriglyceridemia, low levels of HDL cholesterol and high systemic blood pressure. Sex-gender differences in the expression of MS have been reported in the literature. In several studies, there is evidence that women, especially after the age of 50, are more susceptible to developing the syndrome and its associated comorbidities. The most common approach in quantitative research with MS establishes the identification of cases considering a dichotom (presence/absence). Alternatively, MS can be considered as a heterogeneous entity, with variation in grouping of its components. Thus, an interesting approach seeks to characterize MS as a construct (unobserved variable), identifying, empirically, the patterns of its occurrence based on the analysis of the response profiles of its components. This approach uses multivariate statistical methods, including Latent Class Models (LCMs), which have recently been used in MS research. The present study expands knowledge about the MS occurrence among Brazilian women, identifying distinct latent patterns of this disorder in participants of the first two waves of the Longitudinal Study of Adult Health (ELSA-Brasil). For the analyses, different LCMs were used, namely: Latent Class Analysis, Latent Class Analysis with Repeated Measures, Latent Transition Analysis and Latent Class Analysis with Distal Outcomes. At the baseline of ELSA-Brasil, MS patterns were discriminated and the effects of sociodemographic characteristics and menopause status were examined. Using longitudinal latent approaches, trajectories and transition profiles for MS were evaluated using data from the two first waves of the study. The risk for the development of type 2 diabetes mellitus was estimated according different patterns of MS. Initially, three distinct patterns of MS were identified for the women in the study. using baseline data from ELSA-Brasil. Longitudinal analysis mainly revealed trajectories of permanence in MS patterns. Individual characteristics, such as elementary or secondary schooling level, and insufficient leisure-time physical activity, increased the chance to non-changing patterns over time, especially for those patterns of greater metabolic expression. After 4 years of follow-up, the transition from lower to higher health risk patterns was more likely than the reverse transition. The risk of developing DM2 differs according to MS patterns, confirming the relevance of considering the heterogeneous expression of the syndrome. Particularly, we found high prevalence and risk for developing DM2 among the women characterized by the joint occurrence of abdominal obesity, hyperglycemia and high blood pressure. Additionally, the analyzes suggest that abdominal obesity is the main initial abnormality in triggering the syndrome in this population. The results of this study can contribute to guide public policies for the prevention and reduction of MS and ensuing diseases in Brazilian women.

Backgroud: Although efforts have been made in the last 20 years, maternal mortality is still an important public health problem. Extremes of health care coexist, with the persistence of inequalities in access to health care and the excessive medicalization of delivery and the increase in caesarean sections and invasive interventions. Caesarean can save lives of the mothers and the newborns when needed, but studies have been showed that this mode of delivery can also expose women to an increased risk of morbidity and mortality. Alleviating poverty, promoting health education practices and investing in quality services are considered priorities actions for reducing maternal deaths. The Bolsa Família Programme (BFP), a conditional cash transfer programme (CCT), has impacted on improving social determinants and expanding access to healthcare for the Brazilian population. There are references in the literature about positive impacts of CCT on maternal health and its determinants, but the effect of the BFP on maternal mortality has not yet been investigated in Brazil. Overall objective: Evaluate the effect of health and social protection interventions on maternal mortality among low-income women in Brazil. Specific objectives: i) To assess the médium and long-term association between the coverage of the Bolsa Família Programme and the Maternal Mortality Ratio in Brazilian municipalities; ii) Assess the impact of the Bolsa Família Programme on maternal mortality, in the cohort of 100 million Brazilians; iii) To investigate the association between caesarean section and maternal mortality, according to Robson's classification, in the poor and extremely poor women in Brazil. Methods: The thesis was presented in 3 articles according to each specific objective. For the first objective, we conducted an ecological longitudinal design and used all 2,548 Brazilian municipalities with vital statistics of adequate quality during the period 2004–14. BFP municipal coverage was classified in four levels, from low to consolidated, and its duration effects were measured using the average municipal coverage of previous years. We used negative binomial multivariable regression models with fixed-effects specifications, adjusted for all relevant demographic, socioeconomic, and healthcare variables. For the second objective, we conducted a longitudinal population-based study of women of reproductive age (10-49 years old) who had at least one live birth, using data from Brazilian National Health and administrative databases linked to the 100 Million Brazilian Cohort for the period 2004 to 2015. We utilized propensity score kernel weighting to control for socio-demographic and economic confounders in the association between BFP receipt and overall maternal mortality, stratified by different subgroups. We also analysed the effect of the time of BFP receipt. For the third objective, we conducted a population-based cohort study in Brazil by linking routine data, departing from 100 million Brazilian Cohort between 2011 and 2015, Brazilian Live Birth Information System (SINASC) and Mortality Information System (SIM). Women with at least one live birth were classified into one of ten Robson groups based on pregnancy and delivery characteristics. We used propensity scores to match CD with vaginal deliveries (1:1) and prelabour CD with unscheduled CD (1:1) and estimated associations with maternal mortality using Cox regression. We also conducted analyzes with deaths more related to CS and excluding deaths that suggest prenatal morbidities. Results for the first objective: BFP was significantly associated with reductions of maternal mortality proportionally to its levels of coverage and years of implementation, with a Rate Ratio (RR) reaching 0.88(95%CI:0.81- 0.95), 0.84(0.75-0.96) and 0.83(0.71-0.99) for intermediate, high and consolidated BFP coverage over the previous 11 years. The BFP duration effect was stronger among Young (<30 years) mothers (RR 0.77;95%CI:0.67-0.96). BFP was also associated with reductions in the proportion of pregnant women with no prenatal visits (RR 0.73;95%CI:0.69-0.77), reductions in hospital case-fatality rate for delivery (RR 0.78;95%CI:0.66-0.94), and increases in the proportion of deliveries in hospital (RR 1.05;95%CI:1.04-1.07). Results for the second objective: We included 6,677,273 women aged between 10 and 49, 4,056 of whom had died from a maternal-related cause. BFP beneficiaries had an 18% lower risk of maternal death (ORadj: 0.82, 95%CI=0.73-0.96). Increased BFP exposure (1 to 4, 5-9 or ≥9 years) was associated with a higher reduction of maternal deaths (OR: 0.85; 95%CI: 0.75-0.97; OR:0.70;95%CI:0.60-0.82,OR: 0.69 95%CI:0.53-0.88, respectively). The BFP also has led to substantial increases in prenatal appointments and inter-birth intervals, and had the greatest impact on the most vulnerable groups. Results for the thrid objective: 5,239,086 women were analysed. After propensity score matching, CS were associated with an increasing risk of maternal mortality, even in groups with low expected rates of caesarean: Overall (HR= 1.95 IC95% 1.77-2.15); Robson 1-4 (HR= 1.99 IC95% 1.63-2.43), Robson 6-10 (HR= 2.69 IC95% 2.29-3.16). There was no statistically significant difference in mortality risk in groups 5 (HR= 1.02 IC95% 0.74-1.42). The mortality risk was markedly lower excluding causes attributed to antenatal morbidities and substantially higher for thromboembolism death, which reinforces the control for indication bias and suggests the independent risk of these mode of delivery for maternal mortality. Conclusions: Our results showed that the PBF has a role in reducing maternal mortality, both at the municipal coverage level and among the poorest Brazilian women, and these associations remained strong even after adjusting for health care, pregnancy and childbirth characteristics. Increasing the exposure time, the greater the effect of the PBF, suggesting that the sustainability of social protection actions have an effect throughout the life of the beneficiaries. The BFP has also led to substantial increases in antenatal visits and the interval between births, with a greater contribution to more vulnerable women. These findings highlight the possible long-term effect of PTCRs and their potential value in reducing maternal mortality. Regarding the evaluation of caesarean section, the present study suggests that the excessive use of caesarean section may be a risk factor for maternal mortality compared to vaginal delivery. Maternal mortality remains high in lowincome countries, and the route of delivery is one of the main modifiable risk factors for maternal death among several global initiatives aimed at reducing it. Our results reinforce the importance of better monitoring and management of cesarean sections, optimizing interventions and increasing the allocation of resources to the women most in need. Furthermore, social policies must be improved and extended to the greatest possible number of families in poverty, as social development is a fundamental priority to reduce maternal mortality among low-income women.

Substance use disorders (SUD) are among the leading causes and risk factors for the burden of disease and disability worldwide, with a growing impact in the population aged 10 - 24 years. In Brazil, from the 2000s onwards, health care for people with substance use disorders was included in the mental health policy, starting to prioritize the provision of care in community-based services and social reintegration, articulating it in a network of services that replaced the classic psychiatric model. However, the care of children and adolescents with substance use disorders remains a critical point of psychosocial care. This thesis aimed to analyze the evolution and effects of the coverage of Psychosocial Care Centers (CAPS) on hospitalizations of adolescents and young people for substance use disorders in Brazil, being constructed in the format of three articles. Articles 1 and 2 consisted of the description and analysis of hospitalizations and coverage by CAPS, respectively, performing temporal trend analysis, seeking to identify possible joinpoints and estimate percentage changes, using the joinpoint regression. In article 1, it was found that hospitalizations for SUD accounted for 35.1% of hospitalizations for all Mental and Behavioral Disorders (MBD) in the period, with the highest frequency of records of male individuals (80.2 %), people between 19 and 24 years (61.5%) and race/skin color White (41.0%). Polydrug use disorders were the main cause of hospitalization (60.3%) and most occurred in Psychiatric Hospitals (64.1%). The national hospitalization rate was 32.2/100,000 in 2006 and 34.0/ 100,000 in 2018, with an Average Annual Percent Change (AAPC) of 0.2% (95%CI = -2.0; 2.5). There was an average annual reduction of 4.6% (95%CI = -8.7; -0.4) in hospitalization rates for alcohol use disorder and stability for the other drugs, an average annual increase of 7.5% (95%CI = 5.9; 9.2) in hospitalization rates in General Hospitals and a reduction of 3.1% (95%CI = -5.3; -0.7) in Psychiatric Hospitals. Article 2 indicated an expansion of CAPS among Brazilian municipalities, with unequal implementation among federative units and geographic regions. The type I CAPS were the most frequent in 2018 (48.9%), while CAPS with 24-hour operation remained incipient, with the CAPS III corresponding to 4.5% and the CAPS ADIII 4.1%. The national coverage showed an average annual increase of 7.4% (95%CI = 6.5; 8.5), with all regions showing positive and statistically significant mean variations, with changes in trends or a decrease in the magnitude of growth in coverage in the final years of the period. The article 3 applied negative binomial regression model with panel data. Municipalities showing Adequate coverage and presence of 24-hour CAPS reduced by 19% (95%CI = 0.76; 0.86) the rates of hospitalization for SUD. For all MBD, there was a reduction of 3% (95%CI = 0.95; 0.99) in municipalities with Adequate coverage and without 24-hour CAPS, increasing to 23% (95%CI = 0.74; 0.80) with this CAPS. The findings suggest that the implementation of 24-hour CAPS contributes to the reduction of psychiatric hospitalizations among adolescents and young people in Brazil, reaffirming the importance of these services to overcome the asylum/ classic psychiatric model and improve mental health care for children and adolescents.

The organization of regional and integrated healthcare delivery systems has been used as a strategy for optimizing resources and improving efficiency and effectiveness in the provision of health services. The care networks are based on the construction of health territories that go beyond municipal boundaries and require intergovernmental articulation strategies. In turn, arrangements in the provision and management of health services have been diversified, with different configurations between the public and private sectors. The management of the network, therefore, demands articulations of a political nature. A political analysis of the regional management of a health care network was carried out, with regard to the analysis of decision-making processes on the implementation of the oncology network in the Southwest Health Macroregion of the State of Bahia. This is a case study based on Bourdieu's reflexive sociology, which combined semi-structured interviews, document analysis and systematic observation of the meetings of the CIR and the Southwest Macroregional Committee on Chronic Diseases and analysis of secondary data. Empirical data were analyzed from the triangulation of collection techniques compared to the theoretical framework of the study. Medium and high complexity care in oncology in the Southwest Macroregion has the service of two UNACONs, one public and the other private, located in the polo municipality; an oncology specialty outpatient clinic that serves only two of the five health regions; and three Regional Health Polyclinics. Regional management was constituted as an interfield space formed by bureaucratic, political and economic fields, the latter represented by the private sector associated with the SUS. The management of the network took place, partially, in the formally established deliberative spaces, especially in the CIR of the Southwest Health Region and in the Committee. However, the decision-making process was also defined by unilateral deliberations of the executive power of the polo municipality, through party-political criteria, disregarding collective decisions agreed upon in deliberative spaces, which highlights the fragility of the CIR. The main issues at stake were disputes over financial resources, which accentuated conflicts between managers, the bureaucratic field and the private sector. The existence of different management models for service providers intensified the challenges of building an integrated network. Decision-making processes favored the participation of federated managers and service providers, with an absence of civil society, health professionals and little participation in social control, leading to a management restricted to the bureaucratic structures of the State. Decisions were mainly determined by agents in the bureaucratic field who accumulated greater sanitary and bureaucratic capital and by the influence of the economic field through the use of social capital by the private sector. These were the most determining capitals and conferred greater articulation power to agents in the period analyzed. The dominant point of view regarding the organization of the oncology network was based on the flexibility of SUS guidelines, through arrangements with the private sector as a way to guarantee user access to the care network. Although some agents with high health capital defended an integral and equitable oncology network, this point of view was weakened in favor of the logic of accommodating market interests. Evidence indicates that the bureaucratic field has reproduced the historical model of traditional Public Health.

Introduction: Leptospirosis is a neglected and multifactorial disease that mainly affects populations in socialy vulnerable contexts. There are no studies that have been conducted to establish an association between knowledge, attitudes and practices (KAP) with Leptospira transmission among residents of low-income urban communities. Thus, it is necessary to understand if these dimensions impact the risk of transmission to support urban leptospirosis prevention interventions. Objective: To analyze the dimensions of KAP associated with Leptospira transmission among residents of an urban community of Salvador-Bahia. Methodology: A community-based cross-sectional study was conducted with 248 community resident participants from Marechal Rondon, conducted from April to June 2019 and using a validated questionnaire. Analyzes were performed to characterize the KAP of participants and to verify its association with the presence of antibodies against Leptospira by the chi-square test and subsequent logistic regression analysis. Results: A total of 157 (63.3%) female participants and 91 (36.7%) male participants, most aged> 40 years were interviewed. Serological evidence of previous Leptospira infection was found to be 11.7% in the study population. Majority of the participants had satisfactory levels of knowledge 203 (82.5%), attitudes 238 (96.0%) and prevention practices 244 (98.4%) on leptospirosis. Poor knowledge (OR: 3.8, IC95%:1.47 – 9.68) and unsatisfactory prevention practices (OR: 22.4, IC95%: 2.22 – 225.40) were independently associated with the presence of antibodies against Leptospira in a model that also maintained the variables age> 40 years (OR: 4.9, IC95%:1.68 – 14.08) and contact with sewage in the last year (OR: 2.6, IC95%:1.02 – 6.63). Conclusion: Majority of the participants had satisfactory knowledge, attitudes and prevention practices on leptospirosis, and unsatisfactory knowledge and prevention practices were associated with a higher risk of infection. Our findings suggest that future leptospirosis prevention and control actions should prioritize two types of interventions. Interventions should address, the deficiencies of knowledge about the etiological agent, modes of transmission, signs and symptoms, complications and prevention practices of leptospirosis, targeting the most exposed groups through participatory health education actions, aimed at community empowerment and should be consistent with the local reality. Targeted interventions should aim to reduce problems of poor community infrastructure that limits appropriate prevention practices.

Introduction. Scorpionism is scorpion poisoning. Fatal outcomes of scorpionism is associated to scorpion taxon, patient's younger age, late arrival to the health service, and the quality of serotherapeutic treatment. Objective. This study sought to identify risk factors for fatal scorpionism in Brazilian children. Methods. A case-control study with cases of scorpionism (ICD X-22) notified to the Disease Notification Information System (SINAN) in Brazil, from January 1, 2007 to July 18, 2016, of children up to 10 years of age. The cases corresponded to all deaths due to scorpionism that occurred in the period; the controls were randomly selected from those that did not died, in proportion of four controls for each case. The predictors investigated were: sex, age, ethnic group, area of occurrence, time elapsed between the accident and the arrival to the health service, unit of care and serotherapeutic treatment (variable that combined whether the type of serum was adequate or inadequate with the number of ampoules used). Only cases and controls with complete sets of information for all variables investigated were included. Factors associated with fatal scorpionism were identified by bivariate and multivariate logistic regression techniques, using the STATA 12.0 statistical program. Results. We investigated 254 cases of fatal scorpionism and 1,083 controls. After adjusting the final model, the risk factors for fatal scorpionism in children were: age ≤5 years (OR = 1.6), occurrence in non-urban area (OR = 2.0), time between the accident and the arrival to the health service ≥3 hours ( OR = 3.0), serotherapeutic treatment with adequate serum and excessive number of ampoules (OR = 2.2), adequate serum and insufficient number of ampoules (OR = 6.9), inadequate serum (OR = 5.7) and no use of serum (OR = 5.3). Serotherapy was not used in 9.4% of the 254 patients who died. The effectiveness of serotherapy treatment in preventing death was 70.0%, increasing to 77.0% when the patient arrived to the health service less than 3 hours since the scorpion sting. The effectiveness of the treatment was 66.0% in patients aged 0 to 2 years, 67.0% in those aged 3 to 5 years, 74.0% in those aged 6 to 8 years and 75.0% in those aged 9 to 10 years. Conclusion. Fatal scorpionism in children was associated with risk factors that reveal problems in accessing the health service, such as occurrence in non-urban area, late arrival to the health service after scorpion sting, low quality of serotherapeutic treatment provided and child's younger age. The effectiveness of serotherapy treatment was higher in older children and among those who arrived early to the health service.

Introduction: Until a recent past, TB was considered a lower priority disease as a public health problem among children and adolescents, but recent data have shown an increase in TB morbidity and mortality in this population group. Objective: to analyze the pattern of TB incidence distribution in children under 15 years and its relationship with the quality of health care services offered, in the municipalities that participated in the PMAQ during the period from 2012 to 2014. Method: spatial ecological study of population-based, having as unit of analysis Brazilian municipalities that participated in the II PMAQ-AB evaluation cycle and that notified at least one new case of TB in children under 15 in SINAN. Data from SINAN, PMAQ-AB, IBGE and SIAB were used to build quality indicators for TB prevention and/or detection actions. Exploratory spatial analysis of thematic maps was carried out to identify patterns of TB incidence distribution. For spatial autocorrelation analysis, the Moran Global Index was used. Moran's Local Spatial Autocorrelation Index was used to identify clusters, with a significance level of 0.05. To evaluate the association between the quality of the health care actions offered and the TB incidence rates, the bivariate and multivariate SEM (Spatial Error Models) model was used. Results: 1074 municipalities participated in the II PMAQ-AB evaluation cycle. The Northeast region had the highest proportion (41%) and the Midwest region the lowest (8.2%). 7344 cases of TB in children under 15 were reported in these municipalities, with an average annual rate of 7.8/100 thousand inhabitants. The Southeast region had the highest proportion of cases (41.4%) and the Midwest the smallest (6.1%). Spatial autocorrelation (p<0.001) was observed between TB incidence rates in neighboring municipalities in Brazil. The Northeast, Southeast and South regions presented local autocorrelation (LISA) with a greater number of High-High areas and the Southeast and South regions presented a greater number of Low-Low areas. A positive association was observed between the spatial variation in TB incidence rates and the following variables: FHS coverage (β = 1.53; p = 0.000), request for chest X-ray examinations (β = 1.73; p = 0.047); conducting an active TB search (β = 3.73; p = 0.049). There was also a negative association with the performance of risk and vulnerability assessment in the reception of users (β = -5.55; p = 0.000), performance of the user's DOT (β = -5.46; p = 0.038), performance groups with a focus on advising on communicable diseases, according to the needs of the territory (β = -7.75; p = 0.052), visits to families in the area covered by AB at different intervals according to risk and vulnerability assessments (β =-1.15; p = 0.000). Conclusion: The results suggest that TB incidence rates in children under 15 years old are associated with the quality of offered health care services, highlighting the need to strengthen risk assessment, vulnerability, diagnosis and active search for new TB cases in children under 15 years old considering the possibility of TB infection or disease in all visits.

In face of the complexity that is to plan and manage the infirmary attention at SUS, which withholds problems from elevated treatment and technology costs, to an uneven distribution regarding Brazilian regions, of the health unities, the search for alternatives, done by public managers, was directly responsible for the emergence of public-private relations, as a neo-managing perspective coming from the Brazilian Administrative Reform done in 1990. Following the expansion tendency, seen at the Modelos Alternativos de Gestão Indireta - MAGI, SUS Bahia has expanded the use of such models in the implementation of the states public policy for infirmary attention, specially the use of OS and PPP. Furthermore, another alternative that was engaged by Secretaria Estadual de Saúde da Bahia (SESAB), was the public consortium, defined as an interstate administrative model, that favors public policies articulation, negotiation, coordination and implementation as a cooperative movement. Although the extensive number of studies on the subject of consortium, it is evident the existence of a gap in the knowledge over the decision process and experiences done by these public managers that would prioritize such model of infirmary managing at SUS, over other managing models. Thereby, this thesis had the goal of analyzing the decision done by interstate consortium as a model of public management for infirmaries at the SUS Bahia. This paper was developed as a case study with a qualitative approach using as reference the neo-institutionalism. The methodology was constituted by the use of primary data, in the format of an interview, and secondary data, in the format of written documents, from six people, most of these who work at the central level of the state public health management. The experimentational findings suggests that the decision process was defined solemnly by political demand and guided by actors with government bond. In other words, the use of the consortium model was decided primarily without the use of technical knowledge and without prior consulting of the technical responsible in SESAB. On the other hand, the study showed a more positive perspective over discussions on this subject, by the managing instances, over the possibility that this model shows an extensive support to a more decentralized, thus more regional, model of managing the public health. Finally, the study showed a need for further investigations on the subject, with the primary goal of comprehend the best possible model for managing public health, focusing on the well-being of the population.

State actions related to food problems have been recorded in several Latin American countries. The discussions held by the International Labor Organization (ILO) contributed to the insertion of food in the state agenda not only in Brazil, but also in other countries such as Chile, Peru and Argentina. In Brazil, the Serviço de Alimentação da Previdência Social (SAPS) was a policy instituted by the State in 1940, which had as its predecessor the Serviço Central de Alimentação (SCA), whose debates for its construction began in 1936, being implemented in 1939 and transformed into SAPS in 1940. In the transition process between SCA and SAPS, it was possible to notice changes and continuities that contributed to the expansion of the policy. Thus, based on the Bourdieusian framework, the present study sought to analyze the historical period that preceded the SAPS and, especially the SCA, from the analysis of the trajectories, positions and positions of the agents involved with the formulation and management of SAPS, seeking to break with mechanistic conceptions in the formulation of State policies. It identified that the constitution of a space on the problem of the feeding of formalized workers within the Brazilian State resulted from the convergence of the trajectories of agents with similar points of view, but with diversified interests. Thus, it was not an achievement only of agents of the State or of a single individual, but of a set of agents from the different fields that collaborated for its construction. 

Introduction - Health Information Systems (HIS) aim at the collection, processing and analysis of data of an epidemiological nature, which, once interpreted, can subsidize research and actions of public utility. Good quality epidemiological information potentiates effective decision-making processes at different levels of health care management. On the other hand, outdated, incomplete and inconsistent information can compromise administrative decisions and investments made to prevent and treat diseases. This is even more crucial in the case of Sickle Cell Disease (SCD), the most common potentially deadly genetic disorder in the world. In spite of this, both Brazil and the world lack studies on the quality of data on SCD in HIS, a rather striking and undesirable gap. For this reason, studying the quality of SCD data can contribute to improving the health conditions of those affected by the disease. Objective - To study the quality of data on morbidity and mortality due to SCD in the SIS of Bahia in the period from 2012 to 2018. Methodology - An exploratory study of an ecological-spatial type was carried out, with official secondary data from the State of Bahia, having the municipality as a unit of analysis. The Mortality Information System (MIS) and the Notifiable Diseases Information System (NDIS) were explored. The quality of the data was assessed using primary indicators as well as their dimensions and synthetic indicators according to the health macro-region. The three dimensions of quality considered were: completeness, consistency and non-duplicity. Through the Spearman correlation coefficient, the relationship between the dimensions of data quality and synthetic indicators with socioeconomic indicators was studied. Results - The correlation proved to be statistically significant in at least 75% of the relationships. When assessing the completeness of the SCD data for the race / color variable in the MIS, it was found that there are differences between the DF and other diseases, which constitutes indirect evidence of the invisibility of the SCD in the HIS and of institutionalized racism in the capture process of the data. The evaluation of MIS and NDIS, demonstrated that these HIS need to improve their registration procedures so that there is an evolution in the quality of the data available on SCD.

Melanoma, as an oncological disease with new pharmacological approaches, was considered, in this work, as a way of thinking about the multiple realities of Annemarie Mol. This theoretical-methodological approach focuses on everyday practices in which heterogeneous elements are related to the production of multiple versions of the disease. In this case, this dissertation aimed to explore the multiple realities through the experiences and reports produced about melanoma and its pharmacological treatment in different contexts. In order to achieve this, the following specific objectives were adopted: a) to trace the multiple relationships between the disease and oncological drugs in specific environments (scientific articles, biomedical guidelines, hospital and oncology units); b) demonstrate how, on a daily basis, the disease and its treatment produce bodies and different ways of life; c) indicate the actions taken in daily life and the various elements mobilized for the treatment to occur. As a technique for the data production, semi-structured interviews were carried out with people undergoing pharmacological treatment for malignant melanoma. However, informal conversations, observation of the visited places and notes in the field diary gained relevance for the construction of realities, here, presented. In total, there were ten transcribed interviews, four of them conducted with people using pharmacotherapy in private oncology institutions and services and two undergoing treatment in a philanthropic institution in the public health system. Two health professionals, a nurse and a dermatologist from this institution were also interviewed. No diagnosis came in isolation and implied the mobilization of different elements, as well as the active participation of those involved so that the benefits of the indicated biomedical treatments were achieved. The interventions, through chemotherapies and immunotherapies, shaped not only different melanomas, but, inevitably, different ways of living, dealing with and building bodies with the disease. Health systems, therapeutic guidelines, public agencies, biomedical explanations, people who care, expectations and anxieties emerged in a network of associations that made melanoma and the therapies performed to assume a multiple character in the experienced practices. 

This socio-historical study aimed to analyze the emergency of the Brazilian Breastfeeding Program in the period between 1979 and 1983. It's based on documental analysis and grounded on Pierre Bourdieu's reflexive sociology. The documents analyzed were obtained by digital means from public institutional and newspaper collections, such as O Globo, Correio Brasiliense, Folha de São Paulo e O Mulherio. Secondarily, interviews with key complementary informants were conducted aiming to map the breastfeeding space and its agents in the studied period. Released in 1981, the program involved a group of national and international institutions and agents belonging to different fields that fostered the pro-breastfeeding debate, achieving consensus around the importance of breast milk in child development. The main polarizations were related to the focus given to the component involving the regulation process of the breast milk commercialization control measures, an aspect considered decisive to the success of the strategies adopted later. The technical executive group of Brazilian Breastfeeding Program proved to be a binder space of agents with different trajectories and from distinct social fields around breastfeeding by organizing a program that focused on acting in different causes of early weaning. It's also discussed the relevancy of militant spaces to the policy genesis as well as possible aspects related to the highlighted transformations in the implantation of actions in the following decades.

The general objective of this thesis was to understand the normative standards of recognition that modulate the access to social protection rights (BPC) of people in psychological distress in Salvador (BA), as well as to identify the areas of moral conflicts silenced in this process. For that, we start from the experiences of disrespect that hurt the expectations of the users' recognition and we follow them through the different institutional instances (Communitary Mental Health Services CAPS, Social Security National Institute INSS, Federal Justice).
To fulfill this objective, we carried out a work of articulation and conceptual elaboration between the theory of recognition, the paradigm of deinstitutionalization and the Brasilian Psychiatric Reform (RPB). We also used a methodological approach that included unstructured interviews with users and professionals who participate in the BPC process, as well as participant observation in the ethnographic context and documentary analysis (CAPS medical records and reports; INSS instrument; and JF expert reports).
For data analysis we used a hermeneutic approach and the results were presented in two chapters. In the first one, “The misery of the world and the infamous fighters”, following the direction of a sociology of absences and emergencies, we have recovered a fundamental chapter in the social life of our subjects, deficitly recognized by the contribution / benefit polarity. And in the second, “The generalized Other of madness in social assistance”, we present a detailed analysis of the moral grammar of recognition and the silenced conflicts that run through all the institutional instances involved in the BPC process.
From the analysis of silenced moral conflicts and the feelings of injustice experienced by many subjects (users and professionals), it was possible to characterize the intersubjective structure and the socio-structural conditions of recognition pointed out as social pathology. But also, the needs, pretensions, values and ideas of justice from which to develop alternative normative-practical and institutional directions. Finally, subsidies to renew the motivational source of the struggles for the recognition and social inclusion of people in psychological suffering.

Objective: To investigate the occurrence of Common Mental Disorders among Community Health Agents in Brazil and its relationship with the working conditions of these professionals. Methodology: Cross-sectional, analytical study developed with a national sample of ACS. For data collection, a socioeconomic and demographic questionnaire and the Self Reporting Questionnaire were used. Initially, a descriptive analysis was carried out to characterize the sample in terms of its socioeconomic, demographic and working conditions characteristics. To verify the association between the characteristics of the ACS and the TMC, the data were submitted to bivariate analysis and Multiple Logistic Regression Analysis (MRA). Results: The prevalence of CMD among Brazilian ACS was 21%. The chance of having CMD was higher among female ACS, with a performance time of more than 5 years, among those who did not feel respected by colleagues and among ACS who were dissatisfied with the work. Conclusion: The results of this study show that a portion of Brazilian CHA presents symptoms that are defined as Common Mental Disorder and the findingsreinforce the association between CCT and working conditions, with respect to the aspects: seniority in the position, job dissatisfaction and sociopolitical conditions (interpersonal relations)

Northeast Brazil was the epicenter of the Zika epidemic in 2015, yet little if any prospective information exists on Zika virus (ZIKV) transmission among pregnant women from the region and clinical outcomes of their infants. We have been conducting a community-based prospective study of leptospirosis among urban slum residents since January 2013 in Salvador, Brazil. From this population, we identified women who were pregnant from January 2015 to June 2016 and identified incident Zika seroconversion events among participants by analyzing biannually collected samples for the ZIKV35 monoclonal antibody using the Blockade of Binding (BoB) assay. We evaluated adverse outcomes during pregnancy, birth and infancy by interviewing mothers and performing anthropometric measurements as well as neurologic (Hammersmith Infant Neurological Exam, HINE), audiometric and ophthalmological evaluations and examinations with Bayley Scales of Infant Development III. Among a cohort of 655 participants, 66 (10%) had at least one pregnancy during the study period. We completed follow-up for 46 (70%) of the 66 women, of whom Zika seroconversion occurred prior to, during and after pregnancy in 25 (54%), 13 (28%), and 1 (2%), respectively. The 46 infants did not have evidence of microcephaly or congenital defects at birth. However, the 13 infants of mothers who seroconverted during pregnancy had increased risk of having a low cognitive score < 1SD (RR 2.96; 95% CI 1.32 – 6.63) than the 33 infants of mothers who did not seroconvert during pregnancy (4 of 13 [31%] vs. 2 of 33 [6%], respectively). Similarly, infants of mothers who seroconverted during pregnancy had increased risk (RR 6.82: 1.54 – 30.17) of having altered behavioral audiometry findings than infants of mothers who did not seroconvert during pregnancy (5 of 13 [39%] vs. 2 of 31 [7%], respectively). These findings suggest that a significant proportion of infants exposed in utero to ZIKV develop developmental deficiencies despite the absence of clinically evident neurological sequelae.

Public participation has been incorporated into ideological movements, policies and health programs for more than half a century, being included in the public debate in Brazil since the 1970s. It has been subject of conceptual controversies with advances and regressions regarding to its effective institutionalization in the context of Health Policy, particularly within the last 30 years context of the construction of the Unified Health System. It is therefore, relevant subject of scientific research, having stimulated the production of heterogeneous set of studies and research that deal with several aspects and participation practices. The objective of this work is to map and analyze the scientific production on health participation in Brazil in the period 2003-2016, aiming to characterize the temporal evolution and the distribution of the articles on the matter, according to publication vehicle and institutional origin of authors as well as, identifying and analyzing forms of participation in health addressed in the articles selected in the Scielo database. A total of 216 articles were analyzed, showing considerable growth in the period 2003-2016, the majority of which coming from authors linked to institutions in the southeast region of the country. The predominance of studies that approach institutionalized forms of engagement in health councils and conferences was found, especially at municipal level, but there are a significant number of articles that present practices of participation in disease control programs or in primary health care. Studies that analyze participation in social movements and their representatives’ involvement in the formulation of health policies were also identified. It is discussed the possible relationship of this production with the stimulus resulting from the implementation of policies, programs and institutional norms, which culminated in the implementation of the National Strategic and Participative Management Policy - PARTICIPASUS, concluding with the reflection about the risks to which this policy is exposed in the current conjuncture.

The aim of this study is to analyze the characteristics and tendencies of the scientific
production on the Health of the LGBT Population in Brazil by seeking to identify their
health problems and needs, as well as the challenges and obstacles they face in meeting
their demands for actions and services and guaranteeing the right to health. It is a
systematic review of the literature, in which 70 papers published from 2000 to 2018,
indexed in the Scielo and Lilacs databases, were analyzed. The results show poor access
to services and low quality of care for the LGBT population motivated by the
occurrence of discrimination, prejudice and symbolic violence in the institutions. It was
also observed that a significant percentage of individuals are engaged in unprotected
sexual practices and with psychological damage. The conclusion is that there is a need
for further development of research in this area, mainly on the prevalence of chronic
non-communicable diseases as well as on the approach to female homosexuality and its
specific health needs, in order to support the search for alternatives and the
improvement of the programs which offer health care to this population, so that the full
exercise of their rights is guaranteed.

The aim of this work is to analyze the process of construction of the National Policy for
Comprehensive Health of Lesbians, Gays, Bisexuals, Transvestites and Transsexuals
(NPCH-LGBT) in SUS. In order to do so, the theory of the public policy cycle was used
as a reference to characterize the political scenario in which the process of entrance of
the subject in the government agenda took place, the government and non-government
actors involved in the process, the problems and proposals for their solution, actors and
proposals. The collected and analyzed information was extracted from official
documents of the Ministry of Health (MH), Minutes of the National Health Council
(NHC), Reports of the National Health Conferences and documents prepared by entities
of the LGBT Social Movement. The results show that the health of the LGBT
population was incorporated into the government agenda in the 1980s when confronting
the HIV / AIDS epidemic, but an expanded perspective on the problems of prejudice,
discrimination, violence, and the need to address inequalities and iniquities in health
that affect this population was only established after 2004, with the creation of the
Brazil without Homophobia program. More specifically, regarding the construction of
the National Policy for Comprehensive Health of the LGBT population, it identifies the
moments in which the health problems of this group were discussed in meetings of the
NHC and at the Health Conferences held between 2000 and 2007, systematizing the
proposals that made up the structural bases of the NPCH-LGBT, approved by the NHC
in 2009. In conclusion, the LGBT social movement can be pointed out as a political
actor that, through its work in the institutional spaces, took advantage of the "window of
opportunity" that was opened during the governments of Lula I and Lula II (2003-
2010), and managed to insert this theme in the agenda and to build, together with
leaders and technicians of the MH, as well as with other government entities, the
NPCH-LGBT.

Background: The decline in child stunting, still prevalent in socioeconomically vulnerable population groups, has been accompanied by the progressive increase in overweight and chronic noncommunicable diseases, resulting in a double burden of malnutrition (DBM) scenario in many developing countries. Objective: To measure the double burden of malnutrition and its socioeconomic determinants in children beneficiaries of a conditional cash transfer program in Brazilian municipalities. Methods: An ecological study using panel data on the prevalence of stunting and overweight in under 5-year-old children beneficiaries of the Bolsa Família Program in 4,443 Brazilian municipalities between 2008 and 2014. The municipalities were classified according to four scenarios of coexistence between stunting and overweight, including the DBM. Multinomial logistic regression models with fixed effects was conducted to assess the association between socioeconomic variables and the nutritional scenarios. Results: Mean reduction from 14.2% to 12.7% in the prevalence of stunting and mean increase from 17.2% to 18.4% in the prevalence of overweight were observed. The predominant nutritional scenarios in most municipalities were represented mainly by high rates of overweight and DBM, both associated to the progressive increase of GDP per capita. Expected years of schooling, unemployment rate, and household crowding were also associated with the scenarios analyzed. Conclusions: Our findings evidence an advanced stage of nutritional transition among children in the more socioeconomically vulnerable stratum of the Brazilian population, which is marked by an increase in the burden of overweight only or coexisting with stunting (double burden).

Background: The recent launch of HIV self-testing (HIVST) policy (2019) in the Brazilian National Health System is expected to increase the uptake and frequency of HIV testing. Current estimate of HIV prevalence among FSW in Brazil is 5.3%. HIV testing becomes particularly relevant as a point of entry to health care and treatment. We aimed to investigate associated factors with acceptability of HIVST among FSW in Brazil. Methods: A cross-sectional study of 4,245 FSW recruited in 12 Brazilian capital cities by respondent driven sample (RDS) in 2016. Participants were interviewed and the associations of behavioral, sociodemographic, health service related variables, social support and history of violence and discrimination with HIVST acceptability were analyzed. For each city, participants were weighted using RDSII estimator. Combined data was analyzed by STATA 14 complex survey procedure using each city as a stratum and each group of women recruited by the same FSW as a cluster. Odds ratios and 95% CI were estimated using logistic regression.Results: Half of FSW was below 30 years of age and 48% did not complete high school. 73.9% self-identified as black; with lower socioeconomic level (56.2%), and were treated worse than other people in the health services for being a FSW (47.3%). 22.5% had never taken an HIV testing in a lifetime and only 32.4% were aware of HIVST before the study. Acceptability of HIVST upon explanation was high (85.6%). Factors associated with refusal were: older age (more than 40 years) (OR:1.26); self-identified as black (OR:0.71); work at street points (OR: 1,25) and number of clients per day (10 or more vs 1-9) (OR: 1,98). Conclusions: Awareness of HIVST is still low among FSW in Brazil. But it is reassuring that acceptability was high. This represents an opportunity to increase testing coverage among FSW in whom there is a gap in HIV diagnosis. Autonomy, privacy, rapid access to results, and convenience should be emphasized as motivations in developing programmatic strategies for scale-up of HIVST among FSW.

Background: Information generated by the reporting of diseases in Workers' Health (Saúde do Trabalhador – ST) on the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação – Sinan) can be valuable for monitoring, planning actions and assessing their impact. Among work-related reportable diseases are irreversible noise-induced hearing loss (Perda Auditiva Induzida por Ruído – Pair), considered one of the most widespread and prevalent occupational health problems in the world. In Brazil, the number of cases reported in Sinan is still incipient, a fact consistent with the evidence of underreporting, common in the ST field. There is no evidence of studies investigating factors that may influence reporting of the Pair in Sinan. Objective: To investigate contextual factors associated with the reporting of the Pair on the Sinan in Brazil. Methods: Epidemiological study of mixed ecological type, exploratory, in which the units of observation were the 5,570 Brazilian municipalities between 2013 and 2015. The main variable was the reporting of Pair in Sinan. The variables were grouped into two dimensions: a) related to the municipalities: coverage by Cerest, Cerest host municipality, macroregion of the country, Unit of the Federation (UF), distance to UF capital, territorial extension, economically active and occupied population (Peao), proportion of Peao in the industries of transformation (Peao TEC), extraction and construction industry, Peao in the manufacturing industry, Peao on the extractive industry, Peao on the construction industry, Peao on formal employment and the Municipal Human Development Index (IDHM); b) related to Cerest: year of enabling, average number of employment contract, proportion of staff with statutory relationship, average number of speech therapists, and turnover of professionals. We performed both unadjusted and adjusted logistic regression with its 95% CI to assessed the association with number and proportion of municipalities that reported Pair in the Sinan according to the variables described in each dimension. The Peao was considered to be confounder a priori and included in all of the adjusted model. Statistical inferences were made with 95% confidence intervals. Results: 277 (5.0%) municipalities reported 2,588 cases of Pair in Sinan, between 2013-2015. Mato Grosso do Sul had the highest proportion of notifying municipalities (25.3%). In the adjusted model of the variables related to municipalities dimension, we observed a greater likelihood among those municipalities with coverage by Cerest, to be a Cerest host municipality, belonging to the Midwest region, with less distance to the UF capital and with a high/very high IDHM. Belonging to the North region was negatively associated with the Pair notification in these municipalities. In the dimension of the variables related to Cerest, we observed a greater likelihood associated with the municipalities that had at least one speech pathologist in the Cerest team and had low turnover of professionals. Conclusion: The reporting of Pair in Brazilian municipalities was influenced by contextual factors, either by the characteristics of the municipalities themselves and by the characteristics of the Cerest whose area of coverage they belong.

The epidemic of the Zika virus, which was characterized as a mild infection, began to take on the national scene when a possible association with the increase in the number of microcephaly cases in children was suggested. From the doctors' suspicion to recognition by the Ministry of Health, the feeling of uncertainty only increased. The birth of children with brain malformations, hitherto little seen by the media and the authorities, has become a concern that required fast decision-making and the need to disseminate information. It is striking how the less privileged classes were mostly hit. Thus, the family impact that this event has caused and the process of vulnerability to which the most affected families were exposed decades ago in Brazil, aroused the interest in researching on this subject. Overall objective: To understand the meanings attributed by caregivers of children with ZIKV associated microcephaly to such an event and how these meanings relate (or not) to their care experiences. Specific objectives: to identify the caregivers' view on the etiology of microcephaly associated with ZIKV, as well as the possible role of the State in relation to the control of some of its determinants; understand the caregivers' gaze in front of this child, considering their experience of care; to identify if the situations of vulnerability to which these families are exposed, are present in their narratives. Methodological strategies: A qualitative research was carried out involving mothers of children with ZIKV associated microcephaly seen at the Sarah / Salvador unit of the Sarah Network of Locomotor Apparatus Hospitals. Initially, a sociodemographic survey of 261 mothers of children diagnosed with microcephaly and ZIKV, attended at that unit, was carried out through chart analysis. Then, semi-structured interviews were conducted with 25 of these mothers, recorded and transcribed. The thematic analysis of content of the transcriptions, guided by Symbolic Interactionism, was carried out. Results: The majority of mothers attended came from peripheral districts of Salvador and from the interior, and education was predominant among those who attended high school. It was observed that mothers have no doubt that microcephaly is a consequence of virus contamination. The media were the main sources of information. Despite recognizing the increased environmental risks to which they are exposed, most mothers do not relate them to social inequalities. The meanings attributed to the relationship between the epidemic and the microcephaly are directed to experiences of biographical rupture, which situate the challenges faced in the family and work context. These challenges involved the abandonment of work activities, social isolation and the need to seek help to support the shared care of their children. The interactions that emerged with the epidemic, the gestation and birth of a child with microcephaly by ZIKV led these mothers to re-signify the care of their children, their life projects and to organize themselves as a new collective subject. Conclusions: By bringing the caregivers' understanding of the phenomenon to the table, we foster the debate with the objective of giving visibility to these children and their families, aiming at discussing policies that can support them in face of the permanent illness and the absence of State as intermediary of this process.

The analysis of the Brazilian health system reveals the expansion of access and coverage of basic care and complex care processes. However, it maintains the problems that affect the provision of services. For example, the concentration of resources of medium and high complexity in large urban centers and, above all, the dependence of SUS on the private sector. With the objective of analyzing the adequacy of the offer in specialized and hospital care, a study was carried out on the aggregates of the supply of health facilities and the potential coverage of beds, consultations, equipment and medical professionals, having as a unit of analysis the municipalities that integrate the Metropolitan Region of Salvador, Bahia, between the years of 2012 and 2017. Secondary data were used in the Outpatient Information System of SUS, National Register of Health Establishments, Brazilian Institute of Geography and Statistics and National Agency of Supplementary Health. The existing national parameters for the public sector served as a reference for the evaluation of the offer. There was a concentration of health centers in the city of Salvador (82.7%), of which 90.7% did not attend the SUS. In turn, there is a high supply of diagnostic and deficit equipment in all the medical specialties analyzed. Even though hospital beds offer the recommended standard, SUS beds account for less than 50% of the total. The findings of this study may contribute especially to the organization of the service network in RMS, aiming to assist in health planning, as well as giving greater visibility to the social control to be exercised by the population.

The policy of people with disabilities has not translated into the implementation of a line of care in Primary Care or structured operational proposals, making child care still insufficient and unclear at this level of care. The occurrence of the microcephaly outbreak and other changes resulting from Zika Virus increased the number of children with disabilities, highlighting structural problems in the provision of health care, giving visibility to this issue. This study aims to analyze the limits and possibilities of resources of primary care, to characterize the nature of care for the promotion of child development and the mental health of family members, considering the technological density required in this care space and its relations with the family. specialized level of attention. A systematic integrative review was conducted to identify available evidence to guide practice with children and their families in the context of AB. Primary studies that described actions implemented in the context of primary care between 2014 and 2018 were examined. This study categorized: 4 training programs, use of 12 different types of screening instruments and identified 11 actions, five of which support / stimulate development, five family support and one community based. early detection (use of screening tools). In general, these have led to increased levels of development and social participation; provision of community health / resource guidance and information; definition of therapeutic project articulated with other levels of attention; and family welcome. This review provided evidence of the gap in assistance for monitoring child development in the context of PHC, especially for children with disabilities. The nature of these studies also brings an important reflection on the available interventions, since most of them focus on screening and detection, leaving aside the space where life happens: the family and the community.

There is an unequal allocation around care tasks that is not random and obeys an oppressive structure of society, functioning through hierarchies of sex, race / color and social class. Among the caregivers are more women, black and poor women; Among those receiving the most intensive care (in quality and quantity) are the richest white men in the population. We observe that the base of the Brazilian social pyramid (black and poor women) corresponds to a population of professionals of primary care of the SUS, the Community Health Agents, which are a professional category formed mainly by women, the blackest and poorest. among the other professionals. These women are differentially held responsible for care work, which entails various conditions of vulnerability throughout their lives. The main objective of this dissertation is to understand the realities of care present in the lives of women Community Health Agents living in the rural area of Chapada Diamantina, Bahia. We resorted theoretically and methodologically to the ethics of care, the political theory and the concept of intersectionality thought from the perspective of feminist authors. Six months of fieldwork were conducted at the Caeté-Açú Family Health Unit, Bahia, with data collection supported by participant observation and narrative interviews. The results point to gender inequalities and vulnerabilities associated with care tasks in the lives of these women, which were listed in macro and micro categories. Among them, women's socialization, differentiated responsibility, self-care, reciprocity, sexual and racial division of domestic work, public and private spheres, family, maternity and violence. We conclude that the strengthening of the socialization of care and public policies that aim to contribute to the end of social inequalities, gender and race / color, present in care work, mean the strengthening of fairer and more democratic models of society. Care needs to be understood as a priority political responsibility and the balance of their practices needs to be made between actresses and social actors, as advocated by a political-feminist perspective of care.

In the last three decades of the 20th century, capitalism experienced a series of historical and social transformations that significantly impacted the world of work. In 2008, a financial crisis broke out in the United States (USA), which ended up undermining many of the financial institutions in this country, and damaging much of the global financial system. One of the outcomes of the global crisis of capitalism is unemployment. Understanding that health is socially determined, many studies have evaluated changes in suicidal behavior related to economic crises and its association with unemployment, mainly. Our study aims to estimate the association between unemployment and suicide among the Brazilian population in the previous period (2011-2013) and during the economic crisis 2014-2016. It is a cross-sectional study, using the death records of the Brazilian population for the period 2011 a 2016. Mortality data were extracted from the Mortality Information System (SIM) of the Ministry of Health (MS), coded according to the International Statistical Classification of Diseases and Health-Related Problems, in its tenth revision (ICD-10). The results that the suicide profile of the Brazilian population in the crisis period was similar to the profile in the pre-crisis period, in certain aspects – men and white race/color – and distinct in other – women, age group, race/color, education, marital status and work situation (employed and unemployed). Over the period 2011-2016, trends in Mortality Coefficients (CM) for suicide in employed and unemployed people evolved in such a way that it is possible to identify a percentage increase in the two groups. In both periods, occupations of retiree/pensioner, housewive, agribusiness worker in general, agricultural steering-wheel worker, bricklayer and the student were those with the highest proportions of suicide cases. Our results are not fully aligned with those of the other revised studies. As convergence we can cite the increase in the general suicide rate in the period of crisis, and in particular a greater increase in suicide rates among unemployed when compared to employed people; the risk of suicide in the occupations of housewives and farm workers; the fact that CM by suicide are higher in the indigenous population when compared to other categories of the variable race/color; a higher proportion of suicide cases and a higher risk of suicide mortality among men. However, our findings diverge from studies that found a greater
risk of suicide for businessmen and some high-ranking officials in times of economic crisis. The analysis adjusted by the covariates identified lower chances of suicide among the unemployed in relation to the employed people, both in the pre-crisis period and in the period of economic crisis. Although the results found for the period of crisis presented statistical significance, suggesting the existence of a non-casual association between unemployment and suicide, it cannot be said that the outcome studied suffers effects of unemployment.

The research addresses hospital management as an important theme in the analysis of public health policies and is an object of constant concern on the part of managers. The delimitation related to university hospitals (HU) was the focus of the analysis of the present study. The Brazilian Hospital Services Company (EBSERH) was created in 2011 to manage the HU in Brazil, and considered for the research an alternative management model for SUS. Thus, the general objective of this study is to analyze the formulation and implementation process of the EBSERH model in the University Hospitals of the Federal University of Bahia / UFBA from 2010 to 2017. And as specific objectives, identify the legal and normative frameworks for the creation of EBSERH; describe how the decision process was made by the UFBA model (scenarios, actors, decision making and political alternatives); analyze the process of implementation of the EBSERH management in the HU of UFBA and analyze the work management policy adopted by the company from the perspective of the different actors involved in the process. For this purpose, the reference of the Public Policy Cycle is used, and for the production of information from secondary sources through documentary analysis and primary sources, making a total of 85 interviews with managers and workers of the HU. The Public Policy Cycle is taken as theoretical reference. The approval of EBSERH at UFBA was the result of numerous tensions arising from different positions of actors involved in decision arenas. The different actors participated in the process motivated by diverse interests, ideologies and objectives. The conflicts permeated the whole process, from the proposal of the policy, the announcement, the approval of the Law, the decision in the University Council, until the signing of the contract with the company. The implementation of the EBSERH policy occurred in a context of uncertainty and worker dissatisfaction. In relation to labor management, there was a sharp increase in labor relations and inequalities between workers of different legal ties and wage conditions. The results suggest that in relation to the previous model the new model implanted in the HU is close to the proposal of the New Public Management in relation to the results policy and focus on a new performance of the public service. The theoretical framework proved to be an important analytical tool, allowing to clarify several relatively obscure points about how the decisions are made, also indicating crucial aspects of the elaboration and implementation of EBSERH in UFBA

Some investigations address periodontitis as a non-traditional risk factor for complications
and progression of CKD. Thus, the objective of this study was to investigate the association
of periodontal conditions and periodontitis with CKD in individuals under hemodialysis
treatment. The results were organized in three scientific papers. The first article included a
systematic review with meta-analysis of studies investigating the association of periodontitis
with outcomes related to the complication or progression of CKD. The meta-analytic
association measures indicated a positive association of periodontitis with hypoalbuminemia
(PR = 2.47, 95% CI: 1.43-4.26), high levels of C-reactive protein (PR = 1.39, 95% CI = 1.07-
1.81), death due to disease (RR = 2.29, 95% CI: 1.67-3.15) and death from all causes (RR =
1.73, 95% CI = 1.32-2.27). The other two articles are part of a prospective cohort study of
prognosis, performed with 217 individuals with CKD under hemodialysis treatment in Feira
de Santana-BA. Data were collected through questionnaire, oral examination and medical
records. The follow up of the individuals was performed between August 2016 and December
2018. The second paper investigated the association of periodontal parameters with the
evolution of laboratory biomarkers used in clinical monitoring. The CAL was negatively
correlated with mean serum calcium levels (p = 0.021), phosphorus (p = 0.020) and albumin
(p = 0.025) at 12 months follow up. In addition, individuals with higher CAL had significant
changes in the levels of phosphorus (p = 0.053) and alkaline phosphatase (p = 0.005) in the
first six months of follow-up. Individuals with higher PD had a significant increase in serum
alkaline phosphatase levels (p = 0.008) between 0 and 6 months of follow-up. In addition,
dental loss was negatively correlated with mean levels of phosphorus (p <0.001) and albumin
(p = 0.001) over a 12-month follow-up period. In the third paper, the effect of periodontal
condition on survival and risk of death was estimated. Individuals with greater tooth
(p=0.025) loss and greater CAL (p<0.01) had lower survival. Those with the highest CAL
also had the risk of death increased more than twice (HR = 2.88; 95% CI: 1.55-5.36 / adjusted
HR = 2.28; 95% CI: 1.12-4.62). It was concluded that the periodontal condition was
positively associated with the biomarkers of complication and progression of CKD.

Knowledge produced in the field of health on the experience of trans men is still concentrated on the pathologization, essentialization of identities and individualization of eminently social aspects of the trans experience. This has contributed towards the production of suffering in this group, either due to the compulsory requirement of conforming their performance to the criteria of eligibility for access to healthcare, or to the processes of disengagement, stigmatization and exclusion on account of being certified as sick. The objective was to analyze the practice of trans men for producing a better life. The Actor-Network Theory emerges as a useful approach to provide insights on the dynamics of trans men in living their lives – a routine conducted through the inter-action among different groups, senses, institutions and things. The research technique was the Shadowing, used to accompany, during nine months, three trans men in their networks of associations. To resist, in the context of this study, takes up the sense of a “determination to exist”. Hence, resist-existing addresses the practices of trans men to produce a better life for themselves, steeped in the context of rejection for dissenting from the standards of gender. This could mean from strategies for coexisting or not with family members to complex architectures for maintaining their existence. In their practices, the agents of this research evoked such diverse and complex actors as are their lives. Beer; testosterone; parents; friends; buddies; doctors; social movements; trans collectives; software for smartphones; food; online virtual social networks; health, justice, higher education institutions; healthcare services; catholic saints; candles; rosaries; medicaments and a countless network of actors, elements of an unstable cloud of practices producing a better life. The constitution of the trans man from the mimesis of the cis-man or antithesis of the cis-woman puts the trans man in a lower place and establishes a narrative is presented in biomedical practices, in some academic practices, and the practices of political disputes with this population. This is embodied by some trans men and produces suffering in their experiences by putting them in unattainable paths and in no way producing care. However, other arrangements are starting points "from" trans identities, in which a better life, a multiple reality, emerges and operates realities capable of disputing with the cisheteronormative constructs. Aesthetics, semiology, trans narratives and materiality that do not stem from the cis-gender as mandatory alterity are powers that cry out to be strengthened and find/produce echoes in some trans people with whom my paths have crossed during the organization of this study

Despite efforts to identify risk factors / protection for asthma / asthma symptoms, the etiology of the disease remains poorly understood, as well as its dynamics over time, especially in the transition from childhood to adolescence. Initially, a systematic review of the use of statistical methods in longitudinal asthma studies over the past 20 years has been performed. Forty-five epidemiological studies were identified, which demonstrated the incipient use of statistical methods for longitudinal data with repeated outcome measures and, therefore, studies that longitudinally assessed the risk factors associated with asthma / asthma symptoms at various stages of the disease. life, such as childhood and adolescence. This was followed by a study involving longitudinal asthma data from the Social Changes Project, Asthma and Allergy in Latin America (SCAALA-Salvador), with participants followed from childhood to adolescence to assess risk factors associated with asthma. Longitudinal occurrence of asthma / asthma symptoms from childhood to adolescence through the application of three advanced statistical techniques for repeated-measures data modeling. Additionally, we evaluated the impact of missing data on the longitudinal data analysis of asthma, as well as the use of multiple imputation as a strategy to deal with missing data in covariates and outcome, considering different percentages and missing data mechanisms, Overall, estimates of the GHG and multilevel logistic models were consistent in the same direction, demonstrating the deleterious effect of atopy, maternal asthma, and common maternal mental disorder on the occurrence of asthma symptoms over time. Analyzes with missing data and multiple imputation showed that the presence of missing covariate is more harmful than missing in the outcome, and that if a single variable has a high percentage of missing data the estimates obtained using imputation may be invalid. .

Finally, Latent Class Analysis (LCA) was used to define childhood and adolescent asthma phenotypes, as well as Latent Transition Analysis (LTA) to explore the longitudinal patterns of asthma symptoms. , evaluating the transitions between such phenotypes and the effect of predictors that were associated with the longitudinal occurrence of asthma symptoms. The phenotypes found were named "Healthy" and "Symptomatic". About 5% of healthy individuals in childhood became symptomatic in mid-childhood, the same being observed in the transition from mid-childhood to adolescence. Maternal common mental disorder has been identified as a risk factor for unhealthy states in both childhood and adolescence. Longitudinal studies are essential for the study of asthma, as its natural history remains poorly understood, and there is still no consensus on the factors that contribute to its dynamics over time. As asthma is the most common childhood disease and is responsible for high costs for the health system, the identification of associated factors can contribute substantially to the formulation of strategies aimed not only at preventing the disease, but at controlling it during child development. in adolescence.

Depression has been considered a serious and high-incidence disease, which is a public health problem in all regions of the world, since it is the major cause of disability and because it has causal relationships with established social conditions in some countries (WHO, 2010). The aim of the study was to analyze the experience of depression in a virtual community on Facebook. This is a qualitative study. The netnographic method was used to produce data and analysis on the experience of depression Facebook. For this, the immersion in the field, through non-participant observation, the collection of archival data and interviews with administrators and community participants were the techniques used for data production. Results and Discussion: The international review of the literature on Facebook and Depression made it possible to know how researchers from different areas have addressed the issue and to identify the absence, in the Brazilian scientific literature on mental health, of this type of research; the ethnographic method contributed to the recognition of new objects and problems in the study of depression; and also to understand how actors suffering from depression seek out social networks to receive emotional support to learn about illness and caregiving; and to report emotions resulting from concrete social relationships, being affected by depression, generating more emotional distress. The mapping and characterization of the community allowed us to understand the social profile of the community and to analyze the reports about the experience of depression, whose members of the Facebook community expressed their emotions of sadness, melancholy, mourning and the meanings attributed to suffering, pain, stigmas, invisibility and social exclusion in daily life. These impressions were debated in closed virtual environments. It is concluded that communities closed on Facebook, as a field of research, enabled from the reports of its members, to understand the experience of depression, the production of meanings around suffering. Because they felt protected from their identity as people from their face-to-face environment, they were motivated to discuss issues and issues of their public and private life by associating them with depression and without restriction. It was in these collective talks that we saw the construction of webs of meanings about the experience of psychic suffering. Reports of depression in this community, as well as others observed, associate members' situations in their daily lives with people close and distant; they talk about themselves and the other; their perceptions about illness and the social stigmas they face. Finally, the immersion in the field from an ethnographic research revealed the meanings and particularities of the virtual environment only translated by those suffering from depression.

This work intends to analyze the political action of CONASS, in the Lula and Dilma governments, based on the facts produced in the period, the projects defended by it and the political position assumed in relation to the SUS building process. It is a unique ex-ploratory case study (YIN, 2005), of the CONASS action in the health policy process in Brazil, from 2006 to 2016, taking as initial milestone the approval of the "Pacto pela Vida, em Defesa do SUS e de Gestão” (BRASIL, 2006) and as a final mark the President Dilma Roussef's impeachment process in 2016. Documents used by CONASS, semi-structured interviews with key informants, and the researcher's field diary were used as sources of evidence, built during the period in which she lived the daily work of the CONASS Ex-ecutive Secretariat at its headquarters in Brasilia/DF, from September 24 to December 12, 2018. Documents used by CONASS, semi-structured interviews with key informants, and the researcher's field diary, built during the period in which she lived the daily work of the CONASS Executive Secretariat at its headquarters in Brasilia/DF. The results in-dicate CONASS's evolution of the role of political representation of health secretaries in the process of conducting the SUS at the national level, assuming, gradually, a strategic importance in the formulation and implementation of health policies, within states and in some municipalities, playing a relevant role of technical support and cooperation to the SES. In this sense, the analysis of the CONASS action in the period studied, evidences the strengthening of the governance (SUS) network in the Lula I and II Governments (2006-2010), in spite of the conflicts about financing, insofar as the CONASS acted in consonance with the Ministry of Health and CONASEMS, at various times, printing, a directionality to the SUS implementation process consistent with its principles and guide-lines. However, in the Dilma I government (2011-2014) the tension between the relation-ship between MS and CONASS was verified, due to some facts produced at the moment in the federal government, which pointed in the opposite or at least different direction , of the one that had been defended by CONASS. In the Dilma II government (2015-2016), tensions accumulated, to the point of threatening the fabric of the network by the increase of conflicts between the actors participating in the SUS governance process. In this pro-cess, CONASS's institutionality ensured a political independence that makes it indispen-sable in the defense of the SUS, remaining as a "trench" of resistance to the attacks on the SUS filed by both the Executive and Legislative and Judiciary in the 2006-2016.

ABSTRACT
The interest of collective health researchers in the the study of political process has grown in
recent years and has contributed to the deepening of epistemological criticism and to the
theoretical-methodological development of a research strand that has been termed ‘political
analysis in health'. Therefore, this thesis aims to both systematize some of these elaborations,
as well as to problematize them, with a purpose of overcoming that is epistemologically based
on a dialectical approach, developed by an involved subject; methodologically in textual
analysis currents chosen to examine the scientific productions reviewed, either systematically
or narratively; and theoretically in marxist and anarchist approaches, which privilege to treat
three moments in an articulated way: (1) the analysis of structural and conjunctural aspects, so
as to think together about the 'state of things' that lasts in time and the facts of different past,
including the most recent one, which tries to accompany the present, at the local and
international level; (2) the elaboration of objectives and proposals that subsidize their projects,
that is, that fuel expectations about the future; (3) the constitution of the subjects, their
articulations and the act of putting in place, at present, strategies and tactics based on the past,
but with a future-oriented look. Analyzing the articles, different theories and methods were
identified, but it is worth noting the fact that most do not bother to make them explicit. As
regards the analysis of the conjuncture, theoretical and methodological elaborations were
found that subsidize its application in the scientific field and, in the case of applying it to the
study of specific sectors such as health, it was evident the importance of avoiding that the
look is limited to them, since to disregard factors that extrapolate them can harm the action.
Concerning the studies about the health movement, it was observed that the choice of
theoretical and methodological references impacted both the privileged aspects and scope of
the analyzes, as well as the subjects actions. It is worth highlighting the fact that many
scholars of the Brazilian Sanitary Reform present themselves as political subjects of the
movement. On the other hand, the main silencing identified is related to the organization of
these subjects and this is one of the factors that leads to questions about formulations that
propose to treat it as a single cohesive organization. It was possible to identify actions
triggered by several individual and collective subjects, but the articles consider little the way
they were related organizationally, either within the groups that added individual subjects or
those that were constituted from links between collective subjects, in a format that has
similarities with the federations identified in the anarchist referential. It was also perceived
the importance of an epistemological construction that allows to strengthen convergence
elements between the scientific praxis and the concrete action of the subjects, including in
what refers to their political praxis. In this respect, a problem to be faced is the continuity of
relations of oppression that do not depend only on the fact that one has means of production,
but are also fed by inequalities in access to decision-making spaces and by 'scientifically
grounded' coercive impositions.

Problems: extensive academic production related to the National Oral Health Policy (PNSB) in Brazil has been published since 2000, with prioritization of analyzes in the municipal and federal spheres, secondary to the performance of the state level. However, the state authorities have been understood as fundamental in the configuration of the Brazilian federative arrangement for conducting public policies. Objective: This thesis analyzed the implementation of state management of public oral health care in a state of the Brazilian Northeast, and sought to understand elements of the social trajectory of the agents involved and their points of view about the state sphere and the historical conditions of possibility of implementation of the oral health policy at the state level. Methodology: this is a research of an evaluative, exploratory and qualitative nature. In the first moment, a logical model was elaborated to subsidize the evaluation of the state management. International guidelines on health management, state health management reports, state and national health plans, as well as national and international studies were reviewed, with the consequent development of a matrix of criteria and standards, validated by a committee of eleven area experts through the Delphi consensus method. Fifteen leaders, coordinators and technicians related to the oral health area of the state were interviewed. The assignment of points in the matrix was performed by two evaluators separately, based on the triangulation of evidence from key informants, on-site observation and documentary analysis. Finally, it characterized the social trajectories and dispositions of agents involved in the state bureaucratic field of oral health, from the categories agent, dispositions and field, developed by the French sociologist Pierre Bourdieu. Results and discussion: This study revealed that the degree of implementation of oral health management in the state investigated was incipient, reaching 32.8% of the total score, with difficulties related mainly to the lack of communication between the areas within the institution, infrastructure problems and lack of regional public health care projects. Nevertheless, the "tools for implementing the policy" and "accountability" were considered intermediate, reaching 37.2% and 37% respectively of the total points in these dimensions. As for the analysis of the trajectories, the majority graduated in public institutions, with balance in the studied group in relation to the social origin. The insertion in the state bureaucratic field was influenced by the disposition directed to the bureaucratic field, restlessness with the public service, reduction of the private market and the expansion of collective health. The agents' trajectory evidenced a low intersection of the bureaucratic field of oral health with the political and scientific fields, besides the low political disposition of the agents of the state bureaucracy. There is a group composed predominantly of women, with a sanitary disposition, driven by universal interest, expressing their "love for the clinic and public health". In this sense, the ambivalence of dentist / sanitary identity due to the influence exerted by the dental field of origin may make it difficult for dentists to fight within the state bureaucratic field. Final considerations: The present study pointed out that it is probable that the agents' disposition, in view of their adjustment to the bureaucratic field, can facilitate or obscure the conformation of the agenda, the accountability and the management by operations.

Background: Approximately 5% of the occupied population in Brazil works in their
own households. However, little is known about they work conditions, especially
occupational-related exposures that can potentially affect their health. Objectives:
This study describes the occupational characteristics, and occupational exposures,
potential risk factors for health, among home-based informal workers (HBW).
Materials and methods: This study is part of National Health System (SUS)
Integration Project, of teaching-research-cooperation, an initiative of the Institute of
Collective Health, Federal University of Bahia (ISC-UFBA), carried out in the Health
District of Freedom, Salvador, the state of Bahia, Brazil. One of its subprojects, the
Occupational Health Integration in Primary Health Care, trained community health
agents (CHA) to participate in the workers‘ health care and surveillance. As part of
the diagnosis and training, this cross-sectional survey was carried out with workers
living in areas covered by the Family Health Strategy and Community Health Agents
Program (Primary Health Care). Data from the Primary Health Care Information
System (SIAB) was used to identify HBW in the catchment area. Later, trained
interviewers joined CHA household visits to collect detailed occupational data.
Electronic questionnaires on tablets were used, together with quantitative
measurements of formaldehyde (ppm) and noise (dB(A)) assessed by dosimeters.
Results: In the areas covered by Primary Health Care in the Health District, 468
HBW were identified, mostly from retail (35.3%), production and sale of food (25.8%),
personal services/beauty (17.1%), clothing manufacturing (9.4%), and others
(12.4%). The majority of workers was female (77.1%), from 40 years of age or older
(67.3%) and own-account (92.5%), with over 44 hours of work time per week
(62.5%), with no vacations (63.0%). Most reported working every day (45.0%). The
prevalence of perceived noise-related occupational exposure (P-NE), i.e. when one
needs to raise the voice to be understood, was 16.4%. It was higher in the group of
more than 44 hours per week (20.1%), with higher income (19.1%) and among those
of 18 to 39 years of age (18.9%). Among 18 samples from 10 beauty salons, the
level of formaldehyde in the air was above the limit of 0.3 ppm (American Conference
of Governmental Industrial Hygienists, ACGIH) in 9 (50.0%) measurements. Among
female beauty service workers, hairdressers had a mean noise exposure of 75.1 dB
(A), less than the maximum LAEq, 8 h = 85 dB (A) as defined by the National Institute
for Occupational Safety and Health), higher, however, than the levels for the home
environment (Brazilian Association of Technical Standards, ABNT) of LAeq = 40 dB for
living room and LAeq = 30 dB in bedrooms. Conclusions: Informal workers in HBW
are commonly poor, have long working hours, with almost no resting time. They are
mostly women, from services and trading and do not contribute to social insurance.
They are commonly exposed to occupational noise, notably from external sources,
and to chemical agents, specifically formaldehyde, known carcinogenic. These
findings support the participation of Primary Health Care teams in the informal work
environment surveillance, and their strategic role in prevention of occupational health
hazards and their health effects in workers and families.

Hygiene and public health in Bahia, as an academic discipline and intervention object, respectively, are investigated and considered by the specialized literature as part of the events from the first half of the XIX century. Several interpretations on their meaning are elaborated and supported mainly on Foucault concepts on social medicine. However, a little attention has been provided to the institutionalization process, from the analysis of the existing relationships among the physicians involved with such production of knowledge and practices, which main reference was in Europe with the development of a hygienist movement, foremost the French one. This investigation, based on social-historical approach of Pierre Bourdieu, aimed at understanding the emergence of hygiene and public health in the nineteenth century Bahia, questioning the existence of a social space for relationships, implicated with population health issues. We sought from this theory, to understand the logic of the constitution of the medical, political and bureaucratic fields, which emerged in that period in Brazil and that were related to the investigated social space. The findings showed that the creation of the Salubrity Council and the beginning of the inaugural thesis of the medical school provided a space for debates and circulation of ideas from 1840 on. Even given that hygiene did not occupy a status of specialized knowledge, physicians from several areas got involved on the discussion and academic production, occupying some positions on government, towards to population health. In this analysis, two moments with distinct characteristics were identified. The first one, between 1840 and 1865, in which the bureaucratic field, by the salubrity council, and then the Hygiene commissions, was the great propeller for the debates and the approximation of the physicians to these issues. The second moment, from 1866 and 1889, highlighted a distinct dynamics on the medical and bureaucratic fields. On the one hand, there was an emptying of the govern participation, with the deactivation of the salubrity council.  On the other hand, the category was already better organized by its own entities and by the “Gazeta Médica da Bahia” (Bahia Medical Gazette), which became the agglutinative microcosms of the debates on public health. However, in both periods, we did not find any elements allowing to characterize hygiene and health public as specific spaces for fights, involving agents from several education and work areas. The involvement with themes correlated to the hygiene discipline and the occupation of public offices was restrict to the medical field, involving the political and bureaucratic fields by the insertion of the physicians in both of them. The institutionalization of the actions underwent discontinuities and the preponderance of the political logic over the technical and scientific knowledge was the hindrance for the implementation of governmental actions. Thus, at Bahia, during the studied period, we noticed a development, distinct from the one observed in other countries in which the hygienist movement consolidated the knowledge production, the creation of specialized journals and, foremost, on the formulation of propositions towards to facing the population health issues.

ABSTRACT
Introduction: Working in the manufacturing industry commonly involves high levels
of noise. The main consequence of this is Noise-induced Hearing Loss, a common
occupational disease which, although preventable, is irreversible and usually
acquired during a worker’s most productive years, causing harm to the individual,
their family and society. There are gaps about the extent of this problem in Brazil and
globally, particularly in relation to gender differences. Aim: To assess the extent of
noise exposure and hearing loss in workers in the manufacturing industry and its
subsectors, taking into account gender differences. Methods: We conducted an
initial theoretical study aimed at immersion in the issue of gender differences at work,
with a focus on hearing health. We then conducted epidemiological studies using
secondary data referring to all workers in companies in Bahia that implemented the
Environmental Risks Prevention Programme (Programa de Prevenção de Riscos
Ambientais: PPRA) and the Occupational Health Medical Control Programme
(Programa de Controle Médico de Saúde Ocupacional: PCMSO) through the Bahia
Regional Department of the Social Service of Industry between 2014 and 2018;
manufacturing industries were classified according to the National Classification of
Economic Activities. The main variables were noise exposure, in line with the PPRA
assessment, and hearing loss, as defined by audiometry. We estimated the
prevalence for each subsector of the manufacturing industry, separating men and
women. Results: Few studies include any discussion of the issue of gender when
addressing hearing loss in workers and there is a certain neglect of women in these
studies. Between 2014 and 2018, 129,860 workers were assessed from companies
from all 24 manufacturing industry subsectors, 73.5% of these were men. During this
period, the prevalence of noise exposure was 13.9%, estimated as 16.9% in men
and 5.6% in women. Among men, exposure to noise at work was more common in
the manufacture of wood, tobacco, non-metallic minerals and textile products, and
machinery and equipment. For women, exposure to noise at work was more common
in the manufacture of textiles, tobacco and metal, except machinery and equipment.
Hearing loss among workers exposed to noise was 17.8%, estimated as 19.2%
among men and 5.8% among women. For men, at least 1 in 4 workers had hearing
loss in seven of the 24 subsectors: the manufacture of machinery and equipment;
miscellaneous products; electrical machinery, apparatus and materials; tobacco
products; other transport equipment, except motor vehicles; beverages; and the
printing and reproduction of recorded media. Among women, hearing loss was more
prevalent in the manufacture of furniture, tobacco products and clothing articles and
accessories. We also noted variations in the degree of noise exposure and hearing
loss between occupations, with differences between men and women. Conclusion:
Measures adopted to avoid noise exposure and hearing loss in the manufacturing
industry are inadequate, given that a significant portion of workers continue to be at
risk. Planning interventions must prioritize workers in those subsectors that involve
more vulnerable activities and occupations and must recognize evidence of gender
differences.
Keywords: Noise, Occupational; Hearing Loss; Industry; Occupational Health;
Epidemiology.

Healthcare organizations can be seen as social microcosms if we consider the complexity and scope of the actions they need to operate. They have a large contingent of professionals, hierarchically distributed, with a view to the development of their characteristic activities. In addition to being a wide range of possibilities, involving the creativity of those who are yearning for processes, such activities depend on varied knowledge and skills. The formation that the different actors had throughout their lives and the experiences they had in the practice of professional practice also compose this scenario, favoring a constant search for the subjects to match the knowledge brought with the challenges posed by the practice within the institutions. In this sense, occasionally managers and technicians may be led to fill positions and develop management functions with little preparation and low appropriation of the work object for which they were held responsible. This study aimed to analyze the concepts and practices of management in different contexts of the State Secretariat of Health of Bahia. Bourdieu's concepts of social space and capital, Matus's ability to govern and Mendes- Gonçalves's health work process were used as theoretical support. This is a qualitative research, carried out in two SESAB units, using semi-structured interviews and document analysis as techniques. Twenty-nine interviews were conducted from August to October 2018, with eight technicians and twenty-one managers. Among the documents that have been analyzed are the State Guidelines for Surveillance and Comprehensive Health Care, the Participatory Multiannual Plan - PPA (2016-2019), the State Health Plan - PES (2016-2019), the Annual Health Programming - PAS (2016, 2017) and the Annual Management Reports - RAG (2016, 2017). Crossing the categories formation and professional experience that underlie the concept of government capacity formulated by Matus and adopted for this study, to the cultural and bureaucratic capitals of Bourdieu's theory, it was observed that most of the interviewed agents are strengthened by the trajectories that they have been developing, to act in the subspace of health management. However, those agents whose trajectories are still far from this scope need to be contemplated by formative actions that prepare them for the exercise of their functions. In addition, and more broadly, the reorganization of work processes, in which teamwork and knowledge sharing prevail, using more democratic, horizontal and participatory management perspectives seem to favor the development of agents, even though initially present low volume of cultural and bureaucratic capital. It is hoped that the results of this study may contribute to the development of agents working in health management subspaces, with regard to the social valuation of the work performed by their own peers and society in general. In addition, the perspective is that the elements highlighted lead to work management practices and promotion of training processes more appropriate to the real needs of the secretariat.

The health of transgender people has been the focus of several institutional discussions, headed either by the actions of social movements demanding major offers of health care and directed attention to the social determinants of health that directly affect this population, also among the discussions inherent to the transexualization process available in Brazilian Public Health System (SUS) or through the struggles towards pathologization of gender identities that escape the hegemonic dichotomous logic. In the midst of everyday violence, also perpetrated by institutions, trans people claim for autonomy over their own identities, guaranteed access to safe techniques of body modification and the right to self-identification. In this process, they redefine notions of masculinity and femininity, blurring them by undoing their artificial borders, but can also reinforce them as they reproduce hegemonic discourses. This work analyzes discourses about body, identities and femininity in the autobiographical narratives by transgender women and travestis, focusing on the construction of transfeminine identities. Thus, it aims to know and compare the discourses of transgender women and travestis about the production practices of their identities and femininity – and to understand the meanings and repercussions of these processes. For this purpose, 14 semi-structured interviews with transgender women and travestis, from 21 to 59 years old and multiple occupations, were analyzed. From the notion that trans identities lie within the great scope of gender experience possibilities, built by efforts to produce body acts, therefore performative, based in hegemonic aesthetic standards, mainly oriented to cis-heterossexuality. Therefore, the narratives of the construction of transfeminine identities were analyzed based on Butlerian performance, taking into consideration the elements intersected with gender. Thus, the study concluded that the construction of transfeminine identities follows a model here named “stagist”, based on gender-related performances of femininity, initially emphasizing the effeminate child and the male homosexuality categories. The passage to a trans identity is reported as being associated to more body changes, in the sense of reaching the desired femininity, based on notions related to the idea of passing and hegemonic femininity. Searching for intelligibility, it has been identified that trans women establish hierarchical connections based on the association of travestis with marginality and “fantasy”. In this aspect, the identity fluidity presented by some participants – already in the “stagist” construction of transfemininity – was not able to dissolve rigid conceptions based on ideas linked to a hegemonic femininity that leads, for example, to submission in their relationships with intimate partners, as well as to the search for aesthetic and “behavioral” passiveness based on this model. Based on the notion that the production of identities is relational, contradictions in their relationships with transgender pairs, relatives and intimate partners have been observed, as well as violence and resistance in social exclusion contexts.

Social participation in the Unified Health System, regulated by Law No. 8,142 / 1990 of December 28, 1990, should be exercised through the Health Conferences and Health Councils. However, it is observed that the existence of mechanisms officially other forms of social participation that seek to collaborate in the formulation, execution or evaluation of public policies, or even in the critical reflection on them. Faced with the evolution of the media and new technologies, the various media have stood out as important information vehicles, among them blogs, which present themselves as a relevant tool for civil participation. This study aimed to analyze blogs as a social space for civil participation in the Unified Health System in the Santo Antônio de Jesus/Ba microregion. Specific objectives were: a) to characterize blogs about their structure; b) characterize the agents about their trajectories and positions in the social space; c) characterize its publics and main health topics addressed, related to SUS; d) characterize and discuss the relationship of blogs with the local public power and their respective positions, in relation to the SUS; and e) analyze the limits and potential of blogs in the process of civil participation with the SUS in the micro-region of SAJ / BA. A case study of an exploratory nature with a qualitative approach was carried out, which object is a set of blogs created and maintained by bloggers based in the health micro region of Santo Antônio de Jesus/Ba, which is composed of twenty - three municipalities. The results were submitted to content analysis, evidencing that the blogs surveyed point to actions with different purposes. However, it was observed that the impact that the blog has produced in the Unified Health System reveals the configuration of a new space for vocalization of the demands of the population, in relation to health in the region, presenting itself as another alternative of civil participation.

The phenomenon of homeless people is associated to the precarious inclusion in the
labour market and to the weakening of social networks. In spite of being exposed in
several processes of vulnerability, this population faces barriers of access to the
health services, including the Primary Health Care. Even when located inside a
territory, the Family Health Strategy has established a far relationship with its area,
insofar it does not consider social and cultural characteristics, reducing the territory to
a geographical area. From an ethnographic approach, the relationship between
homeless people and a Family Health Unit in the Historical Centre of Salvador was
studied. The access, understood not only as a demand or an offer of services, but in
a perspective of the patient care, was the main variable of analysis. The challenges
of living on the streets have implications in people’s health and in the health services,
affecting the relationship between patients and the service and also influencing
health services response. The social and psychological suffering of homeless –
related to difficulties in communication and institutional insertion (reinforced by
institutions) – the substance abuse, the particular way they treat their body, the
unusual notion of time and the usual violence require proactive attitudes from the
health care services, in order to enable a care practice based on equity and social
justice. However, the distance between the homeless people and the health services,
who often ignore their sociabilities and singularities, create barriers of access: from
the requirement of documents to the discriminatory practices, such as the myth of
dangerousness, the moral judgement, the low availability to listen, the lack of care for
urgent demands, the repugnance of dirt and the understanding of the right to health
as a concession. These practices constitute an institutional violence – in which the
racism is a component – and indicate, besides other aspects, that the category
vulnerability has not been used to operationalize the equity. It is possible to identify in
this field, on the other hand, movements that broaden the access through the
comprehension of the bond as a technological resource and through a constant
thinking about the hardening of rules and the spaces of power. By describing the
bureaucratization of the Family Health Strategy in the face of the care of homeless
people, it seeks to strip its whole bureaucratization, in a work process instituted,
captured and at risk of crystallization.

The More Doctors Programme (PMM), created in 2013, has as one of the main axes the emergency provision of doctors and strengthening of services in Primary Health Care. Through the program, more than 18 thousand doctors were included in the Family Health Strategy in 2015, of which 11 thousand were Cubans. Some studies point to several changes in the practices of the family health teams that received PMM physicians. However, few studies have, specifically, investigated the practices of Cuban physicians, considering their general education with an emphasis on PHC and its influence on the family health team. Therefore, this study took as object the possible influence of the Cuban physician in the development of the practices of the professionals of the Family Health Strategy in the context of the More Doctors Programme. The research had as theoretical-methodological support the Theory of the Process of Work in Health proposed by Mendes-Gonçalves, who based the definition of the analytical categories as agents, objects, technologies, activities and relations. A comparative study of cases with a level of analysis developed under the Family Health Strategy was carried out, with two teams, one of whom joined the PMM and received a Cuban doctor and another team did not join. Semi-structured interviews were conducted with two physicians, one nurse, two nursing technicians and six community health agents, as well as the practices and work process of these professionals. The study was approved by the Research Ethics Committee of the UFBA Institute of Public Health. The results showed that the Cuban medical education differs from the Brazilian training by emphasis in general medicine, with approximation to the content of primary care since the first semester of the course, in a theoretical and practical way. Regarding the work process, the ESF-PMM team, when compared to the ESF team, presented greater development of the practices regarding territorialisation, health situation analysis, local planning, health education, intersectoral actions, determinant control actions and surveillance epidemiological and actions directed to individuals and families. It was concluded that the insertion of the Cuban physician in the health team may have influenced the development of practices with greater number in the accomplishment of activities and in the different way of executing the practices, since this professional, with general training, values the work in the ESF and recognizes the need to develop sanitary practices based on territory and the professional-user link.

The object of analisis in this paper is the More Doctors Program (PMM), which is currently one of the priority strategies of the Brazilian Ministry of Health to confront the challenges of Basic Care (AB) in Brazil. In this sense, a study was conducted focusing on the first-year medical agents of the PMM in the city of Salvador, seeking to understand the trajectories of the participating in the program, as well as their points of view regarding medicine, the PMM and the Unified Health System (SUS). In addiction, we explored the issues at stake in Primary Health Care (APS). For this purpose, 15 semi-structured interviews were conducted with physicians from the first, second and fourth cycles of the program, using as reference the theory of practices of Pierre Bourdieu. It was verified that the investigated cuban medical agents had their formative trajectories conformed in the scope of the APS, whereas the foreign agents (individual exchangers) and brazilians, in general, had little or no insertion in the APS during the graduation. These formative trajectories of the agents had many influences in the conformation of their professional trajectories, which are crossed also by objective elements that make up the social surface in which they are inserted. These trajectories constitute and are constituted from a system of dispositions acquired by the agents, throughout the life, that guide their schemes of perception and action. The different points of view expressed by the agents, about medicine and the SUS, and the reasons that led doctors to join the PMM, also, showed correlations with the dispositions and the positions occupied by the agents. The issues at stake, identified by the agents, have varied in nature, from issues of inadequate infrastructure and lack of material resources to the organization aspects, management of the system and the service network operation, with the understanding that such problems present themselves as historical challenges in the process of implementing Primary Health Care. Evidences of this work also pointed to the need for greater investment in a set of changes, aimed at strengthening APS and SUS, which involve improving the structural conditions of Family Health Centres and the organization of the care network, besides stimuli for the fixation of medical professionals in the Family Health Strategy.

Sarcopenia is an important public health problem, not only because of the high magnitude of its occurrence, but also because of the reduction in physical capacity and quality of life, greater susceptibility to chronic noncommunicable diseases and mortality. Defined by progressive decline in muscle mass, strength and/or function, this condition is considered one of the hallmarks of the aging process, although it may also occur in early stages of adulthood and accentuate during subsequent years due to adverse exposures health conditions, environmental and social during the course of life. The anthropometric trajectory and behaviors of health risks incorporated in lifestyle can influence the pathophysiological mechanisms underlying sarcopenia, implying a greater decline of skeletal muscle mass with aging. However, the contributions of these factors to the occurrence of sarcopenia in adults are still inconclusive. The present thesis attempts to fill this gap by investigating the anthropometric trajectory, lifestyle patterns and its association with the occurrence of sarcopenia in men and women of the ELSA-Brasil cohort. This study is an integral part of the Longitudinal Study of Adult Health (ELSA-Brasil), the largest observational and multicentric cohort in Latin America with the purpose of prospectively investigating chronic diseases and their risk factors. Were used data collected at the baseline (2008-2010) and about 4 years after the start of follow-up (2012-2014). Their results are presented in the form of three scientific articles: 1. Manual grip strength as a discriminator of sarcopenia and sarcopenic obesity in men and women of the Longitudinal Study of Adult Health (ELSA-Brasil); 2. Anthropometric trajectory in the life course and occurrence of sarcopenia in men and women: results of the ELSA-Brasil cohort; and 3. Patterns of lifestyle and sarcopenia in men and women according to age stratum: results from the ELSABrasil cohort. The results showed the manual gripper force (FPM) as a good discriminator of sarcopenia and sarcopenic obesity, capable of achieving performance superior or equal to biomarkers of muscle mass. The prevalence of sarcopenia in men and women who changed the anthropometric trajectory to low weight was twice as high when compared to the participants with a stable weight trajectory. Men and women with patterns of change in the trajectory to excess weight also had a higher amount of lean mass. Unhealthy lifestyle patterns increased 47% the chance of sarcopenia in younger men (OR = 1.47; 95% CI: 1.03-2.10). Among the less healthy men who used dietary supplements, the probability was 3.39 times higher (OR = 3.29, 95% CI: 1.60-6.74). Women with less healthy and premature lifestyle patterns had a 4.64-fold chance of sarcopenia (OR = 4.64; 95% CI: 1.34-16.05). The use of dietary supplements potentiated the effect of less healthy lifestyle patterns for sarcopenia in younger men, and in women a prematurity accentuated the effect of less healthy patterns for the occurrence of sarcopenia. Health surveillance actions to promote healthier lifestyle and safer changes in the anthropometric trajectory should be encouraged to prevent the occurrence and progression of sarcopenia in adults.

The declaration of Alma Ata (1978) introduced the primary healthcare to indigenous populations in terms of health indigenous knowledge recognition and valorization trough the articulation between healthcare practices and gradually embodied in national health systems and health public politics. The Anglo-Saxon and Hispanic-Lusitanian colonial context policy analyses highlight the lack of theory paradigms and the variety of approaches to guarantee the right to cultural appropriate healthcare. However, the homogeneity of biomedical healthcare practices hegemony express an intercultural approach functional to State and non-indigenous society domain.In the Brazilian national health system (SUS), the concept of “differentiated” primary healthcare, consensually defined as ambiguous and contradictory, is the base of the indigenous healthcare national politic (PNASPI, 2002). Within the lack of institutional evaluation, a limited number of studies put in evidence the intercultural transformations from the implementation processes at the local level as well as in the sociocultural healthcare relation.
The lack of primary “differentiated” healthcare analyses focusing on the indigenous populations in the State of Bahia justify the focus of the thesis on its operationalization orientated by the “critical interculturality” as defined by the author Walsh C. (2005) and Dietz G. “intercultural research” model in an exploratory, qualitative, polyphonic and multi-situated research design, focused on the ethnography of Indigenous Healthcare in two different Pataxó territories in the south of Bahia State. The main objective is to
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describe the positions, tensions and approximations between healthcare conceptualizations and practices from speeches and practices analyses of the two local actors, the indigenous primary healthcare teams (EMSIs) and the Pataxó user’s communities in Porto Seguro Base-Pole of the Indigenous Especial Health District of Bahia (DSEI-BA).
The ethnogenesis analysis shows the Pataxó ethnicity nuances and hybridizations as well as their multidentities between indigenization, which is based on the interethnic friction and conflict, and ethnicity bleaching in the assumption and appropriation of the white-man life-style model which (re)produce sociocultural intraethnic conflicts, factionalism to reach community power and differentiation in the community social structure.
This tensions and hybridizations reflected into the polysemy assumed by the conceptions of illness, healthcare and differentiated primary healthcare as well as the poliform of effective healthcare practices realized by the local actors within the illness and healthcare process of the Pataxó communities.
The research highlights the interactions and coexistence of the Pataxó healthcare knowledge system and de white-man medicine even if the growly hegemony of biomedical practices and the prevalence of the formal vision on the differentiated healthcare by limiting the possibilities of knowledge articulation. Other limits to the cultural appropriate priority are the primary healthcare productive perspective and the relevant lack of technical quality and coverage.
Nevertheless, the healthcare model implementation put in evidence the mediations, which produce intercultural adaptations and transformations. In both research fields, the indigenous healthcare professional stands out within the primary heal care local teams for his spontaneous sensibilities, skills and practices of linguistic-cultural facilitation and mediation, while non-indigenous health professionals can develop approximations and ways to articulate healthcare knowledge only when the conditions for their fixation in the indigenous communities are guaranteed.
The thesis ends with a systematization of the research results aggregated into three intercultural empowerment action priorities and their correspondent examples of practice: the Pataxó healthcare knowledge “rescue”, intercultural professional training improvement and the recognition and empowerment of intercultural practices that are already offered.
Is possible to produce these priorities by activating the healthcare systems endogenous resources in a bottom-up model. Therefore, the of the formulation and operational definition limits of the cultural appropriate healthcare call for a review and critic reflection to change ambiguity into ambivalence.

This dissertation analyzes the specificities, vulnerabilities and intersectionalities related to the abuse of psychoactive substances by black women in a city of Recôncavo da Bahia. More specifically, it addresses the consumption experiences, therapeutic itineraries and treatment of women, seeking to identify the present vulnerabilities and intersectionalities and their implications. This is a qualitative study in the area of Collective Health, with approach in Social Sciences in Health. It’s justified the function of psychoactive substance abuse (SPA) is currently considered an important public health problem in Brazil, in addition to data from epidemiological surveys that point to increased use and abuse of substances caused by the female segment, as well as such as early onset and difficulties in accessing treatment. The empirical field for conducting a study was at the Psychosocial Care Center for Alcohol and Drugs (CAPSad), present in the city located in Recôncavo da Bahia. A methodology used with different data collection techniques, such as: systematic service techniques, participant observation of the “Conversations between women” group and semi-structured interviews. Participated in the study 11 (eleven) women users of SPA undergoing treatment at CAPSad. The results showed common characteristics among women: all black women, with income equal to or less than one minimum wage and aged between 26 and 62 years. In their reports, it was observed the presence of multiple social inequalities, of different orders, felt, perceived and signified differently by each one of them, but with a common disorganizing pattern and implications in greater risk for the onset, maintenance of abusive consumption of drugs. drugs and therapeutic advances. The race and gender inequalities, related to the effects of poverty and economic inequality, have resulted in lack of access to basic goods and services, constituting important mechanisms of social exclusion and discrimination, factors that hinder access to prevention and care in situations of abuse of SPA and its implications. Thus, it was discussed at work as permissions to use the notion of vulnerability, in their individual dimensions, social and programmatic, for the study of complex social themes, such as the one addressed, and there may be inherent changes to the fragmentation of the analysis. The notion of intersectionality is presented as a way to study the phenomenon in a more relational and articulate way, which allows the understanding of the various ways in which the interaction between two or more categories (race, class, gender) permeates the experiences of women studied. Thus, the data of the present study point not only to the need for advances in drug policies, regarding the inclusion of the specificities inherent to the treatment of women, as it demonstrates as essential a greater investment in the education and continuing education of health professionals for the provision of services and host actions and care sensitive to gender differences. In addition, it demonstrates the need to overcome social inequalities (race, gender and class) and expansion of health promotion and of the individual as a whole, aiming at the creation of mechanisms that reduce the impacts caused by inequities and social determinants of health, and defend equity, with the objective of improving the quality of life and well-being of the black women.

The aging issue has entered the agenda of Brazilian academic research more often after the increased longevity of the population became evident. The fact is that while old age has always been present in our lives, it is precisely in contemporary times it becomes a "problem" of social security and public health for governments. It is important to mention that this study was not directed by the prospect of old age as a problem to be solved, but by the perception of the old age as a phenomenon to be understood for it engenders a life cycle stage, to be experienced by a portion of the people. Thus, based on the perspective of Cultural Psychology, this research aimed to analyze the changes occurring in the self field, stressing the affective and dialogic-semiotic nature of self-regulation processes taking place when one enters the social category "being old ", involving the construction of new meanings of self and the world, toward an aging well. More specifically, this investigation had the purpose to describe the conditions under which a person becomes "old"; under what conditions a person considers she ages well, from the experience of having or not having children; and analyze the experience of temporality in old age. The research results indicated that, although usually being framed in a homogeneous group, the person who ages has heterogeneous characteristics, fleeing to traditional standards of characterization, reading dependent, vulnerable and gaga. Rather, the conflict of meanings generated by ambivalence 'to be old' / 'not to be old', has generated new ways of experiencing old age among the participants, contributing to a transformation of the meanings of being old both within personal culture, and in the collective culture, engendering a process of transition and transformation of the meaning of collective culture about what it means to be old. The results also showed that public policies that favor the maintenance of agency of aging people as well as their financial autonomy and maintaining bonds in their social network, contribute to age well. The temporality in old age has been perceived as having close relationship with the meanings built along the person’s life trajectory, and the existence of a meaning in life. Plans for the future resized according to the meanings constructed by the person who ages on what it means to be old. Short and medium-term plans through future were mediated by field type signs - that favor the emergence of novelty, and further development - and point type signs, more focused on specific circumstances and less flexible to change.

The health councils represented a great innovation specially from creation of the Sistema Único de Saúde (SUS) (Health Unique System) making legitimate the partcipation of society in the political decisions of the health sector. Like institutionalized channels of participation, they have marked a reconfiguration of relations between State and society, besides instituting a new modality of public control over government actions, being able to be one of the ways to change the care model which has as priority the actions of health promotion and prevention of damages. This was a qualitative and descriptive research of exploratory character whose general aim was to describe the proposals of the Conselho Estadual de Saúde – CES (Health State Council) related to actions of prevention of damages and health promotion from 2007 to 2010. To this end, an analysis of the documents produced by the Health State Council was carried out in order to analyze both actions and demands of the council of the studied period. To establish a link among aims of the study with the findings of documentary analysis, the Theory of multiply streams, elaborated by Kingdon (2011) was adopted as a reference. According to the theoretical basis, it was constructed the Theoretical model which guided the analysis of the documents, composed of four dimentions: structure and composition of council; flow of problems; flow of alternatives; and political flow. During the period studied, it was observed that the Health State Council of Bahia (Brazil) had no parity among its members, having the same number of representatives for all follow-ups of the council. Regards to frequency, state and social representatives presented higher attendance at meetings, in spite of market ones. The non-councelor state representatives were the main responsible for bringing matters to discussions in the council in the form of presentation, while social representatives were the ones who discussed the most the issues presented. Regards to the council´s deliberations, it was observed that the resolutions did not directly adress any subjects on promotion and prevention. A little positive council was observed, taking out burocratic actions, besides matters related to care actions, in spite of the ones of promotion and prevention, performing bureaucratic actions, besides topics related to care actions, in spite of the promotion and prevention actions. It can be concluded that the flow of solutions and political flow related to promoiton and prevention did not converge to the entry of these topics into the decisionmaking agenda. Although they are part of the government agenda, being present in the health state plans and proposals of the 8th Health State Conference, they have not been issues that attract the attention of interest groups neither of government. In this way, it is necessary to strengthen the role of CES-BA in the formulation of policies in order to promoting prevent actions, for the change of the health care model in the State.